kidney disease

An Important Genetic Cause of Kidney Disease in Nigeria- APOL1 Mediated Kidney Disease


Ever wonder why so many people are falling victim to the problems of kidney failure in Nigeria and sub saharan Africa? Well, recent scientific advances show that the cause of this survival disadvantage in Africa is not only inherited from our parents but is part of our defensive response to overcome African sleeping sickness transmitted by the Tsetse fly. The genetic code to resist sleeping sickness that increases risk for kidney disease is called the APOL1 gene

The growing problem of kidney disease around the world and in West Africa in particular is alarming. A casual look at social media pages very often show people reaching out for help to deal with the catastrophic physical and financial burden of kidney failure. Many Nigerians know someone personally who has or is suffering from the burden of kidney disease.

What is the reason for this? Well, for decades, the common medical advice has been that high blood pressure, high blood sugar and lifestyle choices like high alcohol intake, smoking and taking toxic herbal medications and remedies are the major causes of kidney disease and kidney failure in Nigeria. However, recent medical advances in genetic testing and computational science in the last 20 years since the completion of the genome project have indicated that the cause of the plague of kidney disease in Nigeria and the broader sub saharan region is more complicated than just lifestyle choices or blood pressure. The cause seems to be in our cells and this cause has been part of our evolution as a people to survive against things in our environment that could kill us. What in our environment could kill us and make us have to adapt in such a way that we now suffer from kidney disease? Well, the answer has been linked to the story of our relationship with the Tsetse fly.

The Tsetse fly in Western and Sub Saharan Africa causes African sleeping sickness also called African trypanosomiasis. A bite from the tsetse fly releases the parasite into the blood that causes the disease. One of the first historical records of trypanosomiasis is by the famous Arabian geographer Abu Abdallah Yaqut (1179–1229). During his journey into Africa he found in the “Country of Gold” an underground village whose inhabitants and even their dogs were just skin and bones and asleep! The World Health Organization (WHO) in a 1998 report estimated the number of people infected to be about 300 000- likely an underestimation.

The Tsetse fly transmits a very serious and deadly disease called African trypanosomiasis or African sleeping sickness. The first stage of African sleeping sickness, known as the hemolymphatic phase, is characterized by fever, headaches, joint pains, and itching. Invasion of the circulatory and lymphatic systems by the parasites is associated with severe swelling of the lymph nodes, often to tremendous sizes. If left untreated, the disease overcomes the host’s defenses and can cause more extensive damage. The second phase of the disease, the neurological phase, begins when the parasite invades the brain and spinal cord. Disruption of the sleep cycle is a leading symptom of this stage and is the one that gave the disease the name ‘sleeping sickness.’ Infected individuals experience a disorganized and fragmented 24-hour rhythm of the sleep-wake cycle, resulting in daytime sleepiness and nighttime periods of wakefulness.

Human African Trypanosomiasis is causes by trypanosomes transmitted by the tsetse fly. The 2 main species of the parasite Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense are most common in sub saharan Africa (B). The APOL1 gene is key to natural defenses to this infection and over time Africans have evolved even more effective gene variants to kill trypanosomes that resist the ancestral gene G0. These evolved gene variants are called G1 and G2 with a high prevalence in West Africa. You can see in the middle panel that Nigeria is ground zero and a hot spot for a high number of people with the G1 variant of APOL1.

So what has this history of the tsetse fly and African sleeping sickness got to do with kidney disease in Nigeria and other African countries? Well the story gets more interesting and the picture above tells part of the story where you can see an overlap in the occurrence of African sleeping sickness caused by trypanosomiasis with the defense against the illness. Simply speaking, we humans started competing with the tsetse fly. Over time, people affected by African sleeping sickness developed a resistance coded by a gene on chromosome 22 called the APOL1 gene. This gene produces a protein called APOL1 which circulates in the blood and is the tool the body uses to destroy the parasite injected into the body by the tsetse fly. Over hundreds of years the parasite evolved resistance to this ancestral APOL1 gene (G0) and in response humans developed even more effective APOL1 called G1 and G2 variants. People with G1 and G2 variants of the APOL1 gene are able to resist infection transmitted by the tsetse fly. Approximately 23-46% of Nigerians have 2 alleles with either G1 and/or G2 while approximately 60% of Nigerians have at least 1 of the 2 genetic variants of APOL1 that also confers resistance to the infection. However, this survival advantage for people with 2 genetic variants of the APOL1 gene has been found to be a 12 times higher risk for progressive kidney disease.

The burden of kidney disease and kidney failure is now so common that several celebrities- a past president, musicians, actors, journalists have succumbed to the complications of this truly devastating disease. We do not know if APOL1 was the cause of their kidney disease but the chances are high that it may have been involved based on emerging research findings

But why does having an APOL1 gene variant increase the risk for kidney disease? Well, that has taken some time to figure out and scientists first figured out how APOL1 kills the trypanosome parasite. Essentially, the parasite while feeding on nutrients in the blood takes in the APOL1. The APOL1 then binds to structures in the parasite causing it to swell up, burst and die. APOL1 protein is also produced in other tissues as well as part of the defense against sleeping sickness infection and most importantly it is produced in the kidney. In the kidney, a special cell called the podocyte that helps in filtering the blood is damaged whenever APOL1 is activated in the kidney. What can activate APOL1 production in the kidney? Anything that injures the kidney or makes it think it is under attack by the parasite transmitted by the tsetse fly. This activated APOL1 in the kidney then kills the podocyte cell in the kidney in very much the same way that it kills the parasite leading to damage to the kidney filtration system of the kidney and eventually to rapidly progressive kidney problems and kidney failure. In fact is has been documented that patients with 2 APOL1 gene variants with kidney disease progress 2-3 times faster to kidney failure than patients with only 1 or no gene variants for the APOL1 gene.

QUESTIONS

  1. Is there a test for APOL1 gene variants? The answer is yes. However, it is not easy to get by walking into any lab and it is only becoming more commonly available in places like the US. For now it is expensive.
  2. Does everyone with 2 APOL1 genetic variants develop kidney disease? The answer is No and we do not yet know why. However, we do know that something can happen in the life of people with 2 APOL1 gene variants like infection, taking toxins contained in many of our herbal medicines that can hurt the kidney or other health problems that triggers increased production of APOL1 and that leads to accelerated kidney injury.
  3. Does this mean that controlling blood pressure, body weight, blood sugar and avoiding excessive alcohol and smoking are no longer important? Absolutely not. These are still very important causes of kidney disease and can make the kidney disease in many of us who have 2 APOL1 gene variants progress much faster. So please continue to exercise, eat healthy, avoid excess alcohol, avoid smoking, get BP checks and take medication when prescribed.
  4. Can the risk for APOL1 mediated kidney disease be inherited? Yes. If only one parent has a risk gene, it may be inherited by offspring but people with only one gene variant do not appear to be at increased risk for kidney disease. If both parents have the genetic variants, then the children can inherit the genetic variants and be at risk. Remember not all people with 2 variants will develop kidney disease and we do not yet know why.
  5. Can APOL1 mediated kidney disease be treated? Well there are no specific treatments yet for this yet but efforts are under way in the US to develop treatments for this problem.

Exercise for patients on dialysis


This post is meant to help you the dialysis patient live strong and well and overcome challenges you may be facing

Why is exercise important to me?
No matter how old you are, exercise can make you stronger, more flexible. If you stay fit, you will be more able to do things, like go food shopping or visit friends. Think of your body as a rechargeable battery. It helps control blood pressure, too. If you are diabetic, exercise can lower blood sugar. It aids circulation and helps you sleep. Exercise can also help keep your bones healthy. Exercise can fight depression and help you feel more positive about your life.


How should I start to exercise?
First, tell your doctor that you want to exercise. He or she can make sure you do not have any special problems that would be made worse by a workout.  After checking with your doctor, write down a goal you would like to reach. Goals might be walking around the street without stopping, bike riding with your family, shopping at the mall with a friend, or going dancing. Make an exercise plan that will work for you. Write down how often you will exercise, what time of day, and for how long. Start with small blocks of time, like 10 minutes every other day. Increase it by a minute or two each week.


How will I know exercise is helping?
It can take a few weeks or a few months—to feel better with exercise. Keep track of when you exercised, what you did, and how it felt. You will be able to see your progress. This can keep you from getting discouraged. Once you reach your goal, set a new one. Exercise should become a long-term habit.


Can people in wheelchairs exercise?
Yes. There are many stretching and strengthening exercises that can be done in a chair.

Travel Advice for kidney disease, dialysis and transplant patients


Are you a patient with kidney disease or a kidney transplant or a patient on dialysis thinking about travelling? Are you a business person wishing to travel for a meeting or are you interested in attending the wedding of a family member, or being with family for a ceremony like a graduation or simply want to get a break and go on a holiday?

 

Whether you are traveling within the country or traveling internationally, patients with kidney disease, on dialysis or with a kidney transplant can travel if they are stable.  There are a few things you need to consider and plan for to remain safe, maintain your self-esteem and enjoy your life.

 

Advice No 1: Plan ahead and talk to your doctor early about your plans

Give yourself time to decide on your travel plans. Talk to your family and friends and doctor early. They will share ideas with you and if there are any special consideration your doctor can inform you in time and help make arrangements that may involve another doctor or center at your travel destination. If you are planning on travelling to multiple destinations, a plan for every destination is necessary so even more time is needed.

 

Advice No 2: Find and communicate with a doctor or center that can care for you at your destination.

Your doctor can help you find a dialysis center or kidney disease or transplant doctor that can care for you. Family and friends at your destination may be able to make a good recommendation for you and a search online for your options can help

The receiving doctor or center will need some basic information about your medical condition.

If you have kidney disease or have a kidney transplant, being armed with an updated report from your home doctor that outlines your medical issues and lists your recent medications and lab tests will be important.

If you are on dialysis, a medical report, your dialysis prescription, your medication lists and recent lab tests will be required. Depending on your doctors other information may be required. Put your doctors in touch with each other.

 

Advice No 3: Try and get some information for yourself on the quality of care offered by the doctor or center

The experience of the doctor in caring for patients with kidney disease or with a kidney transplant will be useful if you have any of these conditions.

If you are a dialysis patient, find out if the center you are going to be working with at your destination has experience with your kind of dialysis ie hemodialysis or peritoneal dialysis. Also ask

  • What is the cost of dialysis and is your insurance accepted at the destination center?
  • Does the unit reuse dialysis filters or blood lines?
  • How far is the unit from where you will be staying at your destination?
  • Can they provide a convenient treatment time and treat you for the duration you need?
  • What kind and size of dialyzer filters are used at the center?
  • Can you get all the medications or supplies you usually use at your home center?
  • If you fall ill and need to be hospitalized, where do you go? You may or may not need to investigate the hospital offered.

 

Advice No 4: If you are waiting to get a transplant, just let your doctors know.

They may have to make alternative plans that you should be aware of. You can then make a decision if you should travel or not.

 

Advice No 5: Diabetics need extra plans to be made.

If you are also diabetic, make plans to have adequate supply of insulin, medications and readily available sources of sugar if needed

Urinary Tract Infections: An Introduction


A urinary tract infection (UTI) is an infection in any part of your system responsible for making and passing urine — your kidneys, ureters, bladder and urethra. In men the prostate may be involved in urinary tract infections. Most infections involve the lower urinary tract — the bladder and the urethra.

Urinary-tract-anatomy

Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys.

Symptoms

Urinary tract infections don’t always cause signs and symptoms, but when they do they may include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
  • Pelvic pain, in men when the prostate is involved.

UTIs may be overlooked or mistaken for other conditions in older adults. Sometimes especially in the elderly the beginning of a UTI can present as confusion and decreased appetite.

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Signs and symptoms
Kidneys (also called pyelonephritis) ·       Upper back and side (flank) pain

·       High fever

·       Shaking and chills

·       Nausea

·       Vomiting

Bladder (cystitis) ·       Pelvic pressure

·       Lower abdomen discomfort

·       Frequent, painful urination

·       Blood in urine

Urethra (urethritis) ·       Burning with urination

·       Discharge

When to see a doctor

Contact your doctor if you have signs and symptoms of a UTI. It may be really serious  with complications or it might be a sign of something else that needs medical attention

Causes

Urinary tract infections can be caused by bacteria, parasites, viruses or fungi. The most common infections are causes by bacteria which are typically treated with antibiotics. If you have a UTI causes by other organisms such as viruses, parasites or fungi, other special medication or anti-microbials will be necessary to treat the infection and may take a longer time to cure. You can take steps to reduce your chances of getting a UTI in the first place.

UTI’s typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. On the other hand infections of the urinary tract may occur from a blood infection that settles directly in the kidneys. In men, an infection of the prostate can start when bacteria in urine leak into your prostate. Antibiotics are used to treat the infection. If they don’t eliminate the bacteria, prostatitis (prostate infection) might recur or be difficult to treat

The most common UTIs occur mainly in women and affect the bladder and urethra.

  • Infection of the bladder (cystitis).This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.

Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.

  • Infection of the urethra (urethritis).This type of UTI can occur when intestinal bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Risk factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

  • Female anatomy.A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
  • Sexual activity.Sexually active women tend to have more UTIs than do women who aren’t sexually active. Having a new sexual partner also increases your risk.
  • Certain types of birth control.Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
  • After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

  • Urinary tract abnormalities.Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
  • Blockages in the urinary tract.Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
  • A suppressed immune system.Diabetes and other diseases that impair the immune system — the body’s defense against germs — can increase the risk of UTIs.
  • Catheter use.People who can’t urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
  • A recent urinary tract procedure.Urinary surgery or an examination of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

  • Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
  • Permanent kidney damage leading to kidney disease or even kidney failure from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
  • Increased risk in pregnant women of delivering low birth weight or premature infants.
  • Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
  • Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Prevention

You can take these steps to reduce your risk of urinary tract infections:

  • Drink plenty of liquids, especially water.Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
  • Drink cranberry juice.Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
  • Wipe from front to back.Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Empty your bladder soon after intercourse.Also, drink a full glass of water to help flush bacteria.
  • Avoid potentially irritating feminine products.Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
  • Change your birth control method.Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

Diagnosis

Tests and procedures used to diagnose urinary tract infections include:

  • Analyzing a urine sample.Your doctor may ask for a urine sample for lab analysis to look for white blood cells, red blood cells or bacteria. To avoid potential contamination of the sample, you may be instructed to first wipe your genital area with an antiseptic pad and to collect the urine midstream.
  • Growing urinary tract bacteria in a lab.Lab analysis of the urine is sometimes followed by a urine culture. This test tells your doctor what bacteria are causing your infection and which medications will be most effective.
  • Creating images of your urinary tract.If you are having frequent infections that your doctor thinks may be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Your doctor may also use a contrast dye to highlight structures in your urinary tract.
  • Using a scope to see inside your bladder and urinary tract.If you have recurrent UTIs, your doctor may perform a cystoscopy, using a long, thin tube with a lens (cystoscope) to see inside your urethra and bladder. The cystoscope is inserted in your urethra and passed through to your bladder.

Treatment

Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

Simple infection

Drugs commonly recommended for simple UTIs include:

  • Trimethoprim/sulfamethoxazole (Bactrim, Septra)
  • Fosfomycin (Monurol)
  • Nitrofurantoin (Macrodantin, Macrobid)
  • Cephalexin (Keflex)
  • Ceftriaxone

GET IN TOUCH WITH YOUR DOCTOR BEFORE STARTING ANY ANTIBIOTICS. YOU MAY NEED TESTS DONE BEFORE STARTING TREATMENT. THE DOCTOR WILL HELP YOU SELECT THE SAFE AND APPROPRIATE OPTION FOR YOUR SITUATION.

The group of antibiotic medicines known as fluoroquinolones — such as ciprofloxacin (Cipro), levofloxacin (Levaquin) and others — isn’t commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, your doctor might prescribe a fluoroquinolone medicine if no other treatment options exist.

Often, symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. Take the entire course of antibiotics as prescribed.

For an uncomplicated UTI that occurs when you’re otherwise healthy, your doctor may recommend a shorter course of treatment, such as taking an antibiotic for one to three days. But whether this short course of treatment is enough to treat your infection depends on your particular symptoms and medical history.

Your doctor may also prescribe a pain medication (analgesic) that numbs your bladder and urethra to relieve burning while urinating, but pain usually is relieved soon after starting an antibiotic.

Frequent infections

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

  • Low-dose antibiotics, initially for six months but sometimes longer
  • Self-diagnosis and treatment, if you stay in touch with your doctor
  • A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity
  • Vaginal estrogen therapy if you’re postmenopausal

 

Severe infection

For a severe UTI, you may need special tests to determine the cause of the infection and treatment with intravenous antibiotics in a hospital.

 

What to Know About the Kidneys As We Get Older


Portrait of senior African American couple

Growing old is a compulsory process in life. As we age certain things weaken. The brain, our muscles, our joints age. Our kidneys get old too and their function reduces sometimes to a level that causes important problems requiring the attention of a doctor or kidney specialist.

As we get older, there are a number of changes that happen to our bodies that we can not avoid. Our memory weakens, our strength in our muscles and joints fall over time. Our energy levels reduce. The same thing happens to our kidneys too. The kidneys loose function as we age even though we might be healthy. This makes added problems such as high blood pressure, high blood sugar, heart problems, urine infections, taking medications at the wrong dose or wrong frequency problems we should avoid because they damage the kidneys even further and put our older people at high risk for kidney failure and premature death.

This post is meant to empower the older among us as well as to make family members of our older population more aware of the changes that happen in the kidney as we get older and the things that can be done to reduce additional damage to the kidney.

What happens to the kidneys as we get older?

As we age, the filtering units of the kidney called the glomeruli get scarred over and we loose some of the filtering units every year from the age of 40 or so. There is also a thickening of the blood vessels supplying the kidney leading to a reduction of blood flow to the kidney. Reducing filtering units and reduced blood flow to the kidney together lead to reductions in overall function of the kidney. In fact, approximately 2-3 our of every 10 elders over the age of 70 years old are believed to have only 60% or less of their kidney function left. In some clinical studies, it has been observed that about 1% of kidney function is lost every year we get older after the age of 40 years although it is not entirely clear if the loss of kidney function is due to age or diseases like high blood pressure, high blood sugar or other problems.

Why is it important to be aware of changes in kidney function as we age?

  • Kidney disease can progress faster if a new problem such as diabetes develops.
  • There are no proven treatments to stop or reverse age-related decreases in kidney function. Any treatment aimed at improving kidney function by causing the remaining functional kidney to work more may actually be harmful rather than beneficial to the kidney.
  • Increased risk for sudden kidney injury from even mild events such as dehydration or exposure to usual amounts of pain medication such as aspirin, naproxen, indocin, ibuprofen and other similar drugs.
  • Toxic accumulation of some medications that are cleared by the kidney may occur. Patients with disease or age-related decreases in kidney function may require medication dose adjustments. For example the dose of the drug may need to be reduced significantly or the frequency of the dosing reduced as well.
  • With the increase in number of living kidney donor transplants, we need to be aware that even healthy older people may not be appropriate candidates for kidney donation.

How are Nigerians aging, what are the most important causes of death and what has this information got to do with kidney disease?

Life expectancy refers to the average length of time people can expect to live. It provides summary information of the death rates and health of a nation, an area, or a group of people. In the last 100 years, the global average life expectancy has more than doubled but there remains marked difference between countries with the highest and lowest life expectancy (Japan 82.1 years versus Angola 38.2 years)

Overall, Nigerians rank 183rd in life expectancy among 194 countries based on 2013 WHO statistics. The life expectancy at birth for a Nigerian in 1960 was about 37 years. By 2013, this had risen appreciably to 52.5 years. Other analyses show that a 60 year old Nigerian person is expected to live till about the age of 75. This means that an increasing number of elders will have to contend with problems related to kidney disease simply by aging even if they do not have any known medical problems. The problems older people have with kidney disease may be accelerated however if they develop other medical conditions such as high blood pressure, high blood sugar or heart disease.

Pneumonia, HIV infection, stroke and heart disease are the leading causes of death in Nigeria. While kidney disease is not a top cause of death, about 20,000 people were estimated to have died from kidney disease in 2013- greater than all the people that died from Asthma and appendicitis combined.

Therefore, as Nigerians get older, more people will have kidney problems to pay attention to and these kidney problems can become a real and large cause of expense, suffering and death. In support of these statements, In many parts of the world, the fastest growing population of patients on dialysis or getting a transplant due to kidney failure are patients over the age of 65 years.

 

KidneySolutions-kidney-disease

The death rate per 100,000 deaths in Nigeria due to kidney disease is estimated at about 17.4. Nigeria ranks 58th in the world in death rates due to kidney disease. Worse than Ukraine with the lowest death rates due to kidney disease in the world by 2013 WHO data. South Africa ranks 11th in the world with a higher death rate per 100,000 due to kidney disease of 26.6

Thanks for reading this short post. Share the information you learn with others and if you have any questions feel free to ask them in the form below

 

Living Kidney Donation- What the donor must know.


Are you considering donating a kidney to a family member or friend?

If you are, This post is for you to help empower you to be a smart kidney donor. 

Wanting to donate a kidney to improve or even save the life of another person suffering from kidney failure is a noble and honorable thing. The donation of a live kidney is the best option for the recipient compared to donation from a deceased person as it will last longer and work better if put in properly and taken good care of. It is also certainly offers the recipient of the kidney a better and longer life compared to continued dialysis.

However, the most important thing for you to know about kidney donation as a possible donor is that donation is not safe for everybody.

Your primary responsibility is to ensure that it is safe for you to donate a kidney.

The doctors primary responsibility to you as a potential donor is to help you determine if it is safe for you to donate and nothing else.

If you do not really want to be a donor for whatever reason, you should not be forced to do so. Talk to the doctor evaluating you as a donor in private and tell the doctor your concerns. Your doctor will be able to speak confidentially on your behalf and tell the person hoping to get the kidney from you that you are not medically fit to be a kidney donor. The doctor does not need to tell them of your fears or concerns unless you ask them to do so.

First things first – who can donate a kidney?

The person intending to donate a kidney generally should be healthy, be between the ages of 20 and 65, should have 2 kidneys, should not be obesse (defined as a body mass index of >30) and have none of the following.

1) kidney disease or kidney stones

2) high blood pressure or high blood sugar

3) Large amounts of protein or blood in the urine

4) Have normal liver, heart and blood vessel function.

5) Have no ongoing infections, cancers or bleeding issues

6) Be mentally stable

Many people assume that everybody has 2 kidneys. However, it is important to know that many people live normal healthy lives being born with one kidney as long as it doesn’t get diseased. It is estimated that as many as 1 in 1000 to 1 in 1500 (100,000 to 150,000 Nigerians) were born with one kidney so do  not assume you have 2 kidneys and can donate. 

Most kidney transplants in Nigeria are either from related or unrelated living persons that are ABO blood group compatible. This means that a person with blood group O can donate to a patient with any blood group. A person with blood group AB can only donate to persons with blood group AB, while people with blood group B can only donate to patients with blood group B.  People with blood group A can donate only to patients with blood group A.  In special circumstances of donor blood group type A2, donation to patients with blood group O, B and AB is possible but decisions for such need to be very carefully made. Transplant outside these assignments while possible is associated with a higher risk of rejection of the transplant by the recipient and requires more high risk treatments to the recipient such as removal of the spleen or treatment with strong medications. Rhesus blood group is not considered a barrier to kidney transplantation

Donor Testing

As a donor, you need testing done. This is to ensure the you are of the right blood group, you have 2 kidneys, you are healthy, can stand the stress of surgery and do not have silent kidney disease or conditions that can cause kidney disease as well. Testing is also necessary to ensure that you do not transmit infections or cancers to the recipient. A psychological evaluation may also be necessary to ensure you can withstand the emotional stresses that may come during and after kidney donation.

Special testing also needs to be done to ensure you and the recipient are compatible to avoid rejection and help the surgeons know which kidney to take out of the donor and how best to take it out. Some transplant centers require that a donor be related to the recipient while other transplant centers do not insist on such a relationship.

Donor Surgery

As a donor, you should also know who will be performing the surgery and what their track record is. Not all surgeons know how to take out a kidney for the purpose of kidney donation. Taking out the kidney for the purpose of kidney donation is very different from taking the kidney out because of kidney disease. The kidney for donation has to be very carefully handled and it needs to be done quickly with minimal injury to the patient. Therefore ensure your surgeon knows what he or she is doing. Kidney donation surgery can be done in two ways.

The more recent way of taking out the kidney is a more recent and less painful way and is called keyhole or laparoscopic surgery. With this approach, 3 small holes and a 2-3 inch incision are made in your abdomen to remove the kidney. The scars are small, after a while are difficult to see and the recovery time is short. The other way is by open surgery where a long incision 8 or more inches in length is made on your side to take out the kidney. More painful with a longer recovery. Whatever method is used, make sure that the surgeon knows what he is doing. Ask about their complication rates and how many of the procedures they have done to determine their level of experience. A confident doctor should be willing to tell you what you want to know.

The decision to take out the right or the left kidney if prior testing is acceptable really depends on a number of factors that are best determined by the surgeon. However, in general, the right kidney is often selected for removal because it has a longer main artery and vein. Other considerations may make removal of the left kidney a better option.

KidneySolutions-Ikeja-Lagos-Transplant donationKidneySolutions-Ikeja-Lagos-Transplant Donation-2

Risks of kidney donation – short-term and long-term. 

The whole point of testing to ensure that the donor is healthy and finding an experienced surgeon is to ensure that the risk of harm to the donor is as low as possible.

The first living donor kidney transplant was performed over 50 years ago and since then several thousand kidney donations from living persons have been performed. A vast majority of these donors have been doing well several years after donation so the consensus now is that in properly tested and selected donors, the long term outlook is very good. There is also experience from soldiers and other victims of war who were healthy but had to have one kidney removed because of war injuries. These otherwise healthy soldiers or victims of war have also been shown to live well without problems of kidney failure decades afterwards.

However, it is important to know that even if you have 2 kidneys, if you have risk factors for kidney disease or you are not selected properly for donation, you could have problems and possibly end up on dialysis or needing a transplant yourself. 

If after you are evaluated and you are considered a good candidate and eventually donate , you need to follow a few simple rules to ensure all goes well in the long term

1) You must live a healthy life after kidney donation. This means you can not smoke, drink, add weight or engage in any other risky behaviours that could increase your risk for kidney disease.

2) You need to exercise and eat healthy continually.

3) You need to see a doctor at least once a year for the rest of your life. This is not because of a high concern for kidney disease. This is to help identify problems that might lead to kidney disease early so that progressive kidney disease can be treated and hopefully avoided.

Data from the United States shows that the risk of death within 90 days of living kidney donation is approximately 3 per 10,000 donor surgeries. This is better than the risk from laparoscopic gall bladder removal (18 per 10000 cases) or non donor nephrectomy (260 per 10,000). Other risks such as bleeding, infections, problems with wound healing etc occur at a rate of 2 to 5 per 100 cases. The incidence rates in Nigeria or other countries may be significantly different and data is not readily available on such.

The key long term concerns after donation are that of progressive and end stage kidney disease that might also require dialysis or transplant. Similarly, data from the United States and other developed countries show that the long term risk of developing kidney failure in properly selected donors who continue to maintain healthy lifestyle and habits is low.

General acceptability of kidney donation and kidney transplantation. 

Some patients and their families may have concerns that it is religiously unacceptable to get a kidney transplant. The Catholic and Anglican Church, the major Islamic bodies and Jehovah’s Witness church have approved kidney transplantation from either cadaver or living donors. In the case of Jehovah witnesses, the organ is purged/flushed of all blood and transplantation without blood transfusion while risky is possible.

Disclaimer

This post is no substitute for an actual evaluation in a medical center by a qualified and experienced professional. This post is not a recommendation to come to KidneySolutions or any other specific medical center either.

This post is only meant to educate and empower potential donors so that the experience of kidney donation is not as frightening, evaluation is properly done and potential donors have an idea of what is going on.

Questions?

If you have any questions regarding kidney donation, feel free to fill the contact form below. We will endeavour to get back to you with answers as soon as possible.

 

The silent actors in the drama of kidney disease- Smoking and alcohol


Chronic kidney disease (CKD) is a growing worldwide problem that is increasingly shown to be interwoven with cardiovascular disease (CVD), smoking and excessive alcohol consumption. In addition, because of the kidneys’ important and varied role in the body, impairment of their function can result in a range of disorders, from mild differences in fluid balance to acute kidney failure and death. Alcohol, one of the numerous factors that can damage and reduce kidney function, can interfere with kidney function directly, through short term excess or long term consumption, or indirectly, as a consequence of liver disease.

alcohol-weight-loss-1

Alcohol when taken in excess has many negative effects on the body. From impacts on brain function where it leads to confusion and risk for accidents and dementia, to liver disease and cancer. Alcohol can also have negative effects on kidney function.

The benefits of smoking or alcohol consumption are very difficult to identify and are at best minimal and of no real tangible benefit to its users. However, the harmful effects of these common social pleasures are well documented but not commonly known.

This post is aimed at educating readers on the harms of these silent actors to a common and growing problem of kidney disease and kidney failure. In summary, there is no safe amount of cigarette smoke to be exposed to. There are levels of alcohol intake above which health problems occur including kidney disease.

Alcohol and the kidney

Drinking alcohol can affect many parts of your body, including your kidneys. A little alcohol—one or two drinks now and then—usually has no serious effects because the body can easily and quickly get rid of the alcohol from the body. But drinking too much even if you do not have a damaged liver can harm your health and worsen or accelerate kidney disease.

For instance, alcoholics with damaged livers have been shown to have enlarged kidneys  with reduced blood flow to the kidneys. Alcohol can have effects on the kidney even in people without damaged livers by causing loss of water (remember the frequent urination?) as well as nutrients in the body such as magnesium, phosphate, calcium, sodium and potassium all of which have important functions in the body. Alcohol taken in large quantities over months to years can also impair the ability to control blood pressure through mechanisms that are yet to be fully understood and has a negative impact on the ability of the kidney to control acid balance.

How much alcohol is too much?

When experts talk about one drink, they are talking about one 350 ml bottle of beer, one glass of wine (150 ml), or one shot (45 ml) of “hard liquor.” Hard liquor includes vodka, brandy, whisky and other spirits.

Having more than three drinks in a day (or more than seven per week) for women, and more than four drinks in a day (or more than 14 per week) for men, is considered “heavy” drinking. The kidneys of heavy drinkers have to work harder. Heavy drinking on a regular basis has been found to double the risk for kidney disease and kidney failure requiring dialysis and kidney transplantation.

Binge drinking (usually more than four to five drinks within two hours) can raise a person’s blood alcohol to dangerous levels. This can cause a sudden drop in kidney function known as “acute kidney injury.” When this happens, dialysis is needed until a person’s kidney function returns to normal. Acute kidney injury usually goes away in time, but in some cases, it can lead to lasting permanent kidney damage.

Some people should not drink at all. Ask your healthcare provider if it is safe for you to drink, especially if you have a medical condition or take medicines that might be affected by using alcohol. Women, older people, and those with smaller bodies should be especially careful. Of course, pregnant women are advised not to drink alcohol.

For more information on the use of alcohol in Nigeria and the harmful effects including the impact on liver disease and road traffic accidents, read a world health organization report by clicking here.

Smoking and the kidney.

One of the many things that contribute to the poor understanding of the harmful effects of cigarette smoking is a lack of knowledge of what is contained in a cigarette. There are few effective labels or warnings about the dangers or harms of smoking.

cigarette

There are no known health benefits of cigarette smoking

Nicotine is the principal substance contained in cigarettes that not only has impact on brain function but has addiction potential. There are approximately 600 ingredients in cigarettes. When burned, they create more than 7,000 chemicals. At least 69 of these chemicals are known to cause cancer, and many are poisonous or can damage the kidney.

Many of these chemicals are also found in consumer products, but these products have warning labels. While the public is warned about the danger of the poisons in these products, there is no such warning for the toxins in tobacco smoke.

Here are a few of the chemicals in tobacco smoke, and other places they are found:

  • Acetone – found in nail polish remover
  • Acetic Acid –  an ingredient in hair dye
  • Ammonia – a common household cleaner
  • Arsenic – used in rat poison
  • Benzene – found in rubber cement
  • Butane – used in lighter fluid
  • Cadmium – active component in battery acid
  • Carbon Monoxide – released in car exhaust fumes
  • Formaldehyde – embalming fluid
  • Hexamine – found in barbecue lighter fluid
  • Lead – used in batteries
  • Naphthalene – an ingredient in moth balls
  • Methanol – a main component in rocket fuel
  • Nicotine – used as insecticide
  • Tar – material for paving roads
  • Toluene – used to manufacture paint

 

Can smoking cigarettes affect my kidneys?

Yes, for the following reasons:

  • Smoking can interfere with medicines used to treat high blood pressure. Uncontrolled or poorly controlled high blood pressure is a leading cause of kidney disease.
  • Substances released from inhaling cigarette smoke can damage blood vessels and eventually slows the blood flow to vital organs like the kidneys and can worsen already existing kidney disease.

E-cigarettes?

E-cigarettes have not been fully studied, so consumers currently don’t know:

  • the potential risks of e-cigarettes when used as intended,
  • how much nicotine or other potentially harmful chemicals are being inhaled during use, or
  • whether there are any benefits associated with using these products.

Additionally, it is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.

 

What health problems are related to smoking?

According to the World Health Organization, smokers have an increased risk of developing:

  • Lung cancer
  • Bladder cancer
  • Lung disease
  • Mouth cancer
  • Heart disease
  • Pancreas cancer
  • High blood pressure
  • Cervical cancer
  • Stroke
  • Pregnancy complications
  • Kidney cancer
  • Early menopause

For more information on the impact of tobacco use on health, read the world health organization fact sheet on tobacco use by clicking here.

 

SICKLE CELL ANEMIA AND KIDNEY DISEASE IN NIGERIA- A BRIEF REVIEW


The red blood cell is an important cell component of the blood and functions to deliver oxygen to all the tissues. Each red blood cell contains what is called hemoglobin, the vehicle for carrying oxygen within the red blood cell. Abnormalities of the hemoglobin in the red blood cell can make the red blood cell function abnormally and cause serious problems in tissues of the body including the bone, brain, intestines, lung and even the kidney.

Sickle cell disease is also called sickle cell anemia or drepanocytosis. It is a hereditary disorder of red blood cells most common in Africa and in persons of African descent where under stressful conditions such as infection, dehydration or low oxygen tissue supply, the red blood cells assume an abnormal rigid sickle shape- a process called sickling. Sickling decreases the flexibility of the red blood cell makes the red blood cell unable to pass through the blood vessels easily and for this reason reduces oxygen supply to tissues including the kidneys. If this sickling happens sufficiently, it can cause damage in these tissues and even death.

sickle cell1

A high powered electron micrograph of a sickled red blood cell. See how different it looks from the smooth round normal red blood cells nearby. These sickle cells are rigid and when a sufficient number of sickle cells accumulate in the blood, they block the blood vessels and cause crises in body tissues such as the brain, lung, bone, intestines and even the kidney.

 

function due to sickling

The blood vessel on the left shows how normal red blood cells permit normal overall blood flow. In the blood vessel on the right, the sickled red blood cells are rigid, inflexible and obstruct normal flow of blood and therefore oxygen to involved blood vessels.

 

There is also a less severe form of the sickling condition called the sickle cell trait or “AS” condition, where in simple language only half of the hemoglobin expressed is at sickling risk. Because the other half of their available hemoglobin is normal, they can provide oxygen better to tissues and are at much lower risk for clinical problems although if stressors are very severe, they may develop crises.

 

The number of people living with sickle cell disease is highest in Nigeria where over a million people live with the full sickle cell disease (SS) and over 30 million live with the sickle cell trait (AS). There are also high numbers of people born with the disease in east Africa (specifically, the Democratic Republic of Congo) and India. It has been estimated that about 90,000 babies were born with sickle cell disease in 2010 and this number is expected to grow to about 150,000 in 20501. This therefore means that a larger number of people will be alive with the disease and attention has to be paid by doctors in caring for the people as the number of cases of kidney disease due to sickle cell anemia will also increase.

15799_Sickle_cell_anaemia_MAP

Heat map showing the distribution of persons living with sickle cell disease across the world. The highest prevalence of sickle cell disease (number of people living with a disease) is in west and east Africa. A large number of sickle cell anemia patients also live in India. Up to 25% of the Nigerian population have the sickle cell trait (AS), up to 6% of the population have the full blown sickle cell disease (SS).

 

Sickle cell disease and the kidney

About 1 or 2 out of every 20 patients with sickle cell disease will develop problems with decreased kidney function2,3. The number of patients with sickle cell disease and kidney problems increases with age and among sicklers alive and over the age of 45, 6 out of 10 of them will have kidney problems requiring medical attention. However, only 1-5 out of 20 sickle cell patients with kidney disease will go on to develop kidney failure requiring dialysis or kidney transplantation2,3.

Problems with the kidney due to sickle cell disease is usually due to sickling in the small blood vessels of the kidney. The beginning of kidney problems in patients with sickle cell disease is usually quiet starting between the ages of 10 and 20 without symptoms. This symptom free stage is however progressive and requires close attention by doctors to detect early.

The most common signs of kidney disease in sickle cell patients is-

–        Frequent urination and increased volume of urine. Noticed even in the first 10 years of life and is just another reason for sicklers to always remain well hydrated and drink sufficient amounts of water

–        The presence of protein in the urine,

–        The presence of blood even in microscopic amounts in the urine

–        The development of high blood pressure and

–        Worsening anemia.

The presence of any of these problems in a sickler should push the patient and doctor to pay close attention to kidney function in order to prevent progression to kidney failure. Majority of patients with sickle cell disease and kidney failure present between the ages of 20 and 40 years and these patients often are dead within 4 years of diagnosis of kidney failure2,4.

It may appear that the number of people with sickle cell disease and kidney disease is low. However kidney failure is clearly an identified risk for death among sicklers so it is important to prevent kidney disease due to sickle cell anemia and control of kidney disease in those who already have poor kidney function is important.

It is equally important to note that not all kidney disease in patients with sickle cell anemia is due to sickle cell disease. Other causes of kidney disease in these patients might include lupus, or infection with hepatitis B, Hepatitis C or HIV. These infections are common infections among Nigerian sickle cell patients because of all the blood transfusions they often need over time that puts them at increased risk for acquiring the infections.

For more information on the concerns about blood transfusion and how they may be of importance to sickle cell patients, read our recent blog post about these infections by clicking here.

Sickle cell disease patients also appear to be at increased risk for medullary cancer of the kidney. This often presents with abdominal pain, a swelling in the abdomen, blood in the urine and weight loss. Any sickle cell patient with these symptoms must discuss immediately with their doctor.

What to do to prevent or control kidney disease and symptoms in sickle cell patients.

  • (Please note that these recommendations are only good practices to help empower patients with sickle cell disease. They do not replace the need to see a trained medical professional for detailed proposals for treatment and follow up.)

 

  1. Be vigilant for signs and symptoms of kidney disease such as increasing blood pressure and blood in the urine.
  2. Visit your doctor regularly and ask for a kidney check up with blood and urine tests.
  3. Drink plenty of water
  4. Pay attention to controlling blood pressure.
  5. Make sure as a sickler you get vaccinated against common infections. Fevers and infections are dealt with as quickly as possible by seeing a doctor.
  6. If you already have some kidney disease as a sickler make sure you are seen from time to time by a kidney specialist
  7. Talk to your doctor about medications like EPO, iron and vitamins you can take to increase blood production and decrease the need or frequency of blood transfusions.

 

References

  1. Piel FB, Hay SI, Gupta S, Weatherall DJ, Williams TN. Global burden of sickle cell anaemia in children under five, 2010-2050: modelling based on demographics, excess mortality, and interventions. PLoS Med. 2013;10(7):e1001484. doi: 10.1371/journal.pmed.1001484. Epub 2013 Jul 16.
  2. Saborio P1, Scheinman JI. Sickle cell nephropathy. J Am Soc Nephrol. 1999 Jan;10(1):187-92.
  3. Sharpe CC, Thein SL. Sickle cell nephropathy – a practical approach. Br J Haematol. 2011 Nov;155(3):287-97. doi: 10.1111/j.1365-2141.2011.08853.x. Epub 2011 Sep 9. Review.
  4. Wong WY, Elliott-Mills D, Powars D. Renal failure in sickle cell anemia. Hematol Oncol Clin North Am. 1996 Dec;10(6):1321-31.

Important web links for patients

  1. The sickle cell foundation of Nigeria. http://www.sicklecellfoundation.com/
  2. World Health Organization Fact sheet on sickle cell disease. http://www.who.int/mediacentre/factsheets/fs308/en/

 

UPCOMING BLOG POST- SICKLE CELL DISEASE AND THE KIDNEY IN NIGERIA


The red blood cell is an important cell component of the blood and functions to deliver oxygen to all the tissues. Each red blood cell contains what is called hemoglobin, the vehicle for carrying oxygen within the red blood cell. Abnormalities of the hemoglobin in the red blood cell can make the red blood cell function abnormally and cause serious problems in tissues of the body including the bone, brain, intestines, lung and even the kidney.

Sickle cell disease is also called sickle cell anemia or drepanocytosis. It is a hereditary disorder of red blood cells most common in Africa and in persons of African descent where under stressful conditions such as infection, dehydration or low oxygen tissue supply, the red blood cells assume an abnormal rigid sickle shape- a process called sickling. Sickling decreases the flexibility of the red blood cell makes the red blood cell unable to pass through the blood vessels easily and for this reason reduces oxygen supply to tissues including the kidneys. If this sickling happens sufficiently, it can cause damage in these tissues and even death.

sickle cell1

A high powered electron micrograph of a sickled red blood cell. See how different it looks from the smooth round normal red blood cells nearby. These sickle cells are rigid and when a sufficient number of sickle cells accumulate in the blood, they block the blood vessels and cause crises in body tissues such as the brain, lung, bone, intestines and even the kidney.

function due to sickling

The way sickle cells can block red blood cell flow and delivery of oxygen to tissues.

The prevalence of sickle cell disease is highest in Nigeria where over a million people live with the full sickle cell disease and over 30 million with the sickle cell trait.

15799_Sickle_cell_anaemia_MAP

The highest prevalence of sickle cell disease (number of people living with a disease) is in west and east Africa. Up to 25% of the Nigerian population have the sickle cell trait (AS), up to 6% of the population have the full blown disease (SS).

 

Stay tuned for an update to this post for a full description of how this common, dangerous and important disease can affect the kidney. We will discuss what can be done to reduce the impact of the disease on the kidney as well.

Kidney stones- A beginers guide for patients


What are kidney stones?

Kidney Stones are solid materials that develop from substances dissolved in high concentration in urine. Kidney stones may remain in the kidney or break loose and move down the urinary tract to be passed in the urine. Sometimes kidney stones may form in the bladder. Depending on the size of the stone, the stone may pass freely into the urine with or without symptoms. On other occasions, the stone gets trapped along the urinary tract causing pain, blockage to the free flow of urine or other problems.

5338_kidney_stones (1)

Figure 1: Kidney stones may develop anywhere along the urinary tract. They may form in the kidneys, the ureters or the bladder.

Kidney stone- img_2 kidneystones size-201_calcium_oxalate_0-sizes

Figure 2: Kidney stones vary in size from being invisible to the eye to being as large as a finger nail. Small stones or large stones are still capable of causing symptoms. Larger stones are most painful and problematic.

How common are kidney stones?

Even though kidney stones are less common in Africans compared to white people, kidney stones occur fairly frequently among Nigerians and it is estimated that about 65,000-130,000 new cases occur every year in Nigeria. Several hundred thousand Nigerians with longer histories of kidney stones live with kidney stones occurring predominantly in men and in those between the ages of 20 and 45 years of age.  Once a person develops the first kidney stone, he or she is more likely to develop additional stones.

The number of people suffering from kidney stones every year is increasing. The reasons for this are not entirely clear but changing food intake and better diagnostic capability are considered likely causes.

Who gets or develops kidney stones?

Increasing body weight, diabetes, hot temperatures, excessive salt and protein intake and insufficient water intake are considered risk factors for developing kidney stones as well.

The typical person with a kidney stone is a heavy Nigerian male between the ages of 20 and 45 years with a family history of kidney stones who lives in the northern part of the country and works outside most of the time.

It is interesting to note that obese people and diabetic patients have a lower urine pH and a higher urinary uric acid excretion putting them at increased risk  of developing uric acid kidney stones

What are the kinds of kidney stones?

It is important to know that there are different kinds of kidney stones because the treatments for a particular kind of kidney stone may be different from treatments for other kinds of kidney stones. Some patients may have mixed types of kidney stones.

The most common kind of kidney stone is a calcium stone. For patients with calcium stones, the calcium in the urine combines with substances like oxalate or phosphate to form a salt crystal in the urine that can grow and form a large stone. Calcium is an important substance needed for giving strength to bones and teeth, and important in muscle and heart contraction, blood clotting, food digestion, nerve function and many other functions. Free calcium in the blood is filtered by the kidneys into the urine and if calcium accumulates in excess in the blood or urine, it can increase the risk of kidney stone formation. Concentrated urine, excessive amounts of oxalate and uric acid in the urine or low amounts of citrate in the urine are risk factors for developing calcium stones.

Struvite stones form in patients who have infections in the urinary tract with ammonia producing microorganisms. Usually involves gram negative bacteria that are urea splitting . Highly alkaline urine and a high urinary magnesium load can predispose to struvite stones in the presence of the right bacteria. These stones can grow to be very large, may need surgical removal and often need treatment with long term antibiotics along with other measures to control or prevent them.

Cystine stones result from a genetic disorder called cystinuria that causes cystine to leak through the kidneys and into the urine, forming crystals that tend to accumulate into stones. These stones can be hard to find even on x-ray. Cures do not exist but they can be managed effectively by a good doctor.

Uric acid stones develop in people who over produce uric acid or with normal uric acid concentrations but with high urinary uric acid excretion. Some genetic disorders of metabolism as well as gout can be associated uric acid stones. Some blood cancers and defects in kidney handling of uric acid can also predispose to uric acid stones. Low urine pH increases the likelihood of developing a uric acid stone.

Excessive excretion of oxalate in the urine may also be a cause of kidney stones. This excessive excretion may be genetically inherited with treatment ranging from vitamin B6 administration for mild disease to simultaneous liver-kidney transplant for patients with severe disease often leading to kidney failure. On other occasions, the excretion of oxalate in high quantities into the urine may be due to other disorders such as poor intestinal absorption of fatty and bile acids.

Other uncommon causes of kidney stones occur in patients with cystic fibrosis, in those taking the HIV drug called indinavir or in those taking excessive amounts of Vitamin C

21_brushite_apatite_017_struvite_apatite_0_001_calcium_oxalate_0-sizescystine stones06_uric_acid_010_stone_shower_0_0

Figure 3: Types of kidney stones. Kidney stones can come in different colors, sizes and shapes. Sometimes they can be mixed. Different types of stones require different types of treatment.

Top left- Brushite/Apatite stones, Top right- Struvite stones, Middle left- Calcium oxalate stones, Middle right- Cystine stones, Bottom left- Uric acid stones, Bottom right- Mixed type stones.

What are the symptoms, signs and complications of kidney stones?

Symptoms of kidney stones might include some or all of the following

  • Pain in the abdomen or groin,
  • Bloody urine,
  • Nausea, vomiting and frequent urination,
  • Cloudy  or smelly urine
  • Fevers and body shaking if associated with infection of the urinary tract.

Locations for kidney stone pain

Figure 4: Locations for kidney stone pain. The pain often is only on one side but may be on both sides.

Signs of kidney stones that may be detected by a medical professional include

  • Tenderness in the lower back, abdomen or bladder regions
  • Decrease intestinal activity
  • Painful groin or testicles
  • High heart beat or blood pressure
  • Fevers and chills

Complications of kidney stones include

  • Urinary tract obstruction
  • Urinary tract infection including abscess formation
  • Perforation along the urinary tract and leakage of urine
  • Urinary fistula formation
  • Increased risk for kidney disease and kidney failure due to obstruction or infection
  • Increased risk of hypertension which in turn can damage the kidneys.

How do I know if my symptoms are from a kidney stone? Could it be from something else?

Do not assume that all abdominal pain is due to a kidney stone. It is important that you go to see a doctor so that a proper diagnosis can be made because if the wrong diagnosis is made, it may be life threatening. Important other diagnoses to be considered include

  • Abdominal aortic aneurysm
  • Appendicitis
  • Gall bladder infection or gall stone disease
  • Diverticulitis- inflammation of the colon
  • Gastric or duodenal ulcers
  • Liver abscess
  • Pancreatitis
  • Testicular torsion or epididymitis

What tests can be performed to determine if I have kidney stones?

A number of tests need to be performed to determine

1)      if your symptoms are due to kidney stones,

2)      if there are complications due to the kidney stones

3)      what kind of kidney stone you have

4)      the best sort of treatment to offer you.

Tests should be performed on your urine and blood. Special x-rays, CT scans or ultrasound tests may need to be performed to determine the size and location of the stone or if there are any complications of the stone such as abscess for fistula formation. A good doctor will ask you to bring in a sample stone if possible for detailed analysis of the stone type or ask you to perform a collection of all urine passed in a 24 hour period to determine the type of urine abnormality leading to stone formation.

How are kidney stones treated?

Treatment of kidney stones involves medical treatment and at times surgical management. Depending on the situation, this may need to be provided on an emergency basis.  Some cases will need hospital admission while sometimes the situation can be managed on an outpatient basis.

  • Fluid hydration. You need to take at least 3 liters of water every day to help prevent formation of more stones and help dissolution of existing stones
  • Treating possible infection with antibiotics
  • Pain control- with medication or with emergency stenting or drainage.
  • Attempts at medical management to enable passing the stone without surgery can be planned by your kidney specialist or urologist. It is not always successful.
    • The medical management often involves fluid hydration, drugs to help relax the urinary tract and enable passing of the stone in the urine, reducing calcium, oxalate or uric acid excretion into the urine, increasing substances in urine to help prevent and dissolve stones. Those with struvite stones in addition to antibiotics may need to be treated with drugs that inhibit some of the activity of urea splitting bacteria while those with cystine stones may need additional treatment with a binding agent that increases the dissolution of  excess cystine in the urine.
    • There often is a need to modify your diet to reduce the amount of stone forming substances in your urine. For example, kidney stone patients need to significantly reduce their salt and animal protein intake. For patients with oxalate stones, reducing the amount of oxalate intake in food such as is seen in chocolate and spinach and other green leafy vegetables is recommended. patients with uric acid stones need to reduce their intake of organ meats.  There is often no need to reduce the amount of calcium in the diet as long as 
    • Weight loss and better control of diabetes may also be important in some patients especially those with uric acid stones.

Your doctor will determine which drugs, diet and lifestyle changes are necessary for you to undertake  depending on the type of stone you have.

  • When a stone is too big or medical non-surgical attempts at passing the stone have failed, or there are significant complications, surgical treatment is required and can range from
    • Stenting or urinary diversion
    • Open surgery
    • Ultrasound blasting/dissolution of the stone(s)
    • Video assisted removal of the stone often by passing a scope into the bladder and upwards into the urinary system

Make sure you see a well trained doctor to advise you on whether you have kidney stones, what type of kidney stone you have and what the proper treatment is. Not all kidney stones are treated the same way. Always ask about your options and what you can do to prevent kidney stones.