Frequently Asked Questions (FAQ) on Kidney Health, Chronic Kidney Disease (CKD), Dialysis, Renal Transplant & Renal Diet
(Updated 1 April 2021)
I feel as though the stream of my urine is blocked when I urinate. This comes with pain in the left side of my lower back. Is this a kidney problem? I am worried because I often hold my pee in.
Sensation of urine blockage with less strength in the urine stream can indicate prostate enlargement. The accompanying lower back pain could indicate infection/inflammation of the prostate, what we call prostatitis.
Some patients with prostatitis complain instead of pain in the pelvic area, and others can have also fever, chills, cloudy urine and burning sensation while passing urine. I wonder if you have experienced any of those symptoms.
If you were to have prostatitis, the treatment of prostatitis is antibiotics, and they must be started empirically, but it is ideal to identify the causing agent by doing cultures to prescribe the right therapy, as prostatitis can be caused by bacteria normally found in the gut but occasionally can occur after getting a sexually-transmitted disease; requiring different antibiotics.
However, it is very difficult to commit to a diagnosis with very limited information and without taking proper history from you, without physical examination and without ordering the relevant tests. Prostatitis must be identified and treated promptly to avoid the infection spreads and other complications. Therefore, I advise you to go and see a urologist soon, who can assess you properly and can corroborate this suspicion or not; because there are other causes of back pain and sensation of urine obstruction, which might not be as benign as an infection and need to be excluded.
Regarding your question if this could be related to the kidney: Infections of the kidney (pyelonephritis) can cause loin or back pain, but typically do not obstruct the urine flow, unless there is an associated complication. A blocking urinary stone can cause back pain too and stones can obstruct the urine flow at certain levels – although the way you described it, makes me think that the obstruction is at the level of the prostate. So, just please get yourself checked personally by a doctor, soon. He will have all the elements necessary for a proper diagnosis.
Since having dialysis, my wife’s thighs are swollen and yellow-ish. Her stomach is also bloated and she has lost her appetite. Is this a normal reaction?
Indeed, the body of patients need to adapt to the dialysis process and some patients experience some sensation of feeling drained or very tired after dialysis, which little by little tends to get better. But the symptoms you commented might indicate other problems.
I need to mention that without assessing your wife properly in person, it is difficult to commit to a diagnosis and advise you/her accordingly, so I recommend you to communicate as soon as possible this to your usual nephrologist and/or the nurses in the dialysis centre, who can run it through the doctor in charge of the dialysis centre; and any of them can do the proper assessment and examination, and then give you the correct advice.
Nevertheless, the swollen thighs (and the different tone of their skin) might indicate fluid retention. She might have noted that her weight has been progressively increasing due to the excess of water retained.
Sometimes, the fluid retention is significant enough to go all the way up to the skin of the tummy, making the tummy feel heavier and making the patients feel bloated. Some patients actually store the excess of fluid inside the abdomen (what we call ascites) and this can also cause bloatedness.
The dialysis therapy helps removing the excess of fluid, but there is a limit of fluid removal that the body can tolerate and a limit for amount of fluid that can be removed in a given dialysis session. This is to avoid dizziness, cramps, drops in blood pressure, or worse complications. So, the long-term solution for fluid retention problems is to put more effort in moderating the intake of water and any other fluid or watery food, and to minimise the intake of salt (which helps retaining water and makes patients thirsty, then drinking more water, exacerbating the fluid retention). She might need to talk again with the nurses or with a dietitian, who can give her some tips to control the fluid intake better, and suggest how to eat a diet lower in salt.
If she is still passing urine, sometimes water tablets (diuretics) help to get rid of extra fluid.
If someone feels bloated, he/she might have less appetite and feel nauseous, and this could explain her other symptoms. But there are other causes of lack of appetite and bloatedness; some related to gut or other diseases; so a proper doctor’s assessment is ideal. Just please get this issue checked as soon as possible. Especially, that fluid retention can complicate with breathlessness and puts great strain to the heart.
And this junction, it will be also important to do a blood work as well, and to assess the adequacy of her dialysis prescription, to see if something can be optimised and some of these symptoms can improve.
My uncle has been undergoing dialysis and for the past few nights he told me that he saw specks of blood in his urine. Why is that happening? Is it a sign that there’s something wrong with his dialysis? Should we observe first or discuss with a specialist?
Passing blood in the urine is not normal, especially if you can see it.
There are multiple causes of blood in the urine (ranging from infections to injuries to stones to bleeding tendencies to cancers, etc; so I will not speculate too much on what could be the cause in your uncle, without knowing his medical history…
…and only by knowing in detail his medical and medication history and by doing a proper examination, the cause can be pinned down more accurately, and the correct diagnostic and treatment strategies can be implemented.
Please do comment that with his usual kidney specialist and flag it as well to the dialysis nurse, who can then discuss the next best course of action with the doctor in charge of the dialysis centre, which certainly will include urine analysis and culture and potentially a scan of his kidneys and urinary tract, and whatever else your doctor believes as pertinent; for instance, a full blood count.
The fact that it is just specks of blood means that the blood loss might not be significant. However, things can change especially that blood thinners are given during dialysis.
The dialysis per se (the cleaning of the blood) would not be causing this, however, those blood thinners that are used to prevent the blood to clot inside the dialysis machine during the cleansing process could trigger some bleeding in predisposed patients, which can be in any part of the body, including the urine.
Do not over worry at this junction but certainly your uncle needs to be assessed promptly by a doctor -or better, his usual specialist (as he/she knows his situation very well) and ideally before the next dialysis.
Also, as he is having some bleeding in the urine, his dose of blood thinners might need to be reduced or better stopped until this problem is thoroughly investigated.
Please discuss all this with his dialysis centre, too. They certainly can advise you more appropriately than me at the distance and having only minimal information.
My very best wishes, hoping nothing major is found and your uncle adapts well to the dialysis procedure.
I have been seeing foam in my urine for almost a week. And my urine feels warm. The warmth even persists after. I am a 34 year old female. Is this condition dangerous? What condition could it be?
The symptom of feeling some warmth when passing urine may indicate a urine infection. I recommend you to simply go and see a general doctor soon, so he/she can take proper history from you and examine you, order some basic urine tests and likely a urine culture, and prescribe you some empiric antibiotics.
Urine infections are common encounters in young women and are easily treated, but please do not let it unattended if indeed is an infection, as it can get worse. Let your doctor see you personally and do a proper diagnosis first, to be sure there is nothing else going on.
It is possible that inflammation of the bladder or urine tract during an infection can cause your foamy urine. Typically, when someone has foamy urine, we look for protein leakage in the urine. But let your doctor know all this and he will decide on the best course of action.
I am 40 years old and I have been having pain in my lower back and side for a week. My body feels weak and for the last two days, I also have a slight fever. How do I know if I am having problems with my kidney? The location of the pain is making me worried it’s a kidney issue.
Indeed, those symptoms can indicate a kidney infection or any other kidney or urological problem, eg an obstructive stone, etc. However, there are many more causes of back pain with fever like lumbar spine issues or infection of some organs in the abdomen like the pancreas, etc. For that reason, let’s not speculate (for your safety) and I suggest you to go and see a doctor or the A&E department as soon as you can, for proper history taking, detailed physical examination, specific blood work and for any necessary analysis like urine culture or any scans that the doctor, once examining you, sees as pertinent. Especially, that you have fever and not feeling that well, to avoid this worsens and you receive the right treatment promptly…also being sure nothing else is missed. Once a proper diagnosis is done, the doctor can refer you to the appropriate specialist if necessary.
Nothing trumps a proper medical assessment in person for acute problems. I hope that no major issues are found and you are on your path for recovery soon.
My father’s kidney stones are back after he went for laser treatment two years ago. Why does his condition recur? Is there any way to permanently treat it?
Unfortunately, kidney stones can reappear in many patients; especially if the underlying medical or metabolic problems associated with stone formation persist eg suffering from a chronic illness associated with stone formation; having predisposition to it (that is, running in the family); or if the necessary preventive dietary and lifestyle changes in between were not sufficient to prevent the formation of new stones.
In occasions, patients have multiple smaller stones and all of them cannot be removed and as a consequence one or some of them can grow with time; later giving problems to patients. In addition, if fragments of the original stone remained after the extraction or fragmentation procedure, bigger stones can grow on them with time.
For the prevention of new stones formation or their growth is crucial to implement the necessary diet, fluid and lifestyle changes. This is because certain diets, eg rich in sodium (salt), low in potassium, low in calcium (contrary what most people think), high in oxalate, low in citrate, high in uric acid and rich in sugars and simple carbohydrates have been associated with higher risks of stone formation.
Similarly, drinking not enough water (being slightly dehydrated), sedentary lifestyle, sugary carbonated drinks or taking some supplements like calcium supplements or vitamin C supplements can favour stone formation in predisposed patients.
It is also necessary to exclude and treat adequately any metabolic problems that patients might have like metabolic syndrome, gout, diabetes mellitus or even excess of weight, which predispose to stone formation.
Some patients might have rarer diseases, which are associated with stone and only after a thorough clinical assessment, they can be detected.
Finally, some patients might have anatomical problems in the kidneys or the urinary tubes, or frequent urine infections, which also predispose to stone formation.
Apart from the typical scans done for patients with stones and referring patients to a urologist for stone removal, I advise some extra tests for my patients to exclude many of the metabolic conditions (above mentioned) associated with different types of urinary stones; check what medications are taking, taking a detailed medical history, etc.
I also suggest a chemical analysis of the urine or even chemical analysis of the stone if is ever passed (or after being extracted), so we can identify more accurately what type of stones patients might be forming and target and personalise our medical, dietary and lifestyle advice more accurately to that type of stone.
In some conditions, we can prescribe preventive medications, for example anti-gout medications for uric acid stone formers or some types of medications that can reduce the excretion of calcium in the urine when patients excrete high amounts of calcium in the urine (reason for the urine chemical analysis, it can be very helpful to decide on preventive measures); among others.
Overall, there are few types of stones with different associating causes and some distinct treatment or preventive measures, so our diagnostic strategy and treatment advice must be personalised.
If you would like me to assess the case of your father in more detail and see what we can do to reduce his risks of stone reformation, you could book a tele-consultation with me using this platform, following this link: https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
Is contrast dye harmful to patients with multiple kidney cysts (eGFR 90)? My husband needs to take MRI of the prostate with contrast.
We typically recommend to avoid MRI contrast (gadolinium) in patients with advanced chronic kidney problems (i.e. glomerular filtration rate, GFR, below 30) or with kidney failure; unless it is really necessary like a life-saving test or to diagnose a cancer, where there is no other way or other test to use. But this seems not to be the case of your husband because of his normal kidney function (GFR 90).
The main risk we are concerned about is the risk of developing nephrogenic systemic fibrosis; which is a rare disease, but which can bring many problems to patients including thickening and scarring of the skin and many organs inside the body, and can be fatal. I get that is why you might be worried. But according to your husband's GFR, he does not have heightened risk for this condition.
In patients with advanced kidney problems, we explore if we could use other diagnostic modalities to obtain an answer and be able to treat the patients, like a CT or a non-contrast MRI. Again, based on his kidney function level, he likely can use gadolinium without major risks. But if you are still worried after my explanation, talk again to your doctor to see if there is another suitable type of scan that can get him/her similar information. However, keep in mind that not using contrast when it is indicated can lead to diagnostic and treatment errors; which can bring other types of worries and problems.
There are few types of gadolinium-based MRI contrast agents, some with lesser risk for this condition. Typically, MRI labs use the minimum necessary amount and use the gadolinium-based agents associated with less risks.
Other factors increasing the risk for this condition in patients with significant kidney problems are the presence of other diseases like diabetes, hypertension, acute illness and acute kidney injury. Kidney transplant patients and patients with a single kidney might have slightly higher risk, too.
Important to say that when we want to characterise the structure of irregular kidney cysts, to be sure they are not cancerous, gadolinium-based MRI is one of the options. So, we use it in patients with kidney cysts.
I hope no major issues are found in your husband's prostate scan. For more specific advice to his case, he can contact me privately, booking a teleconsultation using this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
For someone who has kidney failure, how much improvement can we expect from dialysis? Can kidney failure be cured and is it possible for the patient to live without dependency on the treatment?
In total kidney failure – what we doctors call end-stage kidney disease -, the kidneys cannot any longer perform their functions satisfactorily; to a sufficient level to sustain life or to avoid life-threatening complications. This is because in kidney failure, the failed kidneys cannot clean off from the body the excess of toxins; cannot regulate adequately the water content in the body; cannot aid in the control of good blood pressure; cannot balance accurately certain salts, electrolytes and acid in the blood; and fail to produce some hormones important to prevent anaemia and some necessary for bone health.
Unfortunately, total kidney failure is irreversible and has no cure (obviously, acute kidney failure is a totally different situation and I am not discussing that one here; where indeed there could be chances for recovery).
As a consequence of the kidneys not performing their roles as they should, patients develop different problems and symptoms like fluid retention, breathlessness, fatigue, anaemia, lack of appetite, nausea, vomiting, uncontrolled blood pressure, severe itch, bone weakness, etc; and if kidney failure is left unattended, patients can have many severe medical complications including heart failure, erratic rhythms of the heart and even cardiorespiratory arrest.
To avoid or rather to minimise the chances of that happening, plus to control many of the symptoms of kidney failure, patients with total kidney failure are advised to start dialysis or, better, to undergo a kidney transplant -if feasible and no medical or practical contraindications.
However, dialysis only replaces partially some of the functions of the normal kidney, in particular getting rid of the excess of body water and reducing the level of toxins in the blood to the minimum level to sustain life, to minimise symptoms and to reduce the risk for severe complications. Dialysis is not as good at that job as the kidneys are.
Patients with kidney failure having the symptoms enumerated above can experience improvement after starting dialysis. This is because the dialysis removes great part of the toxins and gets rid of the excess of water retained in the body. But sad to say, dialysis does not help make the kidneys recover or to work better. It is just a life-sustaining therapy, which aids in symptom control. Dialysis is not a treatment or cure for kidney failure. That is why we call it a type of kidney replacement therapy.
For this reason, we advocate patients to consider kidney transplantation over dialysis if that is a realistic option, because kidney transplantation provides a functional live kidney, which can perform many other functions than the dialysis cannot do; and because a kidney transplant is more efficient to clean the blood and to remove the excess of water, and works 24/7/365 (like the normal kidneys do). In addition, dialysis is also an intermittent therapy (eg only given 3 times a week for a few hours), while a kidney transplant works continuously.
For what I have mentioned, because the kidneys cannot work any longer, dialysis needs to be continued for life or until a kidney transplant is performed.
If your aim is to live as long and as best as possible, also wishing to avoid dialysis, my advice is to consider kidney transplantation (again if this is feasible and realistic).
Dialysis and kidney transplantation are complex matters and deciding on one or the other is also a complex and delicate decision, requiring thorough assessment of patient’s medical history and overall health condition, balancing many of the pros and risks of both dialysis and kidney transplantation. This re requires personalised expert advice. Discuss this further with your current doctor, but I could certainly assess your case and give you my opinion and advice. If you think I can help you to understand this better, you could book an appointment with me to assess your situation thoroughly within this platform using this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
Doctor, my CT scan results show I have a kidney cyst. I am told this condition is benign and doesn’t need treatment. Is that correct? How do I know if this is cancerous or not?
Kidney cysts are relatively common, even in people without kidney problems. Some people have one, other people many more; and they can occur in one or both kidneys.
There are different types of cysts and there are different medical situations associated with kidney cyst formation. Many/most of them are benign, meaning non-cancerous; but others could be the precursors of cancer. So, I understand why you are concerned, but let me reassure you. Usually, they do not produce any symptoms and most of them do not confer major risks to patient’s health.
The shape (anatomy) of the cyst(s) as seen in imaging tests like the one you did helps us to classify them according to the so-called Bosniak classification and to estimate their risk for cancerous transformation. I will not explain this Bosniak classification in detail but when the cysts are well-contoured, like a uniform sphere, they are called simple cysts (like the one you have), which are typically benign. When their shape is irregular or they have some deposits of calcium in their wall, they are called complex cysts and they need to be monitored closely for any further potential changes through time – this is to detect on time if they were to transform into a solid nodule, which indeed could be cancerous. There are people who has more chances of this cancerous transformation like patients suffering from chronic kidney disease or kidney failure or taking immunosuppressive drugs -I hope that is not your situation.
This potential cancerous transformation is not the rule. Most people having kidney cysts live a normal life without experiencing cancer transformation. Besides, if occurs, it is a slow-motion process, even in people of higher risk; giving us time for monitoring and opportune intervention.
For the things explained above, the majority of the simple kidney cysts require no intervention; this latter reserved when there is a complication like the ones enumerated above.
I hope you this reassures you. If you dont have any medical condition, maybe few years down the road you can do an ultrasound, but discuss that with your doctor; this most be individualised.
If you have further doubts or you would like me to assess your particular health situation formally, you could book a teleconsultation with me using this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
I feel pain in my lower back and around my groin when I’m urinating. I read online that this could be symptoms of kidney stones. What examination should I undergo to have it checked?
Indeed, having lower back and groin pain upon urinating could suggest a urinary stone or other urological (urinary tubes) problems. So, it will be ideal to consult a urologist, who is the specialist of the urinary tubes and anatomical problems of the kidneys. Alternatively, you can see first a general practitioner or a nephrologist, and then they can guide you.
Before recommending any investigation to confirm the suspicion, it is always ideal to be seen properly by a doctor. The doctor will ask your medical history (for example, any other accompanying symptoms and signs like fever, blood in the urine, passing gravel or stones in the urine, problems urinating, any other symptoms, any accompanying medical conditions, type of diet, any medications or supplements, fluid intake and lifestyle habits, and a more detailed characterisation of your pain). It is important to check if you have any family history of stones, as that increases your risks. The doctor must examine you, too; so overall he/she can have a more accurate view of the situation and propose a more targetted and personalised plan to you; including also analgesics and diet and lifestyle advice.
There are different types of scans used when stones are suspected. A plain CT or a CT urogram are commonly ordered but some doctors do an ultrasound of the kidney and urinary tubes first together with a kidney ureter bladder X ray. Sometimes, other scans are used, depending on the initial assessment and patient’s particular situation like an MRI etc. So, my recommendation is to allow a doctor to examine first, and then decide.
Other tests might be necessary, including some metabolic blood work detecting some conditions associated with different types of urinary stones, chemical analysis of the urine or even chemical analysis of the stone if you ever pass it, so we can identify more accurately what type of stones you could be forming (if they are confirmed) and advise you more accurately regarding changes in diet and lifestyle, and potentially prescribing medications. There are few types of stones with different associating causes and some distinct treatment or preventive measures.
If the stones are confirmed, apart for whatever the urologist recommends as treatment (any type of removal) -but occasionally stones are passed spontaneously-, we nephrologists can co-manage patients especially if a metabolic condition predisposing to stones is identified or suspected, to do the blood work and urine chemical analysis I am commenting above and to suggest preventive diet and lifestyle modifications (and occasionally medications) to avoid the formation of further stones.
When I identify a stone in a patient, I refer him/her to a urologist to assess the patient for potential removal of the stone. When a urologist treats a patient with a urinary stone, he/she refers the patient to me for the blood work and chemical analysis of the urine and to implement preventive measures for the formation of further stones. I hope the best outcome for you. Please sort this soon as it is indeed very painful and sometimes stones can complicate with infections or even obstruction of the urine, which can affect your kidney function…or to be sure there is not something else going on.
Feel free to consult me formally for further metabolic or preventive advice -if a stone is confirmed, after you see the urologist- using this platform through this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
Lately when I drink more caffeine, I see foam in my urine. I’ve tried to reduce my caffeine intake and drink more water in the past and it worked in terms of reducing the amount of foam. But these days, the foam is still there even when I stop drinking caffeine. Is there something wrong with my kidneys?
Urine foaming or bubbles in the urine can occur occasionally in some people with no abnormality found. And this, hopefully, can be your situation.
However, people with persisting foamy urine must be investigated for protein leakage in the urine; which, if present, is an indicator of some kidney issues or inflammation in the kidneys (what we call glomerulonephritis). So, my recommendation is to get checked by a general practitioner, so he/she can take your medical history, examine you, measure your kidney function, order detection of both protein and blood in the urine, and then do the necessary afterwards: If nothing found, then reassure you; but if an issue discovered, refer you to a nephrologist for further investigations and advice.
Do not worry too much at this moment, but do not leave it unattended and see a doctor soon. I hope nothing major is eventually found. But if some leakage of protein found, please see a kidney specialist or alternatively you can book a tele-consultation with me using this platform through this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
Regarding your caffeine intake, remember, everything with moderation is better.
Doctor, my dad has just started his hemodialysis. How do we know if it’s going well and are there any signs? And we heard that if the kidney disease is chronic, then a patient needs to do dialysis all his life. Is it true? Is there any diet you will recommend for my dad?
If he has been confirmed with total kidney failure (what we doctors call end-stage kidney failure), he would need dialysis for the rest of his life; both to keep him alive and to feel as best as possible.
Said that, if he were to be a good candidate for kidney transplantation, this is another management option for patients with total kidney failure, and has overall more benefits over dialysis. This decision must be individualised.
The best way to know if he is doing well is to know if he is feeling better, if he seems well-nourished and thriving, and if he is able to do/resume/enjoy most of his usual activities, as normal and as best as possible once he has started and -hopefully- adapted to his dialysis regimen. Also, it is ideal to be sure he has no major issues or symptoms during or after dialysis; so he is not struggling with it.
Obviously, we doctors quantify some dialysis parameters and measure several laboratory parameters also to be sure the dialysis dose and dialysis adequacy (how well he is being dialysed) is optimal.
Modifications of the dialysis prescription, changes in medications and giving extra diet and lifestyle advice are necessary measures to improve his overall well-being. But in the centre of adequate care, and actually the most important factor, is to practice self-care. Patients assuming this role (and/or their caregivers if needing extra assistance); in other words, patients being in charge of their own health and managing their condition and diet and lifestyle decisions under the guidance of healthcare professionals, and deciding to live a more frugal and active lifestyle with a more positive mindset, learning to live well despite their disease, tend to do much better and live longer than other patients. Patients and their caregivers can learn all that and become empowered in self-care under the right guidance and support from their healthcare providers.
Patients on dialysis need to have certain diet restrictions, what we call the renal diet. Typically, most patients need to minimise the intake of fluids and of food high in salt, potassium and phosphorus. But again, diet advice must be tailored to their needs, requirements, cultural background and palate preferences. Many patients find implementing this diet changes difficult and are unable to keep with them, so they tend to do not that well.
Because adequate nutrition and these restrictions are crucial to minimise symptoms and complications and for an overall better physical well-being; it is pivotal for patients to do their best efforts to adhere not only to the dialysis or medications prescriptions, but also to the suggested diet and lifestyle changes.
With the aid of an experienced and empathetic dietitian, a good balance can be achieved, making the restrictions less unpalatable and preventing malnutrition, which is common in kidney failure.
I invite you to check this link https://www.franciscokidneycentre.com/kidney-health-guide/ , which leads you to my free e-guide on kidney health and disease with some useful chapters on dialysis and renal diet.
Also, it would be my pleasure to assess your dad’s overall condition and medical situation and advise you better, and address all your concerns; for which a formal and thorough teleconsultation would be necessary. If interested, you could book an appointment with me within this platform following this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
What are the things should we consider before deciding to undergo a kidney transplant?
This is a very interesting but not simple question. This is because every patient is a world on his/her own, with different medical conditions, functionality and health status; needs, requirements, preferences, priorities in life, dreams, aspirations and personality; as well as different worries, concerns and fears; plus having different lifestyle and family, socio-economical and work-related conditions, and distinct roles in society; and different access to healthcare and different levels of support. So, different patients put on the balance different factors when considering kidney transplantation over remaining on dialysis. In addition and importantly, some patients might have certain medical contraindications for kidney transplant or situations posing extra risks than the average patient -not necessarily contraindicating transplantation- but that require serious thoughts.
Therefore, the option for transplantation must be personalised taking into account all those factors and their relative importance to each patient’s personal, family, social and professional (or student) life.
There are many permutations of the above mentioned factors to consider. For instance, a patient without family members able to donate, living alone, with no insurance, not working, worried if can afford the transplant or not or being able to pay for the medications, etc needs to put on the balance other factors that someone with available donors, permissive job, insurance, where paying for the transplant is not a worry, with lots of family support…
Overall and in most patients, kidney transplantation is regarded as the best type of renal replacement therapy (for patients with total kidney failure) over dialysis. It offers better opportunities to live a longer life as normal and as best as possible over what dialysis offers to most patients. So, this is in fact, the most important consideration when deciding if going for a kidney transplant or not. Then, the second might be considering what type of transplant; for example from a living donor (relative or spouse) or from a deceased donor; because live-donor transplantation offers overall better outcomes over deceased-donor transplantation. If transplantation is readily available, considering doing it before starting dialysis (what we call pre-emptive transplant) is ideal. So, this is an option to consider as well.
Furthermore, who is going to be donor gives complexity to the equation. Your spouse, a twin sister, mother, etc. Plus the fact that the donor is again a whole world on his/her own, too.
All these factors (and more) are assessed and discussed with the prospective recipient and donor during the medical evaluation in preparation for kidney transplantation, at great detail and in a very personalised way. I would be happy to give you detailed and personalised advice in regards to your particular situation, but I would need to assess your situation formally and thoroughly. If interested, you could book an appointment with me within this platform following this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa
Alternatively or at the same time, why don’t you check out my recently published free e-guide on kidney health and disease, where I discuss in more detail my view on kidney transplantation and donation, mentioning many of the factors to consider. Please follow this link https://www.franciscokidneycentre.com/kidney-health-guide
During dialysis, I have irregular menstruation. Is it normal for my period to be affected? Is it okay to leave it untreated?
It is common for women on dialysis to have irregular menstruations or lack of menstruation (amenorrhoea); which has been associated also with problems conceiving. The high levels of blood toxins and other biochemical alterations in the body of kidney failure can contribute to some hormonal imbalances and lack of ovulation.
Fertility issues are what usually trigger patients to seek further help with a fertility specialist. If you are trying to conceive, this will be necessary.
If any other symptoms related to your menstruation or sexual function arise, it could be ideal to seek also an opinion from a gynaecologist and/or an endocrinologist with experience in menstrual disorders; which could help you to potentially sort the issue or give you reassurance if you are worried.
For some patients, optimising dialysis treatment (adequate dose of dialysis), correcting anaemia with erythropoietin, improving their mineral bone metabolism/disease (calcium, phosphorus, iPTH, vitamin D), improving nutrition, remaining active and/or minimising stress helps a bit; especially in younger patients. You probably need to double check (with your doctor) for any potential improvements in those aspects.
However, the best solution to this menstrual (or fertility) problem is to have a kidney transplant. The kidney transplant is overall (in most patients) superior to dialysis not only to correct imbalances like the one we are describing, but to allow patients to live a longer and fuller life. Can I ask you? Are you in the waiting list for a kidney transplant? Can anyone in your family donate a kidney to you?
If you would like me to have a look at your dialysis parameters and overall health situation and advise you more specifically to see if some improvements can be done, or if you would like to have more information on kidney transplantation (the rationale, pros and risks); I recommend you to book a formal consultation with me using this platform following this link
Your current worry and main issue now is the irregular menstruation, I gather that, but seeing the bigger picture your focus could be to try to improve your current health (or at least check that everything is optimal) and to seriously considering getting a kidney transplant because that might be the best rounded option for you, as a whole.
This morning, I had foamy yellowish urine. Before this, I also suffered from frequent urination. I have tried to manage it by quitting coffee and alcohol, and limiting my water intake. However I get muscle cramps in my thighs and lower back. Is this related to some sort of kidney issue and is it serious, Doctor?
The urinary symptoms you mentioned could suggest that either a kidney or urological problem might be going on. It could be as simple as a urine infection, but, even if it is an infection, it is not ideal to let it un-investigated and untreated. So, you definitively need to be checked by a general doctor, at least and at first. He/she might take a more detailed medical and medication history, asking you for any other symptoms like fever, pain during passing urine, or symptoms of kidney or urological problems, etc, and examine you and do some simple blood work including kidney function tests and electrolytes (and other routine tests), and some urine tests looking for blood and protein leakage in the urine and a potential urine infection. He might need to order some scans, depending on his/her findings and/or refer you to a nephrologist and/or a urologist for further investigations and specialist opinion.
The cramps might or not be related. It is difficult to answer that at the distance and without examining you properly; but the doctor I recommend you to see can help you with that once he/she has all the information at hand. And then take the necessary best next step.
Do not worry too much at this junction, but do seek medical advice soon. I hope a minor treatable issue is found and this is sorted soon, so you can start feeling better. I hope no major issues found on the kidneys; but if so, you could share later all the results of the initial analyses and I would be honoured to give you my professional opinion. Again, if that happens, hopefully not, I recommended you to book a formal consultation with me using this platform following this link https://www.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa so I can assess you and advise you properly.
Moderating your intake of alcohol and coffee would be always good for your health. I understand why you might have reduced your water intake, but I suggest do not do that until you see a doctor. In occasions, that can bring new problems as kidneys need sufficient amount of fluid to work properly and for you to be ok.
My uncle has been undergoing dialysis for 2 years now. I personally feel this treatment works only to keep his kidneys from failing, and his condition doesn’t seem to improve. Our family has been discussing a kidney transplant and we want to ask your opinion on this. What should we consider before deciding to have a transplant? If we keep him on dialysis, is there a chance to improve his condition?
When the kidneys start failing, we recommend patients to start dialysis or to undergo a kidney transplant.
People in that situation, for example needing to start dialysis, is because their own kidneys cannot any longer eliminate the excess of toxins in the body nor the excess of body water. However, dialysis only do that job partially, to the minimum level to at least keep your uncle (or any patient) alive and relatively well. Unfortunately, dialysis does not help preserving the remaining kidney function nor makes the kidneys better. Dialysis only helps sustaining live and regulating to certain degree many of the body and blood parameters. That could be the reason you do not see progressive improvement in your uncle’s condition. Said that, it would be ideal to have a thorough assessment of his condition to be sure nothing else is missed, that could be contributing to that, for example, some metabolic imbalances, malnutrition, poor control of any accompanying disorder like diabetes, etc.
In comparison to dialysis, in most patients, kidney transplantation seems to be the best option to replace the functions of the kidneys, to regulate better the body fluid and many body components, and to make patients feel better and likely live for longer. Kidney transplantation also offers the best chance for life rehabilitation; allowing patients to live a life as normal as possible and as enjoyable as possible; again in comparison to dialysis. For those reasons, kidney transplantation could be a better option over dialysis for most patients.
However, not every person is suitable for kidney transplantation. Candidates for kidney transplantation need to be assessed properly and thoroughly before being advised in pro for transplantation. If your uncle has no contraindications for kidney transplantation and he is relatively fit and strong to undergo such a surgery -after thorough assessment by a specialist team, experienced in kidney transplantation- transplantation could be indeed a better option for him. It is important to know if his doctors already recommended this option to him or not; and if not, why.
There are many types of kidney transplantation, depending on the type of donor and many other factors. The one associated with better outlook and outcomes is when the donor comes from his own family when compared to receiving a kidney from a deceased donor (ie being in the national waiting list). There are multiple reasons for that including better organ compatibility if the organ is donated within his family and no needing to wait for long time for a kidney in the waiting list; because a donor within the family is readily available, no needing to continue for long periods on dialysis; which also have progressive side effects for dialysis patients.
I hope I have answered your main concerns. However, dialysis and kidney transplantation are complex matters and deciding on one or the other is also complex and delicate decision, requiring thorough assessment of your uncle medical condition and relative fitness, balancing many of the pros and cons of both options; requiring a personalised advice. Helping and advising patients at that difficult junction is what I do every day. For that reason I would recommend as best next step to re-discuss all this with his treating physician; but I would be also honoured to advise further on his case; but I would need to assess him properly with all his medical details; so to give him the safest and most accurate possible advice. If interested, you could book an appointment with me within this platform following the respective link.
Otherwise, I hope your uncle's situation stabilises or gets better and you all move towards the best treatment option for him.
Dr Francisco, wishing your uncle the best possible health!
Why is it important for our kidneys to work well?
Our kidneys remove excess toxins and water from the body, regulate salt and water balance in the body, and produce the hormones necessary for red blood cell production and healthy bones.
What puts you at risk for kidney disease?
==> High blood pressure
==> Family history of kidney disease
==> Congestive or coronary heart disease
==> Prolonged use of non-prescription drugs
What are the first symptoms of kidney disease?
Signs and symptoms of chronic kidney disease may include fluid retention, decreased urine output, leg swelling at the end of the day and breathlessness.
What are the causes of kidney failure?
There are a number of medical conditions that can cause kidney failure, whether it is over a period of time or suddenly. The sudden kidney failure (or acute renal failure) may be due to certain drugs, infections or trauma. This organ failure that happens over a period of time may be caused by diabetes, high blood pressure, and heart disease which are not controlled in the long run, thus causing end organ damage, and kidney failure is one of them.
What is the difference between chronic kidney disease and kidney failure?
Both chronic kidney disease and renal failure are the spectrum of the same disease process that affects the kidney function and the well-being of the kidneys.
That process goes through different progressive stages of chronic kidney disease, where the last stage is referred to by many as total kidney failure, when the kidneys stop working; although the preferred medical term for the last stage is end-stage kidney disease.
For clarity, I will use the term of total kidney failure.
Chronic kidney disease is the consequence of the damage caused by many different disorders and diseases in the kidneys.
These disorders result in the progressive damage to the kidneys, impairing all the functions of the kidneys.
There are five stages of chronic kidney disease, from stage 1 to 5; where stage 1 is the least advanced and stage 5 the most advanced, and which can lead to total kidney failure, when the kidneys completely stop working and this is typically irreversible.
When kidney function drops below 5-10%, patients can become very ill.
The situation can be life-threatening, and dialysis or a transplant needs to be performed to replace the lost kidney function or a patient might lose his or her life.
In Francisco Kidney & Medical Centre, we understand how confusing this can be. So, we give detailed explanations to our patients, with the aim of answering their queries and dissipating their concerns.
What are the stages of chronic kidney disease?
There are 5 stages of chronic kidney disease.
The 5 stages are classified according to the so-called glomerular filtration rate or GFR.
The GFR is an approximate measure of the percentage of kidney function.
In stage 1, the GFR is normal. Therefore, the kidneys clean the blood efficiently, but there is already detectable damage to the kidneys either because of protein or blood leakage in the urine, known kidney disease, for example, scars, or structural problems of the kidneys like cysts or stones.
In this stage, patients have no symptoms related to kidney dysfunction, but they might have symptoms of the original disease.
When the kidney function starts dropping progressively, meaning also the GFR starts dropping, and the injury to the kidneys progresses in intensity, chronic kidney disease moves from stage 1 to stages 2, 3, 4 and then 5.
In stages 2 to 4, typically the patient has no symptoms or only minor symptoms. Thus, it’s common to be unaware that he or she is suffering from kidney problems, unless the original disease gives them symptoms, pushing them to get checked by a doctor. For example, joint pains in lupus patients.
But those are not symptoms of chronic kidney disease.
By stage 4, many patients might have still no symptoms of kidney dysfunction or no major symptoms. However, it is advisable that patients at this stage start planning for dialysis or for a kidney transplant.
Not to start dialysis yet, but to start the planning of it. As everything in life, it is better to be prepared, to be ready and top of everything when total renal failure occurs, rather than renal failure catching the patient unguarded by surprise.
Many patients, due to natural fear for dialysis, delay the planning and end up having more complications or needing to start dialysis as an emergency.
By stage 5, many patients start having some of the symptoms of kidney failure; which were mentioned above.
As stage 5 progresses, the symptoms might be imposing on patients’ activities and well-being or might become life-threatening. In these scenarios dialysis needs to be started or a kidney transplant needs to be performed.
What is important to emphasize is that detecting chronic kidney disease early is crucial, as opportune intervention (for instance, diet and lifestyle modifications, and medications) can halt disease’s progression if they started on time.
When should you see a kidney specialist or nephrologist?
Unfortunately, kidney disease comes with very few symptoms until the patient has late stage chronic kidney disease. The best time to see a kidney specialist varies based on your kidney functions, renal conditions, and other risk factors. Some people should see a kidney doctor much sooner to control and manage their kidney conditions, especially those with diabetes and high blood pressure. To be safe, you should go for regular health screening so your doctor can pick up signs like blood or protein in the urine and institute corrective measures for you early if any abnormalities are found.
How are other organs affected by kidney disease?
With chronic kidney disease, many other organs get also affected.
The heart, vascularised organs, the brain and the nervous system are common targets.
For instance, patients with advanced chronic kidney disease, and even more, with total kidney failure, are at increased risk of heart attacks, heart failure, or erratic rhythms of the heart, or arrhythmias, that can even end-up in the heart going into stillness.
The blood pressure can go very high and this damages many other organs.
Severely increased blood pressure can precipitate a heart attack or a stroke or a bleed in the eyes.
If the potassium levels go too high, it can even make the heart stop. This can also happen with abnormalities in other electrolytes.
The bones can become fragile, leading to pain, deformities and fractures.
The muscles can also become very weak, and suffer from painful and sustained cramps.
The blood vessel can become stiff, which can cause circulation problems to many organs, then their function can be impaired.
The circulation to the heart, to the brain, to the legs, to the genitals, etc can be affected.
The nerves of the body also get affected and the patient can have loss of sensation of the skin, abnormal movement and impaired function of some organs as all organs depend on a healthy nervous system.
The skin becomes dry, which exacerbates the itch accompanying kidney disease.
And scratching predisposes to skin infection.
Organs like the liver can also not work that well with high levels of toxins, and the liver is also an important detoxifier of the body.
As the kidney disease progresses, the patient becomes more and more malnourished, losing flesh and strength.
This, together with weaker muscles and some electrolyte abnormalities, can predispose to falls and all their consequences.
If the patient becomes weaker, he becomes susceptible to transmissible infections, or he or she becomes more ill if suffering any sort of infection. Or he or she becomes more ill if suffering any sort of infection.
The mood of patients also changes, going downhill.
This might be an effect caused by the toxins or the psychological effect of knowing you have kidney disease.
In Francisco Kidney & Medical Centre, we are very aware of all the complications that kidney patients can suffer and their implications.
We provide empathetic, approachable and flexible specialist renal and medical care; because we can imagine the struggles our patients and their relatives could face in these situations. Because taking care of both the physical and mental well-being of our patients and their families is my top priority.
Does chronic kidney disease affect one or two kidneys?
Unfortunately, most kidney diseases affect both kidneys, and they affect them in similar fashion, like diabetes, high blood pressure, different types of inflammation (the so called glomerulonephritis) or systemic inflammation like lupus, allergy in the kidneys (e.g. reactions to medications), urine flow obstruction that affects the urinary tubes in both sides or the bladder, polycystic kidney disease plus many other rare diseases that affect both kidneys.
But true there are diseases that can affect only one kidney like stones, tumours, accidental injuries, obstruction of the urine flow of one single kidney, a urine infection, etc. Although, true also these problems can affect the two kidneys.
The crucial matter is that many of these problems can progress to kidney failure, especially if not discovered on time or not managed adequately or by not following doctor’s recommendations. Thus, in many cases kidney failure and the need for dialysis can be prevented or at least their chances reduced if we detect them early and we treat them promptly and adequately.
Does necessarily kidney disease end in kidney failure and the need for dialysis or a kidney transplant?
Not all patients with chronic kidney disease eventually develop kidney failure. In other words, not all patients with kidney disease need to undergo dialysis or a kidney transplant.
There are many factors responsible for this.
First of all, there is no single cause of kidney disease. And every disease behaves differently, some more aggressively than others. So, the progression and risk is different in every single patient; plus the fact that every patient is per se in general different.
Second, the current status of your kidney problem or the status of your kidney disease when it was detected can also determine your chances to progress to kidney failure or not.
For example, if the disease is detected early and is amenable to modification of habits and/or the use of medications to protect the kidneys, the chances of disease progression tend to be lower.
But if detected late or your percentage of kidney function left is already quite low, you will have higher chances of developing kidney failure as the time passes by.
This illustrates the importance of early detection and screening, especially if the patient has personal or family risk factors like diabetes, high blood pressure, or inheritable diseases like polycystic kidney disease; among many other causes.
Third, not every patient takes the same good care of their health; or adhere to their treatment for his or her underlying conditions; or modifies accordingly his/her diet and lifestyle.
As a consequence, and it is totally my professional experience and observation, patients with chronic metabolic conditions and kidney disease, who live a more frugal and active lifestyle, attending their appointments (i.e. getting opportune advice) and following that medical advice tend to have less risk of disease progression and chances of kid-ney failure. The opposite is true for those not taking good care of themselves.
There are other important factors to determine your chances to develop kidney failure, and as I mentioned, they vary patient to patient, so…taking into account your health and wellbeing is at stake, I recommend you to address your concerns with and be evaluated by a specialist kidney doctor, who can individualise his or her opinion to your particular case.
It is not easy living with kidney problems, the worry of disease progression, or having developed kidney failure already.
So, aiming to prevent or slow down kidney disease progression or its complications, and getting help to fully understand this process and managing properly is crucial. However, many times despite all the efforts, the kidneys still give up and go into failure…and we need to advise our patients to prepare or go for dialysis or a kidney transplant.
Before concluding, it is important to mention that there are cases of temporary kidney failure, what we doctors call acute kidney failure, where the patient can need dialysis for a variable period of time and later showing recovery and the dialysis can be stopped.
However, these patients need to continue on follow up as they have higher risk of developing progressive kidney disease than normal people.
How are your kidney functions assessed?
In the clinic, we use different methods to assess the degree of kidney function or kidney dysfunction, depending how you want to see it, and to confirm if your kidneys are working fine or not. Specifically, regarding how well they clean the blood.
We measure the creatinine and the urea in the blood, which indicate indirectly the levels of toxins in your body.
Higher levels of these parameters represent higher levels of toxins in the blood, indicating a lower kidney function, and that the kidneys are not cleaning the blood properly.
We also measure the glomerular filtration rate or GFR, that simplistically is an approximate measurement of the percentage of kidney function. Thus, the higher the GFR, the better the kidney function.
As part of the general assessment, we also order other tests.
An ultrasound of the kidneys, for instance.
On occasions, it helps finding the cause of the kidney problem or to detect a complication. For example, it can detect a blockage from a stone, a tumour, etc.
But the ultrasound does not measure directly the degree of kidney function, not help finding all causes of kidney problems. The fact that an ultrasound is reported as normal, it does not mean that everything is ok, still there could be an underlying problem of the kidneys, at the microscopic level, like glomerulonephritis.
But true, if the kidneys are small in the ultrasound (likely scarred), it tallies with a lower level of kidney function and usually indicates that the kidney has been injured progressively and the kidney function progressively declined through prolonged time.
In this respect, there is another useful but more invasive test, the kidney biopsy, which is a procedure using a long needle to take small pieces of the kidney for analysis under the microscope. It does not measure the capacity of cleaning of the blood, but it is in theory the best method to check the status and health of your kidneys – that is, their vitality – ; and also to find the cause of your kidney problem. However, it can be risky in patients with certain conditions and when the kidneys are too small. So, not everyone can undergo a kidney biopsy.
We also perform something we call nephritic or autoimmune screen, which consists of special blood tests, which are more detailed and expensive than routine ones. But they can be seen as an investment as they can give us peace of mind, to both doctor and patients, if they are negative; as usually point to a more severe disease. But if positive, at least a hidden process can be detected opportunely and treatment implemented promptly.
What is the purpose of a kidney biopsy?
A kidney biopsy is a medical procedure by which a small tissue sample of one of the kidneys is taken with a fine needle. The sample is then prepared in special ways, and examined under a microscope.
This allows for detailed examination of the micro-anatomy of the kidney, revealing in most instances the cause of the kidney injury, the cause of kidney dysfunction or the cause of protein or blood leakage in the urine.
A kidney biopsy, per se, does not measure the capacity of cleaning the blood, but it is in theory the best method to check the status and health of your kidneys, and the degree of scarring of the kidneys (tissue that cannot be repaired).
A kidney biopsy can also help guide the correct treatment for your kidney condition and can help determine the prognosis or outlook of your condition. That is, the chances of disease progression.
A kidney biopsy is crucial in the management of many patients with kidney disease, but it is not a simple procedure and it is bound to complications. They are not common but they can be significant…like internal bleeding.
Therefore, patients must be assessed thoroughly by a kidney specialist.
First, to understand if a biopsy is necessary and if it needs to be performed urgently.
Second, to ensure it is safe to perform it. As it can be risky in patients with certain conditions, taking blood thinners including aspirin, and when the kidneys are too small.
So, not all people are suitable for this investigation.
Most experts agree when the kidneys are small or the damage seems to be permanent, a kidney biopsy might not be helpful also.
Many patients, in fact, refuse to have a kidney biopsy done. In many occasions, this is riskier than the biopsy itself, because the cause of the kidney problem might remain unfound, the underlying problem not treated, not monitored adequately and allowed to progress on its own, making the prognosis uncertain or not good at all.
On many occasions, with the results from the biopsy, and a proper assessment and treatment plan, kidney failure can be slowed down or even avoided at all.
What can you do if you have been diagnosed with kidney disease?
In general, we advise patients to modify any risk factor (i.e. diet or lifestyle habits) that could enhance disease progression.
For instance, avoid smoking, aim for better control of your blood pressure, better control of diabetes, aim for a healthier weight, and so on.
This in fact works in some patients, and on occasions that alone can halt or at least slow down disease progression to kid-ney failure, prolonging the life of the kidneys for as long as possible.
But if you have kidney problems or a specific disease of the kidneys, on top of managing the specific disease, you then need to ensure you manage well other conditions you might have or put efforts in not developing other conditions, by following a healthy diet and lifestyle.
For instance, you might have inflammation of the kidneys, but ideal for you to lose weight if you have excess weight to avoid first that your kidneys overwork, and second to avoid added insults, which can increase the rate of disease progression.
For some diseases, especially the ones related to inflammation or allergy in the kidneys, patients need to undergo special treatments with powerful anti-inflammatory drugs, which sometimes successfully can halt the disease.
But sometimes the disease is too aggressive; or, severe damage has been already caused to the kidneys, that the expectations of recovery and to avoid dialysis are low.
All this information can be puzzling, therefore it can cause you additional stress, which is not good for your overall health. In Francisco Kidney & Medical Centre, we provide empathetic, approachable and flexible specialist renal and medical care; because we can imagine the struggles our patients could face, and we care about the physical and mental wellbeing of our patients and their families. So, we are happy to spend extra time being sure our patients understand very well their diseases and the rationale of our management strategies.
What are the general recommendations to take care of your kidneys – especially if you have risk factors for kidney disease or the disease already?
1. Blood pressure control is very important to protect the kidneys. When high, it can cause what we call hydrostatic injury to the kidneys. You can imagine the higher the pressure, the more the damage. To achieve good blood pressure control, it is essential for you to monitor your blood pressure at home and consult your doctor if any issues, to take your blood pressure tab-lets as prescribed, and to reduce salt intake in your diet. Exercise and losing weight also help keeping a healthier blood pressure and sometimes to reduce it.
2. Quit smoking. Smoking is very toxic for many organs of your body including the kidneys. This will be good for your general wellbeing, but also to minimise insults to the kidneys.
3. We already commented a bit about the effect of losing weight for blood pressure control. But also controlling your weight can help protect the kidneys.
In a way, the larger your body size the more effort the kidneys tend to put to clean your body; and with time some consequences of that overwork (what we kidney doctors call over-filtration) can cause kidney damage (let’s call it fatigue of the kidneys).
You probably know what you need to do to lose weight: Diet improvements (for example, eat a more balanced and moderate diet with reduction of sugar and fatty food), and to have a more active lifestyle.
This will be simpler with the help of a dietician, or if you join a healthy weight loss programme, especially if you find it is too difficult to do it alone or you have tried and failed and about to or already given up.
In fact, I developed a weight loss programme with the same aim to improve health, prevent diseases like diabetes, to protect the kidneys (and the general health) for my patients and clients – The OLYMPIA Lifestyle Health Enhancement & Weight Loss Programme. If interested to know more, you know how to contact me.
4. Do exercise (as tolerable, but consult your doctor first) to maintain your weight and improve your health.
5. Control your blood cholesterol, and if high, consult your doctor for diet advice. On many occasions, medications are needed.
6. If you have pre-diabetes or diabetes, reduce sugary food and sugary drinks and aim for good blood sugar control. Plus follow all general advice for diabetic people. But, irrespective of this, even if you do not have these conditions, it is always advisable to minimise your sugar content to prevent them. In my weight loss programme, we focus also on better metabolic control of people with diabetes, pre-diabetes or at high risk of it.
7. If your doctor prescribed certain diet restrictions to protect your kidneys, the so-called renal diet, consult an experienced dietician. She or he will guide you.
It will be simpler and more effective than figuring out those diet recommendations and restrictions on your own. The dietitian can translate that into a tailored diet plan for your needs.
In general, patients with kidney problems benefit from a diet low in sodium, fat and sugar; and in many occasions low in potassium, phosphate, and protein content.
To control the phosphate some patients need phosphate lowering medications.
8. Protein restriction in the diet can benefit many patients, slowing down some of the progression of kidney disease, but please check this with your doctor and your dietitian.
First, if it is necessary. Second, to what degree. This must be adjusted greatly to the degree of kidney dysfunction, your nutritional condition and if you have any other accompanying diseases. Third, how to make your diet more balanced, to avoid over-restriction and prevent consequent malnutrition. Especially, patients with kidney problems, in particular in more advanced stages, they are more susceptible to malnutrition.
9. Control of fluid intake; what we call fluid or water restriction. It is important to stress that it is fluid restriction not only water restriction.
The restriction includes any fluid including other beverages like coffee, soda and juices, any soups or watery dishes like porridge, or even fruits like watermelon and others.
Many patients claim to attach to water restriction and maybe they have, but they need to review their diet from these other sources of dietary water.
In patients with more advanced stages of kidney disease, fluid restriction might be necessary as progressively it is more difficult for ill kidneys to handle the excess of water and you can develop fluid retention.
Water is vital, but when the kidneys do not work well, an excess of water can become toxic.
So, despite how difficult it can be; when the kidneys do not work well, fluid restriction becomes vital. So, if your doctor prescribed fluid restriction, try to attach to it, otherwise you can develop fluid overload with leg swelling, breathlessness, tiredness, potentially flooding the lungs and precipitating a heart failure episode, needing emergent hospital admission or worse.
In addition, not controlling the fluid intake through long periods of time imposes on the heart, making it overwork and with more chances to get fatigued (that is, developing chronic heart failure).
To prevent fluid overload, a low salt diet helps. Salty food triggers thirst; and salt is also a sort of sponge for water, increasing its retention (and remember, it also can increase the blood pressure).
Frequently, patients need to take water tablets (diuretics) to eliminate excess of fluids retained. But again, water tablets work better if fluid and salt restrictions are optimised.
10. Attending appointments and not missing them, even if you feel ok. If you miss it, you might think you are saving time, hassle and money; especially if the doctor tells you everything is fine or stable.
But that is crucial. You gain peace of mind. You know the current approach is working and you are doing the necessary. However, if missing appointments and there were to be an issue, you can miss it or at least delay its discovery.
On many occasions those details can harm your health, can allow a complication to develop or can allow an underlying condition to cause damage or scarring in some organs like the kidneys, which might not be reversible. Also, feeling well can be deceiving of what actually is going on inside your kidneys.
Kidney problems in early and moderate stages are typically asymptomatic (meaning you do not feel anything wrong), so that can give you false reassurance. By missing appointments, you can miss to discover things on time and miss the chance to intervene opportunely with the aim of delaying progress of your kidney dysfunction. This is a common issue.
11. Take all your medications as prescribed. Again, I cannot stress how important is not to miss medications and to take them as prescribed, avoiding under or overdosing.
In this latter issue, if you think you would need less or more medications, that might be true, but make aware your primary doctor, so he can adjust your management. Otherwise, if missing medications or not having the right doses, it is difficult for the treatment to work, it is difficult for your condition to improve, halt or reduce its deterioration speed and can precipitate side-effects.
Talking about prevention and renal protection. Some patients are prescribed anti-proteinuric medications, as they can protect your kidneys, in a way, by reducing the blood pressure inside the kidney at the microscopic level, making the filtering of the blood more gentle, and by minimising leakage of protein.
But not everyone should or can take them. Some patients might have contraindications for them and cannot use them. Check this with your doctor.
12. Many patients with high cardiac risk factors can benefit from taking aspirin or especial types of blood pressure tablets, so ask your doctor if they are suitable for you as not everyone can take aspirin, for example.
13. If you have anaemia, take your iron supplements and/or administer your erythropoietin injections as prescribed to improve your haemoglobin levels to the recommended range.
14. If your blood is acidic (low serum bicarbonate), take your bicarbonate supplements.
15. If your uric acid is high, take care of your diet and take anti-uric acid medications if prescribed by your doctor
16. Ask your doctor if you need some vitamin supplements.
17. If you have a stressful life, check what you can do to minimise your stress. Similarly, if you cannot sleep well, check what you can do to improve that. It could be from something like planning your life differently with the people around or involved in those situations, practicing meditations, mindfulness and other practices, or by asking help.
Sometimes is stress of busy modern lives with all their challenges. Sometimes there might be an underlying medical disorder.
18. Check with your doctor if your 25 vitamin levels must be checked, and if low, take supplements. In addition, some patients with advanced kidney disease might also need to take a more special active type of vitamin D or other medications to control the phosphorus and calcium in your body.
19. If you have high blood pressure and/or diabetes, you might need to see an eye doctor to examine the back of your eye.
20. Check what vaccinations are recommended for you. It varies patient to patient but typically vaccinations against influenza, pneumococcus and hepatitis B are advisable.
21. Follow all the necessary precautions recommended by international and local health advisory boards on COVID 19, for your own protection and the protection of the community in general. They can vary from country to country, so be attentive to that.
Overall, practice respiratory etiquette and wear a face mask when in public and especially if you are ill with flu-like symptoms; but if you are ill, better see a doctor and/or stay at home. Even if you are not ill, stay at home if you don’t need to commute or be outside, and avoid large crowds, keeping physical distance at your best capacity.
Eat healthy and maintain yourself active (eg do exercise outdoors -if allowed- or at home). If you smoke, stop smoking. Control your diabetes as best as possible and any other medical conditions that you might have. Lose weight if you have excess weight. And remember stay vigilant, stay safe and stay healthy.
22. If you have chronic kidney disease and renal cysts, you might need monitoring of the appearance and size of the cysts by ultrasound, performed at different intervals. Consult your doctor to see if this is necessary for you.
23. Inform your doctor immediately after becoming pregnant as you might need to discontinue medications like anti-cholesterol and anti-proteinuric medications or any other special medication given for certain kidney problems (diseases with inflammation in the kidneys) like some immunosuppressants
Go back to consult your doctor if you have queries or worries about your health or side effects of therapies, which can be more common in patients with kidney problems, or if you do not respond as both of you expected to the strategy proposed by your doctor.
Your doctor must be told about that, so he can advise you what will be the next step. Not all medications work for all patients or to the same degree in all patients.
Finally, I need to mention there is no magical answer, medication or strategy to make the kidneys recover or to never go into failure, especially if the process is ongoing, the kidney function deteriorating progressively or the kidney dysfunction quite advanced.
Understandably many patients have great hopes on newer therapies or some unregistered approaches. We as doctors cannot destroy hope from patients, but we have the duty to be objective and frank, irrespective how doom the outlook or thin the hope is.
All these strategies above will help you to prolong the life of the kidneys to different degrees, but a more realistic expectation for many patients is to maintain the kidney function stable for as long as possible or if deteriorating, to deteriorate as slow as possible; that is, the aim is to prolong the life of the kidneys, hopefully for the rest of the lives of the patients.
Since the treatment is complex and diverse, it needs to be personalised to your condition and wishes, after carefully explained the rationale, pros and cons of all options, my practical recommendation is to visit your kidney doctor to explain all that to you, taking into account your personal priorities and preferences.
What is the treatment of chronic kidney disease?
The treatment or management of chronic kidney disease can be divided into:
a) specific treatment of the original cause of kidney disease
b) treatment of the accompanying diseases
c) general management
Specific treatment aims to control the original cause of the kidney problems and prevent further or continuous damage as a consequence of it.
Specific causes of chronic kidney disease include diabetes, high blood pressure, different types of inflammation of the kidneys like glomerulonephritis, allergies, urine flow problems, rare diseases, recurrent infections, side-effects of medications or other agents, etc. So, the specific treatment includes treating specifically these conditions.
I will not be able to mention all the specific treatments for distinct diseases or associated conditions, but the principle is simple: specific treatment is directed to the specific cause. For instance, if diabetes is the cause, aim for good sugar control and follow all general recommendations for diabetic patients.
Plus knowing there are many ways to achieve good diabetic control. If blood pressure is the cause or accompanying factor, aim for good blood pressure control and do the necessary diet and lifestyle modifications. If inflammation is the cause, the patient might need to receive powerful anti-inflammatory drugs like steroids or more targeted specialised (and expensive medications) to treat the original disease process more effectively.
And there are many options to achieve those targets, that is, many ways to achieve good diabetic control, for example, etc.
The treatment of any accompanying disease or diseases, irrespective of being the cause or not of the kidney problem, will prevent extra insults and injury to the kidneys, which are already under siege by the original disease.
That is if diabetes is the cause of the kidney problem but you have high blood pressure, blood pressure control is a crucial aspect of your management to prevent added and extra injuries to your kidneys, in other words, to aim to prolong the life of your kidneys.
On the other hand, general management consists of general and similar recommendations given to most patients suffering from the kidneys, irrespective of the original cause of the kidney problem, aiming to halt or slow down the progression of the chronic kidney disease by minimising extra insults to the kidney coming from certain risk factors, medications, diet or lifestyle, in other words to prolong the life of the kidney; and to prevent developing new conditions that will make the kidneys suffer further.
What does dialysis mean?
Dialysis is a medical procedure to remove excess waste, salt and fluids from the blood when the kidneys are not working properly by diverting blood to a dialysis machine to be cleansed.
When our kidneys are functioning properly, excess fluids and waste products are filtered and removed by our kidneys via urine to be passed out of our body.
What is the difference between haemodialysis and peritoneal dialysis?
The main difference lies on how the filtering process is done.
Haemodialysis uses a kidney machine to clean the blood, while peritoneal dialysis uses the abdomen’s lining (the peritoneum) for the filtering process.
Choosing between the two types of dialysis treatments is based on the patient’s medical condition, lifestyle, and personal preference.
Can dialysis be done at home?
Is kidney transplantation better than dialysis?
Kidney transplantation can prolong and improve the lives of patients with kidney failure.
When compared to dialysis, either peritoneal dialysis or haemodialysis, the outlook of patients choosing a kidney transplant is much better. They tend to live longer.
Kidney transplantation can also give patients a better quality of life. Most patients refer higher levels of energy, because indeed dialysis can be tiring and draining. Patients who have gone through dialysis note that change.
Most patients also comment that kidney transplantation allows them to regain their freedom to do many of the things that they used to do or they used to enjoy before developing kidney failure and needing to go for dialysis.
Thus, kidney transplantation appears to offer patients the best chances for rehabilitation in many aspects of their lives, including the medical aspect, family life, work or student life, social life and any sort of leisure, including freedom for travelling.
Although true they need to take more precautions regarding catching an infection, because they are taking medications called immunosuppressants to prevent the rejection of the transplant.
Patients undergoing a kidney transplant are subjected to less dietary and fluid restrictions than dialysis patients, which increases their quality of life significantly. Kidney transplant patients have also greater fertility and many patients become pregnant after transplantation when they tried and failed while on dialysis.
Importantly, kidney transplantation increases the chances of greater sense of personal fulfilment with a fuller and more harmonious personal, family, and work life. Many patients are able to reinstate their profession or previous work life after transplantation, which in some cases was severely affected after starting dialysis.
This does not mean that these goals cannot be achieved by dialysis patients, especially when taking good care of themselves. But it is true that the bulk of patients with a kidney transplant tend to do better than the bulk of patients on dialysis.
But true, in both modalities, there are exceptional or extreme cases: I am talking about those patients who lose the transplant on the same day of the surgery or have a major surgical complication, or dialysis patients who live for many decades with a very active and productive life.
However, kidney transplantation is not a cure for kidney failure. It is not either going back to the health status before having kidney disease. Kidney transplantation has also some disadvantages and patients do experience some symptoms as side-effects of anti-rejection medications and some complications.
Immunosuppression is well-known for increasing the chances of developing infections, metabolic problems like diabetes or high cholesterol; and even having a heightened risk of developing cancers. This does not happen in most people and in many instances the cancers can be curable. But true many cancers can grow faster in patients under immunosuppression. So going thorough routine check ups is advisable.
But again, despite these are significant side-effects to consider, the vast majority of patients undergoing a kidney transplant live longer and fuller lives than if remaining on dialysis. Because dialysis brings by itself many hassles, struggles and medical complications, especially heart-related complications and infections, which together lead to a shortened lifespan and lesser quality of life for most dialysis patients, compared to most kidney transplant patients.
But remember this is more complex than this and the discussions and advice must be individualised to your particular medical situation and preferences.
What is the best type of kidney transplant? Is it the same if I receive a kidney transplant from a living donor than from a deceased donor?
The short answer is NO. The outlook, in terms of quantity and quality of life, plus the actual length of life of the transplant itself, is better in most patients undergoing a kidney transplant from a living donor than from those receiving a transplant from a deceased donor.
However, kidney transplantation is a very complex field.
What I just mentioned is true for the average standard patient. But many patients with kidney disease defer greatly in their health and medical problems.
Anyway. Let’s go into more details.
There are different types of kidney transplants depending on the types of donors; and the outcomes greatly depend on this as I just mentioned.
Life donation occurs when people who is alive donate one of his or her kidneys to a loved one, a closed one or to someone they do not know, but do it, ideally, altruistically. Family members are commonly the living donors, or life partners.
One of the reasons of this type of transplant providing more benefits for transplant survival is the fact that the degree of organ and genetic compatibility between the patient and the donor is greater when they are from the same family. And if they are not, doctors have the opportunity to search for a better compatible donor.
This means they have fewer chances for transplant rejection, which in turn means that they might need lower doses of the immunosuppressive medications to prevent the rejection of the transplant, and in turn lower chances to use rescue anti-rejection medications if they were to suffer a rejection episode. This antirejection medications bring up more toxicity and side-effects.
Many doctors say that with modern immunosupression, achieving the best possible immune compatibility is not that important. I don’t fully agree with that.
Yes, modern immunosuppression is powerful and can be tuned up to minimise risk of rejection or transplant loss; and many episodes of rejection can indeed be treated…but there is always some risk left behind…the immune system has already been primed… But a better compatibility will come with less need for higher doses of immunosuppression and less chances of using salvage immunosuppression and their accompanied toxicity.
Remember, one of my premises of care is prevention being better than cure, and I prefer to be preemptive over being reactive.
In living donation, also the quality of the donated kidney, that is the quality of the kidney tissue itself, is higher as it comes from a Iiving person, a healthy family member (or a close person).
This means that the kidney transplant has more chances to last for longer than kidneys from deceased donors.
Also, after someone dies and donate his or her kidneys, they need to be left on ice or a solution for a good length of time while finding a compatible recipient in sort of a rush. Organs left on ice or similar preservation solutions for few hours can suffer some decay as well.
In addition, in living donation, in contrast to donation from deceased donors, the kidney transplant can be performed promptly without the need to remain for years on a waiting list for a kidney from a deceased donor.
This is very important as during those years on a waiting list, undergoing dialysis, complications can occur, and many of them can lead to patient’s loss of health and loss of fitness to undergo a major surgery like kidney transplantation in the future.
These benefits can be even greater if kidney transplantation is performed before undergoing dialysis, what is called pre-emptive transplantation, or as soon as possible after starting dialysis; which avoids the side-effects of prolonging the kidney failure status and the side effects of ‘partially effective’ dialytic therapies, as they cannot clean the blood as well as the transplanted kidney, and the body is ‘living; for long periods of time in an environment with higher levels toxins even while being dialysed.
Because dialysis only can clean the blood to the level that patients are definitively alive and as free of symptoms and complications as possible, but the blood is never cleaned to normal or close to normal levels.
Furthermore, this is true because the kidney transplant, as it is a natural, normal, fully functional kidney, provides to the patient with all the other important functions the kidneys have, not only cleaning the blood, but controlling water and salt levels, production of hormones for bone health or anaemia protection, etc; which no dialysis machine or therapy can do.
Overall, the best potential option for replacement of kidney function is a kidney transplant, and the best potential type of kidney transplant, for patients who can choose between all these options, is a pre-emptive kidney transplant, where the kidney organ comes for a living family member or partner (ideally aged matched); offering the best potential outcomes, leaving deceased donor transplantation and dialysis as second or third options, respectively.
As commented before, not every patient is, unfortunately, suitable for kidney transplantation.
Also the kidney transplant surgery is bound to heart, surgical and anaesthetic risks as any other major surgery. In addition, patients with kidney failure tend to have several co-existing illnesses and some have many medical complications.
If doctors are worried that the risk for surgery is too high, they might advise against transplantation. For instance, patients having multiple or frequent complications or the consequent disabilities, especially if elderly and frail.
Likewise, patients with active or recent cancers or active or serious infections or having other medical contraindications might not be suitable for kidney transplantation. Thus, in some patients dialysis might be safer than kidney transplantation, and the only option. Therefore, all decisions must be individualised.
If you start dialysis, do you need to do it for life? If you start dialysis, will you become dependent on dialysis?
These are very common and important questions that I have been asked many times.
The facts are that progressive and severe injury to the kidneys can cause permanent and irreparable damage to them; which can end up in total kidney failure.
If total kidney failure is confirmed by your doctor, dialysis will be needed for life. Obviously, unless you have the option of a kidney transplant.
Dialysis will be then for life, because, unfortunately, permanent and severe damage cannot be repaired and the kidney function will not recover on its own- not because you become or have become dependent on dialysis – like becoming dependent on a drug.
It is simply that your kidney problem is too advanced or severe enough that the kidneys cannot clean the blood adequately anymore to sustain your life or to keep you well, and then, as a consequence, dialysis is necessary; or otherwise you will become very ill and your life could be in imminent danger.
All what I just mentioned applies when chronic kidney failure progresses to total kidney failure.
But it is important to discuss acute kidney failure, too.
Some patients develop acute kidney failure, which can be potentially reversible and they might need to be supported with some sort of dialysis for a certain period of time, while their kidneys or their general condition improves. Then, dialysis can be stopped. So, in these cases, dialysis will not be forever.
Similarly, some other patients develop an acute deterioration of a chronic kidney problem. For instance, they might have chronic kidney disease, let’s say due to diabetes, and they suddenly become acutely ill due to an infection or a heart attack, causing their general condition to deteriorate fast and making their kidney function to drop to the point of needing dialysis, but later the general condition of the patient improves and the kidney have sufficient recovery to be off dialysis.
So, in these scenarios, dialysis will not be forever.
However, many patients present with kidney function seemingly in the levels of kidney failure, without other previous tests or clues suggesting if indeed the disorder is chronic or acute problems. What I mean is, patients just discovered out of the blue in a health screen with poor kidney function or after seeing a doctor for some unexplained symptoms.
Then we, nephrologists, need to use our clinical experience and extra tests to help us differentiate these two situations, for example the size of the kidneys on ultrasound and many more. But occasionally, only time passing by gives us the answer. If through time there is no observable recovery, it is most likely that the damage is permanent.
In fact, some patients might need to start dialysis first. Although it is not an exact rule: if by three months the kidneys do not show signs of recovery, it is more likely that the kidney dysfunction is permanent and dialysis will be needed for the rest of the patient’s life. Or that they need to be transplanted.
On occasions, some patients start showing some signs of recovery; for instance, more urine volume or the creatinine levels are too good for a patient on dialysis, then maybe the kidneys have improved through the time to the point of not needing dialysis.
Every patient and every situation is different, so it is sometimes difficult to predict the chances of recovery for specific patients.
What are the side effects of dialysis?
While dialysis can help prolong your life, both haemodialysis and peritoneal dialysis will make you feel exhausted, and they come with certain risks and side effects.
Haemodialysis Side Effects
Some of the side effects of haemodialysis include muscle cramps, itching, sepsis (blood poisoning), sleeping difficulty, high blood potassium levels, anemia, irregular heartbeat and sudden cardiac arrest.
Peritoneal Dialysis Side Effects
Peritoneal dialysis can put you at risk of developing peritonitis, an infection of the thin membrane that surrounds your abdomen. Other side effects may include fever, stomach pain, weight gain, high blood sugar due to dextrose in the dialysis fluid (dialysate), or hernia.
Why is a renal diet important for people with kidney disease?
A renal diet is a kidney-friendly diet that helps prevent kidney disease from getting worse so you can stay healthier longer.
Our kidneys are important organs that perform many important functions, such as filtering waste products, removing toxins, balancing fluids in the body, and releasing hormones that regulate blood pressure.
There are a number of ways in which these vital organs can be damaged, the 2 main risk factors being diabetes and high blood pressure. Other risk factors for kidney disease includes genetics, smoking, and obesity.
When the kidneys are not functioning optimally, toxins and excess fluid build up in the blood, which may cause various health issues (such as muscle cramps, blood in the urine, shortness of breath, swollen feet (from water retention), erectile dysfunction, and more), and can even be fatal in the long run.
That is why people with kidney disease needs to follow a proper renal diet.
What are the foods to avoid (or restrict) for kidney health
For most people with chronic kidney disease (CKD), it’s critical to adopt a kidney-friendly renal diet that helps decrease the amount of waste products in the blood.
Those with kidney disease need to restrict foods that contains the following nutrients:
Phosphorus is found in chicken, turkey, seafood, dairy, nuts, and food preservatives found in most fast foods, canned foods, and processed foods. Because damaged kidneys are not able to clear out excess phosphorus.
Sodium is a major component of salt and is found in many foods such as salted or canned meat, fish or poultry (bacon, sausage, ham, sardines, anchovies, etc). Because kidneys that are not functioning optimally cannot remove excess sodium, and this will cause your blood level to rise.
Potassium is found in bananas, oranges, raisins, potatoes, etc. Those with kidney disease need to limit potassium to avoid high blood levels.
Fortunately, there are many healthy options are low in phosphorus, sodium, and potassium that you can include in your well-balanced renal diet.
To help protect your kidneys, you also need to watch your protein intake. Because when your body uses protein , it produces waste products, which is then removed by your kidneys. This means if you eat more protein, your kidneys need to work harder, and this is a problem for those with kidney disease.
But your body still needs enough protein for enzyme and hormone production, immune function, and would healing. So the solution is to eat the right amount of protein based on your height, weight, and health conditions.
Protein can be found from both animals (meat, fish, eggs, dairy) and plants (nuts, grains, beans). Be sure to speak to your kidney doctor or dietitian to get the right combination of protein foods.