WebMD: The kidneys are a pair of bean-shaped organs on either side of your spine, below your ribs and behind your belly. Each kidney is about 4 or 5 inches long, roughly the size of a large fist. The kidneys‘ job is to filter your blood.
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They remove wastes, control the body’s fluid balance, and keep the right levels of electrolytes. All of the blood in your body passes through them several times a day.
Picture of the Human Kidney Source: WebMD
Image credit: Developing Healthy Habits, LLC .. “Kidney disease can’t be cured, but treatment can help manage symptoms and prevent progression. Get the information you need about dialysis, coping, and more,” Verywell HealthKidney Conditions
- Pyelonephritis (infection of kidney pelvis): Bacteria may infect the kidney, usually causing back pain and fever. A spread of bacteria from an untreated bladder infection is the most common cause of pyelonephritis.
- Glomerulonephritis: An overactive immune system may attack the kidney, causing inflammation and some damage. Blood and protein in the urine are common problems that occur with glomerulonephritis. It can also result in kidney failure.
- Kidney stones (nephrolithiasis): Minerals in urine form crystals (stones), which may grow large enough to block urine flow. It’s considered one of the most painful conditions. Most kidney stones pass on their own, but some are too large and need to be treated.
- Nephrotic syndrome: Damage to the kidneys causes them to spill large amounts of protein into the urine. Leg swelling (edema) may be a symptom.
- Polycystic kidney disease: A genetic condition resulting in large cysts in both kidneys that hinder their work.
- Acute renal failure (kidney failure): A sudden worsening in how well your kidneys work. Dehydration, a blockage in the urinary tract, or kidney damage can cause acute renal failure, which may be reversible.
- Chronic renal failure: A permanent partial loss of how well your kidneys work. Diabetes and high blood pressure are the most common causes.
- End-stage renal disease (ESRD): Complete loss of kidney strength, usually due to progressive chronic kidney disease. People with ESRD require regular dialysis for survival.
- Papillary necrosis: Severe damage to the kidneys can cause chunks of kidney tissue to break off internally and clog the kidneys. If untreated, the resulting damage can lead to total kidney failure.
- Diabetic nephropathy: High blood sugar from diabetes progressively damages the kidneys, eventually causing chronic kidney disease. Protein in the urine (nephrotic syndrome) may also result.
- Hypertensive nephropathy: Kidney damage caused by high blood pressure. Chronic renal failure may eventually result.
- Kidney cancer: Renal cell carcinoma is the most common cancer affecting the kidney. Smoking is the most common cause of kidney cancer.
- Interstitial nephritis: Inflammationof the connective tissue inside the kidney, often causing acute renal failure. Allergic reactions and drug side effects are the usual causes.
- Minimal change disease: A form of nephrotic syndrome in which kidney cells look almost normal under the microscope. The disease can cause significant leg swelling (edema). Steroids are used to treat minimal change disease.
- Nephrogenic diabetes insipidus: The kidneys lose the ability to concentrate the urine, usually due to a drug reaction. Although it’s rarely dangerous, diabetes insipidus causes constant thirst and frequent urination.
- Renal cyst: A hollowed-out space in the kidney. Isolated kidney cysts often happen as people age, and they almost never cause a problem. Complex cysts and masses can be cancerous.
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Kidney Tests
- Urinalysis: A routine test of the urine by a machine and often by a person looking through a microscope. Urinalysis can help detect infections, inflammation, microscopic bleeding, and kidney damage.
- Kidney ultrasound: A probe placed on the skin reflects sound waves off the kidneys, creating images on a screen. Ultrasound can reveal blockages in urine flow, stones, cysts, or suspicious masses in the kidneys.
- Computed tomography (CT) scan: A CT scanner takes a series of X-rays, and a computer creates detailed images of the kidneys.
- Magnetic resonance imaging (MRI) scan: A scanner uses radio waves in a magnetic field to make high-resolution images of the kidneys.
- Urine and blood cultures: If an infection is suspected, cultures of the blood and urine may identify the bacteria responsible. This can help target antibiotic therapy.
- Ureteroscopy: An endoscope (flexible tube with a camera on its end) is passed through the urethra into the bladder and ureters. Ureteroscopy generally cannot reach the kidneys themselves, but can help treat conditions that also affect the ureters.
- Kidney biopsy: Using a needle inserted into the back, a small piece of kidney tissue is removed. Examining the kidney tissue under a microscope may help diagnose a kidney problem.
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Kidney Treatments
- Antibiotics: Kidney infections caused by bacteria are treated with antibiotics. Often, cultures of the blood or urine can help guide the choice of antibiotic therapy.
- Nephrostomy: A tube (catheter) is placed through the skin into the kidney. Urine then drains directly from the kidney, bypassing any blockages in urine flow.
- Lithotripsy: Some kidney stones may be shattered into small pieces that can pass in the urine. Most often, lithotripsy is done by a machine that projects ultrasound shock waves through the body.
- Nephrectomy: Surgery to remove a kidney. Nephrectomy is performed for kidney cancer or severe kidney damage.
- Dialysis: Artificial filtering of the blood to replace the work that damaged kidneys can’t do. Hemodialysis is the most common method of dialysis in the U.S.
- Hemodialysis: A person with complete kidney failure is connected to a dialysis machine, which filters the blood and returns it to the body. Hemodialysis is typically done 3 days per week in people with ESRD.
- Peritoneal dialysis: Placing large amounts of a special fluid in the abdomen through a catheter allows the body to filter the blood using the natural membrane lining the abdomen. After a while, the fluid with the waste is drained and discarded.
- Kidney transplant: Transplanting a kidney into a person with ESRD can restore kidney function. A kidney may be transplanted from a living donor, or from a recently deceased organ donor.
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Image credit: Amazon.comMedical science tells us that harmful wastes can build up in our body. Our blood pressure may rise. Our body may retain excess fluid and not make enough red blood cells. Doctors call this kidney failure.
“If your kidneys fail, you need treatment to replace the work they normally do,” says the National Institute of Health in the United States. “Before dialysis was available, total kidney failure meant death,” notes the US National Kidney Foundation (NKF). “Today, people with kidney failure can live because of treatments, such as dialysis and kidney transplant.”
According to medical experts, dialysis is a way of cleaning our blood when our kidneys can no longer do the job. It gets rid of our body’s wastes, extra salt and water, and helps to control our blood pressure.
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Actually, there are two kinds of dialysis: hemodialysis and peritoneal dialysis. “In hemodialysis, blood is pumped out of your body to an artificial kidney machine, and returned to your body by tubes that connect you to the machine,” NKF explains. “In peritoneal dialysis, the inside lining of your own belly acts as a natural filter. Wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of your belly in cycles.”
Among these patients with kidney failure in the Philippines, “only around 86 percent could undergo dialysis and only 14 percent could undergo transplantation because of the high cost of treatment,” wrote Francis James B. Gatdula in an article that appeared in Health and Lifestyle.
Dialysis does help lengthen the life of the patient, but it is expensive. It costs around P60,000 to P70,000 a month—that’s P720,000 to P840,000 a year. This does not yet include the fees for required laboratory tests and medicines.
“In the long term, kidney transplantation is cheaper than dialysis,” said Dr. Enrique Ona, former NKTI director. “Moreover, survival rates and quality of life in transplants are much better.”
A transplant costs half a million pesos to P1-million for a one-time surgery, as long as the donated organ is not rejected by the recipient’s system.
“Kidney diseases are on the rise, and it can be considered part and parcel of the dreaded epidemic of noncommunicable diseases,” points out Dr. Castillo. “In fact, there can be hardly any argument that most chronic kidney disorders are also lifestyle-related problems, and share the same risk factors as cardiovascular and cerebrovascular diseases.”
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An ounce of prevention, so goes a saying, is better than a pound of cure. The same is true with your kidneys. In their book, Stay Younger, Live Healthier, Dr. Willie Ong and his wife, Dr. Liza Ong, shared ten ways to protect your kidneys (based from their interview with Dr. Elizabeth Montemayor, a nephrologist at the Philippine General Hospital):
1 Limit your salt intake.
Too much salt is not only bad for your blood pressure; it’s also bad for your kidneys. Many die of kidney disease, which can be partly attributed to a high salt intake and fondness for fish sauce, soy sauce, salt and salted fish. Even instant noodles, chips and nuts are teeming with salt.
2 Don’t load up on high-protein foods, such as meat and steaks. A high-protein diet makes the kidneys work twice as hard. Pretty soon, your kidneys could get tired, and some of the weaker kidney cells can die. Eat a balanced diet of rice, vegetables, fish and fruits, and you can’t go wrong.
3 Keep your blood pressure at 130/80 or lower. If your blood pressure is above 140 over 90, this can cause kidney damage within five years. The kidneys are said to be “happiest” with a blood pressure of 130/80 or lower. To help control your blood pressure, you should limit your salt intake, reduce weight and take medicines for high-blood pressure, if needed.
4 Keep your blood sugar below 120 mg/dl. Diabetes and high-blood pressure are the two leading causes of kidney failure. A person with uncontrolled diabetes for 5 to 10 years may develop significant kidney damage. Consult your doctor and keep your blood sugar under control with diet, exercise and maintenance medicines.
5 Drink 8 glasses of water a day. Doctors usually advise people to take in eight glasses of water a day, but this really depends on your age and condition. If you’re sweating a lot and work outdoors, you may need to drink more than 8 glasses a day. However, if you are above 65 years of age, you may do well with just 6 glasses a day. Drinking enough water also prevents the formation of kidney stones.
6 Watch your intake of pain relievers and other drugs. Taking pain relievers for a prolonged period of time may cause kidney damage. Because of this, we should limit taking these medicines to only a week, or just take them as needed. For those with chronic arthritis, try to look for other ways to relieve the pain, such as using a hot water bag, pain-reliever ointments or the safer paracetamol tablet.
7 Be careful with tests and procedures using contrast dyes. Some tests, like CT Scans and MRIs, and angiograms, use a contrast dye, which helps doctors delineate the organs better. The problem with such dyes is that they can cause kidney damage. To be safe, consult a kidney specialist before undergoing such procedures.
8 Don’t drink too much vitamin C. Excess vitamin C (ascorbic acid) can lead to the formation of kidney stones in predisposed individuals. If you need to take vitamin C, a dose of 500 mg or less is safer.
9 Don’t rely on food supplements to protect your kidneys. The aforementioned tips are, so far, the best tips to care for the kidneys.
10 Get a kidney check-up. Simple tests, such as a complete blood count and a urinalysis, are the first screening tests for the kidneys. Finding a trace of protein in the urine can alert the doctor of possible kidney disease.
“The health advice in this forum is only for general knowledge,” Dr. Ong reminds. “For your specific questions, kindly consult your personal physician.”
Verywell Health: Overview of Dialysis for Kidney Failure
When your kidneys begin to fail, you will typically go through progressive stages of loss of kidney function. These stages are classified from stage 1 through 5 of chronic kidney disease (CKD). Stage 5 is the worst when many people would require either dialysis or a kidney transplant. Not everyone who starts off with mild kidney disease (stage 1-3), will progress to stage 5.
Kidney disease comes with a long laundry list of complications. In the early stages of CKD, these complications are typically treatable with medical management. That is, pills should suffice to treat complications like high blood pressure, abnormal electrolytes, swelling or edema (that are expected to occur in CKD). However, eventually, if you do happen to progress to advanced kidney disease, or CKD stage 5, these complications begin harder and harder to treat with medical management alone. At this time, should you not get a kidney transplant (or if you are not eligible for it), you will often need dialysis. So let’s talk about a few basic questions that most patients will have about dialysis.
Dialysis is an artificial way of replacing some of the kidneys’ functions. The kidney performs a lot of essential functions in the body, beyond just “making urine.” I have covered these functions in detail elsewhere, but here is a brief summary:
- The kidneys regulate and maintain the level of all electrolytes like sodium, potassium, etc within a range that is essential for normal life
- They regulate the amount of water in your blood, and hence the concentration of your blood.
- They produce a hormone that is essential to make red blood cells, called “erythropoietin”
- They make sure that your bones stay healthy by producing a form of vitamin D
- They dump excess acid, that is generated from normal metabolism, out from your system
- Very importantly, they control your blood pressure
Dialysis attempts to replace some, but not all of these functions.
HOW IS DIALYSIS PERFORMED? WHAT ARE THE KINDS OF DIALYSIS?
How dialysis gets performed depends on the kind of dialysis. One technique (which is the commonest one employed in the US) is called hemodialysis. Hemo is the Greek word for blood. Hence “blood dialysis” is when the patient’s blood is taken from a “dialysis access” and circulated through a machine which has a filter that mimics the kidney’s filtration function. Once the blood goes through this filter (called the dialyzer), the purified blood is returned to the patient. Hemodialysis is typically performed in a “dialysis center” (in-center hemodialysis), where it is usually done about three times every week, for three to four hours (this depends on the patient’s size). However, it is also possible to perform hemodialysis at home. This is called home hemodialysis. This technique might be performed as often as five to seven times per week, but each session tends to be shorter at two to four hours each.
Another kind of dialysis that is also performed at home is called peritoneal dialysis. Peritoneum refers to the abdominal cavity. In this modality, a permanent catheter is inserted into the patient’s peritoneum through the abdominal wall. Clean dialysis fluid is then instilled into the peritoneum, and this fluid sits there for a few hours where it cleans the blood of toxins. Then, this dirty fluid is drained out, and more clean fluid is instilled. This cycle is repeated a few times (typically at night using a machine called the “cycler”), and in the morning, the patient unhooks himself from the cycler and caps the catheter.
A dialysis access or shunt is the site where two needles are inserted when someone is receiving hemodialysis (patients on peritoneal dialysis will not have such a shunt, but rather a catheter that sits permanently on their belly). One of the needles in the shunt will channel blood from the body to the dialysis machine, and the other one will carry back the clean blood from the machine to the patient.
The shunt itself is a really a connection between an artery and a vein. It is placed by a surgeon, who might use your own vein to create this connection (this is called a fistula) or might use an artificial tube to make this connection (this is called a graft).
Yes! Both peritoneal dialysis and home hemodialysis can be performed by the patients themselves at home. Your nephrologist and a dialysis nurse will train you for a few weeks on how to do this. Once you are comfortable doing it, they will let you do it in the comfort of your home.
You will still need to be seen about once a month by your nephrologist, and you will have both the nephrologist and a dialysis nurse available on call for troubleshooting. Dialysis nurses will often schedule a visit to your home in case it is something that cannot be taken care of on the phone.
WHICH TYPE OF DIALYSIS IS THE “BEST”?
From a medical standpoint, no study has proven any modality to be necessarily better than the other. It is more of a lifestyle choice. Home dialysis is often preferred by patients who have the ability to take care of themselves, are proactive, do not want to be “tied down” to a dialysis center, or want to travel frequently. The independence that comes with home dialysis is empowering and means a lot to many patients. It also improves the quality of life since you are not making thrice-weekly trips to a dialysis center. However, “with great power comes great responsibility” since you do need to take ownership of your health to a large extent!
Manila Bulletin: KIDNEY PATIENTS, KIN HOPE CONGRESS WILL PASS ‘FREE DIALYSIS’ LAW
By Philippine News Agency
Dialysis patients and their families have high hopes the “free dialysis bill” pending in Congress will soon become a law and save thousands of lives in the country.
“We are hoping that the bill will be passed before the end of the 17th Congress,” Baguio City Rep. Mark Go said in a press conference here on Thursday.
Updating advocates in the city–dialysis patients, their families, supporters, and the city government– Go said the House Committee on Health, where he is a member, had approved the proposed substitute bill.
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It was also referred to the Committee on Appropriations afterward, he said.
When the committee submits a report, it will be up for deliberation in the plenary for second reading.
After passage on second reading, it will be calendared for third and final reading and the copy of the approved bill transmitted to the Senate.
The same process is undertaken and if the bill is passed by the Senate, the enrolled bill is transmitted to the Office of the President for his signature, effectively making it a law.
House Bill (HB) 5503, which Go has authored, was matched by nine other bills in Congress. A technical working group was later formed that drafted a substitute bill, consolidating the contents of the proposed bills.
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“The bill, when approved, will cover the procedure for a kidney transplant, a peritoneal dialysis, and a hemodialysis,” he said, citing records from the Department of Health (DOH) has so far recorded over 50,000 kidney patients nationwide from the 25,000 in 2016.
The consolidated bill entitled “A comprehensive renal replacement therapy (RRT) for patients with end-stage renal disease in a national, regional, and provincial government hospitals and increasing the Philhealth package rate for renal replacement and increasing members and appropriating funds thereof” is hoped to be passed the soonest, especially considering the urgency of the law that relates to the existence of the life and survival of the thousands of patients.
The bill’s approval will delete the 90 dialysis sessions ceiling of the Philhealth coverage and will be replaced with completely free sessions. Some patients undergo two sessions a week or a total of 96 sessions a year. Those who require three sessions weekly will need 144 sessions annually, while to a number of patients, four sessions a week is needed, making the requirement 182 sessions a year.
Such scenario makes it difficult for a patient or his family to produce a minimum of PHP202,400 to live for the whole year, specifically for those requiring four sessions a week.
It would be a waste if after eight months of continuous treatment, they would stop because they no longer have a Philhealth coverage. Skipping the procedures could lead to a patient’s death.
Some even resort to multiple addresses only to beg congressmen and officials from other provinces for financial aid and allow them or their families to finance the sessions not covered by Philhealth.
“I have one advise, please do not give up… There is no reason for dying but there is reason for hoping,” Go told the patients and their families.
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Senate of the Philippines: Senator Sonny Angara is pushing for the approval of his proposed measure that would give free dialysis treatment to kidney disease-stricken Filipinos living in the provinces.
Under his Senate Bill No. 1329 or the proposed “Dialysis Center Act,” all national, regional and provincial government hospitals are required to establish, operate and maintain a dialysis ward or unit that will give free treatment to indigent kidney patients.
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Angara filed the measure, noting that poor patients suffering from kidney ailment who are living in the provinces could not afford the expenses of traveling all the way to urban cities to seek dialysis treatment, and the high cost of the procedure itself, which is needed on a regular and sustained basis.
“The optimum frequency of dialysis is three times a week but because of its high cost and inaccessibility, some patients settle with less but with their health deteriorating more progressively,” Angara pointed out.
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“Worse, some patients have died without given a chance to undergo dialysis because they could not afford it,” he added.
The cost for each dialysis treatment, including the use of machines and medicines, is between P2,000 to P2,500 in government hospitals, and around P4,000 in private facilities.
June is celebrated every year as the National Kidney Month by virtue of Presidential Proclamation No. 184 signed on May 31, 1993 by then President Fidel Ramos. The declaration aims to instill consciousness and increase public awareness of the fatal consequences of renal diseases.
“The House Committee on Health has approved the proposed free dialysis for poor Filipinos.
The proposed law mandates each government hospital to set up a dialysis facility.
The bill also seeks to expand the coverage of the Philhealth benefit package to include kidney transplant.
Under the proposal, the Department of Social Welfare and Development (DSWD) will be in charge of identifying the beneficiaries of the free medical service.
The bill is scheduled for plenary debate and voting before passing it into third and final reading at the House of Representatives. ” — UNTV News & Rescue
Verywell Health: REFUSING DIALYSIS? HERE IS WHAT YOU COULD EXPECT
Patients with advanced kidney disease that approaches stage 5 have two choices when it comes to managing their disease, either getting started on some kind of dialysis (in center hemodialysis being most common in the US, or home dialysis which could be either hemodialysis or peritoneal dialysis), or getting a kidney transplant. But what if a patient cannot have, or does not want any of these options for any reason. What happens when a patient with kidney failure does not receive dialysis or a transplant? How long can they expect to live? This article will attempt to answer a few of these questions
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Image credit: newhopeforkidneypatients.com Not every patient would necessarily make a good candidate for MCM, and other options might be more appropriate. Conservative management is a good fit in various settings. These could include advanced age and frailty, severe dementia, presence of other severe disease conditions like heart failure or metastatic cancer, etc. In such cases, it is hard to always predict if dialysis would add anything to the quality/quantity of life. And often, patients are simply looking at the “big picture”, especially if life expectancy is limited.
However, MCM is not for everyone. Patients should be educated that there are only so many complications of kidney failure that are treatable with pills, and some symptoms/signs will only respond to dialysis. This is because the so-called uremic toxins that accumulate in kidney failure and are the reason for most complications will not be removed with conservative management (although even dialysis does not necessarily remove all of them either). The patient and the physician might need to sit together to go over the expectations and chart a plan for care. And when the talk is about expectations, two questions will often pop up from patients who are refusing dialysis:
- How would I feel if I refuse dialysis?
- Would my life span be shortened if I refuse dialysis?
Given the small amount of data, these are not easy questions to answer. But we do have more data available about life expectancy in patients who do opt for dialysis. As per the United States Renal Data System report, expected survival for patients on dialysis could vary from 8 years (for patients aged 40 to 44) to 4.5 years (patients between 60 to 64 years of age). This is however the average, with wide fluctuations seen depending on the patient’s age, nutritional status, and presence of other co-existing disease conditions like ischemic heart disease, cancer, etc. I would also like to direct your attention to a graph that compares the expectancy of a normal 55-year old male to a similar patient on dialysis, or one who has received a kidney transplant.
Let’s look at some studies that have tried to compare survival between these two categories. A study on patients with stage 5 kidney disease who were at least 80 years of age reported a median life span that was 20 months longer (29 months vs 9 months) in patients choosing dialysis. Another study that compared survival between patients who opted for dialysis with those who chose conservative management also reported better survival in patients who chose dialysis. All the patients were at least 75 years old. The 1-year survival rates were 84% in the group choosing dialysis and 68% in the group choosing non-dialytic management. One might deduce from this data that kidney failure patients who opt for dialysis will generally tend to live longer.
However, the above would be a simplistic assumption. Patients with advanced kidney disease will often have multiple other serious disease conditions like heart failure, diabetes, cancer, etc; what we physicians call “co-morbidities”. And so, if we take another look at the data we have discussed above, we realize that life expectancy in patients who had other severe co-existing disease conditions like ischemic heart disease actually did not differ; whether they chose dialysis or not! In other words, in a patient who has severe co-morbidities, survival might be determined more by these conditions than by whether the patient is dialyzed or not. The take home message is that dialysis will increase your lifespan as long as you don’t have multiple other serious illnesses mentioned above.
For patients who decide to not chose dialysis after a discussion with their nephrologists, an obvious question that arises is, “how would I feel”? Most patients are in fact more worried about this than about the possible reduction in life expectancy.
In 1949, Dr David Karnofsky described a scale (100 being a normal healthy person, and 0 implying death) that could be used to objectively measure the functional status of cancer patients. The scale has now been applied to measure the rate of functional decline of kidney failure patients who are managed conservatively without dialysis. What is interesting to note is that such patients would probably require only occasional assistance till about the last month of their life, after which they will see a steep decline in their functional status, thus progressively requiring special care/hospital admission. The scale and the article do give us some more insight on what to expect when kidney failure patients look into the future and decide to opt for a life without dialysis. What I would like to emphasize here is that these conclusions are based on the assumption that the patients are well taken care of conservatively, in a non-aggressive way.
This is what we now refer to as Maximal Conservative Management (MCM) and here are its details.
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The kidney failure patients who are on dialysis will have itching skin, poor appetite, weakness and other discomforts. And the dialysis will diminish the renal function rather than protecting the kidney from further damage. While, what is the alternative treatment to kidney failure with dialysis?
Toxin-Removing Therapy can help the patients eliminate the toxins and alleviate the symptoms with less side effects. It can protect the kidney from injuring and create a cleaned and healthy surrounding for the other treatments to take a better effect on repairing the kidney.
Full Bath Therapy can not only carry out the poisons, but also take a part in restore the renal function. During the period of the treatment, the patients should bath their whole body with the bath foam which is full of the essences abstracted from Chinese medicines. It is a safer and handier treatment for the kidney failure patients.
the kidney self-healing ability and so on. So that, the renal function will be increased with safety and effectivity. It is a better option to help the kidney disease patients with dialysis.
When the kidney is renovated, the undesired things will be cleaned up, the symptoms will disappear, and the patient can have a better life. In this case, the patients have no need to take dialysis.If you want to gain more information about the alternative treatment for kidney failure patients with dialysis, please leave a message below or send your contact information to us. We will try our best to help you.
What are your thoughts?