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July 9, 2018
Kidney transplant patient care is very complex and requires special expertise. We work with University of Cincinnati and University of Louisville KY Transplant Programs. University kidney transplant specialists are certified by the United Network of Organ Sharing, which oversees the nation’s organ transplantation programs. These transplant specialists have experience in managing immunosuppressive medications and complications of transplant. This innovative program uses steroid-free immunosuppressive regimens when possible after transplantation to avoid side effects of long-term steroid use. Both university programs participate in paired kidney donations, matching “incompatible” donor/ patient pairs with another pair from anywhere else in the country.
When kidneys stop functioning, fluid and waste products build up in the blood and body. This advanced kidney failure is termed end-stage renal disease (ESRD), and eventually leads to life-threatening levels of toxins and fluid in the body. There are several important treatment options for patients with ESRD that include dialysis and kidney transplantation. Dialysis may be performed through the blood, either at home or at a dialysis facility, termed hemodialysis; or through the abdominal cavity, termed peritoneal dialysis. Many patients receive a kidney transplant as a treatment for ESRD. We discuss the risk and benefits of each treatment option in detail with patients and families, utilizing shared decision-making to decide on the treatment of choice for each patient. Our dialysis unit medical director has over 10 years of expertise in dialysis unit management. Additionally, our home dialysis program has dedicated personnel who belong to the International Society for Peritoneal Dialysis.
Dialysis is necessary for kidney failure patients; the procedure helps the kidneys remove wastes from the body when they can no longer do the job effectively themselves. We offer the most advanced dialysis services at our Florence and Edgewood locations.
We offer the most advanced dialyzers available to maximize blood purification. We use online bicarbonate preparation and extra water purification steps to prepare very high quality dialysate.
Hemodialysis at a dialysis facility usually involves treatment three times each week to remove waste products from the blood. Our dialysis centers are staffed by kidney specialists, dialysis nurse practitioners, nutritionists, social workers, nurses, and dialysis technicians who are trained to provide compassionate and effective care of the patient with ESRD. Dialysis facilities are equipped with reclining, heated chairs with options of massage and televisions for patient comfort and ease in an environment that provides opportunities for interacting with other patients receiving dialysis, as well as rest.
Thanks to home dialysis, many patients with kidney diseases in Northern KY who previously had to come to the medical center for treatment can now receive dialysis in the comfort of their own homes or even while they are traveling, offering a greater level of freedom to kidney failure patients. At our dialysis centers, we offer training in both peritoneal dialysis as well as home hemodialysis. We offer patients continual support through dedicated nurses and physicians as they go through the process of training in-home dialysis.
We provide both peritoneal dialysis and home hemodialysis.
Most patients including diabetics with well-controlled blood sugars are eligible for peritoneal dialysis.
We now offers portable home hemodialysis with the NxStage system as well as Fresenius new K machine, a new technology that gives dialysis patients freedom to travel without sacrificing their own health, and to perform their dialysis in the comfort of their own homes.
Mostly done in collaboration with vascular surgeons, Interventional Radiologists at Local Hospitals.
The procedures include:
Patients have a choice where they receive their vascular access care. A functioning vascular access is essential for patients to receive adequate dialysis. We strive to treat the whole patient by providing not only excellent hemodialysis access care, but also complementary services for our unique patient population.
Fluid overload, is the medical condition where there is too much fluid in the blood. The opposite condition is hypovolemia, which is too little fluid volume in the blood. Fluid volume excess in the intravascular compartment occurs due to an increase in total body sodium content and a consequent increase in extracellular body water. The mechanism usually stems from compromised regulatory mechanisms for sodium handling as seen in congestive heart failure (CHF), kidney failure, and liver failure. It may also be caused by excessive intake of sodium from foods, intravenous (IV) solutions and blood transfusions, medications, or diagnostic contrast dyes. Treatment typically includes administration of diuretics and restriction of the intake of water, fluids, sodium, and salt.
Healthy kidneys do not allow a significant amount of protein to pass through their filters. But filters damaged by kidney disease may let proteins such as albumin leak from the blood into the urine. If a person is passing proteins and/or blood in the urine, its generally a sign of Kidney Disease. Treatment depends on the underlying cause.
The most common cause by far is Diabetes. Both Diabetes and Hypertension can also cause protein to leak into the urine. Examples of other causes include:
Other Risk Factors include:
Proper screening for immune disorders, urine and blood tests, Renal Ultra Sound is generally needed to reach a diagnosis. In some cases, Kidney Biopsy will need to be done. All this is done in consultation with Nephrology in the Nephrology Clinic.
This depends on the underlying cause.
In mild or temporary cases, no treatment is necessary. Drugs are sometimes prescribed, especially in people with diabetes and/or high blood pressure. These may come from two classes of drugs: ACE inhibitors (angiotensin-converting enzyme inhibitors). ARBs (angiotensin receptor blockers).
Specific Treatment, diet recommendations are made once the underlying process is recognized.
Glomerulonephritis is a group of diseases that injure the part of the kidney that filters blood (called glomeruli). Other terms you may hear used are nephritis and nephrotic syndrome. When the kidney is injured, it cannot get rid of wastes and extra fluid in the body. If the illness continues, the kidneys may stop working completely, resulting in kidney failure.
Yes. There are two types of glomerulonephritis—acute and chronic. The acute form develops suddenly. You may get it after an infection in your throat or on your skin. Sometimes, you may get better on your own. Other times, your kidneys may stop working unless the right treatment is started quickly. The early symptoms of the acute disease are:
You may be short of breath and cough because of extra fluid in your lungs. You may also have high blood pressure. If you have one or all of these symptoms, be sure to see your doctor right away.
The chronic form may develop silently (without symptoms) over several years. It often leads to complete kidney failure. Early signs and symptoms of the chronic form may include:
Symptoms of kidney failure include:
The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture’s syndrome, Wegener’s disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure.
Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.
The first clues are the signs and symptoms. Finding protein and blood cells in your urine is another sign. Blood tests will help the doctor tell what type of illness you have and how much it has hurt your kidneys.
In some cases, a test called a kidney biopsy may be needed. In this test, a tiny piece of your kidney is removed with a special needle, and looked at under a microscope. A biopsy will help the doctor plan the best treatment for you.
Not until more is known about its causes. However, good hygiene, practicing “safe sex” and avoiding IV drugs are helpful in preventing viral infections such as HIV and hepatitis, which could lead to this illness.
If you have the chronic type of glomerulonephritis, it is very important to control your blood pressure since this may slow down kidney damage. Your doctor may tell you to eat less protein. A dietitian trained to work with kidney patients (a renal dietitian) can be very helpful in planning your diet.
The acute form may go away by itself. Sometimes you may need medication or even temporary treatment with an artificial kidney machine to remove extra fluid and control high blood pressure and kidney failure. Antibiotics are not used for acute glomerulonephritis, but they are important in treat other forms of disease related to bacterial infection. If you illness is getting worse rapidly, you may be put on high doses of medicine that affect your immune system. Sometimes, your doctor may order plasmapheresis, a special blood filtering process to remove harmful proteins from your blood.
There is no specific treatment for the chronic form of the illness. You doctor may tell you to:
Nephrotic syndrome (also called nephrosis) happens when your kidneys start losing large amounts of protein in your urine. As your kidneys get worse, extra fluids and salt build up in your body. This causes you to have swelling (edema), high blood pressure and higher levels of cholesterol. Nephrotic syndrome may come from kidney diseases or from other illnesses such as diabetes and lupus. Some medicines, IV drug abuse and HIV (the AIDS virus) may also cause it. Sometimes, nephrotic syndrome goes away after treatment. Other times, this condition may last for many years and eventually lead to kidney failure.
Your doctor may prescribe corticosteroids, such as prednisone. If prednisone does not work, your doctor may suggest other medicines that affect your immune system, such as cyclophosphamide.
Your doctor may also suggest:
Polycystic kidney disease (PKD) is an inherited disorder in which clusters of cysts develop primarily within your kidneys. Cysts are noncancerous round sacs containing water-like fluid. The cysts vary in size and, as they accumulate more fluid, they can grow very large.
Although kidneys usually are the most severely affected organs, polycystic kidney disease can cause cysts to develop in your liver and elsewhere in your body. The disease causes a variety of serious complications.
A common complications of polycystic kidney disease are high blood pressure and Kidney failure.
Polycystic kidney disease varies greatly in its severity, and some complications are preventable. Lifestyle changes, Low Protein Diets and medical treatments may help reduce damage to your kidneys from complications, such as high blood pressure
Most people do not develop symptoms until they are 30 to 40 years old. The first noticeable signs and symptoms may include:
Ultrasound is the most reliable, inexpensive and non-invasive way to diagnose PKD. If someone at risk for PKD is older than 40 years and has a normal ultrasound of the kidneys, he or she probably does not have PKD. Occasionally, a CT scan (computed tomography scan) and MRI (magnetic resonance imaging) may detect smaller cysts that cannot be found by an ultrasound. MRI is used to measure and monitor volume and growth of kidneys and cysts.
In some situations, genetic testing might also be done. This involves a blood test that checks for abnormal genes that cause the disease. Genetic testing is not recommended for everyone. The test is costly, and it also fails to detect PKD in about 15% of people who have it.
No. About 50 percent of people with PKD will have kidney failure by age 60, and about 60 percent will have kidney failure by age 70. People with kidney failure will need dialysis or a kidney transplant.
At present, there is no cure for PKD. However, a lot of research is being done. Recent studies suggest that drinking plain water throughout the day and avoiding caffeine in beverages can slow the growth of cysts. Research is also helping us understand the genetic basis of PKD.
Studies also suggest that some treatments may slow the rate of kidney disease in PKD, but further research is needed before these treatments can be used in patients. In the meantime, many supportive treatments can be done to control symptoms, help slow the growth of cysts, and help prevent or slow down the loss of kidney function in people with PKD. These include:
PKD runs in families. It is an inherited disorder that is passed from parents to children through genes. A genetic disease can happen if one or both parents pass abnormal genes to a child. This happens through something called dominant inheritanceor recessive inheritance.
If one parent has the disease and passes an abnormal gene to the child, it is called dominant inheritance. Each child has a 50% chance of getting the disease. The risk is the same for every child, regardless of how many children develop the disease.
If both parents carry the abnormal gene, and both parents pass an abnormal gene to the child, it is called recessive inheritance. In this situation, every child has a 25% chance of getting the disease.
Yes. The three main types of PKD are:
This form of the disease is passed from parent to child by dominant inheritance. In other words, only one copy of the abnormal gene is needed to cause the disease. Symptoms usually begin between the ages of 30 and 40, but they can begin earlier, even in childhood. ADPKD is the most common form of PKD. In fact, about 90 percent of all PKD cases are ADPKD.
This form of the disease is passed from parent to child by recessive inheritance. Symptoms can begin in the earliest months of life, even in the womb. It tends to be very serious, progresses rapidly, and is often fatal in the first few months of life. This form of ARPKD is extremely rare. It occurs in 1 out of 25,000 people.
ACKD can happen in kidneys with long-term damage and severe scarring, so it is often associated with kidney failure and dialysis. About 90 percent of people on dialysis for 5 years develop ACKD. People with ACKD usually seek help because they notice blood in their urine. This is because the cysts bleed into the urinary system, which discolors urine.
Individuals with PKD who are concerned about passing the disease to their children may want to consult a genetics counselor to help them with family planning. Many university medical centers have this service.
Most of the women with PKD (80 percent) have successful and uneventful pregnancies. However, some women with PKD have an increased risk for serious complications for themselves and their babies. This includes women with PKD who also have:
Women who have PKD with high blood pressure develop pre-eclampsia (or toxemia) in 40 percent of pregnancies. This is a life-threatening disorder for both the mother and baby, and it can develop suddenly and without warning. Therefore, all women with PKD, particularly those who also have high blood pressure, should be followed closely during their pregnancy by their doctor.
More than 20 million Americans have kidney disease and another estimated 20 million are at risk and don’t know it. By the year 2010, the number of people with End Stage Kidney Disease was more than double to 650,000. End-stage kidney disease itself affects more than 2 out of every 1000 people in the United States. By definition chronic kidney disease is a slow loss of kidney function over a period of time. Kidneys are not able to remove the waste products and excess water from the body
Risk factors for developing CKD: Following conditions are commonly associated with a developing chronic kidney disease:
Chronic kidney disease is divided into 5 stages. In the early stages there may be no symptoms. It can take many months or years before the loss of function progresses. It may be so slow that symptoms do not appear until the kidney function is less than 1/10 of the normal. The final stage, runny kidney disease stage V, is called end-stage renal disease or ESRD. At this stage the kidneys are not longer able to remove the waste products and excess water from the body and as such the patient needs dialysis or kidney transplant.
The most common symptoms associated with chronic kidney disease may include:
Loss of appetite, general fatigue and a feeling of ill being, headaches, itching, nausea and weight loss.
The other symptoms may develop later especially when the kidney function has gotten worse:
This includes: Skin discoloration, generalized aches, drowsiness, confusion, problems with concentration or thinking, muscle twitching, breath odor, easy bruising, excessive thirst, excessive, lower level of sexual interest, shortness of breath, insomnia as well as restless leg syndrome
Exam and tests commonly done include:
Every patient needs to have labs checked every 2-3 months when the kidney disease is getting worse. This includes albumin, calcium, cholesterol, CBC, electrolytes, magnesium, phosphorus, potassium, sodium
Preventing chronic kidney disease as well as treatment of chronic kidney disease is a teamwork several things have to be looked into and taken into consideration:
Controlling the blood pressure will slow the progression of kidney damage. Ace inhibitors or angiotensin receptor blockers are commonly used for this. Goal blood pressure is at or below 1:30/80 mmHg.
Other tips to prevent progression of chronic kidney disease:
The dietitian plays an important role in helping control the diet. Our team involves physicians, nurse practitioners, dietitian, social worker and nurse assistants to formulate a comprehensive plan to treat and prevent further progression of chronic kidney disease. When the loss of kidney function becomes more severe, he will need to be prepared for a kidney transplant or dialysis. Our TOPS program is geared towards proper education on different modalities of dialysis, dietary information, transplant education etc. and involves one-on-one training using videos and notes.
There is no cure for chronic kidney disease, however, early intervention, changes in diet can prevent further progression of chronic kidney disease and eventually prevent worsening to end-stage renal disease
Hypertension is a medical term for high blood pressure. Blood pressure refers to the pressure exerted by circulating blood on the inner walls of the arteries that carry blood from the heart. It is measured based upon two values for arterial pressure: the systolic pressure as the heart contracts and the diastolic pressure as it relaxes between beats.
Blood pressure varies naturally over a person’s lifetime (normally increasing with age) as well as over the course of a day. In addition, activity affects blood pressure, which rises as a normal response to physical exertion and stress. However, patients with hypertension have high blood pressure even at rest. Untreated hypertension puts strain on the heart and arteries, eventually damaging such tissues, and is a key risk factor for heart failure, heart attack (myocardial infarction), and stroke.
The classification for hypertension:
These definitions apply to adults who are not taking medications for hypertension and who are not acutely ill. If the two pressures fall in different categories, the higher one is used to determine the severity of the hypertension.
Hypertension is a common health problem. According to a national health survey in the United States, hypertension (systolic >140 mmHg and/or diastolic >90 mmHg) was present in 32 percent of African-Americans and 23 percent of whites and Mexican-Americans. Hypertension is more common as people grow older. As an example, among people over age 60, it occurs in 65 percent of African-American men, 80 percent of African-American women, 55 percent of white men and 65 percent of white women.Unfortunately, even though increasing numbers of people are being diagnosed with hypertension, many people still are not controlling it adequately. According to the same national survey, control of hypertension was achieved by only 25 percent of African-Americans and whites and 14 percent of Mexican-Americans.
The diagnosis of hypertension is made by measurement of the blood pressure, An individual’s blood pressure varies with time and some are anxious on a visit to a doctor’s office. As a result, an individual should not be labeled as having hypertension unless their blood pressure is persistently high after at least three office visits over several weeks to months. The only exceptions are if the blood pressure is very high or if there is evidence of damage from elevated blood pressure, such as heart, eye, or kidney injury (also called “target organ damage”). During the initial evaluation period before a treatment decision is made, patients should also be encouraged to measure their blood pressure at home or work.
Untreated hypertension can lead to a variety of vascular complications, such as heart disease, congestive heart failure, renal disease, stroke and retinal hemorrhage causing blindness
Treatment of hypertension usually begins with nondrug strategies. These include moderate restriction on salt in the diet, weight reduction in those who are overweight, avoidance of excess alcohol intake, and regular aerobic exercise .
The indication for antihypertensive drug therapy in most patients is a blood pressure that is persistently 140/90 mmHg or higher. On the other hand, drug treatment is warranted in patients with diabetes or chronic renal failure who have a blood pressure that is greater than 130/80 mmHg.
Each year, nearly one million Americans are treated for kidney stones. As part of the “stone belt” – an area comprised of several Southern states – Kentucky has among the highest rates of kidney stones in the nation. Many factors play a role in this finding, including lifestyle, diet, obesity and a warmer climate. Kidney stones form when chemicals in the urine crystallize and stick together. Small kidney stones may pass easily through the urinary tract. Larger stones, however, may get lodged in the urinary tract and block urine flow.
These are by far the most common type. Factors that promote these type of stones include dehydration, hypercalcemia, sedentary life styles and diet high in red meat.
Uric acid stones are more common in patients with high uric acid in the blood, have persistently acidic urine, and drink less fluids or are dehydrated. Increased uric acid excretion in the urine as seen during treatment of Lymphoma and Leukemia can also lead to uric acid stones.
Struvite stones are caused by urinary infections with urease producing organisms, the most common being Proteus mirabilis. These stones are mostly comprised of Phosphate (ammonium magnesium phosphate) and can grow rapidly and sometimes large (staghorn shaped) stones develop that are extremely difficult to treat.
Cystine stones are produced in patients with a homozygous recessive gene for cystine transport, producing excess urinary cysteine that leads to these type of stone formation that are also extremely difficult to treat..
In general, you can help to prevent kidney stones by drinking plenty of fluids and avoiding dehydration. This dilutes your urine and decreases the chance that chemicals will combine to form stones. You can prevent calcium oxalate stones by eating low-fat dairy products and other calcium-rich foods. Taking calcium supplements, however, can increase the risk of stone formation. People who excrete too much oxalate into their urine should avoid eating foods high in oxalate. These foods include beets, spinach, chard and rhubarb. Tea, coffee, cola, chocolate and nuts also contain oxalate, but these can be used in moderation. Eating too much salt and meat can cause more kidney stones to form. Here at KDC we do full metabolic work up, do chemical analysis of the stone and structure diet based on that.
Several different treatment strategies are being used to treat kidney stones. Along with medical and dietary treatment other options include:
Severe pain in your back or side, with or without nausea and vomiting Unusually frequent urination or a persistent urge to urinate A burning and discomfort when urinating Urine that is colored pink or tinged with blood Trapped kidney stones can lead to a urinary tract infection. Call your doctor if you have flank pain, fever and chills, or if your urine becomes cloudy or foul smelling.
The prognosis varies from person to person. Up to half of people who pass a kidney stone will never pass a second. For people with a recurrent kidney stone, the prognosis depends on the cause of the kidney stones and the response to preventive therapies.
Renal osteodystrophy is a bone disease that occurs when your kidneys fail to maintain proper levels of calcium and phosphorus in the blood. It’s common in people with kidney disease and affects most dialysis patients.
The bone changes from renal osteodystrophy can begin many years before symptoms appear in adults with kidney disease. For this reason, it’s called the “silent crippler.” The symptoms of renal osteodystrophy aren’t usually seen in adults until they have been on dialysis for several years. Older patients and women who have gone through menopause are at greater risk for this disease because they’re already vulnerable to osteoporosis, another bone disease, even without kidney disease. If left untreated, the bones gradually become thin and weak, and a person with renal osteodystrophy may begin to feel bone and joint pain. There’s also an increased risk of bone fractures
Calcium is essential for building new bone cells and keeping existing bones strong. Milk, yogurt, cheese and canned fish with bones are rich with calcium, but also provide too much phosphorus for a kidney diet. Sometimes calcium pills are prescribed to provide extra calcium instead of these high-phosphorus foods for people with chronic kidney disease (CKD). If calcium levels in your blood becomes too low due to kidney failure, your parathyroid glands (four small glands in your neck) release a hormone called PTH. If blood calcium levels are too low, the PTH will begin removing calcium from your bones to get calcium blood levels back to normal. Over months and years, as calcium is stripped from the bones, this can make the bones weak, so their texture becomes more like a piece of chalk than of a sturdy bone.
After calcium, phosphorus is the second most common mineral in the body. About 85 percent of phosphorus in your body is stored in your bones and teeth. Phosphorus is found in milk and milk products, whole grains, dried beans and peas, nuts and seeds, organ meats, meat and fish, colas, chocolate and some types of baking powder. In addition, many processed foods contain phosphate additives.
A high blood phosphorus level causes your body to pull calcium from your bones in an attempt to balance all the body’s minerals. When calcium is being pulled from your bones, your bones begin to break down and lose the ability to provide structural support.
Healthy kidneys activate vitamin D. The activated form of vitamin D is called calcitriol. Calcitriol helps the body absorb calcium. Working together, calcitriol helps maintain normal PTH levels, and they carefully balance calcium in your system. When kidneys fail, they stop converting inactive vitamin D to calcitriol. Your body is unable to absorb calcium from food, so it “borrows” the calcium it needs from the greatest calcium storage depot—your bones.
Renal osteodystrophy is often called the “silent crippler” because symptoms do not occur until a patient has been on dialysis for a few years. Typical symptoms can be:
Early indicators of renal osteodystrophy include high phosphorus and/or high PTH levels, red eyes, itching and sores from calcium-phosphorus deposits.
Testing for renal osteodystrophy involves taking a blood sample to measure your levels of calcium, phosphorus and PTH. If you are on dialysis, calcium and phosphorus tests are done on a monthly basis (or sometimes more frequently). PTH is measured quarterly for most patients—although testing may be done more frequently for people just starting vitamin D therapy or those with severe bone disease while the healthcare team is determining the correct dosage of vitamin D. Your renal dietitian will review your lab results and recommend changes in your diet or change your phosphorus binder prescription.
The goal of treating renal osteodystrophy is to restore balance between calcium, PTH, phosphorus and vitamin D in the body. Renal osteodystrophy can be managed with phosphorus binders, activated vitamin D and a low-phosphorus diet. If you have a high level of PTH in your blood, it’s important to bring it back to a normal level to prevent calcium loss from your bones. Medicines to treat renal osteodystrophy can be given in pill form, but are usually given intravenously during dialysis treatments for people on in-center hemodialysis. These medicines are only used in people with kidney disease. Another drug that may be used acts directly on the parathyroid glands to block PTH release. In severe cases the parathyroid glands may be surgically removed.
In addition to a low-phosphorus diet and taking prescribed medicines, exercise can also help increase your bone strength. Check with your doctor before beginning an exercise program.
AKI is a syndrome that results in a sudden decrease in kidney function or kidney damage within a few hours or few days.
AKI is common in patients who are in the hospital especially in the elderly and those in intensive care units (ICU). AKI causes a build-up of waste products in your blood and makes it hard for your kidneys to keep a balance of fluid in your body. This can also affect other organs such as the brain, heart, and lungs.
In the United States, AKI is one of the most serious and common health problems. It occurs in up to 1 in 5 patients in the hospital, and twice as often in a critical care setting.1-3
Decreased blood flow to the kidneys. This can result from:
It is also important to make sure that all healthcare providers caring for you, particularly radiologists, anesthesiologists, and surgeons, know about your kidney health, or any other risk factors you may have for AKI. The kidneys clear certain medicines and contrast dye used in imaging studies. If your kidneys are not working normally, these drugs may not be a good choice for you as they may increase your chance for AKI. These drugs or imaging studies may be important for your health care, so you and your healthcare provider should decide what is best for you.
Stay well hydrated – drink water and avoid long term use of drugs that are toxic to the kidneys such as NSAIDs (ibuprofen, naproxen) or herbal remedies