I've been dealing with doctors for one long term condition or another since I was 9; after 45 years of listening to docs, I have figured out that it is best to do as much reading and to learn as much as you can so that things seem to fit together into a more or less coherent whole.
I'm basically a science geek anyway, always have been. (I was the weird kid who just HAD to take the thermostat apart to figure out how it worked. LOL.) Chemistry, biology, anatomy and physiology just seem to sort of naturally make sense to me.View Thread
I'd start by asking the doc what the other lab numbers seemed to indicate, especially as the others relate to the 44 ml/min eGFR calculation. And if these tests were drawn fasting, nothing by mouth after midnight, how big an effect that slight dehydration might have had on the numbers.
Ask what, if anything, you can do to stabilize renal function: avoiding over the counter pain killers, lowering cholesterol and other dietary fats, improving cardiovascular condition, anything in your overall health that might have a long term effect on renal function.
Remember that the "44" is not really on a 0-100 scale. It may be slightly reduced from the ideal numbers, it isn't anything to panic over (anything over 60 is basically ignored because it is so 'normal' that it isn't worth mentioning). Just keep an eye on it as the years go by.View Thread
A definite yes. In fact the only way to diagnose kidney disease early is with lab tests. Humans are born with an excess of renal function, so by the time that physical symptoms show up, renal disease is farily advanced.
That said, basic lab tests generally use an eGFR (ESTIMAATED glomerular filtration rate). This test is a mathematical calculation based on other blood test numbers, so it is highly variable and less than perfectly accurate. In addition, and most docs won't bother to explain this, the number is NOT based on a 0 to 100% scale. The real GFR range is more like 15% to 60%. Anything higher than 60% isn't really worth measuring. (Note that on most tests, the highest number is not 100, it is "greater than 60 ml/min".)
The test can also be thrown off by slight dehydration, medications, low blood pressure, a whole lot of things.
Still, I would ask a lot of questions about a 44 ml/min score. Chronic renal disease has no 'fix'. Kidneys cannot repair themselves. So if there is some genuine concern, then the only way to go is to figure out what is the cause, treat that, and try to stabilize funtion where it is now.View Thread
Swelling could be caused by infection (but at the same time, the infection could be made worse by the swelling.)
What about the other leg/ankle? Is there swelling in the wrists or in the face?
It is common for dialysis patients to have some peripheral edema, and though the docs say the circulation is "good", it obviously is not quite good enough to avoid edema.
One of the biggest factors to successful hemodialysis is the patient's control of fluid intake. This is difficult but absolutely critical. A three or four hour session on the machine three times a week simply cannot remove all of the fluid from the previous two or three days consumption.
There are a lot of complex reasons for this, if you want to know more detail, search for the terms: "intracellular extracellular fluid" or "dialysis hemodynamic instability".
I'd ask her dialysis center about weight fluctuations between treatments, or if they are having trouble getting adequate ultrafiltration in her case. This might point to a couple of things, including fluid restriction.View Thread
These agencies rarely communicate directly with patients, since they are responsible for distributing donated organs in a specific geographical area. The only way to go about it is to select a hospital/transplant center in your area. They will connect to the local OPO and through that contact will connect to the local and the national waiting list. In some area it is possible to list yourself with more than one transplant center, but this is not true everywhere; it depends on local rules and protocols.
As for a living donor, you are more or less on your own to arrange for a donor, who will then be tested by your chosen transplant center for tissue compatibility.
There are 'paired exchange' programs if you have a donor who is not tissue compatible with you. In this case, your prospective donor will donate to a pool of donors and then you move to the top of the list for tissue compatible donors in the pool. This can in many cases widen the availability of a compatible donor.
In any event, the short answer is to get in touch with the transplant center closest to you; there will be a lot of trips back and forth to the center before and shortly after the procedure, so proximity is a big factor to consider. I've known several patients who crossed state lines to list at a specific transplant center, but all the travel back and forth can be a serious problem.
I can't help at all with anything outside the standard US model for donations.View Thread
ACE inhibitors (usually used for blood pressure control) are usually the first choice for limiting proteinura.
Some patients have had good response from adding fish oil supplements to the diet, but this does not work for everybody. Still, if your doctor thinks it is a good idea then it might be worth trying for a few months.
If you are taking any over the counter high-protein supplements, that needs to stop (unless your protein losses into urine are so huge that your doctor thinks that protein supplements are required).
A few docs will try a low-protein diet with a few select patients, but again, this is not a good idea for everybody. And it needs to be done with medical supervision. Doing it on your own might actually make things worse in the long run.
Sorry but there just are not a lot of options without some sort of medication. Good luck.View Thread
As mentioned, there are different systems of classifying 'stages'. Most consider #3 to be "moderate" damage with some loss of function, but not dramatic loss of function. GFR of somewhere between 30 and 59 ml/min.
Some patients feel tired at this point, others dfo not. Some retain fluid, others don't. Elevated blood pressure is common, but not universal. Some become slightly anemic.
At this point, the goal of treatment is to control blood pressure, and to identify the underlying causes, then treat those causes. Diabetes is the most common cause in the US, but there are dozens of other causes.View Thread
It tends to vary with the patient and the transplant center.
The basic definition of ESRD, which is usually the main qualifer for a transplant, is marked at 15% residual renal function, 20% RRF for diabetics. And while a lot of physicians use GFR as a rough guide to RRF there are differences.
And other things get factored in by the docs: overall medical history, complicating conditions particularly cardiovascular health, patient compliance, psychological factors, just a lot of stuff.
It would be good to stay well ahead of the numbers, though. The transplant evaluation takes a while, and in most centers there is a fairly long waiting list. Both time on the wait list and severity of need are considered when committees meet to decide who gets on the list and where one stands in the waiting line. It's a pretty complex decision.
Patients with a living donor can jump over some of these hoops: you have one donor willing to give to one particular patient, and that cuts out the wait for the next cadaver kidney.
You probably need to be seen by a good nephrologist, probably by a urologist or a general surgeon who will remove the cystic tissue, and then get in touch with the local centers that do transplants.
I spent 4 years waiting, and while that is a lot longer than the average wait, it can take a while to get things rolling.View Thread
A history tale: for almost all of human existence, protein rich foods were the hardest ones to come by. Ancient people had to hunt or trap to get a high protein meal. So human bodies evolved to conserve and recycle as much protein as possible. That's a big reason that kidneys developed the way that they turned out. Only since the end of WWII has a consistent, inexpensive ultra-high protein diet been available to the wide spectrum of humanity. So the kidneys still try to conserve and reuse all the protein that is in the system. Dietary need for new protein is still rather low.
It's not great to overload the system with protein since any excess has to be filtered out by the kidneys, and the kidneys are specifically designed to keep the fairly large protein molecules IN the bloodstream, not to let them escape. So forcing the kidneys to excrete these molecules eventually damages the tiniest filtering units, glomeruli.
I can't begin to guess how much is safe to take since everybody's metabolism is different. What I can suggest is that you get a set of basic metabolic blood tests at your doctor. If you total protein and albumin numbers are within the normal range, then that is about the best you can do.
Taking in more protein than the body can use is expensive, wasteful, and potentially dangerous. You simply cannot FORCE the body to use more protein by providing an oversupply. It just doesn't work that way.View Thread