Health Talk: Kidney Disease
Hosted by Craig Stoltz
Washington Post Health Editor
Tuesday, April 4, 2 p.m. EST
After revealing his advanced kidney disease last July and then receiving a transplant from his brother, NBA star Sean Elliott defied the odds and returned to play for the San Antonio Spurs.
Dr. Leslie Spry, nephrologist and spokesperson for the National Kidney Foundation, is our guest for this week's "Health Talk" with Craig Stoltz. Dr. Spry will answer your questions on kidney disease and transplantation.
Please read the transcript below.
Dr. Spry, we're delighted to have you with us this afternoon. Sean Elliott's remarkable comeback
in the NBA is intriguing for several reasons: it suggests both how far kidney transplantation--and, more to the
point, post-transplant survival--has come just in the past decade; yet it also suggests that any of us is vulnerable
to this disease. We have many questions and comments from readers waiting, so let's jump right in.
About 18 months ago, I was privileged to donate a kidney to my mother, whose own kidneys had failed due to hereditary Polycystic Kidney Disease (PKD). Mom is doing great now, but in the midst of all the pre-op testing, surgery, and recovery, I discovered that there is very little information "out there" for kidney donors on the post-surgical effects of organ donation. Specifically, I'm wondering how being a one-kidney woman will affect pregnancy and childbirth. I'm also training for a marathon and looking for information on how a single kidney affects sports potential, including physical endurance.
A great question, and one that raises an issue we really didn't get to in today's story in the Health section: What sort of health risks and activity limits does a *donor* face?
Dr. Leslie Spry: Many people are born with one kidney. A single kidney does not seem to detract from any physical activities. Multiple births have been reported for many renal transplant recipients. There is no physical limitations to renal transplantation.
What are some of the warning signs of Kidney Disease?
Dr. Leslie Spry: Blood in the urine. High blood pressure. Having a family history of kid dis. Bladder infections. Painful urination. Abnormal kidney functions.
I am a 60 yr. old white male in good general health. During the last year my general physician discovered that my creatine level had risen a little and sent me to a nephrologist. After two or three blood and urine tests my results were inconclusive; the doctor said that we should continue to monitor the situation every 6 months. Every so often I get a tired feeling which lasts a few hours. Is there any connection? Am I in the beginning stages of kidney failure? I might add that I drink very little water, maybe 3-4 glasses a day.
Dr. Leslie Spry: The testing should have included an ultrasound of the kidneys and 24 hour urine collection. In some cases a kidney biopsy may need to be done.
Early kidney disease frequently has no symptoms. You should be tested every 4 to 6 months for progression to disease. This involves only blood work in most cases.
Is there a way to prevent kidney disease?
Dr. Leslie Spry: The most important thing to do is monitor your blood pressure. 60% of people end up with dialysis or transplant because of inadequately controlled hypertension. Control of diabetes and a healthy lifestyle are also important.
How does diet affect the function of one's kidneys. For example, can high-proteins diets lead to kidney disease?
Dr. Leslie Spry: High protein diets such as 2 or more grams per kg body weight have been shown to accelerate kidney disease. The average diet at 0.8 to 1.2 grams per kg are safe. Low protein diets are advocated only for diabetics.
Low salt diets may be helpful with hypertension.
Low phosphorus and low potassium are used in some cases.
What are the risk factors for kidney disease, and are there preventative measures that people who are high risk can take?
Dr. Leslie Spry: Diabetes and hypertension are the two most common risk factors. Kidney infections and family history (ie hereditary kid dis) are next. Then there are diseases such as nephritis (ie lupus). In the older population, prostate disease and hardening of the arteries are the most common.
I am a 46 year old woman who at 22 was diagnosed with renal arterary stenosis. I had one of my kidneys removed and have been fine since. I understood that my problem resulted in a narrowing of my renal arterary. Will I have a greater chance of problems with
my heart arteries?
Dr. Leslie Spry: Yes if the blockage was related to hardening of the arteries
(ie atherosclerosis) but if you had a disease known as fibromuscular hyperplasia which occurs in young ladies esp when taking birth control pills, this does not mean you are at the same risk for your heart.
Does having a dropped kidney have any bearing on future problems with kidney disease?
Dr. Leslie Spry: A dropped kidney aka ptotic kidney is a birth abnormality and means that you have one kidney in a lower place than usual ( ie the pelvis or next to the bladder). It confers no risk for kidney disease as long as it was otherwise formed normally at birth.
A year ago told my doctor about an abrupt change in the color of my urine. Excess protein was found in a urine test and an ultrasound showed a single large cyst -4.8 cm by 5.2 cm- on one kidney. I was told it was a stable cyst but I should have it checked in a year. What is the typical rate of progression for kidney disease and how well can doctor's predict what is stable and what is not?
Dr. Leslie Spry: The ultrasound is the best test to determine benign or maligant disease. 40% of individuals as they age will develop benign kid cysts. Kidney disease does not develop in a benign cyst.
There was an interesting article three years ago in the Emerging Infectious Diseases Journal -Polycystic Kidney Disease: An Unrecognized Emerging Infectious Disease? by M. A. Miller-Hjelle et al., Jun 97- that indicated evidence of bacterial and-or fungal infection in nearly all kidney cysts. Why isn't more work being done to detect and eliminate these infections before major kidney damage occurs?
I understand that several of the suspected bacteria are very difficult and expensive to detect and culture in the laboratory. However, if even 10% of cases could be stopped before kidney failure occurs, the transplant and dialysis cost savings would easily pay for the laboratory testing. Each cases caught before major kidney damage occurs would also free-up a donor kidney for someone else.
Dr. Leslie Spry: At the present time the only way to diagnose infection is by cyst puncture. This involves placing a long needle into the back and sampling the fluid for culture. Many years ago this was done routinely but we learned that this actually accelerated the disease by distroying more kidney tissue and the results of these studies were not conclusive. Attention is now on genetic research of polycystic kid dis and how cysts come to be formed.
Avella, Pa. :
I had a kidney removed 2-15-00 due to cancer; the tumor was clear cell type, grade 11 (5 cm dia.) No invasion beyond renal capsule. No renal vein invasion. Is this good or bad?
Dr. Leslie Spry: This should be a good prognosis, but the only way to tell is to wait for 5 years. You should also have a repeat CAT scan or MRI every year because there is an increased chance of a second kidney cancer in your other kidney.
How close are we to finding a cure for PKD?
Dr. Leslie Spry: We know the two genes that are involved in the two most common forms of PKD. We have discovered the protein that they code for but as yet we don't have the answer to what those protein do and why abnormal proteins cause cysts. This is ongoing study. It is estimated that PKD will be one of the first kid diseases to be treated with gene therapy. The other is Alport's syndrome.
Do you have any idea what Sean Elliot's Creatinine level was when he got his transplant?
Dr. Leslie Spry: His creatinine level was between 6 and 7 prior to transplant and even more amazing, his hemoglobin was less that 10 during the NBA championship series. I find this astounding given his level of play.
My 52 year old husband has Polycystic Kidney disease. When he finally recieves a kidney transplant, will both of his diseased kidneys be removed?
Dr. Leslie Spry: No. This is only done for severe symptoms such as pain or bleeding or infection in cysts. It is rarely done to one kidney if that kidney is so large that it interferes with the surgeon being able to put the new kidney in the pelvic area (groin area).
My son in law just started dialysis. The doctor told him he can only have 6 cups of fluid a day. Why? Can he have more to drink in the summer? Also, does the age of the kidney donor affect the sucess of the kidney transplant? Does an older kidney wear out faster?
Dr. Leslie Spry: This is dependent on the amount of urine he makes every day. We usually allow 500 cc plus urine volume each day. It has to do with fluid accumulation. If he drinks too much the machine has to work harder to remove the fluid and it can make him sick at the end of dialysis.
Younger donors have a little better success rate than older donors but will not discourage most surgeons from accepting the kidney.
Older kidneys up to age 65 are commonly taken. Beyond this age it is a surgeons choice. But older people can donate many things other than kidneys,(ie bone, skin, corneas, and other useful tissues) It seems so unfair to bury this valuable resource.
Settle a bet-
If your body "rejects" a kidney transplant, does your doctor remove the transplant or leave it in?
Dr. Leslie Spry: We leave it in. You have the other groin area for a second txp and we only remove one for infection, bleeding or the third txp. Can I split the payoff?
Will a person who has PKD at this point in time benifit from gene therapy?
Associated with that, Dr. Spry, I'm wondering whether the recent shut-down of high-profile gene therapy trials (looking at applications to other diseases) has slowed gene therapy work in relation to kidney disease?
Dr. Leslie Spry: The government has put all human testing on hold since the recent problems at the Univ of Penn. At the present time there are no trials and until we know what the gene product does in PKD we won't even have the opportunity to try it.
My son was born with a post urethral valve causing bilateral hydronephrosis. This was found with ultrasound around 24 wks; he was born at 35 wks. Rest of pregnancy was normal. Long tortuous ureters. Greatly distended kidneys which are now not "kidney shaped." He was lucky in that when the pressure built up enough he was able to urinate thereby sparing his life.
He has a twin which kept the doctors from trying anything in utero with him. His BUN and Creatinine values are normal at this time of his life. He is small for his age--he's now six--and as compared to his identical brother.
Our doctors never want to talk about the future. What I have read is written in such a manner for me not to be able to decipher much except that it didn't sound good. I know you can not see the future for my son but I was wanting to gain some insight as to what we could normally expect in this situation? Will more than likely he need a transplant in his future? I would appreciate any comments or reading material that I could understand that you could point me towards. Thank you.
Dr. Leslie Spry: The kidney foundation has information about obstructive uropathy and can be accessed at 1-800-622-9010 or their web site at kidney.org. In general, if the kidney is now unobstructed and if infections are not a problem and he is voiding normally, there should not be a problem.
What are some of the side effects of dialysis? Can a patient miss one dialysis session when on vacation?
Dr. Leslie Spry: Missing dialysis is always a bad thing. You are paying for a certain amount of treatment and you should take advantage of all the dialysis you can. Studies have shown that missing only one dialysis treatment per month can shorten your life.
Side effects can be minimized by careful attention to you prescription, but include low blood pressure, cramps, nausea and vomiting, fatigue right after dialysis.
Is a low blood hemoglobin level an indicator of kidney disease? What are other blood test results that would indicate kidney disease?
Dr. Leslie Spry: Abnormal creatinine,abnormal blood urea nitrogen (BUN), elevated phosphorus, as well as anemia.
That's all we have time for today; thanks again to Dr. Spry, and to everyone who asked questions. Catch us next week at 2 p.m. for another session of Health Talk. Meantime, those of you with ESPN might want to catch kidney transplantee Sean Elliott on the floor tonight, when the Spurs play Orlando at 7:30 p.m. The comeback continues. . . .
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