Q: I donated my left kidney to my godchild in 2003. At the time, they told me that if I ever needed an organ I would be moved to the top of the donor list. They recently discovered a 2cm lateral upper pole and tumor on my right kidney. I will have surgery in January to remove it, but I am wondering what my potential status actually would be should I eventually need a transplant.

A: The United Network for Organ Sharing (UNOS) has a policy that patients who have donated a kidney and subsequently develop kidney failure and need a transplant will have an advantage on the transplant list.  They are given “4 extra points” although they do not actually “go to the head of the list”.  You have to be accepted onto the list first.  If you have cancer, there may be some waiting time needed to make sure there is no spread of the cancer. You may review the UNOS policy at: http://www.unos.org/PoliciesandBylaws2/policies/pdfs/policy_172.pdf

Good luck on your upcoming surgery.

Q: A doctor recently informed my father-in-law that his kidneys are functioning at a level of 31 percent. Is this critical?

A: An estimated glomerular filtration rate (eGFR) of 31 ml/minute per 1.73 meters squared is considered Stage 3 chronic kidney disease (CKD) by the National Kidney Foundation criteria.  This level should be carefully monitored for progression by you physician.  Stage 4 CKD is designated by an eGFR between 15 and 29 and we recommend planning for kidney failure including preparing for dialysis or transplantation at this level.  Stage 5 CKD is an eGFR less than 15 and may necessitate dialysis although this level of kidney function can be managed without dialysis for some time. 

Q: My son currently undergoes peritoneal dialysis treatment. He has an issue with the protein levels in his body and needs to eat every two hours, otherwise he feels weak and sick all day. Do you have any advice for how we should proceed?

A: I would recommend consultation with a dietician.  Protein malnutrition in peritoneal dialysis patients is a very common condition and must be managed with appropriate diet.  If there are other factors such as stomach problems that limit intake, review with your nephrologist or referral to a stomach specialist (gastroenterologist) may be necessary.  Another cause of poor nutritional intake is inadequate dialysis.  The dialysis prescription should be reviewed with your nephrologist to make sure he is performing his dialysis effectively.

Q: My doctor has recently prescribed me Kayexalate, to be taken on my days off to control my potassium level. Is there a reason not to use a zero potassium bath?

A: I do not advocate the use of zero potassium bath.  I have rarely used them, but generally not in a stable outpatient situation.  Zero potassium bath may result in a rapid lowering of the blood potassium which can be toxic to the heart and cause heart rhythm disturbances including cardiac arrest.  Use of a zero potassium bath should generally be restricted to use in a hospital under special heart monitoring in my opinion.  It is a much better idea to have a thorough review of your diet and try to decrease the potassium in your diet.  Kayexalate may be used, but adjustments in the diet are preferred.

Q: My daughter has Acute Renal Polycystic Kidney Disease (ARPKD). At our last visit with our nephrologist, he told me that her kidney function was at 33 percent. At that time, her creatinine level was 2.0. Now, two months later, her level is 2.07. How can I determine her percent function at this point? Is there a formula?

A: You may estimate the kidney function by using the calculating equations that are found on the National Kidney Foundation web site at: 

http://www.kidney.org/professionals/KLS/gfr_calculator.cfm

There is an equation for children as well as adult.  You must enter the information requested including age, sex, whether the patient is black or non-black and the creatinine level.  For children, you must enter the height.

Q: My wife has recently discovered she has an atrophic left kidney, likely from a urinary tract infection she had when she was younger. The doctors have told us the lower half of her kidney is damaged. She is now 33 years old with no sign of kidney issues. Is it likely that she will develop issues in the future?

A: An atrophic (small) kidney can be the result of infection and/or could be the result of a condition that was present at birth (congenital atrophic kidney).  Trying to make a diagnosis in retrospect is very difficult.  As long as she keeps herself otherwise healthy and monitors the kidney function on a regular basis, I would not foresee any complications.  It must be remembered that there is a natural loss of kidney function with aging and that this cannot be avoided.  Hence, any loss of function she had as a result of injury in youth or a defect that she was born with will leave her with less reserve kidney function as she ages.

Q: I am a 35yrs old female in desperate need of information on Stage II Iga Nephropathy, with rapidly progressive crescent formation. I was diagnosed about 7 months ago. I feel like I have the flu all the time and severe joint and side pain.

A: I recommend you review our fact sheet on the National Kidney Foundation website at: http://www.kidney.org/atoz/content/iganeph.cfm

The fact that you have rapidly progressive crescent formation is a very bad prognostic sign. This should be discussed with your nephrologist and follow the recommendations that are provided.

Q: Is a person with Thalassemia minor a possible candidate to donate a kidney? Is weight a factor in being able to donate? I am asking for a person who has Thalassemia minor and is overweight. She has a friend who lives in upstate NY who has been waiting a long time for a kidney.

A: This is a very difficult question to answer, because each transplant program has unique criteria for permitting living donor transplantation. We do not have universal criteria for living donors in this country.  Under most circumstances, Thalassemia minor alone should not present a problem for the donation of a kidney for transplantation, but this must be discussed and reviewed with each individual program.  The weight and obesity issue is also very unique to each program.  Some programs will not permit transplantation with BMI over 30 and some much higher.  I recommend discussing this with the transplant program that is evaluating the friend in question.

Q: My father is at end stage renal disease (stage five) with hypertension. In 2005, his HB-10.8, urea-124mg, creatinine-5.4mg. Now, his HB-6, urea-130mg/dl creatinine-3.4mg. The nephrologist told him to start renal dialysis, but my father is not ready. What sort of treatments should we follow?

A: The blood chemistries that are given here demonstrate very poor kidney function. I cannot give any specific advice other than to suggest you follow the recommendations of your nephrologist.  Your father is very anemic, and has very poor kidney function.  I would agree that he needs to consider dialysis therapy, although some patients choose to forego treatments and last as long as they can without dialysis. This should be your father’s choice if he understands that he may die with kidney disease of this degree.

Q: What is the life span of a kidney transplant patient? Does it matter if the donor is the mother?

A: There is no exact answer to this question. As a kidney transplant recipient, one should take all medications faithfully, monitor the levels of medication in the blood, stay physically fit, control blood pressure, treat any other underlying problems such as diabetes, heart disease, cholesterol problems and make sure that your vaccinations are current. Prevention of bone disease is very important.  You should make regular visits to your transplant physician. Statistics tell us that according to the most recent data from the United Network for Organ Sharing that more than 89% of living related donor kidney transplants are functioning at 5 years.  This is the best data we have at the present time.