Category Archives: Dialysis

Dr. Spry, My father suffered a kidney failure, apparently resulting from a UTI this past March. Though he is a long-term diabetic (over 27 years), his medical records state his condition as AKI rather than CKD. He is now dialysis-dependent, but his doctor seems to believe his kidneys could recover sufficient functionality for him to go off dialysis, though it’s been nearly 8 months since the diagnosis. What indicators would a doctor use to identify AKI vs CKD in a less obvious scenario where the UTI or the Diabetes could be the root cause, unlike an actual physical injury or nephropathy in the absence of a pathogen beyond diabetes, where I presume it would be easier to classify as AKI or CKD, respectively. How would the doctor determine if there is a possibility for some kidney function to return? From what I can tell of his creatinine, potassium, urea, albumin levels, there doesn’t appear to be a consistent improvement in any metric that would allow a quantitative assessment of kidney recovery. Is there a qualitative method to assess the viability of a kidney? Short of a biopsy is there another quantitative method outside the typical blood work to judge how much kidney function is just dormant vs. how much has been lost permanently? Apologies for the multiple questions! My father is being treated at the top hospital in his city, one well-known for international medical tourism (though he’s a local). His doctor appears to be a very competent and straightforward professional. Unfortunately, doctors in India are extremely reluctant to share technical patient information and I’m relegated to scouring the internet to help my dad navigate his condition. Thank you for any information you can share on the subject!

Acute kidney injury (AKI) means that the tubules of the kidney have been injured but the filters of the kidney (glomeruli) remain intact. If there is tubular injury, then the kidney is capable of repairing this injury and then the … Continue reading

Posted in Acute Kidney Injury, Ask the Doctor, Chronic Kidney Disease, Diabetes, Dialysis, Kidney Failure, Kidney-Related Health Questions, Urinary Tract Infection/Pyelonephritis

If and or when is it OK for the Doctor to decide to take the patient off of dialysis?

The decision to stop administering dialysis treatments for someone is very complicated. This requires making sure that someone is competent to make a decision for forgo any further dialysis. The nephrologist would then confer with the patient and the patient … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

I have been on dialysis for 10 months am still learning, questioning and seeking all the information I can get. My questions are what is the acceptable goal for spKt/v for a person like me who has dialysis 3 days a week at 3 hours @ treatment. I am currently at 1.94 on my spKt/v. I also have an ostomy and want to know if it can sometimes have an effect on the amount of scant urine I sometimes have because the amount varies and my ostomy bag sometimes has a odor of urine. My ostomy is always full and fluid/liquid in content.

You will have to check with your dialysis unit nurse or your nephrologist as to how they report the single pool Kt/V (spKt/V).  If they are reporting a single session of dialysis spKt/V then then goal is usually somewhere about … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist

Good morning, It is really nice that NKF has this service. My question is about nephropathy. My neprhologist and neurologist simply say that many CKD patients get it. My question is why. There is nothing I have heard that says the kidneys interact directly with the nervous system. Two years ago, I was fine. Hiking, playing basketall and very active for 59. Then I had a little back pain and got some bad medical advice on prescriptions. Caused some brain issues e.g. lesions. I have drop foot and nephropathy but two doctors say these conditions are related to my ESRD. I have been on hemo dialysis for about two years and did PD for a year prior. My guess is that the restrictions on EPO to maintain my hemoglobin below 12 is at least a partial cause. Is this correct? What are the causes based on your knowledge?

From the information that you provide, I will assume you are talking about “neuropathy” and not “nephropathy”. Nephropathy means kidney disease and as you are on dialysis, you obviously have “nephropathy”. Since you mentioned your neurologist, I will assume that … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, Kidney-Related Health Questions, Transplantation

Hi Doc, I experienced acute renal failure two yrs ago. I had six sessions of dialysis in two weeks and by the fourth session my kidneys were back up functioning normal (0.9creatinine), but my blood pressure was up 150/90 and I started spilling protein ++. My doctor at the time placed me on Losartan and was of the opinion that the protein will stop but it did not. I sought a second opinion from another doctor who placed me on prednisone high dose and reduced it as the weeks progressed but there was no difference as ESR, cholesterol remained high but kidney function remained normal. At this point he ordered a biopsy following which he made a FSGS diagnosis but said I should just keep taking the losartan and made no further treatment plan. I last checked my function last year September and the kidneys still functioned normally but I still spilled protein ++. What can I do to get better although I feel very well.

Unfortunately, kidney disease often has no symptoms at all. Focal segmental glomerulosclerosis (FSGS) is a chronic scarring disease of the kidney and there is no specific treatment. Steroids are often tried, but may not be effective. Uses of drugs such … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Dialysis, FSGS, Kidney-Related Health Questions, Nephrologist

My husband has been on dialysis for over 6 years now and he has had probably 10-12 catheters, 5 FISTULAS and 2 GRAFTS and the HERO GRAFT, and they all have failed. The surgeon said there is nothing else he can do. We are at loss. Does he have any more options? What is the life expectancy of a person just using catheters for dialysis? Any information would be appreciated. Thank you.

The only other options that could be considered are kidney transplantation or peritoneal dialysis. I suggest that you discuss transplantation and peritoneal dialysis with your husband’s nephrologist.

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist, Transplantation

My GFR is 15ml, creatinine is 3.33mg, urine creatine is 36.2. Will I now at this stage need to have dialysis?

The decision to start dialysis does not depend on a number. It depends on your symptoms and your overall evaluation with your nephrologist. If you have symptoms that can be benefited by dialysis and you have advanced kidney disease, then … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, GFR, Kidney-Related Health Questions, Nephrologist, Serum Creatinine

How to decrease creatinine?

There is no medical treatment that will consistently decrease the serum creatinine. Dialysis and transplantation will decrease the serum creatinine, when and if kidney failure occurs. Otherwise the goal of treatment of chronic kidney disease (CKD) is to slow the … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, Kidney-Related Health Questions, Serum Creatinine, Transplantation

My brother 24 years old is diagnosed with IGA Nephropathy with Cresents with Sclerosis with Hypertension on 19 july 2017. He is on Wysolone 90mg OD since two and half months (20 july 2017 -present),Telmisartan 40mg OD (22 sep 2017-present), Cilnix 10mg OD, Metcy 100mg OD ,Moxovas 0.2mg OD ,Lasix 20mg OD, Renosave OD, Sobisis forte TDS, Atorlip-f 20mg, Hosit OD (3 july 2017-present), corcal 500mg BD. His creatinine is 3.09 and 24 hr urine protein is 1.6 gm (20 sep 2017)which was 4.64 and 4gm at the time of biopsy. All RFT test with in normal range. His BP is within 130/90 (measure 3 times a day). Will he need dialysis and what is the prognosis. What will be line of treatment in future?

I am unable to provide a prognosis based on the information that you present. IgA nephropathy has a very variable clinical course and is different from one individual to the next. The biopsy that you mention suggests very aggressive disease … Continue reading

Posted in Ask the Doctor, Dialysis, IgA Nephropathy/IgA Dominant Glomerulonephritis, Kidney-Related Health Questions

How long should dialysis keep my 82 year old husband alive?

I am unable to offer a prognosis without performing a complete history and physical examination on your husband. The best person to discuss your concerns is the nephrologist (kidney doctor) who is caring for your husband.  He or she can … Continue reading

Posted in Ask the Doctor, Dialysis, Kidney-Related Health Questions, Nephrologist