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I do not want dialysis: how long can I expect to live, and how would I feel?

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I often see patients in my office who refuse dialysis (should it become necessary) for their advancing kidney disease. I divide these patients in to two categories. The more common category is patients who refuse it because of the "fear of dialysis". They could have trouble understanding dialysis and what potential benefits they could derive from it. They would often make good dialysis candidates who have more to lose than gain by refusing dialysis therapies.

The other category is the patient who rightfully refuses dialysis because she or he would not make a good candidate for such treatment. There could be multiple reasons for that. It could be advanced age and frailty, presence of other severe disease conditions like heart failure or metastatic cancer, etc. In such cases, it is hard to always predict if dialysis would add anything to the quality/quantity of life. And often, patients are simply looking at the "big picture". So the questions that come up in this s…

Can we create an artificial/mechanical kidney to treat kidney failure?

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THE FUTURE IS HERE.....WELL, ALMOST!
It has been a while since researchers started working on developing prototypes of artificial kidneys that could literally be implanted in to a human suffering from kidney failure. Theoretically, this kind of artificial kidney would replace the functions of a normal human kidney. It would flush the blood of all metabolic toxins, maintain all body electrolytes in the narrow range necessary for all life processes, produce hormones like erythropoietin (that drives the bone marrow to produce red blood cells), activate vitamin D, regulate blood pressure, etc etc. Yes, these are all some of the functions that those miracles of nature sitting in your flanks, your kidneys, are doing right now.

Is drinking coffee/caffeine bad for your kidneys?

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This is a question that often comes up when I see patients in my office for treatment of chronic kidney disease (CKD). As always, I tend to emphasize the huge role that diet plays in the management of CKD. I noticed that my recent posts might be becoming too wordy, so I am going to keep myself very brief today!

What are "kidney cysts"? Should I be worried? How do you treat them?

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Cysts, or abnormal pockets of fluid filled sacs, are a common finding on imaging studies like ultrasounds that are done on the kidney. I often see concerned patients in consultation about this finding. The question in that situation is...should you be worried if you discovered that you have cyst/s in your kidney?

HOW COMMON ARE KIDNEY CYSTS?
Cysts in the kidney are a pretty common occurrence. They tend to get more prevalent in the older age groups. For instance, 11.5% of individuals aged 50-70, and 22.1% of all individuals aged over 70 yrs will have at least one cyst in the kidney. However, the challenge is to identify whether it is a benign age related finding or something as serious as cancer (which can present as cysts). Cysts often will have no symptoms, and will usually be discovered incidentally as part of imaging of the kidneys for unrelated reasons.

Can over-the-counter pain medications cause kidney disease? How can patients with kidney disease treat their pain?

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The fact that a number of painkillers are available freely over-the-counter (OTC) often gives a lot of people a false sense of security about the safety of these medications. A statement that I here from some of my patients is, "it was available without a prescription, so I thought it wasn't too strong". So very often, patients assume that if a medicine is not too potent, it probably does not have serious side effects either. Sadly, a medication's potency is not necessarily proportional to its side effect profile.

HOW DO PAIN MEDICATIONS DAMAGE THE KIDNEYS: EFFECTS ON KIDNEY FUNCTION
Pain medications can have different renal effects. These can range from reversible, short term reductions in kidney function due to a decrease in the blood supply to the kidneys (called Acute Renal Failure, or Acute Kidney Injury), to a more chronic disease where the kidneys shrink in size, develop a rough and bumpy surface, and demonstrate tissue breakdown called "papillary necrosi…