Demystifying Kidney Disease for the Average Joe!

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 ...

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.

I look at the artificial kidney that I talked about in my last post as a sort-of futuristic automaton. It can work (in principle) on the body's internal power (the blood pressure) and does not require the frequent tweaks (again, in principle) that are required with conventional dialysis; thus giving patients more freedom with their lives. However, the technology that really has the trans-humanist in me jumping up and down with excitement is the promise of regenerating a "natural" human kidney in the lab. In Greek mythology, Prometheus' liver would regenerate even after an eagle nibbled on it every day, all while the poor fellow lay chained to a rock (he was lucky the eagle didn't mess with his kidneys, which don't quite possess the same regenerative capacity!). My fantasy is not quite the same, but what I had always conceptualized is that with the advances in regenerative medicine, we might be able to just play God, and "make a kidney", a rea...

After I wrote my last post on the treatment options that patients with advanced kidney disease and kidney failure  have when it comes to managing their disease, I came across a really nice 10 minute long video on YouTube that pretty much summarizes everything that I wrote in that article. The video goes into options that patients with kidney disease will typically have- dialysis being the most common one, transplantation, and finally not doing anything aggressive and treating it conservatively (I have written on conservative management and what happens when patients refuse dialysis here ).  The video also covers questions like when to start dialysis, and the decision making that goes in to deciding who would make a good candidate for home dialysis. All in all, it is a great way in which kidney disease patients and their loved ones can educate themselves. The format is engaging and you won't have to read pages of text that many patients find boring!  The video...

We are years, if not decades away from creating an artificial kidney . Until then, in an ideal world, every patient with advanced stage-5 kidney disease who needs kidney replacement therapy would get a kidney transplant. Unfortunately, kidneys are a scarce and limited resource. The number of people with kidney failure who could use a transplant far outweighs the number of transplants that actually occur every year. As per the latest USRDS Annual Data Report (2013) , 17,671 kidney transplants were performed in the United States in 2011 (111 fewer than in 2010). Meanwhile, the waiting list had 90,474 patients in line, as of December 31st of the same year. As you can see, the active waiting list is more than three times larger than the actual supply of donor kidneys. In the light of this stark mismatch, desperate patients have to make a decision about the next best option, dialysis. And the question that any proactive patient will ask, and should ask, is what kind of dialysis is the ...