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Nephrology


Kidney Disease (Nephrology)

Despite major advances in medicine, kidney disease continues to increase, and has reached epidemic proportions worldwide. The Comprehensive Kidney Program at the University of Michigan Health System practices and teaches optimal care for patients with kidney diseases at all stages, and is committed to clinical research aimed at both better treatment and prevention of kidney-related health issues.

Serving patients from across the country in all areas of kidney disease.

  • Acute and chronic kidney diseases
  • Cystic diseases of the kidney
  • Diabetes
  • Fluid and electrolyte disorders
  • Glomerulonephritis and glomerular diseases
  • Lupus
  • Hypertension
  • Kidney and pancreas transplantation
  • Kidney-related metabolic disorders
  • Kidney stones
  • Rare and genetic kidney diseases

Many of the recent advances in the diagnosis and treatment of kidney disease require close collaboration between kidney specialists with diverse areas of expertise. In recognition of these advances, we have brought together a team of specialists to evaluate and treat patients with known or suspected kidney disease in a timely and coordinated manner. Our patients also have access to clinical research opportunities and cutting-edge treatments.

Kidney Transplant in India.

What do kidneys do?
Your two kidneys work more than you realize. The kidneys remove excess body water and waste products 24 hours a day. The excess body water and waste products are removed from your body in the urine.

Besides the “removal” or “cleaning” job, kidneys have several other very important functions:

• They regulate electrolytes such as potassium and sodium (salt) concentration in your body.

• They produce hormones to:

a) control blood pressure
b) produce red blood cell
c) keep your bones strong
What happens when kidneys fail?
When the kidneys start to fail, they cannot perform all their important functions. Excess body water and waste products build up in your blood. This is called uraemia. Due to the accumulation of water and waste products, and the decreased production of certain hormones, you may start to feel sick. There are different kidney replacement therapy options available to do the work your kidneys used to do.
Who is at higher risk of kidney disease?
Many factors can increase the probability of getting chronic kidney disease, such as:
• Diabetes
• Family history of kidney disease
• High blood pressure
• Increasing age (over 50 years)
• Obesity
• Smoking

Early detection of kidney disease is very important. That is why you should ask your doctor to check whether you should be screened for chronic kidney disease.
Symptoms
When the kidneys begin to fail, there is an accumulation of water and waste products in the blood and additionally other problems occur, leading to one or more of the following symptoms:

• Swelling of hands, face, legs
• Tiredness
• Loss of appetite
• Nausea and vomiting
• Decreased amount of urine
• Shortness of breath
• High blood pressure

Chronic Kidney Disease (CKD)

 

means that your kidneys stop working well enough to keep you healthy. This is a process that usually takes place over a period of months or years. The process cannot be reversed, but with an early diagnosis, the right treatment and some lifestyle changes, it can be slowed down or in some cases even halted. If you have kidney disease, learn everything you can do about it; the correct treatment and changes in your lifestyle can help you stay healthier for longer. Your doctor will also work closely together with you to do everything to stop or at least slow down the progression of the disease by controlling the underlying causes.

CKD is divided into 5 disease stages (CKD 1-5). CKD stage 3 is often subdivided into 3a and 3b. For simplicity’s sake CKD stages 1 to 3a can be called early stage and CKD 3b to 5 late stage. To help you make the right changes in your life it is necessary to know your disease stage, which tells you how far the disease has advanced. The five disease stages are determined on the basis of the glomerular filtration rate (GFR). Therefore, it is important for you to understand what the GFR is.
The glomerular filtration rate (GFR) is a measurement of kidney function that can be estimated from a simple blood test which measures the creatinine and albumin levels in your blood as well as taking into consideration your age, race, gender and other factors. By means of the GFR your doctor can determine your stage of kidney disease and plan your treatment. The lower your GFR the higher is the risk of the progression of the disease. The risk of progression provides information about how likely it is that CKD will advance.
In addition to the GFR, the level of albuminuria may be important. Albuminuria means that you have an abnormal amount of protein in your urine, which may be an early sign of ongoing kidney disease and means that your kidneys are not filtering your blood well enough. Albuminuria can be detected using a simple urine dipstick test to see if protein can be found in your urine. The higher your level of albuminuria the higher is your risk of progression of CKD

EARLY STAGE

Most people in the early stage (CKD 1, 2, and 3a) hardly have any symptoms or only very unspecific ones, which makes CKD hard to detect.

However proper treatment during these early stages of CKD can prevent or at least slow down progression of the disease. And this is why it is so important to know your stage, the corresponding symptoms and what you can do.

At stage 1 CKD, the glomerular filtration rate (GFR) is at a normal or increased level of 90 ml/min and above. Stage 1 is the mildest form of CKD and may pass by undetected because those affected do not experience any signs or symptoms.
A person with stage 2 CKD has kidney damage that causes a mild decrease in their glomerular filtration rate (GFR) to a level of 60-89 ml/min. Even at this stage, there are usually no symptoms to indicate that the kidneys are damaged.
A person with stage 3 CKD has moderate kidney damage. Stage 3 CKD is divided into stage 3a and stage 3b. In stage 3a, the glomerular filtration rate (GFR) is decreased to a level of 45-59 ml/min. Even at this stage, the patient often does not experience any symptoms that indicate that the kidneys are damaged.
In the early stage it is very important to slow down the progression of CKD and to reduce the risk of other complications. During CKD stages 1, 2 and 3a, conservative treatment such as a healthy lifestyle, a special diet and medication may be enough to stop or at least slow down the progression. A dietician will help you to understand which foods to avoid and which are okay for you to eat.

LATE STAGE

In the late stage of CKD (3b, 4 and 5) the functioning of your kidneys is severely reduced. Due to your kidneys’ loss of ability to perform all their important functions excess body water and waste products build up in your blood. This is called uraemia. 

In this late stage of CKD, it is important to do everything to slow down the progression through to complete kidney failure. If the kidney fails, that means if the function of the kidney is reduced to less than about 10 to 15% of the normal kidney function, the loss must be replaced by dialysis or a kidney transplant. The exact GFR when to start dialysis depends on many factors (e.g. underlying kidney disease, malnutrition, uraemic symptoms etc.). Please follow your doctor’s advice.

Stage 3 CKD is divided into stage 3a and stage 3b. Stage 3b belongs to the late stage of CKD. A person with stage 3b CKD has moderate kidney damage and the GFR is at 30-44 ml/min. Common symptoms that can appear in this CKD stage can include low blood count, malnutrition, bone pain, tingling or numbness of nerves, difficulties in concentrating and a generally reduced sense of well-being.
At stage 4 CKD, the kidney has advanced damage leading to a GFR of only 15-30 ml/min. In addition to the symptoms mentioned before, some of the most common symptoms in stage 4 CKD are bone disease, restless legs, itchy skin and anaemia. Anaemia means that you have a shortage of red blood cells which can cause fatigue, difficulties when trying to concentrate, loss of appetite, swelling, especially in the legs and around the eyes, shortness of breath and pale skin.
A person with stage 5 CKD has kidney damage resulting in a decreased GFR of 15 ml/min or less. The kidneys have lost almost all their ability to work efficiently. Eventually, the kidney disease has reduced the kidneys’ functions to a level where a replacement therapy becomes necessary.
In the late stage of CKD, you and your doctor will try everything to slow down the progression through to complete kidney failure. The right diet and treatment are more important than ever.

In addition, you should start thinking about renal replacement therapy; learn about the different options you have early enough to allow sufficient time for the necessary preparations.

There are three different treatment options available to replace some of the lost kidney function:

Kidney transplantation
Haemodialysis
Peritoneal dialysis

Transplantation:

is an important topic for thousands of people worldwide with chronic kidney disease. For those who do receive a donor kidney, it offers hope for a chance to live more freely and with fewer dietary restrictions. It’s a complex subject that requires ample information, time and thought before you can make the best decision for yourself. 

What is kidney transplantation?
Many patients with chronic kidney disease are suitable candidates for transplantation, but not everyone is. So if you would like to explore transplantation as a treatment option, the first step is to discuss your personal situation with your nephrologist. He or she will evaluate a number of aspects of your overall health and kidney condition before making a recommendation for you.

If your nephrologist concludes you are a good candidate, you will need to complete the necessary examinations and tests. Then your doctor can place you on the national transplant list to receive a kidney from a deceased individual, or find a compatible live donor.
Compatibility is key.
For successful transplantation, the recipient and the donor must be compatible with each other. This means that both parties have a compatible blood type and matching tissue, which lowers the risk of the recipient’s body rejecting the donor kidney. Prior to the operation, a range of laboratory tests will be done to verify compatibility.
Receiving a kidney
There are two ways to get a donor kidney: from a living person or a deceased donor. Living donors tend to be someone in your family – one of your parents or a sibling – or someone close to you like a friend or spouse.

The main advantage of receiving a kidney from a living person is the time saved. As soon as you find someone who is compatible with you and willing to donate, the transplantation process can begin.

Deciding to donate a kidney requires careful thought and consideration. The donor should be aware of the risks associated with the operation to remove the healthy kidney and know that monitoring is required post-operation to ensure that the remaining kidney is adequately filtering out the body’s wastes.

In contrast, receiving a deceased donor kidney, which usually originates from someone who died in an accident, requires patience.

After placing your name on the national transplant waiting list, there is no rule about how much time will pass before a matching donor kidney will become available.

Occasionally the wait is short. But realistically you may wait for a few years – though the average waiting times differ from country to country.

Dialysis:

is a procedure used to replace some of the kidneys’ function. This treatment can replace only some basic functions of a normal kidney.

Two of the most important kidney functions – removal of excess body water and removal of waste products that have built up in the blood – are managed by the dialysis treatment.

However, even with this treatment, you will need to play your part in following the proper diet to keep water and waste products at an acceptable level.

Other functions, such as the role the kidneys play in building red blood cells and keeping your bones strong, are managed by medication.

peritoneal dialysis takes place within it.
takes place outside the body

Making the right choice

 

Transplantation is a highly personal topic – one that you should give both time and thought to. Perhaps begin by speaking to your nephrologist about your own situation. If you both agree that transplantation is an option, you can always place yourself on the list if you don’t have a living donor, and give the decision more thought while you wait.

Speaking to others about the pros and cons of transplantation could help you reach a decision.

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