Dialysis deferral 5 years so far

Tim Ahlstrom first came to Johns Hopkins in March 1989, at age 50, with the following history. Protein had been noted in his urine during a routine exam 25 years earlier. Four years earlier he had developed heart failure, fever, anemia, and a moderate degree of kidney failure, all of which remained unexplained and receded, except for the kidney failure, which persisted. He was placed on a diet mildly restricted in protein and given drugs to control high blood pressure. He gained 30 to 40 pounds...

Behaviors and Medical History That May Lead to Kidney Failure

Nonprescription analgesic drugs, sometimes called nonsteroidal anti-inflammatory drugs (NSAIDs), sold singly or in combinations, have the potential to cause kidney failure, when taken long term. Examples are Advil, Aleve, Alka-Seltzer, aspirin, BC Powder, Ecotrin, Excedrin, ibuprofen, Motrin, Tylenol, Vanquish, and many others. Combination drugs seem to be especially dangerous. NSAIDs are probably the most widely used drugs in the United States, but no one knows for sure how many patients with...

Excessive Potassium

Excess potassium leads to an increase in serum potassium concentration above the upper limit of normal, a condition called hyperkaliemia. Normal serum potassium concentration is 3 to 5 mEq per liter. At 5 to 6 mEq per liter, hyperkaliemia is not threatening, but above 6 mEq per liter, it is very dangerous. Occasional patients may develop intestinal symptoms, but generally hyperkaliemia causes no symptoms. Sudden death from cardiac arrest occurs without warning. The electrocardiogram will show...

Dialysis deferral 4 years

Jerry Strong, a 35-year-old social worker, had developed glomerulonephritis at age 19 and had had recurrent ankle swelling and occasional gout ever since. After one year of observation, he was started on a very-low-protein diet supplemented by either essential amino acids or ketoacids. By age 39 it was clear that his kidney disease was still progressing, and ketoconazole plus low-dose prednisone was added. For the next four years he continued this regimen. During this time he complained only of...

Is Remission of Kidney Failure Possible

There has been a lot of talk recently about remission of chronic renal failure. A decrease in the loss of protein in the urine, in the absence of kidney failure, or when the kidney disease is acute, certainly does occur. But a small scarred kidney is not going to grow back into a normal one, no matter what. There is no such thing as remission of chronic renal failure. However, arresting the progression of the disease is a real possibility, as shown by a number of publications and by several...

Patients with Kidney Failure Caused by Drug Abuse

Leigh Dell, age 73, has never been to Johns Hopkins, because he lives too far away. He has had protein in his urine for many years (perhaps as a result of taking Advil over a period of years following a leg fracture). He learned in August 1999 that his serum creatinine level was elevated (to 2.9 mg per dl) and his serum urea nitrogen level was 58 mg per dl (normal is less than 25 mg per dl). His wife, after some reading, decided to start a low-protein diet and tried to assemble an essential...

When to Opt for Dialysis

Despite all the work that you may have done in following the advice and treatment plans given in this book, and working with dietitians and your doctors, you may find that one day you do need dialysis. When kidney function gets very low, dialysis is necessary to replace the work of healthy kidneys and to remove waste products from the blood and body fluids. The two types of dialysis, hemodialysis and peritoneal dialysis, are very different. During hemodialysis treatment, your blood travels...

Dietary Treatment of the

The nephrotic syndrome has been mentioned throughout the book as something that is different from kidney failure, but which often ends up causing kidney failure. Let's examine exactly what the nephrotic syndrome is and how it can be treated. The nephrotic syndrome is defined as a very high rate of excretion of protein in the urine (greater than 3.5 g per day), a low level of albumin in the blood (less than 3.5 g per dl), and edema (swelling of soft tissues, such as the ankles, the abdomen, and...

Coping with Kidney Disease

A 12-Step Treatment Program to Help You Avoid Dialysis and contributions by Nga Hong Brereton, M.S., R.D., I.B.C.L.C. Copyright 2004 by Mackenzie Walser, M.D., and Betsy Thorpe. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada Design and production by Navta Associates, Inc. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical,...

The Low Protein Diet and Predialysis Treatment

Before putting any patient on dialysis, doctors have an obligation to tell the patient that there is an alternative available, namely dietary treatment and close follow-up to watch for the other conditions that could endanger the patient with kidney failure. The low-protein diet is discussed in detail in Chapter 7, and other complications and their treatments are discussed in the following chapters. But let's explore the case for and against this alternative treatment that I advise as a first...

Ketoconazole and Low Dose Prednisone

Ketoconazole Nizoral has been used extensively to treat fungal infections for a number of years. Ketoconazole also is used in renal transplant recipients to reduce the rate of metabolism of cyclosporine, thereby lowering the dosage requirement of this expensive drug. Ketoconazole inhibits the synthesis of cortisol, the main glucocorticoid hormone produced by the adrenal cortex. High rates of production of cortisol are associated with faster progression of chronic renal failure, while low rates...

What Do Kidneys Do and What Happens When They Fail

Before we look at what you can do when your kidneys start to fail, it's a good idea to review the basics on how the kidneys work in the body. With this knowledge, you will get a better understanding of why the kidneys are so important in the functioning of your body and the extent of the damage that can occur to your health if things do go wrong. The two kidneys lie in the abdomen on the muscles of the back, near the waist, and are about 5 inches long. The urine formed from each kidney passes...