Kidney Disease and Transplant: Frequently Asked Questions

Who qualifies for a transplant? Is there an order of qualifications?
Who determines who is qualified for transplant is determined at each medical center. The doctors who are caring for the patients do this. Once a patient is ready for listing, then all patients in the United States are listed with The United Network for Organ Sharing. (UNOS). There are rules that determine the priority of order that differ for each different kind of organ.
I am 27 and female, and I have kidney disease. I am wondering when a kidney shuts down, is it removed?
Generally speaking, it is not necessary to remove the native kidneys when they are not working. There are some special circumstances where that may be needed.
I saw a headline about kidney transplants lasting longer. How long can one expect the transplant to last?
On average, kidney transplants last somewhere between 10 and 12 years. Some may fail shortly after transplant; some may go on for the life of the recipient.
Do recurrent kidney stones lead to kidney disease?
Generally speaking, recurrent kidney stones don't lead to kidney failure, but they may, if they cause long-term obstruction of the kidney.
Can the non-functioning kidney cause recurrent UTI's?
No, generally speaking, patients do not get urinary tract infections because of a nonfunctioning kidney.
What effect does diabetes have on the kidneys?
Diabetes is now the most common cause for kidney failure in the US. In about 1/3 of patients kidney failure is due to diabetes. There are several things that can be done to reduce the likelihood of kidney failure in diabetics. One is tight control of blood sugar. Another is reducing the blood pressure. This should be about 125/75. The third is certain kinds of blood pressure medicines have been shown to protect against progression of kidney disease from diabetes.
Is kidney disease hereditary?
About 10 percent of patients with kidney failure are due to hereditary causes. The commonest is a condition known as polycystic kidney disease.
What does blood in the urine typically mean?
Blood in the urine may often be a benign condition related to infection or other problems. It may mean a stone or even urinary tract cancer. Therefore, anyone who has blood in the urine should see his or her doctor about it.
Are alcoholics at risk for kidney disease? If so, why?
No, kidney disease is not a common problem amongst alcoholics.
How long can you live with one kidney?
As long as your the kidney is healthy, having only one kidney does not affect your survival at all.
What is the recovery time after a kidney transplant? What kind of lifestyle changes do you need to make?
You recover from a kidney transplant much like any major surgical procedure. Typically after two weeks, you are feeling pretty good. You need to take drugs to prevent rejection for the rest of your life. The only other lifestyle change is that we urge transplant patients not to be involved in contact sports.
How do you know if you are at risk?
Everybody should have his or her blood pressure measured at least once a year. This is because high blood pressure is one of the earlier warning signs for kidney problems. There is a great deal of interest also in screening for protein in the urine. This can be an evidence of early kidney disease.
When is there a concern about dialysis?
Patients differ a great deal in the symptoms they have from kidney failure as their serum creatinine rises. Generally speaking, when the serum creatinine is about 8 mg/dl, serious consideration should be given to starting dialysis.
Is the kidney regularly "monitored" in diabetes patients and if so how?
Yes, it is very important for kidney function to be monitored in diabetic patients. This is done both by monitoring blood pressure and for a special test for protein in the urine. It should be done at least yearly.
When the kidneys are echogenicity what does that mean?
Echogenecity describes what we see with a special kind of x-ray like test of the kidney. Typically what it means is that there are scarring or cysts within the kidney.
The athlete who plays basketball in San Antonio has recently started playing again with a kidney transplant. Do you see this as risky, or should he be able to do it without additional risk to the kidney?
In general, we recommend that people avoid contact sports, and college and professional basketball can be pretty rough. This man's whole life is basketball, and the presence of a kidney transplant is not a complete reason for him not to do so.
For patients who need dialysis, how often does it need to be done? Daily?
No, most patients who get dialysis with a machine at a center (hemodialysis) are dialyzed three times a week.
What causes rejection after a kidney transplant? Isn't there a way to tell if it will be rejected before the surgery?
Rejection of a kidney is due to the same immune response that helps to protect yourself against colds and other viruses. We can do some tests, which indicate in a general way, how likely rejection will be. Unfortunately, there is no way to be sure about it.
What can be does for fatigue when you have kidney disease?
Fatigue is a very common problem with kidney failure. Sometimes it is due to a low red blood cell count. We have special medicines that can take care of that problem. Unfortunately, if fatigue is severe, due to kidney failure generally the best way to manage it is with dialysis.
What are some other causes of kidney failure, and what can be done to prevent it from happening?
As I said, the commonest cause in the US is diabetes. The second commonest cause is high blood pressure. This is a particular problem amongst African-Americans. After diabetes and high blood pressure comes a group of special diseases of the kidneys called glomeronephritis. The fourth commonest cause is hereditary kidney disease such as polycystic kidney disease.
I read something about a German study concerning a vaccine and fighting kidney cancer, any comments?
I don't know about that study. Kidney cancer is a serious problem and like other kinds of cancer, we are actively looking for ways to use the immune system to fight cancer.
What is serum creatinine?
Serum creatinine is a test that your doctor gets to measure how well your kidneys are filtering.
What is the percentage of rejection in kidney transplantation?
With current treatment for kidney transplants, early rejection is now down to about 15 percent. Most of these people will not lose the kidney from rejection. In the longer term, what is called chronic rejection, can cause the loss of about half of kidneys during a patients lifetime.
I have had diabetes for 34 years and now I have diabetic kidney disease. I am taking 20 mg of accupril and low sodium and low protein diet. I want to save my kidney as long as possible. Can you give me some advice?
It sounds as though your doctor has told you all the right things. Accupril is one of the special medicines I referred to before that protects the kidneys against diabetic kidney disease.
What causes recurrent kidney infections when you have kidney disease?
Many people, particularly women, have recurrent urinary tract infections. These typically don't damage the kidney and aren't related to kidney disease but rather problems with the bladder. Occasionally, a patient with scarred kidneys will also have frequent kidney infections. This may be because it is harder to treat an infection in the presence of a lot of scarring.
What can we do to take better care of our kidneys?
The most important thing is to make sure that your blood pressure is under good control by having it measured once a year. It may also be wise to have your urine tested for protein periodically.
I also read that nervous leg syndrome goes along with kidney disease?
Patients with diabetes often have injury to the nerves in the legs that cause "nervous leg." This may accompany kidney disease, which is also common in diabetes. Patients who are on dialysis sometimes have cramps in their legs following a dialysis treatment.
My 10 year old daughter just had some diagnostic testing completed following years of UTI's, and the results said her right kidney has class III scarring. She has some reflux as well. Our family physician said that she needs to go to an urologist in the next few months. Should I be concerned and get her in quicker?
I can't give you advice specifically about your daughter, but it sounds to me like your doctor has given you good advice that you should follow and not be overly worried at this point.
What is the process of dialysis?
The major function of your kidneys is to filter impurities out of your blood just the same way as you purify water using a filter at home. When the kidneys don't work, we have to use another process to do the same job. We do this by running the blood across one side of their membrane and the washing fluid on the other. This is to permit the impurities to cross from the blood into the washing fluid. This is called dialysis.
In a recent study of the frequency of high blood pressure in the United States, it was found that one-third of the patients with high blood pressure didn't even know they had it. Have all of you had your blood pressured checked within the last year? You can get your blood pressure measured in many drug stores, often at work, and many doctors will have their nurses measure your blood pressure for free. The two most important things that we can do in this country to improve health would be to stop smoking and be sure everybody's high blood pressure is treated.
What is the relationship between blood pressure and kidney disease?
Blood pressure and kidney disease go together in two ways. First, high blood pressure is the second commonest cause of kidney failure and contributes to kidney failure in diabetes and other forms of kidney disease. At the same time, kidney disease causes high blood pressure. If you get kidney disease and then get high blood pressure from it, that high blood pressure will cause further damage to your kidneys.
What else should be done to get tested to make sure kidney disease isn't imminent?
There isn't a whole lot you can do besides to get your blood pressure checked and have your urine checked.
Where do kidneys come from for transplantation?
Currently, in the US, about 30 percent of kidneys for transplantation are coming from relatives or friends of the person with kidney failure who are willing to donate a kidney for transplantation. The other 70 percent comes from patients who have died suddenly (generally because of severe brain injury) and who have indicated that they want to have their kidneys used for transplantation if they die.
When does someone go on dialysis if the one kidney is only 70 percent functional?
If you have one normal kidney, you will not need to have dialysis at all. Having only one kidney 70 percent functional is not much of a worry as long as it doesn't progress.
If you only have one kidney, how do you know when the other one is going bad?
The most important things to do are to measure the urine protein, the blood pressure, and the blood chemical measurement called the serum creatinine. It is important to know why the first kidney went bad. In many situations when one kidney goes bad, it will not have an effect on the other kidney.
Can kidney disease cause back pain?
Kidney infections and certain kinds of kidney obstructions can cause back pain. Most people who have kidney disease do not have back pain. Most patients with back pain don't have kidney disease. There is no necessary relationship.
My potassium, Creatinine, and Bun tests are all higher than normal. What are the highest numbers these get to before dialysis?
Generally speaking, patients whose creatinine gets higher than about eight will be started on dialysis. You should ask your own doctor specifically about your circumstances.
How long can you stay on dialysis while waiting for a transplant?
I have had some patients who have been on dialysis for more than 25 years. There is no upper limit. However, a recent study has shown pretty convincingly that survival is better when patients get a transplant. In my opinion, anyone on dialysis who is in generally good health should be eager to get a kidney transplant.
I have heard that some patients can do dialysis themselves at home. When and how can this be done?
Yes, the patient at home generally does a kind of dialysis called peritoneal dialysis. Somewhere around 1/4 of all of our patients are dialyzed that way. Any patient should discuss this possibility with their doctor. A small fraction of the patients, may be around five percent, do hemodialysis at home. Here in Iowa, where patients often have to travel a long way to get to a dialysis center, we have encouraged this kind of home dialysis.
Being over weight, can that cause your other kidney to shut down?
People who are very seriously overweight have an increased frequency of kidney failure. That is not striking for patients who are only modestly overweight. However, being overweight is a major contributor to high blood pressure. Patients whose blood pressure is high should try to get their weight down.
What can be done for swelling and fluid?
For patients who don't need dialysis, we have medicines called diuretics that help patients get rid of extra fluid. In addition, patients with kidney disease should generally avoid a lot of salt in their diet. Too much salt in the body is the major cause for edema, or swelling.
Is being on dialysis that bad? People say it is horrible.
I have had some patients who work full time in addition to having time to dialyze themselves three times a week. One of my friends is a doctor and another a radiation physicist. People on dialysis can do quite well. On the other hand, it is troublesome to do dialysis three times a week. Some patients have real problems with the dialysis treatments. We feel having normal kidneys is best of all. If you have kidney failure, a transplant is next best. Dialysis can be fine and is better than being dead.
Can people with kidney failure still eat sweets? I've heard that they can't?
There is no particular problem with sweets in kidney failure. Since one-third of patients with kidney failure have diabetes, and diabetics should be careful about sweets, many patients with dialysis should be careful about sweets.
What are the advantages of living donation?
There are three advantages to living donation over the patient getting a cadaveric kidney (a kidney from a patient who recently died). The first is that there simply are not enough cadaveric kidneys to go around. Patients may need to wait years for their chance to get a cadaveric kidney transplant. Since patients with a transplant survive better than patients on dialysis, a timelier transplant actually improves survival. Secondly, the kidney from a living donor is a completely healthy kidney in comparison from a kidney from a person who has just died that has had the injury due to the patient's fatal condition of death. Kidneys from living donors work better and longer than kidneys from cadaveric donors. Thirdly, in the case of kidneys from a related donor, there may actually be an advantage in tissue matching that also translates into better and longer kidney survival.
Can someone who is not a close relative be a living donor?
Yes, a kidney from a non-related living donor will have the first two advantages but not the third.
How does living donation affect the donor?
There is a very small risk of serious injury related to the donation surgery itself (1 in 3 to 10,000). Patients who have donated a kidney can be sore for a period of time. This is less of a problem with a new technique being developed to remove donor kidneys by laparoscopy (a method similar to the new way of doing gallbladder surgery through a very small incision). The long-term risks to being a kidney donor are very small indeed.
What does the operation involve?
The operation is different depending on whether it is done by "open or by laparoscopy." In either case, an incision is made into the person's side, the blood vessels to the kidney are tied off, and the ureter (tube from the kidney to the bladder) is tied off and the kidney is taken out. Typically patients recover from laparoscopic surgery within a week and from the donor surgery within a couple of weeks.
Why are more African-Americans more prone to kidney disease?
The reason for the high frequency of kidney disease in African-Americans is not well understood but probably relates to a tendency for African-Americans to scar more severely than other people. Given a certain injury in the kidney where another person might heal that injury with no loss of function, the African-American may scar the area and lose function. In addition, African-Americans have a much higher incidence of high blood pressure. This is a common cause of kidney failure amongst them. These two issues, the high blood pressure and the kidney disease may actually be related.
If I had kidney failure, is it more of a chance my kids will have to kidney problems?
About 10 percent of kidney disease is due to hereditary problems. Both high blood pressure and diabetes are more common in children whose parents have high blood pressure and diabetes. If your children don't have either high blood pressure or diabetes, then they won't be at increased risk.
Can kidney and urinary tract abnormalities be detected before birth?
The commonest urinary tract problems affecting babies can often be diagnosed by ultrasound before birth. Sometimes, these can be repaired before birth.

Lawrence Hunsicker, MD
Department of Internal Medicine