Young diseases

If your child has been diagnosed with kidney disease, you are no doubt feeling distressed and bewildered. These feelings are normal. And once you realize that your child's illness is a reality the family must accept, you can develop some practical ways to cope with the day-to-day aspects of it. Here are some guidelines others have found helpful:

* Learn about the disease and its treatments.
* Learn as much about your child's disease and its treatment as you possibly can. And pass this information on to your child. You'd be surprised at how much even very young children can understand. And many times they will accept information more easily than an adult.
* Encourage your child to ask questions. Many times, your child will ask questions you had not thought about or were afraid to ask because you thought they sounded "dumb".
* Don't try to explain more than your child can understand, but don't lie and don't apologize for any treatments or procedures that have to be followed.
* Help your child understand that the doctors, nurses, social workers, dietitians, laboratory personnel and everyone else is on his or her side. They all want to help your child feel better, even if that means they have to do things that will cause some temporary pain or discomfort.
* Actively participate in your child's care.
* Develop a spirit of mutual respect and cooperation with health professionals.
* Write out all the details of your child's medical history, including dates. This will make it easier for you each time you come in contact with a new doctor.
* Try to be with your child as much as possible during treatments and any hospitalization that might be necessary. If you cannot be there, arrange for someone else to be presents i.e. a grandparent, other relative, or close family friend. And make sure a favorite book, stuffed animal or special blanket is taken along.
* Help your child take control of the illness.
* Try to maintain a normal daily routine, even during hospitalization.
* Help your child understand about doctor's offices, hospitals, dialysis centres and laboratories and how they are used. By helping your child understand the places that are filled with strange and frightening instruments and machines, you can help eliminate a lot of your child's fear.
* Be creative in finding ways for your child to participate in his or her own care. Your child will feel much more in control if you provide as many opportunities to do so as you can.
* Help your child to understand and accept diet restrictions. Even a child as young as 2 or 3 can understand about "diet" if it is explained simply. Often, the child will be more compliant with dietary restrictions than an adult will. Have your child make a list of favorite foods and take him or her with you when you talk to the dietitian to see if these foods can be incorporated into the diet plan. Whatever you do, don't ever use bribes or force your child to eat. These tactics rarely work and more often turn mealtime into a very unpleasant experience.
* Don't let medicine time ruin your day. A matter-of-fact attitude is your best weapon in getting your child to take medication. Your child has no choice about whether or not to take prescribed medication, but you can offer a choice of when and where. And once the choice is made, make a schedule and stick to it. Unpleasantness is a lot easier to cope with if you know exactly when it is coming and don't procrastinate. Sometimes medication must be given with meals, but don't give it at the table where your child eats. Find a place not associated with food and eating, such as the living or family room while your child is distracted by a favorite TV show.
* Another weapon you have at medicine time is plain, ordinary water. If your child is on a fluid-restricted diet, water may be one of the things he or she would like to have most, so reserve part of the day's fluid intake for a couple of swallows after medicine time.
* Share your experience with others. Don't let yourself become isolated. Talk with the kidney staff and with other families of children with kidney disease.
* Don't hesitate to ask relatives and friends for help. Chances are they want to, but don't know how, and are just waiting for you to ask. Sharing your experience will help you find ways to grow with it.

Since another medical ailment usually causes chronic kidney disease, the most effective way to treat kidney disease is to treat and manage the disease that originally caused your kidney damage, for instance diabetes and hypertension.

In Malaysia, some 57% of kidney failure patients are diabetics and 6% hypertensive. Hence, your doctor will use blood and urine tests to regularly monitor your kidney’s condition. These tests will determine how your kidneys are functioning and whether any changes to your treatment plan is required.

Chronic Kidney Disease (CKD)
CKD is often progressive, and if this happens, your symptoms may occur more frequently or become severe.

Depending on your stage of CKD, you may need to make dietary changes to help slow its progression. You may be asked to limit your use of salt or watch how much potassium or phosphorus is in your diet.

In the early stages of this disease, only a small part of the kidney is involved. Some people have destruction of the glomerulus or renal tubules. Early kidney disease can cause scarring, which interferes with the blood flow to a portion of the kidney.

In many cases, early detection and treatment may keep CKD from getting worse.

Over time, if CKD is not treated, End Stage Kidney Failure occurs, one will require immediate and ongoing dialysis treatment or a kidney transplant.

In most patients, medication is used in addition to dietary restrictions to prevent further damage to the kidneys. This is done to try and delay the progression to End Stage Kidney Failure.

Kidney Failure
The treatment of End Stage Kidney Failure involves haemodialysis (using a kidney machine), peritoneal dialysis or kidney transplantation.

The type of treatment chosen is determined by the general health and medical condition of the person, by its impact on the person's lifestyle and by the person's personal preference.

Many people may receive each one of these three forms of treatment at various times. What may be the best treatment for one person at one time might not be the best for another or for the same person at a different time.

Dialysis is a life-saving process that artificially replaces part of the functions of the kidney.

There are two types of dialysis: haemodialysis and peritoneal dialysis.

Haemodialysis involves removing blood from the body and filtering it in an artificial kidney


(dialysis machine). The patient is connected by a tube to the dialysis machine, which continuously draws blood out, cleans it and removes excess fluid and then returns the blood back to the patient. Haemodialysis must be performed for 3 to 4 hours at least three times a week. It is usually performed at a dialysis centre, though home dialysis is also possible.

Peritoneal Dialysis is internal or in-body dialysis. Peritoneal dialysis entails use of a blood-cleansing solution called "dialysate" that is introduced into the peritoneal cavity, the region of the abdomen that is lined by the peritoneum. While in the peritoneal cavity, the dialysate works to extract toxins and excess fluids from the blood. After a period of time, the solution is then drained from the body cavity.

Three types of peritoneal dialysis are available.
1. Continuous Ambulatory Peritoneal Dialysis (CAPD).
CAPD requires no machine and can be done in any clean, well-lit place. With CAPD, your blood is always being cleaned. The dialysis solution passes from a plastic bag through the catheter and into your abdomen, where it stays for several hours with the catheter sealed. The time period that dialysis solution is in your abdomen is called the dwell time. Next, you drain the dialysis solution into an empty bag for disposal. You then refill your abdomen with fresh dialysis solution so the cleaning process can begin again. With CAPD, the dialysis solution stays in your abdomen for a dwell time of 4 to 6 hours, or more. The process of draining the used dialysis solution and replacing it with fresh solution takes about 30 to 40 minutes. Most people change the dialysis solution at least four times a day and sleep with solution in their abdomens at night. With CAPD, it’s not necessary to wake up and perform dialysis tasks during the night.

2. Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
CCPD uses a machine called a cycler to fill and empty your abdomen three to five times during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day. You may do an additional exchange in the middle of the afternoon without the cycler to increase the amount of waste removed and to reduce the amount of fluid left behind in your body.

3. Combination of CAPD and CCPD
If you weigh more than 175 pounds or if your peritoneum filters wastes slowly, you may need a combination of CAPD and CCPD to get the right dialysis dose. For example, some people use a cycler at night but also perform one exchange during the day. Others do four exchanges during the day and use a minicycler to perform one or more exchanges during the night. You’ll work with your health care team to determine the best schedule for you.


6.4. Kidney Transplantation
A kidney transplant involves the taking of a kidney from the body of a healthy person or cadaver and implanting it surgically into the body of someone who has lost kidney function. The transplanted kidney can then perform the function of that person's own kidneys. A successful kidney transplant will allow you to have a better quality of life, improves lifestyle and will free you from dialysis treatments.

Whilst a transplant is not a cure for kidney failure, it does allow patients to live a more "normal" life than that experienced on dialysis. Patients with a well-functioning transplant have a greater sense of well-being and are able to enjoy a lifestyle free of dependence on dialysis treatments, although they must continue with their transplant drug treatment.

A transplant can mean improvement in anaemia, bone disease and in children, body growth. It also offers freedom from previous dietary and/or fluid restrictions and from restrictions on time and mobility.

It is the treatment of choice for chronic kidney failure for those who are considered suitable candidates for a transplant. To find out if you are a candidate, your health care team will perform a series of tests as part of a complete medical assessment.

Many ESRD patients benefit greatly from a kidney transplant. After successful transplantation, patients no longer require dialysis. Today there are many patients on waiting list to receive a kidney transplant. The development of effective anti-rejection drugs means that the prognosis for five-year survival for most of these patients is high.

To avoid rejection, the best possible source of kidney donation is a close relative whose blood and tissue type match the patient's. Donated organs from cadavers also have high success rates. A growing source of kidneys for transplantation comes from living donors who are not blood relatives, but with whom the patient has an emotional tie, such as a spouse, friend or co-worker.

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One belongs to the high risk group if he has the following or he is:
o Diabetes
o High blood pressure
o Family history of kidney disease, diabetes or high blood pressure
o Obesity
o Kidney stone
o Above 50 years old

Patients with diabetes, high blood pressure or individuals with a family history of kidney disease, diabetes or high blood pressure should have checkups on blood pressure, blood sugar and urine tests for at least once a year to check on the status of their kidneys. It is important that patients with established kidney disease must monitor their condition by visiting their doctors regularly.

Practice a Balanced Diet
o Lower the fat, salt and sugar content in your diet and add more fiber, fresh fruits and vegetables. A low salt diet is especially important if you have high blood pressure.

Overcome Obesity
o The best way is with regular exercise and a well balanced diet. Exercise for 30 minutes for at least 3 times a week if possible.

Quit Smoking
o There is no 'safe' level of smoking and smoking is damaging to blood vessel walls. Damaged blood vessel walls can lead to atherosclerosis (hardening of blood vessels) and ischemia of the kidneys.

Avoid Unnecessary Medications
o Certain medications are toxic to the kidneys in susceptible individuals, especially if taken in large amounts over long periods. Your doctor can give you specific advice on what medications to avoid.


Screening Is Vital!
Annual Health Screening is vital to check whether your kidneys are healthy. Your checkup should include:

* Blood pressure
* Blood test for glucose and creatinine
o A kidney profile includes measurement of various chemicals and waste products in the blood. This test would be able to tell you if you have moderate to severe kidney failure. It is important to note that this test is usually normal in early kidney disease.
* Urine test
o The urine test is important in screening for kidney disease. Specialized urine test will be able to confirm early kidney disease thereby allowing appropriate treatment to prevent further kidney damage.

Ultrasound may be required for certain individuals. It is a form of scanning which looks at the kidneys and urinary tract. Certain diseases such as kidney stone, tumor, cyst or blockage of the urinary tract can be detected by an ultrasound scan.

he two major contributors to Chronic Kidney Failure in Malaysia are diabetes and high blood pressure. Hence, the sooner these illnesses are treated, the better the chance of preventing Chronic Kidney Failure.

Those suffering from these ailments should be medically supervised, because careful control of blood pressure, blood sugar level, taking a low protein diet and weight reduction can significantly slow down or even prevent the development of chronic kidney diseases.

In the case of acute kidney diseases, it is also important to seek medical attention early, so that effective therapy can be started promptly. Early treatment of acute kidney disease can prevent permanent damage, whereas delay in diagnosis and treatment may result in permanent kidney failure.

Even in the case of irreversible kidney failure, dialysis and kidney transplantation have made remarkable progress in recent years, enabling patients with End Stage Kidney Failure to lead active lives.

Signs & Symptoms of Kidney Disease



When kidney disease develops over a short period of time it’s called Acute Kidney Failure. This is usually caused by an acute 'insult' (damage) to the kidneys. Unlike Chronic Kidney Failure, this can usually be treated and cured. Acute kidney diseases often cause symptoms that are quite obvious, the most prominent being:
# blood in the urine
# swelling of the face, feet, ankles and legs
# new onset of high blood pressure
# shortness of breath

The above symptoms are more likely to occur in children because they are more likely to suffer acute kidney diseases. However, that does not mean adults are free of them, so if you note any combination of these symptoms, immediately seek medical attention.

Note that other diseases can also cause similar symptoms, but a simple urine test can indicate if they are due to kidney diseases. For instance, the urine test will indicate if albumin (protein) and blood are present in the urine, as they imply the presence of kidney diseases. A blood test can also show how well your kidneys are performing their main function of eliminating waste products.

In contrast, many chronic kidney diseases do not manifest clear warning signals in their early stages. There may be loss of appetite, mild swelling in the legs, and tiredness. It is not uncommon for these symptoms to be so mild or non-specific that they are ignored over long periods of time.

In fact, some people with chronic kidney disease do not have any symptoms in the initial stages. But as kidney function declines, symptoms may include:
# fatigue
# frequent headaches
# loss of appetite (anorexia)
# sleep problems (insomnia)
# itchy skin
# frequent urination or urinary retention
# nausea or vomiting
# swelling or numbness of the hands and feet
# darkening of the skin
# muscle cramps

Chronic Kidney Disease (CKD) means a condition that damages one’s kidneys. It decreases kidneys’ ability to keep one healthy by doing their functions.

CKD is a common, life-threatening illness that often goes undetected until very advanced.
CKD may progress slowly over a long time. A lot of people are not aware that they have
kidney disease until it’s severe. If it’s found and treated early, CKD may often be slowed down or stopped.

The risk factors for CKD include:
– Diabetes
– High blood pressure
– A family history of kidney disease, diabetes or high blood pressure
– Obesity
– Kidney stone
– Above 50 years old

Annual Health Screening is vital to check whether your kidneys are healthy.

You should visit your doctor or clinic and get tested. Your checkup should include:
o Urine test for protein
- Protein is an important building block in your body. Any filtered protein
is normally reabsorbed and kept in your body. When your kidney are
damaged, however, protein leaks into your urine.
- There are different tests to check for protein in your urine. If you have two
positive tests over several weeks, you are said to have persistent protein
in your urine. This is a sign of CKD.
o Blood pressure
o Blood test for glucose
o Blood test for creatinine
- Creatinine is a waste product that comes from muscle activity.
- Your kidneys normally remove creatinine from your blood. When your
kidneys are damaged, however, your blood creatinine may build to a high
level.
- The results of your test should be used to estimate your Glomerular
Filtration Rate, or GFR. Your GFR tells how much kidney function
you have.

Test results show CKD
Your doctor will want to pinpoint your diagnosis and check your kidney function to help plan your treatment. The doctor may do the following:

* Calculate your GFR, which is the best way to tell how much kidney function you have. You do not need to have another test to know your GFR. Your doctor can calculate it from your blood creatinine, your age, race and gender. Your GFR tells your doctor your stage of kidney disease and helps the doctor plan your treatment. (See the chart below on “5 Stages of Chronic Kidney Disease”)
* Perform an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your doctor whether your kidneys are too large or too small, whether you have a problem like a kidney stone or tumor and whether there are any problems in the structure of your kidneys and urinary tract.
* Perform a kidney biopsy, which is done in some cases to check for a specific type of kidney disease, see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor removes small pieces of kidney tissue and looks at them under a microscope.

Stage Description GFR Level mL/ min
1 Kidney damage with normal or higher GFR 90 or more
2 Kidney damage and mild decrease in GFR 60 to 89
3 Moderate decrease in GFR 30 to 59
4 Severe decrease in GFR 15 to 29
5 Kidney failure
(dialysis or kidney transplant needed) Less than 15


To prevent CKD progression
Early detection and treatment can often slow or stop CKD. How well your treatment can achieve this goal depends on:

* Your stage of CKD when you start treatment. The earlier you start, the better you are likely to do.
* How carefully you follow your treatment plan. Learn all you can about CKD and its treatment, and make sure to follow all the steps of your treatment faithfully.
* The cause of your kidney disease. Some kidney diseases are more difficult to control..

Do you know that your Kidneys…?

1. Weigh less than 1% of your body weight?
2. Receive 20% of the blood that is pumped by your heart?
3. Filter 180 litres of fluids per day to produce 2 litres of urine?
4. Maintain your body’s internal environment constant?
5. Remove harmful wastes from your body via urine?
6. Produce certain essential hormones?
- Erythropoietin which stimulates the bone marrow to produce red blood cells
- Renin to regulate blood pressure
- Activate Vitamin D to produce calcitriol which helps maintain calcium balance in
the bones.