FREQUENTLY ASKED
QUESTIONS

A Nephrologist is a physician who specializes in kidney care and treating diseases of the kidneys. Nephrologists are educated in internal medicine and then undergo more training to specialize in treating patients with kidney disease. Nephrologists are the only physicians specialized in managing dialysis care for people with end stage renal disease.

You should choose a Nephrologist that is trusting, collaborative and focused on partnering with you to provide the best individual treatment to maintain your quality of life. It helps if your Nephrologist works in a group that provides all services for kidney disease and is on staff at your hospital of choice. Ideally the physician group should be able to see you for all stages of kidney disease, including kidney transplantation and dialysis access intervention.

Kidneys are the organs that filter our blood to remove waste products and regulate the chemical in our blood. The kidneys also secrete hormones that help regulate blood pressure, prevent anemia (low blood count) and promote bone strength.

The kidneys can be affected by many diseases; the most common are hypertension (high blood pressure) and diabetes. If not well controlled, either of these conditions can result in kidney failure requiring dialysis treatment.

Symptoms of kidney disease can go unnoticed until severe damage has occurred. Some of the symptoms that you might notice late in the disease process are itching, muscle cramps, nausea and vomiting, loss of appetite, swelling in your feet and ankles, trouble sleeping, shortness of breath and decreased urine production.

Your physician may recommend a diet low in protein to help preserve kidney function, or a low-sodium diet to help lower blood pressure; however you should talk with your doctor before starting any diet.

Kidney function is most commonly determined by measuring the level of creatinine in the blood. As kidney function decreases the level of creatinine rises. The creatinine test is a simple blood draw and the result is used to determine Glomerular Filtration Rate (GFR). You may be required to have your urine tested; this helps your doctor understand if there is any leakage of protein or blood from the kidneys. Nephrologists also can use an ultrasound to look at the size and shape of the kidneys.

GFR stands for Glomerular Filtration Rate. GFR is the best test to measure your kidney function and determine your stage of kidney disease. GFR is calculated it from the results of your blood creatinine test, your age, body size and gender. Your GFR tells your doctor your stage of kidney disease and helps the doctor plan your treatment. If your GFR number is low, your kidneys are not working as well as they should. The earlier kidney disease is detected, the better the chance of slowing or stopping its progression. What can I do to protect my kidneys from damage? Since diabetes and high blood pressure are the most common cause of kidney disease it is important to work with your doctor to keep these under control. Living a healthy lifestyle including not smoking tobacco, maintain a healthy weight, and regular exercise can help lower your risk for kidney disease. Over the counter and prescription pain medications can damage the kidney. If you take a lot of these pills tell your nephrologist and make sure that any doctor who prescribes you pain medications knows about your kidney disease.

A kidney biopsy can identify what is interfering with your normal kidney function. A biopsy is a diagnostic test that involves collecting small pieces of tissue, usually through a needle, for examination under a microscope. You’ll be positioned so that you are lying on your stomach. This keeps your kidneys easily accessible from your back. You may be given a pillow or towel, since you have to remain still and stay in this position for about 30 minutes. The procedure usually takes less than an hour. Not everyone with kidney disease will need a kidney biopsy; you need to speak to your physician to determine if this procedure is necessary for your condition.

Complete and irreversible kidney failure is called end-stage renal disease, or ESRD. Patients whose kidneys have completely shut down can live productive lives for years using a renal replacement therapy. There are three types of renal replacement therapy: hemodialysis, peritoneal dialysis and kidney transplantation.

In hemodialysis, a dialysis machine and a special filter called a dialyzer, are used to clean your blood. The artificial kidney (dialyzer) works by pumping the patient's blood through thousands of tiny tubes that are bathed in a special solution, called the dialysate. Waste products in the blood float across the tubes into the dialysate, purifying the blood. Hemodialysis is generally done three times a week, and takes between three and four hours per session at a dialysis center.

In peritoneal dialysis, special fluid is introduced into the abdomen through a plastic catheter. The fluid remains in the abdomen and draws excess fluid and waste products from the blood. After a prescribed period, the fluid (with the waste products) is drained and discarded. Peritoneal dialysis is done by the patient or family member at home and requires some training.

A pathway to your blood is needed for hemodialysis, vascular access is created to make treatment possible. The access is usually created in your arm during a short surgery. One type of access is a fistula, another type of access is a graft. In some cases an external catheter may be inserted into a vein in your chest or neck. A catheter is usually temporary and replaced by a fistula or graft.

A donated kidney may come from an anonymous donor who has recently died or from a living person, usually a relative. If you are interested in transplantation your physician will refer you to a transplant center where you will be followed by a Transplant Nephrologist throughout the transplant process. Not everyone is a candidate for kidney transplantation, however you will undergo through testing to ensure it is safe for you to receive a transplant. It is best to explore transplant early in your disease course.

The wait time to receive a transplant can vary depending on the location, your blood type, immune system activity and other factors. In general, the average wait time is 3-5 years; however you should speak to your Transplant Nephrologist to get the estimated time frame specific to your unique factors.