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Dialysis of kidney, blood cleaning process, hospitalization. Kidney transplant required ?

Answered by
Dr.
Dr. Sree Bhushan Raju

Nephrologist

Practicing since :1994

Answered : 92 Questions

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Posted on Fri, 28 Sep 2012 in Kidney Conditions
Question: Dear Doctor,
This is for my brother XXXXXXX, Age 36 years, height 173 cms, weight 103 kgs. I have just undergone a medical health checkup and the doctor advised dialysis of the kidney where the doctor say it will take about 7 days hospitalization to start the process , also he further said that all the blood has to be cleaned during this process. We are worried and would like to have second opinion on this, will upload the medical checkup report.

thank you so much,
XXXXXXX
doctor
Answered by Dr. Sree Bhushan Raju 21 hours later
Hello XXXXXXX,

Thanks for posting your query.

You have provided with good information but I would like to know few more things as this would help me in suggesting you better.

You did not mention whether it was a routine health checkup or investigations done out of major symptoms like swelling of body, loss of apatite etc.

It makes a big difference in your case as routine check up detecting renal failure is unlikely to push the patients towards dialysis.

You also did not mention about the renal function test, Kidney size in the ultrasound etc.

You need to give more clinical and biochemical details so that we can discuss about his requirement of dialysis.

Awaiting your response.

Regards,
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sree Bhushan Raju 4 hours later
Dear Doctor,
Thanks for the reply. Doctor, I have already attached the report and it would be difficult for me to explain about the medical checkup details and other test results. I would like to request you to kindly check the attached medical investigation reports please.
1) It wasn't a routine checkup , it was done as he had diarrhoea a week back and after few days his feet started swelling etc.
2) If we go ahead with the dialysis as advised by the Apollo Doctors there in Kolkata, will it be a life-long treatment or for a certain period of time ?

Waiting for your kind reply and thanks
regards
XXXXXXX
doctor
Answered by Dr. Sree Bhushan Raju 15 hours later
Hello XXXXXXX,

Thanks for the follow up query.

I have gone through the reports that you have sent across. But, the doctor notes shows that your brother has Diabetes and significant renal failure with S. Creatinine of 16.2 mg/dl.

There is definitely a significant amount of problem in his kidneys.

He has a derangement in his renal function. He has a Blood urea of 176 mg/dl, Serum Creatinine of 16.2 mg/dl, high serum uric acid levels as 9.6 mg/dl which indicates moderate to severe kidney malfunction.

He also has Bilateral small kidneys with increased cortical echogenicity and loss of cortico-medullary differentiation suggesting Renal parenchymal disease.

He also has a very low Haemoglobin level of 8% with a raised ESR of 95mm.

Urine routine shows presence of proteins in +++ range.

Also GGT is around 134 U/L which is high.

However his ECG, 2 D echo reports are normal suggesting normal heart functions.

Usually patients with Diabetes will have normal sized kidneys despite having almost 100% kidney failure. This shows that he must be having a non diabetic kidney disease.

However as kidneys are small ( which cannot take place over a period of days, definitely over years) we presume that he must be having it since a long time.

As he had very high creatinine at the time of diagnosis preceded by loose motions and vomitings, which is an acute component. We call it as acute on chronic kidney disease.

There is a possibility that he can improve after few sessions of hemodialysis.

However a major group of patients in such situation may not improve and continue to require dialysis followed by transplantation.

Hope this reply is of help to you.

I will be available for your further queries if any.

Regards.
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Sree Bhushan Raju 7 hours later
Dear Doctor Sree Bushan ,

thank you so much for the reply and it is gonna definitely help us in taking decision on what course of actions we take regarding my brother. He will be starting his dialysis tomorrow ie 13th Aug 2011. I have a few query if you would be kind enough to answer them ...
1) This dialysis will help or should we look forward to kidney transplantation ( his blood brother can donate kidney). Or can he get better and recover from dialysis completely?
2) What are the chances of patients having the same condition as my brother recovering through hemodialysis
3) If we decide to go for kidney transplantation, which hospital will be the best in India? and how long will it take to recover from this.

Once again, thank you so much
regards
XXXXXXX
doctor
Answered by Dr. Sree Bhushan Raju 17 hours later
Hello XXXXXXX,

Dialysis will help your brother as a temporary measure but it is not a permanent treatment.

Kidney transplantation is the ideal treatment for your brother however you need to wait for few weeks before declaring it as end stage renal disease and opting for the transplantation.

He may not get better and recover from only Dialysis. As I said Renal transplantation would be required depending on his progress.

Dialysis is not to cure the kidney failure it only supports the body by removing the toxins in the absence of kidney function. Hence, don't presume that he will be cured of his kidney failure through dialysis.

There are at least 100 good hospitals in the country where transplantation program is being successfully organized.

You need to choose the center depending on your economical, Physical and social factors rather than going by"the best in the country" concept.

Recovery in the post operative period is quite good with very minimal or no complications at all.

Hope I have answered your query.

Regards,
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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