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Living with One Kidney
Note: The information on this page is not medical advice. It should not replace consultation with trained and certified medical professionals. Use the information on this page at your own risk.
A common question among living kidney donors is "What should I do, now that I have only one kidney, to maintain my health?" The answer should come from your doctor. In the meantime, here is an edited version of responses to that question in an LDO message thread from February 2009.
From Dr. William L. Freeman, Living Kidney Donor
We Living Kidney Donors (LKD) on LDO or reading this do not need to wait for someone else in the health care system to prevent early heart attack, stroke, and CKD/ESRD in us. We can prevent them ourselves. The National Institutes of Diabetes, Digestive, and Kidney Diseases (NIDDK) is the institute in the NIH that is expert on kidney disease and preventing kidney disease. The NIDDK has a webpage for LKDers (also cited in LDO): "Solitary Kidney" http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney/ . NIDDK recommends that we people with one kidney:
. . "SHOULD KEEP THEIR BLOOD PRESSURE BELOW 130/80" --
and eat a low
salt diet that is
. . LESS THAN 2,000 MILLIGRAMS OF SALT PER DAY -- and, unless there is
a problem with taking them, use for anti-hypertensive medicines
. . ACE inhibitors or angiotensin receptor blockers, and if needed to
keep blood pressure below 130/80, 2 medicines -- and
. . a moderate protein diet -- and
. . avoid injury to the kidney.
I also recommend that:
. . we see a physician or nurses practitioner at least once a year; and
. . we get, record, and keep our blood pressure; and
. . we insist that the person adhere to those guidelines by NIDDK; and
. . we insist that we get at least yearly a serum creatinine, estimated
GFR using the MDRD equation, and urine albumin-creatinine ratio; and
. . we get, keep, and record those values; and
. . if the eGFR is less than 60, we get a 24 hour urine for creatinine
clearance or other direct test of GFR by isohexol or similar methods;
and
. . if the direct GFR is less than 60 ml/min, or if urine
albumin-creatinine ratio is above normal, we insist that the person
start us on either anti-hypertensive medicine recommended by the NIDDK.
. The DPP tells us what we need to do to prevent type 2 diabetes as
well:
. . we should exercise moderate at least 30 minutes a day 5 days a week;
. . we should eat a lower fat, lower calorie, diet; and
. . we should (if overweight) lose at least 7% of weight.
Let me add one more. Kidney stones in people with 2 kidneys are never good, and can be some of the strongest pain many people will ever experience. Kidney stones in people with only 1 kidney can be devastating -- and cause ESRD to boot. The hot climate of southern USA is known as the kidney stone belt, because the higher sweating requires that people drink more water to compensate. Most kidney stones usually form due to at least one common imbalance: not drinking adequate water for a long term. People with one kidney living in hot climates may need to drink as much as 64 ounces of liquid daily (not necessarily water, but any liquid) to prevent kidney stones.
From Diane Curtiss, Living Kidney Donor
I am going to share some information I put together a while back for another source. I have hesitated before to post it as I am NOT a physician and was reluctant to have others view it as a catch-all document for post donation. It was originally created more as a reminder for myself than anything because there is so little information out there for the layman - and what is out there for access is pretty sketchy.
Anyone can feel free to adapt it for their purposes, but please view it as informational only and certainly should not be interpreted as all inclusive or as God's law for living donors.
POST DONATION – THINGS TO CONSIDER
LIVING KIDNEY DONORS
This document lists items for living donors of kidneys to consider as concerns post donation life with one kidney. These items are guidelines only to aid in discussions with your individual primary care physician. Your situation may be different. Any questions or individual circumstances should be directed to your transplant center or personal physician. This list is not meant to diagnose nor to be used as a substitute for professional medical care. The items are numbered for easy reference and identification. The numerical sequence is not an indicator of the importance of the particular item.
1. Wear a medic-alert bracelet or jewelry to alert emergency personnel that you have only one kidney. Be sure to identify which kidney you have – i.e. “One kidney – right”. The bracelet should also identify any allergies or other conditions. Many pharmacies or doctor’s offices have information for placing an order. A source on the internet is American Medical ID at www.identifyyourself.com
[An addendum from Fr. Pat: Medical Alert bracelets for
persons with only one kidney are also provided by local chapters of the
National Kidney Foundation (www.kidney.org) and you can put
four short lines of medical/personal information on each side, as you
wish. Some local chapters provide them free, while others have to
charge a small fee. Locate your local chapter at the above website.]
2. Do not use NSAIDs (Aleve), aspirin, or ibuprofin (Advil). These pain relievers are hard on the kidneys. Use acetaminophen (Tylenol) only. Some transplant centers have said it is okay to use these occasionally, but if you do not have to, it is best not to do so. If you feel you need to use these drugs, discuss this with your personal physician.
3. Be cautious regarding any over-the-counter medications. Some contain ingredients you may not wish to use such as pseudoephedrine. An example is Pepto-Bismol which contains aspirin. Discuss with your physician and pharmacist which products you may use in the event of a cold, upset stomach, etc. It is best to review acceptable products in advance rather than waiting until you are in the throes of a bad cold.
4. Be cautious of supplements of ANY kind – even vitamins. Remember that anything you take orally will eventually work its way through your kidneys. The ingredient list of ANY supplement or vitamin should be reviewed with your transplant center and primary care physician before continuing with their use.
5. Avoid smoking. Among other things, smoking can damage the circulatory system. With one kidney, it is important to keep those arteries and veins in top working condition. Smoking may also lead to high blood pressure, which is damaging to the kidneys.
6. Use alcohol sparingly. In excess, it can cause dehydration, which is hard on your remaining kidney. Watch the amount of soft drinks you are consuming. Some of the ingredients (particularly in colas) have been linked to kidney stone formation. Kidney stones can cause not only discomfort, but damage to the structure of your remaining kidney. However, do make sure you drink plenty of water, as dehydration has also been indicated as a potential link to kidney stone formation. Water will hydrate you and continue to flush impurities from your system.
7. At EVERY doctor or dentist visit of any kind, be sure
you inform the nurse and doctor that you have only one kidney. For any
test or procedure ordered, ask how it will affect your remaining
kidney. Certain dyes used in MRIs and other tests can be damaging to
your kidney. Make sure to ask about any test that uses dye. Following
is a recent link regarding potential kidney damage from certain bowel
preps. http://www.medscape.com/viewarticle/531907
(requires membership)
You need to continue to alert everyone you come in contact with
throughout any medical visit or procedure that you have one kidney, and
you want to know how the procedures and medications will affect you.
You are one of many patients, and sometimes they may forget this
valuable information or may not see it listed on your chart.
8. Alert your pharmacy to note in your records that you have one kidney. In some pharmacies, such information will generate a “tickler” and have any medication dispensed reviewed by the pharmacist before it is dispensed to you. As with the physicians, prescriptions should always be reviewed with the pharmacist regarding any potential for causing problems with your kidney.
9. Be aware of high blood pressure and its potential causes. Uncontrolled high blood pressure is one of the leading causes of kidney failure. Your physician should check your pressure annually, but it is also a good idea to check it yourself monthly. It can be monitored with a home blood pressure cuff found in pharmacies or general merchandise stores. Many pharmacies also have a blood pressure cuff machine available for public use. Normal pressure is classified as 120 Systolic (top number) or less and 80 Diastolic (bottom number) or less. However, check with your physician to be sure what is normal for your particular circumstance. Excess salt is one of the main culprits in contributing to high blood pressure. Watch for hidden salt in fast food, restaurant food, and processed food. The American Heart Association at www.americanheart.org has some good information regarding blood pressure, salt, and heart health in general.
10. Diabetes is also a leading cause of kidney failure. Watch for family history of this disease. Eat well, exercise, and maintain a healthy weight. Consult with your physician regarding monitoring and prevention if you have a family history of this disease.
11. Exercise of any kind is good! Not only for general health, but as a preventative against high blood pressure and diabetes. Make sure to drink plenty of water during exercise, as you do not want to become dehydrated.
12. Do not engage in fad diets. Atkins or other high protein style diets should be avoided due to the imbalance they cause in kidney function. Excess protein consumption may cause a problem in persons with compromised kidney function. Discuss with your doctor the amount of protein you should or should not be eating. Eat a well balanced, healthy diet with plenty of fresh fruits and vegetables. www.mypyramid.gov provides valuable nutrition and dietary information. You may wish to do further research regarding the benefits of organic foods. Normally, the less processing involved, the more nutrition the food item retains. If you have specific dietary needs or restrictions, be sure to review any change in diet with your physician.
13. Keep up on your immunizations such as tetanus, flu shot, pneumonia shot, etc. Besides being good sense for general health, it can protect you from diseases that may be hard on not only your remaining kidney, but your body in general.
14. Have a copy of your donation records sent to your primary care physician. At your next visit, make sure they have read and understand them. At about four months post donation, it would be wise to have the following tests done, at a minimum, to establish baseline kidney function:
> CBC (Complete Blood Count) – Your
kidneys produce a hormone that signals the body to produce red blood
cells. This test, among other things, will monitor for anemia.
> BMP (Basic Metabolic Panel)- This evaluates the current status
of the kidneys (including BUN/Blood Urea Nitrogen and Creatinine
levels), electrolyte, blood sugar and calcium levels.
> Urine Analysis with macro, micro and culture – This
looks for protein in the urine and potential bacteria in the urine.
Your primary care physician should repeat these tests each year to
compare against your initial baseline numbers. They may order
additional tests, as needed,depending on the results. This annual
testing will help to identify and treat any problems as early as
possible. It is wise for donors to have an annual physical for general
health purposes, and these tests can be included as part of that annual
physical.
15. Be alert for Urinary Tract Infections (UTI’s). Typical symptoms include frequent urination and pain or burning during urination. Have them treated by your physician as quickly as possible to prevent the infection from potentially traveling to your remaining kidney. You can sometimes prevent UTI’s by drinking plenty of water, and many people recommend drinking cranberry juice as a preventative. It is important for donors, in any case, to drink plenty of water throughout the day to be sure they are well hydrated so their remaining kidney can function properly.
16. It is wise to avoid heavy contact sports such as football and boxing. The kidney is well protected by the ribs and organs in front of it, but arteries and veins that service the kidney are much more easily damaged.
17. Be aware of your family medical history and stay alert for possible conditions that could damage your remaining kidney. No one says that you are, for sure, going to be subject to Aunt Myrtle’s diabetes, but it pays to be cautious and do what you can to prevent diseases that run in the family tree. Discuss prevention and signs of potential diseases with your primary care physician.
RESOURCE LINKS
The following resources can provide some basic information regarding
kidney and general health.
General Health
www.identifyyourself.com American
Medical ID
Online retailer of medical identification jewelry
www.americanheart.org American
Heart Association
Information on heart disease and heart healthy nutrition and lifestyles
www.diabetes.org American Diabetes
Association
Information on diabetes prevention. Also provides information on
nutrition and exercise that can apply to anyone.
www.mypyramid.gov US Department of
Agriculture
Provides advice on nutrition and healthy eating. Includes tools for
meal planning, and individual tracking of exercise and food.
www.organicconsumers.org Organic
Consumers Association
A good starting point if you wish to do additional research on organic
foods.
Provides articles, information and resources.
Kidney Related
www.kidney.org National Kidney
Foundation
Provides information on kidney health. Some tools provided such as a
GFR on-line calculator.
www.nkdep.nih.gov US Department of
Health & Human Services
National Kidney Disease Education Program. Identifies a good number of
resources and topics such as “What do my kidneys
do?”; “ How to Talk to your Doctor”;
“ How to protect your kidneys”.
www.aakp.org
American Association of Kidney Patients
Provides general information on kidney health
www.transplantliving.org Part of
United Network for Organ Sharing (UNOS) website
Some information on living donation, but mainly involving the
evaluation and surgery.
www.kidneyschool.org Part of
“Life Options” website
This website has several educational modules that are in an online
educational format and take about 20 minutes each to complete. While
the majority are geared towards people with ESRD and dialysis issues,
there are a couple “Kidneys – How they
work” and “Understand Kidney Lab Tests”
that living donors may find useful.
