Renal Biopsy

Renal Biopsy is a small procedure to obtain a tissue from kidney to examine and diagnose any kidney disease. A biopsy is also performed when there is blood in the urine or high protein in the urine. Renal Biopsy is a small procedure and common too. With Kidney transplant patients, patients have commented, at for some on an average atleast 2 biopsies are done a year. This is the case with people who have a few ups and downs with their kidney and related issues.

Kidney Biopsy and Needle

A special kind of needle is used in Biopsy to obtain a sample for the kidney.  Patients are given local anaesthetic or given injection to knock you off for good few hours. It varies, but With personal experience, I have always been knocked off for a good few hours. There is a computer like machine on  a trolley and specialist consultants perform this procedure. It is small procedure but requires a good preparation.

Once you are given anaesthetic, within few seconds/minutes you are sleeping and after that dont know what is happening. The procdure is not painful, while the process in on. I can say that personally, as I have been sleeping in all of my biopsies, roughly 5-6 so far in the first year of transplant. But had another patient, who was chatting away to glory during the process with the consultant all the while the procedure was in progress. Every body is different.

Once this is done, you tend to get up after an hour or 2. Sometimes, the real pain starts, as the reason so far is unknown to me. having a few biopsies, 2 have been extremely painful for 2-3 days after the procedure. After mentioning to the doctors, I came to known that this was normal. A few times, I got up after 5-6 hours, had a nice sleep. You tend to feel hungry after getting up, Perhaps it was very exhausting procedure.  

Kidney Biopsy

On the site where the needle is inserted a bandage is sealed to protect for any bleeding. The area that is red is very small. But there are times, when a big red/blue path occurs around the site of biopsy. It looks as if it is bleeding all around and looks very scary. Again, it is a risk and a part of the procedure., BUT, please mention it to the doctor as they should know anything and everything that is related to your kidney and overall health.

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Kidney Biopsy

Certain Risks with Kidney Biopsy

Certain risks are involved with this procedure. As mentioned earlier, it is bleeding around the kidney. Technically, there is a possibility of a blood clot around the kidney. Not a grave risk, but has to be monitored and treated, if required.  Certain technical documents mention that in extreme cases possibilities like to also could require procedures like ultrasound, angiogram, or maybe a major operation (this could result in losing your kidney) or even death. But these are statistics of these cases and they are rare. I believe, these cases may have occured and the possibilities are rare, but they have to be made clear before a patinet undergoes kidney biopsy. Well, this is book knowledge, and like terms and conditions in a software or any service/product, you have to say yes, else you cannot go ahead.

In some situations, patient might require blood transfusion, if there is heavy blood loss. lot of patients pass blood in urine, this usually clears soon.

There are no alternatives to a biopsy. Well, I have seen, that the consultants/doctors, try not to go for kidney biopsy until it is essential. The less you poke you kidney with needles, the better it is.

Some Important things to note:

1. Patients taking drugs like aspirin, dipridamole,clopidogrel, warfarin and painkillers, should STOP taking these medicines 10 days prior to the biopsy. Patients on Tizaparin Injections and similar should stop atleast a day or 2 before the biopsy. However, please consult your doctors,nurses,consultants etc. for more information.
2. Small after effects of biopsies need to be monitored. Like bleeding, muscles aches, back aches. For Bleeding, you have to inform your doctors and for aches, patients are advise to take paracetamol every 12 hours(if required.)
3. You will be kept Nil by Mouth for a few hours before the procedure.
4. Prefer to be knocked off to sleep. (this is less dreadful, I suppose).

 

The procedure is small but very helpful. It gives and insight about your kindey to the doctors, who in turn can discuss and take the next step ahead for your kidney to last forever(I hope – at least till I am alive).I have had a few biopsy, nothing to be proud about, but these tests were performed due to constant issues with my health. In 2010, I was discovered with BK Virus, after a Biopsy was performed. Did know much about it, but researched and talked to other patients, who have been through or have one. I am writing another blog post on this.

Not much to mention about this , as there is less preparation, Small procedure, Low Risk and helpful for understanding and taking the right course of action to keep your kidney health. However, biopsy itself, is not healthy for the kidney.

Good Luck for your Kidney. If you have any questions or comments, please leave a reply or comments.

 

What is Creatinine Level ?

Creatinine is a chemical waste molecule that is generated by muscles. Creatinine is produced from creatine, that produces energy for muscles. Approximately 2% of body’s creatine is converted to Creatinine every day. Creatinine is transported via the blood to the kidney, that filters  it and dispose it through urine. For healthy people, the level is generally the same as the muscles growth in the body is relatively slow.

The kidney maintains the level of creatinine in the normal range. It is one of the indicators for Kidney Function. A high level of creatinine possibly indicates damage or malfunction of the kidney or possible kidney failure.

Creatinine Levels & Kidney Function

With Kidney Transplant patients, Creatinine is one the importantant levels that needs to be checked regularly and maintain within the normal Levels.

The Normal Levels are calculated, depending where you are. In Americas the it is calculated as mg/dl and in Europe as umol/L) The normal levels for Males are 60-110 umol/L and for females is about (45-90). This also varies for certain males or females where they are excessive muscular or extremely week. With older people the levels are a bit low. But on an average it is in the ranges specified.

If you are above this range that means that there is something wrong with the filtration of creatinine by your kidney and you could possibly be looking at a Kidney malfunction. This could also mean kidney failure.

With a blood test, the level of creatinine level can be determined and if things are not right, you doctor or consultant may contact you.

Creatinine

Creatinine plays an important part in your life when on Dialysis and especially importnat after a Kidney transplant. It is like the lifeline of the patient. After transplant, it is like an indicator that how well your kidney is working. Again, the levels could vary from one individual to another. But generally the more controlled it is, the better funciton of your transplanted kidney is.

I have personally have been having creatinine levels jumping up and down. Which is relatively common after a kidney transplant. But not with everyone. Some people are lucky and the kidney is well controlled and maintain by the body and everything is hunky dory. After my transplant my creatinine level was 800. Which is obviously very very high. Having such a major operation I was not much in my senses, but knew were not in order and they had to come in control with the right treatment. With luck i had the best doctors around in the hospital taking care. I was treated in Hammersmith Hospital, London.

I underwent a treatment of IVIG and plasma exchange. Both treatments acted like a miracle for me. I could see the graph falling down from 800 to 200 with 2 sessions of plasma exchange.(Each session consists of 5 exchanges. There is normally a gap of a day within these 5 exchnages). the results are monitored daily or perhaps more often and hence further treatment(s) can be decided. After complete 2 sessions, I personally felt better as kidney function was increasing and i started passing more uring (around 5 centilitres, as compared to 500 ml a day).

What can be done to lower Creatinine Level, after Transplant?

Personally, I researched a lot and talked to a lot of people. I got advise that I should drink more water, so kidney clears all the toxins, someone said that try detox teas, or detox treatments. But I guess, i could not find any answers or suggestion said with confidence or proven. Hence, i presume, that IViG treatment is the solution.

I have been admitted to Hospital many times after my transplant, as my creatinine levels have been high, and IViG has solved the problem. I am still hunting for some natural soltuion (Of course, we have treatments from the Hospital) but something which what I can do keep a balance and control of my kidney and it’s levels.

What are the reasons for elevated blood creatinine?

Any condition that impairs the function of the kidneys will probably raise the creatinine level in the blood. It is important to recognize whether the process leading to kidney dysfunction (kidney failure, azotemia) is longstanding or recent.

The most common causes of longstanding kidney disease in adults are high blood pressure and diabetes mellitus. Certain drugs can sometimes cause abnormally elevated creatinine levels. Serum creatinine can also transiently rise after ingestion of large amount of dietary meat.

Are there any symptoms associated with elevated blood creatinine levels?

The symptoms of kidney dysfunction (renal insufficiency) vary widely. Some people may have a incidental finding of severe kidney disease and elevated creatinine on routine blood work without having any symptoms at all. In others, depending on the cause of problem, many different symptoms may be present including:

Feeling dehydrated, fatigue, shortness of breath, confusion, or  many other nonspecific symptoms.

I hope this information is good enough for the starters. Well, it is all by experience and Research. More to come.

References:

A few questions in the end have been referrred from

http://www.medicinenet.com/creatinine_blood_test/article.htm

And I would like to give them credit on this. thanks. And Good Luck.

Anaemic after Transplant

Well, What is Anaemia, that’s the first questions. In greek it means lack of Blood. Well it is reduction in number of Red Blood Cells or Hemoglobin in you blood. Well hemoglobin found in Red Blood cells carries oxygen from the lungs to the tissues of your body. Lack of hemoglobin means, lack of oxygen to your tissues and hence this could lead to serious consequences over a period of time.

“This article has little technical information and more practical experience and knowledge after discussing with  other fellow patients. I am patient and learning from all such problems arising”

This has been a common problem with a lot of people and with Dialysis and Transplant patients it is quite common. But there is a level below which it can even cause death. Some thing like this, that as hemoglobin is low, enough oxygen is not being provided to your tissues. And Red blood cells count goes low, it would say, blood loses its power and enough red blood cells are not being generated. This starts damaging the body rapidly.

Red Blood Cells & Hemoglobin

Symptoms

So what are the symptoms?  Generally

1) Feeling Tired

2)Looking Pale- check you nails, they start looking whitish or yellowish as if they don’t have the glow in them

3) feeling breathless after little exercise, even walking

4) a rapid pulse of palpitations (you will be able to hear your heartbeat or feel it pumping ).There are more symptoms specific to the cause of Anaemia, but  these common ones which patients have discussed.

Normal Levels

Normal Levels for Hemoglobin

Children – 11 -13 gm/dl

Adults  – 12 – 17 g,/dl

Depending on your condition (if you have Kidney failure or any other problem) lower levels sometimes are accepted since you are being treated for certain conditions. Certain countries follow different range for normal hemoglobin levels.

Causes

There are many causes for anaemia. 1) Loss of Blood being one of them. You might have bled externally and need blood, or it could be internal which could be dangerous. 2) You body is not making enough Red Blood Cells or Heamoglobin. There are many reasons for this, like iron deficiency, B12 deficiency, lack of ixygen in the body, lack of certain vitamins (related to your diet). 3) It is also related to Bone Marrow Disorder such as Leukaemia or Aplastic Anaemia( a rare condition where bone marrow fails to produce blood cells properly) 4) Any chronic disease (Commonly in Kidney Patients is Chronic Kidney Failure) 5) Sometime it is high dosage of certain tablets that are regularly taken by patients (Like immunosuppressants for Kidney Patients) which slow down the production of Red Blood Cells in order to Treat your Kidney.

Benefits of Vitamin B12

Tests you may have to Undergo

There are a  few test that you have to undergo in order to understand the case of being anaemic and getting the right treatment.

1) Blood Film Tests, here they test the blood under the microscope

2) Lots more blood tests, especially for B12 levels

3) Gastroscopy, procedure where they insert the camera from the anus and look inside for bleeding. This test is troublesome, with some people they give you powder mixed with 1 litre of water and you keep drinking to clear your stomach. Normally 3-4 packets of such medium sized pouches are given to patients to clear the waste completely, so that the tets can be conducted without obstructions. Well, who may to sit near the toilet for almost a day and a half and not eat anything.  This tests generally lasts for 30 mins,and you are given a sedative so you dont know what is happening. One surpising thing about the sedative they give is that, after the test you dont tend to remember anything. What happened ? God Knows? Or the nurses and the doctor. It happend and Idont remember a thing.

4) Colonoscopy, a better version of Gastroscopy, as the camera is inserted from your mouth to check for bleeding . Not very painful as they spray your throat mkaing it numb so thhat the camera does not hurt. The process is uncomfortable, but lasts for up to 5 mins generally. After that within 30 mins you can drink. But before the test you should be empty stomach for a good few hours.  I had this as well, and problem I developed later after a few days was acidity in my throat, whatever I eat, was like stuck in my throat, could not go down. It was quite acidic and painful but gradually disappeared.

5) Stool Test, I gues that should be simple, Dont want to elaborate on that.

6) Bone Marrow Biopsy – A Sample of your bone marrow is taken, They take it generally from your Hip Bone, giving local anaesthesia, since you have to sit in a particular position. I dont know about General Anesthesia, as different Hospitals or Countries have different rules. All I know is that this leaves a bruise and it is painful

Treatment

Treatments are various kinds and will dpeend on the cause and your body condition.

Diet – Helps in increasing Hemoglobin or prevent it from going Low.

1) Iron is one of the main sources that increases red blood cells. Foods that are high in iron are Apple, Liver, Green Vegetables, Dried Fruits, Pulses (Lentils, Chick Peas), Certain Breatfast Cereals and Bread. There are Iron tablets or liquid available, but it is better to consult your doctor before you consume them.

2) Vitamin B12 – Found in Meat, Cheese, Eggs, Milk, and certain prepared or processed foods where iron is added later.

3) Folate – Again found in liver, red meat, yeast extract, green vegtables and oranges

Foods High in B12

Well Green vegetables are a very good source or iron and also dried fruits. I have staterted with a balanced diet of Meat and Greens since they help in iron levels and over are beneficial.

Please consult your doctor or dietician, since a lot of people have alergy and are unable to consume certain foods. For vegetarins, greens are good or you could also ask your doctor for supplements.

I am facing this problem, since quite a few years. Initially the symptoms I was getting, I did not have a clue that this was due to hemoglobin. It thought it was over exertion or maybe something not known. But it was low count of hemoglobin. I was peritoneal dialysis then and health over all was fine, hence i used to have clinic appoints once every 3 months. And due to this, no bloods were taken and overall health and pd probelms were attended to. I had report to my dialysis clinic and they found that the hemoglobin level was 6. This was much below than normal and this could lead to death. A Bit scared initially, but I was given immediate transufsion and thing got better. Since then I have had this problem now and then, generally within a period of 6 months. But after moving from Peritoneal Dialsysis to Hemodialsysi, It became a frequent thing. I was given transufions every other month and started with EPO Injections. I have to come to know that the problem of being Anaemic is quite common with Kidney Failure Patients.

Red Blood Cells Level When Anaemic

After my transplant i have got this problem again after 6 months and have done loads of test (Like Endoscopy, Colonoscopy, Kidney Biopsy, Various Kinds of Blood Tests). Proposed tests are Bone Marrow tests which are very painful and leave a bruise in you hip bone. I hope I dont have to undergo that test. Currenctly my hemoglobin is under control. Ofcourse due to certain medicines being stopped and precaustions takem, Also I have changed my diet so that I can each Iron rich foods and help myself to overcome this problem. I belive, if things can be controlled naturally, taking extra medicines, transfusions or undergoing tests, is just damaging your body.

Well, Good luck, if you have such a problem, it is controllable, provided detected and treated and the right time. If you have even a small sympton, dont take a risk.

IVIG – the Miracle Drug for Kidney

Intravenous Immunoglobin

IVIg in technical terms is Intravenous Immunoglobulin.

Immune globulins or immunoglobulins (Ig) are specialized glycoproteins which function as antibodies.  Produced by plasma cells, there are five human isotypes of immunoglobulins, IgA, IgD, IgE, IgG and IgM.  Of these, IgG, IgA and IgM are referred to as natural antibodies as they are produced without deliberate immunization or antigen exposure.  IgD and IgE are generally produced in response to the introduction of foreign antigens to which they bind and deactivate.  Together, all immunoglobulin isotypes are vital components of the body’s immune response.

IgG is the most common of the immunoglobulins, with multiple functions including placental antibody transfer, phagocytic cell surface binding and activating complement.  Commercial preparations of intravenous immune globulins (IVIGs) are sterile, highly purified IgG products manufactured from large pools of human plasma, typically from 1000 or more healthy blood donors.  They contain more than 95% unmodified IgG but only trace amounts of IgA and/or IgM.  IVIGs are used in the treatment of multiple conditions.

Source: www.bcbst.com

I am surpirsed that it requires so many healthy blood donor to make IVIg. And we just get a dose of 6 bottles(dosage varies) and just feel well. We dont even think, how is this made, where does it come from. But it really works. I have had many sessions of this dose and I am back again to my feet after Kidney Transplant. this dosage is sometimes given over a period of 4-5 days (6 bottles course per day) with a gap day.(Depends on the process and requirement to the patient)
Anytime I am suffering with creatinine or rejection issues with the Kidney, Doctors have generally prescribed IVIg and it does the job.
IVIg is used in treating  many diseases but it is also used in Pre Transplant and given to receipt in the case where the receipeint is at high risk of anti body rejection and After Transplant for anti body mediated rejection. If any foreign body is transplanted in you, there are chances of rejection and rise in anti bodies. There IVIg comes into picture. Mind you, there are other treatments and medicines also given to treat, but IVIg is also one of thyem. As every treatment has a different process to treat the problem, Different treatment are given to patients (depending on the other factors) and they might be effective and might not need IVIg.

Intravenous Immunoglobin

I have seen patients who never even heard of IVIg but had a successful Kidney Transplant.

Some Important Facts:

1. IVIG is an infusion of IgG antibodies only. Therefore, peripheral tissues that are defended mainly by IgA antibodies, such as the eyes, lungs, gut and urinary tract are not fully protected by the IVIG treatment.
2. In case of recurring side effects, it is recommended to slow the pace of the IVIG administration and to reduce the dosage. It is also advisable to change IVIG brand, as some people react against to a specific brand.
3. If the patient is diabetic, he should take into consideration the medium in which the antibodies are solubilized in the IVIG treatment, as some brand solubilize antibodies with high concentrated sugars (such as sucrose and maltose).
4. IVIG can be given to pregnant women.
5. IVIG is also used as a treatment for unexplained recurring miscarriages. The effectiveness of the therapy is controversial.

End of the day, this drug has helped me a long way. I would appreciate if you can contribute more information by leaving comments.

What is Plasma Exchange

Plasma is a yellow coloured fluid in the blood. It help the blood flow and carrier other products around the body.
Plasma exchange is a process where the blood is broken down into 4 parts; white cells, red cells, platelets and plasma.

Plasma Exchange Machine

Plasma Exchange also known as plasmapheresis. In the exchange process, after dividing the blood into 4 parts, plasma is then removed and replaced with substitutes. Plasma exchange is done when you blood gets thicker and makes it difficult for the blood to flow smoothly and reach every part of the body.

Plasma exchange in many processes, but especially in patients who are going to have a Kidney transplant or have had a transplant. Generally people who have been through plasma exchange have seen constant improvement in levels. Before kidney transplant, if the donor and recipient have a antibodies in the blood, plasma exchange helps in balancing the anti bodies between the two blood groups, hence helping for a smooth kidney transplant. It helps is reducing protein levels in the blood.

The process of plasma exchange is something similar to hemodialysis. The patient is connected to a machine called as cell separator. Connection for Kidney patients is generally through a tesio line or a fistula. The process is similar to dialysis, as one line is in, blood is cleaned and put back into your body. The machine is quite different from hemodialysis. The process lasts for about an hour. But the preparation time is more, as there are many fluid bags and all are verified for patient,expiry etc.. Unlike dialysis, this process is constantly monitored by a nurse who connects you. Process are varied according to you age and weight. Constant blood Pressure monitoring is necessary, as to see the patients condition.A warm blanket is provided, since you undergo a range of emotions and temperature.

Generally you will feel dizzy while the exchange starts, you feel very cold, shivering, numbness, tickling and shaking. The whole body is like out of control for a few minutes, but since you are dizzy you cant feel the effects 100%. Some funny tastes in the mouth when they give you the some injections, which also make you feel dizzy. But overall the process is short and you could feel much better after the process.Personally I used feel tired and exhausted despite of sleeping well on the process. But overall it used to makes me feel fresh.

If you are awake, you can drink normally and have visitors if you wish. And also i have experienced that one tends to pass a lot of urine (if you are passing or have had a kidney transplant) in the process.

The process is in the UK in set of sessions of 5 exchanges. Depending on individual some are done with 1 set and some more. There are a lot patients whom visit the clinics ,mentioned that they had a few sets before the the transplant (in case of live donor) and few after the transplant. And some had to be continuously treated with gap period for months. Personally, I had 2 sets of exchanges and my creatinine level fell down by 600. It was amazing and a life saver for me after Kidney Transplant.

Plasma Exchange Diagram

Everybody has plasma exhcange in different situations and purposes. And a lot of them have had kidney transplant but never were aware what is plasma exchange, since they never had one. I would mention that it is a life saving process and helps kidney patients recover and lead a normal life.

There may be different types of plasma exchanges and you may find this article wrong. But this is the real process which I have experienced in the United Kingdom.