One of my coworkers recently suffered kidney failure and will now have to be on dialysis for the rest of his life (he’s diabetic and given the spotty nature of transplants, figures he’s better off hooking himself up to a machine instead). What I’m wondering is if the doctors left his kidneys inside him, or if they removed them.
I believe the answer is: it depends. What kind of kidney failure? Chronic, acute; caused by? If a chronic renal failure develops over time (due to complications with diabetes) into an end-stage renal failure, thereby requiring dialysis, I don’t think that they remove the kidneys.
On the otherhand, there are some acute diseases which can cause renal failure and does require the removal of the kidneys. This was the case with the daughter of a coworker/friend of mine. At eight years old she had to have her kidneys removed and went onto dialysis three times a week. After a year her family got the phone call they had been waiting for, and four months ago she finally had her kidney transplant 
. And although all transplant procedures carry risks, more and more they are being practiced and perfected into becoming safer. So don’t knock it, mmmkay?
Edit: And IANAD
IANAD, but I dont see how leaving a defunct kidney intact would do any harm. I mean, it’s not rotting or anything; it just doesnt do its job.
I’m not knocking it. Diabetics have a hard time healing, so getting yourself sliced open is no picnic, and given that he nearly died when his kidneys went out, I can understand his reluctance at having a transplant performed.
It does depend. As long as the person’s blood pressure stays within the normal range, the defunct kidneys stay. Since, even though they no longer filter the blood, their endocrine functions may continue. The kidneys make erythropoietin, which is important in blood formation. They’re also responsible for the renin/angiotensin cascade. Unfortunately, when that part of the kidney begins to fail, it’s more dangerous in than out. I don’t have the stats on diabetic endocrine renal failure in my head. But, IIRC, nephrectomy is necessary in about half the the cases.
Unless things have changed a great deal, he may not be a transplant candidate. The reasons for his renal failure haven’t, and can’t be resolved, so the transplanted kidney would very likely fail as well.
Is diabetes-related kidney failure reversible? If the patient improves his glucose level (and probably blood pressure as well) through diet and exercise, are the kidneys capable of healing?
Only to a certain extent, and also depending greatly on what most recently brought down their function. If the kidneys were chronically failing due to diabetes but were not so far advanced as to need dialysis yet, and then the patient got dehydrated and/or infected, and that pushed him over the edge into needing dialysis, treating that may restore function enough to stop dialyzing.
I had a guy like this last month. Diabetic, kidneys failing but not failed yet, then he had a heart attack. Catheterization with dye allowed the team to restore coronary blood flow and minimize heart damage, but the dye shut down his kidneys, and he needed dialysis for 6 weeks, before his kidney function finally returned to his baseline (which was about 10% that of a normal person), so he could get off the machine.
But most chronic kidney failure is not easily recoverable from.
As for the OP, unless there’s a need to remove the kidney, it’s allowed to stay in.
QtM, physician to waaaaaay too many dialysis patients these days.
Diabetics can get kidney transplants, and it’s not unheard of them to get a combined kidney/pancreas transplant. The latter, double tranplant not only “cures” the kidney failure but also the diabetes. Of course, you’re trading diabetes/kidney failure for a lifetime of immune suppression and monitoring, but for some people the trade off results in a net benefit.
However, kidney transplants for diabetics pose some problems. For one thing, continued diabetes will threaten the new kidney. Obviously, proper blood sugar control is VERY important. There’s the matter of age, other possible physical problems (cardiovascular disease, etc.)… Even if you’re deemed healthy enough to qualify for transplant, you then have the long wait for the Magic Phone Call. Unless you can talk someone into being a living donor for you.
Your co-worker’s situation, like that of every other patient in his predicament, is unique to him and needs to be evaluated on an individual basis. Also, things change over time. While dialysis may be his preferred choice right now in a couple years things could change.
Why do you say that? I’m waffling between rising rates due to increases in diabetes, dialysis is a PITA for physicians, or perhaps your, uh… patient demographic usually has other problems that require it?
I guess I’d forgotten that diabetes often led to kidney failure… It seems to me the progression is high blood sugar -> decreases kidney efficiency/increases kidney workload -> waste filtering stops working -> go to step 2.
Now I remember what those protein tests strips my brother got years ago were for. (Though AFAIK he doesn’t use them anymore).
Multifactorial. They take a lot of time and staff and money to care for, they tend to be folks that are not so compliant in their own care or they wouldn’t need dialysis (that’s a truth for my patient population, not a slam against folks who need dialysis in general), it’s a sign of a sicker population with a greater rate of diabetes and IV drug use (which knocks off kidneys frequently too), and we’re running out of dialysis chairs! We work 3 shifts on dialysis day, but we can only dialyze 18 patients in our entire prison system. And our plans for another dialysis center in one of the other prisons are moving ahead at a snail’s pace.
DH’s grandma has a kidney that quit working a couple of years ago due to high blood pressure and generally poor health. The kidney was not removed.
(Grandma drops these bombs…“Hey, Grandma. What’s up?” “Oh, nothing new. I did a little laundry, vacuumed, went to the Doctor. The Doctor said my kidney up and died…shriveled up to the size of my fist! And, I saw Noreen at the cafeteria. We’re going to the Legion Tuesday…”
My friend at work is donating a kidney to her mom in two weeks. So my friend will have one kidney and her mom will have three.
For those who wish to see a pictorial representation of this thread’s question, I give you the following illustration of mine:
(not graphic): When Kidneys Go Bad!
As previously stated, it depends on what type of kidney disease. In the case of Polycystic kidney disease the cysts can spread to other organs, especially the liver
(this is what happened to my Dad). So a defunct kidney that has a spreadable condition should be removed.
Polycystic disease does effect multi organs, but it doesn’t “spread” from the kidney to the liver. Polycystic kidneys are removed for renin/angiotensin blood pressure control.
I read recently that Art Buchwald chose to die rather than undergo dialysis. Supposedly he considered the prolonging of his life via dialysis to be “too burdensome a cost.” I didn’t understand this when I first read it, and I still don’t understand it. Is dialysis really so bad that death is a reasonable alternative?
Given QTM’s statement:
It certainly wouldn’t seem so. So anybody know what was going on here?
It takes a lot out of a person. Most of my dialysis patients feel pretty awful both during and after dialysis, and it ruins most of the day for a number of them. And since it must be done 3 times a week, it is rather onerous.
If one is otherwise young and strong, it tends to be less of a problem. But for older, infirm folks, it can be quite a burden to bear. Still many do put up with it, but usually with the idea that a transplant may be in their future, then they can leave the damn dialysis machine behind.
Should I be facing dialysis at an advanced age, with no plans for a transplant, with other serious disease slowing me down, I’d consider just saying “no thanks”.
Thanks QTM, it’s nice to have someone around who can answer these kinds of questions.
I think Buchwald was in his eighties, so it would seem his decision wasn’t so crazy after all. I think I too would say “no thanks” but one never knows until the decision stares you in the face.
It seems a little weird that we have two kidneys but that both always seem to go at the same time.
Qadgop, why does dialysis make people feel ill?
Massive fluid shifts (more if the person has gained a lot of water weight between dialyses) cause fluctuations in blood pressure, with light-headedness, nausea, and sweats.
These fluid shifts can also cause sudden declines in core body temperature, causing shaking chills and decreased mentation.
Muscle cramps are also quite common, and can be very severe. This is also attributed to fluid shifts, but may also be due to fluctuating calcium and magnesium levels.
General malaise, headaches, and aches and pains seems to be a complication of combinations of fluid and electrolyte shifts.
Abnormalities of the parathyroid gland, which is affected by chronic dialysis, also play havoc on normal phosphorus and calcium regulation.
Severe itching may occur, due to elevated phosphorus levels.
The access site (fistula or graft) needs special care, is often a site for local infection, and tends to ooze a lot or clot shut at untoward times, causing a variety of symptoms.