Kidney biopsy is a procedure to remove a small piece of kidney tissue that can be examined under a microscope for signs of damage or disease.
Your doctor may recommend a kidney biopsy (renal biopsy) to diagnose a suspected kidney problem. It may also be used to see how serious a kidney condition is, or to monitor treatment for kidney disease. You may also need a kidney biopsy if you've had a kidney transplant that's not working properly.
Most often, a doctor performs a kidney biopsy by inserting a thin needle through the skin. This is called a percutaneous kidney biopsy. An imaging device helps the doctor guide the needle into the kidney to remove tissue.
Why it is done ?
A kidney biopsy may be done to:
Diagnose a kidney problem that can't otherwise be identified
Help develop treatment plans based on the kidney's condition
Determine how quickly kidney disease is progressing
Determine the extent of damage from kidney disease or another disease
Evaluate how well treatment for kidney disease is working
Monitor the health of a transplanted kidney or find out why a transplanted kidney isn't working properly
Your doctor may recommend a kidney biopsy based on the results of blood or urine tests that show:
Blood in the urine originating from the kidney
Protein in the urine (proteinuria) that's excessive, rising or accompanied by other signs of kidney disease
Problems with kidney function, leading to excessive waste products in the blood
Not everyone with these problems needs a kidney biopsy. The decision is based on your signs and symptoms, test results, and overall health.
Risks
In general, percutaneous kidney biopsy is a safe procedure. Possible risks include:
Bleeding. The most common complication of a kidney biopsy is blood in the urine. The bleeding usually stops within a few days. Bleeding that's serious enough to require a blood transfusion affects a very small percentage of people who have a kidney biopsy. Rarely, surgery is needed to control bleeding.
Pain. Pain at the biopsy site is common after a kidney biopsy, but it usually lasts only a few hours.
Arteriovenous fistula. If the biopsy needle accidentally damages the walls of a nearby artery and vein, an abnormal connection (fistula) can form between the two blood vessels. This type of fistula usually causes no symptoms and closes on its own.
Others. Rarely, a collection of blood (hematoma) around the kidney becomes infected. This complication is treated with antibiotics and surgical drainage. Another uncommon risk is development of high blood pressure related to a large hematoma.
How you prepare?
Before your kidney biopsy, you'll meet with your doctor to talk about what to expect. This is a good time to ask questions about the procedure and make sure you understand the benefits and risks.
Medications
When you meet with your doctor, bring a list of all medications you take, including over-the-counter medications, vitamins and herbal supplements. Before your kidney biopsy, you'll be asked to stop taking medications and supplements that can increase the risk of bleeding. These include:
Blood-thinning medications, such as warfarin (Coumadin, Jantoven), rivaroxaban (Xarelto), dabigatran (Pradaxa) or enoxaparin (Lovenox)
Drugs that keep blood platelets from excessively sticking together, such as clopidogrel (Plavix)
Aspirin
Ibuprofen (Advil, Motrin IB, others) and other nonsteroidal anti-inflammatory drugs (NSAIDs)
Certain dietary supplements, such as omega-3 fatty acids
Your doctor or nurse will let you know when to stop taking these medications and supplements, and for how long. Often, these medications are stopped seven days before the procedure and then started again seven days after the procedure.
Blood and urine samples
Before your biopsy, you'll have blood drawn and provide a urine sample to make sure you don't have an infection or another condition that would make the biopsy risky.
Diet
You may be asked not to drink or eat for eight hours before the kidney biopsy.
What you can expect?
You'll have a kidney biopsy at a hospital or outpatient center. An IV will be placed before the procedure starts. Sedatives may be given through the IV.
During the procedure
During the biopsy, you'll be awake and lie on your abdomen or your side, depending on which position allows best access to your kidney. For a biopsy of a transplanted kidney, most people lie on their backs.
A percutaneous biopsy includes these steps:
With an ultrasound probe, your doctor identifies exactly where to insert the needle. In some cases, a CT scan may be used instead of ultrasound.
Your doctor marks your skin, cleans the area and applies a numbing medication (local anesthetic).
Your doctor makes a small incision where the needle will go in and uses the ultrasound device to guide the needle into your kidney.
You may be asked to hold your breath as your doctor collects a sample using a spring-loaded instrument. You may feel a "pop" or pressure and hear a sharp clicking noise.
Your doctor may need to insert the needle several times — often through the same incision — to get enough tissue.
Your doctor removes the needle and places a small bandage on the incision.
Other kidney biopsy procedures
Percutaneous kidney biopsy isn't an option for some people. If you have a history of bleeding problems, have a blood-clotting disorder or have only one kidney, your doctor may consider a laparoscopic biopsy.
In this procedure, your doctor makes a small incision and inserts a thin, lighted tube with a video camera at its tip (laparoscope). This tool allows the doctor to view your kidney on a video screen and remove tissue samples.
After the procedure
After the biopsy, you can expect to:
Spend time in a recovery room where your blood pressure, pulse and breathing will be monitored.
Have urinalysis and complete blood count tests done to check for bleeding and other complications.
Rest quietly for around four to six hours.
Receive written instructions about your recovery.
Feel some soreness or pain at the biopsy site for a few hours. You'll be given medications to relieve pain.
Most people can leave the hospital the same day, about 12 to 24 hours after the procedure. Once home, your doctor will probably recommend that you rest for another day or two. Your health care team will let you know about any activity restrictions, such as avoiding heavy lifting and strenuous exercise.
Your kidney tissue goes to a lab to be examined by a doctor who specializes in diagnosing disease (pathologist). The pathologist uses microscopes and dyes to look for unusual deposits, scarring, infection or other abnormalities in the kidney tissue.
Call your doctor if you experience:
Significant bright red blood or clots in your urine more than 24 hours after the biopsy
Changes in urination, such as an inability to pass urine, an urgent or frequent need to urinate, or a burning sensation when urinating
Worsening pain at the biopsy site
Fever over 100.4 F (38 C)
Faintness or weakness
Results
It may take up to a week before your doctor has your biopsy report from the pathology lab. In urgent situations, a full or partial report may be available in less than 24 hours.
Your doctor will usually discuss the results with you at a follow-up visit. The results may further explain what's causing your kidney problem, or they may be used to plan or change your treatment.
Overview
A urinary tract infection (UTI) is an infection in any part of the urinary system. The urinary system includes the kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra.
Women are at greater risk of developing a UTI than are men. If an infection is limited to the bladder, it can be painful and annoying. But serious health problems can result if a UTI spreads to the kidneys.
Health care providers often treat urinary tract infections with antibiotics. You can also take steps to lower the chance of getting a UTI in the first place.
Symptoms
UTIs don't always cause symptoms. When they do, they may include:
A strong urge to urinate that doesn't go away
A burning feeling when urinating
Urinating often, and passing small amounts of urine
Urine that looks cloudy
Urine that appears red, bright pink or cola-colored — signs of blood in the urine
Strong-smelling urine
Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
In older adults, UTIs may be overlooked or mistaken for other conditions.
Types of urinary tract infections
Each type of UTI may result in more-specific symptoms. The symptoms depend on which part of the urinary tract is affected.
Part of urinary tract affected: Kidneys Signs and symptoms
Back or side pain
High fever
Shaking and chills
Nausea
Vomiting
Part of urinary tract affected:Bladder
Signs and symptoms
Pelvic pressure
Lower belly discomfort
Frequent, painful urination
Blood in urine
Part of urinary tract affected:Urethra
Signs and symptoms
Burning with urination
Discharge
Causes
UTIs typically occur when bacteria enter the urinary tract through the urethra and begin to spread in the bladder. The urinary system is designed to keep out bacteria. But the defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.
The most common UTIs occur mainly in women and affect the bladder and urethra.
Infection of the bladder. This type of UTI is usually caused by Escherichia coli (E. coli). E. coli is a type of bacteria commonly found in the gastrointestinal (GI) tract. But sometimes other bacteria are the cause. Having sex also may lead to a bladder infection, but you don't have to be sexually active to develop one. All women are at risk of bladder infections because of their anatomy. In women, the urethra is close to the anus. And the urethral opening is close to the bladder. This makes it easier for bacteria around the anus to enter the urethra and to travel to the bladder.
Infection of the urethra. This type of UTI can happen when GI bacteria spread from the anus to the urethra. An infection of the urethra can also be caused by sexually transmitted infections. They include herpes, gonorrhea, chlamydia and mycoplasma. This can happen because women's urethras are close to the vagina.
Risk factors
UTIs are common in women. Many women experience more than one UTI during their lifetimes.
Risk factors for UTIs that are specific to women include:
Female anatomy. Women have a shorter urethra than men do. As a result, there's less distance for bacteria to travel to reach the bladder.
Sexual activity. Being sexually active tends to lead to more UTIs. Having a new sexual partner also increases risk.
Certain types of birth control. Using diaphragms for birth control may increase the risk of UTIs. Using spermicidal agents also can increase risk.
Menopause. After menopause, a decline in circulating estrogen causes changes in the urinary tract. The changes can increase the risk of UTIs.
Other risk factors for UTIs include:
Urinary tract problems. Babies born with problems with their urinary tracts may have trouble urinating. Urine can back up in the urethra, which can cause UTIs.
Blockages in the urinary tract. Kidney stones or an enlarged prostate can trap urine in the bladder. As a result, risk of UTIs is higher.
A suppressed immune system. Diabetes and other diseases can impair the immune system — the body's defense against germs. This can increase the risk of UTIs.
Catheter use. People who can't urinate on their own often must use a tube, called a catheter, to urinate. Using a catheter increases the risk of UTIs. Catheters may be used by people who are in the hospital. They may also be used by people who have neurological problems that make it difficult to control urination or who are paralyzed.
A recent urinary procedure. Urinary surgery or an exam of your urinary tract that involves medical instruments can both increase the risk of developing a UTI.
Complications
When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, UTIs can cause serious health problems.
Complications of a UTI may include:
Repeated infections, which means you have two or more UTIs within six months or three or more within a year. Women are especially prone to having repeated infections.
Permanent kidney damage from a kidney infection due to an untreated UTI.
Delivering a low birth weight or premature infant when a UTI occurs during pregnancy.
A narrowed urethra in men from having repeated infections of the urethra.
Sepsis, a potentially life-threatening complication of an infection. This is a risk especially if the infection travels up the urinary tract to the kidneys.
Prevention
These steps may help lower the risk of UTIs:
Drink plenty of liquids, especially water. Drinking water helps dilute the urine. That leads to urinating more often — allowing bacteria to be flushed from the urinary tract before an infection can begin.
Try cranberry juice. Studies that look into whether cranberry juice prevents UTIs aren't final. However, drinking cranberry juice is likely not harmful.
Wipe from front to back. Do this after urinating and after a bowel movement. It helps prevent the spread of bacteria from the anus to the vagina and urethra.
Empty your bladder soon after having sex. Also drink a full glass of water to help flush bacteria.
Avoid potentially irritating feminine products. Using them in the genital area can irritate the urethra. These products include deodorant sprays, douches and powders.
Change your birth control method. Diaphragms, unlubricated condoms or condoms treated with spermicide can contribute to bacterial growth.
Renal Transplant
The kidney is an important organ in the human body that regulates blood pressure and its main function is to expel/excrete wastes from the body through urine. Since this function is imperative for the body to function, should the kidneys malfunction, harmful levels of waste accumulate in the body. This is likely to increase the body’s blood pressure and inevitably lead to renal failure.
About Renal/Kidney Transplant
Several factors cause chronic kidney disease or renal failure. These are, but are not limited to:
Chronic Blood Pressure
Uncontrolled High Blood Pressure
Chronic Glomerulonephritis is inflammation and scarring of the glomeruli (tiny network of filters within the kidney).
Polycystic kidney disease
Diabetes
Obstructions
Lupus
Immune System Diseases
Haemolytic Uremic Syndrome
Different Types Of Renal Transplant
There are two tests to find out whether your kidneys are functioning or not, namely the Albumin to Creatinine Ratio and Glomerular Filtration Rate (eGFR). The eGFR measures your kidney function and determines the stage of chronic kidney disease (CKD) that you are on.
The stages are as follows:
Stage 1: eGFR 90 or Greater
Stage 2: eGFR between 60 and 89
Stage 3: eGFR between 30 and 59
Stage 4: eGFR between 15 and 29
Stage 5: eGFR Less than 15
A patient with end-stage renal disease will need to remove waste from their bloodstream via dialysis (a machine that drains toxins from the body) or a renal transplant to prolong their lives and improve the quality of their lives. A kidney or renal transplant is an intricate surgical procedure to transfer a healthy kidney from a person who is alive or dead, to a person who has a failing kidney.
Preparing For A Renal/Kidney Transplant-
To replace two failed kidneys, only one donated kidney is required. This makes it possible for a living-donor kidney transplantation.
If you do not have a compatible living donor, your name is placed on a kidney transplant waiting list for a kidney from a deceased donor.
Before Surgery
You will be assessed to ensure that you are an eligible kidney transplant candidate. Blood and tissue matching tests will also be conducted. Your surgeon, inclusive of a transplant team, will discuss the procedure in detail and this will be the perfect opportunity for your to clear any doubts.
During Surgery
The surgery will be done under general anaesthesia. Your surgeon makes a cut/incision in the lower region of one side of abdomen to place the new kidney into your body.
The new kidney’s blood vessels are attached to the blood vessels in the lower section of the abdomen, above one of your legs.
The new kidney's ureter (tube that links the kidney to the bladder) is connected to your bladder.
After Surgery
After the surgery, you will be placed in a recovery room where you will be monitored to ensure that your blood pressure and other vital signs are stable. Patients who received a kidney transplant will have to stay in the hospital for a week or more. The new kidney should start to work immediately by removing harmful toxins from the body. You will also be given immunosuppressant drugs to ensure that your body does not reject the new kidney.
Benefits Of A Renal Transplant
Most people choose to have a kidney transplant instead of dialysis . Patients who have a kidney transplant enjoy an improved quality of life will no longer be dependent on dialysis, have more energy, and have lesser restrictions on what they can consume. However, a proper diet is important to maintain a healthy body.
Risks Of A Renal Transplant
While kidney transplantation can treat kidney failure and advanced kidney disease, it is not a cure. Certain forms of kidney disease may return after the transplant surgery.
The health risks linked to kidney transplant are those linked directly with the surgery itself, including rejection of the donor kidney and side effects of taking immunosuppressants or anti-rejection medicines required to prevent your body from rejecting the donor kidney.
Complications Of The Procedure
Kidney transplant surgery carries risk of substantial complications, such as:
Infection
Bleeding and blood clots
Blockage of or leaking from the tube (ureter) that links the kidney to the bladder
Stroke heart attack and even death
Rejection or failure of the donated kidney
Cancer or an infection that can be transmitted with the donated kidney
Side-effects of anti-rejection medication. After a kidney transplant, you will take medicines to help prevent your body from rejecting the donated kidney. These drugs can cause various side effects.
A kidney transplant will help you improve the quality of your life. It may also prolong your life. While you may be on anti-rejection medicines for the rest of your life, new medicines are constantly being developed to ensure that organ rejection does not happen. While life is unpredictable, we can still choose to make good choices about our health to ensure that we live without any pains or ailments.
Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by filtering wastes from your blood. If kidney disease worsens, wastes can build to high levels in your blood and make you feel sick. You may develop complications like:
high blood pressure
anemia (low blood count)
weak bones
poor nutritional health
nerve damage
Kidney disease also increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long time. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.
For kidney disease diagnosis, you might also need certain tests and procedures to determine how severe your kidney disease is (stage). Tests might include:
Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.
Urine tests. Analyzing a sample of your urine can reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.
Imaging tests. Your doctor might use ultrasound to assess your kidneys' structure and size. Other imaging tests might be used in some cases.
Removing a sample of kidney tissue for testing. Your doctor might recommend a kidney biopsy, which involves removing a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problem.
What are the symptoms?
Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:
feel more tired and have less energy
have trouble concentrating
have a poor appetite
have trouble sleeping
have muscle cramping at night
have swollen feet and ankles
have puffiness around your eyes, especially in the morning
have dry, itchy skin
need to urinate more often, especially at night
What will happen if my doctor suspects chronic kidney disease?
Your doctor will want to pinpoint your diagnosis and check your kidney function to help plan your treatment. The doctor will perform these blood and urine tests:
Albumin to creatine ratio urine test: Albumin is a protein that shouldn't be found in urine and indicates kidney function problems.
Blood test for creatinine: This determines if there is too much creatinine, a waste product, in the blood. Learn about lab values.
Glomerular Filtration Rate (GFR): The doctor will calculate your Glomerular Filtration Rate (GFR) using the results from the tests and other factors like age and gender. The result of the GFR is the best way to measure your level of kidney function and determine your stage of kidney disease.
Treatment
Depending on the cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure.
Treatment usually consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease. If your kidneys become severely damaged, you might need treatment for end-stage kidney disease.
Treating the cause
Your doctor will work to slow or control the cause of your kidney disease. Treatment options vary depending on the cause. But kidney damage can continue to worsen even when an underlying condition, such as diabetes mellitus or high blood pressure, has been controlled.
Treating complications
Kidney disease complications can be controlled to make you more comfortable. Treatments might include:
High blood pressure medications. People with kidney disease can have worsening high blood pressure. Your doctor might recommend medications to lower your blood pressure — commonly angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers — and to preserve kidney function. High blood pressure medications can initially decrease kidney function and change electrolyte levels, so you might need frequent blood tests to monitor your condition. Your doctor may also recommend a water pill (diuretic) and a low-salt diet.
Medications to relieve swelling. People with chronic kidney disease often retain fluids. This can lead to swelling in the legs as well as high blood pressure. Medications called diuretics can help maintain the balance of fluids in your body.
Medications to treat anemia. Supplements of the hormone erythropoietin (uh-rith-roe-POI-uh-tin), sometimes with added iron, help produce more red blood cells. This might relieve fatigue and weakness associated with anemia.
Medications to lower cholesterol levels. Your doctor might recommend medications called statins to lower your cholesterol. People with chronic kidney disease often have high levels of bad cholesterol, which can increase the risk of heart disease.
Medications to protect your bones. Calcium and vitamin D supplements can help prevent weak bones and lower your risk of fracture. You might also take medication known as a phosphate binder to lower the amount of phosphate in your blood and protect your blood vessels from damage by calcium deposits (calcification).
A lower protein diet to minimize waste products in your blood. As your body processes protein from foods, it creates waste products that your kidneys must filter from your blood. To reduce the amount of work your kidneys must do, your doctor might recommend eating less protein. A registered dietitian can suggest ways to lower your protein intake while still eating a healthy diet.
Your doctor might recommend regular follow-up testing to see whether your kidney disease remains stable or progresses.
Treatment for end-stage kidney disease
If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, you need dialysis or a kidney transplant.
Dialysis. Dialysis artificially removes waste products and extra fluid from your blood when your kidneys can no longer do this. In hemodialysis, a machine filters waste and excess fluids from your blood. In peritoneal dialysis, a thin tube inserted into your abdomen fills your abdominal cavity with a dialysis solution that absorbs waste and excess fluids. After a time, the dialysis solution drains from your body, carrying the waste with it.
Kidney transplant. A kidney transplant involves surgically placing a healthy kidney from a donor into your body. Transplanted kidneys can come from deceased or living donors. After a transplant, you'll need to take medications for the rest of your life to keep your body from rejecting the new organ. You don't need to be on dialysis to have a kidney transplant.
For some who choose not to have dialysis or a kidney transplant, a third option is to treat your kidney failure with conservative measures. Conservative measures likely will include symptom management, advance care planning and care to keep you comfortable (palliative care).
Overview
Peritoneal dialysisOpen pop-up dialog box
Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove waste products from your blood when your kidneys can't adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis.
During peritoneal dialysis, a cleansing fluid flows through a tube (catheter) into part of your abdomen. The lining of your abdomen (peritoneum) acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded.
These treatments can be done at home, at work or while traveling. But peritoneal dialysis isn't an option for everyone with kidney failure. You need manual dexterity and the ability to care for yourself at home, or you need a reliable caregiver.
Why it's done
You need dialysis if your kidneys no longer function well enough. Kidney damage generally progresses over a number of years as a result of long-term conditions, such as:
Diabetes
High blood pressure
Kidney inflammation (glomerulonephritis)
Multiple cysts in the kidneys (polycystic kidney disease)
In hemodialysis, blood is removed from the body, filtered through a machine and then the filtered blood is returned to the body. Hemodialysis is typically done in a health care setting, such as a dialysis center or hospital, though it can sometimes be done at home.
Although both types of dialysis can effectively filter your blood, the benefits of peritoneal dialysis compared with hemodialysis include:
Greater lifestyle flexibility and independence. These can be especially important if you work, travel or live far from a hemodialysis center.
A less restricted diet. Peritoneal dialysis is done more continuously than hemodialysis, resulting in less accumulation of potassium, sodium and fluid. This allows you to have a more flexible diet than you could have on hemodialysis.
Longer lasting residual kidney function. People who use peritoneal dialysis might retain kidney function slightly longer than people who use hemodialysis.
Talk with your doctor about which type of dialysis might be best for you. Factors to consider include:
Your kidney function
Your overall health
Your personal preferences
Your home situation
Your lifestyle
Peritoneal dialysis may be the better option if you:
Can't tolerate the rapid changes of fluid balance associated with hemodialysis
Want to minimize the disruption of your daily activities
Want to work or travel more easily
Have some residual kidney function
Peritoneal dialysis might not work if you have:
Extensive surgical scars in your abdomen
A large area of weakened abdominal muscle (hernia)
Limited ability to care for yourself, or a lack of caregiving support
Inflammatory bowel disease or frequent bouts of diverticulitis
It's also likely that people using peritoneal dialysis will eventually have a decline in kidney function that requires hemodialysis or a kidney transplant.
Risks
Complications of peritoneal dialysis can include:
Infections. An infection of the abdominal lining (peritonitis) is a common complication of peritoneal dialysis. An infection can also develop at the site where the catheter is inserted to carry the cleansing fluid (dialysate) into and out of your abdomen. The risk of infection is greater if the person doing the dialysis isn't adequately trained.
Weight gain. The dialysate contains sugar (dextrose). Absorbing some of the dialysate might cause you to take in hundreds of extra calories daily, leading to weight gain. The extra calories can also cause high blood sugar, especially if you have diabetes.
Hernia. Holding fluid in your abdomen for long periods may strain your muscles.
Inadequate dialysis. Peritoneal dialysis can become ineffective after several years. You might need to switch to hemodialysis.
If you have peritoneal dialysis, you'll need to avoid:
Certain prescription and over-the-counter medications that can damage your kidneys, including nonsteroidal anti-inflammatory drugs.
Soaking in a bath or hot tub, or swimming in a lake, pond, river or nonchlorinated pool — which increases the risk of infection. Showers and swimming in a chlorinated pool are generally acceptable.
How you prepare
You'll need an operation to insert the catheter that carries the dialysate in and out of your abdomen. The insertion might be done under local or general anesthesia. The tube is usually inserted near your bellybutton.
After the tube is inserted, your doctor will probably recommend waiting up to a month before starting peritoneal dialysis treatments to give the catheter site time to heal.
You'll also receive training on how to use the peritoneal dialysis equipment.
What you can expect
During peritoneal dialysis:
The dialysate flows into your abdomen and stays there for a prescribed period of time (dwell time) — usually four to six hours
Dextrose in the dialysate helps filter waste, chemicals and extra fluid in your blood from tiny blood vessels in the lining of your abdominal cavity
When the dwell time is over, the solution — along with waste products drawn from your blood — drains into a sterile collection bag
The process of filling and then draining your abdomen is called an exchange. Different methods of peritoneal dialysis have different schedules of exchange. The two main schedules are:
Continuous ambulatory peritoneal dialysis (CAPD)
Continuous cycling peritoneal dialysis (CCPD)
Continuous ambulatory peritoneal dialysis (CAPD)
You fill your abdomen with dialysate, let it remain there for a prescribed dwell time, then drain the fluid. Gravity moves the fluid through the catheter and into and out of your abdomen.
With CAPD:
You may need three to five exchanges during the day and one with a longer dwell time while you sleep
You can do the exchanges at home, work or any clean place
You're free to go about your normal activities while the dialysate dwells in your abdomen
Continuous cycling peritoneal dialysis (CCPD)
Also known as automated peritoneal dialysis (APD), this method uses a machine (automated cycler) that performs multiple exchanges at night while you sleep. The cycler automatically fills your abdomen with dialysate, allows it to dwell there and then drains it to a sterile bag that you empty in the morning.
With CCPD:
You must remain attached to the machine for about 10 to 12 hours at night.
You aren't connected to the machine during the day. But in the morning you begin one exchange with a dwell time that lasts the entire day.
You might have a lower risk of peritonitis because you connect and disconnect to the dialysis equipment less frequently than you do with CAPD.
To determine the method of exchange that's best for you, your doctor will consider your medical condition, lifestyle and personal preferences. Your doctor might suggest certain modifications to individualize your program.
Results
Many factors affect how well peritoneal dialysis works in removing wastes and extra fluid from your blood. These factors include:
Your size
How quickly your peritoneum filters waste
How much dialysis solution you use
The number of daily exchanges
Length of dwell times
The concentration of sugar in the dialysis solution
To check if your dialysis is removing enough waste products, your doctor is likely to recommend tests, such as:
Peritoneal equilibration test (PET). This test compares samples of your blood and your dialysis solution during an exchange. The results indicate whether waste toxins pass quickly or slowly from your blood into the dialysate. That information helps determine whether your dialysis would be improved if the solution stayed in your abdomen for a shorter or longer time.
Clearance test. A blood sample and a sample of used dialysis solution are analyzed to determine how much of a certain waste product (urea) is being removed from your blood during dialysis. If you still produce urine, your doctor may also take a urine sample to measure its urea concentration.
If the test results show that your dialysis schedule is not removing enough wastes, your doctor might change your dialysis routine to:
Increase the number of exchanges
Increase the amount of dialysate you use for each exchange
Use a dialysate with a higher concentration of dextrose
You can improve your dialysis results and your overall health by eating the right foods, including foods low in sodium and phosphorus. A dietitian can help you develop an individualized meal plan. Your diet will be based on your weight, your personal preferences, and your remaining kidney function and other medical conditions, such as diabetes or high blood pressure.
Taking your medications as prescribed also is important for getting the best possible results. While receiving peritoneal dialysis, you'll likely need various medications to control your blood pressure, stimulate production of red blood cells, control the levels of certain nutrients in your blood and prevent the buildup of phosphorus in your blood.
Lifestyle and home remedies
As part of your treatment for chronic kidney disease, your doctor might recommend a special diet to help support your kidneys and limit the work they must do. Ask your doctor for a referral to a registered dietitian who can analyze your diet and suggest ways to make your diet easier on your kidneys.
Depending on your situation, kidney function and overall health, dietary recommendations might include the following:
Avoid products with added salt. Lower the amount of sodium you eat each day by avoiding products with added salt, including many convenience foods, such as frozen dinners, canned soups and fast foods. Other foods with added salt include salty snack foods, canned vegetables, and processed meats and cheeses.
Choose lower potassium foods. High-potassium foods include bananas, oranges, potatoes, spinach and tomatoes. Examples of low-potassium foods include apples, cabbage, carrots, green beans, grapes and strawberries. Be aware that many salt substitutes contain potassium, so you generally should avoid them if you have kidney failure.
Limit the amount of protein you eat. Your registered dietitian will estimate how many grams of protein you need each day and make recommendations based on that amount. High-protein foods include lean meats, eggs, milk, cheese and beans. Low-protein foods include vegetables, fruits, breads and cereals.
Receiving a diagnosis of chronic kidney disease can be worrisome. To help you cope with your feelings, consider:
Connecting with other people who have kidney disease. They can understand what you're feeling and offer unique support. Ask your doctor about support groups in your area. Or contact organizations such as the American Association of Kidney Patients, the National Kidney Foundation or the American Kidney Fund for groups in your area.
Maintaining your normal routine, when possible. Try to keep doing the activities you enjoy and continue working, if your condition allows. This can help you cope with feelings of sadness or loss that you might have.
Being active most days of the week. With your doctor's advice, aim for at least 30 minutes of physical activity most days of the week. This can help you cope with fatigue and stress.
Talking with someone you trust. You might have a friend or family member who is a good listener. Or you may find it helpful to talk with a faith leader or someone else you trust. Ask your doctor for a referral to a social worker or counselor.
