Patient Education

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When should you contact a nephrologist?

There are various indication to consult with a kidney specialist.

Referrals are generally made via your general practitioner if they identify a problem.
Patients can consult with a nephrologist directly without a referral in South Africa.
General indications for a consult would include the following screening or symptoms.

Screening

A long-standing history of diabetes or hypertension.
A first degree relative with kidney failure or kidney damage.
Wellness checks.
Previous history of resolved kidney disease.
History of drug or NSAIDS use.
Patients over the age of 60yrs.

Symptoms

Swelling and puffiness over the face and body.
Fatigue or shortness of breath.
Blood in the urine or decreased urine output.
Nausea or vomiting.
Weakness.
Sleep disturbance.
Irritated Skin.
Uncontrolled blood pressure.

These are some of the symptoms of kidney disease but are not specific to kidney damage It therefore important to visit a nephrologist and have directed tests to exclude kidney disease.

Patients with CKD (chronic kidney disease) can go many years without realising there is a problem, hence screening is very important especially in high-risk patients like diabetics and hypertensives.

Chronic Kidney Disease

This is a gradual loss of kidney function leading to kidney failure. The kidneys filter waste and excess water from the blood and as the kidneys start to fail waste products build up in the body. Symptoms are slow to develop and are nonspecific to the disease. Medication can help to control symptoms, but some causes cannot be reversed by medication.

As the condition progresses, filtration of the blood using a machine (dialysis) is required. The only cure for kidney failure is a kidney transplant.

Contact us for an individualised treatment plan focusing on medical care, nutrition and the social implications of chronic kidney disease.

5 Stages of Chronic Kidney Damage

(using glomerular filtration rates)

Stage 1 – > 90 ml/min
Stage 2 – 60-90 ml/min (mild)
Stage 3 – 30-59 ml/min (moderate)
Stage 4 – 15-29 ml/min (severe)
Stage 5 – <15 ml/min (end stage)

Haemodialysis

This is a procedure that filters a patient’s blood through a machine that removes waste and excess water from the blood. Haemodialysis is done via a dialysis catheter or a fistula (a created high pressure access generally on the forearm by joining an artery and vein)

These ports are inserted or created in a theatre by a renal surgeon. Haemodialysis is performed 2 or 3 times a week for 4 hours depending on the individual needs of a patient.

Dialysis is performed at a dedicated renal unit sometimes decided by your medical insurance option. Haemodialysis does not repair the damaged kidneys but replaces some of its vital functions.

Peritoneal Dialysis

This is a form of dialysis which uses the peritoneum in a person’s abdomen as the diffusing membrane through which fluid and waste are removed from the blood into the abdominal fluid. The peritoneum is a membrane that lines the inside of the abdomen and pelvis (parietal) and covers the organs inside (visceral)

The space between the 2 membranes is called the peritoneal cavity a dialysis port is inserted into the peritoneal cavity by a surgeon after careful assessment sterile fluid is infused into the abdomen via the port and allowed to dwell for a period of time. It is then allowed to drain out via the exit port and a new bag of sterile fluid in run into the peritoneal cavity.

This form of dialysis can be done in the comfort of your home or work provided sterile measures are taken close monitoring and review needs to done by your nephrologist. Contact us to discuss this option and if it may be an option for you

Kidney Transplant

A kidney transplant is a surgery to place a healthy kidney from either a living donor (live related donor) or a deceased donor (cadaver) into a person with end stage kidney failure. Patients with end stage kidney failure are referred to a transplant centre for an assessment and to begin an intensive work up to determine safety and eligibility to be placed a transplant waiting list.

A potential donor (family member or other) can be referred to the transplant centre to be screened for his/ her eligibility to be a kidney donor. Strict criteria are applied for both donor and recipient. The transplant panel decide if there are concerns related to donor or recipients having the transplant.

Cadaver kidneys are donated to the closest matched accepted candidate on the waiting list the South African Nephrology Society (SANS) endorses the Declaration of Istanbul on organ trafficking and transplant tourism – declarationofistanbul.org

Home Dialysis

Some patients are able to financially afford home haemodialysis. There are dialysis companies that can assist with the machine hire or purchase, the consumables, water systems and nursing staff to assist with home haemodialysis. Supervision and monitoring are required by a treating nephrologist many medical aids/funders are happy to engage directly with patients regarding the costs and their contributions towards the set up.

There are 3 different commonly used home haemodialysis options

Standard home haemodialysis 3x week (3-5 hrs per session)
Short daily sessions 5-7 x week (2-4 hrs per session)
Nightly home sessions 3-6 x week at night

These sessions of haemodialysis will be reviewed and changed accordingly by your nephrologist contact us to discuss these options and if this may be a viable option for you to consider.