LIVING KIDNEY
DONORS
POST DONATION – THINGS TO CONSIDER
by Diane Curtiss
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.
- 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
- Do not
use Nsaids (Aleve), aspirin, or ibuprofin (Advi). 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.
- 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.
- 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.
- 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.
- 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. Water will hydrate you and
continue to flush impurities from your system.
- 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 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.
- 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.
- 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. If you
have a salt shaker – throw it away! 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.
- 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.
- 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.
- 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.
- 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 would be hard on your body in general.
- 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 4
months post donation, it would be wise to have the following tests 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 test can be included as part of that annual physical.
- 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.
- 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.
- 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. There are few sources out there
specifically directed towards living kidney donors, but sifting through the
kidney related websites can provide some information as relates to protecting
kidney function.
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.