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Kidney Disease Q&A

Two of our Nephrology specialists answer common questions on kidney disease including signs and symptoms, causes and effective treatments.

Dr Bassam Alchi
Consultant Nephrologist

BMI The Princess Margaret Hospital

Dr Andrew Palmer
Consultant Nephrologist

BMI The Clementine Churchill Hospital
BMI The Chiltern Hospital

What are the common types of kidney disease?

Dr Bassam Alchi

The most common type of kidney disease is “chronic kidney disease” a condition characterised by a gradual loss of kidney function over time. Both kidneys are affected. There are 5 stages of chronic kidney disease, with stage 5 being the more advanced.

Another more serious type of kidney disease is “acute kidney injury” a sudden and recent reduction in the level of kidney function. Acute kidney injury is a medical emergency as it can be potentially reversible if treated early.

Dr Andrew Palmer

There are many types of kidney disease but the majority of patients are a result of just a few conditions. These can be split into problems that affect the kidney alone such as inflammation called 'nephritis' or inherited cystic diseases or more generalised conditions that also affect the kidney. These include diabetes, hypertension, and more complex problems such as auto-immune conditions and treatment related to other medical problems such as cancer.

What are the causes of kidney disease?

Dr Bassam Alchi

Kidney disease can be caused by a variety of medical conditions; some of which are “genetic” such as polycystic kidney disease but the majority are “acquired”. Diabetes, hypertension, glomerulonephritis (inflammation of the filtering units in the kidneys), urinary tract infection, kidney stones, urological malignancies and multiple drugs may damage the kidneys.

Dr Andrew Palmer

The cause of chronic kidney disease is when conditions described above lead to the irreversible loss of renal tissue and results in scarring and often the kidneys become smaller with time. This is in contrast to acute renal failure when patients temporarily lose renal function in the context of a severe illness and may need dialysis before recovering. Patients with chronic kidney disease often hae a slow decline renal function with additional factors such as blood pressure affecting patient's progress.

What are the symptoms of kidney disease?

Dr Bassam Alchi

Most people with kidney disease have no symptoms and are usually diagnosed by a routine blood or urine test. Kidney disease is often associated with high blood pressure. A person may develop swollen ankles or face, change in the amount or colour of urine, loin pain with or without fever. As kidney function deteriorates, symptoms such as general tiredness, loss of appetite or shortness of breath may occur.

Dr Andrew Palmer

The symptoms of kidney disease are either a result of the underlying cause or a direct consequence of the reduced level of function. The former may be obvious and quite varied due to the wide range of conditions affecting the kidney. The symptoms of poor kidney function often occur late and in quite advanced renal failure. They are rather non-specific including loss of energy, poor appetite, nausea and itching of the skin. It is for this reason that kidney disease often presents after being present for some time.

What treatments are there for kidney disease?

Dr Bassam Alchi

Treatment will depend on the underlying cause as well as the symptoms that you have. It may involve taking certain medications to control the blood pressure, reduce the level of protein in the urine and/or control blood sugar levels. However, patients with glomerulonephritis e.g. may require specific treatment to supress the immune system. There are treatments available to prevent kidney stone formation. A kidney specialist will be able to advise you about the best treatment in your case.

Dr Andrew Palmer

The treatment of kidney disease is split into two areas. The first is that if the cause can be identified then this should be specifically treated. It is for this reason that patients should be fully investigated. Each diagnosis will need its own therapy so forms of kidney inflammation may need steroids, narrowing of kidney arteries may require balloon dilatation and stents like with the heart and obstuction of the bladder may need a catheter and the advice of a urologist. Patients with chronic kidney disease will also need certain specific measures such as good blood pressure control with specific drugs that also help to stop further deterioration in kidney function.

What is kidney dialysis?

Dr Bassam Alchi

Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. There are two main types of dialysis: haemodialysis and peritoneal dialysis.

Dr Andrew Palmer

Kidney dialysis is a form of treatment that replaces the function of the kidneys. The first is haemodialysis whereby blood is taken from the patient, either by a catheter or a blood vessel called a fistula and circulates through an artificial kidney whereby fluid and toxins are removed before the treated blood is returned to the patient. Most patients need three times per week 3-4 hour sessions which is usually done in a local hospital but can be set up at home. The alternative form of dialysis is peritoneal dialysis where specific fluid is instilled via a catheter into the abdomen either 4x / day or overnight with a machine with the same effect. Patients in the UK are carefully counselled and can choose which form of therapy they would like.

What made you want to become a consultant?

Dr Bassam Alchi

I have always wanted to become a nephrologist having lost my father due to kidney failure before I stated my medical education. Being a consultant helped me to develop areas of interest and skills to provide the best treatment for my patients.

Dr Andrew Palmer

I always wanted to be a physician rather than a surgeon and once I embarked on my training and career I was excited by the prospect of hospital based medicine and in particular renal medicine. This was because the roles of a renal specialist are varied between caring for patients with simple kidney disease to more complicated areas such as dialysis and transplantation. The many exciting developments that have continued to occur in my field of medicine has also been a particular attraction.

What is your career highlight to date?

Dr Bassam Alchi

The highlight of my career is completing the “Doctor of Philosophy” degree in kidney transplant rejection from Niigata University Hospital in Japan. I have more than 30 publications in reputed international journals and published a chapter in the Oxford Textbook of Clinical Nephrology.

Dr Andrew Palmer

I do not have any specific highlight but would prefer to emphasis the tremendous rapport and relationships I have built up with my patients over many years. It is common for consultants in my speciality to have looked after patients for over 20 years and this has been extremely rewarding.

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