Author: Manminder

Fertility (the ability to have a child) tends to increase in both men and women after a transplant. Are you thinking about pregnancy? If so, you should discuss it beforehand with your transplant team and other healthcare providers. There are many things to consider. You and your healthcare provider should discuss them all very carefully.
Here are a few brief answers to some common questions about kidney disease and pregnancy.

Can a woman who has a kidney transplant have a baby?
Yes. If you have a kidney transplant, you are likely to have regular menstrual periods and good general health. Therefore, getting pregnant and having a child is possible. But you should not become pregnant for at least one year after your transplant, even with stable kidney function. Some medicines that you take after a kidney transplant can cause problems to a developing baby. In some cases, pregnancy may not be recommended because there is a high risk to you or the baby. Another reason is if there is a risk of losing the transplant.
Talk with your healthcare provider if you have a transplant and are thinking about getting pregnant. Your healthcare provider may need to change your medications so that it is safe for you to become pregnant. It is very important to use birth control until you and your healthcare provider have agreed that it is safe for you to become pregnant.

How might medicines taken by transplant patients affect an unborn child?
Many anti-rejection medicines are generally safe for a pregnant woman and her baby. However, there are some types that can affect pregnancy and the baby. These types should be avoided during pregnancy and stopped at least six weeks (or more) before becoming pregnant. Your doctor will likely monitor you after you’ve stopped, and let you know when it’s safe to attempt pregnancy.
If you have a kidney transplant and are considering pregnancy, you should discuss it carefully with your transplant team and your kidney doctor. Your doctor may want you to switch to a different anti-rejection medicine.

What kind of birth control is recommended for transplant patients?
Transplant patients who are sexually active and have not undergone menopause should use birth control to prevent pregnancy. Your healthcare provider can recommend the type of birth control that should be used. Many women who have high blood pressure should not use “the pill” (oral contraceptives) since this type of medicine can raise blood pressure and increase the chance of blood clots. The diaphragm, sponge, and condom are usually acceptable means of birth control, especially when used with spermicidal creams, foams or jellies. The newer IUD is also possible.

Can I become pregnant after receiving a transplant?
Yes! After receiving a transplant your fertility can return quickly and you can become pregnant. You should use appropriate birth control measures and any consideration of pregnancy should be discussed with your healthcare providers.

Is pregnancy safe after transplant?
Depending on the type of transplant you received and your other personal health factors, there may be special issues to consider. Although not very common, pregnancy may cause problems. Successful pregnancy is most likely when your transplanted organ is working well and your medication doses are stable prior to pregnancy.

Do the children develop normally?
The NTPR continually updates its information with a special focus on child health and development. At follow-up, the children are overwhelmingly reported to be healthy and developing well. Rare health or development problems have occurred, more likely due to prematurity or inherited disorders.

Fertility generally returns after renal transplantation. Approximately 74% of pregnancies in kidney transplant recipients end successfully in life births.

The hemodialysis diet is an eating plan tailored to patients who are on hemodialysis. It’s designed to reduce the amount of fluid and waste that builds up between hemodialysis treatments so that you can feel your best.

Now that you are beginning hemodialysis, there may be many changes in your daily life. Your doctor has probably told you that you may need to make some changes in your diet. The renal dietitian at your dialysis center will help you plan a diet for your special needs.

Why do I need to be on a special diet?
Because your kidneys are not able to get rid of enough waste products and fluids from your blood and your body now has special needs, you will need to limit fluids and change your intake of certain foods in your diet. How well you feel will depend on:

• Eating the right kind and amounts of food from your diet
• Having the hemodialysis treatments your doctor orders for you
• Taking the medications your doctor orders for you.

Your diet is very important to your care. It is important that you have the right amount of protein, calories, fluids, vitamins and minerals each day. Your dietitian will help you plan your meals to make sure you get the proper balance. Some general guidelines to follow can be found in our free brochure, “Nutrition and Hemodialysis.

What can I eat?
In addition to enjoying a variety of nutritious foods, the hemodialysis diet will introduce a higher amount of high-quality protein into your eating plan. Your dietitian will determine the amount. High-protein foods such as lean meat, poultry, fish and egg whites provide all the essential amino acids your body needs.

What can’t I eat?
Foods containing high amounts of sodium, phosphorus and potassium are restricted. Your dietitian will provide you with food lists that indicate which foods are allowed and which ones you should avoid or limit. You will also limit your fluid intake.

Why do I have to eat this way?
Your dietitian and doctor will strongly recommend you follow the hemodialysis diet, so your dialysis treatments will be effective, you can feel your best, and help reduce the risk of health complications associated with kidney disease and dialysis.

What about fluid intake?
Too much fluid gain between hemodialysis sessions can cause discomfort, including swelling, shortness of breath or high blood pressure. Fluid intake is not limited to what you can drink; it’s also hidden in some foods you eat, including gelatin, ice, sherbet, watermelon, sauces and gravies. Your dietitian will give you guidelines to help you monitor your fluid intake.

What if I have high cholesterol?
Changing your diet may help lower the cholesterol level in your blood. Your dietitian will talk with you about the kinds of fat and animal foods you eat. Also, your doctor may decide you need a special medication to reduce the cholesterol in your blood.

What if I have diabetes?
In some cases, you may need to make only a few changes in your diet to fit your needs as a kidney patient. For example, some of the free foods you have been using may need to be limited on your kidney diet. Your dietitian will help develop a meal plan especially for you.

How does the hemodialysis diet help?
Your hemodialysis diet will include a balance of nutrients to help keep your body healthy and strong, while allowing the amount of potassium, phosphorus and sodium your body can safely handle.

Potassium is easily removed by dialysis, but when it builds up in the blood between treatments, it can cause muscle weakness and make your heart stop beating. Certain fruits, vegetables, dairy products and other foods that are high in potassium will need to be restricted from your diet.

Phosphorus is difficult for hemodialysis to filter from the blood so it’s important to limit foods that contain the mineral. Phosphorus can build to high levels in the bloodstream and cause weak bones, heart problems, joint pain or skin ulcers. Your doctor may also prescribe a medicine called a phosphorus binder to help keep phosphorus levels normal.

Sodium causes your body to hold onto more fluid and raises your blood pressure. Eating less sodium and drinking less fluid can help you feel comfortable before and after your dialysis sessions.

How long do I have to follow the hemodialysis diet?
You will follow the hemodialysis diet as long as you need hemodialysis. Your dietitian may make some changes to it in order to adjust to your current condition and activity levels.

Is there anything else I should know?
The following important tips can be helpful with your diet:

• Fresh or plain frozen vegetables contain no added salt. Drain all the cooking fluid before serving.
• Canned fruits usually contain less potassium than fresh fruits. Drain all the fluid before serving.
• Non-dairy creamers are low in phosphorus and can be used in place of milk.
• Labels on food packages will give you information about some of the ingredients that may not be allowed in your diet. Learn to read these labels.
• To help you avoid salt, many herbs and spices can be used to make your diet more interesting. Check with your dietitian for a list of these.

If I follow the hemodialysis diet will my kidneys get better?
Your kidneys are already damaged and cannot be cured or reversed. However, the hemodialysis diet can help you feel you are best between dialysis treatments and afterwards.

Acute Kidney Injury (AKI)
Acute kidney failure is also called acute kidney injury or acute renal failure. It’s common in people who are already in the hospital. It may develop rapidly over a few hours. It can also develop over a few days to weeks. People who are critically ill and need intensive care have the highest risk of developing acute kidney failure.
Acute kidney injury (AKI) is sudden damage to the kidneys that causes them to not work properly. It can range from minor loss of kidney function to complete kidney failure. AKI normally happens as a complication of another serious illness. It’s not the result of a physical blow to the kidneys, as the name might suggest.
This type of kidney damage is usually seen in older people who are unwell with other conditions and the kidneys are also affected. It’s essential that AKI is detected early and treated promptly. The role of the kidneys is to:

• filter – removing waste and water from the blood (as urine, via the bladder)
• clean the blood
• keep the bones healthy
• look after blood pressure
• stimulate the bone marrow to make blood

Without quick treatment, abnormal levels of salts and chemicals can build up in the body, which affects the ability of other organs to work properly. If the kidneys shut down completely, this may require temporary support from a dialysis machine, or lead to death.

Signs and symptoms
Signs and symptoms of acute kidney injury differ depending on the cause and may include:

• Too little urine leaving the body
• Swelling in legs, ankles, and around the eyes
• Fatigue or tiredness
• Shortness of breath
• Confusion
• Nausea
• Seizures or coma in severe cases
• Chest pain or pressure
• Dehydration
• high blood pressure
• abdominal pain
• slight backache

In some cases, AKI causes no symptoms and is only found through other tests done by your healthcare provider.

Causes
Acute kidney injury can have many different causes. AKI can be caused by the following:

• Impaired blood flow to the kidneys

Some diseases and conditions can slow blood flow to your kidneys and cause AKI. These diseases and conditions include:

• Blood or fluid loss
• Blood pressure medications
• Heart attack
• Heart disease
• Infection
• Liver failure
• Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen (Aleve, others) or related drugs
• Severe allergic reaction (anaphylaxis)
• Severe burns
• Severe dehydration
• Direct damage to the Kidneys

Some disease and conditions can damage your kidneys and lead to AKI. Some examples include:

• A type of severe, life-threatening infection
• A rare condition that causes inflammation and scarring to your blood vessels, making them stiff, weak, and narrow
• An allergic reaction to certain types of drugs
• A group of diseases that affect the connective tissue that supports your internal organs
• Conditions that cause inflammation or damage to the kidney tubules, to the small blood vessels in the kidneys, or to the filtering units in the kidneys
• Blockage of the urinary tract

In some people, conditions or diseases can block the passage of urine out of the body and can lead to AKI.
Blockage can be caused by:

• Bladder, prostate, or cervical cancer
• Enlarged prostate
• Problems with the nervous system that affect the bladder and urination
• Kidney stones
• Blood clots in the urinary tract

Acute kidney failure can occur when:

• You have a condition that slows blood flow to your kidneys
• You experience direct damage to your kidneys
• Your kidneys’ urine drainage tubes (ureters) become blocked and wastes can’t leave your body through your urine

Risk factors
The chances of acquiring acute kidney failure are greater if you’re an older person or if you have any of the following long-term health problems:

• kidney disease
• liver disease
• diabetes, especially if it’s not well controlled
• high blood pressure
• heart failure
• morbid obesity

If you’re ill or being treated in a hospital’s intensive care unit, you’re at an extremely high risk for acute kidney failure. Being the recipient of heart surgery, abdominal surgery, or a bone marrow transplant can also increase your risk.

When should AKI be suspected?
A doctor may suspect AKI in people known to be at risk who suddenly fall ill or develop symptoms which suggest complications of AKI.
AKI may also be suspected in people who have been unwell for a while and have either:

• chronic kidney disease
• a urinary system disease
• new or worsening urinary symptoms
• symptoms or signs of a disease affecting the kidneys and other organs

Diagnosis
If you have acute kidney failure, you may have generalized swelling. The swelling is due to fluid retention. Using a stethoscope, your doctor may hear crackling in the lungs. These sounds can signal fluid retention. Results of laboratory tests may also show abnormal values, which are new and different from baseline levels. Some of these tests include:

• blood urea nitrogen (BUN)
• serum potassium
• serum sodium
• estimated glomerular filtration rate (eGFR)
• urinalysis
• creatinine clearance
• serum creatinine

An ultrasound is the preferred method for diagnosing acute kidney failure. However, abdominal X-ray, abdominal CT scan, and abdominal MRI can help your doctor determine if there’s a blockage in your urinary tract. Certain blood tests may also reveal underlying causes of acute kidney failure.

Polycystic Kidney Disease
Polycystic kidney disease (also called PKD). PKD is an inherited kidney disorder. It causes numerous cysts to grow in the kidneys. These cysts are filled with fluid. If too many cysts grow or if they get too big, the kidneys can become damaged. PKD may impair kidney function and eventually cause kidney failure. PKD is the fourth leading cause of kidney failure.

• Polycystic kidney disease (PKD) causes cysts to form on the kidneys.
• There are three types of PKD: autosomal dominant PKD, autosomal recessive PKD, and acquired cystic kidney disease.
• There is no cure for PKD, but there are treatments that can control symptoms.

Other organs besides the kidney are affected by PKD
PKD can affect other organs besides the kidney. People with PKD may have cysts in their liver, pancreas, spleen, ovaries, and large bowel. Cysts in these organs usually do not cause serious problems, but can in some people. PKD can also affect the brain or heart. If PKD affects the brain, it can cause an aneurysm. An aneurysm is a bulging blood vessel that can burst, resulting in a stroke or even death. If PKD affects the heart, the valves can become floppy, resulting in a heart murmur in some patients.

Symptoms
Many people live with PKD for years without experiencing symptoms associated with the disease. Cysts typically grow 0.5 inches or larger before a person starts noticing symptoms. Initial symptoms associated with PKD can include:

• pain or tenderness in the abdomen
• blood in the urine
• frequent urination
• pain in the sides
• urinary tract infection (UTI)
• kidney stones
• pain or heaviness in the back
• skin that bruises easily
• pale skin color
• fatigue
• joint pain
• nail abnormalities

Children with autosomal recessive PKD may have symptoms that include:

• high blood pressure
• UTI
• frequent urination

Symptoms in children may resemble other disorders. It is important to get medical attention for a child experiencing any of symptoms listed above.

CausesAbnormal genes cause polycystic kidney disease, and the genetic defects mean the disease runs in families. Rarely, a genetic mutation can be the cause of polycystic kidney disease.
There are two types of polycystic kidney disease, caused by different genetic flaws:

• Autosomal dominant polycystic kidney disease (ADPKD). Signs and symptoms of ADPKD often develop between the ages of 30 and 40. In the past, this type was called adult polycystic kidney disease, but children can develop the disorder.

Only one parent needs to have the disease in order for it to pass along to the children. If one parent has ADPKD, each child has a 50 percent chance of getting the disease. This form accounts for about 90 percent of cases of polycystic kidney disease.

• Autosomal recessive polycystic kidney disease (ARPKD). This type is far less common than is ADPKD. The signs and symptoms often appear shortly after birth. Sometimes, symptoms don’t appear until later in childhood or during adolescence.

Both parents must have abnormal genes to pass on this form of the disease. If both parents carry a gene for this disorder, each child has a 25 percent chance of getting the disease.

Diagnosed?
To diagnose all three types of PKD, your doctor may use imaging tests to look for cysts of the kidney, liver, and other organs. Imaging tests used to diagnose PKD include:

• abdominal ultrasound: a non-invasive test that uses sound waves to look at your kidneys for cysts
• abdominal CT scan: can detect smaller cysts in the kidneys
• abdominal MRI scan: uses strong magnets to image your body to visualize kidney structure and look for cysts
• intravenous pyelogram: uses a dye to make your blood vessels show up more clearly on an X-ray

Does everyone with PKD develop kidney failure?
No. About 50 percent of people with PKD will have kidney failure by age 60, and about 60 percent will have kidney failure by age 70. People with kidney failure will need dialysis or a kidney transplant. Certain people have an increased risk of kidney failure including:

• Men
• patients with high blood pressure
• patients with protein or blood in their urine
• women with high blood pressure who have had more than three pregnancies

Treatments
Some of the treatment options may include:

• pain medication, except Ibuprofen, which is not recommended as it may worsen kidney disease
• blood pressure medication
• antibiotics to treat UTIs
• a low sodium diet
• diuretics to help remove excess fluid from the body
• surgery to drain cysts and help relieve discomfort

With advanced PKD that causes renal failure, dialysis and kidney transplant may be necessary. One or both of the kidneys may need to be removed.

Kidney Failure
Kidney failure, also called end-stage renal disease (ESRD), is the last stage of chronic kidney disease.Healthy kidneys do many important jobs. They keep your whole body in balance. They remove waste products and extra water from your body, help make red blood cells, and help control blood pressure. When your kidneys fail, it means they have stopped working well enough for you to survive without dialysis or a kidney transplant. They cannot do these important jobs well enough. Having kidney failure means that:

• 85-90% of your kidney function is gone
• Your kidneys don’t work well enough to keep you alive

There is no cure for kidney failure, but with treatment, it is possible to live a long life. Having kidney failure is not a death sentence. People with kidney failure live active lives and continue to do the things they love.

Causes
In most cases, kidney failure is caused by other health problems that have done permanent damage (harm) to your kidneys little by little, over time.When your kidneys are damaged, they may not work as well as they should. If the damage to your kidneys continues to get worse and your kidneys are less and less able to do their job, you have chronic kidney disease. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease, or ESRD for short.
Diabetes is the most common cause of ESRD. High blood pressure is the second most common cause of ESRD. Other problems that can cause kidney failure include:

• Autoimmune diseases, such as lupus and IgA nephropathy
• Genetic diseases (diseases you are born with), such as polycystic kidney disease
• Nephrotic syndrome
• Urinary tract problems

Sometimes the kidneys can stop working very suddenly (within two days). This type of kidney failure is called acute kidney injury or acute renal failure. Common causes of acute renal failure include:

• Heart attack
• Illegal drug use and drug abuse
• Not enough blood flowing to the kidneys
• Urinary tract problems

This type of kidney failure is not always permanent. Your kidneys may go back to normal or almost normal with treatment and if you do not have other serious health problems.

Having one of the health problems that can lead to kidney failure does not mean that you will definitely have kidney failure. Living a healthy lifestyle and working with your doctor to control these health problems can help your kidneys work for as long as possible.

Symptoms
Healthy kidneys remove wastes and extra fluid from your blood. But when your kidneys fail, wastes and extra fluid can build up in your blood and make you feel sick. You may have some of the following symptoms:

Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body.

You may notice one or more of the following symptoms if your kidneys are beginning to fail:

• Itching
• Muscle cramps
• Nausea and vomiting
• Not feeling hungry
• Swelling in your feet and ankles
• Too much urine (pee) or not enough urine
• Trouble catching your breath
• Trouble sleeping

If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:

• Abdominal (belly) pain
• Back pain
• Diarrhea
• Fever
• Nosebleeds
• Rash
• Vomiting

Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.

Once you begin treatment for kidney failure, your symptoms will improve and you will begin to feel much better.

Treatment
If you have ESRD, you will need dialysis or a kidney transplant to survive. There is no cure for ESRD, but many people live long lives while having dialysis or after having a kidney transplant.

When it comes to dietary sodium, less is certainly best. Diets high in sodium increase blood pressure levels. High blood pressure damages the kidneys over time and is a leading cause of kidney failure.

• Make reading food labels a habit. Sodium content is always listed on food labels. Sodium content can vary from brand to brand, so compare and choose the lowest sodium product. Certain foods don’t taste particularly salty but are actually high in sodium, such as cottage cheese, so it’s critical to check labels.
• Stick to fresh meats, fruits and vegetables rather than their packaged counterparts, which tend to be higher in sodium.
• Avoid spices and seasonings that contain added sodium, for example garlic salt. Choose garlic powder instead.
• Many restaurants list the sodium content of their products on their websites, so do your homework before dining out. Also, you can request that your food be prepared without any added salt.
• Wait it out. You can learn to adjust to eating less salt. It typically takes about six to eight weeks on a low-sodium diet to get used to it. After that, you’ll actually find that some of your favorite salty foods, like potato chips, taste too salty to you.

“You can learn to adjust to eating less salt. It typically takes about six to eight weeks on a low-sodium diet to get used to it. After that, you’ll actually find that some of your favorite salty foods, like potato chips, taste too salty to you.”

In recent years, better ultrasound machines have allowed your doctor to see your baby’s kidneys more clearly during pregnancy. Different types of problems can be found including the absence of one or both kidneys, abnormal position of a kidney, hydronephrosis (swelling of a kidney), fluid-filled cysts and tumors.

The following overview of the urinary tract will help you understand the problems your baby may have.

What does the urinary tract do?
The main function of the urinary tract is to remove wastes and fluid from the body. The urinary tract has four parts: the kidneys, the ureters, the bladder and the urethra. The urine is formed when the kidneys filter blood and remove excess waste materials and fluid. The urine collects into a part of the kidney called the renal pelvis. From the renal pelvis, the urine travels down a narrow tube called the ureter into the bladder. The bladder slowly fills up with urine, which empties from the body through another small tube called the urethra.

During pregnancy, the baby floats in the amniotic fluid within the mother’s womb. This fluid is composed mostly of urine made by the baby. If not enough urine is being produced, there may not be enough amniotic fluid.

What types of problems can happen to the urinary tract in the baby?
Birth defects can occur in any part of the urinary tract. For example:

• The kidneys may be missing or in a wrong position.
• A blockage of the outflow of urine or reverse flow of urine already in the bladder (called reflux) can cause the renal pelvis to become enlarged. This is usually called hydronephrosis.
• A blockage of the urethra can affect emptying of the bladder, causing the pressure in the bladder to be greater. This places extra pressure on the renal pelvis in both kidneys and on the ureters, which can dilate. In boys, the most common blockage of the urethra is called urethral valves.
• Two ureters can drain a single kidney. In some cases, the connections can be abnormal and hydronephrosis or reflux can be a problem.

World AIDS day:
World AIDS Day, designated on 1 December every year since 1988, is dedicated to raising awareness of the AIDS pandemic caused by the spread of HIV infection, and mourning those who have died of the disease.

World AIDS Day is one of the eight official global public health campaigns marked by the World Health Organization (WHO).

As of 2013, AIDS has killed more than 36 million people worldwide (1981-2012), and an estimated 35.3 million people are living with HIV, making it one of the most important global public health issues in recorded history. Despite recent improved access to antiretroviral treatment in many regions of the world, the AIDS epidemic claims an estimated 2 million lives each year, of which about 270,000 are children.

What is HIV/AIDS?
Human immunodeficiency virus (HIV) is a replicating virus or retrovirus that can lead to acquired immunodeficiency syndrome (AIDS). AIDS is a health condition that causes the immune system to fail, which leads to a number of life-threatening infections and complications. HIV is transmitted when infected body fluid such as blood, semen, vaginal fluid and breast milk come into contact with a mucous membrane or the bloodstream of another person. Although HIV and AIDS medicines help slow the progression of the virus, there is no cure for HIV or AIDS.

Kidney disease is common in people living with HIV/AIDS—up to 30% have abnormal kidney function. HIV can affect your kidneys in many different ways, but the most common are HIV-associated nephropathy and nephrotoxicity.

HIV ASSOCIATED NEPHROPATHY (HIVAN)
HIVAN is damage to your kidneys caused by the Human Immunodeficiency Virus (HIV) itself. African American men with HIV/AIDS seem to be most at risk for developing HIVAN. It is most common in patients with CD4 counts less than 200 cells/mm3, but it can occur at any CD4 count. HIVAN is extremely uncommon in individuals with HIV who have a suppressed viral load (a low amount of HIV in their blood). Therefore, if you have HIVAN, it is very important to be started on antiretroviral therapy (ART) at the earliest sign of kidney problems—and to stay on it—no matter what your CD4 count is. Research shows that people who have HIVAN can stay healthy and live longer by staying on ART.

NEPHROTOXICITY
“Nephrotoxicity” is a term that means “toxicity or injury to the kidneys.” For people living with HIV/AIDS, nephrotoxicity can be an adverse side effect of certain HIV medications, including protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTIs—commonly called “nukes”). Your kidneys clear many medications from your body, so if your kidneys aren’t working properly, your healthcare provider may need to adjust the HIV meds that you are taking. Sometimes that means changing which HIV meds you take; other times it means changing your dosage. Work with your healthcare provider to find a treatment regimen that works for you.

How does HIV/AIDS affect the kidneys?
HIV-related kidney problems are commonly known as HIV-associated nephropathy (HIVAN). Up to 30 percent of people with HIV or AIDS have protein in their urine, a sign of abnormal kidney function, and about 10 percent of people with HIV develop kidney disease. This means HIV patients make up 1 to 2 percent of the end stage renal disease (ESRD) population.
Renal problems related to HIV can be caused directly by the HIV virus when it enters the kidneys and multiplies or by the medicines patients must take to manage HIV. Highly active antiretroviral therapy (HAART) and other HIV treatments have side effects that can sometimes be toxic to the kidneys, including:

• lactic acidosis — a buildup of lactic acid in the body
• crystal-induced obstruction — a buildup of crystals in the kidneys
• interstitial nephritis — a disorder in which tissues surrounding the kidneys become inflamed
• electrolyte abnormalities — abnormalities in the body’s levels of sodium, potassium or calcium

Treatment for CKD
HIV-positive patients who have or are at risk for CKD should have their treatment tailored to their needs and circumstances. Some treatments for CKD include managing phosphorus levels, reducing blood pressure, managing fluid balance and/or antiretroviral therapy.
The six classes of antiretroviral medications approved by the Food and Drug Administration are: Nucleoside reverse transcriptase inhibitors (NRTIs), Non-nucleoside reverse transcriptase inhibitors (NNRTIs), Protease inhibitors (PIs), Entry inhibitors, Fusion inhibitors and Integrase inhibitors.

• Nucleoside reverse transcriptase inhibitors (NRTIs) bind to and disable reverse transcriptase, a protein that HIV needs to make more copies of itself.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) create faulty versions of building blocks that HIV needs to make more copies of itself. When HIV uses one of these faulty building blocks instead of a normal building block, reproduction of the virus is stalled.
• Protease inhibitors (PIs) disable protease, a protein that HIV needs to make more copies of itself.
• Entry inhibitors work by blocking HIV entry into cells.
• usion inhibitors work by blocking HIV entry into cells.
• Integrase inhibitors disable one of the proteins that HIV uses to insert its viral genetic material into the genetic material of an infected cell.

HIV-positive people with ESRD who are on dialysis may want to consider a kidney transplant. Doctors can help HIV-positive patients with CKD and end stage renal disease determine a treatment regimen that manages both HIV and kidney disease.

1. Overusing Painkillers
Over the counter pain medicines, such as NSAIDs (non-steroidal anti-inflammatory drugs), may alleviate your aches and pains, but they can harm the kidneys, especially if you already have kidney disease. Reduce your regular use of NSAIDs and never go over the recommended dosage.

2. Abusing the Salt Shaker
Diets high in salt are high in sodium, which can increase blood pressure and, in turn, harm your kidneys. Flavour your foods with herbs and spices instead of salt. Over time, you may find it easier to avoid using added salt (sodium) on your food.

3. Eating Processed Foods
Processed foods are significant sources of sodium and phosphorus. Many people who have kidney disease need to limit phosphorus in their diets. Some studies have shown that high phosphorus intake from processed foods in people without kidney disease may be harmful to their kidneys and bones. Try adopting the DASH diet to guide your healthy eating habits.

4. Not Drinking Enough Water
Staying well hydrated helps your kidneys clear sodium and toxins from the body. Drinking plenty of water is also one of the best ways to avoid painful kidney stones. Those with kidney problems or kidney failure may need to restrict their fluid intake, but for most people, drinking 1.5 to 2 litres (3 to 4 pints) of water per day is a healthy target.

5. Missing Out on Sleep
A good night’s rest is extremely important to your overall well-being and, it turns out, your kidneys. Kidney function is regulated by the sleep-wake cycle which helps coordinate the kidneys’ workload over 24 hours. Research shows that people who sleep less usually have faster kidney function decline.

6. Eating Too Much Meat
Animal protein generates high amounts of acid in the blood that can be harmful to the kidneys and cause acidosis – a condition in which kidneys cannot eliminate acid fast enough. Protein is needed for growth, upkeep and repair of all parts of the body but your diet should be well balanced with fruits and vegetables.

7. Eating Too Many Foods High in Sugar
Sugar contributes to obesity which increases your risk of developing high blood pressure and diabetes, two of the leading causes of kidney disease. In addition to desserts, sugar is often added to foods and drinks that you may not consider “sweet.” Avoid condiments, breakfast cereals, and white bread which are all sneaky sources of processed sugar. Pay attention to the ingredients when buying packaged goods to avoid added sugar in your diet.

8. Lighting Up
Sure, smoking isn’t good for your lungs or your heart. But did you know that smoking may not be good for your kidneys either? People who smoke are more likely to have protein in the urine – a sign of kidney damage.

9. Drinking Alcohol in Excess
Regular heavy drinking – more than four drinks a day – has been found to double the risk chronic kidney disease. Heavy drinkers who also smoke have an even higher risk of kidney problems. Smokers who are heavy drinkers have about five times the chance of developing chronic kidney disease than people who don’t smoke or drink alcohol to excess.

10. Sitting Still
Sitting for long periods of time has now been linked to the development of kidney disease. Although researchers don’t know yet why or how sedentary time or physical activity directly impact kidney health, it is known that greater physical activity is associated with improved blood pressure and glucose metabolism, both important factors in kidney health.

High blood pressure is common in children with chronic kidney disease (CKD). Because of their young age when they develop CKD and high blood pressure, there is a high risk that these children may eventually have heart problems and a worsening of CKD. It is very important for children with CKD to be checked for high blood pressure. Early detection and treatment of high blood pressure helps to reduce the chance of these complications. This fact sheet is written for parents of children with CKD. The booklet will tell you what you need to know about detection and treatment of high blood pressure in your child.

What is chronic kidney disease?
Chronic kidney disease means that the kidneys have been damaged by diseases such as the ones listed in the next question. As a result, the kidneys are less able to do the following jobs to help maintain health:

• Remove wastes and extra fluid from the body

Release hormones that:

• Control blood pressure
• Prevent anemia (low blood count)
• Promote strong bones
• Make hormones that promote normal growth and development in children
• Keep the right balance of important chemicals in the blood, such as sodium, potassium, phosphorus and calcium.
• Maintain the body’s balance of acids and bases.

What is high blood pressure?
Blood pressure is the force of your blood against the walls of your blood vessels as the heart pumps blood around the body. If this pressure becomes too high, someone is said to have high blood pressure, or hypertension.

What causes high blood pressure in children?
As in adults, high blood pressure is more common in children who:

• Are overweight
• Are African American
• Have a family history of high blood pressure
• Have CKD.

When a child has high blood pressure, the doctor should check for kidney diseases (such as the ones listed earlier) as a possible cause of high blood pressure.

How are high blood pressure and CKD-related? High blood pressure is a leading cause of CKD in adults and contributes to the worsening of CKD in children. High blood pressure can also be a complication of kidney disease. The kidneys play a key role in keeping blood pressure in a healthy range. If your child’s kidneys are damaged, they are less able to help regulate blood pressure. As a result, the child’s blood pressure increases and CKD gets worse. Making sure your child’s treatment plan is followed carefully and his/her blood pressure is controlled can help keep kidney disease from getting worse and prevent heart disease.