Do Patients with Kidney Shrinkage Always Need Dialysis? Insights and Alternatives

Is dialysis necessary if kidney size has shrunk to 7.5-8.5 centimeters?

Hello Dr.
Wang: My mother visited the nephrology department at Veterans General Hospital last week with symptoms of nausea, loss of appetite, jaundice, and fatigue (BUN: 150, creatinine: 8).
She has severe anemia, and the doctor provided a blood transfusion to improve her anemia status and will continue to monitor her.
I would like to ask Dr.
Wang:
1.
In such cases, is it inevitable that she will require lifelong dialysis, or are there other better treatment options available?
2.
Currently, my mother has little appetite for three meals a day.
Are there any specific dietary considerations we should pay attention to? (Aside from avoiding starfruit and monitoring low sodium, potassium, phosphorus, and calcium.) Should milk or sugar also be restricted?
3.
My father heard that drinking juice made from sweet potato leaves and apples may help improve her condition.
Is this beneficial or could it be harmful?
4.
Is taking traditional Chinese medicine prescribed by a qualified practitioner (targeting kidney issues) potentially harmful to her remaining kidney function?
5.
Should she avoid excessive labor or sun exposure (since we work in agriculture at home)? Thank you in advance for your guidance!

yeon, 30~39 year old female. Ask Date: 2006/03/12

Dr. Wang Weijie reply Internal Medicine

Hello,
Your mother’s symptoms are indicative of uremia, chronic kidney failure accompanied by anemia.
Ultrasound imaging shows renal atrophy, and dialysis will be necessary as long as her life continues.
Dialysis, specifically hemodialysis, is a procedure that removes high levels of toxins from the blood through a dialysis machine, allowing clean blood to flow back into the body, thereby reducing internal toxins and improving quality of life.
1.
There are three treatment options for kidney failure: hemodialysis, peritoneal dialysis, and kidney transplantation.
Prior to peritoneal dialysis and transplantation, several sessions of hemodialysis are required to lower the toxins in the body to an acceptable level.
2.
If your mother does not have diabetes, her intake of milk and sugars is not overly restricted.
It is recommended that she consumes an adequate amount of protein, approximately 0.6 to 0.8 grams per kilogram of body weight daily.
It is suggested that two-thirds of this protein should come from animal sources such as chicken, duck, beef, fish, eggs, and milk, while the remainder should come from rice, noodles, and fruits and vegetables to reduce the production of waste products.
3.
It is not advisable to drink juice made from sweet potato leaves and apples, as these vegetables contain higher levels of potassium.
It is safer to consume vegetables after blanching them.
Sincerely,
Dr.
Wang Wei-Jie, Internal Medicine

Reply Date: 2006/03/12

More Info

When dealing with kidney shrinkage, or renal atrophy, the necessity for dialysis is not always a foregone conclusion. The decision to initiate dialysis depends on several factors, including the degree of kidney function impairment, the presence of symptoms, and the overall health status of the patient. In your mother's case, with a BUN of 150 and a creatinine level of 8, she is experiencing significant renal dysfunction, which may indicate that she is approaching end-stage renal disease (ESRD). However, there are alternatives and considerations that can be explored before committing to lifelong dialysis.

1. Treatment Options Beyond Dialysis: While dialysis is a common treatment for ESRD, it is not the only option. Some patients may be candidates for kidney transplantation, which can restore kidney function and eliminate the need for dialysis. However, this option depends on various factors, including the patient's overall health, age, and the availability of a suitable donor. Additionally, there are conservative management strategies that can be employed to manage symptoms and improve quality of life, such as dietary modifications, medications to manage blood pressure, and erythropoiesis-stimulating agents to address anemia.

2. Dietary Considerations: Given your mother's symptoms of nausea, lack of appetite, and fatigue, dietary management is crucial. In addition to avoiding foods high in potassium, sodium, and phosphorus, it is essential to ensure she is consuming adequate protein, especially if she is undergoing dialysis or has significant protein loss. Milk and sugar can be included in moderation, but it is vital to monitor her overall intake of fluids and electrolytes. Consulting with a renal dietitian can provide personalized dietary recommendations tailored to her specific needs.

3. Alternative Remedies: Regarding the suggestion of drinking juice made from sweet potato leaves and apples, it is essential to approach such remedies with caution. While some natural remedies may offer health benefits, they can also pose risks, especially in patients with compromised kidney function. It is advisable to discuss any alternative treatments with her healthcare provider to ensure they do not interfere with her current treatment plan or exacerbate her condition.

4. Herbal Medicine: The use of traditional Chinese medicine or herbal supplements should also be approached with caution. Some herbs can be harmful to the kidneys, especially if they are not prescribed by a qualified practitioner familiar with renal health. It is crucial to consult with her nephrologist before introducing any herbal treatments to avoid potential adverse effects on her remaining kidney function.

5. Activity Level: Regarding physical activity, it is essential to balance rest and activity. While moderate exercise can be beneficial, excessive exertion or exposure to extreme conditions (like prolonged sun exposure) should be avoided, especially if she is feeling fatigued or unwell. Encouraging gentle activities that do not overstrain her body can help maintain her overall health without exacerbating her symptoms.

In conclusion, while your mother is facing significant challenges with her kidney health, there are various avenues to explore before resorting to lifelong dialysis. Open communication with her healthcare team is vital to ensure she receives comprehensive care tailored to her needs. Regular monitoring and adjustments to her treatment plan, including dietary modifications and potential alternative therapies, can significantly impact her quality of life.

Similar Q&A

Understanding Glomerular Pressure Relief Therapy for Kidney Health

Dear Dr. Yang, My father has been suffering from long-term diabetes, and he recently visited Kaohsiung Veterans General Hospital. The doctor informed us that if his kidney function continues to deteriorate, he will soon need to start dialysis. Over the past couple of days, I als...

Dr. Yang Hongzhi reply Internal Medicine
The renal glomerular decompression therapy you mentioned likely refers to certain antihypertensive medications that can reduce glomerular pressure, which is beneficial for diabetic nephropathy. This approach is currently widely used; however, it may only slow the progression of t...

Chronic Kidney Disease (Membranous): Treatment, Management, and Concerns

Is chronic glomerulonephritis (membranous) always destined to require dialysis in the end? If treatment and management are ongoing, what should be noted in daily life? Will conditions like cold, fever, blood tests for creatinine, and albuminuria increase?

Dr. Wang Weijie reply Internal Medicine
Hello, for membranous nephropathy (chronic nephritis), it is recommended to identify the underlying causes, manage diet, proteinuria, and blood pressure. Dialysis may not be inevitable. It is advised to follow up at a nephrology clinic for further consultation. Wishing you peace ...

Managing Bilateral Hydronephrosis: Insights on Treatment and Kidney Function

Hello Doctor: Due to endometriosis causing ureteral stricture and hydronephrosis, I have had three double-J stents placed in my right kidney over the past four years, with no significant improvement and persistent hydronephrosis. Recent examinations revealed extremely low renal f...

Dr. Wu Hongjie reply Internal Medicine
Dear Friend, 1. The decision regarding the first issue depends on the circumstances. In principle, severely reduced kidney function is not an indication for nephrectomy unless there are recurrent, persistent infections that have led to abscess formation, or the presence of malig...

Understanding Kidney Issues in Sedentary Patients: A Neurology Perspective

Hello Dr. Yeh: A colleague's husband, aged 46, has not exercised for many years and has irregular eating habits and lifestyle. He also rarely puts in effort at work. Initially diagnosed with hypertension, he experiences dizziness and headaches, and he does not take his medic...

Dr. Ye Boshou reply Neurology
The primary treatment for hypertensive nephropathy is blood pressure control, which may not necessarily affect the need for dialysis. Please follow your physician's medication regimen to prevent complications.