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Old 08-19-2008, 07:01 AM   #3
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Re: help, brother soon to have both kidneys removed

Hi dorothy! Welcome to the healthboards (weird coming from me because I'm pretty new here myself!)

Polycystic kidney disease is obviously a difficult thing to have--especially when you see so many of your loved ones afflicted with the same condition. It is the fourth most common cause of renal failure leading to dialysis in N. America, and unfortunately, there's not much you can do to treat it.

So replacing the renal function that is lost is maintained somewhat by doing dialysis 3X week, but obviously, not all of the kidney's function is being replaced so defecits occur. Usually, doctors will put patients with chronic kidney failure (i.e. slow loss of kidney function over time) on dialysis when they have ~10% of kidney function left, or around that and are having significant symptoms of kidney failure (confusion, severe malaise, weight loss, loss of appetite etc). It is very true that having SOME kidney function is better than none at all in dialysis patients. Many dialysis patients retain some small amount of renal function, and actually do end up producing some urine every day; however, you have to weigh this benefit with the risks of retaining the kidneys. In someone who had to go on dialysis because if diabetic nephropathy (the most common form of renal failure in N. America) there is not all that much risk of keeping the kidneys there....

In PKD, there are many complications that can occur with the retained kidneys. First of all, they are VERY bulky and can affect the function of other organs in the abdominal cavity. The cysts themselves can become infected, and it is very difficult to treat with antibiotics. As renal function lessens and a person is on dialysis for a longer period of time, the immune system deteriorates to a certain point and the person becomes more prone to infections. Finally, as in your baby brother's case, the cysts can bleed, and if he is on blood thinners such as warfarin (coumadin) the bleeding can be catastrophic. These are the risks that must be weighed. If your brother doesn't produce ANY urine at all, the nephrologist likely wouldn't think twice about taking the kidneys out if he was on warfarin. If your brother produces some urine, it becomes a bit more of a judgement call, but again, depending on how bulky his kidneys are, the risk of taking his kidneys out is much less than the risk of keeping them in and concurrently being on warfarin. Cystic bleeds can be catastrophic.