Over time, many people with T1D start to have problems with their kidneys. The tiniest blood vessels can become damaged that impairs the ability of the kidneys to do their job: filtering toxins from the blood. It is a progressive process that in some cases can lead to kidney failure. When that happens, there are two options to keep the patient alive: dialysis or a kidney transplant.
Dialysis is a mechanical process where a machine is used to filter the blood. A vein in the arm is modified so that blood can be circulated from the body, through a filtering machine and then back into the body. The process takes a few hours and must be repeated 3 or 4 times a week. One alternative is to use the tissues of the abdominal lining to act as the filter and to circulate special fluid in an out of the abdomen through a special port to remove the toxins.
While dialysis is a lifesaving and life extending technique, it is not without complications and it is both inconvenient and expensive.
The second option is to do a kidney transplant. Unlike when a heart or lungs are transplanted, with a kidney the old ones are left in place and a new one is installed in the lower abdomen - attached to the main vein and artery leading from the leg to the heart. In other words, after a kidney transplant, the recipient has 3 kidneys - one that works and does a fine job by itself and the two that don't work. The old ones are left in place because they aren't doing any harm but they just don't work. Taking them out is of no benefit to the patient and just makes the surgical procedure needlessly complex.
We come equipped with two kidneys, but in reality one healthy one does a fine job of adequately filtering the blood all by itself. In fact, many transplant recipients get their kidney from a living donor. That person (often a blood relative, but less frequently a friend who is a match) has an operation where one kidney is removed and then put into the patient who needs it.
When is the kidney damage sufficient to warrant a new kidney? Doctors use several different tests to measure kidney function to arrive at that answer. One is called the EGFR - or Estimated Glomerular Filtration Rate. It measures how well the kidney filtration function is working and is expressed as a percentage. This is a basic yardstick where you want a bigger filtration percentage than a lower one. Mine runs right at 30%.
Another test is creatinine. It is a waste product in the blood that the kidneys filter out and remove. If that number is above normal limits, it means that the kidneys are damaged and not doing their job adequately. Normal is 0.6 to 1.2 and mine averages 2.2.
Finally, the levels of protein in urine are an important indicator of kidney damage. Normally albumin (a protein found in the bloodstream) is not excreted in urine. When it is, it is called proteinuria and is a sign of kidney damage.
In my particular case, my EGFR, creatinine are indicative of moderate to severe kidney damage. I did have increasing amounts of protein being passed which is another indicator of worsening kidney function. Recently, that has almost stopped, leading my neprologist to wonder if my kidneys have not "burned out." My kidneys are certainly damaged, but not yet at the point to warrant a transplant. So why are my doctors talking about it now?
I'll explain in my next post.