15% believed that donation impacted their health negatively, 34% worried at least once in a while about having only 1 kidney and 2% worried fairly often. Postoperatively 4 donors (2%) had kidney disease, 9 (5%) had hypertension, 1 (1%) had diabetes, 3 (2%) had heart disease and 3 (2%) had cancer. (4)

Things you can do to protect your health now that you're a member of the one-kidney club, compiled from the National Institute of Diabetes and Digestive and Kidney Diseases, Dr. William Freeman, retired physician and living kidney donor, OrchidLady, a regular contributing member of LDO and a living kidney donor, LD101 and other sources.

1. Wear medical-alert jewelry to notify emergency personnel.

Be sure to identify which kidney remains – i.e. “One kidney – right”, as well as "No NSAIDS or Contrast Dyes" and any allergies, medications or other conditions. In general, the information on the jewelry should not facts that will not change in the future.

Many pharmacies or doctor’s offices have information for placing an order or many options are available online: bracelets, necklaces, dog tag style necklaces and keychain fobs. Aluminum, stainless steel, silver, gold, and titanium.

Some necklace pendants now contain a USB flash drive to include a more detailed medical history.

LD101 has not confirmed this, but it has been said that local chapters of National Kidney Foundation will provide free medical alert bracelets.

 

2. Notify and remind everyone during any and all medical appointments or procedures about the single kidney.

For any test or procedure ordered, ask how it will affect the remaining kidney. Do not assume any medical professional has the most up-to-date statistics and information regarding living donation and single kidney-ed persons.

It is imperative to be your own advocate.

3. Avoid or minimize the use of contrast dyes in MRIs and other scans.

Certain dyes used in MRIs and other tests can be damaging to kidneys. Ask about any test that uses dye. Here is a recent link regarding potential kidney damage from certain bowel preps.  Find out if there are other diagnostic tests available. If not, insist the technician utilize the minimum amount necessary to achieve scan.

4. Alert pharmacy.

A note should be put in the patient file regarding the single kidney. In some pharmacies, such information will generate a “tickler” and have any medication dispensed reviewed by the pharmacist before it is dispensed. As with the physicians, prescriptions should always be reviewed with the pharmacist regarding any potential for causing problems.

5. Avoid NSAIDS (Aleve), aspirin, or ibuprofin (Advil).

Nonsteroidal  anti-inflammatory medications affect potassium level.

There is much debate about the  'ocassional' use of these pain relievers by those with one kidney. If people with renal disease and those who have undergone a kidney transplant are forbidden from using NSAIDs, then it only makes sense a living donor should avoid them too.  Use acetaminophen (Tylenol) only. If you feel you need to use these medications, discuss with your personal physician.

A list of medications that include aspirin and other NSAIDs.

6. Be cautious regarding any over-the-counter medications.

Some contain ingredients such as pseudoephedrine,  or Pepto-Bismol which contains aspirin. Discuss with your physician and pharmacist which products you may use in the event of a cold, upset stomach, etc. It is best to review acceptable products in advance rather than waiting until you are ill.

From CJAN (Clinical Journal of the American Society of Nephrology), a list of nephrotoxic dietary supplements.

7. Be cautious of supplements of ANY kind – even vitamins.

Remember that anything taken orally will eventually be filtered through the kidney. The ingredient list of any and all supplements or vitamins should be reviewed with your primary care physician or nephrologist before continuing use.

8. Do not engage in fad diets.

Atkins or other high protein style diets should be avoided. They cause an imbalance in kidney function. Excess protein consumption may cause a problem in persons with compromised kidney function. Discuss with your doctor the amount of protein you should or should not be eating.

Eat a well balanced, healthy diet with plenty of fresh fruits and vegetables. www.mypyramid.gov provides valuable nutrition and dietary information. You may wish to do further research regarding the benefits of organic foods. Normally, the less processing involved, the more nutrition the food item retains. If you have specific dietary needs or restrictions, be sure to review any change in diet with your physician.

(see Diet page for more specific suggestions)

9. Avoid injury to the remaining kidney, especially heavy contact sports such as football and boxing. The kidney is well protected by the ribs and organs in front of it, but arteries and veins that service the kidney are much more easily damaged.

10. Avoid smoking.

Among other things, smoking can damage the circulatory system. With one kidney, it is important to keep those arteries and veins in top working condition. Smoking may also lead to high blood pressure, also damaging to the kidneys.

 

11. Be aware of High Blood Pressure and its potential causes.

Uncontrolled High Blood Pressure is one of the leading causes of kidney failure. The kidney's inability to properly filter sodium is the leading cause of secondary hypertension (see the pattern?).

Your physician should check your pressure annually, but it is also a good idea to check it yourself monthly. Normal pressure is classified as 120 Systolic (top number) or less and 80 Diastolic (bottom number) or less. However, check with your physician to be sure what is normal for your particular circumstance. Excess salt is one of the main culprits in contributing to high blood pressure. Watch for hidden salt in fast food, restaurant food and processed food.

The American Heart Association at www.americanheart.org has some good information regarding blood pressure, salt, and heart health in general.


12. Diabetes is also a leading cause of kidney failure.

Watch for family history of this disease. Eat well, exercise, and maintain a healthy weight. Consult with your physician regarding monitoring and prevention if you have a family history of this disease.

To prevent Type 2 diabetes, engage in moderate exercise of at least 30 minutes per day, 5 days a week; eat a lower fat, lower calorie diet; and if overweight, lose 7% of body weight.

Of course...

13. Exercise!

It reduced blood pressure, helps regulate potassium and helps prevent diabetes. Plus, exercise has been shown to reduce stress and cholesterol levels. Drink plenty of water during exercise to avoid dehydration.


14. Keep up on immunizations such as tetanus, flu shot, pneumonia shot, etc.

The CCDCs Advisory Committee on Immunization Practices (ACIP) has issued guidelines that persons with Chronic Kidney Disease (CKD) be given priority in receiving the H1N1 (Influenza A) vaccine.

Besides being good sense for general health, it can protect from diseases that may be hard on not only the remaining kidney, but the body in general.

15. Be alert for Urinary Tract Infections (UTI’s).

Typical symptoms include frequent urination and pain or burning during urination. Have them treated by your physician as quickly as possible to prevent the infection from potentially traveling to your remaining kidney. You can sometimes prevent UTI’s by drinking plenty of water, and many people recommend drinking cranberry juice as a preventative. It is important for donors, in any case, to drink plenty of water throughout the day to be sure they are well hydrated so their remaining kidney can function properly.


16. Be aware of your family medical history

Stay alert for possible conditions that could damage your remaining kidney. No one says that you are, for sure, going to be subject to Aunt Myrtle’s diabetes, but it pays to be cautious and do what you can to prevent diseases that run in the family tree. Discuss prevention and signs of potential diseases with your primary care physician.

17. Have an annual physical examination.

Including blood pressure, GFR and protein level in urine. Make sure the GFR is 'measured' through a 24 urine collection and concurrent blood draw for creatinine measurement and not simply an 'estimated' GFR.

From Dr. Freeman: If mGFR is less than 60, or if urine albumin-creatinine ratio is above normal, or if blood pressure gets above 130/80 (to clarify--systolic more than 130 OR diastolic more than 80), ask primary care provider about an ACE-inhibitor or other anti-hypertensive medicine to protect remaining, solitary, kidney -- per the recommendation by the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK).  http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney/

 Have a copy of your donation records sent to your primary care physician. Discuss the potential risks, complications and issues at the next appointment. Not all physicians are savvy in terms of single-kidneyed persons, especially living donors. It is possible the living donor will have more extensive knowledge.

Dr. Freeman recommends at about 4 months post-donation, to have the following tests done, at a minimum, to establish baseline kidney function:

CBC (Complete Blood Count) – Kidneys produce a hormone that signals the body to produce red blood cells. This test, among other things, will monitor for anemia.

BMP (Basic Metabolic Panel)- This evaluates the current status of the kidneys (including BUN/Blood Urea Nitrogen and Creatinine levels), electrolyte, blood sugar and calcium levels.

Urine Analysis with macro, micro and culture – This looks for protein in the urine and potential bacteria in the urine.

The primary care physician should repeat these tests each year to compare against initial baseline numbers. They may order additional tests, as needed. This annual testing will help to identify and treat any problems as early as possible.

Please see our Facts and Risks page for more potential long-term issues related to living organ donation, such as pregnancy, life and health insurance, depression, obesity and more.

Much, much more to come....

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