IS KIDNEY DISEASE GENETIC?

Kidney disease can have genetic causes. Patients who are found to have early stage kidney disease often undergo kidney biopsies to help determine the etiology or cause of their kidney disease.

Doctors also take family medical histories of patients with kidney disease to help determine if their kidney disease is known to occur in their family.  Knowing if there is a hereditary cause of a patient’s kidney disease is important. It can help direct early interventions in the attempt to treat, reverse or slow the progression of disease, depending upon the result of the biopsy. It can also predict, in some cases, the advisability of whether a given patient’s disease may or may not allow them to safely receive a kidney transplant and determine the timing of such a kidney transplant.

However, most cases of kidney disease are not genetic in origin for kidney disease but related to higher rates of high blood pressure and/or diabetes, both of which have strong genetic components in family members.

However, just because one has a strong family history of high blood pressure and/or diabetes does not automatically mean that a given individual is destined or pre-determined to develop hypertension, diabetes or kidney disease themselves.

African American’s have 4-6 times greater incidence of developing kidney disease compared to Caucasian Americans, largely because of much greater incidence rates and rates of untreated hypertension and/or diabetes.

CAN KIDNEY DISEASE BE SUCCESSFULLY TREATED?

Not all cases of kidney disease progress to kidney failure of chronic kidney disease.  However, most cases of kidney disease do progress to chronic kidney disease but not all cases of chronic kidney disease progress to kidney failure and the need for dialysis or kidney transplant.

If a patient has developed chronic kidney disease as a result of high blood pressure and/or diabetes, tight control of their high blood pressure and/or diabetes can significantly slow the progression of their chronic kidney disease and prevent them from developing kidney failure.  This is good news.

WHEN IT GETS TO THE POINT WHERE SOMEONE NEEDS A TRANSPLANT – WHAT STEPS DO YOU RECOMMEND?

Kidney transplantation is the preferred therapy for kidney failure compared to maintenance dialysis. There are two different types of kidney transplantation: deceased donor kidney transplantation and living donor kidney transplantation.  Outcomes at all-time points are far superior following living donor kidney transplantation compared to deceased donor kidney transplantation.

Patients, in order to qualify for a kidney transplant, must first be referred to a kidney transplant center to undergo a formal pre-kidney transplant evaluation. Patient’s primary care providers and nephrologists commonly are the doctors referring patients for pre-kidney transplant evaluations, but patients can refer themselves (and ADVOCATE for themselves to be referred) to under pre-kidney transplant evaluations by transplant centers.

There is an advantage for patients to be evaluated by more than one kidney transplant center to increase their chances of receiving a kidney transplant from the deceased donor list.  For patients with chronic kidney disease, it is advisable that they seek a kidney from a living person, either a blood relative or non-blood living individual, because results/ outcomes following living donor kidney transplantation are superior to outcomes of kidney transplantation from deceased donors.

Patients should read and learn as much as they can about kidney transplantation, the risks and benefits, the process to undergo kidney transplantation evaluation and the process of receiving a kidney transplant and process following a kidney transplant.

Patients need to demonstrate to transplant centers that they are compliant with taking their prescription medications, fluid restrictions if they are on fluid restrictions, and compliant with showing up and undergoing their dialysis treatments if they are on dialysis.

Transplant candidates will need to demonstrate that they have a social support system to assist them in getting to and keeping post-kidney transplant follow-up appointments and that they have resources to receive their post kidney transplant medications necessary to prevent post kidney transplant rejection.

Kidney transplant centers have social workers who are available to work with patients regarding medical and prescription medical insurance financial considerations regarding kidney transplantation and post-transplant medications.

When undergoing pre-kidney transplantation evaluations, patients should be prepared to ask questions and receive answers regarding the transplant evaluation and what is expected of them to complete the kidney transplant evaluation process, get approved to receive a kidney transplant and be activated on the kidney transplant waiting list or undergo evaluation of a living donor kidney transplant.

Importantly, patients considering, undergoing kidney transplant evaluation or on the waiting lists for kidney transplantation, whenever possible, unless for emergency situations, should avoid receiving blood transfusions prior to their kidney transplant because blood transfusions can increase their levels of antibodies which can make if much more difficult for them to be matched with an acceptable kidney for transplantation.

A great source of information for patients with kidney disease is the National Kidney Foundation website.

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