From Renal Failure to Renal Transplant

A Personal Case

By

Michel Wan

Updated 6 October

2013

Disclaimer Notice

This presentation is for informational purposes and is not intended to be

a substitute for the advice of a doctor or healthcare professional or

a recommendation for any particular treatment plan. Like any presentation

material, it may become out of date over time. It is important that you rely

on the advice of a doctor or a healthcare professional for your specific condition.

1. History

• Name: Michel Wan B N (Male)

• Age: 62 years ( Born 15 July 1951 )

• Status: Married, with 2 daughters & 1 son

• Profession: Chartered Engineer, FIET

• Medical Background: - Obese ( 110 kg )

- Hypertensive ( 95 / 150 mmHg )

- Diabetic ( HbA1C 7.8 % )

• Diagnosis: - 1982: R-Kidney hypotrophic, 26% activity

- 2011 Mid: Near End Stage Renal Failure

- 2012 April: Renal Transplant

2. Some Images of Kidneys

Blood in

Blood out

Urine out

3. SYMPTOMS • No noticeable symptoms at early stages of CKD ( stage 1 & 2 )

• Mid stages CKD: fatigue, short of breath, sleepy, lack of stamina,…

• Near end stage and end stage CKD: very tired, very sleepy, no stamina, no appetite for food, soapy taste of saliva, feel like vomiting/ Nausea, dark-tainted face (hyperuremia), Loss of weight, Very clear urine ( like clear

water),water retention, BG level dropped….

More Symptoms: • Frequent cramps

• Shaking hands, fingers…

• Urge for urinating frequently

• Feeling thirsty

• Difficulty in sleeping

• Bad Breath

• Lack of taste & smell

• Brittle Teeth & Nails

• NSD / ED

• Dream Mood

4. Clinical Conditions

Renal Profile/Panel:

• Sodium

• Potassium: high

• Chloride

• Glucose

• Urea: high

• Uric Acid

• Creatinine: high

• Microalbumine

• Haemoglobine: low

• Calcium - low

• Phosphate – high

• Total Protein - low

• Blood Pressure – high to low

Very difficult to reach a biochemistry balance amongst these parameters

5. Causes

• Genetic / Family History

• High Blood Pressure / Hypertension

• High Blood Glucose / Diabetic

• Toxicity / Drugs Side-Effects, e.g Excessive use of Aspirin, Paracetamol and anti-inflamatory drugs.

• Infections

• Polycystic Kidney

• Accidents

• Abnormalities

6. Stages of Renal Failure • Stage 1: Renal Function @ 90-99 ml/min ( GFR )

Creatine level of 130 – 200 umol/l approx

• Stage 2: Renal Function @ 60-89 ml/min

Creatinine level of 201 – 300 umol/l

• Stage 3: Renal Function @ 30-59 ml/min

Creatinine level of 301 – 400 umol/l

• Stage 4: Renal Function @ 15-29 ml/min

Creatinine level of 401 – 600 umol/l

• End Stage 5: Renal Function < 15ml/min

Creatinine level > 601 umol/l • Normal Creatinine level is 60-130 umol/l

National Kidney Foundation*

7. Treatment

• Dialysis: 1. Peritoneal Dyalysis

2. Haemo-dialysis: monitoring of body

temperature & blood pressure

during dialysis session

• Transplant: Laparoscopic Procedure for Donor

Open Surgery for Receipient

• Improvement in Quality of Life:

Dialysis: +15%

Transplant: +85%

8. Dialysis

• Life Supporting. Low Total Protein,Low HGB,High Potassium, High Phosphate….still persist

• Peritoneal dialysis:

o Continuous Ambulatory PD

o Continuous Cycler PD

• Haemodialysis:

o Preparation of Fistula – 2 months to ready

o 4 hours / session, 3 sessions / week

o Cost and Time

o Does not solve all problems

o Not a Cure but a Life Support Solution

o Risk of Infection

9. Renal Transplant

• A Cure to CKD

• Anti-rejection Drugs for Life

• Costly Surgical Operation & Lifetime Drugs

• Difficult Availability & Compatibility of Donated Kidney

• Medical, Legal & Ethical Process:

- Age Limit (65)

- Medical Considerations: Fitness, Compatibility, No

other Life Threatening Diseases…

- No Kidney Trafficking

- No Challenge to Kidney Donation

- Ethic Committee Approval

• Surgical Operation: 4 + 4 hrs

• Hospitalisation: 8 to 10 days

10. Some Lab Results ( Prior to Transplant)

1

2

3

4

5

Expanded View for last 2 Years Prior to Transplant

Near End to End Stages

4

Yearly Average Creatinine Level Over Last 12 Years

0

100

200

300

400

500

600

700

800

900

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Creatinine umol/l

Creatinine umol/l

Yearly Average Urea Level Over Last 12 Years

0

5

10

15

20

25

30

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Urea mmol/l

Urea mmol/l

Weekly Creatinine Value Mid Dec 11 – End April 12

0

200

400

600

800

1000

1200

1400

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Series1

Post-Dialysis Sessions

Post- Transplant

Day 1 Day 3 Day 5 Day 8 Day 10

1304

umol/l

before

898

umol/l

after

Some Other Info

• Approx 1,300 Dialysis Patients under MoH.

• Each Dialysis Session Costs MoH Rs 1,500 in Direct Cost

Approx Rs 18,000 /patient/month

• Approx 300 (?) Transplant Patients under MoH.

• Each Transplant Patient on Anti-Rejection/Immuno-Suppressant Drugs Cost MoH approx Rs 20,000/month

****************************************************

• Each Dialysis Session Removes 1 to 3 Litres of Water from Body

• Government Offers Free Dialysis & Kidney Transplant

• In Private: each Dialysis Session Costs Rs 3,500 / S$ 550

each Renal Transplant Costs S$ 90,000 + Pre-Op

Examination & Procedures + Hotel + Foods+ Air

Constituents of Blood: Plasma

7% Protein + 3%(Sugar+Salts+Fats)

45%: Red + White Cells +Platelets

90% Water

55% Plasma

Protecting Your Kidneys

1. Limit Salt Intake

2. Limit Sugar Intake

3. Limit High Protein Foods Intake

4. Drink Plenty of Water ( Min 2 Litres/day )

5. Avoid High Intake of Vitamin C

6. Avoid Over Intake of Pain Killers & Other Drugs

7. Pay Attention to Tests & Procedures Involving Contrast Media/Dyes

8. Do Not Rely on Food Supplements

9. Check Your Kidney Function Regularly:

- Blood & Urine Tests

- Ultrasound Tests

10. Maintain Blood Pressure at or below

130/80

Kidney Diseases Are Expensive & Difficult To Treat !!!

Acknowledgement

Following my renal transplant effected in April 2012, I am now living a

normal life, with most renal profiles within normal values.

My ever lasting thanks go to my sister Laurence Ah Chin Moy Reno who so

generously, lovingly and courageously donated to me her kidney.

My thanks also go to my wife Rosemay and 3 children who supported me

at all times; my brothers and sisters, relatives and friends all around the world

who prayed for and supported me; Dr Ah Khiet Ng Kee Kwong, Dr Kune Lin

Ho Wan Chok, Dr Gaya, and the transplant team Dr Pary Saviraman and

Dr James Tan of Singapore.

I will never forget you all.

Michel Wan

Thank You

&

Take Good Care of Your

Kidneys