Kidney Function after Kidney Surgery

Having had a nephrectomy or kidney removal because of cancer almost five months ago, I am now trying to come to terms with living with one kidney. The relief of having all of the cancer removed is immense, but now I am learning more about the effects from losing that kidney.

I expected to be totally back to normal by now and I must say it is getting a little better month by month, but I am still not quite there yet. I still get some pain on sudden movements of the twisting and bending kind. Occasionally I get pain where my kidney used to be but it is fleeting and bearable. I am going to be having my first abdominal scan since the operation next week but don’t see my kidney specialist until February, which will be seven months post operatively speaking.

Some people are born with only one kidney, may not even be aware of this, and most go on to lead relatively healthy normal lives. I already knew this before my surgery, and thought little of having to live with one kidney when I talked to my surgeon about the operation. All I was told was that many people lead normal lives with one kidney and that my remaining kidney would do the work of two kidneys.

I have had three blood tests since surgery to test my remaining kidney function, and this has resulted in me being diagnosed as having stage three chronic kidney disease. It is not imminently life threatening in the same way as the cancer was, but shocking all the same. I decided to look into what it means to have one kidney and chronic kidney disease, or CKD as it is commonly known.

When the function of the kidneys decline, they are less efficient at filtering waste products from the blood. There are many reasons that people might get CKD, and you may be predisposed to it if you have any of the following factors:

• Diabetes
• Family member with kidney disease
• High blood pressure

A blood test can show the function of your kidney(s) by measuring something called the glomerular filtration rate, commonly known as GFR. Before my kidney was removed, my GFR rate was over 90. With only one kidney, my GFR rate is now around 49! At first I thought it must be normal, because surely you halve the rate when you lose a kidney? This is not quite how it works I’m afraid.

Before the operation, I would have been considered to have the first stage of kidney disease, but I would expect many middle aged people to have that stage. The chart below shows you how kidney disease progresses through the stages.

Prior to surgery, the doctors and surgeon involved in my nephrectomy didn’t mention that I would be classed as having chronic kidney disease after surgery, which equates to me not giving informed consent for the operation really. My general doctor seemed alarmed at my blood results, but recently I have done a bit of internet research and found the huge drop in GFR is common after having a kidney removed. This applies to kidney donors too! I wondered why I was not informed of this and genuinely felt shocked.

To find out about frequently asked questions concerning GFR rates please read this PDF document written by the National Kidney Foundation.

Kidney function has a habit of declining with age. My research doesn’t give me a lot of hope for improvement really, though sometimes certain lifestyle changes, especially diet, can raise your GFR level a little or at least slow down the decline of function. CKD is a slow progressive disease. I have read only one story of someone achieving a near normal kidney function after being diagnosed with chronic kidney disease and I believe he was trying out some new pioneering treatment that is not available to all.

Research on treating kidney disease is ongoing, and I hope a positive treatment is found soon. The best a person can do with one kidney and who has been diagnosed with CKD, is to follow advice on diet and lifestyle, and generally look after their health better.

I would like to add that since writing this article my kidney function has improved tremendously. My EFGR has gone up from 49 to 92 in three and a half years.

I have noticed that I get tired easily, run to the toilet more often, and I am now more prone to get headaches. I haven’t been told these symptoms are caused by kidney disease but here is a list of some of the symptoms you may experience, especially with a more severe declining function:

• Urination frequency, but decreased output as disease progresses
• Foamy urine
• Blood in urine
• Fatigue – feeling more tired than usual
• Headaches
• Nausea and vomiting
• Fluid build up in tissues known as edema
• Itchy skin
• Loss of appetite
• Weight loss
• Sleeping difficulties
• Restless legs
• Cramps
• Concentration, thinking problems

You may not notice some of these symptoms until the disease has progressed considerably, even as far as kidney failure.

The fact that I now have a diseased kidney gives me some concern for my health in the future. My general doctor tells me that I must aim to keep my blood pressure as low as possible. It currently tends to even out at around 124/82 which is not a blood pressure reading to be worried about, but I must follow all the guidelines for combating high blood pressure such as:

• Exercise
• Healthy diet
• Quit smoking
• Reduce or stop drinking alcohol
• Keep weight down

High blood pressure increases the chance of damage to the nephrons in the kidney and further complicates waste removal. People with chronic kidney disease are also more at risk of developing cardiac problems or having a stroke.

According to online resources, at stage 3 of kidney disease and to protect my kidney function as much as possible, I should:

• Lower my salt (sodium) intake
• Avoid too much potassium
• Keep my cholesterol down
• Eat a low protein diet
• Avoid certain drugs

I put this to my general physician who hadn’t mentioned all of this barring the blood pressure aspect and warning me about certain drugs. She arranged a meeting with a dietician for me which took place several weeks ago. I was told I didn’t need a special diet but to eat healthily! She said that I would possibly need to go on a specific diet when my kidney declines much more in the future! This has confused me somewhat, but all I can do is follow the advice I am given. I will be writing an article on diet for CKD at a later date, but I have to say that some research shows it doesn’t make a lot of difference to GFR levels. It’s more a way of staying very healthy so that you preserve your kidney(s) for longer.

I now must have an annual influenza vaccination, and I have been offered the pneumonia vaccination also. I should avoid certain drugs such as:

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) - Ibuprofen, Naproxen, Aspirin
• Antacids - Milk of Magnesia, any indigestion remedies with high sodium content
• Certain antibiotics
• Contrast dyes used in CT and MRI scans

Given that as I age, my kidney will deteriorate further anyway, I must do everything I can to stay healthy. Luckily I don’t suffer with high blood pressure, heart problems, circulatory problems, lung problems or diabetes, but it has to stay that way for me to prevent massive problems as I get older. The ultimate of course is kidney failure, but I am told it doesn’t happen quickly, and with intervention and working closely with my doctor by keeping appointments, I stand a better chance of leading a relatively normal life. Still pretty scary stuff though!