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 1 
 on: Today at 09:40:48 AM 
Started by Scuba Girl - Last post by Scuba Girl


Organ transplant patients face higher risk of skin cancer
By Victoria Colliver, October 1, 2014


http://m.sfgate.com/health/article/Organ-transplant-patients-face-higher-risk-of-5789565.php
 
When doctors informed Darrell Johnson that his lung transplant would put him at higher risk of skin cancer, he didn't give it a lot of thought. His concerns at the moment were bigger.
 
A genetic disease had slowly robbed his lungs of the ability to expand and contract. He couldn't breathe without an oxygen tank, which he carried in a backpack, and only a double lung transplant, which he received in August 2008 at UCSF, would save his life.
 
The higher risk for skin cancer came after surgery, with the daily regimen of medications Johnson had to take to decrease the possibility of organ rejection. The drugs would allow him to keep his new lungs, but would also weaken his body's immune system and his ability to ward off certain cancers, skin cancer in particular.
 
Studies show the medications increase the odds that transplant patients will acquire skin cancer by up to 100 times compared with the general population, and their risks increase every year there on out. Twenty-five percent of them will develop the potentially fatal disease at five years, and at least half will be diagnosed with it after 10 years.
 
"It's really devastating for transplant patients, given a new lease on life from their transplant, to discover they're struggling with skin cancer," said Dr. Sarah Arron, director of UCSF's High Risk Skin Cancer Clinic.
 
Monitoring risk crucial
 
Some patients, and even their physicians, aren't aware of the connection between transplantation and elevated cancer risk, specifically skin. In some cases, the risk may not be monitored closely enough and the skin cancers tend to be more aggressive in transplant patients.
 
"It's heartbreaking to have a functioning transplant patient die of skin cancer, and unfortunately that's happening more than we would wish," Arron said. A link has also been made between transplants and certain forms of leukemias and lymphoma, as well as a cancer that appears on the skin called Kaposi's sarcoma.
 
Medical researchers aren't exactly sure what causes the elevated risks of skin cancer, but they have theories. They believe some skin cancers may actually be caused by viruses, which transplant patients have a tougher time fighting off. They are also hampered in attacking cancer cells as they form in the body.
 
But Arron said the fact that transplant recipients are living longer has bolstered efforts to get patients checked and treated more quickly. For Johnson, the risk became a reality almost immediately. "They gave me the heads up, they started checking me, and they started finding things," said the 64-year-old man, who lives in Grass Valley (Nevada County). Johnson said he's has lost track of how many skin cancers he's had removed since his transplant, but he counted five surgeries this year and three the previous year.
 
Potentially deadly
 
Virtually all of Johnson's skin cancers have been what's known as squamous cell carcinomas, the second-most-common form of skin cancer behind basal cell. Skin cancer is the most common type of cancer in the United States, with 3.5 million cases diagnosed in more than 2 million Americans each year.
 
Squamous and basal skin cancers are generally not life-threatening for most people, but they can be deadly for transplant patients. "Sometimes the cancers themselves are so aggressive that even the best we can do isn't good enough," Arron said. "These patients don't get one squamous (skin cancer). They get five, 10 or 15 a year."
 
To better understand the connection between organ transplant and skin cancer, Arron and her colleagues are collaborating with the UCSF transplant team on several research projects. UCSF will serve as the lead among 20 centers in an American Academy of Dermatology study looking at the incidence and death rates of skin cancer in transplant patients.
 
UCSF researchers are also involved in a National Cancer Institute study on melanoma in organ transplant patients, which includes examining how safe it would be for a patient already diagnosed with melanoma to have a transplant. They recently published a paper showing the relatively poor outcomes in transplant patients who have an even deadlier form of skin cancer than melanoma called Merkel cell carcinoma.
 
About 250,000 organ recipients are living in the U.S., and Arron said she hopes the research will provide insight into the broader population of people who have been diagnosed with skin cancer. "What can we learn about skin cancer in the transplant patient that can help us understand why skin cancer forms in the general population?" Arron said. "We're learning how the immune system fails in a transplant patient and allows tumors to grow so we can identify in a non-transplant patient how that immune system can fail in the same way."
 
Specimens in research
 
David C. Brown, a UCSF heart transplant recipient from Mill Valley, has agreed to be in virtually every skin cancer study he'd been asked to participate in, a process that generally involves allowing his biopsy specimens to be used for research. "Honestly I don't know how many studies I'm in," said Brown, who received his transplant in 1990 at age 36.
 
Brown, 60, describes his post-transplant life as "reasonably smooth sailing medically," but said he's had about 13 skin cancers in the past decade, mostly basal cell carcinomas. The pace has quickened recently, he said. He's had three in the past few months, including one that he had removed recently on his finger.
 
"I don't really worry about it a whole lot because they seem to be caught and treated very efficiently," he said. "I'm getting smarter about responding to them sooner. All this stuff feels petty ... but if one digs deep enough, I'm going to have a real problem."
 
Surgeries take toll
 
Both Brown and Johnson know that their age, gender, and past history of sun exposure put them at higher risk of skin cancer, regardless of being transplant patients.
 
Johnson has undergone five or six skin cancer procedures this year alone to remove cancers at the top of his head, and the surgeries are taking a toll. But, like Brown, he said he feels so grateful for the outcome of his transplant, he won't complain.
 
He recently started trying an approved cream and a drug and is being treated with photodynamic therapy in hopes of reducing his incidence of cancer. Like all transplant patients, he has reduced his exposure to the sun by using sunscreen and protective clothing.
 
So far, it seems the increased preventive steps may be working. For the first time he can remember, Johnson said he went to UCSF a few weeks ago and his doctors did not find a new lesion.
 
Finally, he said, his head will be able to heal enough that he won't feel self-conscious and cover his head indoors. "I'm going to a party and won't be wearing a hat for the first time for at least a year and a half," he said.


 2 
 on: Yesterday at 09:05:16 PM 
Started by getlife - Last post by getlife
No, I didn't. I am confused about a couple of things. A lot of people are concerned from the comments I am seeing on facebook.

I think it all is based on the calculation you get. If you are in the top 20%..your chances are good. I really did not know this is how it was going to be. It's sounds like number of years on dialysis..previous transplants...etc is against us. I can clearly understand getting a kidney from someone either within the close ranges.

With today's anti-rejection meds..being so good as I was told. What are the chances of getting a perfect match, when they can give a 2 of 6 match, 1 of 6...etc. to people.


 3 
 on: Yesterday at 08:58:15 PM 
Started by newmem - Last post by getlife
Stage 4 of Kidney Disease.

Stage 4 of Chronic Kidney Disease

A person with stage 4 chronic kidney disease (CKD) has advanced kidney damage with a severe decrease in the glomerular filtration rate (GFR) to 15-30 ml/min. It is likely someone with stage 4 CKD will need dialysis or a kidney transplant in the near future.

As kidney function declines, waste products build up in the blood causing a condition known as uremia. In stage 4, a person is likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells), bone disease, heart disease and other cardiovascular diseases.

Symptoms of stage 4 kidney disease

Symptoms that are experienced in stage 4 include:
-Fatigue
-Fluid retention, swelling (edema) of extremities and shortness of breath: Urination changes (foamy;
  dark orange, brown, tea-colored or red if it contains blood; and urinating more or less than
  normal)
-Kidney pain felt in their back
-Sleep problems due to muscle cramps or restless legs
-Nausea and/or vomiting
-Taste changesa metallic taste in the mouth
-Bad breath due to urea buildup in the blood
-Loss of appetite: People may not feel like eating, and some people report having a metallic taste in
 their mouth or bad breath.
-Difficulty in concentrating: Having trouble doing everyday things such as balancing a checkbook or
  focusing on reading the newspaper can occur.
-Nerve problems: Numbness or tingling in the toes or fingers is a symptom of CKD.

Seeing a doctor when you have stage 4 CKD

At stage 4, itís necessary to see a nephrologist (a doctor who specializes in treating kidney disease). The nephrologist examines the patient and orders lab tests to gather information to recommend treatment.

People in stage 4 CKD will usually visit their doctor at least every three months. Blood tests for creatinine, hemoglobin, calcium and phosphorus levels will be done to see how well the kidneys are working. The doctor will also monitor other conditions such as high blood pressure and diabetes. In addition to helping the patient keep their kidneys working as long as possible, the nephrologist will also help prepare the patient for dialysis or a kidney transplant.

Looking at treatment options when you have stage 4 CKD

Those with stage 4 CKD who will need treatment are told about their choices, including:
-Hemodialysis: This is a treatment that can be done in a center or in a patientís home with assistance from a care partner. A dialysis machine removes a small amount of a patientís blood through a man-made membrane called a dialyzer, or artificial kidney, to clean out toxins that the kidneys can no longer remove. The filtered blood is then returned to the body.

-Peritoneal dialysis (PD): Unlike hemodialysis, PD is a needle-free treatment and a care partner is not required to to help assist during treatment. PD can be performed at home or at work.
Kidney transplant: This is a preferred treatment and does not require as many diet restrictions as those who are on hemodialysis or PD.

Meeting with a dietitian when you have stage 4 CKD

A person in stage 4 may also be referred to a dietitian. Because diet is such an important part of treatment, the dietitian will review a personís lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health.

Diet and stage 4 CKD

For stage 4 CKD, a healthy diet is likely to consist of:
-Reducing protein consumption to help decrease the buildup of protein waste
-Consuming a some grains, fruits and vegetables (potassium and phosphorus are at normal levels)
-Limiting phosphorus to help PTH levels remain normal, prevent bone disease and even preserve
  existing kidney function
-Restricting potassium if blood levels are above normal
-Lowering calcium consumption
-Cutting back carbohydrates for those with diabetes
-Decreasing saturated fats to help lower cholesterol
-Lowering sodium for people with hypertension or fluid retention by cutting out processed and pre-
 packaged foods
-Limiting calcium if blood levels are too high
-Taking water soluble vitamins such as vitamin C (100 mg per day) and vitamin B complex, or
 completely avoiding over-the-counter dietary supplements (unless approved by the nephrologist)

Medications and stage 4 CKD

Itís recommended that people in stage 4 keep their blood pressure at a healthy level and those with diabetes keep their glucose level under control. Taking all the medicines as prescribed by the doctor may help prolong kidney function.

Managing stage 4 CKD

In addition to eating right and taking prescribed medicines, exercising regularly and not smoking are helpful in maintaining health. Patients should talk to their doctors about an exercise plan. Doctors can also provide tips on how to stop smoking.

The National Kidney Foundation (NKF) guidelines recommend starting dialysis when kidney function drops to 15 percent or less. By doing everything possible to help prolong kidney function and overall health, the goal is to put off dialysis or transplant for as long as possible.

 4 
 on: Yesterday at 08:49:54 PM 
Started by newmem - Last post by getlife
OK. I am sharing this information from a DaVita.com. It's one of the largest dialysis organizations in the United States...there are others. This is in regards to Stage 3 of kidney disease.

http://www.davita.com/kidney-disease/overview/stages-of-kidney-disease/stage-3-of-chronic-kidney-disease/e/4749


Stage 3 of Chronic Kidney Disease

A person with stage 3 chronic kidney disease (CKD) has moderate kidney damage. This stage is broken up into two: a decrease in glomerular filtration rate (GFR) for Stage 3A is 45-59 mL/min and a decrease in GFR for Stage 3B is 30-44 mL/min. As kidney function declines waste products can build up in the blood causing a condition known as ďuremia.Ē In stage 3 a person is more likely to develop complications of kidney disease such as high blood pressure, anemia (a shortage of red blood cells) and/or early bone disease.

Symptoms of stage 3 CKD

Symptoms may start to become present in stage 3:
-Fatigue
-Fluid retention, swelling (edema) of extremities and shortness of breath:
-Urination changes (foamy; dark orange, brown, tea-colored or red if it contains blood; and
  urinating more or less than normal)
-Kidney pain felt in their back
-Sleep problems due to muscle cramps or restless legs
-Seeing a doctor when you have stage 3 CKD

As stage 3 progresses, a patient should see a nephrologist (a doctor who specializes in treating kidney disease). Nephrologists examine patients and perform lab tests so they can gather information about their condition to offer the best advice for treatment. The nephrologistís goal is to help their patient keep their kidneys working as long as possible.

Meeting a dietitian when you have stage 3 CKD

Someone in stage 3 may also be referred to a dietitian. Because diet is such an important part of treatment, the dietitian will review a personís lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health.

Diet and stage 3 CKD

For stage 3 CKD, a healthy diet is likely to consist of:
-Eating high-quality protein and potassium (if blood levels are above normal)
-Consuming a some grains, fruits and vegetables (potassium and phosphorus are at normal levels)
-Limiting phosphorus to help PTH levels remain normal, prevent bone disease and even preserve
 existing kidney function
-Lowering calcium consumption
-Cutting back carbohydrates for those with diabetes
-Decreasing saturated fats to help lower cholesterol
-Lowering sodium for people with high blood pressure or fluid retention by cutting out processed and
  pre-packaged foods
-Limiting calcium if blood levels are too high
-Taking water soluble vitamins such as C (100 mg per day) and B complex, or completely avoiding
 over-the-counter dietary supplements (unless approved by the nephrologist)

Itís helpful to work with a registered renal dietitian because as the stages of CKD change, so will the diet.

Medications and stage 3 CKD

Many people who develop CKD have diabetes or high blood pressure. By keeping their glucose level under control and maintaining a healthy blood pressure, this can help them preserve their kidney function. For both of these conditions, a doctor will likely prescribe a blood pressure medicine.

 Studies have shown that ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) help slow the progression of kidney disease even in people with diabetes who do not have high blood pressure. Patients should ask their doctors about all of their medicines and take them exactly as prescribed.

More ways to manage stage 3 CKD

In addition to eating right and taking prescribed medicines, exercising regularly and not smoking are helpful to prolonging kidney health. Patients should talk to their doctors about an exercise plan. Doctors can also provide tips on how to stop smoking.

Get help when you have stage 3 CKD

There is no cure for kidney disease, but it may be possible to stop its progress or at least slow down the damage. In many cases, the correct treatment and lifestyle changes can help keep a person and their kidneys healthier longer.

 5 
 on: Yesterday at 07:02:47 AM 
Started by getlife - Last post by obsidianom
I am aware of the dangers of pyelonephritis. But not all UTIs lead to kidney infection? I did seem to have some bout of mild flu-like symptoms during the summer months when I developed this UTI, but I'm not sure whether it was actually pyelonephritis though ... Is there a test that can show whether one has pyelonephritis?
Not all UTIs leads to pylonephritis. But any significant UTI can go there . In addition there are chemicals that are produced in the urinary system when there is an infection that can do some damage. There are inflamatory proteins produced during the infection that can scar the mucosa and kidney . It is a fairly complicated set of reactions caused by the bacteria , especially e-coli which is the number one UTI bacteria.
An ultrasound is helpful to check on the kidneys. That would show some of the after effects if any. It is a simple non invasive test .

 6 
 on: Yesterday at 06:06:27 AM 
Started by getlife - Last post by PrincessLeila
I am aware of the dangers of pyelonephritis. But not all UTIs lead to kidney infection? I did seem to have some bout of mild flu-like symptoms during the summer months when I developed this UTI, but I'm not sure whether it was actually pyelonephritis though ... Is there a test that can show whether one has pyelonephritis?

 7 
 on: Yesterday at 05:57:46 AM 
Started by getlife - Last post by obsidianom
From another article----------   "This report demonstrates that one episode of acute pyelonephritis can lead to severe renal scarring. Whereas antenatal lesions are thought to have a stronger role in the causal pathway for reflux nephropathy than is UTI in addition to VUR, this observation reminds us that UTI can truly play an important role in damaging kidneys."
"'

 8 
 on: Yesterday at 05:51:57 AM 
Started by getlife - Last post by obsidianom
It's sure a tough question about what exactly caused the increase in creatinine levels, the UTI or the antibiotic (or both)! My new Neph actually doesn't think UTIs are that dangerous. It was a passing comment & I didn't question him more about it. Perhaps UTIs are only dangerous to kidneys if it leads to a kidney infection? If it stays as an UTI, it might be less harmful? I'm burning to ask him when I see him next time (31 Oct).


I disagree that urinary tract infections cannot cause kidney damage . I have seen too many of this.I remeber a patient who I was very close to end up on dialysis when her nurse parctiioner did not take her UTI seriously. It killed her kidneys. I have seen MANY other cases of this.
Read this first paragraph from a recent article.


Int J Gen Med. 2011;4:333-43. doi: 10.2147/IJGM.S11767. Epub 2011 Apr 19.

Urinary tract infections in women: etiology and treatment options.

Minardi D1, d'Anzeo G, Cantoro D, Conti A, Muzzonigro G.

Author information

1Department of Clinical and Specialist Sciences, Urology, Polytechnic University of the Marche Medical School and United Hospitals, Ancona, Italy.

Urinary tract infections (UTI) are common among the female population. It has been calculated that about one-third of adult women have experienced an episode of symptomatic cystitis at least once. It is also common for these episodes to recur. If predisposing factors are not identified and removed, UTI can lead to more serious consequences, in particular kidney damage and renal failure.

 9 
 on: Yesterday at 05:24:14 AM 
Started by getlife - Last post by PrincessLeila
It's sure a tough question about what exactly caused the increase in creatinine levels, the UTI or the antibiotic (or both)! My new Neph actually doesn't think UTIs are that dangerous. It was a passing comment & I didn't question him more about it. Perhaps UTIs are only dangerous to kidneys if it leads to a kidney infection? If it stays as an UTI, it might be less harmful? I'm burning to ask him when I see him next time (31 Oct).


 10 
 on: Yesterday at 04:38:49 AM 
Started by getlife - Last post by obsidianom
That reminds me BJ, I too was put on the normal recommended dose of Keflex for adults. The walk in GP ignored my telling him I've got CKD & said that unless I take the standard 1,000 mg per day (4 capsules), the UTI won't be eliminated.

I'm not sure my side effects were "allergic" reactions either. Allergies tend to have swelling, difficulty breathing, rashes symptoms. I just think it was damage from the prolonged use of the antibiotic.
Actually that dose is not that high. Yes kidney disease slows the elimination of cephalexin but 1000mg per day is just a low-moderate dose. I usually use doses of 1500 to 2000 mg on skin /soft tissue infections and on kidney patients it is recommended to reduce the frequency or lengthen the time between doses as the elimination slows. I have never seen it damage kidneys in 30 years of using it. In your case the actual UTI could have caused the kidney damage. That is far more common. It happens a lot.

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