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Monday, November 16, 2015

Home Dialysis Los Angeles

There are 2 kinds of home dialysis modalities:
1. Home hemodialysis
2. Home peritoneal dialysis.

Home dialysis has several benefits when compared to in-center hemodialysis. In both choices of home dialysis, patients receive more frequent dialysis session than in-center hemodialysis. As such, they have better blood pressure control. This may reduce stress on the heart and blood vessels.

Patients on home dialysis and nocturnal dialysis are able to eat more and use fewer medications. In addition, patients can do more of their daily activities and continue working.

If you are on home dialysis and planning to travel, you need to talk to your dialysis nurses. They are usually available 24 hours - 7 days of the week. They will arrange for you for either hemodialysis or continuing peritoneal dialysis at your destination.

Patients who do home dialysis are more involved in their care, and as such, are more proactive in living healthy and getting better. On the other hand, in-center hemodialysis patients have better support group as they meet with nursing staff and case managers on regular basis.

When making a decision about the type of treatment, you should take into consideration that home dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Both home peritoneal dialysis and home hemodialysis are excellent choices in treatment on end stage renal disease patients. They are both as effective form of dialysis as in-center hemodialysis.

There are some people for whom home dialysis may not be appropriate. Home dialysis requires independent patients with good family and social support that can help the patient in this process. Home dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.


Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Source: blogger posts
Home Dialysis Los Angeles

Saturday, August 15, 2015

Ig A Nephropathy and Bloody Urine

The most common clinical presentation of Ig A nephropathy is bloody urine provoked by upper respiratory infection. Infectious source with microbial and viral infection is occasionally present. Food particles have also been proposed. Alternatively, Ig A naphropathy may be an autoimmune disease. Ig A Nephropathy is one of the most common causes of kidney disease. In Caucasians, Ig A nephropathy is more common in men with ratio of 3:1 than women. However, in Asians, the ratio approached 1:1. This disease can be transient or progress to chronic kidney disease and possible end stage renal disease requiring dialysis.

Ig A nephropathy is associated with other diseases such as rheumatoid arthritis, celiac disease, alcohol liver disease, cirrhosis, dermatitis herpetiformis, and HIV/AIDS.

The clinical presentation may be suggestive of Ig A nephropathy. However, renal biopsy is required for confirmation. Kidney biospay further helps for predicting the course of the disease. That being said, not all patients require to have kidney biopsy.

Natural Progression
Some patient with mild disease have remission. However, the presence of high blood pressure, protein in the urine, and reduced kidney function as well as some findings on kidney biopsy increase progression and poor outcomes.

Treatment
Treatment of Ig A nephropathy depends to clinal presentation, urine studies and kidney biopsy result. Depending to the presentation, the treatment of Ig A nephropathy varies from blood pressure medications to immunosuppresive medications. Close follow up with a nephrologist is crucial.

Dietary gluten restriction has not been show to preserve kidney function.


Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Saturday, February 21, 2015

High Blood Pressure - Chronic Kidney Disease, Sodium, and Salt Intake

In patients with chronic kidney disease, management of high blood pressure is crucial. Uncontrolled blood pressures can have devastating effects on your health (heart attack, stroke, death). It is important to check blood pressure frequently and review the numbers with your kidney doctor (nephrologist). Low salt diet (2 gram per day) is the first step. There are many different medications to help with elevated blood pressure. But if you do not decrease your salt intake, control of blood pressure can be very difficult.

With high salt (sodium) intake, you will be more thirsty. As such, you will drink more which can lead to swelling and raise your blood pressure. This can damage your kidneys more and make your heart work harder. One of the best things that you can do to stay healthy is to limit how much salt (sodium) you eat.

To limit sodium in your meal plan:
1. Do not add salt to your food when cooking or eating. One of the first steps in becoming healthy is cooking your own food. With cooking your own food, you will become more health conscious and use healthy ingredients.

2. Try cooking with fresh herbs, lemon juice or other salt-free spices. To make the food delicious and tasty, you do not have to add salt. Fresh herb and lemon juice can be good alternatives. Make sure you do NOT use potassium supplements though (see below)

3. Choose fresh or frozen vegetables instead of canned vegetables. If you do use canned vegetables, drain and rinse them to remove extra salt before cooking or eating them.

4. Avoid processed meats like ham, bacon, sausage and lunch meats. These foods have high salt content. It is much healthier to cook fresh meat.

5. Eat fresh fruits and vegetables rather than crackers or other salty snacks. As the old saying goes: an apple a day keep the doctor away. Try to have healthy habits during the day. One such habits is eating vegetables.

6. Avoid canned soups and frozen dinners that are high in sodium. Try to cook your own soup with fresh ingredients. Its more delicious! You can eat more of it and yet not worry about gaining weight.

7. Avoid pickled foods, like olives and pickled. Substitute it with healthy fruits like avocado.

8. Limit high-sodium condiments like soy sauce, BBQ sauce and ketchup.

One important point! Be careful with salt substitutes. Many food with "low salt" advertisements are high in potassium. Too much potassium can be dangerous for someone with kidney disease. Potassium is mainly excreted with kidney. Patient with chronic kidney disease have decreased kidney function and as such have excretion of potassium. Make sure to look at the nutritional facts for the food. Avoid high potassium foods. Work with your kidney doctor (nephrology) or dietitian to find low-sodium foods that are also low in potassium.




Sources:
http://www.healthaliciousness.com/articles/what-foods-high-sodium.php
http://www.cdc.gov/salt/

Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Monday, November 17, 2014

Kidney Stone Lifestyle Changes


1. Drink 2 L of water. Make sure you are measuring this! It is really easy to think you have increased fluid intake with only few glasses of water. I recommend to buy a 1 L bottle of water and measure your water intake. (If you have heart failure, kidney failure or liver disease, discuss this with your doctor first as you can easily accumulate fluid). Drinking water helps you with digestion and prevents constipation. In addition, drinking water helps excreting toxins through your kidney. Try to form a habit of drinking 2 L water per day. This habit will encourage you to live healthy and actually helps with weight loss. Leave the bottle of water at your work and on your table. This way, by seeing the bottle on your table, you slowly form this habit. This is an excellent way of forming healthy habits and avoid kidney stones.


2. The most common cause of kidney stone is calcium oxalate. Even if you have other kind of kidney stones, calcium oxalate usually complicates the picture. As such, it is highly important to avoid the diet that contains the oxalate! Cola beverages, coffee, and tea should be limited to two cups a day because these fluids contain oxalate. Remember, I said avoid oxalate and not the calcium! One of the common mistakes that I hear from my patients and occasionally from physicians is to decrease calcium intake as well. This is a mistake. You should continue to have normal calcium intake. The normal calcium intake in gut will bind to oxalate and prevents it from absorption from the intestine.



3. Drinking lemonade made from fresh lemons or lemon juice may help reduce the risk of kidney stone formation. Lemon juice increases the level of citrate in the urine which in turn prevents the formation of kidney stones. Citrate will increase the solubility of the stones in your urine. It helps with preventing new kidney stone formation AND shrinking the previous kidney stones. Remember this is part of life style modification. Depending to the size and kind of your kidney stone, you may need procedures or medications. Do not forget to follow up with your physician closely. Discuss this different life style modifications with your doctor. As a nephrologist and a kidney doctor, I love it when my patients come to clinic prepared to ask questions about their health. This tells me they are proactive.

4. Decrease salt intake to 2 gram per day. (A tablespoon of salt contains 2,325 mg of salt.) What does salt have to do with kidney stones? The higher salt intake, the more kidney has to excrete the salt. In this process, kidney will also excrete other electrolytes that will make you prone to forming kidney stones. Limiting salt intake has 2 benefits. First, limiting salt intake is important with controlling hypertension. Secondly, by limiting salt intake, you prevent new kidney stone formation or worsening of existing kidney stone. 

5. Eat a healthful amount of calcium. Many people think that if they have kidney stone, they need to decrease their calcium intake. On the contrary, you need healthful amount of calcium. Please read # 2 point above. I explained this in detail. But again, if you have kidney stones, you should not limit calcium intake. Normal calcium intake is highly important. 

6. Moderating consumption of animal protein such as: red meat, poultry, eggs, and seafood. Animal proteins increased uric acid levels in your body. High levels of uric acid will increase your chance of gout and uric acid kidney stones. In addition, a high-protein diet reduces levels of citrate, the chemical in urine that helps prevent stones from forming. Now I don't say do not eat meat. The key is moderation. Limit your daily meat intake to a quantity that is no bigger than a pack of playing cards. This is also a heart-healthy portion.

7. Decrease consumption of oxalate-rich foods. The highest amounts of oxalate are found in dark-green leafy vegetables such as kale, beet greens, okra, spinach, and swiss chard. Other plants that are rich in oxalate include instant coffee, rhubarb, starfruit, soy nuts, tofu, soy yogurt, soy milk, beets, and sweet potatoes. Limiting consumption of these foods may help prevent calcium oxalate stones from forming. 

8. Discuss the over the counter medications that you are using with your doctor. Over the counter medications do not need FDA approval and some of them contain substances that can damage your kidney or worsen your kidney disease.


What kind of kidney stone do you have? Were you ever hospitalized? Do you know if you have any kidney damage from the stone?

Resources:
http://health.usnews.com/health-conditions/urology/kidney-stones/prevention
http://www.health.harvard.edu/blog/5-steps-for-preventing-kidney-stones-201310046721
http://kidney.niddk.nih.gov/KUDiseases/pubs/kidneystonediet/

Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, November 2, 2014

Living Kidney Donation: Act of Kindness from the Donors but no Incentives from the Government

When I started my nephrology fellowship training, I was saddened with the quality of life our dialysis patients live. I started this blog with the goal of dedicating time and effort to add some quality to these patients lives.

Dialysis patients are by far the most complicated patients in medical field. Even with their best adherence to medical therapy, their survival is only 20%. Yet, if they get a living kidney donation, they can live much longer with close to normal quality of life.

As a society, we have focused for paying medical bills for the dialysis patient but have not looked at how to provide incentives to encourage living kidney donation. I have seen this youtube video and was blow away with the facts this speaker presented. Please look at this video and let me know what do you guys think are possible incentives that might increase living kidney donation.





Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, October 26, 2014

Home Dialysis Los Angeles

There are 2 kinds of home dialysis modalities:
1. Home hemodialysis
2. Home peritoneal dialysis.

Home dialysis has several benefits when compared to in-center hemodialysis. In both choices of home dialysis, patients receive more frequent dialysis session than in-center hemodialysis. As such, they have better blood pressure control. This may reduce stress on the heart and blood vessels.

Patients on home dialysis and nocturnal dialysis are able to eat more and use fewer medications. In addition, patients can do more of their daily activities and continue working.

If you are on home dialysis and planning to travel, you need to talk to your dialysis nurses. They are usually available 24 hours - 7 days of the week. They will arrange for you for either hemodialysis or continuing peritoneal dialysis at your destination.

Patients who do home dialysis are more involved in their care, and as such, are more proactive in living healthy and getting better. On the other hand, in-center hemodialysis patients have better support group as they meet with nursing staff and case managers on regular basis.

When making a decision about the type of treatment, you should take into consideration that home dialysis is usually a daily process, similar to the working of the kidney and may be more gentle with fluid removal from the body. Both home peritoneal dialysis and home hemodialysis are excellent choices in treatment on end stage renal disease patients. They are both as effective form of dialysis as in-center hemodialysis.

There are some people for whom home dialysis may not be appropriate. Home dialysis requires independent patients with good family and social support that can help the patient in this process. Home dialysis is not for everyone. People must receive training and be able to perform correctly each of the steps of the treatment. A trained helper may also be used.


Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328

Sunday, June 22, 2014

Peritoneal Dialysis Frequently Asked Questions Part 5

This is Peritoneal Dialysis Frequently Asked Questions Part 5
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4

15. Can I remain sexually active once I begin dialysis?
Yes. You are encouraged to maintain a normal lifestyle. Some patients may experience a decrease in sexual drive. If this becomes a problem for you, talk to your doctor. Decrease sexual drive on dialysis is multifactorial. If you are feeling sad or depressed, please make sure to talk to your doctor. Some peritoneal dialysis patients find it difficult to accept a permanent PD catheter. They worry that the catheter may affect their sexual activity and their relationship with their partner. Peritoneal dialysis nurses can help with tips on how to disguise the PD catheter.National Kidney Foundation has a very good and detailed page on sex and dialysis which you can access by clicking here.

16. Should I cancel my current Insurance?
This is a good question. Most of the patients when they start dialysis have many questions about the insurance and their coverage. Each insurance is different and have different requirement. The social worker will do everything for you. Do not worry about insurance too much. The social worker will be in touch with your insurance and try to arrange everything for you. Do not cancel any insurance policy without discussing your options with your social worker. Being on dialysis will qualify you for medicare. Discuss your options with your dialysis center social worker.

17. How will I get the supplies I need for peritoneal dialysis?
Supplies will be delivered to your home on a regular basis. A nurse will order your first shipment. A customer service representative will call you to set up future deliveries. Make sure to keep the information for you supplier so you can easily reach them. If you ever had any difficulties, call your peritoneal dialysis team. They will help you to get your peritoneal dialysis supplies. Make sure to not wait until the last day to order the new supplies. Also, if you are planning to travel, make sure to talk to your peritoneal dialysis team and supplier in advance so they can arrange the dianeal fluid to be sent to your destination. To access you Baxter account Click Here. If you need to contact Baxter Click Here. This is a video of peritoneal dialysis delivery if you would like to watch. Video

18. How often will I need peritoneal dialysis? 
Peritoneal dialysis is done every night. At night time, you or your loved one will connect you to the peritoneal dialysis machine and in the morning, you will get disconnected and can go to work. One of the benefit of the peritoneal dialysis is that because you do dialysis on daily basis, your fluid balance is well controlled and as such your blood pressure will be better controlled. Another benefit of peritoneal dialysis is that it gives the patients much autonomy and ability to continue life and have active life style. Your doctor will determine your exact peritoneal dialysis “prescription.” You can always talk to your doctor about your daily activities and see if he/she can change the prescription to be suitable to your lifestyle. If you are going to travel, make sure to arrange for the peritoneal dialysate (fluid for PD) to be delivered there in advance. You peritoneal dialysis team can help you with that. In addition, if you are going to miss a peritoneal dialysis session, make sure to contact you dialysis team and update them.

This is Peritoneal Dialysis Frequently Asked Questions Part 5
Click here for Part 1
Click here for Part 2
Click here for Part 3
Click here for Part 4



Ardavan Mashhadian D.O.
Nephrologist
1127 Wilshire Blvd Suite 510
Los Angeles CA 90017
(213) 537-0328