Ask a Renal Medicine and Kidney Specialist: Dr Francisco Salcido-Ochoa from Mount Elizabeth Novena Hospital Singapore

Ask a Doctor ForumCategory: Renal MedicineAsk a Renal Medicine and Kidney Specialist: Dr Francisco Salcido-Ochoa from Mount Elizabeth Novena Hospital Singapore
Dr Francisco asked 10 months ago

I am a nephrologist (renal physician) and transplant immunologist practising at Francisco Kidney & Medical Centre in Mount Elizabeth Novena Hospital in Singapore.

I specialise in treating chronic kidney disease, kidney failure, general nephrology and acid-base and electrolyte metabolic disorders, and I am experienced in kidney transplantation, kidney dialysis and renal replacement therapies.

I graduated with honours from the Faculty of Medicine at the National Autonomous University of Mexico in 1998. I went to the United Kingdom to pursue my postgraduate research studies at the Imperial College London, Department of Immunology, under the mentorship of Prof Sir Robert Lechler. I was awarded a distinction for my Master of Science (Immunology) in 1999 and granted a straight-pass on my PhD thesis, ‘Transplantation Tolerance and Immunoregulation’ in 2005.

During my PhD studies, I made a significant contribution to the description of a novel pathway in immunology. Subsequently, I underwent further medical training at the Royal London Hospital and Barts Hospital, and obtained my Member of the Royal College of Physicians of the United Kingdom in 2007.

I relocated to Singapore in 2008 and continued my specialist training in nephrology at the Singapore General Hospital (SGH). I worked as an associate consultant until 2013. From 2013 to 2017, I worked in SGH as a consultant nephrologist with subspecialty in renal transplantation. I have worked as a visiting consultant for the National Kidney Foundation (Singapore) in 2018, as interim medical director for Davita Singapore from 2019 to 2020 and again as visiting consultant for the National Kidney Foundation since 2020 up to now.

During my service in SGH, I successfully obtained a few institutional research grants and participated in numerous research projects related to the immune mechanisms underlying kidney transplant rejection and glomerulonephritis, as well as the discovery of novel biomarkers. I have several international publications and have been invited for several oral presentations in different countries including the UK, Mexico, Switzerland, Malaysia, Spain and Singapore.

To me, the quality of care as well as the patient’s experience and satisfaction are of utmost importance. Great part of my management is focused on disease prevention or minimisation of complications. A sincere and empathetic approach to patient care has been my guiding principle and the patient’s interests have been my top priority.

Learn more about me here: https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/

I am excited to be here to share/discuss Renal Health with everyone. I will be actively answering questions. Whether you’ve got questions about kidney disease, kidney failure, kidney transplants, kidney dialysis or renal placement therapies, ask me anything!

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18 Answers
Karen answered 10 months ago

My uncle has been undergoing dialysis for 2 years now. I personally feel this treatment works only to keep his kidneys from failing, and his condition doesn’t seem to improve. Our family has been discussing a kidney transplant and we want to ask your opinion on this. What should we consider before deciding to have a transplant? If we keep him on dialysis, is there a chance to improve his condition?

Dr Francisco
replied 10 months ago

Dear Karen,

Thank you for your question. I am sorry to hear about your uncle’s situation. Please let me clarify some aspects of your enquiry, and then I shall give you my opinion on some possible options.

When the kidneys start failing, we recommend patients to start dialysis or to undergo a kidney transplant.

People in that situation, for example needing to start dialysis, is because their own kidneys cannot any longer eliminate the excess of toxins in the body nor the excess of body water. However, dialysis only do that job partially, to the minimum level to at least keep your uncle (or any patient) alive and relatively well. Unfortunately, dialysis does not help preserving the remaining kidney function nor makes the kidneys better. Dialysis only helps sustaining live and regulating to certain degree many of the body and blood parameters. That could be the reason you do not see progressive improvement in your uncle’s condition. Said that, it would be ideal to have a thorough assessment of his condition to be sure nothing else is missed, that could be contributing to that, for example, some metabolic imbalances, malnutrition, poor control of any accompanying disorder like diabetes, etc.

In comparison to dialysis, in most patients, kidney transplantation seems to be the best option to replace the functions of the kidneys, to regulate better the body fluid and many body components, and to make patients feel better and likely live for longer. Kidney transplantation also offers the best chance for life rehabilitation; allowing patients to live a life as normal as possible and as enjoyable as possible; again in comparison to dialysis. For those reasons, kidney transplantation could be a better option over dialysis for most patients.

However, not every person is suitable for kidney transplantation. Candidates for kidney transplantation need to be assessed properly and thoroughly before being advised in pro for transplantation. If your uncle has no contraindications for kidney transplantation and he is relatively fit and strong to undergo such a surgery -after thorough assessment by a specialist team, experienced in kidney transplantation- transplantation could be indeed a better option for him. It is important to know if his doctors already recommended this option to him or not; and if not, why.

There are many types of kidney transplantation, depending on the type of donor and many other factors. The one associated with better outlook and outcomes is when the donor comes from his own family when compared to receiving a kidney from a deceased donor (ie being in the national waiting list). There are multiple reasons for that including better organ compatibility if the organ is donated within his family and no needing to wait for long time for a kidney in the waiting list; because a donor within the family is readily available, no needing to continue for long periods on dialysis; which also have progressive side effects for dialysis patients.

I hope I have answered your main concerns. However, dialysis and kidney transplantation are complex matters and deciding on one or the other is also complex and delicate decision, requiring thorough assessment of your uncle medical condition and relative fitness, balancing many of the pros and cons of both options; requiring a personalised advice. Helping and advising patients at that difficult junction is what I do every day. For that reason I would recommend as best next step to re-discuss all this with his treating physician; but I would be also honoured to advise further on his case; but I would need to assess him properly with all his medical details; so to give him the safest and most accurate possible advice. If interested, you could book an appointment with me within this platform following this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/

Otherwise, I hope your uncle situation stabilises or gets better and you all move towards the best treatment option for him.

Dr Francisco, wishing your uncle the best possible health!

Daniel answered 10 months ago

This morning, I had foamy yellowish urine. Before this, I also suffered from frequent urination. I have tried to manage it by quitting coffee and alcohol, and limiting my water intake. However I get muscle cramps in my thighs and lower back. Is this related to some sort of kidney issue and is it serious, Doctor?

Dr Francisco
replied 10 months ago

Dear Daniel,
Thank you for your enquiry.

The urinary symptoms you mentioned could suggest that either a kidney or urological problem might be going on. It could be as simple as a urine infection, but, even if it is an infection, it is not ideal to let it un-investigated and untreated. So, you definitively need to be checked by a general doctor, at least and at first. He/she might take a more detailed medical and medication history, asking you for any other symptoms like fever, pain during passing urine, or symptoms of kidney or urological problems, etc, and examine you and do some simple blood work including kidney function tests and electrolytes (and other routine tests), and some urine tests looking for blood and protein leakage in the urine and a potential urine infection. He might need to order some scans, depending on his/her findings and/or refer you to a nephrologist and/or a urologist for further investigations and specialist opinion.

The cramps might or not be related. It is difficult to answer that at the distance and without examining you properly; but the doctor I recommend you to see can help you with that once he/she has all the information at hand. And then take the necessary best next step.

Do not worry too much at this junction, but do seek medical advice soon. I hope a minor treatable issue is found and this is sorted soon, so you can start feeling better. I hope no major issues found on the kidneys; but if so, you could share later all the results of the initial analyses and I would be honoured to give you my professional opinion. Again, if that happens, hopefully not, I recommended you to book a formal consultation with me using this platform following this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/ ; so I can assess you and advise you properly.

Moderating your intake of alcohol and coffee would be always good for your health. I understand why you might have reduced your water intake, but I suggest do not do that until you see a doctor. In occasions, that can bring new problems as kidneys need sufficient amount of fluid to work properly and for you to be ok.

Dr Francisco, wishing you the best possible health!

Pam answered 10 months ago

During dialysis, I have irregular menstruation. Is it normal for my period to be affected? Is it okay to leave it untreated?

Dr Francisco
replied 10 months ago

Hi Pam,

Thank you for your question and sorry to hear about your predicament.

It is common for women on dialysis to have irregular menstruations or lack of menstruation (amenorrhoea); which has been associated also with problems conceiving. The high levels of blood toxins and other biochemical alterations in the body of kidney failure can contribute to some hormonal imbalances and lack of ovulation.

Fertility issues are what usually trigger patients to seek further help with a fertility specialist. If you are trying to conceive, this will be necessary.

If any other symptoms related to your menstruation or sexual function arise, it could be ideal to seek also an opinion from a gynaecologist and/or an endocrinologist with experience in menstrual disorders; which could help you to potentially sort the issue or give you reassurance if you are worried.

For some patients, optimising dialysis treatment (adequate dose of dialysis), correcting anaemia with erythropoietin, improving their mineral bone metabolism/disease (calcium, phosphorus, iPTH, vitamin D), improving nutrition, remaining active and/or minimising stress helps a bit; especially in younger patients. You probably need to double check (with your doctor) for any potential improvements in those aspects.

However, the best solution to this menstrual (or fertility) problem is to have a kidney transplant. The kidney transplant is overall (in most patients) superior to dialysis not only to correct imbalances like the one we are describing, but to allow patients to live a longer and fuller life. Can I ask you? Are you in the waiting list for a kidney transplant? Can anyone in your family donate a kidney to you?

If you would like me to have a look at your dialysis parameters and overall health situation and advise you more specifically to see if some improvements can be done, or if you would like to have more information on kidney transplantation (the rationale, pros and risks); I recommend you to book a formal consultation with me using this platform following this link

https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/

Your current worry and main issue now is the irregular menstruation, I gather that, but seeing the bigger picture your focus could be to try to improve your current health (or at least check that everything is optimal) and to seriously considering getting a kidney transplant because that might be the best rounded option for you, as a whole.

Dr Francisco, wishing you the best possible health!

Stacie Y answered 10 months ago

What are the things should we consider before deciding to undergo a kidney transplant?

Dr Francisco
replied 10 months ago

Hi Stacie,

This is a very interesting but not simple question. This is because every patient is a world on his/her own, with different medical conditions, functionality and health status; needs, requirements, preferences, priorities in life, dreams, aspirations and personality; as well as different worries, concerns and fears; plus having different lifestyle and family, socio-economical and work-related conditions, and distinct roles in society; and different access to healthcare and different levels of support. So, different patients put on the balance different factors when considering kidney transplantation over remaining on dialysis. In addition and importantly, some patients might have certain medical contraindications for kidney transplant or situations posing extra risks than the average patient -not necessarily contraindicating transplantation- but that require serious thoughts.

Therefore, the option for transplantation must be personalised taking into account all those factors and their relative importance to each patient’s personal, family, social and professional (or student) life.

There are many permutations of the above mentioned factors to consider. For instance, a patient without family members able to donate, living alone, with no insurance, not working, worried if can afford the transplant or not or being able to pay for the medications, etc needs to put on the balance other factors that someone with available donors, permissive job, insurance, where paying for the transplant is not a worry, with lots of family support…

Overall and in most patients, kidney transplantation is regarded as the best type of renal replacement therapy (for patients with total kidney failure) over dialysis. It offers better opportunities to live a longer life as normal and as best as possible over what dialysis offers to most patients. So, this is in fact, the most important consideration when deciding if going for a kidney transplant or not. Then, the second might be considering what type of transplant; for example from a living donor (relative or spouse) or from a deceased donor; because live-donor transplantation offers overall better outcomes over deceased-donor transplantation. If transplantation is readily available, considering doing it before starting dialysis (what we call pre-emptive transplant) is ideal. So, this is an option to consider as well.

Furthermore, who is going to be donor gives complexity to the equation. Your spouse, a twin sister, mother, etc. Plus the fact that the donor is again a whole world on his/her own, too.

All these factors (and more) are assessed and discussed with the prospective recipient and donor during the medical evaluation in preparation for kidney transplantation, at great detail and in a very personalised way. I would be happy to give you detailed and personalised advice in regards to your particular situation, but I would need to assess your situation formally and thoroughly. If interested, you could book an appointment with me within this platform following this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/

Alternatively or at the same time, why don’t you check out my recently published free e-guide on kidney health and disease, where I discuss in more detail my view on kidney transplantation and donation, mentioning many of the factors to consider. Please follow this link https://www.franciscokidneycentre.com/kidney-health-guide/

Dr Francisco, wishing you the best possible health!

Ida answered 10 months ago

Doctor, my dad has just started his hemodialysis. How do we know if it’s going well and are there any signs? And we heard that if the kidney disease is chronic, then a patient needs to do dialysis all his life. Is it true? Is there any diet you will recommend for my dad?

Dr Francisco
replied 10 months ago

Hi Ida,

Thank you for your question and sorry to hear about your dad’s complication.

If he has been confirmed with total kidney failure (what we doctors call end-stage kidney failure), he would need dialysis for the rest of his life; both to keep him alive and to feel as best as possible.

Said that, if he were to be a good candidate for kidney transplantation, this is another management option for patients with total kidney failure, and has overall more benefits over dialysis. This decision must be individualised.

The best way to know if he is doing well is to know if he is feeling better, if he seems well-nourished and thriving, and if he is able to do/resume/enjoy most of his usual activities, as normal and as best as possible once he has started and -hopefully- adapted to his dialysis regimen. Also, it is ideal to be sure he has no major issues or symptoms during or after dialysis; so he is not struggling with it.

Obviously, we doctors quantify some dialysis parameters and measure several laboratory parameters also to be sure the dialysis dose and dialysis adequacy (how well he is being dialysed) is optimal.

Modifications of the dialysis prescription, changes in medications and giving extra diet and lifestyle advice are necessary measures to improve his overall well-being. But in the centre of adequate care, and actually the most important factor, is to practice self-care. Patients assuming this role (and/or their caregivers if needing extra assistance); in other words, patients being in charge of their own health and managing their condition and diet and lifestyle decisions under the guidance of healthcare professionals, and deciding to live a more frugal and active lifestyle with a more positive mindset, learning to live well despite their disease, tend to do much better and live longer than other patients. Patients and their caregivers can learn all that and become empowered in self-care under the right guidance and support from their healthcare providers.

Patients on dialysis need to have certain diet restrictions, what we call the renal diet. Typically, most patients need to minimise the intake of fluids and of food high in salt, potassium and phosphorus. But again, diet advice must be tailored to their needs, requirements, cultural background and palate preferences. Many patients find implementing this diet changes difficult and are unable to keep with them, so they tend to do not that well.

Because adequate nutrition and these restrictions are crucial to minimise symptoms and complications and for an overall better physical well-being; it is pivotal for patients to do their best efforts to adhere not only to the dialysis or medications prescriptions, but also to the suggested diet and lifestyle changes.

With the aid of an experienced and empathetic dietitian, a good balance can be achieved, making the restrictions less unpalatable and preventing malnutrition, which is common in kidney failure.

I invite you to check this link https://www.franciscokidneycentre.com/kidney-health-guide/ , which leads you to my free e-guide on kidney health and disease with some useful chapters on dialysis and renal diet.

Also, it would be my pleasure to assess your dad’s overall condition and medical situation and advise you better, and address all your concerns; for which a formal and thorough teleconsultation would be necessary. If interested, you could book an appointment with me within this platform following this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/

Dr Francisco, wishing your dad the best possible health!

Jerome answered 10 months ago

Lately when I drink more caffeine, I see foam in my urine. I’ve tried to reduce my caffeine intake and drink more water in the past and it worked in terms of reducing the amount of foam. But these days, the foam is still there even when I stop drinking caffeine. Is there something wrong with my kidneys?

Dr Francisco
replied 10 months ago

Hi Jerome,

Thank you for your question. Urine foaming or bubbles in the urine can occur occasionally in some people with no abnormality found. And this, hopefully, can be your situation.

However, people with persisting foamy urine must be investigated for protein leakage in the urine; which, if present, is an indicator of some kidney issues or inflammation in the kidneys (what we call glomerulonephritis). So, my recommendation is to get checked by a general practitioner, so he/she can take your medical history, examine you, measure your kidney function, order detection of both protein and blood in the urine, and then do the necessary afterwards: If nothing found, then reassure you; but if an issue discovered, refer you to a nephrologist for further investigations and advice.

Do not worry too much at this moment, but do not leave it unattended and see a doctor soon. I hope nothing major is eventually found. But if some leakage of protein found, please see a kidney specialist or alternatively you can book a tele-consultation with me using this platform through this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/

Regarding your caffeine intake, remember, everything with moderation is better.

Dr Francisco, wishing you the best possible health!

Aaron answered 10 months ago

I feel pain in my lower back and around my groin when I’m urinating. I read online that this could be symptoms of kidney stones. What examination should I undergo to have it checked?

Dr Francisco
replied 10 months ago

Hi Aaron,

Thank you for your question.

Indeed, having lower back and groin pain upon urinating could suggest a urinary stone or other urological (urinary tubes) problems. So, it will be ideal to consult a urologist, who is the specialist of the urinary tubes and anatomical problems of the kidneys. Alternatively, you can see first a general practitioner or a nephrologist, and then they can guide you.

Before recommending any investigation to confirm the suspicion, it is always ideal to be seen properly by a doctor. The doctor will ask your medical history (for example, any other accompanying symptoms and signs like fever, blood in the urine, passing gravel or stones in the urine, problems urinating, any other symptoms, any accompanying medical conditions, type of diet, any medications or supplements, fluid intake and lifestyle habits, and a more detailed characterisation of your pain). It is important to check if you have any family history of stones, as that increases your risks. The doctor must examine you, too; so overall he/she can have a more accurate view of the situation and propose a more targetted and personalised plan to you; including also analgesics and diet and lifestyle advice.

There are different types of scans used when stones are suspected. A plain CT or a CT urogram are commonly ordered but some doctors do an ultrasound of the kidney and urinary tubes first together with a kidney ureter bladder X ray. Sometimes, other scans are used, depending on the initial assessment and patient’s particular situation like an MRI etc. So, my recommendation is to allow a doctor to examine first, and then decide.

Other tests might be necessary, including some metabolic blood work detecting some conditions associated with different types of urinary stones, chemical analysis of the urine or even chemical analysis of the stone if you ever pass it, so we can identify more accurately what type of stones you could be forming (if they are confirmed) and advise you more accurately regarding changes in diet and lifestyle, and potentially prescribing medications. There are few types of stones with different associating causes and some distinct treatment or preventive measures.

If the stones are confirmed, apart for whatever the urologist recommends as treatment (any type of removal) -but occasionally stones are passed spontaneously-, we nephrologists can co-manage patients especially if a metabolic condition predisposing to stones is identified or suspected, to do the blood work and urine chemical analysis I am commenting above and to suggest preventive diet and lifestyle modifications (and occasionally medications) to avoid the formation of further stones.

When I identify a stone in a patient, I refer him/her to a urologist to assess the patient for potential removal of the stone. When a urologist treats a patient with a urinary stone, he/she refers the patient to me for the blood work and chemical analysis of the urine and to implement preventive measures for the formation of further stones. I hope the best outcome for you. Please sort this soon as it is indeed very painful and sometimes stones can complicate with infections or even obstruction of the urine, which can affect your kidney function…or to be sure there is not something else going on.

Feel free to consult me formally for further metabolic or preventive advice -if a stone is confirmed, after you see the urologist- using this platform through this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/ …Otherwise, I am Dr Francisco, wishing you the best possible health!

Ren Yang answered 9 months ago

Doctor, my CT scan results show I have a kidney cyst. I am told this condition is benign and doesn’t need treatment. Is that correct? How do I know if this is cancerous or not?

Dr Francisco
replied 9 months ago

Hi Ren,

Thank you for your question.

Kidney cysts are relatively common, even in people without kidney problems. Some people have one, other people many more; and they can occur in one or both kidneys.

There are different types of cysts and there are different medical situations associated with kidney cyst formation. Many/most of them are benign, meaning non-cancerous; but others could be the precursors of cancer. So, I understand why you are concerned, but let me reassure you. Usually, they do not produce any symptoms and most of them do not confer major risks to patient’s health.

The shape (anatomy) of the cyst(s) as seen in imaging tests like the one you did helps us to classify them according to the so-called Bosniak classification and to estimate their risk for cancerous transformation. I will not explain this Bosniak classification in detail but when the cysts are well-contoured, like a uniform sphere, they are called simple cysts (like the one you have), which are typically benign. When their shape is irregular or they have some deposits of calcium in their wall, they are called complex cysts and they need to be monitored closely for any further potential changes through time – this is to detect on time if they were to transform into a solid nodule, which indeed could be cancerous. There are people who has more chances of this cancerous transformation like patients suffering from chronic kidney disease or kidney failure or taking immunosuppressive drugs -I hope that is not your situation.

This potential cancerous transformation is not the rule. Most people having kidney cysts live a normal life without experiencing cancer transformation. Besides, if occurs, it is a slow-motion process, even in people of higher risk; giving us time for monitoring and opportune intervention.

For the things explained above, the majority of the simple kidney cysts require no intervention; this latter reserved when there is a complication like the ones enumerated above.

I hope you this reassures you. If you dont have any medical condition, maybe few years down the road you can do an ultrasound, but discuss that with your doctor; this must be individualised.

If you have further doubts or you would like me to assess your particular health situation formally, you could book a teleconsultation with me using this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/ …Otherwise, I am Dr Francisco, wishing you the best possible health!

Thomas Eng answered 9 months ago

For someone who has kidney failure, how much improvement can we expect from dialysis? Can kidney failure be cured and is it possible for the patient to live without dependency on the treatment?

Dr Francisco
replied 9 months ago

Dear Mr Eng,

Thank you for your question.

In total kidney failure – what we doctors call end-stage kidney disease -, the kidneys cannot any longer perform their functions satisfactorily; to a sufficient level to sustain life or to avoid life-threatening complications. This is because in kidney failure, the failed kidneys cannot clean off from the body the excess of toxins; cannot regulate adequately the water content in the body; cannot aid in the control of good blood pressure; cannot balance accurately certain salts, electrolytes and acid in the blood; and fail to produce some hormones important to prevent anaemia and some necessary for bone health.

Unfortunately, total kidney failure is irreversible and has no cure (obviously, acute kidney failure is a totally different situation and I am not discussing that one here; where indeed there could be chances for recovery).

As a consequence of the kidneys not performing their roles as they should, patients develop different problems and symptoms like fluid retention, breathlessness, fatigue, anaemia, lack of appetite, nausea, vomiting, uncontrolled blood pressure, severe itch, bone weakness, etc; and if kidney failure is left unattended, patients can have many severe medical complications including heart failure, erratic rhythms of the heart and even cardiorespiratory arrest.

To avoid or rather to minimise the chances of that happening, plus to control many of the symptoms of kidney failure, patients with total kidney failure are advised to start dialysis or, better, to undergo a kidney transplant -if feasible and no medical or practical contraindications.

However, dialysis only replaces partially some of the functions of the normal kidney, in particular getting rid of the excess of body water and reducing the level of toxins in the blood to the minimum level to sustain life, to minimise symptoms and to reduce the risk for severe complications. Dialysis is not as good at that job as the kidneys are.

Patients with kidney failure having the symptoms enumerated above can experience improvement after starting dialysis. This is because the dialysis removes great part of the toxins and gets rid of the excess of water retained in the body. But sad to say, dialysis does not help make the kidneys recover or to work better. It is just a life-sustaining therapy, which aids in symptom control. Dialysis is not a treatment or cure for kidney failure. That is why we call it a type of kidney replacement therapy.

For this reason, we advocate patients to consider kidney transplantation over dialysis if that is a realistic option, because kidney transplantation provides a functional live kidney, which can perform many other functions than the dialysis cannot do; and because a kidney transplant is more efficient to clean the blood and to remove the excess of water, and works 24/7/365 (like the normal kidneys do). In addition, dialysis is also an intermittent therapy (eg only given 3 times a week for a few hours), while a kidney transplant works continuously.

For what I have mentioned, because the kidneys cannot work any longer, dialysis needs to be continued for life or until a kidney transplant is performed.

If your aim is to live as long and as best as possible, also wishing to avoid dialysis, my advice is to consider kidney transplantation (again if this is feasible and realistic).

Dialysis and kidney transplantation are complex matters and deciding on one or the other is also a complex and delicate decision, requiring thorough assessment of patient’s medical history and overall health condition, balancing many of the pros and risks of both dialysis and kidney transplantation. This re requires personalised expert advice. Discuss this further with your current doctor, but I could certainly assess your case and give you my opinion and advice. If you think I can help you to understand this better, you could book an appointment with me to assess your situation thoroughly within this platform using this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa/

Otherwise, I am Dr Francisco, wishing you the best possible health!

Ellen answered 9 months ago
Hi doc. Is contrast dye harmful to patients with multiple kidney cysts (eGFR 90)? My husband needs to take MRI of the prostate with contrast.
Dr Francisco
replied 9 months ago

Hi Ellen,

Thank you for your question.

We typically recommend to avoid MRI contrast (gadolinium) in patients with advanced chronic kidney problems (i.e. glomerular filtration rate, GFR, below 30) or with kidney failure; unless it is really necessary like a life-saving tets or to diagnose a cancer, where there is no other way or other test to use. But this seems not to be the case of your husband because of his normal kidney function (GFR 90).

The main risk we are concerned about is the risk of developing nephrogenic systemic fibrosis; which is a rare disease, but which can bring many problems to patients including thickening and scarring of the skin and many organs inside the body, and can be fatal. I get that is why you might be worried. But according to your husband's GFR, he does not have heightened risk for this condition.

In patients with advanced kidney problems, we explore if we could use other diagnostic modalities to obtain an answer and be able to treat the patients, like a CT or a non-contrast MRI. Again, based on his kidney function level, he likely can use gadolinium without major risks. But if you are still worried after my explanation, talk again to your doctor to see if there is another suitable type of scan that can get him/her similar information. However, keep in mind that not using contrast when it is indicated can lead to diagnostic and treatment errors; which can bring other types of worries and problems.

There are few types of gadolinium-based MRI contrast agents, some with lesser risk for this condition. Typically, MRI labs use the minimum necessary amount and use the gadolinium-based agents associated with less risks.

Other factors increasing the risk for this condition in patients with significant kidney problems are the presence of other diseases like diabetes, hypertension, acute illness and acute kidney injury. Kidney transplant patients and patients with a single kidney might have slightly higher risk, too.

Important to say that when we want to characterise the structure of irregular kidney cysts, to be sure they are not cancerous, gadolinium-based MRI is one of the options. So, we use it in patients with kidney cysts.

I hope no major issues are found in your husband's prostate scan. For more specific advice to his case, he can contact me privately, booking a teleconsultation using this link https://patients.smarterhealth.sg/specialist-doctor/francisco-salcido-ochoa

Otherwise, I am Dr Francisco, wishing you and your husband the best possible health!

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