Q: I am a 20 years old male suffering from kidney failure since the last 2 years. My renal biopsy was done which detected crescentic glomerulonephritis. Presently, my serum creatinine is about 6 and my blood urea is about 250. I went for temporary dialysis 2 years back. Since then I haven't had any dialysis and continuing with dietary restrictions. Presently I feel a continuous burning and irritation in my feet, which are most of the time swollen. Sometimes, I feel as if some hot-cold fluid is flowing inside my legs. I also suffer from severe cramps in my legs. I do not perspire at all. And my body temperature rises extremely high when I go outside in the sun. Are all these problems related to my kidney problem or do they indicate some other disease? How can I get rid of these problems?

A:You have advanced kidney failure as a result of crescentic glomerulonephritis (GN) with kidney functioning less than 10%. It is not known what was the cause of your crescentic glomerulonephritis and how was it treated. Some forms of crescentic glomerulonephritis may carry a favourable prognosis such as haemolytic uremic syndrome, paucimmune GN and Good Pastures syndrome if they are treated early in the course of disease. However, the symptoms described herein seem to suggest uraemic neuropathy and uraemic syndrome due to toxins accumulating in your system since your kidneys are unable to clear them. It is very likely that you need and will benefit significantly from dialysis therapy. There is no reason to postpone this since longer you wait your symptoms are likely to get worse. There are two forms of dialysis therapy: haemodialysis (HD) and peritoneal dialysis (PD). You need to consult your kidney specialist regarding details. Finally, the option of kidney transplant remains the best option. But it must be emphasized that it is important to identify the cause of crescentic glomerulonephritis since certain diseases are known to recur following transplantation and may require increased surveillance to prevent loss of transplanted kidney due to recurrence.