Q: I am a physically challenged man having abnormal growth from waist down and on a wheel chair. I have a neurogenic bladder and due to my abnormalities there was a reflux and the urine was being sent back to the kidneys. Because of which both my kidneys are damaged. This was diagnosed about 3 years ago and the situation has now worsened. The left kidney is not functioning at all and the right side is functioning around 30-40%. My serum creatinine measured about a week back is 3.8. My doctor also had the nuclear scanning done and the results was 24 ml/min clearance. He also suggested that I may have to undergo Dialysis 6 months down the line and a transplant at a later stage. Currently I am doing CISC every 4-5 hours to empty my bladder. What care I should take now and would transplant really benefit me? Also please let me know the various types of Dialysis available and approximate cost of each?

A:You should continue to do Clean Intermittent Self-Catheterisation (CISC) every 3-4 hours to empty the bladder and if you have high blood pressure it should be controlled meticulously. You should get 24 hrs urine protein estimated. Yes, you may require dialysis or transplantation once the kidney function deteriorates to less than 10%. Unfortunately at present there are no means to totally stop further deterioration of renal function we can at best slow it down. Once kidney function deteriorates to less than 10% (End Stage Kidney Failure) then the only means of leading a normal life is by dialysis or kidney transplant. Dialysis is either haemodialysis (3 times a week for 4 hrs) or peritoneal dialysis (CAPD). Approximate cost/month of dialysis is about Rs. 20-25000/-. Transplant is the best and most cost effective treatment provided there is a family donor. However your bladder needs detailed assessment by a qualified urologist before undertaking a kidney transplant. CISC will most likely have to be continued after transplant also.