My kingdom for a kidney

Last updated at 8:53 AM on 17/02/08

My kingdom for a kidney

Peter Jackson
The Telegram

This past Christmas, I bought my wife a matching necklace and earrings. Not too extravagant, not too cheap. The chain was white gold and the stones were blue topaz, her birthstone.

It was a thoughtful little gift. She seemed to like it.

Fact is, though, I could have given her the moon and still not measured up to what she'll be giving me in a couple of weeks: a kidney.

Ours is a journey that began eight years ago when I was hit by chronic problems with the lining of my nasal passages. Despite several visits to a specialist, the condition got worse and I finally had to undergo surgery to replace a collapsed septum.

But I still had no firm diagnosis until a few months later, when I developed severe flu-like symptoms that wouldn't go away. Upon being admitted to hospital, I was finally tagged with a rare autoimmune condition called Wegener's granulomatosis.

The diagnosis came too late, however, to prevent damage to my kidneys. My renal function has been slowly going downhill ever since.

Last year, I underwent a battery of tests in preparation for a transplant. At first, my sister was matched with me. But after several months of anticipation, she was rejected as a donor at the 11th hour.

Now, my wife Sheila has graciously agreed to step up to the plate and lend me one of her kidneys, knowing full well she probably won't get it back.

The tests - well, that's another matter. Apart from a pap smear and a full DNA profile, I've undergone just about every other test you can imagine.

They've taken samples of my urine, and sucked out enough blood to fill a small bathtub. They've X-rayed and ultrasounded my innards, and measured my bone density. They've hooked me up to EKG machines and pricked my arm to test for TB.

None of the tests was particularly uncomfortable, and the technicians were all quite pleasant. But after so many rounds of being poked and prodded, you can't help feeling like a piece of livestock.

Now, the tests have wrapped up and the ball is in the court of the Halifax surgeon.

Before all this doggy-do hit the fan, I had no real awareness of what kidneys did. For all I knew, they were just a couple of innocuous organs that took up space. Turns out they're kind of important. Who knew?

Renal regulation

In a nutshell, kidneys are filters. Blood runs through them and impurities and excess fluid seep out into the ureter. From there, the waste fluid goes to the bladder, where it is held until you "make water" (as nurses are euphemistically fond of saying).

Kidneys keep various electrolytes (dissolved stuff) in balance. If you have too much salt or potassium in your blood, for example, the concentration will be adjusted.

Kidneys also produce important hormones.

As a rule, people are born with two kidneys, but one good kidney is more than sufficient to do the job - hence, the potential for living donors.

Damaged kidneys can repair themselves - to a point. If the damage is not permanent, the kidneys can recover; even acute kidney failure can reverse itself. But there is a tipping point after which damaged kidneys will slowly continue to deteriorate. This is chronic kidney failure, or progressive renal insufficiency (PRI). It may take months or years, but PRI will eventually lead to end-stage failure, where the kidneys quickly begin to pack up completely. If nothing is done at this point, you die.

The only treatment for severe kidney failure - apart from transplant - is dialysis. This usually entails getting hooked up to a big machine for a few hours, three or four times a week. There is another kind of treatment - peritoneal dialysis - in which the patient regularly injects a bag of fluid into the abdominal cavity. The membrane around this cavity acts as a substitute filter for the blood. This latter process frees the patient from having to go to a clinic, but it's a cumbersome procedure that has to be done several times throughout the day.

I have managed to avoid dialysis so far. In the past, a patient would usually be on dialysis before any consideration would be given to a transplant. But more recent research suggests a transplant conducted in advance of dialysis has a better chance of success.

Discussing dilemma

Now, some people revel in the particulars of bunions, cysts and ingrown toenails, while others prefer to keep medical matters to themselves.

I've always been somewhere in between. I don't mind people knowing about my health concerns -heck, I'll even discuss them if prompted - but I generally don't set out to regale people with all the gory details.

So, with a transplant operation looming in my immediate future, I've been caught in a dilemma. Do I blather on about the pending organ swap, or do I just ignore it? After some consideration, it occurred to me that many people - for whatever reason - might be just a little curious about what's involved in a kidney transplant. And if talking about my experience offers any extra incentive for people to consider organ donation, well, that's a good thing, isn't it?

Since I will be out of commission for at least a couple of months, I've decided I may as well chronicle the adventure.

In my next column, on the eve of surgery, I'll discuss what it's been like living with substandard kidneys.

Stay tuned.

Peter Jackson is The Telegram's editorial page editor. He can be contacted at

pjackson@thetelegram.com

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