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  Chat Transcript
Open Q&A and Kidney Health - Elva Parker, C.D.E, and Carlos Marroquin, M.D. (Surgical Director of the Kidney Transplant Program, University of Rochester Medical Center) - March 12, 2013

 Elva@Unity:
 Welcome to our special guest, Dr. Carlos Marroquin, Surgical Director of Kidney Transplant program at the University of Rochester!
 juanitajolley:
 Hello Dr. Marroquin and welcome. Is there a correlation between one's A1c and kidney disfunction?
Dr. Marroquin:  
There is a correlation in that normoglycemia is protecive of nephropathy. In fact, a comparison of diabetic patients who received a pancreas transplant to diabetic patients who did not, mesangial injury to the kidney was seen to reverse.
  juanitajolley:
Can kidney disease be reversed without a transplant? 
sassy35: 
 Dr. Marroquin - I'm wondering how common kidney problems are for diabetics?
 Elva@Unity:
 Dr. Marroquin: Is it possible to get a kidney and pancreas transplant at the same time?
 Dr. Marroquin:  
There was something called The Diabetes Control and Complications Trial (I may have that a little off), but nevertheless they conducted a very nice study that demonstrated that intensive insulin therapy effectively delays the onset and slows the progression of many diabetic sequelae including npehropathy.
Dr. Marroquin:   
Since that study, medical management has continued to improve and management of associated diseases like hypertension has been shown to ameliortae the progression of nephropathy. So, I do think that in very compliant patients, a transplant can be avoided and in fact, should be avoided. One avoids the surgical risks and the associated risks of immunosuppression.
 Elva@Unity:
 Dr. Marroquin; Could you please explain what the GFR is and what is a "good number" to have?
 Dr. Marroquin:  
Please forgive me because I type slowly...yes, one can receive a kidney and a pancreas transplant at the same time. This is referred to as an SPK. In fact, my bias is that patients should receive the SPK preferentially. The outcomes and survival are far better for an SPK for both the kidney and pancreatic allograft than they are for the pancreas alone, or pancreas after kidney transplant and the patients survivals are also better.
Mets1986: 
 Very interesting.
 Dr. Marroquin:
The GFR is the real value we look at to determine the degree of renal injury/disease. Most people are told your creatinine is increasing, but that is actually a poor surrogate of what is really happening. Kidney disease is classified by disease stage and each stage is defined by GFR. There are very accurate ways to figure one's GFR which involve nuclear medicine studies, but we can "guestimate" with reasonable accuracy with formulas.
Dr. Marroquin:  
 These formulas take into account the person's serum creatinine, age, gender, race and body size.
 Elva@Unity:
 It is always important with diabetes management to keep A1c, blood pressure and lipid levels within good control to protect the kidneys, as well as all the organs that can be affected by diabetes.
 Dr. Marroquin:  
Once calculated, we get a sense of the degree of renal disease. It is really important to know that we all age and our kidneys age with us. So, all of us have some degree of renal injury by the time we are in our mid 60s.
 Elva@Unity:
 How does one know if a family member or friend is a good match to donate a kidney, Dr. Marroquin?
lucyblue:  
 Do you recommend people with diabetes and kidney disease follow a special diet?
 Dr. Marroquin:  
The stages breakdown from stage I to V, with decreasing GFR being the hallmark of each stage. To sum up that question, most everyone avoids dialysis if the GFR is greater than 20, but other factors can affect the need for dialysis, diet being one of them. Sorry that was so long winded.
 Elva@Unity:
 No problem, Dr. Marroquin! Thank you for your answer.
 Dr. Marroquin:  
First, all potential donors are screened out for renal disease and other disease states that are known to predispose to renal disease such as hypertension, diabetes, etc. Once an initial screen has been performed, then a more indepth evaluation is performed to insure they are safe donors. In some cases, the process uncovers other issues or diseases that may not have been know. The process is fairly extensive and the objective is to insure the safety of all potential donors.
 Jane@Unity:
 What are other kidney tests to check the health of the kidneys?
 Dr. Marroquin:  
 People with diabetes and kidney disease should definitely follow a very careful diet. Proper dietary measures can help ameliorate other problems and in some cases prolong the need for dialysis and other insults to the cardiovascular system along with exercise and smoking cessation.
 Elva@Unity:
 Healthy diet, exercise,  not smoking: all very important lifestyle changes that can be made to protect our kidneys.
 Dr. Marroquin:
The main test is the GFR which is a composite of the factors I indicated earlier. That along with a urinalysis looking for protein in the urine are enough to demonstrate the presence of disease. Once one is found to have some decrease in their GFR, the important thing is to be followed by a nephrologist who will tract the disease trajectory and hopefully guide you to a healthier lifestyle that may prolong and ameliorate the progression of disease by controlling hypertension and diabetes better.
 Elva@Unity:
 That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Be sure to join us for our next chat Tuesday, March 26 at 8 p.m. with Dr. Bingham. He will be holding an open Q&A session and talking about the importance of Diabetes Alert Day.
 juanitajolley:
 Dear Dr. Marroquin, thank you so much for the time you've given us this evening. It really helps to be informed. Having an expert available and willing to address questions means a lot.
  Elva@Unity:
 Thanks so much for your time and expertise, Dr. Marroquin!
lucyblue: 
 Dr. Marroquin, I so appreciate your sharing your expertise – I learned a lot! Thank you!
 Dr. Marroquin:
 Please feel free to contact me at work anytime. It has been my pleasure.
 
 
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