There has been a lot of talk recently about "remission" of chronic renal failure. A decrease in the loss of protein in the urine, in the absence of kidney failure, or when the kidney disease is acute, certainly does occur. But a small scarred kidney is not going to grow back into a normal one, no matter what. There is no such thing as remission of chronic renal failure.
However, arresting the progression of the disease is a real possibility, as shown by a number of publications and by several detailed accounts of patients given in Chapter 22. If kidney failure can be arrested permanently before it gets severe enough to cause symptoms, the only problem for the patient is the drugs and/or diet that must be followed for this situation to continue. This is not remission, but arrested progression.
I did have one case of real remission (page 160), in which kidney function rose to normal. This must mean that the low kidney function seen at the patient's first visit was caused not by chronic renal failure but by profound changes in kidney blood flow. The patient probably never had a loss of functioning units in the kidney. The nephrotic syndrome (see Chapter 18) caused these changes in renal blood flow; the syndrome receded as kidney function rose back to normal and urine protein loss stopped. But this is very unusual. Most patients with chronic renal failure do not have the nephrotic syndrome, and few patients with the nephrotic syndrome and low glomerular filtration rate ever recover normal function.
This book makes a case for a pre-end-stage renal disease program. The government has mounted an education program but has not seriously considered supporting predialysis care by payments to physicians (other than through existing Medicare and Medicaid programs). Keeping someone off dialysis should be rewarded at least as much as keeping someone on dialysis, but the government, having already incurred costs far exceeding earlier projections for the ESRD program, is not about to initiate yet another program. However, a recently enacted amendment to the Medicare legislation (Section 105, HR 5543) authorizes reimbursement for care by a nutritionist prior to the initiation of dialysis.
Perhaps someday the wisdom of government support for predialysis care by physicians will become apparent. This would not only reduce the cost of treatment of chronic kidney disease by both programs combined, but would also lead to an increased rate of rehabilitation of patients with kidney disease. The government also could play an important part in facilitating nondirected kidney donation for transplantation (see Chapter 20), reducing the number of patients on dialysis. These combined initiatives could, at least in theory, reduce the number of patients on dialysis to a handful.
In the next chapter, we'll scrutinize the kind of treatment you may be getting from your health care team and see whether you are receiving the best care possible.
Was this article helpful?