FAQ\\\’s

Dr Voss sees people referred for specialist nephrologist or specialist renal physician opinion. Usually such people are referred by their general practitioner or immigration consultant or assessor. It is imperative you bring with you to an immigration assessment appointment with Dr Voss copies of any letters you have from Immigration New Zealand. In order for Dr Voss to write a relevant immigration medical report (written by Dr Voss to the medical assessor of Immigration New Zealand) to answer the question(s) the medical assessor asks you must bring – if you have one – the letter you have from Immigration New Zealand. Sometimes your Immigration Consultant or lawyer has this, and you should contact this person and get a copy of the letter(s) before your appointment.

Your Immigration New Zealand application number and client number are important – please also bring these with you to your first appointment. Please also bring with you:

• A list of your medications including any herbal or nutritional supplements.
• Preferably bring your medications with you.
• Copies of any other medical records you may have from your home country.
• Any relevant x-rays, MRI and CT scans and ultrasounds, particularly anything including the abdomen or kidneys.

Your medical file is both electronic and paper. Since December 2010 all new medical files are electronic only. Your medical record is filed in a password protected computer at the office. The office is remote to the clinics. A backup electronic record is also held. Any current relevant paper records are scanned, and the originals shredded and destroyed after scanning.

Any archived paper records (pre-December 2010) are stored securely until the file has been inactive for seven (7) years.

In 2018, all pre-existing paper records held will be securely destroyed. Dr Voss anticipates no paper records at all on any patient will be retained after 31 March 2018.

Your medical records are the property of Dr Voss but the information is yours and you are entitled to a copy at request. Dr Voss will accept an email from your last known email address as consent to provide your medical records to that email address. Your medical records can only be provided to a third party (not you or Dr Voss) with your signed consent in writing received by Dr Voss directly. Your medical records may be released to a third party if the person requesting is a registered medical practitioner and if Dr Voss believes that the information requested by that medical practitioner is to the benefit of your healthcare. Often this occurs in response to a request by you to the medical practitioner to contact Dr Voss but does not usually require your formal consent.

Clinical information about you may also be released to another health professional, e.g. dietitian or nurse when there is a need to enhance your best care.

Following each clinic consultation and sometimes following telephone or email communications a letter is written to the referring doctor or other appropriate medical professional (e.g. dietitian) and your medical information will be shared with these people where considered appropriate and to your health benefit. This may include referring you to other specialists, including – but not limited to – surgeons, radiologists (“x-ray” doctors) and laboratory specialists.

You will routinely receive your own copy of these communications. Your copy of the consultation letter and/or letter to the referring doctor (usually your general practitioner) – and if appropriate immigration medical report – is forwarded to you by post or electronically by email – if you provided Dr Voss with your email address. Many people have more than one email address. As your medical information is personal and confidential to you, consider carefully what email address you provide for your medical information to be sent to.

You do not need a referral letter but information contained in your medical records over previous years (usually held by your GP) does assist in Dr Voss’ assessment.

• You can request your General Practitioner to refer
• You can ring directly the appointment line 0508 KIDNEY (0508 543 639) from within in New Zealand; or +649 277 1540.

There are very few symptoms of kidney disease until the kidneys are severely affected. Usually kidney disease is picked up early, by early monitoring or screening blood (serum creatinine particularly) and urine tests (to detect blood and protein).

Symptoms may include:

• Nocturia (getting up at night to pass urine)
• Tiredness / lethargy
• Loss of appetite
• Increased or decreased urine volume
• Pain in the loin and groin (especially kidney stones)
• Discomfort over the bladder / lower abdomen area
• Discomfort from passing urine (often urinary infections are not associated with kidney disease)
• High blood pressure.

• Presence of hypertension (high blood pressure)
• Having diabetes mellitus
• Being over the age of 50 years
• Being overweight
• Being a smoker
• Family history of kidney disease (reflux nephropathy and polycystic kidney disease in particular)
• Having small birth weight
• Having lupus (Systemic Lupus Erythematosis)
• Having gout
• Urinary tract infections as a child
• Kidney stones
• Bladder stones
• Regular use of anti-inflammatory and pain relief – especially non steroidal anti-inflammatory medications (NSAID), some herbal and Chinese medicine medications.

Located at the back of the abdomen behind the gut organs, next to the spleen (on the left hand side) and the liver (on the right hand side), either side of the spine protected by the lower ribs.

The most important fluid to drink is water. There is, in most cases, no difference between tap water, filtered water or bottled water. It is important to drink a volume of fluid that is healthy.

In some cases, particularly in established moderate to severe kidney disease, there is a need to limit fluid intake.

Most other people who don’t have such severe kidney failure, the amount of fluid that should be drunk is that which is required to pass 1½ to 2 litres of urine volume per day.

I do not recommend 8 glasses (each glass 200mls) of fluid to be drunk per day which is often quoted. In the winter when the fluid body loss may not be so great this 8 glasses may be adequate. A similar volume may be adequate in office workers or people who work in a sedentary or similar non-physically demanding job or at home/indoors all year round. People who may have a heavy labouring job, working outside in the heat/sun, or people who are very physically active (e.g. running, sports or regularly attending a gymnasium or fitness centre); or in the summer will lose more fluid from sweat. A higher fluid intake (and certainly more than 8 glasses of water per day) is required to keep the urine output up in such people. Again primarily the fluid replacement should be water.

I encourage people with urinary tract disease (especially stones or infections) to at least once measure their urine volume over a 24 hour period as an indication of how much to drink rather than measure how much they drink per day. The urine output should be a minimum of 1.5litres per 24 hour period. Maintaining the urine output at least 1½ to 2 litres per day is very important in people who are recurrent kidney stone or urinary tract infection sufferers.

Rarely some people do drink excessive amounts of fluid. If this leads to a high urine output (some people may consume as much as 10 litres per day of fluid) the kidneys may not be able to cope and the kidneys maybe temporarily damaged by a ‘washing out’ of the compounds that the kidney needs to concentrate urine. This causes a condition called hyponatraemia – low blood sodium – which can cause tiredness and other more serious symptoms.

People who have had a kidney transplant need to keep their fluid intake up. Sometimes this can be difficult after they have been on dialysis for a long time when fluid intake is usually restricted.

Alcohol per se doesn’t usually hurt the kidneys. Heavy alcohol intake can damage the liver and serious liver disease can have an effect on the kidneys. Excessive alcohol can exacerbate high blood pressure (hypertension) and hypertension can damage the kidneys. Most alcohol drinks have a percentage of alcohol (ethanol) greater than 3% and at this level the ethanol has a dehydrating effect (where the fluid loss is greater than the fluid volume taken in). In such situations you can get fluid depleted exacerbating the risk of urinary infections or kidney stones..or worse headaches/hangovers.

Smoking may well harm your health more than just your kidneys. From the kidney perspective tar compounds that are in the inhaled smoke, clog up the blood vessels. The blood vessels that supply the kidneys are very fine and only a small amount of deposit in their walls can lead to a significant reduction of blood flow and therefore loss of kidney function.

Avoid smoking.

Some infections with bacteria in the urinary tract are reduced because the cranberry juice and D-mannose prevent the bacteria adhering to the cells lining the urinary tract. This reduces the bacteria’s ability to “stick around” long enough to cause an infection. Coupled with drinking a large volume of fluid and therefore passing urine frequently flushing the bacteria out from the urinary tract, cranberry juice can reduce infections.

It is important to ensure that bladder is completely emptied to assist such urinary tract infection avoidance.

How does exercise help my kidneys?

“A health heart can mean healthy kidneys”. Having regular exercise and keeping healthy:

• Will help control blood pressure
• If you have diabetes mellitus, will help maintain blood sugar control; and good blood sugar control helps reduce kidney damage from diabetes mellitus
• Helps maintain ideal body weight; not being overweight helps maintain blood pressure and reduce high blood pressure (hypertension)
• Helps reduce heart disease

Prescriptions Medications

Many prescription medications are excreted by the kidney, or their breakdown products are excreted (removed from the body) by the kidney. They can potentially harm the kidney especially if they are concentrated in the kidney. Increasing urine volume by having a high fluid intake can help prevent kidney disease from drugs.

Sometimes prescription medication dosing needs to be adjusted in people who have kidney disease or the elderly.

Common prescription medications that may affect the kidney include:

• Lithium
• NSAIDs (non steroidal anti-inflammatory drugs)
• Some pain relief medication (particularly NSAIDs) Cox II inhibitors (arthritis or anti-inflammatory medications)
• Proton pump inhibitors – e.g. omeprazole, pantoprazole, lansoprazole.
• Some cholesterol lowering agents e.g. fibrates. The statins family of lipid-lowering drugs e.g. simvastatin and atorvastatin are generally “safe” to use in kidney disease.

OTC/non prescription medications.

Medications that can be purchased over the counter (OTC) at health food shops, chemists and supermarkets sometimes have combinations of active ingredients. Most of these are quite safe to use but some may have kidney damaging components, particularly in people who have established kidney disease. Before starting these medications it is worth checking with the person who sells them in the shop, or getting further information from a health professional. Sadly many of the medications are only harmful after a long time of exposure and the damage is then irreversible. This is an important point because often the kidney damage has no symptoms early in the process.

• If you know you have kidney disease it is wise to check with the person supplying the medication if it is safe to use.
• Some agents are marketed as being “safe” or as treatment for kidney disease and yet are harmful.
• Some medications that are marketed are toxic.