Graham has a GFR Test
Graham was sitting at the table waiting for his breakfast when he saw the letter. “Is that letter from the hospital Mum?” he asked.
“Yes it is” she replied. “It’s giving us a date for your next test.”
“Oh no” said Graham, “not again.”
“I know” said Mum, “it’s not fair that you have to have so many tests is it? But it’s fair that you don’t feel very well sometimes and the tests are to find out what is the matter so that people at the hospital can help to make you feel better.”
“But they’ve done lots of tests already, why do I need some more?”
“Well you know that the doctor wants to find out if your kidneys are working properly.”
“But that’s what you said last time, so why do I have to go again?” Graham began to sulk.
“Your kidneys are very important Graham” began Mum.
“I know, I know they make our wee” Graham said quickly.
“That’s right” said Mum “and that’s a very important job because they are working all the time...and it isn’t easy you know.”
“Oh?” said Graham beginning to get interested.
“Not easy at all. They have to filter out the things we need in our blood from the things we don’t need and then get rid of those we don’t into our wee. Every day we’re eating and drinking different things and our kidneys still have to sort out the things we need from those we don’t. So you see, not only do the kidneys work very hard, they have to be very clever as well to respond to all the changes.”
“How can kidneys be clever?” Graham asked.
“They’re not clever in the same way as you are clever” said Mum, “but because they do a very difficult job very well, they are very special. Do you know that machines which filter blood as kidneys do are much bigger than you are? Yet your kidneys are just about as big as your fist.”
“This big?” said Graham, holding out his fist and studying it. “That is clever.”
“Mmm” Mum nodded, “although they’re quite small they have to be fairly complicated inside to find out exactly what the problem is and the doctors and nurses have to work out what is wrong bit by bit...a little bit like solving a puzzle.”
“I couldn’t do that jigsaw puzzle that Claire gave me for Christmas could I?”
“Not at first, but then I helped you a little bit and then you were able to do some more and eventually we were able to solve the puzzle together.”
“I wish the doctors could solve this puzzle quicker!” said Graham.
“They’re doing their best” laughed Mum. “Maybe if you help them as you have done before they will solve the puzzle this time. Finish your breakfast now and we’ll talk about it after tea tonight. I’ll tell you what you have to do this time.”
After tea Graham reminded his Mum that she was going to tell him exactly what would happen at the hospital the next day. She fetched the letter and read the instructions out explaining bits that Graham did not understand. The first thing that he did not understand was the name of the test. It was called a Glomerular Filtration Rate test and because it was such a long name they decided to call it by its short name a GFR.
First he would have to go to the ward – that would be alright because he might recognise some of the nurses there and he knew that there was a playroom full of lovely toys. The nurse who was going to look after Graham would explain again everything that was going to happen to him. Then she would put some special numbing cream on his hands or arms and cover with a clear piece of plastic. Graham knew about the numbing cream called Ametop or EMLA – it made your hand feel numb and that meant that it didn’t hurt if you have to have some blood taken or an injection or if he wished, he could have the cold numbing spray which was like having an ice cube rubbed on your skin. The nurse would also weigh him, measure his height, take his pulse and his blood pressure and test a sample of his wee. Then Graham would go off to play in the playroom while the cream was working. Graham thought that it didn’t sound too bad so far, as he had had all these things before and he knew that they didn’t hurt.
When the cream had made his hand numb he would go into the treatment room and the nurse would place two small tubes into his hands or arms. Graham knew that with these tubes in place, he would not have to have any more needles all day. Then the nurse would inject some very special dye into one of the tubes. Mum explained that this was to help the doctors see what was happening in the kidneys during the test.
After the injection Graham would have to rest otherwise the test would not be accurate. There was also a list of things which Graham could not have on the day of the test – tea, coffee, lucozade or coca cola, vanilla ice cream or chocolate or bananas or yogurt and custard.
“After the test can I have a banana split with chocolate sauce and coca cola?” asked Graham.
Mum laughed, “I think you might be sick if you had all of these, but we might manage to have one treat afterwards. Now listen carefully to the rest of the description, there is only a little more and then it will be time to get ready for bed.” Graham groaned, “O.K what happens next?”
Mum explained that three times during the day the nurse would take a blood sample, but as one of the tubes would still be in place this would not hurt at all.After this was finished, Graham and his mother could go home.
“And then we can forget all about it” said Graham.
“Not quite”, said Mum. “The dye which shows up the kidneys during the test is very slightly radioactive and this means we have to be very careful whenever you wee for the next 24 hours - until teatime the following day. If you have an ‘accident’ in your pants, we have to keep those clothes separate from other things for that time as well until they are no longer a problem. We will also have to be careful about washing hands after going to the toilet.”
“Is that all now?” said Graham.
“That’s all now” said Mum. “I’ll go over it again tomorrow, now you should go and get ready for bed.”
The next morning Mum explained everything to Graham again. He felt a bit worried, but lots of cuddles made him feel better and he was looking forward to playing in the playroom.
When they got to the ward the nurse who was going to look after them gave Graham a big smile and showed them the bed he was going to use. She then asked some questions such as what medicine Graham was taking. Then she measured his height and weight and took his blood pressure just as Mum had said she would. She also put some numbing cream, EMLA or Ametop on his hands and arms and covered it with a thin sheet of plastic which looked like cling film. The nurse explained that the numbing cream would take about an hour to work and then it would make the areas feel numb and it would not hurt when the doctor put a small needle in. While the numbing cream was beginning to work, Graham could go off to the playroom and enjoy himself.
Eventually it was time to go to the treatment room with the nurse. Graham began to feel worried but she was very nice and explained exactly what she was going to do. She was going to put in two cannulas, one for the dye and one for taking blood. This meant two tiny needles in his hand, but Graham would hardly feel these at all because of the cream. The nurse suggested that Graham could count elephants while she was putting in the cannulas to see how long she took. Mum counted with him. “One elephant, two elephants, three elephants...” Before Graham had counted to thirty elephants the nurse said “They’re finished!”
Graham looked at his hand and saw the two little tubes of the cannulas taped into place. The nurse told Graham that she was going to put the special dye into one of the cannulas and then that cannula could come out.
Graham counted some more elephants and it was all over very quickly. The nurse and the doctor told him he had been very good and they gave him a bravery badge to wear.
He would have to wait on the ward for two hours until it was time to have his first blood test. He would need to rest while waiting. The ward had lots of films which Graham had not seen and in this way time passed quickly. When the nurse came to do the blood test, Graham was surprised by how quick and easy it was, and of course it did not hurt because of the cannula. The nurse said that another sample would be done in an hour.
“Good,” thought Graham, “time for another video.”
After another blood sample had been taken Graham was pleased to hear only one more to go!
Graham was told that he could go home as soon as he had had the final blood test taken. Soon they saw the nurse who took the sample and removed the cannula. The nurse told Graham again that he had been brave during the whole day, Graham felt rather proud of himself and he was delighted when the nurse gave him a Certificate to prove it.
“Can I take it in to school to show the whole class?” he asked.
“If you want to” replied his mother. “Now let’s go home. I bought some ice cream and bananas yesterday – I thought you might like a banana split.”
“What about the chocolate sauce since I’ve been very good?” said Graham. “We’ll see” laughed his mother.
Content compiled by members of the Children’s Renal & Urology Unit, QMC Campus, Nottingham University Hospitals.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.