The best option for a patient with end-stage renal disease (ESRD) is to get kidney transplantation done.
- 7.1 What is meant by kidney transplantation?
A healthy kidney from a healthy person is placed by an operation into the abdomen of the patient of ESRD; the blood circulation and urinary drainage systems are connected to the body's natural parts; this new kidney functions with the help of medicines called immuno-suppressant's which do not allow the body's in built immune system to reject the new kidney.
- 7:2 what are the essential requirements of kidney transplantation?
- Blood group of the donor (person giving the kidney) and the recipient (person receiving the kidney) should be the same; Rh factor may or may not be the same; the donor can also have 'o' group (universal donor); AB group patient is universal recipient
- 'Issue type' called HLA system should also match; though it is not essential for blood related donor.
- 7:3 Who are the possible donors? What is the expected cost of medicines used and operation?
- Living related donor real brother, sister, father, mother, son or daughter (age - 20 to 60 years) the spouse (husband or wife) Cost of transplantation 2.5 to 3.0 (in private), one lac in public hospitals.
- Living un- related donor The law allows a donor from this group only if financial gain of any nature has been thoroughly scrutinized and completely ruled out. Because of the possibility of commercialization in the category, it should be discouraged.
- Cadaver (dead body) donor Accident or stroke case-brain-dead- beating heart, with BP maintained on drugs liver, heart, and pancreas can also be utilised, prior consent must have been obtained. Only few centres in India are presently undertaking cadaver transplantation, there are associated social and legal problems; the law needs certain amendments.
- 7:4 Is the donor thoroughly screened for any hidden illness?
Diabetes, high blood pressure other serious system illness involving the kidney liver and heart; renal artery angiography to establish the patency and variation of the renal arteries; selected donor would have already had the HLA typing done.
- 7:5 What screening of the recipient is essential before transplant operation?
- Detailed cardiac assessment to determine suitability for the major transplant surgery
- Corss match is the final check; In case, cross match is positive recipient's body will soon reject the donor kidney as such, this is unsuitable.
- 7:6 What are essential steps of transplant operation and follow up?
- Dialysis so that blood urea and creatinc are brought down significantly.
- Operation is in twin theatre - one for removing the donor kidney and the other for recipient's surgery.
- Usually the donor's left kidney is removed and is placed in the right side lower abdomen of the recipient; generally the recipient's own kidney are not removed operation takes 2-3 hours.
- Patient needs to stay in specially created isolation ward with ICU arrangements to provide complete care and also for close monitoring the patient is usually shifted to single room in 2-3 days.
- Transplanted kidney is expected to produce adequate urine in the first 24 hours most of the retained urea, occasional by creatinine and other substances are removed; adequate fluid replacement will be required. In a patient, transplanted kidneys responds slowly and may need few dialysis in the initial post operation period. Daily kidney function check is required in first week after operation.
- Regular follow up and blood tests are essential, more frequent in first 3 months; less frequent subsequently/life long.
- 7:7 Is there any risk to the kidney donor?
Healthy donor dose not develop any problem after a follow up of over 20 years; BP is marginally higher in Rarely, single kidney in the donor may develop hyper filtration leading to protein leakage and changes in the kidney;
- 7:8 Which complications are common after kidney transplantation?
Technical-ureteic obstruction, leak; medical; graft rejection, occurrence of opportunistic infections, toxic effects of antirjection drugs, risk of cancer rarely.
- 7:9 What are the average expected results of transplantation?
One year graft survival in over 90 percent (10 percent less in diabetic); 3 years survival is 80 percent and 5 year is about 70 percent. cadaver transplant 10-20% less than . living donor transplantation.
- 7:10 Can kidney transplantation be done again in the same person?
Yes, one of my patients had four (4) kidney transplants, fourth is functioning after seven years; total of nine (9) transplants in one person have been recorded in the world literature.
PREVENTION OF KIDNEY DISEASE
- 8:1 How can we prevent kidney disease?
Rapid escalation of the cost of medical care specially in patients of advanced kidney failure, has made it mandatory for the patient and health professional to promote preventive measures in early stages.
- Nephritis proper attention to the public health measures e.g. environmental sanitation, personal hygiene and prompt treatment of throat infection.
- Early recognition of urethral value, meatal narrowing, congential/ defect causing backflow of urine - ' reflux'. Timely treatment of bladder reck obstruction by prostate enlargement in elderly males; repeated kidney for infection high fluid intake is useful.
- Control of diabetes fasting less than 100 mg' and post meal less than 130mg' BP less than 130/80 m and early use of protective drugs ACE inhibitor, usually postpone kidney failure.
- Indiscriminate use of antibiotics, pain killers, indigenous medicines herbal preparations, must be avoided.
- Awareness about certain food items promoting stone formation such as increased intake of milk products (calcium-rich) spinach, tomatoes strawberry, chocolate (oxalate rich), red meat, (uric acid), soda bicarb 2 to4 gm day is useful antibiotics for infective stones.
- Prevention of Kidney failure:
prompt attention to hygenic conditions leading to diarrhoea, dysetery, cholera, other infections resulting in shock anti--mosquito measures; all these will help curtail the development of acute kidney failure.
In patients of 'chronic kidney failure' prompts correction of some of the reversiable factors like dehydration, infection, exposure to drugs and toxins, may be beneficial for retarding progression; In selected situation, ACE-inhibitor drug, antipleteleh drugs, cholesterol lowering medicines are beneficial; early reorganization in vital.
