When the Kidney fails

How do you treat end-stage renal failure? Patients with ESRF can be treated by dialysis or kidney transplantation. Dialysis is of two varieties hemodialysis or blood dialysis and CAPD or water dialysis. Kidney transplantation is the best treatment that can be offered to a patient with ESRF.

What is kidney transplantation? Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with ESRF. The main types of kidney transplant are living donor transplant and cadaveric. In the former, the kidney originates from a deceased (brain-stem-death) person.

In the latter, the kidney is being donated by an organ donor. It is possible to transplant a kidney from a living donor because the body can work just as well with one kidney as with two.

What are the tests done to evaluate a kidney transplant recipient? A transplant evaluation includes many tests to make sure that the recipient is healthy enough to have a transplant. To make sure that the new kidney will be a good match, tests will be done to find out the blood and tissue type. Other tests include a check-up for any active infections, blood clotting profile, a chest x-ray, an ECG and cardiac evaluation, and abdominal ultrasound. Women must be cleared by a gynecologist. Other tests may be required depending on the age and medical history of the patient.

Can patients with kidney failure (ESRF) due to diabetes undergo transplantation? Patients with diabetic kidney failure form the majority of patients in a dialysis unit these days. Some diabetics tend to have concurrent heart problems or blood vessel (vascular insufficiency) blockages, and this has to be attended to before they are cleared for transplantation.

What kind of testing does a living donor go through? A person who wants to be a living donor will go through a set of tests, which will increase the chances of a successful match. They will also make sure that the donor will not be placed at risk. The tests include blood tests, urine tests, chest x-ray, ultrasound scan of the abdomen and ECG. Like the recipient, the donor is also tested for any active infections. Also, a CT/MR scan or arteriogram (an examination of the blood vessels) of the kidney is done.

Potential donors will be examined by a surgeon and a nephrologist.

Anyone with kidney disease, diabetes or high blood pressure would not be considered.

Does the transplant recipient have to take special medications after the transplant? Yes, the patient will have to take immunosuppressive medications such as prednisolone, cyclosporine or tacrolimus, and mycofenolate, but with significant reductions in dosages with time.

What is the most common cause of chronic kidney failure?

Diabetic nephropathy is fast becoming the leading cause of chronic renal failure. It is also one of the most significant long-term complications in terms of morbidity for the individual patients with diabetes.

Diabetes is responsible for more than 50 per cent of all end-stage renal disease cases in India.

Although both type 1 diabetes mellitus (insulin-dependent diabetes mellitus (IDDM) and type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus (NIDDM) lead to ESRD, the great majority of patients are those with NIDDM.

Are there any guidelines for patients at risk for kidney disease? Patients with diabetes mellitus and hypertension (high blood pressure) are at risk for developing kidney disease. Patients with glomerulonephritis (kidney inflammation) and recurrent urinary infections/ obstruction are also at risk of developing kidney failure. Such patients are advised to undergo regular follow-up with a nephrologist.

Regular checks on urine-protein levels (proteinuria) and kidney function (urea and creatinine levels) are mandatory. Aggressive blood pressure control (aim for BP 20/80 mm Hg) and the use of newer medicines (ACEI and ARB) hold the key to the management of such patients with a view to prevent progression of kidney disease.

Source:www.newindpress.com