Kidney Transplant

Kidney Transplant

Overview: Kidneys are very delicate organs of our body. In the case of complete kidney failure, our kidneys are unable to excrete the toxic trash into the urine. 

What are its types?

The five types of kidney failure include:

• Acute prerenal kidney failure: Insufficient blood flow results in this. This type of kidney failure can usually be cured, by finding out the reason for the blockage of the blood supply into the body.
• Acute intrinsic kidney failure: The kidneys can be damaged for several reasons in these cases such as physical impact or an accident. Other causes include ischemia, I.e lack of oxygen to the kidneys.
• Chronic prerenal kidney failure: When there is a lack of blood for a longer period the kidneys begin to shrink and lose the ability to function.
• Chronic intrinsic kidney failure: In this, a long-term injury to the kidneys is caused due to intrinsic kidney disease. Intrinsic kidney disease develops from severe bleeding or a lack of oxygen.
• Chronic post-renal kidney failure: Long-term blockage of the urinary tract prevents urination, this results in kidney damage.

What are its symptoms?

Early-stage, often doesn’t result in apparent symptoms. But as the kidney disease starts developing more, there are possible symptoms that may include: 

• Less amount of urination
• Swelling of your legs, ankles, and feet
• Shortness of breath
• Excessive drowsiness
• Nausea
• Confusion
• Pain or pressure in your chest
• Seizures
• Coma

What are the early signs of kidney failure?

• decreased urine 
• swelling in limbs resulted in fluid retention
• shortness of breath

What does urine color indicate?

The color of your urine plays a major role in the indication of your body functioning properly. Urine color fluctuations may be an indication of some issues. Urine color can raise flags for potential problems such as the following: 

• Clear or pale yellow:  The color of urine indicates you’re well hydrated. This is the ideal color.
• Dark yellow or amber:  This may be the indication of dehydration. Drinking more water and cutting down on dark sodas, tea, or coffee is the solution.
• Orange: This could be an indication of dehydration, or it might be bile in your bloodstream. This isn’t caused by kidney disease.
• Pink or red: Urine with a pink tint or a bit of red is the indication of blood in your urine or could also be caused by certain foods, like beets or strawberries.
• Foamy: Urine with an abundance of bubbles is an indication of a lot of protein in it. Protein in urine is an indication of kidney disease. 

What are the causes of kidney failure?

People who are most at risk have one or more of the following: 

• heart attack
• heart disease
• liver failure
• dehydration
• severe burns
• allergic reactions
• severe infection, such as sepsis.
• kidney stones
• enlarged prostate
• blood clots in the urinary tract 
• injury to the nerves that regulate your bladder. 
• infection
• heavy metal poisoning
• drugs and alcohol
• Inflammation of the blood vessels
• lupus, a disease that is autoimmune that can cause a breakout of many body organs
• glomerulonephritis, an inflammation in the tiny blood vessels of the kidneys
• hemolytic uremic syndrome, which includes the breakdown of RBCs that follows a bacterial infection, usually that of the intestines.
• numerous myeloma, cancer of the plasma cells in a  bone marrow
• scleroderma, an autoimmune circumstance that influences your skin conditions 
• thrombotic thrombocytopenic purpura, an infection causing blood lumps in minor vessels
• chemotherapy drugs that are used in dealing with cancer and some autoimmune ailments
• Some pigments used in some imaging tests
• antibiotics
• diabetes 

What is the treatment?

The treatment you need will depend on the situation of your kidney failure as well as the stage in which it is.

• Dialysis: In this process, the filtration and cleansing of the blood are done by using a machine. Dialysis doesn’t fix kidney failure, but it can be useful in lengthening your life if you stick religiously to the scheduled therapies.
• Kidney transplant: The need for dialysis is no longer needed when the kidney transplant takes place. There’s a longer waiting for a donor kidney that’s compatible with your body. And there is a chance that the process happens more quickly if you happen to get a  living donor. A transplant may not be a suitable treatment for everyone. There is the possibility of the surgery being ineffective.  Drugs named immunosuppressants are provided post-surgery to prevent your body from contradicting the new kidney transplanted. These medications have side effects, which are serious in some situations. 

How is a Kidney transplant in India possible?

Types of kidney transplant:

• Living donor: Usually in India family members like father, mother, brother, sister, or wife preferably can be a donor. Unrelated donors may be considered, but only if a commercial deal between the donor and recipient isn’t occurring.
• Braindead donor: If a living donor is not possible in any case, one can register in a hospital with a zonal coordination center for a deceased donor transplant (Braindead/ cadaver transplant). The main issue with it is that it has a huge waiting list.

Pre Transplant Evaluation:

Once it is decided to go for a kidney transplant in India, you may need to undergo several examinations (1) to determine whether you are fit to undergo this surgery,(2) there is no active infection in your body,(3) detailed history is to be observed if the chances can recur in a transplanted kidney, (4) evaluation of lungs, heart, urinary bladder,(5) women recipients between age 21 to 65 years of age will be evaluated for cervical cancer by the gynecologist. Women more than 40 years old should have been screened for breast cancer,(6) Psychological assessment will be done by a psychiatrist to identify any social, financial, circumstances behavioral issues. (7) Dental, dermatology, ENT evaluation is to be done before transplant.

Besides these, there are some of the laboratory examinations that need to be achieved-

•  Blood group test
• CBC
• Urine routine and culture
• Liver function test
• Blood glucose test
• Lipid profile
• Renal function test
• PT/PTT/BT test
• HbsAg/HCV/HIV/EBV/CMV IgG test
• Tissue typing test
• Uroflowmetry post-void residue test
• CT scan plain/iliofemoral vessel doppler test
• Gastrointestinal endoscopy test

Donor evaluation: 

Donors will be evaluated, and the short and long-term risks will be discussed. The option of paired or swap kidney transplant also exists. So in such cases compatibility and crossmatch testing will be done to evaluate your immunological risk and is crucial by HOTA (Human Organ and Tissue transplant Act.) 

Medical evaluation of donor:

The medical trial of a donor is to determine that you are in good health, don’t have renal problems, diabetes, hypertension, psychologically good, contagious disease that can be transmitted to the recipient. It will be confirmed about your long-term or short-term risk for removing one kidney.

 You will also undergo the following investigations as a donor-

• Cardiac evaluation: ECG, 2D echocardiography, and cardiac stress test.
• Pulmonary evaluation: X-ray Chest, ABG (arterial blood gasses) Lung function tests.

Summary: Kidney failure can be developed due to long-term damages. The possibility that causes kidney failure is diabetes, high blood pressure, high levels of medication, severe dehydration, kidney injury, or other factors. The donor of the kidney can live a healthy life with one healthy kidney. To allow the transplanted kidney survival in the body, the patient will be provided medicines for the rest of their life to fight rejection.

Frequently Asked Questions:

1. What are the preventive steps to be taken?

Ans:  The help that you can provide to lower your risk of kidney failure are:

• Leading a healthy lifestyle
• Taking prescribed medications as directed 
• Checking in with the conditions, such as diabetes and high blood pressure, are well managed or not.

2. What can be the complications related to kidney transplants?

Ans: Complications of kidney transplant include rejection, side effects of immunosuppressants, and other factors too.

3. What is the average life of a kidney transplant?

Ans:  The average of living is  5 to 10 years as long as they follow their treatment. Some people’s life expectancy increases to more than 20 or 30 years.

4. What should be the lifestyle modifications to be taken after a kidney transplant?

Ans: These are the steps to be taken: 

• Lowering alcohol intake
• Dietary changes- Limiting sodium and potassium, Limiting phosphorus, Following protein guidelines. 

5. How much is the cost of a kidney transplant in India?

Ans: The average cost of a kidney transplant ranges between 7 – 10 lakhs. This may differ accordingly from the hospital to the hospital. The best of the best hospitals in India are in Delhi, where the cost is accordingly.

6. What is the Success Rate of kidney transplants?

Ans:  The success rate for lifeless donor transplants is 96% and for living donor transplants is 97%. This percentage also depends on several factors plus there is also a need to be hygienic.