Monthly Archive February 2018

Kidney transplant

A surgeon places the new kidney inside the lower part of the abdomen and connects the renal artery and vein of the patient with those of the new kidney. The patient’s blood flows through the transplanted kidney, which begins to produce urine, as the kidneys of that person did when they were healthy. The new kidney can start working immediately or take a few weeks before starting to produce urine. The patient’s kidneys are left in place unless they are causing infections or hypertension.

How to prepare ?
The transplant process consists of many stages. First, you should talk to your doctor, because a transplant does not suit everyone. The doctor may tell you that the illness you are having would make a transplant dangerous or unlikely to succeed.

A kidney can be received from a relative (living related donor), from a person who has recently died (cadaveric donor), or sometimes from a spouse or a very close friend (non-related living donor). If you do not have a living donor, your name is put on a waiting list for a cadaver kidney. Waiting for a kidney from a cadaveric donor can last for several years.

The transplant team takes into account three factors when allocating the kidneys to potential recipients. These factors help predict whether the patient’s immune system will accept or reject the new kidney.

  • Blood type. Your blood group (A, B, AB or O) must be compatible with that of the donor. This is the most important factor.
  • Human leukocyte antigens ( HLA ). His cells possess six important human leukocyte antigens, three from his father and three from his mother. Your family members are most likely to have compatible antigens. You may be able to receive a kidney even if the HLA compatibility is not complete, as long as your blood group is compatible with the donor’s, and the other tests are negative.
  • Antigen compatibility tests. The last test before implanting an organ is that of compatibility. A small amount of blood is taken from the recipient and mixed with a sample of the donor’s in a tube to see if a reaction occurs. If not, it is considered that the compatibility test is negative and the transplant surgery can be performed.

How long does it take ?
The waiting time to obtain a kidney is variable. Since there are not enough cadaver donors for each person who needs a transplant, you should put your name on a waiting list. However, if a voluntary donor offers a kidney, the transplant can be scheduled as soon as the two people are ready. The main advantage of having a living donor is that the long wait is avoided.

The surgery lasts from 3 to 4 hours. The normal hospitalization period is about one week. After leaving the hospital, you will have to attend frequent checkups.

If someone has donated a kidney, that person will probably stay in the hospital for the same amount of time. However, a new technique for removing the kidney for donation uses a smaller incision and may allow the donor to leave the hospital in 2 or 3 days.

From 85 to 90 percent of cadaver donor transplants are functioning one year after surgery. Transplants from living relatives often work better than those from cadaver donors because they are usually more compatible.

Possible complications
Transplantation is the closest thing to the cure of the disease. However, no matter how compatible it is, your body can reject the new kidney. A frequent cause of rejection is not taking the medications in the indicated way.

The doctor will give you immunosuppressant medications, which prevent your immune system from attacking the kidney in a process called rejection. You should take them every day for as long as the transplanted kidney is functioning. Sometimes, however, these drugs are not enough to prevent the body from rejecting the new kidney. If this happens, you will have to go back to some form of dialysis and you may have to wait for another transplant.

Immunosuppressants can weaken the immune system, which can lead to infections. Some medications can also change your physical appearance. The face can be rounded; You can gain weight and you can get acne or facial hair. Not all patients have these problems. Diet and makeup can help improve them.

Immunosuppressants decrease the ability of cells of the immune system to function. In some patients, after long periods of time, this decreased immunity may increase the risk of cancer. Some immunosuppressants can cause cataracts, diabetes, increased stomach acid, high blood pressure and bone diseases. If used for a long time, they can also cause liver or kidney damage in some patients.

Diet for transplant patients
The diet for transplant patients is less limited than that of dialysis patients, but you may have to eat less of some foods. The diet will probably change as the medications change, blood test results, weight and blood pressure change.

  • You may have to count calories. Medications can make your appetite increase and you gain weight.
  • You may have to consume less salt. Medications can cause your body to retain sodium, which causes high blood pressure.

Advantages and disadvantages
Kidney transplantation has advantages and disadvantages.

Kidney transplant

Advantage

+ A transplanted kidney works like a normal one.
+ You may feel healthier or more normal.
+ You will have less dietary restrictions.
+ You will not need dialysis.
+ Patients who successfully pass through the selection process are more likely to live a longer life.
Disadvantages

– It requires major surgery.
– You may have to wait for a donor to appear.
– Your body may reject the new kidney, so it is possible that a transplant will not last you a lifetime.
– You will have to take immunosuppressants, which can cause complications.

Collaborate with your health care team
Questions you can think of:

  • Is the transplant the treatment that suits me best? Why?
  • What are my chances of the transplant succeeding?
  • How can I find out if one of my relatives or friends can be the donor?
  • What risks does the family member or friend who donates run?
  • If none of my relatives or friends donate, how do I go on the waiting list for a kidney? How long will I have to wait?
  • What are the symptoms of rejection?
  • How long does the transplant work?
  • What are the side effects of immunosuppressants?
  • Who will be part of my health care team? How can these people help me?
  • With whom can I talk about financial issues, sexuality or concerns related to my family?
  • How or where can I talk to other people who have had to face this decision?

Peritoneal dialysis

A mixture of minerals and sugar dissolved in water, called a dialysis solution, is introduced into the abdomen through a soft tube. The sugar, called glucose, extracts waste, chemicals and excess water from the tiny blood vessels of the peritoneum and leads them to the dialysis fluid. After several hours, the solution is removed with the blood waste from the abdomen through the tube. Then the abdomen is filled again with a new dialysis solution and the cycle is repeated. Each cycle is called exchange.

How to prepare ?
Before the first treatment, a surgeon places a small, soft tube called a catheter inside the abdomen. The catheter works best if the insertion site has had enough time to heal, which happens 10 days to 2 or 3 weeks. This is another way in which access planning for dialysis can contribute to treatment success. This catheter is left there permanently to carry the dialysis solution in and out of the abdomen.

Types of peritoneal dialysis
There are three types of peritoneal dialysis.

1. Continuous ambulatory peritoneal dialysis (CAPD)
This is the most common type of peritoneal dialysis. It does not require a machine and can be done in any clean, well-lit place. With CAPD the blood is constantly being purified. The dialysis solution leaves a plastic bag through the catheter and enters the abdomen, where it remains for several hours with the catheter sealed. The period in which the dialysis solution is inside the abdomen is called the residence time. Then, the patient draws the dialysis solution back into the bag to discard it. Using the same catheter, the abdomen is refilled with a new dialysis solution so that the process begins again. In the CAPD the solution has a residence time in the abdomen of 4 to 6 hours (or more). The process of extracting the used solution and replacing it with the new one lasts 30 to 40 minutes. Most people change the dialysis solution at least four times a day and sleep with their abdomen full of solution at night. In continuous ambulatory peritoneal dialysis, it is not necessary to wake up to perform dialysis tasks at night.

2. Continuous cyclic peritoneal dialysis (CCPD)
The CCPD uses a device called a cycler that fills and empties the abdomen three to five times during the night, while the patient sleeps. In the morning, the patient initiates an exchange with a permanence time that lasts all day. An additional exchange can be made in the middle of the afternoon without the cycler to increase the amount of waste removed and to decrease the amount of fluid left in the body.

3. Combination of CAPD and CCPD
If the person weighs more than 175 pounds or if the peritoneum slowly filters out the waste, a combination of CAPD and CCPD may be needed to reach the proper level of dialysis. For example, some people use a cycler at night but also perform an exchange during the day. Others make four exchanges during the day and use a mini-cycler to perform one or more exchanges during the night. With the help of your health care team you will determine the most appropriate program for you.

Who makes it ?
The patient usually performs both types of peritoneal dialysis without the help of another person. CAPD is a form of self-administered treatment that does not require devices. For the CCPD, however, a machine is needed that drains and replenishes the abdomen.

Possible Complications
The most common problem with peritoneal dialysis is peritonitis, which is a serious abdominal infection. This infection can occur if the hole through which the catheter enters the body is infected or if there is contamination when the catheter is connected or disconnected from the bags. Peritonitis requires the doctor to formulate antibiotics.

To avoid this, the procedures must be followed to the letter and you must learn to recognize the initial signs of peritonitis, such as fever, turbidity or unusual color of the fluid used, and pain or redness around the catheter. Inform the doctor immediately of the appearance of these signs so that the peritonitis can be treated quickly and serious problems are avoided.

Diet for peritoneal dialysis patients
The diet in the case of peritoneal dialysis is slightly different from that of hemodialysis patients.

  • In any case, you will have to restrict the consumption of salt and liquids, but you can consume them in greater quantity, compared with a hemodialysis patient.
  • You must consume more proteins.
  • The restrictions on potassium consumption may be different.
  • You may need to decrease the amount of calories you eat because the dialysis fluid contains calories that can make you gain weight.

The doctor and a nutritionist who specializes in treating people with kidney failure will help you plan your meals.

Advantages and disadvantages
Each type of peritoneal dialysis has advantages and disadvantages.

CAPD

Advantage

+ You can do it alone.
+ You can do it at the hours you want as long as you make the number of exchanges needed for each day.
+ It can be done in different parts.
+ A machine is not needed.
Disadvantages

– You can alter your schedule each day.
– It is a continuous treatment and all exchanges must be made 7 days a week.

CCPD

Advantage

+ It can be done at night, mainly while you sleep.
Disadvantages

– A machine is needed.

Collaborate with your health care team
Questions you can think of:

  • Is peritoneal dialysis the treatment that suits me best? Why? If it is, which type is better?
  • How long will it take me to learn how to do peritoneal dialysis?
  • How does it feel during peritoneal dialysis?
  • How does peritoneal dialysis affect blood pressure?
  • How will I know if I have peritonitis? What is the treatment?
  • As a peritoneal dialysis patient, can I continue working?
  • How much exercise should I do?
  • Where should I store the implements?
  • How often will I have a consultation with the doctor?
  • Who will be part of my health care team? How can these people help me?
  • Who should I call when there is a problem?
  • With whom can I talk about financial issues, sexuality or concerns related to my family?
  • How or where can I talk to other people who have had to face this decision?

Dialysis is not the cure
Hemodialysis and peritoneal dialysis are treatments that help to perform the work that the kidneys performed. These treatments help you feel better and live longer, but they do not cure kidney failure. Although today patients with kidney failure live longer than before, over the years kidney disease can cause problems such as heart disease, bone diseases, arthritis, nerve damage, infertility and malnutrition. These problems will not go away with dialysis, but doctors now have new and better ways to prevent or treat them. You should discuss these complications and treatments with the doctor.

Hemodialysis

In hemodialysis, a special filter called a dialyzer is used that works like an artificial kidney to purify the blood. During treatment, blood passes through tubes into the dialyzer, which filters and removes waste and excess water. Then the purified blood flows back into the body through another series of tubes. The dialyzer is connected to a machine that controls blood flow and removes waste from the blood.

Hemodialysis should usually be done three times a week. Each treatment lasts 3 to 5 hours, or more. During the same, the patient can read, write, sleep, chat or watch television.

How to prepare ?
If you choose hemodialysis, you have to establish a pathway to the bloodstream several months before you receive the first treatment. You may have to spend a night in the hospital, but many patients are placed on this path as ambulatory. Access is an effective way to get blood out of the body into the dialysis machine and return it to the patient without causing discomfort. The two main types of access are fistula and graft

The surgeon makes a fistula using the patient’s blood vessels. An artery of the arm is usually connected directly to a vein. The increased blood flow causes the vein to grow and strengthen so that it can be used for frequent punctures. This is the preferred type of access. It may take several weeks before it is ready to be used

The graft connects an artery with a vein by means of a synthetic tube. Unlike the fistula, it does not have to develop, so it can be used sooner, but it can present more infection problems and the presence of clots.

The needles are placed inside the access path to draw blood. The patient is given a local anesthetic to minimize pain during dialysis.

If kidney disease has progressed rapidly, there may not be time to establish a permanent vascular access before starting hemodialysis treatments. It may be necessary to use a temporary catheter, which is a tube that is inserted into a vein in the neck, chest or leg, near the groin. Sometimes a catheter is used as a long-term access route. The catheters that will be needed for more than 3 weeks are designed to go under the skin in order to increase comfort and reduce complications.

Possible Complications
Problems with venous access are the most common reasons for hospitalization among people receiving hemodialysis. Among the frequent problems are infections, blockage by clots and poor blood flow. These problems can prevent the treatment from working. You may have to do repeated surgeries to get access that works properly.

Other problems can be caused by rapid changes in the balance of water and some chemicals in the body during treatment. Two of the common side effects are muscle cramps and hypotension, or sudden drop in blood pressure. Hypotension, or low blood pressure, can make the patient feel weak, dizzy, or feel like vomiting.

You will probably need a few months to adjust to hemodialysis. Side effects can often be treated quickly and easily, so you should always report your appearance to the doctor and dialysis staff. You can avoid many of the side effects by eating a proper diet, limiting the intake of fluids and taking the drugs that are formulated.

Diet for hemodialysis patients
Hemodialysis and a proper diet help to reduce the waste that accumulates in the blood. In all dialysis centers there is a nutritionist available to help the patient plan their meals according to the doctor’s instructions. When choosing foods, you should remember the following:

  • Eat balanced amounts of high protein foods, such as meat, poultry and fish.
  • Control the amount of potassium you eat. Potassium is a mineral found in salt substitutes, in some fruits (bananas and oranges), in vegetables, chocolate and nuts. Excess potassium can be dangerous .
  • Limit the amount of fluid you drink. When the kidneys do not work, water quickly accumulates in the body. Excess fluid causes tissues to swell and can cause high blood pressure, heart problems, and cramping and hypotension during dialysis.
  • Avoid salt. Salty foods cause thirst and cause the body to retain water.
  • Limit foods such as milk, cheese, nuts, dried beans and dark cola drinks because they contain large amounts of a mineral called phosphorus. Excess phosphorus in the blood causes calcium to leave the bones, which makes them weak and brittle, and can cause arthritis. To avoid bone problems, the doctor may formulate special medications that you should take every day with meals as directed.

Advantages and disadvantages

Each person reacts differently to similar situations. What can be a negative factor for one person can be positive for another. The table mentions the general advantages and disadvantages of hemodialysis performed in a dialysis center and home hemodialysis.

Hemodialysis in a Dialysis Center

Advantage

+ The centers that carry it out are everywhere.
+ There are trained professionals at your side at all times.
+ You can get to know other patients.

Disadvantages

– The treatments are programmed by the center and are relatively difficult to modify.
– You must go to the center to receive the treatment.

Home hemodialysis

Advantage

+ You can do it at the time you prefer (but as often as the doctor orders).
+ You do not have to move to a center.
+ You acquire a sense of independence and control of treatment.

Disadvantages

– You must have a person to help you.
– Helping with treatments can be stressful for your family.
– Your assistant and you need training.
– Need space at home to store the machine and implements.

Treatments for kidney disease

There’s no cure for kidney disease , but treatment can help relieve the symptoms and stop it getting worse.

Your treatment will depend on how severe your kidney disease is.

The main treatments are:

  • lifestyle changes to ensure you remain as healthy as possible
  • medication to control associated problems such as high blood pressure and high cholesterol
  • dialysis – treatment to replicate some of the kidney’s functions; this may be necessary in advanced kidney disease
  • kidney transplant – this may also be necessary in advanced kidney disease

You’ll also be advised to have regular check-ups to monitor your condition.

Read more about how CKD is treated and living with kidney disease.

Outlook for kidney disease

kidney disease can range from a mild condition with no or few symptoms, to a very serious condition where the kidneys stop working, sometimes called kidney failure.

Most people with kidney disease will be able to control their condition with medication and regular check-ups. kidney disease only progresses to kidney failure in around 1 in 50 people with the condition.

But if you have kidney disease, even if it’s mild, you’re at an increased risk of developing other serious problems, such as cardiovascular disease. This is a group of conditions affecting the heart and blood vessels, which includes heart attacks and strokes.

Cardiovascular disease is one of the main causes of death in people with kidney disease, although healthy lifestyle changes and medication can help reduce your risk of developing it.

Causes of kidney disease

Kidney disease is usually caused by other conditions that put a strain on the kidneys. Often it’s the result of a combination of different problems.

kidney disease can be caused by:

  • high blood pressure – over time, this can put strain on the small blood vessels in the kidneys and stop the kidneys working properly
  • diabetes – too much glucose in your blood can damage the tiny filters in the kidneys
  • high cholesterol – this can cause a build-up of fatty deposits in the blood vessels supplying your kidneys, which can make it harder for them to work properly
  • kidney infections
  • glomerulonephritis – kidney inflammation
  • polycystic kidney disease – an inherited condition where growths called cysts develop in the kidneys
  • blockages in the flow of urine – for example, from recurrent kidney stones or an enlarged prostate
  • long-term, regular use of certain medicines – such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs)

You can help prevent kidney disease  by making healthy lifestyle changes and ensuring any underlying conditions you have are well controlled.

Tests for kidney disease

kidney disease can be diagnosed using blood and urine tests. These tests are used to look for high levels of certain substances in your blood and urine that are signs your kidneys aren’t working properly.

If you’re at a high risk of developing kidney disease – for example, you have one of the conditions mentioned above – you may be advised to have regular tests to check for kidney disease so it’s picked up at an early stage.

The results of your blood and urine tests can be used to tell the stage of your kidney disease. This is a number that reflects how severe the damage to your kidneys is, with a higher number indicating more serious kidney disease.

Read more about how kidney disease  is diagnosed.

kidney disease

Chronic kidney disease is a long-term condition where the kidneys don’t work as well as they should.

It’s a common condition often associated with getting older. Anyone can get it, although it’s more common in black people and people of south Asian origin.

kidney disease can get gradually worse over time and eventually the kidneys may stop working altogether, but this is uncommon. Many people with kidney disease are able to live long, largely normal lives.

Symptoms of kidney disease

There are usually no symptoms of kidney disease in the early stages. It may only be picked up if blood or urine tests carried out for another reason detect a possible problem with your kidneys.

When it reaches a more advanced stage, symptoms can include:

-tiredness

-swollen ankles, feet or hands

-shortness of breath

-feeling sick

-blood in your urine

See your GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

Read more about the symptoms of kidney disease.