Archives

End Stage Renal Failure

End Stage Renal Failure

This entry is part 1 of 6 in the series Dr Lisa

End Stage Renal Failure

End Stage Renal FailureEnd Stage Renal Failure is the failure of kidney to function properly. Renal failure has two types. These are acute and chronic renal failure.
Acute renal failure (ARF) is sudden-onset renal failure with failure of excretion of the products of nitrogen metabolism, water, electrolytes and failure to maintain osmotic and acid-base balance. These changes are the result of acute severe impairment of renal blood flow, GFR and tubular re-absorption, usually all occurring at the same time.
Acute renal failure occurs when both kidneys suddenly stop working.
Chronic renal failure/ Chronic kidney disease (CKD) occurs when renal failure damage persist and kidneys are permanently damaged. It is most of the times the acute renal failure which fails to recover and then progresses to the chronic renal failure.
Acute renal failure may occur for various reasons, including structural diseases of kidney, partial or complete blockage of the urinary tract and the reduction of blood volume, for example, after a severe blood loss. Symptoms may develop over several days: urine output may decrease sharply, and the fluid to be excreted is stored entirely in the tissues resulting in edema and weight gain, particularly in the dependent areas e.g. legs.
CAUSES
Causes of acute renal failure are divided into three groups.
– Pre-renal Acute Renal Failure (ischemic)
•    Kidney shock (trauma, loss of fluid, solid tissue decay, hemolysis, septic shock, cardiogenic shock).
•    Loss of extracellular volume (gastric or urinary loss of fluid, burns).
•    Loss of intravascular volume or re-distribution (sepsis, bleeding, hypo-albuminemia).
•    Decreased cardiac output (heart failure , cardiac tamponade, cardiac surgery).
•    Other causes of decreased GFR (hypercalcaemia, hepatorenal syndrome).
– Renal Acute Renal Failure.
•    Exogenous intoxication (kidney damage by poisons used in industry and everyday life, bites of poisonous snakes and insects, intoxication with drugs and radio-opaque substance).
•    Acute infectious renal intoxication due to indirect and/or direct effects on the kidneys
•    Renal vascular lesions (hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, scleroderma, systemic necrotizing vasculitis, thrombosis of arteries or veins, atherosclerotic emboli in severely atherosclerotic main vessels – especially the aorta and renal arteries).
•    Open and closed kidney trauma.
•    Post-ischemic acute renal failure.
– Post-renal Acute Renal Failure.
•    Extra-renal obstruction in urinary tract (obstruction of the urethra, bladder tumor, prostatic cancer , pelvic masses, blockade in ureter due to stone, pus, blood clots etc. Kidney stones, tubular blockade by urate in the natural course of leukemia, myeloma, gouty nephropathy, treatment with sulfonamides, ligation of the ureter during surgery)

Dr. Lisa

Kidney Donor Requirements

Kidney Donor Requirements

This entry is part 2 of 6 in the series Dr Lisa

Kidney Donor Requirements

Kidney Donor RequirementsKidney donor requirements require that one must be healthy with both kidneys being normal. A person who is planning to donate one kidney should have a second kidney to fulfill his own body requirements. The kidney donor must also be healthy because there is no fun in donating a diseased or defective kidney. Kidney donor must fulfill criteria to be a successful donor.
1. Smoking: Thеrе аrе mаnу known hеаlth risks frоm ѕmоking. Surrоunding a ѕurgiсаl рrосеdurе, smoking саn cause potentially life-threatening rеѕрirаtоrу соmрliсаtiоnѕ during оr immеdiаtеlу аftеr аnеѕthеѕiа. Smоking may аlѕо increase thе riѕk оf developing blood clots in thе leg veins whiсh can brеаk lооѕе, trаvеl tо thе lungs and роtеntiаllу cause death.  Smoking саuѕеѕ inсrеаѕеd muсuѕ рrоduсtiоn аnd a dесrеаѕеd аbilitу to clear thе lungѕ whiсh саn lеаd tо рnеumоniа. Smоking аlѕо саuѕеѕ heart аnd vаѕсulаr diѕеаѕе. Smoking causes dесrеаѕеd wоund healing. Cаndidаtеѕ will nоt bе considered fоr a kidney dоnаtiоn unlеѕѕ they hаvе been tоbассо frее (including chewing tobacco) for at lеаѕt 8 wееkѕ prior tо donation and ѕmоking iѕ ѕtrоnglу discouraged after dоnаtiоn tо рrоtесt long tеrm health.
2. Drug Use: Potential donors muѕt nоt uѕе аnу illicit drugѕ. This inсludеѕ реriоdiс uѕе of any drug ѕuсh аѕ mаrijuаnа in аnу form (including оrаllу). Pоtеntiаl dоnоrѕ who uѕе chronic раin mеdiсаtiоn еxреriеnсе a highеr inсidеnсе оf post-operative раin аftеr donation.  Thеѕе individuals mау bе requested to see a surgeon and/or psychiatrist prior tо bеing considered fоr dоnаtiоn.  Thе trаnѕрlаnt tеаm mау rеԛuеѕt rаndоm drug ѕсrееning if thеrе is concern rеgаrding drug uѕе. Failure tо соmрlу with rеԛuеѕtѕ fоr drug ѕсrееning wоuld be соnѕidеrеd cause fоr dесlining donation.
3. Agе > 18: Our рrоgrаm will nоt соnѕidеr dоnаtiоn from individuаlѕ under thе аgе of 18.
4. Hеаlth Prоblеmѕ: Kidney donor requirements require that one muѕt bе hеаlthу individuаlѕ. If a donor hаѕ a раѕt hiѕtоrу of ѕuffеring frоm thе fоllоwing рrоblеmѕ, оr if these аrе diѕсоvеrеd during thе mеdiсаl еvаluаtiоn, a donor mау bе dесlinеd. Thе RN will diѕсuѕѕ thе donor’ѕ health history in dеtаil bеfоrе thе еvаluаtiоn bеginѕ and the doctor will rеviеw it аgаin аt thе firѕt сliniс viѕit.

Other Kidney donor requirements
•    High blооd pressure trеаtеd with mеdiсаtiоn (thеrе mау be rаrе selected situations whеn the tеаm may consider a dоnоr оn a ѕinglе blооd рrеѕѕurе mеdiсinе).
•    Diabetes. In ѕоmе cases, уоung dоnоrѕ may bе dесlinеd fоr a very strong fаmilу history оf diаbеtеѕ еvеn if thе donor does nоt currently suffer frоm diаbеtеѕ, duе tо thе riѕk оf dеvеlорing it later in lifе.
•    Gestational diаbеtеѕ (diаbеtеѕ during рrеgnаnсу). Dоnоrѕ lеѕѕ thаn аgе 40 уеаrѕ оld with a hiѕtоrу of gеѕtаtiоnаl diabetes will nоt bе a саndidаtе fоr dоnаtiоn.  Donors over thе age оf 40 уеаrѕ оld will be соnѕidеrеd оn a саѕе by case basis.
•    Systemic luрuѕ erythematosus
•    Pоlусуѕtiс kidney diѕеаѕе
•    Subѕtаnсе аbuѕе
•    Psychiatric illnеѕѕ. If a dоnоr has a history of mеntаl health рrоblеmѕ inсluding a remote history оf anxiety or оthеr соmmоn diѕоrdеrѕ, thе tеаm mау request a psychiatric еvаluаtiоn. Dоnоrѕ with сurrеnt mеntаl hеаlth соnсеrnѕ may nоt bе саndidаtеѕ fоr living kidney donation.
•    Heart / heart vаlvе disease оr реriрhеrаl vascular disease (disease оf blооd vеѕѕеlѕ in the lеgѕ)
•    Lung diѕеаѕе with imраirеd oxygenation оr ventilation.
•    Rесеnt cancer оr a history оf саnсеr thаt typically tаkеѕ a long time tо rесur
•    Lоw kidnеу funсtiоn (usually creatinine сlеаrаnсе оf <80ml/min (a test of kidney funсtiоn).
•    Prоtеin in thе urinе > 300 mg per 24 hоurѕ (a tеѕt оf kidney function).
•    Aсtivе hepatitis B or C infесtiоn оr HIV infection.
•    Use оf mеdiсinеѕ thаt аrе knоwn to cause kidnеу dаmаgе.
•    Hiѕtоrу оf blооd сlоtѕ оr riѕk fасtоrѕ for the development оf blood сlоtѕ. (uѕе оf birth control рillѕ, ѕmоking аnd оbеѕitу аrе factors that may tеmроrаrilу disqualify a donor duе to thе riѕk оf dеvеlорing blood сlоtѕ.
5. Psychosocial Iѕѕuеѕ: Thе social wоrkеr will evaluate many psychosocial аѕресtѕ оf living dоnаtiоn with the роtеntiаl donor. Donors mау be dесlinеd if they hаvе inаdеquаtе support fоr rесоvеrу,quеѕtiоnаblе dоnоr-rесiрiеnt rеlаtiоnѕhiр or mоtivаtiоn fоr donation, a history оf рооr сорing or рѕусhiаtriс illnеѕѕ, a hiѕtоrу of not tаking good care оf thеir hеаlth, оr оthеr ѕimilаr соnсеrnѕ.
6. Inѕurаnсе coverage and рrimаrу саrе dосtоr: It is ѕо imроrtаnt for donors to have good оngоing mеdiсаl саrе tо monitor thе function оf the remaining kidnеу. So, it is rесоmmеndеd thаt all dоnоrѕ should hаvе health inѕurаnсе аnd a рrimаrу care dосtоr.
7. Obesity:  Obеѕitу is аn independent riѕk factor fоr kidnеу diѕеаѕе. Candidates with a bоdу mass indеx оf оvеr 35 will generally nоt bе considered fоr dоnаtiоn unlеѕѕ an individual is very muscular. Individuаlѕ with a BMI of >25 will meet with a diеtitiаn tо diѕсuѕѕ strategies to rеmаin аt a healthy wеight fоr lifе.

Dr Lisa

A kidney infection could lead to serious problems

Kidney Infection (Pyelonephritis)

This entry is part 3 of 6 in the series Dr Lisa

Kidney Infection (Pyelonephritis)

A kidney infection could lead to serious problems

A kidney infection could lead to serious problems

Acute and chronic Kidney Infection (Pyelonephritis) is the most common non-specific inflammatory diseases of the “upper urinary tract”. It is about 2/3 of all urological diseases. In addition, it is the most common kidney disease in the all age groups. Pyelonephritis can make you sick at any age but high risk groups are:
•    Children up to 7 years with developmental diseases of urinary system
•    Girls and women of 18-30 age. Pyelonephritis in this group is associated with the onset of sexual activity , pregnancy or childbirth (girls develop this disease 6 times more often than boys)
•    Older men with BPH
Kidney Infection (Pyelonephritis) is a kidney disease having an inflammatory nature. In most of the cases, the causative agents are bacteria, most common being E. coli , Proteus, Enterococci, Pseudomonas aeruginosa and Staphylococcus. These organisms spread throughout the body via the bloodstream (known as bacteremia) from any source of infection. Infection can also travel from lower urinary tract and then ascend upward towards kidneys. In this case, the disease begins with urethritis or cystitis . A common underlying cause of illness is urolithiasis (stone somewhere in urinary tract). Chronic illnesses, frequent hypothermia and other adverse factors make the kidneys particularly vulnerable to such disease processes.
Symptoms of acute pyelonephritis:
•    a sharp rise in body temperature to 39-40 ° C,
•    weakness,
•    headache ,
•    profuse sweating ,
•    loss of appetite,
•    nausea and vomiting ,
•    pain
•    children: abdominal pain .

Urine analysis reveals pus cells, red blood cells, proteins and a large number of bacteria.
Chronic Pyelonephritis is often caused by undiagnosed or partially treated acute pyelonephritis. In this case, the patient shows non-specific signs and symptoms e.g. fatigability, fever, hypertension , painful urination, increased frequency of urination etc. During periods of exacerbations, these patients exhibit all signs of acute pyelonephritis listed above. If untreated, a pyelonephritis may develop into suppurative complications e.g. renal abscess or carbuncle, necrosis of the renal papillae etc. All of these complications are indicators for surgery or some invasive procedure.

Treatment

Mainstay of treatment is antibiotics. Treatment of pyelonephritis usually lasts 2-3 weeks. In severe cases, surgery may be needed. Kidney de-capsulation is performed in purulent pyelonephritis (Pyelonephritis in which frank pus is formed).
The best means of preventing pyelonephritis is timely treatment of diseases that predispose to this condition (primarily, urolithiasis and benign prostatic hyperplasia). Special care should be adopted by pregnant women with multiple pregnancies, Polyhydramnios etc. Experts recommend at least one bacteriological analysis of urine and urodynamic study per month in such patients.

Dr Lisa

Kidney Donation

Kidney Transplantation

This entry is part 4 of 6 in the series Dr Lisa

Kidney Transplantation

Kidney_TransplantationKidney Transplantation was started in 1902. Emery Ullman was the first person who performed this procedure on an animal. After that, various surgeons tried to apply the technology to humans, but the experiments couldn’t be completed successfully. Dr. Yuri Crow was the first surgeon who transplanted human kidney transplanted to another person from a dead donor but did so unsuccessfully. In 1954 he made his first successful attempt of kidney transplant surgery from a living donor to a patient. Since then, a new era of kidney transplantation has started and a lot of kidney transplants have since been performed all over the world. Special drugs have been developed that help a new kidney survive in the donor’s body and they are getting better all the time.
Why do we need Kidney Transplantation
Kidney transplant is the best treatment option for patients with end stage renal disease (in which complete renal shut down has occurred). Only renal replacement therapy in form of dialysis or kidney transplant can extend the life of these patients in the long term.
The organ is taken most of the time from a live person, usually a relative. A donor is not compatible if he/she has different blood group, very different age/weight and presence of the serious diseases. The patient should not be too old. Also very young children do not tend to have such operations.
Where can we carry out Such Operations
Different countries have their own centers where they can carry out these operations. Depending on the expertise and the quality of care provided, the success rate is different in different regions of the world. People usually turn to different countries with good surgical outcomes, best medical facilities and lower cost. Among them, the most popular countries are United States, Israel, Germany and even Pakistan because of the reasonable cost.
So kidney transplant in Germany costs about 110 thousand Euros.
Kidney from a Donor before Surgery
In the world there is an acute shortage of both the donors and the organs. Demand is more than the supply of organs. Not everyone can give his kidney without compromising his own health. The donors with other health issues can develop complications after donation.
After removing the kidney it is best to use it on the same day. In the longer term and for transport of the kidney, it is stored in a special solution at a temperature of 6 degrees. Its viability is for three days.
Few Medical Aspects
The new kidney is transplanted without removing the old diseased kidney. Right kidney is transplanted on the left side, and vice versa.
Once an organ has been secured for you – either from a living or deceased donor – you must begin preparing for surgery.
You should not eat or drink immediately prior to surgery unless cleared to do so by your Transplant Coordinator.
It is very important that you are healthy for your surgery. If you have a cold, flu or any other type of infection or sickness, your transplant surgery may need to be postponed. Once you arrive at the hospital, you will have a chest x-ray, electrocardiogram, urinalysis, and blood work done to assess your current health.
An anesthesiologist will discuss your anesthesia care with you. You may be asked to shower with a medicated soap. You will receive antibiotics intravenously (IV) just before you go to the operating room.
While you are being prepared for surgery, a team of surgeons are working to remove the organ from the donor. In most instances, the organ is found to be suitable and the transplant proceeds as scheduled. On average a kidney transplant takes approximately 8-12 hours.
On rare occasions the surgeon may find something that makes the organ unsuitable for transplant. In this case your operation will be postponed. While we understand this can be disappointing, it is critical that we obtain the best organ possible for you to avoid complications.
The transplant surgeon will notify your family when the procedure is completed. They may be able to see you for a few minutes immediately following the surgery.
Postoperatively
The new kidney is not always easily accepted by the body. The doctors monitor the response of the body towards newly transplanted kidney. A patient takes powerful drugs to avoid failure of the new kidney. The kidney is gradually accepted by the body, but the risk of rejection of this kidney is always present.
The prognosis of renal transplant surgery is getting better gradually. Sometimes very serious consequences require a more rigorous treatment.
The patient is discharged after kidney transplantation after telling adequate restrictions and making sure that patient is compliant in every aspect. The doctors may restrict the amount of fat consumed (about 25%), carbohydrates (50%) and other substances. Patient is often discharged with a diet chart usually having several dietary options taking into account the patient’s dietary needs and restrictions.
Cost
This is a big question. The cost of Kidney Transplantation, including preliminary testing, the surgery itself and post-operative recovery costs vary country to country and depend on the hospital and level of care provided. These costs start to add up, even before transplant. The estimated cost of renal transplant in USA is around $262,900. Other countries like Singapore, UK, India and Pakistan have different costs. There are some centers which provide these services free of charge e.g. in Pakistan a center named Sindh Institute of Urology and Transplantation (SIUT) performed about 60,910 kidney transplant surgeries last year without any charge and the medicines after surgery are also provided free of cost for lifetime period.
Why the Original Diseased Kidney is not usually removed during kidney transplant?
In most cases, the diseased kidneys are not removed. There are three conditions that might require your diseased kidneys to be removed:
•    Repeated infection that could spread to the transplanted kidney
•    Uncontrollable hypertension caused by your original kidneys
•    Backup of urine into your kidneys (a condition called reflux)
This is because removal of kidney carries additional risk of bleeding and may complicate the renal transplant surgery. And also the diseased kidney may have some residual function left. If the surgeon remove the original kidney and you reject the new kidney as well, the prognosis becomes grave because you can’t live without a kidney.

Dr Lisa

Kidney Transplantation

Kidney Donation

This entry is part 5 of 6 in the series Dr Lisa

Kidney Donation

Kidney Donation_liveWith time, the increasing numbers of the patients are awaiting the kidney transplantation. Each year, the number of kidney transplants is less than the number of new patients on the waiting list. In this situation, all sources of grafts are important and must be developed in parallel. The available data shows that renal transplantation from living donors is an effective option for the patient and safe for the donor. Can a live kidney donation work for you?

Life of Donated Kidney

Transplanted kidney has a life span. It doesn’t live as long as your own kidney. But still, it is the best option for a patient suffering from Chronic Renal Failure (CRF). A kidney donated from a cadaver doesn’t live as long as a kidney from live donor, but still it is a very good option. A kidney from cadaver on average has a life span of 10-15 years. While a kidney from a live donor live for about 15-20 years. More information on a kidney donation is here.

Donation after death

When the brain ceases to function because of the injuries, illness or accident and the person cannot be saved, the intact organs and tissues can help the other people. In Estonia, the transplant of organs and tissues is possible only from cadavers.

Brain death means the condition in which the human brain has permanently ceased to function and the heart and breathing are artificially supported by various devices and medicines. If you turn off the devices or stop the medicines, it will stop these vital functions. Brain death is diagnosed after a whole range of tests with the participation of several medical specialists. After brain death, the cadaver can still help the society: four people can get new organs (two kidneys, one liver and two lungs), two cornea and a few others will be able to get help from transplantation of blood vessels and bone.

Living Donors

The donor kidney may be a close relative of the patient who is in need of a kidney. A relative can donate a kidney only after voluntary consent. Donating a kidney does not hurt the donor since the remaining kidney has very high ability to compensate. The remaining kidney will enlarge itself and enhance its functional capabilities. If a person has at least one healthy kidney, it can easily clean your body without any disturbances. People who have donated a kidney for transplant should avoid certain risk factors, such as smoking and obesity. They should also monitor the blood pressure. Living with one healthy kidney does not impose any restrictions; the donor can live perfectly normal and active life.

The part of body which is most often subjected to donation is the kidney. Of all transplants performed, it is the kidney transplant which has the highest rate of success. Other organs can also be donated by a live donor e.g. part of a liver, a lung, small intestine and pancreas.

Some of the advantages of a living organ donation

The surgery for removal of the organ and the transplant can be planned only when the donor and recipient are in the best health possible. This will help ensure that the transplanted organ is also in the most optimal conditions. In the case of a live donation, the time that elapses between collection and kidney transplantation is shorter than in the case of a donation from a deceased person. This can help renal graft function better and / or longer.

The waiting time required for an organ to become available is shorter when it comes from a living donor. Kidney donation save the person from need of dialysis, so make the resources available for those who have not yet received a donor kidney.

Best kidney survival

Three major reasons for the best kidney survival when it comes from a live donor:

ü  A kidney transplanted from a living donor remains functional for a longer period of time. This is because we have more time to do the necessary tests in order to obtain better tissue matching between donor and recipient. Better compatibility reduces the risk of tissue rejection.

ü  The kidney is usually healthier. The kidney from a living donor is usually healthier than a kidney from a deceased donor and can remain longer functional: 15 to 20 years on average compared to 10-15 years for a kidney from a deceased donor. This was mainly due to the fact that the donor is subject to extensive testing to check that his kidney function is excellent.

ü  The kidney starts working immediately. Usually a kidney from a living donor immediately starts to function in the recipient. If there is a kidney from a deceased donor, it can take days and weeks before the kidney begins to function normally. In the meantime, the recipient may still need dialysis for some time after receiving a kidney form cadaver.

A sense of satisfaction

For the living donors, it is very rewarding to know that they have contributed to help another person who otherwise might have lived a miserable life.

Kidney Infection Symptoms can be subtle, but dangerous.

Kidney Infection Symptoms

This entry is part 6 of 6 in the series Dr Lisa

Kidney Infection Symptoms

Kidney Infection Symptoms can be subtle, but dangerous.

There are several forms of urinary tract infections (UTI). They are divided into upper and lower urinary tract infections. In upper urinary tract infection, the kidney is the most important structure which is involved. It is often known as pyelonephritis. Lower urinary tract infection involves urethra and urinary bladder. There are several symptoms which can differentiate among the two viz. upper and lower urinary tract infections. Being an infectious disease, urinary tract infection presents with signs and symptoms of infection and inflammation. Look for the signs of kidney infection symptoms.

Pyelonephritis

Pyelonephritis is an infectious (usually bacterial) and inflammatory disease of the kidneys. Typically, the disease affects only one kidney. It occurs in acute or chronic form. Pyelonephritis is more common in women than men. Furthermore, elderly men more often suffer from this disease.

Pyelonephritis in women typically begins after cystitis (inflammation and infection of urinary bladder) and ascending towards kidney resulting into pyelonephritis. Pyelonephritis in men is often a complication of urological diseases such as benign prostatic hyperplasia, any mass obstructing the flow of urine, prostatitis (inflammation of the prostate), kidney stones etc.

Causes of pyelonephritis

Kidney infection is usually caused by bacteria, most common being Escherichia coli (E.coli). The bacteria enter the urethra and travel up the urinary tract. Once in one or both channels connecting the bladder and kidneys (ureters), bacteria reach the kidney and contribute towards the development of the disease. Women are more exposed to the risk partly due to the fact that their urethra is located closer to the anus (where bacteria from the intestines leave the body). This simplifies the way the bacteria enter into the urethra. Sometimes kidney infection can occur without infection of the bladder. For example, if the ureter or kidney outflow is blocked by a stone.

Symptoms of pyelonephritis

Symptoms of acute kidney infection (Upper Urinary Tract Infection Symptoms) often develop rapidly over several hours or days: • High temperature (over 38 ° C) • Swelling of the face • Tremors • Pain in the lower back (maybe on one side only) • Feeling of being sick (nausea) • vomiting About one-third of the patients with an acute kidney infection also have the symptoms of bladder infection (Lower Urinary Tract Infection Symptoms) as well.

These symptoms may also be present when isolated lower urinary tract infection is seen e.g. infection of urethra, urinary bladder, prostate etc. These symptoms may include: • Burning sensation while urinating • The need to urinate more often than usual • Muddy, dark urine • Sharp unpleasant smell of urine • Blood in the urine These symptoms may be caused by other problems as well. So, if you have any of these symptoms, consult a doctor. If you are searching for a way to tell others about your kidney failure, you may be interested in a Live Kidney Donation.