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THE TWO major treatment alternatives for any patient with renal failure are:
[1] Dialysis: (a) Continuous Ambulatory Peritoneal Dialysis (CAPD). (b) Maintenance Hemodialysis.
[2] Kidney Transplantation.
[1] Dialysis: Dialysis is an artificial means of removing wastes and excess of salt and water from body. The normally functioning kidneys are working round the clock every minute of the day. Thus, any artificial substitute of kidneys function like dialysis has to be done on regular basis life long to be an effective alternative to the normal kidneys. Patients with End Stage Renal Failue can live for many years on regular dialysis schedule.
(a) Continuous Ambulatory Peritoneal dialysis (CAPD): This form of Dialysis occurs inside the body. It uses your peritoneal membrane (the lining of your abdomen) as the filter. For this treatment, a tube called a catheter is surgically placed through the wall of your abdomen. With CAPD, you connect tubing and a bag of sterile dialysis solution to the peritoneal catheter. By raising the bag to shoulder level or higher, the solution flows into peritoneum. When empty, simply remove and throw away the tubing and the solution bag. During dialy activities, the peritoneal membrane acts as a filter for your blood. Waste products and excess water transfer to dialysis solution. After a few hours, you attach new tubing and an empty bag to the catheter. Then lower the bag to drain the waste-filled fluid from the peritoneum. The number of exchange per day, and lenth of time per exchange, varies by person. Usally, CAPD is performed three to four times a day. Each solution exchange lasts about one-half hour.(b) Maintanace Hemodialysis: Blood is pumped outside the body to an artificial kidney machine. The machine cleanses the blood and returns it to the body. Only a small amount of blood is out of the body at any time. Two needles are placed into fistula or graft. the needles are then attached by plastic tubing to a special filter. This filter is an artificial kidney called a Dialyzer. One needle withdraws blood for cleansing. The other needle returns filtered blood to the body. A pump pushes the blood through the dialyzer. Blood passes on one side of the filter. Solution made by dialysis machine passes on the other side. The solution draws excess fluid and waste out of the blood. A filter is used with pores large enough to allow waste to leave. Larger molecules like blood cells cannot pass through the filter. The average person receives three treatments per week. Each treatment lasts three to four hours. There are two options for Hemodialysis: (1) Home, and (2) In-center or Clinic Hemodialysis. A "FISTULA" (the surgical linking of an artery to a vein) provides access to blood vessels. So does a "GRAFT" (tubing surgically placed under the skin, linking an artery to a vein).
[2] Kidney Transplatation: A kidney transplatation is a surgical procedure in which a kidney is removed from one person (Donor) and placed into the body of a person suffering from renal failure (Recipient), in whom the transplanted kidney can perform all functions which the patients own kidneys are not able to perform.
Why Kidney Transplant is necessary ?
About the failed kidneys.
Age and Transplatation.
Advantages of Transplatation over Dialysis.
Donating or Receiving a Kidney based on Blood Type.
When One Kidney Fails: As mentioned before most of us have two kidneys. Due to an injury or disease process, one kidney may be lost. The second kidney under these circumstances grows and a person can live perfectly normal life with single kidney. It is this fact that makes it possible to transplant a kidney from one healthy person to a patient whose both the kidneys have failed.
When Both The Kidneys Fail: Just one Kidney at 20 % capacity, can keep a person healthy. Below that level, you begin to feel tired or weak, and lose your appetite. This is because toxic wastes start to build up in the blood, fluid collects, causing tissue swelling, lung congestion and high blood pressure. To stay healthy, a method is needed to replace lost or partly damaged Kidney. The loss of Kidney function may be sudden, over a period of days, or gradual, over a period of months to years. A sudden loss of Kidney is called Acute Renal Failure (ARF), while gradual loss is called Chronic Renal Failure (CRF).
Why is Kidney Transplant Necesssary: When a person has "RENAL FAILURE", the kidneys do not function properly filter harmful waste products; as a result, excess waste and chemicals start to accumulate in the blood. When this happens a dangerous accumulation of waste products can occur, causing a condition know as uremia. Any patient whose own kidneys have failed permanently is a potential candidate for a kidney transplant. There are several factors in each individual case which determine whether a kidney transplant or life long dialysis is the better form of treatment for that patient. These factors include age, availibility of family donors and the presence of antibodies in the patient. (this increases the risk of kidney failure after transplantation). The health factors which increase the risk of kidney failure after transplant operation are mainly heart disease, cancer or infection.
About Failed Kidneys: The removal to kidneys (Nephrectomy) which are diseased is usually not necessary prior to the time of transplant. The original kidneys may have to be removed if they are producing damaging effects in body, such as in case of:
High blood pressure.
Infected kidneys with recurring urinary tract.
Large polycystic kidneys.
Age of Transplatation:The majority of kidney transplant patients have been in the 10-60 years age group. However recently patients who are healthy and are between the ages of 60-70 years have been considered for transplant. Advanced age carries with it an increased likely hood of other problems and complications. Renal transplatation can only solve the problem due to renal failure; so such a decision can be taken only by transplant team, along with patient or his relatives.
Advantages of Transplantation over Dialysis:
There is no dependence on the machine thrice a week for rest of one's life.
There are hardly any restrictions in the diet and fluid intake after a succcessful transplant.
The physical sense of well-being is so much better that one can go back to work in style similar to that before illness.
Usually the anemia (and feeling of tiredness) seen in patients with renal failure is reversed after a successful transplant, since the kidney is functioning to maintain normal red cell production. For patients on dialysis, correction of anaemia requires life-long use of erythropoietin injections which are extremely expensive.
A woman may be able to conceive a child after having a successful transplant. (Women on dialysis usually do not ovulate and therefore are unable to become pregnent).
Men, who may be having sexual problems such as inability to maintain erection may find this problem eliminated once they receive a successful transplant.
Donating or Receiving a Kidney Based on Blood Type: The donor and recipent must be ABO group compatible as shown in the table below. The RH-typing of blood need not be identical between donor and recipent.
BLOOD GROUP CAN RECV FROM BLOOD GROUP CAN DONATE TO BLOOD GROUP O O A,B,AB,O A A,O A,AB B B,O B,AB AB O,A,B,AB AB
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