Treatment Information Centre

Kidneys are one of the most vital organs of the body. It is bean shaped and comes in a pair and you need at least one kidney to stay alive. Each kidney is about 8cm or 3 inches wide and about 13 cms or 5 inches long, which is located on either side of the backbone above your waist. Once the blood enters into each kidney, there are about a million tiny blood filtering units called nephrons which filters the waste from the blood and makes urine, which is the main function of kidneys. Thus healthy kidneys are required to,

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• Balance the volume of fluid in the body.

• They help in making red blood cells.

• Release the hormone that directs production of red blood cells( called erythropoietin)

• Release a hormone that regulates blood pressure( called renin )

• Activate Vitamin D to maintain healthy bones

• Keep blood minerals in balance (sodium/phosphorous/potassium/chloride/bicarbonates/magnesium)

 

So taking care of kidneys is of vital importance. Kidney disease occurs when the kidneys cannot function properly. There are number of conditions that causes disease / or loss in kidney function. Most of them fall into the following causes ;

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• Diabetes

• High Blood Pressure

• Obesity

• Overload of toxins and certain antibiotics / Infections

• Drugs and Alcohol

• Autoimmune diseases

• Certain acute and chronic diseases

• Congenital diseases

• Tumors

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which can damage the blood vessel within the kidney. When this occurs the kidneys are unable to function at optimal level which can cause waste to build up in the blood from the food you consume. That is the prime reason for those who have kidney disease, a strict diet is advised, which restricts sodium, potassium, protein and phosphorous, as damaged kidneys have a hard time filtering these particular minerals out of your system. Depending on the extent of kidney damage, it is mainly classified as three stages;

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• Acute Renal Failure : This is a rapid loss of kidney function. Often it is caused by trauma / illness / medications that can damage kidneys. This may be reversed and if the condition persists, then it may progress to next stage

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• Chronic Kidney Failure : Significant degree of kidney function is noticed over a period of time gradually. If detected early, this can be treated through medical management and can progression to next stage can be delayed

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• End-stage Renal Disease (ESRD) : This is a total loss of kidney function and is permanent. Treatment with dialysis or kidney transplant is the only option at this stage

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How to check kidney health

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Kidney tests are taken to check the functioning of kidneys. This includes blood, urine, and imaging tests. If there are any risk factors in the family history such as high diabetes, heart disease, or kidney failure, it is important to take these tests and get checked. A sample of Urine and Blood is drawn for checking the working conditions of kidneys. This is commonly called Renal Panel Tests or Kidney Function Tests ( KFT) This includes the following ;

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Electrolytes : It measures the blood levels of the main electrolytes in the body, namely Sodium / Potassium / Chloride / Bicarbonate. The kidneys help maintain proper levels by re-absorption or by elimination into the urine.

 

Urea : Most diseases or conditions that affect the kidneys or liver have the potential to affect the amount of urea present in the blood. If increased amounts of urea are produced by the liver or if the kidneys are not working properly and have difficulty filtering wastes out of the blood, then urea levels will rise in the blood. 

 

Creatinine and GFR : Your blood will be tested for a waste product called creatinine. It comes from muscle tissue. When the kidneys are damaged, they have trouble removing creatinine from your blood. The kidneys remove excess fluid and waste materials by a filtration process known as Glomerular filtration. It is a calculation that determines the efficiency of the filtration process, thus helping measure kidney functioning and to determine the stage of the chronic kidney disease. The calculation of GFR is done by a mathematical formula that compares an individual’s age, sex, race, and size to serum creatinine levels.

 

Urine Test : Albumin is a protein found in your blood. A healthy kidney doesn’t let albumin pass into the urine. A damaged kidney lets some albumin pass into the urine. This test is done to check if there is any damage in Kidneys

 

Imaging Test : If a structural problem or blockage is suspected, imaging of the kidneys can be helpful. Imaging techniques such as an ultrasound, CT scan or kidney biopsy is advised to decide further.

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Types of Treatment for Kidney Disease

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If there are any symptoms of kidney disease, it is always better to get checked and discuss with your Nephrologists to understand further on the choices of treatment options available. Kidney disease can get worse over time, and which may lead to kidney failure. If less than 15% of your kidney is working normally, then it is considered as kidney failure. During this time, the body may experience fluid retention, as excess build up of waste products and water accumulates. There are three treatment options available to filter the blood, hemodialysis, peritononeal dialysis and kidney transplant. Conservative management is also advised, which doesnt require dialysis or transplant. But above choices are advised only by the Nephrologist, who examines the patient in detail, and advice according to their body symptoms and conditions

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​Hemodialysis : It is a type of treatment to filter waste and water from the body, through a machine called dialyzer, which is also called artificial kidney. It helps to control blood pressure and balance important minerals such as potassium, calcium, sodium in the blood. During hemodialysis, the blood is pumped through a filter, called  dialyzer. The dialysis machine pumps blood through the filter and returns the blood to the body. During the process, the dialysis machine checks blood pressure and controls how quickly blood flows through the filter fluid is removed from the body. Your Nephrologist will monitor the dialysis, and will test your blood frequently to check the balance of minerals, weight gain / loss in the body, which reflects in the overall health.

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Dialysis will help improve energy level, and with renal diet and limiting water or liquid intake, it can help keep too much fluid from building up in your body between treatments. Dialysis technicians, nephrologists, dieticians, will always be available to monitor and help during this phase. Depending on the extent of kidney disease, the frequency of dialysis that is needed per we, the nephrologists will advice the sessions accordingly.

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Vascular access surgery

 

One important step before starting hemodialysis treatment is having minor surgery to create a vascular access. This vascular access will be your lifeline through which you’ll connect to the dialyzer. Dialysis moves blood through the filter at a high rate. Blood flow is very strong. The machine withdraws and returns almost a pint of blood to your body every minute. The access will be the place on your body where you insert needles to allow your blood to flow from and return to your body at a high rate during dialysis.

 

Three types of vascular access exist

• an arteriovenous (AV) fistula

• an AV graft

• a catheter

 

Your nephrologist will discuss on the type of access you need and plan for this surgery. It approximately takes 6 weeks for the access to develop or mature, so you can start having dialysis through this access. This access is your lifeline. When blood is flowing through your access and your access is working well, you can feel a vibration over the area.

If your kidney disease has progressed quickly, or you have not had a vascular access placed before you need dialysis, you may need a venous catheter—a small, soft tube inserted into a vein in your neck, chest, or leg near the groin—as a temporary access.

 

Peritoneal dialysis (PD)

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PD is a treatment that uses the lining of abdomen (belly area), called peritoneum, and a cleaning solution called dialysate to clean the blood. Dialysate absorbs waste and fluid from the blood, using peritoneum as a filter. During PD, the abdomen is filled with dialysate leaving it for a period of time. After which it is drained and disposed, and again abdomen is refilled with fresh dialysate. This process of draining used dialysate and refilling your abdomen with fresh dialysate is called an exchange. Each exchange (drain and refill) usually takes between 30 and 40 minutes. One benefit of PD is that it is not done in a dialysis center.. Pd's are done at a clean, sterile place at your home. This can allow you more freedom to work, travel or do other activities you enjoy without worrying about scheduling dialysis appointments.

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Kidney Transplant Surgery

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A kidney transplant surgery is a permanent solution for a patient who is diagnosed with kidney failure. It is a procedure in which a healthy kidney from a donor is placed in the patient's body. This newly donated organ does the role of kidneys the body requires. The donated kidney can come from someone you don’t know who has recently died (deceased / cadaver donor), or from a living person—a first degree relative ( parents / spouse / children / siblings )  Due to the shortage of kidneys, patients on the waiting list for a deceased donor kidney may wait many years. By opting for transplant surgery, the patients may feel relieved from dialysis and have better quality of life. But they have to take life-long immunosuppressive drugs and keep the new transplanted organ from rejection.  

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An Incision is made in your abdomen and the donor kidney is placed either  your left or right groin near the bladder inside. Arteries and Veins from Donor kidney are connected to the recipient arteries and veins. This will allow the blood to flow through the new kidney.  The old kidneys are left in the body  and they are not removed unless it is extensively damaged like in case of cancer or other infections.

Blood flows through the new kidney and the urine produced drains directly into the urinary bladder. Your vital signs are monitored continuously until you are stable and then you are shifted to the room. Most of the recipients stay in the hospital for 7-8 days and the donor stays for 4-5 days.

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The new kidney may start to clear waste from the body immediately, or it may take up to a few hours / days before it starts functioning. Kidneys donated by family members usually start working more quickly than those from deceased donors. Your surgeon / nephrologist will put you on a strict schedule of immunosuppressant drugs to stop your body from rejecting the new kidney. You’ll need to take these drugs every day for the lifetime to prevent your body from rejecting the donor kidney. During the first few weeks of discharge, you will need to take blood tests to check the kidney functions. After about 3 months, the visits are reduced to once a month, which is again reduced subsequently, depending on your health stats. This healthy kidney does the routine job, like your normal kidneys would do. Thus this surgery gives more freedom and a better quality of life to patients than being in dialysis. Patients of all ages - children to seniors can have this surgery. Healthy body condition for the surgery is the only main requirement for this transplant.

 

Kidney Transplant Tests

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Every person being considered for transplant will get a full medical ( clinical / radiological ) and psychosocial evaluation to make sure they are a good candidate for transplant.  The evaluation helps to find any underlining medical problems, so they can be corrected before transplant.  Careful evaluation is needed to understand and treat any other symptoms or illness, like Diabetes, Smoking, Other Infections etc. ​Most important test would be the Blood Type, HLA - Tissue Type and Cross Match

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Blood typing is the first blood test that will determine if your blood is compatible with the potential donor's blood. If the donor's blood type works with your blood type, the donor will take the next blood test (tissue typing). Kidney donors must have a compatible blood type with the recipient.

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The following blood types are compatible:

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• Donors with blood type  A   can donate to recipients with blood types A and AB

• Donors with blood type  B   can donate to recipients with blood types B and AB

• Donors with blood type  AB can donate to recipients with blood type AB only

• Donors with blood type  O   can donate to recipients with blood types A, B, AB and O                                                                           (O is the universal donor: donors with O blood are compatible with any other blood type)

 

So,

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• Recipients with blood type  O  can receive a kidney from blood type O only

• Recipients with blood type  A  can receive a kidney from blood types A and O

• Recipients with blood type  B  can receive a kidney from blood types B and O

• Recipients with blood type  AB can receive a kidney from blood types A, B, AB and O                                                                              (AB is the universal recipient: recipients with AB blood are compatible with any other blood type)

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During your evaluation for a transplant, you’ll have blood tests to determine your human leukocyte antigen (HLA). HLA is a group of antigens located on the surface of your white blood cells. Antigens are responsible for your body’s immune response. If your HLA type matches the donor’s HLA type, it’s more likely that your body won’t reject the kidney. Each person has six antigens, three from each biological parent. The more antigens you have that match those of the donor, the greater the chance of a successful transplant.

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Once a potential donor is identified, you’ll need another test to make sure that your antibodies won’t attack the donor’s organ. This is done by mixing a small amount of your blood with the donor’s blood. The transplant can’t be done if your blood forms antibodies in response to the donor’s blood. If your blood shows no antibody reaction, you have what’s called a “negative crossmatch.” This means that the transplant will be successful. Your transplant surgeon will consider tissue typing and cross match results, and over all clinical evaluations before proceeding with surgery. This is a high risk surgery and you may need many consultations with your medical team before finalising on the surgery.

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Donor Kidneys

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It is perfectly fine for the human body to work with one kidney, and that's why family members are encouraged to donate. Most of the times, it is easier with the blood and tissue match within family, which helps to schedule the surgery at the earliest. It reduces the risk that your body will reject the kidney, and it enables you to bypass the multiyear waiting list for a deceased ( cadaver ) donor. However, a cadaver organ is a good alternative if you don’t have a family member who’s willing or able to donate a kidney. Every state maintains an Organ Registry, where patients are enrolled as waiting list, and which directly interacts with the approved transplant centres. In case of any cadaver organ available, it is allotted to the hospital based on the zone / district, and wait list of the patients. This is a detailed process, which includes declaration of brain dead, written consent of the donor family who voluntarily donate organs, pathology report of the quality of organ, emergency patients on the wait list, etc. Preference is given only for the state transplant patients who are in the wait list, and if none are willing it is given for other state patients who are on the wait list.

 

Transplant Approval Committee

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In India, Organ Transplants are governed by Transplant Act, which has a state and Nation wide registry. Any organ transplant is conducted in the state only with the approval of state transplant committee. An authorisation committee was constituted by the Government for the regulation of transplant of human organs and to prevent any commercial dealings.

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This committee consists only of  Director of Medical Education, Director of Medical and Rural Health Services, Dean of Madras Medical College ( committee in chennai ) ( Additional committee is at Coimbatore and Madurai for the whole state of TN )The approved transplant centres, submit the total legal and ethical documents of their patients to this committee. They verify all the documents, including identification, verification, notary and magistrate signatures, relationship evidence, patient and recipient affidavits, nativity, clinical documents etc, and personally interview the recipient and donor to check the final genuinity. After this process, the approval is sent to hospital and the medical team proceeds for the surgery.

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This committee as per the act, will approve only Live Donor Related Organ Transplants. Live donor is usually the first degree relative ( husband / wife / parents / brother / sister / son / daughter ) and in case first degree donors are not available, then proven second degree related donors are accepted. Unrelated Donors are not permitted , according to our Organ Transplant Laws

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Diet and Exercise after Transplant

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Nutrition or your healthy diet plays a major role after kidney transplant. It is imperative to keep a healthy weight and exercise regularly. A balanced lifestyle with nutrition and physical workouts will help prevent high blood pressure, high blood sugar, excess weight gain, and promote overall wellness and health. It also helps to cope with stress and anxiety. After transplant, you will be advised with diet low in salt and high in fiber, with a good balance of fresh fruits and vegetables, lean meats, reduced diary products, whole grains, and plenty of water. If you are allergic to certain foods, it will be discussed accordingly. Your healthcare team can help you understand which foods you should avoid – and why.

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Due to unwanted weight gain, it’s important to make healthy food choices and stick to appropriate portion sizes. It may be good to avoid fatty foods and foods high in simple sugar. Check with your doctor before exercise. Most often, you may need to exercise 3-4 times a week for 20-30 minutes each time. Good nutrition is the key to good mental and physical health. Eating a balanced diet is an important part of good health for everyone. The kind and amount of food you eat affects the way you feel and how your body works. 

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