Chronic Kidney Disease

also known as chronic renal disease a progressive loss in renal function over a period of months or years Common causes: 1. Diabetes Mellitus 2. Hypertension 3. Glomerulonephritis

Stages of Chronic Kidney Disease

Stage 1- has kidney damage with a glomerular filtration rate at a normal or high level greater than 90 ml/min. Symptoms: no symptoms to indicate the kidneys are damaged. Stage 2- kidney damage with a mild decrease in their GFR of 60-89 ml/min Symptoms: Blood or protein in the urine

Stages of Chronic Kidney Disease

Stage 3- has kidney damage with a moderate decrease in the GFR of 30-59 ml/min Symptoms: Fatigue, change in urination, kidney pain and sleep problems

Stage 4: has advanced kidney damage with a severe decrease in the GFR to 15-30 ml/min. Symptoms: Nausea, taste change, uremic breath, loss of appetite, difficulty in concentrating, nerve problems

Stages of Chronic Kidney Disease

Stage 5- End Stage Renal Disease (ESRD) -GFR of 15 ml/min or less. At this advanced stage of kidney disease Symptoms: Loss of appetite, nausea or vomiting, headaches, being tired, being unable to concentrate, itching, making little or no urine, swelling, especially around the eyes and ankles muscle cramps, tingling in hands or feet, changes in skin color, increased skin pigmentation

1. Hemodialysis-requires that an access be created to get the blood from the body to the dialyzer (artificial kidney) so it can be cleaned and then go back into the body.

Dialysis

2. Peritoneal dialysis- a catheter access is placed in the abdomen. PD is performed by running dialysate solution through the catheter into the peritoneum and then removing the solution after a time and replacing it with new dialysate.

Dialysis

Kidney Transplant
replacement of nonworking kidneys with a healthy kidney from another person (the donor). The healthy kidney takes over the functions of the nonworking kidneys. a person can live normally with only one kidney as long as it functions properly.

Kidney Donor Classification

1. The Living Donor Sometimes family members, including brothers, sisters, parents, children (18 years or older), uncles, aunts, cousins, or a spouse or close friend may wish to donate a kidney. That person is called a "living donor." The donor must be in excellent health, well informed about transplantation, and able to give informed consent. Any healthy person can donate a kidney safely.

Kidney Donor Classification

2. Deceased Donor A deceased donor kidney comes from a person who has suffered brain death. The Uniform Anatomical Gift Act allows everyone to consent to organ donation for transplantation at the time of death and allows families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected.

Nephrectomy
1. Open incision- standard for the removal of the donated kidney. It involves a 5-7 inch incision on the side, division of muscle and removal of the tip of the twelfth rib. The operation typically lasts 3 hours and the recovery in the hospital averages 4-5 days with time out of work of 6-8 weeks.

Nephrectomy 2. Laparoscopic- performed under general anesthesia, uses

very small incisions, a thin scope with a camera to view inside of the body, and wand-like instruments to remove the kidney. Pros: Decreased need for strong pain medications Shorter recovery time in the hospital Quicker return to normal activities Very low complication rate The operation takes 2-3 hours. Recovery time in the hospital is typically 1-3 days. Donors often are able to return to work as soon as 2-3 weeks after the procedure.

Nephrectomy
Open Incision Laparoscopic

Blood Type Testing

Transplant Evaluation Process

The first test establishes the blood type. . The recipient and donor should have either the same blood type or compatible ones, unless they are participating in a special program that allow donation across blood types. The list below shows compatible types: If the recipient blood type is A Donor blood type must be A or O If the recipient blood type is B Donor blood type must be B or O If the recipient blood type is O Donor blood type must be O If the recipient blood type is AB Donor blood type can be A, B, AB, or O

Transplant Evaluation Process

Tissue Typing
The second test, which is a blood test for human leukocyte antigens (HLA), is called tissue typing. Antigens are markers found on many cells of the body that distinguish each individual as unique. These markers are inherited from the parents. Both recipients and any potential donors have tissue typing performed during the evaluation process. To receive a kidney where recipient's markers and the donor's markers all are the same is a "perfect match" kidney. Perfect match transplants have the best chance of working for many years. Most perfect match kidney transplants come from siblings.

Crossmatching

Transplant Evaluation Process

Throughout life, the body makes substances called antibodies that act to destroy foreign materials. Individuals may make antibodies each time there is an infection, with pregnancy, have a blood transfusion, or undergo a kidney transplant. If there are antibodies to the donor kidney, the body may destroy the kidney. For this reason, when a donor kidney is available, a test called a crossmatch is done to ensure the recipient does not have pre-formed antibodies to the donor . The crossmatch is done by mixing the recipient's blood with cells from the donor. If the crossmatch is positive, it means that there are antibodies against the donor. The recipient should not receive this particular kidney unless a special treatment is done before transplantation to reduce the antibody levels. If the crossmatch is negative, it means the recipient does not have antibodies to the donor and that they are eligible to receive this kidney.

Transplant Evaluation Process

Serology
Testing is also done for viruses, such as HIV (human immunodeficiency virus), hepatitis, and CMV (cytomegalovirus) to select the proper preventive medications after transplant. These viruses are checked in any potential donor to help prevent spreading disease to the recipient.

Phases of Transplant Pre-transplant Period

Time that a patient is on the deceased donor waiting list or prior to the completion of the evaluation of a potential living donor. The recipient undergoes testing to ensure the safety of the operation and the ability to tolerate the anti-rejection medication necessary after transplantation. The type of tests varies by age, gender, cause of renal disease, and other concomitant medical conditions. These may include, but are not limited to: General Health Maintenance: general metabolic laboratory tests, coagulation studies, complete blood count, colonoscopy, pap smear and mammogram (women) and prostate (men) Cardiovascular Evaluation: electrocardiogram, stress test, echocardiogram, cardiac catheterization Pulmonary Evaluation: chest x-ray, spirometry

Transplant Surgery

Phases of Transplant

The transplant surgery is performed under general anesthesia. The operation usually takes 2-4 hours. This type of operation is a heterotopic transplant meaning the kidney is placed in a different location than the existing kidneys. The kidney transplant is placed in the front (anterior) part of the lower abdomen, in the pelvis.

Phases of Transplant
Transplant Surgery (cont.)
The artery that carries blood to the kidney and the vein that carries blood away is surgically connected to the artery and vein already existing in the pelvis of the recipient. The ureter, or tube, that carries urine from the kidney is connected to the bladder. Recovery in the hospital is usually 3-7 days.

Post Transplant Period

Phases of Transplant

The post transplant period requires close monitoring of the kidney function, early signs of rejection, adjustments of the various medications, and vigilance for the increased incidence of immunosuppression-related effects such as infections and cancer. Just as the body fights off bacteria and viruses (germs) that cause illness, it also can fight off the transplanted organ because it is a "foreign object." When the body fights off the transplanted kidney, rejection occurs.

Anti-Rejection Medications
also known as immunosuppressive agents, help to prevent and treat rejection. They are necessary for the "lifetime" of the transplant. If these medications are stopped, rejection may occur and the kidney transplant will fail.

Anti-Rejection Medications
Anti-inflammatory Medication Anti-proliferative Medications Cytokine Inhibitors Antilymphocyte Medications