THE NEED FOR KIDNEY TRANSPLANTATION
Dr. V. N. Unni, MD, DM, DNB
Chairman, Nephrology Services
Amrita Institute of Medical Sciences, Kochi
Kidneys are a pair of bean shaped organs, which weigh about 150 grams
each in an adult. Each kidney measures about 11 x 6 x 3 centimeters in size, and
are situated inside the abdomen on either side of the vertebral column; these
are principal excretory organs of our body. Proper functioning of the kidney is
essential for normal healthy living. The most important function of the kidney
is to remove the waste products from blood and excrete them through
urine. Maintenance of salt and water balance, control of blood pressure,
stimulation of production of red blood cells by the bone marrow, production of
active form of Vitamin D (needed for normal bone growth and development) are
some of the other functions of kidneys. Hence kidney failure leads to
dysfunction of many other organ systems in our body. Patients with kidney
diseases may have different symptoms. Swelling of the face and feet, decrease in
urine output, presence of blood in the urine, rise in blood pressure, anaemia,
loss of appetite, nausea, vomiting and breathlessness may occur. However some
patients may not have significant symptoms until late in the course of the
disease; blood and urine tests are required in these subjects to ascertain the
nature and severity of the renal disease. Kidney diseases can be
excluded by doing certain inexpensive blood and urine tests. Kidney failure can
result from many types of diseases. There are two types of kidney failure. 1)
Acute Renal Failure :- Thispotentially reversible type of failure which is of
sudden onset, occurs due to bacterial infections, rat fever, malaria, snake
envenomation, loss of blood or fluid from the body, intake of heavy metals and
certain drugs. Majority of these patients are likely to recover with proper
treatment. Some of them may need dialysis for a short period. Chronic Renal
Failure :- Slow and insidious in onset but invariably progressive in nature,
this type of kidney failure occurs due to long standing diabetes mellitus,
uncontrolled blood pressure, a disease known as chronic glomerulonephritis,
obstruction to urinary tract, and certain inherited diseases. Diabetes mellitus
is probably the commonest cause of Chronic renal failure in our country today.
About a third of patients who are diabetic, develop diabetic kidney disease
(diabetic nephropathy) about fifteen years after the onset of disease. The
incidence of kidney disease is more in patients with uncontrolled blood pressure
and very high blood sugar levels. Glomerulonephritis is a disorder which
commonly occurs in young people; in these patients proteins known as
immunoglobulin get deposited in the kidney and causes deterioration of kidney
function. Stones, tumors and infections in urinary tract can also lead on to
kidney failure. Long term and repeated courses of some drugs like painkillers
and heavy metals can result in dysfunction of kidneys. Depending on the type and
severity of the renal disease, patients would need to have certain dietary
restrictions, medicines to control blood pressure and blood sugar and certain
modes of supportive treatment. In the initial stages of kidney failure, patients
can be treated with dietary restrictions and medications. However when more than
ninety percent of kidney functions is lost, these patients need dialysis or
kidney transplantations. This stage is called end stage renal disease. It has
been estimated that around 100,000 new patients develop end stage renal disease
in our country every year. In order to sustain life these patients need life
long dialysis or kidney transplantation. Dialysis : This is a mode of treatment
where in waste products from the patients blood are removed using a machine.
Haemodialysis (HD) is a therapeutic procedure in which the patient’s blood is
passed through a filter known as artificial kidney; this kidney purifies blood
and the clean blood is returned to the patient. Thus the artificial kidney
removes the excess of water and solute that have accumulated in a patient with
kidney failure. In peritoneal dialysis (PD), a particular solution called the
peritoneal dialysis fluid is passed into the patient’s abdomen through a plastic
tube known as PD catheter; this fluid is kept inside the patient’s abdomen for a
period of time and then drained out; this process has to be repeated three or
four times a day. A thin membrane (Peritoneum) which covers our intestines act
as the filter to purify the blood which passes through small blood vessels
called capillaries. The main advantage of this form of dialysis known as CAPD
(Continuous Ambulatory Peritoneal Dialysis) is that this procedure can be done
at home by the patient or his relatives. Kidney Transplantation :- The ideal
treatment for patients with end stage renal disease is transplantation if they
are medically fit for the procedure. Usually patients below 65 years of age who
do not have any other systemic diseases,
cancers or infections can be considered for transplantation. As per our law,
kidney can be donated by the patient’s near relatives (parents, siblings, spouse
or children). Any healthy adult between 20 and 60 years of age who does not have
any medical illness can safely donate one of his kidneys to his near relative.
Kidney donation has been in vogue for the last fifty years and is considered to
be safe procedure and an act of extreme altruism. Patients who don’t have a
suitable near relative as the kidney donor, can hope for a transplantation if
cadaver organ donation is promoted and encouraged in our country. Persons who
suffer an irreversible damage to the brain may be pronounced as brain dead after
a detailed evaluation by a team of doctors. Donation of organs from brain dead
persons is termed as cadaver organ donation. This concept of organ donation
after brain death has been legalized about thirty years back and is carried out
in almost all countries. The Indian Parliament passed the Human Organs
Transplantation Act in 1994, wherein the cadaver organ donation and
transplantation is legalized; the Government of Kerala notified the Act in 1996.
However, there seems lack of awareness about this concept amongst our people. By
donating our organs after our death to our unfortunate fellow human beings who
suffer from organ failure, we would be committing an extremely noble and humane
act. Our organs which are not needed for us after our death, can give light and
life to some of our brethren in our community, who have organ failure.