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 patientís 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 patientís abdomen through a plastic tube known as PD catheter; this fluid is kept inside the patientís 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 patientís 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 donít 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.