The kidneys are bean-shaped organs probably the size of your fist located in the middle of your back on both sides, and their main job is to filter the circulating blood and remove the waste products through urine. But this is not the only thing they do. The kidneys perform a wide range of functions apart from filtering the blood which includes assistance to the formation of red blood cells, control of blood pressure, strengthening of bones, aiding the sugar metabolism in the body and many more.
A kidney disease means that the kidneys are damaged and can not filter blood as they should. This damage can cause wastes to build up in the body. It also can cause other problems that can harm your health. The term 'chronic’ indicates the irreversibility to the normal state, which is opposed to 'acute kidney injury' which is a temporary phenomenon.
Kidney disease is most often caused by diabetes or high blood pressure, which usually occurs progressively at a slow pace over the years.
Uncontrolled Diabetes: Levels of blood sugar make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak, and useful protein is lost in the urine.
Uncontrolled Hypertension: This may be due to kidney disease and can also lead to kidney damage.
Still, there can be some people who have rapid deterioration of renal function. Systemic diseases affect both the kidneys at the same time, which leads to the low functional reserve.
Early detection is the first step in treating chronic kidney disease. The symptoms of kidney disease may include:
Changes in urination: Kidneys make urine, so when the kidneys are failing, the urine may change
Urine may be foamy or bubbly
You may urinate more often, or less than usual
You may urinate less frequently, or in smaller amounts than expected, with dark-coloured urine
The urine might contain blood
You may feel pressure or have difficulty urinating
Protein in urine
Urinary tract infection (UTI)
Burning sensation in urine
Swelling: Failing kidneys don't remove extra fluid. This builds up in your body, causing swelling in the legs, ankles, feet, face, and/or hands, and puffiness around the eyes.
Nausea and vomiting: A severe build-up of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.
Increased fatigue and sleepiness, decrease in appetite
Shortness of breath
Loss of appetite
Muscle cramps, especially in the legs
Excessively dry, itchy skin
Dizziness and trouble concentrating
Pain in abdomen with fever
At Max Healthcare, we offer comprehensive treatment for various urological conditions. Our state-of-the-art centres specialise in providing services in the areas of urology, uro-oncology, reconstructive urology, robotic surgery, kidney transplantation & laparoscopic andrology services, among others. Some of our exceptional services include laparoscopic urological surgery, ABO -Incompatible kidney transplant, renal transplantation, uro-oncology, reconstructive surgery of urinary tract, and laser urological procedures. In addition to this, we use intuitive surgical Da Vinci XI Robotic System to perform highly complex urological procedures like radical cystectomy, radical prostatectomy, partial nephrectomy, etc. All the urological surgeries are performed laparoscopically to ensure great precision for improved patient outcomes.
Kidney disease can be controlled and prevented if we understand the circumstances and risk factors which predispose to it. This goes a long way in preventing a patient ending up on dialysis or requiring a kidney transplant. A kidney patient, even if on dialysis or after a transplant, can lead a healthy life if adequate measures are taken. This would mean many people detected and prevented from the dangers of kidney failure and in the long term, inseparable from the others who don’t have it.
At Max Healthcare, diagnosing and testing for kidney diseases requires a complete health history of the patient along with a physical exam. The diagnosis of kidney failure usually is made by blood tests measuring BUN, creatinine, and glomerular filtration rate (GFR).
Increased creatinine equal to or more than 0.9
Low GFR (glomerular filtration rate)less than 60
Increased Urea of more than 50
A patient with end-stage kidney failure has dialysis and transplantation as the only options available for his/her survival. As and when the patients reach a stage where their kidneys fail to sustain body functions, they have to be put on regular dialysis for keeping them alive. Dialysis is a substitute for failed kidneys but does not replace kidney function. Patients on dialysis do not do well in the long run and develop some complications, which are not seen after transplantation. Patients live longer after transplantation than on dialysis. Accordingly, most people who have irreversible renal failure and are on dialysis can be considered for transplantation.
Test & diagnosis of a Donor
There are no strict age restrictions on receiving a kidney from a donor. However, the potential recipient must be in good general health and may require further investigations to assess their overall fitness before the procedure can go ahead. Each donor-recipient pair will be considered on a case-by-case basis.
Potential donors have to pass certain tests before they are declared medically fit to donate a kidney. Their blood samples are taken to measure the amount of blood group antibody present in the body. This will guide whether the transplant can take place and how much treatment is necessary before the transplant operation. If your antibodies are too high at this stage, you will need to consider the paired-exchange program.
Besides matching blood groups of the donor and recipient, we also match blood cells like T and B cells. This is called 'tissue typing' and 'cross-matching'. In both live-donor and deceased donor transplants, it is important that blood and tissue types are compatible.
Blood typing: It matches red blood cells of donor and patient and must be consistent, as for blood transfusion. Like a B blood group patient must have a kidney from the same, i.e. B blood group or O groups (universal donor).
Tissue Typing: This involves the matching of a type of white blood cell called 'lymphocyte'. These cells have special markers called antigens. It is now known that a special group of these antigens, called HLA Antigens (Histocompatibility Locus Antigens) are important for the success of transplantation. The closer the match of antigens between the patient and donor, the better will be the chance of a successful transplant.
Cross-match: Just before the transplant, blood is taken from the donor and the recipient, and mixed to ensure no reaction, i.e. negative cross match.
Open Donor Nephrectomy: The kidney is removed by 9 to 12 cm incision in the flank and the rib may be excised for better access. It is a time-tested old operation but is associated with significant morbidities like pain, pseudo hernia and prolonged convalescence. It is rarely done now. We, at our hospital, don't do this operation. This operation is more morbid, painful and associated with an ugly scan.
Laparoscopic Donor Nephrectomy: The kidney is dissected with the help of laparoscopic instruments (Keyhole surgery), and finally, it is removed by a 6 cm non-muscle cutting incision just above the pubic bones. This incision is not visible and is associated with good cosmetics. There is minimal morbidity and pain. The donor can go home after 3-4 days and can resume his work within two weeks. In female patients, the kidney can be removed through the vaginal route to avoid any incision in the abdomen to make it a very cosmetic operation. This form of kidney removal is becoming very popular, and now in the west, 95% of all kidneys are removed by this method.
Following discussion with the doctors and assessment of ABO antibody levels, a plan is drawn up detailing when the patient will need to come to the hospital for appointments and treatments.
Immunoadsorption is used to remove blood group antibodies from your blood on a machine in a process resembling a haemodialysis session. The session lasts 3-4 hours, and the number of sessions is dependent on the amount of antibodies present. Most people require 2-4 sessions, but some need a lot more.
Your blood group antibodies will be monitored during this process, and the transplant will only proceed if the antibody levels are sufficiently low. Occasionally (about 1 in 10 cases) it may not be possible to reduce your antibodies. Sometimes high levels of antibodies come back after transplantation, and further sessions of immunoadsorption are required. You will start your anti-rejection medications 4-6 days before transplantation.
Intensive Care: After your transplant operation, you will stay in Transplant ICU (KTU). It is a specialised unit in which you are closely monitored. The visiting hours may be limited, so your visitors will need to check with the nurses before coming to the hospital.
Vital Signs: The nurses will take your vital signs (blood pressure, pulse, temperature, respiratory), enabling them to assess your condition.
Intake And Output: Measurement of the amount of liquid you drink and get intravenously (intake) is compared to the amount you urinate and drain through your various tubes (output). These totals, along with your weight, give the team valuable information about your fluid balance and how well your kidneys are functioning.
Physiotherapy may be recommended to:
Minimise postoperative pulmonary complications
Minimise the deconditioning effects of bed rest
Increase general strength, endurance and flexibility
Develop and reinforce a habit of regular exercise
A) Special Ward: The transplant patients are cared for in a ward separate from other patients. It is sometimes necessary for transplant patients to be nursed in this area since medications taken to prevent rejection of the new kidney also makes patients more susceptible to infection. For this reason, the number of visitors is restricted. In transplant ICU, flowers and food from outside are not permitted, as they may transmit infection to the patient.
The patient is allowed to take liquid diet on day 1 and is allowed to do breathing exercises. He is mobilised on day 2. The Foleys catheter and drains are removed on the 5th postoperative day. The patient is usually discharged on the 7th day. The stent which is placed during surgery is removed around the 10th day as an outdoor procedure with the help of flexible cystoscopy. Stitches are also removed around the same time. If a patient has permacath, it is also removed at the same time.
B) Hospitalization: The length of stay in the hospital depends on how well the kidney works and the occurrence of any complications. The average stay is about 5 days for the donor and a week for the recipient but may vary in case of complications.
If the kidneys fail completely, the only treatment options available may be dialysis or transplant. Max Healthcare offers two options for dialysis:
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Other options depending on the severity of the disease include:
Surgery: Surgical treatments are performed depending on the condition and the stage of the disease. Some common surgical procedures are laparoscopic urologic surgery, robotic surgery, kidney transplantation and reconstructive surgery of the urinary tract.
Lifestyle Changes: In conditions such as Urinary Tract Infection (UTI), doctors recommended some lifestyle changes to the patient in the initial stages to control the symptoms. This may include limiting the amount of caffeine, quitting smoking, drinking enough water to stay hydrated and consumption of cranberry juice.
Medical Therapy: Your doctor will prescribe medications to cure the kidney disease. The medications may range from antibiotics to chemotherapy drugs, depending on the type and stage of the condition.
If kidney disease is not treated, it can lead to ESRD. This means the kidneys stop working. Once the kidneys fail, you will need dialysis or a kidney transplant to maintain health. If the kidneys fail completely, the only treatment options available may be dialysis or transplant.