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What functions do the kidneys perform?

The kidneys play central role in the maintenance of the volume and the ionic composition of the body fluids known as the homeostasis.

How do patients with renal stones present? Or What is renal colic?

Renal Colic is a manifestation of spasm of the ureter which is produced by the irritation of the stone and accompanying obstruction. The pain usually begins in the flank area and migrates towards the groin.. The pain may subsides after the stone or clot are passed and may be accompanied by a passage of blood in the urine. If infection occurs incurs then it leads to fever, difficulty in urination and increase frequency of urination.

What necessitated the passing of the Organ Donation Act in India?

The act was passed to curb the commercial purchase of kidneys. The situation was exploited by middlemen resulting in very little remuneration to the donor who was usually from a low socioeconomic status. In addition there were instances when kidneys were removed from patients without their knowledge. The act also defined the criteria for brain death in order to encourage cadaveric donation.

What is the importance of the blood group in kidney transplant?

Matching of the blood groups is an absolute pre–requisite for kidney transplantation. The following guidelines are used. However the following matches are also feasible:

Donor Blood Group Donate To
A A, AB
B B, AB
AB AB
O A, B, AB, O

The Rh–typing of the blood need not be the same. For eg : from a mother who is B(+)ve to a patient daughter who is B(–)ve.

What is the concept of kidney “Matching” in kidney transplantation?

In addition to the blood group HLA matching is done. HLA (human leukocyte antigens) are proteins present on white blood cells that are the products of closely linked genes on chromosomes no 6. There are more than 100 such identifiably proteins. They are divided into different classes A, B C and D and DR. For each of these subgroups the matching is done.

Can a kidney be transplanted if there is not a single match?

This situation does arise. It is called “Zero” match. Transplant surgeons weigh the merits of the necessity and make the decision.

What are the medicines usually taken by transplant patients after their transplant?

Usually after a transplant the patients are placed on medicines to prevent the kidney from being rejected. A three drug regimen is used. Cyclosporine, prednisone (a steroid), mycophenolate mofetil or azathioprine.

What are the infections that can take place in the Renal transplant patients?

The transplant patients has the ability to fight infections is low. Actually 75% of the renal transplant patients will suffer at least one episode of infection in the 1st year after transplant. The infection seen in the transplant patient are different than those seen in the general community. The initial infections are in the first one month after transplantations are usually bacterial. After the first month however viral infections such as cytomegalo virus, fungal infections, tuberculoses and parasitic infections are common.

What is the survival rate of a kidney after transplant?

The first year survival for a living related kidney donation is about 85–90% for cadaveric is about 80%.

What are the side effects of the drugs used in kidney transplant?

Steroids: for a long period of time can result in high blood pressure, weight gain, abnormalities in the glucose levels cushings syndrome, cataracts.osteoprosis and fractures. Cyclosporin can also have an adverse affect like aggravating the hypertension because excessive hair growth excessive gingival growth. It can also be toxic to the kidney especially if the levels are not monitored. Cell cept has effects on suppressing the bone marrow and the patients can have anemia, a low white cells count or and low platelet count. Cell cept can also cause diarrhoea.

What is acute renal failure?

An acute deterioration of the kidney function which may be reversible is called acute renal failure.

What causes acute renal failure?

From low blood pressure causing decreased blood supply to the kidney: Can be seen in a variety of conditions From excess loss of fluid from the body as in vomiting diarrhea, excess bleeding (hemorrhage) usually after surgery, burns.

Injury to the kidney from drugs such as antibiotics or dyes or abnormal proteins as in myeloma. Used for imaging purpose.. Some antibiotics caused direct injury (e.g. Gentamycin) while others cause are due to drug allergy called interstitial nephritis (e.g. sulfa drugs). Obstruction to the flow of urine as in prostate enlargement, stones, or cancers constricting ureters.

Can acute renal failure be fatal?

Yes. ARF is a serious condition. In hospital admitted patients the mortality is as high as 50%.

How is ARF detected?

ARF is detected when there is an abrupt decrease in the urine output and there is a rise in the creatinine. The symptoms will depend on the underlying condition that caused it. For E.g. in excess vomiting the patient will present with signs and symptoms of volume depletion.

Is there any treatment for acute renal failure?

The treatment of ARF is directed at the underlying cause. In volume depleted patients the blood pressure should be raised by giving fluids. blood etc. The offending drug has to be identified and stopped. In some cases dialysis may have to be started which usually is temporary.

Does a patient with CRF require any vitamin supplements?

The diet should be supplemented with vitamins B, vitamins C and also folic acid. Vitamin D should be reserved for those for treatment with severe Renal Osteodystrophy. It is a condition which result from low calcium in the blood which stimulates secretion of a hormone called as PTH which acts on the bone. These patient will usually have low calcium and a high phosphorous. These patients should be treated with calcium supplements.

Is there is any restriction on intake of potassium?

The patients should be watchful about their intake of potassium. High potassium containing foods like bananas, tomatoes, oranges, fruit juices should be avoided.

How much water am I permitted if I have chronic renal failure?

Intake of water should be based on the individual requirements as assessed by the physician. It is important to note that the patients with chronic renal failure are sensitive both to volume expansion and contraction and therefore should have regular follow up with the physicians. Generally mild fluid restriction is advised about 1–1.5L/day.

How important is it to control the blood pressure in CRF?

The treatment of hyper tension is extremely important as studies are shown that the control of hypertension slows the process of chronic renal failure.

What is the cause of anemia in CRF?

It is related to the deficient Erythropoeitin production. Erythropietin stimulates the bone marrow to produce red blood cells.

Is there any treatment for the anemia?

Erythropoeitin injections can be used to treat the anemia. It is important to evaluate the iron status prior to starting these injections.

What are the different treatments available for the treatment of end stage renal failure?

The following methods are available

When is dialysis initiated in a patient with CRF?

Current recommendations are to initiate dialysis early i.e. when the kidney function falls below 25% of normal as measured by the creatinine clearance. It is not considered prudent to wait till symptoms of advanced renal failure have set in such as nausea, vomiting, or fluid accumulation in the lungs.