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Life After Kidney Transplant

The Technological advances in transplantation have enabled thousands of procedures that benefit organ and tissue recipients worldwide. Transplantation benefits patients who need solid organs, tissues and cells by means of the development and improvement of surgical techniques, inputs, equipment and immunosuppressive drugs needed to this therapy. The number of kidney transplant performed has increased significantly.

In most situations these procedures are presumed as the only resource for sustaining life. However, this treatment option is not always available for those who are waiting for organ transplantation because it requires a donation.

Kidney transplantation requires compatibility between tissues obtained for the Human Leukocytes Antigen typing (HLA).While waiting for a donor, the chronic renal disease patients have other forms of Renal Replacement Therapy (RRT) which allow the maintenance of their life and also justify the increasing number of patients registered on the waiting list for kidney transplantation.

Renal Insufficiency and the complications associated with its treatment constitute a serious public health problem worldwide, with social and financial burden resulting from increasing rates of young patients with renal function failure.

A number of diseases are capable of destroying renal function in all age groups. The most common causes for renal disease leading to kidney transplantation are the following:

Diabetes -31%

Chronic glomerulo nephritis -28%

Polycystic kidney disease -12%

Nephrosclerosis ( Hypertensive)-9%

Systemic lupus Erythematosus (SLE)-3%

Interstitial nephritis -3%

Thus, measurement of the patient’s quality of life after kidney transplantation is a relevant topic for many individuals who are on dialysis and receive care in a dialysis center.

Renal transplantation is the best therapeutic option for patients with chronic kidney disease. The surgical procedure is relatively simple, and post transplantation certain actions are necessary such as the use of immunosuppressive drugs and the outpatient follow-up. Therefore for these patients, the clinical management, the evaluation of treatment results and impacts on quality of life are important issues.

Health –related quality of life contains multiple aspects of health related issues from the patient’s perspective including physical, psychological and social functioning and overall well being. Numerous clinical trials have established the importance of health related quality of life in various diseases and it is increasingly popular to evaluate disease specific health related quality of life as a measure of patient’s subjective state of health.

Kidney transplantation is the treatment of choice for end stage renal disease (ESRD). Advances in renal transplant procedures and immunosuppressive therapies have increased dramatically the survival over the last decades, one year allograft survival rates are currently over 90%.

The major goal of transplantation is the achievement of maximal quality and quantity of life while minimizing the effects of disease.

In renal transplantation the costs are not only limited to the transplant procedure but also to the evolving costs to treat adverse events, some of them caused by the immunosuppressive therapy.

Since the first successful kidney transplantation as early as the early 1950s, immunosuppressive therapies improved considerably, the most revolutionary development being the introduction of cyclosporine in the early 1980s. The introduction of new immunosuppressive agents has further increased the therapeutic options for immunosuppressive combination therapies in transplanted patients.

In parallel to better patient care and new immunosuppressive regimens the median survival of renal allograft improved continuously. Hand in hand with these achievements, greater attention has been given to long term quality of life. It is generally accepted however, that patients with a functioning renal allograft have a improved health-related quality of life as compared to patients on dialysis.

Summary Points:

·         The global burden of End Stage Renal Disease is increasing.

·         Renal transplantation increases patient survival and quality of life and reduces the cost of care for patients with End stage renal disease.

Longer life with a transplant

On the other hand, patients who receive a kidney transplant typically live longer than those who stay on dialysis. A living donor kidney functions, on average, 12 to 20 years and a deceased donor kidney from 8 to 12 years.

·         Most donor kidneys come from ‘brain death’ or ‘cardiac death’ donors, but donations from living donors are increasing.

·         Pre-emptive transplantation from a living donor is the best treatment choice for patients with end stage renal diseases and has been associated with improved allograft and patient survival. ***

·         Long term outcomes in kidney transplantation are improving

·         Better Quality of life

Even though kidney transplant is major surgery with a phased recovery period, it can, in comparison to dialysis, offer you the opportunity for a longer, more satisfying life. Most patients who have been on dialysis and then had a transplant report having more energy, a less restricted diet and fewer complications with a transplant than if they had stayed on dialysis. Transplant patients are also more likely to return to work after their transplant than dialysis patients.

*** Data from the Organ Procurement and Transplantation Network for transplants performed in 2002-2004 show that the 1-year survival rate for grafts from living donors is approximately 95% and the rate for deceased donor grafts is approximately 89%. The half life for grafts from living donors increased steadily from 12.7 to 21.6 years.

Preemptive transplantation refers to kidney transplantation before a patient needs to start dialysis therapy. Patients who get a preemptive transplant receive their kidney when their health is generally good, which can improve new kidney function and enhance overall health and life expectancy.

                                Epidemiological data from the past decade suggest that the global burden of the patients with renal failure who receive renal replacement therapy exceeds 1.4 million and that this figure is growing by 8% a year.

Transplantation is the renal replacement modality of choice for patients with diabetic nephropathy and pediatric patients.

PRETRANSPLANT EVALUATION:

Candidates for renal transplantation undergo and extensive evaluation to identify factors that may have an adverse effect on outcome.

Mostly, all transplant centers have a committee that meets regularly to discuss the results of evaluation in a patient and select medically suitable candidates only to place on the waiting list.

In addition to a thorough medical evaluation the committee also evaluates the social background of the patient to determine conditions that may interfere with the outcome of transplantation, such as financial and travel restraints or a pattern of noncompliance.

Laboratory Studies in transplant candidatesInfectious profile in transplant candidates
Blood ChemistriesHepatitis B And C serology’s
Liver function testsEpstein –Barr Virus, serology (IgM and IgG)
Complete Blood Count (CBC)Cytomegalovirus (CMV) serology’s (IgM and IgG)
Coagulation  ProfileVaricella –zoster virus, serology’s (IgM and IgG)
 Rapid plasma reagin (RPR) test for syphilis
 HIV
 Purified protein derivative (PPD)- tuberculosis skin test

Urine analysis, Urine culture and cytospin should be ordered when indicated.

A complete cardiac workup and immunologic evaluation (ABO blood group determination, Human Leukocyte Antigen (HLA) typing, serum screening for antibody to HLA phenotypes, cross matching) are also done.

Management

In addition to the surgical transplantation procedure itself, management includes the following:

·         Organ procurement

·         Provision of immunosuppressive therapy to the recipient

·         Short and long term follow-up to look for indications of renal allograft dysfunction and other complications

Organ Procurement

·         Identification of potential donors

·         Assessment of donor suitability

·         Determination of donor brain death

Immunosuppressive therapy after transplant

All kidney transplant recipients require life-long immuno suppression to prevent a T-cell alloimmune rejection response. The goals are as follows:

·         Prevent acute to chronic rejection

·         Minimize drug toxicity and rates of infection and malignancy

·         Achieve the highest possible rates of patient and graft survival

The critical considerations in medical follow up are as follows:

·         Rejection

·         Nephrotoxicity of calcineurin inhibitors (i.e. cyclosporine, tacrolimus)

·         Recurrence of native kidney disease

Transplant recipients tend to be highly experienced patients. Many dealt with their chronic illness for years have been treated and examined by innumerable doctors, have undergone dialysis and its attendant intrusions on their lifestyle, have managed a complicated regimen of medications and have (in many cases) developed a certain expertise related to their own care.

Such patients are invariably grateful for any recognition or acknowledgment of their ordeal. Thus, it is advisable that they are educated about and encouraged to participate actively in their disease management to the fullest possible extent. That said, these patients problems are often complex and decisions regarding their care should be made after consulting the appropriate transplant team.

It is worthwhile to mention-

·         Till date, more than 250,000 kidney transplants have been performed in United States alone.

·         In 2007,6037 kidney transplants were performed from living donors and 10,082 from deceased donors.

·         Currently more than 100,000 people in the United States are living with the functioning kidney transplant.

This number represents 27% of the nearly 350,000 persons enrolled in the US ESRD program.

In1973, congress enacted Medical entitlement for ESRD treatment to provide equal access to dialysis and transplantation for all patients with ESRD in the Social security system by removing the financial barrier to care.

Currently, the main obstacle is donor organ shortage. An increasing rise in ESRD coupled with a lack of donor organs has resulted in an average waiting time of more than 4 years for a deceased donor renal transplant.

The social factors and the perception of the complications of donation by the donor, family members or even the recipient can affect the act of voluntary donation. In India, the Human Organ Transplantation Act of 1994 and its amendments discourages unrelated transplant due to ethical reasons and to avoid exploitation of the financially disadvantaged people.

The latest statistics says that the donors volunteer themselves for transplant evaluation in 28% of the cases and in the rest, it is either requested by the recipient or suggested by the recipient’s physician.

Of all the donors who come for evaluation, 46 (22%) report at least one instance of an attempt to discourage donation and donor’s spouse is the commonest (47.8%) identified cause. Similarly the commonest cause for some of the possible donors declining to even come forward for donor evaluation is again the spouse refusing to give consent.

This emphasizes the fact that the donor’s spouse is always a part of decision making along with the donor to alley some of the fears associated with donation.

It takes courage to ask others for help- and there’s no bigger ask than asking for a kidney and it is always good to help others and there is no greater help than donating an organ and giving a new lease of life to someone.

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How to Keep Your Kidneys Healthy

Kidneys maintain a balance of bodily fluids and control the formation of urine to excrete toxins. The right kidney is situated a little lower than the left one. They are placed in the upper abdominal cavity touching the back muscles as support. Kidneys play an important role in waste excretion, blood pressure regulation, water level balancing, acid regulation and the formation of red blood cells. Therefore, it is very important to keep our kidneys clean and healthy so that all these functions can be performed smoothly. Here are few things you can ensure to help your kidneys function well:

1. Drink lots of water

Water helps in detoxifying the body and flushes out toxins. It is also one of the simplest ways to keep the kidneys clean. It dilutes the minerals that can cause harm and helps in their excretion. Drinking water with baking soda may help in relieving discomfort caused due to infections in the urinary tract.

Drinking lime water helps in the filtration of blood. Dr. Varun Verma, Senior Consultant (Nephrology) at Fortis Hospital in Faridabad suggests that you must drink at least 2 liters of water every day. He says, “Start your day with 2 glasses of water and end your day with a glass of water. If you have stones in the kidneys, you should drink at least 3 liters of water daily”. 

2. Have less salt, sugar and soy

The sodium in salt increases the calcium content in the body which has a negative effect on the kidneys. Excess calcium in the body may lead to the formation of stones. Similarly, too much sugar absorbs more calcium and magnesium which also contributes to kidney stones. Soy and soy-related products may have a high content of oxalate that can be harmful for the kidneys. According to Dr. Verma, Indian meals contain 25-30 grams of salt in our daily diet, while one shouldn’t consume more than 5-10 grams. 

3. Have a teaspoon of apple cider vinegar early morning

Apple cider vinegar is known for its antioxidant properties that fight oxidative stress and it also helps in controlling your blood pressure and sugar levels in the body. 

4. Exercise regularly

Any form of exercise is good for you as it it keeps the heart healthy, burns unwanted fat and helps with the flow of blood to other organs which includes the kidneys. Dr. Deepak Kalra from the Nephrology Department at Fortis Hospital stresses on maintaining your weight, “It’s important to eat healthy, drink healthy and maintain a healthy body weight for your kidneys to be able to function well.”

5. Cut caffeine 

Coffee has its benefits, but excess intake of caffeine can harm your health. Caffeine tends to dehydrate your body and absorb all the moisture which can lead to kidney stones.

6. Eat green vegetables and avoid meat

The minerals present in green vegetables reduce the oxalate levels in the body that can have a damaging effect on your kidney. One should also avoid consuming too much meat and shellfish as they may contain harmful uric acid that can affect the functioning of the kidneys.

7. Eat berries and beets

Berries are a powerful source of antioxidants which help prevent the risk of kidney diseases. Strawberries, blueberries, raspberries and blackberries are great for your kidneys. Similarly, beetroots contain betaine which is an antioxidant that helps in the removal of calcium phosphate build-up and increases the acidity of urine. The iron, magnesium and folate present in beetroots helps in the flow of blood.

Apart from these simple tips, people who are diabetic need to take extra care as it can affect their kidneys. In fact, it is recommended, that every individual above the age of 50 years should undergo a full body check-up twice a year and those who are younger should get it done at least once a year. 

Source: http://food.ndtv.com/health/how-to-keep-your-kidneys-healthy-1707050

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Detoxing your organs

What Is a Kidney Cleanse?
If you consume adequate fluids, which can take the form of foods such as fruits and vegetables as well as water and other liquids, the kidneys are self-cleansing.

A number of products, foods, or specialized diets (typically marketed under the term “kidney cleanse”) claim to detoxify the kidneys in order to promote healthy kidney function and prevent kidney stones. Kidney cleanses are also purported to help keep blood pressure in check, improve the functioning of the urinary tract and bladder, boost immunity, and clear toxins from the entire body.
Other kidney cleanses emphasize certain foods, including:

Beet juice
Watermelon
Lemon juice
Cranberry juice
Pumpkin seeds
Smoothies
Ginger
Turmeric
Caring for Your Kidneys
Here are several science-supported methods for caring for your kidneys and reducing your risk of kidney disease:

Avoid smoking and excessive consumption of alcohol and caffeine
Maintain normal blood pressure and blood sugar levels
Keep your cholesterol in check
Drink enough water and other fluids
Stay at a healthy weight

Drink More Water
Water does so much more than quench your thirst. It regulates your body temperature, lubricates joints, aids digestion and nutrient absorption, and detoxifies your body by removing waste products (25Trusted Source).

Your body’s cells must continuously be repaired to function optimally and break down nutrients for your body to use as energy.

However, these processes release wastes — in the form of urea and carbon dioxide — which cause harm if allowed to build up in your blood (26Trusted Source).

Water transports these waste products, efficiently removing them through urination, breathing, or sweating. So staying properly hydrated is important for detoxification (27Trusted Source).

The adequate daily intake for water is 125 ounces (3.7 liters) for men and 91 ounces (2.7 liters) for women. You may need more or less depending on your diet, where you live, and your activity level (28).

Eat sulfur-containing foods. Foods high in sulfur, such as onions, broccoli, and garlic, enhance excretion of heavy metals like cadmium (61Trusted Source).
Try out chlorella. Chlorella is a type of algae that has many nutritional benefits and may enhance the elimination of toxins like heavy metals, according to animal studies (62Trusted Source).
Flavor dishes with cilantro. Cilantro enhances excretion of certain toxins, such as heavy metals like lead, and chemicals, including phthalates and insecticides (63Trusted Source, 64Trusted Source).
Support glutathione. Eating sulfur-rich foods like eggs, broccoli, and garlic helps enhance the function of glutathione, a major antioxidant produced by your body that is heavily involved in detoxification (65Trusted Source).
Switch to natural cleaning products. Choosing natural cleaning products like vinegar and baking soda over commercial cleaning agents can reduce your exposure to potentially toxic chemicals (66Trusted Source).
Choose natural body care. Using natural deodorants, makeups, moisturizers, shampoos, and other personal care products can also reduce your exposure to chemicals

Lung detox food
Ginger has been used for 2,500 years as a healing root. There are many benefits of eating ginger, including better lung health. Ginger helps to break down mucus, making it easier for your body to expel air. It also helps improve circulation to the lungs and reduces inflammation. Boil ginger in water with jaggery and drain . drink warm water to detox lungs.

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