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  • 09Jan

    Kidney transplant criteria – who needs surgery?

    Kidney or renal transplantation is a surgical procedure in which a donor kidney is transplanted in the recipient with or without removal of the diseased kidney. It is the preferred treatment for many patients with end-stage renal disease because it provides a much better quality of life than frequent dialysis. Transplantation releases patients from the dietary and fluid restrictions of dialysis and the physical constraints imposed by the need to dialyse in a hospital. Transplantation is also more cost-effective and improves survival. However, to undergo this serious medical procedure, patients need to meet specific criteria.

    Criteria for kidney transplant

    The main indication for kidney transplantation procedure is end-stage renal disease. The causes of  this disease are numerous and include:

    • Diabetic nephropathy – it is defined as microvascular (small vessels) involvement of the kidneys. This condition is due to albuminuria – loss of albumin protein in the urine. About 20 – 40% patients with diabetes develop nephropathy (disease of the kidneys). During the early years of diabetes, the kidneys increase in size (hypertrophy) and this is associated with an increase in blood flow (hyperperfusion). These changes result in an increase in glomerular filtration and urine production. During the next few years these changes in kidneys revert back to normal with return of glomerular filtration (urine formation) to normal volume. Thereafter, during the next ten years, the kidneys start losing albumin protein as microalbuminuria (microscopic losses) initially and macroalbuminuria (macroscopic losses) later. Microalbuminuria is defined as 30–299 mg/d presence of albumin protein in a 24-h urine collection and macroalbuminuria as >300 mg/d in urine or, in albumin/creatinine ratio, > 300 g/mg creatinine. Microalbuminuria is a risk factor for heart disease. Once macroalbuminuria is present, there is a gradual decline in kidney function and 50% of patients develop kidney failure in 7–10 years.
    • About 20 – 40% patients with diabetes develop nephropathy.

      About 20 – 40% patients with diabetes develop nephropathy.

      Glomerulonephritis – a glomerulus is a structural component of kidney and each kidney in an adult has one million of it. It is responsible for filtration of blood leading to the production of urine which carries the excretory products of metabolism. Inflammation of the glomerular capillaries is called glomerulonephritis. It can occur due to bacterial, viral or fungal infection. In some cases it is due to immunity mediated damage where antigen-antibody complex deposition occurs in the kidneys. This results in infiltration of the kidneys by inflammatory cells (neutrophils, macrophages, T-cells). These cells produce chemical (cytokines) which causes fibrosis (deposition of fibrous tissue) in the kidney. This results in reduction of renal filtration and kidney failure.

    • Hypertension associated kidney disease (nephrosclerosis) – uncontrolled hypertension causes permanent damage to the kidneys in about 5% of the patients. There is loss of red cells and albumin in the urine. A control of blood pressure with regular treatment is the only way to slow the progression of kidney failure.
    • Renal vascular disease – atherosclerosis or cholesterol deposition in the renal vessels can affect the blood flow to the kidneys. It is associated with obesity, smoking, hypertension and diabetes and results in chronic kidney failure.
    • Polycystic kidney disease – this condition is one of the most common life-threatening inherited disorders and frequently causes kidney failure.
    • Pyelonephritis – it is an infection of the kidneys caused by bacteria like E. coli, Klebsiella, Proteus, Pseudomonas and Citrobacter species. It presents with high fever, flank pain, nausea and vomiting. Recurrent infections result in renal failure.
    • Obstructive uropathy – obstruction to the flow of urine from multiple causes results in stagnation of urine and elevation in urinary tract pressure. It impairs renal function and is a common cause of obstructive nephropathy. If relief of obstruction is provided early, the function usually improves but chronic obstruction may produce permanent loss of renal excretory capability, as well as increased risk of infection and stone formation.
    • Some of the other indications are systemic lupus erythematosus and chronic analgesic (phenacetin, aspirin) intake which result in renal loss of function.

    Kidney transplantation is a major surgery which requires a lifelong immunosuppression. It is fraught with risk of many complications. In a patient who is already suffering from an involvement of systemic diseases like diabetes or hypertension, a regular consultation with the physician should be taken. The aim is to slow the progression of target organ damage.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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