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| Frequently Asked Questions | ||||||||||||||||
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What are the symptoms of kidney failure? Kidney disease which affects both kidney usually produce kidney failure Remember many forms of kidney disease do not produce symptoms until late in the course of disease Symptoms starts when approximately 80% of kidney function is lost Person needs replacement of renal function when 90% of kidney function is lost i.e. called as End Stage Renal Disease (ESRD) or ESRF (End Stage Renal Failure) Symptoms may not be directly related to kidney and urinary tract Urine out put may remain good till ESRD in many patients |
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How does one make out if there is a kidney problem? It is estimated that 1 lac Indians are affected by kidney disease and many more are at risk for developing kidney disease. Consult doctor in case you have: • Burning sensation during urination or difficulty urinating. • Frequent urination, especially at night • Foamy, blood or coffee colo. urine • Swelling throughout the body, especially puffiness around the eyes or swelling of ankles or hands (particularly in children) • Lower back pain (just below the ribs in the small of the back) that is not affected by movement. • High blood pressure • Listless or feeling |
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How is a kidney problem
diagnosed? |
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| At what
level of or stage of renal failure the renal placement therapy
will be requi.?
RRT (Renal Replacement Therapy ) will be
requi. when more than 90% of kidney function is
lost.
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What are treatment options?Remember End Stage Renal Disease is not
end of life
Appropriate and adequate therapy can give prolonged useful, good quality of life It is proved scientifically that transplant is the long term cost effective treatment for ESRD. Non treatment – is also an option – the non treatment choice will lead to death
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For many people who have nonfunctional kidneys, dialysis is an alternative to kidney transplant. There are different types of dialysis. Hemodialysis: A dialysis machine contains an artificial kidney called a dialyzer. The dialyzer gets rid of waste and excess fluid. The waste and fluids that are removed from your body are called the dialysate. The process takes three to four ours and most people who undergo treatment with haemodialysis go to a dialysis center three times per week. The “clean” blood re-enters your body through a surgically created access on your arm, called a fistula. The access is permanent for the dialysis treatments, and it is very important to keep your access clean. Peritoneal Dialysis: Removes waste and excess fluid from blood internally, without the blood leaving the body. The peritoneum, the lining of the peritoneal cavity in the abdomen, acts as a natural filter, allowing waste products and fluids to pass through it into a cleansing solution, while holding important components back. It is done continuously every day. Additionally, a catheter needs to be permanently placed in the abdominal cavity. Continuous Ambulatory Peritoneal Dialysis
(CAPD) is
a continuous dialysis process in which the recipient does fluid exchanges at times and places of personal choosing: Continuous Cycling Peritoneal Dialysis (CCPD) is a continuous dialysis in which a fluid exchange is done at night while the recipient is sleeping, with the help of a machine called a cycler. The cycler does bag exchanges by automatically filling the abdominal cavity with fresh solution and automatically draining it out at the appropriate time. CCPD takes eight to ten hours at night. |
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| Is
dialysis as good as transplant?
Dialysis does not do everything that a kidney does; people on all types of dialysis require special diets and medications. For example, healthy kidneys produce a harmone called erythropoietin, which helps the body to produce . blood cells, which are important for carrying oxygen from the lungs to all parts of the body. When the kidneys fail, the number of . blood cells drops causing anemia, a condition characterized by fatigue. Dialysis does not cause the kidneys to produce erythropoietin and therefore, people on dialysis will require synthetic erythropoietin injections. Additionally, dialysis does not affect or maintain an appropriate nutritional balance. Dialysis patients have very strict diet requirements for protein, potassium, sodium, and phosphorus. Because certain foods are limited in theses patients, a physician may recommend special vitamins. |
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In transplantation, a healthy kidney is put inside the body to do the work of failed kidneys. Although a transplant eliminates the need for dialysis and some of the dietary requirements, a commitment to take care of yourself and take some important medications is requi. following a transplant. The decision to undergo a kidney transplant is a personal choice of the specializes in kidney disorders. |
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Where do kidneys for transplantation come from? There are three sources of kidneys for
transplantation: |
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Important Functions: |
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There are two eternal paths for any living being after he leaves this body: the bright and the dark. God vouches to every ‘Jiva’ a golden opportunity to attain the supreme abode from which there is no return. On the other hand, the path which leads to Brahma is comparatively dark from where he returns to the mortal world i.e. he becomes a subject to birth and death once more. There are few acts in life that are nobler than donating our organs. Donating our organs after we gone is the closest that we can come to giving life to another individual. Organ donation is a wonderful legacy we can leave behind. The eyes continue to see the wonders of the world and the heart continues to sing a new song. The organs that a single person donates can give a new lease life to many persons. Eye donation can give precious sight to two individuals. Besides these various other parts can help repair other organs. (It is possible for a single donor to donate organs and tissues that may help as many as 60 recipients) Top
When we lose the functioning of an organ like kidney or a tissue like bone and skin it is possible put another person’s organ or tissue and with modern surgical techniques and drugs; it can be made to work. This is gifting an organ after one ceases to need it any more. This known as transplantation and it is the “Gift of Life”. Top
How successful is this treatment by transplantation? 80 – 90% of patients who receive a kidney live for 5 years. Longest survivor is 34 years. Receiving this new lease of life means that the recipient will be free from continuous hospital visits to receive dialysis. Top
How long one can live waiting for a transplant? In case of kidney failure, patient can be maintained on regular dialysis. During a dialysis treatment, the patient’s blood is filte. artificially. This treatment is time consuming and is repeated 2-3 times every week for life. In case of other organ failures like heart, lungs and liver; patients can be kept alive only a short time on drugs, unlike kidney failure patients; since there is no ‘dialysis like’ treatment for other organs. Top
Which are the organs and tissues can be used? It is possible to transplant twenty-five different organs and tissues including cornea, heart valves, liver, kidneys, bone and cartilage, bone marrow, skin, pancreas, lung intestine and more. Top
Aren’t these organs and tissues requi to be used immediately? No. These vital organs need to be retrieved from a dead person immediately and can be preserved up to various lengths of time by preservation techniques. Heart and Lung can be preserved by 4-6 hours and kidneys 48 – 72 hours. Skin and bone may be preserved for 5 years or more. Top
Who requires these organs and tissues? Each of us has a number of vital organs like brain, heart, kidneys, lungs, liver etc. Failure of any organ means certain death. Except for the brain all other organs can be replaced – which might be life saving. Besides organs – many tissues like cornea, heart valve, skin and bone may be used for repair and reconstruction. Top
Any person in good health if dies suddenly, possibly through an accident or even other causes like brain hemorrhag and who has been decla. ‘brain dead’ can be an organ donor. This is called the “cadaver donation” in contrast to “live donation” which is possible only in kidney and bone marrow. Top
Normally the death is said to occur when heart stops. But with modern technology the heart and lungs canbe made to function through mechanical support even when brain function has completely and permanently ceased. Thus once brain death occurs; the person becomes a cadaver with a beating heart. Top
How does one diagnose ‘brain death’? In 1959, Neurosurgeons in Lyons (France) found that deeply comatosed patients, who had sustained head injury, never regained consciousness. Although their heart continued to beat and kept their circulation going, these patients were clinically dead. If their breathing support machines were stopped, the heart also stopped. Thus a new definition of death emerged. As this death was under controlled circumstances (that is, in the intensive care unit of hospitals) it was possible to retrieve some of their organs such as kidneys, heart and liver after their relatives are consented. In the west, the transplantation of organs from brain dead patients is an accepted part of medical treatment for quite some time. The government of India has now accepted this new definition of death and has formulated the Human organs transplantation act 1994 and hence it is legal to diagnose and declare brain stem death. Top
Brain death usually results from a severe head injury or bleeding in the brain that causes all brain activity to stop. This can happen after a major road accident or brain hemorrhage due to a stroke. This also can happen in brain tumour. Top How do doctors know a ‘brain dead’ patient is really dead? Four doctors from a panel recommended by government, carry out a series of tests to confirm that a patient is “brain stem dead”. The standards are very strict and are accepted medically and ethically all over the world. The four doctors are of following category; 1. Neuro Surgeon / Neuro Physician 2. Treating doctor 3. An other specialist as approved by State Appropriate Authority 4. Medical Superintendent of the hospital. Top Doctors who treat patients in life and death situations have nothing to do with possible donation of their organs and tissues. Every effort is made to save that person’s life. Organ donation is not even conside. till that person has died. Top What is the difference between Brain Death and Cardiac Death? Brain death occurs when person’s brain has permanently stopped. Cardiac death is said to occur when heart stops beating. Both are legal declarations of death. Brain death does not occur as often as cardiac death. Top
Are Coma and Brain death same thing? No. Coma is decrease in brain function and thee is a chance that person may regain consciousness. Brain death is irreversible loss of brain function. There is no chance of recovery after brain death. Top
If someone is brain dead why does his heart keep beating? As long as heart has oxygen, it continues to work. A mechanical ventilator provides enough oxygen to the heart to keep it working. Without this mechanical support it will stop beating. By giving brain dead patients oxygen making their heart beat with medication controlling their Blood Pressure, their organs continue to work. That is why brain dead patients can be organ donors. This donation of organs may not be possible if one dies out side the ICU. Without Intensive Care all brain death is followed by cardiac arrest within minutes. Only eyes, skin and other tissues can be donated after the cardiac death. Top
Will donation cause pain and inconvenience to one’s family? Organ donation is often an immediate and lasting consolation. It is often comforting to the family that even though their loved one has died, one or more persons can live on through their gift of life. Top
In case organs are donated, can one still have normal funeral? After someone dies, organs are surgically removed as if the person were still alive. Careful attention to incisions and scars is made so that he can still receive a traditional burial or cremation. Top
Is donating organs is against religious beliefs? All major religious including Hinduism, Protestant, and Roman Catholic, Islam, Buddhism and others fully support organ and tissue donation. Top
Is there an age to donate organs? Anyone is eligible to be an organ donor depending on doctor’s decision. Tissues and organs transplanted after death include corneas, heart, liver, kidneys, bone and cartilage, bone marrow, skin, pancreas, lungs and others. One can only donate kidneys and bone marrow as a live donor. As per the norms and guidelines of Government of Maharashtra organ donation can be done between 2 yrs to 65 yrs. Top
Yes – only for kidneys and bone marrow. God has given us two kidneys which are good enough for four people. But only the near and dear ones are allowed to donate and by law parents, siblings, son, daughter and spouse are treated as ‘near relatives’. Top
Can only ‘near relatives’ donate while alive? Yes. That is the law. This law is to avoid exploitation of poor people who want to donate their kidneys for monetary benefits. However other relatives and friends can donate as an ‘altruistic’ measure. The state authorization committee headed by DMER has to be satisfied that is it truly an altruistic donation and no commercial interests are involved. Top
Is it safe to donate while alive? Yes. The potential donor is made to undergo rigorous evaluation before the person is accepted as donor. Doctors cannot guarantee the success in recipient but it is made sure that the donor comes to no harm. However complications are known to occur in 1in 1000 surgeries. Top
But does the donor have a healthy life afterwards? As already mentioned one kidney is good enough to sustain two people. In World War II it was seen that a number of people who lost a kidney due to injury were observed for years without any long term problems. Now the live transplantation is being practiced all over the world since 1954 and donors have been observed for about 50 years without any ill effects. Top
Can anyone become a donor? What is the minimum requirement to become a donor? The blood group should be non-interfering. If the recipient is blood group ‘O’ – only ‘O’ can be a donor; if the blood group is AB - any blood group O, A, B & AB can be a donor. This is for live kidney donation. Rh group (positive or negative is not conside. at all. In cadaver organ donation the blood group match is strictly adhe.. This is an ethical issue and ‘O’ group being an universal donor will always donate to all the recipients of any blood group and the ‘O’ group recipient will waiting for ever. Top
Is there any other matching between donor and recipient besides the blood grouping? Blood Grouping is the most important for solid organ transplantation like kidney, heart or liver. The tissue matching and cross matching have finer implications in the long term graft survival. Top
Once patient is admitted; all efforts are
made to stabilize the patients. If all efforts fail, patient
is pronounced brain-dead after evaluation, testing and
documentation. Consent from the family is obtained to proceed
with donation and organ procurement organization (OPO) is
informed. Consent from coroner/legal authorities is obtained.
In the mean time the organ donor is maintained on ventilator,
stabilized with fluids, medications and undergoes numerous
laboratory tests. Recipients are also identified for placement
of organs.
What is organ procurement organization? An organization is formed to improve organ donations, procurement and transplantation system in the city, state and the country. Thus in Sep. 1998; ZTCC (Zonal Transplant Co-ordination Center) was formed in city of Mumbai. Subsequently the same model will be adopted all over Maharashtra. Top
1. It helps in effective cadaver organ procurement. 2. Increase patient access to state of art transplant technology. 3. To improve system of sharing renal and extra renal organs. This is done by: a) Donor and recipient matching by specific criteria established for each organ. b) Improve transplant outcome. c) Provide a system by which immonologically sensitized patients offe. best possible opportunities. d) Decrease the wastage of organs. 4. Assure quality control by collection analysis and publication of data on organ donation and transplants. 5. Maintain and improve professional skills of those involved in organ procurement and transplantation. 6. To have immunosuppressive drug bank. 7. To increase public awareness. Top ZTCC as organization was composed of every recognized transplant institution of Mumbai. This includes 16 recognized hospitals including 3 municipal medical colleges, 1 government medical college, 1 central government Hospital (INHS Asvini) and 11 private corporate hospital. Top
Once you have decided to become a donor, the most important step is telling your family. Even if you sign the ‘donor card’ – your family still has to consent before organs are gifted. Top
Is it normal to get nervous when you become a donor? What are the chances of actually donating? An average male will live for 75 years and female 80 years. The chances of becoming an organ donor in real are quite small. Mumbai with a population of 1.2 crores; about 600 deaths are due to vehicular deaths i.e. 1 in 20,000. If whole of the city become willing donors – then may be there will be 300 – 400 suitable donors. Top
In India most of the transplants are from live donors since cadaver donation is still in infancy due to lack of public awareness. Hence there are a large number of patients who have no suitable donor and hence look for commercial donors. All of such transplants are discouraged. But patients in a situation of life and death do manage to convince the doctors and the authorization committee. Occasionally doctors do turn a blind eye in order to save life. Thus only long term solution to this problem of ‘kidney racket’ is to have a viable cadaver transplant program in the while country. Top
Why are so few cadaver transplants in the country? No cadaver transplant programme can be successful unless there is time bound co-ordination amongst intra hospital, inter hospital and the society at large. Cadaver transplant activity is a hospital based activity with participation of all strata of society. The core group, which makes the donor organ functional in recipient, is the transplant surgeons and the Nephrologists. They in turn are dependant on entire hospital i.e. on intensives, neurosurgeons, neurologists, administrators, anesthesiologists in addition to service branches like pathology, microbiology, imaging services. The role of Transplant coordinator is of paramount importance; since coordinator is the first person coming in contact with the grieving family. Top
Should I have a living related or cadaver donor transplant? A number of factors enter into this decision, including success rates following transplantation and the availability of donors. The best results following transplantation are obtained with HLA – identical (6 antigen matched) living related donors, which almost always come from a sibling, rarely from a cadaver. A major advantage of living donor transplants is the ready availability of the donor. This allows the transplant to be performed without a long waiting period, as thee are currently more potential recipients than available cadaver donors. For this reason, we encourage living related donation whenever the family situation is appropriate, and, if circumstances are correct, donations for spouses. Top
How is a living related donor chosen? Potential living related donors usually are identified in discussions with your family and your doctor. Tissue typing is then scheduled; the requi. tests include blood group typing, HLA typing, and a mixed lymphocyte culture. Based on these tests it is frequently possible to identify the donor most likely to result in a successful transplant. Choosing the donor is best done in consultation with your doctor and the transplant team. The selected donor is then scheduled for admission to the hospital for a donor evaluation. This evaluation is primarily on an out-patient basis and involves a wide variety of tests to ensure the health of the donor. Included in these tests is an arteriogram, an x-ray procedure in which dye is injected into the arteries supplying the kidney. This test allows the surgeon to decide which kidney would be best to remove. After completion of all tests, the physician responsible for the donor evaluation, who is not a member of the transplant team, will discuss the results with the potential donor privately. Only donors who are healthy and have two completely normal kidneys will be accepted. Top
Are there any risks to the donor? The short term risks of donation are those associated with major surgery, including the risks of general anesthesia, wound infection, and the possible need for a blood transfusion. These risks are very small in healthy people. The donor evaluation process is designed to identify any special factors which would place a donor at increased risk; such donors would not be accepted. The longer term risks are slightly more uncertain. Some studies of donors 10 – 15 years following donation have suggested a slightly higher incidence of mild high blood pressure and protein in the urine; although these changes are not particularly different from the general aging population. The significance of these studies is known, and there is not evidence of renal failure in prior donors. The remaining kidney expands and takes over the function previously performed by two. Because most kidney diseases affect both kidneys simultaneously, the donor is not at increased risk of kidney failure should he or she contract such a disease. Donors are cautioned to avoid contract sports or other activities which could cause major trauma to the remaining kidney. We believe that donors will lead perfectly normal lives. Top
What are the chances of my transplanted kidney will work? The success rate following transplantation depends upon the closeness of the tissue match between donor and recipient. A kidney from a brother or sister with a “complete” match has a 95% chance of working gat the end of one year. A kidney from a parent, child or “half-matched” sibling has an 85% chance of working for at least one year. Finally a cadaver donor kidney has an 80% chance of working at least one year. If you are having a repeat transplant, the success rate will b3 10%-15% less. These kidneys are not immortal, however, with 50% of cadaver kidneys declining over 6 – 10 years, a rate faster than the relatively stable success of related kidneys. Top
What happens if my new kidney fails? If the transplant fails, patients return to dialysis as before. The transplant will be removed only if it is causing symptoms, such as fever or pain. This is often necessary if the kidney fails soon after transplant, but rarely does it fail after several months. You may be able to have another transplant later, if you desire. Top
What are the chances that I will die as a result of receiving a kidney transplant? One of the major achievements in the field of transplantation in the last ten years has been a major .uction in the risk of death. Currently at this hospital, the risk of death in the first year after a kidney transplant is about 3 – 5%, occurring primarily in high risk patients, particularly those over 60-65 and, to a less extend, those with juvenile diabetes. This includes death from any cause, whether or not related to the transplant. This risk is not significantly different from that sustained during a year of dialysis. During your transplant evaluation, any risk factors you may have that will increase your risk for transplantation will be identified and discussed with you. Top
How to prevent kidney failure? Prevention is better than cure lost of cost is involved in treatment of ESRD | ||||||||||||||||