We have got two kidneys. They are bean-shaped organs located on each side of our vertebral column below the diaphragm in the back of the upper part of the abdomen. They maintain our health by removing waste products, excess water, and salt (sodium and potassium). They also keep blood pressure, bone health, and hemoglobin. When the kidney is not able to perform these functions efficiently, we call it kidney failure. When the kidney stops functioning completely, we call it end-stage kidney failure (> 90-95% of kidney function is lost). There is a threat to life. Kidney failure can be of 2 types. 1) Acute kidney failure (Temporary failure), which is potentially recoverable. 2) chronic kidney failure (permanent kidney failure), where there is permanent, irreversible damage to the kidney. We are fortunate that artificial kidney is available to do kidney function i:e, dialysis adding many years to life. When the kidney fails permanently – end-stage kidney disease, diseased kidney function can be replaced surgically by a healthy kidney. It is called a kidney transplant. Kidney transplant is the preferred treatment because it is associated with better quality of life, longer survival, fewer dietary restrictions, lower cost, and almost full capacity to work compared to lifelong dialysis.
Causes of End-stage kidney failure (Permeant irreversible damage to the kidney)
Common causes include:
- Diabetes: persistently uncontrolled blood sugar can damage kidneys. This has become the most common cause of end-stage kidney failure.
- Chronic glomerulonephritis: This is a condition characterized by inflammation of the filter, usually by the altered immune system, and presents with proteins in the urine, high Blood pressure, and increased creatinine.
- Chronic uncontrolled high blood pressure.
- Chronic recurrent infection of the kidney is known as chronic pyelonephritis.
- Chronic obstruction to urine flow by stones, prostate, cervical cancers (in females)
- Hereditary or familial disease like multiple cysts in the kidney, single kidney, developmental abnormality of urinary storage bag i:e bladder can damage kidneys.
For patients suffering from end-stage kidney disease to keep alive, we have options like:
This is like an artificial kidney. It does almost all excretory functions of the kidney, like removal of waste products, excess of salt, water, potassium, and phosphorus. It helps to control acid balance and blood pressure. Blood is pumped from the body by vascular access through a dialyzer filter (artificial kidney) by machine and then returned to the body. Hemodialysis can be done at the center or at home.
Here, our peritoneal membrane in our abdomen, which covers our organs act as a filtering membrane. Fluid is pumped into the abdomen (peritoneal) via a catheter; fluid is exchanged every 4-6 hours daily. This is slow dialysis. There is no stress on heart or blood pressure fluctuations, and there is slow removal of toxins and water like our normal kidneys. This is a home-based therapy.
A Kidney transplant
Is the treatment of choice for end-stage kidney disease. It does all functions of a kidney with better quality of life, longer life span at a lesser cost overall. One healthy kidney from a donor is removed surgically and inserted into the patient (recipient). A transplanted kidney does the job of a failed kidney. One kidney is sufficient to maintain life and to live a long healthy life.
Types of kidney transplant
Kidney comes from usually a family member like father, mother, brother, sister, or wife preferably. If a related donor is not available unrelated may be considered, but there should not be a commercial deal between the donor and recipient.
If a living donor is not available, one can register through a hospital with a zonal coordination center for a deceased donor transplant (Braindead/ cadaver transplant). A transplant will be performed when a kidney becomes available. The main problem is the long waiting list which maybe takes 3-5 years to get a kidney depending on the frequency of donations.
While waiting for a transplant, living donor, or deceased donor, you have to remain relatively healthy and free from infection.
- Take regular and adequate dialysis
- Avoid excessive weight gains between dialysis
- Do not miss dialysis
- Take adequate proteins when you are on dialysis
- Control your blood pressure
- Maintain hemoglobin between 10-12 g/dl
- Regular monthly check-up of health and blood test
- Regular exercise, avoiding smoking, and consumption of alcohol
- Take all medication regularly
- Do heart check-up regularly while on dialysis
Stay at Hospital
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