विवरण
Kidney transplantation is a surgical procedure that involves placing a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly. The new kidney's urine tube (ureter) is connected to the bladder, and the blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above one of the legs. Unless they are causing complications, the patient's own kidneys are left in place. Kidney transplantation offers a more active life, freedom from dialysis, and freedom from restrictions on fluid and dietary intake.Dialysis is a treatment for kidney failure that helps remove waste products and excess fluid from the blood. There are two types of dialysis: hemodialysis and peritoneal dialysis. In hemodialysis, blood is pumped out of the body to an artificial kidney machine, filtered, and then returned to the body. In peritoneal dialysis, the inside lining of the belly acts as a natural filter, and wastes are taken out by means of a cleansing fluid called dialysate, which is washed in and out of the belly in cycles.
सारांश
- Renal replacement therapy (RRT), encompassing dialysis and kidney transplantation, is crucial for maintaining homeostasis when kidney function deteriorates. Diabetes, prevalent in India, often leads to microvascular complications like diabetic nephropathy, a major cause of kidney failure. Hypertension, combined with diabetes, further accelerates glomerulosclerosis and kidney damage. Chronic Kidney Disease (CKD), replacing the term chronic renal failure, affects approximately 10% of Indians, highlighting the growing need for RRT.
- End-Stage Renal Disease (ESRD) necessitates RRT. CKD is defined by kidney damage lasting over three months, indicated by structural abnormalities (e.g., kidney stones), biochemical abnormalities (e.g., proteinuria), or decreased Glomerular Filtration Rate (GFR). CKD is classified into five stages based on GFR and albuminuria, with ESRD characterized by a GFR below 10. Symptoms of ESRD include uremic symptoms like loss of appetite, nausea, itching, anemia, sarcopenia, and encephalopathy.
- Hemodialysis, a common RRT, involves filtering blood externally. It requires a minimum of three sessions per week, lifelong. The process uses a dialyzer, an artificial kidney with micro pores, to remove waste products via osmosis. A temporary internal jugular vein catheter or a permanent tunneled catheter (permacath) provides vascular access. Arteriovenous fistulas, created by connecting an artery to a vein, provide permanent access.
- Peritoneal dialysis (CAPD) is an alternative where dialysate fluid is instilled into the peritoneal cavity. The peritoneal membrane acts as a semi-permeable membrane, allowing diffusion of waste products. CAPD offers advantages like home-based treatment, fewer transport issues, and stability of blood pressure, making it suitable for fragile patients, children, and those prioritizing lifestyle. Cycles of fluid instillation, equilibration, and drainage are repeated daily.
- Kidney transplantation is considered the optimal RRT. The transplanted kidney is placed anteriorly in the abdomen, retaining the original kidneys. Immunosuppressant medications are required lifelong to prevent rejection. While costly initially, transplantation is more cost-effective long-term compared to dialysis. Absolute contraindications include psychiatric issues affecting medication adherence. Relative contraindications like HIV, HCV, HBV, or incompatible donors are often surmountable with advancements.
- Hemodialysis can induce complications like hypotension, dialyzer reactions, and heparin-related issues. Electrolyte shifts may lead to arrhythmias. Blood transfusions carry risks of viral infections. Peritoneal dialysis poses a risk of peritonitis and catheter infections, requiring aggressive treatment or catheter removal. Hemodialysis filtration is superior to hemodialysis since it removes more middle molecules than the standard form, which could lead to several issues, such as amyloidosis.
- The ideal RRT should depend on the patient's comfort, life expectancy, and availability of resources. Kidney transplantation offers a normal life, sexual function, and even pregnancy, albeit with immunosuppression. Pre-emptive transplantation, performed before dialysis, can improve outcomes. Timing is crucial, with earlier transplantation leading to better results, except in cases of active autoimmune disease where delay is warranted. Screening high-risk individuals for CKD enables early intervention, preventing progression to ESRD.
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