Transplantation and renal dialysis

Transplantation and renal dialysis

• Description
• Causes
• Epidemiology
• Symptoms
• Diagnosis
• Prognosis
• Treatment
• Preventive measures
• Rehabilitation

 

 

 

Description

The kidneys are vital functions in our body:

• They remove waste substances.
• They produce hormones for the formation of bone and red blood cells.
• Regulate blood pressure.
• They control the water and salts in our agency: hydro-electrolytic balance.

These basic functions those made possible by structures called glomeruli responsible for filtering the blood and collecting substances in waste and excess water, forming urine. If for any reason it stops working, build up of waste substances, toxic substances and water, altered the production of red blood cells and the normal metabolism of the bones.

All these facts lead to a series of symptoms:

• Weakness.
• Fatigue.
• Dizziness.
• Nausea.
• Vomiting.
• Decreased appetite.
• Changes in the speed and appearance of urine.
• Increase in blood pressure.
• Inflammation of certain parts of the body by accumulation of fluid.
• Sleep disturbance.
• Cramps.
• Muscle aches.

If you see some of these symptoms, go to your doctor that examine you and determine the cause that causes.

An early diagnosis of kidney disease gives the possibility to establish a rapid treatment to avoid permanent damage to the kidneys. Unfortunately, not always manages to control the progression of the disease and to reach a permanent failure in its function, which is known as Renal failure. Various diseases can trigger permanent kidney failure, with some symptoms that can be controlled by the doctor with the cooperation of the patient, but it may to despite a good control, finish making needed dialysis.

If the detection of the kidney problem is precocious and retains certain functionality, you can, with treatment that prompted your doctor, take a life free of the need to undergo dialysis. Otherwise, it may be necessary to start with some of the different treatment modalities that exist to replace kidney function, since otherwise there is the risk of losing their lives.

When it is no longer able to perform an adequate blood cleaning, the degree of functionality with the kidney is what we call function Renal Residual (RRF), which goes down until that requires dialysis or transplantation.

Causes:

Possible causes of kidney damage:

• Hereditary diseases.
• Inflammatory diseases of the kidneys (nephritis).
• Diabetes.
• High blood pressure.
• Stones or stones in the kidney.
• Infections.
• Disorders of blood circulation.
• Tumors.
• Ingestion of toxic products.
• Complication after surgery

Causes:

To these causes must be added:

 

Risk factors

• Age: chronic renal failure between 65 and 75 years is six times more frequent that between 20 and 25 years.
• Race: black people are three times more likely to develop chronic renal failure.
• Sex: more common in males.
• Family history: some diseases that cause failure chronic renal are family history.

 

 

 

Epidemiology

Canary Islands ranked first by the number of patients starting renal replacement therapy (TRS). The growth of the dialysis population occurs primarily on the basis of the increase in the number of patients over 60 years old and, especially, those older than 70 years, who are accepted to start TRS.

It is possible to see an increase in the incidence of diabetic nephropathy, which can reach the first place among the causes of home dialysis. There is no clear cause for the increase in incidence of diabetic nephropathy and is ageing, the general population, both that which is selected to start the TRS. Cardiovascular problems are the leading cause of death among patients of terminal chronic renal failure in TRS, even within the Group of patients who have received a kidney graft.

The media in Spain, in the year 1998 incidence was 116.5 year per million population (in the Canary Islands 187).

The average prevalence rate was 747,7 per million inhabitants and the communities with the highest number of sufferers are the Canary Islands, Catalonia and Valencia.

The average prevalence of kidney transplant as a measure of Renal replacement therapy (TRS) was 44.1 per cent.

With regard to sex, the number of men who started the TRS was higher than women’s in all age groups, but the ratio tends to equalize over 75 years.

Causes of mortality

• • Disease mortality
  • Cardiovascular� -� 40
  • Infections – 20
  • Liver – 15
  • Number – 10
  • Not filiada – 15

Symptoms

As kidney function decreases gradually and progressively, there is no clinical manifestations in the beginning. The first symptoms appear when 70-80% of the body is affected or until the leakage rate is less than 20 or 25% of normal values.

The clinical manifestations can be varied:

• Nausea.
• Vomiting.
• Diarrhoea.
• Headaches.
• Dizziness.
• Drowsiness.
• Seizures.
• Sweating.
  Anemia

There is a decrease of red blood cells because the kidneys cannot produce a fundamental substance to develop them, which is the EPO. Due to anemia occur une series of symptoms:

• Fatigue.
• Weakness
• General malaise.

The Agency needs to have enough iron, haemoglobin and erythropoietin to produce red blood cells. Until recently, the only solution was to practice blood transfusions, but had to repeat them every time. Currently, with the advent of synthetic erythropoietin (EPO) many patients have could benefit. Often put subcutaneously, but it can be used in patients undergoing dialysis the intravenous taking advantage of the assistance from the Centre of treatment.

All persons who use EPO, should monitor blood pressure, that it can increase blood have more red blood cells.

The EPO will get a higher quality of life, increases the ability to do physical exercise, improves appetite and sexual function.

Once the transplant has been carried out, the anemia improves because the new body can produce erythropoietin; If with ASA, implanted body loses part of its function, anemia can appear again, by what is convenient it becomes to manage EPO subcutaneous.

Diagnosis

The causal diagnosis of the disease is not always possible to do it because the chronic renal failure is the final process of many diseases. Clinical diagnosis is also difficult for the length of time that passes from the onset of the disease until the first symptoms appear.

Biological diagnosis is simple to do through the determination of urea and serum creatinine or urinary tract anomalies findings: proteins in urine (proteinuria) or red blood cells in urine (hematuria).

The most accurate measurement to measure kidney function is aclaramientode creatinine, for what is needed to collect urine in 24 h, although there are formulas that do not need and you get a rough estimate.

Symptoms that suggest chronicity include:

• Prolonged duration of symptoms.
• Good tolerance of high figures of urea and creatinine.
• Gastrointestinal manifestations such as nausea and vomiting.
• Nocturia (emission of urine more frequent at night than by day or abundant).
• Itching.
• Anemia.
• Bone pain or neuromuscular symptoms such as cramping.

Prognosis

17.6 Mortality deaths per 100 patient year. The life expectancy for the 55 to 64 age group is 22 years, but in terminal damage it is 5 years. The main cause of death are heart complications, followed by neurological injuries, infection and malignancy. Diabetes and hypertension worsen the prognosis and are predictors of high mortality.

Treatment

• Dialysis

Dialysis is an artificial procedure that allows to extract harmful or toxic substances for the body of the patient’s blood, as well as the accumulated excess water.

This treatment is not healing and is of lifetime already not amending the injury that occurred in their kidneys. These treatments enable you to improve symptoms and live longer, giving you the future possibility of a kidney transplant.

Hemodialysis and peritoneal dialysis are treatments aimed to replace the function of the kidneys no longer function. These treatments will help you live longer and feel better, but are not a cure for the disease. While currently Renal failure patients living longer than ever before, over the years there may be problems. Among these are:

• Disorders of the bones.
• High blood pressure.
• Nerve injuries
• Anemia (insufficient number of red blood cells in blood)

 

Although cannot disappear these problems with dialysis, doctors are now with better weapons to treat them or avoid them.

There are today in day 3 types of dialysis:

• Hemodialysis
• Continuous ambulatory peritoneal dialysis.
• Automated peritoneal dialysis.

Hemodialysis

It is the most commonly used in the current procedure; to make it is necessary to extract blood from the patient and make it move in a tube into the dialysis filter. This filter is divided into two spaces through a semi-permeable membrane: on the one hand passes the blood and the other (dialysate) dialysis fluid. The membrane contains pores that allow the passage of water and waste substances from the blood into the dialysis fluid, but does not allow the passage of other substances such as red, white blood cells, proteins of large size, hormones, etc. This process of “dissemination” flame.

In dialysis, blood is full of toxic substances and the dialysis fluid does not contain them, so it tends to equate concentrations. Get clean blood returns to the patient and enters blood with toxins; on the other hand, leaves dialysate with toxins and enters dialysate without them, always giving the difference in concentration needed to be able to clean toxins on an ongoing basis.

He is needed to extract the water that has accumulated in the body, increases blood pressure and heart and for this work causes an increase in pressure in the compartment of the blood within the filter that pushes the liquid against the membrane forcing him to cross to the dialysate compartment, where it is eliminated: process of “ultra filtration” or “osmosis”.

Treatment is to be effective they have to meet conditions:

Duration: 4 hours.
Frequency: 3 sessions per week.
The amount of blood which may be circulated by the artificial kidney.
The amount of blood will depend on the ease with which her let us draw the body; We do that through a vascular access that connected the circulatory system with the machine. There are two types of vascular access:

• Transitional: a catheter (tube) is inserted into a vein of large size under local anesthesia.
• Final: joins an artery and a vein, usually in the arm, causing an increase in the amount of blood flowing through the vein, dilating her and facilitating the insertion of needles that will connect with the artificial kidney.

Peritoneal dialysis

Covering the abdominal cavity, the intestines and other organs is a membrane called the peritoneum that has thousands of small vessels that bring blood we need clean and works as a semi-permeable membrane, such as hemodialysis filter. It is inserted into the abdominal cavity dialysate fresco which comes into contact with the peritoneum, producing sufficient concentration difference so that toxins from the blood that flows through the peritoneal membrane become the dialysate, which is evacuated after few hours towards the outside world through a tube, called a peritoneal catheter. This procedure makes the patient only, so it is necessary to a rigorous training. The peritoneal catheter is placed through a very simple operation and in permanent way.

Some studies claim that the RRF (Residual Renal function) is better in patients treated with peritoneal dialysis to which receiving hemodialysis.

Automated peritoneal dialysis

It is the newest form of dialysis: A machine made changes in fluids at night, at home, while you sleep. Each one or two months goes to the hospital to carry out the controls. According to the needs of each individual programme is so you can more or less fluid exchange.

To get to the hemodialysis requires time and may have side effects due to rapid change in the balance of fluids and chemicals:

Muscle cramps.
Lowered blood pressure (hypotension): causes weakness, dizziness and nausea.
These side effects can be avoided if follow a proper diet and taking remedies that prompted your doctor

Pros cons
Hemodialysis is at his side at all times to trained professionals. You can meet other people. The hours of treatment centre fixed. It has to go to the Center.
The Peritoneal Dialysis makes time to decide. You don’t have to move to the Center. Achieved a sense of independence and control over your treatment work with treatment may be cause of stress for relatives or friends. You need training. It takes up space

Kidney transplant

It is without doubt the best replacement therapy in the IRC. However, not all dialysis patients are capable of being transplanted. There are risks inherent in the transplant may not be borne by patients with certain pathologies (chronic infections, heart problems, history of neoplasms, etc.), that the risk of surgical intervention and the subsequent treatment to prevent rejection is greater than the potential benefits of transplantation.

It should every patient with CKD on dialysis program, to be included in waiting list for transplantation, be subjected to a series of studies, on the one hand, are going to rule out the existence of diseases which counter-indicates the transplant, and on the other hand are going to define the profile of histocompatibility of the patient.

It consists of implant in your body a healthy human kidney of someone else, which may be a direct relative (donor related live) or a newly deceased person. On some occasions, the transplant law provides donation direct transactions people such as wife or (unrelated donor live). Spain is one of the countries with the largest number of transplants by number of inhabitants; in 1998 the national organization for organ transplants (ONT) coordinated 1,995 transplants.

A number of requirements, both the patient and the donor must be provided to perform a transplant:

Be provided by law: not all people can donate their organs in donor unrelated live cases.
There has to be compatible with the blood and tissues, need to perform compatibility testing to demonstrate that the immune system will not react against graft, in other words, there will be no rejection. Normally, 75 to 80 per cent of the transplant of donor bodies continue running at the year of the operation
In the case of donor live, should be carefully evaluated his State of health.
Transplant recipient must have studies that analyze your physical condition prior to the transplant and detect illnesses that should be corrected to avoid complications after making it.
To perform the transplant, the new kidney between the upper part of the thigh and abdomen is placed and connects the artery and vein of the new kidney to an artery and vein in the body. The flow of blood through the new kidney produce urine while not always of immediate, but that it may take several weeks. Damaged kidneys are left in place unless they cause infection or rise in blood pressure.

The duration of the operation is usually between 3 and 6 hours and stay usually lasts between 10 and 14 days.

The transplant is not a cure. There is always the possibility that his body rejected the new kidney. The odds that your body accept the new kidney depends on their age, race, and medical condition.

Your doctor will prescribe you special medicines to help prevent rejection. These medications are called inmunosupresivos. It will take them all the days for the rest of his life. Sometimes these drugs fail to prevent the body rejected the new kidney. If this happens, you will need to be adi�lisis and posiblementeesperar another transplant.

Treatment with these medications can cause side effects. The most serious is the fact that weaken the immune system and facilitate the development of infections. Some medications cause changes in the appearance of the person: the face you could put more full, could gain weight or develop acne or facial hair. Not all patients with these problems, and cosmetics and diet may be helpful.

Some of these medications can cause problems such as cataracts, acid gas