Kidneys are the organs responsible for excreting metabolic products through urine production and providing the body’s fluid balance. Average 1-2 liters of urine output occurs per day although it varies depending on the fluid intake and fluid loss. The minimum required amount of urine for sufficient excretion of metabolic products is 0.5 liters / 24 hours.
They carry out vital functions such as ensuring fluid and electrolyte balance of the body, active vitamin D synthesis, contributing to the regulation of blood pressure except ensuring excretion of metabolic waste harmful to the body.
Occur as a result of function loss of the kidneys due to different reasons. Diabetes, high blood pressure, chronic renal infections, stones, immune system diseases (glomerulonephritis), use of long-term kidney-damaging drugs (non-steroidal anti-inflammatory, antibiotics harmful to the kidney, etc.) can cause chronic renal failure. It can emerge in childhood due to congenital problems in the urinary tract, and can also emerge in different age groups depending on diabetes.
Chronic renal failure defines irreversible loss of kidney functions. It can emerge in patients of all age groups depending on the actual underlying cause.
All studies within the field of preventive medicine define whole disease preventive studies. It is possible to protect yourself from chronic renal failure. Chronic renal failure that may develop due to unconscious drug use constitutes the best example. Similar situation is in question also for other reasons. It is possible to protect the functions of the kidneys in patients, who adhere their nutrition, insulin therapy and controls in the presence of diabetes. Despite everything, kidney functions may be extended to maximum time with disciplined follow-up and treatment in patients that chronic renal failure will develop. The actual treatment of chronic renal failure will be preventing the disease within the scope of preventive medicine.
In people with risk factors that can cause disease (diabetes, hypertension, etc.); kidney functions should be monitored with close follow-up, risk factors should be treated optimally and kidney functions should tried to be protected. This process will give the opportunity to make preparations for the treatment when a reduction in kidney functions of the patient is detected. Performing kidney transplantation without entering dialysis is an alternative when need of dialysis arose in candidates evaluated as suitable for kidney transplantation. Need of emergency dialysis is present in sudden occurring renal failure as it cannot be possible in all patients to detect the reduction in kidney functions. In this case, the patient is taken to dialysis with a dialysis catheter inserted from the neck or groin; in case that chronic renal failure become definite the patient continues to hemodialysis by performing vascular access surgery (AV fistula) for dialysis. Also peritoneal dialysis can be performed in a group of patients due to the patient’s preference, vascular problems. The patients should be evaluated in terms of kidney transplantation in any case and kidney transplantation should be considered as primary treatment in patients suitable for transplantation.
All patients with a diagnosis of chronic renal failure are candidates for kidney transplantation. The progress achieved in the field of organ transplantation narrow the definition of the patient that cannot be performed transplantation. The conditions that patient’s comorbidities obstacle to have surgery (severe heart diseases, lung diseases), immune system disease to be in active period in patients with chronic renal failure developed due to immune system diseases, the presence of active infectious disease, to be detected cancer recently are conditions that constitute the major obstacle. In cases that kidney transplantation is appropriate upon the results of all evaluations and examinations, there should be no tissue incompliance between the donor and the recipient. This situation defines lack of sensitivity in the recipient against donor tissue groups in the recipients and the donors with blood group compliance.
It is performing kidney transplantation as a result of matching recipient and donor couples having similar problems in the presence of reasons such as blood and / or tissue incompliance with donor of the patients with living donors. In case that the tests result as compliant when donors are changed, transplantation can be performed by exchanging kidney between couples.
Today, it is clearly demonstrated as a result of long-term kidney donor follow-up that giving kidney in healthy individuals eligible to be kidney donors does not shorten life, does not lead to deterioration of their health. On the contrary, the problems detected in the donor candidates taken to detailed examination as a kidney donor without any complaints can be treated early. The candidates with no obstacle to be kidney donors are taken under long-term follow-up by organ transplantation centers and their health standards are increased with regular controls. Because their health consciousness is increased,
social habits obstacle to donation (smoking, being overweight) are regulated, organizing their life style which they cannot change under normal conditions in a way of ensuring to be more healthy in the long term are possible in the process they donated kidney. All of these facts do not mean that the donor candidate takes no risk in surgery. If it is considered that even the simplest surgical intervention cannot be performed with zero risk, it is clear that also kidney donor take the risk, albeit low. A completely healthy person to take such a risk, albeit low constitutes the most sensitive point of living donor kidney transplantation. Therefore, to evaluate donor candidate seriously, to make risk analysis accurately and finally to perform the surgery in an experienced and equipped center is vital in performing living donor kidney transplantation. Preventing damage to the person donating organ must be the main target of the organ transplantation center.
Donor candidates are examined primarily. Previous diseases, surgeries, used and using drugs, the diseases in the family are questioned during the examination. All body systems are passed through a detailed examination. Screening is performed with extensive biochemical blood tests. Kidney function of the donor candidate is investigated by examining twenty-four hour collected urine. Kidney size and structure are examined first by performing ultrasonography. Gallbladder, liver and spleen, pancreas within the abdomen are examined by ultrasonography and the presence of a problem is investigated. Cardiovascular system is evaluated based on cardiology examination, electrocardiography findings, by performing further examinations when necessary. Blood pressure is measured and the pulse is evaluated. Decision-making ability and volunteering in the kidney donation on the body of the donor candidate are questioned with psychiatric evaluation. Male donor candidates over the age of forty are examined in terms of prostate, all female donor candidates are examined in terms of gynecological diseases although they do not have any complaint.
Chronic renal failure is a result that can occur from different reasons. A very good examination and medical history inquiry of the patient are performed first. Previous operations and treatments are evaluated in detail. The duration that the patients receive treatment creates very different results in the patients that enter hemodialysis or peritoneal dialysis. The problems that may arise due to dialysis can also be increased when the duration of dialysis treatment of the patient gets longer before kidney transplantation. The condition of the cardiovascular system is the most important determinant. In case that a situation that requires intervention is detected in the cardiovascular system of the patient in detailed examination, then this treatment is given priority. Otherwise, the investigation is performed with examination of other systems and detailed blood tests. Thanks to this extensive investigations and examinations, only the evaluations performed to determine the eligibility of the person for kidney transplantation even increases the quality and duration of the patient’s life. Nephrology, transplantation surgery, chest diseases, urology, obstetrics and gynecology, psychiatry, anesthesiology examines the patient in their areas in detail.
Kidney donors can be discharged within 2-3 days. They can return to daily life within 10-15 days after surgery. This time may vary depending on the surgical technique used. The recovery time occurs faster in the case, which closed surgical techniques are used, and more promising outcomes can be achieved in closed surgical technique in terms of both cosmetic results and postoperative pain. Both closed and open donor surgical techniques are performed in our center. The mean duration of discharge of kidney recipients can be within 6-7 days however, this time shows more variable feature compared to the donor. Length of stay in hospital may vary due to parameters such as setting the drug levels, follow-up of the kidney functions.
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Group Florence Nightingale Hospitals Ltd UK 2020, all rights reserved.
Group Florence Nightingale Hospitals Ltd UK 2020, all rights reserved.