One of the most common types of transplantation is a kidney transplant. What are the indications, the process, and post-procedure care? Let's discuss this further.
There are various types of kidney surgery. These procedures vary widely and are greatly influenced by the underlying cause. In cases of kidney stones, conventional surgery can be performed to remove the stones from the kidney.
In cases of kidney tumors that require total removal, a nephrectomy can be performed to remove the entire kidney, especially if there is a suspicion of malignancy to prevent the spread or metastasis.
Everyone should have two kidneys in the retroperitoneal area. If one kidney has been removed but the other is still functioning optimally, no further intervention is usually necessary. In this situation, routine follow-up is usually all that's needed.
However, in patients with end-stage kidney failure who are no longer able to respond to other therapies, a kidney transplant may be considered. This is usually due to impaired kidney function. Therefore, a transplant is the best option to assist kidney function.
Kidney failure
The kidneys play a crucial role in the body. They regulate fluid and electrolyte balance, control blood pressure, and even remove toxins from the body. Therefore, if they don't function properly, it can significantly impact the body's metabolism and pose a risk of death. Broadly speaking, kidney failure can be divided into two categories: acute and chronic kidney failure. Acute kidney failure, or acute kidney injury (AKI), occurs more rapidly.
This condition can be triggered by dehydration, trauma, severe infections, or side effects of medication. Some kidney failure conditions can be managed and controlled by addressing the underlying cause. If dehydration is the cause, appropriate fluid therapy can be very helpful. If infection is caused by bacteria, antibiotics can be given to treat it.
If caused by side effects of certain medications, reducing the dosage or even stopping the medication can help manage acute kidney failure to prevent it from worsening and causing complications. Chronic kidney disease (CKD), on the other hand, tends to progress more slowly. This condition can be caused by various underlying chronic diseases, such as diabetes, hypertension, recurrent kidney disease, and autoimmune diseases.
Symptoms of kidney failure in the early stages, particularly chronic kidney failure, may be insignificant because they don't interfere with daily activities. However, as time passes and the disease progresses, symptoms can include fatigue, swelling, nausea, increased blood pressure, and dry, itchy skin.
Meanwhile, in acute kidney failure, the signs and symptoms are more easily recognized, such as decreased urine output, fatigue, and swelling in the legs. AKI is usually treatable with prompt treatment.
On the other hand, CKD usually requires long-term treatment and therapy, as well as close monitoring. Recovery is difficult, but therapy is usually carried out to slow the progression of the disease and prevent it from worsening. Some risk factors that must be considered and controlled to prevent kidney failure are diabetes mellitus, hypertension, cardiovascular disease, and excess weight.
Therefore, if you have multiple comorbidities, it's crucial to keep them well-controlled. Taking medication and having regular check-ups is crucial. It's also crucial to maintain a healthy lifestyle with a balanced diet and regular exercise. These efforts can help maintain a healthy weight and prevent various potential chronic diseases.
Furthermore, it's important to consider a family history of kidney disease and age. If you're at risk, it's recommended to undergo regular screenings with regular medical check-ups to detect complications early.
Stages of chronic kidney failure
Chronic kidney failure, or CKD, has several stages due to its long-term course. One indicator is a kidney function test, which measures the glomerular filtration rate (GFR).
Stage 1
Even if the GFR remains high, above 90 mL/min/1.73 m2, early signs of kidney damage, such as protein in the urine and structural abnormalities within the kidneys, may be present. However, it may not cause any symptoms.
Stage 2
At this stage, the GFR is between 60-89 mL/min/1.73 m2, and decreased kidney function may be present, even without obvious symptoms. This is more or less the same as stage 1.
Stage 3
The GFR at this stage is 30-59 mL/min/1.73 m2, and symptoms begin to appear, although not typical. Patients typically experience fatigue, changes in urination, and the onset of swelling.
Stage 4
At this stage, the GFR ranges from 15 to 29 mL/min/1.73 m2. Symptoms can include anemia and increased blood pressure. Other accompanying symptoms may include weakness, fatigue, and a tendency toward pallor. Furthermore, quality of life decreases due to impaired activity.
Stadium 5
At this stage, the GFR is very low, below 15 mL/min/1.73 m2. At this point, the kidneys have lost their vital functions, and the body's metabolism is unable to function properly. In end-stage kidney disease, the treating internist will begin recommending a kidney transplant if dialysis and other methods fail to maintain kidney function.
Kidney organ transplant
A transplant is a method used to transfer an organ from a donor to a recipient to replace an organ that is no longer functioning properly, with the aim of maintaining proper organ function and body metabolism.
In cases of chronic kidney failure that no longer respond to dialysis or other treatments, a kidney transplant is a last resort. However, this procedure involves a lengthy and complex process to find a donor with the right organ and a good match for the recipient.
Kidney transplant stages
Patient examination
As a patient with end-stage kidney failure who requires a kidney transplant from another person, a comprehensive examination and evaluation will be carried out, from a physical examination, laboratory examination and other supporting examinations.
It's also crucial to educate the patient and all family members about the upcoming kidney transplant. Furthermore, a psychological assessment is crucial before the transplant.
Donor examination
Not only does the patient receiving an organ require screening, but so does the donor. Clear education is crucial for the donor and, if necessary, the family. Psychological assessments are also crucial to prepare the donor for the procedure.
Donor and patient matching
After each donor and patient have been screened, the next step is crucial. Matching between donor and patient will be performed. Blood tests are essential to minimize the risk of organ rejection. One of the primary tests is blood type.
Additionally, tests that can be performed include Human Leukocyte Antigen (HLA). This test is also crucial for the success of the transplant.
Kidney transplant procedure
If all test results are positive, indicating a good match between the donor and recipient, a kidney transplant can be performed. The kidney transplant procedure is performed under general anesthesia.
The kidney will be taken from a donor. It will then be placed in the patient's pelvis and connected to the recipient's blood vessels. If there is an infection or other underlying condition, the patient's old kidney may be removed.
Post-operative care
After the procedure, the doctor will recommend hospitalization for intensive and regular evaluation. Kidney transplants are susceptible to infection and rejection. Therefore, close post-procedure follow-up is crucial.
Kidney transplant recipients are given immunosuppressant drugs to prevent their immune system from rejecting the new kidney. These medications are usually taken for life.
Therefore, it is crucial to have regular check-ups with your doctor, especially if you experience symptoms. The results of these check-ups will monitor your kidney function, assess for organ transplant rejection, and adjust your medication dosage.
Kidney transplant complications
Various organ transplant procedures carry the risk of complications. Post-kidney transplantation can lead to complications. Therefore, it is crucial to have regular check-ups and take medications as directed by your doctor. One possible complication is rejection of the transplanted organ.
This can still occur despite undergoing a series of pre-donation examinations, a smooth surgical procedure, and regular use of immunosuppressant medications. Taking immunosuppressant medications is crucial to help reduce the risk of transplant organ rejection. However, long-term use of these medications can weaken the immune system and increase the risk of infection.
After a transplant, kidney function may improve and return to normal. However, over time, it's possible for kidney function to decline again, especially if other underlying chronic conditions are not well-controlled.
Can kidney transplants be performed in Indonesia?
Yes. Kidney transplants are now available in Indonesia, although this service is not yet available in all hospitals. Furthermore, the current challenge is the long waiting list. Many cases of kidney failure in Indonesia are in the final stages and cannot be treated with dialysis or hemodialysis.
Therefore, the solution is a kidney transplant. Furthermore, the limited availability of donors and the difficulty in finding a match between donor and recipient can also be obstacles. Kidney transplants are also considered expensive procedures. This is a consideration for doctors and patients seeking a kidney transplant.
Can humans live with only one kidney?
Although humans are equipped with two kidneys, it turns out that those with only one kidney can still function well without metabolic disturbances. This can occur in people with a genetic disorder that results in them being born with one kidney or after a nephrectomy, or kidney removal, for specific medical reasons.
Furthermore, after donating a kidney, the donor can continue living a normal life without any disruption to daily activities. Although they have undergone a series of tests to be declared fit to donate, the body will still need to recover and adjust to living with one kidney after the procedure.
Ginjal yang tersisa akan berusaha untuk bekerja lebih agar dapat menjalankan proses filtrasi dengan normal seperti pada kondisi tubuh dengan dua ginjal sebelumnya. Kondisi ini dapat disebut dengan hiperfiltrasi. Namun jika sudah terbiasa, tidak ada kendala berarti setelahnya dalam beraktivitas sehari-hari.
However, to maintain healthy kidneys and ensure they function optimally, it's crucial to maintain a healthy lifestyle by consuming a balanced diet, meeting daily fluid requirements, and exercising regularly. Choose a diet low in salt, low in protein, and rich in fruits and vegetables. This is crucial for maintaining kidney health and preventing overwork, which can impact kidney function and metabolism.
Furthermore, it's important to avoid medications that have side effects that affect kidney function. Be cautious when taking pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs). It's best to consult a doctor before taking these medications. They can usually recommend alternatives that are safer for kidney health.
Not only do organ donor recipients require regular checkups and examinations, but donors also require regular follow-up to monitor kidney function and ensure it remains adequate after the donation. Supportive tests, such as blood and urine laboratory tests, will also be performed. Blood pressure monitoring is also necessary. One sign of impaired kidney function is elevated blood pressure.
Long-term, uncontrolled or poorly managed hypertension can increase the risk of kidney dysfunction and even kidney failure. For daily physical activity, there are usually no restrictions or prohibitions for people with one kidney.
However, it's best to avoid high-risk sports that could cause physical contact or impact to the kidney area. Before deciding whether to donate a kidney or undergo a kidney transplant, it's best to consult a doctor to assess your current condition and obtain clear information. It's also important to consult with all family members before making a decision.
A kidney transplant is usually the last resort in cases of kidney failure. If a nephrologist has made every effort but the results of kidney function improvement are insufficient, the doctor may consider a kidney transplant. Regular post-procedure checkups are essential.
Not only to evaluate kidney function, but also to ensure that the condition of the kidney organ after transplantation does not show any signs of rejection.
Written by Dr. Valda Garcia Reviewed by Dr. Ernest Eugene
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