Medical Treatment for Kidney Disease and Failure

Millions of people across the world suffer from various kidney diseases and organ failure at a later stage of the sickness. When kidney functions are completely lost, it is known as ESRD (End Stage Renal Disease) or renal failure. Kidney disease can never be reversed. Its progression can only be slowed down. In addition to primary kidney ailment; a person will require medical treatment if his/her kidney has stopped working due to an injury, severe burns or biological defects. There are very few options to treat issues related to kidney based on the root cause of the disease and also overall working condition of kidney at the time of starting the treatment. People suffering with ESRD can live longer with the help of dialysis or kidney transplant.

Constructive Lifestyle and Supportive Medication

Although minor kidney disease symptoms do not alarm a person to consult a doctor but either regular annual check up findings or if family and personal history suggests high risk of kidney failure then a specialist doctor’s help can be solicited. The doctor will consult and further analysis a person’s reports to find out the underlying cause or disease which is damaging kidney. As there is no particular pills for treating kidney disease; medicine are given to slow down or control the following other disease which affects adversely on kidneys.

• high blood pressure
• diabetics
• anaemia
• high cholesterol levels

 

In addition to the above doctor can prescribe medicines to relieve swelling by treating water retention and also suggest vitamin D and calcium supplement for healthy bones.

Simultaneously positive change in lifestyle by doing regular physical exercise, healthy food which is good for kidney (ex. less protein, salt, sodium, and potassium) helps to extent kidney life.

Dialysis

Once a person is sick with the kidney disease, nephrons are destroyed gradually or swiftly and both kidneys get affected at the same time. These tiny ‘nephrons’ (filters) present in the kidneys are responsible for purifying blood and flushing out body waste. If the health condition of the patient reaches to the stage, where kidney functions are restricted to minimal and body waste cannot be washed out thoroughly, then the initial option is dialysis. A person with damaged kidney needs to take help of a special machine that acts like a kidney to wash and clean the blood. This is called dialysis. This is a procedure to remove waste products and excess fluid from the blood. Dialysis becomes inevitable when kidneys start deteriorating in advanced (stage 5) of CKD. It is important to understand that dialysis doesn’t cure kidney failure.

There are two main types of dialysis:

a) Peritoneal Dialysis: It is a one of the dialysis treatment option which involves pumping dialysis fluid into the gap within the patient’s stomach to draw out body waste from the blood. A slim tube (catheter) inserted into patient’s abdomen which fills empty space with a dialysis solution that absorbs waste and excess fluids. After a period of time, this dialysis solution is drained out from the patient’s body, carrying the waste with it. Peritoneal dialysis process can be done at home easily but it has to be repeated several times within 24 hours or preferred overnight to save daily routine time schedule.

b) Haemodialysis: In this process, a special external machine is used to filter waste and excess fluids from patient’s blood. Impure blood of the patient is taken out through tubes, filtered in the dialysis machine and then inserted again to the body. Initially haemodialysis is started once or twice in a week as per treating doctor’s decision but gradually dialysis is required for about three times per week. Mostly haemodialysis is done in the hospital by professional staff supervision however some people prefer to install the machine at home and undergo the procedure with the help of healthcare professionals. Until kidney transplant is done, dialysis need to be life-long.

Kidney Transplant

Filtering blood through dialysis is time consuming and also not convenient in the long term. Therefore kidney transplant is selected as last treatment option by the kidney failure patients, if not selected at initial stage.  

A kidney transplant involves surgical placement of a healthy kidney from the donor into patient’s body done in the hospital. Transplanted kidneys can be obtained from deceased or living donors. The majority of organ transplants are from deceased donor. However as demand of the organ is on high with huge waiting list and availability/suitability of deceased kidney is very less, there is a great need to have more living kidney donor. Since a person can live a normal life with even one healthy kidney, living kidney donation is the best option.

Procedure to Match Kidney

In order to be a match for a kidney transplant, patients must match blood type and human leukocyte antigen (HLA) factors with their donors. They must also have no reactions to the antibodies from the donor’s kidneys. A match is good if the donor and recipient have compatible blood types. This is to increase the chance that the recipient's body accepts the new kidney.

Blood Tests

There are three main blood tests that will determine if the recipient will accept your kidney. They are blood typing, tissue typing and cross-matching.

Blood typing (ABO compatibility)

This is the very first simple blood test to check the compatibility between the kidney recipient and the donor.

Tissue (genetic) typing

Tissue typing is a blood test that matches the number of antigens the donor and recipient share. An antigen is a genetic marker that can recognize the difference between two people's body tissue. Genetic markers are unique in each person’s body.

Cross-matching of blood test

It is a blood test which is conducted twice at least for the patient and the kidney donor. As the name suggests, blood reaction possibility is confirmed to decide transplant can be done or not. This blood test (cross-matching) has to be negative that means there should not be any reaction in patient’s body and transplant surgery can be done. If this test turns out to be positive then transplant cannot happen because this refers to the situation where the kidney recipient's body would not accept donated (new) kidney and transplant will not be successful.

Types of Kidney Transplant Surgery

The kidney donor and the patient (organ receiver) undergo the surgery at the same time in separate operation theatre. On one hand, half of healthy kidney is extracted from the donor’s body and simultaneously transplanted to the kidney receiver’s body. There are two types of operation done to transplant kidney.

(i) Traditional Surgery: This is the traditional way of operation in which an open cut is made by the surgeon and the process of surgery is done with medical instruments.

(ii) Laparoscopic Surgery: Process of this operation is relatively advanced technique. This surgery is also referred as minimally invasive surgery (MIS) or keyhole surgery. Unlike open cut surgery, several small incisions are made with the help of a scope and camera.

Both these methods of surgery serve the same purpose except the fact that the size of incision is far less in laparoscopic procedure though the suitability to choose the surgery type is sole decision of the surgeon depending upon various aspects.

Eligibility Criteria for the Living Kidney Donor

• In India, the very first criteria for being the organ (kidney) donor is that he/she should be the close relative of the recipient (patient). The patient’s (kidney receiver) spouse, children, grandchildren, siblings, parents and grandparents are referred as ‘close relative’ and are considered eligible as kidney donor.

(Please note: There are systematic procedures (genetic tests) and committees/department/officials to verify legal documents of the patient and donor as valid proof of their relationship.)

• Donor should be between the age group from 18 to 55 years
   
• All the necessary medical tests are performed prior to the transplant.
   
• Donor should be healthy and declared physically and medically fit to donate the organ by the specialist doctor after ensuring normal structure of kidney and functioning of the full body system. All the required tests should be conducted in the hospital before the surgical procedure is done.