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Dr. Jeff Hersh: When is a kidney transplant necessary? – Clinton, MA – The Times &

By Dr. Jeff Hersh

Posted Oct 29, 2013 @ 06:43 PM

Q: My niece’s son is going to have a kidney transplant. Why is this needed? A: Kidney function (also called renal function) is necessary for life. An adult’s kidneys filter over 200 quarts of blood per day in order to: – remove toxins and waste; – remove drugs and medications; – keep the body in correct fluid balance; – regulate the concentrations of the body’s electrolytes (including sodium, chloride, calcium, potassium and others); – regulate the acid/base balance of the blood. In addition, the kidneys: – release hormones to help regulate blood pressure; – produce vitamin D to help keep the bones strong; – help control the production of red blood cells. Even if the kidneys only function at 30 to 50 percent of normal, they can usually keep up with the body’s needs. In fact one well-functioning kidney is typically sufficient to keep someone healthy; people born with only one functioning kidney usually do very well. However, if renal function drops below 25 percent of normal the patient will usually develop symptoms, and if it drops below 10 percent of normal the patient will typically need replacement therapy (either dialysis or a kidney transplant). Dialysis is an artificial technique to replace the kidney’s filtering functions (noted above); medications are used to help replace the kidney’s other functions. Dialysis can be done by hemodialysis or peritoneal dialysis: – Hemodialysis filters the patient’s blood externally to their body. The patient will have a procedure to establish “vascular access” so that blood can be carried out of their body to the dialysis machine (where it is filtered) and then returned to their bloodstream. – Peritoneal dialysis utilizes a catheter placed into the patient’s abdominal cavity to instill, circulate and withdraw a special solution of fluid, allowing absorption of waste/toxins/drugs, regulation of electrolytes and acid/base balance, and control of overall body fluid balance. In essence this technique uses the lining of the patient’s abdomen as their “dialysis machine.” Some babies are born with kidneys that do not function normally, or are born with a condition that causes their kidneys to fail soon after birth. In addition there are many diseases and conditions that may (in some cases) cause renal failure as a complication, such as diabetes, hypertension and certain kidney conditions (for example glomerular diseases, infections, toxicities, etc.). The symptoms of kidney failure can be subtle, and may include changes in urination (going more or less often), feeling tired (which can be because of low blood count since the kidneys help regulate red blood cell production, but can also be due to electrolyte or other imbalances), swelling (from fluid retention), muscle cramps (from electrolyte imbalances), feeling itchy (from chemical imbalances), skin changes and many others.

A full history and physical exam (paying close attention to blood pressure) is the first step to evaluate someone with suspected kidney failure. Blood and urine tests can help evaluate the severity of the failure and help identify possible causes. Imaging of the kidneys, often starting with an ultrasound examination, is usually indicated.

Kidney transplant, when appropriate and available, is the treatment of choice for renal failure. Although dialysis can be very beneficial, it can have a negative effect on the patient’s quality of life (it can be time- and energy-demanding), and is not as effective as a well-functioning kidney.

Due to improved medications to manage possible organ rejection (where the patient’s immune system tries to “fight off” the transplanted kidney), almost 90 percent of kidney transplants are still functioning well one year after transplant.

Immunosuppression treatments include an induction phase (where the patient’s immune system is initially prepared for the “non-self” kidney) and maintenance regimens (where the immune system is chronically suppressed to prevent organ rejection).

A candidate for kidney transplant must be thoroughly evaluated to be sure the procedure is appropriate for them. This will include evaluation of their overall health to assess whether they will they be able to tolerate the immunosuppression treatments and the other stresses of surgery, whether another disease would significantly limit their life expectancy (such as certain cancers) or whether there are other medical conditions that may cause concern such as advanced heart disease, brittle diabetes, severe respiratory conditions, propensity for infection (for example pre-existing immune diseases such as AIDS) or others.

There are almost 100,000 Americans waiting for a kidney transplant (about a third of these are “inactive,” meaning they are temporarily not a good candidate for a transplant, perhaps because of an acute infection or other condition, but they remain on the waiting list), and there is a limited supply of donated organs. The decision as to which patient will be transplanted depends on how long they have been on the waiting list, as well as how “compatible” they are with the genetics of the donor kidney (for live donor kidneys).

A kidney transplant can improve the quality and quantity of the lives of people with renal failure. Everyone should consider being an organ donor (in case something tragic should happen to them), and to be sure their family and loved ones know of their wishes. Organ donation is an amazing way to help improve and even save someone’s life.

Jeff Hersh, Ph.D., M.D., can be reached at

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via Dr. Jeff Hersh: When is a kidney transplant necessary? – Clinton, MA – The Times & Courier.

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