Discuss the Management of Kidney Failure by Dialysis and Transplant
Most humans are born with two bean-shaped kidneys (approximately 11cm long and 6cm wide) located in front of the twelfth ribs at the back of the abdominal cavity. Oxygenated blood and nutrients are supplied to the kidneys by the renal artery and the renal vein carries away filtered blood to the heart.
Kidneys play a crucial role in homeostasis, working as vital filtration and purification organs. They filter poisonous urea and other waste products from the bloodstream so that they can be eliminated by excretion from the body in urine. The production of urine containing variable amounts of water and solute concentrations allows the kidneys to control the water and ion content of the body; osmoregulation. They produce the hormone, erythropoietin, which stimulates erythrocyte production in the bone marrow.
Complications of diabetes, uncontrolled hypertension, inflammation affecting kidney tissue and inherited diseases, such as polycystic kidney disease, are the main causes of kidney failure. Toxins, including urea and other nitrogenous wastes are not filtered from the blood and amass in the tissues. The kidneys are rendered incapable of maintaining the composition of body fluids. Currently 35,000 UK residents receive treatment for kidney failure. Patients are often anaemic, feel ‘run down’ and suffer with cramps, loss of appetite, itching or vomiting. Kidney failure, once inevitably fatal, can be treated by three options: haemodialysis, peritoneal dialysis and kidney transplant.
Kidneys In vertebrates, kidneys are the two major organs of excretion. Excess water, toxic waste products of metabolism such as urea, uric acid, and inorganic salts are disposed of by kidneys in the form of urine. Kidneys are also largely responsible for maintaining the water balance of the body and the pH of the blood. Kidneys play important roles in other bodily functions, such as releasing the ...
Haemodialysis, the most common treatment for kidney failure, uses a filter known as a dialyser as an artificial kidney. The patient’s arterial blood, about 200cm3 outside the body at any one time, is usually pumped from a shunt from a vein in the forearm through the dialyser where molecules are exchanged between the dialysate and the blood. A net movement of urea, water, glucose and salts such as sodium and potassium out of the blood is ensured by the composition of the dialysate. The cleaned blood returns. Haemodialysis is usually carried out in hospital or a special clinic, the process taking four hours, three times a week. Patients will be lying on a couch or sat in a chair and can pass the time reading or watching television. Home treatment is possible but only after extensive technical training has been received by the patient. For home treatment, this form of dialysis, unlike peritoneal dialysis, realistically requires a separate room and therefore has a greater degree of interference with the home.
Peritoneal dialysis utilizes the peritoneum as a dialysing membrane. A stoma is made in the abdomen wall and the dialysing fluid is introduced through a tube. It must be performed four times every day but as a dialysing treatment is still considered to be the least time consuming as haeomodialysis can involve lengthy journeys to and from hospital. Perhaps its greatest advantage is that during peritoneal dialysis treatment, the patient is free to walk around. It can be done at any hour and can provide a greater sense of independence. The dialysate must be exchanged every six hours but this is a simple procedure which the patient can carry out themselves after some basic training. It can be executed at home, in the workplace or on holiday, with comparative ease. Bags of solution are easy to take on holiday. In the case of Haemodialysis, holidays are only possible where dialysis can be organised in another unit. If the unit is non-NHS, the patient is responsible for costs that exceed the NHS equivalent.
Diet is essential in kidney failure because waste products from our food can not be eliminated and so should be reduced. Salty foods should be avoided. Potassium and phosphate should be controlled. The diet for a haemodialysis patient is stricter than that of a peritoneal dialysis patient.
If a patient develops a blood clot in the femoral vein of the left lower limb and a portion of the clot breaks loose, where is the blood flow likely to carry the embolus? What symptoms are likely? To add to your thoughts, the blood flow is likely to carry the embolus to the patient’s lungs. This is called a pulmonary embolism. Pulmonary embolisms usually originate in the legs, like in this case. ...
Dialysis is an invasive technique and it presents risks and side effects. Damage to the access point or bleeding can occur. Catheters present risk. Risks of infection, particularly peritonitis (in peritoneal dialysis) with its flu-like symptoms or septicaemia (particularly haemodialysis) are possible. Cleanliness and good hygiene facilitate prevention. Anaemia due to reduced levels of erythropoietin (especially haemodialysis), hypertension, MRSA, risk of hepatitis B and C due to exposure to blood during treatment and the theoretical risk of HIV are all concerns.
Overall, it is considered that of the dialysis options, peritoneal dialysis entails less financial burden. Dialysis filters are expensive pieces of precision engineering that can be used for only a few sessions and must then be discarded. Due to the costs of this equipment, maintenance and personnel, dialysis treatment is substantially more expensive than kidney transplant.
Kidney transplantation involves a kidney from a donor being implanted in the lower abdomen and connected to the recipient’s blood supply and bladder. The failed kidneys will usually be left in place. The donated kidneys can be transplanted from either a matching cadaver or a living donor who can safely donate one of their two kidneys.
In 2007-2008 there were 6980 patients on the UK active kidney transplant list and 1453 transplants were carried out. Too few people carry donor cards and permission to use organs from recently deceased people has to be given by distressed relatives, who often say no. What’s more, improvements in road safety and prevention of strokes in younger people have caused organ availability to fall. Additionally, amongst the growing Asian and Black populations there is a desperate need for more donors. A few people with rare tissue types may only be able to receive a well-matched kidney from someone of the same ethnic origin and the UK Register shows that less than 3% of cadaveric donors are from ethnic minority groups. All of this, perhaps coupled with a strain on NHS resources (there are not enough dialysis machines), has led to England’s Chief Medical Officer calling for an ‘opting out, not opting in’ system of presumed consent to organ donation. Indeed, some senior doctors have expressed concern for the growing strain placed on the NHS by botched transplant operations conducted abroad; in 2006 Iran legalised the sale of kidneys. Legalized organ sales could save thousands of lives every year, but surely it unfairly targets poor people. Some have called for prisoners, street children or brain-damaged patients to become compulsory donors. This is both disconcerting and unethical.
In today's fast-paced world where technology rules, the medical profession is also advancing. In 1991, 2, 900 liver transplants were performed in the United States while there were 30, 000 canidates for the procedure in the United States alone (Heffron, T. G. , 1993). Due to shortages of available organs for donation / transplantation , specifically livers, once again science has come to the ...
Kidneys transplants from living donors have a better outcome than those from a cadaver. An organ from a donor who is genetically identical to the recipient – an identical twin – is ideal. The next best alternative is one from a blood sibling, followed by a parent or other blood relative.
To combat rejection, kidney recipients must take immunosuppressive drugs for life. These can increase susceptibility to infections such as cytomegalovirus and varicella (chickenpox).
Additionally, bone marrow must be irradiated (to stop white cell production) and ABO blood group and tissue-type compatibility must be matched.
Dialysis treatment substitutes the work done by the kidneys. It does not cure kidney failure. Equally, a transplant is not always a long-term cure. Cadaver kidneys have a four-year survival rate of 66%, living donor kidneys 80.9% and some patients have had as many as five or six transplants. However, there have been cases of living and cadaver kidneys functioning well for over 30 years. Dialysis is an inconvenient treatment but it is essential. With transplantation, matching donors are not readily available and there is often a long waiting list. Here, dialysis has its role. Furthermore, it is paramount in the early stages of a transplant when the new kidney is establishing an acceptable level of functioning. If a transplant is rejected or when one eventually ceases to function; dialysis is the answer. Transplantation is major surgery involving risks of bleeding, the anaesthetic and possible damage to surrounding organs and is therefore unsuitable for the elderly or weak. Patients with a history of heart disease, lung disease, cancer, or hepatitis may not be suitable. However, countless suitable recipients after a successful procedure do go on to lead a relatively normal life often discovering increased energy and a transformation of self-perception – no longer seeing themselves as chronically ill.
Organ donation is such a simple and selfless action one takes to save the lives of others. The pros of declaring oneself as a donor far outweigh the cons, for nearly 90% of Americans claim to support donation. Only 30%, however, know how to or actually become donors, according to Donate Life America; so, what steers people away? Many avoid declaring themselves as organ donors because there are ...
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