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UC Davis Transplant Center

UC Davis Transplant Center

When the Kidneys Fail

There are two types of kidney failure, acute and chronic.

Acute kidney failure occurs over a period of hours or days and it is usually reversible.  It may take several weeks for function to return.  Acute kidney failure can be could be caused by:

● Accidents, injuries or bleeding which lower the blood supply to the kidneys - This is called acute tubular necrosis or ATN

● Poisons

● Injuries, growths or blockages of the kidneys, blood vessels or ureters

Although acute kidney failure is usually temporary, in some cases, failure may be permanent.  Permanent or chronic kidney disease is complete and permanent loss of kidney function.  Chronic kidney disease is also known as end stage renal disease (ESRD), or stage 5 kidney disease.   Chronic kidney disease can be caused by inherited kidney diseases or can occur for an unknown reason at any time in your life. Kidney disease usually has no symptoms until most of the damage has been done.  Earlier stages of kidney disease are usually found during exams for other problems. There are many possible causes of chronic kidney disease.  Some common causes include:

• Glomerulonephritis - inflammation and destruction of the kidney's filtering system

• Pyelonephritis - chronic infection

• Polycystic disease - cysts grow in the kidney and destroy its function.  This disease runs in families

• Hypertension - high blood pressure

• Diabetes

When it is found in the early stages, kidney disease can be managed with medications, a controlled diet and fluid reduction.  Ultimately, however, the disease may progress to a stage where the kidneys can no longer function. There are three options for the treatment of end stage kidney disease:

Hemodialysis
In hemodialysis, your blood flows through a special machine that removes waste products of metabolism and extra water. The “cleaned” blood is then returned to the body. Hemodialysis is done on a strict schedule. Most patients have dialysis for three to four hours, three times a week. Hemodialysis requires a vascular access to allow for removal and replacement of your blood (a surgical procedure). Some dialysis centers teach patients to do hemodialysis treatments at home.

As with any medical therapy, complications can occur with hemodialysis. The most common complication is low blood pressure. This is related to the removal of water over a period of hours rather than the slow removal of water that would happen if you went to the bathroom to urinate every few hours. Also related to the rapid removal of water, leg cramps can occur.  Other common complications of hemodialysis include heart rhythm problems and decreased oxygen levels in the blood.

Peritoneal Dialysis
In peritoneal dialysis (PD), a soft tube called a catheter is used to fill your abdomen with a cleansing liquid called dialysis solution or dialysate. The placement of the catheter requires a surgical procedure. The walls of your abdominal cavity are lined with a membrane called the peritioneum. The peritoneum acts as a natural filter that allows waste products to move from the body into the fluid. It also pulls extra body water into the fluid. The dialysis solution, along with the waste and extra water are then drained out of the abdominal cavity after being allowed to dwell there for 4-6 hours. The process of draining and filling is called an exchange. A typical schedule calls for four exchanges a day.

Another form of PD, called CCPD, requires a machine called a cycler to drain and fill the abdomen while you sleep.

The most common complications of PD include abdominal infection or infected catheters and diabetes. 

Kidney Transplantation
Another option for end stage kidney disease patients is transplantation.  A kidney transplant is an operation where a kidney is removed from the body of one person and is placed into another person.  The remainder of the information here discusses all aspects of kidney transplantation. Kidneys used for transplants are gifts, which come from one of two sources, living donors and deceased donors.

Living donors are parents, brothers, sisters, adult children, husbands, wives or friends who want to donate to you. Sometimes people want to donate a kidney to anyone on the list. These are called altruistic or non-directed living donors.

Deceased donors are people who, after death, have their organs donated either by prior arrangements or by their family.

People want transplants for many different reasons.  Some want to feel better and some want a freer lifestyle.  Other patients may have medical reasons for considering transplant.  An example would be repeated clotting of vascular accesses.

Some of the advantages of transplant include the following:

● It is a more normal means of keeping the body in proper chemical balance

● You may have an increase in energy level

● Your diet is much less restrictive

● A vascular access is not needed

● Some patients find that sexual interest and ability returns after transplantation

● You do not have to go to dialysis

● Most recipients report a better quality of life

There are some disadvantages to transplant as well:
 
 ● Risk of rejection

● There is no way to predict how long the kidney will last

● Medications must be taken every day for as long as your kidney works.  These medicines have some unpleasant side effects

● There are risks and complications as there are with any operation These will be discussed more completely in another area 

 

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