4.5.5 Kidney Transplant: Process and Problems

Definition: Kidney transplantation is the surgical procedure of placing a fully functioning kidney into a person with chronic kidney failure.

• The kidney graft is taken from a deceased donor or from a related or unrelated person.
• ABO blood group compatibility between donor and recipient is essential.
• It is usual to select donor kidneys on the basis of human leucocytes antigen (HLA) matching as this improves graft survival.
• A person can live normally with just one kidney.

• The two problems are rejection and toxic effects of cyclosporine.
• These problems are usually treated simultaneously by adding extra doses of steroids.
• Patients are required to take medications such as cyclosporine etc., to suppress their immune system in order to prevent rejection of the transplanted kidney.
• If at any point a recipient stops taking the medications, rejection can occur; even ten or fifteen years after the transplant.

Science, Technology and Society Connections: Describe the importance of kidney donation for the benefit of kidney failure patients.

Kidney donation is a relatively safe operation, and many donors will never feel the loss of their second kidney. It's the most expendable of organs. So giving up a kidney causes no disadvantage to your long-term health. In fact, studies have shown that kidney donors actually live longer than the general population, because donors come from a pool of people in good health.

STEAM Activity 4.1

Experiment to Show Blood Dialysis and Kidney Functions

• Three small beakers or jars (not larger than 250 mL size)
• Distilled or deionized water
• Scissors
• Ruler
• Timer or clock
• Paper towels
• String (optional)

• Cut the dialysis tubing into three 4-inch segments.
• Soak the segments of dialysis tubing in a jar or beaker filled with distilled water for at least one hour.
• Add 75–100 mL distilled or deionized water to three separate beakers or jars. Label "Normal", "P1", and "P2". These are the water baths.
• Carefully tie a single knot at one end of all three dialysis tubing segments. Tie the knots as close to the ends as possible. You can also use string to tie the ends.
• Fill the first dialysis tubing with 2 mL of the Normal Patient Sample. To do this:
• Rinse the filled-tied dialysis tube with water, especially near the tied ends and place the bag on a paper towel in front of the beaker labeled "Normal" (do the same for P1 and P2 when you fill those).
• In a separate container, rinse the transfer pipet with water by repeatedly squeezing the bulb and flushing the pipette.
• Repeat steps 5 and 6 for Patients 1 and 2. Quickly place all dialysis tubes in their respective water baths.
• Monitor the three dialysis water baths every 5 minutes or so, taking notes as to any changes in the color of the water outside the dialysis bag. Allow the bags to soak for up to 30 minutes.
• After you have recorded your results, you can cut or untie dialysis tubing, empty, and rinse well to reuse for another experimental trial.

Observation Table:

Intermediate Level

Urinary Tract Infections

Kidney Stones

Kidney Failure

Dialysis

Kidney Transplant

Formula / Mathematical Form

Not applicable to this topic.

Solved Example

Not applicable to this topic (descriptive topic).

Important Points

• 1. UTIs are 50 times more common in women.
• 2. Female urethra is 1.5 inches; male is 8 inches.
• 3. Urethritis = infection of urethra.
• 4. Cystitis = infection of bladder.
• 5. Pyelonephritis = infection of kidneys.
• 6. UTIs are treated with antibiotics.
• 7. Kidney stones are hard, crystalline mineral materials.
• 8. Kidney stones are 2–3 mm in diameter.
• 9. Calcium oxalate stones form in acidic urine.
• 10. Calcium phosphate stones form in alkaline urine.
• 11. Uric acid stones form in persistently acidic urine.
• 12. Hypercalcemia = high calcium in blood.
• 13. Hypercalciuria = high calcium in urine.
• 14. Hyperoxaluria = high oxalate in urine.
• 15. Hyperuricemia = high uric acid in blood.
• 16. ESWL = extracorporeal shock wave lithotripsy.
• 17. PCNL = percutaneous nephro lithotripsy.
• 18. Chronic renal failure = irreversible deterioration.
• 19. Acute renal failure = sudden decline.
• 20. Haemodialysis = blood filtered outside body.
• 21. Peritoneal dialysis = uses peritoneum.
• 22. Kidney transplant = surgical replacement.
• 23. ABO compatibility and HLA matching are essential.
• 24. Rejection and cyclosporine toxicity are problems.
• 25. Immunosuppressive drugs are required.

Remember

• - UTI = urinary tract infection
• - Urethritis = infection of urethra
• - Cystitis = infection of bladder
• - Pyelonephritis = infection of kidneys
• - Kidney stones = hard deposits in kidney
• - Nephrolithiasis = condition of having stones
• - Hypercalcemia = high calcium in blood
• - Hypercalciuria = high calcium in urine
• - Hyperoxaluria = high oxalate in urine
• - Hyperuricemia = high uric acid in blood
• - ESWL = extracorporeal shock wave lithotripsy
• - PCNL = percutaneous nephro lithotripsy
• - Chronic renal failure = irreversible deterioration
• - Acute renal failure = sudden decline
• - Haemodialysis = blood filtered outside body
• - Peritoneal dialysis = uses peritoneum
• - Kidney transplant = surgical replacement
• - ABO compatibility = essential for transplant
• - HLA matching = improves graft survival
• - Rejection = problem with transplant
• - Cyclosporine = immunosuppressive drug

Common Mistakes

• 1. Thinking UTIs are more common in men — UTIs are 50 times more common in women.
• 2. Confusing urethritis, cystitis, and pyelonephritis — Urethritis = urethra; cystitis = bladder; pyelonephritis = kidneys.
• 3. Mixing up the types of kidney stones — Calcium oxalate, calcium phosphate, uric acid, etc.
• 4. Forgetting the pH relationship — Calcium oxalate = acidic; calcium phosphate = alkaline.
• 5. Confusing hypercalcemia and hypercalciuria — Hypercalcemia = blood; hypercalciuria = urine.
• 6. Mixing up ESWL and PCNL — ESWL = shock waves; PCNL = tube through back.
• 7. Confusing chronic and acute renal failure — Chronic = gradual; acute = sudden.
• 8. Mixing up haemodialysis and peritoneal dialysis — Haemodialysis = external filter; peritoneal = peritoneum.
• 9. Forgetting the problems with transplant — Rejection and cyclosporine toxicity.
• 10. Thinking a person cannot live with one kidney — A person can live normally with one kidney.

Quick Revision

The urinary tract can be affected by various disorders. Urinary tract infections (UTIs) are 50 times more common in women due to the shortness of the female urethra. Types include urethritis (urethra), cystitis (bladder), and pyelonephritis (kidneys). Kidney stones are hard, crystalline mineral materials that form in the kidney; they can be calcium oxalate, calcium phosphate, magnesium ammonium phosphate, uric acid, or cystine. Causes include hypercalcemia, hypercalciuria, hyperoxaluria, and hyperuricemia. Treatment includes ESWL and PCNL. Kidney failure can be chronic (irreversible, gradual) or acute (sudden). Dialysis is a procedure to filter toxins from the blood by artificial methods; types include haemodialysis and peritoneal dialysis. Kidney transplantation is the surgical placement of a functioning kidney; principles include ABO compatibility and HLA matching; problems include rejection and cyclosporine toxicity.

60-Second Revision

• UTI = urinary tract infection
• Urethritis = infection of urethra
• Cystitis = infection of bladder
• Pyelonephritis = infection of kidneys
• Kidney stones = hard deposits in kidney
• Nephrolithiasis = condition of having stones
• Hypercalcemia = high calcium in blood
• Hypercalciuria = high calcium in urine
• Hyperoxaluria = high oxalate in urine
• Hyperuricemia = high uric acid in blood
• ESWL = extracorporeal shock wave lithotripsy
• PCNL = percutaneous nephro lithotripsy
• Chronic renal failure = irreversible deterioration
• Acute renal failure = sudden decline
• Haemodialysis = blood filtered outside body
• Peritoneal dialysis = uses peritoneum
• Kidney transplant = surgical replacement
• Warning: UTIs are 50 times more common in women

NEXT TOPIC

• Chapter:
• 4. Urinary System of Man

• Topic:
• 4.5.1 URINARY TRACT INFECTION

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