The kidneys are two bean-shaped organs located on each side of the spine just below the rib cage. Each is about the size of a fist. Their main function is to filter and remove waste, minerals, and fluid from the blood by producing urine.
Chronic Kidney disease (CKD) is a renal disease that makes the kidneys lose this filtering ability and harmful levels of fluid and waste accumulate in your body. CKD is one of the major causes of death around the world. Early detection and treatment can help to cure this disease or prevent the damage it causes. The most alarming thing about kidney diseases is most of the people don’t even know that they have CKD.
If left untreated CKD can raise your blood pressure and result in kidney failure (end-stage kidney disease). End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally.
Common causes of end-stage kidney disease include:
- Chronic, uncontrolled high blood pressure
- Chronic glomerulonephritis —an inflammation and eventual scarring of the tiny filters within your kidneys (glomeruli)
- Polycystic kidney disease
People with end-stage renal disease need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant to stay alive. But in case of renal failure, the only option for survival are dialysis or a kidney transplant. Kidney transplantation is considered the treatment of choice for many people with severe chronic kidney disease because quality of life and survival (life expectancy) are often better than in people who are treated with dialysis. On average the life expectancy of a kidney transplant patient is 12 years to 20 years. Kidney transplant is a surgical procedure to place a healthy kidney from a living donor into a person whose kidneys no longer function properly.
Aspects taken into consideration before conducting surgery:
- Legal means should be used throughout the process for example, the organ is legally harvested and provided.
- Recipient and donor both are medically fit for the surgery.
The Kidney Transplant Team at Rehman Medical Institute (RMI) is trained specially in meeting the needs of kidney transplant patients. The team is committed to providing comprehensive care in a compassionate setting.
The Kidney Transplant Team members include:
- Transplant Surgeons
- Transplant Nephrologists
- Transplant Coordinators
- Transplant Fellows and Residents
- Transplant Program Assistants
- Financial Counsellors
- Transplant Psychiatrist
- Transplant Pharmacists
- Nurse Practitioners
- Registered Nurses
- Nursing Assistants
Having all of this subspecialized expertise in a single place, focused on you, means that you're not just getting one opinion — your care is discussed among the team, your test results are available quickly, appointments are scheduled in coordination, and your transplant care team works together to determine what's best for you.
Additional consultants may also include:
- Vascular Medicine or Surgery
- Infectious Disease
The following RMI Transplant Centre doctors and staff specialize in Kidney Transplants:
Kidney Transplant Program Leadership:
- Surgical Director: Dr. Taqi Toufeeq Khan
- Medical Director: Dr. Nisar Anwar
- Clinical Head Nurse: Ms. Jamila Begum
- Manager Operations : Mohsin Iftikhar
Kidney Transplant Program Surgeons:
- Dr. Taqi Toufeeq Khan
- Dr. Ata ur Rehman Khan
Kidney Transplant Program Physicians:
- Dr. Nisar Anwar
- Dr. Irfan Mirza
- Dr. Tahir Rashid
Kidney Transplant Fellows:
- Dr. Qaiser Khan
- Dr. Naqeeb
- Dr. Muhammad Touqeer
The term “chronic kidney disease” means lasting damage to the kidneys that may get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will need dialysis or a kidney transplant in order to live.
Who is affected?
- 10% of the population worldwide is affected by CKD
- CKD can affect people of all ages and races
- Half of people aged 75 have some degree of CKD
- 1 in 5 men and 1 in 4 women between 65-74 have CKD
What Causes CKD?
Anyone can get CKD. Some people are more at risk than others. Some things that increase your risk for CKD include:
- High blood pressure (hypertension)
- Heart disease
- Having a family member with kidney disease
- Being Asian
- Being over 60 years old
Symptoms of Chronic Kidney Disease:
Chronic Kidney Disease (CKD) usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body. You may notice one or more of the following symptoms if your kidneys are beginning to fail:
- Muscle cramps
- Nausea and vomiting
- Not feeling hungry
- Swelling in your feet and ankles
- too much urine or not enough urine
- Trouble catching your breath
- Trouble sleeping
If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:
- Abdominal (belly) pain
- Back pain
Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.
Complications of CKD:
Your kidneys help your whole body work properly. When you have CKD, you can also have problems with how the rest of your body is working. Some of the common complications of CKD include anemia, bone disease, heart disease, high potassium, high calcium and fluid build-up.
Stages of CKD:
Chronic Kidney Disease (CKD) refers to all 5 stages of kidney damage, from very mild damage in Stage 1 to complete kidney failure in Stage 5. The stages of kidney disease are based on how well the kidneys can do their job – to filter waste and extra fluid out of the blood.
How to detect CKD:
Early CKD often has no sign or symptoms. A person can lose up to 90% of their kidney function before experiencing and signs. But it can be detected by simple tests:
- A urine test to check if there is any protein in your urine.
- Blood test to measure the level of creatinine in your blood.
Signs of advancing CKD:
Swollen ankles, fatigue, difficulty concentrating, decreased appetite, and foamy urine.
How can I prevent CKD?
Diabetes and high blood pressure are the most common causes of CKD. If you have diabetes or high blood pressure, working with your doctor to keep your blood sugar and blood pressure under control is the best way to prevent kidney disease.
Living a healthy lifestyle can help prevent diabetes, high blood pressure and kidney disease, or help keep them under control. Follow these tips to lower your risk for kidney disease and the problems that cause it:
- Follow a low-salt, low-fat diet.
- Exercise at least 30 minutes on most days of the week.
- Have regular check-ups with your doctor.
- Do not smoke or use tobacco.
- Pediatric transplant
- Recipient with complication of diabetes
- Recipient with vascular calcification
Did you know that your kidneys:
- Make urine and remove acid wastes from the body
- Remove wastes and extra fluid from your blood.
- Control your body’s chemical balance
Kidney also makes hormones that:
- Help control your blood pressure
- Help keep your bones healthy
- Help you make red blood cells
Kidney diseases are silent killers, which largely affect your quality of life. There are however several easy ways to reduce the risk of developing kidney diseases:
1. Keep your body fit and active.
2. Keep regular control of your blood sugar.
3. Monitor your blood pressure.
4. Eat healthy and keep your weight in check.
5. Maintain a healthy fluid intake.
6. Do not smoke.
7. Do not take over the counter pills on regular basis.
8. Get your kidney function checked if you have one or more of the following high risk factors:
- You have diabetes
- You have hypertension
- You are overweight
- One of your parents or family member suffers from CKD
- You are of Asian origin
Kidneys suffering from CKD cannot function properly and filter out the wastes like it should. So, one must follow a healthy diet with some restrictions of certain food and proper balance of all the nutrients so the body can have what it needs and stay healthy.
Taking care of the following factors in your diet, you can reduce the risk of further damaging your kidneys.
1- Cut the Sodium:
Cut the sodium by eating food low in sodium because it absorb too much water from the body and increase blood pressure. Prime source of sodium is table salt. to avoid high sodium intake
- Eat lesser processed and canned foods.
- Instead make home-made food and add too little salt. eat fresh or frozen vegetables such as cauliflower.
2- Cut the potassium:
Similarly potassium is also harmful for CKD patients. To control potassium
- Eat foods which are low in potassium, such as grapes, apples, pineapples, cranberries, strawberries, or blueberries.
- Eat more fruits and vegetables (low in phosphorus) instead of meat and pulses.
3- Cut the Phosphorus:
Reduce intake of phosphorus especially in salt form, as it is highly absorbable by intestines. In natural foods it is not that much harmful but sodas and especially black sodas contain very high amounts of it. thus it should be avoided at all costs.
4- Always consult your dietitian or your health care provider for your diet choices.
5- The diet intake and restrictions may vary with the severity of CKD.
Since January 2019 till January 2021, we have performed a total of 41 surgeries. RMI has catered patients from all over the KP, including Orakzai Agency, Mardan, Swat, Mansehra and Kohat and even Karachi. Some of these cases were of high risk having diabetes, hypertension, and cardiovascular disease. So far, our youngest patient for surgery was 17 years and the oldest 55 years. The success rate of our Kidney Transplant Unit matches international standards.
Throughout the entire transplantation process, the RMI kidney transplant team ensures that you receive the best possible care. Team members are there each step of the way.
Remember, each patient has a different rate of recovery. You will be discharged only after your Transplant Team has determined that you have regained your strength and your health is stable.
Your length of stay and recovery in the hospital will depend on a few factors including:
- Type of transplant procedure.
- Your body's acceptance of the new organ.
- Your overall health.
Transplant team members are available after patients have returned home to provide additional information and answer questions. The team also can help with follow-up care, including routine blood testing, medication evaluation and adaptation, and visits to ensure that patients are doing well. Your transplant team will give you instructions on how and when to contact the post-transplant office following your discharge.
Taking Care of Yourself
Soon after surgery and during your stay in the hospital, your Transplant Team will teach you more about taking your new medicines. You will learn when to take your medicines, how to take them, what happens if you miss a dose, and what side effects the medicines might cause.
A daily record of your health is kept during your stay at the hospital, and you will need to continue monitoring your health when you go home. Before you leave, a nurse will teach you how to accurately measure both your liquid intake and urine output. To ensure that your kidney is functioning well, you will need to measure and record how much you drink and the amount you urinate for at least six weeks after the transplant surgery. You will also need to record your daily temperature, blood pressure, and weight.
When will I be able to go home?
Our goal is to help you feel comfortable and confident about taking care of yourself before you go home. Before going home, you will need to be able to:
- Follow your medicine schedule correctly without assistance
- Take your temperature and blood pressure
- Keep track of and record your fluid intake and urine output
- Know whom to call for an emergency appointment
- Know what problems should be reported to the transplant coordinator
The Transplant Team will be monitoring your health closely after the transplant and during your follow up appointments. Therefore, it is very important to keep your scheduled lab and follow-up appointments.
How should I take care of myself once I go home?
Once you are discharged home, you will need to continue recording your daily temperature, blood pressure and weight in a notebook. It is also very important to keep your list of medications updated.
Remember to keep the records in your notebook for at least six weeks, or longer if you have complications. The Transplant Team will let you know when it is okay to stop recording this information. Remember to always bring your post-transplant notebook and medicines to each Transplant Clinic visit.
What will I need before I go home?
It is important to make sure you have each of these before you go home:
- Blood pressure scale
To decrease the chance of infection, you must avoid people with colds or flu for at least three months. By avoiding illness now, you will be able to return to an active life within a few months.
Tips for a Healthy Transplant Recovery:
- Take all your medicines exactly as prescribed
- Keep all of your scheduled appointments with the Transplant Team
- Call the Transplant Team if you have any questions or concerns
- Have your blood drawn promptly, as recommended by the Transplant Team
- Follow your recommended dietary plan
- Follow your recommended fluid intake
- Follow your recommended exercise plan
- Avoid being around anyone who has an infection
Call the Transplant Team if you experience any of the following:
- A fever higher than 100°F (38°C)
- Flu-like symptoms such as chills, aches, headaches, dizziness, nausea or vomiting
- New pain or tenderness around the transplant
- Fluid retention (swelling)
- Sudden weight gain greater than 4 pounds within a 24-hour period
- Significant decrease in urine output
What is transplant rejection?
One of the most common complications following a kidney transplant is rejection. Rejection is your body’s way of not accepting the new kidney. Although rejection is most common in the first six months after surgery, it can occur at any time.
Fortunately, the Transplant Team can usually recognize a rejection episode before it causes any major or irreversible damage. It is very important for you to continuously take your medications as prescribed and have your blood work drawn as scheduled.
What are the warning signs of possible rejection?
It is vital for you to be aware of the possible signs of kidney rejection. If you think you are experiencing any of these symptoms, contact the Transplant Team immediately:
- Fever over 100°F (38°C)
- "Flu-like" symptoms: chills, aches, headache, dizziness, nausea and/or vomiting
- New pain or tenderness around the kidney
- Fluid retention (swelling)
- Sudden weight gain greater than 2 to 4 pounds within a 24-hour period
- Significant decrease in urine output.
How is rejection identified?
The Transplant Team will be able to determine if your body is rejecting your kidney by completing routine tests of kidney function. If the Team thinks you may be experiencing any problems with your new kidney, the following tests may be completed:
- Repeated blood work
- Renal flow scan (which checks blood flow to the kidney)
- Renal ultrasound (which checks for other physical problems)
- Kidney biopsy
How is rejection treated?
If rejection develops, your physician may prescribe medications to treat rejection and prevent continued complications. In order to control the rejection, you may need to be admitted to the hospital, or you may receive care in the outpatient setting.
Will rejection treatment cause side effects?
The medications used to treat a kidney rejection episode are strong drugs. The first few doses may cause the following side effects:
- Fever, chills
- Nausea, vomiting
- General flu-like symptoms
To help control these symptoms, you may receive a pre-medication of acetaminophen (Tylenol) and diphenhydramine hydrochloride (Benadryl) before each dose.
1- What is organ transplantation?
If you have a medical condition that may cause one or more of your vital organs to fail, transplantation may be a treatment option. A transplant is a surgical operation to give a functioning human organ to someone whose organ has stopped working or is close to failing. In some cases, a living person can donate all or part of a functioning organ.
2- Which organs can be transplanted?
The organs that can be transplanted are:
- kidney/pancreas (can be transplanted at the same time)
- heart/lung (can be transplanted at the same time)
- vascularized composite allografts (VCAs), such as face and hand transplantation
3- How do I find out whether I am eligible for a kidney transplant?
Our team of Nephrology at RMI will be able to provide you with information on kidney transplantation. Following discussion about its advantages and disadvantages, a decision can then be made about your suitability for transplantation.
4- How much kidney transplant Costs?
It costs Rs.1,500,000 (Rs.1.5 million) for both donor and recipient. In case of complications, multiple donors or rejection, the price can wary.
5- What is the recovery time after a kidney transplant?
Two weeks after the surgery, you should start to feel much better, however, you need to take medication to prevent rejection for the rest of your life.
6- What kind of lifestyle changes do you need to make?
The only other lifestyle change we encourage is for transplant patients not to be involved in contact sports. We recommend that you stay active, avoid smoking and alcohol, and stick to a healthy diet.
7- Can competitive athletics continue after a kidney transplant?
We recommend that people avoid contact sports: football, basketball, wrestling, soccer, and certain other sports that could result in injury to the area of the body where the transplanted kidney has been placed.
8- What causes rejection after a kidney transplant?
Rejection is due to the same immune response that protects yourself against colds and other viruses. Though we run tests to indicate how likely rejection will be, there is no way to be sure about whether rejection will happen or not.
9- What are the advantages of living donation?
There are three advantages to living donations versus getting a deceased donor kidney:
- Getting a kidney from a spouse or relative is often quicker.
- A kidney from a living donor is completely healthy. They are known to work better and longer than deceased donor kidneys.
- If the kidney is donated from a relative, the tissue may be a closer match and lower the chance of rejection.
10- Can someone who is not a close relative be a living donor?
Yes, a kidney from someone who is not a relative can work very well.
11- How does living donation affect the donor?
The risk of serious injury from a donation is low, around 1 in 10,000. Patients who donate a kidney may also be sore for some period of time, as after any major surgery.
12- Are there age limits or medical conditions that rule out organ transplantation?
There is no upper age limit for kidney transplantation although it is important that whenever it is considered, the potential benefits should outweigh the disadvantages. The transplant operation and the subsequent treatment can be testing and therefore a patient needs to be fit enough to withstand the entire process. The decision on the appropriateness of transplant surgery is made by the individual concerned in consultation with their doctors.
13- What factors are considered in organ matching and allocation?
Many different medical and logistical characteristics are considered for an organ to be distributed to the best-matched potential recipient. While the specific criteria differ for various organs, matching criteria generally include:
- Blood type and size of the organ(s) needed.
- Time spent awaiting a transplant.
- The relative distance between donor and recipient.
- For certain organs other factors are vital, including:
- The medical urgency of the recipient.
- The degree of immune-system match between donor and recipient.
- Whether the recipient is a child or an adult.
14- Will a living donor experience any adverse effects and how quickly will the donor recover to full health?
Although living kidney donation is associated with a very small risk of death, the vast majority of live donors will quickly recover from the operation. Patients can expect to be in hospital for 3-5 days and will normally not work or undertake work-like activities for between four to six weeks. Evidence is available that long-term health is not affected by kidney donation.
15- How long will I be in the hospital?
Following a kidney transplant, the length of stay in the hospital is usually five to seven days, but can extend to several weeks in more complicated cases. You will be seen daily by the transplant team. Discharge planning is started at the time of admission by the coordinator with plans for care at home, transportation to clinic visits. Education about all aspects of after-transplant care including medications, clinic visit schedule and daily activities will be provided by the transplant coordinator.
16- What are the steps for kidney donor evaluation process?
The first step is the Initial Interview and if there is more than one potential donor, establishing compatibility.
The second step is the assessment about your overall health status. A comprehensive medical history and physical examination is performed. It is very important that you declare all health-related history such as having high blood pressure, diabetes, kidney disease, kidney stones, stroke, heart and lung diseases and surgical interventions. You need to report your family history, especially family history of kidney diseases. History of smoking, drugs and alcohol needs to be discussed.
After the complete medical clearance is complete, the donor will meet with the surgeon to discuss the risks of donor surgery. Once the donor is fully cleared to proceed, the surgery date for the donor and recipient can be scheduled, at their convenience.
17- What tests do I need during the evaluation process?
- During your evaluation, the transplant team will complete urine and blood tests to assess your kidney function, blood chemistries, blood cell counts, liver function and exposures to infections such as Hepatitis B, Hepatitis C, HIV and tuberculosis.
- An electrocardiogram (ECG) needs to be performed to assess the heart.
- Chest X-ray and abdominal CT scan are the required imaging studies.
- Other tests such as heart exercise test and cancer screening might be required.
18- Does kidney donation shorten my lifespan?
The answer is NO. Kidney donation is generally safe however it is not risk-free. There are some risks associated with any major surgery including surgery for kidney donation. Studies have shown that kidney donors have a lifespan similar to the general population.
19- Can I exercise after donating a kidney?
Yes, you may exercise after donating your kidney, however there will be a brief period of exercise restrictions while you are recovering from kidney donation surgery.
20- Is there any specific diet that I need to follow?
RMI recommends that you follow a healthy diet, balancing proteins, carbohydrates and fats. There are no dietary restrictions other than avoiding unhealthy food.
21- What will be expected of the donor?
The donor will be assigned a nurse coordinator who will be responsible for educating them through the donation process. The coordinator will work only with the donor and cannot disclose any health information to their family or the recipient.
22- How long does the process take?
The donation process depends on how many tests are required of the donor and how quickly he or she is able to complete them. The average donor work up may take couple of weeks for completion and may depend on test results, which may indicate additional evaluation is required. A transplant date cannot be set until the entire work up has been completed and has been evaluated by the surgeon. The transplant center does its best to accommodate the needs of the donor and recipient, but appointment times may be limited.
23- What if the donor is not a match?
When compatibility testing shows that the donor is not a match to the recipient there are other options to consider so that the recipient might not have to wait for a deceased donor organ to become available. In some cases, the donor may still be able to donate directly to the recipient as part of our Blood Type (ABO) Incompatible Transplant Program. More testing must be done to decide if this is an option.
24- Who will take care of my health needs after I leave the hospital?
Follow-up at RMI continues as long as the kidney continues to function. Initially, you will be seen couple of times a week. At about two months, you will be returned to your referring nephrologist. Periodic but less frequent visits to RMI will continue over time. Your referring nephrologist and RMI nephrologist will work together to provide your care.
25- What effect does diabetes have on the kidneys?
Diabetes is now the most common cause of kidney failure in America. About one third of patients with kidney failure have it because of diabetes. There are three main things that can be done to reduce the likelihood of kidney failure in diabetics:
- Have tight control over blood sugar.
- Reduce blood pressure, by weight loss or other means.
- Take blood pressure medicines that are designed to protect against the progression of kidney disease.
26- Do recurrent kidney stones lead to kidney disease?
Kidney stones don’t lead to kidney failure often. However, if they cause long-term obstruction of the kidney, they may lead to kidney failure.
27- Can being overweight cause kidneys to fail?
Being overweight is a major contributor to high blood pressure, which often has a relationship with kidney failure. Patients who are seriously overweight should try to get their weight and blood pressure down.