What is Chronic Kidney Failure?
Chronic kidney failure means permanent impairment of kidney functions. Today, the only known treatment for chronic kidney failure is kidney transplantation, which is the most common organ transplant. However, some of the chronic renal failure patients use the dialysis option.
Dialysis should not be considered as an alternative to kidney transplantation, as it can only restore (partially) some of the kidney functions. Moreover, there are many negativities for patients on dialysis such as
- strict diets,
- water restriction,
- travel restriction,
- isolation from social life,
- withdrawal from work or education, and
- developmental delay in pediatric patients.
Patients on dialysis are deprived of most of the functions performed by the kidneys, and therefore have to use drugs intensively. (blood pressure, blood-making drugs, etc.) For these reasons, the quality of life and duration of kidney transplant patients are much better than patients on dialysis. Patients can continue their lives as healthy individuals with a successful kidney transplant and postoperative follow-up.
What are the Symptoms of Renal Failure?
Renal failure, which is one of the most insidious diseases of our age and can occur without any symptoms, is spreading rapidly every day. 2 million patients worldwide are living on dialysis and waiting in line for transplantation.
The most important causes of chronic kidney failure are listed as
- high blood pressure and
- kidney inflammation (nephritis).
The disease, which progresses without any symptoms, begins to show symptoms when the filtering function of the kidneys falls below 30, which should be in the 85-100.
The presence of a significant amount of protein in the person’s urine causes foamy urine to occur. There may be a small amount of protein in the urine (1-14 mg / dl daily). However, large amounts of protein in the urine are abnormal and this condition is known as proteinuria or microalbuminuria. Foaming in the urine indicates the onset of kidney disease and even progress.
What are the Required Conditions for Kidney Transplant?
Unless the precautions are not taken, the rapidly progressing disease may disrupt the function of the kidney within 2-3 years.
When the rate of filtering function drops below 10, it makes it difficult for chronic kidney failure patients to hold on to life without a supportive treatment.
Kidney transplantation is generally recommended for patients who do not have any other treatment options other than dialysis and transplantation in order to increase the quality of life and provide permanent recovery in a short time. Almost there is no age limitation for kidney transplantation.
What is Kidney Transplant?
Every patient diagnosed with end-stage renal disease should be evaluated as a kidney transplant! Kidney transplant is explained as the insertion of a kidney taken from another person into the patient’s body.
The kidney to be used for transplantation is obtained from two sources:
- From a living donor or
- From people with brain death.
Who Can be a Right Donor for Kidney Transplant?
Organ and tissue transplantation from a person can be made from the relatives ranging from 1-4th degree as follows:
If the situation of organ and tissue donor candidates outside this scope is evaluated by the Local Ethics Committee at the relevant Organ and Tissue Transplantation Center and found appropriate, the transplant can be performed.
Regarding fourth degree kinship; In the 17th article of the Turkish Civil Code, it is stated that “the degree of blood kinship is determined by the number of births that connect relatives to each other”.
According to the Kinship Degree of the Person in Blood Affinity;
1st degree relatives: Mother, father, child
2nd degree relatives: Brother, grandfather, grandmother, grandson
3rd degree relatives: Uncle, aunt, uncle, aunt, niece (sibling child)
4th degree relatives: Children of 3rd degree relatives.
In case of kinship, relatives of the person are graded in the same way.
Unrelated Donors ( NO Kinship)
Organ transplantation from a living being can be performed from the recipient’s spouse with whom he has been living together for at least two years, up to the fourth degree (including fourth degree) blood relatives and beech relatives.
However, of course, it is possible for people who do not have any relatives and relatives to donate organs to each other. However, in accordance with the law, a very meticulous research is carried out on this subject.
Except for the above living donor candidates, in order to be able to transplant from living beings, the Ethics Committee to be established in the province where the transplant will be made must approve that there is no issue contrary to the regulation and other relevant legislation, and that the organ donation is ethically appropriate.
In this case, the recipients and donors are obliged to apply to the commission first through the Provincial Health Directorate.
Who Cannot Become a Living Donor for Kidney Transplant?
A person who has one of the following criteria, can not be a donor for kidney transplant.
- Age is below 18
- Those with hypertension (> 140/90 mmHg) or those using hypertension medication
- Diabetes patients
- Proteinuria (250 mg / 24 hours)
- A history of recurrent kidney stones,
- Low GFR (<80 ml / min)
- Microscopic hematuria
- Those with urological abnormalities in their kidneys
- Those with serious medical illnesses (chronic lung disease, recently diagnosed cancer disease)
- Fat ones (those who are over 30 percent of their ideal weight)
- Those with a history of thrombosis or thromboembolism
- Those with psychiatric illnesses
- Those with a strong family history of diabetes, hypertension and kidney disease.
Why is a Living Donor Preferred in Kidney Transplant?
In kidney transplantation, the donor is preferred to be alive. Because it has many advantages for the patient compared to kidneys taken from people with brain death.
- Better short term results (Graft survival rate: 95% vs 90%)
- Better long term results (Graft half-life: 8-9 years versus 12-20 years)
- Earlier kidney function and easier manipulation of the patient
- Lack of brain death stress
- Less incidence of delayed graft function
- Save time for the transport team and the patient until the transfer
- Relatively mild immune suppression
- Providing moral support by reducing the pressure on the kidney supply system from the brain dead donor