The Kidney is a sophisticated processing system which removes waste products from the body. Read on to find out how to take are of themto avoid life threatening conditions.
The majority or kidney disease either improve spontaneously or can be treated by medicines without impairing patients lives. However, some people develop irreversible kidney disease called CRF-chronic renal failure, the most common type of kidney disease today. Exceptin a few cases, CRF invariably progresses to a stage at which practically the entire kidney function is lost. This stage is, as mentionedearlier, called End Stage Renal Disease - ESRD.
Reasons for CRF are mainly two Diabetes and High Blood Pressure. Family history has also been identified as a contributory factor for kidney diseases.
Swelling of hands and feet and puffiness around the eyes especially in the mornings. Shortness of breathe, frequent urge to urinate especially at night or passing small amount of urine. Bubbly or foamy urine, blood in urine, difficulty or burning sensation when urinating. Persistent fatigue, drowsiness or trouble concentrating. Any change in pattern of urination is also a cause to worry.
Other symptoms to look out for are skin darkening, skin rash or itching, nausea or vomiting, unpleasant taste in the mouth /ammonia breathe, or feeling cold without any valid reason.
Routine blood and urine test is the most common form of testing the normal functioning of Kidneys. Dr.Bhart V. shah, cautions,"A regularurine test, if there is a family history of Kidney disease, or if one has been through one some Kidney disease like a Kidney stone etc,is a must, Check BP and blood sugar constantly if you have high BP or diabetes."
Kidney disease in children can be inherited and congenital kidney disease can remain silent for months. The first sign of kidney disease in child is high BP, anemia, weak bones and blood or protein in the urine. Research shows that in the area of genetics, effective therapies are worked upon to prevent or treat hereditary kidney disease.
Dialysis is a process where waste products and excess fluids that accumulate in the blood as a result of kidney failure are removed. Dialysis is not a cure but just substitutes for the excretory functions of the kidney.
Two major forms of dialysis are haemodialysis and peritoneal dialysis. In haemodialysis your blood is sent through a filter that removes waste products. The clean blood s then returned back to the body. Haemodialysis is usually performed three times a week for three to four hours.
Peritoneal is where a fluid is put in your abdomen. This fluid captures the waste products from your blood. After a few hours the fluid containing body waste is drained away. Then a fresh bag of fluid is dripped into the abdomen. Patients can perform dialysis by themselves.
In recent times, kidney transplantation has earned a bad name. Dr Shah says that kidney transplantation is a panacea to the needy. "Many people get ESRD and for them kidney transplantation is the only answer. "He suggests that a registry be maintained of the donor and the donee, so that such procedures are have legal authorization and are over board. He goes further saying that all the donors may be compensated suitably. To clear any doubt, he says that people who donate one kidney can lead a very normal life. The donated kidney must be a good match for your body, or else your immune system will reject it. You may have to take special drugs to trick your immune system.
Center for cheaper dialysis soon Delhi To House 1st Clinic That Will Charge Patients Less Than Rs. 1,000 Patients suffering from damaged kidneys and needing life-long dialysis to survive now have a reason to cheer. The health ministry is planning to open standalone dialysis centers across the country, much like pathological labs, where patients-both CGHS beneficiaries and the general public-can undergo the life-saving procedure at a minimal rate. The first such 10-bedded dialysis centre, which will also assess the project's overall feasibility, will come up by May in Delhi's Sadiq Nagar area. Each bed will cater to three patients every day. Following a review after eight months, the ministry, under the first phase, plans to start three more such centers in Delhi and few others in Mumbai, Chennai, banglore and Hyderabad.
At present, of the 1.5 lakh new patients who suffer from end -stage renal failure annually, only 3,500 get kidney transplants and 6,000 undergo dialysis. The rest perish, thanks to an acute shortage of dialysis centres in India and nephrologists to man them.
According to Delhi Nephrology Society president Dr. Harsh Johari from Sir Gangaram Hospital, India has just 800 nephrologists for 7.5 lakh people suffering from various degrees of chronic Kidney disease (CKD).
Health minister A Ramadoss told TOI, "National estimates say 1in 10 Indians suffer from some degree of CKD. In India, 5%-7% of stage 5 CKD patients will require life-long dialysis. That's why under the soon to be launched National Organ Transplant Programme , standalone dialysis units for life-long maintenance dialysis are being set up." At present, the health ministry pays Rs. 850 for every dialysis session that a CGHS beneficiary undergoes in stipulated private hospitals. An official said " The rates, both for CGHS beneficiaries and common people visiting the dialysis centres, will be less than Rs.1,000 which is almost one-fourth of the cost in private hospitals.
Joint secretary Vineet Chaudhry said while trained staff and equipment in the Delhi centre would be provided by a private partner, the building would be provided by the ministry. The private partner, yet to be finalized, will be given a guaranteed turnover of patients daily.
"Since there is an acute shortage of nephrologists, decided to follow the US model where the standalone dialysis cnetres are run by trained medical personnel and nurses with a nephrologists being on call 24 hours. They visit once a week to ensure quality control. Our ultimate goal is to have one dialysis centre for every district,"Chaudhary said. Dialysis is a method of removing toxic substances from the blood when the kidneys are unable to do so.
Dr. Johari , welcoming the Centre's move, said: "India's dialysis programme is awful at presents. Hospitals don't have stand alone facilities because it isn't profitable. There is also an acute shortage of nephrologists. The ministry needs shortterm courses to train medical officers in dialysis." According to Dr. Johri, a patient requiring dialysis, which lasts 4-6 hours, three times a week ends up spending nearly Rs. 10,000.
Most Kidney patients have to wait for a transplant and many have to do without it. Dialysis is what keeps them alive and even improves their quality of life.
Originated from the Greek word, dialusis (dissolution) Dialysis is a method of removing toxic substances from the blood when the kidney are unable to do so due renal failure. Dialysis usually lasts 6-8 hours with patients suffering from advanced renal failure requiring it 5-7 times a week.
Patients suffering from temporary or permanent loss of their kidney function and requiring a kidney transplant.
There are two main types of dialysis, Hemodialysis and peritoneal dialysis
chronic kidney disease(CKD) is the 3rd most common non- communicable disease in India.
Over 7.5 lakh people suffer from CKD
1.5 lakh new patients get end-stage renal failure every year.All Of these, only 3,500 undergo kidney transplants.
About 6,000 get dialysis while the rest perish.
Thomas Graham of Glasgow, first presented the principles of solute transport across a semipermeable membrane in 1854. Abel, Rountree & Turner developed the first artificial kidney in 1913. The first Peritoneal Dialysis was done by Georg Ganter (1923), first hemodialysis was by Hass(1924) and the artificial kidney was developed into a clinically useful apparatus by Kolff in 1943-45.
BANGLORE:Around 10,000 people in Karnataka develop kidney failure every year. And one in ten people in India suffers from some form of mild kidney disease. "Most of the Kidney related ailments are progressive and if not diagnosed and treated at an early stage, can result in end stage renal failure," said Dr. H.S. Ballal, director, Manipal Institute of Nephrology and Urology.The world Kidney Day, which was launched in 2006, is on March 8 this year. " The day, observed on every second Thursday of March, is to create awareness among people on how to prevent kidney diseases," he added.What makes the situation of kidney patients worse is the exorbitant cost of treatment. "About 90 per cent of kidney patients die a slow death because, either they don't have access to treatment or they find it extremely expensive. Dialysis costs any where between Rs. two lakh and Rs. four lakh per year,"said the nephrologists. The lack of availability of nephrologists in small cities and towns is another major issue. "In Karnataka 80 percent of the nephrologists are in Banglore." he added.Kidney diseases are often diagnosed at a later stage because in the initial stages, they could remain 'silent.' "It's important that those vulnerable (see box) should get themselves periodically checked, " said Dr. Ballal. For patients with end stage renal failure there are only two lines of treatment; dialysis or transplant. " The cost s prohibitive, and drains the family. Hardly five percent of the patients undergo dialysis and less than two per cent go in for transplant," said Dr. Venkatesh Krishnamurthy, medical director, N U Trust. "A transplant could cost between Rs 60,000 and Rs four lakh. There's very little awareness on transplant, especially cadaver transplant," he added. What is also of concern is that a good number of people in their financially active years are coming up with kidney problems, said Senior Consultant Nephrologists, Sagar Apollo Hospitals, Urmilla Anand. " We Are now seeing patients as young as 35 and 40 years old with kidney diseases," she said.
Manipal Institue of Nephrology and Urology, along with some philanthropists, would launch Mrs. Prema Devi Malimath Memorial Free Dialysis Scheme, for economically weak kidney patients, on Thursday. She was the wife of justice V.S. Malimath.
Deccan Herald spoke to justice Malimath on the eve of the launch. " My wife was diagnosed with a kidney problem in 2001. She used to go to the Manipal Hospital for dialysis. We lost her on September 16, 2006, at the age of 71. She had a very positive attitude, and remained cheerful till the end. I never thought that she would die so soon, "said Justice Malimath.
"Dialysis is an extremely traumatic experience besides being very expensive. I could afford it because I'm entitled to medical reimbursement." " It's impossible for a common man to meet the treatment cost. People die because the can't afford dialysis," he added.
People with diabetes, hypertension, family or previous history of kidney ailments are vulnerable to kidney diseases.
Simple blood (to check creatinine) and urine (albumin) tests can diagnose kidney disease.
Watch out for symptoms such as puffiness of face, swelling in legs, decrease in urine ouput, anaemia & weakness.
Kidney diseases, if diagnosed at an early stage, can be treated.
They can enhance the risk of heart disease by 100 times.
Study Confirms That Many in The Diabetes Capital of the World Also Suffer from Chronic kidney disease
Mumbai: Kidney filter 20 buckets-full of blood every day, flushing out toxins and maintaining good health. But this all-important function is impaired in every 17th Indian, says a new study that provides for the first time the prevalence of Chronic Kidney Disease (CKD) in India.
Given the fast-paced life and poor diet discipline in metropolitan cities, CKD is emerging as the latest lifestyle slayer. A whopping 24.3% urban Indians have a diseased kidneys in comparison to 9.2% in rural areas, says the SEEK (Screening and Early Evaluation of Kidney Disease) stud, which concluded in November 2007.
What makes CKD a serious problem is that it in various problems is that it invariably progresses to twice- or thrice-a-week dialysis or a kidney transplant. Not only is there physical discomfort of hospitalisation and operations, there also is a huge price tag attached to treatment.
The SEEK study, conducted by the Indian Society of Nephrology across 21 centres in collaboration with Harvard Medical School, underlines what doctors always knew: Indians with their genetic disposition for diabetes and hypertension are more susceptible to CKD. Dr. Vidya Acharya, one of the senior most nephrologists in Mumbai who was part of the SEEK study, points out that risk factors for CKD include sedentary occupation obesity, hypertension, diabetes, smoking and consumption of tobacco.
Concurs Dr. Bharat Shah of the Narmada Kidney Foundation, "India is being called the diabetes capital of the world. So, with diabetes and hypertension increasing due to faulty lifestyle, the burden of kidney diseases too is increasing," In fact, the theme for this year's World Kidney Day on Thursday is the disease's link with diabetes. " People with diabetes are 17 times more at risk to CKD than the normal population," says Dr. Hemant Mehta, who heads the Mumbai Nephrology Group.
One of the main findings of the SEEK study is the fact that there is a low awareness of the disease and people hence turn up later for treatment. "Only 8% of the patients who participated in the study knew about their disease," says Dr. Acharya.
Dr.M Bahadur of Jaslok Hospital believes that better awareness could lead to preventive strategies. " If people detected with hypertension know about its link with CKD, they can undergo medical treatment to prevent or delay the progress to CKD. Secondly, people can change their dietary patterns, lower their salt and protein in-take," he explains. Such measures would help them stay healthier for a longer time. Depending on the nature of the disease( whether it's aggressive or slow), patients can remain on medications for one year or a decade before going in for dialysis.
Doctors recommend that people undergo a urine and blood test every year to detect protein levels. "Doctors should not ignore if the level is more than 1and advise interventions, " says Dr. Bahadur.
Offering hope for those detected early, Dr. Acharya says that people in the early stages of the five-stage CKD can be managed on drugs for many years before they have to turn to dialysis or transplant. Dr.William Mich of the University of Taxes, who was in the city last week to propagate the relatively-new keto-acid therapy for kidney patients said, "We realised that the nitrogen in proteins worsens CKD and recommended lesser protein in diets. In Indians, however, this is a problem as it could lead to malnutrition further worsening the patient's condition. So for such patients we now use ketoanalogues supplements." Dr. shah adds, "One should not only work hard to prevent kidney disease, but also work hard to increase the number of donors."
An annual blood and urine test can help detect the disease early
The Kidney removes wastes and fluid from the body. CKD decreases the body. CKD decreases the kidney's ability to pump out the waste, leading to complications such as high blood pressure, anaemia, and heart and blood vessel disease. When kidney disease progresses, it eventually leads to kidney failure, which are requires dialysis or a kidney transplant to maintain life.
Most people may not have any severe symptoms until their kidney disease is advanced, but people may:
feel more tired and have less energy.
have trouble concentrating
have a poor appetite
have trouble sleeping
have muscle cramping at night
have swollen feet and ankles
have puffiness around the eyes, especially in the morning
have dry, itchy skin
need to urinate more than, especially at night
Have your urine, blood and blood pressure checked regularly by your doctor
Control your blood sugar.
Control high blood pressure (less than 130/80 on most reading)
Make the proper food choices
Avoid excess alcohol
See your doctor if you think you have a bladder infection
Get enough sleep
Ask you doctor about any new developments in the treatment of diabetes.
Chronic kidney disease affects about 175 to 200 millions in India (roughly 17.4%), says the latest study by the Indian Society of Nephrology and University of Harvard. Worldwide, the prevalence is believed to be one in every 10 adults.
In urban areas, the prevalence is higher- 24.3% -and it is 9.2 % in rural areas.
Nearly 50% of the prevalence is attributed to diabetes and hypertension. The National Kidney Foundation of Indian in 1994 found every fifth person (between 25 and 45 years of age) had hypertension and every seventh had diabetes.
Mumbai --- 9.6%
Less than 8th grade Education 38%
Sedentary lifestyle 48%
Low income 47%
Tobacco chewing 15.1%
Mumbai:Kidney disease may slow down your system, but it needn't dampen your spirits. This is the lesson that yesteryear actor Shammi Kapoor(77) is trying to propagate.Detected with chronic kidney disease five years back, he has not let it overshadow his zest for life.
"You can choose to either live with kidney disease or die of it," says Kapoor , who has decided to smilingly cope with the condition.
The septuagenarian, who is best identified with his song Yahoo from the movie Junglee, puts it simply: " I devote three days to hospital (for dialysis) and four days to home (for family)."
Pointing out that it is important to accept that chronic kidney disease is irreversible, he feels it becomes easier when one realises that" you happen to be one among the many suffering from it" and have to adapt to the circumstances.
Kapoor was diagnosed with CKD five years ago when he was admitted to Breach Candy Hospital with pneumonia." I was on a ventilator for a month and one fine day I realised I was in the dialysis room," said Kapoor, who has been following the routine ever since.
Swollen kidneys from retained urine. More detailed information about the symptoms, causes, and treatments of Hydronephrosis is available below.
Reduced urine output
No early symptoms
Dull groin ache
Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Hydronephrosis) that could possibly cause Hydronephrosis includes:
Congenital defect of the urinary tract
The list of possible underlying conditions mentioned in various sources for Hydronephrosis includes:
Congenital defect of the urinary tract
Renal failure, chronic
Kidney removal - satisfactory if only one kidney is affected.
Treatment of any underlying cause of hydronephrosis
Alternative treatments or home remedies that have been listed in various sources as possibly beneficial for Hydronephrosis may include:
With longevity and the overall health of Indians improving, there s a small batch of grandparents who are turning donors for their less fortunate family members. A couple of years ago, Ghatkopar resident Lalji Patel, at 72 years of age, donated a kidney to his then eight-year-old grandson Nishit at Lilavati Hospital.
Dr Sandeep Guleria, transplant surgeon of the All-India Institute of Medical Sciences, Delhi and secretary of the Indian Society for Organ Transplantation, points out that several senior citizens have donated kidneys. "It is not t0he chronological age of the person, but the condition of the donor's kidneys that is important," he says. The trend of 70-plus donors is also reported elsewhere in the world (See, 'Age No Bar').
On Monday, Thane resident Vijaya Bapat,53, with a mask in place, spoke about the unique" gift" she has received, a kidney from her 74-year-old mother Shailaja Joshi. "I was diagnosed with bilateral shrunken kidneys two years back. My creatinine (a serum whose high levels in blood indicate kidney impairment) levels had periodically spiked to 6 and 7.5," she says. She was advised a transplant and her husband Anand Bapat was ready to donate a kidney, "But our blood groups are different".
Sensing her dismay, her mother Shailaja volunteered. "My mother kept telling me over the last two years that she would donate her kidney for me, but I didn't want it that way," says Bapat. She thought of signing up for a cadaver (brain-dead) donor as "the wait could be a long one".
"My mother is a mentally as well as physically strong person. No words can match my gratefulness for the gift she has given me," adds Bapat
It was with much cajoling from the mother-daughter duo that the Jaslok Hospital team of nephrologhist Dr. Rushi Deshpande and transplant surgeon Dr. K Desai decided to evaluate Joshi for the operation. " I was put through 12 tests or more before the doctors were satisfied," says Joshi.
Deshpande says he wants to show that older donors who are healthy can be a good operation given the scarcity of donors in India. "If the Kidney is good, then it can increase the donor pool," he adds.
But a senor doctor who didn't want to be named says grandparents should be the exception and not the rule. "Many times they are economically dependent on family members". There is no way of establishing if they were emotionally coerced into donating.
There are roughly 4,500 to 5,000 kidney donations a year in India, according to the Indian Society for Organ Transplantation, which runs the Indian Transplant Registry.
15 years ago, India passed the Transplantation of Human Organs Act, allowing for organ retrievals from brain-dead patients, but over 90% of transplanted kidneys still some from live donors From 1971 to 2009, there have been 18,121 kidney transplants in India according to the Indian Transplant Registry which collected data from 33 hospitals.
There are approximately
1,000 live kidney donations every year.There have been 33 kidneys transplanted from brain-dead patients so far in 2009
There are about 27,000 living kidney donor transplants worldwide every year, according to a Feb 2009 report in kidney international journal Of these, 6,435 take place in the US and 1,768 in brazil. India has been pegged in between these two figures, with about 3,200 transplants.
Some instances of kidney donations by the elderly
The oldest brain-dead donor in the US was 87 years old. Among live donors, there was a transplant between two 71-year-old spouses.
In the UK, the oldest donor was an 83-year-old man who earlier this year donated a kidney to his wife In April, an 81-year-old mother donated a kidney to her 51-year-old son.
In July 2009, a 75-year-old mother donated a kidney to her 46-year -old daughter.
Mumbai:-While the financial capital is considered one of the most expensive cities in the country, there is a cheerful news for patients with kidney failure. Mumbai's hospitals and stand-alone dialysis centres---120 in all-offer the cheapest dialysis rated in the country.
According to the findings of three-month-long survey done by the Mumbai Nephrology Group, the average cost of dialysis is Rs. 750 in Mumbai against Rs. 750 in Mumbai against Rs 1,200 in Chennai "in Lilavati Hospital, where I practice, dialysis costs Rs. 1,150, while it costs double in Delhi hospitals, "said Dr. Hemant Mehta of the Mumbai Nephrology Group.
He recollects a patient's son who had taken his mother to Benaras for holidays stating that the cost of dialysis in a private hospital in the north India pilgrim city is Rs 1,700.
Why is Mumbai affordable as against the other cities ? Nephrologists Dr Umesh Khanna of the Mumbai Kidney Foundation and the group says charity is one of the biggest reasons. "Mumbai has many charity organizations that offer donations to dialysis centres," he says.
Secondly, there , is the Mumbai dialysis model. Said Dr. Khanna, "Mumbai has many standalone dialysis centres that have an affordable model without the overheads that hospitals actually have to pay,"
The Group's survey states that "satellite dialysis units essentially offer only dialysis facility. They can offer dialysis at a reasonable price by cutting down the overheads. It comprises a full-fledged dialysis centre with 10-20 dialysis machines with isolated machines for hepatitis B and C, RO plant and a resuscitation trolley with monitor & defibrillator. It has trained nurses, technicians and doctors trained in resuscitation of a serious patient."
|ZONE AND CITY WISE COST OF PROCEDURE|
|Zone||Cost per session (RS)|
Mumbai: At 31, Andheri house wife Rohini Munde has got a second lease of life. A successful kidney transplant that was conducted about a month ago means no more painful needle pricks, no bouts of illness and, most importantly,no visit to the dialysis center three times a week.
Her zeal to return to normal life was so strong, say doctors that within then days of the transplant on January 30, she was fit enough to be discharged from the hospital. According to doctors of the Fortis hospital, within 36 hours if transplant, the alien kidney in her body began to function normally, as if it were her own. And unlike other transplant patients, she did not need a dialysis post surgery.
Four years ago, Rohinis life took a turn for the worse when an infection damaged both her kidneys beyond repair. The young mother of two children, aged 10 and 13, saw her family life to haywire. Her husband, police constable kamlakar could barely juggle time between his ailing wife and a demanding job.
"Regular visits to dialysis centres were the worst phase phase of my treatment days. were the worst phase of my treatment days, "she said, "four hours in the cnetre, the depressing environment and those painful needle pricks added to my mental and physical agony."After a point, even dialysis did not seem to be effective enough for her.
The only option left then was a transplant, she said. But the death of a close friend within five months of a cadaver transplant frightened her. But then, there was no her. But then, there was no other choice. As the hunt began, her father was found to be too old to donate and her mother's blood group did not match. "We started registering in various hospitals but there was no response."
It was only this January that she received a call from Fortis Hospital in Mulund, informing her that there was a possibility of a cadaver donation. "IN no time, her tests were done and she was ready for the transplant," said Dr. Haresh Dodeja, nephrologists and transplant physician, Fortis Hospital. "We managed to cut the time involved in all logistical work and concentrate on carrying out the transplant as soon as possible," he said.
Dodeja said that Rohini's surgery was close to a live transplant as the kidney harvested from the cadaver was almost immediately transplanted.
Donors Do Better As they Take Care Of Themselves, Says Study
Researchers from johns Hopkins University School of Medicine followed 80,000 people who underwent kidney donation surgery between 1994 and 2009 and compared their health status with 9,364 healthy participants.
New Delhi: Thinking about donating a kidney to save the life of a loved one ? Afraid that it might handicap you forever ? An interestinglarge scale study, whose results were announced on Wednesday, can now help you decide.
Researchers from Johns Hopkins University School of Medicine followed 80,000 people who underwent kidney donation surgery between 1994 and 2009 and compared their health status with 9,364 healthy participants and found that kidney donors fared just as well as non-donors over the long term. In fact, researchers said donors lived somewhat longer because they tended to take better care of themselves after the procedure.
"It's Just that kidney donors face a higher risk of death in the 90 days immediately following surgery because of risks related to surgery," the team said. The study said the practice of live kidney donation should continue to be considered safer than deceased donor organs-yet to come alive in India. At present, of the 1.5 lakh new patients who suffer from end-stage renal failure annually in India, only 3,500 get kidney transplants and 6,000 undergo dialysis . The rest perish thanks to an acute short-age of dialysis centres, available kidneys for transplantation and nephrologists to man them. Experts say India has just 800 nephrologists for 7.5 lakh people suffering from various degrees of chronic kidney mates say 1 in 10 Indians suffer from some degree of CKD. National estimates say 1 in 10 India suffer from some degree of CKD.
According to the study published in the march 10 issue of the Journal of the American Medical Association, over a 15 year period, both donors and non-donors lived healthily.
Ahmadabad; A Pioneering transplantation of the kidney through minimally invasive laparoscopy was successfully completed by surgeons at the Institute of kidney Disease and Research Centre (IKDRC) here.
Experts said this is the first time this procedure has been don in the country. "This surgery is challenging but is good for the patients as it leads to less pain and short hospital stay. The operation is over in an hour and out surgeons have done three cases. Till date, only one case has been reported from Spain," said IKDRC director Dr HL Trivedi.
Doctors performed the procedure on three patients simultaneously. In this method, instead of a huge cut through the stomach, surgeons made just three little holes and a small incision on the patient. One of the three holes is for inserting camera and the other two for inserting surgical instruments.
Sanjay Sharma, 32, from Rajashtahan had undergone his first kidney transplant through open surgery. After it failed, he underwent a second transplant surgery. This time it was done laparoscopically and Sanjay's body reflected the huge cut made earlier and the negligible incisions this time. "I recovered from surgery pretty early compared to my first transplant. Pain is also less," Sanjay said.
Rajesh Dabdi, 48, too underwent his second kidney transplant laparoscopically. Chief transplant surgeon Dr. Pranjal Modi said this is the first time kidney transplant has been successfully attempted this way. Kidney retrieval from donor throughlaparoscopes is done in many centres through
Mumbai: HIV-positive Susheel Jha's 64-year-old mother Sitara donated one of her kidney to her first-born son." I just want to see my child living healthy next to her first-born son. "I just want to see my child living healthy next to me," she said over the phone from Benares.
The transplant is a milestone of sorts. Not surprisingly then, Jha's nephrologist Dr. M Bahadur, transplant surgeon Shailesh Raina and medical consultant Dr. Om Srivasatava are ecstatic with his progress since the transplant was carried out at Jaslok Hospital last November 26.
"This is the first time in Maharashtra that a HIV-positive person has a got a transplant. It needs experience specialists to manage the patient carefully to ensure that his body doesn't reject the donor organ while ensuring that the HIV infection doesn't flare up, "Bahadur, who has been treating Jha since 2006, said.
Admitting that it had indeed been a challenge to handle a hive-positive patient, Srivastava said that the right medical environment (as in a superspecially hospital like Jaslok), right protocol and medicimnes were needed for such transplants. "If the HIV-positive patient’s CD4 count is adequate and his viral load is negative, then he can safely undergo a transplant," added the Jaslok doctors.
Worldwide, too transplants for HIV-positive patients are a relatively new concept. In 2004, the US reported about a 100-add liver and kidney transplants for HIV-positive patients.
This man himself is lam. " MY HIV status was detected in 1997 and my kidney failure in 2006," Jha was on dialysis for three years before doctors realized that transplant would be the only hope. "In my 13 years with HIV, I took only 77 days of leave but I needed over three months for transplant and the minor problems thereafter."
Jha also believes that his employer, the Railway, played a great role in his "healthy but HIV" status. "I have had access to antiretroviral drugs for 10 years. I was never discriminated against or passed up for promotion. My dialysis would cost tens of thousands of rupees but the railways always paid up. "said the father of two.
Dr Harsh Jauhari, one of the senior-most nephrogists in the country, said that while a couple of HIV-positive patients had undergone transplants in India, little was chronicled, "There is a confidently clause with HIV-positive patients that can not be tampered with. So it is likely that we don't know about all the transplants that have taken place in this category. But there is no denying that these patients need specialised care," added the Delhi-based Jauhari. (The patient's name has been changed)
A positive Development
THE ISSUE Mumbai reports first kidney transplant for an HIV-positive person, Until recently, HIV was considered an absolute contra-indication to transplant.
WHY ? There were concerns about the side-effects of immune-suppressive drugs in HIV-positive patients.
INDICENTLY HIV-associated nephropathy is the most common cause of kidney failure.
Any HIV patient with renal disease can undergo a kidney transplant if his or er HIV infection is stable.
3 June 2008/ A 66-YEAR-OLD Nigerian male got a kidney from his son-low at the Fortis Hospital, Noida
14 May 2008/A 49-year-old hypertensive healthcare worker from Africa underwent live, related transplant at Sri Ramchandra Institute,Chennai
Have a kidney problem ? Better keep a close eye on your heart too. Recent data from the National Cjhronic Kidney Disease(CKD) Registry revealed that a whopping 96 % of patients battling kidney disease had developed cardiovascular problems towards the end stage of the disease.
A bigger concern, however lay in the fact that not many kidney patients were checked for cardiovascular problems before reaching an advanced stage of kidney failure. For instance, out of 38,193 patients of chronic kidney disease studied in the registry, only 11,599 were checked for cardiovascular diseases. Of these, as much as 66.9 % or 7,755 patients had cardiovascular disease. Nephrologists fear that undetected kidney diseases were causing many cardiovascular deaths and brain strokes which are mostly going unexplained. Many are dying of cardiac arrests or strokes just because their kidney disease may not have been detected, said Dr Vidya Acharya, professor, Bombay Institute for prevention and control of kidney diseases."Now, we know many metabolic changes occuring in the body due to diabetes, originate from the kidneys and can manifest into a heart or brain problem," she said. Diabetes goes on to affect blood vessels and also the filtering mechanism of kidneys. Malfunctioning blood vessels affect vessels in the heart and the brain. But often during diagnosis it does not come to light that the malfunctions have originated from the kidneys.
The registry underlined that as and when the kidney disease progresses, cardiac problems too start intensifying. According to the figures, little above 3% of patients who were in initial stages of CKD had developed heart problems. But the percentage went up as 19.7% of those in third stage of kidney disease had cardiac problems, 28.7% of those in fourth stage and 48.5% of those in the end stage of renal failure were suffering from heart ailments.
Nephrologist Dr. Hemant Mehata of Lilavati hospital said cardio-renal syndrome can be tricky, adding heart problems can be accelerated by bad kidneys and vice versa. Among many causes, some basic ones are that when kidneys fail, toxins start pilling up and the functioning of heart automatically decreases, he said. Inadequate dialysis can also lead to heart problems, he said. Heart disease is largely caused by irregular lipid levels, which also lead to kidney problems, said interventional cardiologist Dr.Vijay Bang.
Experts say heart and kidney treatments should not be compartmentalised. Healthy lifestyle and food habits can prevent both, said Mehta.
Cardivoscular disease in CKD according to stage - Stage I---0.6% Stage II---2.6% Stage III---19.7% Stage v---48.5% Stage VI---28.7%of 1,1599 kidney disease patients checked 7,755 had cardiovascular disease (CVD)
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