ALL ABOUT KIDNEY

FAQ ABOUT KIDNEY TRANSPLANT

2006-03-24T19:08:00.000+07:00

When an individual's kidneys fail, three treatment options are available: hemodialysis, peritoneal dialysis and kidney transplantation. Many patients feel that a successful kidney transplant provides a better quality of life because it allows greater freedom and often is associated with increased energy levels and a less restricted diet. In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have had a kidney transplant. You also need to speak to your doctor, nurse and family members.

What is a kidney transplant?

A kidney transplant is an operation in which a person whose own kidneys have failed receives a new kidney to take over the work of cleaning the blood.

Are there different kinds of kidney transplants?

Yes. There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse or close friend, and in some cases a stranger who wished to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants. These are covered in the NKF's free brochure "Kidney Transplant." You can obtain a copy by calling 800 622-9010.

How do I start the process of getting a kidney transplant?

Your doctor can discuss the transplant process with you or refer you to a transplant center for further evaluation.

How can I pay for my transplant?

Most private health insurance policies cover many expenses associated with kidney transplants, including medications. In addition, most kidney transplant candidates are eligible for Medicare, which will cover 80 percent of the cost of the transplant surgery. After transplantation, you will need to take medications to prevent rejection of your new kidney. Medicare Part B will cover 80 percent of the cost of these anti-rejection medications, but not the cost of other medications you may need. For most patients, this Medicare coverage will stop after 36 months. However, if you are eligible for Medicare coverage based on age or disability, the cost of your anti-rejection medications may be covered for as long as you are on medicare. The social worker or financial counselor at your transplant center should be available to answer questions about your coverage options.

What is rejection?

The most important complication that may occur after transplant is rejection of the kidney. The body's immune system guards against attack by all foreign matter, such as bacteria. This defense system may recognize tissue transplanted from someone else as "foreign" and act to combat this "foreign invader."

You will need to take medications every day to prevent rejection of your new kidney. Most patients need to take three types. The major one is usually cyclosporine or tacrolimus or sirolimus. In addition, you will most likely be taking some type of steroid and a third medication, such as mycophenolate mofetil, azathioprine or rapamycin. Additional treatment may be needed if a rejection episode occurs. Regular checkups at your transplant center will ensure early detection and treatment of rejection.

What are the side effects of the anti-rejection medications?

Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed. Fortunately, these side effects usually are manageable for most patients. If side effects do occur, changing the dose or type of the medications will usually take care of them. Some of the most common side effects include high blood pressure, weight gain and a susceptibility to infections and tumors. You may also require additional medications to maintain blood pressure and prevent ulcers and infections.

What are the chances that a transplanted kidney will continue to function normally?

Results of transplantation are improving steadily with research advances. In the event that a transplanted kidney fails, a second transplant may be a good option for many patients.

Will I need to follow a special diet?

Kidney transplants, like other treatments for kidney failure, often require following special diet guidelines. If you were on dialysis before, you may find this new diet less restricted. The length of time you must follow the special diet varies. Your progress will be followed closely, and your doctor and dietitian will change your diet as needed.

FINANCIAL CONSIDERATION FOR TRANSPLANT

2006-03-24T19:01:00.000+07:00

Transplant Financial Services as well as a social worker will work together to help transplant patients develop a financial plan. This would include understanding how transplant-related charges will be paid as well as how to cope with such things as transportation and caring for children or other family members during this time.

Costs related to transplant include evaluation and testing, transplant surgery and hospitalization, follow-up care and medication. Transplant Financial Services will assist each patient in developing a plan for addressing these financial obligations. A patient's insurance coverage plays a vital role, whether it is through a private company or a governmental program. So, it is important that each patient fully understand his or her coverage.

Here are some of the most important questions to ask your insurance company as you begin to consider transplant as a treatment option.

Is transplant a covered benefit?
Is there a maximum allowance on transplant and transplant-related services?
Is there a maximum allowance on procurement of the organ?
Is there a lifetime maximum or "cap" on the policy?
Is there adequate coverage for post-transplant medications?
What is the annual "out of pocket" maximum amount on the policy?

In the event that the patient does not have access to adequate insurance coverage for transplant, there may be other avenues to obtaining support to offset the expenses related to transplantation. These include charitable organizations, advocacy groups, or fund-raising campaigns. Again, Transplant Financial Services and/or a social worker can help identify what option is best for you.

L.A. Mom Has Dual Organ Transplant

2006-03-24T18:55:00.000+07:00

LOS ANGELES (AP) - When her children offered their own organs to save her life, Maria Alvarez was terrified - not for herself but for them.

The 57-year-old had been on dialysis for 31/2 years after kidney failure, and her liver was more than twice normal size and barely functioning due to polycystic disease. Fluid from the liver had already caused one infection that had nearly killed her.

But despite the pain, Alvarez was reluctant when doctors told her that dual transplants - a kidney from Rosario Proscia, 34, and part of the liver of son Jose Alvarez, 36 - could help her become healthy again.

``She didn't want us to suffer, or possibly even die,'' said Proscia, who had urged the doctors at University of Southern California University Hospital to consider the transplants. ``It took her a few months to get used to the idea.''

Five months after the dual surgeries, all three are recovering well, their doctors said Wednesday.

``I believe it is the first of this particular kind of transplant, when one child donates a liver and another child donates a kidney to a parent,'' said the surgeon in both operations, Dr. Rick Selby.

Proscia said she had been inspired by her mother's refusal to give up.

``My surgery was nothing compared to what she has been going through,'' she said.

Jose Alvarez said pain from removal of less than half of his liver ended in about eight days.

``We feel privileged that we were able to do this,'' he said. ``Mom was very sick for 31/2 years, and we nearly saw her die.''

Their mother, meanwhile, said she hoped other people would be encouraged by her story to donate organs. According to the United Network for Organ Sharing, 48,245 people are currently on waiting lists for kidney transplants and 17,286 are awaiting liver transplants.

``I'm proud of my children,'' she said. ``I'm so happy God gave me such good children.''

PERBANDINGAN BIAYA TRANSPLANTASI GINJAL

2006-03-22T14:50:00.000+07:00

Dokter Zubairi yth,
Ayah saya, 51 tahun, saat ini sudah menjalani cuci darah menahun. Selama ini biaya ditanggung oleh kantor, namun karena diminta untuk pensiun dini, maka kami memperkirakan sekitar 1,5 tahun keuangan kami akan lumayan sulit karena dalam satu bulan kantor harus mengeluarkan biaya sekitar 8 juta rupiah untuk cuci darah, obat-obatan, dan keperluan lain.

Kami mendengar bahwa dengan melakukan transplantasi ginjal maka keadaan ayah saya akan lebih baik. Saya ingin mendapat informasi mengenai masalah ini. Siapa saja yang dapat menjadi donor dan apakah jika dilakukan di Indonesia keberhasilannya selama ini cukup baik? Apakah ada kemungkinan penyakit ayah saya akan kambuh setelah transplantasi berhasil?
Tania, Bandung

Ibu Tania yang baik,
Transplantasi ginjal memang merupakan solusi untuk orang yang mengalami gagal ginjal kronik dan telah masuk tahap terminal. Biaya rata-rata yang dikeluarkan untuk transplantasi ginjal relatif lebih murah dibanding bila pasien tetap harus menjalani terapi hemodialisis (cuci darah). Di Indonesia, transplantasi ginjal telah mulai dilakukan sejak tahun 1977. Jadi, secara teknis tidak ada masalah untuk melakukan transplantasi ginjal di Indonesia.

Donor ginjal tidak harus berasal dari orang yang mempunyai hubungan darah. Yang terpenting adalah donor dan penerima mempunyai kecocokan HLA (human leucocyte antigen). HLA adalah sejenis protein yang terdapat di permukaan sel darah putih dan sel-sel tubuh jaringan tubuh lain. HLA terdiri dari banyak jenis. HLA diturunkan dari orangtua ke anak, jadi seorang anak mempunyai kombinasi HLA dari ayah-ibunya. Karena itu, orang yang mempunyai hubungan darah memang kemungkinan untuk cocok HLA-nya lebih besar. Tetapi, HLA yang diturunkan tidak selalu sama jenisnya, sehingga sesama saudara pun belum tentu cocok HLA-nya. Tapi bisa saja orang lain yang tidak mempunyai hubungan darah mempunyai HLA yang cocok.

Donor dapat berasal dari orang hidup atau jenazah, hanya di Indonesia setahu saya donor dari jenazah belum dapat dilaksanakan. Tingkat keberhasilan transplantasi lebih tinggi jika berasal dari donor hidup. Prinsip donor ginjal adalah tidak akan ditolak oleh tubuh penerimanya. Untuk itu perlu dilakukan beberapa pemeriksaan imunologis, seperti pemeriksaan golongan darah, HLA, dan antibodi terhadap HLA. Kemudian dilakukan tes crossmatching yaitu suatu tes yang dilakukan di luar tubuh untuk mengetahui apakah penerima mempunyai antibodi yang dapat merusak HLA sehingga ginjal dari donor akan ditolak. Jika hasilnya menunjukkan tidak ada antibodi, barulah transplantasi dapat dilaksanakan.

Sebelum operasi, selain pemeriksaan yang sudah saya sebutkan, akan ada pemeriksaan-pemeriksaan lain baik untuk donor dan pasien yang terdiri dari pemeriksaan fisik, laboratorium dan ronsen untuk mengevaluasi kondisi pasien dan donor.
Untuk mengurangi kemungkinan reaksi penolakan yang fatal terhadap ginjal baru, maka pasien diberikan obat-obat imunosupresan (untuk menekan reaksi imun). Reaksi penolakan dapat terjadi segera setelah operasi atau beberapa waktu sesudahnya.

Penyakit ginjal dapat kembali dialami setelah transplantasi. Hal ini salah satunya ditentukan oleh apakah penyebab penyakit ginjal yang terdahulu. Jika penyebabnya masih belum teratasi, maka tentu saja kemungkinan timbulnya penyakit ginjal akan lebih besar.

Untuk informasi dan keterangan lebih jelas, Anda dapat meminta informasi lebih rinci lagi pada dokter yang merawat ayah Anda. Atau Anda dapat menghubungi dokter spesialis penyakit dalam subspesialis ginjal-hipertensi untuk informasi yang lebih lengkap. Pelaksanaan operasi dilakukan oleh dokter ahli bedah urologi. Terdapat beberapa rumah sakit di beberapa daerah di Indonesia yang selama ini aktif melakukan transplantasi ginjal. Di Jakarta, rumah sakit yang telah melakukan operasi transplantasi ginjal adalah RS Cikini, RS Cipto Mangunkusumo, dan RSPAD Gatot Subroto.

PATIENT’S GUIDE TO KIDNEY TRANSPLANT

2006-03-21T14:53:00.000+07:00

HOW THE KIDNEYS WORK
The kidneys are two bean-shaped organs located toward the back of the body on either side of the spine near the waistline. They are about the size of a fist and are protected by other organs and two of the lower ribs. Normal functioning kidneys serve the body in several very important ways. They:
- Clean your blood and remove waste products
- Balance water and salt to control fluid in the body
- Control blood pressure
- Help make red blood cells and strong bones
- Control the amount of potassium, calcium, magnesium and phosphorus in the blood

SYMPTOMS OF KIDNEY DISEASE
Symptoms may include:
- Fluid retention
- Shortness of breath
- Change in mental status
- Abnormal urine or blood test results
- Headache
- High blood pressure
- Fatigue

WHY A TRANSPLANT IS NECESSARY
A number of diseases can directly damage the kidney. Damage to the kidney can seriously affect the removal of water and waste products, production of red blood cells, regulation of blood pressure and balance of electrolytes such as potassium, calcium and phosphorus.
If the damage is severe enough, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life.

PRETRANSPLANT EVALUATION
Pretransplant tests, as well as giving a clear picture of the patient's overall health status, help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option. This increases the likelihood of success.
The following procedures help in evaluating a patient's health status:
- Physical exam - Gives the doctor an overall picture of the patient's conditions.
- Chest x-ray - Determines the health of the patient's lungs and lower respiratory tract.
- Complete medical and surgical history - Determines what additional tests may need to be done.
- Electrocardiogram (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that was previously unsuspected.
- Ultrasound with Doppler examination - Determines the quality of the iliac vessels.
- Blood tests - The patient's blood count, blood and tissue type, blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed.
- Blood typing - Every person is a blood type A, B, AB or O. The donor's blood type does not have to be the same as the recipient's blood type, but it must be "compatible" (see crossmatch testing).
- Pulmonary function test - The patient will be asked to breathe into a tube attached to a measuring device, which will reveal how well his lungs are working and determine his blood's capacity to carry oxygen.
- Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free.
- Lower GI series - Ensures that the patient is free of intestinal abnormalities.
- Renal function studies - Urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function.
- Tissue typing - This test is done on white blood cells. White blood cells have special "markers" that distinguish "tissue type", which are used to find a matching kidney.
- Panel Reactive Antibody (PRA) - A way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. It is easier to acquire a kidney if a recipient's immune system is calm or measures 0%. An immune system may be active from blood transfusion, pregnancy, a previous transplant or a current infection.
- Viral testing - Determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome.
- Mammogram - X-ray of a woman's breast that can detect signs of breast cancer.
- Pap smear - Cells collected from a woman's cervix that are microscopically analyzed for signs of cancer.
- Echocardiogram - Reveals any abnormalities in the heart.
- Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant.
- Other tests - Any special tests or doctor visits that might be needed for the transplant workup.

Histocompatibility Laboratory Tests
Tissue Typing - This test is done on white blood cells. The white blood cells have special "markers" that tell your "tissue type". You inherit tissue type from your mother and father. This test is used to match a kidney and/or pancreas to you.
Panel Reactive Antibody (PRA) - This test shows how active your immune system is. It is easier for you to get a kidney if your immune system is calm or measures 0%. Blood will be drawn at your dialysis center and sent to our laboratory. Your immune system may be active from blood transfusions, pregnancy, a previous transplant or a current infection.
Crossmatch Testing - This test is done when a donor kidney is available. Your blood is mixed with the donor's blood. If there is no reaction (negative crossmatch) it means you are "compatible" with the donor. If there is a reaction (positive crossmatch), the kidney will not work for you because it is "incompatible".
Other Tests - The transplant doctors will ask for any special tests they think you will need. For example, people with diabetes will need more tests for their heart. Your transplant coordinator or dialysis doctor can help you make arrangements for these tests.

Clinical Laboratory Tests
Blood Typing - There are four different blood types. They are A, B, AB and O. Every person has one of these blood types. The donor's blood type does not have to be the same. However, it must be "compatible" with your blood type for you to receive the kidney and/or pancreas.
Viral Testing - It is important for us to know if you have been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS). We will test you for these at your clinic appointment.

THE TRANSPLANT TEAM(Click on each for more information)

Transplant Surgeon
Transplant Physician (Nephrologist)
Transplant Coordinator
Floor or Staff Nurse Physical Therapist Dietician-->
Psychologist / Psychiatrist
Social Worker
Pharmacist
Each of the skilled health care professionals who make up the transplant team take a personal interest in answering a patient's questions and taking care of his medical needs. They will also help the patient keep his spirits up along the way.
The patient is the most important member of the transplant team. To a certain extent, all the other team members will respond to his cues. The patient's physical, emotional, and practical needs will help them shape a personalized pretransplant and posttransplant treatment program.

PREPARING AND WAITING FOR A KIDNEY TRANSPLANT
Days and weeks may pass while the transplant team waits for UNOS to locate the right kidney for a specific patient. During this time, the patient should prepare as much as possible and take positive steps to deal with the stresses of waiting, always staying focused on reaching the goal of transplant.
The Telephone as a Lifeline
Make a List and Pack Ahead of Time
Getting to the Transplant Center
Dealing with Pretransplant Stress

GETTING THE GO-AHEAD
When that important phone call comes, the patient should make sure to bring the following to the hospital:
- A list of all the medications the patient is taking
- A list of the patient's drug allergies, if he has any
- The patient's health insurance information
IMPORTANT: As soon as a kidney is available, the patient should stop all eating and drinking immediately. The patient's stomach must be empty when he is taken into the operating room.

AT THE HOSPITAL
After admission, the patient will have a thorough physical examination, including more blood work, a chest x-ray, and EKG, dialysis and, possibly, other tests.
Unfortunately, surgery must be postponed in some cases. The patient will be sent home again if:
- he has an infection or has developed any other medical problem that would interfere with surgery or recovery
- The donor kidney shows signs of deterioration or poor function
If surgery is postponed, the transplant team can help the patient through the disappointment. This is only a temporary setback, and the search for a new kidney will go on.

PREPARING THE PATIENT FOR SURGERY
Before the operation, the patient may receive an enema or a laxative to clean out his intestines and prevent constipation after surgery. Hair from the chest and abdomen will be shaved to prevent infection, and an intravenous (IV) line will be inserted in the arm or just under the collarbone to give medication and prevent dehydration. The patient will also be given a sedative to help him relax and feel sleepy before going to the operating room.
IMPORTANT:Because transplantation is a major surgical procedure, the patient may need a transfusion. Today, all blood is screened very carefully; the likelihood of contracting a disease is very small. Any concerns that the patient has regarding the source of the blood should be relayed to the transplant team during the waiting period, before getting to the hospital. Most hospitals offer the option of "autotransfusion" - this is when the patient donates his own blood before surgery. His own blood is stored and then used during transplantation.

THE KIDNEY TRANSPLANT SURGERY PROCEDURE
The patient will be under general anesthesia throughout the surgery. Once asleep, the transplant surgeon will make an incision on the right or left side of the lower abdomen just above the groin.
The surgical team will then place the donor kidney into the abdomen and connect the kidney's blood vessels to the recipient's iliac artery and vein. The surgeons will then connect the ureter to the bladder. A small drain, called a Jackson Pratt, may be placed into the abdominal cavity to drain any excess fluid.

WAKING UP IN THE INTENSIVE CARE UNIT (ICU)
After the surgery, the patient will wake up in the intensive care unit (ICU) after the anesthesia wears off.
This is what the patient should expect:
- Some pain and discomfort, which medication will help to relieve.
- The patient will be asked to cough periodically to keep his lungs clear. If it hurts to cough, the patient should ask someone to support his abdomen.
- The patient will have an IV line in his arm or neck under the collarbone, which will be used to give fluids and medication for the first few days after surgery.
- For several days after surgery, the patient will have a catheter in his

bladder to drain urine. He may feel uncomfortable, and may feel that he has to urinate constantly, but it is only temporary.
- During surgery, one drain may be placed in or near the incision. The drain will be removed 5 to 10 days after surgery.
- Dialysis may still be needed to help clear excess fluid and toxins in the body until the kidney recovers from the procurement process.
The length of a hospital stay will depend on a patient's progress. A patient is encouraged to talk to someone on his transplant team if he is uneasy or uncomfortable.

MEDICAL MANAGEMENT IN THE ACUTE CARE UNIT
After the patient's medical condition has stabilized, he will be transferred from the ICU to the acute care unit. During the patient's stay on this unit, his laboratory studies, medications, nutritional status and exercise tolerance will be monitored. As soon as the patient is able, discharge instructions will begin to prepare him for going home.

CLINIC VISITS
Upon leaving the hospital, the patient will receive a schedule of follow-up clinic visits for lab tests and checkups. The purpose is to track your progress and detect potential complications as early as possible.
Follow-up visits
On days when the patient is scheduled for follow-up visits, he should bring his medication list and his surgery handbook. He will be given specific instructions for routine lab work or special tests that he might need.

LAB TESTS
A usual lab test monitors blood count, kidney function,

electrolytes, and medication levels in the patient's blood. Other tests may be ordered as necessary.
Tests for BLOOD COUNT:
- WBC tell if the patient's white blood cells have increased (usually a sign of infection) or decreased (indicating a lower defense against infection).
- HCT measures the hematocrit, which is the percentage of red blood cells in the blood. Red blood cells carry oxygen to all parts of the body. When a patient's HCT is low, he may feel tired or have little energy.
- PLT measures the level of platelets. Platelet cells form a blood clot when the body is injured. Low platelet levels may cause someone to bruise easily and to bleed for a longer time when injured.
Test for KIDNEY FUNCTION:
Creatinine and BUN tell how well the kidneys work by measuring levels of creatinine and blood urea nitrogen, waste products normally removed from the blood by the kidneys.
Tests for ELECTROLYTES (dissolved minerals):
- Ca measures calcium, which is necessary for strong bones and teeth, blood clotting, and heart and nerve function.
- PO4 measures phosphate, which works closely with calcium to strengthen bones.
- Mg measures magnesium, which is necessary for normal functioning of muscles and for blood clotting.
- K measures potassium, which is needed for normal heart and muscle function.
- Na measures sodium, which helps maintain the balance of salt and water in the body.
- CO2 measures bicarbonate, which helps maintain acid balance in the body.
- Creatinine measures how well the kidneys are functioning. When this number rises, the cause may be rejection or a side effect of medication.
Other blood tests:
Drug levels measure Tacrolimus (Prograf®) or Cyclosporine (Sandimmune®) in the blood. Tacrolimus or Cyclosporine blood levels must be checked regularly to avoid levels that are too high or too low. High levels could lead to toxicity or over-immunosuppression, and low levels may lead to rejection.
NOTE: The desired level (normal range) will differ for each person, depending on the combination of immunosuppressive medications and the length of time since the transplant.
Glu measures glucose, levels of sugar in the blood; some medications may produce a diabetes-like condition in which blood-sugar levels are too high.

ADDITIONAL TESTS AND PROCEDURES
The transplant team may perform one or more of the following tests and procedures to monitor a patient's transplant:
Ultrasound - This test is performed to make sure all the main blood vessels leading to the kidney are functioning normally. This test is also used to check for collections of fluid, such as blood. The procedure consists of placing a cool gel on the patient's abdomen, over which a wand (transducer) is moved to transmit sound waves. These are converted into images of the kidney and projected onto a television screen.
Kidney biopsy (test sample) - This test is usually performed to check for rejection, or other possible problems. This may be done in the hospital or in the outpatient/short-stay unit. The patient will receive special instructions regarding the procedure. Before the procedure, the patient will receive a numbing injection (local anesthetic) on the right side of his abdomen. Then a special needle will be inserted to withdraw a small sample of kidney tissue that will be examined with a microscope.
Computerized tomography (CT) scan - This is a type of X ray that allows the physician to view the patient's kidney from many different angles to detect infections, fluid collections, or other problems. The procedure requires that the patient drink a liquid that outlines his stomach and intestines and makes his kidney more visible; then he lies flat for 1 hour while the machine takes X rays around him.
Magnetic resonance imaging (MRI) - This is another type of test that produces an image. Somewhat like a CT scan, it also allows a patient's kidney to be viewed from different angles and in three-dimensional images. An MRI shows soft tissues, such as the kidney, more clearly than a CT scan does.

MONITORING HEALTH AND A NEW KIDNEY AT HOME
After a patient is discharged from the hospital, he may be asked to monitor:
- temperature
- pulse
- blood pressure
- weight
Temperature - A patient should check and record temperature any time he feels chilled, hot, achy, or ill. This may be the first sign of infection.
WARNING: DO NOT USE TYLENOL®, ADVIL® (Ibuprofen), aspirin, or other such products except under the direction of a physician, as these drugs may cause further symptoms.
If a patient's temperature is higher than normal at any time, he should notify his transplant coordinator immediately. This is considered an emergency, because an elevated temperature could indicate a serious infection or rejection.
Blood pressure - A nurse or transplant coordinator will show how to measure blood pressure, if necessary. The top number (systolic) is noted at the first sound, and the bottom number (diastolic) is noted when the sound changes (not stops). It is important that a patient knows his normal blood pressure, normal changes, and when he should be concerned.
Pulse - If a patient is taking medication that affects heart rate, the nurse or coordinator will show how to check his own pulse at home.
NOTE: If a patient experiences chest pain or has difficulty breathing, he should call 911 for an ambulance and go to the nearest emergency room. He SHOULD NOT attempt to drive himself.
Weight - The patient may weigh himself on a standard bathroom scale at the same time every morning (after going to the toilet). If he gains more than 2 pounds per day, he could be retaining fluid. This should be reported to the transplant coordinator.

RESUMING NORMAL ACTIVITIES
Although the patient is encouraged to resume normal activities after recovery, it is important to understand that having a new kidney brings new responsibilities.

- Skin and Hair Care
- Sexual Activity
- Smoking
- Vacations and Travel
- Dental Care
- Pregnancy
- Exercise
- Diet and Nutrition
- Alcoholic Beverages

Signs to Watch Out For
While primary concerns involve infection and rejection, many other problems, such as colds or flu, adjustment of other medications, and minor infections can be handled by a local physician. A patient needs to take precautions and learn to watch for signs of infection and rejection that necessitate notifying a local physician or transplant team immediately. These include:
- a fever that continues for more than 2 days
- shortness of breath
- a cough that produces a yellowish or greenish substance
- a dry cough that continues for more than 1 week
- prolonged nausea, vomiting, or diarrhea
- an inability to take prescribed medication
- a rash or other skin changes
- vaginal discharge or itching
- burning discomfort with urination
- exposure to mumps, measles, chicken pox, or shingles
- unusual weakness or light-headedness
- emergency-room treatment or hospitalization
- pain, redness, tenderness or swelling at the incision site
- fluid retention/weight gain (2 lbs. in 24 hours)
- decrease in urine output
- pain or burning during urination
- blood in the urine
- strong odor to the urine
- feeling urgent need to urinate or need to urinate frequently

AVOIDING INFECTION
Because immunosuppressive medications interfere with a patient's natural immune system, he needs to protect himself consciously from infection after the surgery by taking the following precautions:
- Wash hands often.
- Keep hands away from face and mouth.
- Stay away from people with colds or other infections.
- Ask friends to visit only when they are well.
- If the patient has a wound and must change his own dressing, wash hands before and after.
- Wash hands after coughing or sneezing, and throw tissues into the trash immediately.
- If someone in the patient's family becomes ill with a cold of flu, have that individual follow normal precautions (use separate drinking glasses, covering their mouths when coughing, etc.)
- Avoid working in the soil for 6 months after the transplant. Thereafter, wear gloves.
- Avoid handling animal waste and avoid contact with animals who roam outside. Do not clean bird cages or fish or turtle tanks or cat litter. The cat litter box should be covered and taken out of a patient's home before it is changed.
- Avoid vaccines that consist of live viruses, such as Sabin oral polio, measles, mumps, German measles, yellow fever, or smallpox. The live virus can cause infections. If a patient or any family member intends to receive any vaccinations, they should notify the transplant team or local physician.
- Take good care of your teeth by brushing two times a day and seeing the dentist twice a year for cleaning and checkup.

SPECIAL WARNING TO PARENTS OF CHILDREN WHO HAVE HAD TRANSPLANTS:Ask the school nurse or other official to notify you immediately of any communicable diseases (for example, measles, chicken pox) that may be circulating in your school.

COMMUNICATING WITH THE HEALTHCARE TEAM
Communication and cooperation between the

transplant team, local physician, pharmacist, dentist, and the patient himself is vital to his well-being. Having a transplanted kidney and taking the medications needed to prevent rejection put a patient at risk for a number of complications. It is important to follow the instructions that will help prevent or lessen complications.
One of a patient's most important jobs is to make certain that all members of his local healthcare team - family physician, dentist, local pharmacist, and any other healthcare professionals he sees - are aware of the transplant, the medications he takes each day, and the precautions he must follow to stay healthy. Each of his local healthcare providers should be given the telephone number of his transplant team. He should ask that they contact the transplant center for specific information.

Anxiety and Depression
A serious procedure such as the one just experienced can create many personal and family stresses. It is not uncommon for transplant patients to experience anxiety and perhaps depression following their surgery, hospital confinement, and return home. To help a patient adjust to life at home and an eventual return to work or school, counseling services are available. He should consult the transplant coordinator or social worker for information regarding services available to help resolve stress and anxiety.

TRANSPLANTASI GINJAL

2006-03-21T12:05:00.000+07:00

Transplantasi adalah pergantian organ atau jaringan tubuh yang tidak lagi berfungsi dengan organ atau jaringan sehat yang berasal dari tubuh sendiri atau orang lain. Transplantasi mulai populer di dunia kedokteran sejak pertengahan tahun 50-an (walaupun transplantasi kulit sebenarnya sudah dilaksanakan jauh sebelum itu).
Problem terbesar dalam transplantasi adalah rejeksi (penolakan). Seperti terhadap kuman atau benda asing yang memasuki tubuh, tubuh penerima akan mengembangkan berbagai reaksi penolakan atau rejeksi terhadap organ dan jaringan yang baru dicangkokkan tersebut.
Transplantasi paling baik dilakukan bila organ atau jaringan pengganti berasal dari tubuh sendiri. Hal ini tidak akan menimbulkan rejeksi. Sebaliknya, organ atau jaringan yang berasal dari orang lain (kecuali saudara kembar satu telur) sering menimbulkan reaksi penolakan yang mungkin mengakibakan berbagai komplikasi.
Bagaimana cara untuk mengatasi reaksi penolakan serta metode yang tepat untuk menguji kecocokan antara donor dan penerima, merupakan dua hal dalam bidang transplantasi yang sampai kini terus dikaji oleh para ahli.
Dewasa ini teknologi transplantasi sudah sangat berkembang sehingga dapat dilakukan terhadap organ yang dulu tidak dapat ditransplantasikan. Transplantasi organ tubuh yang pertama kali sukses dilakukan adalah transplantasi ginjal antara sepasang kembar identik. Setelah itu, transplantasi ginjal terus dikembangkan untuk memungkinkan transplantasi di luar kembar identik. Setelah mendapatkan cukup pengalaman dengan transplantasi ginjal, dunia kedokteran mulai mengembangkan transpalantasi hati, paru dan jantung. Transpalntasi jantung pertama kali sukses dilakukan tahun 1967.
Hingga kini sudah banyak organ atau jaringan yang dapat ditransplantasikan, antara lain kulit, kornea, tulang, pembuluh darah, ginjal, jantung, hati, paru, dan pangkreas.
Masalah penyimpanan organ yang akan ditransplantasikan juga tak kalah peliknya. Berkaitan dengan masalah penyimpanan ini, dewasa ini kita mengenal apa yang dinamakan bank jaringan dan organ, untuk menyimpan bahan yang akan ditransplantasikan dalam jangka waktu yang lama.

KONSULTASI TENTANG TRANSPLANT GINJAL

2006-03-21T11:58:00.000+07:00

Bagaimana Sebenarnya Cangkok Ginjal?
Ayah Saya Dianjurkan Cangkok Ginjal

Tanya:
Ayah saya umur 65 th, sejak awal tahun ini berobat untuk penyakit ginjal. Beliau pernah operasi batu, dan juga akhirnya ginjal kirinya diangkat beberapa tahun yang lalu. Dalam perjalanan 6 bulan ini fungsi ginjalnya terus menurun sehingga akhirnya bulan lalu menjalani cuci darah. Dokter telah menjelaskan bahwa sebaiknya ditargetkan untuk kemungkinan cangkok ginjal. Kami sekeluarga masih buta tentang cangkok ginjal ini. Mohon dapat dijelaskan beberapa hal sebagai berikut: Apakah cangkok ginjal sudah ada/ umum di Indonesia? Ginjalnya dapat diperoleh dari mana? Apa persiapan untuk cangkok ginjal tersebut? Apakah ginjal yang lama dibuang? Apa masih harus minum obat setelah cangkok ginjal? Apa bahaya cangkok ginjal?Demikian pertanyaan kami, terima kasih atas penjelasan Dokter.
Bachtiar T, Depok

Jawab:
Sdr. Bachtiar yth, cangkok ginjal atau transplantasi ginjal adalah merupakan prosedur rutin di beberapa rumah sakit di Indonesia. Rumah-rumah sakit yang telah rutin menjalankannya (sesuai dengan ’kurva belajar’ / learning curve) akan makin terampil dan handal dalam melakukan prosedur transplantasi ginjal.
Persiapan. Persiapan yang perlu dilakukan adalah melakukan inventarisasi data/ pemeriksaan pada pasien atau disebut resipien antara lain: golongan darahnya, tipe jaringannya, antibodi-antibodi yang ada, penyakit-penyakit potensial misalnya TBC, Hepatitis, virus CMV (Cytomegalo virus), pemeriksaan fungsi-fungsi organ lain misalnya jantung, hati, dsb, juga keadaan pembuluh darah tempat menempelnya ginjal dan berbagai hal tentang kondisi kesehatannya. Biasanya pasien telah menjalani hemodialisis sehingga keadaan fisiknya menjadi optimal menghadapi operasi dan pengobatan-pengobatan lain.
Donor. Berikutnya adalah pemeriksaan terhadap donor ginjal. Di Indonesia dan di banyak negara, ginjal seperti juga darah dilarang untuk diperjual belikan, sehingga rumah-rumah sakit yang melakukan transplantasi ginjal akan meneliti donor apakah ada kemungkinan yang bersangkutan ’menjual’ ginjalnya kepada resipien. Tentu yang paling baik adalah donor berasal dari/punya hubungan famili dengan resipien. Donor akan diperiksa kesehatannya secara umum dan khusus, baik fisik dan mental. Mulai dari golongan darahnya, golongan darah yang sama tentu yang terbaik. Tetapi kondisi lain dapat juga: resipien golongan O dapat menerima dari donor O, resipien A dapat menerima dari donor O dan A, resipien B dapat menerima dari donor O dan B, resipien AB dapat menerima dari semua: O, A, B, AB. Selanjutnya diperiksa tipe jaringan untuk menentukan: tipe antigen HLA (human leucocyte antigen), ada yang Class I dan Class II. Kecocokan 100 % antara resipien dan donor sulit dicapai kecuali pada pasangan kembar, jadi dicari adanya kecocokan yang setinggi mungkin, minimal harus cocok 25%. Selain itu dibantu oleh pemeriksaan cross match: yaitu serum resipien dicampur dengan limfosit donor. Tes ini merupakan langkah pengamanan penting karena bila ada reaksi dapat dipastikan terjadi reaksi penolakan yang hiperakut. Donor tentunya harus kedua ginjalnya sehat dan secara anatomis cukup baik. Diperiksa juga terhadap potensi penyakit Diabetes, Hipertensi, Hepatitis, Tbc, infeksi CMV.
Donor dapat berasal dari orang hidup. Di Indonesia masih menggunakan cara ini, biasanya dari keluarga (living related donor). Dapat juga berasal dari orang meninggal (cadaver donor), tentunya meninggal dengan mati batang otak yang jantungnya masih berdenyut sehingga ginjal masih menerima suplai darah.
Ginjal sebaiknya berasal dari donor yang berumur paling tidak 21 th sehingga dia dapat memutuskan sendiri persetujuannya (Informed Consent), dan sebaiknya tidak lebih dari 60 th karena donor usia lanjut cenderung mempunyai pembuluh darah yang kaku (atherosclerosis) sehingga susah dan cukup berbahaya untuk dijahit / disambung. Apakah aman ginjal diambil? Ini pertanyaan yang sering diajukan. Orang yang telah diangkat satu ginjal, maka ginjal yang masih ada akan mengambil alih fungsi ginjal yang diangkat sehingga donor tsb dapat hidup normal sekalipun dia adalah seorang pilot, atau tentara, atau pekerja tambang.
Operasi transplantasi. Bila donor memenuhi syarat, akan diambil satu buah ginjal termasuk 3 saluran: pembuluh darah Arteri dan Vena ginjal, serta Ureter. Ginjal dari donor akan diletakkan di dalam panggul sebelah kandung kencing, biasanya sebelah kanan. Pembuluh darah ginjal disambung ke Arteri Iliaca Interna dan Vena Iliaca Communis, Ureter akan ditanam dalam dinding dan bermuara di dalam kandung kemih (lihat gambar). Ginjal lama tidak dibuang kecuali memang mengganggu kesehatan pasien, misalnya hipertensi yang tinggi dan susah dikontrol. Operasi transplantasi ginjal berlangsung antara 1,5 – 2.5 jam.
Obat. Obat utama yang diberikan adalah obat-obat yang menjegah penolakan jaringan / organ disebut obat imunosupresif, yang paling sering dipakai adalah Cyclosporin A atau Tacrolimus, dikombinasi dengan Azathioprine atau Mycophenolate, dan Prednisolon. Obat-obat ini umumnya makin lama akan berkurang dosisnya, dan atau jumlahnya, tergantung dari kondisi kecocokan jaringan dan kondisi perjalanan kesehatannya.
Bahaya cangkok ginjal. Dengan persiapan yang baik biasanya bahayanya minim: a.l. penolakan akut (acute rejection), terjadi arus darah tidak lancar (klot), kebocoran urin, infeksi luka operasi. Komplikasi yang timbul kemudian adalah penolakan kronis (chronic rejection), infeksi, penyempitan arteri, penyakit ginjal asli kambuh. Demikian penjelasan kami, semoga bermanfaat.

Dr. Nico A. Lumenta, K.Nefro
Konsultan Ginjal-Hipertensi
RS Mediros

HIDUP DENGAN SATU GINJAL

2006-03-21T11:16:00.000+07:00

Ginjal, pengetahuan kita diajak mengingat kembali fungsinya menyaring darah dan membuang zat/material yang berbahaya. Ketakutan ginjal rusak atau katakanlah menjelang tak berfungsi bisa kita kurangi dan hilangkan dengan gaya hidup sehat dibarengi minum air secukupnya. Namun tak terlepas dari hal itu, satu bagian yang masih membayangi perkembangan dunia kesehatan Indonesia mengenai ginjal, yaitu bagaimana memasyarakatkan donor ginjal.”
Pada prinsipnya kami menyampaikan sosialisasi mengenai donor ginjal itu tak menakutkan dan dapat menjadi memasyarakat. Selain mengenal apa itu cangkok ginjal/transplantasi ginjal, bagi pasien (resipien ginjal) dia memiliki ginjal baru sedangkan pada donor ginjal yang perlu disosialisasikan adalah hidup dengan satu organ ginjal tetap normal dan hal biasa”, ungkap Dr. Indrawati Sukadis selaku Ketua Simposium Pelayanan Ginjal Terpadu yang diadakan RS PGI Cikini saat ulang tahun ke-106 beberapa waktu lalu.Hidup dengan satu ginjal sepertinya memang menyeramkan bila kita membayangkan organ itu hilang. Bukan karena rusak atau terjadi penurunan fungsi, tetapi karena didonorkan. Tentu timbul pertanyaan, bisahkan nantinya hidup tetap seperti sedia kala, atau sebaliknya?”Tidak perlu khawatir. Karena dengan satu ginjal kita bisa hidup sehat, berkualitas dan tetap produktif”, tambah Indrawati Sukadis kembali.Menurut dokter yang menjabat sebagai Koordinator Transplantasi Ginjal di PGI Cikini itu, dari kedua fungsi ginjal, hanya satu ginjal yang berkerja sepenuhnya. Sedangkan pasangannya, sejumlah 75 % sebagai cadangan. ” Ibarat sampai kita berumur 80 tahun, cuma satu ginjal yang berfungsi. Jadi tak masalah hidup dengan satu ginjal dan tidak berarti kerja ginjal menjadi dua kali lebih berat. Asal kita semua membarengi dengan pola hidup sehat”, paparnya.Indrawati mengharapkan persepsi salah yang beredar mengenai kerja ginjal di atas dapat ditanggulagi melalui kinerja yang proaktif para dokter. Jadi bisa dibayangkan, berapa ratus ginjal yang tidak dioptimalkan di Indonesia, salah satu contoh kasus ya mengenai minimnya donor ginjal di negeri ini.

Jual-beli Ginjal
Ahli hukum kedokteran RSCM, dr. Herkutanto, SH, menjelaskan bahwa transplantasi organ termasuk cangkok ginjal telah diatur dalam pasal 34 Undang-Undang Kesehatan No 23/1993.”Transplantasi jaringan tubuh hanya boleh dilakukan tenaga-tenaga kesehatan yang memang berkompeten dan juga memiliki syarat persetujuan dari donor maupun ahli waris”, ungkap Herkutanto menjelaskan isi pasal tersebut. Dari uraian itu jelas sudah garis hukum Indonesia melarang keras transplantasi organ tanpa sebab. Namun Herkuntanto mengakui mengenai transplantasi donor ginjal jenazah belum memiliki dasar maupun ketentuan yang kuat antara pemerintah dan instansi kesehatan. ” Pada umumnya, donor ginjal dari jenazah sudah tak terpakai lagi dan juga tidak dilakukan di Indonesia. Sedangkan donor dari sang terpidana mati”, mesti memiliki asas kesukarelaan, tambahnya kemudian.
Mengenai jual-beli ginjal pun, prinsip itu tak berlaku di RS PGI Cikini yang menerapkannya sejak tahun 1977. Menurut Indra Sukadis, selain aturan agama dari sisi etika kedokteran jelas hal itu melanggar sumpah. Namun sayangnya, asas jual-beli organ ginjal itu hingga kini tidak memiliki aturan hitam di atas putih. Pelanggaran Undang-Undang Kesehatan hanya menjabarkan kesalahan pihak-pihak yang melakukan transplantasi tanpa keahlian memadai, itu pun diganjar dengan hukuman penjara tujuh tahun pada pasal 81 UU Kesehatan.Bertolak belakang dengan di negeri kita, China malah menjadikan organ ginjal tersebut sebagai devisa negaranya. Pasalnya, negeri berasaskan komunis itu membuka seluas-luasnya kepada penduduknya untuk menjual ginjalnya. Bahkan bagi pendonor ada reward yang diberikan pemerintah, seperti pemberian pekerjaan hingga asuransi kesehatan. Pengalaman tersebut diungkapkan Dr. Herman, yang merupakan anggota Paguyuban Cangkok Ginjal, saat mencangkok ginjalnya di tahun 2001. Menurutnya, selain kemudahan pembelian ginjal, penerima pun mengetahui identitas pendonornya. ”Namun, kita hanya boleh mengetahui berapa usianya, alamat dan penyebab kenapa ia meninggal, itu saja”, ungkap Herman yang ahli di Bidang Hemodialisis (cuci darah) tersebut.

Ginjal Mayat
Semua manusia memiliki ginjal, namun tidak semua dapat menyumbangkan ginjalnya setelah dirinya wafat. Lalu kapan sebenarnya orang yang meninggal itu dapat diambil ginjalnya? Dr. Indrawati Sukadis mengatakan saat manusia meninggal dan dikatakan mati batang otak.Sedangkan Neurologis RSCM, Dr. Jofizal Jannis menambahkan bahwa mati batang otak itu adalah fungsi otak sudah tak berguna lagi. Dijelaskan Jofizal, penentuan mati batang otak itu ada beberapa kriteria, yaitu pertama melalui pengetesan terhadap reaksi efek pupil bila diberikan cahaya. Kedua, tes dengan istilah reflek mata boneka, yaitu memutar-mutar kepala. ” Kalau bola mata bergerak itu normal, dan sebaliknya tetap berhenti bila ada kematian batang otak. Dan terakhir mengetes kornea mata, apabila disentuh tapi tidak menutup itu berarti kena batang otak juga”, urai Jofizal.
Rasa nyeri juga tak terasa pada orang yang batang otaknya mati. Tetapi pada manusia yang kesadarannya turun hebat tentu rasa nyeri itu masih terasa. Pasalnya, kematian batang otak akan mengarah pada kematian. Sedangkan kematian itu sendiri diuji dengan alat EEG. Pada alat ini, akan terlihat gelombang datar. Selain EEG, alat TCD juga dapat mengukur kematian batang otak dengan tak adanya aliran darah pada penunjukan alat.

Oleh Rakhmat Bernadi. AR
Penulis adalah wartawan khas bidang kesehatan.

ALL ABOUT KIDNEY

2006-03-21T09:43:00.000+07:00

Location:
In humans, the kidneys are located in the posterior part of the abdomen. There is one on each side of the spine; the right kidney sits just below the liver, the left below the spleen. Above each kidney is an adrenal gland (also called the suprarenal gland).
The kidneys are retroperitoneal, which means they lie behind the peritoneum, the lining of the abdominal cavity. They are approximately at the vertebral level T12 to L3, and the right kidney usually lies slightly lower than the left in order to accommodate the liver.
The upper parts of the kidneys are partially protected by the eleventh and twelfth ribs, and each whole kidney is surrounded by two layers of fat (the perirenal fat and the pararenal fat) which help to cushion it.

Structure:
Organization:
In a normal human adult, each kidney is about 11 cm long and about 5 cm thick, weighing 150 grams. The kidneys are "bean-shaped" organs, and have a concave side facing inwards (medially). On this medial aspect of each kidney is an opening, called the hilum, which admits the renal artery, the renal vein, nerves, and the ureter.
The outermost portion of the kidney is called the renal cortex, which sits directly beneath the kidney's loose connective tissue capsule. Deep to the cortex lies the renal medulla, which is divided into 10-20 renal pyramids in humans. Each pyramid together with the associated overlying cortex forms a renal lobe. The tip of each pyramid (called a papilla) empties into a calyx, and the calyces empty into the renal pelvis. The pelvis transmits urine to the urinary bladder via the ureter.

Blood Supply:
Each kidney receives its blood supply from a renal artery, two of which branch from the abdominal aorta. Upon entering the hilum of the kidney, the renal artery divides into smaller interlobar arteries situated between the renal papillae. At the outer medulla, the interlobar arteries branch into arcuate arteries, which course along the border between the renal medulla and cortex, giving off still smaller branches, the cortical radial arteries (sometimes called interlobular arteries). Branching off these cortical arteries are the afferent arterioles supplying the glomerular capillaries, which drain into efferent arterioles. Efferent arterioles divide into peritubular capillaries that provide an extensive blood supply to the cortex. Blood from these capillaries collects in renal venules and leaves the kidney via the renal vein. Efferent arterioles of glomeruli closest to the medulla (those that belong to juxtamedullary nephrons) send branches into the medulla, forming the vasa recta.

Nephron:
The basic functional unit of the kidney is the nephron, of which there are more than a million in each normal adult human kidney. Nephrons regulate water and soluble matter (especially electrolytes) in the body by first filtering the blood, then reabsorbing some necessary fluid and molecules while secreting other, unneeded molecules. Reabsorption and secretion are accomplished with both cotransport and countertransport mechanisms established in the nephrons and associated collecting ducts.

Collecting duct system:
Fluid flows from the nephron into the collecting duct system. This segment of the nephron is crucial to the process of water conservation by the organism. In the presence of antidiuretic hormone (ADH; also called vasopressin), these ducts become permeable to water and facilitate its reabsorption, thus concentrating the urine and reducing its volume. Failure of the organism to produce ADH (or inability of the collecting ducts to respond to it) may cause excessive urination, called diabetes insipidus. Conversely, when the organism must eliminate excess water, such as after excess fluid drinking, the production of ADH is decreased and the collecting tubule becomes less permeable to water, rendering urine dilute and abundant. Failure of the organism to decrease ADH production appropriately may lead to water retention and dangerous dilution of body fluids, which in turn may cause severe neurological damage. After being processed along the collecting tubules and ducts, the fluid, now called urine, is drained into the bladder via the ureter, to be finally excluded from the organism.

Functions
Excretion of waste products
The kidneys excrete a variety of waste products produced by metabolism, for example, urea (from protein catabolism) and uric acid (from nucleic acid metabolism).

Homeostasis
Acid-Base Balance
The kidneys regulate the pH, mineral ion concentration, and water composition of the blood.
By exchanging hydronium ions and hydroxyl ions, the blood plasma is maintained by the kidney at pH 7.4. Urine, on the other hand, becomes either acidic at pH 5 or alkaline at pH 8.
The pH is maintained through four main protein transporters: NHE3 (a sodium-hydrogen exchanger), V-type H-ATPase (an isoform of the hydrogen ATPase), NBC1 (a sodium-bicarbonate cotransporter) and AE1 (an anion exchanger which exchanges chloride for bicarbonate). Due to the polar alignment of cells in the renal epithelia NHE3 and the H-ATPase are exposed to the lumen (which is essentially outside the body), on the apical side of the cells, and are responsible for excreting hydrogen ions (or protons). Conversely, NBC1 and AE1 are on the basolateral side of the cells, and allow bicarbonate ions to move back into the extracellular fluid and thus are returned to the blood plasma.
Water Balance
Sodium ions are controlled in a homeostatic process involving aldosterone which increases sodium ion absorption in the distal convoluted tubules.
Plasma Volume
Any rise or drop in blood osmotic pressure due to a lack or excess of water is detected by the hypothalamus, which notifies the pituitary gland via negative feedback. A lack of water causes the posterior pituitary gland to secrete antidiuretic hormone, which results in water reabsorption and an increase in urine concentration. Tissue fluid concentration thus returns to a mean of 98%.

Hormone secretion
The kidneys secrete a variety of hormones, including erythropoietin, renin, and vitamin D.

Terms
renal capsule: The membranous covering of the kidney.
cortex: The outer layer over the internal medulla. It contains blood vessels, glomeruli (which are the kidneys' "filters") and urine tubes and is supported by a fibrous matrix.
hilus: The opening in the middle of the concave medial border for nerves and blood vessels to pass into the renal sinus.
renal column: The structures which support the cortex. They consist of lines of blood vessels and urinary tubes and a fibrous material.
renal sinus: The cavity which houses the renal pyramids.
calyces: The recesses in the internal medulla which hold the pyramids. They are used to subdivide the sections of the kidney. (singular - calyx)
papillae: The small conical projections along the wall of the renal sinus. They have openings through which urine passes into the calyces. (singular - papilla)
renal pyramids: The conical segments within the internal medulla. They contain the secreting apparatus and tubules and are also called malpighian pyramids.
renal artery: Two renal arteries come from the aorta, each connecting to a kidney. The artery divides into five branches, each of which leads to a ball of capillaries. The arteries supply (unfiltered) blood to the kidneys. The left kidney receives about 60% of the renal bloodflow.
renal vein: The filtered blood returns to circulation through the renal veins which join into the inferior vena cava.
renal pelvis: Basically just a funnel, the renal pelvis accepts the urine and channels it out of the hilus into the ureter.
ureter: A narrow tube 40 cm long and 4 mm in diameter. Passing from the renal pelvis out of the hilus and down to the bladder. The ureter carries urine from the kidneys to the bladder by means of peristalsis.

Diseases and disorders
Congenital
Polycystic kidney disease
Congenital hydronephrosis
Renal dysplasia
Congenital obstruction of urinary tract
Horseshoe kidney
Duplicated ureter

Acquired
Renal failure
Acute renal failure
Chronic renal failure
Kidney stones are a relatively common and particularly painful disorder.
Pyelonephritis is infection of the kidneys and is frequently caused by complication of a urinary tract infection.
Azotemia is a toxic condition characterized by abnormal and dangerously high levels of urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.
Hydronephrosis is the enlargement of one or both of the kidneys caused by obstruction of the flow of urine.
In nephrotic syndrome, the glomerulus has been damaged so that a large amount of protein in the blood enters the urine. Other frequent features of the nephrotic syndrome include swelling, low serum albumin, and high cholesterol.
kidney tumors
Wilms tumor
Renal cell carcinoma
Glomerulonephritis
Diabetic nephropathy
Lupus nephritis
Minimal change disease
Trauma
Interstitial nephritis

Dialysis and kidney transplants
Generally, humans can live normally with just one kidney. Only when the amount of functioning kidney tissue is greatly diminished will renal failure develop. If renal function is impaired, various forms of medications are used, while others are contraindicated. Provided that treatment is begun early, before a serum creatinine of 2 mg/dl, it may be possible to reverse chronic kidney failure due to diabetes or high blood pressure. If creatinine clearance (a measure of renal function) has fallen very low ("end-stage renal failure"), or if the renal dysfunction leads to severe symptoms, dialysis is commenced. Dialysis is a medical procedure, performed in various different forms, where the blood is filtered outside of the body.
Kidney transplantation is the only cure for advanced chronic renal failure; dialysis, while correcting the abnormalities to a degree, is seen as a form of "buying time" to bridge the inevitable wait for a suitable organ.
The first successful kidney transplant was announced on March 4, 1954 at Peter Bent Brigham Hospital in Boston. The surgery was performed by Dr. Joseph E. Murray, who was awarded the Nobel Prize in Medicine in 1990 for this feat.
There are two types of kidney transplants: living donor transplant and a cadaveric (dead donor) transplant. When a kidney from a living donor, usually a blood relative, is transplanted into the patient's body, the donor's blood group and tissue type must be judged compatible with the patient's, and extensive medical tests are done to determine the health of the donor. Before a cadaveric donor's organs can be transplanted, a series of medical tests have to be done to determine if the organs are healthy. Also, in some countries, the family of the donor must give its consent for the organ donation. In both cases, the recipient of the new organ needs to take drugs to suppress their immune system to help prevent their body from rejecting the new kidney [1].

Medical terminology
Medical terms related to the kidneys involve the prefixes renal- and nephro-.
Surgical removal of the kidney is a nephrectomy, while a radical nephrectomy is removal of the kidney, its surrounding tissue, lymph nodes, and potentially the adrenal gland. A radical nephrectomy is performed for removal of cancers.

See also
Urology
Nephrology
Nephropathy
Human anatomy
Kidney development