Renal transplant Health Dictionary

Relating to the kidneys... renal

See HYPERNEPHROMA.... renal cell carcinoma

The procedure by which malignant or defective bone marrow in a patient is replaced with normal bone marrow. Sometimes the patient’s own marrow is used (when the disease is in remission); after storage using tissue-freezing technique (cryopreservation) it is reinfused into the patient once the diseased marrow has been treated (autologous transplant). More commonly, a transplant uses marrow from a donor whose tissue has been matched for compatibility. The recipient’s marrow is destroyed with CYTOTOXIC drugs before transfusion. The recipient is initially nursed in an isolated environment to reduce the risk of infection.

Disorders that can be helped or even cured include certain types of LEUKAEMIA and many inherited disorders of the immune system (see IMMUNITY).... bone marrow transplant

A procedure in which cells – for example, from the pancreas – are taken from an aborted FETUS and then transplanted into the malfunctioning organ (pancreas) of an individual with a disorder of that organ (in this case, diabetes). The cells from the fetus are intended to take over the function of the host’s diseased or damaged cells. Fetal brain cells have also been transplanted into brains of people suffering from PARKINSONISM. These treatments are at an experimental stage.... fetal transplant

See KIDNEYS.... renal tubule

Transplantation of tissues or organs of the body are de?ned as an allotransplant, if from another person; an autotransplant, if from the patient him or herself – for example, a skin graft (see GRAFT; SKIN-GRAFTING); and a xenotransplant, if from an animal.

The pioneering success was achieved with transplantation of the kidney in the 1970s; this has been most successful when the transplanted kidney has come from an identical twin. Less successful have been live transplants from other blood relatives, while least successful have been transplants from other live donors and cadaver donors. The results, however, are steadily improving. Thus the one-year functional survival of kidneys transplanted from unrelated dead donors has risen from around 50 per cent to over 80 per cent, and survival rates of 80 per cent after three years are not uncommon. For a well-matched transplant from a live related donor, the survival rate after ?ve years is around 90 per cent. And, of course, if a transplanted kidney fails to function, the patient can always be switched on to some form of DIALYSIS. In the United Kingdom the supply of cadaveric (dead) kidneys for transplantation is only about half that necessary to meet the demand.

Other organs that have been transplanted with increasing success are the heart, the lungs, the liver, bone marrow, and the cornea of the eye. Heart, lung, liver and pancreas transplantations are now carried out in specialist centres. It is estimated that in the United Kingdom, approximately 200 patients a year between the ages of 15 and 55 would bene?t from a liver transplant if an adequate number of donors were available. More than 100 liver transplants are carried out annually in the United Kingdom and one-year-survival rates of up to 80 per cent have been achieved.

The major outstanding problem is how to prevent the recipient’s body from rejecting and destroying the transplanted organ. Such rejection is part of the normal protective mechanism of the body (see IMMUNITY). Good progress has been made in techniques of tissue-typing and immunosuppression to overcome the problem. Drugs are now available that can suppress the immune reactions of the recipient, which are responsible for the rejection of the transplanted organ. Notable among these are CICLOSPORIN A, which revolutionised the success rate, and TACROLIMUS, a macrolide immunosuppressant.

Another promising development is antilymphocytic serum (ALS), which reduces the activity of the lymphocytes (see LYMPHOCYTE) cells which play an important part in maintaining the integrity of the body against foreign bodies.

Donor cards are now available in all general practitioners’ surgeries and pharmacies but, of the millions of cards distributed since 1972, too few have been used. The reasons are complex but include the reluctance of the public and doctors to consider organ donation; poor organisation for recovery of donor kidneys; and worries about the diagnosis of death. A code of practice for procedures relating to the removal of organs for transplantation was produced in 1978, and this code has been revised in the light of further views expressed by the Conference of Medical Royal Colleges and Faculties of the United Kingdom on the Diagnosis of Brain Death. Under the Human Tissue Act 1961, only the person lawfully in possession of the body or his or her designate can authorise the removal of organs from a body. This authorisation may be given orally.

Patients who may become suitable donors after death are those who have suffered severe and irreversible brain damage – since such patients will be dependent upon arti?cial ventilation. Patients with malignant disease or systemic infection, and patients with renal disease, including chronic hypertension, are unsuitable.

If a patient carries a signed donor card or has otherwise recorded his or her wishes, there is no legal requirement to establish lack of objection on the part of relatives – although it is good practice to take account of the views of close relatives. If a relative objects, despite the known request by the patient, sta? will need to judge, according to the circumstances of the case, whether it is wise to proceed with organ removal. If a patient who has died is not known to have requested that his or her organs be removed for transplantation after death, the designated person may only authorise the removal if, having made such reasonable enquiry as may be practical, he or she has no reason to believe (a) that the deceased had expressed an objection to his or her body being so dealt with after death, or (b) that the surviving spouse or any surviving relative of the deceased objects to the body being so dealt with. Sta? will need to decide who is best quali?ed to approach the relatives. This should be someone with appropriate experience who is aware how much the relative already knows about the patient’s condition. Relatives should not normally be approached before death has occurred, but sometimes a relative approaches the hospital sta? and suggests some time in advance that the patient’s organs might be used for transplantation after death. The sta? of hospitals and organ exchange organisations must respect the wishes of the donor, the recipient and their families with respect to anonymity.

Relatives who enquire should be told that some post-mortem treatment of the donor’s body will be necessary if the organs are to be removed in good condition. It is ethical (see ETHICS) to maintain arti?cial ventilation and heartbeat until removal of organs has been completed. This is essential in the case of heart and liver transplants, and many doctors think it is desirable when removing kidneys. O?cial criteria have been issued in Britain to recognise when BRAIN-STEM DEATH has occurred. This is an important protection for patients and relatives when someone with a terminal condition

– usually as a result of an accident – is considered as a possible organ donor.... transplantation

A condition in which the kidneys are unable to excrete normal amounts of acid made by the body.

The blood is more acidic than normal, and the urine less acidic.

Causes include kidney damage due to disease, drugs, or a genetic disorder; but in many cases the cause is unknown.

The acidosis may result in osteomalacia, kidney stones (see calculus, urinary tract), nephrocalcinosis, and hypokalaemia (an abnormally low level of potassium in the blood).... renal tubular acidosis

The insertion of a piece of bone from another site or from another person to ?ll a defect, provide supporting tissue, or encourage the growth of new bone.... bone transplant

An operation in which a patient’s diseased lungs and heart are removed and replaced with donor organs from someone who has been certi?ed as ‘brain dead’ (see BRAIN-STEM DEATH). As well as the technical diffculties of such an operation, rejection by the recipient’s tissues of donated heart and lungs has proved hard to overcome. Since the early 1990s, however, immunosuppressant drug therapy (see CICLOSPORIN; TRANSPLANTATION) has facilitated the regular use of this type of surgery. Even so, patients receiving transplanted hearts and lungs face substantial risks such as lung infection and airway obstruction as well as the long-term problems of transplant rejection.... heart-lung transplant

UK legislation that lays down the framework and rules governing organ transplantation. The UK Transplant Support Service Authority (UKTSSA), a special health authority set up in 1991, is responsible for administering the NHS Organ Donor Registry and the Act (see APPENDIX 7: STATUTORY ORGANISATIONS).... human organs transplants act

See TRANSPLANTATION.... organ transplantation

These have almost completely replaced BONE MARROW TRANSPLANT, used to treat malignancies such as LEUKAEMIA and LYMPHOMA for the past 20 years. The high doses of CHEMOTHERAPY or RADIOTHERAPY used to treat these diseases destroy the bone marrow which contains stem cells from which all the blood cells derive. In 1989 stem cells were found in the blood during recovery from chemotherapy. By giving growth factors (cytokines), the number of stem cells in the blood increased for about three to four days. In a peripheral-blood stem-cell transplant, these cells can be separated from the peripheral blood, without a general anaesthetic. The cells taken by either method are then frozen and returned intravenously after the chemotherapy or radiotherapy is completed. Once transplanted, the stem cells usually take less than three weeks to repopulate the blood, compared to a month or more for a bone marrow transplant. This means that there is less risk of infection or bleeding during the recovery from the transplant. The whole procedure has a mortality risk of less than 5 per cent – half the risk of a bone marrow transplant.... peripheral-blood stem-cell transplants

Calculi relating to kidney... renal calculi

See KIDNEYS, DISEASES OF.... renal diseases

Inefficient functioning of the kidney, leading to death unless acute medical attention is available. Envenomation (especially snake bite) is a common cause, as well as a range of medical conditions, including infection..... renal failure (acute)

Before the advent of small-bowel transplants, long-term intravenous feeding (total parenteral nutrition or TPN) was the last option for patients with chronic intestinal failure. Most recipients are children, and small-bowel transplantation is currently reserved for patients unable to continue on long-term parenteral nutrition. The main constraints to small-bowel transplantation are the intensity of rejection (necessitating high levels of immunosuppression), and the lack of donors who are the same size as the recipient (a particular problem for children).... small-bowel transplantantion

In the UK, this NHS authority (UKTSSA) provides a 24-hour service for matching, allocating and distributing organs. It is also responsible for keeping the records of all patients awaiting transplants. Established in 1991, the authority allocates donor organs without favour, following protocols set by advisory groups. It also administers the Human Organ Transplant Act on behalf of the Department of Health. (See TRANSPLANTATION.)... transplant support services authority

See corneal graft.... corneal transplant

See kidney biopsy.... renal biopsy

Spasms of severe pain on one side of the back, usually caused by a kidney stone (see calculus, urinary tract) passing down the ureter.

There may also be nausea, vomiting, sweating, and blood in the urine.

Treatment is usually with bed rest, plenty of fluids, and injections of an analgesic drug, such as pethidine.... renal colic

See kidney failure.... renal failure

acute kidney injury (see AKI).... acute renal failure

a disease associated with diffuse atherosclerosis and sloughing of atheromatous plaques in the aorta and main renal arteries. This results in occlusion of smaller arteries and arterioles downstream within the kidney, with ischaemic and inflammatory reactions. This leads to the onset of renal impairment. Precipitating factors include invasive procedures with aortic cannulae, vascular surgery, and therapy with thrombolytics or anticoagulants. Less commonly the condition can occur spontaneously.... atheroembolic renal disease

 Oedema. Hydrops. Not a disease but a condition. An abnormal accumulation of fluid in a body cavity or beneath the skin. Due to weakened walls of capillaries caused by circulating toxins obstructing the flow of blood or lymph. Gross oedema of nephrotic syndrome associated with low plasma protein level and high proteinuria.

Renal dropsy is worse in the early morning, with loose tissues under the eyes.

Treatment. When fluid rapidly collects it may have to be aspirated (drawn off) but before this stage is reached herbal diuretics and cardiac tonics have much to offer. In acute conditions, sweat glands should be stimulated by suitable diaphoretics to assist elimination of excess fluid through the skin. Attention to the bowels is important; a timely copious bowel action greatly assisting elimination. A well-known diuretic for dropsy is Juniper, 3 to 5 drops taken in honey 2 or 3 times daily.

Alternatives. Teas. (Simple infusions): Agrimony, Bearberry, Boldo, Boneset, Borage, Buchu, Celery seed, Clivers, Corn Silk, Dandelion leaves, Parsley leaves, Elderflowers, Bogbean, Heartsease, Lime flowers, Parsley Piert, Pellitory, Plantain, Sea Holly, Wild Carrot, Yarrow.

Decoctions. Broom tops, Lovage, Burdock root, Couchgrass, Dandelion root, Juniper berries, Blue Flag root.

Bean Cure (Phaseolus vulgaris). 1 tablespoon kidney (haricot) bean pods, sliced, in cup water simmered gently for 5 minutes. 1 cup morning and mid-day.

Sassafras root. An old Swedish colonist of the late 18th century related how his mother cured many cases of dropsy with a decoction of Sassafras root. (American Indian Medicine. Virgil Vogel, p.363) Of historic interest only, this root is no longer used in herbal practice.

Tablets/capsules. Buchu. Dandelion. Juniper. Celery. Garlic. Blue Flag.

Powders. Equal parts: Buchu, Dandelion root, Stone root, Senna leaf. Mix. Dose: 500-750mg (2 × 3 × 00 capsules or one-third to half a teaspoon) thrice daily.

Liquid Extracts. Equal parts: Buchu, Clivers, Blue Flag. Mix. 30-60 drops, thrice daily.

Practitioner. Alternatives with a record of efficacy. Tinctures.

Formula 1. Burdock, 20ml; Buchu, 20ml; Bearberry, 20ml; Aqua to 100ml. Dose: 5ml 3 times daily in water.

Formula 2. Juniper, 10ml; Buchu, 20ml; Broom, 10ml; Dandelion, 10ml. Aqua to 100ml. Dose: 5ml, 3 times daily, in water.

Topical. Poultice over kidney area: quarter of an ounce Irish Moss gently simmered in half a pint water to a jellied mass and applied on linen or suitable material to the small of the back. Repeat 2 or 3 times with fresh hot poultices.

Diet. High protein, low salt. Fresh conservatively-cooked vegetables, polyunsaturated oils. Bottled or spring water.

Supplementation. Vitamin A, B-complex, B1, B6, C, E, Potassium.

General. Elevation of affected limbs above level of abdomen.

This condition should be treated by or in liaison with a qualified medical practitioner. ... dropsy, renal

A cosmetic operation in which hairy sections of scalp are removed and transplanted to hairless areas to treat alopecia (baldness). There are several different techniques.

In strip grafting, a strip of skin and hair is taken from a donor site, usually at the back of the scalp or behind the ears. The removed hairs and their follicles are then inserted into numerous incisions made in a bald area, known as the recipient site. The procedure usually takes 60–90 minutes. The patient is given a mild sedative and anaesthetic on the donor and recipient sites. The donor site heals in about 5 days. Transplanted hairs fall out shortly afterwards, but new hairs grow from the follicles 3 weeks to 3 months later.

Other transplant techniques include punch grafting, in which a punch is used to remove small areas of bald scalp, which are replaced with areas of hairy scalp; flap grafting, in which flaps of hairy skin are lifted, rotated, and stitched to replace bald areas; and male pattern baldness reduction, which involves cutting out areas of bald skin and stretching surrounding areas of hair-bearing scalp to replace them.... hair transplant

Replacement of a patient’s damaged or diseased heart with a healthy heart taken from a donor at the time of death. Typically, transplant patients have advanced coronary artery disease or cardiomyopathy. During the operation, the function of the heart is taken over by a heart–lung machine.

Most of the diseased heart is removed, but the back walls of the atria (upper chambers) are left in place.

The ventricles (upper chambers) are then attached to the remaining areas of the recipient’s heart.

Once the immediate post-operative period is over, the outlook is good.

Patients face the long-term problems associated with other forms of transplant surgery.

(See also heart–lung transplant.)... heart transplant

(ESRF, CKD 5) the most advanced stage of kidney failure, which is reached when the *glomerular filtration rate (GFR) falls to 15 ml/min (normal GFR = 100 ml/min).... end-stage renal failure

see orthotopic transplantation.... heterotopic transplantation

a new technique still under evaluation for curing type 1 *diabetes mellitus, which involves the injection of donated cells from the pancreatic *islets of Langerhans into the liver, where it is hoped they will seed and survive. The transplanted cells then take over insulin production from the recipient’s diseased pancreas.... islet cell transplantation

acute kidney injury caused by myoglobin that is released from damaged skeletal muscle (*rhabdomyolysis). This is usually the result of trauma and the condition was first recognized in victims trapped and crushed during the London Blitz. Muscle injury can also occur with pressure necrosis, particularly in the unconscious or immobile patient, or with a *compartment syndrome. Rarely it may complicate intensive muscular exercise or extensive viral myositis and it is a recognized complication of modest overexertion in some inherited disorders of muscle metabolism, such as *McArdle’s disease.... myoglobinuric acute renal failure

(NHSBT) a *special health authority established in 2005 to provide a safe and reliable supply of blood, organs, stem cell services, and diagnostics to hospitals. NHSBT also provides specialist therapeutic apheresis services, which remove or replace a single component of blood (e.g. malignant white cells or low-density lipoprotein), at six sites in England.

NHS Blood and Transplant website... nhs blood and transplant

Replacement of a diseased liver with a healthy liver removed from a donor. Liver transplants are most successful in the treatment of advanced liver cirrhosis in people with chronic active hepatitis or primary biliary cirrhosis. People who have primary liver cancer are rarely considered for transplantation because there is a high risk that the tumour will recur.During this procedure, the liver, gallbladder, and portions of the connected blood and bile vessels are removed.

The donor organs and vessels are connected to the recipient’s vessels.

After the transplant, the recipient is monitored in an intensive care unit for a few days and remains in hospital for up to 4 weeks.... liver transplant

Replacement of a diseased organ or tissue with a healthy, living substitute. The organ is usually taken from a person who has just died. Some kidneys are transplanted from a patient’s living relatives (see organ donation). The results of surgery have also been improved by testing for histocompatibility antigens and tissue-typing.

Rejection is a major problem. However, a combination of a corticosteroid drug and ciclosporin are given in order to suppress this response.

Every patient who undergoes an organ transplant operation must take immunosuppressant drugs indefinitely. (See also heart transplant; heart–lung transplant; liver transplant; kidney transplant.)... transplant surgery

transplantation of a donor organ or tissue (usually the liver) into a recipient at the site where the recipient’s organ has been removed. In contrast, heterotopic transplantation involves the preservation of the recipient’s organ in its natural site and the addition of the donor organ at another site.... orthotopic transplantation

either of two large arteries arising from the abdominal aorta and supplying the kidneys. Each renal artery divides into an anterior and a posterior branch before entering the kidney.... renal artery

tests for assessing the function of the kidneys. These include measurements of the specific gravity of urine, creatinine *clearance time, and blood urea levels; intravenous urography; and renal angiography.... renal function tests

see osteodystrophy.... renal osteodystrophy

see transplantation.... renal transplantation