How Do We Know If Probiotic Therapy Is Working
Although measuring fecal samples before and after introducing probiotic therapy would be fantastic to see what positive changes ensue, unfortunately, this is impossible for many of us.
So how do we know if probiotic therapy is effective and beneficial?
There are several potential markers of success in the effectiveness of probiotics. Closely monitoring for improvements in gastrointestinal symptoms, lab changes, and even quality of life are all telltale signs that probiotics are benefiting our patients. Some of the improved GI symptoms to watch for include:
- Improved IBS symptoms
- Less gas or bloating
While there are considerable benefits to utilizing these available therapies, we cant overshadow the importance of a healthy balanced diet.
Taking a pill or powder cannot undo or improve the effects of a poor diet. Instead, the use of probiotics in addition to a healthy balanced diet full of fiber and prebiotics may result in significant improvements in kidney and gut health in our CKD patients!
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What Are The Different Types Of Kidney Transplants
There are two kinds of kidney transplants depending on who donates the new kidney.
A living-donor transplant is when someone gets a kidney from a person who is still alive and well. It’s usually from a relative or close friend, but sometimes strangers donate.
A is when people donate their kidneys for transplant after they die. This requires people who need kidneys to put their names on a waiting list until a donor is found.
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Risks For The Living Kidney Donor
A donated kidney from a living person is likely to remain healthy for longer than one from a deceased donor. However, there is some risk to the donor. The surgery lasts for about three hours and will be followed by a hospital stay of four or five days. The surgery can have complications, but people can usually resume their everyday lives after six to eight weeks.Donating a kidney is not likely to cause any long-term health problems, unless the remaining kidney becomes injured or diseased.
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Predisposing Factors For Utis After Rtx
Many factors are believed to contribute to the high incidence of UTI in RTx recipients. Some exist prior to transplant, including female gender, diabetes mellitus and underlying urinary tract abnormalities. Peri-transplant factors are often related to instrumentation of the urinary tract, including ureteral stenting and prolonged urinary catheterization. Additional risk factors contributing to UTI post-transplant include immunosuppression and graft dysfunction or rejection. It is noteworthy that so far no direct association has been found between the risk of UTI and dose or type of maintenance immunosuppression. It is the net state of immunosuppression that impairs host defense capability against infections in general. Various authors have suggested different potential UTI risk factors, and their findings are not always consistent. The potential pre-, peri- and post-transplant risk factors for UTI in RTx recipients are shown in Table 1.
| Pre-transplant |
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What Are Some Of The High
It is recommended to avoid foods that are spoiled, moldy or past its use by date, as well as avoid the foods listed below. If you have any questions, talk to your healthcare team.
Meat, fish and poultry
- Unpasteurized milk, cheese or yogurt
- Uncooked or undercooked eggs and any products containing them
Fruits and vegetables
- Grapefruit or grapefruit juice and pomegranate or pomegranate juice especially if you are taking cyclosporine or prograf
- Unwashed raw fruits and damaged fruits
- Unwashed raw vegetables and unwashed salads
- Unpasteurized juices or ciders
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Living With Transplant Recipients
A person who is living with a loved one who has contracted COVID-19 is at risk of also becoming infected. This is especially true for posttransplant patients.
Therefore, it is important for anyone to limit going into the public, especially if there is an active and expanding outbreak in their area, or if local and state authorities recommend remaining in place in an effort to maintain social distancing to help control the spread of the virus.
If people need to go into public, then they should take certain precautions, including limiting the time spent outside as much as possible, avoiding large crowds, and maintaining social distances . People with a kidney transplant should also consult with their healthcare team to find out what precautions should be taken by them and their caregivers. This might include additional hand washing/sanitizing, face coverings, or other measures.
Could Delayed Kidney Function Leading To Gut Dysfunction Favor Rejection
The structure of the gut microbiome is known to be altered in individuals with kidney disease . Investigations in humans and rat models have shown differences between the gut microbiome in uremic subjects with ESRD and healthy controls . The effect of renal transplantation has, however, not been extensively investigated. Renal dysfunction with increased serum urea leads to intestinal barrier dysfunction and disruption of the epithelial tight junction . Such disruptions allow bacterial fragments and toxins to translocate from the gut microbiome into the bloodstream, promoting chronic systemic inflammation whether this has a causal or exacerbating affect in co-morbidities associated with ESRD is unclear. After transplantation, there is some degree in variability as to how quickly the kidney allograft begins to function, although in recent years the incidence of delayed graft function has increased, possibly due to the use of expanded donor criteria, to within the range of 2045% of cases . Delayed graft function may expose the patient to a longer period of uremia and an increased risk of gut dysfunction, systemic inflammation, and allograft rejection. A delayed graft function of more than six days has been found to strongly decrease the long-term survival of transplanted kidneys .
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Risks And Benefits Of Living Kidney Donation
People who are considering becoming a kidney donor must carefully weigh the potential risks and benefits of donating a kidney.
Although the surgery itself is often a major component of this decision, other factors such as medical risks, the cosmetic result, and socioeconomic factors also play an important role in the decision-making process, as described in detail in this section.
What Should I Expect After My Kidney Transplant
Our patients are generally out of bed and eating the day after their transplant, with the support of our nursing team. We make sure to tell our patients that in addition to their immunosuppressant medicines which theyll take for the rest of their lives they may also receive antibiotics and pain relievers.
My advice is usually this: If youre feeling well and your body is accepting the new organ, you may be released from the hospital within a few days.
In the weeks and months after your procedure, youll have regular check-ups and blood tests to ensure youre healthy and your new kidney is functioning properly.
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Uremic Toxins Damage Your Gut And Kidneys
Lets start with uremic toxins. Probiotics may be helpful in reducing uremic toxins generated in your gut . .
You may or may not be familiar with the word uremia. Its been around since 1847 and a big deal with kidney disease. Uremia is more or less defined as urine in the blood.. Sounds gross, right?
Healthy working kidneys normally filter out something called uremic toxins, thus the word urine. Urea is one of the most well-known uremic toxins but there are many others. When the kidneys arent working at full capacity some uremic toxins stay in the blood and can damage the kidneys, heart, and bones .
Protein is the precursor of uremic toxins. Thus, when you eat protein some of it gets broken down into these uremic toxins. There are many uremic toxins, but I wrote about two of these in my recent post about kidney care and the gut. Uremic toxins normally are absorbed through the gut lining into the blood stream and then processed out through the kidneys.
What some scientists have found is that protein is not the only source of uremic toxins. Bacteria in the gut can produce uremic toxins. Bacteria can also eat uremic toxins. This is why the gut in kidney disease is so very important. The toxic load that is part of the progression of kidney disease can be modulated by the bacteria in the gut both for good and ill.
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The Oral Microbiome During Immunosuppression
There is a longstanding association between immunosuppressive agents and oral disease. Gingival hyperplasia, for example, has been associated with the immunosuppressant ciclosporin, and kidney-transplantation where bacteria-induced inflammation could be affected by transplant-driven microbiome changes . In a large study of kidney transplant patients, 60% had at least one type of oral mucosal ulcer . Similar studies indicate that these lesions are common in transplant or immunocompromised cohorts with causal links to oral microbiome constituents. Oral candidiasis is also more common in transplant recipients and immunosuppressed cohorts . Whether the overgrowth and increased prevalence of Candida spp. in this context is caused by failure of the immunocompromised host to maintain normal suppression of its growth, or a side effect of prophylactic antibiotic use , remains to be discerned.
Table 1 Summary of recent studies reporting microbiome-associated differences using kidney transplant recipient cohorts.
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Urinary Microbiome May Hold Key To Early Rejection Detection
Since the recognition of its medical relevance, the urinary microbiome has been receiving growing attention . The most frequently reported genera are Lactobacillus and Streptococcus, with Alloscardovia, Burkholderia, Jonquetella, Klebsiella, Saccharofermentans, Rhodanobacter, and Veillonella also found less frequently . Whilst the importance of the urinary microbiome in health is still emerging, evidence from several studies confirm its composition is altered by some post-transplant situations . A study comparing the urinary microbiome of 21 kidney transplant recipients with that of 8 healthy controls reported marked differences between the two groups . Under the multiple stressors of kidney transplantation the urinary microbiota of kidney-transplant recipients suggested an overall decrease in diversity when compared to healthy controls, alongside an increased abundance of opportunistic pathogens and may select for promotion of antibiotic resistance. The effect of elevated urinary urea concentrations on urinary tract infections caused by urealytic pathogens also warrants further investigation. In the future, frequent, longitudinal sampling of the patients urinary microbiome might be implemented to detect deviations from microbiome stability. If these changes are shown to precede organ damage or loss, this may be useful as a non-invasive method of early detection.
Are Dental Implants Suitable After A Kidney Transplant
Chronic kidney disease and renal failure is a major health problem worldwide. The issue is growing each year and causes major complications in international patients across the world. A majority of patients suffering from renal failure suffer from oral diseases and complications.
In such a case where kidney transplant patients suffer from irreversible dental issues, dental implants can be a life-changing treatment. However, due to complications in end-term renal failure such as infections, bone lesions, bleeding risks, and altered drug metabolism, dental implant treatment for renal failure patients on dialysis is more challenging.
At GoMedii, we support our international patients as not only a medical tourism partner but a medical treatment partner as well. India has made major strides in dental implants suitable for patients after kidney transplant treatments.
To get an instant appointment or consultation regarding dental implants suitable after kidney transplant in India, just drop us a query on our website or contact us on Whatsapp or email us at [email protected], regarding our services. Our team will get back to you as soon as possible.
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Who Might Need A Kidney Transplant
A kidney transplant may be an option if your kidneys have stopped working entirely. This condition is called end-stage renal disease or end-stage kidney disease . If you reach this point, your doctor is likely to recommend dialysis.
In addition to putting you on dialysis, your doctor will tell you if they think youre a good candidate for a kidney transplant.
Youll need to be healthy enough to have major surgery and tolerate a strict, lifelong medication regimen after surgery to be a good candidate for a transplant. You must also be willing and able to follow all instructions from your doctor and take your medications regularly.
If you have a serious underlying medical condition, a kidney transplant might be dangerous or unlikely to be successful. These serious conditions include:
- cancer, or a recent history of cancer
Your doctor may also recommend that you dont have a transplant if you:
- smoke
- drink alcohol in excess
- use illicit drugs
If your doctor thinks youre a good candidate for a transplant and youre interested in the procedure, youll need to be evaluated at a transplant center.
This evaluation usually involves several visits to assess your physical, psychological, and familial condition. The centers doctors will run tests on your blood and urine. Theyll also give you a complete physical exam to ensure youre healthy enough for surgery.
Kidney donors may be either living or deceased.
What Is Better Between A Live Donor And A Deceased Donor Transplant For The Recipient
- A kidney from a deceased donor has a 50% chance that it wont function initially which makes the postoperative course more complicated. With a live donor, the kidney will work properly from the initial stages about 90% percent of the time.
- The risk of rejection is less in live donor transplants.
- Long-term results are better in live donor transplants.
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Evaluation After Having Covid
You can still receive an evaluation after having COVID-19, but your healthcare team will need to tell you when you will be free from infection. Also, depending on your current health status and the impact of COVID-19 on hospital staff and supplies, your transplant may be delayed or postponed. You should discuss this with your transplant center.
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Donor And Recipient Characteristics
Donor characteristics are summarized in Table . The mean donor age, BMI, and pre-retrieval sCr level of the DKT group were 74.5yrs., 24.5kg/m2, and 2.1mg/dL, respectively which represented the highest values among groups . More donors of the ECD and DKT groups had diabetes or hypertension and died from cerebrovascular disease . The kidney donor profile index and kidney donor risk index were highest in the DKT group . Recipient characteristics are summarized in Table . The mean recipient age was 63.7yrs. in the DKT group, which was the highest among the groups . More diabetic recipients underwent DKT . Patients with a previous history of KT, panel reactive antigen over 50%, or DSAs were more prevalent in the SCD group . Mean cold ischemic times were not different among groups. Mean dialysis duration before KT in the DKT group was shorter than in the ECD group , although the difference was not statistically significant .
Table 1 Donor characteristics
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Financial Aspects Of Living Donation
Many potential kidney donors have questions regarding the financial impact of becoming a donor. There will be both covered expenses and non-covered expenses associated with evaluation and donation that potential donors need to consider carefully.
Covered Expenses
The insurance of the intended recipient of your kidney covers the testing needed to see whether or not you can be a donor as well as the surgery and hospitalization needed for the kidney donation.
In general, some follow-up/post-operative care is covered, but not all. The extent of covered follow-up care will vary depending on your recipient’s insurance.
Non-Covered Expenses
In general, the following expenses are not covered by insurance, so should be considered “out-of-pocket” costs:
- Travel and hotel stay
- Elder care
- Follow-up costs
- Lost wages )
- Federal Employees 30 days paid leave for organ donation
- American Society of Transplantation’s list of organizations that provide paid leave
How Will I Pay For A Transplant
Medicare covers about 80% of the costs associated with an evaluation, transplant operation, follow-up care, and anti-rejection medicines. Private insurers and state programs may cover some costs as well. However, your post-transplant expenses may only be covered for a limited number of years. Its important to discuss coverage with your social worker, who can answer your questions or direct you to others who can help.
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Who Can Have A Kidney Transplant
Most people who need a kidney transplant are able to have one, regardless of their age, as long as:
- they’re well enough to withstand the effects of surgery
- the transplant has a relatively good chance of success
- the person is willing to comply with the recommended treatments required after the transplant such as taking immunosuppressant medication and attending regular follow-up appointments
Reasons why it may not be safe or effective to perform a transplant include having an ongoing infection , severe heart disease, cancer that has spread to several places in your body, or AIDS.
What Happens After A Kidney Transplant
After kidney transplant surgery, your child will spend a few days in the hospital to recover. The health care team will watch closely to make sure there are no complications from the surgery, such as bleeding or infection.
You and your child will learn about the medicines needed to keep the body from rejecting the new kidney. These are called immunosuppressants. Taking them can make your child more likely to get infections, especially in the days right after surgery. So keep your child away from sick people, and have everyone at home wash their hands well and often.
For the first couple of months after surgery, you’ll see the doctor often to make sure the new kidney is working well. If your child gets a fever or soreness in the area of the transplant, tell a doctor right away. These could be signs that the body isn’t accepting the new kidney or that your child has an infection.
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