When Do I Have To Start Dialysis
For most people, the need for dialysis comes on slowly. Symptoms, such as losing your desire to eat and losing muscle, may begin so slowly that you dont notice them. Many people start dialysis when their kidney function is between 5 and 10. When kidney function is this low, you may have symptoms from kidney failure and starting dialysis may help relieve them. Starting dialysis can help you regain your appetite and maintain your strength, which is harder to rebuild than it is to retain. Your health care provider can help you decide the best time to begin treatment.
Laparoscopic Nephrectomy And Robotic
These approaches to the operation are done through several small incisions instead of one large one. If a radical nephrectomy is needed, many doctors and patients now prefer to use these approaches when they can.
Laparoscopic nephrectomy: Special long instruments are inserted through the incisions, each of which is about 1/2-inch long, to remove the kidney. One of the instruments, the laparoscope, is a long tube with a small video camera on the end. This lets the surgeon see inside the abdomen. Usually, one of the incisions has to be made longer in order to remove the kidney .
Robotic-assisted laparoscopic nephrectomy: This approach uses a robotic system to do the laparoscopic surgery remotely. The surgeon sits at a panel near the operating table and controls robotic arms to operate. For the surgeon, the robotic system may allow them to move the instruments more easily and with more precision than during standard laparoscopic surgery. But the most important factor in the success of either type of laparoscopic surgery is the surgeons experience and skill. This is a difficult approach to learn. If you are considering this type of operation, be sure to find a surgeon with a lot of experience.
Special Programs For Living Donor Transplantation
Many patients have relatives or non-relatives who wish to donate a kidney but are not able to because their blood type or tissue type does not match. In such cases, the donor and recipient are said to be “incompatible.”
See also: National Kidney Registry
Live Donor to Deceased Donor Waiting List Exchange
This program is a way for a living donor to benefit a loved one, even if their blood or tissue types do not match. The donor gives a kidney to another patient who has a compatible blood type and is at the top of the kidney waiting list for a “deceased donor” kidney. In exchange, that donor’s relative or friend would move to a higher position on the deceased donor waiting list, a position equal to that of the patient who received the donor’s kidney.
For example, if the donor’s kidney went to the fourth patient on the deceased donor waiting list, the recipient would move to the fourth spot on the list for his or her blood group and would receive kidney offers once at the top of the list.
Paired Exchange Kidney Transplant
This program is another way for a living donor to benefit a loved one even if their blood or tissue types do not match. A “paired exchange” allows patients who have willing but incompatible donors to “exchange” kidneys with one another-the kidneys just go to different recipients than usually expected.
That means that two kidney transplants and two donor surgeries will take place on the same day at the same time.
Blood Type Incompatible Kidney Transplant
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How Might My Life Change After My Kidney Is Removed
People who have only one kidney after a nephrectomy need ongoing care to monitor kidney function. You will need urinalysis and blood tests at least once a year.
You will also have to stay away from activities that increase your risk of kidney injury. For example, you should avoid high-contact sports such as hockey, football or wrestling.
A note from Cleveland Clinic
During a nephrectomy, surgeons remove all or part of your kidney. Healthcare providers may use nephrectomy to remove a tumor or remove a kidney for donation. While most people are born with two kidneys, you can usually function well with only one. You should be able to return to normal activities about six weeks after surgery. After nephrectomy, you’ll need follow-up care to keep an eye on the function of your remaining kidney.
Last reviewed by a Cleveland Clinic medical professional on 05/02/2021.
References
When To Call The Doctor
- You have a temperature above 100.5°F
- Your surgical wounds are bleeding, are red or warm to the touch, or have a thick, yellow, green, or milky drainage
- Your belly swells or hurts
- You have nausea or vomiting for more than 24 hours
- You have pain that does not get better when you take your pain medicines
- It is hard to breathe
- You have a cough that does not go away
- You cannot drink or eat
- You cannot pee
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What Questions Should I Ask About Peritoneal Dialysis
You may want to ask your health care provider these questions:
- Is peritoneal dialysis the best treatment choice for me? Why? If yes, which type is best?
- What type of training do I need, and how long will it take?
- What does peritoneal dialysis feel like?
- How will peritoneal dialysis affect my ____ ?
- Will I be able to keep working?
- Will I be able to care for my children?
- How much should I exercise?
- Where do I store supplies?
- How often do I see my doctor?
- Who will be on my health care team? How can the members of my health care team help me?
- Who do I contact if I have problems?
- Who can I talk with about finances, sex, or family concerns?
- Can I talk with someone who is on peritoneal dialysis?
Learn about peritoneal dialysis.
How The Kidneys Work
The kidneys are like the body’s garbage collection and disposal system. Through microscopic units called nephrons, the kidneys remove waste products and extra water from the food a person eats, returning chemicals the body needs back into the bloodstream. The extra water combines with other waste to become urine, which flows through thin tubes called ureters to the bladder, where it stays until it exits through the urethra when someone goes to the bathroom.
The kidneys also produce three important hormones:
- erythropoietin, which stimulates the bone marrow to make red blood cells
- renin, which helps regulate blood pressure and
- the active form of vitamin D, which helps control the calcium balance in the body and maintain healthy bones.
Kidney failure, which is also called renal failure, is when the kidneys slow down or stop properly filtering wastes from the body, which can cause buildups of waste products and toxic substances in the blood. Kidney failure can be acute or chronic .
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Obstructive Kidney Stones: What You Need To Know
Obstructing stones cause blockage in the urinary system and can be potentially dangerous. Obstructing stones usually, but not always, cause symptoms. Obstruction can be complete or partial. Symptoms are typically more severe with complete obstruction but occasionally even patients with large stones and complete obstruction do not have much pain but only some discomfort.
Most commonly obstructing stones are located in the ureter. Obstructing ureteral stones can also occur at UPJ and in the kidneys.
Stones can also be partially obstructing or intermittently obstructing. This is likely the explanation for intermittent pain the severity of obstruction increases as stone moves and leads to pain. If it moves and becomes less obstructing, pain subsides.
Obstructing stones can lead to severe infection and renal failure. Stones associated with infection or renal failure require prompt treatment.
The presence of obstructing stones in both ureters concurrently, although rare, is a urological emergency as it can lead to acute renal failure because of the inability to pass urine. ESWL cannot be performed in patients with an obstructing stone and signs of infection .
What Are The Treatments For Kidney Cancer
Once you have a diagnosis and know your stage of kidney cancer, you and your doctor can plan treatment. You may want to gather information to help you feel more informed about your decision. Your doctor may refer you to a specialist for treatment. This could include an urologist, a medical or radiation oncologist, or a surgeon. Before beginning treatment, many people find it helpful to get a second opinion about the diagnosis of kidney cancer and the treatment plan.
Kidney cancer is one of the more common cancers to undergo spontaneous regression, in which it may return to an eralier stage. However, the incidence is quite low .
There are several standard types of treatment for kidney cancer. In most cases, surgery is the first step. Even if surgery removes the entire tumor, though, your doctor may suggest an extra treatment to kill any remaining cancer cells that can’t be seen.
Surgery for kidney cancer
These are the main types of surgery for kidney cancer. Which type you have depends on how advanced your cancer is.
You can survive with just a part of one kidney as long as it is still working. If the surgeon removes both kidneys or if both kidneys are not working, you will need a machine to clean your blood or a new kidney . A transplant is possible if your cancer was found only in your kidney and a donated kidney is available.
If surgery can’t remove your kidney cancer, your doctor may suggest another option to help destroy the tumor.
Biologic therapy for kidney cancer
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What Are The Basics About Conservative Management
Conservative management for kidney failure means that your health care team continues your care without dialysis or a kidney transplant. The focus of care is on your quality of life and symptom control.The decision to start dialysis is yours. For most people, dialysis may extend and improve quality of life. For others who have serious conditions in addition to kidney failure, dialysis may seem like a burden that only prolongs suffering.
You have the right to decide how your kidney failure will be treated. You may want to speak with your family, doctor, counselor, or renal social workerwho helps people with kidney diseaseto help you make this decision.
If you decide not to begin dialysis treatments, you may live for a few weeks or for several months, depending on your health and your remaining kidney function. Many of the complications of kidney failure can be treated with medicines, but only dialysis or transplant can filter wastes from your blood. As your kidney function declines, you may want to consider adding hospice, or end-of-life, care. You can have hospice care in a facility or at home. The hospice program is designed to meet end-of-life physical and emotional needs. Hospice care focuses on relieving pain and other symptoms.
Why 3 Kidneys Can Be Better Than 1
Q. My brother is having a kidney transplant because he has polycystic kidneys. They will add the new kidney in a different spot. His kidneys are very enlarged, but they won’t be removed from his body. Why not?
A. In most cases, even for patients with polycystic kidney disease, which is a genetic disorder that causes the formation and growth of cysts in the kidneys, surgeons don’t remove the person’s own kidneys during kidney transplantation. Instead, the surgeon usually places the new kidney in the lower abdomen. The blood vessels of the new kidney are attached to blood vessels in the lower part of the abdomen, just above the leg. The new ureter, the tube through which urine flows out of the kidney, is connected to the bladder.
In some cases, surgeons may have to remove the native kidneys. For patients with polycystic kidney disease, for example, this removal may be necessary because of significant pain or discomfort, recurrent infection, bleeding from or into the kidney cysts, or extremely large kidneys that prevent a kidney transplant. Evidently your brother’s kidneys, though enlarged, do not pose this problem.
— Patrick Dean, MD, transplantation surgery, Mayo Clinic, Rochester, Minn.
Eye emergencies
If you get a foreign object in your eye, don’t rub the eye. Try to flush the object out with clean water or saline solution.
Seek emergency help if:
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Life Expectancy After Kidney Removal
Life expectancy after kidney removal can vary. The answer is also dependent on several factors. But overall, the prognosis is pretty good. Another thing to remember that there is no any statistic or data that can tell you exactly what will happen each case is unique!
Nephrectomy is a common term used to call surgery that removes part or all of a kidney. And there are a number of reasons why some people need to take this kind of surgery.
Care Of The Remaining Kidney
Tests will be done on a regular basis to check how well the remaining kidney is working. A urinalysis and blood pressure check should be done every year, and kidney function tests should be checked every few years . Regular urine tests for protein should be performed as well. The presence of protein in the urine may mean that the kidney has some damage.
People with one kidney should avoid sports that involve higher risks of heavy contact or collision. This includes, but is not limited to, boxing, field hockey, football, ice hockey, lacrosse, martial arts, rodeo, soccer and wrestling. This may also include extreme activities such as skydiving. Anyone with a single kidney who decides to participate in these sports should be extra careful and wear protective padding. He or she should understand that losing the remaining kidney is a very serious situation.
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What Happens During A Kidney Transplant
A kidney transplant requires a stay in a hospital. Procedures may varydepending on your condition and your healthcare provider’s practices.
Generally, a kidney transplant follows this process:
You will remove your clothing and put on a hospital gown.
An intravenous line will be started in your arm or hand. More catheters may be put in your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples. Other sites for catheters include under the collarbone area and the groin blood vessels.
If there is too much hair at the surgical site, it may be shaved off.
A urinary catheter will be inserted into your bladder.
You will be positioned on the operating table, lying on your back.
Kidney transplant surgery will be done while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure.
The anesthesiologist will closely watch your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin over the surgical site will be cleansed with an antiseptic solution.
The healthcare provider will make a long incision into the lower abdomen on one side. The healthcare provider will visually inspect the donor kidney before implanting it.
The renal artery and vein of the donor kidney will be sewn to the external iliac artery and vein.
The donor ureter will be connected to your bladder.
Who Performs A Nephrectomy
The following specialists perform a nephrectomy:
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Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs.
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Pediatric urologists specialize in diseases and conditions of the urinary tract and male reproductive organs in infants, children and adolescents.
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Transplant surgeons specialize in transplant surgery of the kidney, liver, pancreas, and other organs.
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What Causes Kidney Failure
Kidney failure may occur from an acute situation that injures the kidneys or from chronic diseases that gradually cause the kidneys to stop functioning.
In acute renal failure, kidney function is lost rapidly and can occur from a variety of insults to the body. Since most people have two kidneys, both kidneys must be damaged for complete kidney failure to occur. Fortunately, if only one kidney fails or is diseased it can be removed, and the remaining kidney may continue to have normal kidney function. If both patient’s kidneys are injured or diseased, a donor kidney may be transplanted.
The list of causes of kidney failure is often categorized based on where the injury has occurred.
Prerenal causes causes are due to decreased blood supply to the kidney. Examples of prerenal causes of kidney failure are:
- Hypovolemia due to blood loss
What Happens When Your Kidneys Fail
Kidneys act as a natural filter for all the waste products produced in the body, they also help to regulate the fluid and electrolyte balance. They help to keep the blood pressure within normal limits and secrete a hormone which helps in red blood cell production.
When kidneys fail to perform their normal function, the waste products accumulate in the blood and the fluid balance is disturbed, this is termed as kidney failure on ESRD , which can happen gradually or suddenly. People with ESRD need dialysis or transplant to sustain life.
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What Is The Difference Between A Laparoscopic And Open Surgery
Surgeons use two different techniques for nephrectomies. A laparoscopic nephrectomy uses a small tool with a camera and a few tiny incisions. In a robotic-assisted laparoscopic case, a surgical robot is controlled by the surgeon to manipulate these small tools. An open nephrectomy uses one large incision. Surgeons view directly inside the body and do not use a camera.
Laparoscopic nephrectomy may lead to shorter hospital stays and quicker recovery times. However, surgeons may use open surgery if laparoscopic surgery is not an option. For example, laparoscopic surgery often requires longer periods under anesthesia. Some people may not respond well to being under anesthesia for long periods. Also, others may have a large kidney tumor for which these minimally-invasive techniques may not be the best choice. In these cases, an open approach could be safer.