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Since the mid-nineteenth century, when Richard Bright first wrote about a patient with terminal kidney failure, until the early sixties of this century, there was little hope for patients with renal insufficiency.

Kidney dialysis, as a new method of treatment, has saved the lives of hundreds of thousands of people with kidney insufficiency. Kidney dialysis continues to be improved to the extent that it not only allows patients to live longer but also to rehabilitate and live a better quality of life.

However, dialysis cannot completely replace all the complex functions of the kidneys.

Although kidney dialysis represents a way to help these organs properly filter all toxins we consume through food and drink, its long-term use becomes a "double-edged sword" – affecting other organs, such as bones and muscles, adversely.

For this and many other reasons, many people opt for radical measures such as kidney transplantation. It is generally accepted that a successful kidney transplant offers the highest quality of life for patients with terminal renal insufficiency.

However, before we move on to the topic of transplantation itself, let's get to know better the functions that the kidneys perform and what role they play in maintaining normal life.

Kidneys – the filter without which we cannot live

The kidneys are two relatively small organs in the lower back, and they are composed of nearly 2 million tiny units, scientifically known as nephrons. The basic functions of the kidneys are the excretion of waste metabolic products, removal of excess water and electrolytes, regulation of blood acidity, and regulation of blood pressure – essentially removing all harmful fluids from our body as urine.

The kidneys also function as a blood filter. Through them, every minute, one-fifth of the blood pumped by the heart passes. They also secrete hormones involved in the formation of red blood cells, calcium, and phosphorus.

Approximately 180 liters of fluid pass through the kidneys daily!

Most of the fluid filtered by the kidneys is returned to the blood through small tubes (tubules) for other useful processes, while the "waste" fluid is directed to the bladder.

The kidneys can maintain balance in the body quite well even when performing only about fifteen percent of their normal function, but when this function decreases to 10% or less – terminal renal insufficiency occurs.

Terminal Renal Insufficiency and its Treatment

As a result of the kidneys' inability to excrete toxic substances into the urine, these harmful metabolic products accumulate in the blood, which has serious health consequences. Symptoms that occur and indicate kidney weakness include:

• Rapid fatigue
• Chest pain
• Loss of appetite
• Altered taste in food
• Itching and/or bruising
• Swelling in the body
• Cramps
• Nausea and vomiting
• Significant reduction in sexual function

In the early stages of many kidney diseases, symptoms can often be very sparse, and physical examinations may often be normal. Only detailed examinations and specific laboratory and radiological tests can reveal the presence of kidney disease. Today, there are three methods available for treating terminal renal insufficiency:

1. Hemodialysis – blood purification using special machines and filters
2. Peritoneal dialysis – kidney dialysis through the abdominal membrane
3. Transplantation, or kidney grafting

All three methods are complementary, and a patient during treatment usually uses two methods successively, and rarely all three methods of treatment. In the following text, we will address one of the most effective yet not radical methods of treating kidney diseases, which is transplantation.

Kidney Biopsy as the Ultimate Diagnostic Tool

A kidney biopsy is essential for timely diagnosis and appropriate therapy. When the kidney does not function properly or its function worsens, a biopsy is often necessary. It is performed under local anesthesia and with ultrasound guidance.

Most patients find it less uncomfortable than having a tooth extracted.

Kidney Transplantation and its Benefits

Kidney transplantation is considered the most acceptable method of treating terminal renal insufficiency. The benefits of organ transplantation compared to dialysis include:

• More efficient removal of toxins,
• Chronic complications are minimized,
• Prevention of jaundice infection,
• Improvement in overall health and strength, which means
• Faster return to normal life – work, travel, social activities...
• Restoration of sexual function and fertility

After the first post-transplantation year, which is the most critical for long-term kidney function, the transplanted kidney functions in 90-95% of patients who had a living donor and about 80-85% in patients who had a "cadaveric" donor.

In a smaller number of patients, the reason for transplant failure is surgical complications (thrombosis of blood vessels, etc.) that occur in the immediate postoperative period. In other cases, it is due to acute or chronic rejection of the transplanted kidney.

The long-term function of a transplanted kidney depends on the type of kidney donor (living or deceased) and the degree of tissue compatibility between the donor and the recipient.

For example, ten years after transplantation, a kidney from a living person functions about 75%, while in patients who received a kidney from a cadaveric donor – it has about 40-50% function.

The longest recorded function of a transplanted kidney so far is 35.5 years.

How Does the Kidney Transplant Surgery Proceed?

Kidney transplantation is now a routine operation that usually lasts about 2 or 3 hours. The kidney is placed on the right or left side of the lower abdomen. The kidney's blood vessels are connected to the recipient's blood vessels, and the ureter is connected to the bladder.

A flexible tube (stent) is left in the ureter for easier and safer passage of urine, which is usually removed three weeks after transplantation (ambulatory, non-surgical method – cystoscopy).

It is common to experience pain in the incision area and a slightly elevated temperature after surgery, which is related to the surgery itself or to the administration of immunosuppressive therapy.

A drain is left in the surgical wound to remove blood or lymph that accumulates around the kidney and is removed after a few days. A catheter is placed in the bladder to facilitate the easy passage of urine.

A cannula is placed in the patient's neck through which therapy and infusion solutions are administered. This cannula does not interfere too much with the patient and is usually removed a few days after kidney transplantation.

Potential Problems After Kidney Transplantation

Today, kidney transplantation is considered the best method for treating terminal renal insufficiency. However, transplantation is associated with certain risks and problems, and the patient must be clearly informed about them in order to make an informed decision about transplantation in consultation with their family.

The most common risks during kidney transplantation are similar to other surgeries and are related to general anesthesia and complications in the immediate postoperative period, such as bleeding, vein thrombosis, pulmonary embolism, wound infections, but they can also be somewhat more serious.

1. Acute rejection of the transplanted kidney – occurs in the immediate postoperative period (the first 4-6 weeks) and is a consequence of a strong reaction of the recipient's immune system to the transplanted organ.

   It is successfully treated with high doses of cortisone or similar drugs. Acute rejection can occur in up to 25% of patients, but if treated properly, kidney function can be restored.

2. Chronic rejection of the transplanted kidney – develops slowly, after 3 to 6 months, and is caused by a gradual loss of kidney function. Chronic rejection occurs in up to 30% of patients.

   Chronic rejection is less treatable, and the final result is usually a gradual loss of function of the transplanted kidney. In the early stages of this process, symptoms are usually absent.

3. Side effects of immunosuppressive therapy – can cause a significant decrease in resistance to infections, which makes the patient prone to infections. Side effects also include high blood pressure, blood sugar increases, kidney damage, and various malignancies (lymphomas, skin tumors, etc.).

4. Other complications – include complications of the surgical procedure itself (bleeding, wound infections, etc.), but also complications related to kidney function (urine leakage, thrombosis of the renal artery or vein, etc.).

In the long run, all these risks can be managed with proper treatment and adequate medical care.

The quality of life of kidney transplant recipients depends on several factors:

• On the type of donor kidney (living or cadaveric)
• On the degree of tissue compatibility between the donor and the recipient
• On the patient's adherence to the prescribed immunosuppressive therapy
• On regular follow-up examinations and timely treatment of any complications

With modern methods of organ transplantation, a patient can hope for a long and quality life, although many patients will need to adapt to a new way of life and deal with certain health challenges even after transplantation. Many of these patients can lead a normal and active life.

Summary

Kidney transplantation is a highly effective treatment for terminal renal insufficiency. It offers a chance for a longer and better quality of life for patients who might otherwise face the limitations and complications of long-term dialysis. However, successful transplantation requires a thorough understanding of the potential risks and benefits, and ongoing medical care and compliance with prescribed treatments.