Genitourinary disorders are conditions that affect the genitourinary system, which includes the urinary and reproductive systems. Some are congenital, and others are acquired later in life. Large numbers of patients suffer from a variety of diseases in the genitourinary system, which is composed of kidneys, ureters, bladder, urethra, and genital organs. Genitourinary diseases include congenital abnormalities, iatrogenic injuries, and disorders such as cancer, trauma, infection, and inflammation.

2. S.No. Content
1. Nephritis
2. Hydronephrosis
3. Nephrotic syndrome
4. Renal calculus
5. Renal Failure [Acute+ Chronic]
6. Kidney transplantation
7. Benign Prostatic Hyperplasia

3. S.No. Content
8 Congenital anomalies of kidney and urinary tract
9 Renal cancer
10 Prostate Cancer
11. Wilm’s Tumor [ Nephroblastoma]
12. Urinary tract infection
13. Urethral Disorders
14. Epispadias
15. Urethral stricture

4. Enuresis Glycosuria Nocturia Polyuria
Bedwetting Sugar in
urine
Frequent
urination at
night
Large
amounts of
urine

5. Pyuria Anuria Hematuria Diuretic
Pus in
urine
No urine
produced
Blood in
urine
Drug or
substance to
increase
urine
production

45. Nephritis is an inflammation
of the nephrons, which are
part of the kidneys. Also
known as
glomerulonephritis.
It can affect kidney function,
leading to changes in urine
and urination habits and
swelling in the hands, feet,
and elsewhere.

80.  An acute or chronic bacterial infection of the kidney and the
lining of the collecting system (Renal pelvis).
 Acute pyelonephritis presents with moderate to severe
symptoms that usually last 1 to 2 weeks. If the treatment of
acute pyelonephritis is not successful and the infection recurs,
it is termed chronic pyelonephritis.

81.  A kidney infection (pyelonephritis) is a type
of urinary tract infection (UTI). Bacteria
cause it when they move from another part
of your body, like your bladder, up to one or
both of your kidneys.
 Kidney infections can be more serious than
lower UTIs.

87. Acute
Chronic

88.  Fever
 Flank Pain
 U.A. shows pyuria
and bacteriuria
 Urinary signs:
frequency, urgency,
and burning

89.  Flank pain or tenderness
 Chills, fever, and malaise
 Frequency and burning on urination if there is an accompanying
cystitis (bladder inf)
 Some with chronic are asymptomatic
 Others have a low-grade fever and vague GI complaints.
 Polyuria and nocturia develop when the tubules of the nephrons fail
to reabsorb water efficiently.

97. LAB TEST:
 BUN,
 creatinine,
 serumelectrolytes,
 urine culture
IVP

100.  Antibiotics
 If severe enough to cause renal failure, then
renal dialysis is indicated

147.  Nephrolithiasis refers to renal stone disease;
 Urolithiasis refers to the presence of stones
in the urinary system.
 Stones, or calculi, are formed in the urinary
tract from the kidney to bladder by the
crystallization of substances excreted in the
urine


150. IMMOBILITY
SEDENTA
RY LIFE
STYLE
DEHYDRATIO
N
METABOLIC
DISTURBANC
ES
HISTOR
Y OF
RENA
L
CALCU
LI

151. HIGH MINERAL
CONTENT IN DRINKING
WATER
DIETARY INTAKE
UTI & H/O FEMALE
GENITAL MUTILATION
PROLONGED
INDWELLING
CATHETERISATION
NEUROGENIC BLADDER

156.  sharp, severe pain

161.  When the pain is severe, the client usually has
nausea, vomiting, pallor, grunting respirations,
elevated blood pressure and pulse, diaphoresis,
and anxiety

163. RETROGRADE
PYELOGRAM
CT SCAN
24 HOUR URINE
SPECIMEN
LAB
INVESTIGATIONS

165. DRUG THERAPY
Opioid agents
NSAIDS
Spasmolytic agents

173. Hypnosis,
imagery,
therapeutic or
healing touch,
acupuncture and
breathing
techniques

174.  Low-calcium diets are not generally recommended,except for true
absorptive hypercalciuria. Evidence shows that limiting calcium,
especially in women, can lead to osteoporosis and does not
prevent renal stones.
 Avoid intake of oxalate-containing foods (eg, spinach,strawberries,
rhubarb, tea, peanuts, wheat bran).

175.  During the day, drink fluids (ideally water) every1 to 2 hours.
 Drink two glasses of water at bedtime and an additional glass at
each nighttime awakening to prevent urine from becoming too
concentrated during the night.

176.  Avoid activities leading to sudden increases in environmental
temperatures that may cause excessive sweating and dehydration.
 Contact your primary health care provider at the first sign of a
urinary tract infection

177.  The inability of the nephrons within the
kidneys to maintain fluid, electrolyte, and
acid-base balance, excrete nitrogen waste
products, and perform regulatory functions
such as maintaining calcification of bones
and producing erythropoietin.

178.  There are two types of renal failure:
 1. Acute renal failure (ARF) is characterized by
sudden and rapid decrease in renal function.
ARF is potentially reversible with early,
aggressive treatment of its contributing etiology.
 2. Chronic renal failure: (CRF) is characterized
by progressive and irreversible damage to the
nephrons. It may take months to years for CRF
to develop.

179.  Is a reversible clinical syndrome where there is a
sudden and almost complete loss of kidney
function (decreased GFR) over a period of hours
to days with failure to excrete nitrogenous waste
products and to maintain fluid and electrolyte
homeostasis.
 ARF manifests as an increase in serum creatinine
(M=53-132umol/L; F=44-97umol/L) and BUN (7-
20mg/dl). Urine volume may be normal, or
changes may occur. Possible changes include
oliguria (<400ml/day), nonoliguria (>400ml/day), or
anuria (<50 ml/day)

180. 1. Prerenal- occurs in 60%-70% of cases,
is the result of impaired blood flow to
that leads to hypoperfusion of the
kidney and a decrease in the GFR.
Common clinical conditions are
volume-depletion states (hemorrhage
or GI losses), impaired cardiac
performance (MI, HF, or cardiogenic
shock), and vasodilation (sepsis or
anaphylaxis)

181. 2. Intrarenal- is the result of actual
parenchymal damage to glomeruli or
kidney tubules. Nephrotoxic agents such
as aminoglycosides and radiocontrast
agents account for 30% of cases of
acute tubular necrosis (ATN), and
ischemia due to decreased renal
perfusion accounts for more than 50% of
cases
 Characteristics of ATN are intratubular back leak (abnormal
absorption of filtrate and decreased urine flow through the
tubule), vasoconstriction, and changes in glomerular
permeability. These processes result in a decrease of GFR,
progressive azotemia, and impaired fluid and electrolyte
balance.

182.  Conditions such as burns, infections, crush injuries, and severe blood
transfusion reactions can lead to intrarenal ARF and ultimately ATN
 With burns and crush injuries, myoglobin (a CHON released from muscle
when injury occurs) and hemoglobin are liberated, causing obstruction,
renal toxicity, and ischemia
 Medications such as NSAIDs and ACE inhibitors interfere with the normal
auto regulatory mechanisms of the kidneys and may cause
hypoperfusion and eventual ischemia.
3. Postrenal – is usually the result of an
obstruction somewhere distal to the
kidneys. Pressure rises in the kidney
tubules and eventually, the GFR
decreases

183. Characteristics Categories
Prerenal Intrarenal Postrenal
Etiology Hypoperfusion Parenchymal
damage
Obstruction
BUN value Increased Increased increased
Creatinine Increased Increased Increased
Urine output Decreased Varies, often
decreased
Varies, may be
decreased, or
sudden anuria
Urine sodium Decreased to < 20
mEq/L
Increased to
>40mEq/L
Varies, often
decreased to
20mEq/L or less
Urinary sediment Normal, few hyaline
casts
Abnormal casts
and debris
Usually normal
Urine osmolality Increased to
500mOsm
About 350 mOsm
similar to serum
Varies, increased
or equal to serum
Urine specific
gravity
Increased Low normal Varies

184. A. Prerenal
1. Volume depletion resulting from:
a. hemorrhage
b. renal losses (diuretics)
c. GI losses (vomiting, diarrhea, NG suctioning)
2. Impaired cardiac efficiency resulting from:
a. MI
b. Heart failure
c. Dysrhythmias
d. Cardiogenic shock
3. Vasodilation resulting from:
a. sepsis
b. anaphylaxis
c. antihypertensive medications or other medications that cause

185. B. Intrarenal
1. Prolonged renal ischemia resulting from:
a. pigment nephropathy (associated with the breakdown of blood
cells containing pigments that in turn occlude kidney
structures)
b. Myoglobinuria (trauma, crush injury, burns)
c. Hemoglobinuria (transfusion reaction, hemolytic anemia)
2. Nephrotoxic agents such as:
a. Aminoglycosides antibiotics (gentamicin, tobramycin)
b. Radiopaque contrast media
c. Heavy metals (lead, mercury)
d. Solvents and chemicals (carbon tetrachloride, arsenic)
e. NSAIDs, ACE inhibitors
3. Infectious processes such as:
a. acute pyelonephritis
b. acute GN

186. C. Postrenal
1. Urinary tract obstruction, including:
a. calculi (stones)
b. tumors
c. BPH
d. Strictures
e. Blood clots

187. 1. Initiation – begins with the initial insult and
ends when oliguria develops
2. The oliguria period is accompanied by an
increase in the serum concentration of
substances usually excreted by the kidneys
(uric acid, urea, creatinine, organic acids). In
this phase uremic symptoms first appear
and life-threatening conditions such as
hyperkalemia develop.
3. The diuresis period is marked by a gradual
increase in urine output, which signals that
glomerular filtration has started to recover.
4. The recovery period signals the improvement
of renal function and may take 3-12 months.
Lab values return to normal level. Although
a permanent 1%-3% reduction in the GFR is
common.

188. 1. Provide adequate hydration to patients at risk of dehydration:
a. surgical patients before, during and after surgery.
b. Patients undergoing intensive diagnostic studies requiring fluid
restrictions and contrast agents
c. Patients with neoplastic disorders of metabolism and those receiving
chemotherapy
2. Prevent and treat shock promptly with blood and fluid replacement.
3. Monitor CV and arterial pressures and hourly urine output of critically
ill patients to detect the onset of renal failure as early as possible.
4. Treat hypotension promptly.
5. Continually assess renal function when appropriate.

189. 6. Take precautions to ensure that the
appropriate blood is administered to the
correct patient in order to avoid severe
transfusion reactions, which can precipitate
renal failure.
7. Prevent and treat infections promptly.
Infections can produce progressive renal
damage.
8. Pay special attention to wounds, burns and
other precursors of sepsis
9. To prevent infections from ascending in the
urinary tract, give meticulous care to
patients with indwelling catheters. Remove
catheter ASAP.
10. To prevent toxic drug effects, closely monitor
dosage, duration of use, and blood levels of
all medications metabolized or excreted by
the kidneys.

190. 1. Pharmacologic therapy
a. hyperkalemia is the most life-threatening of the F/E
changes that occur in RF, the elevated K levels
may be reduced by administering cation-exchange
resins (sodium polystyrene sulfonate [Kayexalate]
orally or by retention enema. It works by
exchanging sodium ions for potassium ions in the
intestinal tract.
b. Sorbitol may be administered in combination with
Kayexalate to induce diarrhea type effect (induce
water loss in the GIT)
c. If hemodynamically unstable, IV dextrose 50%,insulin
and calcium replacement may be administered to
shift potassium back into the cells.
d. Diuretics are often administered to control fluid
volume, but they have not been shown to hasten
the recovery form ARF.

191. 2. Nutritional Therapy
a. Dietary proteins are individualized to provide the
maximum benefit. Caloric requirements are met
with high-carbohydrate meals, because
carbohydrates have a protein- sparing effect.
b. Foods and fluids containing potassium or
phosphorous such as banana, citrus fruits and
juices, coffee are restricted

192.  Monitoring fluid and electrolyte balance
 Reducing metabolic rate
 Promoting pulmonary function
 Preventing infection
 Providing skin care
 Providing support

193.  Is a progressive, irreversible
deterioration in renal function
in which the body’s ability to
maintain metabolic and fluid
and electrolyte balance fails,
resulting in uremia and
azotemia.

194. Causes:
1. DM, HPN, chronic glomerulonephritis,
pyelonephritis, obstruction of the urinary
tract, hereditary lesions as in polycystic
kidney disease, vascular disorders,
infections, medications, or toxic agents.
2. Environmental and occupational agents that
have been implicated in CRF include lead,
mercury and chromium. Dialysis or kidney
transplantation eventually becomes
necessary for patient’s survival.

195. As renal function declines, the end products of CHON metabolism
(which are normally excreted in urine) accumulate in the blood.
Uremia develops and adversely affects every system in the body.
Stages of CRF: are based on the GFR. The normal GFR is
125cc/min/1.73m2
1. Stage 1 = GFR > 90 ml/min/1.73m2. Kidney damage with normal or
increased GFR.
2. Stage 2 = GFR = 60-89 mL/min/1.73m2. Mild decrease in GFR.
3. Stage 3 = GFR = 30-59 mL/min/1.73m2. Moderate decrease in
GFR.
4. Stage 4 = GFR = 15-29 mL/min/1.73m2. Severe decrease in GFR.
5. Stage 5 = GFR <15 mL/min/1.73 m2. Kidney failure

196. 1. CV manifestations:
a. HPN – due to Na and H20 retention or from R-A-A
activation,
b. heart failure and edema - due to fluid overload
c. pericarditis - due to irritation of pericardial lining by
uremic toxins
2. Dermatologic manifestations
a. severe pruritus is common
b. uremic frost, the deposit of urea crystals on the
skin.
3. GI manifestations:
a. anorexia, nausea and vomiting, and hiccups
b. The patient’s breath may have the odor of urine
(uremic fetor); this may be associated with
inadequate dialysis
4. Neurologic manifestations
a. altered LOC, inability to concentrate, muscle
twitching, agitation, confusion and seizures.
b. Peripheral neuropathy, a disorder of the peripheral
NS, is present in some patients

197. 1. GFR
2. Sodium and water retention
3. acidosis – due to inability of the kidneys to
excrete increased load of acid
4. Anemia
5. calcium and phosphorous imbalance –
hypocalcemia and increase in phosphorous

198. 1. Hyperkalemia due to decreased excretion,
metabolic acidosis, catabolism and
excessive intake (diet, meds and fluids)
2. Pericarditis, pericardial effusion and pericardial
tamponade due to retention of uremic waste
products and inadequate dialysis.
3. Hypertension due to sodium and water
retention and malfunction of the R-A-A
system
4. Anemia due to decreased erythropoietin
production, decreased RBC life span,
bleeding in the GIT from irritating toxins and
ulcer formation, and blood loss during
hemodialysis
5. Bone disease and metastatic and vascular
calcifications due to retention of
phosphorous, low serum calcium levels,
abnormal vitamin D metabolism and
elevated aluminum levels.

199.  Dialysis
 Fluid and dietary restrictions that include:
 Low protein
 High calories
 Low sodium
 Low potassium

200. 1. Pharmacologic Therapy
a. calcium carbonate (Os-cal) or calcium acetate
(Phoslo) are prescribed to treat
hyperphosphatemia and hypocalcemia
b. Antiseizure agents – diazepam (Valium) or
phenytoin (Dilantin)
c. Antihypertensive and CV drugs - digoxin
(Lanoxin) and dobutamine (Dobutrex)
d. Erythropoietin (Epogen) to treat anemia. It is
initiated to reach a hematocrit of 33% - 385 and
a target hemoglobin of 12g/dl.
2. Nutritional Therapy
a. low sodium, low CHON and low K diet
3. Dialysis

201. Nursing Management:
1. Assessing fluid status and identifying potential sources of imbalance.
2. implementing a dietary program to ensure proper nutritional intake
3. promoting positive feelings by encouraging increased self-care and
greater independence.
4. Provide explanations and information to the patient and family
concerning ESRD, treatment options and potential complications.
5. Provide emotional support to the patient and family.

202.  Dialysis is a process that artificially removes
metabolic wastes from the blood in order to
compensate for kidney (renal) failure.
 Most common type is homodialysis

203.  Is used to substitute some kidney functions during
renal failure.
 It is used to remove fluid and uremic waste
products from the body when the kidneys are
unable to do so.
 It may be indicated to treat patients with edema that
do not respond to treatment.
 Acute dialysis is indicated when there is a high and
increasing level of serum potassium, fluid overload,
or impending pulmonary edema, increasing
acidosis, pericarditis and severe confusion. It may
also be used to certain medications or other toxins
in the blood.

204.  A procedure for cleaning and filtering the
blood.
 It provides a substitute for kidney function
when the kidneys are unable to remove the
nitrogenous waste products and maintain
adequate fluid, electrolyte, and acid-base
balance.

205.  Chronic or maintenance dialysis is
indicated in ESRD in the following
instances:
1. Presence of uremic signs and symptoms
affecting all body systems (nausea and
vomiting, severe anorexia, increasing
lethargy, mental confusion)
2. Hyperkalemia and fluid overload not
responsive to diuretics and fluid
restriction.
3. General lack of well-being.
 An urgent indication for dialysis in
patients with CRF is pericardial friction
rub.

214.  Dialysis is performed by hemodialysis and
peritoneal dialysis.
 Either technique can be performed at home
or in a dialysis center.
 Each type of dialysis has advantages and
disadvantages.

216. Allows abnormal substances to diffuse out of blood, cleaning it
The dialysis fluid creates a diffusion gradient
Patients blood is transported through a semipermeable tube into an
apparatus which contains dialysis fluid
Homodialysis

248.  A kidney transplant is
a surgery that
involves taking a
healthy kidney from a
donor and placing it
into a person whose
kidneys are no longer
working properly.

249.  Kidney transplant success rate in India
 In 1971, first kidney transplant was successfully
performed at the Christian Medical College hospital at
Vellore in Tamil Nadu by Dr. Johnny and Dr. Mohan
Rao.
 In 12 aug 2019 First ever kidney transplant operations
were successfully done at Indira Gandhi Medical
College and Hospital (IGMCH), Shimla, on Monday by a
team of doctors under the supervision of doctors from
AIIMS, New Delhi. First kidney transplant operation
started at 9am and was completed at 11.30am while
second operation stared at 12 noon and completed at
around 2pm.

250.  The kidney transplant procedure success
rate in India is reported to be one of the
highest in the world, with an estimated
over 90% kidney transplant success
rate for 7500 kidney transplantations
per year. Presently, 90% of kidney
transplants are obtained from living
donors, and only 10% are from deceased
donors (patients who died due to brain
stroke or accidents).

252. Normal Kidney Function: The kidneys are organs whose
function is essential to maintain life. Most people are born with
two kidneys, located on either side of the spine, behind the
abdominal organs and below the rib cage. The kidneys perform
several major functions to keep the body healthy.
 Filtration of the blood to remove waste products from normal
body functions, passing the waste from the body as urine, and
returning water and chemicals back to the body as necessary.
 Regulation of the blood pressure by releasing several
hormones.
 Stimulation of production of red blood cells by releasing the
hormone erythropoietin.
 The normal anatomy of the kidneys involves two kidney bean shaped
organs that produce urine. Urine is then carried to the bladder by way of
the ureters. The bladder serves as a storehouse for the urine. When the
body senses that the bladder is full, the urine is excreted from the bladder
through the urethra.

253. Kidney Disease: When the kidneys stop
working, renal failure occurs. If this renal failure
continues (chronically), end-stage renal disease
results, with accumulation of toxic waste
products in the body. In this case, either dialysis
or transplantation is required.

255.  Step 1 – The surgeon makes an incision in the lower part of one
side of your abdomen and places the new kidney into your body.
 Step 2 – The blood vessels of the new kidney are attached to blood
vessels in the lower part of your abdomen, just above one of your
legs.
 Step 3 – The new kidney’s ureter is connected to your bladder. The
ureter is a tube that carries urine from the kidney to the urinary
bladder.
 Step 4 – The transplanted kidney is monitored for kidney infections
by the transplant team and intensive care doctors.
 Most kidney transplant surgery patients can return to their normal
activities within eight weeks after transplant but lifting heavy objects
should be avoided. Medications are to be taken for the rest of your
life.

257. Kidney Transplantation
 Kidneys for transplantation come from two different sources: a living donor or a
deceased donor.
The Living Donor
 Sometimes family members, including brothers, sisters, parents, children (18 years
or older), uncles, aunts, cousins, or a spouse or close friend may wish to donate a
kidney. That person is called a "living donor." The donor must be in excellent
health, well informed about transplantation, and able to give informed consent.
Any healthy person can donate a kidney safely.
Deceased Donor
 A deceased donor kidney comes from a person who has suffered brain death. The
Uniform Anatomical Gift Act allows everyone to consent to organ donation for
transplantation at the time of death and allows families to provide such permission
as well. After permission for donation is granted, the kidneys are removed and
stored until a recipient has been selected.

258. Blood Type Testing
 The first test establishes the blood type. There are four blood types: A, B, AB, and
O. Everyone fits into one of these inherited groups. The recipient and donor should
have either the same blood type or compatible ones, unless they are participating
in a special program that allow donation across blood types. The list below shows
compatible types:
 If the recipient blood type is A Donor blood type must be A or O
 If the recipient blood type is B Donor blood type must be B or O
 If the recipient blood type is O Donor blood type must be O
 If the recipient blood type is AB Donor blood type can be A, B, AB, or O
 The AB blood type is the easiest to match because that individual accepts all other
blood types.
 Blood type O is the hardest to match. Although people with blood type O can
donate to all types, they can only receive kidneys from blood type O donors. For
example, if a patient with blood type O received a kidney from a donor with blood
type A, the body would recognize the donor kidney as foreign and destroy it.

259. Tissue Typing
 The second test, which is a blood test for human leukocyte antigens (HLA), is
called tissue typing. Antigens are markers found on many cells of the body that
distinguish each individual as unique. These markers are inherited from the
parents. Both recipients and any potential donors have tissue typing performed
during the evaluation process.
 To receive a kidney where recipient's markers and the donor's markers all are the
same is a "perfect match" kidney. Perfect match transplants have the best chance
of working for many years. Most perfect match kidney transplants come from
siblings.
 Although tissue typing is done despite partial or absent HLA match with some
degree of "mismatch" between the recipient and donor.

260. Crossmatch: Throughout life, the body makes substances called antibodies that act to
destroy foreign materials.
 Individuals may make antibodies each time there is an infection, with pregnancy,
have a blood transfusion, or undergo a kidney transplant. If there are antibodies to
the donor kidney, the body may destroy the kidney. For this reason, when a donor
kidney is available, a test called a crossmatch is done to ensure the recipient does
not have pre-formed antibodies to the donor .
 The crossmatch is done by mixing the recipient's blood with cells from the donor.
If the crossmatch is positive, it means that there are antibodies against the donor.
The recipient should not receive this particular kidney unless a special treatment is
done before transplantation to reduce the antibody levels. If the crossmatch is
negative, it means the recipient does not have antibodies to the donor and that they
are eligible to receive this kidney.
 Crossmatches are performed several times during preparation for a living donor
transplant, and a final crossmatch is performed within 48 hours before this type of
transplant.
Serology: Testing is also done for viruses, such as HIV (human immunodeficiency
virus), hepatitis, and CMV (cytomegalovirus) to select the proper preventive
medications after transplant. These viruses are checked in any potential donor to help
prevent spreading disease to the recipient.

261. Phases of Transplant
Pre-transplant Period
 This period refers to the time that a patient is on the deceased donor waiting list or
prior to the completion of the evaluation of a potential living donor. The recipient
undergoes testing to ensure the safety of the operation and the ability to tolerate
the anti-rejection medication necessary after transplantation. The type of tests
varies by age, gender, cause of renal disease, and other concomitant medical
conditions. These may include, but are not limited to:
 General Health Maintenance: general metabolic laboratory tests, coagulation
studies, complete blood count, colonoscopy, pap smear and mammogram (women)
and prostate (men)
 Cardiovascular Evaluation: electrocardiogram, stress test, echocardiogram, cardiac
catheterization
 Pulmonary Evaluation: chest x-ray, spirometry

262.  Potential Reasons of Excluding Transplant Recipient
 Uncorrectable cardiovascular disease
 History of metastatic cancer or ongoing chemotherapy
 Active systemic infections
 Uncontrollable psychiatric illness
 Current substance abuse
 Current neurological impairment with significant cognitive impairment and no
surrogate decision maker

263.  The kidney transplant procedure is an operation that involves replacing the kidney of a
patient that is failing with a healthy kidney from the donor. Here are some key details to
know regarding kidney transplants.

 Criteria for eligibility: Only some people are eligible for a transplant of kidney. The
candidate must satisfy specific requirements to guarantee the success of the organ transplant,
including having an overall good health condition and not having active cancers or
infections.

 Explanation: The new kidney takes the role of the old kidney that has failed. The kidney
filters waste and excess fluid from the blood and generates urine.

 Validity: A kidney transplant is an effective treatment option for majority of patients
with end-stage renal diseases (ESRD) and has better survival and quality of life vs dialysis.

 Advantages: There are many advantages of choosing a transplant surgery over other options
for treatment, such as a better standard of living, a better rate of survival, and fewer
restrictions on food and activities.

 By understanding the nature of kidney transplants and the advantages they may provide,
patients can make an informed choice on whether it's the best treatment choice for them.


264. Transplant Surgery
 The transplant surgery is performed under general anesthesia. The operation
usually takes 2-4 hours. This type of operation is a heterotopic transplant meaning
the kidney is placed in a different location than the existing kidneys. (Liver and
heart transplants are orthotopic transplants, in which the diseased organ is
removed and the transplanted organ is placed in the same location.) The kidney
transplant is placed in the front (anterior) part of the lower abdomen, in the pelvis.
 The original kidneys are not usually removed unless they are causing severe
problems such as uncontrollable high blood pressure, frequent kidney infections,
or are greatly enlarged. The artery that carries blood to the kidney and the vein that
carries blood away is surgically connected to the artery and vein already existing
in the pelvis of the recipient. The ureter, or tube, that carries urine from the kidney
is connected to the bladder. Recovery in the hospital is usually 3-7 days.
 Complications can occur with any surgery. The following complications do not
occur often but can include:
 Bleeding, infection, or wound healing problems.
 Difficulty with blood circulation to the kidney or problem with flow of urine from
the kidney.
 These complications may require another operation to correct them.

265.  The preparation for a kidney transplant: Preparing to undergo a kidney transplant takes
numerous steps to ensure the most effective outcome.
 kidney transplant procedure
 Finding a compatible donor: One of the most crucial aspects of getting ready for an organ
transplant is finding an appropriate donor. This could include a live donor, for example,
someone from your family or a deceased donor.

 Evaluation procedure: Before considering kidney transplant surgery, the patient must
undergo a thorough assessment to determine if they're a good candidate. This involves a
thorough review of the medical record, physical tests, and tests to determine the general
health and kidney function.

 Medical aspects: To prepare for the possibility of a successful transplant, patients might
have to undergo additional medical procedures, including vaccines or medication, to treat
current medical issues. It's crucial to discuss these issues with your medical team and follow
their recommendations with care.

 Lifestyle factors: Making certain lifestyle adjustments before surgery can aid in the
transplantation process's effectiveness. The changes could be as simple as quitting
smoking adhering to an appropriate diet, and working out regularly to maintain general
health. When they follow these measures to get ready for an organ transplant, patients can
ensure a successful procedure and a better result.

267. A kidney transplant procedure
The kidney transplant procedure is a complicated process that requires the kidney
transfer of healthy organs from the donor to the recipient. Some crucial tips to be aware
of are:
Surgical procedure: A surgical process for a kidney transplant entails cutting an
incision through your lower abdominal area, then placing the healthy kidney inside the
body of the recipient, then linking the kidney's blood vessels, as well as the urinary tract,
to the patient's existing blood vessels and bladder.
Potential risks and problems: Like any surgical procedure, it is accompanied by some
risks and possible complications. They could result in bleeding, infection, or rejection of
the kidney transplanted. It's important to discuss the potential risks with your medical
team and adhere to their advice closely to avoid the possibility of developing
complications.
Recovery procedure: After the organ transplant, the patient has to stay in the hospital
for a couple of days to be monitored for any issues. They'll also have to take medication
to prevent rejection of the transplanted kidney and treat any other medical issues. The
healing process can last up to a few months or weeks, and patients must follow their
medical team's instructions closely during this period

269. Post Transplant Period
 The post transplant period requires close monitoring of the kidney function, early
signs of rejection, adjustments of the various medications, and vigilance for the
increased incidence of immunosuppression-related effects such as infections and
cancer.
 Just as the body fights off bacteria and viruses (germs) that cause illness, it also
can fight off the transplanted organ because it is a "foreign object." When the body
fights off the transplanted kidney, rejection occurs.
 Rejection is an expected side effect of transplantation and up to 30% of people
who receive a kidney transplant will experience some degree of rejection. Most
rejections occur within six months after transplantation, but can occur at any time,
even years later. Prompt treatment can reverse the rejection in most cases

270.  Post-surgery care: After the procedure, patients will be required to keep regular
appointments with their medical team to assess the condition of the kidney transplanted and
alter their medications as required. Patients will also have to adopt specific lifestyle changes
to improve the effectiveness of the transplant, for example, maintaining a healthy diet and
staying away from certain activities or medications which could cause harm to the kidney
transplanted.
 By understanding the procedure, the risks, and complications, as well as the process of
recovery and post-surgery medical care required for kidney transplants, patients are better
prepared for surgery and improve the likelihood of a successful result.
 Life after an organ transplant
 Life after an organ transplant: Life after a kidney transplant surgery" requires essential
lifestyle changes and continuous medical attention. Patients need to go for follow-ups after
the kidney transplant and take anti-rejection medication to avoid complications and surgery
effects. The recovery involves changes in diet and daily exercise to live an active, healthy
life post-transplant.
 Despite the hardships, a functional kidney transplant surgery has many advantages that may
provide new perspectives on life for patients. If you take the proper care and help, many
patients can live a happy and healthy lifestyle following a kidney transplant procedure.

272.  Anti-Rejection Medications
 Anti-rejection medications, also known as immunosuppressive agents, help to
prevent and treat rejection. They are necessary for the "lifetime" of the transplant.
If these medications are stopped, rejection may occur and the kidney transplant
will fail.
 Below is a list of medications that might be used after a kidney transplant. A
combination of these drugs will be prescribed dependent on the specific transplant
needs.
 Anti-inflammatory Medication
 Prednisone is taken orally or intravenously. Most side effects of prednisone are
related to drug dosage levels. Prednisone is used at low dosages to minimize side
effects. The possible side effects of prednisone are:
 Changes in physical appearance such as puffiness of the face and weight gain.
 Irritation to the stomach lining.
 Increased risk of bruising and decreased rate of healing.
 Increased sugar level in the blood (steroid-induced diabetes).
 Unexplained mood changes. This may mean depression, irritability, or high spirits.
 General muscle weakness or pain in knees or joints.
 Formation of cataracts. A clouding of the lens of the eye occurs infrequently with
long-term use of prednisone.

273. Anti-proliferative Medications
 Azathioprine (Imuran®) is taken orally or intravenously. The most common side effects
associated with azathioprine are:
 Thinning of hair
 Irritation of the liver
 Decreased white blood cell count
 Mycophenolate mofetil (CellCept®) is taken orally. The most common side effects of
mycophenolate mofetil are:
 Abdominal aches and/or diarrhea
 Decreased white blood cell count
 Decreased red blood cell count
 Mycophenolate sodium (Myfortic®) is taken orally. It provides the same active ingredient as
mycophenolate mofetil and generally has the same side effect profile. It is enterically coated
to potentially reduce abdominal aches and diarrhea.
Sirolimus (Rapamune®) is taken orally. The most common side effects of sirolimus are:
 Decreased platelet count
 Decreased white blood cell count
 Decreased red blood cell count
 Elevated cholesterol and triglycerides

274. Cytokine Inhibitors
 Cyclosporine (Neoral®, Gengraf®) is taken orally. The most common side effects of
cyclosporine therapy are:
 Kidney dysfunction
 Tremors
 Irritation of the liver
 Excessive body hair growth
 High blood pressure
 Swollen/bleeding gums
 High potassium in the blood
 Increased sugar level in the blood (drug-induced diabetes)
 Tacrolimus (Prograf®) is taken orally. The most common side effects of tacrolimus therapy
are:
 Kidney dysfunction
 High blood pressure
 High potassium in the blood
 Increased sugar level in the blood (drug-induced diabetes)
 Tremors
 Headaches
 Insomnia

275. Antilymphocyte Medications
 Antithymocyte globulin (Thymoglobulin®) is given intravenously. Thymoglobulin
can cause:
 Decreased white blood cell and platelet counts
 Sweating
 Itching
 Rash
 Fever

276. Living Donor Kidney Transplantation
 Living donor kidney transplants are the best option for many patients for several
reasons.
 Better long-term results
 No need to wait on the transplant waiting list for a kidney from a deceased donor
 Surgery can be planned at a time convenient for both the donor and recipient
 Lower risks of complications or rejection, and better early function of the
transplanted kidney
 Any healthy person can donate a kidney. When a living person donates a kidney
the remaining kidney will enlarge slightly as it takes over the work of two kidneys.
Donors do not need medication or special diets once they recover from surgery. As
with any major operation, there is a chance of complications, but kidney donors
have the same life expectancy, general health, and kidney function as most other
people. The kidney loss does not interfere with a woman's ability to have children.

277.  Potential Barriers to Living Donation
 Age < 18 years unless an emancipated minor
 Uncontrollable hypertension
 History of pulmonary embolism or recurrent thrombosis
 Bleeding disorders
 Uncontrollable psychiatric illness
 Morbid obesity
 Uncontrollable cardiovascular disease
 Conronic lung disease with impairment of oxygenation or ventilation
 History of melanoma
 History of metastatic cancer
 Bilateral or recurrent nephrolithiasis (kidney stones)
 Chronic Kidney Disease (CKD) stage 3 or less
 Proteinuria > 300 mg/d excluding postural proteinuria
 HIV infection
 If a person successfully completes a full medical, surgical, and psychosocial evaluation they
will undergo the removal of one kidney. Most transplant centers in the United States use a
laparoscopic surgical technique for the kidney removal. This form of surgery, performed
under general anesthesia, uses very small incisions, a thin scope with a camera to view
inside of the body, and wand-like instruments to remove the kidney. Compared with the large
incision operation used in the past, laparoscopic surgery has greatly improved the donor's
recovery process in several ways:

278.  Decreased need for strong pain medications
 Shorter recovery time in the hospital
 Quicker return to normal activities
 Very low complication rate
 The operation takes 2-3 hours. Recovery time in the hospital is typically 1-3 days.
Donors often are able to return to work as soon as 2-3 weeks after the procedure.
 Occasionally the kidney needs to be removed through an open incision in the flank
region. Prior to the use of the laparoscopic technique, this surgery was the standard
for the removal of the donated kidney. It involves a 5-7 inch incision on the side,
division of muscle and removal of the tip of the twelfth rib. The operation
typically lasts 3 hours and the recovery in the hospital averages 4-5 days with time
out of work of 6-8 weeks.
 Although laparoscopy is increasingly used over open surgery, from time to time,
the surgeon may elect to do an open procedure when individual anatomic
differences in the donor suggest that this will be a better surgical approach.
 The quality and function of the kidneys recovered with either technique work
equally well. Regardless of technique all donors will require lifelong monitoring
of their overall health, blood pressure and kidney function.

287. Causes of Benign Prostatic Hyperplasia
 The specific causes of BPH remain unclear, although hormonal changes
are often pointed out as a possible factor.
 One of the affected hormones may be dihydrotestosterone (DHT), a sex
hormone that exists in both men and women. This hormone is mainly
responsible for developing male characteristics such as deep voice, body
hair and pubic hair, as well as the maturation of male reproductive organs
including the prostate gland. While it is natural to have your prostate
enlarged especially during puberty, a rise in DHT levels may worsen the
enlargement.
 Imbalance in testosterone and oestrogen levels may also serve as
another factor. The level of active testosterone gradually decreases as men
age, making oestrogen levels comparatively higher. Higher levels of
oestrogen are known to trigger the growth of prostate cells, thus leading to
enlargement.