The document discusses various kidney-related conditions, including nephritis, renal failure, and urinary tract infections, detailing their causes, symptoms, and treatment options. It emphasizes the importance of early detection and intervention for conditions like acute renal failure and outlines the stages of chronic renal failure. Additionally, it highlights the significance of dialysis as a treatment for kidney failure, providing an overview of the procedure and the dietary and pharmacological management of patients.

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


156.  sharp, severe pain

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

166. DRUG THERAPY
Opioid agents
NSAIDS
Spasmolytic agents

174. Hypnosis, imagery, therapeutic
or healing touch, acupuncture
and breathing techniques
Positioning the client to
comfortable position aids in pain
reduction

175.  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).

176.  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.

177.  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

178.  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.

179.  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.

180.  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)

181. 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)

182. 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.

183.  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

184. 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

185. 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
vasodilation

186. 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

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

188. 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.

189. 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.

190. 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.

191. 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.

192. 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

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

194.  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.

195. 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.

196. 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

197. 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

198. 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

199. 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.

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

201. 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

202. 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.

203.  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

204.  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.

205.  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.

206.  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.

215.  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.

249.  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.

250. 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.

251.  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).

253. 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.

254. 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.

256.  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.

258. 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.

259. 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.

260. 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.

261. 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.

262. 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

263. 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

264.  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.


265. 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.

266.  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.

268. 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

270. 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

271.  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.

273.  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.

274. 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

275. 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

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

277. 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.

278.  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:

279.  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.

288. 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.