Technology

The kidneys are one of the vital organs of the body which needs attention and care to be able to live a normal and fulfilling life. Once these organs are damaged, the patient is faced with a lifetime condition which threatens the patients existence in this world. The disease that doctors would avoid for their patients to have is end-stage renal disease. It is a disease which is a condition that deems to cause the patient his life.

First and foremost, it is important to understand the role and functions of the kidneys. As discussed in Emedicine Health in their article Kidney Transplant, these pear-shaped organs are responsible for the clearance of unwanted substances in the blood and it also helps in regulating the blood pressure in the body. In addition, it filters the wastes in the blood and maintains the electrolyte balance in the body. It also removes chemicals, drug metabolites and toxins in the bloodstream. In regulating the blood pressure, it retains water by reabsorbing sodium when blood pressure is below normal but if blood pressure is higher than normal, it promotes sodium excretion thus allowing water to be excreted. In this manner, the kidney plays a big role in regulation of fluid volume and electrolyte in the body. It also has the ability to secrete hormones which causes the absorption of calcium from the food ingested, and it aids in the production of red blood cells which prevents anemia.

To understand further how the functions of the kidneys are carried out, it is important to be familiar of its structure. This will also enlighten people on the complexity of this organ, thus giving weight more on its importance in human existence. As discussed in the article Kidney in Encarta Encyclopedia, the kidneys outermost layer is the cortex, which lies superior to the medulla, which contains 8 and18 cone-shaped sections called pyramids. These structures are formed by microscopic tubules. The distal end of these pyramids points to the central portion of the kidney, the renal pelvis. The cortex spans even to the spaces located between the pyramids, thus forming the renal columns. Filtration of blood happens mainly in the cortex and medulla by the structures called nephrons. These structures are wherein blood can pass through and are capable of re-absorption and excretion of substances. Initially, upon entrance of blood in the nephrons, it is filtered by the glumerolus located in the Bowmans capsule. Distal to the Bowmans capsule is the renal tubule which is composed of different parts, wherein these areas allows excretion or re-absorption of different ions and substances. This then drains in the collecting tubule which carries the urine toward the renal pelvis. Thus, these nephrons have the only capability to perform these functions. It also dont have the ability to regenerate thus, when damaged it cannot be restored.

Also in the article Kidney in Encarta Encyclopedia, continued exploit to the kidneys and long term abuse can damage the organ which may lead to chronic renal failure. This is a progressive deterioration of the kidneys, which can also be caused by diabetes mellitus, hypertension, lupus erythematosus, and myeloma and acquired immunodeficiency syndrome (AIDS). Early diagnosis and treatment can slow down the pace of the degenerative process, however, there are no means to reverse the damage sustained by the organ. The chronic renal failure can progress to end-stage renal failure, which is a life-threatening condition that cant be reversed and needs a long-term dialysis or kidney transplant.

In the article Kidney Transplant in MedlinePlus, kidney dialysis is also known as hemodialysis and it is a medical treatment for removing waste products in the body of patients who are deficient of renal function. Although this treatment is considered non-invasive and provides immediate results to patients, it is not advisable for long term use because of practicality. Eventually, these patients will need a new kidney through kidney transplant. However, kidney transplant is not an easy process.

Kidney transplantation is done to replace the damaged kidney to restore normal kidney function. The contraindication for this procedure includes presence of cardiac and pulmonary insufficiency and hepatic disease. The donated kidney may come from a living related donor, living unrelated donor, or a deceased donor. After removal of the kidney from the donor, the health provider only has a window of 48 hours to transport and implant the kidney to the patient because after 48 hours, if the kidney is not transplanted, will be useless. However, finding a donor is a tedious task and it several tests before somebody can donate hisher kidney to a patient. The donors kidney must be matched first to the recipient. Usually, physicians prefer a well matched kidneys wherein the blood type of the donor matches the blood type of the recipient, there is well defined tissue typing and all crossmatch results are negative. These parameters have ensued that recipients wont reject the transplanted organ as mentioned in the article Kidney Transplant in MedlinePlus.

As discussed by Thomas Peters, MD in his article Kidney Transplant Matching What it means, crossmatching of donated kidney to the recipient is a extremely sensitive test and it is usually the final test performed on a kidney donor and recipient. The laboratory techniques for crossmatching has been refined over the years and it can now enable physicians and scientist to relatively define the response of a kidney transplant recipient to particular cells or proteins in the donated kidney. The enhancements of the crossmatching techniques have directed to very accurate tests thus ensuing that the result generated is really reliable. These sophisticated tests were not available even a few years ago.

The crossmatching test involves mixing of serum and cells to determine the response that the recipient might have to the donated kidney as discussed by Thomas Peters, MD in his article Kidney Transplant Matching What it means. This will also predict the percent possibility of recipients rejection to the transplanted kidney. Thus, one can attest that crossmatching has come a long way and it has helped in all transplantation processes for the improvement of results.

Crossmatching has different phases during the whole duration of testing. It tests for positive crossmatch to histocompatibility antigen. This involves the HLA major histocompatibility complex (MHC), which a group of genes located in a single chromosome. Major histocompatitbility complex (MHC) influences the collaboration ability of different cell types, which can produce or suppress immune responses of the body. Thus a positive crossmatch to these antigens means that the patient has antibodies against donor HLA antigens. This means that the patient is not compatible with the kidney donor. Thus, the patient will still need to wait for transplant. These antibodies can develop as a result of pregnancy, blood transfusion or organ transplant. Thus, when these antibodies are already formed, these cells can again act on the same antigen in the future due to the action of the memory B-cells. These cells are specialized plasma cells that are present for a life-time and can recognize to the specific antigen, thus allowing an immune response against the antigen when it invades the body again as mentioned in the article of Mayo Clinic entitled Overcoming Antibody Barriers to Kidney Transplant.

In accordance to the test, a positive crossmatch indicates that the recipient has responded to the donor and that kidney transplant should not be performed. Conversely, a negative crossmatch means that the recipient has not response on the donor, thus transplantation should be safe and may be done as discussed by Thomas Peters, MD in his article Kidney Transplant Matching What it means. However, for a patient whose life is on the line, a positive crossmatch result is not acceptable because every minute that the patients kidneys are not replaced would also mean that he is a minute closer to death.

Thus, some scientists and physicians have tried to still do kidney transplant in spite of the positive crossmatch result as declared by the UCSF Medical Center. They have found out that the success of the operation has allowed patients with kidney failure to avoid indefinite waiting for a deceased donor transplant. It was also found out that the success rates are close to those transplants with compatible donor transplants. To avoid the antibody response, the patient is under medication to decrease their antibody levels or they may choose to undergo plasmapharesis treatments to directly remove harmful antibodies from their blood. Plasmapharesis is somewhat similar to dialysis however, instead of filtering the impurities in the blood, it removes harmful antibodies from the blood. Patients usually require five to ten treatments with plasmapharesis before transplant when they are positive crossmatch. They may also require several plasmapharesis after the operation to manage the antibody levels.