Renal Transplantation 3

Live Doner Nephrectomy

*  The patient should receive a preoperative fluid and a diuresis

   should  be  stimulated by the  administration  of  intravenous

   Mannitol during the operation.

*  The  kidney  is usually  approached through  a  standard  loin

   incision excising the twelth rib

*  It is important to avoid damaging the hilum in mobilising  the

   kidney

*  Once the renal artery and the renal veins have been mobilised,

   the  ureter  shoud be carefully disected to the level  of  the

   pelvic brim. It is essential to preserve the periureteric  fat

   and connective tissue.

*  Once the ureter has been divided and ligated the renal vessels

   can be clamped and the kidney removed

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Renal Transplantation 2

KIDNEY FAILURE

Causes of end stage renal failure include:

* Glomerulonephritis

* Chronic pyelonephritis

* Diabetes mellitus

* Obstructive Uropathies

* Polycystic disease

In   the  end  stage  of  kidney  failure,  dialysis  (haemo   or

peritoneal)  has  the potential of maintaining life  and  provide

alternate  therapy for these patients. Patients on dialysis  have

anaemia, hypertension, lower vitality and increased dependence on

hospital    facilities.   Transplantation   under   ideal    home

circumstances provides a cost effective alternative ensuring near

normal productive quality of life and life span.

1.2 DONOR SOURCE

There are two sources of kidney

a) Cadaver

b) Live related donor

1.2.1 Cadaver

The kidney from this source becomes available in cases of  trauma

or   other   irreversible  disorders  like   brain   tumour   and

cerbrovascular accidents. All these conditions can lead to  brain

death  an  essential pre-requisite for kidney  availability  from

this source.

Brain death is diagnosed-

*  When there is no spontaneous respiratory movement with  normal

   pCO2

*  In absence of gag and corneal reflex

*  There are bilateral fixed pupils

1.2.2 Related Doner

Identical twin or blood relation can be considered as donors.

*  They are investigated to eliminate any intercurrent disorder

*  Today careful screening of donor for hepatitis B and AIDS  are

   required to reduce risk and costs

*  Also blood grouping and HLA typing, Renal Arteriogram and  IVP

   are indicated. Unrelated donors may also be considered

*  All donors after investigations must give informed consent

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site,please write to address above.

To create consumer/provider engagement visit www.otmanage.blogspot.com

www.surginstruatlas.blogspot.com           www.drmmkapur.blogspot.com
Now also available on android &smart phones same internet address.

additional information at Distance Learning Support Tryselfcare page Face book