Kidney transplant
Introduction
Introduction to kidney transplantation Kidney transplantation is an effective method for treating chronic renal failure by transplanting a healthy person's kidney to a patient with kidney disease and losing kidney function. Kidney transplantation is divided into autologous kidney transplantation, homologous kidney transplantation and xenogeneic kidney transplantation because of its different sources of kidney supply. It is customary to refer to the same kind of kidney transplantation as kidney transplantation. The other two kidney metastases are distinguished by "autologous" or "heterologous" kidney transplants. The quality of life of patients after kidney transplantation is significantly improved, and kidney transplantation is undoubtedly the best way to treat chronic renal failure. However, not all patients with renal failure can well tolerate transplantation and postoperative high-dose hormone and immunosuppressive therapy. Before kidney transplantation, it is necessary to answer whether the case is suitable for kidney transplantation, and the postoperative prediction effect will be. Some patients may even have serious life-threatening complications after surgery. basic knowledge Probability ratio: one of the preferred methods for the treatment of renal failure, the incidence rate of patients with chronic nephritis is about 10% Susceptible people: no special people Mode of infection: non-infectious Complications: immunosuppressive drugs and anticancer drugs toxic nephropathy
Cause
Cause of kidney transplantation
Cause:
If various chronic kidney diseases develop into uremia, drug treatment is ineffective. Only dialysis treatment or kidney transplantation can save lives. Dialysis can only remove some of the toxins produced in the body. Long-term dialysis can cause a series of complications and can not be separated for a long time. In hospitals, the quality of life is far worse than that of ordinary people. Kidney transplantation is to implant a healthy kidney for patients. After surgery, it can completely correct the systemic complications of uremia and end-stage renal disease. It can be reintegrated into society, and the quality of life and ordinary people are not. This is what every uremic patient is looking for, and the long-term cost is less than dialysis.
Prevention
Kidney transplantation prevention
1, pay more attention to diet, supplement nutrition, so that nutrition is sufficient to improve their own immunity.
2. Regularly review the concentration of anti-rejection drugs such as cyclosporine in the blood, and adjust the dosage according to the blood drug concentration. If the dosage is too large, the immune function may be excessively destroyed, and the infection may occur easily; and if the dosage is too small, the rejection reaction is likely to occur.
3, try not to go to public places, do not touch too many people.
4, pay attention to food hygiene, to avoid food that is not fresh and cold.
5, pay attention to keep warm, to avoid catching a cold. If you have a cold, you can take Qingrejiedu Oral Liquid, Shuanghuanglian Oral Liquid and other drugs.
Complication
Kidney transplant complications Complications Immunosuppressive drugs and anticancer drugs toxic nephropathy
Some patients have irreversible chronic graft rejection, other late complications include drug toxicity, potential renal disease recurrence, prednisone side effects and infection, and the incidence of malignant tumors in the same kidney transplant patients increases. The risk of epithelial cancer is 10 to 15 times greater than that of normal people, and the risk of lymphoma is about 30 times. The treatment of tumors is the same as that for non-immunosuppressive patients. There is no need to reduce or stop immunity in the treatment of squamous cell carcinoma. Inhibitors, but tumors and lymphomas that process faster progress advocate suspending immunosuppressive agents. In recent years, in transplant recipients, Epstein-Barr virus-associated B-cell lymphoma is very common, although various tumors have been hypothesized Sporomycin is associated with ALG or OKT3, and more like it is consistent with the over-inhibition of immunization with more potent immunosuppressive agents.
Symptom
Kidney transplantation symptoms common symptoms immune damage no hematuria, renal tubular necrosis, proteinuria, renal interstitial edema, oliguria
Acute rejection: The diagnosis of acute rejection is sometimes very difficult and difficult to distinguish from other conditions. Especially in the case of infection, the treatment principles are completely different and must be identified in time.
Acute onset, renal tubular necrosis occurs early after surgery without urine or oliguria, and more related to renal ischemia, such as long-term warm ischemia, poor perfusion, preservation time is too long; or caused by urography or angiography Renal biopsy is often needed to identify, manifested as renal interstitial edema, localized ischemia, extensive tubular degeneration and necrosis.
Chronic rejection: occurs after 6 months to 1 year after surgery, after the prolonged humoral immunity and cellular immunity, it can have both characteristics of immunity, often in the former, mostly due to early postoperative rejection Incomplete treatment, or repeated acute rejection, often occult.
The clinical manifestations are slow-moving hypertension, proteinuria, progressive reduction of transplanted kidney, dysfunction, hematuria, oliguria, serum creatinine, elevated urea nitrogen, decreased endogenous creatinine clearance, and decreased hemoglobin.
Examine
Kidney transplant examination
Because of the difference in antigen between the transplant recipient and the kidney transplant recipient, it is the basis of rejection after renal transplantation. The occurrence of rejection directly affects the survival of the transplanted kidney. In humans, there are mainly red blood cell ABO blood types related to transplantation. The antigenic system and the human leukocyte antigen system (HLA), in order to avoid or reduce the possibility of rejection after renal transplantation, to achieve the success of kidney transplantation and long-term survival of the transplanted kidney, must include blood type, lymphocyte toxicity test before kidney transplantation , human leukocyte antigen (HLA) system and selective screening of population reactive antibodies (PRA).
Ask about medical history and comprehensive medical examination.
Matching experiment.
blood group.
Human population antibody response assay (PRA).
HLA typing.
Cross-matching test (lymphatic test).
Laboratory inspection
Blood routine, clotting time, prothrombin time / partial prothrombin time;
Blood biochemical routine examination, liver and kidney function, blood sugar, blood lipids.
Hepatitis B virus (HBV), hepatitis C virus (HCV), cytomegalovirus (CMV), human immunodeficiency virus (HIV), plasma rapid responsiveness test (syphilis).
Urine routine, urine culture.
Stool routine, occult blood test.
Film degree exam
Chest X-ray, abdominal B-ultrasound, gastrointestinal barium meal examination (endoscopy if necessary).
ECG.
Special examination of the kidneys.
Abdominal plain film + intravenous pyelography, radionuclide kidney map, spiral CT renal angiography.
Diagnosis
Kidney transplantation diagnosis
1. Insufficient renal perfusion: insufficient blood volume, renal vascular embolization, renal artery anastomotic stenosis, perirenal hematoma, lymphatic cyst compression of renal blood vessels, renal perfusion limitation, renal ischemia can cause oliguria after renal transplantation, but there are Its corresponding performance is generally not difficult to identify.
2, urinary tract obstruction: ureteral ureteral anastomotic stenosis or blockage of blood clots, catheter blockage, etc., 24 to 48 hours after surgery, sudden reduction in urine output or no urine, by flushing the catheter, cystoscopy or insertion of ureter Catheters, etc., can be identified.
3. Infected foci in the body, although not serious, but due to low body resistance, can also cause chills and fever, decreased urine output, serum creatinine, elevated urea nitrogen and other changes, and can induce acute rejection, often occurs in Within 3 months after surgery, most of the lung infection, urinary tract infection, can also be a systemic infection, should be lung X-ray examination, urine culture, blood culture, etc., carefully looking for possible infections, so as not to delay treatment .
4, drug toxicity: certain drugs, such as gentamicin, kanamycin, cephalosporin, etc., have certain nephrotoxicity, when the kidney function has not been stabilized, such as improper application, can cause kidney damage, oliguria , urinary closure, serum creatinine, elevated urea nitrogen, a large amount of useful agents, a longer history, significant changes in urine, protein, tube type, not difficult to identify.
