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KIDNEY TRANSPLANT RENAL

Department of Nephrology. University Hospital. Pamplona.

INTRODUCTION Treatment of end stage renal disease (ESRD) should be unitary and integrated in the various options of hemodialysis (hospital in the dialysis center in home), peritoneal dialysis (chronic ambulatory, with nighttime cycler, etc.) and renal transplant (RT). In each patient must choose the most appropriate initial therapy and for this we must evaluate the various characteristics of the patient's personal, social and labor, co-morbidity, assessment of benefits, risks, quality of life, etc.., With each option therapy. To be integrated allows passage from one to another treatment for complications, intolerance, graft rejection, etc.. The TR is successful today and for years Choice1 therapy for most causes of renal failure that is indicated. Improving quality of life by disregarding the dependence on dialysis and strict diets, increases survival of patients and treatment is more economical when compared with dialysis. It is a routine procedure and its applicability is limited by the availability of kidneys in relation to the growing demand of patients who need it. This imbalance between patients on the waiting list of TR and the availability of cadaveric kidneys expands every year. For this has been increasing donor age and used expanded criteria kidneys or kidney suboptimal heart-beating donors, etc. The TR option of living is an excellent alternative because it allows formal surgery, can be achieved in dialysis and preferably situation is indicated in young people where they are most beneficial results. This option is currently being extended to the point that in countries like the United States half of all kidney transplants are from living donors. INDICATIONS AND CONTRAINDICATIONS TR progressive success has led to an increase in the list of indications and currently there are only absolute contraindications.

is indicated in most of the diseases that progress to ESRD remained the leading causes of chronic glomerulonephritis, diabetic nephropathy and nephrosclerosis. Less common causes include chronic pyelonephritis, hereditary kidney disease, metabolic disease other than diabetes mellitus, obstructive uropathy, toxic nephropathy, etc. Some of these diseases, especially primary and some secondary glomerulonephritis may recur in the graft (focal segmental glomerulonephritis, membranoproliferative, IgA, Schönlein-Henoch purpura, hemolytic-uremic syndrome, diabetes mellitus, oxalosis, amyloidosis, etc.). . Yet rarely are contraindicated TR in these patients. Two of the most important factors to consider when accepting patients for inclusion on a waiting list of TR are age and disease associated (comorbidity), mainly cardiovascular, liver, lung or central nervous system. Until recent years, infection by human immunodeficiency virus (HIV) as an absolute contraindication, but now it is considered that in the absence of viral replication for more than 3 months, presence of CD4 lymphocytes than 200/mm3 for more than 6 months and absence of infections or tumors with stable or controlled infection with antiretroviral drugs does not contraindicate renal transplantation. STUDY pretransplant necessary to evaluate all patients with ESRD before inclusion on the waiting list for TR. It should facilitate the study as early as the glomerular filtration is about 20 ml / min because it allows the realization of renal transplantation in predialysis situation, leading to better results in both patient survival and graft in comparison with patients who have been waiting on the waiting list for kidney transplantation. The initial evaluation involves a complete medical history and physical exam along with supporting data (laboratory and imaging tests), urological and vascular assessment and extensive information to paciente2. It is convenient to carry out an initial study mandatory for all patients and complete with optional studies that require those under the criteria of each center and features for each patient (history and background, age, sex, type of nephropathy, examination findings, presence or suspicion of urological or vascular claudication type, blowing, etc.)-Table 2 -.

The patient information must be comprehensive in terms of surgical risk and complications, need for lifelong immunosuppression and risk of cancers and infections that leads, information about the possibility of a return to dialysis for various reasons mainly due to chronic rejection, information on potential benefits and risks of living donor transplantation, the need for dialysis care to get the transplant in the best possible information the overall performance and level of the center, etc. Optional studies will depend on the criteria of each center and in this special way affect the characteristics of each patient (history and background, age, sex, type of nephropathy, examination findings, presence or suspicion of urological or vascular type reflux, accidents stroke, claudication, bruits, etc.). SELECTION OF RECEIVER AND DONANTETrasplante living donor kidney Once checked in the evaluation that the candidate is suitable for transplantation should assess whether there is in the family real options for the TR live especially if the patient is young. This is an excellent therapeutic option for ESRD treatment to be based on ethical principles of altruism, the absence of coercion or financial reward, autonomy in decision making, and charity and not maledicencia3. Its use is justified by the shortage of cadaveric organs in relation to demand, low risk to the donor and better patient survival and graft. Also permits the implementation of the protocol and / or under pre-dialysis or after a short stay on dialysis which significantly reduces the morbidity associated with dialysis and character aspects of school improvement, employment, reduce costs, etc.

Employment living donor differs greatly from one country to another and some like the U.S. and Brazil account for 50% of TR made. In Spain, the world leader in the cadaver transplant activity, made a number less than 4% although there is now a policy to increase living donation to reduce waiting lists. It must meet certain legal requirements (Act 30/1979 and Royal Decree 2070/1999 of 30 December). If more than one potential donor of living would be valued donor characteristics (age, risk, difference in age and body mass between donor and recipient, and the degree of HLA and ABO compatibility). The donor will undergo a study protocol or rigorous evaluation and testing stages starting with general and cross match, leaving for later more sophisticated examinations such as angiography, CT angiography or MRI angiography. Needs to be clarified as soon as possible a contraindication as decreased creatinine clearance, proteinuria and / or hematuria, hypertension, diabetes, obesity and history of cancer, hepatitis stones or not to continue with their studies.

It is now increasingly used in laparoscopic donor nephrectomy because it offers advantages over open surgery in that it reduces postoperative pain, reduced hospital stay and recovery time as well as long-term physical sequelae. The survival results are generally excellent and more than ten years 17 to 20% to those from cadaver donors. CadáverSi donor kidney transplant recipient does not have the option of a living donor may be included on the waiting list for cadaver transplantation and the selection is usually made according to the degree of ABO and HLA compatibility.

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RURAL ROAD TO KNOWLEDGE Superhighway Pablo Luis Bustos

Center College
"Human beings are being transformed to be transforming the environment in which we live."

know that the first forms of communication were through paintings and hieroglyphics that decorate well, served well and used to teach and educate.

With the invention of writing and the book there are great sages like Thales of Miletus (600 BC), Pythagoras of Samos (540 BC), Plato (390 BC), Aristotle (350 BC), Euclid (325AC), and Archimedes (287 BC) who had much knowledge of different branches of science, but we know that knowledge was exclusive and is generally transmitted only to the privileged society.

Many centuries later (XV century), the German Johannes Gutenberg invented the printing press, thus beginning an unstoppable human literacy, as it was put to reach the vast majority of the books so far were treasures in the hands of privileged few. Also made possible the existence of newspapers and magazines and the invention of advertising and commercial labels.

Great scientists such as Galileo Galilei (1564), Johannes Kepler (1571) and Isaac Newton (1642), innovated and revolutionized the knowledge that for centuries had been passed down for generations, These scientists contributed a great knowledge in different fields of science (but I dare say with all due respect they were real living encyclopedias.)

Samuel Morse invented the telegraph in 1844 and this was achieved a breakthrough of knowledge, because information can now travel at the speed of light. Then the telephone (Alexander Graham Bell), Phonograph (Thomas A. Edison), Cinematography (Lumiere Brothers), the Radiocommunications (Alexandre papova), and many inventions that have radically transformed our way of life.

... and one day (circa 1960) came the Internet which was a scientific research network connecting several U.S. universities and is also used for military purposes, but it was not until the late 90 `s, when it began to be used by all users, bringing the result that access to knowledge would be exponential and so both cease to exist each time Smarty people.


questions arise here: What to do with such information How to use it so meaningful? How to get this competition? Jordi Adell

tells us that digital competence is acquired by faces:

The first phase is the access, ie to learn the basic use of technology

The second phase is the adoption or use computers to do the same thing done without computers (no innovation).

The third phase is the adaptation which integrates traditional practices increase productivity but

The fourth phase is the appropriation, at this stage begin to experience new ways of working using new technology didactically and without them it would be impossible

The fifth and final stage is innovation, ie to use technology so that no one is done before

CONCEPTION OF ADOLESCENT

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renal failure (or renal failure)

is the condition in which the kidneys fail to function properly. Physiologically, renal failure is described as a decrease in blood filtration glomerular filtration rate (GFR). Clinically, this manifests in an elevated serum creatinine.
still not well understood many of the factors that influence the speed with which it produces kidney failure or kidney failure. Researchers are still studying the effect of the protein in food and cholesterol in the blood to renal function


Rating
renal failure can be divided broadly into two categories, acute renal failure and chronic renal failure.

acute renal failure

Some kidney problems happen quickly, like an accident that causes kidney damage, the loss of much blood that can cause sudden kidney failure or certain drugs or poisonous substances can cause the kidneys to stop working. This sudden drop in kidney function are called acute renal failure.

acute renal failure (CRF) or (ARF) is, as its name implies, a rapidly progressive loss of renal function, generally characterized by oliguria, decreased production of urine (measured as less than 400 ml day for adults, less than 0.5 mL / kg / h in children, or less than 1 mL / kg / h in infants), imbalances in water and body fluids and electrolyte disorder. An underlying cause must be identified to stop progress, and dialysis may be necessary for the time required to address these root causes.
acute renal failure can lead to permanent loss of kidney function. But if the kidneys not suffer serious injury, this failure can be counteracted.


chronic renal failure Chronic renal failure (CRF) or (CRF) is a condition that is caused by permanent and irreversible damage of the kidney function secondary to any cause. Globally, the most frequent causes (but not sole) of CKD are diabetes, hypertension, obstructive diseases of the urinary tract (such as stones, tumors, etc.).. It may be the complication of a large number of kidney diseases such as IgA nephropathy (Berger's disease) inflammatory diseases of the kidneys (glomerulonephritis collectively called), chronic pyelonephritis and urinary retention, and use of drugs toxic to the kidney (especially contrast media and some antibiotics). Terminal renal failure (ESRF) or (ESRF) is the final result, which usually requires dialysis until you find a donor for a kidney transplant.

In most cases, renal function deteriorates slowly over several years and gives few symptoms initially, allowing the patient does not feel many things in spite of having anemia and even have high levels of toxins in the blood. When the patient feels bad, usually we are dealing with very advanced cases of the disease in which most of the time it becomes necessary to commence early therapy to replace the function of kidney dialysis.
Any person may suffer from kidney disease, but the highest risk are diabetics, hypertensives and relatives of people suffering from kidney disease. As renal disease no symptoms (the kidneys do not hurt as people often think only in case of calculations), those at risk should have mentioned earlier studies to detect the disease, the basics are a part of urine and creatinine.
If the disease is detected early can reduce the rate at which damage progresses, delaying the need to initiate replacement therapy on renal function and better prepare the patient for your home when necessary. Renal replacement therapies are hemodialysis, peritoneal dialysis and renal transplantation.

acute renal failure-on-chronic
acute renal failure may be present on top of chronic renal failure. This is called acute renal failure-on-chronic (AoCRF). The acute part AoCRF may be reversible and the goal of treatment, such as ARF, is to return the patient basic kidney function, which is typically measured by serum creatinine. Both AoCRF, like ARF, can be difficult to distinguish from chronic renal failure if the patient has been followed by a doctor and not a job available basis (ie, previous blood samples) for comparison.


end-stage renal disease status in which there is total renal failure or nearly total and permanent kidney disease is called terminal. People with this kind of disease must be subjected to preserve life, dialysis or a transplant.

Use of the term uremia
Before the advances of modern medicine, renal failure could be referred to as uremic poisoning. Uremia was the term used to describe the contamination of blood with urine. Starting around 1847 this term was used to describe reduced urine output, now known as oliguria, which is thought was caused by urine mixed with blood instead of being disposed of through the urethra.

Causes of renal failure
In the United States, about 80,000 people are diagnosed with kidney failure each year. This is a serious condition in which the kidneys fail to remove waste from the body. Kidney failure is the final stage of slow deterioration of the kidneys, a process known as nephropathy.
Diabetes is the most common cause of kidney failure and is more than 40 percent of new cases. Even when drugs and diet can control diabetes, the disease can lead to nephropathy and kidney failure. Most diabetics do not develop nephropathy that is severe enough to cause kidney failure. There are about 16 million diabetics in the United States and of those, about 100,000 suffer from kidney failure as a result diabetes.
People with kidney failure must undergo dialysis, which replaces some of the filtering functions of the kidneys, or transplantation to receive a kidney from a healthy donor. Most U.S. citizens who have renal failure can receive medical care funded by the federal government. In 1997 the U.S. federal government spent about $ 11,800 billion in the care of patients with renal failure.

Treatment Options

There are a lot of effective treatment options for kidney disease. When

renal function is about 15%, it is necessary to choose a treatment option:

peritoneal dialysis. Hemodialysis
.
renal transplantation.

There is no treatment that applies to all cases: the three types of therapy has its advantages and disadvantages. They all work, you and your doctor should decide what is best for you.

renal transplantation

A kidney transplant is an operation by a surgeon that specializes in placing a kidney from another person (donor) to replace the kidneys no longer work.

transplanted kidneys have two sources: living donors
- may be related or unrelated. Donors
dead - people who decided to donate their organs upon death.


transplanted kidney function is the closest thing to own. The transplant is one treatment for kidney disease, not a cure.
Not everyone can receive a kidney transplant. Doctors, social workers and a transplant coordinator considered as general health and strives to keep healthy, plus it follows the recommendations of medical EAM related to diet, exercise and, of course, dialysis therapy.

To be considered for a transplant, must undergo a series of tests to check heart function, lung and other body functions.

There are very few donor kidneys compared with the amount of people waiting for one, may be years before finding the appropriate donor. Renal
From Wikipedia, the free encyclopedia

Fakku Down November 2010

Summary

Roberto Alcázar Arroyo, Luis M ª Orte Martínez, Alfonso Otero González
Chronic Kidney Disease (CKD) is, like other chronic diseases, a major public health problem, both for its high incidence and prevalence, for its high morbidity and mortality and socioeconomic cost.
Advanced Chronic Kidney Disease (ERCA) includes stages 4 and 5 of the classification of CKD. Is therefore defined as chronic kidney disease that causes severe decrease in glomerular filtration rate (GFR <>

In each health area should protocolized joint monitoring between primary care and nephrology (Strength of Recommendation C). The creation of multidisciplinary units ERCA including nephrologists, nephrology nurse, dietitian and social worker, can comprehensively address the different aspects of the treatment of patients with ERCA, being cost-effective (Strength of Recommendation B).

. M. López Gómez
In most units of hemodialysis (HD) acts les, two of the most important problems that exist are the vascular access and the gradual increase in the incidents elderly patients. Both are risk factors of mortality and morbidity, requiring frequent hospital admissions in and involving a very remarkable health costs. The aim of this review is to show the most interesting studies published in 2007 on these two aspects.
Around vascular access for hemodialysis, a very worrying is the progressive increase in the percentage of incident and prevalent patients dialyzed with indwelling catheter, knowing that the catheter is a risk factor for major morbidity and mortality. The objectives of the dialysis units should be directed to-nuir decrease the percentage of catheters and early detection of arteriovenous fistulas at risk of thrombosis.
In recent years, the incidence of very elderly patients is experiencing a stable increase in stresses. This type of patient has a high rate of morbidity and mortality. The great challenge for nephrologists is to know which are the patients who truly can benefit from dialysis treatment.
addition, these patients presents some characteristics different from the rest of the general population on dialysis, requiring the adoption of different clinical criteria.

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Throughout my working life I have lived with teenagers and young people. At all times seek to be also an educator, a friend, a confidant, ie a person where the doors are open, not only intend to support them academically, even in personal situations.

Living with teens I realized they have a higher affinity for educators who are authentic, with whom they share and understand their joys, sadness or excitement, as well as changes in moods and especially those are present when needed.

is important to consider that teens generally want to study with fellow leaders who have wood, with which are more participatory, with more accountable, to achieve better grades, ie the proportion can help them in their learning. On the other hand they do not want peer to irresponsible, lazy, aggressive.

Teenagers have as friends people who have many things in common, whether sports, music, dress, way of acting, thinking or the same social statement.

Regarding the relationship with parents most agree that you are big differences and little communication with them, so look for friends who share their problems and secrets

Teens personally by about 70%, describe themselves as people happy, friendly, understandable, friendly, studious and intelligent. The other percentage not least itself as suspicious persons, violent or unsafe
Finally I want to tell that a group asked her to write a message I would like to express. I write some of them, who left for reflection ...

Intelligence chases me ... but I am faster.
Work is sacred ... not to be touched.
The blind do not see with the eyes.
I'm not your ... are me. Old habits die
.
is unique, be yourself and live a happy life.
no longer what is right and what is real.
never cry, only suffers in silence

AND TAUGHT