A senior consultant in surgical oncology in Apollo Hospital, New Delhi, India, Dr Vikram Singh, in this interview with WINIFRED OGBEBO, speaks on the increasing cases of kidney failure around the world caused by a number of factors. He sheds light on kidney transplant, one of the ways of handling the situation and says patients live normal life after. The excerpt.
Is transplant the only way to deal with kidney failure?
We have quite a lot of patients from your country, particularly for transplantation or other kidney problems, including renal transplantation. When the kidney is not working because of many reasons, like diabetes, long use of painkillers, or has failed completely, there are two options: transplantation and dialysis. In dialysis you continue it for life, but in transplant, you get one kidney. I have seen a patient from Lagos, 68 years old, his wife and daughter had transplants five years back and they are doing nicely. Even at 65, 70, they get very well after a transplant and they do normal jobs and get back to routine life. That is required way to deal with kidney failure. Suppose there is no donor for transplant, then you go for dialysis – cleaning of the blood by a machine for four hours, and it is required for two or three times a week and it is lifelong.
How easy is it to get a donor?
Most of the transplants we have done in India and in your country, families used to donate. But we get cadavers also-brain dead but heart is working. Last week we did one, with a brain haemorrhage, the family donated the kidney. We put one kidney into an 18-year old girl and the other into a 25-year-old woman. Both are doing well. But we are not using them much because families don’t give consent for cadaver transplants. Main programme is life related, from family members.
In a case where family members don’t give consent, what happens?
If they don’t give consent, we cannot take the kidney. Consent is necessary even in life related transplants.
What’s the life expectancy for people who have had kidney transplant?
We have heard of rejection in kidney transplants. In most cases it is caused by noncompliance-medicine is not available, or sometimes they think they don’t need medicines because they are alive and reduce the dose or stop it. But the body is different and the kidney is different, so rejection can happen. In that case we do a second transplant or go for dialysis.
But what’s the quality of life?
Absolutely normal life, but medication is there.
What increases chances of compatibility?
We usually test for tissue matching, and secondly give drugs known as immunosuppressants they have to take regularly. It starts with a high dose, but later on comes down.
Have there been cases where the body keeps rejecting a kidney?
That happens in two types of non-compatibility, when the blood group is not matched and when the body rejects the kidney. Again you want to transplant. So when the blood group does not match, and there is rejection, the antibodies increase and that increases the chances of a second rejection.
When the donor match is positive, we still cannot do a transplant otherwise the body will reject the kidney. What we do is plasma exchange to take out the antibodies, and when the cross-match matches, then we do the transplant.
What causes kidney damage?
There are three, four things causing kidneys to damage nowadays. One is diabetes—every third or fourth person is diabetic, because of lifestyle, they don’t go out, or do morning walks, their eating is bad—just sitting watching TV and eating fatty foods. Even in India, fifteen years ago, we were seeing 10 to 20 percent diabetes cases, now they are up to 40 percent. Half of the cases we transplant are diabetics. The second thing is hypertension. Smoking was thought to affect only heart and lungs, but now we know it is injurious to kidneys too.
Third important factor is drugs: people go into pharmacies after a hard day’s work and get tablets for pain relief for self-medication. Pain killers over a long time cause kidney damage. Pain killers should be taken only when required. If we take care of these things, we can cut down the numbers of patients with kidney failure.
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