Kidney Center Virtual Book EN

Bumrungrad International Hospital

replacement therapy Chronic kidney disease and renal

Overview: Kidney structure Kidneys What is a kidney? is its function?

Renal arteries send “waste” to the kidney to be ltered.

Kidney

Renal veins return ltered blood to the body.

Inside the kidneys

Ureter

Bladder

Urethra

Typically, humans have 2 kidneys in the back below the lower ribs.

Kidneys remove wastes and unwanted minerals as well as extra fluid from the body through urine.

Kidneys are “bean-shaped.”

Overview: Kidney structure Kidneys

Renal cortex

Minor calyx

Renal medulla Major calyx Renal column

Pelvis

Renal artery

Renal Papilla

Renal vein

Ureter

Bowman's Capsule

Nephron Anatomy

Glomerulus

Proximal tubule

filters the blood and then returns the cleaned blood to the body, removing waste

Nephron = functional unit of the kidney Each kidney has about one million nephrons.

and extra fluid through urine.

Cortex

Medulla

Loop of Henle

Distal Tubule

Collecting Duct

Peritubular Capillaries

Overview: disease Kidneys

Remove waste and excess fluid from the body

Maintain the balance of acid-base in the body

Important functions of

Control the urine concentration

the kidneys

Regulate the balance of minerals in the blood

Produce hormones • Hormone producing red blood cells • Hormone producing vitamin D • Hormone regulating blood pressure

Renal Failure or Renal Dysfunction Kidney Failure

Kidney failure or renal failure is a condition where one or both kidneys no longer work properly or at all. Wastes cannot be removed well enough through urine, resulting in a higher waste level in the bloodstream and illness.

types of kidney failure: two

Acute Kidney Injury

There are

means that the kidneys lose their function rapidly due to various causes. If treated promptly, there is a chance that the kidneys will recover and function normally.

Chronic Kidney Disease

means that the kidneys' function has decreased for more than 3 months. The chance of the kidneys recovering their function is lower.

Stages of chronic kidney disease

≥ 90 % Mild symptoms or no symptoms Stage 1

Less than 15% Stage 5

Swelling, fatigue, paleness, itching, lethargy, high blood pressure, etc.

60-89 % Mild symptoms or no symptoms Stage 2

30-59 % Mild symptoms or no symptoms Stage 3

15-29 % Mild symptoms or no symptoms Stage 4

**Patients with stage 5 chronic kidney disease must be closely monitored for consideration of renal replacement therapy.

Signs and symptoms of chronic kidney disease

Itchy skin Dark skin

Easy bruising

Decreased urine volume or frequent urination at night

Symptom

Loss of appetite

High blood pressure

Nausea and vomiting

Pale skin

Signs

Swelling

Fatigue

Foamy urine or urine color change

Renal replacement (for patients with end-stage renal disease) therapy

Hemodialysis

Each treatment takes about four hours, to be given 2-3 times a week. It can be required as a lifelong treatment or until kidney transplant.

Hemodialysis is a treatment for patients with kidney failure, using

a machine acting as an artificial kidney to remove waste and extra fluid from the blood and maintain the mineral balance through a filter. The filtered blood is then returned to the body.

It is thus necessary to have “vascular access” or a catheter for dialysis inserted.

Vascular access surgery

This is a surgery that creates a connection between an artery and a vein in a patient's arm for dialysis. There are two types of vascular access:

Arterio- venous anastomosis

Arteriovenous fistula (AVF)

Vein

Artery

Blood from dialysis machine

Blood to dialysis machine AV

Artery Vein

stula

Permanent vascular access

Vein

Artery

Arteriovenous fistula (AVF) and Arteriovenous graft (AVG)

Arteriovenous graft (AVG)

Graft

Arterio- venous graft

Blood from dialysis machine

Artery Vein

Tunneled cuffed catheter Semi- permanent vascular access

Synthetic bridge graft Blood to dialysis machine

For AVF and AVG, the surgeon connects an artery to a vein as access point in preparation for dialysis, making an incision on the non-dominant arm near the wrist or the elbow. For a tunneled cuffed catheter, surgery is done under local anesthesia and does not require hospitalization after surgery.

Catheter

Right atrium of heart

Blood to dialysis machine

Blood from dialysis machine

Types of dialysis access

There are two types of vascular access for dialysis:

Permanent access

Hemodialysis: Central Venous Catheter

Arteriovenous Fistula (AVF)

This involves a surgical procedure to connect the vein and the artery in the patient's arm to create a larger vein and thicker vein walls. It usually

Hemodialysis: Arteriovenous Graft

takes at least six weeks before it can be used.

Hemodialysis: Arteriovenous Fistula Arteriovenous Graft (AVG) This is required in cases where the patient's veins are too small or there are no veins suitable for dialysis. The ideal vein size is 2-2.5 millimeters in diameter. The surgeon uses an AV graft to connect the artery and the vein. The access can be used for dialysis from 1-3 weeks after surgery depending on the type of the graft. Compared to AV fistula, AV graft has a shorter lifespan and more complications and is more costly.

Peritoneal Dialysis

Permcath or Tunneled cued venous catheter Semi-permanent access

This type of catheter involves the insertion of a dialysis catheter into a vein for long-term access. Designed to be tunneled underneath the skin, it also has a small cuff that helps to secure it in place and creates a barrier to prevent infection.

Renal replacement therapy (for patients with end-stage renal disease)

2 involves passing a cleansing fluid through a catheter tube placed in the abdomen. The fluid then absorbs waste products in the blood vessels through the lining of the abdomen. Usually performed daily, it can be done at home or at work. Permanent peritoneal dialysis (PD)

There are two main types of PD:

Connector

Solution bag

Connector

Catheter

1 Continuous ambulatory peritoneal dialysis (CAPD), with solution exchange 4-5 times/day

Drainage bag

2 Continuous cyclic peritoneal dialysis (CCPD) or automated peritoneal dialysis

Peritoneal dialysis can be done at home, with no need to visit a dialysis center.

Renal replacement therapy (for patients with end-stage renal disease)

3 Kidney

Kidney transplant is a surgical procedure in which a donor kidney is placed in the patient's body to replace the kidney that no longer functions.

Transplantation

Kidney transplant

Donor: Functioning kidneys

Recipient: Non-functioning kidneys

Living Donor Kidney Transplantation

Deceased Donor Kidney Transplantation

Kidney transplant

Treatment of end-stage renal disease with kidney transplant surgery

Bumrungrad Hospital, performing the first

kidney transplant surgery in 1987, has over 30 years of experience so far in kidney transplant.

We work as a team in providing continuous care from before surgery to post-transplant care.

Kidney Transplant Type 1

In living donor kidney transplant, one of the donor's healthy kidneys is surgically removed and placed in a recipient whose kidneys no longer function. The donor should be between 20 and 55 years old. A legally eligible living donor is required to be a blood

Living Donor Kidney Transplant

relative such as father, mother, child, sibling, or spouse.

Kidney Transplant Type 2

Deceased Donor Kidney Transplant

In a deceased donor kidney transplant, a kidney of a deceased

person donated by the family to the Thai Red Cross Organ

Donation Center is given to a patient.

Kidney transplant process

For patients ready and suitable for kidney transplant

Consultation with nephrologists

In the case of living donor kidneys

For those waiting for a deceased donor kidney

Blood typing and physical examination of the patient and the kidney donor

Physical examination: blood typing, tissue compatibility typing and other tests as determined by the doctor

Tissue compatibility typing and/or DNA test

Patients and relatives getting self-care advice from the organ transplant team

as determined by the doctor

Registration:

to be on the waitlist for a kidney donation from the Thai Red Cross after having started hemodialysis or peritoneal dialysis

Kidney transplant subcommittee approval meeting

Patients returning home and taking care of themselves at home

Patients keeping the scheduled appointments

Kidney transplant when a donor

Kidney transplant surgery date scheduled

for follow-up check-ups and blood tests to check medication levels

kidney is available

Kidney transplant

Consideration of Patient’s Readiness for Kidney Transplant

1. Physically: Physical examination showing good health 2. Emotionally: Emotionally stable

3. Socially: Support, care and help available 4. Mentally: Treatment plan accepted and no psychiatric problems 5. Financially: Afford to bear the costs, including

those related to transplant surgery and post-transplant lifelong medications

Assessment of Kidney Transplant Recipients

5. Other assessments deemed appropriate by doctors, such as those of gastrointestinal tract and liver, respiratory tract, etc.

4. Mental state

3. Surgical assessment and urinary tract assessment

2. Cardiovascular:

ECG, Echocardiogram, EST 3. Surgical assessment and urinary tract assessment

1. Internal Medicine: Physical examination, blood test, cancer screening, infectious disease screening, readiness for surgery,

and assessment of underlying diseases

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For patients with end-stage renal disease, kidney transplant is another treatment option that can help patients return to normal life.

For further information, please contact:

Nephrology (Kidney) Center, Building A (Clinic), 19 th oor, Counter B Opening hours: Every day from 8:00 a.m. to 8:00 p.m.

Kidney disease consultation hotline: 02 011 3992 or 1378

Hotline: 081 834 3439 Kidney transplant consultation with Organ Transplant Nurse Coordinator

Follow for information about kidney disease

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