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1. How my kidneys work?

What are kidneys and where are they located?

The kidneys are two bean-shaped organs about the size of a fist. They are located on either side of the spinal column in the back of the body, at waist level.

Why are the kidneys so important?

The kidney's function is to cleanse the blood of waste products and excess water that the body needs to eliminate.

How do kidneys work?

Blood passes through the kidneys, which filter wastes and excess water from the blood.

What are the main functions of the kidney?

To eliminate waste products.
The types of waste that the kidneys primarily have to eliminate are called "urea" and creatinine".
To control the amount of fluid.
Healthy kidneys control the amount of fluid in the body and help to eliminate excess fluid fromthe blood.
To control blood pressure.
Blood pressure needs to be maintained at the proper level so that you have enough blood in all parts of your body. Controlling blood pressure at its normal level is important because it reduces the risk of having heart problems. If the blood pressure is very high, the heart has to work harder.
To facilitate the production of red blood cells.
The kidneys produce a hormones called erythropoietin, which helps the body produce red blood cells.
To maintain healthy bones
The kidneys regulate the amount of phosphorus and calcium in the blood; balancing them promotes healthy bones.

What happens when the kidneys stop working?

When the kidneys stop working, these five functions in the body cease to be performed adequately and, as a result:

You will feel sick.
The excess toxic substances in the blood cause you to feel unwell; this symptom is known as "uremia" and you will feel sleepy, confused, and nauseous.

You will look pale and feel tired.
When the kidneys cannot help the body produce red blood cells, "anemia" occurs.

Your feet, ankles, and area round your eyes swell.
When the kidneys cannot eliminate excess water, fluid begins to accumulates in your lungs, you will feel breathless.

You will continue to eliminate urine.
However, this urine does not contain the normal amount of waste that it should contain.

You will have a bad taste in your mouth.
Since the kidneys are not eliminating wastes, these accumulate in your body and will cause a bad taste in your mouth, loss of appetite, and nausea.

When the kidneys ceases to function at up to 90% of their capacity, the patient is said to have Chronic Renal Failure (CRF). There is permanent and irreversible damage, since the main kidney cells, which are called nephrons, have been damaged.

There are different treatments for CRF, such as kidney transplant, dialysis, diet, and medication.

There are various causes for Renal Failure such as:

Diabetes
High blood pressure.
Recurrent kidney infections.
Lithiasis (stones in the kidney)
Glomerulonephritis.
Polycystic kidney disease, lupus, intoxications, etc.

Source:

R E M E M B E R

When the kidneys fail, we have to substitute part of their functions by means of:

• Diet
• Medications
• Dialysis
• Kidney transplant

2. What is Dialysis? Types of Dialysis.

Dialysis is a treatment that does some of the things done by healthy kidneys. It is needed when your own kidneys can no longer take care of your body's needs.

When is dialysis needed?

You need dialysis when you develop end stage kidney failure --usually by the time you lose about 85 to 90 percent of your kidney function.

What does dialysis do?

Like healthy kidneys, dialysis keeps your body in balance. Dialysis does the following:

removes waste, salt and extra water to prevent them from building up in the body
keeps a safe level of certain chemicals in your blood, such as potassium, sodium and bicarbonate
helps to control blood pressure

Is kidney failure permanent?

Not always. Some kinds of acute kidney failure get better after treatment. In some cases of acute kidney failure, dialysis may only be needed for a short time until the kidneys get better.

In chronic or end stage kidney failure, your kidneys do not get better and you will need dialysis for the rest of your life. If your doctor says you are a candidate, you may choose to be placed on a waiting list for a new kidney.

Where is dialysis done?

Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes. Are there different types of dialysis? Yes, there are two types of dialysis --hemodialysis and peritoneal dialysis.

What is hemodialysis?

In hemodialysis, an artificial kidney (hemodialyzer) is used to remove waste and extra chemicals and fluid from your blood. To get your blood into the artificial kidney, the doctor needs to make an access (entrance) into your blood vessels. This is done by minor surgery to your arm or leg.

Sometimes, an access is made by joining an artery to a vein under your skin to make a bigger blood vessel called a fistula.

However, if your blood vessels are not adequate for a fistula, the doctor may use a soft plastic tube to join an artery and a vein under your skin. This is called a graft.

Occasionally, an access is made by means of a narrow plastic tube, called a catheter, which is inserted into a large vein in your neck. This type of access may be temporary, but is sometimes used for long-term treatment.

How long do hemodialysis treatments last?

The time needed for your dialysis depends on:

how well your kidneys work
how much fluid weight you gain between treatments
how much waste you have in your body
how big you are
the type of artificial kidney used

Usually, each hemodialysis treatment lasts about four hours and is done three times per week.

A type of hemodialysis called high-flux dialysis may take less time. You can speak to your doctor to see if this is an appropriate treatment for you.

What is peritoneal dialysis and how does it work?

In this type of dialysis, your blood is cleaned inside your body. The doctor will do surgery to place a plastic tube called a catheter into your abdomen (belly) to make an access. During the treatment, your abdominal area (called the peritoneal cavity) is slowly filled with dialysate through the catheter. The blood stays in the arteries and veins that line your peritoneal cavity. Extra fluid and waste products are drawn out of your blood and into the dialysate. There are two major kinds of peritoneal dialysis.

What are the different kinds of peritoneal dialysis and how do they work?

There are several kinds of peritoneal dialysis but two major ones are: Continuous Ambulatory Peritoneal Dialysis (CAPD) and Continuous Cycling Peritoneal Dialysis (CCPD).

Continuous Ambulatory Peritoneal Dialysis (CAPD) is the only type of peritoneal dialysis that is done without machines. You do this yourself, usually four or five times a day at home and/or at work. You put a bag of dialysate (about two quarts) into your peritoneal cavity through the catheter. The dialysate stays there for about four or five hours before it is drained back into the bag and thrown away. This is called an exchange. You use a new bag of dialysate each time you do an exchange. While the dialysate is in your peritoneal cavity, you can go about your usual activities at work, at school or at home.

Continuous Cycling Peritoneal Dialysis (CCPD) usually is done at home using a special machine called a cycler. This is similar to CAPD except that a number of cycles (exchanges) occur. Each cycle usually lasts 1-1/2 hours and exchanges are done throughout the night while you sleep.

Will dialysis help cure the kidney disease?

No. Dialysis does some of the work of healthy kidneys, but it does not cure your kidney disease. You will need to have dialysis treatments for your whole life unless you are able to get a kidney transplant.

Is dialysis uncomfortable?

You may have some discomfort when the needles are put into your fistula or graft, but most patients have no other problems. The dialysis treatment itself is painless. However, some patients may have a drop in their blood pressure. If this happens, you may feel sick to your stomach, vomit, have a headache or cramps. With frequent treatments, those problems usually go away.

How long has dialysis been available?

Hemodialysis and peritoneal dialysis have been done since the mid 1940's. Dialysis, as a regular treatment, was begun in 1960 and is now a standard treatment all around the world. CAPD began in 1976. Thousands of patients have been helped by these treatments.

How long can you live on dialysis?

We do not yet know how long patients on dialysis will live. We think that some dialysis patients may live as long as people without kidney failure.

Is dialysis expensive?

Yes. Dialysis costs a lot of money. However, you may contact your private health insurance or state medical aid also help with the costs.

Do dialysis patients feel normal?

Many patients live normal lives except for the time needed for treatments. Dialysis usually makes you feel better because it helps many of the problems caused by kidney failure. You and your family will need time to get used to dialysis.

Do dialysis patients have to control their diets?

Yes. You may be on a special diet. You may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis.

Can dialysis Patients travel?

Yes. Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized. You must make an appointment for dialysis treatments at another center before you go. The staff at your center may help you make the appointment.

Can dialysis patients continue to work?

Many dialysis patients can go back to work after they have gotten used to dialysis. If your job has a lot of physical labor (heavy lifting, digging, etc.), you may need to get a different job.

3. Preparing yourself for the transplant.

WHY A TRANSPLANT IS NECESSARY

A number of diseases can directly damage the kidney. Damage to the kidney can seriously affect the removal of water and waste products, production of red blood cells, regulation of blood pressure and balance of electrolytes such as potassium, calcium and phosphorus.

If the damage is severe enough, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life.

PRETRANSPLANT EVALUATION

Pretransplant tests, as well as giving a clear picture of the patient's overall health status, help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option. This increases the likelihood of success.

The following procedures help in evaluating a patient's health status:

Physical exam - Gives the doctor an overall picture of the patient's conditions.

Chest x-ray - Determines the health of the patient's lungs and lower respiratory tract.

Complete medical and surgical history - Determines what additional tests may need to be done.

Electrocardiogram (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that was previously unsuspected.

Ultrasound with Doppler examination - Determines the quality of the iliac vessels.

Blood tests - The patient's blood count, blood and tissue type, blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed.

Blood typing - Every person is a blood type A, B, AB or O. The donor's blood type does not have to be the same as the recipient's blood type, but it must be "compatible" (see crossmatch testing).

Pulmonary function test - The patient will be asked to breathe into a tube attached to a measuring device, which will reveal how well his lungs are working and determine his blood's capacity to carry oxygen.

Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free.

Lower GI series - Ensures that the patient is free of intestinal abnormalities.

Renal function studies - Urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function.

Tissue typing - This test is done on white blood cells. White blood cells have special "markers" that distinguish "tissue type", which are used to find a matching kidney.

Panel Reactive Antibody (PRA) - A way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. It is easier to acquire a kidney if a recipient's immune system is calm or measures 0%. An immune system may be active from blood transfusion, pregnancy, a previous transplant or a current infection.

Viral testing - Determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome.

Mammogram - X-ray of a woman's breast that can detect signs of breast cancer. Pap smear - Cells collected from a woman's cervix that are microscopically analyzed for signs of cancer.

Echocardiogram - Reveals any abnormalities in the heart.

Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant.

Other tests - Any special tests or doctor visits that might be needed for the transplant workup.

Histocompatibility Laboratory Tests

Tissue Typing - This test is done on white blood cells. The white blood cells have special "markers" that tell your "tissue type". You inherit tissue type from your mother and father. This test is used to match a kidney and/or pancreas to you.

Panel Reactive Antibody (PRA) - This test shows how active your immune system is. It is easier for you to get a kidney if your immune system is calm or measures 0%. Blood will be drawn at your dialysis center and sent to our laboratory. Your immune system may be active from blood transfusions, pregnancy, a previous transplant or a current infection.

Crossmatch Testing - This test is done when a donor kidney is available. Your blood is mixed with the donor's blood. If there is no reaction (negative crossmatch) it means you are "compatible" with the donor. If there is a reaction (positive crossmatch), the kidney will not work for you because it is "incompatible".

Other Tests - The transplant doctors will ask for any special tests they think you will need. For example, people with diabetes will need more tests for their heart. Your transplant coordinator or dialysis doctor can help you make arrangements for these tests.

Clinical Laboratory Tests

Blood Typing - There are four different blood types. They are A, B, AB and O. Every person has one of these blood types. The donor's blood type does not have to be the same. However, it must be "compatible" with your blood type for you to receive the kidney and/or pancreas.

Viral Testing - It is important for us to know if you have been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS). We will test you for these at your clinic appointment.

THE TRANSPLANT TEAM

Transplant Surgeon - The transplant surgeon performs the actual transplantation procedure and monitors a patient's medication before, during, and after surgery. He or she will assess the quality of the donor's kidney before surgery, and monitor the patient's general and kidney status following transplantation. He or she will also check the patient's medication needs, and periodically check the incision to make sure it is healing properly.
Transplant Physician (Nephrologist) -A transplant physician monitors all non-surgical aspects of patient care. A transplant patient will see this doctor often. The transplant physician will perform examinations, check test results, and adjust medication as needed. A patient should not be shy in asking questions and alerting his physician regarding changes in the way he feels, no matter how insignificant it may seem.
Transplant Coordinator -This team member, usually a registered nurse, will have two key responsibilities:

First, he or she will coordinate all the events leading up to and following surgery. These may include scheduling pretransplant testing, locating donor kidney, testing for donor compatibility, contacting the patient once a kidney has been found, and making sure that the patient has proper follow-up care.

Second, the coordinator will teach the patient how to take care of himself before and after transplantation, including how to take medication and when to return to the transplant center for follow-up visits. He or she can put the patient in touch with community services that will make life easier for him and his family.

Makes all communications between patients, hospital, clinics and doctors.
Floor or Staff Nurse -This nurse will help coordinate the activities of the transplant patient's other caregivers, as well as tending to the patient's needs during his hospital stay and preparing him for discharge. The staff nurse will also keep the lines of communication open between the patient and the other members of the transplant team.
Psychologist / Psychiatrist -A patient and his family members may find it helpful to talk about their feelings with a professional before and after surgery. Frank discussion may help cope with the transplant experience and with the changes it will make in a transplant patient's life. The psychologist or psychiatrist can offer insight and support along every step of the way.
Social Worker -The social worker will link the patient to services and people in the community who can help with his recovery after leaving the hospital. If the patient needs transportation, help at home, or a hand when he goes back to school or work, the social worker will help arrange it. The social worker can also advise about Medicare, Medicaid, and other insurance coverage, as well as helping with psychosocial and family matters.
Pharmacist -Since medication will become a regular part of a patient's life before and after surgery, the pharmacist will be available to educate the patient and family. He or she can give advice about drugs, including the immunosuppressive medications that will help prevent the body from rejecting a new kidney.

Each of the skilled health care professionals who make up the transplant team take a personal interest in answering a patient's questions and taking care of his medical needs. They will also help the patient keep his spirits up along the way. The patient is the most important member of the transplant team. To a certain extent, all the other team members will respond to his cues. The patient's physical, emotional, and practical needs will help them shape a personalized pretransplant and posttransplant treatment program.

PART I

THE ROAD TO RECOVERY:

Resuming Normal Activities

When to resume for a post transplant patient?

DIET AND NUTRITION

Eating right is an important part of your recovery. A nutritionist can help you develop an eating plan that provides a balanced diet to meet your needs. The number of calories you need will be based on whether you need to gain, maintain, or lose weight and on your level of activity.

Health food- Your diet should include a variety of foods, such as:

Fruits
Vegetables
Whole-grain cereals and breads
Low-fat milk and dairy products or other sources of calcium.
Lean meats, fish, and poultry or other sources of protein.

Use of salt, sugar, and fat- Your use of salt may be restricted to help limit the amount of fluid your body holds and to control blood pressure and blood sugar. Consult your nutritionist about using salt, sugar, and fat in your diet.

CARING FOR YOUR BONES

Research has shown that transplant patients are in more danger than other people for having bone fractures. The feet and ankles seem to be particularly vulnerable, but other bones can break too.

To lower your fracture risk, make sure you are getting enough calcium and vitamin D in your diet (unless your doctor says not to). Here are few good dietary sources of calcium:

Yogurt
Ricorta cheese, part skim
Skim or low-fat milk
Provolone cheese
Mozzarella cheese, part skim
Sardines with bones, canned
Salmon with bones, canned
Calcium-fortified orange juice

Anxious to resume activities following transplant, many patients inquire about the timeline for their recovery.

The following list describes different activities and recommendations about how and when to start:

EXERCISE

It is recommended that patients begin light exercise immediately after transplant. This involves walking-and lots of it. Although patients may not be in the best physical shape because of previous kidney failure, they need to push themselves, even if the exercise is tiring. After several weeks, riding a stationary bike offers another good source of exercise. By six weeks post-transplant, patients can start virtually any activity within reason. However, any new activity should be started slowly.

WARNING: If you have any of the following symptoms, stop your exercise until you talk to your doctor.

Pain or pressure in your chest, neck, or jaw.
A lot of fatigue that is not related to lack of sleep
Unusual shortness of breath
Dizziness or light- head ness during or after exercise.
Continuing rapid or irregular heart rate, new since your transplant, during or after exercise.

SEXUAL ACTIVITY

Besides returning to work or school as soon as possible, you may resume sexual activity as soon as you feel well enough. How quickly you feel ready will depend a lot on your recovery progress. You should discuss this during your clinic visits.

Your sexual functioning may be affected by your transplantation. Certain medications can also interfere with sexual functioning. Some people avoid sexual activity because they are afraid of kidney rejection, of hurting the kidney, or of infection. If you have any of these fears, you may want to check with your transplant team..If you are sexually active and do not have a steady sexual partner, you must use condoms to reduce the risk of sexually transmitted diseases such as AIDS, syphilis, herpes, hepatitis, or gonorrhea. You must use contraception to prevent unplanned pregnancy also.

DRIVING

Most patients can resume driving about three to four weeks post-transplant. Before driving ensure that your wound is healing well, that you are alert and not fatigued, no longer experiencing significant pain or taking medications that can cause drowsiness. It is recommended that another adult driver accompany you on your first drive post-transplant.

WORK

Transplant patients can consider returning to work after about six weeks, although this time-line varies by individual. Some patients actually do some work earlier (if it involves low stress and little physical activity), while some need more time.

PART II

THE ROAD TO RECOVERY:

Medications After Transplant, Your Life Line

MEDICATIONS

You are responsible for taking the medications that have been prescribed for you. Talk to your doctor, pharmacist, transplant nurse and/or coordinator so you understand:

The name and purpose of each medication
When to take each medication
How to take each medication
How long to continue taking each medication
Main side effects of each medication.
What to do if you forget to take a dose.
When to order more medication so you do not run out
How to get your medication
What you should avoid (such as drinking alcohol or driving) while you are taking medication.

At home, you will continue taking most of the medicines you began taking in the hospital after your surgery.

Your immune system recognizes your new kidney as foreign and will try to reject it. Therefore, your immune system must be controlled with antirejection medications. You probably will have to take one or more of these drugs for the rest of your transplanted kidney's life, in addition to other medications.

REMINDER: Never stop taking your medications or change the dosage without your transplant team's approval. There is always a risk of rejection and loss of the new kidney.

GENERAL GUIDELINES FOR STORING YOUR MEDICATIONS

Keep medications in the original container, tightly capped. If you use a special container to hold your pills, keep the container tightly sealed.
Store in a cool, dry place away from direct sunlight.
Do not store medications in the bathroom- moisture can cause them to lose their strength.
Do not allow liquid medications to freeze.
Do not store medications in the refrigerator unless your doctor or pharmacist advises you to do so.
Keep all medications away from children.

BEFORE YOU TAKE YOUR MEDICATIONS

Ask your nurse, transplant coordinator, or pharmacist to help you choose the best times to take your medications.
Try to take each medication at the same time every day.
Follow a written schedule.
DO NOT cut or crush a tablet unless your are advised to do so.

NOTIFY YOUR TRANSPLANT TEAM IF YOU…

Cannot take your medicines by mouth because of illness.
Have a long illness (nausea, vomiting, diarrhea)
Think the directions on the label may be different from what you were told
Have trouble removing child- resistant caps
Have a reason to take aspirin, Tylenol (acetaminophen), Advil (ibuprofen, other pain relievers, cold remedies, or diet pills
Feel you are having a reaction to your medications
Have had a change in health or eating habits
Have a new prescription from your local doctor or a change in a current prescription
Experience any unusual symptoms or side effects, since they may be related to the medication you are taking.

COMPLICATIONS

Complication after Surgery

A number of complications are possible after surgery. There is no way to predict for sure which patients will have which problems. Your transplant team will do their best to reduce your chance of having complications and to treat them right away if you have any. Following instructions carefully and keeping your transplant team informed of any problems will help you return quickly to a normal, active life.

Infections

Anti-rejection medication interferes with your natural immunity; therefore, you will be more likely to get infections after your transplant surgery. The following are some of the most common infections.

Viral Infections:
Cytomegalovirus (CMV) - CMV is one of the viral infections that occur most often in transplant patients. The risk of CMV is highest in the first months after transplantation. Signs include fatigue, high temperature, aching joints, headaches, trouble seeing, and pneumonia. Treatment may include hospitalization, and you may have to take medicine intravenously or by mouth for several weeks or months, even after discharge from the hospital. Herpes- simplex virus type 1 and 2- These viruses most often infected the skin but can also turn up in other areas like eyes and lungs. Type 1 causes cold sores and blisters around the mouth, and type 2 causes genital sores.

Herpes is an infectious disease and can be transmitted sexually. Herpes infections in transplant patients, however, are not necessary transmitted sexually. Most herpes simplex infections are mild, but sometimes they can be severe. Although there is no cure for herpes, it can be treated. Depending on the severity of the infection., The treatment is either by mouth, on the skin, or intravenous. Contact your transplant team right away if you think you have herpes.

Symptoms of herpes include feeling weak and having painful, fluid-filled sores in your mouth or genital area. Women should also watch for any unusual vaginal discharge.

Precautions:

Keep the sore areas as clean and dry as possible.
Wash your hands with soap and water after touching the sore.
Wear loose-fitting clothing to avoid irritating the sores and spreading the virus.
Avoid kissing or having oral sex with someone who has a cold sore.

Herpes zoster (shingles)- Shingles appears as a rash or small water blisters, usually on the chest , back or hip. The rash may or may not be painful. Call your transplant tean if you have this kind of a rash.

Varicella zoster (chicken pox)- Chicken pox may appear as a rash or small blisters. Call your transplant team immediately if you have been exposed- do not wait to see if you are going to get sick.

Fungal Infections: Candida (yeast)- Candida is a fungus that can cause a variety of infections in transplant patients. It usually starts in the mouth and throat but may also be in the surgical wound, eyes or respiratory and urinary tracts. Candida is most severe in the bloodstream. If there is infections in the mouth or throat. It is called thrush. Thrush causes white, patchy lesions (raw areas), pain tenderness, a white film on the tongue, and difficulty swallowing. Candida can also infect the tube from the mouth to the stomach (esophagus) or, in women, the vagina. Vaginal infections usually cause an abnormal discharge that may be yellow or white. Call your transplant team if you think you have a yeast infection. Treatment of severe fungal infections may include hospitalization where you may receive an IV drug such as Amphotericin B, AmBisome, Abelcet, Amphotec.

Bacterial Infections:
Wound Infections- Bacterial wound infections happen at the surgical site. If you have a fever or notice redness, swelling, tenderness, or oozing at your incision, call your transplant team. After a test for bacteria is taken, you will be given an antibiotic if you have an infection.

Other Infections:
Pneumocystis carinii is a germ that is a lot like a fungus, and it is normally found in the lung. In people whose immune systems are suppressed (such as transplant patients), it may cause a type of pneumonia. Early in the illness, you might have mild, dry cough and a fever. If you think that you have a cold or flu- like illness that does not get better, contact your transplant team right away.

If you have been after on peritoneal dialysis, your catheter will likely be left in place for several months after transplantation. It is important to continue to take regular care of your peritoneal catheter exit site to prevent infection.

REJECTION

Your Body's immune system protects you from infection by recognizing certain foreign bodies, like bacteria and viruses, and destroying them. Unfortunately, the immune system sees your new kidney as a foreign substance also. Rejection is an attempt by your immune system to attack the transplanted kidney and destroy it. To prevent rejection, you must take anti-rejection medications, as prescribed, for the rest of your kidney's life.

In spite of all precautions, rejection can occur. Up of half of all kidney-transplant patients will have at least one rejection episode often happens within 2 to 3 months of surgery. Rejections are usually controlled by changing the dosages of your anti-rejection medications or adding a new one temporarily. Kidney rejection does not necessarily mean kidney failure.

Most episodes of rejection can be reversed with anti-rejection medications. If they are detected early, most rejection episode can be reversed successfully. You should look for the signs of rejection and call your transplant team promptly if you have the following:

Fatigue/ weakness
Fever
Pain or tenderness over your kidney transplant
Less urine output that usual
Swelling of your hands or feet
Sudden weight gain

You may not have any symptoms, but your kidney- function test may be abnormal, suggesting that rejection is happening. This is why getting lab test done as scheduled is critical.

When your transplant team thinks you are having a rejection, they usually confirm it with a kidney biopsy. Based on the results, your transplant team will decide the best treatment for you.

DELAYED GRAFT FUNCTION
The functioning of your kidney transplant may be delayed, causing a need for dialysis until the kidney "wakes up". Delayed functioning may last from several days to several weeks.

ANXIETY AND DEPRESSION
A serious operation such as the one you have had can put a lot of stress on you and your family. It is common for transplant patients to have anxiety and perhaps depression after their surgery, stay in the hospital, and return to work or school. Ask your transplant team for information about these services.

DIABETES
Some of the anti-rejection medications that you take may cause diabetes. Diabetes is an increased level of sugar in your blood. Signs of diabetes may include being thirstier, urinating more often, having blurred vision, and being confused. Call your transplant team if you have any of these signs. Early may need an oral diabetes drug or insulin injections. If you get diabetes, you will be given special teaching about how to deal with this problem.

HIGH BLOOD PRESSURE
High Blood pressure and heart disease are common disorders that people get more as they grow older. High blood pressure is also a side effect of some of the medications you will be taking. You may need to take another medication to control your blood pressure or your transplant doctor may make a change in your anti-rejection medication. There are many different medications before you find the right one, Your tranplant team or local health care provider will choose the one that works best for you. You may also be given a water pill (diuretic) to lower your blood pressure, increase your urine output, and remove extra fluid.

INFORMATION ABOUT SPECIFIC MEDICATIONS
This section is a general guide to each medication's function, proper use, dosage, precautions, and side effects. The information does not cover everything about each medication and does not replace your doctor's advice. It is just an overview. Always follow the instructions given to you by your transplant team. Not all of the medications talked about in this handbook will be prescribed by your transplant doctor. You probably will not experience all of the side effects listed for each medications. Also, side effects usually decrease with time.

ANTIREJECTION MEDICATIONS
Tacrolimus (Progaf)

Purpose: Tacrolimus is used to prevent or treat rejection in people who have received kidney transplants. You may have to take it for the rest of your kidney's life.

How to take:

Capsules- 1mg (milligram) and 5 mg. If you take tacrolimus twice daily, doses should be 12 hours apart. Either oral or intravenous tacrolimus may be given to you immediately after your transplant.
Your transplant team will determine the right dosage for you based on you r weight, your blood levels, other lab tests, and the possible side effects of tacrolimus.
Tacrolimus should be taken 1 hour before meals or 2 hours after meals. It is important to do this regularly to keep drug levels steady.
Tacrolimus is usually taken with:

- Corticosteroids, such as prednisone (Deltasone)
- Azathioprine (Imuran) or mycophenolate mofetil (CellCept)

Precautions

You will probably have frequent lab tests during the first few months to keep watch on the effectiveness and side effects of tacrolimus.
On a day when your tacrolimus level is to be measured, do not take your morning dose until your blood has been drawn.
Store tacrolimus at room temperature (59` to 86`F) and away from children.
Tacrolimus may interact with some commonly used drugs including those purchased over the counter. Check with your transplant team before starting any new medications.
The benefits of taking this medication if you are pregnant or breastfeeding must be weighed against the possible danger to you, your unborn baby, or your infant. Call your transplant team immediately if you think you are pregnant.

Main side effects:
These include, but are not limited to headaches, nausea, diarrhea, high blood sugar, tremor, hair loss, trouble sleeping, numbness and tingling of your hands or feet and abnormal kidney function.

Switching drugs:
Your transplant team may decide to give you tacrolimus instead of cyclosporine (Sandimmune, Neoral), because of side effects such as rejection, high cholesterol, high blood pressure, excessive hair growth, tremors, overgrowth of gums or need for gum surgery or to reduce or alter other drugs you may be taking, such as steroids. If this happens, follow the instructions of your transplant team.

Cyclosporine (Sandimmune, Neoral)®
Note: Sandimmune, Neoral and generic cyclosporine A should not be substituted for one another except under the direction of your tranplant team.

Purpose:
Cyclosporine is used to prevent rejection of a transplanted kidney. You may have to take it for the rest of your life.

How to take:

Capsules- 25 mg, 50 mg, and 100mg. If you take cyclosporine twice daily, doses should be 12 hours apart. You may be given intravenous cyclosporine for the the first few days after your transplant.
Liquid 100mg per ml (milliliter). The liquid form will taste better if you mix it with milk, chocolate milk, or orange juice. Mix it with a room-temperature liquid in a glass or hard plastic container and stir it with a metal spoon. Do not use a plastic foam container.
Your transplant team will determine your dosage based on your dosage on your weight, your blood levels, other laboratory test, and the possible side effects of cyclosporine.
Cyclosporien is usually taken with:

- Corticosteroids, such as prednisone (Deltasone)
- Azathioprine (Imuran) or mycophenolate mofeil (Cell Cept)

Precautions:

You will probably have frequent lab tests during the first few months to keep watch on the effectiveness and side effects of cylclosporine.
On a day when your cyclosporine level is to be measured, do not take your morning dose until your blood has been drawn.
Store cyclosporine capsules below 77°F, store liquid below 86°F. Do not leave cyclosporine in your car or store it in a refrigerator or bathroom medicine cabinet or exposed to direct light. Good places to store this drug include the kitchen or your bedroom- away from heat, cold, moisture, and children.
An open bottle of liquid cycloporine is good for 2 months. You should not remove a capsule from a wrapper until you are about to use it.
Cyclosporine interacts with many commonly used drugs including those purchased over the counter. Check with your transplant team before starting any new medications.
The benefits of taking this medication if you are pregnant or breastfeeding must be weighed against the possible danger to you, your unborn baby, or your infant. Call your transplant team immediately if you think you are pregnant.

Main side effects:
These include, but are not limited to, headaches, tremor, abnormal kidney function, high blood pressure, high blood sugar, hyperlipidemis, excessive hair growth, trouble sleeping, swelling or overgrowth of the gums, need for gum surgery.

Switching drugs:
Your transplant team may decide to give you cyclosporine instead of tacrolimus (prograf), or the other way around, because of side effects. If this happens, follow the instructions of your transplant team.

Prednisone (Deltasone)- prednisolone, a related drug, is used for some patients.

Purpose:
Prednisone helps prevent and treat rejection of transplant kidneys. You may have to take it for the rest of your kidney's life.

How to take:

Tablets come in several different strengths; your transplant team will decide the best tablet strength; liquid- 5 mg per ml; injectible forms are also available.
It is best to take prednisone with food.
Avoid taking prednisone within hour of taking antacids or antiulcer medications.
If you take predinisone once a day, you should take it in the morning- ask your transplant team for specific directions. Your transplant team will determine the right dosage for you according to your weight, how well your transplant is functioning, and the length of time since your transplant.

Precautions:

The benefits of taking this medication if you are pregnant or breastfeeding must be weighed against the possible danger to you, your unborn baby, or your infant. Call your transplant team immediately if you think you are pregnant.

Main side effects:
These includes, but are not limited to, fluid and salt retention, muscle weakness, hyperlipidemia, bone disease, stomach ulcers, difficulty with wound healing, acne, mood swings, anxiety, cataracts, glaucoma, weight gain, and slow growth in children.

Azathioprine (Imuran)®

Purpose:
Azathioprine is given to you with other drugs to help prevent rejection of your new kidney. You may have to take it for the rest of your kidneys's life.

How to take:

Tablets- 50 mg; liquid- 10 mg per ml. Intravenous azathioprine may be given to you for the first few days after transplantation.
Your transplantation team will determine the right dosage for you based on your weight and white blood cell cont.