Human body organs have for ages been medically moved from one person to another to replace damaged ones, but neurologists say the most common one is the kidney transplant.

According to Charles Sindabimenya, a nephrologist at Doctors Plaza Kimironko, Kigali, kidneys are vital organs in the body, and without proper care they can get damaged hence requiring a transplant to survive which is costly and risky.

He notes that illness such as malaria, sudden dehydration and urinary tract obstruction can lead to the failure of the kidney. This stage is known as acute kidney failure or acute renal failure, but here a patient can be treated without a transplant.

"At this stage, a patient should first be treated for the disease that resulted into kidney failure. After dealing with the cause, the kidney itself should be treated to avoid further complications that could a rise due to poor treatment,” he says.

Francis Kazungu, a general practitioner in Kigali, says acute kidney failure can develop into chronic kidney failure if not managed well, where the only option is a transplant or dialysis.

He says this can happen either if the patient didn’t get proper treatment during the acute stage; or due to other diseases that could result in chronic kidney failure.

"The commonest causes of kidney failure are diabetes and hypertension. High blood pressure damages the blood vessels in the kidney reducing their ability to function well. This can weaken the blood vessels throughout the body,” he says.

Kazungu says although there are also other diseases that cause kidney failure, these two (diabetes and hypertension) are the most known common cause for this condition.

He notes that at the chronic level, the kidney is believed to have shut down completely, and a transplant or prerenal dialysis should be done.

Although other treatments can be done to a patient with chronic kidney failure, Kazungu says the ideal one is a transplant.

Who should be a donor?

Didier Nkurikiyezu, the executive director of Healthy Kidney Foundation Rwanda, says for one to donate a kidney, they should be healthy in the first place.

"Before one qualifies to be a donor, they should be tested for chronic illnesses, inactive diseases and any restriction that would lead to kidney rejection,” he says.

Diseases such as tuberculosis, HIV/AIDS, hepatitis, and cancer, among others, are the ones that a donor should be free from.

"If found to be having one of them, one ceases to be a candidate. Therefore, detailed examining is required before transplanting the kidney. Failure to do so, there is high chances of kidney rejection,” Nkurikiyezu says.

He says another key factor that should be considered about the donor is that their blood should be compatible with that one of the patient.

"If one is given a kidney of another person whose blood isn’t compatible, the body of the patient will react against it leading to serious complications,” Nkurikiyezu says.

For this reason, Sindabimenya says most of the time relatives of the patient are highly considered before any other people who share the same blood group with the patient.

"This is because, when a family member donates a kidney, there are minimal chances of rejection, unlike the case with outsiders where for some unknown reasons this may arise leading to complications,” he says.

For any donor, Nkurikiyezu adds that proper counseling should be done by a nephrologist. This is to make them understand the implications so that they don’t change their mind later.

He adds that there should be signing of consent before the beginning of the surgery.

The patient (recipient)

"The patient should be well dialysed prior to the transplant surgery to minimise post-operative complications. They should also be carefully assessed for risks, complications as well as of drug side effects,” says Yves Bandora Iraguha, a member of Healthy Kidney Foundation Rwanda, who doubles as a general nurse at Rwanda Military Hospital Kanombe.

Although a patient could be at risk of losing their lives if they don’t get a compatible kidney, Iraguha says there are some factors that are also considered before the replacement is done.

"For instance, for those aged over fifty, or with advanced cardiovascular diseases, as well as other advanced organ failures, there are higher risks of developing complication or rejection incase a transplant is done,” he says.

Iraguha explains that due to such conditions, one can be given a kidney but later their body rejects it due to some unknown reasons.

He also says that patients, who are already on medication for life, may be at risk of developing resistance or rejection.

Iraguha says some research shows that the function of the kidney starts depreciating as age advances.

Management after surgery

For the donor, Nkurikiyezu says as any other sugeries, complications may occur, but normally very minimal. He emphasizes that most importantly both donor and patient need review immediately after surgery.

"All drugs are chemicals, and they can cause reactions within the body, which can lead to some complications or cause some resistance.”

He notes that drugs should be given to control secondary infections as well as to reduce pain to the donor. As long as they have been found out to be stable by the doctor, they can be discharged and continue with normal life.

Nkurikiyezu says patients need review immediately after surgery, and frequently thereafter with repeated testing of electrolytes (nutrients or chemicals present in the body that have many important functions), monitoring of urine output and re-assessment of fluid balance.

Immunosuppressive drugs should always be given to prevent rejection of the kidney. Habits such as smoking and drinking alcohol should be stopped if someone has had their kidney replaced.

"This is because such habits increase chances of kidney rejection. The patient should also strictly take their medications as prescribed,” he says.

Besides, he points out that after the transplant, the kidney is likely to work effectively for 10-15 years; after that, it’s believed that its function starts to go down again.

Habits to avoid

According to Kazungu, before the kidney failure reaches the chronic phase, there are some habits that need to be eliminated. And to prevent that, people should try to prevent anything that can result to developing kidney complications.

"For instance, keeping the urine in your bladder for too long is a bad vice which should be avoided in order to keep our kidneys healthy,” he says.

Kazungu explains that a full bladder can cause bladder damage because the urine that stays in the bladder multiplies bacteria quickly, and once the urine refluxes back to the urethra and kidneys, the toxic substances can result in kidney infections.

"Further, the urinary tract infections will lead to nephritis, and even uremia. All this can result into the kidney failure. Therefore, relieving yourself as soon as the urge comes is essential,” he adds.

Iraguha says limiting the amount of salt is essential because a lot of it does a lot of damage to the kidney. He advises that 5.8 grams of salt daily is the recommended amount.

He also says reducing protein in your diet prevents one from being a victim of kidney problems.

"The reason is that protein digestion produces ammonia (a toxin that is very destructive to the kidneys), leading to kidney damage.

"Caffeinated products should be avoided because caffeine raises blood pressure, resulting in kidney problems.

"Kidneys should be hydrated properly to perform their functions well. Therefore, drinking a lot of water is ideal. When one drinks less, the toxins start accumulating in the blood due to less fluid to drain them through the kidneys,” he says.

Additionally, treating all health problems will ensure a healthy kidney.

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EXPERT TIPS

Alphonse Muhizi, medic at AVEGA Clinic, KisementiThe first thing is to prevent diseases such as diabetes, high blood pressure by trying to stay healthy, eating right as well as exercising. Habits such as smoking and excessive alcohol consumption are vices that should be avoided as they can lead to diseases that damage the kidney.

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Phiologan Kwizera, medical studentFoods that have high water content such as watermelon and pumpkin help the kidney in flashing out toxins. On the other hand, limiting the amount of salt one takes is important as it tends to enhance the depositing of fat in the blood vessels, which could result in complications for organs in the body including kidney.

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Yvan Ntwari, medic at University Teaching Hospital, Kigali (CHUK)A healthy diet that contains mostly vegetables and fruits, whole grains and low fat dairy products is ideal. One should also limit sweetened foods and drinks. In case of any other conditions that come suddenly, immediate medical attention is needed as some of them may result into kidney problems.

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Immaculate Kiza, medical student at University of RwandaThe best approach lies in a good lifestyle. In case of acute kidney failure, proper treatment should be done to avoid further complications that may arise later. Maintaining a balance between salt and water intake is important when it comes to dealing with kidney problems.