- Temporery dialysis access: Subclavian vein/Jugular vein catheter, Perm catheter
- AV fistual for permanent dialysis
- USG guided renal biopsy.
- Other surgical operation:
Stone surgery
Lower Urinary tract Obstruction
Kidney, bladder, prostate surgery
Paediatric urological problem.
Radiology and Imaging
- Modern Ultra-sound with biopsy guiding facility
- Doppler study to see blood flow for organ
- X-ray with mobile unit
Emergancy department :
- 24 hour doctors on duty
- Facility for emergency intervention like jugular catheter/femoral catheter
- Intensive care management facility
Other surgical operation :
| Stone surgery
| Lower Urinary tract Obstruction
| Kidney, bladders, prostate surgery
| Pediatric urological problem.
All procedure and surgical operation performed at affordable prices
within your reach as compared to profitable centers.
How a kidney donor is selected in kidney foundation
The following relationship with patient is evaluated first.
| The Relationship is a must : -
• Parent to sibling
• Sibling to sibling
• Maternal and paternal uncle/Aunty
• Spouse to spouse
| Age-Between 18-65 years age
| Blood Group :
• 'O' for Universal donor
• AB for Universal recipient
• A and B similar with donor & recipient
The following disease are excluded from donor
• Diabetes, Hypertension, kidney disease,systemic disease affecting kidney,cancer :
The Kidney function and other test of donor must be normal :
| eGFR > 75 ml sqm/min
| UTP < 250 mg/ day
| HbsAg, Anti HCV, HIV, VDRL-all negative
| CMV- negative
Tissue Type : Should be done in all cases :
| At least 25% match with recipient. Cross match negative including
| T cell and B cell.
| Renal C-T angiogram..
| ECG/X-ray chest/other as & when necessary.
How a recipient is selected :
The recipient must be End Stage Kidney Disease
• Age -12 to 60 years age
The Cause of ESRD to be evaluated for recipient :
The following diseases are contra-indicated for transplant :
• Obstructive Uropathy
• Neurogenic bladder
• Accelerated Hypertension
• Acute myocardial infarction
• Severe left ventricular dysfunction
• Atherosclerotic changes in medium and great vessels
• Cancer
• Chronic infection
• Rapidly progressive GN of recent onset
• Active tuberculosis
• Active CMV infection.
| Preparation for a recipient :
• Physical fitness
• Control of Hypertension and diabetes
• Control of infection
• HbsAg, HCV, HIV, VDRL-negative
• Blood group/tissue type
• Psychiatric assessment
• Social assessment
• Economic condition.
| How a Kidney Recipient is prepared :
• eGFR- ? 15 ml-Preparation for RRT to be started
• Cause of ESRD-.
• A-V fistula constructed
• Monthly monitoring of renal function test.
Kidney foundation is also preparing to perform
cadaver/deceased kidney transplant :
Deceased kidney transplant :
| During life one can donate kidney only to close relations.
| After death, any body between 5-60 years of age can donate kidney.
| The death is defined as "Brain death" not the death of other tissue.
| Once brain tissue is dead the person is declared "death" by a team of doctor (brain death committee)
Evaluation and selection of deceased donor.
Once consent is obtained from close relations the following factors is to be considered for deceased donor.
a) Donor history on the mechanism of death
b) Period of hypotension or cardiac arrest.
c) Need for vaso-active medications
d) Previous surgery
e) Social history
f) Presence of infectious disease HIV, HbsAg, Anti, HCV, CMV
g) Specific organ function :
h) X-ray chest /ECG/ECHO
Absolute contraindication to deceased organ donation :
1. Malignancy outside CNS
2. Long standing Hypertension .
3. Prolonged warm ischaemia
4. Hepatitis-B surface antigen
5. Sepsis
6. Intravenous drug abuse
7. HIV infection
Relative contra-indication of deceased kidney donor :
Age > 60 < 6
Hypertension -
Diabetes mellitus
ATN
Cr > 2.5 mg/dl
Hepatitis -C
Prolonged warm and cold ischaemic time
Ideal deceased donors are young, brain death donors free of any disease with minimal warm ischaemic times.
Haemodynamic management of deceased donor :
1. Maintaining adequate blood pressure systolic > 100 mm of Hg
Urine out put > 100 ml/Hr
2. Maintaining adequate hydration, not over hydration.
3. Haemodynamic monitoring with
a) CVC
b) Arterial line
c) Pulmonary artery catheter
4. Vesopressure support :
a) Dopamine up to 15 mg/kg/min
(Renal dose 3-5 mg/kg/min)
5. Warm ischaemia time of less than one hour time.
Organ preservation :
Preservation of organ after retrieval is the cornerstones of successful transplantation.
Two methods for kidney preservation.
1. Static cold storage = 18-24 hour
2. Machine perfused Kidney = 24-30 hours