The New Nation - Internet Edition

Most people know that a major function of the kidneys is to remove waste products and excess fluid from the body. These waste products and excess fluid are removed through the urine. The production of urine involves highly complex steps of excretion and reabsorption. This process is necessary to maintain a stable balance of body chemicals.

The critical regulation of the body's salt, potassium and acid content is performed by the kidneys. The kidneys also produce hormones that affect the function of other organs. For example, a hormone produced by the kidneys stimulates red blood cell production. Other hormones produced by the kidneys help regulate blood pressure and control calcium metabolism.

The kidneys are powerful chemical factories that perform the following functions:

remove waste products from the body

remove drugs form the body

balance the body's fluids

release hormones that regulate blood pressure

produce an active form of vitamin D that promotes strong, healthy bones

control the production of red blood cells

What is chronic kidney disease (CKD)?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

What Are the Warning Signs of Kidney Disease?

Kidney disease usually affects both kidneys. If the kidneys' ability to filter the blood is seriously damaged by disease, wastes and excess fluid may build up in the body. Although many forms of kidney disease do not produce symptoms until late in the course of the disease, there are six warning signs of kidney disease:

High blood pressure.

Blood and/or protein in the urine.

A creatinine and Blood Urea Nitrogen (BUN) blood test, outside the normal range. BUN and creatinine are waste that build up in your blood when your kidney function is reduced.

A glomerular filtration rate (GFR) less than 60. GFR is a measure of kidney function.

More frequent urination, particularly at night; difficult or painful urination.

Puffiness around eyes, swelling of hands and feet.

kidney transplant?

A kidney transplant is an operation in which a person whose own kidneys have failed receives a new kidney to take over the work of cleaning the blood.

There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse or close friend, and in some cases a stranger who wished to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants.

Living Donor Kidney Transplant

There are many advantages for patients who receive an organ from a living donor rather than from a deceased donor.

A living donor kidney is the best quality of kidney that a patient can receive. It can be thoroughly tested before the transplant.

There is less chance of rejection and kidney recipients may not have to take as many immunosuppressive medications.

Recipients do not have to wait the three to five years it can take to receive a deceased organ.

A living donor kidney will last longer than a deceased donor kidney. The life span for a living donor kidney is almost twice that of deceased donor kidneys. In other words, half of the living donor kidneys transplanted today will still be functioning 25 years from now, whereas half of the kidneys from a deceased donor will be functioning ten years from now.

Most living donor kidneys work well immediately, where as a deceased donor kidney does not immediately work as well.

Our Transplant surgeons say a kidney transplant is not a complicated surgery and people should not be afraid to donate a kidney to help save another person's life.

Dr. Lye Wai Choong, our world famous kidney transplant specialist emphasizes living donor kidney transplants as the best option for patients. Live donors may be related or unrelated to the patient. Living donor organs offer many advantages including:

The living donor kidney is the best quality kidney that a patient can receive because the donor can be tested thoroughly prior to transplantation.

Living donor kidneys last longer. Half of living donor kidneys transplanted today will still be functioning 25 years from now, whereas half of cadaveric kidneys will fail in the first 10 years.

The living donor kidney can be transplanted immediately. The waiting time for a cadaveric kidney ranges from three to five years.

Most living donor kidneys function immediately after transplantation, while many cadaveric kidneys do not function well initially.

Kidney Transplant Centre at Mount Elizabeth Hospital is worldwide leader in "HALKT" (Hand Assisted Laparoscopic Kidney Transplant) & "HALDN" (Hand Assisted Laparoscopic Donor Nephrectomy) in which the donor's kidney is removed through a remarkably small incision & transplanted to recipient's body using a multi-activity laparoscope. This procedure is safer for both the recipient & donor, involves less pain and allows quicker recovery.

About the Procedure

Live donor Laparoscopic Transplant

Laparoscopic surgery is performed by inflating the abdomen with gas, usually carbon dioxide, which creates a space between the wall of the abdomen and the organs inside.

Using short incisions in the skin, narrow tubes are inserted through the abdominal wall so that instruments can be slid through them to perform the maneuvers necessary for the operation. All this is viewed directly on a video monitor which receives its picture from a video camera attached to the laparoscope.

Using these techniques, operation on the gallbladder, stomach, intestines, kidney, and other organs is possible.

Laparoscopic Kidney Removal

Using narrow instruments inserted through tiny punctures no more than a ½ inch long it is now possible for the surgeon to free up the kidney and tie off the blood vessels. A short incision about 2 ½ inches long is made to remove the kidney. The site on the abdominal wall depends on the kidney to be donated because the donor is positioned on the operating table with the chosen kidney uppermost (see diagram below). The place is selected for cosmetic considerations and reduced disturbance to the muscles underneath in order to minimize pain.

The Operation

Four or five tiny incisions are made in the abdominal wall for the video equipment and instruments to dissect, insert metal clips, staples or tie knots, and remove the kidney from its attachments. A blood-thinning drug (heparin) is given to prevent blood clotting in the kidney after it is removed. The kidney is placed in a bag and extracted from the abdomen through a short incision (5 in above diagram) and chilled on ice. It is then prepared for immediate implantation into the recipient who will already be anesthetized in an adjoining operating room. Drugs are given to make the kidney excrete large volumes of urine just before removal so a catheter is left in the bladder to measure the urine output and keep you comfortable. It is usually removed within a few days.

Benefits

The advantages of laparoscopic surgery come from minimizing the trauma of access to internal organs. By avoiding a long incision through the muscles, many post-operative problems are eliminated and pain is markedly reduced. This enables the donor to breathe and cough better. Use of strong pain medications is drastically reduced so the drowsiness, fatigue and unsteadiness they cause is minimized.

Admission and Discharge

Admission takes place two hours before the planned procedure. The donor operation takes 3-4 hours and the recipient operation lasts about 3 hours. In addition, the time necessary for anesthesia before and after operation may be 30-60 minutes. We will call your waiting relatives as soon as the surgery is finished to report on your progress.

You will be allowed to drink a few hours after you wake up and will start light foods the next day. The area of the kidney often slows normal bowel function so return to a normal diet must be cautious. You may be able to go home the next day, or the day after depending on how comfortable you are.

-Parkway Health

Michael Torchia

Our current strategy to cure the obesity epidemic focuses on individual weight loss when instead we need to transform the American lifestyle as a whole. As a capitalistic society, we embrace any innovation that promotes convenience and efficiency. Naturally, fast food, movies in the mail, online shopping and TV dinners have become mainstays of the American lifestyle - not to mention beach-ball bodies. The percentage of Americans ages 20 to 74 with body mass indexes (BMI) higher than 25, which is classified as "overweight," has risen from 45 percent in 1961 to 66 percent in 2008, according to the Center for Disease Control and Prevention.

American-born, African, Hispanic and Asians between the ages of 12 and 15 are more than twice as likely to be obese than their peers who were born in their own countries, according to a University of North Carolina study. From fast food restaurants to movies in the mailbox, the way we live fuels America's escalating obesity rates. Far too often, weight-loss experts blame our genes for this dismal statistic. In the book, "Rethinking Thin," New York Times science writer Gina Kolata argues that most people who are overweight struggle to slim down their entire lives, but remain stuck "within a relatively narrow weight range set by their genes." Although it is true that our genes are working against us - human evolution has favored genes that conserve energy, and therefore store fat, for survival in times of scarcity - the facts remain. First of all, we cannot change our genes. Secondly, in the early 1960s, the majority of Americans were at a healthy weight. The human genome has not changed in a span of less than 50 years. And genes can't explain why there's a higher adolescent obesity rates in American-born minorities than in immigrant adolescents. In both cases, the groups with the higher incidence of overweight subjects have one thing in common - the modern American lifestyle. Although we can't modify our "weight genes," we can change the culture that allows them to express their predisposition to store fat.

We are making progress in our quest to change the shape of the average American, but it might be in the wrong direction. From government Web sites like www.mypyramid.gov to America's $40 billion weight-loss industry, slim-down resources now appear everywhere. Even some advertisements for diet pills are telling us the right way to lose weight. According to a nanoSLIM ad issue of Abs Magazine, regular exercise and proper nutrition are essential for achieving your weight-loss goals. It's great that we are trying to turn things around, but it's obviously not helping that much. Only 5 percent of attempts to lose weight and keep it off end in success, according to the FDA.

The problem is that we aren't looking at the big picture - the big picture being the American way of life. Our current strategy to cure the obesity epidemic focuses on individual weight-loss when instead we need to transform the American lifestyle as a whole. We need to start centering social events around "active fun" like long walks or dancing instead of oversized, fried meals and alcohol. We need to make nourishment - not gluttony - a priority of eating once again. A sedentary workday should be punctuated with exercise breaks instead of latte breaks.

Every American, heavy or fit, needs to make an effort to change our culture. Thousands of overweight people die each year from complications associated with Type II diabetes, coronary heart disease cancer. Even worse is the humiliation, discrimination and emotional damage that being fat in America brings. But if compassion isn't your thing, taking personal responsibility to change the American culture could save you a lot of money in taxes. Staggering obesity rates account for $117 billion in U.S. healthcare annually, according to the FDA.

So get moving. Ask a friend to take a neighborhood stroll with you rather than catching up over chips and queso. Plan a camping trip or a sand volleyball game rather than organizing a keg party. Contact your favorite campus restaurant and suggest that they add some healthy choices to the menu. During your lunch breaks, get a few of your colleagues to walk with you to a healthy restaurant instead of driving to the nearest fast food restaurant. Although one person can't change the entire American way of life, such individual efforts constitute crucial baby steps towards a collective initiative. If everyone starts spreading these healthy habits within their circle of friends, family members and co-workers, the ripple effect will create a groundswell of attitude and behavior change that will revolutionize the American way of life.

Soon, inexpensive fast-food joints will be forced to swim with the current, adding even more light, nutritious meal options than they already offer. Overpriced health-food restaurants such as Whole Foods will have to lower their prices to remain competitive. A healthy lifestyle will become more affordable all around, providing even the lower socioeconomic classes - the segment of society with the highest obesity rates - with the resources necessary to slim down. But all this begins with individual efforts to positively change our lives and the lives of the people closest to us. If we make sure that an unhealthy lifestyle is no longer the norm, a BMI over 25 won't be either.