The ability of the urinary bladder to store urine at low pressure and to empty completely at intervals with simultaneous relaxation of the sphincter complex is essential to preserve the integrity of the kidneys and to achieve continence. Although an…
Kidney transplantation is a major surgical procedure that involves both vascular and ureteric anastomoses, and it is usually performed by a dedicated transplant surgeon, although in the past it was performed predominantly by urologists or vascular surgeons. Most recipients are…
Historical Background The study of histocompatibility accelerated during the 1960s when the pioneers of clinical kidney transplantation recognized that graft destruction was mediated through immunologic mechanisms. In 1961 the introduction of chemical immunosuppression, first 6-mercaptopurine followed soon after by azathioprine…
Introduction At the start of the first transplant programs, the donor and recipient would be operated in the same surgical center. The only preservation method therefore undertaken would be to flush out the kidney with either blood or Ringer’s lactate…
Deceased Donor Nephrectomy Deceased donor renal donation predominates as the source of transplantable kidneys. In the US, deceased donors provide approximately 13,000 kidneys per year or 70% of the available pool of transplantable kidneys ( Fig. 8.1 ). Recent years…
History of Living Donation and Donor-Related Ethics The first long-term successful organ transplant was a living donor kidney transplant between monozygotic twin brothers performed in 1954 at the Peter Bent Brigham Hospital in Boston. This procedure marked the first time…
Introduction As the number of people awaiting organ transplantation grows yearly, the relative scarcity of available organs increasingly requires a standardized, evidence-based approach to the management of each donor. From the initial diagnosis of death by neurologic criteria or imminent…
Introduction Worldwide the population of patients with chronic kidney disease (CKD) is expanding, leading to increasing numbers of patients hitting end-stage renal failure (ESRF) and requiring renal replacement therapy (RRT). In the UK the incidence of new dialysis starters increased…
The Patient with Chronic Kidney Disease The insidious nature of progressive uremia deludes many patients with chronic kidney disease (CKD) into failing to take the opportunity to understand their disease; learn about their dialysis, transplant, and palliative care options; and…
Introduction Renal replacement therapy (RRT) is a general term encompassing a range of different treatment modalities for patients with what was formally termed acute renal failure and end-stage kidney disease, which are now called acute kidney injury stage 3 (AKI-3)…