Kidney Quest: Last Tests

In the last week, you will have the last tests. For us, the test came five days before the transplant. Alan and I returned to Mount Sinai for final testing. Since the HLA (Human Leukocyte Antigens) can change, within a week of the transplant, the recipient and donor must be re-matched to be sure we were still negative antigen reactive--i.e. he won't reject my kidney.

Alan had to have an X-ray and CAT scan. We both needed to be examined by an anesthesiologist. Alan had to be seen by the doctor who would do his surgery. I had to see mine.

So on surgery minus one week--you can expect:

1. an additional cross matching
2. and X-ray and CAT scan
3. a check-up by an anesthesiologist
4. a check-up with the surgeon

Site of kidney extraction:

Formerly, ribs had to be removed and the kidney was taken out from the donor's back. This left the donor in a lot of pain and often produced unsightly bulges in the muscles. Donors complained, so doctors began taking the kidney from the front. Still, ribs had to be removed.

Once laproscopic surgery became feasible, the kidney had generally been removed near the navel and no ribs were taken.

My doctor took it one step further. He would remove the kidney near the pubic bone. This would leave the scar hidden by bathing suits or underwear. I nice thought for a single, fifty-year-old!

It took us three months to complete everything. However, all the tests can be completed within three weeks. Most of the time and effort is spent before the surgery.

Kidney Quest: Save the Urine

Not a big enough bottle for the 24 hour urine test

Sunday, October 12, 2003, the day before the barrage of testing, I began the dreaded twenty-four hour urine collection.

Why must we collect a full day's worth?

This test is a more accurate measure of creatinine levels. Since creatinine is a muscle by-product, the more muscle one has, the more creatinine she produces. So weightlifters generally have high levels and babies have low ones.

That's the scientific end of the story. However, consider the logistics.

Mount Sinai mailed me a jug. It looked like a plastic half-gallon milk container. The opening was  about four inches in diameter. Have you, as a female, ever tried to pee in a milk bottle? (and I hope you males don't do it regularly).

Logistics:

1. How do you aim and get the pee into the bottle and not on your hands?
2. How do you hold a milk bottle under you and still fit over the toilet?
3. How do you go out anywhere, drink lots of coffee and not use the ladies' room?
4. How do you refrigerate it? Yes, you heard me right. The whole kit and kaboodle has to be refrigerated. (What if someone mistook it for apple juice?)
5. How do you fit a day's worth of urine in a half gallon jug?

Now isn't this juicy info for a blog? Tune in this weekend for the answers.

Related articles

• Kidney Quest: 24 Hour Urine Collection
• Kidney Quest: The Story of Organ Donation
• Kidney Quest: Initial Screening for Donors

Kidney Quest: Avoiding Dialysis

A hemodialysis machine, used to physiologically aid or replace the kidneys in renal failure (Photo credit: Wikipedia)

Unfortunately, Alan's kidney function deteriorated to about twelve percent--the point where dialysis is indicated. Transplant results improve if no dialysis occurs, so our five year wait shrunk to a matter of weeks.

My brother roofs. That means he spent twelve hours a day on the top of steamy roofs, hauling shingles, hammering them in and cleaning up. It was August, hot on Long Island and his busy season. If anyone knows a roofer, he knows this is not an easy job--one that is hard on a healthy body, and worse for one that is failing.

If potential donors weren't already incubating, Alan's nephrologist would have begun dialysis. Although hemodialysis saves lives, the procedure taxes the body. So with two of us being tested, he waited. Instead, he sent a nurse to Alan's home. She explained how a shunt would be insertd into an artery and vein that was grafted together in his abdomen.

Peritoneal dialysis (Photo credit: Wikipedia)

This fistula could then support the turbulent blood flow of the procedure. Then every night, while Alan slept, special solutions would be infused into his abdomen. They would stay there for a while and then be drained out. This process would keep him healthy.

He was lucky. He could do his dialysis at home. I worked with a man who used to take care of his dialysis at work until the illness sent him into retirement. Most people need to spend three to five hours in a hospital, three days a week. The process exhausts the patient along with the caregivers who must transport and often wait for the patient.

However, it would take four to six weeks for the fistula to heal, so they had to begin now.

Who would be the donor--Art or me? We clearly had a decision to make.

Have you had to have dialysis or known someone going through it? I'd love to hear your story.

Related articles

• Kidney Quest: The Story of Organ Donation
• Dialysis Treatment: How Does It Help Kidney Patients?
• Dialysis