3-15. KIDNEY TRANSPLANTS
A possible solution for a patient with very limited renal function is to have a
healthy kidney transplanted into his body. Many hundreds of kidney transplants have
been performed successfully during the last several years. The transplant kidney must
be from a donor whose tissue is compatible with the patient's tissue. Records show that
the likelihood that a transplant will be successful is greatest when a living donor who is
closely related to the patient is used. However, organs from deceased donors have
proven satisfactory in many cases. The problem of the patient's body rejecting the
transplanted kidney is still a major difficulty. Extensive tissue cross-matching is done,
and immune-supressing drugs are used to try to avoid problems with the transplanted
kidney. If the patient's body rejects the transplanted kidney, he will have to return to
dialysis therapy.
NOTE:
Individuals can usually do well with only one kidney. The reason is that the
kidneys have a great deal of extra functioning tissue.
Section IV. DISORDERS OF THE URETERS
3-16. URETER ABNORMALITIES/OBSTRUCTIONS
Abnormalities in structure of the ureter include double portions at the kidney
pelvis and constricted or abnormally narrow parts called strictures. Narrowing of the
ureter, another abnormality, may be caused by abnormal pressure from tumors or other
masses outside the ureter. Ureters may be obstructed by stones from the kidneys. If a
small stone moves through the ureter, the patient will experience excruciating pain.
Ptosis of the kidney (the kidney dropping) can cause the ureter tube to kink.
3-17. TREATMENT OF STONES IN THE URETERS
a. Early Treatment. Early treatment for stones in the ureters was by "barber
surgeons" who removed stones in the ureters, operating without anesthesia. These
surgeons cut through the patient's skin and muscles of the back to remove stones from
the ureters. Termed "cutting for stone," this method was relatively successful even
though there was no sterile technique. The reason was because by approaching the
stones through the back, the peritoneal cavity was avoided, thus reducing the risk of
deadly peritonitis.
b. Present Day Treatment. Modern surgery uses a variety of instruments for
removal of stones from the ureter, including endoscopes. Stones in the ureter are
removed by the transurethral route. That is, removal is through the urethra and the
urinary bladder from the ureter. Entrance through the skin and muscles of the back may
be used to remove calculi from the kidney pelvis or from a ureter.
MD0579
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