Disease Information

Why You May Need a Kidney Transplant

The Healthy Kidney

The kidneys perform several critical functions including:

• Filtering the blood to remove waste products such as nitrogen and creatinine that can become toxic if left to accumulate.
• Removing excess fluid that can accumulate around the heart and lungs.
• Returning nutrients to the blood stream.
• Producing a substance that helps regulate blood pressure.
• Producing a substance that is necessary for red blood cell production, thus preventing anemia.

The kidneys are two bean-shaped organs, weighing about four to six ounces each in adults and located on either side of the spine behind the upper abdominal organs. About one-fourth of the blood volume pumped during each heartbeat goes to the kidneys. This adds up to about 160 quarts of blood every 24 hours. From this, about 1 1/2 quarts of urine are eliminated through the bladder. The kidneys filter the blood using tiny components called nephrons and glomeruli.

The Failing Kidney

Some of the most common causes of kidney failure include:

• hypertension (high blood pressure)
• diabetes mellitus
• kidney stones
• inherited kidney disease
• inflammatory disease of the nephrons and glomeruli
• side effects of drug therapy for other diseases

When your kidneys fail to remove waste products from the blood, a condition known as uremia develops. Since you normally have more kidney functioning ability than you need, most people do not develop symptoms of kidney failure until 90% of kidney function is lost. Once this occurs, the work of your kidneys must be done by dialysis (an artificial means of filtering the blood) or function must be replaced by transplantation. One main advantage of transplantation over dialysis is quality of life. Many people prefer transplantation because they are able to return to a more normal lifestyle.

Why You May Need a Pancreas Transplant

Your decision to undergo a simultaneous kidney-pancreas transplant should involve many considerations. At Emory University Hospital , we consider kidney-pancreas transplantation for patients with Type I diabetes that are on, or close to requiring, dialysis. A kidney-pancreas transplant can offer a better quality of life for such patients. With a new kidney, you will no longer experience renal failure, but your new pancreas also will maintain your blood sugars at a normal level. Kidney-pancreas transplantation thus can offer you the chance to return you to a more normal, productive lifestyle.

The Emory kidney-pancreas transplant team strives to thoroughly educate every candidate about transplantation. Post-transplant management can be difficult and demanding. You and your family must completely understand the risks, limitations, and benefits of a kidney-pancreas transplant before you can make an informed decision concerning the procedure. It is important that you understand that a kidney-pancreas transplant is an ongoing treatment, not a cure for your disease. You will need daily medications and rigorous follow-up by the transplant team and your local physician for the rest of your life.

The Healthy Pancreas

Your pancreas is a slender gland located between your stomach and spinal cord. This gland performs two major functions. First, it secretes two substances that control the amount of blood sugar in your body: insulin and glucagon. Insulin helps your body absorb blood sugar from the blood into your cells to produce energy. This process, however, also lowers your blood sugar level. Glucagon, on the other hand, raises your blood sugar level by stimulating sugar production in various organs.

The other function of your pancreas is to produce enzymes that are secreted into the small intestine to help with digestion.

Diabetes Mellitus and its Effect on the Kidneys

Diabetes mellitus is a disease in which the pancreas either manufactures very little or no insulin or the pancreas makes insulin but the body is unable to use that insulin properly.

There are two types of diabetes. Type I diabetes occurs early in life, usually by the age of 25. In this type of diabetes, your body's immune system attacks the insulin-producing cells of the pancreas. As a result, your pancreas makes little or no insulin, causing the level of your blood sugar to rise. If you have Type I diabetes, you must use insulin injections or an insulin pump to help control your blood sugar. Type II diabetes generally occurs later in life. In Type II, although the pancreas still makes insulin, your body resists the action of that insulin. One key difference between Type I and Type II is that Type II is generally easier to control, often by diet and exercise alone. When these are not effective by themselves, patients with Type II diabetes may take medications by mouth or require insulin injections.

Both types of diabetes may lead to serious, long-term complications. In the United States, 7.3 million people are living with diabetes. Of those, about 700,000 have Type I diabetes. Each year 30,000 new cases of Type I diabetes are diagnosed.

Over a period of time, the kidneys of patients with diabetes may also become damaged by the body's inability to maintain the proper balance of glucose. Kidney disease, one of the most serious complications of diabetes, causes at least one third of patients with Type I diabetes to experience kidney failure within 20 to 30 years after the onset of their disease.

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