Transplant
As kidney functioning declines below 20%, we with PKD begin to think about transplant or dialysis. This can be delayed but with inherited PKD I have not found anyone with a GFR of 20 correct this or reverse it.
If one can find a living donor, even if they are not a match this is great news. There are many donor exchange programs underway and even some experimental stem cell research that has been found to be helpful. Study suggests breakthrough in organ transplants. Dr. Robert Montgomery from Johns Hopkins has pioneered organ exchange work and has been successful at getting medicare to pay for the donor exchange program at Johns Hopkins.
After transplant, several articles claim that alkalinity is best for renal transplant recipients. Higher intake of fruits and vegetables and lower animal protein intake is associated with less acidosis.
Medicare
When we reach this point in PKD, you will qualify for Medicare coverage if you are diagnosed with ESRD end-stage kidney disease and your doctor has written an order (prescription) for dialysis treatments. For people already on Medicare, coverage starts right away. For those under 65, coverage will not start until the fourth month of dialysis. If we reach dialysis or transplant we get full coverage from medicare for 36 months. If we have another insurance other than medicare, then medicare becomes secondary for 30 months and primary for the final six months.
Transplant vs Dialysis
A choice transplant or dialysis? One individual went straight to transplant avoiding dialysis altogether. If natives are removed prior to dialysis, kidney functioning is zero.
Transplant Donors
Doctors from Johns Hopkins removed a healthy kidney donor's organ vaginally.Paired Donor Exchange listen to a lecture. It was pioneered at Johns Hopkins by Robert Montgomery MD. Here is another link explaining Paired donation.
Transplant and Native Nephrectomy
Some possible reasons to have native kidneys removed:
Uncontrolled high blood pressure
Size (removal may give an energy increase)
Bleeding
Recurrent UTI
Renal Cell Carcinoma ↑ with PKD
Early satiety or pain
Simultaneous bilateral native nephrectomy and living donor renal transplantation are successful for Polycystic Kidney Disease: University of Maryland experience: Bilateral nephrectomy, immediate transplantation in patients with ADPKD done.
Native nephrectomy in PKD transplant patients performed laparoscopically. Hematuria in such patients should not be assumed to be of benign origin and requires exclusion of urinary tract malignancy as there is an ↑ incidence of Renal Cell Carcinoma in PKD.
Staged nephrectomy vs bilateral laparoscopic nephrectomy in patients with autosomal dominant polycystic kidney disease. Renal transplantation and ipsilateral native nephrectomy carry no significant additional morbidity compared to that of renal transplantation alone.
Transplant Centers
Locate a transplant center by entering your zip code.Preventing Acute Kidney Injury
Preventing further acute kidney injury is a world wide problem. Here is a booklet outlining suggestions for physicians.
Two weeks prior to surgery these are items to be avoided. Following surgery there are certain beneficial things to try.
