Max Super Speciality Hospital

Namashkar!

My name is Dr. Yogesh Kumar Chhabra hai. Mai consultant nephrology hoon. I am practicing in Rohini, Shalimar Bagh, Pitampura and adjoining areas. Agar aaj ki hamari jo discussion ka point hai woh hai myths and facts of renal transplantation yani ki kidney transplant se related kya satya hai aur kya brahm hai? Sabse pehle question hai ki kab karna chahiye kidney transplantation? Kidney transplantation sirf chronic kidney disease ke patients mein bola jata hai jaha pe GRF ki matra less than 5ml/min yani ki kidney is state pe pahuch jati hai ki vo koi zehrile padarth ko sahi tarike se nahi nikal paa rahi jo ki baki organs ke liye khatarnak ban sakta hai. To aisi stithi mein dialysis ya transplant hi ek upaye bachte hai. If we compare kidney transplant to the alternatives like peritoneal dialysis, like haemodialysis; definitely kidney transplant is much better alternative. Kidney transplant se behtar koi aur upaye nahi bachta. Kidney transplantation mein patient ki life bhi behtar hoti hai, uski zindagi zada lambi hoti hai aur financially bhi ye zada affordable cheez rehti hai. Ab question aata hai kya acute kidney injury mein bhi kidney transplant ka koi role hai?

Nahi, acute kidney injury yani ki jo kidney abhi haal filhal mein kharab hue hai because of any drugs, because of any infection usme kidney transplantation ka koi role nahi hai. Aisi stithi mein acute kidney injury mein vo zadatar recover karte hai. Agar nahi recover karti jab tak vo chronic kidney disease ki stithi mein nahi pahuchti jab tak vo declare nahi hota tab tak kidney transplantation karne ka koi role nahi hai. Kon donor ho sakte hai? Hamare yaha pe India mein 2 tarah ke ki committees hoti hai: 1 hota hai authorisation committee, 1 hota hai competent authority. Competent authority permission de sakti hai keval near relative ko, ye competent authority hospital ke internal committee hoti hai jo authorisation committee hai woh external committee hoti hai. Jo competent authority hai vo sirf near relative ke liye permission de sakti hai, near relative yani ki jo spouses hai, ya fir parents hai, grandparents hai, siblings hai, children hai ya grandchildren hai yahi permitted hai, inke alawa jitne bhi log hai vo sab extended relation mein aate hai, uske liye authorisation committee ki permission ki avashyakta padti hai. Lekin hamari society mein isse bhi bade bade brahm hai ki kya kidney dene se ek donor pe koi effect padta hai; my answer is no. Jitni bhi studies dekhi gayi hai, kafi studies ho chuki hai jisme general population se compare kiya gaya hai donor ki population ko aur vo log long-term mein koi kidney disease related zada problem nahi aati hai agar disciplined life vyateet kari jaye donor se.

Dusri important cheez koi diabetes ka risk badta nahi hai, koi hypertension ka risk nahi badta aur koi life ki term pe koi difference nahi padta yani ki life unti hi rehti hai jitni agar kidney na donate kare tab bhi, agar vo disciplined life vyateet karein to. Overall regular check-up required rehte hain lekin donor ko koi long term medication ki zaroorat nahi padti hai. Medication keval recipient yani ki jisko kidney mili hai usi ko chahiye hoti hai jo ki shuruat mein thode se around 25-30,000 rupee per month ki rehti hai baad mein dheere dheere kam hoke vo 8-10,000 rupee per month tak pahuch sakti hai. Question ye ata hai ki kya sirf jaha pe blood group match kar raha ho yani compatible blood group ho kya wahi pe kidney transplant kar sakte hai? Answer hai no. Aaj kal techniques bohot badal gayi hai, pichle 5-7 saal mein to results itne change ho chuke hain, techniques itni better ho chuki hai ki ab blood group chahe match kare ya na kare usse bohot zada difference nahi aata. Hume inn titers ki value dekh ke tab decision lena hota hai, agar blood group nahi match karta we can go on with ABO compatible transplant but obviously that is more costly.

Uski cost thodi zada hai lekin uske results, uski efficacy almost equivalent hai jo blood group compatible transplant ke hai. Nahi to options rehte hai jaisi ki swab transplant, agar ek parent mein jo doosra blood group jo donor hai agar uska blood group match nahi karta to vo doosre kisi parent ke recipient ko de sakta hai aur uss jo doosre parent ke recipient donor se pehle recipient ko bhi donation ho sakti naye simultaneously kiya jana chahiye jisko hum swab transplant kehte hai aur iske results bhi ek dum appropriate hai jo ki hamare apne centres mein bhi hum kar chuke hai aur India mein ye kafi commonly ho pa raha hai. Next question aata hai kya kidney transplant ke baad puri life sahi chal jati hai kidney? Nahi, aisa nahi hai. Usually 1 kidney ki life hum 12-15 saal ke liye kehte hai jo transplant ke baad, halaki hum apne experience mein dekhe to aise bhi patients hai jo 30-32 saal tak bhi chale hai lekin aise patients bhi hai jo 6-8 saal mein bhi jinki kidney kharab ho gayi hai. To average life jo boli jati hai woh 12 se 15 saal ki boli jati hai lekin appropriate medication ki avashyakta rehti hai.

To agar hum dekhe to definitely kidney transplantation over the years have improved, ab results jo hai rejection ke kafi kam ho chuke hai, rejection mushkil se 10% case mein hota hai jisme se 95% case mein to vo puri tarah treatable hota hai, so that means ki success rate for a kidney transplantation has increased over the years. Now it is more than 98% in most of the centres. Results kafi cheezo pe depend karte hain ki donor ki age kitni hai, donor ki general health kaisi hai, isilye jyadatar investigation donor se related rehti hai na ki recipient se. Hame jo basically matching dekhni hai aur ye zarur dhyan rakhna hai ki donor ko short term ya long term koi apatti na rahe, koi problem na bane yeh sab cheeze dekh ke investigation wise tabhi hum aage proceed karna chahte hain. To definitely kidney transplantation is one of the best alternatives. Isse related hamari society mein bohot sare brahm hai and merko lagta hai ki ye talk shayad usme se kuch satya ki kiran dikha paye aur aage hum sahi tareeke se uss mein proceed kar paye. Hamara maksad ye hai ki hamare kidney ke patient maximum to maximum organ transplantation ka benefit utha paye chahe lab related ho ya candidate related ho yani ki jo mrityu uprant bhi de sakte hai log uske bare mein bhi mereko jankari dena sahi rahega vo I think next kisi talk mein hum age discuss karna chahenge.

Thank you.

Hi,

I am Dr. Yogesh Kumar Chhabra, Nephrologist. Aaj me baat krunga nephrotic syndrome ke bare me. Is problem me urine ki quantity badh jati hai, swelling ho jati hai, hypertension ho jata hai. Ye problem mainly bachon me dekhi jati hai. Jo bache medications ke through steroids pe response nhi krte hain to hum biopsy ke bare me sochte hain. Kuch bachon me biopsy ke bina bhi treatment ho jata hai. Isme hum kidney ko diagnose krte hain. Ye ek minor procedure hai. Ye treatment hum ultrasound and medications ke through dete hain.

Kayi cases me ye problem diabetes, blood pressure, hepatitis B & C ki vjha se bhi ho jati hai. Treatment patient to patient vary krta hai. 90% cases me result acha dekha jata hai. Or agar kuch patients me acha effect nhi hai treatment ka to hum 2nd line of the treatment dekhte hain. Kuch cases me hota hai ki protein ki leakage nhi ruk pati hai. Agar timely treatment na dia jaye to chronic kidney disease ka problem ho jata hai. Aisa case bhi ban jata hai ki patient ko dialysis ki jrurat pad jati hai.

Nephrotic synrome me RBC ka leakage hota hai. Patient ko skin infection ho skta hai. Young adults me nephropathy ka problem ho jata hai. Patient ko vasculitis ka problem bhi ho skta hai. Kayi cases me rheumotoid arthritis ka problem bhi ho jata hai. Kafi hadd tak nephrology me correction kia ja skta hai. Islia timely treatment important hai. Islia aap apne Dr se apni problem discuss kren.

Thank You.

Namaskar,

Me Dr. Yogesh Kumar Chhabra hun, Nephrology. Aaj me apko kidney disease ke bare me btaunga. Kidney disease 2 types ka hai. Acute and chronic. Acute kidney me infection ya kisi medicine ka asar joki reversible hai. Isme kidney puri trha thik ho skti hai. Chronic me disease dheere dheere develop hoti hai. Ye reversible nhi hota hai. Iska cause diabetes and hypertension hota hai. Agar aap shi time pe nephrologist se contact krte hain to is disease ko slow ya ruka ja skta hai with adequate medicines. Diabetes and blood pressure ki medicines ko thik se len. Chronic kidney disease ke 1-5 stages hote hain. Maximum patients stage 3 & 4 me aate hain. Patient stage 5 me bhi aate hain. Patient ko vaccination ki bhi jrurat hoti hai hepatitis B, pneumonia and influenza.

Patient ko dialysis ke lia bhi prepare kia jata hai. Patient ko transplant ke lia bhi prepare kia jata hai. Patient ko stage 5 me dialysis ki bhi jrurat padti hai. Dialysis ke 2 types hain. Hemodialysis and peritoneal dialysis. Hemodialysis me blood ko clean kia jata hai. Peat ki dialysis ko peritoneal dialysis kha jata hai. Ek treatment hai kidney transplant jo sabse better hai. Kidney transplant means renal transplant. Agar kidney transplant me blood group match nhi krta tab bhi transplant ke lia socha ja skta hai. Depend krta hai ki patient ki body use accept kregi ya nhi. Isme patient ka quality of life improve ho jata hai and regular medication suggest ki jati hai. Patient ko regular hospital aane ki jrurat nhi pdti. Transplant price wise bhi kafi acha hai.

Dialysis me 5 saal ke baad karib 50% hi survival hota hai and diabetics me 35% survival rate hai. Lekin transplant me survival rate is more than 90%. Lekin transplant me ek problem bhi aati hai. Donors jyada available nhi hote hain. Kabhi blood group match nhi krta ya fir kisi medical reason se donor shi stage pe nhi mil pate hain. Hume logon ko motivate krna chaiye ki apne organs ko donate kren. Is se patient ki life ko improve kia ja skta hai. Kidney transplant ki life hoti hai 12-15 saal. kayi baar 30-32 saal bhi ja skti hai. Quality and quantity of life both can be improved.

Thank You!