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Hemodialysis: In cases of severe kidney damage or kidney failure, hemodialysis may be administered. Dialysis is a method of removing toxic substances and waste from the blood because dysfunctional kidneys are unable to perform this function. During the procedure, a hollow tube, called a catheter, is inserted into a patient's vein at the hospital. The blood is then filtered through a dialysis machine to remove waste products from the blood. The filtered blood is then returned to the patient. This procedure typically lasts about three to four hours. In general, patients with kidney failure undergo dialysis about three times a week. Patients who develop nephrotoxicity may also require dialysis in order to remove toxic substances from the body. Peritoneal dialysis: Patients who have kidney failure may undergo peritoneal dialysis. This type of dialysis can be performed at home, but it must be done every day. During peritoneal dialysis, a catheter fills the abdomen with a dialysis solution, which removes toxins from the blood. The abdominal walls are lined with a membrane called the peritoneum. This membrane allows extra fluid to pass from the blood and into the dialysis solution. The dialysis solution collects the waste, and then the dialysis solution is drained from the body. The entire process takes about 30-40 minutes per day. Most patients have to repeat this process about four times a day. A type of peritoneal dialysis called continuous ambulatory peritoneal dialysis (CAPD) does not require a machine. Patients are able to go about their normal daily activities while the dialysis solution is in the abdomen. Another type of peritoneal dialysis, called continuous cycling peritoneal dialysis (CCPD), involves a machine that fills and drains the abdomen, usually while the patient sleeps. Diuretics: Diuretics, such as furosemide (Lasix®), have been used to treat edema, which is associated with many types of kidney disorders, including focal segmental glomerulosclerosis (FSGS) and glomerulonephritis. These drugs signal the kidneys to increase urine output. This reduces the amount of fluid in the bloodstream, which subsequently reduces swelling and lowers blood pressure. Anti-hypertensives (ACE inhibitors): Anti-hypertensives (drugs that lower blood pressure) have been used to treat high blood pressure. When the kidneys do not filter the blood properly, the pressure in the blood vessels may increase, causing high blood pressure. One type of drug for high blood pressure, called an ACE inhibitor, reduces the amount of protein in the urine by reducing the amount of pressure and resistance on blood as it circulates through the body. Extracorporeal shock wave lithotripsy (ESWL): If patients with kidney stones are unable to pass their stones by drinking extra fluids, a procedure called extracorporeal shock wave lithotripsy (ESWL) may be performed. This is the most commonly used procedure to remove kidney stones. Sound waves (shock waves) are used to break the stone into smaller pieces. Patients will receive sedatives and/or anesthesia before the procedure. The patient will either be partially submerged in a tub of water or will lie on a soft cushion. Patients wear headphones because the shock waves are loud. High-energy sound waves then pass through the patient's body and break the stone into smaller pieces. The healthcare provider usually uses X-rays or an ultrasound to ensure that the stone breaks down. Treatment usually lasts for about one hour. Side effects of treatment include blood in the urine, bruising on the abdomen or back, bleeding around the kidney or nearby organs, and pain when the stone fragments are passed in the urine. Transplant: Some patients with kidney disease may develop kidney failure. When this happens, the kidneys are no longer able to function properly. Kidney failure is fatal without a kidney transplant because these organs are vital for daily living. Since individuals can function with just one kidney, only one donated kidney must be transplanted into the patient. After the kidney transplant, patients will need to take drugs called immunosuppressants for the rest of their lives in order to prevent their bodies from attacking the transplanted organs. The most commonly prescribed oral immunosuppressants include tacrolimus (Prograf®), mycophenolate mofetil (CellCep®t), sirolimus (Rapamune®), prednisone (Prednisone Intensol®), cyclosoporine (Neoral®, Sandimmune®, or Gengraf®), and azathioprine (Imuran®). In general, patients are typically prescribed two to three medications for long-term immunosuppression. Also, since kidney transplant recipients have only one functioning kidney after surgery, patients will need to alter their diets so the kidney is not overworked. For instance, alcohol and caffeine should be avoided because these products contain many toxins and wastes that are difficult for just one kidney to filter from the blood. Not all kidney failure patients are suitable candidates for kidney transplantation. The transplant must come from a donor whose body tissues are a close biological match to the recipient. The donated kidney may come from a living relative who is a match or from a deceased donor. In order to receive an organ from a deceased donor, patients are added to a national waiting list. Members of the transplant center conduct medical tests and consider the patient's mental and physical health, as well as his/her personal support system before adding him/her to the transplant list. There is no way to know how long a patient will wait. Some patients will wait weeks, while others may wait years. Some patients die of kidney failure before they are able to receive an organ. As with any major surgery, serious health risks are associated with the kidney transplantation. Individuals who have weakened immune systems are at risk of developing graft-versus-host disease after surgery. This condition occurs when the transplanted organ attacks the recipient's weakened immune system. Other recipients may experience transplant rejection, which occurs when the body's immune system attacks the donated organ. Surgery: Patients with kidney cancer typically have their tumors surgically removed, if possible. If the tumor is very large, the kidney may also need to be removed. Individuals are able to live with just one kidney. However, if both kidneys are removed, the patient must receive a kidney transplantation. Radiation therapy: Radiation therapy may be used along with surgery to treat patients with kidney cancer. During the procedure, the patient's kidney is exposed to high-energy beams, which kill cancerous cells. Patients typically receive treatment five days a week for several weeks. Side effects may include fatigue, skin rash, nausea, and vomiting. Chemotherapy: Chemotherapy, which involves drugs that kill cancerous cells, is generally not used to treat kidney cancer. This is because chemotherapy has not been shown to be an effective treatment for patients with kidney cancer. Other therapies, such as surgery and immunotherapy, have been shown to be more effective treatments. Arterial embolization: Patients with kidney cancer may undergo a procedure called arterial embolization. A specialized healthcare professional, called a radiologist, injects a chemical into the main blood vessel that leads to the kidney. This substance clogs the blood vessel, which starves the tumor of nutrients. This procedure is typically used when the tumor cannot be surgically removed. Side effects may include temporary nausea, vomiting, or pain. Cryoablation: A procedure, called cryoablation, may be performed if a kidney tumor cannot be removed. During the procedure, one or more specialized needles are inserted into the tumor. The needles contain a gas that causes the tumor to become so cold that it freezes. The needles are removed. Then, needles that contain a different kind of gas are inserted into the tumor. These needles warm the tumor. When the tumor is thawed, the process is repeated. The cycle of freezing and thawing the tumor eventually kills the tumor. Patients may experience pain after cryoablation. Rare side effects include infection, bleeding, and damage to the tissues surrounding the tumor. Immunotherapy: Patients with kidney cancer may also receive immunotherapy, which helps the body's immune system fight against cancerous cells in the body. Patients receive injections with interferon and/or interleukin-2, which are normally produced by the body. Immunotherapy is usually administered in combination with surgery. The duration of treatment varies among patients. Medication may be given daily, weekly, or several times a week. Side effects may include nausea, vomiting, decreased appetite, fatigue, and fever. Some patients may bruise easily after treatment.
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