For uremic dialysis patients, it is urgent to know whether renal transplantation should be performed or when to undergo renal transplantation. We suggest that the following aspects should be considered: the type of primary diseases, age, health status of patients, and contraindications to renal transplantation.
Glomerulonephritis is the most common primary disease in uremic patients, and it is also the most common primary disease suitable for renal transplantation. But it should be noted that some glomerular diseases may recur after transplantation, but there are not many patients with renal allograft dysfunction due to recurrence of primary diseases, which may be due to immunosuppressive drugs after renal transplantation. Therefore, we suggest that the primary disease of the patient should be clearly defined before renal transplantation. If the disease is easy to recur, then the kidney transplantation should be carried out after the condition is stabilized for more than half a year.
Due to the increasing incidence of diabetes, the absolute number of patients with diabetes gradually increased, resulting in uremia patients are gradually increasing. Patients with diabetic nephropathy can receive kidney transplantation, but if diabetes has been suboptimal treatment, it will also lead to increased risk of surgery. Therefore, we suggest that renal transplantation should be performed as early as possible under the condition of uremia.
Hypertensive nephropathy is due to years of hypertension leading to chronic renal insufficiency, and gradually developed into uremia. After renal transplantation, hypertension can be improved to varying degrees. It should be noted that even after renal transplantation, blood pressure should be monitored closely and antihypertensive treatment is necessary.
Hereditary disease. Polycystic kidney disease is the most common and is suitable for renal transplantation. It is an autosomal dominant genetic disease, and most of the patients gradually develop renal dysfunction after 40 years of age. But not to say that once the diagnosis of polycystic kidney, immediately after kidney transplantation, because some patients with relatively stable renal function, did not develop into uremia. Therefore, renal transplantation should be performed only when the renal function has reached the stage of uremia.
Immune diseases. Lupus nephritis mainly refers to lupus nephritis. Since the treatment of primary disease is similar to the immunosuppressant used after renal transplantation, the recurrence after renal transplantation is rare. We suggest that the lupus disease can be treated with renal transplantation at stable stage.
Other diseases. More often refers to infection, drug allergy, toxic substances damage, congenital malformations, tumors, tuberculosis and so on, these diseases must be completely controlled before transplantation. The recurrence rate of tumor patients is higher within 1 years after transplantation, but it is not taboo to transplant the tumor after 1 years of treatment. It is mainly the long-term immunosuppressive drugs after kidney transplantation, which is easy to cause tumor recurrence.