Keeping Track of Kidney Function after a Transplant of any Organ

By Jaime Myers, RN, BSN, CCTC

What are kidneys and what do they do?

There are two kidneys in our bodies.  They are bean shaped organs about the size of the fist.  One lies on each side of the spine just below the rib cage.  They have many functions that include:

  • Making sure the body has the right amount of water, minerals, and acids
  • Removing waste products from the body through urine
  • Helping to make red blood cells
  • Helping to control blood pressure
  • Releasing hormones that help maintain healthy bones.

What causes kidneys not to work?

There are many things that can cause the kidneys not to work properly.  As we age, kidney function decreases.  There are many diseases that can affect the kidneys.  These can be diseases you are born with (for example, polycystic kidney disease) or develop sometime during your life (such as glomerulonephritis). Two common diseases that cause kidney failure include diabetes (both type 1 and type 2) and high blood pressure (hypertension). Also, diseases that cause failure in other organs, such as the heart or liver, often will cause damage to the kidneys. Kidneys can become damaged if they are not getting good blood flow. This can happen if you become dehydrated or seriously ill. Other things that can damage the kidneys include kidney stones, urinary tract infections, and medications or drugs.

After having an organ transplant, you will take medications to prevent your body from rejecting your new organ. Some of these medications may be hard on the kidneys and over time can cause damage.

Can I tell if my kidneys are damaged?

You will often not have signs or symptoms of kidney damage until the damage is severe.  Your transplant team and other doctors can detect kidney damage through blood and urine tests.  The blood tests used to monitor for kidney damage include creatinine and BUN. Doctors can also measure creatinine clearance through urine tests and look for substances in the urine that can indicate kidney damage. 

When the kidneys aren’t working properly waste products build up in your body and make you feel sick. Your body may not be able to regulate fluid and you can get swelling in your extremities (edema). You may not be able to make enough red blood cells, causing you to become anemic. You may develop high blood pressure and your bones may become weaker.

Can kidney damage be treated? 

Yes! This usually involves treating the cause of the kidney damage. For example, doctors can treat kidney stones and urinary tract infections to help prevent them from causing serious or permanent kidney damage. Using medications to control blood pressures and keep blood sugars in normal ranges can greatly impact long-term kidney function. If medications are causing kidney damage doctors can often switch to different medications or lower doses to protect the kidneys.

When the kidneys become permanently damaged, patients need dialysis or a kidney transplant to restore the functions of the kidneys. 

Are there things I can do to prevent kidney damage? 

Yes! There are many things you can do to help prevent kidney damage:   

  • Have blood tests done on a routine basis: This will help your transplant team and other doctors monitor for and detect kidney damage early so they can treat it.
  • Avoid dehydration: Good fluid intake is important. Remember, fluids that have caffeine will cause further dehydration! If you are losing a lot of fluid through nausea, vomiting, or diarrhea, notify your transplant team. You may need to get fluids through an IV to prevent dehydration. 
  • Check your blood pressure regularly and notify your transplant team if it is high (a goal blood pressure is less than 130 on top and less than 80 on the bottom). High blood pressure (over 130/80) can cause kidney damage.
  • If you are diabetic, check your blood sugars regularly. Notify your transplant team if your blood sugars are not in the goal range (70 to 150).
  • Avoid medications that are toxic to the kidneys such as ibuprofen (Advil®), Alleve®, etc.
  • Notify your transplant team of any medications, including those over-the-counter and those prescribed by other doctors, that you are taking. Some of these medications may cause kidney damage and they may advise that you avoid them.
  • See your transplant team and other doctors regularly. These routine appointments allow your doctors to monitor for signs of kidney damage and review medications you are taking that may be causing kidney damage. Over time, they may be able to decrease doses of the medications that are used to prevent rejection that may cause kidney damage. 

Having an organ transplant is a lifelong commitment. Along with keeping your new organ working properly, patients must take steps to avoid damage to other organs in their bodies. Members of your transplant team are available to assist with keeping you healthy and helping you maintain a normal, active life.

Jamie Myers is a registered nurse transplant coordinator who works primarily with patients post liver transplant at the University of Wisconsin Transplant Program in Madison.

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© 2014 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.