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Nursing2015

January 2013, Volume 43 Number 1 , p 58 - 62

Authors

  • Carmel T. Ficorelli MSN, RN, FNP
  • MaryAnn Edelman MS, RN, CNS
  • Bridget H. Weeks MS, RN, CEN, PNP-C, FNP

Abstract

MRS. G, 65, HAS A LONG HISTORY of chronic kidney disease (CKD) and has been closely followed by a nephrologist for years. When her glomerular filtration rate (GFR) fell to 18 mL/minute/1.73 m2, the nephrologist recommended establishing vascular access for dialysis and referred her for evaluation for a kidney transplant.Incredibly, four family members and two close friends offered to undergo living kidney donor evaluation with the hope of being a match. One son was found to be a match. He and Mrs. G then began the arduous testing process to prepare for removing one of his kidneys and transplanting it in Mrs. G.Mrs. G is one of an estimated 26 million Americans who have CKD.1 Many patients with CKD and end-stage renal disease (ESRD) who are otherwise healthy are potential candidates for a kidney transplant from a living or deceased donor. This article discusses the kidney transplant process with a living donor.Two out of 1,000 Americans have CKD or ESRD. The two most common causes are diabetes mellitus and chronic hypertension.2 (For other risk factors, see Risk factors for CKD and ESRD.) As the kidneys begin to fail, nitrogenous wastes build up in the bloodstream, contributing to signs such as hypertension, anemia, hypocalcemia, and poor overall health. Although signs and symptoms may seem to have an abrupt onset, ESRD results from years of damage.GFR refers to the filtration of plasma by the kidneys per unit of time and therefore reflects kidney function. (See Tubular reabsorption and secretion.) Normal GFR ranges from 90 to 120 mL/minute/1.73 m2 and varies based on age, gender, and body size. As a practical matter, GFR can't be measured directly so kidney function is commonly inferred from the estimated GFR (eGFR). Common formulas used to calculate eGFR include Modification of Diet in Renal Disease (MDRD) and the Cockcroft-Gault equations, both of which include the patient's serum creatinine. For more information on GFR calculators, visit http://nkdep.nih.gov/lab-evaluation/gfr-calculators.shtml

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