When kidneys fail, the only available treatment options are dialysis and kidney transplant. A limited number of patients are candidates for transplant, depending on age and health status. The new kidney may come from a living or deceased donor. The recipient must take rejection medication for the rest of her life to prevent her body from rejecting the new organ. Even with proper care, organ rejection remains a common occurrence. There are three types of kidney transplant rejection, each with its own set of symptoms.
Hyperacute Rejection
The textbook "Medical-Surgical Nursing" explains that hyperacute rejection occurs within the first two days after surgery. It happens when the recipient has antibodies to the new kidney already present in his blood. Signs of this serious manifestation include unusual pain at the site of the new kidney, increased blood pressure and a fever. Hyperacute rejection usually requires removal of the new kidney.
Acute Rejection
Acute rejection occurs within the first two years after a transplant, usually within the first six months. It is caused by antibodies that were already present in the blood, antibodies that develop within the first week, or lymphocytes that attack the kidney due to antigens from the organ. Symptoms of acute rejection include a fever higher than 100 degrees, swelling of feet or hands, excessive tiredness and elevated blood pressure. Columbia University Medical Center explains that the patient may gain weight due to fluid retention. The new kidney may be enlarged and feel sore. Blood tests will reveal that potassium, creatinine and blood urea nitrogen levels are elevated. The patient's urinary output may be decreased or stop altogether. Acute rejection is treated by increasing the dosage of anti-rejection drugs, called immunosuppressants.
Chronic Rejection
Chronic rejection is usually the only rejection to fear after the two-year anniversary of the transplant. It can occur anytime from a few months post-transplant through the rest of the recipient's life. Chronic rejection can be the product of antibody development or action of the cells of the body. Signs of chronic rejection include swelling of feet or hands, fatigue and weight gain due to fluid retention. Other changes are noted only in blood work: an increase in creatinine, an increase in blood urea nitrogen and deviations in electrolyte levels. Treatment involves measures to preserve the kidney including dietary and fluid intake modifications. Dialysis may eventually be necessary if the donor kidney fails.
References
- U.S. National Library of Medicine: Transplant Rejection
- Columbia University Medical Center, Department of Surgery: Your Kidney Transplant: Rejection
- "Medical-Surgical Nursing": Donna Ignatavicius, M.S., R.N. and Linda Workman, Ph.D., R.N.; 2002
