When someone is diagnosed with diabetes one must be aware of how important it is to control the disease. If this is not achieved, it is possible that over time this condition affect other organs such as eyes, heart, nerves and kidneys. Regarding the latter, it is important to know that diabetes is the leading cause of what is known as chronic renal failure: estimated to be responsible for 45 percent of cases of kidney failure. Imagine the impact it causes, because in the world has about 171 million people with diabetes!

So you can understand it better, renal failure or renal failure occurs when the kidneys stop functioning properly or stop working altogether. The kidneys are two organs of fist-sized, bean-shaped, located in the middle of the back, which play a vital role for the body, filter and purify the blood, that is, keep it chemically balanced.

Every day, a person’s kidneys process about 190 liters of blood to sift out about 2 quarts of waste products and excess water, the body loses during urination. If this is not done, the wastes would build up in the blood and damage the body. For example, excess fluid can endanger life and can affect the functions of the heart and brain.

Now, why people with diabetes are more likely to suffer kidney failure? Because high levels of blood sugar, characteristic of diabetes, can damage blood vessels throughout the body including the kidneys. These vessels are the filter and allow them to perform their function, but the damage was narrow and become blocked and blood flow decreases. By decreasing the amount of circulation and blood, the kidneys are damaged, and can not function well, the first sign is that the albumin (a type of protein) filters instead of resorb again to enter the bloodstream and is passed urine, where it should be.

Diabetes can also damage nerves in the body, which are those that carry messages between the brain and other organs like the bladder. If the nerves of the bladder are damaged, you may not recognize when the body is full, and the pressure of a full bladder can damage the kidneys.

Also, if the urine stays too long in the bladder can cause urinary tract infection due to bacteria that grow rapidly in urine with high levels of sugar. Often, these infections affect the bladder, although sometimes spread to the kidneys.

When a person develops chronic renal failure, sometimes you need what is known as renal replacement therapy that, to put it simply, is to find an artificial way for the body to eliminate waste, like you would through of their own bodies.

It uses something called dialysis, which can be of two types, hemodialysis or peritoneal dialysis. Hemodialysis filters waste substances and removes excess fluid from the blood. Usually done at a dialysis sessions three to four hours three times a week.

Peritoneal dialysis, however, does not filter the blood directly but does so through a sterile fluid is introduced into the abdominal cavity through a tube called a catheter, placed permanently under the skin. The liquid is then removed to absorb the waste. If you learn, you can use this method at home, so it is a good alternative for some people, but it takes time and care.

Another alternative to dialysis is to have a kidney transplant operation, in the case of diabetics, usually done with a pancreas transplant (thus said to be a kidney-pancreas transplant). The pancreas is the organ that produces insulin, a substance able to process glucose (sugar) from food into energy for the body.

This operation is not for everyone, this is a complicated and risky surgery (when including both bodies takes about six hours!), Although it has been shown to improve the quality of life of people with kidney failure and diabetes, especially when organs are donated by a family member or relative. The kidneys may also be obtained from other donors, whether living or recently deceased. Each place has its own regulations regarding organ donation.

You see, all these options have their advantages and disadvantages. Your doctor will help you choose which is most appropriate for you, according to your health and your habits.

Finally, if you have diabetes, remember that you can do much to prevent kidney problems: control your blood sugar in the blood, maintain blood pressure and cholesterol under control, get control and take your medicine as you directed by your doctor. Also, remember that eating a healthy and balanced (as you have recommended for your diabetes, low in salt and saturated fat) to the same hours, exercising regularly and avoiding snuff, are an integral part of your treatment .

Before leaving the hospital, the doctor will prescribe various drugs to prevent infection and reduce the risk of your body from rejecting transplanted organs. Also scheduled visits. If you have questions, concerns or unexpected symptoms after receiving the transplant, contact the surgical team at any time of day.

Risks

Approximately 64 percent of transplant patients receiving combined heart and lung survive for 3 years after surgery. In the first two weeks after receiving the transplant, some patients experience an episode of rejection of the transplanted organ. This does not happen often and can be treated with steroid-based drugs.

As with any surgery, there are risks of infection and bleeding. It is also possible that the transplanted organs do not function well. Between 30 and 50 percent of patients may exhibit a form of chronic rejection (known as bronchiolitis obliterans) that attacks the new lungs and causes breathing problems usually have no treatment.

When To Call a Professional

- Once you leave the hospital, contact your doctor immediately if:
- Pain in chest, trouble breathing, dizziness, or irregular heartbeat.
- You have a fever.
- The incision redness, swelling, pain or oozing blood.

New lungs are inflated smoothly. The new heart and lungs have been kept cold before transplantation. As the new heart takes room temperature, you can start beating on its own.

If not, the surgeon stimulates the heart by applying an electric shock to start beating. Once confirmed that the new lungs are working well and that all places where there may be bleeding is controlled, is decoupled from the machine’s heart and lungs. The surgeon closes the chest and you are transferred to the intensive care unit for coronary patients.

After spending several days in intensive care will be taken to a private room. The total duration of hospitalization is about two weeks.

- 55 or less and is likely to die in one or two years if it receives a transplant;
- no other health problem that threatens his life. There are health problems that can incapacitate the patient to receive kidney transplants as serious, HIV, pneumonia, or other active infection, cancer, history of stroke or circulation problems that affect the brain serious or chronic diabetes type 1 (insulin-dependent );
- emotionally stable;
- is willing to follow a rigorous program of diet and exercise and take medication;
- does not take high doses of steroid medications;
- has not previously had chest surgery, that even this dispute.

Comprehensive evaluations will be conducted including a physical examination, chest radiography, imaging of the heart and lungs, tests to check the functioning of the lungs, cardiac catheterization and cardiac biopsies and lung tissue. These studies confirm if you have heart and lung problems that endanger their lives and can not be cured medically.

In turn, blood tests to assess kidney function, check for anemia or other blood problems and rule out viral illnesses such as HIV, hepatitis, herpes simplex virus and cytomegalovirus. It also draws blood for the type of tissue and blood type and find a suitable donor. If you have problems with alcohol or drug addiction, you must complete a treatment program before receiving a transplant combined heart and lung.

- birth defects that affect the heart and lungs, including Eisenmenger syndrome (accounts for 37 percent of transplants combined heart and lung made ​​in USA. UU. in 1997);

- Primary pulmonary hypertension: a condition that causes increased pressure in the arteries of the lungs, which affects blood flow and oxygen exchange (about 19 percent of heart-lung transplants);

- Cystic fibrosis (about 2 percent of transplants combined);

- other causes (about 25 percent) such as emphysema, sarcoidosis, eosinophilic granuloma (blood vessel disorder that causes inflammation and damage to the lungs and elsewhere), asbestosis and idiopathic pulmonary fibrosis (a disease that causes scarring of the lungs without a known cause).

Currently, surgeons performing fewer than 50 transplants combined heart and lung per year in the United States. The fact that this figure is reduced is mainly due to the lack of suitable donors. The requirements for a heart and lung donation are much more demanding than those to donate a heart only. Between 10 and 20 percent of people who are able to donate the heart may also meet the criteria for donating both the heart and lungs.

The heart and lung donors typically less than 50 years of age, have no history and no cardiac or pulmonary infectious diseases. Both the donor and recipient must have an approximate weight and height so that the lungs are the same size. The donor’s chest X-rays should be normal and lungs must submit a normal elasticity (ability to expand).

The recipient and the donor must also have the same blood. There are about 200 patients on the waiting list nationwide to receive a combined transplant of heart and lung. And it is likely that between 20 and 40 patients die within 12 months because they were not appropriate bodies. In most cases, the organs of potential donors were obtained through an organization called the International Network for Organ Sharing (United Network for Organ Sharing, UNOS).

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- Check out more calmly the material they gave you. If you do not understand something or do not remember either, call the consultation and ask to speak to your doctor or an assistant.

- If you’re not sure when you receive the results of any tests, do not sit and wait: call for consultation and questions. If you do not arrive on the specified date, called again.

- Stick to the letter the doctor’s instructions. Take all medications as prescribed and dosages. Meets the prescribed diet and physical exercise if they are part of treatment.

- Make follow-up. Tell the doctor without any changes need to occur in your body, or any negative reaction from medication.

- If you facilitate the work of the physician, not only good communication with him or her, but you better understand the condition and treatment will affect you said. Follow these simple suggestions for you to take an active role in relation to your health.

- Try to get at least half an hour before the appointment so you have time to complete the forms and do some testing, if required.

- He plays the most important issues first be stressed. Do not hide it from your doctor or the most difficult issues such as incontinence, sexual problems, etc.. Do not lie about the snuff, alcoholic beverages, etc.. It’s your health.

- Answer all questions honestly.

- Stick to talking about your health problems. Consultation is a friendly chat. Do not talk about your kids, your house or your personal affairs, for fun or interesting that you find.

- Take note of everything the doctor tells you, especially your instructions. Clear up any confusion about medications, dosages, times when you should take them and if you accompany them with food. Make sure you understand everything clearly.

- Ask your doctor what you can get treatment, how it will affect your work and if there are alternatives.

If you need additional information or have any questions, talk to go with his assistant or a member of your team.

Regardless of how long you have to wait in the waiting room of the query, or the time spent with the nurse for routine checks, the interview face to face with the doctor is short, on average, lasts about 15 to 20 minutes . To take advantage of that time, the task to the doctor. Make it easy by taking some simple steps before, during and after the visit. Not that you’re doing you a favor, all the benefit will be for you!

Before the visit:

- If this is your first visit, be sure you have the correct address of the office, and calculates the time you will arrive on time.

- If you have been referred to a specialist and your GP has your previous analysis, get a copy of all data related to the query, including results of tests and examinations, copies of x-rays, lab tests, etc.. Also carries information about your illnesses, surgeries, and previous hospitalizations, your allergies and your family health history (diseases your parents, siblings, grandparents, etc.)..

- Make a detailed list of all medications you take and their dosages, no missing vitamins and supplements, no matter whether or not prescribed. If necessary, consultation takes medication containers. So the doctor will have a clear idea of ​​your health and your risks.

- Make also a list of points you should explain to the doctor, as well as questions to ask. In this way, you are not forgotten. Remember to mention any symptom that worries you. And the most important points, as they may not have time to treat it all on that visit. If you are unsure what you ask, this column will find information about what you should ask.

- Wear comfortable clothes, easy to remove and place suitable for a physical exam.