Kidney failure, a condition where the kidneys lose their ability to filter waste from the blood, often necessitates a life-altering intervention. When kidneys function at less than 15% of their normal capacity, it marks the stage of end-stage renal disease (ESRD), requiring either dialysis or a kidney transplant to sustain life. A kidney transplant is the most effective treatment for end-stage renal disease (ESRD), offering improved quality of life and often a longer lifespan compared to lifelong dialysis. For many individuals undergoing this procedure, a notable aspect is that their original, diseased kidneys are frequently left within the body, a practice that might seem counterintuitive at first glance. This approach is standard procedure unless specific medical complications arise.
Surgical Reasons for Leaving Native Kidneys
Leaving the diseased native kidneys in place during a transplant operation is a common surgical strategy, primarily to minimize risks and simplify the procedure. Removing the original kidneys would significantly increase the complexity and duration of the surgery. This could lead to greater blood loss, prolonged anesthesia exposure, and an elevated risk of damaging surrounding organs or major blood vessels, such as the vena cava or aorta. Surgeons typically place the new, healthy kidney in a different, more accessible location within the lower abdomen, specifically in an area called the iliac fossa.
The iliac fossa, located just above the groin, offers several advantages for the transplanted kidney. This site is relatively easy to access surgically and provides a strong blood supply from the internal iliac arteries and veins. The bony pelvis in this region can offer protection to the newly implanted organ. Because the new kidney is positioned separately and connected to different blood vessels, there is no direct need to remove the native kidneys, avoiding surgical trauma and complications.
How the Body Adapts to Extra Kidneys
The human body adapts to the presence of an additional kidney after transplantation. Once the new, healthy kidney is successfully implanted, it assumes the primary function of filtering waste products and excess fluid from the bloodstream. This new kidney renders the old, diseased kidneys largely redundant in terms of their excretory function.
Over time, the native kidneys shrink in size due to disuse. This reduction in volume means they do not cause obstruction or discomfort. The body can accommodate three kidneys without adverse physiological effects, as the transplanted kidney takes over waste removal.
Conditions Requiring Native Kidney Removal
While leaving native kidneys in place is the standard practice, certain medical circumstances necessitate their removal. Chronic or recurrent infections within the native kidneys, such as pyelonephritis, can pose health risks. Uncontrolled high blood pressure caused by the diseased kidneys can also indicate removal, as their presence can exacerbate hypertension even after a transplant.
Significantly enlarged polycystic kidneys are another common reason for removal. These can cause discomfort, pressure on adjacent organs, or restrict space needed for the transplanted kidney. If there is suspicion of kidney cancer within the native organs, or if severe vesicoureteral reflux (a condition where urine flows backward from the bladder into the kidneys) is present, removal may be advised to prevent complications.
Life After Transplant with Native Kidneys
For individuals who have undergone a kidney transplant with their native kidneys remaining, daily life largely revolves around the care and monitoring of the new, functioning organ. The primary focus shifts to ensuring the transplanted kidney maintains optimal function and preventing rejection. Patients adhere to a strict medication regimen, including immunosuppressants, to prevent their immune system from attacking the new kidney.
The native kidneys, though still present, become asymptomatic and do not require specific management. Regular follow-up appointments with the transplant team are important to monitor the health of the transplanted kidney and address any potential complications. This care ensures the long-term success of the transplant and allows patients to lead active lives.