Introduction : 

The kidneys are bean-shaped organs located below the rib cage on both sides of your spine and are the leading organs of the renal system. One of the most important functions of the kidneys is to remove waste from the body, filter your blood, remove acid that is produced by the cells of your body, and maintain fluid and electrolyte balance. 1

When the kidney, either one or both, no longer works like they should they are said to be failing. Kidney Failures may be sudden and temporary or might be chronic. Below are the symptoms that follow kidney failure.

Symptoms of Kidney Failure :

Some of the possible symptoms of kidney failure may include: 

• Reduced amount of urine
• Swollen legs, ankles, and feet from retention of fluids caused by the failure of the kidneys to eliminate water waste
• Breathlessness
• Fatigue or lethargic
• Confusion
• Seizures or coma in certain cases3
• Uneasy sleep 
• Roughness of the skin ‍
• Blood in urine12

Kidney Transplant :

When your kidneys do not work as they should, you have a higher chance of having severe health problems such as kidney failure. Kidney failure is when your kidneys suddenly stop working. 2

A kidney transplant is a procedure done to replace an infected or failed kidney with a healthy kidney from a donor. Family members or friends who are highly compatible are considered to be healthy donors. An individual who donates a kidney can live a healthy life with one healthy kidney. 4

Causes of Kidney Transplant :

Many diseases can damage the nephrons by affecting the filtering capacity of the kidney. When the kidneys lose around 90% per cent of their filtering capacity it is considered as end-stage renal disease, also called an end-stage kidney disease or kidney failure.5 When kidneys are not able to perform their functions properly or lessen their filtration rate then, threatening fluid, electrolytes and wastes build up in the body.6 The cure for end-stage renal disease is dialysis or kidney transplant. A kidney transplant is more preferable to dialysis as it has fewer side effects and helps you live a better life. 5

Nutrition for a Post Kidney Transplant :

In a post kidney transplant, food plays a major role to sustain a healthy life. The dietary restriction after surgery is different from before surgery. A well-balanced diet helps keep your newly transplanted kidney healthy and well functioning. The advice from nutritionists in choosing the correct foods is important for post kidney transplant cases. A Functional Nutritionist will plan a customized protocol according to your weight,  blood reports and will take your kidney markers into consideration.7

Nutrition after kidney transplant can be affected by several factors such as side effects of immunosuppressive and other drugs and possible food-drug interaction.  And one must also take into account that post kidney transplant a person's appetite is affected. In early kidney transplants, adequate nutrition is important for a speedy recovery from wound healing and injuries. For long-term renal health, nutrition helps in sustaining a healthy life. Nutritional assessment of kidney transplant patients should be planned every month for, at least, the first three months. 8 

Here are some of the principal nutrients which we should be kept in consideration for a successful kidney transplant:

Sodium:

Sodium is the most important marker when it comes to kidney function. Many people can experience high blood pressure or fluid retention after the procedure of a kidney transplant. Such patients should opt for a low sodium diet. Limit the use of salt, which contains sodium, while preparing your food. Salt is also used as a preservative so, it's better to avoid Processed foods like soups, sausages, pickles, and canned beverages as it is high in sodium. 9

Potassium:

After a kidney transplant, some of the drugs increase your serum potassium level and some of the drugs lower them. Patients can experience complications in the working of the heart and muscles. The incorporation of potassium-rich foods is dependent on particular cases. And should be based on serum potassium level.7

Phosphorus: 

As your kidney is functioning well, your body starts building bone mass again that might have been lost during kidney failure. At the same time, your body shows low levels of phosphorus when it is used by malnourished bones. Your functional nutritionist will ask you to have foods that are high in phosphorus depending upon your serum Phosphorus levels.7

Protein: 

Protein is one of the chief nutrients in the early stage of a kidney transplant as it helps the body to overcome the injury. Food that is high in protein will help you in wound healing. Additionally, the prescribing of steroids might cause muscle breakdown after a kidney transplant and proteins play a key role in building back your muscles. Creatinine, the waste product released from muscles, will give you a clear idea of how your kidney is functioning. Well-functioning kidney transplants show creatinine levels between 0.8-1.1mg/dl. 9

Carbohydrate:

After the kidney transplant, Immunosuppressants can cause side effects,8 as your body does not use carbohydrates as a source of energy due to certain medications. As a result, we can see a rise in blood sugar levels. This condition is also called hyperglycemia or steroid-induced diabetes. Food that is high in simple carbohydrates such as concentrated fruit juices, syrups, sugary drinks will trigger the symptoms of hyperglycemia. 9

Complications of Post Kidney Transplant:

Infection is one of the common complications in the early stage of a post kidney transplant. Most infections in the early stage are associated with healthcare-related infections. Community-acquired infections might be experienced at a later stage of a kidney transplant. Research shows, in post kidney transplant Viral (BK virus, Epstein-Barr virus), bacterial (Urinary tract infection) and fungal infection are the most common complications. 10

The risk after kidney transplantation is directly associated with the surgical procedure of kidney transplant. Accurate diagnosis and timely management of surgical complications of a kidney transplant patient should be managed strictly. Masking the identification of the complications may result in significant morbidity in recipients.11 Below are the common complications patients suffer post kidney transplant:

1. Heart attack & stroke
2. Failure or the rejection of transplanted kidney
3. Blood clotting

Anti-rejection medications after kidney transplantation may also lead to certain complications like diabetes, hair fall, bone thinning, high cholesterol levels, high blood pressure level.6

Post Kidney Transplant Care:

In many cases, a kidney transplant is the best decision to live healthy for a longer time. Proper guidance will help you in keeping your kidney healthy and functional. Organ rejection is one of the biggest complications in the early stage of a kidney transplant.11 Protecting your kidney from several infections may reduce the chances of kidney rejection and other health issues. Post kidney transplant care is similar to other surgical procedures. Some of the other major areas that need to be kept an eye on are:

• Fluid and electrolyte balance
• Wound healing after transplantation process
• Monthly assessment of kidney markers to check how your kidney is functioning
• Refrain from social gatherings to avoid community-acquired infections for 6-12 months.10
• Maintain personal hygiene to reduce the risk of urinary tract infections.
• Use activated charcoal for cleaning fruits and vegetables to keep yourself away from bacterial infections.

References:

•  https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work 
•  https://www.healthline.com/health/kidney-failure#types
•  https://www.healthline.com/health/kidney-failure#symptoms 
• https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/kidney-transplan 
• https://www.maxhealthcare.in/blogs/when-kidney-transplant-needed 
• https://www.mayoclinic.org/diseases-conditions/end-stage-renal-disease/symptoms-causes/syc-20354532 
• https://my.clevelandclinic.org/health/articles/4431-nutrition-after-kidney-transplant 
• https://clinicalnutritionespen.com/article/S2405-4577(16)30191-7/fulltext#relatedArticles 
• https://columbiasurgery.org/kidney-transplant/nutrition-after-renal-transplant 
• https://cjasn.asnjournals.org/content/17/2/286 
• https://pubmed.ncbi.nlm.nih.gov/16398714/ 
• https://www.kidney.org/news/ekidney/august14/10_Signs_You_May_Have_Kidney_Disease

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