MEDICINE FOR ALL

KIDNEY TESTS

Renal ultrasound

Your child will have had a renal ultrasound before the transplant. This test uses sound waves to:

• Check the size, shape, and structure of the transplanted kidney
• Determine blood flow to the kidney and rule out thrombosis (blood clots) or urine leak
• Identify if there is any fluid around the kidney (hematoma, lymphocele)

Laboratory tests

Most transplant patients have regular blood, urine, or other lab tests. Some things that are tested include:

• A patient’s white blood cells count, to show any possible infection or side effects from transplant medications 
• The level of waste products, such as creatinine and blood urea nitrogen in the blood, to show how well a patient’s kidneys and liver are working
• “Levels”, which is short for how much immunosuppresant medications stays in a patient’s bloodstream and for how long (high levels could be toxic or suppress the immune system too much and low levels may cause a patient to reject the new kidney)
• Urine analysis and culture to make sure there are no signs of urinary infection and to check for protein in the urine which can be abnormal)
• The amount of glucose (sugar), or lipids (cholesterol and other fats) in the blood (some transplant medications can made them too high)
• Signs of any recent  viral infections
• The level of HLA antibodies in the blood, to check if the body might start to reject the donor kidney

Clinic visits and routine testing

Clinic visits and routine tests are intended  to track your child’s health and development after their kidney transplant and identify any problems as early as possible.

This section outlines some tests that kidney transplant  patients may undergo, but remember that every patient and every transplant program is different. Your transplant team will explain the routine in your center and the plan for your child’s specific situation and health concern.

Immediately after their transplant, your child will usually visit the clinic once or twice a week. Over time, these visits will often become less frequent, once your child doesn’t  have any problems. Many centers eventually cut down appointments to once every six months for patients who are doing well.

LIFE AFTER KIDNEY TRANSPLANT

After the transplant, your child’s care will be managed by a health care team. It will consist of your pediatric nephrologist, your transplant surgeon, usually a nurse coordinator, a dietitian, a pharmacist and a social worker.

Similar to before the transplant, you will continue to see your child’s local family doctor. Right after your child is discharged from hospital, they will need to have frequent follow-up appointments at the kidney transplant clinic. These can be emotionally and financial draining, but the transplant team will work with you to help your child’s follow up care go as smooth as possible.

Your child’s appointments will be less frequent after the first few months and especially after the first year. Eventually, the appointments will more easily fit into a normal family schedule.

Note, too, that schedules and tests may change for many different reasons. Your kidney transplant team members will explain why they are doing a certain test or procedure in your child at a specific time. Many of the principles of renal transplant care are the same for children and adults.

Working with your child’s health care team

Once your child is out of the ICU and in a regular hospital room, the nurse who looks after them regularly will also have other patients to care for, unlike the ICU. Because of this you will be encoraged to play a greater role in your child’s care.

At this point, too, other transplant team member, such as the physiotherapist, occupational therapist, and dietitian, become involved again in your child’s care. It is important that you and your child follow their recommendations and instructions so that your child can begin to experience life with their new kidney.

This is also a time when the transplant coordinators and pharmacists will work closely with you to make sure that you are getting ready to care for your child at home.

Caring for a child with a chronic illness and going through a transplant can be stressful for everyone and can affect family dynamics. It is important to consider how other siblings might feel and make time for spouses/partners. Many families find benefit from family-centered therapy. If this is something you  feel might be helpful, your transplant team can help you identify sources of support.

Moving out of the ICU

As your child recovers from the surgery, the medical team will reduce their medications and begin to remove the invasive lines and monitors. The breathing machine will do less work as your child is woken up from sedation. When your child is finally disconnected from the breathing machine, they will be able to speak and, in time, have a drink.

Depending on their condition, a child can stay in the ICU for a few days or even a few weeks. When your child no longer needs intensive care, they will be moved to a regular hospital room.

Although most of the monitoring equipment will have been removed, your child may still have a bladder catheter and intravenous infusions. Over the following days, these will be gradually removed as your child’s condition improves.

Lab testing

Your child will have frequent blood tests to determine how the new kidney is  working and to monitor for complications after surgery. Most often these blood tests can be drawn from one of your child’s intravenous lines, avoiding the need to be poked for lab draws during this initial period.