الفهرس 
• Etiology and Pathophysiology of end Stage Renal Failure in ChildrenOnly 14 pages are availabe for public view
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Abstract
rgan transplantation typically results in dramatic improvement of all aspects of physical, emotional, and social functioning. Importantly, cognitive skills improve after successful renal transplantation, suggesting stabilization of neurophysiological functioning. Health-related quality of life measures are generally good, especially in older children and adolescents, although all ages reports some problems with usual activities. Interestingly, the perceived emotional status of the children was actually better than controls, especially during and after adolescence (Apajasalo M et al., 1997).
Candidates for renal transplantation undergo an extensive evaluation to identify factors that may have an adverse effect on outcome, Other information necessary in the evaluation of any illness includes blood pressure, body weight, and serum creatinine level. Patients with renal transplants or their families usually are very knowledgeable about their baseline status and are valuable sources of important clinical data (Salifu MO et al., 2005).
Physical examination and Laboratory Studies done for both donor and recepient, Blood chemistries, Liver function tests, Complete blood count (CBC), Coagulation profile and serology done to identifying and treating all coexisting medical problems that may increase the morbidity and mortality rates of the surgical procedure and adversely impact the posttransplant course. In addition to a thorough medical evaluation, evaluate the social issues of the patient to determine conditions that may jeopardize the outcome of transplantation (McCullough KP et al., 2009).
Recipients of kidney transplants undergo an extensive immunologic evaluation that primarily serves to avoid transplants that are at risk for antibody-mediated hyperacute rejection. The immunologic evaluation consists of ABO blood group determination, Human leukocyte antigen (HLA) typing, Serum screening for antibody to HLA phenotypes and Crossmatching, ABO blood group determination is used to determine if the patient is a potential target of recipient circulating preformed cytotoxic anti-ABO antibody. Transplantation across incompatible blood groups may result in humoral-mediated hyperacute rejection.
All transplant recipients undergo tissue typing to determine the HLA class I and class II loci; 6 HLA antigens are determined. The kidney donors also undergo HLA typing, and the degree of incompatibility between the donor and the recipient is defined by the number of antigens that are mismatched at each of the HLA loci, All transplant candidates are screened to determine the degree of humoral sensitization to HLA antigens. Sensitization to histocompatibility antigens is of great concern in certain candidate populations. This occurs when the recipient is sensitized because of receiving multiple blood transfusions, a previous kidney transplant, or from pregnancy. Transplantation of a kidney into a recipient who is sensitized against donor class I HLA antigens puts the recipient at high risk for hyperacute antibody-mediated rejection. (Montgomery RA et al., 2008).
Improvements in surgical technique and the advent of more potent immunosuppressive agents have reduced early complications of renal transplantation. Greater emphasis is now placed on preventing late complications. This is accomplished in the outpatient setting through routine assessment of patients who have received transplants.
Chronic systemic immunosuppression is a double-edged sword. The same immunosuppressive effects that prevent rejection of the allograft pose a risk for development of malignancy and infectious diseases. Routine cancer surveillance is mandatory to assure rapid diagnosis and treatment of any malignancy (McDonald SP et al., 2004).
Renal artery thrombosis, Renal artery stenosis & Venous thrombosis are vascular complication happen after renal trasplantation diagnosed by clinical picture and imaging studies. Tratment either conservative or intervetinal according to the case (Giustacchini F, 2002).
Urine leaks occur at the ureterovesical junction or through a ruptured calyx secondary to acute ureteral obstruction. They result from disruption of the anastomotic connection of the ureter to the graft, generally within the first 2 months after transplantation. Often, early urine leak is due to necrosis of the tip of the ureter. Urine leaks manifest as diminished urine output, an increase in creatinine levels, fever, and lower abdominal or suprapubic discomfort. Ultrasonography demonstrates perigraft fluid collection. Repair of urine leakage with minimal intervention may be attempted either by means of percutaneous nephrostomy and drainage with internal stenting or by means of a cystoscopic retrograde approach. More aggressive treatment involves operative intervention with either reimplantation of the ureter or ureteroureterostomy utilizing the ipsilateral native ureter (Rosenthal JT, 1994).
Urologic complications include Ureteral stenosis Lymphocele, and urinary fistula (Adani GL et al., 2007; Burgos F et al., 2009).
Renal allograft failure is one of the most common causes of end-stage renal disease after transplantation. Various clinical syndromes of rejection can be correlated with the length of time after transplantation, Hyperacute rejection, Acute rejection, Accelerated acute rejection, Diagnosis is by renal biopsy, and treatment depends on the identified cause, application of conventional antirejection agents (eg, corticosteroids or anti–T-cell antibodies) (Perico N et al., 2004).
Prognosis after kidney transplantation is good, with 1-year graft survival rates ranging from 80% to 95%. Many factors influence the anticipated outcome. HLA-ID transplants from living related donors have the best overall graft survival rate, Other factors affect outcomes after kidney transplantation. One such factor is kidney preservation time. Prolonged cold ischemia can result in delayed graft function immediately after transplantation and may result in a somewhat shorter lifespan for the transplant. Another factor is donor age: Greater age in the donor can adversely affect both immediate graft function and long-term outcomes. In general, both delayed graft function after transplantation and early rejection episodes adversely affect the long-term outcome of the transplant (Gallagher M et al., 2009).
Long-term survival is generally excellent, and measures of quality of life have demonstrated excellent rehabilitation in long-term survivors. More than 90% have rated health as good or excellent, and most did not feel that health interfered with normal functioning. Most of them were full-time students or were employed. The majority was below normal height, and up to a third were dissatisfied with their body appearance. only a small minority of long-term survivors were married,, some even had children (Apajasalo M et al., 1997).