Setelah Transplantasi Ginjal: Merawat Kesehatan Organ Anda

Dalam satu hingga dua bulan setelah menerima ginjal baru, sebagian besar pasien telah pulih total, kembali bekerja, dan melanjutkan kehidupan normal yang aktif. Pada awalnya, Anda akan cukup sering menemui dokter Anda untuk kontrol/perawatan lanjutan, dan Anda akan dipantau secara cermat untuk memastikan ginjal baru Anda berfungsi dengan baik. Anda akan terus bekerja sama dengan ahli bedah transplantasi dan nephrologist, koordinator Anda, dan anggota tim pelayanan sosial. Dokter setempat Anda akan tetap menjadi anggota kunci dari tim perawatan, memainkan peran aktif dalam pemulihan Anda.

Pada perawatan lanjutan, Anda akan menjalani jadwal rutin perawatan diagnostik dan medis, termasuk pemeriksaan fisik, darah lengkap, urin, dan analisis X-ray, peninjauan ulang obat-obatan, perawatan gigi dengan profilaksis antibiotik, dan pemeriksaan mata tahunan dan, bagi perempuan, perawatan ginekologi. Perawatan lanjutan ini dikoordinasikan secara hati-hati antara dokter bedah Anda, nephrologist, dan dokter yang merujuk untuk memastikan semuanya berjalan secara optimal, efektif dan nyaman untuk Anda.

Sementara kami mendorong dokter utama Anda untuk berpartisipasi dalam perawatan Anda dan untuk terus memantau kesehatan Anda setelah transplantasi Anda, kami menyarankan, selama tiga bulan pertama setelah transplantasi, Anda tetap berkomunikasi aktif dengan team dokter transplant Anda. Team dokter transplantasi harus diberitahu setiap perubahan dalam fungsi ginjal anda (tingkat kreatinin meningkat) atau perubahan obat. Anda juga harus terus mengunjungi spesialis yang telah terlibat dalam perawatan kesehatan Anda, seperti dokter jantung Anda, dokter kandungan, atau, dalam kasus pasien yang lebih muda, dokter anak.

Ingatlah untuk menginformasikan kepada tim dokter transplant Anda setiap perubahan informasi kontak untuk dokter pelayanan utama anda atau spesialis.

[english version]

Sumber:  http://www.columbiakidneytransplant.org/postcare.html

What You Need to Know After Kidney Transplant

[versi bahasa Indonesia]

• Post-Transplant Care
• Resuming Life After Kidney Transplantation
• Health Concerns
• Follow-up Visits
• Nutrition
• Immunosuppressant Medications
• Infections
• Organ Rejections

After Kidney Transplantation: Caring for a Healthy Organ

Within one to two months after receiving a new kidney, most patients recover fully, return to work, and resume a normal, active life. At first, you will see your doctor quite often for follow-up visits, and you will be monitored carefully to make sure your new kidney is functioning properly. You will continue to work closely with your transplant surgeon and nephrologist, your coordinator, and members of the social services team. Your local physician will remain a key member of the care-giving team, playing an active role in your recovery.

At follow-up visits, you will participate in a regular schedule of diagnostic and medical care, including physical examinations, complete blood, urine, and X-ray analysis, review of medications, dental care with antibiotic prophylaxis, and annual eye exams and, for women, gynecologic care. This follow-up care is carefully coordinated among your surgeon, nephrologist, and referring physician to ensure it is optimally effective and convenient for you.

While we encourage your primary physician to participate in your care and to continue to monitor your health after your transplant, we recommend that, for the first three months after your transplant, you receive primary care at our center. The transplant program must be notified of any change in your kidney function (increased creatinine level) or any medication changes. You should also continue to see any specialists who have been involved in your healthcare, such as your cardiologist, gynecologist, or, in case of younger patients, pediatrician.

Remember to inform the transplant office of any changes in contact information for your primary care doctor or specialists.

[versi bahasa Indonesia]

source: http://www.columbiakidneytransplant.org/postcare.html

• Post-Transplant Care
• Resuming Life After Kidney Transplantation
• Health Concerns
• Follow-up Visits
• Nutrition
• Immunosuppressant Medications
• Infections
• Organ Rejections

Resuming Life After Kidney Transplantation

After returning home, you want to resume “normal living.” If you want to go to a movie or a social occasion and feel up to it, DO IT! If you’d like to have friends visit you at home, that’s OK too! Try as much as possible to return to your normal routine.

However, the key is moderation and understanding your limits. Initially, you will probably have less energy than you did before surgery. It takes time for your body to heal and adjust to your new medications. Napping and pacing your activities is recommended to prevent placing a strain on your recovery.

Please note that many of these recommendations specifically apply to patients taking prednisone. Today, the vast majority of our transplant patients do not require prednisone and other steroids long-term.

To learn more about a specific post-transplant concern, click on the related link below:
• Emergency Medical Identification
• Prescriptions
• Exercise
• School and Work
• Driving
• Travel
• Routine Self-Examination
• Immunizations and Vaccinations
• Skin Care
• Skin Cancer
• Hair Care
• Eye Care
• Dental Care
• Smoking
• Sexual Activity
• Pregnancy
• Psychological Health

Emergency Medical Identification
Following transplant, you should wear a medical identification bracelet or necklace at all times. Your nurse can provide an order form for this essential life-saving item. Indicate on the form that you have had a kidney transplant, are “immunosuppressed,” and have our 24-hour number (212.305.6469) included on the tag. You may want to include your local doctor’s phone number as well. If the transplant patient is a child, the parents’ or guardian’s names and contact phone number(s) should be included.

Prescriptions
Your transplant team may be able to recommend a pharmacy that will send all your monthly medications directly to your home. The insurance company who issues your drug plan will have to pre-approve the use of such a service. Generics are generally fine, but please check with the transplant team if your pharmacy wants to make substitutions. Many medications will interact with your immunosuppressants; for this reason, you must always consult with the transplant team prior to taking any new medications, or altering the dosage of the immunosuppressants and other medicines we have prescribed.

Exercise
Exercise will become an important part of your life, enabling a faster return to your routine activities, and helping you maintain overall improved health.
Regular exercise will help you control your cholesterol levels, blood pressure, and weight. Exercise releases tension and helps boost your energy, and encourages positive changes in other important lifestyle habits—such as maintaining a healthy diet.
Exercise has been shown to improve muscle tone, as well as the functioning of your heart and lungs. It also helps reduce stress, and achieve and maintain ideal body weight.
When you return home, we recommend that you exercise daily. We suggest walking 15-20 minutes every day, and gradually increase time as tolerated.
Do not resume strenuous exercise or lifting weights until you have been cleared to do so by the transplant team.

School and Work
You should be able to return to school or work within two months. Your transplant team will help you decide what is best for you. You may wish to discuss career counseling with the transplant team’s social worker.

Driving
You will not be able to drive for approximately two to four weeks after your transplant. You should speak with your physician before driving for the first time after your transplant. The initial doses of the medications we prescribe can cause tremors, weakness, and blurred vision. These side effects, which are often worse in the first few months, make handling a car difficult. Therefore, we recommend that you abstain from driving until you are cleared to do so by the transplant team.

Travel
Travel within the first two to three months after transplant is not recommended. Travel outside the continental U.S. is not recommended for the first six to 12 months. Thereafter if you are traveling to an underdeveloped country please consult your physician regarding vaccinations and the whether you need to avoid water or certain foods in that area.

Routine Examinations
Developing certain cancers is more common when taking immunosuppressive medications. Because of this, we recommend monthly breast and testicular self-examination and routine medical check-ups. PAP smears, breast exams, testicular exams, and skin cancer screening should be done by your physician every year. Your local physician can perform these tests but duplicate reports should be sent to the transplant team to help us with your follow-up care.

Immunizations and Vaccinations
Post-transplant, annual flu shots are recommended after 1 year. If additional innoculations are necessary, you should only receive “dead virus” vaccinations. You may not receive “live virus” vaccines, such as varicella or MMR, because of risk of transmission. Care must be used in contact with family members who were recently immunized, especially infants receiving the polio vaccine, as the virus will be shed in their stool.

Skin Care
Acne
Prednisone may cause acne on your face, chest, shoulders, and/or back, plus cyclosporine can make your skin oily in these areas. Wash any acned area(s) thoroughly three times a day, every day. Scrubbing gently with a wet washcloth and mild soap will help remove accumulating oils, dead skin, and bacteria. Vigorous rubbing and scrubbing can irritate your skin. Avoid soaps that contain creams or oils (such as Dove®, Tone®, or Caress®) because they will aggravate the acne. Completely rinse soap from your skin to leave your pores open and clean. Use a clean washcloth each time you wash. If your skin becomes excessively dry, stop washing those areas temporarily to allow the skin to recover its natural moisture.

If washing with bar soap does not improve or control your acne, use a non-prescription acne mediation with benzoyl peroxide (Oxy® 5 or Oxy® 10). Start by applying benzoyl peroxide 5% once a day. If redness and peeling are not excessive after three days, apply twice per day, gradually leaving it on for longer periods of time until it is left on all day. You may need to use a 10% benzoyl peroxide preparation if your acne is not controlled by the 5% preparation.

We recommend that you do not use Retina A, a powerful acid form of vitamin A. It causes increased sun sensitivity, which should be avoided because you are taking Prednisone.

Other Ways to Control Acne
• Shampoo you hair and scalp frequently.
• Keep your hands away from your face and avoid rubbing the affected skin.
• Do not use cosmetics. Avoid the use of medicated hypoallergenic cosmetics meant to cover acne. If you wear make-up, your acne will probably not improve.
• Do not pick or touch your acne. This will help prevent infections. If acne remains a problem, tell us about it. Severe or infected acne must be treated by a dermatologist.

Dry Skin
If you have problems with dry skin, use a mild soap and apply body lotion after bathing. For severely dry or scaly skin you may need a rich body lotion such as Alpha Keri®. Alpha Keri also offers an excellent bath oil. There are many good moisturizing products available from your local drug store without prescription; try to find those that work best for you.

Cuts and Scratches
Keep minor cuts and scratches clean and dry by washing daily with soap and water. If you wish, you may apply an antiseptic such as Betadine® solution. For larger cuts, dog bites or serious bruises you should contact your physician immediately.

Sun Exposure
Transplant recipients run a substantially increased risk for developing skin and lip cancers, and this risk increases over time (see below). Prednisone makes your skin more sensitive to the sun, so you will burn easier, faster, and to a greater degree than you did before the transplant. Prolonged and repeated exposure to the sun’s ultraviolet radiation produces permanent and damaging skin changes. The darker your skin, the more natural protection you have against burning and skin damage. But, bear in mind that you can now burn even if you are black because your medications make you more sensitive to the sun.

You will not need any special skin care unless you develop problems with acne or dry skin. You should take a bath or shower as often as necessary (daily or every other day) to keep your skin clean. It is important to be aware that any persistent skin problem will require evaluation by a dermatologist.
Skin cancer is more common in transplant recipients. Therefore, it is recommended that you see a dermatologist on an annual basis.

Skin Cancer
Because of your skin’s enhanced sensitivity, it is important that you see a dermatologist on an annual basis for skin cancer screening. It is also essential that you limit your exposure to the sun, and that you protect yourself with proper clothing and sunscreens when you are outside.

Warning signs of skin cancer are any sore that bleeds, scabs, grows, or does not heal in a few weeks. Such sores are most likely to appear on the exposed parts of your body like your face, neck, head (especially if you are bald), and your hands and arms. A mole that bleeds or changes color or size must be examined immediately.

The sun’s radiation responsible for skin cancers are the ultraviolet (UV) rays, which are present even on cloudy days and in shady areas. We advise you to always protect your skin from exposure to UV radiation. Avoid the midday sun (10:00 am-3:00 pm) when ultraviolet rays are strongest. The window glass in cars prevents most harmful ultraviolet rays from reaching you. For extra protection from the sun, wear sunscreen lotion and lip balm (SPF 15 or above), broad brimmed hats, long sleeves and slacks every day when you are outdoors.

Hair Care
Prednisone often weakens the condition of your hair. Permanent wave lotions, tints, dyes, and bleaching may cause your hair to break. We recommend that you check with your physician before you have a permanent or color your hair.

Tacrolimus (Prograf®), an anti-rejection medication, can cause hair loss. The problem of increased hair growth is caused by cyclosporine and to a lesser extent, by prednisone and is especially annoying to women. You can remove hair with a hair removal cream. There are several on the market made especially for the face—i.e., Sally Hansen® facial hair remover, Elizabeth Arden® facial hair remover, or Nair’s® Only for Facial Hair remover. Be sure to test your tolerance of the product by following the directions on the bottle. Hair removers can cause severe irritation to the eyes, lips, and mucous membranes, so apply carefully. A safer way to diminish the appearance of excessive hair is to bleach the growth with a 50% peroxide solution.
Caution
Patients should be particularly careful when using these products on infants and children because their skin tends to be more sensitive.

Eye Care
It is important to have annual vision check-ups with an ophthalmologist. The immunosuppressant prednisone can cause cataracts and initiate changes in your vision. You should schedule your first postoperative ophthalmology exam at six months, or when your prednisone dose is set at 10 mg per day.

Dental Care
You may have received a dental consultation during your pre-transplant workup to be sure that any necessary dental work would be completed before transplantation. If so, it is not necessary to have routine dental work performed for at least six months following transplant. This includes having your teeth cleaned. However, if you have tooth or gum pain, you should see your dentist immediately.

After transplantation, you need to take an antibiotic when you have dental work done, including cleaning and polishing. You can obtain a letter from the Transplant Office for your dentist regarding your antibiotic prescription.

It is extremely important that you practice good oral hygiene after your transplant. Brush your teeth once or twice a day. You should floss your teeth after transplant, but flossing can irritate your gums and cause bleeding, so be gentle.

If your dental work was not completed before transplantation, you must see your dentist for evaluation within the first few months after your return home. Follow the procedure outlined below when you visit the dentist.
• Make an appointment
• Have the dentist examine your mouth and teeth, but do not allow either the dentist or a hygienist to pick, clean, or polish your teeth. If further cleanings or dental work are necessary, antibiotics must be taken.
• Have the dentist take X-rays if necessary.
• Schedule all necessary appointments as closely together as possible when your dentist knows what work needs to be done.

If you are on prednisone, the dose should be as low as possible when dental work is done to reduce the possibility of infection and bleeding, and to enhance the healing process. But do not avoid dental checkups just because your prednisone dose is still high. It is better to have healthy teeth and gums than to allow them to become infected.

If you or your dentist have any questions, contact your transplant team doctor.

Smoking
We recommend strongly that you do not smoke. Smoking damages the lungs, putting you at greater risk for lung infections, including bronchitis, emphysema, and pneumonia. It also increases your risk of developing cancer.
Cancer is a leading cause of death after transplantation and smoking dramatically increases the risk of developing lung cancer after transplant. Smoking diminishes your red blood cells’ ability to carry oxygen, so less oxygen reaches all of your tissues and this decreases your ability to heal. Smoking narrows your blood vessels, especially those in your legs, arms, and heart. It also increases the acid in your stomach which will delay or prevent the healing of any ulcers you may develop. All of these problems are even more serious in individuals taking immunosuppressive medications.

Tips to help you quit
• Avoid beverages that contain caffeine. Caffeine, found in coffee, tea, and many soft drinks, can stimulate your urge to smoke again.
• Drink more liquids and eat fruits during your first three non-smoking days. Body fluids of smokers have high concentrations of nicotine; as these concentrations decrease nicotine cravings increase. Extra liquid can act as an alternative to cigarettes and help nicotine pass out of your body.
• Use deep breathing. When the craving to smoke strikes, you should take slow, deep breaths. This will help you relax long enough to consciously decide not to smoke. It will also help supply your brain and the rest of the body with oxygen. Take in a deep breath with your mouth wide open, bend at the waist, and breathe out; repeat two or three times. Stop if you begin to feel dizzy
• Take your vitamins. Taking a B vitamin may help diminish the nervousness and mood swings that can occur when one tries to stop smoking. Take vitamin C if you are unable to eat fruit. Remember to consult your doctor before taking vitamins.
• Exercise regularly. An aerobic workout, such as walking briskly, can improve lung capacity and vascular tone, and help prevent depression. Consult with your doctor or exercise physiologist before beginning any exercise program.
• Join a smoking cessation group. These groups can be helpful for discussing feelings and learning from others in the same situation. Check the Yellow Pages or your local heart, lung, or cancer society chapter to find a convenient group.
• Try using Nicorette® gum or a nicotine patch to help lessen your urge to smoke.
It is not easy to give up smoking. You may become anxious or irritable. You may develop headaches, nervousness, dizziness, muscle cramps, fatigue, sleepiness, increased sweating, as well as difficulty focusing your attention, a loss of appetite, increased craving for food, or an intense craving to smoke. However, if you stick to your decision not to smoke, you will be breaking a habit that is harming your health and, in time, the “withdrawal” symptoms will diminish and you’ll feel better than ever before.
Your ability to choose not to smoke grows stronger each time you repeat the choice. Instead of thinking about how much you want to smoke, remind yourself of smoking’s harmful effects and the health benefits that will be yours without smoking.

Sexual Activity
Sexuality is an important part of who you are as a person. It is more than sexual intercourse. Sexuality involves how you feel about yourself as a man or woman, the giving and receiving of sensual (feeling) pleasure, the desire for closeness with another person, and the release of sexual tension.

A person’s sexuality is affected when they have kidney failure. This is caused for a variety of reasons. Men may experience impotence (problems getting or maintaining an erection) and a decreased sexual drive (libido). Women’s menstrual cycles may become irregular or stop completely.

Some patients take blood pressure medications that can interfere with sexual function. These medicines can cause drowsiness and fatigue, in addition to decreased sexual drive, menstrual cycle irregularities, and/or decreased vaginal lubrication. Sometimes, even though the body functions normally, the sexual experience is not enjoyable. Some patients have found talking to a counselor helpful and this can be arranged by the transplant team.

Kidney transplantation can improve some aspects of your sexual functioning. Chronic fatigue should diminish and make sexual life more enjoyable. Men will typically have fewer problems in gaining and maintaining an erection. A woman may resume her menstrual cycle and pregnancy is often possible.

After your kidney transplant, however, some things may not get better. You may still need blood pressure medicines and these may affect your sexual functioning. Talk with your doctor or nurse if you are concerned about your blood pressure medicines. Your physician may be able to change your medication to minimize or eliminate side effects that affect your sexual activity, while still controling your blood pressure.

Sexuality can also be affected by the medicines that you take to prevent rejection if they cause certain side effects. These might include developing a “moon face,” acne, bruising, and/or increased body hair. If a person feels less attractive because of these changes, he or she may feel less interested in sex. Talking with your doctor or nurse about how to diminish the side effects can help.

It is common for transplant recipients to resume a more normal lifestyle, including sexual activity, as they recover. Sexual function may not have been an important part of your life before the transplant, but it may now be higher on your agenda. It is not unusual to worry about something that was unfamiliar in your recent past, but is now taking on new importance. You may also be concerned about the safety of your new kidney during intercourse.

Women using immunosuppressant medications can develop urinary tract infections with intercourse because they are more prone to infection, and because of the proximity of the vagina, urethra, and anus. To avoid infections, it is important to wash well after bowel movements and to wipe from the front to back. Urinating before and after intercourse and drinking a lot of water can help to prevent urinary tract infections. Symptoms of urinary tract infection are burning while you urinate, smelly or cloudy urine, a fever, or frequent urination. Contact your local doctor’s office for proper diagnosis and treatment.

Even though you may not be having regular menstrual periods, it is still possible to become pregnant. It is important to use some type of birth control to avoid unwanted pregnancy. The recommended choices are a diaphragm, sponge, and/or condoms. Used correctly, with spermicidal jellies or creams, they are very effective. There is a higher risk for developing a urinary tract infection if a diaphragm is used. If you have questions or concerns about birth control, talk with the transplant team.

Pregnancy
Some people want to start a family once they have had a kidney transplant and have recovered their health. For many women this is possible, but there can be greater risks to the mother and fetus. If planning a pregnancy, it is important to discuss potential risks with transplant team members so that you can make the right decision for you and your family. Medication adjustments are frequently needed.
The transplant program does not recommend pregnancy within the first year after transplant.

Psychological Health
A serious illness such as you have experienced can create many personal and family stresses. To help you and your family make any necessary adjustments, we have a social worker and psychiatrist available for consultation. They are available when you are in the hospital or in the clinic to help you with the concerns that arise after your transplant.

Our transplant team can help you with: job planning or rehabilitation; family stresses, such as parent-child conflicts, marital conflicts, and changes in sexual functioning; and financial concerns, such as questions about Medicare, disability, and insurance.

Your social worker will evaluate your needs, refer you to an agency in your home community, or provide direct counseling if the circumstances and distance permit. You may be able to resolve many questions by talking with the social worker. If you need specialized counseling, we will help you find appropriate alternatives.

source: http://www.columbiakidneytransplant.org/life.html

Ginjal dan Cara Kerjanya

Ginjal, dua organ berbentuk kacang yang terletak di kedua sisi tulang belakang pada tingkat terendah tulang rusuk, melayani berbagai fungsi vital. Pada persimpangan dari sistem peredaran darah dan urin, fungsi utama ginjal adalah membuang kelebihan cairan dan bahan limbah dari aliran darah, proses diawali menghilangkan mereka dari tubuh sebagai urin mengalir melalui ureter, ke kandung kemih, dan akhirnya , keluar melalui uretra. Ginjal juga mengatur kadar natrium, kalium, kalsium, dan bahan kimia lain dalam tubuh yang bisa menjadi beracun jika dibiarkan terakumulasi. Selain itu, ginjal berfungsi sebagai kelenjar, memproduksi hormon untuk membantu menjaga tekanan darah normal, memungkinkan produksi sel darah merah, dan membantu pembentukan tulang.

Ginjal memiliki kapasitas operasi yang luar biasa, ginjal tunggal, bekerja hanya pada 20% dari kapasitas, masih dapat menyediakan semua filtrasi dan regulasi ginjal yang diperlukan. Selain itu, ginjal mampu mengubah kegiatan mereka dari hari ke hari, terus-menerus menyesuaikan diri dengan variasi dan jumlah makanan dan cairan yang dikonsumsi. Ketika kita berpuasa satu hari, atau makan berlebihan pada hari berikutnya, ginjal mengkompensasi untuk menjaga jaringan tubuh agar tidak bengkak oleh cairan atau dehidrasi.

Melalui jaringan jutaan nefron yang terdapat dalam setiap ginjal, darah yang masuk dari arteri ginjal disaring, dan melalui biokimia yang kompleks, zat yang tidak dibutuhkan oleh tubuh (biasanya urea, kreatinin dan asam ureic) dibuang, dan lainnya, seperti sel darah , protein, dan sejumlah air, diserap. Dengan demikian, darah yang meninggalkan ginjal melalui vena renalis mengandung garam yang diperlukan, protein, gula, kalsium dan zat penting lainnya dalam proporsi yang tepat, sementara bahan kimia berlebih, racun dan cairan dibuang ke dalam saluran kemih.

Kelainan saat kelahiran, kelainan bawaan, cedera, hipertensi, paparan racun, batu ginjal, tumor, dan bahkan infeksi di bagian lain dari tubuh dapat mengakibatkan fungsi ginjal terganggu. Banyak penyakit ginjal yang tidak memiliki gejala nyata sampai kerusakan besar dan tak dapat diperbaiki terjadi. Ketika ginjal tidak dapat lagi berfungsi dengan cukup baik dengan sendirinya-yang disebut ” penyakit ginjal stadium akhir” atau ESRD-hemodialisis atau dialisis peritoneal akan diperlukan untuk membantu menghilangkan kelebihan cairan dan limbah dari darah. Namun, bagaimanapun, Dialisis tidak bisa meniru manfaat hormonal dari ginjal. Transplantasi telah terbukti menjadi salah satu cara untuk memulihkan kualitas kesehatan, dan kualitas hidup, yang dinikmati sebelum terjadinya penyakit ginjal stadium akhir.

sumber : http://www.columbiakidneytransplant.org/about_kidneys.html

English version

The Kidneys and How They Function

The kidneys, two bean-shaped organs located on either side of the spine at the level of the lowest ribs, serve a variety of vital functions. At the junction of the circulatory and urinary systems, the kidneys’ primary function is the removal of excess fluid and waste material from the bloodstream, beginning the process of eliminating them from the body as urine flowing through the ureters, into the bladder and, finally, exiting through the urethra. The kidneys also regulate the body’s levels of sodium, potassium, calcium, and other chemicals which can become toxic if left to build up. In addition, the kidneys function as glands, producing hormones to help maintain normal blood pressure, enable the production of red blood cells, and aid the formation of bone.

The kidneys have a remarkable operating capacity—a single kidney, working at just 20% of its capacity, can still provide all needed renal filtration and regulation. And, the kidneys are capable of altering their activities from day to day, constantly adjusting to the variety and amounts of foods and liquids that are consumed. As we fast one day, or overindulge the next, the kidneys compensate to keep the body’s tissues from bloating with fluids or dehydrating.

Through a network of millions of nephrons in each kidney, blood entering from the renal arteries is filtered, and through complex biochemistry, substances not required by the body (typically urea, creatinine and ureic acid) are removed, and others, such as blood cells, proteins, and some amount of water, are reabsorbed. Thus, the blood that leaves the kidney through the renal veins contains necessary salts, protein, sugar, calcium and other vital substances in the right proportion, while excess chemicals, toxins and fluids are sloughed off into the urinary tract.

Congenital anomalies, inherited disorders, injury, hypertension, exposure to toxins, kidney stones, tumors, and even infections in other parts of the body can result in compromised renal function. Many kidney diseases have no noticeable symptoms until substantial and irreparable damage has been done. When the kidneys can no longer function well enough on their own—termed “end-state renal disease” or ESRD—hemodialysis or peritoneal dialysis will be required to help eliminate waste and excess fluids from the blood. Dialysis cannot, however, replicate the kidneys’ hormonal benefits. Transplantation has proven to be the one way to recover the quality of health, and quality of life, enjoyed before the onset of end-stage renal disease.

source : http://www.columbiakidneytransplant.org/about_kidneys.html

Selain itu, Anda juga dapat menurunkan risiko hipertensi dengan cara berbeda yakni mengonsumsi minuman alami.  Berikut ini adalah 6 (enam) minuman yang dapat berkontribusi terhadap penurunan tekanan darah, terutama dalam kombinasi dengan diet sehat dan olahraga teratur.

1. Susu rendah lemak

Cara kerja : Kekurangan kalsium telah lama dikaitkan dengan tekanan darah tinggi. Asupan tinggi kalsium dapat membantu menurunkan tekanan darah tinggi. Tapi perlu diingat, sangat penting untuk memilih jenis susu yang tepat untuk hasil terbaik. Susu rendah lemak sangat kaya akan kalsium ketimbang susu penuh lemak. Jumlah lemak sederhana dapat membantu Anda menyerap kalsium lebih mudah.

Saran:  Sebagai bagian dari ritual menyehatkan, tiga porsi susu rendah lemak terbukti mampu mengurangi tekanan darah sistolik.

2. Teh bunga rosella

Cara kerja : Seperti halnya jus delima, bunga rosella (hibiscus) mengandung phytochemical bioaktif yang bertindak sebagai inhibitor ACE alami. Satu studi menunjukkan bahwa teh rosella sangat efektif menurunkan tekanan darah seperti halnya kaptopril – obat yang biasa digunakan untuk mengatasi hipertensi dan gagal jantung.

Saran: Dalam satu penelitian dipublikasikan secara luas, tiga porsi teh hibiscus dapat menurunkan tekanan darah sistolik prehipertensi subyek secara signifikan. Minumlah tiga cangkir sehari untuk mendaptkan hasil maksimal.

3. Jus delima

Cara kerja: ACE adalah enzim yang meningkatkan tekanan darah dengan menciptakan protein yang disebut angiotensin II, yang menyebabkan pembuluh darah mengkerut. Jus buah delima bertindak sebagai inhibitor ACE alami, mirip dengan jenis obat yang biasa diresepkan untuk mengobati hipertensi dan gagal jantung.

Dalam sebuah kasus disebutkan, jus buah delima dapat mengurangi ACE sebesar 36 persen dan menurunkan tekanan darah sistolik juga. Bahkan beberapa penelitian belakangan secara signifikan menunjukkan, manfaat delima untuk mengurangi plak arteri (sampai 30 persen) dan meningkatkan aliran darah ke jantung.

Saran : Jonny Bowden, salah seorang ahli nutrisi merekomendasikan untuk meminum enam ounce (177 mililiter) jus delima setiap hari tanpa pemanis.

4. Jus cranberry

Cara kerja: Cranberry dan jus cranberry memiliki sifat anti-inflamasi dan antioksidan kuat yang membantu mencegah dan mengurangi kerusakan dalam pembuluh darah, sehingga mencegah peningkatan tekanan darah yang tidak diinginkan. Selain itu, jus cranberry dapat membantu mengurangi tekanan darah dengan melebarkan pembuluh darah dan meningkatkan aliran darah.

Saran: Tidak ada rekomendasi standar untuk mengonsumsi jus cranberry sebagai bagian dari rejimen sehari-hari.

5. Air

Cara kerja: Minum air putih adalah cara sederhana, murah, sehat dan paling efektif untuk membantu menurunkan tekanan darah. Dehidrasi kronis menyebabkan pembuluh darah mengkerut sehingga membuat jantung bekerja lebih keras, dan pada akhirnya mengakibatkan lonjakan tekanan darah.

Saran: Kebanyakan orang mungkin telah sering mendengar anjuran yang mengatakan untuk minum delapan gelas per hari. Tetapi untuk pendekatan yang lebih personal, bisa disesuaikan dengan berat badan Anda. Caranya: berat badan dibagi dua (namun dalam bentuk ounce). Misalnya, orang dengan bobot 150-pound atau sekitar 68 kg harus memenuhi kebutuhan asupan air setidaknya 75 ounce atau sekitar 2 liter setiap hari.

6. Jus Bit

Cara kerja : Buah bit adalah sumber yang baik dari potassium dan folat, dua zat yang penting untuk mengatur tekanan darah.  Selian itu, buah bit juga mengadung nitrat, yang diubah menjadi nitrit ketika diserap oleh tubuh. Nitrit berkhasiat membuat jaringan otot menjadi rileks dan menurunkan aliran darah. Buah bit secara alami dapat membantu kesehatan fungsi pembuluh darah dan melawan homosistein, yang  dapat merusak pembuluh darah.

Saran : Beberapa riset mengindikasikan, konsumsi satu atau dua cangkir jus  bit setiap hari dapat menurunkan tekanan darah secara signifikan dalam waktu cukup singkat yakni sekitar satu jam setelah konsumsi. Penelitian di Inggris juga menyatakan  bahwa jus buah bit sama efektifnya dengan tablet nitrat dalam mengendalikan hipertensi.

A. Tahap Pra Operasi

0. Keluhan Awal, EKG dan Treadmill

Pada awalnya, bapak mengeluhkan adanya sedikit sesak nafas bila berjalan agak tergesa-gesa dan agak jauh. Lalu bapak memutuskan untuk konsultasi ke dokter spesialis jantung (kardiolog). Dari referensi yang kami dapat dari beberapa dokter kenalan kami, kami dirujuk ke salah satu kardiolog yang terbaik di Surabaya, yaitu Dr. Iswanto Pratanu, Sp.JK. Beliau praktek di RS Mitra Keluarga Surabaya dan RS RKZ Surabaya. Selain itu, beliau praktek pribadi di Jl Dharmahusada … (seberang Galaxi Mall).

Pada pertemuan pertama, bapak langsung menjalani pemeriksaan EKG. Namun hasilnya tidak menunjukkan adanya sesuatu yang abnormal. Pemeriksaaan kemudian dilanjutkan dengan treadmill. Hasilnya menunjukkan adanya penyempitan yang cukup signifikan pada pembuluh darah jantung bapak. Namun belum dapat dipastikan berapa titik penyempitan dan berapa besar persentase penyempitan. Untuk mengetahui penyempitan secara lebih detail, dokter Iswanto menyarankan dilakukan prosedur angiografi atau kateterisasi jantung (cat).

Akhirnya disepakati bahwa cat dilaksanakan di Rumah Sakit Mitra Keluarga dalam waktu satu minggu setelahnya. Kami diberikan pengantar untuk diberikan kepada pihak rumah sakit agar disiapkan segala sesuatunya.

1. Kateterisasi (AngioGraphy)

Selama seminggu sebelum prosedur cat dilaksanakan, kami mencari tahu segala sesuatu tentangnya, terutama tentang resiko yang ditimbulkannya. Kami mendapat informasi bahwa prosedur cat mempunyai resiko yang harus diwaspadai terkait dengan emboli (bekuan/gumpalan) darah.

Setelah kami tanyakan ke dokter Iswanto, ternyata resiko itu untuk pasien yang pernah mengalami serangan jantung, karena serangan jantung menyebabkan terjadinya gumpalan darah yang menempel pada dinding pembuluh darah. Saat insersi kateter, emboli tersebut bisa tersenggol kateter sehingga terlepas. Nah, kondisi ini sangat berbahaya karena emboli tersebut bisa langsung menyumbat pembuluh darah jantung. Namun demikian, untuk pasien yang belum pernah mengalami serangan, hal ini tidak perlu dikhawatirkan karena kecil kemungkinannya terdapat emboli.

Setelah mendapat keyakinan bahwa kateterisasi aman, bapak pergi ke RS Mitra Keluarga untuk menjalani cateterisasi. Setelah menyerahkan surat pengantar dari dr Iswanto, kami diminta untuk membayar DP sebesar Rp 9,5 Juta untuk paket Kateterisasi Jantung. Kemudian, dari ruang cat, jadwal disepakati untuk hari berikutnya.

Keesokan harinya, bapak kembali lagi ke RS Mitra Keluarga untuk menjalani prosedur kateterisasi. Prosedur Kateterisasi dilakukan oleh seorang dokter kardiolog, untuk bapak dilakukan oleh dr Iswanto sendiri. Tujuannya adalah untuk melihat jumlah titik penyempitan pembuluh darah jantung sekaligus tingkat persentase keparahannya. Prosesnya sendiri hanya memerlukan waktu sekitar 1 jam. Sebelum dilakukan prosedur, bapak harus berpuasa paling sedikit 4 jam, dan selama itu hanya boleh minum sedikit air putih.

Lokasi insersi kateter umumnya dilakukan pada dua tempat:
a. Pembuluh darah di Perut bagian bawah, dekat selangkangan

Sebagai persiapan, rambut dan bulu disekitarnya, termasuk rambut kemaluan (pubic hair) harus dicukur, dan sebaiknya yang bersih . Hal ini dilakukan untuk menjaga higienitas daerah sekitar luka insersi guna mencegah infeksi yang bisa ditimbulkan oleh kuman yg menempel pada rambut/bulu.

b. Pembuluh darah di pergelangan tangan.

Pada saat itu, bapak dikateterisasi dekat selangkangan. Padahal bila memungkinkan (pembuluh darah tangan cukup besar), sebaiknya kateterisasi dilakukan lewat pergelangan tangan. Hal ini karena proses recovery paska kateterisasi via tangan jauh lebih nyaman dibandingkan bila dilakukan via dekat selangkangan. Jika dilakukan lewat pergelangan tangan, pasien hanya diminta untuk tidak menekuk pergelangan tangan selama 4 jam paska kateterisasi. Namun jika lewat dekat selangkangan, pasien diharuskan bed rest dalam posisi terlentang dan selama semalam tidak boleh menekuk kaki disisi yang dilakukan insersi kateter. Sehingga hal ini cukup menyiksa.

Untuk mencegah rasa sakit, bapak diberikan bius/anestesi lokal. Sehingga selama dilakukan kateterisasi, bapak bisa melihat prosesnya pada layar monitor. Waktu itu kami, selaku keluarga pasien, dipanggil untuk ditunjukkan kondisi penyempitan pembuluh jantung yang diderita oleh bapak dan diajak berunding tentang tindakan terbaik yg dapat dilakukan. Akan tetapi, di RSJ Harapan Kita, hal ini tidak dilakukan karena jumlah pasien cat yang sangat banyak.

Hasil angiografi bapak menunjukkan bahwa terdapat lima penyempitan pembuluh darah jantung. Satu 80%, dua 70% dan dua 50%. Tiga diantaranya (80% dan 70%) terletak pada percabangan. Awalnya dr Iswanto menawarkan dua alternatif tindakan, pasang sten yang bisa dilaksanakan saat itu juga oleh beliau atau bypass pembuluh darah jantung diluar Surabaya oleh dokter ahli bedah jantung. Namun dengan mempertimbangkan posisi penyempitan pembuluh darah di percabangan, dr Iswanto lebih menyarankan untuk diambil tindakan bypass. Alasannya adalah selain posisi itu sulit untuk dilaksanakan pemasangan sten, kalaupun dipaksakan kemungkinan buntu kembali dalam waktu kurang dari 1 tahun sangat besar. Sedangkan bila dilakukan bypass, meskipun resikonya lebih besar (sekitar 5%), bila berhasil kemungkinan buntu kembali jauh lebih lama (secara teori bisa sampai 20 th, bila pola makan dan pola hidup dijaga). Dalam hal ini kami sangat menghargai sikap terus terang dr Iswanto yang mengutamakan kepentingan pasiennya.

Untuk bypass, dr Iswanto menyarankan tiga alternatif tempat:

- Rumah Sakit Pusat Jantung Harapan Kita Jakarta

- Rumah Sakit Aventis Penang Malaysia

- Rumah Sakit Glen Eagles Singapore

Saat itu bapak dan kami belum bisa memutuskan, sehingga oleh dr Iswanto luka insersi kateter ditutup dulu tanpa pemasangan sten. Kami diberi waktu sampai sebulan untuk memikirkan alternatif tindakan yang dipilih.

Sebagai hasil kateterisasi jantung, yang juga dikenal dengan nama angiografi, bapak diberikan foto semacam hasil Rontgen/USG ukuran A0 dan sebuah Video CD yang menggambarkan kondisi penyempitan pembuluh darah jantung bapak. Foto dan Video ini yang akan dievaluasi oleh Cardiolog untuk menentukan alternatif tindakan selanjutnya, yaitu pasang sten, operasi bypass atau hanya dilakukan treatment pengobatan.

Setelah selesai kateterisasi, bapak diantar ke kamar perawatan dan karena kateterisasi dilakukan via dekat selangkangan, maka bapak harus bedrest selama semalam untuk menghindari terjadinya pendarahan.

Sebagai perbandingan, proses cat dan pemasangan sten di RS Mitra Keluarga Surabaya dan RS Harapan Kita Jakarta agak berbeda prosedurnya. Bila di RS Mitra Keluarga Surabaya pemasangan sten bisa dilakukan pada saat yang sama setelah angiografi, di RS Harapan Kita Jakarta tidak bisa. Di RS Harapan Kita Jakarta, angiografi dan pemasangan sten dilakukan terpisah pada hari yang berbeda. Setelah angiografi, pasien harus konsultasi dulu dengan kardiolog untuk kemudian dijadwalkan pemasangan sten yang prosesnya sangat mirip dengan kateterisasi jantung untuk angiografi.

2.Keputusan untuk Operasi ByPass Jantung

Setelah maju mundur dan melakukan pertimbangan yang masak serta masukan dari berbagai pihak, akhirnya bapak memutuskan untuk pergi ke Jakarta guna menjalani Operasi Bypass seperti yang direkomendasikan oleh dr Iswanto. Aku sudah memesan tiket pesawat ke Jakarta menggunakan Mandala Air. Namun menjelang keberangkatan, bapak berubah pikiran. Bapak memutuskan untuk pasang ring/sten. Karena tiket pesawat sudah aku beli, maka kami putuskan untuk tetap pergi ke Jakarta, dan minta second opinion dari dokter disana. pemasangan ring. Saat itu, bapak ada perasaan takut untuk menjalani operasi bypass karena itu adalah operasi besar.

3.Konsultasi ke Dokter Bedah Jantung

4.Setting jadwal Operasi

5.Mendaftar Rawat Inap

6.Persiapan menjelang Operasi
a.@home
b.@hospital

7.Admission->masukrawatinap
a.Konfirm kamar perawatan
b.Bayar down payment

8.Persiapan @hospital
a.H-2
b.H-1
c.H

9.Operasi

10.R.ICU

11.R.Intermediate

12.Kembali ke kamar perawatan

13.Rehabilitasi Medik Jantung

14.Keluar rumah sakit

MENUJU KE RUMAH SAKIT JANTUNG HARAPAN KITA

Kami bertiga–aku, istri dan papi–tiba di Jakarta dari Surabaya hari Senin pagi dengan pesawat MD82 Wings Air yang katanya kena cekal larangan terbang karena masalah kelistrikan. Puji Tuhan penerbangannya oke. Tapi dinginnya itu lho.. minta ampun deh. Dari Cengkareng ke RSJ Harapan Kita kami ada jemputan BMW .. lumayan daripada bayar taxi bandara yang 150 ribu perak itu. Sebenarnya kalo bawaan nggak banyak, utk sampe ke Harapan Kita, kita bisa naik bis Damri jurusan Blok M dan turun di bus stop SLIPI, dekat sekali dengan RSJ Harapan Kita dan RS Dharmais. Yah, lewat dikit lah.. 200 meter kali..tinggal jalan. Oya, RSJ Harapan Kita berada di Jl LetJen S Parman Kav 87, Slipi-Jakarta. Website http://www.pjnhk.go.id.

Hal pertama yang kulakukan setelah sampe di rumah sakit adalah mengurus administrasi rawat inap papi. Karena operasi papi dijadwalkan hari Rabu, 9 April 2008, maka papi harus masuk RS untuk persiapan 2 hari sebelumnya, yaitu hari Senin, 7 April 2008 yang adalah hari itu juga.

JADWAL BEDAH & TIKET PESAWAT

Sebenarnya jadwal ini sudah mundur dari jadwal semula tanggal 31 Maret 2008, dikarenakan dokter bedahnya (dr Maizul) ada operasi mendadak. Sayangnya pemberitahuannya telat (tanggal 28 sore, 1 hari sebelum keberangkatan) sehingga aku yang sudah mengantongi tiket pesawat Mandala Air terpaksa membatalkannya (hangus deh 70%).

Pelajaran yg bisa dipetik: Jadwal Operasi sangat padat dan bisa berubah. So, sebelum ada kepastian tanggal operasi, jangan beli tiket pesawat dulu, karena jadwal bisa berubah. Atau kalau mau beli tiket, pilihlah yang bisa direschedule. Kepastian jadwal operasi bisa ditanyakan di 021-5684093 ext 2222 bagian CAO, hari Senin-Jumat pada jam kerja. Petugasnya bernama Pak Yanto dan Pak Soleh sangat cekatan dalam membantu pasien (makasih ya Pak)..

ADMISSION (MASUK RAWAT INAP)

Untuk masuk rawat inap, pasien perlu menunjukkan surat pengantar dari dokter. Pengantar ini diberikan saat konsultasi terakhir. Karena saat itu tidak bawa, maka aku harus minta lagi ke sekretaris dokter Maizul di lantai 2 seberang kamar bedah.
Setelah surat didapat, muncul masalah baru. Kamar penuh ;-( Papi dapat waiting list nomor 11. Gawat juga nih, pikirku. Saat itu sudah jam 10 pagi, kamar belum dapat. Kapan bisa diproses untuk persiapan nih. Bisa-bisa operasinya mundur kalo gak dapet kamar. Untungnya P Yanto menjamin akan menyediakan kamar karena jadwal operasi sudah fix. Hanya saja kelas kamar bisa naik atau turun. Oya, waktu itu kami memilih kelas 1. So, kami putuskan untuk menunggu dan kami tinggalkan no hp utk dihubungi bila kamar telah tersedia.

KAMAR PERAWATAN

Sampai kami ditelpon, kami menunggu dikamar Om yg sedang menjalani prosedur pasang ring/sten. He..he..sakit jantung kok berjamaah. Kamar Om bagus sekali soalnya dia ambil yang kelas super vip (suite). Seharinya untuk kamar aja 1.250.000. Bandingkan dengan kamar kelas 1 yang cuman 200.000 per hari. Oya untuk kamar perawatan terbagi sbb:
- kelas 3: isi 6 orang/kamar
- kelas 2: isi 4 orang/kamar
- kelas 1: isi 2 orang/kamar
- vip : isi 1 orang+1penunggu
- suite : isi 1 orang+1penunggu dg kamar lebih luas kayak hotel.
Utk kamar kelas 1 pun penunggu bisa menginap, tetapi harus minta kartu penjaga pasien dari satpam yg pengantarnya diberikan oleh suster. Lagian tidak tersedia bed khusus. Jadi harus bawa peralatan tidur sendiri seperti tikar, bantal dan selimut. Tapi kalo nggak mau tidur di lantai, masih banyak alternatif. Ntar akan aku tunjukkan di tips berikutnya.
Akhirnya kami dihubungi setelah jam makan siang. Kamar tersedia. Puji Tuhan. Segera kami kembali ke ruang CAO. Disana P Yanto sdh menunggu dan menyiapkan berkas administrasi. Ternyata utk kelas 1, kami harus bayar downpayment sebesar Rp 55.500.000. Untungnya kami bawa dua kartu atm BCA shg kami bisa bayar Rp 50 jt (masing-masing kartu 25 jt) dulu, jd gak harus 55jt penuh. Oya, kalo bayar pake kartu kredit, ada tambahan charge 2.5% lho, kan sayang.
Setelah pembayaran beres, papi langsung dibawa untuk cek darah. Jadi gak langsung ke kamar. Baru setelah selesai, papi diantar ke kamar.
Kamarnya sendiri bersih. Dua bed, full ac, ada lemari, kamar mandi dalam, dan wastafel.
Setelah diberikan baju pasien warna biru, papi diantar untuk foto rontgen. Yah, itu persiapan untuk hari pertama.