The Effect of Renal Transplantation on Pulmonary Function

Abstract

In patients with chronic renal failure, mechanical and hemodynamic changes could occur in the lungs without obvious pulmonary symptoms and findings and their effects could pave the way to pulmonary functional disorders. In this study, pulmonary functional disorders and especially alveolocapillary defects, which are frequently seen in uremia, were determined in renal transplanted patients. Pulmonary functions and diffusion capacity were assessed in uremic patients (n = 20) and in successfully transplanted patients (n = 20) without any lung disease or pulmonary edema symptoms and findings. Patients were selected randomly among outpatients who were followed up in a Nephrology and Transplantation Unit. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV₁), and peak expiratory flow (PEF_25–75) were measured. Single breath carbon monoxide diffusion test and diffusion lung capacity adjusted for hemoglobin concentration (DLAdj) were done. The means of the spirometric values such as FVC, FEV₁ and FEV₁/FVC were normal in the nondialyzed uremic group, but the PEF_25–75 value (68.7%) and diffusion capacity (DLAdj 72.7%) were found to be slightly low. There were 2 patients with normal values and 18 patients with some functional abnormalities in this nondialyzed uremic group. The means of all spirometric parameters and diffusion capacities were found to be normal in the transplanted group. There were 7 patients with normal function and 13 patients with some functional abnormalities in this transplanted group. When the nondialyzed uremic group and the transplanted group were compared statistically, significant differences were found between their spirometric values (except for FVC) and their diffusion capacities. Even though the uremic patients did not show any symptoms, their pulmonary function tests, especially diffusion capacity, were found to be disturbed. Although the transplanted patients as a group had normal mean spirometric values and diffusion capacity there were nevertheless many individual transplanted patients with defective diffusion capacity and abnormal spirometric values.

Efeitos negativos da insuficiência renal crônica sobre a função pulmonar e a capacidade funcional

“…However, the present authors propose that the main disorders associated with these results are the following: chronic and often subclinical pulmonary edema; decreased serum albumin with consequent water and protein imbalance in the microcirculation; interstitial fibrosis and calcification of the lung parenchyma and bronchial tree; recurrent infections; and alveolitis and fibrosis due to corticosteroid therapy in immunosuppressed patients. Studies that evaluate lung function in patients with CKF undergoing dialysis and after kidney transplantation have described results similar to those found in the present study and help to explain the lesion mechanisms 14,[31][32][33] .…”

“…In analyzing the values of total traveled distance in each group, it was observed that in the DG, only three individuals (15.63%) walked more than 500 meters, whereas 56.67% of the CG walked more than 500 meters (which is the expected minimum normal value, according to authors who mention this test) 31 . These results did not show significant associations in the chi-square test, but there was a tendency for individuals with CKF to walk shorter distances than would be expected for the general population.…”

Effect of Exercise Performed during Hemodialysis: Strength versus Aerobic

“…27 The patients were instructed to interrupt the exercises in the presence of both "hypertension" or "hypotension" above the initial status (<200/110 mmHg or >90/70 mmHg), as well as an "SpO 2 falling" below 89%, and also in presence of the following signals and symptoms: "headache," "nape pain," "chest pain," "nausea," "vertigo," "intense muscular fatigue," "cramps," or any other debilitating muscular symptom. 28 At exercise termination, peripheral muscles' ("ischiotibial" and "triceps surae") passive elongations were developed, maintained for 20 s with two series for every limb, and finalized with passive slipping in the triceps sural muscle. 7,17 Statistical Analysis Data were analyzed with the SPSS 15.0 (Statistical Package for Social Sciences) software, version 13.0, and the quantitative variables were expressed in average and standard deviation.…”

Chest and Cardiac Findings on High-Resolution Computed Tomography in Children on Regular Hemodialysis with Abnormal Spirometry

“…These findings supported the involvement of small airways detected by spirometry. Various studies reported similar results (7,(52)(53)(54). Small airway disease may be attributed to the following conditions: chronic and often subclinical pulmonary edema, decreased serum albumin with consequent water and protein imbalance in microcirculation, recurrent infections, interstitial fibrosis, and alveolitis (7,(52)(53)(54).…”