Some patients who experience kidney failure may undergo kidney transplantation. Kidneys that are transplanted into patients with autosomal dominant PKD do not develop cysts. However, transplantation is associated with complications, including infection and the possibility of rejection of the new organ. To reduce the chance of rejection, patients may need to take immunosuppressant drugs.
This variability in expression and disease is evidence that this disease has multiple interrelated genetic components. Over 50% of the patients never progress to ESRD or transplantation.2,3 Further, the sequelae of ADPKD are not limited to the kidney.
When the kidneys are damaged by some systemic disease process (such as diabetes, arteriosclerosis, heavy metal poisoning or drugs) it's ability to function as a filter is diminished and products of metabolism such as urea nitrogen and creatinine are not removed from the blood. This leads to blunting of the sensorium, loss of cognition and decrease in underwater skills. The extent to which this occurs varies greatly with the individual and a critical level of 'BUN' and creatinine (azotemia) causing mental and cerebral changes dangerous to a diver cannot be stated with accuracy.
Individuals can continue to function with remarkably high levels of creatinine, having some degree of accommodation. These people also have significant fluid and electrolyte shifts, blood pressure problems and renal insufficiency to the point of requiring dialysis (peritoneal or AV shunt). Significant anemia occurs for several reasons and the O2 carrying capacity of the anemic diver in renal failure would be dangerous.
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