HLA B22 Test

A kidney transplant is a procedure that employs an operation to transplant properly functioning kidney in the body. The main job of the kidneys is to remove the excess waste from a person’s body with the help of a filtration process. When the kidneys stop filtering the toxins properly, they become diseased and harmful waste products and toxins begin to accumulate in the body. Following this, the patient has to go through treatment measures like hemo dialysis or kidney transplant.

Read on to know the five things you should keep in mind about a kidney transplant.

1. Treatment: Transplant is one of the best ways to treat chronic kidney disease stage-V, until unless it is contraindicated. Life becomes near normal after transplant as dialysis stops and person can go back to job. Though there is a possibility of rejection of transplant kidney. Patient has to take immunosuppressive medication life long.
2. Medication: Medications are mainly for:
   1. To prevent rejection: Patient takes special immunosuppressive medications life long like steroids, tacrolimus, mycophenolate.
   2. Prevention of infection: Stay away from a person suffering of cough, cold, fever, skin rash. Alternatively you can use face mask.
   3. Other medication: To control diabetes, Hypertension etc.
3. Family Only: The donors are from family or emotionally related (Spouse) or cadavers deceased donor (after brain stem death). HLA-matched donors are better because of less chances of rejections and faster reduction of immunosuppressive.
4. Doing Your Part: Once transplant is done patient becomes normal and he/she lives a normal life. However, they have to take regular medications and to protect themselves from various infection.
5. Need for Kidney Transplant in End Stage Renal Diseases: These diseases includes diabetes mellitus, Hypertension, polycystic kidney disease, chronic glomerulonephritis or interstitial nephritis etc. If you wish to discuss about any specific problem, you can consult a Nephrologist.

Ankylosing spondylitis refers to a form of arthritis that affects the spinal column. This condition causes the bone vertebrae to fuse together leading to a rigid spine. Depending on the extent of the damage, this could result in mild changes or in a stooped posture. Although the cause of this disease is not known, it is said to be passed down from one generation to another through a gene called the HLA-B27. This gene is also linked to spondylitis.

Ankylosing spondylitis cannot be cured, but with treatment, the pain and stiffness associated with it can be managed. Along with medication, physical and occupational therapy is a must when treating this disease. In some cases where the disease has caused severe deformities, surgery may also be recommended. However, an early diagnosis can also help prevent significant deformity.

A physical exam and an X-ray are the key factors used to confirm a diagnosis of Ankylosing spondylitis. Some of the symptoms associated with this disorder are:

1. Pain and stiffness: Everyone complains of a backache at some point or the other but a persistent lower back ache could be a sign of something serious. Spondylitis often starts in the sacroiliac joints and hence the lower back, buttocks and hips are the first to be affected. Pain that lasts for more than three months should not be ignored as it could be a sign of Ankylosing spondylitis.
2. Bony fusion: This condition causes an abnormal growth of bones in the spinal column. This can lead to the fusing of bones in the spine. The bones of the neck, back and hips are most affected by this bone fusion. While this can affect a person’s mobility it can also cause complications. For example, the fusing of the ribs to the spinal column or the breastbone can restrict the expansion of the chest while breathing.
3. Pain in ligaments and tendons: Apart from the bones, this condition also affects a person’s tendons and ligaments attached to the bones. For example, pain in and around the heel may be caused by tendonitis.
4. Other symptoms: The symptoms of ankylosing spondylitis are not restricted only to the joints. Hence, it is also known as a systemic disease. Some of the other symptoms exhibited by people suffering from this condition are fever, fatigue, inflammation of the eyes and a loss of appetite. Some people may also complain of lung and heart problems. 

A kidney transplant is a procedure that employs an operation to transplant properly functioning kidney in the body. The main job of the kidneys is to remove the excess waste from a person’s body with the help of a filtration process. When the kidneys stop filtering the toxins properly, they become diseased as harmful waste products and toxins begin to accumulate in the body. Following this, the patient has to go through treatment measures like dialysis or kidney transplant.

Read on to know the five things you should keep in mind about a kidney transplant.

1. Treatment: Transplant is one of the best ways to treat chronic kidney disease stage-V, until unless it is contraindicated. Life becomes near normal after transplant, though there is a possibility of rejection of transplant kidney. Patient has to take immunosuppressive medication life long. 
2. Medication: Medications are mainly for:
   1. To prevent rejection: Patient takes immunosuppressive medications life long.
   2. Prevention of infection: Patient has to take care all the measures to prevent infections as they are more prone to infections.
   3. Other medication: To control diabetes, HTN etc. 
3. Family Only: The donors are from family or emotionally related or cadavers (after brain death). HLA-matched donors are better because of less chances of rejections and first reduction of immunosuppressive. 
4. Doing Your Part: Once transplant is done - patient becomes normal and he/she lives a normal life. However, they have to take regular medications and to protect themselves from various infection. 
5. End Stage Renal Diseases: These diseases includes diabetes mellitus, HTN, polycystic kidney disease, chronic glomerulonephritis or interstitial nephritis etc.

Consult a Nephrologist before going for renal transplant for detailed check up or line of action.

The bones and joints orchestrate very well with each other for smooth movements of various joints and the spine. However, due to various reasons, some identified and others unknown, there could be inflammation of the areas where the bones join the muscles leading to impaired movement. The range of motion could be reduced or it could be painful, thereby, limiting movement. Spondyloarthritis includes a group of inflammatory diseases that involves the bones and joints and enthuses which are areas where the ligaments and tendons attach to the bones. This causes conditions like plantar fasciitis, ankylosing spondylitis, psoriatic arthritis and reactive arthritis. The term spondyloarthritis is a blanket term to describe any of the above-mentioned conditions.

Read on to know a little more in detail about it:

Causes: While the exact etiology is not identified for sure, most patients with spondyloarthritis have an autosomal dominant gene (HLA-B27). Chronic infections could trigger the onset of the disease too.

Symptoms:

1. In all forms of spondyloarthritis, there is always inflammation of the spine, joints and entheses. If the fingers or toes are involved, there could be swelling leading to what are typically known as 'sausage digits'.

2. There is sacroiliitis which is inflammation of the joint between the pelvis and the spine, and spondylitis which is inflammation of the joints between the spines. 3. Family history and autosomal dominant gene.

Diagnosis:

A detailed medical history and physical examination form the cornerstone of a confirmed diagnosis. In addition, radiographic examination and diagnostic blood tests also could be done to confirm the diagnosis. Radiographs, especially, of the spine and the low back show typical changes including sacroilitis in suspected cases of spondyloarthritis. If the spine does not show these changes, but there is a high likelihood of spondyloarthritis, then MRI (magnetic resonance imaging) can be used to confirm the diagnosis.

As a final step, a blood test for the HLA-B27 gene can also be confirmatory. However, it is not true that a person with the gene will definitely develop the disease.

Treatment:

1. The most important aspect of treatment is the use of pain medications and anti-inflammatory drugs (NSAIDs) which help manage pain and inflammation.
2. Corticosteroid injections may sometimes be given directly into the joint spaces or the membranes to provide quick relief of these symptoms.
3. ESWT / RSWT has a definite role to cure enthesopathy. Plantar fasciitis, and achillodynia can be cured with ESWT. Even small joints of hand and feet are amenable to treatment with RSWT. It is nonoperative and noninvasive treatment and has no side effects.
4. Very rarely, stronger drugs such as methotrexate or sulfasalazine may be used.
5. Another set of drugs known as TNF-blockers (tumor necrotizing factor blockers) are also shown to be highly effective in controlling the pain of the spine and joints.
6. In very severe cases, surgery may be required to correct joint damages or correct severe degenerative changes.
7. Exercise plays a very vital role in controlling the issue and improving range of motion. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

The term bone marrow transplant is actually a misnomer in the present context as a vast majority of transplants are now conducted by harvesting stem cells from the blood of the donor. 

So the correct and logical term now is peripheral blood stem cell transplant. This is just like a blood donation for the donor and poses no risk at all to the donor. The term blood cancer is generally used for leukemias, these can be of two types - acute and chronic. 

For the chronic leukemias, especially chronic myeloid leukemia, stem cell transplant is now generally not required as drugs like imatinib, dasatinib and nilotinib are extremely effective. For chronic lymphocytic leukemia transplant is rarely done these days and is generally reserved for relatively younger patients. Even in the imatinib era transplant is an effective procedure and can cure patients with CML (chronic myeloid leukemia) who do not respond to imatinib and other tyrosine kinase inhibitors. 

For acute myeloid leukemias stem cell transplant is recommended for all cases except the low risk cases, after completion of chemotherapy. Risk is defined based on kind of genetic mutations in the leukemic cells for acute lymphoblastic leukemia transplant is generally done at relapse, but certain genetic mutations necessitate an earlier transplant, so does presence of or increase in minimal residual disease, which signifies cancer cells not visible to the human eye under the microscope.

Procedure of stem cell transplant HLA matching is done between patient and siblings. Best match is selected as a donor. Matched sibling is the most commonly used donor in blood cancers. In many cases a match is not available, for such cases matched unrelated donor, cord blood, or a partially matched donor (haploidentical donor) is sometimes selected. Donor is given growth factor injection subcutaneously to bring out the stem cells from the bone marrow to bloodstream, twice daily for 5 days. After that the stem cells are collected and stored. Patient is given high dose chemotherapy to kill cancer cells as well as his normal marrow. After chemotherapy, donor stem cells are injected into the body of patient from a vein. After approximately 11-14 days the donor cells get engrafted in the patient's marrow and start producing normal blood cells. The donor cells also kill the cancer cells and prevent cancer from coming back. 

Overall depending on whether the patients cancer is controlled or not before transplant the cure rate after transplant can vary from 60 % for patients who have a good control and less aggressive disease biology, to less then 20 % in patients with uncontrolled disease before transplant. Overall, approximately 40 % patients get cured with a transplant. Upto 40 % patients can develop complications, and half of these may be very severe and life threatening. This figure is more in mismatched transplants. Apart from complications, there is still a risk of relapse and these patients need close monitoring in the first few years after transplant.