Home Features HEALTH TIPS: Chronic kidney disease (renal failure) Part- 2
DR TARIQ JAGNARINE
FAMILY MEDICINE, ENDOCRINOLOGY/DIABETES
Chronic kidney disease is a worldwide health crisis. However, chronic kidney disease can be treated. With early diagnosis and treatment, it is possible to slow or stop the progression of kidney disease.
DIAGNOSIS OF CHRONIC KIDNEY DISEASE
The treatment and care for someone with renal failure starts with the primary care physician but eventually take a multidisciplinary approach involving an internist, nephrologist, nutritionist and vascular surgeon. These doctors will check for signs and ask the patient about symptoms. The following tests may also be ordered:
• Blood test – a blood test may be ordered to determine whether waste substances are being adequately filtered out. If levels of urea and creatinine are persistently high, the doctor will most likely diagnose end-stage kidney disease.
• Urine test – a urine test helps find out whether there is either microscopic blood or protein in the urine.
• Kidney scans – kidney scans may include a magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, or an ultrasound scan. The aim is to determine whether there are any blockages in the urine flow. These scans can also reveal the size and shape of the kidneys – in advanced stages of kidney disease the kidneys are smaller and have an uneven shape.
• Kidney biopsy – a small sample of kidney tissue is extracted and examined for cell damage. An analysis of kidney tissue makes it easier to make a precise diagnosis of kidney disease.
• Chest X-ray – the aim here is to check for pulmonary edema (fluid retained in the lungs).
• Glomerular filtration rate (GFR) – GFR is a test that measures the glomerular filtration rate – it compares the levels of waste products in the patient’s blood and urine. GFR measures how many millilitres of waste the kidneys can filter per minute. The kidneys of healthy individuals can typically filter over 90 ml per minute.
TREATMENT OF CHRONIC KIDNEY DISEASE
There is no current cure for chronic kidney disease. However, some therapies can help control the signs and symptoms, reduce the risk of complications, and slow the progression of the disease. Patients with chronic kidney disease typically need to take a large number of medications. Treatments include:
• ANAEMIA TREATMENT
Haemoglobin is the substance in red blood cells that carries vital oxygen around the body. If haemoglobin levels are low, the patient has anaemia. Some kidney disease patients with anaemia will require blood transfusions, taking iron supplements, either in the form of daily ferrous sulphate tablets, or occasionally in the form of injections.
• PHOSPHATE BALANCE
People with kidney disease may not be able to eliminate phosphate from their body properly. Patients will be advised to reduce their nutritional phosphate intake – this usually means reducing consumption of dairy products, red meat, eggs, and fish.
• HIGH BLOOD PRESSURE
High blood pressure is a common problem for patients with chronic kidney disease. It is important to bring the blood pressure down to protect the kidneys, and subsequently slow down the progression of the disease. Patients may need to be on multiple antihypertensive drugs in the care of a nephrologist.
• SKIN ITCHING
Antihistamines, such as chlorphenamine, may help alleviate symptoms of itching.
• NSAIDs (nonsteroidal anti-inflammatory drugs)
NSAIDs, such as aspirin or ibuprofen should be avoided and only taken if a doctor recommends them.
This is when the kidneys are functioning at less than 10-15 percent of normal capacity. The measures used thus far – diet, medications, and treatments controlling underlying causes – are no longer enough. The kidneys of patients with end-stage kidney disease cannot keep up with the waste and fluid elimination process on their own, resulting in the need for dialysis or a kidney transplant in order to survive. Most doctors will try to delay the need for dialysis or a kidney transplant for as long as possible because they carry the risk of potentially serious complications.
There are two main types of kidney dialysis. Each type also has subtypes. The two main types are:
• Haemodialysis: Blood is pumped out of the patient’s body and goes through a dialyzer (an artificial kidney). The patient undergoes haemodialysis about three times per week. Each session lasts for at least 3 hours. Experts now recognize that more frequent sessions result in a better quality of life for the patient, but modern home-use dialysis machines are making this more regular use of haemodialysis possible.
• Peritoneal dialysis: The blood is filtered in the patient’s own abdomen; in the peritoneal cavity which contains a vast network of tiny blood vessels. A catheter is implanted into the abdomen, into which a dialysis solution is infused and drained out for as long as is necessary to remove waste and excess fluid.
The kidney donor and recipient should have the same blood type, cell-surface proteins and antibodies, in order to minimize the risk of rejection of the new kidney. Siblings or very close relatives are usually the best types of donors. If a living donor is not possible, the search will begin for a cadaver donor (dead person).
OTHER TREATMENT OPTIONS
Following a proper diet is vital for effective kidney failure treatment. Restricting the amount of protein in the diet may help slow down the progression of the disease. Diet may also help alleviate symptoms of nausea. Salt intake must be carefully regulated to control hypertension. Potassium and phosphorus consumption, over time, may also need to be restricted.
• Vitamin D
Patients with kidney disease typically have low levels of vitamin D. Vitamin D is essential for healthy bones. The vitamin D we obtain from the sun or food has to be activated by the kidneys before the body can use it. Patients may be given alpha calcidol, or calcitriol.
• Fluid retention
People with chronic kidney disease need to be careful with their fluid intake. Most patients will be asked to restrict their fluid intake. If the kidneys do not work properly, the patient is much more susceptible to fluid build-up.
If the chronic kidney disease progresses to kidney failure, the following complications are possible:
• Central nervous system damage
• Dry skin or skin color changes
• Fluid retention
• Hyperkalemia, when blood potassium levels rise, possibly resulting in heart damage
• Lower sex drive
• Male erectile dysfunction
• Osteomalacia, when bones become weak and break easily
• Pericarditis, when the sac-like membrane around the heart becomes inflamed
• Stomach ulcers
• Weak immune system
• Managing the chronic condition
Some conditions increase the risk of chronic kidney disease (such as diabetes). Controlling the condition can significantly reduce the chances of developing kidney failure. Individuals should follow their doctor’s instructions, advice, and recommendations.
A healthy diet, including plenty of fruits and vegetables, whole grains, and lean meats or fish will help keep blood pressure down.
• Physical activity
Regular physical exercise is ideal for maintaining healthy blood pressure levels; it also helps control chronic conditions such as diabetes and heart disease. Individuals should check with a doctor that an exercise program is suited to their age, weight, and health.
• Avoiding certain substances
Including abusing alcohol and drugs. Avoid long-term exposure to heavy metals, such as lead. Avoid long-term exposure to fuels, solvents, and other toxic chemicals.
Chronic kidney disease causes substantial global morbidity and increases cardiovascular and all-cause mortality. Unlike other chronic diseases with established strategies for screening, there has been no consensus on whether health systems should prioritize early identification and intervention for CKD. Guidelines on evaluating and managing early CKD are available but have not been universally adopted in the absence of incentives or quality measures for prioritizing CKD care. The burden of CKD falls disproportionately upon persons with lower socioeconomic status, who have a higher prevalence of CKD, limited access to treatment, and poorer outcomes. Therefore, identifying and treating CKD at the earliest stages is an equity imperative.