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Chronic Kidney Failure

TOP 1) What do the Kidneys do? The Kidneys have four main functions:   Removal of waste products from the body Control of blood pressure. Production of a hormone called erythropoietin . This hormone is necessary for the production of red blood cells,kidneys therefore maintain normal hemoglobin levels and increase the oxygen carrying capacity of the blood. Maintenance of normal calcium levels in the body.       TOP   2) What happens when the kidney fails?  As the Kidneys began to fail, the waste products mentioned above start collecting in the body and produce harmful effects. If one kidney fails or is removed,the other kidney takes over the entire work of cleaning the blood. You can therefore lead a normal life with one normal kidney. When the Kidneys fail,they affect almost every part of the body. Signs and symptoms of Kidney failure are seen when more than eighty percent of the Kidneys are damaged.  Described below are the adverse impacts on various parts and systems of the body. These adverse impacts are summarized as: Cells and tissue: Kidney failure results in abnormal retention of water and sodium. Excess water leads to weight gain and swelling of the body. This swelling is especially observed around ankles in the evenings and eyelids early in the morning. Skin: Kidney failure can cause anemia. Signs of anemia. are pale skin, especially the skin of the palm,tongue and inner part of the eyelids.Sometimes the skin is dull brown. It becomes very itchy because of high calcium levels.The skin also becomes very dry because the sweat glands become smaller.Smaller sweat glands secrete less oil and thus the skin becomes very dry. Blood: When the kidney fail,they secrete less  erythropoictin --the hormone necessary for formation of red blood cells.Excess urea decreases the life-span of red blood cells. Decreased red blood cells leads to (1) severe anemia.; (2) bleeding tendencies ; and (3) decrease ability to fight disease causing germs.Thus kidney failure can lead to more frequent and more severe infections

•  Lungs: Kidney failure results in excessive collection of liquid in the lungs. This liquid enters the
  air sacs and reduces the lung's ability to absorb oxygen and excrete carbon dioxide.Collection
  of liquids in the lungs is called  pulmonary oedema  It can occur suddenly or over a period of many days.
  Common signs of pulmonary oedema are rapid,shallow and difficult breathing. Restlessness is common
  and the skin is either pale or blue. Phlegm,if present,is frothy and pink
• Heart: Since kidney failure results in increased retention of liquids in the body,the blood volume increases. Increased blood volume causes the heart to work harder to circulate the blood. When the
  heart is not able to pump the excess load,it leads to heart failure.Excess liquid can also cause high
  blood pressure.
• Bones: Kidney failure results in high phosphorus and low calcium levels in the blood.
   Low calcium levels cause weakness of the muscles and bone diseases.
• Brain: Increased urea in the blood results in abnormalities in the brain function. These includes
  decreases alertness,loss of memory,"pins and needles" sensation in the legs and itchy sensation
  which is worse at night. Sometimes Kidney failure can also cause impotence.
• Digestive system: Increased urea in the blood causes nausea, vomiting, lack of appetite, hiccough
  and poor nutritional status. The glucose and insulin levels in the blood also increase.
• Reproductive organs: Kidney failure leads to decreased secretion of sex hormones in both,males and females. Decreased sex hormones in the females leads to absence of menstruation, inability to
  conceive and inability to complete the pregnancy.Decreased sex hormones in the males can lead
  to smaller "testes" and impotence.

3). What are the causes of Chronic Kidney failure?

Some diseases of the kidney including chronic infections, long-standing high blood pressure, diabetes,Kidney stones and excessive use of some medicines such as pain killers and antibiotics can cause chronic kidney failure. These causes are detailed as:

• 
  About twenty to thirty percentage people who have had diabetes for more than fifteen to twenty
  years are at a higher risk of developing kidney failure. This risk is higher if the diabetes is not
  under control.Diabetic people whose parents have high blood pressure are more likely to develop
  kidney failure than those parents have normal blood pressure. There is no difference in the likelihood
  of developing kidney failure among diabetics who take insulin and those who take oral medicines.
   Similarly , males and females have equal chances of developing kidney failure.

  Many people take medicines such as pain killers and antibiotics without consulting with a doctor.
  Excessive and inappropriate use of medicines can lead to kidney failure.It is therefore important
  to monitor kidney functions in people , especially the elderly, who have chronic diseases for which
  they take medicines for a long period of time.

  The percentage of people who have diabetes, high blood pressure and painkiller induced
  kidney failure is higher in developed countries than in developing countries. This is perhaps
  because the propagation of people having diseases such as diabetes and high blood pressure is
  higher in the developed countries.

4). What is the treatment of chronic Kidney failure?

The treatment for chronic Kidney failure can be broadly divided into three categories:
1.  Diet treatment.
2.  Dialysis.
3.  Kidney transplantation.

It is important to remember that the above treatment options cannot cure chronic kidney failure.
This is because the damage to the Kidneys is irreversible.The treatment aims to reduce production
of wastage and their removal through other methods.

5). What is the dietary treatment for chronic Kidney failure?

Dietary treatment is the mildest form of treatment.It is recommended when the kidneys are still functional,
although at a lower level. Common dietary measures are :

• Restricted protein. Reduced protein intake will result in less production of waste matter.
  Thus there will be less burden on the kidneys.Animal protein is used better by the body than
  protein vegetables and grains.Your doctor or a qualified dietitian can give detailed information
  on the quantity and type of protein you can take.Meat,eggs,grams,dals,etc. are rich in protein.
• Restricted liquid intake. Damaged Kidneys are not able to remove excess liquids from the body.
   Thus the liquids build up quickly and the tissues swell. Increased fluid collection in the body can
  lead to high blood pressure and heart problems.
• Restricted salt. Salty foods make you thirsty and you will therefore drink more liquids per day.
  Since the Kidneys are already damaged , this excess liquid will not be excreted.
  It will therefore accumulate in the body.
• Restricted potassium. Potassium is a mineral found in salt substitutes,some fruits, vegetables,
  milk, chocolates and nuts. Too much or too little potassium can harm your heart.
• Restricted phosphorus. Too much phosphorus in the blood results in decreased calcium in your bones.
  Lower calcium levels lead to bone diseases. You should therefore r e s t r I c t phosphorus rich
  foods such as milk,cheese,nuts,dried beans and soft drinks. Your doctor may also recommend
  medicines to prevent bone diseases. You should take these medicines regularly.

6). How can chronic Kidney failure be prevented?

Chronic Kidney failure can be prevented by early diagnosis and management of diseases that can lead to chronic Kidney failure. Below figure lists some

important measures for prevention of chronic kidney failure . It is also important to conduct regular tests to detect kidney damage at the earliest if you suffer from any of the following diseases:
.      Diabetes mellitus;
.      High blood pressure;
.      Family history of Kidney diseases;.      Kidney stones in a family member;
.      Prolonged use of pain Killers and antibiotics.

7). What is haemodialysis?

Haemodialysis is a procedure which cleans and filters the blood with an "artificial kidney" figure shows various components of an artificial kidney. This artificial kidney removes harmful wastes, extra salt and liquids just as your normal kidneys would do. Thus, haemodialysis helps to maintain normal blood pressure and potassium and sodium levels. To carry out haemodialysis, a heamodialysis machine is required.

Haemodialysis uses a special filter called the "dialyser" machine. The pump in the dialysis machine takes about two hundred and fifty milliliters of blood per minute to the artificial kidney. The blood is taken from an artery in your arm which is connected to the dialyser. This blood passes through sterile tubes called "blood line" before reaching the artificial kidney. After the machine cleans the blood it flows back into your body through a tube attached to the vein in the arm. The liquid used for purifying the blood in dialysis is called "dialysate". During the procedure, you can read, write, sleep, watch television, or talk to people.

Common side effects of haemodialysis are sudden drop in the blood pressure which leads to dizziness, weakness and muscle cramps. These side effects can be minimized if you follow the dictary restriction. In most cases of chronic kidney failure haemodialysis is necessary at least twice or thrice a week. This is because the effect of one dialysis is temporary. Haemodialysis has to be done regularly throughout life until a successful kidney transplant is done.

Since the dialysis is done only twice a week, you still have to be careful about the diet and liquid intake.

You must not take foods containing high potassium and salt. Protein intake need not be restricted once dialysis is started and performed regularly.

Haemodialysis costs about ten thousand Rupees every month. You can do the haemodialysis either at home or in the hospital. Box 6.3 lists the advantages and disadvantages of haemodialysis at home and in the hospital.

8). What is peritoneal dialysis?

Peritoneal dialysis is a type of dialysis in which a membrane inside the abdomen called "peritoneal membrane"

is used for the dialysis. Peritoneum is a thin membrane covering the entire wall of the abdomen and the organs inside it. It has many blood vessels. There are the organs inside it. It has many blood vessels. There are three types of peritoneal dialysis: (1) Continuos Ambulatory Peritoneal Dialysis, also called IPD. Of these, Continuous Ambulatory Peritoneal dialysis is the commonest.

Gasteroentrology

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1.)What is Viral Hepatitis?Hepatitis means inflammation (tenderness and swelling) of the liver.

Hepatitis may be caused by viruses, alcohol or medicines (drugs). Hepatitis caused by viruses is called Viral Hepatitis. There are six distinct types of viruses which can cause viral Hepatitis - A, B, C, D, E & G. Out of these, Hepatitis B & Hepatitis C viruses are most deadly and potentially dangerous.

Hepatitis A and Hepatitis E

 The Hepatitis A & E viruses are concentrated by consumption of food or water that has been contaminated with these viruses. They can also be spread by indirect contact with an infected persons hands or contaminated utensils. Its spread is related to overcrowding, poor hygiene and poor sanitation, specially in developing countries.

Within six months of infection usually the body successfully gets dries of the virus on its own (This six months duration is referred as the 'Acute' stage). So the infection does not develop into chronic disease (greater than six months duration is referred to as the 'Chronic' stage).

• Like flu-mild fever and weaknesses
• Like digestive problems - particularly loss of appetite and nausea or coloured stools, yellowing of skins and the eyes.

The hepatitis B virus (HBV) and the hepatitis C virus(HCV) can cause a serious form of Hepatitis. They are more prevalent than HIV, the virus that causes AIDS. The world wide incidents is about 4.5% for HBV and above 0.9% for HCV. In India 40 million individuals are believed to have been infected with HVB and about 5 million with HCV.

Both HBV and HCV are spread in a similar way as HIV i.e. by exchange of blood and body fluids. However HBP is however 100 times more infectious than HIV, so a single exposure carries a much greater risk.

The high risk groups are individuals with multiple sex partners, infants born to infected mothers, family and household contacts of Hepatitis B carries, blood transfusion recipients, hemophiliacs, thalassemics, dialysis patients, transplant patients, intravenous drug abusers, police/military personnel, firemen, institutionalized patients, healthcare professionals laboratory technicians and paramedics. There is also a risk of infection through tattooing, body piercing, or sharing razors, tooth brushes or nail files. However, approximately one-third or more of Hepatitis B & C cases result from unknown sources. This means that you do not necessarily have to be among the "high-risk" groups to become infected with these viruses.

When you are first infected, the severity of the disease can vary, ranging from mild to very serious. If the body's immune system is able to get rid of the virus in six months (i.e. 'Acute' stage), the liver recovers. In some patients however, their immune system does not defeat virus the virus and the infection continues beyond six months (i.e. 'Chronic' stage), even though the symptoms of their initial illness may have stopped. This happens in 5-10% of people with Hepatitis B and 80% of the people with Hepatitis C.

In chronic hepatitis B or C, the virus may continue to cause injury to the liver over a period of time, possibly resulting in severe damage, liver failiure, or even liver cancer. This is very serious because the liver is one of the most important organs in your body. When it is healthy, the liver performs a number of crucial functions that help keep you feeling energetic and alert. It cleans and purifies the blood, helps the body break down certain substances and create others, and it stores sugars, fats and vitamins until they are needed. If the liver is damaged as a result of chronic hepatitis, and is not working properly to provide the body with energy, a person may feel very tired and run down.

In some people, chronic hepatitis B or C can use weakness, tiredness, body aches, fever, nausea and vomiting, diarrhea, mild abdominal pain, loss of appetite, dark urine or jaundice (yellowing of the skin and eyes). In others, there are no recognizable signs and symptoms. However, that does not mean they do not have the disease. In fact, chronic hepatitis B or C can still lead to serious liver damage in patients who do not even know they have it and may unwittingly pass the infection on to others.

Usually symptoms become very obvious only when the disease has progressed to advanced stages like cirrhosis or liver cancer.

Because the symptoms are flu-like or mild or absent, many cases go undiagnosed. The only way these diseases can be positively identified is through blood test.

There is treatment available in India for both Hepatitis B and C. Without treatment, some patients with chronic hepatitis B or C can have their disease lead to serious liver damage, cirrhosis, liver failiure or possibly liver cancer and death.

Hepatitis D virus (HDTV), also known as Delta Hepatitis, is spread in the same way as HBV. HDTV infects only those individuals who are already infected with HBV.

Research is currently going on to know more about the hepatitis G virus.