KIDNEY: We have two kidneys. Each kidney is capable of sustaining life independently.
LOCATION: Kidneys are located on either side of spine at the level of rib cage.
CIRCULATION: Your kidneys convert over 1500 liters of blood per day into about 1.2 to 1.5 liter of concerted urine. (The rate of urine aformation is about 1 ml/min.)
In an adult of normal weight (60-65) about 1200ml of blood flows through both the kidneys every minute.(this is about 20-25 % of heart output).
The urine is removed from the kidney by the URETERS (two twin tubes) and stored in the BLADDER and discharged through URETHRA (intervals).
The main function of the urinary system is REMOVAL OF LIQUID WASTE PRODUTS from the body. This is done to a certain extent by the skin also. Kidney also move excess water from our body and maintains normal salt and water balance.
WARNING SYMPTOMS & SIGNS OF KIDNEY DISEASE
- Burning sensation while urinating
- Frequent and excessive urination (especially in the the night time)
- Blood in the urine. (Brown or coffee color).
- Puffiness or oedema on face and body.
- Hypertension. (High blood pressure).
The above symptoms /sign are given to you as a warning and should be used as general guideline only. Contact your doctor if you notice any of the above. The doctor would advice you further on investigation and treatment.
Kidney disease is detected only when you go for urine/blood check up.
Doctor’s advice is a must for any treatment.
SYMPTOMS & SIGNS OF KIDNEY FAILURE
HOW DO I KNOW MY KIDNEY HAS FAILED?
- Symptoms of kidney failure are so general that most of the times they are not suspected as threatening. (Note: These symptoms may occur due to other reason also).
SYMPTOMS OF SIGN OF KIDNEY FAILURE
- Nausea and Vomiting
- Loss of Appetite
- Increased blood pressure
- Skin itching
- Increase/Decreased frequency of urination(Especially at night)
- Lower back pain
- Swelling of face and leg
- Physical weakness
As soon as kidney failure is detected, patients must get Hepatitis-B vaccination.
TEST TO DETECT KIDNEY DISEASE/FAILUE
When you contact nephrologists for any of the symptom mentioned earlier, doctor might recommend for one or more of the fallowing test to detect kidney problems.
URINE EXAMINATION: For proteinuria (Albuminoidal) Real blood cells or pus cell and casts.
URINE FOR CULTURE AND SENSITIVITY– For infection
BLOOD UREA NITROGEN (BUN) – This is a waste product produced from protein metabolism.
SERUM CREATININE – This is produced from muscle metabolism.
COMPLETE BLOOD COUNT CBC) – Generally blood count (Hemoglobin) level falls with onset of kidney failure.
PLAIN X-RAY ABDOMEN (KUB) – Generally gives information about kidney stones.
ULTRASONOGRAPHY (USG) – This is one of the non-invasive tests. It gives information to doctors about kidneys, tumors or even whether kidney disease is of long standing duration or not. Unfortunately it does not tell any thing about kidney function.
INTRAVENOUS PYELOGRAPHY (IVP or IVU) – This involves giving injection of iodinated dye in vein followed by kidney x-rays. It gives valuable information about kidney function, size etc. It is an invasive test. At times patient can get a reaction (rarely fatal) with dye. It is not done if kidney function is already compromised greatly with creatine greater than 3 to 4 mg/dl.1
RENAL SCAN (NUCLEAR) – it gives you information about kidney size and function also. Sensitively is decreased in renal failure.
CT SCAN KIDNEY- This is occasionally done when tumor is suspected. This is commonly used.
KIDNEY BIOPSY- This involves removal of a tiny piece of kidney tissue for microscopic examination of the kidney. This guides the doctors about the cause and treatment if any.
- Creatine Clearance Tests : To determine exact percentage of kidney function.
- Quantification proteinuria : Urine is collected to see how munch protein is lost in 24 hrs.
TYPES OF KIDNEY FAILURE
- ACUTE KIDNE FAILURE (REVERSIBLE) KIDNEY FAILS SUDDENLY OVER A SHORT TIME DUE TO
- Dehydration (Due to servere diarrhea or vomiting).
- Sudden significant drops in blood pressure.
- Massive Bleeding
- Acute glomerulonephritis
- Snake bite
- Drug overdose
- Food Poisoning etc.
This is generally reversible and kidney recovers in a matter of three days to three weeks time. Till kidney function recovers, patient should be under observation and may require hospitalization for few days and might require few sessions of dialysis.
- CHRONIC KIDNEY DISEASE (IRREVERSIBLE):
- Long standing diabetes
- Uncontrolled high blood pressure for a long time
- Chronic glomerulonephitis
- Chronic infection of kidney pyelonephritis.
- Polycystic kidney disease
- Frequent stone formation in urinary tract
- Enlarged prostage gland.
- Excessive use of medicines over years (mainly pain killers
PREVENTION OF KIDNEY FAILURE
A FEW SUGGESTIONS TO PREVENT KIDNEY FAILURE:
- Proper treatment of diabetes for diabetic patient
- Normal blood sugar level is 80 to 120 mgs%. Tight control of diabetes can prevent kidney failure.
- Regular check up of blood pressure
- Normal level is 120/80 mm of hg . If high blood pressure is present, control it with salt restriction and medicines as per doctor’s service
TREATMENT OF CHRONIC KIDNEY DISEASE (CKD)
TIPS FOR NEW DIALYSIS PATIENTS
- It’s not the end of the world. You have to only change your life style, you can still enjoy life.
- If your job is physical, you probably felt weak long ago. You’ll feel better now
- If you do intellectual work, your brain is not dead yet
- You can still perform intellectual work.
- Learn everything about how the kidney functions, your disease, and the dialysis.
- Ask questions. What is your blood pressure? Lab values and what do they mean
- Maintain your weight as recommended
- Learn what diet you need to take
- Never miss treatment
Hemodialysis is a process by which blood is purified by taking it out of the body with the help of a machine and passing it through a ‘Dialyser’ (Artificial Kidney)
Blood is taken out of the body via a needle (A.V.F). in the dialyser blood and dialyzing fluid flow on either side of a semi permeable membrane. This removes the toxic waste and excess water from the blood. The pure blood is returned to the body.
This process if taking out and putting in the blood continues for 3-4 hours. The dialysis has to be repeated at-least 3 times a week.
Preparation of patient for Hemodialysis:
When a patient has moderately severe renal failure (i.e when kidney is 80% damaged) plan should be made to do A.V fistula access.
Vascular Access: this means that to receive hemodialysis treatment there must be a way to enter the blood vessels easily atleast three times a week. The accesses are:
- Arterio Venus Fistula (A.V.F)
- Jugular Catheter
- Subclavian Catheter
- Femoral Catheter
Last four procedures are done when urgent dialysis is needed. The first procedure is ideal for long term dialysis.
Anterio Venus Fistula (A.V.F)
A fistula is made from sewing two blood vessels together. Two of blood vessels, an artery and a vein, are connected underneath the skin. It is generally done under local anesthesia. It takes about 3 to 4 weeks for A.V Fistula to mature before it can be used.
This new connection will build a vein with large flow of blood. This new path for blood is called a fistula. The fistula is placed between the wrist and the elbow of the arm, which you don not use for writing.
Normally the flow of the blood in veins has almost no pressure, but when these new connection is made between the artery and vein this fistula has a flow of blood with pressure. The fistula is used for hemodialysis by placing two needles in different places in to the fistula.
The needles have special tubing attached. Blood flows through the other needle and tubing. Patients should take following precautions for care of fistula.
- Do not allow blood pressure to be recorded on that arm
- Do not allow blood to be drawn or intravenous injections to be started
- Do not wear a watch or tight clothing with elastic or bands
- Do not sleep on top of your fistula arm
Jugular, Subclavian and Femoral Vein Cannulation
This is a simple procedure and done when a patient needs urgent dialysis and A-V Fistula is not done or not matured. Now days-double lumen catheters are available so that we can do dialysis without any problems.
Part of the tube lies in vein and part is outside the skin. It is used only when there is no other means of vascular access available.
This type of vascular access is done occasionally for urgent dialysis. In this silastic tube is inserted in to the artery and vein and both tubes are secured in place by sutures.
When not in use, both tubes are connected with each other so that blood flows continuously through the tubes and prevents from clotting. Shunt can be used immediately for dialysis. Only problem with this frequent clotting and infections in majority of the patients
Advantages of Hemodialysis:
- It is a treatment provided under the supervision of the professional personnel.
- Treatment is usually 3 times a week.
- Chances of infection are low
- Comparably low cost
With regular dialysis most patients feel better to a great extent and many patients can be rehabilitated. With recent advances anemia can be corrected by injection of erythropoietin and using calcium carbonate with vitamin D3 can minimize bone problems. Patient does not require major surgical procedure.
Patient has to follow diet, fluid, salt and potassium restriction to a great extent (like avoiding dry fruits, fruits, juices, coconut water)
Even with dialysis patient feels weak due to anemia. This can be corrected but will involve additional expenses. Traveling also will be restricted due to need for regular dialysis.
Peritoneal dialysis is a procedure in which one or two liters of dialysis solution is instilled in to abdominal cavity through peritoneal catheter.
About 4 to 6” of catheter is in abdominal cavity while remaining lives outside.
Dialysis solution is instilled in to the abdominal cavity and is kept there for sometime and subsequently drained out. Diffusion of waste product occurs from the blood passing through abdominal cavity in to the dialysis solution through peritoneal membrane.
After fluid is removed fresh solution is instilled again and procedure is repeated tilt desirable effect is obtained.
In short we can say that this is another method of removing excess of water and impurities from the blood. It is done with the help of PERITONEUM, which surrounds the intestine and other organs in the stomach area.
TYPES OF PERITONEAL DIALYSIS
CARD: (Continuous Ambulatory Peritoneal Dialysis)
This is the therapy in which dialysis is done through the peritoneum, manually.
CCPD: (Continuous Cyclic Peritoneal Dialysis)
This is the therapy in which dialysis is done through the peritoneum with the help of a cycled machine.
IPD: (Intermittent Peritoneal Dialysis)
This is the therapy which is mostly used to treat acute renal failure when hemodialysis treatment is not possible.
CARD & CCPD can be done by the patient himself or by his attendant.
The dialysate is introduced and drained through a soft elastic tube (catheter). Time between the filling and draining is the dwell time, in which excess water, urea and other toxic wastes diffuse from blood across the peritoneal membrane in to dialysate.
Kidney Transplantation means placing a kidney from another person (Donor) in to the patients (recipients) body through a major surgery.
After the successful transplant, no life long dialysis treatment is needed. The patient feels better and has more energy to enjoy life. Many restrictions that were imposed during dialysis are lifted.
For Nutrition/ Diet
For kidney failure patients, diet plays a very important role. All food contains proteins, fat, carbohydrate and minerals in varying proportion.
Please speak to our dietician for a balanced diet for you.