Kidney Failure by Prof CS Bhan

Kidney Failure by Prof CS Bhan

Kidney is one of the most important and vital organs of the body. The kidneys being two in number, bean shaped organs, about the size of fist function as body filtration system. The most important function of kidneys is urine formation, filtration of metabolic and other nitrogenous wastes. Otherwise, accumulation of these wastes would upset the balance of chemical constituents resulting into a medical emergency and even death.  Kidney health is naturally a very important and sensitive health matter and there is growing awareness surrounding kidney health nowadays.

If the kidneys fail to filter the waste effectively, a situation known as kidney failure arises. kidney has the sole responsibility of maintaining a stable balance of salt, potassium, and acids in the body. Above all, secretion of renin, from juxtaglomerular cells, a hormone. Its important function is to regulate blood pressure and other body functions. Unfortunately, so many individuals suffer from bad kidney health. Kidney health is not affected by a single medical condition but by many medical conditions, diseases and drugs.

These lead to acute and chronic kidney problems. The term acute means when the onset of symptoms is sudden and a significant change from normal. The term chronic means when the problem is long-developing and persistent.

Kidney failure, whether acute or chronic influences kidney function which rapidly declines as a result of acute renal failure. 

Acute Kidney Failure—generally brought about by medication, disease or trauma. So much so, kidney function may decline quickly, onset of decline  is fast. The goal of the treatment is to address the underlying reason. It is often reversible with prompt treatment.

Chronic Kidney Failure brought on by a long-term illness. Often irreversible but with prompt treatment the further damage can be controlled. Until the damage is severe, symptoms might not appear. Irreversible, focuses on slowing further deterioration. The goal of the treatment is to manage the underlying problem. Most cases of CKD are caused by three conditions that either directly or indirectly affect the internal structure of the kidneys.

High blood pressure. It can cause the hardening and narrowing of the blood vessels innervating the kidneys 

Diabetes –the high blood sugar levels can progressively damage the minute and precious filters of the kidneys, called glomeruli.

Glomerulonephritis is a condition involving the inflammation of glomeruli, The possible causes can be bacterial infections like strep throat, viral diseases like hepatitis C, and autoimmune disorders like lupus or IgA nephropathy.

 The different stages of chronic kidney failure are-

Stage 1: Kidney damage but still working well (GFR ≥ 90).

Stage 2: Mild loss of kidney function (GFR 60-89).

Stage 3: More loss of kidney function (GFR 30-59).

Stage 4: A lot of loss of kidney function (GFR 15-29).

Stage 5: Kidneys have failed (GFR < 15).

Symptoms and Causes of Acute Kidney Failure

Acute kidney failure signs and indicators might include:

Volume of urine is not proper. There is a sudden reduction in urine production.

Color of the urine is an important symptom. It may seem darker than usual. It may be frothy or foamy due to excess excretion of protein in the urine. It indicates improper filtration capability of kidneys. Naturally, decreased kidney function results in the body accumulating fluid, which is often observed as swelling   in feet, hands ankles and puffy eyes or face. Obliviously, this very fluid retention is the reason for the abrupt weight increase. Fluid retention can further cause breathing concerns accumulation of fluid in the lungs.

Fatigue 

Vomiting and nausea.

Abnormal heart rhythm or palpitations.

Twitches and spasms of muscles.

Abdominal pain or discomfort.

Skin itching. 

Causes of Acute Kidney Failure Include:

Dehydration.

Excessive loss of fluids 

Infections—urinary tract infections

Prolonged or high-dose NSAID.

Medications such as dyes, antibiotics, and certain chemotherapeutic medications and other medications used in image tests

Blood clot –In case blood clots in the kidneys or blood vessels, it can impede blood supply to the kidneys

Kidney injury could arise from stones obstructing the urine system.

Blood flow to the kidneys may be influenced  by decreased cardiac output, liver dysfunction.

Symptoms and Causes of Chronic Kidney Failure

In cases where kidney damage advances slowly, signs and symptoms of chronic kidney failure gradually appear. An accumulation of fluid, bodily waste, or electrolyte imbalances can result from renal failure. 

Depending on the extent, kidney function loss might result in following signs and symptoms

Nausea

Weakness 

Vomiting

Decreased appetite

Unintentional weight loss

Sleep issues

Elevated or lowered urine production

Impaired cognitive function

Continuous itching

Parched and discolored skin

Uncontrollably high blood pressure, or hypertension

Breathing difficulties if a buildup of fluid occurs in the lungs

Chest discomfort in the event that fluid accumulates around the heart's lining

When a sickness or disease affects kidney function, kidney damage worsens over a period of months or years, leading to chronic kidney disease. 

The following diseases and conditions can lead to chronic kidney disease:

Uncontrolled blood sugar levels.

Uncontrolled high blood pressure.

Inflammation in kidney tubules and surrounding structural inflammation

Glomerulonephritis.

Kidney diseases that are hereditary, such as polycystic kidney disease.

Extended use of NSAIDs. These are nephrotoxic

History of kidney disease in the family.

Recurrent kidney infection.

kidney stones, enlarged prostates, and some malignancies can lead to prolonged blockage of urinary tract,

Treatment of Acute Kidney Failure

Hospitalization for treatment. The duration of your hospital stay depends on the cause of your acute kidney damage and the speed at which your kidneys heal. In certain situations, the patient can get treatment at home only.

The treatment of acute kidney failure focuses on addressing the underlying cause, supporting kidney function, and preventing further complications. The main aspects of treatment include:

Fluid Replacement: This involves treatments aimed at achieving a balanced blood fluid level. If dehydration is the primary cause of your acute kidney damage, intravenous (IV) fluids are recommended.

Blood Potassium: Your doctor may suggest calcium, glucose, or sodium polystyrene sulfonate (Kionex) if your kidneys are not effectively filtering potassium from your blood, preventing excessive potassium levels from accumulating or hyperkalemia.

Blood Calcium Levels: If case blood calcium levels become too low, calcium infusion is recommended by the nephrologist.

Dialysis: Temporary hemodialysis, also known as dialysis, may be recommended to remove nitrogenous wastes, toxins and extra fluid from your body while your kidneys heal.

Kidney friendly diet is also to be taken care of.

Treatment of Chronic Kidney Failure

It is not curable. One can live a much longer life with healthy, working Kidneys.

Medication Management: Antihypertensive drugs or antidiabetic drugs can be prescribed to control hypertension and Diabetes; underlying conditions need to be managed which might otherwise cause further damage to kidneys. blood pressure is connected. It's possible that you'll also require statins to reduce your cholesterol.

Fluid Control: Diuretics are prescribed to minimize swelling and manage fluid retention during chronic kidney failure. Strict control of fluid intake is recommended not to overload the kidneys.

Dialysis: Dialysis (hemodialysis or peritoneal dialysis) is initiated at advanced stages to remove nitrogenous waste products, toxins and extra fluid from the body.

Kidney Transplantation: Kidney transplantation means the replacement of a damaged kidney with a healthy one. 

Diet: Eating a healthy diet, too much protein intake needs to be restricted. cutting back on protein intake may help slow down the condition's progression.

Regular Monitoring: Regular assessment of renal function is done. 

Conclusion

An optimum weight is to be maintained.  

Don’t get dehydrated.

Follow guidelines on diet, kidney friendly diet guidelines to be followed.

Restrict  alcohol, smoking, and drugs. 

Monitor blood pressure, blood sugar and cholesterol levels and other parameters.