KIDNEY DISEASE AND ITS TREATMENT

Kidney disease and its treatment
Kidney failure is a condition resulting from a variety of disease. It can strike anyone at any age. There is no cure. Left untreated it will inevitably lead to death within days or weeks. Once dignosed, an individual must be on some form of replacement therapy for the rest of his life.This can take several forms:

Hemodialysis

• A process whereby the blood is slowly withdrawn from the body and passed through an artificial machine. patients on hemodialysis require treatments three times per week with each run lasting from three to five hours. These treatments are done primarily in hospitals or sattelite units, often requiring the patients to travel considerable distances. A small number of patients do their own dialysis at home with the aid of a family caregiver.
  

Peritoneal Dialysis

• A cyclical form of dialysis is performed using the patient's own peritoneal cavity filed with the special dialysis fluid that draws out excess water and wastes. The fluid is then drained from the body and the process begins again. The most common form of this treatment requires the patient to exchangethe fluid four or five times per day. This is usually performed at home.
  

Transplantation

• a kidney transplant is considered to be the optimal treatment for kidney failure patients. It offers the best chance of returning to a normal life and is the most cost-effective treatment for kidney failure. Kidneys for transplantation usually come from cadaveric donors. The use of living -related and living-unrelated donors is increasing.

KIDNEYS AND THE HUMAN BODIES

Each human being is made up of billions of cells working 24 hours a day., producing toxic wastes which circualte through the blood. Causing it to become somewhat polluted. It would take very little time for the accumulation of these wastes to intoxicate the human body and death by poisoning could result. Fortunately, the kidneys are there to filter the blood-they remove toxins from the blood, eliminating them from the body in the form of urine. withoutkidneys, one would not survive the inevitable "blood pollution"

when kidneys stop functioning:

Various diseases can attact our kidneys, reduce their effectiveness and renal insufficiency would result. As the kidneys lose their filtering ability, the toxic waste accumilate in the blood and eventually when their lavel becomes sufficiently elevated, symptomps such as fatigue, lost of appetite and nausea appear. Ultimately, uremia, which is the accumulation of one of these wastes in the blood (urea), could kill.

• Preventing kidney failure
  It might take a while for symptomps to appear, that is when ore than 75% of the kidneys have ceased functioning. with the help of blood and urine test, kidneys failure may be detected before the appearance of symptomps. It is therefore possible to find the cause of renal insufficiency, perhaps correct it and threby save the kidneys. However, even if a cure i not possible, treatment can always be undertaken to minimize the progression of renal insufficiency. Diabetes and hypertension are the two major causes of renalinsufficiency which can be prevented by controlling these two problems with a proper diet and when neede, the appropriate medication.
• Treating Kidney failure
  Medical research has resulted in the discovery of techniques which can cleanse the blood of these toxins when the kidneys have completely ceased functioning, dialysis under the form of hemodialysis or peritonal dialysis. Thanks to this techniques, iremia does not kill anymore. However, the most satisfying solution still remains kidney transplants. unfortunately, the number of donors is not by any means sufficient to meet the even increasing need for kidneys.
  

KIDNEYS ROLES TO OUR BODIES

Kidneys play many important roles:

• they control the production of red blood cells through the bone marrow, they help maintain a normal blood pressure,they control the quantity of water in the human body along with the adequate absorption of calcium and they are also necessary to build strong bones.without kidneys, anemia would result and our bones would break very easily. Moreover, kidneys act as the chemists of the body by maintaining the precise chemical composition of the blood.
• Once again, medical research has discovered means of replacing the kidneys in all their functions should they fail.For this reason, kidney patients require a lot of medication along with dialysis treatments. from the avobe, one can fully realize the importance of healthy kidneys as well as medical research; it allows for a better quality of life for those who have lost the use of their kidneys.

THE WARNING SIGNS

Unfortunately kidney disease usually progresses very silently, often destroying most of the kidney function before causing any symptomps, Therefore, people at high risk of developing kidney disease should be evaluated regularly.

These people include:

• People with diabetes
• People with High blood pressure
• close relatives of people with hereditary kidney disease.

SIGNS OF KIDNEY DISEASE

COMMON WARNING SIGNS OF KIDNEY DISEASE INCLUDE:

• High blood ppressure
• Passage of bloody or cloudy urine excessive foaming of the urine
• Puffiness of the eyes, hands, and feet ( especially in children)
• Frequent passing of urine during the night
• Passing less urine or difficulty passing urine
• Fatigue, Loss of appetite or weight
• Persistent generalized itching

VIEW PHOTOS

POLYCYSTIC KIDNEY DISEASE

RED WHITE BLOODCELLS

MICROSCOPIC PHOTOGRAPH= RENAL MEDULLA

ERYTHROPOIETIN

GLOMERULUS

KIDNEY TRANSPLANTATION

KIDNEYS

MICROSCOPIC PHOTOGRAPH= RENAL CORTEX

HEART

MODEL ANATOMY= URINARY KIDNEYS

KIDNEY-CROSS SECTION

BETA-D-GLUCOSE

CREATININE TAUTOMERISM

KIDNEYS TRANSPLANT REQUIREMENTS

Kidney transplant requirements vary from program to program and country to country. Many programs place limits on age (e.g. the person must be less than 69 years old when put on the waiting list) and require that one must be in good health (aside from the kidney disease).
Significant cardiovascular disease, incurable terminal infectious diseases and cancer often are transplant exclusion criteria. In addition, candidates are typically screened to determine if they will be compliant with their medications, which is essential for survival of the transplant. People with mental illness and/or significant on-going substance abuse issues may be excluded.
HIV was at one point considered to be a complete contraindication to transplantation. There was fear that immunosuppressing someone with a depleted immune system would result in the progression of the disease. However, current research does not bear out this fear; in fact there are findings that immunosuppressive drugs and antiretrovirals may work synergistically to help both HIV viral loads/CD4 cell counts and prevent active rejection.

POLYCYSTIC KIDNEY DISEASE

Polycystic kidney disease (PKD, also known as polycystic kidney syndrome) is a progressive, ciliopathic, genetic disorder of the kidneys. It occurs in humans and other organisms. PKD is characterized by the presence of multiple cysts(hence, "polycystic") in both kidneys. The disease can also damage the liver, pancreas, and rarely, the heart and brain. The two major forms of polycystic kidney disease are distinguished by their patterns of inheritance.

POST OPERATION LAST ABOUT THREE HOURS

The donor kidney will be placed in the lower abdomen and its blood vessels connected to arteries and veins in the recipient's body. When this is complete, blood will be allowed to flow through the kidney again, so the ischemia time is minimized. In most cases, the kidney will soon start producing urine. Since urine is sterile, this has no effect on the operation. The final step is connecting the ureter from the donor kidney to the bladder.
Depending on its quality, the new kidney usually begins functioning immediately. Living donor kidneys normally require 3-5 days to reach normal functioning levels, while cadaveric donations stretch that interval to 7-15 days. Hospital stay is typically for four to seven days. If complications arise, additional medicines may be administered to help the kidney produce urine.
Medicines are used to suppress the immune system from rejecting the donor kidney. These medicines must be taken for the rest of the patient's life. The most common medication regimen today is : tacrolimus, mycophenolate, and prednisone. Some patients may instead take cyclosporine, rapamycin, or azathioprine. Cyclosporine, considered a breakthrough immunosuppressive when first discovered in the 1980's, ironically causes nephrotoxicity and can result in iatrogenic damage to the newly transplanted kidney. Blood levels must be monitored closely and if the patient seems to have a declining renal function, a biopsy may be necessary to determine if this is due to rejection or cyclosporine intoxication.
Acute rejection occurs in 10% to 25% of people after transplant during the first sixty days. Rejection does not necessarily mean loss of the organ, but may require additional treatment

KIDNEY TRANSPLANT REQUIREMENTS

Kidney transplant requirements vary from program to program and country to country. Many programs place limits on age (e.g. the person must be less than 69 years old when put on the waiting list) and require that one must be in good health (aside from the kidney disease).
Significant cardiovascular disease, incurable terminal infectious diseases and cancer often are transplant exclusion criteria. In addition, candidates are typically screened to determine if they will be compliant with their medications, which is essential for survival of the transplant. People with mental illness and/or significant on-going substance abuse issues may be excluded.
HIV was at one point considered to be a complete contraindication to transplantation. There was fear that immunosuppressing someone with a depleted immune system would result in the progression of the disease. However, current research does not bear out this fear; in fact there are findings that immunosuppressive drugs and antiretrovirals may work synergistically to help both HIV viral loads/CD4 cell counts and prevent active rejection.

KIDNEYS

Kidneys:


(renal function)

• The kidneys are complicated organs that have numerous biological roles.


• Their primary role is to maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites (such as urea) and minerals from the blood and excreting them, along with water, as urine.


• Because the kidneys are poised to sense plasma concentrations of ions such as sodium, potassium, hydrogen, oxygen, and compounds such as amino acids, creatinine, bicarbonate, and glucose, they are important regulators of blood pressure, glucose metabolism, and erythropoiesis (the process by which red blood cells (erythrocytes) are produced).


• The medical field that studies the kidneys and diseases of the kidney is called nephrology.


• The prefix nephro- meaning kidney is from the Ancient Greek word nephros (?ef???); the adjective renal meaning related to the kidney is from Latin renes, meaning kidneys.

STROKE IN CHRONIC KIDNEY DISEASE

New insight into stroke in Chronic Kidney disease
By: Sami L. Khella
Department of Neurology,
University of Pennsylvania School of Medicine,
Philadelphia, PA.

• Patients with chronic kidney disease are predisposed to stroke, especially as the estimated glomerular filtration rate diseases.


• This update reviews the pathologic mechanisms particular to this stroke population.


• The treatment for primary and secondary prevention of stroke is reviewed with respect to antiplatelet agents, anticoagulants, surgery, and carotid stenting.


• The control of chronic hypertension is particularly important in reducing stroke risk in CDK. In patients with prior stroke from atherosclerosis, antiplatetet agents are most beneficial in reducing secondary stroke risk.


• Those with atrial fibrillation and CDK may benefit from warfarin anticoagulation.


• Statin in CDK for stroke reduction in diabetics receiving dialysis are not useful, and the data are pending for their use in stroke reduction in the general CDK population. In carefully selected cases, carotid endarterectomy can be a treament.


• The data on carotid stenting are conflicting.

RESEARCH IN NUTRITION

Outcomes Research in Nutrition and Chronic Disease

Perspectives, Issues in practice, Processes for improvement

by: Laura D. Byham-Gray
Department of Primary Care,
Graduate Programs in Clinical Nutrition,
University of Medicine and Dentistry of New Jersey,
School of Health Related Professions,
University Educational Center, Strtford, NJ

Despite greater access to health care and advances in medicine and technology, the morbidity and mortality among patients diagnosed with chronic kidney disease (CDK) remain unacceptably high discrepancies in patient care outcomes exist between the United States and other industrialized countries and and are partly explained by variances reported in clinical practice.

Outcomes research (OR) has been the primary methodology used to more fully explore the root causes for the practice variation and to uncover which indicaors have the greatest impact.

Research has established the relatioships between early diagnosis and treatment, cardiovascular disease, quality of life, and malnutrition with morbidity and mortality rates among patients with kidney disease.

Although nutrition parameters are predictive of mortality, they are complex to understand and even more difficult to improve, largely because of the effects of the imflammatory process and the lack of direct measure that defines nutritional status.

Future OR projectsmust focus on specific nutrition-related outcomes and the effectiveness of intervention, as these outcomes can establish clinical guidelines, lead to changes in practice, and create more controlled clinical trials that continue to search for answer to questions on the impact of nutrition and others.

NUTRITION INTERVENSION

Nutrition intervention to address
Cardiovascular outcomes in
Chronic kidney disease
By: Judith A. Beto & Vinod K. Bansal
Loyola University Medical Center, Division of Nephrology and Hypertension, Marywood, IL,USA.

• The high mortality in chronic kidney disease has been linked to cardiovascular risk and this patients are considered at high risk. Dietary intervention can directly address nutritional risk factors in lipid management, calcium-phosphorus balance, and body composition to reduce risk of cardiovascular disease. Nutrient intake can also indirectly address less over risks of dental health, nutritional supplements, and compliance issues.

BACKGROUND

Chronic kidney disease is a major public health problem. However, no study to date has estimated the prevalence of chronic kidney disease base on the clinical guidelines established by the National Kidney Foundation and few studies have explored the rate of diagnoses by primary care providers.

PROGNOSIS

The prognosis of patients with chronic kidney disease is guarded as epidemiological data has shown that all cause mortality (the overall death rate) increases as kidney function decreases.

The leading cause of death in patients with chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5.

While renal replacement therapies can maintain patients indefinitely and prolong life, the quality of life is severely affected.

Renal transplantation increases the survival of patients with stage 5 CKD significantly when compared to other therapeutic options; however, it is associated with an increased short-term mortality (due to complications of the surgery).

Transplantation aside, high intensity home hemodialysis appears to be associated with improved survival and a greater quality of life, when compared to the conventional three times a week hemodialysis and peritoneal dialysis

TREATMENT

The goal of therapy is to slow down or halt the otherwise relentless progression of CKD to stage 5. Control of blood pressure and treatment of the original disease, whenever feasible, are the broad principles of management.

Generally, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin II receptor antagonists (ARBs) are used, as they have been found to slow the progression of CKD to stage 5.

Replacement of erythropoietin and vitamin D3, two hormones processed by the kidney, is usually necessary, as is calcium. Phosphate binders are used to control the serum phosphate levels, which are usually elevated in chronic kidney disease.

When one reaches stage 5 CKD, renal replacement therapy is required, in the form of either dialysis or a transplant.

COMMON CAUSES

The most common causes of CKD are diabetic nephropathy, hypertension, and glomerulonephritis. Together, these cause approximately 75% of all adult cases. Certain geographic areas have a high incidence of HIV nephropathy.
1.) Vascular, includes large vessel disease such as bilateral renal artery stenosis and small vessel disease such as ischemic nephropathy, hemolytic-uremic syndrome and vasculitis

2.) Glomerular, comprising a diverse group and subclassified into

• a.) Primary Glomerular disease such as focal segmental glomerulosclerosis and IgA nephritis


• b.) Secondary Glomerular disease such as diabetic nephropathy and lupus nephritis
  

3.) Tubulointerstitial including polycystic kidney disease, drug and toxin-induced chronic tubulointerstitial nephritis and reflux nephropathy

• a.) Polycystic kidney disease (PKD, also known as polycystic kidney syndrome) is a progressive, ciliopathic, genetic disorder of the kidneys. It occurs in humans and other organisms. PKD is characterized by the presence of multiple cysts (hence, "polycystic") in both kidneys. The disease can also damage the liver, pancreas, and rarely, the heart and brain. The two major forms of polycystic kidney disease are distinguished by their patterns of inheritance.


• b.) Reflux nephropathy, RN is a term applied when small and scarred kidneys (chronic pyelonephritis, CPN) are associated with vesico-ureteric reflux (VUR). CPN being the commonest cause, there are other causes including analgesic nephropathy and obstructive injury. Scarring is essential in developing RN and occurs almost during the first five years of life. The end results of RN are hypertension, proteinuria, CRF and eventually ESRD, end stage renal disease.

4.) Obstructive such as with bilateral kidney stones and diseases of the prostate

• a.) The prostate (from Greek p??st?t?? - prostates, literally "one who stands before", "protector", "guardian" is a compound tubuloalveolar exocrine gland of the male mammalian reproductive system. Women do not have a prostate gland, although women do have microscopic paraurethral Skene's glands connected to the distal third of the urethra in the prevaginal space that are homologous to the prostate.
  
  

The prostate differs considerably among species anatomically, chemically, and physiologically.

STAGES

• 1.) All individuals with a Glomerular filtration rate (GFR) <60>
  
• 2.) All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the level of GFR. The rationale for including individuals with GFR 60 mL/min/1.73 m2 is that GFR may be sustained at normal or increased levels despite substantial kidney damage and that patients with kidney damage are at increased risk of the two major outcomes of chronic kidney disease: loss of kidney function and development of cardiovascular disease.

DIAGNOSIS

Diagnosis In many CKD patients, previous renal disease or other underlying diseases are already known. A small number presents with CKD of unknown cause. In these patients, a cause is occasionally identified retrospectively.

• It is important to differentiate CKD from acute renal failure (ARF) because ARF can be reversible. Abdominal ultrasound is commonly performed, in which the size of the kidneys are measured. Kidneys with CKD are usually smaller (<>
  
• Additional tests may include nuclear medicine MAG3 scan to confirm blood flows and establish the differential function between the two kidneys. DMSA scans are also used in renal imaging; with both MAG3 and DMSA being used chelated with the radioactive element Technetium-99.
  


• In chronic renal failure treated with standard dialysis, numerous uremic toxins accumulate. These toxins show various cytotoxic activities in the serum, have different molecular weights and some of them are bound to other proteins, primarily to albumin. Such toxic protein bound substances are receiving the attention of scientists who are interested in improving the standard chronic dialysis procedures used today.

SIGN & SYMPTOMPS

CREATININE
Initially it is without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As the kidney function decreases:

• 1.) blood pressure is increased due to fluid overload and production of vasoactive hormones, increasing one's risk of developing hypertension and/or suffering from congestive heart failure


• 2.) Urea accumulates, leading to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis and encephalopathy). Urea is excreted by sweating and crystallizes on skin ("uremic frost").


• 3.) Potassium accumulates in the blood (known as hyperkalemia with a range of symptoms including malaise and potentially fatal cardiac arrhythmias)


• 4.) Erythropoietin synthesis is decreased (potentially leading to anemia, which causes fatigue)

ERYTHROPOIETIN SYNTHESIS

• 5.) Fluid volume overload - symptoms may range from mild edema to life-threatening pulmonary edema


• 6.) Hyperphosphatemia - due to reduced phosphate excretion, associated with hypocalcemia (due to vitamin D3 deficiency).


• 7.) Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid etc. This may cause altered enzyme activity by excess acid acting on enzymes and also increased excitability of cardiac and neuronal membranes by the promotion of hyperkalemia due to excess acid (acidemia)
  

BLOOD PLASMA

Blood serum:

Blood plasma is the liquid component of blood, in which the blood cells are suspended. It makes up about 55% of total blood volume. It is composed of mostly water (90% by volume), and contains dissolved proteins, glucose, clotting factors, mineral ions, hormones and carbon dioxide (plasma being the main medium for excretory product transportation).

Blood plasma is prepared simply by spinning a tube of fresh blood in a centrifuge until the blood cells fall to the bottom of the tube.

The blood plasma is then poured or drawn off. Blood serum is blood plasma without fibrinogen or the other clotting factors.

The first place where urine is formed in the kidney, filters fluid from the blood

GLOMERULUS

Glomerular:
A glomerulus is a capillary tuft surrounded by Bowman's capsule in nephrons of the vertebrate kidney. It receives its blood supply from an afferent arteriole of the renal circulation. Unlike most other capillary beds, the glomerulus drains into an efferent arteriole rather than a venule. The resistance of the arterioles results in high pressure in the glomerulus aiding the process of ultrafiltration where fluids and soluble materials in the blood are forced out of the capillaries and into Bowman's capsule.

A glomerulus and its surrounding Bowman's capsule constitute a renal corpuscle, the basic filtration unit of the kidney. The rate at which blood is filtered through all of the glomeruli, and thus the measure of the overall renal function, is the glomerular filtration rate (GFR).

CHRONIC KIDNEY DISEASE

Chronic kidney disease(CKD):

Also known as chronic renal disease, is a progressive loss of renal function over a period of months or years through five stages. Each stage is a progression through an abnormally low and deteriorating glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum.

People with chronic kidney disease suffer from accelerated atherosclerosis and are more likely to develop cardiovascular disease than the general population. Patients afflicted with chronic kidney disease and cardiovascular disease tend to have significantly worse prognoses than those suffering only from the latter.

CONGESTIVE HEART FAILURE

Heart failure is a cardiac condition, that occurs when a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs.

Heart failure should not be confused with cardiac arrest. It can cause a large variety of symptoms (chiefly shortness of breath and ankle swelling) but some patients can be completely symptom free. Heart failure is often undiagnosed due to a lack of a universally agreed definition and challenges in definitive diagnosis, particularly in early stage. With appropriate therapy, heart failure can be managed in the majority of patients, but it is a potentially life threatening condition, and progressive disease is associated with an annual mortality of 10%.

It is the leading cause of hospitalization in people older than 65