Kidney Disease

by mrsbrown1013yahoocom (student)

KIDNEY DISEASE

Kidney Disease

In the human body, kidneys play a major role in removing waste products and regulating the fluid levels in the blood. These waste products are then excreted from the body as urine. Kidney Disease or Chronic Kidney Failure/Disease (CKD) is best described as gradual loss of the kidney function over time. As kidney failure advances and the organ’s function is seriously impaired, dangerous levels of waste and fluid can rapidly build up in the body. This very serious disease includes many factors that come into play and are all very important to understand and help decrease the progression of this disease. These factors include the disease history, etiology, signs and symptoms, laboratory testing, treatment, prognosis, complications, statistics, and prevention.

During the early 1950’s there was very little to no treatment for kidney disease. It was known as a death sentence. It was then that the National Nephrosis Foundation (NNF) was born, but it was primarily used to support families and patients by raising funds for comfort and death expenses. It wasn’t until 1960 that CKD was no longer considered a fatal illness but a chronic disease. This was due to the discovery of the Teflon shunt which solved the problem that had prevented doctors from performing long term treatments. Usually a patient undergoing dialysis suffered from damaged veins and arteries, so that after several treatments, it became difficult to find a vessel to access the patient’s blood. They were now able to research the disease further and educate the patient. Then in 1972, a law passed that provided the federal government financing for nearly all Americans with kidney disease. Today, the National Kidney Foundation participates in research that is helping advance knowledge about chronic kidney disease, treatment and patient outcomes. Test results form NKF’s Kidney Early Evaluation Program are studied, and analyzed to help doctors find ways to improve outcomes and better treat kidney disease in specific, at risk populations.

The cause of CKD is not always known but can result from many primary diseases of the kidneys themselves including kidney infection, narrowing or blocked renal artery, long term use of a medication that damages the kidneys and many more. Risk factors also play a key role in CKD. They are smoking, obesity, high cholesterol, being African-American, Native American or Asian-American, family history of kidney disease or age 65 or older. The most common cause, however, is diabetes and high blood pressure. Diabetes is a condition in which the body produces to little-to-no insulin or has become unable to make effective use of insulin. Insulin is needed to regulate the levels of sugar in the blood. When diabetes is poorly controlled, too much sugar can build up in the blood. It then damages the tiny filters in the kidneys, which affects the ability to filter out waste products and fluids. The first signs of diabetic kidney disease is appearance of low levels of protein in the urine. High blood pressure can damage the blood vessels in the kidney, reducing their ability to work properly. It causes the force of the blood flow to be high, so the blood vessels stretch which make the flow easier. Unfortunately, this stretching causes stretching scars and weakens blood vessels in the body, including the kidneys. This damage disables the kidneys from removing the waste and fluid from the body causing a horrible effect of raising the blood pressure ever higher.

Signs and symptoms can be a little harder to detect in early stages because the loss of function is slow and stretches over a long period of time. Most people with CKD have no symptoms because the body can handle even a big percentage of lost kidney function. Most people start to develop symptoms when CKD becomes severe, stage 4 or worse. The symptoms at early stages may be non specific, such as being tired more, malaise, anorexia, pruritus, and nauseated. Then as the disease worsens symptoms become more like confusion, cramping or twitching muscles, edema and numbness around feet ...

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As the kidney functions decrease, substances such as urea, creatinine, and certain electrolytes begin to build up in the blood. Surprisingly, it is often the routine check ups that alert doctors of this disease before patients even feel symptoms. At these routine visits, urinalysis test are used to check for blood and protein in the urine. Healthy kidneys do not allow protein to pass through its filters. This will prompt further investigations. The eGFR (stimated glomerular filtration rate) blood test is commonly used to diagnose and monitor progression and severity of the disease, as it is able to estimate the volume of blood that is filtered and measure cretonne levels in the blood. The blood urea nitrogen (BUN) test measures how much nitrogen from waste product urea is in your blood. BUN levels rise because the kidneys aren't removing enough urea from the blood. A fasting blood glucose test can be done to measure your blood sugar as high levels can indicate damaged blood vessels in the kidneys. Blood test are used to measure levels of waste products and electrolytes in the blood that should be removed by your kidneys. Testing for anemia is important to check if your kidneys are producing enough of the hormone erythropoietin needed for red blood cells. A renal ultrasound helps estimate how long you have had CKD, it checks whether urine flow from the kidneys is blocked, or if there are any other contributing diseases. A doppler study or angiogram of the kidney can check for problems caused by renal artery stenosis. A blood test for the parathyroid hormone checks the levels of calcium and phosphorus essential for bone health.

The goal of treatment for CKD is to prevent or slow further damage to the kidneys. Treatment will depend on the stage of CKD. Early stages will require lifestyle changes and medication. Great lifestyle changes include cessation of smoking, eating a healthy low-fat diet, not using NSAIDs (anti-inflammatory) medications, moderating alcohol intake, maintaining a healthy weight, and regularly exercising. Medications will be prescribed by doctors and these following prescriptions will be strongly recommended. As the disease progresses more evasive treatment is required. Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. There are 2 types of dialysis: haemodialysis and peritoneal dialysis. Haemodialysis is the most common and is performed in a dialysis center. The blood is cycled into a dialysis machine that filters it before it is cycled back into the body. This procedure is commonly performed 3 days a week and each session can last around 4 hours. Peritoneal dialysis uses the inside lining of the abdomen as the filter, rather than a machine. Like the kidneys, the peritoneum contains thousands of tiny vessels, which make it a perfect filter. A catheter is placed into the peritoneal cavity, where it will be permanently. Fluid is pumped into the peritoneal cavity through the catheter. As blood passes the peritoneal lining, waste products and excess fluid are drawn out and into dialysis fluid, which is then drained into a bag. Changing the fluid takes about 30-40 minutes and is repeated 4 times a day. If the kidney still continues to decline the last option is a kidney transplant. End-stage kidney failure is the most common reason for needing a kidney transplant but being on the waiting list can take 2-3 years or maybe even longer. Often finding a suitable donor is the tricky part because there are so many factors to ensuring the kidney will survive in the new host. CKD can affect almost every part of the body. These complications can often become life threatening diseases of their own. Some of the complications can include: fluid retention in peripheral extremities, high blood pressure, or pulmonary edema, hyperkalemia-impairing the heart's ability to function, cardiovascular disease, weakening of the bones and increased risk of bone fractures, anemia, decreased sex drive or impotence, damage to CNS which can lead to difficulty concentrating, seizures, pericarditis, pregnancy complications, irreversible damage to the kidneys, and dyslipidemia is a major risk factor for cardiovascular morbidity and mortality and is common among patients with CKD. These are just to name some of the most common but there are many more. These complications have a direct link to the prognosis because acquiring any can make a deadly mix. Fortunately, because of the available treatments people are living longer than ever. Although there is no cure, the treatments alone can make the patient live better.

A kidney helps to keep the right balance of nutrients and minerals in the body. Unfortunately, with CKD, the kidneys cannot do this job efficient as they should so making changes to the patient’s diet is very important. People with kidney disease need to control the amount of protein, sodium, potassium, phosphorus and calcium in their diet. This will help the kidney not have to work as hard to remove the extra waste and fluid. Having too much protein can cause waste to build up in the blood and the kidneys will not be able to keep up with filtering it out. Healthy kidneys usually control sodium in the body but with CKD sodium buildup causes fluid buildup, swelling, high blood pressure and strain on your heart. As the kidney functions get lower and lower, extra phosphorus can start to build up in the blood. High phosphorus can cause the bones to get weaker. Most people in the early stages of CKD do not need to limit the amount of fluid they drink but as the disease gets more progressive the patient will need to monitor input and output and drink according to what their kidney can put out.

Kidneys play a huge role in removing waste products and regulating the fluid levels in the blood. These waste products are toxic to the body and as they build up they can cause further complications and continue reducing function of the kidney. Chronic kidney failure is best described as the gradual loss of the kidney function over time. This very serious disease includes many factors that come into play and are all very important to understand and help decrease the progression of this disease. These factors include the disease history, etiology, signs, and symptoms, laboratory testing, treatment, prognosis, complications, statistics, and prevention. Through patient teaching and family support there are ways to live longer, healthier and better lives.

Knowing about the disease often helps because the patient and the family will understand more about what to expect and feel more in control of the illness, instead of feeling like their lives are dominated by the disease and treatment. Self care is an integral part of daily life. The patient must be responsible for their own well being and health, with support from the people around them. Teaching the patient self care will help them stay fit, maintain good physical and mental health, prevent illness and accidents, and overcoming limitations. A good relationship with the healthcare professional can make the patient feel at ease that they are in good hands. All these together will help to give the patient a longer happier life.

References

A Martínez-Castelao, JL. Geris, J Borer; et al. (2014). "Consensus document for the detection and management of chronic kidney disease".

https://www.kidney.org/kidneydisease/aboutckd

https://www.davita.com/kidney-disease/overview

http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/chronic-kidney-disease/