Chronic kidney failure
According to Dr. James I. McMillan, MD, Loma Linda University
Chronic kidney disease is a slow, gradual progression (months to years) in which the kidneys’ ability to filter metabolic waste products from the blood decreases.
* The main causes are diabetes and high blood pressure.
* As the acidity of the blood increases with the occurrence of anemia, nerve damage, bone tissue destruction, and the risk of developing atherosclerosis increases.
* Symptoms may include night-time urination, fatigue, nausea, itching, twitching, muscle spasms, loss of feeling, confusion, difficulty breathing, and yellowish-brown skin color.
* The diagnosis is made through blood and urine tests.
* Treatment aims to restrict fluid, sodium, and potassium intake in the diet, use drugs to correct other conditions (such as diabetes, high blood pressure, anemia, and an electrolyte imbalance), and use dialysis or kidney transplantation when necessary.
Many diseases can cause irreversible damage or injury to the kidneys. Acute kidney injury turns into chronic kidney disease if kidney function is not restored after treatment and the disease persists for more than three months. Therefore, any factor that causes acute kidney injury can cause chronic kidney disease. However, the most common causes of chronic kidney disease in Western countries are:
The two previous conditions cause direct damage to the small blood vessels in the kidney.
Other causes of chronic kidney disease include urinary tract obstruction (obstruction), some kidney abnormalities (such as polycystic kidney disease and glomerulonephritis), and autoimmune disorders (such as systemic lupus erythematosus [lupus]) in which antibodies inflict damage to small blood vessels (Glomeruli) and small tubes (tubules) in the kidneys.
Chronic kidney disease causes many problems in the body:
1- A slight or moderate decrease in kidney function disrupts the kidneys’ ability to absorb water from the urine to reduce the volume and concentration of urine.
2- At a later time, the kidneys’ ability to excrete acids normally produced by the body decreases, and the acidity of the blood increases, a condition called acidosis.
3- Red blood cell production decreases, which leads to anemia.
4- High levels of metabolic waste products in the blood can damage nerve cells in the brain, trunk, arms, and legs. Uric acid levels can increase, sometimes leading to gout.
5- Diseased kidneys produce hormones that increase blood pressure. In addition, diseased kidneys are unable to excrete excess salt and water. Salt and water retention may contribute to high blood pressure and heart failure.
6- The sac surrounding the heart (pericardium) can become inflamed (pericarditis).
7 – The level of triglycerides in the blood is often high because their elevation in conjunction with high blood pressure increases the risk of developing atherosclerosis.
8- The formation and maintenance of bone tissue may be impaired (osteodystrophy of nephrogenic origin) in certain conditions associated with long-standing chronic kidney disease. These conditions include a high level of parathyroid hormone (the parathyroid gland), a low concentration of calcitriol (the active form of vitamin D) in the blood, impaired absorption of calcium, and a high concentration of phosphate in the blood. Renal osteogenic dystrophy may lead to bone pain and an increased risk of fractures.
Symptoms usually occur very slowly. The progression of kidney failure and the accumulation of metabolic waste products in the blood lead to the progression of symptoms.
Mild to moderate loss of kidney function can cause only mild symptoms, such as the need to urinate several times during the night (nocturia). Nocturia occurs as a result of the kidneys’ inability to absorb water from the urine to reduce its volume and concentration, as it usually occurs during the night.
As kidney function worsens and more metabolic waste products accumulate in the blood, people may feel tired and weak, and their level of mental alertness may decrease. Some of them may have a lack of appetite and shortness of breath. Anemia also contributes to fatigue and general weakness.
The accumulation of metabolic waste products also causes nausea, vomiting, and an unpleasant taste in the mouth, which may lead to a lack of nutrition and weight. People with chronic kidney disease tend to bruise easily or bleed for an abnormally long time after cuts or other injuries. Chronic kidney disease also reduces the body’s ability to fight infections. Gout may cause severe joint inflammation, joint pain, and swelling.
A severe decrease in kidney function causes waste products to accumulate in the blood to higher levels. Damage to muscles and nerves can cause twitching, weakness, spasms, and muscle pain. People may also feel pins and needles like pins and needles in the arms and legs, and they may lose sensation in certain areas of the body. They can develop restless legs syndrome. An encephalopathy (a condition in which the brain malfunctions) may lead to confusion, lethargy, and convulsions.
Heart failure may cause shortness of breath. Pericarditis can cause chest pain and a drop in blood pressure. People with advanced chronic kidney disease usually develop peptic ulcers and hemorrhage. The skin may turn yellow-brown and the concentration of urea is sometimes so high that it crystallizes from the sweat, forming a white powder on the skin. Some people with chronic kidney disease experience itching all over their bodies. Their breath may also smell bad.
* Blood and urine tests
* Sometimes biopsy
Basic blood and urine tests. As it confirms the decline of kidney function.
A doctor must try to diagnose and begin treatment for any diseases that may cause kidney dysfunction, because a person may have acute kidney injury that may be cured with appropriate treatment.
When loss of kidney function reaches a certain level in chronic kidney disease, levels of chemicals in the blood usually become abnormal.
* The amount of urea, creatinine, and metabolic waste products that the kidneys filter out increases.
* The blood becomes moderately acidic.
* The level of potassium in the blood is often normal or a slight increase may occur, but it can become dangerously high.
* Blood levels of calcium and calcitriol are decreased.
* Phosphate and parathyroid hormone levels increase.
* The hemoglobin level is usually low (which means that the person has a certain degree of anemia).
The potassium level can become dangerously high when kidney failure reaches an advanced stage, or if people use large amounts of potassium, or if they take a drug that prevents the kidneys from excreting potassium.
A urinalysis may reveal many abnormalities, including protein and defective cells.
Ultrasound imaging is often done to rule out a blockage and to check the size of the kidneys. Small, scarred kidneys often indicate that kidney function is chronic. Accurate cause becomes difficult when chronic kidney disease reaches an advanced stage.
Removing a sample of kidney tissue for examination (kidney biopsy) may be the most accurate test, but it is not recommended if the ultrasound results show that the kidneys are small and scarred.
Chronic Kidney Disease (CKD) Pathophysiology
* For most people, chronic kidney disease eventually progresses regardless of treatment. The rate at which kidney function declines varies somewhat with the underlying disorder causing CKD and with the degree of control of the disorder. For example, diabetes and high blood pressure, especially when they are poorly controlled, lead to a faster decline in kidney function. Chronic kidney disease is fatal when neglected to treat.
* When the decline in kidney function is severe (sometimes called an end-stage renal failure or end-stage kidney disease), survival is usually limited to several months in people who are not treated, but people treated with dialysis may survive Longer period. But even with dialysis, most people with end-of-stage kidney failure die within 5-10 years. Most deaths occur as a result of heart or blood vessel disorders or infections.
Chronic Kidney Disease Treatment
* Treatment of conditions that worsen kidney failure
* Dietary measures and medications
* Renal dialysis or transplantation
Conditions that may lead to the occurrence of chronic kidney disease and its consequences that may negatively affect public health must be treated immediately, such as:
Urinary tract obstruction
* Cases of infection
* Using certain drugs
Adjusting the level of sugar (glucose) in the blood as well as high blood pressure in people with diabetes significantly slows the deterioration of kidney function. Use of drugs called ACE inhibitors and angiotensin 2 receptor blockers that help lower blood pressure may reduce the rate of decline in kidney function in some people with chronic kidney disease.
Doctors avoid prescribing drugs that are released by the kidneys or recommend lower doses of these drugs. It may be necessary to avoid using any other medicines. For example, it may be necessary to stop ACE inhibitors, angiotensin II receptor blockers, diuretic spironolactone, amiloride, and triamterene in people with severe chronic kidney disease and high potassium levels because these drugs may increase potassium levels.
Blockages in the urinary tract are removed or relieved. Bacterial infections are treated with antibiotics.
Dietary measures must be taken and medications may be prescribed to slow the progression of chronic kidney disease.
The decline in kidney function can be slowed slightly by restricting the amount of protein consumed daily. People need to eat an adequate amount of carbohydrates to compensate for the decline in protein consumption. If the restriction of dietary protein intake is severe, it is wise to get the supervision of a dietitian to ensure that you are eating adequate amounts of the amino acid.
Control of acidosis
Mild acidosis can sometimes be controlled by increasing the intake of fruits and vegetables and reducing protein intake. However, moderate or severe acidosis may require sodium bicarbonate.
Reducing triglyceride levels
The levels of triglycerides and cholesterol in the blood can be controlled to some extent by reducing the number of fats in the diet. Drugs such as statins or ezetimibe or both may be necessary to lower triglyceride and cholesterol levels.
Restrict sodium and potassium intake
Restricting salt (sodium) intake is usually helpful, especially in people with heart failure.
It may be necessary to restrict fluid intake to avoid too low the concentration of sodium in the blood. You should avoid eating foods rich in potassium, such as salt substitutes, and you should not eat foods relatively rich in potassium, such as dates, figs, and many other fruits. (See the National Kidney Foundation’s publication Potassium and Your CKD Diet for more information.)
A high level of potassium in the blood increases the risk of a heart rhythm disorder and heart arrest. The use of drugs such as sodium polystyrene sulfonate may help when the potassium level is very high, but kidney dialysis may be necessary in emergency cases.
Adjust phosphorous levels
A high level of phosphorous in the blood may cause deposits of calcium and phosphorous to form in tissues, including blood vessels. Restricting the intake of foods rich in phosphorous, such as dairy products, liver, legumes, nuts, and most soft drinks, lowers the concentration of phosphate in the blood. Also, drugs that bind to phosphates, such as calcium carbonate, calcium acetate, sevelamer, lanthanum, and ferric citrate that are used orally can By reducing the level of phosphorous in the blood. And calcium citrate should be avoided. It is found in many calcium supplements and in many products used as food additives (sometimes called E333). Vitamin D and similar medications are often used orally to lower high thyroid hormone levels.
Treatment of complications
Anemia due to chronic kidney disease is treated with the following:
Medicines such as erythropoietin or darbepoetin
Doctors also investigate and treat other causes of anemia, especially nutritional deficiencies of iron, folic acid, and vitamin B12.
Most people who regularly use erythropoietin or dropouts need to get iron intravenously to prevent iron deficiency, which weakens the body’s response to these drugs. Erythropoietin and darbepoetin should be used only when necessary, because they may increase the risk of stroke. The tendency to bleed can be temporarily suppressed by transfusion of blood products or by taking drugs such as desmopressin or estrogen. It may be necessary to use such treatment after an injury or before surgery or tooth extraction.
A blood transfusion is given only when symptomatic severe anemia is present and is unresponsive to erythropoietin or darbepoetin.
High blood pressure is treated with antihypertensive drugs to prevent worsening weakness of the heart and kidney function.
Diuretics can also relieve symptoms of heart failure, even when kidney function is impaired, but kidney washing may be necessary to exclude excess water from the bodies of people with severe chronic kidney disease.
Treatment of advanced chronic kidney disease
When treatments for chronic kidney disease fail, the only long-term treatment options are dialysis and kidney transplantation. Both treatment options reduce symptoms and extend life. A kidney transplant may be an excellent treatment option when it is possible. As for people who choose not to undergo dialysis, caring for the last stage of their lives is important to them.