Beruflich Dokumente
Kultur Dokumente
Causes,
CKD
Do not smoke.
Eat meals that are low in fat and cholesterol Get regular exercise (talk to your
doctor or nurse before starting).
Take drugs to lower your cholesterol, if necessary. Keep your blood sugar
under control
Stages of chronic kidney disease
Symptoms of CKD
The early symptoms of chronic kidney disease often occur with other
illnesses, as well. These symptoms may be the only signs of kidney disease
until the condition is more advanced.
Symptoms may include:
General ill feeling and fatigue
Generalized itching (pruritus) and dry skin
Headaches
Weight loss without trying to lose weight
Appetite loss
Nausea
Other symptoms that may develop, especially when kidney function has
worsened:
Abnormally dark or light skin
Bone pain
Brain and nervous system symptoms
Drowsiness and confusion
Problems concentrating or thinking
Numbness in the hands, feet, or other areas
Muscle twitching or cramps
Breath odor
Easy bruising
Tests that check how well the kidneys are working include:
Creatinine levels
BUN
Creatinine clearance
Chronic kidney disease changes the results of several other tests. Every
patient needs to have the following checked regularly, as often as every 2 - 3
months when kidney disease gets worse:
Potassium
Sodium
Albumin
Phosphorous
Calcium
Cholesterol
Magnesium
This
Abdominal CT scan
Abdominal MRI
Abdominal ultrasound
Renal scan
disease may also change the results of the following tests
Erythropoietin
PTH
Bone density test
Treatment
Treating the condition that is causing the problem may help prevent or delay
chronic kidney disease.
People who have diabetes should control their blood sugar and blood
pressure levels and should not smoke
Other tips for protecting the kdineys and preventing heart disease
and stroke
Do not smoke.
Eat meals that are low in fat and cholesterol Get regular exercise (talk to your
doctor or nurse before starting).
Take drugs to lower your cholesterol, if necessary. Keep your blood sugar
under control
Pathophysiology of End-Stage Renal Disease and Dialysis
What is Dialysis?
The kidneys are responsible for filtering waste products from the blood.
Dialysis is a procedure that is a substitute for many of the normal duties of
the kidneys.
Patients usually require dialysis when the waste products in their body
become so high that they start to become sick from them
The two major blood chemical levels that are measured are the "creatinine
level" and the "blood urea nitrogen" (BUN) level. As these two levels rise,
they are indicators of the decreasing ability of the kidneys to cleanse the
body of waste products .
Doctors use a urine test, the "creatinine clearance," to measure the level of
kidney function. The patient saves urine in a special container for one full
day. The waste products in the urine and in the blood are estimated by
measuring the creatinine. By comparing the blood and urine level of this
substance, the doctor has an accurate idea of how well the kidneys are
working. This result is called the creatinine clearance. Usually, when the
creatinine clearance falls to 10-12 cc/minute, the patient needs dialysis
If the patient is experiencing a major inability to rid the body of excess water,
or is complaining of problems with the heart, lungs, or stomach, or difficulties
with taste or sensation in their legs, dialysis may be indicated even though
the creatinine clearance has not fallen to the 10-12 cc/minute level.
What types of dialysis are there?
There are two main types of dialysis: "hemodialysis" and "peritoneal dialysis."
Hemodialysis uses a special type of filter to remove excess waste products
and water from the body. Peritoneal dialysis uses a fluid that is placed into
the patient's stomach cavity through a special plastic tube to remove excess
waste products and fluid from the body.
RENAL TRANSPLANTATION
Renal transplantation has transformed the outlook for many patients
with end stage renal disease. One-year patient and graft survival is
98% and 90-95%.
That renal transplantation is the treatment of choice for patients with
end stage renal disease who are fit to receivea renal transplant
Renal disease are frail and elderly and/or have a number of co-existing
medical problems such that they are not fit to undergo major
operation(implantation of the kidney).
For those patients who are fit enough to receive a renal transplant and
are succesfully transplanted, there is a profound survival benefit
compared to remaining on dialysis treatment
Transplantation is a far less expensive treatment than dialysis,
particularly after the first year, when the large majority of the costs are
limited to payment for the immunosuppressive drugs
One of the major challenges for renal transplantation is the
identification of a sufficient number of donor kidneys to fulfil demand.
Kidney donated for the national waiting list are harvested from
deceased donors. At the time of donation, donors are classified as
dead as a consequence of either brain stem as cardiac death; these
are also called heart beating and non-heart beating donors,
respectively
The numbers of deceased donors as a proportion of those on the
waiting list for a kidney transplant have fallen. Therefore, living donor
transplantation has become increasingly common. In addition to part
addressing the scarcity of donor organs, patients who receive kidney
transplant.
This is due to a number of factors, including the quality of the organs,
because living donors undergo a deatailed health screening and if
there is any indication that they have significant medical problems
they are excluded from donation.
One of the major factors responsible for excellent outcomes for kidney
transplant recipients is the use immunosuppressive drugs to control
the response the immune system of the recipient mounts against the
donor kidney. Alloimmunity refers to an immune response against
tissue derived from an individual of the same species as the recipient
of the tissue.
The major disadvantage of all immunosuppressive agents is
their relative non-specificity, in that they cause a general
CASE STUDY
Mr. A is patient with CKD secondary to chronic interstitial nephritis. He
complains of chronic fatigue, lethargy and breathlessness on exertion,
palpitations and poor concentration. His recent haematological results
were found to be:
Reference range
Haemoglobin
5.6 g/dL
(13.5-17.5)
Red cell count
2.92x109 L-1
(4.5-6.5x109 L-1)
Haematocrit
0.208
(0.40-0.54)
Serum ferritin
88.0 cg/L
(15-300)
Question
Explain Mr. As symptoms and haematological results and outline the optimal
treatment.
Therapy with epoetin is the treatment of choice. However, iron and folate
deficiencies should be corrected if poetin therapy is to be successful. Iron demands
are generally raised during epoetin treatment and iron status should be regularly
monitored. If serum ferritin falls below 100 ch/L then supplementation should be
started. Often intravenous iron is required to provide an adequate supply, despite
the dangers associated with administration of iron by this route.
Its good to have money
its good too, to check up
thing that money cant buy.