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Renal failure

Definition

(Formerly called renal insufficiency) kidneys fail to adequately filter toxins and waste products from the blood.

There are two types:

• Acute renal failure
• Chronic renal failure (chronic kidney disease)
Renal failure is described as a decrease in the glomerular filtration rate.
Biochemically, it is elevated serum creatinine level.

Consequences of renal failure:
• abnormal fluid levels in the body
• deranged acid levels
• abnormal levels of potassium
• calcium
• phosphate
• (in the longer term) anemia
• Depending on the cause, hematuria (blood loss in the urine)
• proteinuria (protein loss in the urine) may occur.
Long-term kidney problems can cause: cardiovascular disease.

Acute renal failure :
(ARF) also known as Acute kidney injury (AKI), is a rapidly progressive loss of renal function.

Characterized by:

• Oliguria (decreased urine production, quantified as less than 400 mL per day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants)
• Body water and body fluids disturbances
• Electrolyte derangement

Causes:

• Pre renal
• Intrinsic
• Post renal

Treatment:

An underlying cause must be identified and treated to arrest the progress, sometimes dialysis may be necessary to bridge the time gap required for treating these fundamental causes.

Chronic kidney disease

Chronic kidney disease (CKD) can develop slowly and initially, show few symptoms. CKD can be the long term consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic renal failure

Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic renal failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the patient to baseline renal function, typically measured by serum creatinine.

Symptoms of Renal failure

The following are some of the symptoms of Renal failure :

Symptoms can vary from person to person. Someone in early stage kidney disease may not notice any symptoms. When kidneys fail to filter properly (azotemia) then symptoms become noticeable

Symptoms of kidney failure include:

• High levels of urea in the blood, which can result in:

Vomiting and/or diarrhea, which may lead to dehydration
Nausea
Weight loss
Nocturnal urination
Foamy or bubbly urine
More frequent urination, or in greater amounts than usual, with pale urine
Less frequent urination, or in smaller amounts than usual, with dark coloured urine
Blood in the urine
Pressure, or difficulty urinating
• A build up of phosphates in the blood that diseased kidneys cannot filter out may cause:

Itching
Bone damage
Muscle cramps (caused by low levels of calcium which can cause hypocalcaemia)
• A build up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
Abnormal heart rhythms
Muscle paralysis.
• Failure of kidneys to remove excess fluid may cause:
Swelling of the legs, ankles, feet, face and/or hands
Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
• Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
Pain in the back or side
• Healthy kidneys produce the hormone erythropoietin which stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
Feeling tired and/or weak
Memory problems
Difficulty concentrating
Dizziness
Low blood pressure
• Other symptoms include:
Appetite loss, a bad taste in the mouth
Difficulty sleeping
Darkening of the skin

Causes

Chronic kidney disease

• Diabetes mellitus.
• Long-standing, uncontrolled, hypertension, or high blood pressure
• Polycystic kidney disease( family history of the disease.)
• Other genetic illnesses
• Genetic predisposition
• Overuse of common drugs such as aspirin, ibuprofen, codeine and acetaminophen

Diagnostic approach

• Blood investigations: CBC, ESR, S. urea, S.creatinine, S.calcuim, S.electrolytes,
• Urine: routine microscopy
• The urinary albumin:creatinine ratio is measured using the first morning urine sample where practicable.
• Microalbuminuria is defined as: albumin:creatinine ratio>2.5mg/mmol (men) or >3.5mg/mmol (women) or albumin concentration >20mg/l.
• Proteinuria is defined as: albumin:creatinine ratio >30mg/mmol or albumin concentration >200mg/l.
• USG abdomen
• CT
• Glomerular filtration rate
• Renal biopsy.
Stages of kidney failure
measured in five stages

Stage 1 CKD: decrease GFR ( glomerular filtration rate).mildly diminished renal function, with few overt symptoms.

Stages 2 and 3: increasing levels of supportive medical care for diminished renal dysfunction.

stages 4 and 5: patient requires an active treatment in order to survive (dialysis) or (kidney transplant).


Homeopathic treatment for Renal failure

As per the underlying stage the treatment management varies.

Medical Treatment

There is no cure for chronic kidney disease. The four goals of therapy are to:

1. slow the progression of disease;
2. treat underlying causes and contributing factors;
3. treat complications of disease; and
4. replace lost kidney function.

Strategies for slowing progression and treating conditions underlying chronic kidney disease include the following:

Control of blood glucose: Maintaining good control of diabetes
Control of high blood pressure: It is recommended to keep blood pressure below 130/80 mm Hg. Blood pressure medications known as angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) have special benefit in protecting the kidneys.
• Diet: Diet control is essential to slowing progression of chronic kidney disease
• Fluid retention :diuretic medications
• Anemia :erythropoiesis stimulating agents ,drugs require iron supplements by mouth or sometimes even intravenously.
• Bone disease: drugs to bind phosphorus in the gut, and active forms of vitamin D.
• Acidosis may develop due to breakdown of proteins, inflammation, and bone disease. Use of sodium bicarbonate (baking soda) to correct the problem.

Renal Replacement Therapies

It can be done by dialysis or by kidney transplantation.
The planning for dialysis and transplantation is usually started in Stage 4 of chronic kidney disease. It is usually hemodialysis or peritoneal dialysis.

Follow ups:

• regular measurements of kidney function using serum creatinine concentration and estimated GFR, depending on the severity of kidney impairment (annual in stage 1 and 2 and stage 3 if known to be stable, 6-monthly for newly diagnosed or progressive stage
• advice on smoking cessation
• advice on weight loss if obese
• encouragement to take regular aerobic exercise
• advice to limit alcohol intake to no more than 3 units/day (men) or 2 units/day (women)
• consideration of aspirin treatment for all patients with an estimated 10 year risk of cardiovascular disease of > 20%, so long as blood pressure is < 150/90 mm Hg
• meticulous control of hypertension if present
• lipid lowering

Treated cases on Renal failure

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