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Chronic Kidney Disease

CHRONIC KIDNEY DISEASE: KNOW THE MAIN PHYSIOTHERAPEUTIC TREATMENTS

The kidneys are a pair of bean-shaped organs located in the upper-posterior part of the abdomen. Its main function is to filter the blood, eliminating toxins and excess salt and water from the bloodstream.

The proper functioning of the body depends a lot on the kidneys. Therefore, it is necessary to take special care to avoid possible kidney problems, which can lead to failure and the need for dialysis or hemodialysis.

Chronic kidney disease (CKD) is a slow, progressive and irreversible loss of renal structures that affect the glomerular, tubular and endocrine functions of the kidneys, leading to the body’s inability to maintain metabolic and electrolyte balance.

Characterized by the presence of functional and/or structural changes in the kidneys, for a period longer than three months, with a glomerular filtration rate (GFR) lower than 60 mL/min./1.73m.

CKD has been considered a public health problem worldwide due to its high rates of morbidity and mortality and its impact on physical and biopsychosocial aspects, drastically affecting the quality of life of patients, says the best nephrologist in Delhi.

With that in mind, nephrologist in Delhi prepared this article with the main types of treatment for Chronic Kidney Disease. Keep reading and learn more about them!

Treatment for Chronic Kidney Disease

Treatment for Chronic Kidney Disease aims to help the kidneys maintain homeostasis for as long as possible.

With the deterioration of renal function, dietary intervention is necessary with careful control of protein intake (allowed must be of high biological value – dairy, eggs, meat – to provide essential amino acids), fluid intake (quantity of fluid allowed is 500 to 600 ml more than the 24-hour urine output) to counteract fluid losses, sodium intake to counteract sodium losses, and a certain potassium and phosphate restriction.

At the same time, adequate caloric intake and vitamin supplementation must be ensured.

In general, dialysis in Delhi is started as a form of treatment for Chronic Kidney Disease when the patient cannot maintain the usual lifestyle with the conservative method.

Unfortunately, not all patients are candidates for dialysis or transplantation due to severe psychological problems, ischemia, vascular complications from diabetes and old age, says kidney specialist in Delhi.

Types of dialysis

There are two types of dialysis – hemodialysis (HD) and peritoneal dialysis (PD), both types involve the use of a fluid used to filter impurities in the blood, toxins and fluids passing from the blood through a semi-permeable membrane.

Physiological principles of dialysis

Dialysis is a process of treatment for Chronic Kidney Disease whereby the composition of solutes in a solution A is changed by exposing solution A to a second solution B through a semipermeable membrane.

Water molecules and low molecular weight solutes from the two solutions can pass through the pores of the membrane and therefore mix, while larger solutes (such as proteins) cannot pass through this semi-permeable membrane and thus the amounts of high molecular weight solutes on either side of the membrane will remain unmodified.

The transport of solutes will take place in two ways:

  • Diffusion: transport of solutes through a semi-permeable membrane, obeying the concentration gradient and the molecular weight of the solute;
  • Ultrafiltration: transport of water through the transmembrane pressure gradient with the passage of water from the higher side to the lower pressure.

Peritoneal dialysis

Peritoneal dialysis uses the peritoneum as a natural permeable membrane to balance water and solutes.

The technique is less physiologically stressful for the patient, does not require vascular access that can present numerous complications, it can be performed at home and, for this reason, allows patients greater flexibility in its performance.

Although, with so many advantages, the technique requires much more patient involvement than in a hemodialysis at dialysis centre in Delhi, it needs to be performed carefully and sterile maintenance is of great importance.

Peritoneal dialysis can be done manually or using an automatic device (periodic, overnight, or continuous), and in general, the dialysate is instilled through a catheter into the peritoneal space, remains for a period, and then drains. In the double bag technique, the patient drains the fluid instilled into the abdomen into one bag and then infuses fluid from another bag into the peritoneal cavity.

Quality of life of patients

Although the different dialysis methods of treatment for Chronic Kidney Disease are equivalent in issues related to patients’ rehabilitation and mortality, the quality of life needs to be evaluated.

In a study, it was possible to observe that PD was more favorable to a better quality of life for the patient, as it presents three significant variables (work, patient satisfaction and less contact with the team – less likely to experience situations of stress), while HD presented two significant variables (emotional and physical function).

However, it should be taken into account that the two significant items in HD are more relevant to the daily quality of life of the patient outside the clinic.

Conclusion

Kidney replacement therapies, hemodialysis and peritoneal dialysis, as a treatment for Chronic Kidney Disease represent, in most cases, a life expectancy for those who undergo it, since the disease is characterized as an irreversible process.

Conservative treatment (medicines, changes in diet and lifestyle) can be used to delay the worsening of renal function or stabilize its progression, reduce symptoms (malaise and fatigue, itching and dry skin, headache, loss of unintentional weight, loss of appetite and nausea), prevent complications and improve the quality of life of these patients.

Adapting to this new reality is not an easy process, nor is it a very smooth process, the health professionals involved in the patient’s treatment must understand and help the individual in all aspects, as well as his family, says the kidney doctor in Delhi.

 

Creatinine what is it? Test Purpose and Effect on Kidneys

Its analysis helps to know the functioning of the kidneys;

Within the different parameters that are studied in a routine blood test, one of the most common and usual is known as serum creatinine, mainly because its analysis helps to know the functioning of the kidneys; rather, whether or not the kidneys are performing their functions correctly. But in a routine urine analysis, a parameter related to creatinine is also analyzed, although this time it is medically known as urine creatinine, explains the best nephrologist in Delhi.

What is creatinine?

Creatinine is a substance present in the blood that is produced by the degradation of creatine found in the muscles, it is a waste product that the kidneys filter in order to extract it from the blood and remove it through the urine. So when analyzing creatinine levels it is possible to identify if there is a problem in the kidneys, especially when its value is high in the bloodstream, since it can mean that the kidneys are not able to eliminate it and therefore it is accumulating in the organism, explains kidney specialist in Delhi.

It is generated by our muscles (both by its activity and by the muscle mass itself), and they produce it at a constant speed as part of our normal daily activity.

Since creatinine is a substance that is produced in the body depending on the level of muscle mass, it is normal for men to have higher blood creatinine levels than women, since they usually have more developed muscles.

What is your analysis for?

We must bear in mind that the kidneys are the organs responsible for filtering creatinine by excreting it through the urine, so its measurement is especially useful to monitor if the kidneys are performing their function correctly, explains the nephrologist in Delhi.

The creatinine test is a simple test that becomes the most common indicator about the person’s renal function, says the best kidney specialist in Delhi. For this reason, it is routinely included in the most basic and common blood tests, both in its serum form and in urine. And if renal function is abnormal, creatinine levels tend to increase in the blood since in fact a smaller amount of creatinine is eliminated in the urine.

Normal blood creatinine values

Creatinine values ​​may vary from one laboratory to another, since some laboratories usually analyze different samples, or use different measurements. However, the average normal values ​​are as follows:

  • Normal values ​​of serum creatinine in adult men:7-1.3 mg / dl.
  • Normal values ​​of serum creatinine in adult women:5-1.2 mg / dl.
  • Normal values ​​in children:2-1 mg / dl.

While values ​​above 4 mg / dl are considered as an indication of significant renal failure.

On the other hand, it is possible that when intense physical exercise has been practiced before performing the blood test, there will be slight increases in the blood creatinine value. This increase does not correspond to renal failure, but it reflects muscle activity, top kidney specialist in Delhi says.

Elevated blood creatinine levels may indicate the presence of:

  • Renal insufficiency.
  • Urinary tract obstruction.
  • Acute tubular necrosis
  • Dehydration
  • Diabetic Nephropathy
  • Glomerulonephritis
  • Muscular dystrophy.
  • Pyelonephritis
  • Reduction of renal blood flow.
  • Rhabdomyolysis

What can cause high creatinine?

When blood creatinine levels are above normal, they may indicate a lesion in the blood vessels of the kidneys, a kidney infection or a reduction in blood flow to the kidneys, for example. Some symptoms explained by kidney doctor in Delhi that may arise in cases of high creatinine are:

  • Excessive tiredness;
  • Swelling of the legs or arms;
  • Feeling short of breath;
  • Frequent confusion;
  • Nausea and vomiting

However, athletes and bodybuilders may also have high creatinine due to high muscle activity and not due to kidney injury, says the top nephrologist in Delhi.

Decreased serum creatinine values

Low blood creatinine values ​​are not a cause for concern, being more frequent in pregnant women and in patients with liver diseases, since the liver is also responsible to produce creatinine.

However, nephrologist in Delhi says that in some people it can also indicate diseases in the muscles such as muscular dystrophy, for example, which causes other symptoms such as weakness, muscle pain or difficulty moving the arms or legs.

What Causes Pain in Kidney Failure?

The literature reveals that up to 58% of patients with Chronic Renal Failure (CRF) have some pain that is difficult to control. Despite this, there is a lack of consensus that addresses its diagnosis and treatment in this type of patients. The pain seems to be generally of musculoskeletal origin, although neuropathic pain is also common. It is according to the degree of renal impairment that certain doses of drugs must be adjusted to avoid the accumulation of active metabolites. To dose we must consider a decreased clearance of the drug (Cl), changes in the volume of distribution (Vd), lower protein binding, threshold to decreased respiratory depression, suggests nephrologist in Delhi.

The use of analgesics in patients with CRF is relatively uncommon, considering the prevalence of severe pain in this population. Paracetamol is a safe alternative in this type of patients, and yet it is prescribed very little. The frequency of prescription of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) impresses with being inappropriately high, and the precaution of restricting them in patients with a Glomerular Filtration (GFR) less than 35 ml / minute is rarely taken to avoid further deteriorating renal function. The opioids that are frequently prescribed are of the weak type, and some have inadequate pharmacokinetic properties for patients with kidney disease, says best nephrologist in Delhi.

To treat pain in a patient with CRF, several factors must be considered; the degree of insufficiency, drug interactions and comorbidities. Opioids should be used conservatively and with low titres. The use of NSAIDs is not recommended chronically, but they may have a role in the treatment of renal colic by inhibiting the synthesis of prostaglandins. Its use should not exceed 7 days. In post-dialysis patients kidney specialist in Delhi suggests to start the dose of gabapentin at 100 mg every other day, and pregabalin can be started at doses as low as 25 mg every other day.

It is estimated that up to 50% of patients with CRF have diabetes mellitus. Of these, one third suffer from diabetic neuropathy. Gabapentinoids are not only useful in the treatment of this, they have also been shown to play an important role in other symptoms, such as pruritus and insomnia.

Joint pain is another common problem in patients with CRF. They often have severe shoulder pain without a clear etiology. One hypothesis is that pain is caused by accumulation of B2 microglobulin in the joint. In those patients in whom the pharmacological treatment is not successful, an arthroscopic synovectomy may be a good option. B2 microglobulin deposition can also cause mononeuropathies, including Carpal Tunnel Syndrome (STC), caused by extrinsic compression of the median nerve, which often requires surgical decompression.

Next, best kidney specialist in Delhi will talk about some of the frequently used analgesics and their implications in the IRC:

Paracetamol: It is a powerful analgesic and antipyretic. It is the analgesic of choice in patients with kidney disease (except in those who also have liver failure). Its maximum dose is 3000 mg per day. It usually does not require adjustment according to the glomerular filtration rate (GFR), although some top kidney specialist in Delhi recommends spacing doses every 8 hours when GFR is <10 mL / min.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): May decrease opioid requirements by up to 30%. However, due to its gastrointestinal and renal adverse effects its prolonged use in patients with CRF should be avoided. If your prescription is necessary, it should be limited to no more than 7 days, always monitoring the renal function suggests top nephrologist in Delhi.

Morphine: It is the most widely studied opioid analgesic in kidney disease. It is an agonist of the µ receptors. It causes pain relief through its µ1 agony and respiratory depression through µ2. It is metabolized in the liver to various metabolites. Of these, morphine-6-glucoronide is approximately 10 times more potent than morphine. It accumulates in the CRF causing respiratory depression and depression of the Central Nervous System (CNS), since once it crosses the blood brain barrier (BHE) the effect persists for several days after the drug has been suspended and even after a hemodialysis. It is recommended by kidney doctor in Delhi to reduce the dose by 25%, 50% and 75% in patients with CKD stages 3,4 and 5, respectively.

Codeine: A series of active metabolites (codeine-6-glucuronide, norcodeine, morphine, M3G, M6G, and normorphine) are metabolized via the liver, which are excreted via the kidneys. Its half-life is prolonged up to 5 times in patients requiring hemodialysis. Coidein and its metabolites accumulate in the IR and cause hypotension and respiratory depression.

Fentanyl: It is rapidly metabolized via liver to inactive metabolites. It does not accumulate significantly in the IRC, so it is a safe option. No dose reduction is necessary.

Tramadol: It is an opioid analgesic that also inhibits the re-capture of serotonin and norepinephrine. It is effective in both nociceptive pain and neuropathic pain and has the advantage of producing less sedation and respiratory depression than the rest of opioids. A common adverse effect is nausea. A rare but important effect is seizures, especially in patients taking medications that lower the seizure threshold, such as serotonin reuptake inhibitors. It can also cause serotonin syndrome. In advanced CRF, the elimination half-life may even double, so the dose should be reduced to 200 mg / day in patients with a GFR <30 ml / min, and to 50 mg / day if the GFR is <10 ml / min. Tramadol is eliminated with dialysis, so it should be administered after it.

6 Approaches to Protect your Kidneys

This dynamic duo can take serious risks and give no sign of the problem. Learn how to avoid them with very simple attitudes.

Only 150 grams very well distributed in 12 centimeters in height – it seems little, especially when compared to lungs and liver. However, the kidneys are responsible for vital functions in the body. And, when these notable little ones convalescence, it is certainly a problem : chronic kidney disease (CKD), an evil that does not usually warn about its existence, destroys the renal structures until it reaches the point where the organ stops functioning.

“CKD is the term that refers to all diseases that affect the kidneys for three months or more, which reduces filtration and affects some of its attributions”, explains nephrologist in Delhi. The problem is that kidney diseases do not always have symptoms. “In many cases, the individual does not notice and the diagnosis is made late,” adds kidney specialist in Delhi.

Despite being characterized as a silent disease, CKD can show some signs. However, when they do appear, it is usually too late. “The kidney is a very resistant organ, and these symptoms will only appear in stages 4 and 5 of the problem, when it is very advanced,” says best nephrologist in Delhi. In addition to only appearing in extreme situations, many of these manifestations tend to be confused with other illnesses. Hence the importance of always visiting the doctor and ordering the tests that detect unwanted changes in the filters of the human body.

What if the person finds out that their kidneys are not working as they should? “Person needs to consult periodically with a kidney doctor in Delhi, do tests regularly, take good care of blood pressure and blood glucose, in addition to other changes that occur in kidney disease, such as changes in calcium and phosphorus levels,” says top nephrologist in Delhi.

In cases where CKD has progressed too far and the kidneys have lost much of their ability to remove dirt from the body, the individual can choose two ways: receive the kidney from a compatible donor or go on dialysis. “Okay, some patients have no clinical conditions to perform a transplant. But, in the others, this is the treatment of preference ”, clarifies the best kidney specialist in Delhi.

However, the absence of someone who is able to donate one of his kidneys causes most convalescents to go to hemodialysis, when a machine replaces the main functions that were performed by the excretory device. Some simple actions can eliminate many of these disorders. Check below how to keep this pair in full swing.

  1. Keep diabetes and pressure on a short leash

When these markers are at exaggerated levels, the likelihood of developing CKD is even greater. The atherosclerosis, the formation of fatty plaques, particularly in the renal artery, cause an overload of the kidney filtration work. “And the incidence of these two diseases has been increasing in recent years, something aggravated by the aging of the population, in addition to physical inactivity and obesity”, top kidney specialist in Delhi. In cases where the damage has already been done, the first measure is to keep an eye on pressure and diabetes.

  1. Getting well with the scale

Staying at your ideal weight is also a rule of thumb to keep your kidneys going. Individuals with body mass index (BMI) in healthy parameters are protected from head to toe and, in this package of benefits, natural filters gain. “Today, there is a worldwide epidemic of obesity. The overweight leads to hypertension and diabetes. When healthy habits are acquired, the risk of suffering from a kidney problem is much lower ”, highlights nephrologist in Delhi.

  1. Adopt a balanced diet

Taking care of excess fat and eating foods rich in vitamins and fibers helps a lot to maintain kidney functions. When the individual already suffers from CKD, he is likely to be forced to make some changes to his menu. “There, it is important to adopt a diet with less protein to avoid kidney overload”, says Dr. Sunil Prakash. This menu must be endorsed by the doctor and a nutritionist.

  1. Only use painkillers with guidance

Medicines should only come on the scene with the indication of a specialist. Even when that simple headache appears, escape self-medication. Right now, it can even be resolved, but in the long run, your kidneys can suffer. “Both analgesics and anti-inflammatory drugs are able to harm them if taken in excess because they favor the occurrence of kidney diseases”, warns Dr. Sunil Prakash. Always seek medical advice to identify the cause of the discomfort and eliminate it in the best possible way.

  1. Take it easy with your drink

When ingested sparingly, alcohol can even benefit the work of the kidneys. Experts even recommend one or two very small doses. However, sticking your foot in the jackfruit will not please the small filters, which suffer indirectly. “In excess, alcohol can cause hypertension, which will evolve to generate kidney problems”, warns kidney specialist in Delhi. The drink also causes liver damage, which will ultimately lead to kidney damage.

  1. Put out the cigarette

In the kidneys, the action of smoking is as harmful as in other parts of the body. And the explanation lies in the appearance of small blocks, the fat plates, which decrease the caliber of the tubes through which the blood circulates. This causes pressure problems that, in turn, lead to CKD. “The kidneys are full of blood vessels. Cigarettes trigger inflammations that harm the organ ”, highlights Dr. Prakash.

Watch for these symptoms

  • Tiredness
  • Insomnia
  • Swelling in the feet and ankles
  • Swelling in the eyes
  • Nocturia (desire to go to the bathroom at night)
  • Bad breath
  • Malaise
  • Foamy or bloody urine