Kidney: We have two kidneys. Each kidney is capable of sustaining life independently.
Location: Kidneys are located on either side of the spine at the level of the rib cage.
Circulation: Your kidneys convert over 1500 litres of blood per day into about 1.2 to 1.5 litre of concerted urine. (The rate of urine a formation is about 1 ml/min.)
In an adult of normal weight (60-65) about 1200ml of blood flows through both the kidneys every minute. (this is about 20-25 % of heat output).
The urine is removed from the kidney by the URETERS (two twin tubes) and stored in the BLADDER and discharged through URETHRA (intervals).
The main function of the urinary system is the REMOVAL OF LIQUID WASTE PRODUCTS from the body. This is done to a certain extent by the skin also. The kidney also moves excess water from our body and maintains normal salt and water balance.Warning Symptoms & Signs of Kidney Disease
- Burning sensation while urinating
- Frequent and excessive urination (especially in the night time)
- Blood in the urine (brown or coffee colour)
- Puffiness or oedema on face and body
- Hypertension (high blood pressure)
The above symptoms /sign are given to you as a warning and should be used as a general guideline only. Contact your doctor if you notice any of the above. The doctor would advise you further on investigation and treatment.
Kidney disease is detected only when you go for urine/blood check-up.
Doctor’s advice is a must for any treatment.Symptoms & signs of kidney failure How do I know my kidney has failed?
- Symptoms of kidney failure are so general that most of the times they are not suspected as threatening. (Note: These symptoms may occur due to other reason also).
- Nausea and Vomiting
- Loss of Appetite
- Increased blood pressure
- Skin itching
- Increase/Decreased frequency of urination(especially at night)
- Lower back pain
- Swelling of face and leg
- Physical weakness
As soon as kidney failure is detected, patients must get Hepatitis-B vaccination.Test To Detect Kidney Disease/Failure
When you contact nephrologists for any of the symptom mentioned earlier, the doctor might recommend for one or more of the following test to detect kidney problems.Common tests: Urine examination: For proteinuria (Albuminoidal) Real blood cells or pus cell and casts. Urine For Culture And Sensitivity– For infection Blood Urea Nitrogen (Bun) – This is a waste product produced from protein metabolism. Serum Creatinine –This is produced from muscle metabolism. Complete Blood Count Cbc) – Generally blood count (Hemoglobin) level falls with the onset of kidney failure. Plain X-Ray Abdomen (Kub) – Generally gives information about kidney stones. Ultrasonography (Usg) – This is one of the non-invasive tests. It gives information to doctors about kidneys, tumors or even whether kidney disease is of long-standing duration or not. Unfortunately, it does not tell anything about kidney function.
Intravenous Pyelography (Ivp Or Ivu) – This involves giving an injection of iodinated dye in vein followed by kidney x-rays. It gives valuable information about kidney function, size etc. It is an invasive test. At times the patient can get a reaction (rarely fatal) with dye. It is not done if kidney function is already compromised greatly with creatine greater than 3 to 4 mg/dl.1
Renal Scan (Nuclear) – it gives you information about kidney size and function also. Sensitively is decreased in renal failure.
Ct Scan Kidney- This is occasionally done when tumor is suspected. This is commonly used.
Kidney Biopsy- This involves the removal of a tiny piece of kidney tissue for microscopic examination of the kidney. This guides the doctors about the cause and treatment if any.
- Creatine Clearance Tests: To determine the exact percentage of kidney function.
- Quantification proteinuria: Urine is collected to see how much protein is lost in 24 hrs.
- Acute kidney failure (reversible) kidney fails suddenly over a short time due to
- Dehydration (Due to severe diarrhoea or vomiting).
- Sudden significant drops in blood pressure.
- Massive Bleeding
- Acute glomerulonephritis
- Drug overdose
- Food Poisoning etc.
This is generally reversible and kidney recovers in a matter of three days to three weeks time. Till kidney function recovers, the patient should be under observation and may require hospitalization for a few days and might require a few sessions of dialysis.
Chronic kidney disease (irreversible):
- Common causes:
- Long-standing diabetes
- Uncontrolled high blood pressure for a long time
- Chronic glomerulonephritis
- Chronic infection of kidney pyelonephritis.
- Polycystic kidney disease
- Frequent stone formation in the urinary tract
- Enlarged prostate gland.
- Excessive use of medicines over years (mainly pain killers
- Proper treatment of diabetes for diabetic patient
- The normal blood sugar level is 80 to 120 mgs%. Tight control of diabetes can prevent kidney failure.
- Regular check-up of blood pressure
- The normal level is 120/80 mm of hg. If high blood pressure is present, control it with salt restriction and medicines as per doctor’s service
- It’s not the end of the world. You have to only change your lifestyle, you can still enjoy life.
- If your job is physical, you probably felt weak long ago. You’ll feel better now
- If you do intellectual work, your brain is not dead yet
- You can still perform intellectual work.
- Learn everything about how the kidney functions, your disease, and the dialysis.
- Ask questions. What is your blood pressure? Lab values and what do they mean
- Maintain your weight as recommended
- Learn what diet you need to take
- Never miss treatment
Hemodialysis is a process by which blood is purified by taking it out of the body with the help of a machine and passing it through a ‘Dialyser’ (Artificial Kidney)
Blood is taken out of the body via a needle (A.V.F). in the dialyser blood and dialyzing fluid flow on either side of a semi-permeable membrane. This removes toxic waste and excess water from the blood. The pureblood is returned to the body.
This process if taking out and putting in the blood continues for 3-4 hours. The dialysis has to be repeated at least 3 times a week.
Preparation of the patient for Hemodialysis:
When a patient has moderately severe renal failure (i.e when the kidney is 80% damaged) plan should be made to do A.V fistula access.
Vascular Access: this means that to receive hemodialysis treatment there must be a way to enter the blood vessels easily at least three times a week. The accesses are:
- Arterio Venus Fistula (A.V.F)
- Jugular Catheter
- Subclavian Catheter
- Femoral Catheter
Last four procedures are done when urgent dialysis is needed. The first procedure is ideal for long term dialysis.
Anterio Venus Fistula (A.V.F)A fistula is made from sewing two blood vessels together. Two of the blood vessels, an artery and a vein, are connected underneath the skin. It is generally done under local anaesthesia. It takes about 3 to 4 weeks for A.V Fistula to mature before it can be used. This new connection will build a vein with a large flow of blood. This new path for blood is called a fistula. The fistula is placed between the wrist and the elbow of the arm, which you do not use for writing.
Normally the flow of the blood in veins has almost no pressure, but when this new connection is made between the artery and vein this fistula has a flow of blood with pressure. The fistula is used for hemodialysis by placing two needles in different places into the fistula.
The needles have special tubing attached. Blood flows through the other needle and tubing. Patients should take the following precautions for the care of fistula.
- Do not allow blood pressure to be recorded on that arm
- Do not allow blood to be drawn or intravenous injections to be started
- Do not wear a watch or tight clothing with elastic or bands
- Do not sleep on top of your fistula arm
Jugular, Subclavian and Femoral Vein CannulationThis is a simple procedure and done when a patient needs urgent dialysis and A-V Fistula is not done or not matured. Now days-double lumen catheters are available so that we can do dialysis without any problems. Part of the tube lies in vein and part is outside the skin. It is used only when there is no other means of vascular access available.
ShuntThis type of vascular access is done occasionally for urgent dialysis. In this silastic tube is inserted into the artery and vein and both tubes are secured in place by sutures. When not in use, both tubes are connected with each other so that blood flows continuously through the tubes and prevents from clotting. The shunt can be used immediately for dialysis. The only problem with this frequent clotting and infections in the majority of the patients
Advantages of Hemodialysis:
- It is a treatment provided under the supervision of the professional personnel.
- Treatment is usually 3 times a week.
- Chances of infection are low
- Comparably low cost
With regular dialysis, most patients feel better to a great extent and many patients can be rehabilitated. With recent advances anaemia can be corrected by the injection of erythropoietin and using calcium carbonate with vitamin D3 can minimize bone problems. The patient does not require a major surgical procedure.
The patient has to follow diet, fluid, salt and potassium restriction to a great extent (like avoiding dry fruits, fruits, juices, coconut water)
Even with dialysis patient feels weak due to anaemia. This can be corrected but will involve additional expenses. Traveling also will be restricted due to the need for regular dialysis.
Peritoneal dialysis is a procedure in which one or two litres of dialysis solution is instilled into the abdominal cavity through the peritoneal catheter.
About 4 to 6” of the catheter is in the abdominal cavity while remaining lives outside.
Dialysis solution is instilled into the abdominal cavity and is kept there for some time and subsequently drained out. Diffusion of waste product occurs from the blood passing through the abdominal cavity into the dialysis solution through the peritoneal membrane.
After the fluid is removed fresh solution is instilled again and the procedure is repeated tilt desirable effect is obtained.
In short, we can say that this is another method of removing excess of water and impurities from the blood. It is done with the help of PERITONEUM, which surrounds the intestine and other organs in the stomach area.Types of peritoneal dialysis Card: (continuous ambulatory peritoneal dialysis) This is the therapy in which dialysis is done through the peritoneum, manually. Ccpd: (continuous cyclic peritoneal dialysis) This is the therapy in which dialysis is done through the peritoneum with the help of a cycled machine. Ipd: (intermittent peritoneal dialysis) This is the therapy which is mostly used to treat acute renal failure when hemodialysis treatment is not possible. Card & Ccpd can be done by the patient himself or by his attendant. The dialysate is introduced and drained through a soft plastic tube (catheter). The time between the filling and draining is the dwell time, in which excess water, urea and other toxic wastes diffuse from blood across the peritoneal membrane into dialysate.
Kidney Transplantation means placing a kidney from another person (donor) into the patients (recipients) body through major surgery.
After the successful transplant, no life long dialysis treatment is needed. The patient feels better and has more energy to enjoy life. Many restrictions that were imposed during dialysis are lifted.
For Nutrition/ Diet
For kidney failure patients, diet plays a very important role. All food contains proteins, fat, carbohydrate and minerals in varying proportion.
Please speak to our dietician for a balanced diet for you.