What is Renal Failure?
The situations where the kidney cannot function are described as renal faiure. Occurrence of this condition within days is called acute (sudden onset) renal failure while persisting dysfunction (3 months) is named as chronic (persistent, permanent) renal failure. The disease may occur due to multiple reasons. Most common of them are listed below:
- Fluid loss such as vomiting-diarrhea,
- Use of certain medications or substances (some pain killer types, contrasting agents that are used during imaging methods, some medicines that are sold without prescription etc.)
- Inflammations without infection (without microorganism) involving kidney, which are generally named as “nephritis”.
- Urinary tract infections,
- Long term, unmanaged diabetes and hypertension,
- Obstructive diseases of lower urinary tract such as stones and tumors.
- Rare infections and some other diseases.
What are symptoms of renal failure?
Renal failure generally does not cause symptoms or visible findings. Therefore individuals may be ignorant of the disease or recognize it late. Sudden onset kidney failure may show more signs in comparison to chronic renal failure. Signs of acute and chronic renal failure may be different. Acute, sudden onset, renal failure may cause;
- Lack of appetite, nausea, vomiting
- Hypertension
- Shortness of breath and palpitation
- Swelling (edema) in legs
- Low urinary output / anuria
- Changes in state of consciousness (such as somnolence). However none of these complaints are specific for the disease.
On the other hand, Chronic renal failure may cause;
- Lack of appetite, nausea, vomiting
- Hypertension
- Shortness of breath
- Swelling (edema) in legs
- Changes in state of consciousness
- Itching
- Discoloration of skin
- Paleness, Poor exercise capacity
- Low urinary output. Again, none of these complaints are specific for the disease.
How is Renal Failure identified, diagnosed?
Kidney functions are evaluated with Urea (or BUN), creatinine analyses from basic serum (blood obtained from vessels) and urinalysis. Elevated urea and creatinine levels on physical examination leads to diagnosis of renal failure, at the same time some elements in urinalysis results may form the opinion of your physician. Examination of anatomic structure, location and dimensions of your kidneys with ultrasound (an imaging method used by radiologists with a device that uses sound waves) is also important. Further examinations may be planned after the underlying reason and severity of the disease is determined with these primary examination methods.
What are the Treatment Methods for Renal Failure?
Treatment for renal failure may change depending on the underlying reason of the disease or whether the disease is of acute or chronic character. Eradicating the underlying reason is sufficient for treatment in cases of acute renal failure. For example, administering hydration therapy in a case of acute renal failure secondary to fluid loss due to vomiting and diarrhea or anti-biotherapy in case of urinary tract infection may be sufficient while monitoring in inpatient status, obtaining a specimen from the kidney for analysis and administering drugs that suppress immune system in light of results may be required for cases of inflammation without infection, named as nephritis.
On the other hand, recommendations specific for underlying reason of the disease may be provided in cases of chronic renal failure, such as regular monitoring, life style changes (cessation of smoking, restriction on salt use, healthy diet etc.), regulating blood glucose levels for diabetic patients and managing blood pressure in hypertensive patients. Drugs for suppression of immune system may also be used for specific patient groups.
Treatments for replacing the kidney are considered in cases of terminal renal failure, which is the last stage of chronic renal failure where renal functions are near-totally impaired. These are:
- Treatments in home environment
- Home hemodialysis
- Peritoneal dialysis (abdominal dialysis)
- Treatments in Center (hemodialysis in dialysis centers)
- Renal transplant
However it should be remembered that these applications are treatment methods for the last stage of renal failure. Short term treatments that replace the kidney (especially hemodialysis) may also be required in some Acute (sudden onset) renal failure cases.
What are indications of Kidney Transplant?
Kidney transplant is one of the treatments for replacing kidney which is used in cases of terminal renal failure, where renal functions are near totally impaired. Selection of the treatment among these methods are made together by the patient, patient's relatives and physician. Final decision is made after various factors are considered such as social support for the patient, socio-economic status of the patient and current medical status. Renal transplant is preferable among these methods due to its advantages in many angles.
What is edema? How is it Diagnosed and Treated?
Edema can be roughly described as fluid leakage from vessels. The edema that is generally recognized by the patient occurs as swelling in legs. Patients may generally recognize edema when a collapse-depression occurs after applying pressure over bone or sock marks. There are various causes for edema however it is most commonly caused by long term stay in sitting position or immobility. This is generally a transient condition. However other underlying reasons should be investigated if it becomes permanent. Edema may be caused by heart failure, liver failure and especially renal failure or protein leakage in urine. Certain examination and imaging methods are required along with physical examination to assess this condition. Therefore, blood work, assessment of renal and hepatic functions, urinalysis, Chest PA X-ray, abdominal ultrasound scan and –if necessary- heart ultrasound may be required. The treatment of the disease depends on the underlying disease. Healthy diet recommendations (arrangement of water-fluid intake, diets poor on salt, etc.) and diuretic agents are primarily used. Different and more sophisticated treatment methods may be used depending on the underlying reason.
What is Hypertension? How is it Diagnosed and Treated?
Hypertension can be described as high blood pressure or continuous elevated state of the pressure that is applied to vessels by blood. Blood pressure can be measured with a monitoring device (a sleeve that surrounds arm or wrist). Two different readings are obtained after measurement. Which are Systolic (highest) blood pressure reading and diastolic (lowest) blood pressure reading. Systolic blood pressure below 12 (120 mmHg) and diastolic blood pressure below 8 (80 mmHg) are accepted as normal. Readings which exceed these levels are described as hypertension at different stages. When left untreated, hypertension may damage various organs, primarily hearth, brain and kidneys. Therefore it is necessary to monitor and treat the condition. While the underlying cause of hypertension cannot be identified in most cases, a correctable reason can be found in roughly 5 percent of the patients.
Blood pressure monitoring is essential for diagnosis of the disease. This monitoring can be performed at home, during a physician's examination or with a device for a 24 hour period.
Blood pressure monitoring at home should be performed with an approved and calibrated device while the patient is in a rested and calm position, after a period of time without tea, coffee consumption or smoking and the results should be recorded to show the physician.
Some tests may be required to evaluate organ damage caused by the hypertension and investigate the underlying reason for the patients, who are diagnosed with hypertension in light of blood pressure readings, especially for younger patients. Therefore examinations by physicians regarding assessment of kidney, heart, brain and eye damage, blood work, urinary tests and imaging methods may be planned.
Life style changes are primarily recommended for treatment of hypertension. Within this context, cessation of smoking, managing body weight, healthy diet, increasing physical activity and limiting salt consumption are recommended. Life style changes may correct blood pressure readings on their own. Managing hypertension with oral medication is possible in cases where these recommendations are insufficient. One or more appropriate anti-hypertensive medicines may be required depending on the patent’s age, comorbidities, severity of hypertension and organ damage. Compliance to the treatment, blood pressure monitoring at home, and presenting to control examinations at recommended intervals are critical.