- When kidney function is so bad that pt is likely to die within weeks or months unless special treatment such as dialysis or transplantation is given
Complications:
Pericarditis, cardiac tamponade
Congestive heart failure
Hypertension
Platelet dysfunction
Gastrointestinal loss of blood; duodenal or peptic ulcers
Hemorrhage
Anemia
Hepatitis B, hepatitis C, liver failure
Decreased functioning of white blood cells and immune system
Infection
Peripheral neuropathy
Seizures
Encephalopathy, nervous system damage, dementia
Weakening of the bones, fractures, joint disorders
Permanent skin pigmentation changes
Skin dryness, itching/scratching with resultant skin infection
Changes in glucose metabolism
Changes in electrolyte levels
Decreased libido, impotence
Miscarriage, menstrual irregularities, infertility http://www.nlm.nih.gov/medlineplus/ency/article/000500.htm#Complications
Treatment:
- Your treatment before end stage
Usually kidney failure develops slowly, and at first you may not have noticed anything. Gradually most people begin to feel tired, lose their appetite and may start to itch. Some get swollen ankles or develop high blood pressure. You may have to get up several times during the night to go to the toilet. Initially, you will be treated CONSERVATIVELY. The aim is to keep you feeling well, and to delay or even prevent the need for dialysis.
This form of treatment uses drugs and diet. You may find that you are prescribed a number of different drugs particularly those which are aimed at controlling blood pressure like ACE inhibitors. Your diet plays a very important part in looking after your kidneys and helping you feel well. You will receive advice from a dietitian - this may involve reducing the amount of protein (small amounts of meat, fish, eggs, poultry, cheese and milk) and salt in your diet, and sometimes other advice too.
http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/CRFLong.html#anchor31913728
http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/Dialysis_ESRFLong.html
- End-stage treatment
1. Peritoneal dialysis (CAPD, APD)
Treatment that can usually be carried by you in your own home or at work.
a) CAPD - which stands for Continuous Ambulatory Peritoneal Dialysis - happens throughout the day, at home or at work, while the person goes about his or her daily life. Between 1.5 and 3 litres of fluid is run in four times a day, exchanging for the fluid from the previous exchange. This takes about 30-40 minutes.
b) APD - Automated Peritoneal Dialysis - in which the dialysate solution is changed by a machine, at night, while you are asleep. The machine will exchange 8-12 litres over 8-10 hours and then leave 1-2 litres to dwell during the day.
What is the Peritoneal Dialysis Fluid?
How good is peritoneal dialysis?
What are the problems with peritoneal dialysis?
- There can be problems with fluid leaks in the groin or around the catheter when dialysis starts. These problems can be managed easily.
- Infections are the major risk - either in the exit site or most importantly in the tummy itself, peritonitis. This shows as tummy pain, a fever and a cloudy fluid bag. It is important to ring the kidney unit immediately if a cloudy bag develops. Peritonitis is treated with antibiotics added to the bags and may need admission to hospital for a few days. Rarely, the infection may be so bad that the catheter has to be removed.
- In the long term, there can be a thickening of the peritoneal membrane so that it does not work efficiently. The dialysis fluid may need to be changed or switched to haemodialysis.
http://www.kidneypatientguide.org.uk/site/pd.php
2. Haemodialysis = a form of dialysis in which the blood is cleaned outside the body by a machine which passes the blood across a filter.
- Usually at a dialysis centre.
- Home haemodialysis also available - need comprehensive training in order to become confident and self-reliant. Some alterations to your home’s plumbing and electricity supply may also be needed.
How does it work?
- This form of dialysis removes waste products from the blood by passing it out of the body, through a filtering system (dialyser) and returning it, cleaned, to the body.
- While in the filtering system, the blood flows through tubes made of a membrane that allows the waste products (which are much smaller than blood cells) to pass out through it.
- The waste products pass through the membrane into a dialysis solution (dialysate), then out of the machine. The "clean" blood is carried on through and returned safely to the body.
- This happens over and over again throughout the dialysis session. Each time the "clean" blood is returned to the body, it picks up more waste products from the cells it circulates through, and brings these newly-collected toxins back to the dialyser to be removed.
- Fresh dialysate is passed through continuously, to make the rate of the cleaning process as fast as possible.
- As well as cleaning the blood, the dialysis machine also removes excess water. This part of the process is called ultrafiltration which can be done separately without dialysis.
- It takes about 4 hours (perhaps more) to complete a good session of haemodialysis, which needs to be done 3 times a week.
http://www.kidneypatientguide.org.uk/site/HD.php
Kidney transplants have revolutionised life for many people with kidney failure. Dialysis only keeps you OK - a successful transplant restores your health. The best treatment by far if it is suitable for you.
Medical staff will discuss transplantation with you. For the majority of patients transplantation is the ultimate goal, but for some, particularly those with other medical conditions, long-term dialysis may be the best option.
If transplantation is an option for you, you will undergo a series of blood tests and X-rays. After this, you will be referred to a transplant surgeon for further assessment. At this stage you will be given more information about the actual procedure.
Most patients receive a kidney from someone who has died in hospital, usually on a life support machine. However the best transplants come from living people - who must be a close relative, or in certain cases, a partner or close friend. Live donor transplants can be carefully planned, instead of coming as a surprise at any time, and the kidney is proved in advance to be very healthy.
The transplanted kidney is placed in one or other groin beneath the skin and muscle. As with most operations, you may feel a bit groggy for a couple of days.
All being well, you will soon be up and about and home within a couple of weeks.
The number of kidneys required greatly exceeds the number available, and you may have to wait a long time (sometimes years) before a kidney suited to your blood group and tissue type is found. Some patients, however, are lucky and get a kidney transplant within a few months. The type or place of treatment is irrelevant - the time you wait depends entirely on availability and suitability of the organ available. It is not a queue - it is to some extent a matter of luck.
To prevent your body rejecting the new kidney, you will have to take some special immunosuppressive drugs for kidney diseases.These are tailored to each individual's requirements, but you will need to take at least one anti-rejection drug every day for as long as you have the transplant. Go to http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/ISdrugs.html for more information on immunosuppressive drugs in renal disease.
There is no need for a special renal diet following a transplant. You will, however, be advised about a healthy diet containing not too much sugar or salt, plenty of fruit, vegetables and fibre, but with less fat, particularly animal fat. You will be encouraged to maintain a healthy weight for your height.
http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/TransplantShort.html
4. No dialysis
The best option for some people may be not to have dialysis
- reasons will be discussed in presentation, or look up the link below:
http://renux.dmed.ed.ac.uk/EdREN/EdRenINFObits/NoRRTshort.html
by your keynote speaker:-p
Shantz
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