Riverside Nephrology Physicians Nephrology Doctor | Dr Mohammed Khan

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kidney disease

Treatment of chronic kidney disease

The treatment of chronic kidney disease is always based on the treatment of the diseases involved in renal failure (high blood pressure, diabetes, etc.), measures intended to protect the kidneys and the treatment of complications.

kidney disease

MANAGEMENT OF CHRONIC KIDNEY DISEASE

The management of chronic kidney disease is provided by the attending physician, in coordination with a specialized team: nephrology physicians , endocrinologist, cardiologist …

 

The goals of treatment for chronic kidney disease are to:

 

manage the disease causing kidney failure;

slow the progression to end-stage renal disease by protecting the kidneys;

prevent and manage the cardiovascular risk , treat any associated cardiovascular diseases;

 

supplement renal function (dialysis and kidney transplant) if the stage of end-stage renal disease is reached.

TREATMENT OF DISEASES INVOLVED IN KIDNEY FAILURE

It is :

 

treat high blood pressure ;

control blood sugar in diabetes  ;

offer surgery in the event of an obstacle on the urinary tract …

CHRONIC KIDNEY DISEASE: STEPS TO PROTECT THE KIDNEYS

Control of blood pressure and proteinuria

When a person has chronic kidney disease , their blood pressure numbers should be kept below 140/90 mmHg (or even 130/80 for people with high proteinuria). The self-monitoring of blood pressure allows tracking of blood pressure chifres home.

 

Proteinuria or albuminuria should be reduced.

 

To obtain the expected results, the doctor prescribes specific drugs: inhibitors of the renin-angiotensin system and more particularly ACE inhibitors (enalapril, lisinopril, ramipril, etc.)

 

Chronic kidney disease: precautions in the use of drugs:

Some drugs (called nephrotoxics ) are toxic to the kidneys and cause kidney damage when they pass through the kidney to be eliminated in the urine. They are therefore to be avoided; this is the case with non-steroidal anti-inflammatory drugs , certain antibiotics, etc. Likewise, the iodinated contrast products used for carrying out radiology examinations are nephrotoxic.

 

When kidney function is impaired, some medicines cause side effects due to poor elimination (medicinesdiuretics , anti-gout , certain antibiotics, certain anti- diabetic drugs …). In this case, the dose of the drug concerned should be adapted to the functioning of the kidneys.

 

Self-medication is not recommended because many drugs sold without a prescription are toxic for the kidneys (non-steroidal anti-inflammatory drugs, etc.) or are very rich in salt for example (effervescent, orodispersible drugs, certain laxatives, certain oral solutions, etc. )

 

A balanced diet and adapted physical activity

The diet should be varied and sufficient for the person to maintain good nutritional status . However :

 

salt intake, and if necessary potassium and phosphorus, must be limited;

the protein intake must also be adapted to the functional capacity of the kidney;

water consumption is modulated to avoid dehydration. It is generally 1.5 liters per day.

The physical activity is essential and appropriate to the age and physical condition.

 

Decreased cardiovascular risk

The fight against cardiovascular risk requires:

 

the cessation of smoking ,

correcting overweight ,

the treatment of hypercholesterolemia,

the implementation of food hygiene measures …

TREATMENT OF COMPLICATIONS OF CHRONIC KIDNEY DISEASE

It aims to:

 

correct cardiovascular complications: arterial hypertension , heart failure , arteritis of the lower limbs  ;

reduce anemia by taking iron by mouth or drugs that stimulate erythropoiesis (making red blood cells);

correct abnormalities in blood chemicals:

against acidosis: take bicarbonate or mineral water rich in bicarbonates,

against excess potassium: limit intake (chocolate, bananas, potatoes, diet salts, etc.) and possibly supplement these measures with a prescription for medication,

against excess phosphates: limit protein intake (eg meat or equivalent once a day) and possibly supplement these measures with a prescription of drugs;

correct nutritional deficiencies and in particular the lack of vitamin D and / or calcium (particularly in children);

fight against the risk of infections: people with moderate kidney failure should be vaccinated against hepatitis B , influenza and pneumococcus .

SUPPORT KIDNEY FUNCTION IN END STAGE RENAL DISEASE

When chronic kidney disease develops into end-stage renal disease, the kidney dysfunction should be addressed with dialysis or a kidney transplant ( kidney transplant).

 

The choice of treatment is decided by the medical team, together with the patient and his family.

 

Dialysis

There are two dialysis techniques: peritoneal dialysis and hemodialysis.

 

The two dialysis techniques

 

Peritoneal dialysis

This technique uses the filtration capacities of peritoneum . It allows exchanges between blood and a liquid, called dialysate, introduced inside the peritoneal cavity by means of a permanent flexible catheter placed by surgery in theabdomen . The objective of these exchanges is to filter waste and eliminate excess water.

Peritoneal dialysis is performed every day. The dialysate is introduced into theabdomen before being evacuated, via the catheter.

Three to four cycles are necessary. They are :

  • either manuals made by the person,
  • or automated and performed by a machine, generally at night.

Peritoneal dialysis takes place at home.

Hemodialysis

The blood is filtered through a dialyzer or “artificial kidney”, then returned. The sessions last an average of four hours and are repeated, in general, three times a week. The duration and frequency of the sessions are adapted to each patient.

 

As dialysis sessions are frequent, it is necessary to have permanent vascular access, allowing the patient to be connected to the dialyzer. An arteriovenous fistula, that is to say a communication between an artery and a vein, is created several months before the start of treatment. It is most often located in the forearm.

 

Hemodialysis can be performed:

 

in a hemodialysis center or a medicalized dialysis unit (MDU) when the presence of a doctor is necessary;

in a self-dialysis unit where the person is independent and can, in certain cases, benefit from nursing assistance;

at home, in the presence of a third party trained in handling.

The kidney transplant is the best treatment for kidney failure. It consists in transplanting a kidney taken from a donor and most often allows all renal functions to be restored.

As soon as a transplant is considered, a pre-transplant assessment is carried out.

The patient with renal failure is placed on a waiting list and the transplanted kidney is removed from a deceased person .

The transplanted kidney can also be donated voluntarily by a healthy person to a loved one, under the conditions defined by French law. Indeed, it is possible to live in a completely normal way with only one kidney. It is the kidney donation during his lifetime .

The kidney transplant can take place even before the patient has been on dialysis or when they have been on dialysis for a while.

It allows, most often, to find an almost normal daily life and a good renal function. However, a nephrology doctors should be give you the  some instructionn to avoid re of the transplanted kidney. Regular medical monitoring is also essential.

 

 

 

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