- by Dr Paramesh S
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- Apr 26 2017
Renal Diet and Chronic Renal Failure
The kidneys play three major roles:
- removing waste products from the body, keeping toxins from building up in the bloodstream
- producing hormones that control other body functions, such as regulating blood pressure and producing red blood cells
- regulating the levels of minerals or electrolytes (e.g., sodium, calcium, and potassium) and fluid in the body
It's entirely possible to live a full, healthy life with only one kidney - one fully functioning kidney can do the work of two - but it's essential to watch for signs of any problems with the remaining kidney.
When kidneys get to the point where they can't function at all, kidney dialysis or a transplant is the only way to remove the body's waste products.
Chronic kidney disease (CKD), also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are non-specific, and might include feeling generally unwell and experiencing a reduced appetite. Often, chronic kidney disease is diagnosed as a result of screening of people known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those with a blood relative with chronic kidney disease. Chronic kidney disease may also be identified when it leads to one of its recognized complications, such as cardiovascular disease, anemia or pericarditis.
Chronic kidney disease is identified by a blood test for creatinine. Higher levels of creatinine indicate a lower glomerular filtration rateand as a result a decreased capability of the kidneys to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and the condition is discovered if urinalysis (testing of a urine sample) shows that the kidney is allowing the loss of protein or red blood cells into the urine. To fully investigate the underlying cause of kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small sample of kidney tissue) are employed to find out if there is a reversible cause for the kidney malfunction. Recent professional guidelines classify the severity of chronic kidney disease in five stages, with stage 1 being the mildest and usually causing few symptoms and stage 5 being a severe illness with poor life expectancy if untreated. Stage 5 CKD is often called End Stage Renal Disease (ESRD) and is synonymous with the now outdated terms chronic kidney failure (CKF) or chronic renal failure (CRF).
There is no specific treatment unequivocally shown to slow the worsening of chronic kidney disease. If there is an underlying cause to CKD, such as vasculitis, this may be treated directly to slow the damage. In more advanced stages, treatments may be required for anemia and bone disease. Severe CKD requires renal replacement therapy, which may involve a form of dialysis, but ideally constitutes a kidney transplant.
- Blood pressure is increased due to fluid overload and production of vasoactive hormones created by the kidney via the RAS (renin-angiotensin system), increasing one's risk of developing hypertension and/or suffering from congestive heart failure
- Urea accumulates, leading to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis andencephalopathy). Urea is excreted by sweating and crystallizes on skin ("uremic frost").
Uremic frost on the forehead and scalp of a young man who presented with complaints of chronic anorexia andfatigue with blood urea nitrogen and serum creatinine levels of approximately 100 and 50 mg/dL respectively.
- Potassium accumulates in the blood (known as hyperkalemia with a range of symptoms including malaise and potentially fatal cardiac arrhythmias)
- Erythropoietin synthesis is decreased (potentially leading to anemia, which causes fatigue)
- Fluid volume overload — symptoms may range from mild edema to life-threatening pulmonary edema
- Hyperphosphatemia — due to reduced phosphate excretion
- Hypocalcemia — due to 1,25 dihydroxyvitamin D3 deficiency. The 1,25 dihydroxyvitamin D3 deficiency is due to stimulation of fibroblast growth factor-23. Metabolic acidosis, due to accumulation of sulfates, phosphates, uric acid etc. This may cause altered enzyme activity by excess acid acting on enzymes and also increased excitability of cardiac and neuronal membranes by the promotion of hyperkalemia due to excess acid (acidemia)
People with chronic kidney disease suffer from accelerated atherosclerosis and are more likely to develop cardiovascular disease than the general population. Patients afflicted with chronic kidney disease and cardiovascular disease tend to have significantly worse prognoses than those suffering only from the latter.
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