Chronic renal failure: multidisciplinary treatment

What is it about ?

The kidneys are made up of millions of microscopic filters (the glomeruli). Blood flows continuously through these filters. Filters permanently clean the blood: they rid the blood of excess waste and water, and keep the amount of salts within certain limits. What is in excess is evacuated via the urine.

Sometimes these filters are damaged. This destabilizes the water balance in the body. Some wastes can build up in the blood. The filters can let out elements that would not normally pass through the filter, such as proteins or red blood cells for example. The blood then contains too little protein, and these proteins and red blood cells are found in the urine.

If the kidney filters keep getting damaged, they eventually don’t work at all. In this case, the waste remains in the blood, which can be toxic to the body.

A chronic kidney disease (CRF) refers to any damage to the structure and / or function of the kidney that persists for 3 months or more.

The kidney function can be assessed using glomerular filtration rate (GFR), estimated based on the level of creatinine in the blood. GFR is expressed as a number that indicates how much blood the kidneys can filter / cleanse per minute.

Glomerular filtration rate is used to define the severity of renal failure: from stage 1 (least severe) to stage 5 (most severe).

• Stage 1: normal. The flow rate is greater than 90 milliliters per minute.
• Stage 2: mild renal failure. Flow rate between 60 and 89 milliliters per minute.
• Stage 3: moderate renal failure. Flow rate between 30 and 59 milliliters per minute.
• Stage 4: severe renal failure. Flow rate between 15 and 29 milliliters per minute.
• Stage 5: end-stage renal failure. Flow less than 15 milliliters per minute.

At the same time, the protein concentration in the urine (especially albumin) is determined. The more damaged the kidneys, the more protein there is in the urine. This examination is performed on a sample of morning urine.

What is its frequency?

One in 10 people have kidney function below 60 milliliters per minute. This percentage rises to 1 in 2 people after the age of 85.

Treatment: multidisciplinary care

THE’chronic renal failure causes a very complex situation in the body. There is, on the one hand, an accumulation of substances (waste, drugs, salts, …) which are normally eliminated from the body and, on the other hand, a loss of substances that we need (proteins, vitamins, …). This can result in serious disturbances of different balances. In the terminal stage, the kidneys can completely stop functioning.

A chronic renal failure can also go hand in hand with other health problems, such as hypertension and an increased risk of cardiovascular disease. This is the reason why people with chronic renal failure are being followed very closely. Collaboration between different healthcare providers is very important in this context, involving a nephrologist (kidney specialist), the general practitioner, a pharmacist, a nurse, a dietitian and, of course, the patient and his family. There is a chronic renal failure treatment path, clearly defining the terms of the support to be followed and the controls. The aim of treatment is to slow down the deterioration of kidney function.

What can you do ?

If you are suffering fromchronic renal failure, it’s important to :

• adopt a healthy lifestyle;
• at least 30 minutes of exercise 5 times a week;
• no smoking ;
• eat healthy ;
• aim for an acceptable body weight.
• carefully take the medications prescribed to you;
• consult your doctor regularly for checks;
• inform all healthcare providers you see about your condition;
• never take any herbal medicine without talking to your doctor first, as some products can be harmful to the kidneys.

What can the multidisciplinary care team do?

the general practitioner follows mild to moderate cases ofchronic renal failure via blood and urine monitoring of kidney function, blood pressure measurement and weight measurement. He will adapt the dosages of existing drugs or to be introduced to the renal function. He will be vigilant for possible complications, such as cardiovascular disease and diabetes. The general practitioner will refer the following people to a kidney specialist (nephrologist):

• people who have a glomerular filtration rate of less than 45 ml per minute);
• people in a complex medical situation (for example hypertension, heart defect, diabetes,…);
• people who experience rapid deterioration of kidney function.

the nephrologist finalizes the diagnosis and proposes a treatment plan. He will take into account, in his drug choices, possible adverse effects on the kidneys. If kidney function improves, the person can be seen again by the general practitioner and the multidisciplinary care team. People who do not experience improvement and whose kidney function declines rapidly are followed by the specialist. He will make the necessary arrangements for a replacement therapy for kidney function (kidney dialysis) as soon as the kidney function is too weak or when the kidney function is reduced it causes symptoms. He will also check if the person is eligible for a kidney transplant and prepare him for it. After the operation, the transplant recipient will be followed at least every 3 months, systematically with blood and urine checks. Healthy lifestyle, correct medication (adherence to treatment) and good follow-up are very important, including after a transplant.

the dietitian formulates dietary advice and controls weight. In this context, he must monitor the number of calories and the intake of proteins, salts, potassium and phosphorus in adequate quantities.

the pharmacist follow the medication regimen and ensure good treatment adherence. It will also warn the person when a medicine could harm the kidneys.

THE’nurse controls the blood pressure, weight, general well-being, complaints,… of the person and records this information in his file. The nurse also plays an important role in informing the person about the illness.

People who do not start a kidney dialysis will die from the consequences of kidney failure. A multidisciplinary team must therefore ensure good comfort care and set up support for the patient and his family.

Want to know more?

• Functional anatomy of the urinary system (images) – microbiologiemedicale.fr

• Stop smoking. It’s possible – Tabacstop
• Calculate your Body Mass Index (BMI)
• The food pyramid – Eat Move – Health Question
• Physical activity – Eat Move – Health question
• Move at any age… After 50 too! – Eat Move – Health Question
• Less salt on your plate, it’s possible! – Christian mutuality
• Salt: pay attention to industrial preparations – SSMG – Scientific Society of General Medicine

• Kidney disease: interventions for care – INAMI – National Institute for Sickness and Invalidity Insurance

• Hospital hemodialysis, here, Where to find on this page of Cliniques St Luc UCL
• How to organize your hemodialysis vacation – Hôpital Erasme ULB

• Guide for patients who are candidates for a kidney transplant, here, Where to find on this page of Cliniques St Luc UCL

Are you looking for more specialized help?

• Care paths – How to improve the management of your chronic kidney disease
• Smoking Assistance Center (CAF®) – FARES – Respiratory Affections Fund
• Tobacco specialists – FARES – Respiratory Affections Fund
• Find a registered dietitian – Professional Union of French-speaking dieticians
• Find a nutritionist doctor – Belgian Society of Nutritionist Doctors

Source

www.ebpnet.be