Chronic renal failure

0


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.

Chronic renal failure (CRF) is any damage to the structure and / or function of the kidney that lasts for 3 months or more.

With age, chronic diseases such as diabetes, hypertension and vascular disease is more common, and it can affect the functioning of the kidneys. From kidney stones and the side effects of certain drugs (eg anti-inflammatory drugs) can trigger or accelerate kidney failure. The evolution is very slow and the diagnosis is often made late. However, treatment at the initial stage can have a favorable effect on the course of the disease. It is for this reason that the chronic renal failure (CKD) treatment path was created (see below).

How to recognize it?

Chronic kidney disease starts very gradually and progresses slowly. That’s why you usually don’t notice anything at first. It is only at a more advanced stage that symptoms appear. These are often the result of two factors:

  • the accumulation of waste products in the blood because the kidneys no longer filter sufficiently;
  • the loss of substances that you need through the urine because the kidneys start to leak and pass these substances.

The most frequent consequences are:

  • increased potassium in the blood: this can lead to heart rhythm disturbances;
  • variation in the concentration of calcium, phosphate and vitamin D: this can lead to bone decalcification (osteoporosis), with repercussions of bone deformities and an increased risk of fractures. Muscle pain can also occur;
  • anemia : the kidney no longer produces erythropoietin (EPO); this substance is needed to stimulate the production of new blood cells in the bone marrow. A deficiency in red blood cells is mainly expressed by pallor and fatigue. In severe cases, heart failure can occur;
  • acidification of the blood;
  • loss of proteins, such as albumin, with the urine, resulting in retention of fluids outside the blood vessels, for example in the legs ;
  • decreased urine production (end stage); therefore you are not urinating enough.

How is the diagnosis made?

Diagnosis is based on a simple blood test and urinalysis. In all risk groups (diabetes, hypertension, arterial disease and a family history of chronic renal failure), these examinations are performed annually.

A fasting blood sample measures the concentration of a waste product (creatinine) and makes an estimate of the amount of blood that the kidneys are still able to filter (estimated glomerular filtration rate, eGFR). When chronic kidney failure is suspected, this test is done 3 times over a 3 month period. This test can rule out a temporary decrease in kidney function, for example due to certain medications or dehydration from severe diarrhea. The stage of renal failure is determined on the basis of the results of the examination: from stage 1 (least severe) to stage 5 (most severe).

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 can you do ?

If you are in a risk group, you should have your kidney function checked at least once a year. A healthy lifestyle is important. Get enough exercise, quit smoking, try to eat healthy and control your body weight. Moderate your consumption of meat and salt. Drink 1.5 liters of water per day.

With advanced disease, you should receive specialized dietary recommendations.

Tell all the doctors you see that you have chronic kidney disease. They will take this into account when prescribing medications or administering contrast agents when performing a CT scan. Do not take anti-inflammatory drugs on your own.

How useful is the IRC treatment path?

You can conclude an IRC treatment path with your general practitioner and the kidney specialist (nephrologist). A treatment path is a supervised path that you can follow and that contributes to maximum control of your disease. You have access to a treatment path if you are at least 18 years old, a comprehensive medical record (DMG) with the general practitioner and if your blood and urine tests show that you suffer from chronic renal failure. You cannot yet have had dialysis or a transplant. If you meet these conditions, you can sign a care contract with your general practitioner. The kidney specialist (nephrologist) must also sign it. The request must be renewed every 3 years.

In this treatment path, the general practitioner and the specialist agree on a schedule for monitoring your disease. You should see the general practitioner at least twice a year and go to the kidney specialist at least once. These checks are completely free, so you don’t pay a co-payment. You are also entitled to a free blood pressure monitor and advice from a specialist dietitian.

What can your doctor do?

Many drugs are excreted through the kidneys. If the kidneys are not functioning optimally, dose adjustment may be necessary.

The ideal blood pressure should be between 120/60 and 140/90. If the blood pressure is higher, an antihypertensive drug is prescribed, preferably something called an ACE inhibitor (ACEI).

In case of anemia, it is necessary to administer EPO (by injections) and iron tablets. Calcium, phosphorus and vitamin D supplements may also be necessary.

Taking bicarbonate helps keep the acidity level of the blood.

Particular attention is paid to the monitoring and treatment of heart failure and diabetes.

Want to know more?

Are you looking for more specialized help?

Sources