Chronic kidney failure

Description

Persistently reduced kidney performance is called chronic renal failure (or kidney weakness). It can lead to acute kidney failure.

The kidneys are responsible for cleaning the blood and excreting metabolic waste through the urine.

If their function is impaired, toxins accumulate in the blood and uremia (urine poisoning) occurs. In addition, there is edema (water retention) in the tissues because the fluid supplied by food can no longer be adequately excreted.

In addition to cleansing and excretion, the kidneys produce various hormones. These are hormones that regulate blood pressure, bone metabolism and blood formation. This means that in the case of kidney insufficiency, the body not only has to deal with toxins, but also with disturbed blood pressure, vitamin and hormone balance and blood clotting.

From a failure of about 60% of the kidneys, urinary substances (everything that must be excreted through the urine) accumulate in the blood. If the insufficiency progresses, acute kidney failure can result. If left untreated, this condition is life-threatening. To ensure the excretion of toxins and water, the blood is artificially washed with the help of dialysis. For example, hemodialysis or peritoneal dialysis can be used. A kidney transplant can also provide relief.

If a kidney is insufficient, it can no longer do its job of washing blood and excreting urine.

Normally, each person has two kidneys. They are made up of more than 1,000,000 glomeruli (renal corpuscles), which in turn are made up of tiny veins that are knotted together. Approximately 180 litres of primary urine flow through them every day in a kind of endless loop. Harmful substances and toxins are filtered and concentrated in approx. 1.5 l of urine.

A wide variety of diseases can be responsible for chronic kidney failure. If kidney tissue is affected by a disease, renal corpuscles die along with their tubules.

The remaining glomeruli then have to take over the function of the dead ones in order to maintain the overall performance. Up to a certain point, this is not a problem, which is why renal insufficiency is often only noticed at a late stage, namely when there is already too little tissue.

Annually, 10/100,000 people in Western Europe develop chronic renal failure. The most frequent causes are:

• diabetes mellitus (diabetes)
• Hypertension (high blood pressure)
• Infections of the glomeruli (e.g. glomerulonephritis)
• Urinary tract infections (e.g. pyelonephritis)
• Cystic kidneys (hereditary disease)
• Painkillers (large amounts daily, for years)
• Tumours of the kidney

Onset

The exact course of chronic kidney failure depends on which other disease is the trigger. Consequential diseases are also significantly reflected in the later symptoms.

It is not uncommon for the disease to be diagnosed at a very late stage, since in the case of a mild insufficiency there are hardly any symptoms or symptoms that are difficult to classify. These can be, for example, a drop in performance and persistent fatigue. Affected persons often also show an increased urge to urinate with very light and poorly concentrated urine.

Advanced disease

If kidney failure has progressed further, the following symptoms often become apparent:

• little urine (< 1.5 l/d)
• Oedema (water retention) - especially in the legs and eyelids
• hypertension (high blood pressure)
• renal anaemia (anaemia) - resulting in pallor or café-au-lait discoloured skin
• foamy urine - due to too much protein
• red or red-brown discoloured urine - due to degradation products of haemoglobin (blood pigment)
• aching bones
• muscle weakness
• loss of appetite
• vomiting, nausea
• itching all over the body

For the diagnosis of chronic renal failure, blood and urine are examined. Important values are the urine volume and creatinine clearance, which indicates how well the kidneys are working.

In most cases, the kidney values creatinine and urea (breakdown products of protein) are elevated in impaired function.

Determining the underlying disease is the first priority. Depending on the suspicions of the treating physician, further examinations such as sonography (ultrasound) or biopsy (examination of tissue samples) may follow. At the same time, any secondary diseases (e.g. renal anaemia) must be treated.

The treatment depends on the cause and stage of the disease. First, the underlying disease is treated to prevent further, irreversible death of kidney tissue.

Then the secondary diseases must be treated. This requires:

• increased fluid intake (2 - 2.5 l/d) and diuretics (diuretic drugs)
• regular control of blood electrolytes (salts) and body weight
• treat high blood pressure (ACE inhibitors and AT1 blockers)
• reduce blood lipid levels (lipid-lowering drugs)
• treat renal anemia (anemia)
• treat bone disease (vitamin D deficiency due to renal failure)

diet

The success of treatment also depends to a large extent on diet. The diet should be low in protein and phosphates. As a rule, foods high in protein are also high in phosphate.

Diet tips:

• Foods high in phosphate are nuts, cereals, offal, whole grain bread, processed cheese, cooked cheese, canned milk and various types of sausage. If you don't want to give up sausage, you should ask about the phosphate content before eating it.
• Protein consumed should have a high biological value, i.e. consist of many essential amino acids which the body cannot produce itself. A balanced combination of protein sources is important, e.g.: Potatoes + egg, beans + egg, milk + wheat, egg + wheat, legumes + wheat.
• There are specific low protein foods (e.g. flour and baked goods) that should be used.
• Drinking milk and condensed milk can be replaced by cream and diluted with water depending on the intended use.

Consistent therapy can largely prevent secondary damage to the heart, blood vessels and bones. Renal insufficiency can nevertheless progress so that dialysis (blood washing) or kidney transplantation becomes necessary.

Chronic renal failure can shorten life expectancy, especially if the underlying disease is diabetes mellitus (diabetes). Some of those affected succumb to consequential damage to the heart and blood vessels.

The undisputed most common causes of kidney damage are diabetes mellitus (diabetes) and hypertension (high blood pressure). Well-controlled diabetes can prevent chronic kidney weakness.

Taking medications (even over-the-counter!) puts additional stress on the kidneys. Therefore, discuss any medication with your family doctor. If renal insufficiency already exists, the dose must also often be adjusted.

Home care

As soon as dialysis becomes necessary, there is a major disruption to the patient's usual daily routine. The body has to be reacquainted from scratch, the diet has to be changed and drinking habits have to be altered. Those who are well informed about kidney failure and dialysis are better able to cope with the new situation, and this also applies to relatives.

In addition to understanding, it is also important to listen to the patient's emotional and physical needs and to address them. Support is offered by family, dialysis center staff, support groups and other patients.

• After dialysis treatment, you should give your body the rest it needs and avoid any form of exertion.
• The shunt (connects vein and artery) must be watched because of possible post-operative bleeding. The patch should not be removed until the next day.
• To avoid infection, the skin around the shunt should be cleaned with soap and water daily, especially before dialysis. Healthy, irritation-free skin and a palpable "hiss" would be ideal.
• Under no circumstances should blood pressure be measured on the shunt arm.

Personal hygiene

• Dialysis can cause skin problems (itching, dryness). Mild skin care products with chamomile or sage extract and clear water can help. They also eliminate unpleasant odours. Degreasing soaps should be avoided. Bath oils should be added to a full bath.
• Moisturizer should be applied to the entire body at least 1x a day.
• Alcoholic solutions (e.g. rubbing alcohol) should be avoided. They refresh, but dry out the skin.
• When choosing clothing, natural fibres (breathable!) should be preferred. Increase your well-being with plenty of fresh air and exercise, a cool room climate and sufficient humidity.
• Apart from toothpaste, oral hygiene can be supported with herbal teas, diluted lemon juice or mouthwash.

Sport and exercise

In general, chronic kidney failure does not stand in the way of sports. However, you should check with your doctor whether you can do sport and, above all, which kind. Possible options include

• Water gymnastics
• Swimming
• Cycling
• Hiking

You should never overload yourself, a heart rate monitor can help. Normally, the load is appropriate as long as you can still talk easily.

Eating and drinking

Dietary suggestions that were worked out with you in the hospital must be implemented at home. In doing so, you will contribute to the success of your treatment.

Avoid foods that are high in water and potassium. Too high a potassium blood level can lead to cardiac arrhythmias.

Foods high in potassium are:

• fresh vegetables (spinach, green cabbage, tomato)
• fresh fruit, dried fruit (banana, kiwi)
• fruit and vegetable juices
• nuts
• chocolate and cocoa products
• wholemeal products
• Potatoes

Potatoes and vegetables should be watered a few hours before eating. Canned fruits and vegetables should be given preference as they contain less potassium than fresh ones. When buying ready-made products, take a look at the ingredients, as phosphate is often added (e.g. processed cheese).

Dialysis patients are only allowed to drink a limited amount of fluid. This requires a high degree of discipline. How much may be drunk depends on the urine output per 24h. You should only drink as much as you can excrete, plus 0.5 litres. It should not be forgotten that food also contains liquid (not only soups, but also fruit, vegetables, yoghurt, pudding, fish, meat, etc.).

Thirst quenchers

• Chewing gum without sugar
• Ice cubes
• pieces of lemon
• Rinse your mouth
• Avoid very sweet or salty foods

Peritoneal dialysis patients

Cleanliness is paramount when changing bags. All parts and utensils must be sterile to prevent infection.

The catheter exit site must be checked regularly. Signs of inflammation are redness, swelling or discharge of secretion.

If the skin is intact and without irritation, it is sufficient to change the dressing every 1-2 days. To do this, the area is first disinfected, dried with sterile swabs and then re-bandaged. Daily showering is no problem, but the bandage must be changed afterwards. If the discharge site is reddened, you should consult your doctor.

If you have any further questions, you can contact the nearest dialysis centre.