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Friday, November 28, 2014

Chronic renal failure: be patient, hemo dialisis, praying to god almighty

Unfinished journey (155)

(Part one hundred and fifty-five, Depok, West Java, Indonesia, November 28, 2014, 5:20 pm)

Esnawan Antariksa Hospital
Chronic renal failure: be patient, hemo dialisis, praying to god almighty

It's been months I dialysis (twice a week) at a hospital owned air force dr esnawan space, and already this past week my whole body feels itchy, and I lost my appetite.
Ternnyata it's all due to one of my kidneys symptoms getting worse (see the wikipedia description below).
So there is nothing else from me to keep berzabar and remembrance, beristighfar (Subhan Allah, Alhamdulillah, walaillahailaulah, allahu akbar, walahaulawaqauatailabillah) for four hours of dialysis. Occasionally watching TV when bored.

Chronic renal failure
Indonesian From Wikipedia, the free encyclopedia
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This article provides basic information about health topics. The information in this article may be used only for scientific explanation, not for self-diagnosis and can not replace medical diagnosis.
Caution: The information in this article is not a prescription or medical advice. Wikipedia is not a substitute for a doctor.
If you need help or want to seek treatment consult with a health professional.
Chronic renal failure (English: chronic kidney disease, CKD) is the process of damage to the kidneys with a span of more than 3 months. [1] CKD can cause simtoma form of glomerular filtration rate below 60 mL / min / 1.73 m2, or above the value however is accompanied by abnormal urinary sediment. Kidney stones can also be an indication of CKD in patients with congenital abnormalities such as hyperoxaluria and cystinuria. [2]

The symptoms of kidney function deteriorated non-specific, and may include feeling generally unwell and experiencing decreased appetite. Often, chronic kidney disease is diagnosed as a result of screening of people who are known to be at risk of kidney problems, such as those with high blood pressure or diabetes and those who have a blood relative with chronic kidney disease. Chronic kidney disease can also be identified when it leads to one of the recognized complications, such as cardiovascular disease, anemia or pericarditis [3]

Chronic kidney disease is identified by a blood test for creatinine. The high levels of creatinine indicate fall in glomerular filtration rate and as a result of a decrease in the kidney's ability to excrete waste products. Creatinine levels may be normal in the early stages of CKD, and these conditions are found if the urine (urine sample testing) showed that the kidney is allowing the loss of protein or red blood cells in the urine. To investigate the cause kidney damage, various forms of medical imaging, blood tests and often renal biopsy (removing a small sample of kidney tissue) work to find out if there is a reversible cause of kidney damage [3]. The latest professional guidelines classify the severity of chronic kidney disease in five phases, with phase one of the most mild and usually cause few symptoms and stage 5 being a severe disease with a poor life expectancy if untreated. 'End-stage renal disease (ESRD), Stage 5 CKD is also called chronic renal failure (CKF)' or chronic renal failure (CRF). [3]

There is no specific treatment to slow the firm showed worsening of chronic kidney disease. If there is an underlying cause of CKD, such as vasculitis, can be treated directly with the treatment aims to slow the damage. At a more advanced stage, treatment may be needed for anemia and bone disease. Severe CKD require one form of renal replacement therapy, it may be a form of dialysis, but ideally a kidney transplant [3].

Signs and symptoms [edit | edit source]
CKD initially without specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As [kidney []] function decreases:

Signs or symptoms of early general is itching constantly in the body or body part (varies).
No appetite.
Swelling of fluid in the skin, for example in the skin of the foot, calf, and areas that do not normally.
Hemoglobin decreased drastically in the range of 6-9, characterized by weak and not strong enough to walk for a long time, this is the first sign of symptoms prior to a less critical direction.
Because hemoglobin decreased, normal activities are usually heavier than usual.
Difficult urination, if the volume or quantity of urination decreased, need to watch out.
Increase in blood pressure due to excess fluid and vasoactive hormone production created by the kidneys via RAS (renin-angiotensin system). It increases a person's risk for developing hypertension and / or heart failure.
Urea accumulates, which can lead to azotemia and ultimately uremia (symptoms ranging from lethargy to pericarditis and encephalopathy). Urea is excreted by the sweat and crystallize on the skin ("uremic frost").
Potassium accumulates in the blood (known as hyperkalemia with a variety of symptoms including malaise and potentially fatal cardiac arrhythmias s)
Erythropoietin synthesis decreased (potentially leading to anemia, which causes fatigue)
Fluid volume overload - symptoms can range from mild to life threatening edema pulmonary edema
Hyperphosphatemia - due to reduced phosphate excretion, associated with hypocalcemia (since 1.25 hydroxyvitamin D 3]] deficiency), which is due to stimulation of fibroblast growth factor -23-
In recent years developed into a secondary hyperparathyroidism, renal osteodystrophy and vascular calcification are also interfere with cardiac function.
Metabolic acidosis, due to the accumulation of sulfate, phosphate, uric acid, etc. This may lead to altered enzyme activity by excess acid acting on enzymes and increased excitability of cardiac and neural membranes with promotion [hyperkalemia []] because of excess acid (acidemia) [4]
People with chronic kidney disease suffer from accelerated atherosclerosis and are more likely to develop cardiovascular disease than the general population. Patients suffering from chronic kidney disease and cardiovascular disease tend to have a worse prognosis than those who suffer only from the latter.

Cause [edit | edit source]
The most common causes of CKD diabetes mellitus, hypertension, and glomerulonephritis [5] Together, causing around. 75% of all adult cases. Certain geographical areas have a high incidence of HIV nephropathy.

In most cases, consume energy drinks regularly and continuously for at least three years can lead to chronic kidney disease. Alfiah Kurnia, student Department of Biology Education, Guidance and Counseling, UMS Solo in 2002 researching a supplement drink brands as a sample case study in rats [6]. In the field (or a hospital hemodialysis dialysis routine) discovered an interesting fact to call a nurse or nurse PGI Cikini Hospital as follows: kta if my mama, energy drink that makes the kidneys work harder could Myspace renal failure mama said if sering2 mnum gtuan [7]

Not only the consumption of energy drinks alone, but also on the ice tea [8], as quoted from the second of health Dr. Parlindungan Siregar, SpPD-KGH from the Kidney and Hypertension, Department of Medicine Faculty of Medicine-RSCM. Similarly, iced tea, coffee consumption [9] are excessive and routine can cause problems in the kidney system.

Historically, kidney disease was classified according to the anatomical parts of the kidneys are involved, namely:

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June 2008
Vascular, including large vessel disease such as bilateral renal artery stenosis and small vessel disease such as ischemic nephropathy, hemolytic uremic sindrom- and vasculitis
Glomerulus, is composed of a diverse group and subclassified into
Primary glomerular disease focal segmental glomerulosclerosis and as IgA nephritis
Secondary glomerular diseases such as diabetic nephropathy and lupus nephritis
Tubulointerstitial including polycystic kidney disease, drug and toxin-induced chronic tubulointerstitial nephritis and reflux nephropathy
Obstructive such as with bilateral kidney stones and prostate disease
In rare cases, pin worms infect the kidneys also can cause nephropathy.
Diagnosis [edit | edit source]
In many patients with CKD, renal disease or other underlying diseases are already known. A small amount comes with CKD of unknown cause. In these patients, causing sometimes identified retrospectively

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October 2008.
It is important to differentiate CKD from acute renal failure (ARF) because ARF can be reversible. Abdominal ultrasound, in which the size of [kidney []] s are measured, is generally carried out. Kidneys with CKD is usually small (<9 cm) than normal kidneys, with exceptions such as in diabetic nephropathy and polycystic kidney disease. Another diagnostic clue that helps differentiate CKD from ARF is a gradual rise in serum creatinine (more than a few months or years) as opposed to a sudden increase in serum creatinine (a few days a week). If this level is not available (because the patient was well and had no blood test), it is sometimes necessary to treat the patient briefly as having ARF until it has been determined that the irreversible renal impairment

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Additional tests may include nuclear medicine MAG3 scan for confirmation of blood flow and form a differential function between the two kidneys. DMSA scans are also used in imaging the kidney; with both MAG3 and DMSA used chelated with radioactive element Technetium-99.

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This tag is given dated October 2008

In chronic renal failure treated with standard dialysis, uremic toxins accumulate a lot. These toxins show various cytotoxic activities in the serum, have different molecular weights and some of them are bound to other proteins, primarily to albumin. Toxic substances such as proteins bound to receive the attention of scientists who are interested in improving the standard chronic dialysis procedures used today

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Stages [edit | edit source]
All individuals with [glomerular filtration rate []] (GFR) <60 mL / min / 1.73 m 2 for 3 months were classified as having chronic kidney disease, regardless of the presence or absence of kidney damage. The reason for including people is that the decline in kidney function to lower the level or lose half or more adult level of normal kidney function, which may be related to a number of complications. [3]

All individuals with kidney damage are classified as having chronic kidney disease, irrespective of the level of GFR. The reason for including individuals with GFR> 60 mL / min / 1.73 m 2 is that the GFR can be maintained at normal levels or increased despite substantial kidney damage and that patients with renal impairment are at increased risk of two major outcomes of chronic kidney disease: loss kidney function and the development of cardiovascular disease [3].

The loss of protein in the urine is considered as an independent marker for worsening renal function and cardiovascular disease. Therefore, the British guidelines adding the letter "P" to the stage of chronic kidney disease if there is a significant loss of the protein [10].

phase 1
Slightly reduced function; Kidney damage with normal or relatively high GFR (≥ 90 mL / min / 1.73 m 2). Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies [3].

phase 2
Mild reduction in GFR (60-89 mL / min / 1.73 m 2) with renal impairment. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies [3].

phase 3
Moderate decrease in GFR (30-59 mL / min / 1.73 m 2) [3] British guidelines distinguish between stage 3A (GFR 45-59) and stage 3 (GFR 30 - 44) for the purpose of screening and referral. [10]

stage 4
Severe decrease in GFR (15-29 mL / min / 1.73 m 2) [3] Preparation for renal replacement therapy

stage 5
Defined renal failure (GFR <15 mL / min / 1.73 m 2, or permanent renal replacement therapy (RRT) [3]

NDD-CKD vs. ESRD [edit | edit source]
The dialysis-dependent CKD Istilahnon, also abbreviated as' NDD-CKD, is a term used to encompass the status of people with established CKD not requiring life support treatment for kidney failure is known as renal replacement therapy (including maintenance dialysis or a kidney transplant) . Individuals with CKD condition, which requires one of two types of renal replacement therapy (dialysis or transplantation), referred to as end-stage renal disease ("ESRD). Therefore, starting ESRD is practically irreversible conclusion of NDD-CKD. Although the status of 'non-dialisisbergantung' yangmengacu on the status of people with earlier stages of CKD (stages 1 to 4), patients with advanced CKD (Stage 5), which has not started renal replacement therapy is also referred to as NDD-CKD.

Screening and Referral [edit | edit source]
Early identification of patients with kidney disease are encouraged, as action may be instituted to slow the progression and reduce cardiovascular risk. Among those who should be screened are subject to hypertension or a history of cardiovascular disease, people with diabetes or obesity are characterized, those aged> 60 years, subject to the indigenous (native American Indians, First Nations) racial origin, people with history of kidney disease in the past, as well as subjects who have relatives who have kidney disease that requires dialysis. Examination should include the calculation of estimated GFR / 1.73 m 2 of serum creatinine level, and measurement of urinary albumin-to-creatinine ratio in a first morning urine specimen and display dipstick for hematuria. [11] Guidelines for the nephrologist referral varies between different countries. Nephrology Referral useful when eGFR / 1.73m 2 is less than 30 or decreased by more than 3 ml / min / year, when the urinary albumin-to-creatinine ratio of more than 300 mg / g, when the blood pressure is difficult to control, or when hematuria or other findings indicate both glomerular disorders or diseases, especially secondary agree to special treatment. Another benefit of early nephrology referral include appropriate patient education regarding options for renal replacement therapy as well as pre-emptive transplantation, and timely examination and placement of arteriovenous fistulas in hemodialysis patients opt for the future.

Treatment [edit | edit source]
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If you have to match the characteristics of the symptoms of the condition or personal, please immediately taken to hospital for further diagnosis. Present conditions have been there, usually recommended thorough laboratory tests. Medical steps taken depending on the results of laboratory tests. Important indicators:

Complete blood, including hemoglobin.
Urea and creatinine
After treatment (usually hospitalization) for patients psychological condition is also problematic. High urea and creatinine can cause psychological conditions and brain uncontrolled, like angry without cause, and uncontrolled emotions. Families should tolerate such behavior patient, and continue to wait before the first dialysis. Usually after the second dialysis, the patient's behavior began to calm down and be able to talk / chat. And patients usually do not remember these conditions before Hemodialysis. Because in general, if the number of urea and creatinine have been very much higher over the threshold, then the emotional condition usually occurs.

Treatment of Chronic Kidney Disease (CKD) or chronic renal failure in the form of renal replacement. There are 2 types of treatment are applied to the patient:

Hemodialysis uses a machine, superiority, no need to bother. Please note every patient who has been exposed to chronic renal failure should control the intake / her in liquid / water per day, a maximum of 600 milliliters or 0.6 liter (equivalent to 1 bottle). Remember per day. If not controlled, during routine hemodialysis process, usually the engine will pull up to the dry weight of the patient are met and eventually suffered cramps in the legs, or unstable blood pressure (normally be down dramatically). Dry weight is a normal weight because the water has been removed from the body (due to chronic renal failure patients can not urinate again).
CAPD independently
Besides hemodialysis or CAPD, points to three is alternative medicine. However, do not try at all to leave hemodialysis or CAPD while undergoing treatment alternatives. Because the reality on the ground, there are successful in implementing alternative medicine, but there are also very vain even end up worse as experienced by the deceased famous singer and MC Krisbiantoro [12].
Excerpt: Since 1975 Krisbiantoro routinely undergo kidney in PGI Cikini Hospital, Central Jakarta until now. However, he admitted that during the 36 years of suffering from kidney disease that often exposed to the temptation of "devil". Kris also admitted to taking a variety of herbs, snake blood meal and undergo alternative treatments but the results are futile. Not infrequently behavior was sometimes even life-threatening. Not surprisingly, he had to undergo hospitalization in RS PGI Cikini up to 4 (four) times.

If the patient insists leave hemodialysis or CAPD (which is in fact costly), the decision is yours.

The aim of therapy is to slow or stop the progression of CKD to stage 5. Control blood pressure and treatment of the original disease, whenever feasible, is the broad principles of management. Generally, angiotensin converting enzyme inhibitors s (ACEIs) or angiotensin II receptor antagonists (ARBs) are used, because they have been found to slow the progression of CKD to stage 5. [13] [14] Although the use of ACE inhibitors and ARBs are the current standard of care for patients with CKD, patients increasingly lost kidney function while on these medications, as seen in the {{[15] and RENAAL [16] studies, which reported a decrease from time to time estimated glomerular filtration rate (accurately measure the progression of CKD, as contained in the K / DOQI guidelines <ref name = "KDQOI" />) in patients treated by conventional methods.

Currently, several compounds in development for CKD. These include, but are not limited to, bardoxolone methyl, [17] olmesartan medoxomil, sulodexide, and avosentan [18].

Replacement of erythropoietin and calcitriol, two hormones processed by the kidney, is often required in patients with advanced CKD. Phosphate binders are also used to control serum phosphate levels, which are usually elevated in advanced chronic kidney disease.

When a person reaches the stage 5 CKD, renal replacement therapy is required, in the form of either dialysis or transplant.

Normalization of hemoglobin has not been found to be of any benefit [19]

People with CKD are at real risk of cardiovascular disease, and often have other risk factors for heart disease, such as hyperlipidemia. The most common cause of death in people with CKD due to cardiovascular disease than kidney failure. Aggressive treatment of hyperlipidemia justified [20]

Prognosis [edit | edit source]
The prognosis of patients with chronic kidney disease guarded as epidemiological data have shown that the cause of all deaths. (Overall mortality rate) increases as the decrease in renal function [21] The main causes of death in patients with chronic kidney disease is heart disease, regardless of whether there is progress to stage 5 [21] [22] [23]

While renal replacement therapy to maintain the patient indefinitely and prolong life, quality of life is greatly affected [24] [25] renal transplantation improves survival in patients with stage 5 CKD significantly when compared with the treatment of choice; [26] {{cite [27] However, it is associated with increased short-term mortality (due to complications from surgery). Transplantation aside, high intensity home hemodialysis appears associated with better survival and [quality [of life]] greater, when compared with the conventional three times weekly hemodialysis and peritoneal dialysis. [28]

Epidemiology [edit | edit source]
1.9 to 2,300,000 people in Canada have chronic kidney disease. [19]

In the US, the Center for Disease Control and Prevention found that CKD affected an estimated 16.8% of adults aged 20 years and older, during the years 1999 to 2004. Http://www.cdc.gov/mmwr [29]

British estimates indicate that 8.8% of the population of Great Britain and Northern Ireland have CKD symptoms [30]

Organizations [edit | edit source]
In the United States, the National Kidney Foundation is a national organization representing patients and professionals who treat kidney disease. The American Kidney Fund (AKF) is a national nonprofit organization that provides financial assistance related treatment to 1 out of every 5 patients on dialysis every year. The Renal Support Network (RSN) is a nonprofit that focuses on patients, patients run organization that provides non-medical services for those affected by CKD. The American Association of Kidney Patients (AAKP) is a non-profit, patient-centric group focused on improving the health and well-being of CKD and dialysis patients. The Renal Physicians Association (RPA) is a professional association representing nephrology.

In the United Kingdom, the UK National Kidney Federation representing patients, and renal kidney association representing physicians and work closely with the National Service Framework for renal disease.

The International Society of Nephrology is an international body representing specialist in kidney disease.

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