Unfinished journey (155)
(Part one hundred and fifty-five, Depok, West Java,
Indonesia, November 28, 2014, 5:20 pm)
 |
| Esnawan Antariksa Hospital |
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]
Template: POV-section
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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