This week I saw several patients who were on dialysis, where an external machine filters out blood, which takes over the function of the kidneys. This process has been around for decades, and it has gone under many variations and changes to make it more efficient. The risks associated with dialysis have stayed the same as well, and even though it is rare, cysts may start to form. Polycystic Kidney Disease, or PKD, is when cysts filled with water-like fluid start to form around the outer edges of the kidneys. High blood pressure is very common with this disease.
PKD is also considered to be a genetic disorder, as it is passed down through generations. There are two main types of inherited PKD: Autosomal Dominant and Autosomal Recessive. Autosomal Dominant is never found at an early stage in life, and as a result it is diagnosed when the patient is in adulthood. This type of PKD is especially concerning because symptoms do not appear until the cysts have grown to full length. Autosomal Recessive, on the other hand, is found within the few first months of life, so treatment may begin much earlier. Either way, cysts on the kidneys can cause liver failure, cardiovascular disease, kidney stones, and blindness. All of these conditions sound very difficult to deal with, but treatment is available to weaken these symptoms. It is important for the patient to be on blood pressure medication, as high blood pressure is fairly common with this disease. Pain medication is also necessary, but strong medications such as Aleve or Advil may cause further injury, due to restricted blood flow to the kidneys. Sodium levels need to be controlled as well, as high sodium levels cause damage as well. Kidneys also grow to abnormally large sizes once this disease progresses. If they become too large to the point where renal failure becomes possible, a transplant may be needed. The kidney on the right is healthy, whereas the one on the left has several cysts, and has grown to an unhealthy size. Sources: “ADPKD.” PKD International. 26 Feb. 2017 <http://www.pkdinternational.org/what-is-pkd/adpkd/>. "Polycystic Kidney Disease (PKD) | NIDDK." National Institutes of Health. U.S. Department of Health and Human Services. Web. 26 Feb. 2017. <https://www.niddk.nih.gov/health-information/kidney-disease/polycystic-kidney-disease>.
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This week with Dr. Shakil I met several patients who were suffering from Chronic Kidney Disease, and who had various levels of kidney function. As I was reviewing these patients I was surprised to see that most of them were suffering from Type 2 Diabetes, along with CKD. I asked Dr. Shakil for clarity on the subject, and he explained the process of taking care of a patient with Diabetes. It is very important for the doctor to keep the blood sugar levels at a minimum, because high blood sugar levels may cause progressive kidney failure. If the blood sugar becomes too high, a doctor must prescribe antiglycemic agents, to lower blood sugar and to keep from further kidney damage. Many of those patients who suffer from both Type 2 Diabetes and Chronic Kidney Disease are obese, and it is important for the patient to lose a little weight by maintaining a healthy diet and a daily exercise routine. The more excess fat on the body means the kidneys must function more to maintain blood flow, and the less strain on the kidneys the better.
But how does a diabetic examination differ from a normal one? To start of an exam, Dr. Shakil normally starts off by asking the patient if he/she has been to an optometrist in the past twelve months. While this may seem like a misplaced question in a kidney exam, the blood vessels found in the eyes are very similar to those found in the kidneys. If there is damage due to diabetes in one organ, then there is likely to be damage in the other. Blood sugar is checked as well, and if the levels are too high or too low then the doctor may adjust the levels of medication the patient is taking. Finally, the legs are checked for swelling, because if the kidneys are not filtering out fluid fast enough, fluid will begin to build up in the legs and ankles. Type 2 diabetes is the number one cause of CKD in the United States, and therefore it is very important for those patients to receive effective treatment. Source: Tierney Lawerence, Stephen Mcphee, and Maxine Papadakis. Current Medical Diagnosis and Treatment. Mcgraw Hill, 2005. Print. To get started, Dr. Shakil set aside certain topics for me to study before I begin rotating with him. I first looked at the general considerations for Chronic Kidney Disease, or CKD. I had no idea that one in nine adults in America suffered from CKD, so it is important to find effective treatments for these people. Most of these cases are from people who suffer from Type two Diabetes, as this disease does tremendous harm to the kidneys. Most people who suffer from CKD are completely unaware that they have the condition, because these cases can be asymptomatic until the disease is too late to successfully treat. However once the kidneys start to fail, symptoms include extreme fatigue and weakness. If renal failure has occurred in a patient, it is easily noticeable. It is possible for the patient to have high blood pressure, but the main indication of CKD would be a yellowish tint to the skin. However, one question that I came across during my research was at what stage does CKD become a problem, and when should it be treated? The glomerular filtration rate, or GFR, is a very important indicator of CKD. If a blood test is given, the GFR will tell you how well your kidneys are actually functioning. As seen in the table below, the GFR is measured in milliliters of blood filtered out per minute. Once the filtration rate hits 59 or lower, it is time to begin treatment. Source: Tierney Lawerence, Stephen Mcphee, and Maxine Papadakis. Current Medical Diagnosis and Treatment. Mcgraw Hill, 2005. Print. |
AuthorMuhammad Ali Archives
May 2017
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