Many patients come in to Dr. Shakil’s clinic with diabetes or high blood pressure, and while these are the two most common reasons for Chronic Kidney Disease, they are others who come with rare conditions. Last week I met a patient who suffered from glomerulonephritis, or simply inflammation of the blood vessels in the kidneys. I asked Dr. Shakil for clarification on the matter, and he explained that there are a lot of different causes for inflammation. This specific patient suffers from systemic lupus erythematosus, an autoimmune disease that attacks certain organs in the body. In the patient's case, the kidneys were being attacked by her own immune system, which caused the inflammation. In most cases this inflammation can easily go away without treatment, with the patient we saw treatment had to take place, to avoid damage in the kidneys. The patient showed signs of Chronic GN, because excess protein was found in the urine, and the lower parts of her legs were very swollen. To counter these symptoms, Dr. Shakil put the patient on certain corticosteroids, to suppress the immune system. It is also important for the patient to reduce their intake of salt and protein. As shown in the picture above, Lupus can do extensive harm to the kidneys if not treated. If you have this condition, it is extremely important to check regularly with a doctor, as it can harm not only the kidneys, but other organs as well. If left untreated, the inflamed kidney may end up like the one on the right Sources: Hassan, Saloni Editorial Head Umair. "Nephritis – Symptoms, Causes and Home Remedies." Saloni Health & Beauty Supply. N.p., 22 Sept. 2014. Web. 27 Mar. 2017. <https://makeup.saloni.pk/2014/09/22/nephritis-symptoms-causes-and-home-remedies/>. Written by Christine Case-LoMedically Reviewed by. "Glomerulonephritis." Healthline. N.p., n.d. Web. 27 Mar. 2017. <http://www.healthline.com/health/glomerulonephritis#Symptoms3>.
1 Comment
The fistulas themselves are fairly complicated, because there are several types that are installed for different reasons. A fistula is defined as a surgical passage that connects two “hollow” organs. There are three main types of fistulas that may be used for dialysis: Arteriovenous fistulas, arteriovenous grafts, or venous catheters. In the case of a dialysis fistula (as shown on the left), an artery is attached to the vein in the arm, and maturation of the fistula is necessary. It takes around three- six months for this fistula to mature, so if the patient is becoming close to dialysis, it is important for them to get this surgery. This is the most preferred way to get a fistula, as it has the lowest infection rate. However if the patient has small veins, they must consider other options. Grafts are normally placed if fistulas cannot be created. Instead of the artery being attached to the vein by surgery, an artificial tube made from fabric is added. The tube is put underneath the skin, and when it is time for dialysis, it will be attached to the machine. Arteriovenous grafts tend to last two to three years due to persistent clotting. Many patients I saw at the dialysis center had venous catheters, which are inserted in a large vein in the neck. A large portion of the catheter remains outside the body so it can be easily attachable to a dialysis machine, and as a result it may become easily infected. Sources: "Dialysis." Dialysis. N.p., n.d. Web. 21 Mar. 2017. <http://vascularim.com/dialysis.php>. "Vascular Access, Arteriovenous Fistula, Arteriovenous Graft, Venous Catheter." Department of Surgery. N.p., n.d. Web. 21 Mar. 2017. <http://www.surgery.usc.edu/vascular/vascularaccess.html>. Going back to my very first blog post, Chronic Kidney Disease is comprised of five different stages, each representing the percentage of kidney function that is left. But what options does the patient have if the kidneys are no longer functioning? If the nephrologist concludes there is no recovery possible, he/she will recommend the patient go on dialysis. Dr. Shakil will take several steps early on to avoid dialysis, because it is very costly and time consuming for the patient. However once the patient has little kidney function remaining, there are three options that are available: Hemodialysis, peritoneal dialysis, and hemofiltration. I went to the Kingman Dialysis Center to check out what dialysis is really like. Once inside the building, you will see a large room filled with armchairs and dialysis machines. There are around 15-20 patients at the center at a time, and the process normally takes around four hours a day for three days a week. In the back of the center, out of sight from the patients, is the room where the chemicals are synthesized. Each patient is attached to a large machine, as shown below. The main job of this machine is to take the unfiltered blood out of the body, and it reenters the body after the toxins have been removed. It sounds simple, but the machine itself is fairly complicated. There are normally two jugs that are in front of the machine. One of the jugs mixes the unfiltered waste with an acidic solution, that contains electrolytes and minerals which help keep the patient healthy. The other jug contains a bicarbonate solution, that goes into the machine and mixes with purified water. The two solutions found in these jugs are the same solutions being synthesized in the back! Once the blood is cleansed with the chemicals, they re enter the body. Once this process is over, an alarm will sound, which notifies the patient that the process for the day has been completed. Next week I will explain how the tubes are placed in the arm, along with the surgery that needs to take place so they may remain safely in the patient. Source: "Hemodialysis." The National Kidney Foundation. N.p., 14 Feb. 2017. Web. 12 Mar. 2017. <https://www.kidney.org/atoz/content/hemodialysis>. Along with Polycystic Kidney Disease and Diabetes, simple kidney stones can cause real harm as well. Dr. Shakil explained to me that when high levels of oxalate and calcium are introduced into the kidneys, these minerals may start to crystallize, causing stones to form. Once stones form in the kidneys, the patient may start to see several symptoms, including pain in the sides and back, and unusual smell in the urine.
If the pain gets too unbearable, it is important to see a doctor right away, as stones may lead to more damage. Once the doctor confirms the patient has a kidney stone, several treatment options are available. For small stones that don’t cause much pain, many patients simply choose to pass the stone through simple urination. To do this, it is important for the patient to drink around two-three quarts of water a day. The doctor may also recommend weak pain relievers, such as Aleve or Advil. If the stone becomes too hard to pass, the doctor may prescribe an alpha blocker as well, which relaxes the muscles to help pass the stone without much pain or discomfort. But what happens when the stone is too large to pass? New advances in medicine have allowed shock wave therapy to come into play. The procedure known as extracorporeal shock wave lithotripsy, or ESWl, creates strong sound waves that break up the stone, so these smaller stones are able to pass through urination. If this procedure is unsuccessful, the stone may be removed surgically. These stones in general cause a lot of pain, but they can easily be prevented. Contrary to popular belief, it is important to eat calcium rich foods, as they can still easily pass through the kidney if a large amount is present. A diet low in salt and protein will help with prevention as well, as these may cause sodium to leak into urine. About one in ten people will have at least one kidney stone in their lifetime, so it is important to spread awareness in order to avoid this pain in the future. Source: "Kidney stones." Mayo Clinic. Web. 05 Mar. 2017. <http://www.mayoclinic.org/diseases-conditions/kidney-stones/basics/definition/con-20024829>. |
AuthorMuhammad Ali Archives
May 2017
Categories |