Kidney Failure and Dialysis
What is kidney failure?
The kidney consists of tiny cells called nephrons, which act as filters and remove waste and excess fluid from the body in the form of urine. It also maintains blood pressure in the body and mineral levels in the bones. Kidney failure is a condition in which the nephrons get damaged, affecting its ability to filter waste. This causes build-up of the fluid and wastes to dangerously high levels that may result in coma and even death of an individual. A kidney transplant is the best treatment for kidney failure, where the damaged kidney is replaced with a healthy kidney taken from a donor. However, it often takes months or years to find a suitable donor. Dialysis is an alternative procedure that acts as an artificial filter, replicating the kidney’s function and prolonging the life of individuals with kidney failure until the patient undergoes a kidney transplant.
What causes kidney failure?
Some of the possible causes of kidney failure include:
- High blood pressure
- Diabetic nephropathy (kidney damage due to diabetes)
- Glomerulonephritis (inflammation of nephrons)
- Polycystic kidney disease (passed down in families)
- Reflux nephropathy (back-flow of urine into the kidneys)
- Certain medications
What are the symptoms of kidney failure?
Symptoms are generally not detected during the early stages of kidney disease, until over 90% of the kidney has stopped functioning. Some of the symptoms include:
- Loss of appetite
- Sleeping difficulty
- Impaired concentration and headaches
- Changes in the appearance and amount, or presence of blood in urine
- Pain in the region of the kidney
- Swollen legs and ankles
- Shortness of breath
How is kidney failure diagnosed?
Various diagnostic tests are performed to determine kidney function. They include:
- Blood tests to determine the estimated glomerular filtration rate (eGFR), which measures the ability of kidneys to filter waste products
- Blood pressure measurements
- Urine tests to determine presence of red blood and white blood cells, glucose and albumin
- Imaging tests such as X-rays, computed tomography (CT) scan, and ultrasound
- Kidney biopsy, where a small sample of tissue is removed for microscopic examination
How is kidney failure treated?
Dialysis is recommended when most of the kidney’s filtrating ability is lost and dangerous amounts of wastes and fluid build-up in your body. There are two types of dialysis including:
Hemodialysis: This uses an external dialysis machine to re-route blood for filtering. Patients with kidney failure may require 3 sessions of hemodialysis every week for four hours each. Staff in the dialysis clinic will first measure your blood pressure, pulse and skin temperature before starting hemodialysis. Two needles are inserted into the arteriovenous (AV) fistula (surgically modified blood vessel) in your wrist or upper arm. The AV fistula is ideally created before hemodialysis becomes necessary. During dialysis, blood from your body is removed through one needle and is transferred to the dialysis machine. Membranes present in the machine act as filters to remove wastes and excessive fluid from the blood. The clean blood is then circulated back into your body through the second needle. After the session, the needles are removed and the area is covered to prevent bleeding.
Peritoneal dialysis: A peritoneal dialysis catheter is also placed under general anaesthesia. A small incision is placed (usually around the belly button) and a camera is inserted into the abdominal cavity. A brief exploration is performed and the catheter is placed using an additional two to three tiny incisions in your skin. Sometimes after we look around with a camera, we are unable to place the catheter most often due to scar tissue. That is why if a patient has had multiple abdominal surgeries, it may be impossible to place a peritoneal dialysis catheter.
Are there any complications of dialysis?
As with any procedure, dialysis involves certain risks and complications. They may include, but are not limited to:
- Low blood pressure, invasive bacterial infections, muscle cramps and itchy skin with hemodialysis
- Peritonitis (bacterial infection of the peritoneum), hernia and weight gain with peritoneal dialysis
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