Chronic renal failure

Chronic renal failure

To maintain the health of the kidneys and prevent the occurrence of kidney failure, it is important to follow a balanced diet, drink 1.5 to 2 liters of water daily, reduce alcohol consumption, and exercise regularly.
In addition to primary renal disease, there are other factors that influence the progression of chronic renal failure such as hypertension uncontrolled, the urinary infection , obstruction of the urinary tract, and significant intake of analgesics, among others. Chronic renal failure is currently unhealed and, in general, the disease progresses even if the factors mentioned are kept under control.

The treatment of chronic renal failure, therefore, will be directed to:

Try to neutralize the existing damage at the time of diagnosis.
Avoid factors associated with renal failure, which may cause and potentiate the aforementioned renal lesions.
Avoid factors that cause glomerular sclerosis, such as excess protein and hyperglycemia and, thus, delay the course of the disease.
Go to treatment for symptoms and conditions that appear as kidney failure progresses.
Dietary behavior in uremic syndrome
It is essential to carry out nutritional control in kidney failure.

Goals:

Slow the progression of kidney failure and improve uremic symptomatology by reducing protein intake.
Normalize the internal balance by adjusting the intake of water, electrolytes and minerals, and restore and maintain a good nutritional status.
Basic guidelines:

Control and reduce intake of phosphorus, protein, potassium (in advanced stages).
The amount of calcium, phosphorus, bicarbonate, iron (sometimes called erythropoietin, better known as 'EPO', is needed to control anemia).
Control of hypertension; Very important to prevent the progression of the disease.
Renal function replacement therapy
It allows survival when renal function even with the above measures is practically non-existent and the patient presents with symptoms of advanced deterioration.

There are different treatment options and all have advantages and disadvantages. It is the patient himself, along with his family, and with the help of health professionals who provide him with adequate information, who chooses the modality that best suits his life, his preferences and his personal conditions.

Hemodialysis

It is a technique of extracorporeal depuration, which consists in putting through a semipermeable membrane the blood with a liquid that helps it to be purified and detached from surplus water and uremic solutes (toxins that accumulate as a consequence of The decrease of glomerular filtration).

It is usually practiced three times a week for 3-5 hours per session, depending on the patient and their individual situation.

Before beginning hemodialysis, the preparation of vascular access is required, that is, the preparation of the site from which the blood will be drawn to the dialysis machine and where it will return once it has been purified. For this, a small surgical procedure is usually required on the forearm. The most common is that a fistula is created joining an artery with a vein, which gives rise to a large caliber glass from which you can easily draw and put blood. Less often an artificial graft is implanted between an artery and a vein, or catheters are rarely used directly into the vein.

Usually fistulas can be used for many years without problems, however, there is a small risk of complications such as infections, thrombosis, bleeding, etc., which may become important.

Peritoneal dialysis

The peritoneum (membrane that covers the walls of the abdominal and pelvic cavities and covers the viscera) acts in this case as semipermeable membrane.

It is a simple way (although at first sight it may seem complicated to understand that the purification can be done “in our own gut”) to practice dialysis in the patient's own home, which allows adapting the treatment to their lifestyle and daily activities.

It is used mainly in patients with cardiac alterations, children, diabetics, elderly or patients with contraindication for hemodialysis; However, this method can not be used in people who have damaged peritoneum (due to peritonitis or adhesion).

Kidney transplant
Renal transplantation is the treatment of choice for chronic renal failure, although an organ is necessary for this. Spain is currently the country where most kidney transplants are practiced every year, and are mainly performed with cadaver donor organs, although the practice of using kidneys from a living donor (usually a relative of the patient) is becoming more widespread.

It is necessary that the donor (cadaver in most cases) does not present infections, cancer , renal alterations , severe arterial hypertension, nor is it carrying HIV.

Immunosuppressive treatment
Since it is very difficult to achieve full compatibility between donor and recipient, it is necessary to decrease the immune response capacity of the latter through the use of immunosuppressive drugs, in order to avoid rejection of the transplanted organ. The immunosuppressive treatment, however, has undesirable effects, since it favors the proliferation of infections (that can cause the death of the patient), as well as the appearance of neoplasias.