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Your checkup should include:
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Urine test for
protein (UKF Health
Screening) |
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Blood pressure |
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Blood test for
glucose |
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Blood test for
creatinine
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Kidney Failure
If kidney damage becomes too severe,
one’s kidneys lose their ability to
function normally, this is called
End Stage Kidney (Renal) Disease,
ESRD, or Kidney Failure.
Diabetes and high blood pressure are
the two known leading causes of ESRD,
accounting for more than 60 percent
of new cases of dialysis patients in
Malaysia. Kidney disease can also
develop from infection, inflammation
of blood vessels in the kidneys,
kidney stones and cysts. Other
possible causes include prolonged
use of pain relievers and use of
alcohol or other drugs (including
prescription medications).
There
are three types of Kidney Failure:
Acute Kidney Failure
This is the sudden
loss of kidney
functions over a few
hours or days. It
can be due to one of
the various types of
kidney diseases or
may be due to
infections or low
blood pressure after
an accident.
Loss of kidney
functions in Acute
Kidney Failure is
usually temporary,
but can be life
threatening. In most
cases, this type of
kidney failure is
reversible, but it
occasionally may not
respond to treatment
and may progress to
Chronic Kidney
Failure or End Stage
Kidney Failure.
Acute Kidney Failure
is more common in
men than in women.
When Acute Kidney
Failure occurs,
investigations are
undertaken to
determine the cause.
This may include a
kidney biopsy.
Sometimes there are
specific, treatable
causes, but often it
is simply a case of
waiting patiently
for the kidneys to
heal themselves and
recover their
functions.
Many people with
Acute Kidney Failure
require dialysis,
while they are
waiting for their
kidneys to recover.
However sometimes
Acute Kidney Failure
can be managed
conservatively, by
simply watching the
blood pressure and
the blood chemistry
and waiting for
kidney functions to
return.
Chronic Kidney
Failure
When the loss of kidney functions is
gradual and progressive, it is
referred to as Chronic Kidney
Failure. Eventually, the kidneys are
unable to remove wastes or maintain
the body’s salt and fluid balance,
resulting in the need to receive
dialysis treatment. The symptoms of
this type of kidney failure may not
be noticed immediately.
A build-up of creatinine (a waste
product normally removed by the
kidneys) in the blood will indicate
kidney functions and the level of
kidney impairment. The risk of
Chronic Kidney Failure increases
with age.
End Stage Kidney Failure
This phrase means that the kidneys
have failed completely, and can no
longer support life. Some people
with End Stage Kidney Failure stop
passing urine completely; others
will still pass some weak, watery
urine. |
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Signs & Symptoms
of Kidney Disease
When kidney disease
develops over a
short period of time
it’s called Acute
Kidney Failure. This
is usually caused by
an acute 'insult'
(damage) to the
kidneys. Unlike
Chronic Kidney
Failure, this can
usually be treated
and cured. Acute
kidney diseases
often cause symptoms
that are quite
obvious, the most
prominent being:
• blood in the urine
• swelling of the
face, feet, ankles
and legs
• new onset of high
blood pressure
• shortness of
breath
The above symptoms
are more likely to
occur in children
because they are
more likely to
suffer acute kidney
diseases. However,
that does not mean
adults are free of
them, so if you note
any combination of
these symptoms,
immediately seek
medical attention.
Note that other
diseases can also
cause similar
symptoms, but a
simple urine test
can indicate if they
are due to kidney
diseases. For
instance, the urine
test will indicate
if albumin (protein)
and blood are
present in the
urine, as they imply
the presence of
kidney diseases. A
blood test can also
show how well your
kidneys are
performing their
main function of
eliminating waste
products.
In contrast, many
chronic kidney
diseases do not
manifest clear
warning signals in
their early stages.
There may be loss of
appetite, mild
swelling in the
legs, and tiredness.
It is not uncommon
for these symptoms
to be so mild or
non-specific that
they are ignored
over long periods of
time.
In fact, some people
with chronic kidney
disease do not have
any symptoms in the
initial stages. But
as kidney function
declines, symptoms
may include:
• fatigue
• frequent headaches
• loss of appetite
(anorexia)
• sleep problems
(insomnia)
• itchy skin
• frequent urination
or urinary retention
• nausea or vomiting
• swelling or
numbness of the
hands and feet
• darkening of the
skin
• muscle cramps |
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Haemodialysis |
|
Haemodialysis is a treatment for those
patients whose kidneys cannot function any
more. It is a way of cleansing the blood of
toxins, extra salts and fluids through a
dialysis machine called "artificial kidney".
It helps maintain proper chemical balance
such as potassium, sodium and chloride and
keeps blood pressure under control.
During dialysis, two needles will be placed
into the vascular access, one to remove the
blood and the other to return cleansed blood
to the body. You are connected (via tubing)
to the dialysis machine through a vein in
your arm, the blood is pumped from your body
to a special filter called the dialyser,
which is made of tiny capillaries.
Blood is
continuously pumped through the dialyser,
where waste products and excess water are
removed. The blood becomes purified when the
waste products diffuse from the blood across
the membrane of these tiny capillaries. This
purified blood is then returned to your body
through larger tubes.
Haemodialysis
is performed 3 times a week, with each
session lasting about 3 to 5 hours,
depending on the body size and medical
condition. At the NKF, patients can choose
Mondays, Wednesdays and Fridays or Tuesdays,
Thursdays and Saturdays. They can also
choose the morning, afternoon or evening
session.
Things to take care...
Before and during dialysis, you need to
clean the skin covering the access before
inserting the needles to avoid infection. If
you notice any signs of infection, inform
the nurse immediately. Besides, you need to
make sure that your blood is flowing and not
clotting while on treatment, lightly touch
the area to feel a pulse. It is important
that the catheter be kept dry, even when you
are taking a bath.
You also need to take care of your fistula
or graft. You should not wear anything tight
around the fistula/graft arm i.e. watches,
bracelets, tight clothing, or carry heavy
bags looped over the fistula/graft. Despite
of checking that the fistula/graft is
working by feeling for the buzzing sensation
every morning and night, you should not
allow non-dialysis staff to take blood or
blood pressure on your fistula/graft arm.
Observe for signs of infection, such as
redness, oozing of blood or pus, swelling
and heat, you need to contact the nurse
immediately if there are any problems with
your fistula/graft.
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Peritoneal dialysis
(PD) |
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Peritoneal dialysis (PD) is an alternative
treatment to haemo-dialysis. A special
sterile fluid is introduced into the abdomen
through a permanent tube that is placed in
the peritoneal cavity. The fluid circulates
through abdomen to draw impurities from
surrounding blood vessels in the peritoneum,
and it is then drained from the body.
PD can be carried out at home, at work, or
on trips, but requires careful supervision.
PD gives patients more control. However,
they need to work closely with the health
care team including the nephrologist,
dialysis nurse, dialysis technician,
dietitian and social worker. The role of the
PD patient and his/her family are very
important. By learning more about the
treatment, patients can work with the health
care team to achieve the best possible
results and lead an active life.
How does it work?
The walls of the abdominal cavity are lined
with a membrane called the peritoneum, which
allows waste products and extra fluid to
pass from your blood into the dialysis
solution. In PD, a soft tube called a
catheter is used to fill the abdomen with a
cleansing liquid called dialysis solution.
The solution contains a type of sugar called
dextrose that will pull waste and extra
fluid into the abdominal cavity, will be
exuded out of the body when the dialysis
solution is drained. The used solution will
be thrown away.
The process of draining and filling is
called an exchange and takes about 30 to 40
minutes. The period when the dialysis
solution is in the abdomen is called the
dwell time. A typical schedule calls for
four exchanges a day, each with a dwell time
of 4 to 6 hours. Different types of PD have
different schedules of daily exchanges.
Types of PD
There are two types of Peritoneal Dialysis:
Continuous Ambulatory Peritoneal Dialysis (CAPD)
and Automated Peritoneal Dialysis (APD).
You do not need a machine for CAPD. You
simply need gravity to fill and empty your
abdomen. The doctor prescribes the number of
exchanges a patient needs, typically three
or four exchanges during the day and one
evening exchange with a long overnight dwell
time while one sleeps. As the word
"ambulatory" suggests, you can walk around
with the dialysis solution in your abdomen.
An alternative to CAPD is Automated
Peritoneal Dialysis (APD) where a machine
called a cycler changes the dialysate
solution during the night, usually while
patients are asleep. This means that
patients have to be attached to the machine
for 8-10 hours.
Why APD?
APD is suggested to offer a number of
unproven psychosocial benefits over CAPD. It
relates directly to fewer connections and
allows patient to lead a normal lifestyle
during the day, particularly for workers,
school pupils and those taking care of the
elderly or debilitated patients. Additional
benefits include the absence of fluid during
the day, which possibly reduces back pain
and body image difficulties. Performing APD
at night in the supine position also results
in reduced intra-abdominal pressures as
compared with the upright position in CAPD.
APD is designed to be simple and is often
performed in the bedroom. The machines are
user-friendly. Before going to sleep, the
machine needs to be loaded with fluid. It
will then perform a number of cycles
throughout the night. The fluid is drained
away into a large drainage bag for disposal.
Often, the machine will provide a last fill
of fluid, which stays inside the tummy until
the following night when it is drained away.
Peritoneal dialysis units worldwide are
increasingly adopting APD. It is estimated
that one quarter of the world's peritoneal
dialysis patients are now on APD. The use of
cyclers in North America has increased from
10% in 1990 to 43% in 1997. 60% of patients
treated with APD in North America also
receive at least one exchange during the
day. APD is more expensive than CAPD, but is
usually cheaper than a transfer to in-centre
Haemodialysis.
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ORGAN DONATION &
KIDNEY
TRANSPLANTATION |
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Organ donation is
the removal of the
organs or tissues of
the human body from
a person who has
recently died, or
from a living donor,
for the purpose of
transplanting them
into other persons.
People of all ages
may be organ and
tissue donors. Organ
and tissue donation
is the ultimate
humanitarian act of
charity.
The commonly
transplanted organs
are kidneys, heart,
liver, lungs and
pancreas (currently
no pancreas
transplant has been
done in Malaysia)
while the
transplantable
tissues are cornea
(eyes), arteries or
veins, intestines,
tendons, ligaments
,bones, skin and
heart valves.
There are two
sources:
(a) Living Donors
For many years, most
living donors were
closely related to
the potential
recipient, e.g.
brother, sister or
parent. Such close
relatives were
likely to be a close
tissue match to the
recipient, resulting
in excellent
outcomes. With the
advent of improved
immunosuppressive
medications
(anti-rejection
medications), it is
now possible to
achieve similar
outcomes using
living donors who
are unrelated to the
recipient, but only
emotionally related
such as spouses are
sometimes found to
have a compatible
blood group and
tissue match to the
potential recipient.
(b) Cadaveric
Donors
Organs from
cadaveric donors are
allocated to the
best tissue matched
patients on the
transplant waiting
list. Potential
cadaveric donors
with a history of
cancer or
transmissible
viruses such as
Hepatitis B,
Hepatitis C and HIV
are not considered
for organ donation.
There are 2 sources
of cadaveric donors:
- Heart-Beating
Donors
These donors have
suffered severe
trauma to the brain.
In order to be
considered as organ
donors, these
patients must be
ventilated in an
intensive care unit
and medically
certified as 'brain
stem" dead, meaning
that all functions
of the brain have
ceased. In other
words, life cannot
be sustained. Heart
beat and lung
function are
artificially
maintained by a
respirator. A very
small proportion of
all deaths in
hospitals occur
under these
conditions. Heart,
kidney and liver
transplants are only
possible from
heart-beating
donors.
- Non
Heart-Beating Donors
Only tissues such as
cornea (eye), skin
and heart valves can
be procured after
cardiac death.
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