Kidney failure; increasingly a common problem

Renal failure or kidney failure is a situation in which the kidneys fail to function adequately. It is divided in acute and chronic forms; either form may be due to a large number of other medical problems. When the kidneys do not work very well, problems frequently encountered are abnormal fluid levels in the body, disturbances in acid levels especially in blood where you could find high levels of uric acid due to decrease removal from blood through excretion. Abnormal levels of potassium, calcium phosphate, hematuria (blood in the urine) and in the case of longer term anemia. Long term kidney problems have significant repercussions on other diseases such as cardiovascular disease. Renal failure can broadly be divided into two categories: acute or chronic renal failure. The type of renal failure is determined by the trend in the serum creatinine. Other factors which may help differentiate acute and chronic kidney disease include the presence of anemia and the kidney size on ultrasound. Chronic kidney disease generally leads to anemia and small kidney size. Acute renal failure is a rapidly progressive loss of renal function, generally characterized by decreased urine production. Body water and body fluids disturbances, and electrolyte such potassium, sodium, calcium and sodium imbalance are important criteria to monitor during acute renal failure problem. An underlying cause must be identified to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes. Acute renal failure can result from a large number of causes. Acute kidney failure usually occurs as the result of a sudden interruption in the blood supply to the kidney, or as a result of a toxic overload of the kidneys. Some causes of acute failure include accidents, injuries or complications from surgery where the kidneys are deprived of normal blood flow for an extended period of time. Heart bypass surgery is an example of a situation in which the kidneys receive reduced blood flow. Drug overdoses, whether accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney failure. Unlike in chronic kidney disease, however, the kidneys can often recover from acute failure, allowing the patient to resume a normal life. People suffering from acute failure require supportive treatment until their kidneys recover function, and they often remain at an increased risk of developing future kidney failure. With the chronic kidney failure, the most common cause is diabetes mellitus. The second most common cause is long standing, and uncontrolled hypertension. Polycystic kidney disease is also a well known cause of chronic kidney disease. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Many other genetic illnesses also affect kidney function. Overuse of some common drugs, such as aspirin, ibuprofen and acetaminophen can also cause chronic kidney damage.Chronic kidney failure has several stages. Stage 1 is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 is considered a severe illness and requires some form of renal replacement therapy such as dialysis or kidney transplant whenever feasible. TreatmentThe most effective means for kidney failure management is Hemodialysis. It is a very expensive method and in Rwanda only found in University teaching hospital (CHUB), Hemodialysis uses a machine filter called a dialyzer or artificial kidney to remove excess water and salt, to balance the other electrolytes in the body, and to remove waste products of metabolism. Diet is an important consideration for those with impaired kidney function. Consultation with a dietician may be helpful to understand what foods may or may not be appropriate. Since the kidneys cannot easily remove excess water, salt, or potassium, they may need to be consumed in limited quantities. Foods high in potassium include bananas, apricots, and salt substitutes. Phosphorus is a forgotten chemical that is associated with calcium metabolism and may be elevated in kidney failure. Too much phosphorus can leech calcium from the bones and cause osteophoresis and fractures. Foods with high phosphorus content include milk, cheese, nuts, and cola drinks. Once the kidneys fail completely, the treatment options are limited to dialysis or kidney replacement by transplantation. Dialysis cleanses the body of waste products in the body by use of filter system. There are two types of dialysis. Peritoneal dialysis commonly used at King Faisal hospital is an important element in the management of people with kidney problems. Ends