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CONECTION BETWEEN WATER AND KIDNEY FUNCTION

Kidney function and water: What do we need to know?

The kidneys are vital organs responsible for filtering the blood, removing waste products, and maintaining the balance of fluids and electrolytes in the body. Water plays a key role in these functions, providing the necessary medium for filtering and transporting waste products.

How water affects kidney function:

Blood filtration: Water is needed to thin the blood, making it easier for it to pass through the glomeruli – tiny filters in the kidneys. These filters remove waste products, toxins and excess fluid from the blood, forming urine.

Elimination of waste products: Water is the transport medium through which waste products are removed from the body. Adequate hydration ensures that the urine is diluted, which facilitates the elimination of waste substances and prevents the formation of kidney stones.

Electrolyte regulation: The kidneys play a key role in maintaining the balance of electrolytes, such as sodium, potassium and chlorine, in the body. Water is essential to this process as it allows the kidneys to absorb or excrete electrolytes according to the body’s needs.

Preventing dehydration: Dehydration can lead to a decrease in blood volume, which makes it harder for the kidneys to work. Adequate water intake is essential for maintaining hydration and normal kidney function.

How much water is needed?

Recommended daily water intake varies by age, gender, activity level and climate. In general, healthy adults should aim to consume about 2 liters of water per day.

How do we know if we are drinking enough water?

  • Urine Color: Light yellow urine is an indicator of good hydration. Dark urine may indicate dehydration.
  • Urinary frequency: Urinating every 2-4 hours is normal. Urinating less often can be a sign of dehydration.
  • Feeling thirsty: Thirst is the body’s natural signal to need water. You don’t have to wait until you feel thirsty to drink water.
  • Dry mouth: Dry mouth, sticky lips and sunken eyes can be signs of dehydration.

Tips for drinking more water:

  • Carry a water bottle with you: This way you’ll have water handy wherever you go.
  • Drink water before, during and after meals:
  • Add flavor to your water: Add slices of lemon, lime, cucumber or mint to make your water tastier.
  • Eat foods with high water content: Fruits and vegetables are a great source of water and nutrients.
  • Limit caffeine and alcohol: These drinks can have a dehydrating effect.

Conclusion:

Water is essential for maintaining kidney health. Adequate water intake is important for proper blood filtration, elimination of waste products, regulation of electrolytes and prevention of dehydration. By drinking enough water, you can keep your kidneys healthy and enjoy good general health.

HYPERVOLEMIA

костна система

KIDNEY FUNCTION AND THE HEALTH OF THE BONE SYSTEM

Why the proper kidney function is important for bone health?

Healthy kidneys perform many important tasks. They remove waste and extra fluid from your body, help produce red blood cells, regulate the amount of minerals, and keep your bones healthy. In turn, minerals are nutrients that your body needs to stay healthy.

With advanced kidney disease or kidney failure, your kidneys can’t perform all of these important functions well. As a result, you may develop mineral and bone disorders, a common problem in people with kidney disease and affecting almost everyone with kidney failure.

What is a mineral and bone disorder?

Mineral and bone disorder associated with kidney disease occurs when there is an imbalance in the levels of calcium and phosphorus in the blood. This mineral imbalance can affect your bones, heart and blood vessels.

How do kidney disease and kidney failure lead to bone and heart disease?

When kidney function is impaired, your kidneys can no longer filter excess phosphorus and remove it from the body through urine. Over time, phosphorus from the foods you eat can build up to high levels in your blood.

Healthy kidneys also convert vitamin D from sunlight and foods into active vitamin D that your body can use. When the kidneys fail, there is a lack of active vitamin D. This imbalances the ratio of calcium and phosphorus in the blood.

When blood phosphorus levels rise and vitamin D levels fall, your body begins to produce too much parathyroid hormone (PTH). High levels of PTH cause calcium to move from your bones into your blood. The consequence of this is that your bone system becomes weaker and more brittle.

How are mineral and bone disorders treated?

Diet with low phosphorus content, supplements with Vitamin D. Taking of Calcimimetics – medicaments that are often used when the levels of PTH, calcium and phosphorus in the blood are too high in people on dialysis. Start a training plan – exercises to strengthen the bone system.

 

АПАРАТИ FRESENIUS 5008 S

NEW FRESENIUS 5008 S MACHINES AT DIALYSIS CENTER NEPHROLIFE

Dialysis Center NephroLife is proud to present its new investment in dialysis care – brand new Fresenius 5008 S machines.

By adding them to its amenities and facilities base, the center fulfills the gold world standard for performing hemodiafiltration with pre- and post-dilution.

This method allows better purification of intermediate molecules that are responsible for severe vascular and bone damage, disability and early mortality in hemodialysis patients. The machines themselves are equipped with the highest class of extras, which makes them sensitive to the slightest change in the patient’s condition.

This investment, one of many to come, is dictated by the center’s desire to provide the highest quality dialysis treatment and impeccable medical care.

Dr. Boryana Ivanova shares:

We would like to point out that our center is the only one in Burgas and the region that uses the highest class of medicines offered on the Bulgarian market (synthetic beta erythropoietin, intravenous iron preparations, calcimimetics and synthetic vitamin D analogs).In this way, we manage to offer the perfect symbiosis between medical and equipment overall treatment.

НАДПИСИ МИТОВЕ И ФАКТИ

MYTHS AND FACTS FOR DIALYSIS TREATMENT

MYTHS AND FACTS FOR DIALYSIS TREATMENT

Q: The only option to receive dialysis treatment is to travel to the center at least three times a week for hours. Is it right?

A: Dialysis can be done in many ways: You can have dialysis in a hospital or outpatient clinic, or in your own home. Hemodialysis in the dialysis center is performed three days a week for 3-4 hours each time. The other option is peritoneal dialysis at home. Educate yourself about each option and talk to your healthcare professional about which type of dialysis is best for you.

Q: Is Dialysis procedure painful?

A: Dialysis treatment doesn’t have to be painful. If you feel pain during or after, notify your attending physician or team. Some patients may experience a drop in blood pressure that may lead to nausea, vomiting, headache or cramps. However, by making your diet and fluid restrictions, these types of side effects can be avoided.

Q: Is dialysis absolutely needed to live?

A: Dialysis is a treatment that helps clean your blood of fluids and toxins when your kidneys can no longer function properly. The need to undergo dialysis may sound overwhelming and scary, but dialysis treatment allows you to live.

Q: Can Dialysis patients travel?

A: You can travel on dialysis! But this is some necessary planning. Before your trip, you must make an appointment for dialysis treatment at another center and submit information about your medical treatment and history. The dialysis journey means being prepared – click here to learn more.

Q: Should I stop working? Dialysis patients don’t have the time or energy to maintain normal life.

A: Many dialysis patients continue to work or study. Some of you took time off when you first started dialysis treatment and returned to work or school after getting used to the process.

Q: As a dialysis patient, you worry that you will be a burden on your family.

A: Many people with chronic illness feel this way at some point. Your role in your family may change over time, but it’s important to remember that you have more than just your kidney or dialysis treatment! Seek help when you need it and help others when you can. Be open and honest with your loved ones about how you feel and give yourself the space and time you need to adjust to dialysis treatment. Once you adjust to your ‘new normal’ of dialysis, you will find that you will be able to recover to take on new roles and responsibilities at home.

 

DIALYSIS IN CHILDREN – WHEN IS REQUIRED?

WHAT CONDITIONS REQUIRE DIALYSIS IN CHILDREN?

Dialysis, often considered a life-saving procedure for adults with kidney failure, is just as important for children facing similar health challenges.

There are various scenarios where dialysis may be necessary for the youngest patients. Among them are:

  1. Acute kidney injury (AKI). In children, it can occur due to conditions such as severe infections, dehydration, or under the influence of toxins (eg unintentional ingestion of drugs, poisons, alcohol). The most common cause of acute kidney injury in children is hemolytic uremic syndrome. It usually occurs after infectious gastroenteritis caused by E.coli. It is characterized by hemolytic anemia, a reduced amount of platelets (thrombocytopenia) and elevated residual nitrogen bodies in the blood (urea and creatinine). In these cases, temporary dialysis may be necessary until the kidneys recover their function.
  2. Chronic kidney disease (CKD): Children with progressive kidney damage from congenital anomalies, genetic disorders, autoimmune diseases may eventually reach end-stage chronic kidney disease, where dialysis becomes necessary to sustain life. Some of them are: renal polycystosis, renal dysplasia, Alport syndrome.
  3. Children can develop glomerulonephritis due to immune system dysfunction or infections (eg, poststreptococcal glomerulonephritis). In severe cases, this can lead to significant deterioration of kidney function and the need for dialysis.

SYMPTOMS OF CHRONIC KIDNEY DISEASE IN CHILDREN

  1. Swelling and/or puffiness around the eyes, feet and ankles

2.Frequent headaches caused by high blood pressure

  1. Frequent urination
  2. Delayed growth
  3. Loss of appetite and chronic nausea
  4. Fatigue
  5. Anemia and pale skin

Of course, these symptoms can also be a sign of other conditions. It is important not to ignore them and, when you have concerns, to seek timely medical help.

WHAT ARE THE DIALYSIS OPTIONS?

As in adults, hemodialysis (HD) or peritoneal dialysis (PD) is possible. The advantage of PD is that it can be performed at home, which can significantly reduce the stress associated with hospital visits. The pediatric nephrologist will help you choose the best option for your child that meets their needs and is consistent with their health condition.

The decision to start dialysis in children is based on a variety of factors, including the severity of kidney dysfunction, symptoms, underlying cause, general health, and the child’s age. The goal is to optimize the child’s health and quality of life while minimizing the risks and complications associated with kidney failure.

CKD (CHRONIC KIDNEY DISEASE) IN CHILDREN

 

МЪЖ НА ДИАЛИЗА С КАТЕТЪР

MAINTENANCE OF PERMANENT CATHETER DURING DIALYSIS. HOW TO PREVENT CATHETER INFECTIONS

One of the ways to perform dialysis is by inserting a permanent catheter. Proper care of the catheter is critical to prevent infections and complications that can jeopardize both the effectiveness of dialysis and the health of the patient. In this article, we will discuss the basic steps and best practices for maintaining the functionality of your dialysis catheter.

CATHETER CARE TIPS

  1. Make sure to change the dressings regularly. This should be done after each dialysis procedure, that is, every few days.
  2. If the catheter dressing is dry and clean, you do not need to change it yourself. However, you can ask the nurse at the dialysis center to teach you so that you are prepared in case you need to.
  3. The catheter site should not get wet. You can clean your upper body with a damp cloth. If you intend to shower, cover the catheter with a waterproof dressing, but in any case you should avoid getting water in this area as much as possible.
  4. Wear comfortable loose clothing. Avoid clothing and accessories (eg, long necklaces) that can catch on the catheter or dressing.
  5. Avoid situations where the catheter may be tugged or dislodged (contact sports, carrying bulky objects, etc.)

WHAT ARE THE SIGNS OF A CATHETER INFECTION?

Your most important “task” when using a dialysis catheter is to watch for infections. Inform your dialysis center immediately if:

  1. You notice redness, swelling, pain, or fluid collection around the catheter or
  2. You have a fever, chills or fatigue.

HOW DO I PREVENT DIALYSIS CATHETER INFECTION?

When using a dialysis catheter, strict adherence to hygiene rules is mandatory. It will protect you from potentially life-threatening conditions (sepsis), because the catheter can easily become a portal of entry for infections.

  1. Never touch the catheter or the dressing with dirty hands. Always wash your hands with soap and water and wear gloves before changing your dressing. Make sure your healthcare team also does the same.
  2. Keeping the area around the catheter clean and dry. Moisture around the catheter helps the growth of microorganisms and increases the risk of skin irritation and infection.

By following the rules when using a dialysis catheter, you help ensure your treatment is safe and effective. Always keep in touch with your medical team and seek immediate help if you suspect an infection or experience problems with your dialysis catheter.

VASCULAR ACCESS – PERMANENT CATHETER

ГЛОМЕРУЛОНЕФРИТИ

GLOMERULONEPHRITIS – WHAT CAUSES THEM AND TYPES

Glomerulonephritis (GN) is a group of diseases characterized by damage to the kidney glomeruli – small round structures in which waste products and excess fluids are filtered from the blood.

WHAT CAUSES GLOMERULONEPHRITIS?

There are multiple causes for GN- infections (bacterial, viral), autoimmune diseases (for example, lupus or Goodpasture syndrome), vasculitis, malignancies, toxins, medications. GN is associated with an abnormal response of the immune system due to one of the listed causes. This leads to structural changes in the kidneys that impair their function.

GN can be divided into acute and chronic. Acute GN is characterized by a sudden onset, often in response to infections (most commonly streptococcal and staphylococcal), and may resolve with appropriate treatment. In contrast, chronic glomerulonephritis develops gradually over time, leading to persistent kidney damage and potentially progression to chronic kidney disease.

Early detection and treatment are critical in both cases to prevent complications and preserve kidney function.

SYMPTOMS OF GLOMERULONEPHRITIS

If the disease develops in a mild form, it can be asymptomatic or be discovered accidentally through blood and urine tests. Symptoms of GN include:

  • swelling – first on the face and eyelids, and later on the legs
  • decreased urine output
  • dark colored urine due to the presence of blood (hematuria)
  • high blood pressure
  • laboratory findings: proteinuria (protein in the urine), hematuria, slightly elevated urea and creatinine, leukocytosis (increased white blood cells), accelerated ESR.

The diagnosis is made based on your symptoms, laboratory tests, imaging tests (ultrasound) and a kidney biopsy. Treatment is tailored to the cause that led to GN. In addition, symptomatic treatment is also appropriate – for example, blood pressure medications.

WHAT IS THE PROGNOSIS FOR GLOMERULONEPHRITIS?

The prognosis depends on what type of glomerulonephritis you have.

For example, one of the most common GN is post-infectious. It occurs several weeks after infection (usually of the throat, lungs, skin, or urinary tract). In that case, a complete recovery is expected in almost all patients.

In other forms of GN, the condition may progress to end-stage kidney disease and at some point dialysis may be required.

HOW TO PREVENT GLOMERULONEPHRITIS?

In many cases, there isn’t much you can do to prevent GN. However, the following measures could reduce your chances of getting GN:

  • Treat bacterial infections with antibiotics. Always finish the whole treatment course, as prescribed, even if you feel well after a couple of days.
  • Try to keep chronic diseases such as high blood pressure, diabetes, autoimmune diseases under control.
  • Avoid excessive intake of nephrotoxic drugs. Painkillers such as ibuprofen, metamizole, and naproxen can damage your kidneys. Always ask your healthcare provider about the right dosage.

Each type of glomerulonephritis requires a thorough diagnostic approach and treatment. It is important that people with symptoms suggestive of glomerulonephritis seek immediate medical attention for evaluation of the condition and timely therapy, which is the only way to reduce complications and preserve kidney function.

 

Covid-19 и ХБЗ

COVID-19 IN PATIENTS WITH CHRONIC KIDNEY DISEASE

The COVID-19 pandemic has significantly affected the lives of millions around the world, with certain populations facing a higher risk of severe disease and complications. Among these vulnerable groups are people with chronic kidney disease (CKD), a condition characterized by a gradual loss of kidney function over time.

COVID-19 AND KIDNEY DISEASE

Individuals with CKD often have a compromised immune system, making them more susceptible to infections. The immune response in patients with CKD can be impaired, hindering their ability to effectively fight the virus.

Patients with CKD are at increased risk of severe infection and adverse outcomes when infected with the SARS-CoV-2 virus. The virus can directly affect the kidneys, in some cases leading to acute kidney injury (AKI) on top of pre-existing chronic kidney disease.

AKI is an acute deterioration of renal function in a short period of time, which is accompanied by a significant increase in serum creatinine levels and reduced to absent urine output. The condition has several stages and can range from relatively mild damage to almost complete loss of kidney function. Patients with CKD are prone to hyperkalemia and metabolic acidosis, which combined with a COVID-19 infection and AKI can become life-threatening. Such extreme situations, in addition to treatment with different medications, could require emergency dialysis.

COVID-19 PREVENTION

  To reduce the risk of contracting COVID-19, patients with CKD should strictly follow the known preventive measures:

  • keeping distance and avoiding contact with sick people
  • wearing a mask
  • hand hygiene
  • vaccination.

Vaccination has been shown to be a key tool in preventing severe illness and hospitalization.

Frequent check-ups and the potential future need for dialysis can be a cause of increased anxiety in people with chronic kidney disease. Therefore, the prevention of COVID-19 infections in CKD patients is important not only to avoid severe complications, but also to preserve their emotional health.

WHAT SHOULD I DO IF I GET COVID-19?

If you have been in contact with someone who has tested positive for COVID-19, watch for symptoms (fever, cough, shortness of breath, sore throat, muscle pain, lack of taste and smell).

  If you show symptoms, it is appropriate to get tested (you can choose between an antigen test or a PCR test). Even if you feel relatively well, see your general practitioner, who might refer you to an infectious disease specialist. Keep in touch with your nephrologist and do not resort to self-treatment.

If you are undergoing dialysis, notify your dialysis center immediately. They will help you with possible changes in the schedule of your procedures, so as to ensure maximum safety both for your health and that of the medical team and other patients.

COVID 19 – Precautions

Поликистозна болест

CHRONIC KIDNEY DISEASE IN PATIENTS WITH POLYCYSTIC KIDNEY DISEASE

Polycystic kidney disease (PKD) is a genetic disease characterized by the formation of fluid-filled cysts in the kidneys. These cysts can gradually replace healthy kidney tissue over time, leading to a decline in kidney function. PKD is one of the most common inherited diseases affecting the kidneys and can lead to various complications, including the development of chronic kidney disease (CKD), which can progress to its end stage (End stage renal disease, ESRD).

In about 90% of cases, patients have autosomal dominant polycystic kidney disease (ADPKD). This means that in the presence of 1 sick parent, the probability of children being born with ADPKD is 50%.

WHAT ARE THE SYMPTOMS OF POLYCYSTIC KIDNEY DISEASE?

In autosomal dominant polycystic kidney disease, the first symptoms usually appear around 30-40 years of age. In contrast, the autosomal recessive form manifests itself in childhood.

The most common symptoms include:

  • Pain in the lumbar region due to the enlargement of the kidneys and the pressure exerted by the cysts.
  • In the beginning, the blood pressure tends to be higher compared to the more advanced stages of the disease.
  • Hematuria (blood in the urine). Polycystic kidneys are very susceptible to trauma and minor injury can lead to bleeding.
  • Cysts can interfere with the normal flow of urine, increasing the risk of kidney stones.
  • Urinary tract infections: Cysts can provide a breeding ground for bacteria, leading to recurrent infections.
  • Fatigue, weakness, breathlessness

WHY DOES POLYCYSTIC KIDNEY DISEASE LEAD TO CHRONIC KIDNEY DISEASE?

Chronic kidney disease (CKD) is a progressive condition characterized by gradual loss of kidney function over time. The kidneys play a key role in filtering waste products and excess fluid from the blood, regulating electrolyte balance, and producing hormones that control blood pressure. As CKD progresses, these functions are impaired, leading to the accumulation of toxins in the body and disturbances in basic body processes.

The progression of polycystic kidney disease to chronic kidney disease results from the gradual and cumulative damage that the cysts cause to the kidney tissue over time. Several mechanisms contribute to the development of CKD in individuals with polycystic disease:

  • Replacement of healthy kidney tissue by cysts.
  • Cysts lead to reduced blood flow to the kidneys.
  • Inflammation in the kidneys, as a result of which the healthy kidney tissue is replaced by connective tissue (fibrosis).
  • Arterial hypertension, which is characteristic of polycystic kidney disease, further damages the kidney.
  • Frequent urinary tract infections as well as infections of the cysts.

WHAT IS THE TREATMENT FOR POLYCYSTIC KIDNEY DISEASE?

Currently, there is no cure for polycystic kidney disease. The efforts of medical professionals are aimed at slowing the progression of the disease so as to preserve kidney function as much as possible and postpone the need for dialysis or transplantation.

Maintaining optimal blood pressure is a key aspect of polycystic kidney disease therapy. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) are the medications used.

In patients who are at risk of rapid disease progression, therapy with the medication tolvaptan is possible. Its use slows down the formation of cysts.

Other aspects of polycystic kidney disease therapy include:

  • Appropriate diet
  • Avoidance of contact sports due to risk of renal hemorrhages
  • Symptomatic treatment of the pain caused by the enlarged kidneys
  • Treatment of metabolic disorders
  • Strict control of renal function by a nephrologist, regular imaging studies of the kidneys. Consultations with other specialists if necessary (cardiologist, endocrinologist, etc.)

WHEN IS HEMODIALYSIS OR KIDNEY TRANSPLANTATION NECESSARY?

Unfortunately, a large percentage of people with polycystic kidney disease must at some point begin dialysis treatment or consider a kidney transplant. This is necessary when reaching the end stage of chronic kidney disease, in which the kidneys have stopped functioning or their function is drastically reduced (glomerular filtration eGFR<15ml/min/1.73m2).

This condition is always accompanied by laboratory changes (high urea, creatinine, potassium and phosphates), as well as symptoms (itching, muscle cramps, nausea and vomiting, swelling of the legs and arms, back pain, often complete cessation of urine output, shortness of breath, insomnia).

Kidney transplantation is considered the best treatment option for patients who have reached an advanced stage of the disease. It is important to note that the procedure involves thorough patient assessment, preparation and finding a suitable donor, which takes time. After the surgery, immunosuppressive therapy is necessary, as well as strict monitoring of one’s health.

In cases where polycystic kidney disease progresses to end-stage kidney disease, dialysis (hemodialysis or peritoneal dialysis) must be started to help manage symptoms and maintain overall health. Dialysis is necessary while waiting for a transplant, or in cases where the patient is not a suitable candidate or does not wish to have a kidney transplant. The availability of different dialysis methods, as well as vacation dialysis centers, significantly reduces the limitations associated with regular procedures.

POLY-CYSTIC KIDNEY DISEASE

 

Кардиоренален синдром

WHAT IS CARDIORENAL SYNDROM? – TYPES

Cardiorenal syndrome

In ancient Eastern culture, the kidneys are a symbol of water, and the heart is a symbol of fire.

These two “elements” must be in balance for a person’s spirit to be calm and his body to work well. When the kidneys do not function properly, the water element “floods and extinguishes” the fire of the heart, and if the heart does not work well, it “dries up” the kidneys. With this metaphor, in general, the close connection between kidney and heart functions and their general importance for the human body can be represented.

Cardiorenal syndrome is a condition in which the healthy connection between the kidneys and the heart is disrupted to the extent that they cannot adequately support circulation and blood supply to other organs and systems. A disturbance in the normal functioning of one of the two organs almost necessarily leads to disturbances in the other as well. Treatment of such conditions requires the efforts of both nephrologists and cardiologists.

Depending on the speed and severity of occurrence of the aforementioned imbalance, cardiorenal syndrome can be divided into five types:

Type 1 – Acute cardiorenal syndrome: Sudden and severe heart failure occurs, causing a sudden and severe deterioration of kidney function to the point of acute renal failure. In such a condition, the pumping function of the heart drops dramatically. Because of this, an insufficient amount of blood reaches the kidneys. They “dry up” and urine output stops. Subsequently, in an attempt to restore normal blood flow to itself, the kidneys retain large amounts of water and salt and the cardiovascular system “overflows”. This is how the so-called pulmonary and/or cerebral edema, which are life-threatening conditions. Despite the seriousness of type 1 CRC, the good news is that any acute condition treated in time is completely reversible!

Type 2 – Chronic cardiorenal syndrome: In this case, the gradual and progressive “extinction” of the heart leads to the gradual “drowning” of the kidneys. This damage occurs slowly and gradually, but at the same time it is irreversible. When the heart gradually weakens, it can no longer maintain circulation. Due to this, the blood (water) stagnates in the various tissues and organs, nutrients and oxygen are depleted from it, the levels of toxic substances increase. The kidneys are organs extremely sensitive to the so-called oxygen starvation. When blood stagnates and oxygen is exhausted, irreversible changes occur in their structures, which smoothly and gradually lead to chronic kidney failure. Frequent and sudden changes in blood pressure (very high or alternating high and low blood pressure) act in a similar way, damaging the kidney structures irreversibly.

Type 3 – Acute renocardial syndrome: In this type of damage, the beginning of the imbalance begins with the kidneys – there is a sharp and severe violation of previously healthy kidneys, as a result of which they cannot excrete excess water. It “floods” the heart, repeatedly raises the demands on it and “overstretches” it. In this way, heart function is also quickly and severely impaired, and pulmonary and/or cerebral edema can again be reached. The most frequent causes of such a kidney disorder are the contrast agents used in the so-called “color pictures”, drug abuse, poisoning, some forms of specific kidney diseases (so-called glomeulopathies).

Type 4 – Chronic renocardial syndrome: Here we are talking about an already existing kidney failure, in which over the years too much water, salt, toxic substances are retained and an excessive amount of internal hormones are released, leading to “thickening and stretching” of the heart – chronic heart failure . The primary causes of kidney failure in this case may be other diseases: diabetes, hypertension, metabolic syndrome, gouty nephropathy, chronic pyelonephritis, etc. Again, it is worth mentioning that due to the smooth course of the diseases, the damage is slow but irreversible. In most kidney diseases, there is no pain (with the exception of infections and/or stones), and the complaints are general and non-specific – general fatigue, reduced endurance during physical exertion, tightness and discomfort in the chest and/or lumbar region, decreased appetite, nausea, etc. . The basis of both prevention and treatment of type 4 CKD are regular preventive examinations, restriction of salt and protein intake, high-vitamin diet, light to moderate physical activity.

Type 5 – Secondary Cardiorenal Syndrome: This last type of combined kidney and heart damage occurs to both at the same time and is most often the result of another disease. This type can occur both quickly and severely – for example, with sepsis, trauma, allergic shock, blood loss, dehydration, etc., and smoothly and gradually in the course of a systemic disease such as diabetes, lupus, gout, metabolic syndrome, etc. Quite often, acute type 5 KRS is part of the so-called multiple organ failure, which is a life-threatening condition and requires treatment in intensive care units. Chronic type 5 CRC is part of the “silent” diseases and often goes undetected until the moment when both organs are “wasted” to an irreversible extent.

The prevention of these complications almost entirely depends on the lifestyle and the control of other accompanying diseases – moderate physical activity, avoiding harmful foods and excessive amounts of salt, maintaining normal blood pressure values in hypertensives (around 120-130/80mmHg) , keeping blood sugar up to 9-10mmol/l and glycated hemoglobin around 7-7.5% in diabetics, reducing body weight in obesity, avoiding red meat, eggs, etc. purine-rich foods for gout. Prevention, prevention, diagnosis and treatment of cardiorenal syndrome are a common task of both nephrologists and cardiologists.

Unfortunately, CRS is a relatively new concept in medicine, and the mass of doctors rarely think in this direction. As a cause of reaching kidney failure necessitating dialysis treatment, CRC accounts for about 30% to 50% of cases. Therefore, for patients with already known kidney and/or heart failure, regular monitoring of urea and creatinine values at least once every 3 months, echocardiography and ultrasound examination of kidneys at least twice a year, avoidance of large amounts of salt, etc. are recommended.

– frequently used medications in the treatment of CRS are:

• ACE-inhibitors/ARB-blockers: Medications that suppress excessive “constriction” of small blood vessels and thus reduce both blood pressure and pressure in the vessels of the kidney itself. In this way, they protect the kidneys from further damage.

• Calcium antagonists: These are quite commonly used drugs, especially in the so-called hypertensive crisis. Like ACE inhibitors, they reduce vascular resistance and thus the demands on the heart.

• Diuretics: So-called “diuretics” are among the main drugs used to reduce water load. They act on the kidney, stimulating it to produce more urine than it would normally produce. In this way, excess amounts of water and salt are thrown out.

• Adrenoceptor blockers – for maintaining high blood pressure, the so-called sympathetic nervous system (using internal substances such as adrenaline, noradrenaline, etc. for its action). Accordingly, drugs that block its action lower the heart rate and the volume of blood pushed out by the heart, expand peripheral vessels, reduce the damaging effect on the kidneys.

• Natriuretic Peptide – This relatively new drug is considered a natural internal product of the body, released when the heart is “stretched” by water overload. Its main action is the excretion of excess salt through the kidneys, and with it water, thus reducing the total load on the CCS. In summary, we should emphasize again that the treatment of cardiorenal syndrome of any type is a joint effort of nephrologists and cardiologists. Therefore, our NephroLife DC team offers and maintains close collaboration between these two specialties of internal medicine.

 

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