Category Archives: Informative articles

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

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.

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

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

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.

Often, due to the more thickened and saturated with waste products and salts blood of patients on hemodialysis treatment, it happens that the AV fistula becomes blocked.

This condition is urgent and patients experience it dramatically, because hemodialysis is their life, and without a source – it is really at serious risk.

How to act in case of blocked fistula?

First of all, calm down. Worst decisions are made under stress.

A blocked fistula CAN be unclogged, but it takes time and specialist help:

1. Vascular surgeon – a consultation from an experienced vascular surgeon is necessary, who, in addition to making fistulas, is also specialized in unclogging them. A good specialist will understand the cause of the blockage and, most importantly, will know whether the AV fistula can be “repaired” or whether a new fistula will be needed.

It is possible to require an intervention under anesthesia to unclog the vessels, which is a common option.

But, of course, there is another development of things – the fistula is irreparably damaged and a new one has to be made. No need to worry – we repeat – an experienced vascular surgeon knows that an AV fistula is best for any hemodialysis patient and will schedule the earliest possible date for a new fistula.

2. Invasive cardiologist – there are already cardiology hospitals in which invasive departments a procedure for unclogging dialysis fistulas is performed, which resembles coronary angiography. The manipulation is available via a clinical pathway, performed under local anesthesia and is completed within an hour.

Here we should dwell on the most important question that concerns every hemodialysis patient who is presented with the difficult situation of a blocked (non-working) fistula, namely:

What should I do until my fistula works??? How will I do dialysis in the meantime?

The answer is one, especially if technological time is needed to unblock or build a completely new AV fistula – a temporary catheter is placed.

Placement of a temporary catheter is necessary and life-saving when the fistula cannot be used immediately, as it is unacceptable for patients to miss their hemodialysis procedures.

Of course, temporary catheters are associated with a number of inconveniences, but sometimes they are the only option for a non-functioning fistula.

In conclusion – good blood control, good dialysis, in which blood purification is as good as possible, the best quality dialyzers are used – these are all prerequisites for a long life of the AV fistula.

However, even when blocked, there is always a way out! It is worth reminding that the AV fistula is the best solution for you!

PERM CAT (Permanent Catheter – Permcat)

The permanent catheter (attention! Not to be mistaken with the temporary catheter) is the so-called consumable which, under anesthesia and under ultrasound control, is placed in one of the central vessels of the atrium. And through which, with a high flow rate, the patient’s blood is taken, purified through the hemodialysis machine and then returned to the patient, already filtered.

The visible part of the catheter is usually in the chest area, below the right collarbone.

Positives: – quick to install, can be used immediately.

Negatives: – The indwelling catheter is a kind of entrance for infections. In addition to impeccable disinfection and sterility, which is mandatory for the personnel in the dialysis structure when handling the catheter, it must be maintained in an absolutely clean environment, perfect hygiene must be observed, and it must be sterilely bandaged. Not to be touched, wet, scratched, moved by the patients at home. It would possibly make it difficult or impossible to swim in a pool, go to the sea, etc.

Bathing at home takes place only after placing a waterproof bandage on the catheter, in order to prevent water from reaching it. Dressing of the catheter and its processing is done only by the medical staff in the dialysis center. Despite all precautions and observed rules for disinfection and sterility, contamination of the catheter often occurs, making it an entrance for any infections, entering through it directly into the atrium and quickly covering the patient’s entire organism.

Such infections are extremely dangerous, difficult to control, and the catheter, once infected, must be replaced immediately. Here it is important to note that even with perfect maintenance of the catheter, it is replaced in approx. 4 – 5 years, and if an infection occurs – immediately.

The permanent catheter is a consumable that is not paid for by the Health Insurance Fund. Its price is approx. 550 BGN. – risk of blockage of the catheter – it often happens that the catheter stops working when it is blocked by biological deposits.

Then it needs to be changed again, in quick order. – the aesthetic aspect of the permanent catheter – it is visible, it could hardly remain hidden in the summer. In addition, it is not a suitable option for people who would not want it to be known at their workplace or in the immediate environment that they are undergoing hemodialysis treatment.

Overall, there are pros and cons to both vascular accesses, but it is important to note that the gold standard in hemodialysis requires fistula construction, especially for young and middle-aged patients, and resorting to a catheter only as a true last resort.

CENTRAL VENOUS CATHETER

When it comes time to start hemodialysis, among many other questions, the question of vascular access – AVF or PermCat (or more simply fistula or catheter) invariably arises.

In this article, we will try to look at this choice from all sides in order to give patients the most general idea and to facilitate their choice as much as it is possible to talk about it.

Fistula (AVF): Let’s start with the fistula, because of the two options, building a dialysis fistula is definitely the better option.

The fistula is easier to handle, maintain, less affects the daily routine, way and quality of life of the patients.

It is also much less risky in terms of future infections.

What exactly is an arm fistula?

Here we will try to avoid medical language and explain in an easily accessible way what a fistula in general is a “splicing, fusion” of a vein and an artery of the arm, which is a medical manipulation under anesthesia.

A small incision is made around the wrist or a little higher up the patient’s arm, depending on the doctor’s judgment – this is the so-called “high” (around the bend of the elbow) or “low” (around the wrist) fistula, the vein and

the artery is “merged”, then they are sutured and a certain period is waited for the fistula to heal and work. This may take a month, even two, and it may not work at all – these are precisely the risks of fistula. As for the location – whether the fistula is high or low, it is better if it is low – next to the wrist. The reason for this lies in the fact that if something happens to this fistula and it stops functioning, it can then “walk” up the arm and make a new one. Unfortunately, doctors rarely decide to make low fistulas, perhaps due to the fact that the vessels are much better expressed in the upper part of the arm, accordingly, it is easier to work there and the chances of success are greater.

Fistula positives:

– reduced risk of infections to a minimum

– preserved quality of life and routine

– you can swim, do any kind of work, without, of course, heavy physical work and strain.

Maintenance of daily hygiene occurs without change – as it was before the onset of the disease.

– among the positives, it is important to mention that what worries the patients, namely – pricking with fistula needles for each dialysis – will be painful – no!

The place loses its sensitivity and no pain is felt when it is turned on.

Of course, there is a moment of discomfort, but it is by no means an extremely painful manipulation.

Disadvantages of fistula:

– Time.

Each fistula takes time to develop and become usable, sometimes over two months.

There is a risk that it will never develop, ie. to remain unusable. This is one of the main concerns of hemodialysis patients – how will I continue my treatment if my fistula doesn’t work?

Fistula is not an option for patients who have high values and need to be put on dialysis quickly or urgently.

But, being the best option for vascular access in general, our advice to such patients is to get a catheter but at the same time seek advice from their dialysis center to refer them to a good vascular surgeon to do the fistula. In this way, the necessary dialysis treatment will be started through the catheter, but it will be thought in the perspective of building a good fistula to be used for the patient’s hemodialysis needs in the future.

– another common negative is the sudden stoppage of the fistula.

The reasons for this could be many and varied, but often the culprit is again high blood pressure, left unchecked – it causes the vessels to constrict and the fistula to spontaneously close.

Such an unexpected event puts the patient in an extremely unpleasant, stressful situation where suddenly, without warning, he finds himself with absolutely no vascular access through which to perform dialysis.

In such a case, of course, a temporary / permanent catheter is immediately placed and a new option for fistula construction is sought again. – “Why do they advise me not to make a fistula, but to go directly for a catheter?” – here is an extremely common question from patients. Usually the explanation from doctors is that the patient’s vessels are not good, he is too old, or he has diabetes.. This is not the case. Anyone could get a nice, quality, working fistula.

The trick is to find a good enough specialist to do it for him. We return to infections again to mention how risky they are for hemodialysis patients. When the treatment, the medical staff at the dialysis center are up to standard and professional, patients with fistulas can be absolutely calm that they are not vulnerable to infections introduced into their body.

TYPES OF VASCULAR ACCESS – AV FISTULA

Alport syndrome is an inherited renal condition that damages kidney tissue and glomeruli and leads to kidney failure.

Its name comes from the scientist Arthur Cecil Allport, who at the beginning of the last century first described what was shown, defining it as “hereditary, familial, congenital hemorrhagic nephritis”.

What is the cause of Alport syndrome?

The disease is genetic, which also explains the heredity in patients.

At a certain stage of the development of the embryos, a gene mutation occurs, which leads to changes in the kidney membranes (glomeruli, Bowman’s capsule) and, accordingly, the manifestation of what is shown at a later stage.

There are 3 types of inheritance according to the type of mutation:

1. The X-linked mutation. It is also the most common manifestation of the mutation in which Alport syndrome occurs.

In this case, the disease is transmitted from the mother to the son, but not from the father to the son, since the defect occurs on the X chromosome.

2. Autosomal recessive form It is observed at approx. 15% of cases of patients with Alport syndrome

3. Autosomal dominant form A relatively small number of patients with Alport syndrome have this mutation – only approx. 5%.

These patients manifest the symptoms shown significantly later and better.

How do we know?

Clinical picture: The first symptoms (especially with the Encounter mutation) appear in early childhood, approx. 3 years of age, but there are cases of even earlier manifestation of the syndrome – in infancy from several months to a year).

They include:

– hematuria (blood in the urine) that occurs spontaneously and has no other cause

– proteinuria (loss of protein through the kidneys, excreted in the urine)

– increased serum creatinine and arterial pressure – the increase in these parameters occurs in a slightly later stage of the disease.

– deafness – manifested in early childhood, parallel to the first manifestation of the symptom, often leads to mental retardation and is irreversible, due to damage to the auditory nerve.

– eye changes in the cornea and lens of approx The diagnosis is made by biopsy methods

– kidney, skin biopsy, as well as a genetic test to prove the format and type of Alport syndrome.

Treatment: Unfortunately, there is no cure.

Possible approaches aim to maximize the progress of the disease, as well as kidney transplantation, a stage for hemodialysis has been reached. The good news is that transplant patient syndrome can’t happen again to Alport.

Today we will focus on Fabry disease – a rare genetic disease resulting from a mutation of a gene (GLA) located on the X chromosome.

Like any part of the human body, the kidneys often suffer from various diseases. Some of them which arise spontaneously, are treated and subside quickly. Others are hereditary, appear quietly, inflict their damage, and when the patient feels them, it is already too late – the damage is irreparable – the kidneys do not function and it is necessary to start hemodialysis.

That is why it is important to know the family history – many of the kidney diseases are genetic and determine as the family burden in the family. In these cases, prevention and regular prophylaxis is of paramount importance – even if they cannot always be avoided, hereditary kidney diseases could be caught in time and successfully controlled.

The condition affects people of all ethnic and cultural backgrounds. It mostly affects men (1 in 40,000 men), but women can also be affected by Fabry disease. The reason for this is that women have two X chromosomes, and if one of them is defective, the other manages to somewhat compensate for the defect.

For men, however, this is impossible.

Their symptoms are observed already in the first 10 years of life. Boys complain of reduced physical ability. They get tired more easily and have a harder time tolerating cold and heat because the blood vessels are affected. If the mother observes her son, she will notice that in the group of playing children he gets tired the fastest and goes to rest, hides from the sun or the cold. These are the first things that make an impression on mothers, but sometimes they are interpreted as a whim. Then the pain appears in the limbs, most often the lower ones. There are also unexplained abdominal pains that last for hours or days. They are usually associated with a slight increase in temperature and then disappear spontaneously. Mothers do not always remember to talk about these symptoms because they do not attach much importance to them. Therefore, doctors who know the disease should purposefully ask about the symptoms. In case of doubt, a test is done – most often on urine. A small amount of protein may appear in it. One negative sample is not enough, several are made because the protein appears in periods.

As the symptoms progress, young men develop hypertension (high blood pressure) approx. 20 years of age. In the third-fourth decade, the first strokes appear. After that, more pronounced pains appear, the retina is colored in a specific way, viewed in polarized light. The intermediate products of the exchange due to the genetic defect (metabolites) are released like spokes on wheels. This can be determined by an ophthalmologist who has experience with such patients, however.

After 30 years, impaired kidney function is also established. It is leading in the clinical picture, therefore these patients are usually seen by nephrologists.

In women, the same symptoms occur, but with a 10-15 year delay.

Most visible to the human eye are changes in the skin. Specific rashes appear, which are located on the buttock and abdominal area around the navel and to the inguinal folds. They are so characteristic that if the doctor has seen them, he can diagnose another person on this basis alone. This rash does not hurt or itch, it has only a cosmetic effect. It can appear at the very beginning or later. It is not indicative of the severity of the disease, but if it is known, we can with almost 100% certainty go towards this diagnosis.

And in the next article we will pay attention on – Why Fabry disease should be detected and treated early?