Category Archives: Полезные статьи

Every patient who has started hemodialysis and after the initial emotional shock begins to hard and feverishly prepare for a kidney transplantation – the only possible way to “get his life back”.

Of course, it is very important to note that hemodialysis is often only a stopover for people with CKD on their way to being on the kidney transplantation waiting list, as well as the most important moment – the call that a donor situation has arisen and the patient with CKD is called in for a new organ transplant procedure.

However, how important is it to perform quality hemodialysis until the moment of transplantation?

We will dwell on this question in a little more detail…

Recently, Dr. Georgi Hristov, director of the Medical Oversight Executive Agency, stated that many of the potential kidney recipients who are on the waiting list are called for transplants, but, after tests, they are found to be in such deteriorated health state that they are declared unfit to receive a donor organ.

Perhaps this is also the reason why very few transplants are done in Bulgaria – less than 20 per year – one of the saddest statistics, which causes many people with CKD to become health emigrants.

But why is the level of hemodialysis in Bulgaria bad? The low price of the procedure, paid by the NHIF, the many services that are included under the umbrella of the dialysis procedure and that are not directly related to the healing process also detract from the amount that could otherwise be directed 100% to the essence of the procedure – many explanations , but one bottom line..

High-quality hemodialysis means one thing – a maximally preserved organism for the cherished moment of transplantation.

Good dialysis has several main pillars:

1. Quality and especially NEW equipment of the highest class. We cannot help but mention the name of the leader in dialysis equipment – FRESENIUS. Every center equipped with new FRESENIUS devices is guaranteed to perform excellent dialysis.
2. Consumables – once again FRESENIUS are on the front line – dialyzers from the brand, blood lines – grant the best possible and fine cleaning, maximally reduced blood loss, good physical condition after the procedure, etc.
3. Medicines – when the patient is in the final phase of CKD, respectively undergoing dialysis treatment, his body does not produce the relevant substances and elements necessary to maintain good levels of hemoglobin, for normal levels of phosphorus, calcium, potassium, iron, etc. This requires many and expensive medications, which are part of the procedure, paid for by the NHIF, and are not at the patient’s expense.

However, many of the dialysis centers save on these drugs, at the expense of greater profit for the clinic.

Regular monthly examinations of patients, their physical condition are the best guarantee for the good work of the hemodialysis center.

This is the only way to control medication intake and maintain good levels of elements in the body.

4. Staff – an extremely important component in the dialysis structure is the staff, in the form of experienced nurses and a doctor who does NOT leave the dialysis room for a single moment. In dialysis, the worst can happen in a minute – lines are severed, a catheter is pulled out, while the patient’s blood is literally outside their body as the machine filters it – these are just examples of extremely critical and potentially deadly situations. Which can only be mastered by an experienced nurse with a doctor by his side.

Contrary to the initial impression – everything happens extremely dynamically in dialysis, and only the experienced hands of the nurses can prevent it from ending tragically.

These are just a few points of support on the path of each patient’s choice to protect his right to the best treatment he deserves.

A good diet, strict control over fluid intake, regular monitoring by all kinds of specialists, especially a cardiologist, endocrinologist, pulmonologist, etc. pave the way for transplantation, which is the normal and logical conclusion of the problem called “end-stage CKD”.

STAGES OF CHRONIC KIDNEY DISEASE

It is an indisputable fact that the news of starting hemodialysis, which patients with chronic renal failure (CKD) receive, is an extremely traumatic psychological moment – where starts suffering not only the body, but also the soul of the patient.

Dialysis treatment that continues for years, and the fact that the patient is dependent on the specialized equipment – the dialysis machine, on the observance of a strictly defined dietary regime, significantly limit the personal freedom of the patient, his social contacts, and seriously disturb his professional realization.

As a result, the patient experiences stress and anxiety, which have an adverse effect on the entire healing process, adaptation, emotions and quality of life.

Is hemodialysis treatment so scary and hopeless?

The short answer is: NO.

Here’s the longer one:

Hemodialysis treatment is now years away from what it was in the 90s – the equipment in private dialysis centers is at an excellent level, and in most municipal hospitals the old dialysis machines with hundreds of thousands of hours of service have already been replaced with new ones.

Competition between medical facilities raises the level of service for patients, and brand new Fresenius machines and consumables can now be seen more and more, which contributes to the excellent cleansing of toxins from the patient’s body.

The procedures, in turn, are tolerated by the patient much better, there are no constant vomiting, headaches during dialysis caused by low-quality and repeatedly used consumables, “disinfected” in formalin solution, there is no shortage of drugs to maintain a good level of hemoglobin, iron, calcium, phosphorus no longer “flys in the sky”. Hepatitis epidemics have not occurred for decades.

The many dialysis facilities scattered in the cities allow all patients not to be “tied to the machine”, but to be able to travel, if they wish, to go to the sea or on holiday abroad.

Most patients of working age continue with their employment.

Dialysis patients at a younger age, and not only that, have an excellent chance and opportunity for transplantation – again thanks to the quality dialysis they perform, which preserves the body as much as possible and gives it the necessary time until the cherished moment of transplantation, the chance also increases for the new authority to be accepted.

Cases of patients of childbearing age who, after a successful transplant, become mothers and continue their lives to the fullest are no longer rare.

Of course, for a job between two people to be done successfully and well, both must participate equally. Efforts are also needed on the part of the patients.

A good diet, strict adherence to dietary restrictions, no matter how unpleasant they may be at times, is a necessary part of the process.

Regular control of blood pressure, timely help from various specialists (cardiologist, endocrinologist, etc.), when necessary, are the best helper for the patient with CKD.

Last, but not least, is the choice of a dialysis structure – it is most important that the patient chooses that place where there is a successful symbiosis between excellent, new equipment, excellent medical control carried out during the dialysis sessions – which means the doctor to be constant between his patients, because in dialysis “whites” happen in seconds. One of the most important people in the dialysis facility is the dialysis nurses – they literally hold the patients’ lives in their hands. When the dialysis nurse is experienced, she can “stab” even the most difficult fistula, can sense an approaching danger for the patient even before the doctor has thought about it, and prevent it.

Medicines are also an indispensable part of the treatment and help in the long term to maintain the good general condition of the body. Saving them, unfortunately, does not lead to anything good.

In conclusion, dialysis is a team game, a game of trust and professionalism.

And let’s not forget that there is always a chance!

BALANCING WORK AND DIALYSIS

Let’s start from the beginning – what is the function of the kidneys?

And the answer is – our kidney system is multi-component: kidneys are not just a filter, but also play an important role in:

– excretory function – through the kidneys – excess water, salts and nitrogen-containing substances, which are formed as a result of the exchange of substances in the body of each person, are excreted in the urine.

– maintenance of an optimal balance in the “internal environment” – this is the so-called “homeostasis” – In case of changes in the water-salt and acid-alkaline internal environment of the body, the kidneys include a number of compensatory mechanisms with which they restore this balance.

– stimulating the production of red blood cells (erythrocytes) – specific kidney cells produce the hormone “erythropoietin”, whose task is to stimulate the bone marrow to produce blood cells.

– maintenance of normal strength and structure of human bones – the kidneys are also actively involved in the production of vitamin D3, which is responsible for the strength of bones in the human body.

When do we start talking about chronic kidney failure (CKD)?

When these renal functions begin to decrease until they are completely lost (last stage of renal failure, when creatinine has already reached levels of approx. 850 µmol/l.

Sometimes, quite imperceptibly, the degree of kidney failure is reached, which necessitates frequent examination of the state of kidney function.

Of course, it takes time to reach the end stage of CKD, but eventually, the kidneys are irreversibly damaged.

The first signs are a decrease in the amount of urine excreted – an important symptom, which, however, is not always manifested.

Sometimes the exact opposite symptom is present – excessive excretion of urine (polyuria). This happens when, in an attempt to excrete substances the body does not need, the damaged kidneys excrete more water because they cannot concentrate the urine.

Patients excrete up to 3 or more liters of urine per day, urges to urinate are frequent even at night!

  For comparison – a healthy person usually urinates within 1.5 l/24 hours.

  Other characteristic complaints are easy fatigue, high blood pressure that is not affected by medication, or at least not subject to normal regulation and control, nausea, nocturnal shortness of breath and difficulty breathing, which are due to pulmonary edema, drowsiness. Diabetes is also a ‘first aid in the development of CKD’

That is why prevention and regular monitoring of kidney health by a nephrologist is so important.

If you have any of the symptoms described above, accompanied by frequent urinary infections, kidney pain, if you have been suffering from diabetes for several years – contact a nephrologist who will prescribe preventive tests, including creatinine and urea, and consult you subsequently.

CHRONIC KIDNEY FAILURE AND CARDIOVASCULAR DISEASES

Diabetic nephropathy is the name used to describe kidney damage caused by diabetes. It develops slowly over several years. Almost one in five people with diabetes eventually need treatment for diabetic nephropathy. Despite these alarming statistics, there are many things that can reduce the risk of developing the complication. If detected early enough, diabetic nephropathy can also be delayed with treatment.

What causes kidney disease?

One of the main jobs of your kidneys is to filter your blood by removing excess fluids and waste products from your body through urine.

High blood glucose (sugar) levels can damage the small blood vessels and tiny filters in your kidneys. When the blood vessels are damaged, the kidneys are unable to clean the blood in an optimal way. For this reason, excess fluids, salts, toxic products accumulate in the body and swelling and weight gain begin to be observed.

The earliest sign of diabetic nephropathy is the so-called microalbuminuria, which means an increased level of the albumin protein in the urine.

What is albumin?

Human albumin is a small globular protein consisting of 585 amino acids. Albumin is synthesized in the liver, after which it is excreted into the bloodstream. It plays an important transport role – for hormones, vitamins or medicines.

An important indicator is the amount of albumin and the ratio with total potein in various disease processes: chronic liver diseases, chronic kidney failure, oncological diseases or in the diagnosis of edematous conditions.

Once this damage is present, the remaining kidney filters must work extra to compensate for the deficiencies in the system’s proper functioning. Once the kidneys start working at less than 15% of their capacity, a diagnosis of kidney failure is made and the patient usually goes on dialysis.

There is no specific treatment for diabetic nephropathy, but disease progression can be slowed by controlling blood pressure, optimizing blood sugar levels, and changing diet. Once kidney disease is present, the most important thing to focus on is controlling blood pressure.

Renal colic is a condition that can occur to anyone, without a previous cause of manifestation. This spasm is characterized by extremely intense pain that occurs suddenly and completely unexpectedly, most often in the lower back, where it is strongest.

The patient remains restless with nausea, less frequent regurgitation, abdominal distension, possible sweating and traces of blood in the urine.

In addition, the presence of renal colic should never be considered as a physiological condition, since pain associated with it is a clear manifestation of a problem that requires a visit to a doctor and intervention aimed at resolving the problem.

At its core, renal colic affects the two specific organs responsible for filtering blood and excreting waste in the urine, namely the kidneys. They represent a porous structure extremely rich in small channels, tubules and blood vessels, which act as a mechanical filter.

Colic is caused by a sudden obstruction of the patency of the urethra. Usually, the movement of stones is provoked by physical exertion, high fluid intake, alcohol, caffeine or diuretics. During this passage, the stones inflame their walls and cause the acute clinical manifestation of renal colic.

Renal colic can last from a few minutes to a few hours, and in rare cases – a few days.

It is important to diagnostically rule out other diagnoses such as pyelonephritis, acute pancreatitis, cholecystitis, acute appendicitis, ectopic pregnancy, ovarian cyst, etc.

The disease is proven by ultrasound as this method is safe, highly informative and allows tracking of the person’s condition. In the laboratory, a blood test and urinal analysis are recommended.

The treatment includes the combined use of analgesics and antispasmodics, thus controlling the pain and removing the existing spasm of the ureter. From natural remedies, diuretic and anti-inflammatory-antiseptic teas can be used.

Recurrent nephrolithiasis and urinary tract obstruction eventually lead to chronic renal failure and permanent damage to the urinary tract. Therefore, its timely detection, treatment and prevention are important.

Chronic kidney disease (CKD) is a partial or complete reduction of kidney function and it has five stages, where stage 5 is called renal failure. The disease progresses slowly and is determined by the extent to which kidney function is reduced.

In its initial stages, CKD is asymptomatic. Often, patients do not even know they have a kidney problem, but find out during the course of treatment for another disease, or when their condition is already in an advanced stage.

Symptoms of CKD may include: heaviness or pain in the lower back, high blood pressure, swelling, decreased urine output.

Organs and systems in the body are interconnected. Therefore, a problem in one place affects the whole body. Moreover, the risk factors for these 3 diseases are similar: hyperglycemia (high blood sugar), arterial hypertension, being  overweight, family history and low physical activity.

DIABETES AND CHRONIC KIDNEY DISEASE

Nowadays, diabetes is quite prevalent. Nearly 1 in 3 diabetes patients suffers from some degree of chronic kidney disease.

High blood sugar damages the blood vessels, leading to arterial hypertension, which in turn damages the kidneys and their function. On the other hand, hyperglycemia itself leads to kidney damage.

Therefore, maintaining normal blood sugar levels is crucial. Here, not only the medications your endocrinologist will prescribe are important, but also a healthy lifestyle: body weight control through appropriate diet and exercise, as well as avoiding nephrotoxic (kidney-damaging) medications and taking them only when absolutely necessary.

HEART DISEASE AND CHRONIC KIDNEY DISEASE

Kidney disease often leads to heart complications, while heart problems lead to kidney dysfunction.

Uncontrolled hypertension (blood pressure above 140/90) is one of the causes of CKD. On the other hand, CKD can lead to arterial hypertension and subsequently heart disease.

Many factors that can cause kidney disease also damage the heart and blood vessels. Among them, firstly, come high blood pressure and diabetes, which many patients with CKD have. In second place come obesity and smoking.

There is a strong connection between chronic kidney disease, heart disease and diabetes and it is not rare for one patient to have all three of them.  In their early stages, all of these diseases can be asymptomatic. Therefore, regular check-ups (for example, every year), even if you don’t have any complaints, can significantly increase your quality of life.

CHRONIC KIDNEY FAILURE AND CARDIOVASCULAR DISEASES (nephrolife.bg)

Kidney dysplasia (Renal dysplasia) is a defect in the intrauterine development of the kidneys, which means that one or both kidneys have abnormal appearance (cysts, increased amount of connective tissue, etc.) and impaired function.

IS KIDNEY DYSPLASIA COMMON?

The condition occurs in 1:1000 to 1:4000 live births. It may go undiagnosed when only one kidney is affected and there are no symptoms.

Renal dysplasia in the majority of cases is a consequence of genetic mutations. Usually it is not an isolated condition, but is accompanied by defects in other organs and systems.

  The use of illegal substances and certain prescription medications during pregnancy also increases the risk of giving birth to a child with renal dysplasia. Therefore, it is important that the intake of any medication by the pregnant woman be discussed with an obstetrician-gynecologist.

WHAT ARE THE SYMPTOMS?

Unilateral dysplasia can be asymptomatic or in combination with other defects of the urinary tract. Those affected often develop arterial hypertension and proteinuria (protein in the urine) at a later stage. Lumbar or abdominal pain, frequent urinary tract infections, and slower growth are also possible.

Bilateral dysplasia is one of the most common causes of chronic kidney disease in newborns. It can also be associated with the presence of oligohydramnios (reduced amount of amniotic fluid) during pregnancy.

Kidney changes can be diagnosed in utero by fetal ultrasound. After birth, some characteristic changes in laboratory parameters are also important for the diagnosis.

PROGNOSIS AND TREATMENT

The prognosis depends on the severity of the disease and especially on whether only one or both kidneys are affected.If a child has one functional kidney, a normal life is possible, provided that the condition is monitored regularly (blood pressure, laboratory parameters, urinalysis).

Children born with bilateral dysplasia must be strictly followed up by a pediatric nephrologist, who will order the necessary tests. It is possible for the condition to progress, necessitating hemodialysis or a kidney transplant.

PREVENTION

Genetically determined renal dysplasia cannot be prevented. It is important for pregnant women to lead a healthy life and to let their gynecologist know if they take any medications or have family history of renal dysplasia.

Historically, Dr. Willem Kolff is considered as the father of dialysis. This young Dutch doctor constructed the first dialyzer (artificial kidney) in 1943. The path to creating this innovation for its time began in the late 1930s when he worked in a small ward at the University Hospital in Groningen, the Netherlands.

The idea of ​​developing a blood purification machine was born for Dr. Kolf after observing a patient suffering from kidney failure. He decided to find a way to develop a machine to replace the work of the kidneys. When his invention was complete, he attempted to treat over a dozen patients with acute kidney failure over the next two years. Although only one of the treatments performed proved successful, he continued to experiment in improving his design. However, Kolf’s device only treats acute kidney failure, not end-stage renal disease (ESRD).

Dr. Kolff’s invention is considered the first modern drum dialyzer and remained the standard for the next decade. After the end of World War II, he donated the five machines he made to hospitals around the world. One of those hospitals was Mount Sinai in New York, where he later moved to continue his research and scientific work.

The first patient in the world to be treated with repeated hemodialysis was Clyde Shields, whose first dialysis was in Seattle, USA, on March 9, 1960.

Dr. Belding Scribner, a professor of medicine at the University of Washington, has developed a way for patients with end-stage kidney failure to receive treatment through an access point in their arm. In 1962, Dr. Scribner opened the first formal dialysis clinic for patients. Subsequently, he also developed a portable dialysis machine that allows patients to receive this type of treatment at home.

The kidneys play an extraordinary role in the overall activity of our organism. They perform important functions that keep us healthy by filtering waste and excess fluid from the blood. They also maintain optimal levels of electrolytes such as sodium, calcium and phosphate, control blood pressure and participate in the synthesis of hormones that are necessary to keep bones and blood healthy.

Each kidney contains approximately one million tiny tubules called nephrons, which filter waste and extra fluid from the blood, which is later excreted from the body as urine. Usually, people are born with two kidneys, but sometimes, due to a number of reasons, life is completely possible with only one. In these cases, the only kidney is compensatory enlarged and takes up to 80% of the function of the missing one, which is quite enough for normal existence.

The main reasons why a person may have one kidney include the following:

– Congenital defect – a condition called renal agenesis means that a person is born with only one kidney.

– In another condition, renal dysplasia, a person is born with two kidneys, but only one is functioning.

– Surgical removal (nephrectomy) – removed kidney as a result of cancer or other disease

– Removal of a kidney after trauma or donation.

Many people lead normal and fulfilling lives with one kidney, although long-term health problems may arise that require specific monitoring and treatment.

Some of the problems that can occur include:

– Hypertension – Because the kidneys are involved in maintaining healthy blood pressure, many people with a single kidney are at slightly increased risk of hypertension.

– Proteinuria – Excess protein in the urine can be an indicator of kidney damage and people with one kidney often have above average levels of protein in the blood.

– Decreased glomerular filtration rate (GFR) – GFR indicates how well the kidney filters fluids and waste products from the blood. Often people with one kidney have a reduced GFR.

In conclusion, we could say that the greater percentage of cases lead a completely normal and fulfilling life. It is important to attend preventive examinations at least once a year in order to prevent complications and kidney diseases.

Arterial hypertension (AH), also known as high blood pressure, is one of the most common chronic diseases. It occurs when blood moves in the arteries under greater pressure than normal. Blood pressure usually rises and falls throughout the day, but it can damage the heart and cause health problems if it stays high for a long period of time.

High blood pressure can constrict and narrow the blood vessels in the kidneys, which in turn reduces blood flow and interferes with their normal function. When this happens, the kidneys are unable to remove all the waste products and extra accumulated fluid from the body. This whole process raises the blood pressure even more, creating a dangerous cycle and causing more damage leading to kidney failure.

Arterial hypertension is of two types – primary and secondary.

Primary hypertension, also called essential hypertension, covers the greater percentage of hypertensives. The factors that lead to its appearance can be many and varied from stress, obesity, smoking, sedentary lifestyle, consumption of larger quantities of cooking salt, coffee, alcohol, genetic predisposition.

Unlike the previous one, secondary hypertension occurs as a symptom of another concomitant disease. It is also called symptomatic hypertension and develops most often in renal or endocrine diseases.

Controlling high blood pressure is important for overall health.

Here are some important steps that can be followed:

• A healthy, low-salt diet
• Regular physical activity
• Stress management
• Quitting smoking
• Maintaining a healthy weight
• Limiting caffeine and alcohol intake
• Administration of prescribed medication as needed