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Urinary tract infections are a common condition, especially in women.

They occur when bacteria enter the urinary tract and begin to multiply, the most common cause being the bacteria Escherichia coli that normally inhabit the intestines.

Although they can affect anyone, some people are more susceptible to them.

Symptoms of a urinary tract infection can vary, but most commonly include:

• Frequent urination: More frequent urge to urinate, even with small amounts of urine.
• Pain or burning when urinating: A sharp sensation when passing urine.
• Sensation of incomplete emptying: A feeling that the bladder is not emptying completely.
• Blood in the urine: Sometimes the urine may have a pink or red tint.
• General weakness and fatigue: In some cases, the infection can cause fever, chills and lower abdominal pain.

Causes of urinary tract infections

They may include:

• Anatomical Features: Women are more prone to urinary tract infections due to their shorter urethra compared to men.
• Immune system disorders: Diseases that weaken the immune system can increase the risk of infections.
• Kidney stones: Stones can block the flow of urine and create a breeding ground for bacteria.

Diagnosis and treatment

• Urine analysis

Treatment usually involves taking antibiotics, which are selected depending on the type of infection causing the infection.

Can we prevent a urinary tract infection?

Here are the actions we may take.

• Good intimate hygiene
• Adequate water intake: Increasing fluid intake helps flush bacteria from the urinary tract.
• Avoid urinary retention: When you feel the urge to urinate, go to the toilet.
• Wearing cotton underwear: Cotton allows the skin to breathe and reduces the risk of irritation.

Important: If you have recurring urinary tract infections, consult a doctor to determine the cause and receive appropriate treatment.

ВОДА И БЪБРЕЧНА ФУНКЦИЯ – ВЗАИМОВРЪЗКА

Kidney stone disease is a common condition that affects millions of people worldwide. Kidney stones can be painful and debilitating. The good news is that there are many things you can do to reduce your risk of developing kidney stones.

What is kidney stone disease?

Kidney stone disease is a condition in which hard deposits, called stones, form in the kidneys. Kidney stones can be as small as a grain of sand or as large as a golf ball. They can be composed of a variety of substances, including calcium, oxalate, urate, and phosphate.

Symptoms of kidney stone disease

The most common symptom of kidney stone disease is severe pain in the lower back or side. This pain may radiate down to the groin or thighs. Other symptoms may include:

• Bloody urination
• Nausea and vomiting
• Frequent urination
• Need to urinate urgently
• Pain or burning during urination
• Sensation that the bladder is not emptying completely

Causes of kidney stone disease

The exact cause of kidney stones is unknown, but there are a number of factors that can increase your risk, including:

• Dehydration: Not drinking enough fluids can make your urine more concentrated, making it easier for stones to form.
• Diet: A diet high in animal protein, oxalates, salt and sugar can increase your risk of kidney stones.
• Obesity: People who are overweight or obese are more likely to develop kidney stones.
• Certain medical conditions: Certain medical conditions, such as inflammatory bowel disease and hyperparathyroidism, can increase your risk of kidney stone disease.
• Family history: If you have a family history of kidney stones, you are more likely to develop the condition.

Prevention of kidney stone disease

There are many things you can do to reduce your risk of developing kidney stones, including:

• Drink plenty of fluids: Aim to drink eight glasses of water or other calorie-free beverages a day.
• Eat a healthy diet: Eat a diet rich in fruits, vegetables and whole grains. Limit intake of animal proteins, oxalates, salt and sugar.
• Maintain a healthy weight: If you are overweight or obese, losing weight can help reduce your risk of kidney stones.
• Control your medical conditions: If you have a medical condition that increases your risk of kidney stones, work with your doctor to control it.

Treatment of kidney stone disease

Treatment for kidney stones depends on the size and location of the stone. Small stones can often be passed in the urine on their own with plenty of fluids and pain relievers. Larger stones may need to be broken up with shock waves or laser treatment or removed by surgery.

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

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.

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.

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

3. Frequent urination
4. Delayed growth
5. Loss of appetite and chronic nausea
6. Fatigue
7. 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

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