Nephrology

 

It is a branch of internal medicine that deals with the health and diseases of the kidneys, and it is the application area of one of the internal medicine sciences.

It can also be called kidney diseases medicine / specialty.

 

In our Emsey Hospital Nephrology clinic, services are provided in the diagnosis of kidney diseases, taking preventive measures and treatment of kidney diseases.

 

WHAT IS KIDNEY DISEASE?

Kidney disease is a condition that occurs when your kidneys are damaged and do not perform the functions they should. When kidney disease becomes permanent, it is called chronic kidney disease. If the kidney is damaged in a short time, acute kidney injury is mentioned.

1. Waste products cannot be removed. If you have chronic kidney disease, waste products, salts, and water cannot be properly removed from the body.

2. Waste products accumulate. In chronic kidney disease, waste products and water accumulate in the body.

3. Progress. Chronic kidney disease usually progresses slowly over time, but this progression varies from person to person.

4. Signs and symptoms may not be obvious. The accumulation of waste products usually does not give specific signs and symptoms in the early stages of kidney disease. Few signs occur, often when kidney function drops below 15%.

5 Other organs. The kidneys are in communication with many organ systems such as the heart, lungs, brain, blood and skin. Kidney diseases can also affect these.

 

RISK FACTORS FOR RENAL DISEASE

 

1. Diabetes and high blood pressure. Some other diseases, such as diabetes and high blood pressure, can lead to kidney disease.

2. Family history. If someone else in your family has kidney disease, is on dialysis, or has had a kidney transplant, you have a higher risk of developing kidney disease than people without such a history.

3. Medicines. Some drugs (painkillers other than paracetamol, such as diclofenac, naproxen, etadolac, dexketoprofen) can cause or worsen kidney disease.

4. Age and race. Elderly people and certain races are at an increased risk of developing kidney disease.

 

TESTS REQUIRED FOR DIAGNOSIS OF KIDNEY DISEASE

 

1. eGFR. The eGFR (estimated glomerular filtration rate) test gives you and your doctor information about the rate at which your kidneys remove waste products from the body. Normal eGFR should be greater than 100. An eGFR below 60 indicates kidney disease.

2. Protein in the urine. The protein is normally found in the body but is not seen in the urine. Tests that detect protein in a urine sample can be done. Too much protein in the urine can be a sign of kidney damage.

3. High blood pressure. High blood pressure can be a sign or cause of kidney disease

4. Ultrasound. Scanning the kidneys with an ultrasound device can show kidney sizes, cysts, or kidney stones. It can give information about whether the urine and blood flow from the kidneys is normal.

 

 

KIDNEY DISEASE TREATMENT METHODS

 

1. Blood pressure. In kidney disease patients, blood pressure targets change according to the type of disease. Blood pressure should be kept below 130/80 mmHg frequently to prevent disease progression.

2. Medicines. These patients should take one of the drugs in the ACE inhibitor or Angiotensin Receptor Blocker group at the recommendation of their doctor to slow the progression of the disease.

3.Healthy lifestyle. Patients with kidney disease should not smoke, be physically active, and maintain the weight recommended by their doctor.

4. Dealing with other complications. Patients with chronic kidney disease should be evaluated and treated for conditions associated with kidney disease, such as anemia and bone mineral disorders.

 

WHAT IS END-STAGE KIDNEY DISEASE?

 

End-stage kidney disease (ESKD), also called kidney failure, refers to a condition in which your kidneys cannot excrete waste products, water, and you feel unwell.

End-stage kidney disease is permanent and the chances of regaining kidney function are very low.

In this case, you should talk with your follow-up doctor about the treatment options in end-stage kidney disease and decide on the most appropriate treatment.

 

WHAT ARE THE OPTIONS?

 

There are several treatment options for end-stage kidney disease. These are kidney transplantation, dialysis and supportive therapy. Your choice will help you live longer, improve your quality of life, and reduce other health problems.

Kidney transplantation. In this treatment, someone else's kidney is implanted in your body.  This can be a living person's (family member or, in special cases, a friend) kidney or a brain-dead patient's kidney.

There are 2 types of dialysis

Hemodialysis. In this type of treatment, your blood is passed through a machine to remove waste products and excess fluid from the body. In this treatment, hemodialysis is performed at a center for 4 hours 2-3 days a week, or in some patients, dialysis is performed all night at home.

Peritoneal dialysis. In this type of treatment, a tube is placed in the patient's abdomen to remove waste products and excess water. The patient gives the dialysis fluid to their stomach with this tube, and this dialysis fluid is then discharged from the body along with the waste materials. This dialysis is done every day. It performs cleaning during the day or at night while sleeping.

 

WHY IS A KIDNEY TRANSPLANT NEEDED?

 

If the kidneys are not working well and are not expected to recover, patients will need dialysis or a kidney transplant to survive. In a kidney transplant, the surgeon places a working kidney into a patient with kidney failure. Kidney transplant may be the best treatment option for kidney failure. It is important to discuss this option with your doctor.

After the transplant. Kidney transplant patients are generally healthier, have an improved quality of life, and experience fewer medical complications than patients on dialysis.

 

WHAT IS ACUTE KIDNEY DAMAGE?

 

Acute kidney damage (AKD) is the sudden loss of kidney function that develops within hours or days.

Acute kidney damage and chronic kidney disease.  Kidney functions often improves after acute kidney damage, but in some cases, patients do not fully recover. These patients may develop chronic kidney disease (CKD).

 

WHAT CAUSES ACUTE KIDNEY DAMAGE?

 

Acute kidney damage can develop from reduced blood flow to the kidneys, direct damage to the kidneys, or obstruction in the urinary outflow from the kidneys.

Reasons

The main causes of sudden damage to the kidneys are:

Serious health problems, such as a heart attack, serious infections (sepsis), or the stop of urine flow due to kidney stones

Some drugs that have harmful effects on the kidney, painkillers other than paracetamol, such as diclofenac, naproxen, etadolac, dexketoprofen and herbal supplements

Some drugs used in medical imaging (contrast agents used in angiography and tomography)

Thirst due to not eating or drinking, or vomiting, diarrhea or bleeding

 

WHO IS AT RISK OF ACUTE KIDNEY DAMAGE?

 

Patients with diabetes

Patients with chronic kidney disease,

Patients undergoing cardiac catheterization

Patients undergoing cardiac bypass surgery

Patients with heart failure

Patients with liver disease

Older patients

 

HOW IS ACUTE KIDNEY DAMAGE  DIAGNOSED?

 

Changes in blood creatinine level provide information about the kidney's clearing rate and its ability to remove toxins from the body. If there is a sudden increase in creatinine, it may be from acute kidney damage or sudden loss of kidney function.

The amount of urine is also used to detect problems in kidney function. Decreased urine output or the stop of urine suggests kidney damage.

 

HOW DOES ACUTE KIDNEY DAMAGE AFFECT YOUR BODY?

 

When kidney damage develops, waste materials and fluid accumulation occur in the body.

 

WHAT SHOULD BE DONE?

 

Treatment of acute kidney damage depends on how serious it is and the cause of the acute kidney damage.

Dialysis. If acute kidney damage is severe, short-term dialysis may be needed to remove waste products and fluid from the body. Rarely, dialysis may be needed in the long term.

Post-discharge care. It is important that your doctor re-evaluates you after discharge. You will have to state on other doctor appointments that you have had acute kidney damage before.

 

IS ACUTE KIDNEY DAMAGE PERMANENT?

 

If detected early, acute kidney damage can be reversible when the cause is determined and treated. However, some patients may have chronic kidney disease in the following years.

 

WHAT ARE KIDNEY STONES?

 

A kidney stone is a stone-like deposit of minerals and crystals formed in the kidney. Stones can sometimes interrupt the flow of urine, cause pain or bleeding in the urine.

In patients with kidney stones, the probability of seeing a second stone within 10 years is 50%.

Patients with a family history of kidney stones are twice as likely to develop stones as normal people.

 





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