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Kidney failure is when your kidneys stop working well enough for you to live without
dialysis or a kidney transplant. Kidney failure can happen very suddenly (called acute
renal failure) or slowly over time. In most cases, kidney failure is permanent. This is
called end-stage renal disease or ESRD.
The tests for kidney failure are the same as the tests for CKD. If you think that you may
be at risk for kidney failure, ask your doctor about these tests:
eGFR (estimated glomerular filtration rate)
This test tells your doctor how well your kidneys clean your blood.
Your doctor tests your blood for a kind of waste called creatinine. Healthy
kidneys filter creatinine out of your blood. Your doctor will then use your
creatinine test result to figure out your eGFR.
An eGFR less than 60 for 3 months or more may be a sign of kidney disease.
Urine Test
This test tells your doctor if there is blood or protein in your urine.
Your doctor may test your urine in the office or ask you to collect your urine at
home.
Protein or blood in your urine may be a sign of kidney disease.
Blood Pressure
This test tells your doctor how hard your heart is working to pump your blood.
High blood pressure can cause kidney disease, but kidney disease can also cause
you to have high blood pressure.
For most people, a normal blood pressure is less than 120/80 (120 over 80). Ask
your doctor what your blood pressure should be.
What is CKD?
The term chronic kidney disease (CKD) means lasting damage to the kidneys that can
get worse over time. If the damage is very bad, your kidneys may stop working. This is
called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will
need dialysis or a kidney transplant in order to live.
Who is at risk?
Anyone can develop kidney disease, but you are more at risk if you:
Have diabetes
Have high blood pressure
Have heart disease
Have a family member with kidney disease
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If you treat kidney disease early, you may be able to slow it down!
If kidney disease is not treated, it can cause your kidneys to fail, and you will need
dialysis or a kidney transplant in order to live.
Strenuous exercise
Urinary tract infections
Kidney stones
Kidney injury
Cancer in the urinary tract
Talk to your doctor to find out what is causing blood to be in your urine. He or she may
ask for urine samples and blood tests to help find the cause. If your doctor cannot find
the cause of your hematuria through these tests, he or she may also suggest an imaging
test to get a picture of your urinary tract.
In some cases, the cause for hematuria is never found.
If you have microhematuria, you will not be able to see the blood in your urine. In this
case, your doctor will need to look at a sample of your urine under a microscope to see
the blood cells. For this reason, urine tests are part of regular checkups.
How is it treated?
The treatment for hematuria will depend on what is causing it. Talk to your doctor about
what is causing the blood in your urine and what treatment is right for you.
Classification
Kidney failure can be divided into two categories: acute kidney injury or chronic kidney
disease. The type of renal failure is differentiated by the trend in the serum creatinine;
other factors that may help differentiate acute kidney injury from chronic kidney disease
include anemia and the kidney size on sonography as chronic kidney disease generally
leads to anemia and small kidney size.
from chronic kidney disease if the patient has not been monitored by a physician and no
baseline (i.e., past) blood work is available for comparison.
replace the natural breakdown of old red blood cells. As a result, the blood carries
less hemoglobin, a condition known as anemia. This can result in:
o Feeling tired and/or weak
o Memory problems
o Difficulty concentrating
o Dizziness
o Low blood pressure
Normally, proteins are too large to pass through the kidneys, however, they are
able to pass through when the glomeruli are damaged. This does not cause
symptoms until extensive kidney damage has occurred,[13] after which symptoms
include:
o Foamy or bubbly urine
o Swelling in the hands, feet, abdomen, or face
Other symptoms include:
o Appetite loss, a bad taste in the mouth
o Difficulty sleeping
o Darkening of the skin
o Excess protein in the blood
o With high dose penicillin, people with kidney failure may experience
seizures[14]
Causes
Acute kidney injury
Acute kidney injury (previously known as acute renal failure) - or AKI - usually occurs
when the blood supply to the kidneys is suddenly interrupted or when the kidneys
become overloaded with toxins. Causes of acute kidney injury include accidents, injuries,
or complications from surgeries in which the kidneys are deprived of normal blood flow
for extended periods of time. Heart-bypass surgery is an example of one such procedure.
Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or
chemotherapy, may also cause the onset of acute kidney injury. Unlike chronic kidney
disease, however, the kidneys can often recover from acute kidney injury, allowing the
patient to resume a normal life. People suffering from acute kidney injury require
supportive treatment until their kidneys recover function, and they often remain at
increased risk of developing future kidney failure.[15]
Among the accidental causes of renal failure is the crush syndrome, when large amounts
of toxins are suddenly released in the blood circulation after a long compressed limb is
suddenly relieved from the pressure obstructing the blood flow through its tissues,
causing ischemia. The resulting overload can lead to the clogging and the destruction of
the kidneys. It is a reperfusion injury that appears after the release of the crushing
pressure. The mechanism is believed to be the release into the bloodstream of muscle
breakdown products notably myoglobin, potassium, and phosphorus that are the
products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic
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conditions). The specific action on the kidneys is not fully understood, but may be due in
part to nephrotoxic metabolites of myoglobin.
Genetic predisposition
The APOL1 gene has been proposed as a major genetic risk locus for a spectrum of
nondiabetic renal failure in individuals of African origin, these include HIV-associated
nephropathy (HIVAN), primary nonmonogenic forms of focal segmental
glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to
other etiologies.[19] Two western African variants in APOL1 have been shown to be
associated with end stage kidney disease in African Americans and Hispanic Americans.
[20][21]
Diagnostic approach
Measurement for CKD
Stages of kidney failure
Chronic kidney failure is measured in five stages, which are calculated using a patients
GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with
few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their
medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5
usually require preparation of the patient towards active treatment in order to survive.
Stage 5 CKD is considered a severe illness and requires some form of renal replacement
therapy (dialysis) or kidney transplant whenever feasible.
Glomerular filtration rate
A normal GFR varies according to many factors, including sex, age, body size and ethnic
background. Renal professionals consider the glomerular filtration rate (GFR) to be the
best overall index of kidney function.[22] The National Kidney Foundation offers an easy
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to use on-line GFR calculator[23] for anyone who is interested in knowing their glomerular
filtration rate. (A serum creatinine level, a simple blood test, is needed to use the
calculator).
In addition to tracking your GFR, blood tests can show when substances in your blood
are out of balance. If phosphorus or potassium levels start to climb, a blood test will
prompt your health care provider to address these issues before they permanently affect
your health.
TypesEach patient is classified into one of the following 5 stages of CKD according to the
progression of damage.
Complications
Anemia hemoglobin levels drop and not enough oxygen reaches many parts of
the body.
Central nervous system damage.
Dry skin, skin color changes.
Fluid retention this can lead to swollen tissue, heart failure, and fluid build-up
in the lungs.
Hyperkalemia blood potassium levels rise; this can result in heart damage.
Insomnia this is a common consequence of kidney failure
Lower libido (sex drive)
Male erectile dysfunction.
Osteomalacia bones become weak and break easily.
Pericarditis the sac-like membrane that envelops the heart (pericardium)
becomes inflamed.
Stomach ulcers.
Weak immune system the patient becomes much more susceptible to infection.
Complications in children:
experience worsening hypertension and an increase in waste products in their blood. This
can affect both the mother and her baby.
Women with chronic kidney failure who are pregnant have a significantly higher risk of
developing preeclampsia, compared to other women blood pressure rises dangerously
high. If left untreated the result could be a brain hemorrhage, or hemorrhaging in the liver
or kidneys both potentially fatal for both mother and baby.
Treatment
(a)Treating the cause
First treat the cause, but kidney damage can continue to worsen even when an underlying
condition, such as high blood pressure, has been controlled.
(b)Treating complications
Kidney disease complications can be controlled to make you more comfortable.
Treatments may include:
So medicines to lower the High Blood Pressure are given, commonly angiotensinconverting enzyme (ACE) inhibitors or angiotensin II receptor blockers and to
preserve kidney function.
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If the kidneys cant keep up with waste and fluid clearance on their own and person
develops complete or near-complete kidney failure, he or she has end-stage kidney
disease. At that point, dialysis or a kidney transplant is needed.
Homeopathic medicines1. Ammonium carbonicum: mental sluggishness, fatigue, turbid, bloody, scanty or
fetid urine and painful urination.
2. Apis mellifica: kidney inflammation, urine suppression and general edema.
3. Arsenic album: scanty and burning urination, difficult urination and nephritis.
4. Aurum metallicum: urine with mucous sediment and painful retention of urine.
5. Chelidoniumm majus: copious urination, pale white urine and frequent night
urination.
6. Cuprum Arsenicosum: painful urination, discolored urine and kidney function.
7. Cuprum Metallicum: clear watery urine, sharp pain in urethra, bed-wetting,
urine suppression and frequent urination of fetid and viscid urine.
8. Opium: general edema, urine suppression, uremic convulsions, body
sluggishness, black stool and white urine.
9. Phosphorous: uremia, turbid urine with sedimentation, kidney swelling and
extreme fatigue.
10. Terebinthina: kidney and urinary tract inflammation and discolored urine.
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albuminous urine, bloody urine, anaemia, nausea, vomiting, difficult respiration, anger &
anxiety. So, I prescribed Arsenic Album. The serum creatinine level became normal after
taking this medicine of 6,30 & 200 potencies. But her appetite was not increased by
Arsenic Album. Another complaints of constipation was disturbing her too much. Then I
prescribed the second selected medicine LYCOPODIUM 30 as it is a good medicine for
constipation, old age & loss of appetite. This medicine increased her appetite and cured
constipation. Now she is taking Arsenic Album 1m, 1dose X 15 days for her complaints
of mind.
The MAHT Improvement percentage in CRF stage wise
% of
improvement
in MAHT
Stage
GFR level
CKD1
above
90mL/min/1.73m2
100%
CKD2
60 to 89
mL/min/1.73m2
100%
CKD3
30 to 59
mL/min/1.73m2
70% to 80%
CKD4
15 to 29
mL/min/1.73m2
50% to 60%
CKD5
less than 15
mL/min/1.73m2
50% to 60%
Approximate
Visible
Improvement
Period by
MHAT
Within 1month
Within 1month
Within 2months
Within 4months
Within 4months
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