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Renal Replacement Therapy
Renal Replacement Therapy :
When kidney function is such that life can not be sustained without supplementing kidney function by external help, renal replacement therapy is started. In temporary renal disease (most cases of AKI) this is required for short periods only. Once kidneys recover, RRT is stopped. In permanent kidney disease (End stage Renal Disease) RRT is required through life.
RRT is of 2 types
Dialysis either regular intermittent hemodialysis or Continuous Ambulatory Peritoneal Dialysis.
Renal Transplant is the method of choice in all age groups where feasible. All human beings usually have 2 kidneys. However, about 1 in 400 persons is born with one kidney. They can pass through life without difficulty and without realising that they have only one kidney.
Since one fully functioning kidney is enough to sustain life, in renal transplant an extra kidney is placed in the patient of CKD (Chronic kidney disease). This kidney than can maintain life by working almost as patients own kidneys.
Requirements for renal transplant
The person suffering from kidney failure should not have cancers, advanced diseases of heart, lungs, liver etc. If the life expectancy of the person due to the diseases of other organs is a few months, only transplant is of little benefit. HIV is no longer an absolute contraindication, and many renal transplants have now been done in patients with Hepatitis B and C positivity. Age of the patient is usually not a bar for transplant.
The second important factor is a donor. The donor can be a cadaver ( in case of brain death a heart beating donor or nowadays in some cases a nonheart beating donor as well.). In the latter case, kidneys are removed immediately after cessation of heart activity.
The other variety of donors are live donors who have 2 healthy kidneys and wish to donate one of these for the recovery of their near and dear ones.
In India, Transplant of Human Organs Act with its various amendments from time to time, allows donation from near relatives ie parents, grandparents, siblings, children and spouse. All other transplants are called unrelated transplants. Any transactions financial, inducements of any nature etc are forbidden by law. These are morally indefensible and attract severe punishment for this crime.
The donor has to be willing and should be under no pressure to donate his kidneys. He or she should be well informed about the procedure, its various risks, likely outcomes and associated complications both in the long and short term.
Donors undergo a series of evaluation for determining fitness for the act of donation. These are then examined by a committee to ensure that the transplants can be performed as per the provisions of the law and necessary care has been taken to ensure the safety of the patient.
For patients suffering from type II /adult onset diabetes :In type II diabetes, diagnosis is often late (after the disease has already been present for some time). In early days T2DM (short for the adult type of diabetes) are often without symptoms. Hence the delay in diagnosis. This means complications will be seen early after diagnosis. Foot Care :
Foot disease in diabetes may lead to difficulty in walking, pain and may lead to infections. If neglected amputation may be required.
Inspect feet with a mirror before going to sleep every night.
Use well fitting shoewear.
Do not walk bare feet even in the house.
Socks should be clean and correct size.
In case of deformities of feet, special shoes can be worn. Eye Care :
It is nowadays the commonest cause of blindness throughout the world. Continue Reading ~ Second Medical Opinion / Advice
Nephrotic Syndrome Kidneys receive approximately 1 liter of blood every minute. Of this, about 100 ml gets filtered in the kidney. This contains, small molecules and few large molecules. This is due to the intricate cellular structure that prevents proteins from getting filtered into the urinary space. A derangement of this filter results in passage of heavy amounts of proteins in urine. This condition is called HeavyProteinuria or Nephrotic syndrome or Nephrosis. Definition:
In the urine, the protein excretion is > 3.5 gm/day or in children, it is >50mg/kg of body weight. In most cases, the serum albumin is <3gm/dl (normal>4), and passage of lipids in the urine. The lipids in the blood increase and swelling of face and feet also occur. Causes of Nephrotic Syndrome:
In children, most cases are due to Minimal Change Disease, FSGS, MPGN etc. In adults, most cases are due to primary illness while upto 30% may be due to secondary illness. Clinical Features:
Apart from Edema, ther…
Asthma or Bronchial Asthma is a common disease. About 75 % cases start in childhood before 10 years of age. A large no of patients stop having symptoms at the time of puberty and some may again have the disease in the later years. It is uncommon after 50 years of age. It can be troublesome, disabling and if not treated properly may be dangerous.
The disease results from heightened reactivity of the airways in response to irritants, allergens, fumes and at times exercise. It is typically intermittent and a person feels well when there is no ongoing attack of asthma. Symptoms:
Symptoms of asthma are shortness of breath, difficulty in breathing, cough and whistling sounds during breathing. These symptoms may also be seen in a no of heart, lung or infective conditions. Hence the diagnosis is usually made by experienced doctors after a few episodes have occurred!
The important markers of the disease are rapid reversibility of the signs and symptoms with appropriate treatment or spontaneousl…