samarqureshi

=Living With Kidney Disease: A Global Issue =

[[image:Kidney.jpg width="147" height="215" align="right"]]Kidney Disease
Kidney disease (also known as Renal Failure) can occur from many different sources such as diabetes, high blood pressure (hypertension), and heart disease. It can also be inherited through several different generations of prior ancestry; currently it is not fully understood the scope of the many causes of kidney disease. Chronic kidney disease (CKD) is defined as the decreased level of kidney function for a period of three months or more. CKD can be divided into five stages depending on how severe the damage is to the kidneys, or the level of decrease in kidney function. This does not mean that everyone starts at level 1 (being least severe), many people are diagnosed well into the late stages of failure when triggered by symptoms of kidney disease (KFC, p.2-1). It is estimated that 20 million people in America suffer from one of the 5 stages of CKD, and most don't even know it.

5 Stages of kidney disease [|[InfoSheet]]
People who have diabetes, high blood pressure, or a history of CKD in their family are the highest at risk of developing kidney disease. For the most part, in the first and second stages of CKD there are no symptoms to alarm the person their kidney function is deteriorating. If kidney failure is detected in the first two stages it is recommended to monitor creatinine level, blood pressure, and general health and well-being; it is far easier to sustain the functionality level of the kidney itself because once the kidney gets worse, it wont get any better over time since it doesn't regenerate itself like the liver does (KFC, p. 2-3). The symptoms for detecting CKD usually occur when the kidneys functions fall down to stage 3 in the 30-59% range. At this stage symptoms may include tiredness, poor apatite, and itchiness. In many cases at this stage amnesia may begin to occur as well. Seeing as a lot of these symptoms are common to most people for many different reasons, it is hard to know if it is CKD or something else. Institutions such as the Kidney Foundation of Canada (KFC) and the National Kidney Foundation (NKF) constantly educates people on early detection and promote living healthy and well because by the time most people find out, it‘s usually too late.

Stages 4-5 are the most severe. At stage 4 the kidneys are only functioning 15 - 29% and at this point they are barely able to keep the person alive. Symptoms that someone would feel include tiredness, poor appetite, and severe itching. Doctors would recommend to plan an access site for dialysis and provide education assistance for possible transplantation. At the 5th and final stage, the kidney is functioning less than 15%, the kidney is not working well enough to keep the person alive. Symptoms include poor sleep at night, difficulty breathing, itchiness, and frequent vomiting. At this stage it is required to start dialysis or kidney transplant procedures immediately.

Dialysis
Once an individual’s kidney function declines to about 10-15 % functionality (stage 5) intervention is necessary to sustain life. So, what is dialysis anyway? The concept of dialysis is quite simple. “Extracorporeal dialysis employs the artificial kidney (dialyzer) as semipermeable membrane, while Intracorporeal dialysis employs the peritoneal membrane” (Al-Halali, par 3). In other words, dialysis does the job of kidneys by cleaning out blood by using artificial kidneys (dialyzer) to restore important minerals and discard waste. There are three main types of dialysis: Hemodialysis, Peritoneal dialysis and Hemofiltration.

Hemodialysis means "cleaning the blood" and thats exactly what the treatment does (KFC, p. 3-2). A dialyzer (or artificial kidney) is attached to the machine. The dialyzer has two spaces: a space for blood and a palce for dialysis fluid. Dialysis fluid is a special liquid qhich helps remove waste products from the blood. The two spaces in the dialyzer are separated frome ach other by a very thin artificial membrane. Blood passes through one side of the membrane and the dialysis fluid passes on the other side. After the blood is cleaned, it is returned back into the body via the circut. This pressure gradient causes water and dissolved solutes to move from blood to dialysate, and allows the removal of several litres of excess fluid during a typical 3 to 5 hour treatment. The patient is attached to the dialysis machine in several ways: Internal fistula, Internal graft, and central venous catheter. This process can be done at home or at a dialysis clinic and is frequently done as the patient sleeps because of the lengh of time it requires the patient to be attached to the machine for (KFC, p. 3-9).

Peritoneal dialysis is another form of dialysis used to remove waste products and excess water. It works on the same principles as hemodialysis, but your blood is cleaned while still inside your body rather then attached to a machine (KFC, 3-13). "The inside of your abdomen is called the peritoneal cavity and it is lined with a thin membrane called the peritoneum. This membrane surrounds the intestines and other internal organs. In peritoneal dialysis, this cavity is filled with dialysis fluid which enters the body through a permanently implanted catheter" (KFPD, par. 2). The dialysate is left in the abdomin for a period of time to absorb waste products, and then it is drained out through the tube and discarded. ["This cycle or "exchange" is normally repeated 4-5 times during the day, (sometimes more often overnight with an automated system). Ultrafiltration occurs via osmosis; the dialysis solution used contains a high concentration of glucose, and the resulting osmotic pressure causes fluid to move from the blood into the dialysate. As a result, more fluid is drained than was instilled. Peritoneal dialysis is less efficient than hemodialysis, but because it is carried out for a longer period of time the net effect in terms of removal of waste products and of salt and water are similar to hemodialysis. Peritoneal dialysis is carried out at home by the patient and it requires motivation. Although support is helpful, it is not essential. It does free patients from the routine of having to go to a dialysis clinic on a fixed schedule multiple times per week, and it can be done while travelling with a minimum of specialized equipment"] (wikipedia on Peritoneal dialysis).

['Hemofiltration is a similar treatment to hemodialysis, but it makes use of a different principle. The blood is pumped through a dialyzer or "hemofilter" as in dialysis, but no dialysate is used. A pressure gradient is applied; as a result, water moves across the very permeable membrane rapidly, "dragging" along with it many dissolved substances, importantly ones with large molecular weights, which are cleared less well by hemodialysis. Salts and water lost from the blood during this process are replaced with a "substitution fluid" that is infused into the extracorporeal circuit during the treatment. Hemodiafiltration is a term used to describe several methods of combining hemodialysis and hemofiltration in one process'] (wikipedia on Hemofiltration).

Transplantation
A patient may receive a kidney from a living donor or a deceased donor. For a living donor to donate a kidney, there are several tests that they must go through to ensure good health and compatibility before anything takes place. A positive blood match is crutial for the body to accept the new kidney as its own. The transplanted kidney is placed in the front portion of the patients body under the stomach, not where you would find your typical kidney. The strengths of a kidney transplant are: improved lifespan, frees patient from dialysis, allows a greater variety of food choices, increases patients energy level, lets patent return to a normal life style. The limitations include: use of anti-rejection medication which frequently has side effects, increased possibility for infection, and increased possibility of certain types of cancer (KFC, 4-7). The best overall treatment for kidney failure is a kidney transplant, but as with everything else, there are still many risks. "The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased." (NEJM, par. 1)

Why did I choose this topic?
I was born with a single displastic kidney. This kidney currently is working aproximately 16% say the doctors. Even though doctors told me what that meant several times, only after completing this assignment do I really know where I stand for my own health sake, and I believe this wikipage puts together all the important information that someone with a kidney disease like mine needs to know.

Work Cited:
(A lot of information I used for this report is information doctors, nurses, and general information I have come to know about my own kidney condition compiled together.The wikipedia sources do not necessarily count towards my word count on my essay, I deemed them important to input because the information is elaborate and detailed on the issue [didn't see much point in rewording something that make sense])


 * 1) "Chronic Kidney Disease Growing Globally ( Researchers urge countries to make co...)." __Bio-Medicine - latest biology and medical news/technology__. 05 Feb. 2009 .
 * 2) KFPD - "Kidney Foundation - Peritoneal Dialysis." __The Kidney Foundation -__. 05 Feb. 2009 .
 * 3) (Kidney Foundation of Canada- KFC) __Living with Kidney Disease__. 4th ed. Library and Archives Canada Cataloguing in Publication, 2006.
 * 4) "NEJM -- Long-Term Consequences of Kidney Donation." __The New England Journal of Medicine: Research & Review Articles on Diseases & Clinical Practice__. 05 Feb. 2009 .
 * 5) "Principles of Dialysis." __Dialysis Tips__. Ed. Nabieh Al-Halali. 5 Feb. 2009 .
 * 6) "Your Kidneys and How They Work." __National Kidney and Urologic Diseases Information Clearinghouse__. Apr. 2007. NIDDK. 5 Feb. 2009 .