Renal Failure Treatment

The kidneys play important role in the daily body function, not only by filtering the blood and getting rid of waste products, but also by balancing levels of electroloyte in the body, controlling blood pressure, and stimulating the production of red blood cells.

When kidneys fail, your body needs treatment to replace the work your kidneys normally perform.

Renal Treatments:

Hemodialysis: Which requires a machine used to filter your blood outside your body

Peritoneal dialysis: Which uses the lining of your belly to filter your blood inside the body

Kidney transplantation: In which a new kidney is placed in your body

Renal Calculi Disease

Case Study a two month old small infant presented with failure to thrive, vomiting and recurrent infections, and weight loss. After comprehensive tests and diagnosis, the child was diagnosed to have a Renal tabular defect (d-RTA), and had bilateral nephrocalcinosis (Renal stones in both kidneys). With proper treatment, the baby’s metabolic condition was controlled and long term permanent damage to kidneys prevented.

Renal stones occurs in all parts of Genio-Urinary Tract, 97% occurs in the upper tracts (Parenchyma, Pelvis, Ureters), 3% are localized in the bladder and urethra. The major constituents are calcium oxalate 65% uric acid, 15% Struvite, 7% carbonate and Ohapatite 5%, others - cystine, Ammonia, urate, xanthine, 2,8diHydroxyadanine, protein etc.

Urinary stones (urolithiasis) is increasingly recognized in patients, with a variety of clinical settings.

  • Incedence - 1 – 1000-7000 hospital admissions
  • 110/1 lakh population/year in 10-19yr. age
  • more commen in males (M:F = 2:1)

Urine Stone Formation:

Its factors include age, sex, profession, mentality, nutrition, constitution, climate, race, inheritance leading to abnormal renal morphology + disturbed urine flow + UTI + Metabolic abnormality + genetic factor leading to Increased excretion of stone constituents + decreased excretion of stone forming inhibitors of crystallization leading to Physicochemical change in state of super saturation leading to abnormal (crystalluria + aggregation + growth ) leading to renal stone.

Associated Diseases :

Disturbances of (a) calcium metabolism – pHPT, dRTA, Batters, NF, Wilson’s, medullary sponge kidney, osteoporoses, immobilization, sarcoidosis, osteolytic metastasis, plasmocytoma (b) Oxalate metabolism – primary hyperoxaluria (1&2), Crohn’s ulcerative colitis (c) uric acid metabolism – anemia, neoplasia, intoxication, MI, irradiation, chemotherapy, gout, Lesh-Nyhan synd, Acute and Chronic Renal Failure, metabolic acidosis (d) infections – UTI, (e) Medication – Uricosurics, iuretics, analgesics, high dose vitamin A, D & C.

-Symptoms & Signs – varied, hidden, subtle

-Renal colic (Pain, sweating, abnormal BP, abdominal distension, Vomiting, oligo-anuria, dysuria, urgency, fever, sepsis, haematuria, etc.)

Obstructive pyelonephritis

Diagnosis : Urine – Routine and Culture, Spot (Ca, Urea, Creatinine, Albumin, Uric acid, P, Na, K, oxalate, citrate, Mg, NH3, cystine) with require 24 hours excretions, Radiology – Plain x-ray, USG, IVP, RGP, renal nuclear scans, MCU, Blood – Haemogram, Clotting profile, U/E/C, Ca, P, Alk. Phos, LFT, Uric acid, ABG, PTH. There are specific normograms for blood and specially urine for urinary excretion values, which are age dependent.

Infection induced renal calculi.

Rare in paediatrics, even rarer in infancy, staghorn calculi in early infancy vary rare. M > F, caused by urea splitting bacteria in recurrent Urinary Infections with abnormal super saturation and crystalluria, which causes alkaline urine these stones can contain calcium, Mg, NH3, P and matrix.

Treatment of Infection induced renal calculi. :-

  • 1.Acute UTI
  • 2.Diagnosis of cause of UTI
  • 3. Prophylaxis, urine PH modification, diet advise, watch for medication, which is nephrotoxic or stone causing, metabolic abnormality treatment eg. Vitamin B6, Allopurinal, indomethacin, K – supplementation, hydrochlrothiazie, etc.
  • 4. Urine stone analysis (X-ray diffraction, spectrometry)
  • 5.Watch for sepsis
  • 6.Surgical treatment – Open surgery, Endoscopic, PCNL, URS, Lithotripsy etc.

Dietary Modification helps in controlling kidney stone disease – diets high in cereals, low in animal protein and ketogemic diets often cause stones.

Suggested therapy for use lithiasis:-

  • For Hypercalciuria - reduction in dietary sodium, reduction in Thiazide use, add potassium citrate /phosphates.
  • For Hyperoxaluria - low oxatates, add phosphates, magnesium and pyridoxine
  • For Hyperuricosuria - Alkalinization of urine, with alloperinol.
  • For cystinuria - Alkalinization of urine, reduction of dietary sodium, add D- penicillamine, captopril.
  • Summary: early diagnosis and treatment of peadiatric kidney stone disease prevents chronic kidney failure and end organ damage. Specific centres with correct therapy are available in Delhi for treating even the smallest of infants with this disease