যাঁরা কিডনি সংক্রান্ত
কোনো রোগের জন্যে বেশি
ঝুঁকিতে আছেন বা
যাঁদের বয়স ষাটের বেশি অথবা যাঁদের ডায়াবেটিস কিংবা হাই ব্লাড প্রেসার আছে , এমন কি যাঁদের শরীরে
মেদ বেশি অথবা যাঁদের
পরিবারের কারুর কিডনি ফেইলিওর হয়েছে৷ তদের ঊচিত প্রতি বছরে কমপক্ষেে একবাার কিডনি পরিক্ষা করানো ৷
তবে
খেলাধুলা, হাঁটাচলা বা এক্সারসাইজ করতে পারলে
ব্লাড প্রেসার কমিয়ে রাখা যায় এবং
ডায়াবেটিস ও নিয়ন্ত্রিত রাখা
সম্ভব ৷
ডাক্তাররা বলেন ডায়াবেটিস থেকেই কিডনি’র
সমস্যা দেখা দেয়৷ তাই দেখাা যায়
ডায়ালিসিস পেশেন্টদের ৩০ শতাংশ
হল ডায়াবেটিসের রোগী৷
অন্যদিকে
নিয়মিত ব্লাড
সুগারের লেভেল স্টেডি বা নিয়ন্ত্রনে
রাখা ও
জরুরী ৷কারণ
উচ্চ ব্লাড সুগার কিডনির
ভেতরের ব্লাড ভেসেল’গুলোর ক্ষতি করে থাকে
থাকে ৷ ফলে
ঠিকমতো শরীরের রক্ত
পরিশোধন হয় না৷শরীরের
ব্লাড সুগারের পরিিমান
ঠিক রাখতে পারলে, কিডনিও
ভালো থাকে৷
আর
উচ্চ রক্তচাপ কিডনি
ফেইলিওর-এর দ্বিতীয় প্রধান কারণ হিসেবে আজকাল
গণ্য করা হয়
৷ তাই দীর্ঘমেয়াদে হাই ব্লাড প্রেসার কারো থাকলে
তার শরীরের ব্লাড
ভেসেলগুলোর ক্ষতি
হতে পারে ৷ কিডনির কর্মক্ষমতা
অক্ষত রাখার জন্য রক্তচাপ ১৪০/৯০-এর মধ্যেই রাখতে
হবে ৷তাই রক্তচাপ
কম রাখার জন্য দরকার পড়লে ওষুধ খেতে হবে৷
কিডনিকে
ভাল রাখতে হলেে
প্রয়োজন ব্যালেন্সড ডায়েট গ্রহণের ৷
এই জন্যে অবশ্যই ফলমূল, শাকসবজি, ফাইবার ইত্যাদি খেয়ে ওজন ঠিক
বা নিয়ন্ত্রনে রাখতে হবে
৷শরীর বেশি মোটা হওয়ার সঙ্গে রক্তের উচ্চচাপ এবং ডায়াবেটিস উভয়েরই
যোগ আছে৷ আর এই
সঙ্গে যতো কম সম্ভব লবণ
খাওয়া উচিত ৷ কেননা
শরীরে অতিরিক্ত পরিমাণ লবণ কিডনির ক্ষতি করে ৷
শরীর
থেকে ক্ষতিকর পদার্থ ফিলটার করে বার করার জন্য এবং কিডনির কাজ
চালু রাখতে পানির
প্রয়োজন হয় ৷ তাই একজন লোকের
দিনে দেড় থেকে দু’লিটার
পানি খাওয়া উচিত৷আর ক্রীড়াবিদ
বা যারা বেশী
শারীরিক পরিশ্রমের কাজ
করেন তাদের আরো
বেশি পানি পান করতে
হবে ৷ তবেে ডায়ালিসিস-এর পেশেন্টদের অনেক কমেই কাজ চলে যায়৷
সংগ্রহ কৃত
Some more information ( from internate )
What are the
kidneys?
The kidneys play key roles in body function, not
only by filtering the blood and getting rid of waste products, but also by
balancing the electrolyte levels in the body, controlling blood pressure, and
stimulating the production of red blood cells.
The kidneys are located in the abdomen toward the
back, normally one on each side of the spine. They get their blood supply
through the renal arteries directly from the aorta and send blood back to the
heart via the renal veins to the vena cava. (The term "renal" is
derived from the Latin name for kidney.)
The kidneys have the ability to monitor the
amount of body fluid, the concentrations of electrolytes like sodium and
potassium, and the acid-base balance of the body. They filter waste products of
body metabolism, like urea from protein metabolism and uric acid from DNA
breakdown. Two waste products in the blood usually are measured; 1) blood urea
nitrogen (BUN), and 2) creatinine (Cr). When blood flows to the kidney, sensors
within specialized kidney cells regulate how much water to excrete as urine,
along with what concentration of electrolytes. For example, if a person is dehydrated from exercise or from an illness, the kidneys will
hold onto as much water as possible and the urine becomes very concentrated.
When adequate water is present in the body, the urine is much more dilute, and
the urine becomes clear. This system is controlled by renin, a hormone produced
in the kidney that is part of the fluid and blood pressure regulation systems
of the body.
Kidneys are also the source of erythropoietin in the body, a hormone that stimulates
the bone marrow to make red blood cells. Special cells in the kidney monitor
the oxygen concentration in blood. If oxygen levels fall, erythropoietin levels
rise and the body starts to manufacture more red blood cells.
Urine that is made by each kidney flows through
the ureter, a tube that connects the kidney to the bladder. Urine is stored
within the bladder, and when urination occurs, the bladder empties urine
through a tube called the urethra.
Kidney
failure may occur from an acute situation that injures the kidneys or from chronic
diseases that gradually cause the kidneys to stop functioning.
In acute renal failure, kidney function is lost
rapidly and can occur from a variety of insults to the body. Since most people
have two kidneys, both kidneys must be damaged for complete kidney failure to
occur. Fortunately, if only one kidney fails or is diseased it can be removed,
and the remaining kidney may continue to have normal kidney (renal) function.
If a both patient's kidneys are injured or diseased, a donor kidney(s) may
transplanted.
The list of causes of kidney failure is often
categorized based on where the injury has occurred.
Prerenal causes (pre=before + renal=kidney) causes are due to decreased blood
supply to the kidney. Examples of prerenal causes of kidney failure are:
§
Hypovolemia (low blood volume) due to blood loss
§
Dehydration from loss of body fluid (for example, vomiting, diarrhea, sweating, fever)
§
Poor intake of fluids
§
Medication, for example, diuretics ("water pills") may
cause excessive water loss
§
Abnormal blood flow to and from the kidney due to obstruction of
the renal artery or vein.
Renal causes of kidney failure (damage directly to the kidney itself)
include:
infection and causes
inflammation and shutdown of the kidneys. This usually does not occur with
simple urinary
tract infections.
Medications: Some medications are toxic to the kidney including:
§
Nonsteroidal
anti-inflammatory drugs(NSAIDs) like ibuprofen (Advil, Motrin, and others), and naproxen (Aleve, Naprosyn)
§
Antibiotics like aminoglycosides gentamicin(Garamycin), tobramycin
§
lithium (Eskalith, Lithobid)
§
Iodine-containing medications such as those injected for radiology
dye studies
Rhabdomyolysis: This is a situation in which there is significant muscle breakdown
in the body, and the damaged muscle fibers clog the filtering system of the
kidneys. Massive muscle injury may occur because of trauma, crush injuries, and
burns. Some medications used to treat highcholesterol may causerhabdomyolysis.
Acute glomerulonephritis or inflammation of the
glomeruli, the filtering system of the kidneys. Many diseases can cause this
inflammation including:
§
Goodpasture syndrome.
Hemolytic
uremic syndrome: This condition results
from abnormal destruction of red blood cells. It most often occurs in children
after certain infections, but also may be caused by medications, pregnancy, or
can occur for unknown reasons.
Post renal causes of kidney
failure (post=after + renal=
kidney) are due to factors that affect outflow of the urine:
§
Obstruction of the bladder or the ureters can cause back pressure
because the kidneys continue to produce urine, but the obstruction acts like a
dam, and urine backs up into the kidneys. When the pressure increases high
enough, the kidneys are damaged and shut down.
§
Prostatic
hypertrophy or prostate cancer may block the urethra and prevents the
bladder from emptying.
§
Tumors in the abdomen that surround and obstruct the ureters.
§
Kidney stones. Usually, kidney stones affect only one kidney and do not
cause kidney failure. However, if there is only one kidney present, a kidney stone
may cause the remaining kidney to fail.
Chronic renal failure develops over months and years. The most common causes of chronic
renal failure are related to:
§
poorly controlled diabetes,
§
poorly controlled high
blood pressure, and
§
chronic glomerulonephritis.
Less common causes of chronic renal failure
include:
§
Reflux nephropathy (damage caused by urine backflow from the
bladder into the ureters and kidney)
§
Nephrotic syndrome
§
Alport's disease
§
Interstitial nephritis
§
Kidney stones
What are the signs and
symptoms of kidney failure?
Initially, kidney failure may be not produce any
symptoms (asymptomatic). As kidney function decreases, the symptoms are related
to the inability to regulate water and electrolyte balances, clear waste
products from the body, and promote red blood cell production.
If unrecognized or untreated, the following
symptoms of kidney failure may develop into life-threatening circumstances.
§
Lethargy
§
Weakness
§
Generalized swelling (edema)
§
Generalized weakness due to anemia
§
Loss of appetite
§
Lethargy
§
Fatigue
§
Congestive heart failure
§
Metabolic acidosis
§
High blood potassium (hyperkalemia)
§
Fatal heart rhythm disturbances (arrhythmias)
including ventricular tachycardia and ventricular fibrillation
§ Rising urea levels in the blood (uremia) may lead to brain encephalopathy, pericarditis (inflammation of the
heart lining), or low calcium blood levels (hypocalcemia)
Does kidney failure cause
pain?
Kidney failure in itself does not cause pain.
However, the consequences of kidney failure may
cause pain and discomfort in
different parts of the body.
Amyloid proteins
Normal functioning kidneys filter amyloid (a
protein) from the blood stream. In kidney failure amyloid proteins in the blood
rise, and can separate and clump together forming amyloid deposits into a
variety of tissue and organs, including joints and tendons. This can result in
symptoms of:
§
joint stiffness,
§
pain,
and
§
swelling.
Procedure related pain
§
Patients who are on dialysis may have discomfort when on the
dialysis machine.
Underlying chronic disease pain
§
Pain is often a consequence of the underlying chronic disease that
led to kidney failure, for example:
§
People with poorly controlled diabetes may develop diabetic
neuropathy pain.
§
People who have peripheral
vascular disease also may
have pain in their extremities, and may develop claudication (leg pain that occurs with walking).
§
§
How is kidney failure
diagnosed?
Often, a patient is seen for another medical
condition and the diagnosis of kidney failure is a consequence of the patient's
disease or injury. In patients with chronic kidney disease due to diabetes,
high blood pressure, or another related medical condition; the patient's
medical care team most likely monitors kidney function as part of the patient's
routine long-term medical care plan.
Blood tests
Diagnosis of kidney failure can be confirmed by
blood tests such as BUN, creatinine,
and GFR; that measure the buildup of waste products in the blood.
Urine tests
Urine tests may be ordered to measure the amount
of protein, detect the presence of abnormal cells, or measure the concentration
of electrolytes.
Other tests
Other tests are used to diagnose the type of
kidney failure such as:
§
What is the treatment for kidney
failure?
Prevention is always the goal with kidney
failure. Chronic diseases such as hypertension (high blood pressure) and diabetes are devastating because of the damage
that they can do to kidneys and other organs. Lifelong diligence is important
in keeping blood sugar and blood pressure within normal limits. Specific
treatments depend upon the underlying diseases.
Once kidney failure is present, the goal is to
prevent further deterioration of renal function. If ignored, the kidneys will
progress to complete failure, but if underlying illnesses are addressed and
treated aggressively, kidney function can be preserved, though not always
improved
Diet
Diet is an important consideration for those with
impaired kidney function. Consultation with a dietician may be helpful to
understand what foods may or may not be appropriate.
In
this state of impaired kidney function, the kidneys cannot easily remove excess
water, salt, or potassium from the blood, so foods high in potassium salt
substitutes may need to be consumed in limited quantities. Examples of
potassium rich foods include:
§
Bananas
§
Apricots
§
Cantaloupe
§
Sweet potatoes
§
Yogurt
§
Spinach
§
Avocados
Phosphorus
is a forgotten chemical that is associated with calcium metabolism and may be
elevated in the body in kidney failure. Too much phosphorus can leech calcium
from the bones and cause osteoporosisand fractures.
Examples of foods and beverages high in phosphorus include:
§
Milk
§
Cheese
§
Nuts
§
Dark cola drinks
§
Canned iced teas
§
Yogurt
§
Organ meets
§
Sardines
§
Oysters
§
Baked beans
§
Black beans
§
Lentils
§
Kidney beans
§
Soy beans
§
Bran cereals
§
Caramels
§
Whole grain products
Medications
Different classes of medications may be used to
help control some of the issues associated with kidney failure including:
§
Phosphorus-lowering medications, for example, calcium
carbonate (Caltrate),calcitriol (Rocaltrol), and sevelamer (Renagel)
§
Red blood cell production stimulation, for example, erythropoietin, darbepoetin (Aranesp)
§
Red blood cell production (iron supplements)
§
Blood pressure medications
§
Vitamins
Once
the kidneys fail completely, the treatment options are limited to dialysis or
kidney replacement by transplantation.
Dialysis and Hemodialysis
Dialysis cleanses the body of waste products in
the body by use of filter systems. There are two types of dialysis; 1)
hemodialysis, and 2) peritoneal dialysis.
Hemodialysis uses a machine filter called a
dialyzer or artificial kidney to remove excess water and salt, to balance the
other electrolytes in the body, and to remove waste products of metabolism.
Blood is removed from the body and flows through tubing into the machine, where
it passes next to a filter membrane. A specialized chemical solution
(dialysate) flows on the other side of the membrane. The dialysate is
formulated to draw impurities from the blood through the filter membrane. Blood
and dialysate never touch in the artificial kidney machine.
For
this type of dialysis, access to the blood vessels needs to be surgically
created so that large amounts of blood can flow into the machine and back to
the body. Surgeons can build a fistula, a connection between a large artery and
vein in the body, usually in the arm, that allows a large amount of blood flow
into the vein. This makes the vein swell or dilate, and its walls become
thicker so that it can tolerate repeated needle sticks to attach tubing from
the body to the machine. Since it takes many weeks or months for a fistula to
mature enough to be used, significant planning is required if hemodialysis is
to be considered as an option.
If
the kidney failure happens acutely and there is no time to build a fistula,
special catheters may be inserted into the larger blood vessels of the arm,
leg, or chest. These catheters may be left in place for weeks. In some
diseases, the need for dialysis will be temporary, but if the expectation is
that dialysis will continue for a prolonged period of time, these catheters act
as a bridge until a fistula can be planned, placed, and matured.
Dialysis
treatments normally occur three times a week and last a few hours at a time.
Most commonly, patients travel to an outpatient center to have dialysis, but
home dialysis therapy is becoming an option for some.
Outpatient dialysis is
available on some cruise ships. They are equipped with dialysis machines with trained
health care professionals ready to care for those with kidney failure while
traveling.
Peritoneal dialysis
Peritoneal
dialysis uses the lining of the abdominal cavity as the dialysis filter to rid
the body of waste and to balance electrolyte levels. A catheter is placed in
the abdominal cavity through the abdominal wall by a surgeon, and it is
expected to remain in place for the long-term. The dialysis solution is then
dripped in through the catheter and left in the abdominal cavity for a few
hours and then is drained out. In that time, waste products leech from the
blood flowing through the lining of the abdomen (peritoneum), and attach
themselves to the fluid that has been instilled by the catheters. Often,
patients instill the dialysate fluid before bedtime, and drain it in the
morning.
There
are benefits and complications for each type of dialysis. Not every patient can
choose which type he or she would prefer. The treatment decision depends on the
patient's illness and their past medical history along with other issues.
Usually, the nephrologist (kidney specialist) will have a long discussion with
the patient and family to decide what will be the best option available.
Dialysis
is life-saving. Without it, patients whose kidneys no longer function would die
relatively quickly due to electrolyte abnormalities and the buildup of toxins
in the blood stream. Patients may live many years with dialysis but other
underlying and associated illnesses often are the cause of death
Kidney transplantation
If kidney failure occurs and is non-reversible,
kidney transplantation is an alternative option to dialysis. If the patient is
an appropriate candidate, the healthcare professional and nephrologist will
contact an organ transplant center to arrange evaluation to see whether the
patient is suitable for this treatment. If so, the search for a donor begins.
Sometimes, family members have compatible tissue types and, if they are
willing, may donate a kidney. Otherwise, the patient will be placed on the
organ transplant list that is maintained by the United Network of Organ
Sharing.
Not
all hospitals are capable of performing kidney transplants. The patient may
have to travel to undergo their operation. The most successful programs are
those that do many transplants every year.
While
kidney transplants have become more routine, they still carry some risk. The
patient will need to take anti-rejection medications that reduce the ability of
the immune system to fight infection. The body can try to reject the kidney or
the transplanted kidney may fail to work. As with any operation, there is a
risk of bleeding and infection.
Kidney
transplants may provide better quality of life than dialysis. After one year,
95% of transplanted kidneys are still functioning and after five years the
number is 80%. It seems that the longer a patient is on dialysis, the shorter
the life of the transplanted kidney.
If
the transplanted kidney fails, the alternative is another kidney transplant or
a return to dialysis
What is the prognosis for
someone with kidney failure?
The outlook for kidney failure depends upon the
underlying condition that caused it. Kidney function may return to normal,
especially if it is due to an acute obstruction and that obstruction is
relieved. Other causes of decreased kidney function leading to kidney failure
are due to underlying disease and occur slowly over time.
Prevention
is the best chance to maintain kidney function, and controlling high blood pressure anddiabetes over a lifetime can decrease the
potential for progressive kidney damage. Chronic kidney failure may be managed
by a primary health care practitioner or a nephrologist to help monitor
electrolyte and waste product levels in the bloodstream. Major abnormalities
can be life-threatening, and treatment options may be limited to dialysis or
transplant
Source –
from internate ,
মন্তব্যসমূহ
একটি মন্তব্য পোস্ট করুন