Management Of Chronic Renal Failure Research Articles

Intestinal Dialysis Research Progress and the Early Treatment of a NonDiabetic Patient with Symptomatic Uremia and Fatty Liver with Intestinal Dialysis: The Practice of Evidence-Based Medicine

Background: Chronic renal failure results from a variety of pathophysiological mechanisms and etiologies, and is associated with progressive and irreversible damage and loss of the kidneys’ tissue leading to failure of the kidneys to excrete waste products, and also failure to perform some other functions. Many patients with chronic renal failure in a country like Iraq has been reported to be reluctant to accept dialysis therapies because of the wide spread notion of its association with high mortality. The lack of effective, convenient, and affordable therapy for chronic renal failure in many regions of the world should not mean should that the patients with advanced chronic renal failure are left without other suitable, convenient and acceptable care. The aim of this paper is to describe the early treatment of a patient with symptomatic uremia with intestinal dialysis. Patients and Methods: A 60-year non-diabetic male patient was experiencing progressive symptomatic uremia. On the 18th of November, 2023, blood urea was elevated at 217 mg/dL, serum creatine was 5.2 mg/dL, and he had symptomatic uremia with nausea, vomiting, fatigue, pruritus and anemia. The patient was treated with intestinal dialysis (Acacia gum supplementation plus conservative dietary and pharmacological management of chronic renal failure) which was prescribed according to the latest published guidelines. It was necessary during the first week of treatment to eliminate almost all dietary protein, and his diet was consisting mainly of high calorie juices, grapes, and water melon. Results: When the patient was seen on the 2nd of December, 2023, treatment was associated with marked symptomatic and laboratory improvements. Blood urea was 115 mg /dL, serum creatine was 3.6 mg /dL However, and serum calcium was 5.3 mg/dL (Normal ranges: 8-10.5 mg/dL). Therefore, oral alphacalcidol was added in a dose of 1 microgram daily. Conclusion: Intestinal dialysis will continue to be used to improve the management of chronic renal failure and symptomatic uremia as long as there is no convenient and affordable therapy for chronic renal failure in many regions of the world.

Oral and dental manifestations in chronic renal failure with type 2 diabetic patients receiving hemodialysis

The significance of oral health care, in management of chronic renal failure with type 2 diabetes mellitus (CRF with T2DM) has been widely acknowledged. However, attention to the oral health care has been lacking, especially in developing countries like India because of high burden of renal diseases. To assess the prevalence of oral and dental manifestations in chronic renal failure with type 2 diabetic patients receiving hemodialysis and healthy individuals.: This study was conducted in department of oral pathology, Vydehi Institute of dental sciences, Bangalore. A total of 51 subjects comprising of 24 chronic renal patients with type 2 diabetes mellitus and 27 healthy individuals were considered for the study. Oral examination was performed using diagnostic instruments as described by Kerr, Ash, and Millard. Oral lesions such as gingivitis 14(52%), and periodontitis 4(15%) were most frequently seen lesion in CRF with T2DM when compared to healthy individuals. Candidal infection were found to be 4(17%) in CRF with T2DM and 2(7%) in healthy individuals. Other findings were uremic fetor showed highest prevalence followed by xerostomia, halitosis and so forth. The difference between the group were found to be statistically significant (P<0.005).The study showed the increase in prevalence of oral manifestations in CRF with T2DM as compared to Healthy controls. As the incidence of CRF cases continues to rise worldwide, early diagnosis of oral manifestations and their appropriate management can improve the quality of life.

Management of Chronic Renal Failure (CRF) through Ayurveda –A Case Report

Chronic renal failure (CRF)is one of the clinical entities which occurs as a result hampering of renal function due to many medical or systemic illness developed due to current fast lifestyle. The contemporary science has quite expensive modalities having non confirming results in advanced stages of diseases. Ayurveda, an ancient science, prefers to prevent or treat the disease in initial condition to avoid such complications. The present case study was taken up to evaluate the cumulative effect of Shodhana & Shamana Chikitsa in CRF based on the collaborative application of two fundamental principles of Ayurveda i.e., root cause analysis and treatment according to underlying pathophysiology involved in specific clinical conditions. This is a case report of a male patient having age 69 years who was diagnosed as CRF before five years & on regular conservative treatment in modern science. However, due to persistent increase in values of renal profile, he approached to Panchakarma OPD MGACH& RC. He underwent Dashmooladi Sasneha Niruha Vasti in addition to some proprietary as well as traditional Ayurvedic medicines (Syp. Neeri KFT, Chandrapbha Vati, Punaranavdi Qwath, Gomutra Arka). After one month, there was significant reduction in values of serum creatinine & Serum Blood urea from 4.89 to 1.21 & 64 to 50 respectively with a substantial decrease in systolic & diastolic blood pressure along with improvement in patients' quality of life. This case study will become helpful in planning further research studies with a large sample size based on cost-effective standard regime in Ayurveda for the management of CRF.

Vitamin D and Parathyroid Hormone Profiles in Living Kidney Failure Patients in Côte d’Ivoire

Introduction: Abnormalities in mineral and bone metabolism, particularly phosphocalcic metabolism, are common in renal failure and are associated with a significant morbidity and mortality. The regulation of phosphocalcic metabolism is subject to a particularly precise and complex control of parathormone (PTH) and vitamin D. Assessment of vitamin D and parathyroid hormone concentrations would help to improve the medical management of patients with chronic kidney disease and ensure a better quality of life. Methods: The study population consisted of 138 individuals including 46 non- dialysis renal failure patients, 46 chronic hemodialysis patients and 46 non- renal failure volunteers to serve as controls. Serum Parathyroid hormone and Vitamin D concentrations were measured using the Vidas automated system. Results: 25-hydroxyvitamin D concentrations in controls (65 ± 2.41 nmol/L) and dialysis patients (70 ± 3.03 nmol/L) were significantly higher than those in CKD patients (48 ± 3.34 nmol/L). On the other hand, the mean values of Parathyroid hormone in dialysis patients (312 ± 36.22 pg/mL) and CKD patients (117 ± 10.68 pg/mL) were very high compared to that in controls (25 ± 2.34 pg/mL). Conclusion: Secondary hyperparathyroidism is common in renal failure. Parathyroid hormone and 25-hydroxyvitamin D assays would be adequate for better management of chronic renal failure.

Anaesthesia of the patient with chronic kidney disease

Chronic kidney disease is common, particularly in geriatric animals. General anaesthesia is usually required for routine procedures (dental prophylaxis, ovariohysterectomy or castration) and emergency procedures, which may have profound effects on the body, especially on cardiac output, subsequent blood pressure and on the perfusion of different vital organs. It is essential to understand the effects of renal dysfunction on the patient, as well as the effects that anaesthesia and surgery may have on the kidneys. The understanding of renal physiology, along with the effect of drug choices, is key to successful management of chronic renal failure.

Exemple d’un cas d’hyperkaliémie du nourrisson : proposition d’un circuit pour le prétraitement du lait infantile par résine de polystyrène sulfonate de sodium à l’hôpital

Sodium polystyrene sulfonate (SPS) is used to reduce intestinal potassium absorption in hyperkalemia during conservative management of chronic renal failure in infants. Milk can be pretreated by SPS to reduce the risk of enteropathy associated with oral or rectal administration. We report the case of an infant for whom this pre-treatment has been implemented. The objective of this work was to define the hospital procedure for the pre-treatment of milk by the SPS. This pre-treatment involves both a drug and infant milk. Each product has its own regulation and their processes do not normally cross each other. The roles of each contributor were therefore defined: prescription of pre-treated milk (dose of SPS and volume of milk) by the physician, dispensing of SPS by the pharmacist, delivery of milk by the milk kitchen staff, pre-treatment by a nurse and administration by a nursing auxiliary. The preparation of the bottles is as follows: placing approximately 1g of SPS per 100mL of milk in contact, stirring, resting in the refrigerator for one hour, taking the supernatant to be administered. In the reported case, serum potassium levels were reduced from 5.57mmol/L before treatment to 4.53mmol/L after treatment, in line with the 20% decrease found in the literature. This method of administration is beneficial in terms of tolerance and acceptability. The preparation is simple and allows going back home under treatment.

Antioxidant and nephroprotection activities of Combretum micranthum: A phytochemical, in-vitro and ex-vivo studies

Management of chronic renal failure is exceedingly expensive. Despite of encouraging experimental outcomes, there is a lack of potent nephroprotective drugable molecules in a clinics or market. To develop a nephroprotective phytomedicine, the present study was designed to do a literature survey on reported phytochemical and biological analysis of Combretum micranthum and to carry out chemoprofiling, in-vitro antioxidant and ex-vivo nephroprotective capacity of the title plant. The phytochemical and biological activity survey of C. micranthum has reveals the presence of many bioactive compounds such as flavonoids, terpenoids, steroids and alkaloids with many biological activities. Phytochemical investigation re-confirmed the presence of these compounds. Hydroalcoholic extract of C. micranthum (CM extract) showed a strong antioxidant activity by scavenging AAPH, DPPH, nitric oxide, hydrogen peroxide and chelating metal ions. CM extract exhibited significant (P < 0.001) dose dependent inhibition of ferric chloride-ascorbic acid induced lipid peroxidation. Diabetic nephropathy is a serious and common complication leading to end stage renal disease. Therefore, in the present study, glucose-induced toxicity was also studied in human embryonic kidney cells (HEK-293) as an in vitro model for diabetic nephropathy. The results showed that exposure of cells to high glucose (100 mM) for 72 h significantly reduced the cell viability resulting in morphological changes such as cell shrinkage, rounded cell shape and cytoplasmic vacuolation. Treatment with CM extract at 10 and 25 μg/mL resulted in significant improvement in cell viability from 10 to 23% compared to the high glucose control. This study demonstrated the potential antioxidant and nephroprotective properties of C. micranthum, justifying its traditional use in the treatment of various diseases.

Red blood cell alloimmunization in multitransfused hemodialysis renal patients in central Sudan

Aims: Blood transfusion is an integral part in the management of chronic renal failure (CRF). Alloimmunization is a recognized complication of red blood cell (RBC) transfusion with consequences including delayed hemolytic transfusion reactions and difficulties in getting compatible blood for future transfusion. Therefore, the current study was designed to identify the frequency of RBC alloimmunization and the specificity of alloantibodies against red cell antigen among the hemodialysis patients. Methods: A total of 301 patients (239 males and 62 females) with CRF who received more than two units of blood and matched for ABO and Rh(D) antigen were enrolled in this cross-sectional study which was carried out from December 2016 to December 2017. After detailed history through questionnaire conducted to the patients, antibody screening was done by 2-cell panel with homozygous expression of the antigens (ID-Diacell I-II-DiaMed). Positive samples were further subjected to antibody identification using commercial panels of 11 cells (ID-DiaPanel- DiaMed). Results: Out of 301 patients 239 (79.4%) were males and 62 (20.6%) were females. The prevalence of alloimmunization was 16.9% and the most alloantibody frequent was anti-C (21.3%), anti-E (16.4%), and anti-K (14.8%). The most common alloantibodies produced were against Rh system (64%). Dual and triple antibody was observed. All alloantibodies were immunoglobulin G (IgG) class except anti-M was IgG and immunoglobulin M (IgM). Conclusion: This study showed that 16.9% of the multitransfused patients with chronic kidney disease (CKD) developed alloantibodies, most of which were of the Rh phenotype. These alloantibodies may lead to allograft rejection, or even poor patient survival. Thus, we advocate that renal transplant be instituted at the earliest opportunity whenever it becomes inevitable as a modality of treatment to enhance better outcomes.

Addressing prescription discrepancies in renal patients: a prospective audit.

Background Management of chronic renal failure requires complex medication regimens to manage hypertension, hyperlipidaemia, diabetes, phosphate, anaemia and acidosis. Patient engagement in medicine management is essential to avoid potential harm. Methods We prospectively audited the rate of discrepancies between our hospital record of patient medications and their current prescription. We investigated whether changes to appointment letters reduced the number of discrepancies. Results The proportion of patients attending renal outpatient clinics failing to bring a list or unable to recall their medications fell over a 3-year period following changes to appointment letters (median proportion: 0.45 in 2014, 0.36 in 2015, 0.30 in 2016, Chi-sq = 46.94, p < 0.001); percentage of patients forgetting to bring a list with significant prescription discrepancies fell from 10.9% in 2014 to 3.9% in 2016). Conclusion Changes to appointment letters can potentially improve prescribing safety in an outpatient setting.

Epidemiology and management of chronic renal failure: a global public health problem

Epidemiology and management of chronic renal failure: a global public health problem

A clinical analysis of vitrectomy for severe vitreoretinopathy in patients with chronic renal

BackgroundThe recent advancement in the management of chronic renal failure (CRF) has significantly increased the longevity of the patients, which increase the incidence of severe vitreoretinopathy. The vitrectomy is highly risky in this particular group of patients due to their systemic comorbidity. The timing surgical intervention is usually delayed because of the systemic conditions. This study is to evaluate the safety and effectiveness of 25-guage vitrectomy for severe vitreoretinopathy in the CRF patients.MethodsIn this retrospective study, 16 eyes of 16 CRF patients with severe vitreoretinopathy were undergone 25-guage vitrectomy in the department of Ophthalmology of the Second Hospital of Tianjin Medical University from February 2015 to April 2017. The visual outcome, complications and perioperative medical management were documented and analyzed.ResultsThe best-corrected visual acuity(BCVA)of fourteen eyes were lower than 20/200 preoperatively. Surgery duration ranged from 28 to 72 min, with a mean of 48.4 ± 13.6 min. During the surgery, 12 eyes were diagnosed with DR, while two them were complicated with tractional retinal detachment and one with branch retinal vein occlusion. Three eyes were diagnosed with branch retinal vein occlusion, and one eye was diagnosed with hypertensive retinopathy. Postoperative BCVA of six eyes ≥20/40, seven eyes ≥20/200, and three eyes < 20/200. BCVA of eight eyes improved more than three lines, three eyes improved two lines, and four eyes improved one line. BCVA decreased from hand movement to light perception in one patient who developed neovascular glaucoma two weeks after surgery.ConclusionIn chronic renal failure patients with severe vitreoretinopathy, the well-planned minimally invasive vitrectomy is effective and safe. Additionally, careful management of the perioperative systemic conditions is important to improve the visual acuity and quality of life as well.

Therapeutic Management of Chronic Renal Failure in a Dog

A case of chronic renal failure (CRF) was diagnosed in an eight year old Labrador dog on the basis of history, clinical signs, physical examination, hematology, plasma biochemistry, followed by confirmation with the help of ultrasonography and urinalysis. Urinalysis on the day of presentation revealed turbid straw colored urine, decreased specific gravity, trace amount of non-haemolysed blood, alkaline pH, marked proteinuria, high inflammatory cells, leucocyte count (125cells/µl) and epithelial cast. Basing on the creatinine value, the case was diagnosed as terminal stage 4 CRF. The patient was treated with fluid therapy, antibiotic, antacid, antiemetic, calcium supplement, multivitamin, and erythropoietin. Though the prognosis in case of end stage CRF is guarded, nevertheless, it took 30 days to bring back the animal from stage 4 to stage 2 with clinical signs of improvement and it was followed up to 5 months without any further complication.

Dialysis: A Review of the Mechanisms Underlying Complications in the Management of Chronic Renal Failure.

Chronic renal failure (CRF) is the most prevalent, worldwide public health problem of the elderly population. The main cause of CRF is a damaged kidney. There are five stages of CRF based on the glomerular filtration rate (GFR), and stage 5 (GFR < 15 ml/min/1.73m2) is often called an end-stage renal disease (ESRD). In CRF, there is an accumulation of toxins and excess water due to compromised renal function. Dialysis is the preferred way to treat ESRD and remove accumulated toxins from the body. The cardiovascular risk associated with dialysis is 10 to 20 times higher in patients undergoing dialysis than in normal people. The inflamed kidneys and the process of dialysis also affect endothelial function, aggravating the risk of hypertension and cardiac problems. Therefore, both physicians and patients should be aware of the consequences of undergoing dialysis. There is an urgent need to educate CRF patients regarding facts about the disease, medications, dietary habits, and various measures required to manage the condition and lead a normal life. This paper attempts to delineate the mechanisms that could result in cardiovascular and other complications among CRF patients undergoing dialysis.

HUBUNGAN SELF EFFICACY DENGAN KECEMASAN PENDERITA GAGAL GINJAL KRONIK YANG MENJALANI HEMODIALISA DI RSUD JOMBANG

Chronic kidney disease is irreversible, meaning there could be normal again, who could do is maintain existing renal function undergoing dialysis treatment throughout their lives (usually 1-3 times a week) or to get a new kidney through a kidney transplant operation. It can lead to psychological disorders such as anxiety. With Anxiety will exacerbate the perceived disease. One of the factors that influence anxiety is self-efficacy. This research aims to determine the correlation of self-efficacy with the level of anxiety in patients with chronic renal failure undergoing hemodialysis in Jombang Public Hospitals.This research is a correlation analytic method with cross sectional approach. In this research population of 33 respondents include all patients with chronic renal failure undergoing hemodialysis in Jombang Public Hospitals first time - 6 months. A sample of 30 respondents were taken using accidental sampling. The independent variable was self-efficacy, the dependent variable anxiety, how to collect data by statistical tests used questioner Spearman's rank. The research was conducted on 24-31 May 2016. The statistical test used in this study was Spearman's rank correlation. Based on the results of research in Hemodialysis room Jombang Public Hospitals found that half (50%) of respondents have a positive self-efficacy and nearly half (36.7%) of respondents are not anxiety. Statistical test results showed significancy value of 0.001(p &lt;0.05). It was indicated that there was a correlation of self-efficacy with the level of anxiety in patients with chronic renal failure undergoing hemodialysis in the hemodialysis room Jombang Public Hospitals in 2016.Need to improve services through counseling, information and education on management of chronic renal failure and can provide knowledge about self efficacy other than that can involve the family in supporting the implementation of self-efficacy.&#x0D;

Homeopathic management of chronic renal failure in its various stages – case studies

Chronic Renal Failure is a challenge for the modern medical world and with the changes towards a cosmopolitan life style, its incidence is increasing manifold. Patients are often left with practically no non-interventional treatment option. Renal replacement therapies may prolong life, but the quality of life is severely compromised.

Клиническое наблюдение и тактика ведения хронической почечной недостаточности у ребенка с наследственно детерминированной патологией почек

Клиническое наблюдение и тактика ведения хронической почечной недостаточности у ребенка с наследственно детерминированной патологией почек

A case-control study on the affective temperament profiles, anxiety and depression levels of patients with chronic renal failure

Objectives: To determine the affective temperament profile of patients with chronic renal failure (CRF) in comparison to healthy subjects and to evaluate depression and anxiety status of patients. Methods: This was a case-control study into which 122 CRF patients (63 males, 59 females) and 100 healthy age- and gender-matched controls (66 females, 34 males) were included. The affective temperament profile was determined by Turkish version of Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Auto-questionnaire (TEMPS-A). For the assessment of depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) was used. Results: Of the 122 patients, 28 (23%) were in predialysis, 22 (18%) periton dialysis, 30 (24.6%) hemodialysis and 42 (34.4%) transplantation. The majority of participants (n=169, 76.1%) had no dominant affective temperament according to TEMPS-A. For the remaining participants, the most common dominant affective temperament was depressive temperament (8.6%) followed by mixed temperament (7.7%) and anxious temperament (2.7%). There was no signifcantly difference in terms of affective temperament traits between patients and controls. Patient group had significantly higher depression and anxiety scores than healthy controls. There was no correlation between laboratory results and affective temperaments, anxiety, depression scores of patients. There was no significant difference between predialysis, periton dialysis, hemodialysis, and transplantation subgroups in terms of anxiety, depression or affective temperament traits (p>0.05 for all). Conclusion: There is no affective temperament profile specific to patients with CRF. However, considering the high rate of depression and anxiety among patients with CRF, knowing affective temperament profile of patients will guide clinicians through management of psychiatric disorders and CRF itself, thus will improve disease outcome and patients’ quality of life.

慢性腎不全時におけるリンのコントロールの重要性 3．吸着剤の投与

慢性腎不全時におけるリンのコントロールの重要性 3．吸着剤の投与

Importance of Phosphate Restriction in Management of Chronic Renal Failure

Importance of Phosphate Restriction in Management of Chronic Renal Failure

Importance of Phosphate Restriction in Management of Chronic Renal Failure

Importance of Phosphate Restriction in Management of Chronic Renal Failure