What is asymptomatic bacteriuria?

What is asymptomatic bacteriuria?

Asymptomatic bacteriuria is a situation that is applied as a medical term for when there are bacteria than usual in a person’s urine, however, the person does not have indications of urine tract infection (UTI). 

It is more typical in women than in men, it is found in people who are older and people who are sexually active, plus in people including specific medical dilemmas. It is also very obvious in people who do a urinary catheter; it is a tube that is set inside the urethra if he or she is not capable of urinating properly.

Asymptomatic bacteriuria normally goes beyond on its own as well as it does not lead to difficulties. In most instances, it does not necessitate any treatment.

How do they know if they have asymptomatic bacteriuria?

A urine test can determine if there are bacteria in the urine. However, most of the people who don’t have any symptoms of UTI need to evaluate for any cause of bacteria in urine. 

They might discover out they have asymptomatic bacteriuria after a urine test if the person is pregnant, and when they are planning to have specific kinds of surgery, or during evaluation for kidney transplantation.

What are urinary tract infections?

Urinary tract infections, additionally described by UTIs, further include bacteria in the urine. However, UTIs produce symptoms and signs as well as need treatment. 

UTIs harm the organs like the bladder or the kidneys. Bladder infections (also known as cystitis) are more prevalent than kidney infections. Bladder infections arise when bacteria go inside the urethra as well as it travels up inside the bladder.

Kidney infections (pyelonephritis) occur when the bacteria move even higher, up inside the kidneys. Symptoms of UTI can involve pain or a feeling of burning when they urinate, the necessity to urinate usually or abruptly, plus the blood in the urine (hematuria). Kidney infections can further create fever, nausea, back pain, as well as vomiting.

Throughout the asymptomatic bacteriuria plus UTIs, both include bacteria in the urine; the distinction is that people with asymptomatic bacteriuria do not feel any indications. Additionally, people with UTI signs require treatment with antibiotics, although most of the people with asymptomatic bacteriuria do not.

Do they necessitate antibiotics?

Apparently not, Most of the people with asymptomatic bacteriuria, do not necessitate any kind of treatment, however, few people do. That’s because in specific cases, the bacteria could drive to an infection as well as produce dilemmas.

The doctor will apparently treat them with antibiotics if they:

  • Are pregnant
  • Are preparing to have specific kinds of surgery including the urinary tract or genital area
  • Have had any kidney transplantation

If they are not in one of the above groups, as well as they do not feel any kind indications of a UTI, then they probably don’t need antibiotics. That’s because:

  • Bacteria in the urine normally go beyond without treatment.
  • If they don’t feel any indications, antibiotics will not improve the overall health or make them respond better. They also won’t reduce the chances of getting a UTI in the future.
  • Antibiotics can produce side outcomes like diarrhea, nausea, as well as vomiting.
  • Utilizing antibiotics when they are not required can begin antibiotic resistance. This is when bacteria become so that antibiotics cannot serve on them.

Can asymptomatic bacteriuria be limited?

No. There is a negative proven method to limit asymptomatic bacteriuria. Plus most of the people who possess it don’t even understand it since it does not produce any indications and normally goes beyond on its own.

Acute kidney injury

What is acute kidney injury (AKI)?

When kidney failure sets in a matter of a few hours or few days. Acute kidney injury is the point at which the kidneys all of a sudden quit working. Typically, the kidneys filter the blood and remove waste and water and maintain elements. “Acute” signifies a sudden or temporary or short period of time. In the case of an AKI nephrologist needs to be consulted as early as possible. Acute kidney injury is also known as Acute Kidney Failure or Acute Renal Failure.

What causes acute kidney injury? 

Acute kidney injury can have various causes. It can happen when: 

  • Less blood blood circulation to kidneys as in heart failure, shock, and other critical illnesses mostly in icu patients. 
  • The kidneys get damaged. A few reasons for kidney damage are cancer, infections, certain medicines, and some autoimmune conditions. 
  • Urine outflow tract is blocked. A few reasons for blockages are prostate issues (in men) and cancer. The blockage of urine causes pressure on the kidney, which prompts damage.

What are the symptoms of severe kidney injury? A few people don’t have any symptoms from the start. People who are in the hospital may discover that they have intense kidney damage after they have blood tests for another explanation. 

At the point when people do have symptoms, the symptoms can include: 

  • Less or no urine output 
  • Blood in the urine 
  • Swelling, particularly in the feet or face 
  • Vomiting, or not feeling hungry 
  • Feeling weak, or getting tired effectively 
  • Altered senses 
  • Seizures – Seizures are rushes of anomalous electrical activity in the brain. They can make people drop, or move or carry on abnormally.

Is there a test for acute kidney injury?

The Nephrologist will get some information about your symptoms and do an exam. To make sure how fine your kidneys are working, a nephrologist will do urine and blood tests. Main tests are blood urea, creatinine, electrolytes, urine analysis and ultrasound of the abdomen.

The vast majority will have an imaging test called an ultrasound to search for blockages in the urinary tract. Your kidney doctor may do different tests to search for different reasons for your intense kidney injury. Other tests like vasculitic markers, computed tomography and others.

If these tests don’t show what’s causing your intense kidney injury, your nephrologist may do a test called a kidney biopsy. For a kidney biopsy, the nephrologist will place a needle into your back and into your kidney. A Nephropathologist will look at the sample under a microscope. 

How is acute kidney injury treated?

Treatment relies upon what’s causing your intense kidney injury and how serious the kidney injury is. 

If AKI is because of medicine, a nephrologist will ask you to quit taking that medicine. In addition, to enable your kidneys to heal, the kidney doctor will give you medicines called steroids which might help in managing drug induced AKI or drug induced acute interstitial nephritis.

In the event that your acute kidney injury has another reason that can be treated, your nephrologist will treat it. For example, kidney doctors can treat infections with antibiotics. 

Some cases if AKI is secondary to some acute illness then after managing acute illness there will be spontaneous recovery of AKI.

Until your kidneys can work normally once more, you may require treatments to help ensure your body has the perfect measure of salt, fluid, and nutrients. Also control of excess toxins like urea, creatinine, potassium, phosphorus and others. These treatments can include: 

  • Medicines 
  • Changes in your diet 
  • Renal substitution therapy – This treatment assumes control over the job of your kidneys until they can heal. It includes either: 
  • Hemodialysis – Hemodialysis is a strategy where a machine assumes control over the job of the kidneys. The machine siphons blood out of the body, filters it, and returns it to the body. Frequency and duration might differ from cases of chronic kidney disease. In AKI patients may require daily or alternate days depending upon severity and extent of AKI.
  • Peritoneal dialysis – Peritoneal dialysis is a system that individuals do at home each day. It includes channeling a unique fluid into the belly. This fluid gathers waste and excess salt and water from the blood. At that point the pre-owned fluid drains out of the belly. In AKI generally peritoneal dialysis is not preferred as it can’t be started instantly. To begin this peritoneal dialysis catheter needs to be placed at least 7 days before starting dialysis. In AKI many times the decision of doing dialysis is sudden, there is no time to wait.

Finally AKI is an emergency condition. It needs to be detected at an early stage, as it is difficult to manage at a later stage of AKI. As soon as it is diagnosed, it needs to be referred to a nephrologist. Nephrologists will find out the cause, severity, further management and whether renal replacement therapy is required or not.

Waiting for Kidney Transplant during COVID-19 era

Waiting for Kidney Transplant during COVID-19 era

 

You must know a few facts about kidney transplant recipients, then only you can understand the implications. These patients are continuously required to take immunosuppressive drugs. Therefore, they have a higher risk of infection from corona virus or any other simple virus, such as cold or flu. To lower the chances of getting the coronavirus, kidney transplant patients should follow guidelines. They know how to avoid catching or spreading viruses. Moreover, they can contact their doctors, if they develop symptoms of COVID-19.

Should kidney transplant be done during COVID 19 pandemic?

Difficult to say, depends upon the medical council of state, kidney transplant centre, nephrologist, patient and family members. There are no specific guidelines. As there is very high mortality and morbidity in post kidney transplant patients especially who are having comorbidities like elderly, diabetes, heart disease, lung disease and graft dysfunction (high creatinine). If a patient with chronic kidney disease stage 5 requires kidney transplant and no comorbidities and no active infections can undergo kidney transplant with proper counselling and explaining all risks of covid 19 infection after kidney transplant.

Waiting for kidney transplant and getting COVID 19 infection can undergo kidney transplant?

After recovering with covid 19 infection patients can undergo kidney transplant. Need to check COVID RT PCR test and antibodies just before transplant procedure.

Can a covid 19 infected be a kidney donor?

After recovering, donors can be taken for transplant operation as in case of kidney transplant recipient. Obviously need to confirm that he is asymptomatic and negative covid 19 RT PCR test.

Are post-transplant patients at higher risk from contracting the disease from their family members?

If you have just undergone a kidney transplant and staying with family members. You should be cautious of members who have contracted the disease. They should take care of additional sanitization norms. Also be careful when you come in contact with your kidney transplant physician. Inform your nephrologist when you go for checkup.

Are young kidney transplant patients also at risk from COVID 19 infection?

Yes even kidney transplant recipients of pediatric age group and adolescence are developing mild to severe complications. Don’t take it lightly. They also develop severe pneumonia and are admitted in pediatric intensive care units.

 

How can I get emergency dialysis? 

You should keep your dialysis center number handy. In case, you face a situation where you need dialysis, call them up. They will schedule you, if it is urgent or else they will recommend you to the nearest center.

Moreover, during this time, you should have food with low sodium and potassium.

Do the transplant kidney patients and donors get affected by the virus?

Kidney transplant patients are at a higher risk of contracting Covid -19. However, the risk comes after the surgery. You cannot get the virus from donors. Donors are properly screened. Moreover, living donors should be careful, to take all precautions like use of proper masks, avoid unnecessary outings and better to be isolated.

However, if the following symptoms are there then I need to report.

Cold symptoms

Sore Throat

Fever

Less urine generation

Weight imbalance

Pain over transplant area

 

What should I know about medicines and treatments?

 

As reported worldwide, there is no miracle cure. No patients can be cured overnight. It depends on the patient’s immune system in totality. In fact, research on vaccinations is underway. There has been no concrete success on the same.

 

What are the Prevention tips? 

It is very important that you take proper care of yourself. You can undergo routine tests. Moreover, you can also get your urine samples checked. If there is no option for home testing, you need to go to the lab to give your samples. All healthcare areas are sanitizing their equipment and machinery before starting tests. Moreover, they are using PPEs while interacting with customers and patients. You yourself can wear a mask. Also, come back home and wash properly. Use hand sanitizers, wherever possible.  Moreover, you have to be well prepared.

You should buy extra supplies, that includes masks and disposable gloves.  This is to enable you to fight the virus. Be careful whenever you come into contact with someone at a medical center or someone in your locality. Also remember to disinfect touched surfaces such as doorknobs and countertops.

Will there be any drug supply delays in future?

The government is aiming to maintain a steady supply of all necessary medicines. Moreover, the Food and Drug Administration is keeping a close watch on drug supply and management. So, you need not worry. Just, buy what has been prescribed to you. Do not change the medicines without speaking to your doctor. There is a facility of medical companies supplying medicines through courier.

Are you feeling stressed out and depressed?

It is natural for those, who have been diagnosed with chronic kidney diseases to feel scared. Moreover, there are other patients as well, like those on dialysis, kidney transplant patients and donors to feel depressed. The most that you can do in such cases is to maintain the sanitization norms that the government has advised.  Indian government has some great ways for helping you to manage your stress and anxiety. They have even started helplines to assist you.

 

Do any of the kidney medications increase the risk from COVID-19?

Yes, it is true. Those who have comorbidities are at a higher risk of the infection. Cancer patients and those on immunosuppressive drugs are at a higher risk. These medicines and drugs reduce the body’s immune system. The immune system becomes powerless. Oral steroids taken as a part of the treatment also reduce the normal immune power. Moreover, if you are taking it for a longer time, it becomes all the more evident.

Are other medical conditions responsible for aggravation?

The Covid -19 virus aggravates the situation even more. The virus that causes the disease infects people of all ages. They are the older people over sixty years old.  Then people with medical conditions such as heart diseases, diabetes, asthma, other respiratory disease, and cancer. The risk of severe disease gradually increases with age starting from midlife. It is important that adults in this group save themselves from the virus.

What are various modes of distancing like?

They are self-isolation, quarantine and distancing. The self-isolation refers to separate and stay away in a room or a far off place. You should not talk or interact with anyone. They may be infected.

Quarantine means restricting all your activities. These are people with exposure to Covid conditions. They may not be infected yet but are taking precaution. They may carry symptoms.

Physical distancing means distancing norms for normal people. You should follow these norms when visiting markets and other public places.

Can children catch the disease?

Children and teens are also at a higher risk just like older adults and kidney patients. So, you must ensure to keep them well-protected. These groups should follow the same guidelines as followed by other members of the community. Do not allow children to play with other children from the community. This is a prerequisite. So, take care to follow it without fail.

Medicines used for COVID 19

Medicines used for COVID 19

 

Steroids

Use of steroids like methylprednisolone, hydrocortisone, dexamethasone or prednisolone also plays a very important role.

Steroids therapy in COVID 19 severe infection with respiratory distress leading to hypoxia on oxygen inhalation or on ventilator support –

Dexamethasone 6 mg per day for up to 10 days or until hospital discharge, whichever comes first.

Alternative steroids therapies are

    • Prednisone 40 mg
    • Methylprednisolone 32 mg
    • Hydrocortisone 160 mg
  • Frequency varies according to their half lives.
    • Long half life (36 – 72 hours)-dexamethasone; so need to be given once daily.
    • Intermediate half life (12 – 36 hours)- prednisone and methylprednisolone; administer once daily or in two divided doses daily.
    • Short half life (8 – 12 hours)-  hydrocortisone; administer in two to four divided doses daily.

Remdesivir

Till now the data though not statistically significant suggest that in patients who were on remdesivir showed lower mortality and faster recovery rate. It’s a broad-spectrum antiviral.It’s a nucleotide analog prodrug. 

  • Dose in adults – a single dose of 200 mg infused intravenously over 30-120 minutes first day subsequently once-daily maintenance dose of 100 mg, same administration method. for 4 days.
  • To be diluted in 250 mL 0.9% saline and infuse over 30 to 120 minutes 
  • Duration is 5 days to 10 days. (Data comparing 5 days versus 10 days courses show similar outcomes). In patients with severe illness on ventilator or ECMO support 10 days of therapy is under trials.

Adverse effects

 

  • Hepatitis 
  • Increase prothrombin time.
  • Acute kidney injury over underlying chronic kidney disease.

 

Children

Also there are similar data (with positive results but not statistically significant) on use in children with severe disease requiring support of ventilators and or  ECMO support.

Pregnancy

It is used in pregnancy with good outcomes.

 

Renal Impairment

In patients especially with low glomerular filtration rate (GFR) (less than 30 ml/min) there are many side effects. Patients with eGFR greater than or equal to 30 mL/min are reported to have received remdesivir for treatment of COVID-19 with no dose adjustment of remdesivir. 

It’s active ingredient that is sulfobutylether-β-cyclodextrin sodium salt (SBECD) cleared from kidneys and it’s concentration increases in patients with renal failure, administration of drugs formulated with SBECD (such as remdesivir) is not recommended in adults.

Remdesivir is being used in severe suspected and confirmed cases of COVID-19 infection. But for renal failure data related to safety of its use is not available. thus it is still unknown. Also in dialysis and post kidney transplant patients there is no data available.

 

Drug interactions with remdesivir

Use of chloroquine and hydroxychloroquine (HCQS) with remdesivir is not recommended. with chloroquine or hydroxychloroquine. There is a potential reduction of antiviral activity of remdesivir because of chloroquine or hydroxychloroquine. The vitro data confirmed the antagonistic effect of chloroquine on the intracellular metabolic activation and antiviral activity of remdesivir.

 

Antithrombotic therapy

Not required in non hospitalised patients. Also not to be given post discharge from hospital.

Indicated in hospitalised patients as prophylaxis per protocol of Venous thromboembolism (VTE).

Therapeutic doses of antithrombotics in following-

  1. In cases with incident VTE or clinically highly suspicious of VTE
  2. Patients on ECMO, on dialysis with dialysis catheters

 

Azithromycin

Azithromycin is an antibiotic drug that helps fight the bacteria. It is used to treat various types of infections which are caused by bacteria like respiratory infections, skin  and other infections.

If there is a history of hepatitis post azithromycin it’s use should be avoided. 

Also history of allergic to drugs like clarithromycin, erythromycin, or

telithromycin.

To make sure that one is safe taking this drug one has to tell the doctor if ever had  – 

  • liver disease
  • kidney disease
  • myasthenia gravis
  • a heart rhythm disorder
  • low levels of potassium in your blood or
  • long QT syndrome (family history is also important)

What should not be taken if one is having azithromycin – 

Not to take any antacids that contain aluminium or magnesium before or after 2 hours of taking azithromycin.

 

Renal Dose Adjustments

Moderate to mild renal dysfunction (CrCl greater than 10 mL/min):  adjustment is not recommended.

Severe renal dysfunction (CrCl less than 10 mL/min): to be used with caution.

In dialysis patients dose is not confirmed

 

Hydroxychloroquine sulfate (HCQS)

HCQS tablets constitute 200 mg hydroxychloroquine sulfate, equivalent to 155 mg base.

HCQS is indicated for the treatment of chronic discoid lupus erythematosus and systemic lupus erythematosus in adults.

It’s use is doubtful. Rather recently studies have shown no benefit and it should not be used in COVID 19 infection.

Also if used with azithromycin there can be further prolongation of Qtc.

Dose in COVID 19 800 mg PO once on Day 1, subsequently 400 mg PO once daily for 4–7 days. Duration of treatment is still not confirmed.

 

Adverse effects

  • Prolonged QTc interval, arrhythmia
  • GIT effects (e.g., nausea, vomiting, diarrhea)
  • Increase liver enzymes
  • Low sugars
  • Myopathy
  • Neuropsychiatric effects
  • Allergic reactions

 

Renal dysfunction: No adjustment recommended.

Dialysis : Data not available

 

Vitamin C

Recommended daily dose of vitamin C for adults and children of age more than 4 years is 60 mg. Can be increased to 90 mg/ day in the normal population.

There is insufficient data suggesting use of vitamin c in COVID 19 infection. 

For prevention for COVID 19 200 mg of vitamin C daily or 1-2 grams daily for COVID-19 treatment. 

For maintenance hemodialysis (MHD) patients advise supplementation with ascorbic acid 75-90 mg daily to replace the losses of this water-soluble vitamin that occur during dialysis.

Vitamin C is renal excreted, intake more than 200 mg/day should be avoided in kidney failure to avoid oxalosis. Oxalosis is the accumulation of the metabolic by-product of ascorbic acid. Many organs and body tissues are affected by oxalate deposits, including the kidneys.

Large doses may cause a buildup of oxalate in people with kidney disease.  Accumulation of oxalate in the bones and soft tissue, which can cause severe pain in muscles, bones and other issues over time.

 

Nitazoxanide

It is an antiparasitic agent for managing cryptosporidiosis and giardiasis, both parasites that cause diarrhea, as well as used against anaerobic bacteria, viruses, and other protozoa. However, it does show some in vitro activity, against the influenza virus and other coronaviruses, as well as rotaviruses, and the hepatitis B and C viruses. Finally it is still under trials for prevention and early treatment.

Ivermectin

Ivermectin, an antiparasitic drug, also used for covid 19 treatment.  Dose is not confirmed. In most centres it is used as 12 mg single dose or for 5 days. 

Some have been used as 200 mcg/kg single dose then can repeat after 7 days.

It can cause severe neurotoxicity. 

For Renal failure and dialysis patients :  Dose is not confirmed

Instruction for usage

To be taken before meals with a full glass of water.

Recently studies showed a high-fat meal absorption was significantly higher than in the fasting.

 

Interleukin inhibitors

Immunomodulators are being tried, they have antiinflammatory effects as because of cytokine release there is inflammation leading to severe pneumonia. Interleukin (IL) inhibitors, Janus kinase (JAK) inhibitors , and interferons are used in many trials..

 

IL inhibitors help in managing severe lung injury caused by cytokine release in patients with severe COVID-19 infections. A “cytokine storm” with release of various interleukins with tumour necrosis factor alpha (TNFα) and other inflammatory mediators.

 

Interleukin-6 inhibitors

Tocilizumab is an IL-6 inhibitor. IL-6 is a pleiotropic proinflammatory cytokine secreted by many types of cells like lymphocytes, monocytes, and fibroblasts. SARS-CoV-2 infection causes a dose-dependent production of IL-6 from bronchial epithelial cells.

 

Coronavirus (COVID-19) Treatment

Coronavirus (COVID-19) Treatment

Currently there is no medication available to treat the virus and no cure is available. Antibiotics are not as effective in treating viral infections as COVID 19. Researchers are testing a variety of possible treatment options and innovations.

Antiviral drug remdesivir is a possible effective medicine used to treat severe COVID 19. Also recommended is corticosteroid dexamethasone to treat people with severe COVID 19  who require supplemental oxygen or mechanical ventilation.

 

Supportive care which is aimed at relieving symptoms, may include the following –

  • Pain relievers (ibuprofen or acetaminophen)
  • Cough syrup or medication
  • Rest
  • Fluid intake

In patients with kidney disease NSAIDS like ibuprofen, diclofenac etc are to be avoided. If one has mild symptoms, your nephrologist recommends to stay and recover at home. During this time one has to take care of oneself and efficiently manage stress. Problem is if the patient is on regular haemodialysis patients in a dialysis centre. Dialysis patients can’t skip dialysis. Options for them are covid19 dialysis centres, home haemodialysis, or continuous ambulatory peritoneal dialysis. If chronic kidney disease patient is affected with COVID 19 disease it is all the more important to –

  • One needs to take healthy meals.
  • One needs to get proper sleep.
  • One has to do physical activity as much as one is able to do like exercise or yoga. If one feels better one may go outside for a walk.
  • One may also try relaxing exercises like deep breathing, stretching and meditation.
  • Get plenty of rest.
  • Drink fluids if urine volume is adequate. Otherwise fluid restriction as advised by the kidney doctor.
  • Inform the kidney doctor immediately if the condition worsens.

Convalescent plasma therapy is an experimental treatment that some doctors are trying to cure people with severe coronavirus disease.

People who have recovered from the coronavirus have antibodies – proteins that the body uses to ward off infections of the disease from their blood. This blood from people who have recovered or cured is called convalescent plasma. This is the liquid portion of the blood.

Researchers also believe that the convalescent plasma can be given to people to boost  their ability to fight the virus. This might help people with moderate illness from getting severely ill and developing complications.

If one has got the disease and finally recovered from it, one must consider donating blood through a local donation center or blood bank.

 

Why is it done?

Convalescent plasma therapy might help people with coronavirus who are not helped by any other treatments. Some people might not respond to other drugs while remaining very sick. These kinds of patients might develop respiratory distress syndrome (ARDS) – which is severe lung disorder. They might require a ventilator to breathe and are susceptible to developing organ failure.

This might also help people with higher risk of serious illness like people with serious chronic medical conditions for example heart disease or diabetes or people with weaker immune systems. Convalescent plasma might help these kinds of people from getting further sick if they get the coronavirus.

 

Risks

Plasma and blood are also used to treat various other diseases and are considered very safe. The risk of contracting coronavirus through receiving  convalescent plasma has not been tested till now. But researchers believe that this kind of transmission possibility is very limited because the plasma donor has completely recovered.

Convalescent plasma therapy has the following risks –

  • Might have allergic reactions
  • Difficulty in breathing from lung damage
  • Transmission of infections like hepatitis B and C, HIV

Before the procedure

Prior to the convalescent plasma therapy, the healthcare team prepares one for the procedure. A healthcare member inserts a single-use needle with a tube (intravenous, or IV, line) into a vein of one of the arms.

During the procedure

After the plasma arrives, the uninfected or sterile plasma is attached to the tube and it drips out of the bag into the tube. This takes around one to two hours to complete the procedure.

Results

It is not yet known if plasma therapy will be an effective treatment for coronavirus. One might not experience any benefit .

However this treatment might improve one’s ability to recover from the disease.

The collective results of the treatment on patients of the plasma therapy can provide information about the effectiveness of the therapy and if it might become an approved way of treatment of the coronavirus disease. During the preliminary treatment quite a few people have benefited. Researchers still continue to evaluate the results from people who received  the therapy treatment.

Diagnosis for Covid-19

Diagnosis for Covid-19

When a kidney disease patient develops symptoms of the coronavirus disease 2019 (COVID – 19) or one is exposed to the COVID 19 virus, one must contact the nephrologist immediately. Also if a patient comes in close contact with someone who has been diagnosed  with the virus, then also needs to contact the nephrologist immediately. In haemodialysis centres chances of infection in patients and dialysis staff is very high. In india especially in delhi ncr most of the dialysis centres are having adequate space. Main dialysis unit hall, staff’s rooms, dialysis patients waiting hall, cafeteria, restrooms etc don’t have adequate space to maintain social distancing. Morbidity and mortality are also very high in patients with kidney diseases, post kidney transplant and dialysis patients.

COVID-19 diagnostic testing

  • Molecular test. 

It is also known as PCR test. This test detects the genetic material of the COVID 19 virus using a technique of the lab called polymerase chain reaction (PCR) A testing executive collects fluid from the nose, throat swab or less often from saliva.

  • Antigen test. 

Antigen tests can produce results very fast using a throat swab or nasal swab to get sample fluid. This test is faster and cheaper than the molecular tests. A positive Antigen test is considered very accurate but there is an increased chance of false- negative results. So these tests are not as sensitive as the molecular tests.

For a COVID 19 test one needs to provide sample mucus from nose or throat or may be sample of saliva. The sample needed for testing may be collected at the home, hospital or a drive-up testing centre.

  • Nose or throat swab. 

For this process a healthcare professional inserts a thin flexible stick with a cotton attached at the tip into the nose or at the back of the throat, brushes the swab to collect a sample of mucus. This might be somewhat uneasy. For the nasal sample there might be swabbing into both the nostrils to collect mucus samples for the tests. The swab gets rotated in place before being pulled out, then the sample gets sealed inside a tube and is sent to the lab for further analysis.

  • Saliva sample. 

Though not considered the best way to get a good sample.

COVID-19 antibody testing is also known as serology testing. It is a blood test which is done to find out if one has a past infection with SARS- COV– 2 , the virus that causes the COVID 19 disease.

How much time to develop COVID19 antibodies?

After one is infected with COVID 19 virus, it may take two to three weeks to develop enough antibodies which are detected in an antibody test. So it’s important that one is not tested too soon.

For how long COVID19 antibodies will last?

Antibodies may be detected in ones blood for several weeks after one recovers from 

COVID-19 These antibodies may provide some kind of immunity to the COVID 19 virus but currently there is not enough evidence present to know how long these antibodies or past infection protects one from getting another infection.

Why COVID19 antibodies done?

Antibody testing for the virus may be done if – 

  • One had symptoms of the virus in the past but testing was not done
  • If one have to do a medical procedure in a hospital or clinic
  • One had a positive infection in the past and wants to donate plasma, a part of one’s blood that contains antibodies that can help treat others who have severe cases of COVID 19 

To conduct the antibody test a healthcare professional typically takes a blood sample usually by a finger prick or by drawing blood from a vein in one’s arm.

Kidney stones in children

What are kidney stones?   

Kidneys stones are dense accumulations of salt plus minerals often made up of calcium or uric acid. They develop inside the kidney as well as they can move to different portions of the urinary tract.

Stones diverge in size. Some are very tiny and some are a little bit in inches. Some kidney stones can convert so big they take up the whole kidney.

A kidney stone develops when lots of certain minerals in the body collect in the urine. When you are not properly hydrated, the urine becomes more intense with immense levels of certain minerals. When mineral levels are more eminent, it’s more possible that a kidney stone will develop.

More petite kidney stones that reside in the kidney usually don’t create any symptoms. Might be you not remark anything is awry until the stone passes into the ureter, the tube that urine travels via to get from the kidney to the bladder.

Kidney stones are frequently extremely painful. Most stones will move on their own without medication. But, you may require a method to break up or eliminate stones that don’t move.

What are the indications of kidney stones? The indications can include:

  • Pain in the abdomen or back
  • Color changes in urine because of blood
  • Pain when the child urinates
  • The requirement to urinate in a hurry
  • Nausea and vomiting 

Few children with kidney stones do not feel or observe any complaints. In these children, doctors usually discover kidney stones incidentally. This can occur if a child has an imaging test, like an X-ray, for different reasons.

Should the child see a nephrologist or urologist? Yes. If the child has the complaints mentioned above, take the children to the nephrologist or urologist as soon as possible. Kidney stones can prevent urine flow as well as create infections.

Will the child require tests? Yes. The nephrologist or urologist will take an exam plus prescribe the tests on a sample of the child’s urine. The child will also require an imaging test, like a CT scan, ultrasound, or X-ray and related tests. Imaging tests found photographs of the inside of the body of the child. They can determine if a kidney stone is creating the signs. If the child has a stone, imaging tests can further prove its size as well as where it is placed.

How are kidney stones treated? Each child has required different Treatment for kidney stones. The appropriate treatment depends on:

 

  • The size, variety, and position of the stone
  • the level of pain the child has
  • If the child is vomiting, and how much the child vomits
  • If the child can take large quantities of fluids

If the stone is small as well as produces only mild signs, the child might be ready to stay home plus wait for it to move in the urine on its own. If they stay at home the child will probably require having a high quantity of fluids. Can take pain killers after consulting a nephrologist like diclofenac, ibuprofen etc. Before taking painkillers kidney function (creatinine) should be normal.

The kidney specialist might require you to have the child urinate via a strainer so you can grab the stone when it comes out. The kidney doctor can explain to you how to perform this.

A child might necessitate treatment in the hospital if:

  • The stone is blocks flow of urine
  • The child has hard pain or is ejecting
  • The child cannot take large quantities of fluid

Hospital treatment can include:

  • Pain medication, either in pills or intravenous;
    if he or she is vomiting too much to keep pills down. 
  • Medication to aid pass the stone
  • Fluids delivered within a vein 
  • Treatment to eliminate the stone, or break it inside tinier pieces so it can

Pass more easily. Doctors can do this with:

  • A device that utilizes sound waves to separate up stones within smaller portions, shock wave lithotripsy.
  • A thin tube that goes inside the body where the urine comes out – The

the tube’s distal end has unique devices to split up stones or get them out.

Will the child have different kidney stones?

Maybe if the child receives a kidney stone, they have a tremendous chance of getting a different one later. To aid keep this from occurring, make sure the child takes lots of water.

The kidney doctor will perform tests to discover what made the first stone. Depending on the outcomes, you might require to switch what the child consumes.

If so, the kidney doctor can advise you which feed the child should not have. The child might also order new medications to prevent the child from having extra kidney stones.

Dialysis of COVID-19

Dialysis of COVID-19

As COVID-19 has engulfed the whole world, a pandemic situation has come into existence. Here is a set of questions to intimate you about the dialysis process of COVID-19 patients.

How dialysis of COVID-19 takes place?

The Government has taken initiatives to set up different dialysis centers, especially for COVID-19 patients throughout the country. All the dialysis technicians have to abide by the guidelines formulated by the higher authorities. Each center has three separate units for the tests. They are the outside area, the screening area, and the internal Dialysis Unit.

What are the duties of the Administration for dialysis units?

According to the Government’s general guidelines, the administration authorities of every dialysis center should follow these rules;-

  • The hospital should specify at least one hemodialysis facility with an adequate number of dialysis machines and trained staff
  • District Administration should ensure that dialysis consumables are delivered to both hospitals.

When should a patient visit a Dialysis center for COVID-19?

Before visiting the dialysis unit, the patient should recognize the symptoms first. The usual signs of COVID-19 are fever, sore throat, cough, shortness of breath, body ache, fatigue, etc. There should be appropriate arrangements for all the arrivals in the screening area. The patients stable on maintenance hemodialysis can come to the unit alone without the support of any attendant.

Can dialysis patients recover post COVID-19 infection?

According to the recent reports, around 80% of the COVID patients undergoing dialysis have mild or moderate symptoms. However, 15-20% of the cases show that the patients are suffering from severe conditions. As per experts, after proper dialysis, the COVID-19 patients can fully recover within six weeks on an average. But, the duration can extend to a few months in some severe cases.

After a successful recovery from ventilation, the patients can go through a post-traumatic stress disorder. But, those who lack desirable response in ventilation can suffer from an acute lung disorder. This can also be fatal.

What is the dialysis process for patients with acute kidney injury?

The symptoms are generally mild but AKI patients requiring renal replacement therapy can develop serious complications. For such patients with AKI, bed-side dialysis will be more preferable than shifting to the central dialysis unit.

COVID-19 Impact on Kidney Patients

COVID-19 Impact on Kidney Patients

High rates of kidney damage are prominent in several COVID-19 patients. The symptoms can be mild, as well as severe. Here are some important points one can consider in this aspect. 

What are the precautions for kidney patients to be taken considering COVID-19?

The patients suffering from COVID-19 have the highest chances of getting acute kidney problems. As a precautionary measure, the patients at high risk should do the following;-

  • Wash your hands frequently with soap or hand wash
  • Do not touch your face, eyes, and nose
  • Use alcohol-based sanitizers to keep your hands germ-free
  • Avoid going to crowded places like shopping centers, cinema hall, etc
  • Wear masks whenever you are in the public
  • Keep safe distance with others, especially those who are sick
  • Contact the medical helplines as soon as you notice any symptoms like cough, high fever, breathing problems
  • Keep a stock of emergency supplies like food, medicines, etc. 

Can I get diagnosed on an emergency basis?

If you find the signs of any symptoms of COVID-19, call the nearest dialysis center. You can also contact your nephrologist or the helpline numbers for COVID-19. Schedule an appointment with your kidney specialist or get a suitable time to visit any other dialysis center if there are not enough beds.

Is there more chance of getting attacked by Coronavirus if I have kidney disorders?

The following group of people has the highest chances of occurrences of COVID-19;-

  • Elderly people
  • People suffering from acute health issues including cardiovascular diseases, asthma, weak immune system, HIV, diabetes, chronic kidney disease
  • Pregnant woman

In case you had kidney transplantation or are taking a high dosage of medicines, you may be at a higher risk than others. Hence, strictly follow all the necessary precautions to avoid COVID-19 attacks. 

What are the kidney-friendly foods to stock in this pandemic?

In this pandemic situation of COVID-19, food delivery from outside is not at all recommended. Please try to cook at home only and avoid all the restaurant foods. There are a lot of apps today for the delivery of groceries at your doorstep. Contact with them and maintain a safe distance while taking the delivery. 

Visit the website  to learn about the emergency food articles that you can stock in your freezer or refrigerator to avoid going to markets frequently. 

What to do if I am suffering from depression?

If you are undergoing the dialysis of COVID-19 and suffering from depression, please consult with your nephrologist immediately. The support of your counselor is highly needed at such crucial periods. Mental health counseling is a must during the dialysis as the high-dosage of medications can affect you both physically and mentally. Some tips for anxiety and depression are as follows;-

  • Breathing exercises
  • Meditation
  • Physical exercises
  • Mindful thinking
  • Practice having sufficient hours of sound sleep
  • Journaling

Can I miss by dialytic treatments for COVID-19?

You should never miss your treatments when you are undergoing dialysis for COVID-19. In case of any sickness or other concerns, please consult your dialysis center immediately. Always maintain proper hygiene around you and avoid going out. No medicines should be skipped. For a speedy recovery, listen to all the instructions of the healthcare team. 

What are the effects on patients with Acute Kidney Injury(AKI) and Chronic Kidney Disease(CKD)?

COVID-19 is likely to attack patients suffering from Acute Kidney Injury or Chronic Kidney Disease. The primary symptoms of detecting kidney disease in the patient are swelling, nausea, vomiting, weakness, fatigue and many non specific. On investigations in blood test high creatinine levels or the presence of a high level of proteins in urine. Unfortunately, the mortality rates are higher for people with severe kidney issues. Hence, they should be extra cautious and try to prevent the occurrence of COVID-19. These patients are supposed to regularly consult a kidney specialist and do as per the nephrologist’s instruction. Regular monitoring of those patients is required who has high creatinine in blood and protein in the urine. They are at high risk of getting chronic kidney disease that can be progressed to  end-stage kidney disease also. Immediate treatment and medications can reduce the severity of the case. But, the recovery rates are not very high for such kidney-affected patients. 

Can Coronavirus cause kidney damage?

According to recent cases, it is evident that Coronavirus is targeting the lungs and the kidneys more. Thus, for COVID-19 patients can lead to Acute Kidney Injury(AKI). Such damage in the kidney is not very chronic. But, there are high possibilities that the subsequent stages can be severe for the patient. Proper treatment can cause the recovery of these patients. However, after discharge also, these patients can suffer from low kidney function. 

Early reports from the USA and China show that around 30% of the COVID-19 hospitalized patients have symptoms of mild or moderate kidney damages. Many patients even have high blood pressure or diabetes. Even those who did not have any kind of kidney problems are also suffering from kidney issues after the COVID19 infection. The coexistence of multiple health issues can be dangerous for COVID-19 patients and also requiring dialysis in severe AKI. Hence, the dialysis procedure should be more stringent. Every dialysis center should ensure that there are enough medicines, and they are never out of stock. Abnormal blood through urine should be immediately reported to the physicians for prompt treatment. 

What are the possibilities for kidney damage in the case of COVID-19?

Till now, the exact impact of Coronavirus on the kidneys is not entirely clear. However, the experts suggest a few of the instances in which you can suffer from kidney damage. 

  • Coronavirus can infect the kidney cells and cause potential damage to them. The receptors present in these cells attract the deadly virus and allow them to produce replicas of themselves. Such receptors are also present in the heart and lungs. Hence, new Coronavirus can be found in those cells, too, and the effects of which can be severe. 
  • Malfunctioning of kidneys can cause due to lack of a sufficient amount of oxygen in the organs. The COVID-19 patients show symptoms of breathlessness and lack of oxygen in the blood. Hence, the virus can attack the kidney and even cause pneumonia.
  • The newly born Coronavirus is highly powerful, and the reaction can take your life too. The response can go to an extreme level and give rise to cytokine storms within the patient’s body. This case involves the rapid movement of cytokines inside the body. Actually, these are small proteins that play a leading role in enabling communication between the cells when the immunity system fights against any infection. However, a sudden generation of cytokine storm can cause an inflammatory situation. During the process of destroying the virus, it can severely hamper the kidney functioning. 
  • Due to COVID-19, there can be tiny clots in the blood. These may result in clogging of the blood vessels present in kidneys. In turn, the filtration process of the kidneys may get hampered, thus impairing the functions of it within the body. 

Due to all these symptoms, the nephrologists are always cautious about the impact of COVID-19 on kidneys as the after-effects can lead to severe kidney injury.

Low-potassium diet-kidney-Patients

Patient education: Low-potassium diet (The Basics)

What is potassium?

Potassium is a mineral that is found in almost all foods. Everybody needs potassium to work normally and energetically. It maintains the heart beating and keeps the nerves and muscles working properly. But people need only a limited amount of potassium. Too much or little potassium in the body can create problems.

The presence of too much potassium in the blood is called “hyperkalemia.” This can create problems with heart rhythm and muscle weakness.

When is potassium too low or too high?

 

  • Low potassium

 

Potassium comes from the foods which we have in meals or courses. Healthy kidneys eliminate excess potassium in the urine to aid control of normal blood levels.

Because most fruits contain high potassium, low potassium is difficult in people who have a healthy diet.

Some of the outcomes of low potassium involve muscle weakness, cramping, as well as fatigue.

 

  • High potassium

 

When kidneys lose they can no longer eliminate excess potassium, so the level grows up in the body. High potassium in the blood is identified as hyperkalemia, which may happen in people including advanced degrees of chronic kidney disease. Usually high potassium is silent with no symptoms. Few impacts of high potassium are nausea, weakness, anesthesia, and slow pulse rate.

For people with advanced CKD, dialysis is required to aid control potassium in emergency cases. With dialysis treatment potassium decreases suddenly, but potassium levels increase, so nephrologists have to find out factors of high potassium like high-potassium foods must be restrained.

Daily intake of potassium.

In normal and mild to moderate renal failure daily potassium intake should be 4.7 gram. In advance kidney failure and dialysis patients daily intake should be less than 3 gram. If per serving potassium intake is more than 250 mg then it is considered as high potassium.

The most frequent e

Who might require being on a low-potassium diet?

In chronic kidney disease patients mostly want to be on a low-potassium diet to prevent hyperkalemia. tiology of hyperkalemia is:

  1. 1. Certain medicines– Some medicines contain certain ones for high blood pressure and heart problems which may increase the level of potassium in the body. Examples: Angiotensin-converting enzyme (ACE) inhibitors, aldosterone receptor blockers, Angiotensin II receptor blockers (ARBs).
  2. Kidney disease: the kidneys filter the blood and erase much salt and water through urination. They maintain the level of potassium in the blood normal. When the kidneys don’t work properly or stop working, they can’t get rid of the potassium in the urine. Then, too much potassium is made up in the blood.

Many people who get a treatment called “dialysis” for kidney disease need to be on a low-potassium diet. Dialysis is a treatment that takes over the job of the kidneys.

What does consuming a low-potassium diet include?

Almost all foods contain potassium. So the key is to:

  1. Select foods with low levels of potassium
  2. Leave or eat only small amounts of foods with high levels of potassium

Your nephrologist will perhaps suggest that you work with a dietitian (food expert) to help in making a strategy for your meals. He or she will tell you how much potassium you should eat every day. 

To figure out how much potassium you are eating, you will need to look at the food’s nutrition label. You will need to look at them:

 

1.” Potassium” amount – It says you how much potassium is in 1 course of the food. If you eat 1 meal, then you are eating this quantity of potassium.

2.”Serving size” – It tells you how much a portion is. If you eat 2 courses, then you are having 2 times the quantity of potassium listed.

What are other ways to cut down on potassium?

 

  • Here are some different ways to cut down on potassium:

 

  1. Evacuate the liquid from canned fruits, vegetables, or meats before eating.
  2. If you eat foods that have a lot of potassium, eat only little portions only if your potassium is low or normal. if already high then not to take high potassium food items.
  3. Lessen the amount of potassium in the vegetables you eat. You can do this with both of them i.e. frozen and raw vegetables. (If all the vegetables are fresh and raw, then peel and cut them up first.) To reduce the amount of potassium, soak the vegetables in hot unsalted water for at least 2 hours. Then drain the water and rinse the vegetables in hot water. If you make the vegetables, prepare it without salted water.

Some foods that is low in potassium:

  • Fruits: apple juice, apples, blackberries, blueberries, cherries, cranberries, peaches, pears, pineapples, plums, strawberries, and watermelon. But if high potassium levels then better to avoid most.
  • vegetables: asparagus, cabbage, carrots, cauliflower, celery, corn, cucumber, eggplant, green beans, green peas, green peppers (capsicum), kale, lettuce, okra (ladies’ fingers), onions, radish, water chestnuts, wax beans, yellow squash, zucchini, and spinach. 
  • Proteins: almonds, cashews, chicken, eggs, flaxseed, peanuts, pumpkin seeds, sunflower seeds, turkey and walnuts. 

 Some foods that is high in potassium: 

  • fruits: avocado, bananas, coconut, cantaloupe, and honeydew melons, dates, dried fruits, figs, kiwi, mango, oranges and orange juice, and raisins. 
  • Vegetables: arctic, baked beans, beets, broccoli, Brussels sprouts, cabbage, carrots, olives, potatoes, pickles, pumpkins, and tomatoes and tomato juice. 
  • proteins: black beans, clams, ground beef, kidney beans, lobster, navy beans, salmon, steak and white fish 
  • other: chocolate, dairy products, granola, milk, peanut butter, soups that are salt-free or low sodium, soy milk, sports drink, yogurt, whole grain bread, and tomato sauce. 

 

Medicines for chronic kidney disease

What kind of medicines are utilized to treat chronic kidney disease? 

Individuals with chronic kidney disease are treated with: 
  • Blood pressure medicines – If you have chronic kidney disease, you have a higher possibility of having high blood pressure. Blood pressure medicines can help forestall heart disease and hinder kidney disease. 
  • Other medicines – These will rely upon the kind of kidney disease you have, and if you have other medical issues. 

Normally, the kidneys filter the blood and evacuate waste and overabundance salt and water. In individuals with chronic kidney disease, the kidneys quit working just as they should. They can’t filter medicines just as they normally would, which can cause unsafe levels of medicines in your body. Along these lines, your doctor may guide you to take a lower portion or change to an alternate medicine. Toward the finish of this article there is a list of things you can do to be careful when taking medicines. 

A few medicines can likewise hurt your kidneys. These incorporate “NSAIDs, for example, ibuprofen or naproxen. Before you go for any kind of new medicines, comprising medicines and over-the-counter supplements, ask your nephrologist how they can influence your kidneys. 

Listed underneath are the medicines used to treat chronic kidney disease. 

Medicines that treat high blood pressure and slow kidney disease 

You may require more than 1 kind of blood pressure medicine to support your kidneys: 

  • Diuretics (water pills) – Diuretics lower blood pressure by helping the body dispose of additional salt and liquid. Examples are furosemide (lasix), torsemide (dytor) and others. They cause individuals to urinate a ton, particularly from the start. In the event that this makes it hard for you to take these medicines, work with your kidney doctor to locate a decent time to take them. Usually need to take a morning if once daily dosing. If I need to take twice daily then the second dose to be taken by afternoon only. Diuretics work better in the event that you limit the measure of salt (sodium) you eat. 

A case of a usually utilized diuretic is furosemide (brand name: Lasix). 

  • ACE inhibitors and ARBs – Angiotensin-changing over compound inhibitors (called “Pro inhibitors”) and angiotensin receptor blockers (called “ARBs”) work in comparable ways. These medicines bring down the blood pressure by loosening up the blood vessels. They additionally bring down the pressure inside the kidneys so the kidneys can filter better and delay kidney disease progression.

Instances of ACE inhibitors incorporate ramipril (cardace), Benazepril (Lotensin), Captopril, Enalapril (envas), Fosinopril, Lisinopril (Prinivil, Zestril), Moexipril, Perindopril. Instances of ARBs incorporate candesartan and valsartan. 

  • Other blood pressure medicines – Depending on your blood pressure and the kind of kidney disease you have, your kidney specialist may prescribe different kinds of blood pressure medicines, for example, calcium channel blockers (amlodipine, cilnidipine, benidipine, efonidipine nicardipine, nifedipine, verapamil, diltiazem etc. 

Different medicines 

Your nephrologist may prescribe different medicines, contingent upon the kinds of issues brought about by your kidney disease. These might include: 

  • Vitamin D — Having chronic kidney disease can prompt having low degrees of calcium in the blood. This can mess bone up. To help avoid bone issues, a nephrologist once in a while prescribes vitamin D (cholecalciferol or calcitriol).
  • Phosphate binders — Phosphate is a mineral found in numerous nourishments. Having chronic kidney disease can expand the measure of phosphate in the body. This can be unsafe. To overthrow the evaluation of phosphate in the human body, doctors can prescribe medicines called “phosphate binders.” To work, these medicines must be taken with snacks and meals. Your doctor may likewise prescribe you eat nourishments that have low measures of phosphate. Examples sevelamer and calcium acetate.
  • Sodium bicarbonate — When you have chronic kidney disease, the degrees of acids in your body can get abnormal. This can prompt issues like weak muscles and bones. Your doctor may prescribe a sodium bicarbonate pill to help with this issue. 

Individuals who take sodium bicarbonate need to abstain from eating a lot of salt. That is on the grounds that sodium bicarbonate likewise has salt in it. Having an excess of salt in your body raises your blood pressure and can exacerbate your kidney disease. 

  • Medicines to treat anemia — Anemia is the medical term for when an individual has too hardly any red blood cells. This condition can make you feel tired or weak. It is normal in individuals with chronic kidney disease. 

Kidney doctors treat anemia by giving you additional iron. They can likewise make use of medicines called erythropoiesis-stimulating agents (called “ESAs” or erythropoietins).

Medicines for your other medical conditions 

Medicines that your doctor prescribes for high diabetes (blood sugar) or high cholesterol are additionally important in treating your kidney disease. 

What would I be able to do to be safe? 

To be careful, it’s important to take your medicines precisely as your doctor lets you know, so you get the correct measure of each medicine. Making use of pill boxes and updates can help. 

Your nephrologist needs to know the entirety of the medicines you take. This incorporates any over-the-counter medicines, herbs and vitamins. So it’s a smart thought to keep a list of the names and dosages and carry it with you every single time you go to any doctor. 

If your medicines cause difficult side effects, or if you can’t afford your medicines, converse with your kidney doctor. There are frequently approaches to manage these issues. The initial step is to tell your nephrologist.

Planning for kidney transplant

Planning for kidney transplant

Kidney transplant is the surgical process of replacing the diseased kidney with the healthy one. The need for kidney transplant arises when your kidney is not able to function normally. This is the end stage of the renal disease when it is necessary to replace the kidney. If both kidney’s are not function properly then you just need to replace only one kidney. A person can live normally on his one kidney and live his life normally.

Evaluation before kidney transplant

Before going for kidney transplant, you must have to get full health evaluation by taking proper tests and examinations. It will help you in decision making for the kidney transplant. After deciding for the kidney transplant you have to go through the following steps.

  • Find out the best match with your kidney. The donor can be a family member or an outsider whose blood group is matching with yours.
  • The evaluation will take one day or the several days. On the day of evaluation, you and your family will meet the transplantation team.
  • Several health tests and examinations will take place at the transplantation centre and decide that you have need surgery or not.
  • Tests you need to do are: blood and tissue type tests, HIV and hepatitis test, prostate exam for men, mammogram and pap smear for women, heart and lung examination, kidney and liver test, colon exam etc.
  • You have to ready yourself for the kidney transplant physically as well as mentally. If you are not ready for the surgery then it make your transplantation process dangerous.
  • Before surgery, you have to follow the instructions by the doctors about caring yourself as well as your kidney.
  • Clear all the doubts about your surgery, by asking the questions about financial support system, insurance policy that will help you to plan and prepare the best care of yourself.

After the evaluation, if you are ready for the transplantation then you need a kidney donor. If you do not have living donor then the team of transplantation will added your name in the waiting list of kidney donor. If living donor is available then your transplantation process can be start earlier.

Post kidney transplantation planning

Once your transplantation process has done then you have to stay in the hospital till doctor’s measure your good health condition.  Your stay in the hospital will be depend on some factors like type of transplant procedure, body acceptance of new organ and your overall health condition. Doctors and nurses will take care of you until you will feel comfortable and confident to go home. You need to follow some instruction before going home that is given below.

  • Without any assistance you have to follow your medicine schedule correctly.
  • Keep thermometer and blood pressure cuff with you to take care of your temperature and blood pressure.
  • If any medication problem arise then report immediately to transplant coordinator.
  • Keep a record of fluid intake and urine output regularly.
  • Regularly follow appointments with transplantation team and tell them your health condition. So that they can give you proper medication.
  • After going home keep a record of your weight, blood pressure and temperature daily.
  • You need to avoid being around infected people (with colds and flu) at least three months because in this case the danger of infection is more.

After following the above instructions you will recover from the surgery successfully. It will also help the doctors to identify that your body is accepting the new kidney or not. If not then the prescribed medication treatment by doctors will help you to control the rejection.

About Chronic Kidney Disease

About CKD

What is chronic kidney disease?

What are symptoms of kidney failure?

There are less or no symptoms in mild to moderate kidney failure. Thus, early or even late kidney failure is usually detected on a preventive health check-up.
Swelling over body sometimes it is first noticed over feet (around ankles) or over face (around eyes).
Nausea, vomiting, hiccoughs.
Breathlessness on exertion or physical activity.
Low sugar levels (hypoglycaemia) in case of diabetic related kidney failure.
Generalized weakness, easy fatigability.

Life threatening presentation

a. Convulsions
b. Abnormal heart rate (due to high potassium)
c. Chest pain (pericarditis)
d. Altered sensorium (uremic encephalopathy)
e. Severe metabolic acidosis

How to delay chronic kidney disease progression?

Detection of kidney disease at an early stage.
Control of blood pressure (less than 135/85 mmHg, less than 130/80 mmHg in proteinuria cases)
Control of blood sugar (HbA1c less than 7%)
Avoid nephrotoxic agents (common painkillers, some antibiotics and indigenous agents) and many others
Proper treatment of infections.
Proper treatment of urine outflow obstruction.
Avoid tobacco consumption and smoking
Healthy lifestyle
Very high protein intake
Proper treatment of stones
Some kidney harmful or nephrotoxic medications

Diabetic kidney disease

Kidney disease is very common in diabetic patients. In present scenario life style related diseases like obesity, diabetes, and coronary heart disease related kidney disease are very common. Swelling over feet or face is generally a common symptom in diabetic kidney disease.
Blood sugar level should be:
• Between 70 and 130 before eating ;
• Less than 183 about 2 hours After eating ;
• Between 90 and 150 at bedtime.

How to monitor kidney related complications in a diabetic patients?

• Following to be monitored at least 3 to 6 monthly.
• Urine for proteinuria-urine for micro albuminuria, urine for albumin(dipstick)
• Serum creatinine level.

Whether my both kidneys are affected?

Even a single kidney is enough to perform all functions of kidney (remove all toxins, and other functions) from our body. If serum creatinine level is high then either both kidneys (if both kidneys are working) are affected or if there is a single functioning kidney and that only is affected.
Kidney disease run in family

There are few kidney diseases common in family members. Following kidney diseases are:

1 Diabetes related kidney disease.
2 Polycystic kidney disease (PKD) – autosomal dominant PKD or ADPKD is passed from parent to child by an autosomal dominant type of inheritance. Thus if one parent has the disease, each child has a 50-50 chance of developing the disease.
3 Fabry disease- it involves major organs.
4 Kidney stones
5 High Blood Pressure
6 Alport Syndrome- leading to CKD (hereditary nephritis), deafness and eye abnormalities.
7 Unknown family related kidney disease.

How to manage chronic kidney disease?

How to know how much my kidneys are working?

Glomerular-filtration Rate: It is a rate at which blood is filtered through glomeruli in a minute. It tells us that how much the kidneys are functioning. It can be measured or estimated. There are various formulas for measuring GFR:
1. Cockcroft gault formula (CGF)
2. The Modification of Diet in Renal Disease (MDRD) equation
3. Creatinine clearance (Urine)
4. Others
How to estimate GFR:
1. Inulin
2. DTPA
Most commonly used are CGF and DTPA
Using this GFR we can differentiate chronic kidney disease (CKD) into different stages
Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 5 ND (not on dialysis) Stage 5 D (on dialysis) Stage 5 T (post-transplant) Patient can himself calculate GFR easily by computed formulas which are easily available on mobile applications and internet.

How to prevent kidney diseases?

Kidney diseases are common in:-
A. Diabetic patients
B. Hypertensive patients
C. Coronary heart diseases patient
D. Cerebrovascular disease patient
E. Over weight and Obese patient
F. Persons who are on long term kidney harmful medicines like painkillers (NSAIDS, lithium), some anti-biotic, some indigenous medication.
G. Smokers and chronic tobacco users.
H. Patients having recurrent urine infections.
I. Patients having multiple kidney stones
J. Persons in whom family member is suffering from kidney disease
K. Some genetic related kidney disease.
L. Urine outflow obstructive diseases.
M. Hyperuricemia and gout.
N. Connective tissue diseases like sjogrens, rheumatoid, sarcoidosis and others.
O. Others

If there are above risk factors than routinely kidney function test (creatinine) and urine routine examination to be done.
If any modifiable risk factor is present than we need to modify them.

Medicines for chronic kidney disease (CKD)

In managing CKD there are lots of medicines are required. There is a major issue of pill burden (number of pills per day). Following medicines are used in treating CKD.
• Hypertension-anti-hypertension medicines.
• Anemia-oral or intravenous iron, injection erythropoietin, darbepoetin, mircera.
• Antacids, proton pump inhibitors
• Calcium Supplements.
• Phosphate binders
• Vitamin-D active or Cholecalciferol.
• Vaccination- To prevent hepatitis B, Pneumonia, flu.
• Multivitamins.
• To control acidosis.
• Medicine related to primary disease.
• And others.

How to know how much my kidneys are working?

How to know how much my kidneys are working?

Glomerular-filtration Rate: It is a rate at which blood is filtered through glomeruli in a minute. It tells us that how much the kidneys are functioning. It can be measured or estimated. There are various formulas for measuring GFR:

  • Cockcroft Gault formula (CGF)
  • Modified diet MDRD
  • Creatinine clearance (Urine)
  • Others

How to estimate GFR:

  • Inulin
  • DTPA

Most commonly used are CGF and DTPA
Using this GFR we can differentiate chronic kidney disease(CKD) into different

Stages

  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4
  • Stage 5
  • Stage 5 ND (not on dialysis)
  • Stage 5 D (on dialysis)
  • Stage 5 T (post transplant)

The patient can himself calculate GFR easily by computed formulas which are easily available on mobile applications and internet. Consult with Nephrologist (DR RAJESH GOEL) Sr Nephrologist in delhi NCR.

Nephritic Syndrome

NEPHRITIC SYNDROME:

When there is a mild to moderate protein leaking in urine, microscopic hematuria (cola coloured urine), abnormal renal function (increased serum creatinine), and swelling over body and high blood pressure is known as nephritic syndrome.

Childhood nephritic syndrome is usually self-resolving and requires no specific treatment.

In adults, kidney biopsy and specific treatment is usually required.

NEPHROTIC SYNDROME (NS)

When there is excessive protein leaking through urine which causes swelling of the body low albumin level in the blood than this is known as nephrotic syndrome.

CLINICAL FEATURES

  • Swelling all over the body (early morning facial puffiness and swelling around the ankle late evening are the initial symptom )
  • Frothy urine
  • Breathing difficulty
  • Increased body weight

INVESTIGATIONS

  • Urine routine and examination
  • 24 hours urine for protein and creatinine
  • Serum albumin level
  • Lipid profile
  • Other special investigations

Like kidney biopsy, vasculitic markers like ANA, complement levels, ASO titres

TREATMENT

Conservative, BP control, steroids and immunosuppressive drugs.

CHILDHOOD NEPHROTIC SYNDROME

NS is very common during childhood. Kidney biopsy is usually is not required in childhood ns. It is easily managed by steroids. Rarely kidney biopsy and other immunosuppressive drugs are required. Childhood nephrotic syndrome can be a single episode, infrequent relapsing, frequent relapsing, and steroid dependent and steroid resistant.

Parental guidance :

Parents need to monitor the treatment response at home by decreasing swelling and daily monitoring of protein leaking by using urine albumin sticks.