Nephropathy – Part 6

The topic for this blog is diagnosing and treating end-stage renal problems. In addition to a physical examination and complete medical history, your doctor will use diagnostic procedures for renal failure including the following:

1. Blood tests. Blood tests will determine blood cell counts, electrolyte levels, and kidney function
2. Urine tests
3. Renal ultrasound (also called sonography). A noninvasive test in which a transducer is passed over the kidney producing sound waves which bounce off the kidney, transmitting a picture of the organ on a video screen. The test is use to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.
4. Kidney biopsy. This procedure involves the removal of tissue samples (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.
5. Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Contrast CT usually cannot be done when there is kidney failure.

Specific treatment for renal failure will be determined by your doctor and you, based on:

• Your age, overall health, and medical history
• Extent of the disease
• Type of disease (acute or chronic)
• Underlying cause of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

The treatment may include:

• Hospitalization
• Administration of intravenous (IV) fluids in large volumes (to replace depleted blood volume)
• Diuretic therapy or medications (to increase urine output)
• Close monitoring of important electrolytes such as potassium, sodium, and calcium
• Medications (to control blood pressure)
• Specific diet requirements

In some cases, patients may develop severe electrolyte disturbances. Often toxic levels of certain waste products normally eliminated by the kidneys will be part of this. Patients may also develop fluid overload. Dialysis may be indicated in these cases.

Treatment of chronic renal failure depends on the degree of kidney function that remains. Treatment may include:

1. Medications (to help with growth, prevent bone density loss, and/or to treat anemia)
2. Diuretic therapy or medications (to increase urine output)
3. Specific diet restrictions or modifications
4. Dialysis
5. Kidney transplantation

I will let you read this five page discussion of the two types of dialysis. Each has pros and cons and you will need to decide on the best treatment based on your circumstances.

People with end-stage renal disease (ESRD) are living longer than ever. Dialysis treatments (both hemodialysis and peritoneal dialysis) are not cures for ESRD, but will help you feel better and live longer. Over the years, ESRD can cause other problems such as bone disease, high blood pressure, nerve damage, and anemia (having too few red blood cells). You should discuss prevention methods and treatment options for these potential problems with your doctor.