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Q. What precautions can a patient take to both prevent and retard the progression of the disease?

A. Prevention of ARF can be done by rapid correction of shock, dehydration, hypoxic ischemic injury in a neonate and infants, by avoidance of drugs which are known to cause ARF, prevention of E. Coli gastroenteritis by avoiding uncooked food and contaminated milk and water because verotoxin producing E. Coli cause HUS. Prevention of CRF can be achieved by prevention and adequate treatment of recurrent urinary tract infection, by early detection of vesicoureteral reflux (VUR), correction of congenital anomalies like posterior urethral valves/pelviureteral obstruction/severe grades of VUR. Control of high BP, protein restriction in diet, use of ACE inhibitor to control proteinuria in diabetic or reflux nephropathy, use of drugs in dosage appropriate for the renal function are some of the measures known to prevent rapid progression of the disease.

Q. How does renal transplant help a patient? When is renal transplant required?

A. Renal transplant is the preferred treatment for a patient with end stage renal failure when GFR falls bellow 5-10 ml/min/1.73sq metre. Transplanted kidney from a healthy living donor or cadaver can fulfill all the functions of kidney required for the normal growth and survival of a patient with ESRD.

Q. What is peritoneal dialysis and hemodialysis? When is it given to a patient with renal failure? Which is the recommended one?

A. Peritoneal dialysis is a procedure in which transfer of solutes like urea, sodium, potassium, creatinine and other metabolites and water from blood to dialysate fluid occurs across the peritoneum which serves as a semipermeable membrane. The dialysate fluid is instilled in the peritoneal cavity via a catheter which is specially designed for P.D. for infants and bigger children of various sizes. For patients with ARF, PD is required for 24-96 hours, whilst for CRF patients, chronic PD is required for which a special Tenckhoff catheter is surgically inserted in peritoneal cavity to create a permanent access. PD can be done 4-5 times/day via Tenckhoff's catheter for many years using special bags containing PD fluid.

Hemodialysis is done by creating arteriovenous connection by means of an AV shunt or fistula so that blood from the arterial side can flow alongside the dialysate fluid in a dialyser containing bundles of semipermeable membrane (cuprophane cellulose acetate etc). Mass transfer of solute and water occurs from blood of the patient into the dialysate fluid extracorporeally by diffusion and convection by means of a dialysis machine. Special sets of needles, tubings, dialysers are required for pediatric patients. Hemodialysis is technically difficult in young infants due to small sizes of vessels on long term basis .Hence peritoneal dialysis using Tenkchoff catheter is preferable for children with chronic renal failure. Advantages of CAPD are many viz. can be done at home after a short training by the parents, less chances of hemodynamic instability, no disruption of school/activity, less visits to hospital, no needle punctures and less disturbance to the family. Currently high cost of dialysate fluid, tubings etc. are responsible for less use of CAPD in Indian children with ESRD.

Q. What is the role of Erythropoietin and other vitamin supplements in renal failure ?

A. Role of erythropoetin is to correct erythropoetin deficiency which occurs in CRF. Erythropoietin is synthesized by kidney and by its action on bone marrow is responsible for erythropoiesis. In CRF because of nephron loss, EPO deficiency occurs and results in normocytic normochromic anemia requiring EPO administration for its correction.

Vit D in its active form (calcitriol) is required for the treatment of renal bone disease. 25 OH Vit D is hydroxylated to 1,25(OH)2 Vit D. in Kidney. This conversion is not possible in CRF resulting in demineralisation of bones, rickets and renal osteodystrophy. Oral or IV calcitriol can heal the bones and prevent secondary hyperparathyroidism which is the other cause of renal bone disease.

Q. What is the dietetic advice given to patients with renal failure ?

A. Dietetic management is important in controlling accumulation of nitrogenous metabolites like urea, phosphorus, potassium, sodium and excess fluid in acute and chronic renal failure. Excess protein is harmful in chronic renal disease, as it can cause hyperfiltration and glomerulosclerosis. Protein restriction is an important measure to prevent progression of CRF. Coconut water, Fruit juices etc. contain potassium and hence to be avoided in ARF. Excess intake of salt and water can cause fluid and sodium retention with pulmonary edema in oliguric patients. Non vegetarian diet is rich in proteins, phosphorus and fat which are to be avoided in renal failure.

Q. What is the prognosis of a patient with ESRD?

A. Prognosis of a patient with ESRD is poor unless there is a possibility of getting renal transplant.

Q. What are the complications of renal failure ?

A. Complications of ARF - hypertension, pulmonary edema or CCF, hyperkalemia, uremic or hypertensive encephalopathy gastrointestinal bleeding, nutritional deficiency.

Complications of CRF - growth failure, renal osteodystrophy anemia, cardiac dysfunction, hypertension, neurological and developmental defects in young children.

Q. Can early detection help in better management of the patient? If yes, then how do you suspect and diagnose it early ?

A. Early detection helps in better management. High index of suspicion in the clinical setting of ARF/CRF, estimation of BUN, S. creatinine whenever suspected, monitoring of urine output to detect oliguria are simple methods of early diagnosis of renal failure.

Q. Is there a role of kidney biopsy in renal failure ?

A. Kidney biopsy is only indicated if cause of ARF is not evident by clinical, biochemical or radiological investigations.

Q. What is drug induced renal failure ?Which drugs should one avoid in renal failure ?

A. Drugs which are nephrotoxic and can induce renal failure are NSAIDS, cyclosporin A, aminoglycosides, cephalosporins, indomethacin, sulpha, anticancer drugs (like cisplatinum, ifosfamide), anti-fungal agents (like amphotericin B), antiviral (like acyclovir) and radio contrast medium. Minimum use of drugs in renal failure and modifying the dosage of drugs according to the GFR/ S. creatinine levels are very essential to prevent further damage to kidney.

See the biochemical profile in acute renal failure and chronic renal failure

Last created on 2-01-2001
Last submitted on 01-07-2006