Pharmacotherapy/Treatment Of Chronic Kidney Failure (CKF)

Chronic Kidney Failure

Chronic kidney disease is the gradual loss of kidney function. Kidney filters waste, remove extra fluid from the body and control blood pressure. It also regulates electrolyte and activates vitamin D. In chronic kidney disease, dangerous levels of fluid, electrolyte and waste can build up in the body.

Stages Of Chronic Kidney Failure

Chronic Kidney failure is classified into stages. This is based in glomerular filtration rate (GFR) and manifestations of symptoms.

Read Also: Treatment of glomerulonephritis

Stage 1: GFR rate is normal with evidence of kidney disease

Stage 2: GFR rate is <90ml

Stage 3: GFR rate is <60ml

Stage 4: GFR rate is <40ml

Stage 5: GFR rate is <15 which means there is renal failure

Symptoms

There are no symptoms at an early stage of the disease. Symptoms develop over time. They include;

1. Nausea

2. Vomiting

3. Loss of appetite

4. Fatigue and weakness (Muscle twitching and cramp)

5. Erectile dysfunction

6. Sleep disorder

7. Change in urine pattern and output

8. Decrease in mental sharpness

9. Swelling of feet and ankles

10. Persistent itching

11. Chest pain when fluid build around the lining of the heart

12. Shortness of breath if fluid build up in the lungs

13. High blood pressure

Causes

1. Diabetes type 1 and type 2

2. High blood pressure

3. Glomerulonephritis

4. Interstitial nephritis

5. Polycystic kidney disease

6. Prolong obstruction of the urinary tract due to condition such as enlarged prostate, kidney stones and some cancer

7. Vesicoureteral reflux recurrent kidney infection (pyelonephritis).

Risk Factors

1. Diabetes

2. Hypertension

3. Cardiovascular disease

4. Smoking

5. Obesity

6. African American, American or Asian American descent

7. Family history of kidney disease

8. Abnormal kidney structure

9. Old age

10. Recurring infection

11. Autoimmune disease like lupus

Complications

1. Fluid retention lead to swelling of the body parts like legs and arms

2. Hypertension

3. Fluids in lungs

4. Rise in potassium levels which can cause palpitation

5. Cardiovascular disease

6. Weak bones increasing risk of fracture

7. Anemia

8. Decrease sex drive, erectile dysfunction or reduce fertility

9. Damage to central nervous system which cause difficulty in concentration

10. Personal changes or seizures

11. Decrease immune response

12. Pericarditis

13. Risk to fetus and mother

14. Damage to kidney that is irreversible

Prevention

1. Use non Steroidal Antiinflammatory Agent with doctors prescription

2. Maintain a healthy weight. Body mass index between 18kg/m² and 25kg/m² is considered best.

3. Quit smoking

4. Reduce alcohol

5. Manage other health conditions (hypertension, diabetes)

6. Reduce protein food, salt and potassium

7. Exercise

Diagnosis

1. Blood test look for the level of waste (creatine, urea)

2. Urine test analyse sample of urine to identify cause of kidney disease (kidney function test)

3. Imaging to assess kidney structure and size

4. Biopsy

Pathophysiology Of Chronic Kidney Failure

The kidney has about one-million nephrons. When there is renal injury (regardless of the etiology), the remaining healthy nephrons increase their activities.This action enables the kidney to continue to perform its functions. Plasma levels of substances such as urea and creatine start to show measurable increases only after total GFR has decreased 50%.

The increase in activity of the healthy nephrons (hyperfiltration and hypertrophy) is beneficial as it prevents accumulation of waste and the electrolytes and loss of proteins, it is believed to lead to the death of heading reference. The increase in pressure of heading reference damage the capillaries

Factors other than the underlying disease process and glomerular hypertension that may cause progressive renal injury include the following:

1. Systemic hypertension

2. Nephrotoxins (e.g, nonsteroidal anti-inflammatory drugs [NSAIDs], intravenous contrast media)

4. Decreased perfusion (e.g, from severe dehydration or episodes of shock)

4. Proteinuria (in addition to being a marker of CKD)

5. Hyperlipidemia

6. Hyperphosphatemia with calcium phosphate deposition

7. Smoking

8. Uncontrolled diabetes

A study postulated that episodes of acute kidney failure with hospitalisation increase the possibility of chronic Kidney failure. Another also said that inflammation and hemostasis are possible pathophysiology.

Pharmacotherapy/Treatment Of Chronic Kidney Failure

Treatment is to control signs and symptoms and also to manage underlying disease.

1. Hypertension is best treated with angiotensin converting enzyme (ACE) inhibitors. Losartan 25-100mg daily dose is recommended.

2. High cholesterol levels should be reduced with statins such as simvastatin 20mg daily. They are best taken at night as cholesterol is produced at night.

3. Anaemia which is a low red blood cell in the body can easily be treated with a good iron building supplement. There are so many out there. The last option is blood transfusion.

4. Swelling in the arms and legs can be reduced with the use of diuretics. Loop diuretics are recommended. An example is furosemide 20-80mg daily.

5. Chronic Kidney failure can result in weak business which can be treated with calcium and vitamin D supplement. There is another problem with calcium supplements. They can lead to blood vessel damage by depositing on the vessel. To Prevent this, a phosphate binder is added to the diet and supplementation.

6. Antihistamine such as chlorpheniramine and loratadine is used to reduce itching. Chlorpheniramine 2-4mg every eight hours or loratadine 5-10mg daily can stop itching. Vomiting is another symptom that can be handled with antiemetic like promethazine. Typical dosage for active nausea and vomiting: 25 mg. Between 12.5 mg and 25 mg may be taken again every 4–6 hours, if needed.

Typical dosage for preventing nausea and vomiting: 25 mg every 4–6 hours as needed. Children's dose is different.

Read Also: Treatment of acute kidney failure

7. Dialysis and kidney transplant is at the last stage of kidney damage. Dialysis is the removal of waste from the body. There are two types of dialysis. They are peritoneal and hemodialysis. Peritoneal dialysis involves running a liquid through the perineum to absorb waste from the body. The frequency depends on the individual. It is not very effective.

Hemodialysis use machines inserted into the vein and artery of the arms to remove excess waste from the body. It is done three to fives time in a week under three hours each. However, recent studies encourage greater frequency. It can be done at home or in the hospital.

Kidney transplant is the last option. The kidney is from a compatible donor. The person will have to take drugs for the rest of life. The drug is to force the body to accept the new kidney. Otherwise, it will treat it like a foreign body and destroy it.

Medications After Kidney Transplant

The medicines you will be taking after your transplant to keep your body from rejecting your new kidney are called immunosuppressants. You will have to take these medicines every day for as long as you have your transplant. In some cases, even after a transplant stops working, we recommend remaining on small doses of these medicines to prevent antibody formation. This will make you more likely to have another compatible transplant later.

There are a number of immunosuppressants that can be used. You will not be taking all of these medicines but will be on some combination of them. All of them have potential side effects, but remember that not all patients suffer from all the side effects listed.

1. prograf (FK506) – is taken twice a day

2. cyclosporine – is taken twice a day

3. prednisone – is taken for a few days immediately after your transplant. Some patients will suffer from difficulty sleeping or may feel "hyper". These feelings will pass in a few days. Some patients will need to be on prednisone long term. The decision to use prednisone will be based on the type of kidney disease you have and your risk for rejection.

There are others too. Because these drugs weaken the immune system, the person may be prone to infection. You will have to take antibiotics for the first three to six months after your transplant to help prevent infection. You will need to have regular physicals with your primary care doctor for cancer screening including screening for skin cancer which is the most common post-transplant cancer.

Note that regenerative therapy is on the horizon.