“KIDNEY/FLUID/ ELECTROLYTE DISORDER”

 “KIDNEY/FLUID/ ELECTROLYTE DISORDER”

 The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste products, but also by balancing levels of electrolyte levels in the body, controlling blood pressure, and stimulating the production of red blood cells.

The kidneys are located in the abdomen toward the back, normally one on each side of the spine. They get their blood supply through the renal arteries directly from the aorta and send blood back to the heart via the renal veins to the vena cava. (The term "renal" is derived from the Latin name for kidney.)

Kidney disorder 

There are two general types of kidney failure:

• Acute renal failure  is a condition in which there is damage and deterioration of kidney function that occurs suddenly, generally over a period of days. Acute renal failure can be caused by such conditions as shock, acute pyelonephritis, urinary tract obstruction, or ingestion of certain toxic substances.

• Chronic kidney failure is a condition in which there is damage and deterioration of kidney function that occurs over a long period of time (months to years). Chronic kidney failure is generally caused by long-term diseases, such as diabetes and hypertension.

Kidney failure symptoms 

• Itching

• Weakness / tiredness

• Loss of appetite

• Poor concentration

• Restless legs

• Leg cramps

• Swollen ankles

• Shortness of breath

• Poor sleeping

• Feeling cold

• Cloudy or discolored urine

• Difficulty urinating

• Easy bruising

• Foul smelling urine

• Frequent urination

• Painful urination (dysuria)

• Urgent urination

Treatment for kidney failure

Dialysis 

 Cleanses the body of waste products in the body by use  of filter systems.

There are two types of dialysis; 

1) hemodialysis, 

        Treatment for hemodialysis  takes place in a hemodialysis unit. This is a special building that is equipped with machines that perform the dialysis treatment. Special equipment adds the proper materials to purified water for the dialysis machines. The dialysis unit is also the place where patients can receive dietary counseling and help with social needs.

Patients generally go to the dialysis unit three times a week for treatment. For example, the schedule is either Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday. Before treatment, patients weigh themselves so that excess fluid accumulated since the last dialysis session can be measured. Patients then go to assigned chairs that are like lounge chairs. The area of the graft or fistula (the connection between the artery and vein), is cleaned thoroughly. Two needles are then inserted into the graft or fistula. One takes the blood to the machine where it is cleaned. The other needle allows blood that is returning to the patient to go back into the patient's body.

Treatments last from 2 ½ to 4 ½ hours. During this time, the dialysis staff checks the patient's blood pressure frequently and adjusts the dialysis machine to ensure that the proper amount of fluid is being removed from the patient’s body. Patients can read, watch television, sleep, or do other work during treatment.  

Hemodialysis schematic 

2) Peritoneal dialysis 

            Peritoneal dialysis requires the patient to play a more active role in their dialysis treatment. Of primary importance is the patient's responsibility for maintaining a clean surface on the abdomen, where treatment is administered, in order to prevent infection.

In this process, the patient weighs herself/himself to determine the fluid to be used. The patient then puts on a mask and cleans the peritoneal catheter site. Fluid that has been allowed to stay in the peritoneal cavity is drained back into the plastic bag that originally contained the fluid. The patient then disconnects this bag and connects a new bag of solution that is allowed to drain into the peritoneal cavity. Once the fluid is in the body, the new bag is rolled up and placed in the patient's underwear until the next treatment. This procedure usually takes 30 minutes to accomplish and must be done four to five times a day.  

Schematic diagram of peritoneal dialysis

Kidney Transplantation 

If kidney failure occurs and is non-reversible, kidney transplantation is an alternative option to dialysis. If the patient is an appropriate candidate, the health care practitioner will contact an organ transplant center to arrange evaluation to see if the patient is suitable for this treatment. If so, the search for a donor begins. Sometimes, family members have compatible tissue types and, if they are willing, may donate a kidney. Otherwise, the patient will be placed on the organ transplant list that is maintained by the United Network of Organ Sharing.

Not all hospitals are capable of performing kidney transplants. The patient may have to travel to undergo their operation. The most successful programs are those that do many transplants every year.

While kidney transplants have become more routine, they still carry some risk. The patient will need to take anti-rejection medications that reduce the ability of the immune system to fight infection. The body can try to reject the kidney or the transplanted kidney may fail to work. As with any operation, there is a risk of bleeding and infection.

Kidney transplants may provide better quality of life than dialysis. After one year, 95% of transplanted kidneys are still functioning and after five years the number is 80%. It seems that the longer a patient is on dialysis, the shorter the life of the transplanted kidney.

If the transplanted kidney fails, the alternative is another kidney transplant or a return to dialysis.

Electrolytes 

            Substances that become ions in solution and acquire the capacity to conduct electricity. Electrolytes are present in the human body, and the balance of the electrolytes in our bodies is essential for normal function of our cells and our organs.

Common electrolytes that are measured by doctors with blood testing include sodium, potassium, chloride, and bicarbonate.

• Sodium 

                -- is the major positive ion (cation) in fluid outside of cells. The chemical          notation for sodium is Na+. When combined with chloride, the resulting substance is table salt. Excess sodium (such as that obtained from dietary sources) is excreted in the urine. Sodium regulates the total amount of water in the body and the transmission of sodium into and out of individual cells also plays a role in critical body functions. Many processes in the body, especially in the brain, nervous system, and muscles, require electrical signals for communication. The movement of sodium is critical in generation of these electrical signals. Too much or too little sodium therefore can cause cells to malfunction, and extremes in the blood sodium levels (too much or too little) can be fatal.

• Increased sodium (hypernatremia) in the blood occurs whenever there is excess sodium in relation to water. There are numerous causes of hypernatremia; these may include kidney disease, too little water intake, and loss of water due to diarrhea and/or vomiting.

• A decreased concentration of sodium (hyponatremia) occurs whenever there is a relative increase in the amount of body water relative to sodium. This happens with some diseases of the liver and kidney, in patients with congestive heart failure, in burn victims, and in numerous other conditions.

A Normal blood sodium level is 135 - 145 milliEquivalents/liter (mEq/L), or in international units, 135 - 145 millimoles/liter (mmol/L).

• Potassium

              --Potassium is the major positive ion (cation) found inside of cells. The chemical notation for potassium is K+. The proper level of potassium is essential for normal cell function. Among the many functions of potassium in the body are regulation of the heartbeat and the function of the muscles. A seriously abnormal increase in potassium (hyperkalemia) or decrease in potassium (hypokalemia) can profoundly affect the nervous system and increases the chance of irregular heartbeats (arrhythmias), which, when extreme, can be fatal.

• Increased potassium is known as hyperkalemia. Potassium is normally excreted by the kidneys, so disorders that decrease the function of the kidneys can result in hyperkalemia. Certain medications may also predispose an individual to hyperkalemia. 

• Hypokalemia, or decreased potassium, can arise due to kidney diseases; excessive loss due to heavy sweating, vomiting, or diarrhea, eating disorders, certain medications, or other causes.

The normal blood potassium level is 3.5 - 5.0 milliEquivalents/liter (mEq/L), or in international units, 3.5 - 5.0 millimoles/liter (mmol/L).

• Chloride

               -- Chloride is the major anion (negatively charged ion) found in the fluid outside of cells and in the blood. An anion is the negatively charged part of certain substances such as table salt (sodium chloride or NaCl) when dissolved in liquid. Sea water has almost the same concentration of chloride ion as human body fluids. Chloride also plays a role in helping the body maintain a normal balance of fluids. The balance of chloride ion (Cl-) is closely regulated by the body.

• Increased chloride (hyperchloremia): Elevations in chloride may be seen in diarrhea, certain kidney diseases, and sometimes in overactivity of the parathyroid glands.

• Decreased chloride (hypochloremia): Chloride is normally lost in the urine, sweat, and stomach secretions. Excessive loss can occur from heavy sweating, vomiting, and adrenal gland and kidney disease.

The normal serum range for chloride is 98 - 108 mmol/L.

• Bicarbonate

                 -- The bicarbonate ion acts as a buffer to maintain the normal levels of acidity (pH) in blood and other fluids in the body. Bicarbonate levels are measured to monitor the acidity of the blood and body fluids. The acidity is affected by foods or medications that we ingest and the function of the kidneys and lungs. The chemical notation for bicarbonate on most lab reports is HCO3- or represented as the concentration of carbon dioxide (CO2). The normal serum range for bicarbonate is 22-30 mmol/L.

The bicarbonate test is usually performed along with tests for other blood electrolytes. Disruptions in the normal bicarbonate level may be due to diseases that interfere with respiratory function, kidney diseases, metabolic conditions, or other causes.

References

Mackenzie Walser, M.D., Coping with Kidney Disease, (New Jersey: Hoboken, 2004), 240

Juliet Aier, Living Well with Kidney Failure, (London: Barb House, 2005), 154

Andy Stein, Janet Wild, Kidney Failure Explained second edition/ (London: Barb House, 2002), 154

Laura D. Byham-Gray, Jerrilynn D. Burrowes, Glenn M. Chertow, Nutrition in Kidney Disease, (USA: Totowa, 2008), 621

http://www.medicinenet.com/electrolytes/discussion-382.htm

http://en.wikipedia.org/wiki/Chronic_kidney_disease

http://www.bettermedicine.com/article/kidney-failure/treatments

http://kidney.niddk.nih.gov/kudiseases/pubs/hemodialysis/

http://en.wikipedia.org/wiki/Dialysis

http://www.kidney.org/professionals/KDOQI/guidelines_ckd.