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Semelhante a 41 rcs renal failure
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41 rcs renal failure
- 1. RCS 6080 Medical and Psychosocial Aspects of Rehabilitation Counseling Renal Failure
- 10. Treatment for Diabetic Nephropathy Stage Assessment Treatment No Proteinuria Monitor BP & Glucose Screen for micoalbumininuria Hypertension drugs if needed (BP should be 130/85 or lower). Dietary advice for sugar and fat, stop smoking Microalbuminuria Close monitoring of BP, Glucose and blood lipids, monitor urinary proteins & CCr Add more Hypertension drugs if needed needed. Monitor cholesterol and add ACE inhibitor if needed Proteinuria Close monitoring of BP, glucose and blood lipids, monitor urinary protein and 24 CCr BP should be lower than 125/75, low protein diet Declining kidney function Prepare for dialysis &/or transplant
- 16. Conservative Treatment Dialysis Transplant Hemodialysis Peritoneal Related Donor Cadaver Donor Home Center
Notas do Editor
- Diabetic nephropathy is the kidney disease that occurs as a result of diabetes. It is a leading cause of kidney failure in Europe and the USA. After many years of diabetes the delicate filtering system in the kidney becomes destroyed, initially becoming leaky to large blood proteins such as albumin which are then lost in urine. This is more likely to occur if the blood sugar is poorly controlled. The overall risk of developing diabetic nephropathy varies between about 10% of type II diabetics (diabetes of late onset) to about 30% of type I diabetics (diabetes of early onset). Black men have a 3.5-4 fold increased risk of CFR compared to white men. Blood pressure and SES correlated with CFR in whites and blacks. Unclear if Blacks have increased risks when blood pressure and income are similar. Analgesic nephropathy: slow progression of disease due to chronic daily ingestion of analgesics Associated with long-term use of of NSAIDs and Acetaminophen. Chronic interstitial nephritis, renal papillary necrosis and renal calcifications seen
- Good blood glucose control can prevent the development and slow the progression of diabetic nephropathy, as well as preventing the other complications of diabetes, even if kidney failure has developed. This can not be achieved by tablets and/or insulin alone, but requires a good diet too. Achieving these things will involve discussion with doctors, nurses and dieticians. The recommended target blood pressure is 125/75 mmHg in diabetic patients. This usually requires more than one type of tablet to achieve. If you are overweight, losing weight will help too. Two classes of drug used to control blood pressure deserve special mention. These are the A ngiotensin- C onverting E nzyme ( ACE ) inhibitors and a ngio t ensin II ( AT II ) receptor antagonists. Many studies have documented the greater potency of ACE inhibitors at reducing proteinuria and the progression of kidney disease compared to other classes of drug. These drugs not only reduce blood pressure in the large blood vessels, but also directly in the kidneys' filtering system (called glomeruli). Although these drugs tend to be preferentially used, they need to be monitored as they may have a detrimental effect on some people. It is thought that AT II receptor antagonists will have a similar effect, and these are often used in those unable to tolerate ACE inhibitors. A modest reduction in dietary protein intake may be of benefit in those who already have kidney impairment. However this is a controversial and uncertain area, because the effect may be small if other things are well controlled, and low protein diets can be hazardous. Many (eg the American Diabetic Association) recommend moderate restriction of dietary protein. Other aspects of diet (including energy, calcium and phosphate intake) are important in renal failure, and the assistance of a renal dietitian is usually required. Although the role of lipid-lowering is unclear in the course of diabetic nephropathy, it helps to prevent heart disease and possibly strokes. Lowering blood lipids requires both dietary and drug treatment, with the current available data pointing towards a target cholesterol of 5.2mmol/l. You really shouldn't smoke, not only for the sake of your kidneys, but also for the sake of your heart and brain blood vessels. Smokers die earlier than non-smokers, but diabetic smokers die much earlier and often develop serious circulation problems at a young age.
- Albumin is a protein which is present in the blood. The kidneys act as a filter for waste products in the blood. Protein is not allowed to spill over into the urine unless the filter system is ‘leaky’. Microalbuminuria refers to the appearance of small but abnormal amounts of albumin in the urine. If measured, this protein excretion is between 30 and 300 mg during a 24 hour period
- The symptoms and signs which constitute the uremic syndrome are summarized below: Neurological Disorders: Fatigue, lethargy, sleep disturbances, headache, seizures, encephalopathy, peripheral neuropathy including restless leg syndrome, paraesthesia, motor weakness, paralysis. Hematologic Disorders: Anemia, bleeding tendency – due in part to platelet dysfunction. Anemia is universal as GFR falls below 25 ml/min.; in certain disorders it may occur with mild renal insufficiency Cardiovascular Disorders: Pericarditis, hypertension, congestive heart failure, coronary artery disease, myocardiopathy. Hypertension occurs in 80% to 90% of patients with renal insufficiency Pulmonary Disorders: Pleuritis, uremic lung. Gastrointestinal Disorders: Anorexia, nausea, vomiting gastroenteritis, GI bleeding, peptic ulcer. Metabolic-Endocrine Disorders: Glucose intolerance, hyperllipidemia, hyperuricemia, malnutrition, sexual dysfunction and infertility. Bone, Calcium, Phosphorus Disorders: Hyperphosphatemia, hypocalcemia, tetany, metastatic calcification, secondary hyperparathyroidism, 1,25-dihydroxy vitamin D deficiency, osteomalacia, osteitis fibrosa, osteoporosis, osteosclerosis. Skin Disorders: Pruritus, pigmentation, easy bruising, uremic frost. Psychological Disorders: Depression, anxiety, denial, psychosis. Fluid and Electrolyte Disorders: Hyponatremia, hyperkalemia, hypermagnesemia, metabolic acidosis, volume expansion or depletion.
- Various social or medical factors influence decisions about peritoneal or hemodialysis, and transplantation in the treatment of end-stage renal failure