Chronic Renal Failure

Although previous research has demonstrated that referral to pre-dialysis clinics is associated with favourable objective outcomes, the benefit of a pre-dialysis clinic from the perspective of patient-perceived subjective outcomes, such as quality of life (QOL), is less well defined. A retrospective incident cohort study was conducted to determine if pre-dialysis clinic attendance was a predictor of better QOL scores measured within the first six months of hemodialysis (HD) initiation. Inclusion criteria were HD initiation from January 1 1998 to January 1 2000, diagnosis of chronic renal failure, and completion of the QOL questionnaire within six months of HD initiation. Patients receiving HD for less than four weeks were excluded. An incident cohort of 120 dialysis patients was identified, including 74 patients who attended at least one pre-dialysis clinic and 46 patients who did not. QOL was measured using the SF 36-Item Health Survey. Independent variables included age, sex, diab...

Chronic kidney disease is one of the leading co-morbidity at present. With the increasing prevalence of diabetes mellitus and hypertension, more and more peoples are developing diabetic and hypertensive nephropathy. As chronic kidney disease patient can present as an asymptomatic stable patient in one end and a multi-organ involved complicated end-stage disease in other ends, their management plan also varies. The serum creatinine levels of as low as 1.5 mg% have been linked to perioperative major cardiac events like myocardial infarction and arrest; these patients poses a challenge to the perioperative team. Moreover, a chance of developing acute kidney injury on the chronic kidney disease is also higher. These patients are also often elderly, with diabetes mellitus and/or hypertension. Therefore, accepting such patient for perioperative care needs systematic and meticulous approach. Preoperative assessment, risk stratification, and optimization play a great role. Both intraoperative and postoperative management needs a tailored approach. The present narrative review is prepared to give the current insight on these aspects.

Nephronophthisis (NPH) is an autosomal recessive disease characterized by chronic tubulointerstitial nephritis that progress to terminal renal failure during the second decade (juvenile form) or before the age of 5 years (infantile form). In the juvenile form, a urine concentration defect starts during the first decade, and a progressive deterioration of renal function is observed in the following years. Kidney size may be normal, but loss of cortico-medullary differentiation is often observed, and cysts occur usually after patients have progressed to end-stage renal failure.

Chronic kidney failure is a significant problem in modern society. Botanical medicine can be used to help forestall the need for dialysis by-treating the causes and effects of renal failure, as well as reducing the many adverse effects of dialysis itself.; Botanicals used to treat kidney failure include: Rheum palmatum (Chinese rhubarb, da huang), Ephedra distachya (ephedra) stem, Geranium thunbergii (Thunberg's cranesbill) root, Cinnamomum cassia (cassia) bark, Bao yuan da huang tang (a decoction of Panax ginseng [Asian ginseng] root, Astragalus membranaceus [astragalus] root, cassia bark, Glycyrrhiza uralensis [licorice] root, and Chinese rhubarb), Lespedeza capitata (round-headed lespdeza), Silybum marianum (milk thistle) seed, Urtica dioica (stinging nettle) seed, Parietaria judaica (pellitory-of-the-wall) herb, Orthosiphon stamineus (Java tea), Cordyceps chinensis (cordyceps, Chinese caterpillar fungus), Centella asiatica (gotu kola), and Capsicum spp. (cayenne).

A insuficiência renal crônica é uma doença sistêmica relativamente comum. Manifestações sistêmicas tais como anemia, hipertensão, distúrbios plaquetários e manifestações bucais como xerostomia, estomatite urêmica, doença periodontal, alterações radiográficas na maxila e mandíbula podem ser observadas em pacientes com insuficiência renal crônica. Frente à freqüência desta condição e à necessidade de informações para o cirurgião-dentista lidar com essa condição, este artigo discute os aspectos mais importantes da insuficiência renal crônica, abordando suas manifestações sistêmicas e orais e o tratamento odontológico de pacientes renais crônicos. A descrição de um caso clínico é apresentada.

La Insuficiencia Renal Crónica (IRC) es una enfermedad en la que los riñones dejan de filtrar la sangre o lo hacen inadecuadamente, provocando envenenamiento progresivo que deteriora las funciones corporales. En estos pacientes tras confirmar el diagnóstico, existen restricciones propias del tratamiento, como una estricta dieta, reducida ingestión de agua, medidas extremas de limpieza, diálisis hospitalaria o en casa, así como emergencias continuas que provocan cambios medulares al estilo de vida; basado la Teoría de Constructos Personales, se hipotetizó que adquirir la noción de enfermo crónico puede cambiar el ciclo de la experiencia, modificando sustancialmente la noción del sí mismo y de los otros, por ello se utilizó la Técnica de Rejilla de Constructos Personales para evaluar tres índices que permiten también dar un perfil del sí mismo. Los resultados indican que estas 30 personas adultas con IRCpresentan características particulares, destacando que la Autoestima (correlación Yo Actual-Yo Ideal) tiende a ser baja, al igual que la medida de Aislamiento Social Autopercibido (correlación Yo Actual-Otros) en más de la mitad de la muestra, mientras el nivel de Adecuación Percibida en los Otros (Yo Ideal-Otros) es alto en un 63% de los casos, indicando una percepción de insatisfacción con los otros. Finalmente, el perfilpredominante de sí mismo, resultado de la combinación de las tres medidas anteriores, es el de Aislamiento o bien de Resentimiento. Los hallazgos confirman la hipótesis inicial y sugerimos que el tratamiento de IRC debe incluir el aspecto psicológico para atender el considerable malestar sufrido.

Different themes emerged from the lived experiences
of the 36 co – researchers, here referred to individually with their
fictitious names. The following are the themes and their
respective meaning: A)  Desensitizing information  - Initial
reactions of the condition: counting the days left, full of disbelief,
unbearable, unacceptable, Why me!,  What have I done?, and
difficult to explain; (B) Holistic disease experience  – individual
symptomatic experience:

The purpose of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis or peritoneal dialysis. One-hundred and two patients with CRF were examined for the presence of cutaneous alterations. All patients examined had at least one cutaneous lesion. The most prevalent findings were alterations in the cutaneous pigmentation. Of particular interest was an increased prevalence of hyperpigmented macules on the palms and soles. Other manifestations, seen particularly in the hemodialysis group, included the half-and-half nail, pruritus, and keratotic pits of the palms and soles. Infectious processes were more prevalent in the group undergoing peritoneal dialysis. This study showed that all patients with CRF have some type of cutaneous alteration and that the type of dialysis could have some influence upon the incidence of these changes.

Nowadays, alternative medicines have become a multibillion-dollar industry and continue growing. Herbal medicine is one of the primeval forms of medicine which is prepared exclusively from herbal plants. The Ayurvedic medicinal cure method is also been used as a prescription for chronic diseases such as cancer, asthma, diabetes, and end-stage renal diseases and increasing interest in European countries respectively. According to the report of world health organization (WHO), 4 billion people (80% of the world's population) use herbal medicines for some perspective of primary healthcare; approximately 25% of modern drugs used in the United States have been procured from plants. It is estimated that 11% of the total 252 medicinal drugs found in crucial medicine list of WHO are particularly of plant origin. The purpose of this study is to find out the toxic and beneficial effects of medicinal herbs on renal health by which evidence for benefit or toxicity has been found. The review aims to provide knowledge and guide to encourage future toxicity studies on the kidney by medicinal herbs.

During the last two decades, Sri Lanka, located close to the equator, has experienced an escalating incidence of chronic kidney disease (CKD) of unknown aetiology (CKDue) in dry zonal areas.  Similar incidences of unusual CKDs have been reported in the dry zonal, agricultural areas of several other equatorial countries. In Sri Lanka, the incidence of CKDue is highest in the North Central Province (NCP), where approximately 45 % of the country’s paddy fields are located.  However, in recent years, the disease has spread into areas adjacent to as well as distant from the NCP.  The cause of CKD in Sri Lanka is unknown, and may likely due to interactions of different potential agents; thus, CKD is of multi-factorial origin (CKD-mfo).  These factors include, the negative effects from overuse of agrochemicals. Nevertheless, the potential interactions and synergism between probable agents have not been studied.  This systematic review discusses the proposed hypotheses and causes of CKDmfo in Sri Lanka, and ways to decrease the incidence of this disease and to eradicate it, and provide some recommendations.  During the past decade, a number of groups have investigated this disorder using different methodologies and reported various correlations, but failed to find a cause.  Research has
focussed on the contamination of water with heavy metals,
agrochemicals, hard water, algae, ionicity, climate change,
and so forth. Nevertheless, the levels of any of the pollutants or conditions reported in water in NPC are inconsistent not correlated with the prevalence of the disease, and
are too low to be the sole cause of CKD-mfo.  Meanwhile,
several nephrotoxins prevalent in the region, including
medications, leptospirosis, toxic herbs, illicit alcohol,
locally grown tobacco, and petrochemicals, as well as the
effects of changed habits occured over the past four decades have not been studied to date.  Taken together, the geographical distribution and overall findings indicate that
combinations of factors and/or their interactions are likely
to precipitate CKD-mfo, which kills more than 5,000
people annually in Sri Lanka; most victims are middleaged male farmers.  Much anecdotal evidence from this region suggests that consumption of contaminated water is the most likely source of this deadly disease.  Although the aetiology is unknown, prevention of this ‘‘environmentally acquired’’ disease seems relatively straightforward. Solutions include (a) preventing environmental pollution, (b) stopping the irresponsible use and decreasing the usage of agrochemicals, and encouraging the use of environmentally friendly agricultural methods, (c) taking proper precautions when using agrochemicals and safe disposal of their containers, (d) changing the risky behaviour of farmers and educating them to preserve the environment, and (e) providing clean potable water to all affected regions.  Implementing a well-coordinated, in-depth, region-wide, broad-based research study together with a long-term effective surveillance programme across the
country is essential to curbing this disease. Unless firm actions are taken promptly, more than three million healthy people in the country, live in agricultural regions, are at risk for contracting CKD-mfo and succumb to premature deaths, which are preventable.

Epoetin alfa and darbepoetin alfa are erythropoiesis-stimulating agents (ESAs) indicated for the treatment of anemia in chronic renal failure, including patients on dialysis and patients not on dialysis. Clinical experience demonstrates that the dose conversion ratio (DCR) between epoetin alfa and darbepoetin alfa is nonproportional across the dosing spectrum. However, previous calculations of the dose relationship between epoetin alfa and darbepoetin alfa, described in previous work as the "dose ratio" (DR), (a) used cross-sectional designs (i.e., compared mean doses for patient groups using each ESA) and were therefore vulnerable to confounding or (b) did not adjust for the nonproportional dose relationship. DRs reported in the literature range from 217:1 to 287:1 epoetin alfa (Units [U]):darbepoetin alfa (micrograms [micrograms]). Payers may need a single DCR that accounts for the nonproportional dose relationship to evaluate the economic implications of converting a no...