Clinical Procedures & Services

Kidney Failure & Disease

Acute kidney failure is the sudden loss of your kidneys' ability to perform their main function of eliminating excess fluid and salts (electrolytes) as well as waste material from your blood. When your kidneys lose their filtering ability, dangerous levels of fluid, electrolytes and wastes accumulate in your body.

Acute kidney failure, which is also called acute kidney injury, develops rapidly over a few hours or a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.

Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you're otherwise in good health, you may recover normal kidney function.

http://www.mayoclinic.com/health/kidney-failure/DS00280


Chronic Kidney Disease

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.

http://www.kidney.org/kidneydisease/


Dialysis

Dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. It is a life support treatment and does not treat any kidney diseases. Dialysis may be used for very sick patients who have suddenly lost their kidney function (acute renal failure) or for quite stable patients who have permanently lost their kidney function (end stage renal failure).

http://www.aakp.org/dialysis-information/


Hemodialysis

Perhaps the biggest impact on lifestyle is whether or not a person has dialysis in a center or does it at home. Dialysis in a center requires the patient go to a dialysis center for treatment three times a week for about four hours each treatment. Treatments in a center need to be scheduled and the patient needs to arrive at their appointment time. Dialysis at home provides more flexibility because the patient can perform dialysis at their convenience. For people who work or go to school, have children to care for, live active lifestyles or just want more freedom and control over their time, home dialysis may be a better option.

Diet is another factor to consider when choosing a modality. For people on dialysis, diet is part of their treatment. Foods containing the minerals phosphorus, potassium and sodium are usually limited on the dialysis diet, although a greater intake of potassium-containing foods is usually allowed for patients on peritoneal dialysis. Fluid consumption is also restricted. Renal dietitians work with their dialysis patients to counsel and educate them about a healthy diet and modify nutrient intake based on their monthly lab results. Dialysis patients who perform their treatments more often than three times a week may have more liberal diets than those patients who perform treatments three times per week.

Travel is another consideration. While people who choose in-center hemodialysis are free to travel, they will need to plan ahead and make arrangements to receive dialysis in a center where they are visiting. Although large and bulky, many home hemodialysis machines are portable, and people on home hemodialysis usually have a choice of bringing their equipment to their destination or going to a dialysis center in the place they are visiting to get treatment. Peritoneal dialysis cycler machines are smaller and portable, and PD supplies can be delivered directly to a vacation destination. Therefore, peritoneal dialysis patients can generally travel with greater ease.

http://www.davita.com/treatment-options/choosing-the-right-treatment/what-are-my-dialysis-choices?/t/5415


Peritoneal Dialysis

Hemodialysis is a treatment for kidney failure that removes the blood from the body so it can be filtered through a dialzyer (artificial kidney) and then returned to the body. The blood is removed from and returned to the body through an access — either a catheter or vascular access, such as an arteriovenous (AV) fistula or AV graft. The blood is filtered many times during a four-hour treatment to remove wastes and extra fluid. Hemodialysis can be performed in a dialysis center or at home. There are several hemodialysis choices including: in-center hemodialysis, in-center self care hemodialysis, in-center nocturnal hemodialysis, traditional home hemodialysis and short daily home hemodialysis. In-center self care, in-center nocturnal hemodialysis and the home hemodialysis options may not be available in some areas throughout the U.S.

Peritoneal dialysis (PD) removes wastes and extra fluid; however, it is performed within the body. The peritoneal cavity in the abdomen holds dialysis solution called dialysate, and the peritoneum, the membrane around the cavity, acts as a filter. A PD catheter, which is a small, flexible tube, is placed in the abdomen so the peritoneal cavity can be filled with dialysate. Waste passes through the peritoneum into the dialysate, which is then drained and replaced after an amount of time prescribed by the doctor. PD is performed at home, but can also be performed at work or in any other clean environment. The types of PD include: automated peritoneal dialysis (APD), which consists of continuous cycling peritoneal dialysis (CCPD) performed with a machine called a cycler, and continuous ambulatory peritoneal dialysis (CAPD), which is performed manually. PD is a dialysis option wherever home dialysis is http://www.davita.com/treatment-options/choosing-the-right-treatment/what-are-my-dialysis-choices?/t/5415


Hypertension

Hypertension is the term used to describe high blood pressure.

Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body.

Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.

The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure.

  • Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time.
  • High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above most of the time.
  • If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension.

If you have pre-hypertension, you are more likely to develop high blood pressure.

If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.

http://health.nytimes.com/health/guides/disease/hypertension/overview.html


Transplantation

Many people view a kidney transplant as a cure, but it's simply another treatment option. When a kidney from another person is put into someone whose kidneys are no longer working, it's called a kidney transplant. Usually one kidney is put in during a transplant. One healthy kidney can do the work of two. The transplant involves an operation, which usually takes about three hours. Once you have the transplant operation, you'll take medications as long as you have a working transplant. These medicines help your body accept the kidney and are called anti-rejection medicines.

http://www.aakp.org/transplant-information/


Electrolyte Disorders

Hyperkalemia:

The most common cause of high potassium (hyperkalemia) is impaired kidney function. Other causes of hyperkalemia include:

  • Certain medications, such as angiotensin-converting enzyme (ACE) inhibitors, Angiotensin Receptor Blocker (ARB) Heparon, Bactrum.
  • Hormone deficiencies, including adrenal failure (Addison's disease)
  • Destruction of red blood cells due to severe injury or burns
  • Excessive use of potassium supplements

Most of the potassium in your body is within your cells. As a result, the amount of potassium in your red blood cells is much greater than in the liquid part of your blood (plasma or serum). Your kidneys control the excretion of potassium in your urine.

True hyperkalemia is a serious and potentially life-threatening disorder. It can cause muscle fatigue, weakness, paralysis, abnormal heart rhythms (arrhythmias).

Sometimes a report of high blood potassium isn't true hyperkalemia. Instead it may be caused by the rupture of red blood cells in the blood sample during or shortly after drawing the sample. The ruptured cells leak their potassium into the serum. This falsely elevates the amount of potassium in the blood sample, even though the potassium level in your body is actually normal.


Hypokalemia:

Low potassium in the blood (hypokalemia) may result from many different conditions. The most common cause is excessive potassium loss in the urine or from the gastrointestinal tract, such as due to:

  • Use of diuretics
  • Excessive production of the hormone aldosterone (hyperaldosteronism) by the adrenal gland
  • Excessive use of laxatives
  • Eating disorders
  • Severe vomiting or diarrhea

Rarely, hypokalemia is due to not getting enough potassium in your diet.
Potassium is an electrolyte that is critical to the function of nerve and muscles cells, including those in your heart. Most of the potassium in your body is inside your cells. So the levels of potassium in your blood may not reflect your total body potassium.
Signs and symptoms of low potassium may include; weakness, fatigue, muscle cramps, constipation, abnormal heart rhythms (arrhythmias), certain kidney diseases such as renal tubular acidosis.

Treatment is directed at the underlying cause of the low potassium and may include potassium supplements. A very low potassium level is life-threatening.


Hypercalcemia:

Hypercalcemia is a higher than normal level of calcium in the blood. The most common cause is an overactive parathyroid gland (hyperparathyroidism). The parathyroid glands, which are located below the thyroid gland, regulate calcium in your body.
Other causes of hypercalcemia include:

  • Certain medications, such as lithium or thiazide diuretics
  • Certain cancers, including breast, lung and certain blood cancers
  • Sarcoidosis, an inflammatory disorder
  • Excessive intake of calcium or vitamin D supplements
  • Familial hypocalciuric hypercalcemia, a genetic disorder
  • Dialysis for chronic kidney failure
  • Adrenal gland failure
  • Overactive thyroid (hyperthyroidism)

Severe hypercalcemia may cause; nausea, vomiting, excessive thirst, constipation, abdominal pain, muscle weakness, confusion, lethargy and fatigue

A doctor may make a diagnosis of hypercalcemia by a blood test. Treatment is directed at the underlying cause. Severe hypercalcemia may require hospitalization to reduce calcium to safe levels. In such cases, treatment may include: intravenous fluids, diuretics, bisphosphonates, glucocorticoids (corticosteroids).

If untreated, hypercalcemia can lead to kidney stones, osteoporosis, abnormal heart rhythm (arrhythmia), or kidney failure.

http://www.mcw.edu/Nephrology/ClinicalServices/ElectrolyteDisorders.htm

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About OC Kidney

The Nephrologists at Orange County Kidney are specialized doctors with expertise in the kidneys and kidney disease.

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Sandeep S. Dang, M.D.

A graduate from University of Southern California School of Medicine, Dr. Sandeep Dang is passionate about advancing...

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Procedures & Services

Kidney Failure & Disease

Acute kidney failure is the sudden loss of your kidneys' ability to perform their main function of eliminating...

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