Intercorrências Clínicas em Hemodiálise Ambulatorial: Intervenções do Enfermeiro

Os rins têm função vital, pois são responsáveis pela eliminação de toxinas, regulação do volume de líquidos e pela filtragem do sangue (filtram, por minuto, em média 20% do volume sanguíneo bombeado pelo coração). Dessa forma, a função renal é avaliada com base na filtração glomerular (FG) e sua redução é observada na doença renal crônica (DRC), quando ocorre a perda das funções reguladora, excretora e endócrina dos rins. Desequilíbrios esses que podem ser de consequência vascular, por comorbidade secundária, por doença renal secundária a drogas ou agentes tóxicos, infecções urinárias de repetição, doença de próstata, doenças policísticas renal, entre outras. Nas terapias renais substitutivas, a diálise é empregada para remover líquidos e produtos residuais urêmicos do organismo, quando o corpo não consegue mais fazê-lo. Tendo em vista que o procedimento hemodialítico tem complicações potenciais, considera-se vital que o enfermeiro deva estar apto para intervir em tais intercorrências, portanto, ficando evidente a importância deste estudo. Objetiva-se, portanto, descrever as intervenções do enfermeiro em intercorrências clínicas durante a hemodiálise ambulatorial, bem como descrever as principais intercorrências durante as sessões de hemodiálise ambulatorial e se há protocolos específicos de intervenções do enfermeiro em intercorrências com o paciente dialítico. Trata-se de uma pesquisa de revisão integrativa da literatura, pois esta metodologia de revisão tem por propósito realizar uma dada síntese rigorosa de todas as pesquisas encontradas relacionadas a uma questão específica. Palavras-chave: Enfermagem. Hemodiálise. Intercorrências Abstract The kidneys have a vital function, as they are responsible for eliminating toxins, regulating the volume of fluids and filtering the blood (they filter, on average, 20% of the blood volume pumped by the heart per minute). Thus, renal function is assessed based on glomerular filtration (FG) and its reduction is seen in chronic kidney disease (CKD), when the loss of the kidneys regulatory, excretory and endocrine functions occurs. These imbalances can be of vascular consequence, secondary comorbidity, kidney disease secondary to drugs or toxic agents, recurrent urinary infections, prostate disease, polycystic kidney diseases, among others. In renal replacement therapies, dialysis is used to remove uremic fluids and waste products from the body when the body is unable to do so. Bearing in mind that the hemodialysis procedure has potential complications, it is considered nodal that the nurse must be able to intervene in such complications, therefore, the importance of this study is evident. Therefore, the objective is to describe the nurse's interventions in clinical complications during the outpatient hemodialysis, as well as to describe the main complications during the outpatient hemodialysis sessions and if there are specific protocols for the nurse interventions in complications with dialysis patients. It is an integrative literature review research, since this review methodology aims to perform a given rigorous synthesis of all the studies found related to a specific issue. Keywords: Nursing. Hemodialysis. Complications

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Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients

Toxins ◽

10.3390/toxins13040289 ◽

2021 ◽

Vol 13 (4) ◽

pp. 289

Author(s):

Adamasco Cupisti ◽

Piergiorgio Bolasco ◽

Claudia D’Alessandro ◽

Domenico Giannese ◽

Alice Sabatino ◽

...

Keyword(s):

Kidney Disease ◽

Residual Renal Function ◽

The Body ◽

Uremic Toxins ◽

End Stage Kidney Disease ◽

Waste Products ◽

Hemodialysis Treatment ◽

Life Saving ◽

Kidney Replacement Therapy ◽

End Stage

The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.

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A Single Arm Clinical Trial to Assess the Combined Effectiveness of Anubhuta Kashaya and Kaishora Guggulu in the Management of Chronic Kidney Disease (CKD)

International Journal of Ayurveda and Pharma Research ◽

10.47070/ijapr.v9i9.2013 ◽

2021 ◽

pp. 11-20

Author(s):

Rajshekar N. Shettar ◽

Prashanth A.S

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Filtration Rate ◽

Signs And Symptoms ◽

Good Health ◽

The Body ◽

Inclusion Criteria ◽

Waste Products ◽

Progressive Decline ◽

General Signs

CKD encompasses a spectrum of pathophysiologic processes associated with abnormal kidney function and a progressive decline in the glomerular filtration rate (GFR). Elimination of Malas from the body is also an inductive of good health. There are totally three Malas explained by the Samhitas namely Purisha, Mutra & Sweda. In Chronic Kidney Disease (CKD) where there is a less formation of Mutra, the Karma of Mutra is removing Kleda (waste products) from the body. So, the Kleda which resides in the body causes Pratiloma gati of Vata leading to different variety of diseases which involves Dusti of Rakta. Therefore, use of Mutrala & Raktashodhaka Dravyas may be helpful in the subjects of CKD. There is no availability of direct description of CKD in Ayurvedic science, except Vrukka roga Adhikara of Bhaishajya Ratnavali. So, we studied the disease with Ayurvedic concepts on the basis of general signs and symptoms. Here 28 subjects diagnosed with Chronic Kidney Disease (CKD) fulfilling the inclusion criteria were selected incidentally for study. For each subject of CKD Amapachana and Koshtashodhana was done with Hareetakyadi churna, Anubhuta Kashaya and Kaishora Guggulu are administered as Shamanoushadhi. With this intervention, we are able to give mild to moderate improvement in subjective and objective parameters. During the study improvement of subjective parameters are well appreciated than the objective parameters. The objective of the study is to establish the combined effectiveness of Anubhuta Kashaya and Kaishora guggulu in the management of Chronic Kidney Disease.

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Cystic Kidney Diseases

Kidney Protection ◽

10.1093/med/9780190611620.003.0038 ◽

2019 ◽

pp. 373-388

Author(s):

Fouad T. Chebib ◽

Vicente E. Torres

Keyword(s):

Kidney Disease ◽

Kidney Diseases ◽

Average Rate ◽

Cystic Kidney ◽

Renal Protection ◽

Clinical Complications ◽

Kidney Cysts ◽

Autosomal Dominant Polycystic Kidney ◽

Stage Renal Disease ◽

End Stage

Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenic kidney disease, is characterized by relentless development of kidney cysts, hypertension, and eventually end-stage renal disease. The enlargement of the bilateral kidney cysts is gradual throughout the lifetime of the patient until little renal parenchyma is recognizable. At that stage, the average rate of GFR decline is 4.4 to 5.9 mL/min/year. Over the past few years, several advancements in diagnosing, prognosticating, and understanding the pathogenesis of the disease have been made. The natural course of ADPKD makes it an ideal disease to be targeted for renal protection. This chapter discusses various aspects of pathophysiology and molecular pathways and addresses in details the various pharmaceutical and nonpharmaceutical interventions in the journey of prevention of clinical complications of ADPKD.

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Environmental Toxins and the Kidney

Kidney Protection ◽

10.1093/med/9780190611620.003.0014 ◽

2019 ◽

pp. 147-154

Author(s):

Joshua D. King ◽

Bernard G. Jaar

Keyword(s):

Heavy Metals ◽

Kidney Disease ◽

Kidney Diseases ◽

Food Additives ◽

Kidney Injury ◽

Toxic Agent ◽

Toxic Agents ◽

Relationship Of ◽

The Relationship

While many compounds are known to be environmental and occupational nephrotoxins, it is often difficult to define the exact contribution of individual toxins to the development of kidney disease. This chapter discusses the relationship of environmental and occupational toxins to kidney diseases, explores the pathogenesis of nephrotoxicity of specific agents, stresses the importance of removal from the toxic agent(s), and describes considerations relevant to medical treatment of selected toxic exposures causative of kidney disease. A number of individual nephrotoxins such as heavy metals, silica compounds, herbal medications, and food additives are discussed in more detail, as is the epidemiology of chronic kidney disease and acute kidney injury due to environmental and occupational toxins. Options for treatment and controversies pertaining to the therapy of toxic agents causative of kidney disease are explored, particularly the role of chelation of heavy metals.

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Exosomes: Emerging Therapy Delivery Tools and Biomarkers for Kidney Diseases

Stem Cells International ◽

10.1155/2021/7844455 ◽

2021 ◽

Vol 2021 ◽

pp. 1-18

Author(s):

Can Jin ◽

Peipei Wu ◽

Linli Li ◽

Wenrong Xu ◽

Hui Qian

Keyword(s):

Kidney Disease ◽

Kidney Diseases ◽

Rapid Development ◽

Diagnostic Value ◽

The Body ◽

Biologically Active ◽

Target Cells ◽

Isolation And Identification ◽

Beneficial Effects ◽

Positive Effects

Exosomes are nanometer-sized small EVs coated with bilayer structure, which are released by prokaryotic and eukaryotic cells. Exosomes are rich in a variety of biologically active substances, such as proteins, nucleotides, and lipids. Exosomes are widely present in various body fluids and cell culture supernatants, and it mediates the physiological and pathological processes of the body through the shuttle of these active ingredients to target cells. In recent years, studies have shown that exosomes from a variety of cell sources can play a beneficial role in acute and chronic kidney disease. In particular, exosomes derived from mesenchymal stem cells have significant curative effects on the prevention and treatment of kidney disease in preclinical trials. Besides, some encapsulated substances are demonstrated to exert beneficial effects on various diseases, so they have attracted much attention. In addition, exosomes have extensive sources, stable biological activity, and good biocompatibility and are easy to store and transport; these advantages endow exosomes with superior diagnostic value. With the rapid development of liquid biopsy technology related to exosomes, the application of exosomes in the rapid diagnosis of kidney disease has become more prominent. In this review, the latest development of exosomes, including the biosynthesis process, the isolation and identification methods of exosomes are systematically summarized. The utilization of exosomes in diagnosis and their positive effects in the repair of kidney dysfunction are discussed, along with the specific mechanisms. This review is expected to be helpful for relevant studies and to provide insight into future applications in clinical practice.

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Calcium Signaling Mediates Cell Death and Crosstalk with Autophagy in Kidney Disease

Cells ◽

10.3390/cells10113204 ◽

2021 ◽

Vol 10 (11) ◽

pp. 3204

Author(s):

Bo Ning ◽

Chuanzhi Guo ◽

Anqi Kong ◽

Kongdong Li ◽

Yimin Xie ◽

...

Keyword(s):

Cell Death ◽

Kidney Disease ◽

Autosomal Dominant ◽

Kidney Diseases ◽

Ischemia Reperfusion ◽

Kidney Injury ◽

The Body ◽

Polycystic Kidney ◽

Progression Of Kidney Disease ◽

Autosomal Dominant Polycystic Kidney

The kidney is an important organ for the maintenance of Ca2+ homeostasis in the body. However, disruption of Ca2+ homeostasis will cause a series of kidney diseases, such as acute kidney injury (AKI), chronic kidney disease (CKD), renal ischemia/reperfusion (I/R) injury, autosomal dominant polycystic kidney disease (ADPKD), podocytopathy, and diabetic nephropathy. During the progression of kidney disease, Ca2+ signaling plays key roles in various cell activities such as necrosis, apoptosis, eryptosis and autophagy. Importantly, there are complex Ca2+ flux networks between the endoplasmic reticulum (ER), mitochondria and lysosomes which regulate intracellular Ca2+ signaling in renal cells and contribute to kidney disease. In addition, Ca2+ signaling also links the crosstalk between various cell deaths and autophagy under the stress of heavy metals or high glucose. In this regard, we present a review of Ca2+ signaling in cell death and crosstalk with autophagy and its potential as a therapeutic target for the development of new and efficient drugs against kidney diseases.

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Biological Role, Mechanism of Action and the Importance of Interleukins in Kidney Diseases

International Journal of Molecular Sciences ◽

10.3390/ijms23020647 ◽

2022 ◽

Vol 23 (2) ◽

pp. 647

Author(s):

Paulina Mertowska ◽

Sebastian Mertowski ◽

Iwona Smarz-Widelska ◽

Ewelina Grywalska

Keyword(s):

Blood Pressure ◽

Kidney Disease ◽

Kidney Diseases ◽

The Body ◽

Immune Disorders ◽

Biological Functions ◽

The Public ◽

Number Of Patients ◽

Late Detection

Each year, the number of patients who are diagnosed with kidney disease too late is increasing, which leads to permanent renal failure. This growing problem affects people of every age, sex and origin, and its full etiopathogenesis is not fully understood, although the involvement of genetic susceptibility, infections, immune disorders or high blood pressure is suggested. Difficulties in making a correct and quick diagnosis are caused by the lack of research on early molecular markers, as well as educational and preventive activities among the public, which leads to the late detection of kidney diseases. An important role in the homeostasis and disease progression, including kidney diseases, is attributed to interleukins, which perform several biological functions and interact with other cells and tissues of the body. The aim of this article was to systematize the knowledge about the biological functions performed by interleukins in humans and their involvement in kidney diseases development. In our work, we took into account the role of interleukins in acute and chronic kidney disease and kidney transplantation.

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Rancang Bangun Aplikasi Pendeteksi Penyakit Ginjal Kronis dengan Menggunakan Algoritma C4.5

Jurnal ULTIMATICS ◽

10.31937/ti.v9i1.558 ◽

2017 ◽

Vol 9 (1) ◽

pp. 10-18

Author(s):

Robi Rianto ◽

Ni Made Satvika Iswari

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Decision Tree ◽

Kidney Diseases ◽

Detection System ◽

Waste Product ◽

The Body ◽

Test Results ◽

Tree Detection ◽

Index Terms

Kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Kidneys are vital organs contained in the human body and serve to filter the blood of metabolic waste product and throw it in the form of urine. Given the changing conditions in the body can affect the kidneys, causing a decrease in the function of these organ and lead to chronic kidney disease. In an article on the website of the National Institute of Diabetes and Digestive and Kidney Diseases (2014) argued that chronic kidney disease is a silent disease, in which patients appear normal and show no symptomp but the test results stating the patient’s kidney function had decreased. Based on the above information, the research on how to detect chronic kidney disease will be conducted. Applications built on the basis of desktop and using Decision Tree algorithm C4.5. The trial was conducted to determine how much the level of accuracy that can be generated by the application. The testing process is done by using cross-validation and based on the results already calculated this application has an accuracy of 91.50% at the time of the decision tree is made without using preprocess menu. Index Terms— C4.5, chronic kidney disease, decision tree, detection system.

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Biochemical Investigation to Determine the Factors Involved in Renal Failure Formation for Dialysis Patients

Research Journal of Pharmacy and Technology ◽

10.52711/0974-360x.2021.01085 ◽

2021 ◽

pp. 6275-6280

Author(s):

Marwan Talib Joudah ◽

Shaker M. Saleh ◽

Wisam Talib Joudah ◽

Mohammed Talib Joudah

Keyword(s):

Renal Failure ◽

Kidney Diseases ◽

The Body ◽

Dialysis Patients ◽

Waste Products ◽

Dialysis Unit ◽

Medical Facilities ◽

High Hba1c ◽

Other Substances ◽

Positive Results

Renal failure is on the top list of kidney diseases as being frequently reported in many medical facilities around the globe. Human kidneys play an important role in excreting, reabsorbing, secreting and filtrating substances in the body. Healthy kidney must excrete the waste products of the body in urine and preserve albumin, and other useful substances in the body. The current study aims to figure out the expected factors of renal failure formation in dialysis patients. Likewise, it is designed to search for any correlation between the imbalanced levels of electrolytes and kidney deterioration. The current study was conducted in Ramadi city-Iraq with the assistance of Al-Ramadi Educational Hospital (REH). The (14th) samples of renal failure patients were collected from dialysis unit at (REH). (2-3 mL) of blood was taken from a patient’s vein. The serum was separated from plasma with the use of a centrifuge. All samples were undergone centrifuging for (4-7 min) at (550 rpm). Afterward, samples were subjected to biochemical examinations to determine the levels and quantities of some biochemical elements and other substances in the selected cases. It was found that some patients had been recorded with a decrease in glomerular filtration rate (GFR), high HbA1c level (˃ 6.5 mg/dL) (21.5%), anemia (˂ 12.0 mg/dL) (%100) in women and (˂ 13.5 mg/dL) in men (%100), Uremia (˃ 45mg/dL) (%100), hypercalcemia (˃10.5 mg/dL) (%7.14), hyperkalemia (˃ 5.1 mg/dL) (%92.8), and Hypernatremia (˃145 mg/dL) (%28.5). Some results obtained, imbalanced levels of the mentioned substances, are either progressed with kidney deterioration, or they are the causes of renal failure. Changes in the levels of some blood substances were observed, and positive results were obtained regarding the aim of the study. Levels or quantities of some blood substances play an important role in preserving kidneys good performance. For instance, when the level of glucose in blood raises, a severe damage to the blood vessels of the kidney takes place and results in poor kidney's performance. While, an increment in the K serum level causes a sudden cardiac death. Changing in some levels and quantities of blood substances could be a core cause of renal failure formation, however, some of them develops when kidney deteriorates.

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MO1025SCREENING FOR CELIAC DISEASE AMONG PEDIATRIC PATIENTS WITH CHRONIC KIDNEY DISEASE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab108.0022 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Magid A Abd El Fattah Ibrahim ◽

Ahmed M Hamdy ◽

Doha Anwar ◽

M Said Ragia

Keyword(s):

Chronic Kidney Disease ◽

Celiac Disease ◽

Kidney Disease ◽

Renal Disease ◽

Pediatric Patients ◽

Kidney Diseases ◽

Tissue Transglutaminase ◽

The Body ◽

Watery Diarrhea ◽

Healthy Children

Abstract Background and Aims Chronic kidney diseases (CKD) in children are a group of diseases that not only affects the kidneys but also all systems of the body particularly causing anemia, bone diseases and failure to thrive in that age group. Gastrointestinal tract (GIT) manifestations are not thoroughly highlighted in those patients although they definitely have repercussions on their growth and development. GIT diseases such as celiac disease (CD) has been long linked to renal manifestations either through increasing risk of kidney diseases or as a proved association. The aim of this study was screening for celiac disease and GIT symptoms among pediatric patients with chronic kidney disease. Method A case-control study included 90 CKD patients from Nephrology unit, Children’s Hospital, Ain Shams University, who has been diagnosed for at least 3 months and not receiving steroids or immunosuppressive therapy: 60 patients with end stage renal disease (ESRD) on regular hemodialysis (HD) & 30 with CKD on conservative treatment. Their ages ranged between 2-13 years old, 47 males, 43 females. 200 controls were also enrolled in the study (for GIT manifestations): healthy children with ages ranging from 2-13 years old, 77 males, 123 females within a period of 12 months. All patients & controls were interviewed about GIT manifestations they regularly experience and any GIT troubles they have. All CKD patients were screened for CD by Anti Tissue transglutaminase IgG and IgA blood testing. Results Reviewing the most significant GIT symptoms among patients, we found that 86.7% had mucoid diarrhea, 77.8% had abdominal distension, 75.6% had anorexia, 64.4% had epigastric pain, 51.1% had watery diarrhea, 30% had nausea, 30% had vomiting, and 25.6% had constipation. None suffered from hematemesis, melena or bloody diarrhea. GIT symptoms were significantly more pronounced in CKD patients compared to controls and even more in ESRD patients than CKD patients. All patients were negative for CD screening by Anti Tissue transglutaminase IgG and IgA. No significant correlations were seen between Anti Tissue transglutaminase IgG and IgA and age, sex, anthropometric measures (except for BMI), biochemical results (except for s. ferritin) or eitiology of renal disease were observed. Conclusion GIT troubles are more pronounced in children with CKD compared to age and sex matched healthy controls. CD is not particularly prevalent among CKD pediatric patients compared to the known percentage among this age population.

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