COVID-19 in Single Kidney Patient

The COVID-19 pandemic has affected all people in the world, especially those at risk of kidney disorders. Early kidney damage in patients born with unilateral renal agenesis (URA) or solitary kidney can happen. These patients are at risk of chronic kidney disease (CKD), high blood pressure, and developing proteinuria. Unilateral renal agenesis is a cause of CKD. Therefore, it is very interesting that observe a unilateral renal Patient that Suffers from COVID-19. Hence, the management of these patients with COVID‐19 is an area of interest, and a unique approach is warranted. A 43-year-old male patient with unilateral renal presented to our hospital for corona disease. The case was discussed between the nephrologists, Infectious disease specialists, and nursing head nurses for a care plan daily. The patient had unilateral renal disease, and COVID-19 could have a detrimental effect on the renal, but renal tests were normal, and the patient recovered without acute renal complications. The treatment of such patients is the need for teamwork contain nephrologists, critical care nurses, and specialists in infectious and tropical diseases. This was a new experience in Iran.

DIETARY MANAGEMENT OF CKD IN DIABETIC PATIENT IN A TERTIARY CARE HOSPITAL

Chronic kidney disease (CKD) is perhaps the most pervasive entanglements of diabetes, and patients with diabetic kidney disease (DKD) have a considerably higher danger of cardiovascular disease and demise contrasted with their non-diabetic CKD partners. Notwithstanding pharmacologic management procedures, nutritional and dietary mediations in DKD are a fundamental part of the board with the potential for enhancing kidney function decay and forestalling the improvement of opposite of other end-organ complications. In this study we detailed a patient having CKD and observed all require parameter in dietary management. Initial days, the patients Hb level was below normal, so, he was suggested iron-rich foods like beetroot, turnip, and carrot, raw banana in stewed form or in curry form. Also, in later, as the urea and creatinine content of the patient was too high from the normal patient, he was restricted from consuming protein-rich foods. On the day of discharge, all his reports were up to mark except urea and creatinine, as he was renal patient. Although nutrition intervention for DKD does require calculation of macro- and micronutrient and electrolyte requirements, a growing body of evidence suggests that specific dietary patterns of intake may confer additional therapeutic benefit.

Strategies and actions used by nurses against chronic renal patient sexuality: integrative review / Estratégias e ações utilizadas pelo enfermeiro frente à sexualidade do paciente renal crônico: revisão integrativa

Objetivo: identificar na literatura as estratégias e ações utilizadas pelo enfermeiro na promoção da sexualidade de pacientes com Doença Renal Crônica. Método: Revisão integrativa, com abordagem qualitativa e coleta de dados nas bases Literatura Latino-Americana e do Caribe em Ciências da Saúde, no Banco de Dados em Enfermagem e no Medical Literature Analysis and Retrieval System Online, utilizando os seguintes descritores: “Sexualidade” and “Doença Renal Crônica” and Enfermagem or Enfermeiro”. A busca resultou em 232 produções, sendo 12 selecionadas para análise. Resultados: As estratégias e ações utilizadas pelo enfermeiro estão relacionadas ao cuidado e à utilização do processo de enfermagem. Conclusão: A atuação do enfermeiro contribui para a promoção da assistência integral ao paciente renal crônico, em todas as dimensões do cuidado, abrangendo a sexualidade. Ao aplicar o processo de enfermagem é possível traçar um plano de cuidado conforme sua realidade e auxiliar para uma melhor qualidade de vida.

Autocuidado do paciente renal com a fístula arteriovenosa

Objetivo: Avaliar atividades de autocuidado com a fístula arteriovenosa em renais crônicos. Metodologia: Estudo descritivo, transversal, com abordagem quantitativa, realizado com 60 pacientes em unidade de diálise no Nordeste Brasileiro, de setembro a outubro de 2018. Os dados foram coletados por meio de entrevistas e analisados através de estatística descritiva. O estudo foi aprovado pelo Comitê de Ética e Pesquisa (Parecer nº 233.953/13). Resultados: Os cuidados realizados frequentemente foram: não permitir a verificação da pressão arterial (71,7%), administração de medicamentos e a coleta de sangue no membro da fístula (71,6%), realizar higiene do membro da fistula (68,4%) e evitar carregar peso (68,3%). Os cuidados menos referidos foram: colocar compressa morna no dia anterior à hemodiálise (30,0%) e fazer exercícios de preensão com bola de borracha (15%). Conclusão: O conhecimento dos pacientes quanto às atividades de autocuidado com a fístula arteriovenosa foi considerado insuficiente, ao evidenciar maior preocupação ante a possibilidade de procedimentos clínicos realizados no braço da fístula, seguidos da higiene e sobrecarga no membro. Estes dados reforçam a importância do planejamento das atividades educativas de forma criativa e permanente pelos profissionais de saúde direcionadas para este público e que poderão auxiliar o enfermeiro na priorização das ações.Descritores: Autocuidado; Diálise Renal; Educação em Saúde; Cuidados de Enfermagem.AUTOCUIDADO DEL PACIENTE RENAL CON LA FÍSTULA DE ARTERIOVENOSAObjetivo: Evaluar actividades de autocuidado con fístula arteriovenosa en renales crónicos. Metodología: Un estudio descriptivo, transversal con un enfoque cuantitativo, realizado con 60 pacientes en una unidad de diálisis en el noreste de Brasil, de septiembre a octubre de 2018. Los datos fueron recolectados por médio de entrevistas y analizados mediante estadística descriptiva. El estudio fue aprobado por el Comité de Ética e Investigación (Opinión nº 233.953/13). Resultados: Los cuidados más frecuentes fueron: no permitir la verificación de la presión arterial (71,7%), la administración de medicamentos y la recolección de sangre en la extremidad de la fístula (71,6%), realizar la higiene de la extremidad de la fístula (68.4%) y evitar cargar peso (68.3%). Los cuidados menos informadas fueron: poner una compresa tibia el día anterior a la hemodiálisis (30.0%) y hacer ejercicios de agarre con pelota de goma (15%). Conclusión: El conocimiento de los pacientes renales crónicos con respecto a las actividades de auto cuidado con fístula arteriovenosa fue insuficiente, y se identificó la actividades más y menos conocida entre los pacientes. Estos datos refuerzan la importancia de las actividades educativas planificadas por profesionales de la salud dirigidas a este público y pueden ayudar a las enfermeras a planificar estas acciones.Descriptores: Autocuidado; Diálisis Renal; Educación en Salud; Atención de Enfermería.SELF CARE OF THE RENAL PATIENT WITH THE ARTERIOVENOSA FISTULAObjective: To evaluate self care activities with arteriovenous fistula in chronic renal patients. Methodology: A descriptive, cross-sectional study with a quantitative approach, conducted with 60 patients in a dialysis unit in Northeast Brazil, from September to October 2018. Data were collected through interviews and analyzed using descriptive statistics. The study was approved by the Ethics and Research Committee (Opinion nº 233.953/13). Results: The most frequent cares were: not allowing blood pressure verification (71.7%) and medication administration and blood collection in the fistula limb (71.6%), perform fistula limb hygiene with water and antiseptic soap (68.4%) and avoid carrying weight (68.3%). The least reported cares were: putting warm compress on the day before hemodialysis (30.0%) and do pressure exercise with rubber ball (15%). Conclusion: The knowledge of chronic renal patients regarding self care activities with arteriovenous fistula was insufficient, and the most and least known care among patients was identified. These data reinforce the importance of educational activities planned by health professionals aimed at this audience and can assist nurses in planning these actions.Descriptors: Self Care; Renal Dialysis; Health Education; Nursing Care.

Feelings, experiences and expectations of kidney transplant individuals and challenges for the nurse

ABSTRACT Objectives: to identify feelings, experiences, and expectations of kidney transplant patients, generated from the diagnosis of chronic renal disease until the post-transplant period, highlighting the challenges for nurses to incorporate individualized care to cope throughout the disease process. Methods: qualitative, descriptive research, carried with seven kidney transplant patients, in the city of Manaus, State of Amazonas. The data analysis followed the methodological referential of Bardin’s content analysis. Results: the diagnosis of the disease was experienced negatively, and hemodialysis was described as an imprisonment and health decline. The transplant meant an improvement in quality of life. The main difficulties were lack of a specialized hospital and low immunity. Conclusions: the nurses’ approach of chronic renal patient and with the renal transplantation favored the discovery of solutions facing the demands of the disease and allowed greater capacity to implement individualized care, surrounding a relationship of trust and respect.

Caloric Intake in Renal Patients: Repercussions on Mineral Metabolism

The aim of this paper is to review current knowledge about how calorie intake influences mineral metabolism focussing on four aspects of major interest for the renal patient: (a) phosphate (P) handling, (b) fibroblast growth factor 23 (FGF23) and calcitriol synthesis and secretion, (c) metabolic bone disease, and (d) vascular calcification (VC). Caloric intake has been shown to modulate P balance in experimental models: high caloric intake promotes P retention, while caloric restriction decreases plasma P concentrations. Synthesis and secretion of the phosphaturic hormone FGF23 is directly influenced by energy intake; a direct correlation between caloric intake and FGF23 plasma concentrations has been shown in animals and humans. Moreover, in vitro, energy availability has been demonstrated to regulate FGF23 synthesis through mechanisms in which the molecular target of rapamycin (mTOR) signalling pathway is involved. Plasma calcitriol concentrations are inversely proportional to caloric intake due to modulation by FGF23 of the enzymes implicated in vitamin D metabolism. The effect of caloric intake on bone is controversial. High caloric intake has been reported to increase bone mass, but the associated changes in adipokines and cytokines may as well be deleterious for bone. Low caloric intake tends to reduce bone mass but also may provide indirect (through modulation of inflammation and insulin regulation) beneficial effects on bone. Finally, while VC has been shown to be exacerbated by diets with high caloric content, the opposite has not been demonstrated with low calorie intake. In conclusion, although prospective studies in humans are needed, when planning caloric intake for a renal patient, it is important to take into consideration the associated changes in mineral metabolism.

The renal patient seen by non-renal physicians: the kidney embedded in the ‘milieu intérieur’

Chronic kidney disease is defined as a decrease in renal function or evidence of kidney injury for >3 months. This represents an oversimplification that may confuse physicians. Thus kidney function is equated to glomerular filtration rate, which represents one of multiple kidney functions. Some potentially more important renal functions are lost earlier, such as the production for the anti-ageing factor Klotho. Overall, these changes modify the emergent properties of the body, altering the relationships between different organs and systems, in a manner that is difficult to predict the response to interventions based on normal physiology concepts, as there is a novel steady state of interorgan relations. In this regard we now discuss the impact of CKD on heart failure; osteomuscular and joint pain and bone fragility and fractures; and osteosarcopaenia as seen by a cardiologist, a rheumatologist and a geriatrician.