Ayurvedic tablets make the kidneys fail

Chronic kidney failure: treatment

Untreated chronic kidney failure often leads to complete failure of the kidneys after years (terminal kidney failure), especially with hereditary diseases of the kidneys or when there is a lot of protein in the urine. The more a treatment can reduce blood protein levels, the sooner it can prevent complete kidney failure.

The aim of any treatment is to prevent or at least delay the progression of the disease. A complete cure is not possible in most cases, but the earlier a kidney weakness is treated, the higher the chances of success. For some hereditary diseases such as the familial cystic kidney, however, there is still no therapy.

A distinction is made between treatment of the disease on which the kidney weakness is based, e.g. B. diabetes, high blood pressure or glomerulonephritis, as well as symptomatic treatment intended to alleviate the effects of kidney failure, e.g. B. Anemia, edema, increase in potassium. Early treatment of the underlying disease is a prerequisite for successful treatment of kidney weakness.

If kidney weakness has not progressed too far, it can be treated with medication. Later, artificial blood cleansing (dialysis) or a kidney transplant is usually necessary.

Medication

Diabetes medication

In the case of diabetes mellitus, blood sugar-lowering drugs are used, for high blood pressure, anti-inflammatory drugs are used, and for inflammation of the kidney corpuscles anti-inflammatory drugs. A good adjustment of blood sugar and blood pressure and a permanent control of these two values ​​can prevent the occurrence of kidney disease from the outset or slow down the progression of an existing kidney weakness.

Blood pressure medication

In patients with high blood pressure, antihypertensive agents may slow the progression of declining kidney function. So-called ACE inhibitors and angiotensin II receptor antagonists are preferred, which, in addition to their antihypertensive effect, also hardly put any strain on the kidneys. It is important that the ACE inhibitors protect the kidneys and are independent of blood pressure. The ACE inhibitors are also prescribed for normal blood pressure levels. The target value is a blood pressure of 130/80. To achieve this, several drugs with different mechanisms of action have to be used in many cases. Patients can support drug therapy through physical activity, no nicotine, and a low-salt diet.

Anti-inflammatory drugs

Inflammation of the kidney corpuscles (glomerulonephritis) can be treated with drugs that reduce the activity of the immune system. These so-called immunosuppressants include drugs such as B. cortisone, cyclosporine or cyclosphosphamide.

Hormones

Since the formation of new red blood cells decreases when the kidneys are weak, the kidney hormone erythropoietin (Epo) is administered in cases of anemia (renal anemia), which stimulates the formation of new blood and thus increases the number of red blood cells. Before using Epo, the doctor will measure the amount of iron in the body, because with chronic kidney weakness and anemia, iron is often also missing.

Fat reducers

Blood lipid lowering drugs, e.g. Statins, such as statins, are used to treat high cholesterol and to treat cardiovascular diseases such as arteriosclerosis.

Diuretics and phosphate binders

Urinary drugs called diuretics increase the excretion of salt and water. Although the agents can increase the amount of urine, they do not improve the detoxification function of the kidneys. If a low-phosphate diet can no longer keep the phosphate levels stable as kidney function continues to decline, so-called phosphate binders are used, e.g. B. Calcium Carbonate, Potassium Acetate, Calcium Citrate. These bind part of the phosphate in the food in the gastrointestinal tract. They should be taken in the correct dosage immediately before or at the beginning of the meal.

Treatment with vitamin D and / or vitamin D analogues also serves to normalize calcium and phosphate metabolism.

dialysis

According to today's specifications, the initiation of renal replacement therapy (dialysis) is recommended at the latest when the creatinine clearance is less than 5-10 milliliters / minute, and earlier in diabetes patients. If a patient is already suffering from damage to many organs (uraemic syndrome) or if edema or high blood pressure cannot otherwise be brought under control, renal replacement therapy should be started earlier.

It is important that kidney replacement therapy is prepared and initiated in good time. Adequate nutritional status, well-controlled blood pressure and a balanced blood count are important requirements.

If terminal kidney failure occurs despite all therapeutic measures, only dialysis or a kidney transplant can help. This is the case when the consequences of impaired kidney function can no longer be controlled through an appropriate diet and medication. Since an early start improves the chances of treatment, preparations should be started in good time. Today there are two different blood purification procedures: on the one hand hemodialysis, the most commonly used procedure, and on the other hand, peritoneal dialysis.

Kidney transplant

In a kidney transplant, a kidney patient receives a healthy kidney from a living or deceased donor. The surgeon will either transplant a kidney from a deceased or a living relative or loved one to the patient. This is possible without any health restrictions for the donor, since one of the two kidneys that every person usually has is sufficient for blood purification and urine formation.

According to the Transplantation Act that came into force in Germany in 1997, the requirement for organ removal for a donation from a deceased person is the determination of brain death. In the case of a living donation, no economic motives or emotional pressures should influence the decision to donate. The prerequisite is that the blood group and other specific genetic characteristics of the donor and recipient match so that the new kidney is not rejected by the recipient's own immune system.