1. What is chronic kidney failure?

Kidneys are made up of nephrons, which are tiny structures that filter waste out of the blood. When a person is diagnosed with a kidney disease or disease that affects the kidneys (such as diabetes or high blood pressure), the nephrons will be damaged over time and lose their filtering ability.

Then the body retains fluids and harmful wastes build up in the body. The patient develops fatigue, nausea, loss of appetite, vomiting, hypertension, anemia, pericarditis, and bone diseases.
These symptoms will progress into chronic kidney disease, the gradual loss of kidney function.


2. Kidney Functions
As blood passes through the kidney, it cleans the body’s waste products (carbamide from protein waste, uric acid, creatinine acid, and organic acid) and excess fluids, saline, and any electrolytes (calcium, kalium).
A healthy kidney balances the chemicals in the blood. It produces hormones that control blood pressure and maintain healthy blood cells and bones. It also produces the hormone erythropoietin, which helps make red blood cells and activates vitamin D to maintain healthy bones.

When a person has anemia, it can be treated by a genetically engineered form of erythropoietin hormone.

Chronic kidney disease is the slow breakdown of kidney function. One who has been diagnosed with chronic kidney disease, has been unwell for a long time.

The symptoms may not be noticed until a significant loss of kidney function occurs. When kidney function is at 50-75% of normal, no symptoms may show. When the kidney function is at 20-50% of normal, you may only notice symptoms at times of high stress.

When patients finally feel the effects of their damaged kidneys, they will experience an overall ill feeling. This is called uremia.


1.Uremia.
Uremia occurs, when less than 15% of kidney function remains. Too much fluid and waste will build up as toxins in the bloodstream. This condition leads to weight gain, high blood pressure, edema, and shortness of breath. Sufferers also develop fatigue, nausea, loss of appetite, vomiting, and seizures in the progression of uremia.


2.Edema
Chronic kidney disease is a slow process. Chronic kidney failure silently creeps up over a long period, but is devastating nonetheless. There are millions of nephrons in each kidney, and a person may not notice when a few nephrons become damaged. The remaining healthy nephrons normally are able to expel and filter salts, so the symptoms of edema (bloating) and high blood pressure are not readily apparent. However, when nephron damage reaches the last stage of chronic kidney failure, most patients build up sodium, as intake is greater than output. When lesions occur in the heart, the feet are first to bloat. Swelling of the face and eyelids is a symptom of infected kidneys, and it leads to edema and less urination than usual.


3.Albuminuria
When lesions develop in the kidney nephrons, the tissue fills up, narrowing the filter area and changing the character of the filter. When functioning properly, protein (albumin-a) that has not passed through is also filtered. This protein normally stabilizes water in the bloodstream. When the protein flows into the urine, the water in the bloodstream destabilizes, and the urine may be “frothy.”

Unfortunately, chronic kidney failure often cannot be cured. Dialysis and/or a kidney transplant may be needed when the kidneys do not work well enough after treatments with medications and a proper diet.


1.Hemodialysis
- Blood is sent through a filter called an artificial kidney, or a hemodialyzer, that removes waste products. The clean blood is returned to the body.
- Hemodialysis is usually performed three times per week, for 3 to 4 hours at a time.


2.Peritoneal dialysis
- A cleansing solution called dialysate travels through a special tube known as a catheter into the abdomen.
- Fluid, waste, and chemicals pass from tiny blood vessels in the peritoneal membrane to the dialysate solution.
- After several hours, the dialysate drains from the abdomen, taking the wastes from the blood with it. Then the abdomen is refilled with fresh dialysate and the cleaning process begins again.


3. Diet
- Limited sodium intake Avoid salt.
Salty food promotes thirst and causes the body to retain water, which can lead to edema, weight gain and high blood sugar.
- Limited fluid intake.
Limit the amount you drink. Fluid builds up quickly in the body when the kidneys aren’t functioning well. Too much fluid swells the tissues swell and can cause hypertension, weight gain, heart trouble and shortness of breath due to edema of the lungs. Patients must control the consumption soup, soft drinks, milk, teas, ice, and ice cream as well.
- Proper protein intake.
Excessive intake of protein when on hemodialysis will exacerbate uremia, while insufficient protein will bring on anemia or nutrition deficiency. Quality animal protein (eggs, meat, fish, milk) should be eaten in the right amounts at every meal.
- Adequate caloric intake
Insufficient calories will weaken the muscles and waste them away, and waste will build up. After dialysis the patient must check his/her weight and get the extra calories if needed from sources such as candy, jelly, and honey.
-Limited phosphorus intake
Diseased kidneys are unable to remove phosphorus from the blood sufficiently. Too much phosphorus in the blood may lead to loss of calcium in the bones, causing them to weaken, become brittle and break easily. High phosphorus levels in the blood can affect the heart rhythm, and lead to stroke.
Phosphorus comes from many foods in the diet. However, proper food handling can remove phosphorus prior to consumption, such as soaking vegetables in water for more than 2 hours or to blanching them in boiling water before eating.
- Water-soluble vitamins
The patient who is on dialysis should take water-soluble vitamins, especially folic acid and iron, because they are removed from the body by the dialysis procedure.
- Recommended foods
* For calories: honey, candy, white sugar, jelly, vegetable oil, syrup, flour with low protein.
* For flavor: hot pepper, black pepper, curry, vinegar, vanilla, mustard.
- Foods to limit or avoid
MSG, baking powder, chocolate, cocoa, brown and dark sugar, orange juice, instant coffee, tomato ketchup.

Chronic renal failure and anemia.

1.The symptoms of anemia from chronic kidney failure.
Anemia, a condition in which the blood does not contain enough red blood cells, is common among people with chronic kidney failure. Healthy kidneys produce a hormone called erythropoietin (EPO), which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen through the body and to the vital organs.

Debilitated kidneys, however, often do not produce enough EPO, and the bone marrow makes fewer red blood cells. These red blood cells easily break down and do not live very long, stimulating the secretion of much parathyroid hormone. This causes developed myelofibrosis and bleeding of gastrointestinal track.
- Easily fatigued
- Shortness of breathing after doing light exercise.
- Sleepy during the day and difficulty sleeping at night.
- Difficulty dealing with the cold


2.Treatment of anemia.
Healthy kidneys make the hormone EPO, which stimulates the bones to make more red blood cells. When diseased kidneys do not make enough EPO, treatment with a genetically engineered form of EPO may be needed to supplement the function of EPO. The injection dosage will depending on tests results for hemoglobin (Hgb) count and hematocrit (Hct). If the iron level is low, iron pills may be taken or iron given intravenously in cases of chronic kidney failure.