Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
I hope after last week's article you appreciate how
important one's kidneys are. To review, they filter out
dissolvable poisons from the body, make sure that the acid-
base balance in the body is where it should be; they
stimulate the creation of red blood cells; they control the
amount of fluid in our body and, as a result, influence the
blood pressure as well, and they stabilize the balance of
the salts in our body.
Often the kidneys come to the rescue when there are problems
elsewhere in the body. When vomiting and diarrhea threaten
to dehydrate a person, the kidneys will try to conserve
water. Vomiting and diarrhea also create losses of acids and
potassium; the kidney will attempt to conserve potassium and
throw out base so that acids are conserved. If you eat a
particularly salty meal -- watch out especially for Chinese
food -- then the kidneys will try to excrete more water
taking the salt with it.
In situations of shortness of breath, where too much acid is
produced, again the kidneys will come to the rescue. The
problem is that the kidneys do need time to make these
adjustments.
One can therefore appreciate that kidneys that fail will
result in havoc: Potassium can accumulate to dangerous, even
fatal, levels. Acids collect in the blood and make it harder
for the heart and brain to work. Calcium levels fall and
phosphorus levels can rise dangerously. Anemia results
because there is no stimulus to make blood cells. Fluid
retention can overcome the heart's ability to pump and cause
dangerous levels of blood pressure. Creatinine and urea
accumulate in the blood, and can poison the person through
their effects on acids and on the heart, its covering and
other parts of the body.
In the past, that would be the end. Nowadays, a miracle
machine called "dialysis" exists, where the machine filters
the blood and acts like an artificial kidney. This can be
done by creating an access blood vessel (commonly done by a
vascular surgeon) and then three time a week dialysis is
accomplished by inserting this machine's needle into the
blood vessel. In milder cases, peritoneal dialysis can be
done, where a catheter is introduced into the belly and
fluid exchange is done there.
Dialysis is life saving, but people with kidney failure
often live shortened lives even so. Nevertheless with the
exception of not making urine and spending a couple of hours
three times a week hooked up to a machine, they live normal
lifestyles.
Next week we will discuss how kidney failure occurs and how
we detect it. We will also discuss the urinalysis and
understand why it is such an important test. Write me in
care of the Yated.
A message from Glaxo, sponsor of this column. It has
been a while since we spoke about Zinnat, but with winter
upon us, you should know that it is the recommended therapy
for pneumonia in the elderly and people who smoke or have
any other lung and heart diseases. Zinnat often gives these
patients an opportunity to be treated in the safer
environment of their homes.
