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7 Nissan 5763 - April 9, 2003 | Mordecai Plaut, director Published Weekly
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Home and Family


Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

Now that we know what the kidneys and urinary tract do, it won't be too hard to figure out what happens when the kidneys fail. First and foremost, fluids begin to accumulat, putting extra strain on the heart and making the legs swollen. Potassium levels can get very high and cause death. Calcium levels fall and phosphorus levels climb -- these can also make for a dangerous situation. Magnesium levels may also climb, especially if magnesium is given in antacid form or as an enema. It is the main component in many laxatives and enemas. Blood cell count falls since there is no hormone being secreted to stimulate red blood cell production. Acids accumulate in the blood and poisons such as urea and uric acid accumulate.

However, a marvelous process called dialysis was invented. People with failing kidneys have a vein connected to an artery in their arms and that becomes their access to a machine that filters the blood and deals with all of the above problems with the exception of blood cells. (Supplemental hormone through injections deals with this problem.)

Dialysis is usually given three times a week and is well tolerated. Dialysis can also be done at home through the abdomen, but complications are frequent. While these wonderful inventions have saved lives, patients still have a reduced life expectancy, usually due to heart troubles. People with the access site in their arm must be careful that blood tests are not taken from that arm and also that the site doesn't clot or become infected.

Why do kidneys fail? For sure there are many causes which are not known, but the most common cause remains diabetes, especially those who do not take their disease seriously. Vascular insult, such as low blood pressure in a shocky patient, can also lead to kidney failure, a common occurrence in a patient whose end is near R"l.

Medications can cause this problem, such as the use of the antibiotic gentamycin and the use of NSAIDS, a family of drugs that include Voltaren, ibuprofen, and Naproxen. It is usually reversible when the drug is discontinued and is usually -- but not always -- in chronic users.

In kids a problem called reflux can also lead to failure which is why we study young children who have had infection in their urinary tract. Rheumatologic diseases are also a cause.

First signs of kidney failure appear on blood tests. Urea and creatinine often rise first, with potassium rising as well. Fluid accumulation may appear, and protein appears in the urine. Urine production may decrease significantly or on the other hand the kidneys may just let everything through and there is too much production. We'll speak about the kidney more next week, especially as far as mechanical problems are concerned. Write me in care of the Yated.

A message from Glaxo, sponsor of this column. A recent study was presented in Sweden on how effective Zyban is in smokers who have had heart attacks. We discussed in the past that smoking is as addictive as street drugs and the best way to prevent smoking illnesses is never to start. Zyban gives new hope, especially in those who must stop quickly, as in heart patients. Zyban is worth the price!

 

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