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
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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!
