Kidney failure usually progresses insidiously without symptoms. Chronic renal failure, which develops as a result of diseases such as diabetes, blood pressure, and kidney inflammation, sometimes manifests itself with edema in the legs and chronic fatigue. Yeditepe University Hospitals Internal Medicine and Nephrology Specialists stated that these symptoms should be taken into consideration in patients and warned them to consult a doctor before it is too late.  they also answered the questions about chronic renal failure.

What is Chronic Renal Failure?

Nephritis, kidney and urinary tract stones, congenital and genetic diseases, structural disorders of the kidney, as well as diabetes, high blood pressure, atherosclerosis, rheumatological diseases, infections, and congenital and genetic syndromes, which directly affect the kidney, involve the kidney as well as many other organs and systems, resulting in specific clinical conditions. These conditions, such as those caused by diabetes, blood pressure, nephritis, stones, infections, or rheumatological diseases, can be completely or significantly cured if they are recognized at an early stage and treated appropriately. Most of the time, however, the diagnosis is made late or the disease tends to progress due to its nature. As a result of this progression, the functioning units of the kidney, which cleanse the blood and remove wastes and toxins such as urea, and creatinine, which are formed as a result of metabolic activity in the body with urine, are destroyed slowly and then rapidly and transformed into connective tissue. The structure of the kidneys deteriorates and starts to shrink. In multiple cystic kidney diseases, the kidney does not shrink but takes a shape filled with abnormally large cysts.

What are the Initial Symptoms of Chronic Renal Failure?

If the underlying disease is known and monitored, it is easier to recognize. In those with an insidious course, depending on the nature and amount of damage to the kidney, symptoms such as high blood pressure, chronic fatigue, weakness, night-time urination, foul breath, increased need to drink water, and edema of the legs may occur. Unfortunately, especially in young people, symptoms only become apparent after the disease has reached an advanced stage.

How to Diagnose Chronic Kidney Disease?

First of all, the disease should be recognized by oneself. Kidney disease should be suspected in uncontrolled hypertension, people with hypertension under the age of 30, people with diabetes, people suffering from frequent urinary tract infections, drop stones frequently, patients with coronary heart disease, patients with edema, patients with a family history of kidney disease, patients with unexplained anemia and patients with many organ and system diseases. If kidney diseases are recognized in the acute phase of their onset - which roughly corresponds to a period of 3 months - there is a possibility of recovery or control and prevent progression to failure.  All kidney diseases that have not improved within 3 months of onset are considered "chronic kidney disease". The laboratory diagnosis of chronic kidney disease is made by elevated creatinine and urea values. The reason for this increase is the decrease in the cleaning capacity of the kidney. In addition, depending on the level of failure, many metabolic disorders, especially anemia, occur.

How Many Stages Does Renal Failure Have?

There are different academic classifications. In practice, we can divide it into stages: mild, moderate, advanced, and end-stage. This staging is based on the amount of filtration by the kidney. This amount is calculated according to the level of creatinine - a residual substance formed in our muscles. If half of the filtering power of the kidney is permanently lost as a result of permanent tissue loss in an adult, we speak of chronic kidney disease.  Kidney disease at this stage is expected to progress to the end stage where dialysis treatment or organ transplantation is necessary. In reality, however, not all patients progress to the end stage. Patients with mild kidney disease controlled blood pressure, and low risk may remain in this stage for years. Patients in the intermediate and advanced stages are not so lucky, and even if the progression is slowed down, they will inevitably reach the end stage.

How Does Early Diagnosis Affect the Results?

Glomerulonephritis-type kidney diseases that are treated and completely cured in the acute phase may sometimes recur. In these cases, they can be successfully treated if the patient is still being monitored by a physician. If a patient with diabetes has regular blood sugar, controlled blood pressure, and appropriate outpatient follow-up, or if a person with familial Mediterranean fever (FMF) receives regular treatment, no kidney disease may develop. For this reason, effective treatment of systemic diseases that can also involve the kidney and regular follow-up of patients is necessary.

Some kidney diseases are inherently prone to progression, to become chronic. In such diseases, controlling the most important factors such as high blood pressure and protein loss through urine with certain medications and restricting salt and protein foods reduce the rate of progression.

What to Do to Delay or Prevent Renal Failure?

In systemic diseases involving the kidney, such as diabetes and hypertension, treatment of the underlying disease should not be overlooked.  The better the disease is controlled, the less likely it is that the kidney will be affected.

Likewise, regardless of the underlying cause, it is necessary to control blood pressure, reduce salt regardless of where it comes from, reduce animal proteins in meals, lose weight, quit smoking, not use painkillers, or anti-inflammatory drugs without consultation, and not have tomography, angiography, and radiography with contrast agent (dye) without consulting a nephrology or internal medicine specialist except in emergency conditions. It is necessary to be regularly examined at certain intervals. In addition, other drug treatments such as blood sugar control, alkaline therapy, and reduction of uric acid may also be prescribed.

Which of these Treatments is the Best?

Since many factors are involved in chronic renal failure, all these factors need to be controlled together. For example, blood pressure cannot be controlled despite medication without reducing salt. Without using appropriate blood pressure medication, protein loss in urine will not decrease. blood pressure and sugar control will be difficult without weight loss. Even if alkaline therapy is received, deterioration of the kidney cannot be slowed down without reducing animal protein. In other words, there is no such approach as "let him/her take this treatment and everything will be fine".

Chinese herbal treatments such as gilaburu, cranberry, rosemary, cantorun, bitter melon, and Chinese herbal treatments, which are widely recommended on the internet, have no benefit, especially because Chinese herbal treatments can increase the progression of the disease. Gilaburu, cranberry may have the effect of reducing the frequency of urinary tract infections such as frequent cystitis due to a substance they contain. However, it has not been proven by scientific studies.

In Which Situations is Dialysis Recommended?

When advanced renal failure develops, many systems in the body begin to deteriorate, fluid accumulates, the amount of acid increases, potassium salt, which is toxic for the heart, increases, and anemia deepens, in other words, "uremia syndrome" begins to develop. In this case, treatments to replace the kidney are needed. Sometimes dialysis treatment is performed by inserting a catheter under emergency conditions. Otherwise, the patient may die if treatment is not started. There are two types of dialysis. The first is done with a peritoneal catheter. In other words, a tube is inserted into the patient's abdominal cavity. Dialysis fluids are given into the patient's abdomen through this tube. Since it is very small, the presence of the catheter does not disturb the patient. The second is hemodialysis, i.e., dialysis with the help of a machine. With this method, the patient's dirty blood is taken into the dialysis machine and cleaned, then the blood is given back to the patient.

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