In cases of kidney dysfunction, doctors prescribe patients with renal replacement therapy. For this purpose, there are clearly indicated indications and they can relate not only to urological diseases.
Replacement renal therapy - what is it?
Replacement renal therapy is a complex of therapeutic measures that implies full support of kidney function in irreversible pathological processes. Such a package of measures involves placing the patient in a medical institution, but usually the period of his stay in the hospital does not differ in duration. Those patients who are shown permanent renal therapy of a substitute nature, periodically visit the clinics( according to the schedule prescribed by the doctor) and receive the necessary treatment.
Indications for
This type of therapy is prescribed in the case of diagnosing irreversible pathological changes in the kidneys that have led to their dysfunctionality.
Indications for the appointment in this case are:
- acute renal failure, occurring in a severe stage;
- chronic renal failure;
- surgically removed one or two kidneys;
- violation of the functionality of one kidney - only if the remaining kidney does not cope with the work.
Unconditional indication for renal replacement therapy is uremia, a condition characterized by the poisoning of protein metabolism products, which is always associated with impaired renal function. If the uremia occurs at an early stage, the doctors try to restore the patient's health to drug therapy, but in the case of seizures, coagulopathy, encephalopathy and pericarditis( complications against rapidly progressing uremia), there is no doubt that only the replacement renal therapy can save the patient's life.
Another disease of the kidneys, which in a particular case involves the conduct of the therapy in question - azotemia. The patient with this diagnosis will be diagnosed with a high content of nitrogenous compounds in the blood, and this figure of 30 m / mole and above is a direct indication for conducting renal replacement therapy.
In addition to kidney disease, this type of therapy can be prescribed for acidosis, pulmonary edema, hyperkalemia, sepsis, congestive heart failure and high-toxic drugs.
Methods and types of
The treatment in question can be performed in several different ways.
Hemodialysis
A procedure involving the purification / filtration of blood by passing it through the membrane with the help of special equipment called" artificial kidney ".
By carrying out such a renal replacement therapy, it is possible:
- to filter out( remove from the blood) toxins;
- remove urea from the blood;
- to stabilize the electrolyte balance;
- normalize blood pressure;
- restore the acid-base balance.
Apparatus "artificial kidney", in simple terms, perform the functions of the kidneys, allowing the patient to lead a habitual way of life, continue working( in the event that he does not have a disability and is allowed to work).
How hemodialysis can be performed:
1. At home. Special devices have been developed for this purpose, the patient is being trained in their operation. The advantage of this method of conducting renal replacement therapy is the opportunity to stay at home, to conduct some kind of labor activity and at the same time to support the work of the kidneys. The problem is that such portable equipment has a high price and only a few can buy it.
2. In an outpatient setting. This is the best option - a patient three times a week should visit the center for a 4-hour procedure.
Advantages of this method:
- procedure is performed under the supervision of qualified medical personnel;
- in the clinic / center all sterility conditions are observed;
- doctors conduct blood and urine sampling for laboratory testing, thereby constantly monitoring the work of the kidneys.
The disadvantage of this method is the risk of infection with hepatitis B and C and waiting for a queue for the procedure - it is "live", it is impossible to make an appointment in advance.
3. In stationary conditions. The principle of conducting the same in all cases, but in this - the patient is in the clinic around the clock or in the day hospital. He is under constant surveillance, experts monitor his health and can immediately respond to changes by adjusting appointments.
Separately it is necessary to describe peritoneal dialysis - an alternative to classical hemodialysis. The essence of the method:
- in the abdominal wall of the patient, doctors form a hole;
- a catheter is inserted through this opening;
- 4 times a day, 2 liters of dialysate are poured into the abdominal cavity through a catheter;
- after dialysate, the catheter is closed and the patient can do his own business for 6 hours;
- after 6 hours the fluid from the abdominal cavity merges and a new portion of dialysate is poured.
Advantages of this method are:
- the possibility of carrying out the procedure at home;
- slow elimination of fluid from the body;
- reduced heart burden;
- administration of heparin is not required.
On the principle of the action of the apparatus for hemodialysis "artificial kidney":
Haemofiltration
In hemofiltration, the catheter is inserted into the central vein and blood is already drawn through it and replacement drugs are introduced. It is mandatory for this procedure to use heparin, lactam-ionic liquid, magnesium / calcium / phosphate preparations.
Hemofiltration is considered preferable, as there are few complications after it, and the patient's placement in the hospital is not provided.
Drugs that are used to perform renal replacement therapy for chronic kidney failure and other pathologies:
- Heparin and Warfarin - reduce the formation of blood clots;
- Kapoten, Atenolol - are necessary for the control of arterial pressure;
- Aatarax is an antihistamine, used to stop itching( a side effect of hemodialysis and hemofiltration);
- vitamin complexes with folic acid - are needed to replenish the amount of vitamins in the blood, as in the majority they are "washed out";Preparations of iron, calcium and phosphorus.
The video device for hemofiltration:
Hybrid replacement therapy technologies
Hybrid technologies mean the daily "slow" hemodialysis - the rate of blood purification is slow, which allows for constant monitoring of the patient's condition.
Hybrid technologies are not widely used in medical practice, although they make it possible:
- to select treatment tactics for a specific patient;
- detoxify slowly, which automatically reduces the risk of complications( for example, the risk of progression of brain edema is reduced);
- in parallel with hemodialysis conduct other therapeutic procedures;
- to reduce the cost of the procedure in question.
Hybrid technology treatment lasts for 6-8 hours every day. The specialists should have the opportunity to introduce the necessary medications - their list does not differ from that required for the treatment under consideration by classical methods. Hybrid technologies allow for a hemodialysis procedure at night, and during the day - to carry out diagnostic and other medical measures.
On the video about renal replacement therapy: