CONSULTANT IN SURGERY, VASCULAR SURGERY AND VISCERAL SURGERY
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Kidney failure

What are the signs and symptoms of kidney failure?

The most important function of the kidneys is to clean the human body from harmful substances. It does so by filtering these substances out of our blood and excretes them via the urine. The human has normally two kidneys doing so, one kidney is for the filtration process of our body enough. Around 1-3 litres of fluid are filtered and excreted via the urine during one day. In the case of kidney failure, the filtration is impaired and the harmful substances accumulate in the body. The early phase of the disease is almost without symptoms. There might be elevated blood values. Later there is a dark coloration of the urine, the overall feeling gets worse and the patient develops itching. Due to several factors being impaired through the kidney failure, different organs get involved, an example is water accumulation in the lungs, what leads to problems with breathing. The end stadium is Uraemia, which untreated leads to death.


What are the causes of kidney failure?

There are two types of Kidney Failure, acute and chronic. In both cases the kidney function is not efficient enough.

The acute form, being manifested by a new, sudden onset of oliguria (low urine output), can be caused by an already pre-existing kidney disease or by any other acute illness causing injury to the kidney. An acute drop in blood perfusion, urinary retention, intoxication and/or inflammation can lead to acute kidney failure.

Chronic Kidney failure is characterized by a prolonged uraemia, it develops over months up to years. It is the end stage of all chronic renal diseases like: diabetic nephropathy, glomerulonephritis, vascular diseases, cystitis, destruction due to hypertension and/or drugs.

In the industrialized countries Diabetes mellitus type 2 is the most common cause of Kidney failure.
 

How is kidney failure treated?

In the case of a complete dysfunction of the kidney there are three options of treatment:

Hemodialysis; is more efficient per unit of time. The patient is connected to a dialyzer via a catheter that is inserted into the AV fistula (surgically created connection between artery and vein) of the patient. Thereby the blood of the patient can get filtered by the dialyzer. It is composed of a semipermeable membrane, that under high pressure “cleans” the patients blood.

Peritoneal dialysis; here the capillary system of the peritoneum in the abdomen works as “filtration center”. There is a semipermeable membrane, which can filtrate fluid and substances from blood. Via a permanent catheter a special fluid is introduced into the abdominal cavity and flushed out hours later.

Kidney transplantation; it is the best option for the patient. A “new” healthy kidney will take over the function of the diseased kidneys and the patient can live a normal life. Unfortunately the waiting time for a transplantation is very long, it can take several years to find a matching organ.


What is a fistula?

In order to get the patients blood dialyzed a kind of access needs to be created. For that a vessel in a good condition is necessary. It is a small surgical procedure, where a superficial vein gets connected to an artery. A good place for this “shunt” is the forarm, where we can connect the radial artery with the cephalic vein (Cimino- Brescia fistula). An AV fistula can be as well created in amore central place. In problematic vessels the fistula is created out of synthetic material. In emergency situations a temporary catheter is inserted via the internal jugular vein into the superior vena cava. In the case the patient is in a bad general condition and has a bad vessel condition the use of a permanent catheter is advised. It is inserted via a big vein into the right atrium (Demers-catheter).

Author: Dr. Andreas Franczak