All posts by Dr Vinant Bhargava

hypertension and chronic kidney disease

Hypertension And Chronic Kidney Disease

Chronic kidney disease (CKD) requires special care before and after requiring a kidney transplant. This is due to possible health complications, especially hypertension, a disease that frequently occurs in patients with CKD. This is why today we want to tell you about the relationship of these diseases and how to identify when they manifest simultaneously.

What is hypertension?

First, it is important that you are clear about what hypertension consists of. It is a disease where the blood pressure (the force of the blood that is generated against the walls of the arteries due to the pumping function that the heart fulfils in order to carry blood throughout the body), is too high and is generated with greater force.

Chronic kidney disease (CKD) and hypertension

A patient with kidney failure has a high possibility of developing hypertension because these diseases are related in two ways.

One of them is the fact that hypertension is one of the main causes of CKD. The foregoing since there is pressure against the walls of the arteries for several years, they will stop working properly. This process reduces the blood supply to the kidneys, to later also suffer damage.

Just as hypertension may appear first, it is possible that it is the other way around, this being a complication of CKD. The cause is that the function of the kidneys is to maintain adequate blood pressure, and if there are deficiencies in these organs, there will naturally be failures to maintain healthy blood pressure.

An important point to consider is that when CKD is the cause of hypertension, the progress of the insufficiency will be accelerated, which means that you should not neglect your treatment at any time, in addition to following the instructions of your nephrologist in Delhi.

Over time, high blood pressure damages the blood vessels in the kidney.

The nephrons of the kidneys are supplied by a dense network of blood vessels with high amounts of blood flow. Over time, uncontrolled high blood pressure can cause the arteries around the kidneys to narrow, weaken, or harden. These damaged arteries cannot supply enough blood to kidney tissue.

  • Damaged renal arteries do not filter blood well. The kidneys have small, finger-like nephrons that filter blood. Each nephron receives its blood supply through tiny hair-like capillaries, which are the smallest blood vessels. When the arteries are damaged, the nephrons do not receive essential oxygen and nutrients. Because of this, the kidneys lose their ability to filter blood and regulate the flow of hormones, acids, and salts from the body.
  • Damaged kidneys do not regulate blood pressure. Healthy kidneys respond to a hormone called aldosterone which is produced in the adrenal glands, to help the body regulate blood pressure. Kidney damage and uncontrolled high blood pressure contribute to a negative spiral. As more arteries become clogged and stop working, the kidneys eventually fail.

How do I know if my blood pressure is high?

Hypertension is known as the ‘silent killer’ because it has no symptoms, and the only way to know about it is to get measured. However, you should keep in mind that a single high result in a regular check-up does not mean that you have the disease, several follow-up checks should be done to identify or rule it out.

How can I control hypertension as a CKD patient?

Because hypertension can be caused by many factors, it is necessary to start with a series of changes in your daily habits, which includes:

  • Follow a plan of regular and efficient physical activity, it is recommended that it be at least 30 minutes a day. You can do this with the accompaniment of your kidney specialist in Delhi.
  • Significantly reduce salt intake.
  • Do not consume alcohol.
  • No Smoking.

These measures and restrictions have shown their efficiency in most cases, bearing in mind that salt is one of the main causes of high blood pressure since sodium levels influence the renin-angiotensin-aldosterone system (the hormonal system that is responsible for regulating blood pressure).

Medications, meanwhile, play a fundamental role in the treatment of CKD as they help prevent and control hypertension. In addition, they help kidney disease progress while contributing to the prevention of urinary infections.

This is why if you have received a kidney transplant you must be extremely responsible with your medical visits, as well as follow each of the recommendations in your diet and physical habits.

hematuria

Blood in the urine, a symptom of deficiency in the kidneys

In the medical area, hematuria is the presence of blood in the urine. According to Nephrologist in Delhi, there are two types of hematuria that are:

  • Macroscopic hematuria: when blood is visible in the urine, changing its color to a reddish or brown one, or, when blood stains are observed during grooming.
  • Microscopic hematuria- this case can only be detected by a urinalysis.

In both types, the presence of blood indicates that the person may have conditions in the kidneys or urinary tract.

Causes for blood to be in the urine

There are several factors by which blood reaches the urinary tract and becomes hematuria. The most common causes are:

  • Inflammation and infection in the kidneys
  • Lesions and inflammation in the urinary tract.
  • Polycystic kidney disease.
  • Immune system conditions (lupus, etc.)
  • Disease of red blood cells that favor their destruction.

It also mentions the reasons that make a person more likely to suffer from hematuria and include:

  • Family diseases of the kidneys.
  • Enlarged prostate in men.
  • Having had kidney stones.
  • The consumption of medications such as analgesics, anticoagulants and antibiotics.
  • Have had recent infections.

Symptoms of hematuria

Dr Vinant Bhargava indicates that usually the presence of blood droplets is already a sign of macroscopic hematuria; however, we must be aware of the appearance of:

  • Blood clots in the urine.
  • Pain in the bladder or back.

Another important alteration of the functioning of the kidneys: foamy urine

One of the main functions that the kidneys have in the body is to filter and purify the blood. Through urine, many toxins and excess fluids are eliminated from the body; however, when we observe foamy or bubbling urine, we must be alert and investigate if there is protein loss in the urine. If you have noticed this alteration, it is very important to visit the nephrologist who will perform the necessary tests to determine if this problem exists and thus treat it immediately so that it does not generate serious consequences.

How is hematuria treated?

If you have presented these alterations and your nephrologist has diagnosed you with hematuria, it is important to identify the site of origin of this and that can be in the kidney, bladder, prostate or urinary tract. The tests to which patients are subjected in this case are:

  • Review of medical history
  • Physical exam
  • Urinalysis
  • Other tests

At Sir Ganga Ram Hospital, Dr Vinant Bhargava has several years of experience in the treatment of hematuria. She will help you detect this medical picture and will assist you in your recovery so that you can have a good functioning of the kidneys, in addition to avoiding kidney failure.

kidney disease

Kidney Disease – Major Cause of Death

Kidneys are extraordinary organs. They contain millions of little blood vessels that act as a very effective filter. When blood passes through these vessels, the salt, waste and excess of fluid are held inside the kidney, while protein and red blood cells are simply too big to be “captured” by the kidneys, so they stay in the now purified blood, which continues to circulate. All waste products then become part of urine and are eliminated from the system with it.

Sometimes, certain circumstances may cause the kidneys to malfunction. This is known as Kidney Disease. When this happens, waste accumulates in the blood and causes sickness.

There are several types of kidney disease, and their treatment varies according to their causes and the amount and type of kidney tissue involved. Also, kidney disease increases your risk of having heart and blood vessel disease.

Statistics Of Kidney Disease Patients

In India, kidney disease is the cause of 66.7% death; and is also a cause of severe reduction on the population’s life quality. In 2020, we estimate that about 7.63 million Indian adults died prematurely as a result of kidney disease, representing about 20% of all premature adult mortality.

Causes Of Kidney Diseases

Kidney disease may happen as a consequence of disorders like diabetes, high blood pressure and others. Some kidney diseases are genetically inherited and cannot be prevented.

Symptoms Of Kidney Diseases

Although they can substantially vary from individual to individual and from a specific disease to another, symptoms of kidney disease may include high blood pressure, anemia (low blood count), poor nutritional health, weak bones, ankle swelling and nerve damage.

Treatment Of Kidney Diseases

Treatment of kidney disease is specific to each disease. However, common treatments against unstoppable diseases consist on compensating the malfunction of the kidneys and supplement their function with an artificial kidney. This is known as dialysis. Kidney infection, when present, can be fought against with the help of antibiotics.

Prevention Of Kidney Diseases

As a general rule, keeping a balanced diet, drinking abundant liquid, reduced sodium ingestion (salt) and maintaining an overall healthy life may prevent most preventable kidney diseases. The best way to cure a kidney disease early is to regularly consult your kidney specialist in Delhi.

kidney disease types

Kidney Diseases: Know The 5 Most Common Types

In India, one in ten Indians suffers from kidney disease. Chronic Kidney Diseases (CKD) are a general term for heterogeneous changes that affect both structure and kidney function, with multiple causes and multiple risk factors. It is a long-term disease, which may seem benign, but which often becomes severe and most of the time has asymptomatic evolution.

Most of the time, the evolution of chronic kidney disease is asymptomatic, making the diagnosis late. In such cases, the main immediate treatment is the hemodialysis procedure, says nephrologist in Delhi.

The main risk factors for chronic kidney diseases are:

  • People with diabetes (either type 1 or type 2).
  • Hypertensive person, defined as blood pressure values ​​above 140/90 mmHg in two measurements with an interval of 1 to 2 weeks.
  • Obesity patients (BMI> 30 Kg / m²).
  • History of circulatory system disease (coronary heart disease, stroke, peripheral vascular disease, heart failure).
  • Family history of chronic kidney disease.
  • Use of nephrotoxic agents, especially medications that require adjustments in patients with impaired renal function.

The most common types of kidney disease

1. Kidney stones

Kidney stones are formed mainly by little fluid intake (characterized by dark urine), high salt and protein consumption, among other problems.

When the stones move and descend through the urethral canal, they cause a lot of pain, due to the obstruction of the urinary flow and dilation of the kidney. They can be complicated by urinary tract infection and can be life-threatening.

2. Kidney infection or pyelonephritis

It is usually caused by a bacterium in the bladder, cystitis, which ends up in the kidney, causing fever and pain on the affected side. Treatment must be with antibiotics and often requires hospitalization.

3. Renal cysts

These are “blisters” that form in the middle of the kidney. Very common after 40 years of age, cysts are diagnosed by routine tests and usually do not cause problems or symptoms or require treatment and can only be followed up.

4. Tumor or kidney cancer

Rare, the tumor occurs due to the high frequency of kidney cysts. It is very common to have to request diagnostic imaging tests for the correct exclusion of this possibility. Tumors are solid lesions different from cysts that contain liquid inside. They are often malignant, but if treated early, there is a good chance of a cure.

5. Loss of kidney function (kidney failure)

Kidney failure occurs when the kidney loses the ability to filter waste, salts and fluids from the blood. Diseases such as diabetes and hypertension that are not well controlled can lead to progressive renal deterioration and eventually the need for hemodialysis and/or kidney transplant for its treatment.

Main symptoms of kidney disease:

– High blood pressure;
– Swelling around the eyes and legs;
– Constant weakness;
– Nausea and frequent vomiting;
– Difficulty urinating;
– Burning or pain when urinating;
– Urinate often, especially at night;
– Bloody-looking urine;
– Urine with lots of foam;
– Low back pain, which does not worsen with movements;
– History of kidney stones.

Chronic Kidney Disease And Delayed Male Puberty

Chronic Kidney Disease And Delayed Male Puberty: Understand The Relationship

Chronic Kidney Disease is the failure or gradual loss of kidney function. According to the best nephrologist in Delhi, it is estimated that about 20 million people suffer from the condition in India.

The kidneys are the organs responsible for filtering substances and nutrients present in the body. Thus, the necessary components are absorbed and the rest is eliminated in the urine. When they don’t work properly, the body goes out of balance, causing a series of consequences.

Among the problems caused by the failure or partial loss of function of these organs, is the delay of puberty among boys. In this post, we will understand more about the subject. Follow!

Late puberty

Late puberty is when sexual maturation does not begin at the expected time or age. In boys, this is characterized, for example, by the lack of growth of the testicles until the age of 14.

The changes in this stage of life are due to the awakening of the brain endocrine glands, called hypothalamus and pituitary gland. They produce hormones that stimulate the activity of the testicles which, in turn, initiate the production of testosterone, the hormone responsible for the development of male characteristics. The substance is also produced in the adrenal glands, located just above the kidneys.

Some symptoms indicate that the process was not triggered in boys, such as: lack of pubic hair and face, lack of growth of testicles and penis. This delay can occur due to several diseases, such as diabetes, cystic fibrosis, anemia or autoimmune diseases in general. Patients undergoing cancer chemotherapy or radiation therapy may also experience a delay in entering puberty.

Any condition that prevents or disrupts the action of the brain glands and testicles can make it difficult to stimulate puberty. This can occur in boys with Chronic Kidney Disease and is attributed to several factors. Among them is the difficulty in absorbing nutrients, which leads to protein caloric malnutrition, for example.

Psychological stress and anemia, common consequences of treatment, are also situations that make the body’s work more complex, as well as the damage caused to the functioning of the adrenal glands.

The diagnosis

As we mentioned, boys who did not show testicular growth until the age of 14 are considered late puberty. Doctors also observe whether the period of onset and end of growth of Organs sexual organs has exceeded five years.

To give a complete diagnosis, the kidney specialist in Delhi not only evaluates apparent symptoms, but requests more in-depth tests, which will measure blood hormone rates, for example, and identify the adolescent’s bone age.

The treatment

Boys with Chronic Kidney Disease, that is, who are affected by late puberty, should initially receive treatment focused on correcting nutritional deficiencies and metabolic changes.

For that, adjustments and supplements are indicated in the diet in order to replace calories, proteins or other nutrients. Only after this protocol, hormonal therapy is usually recommended with due medical monitoring.

Want to know more? I am available to answer any questions you may have and I will be very happy to respond to your comments on this matter.

What are kidney diseases and how do they manifest themselves?

The scope of kidney disease includes a lot of different ailments – their causes are just as many. Most often they all lead to insufficiency of the excretory system. Kidney diseases, apart from traditional ailments such as kidney stones, are still a huge challenge for modern medicine.

The most common kidney diseases include kidney malformations, urolithiasis and its complications, nephritis, kidney damage as a result of the disease, and cancers.

When it comes to developmental defects, the most common examples are: complete lack of a kidney, additional kidney (so-called third kidney), its abnormal shape. However, this is not a big problem, because a person is able to function well with one healthy kidney. A greater risk is a renal failure or other derivatives thereof, such as nephrotic syndrome in children, diabetic changes, systemic and rheumatic diseases, viral infections, syphilis, tuberculosis, malarial diseases, effects of certain drugs or toxic substances.

Kidney disease and its symptoms

One of the most common symptoms of kidney disease is severe pain. Appears in the lumbar region, radiating downwards forward or generally to the back. In addition, nausea and vomiting occur most often but mainly changes in the urine, e.g. blood. In addition, heart disease, shortness of breath and even coughing may also be symptoms of kidney disease. Inflammation of the kidneys or fibrosis of the renal parenchyma leads to hypertension. Lowering such pressure is very difficult, it can also be prevented by impaired blood flow through the kidneys.

When do we talk about kidney failure in kidney disease? At a time when their efficiency decreases by 20 per cent. from the accepted standard. It manifests itself in the fact that there is increased excretion of non-concentrated urine, and as a result, a reduction or stopping of renal filtration.

Kidney disease – how to treat?

If the cause of the kidney disease lies in the action of the infection, it is necessary to use antibacterial agents and those that will allow urine secretion. Management of kidney problems depends on the type of disease. Kidney stones are treated pharmacologically, using painkillers and antispasmodics, or surgery. It crumbles and breaks up stone deposits during the procedure. In turn, diabetes requires regular monitoring of blood glucose levels. The glomerulus is treated with anti-inflammatory drugs. Renal failure requires more serious treatment. It’s a disease that leads to death. Therefore, any toxic substances such as urea or excess potassium should be removed from the patient’s body. When treating this kidney disease performed among others peritoneal dialysis. However, to keep a person suffering from kidney failure alive, they are referred by a nephrologist in Delhi for hemodialysis or kidney transplant in Delhi.

Kidney disease – prevention

Actions to reduce the risk of kidney disease include regular pressure control, limiting salt and other food, drinking large amounts of water, physical activity (at least about 30 minutes a day), controlling urine changes, urine tests, measuring blood sugar levels.

pregnancy on dialysis

Is Pregnancy On Dialysis Possible?

The frequency of pregnancies in women on dialysis is extremely low, although the percentage of successful pregnancies has increased over the years, being, according to different series, higher than 70%. These pregnancies are not without complications for both the mother and the fetus, the management of which requires the joint work of the nephrologist in Delhi, the gynecologist, the nurse and the nutritionist.

Increased dialysis time is known to prolong gestation, resulting in children with higher birth weight, improved life chances, and decreased long-term complications.

The total dialysis time that should be administered weekly varies in the different studies, but, regardless of the criteria that are followed, the prescription of hemodialysis must be sufficient to maintain stable maternal conditions in relation to blood volume, blood pressure and blood pressure gain, weight between sessions.

Nocturnal hemodialysis would have the following advantages: it would allow greater clearance of small and medium molecular weight molecules, and it would improve the control of metabolic, electrolytic, phosphorous, volemia, and blood pressure profiles.

Experience with peritoneal dialysis in pregnant women is limited to a very small number of patients; in fact, the incidence of pregnancy in these patients is lower than those on hemodialysis. This could be due to the presence of hypertonic solutions in the peritoneum, to previous episodes of peritonitis or to physical factors that would interfere with fetal implantation. Most authors recommend not to change the dialysis modality after conception.

The measures referred to in the different publications to achieve successful pregnancies in these patients include: the multidisciplinary approach, increasing dialysis time, keeping pre-dialysis urea levels low, trying to prevent prematurity, strictly controlling blood pressure and electrolytes, preventing urinary infections and adequate fetal monitoring.

Kidney Disease In Pregnancy

The Kidney And Kidney Disease In Pregnancy

Pregnancy is a very special period in the life of a couple and in particular, a woman, but it may seem like a difficult dream to achieve in kidney patients.

THE IMPACT OF PREGNANCY ON THE KIDNEY

In women without kidney disease, the urinary system undergoes anatomical and functional changes to adapt to the new state: blood flow to the kidney increases up to 60%, which causes creatinine to drop slightly and proteinuria to rise (parameters that usually serve to evaluate renal function). It also increases the amount of water in the body which leads to a dilution of hemoglobin (anemia of pregnancy that is physiological) and blood pressure drops slightly. These normal changes may not happen in women with kidney disease.

PREGNANCY IN CHRONIC KIDNEY DISEASE

Kidney patients have a harder time getting pregnant. When it happens, the pregnancy itself may be subject to more complications than in a healthy woman, which always means a risky pregnancy and implies a closer follow-up by the obstetrician and the nephrologist. Usually, kidney disease does not worsen during pregnancy, but it can get significantly worse after delivery. The baby also requires special monitoring. The cause of kidney disease and the stage (severity) of it also determine the evolution of pregnancy.

DIALYSIS PREGNANCY

Pregnancy in women on dialysis is rare.

There are reports of pregnancies occurring on peritoneal dialysis, but the increase in abdominal volume due to pregnancy makes exchanges on peritoneal dialysis difficult, so if a woman on peritoneal dialysis becomes pregnant, she should consider switching to hemodialysis (albeit temporarily, during gestation).

When women on hemodialysis become pregnant, they see the treatment changed. Among other technical changes, they must undergo dialysis daily (five to six sessions/week) so that the toxics do not accumulate and suffer as little variation as possible so as not to affect the baby.

In both peritoneal dialysis and hemodialysis, the risk of miscarriage is greater than in a patient who does not undergo dialysis, and as such, the follow-up must be done by the obstetrician and the best nephrologist in Delhi on a regular and careful basis.

PREGNANCY IN KIDNEY TRANSPLANTATION

In kidney transplant women, fertility is partially restored, making it easier to get pregnant. These pregnancies must be planned and monitored, as they are still risky pregnancies. One of the main precautions is the choice of immunosuppression. Some drugs can affect the baby, so the medication schedule may have to be changed. In this context, there may be a higher risk of rejection of the transplanted kidney. With regard to childbirth, this should preferably be done vaginally so that there is no risk of injuring the transplanted kidney during a cesarean section.

PREGNANCY IN KIDNEY DONORS

If a woman donates a kidney to a kidney patient, her fertility is not affected and pregnancy does not involve greater risks than if she had both kidneys.

Habits That Affect Your Kidneys

Habits That Affect Your Kidneys

The kidneys are two organs located in the upper abdominal cavity, just below the chest, one on each side of the spine.

They play a role in cleaning the blood and help the body filter waste products through the urine. When they are not functioning properly, the whole body suffers.

The kidneys produce hormones, filter blood, absorb minerals, produce urine and maintain a healthy balance between acidity and alkalinity in the body.

Common symptoms that indicate kidney problems

changing the color and quantity of urine;

  • dizziness;
  • vomiting;
  • anemia;
  • breathing problems;
  • cold sensation;
  • fatigue ;
  • itching of the skin;
  • bad breath.

What causes kidney problems

A number of habits are meant to affect the proper functioning of the body.

1. Drug overdose

Consumption of certain drugs, such as non-steroidal anti-inflammatory drugs that are known to relieve pain, can affect the kidneys, especially if there is already a sensitivity at this level. Therefore, it is important that the recommended dose should never be exceeded.

2. Salt abuse

Diets high in salt mean a high sodium intake in the body. It can increase blood pressure and, in turn, damage the kidneys. Being difficult to remove, the kidneys have to put much more effort into cleansing the body, which can lead to their disease.

3. Consumption of processed foods

Processed foods are important sources of sodium and phosphorus. Some studies have shown that high phosphorus consumption can be harmful to the kidneys and bones.

4. Insufficient water consumption

One of the main functions of the body is to remove metabolic waste from the body. In this way, the number of red blood cells becomes balanced.

But this can only happen in the presence of water because in its absence the kidneys do not work properly. High water consumption also has the role of avoiding the formation of kidney stones.

5. Lack of sleep

Good sleep is very important for the well-being of the body and, implicitly, of the kidneys. The renal function is regulated by the sleep-wake cycle.

During sleep, the kidney cells regenerate, so that they can function properly and at maximum capacity during the active period.

6. Delay urination

Maintaining, for too long, the bladder causes kidney problems. Specifically, kidney injury.

In addition, bacteria in the urine multiply and can cause urinary tract infections or kidney infections. Maintaining urine increases the pressure on the kidneys, which can lead to kidney failure and incontinence.

7. Too much alcohol consumption

Toxins found in alcohol accumulate in the liver, damaging them. But a negative effect also has on the kidneys. Large amounts of alcohol can cause kidney failure or other chronic kidney diseases, warns a nephrologist in Delhi.

8. Lack of magnesium

Magnesium is a very important mineral for the body. It plays an important role in the production of energy, in the synthesis of acids and proteins, relaxes the muscles and regulates the metabolism.

The lack of magnesium leads to the crystallization of calcium in the body, thus favoring the appearance of stones in the kidneys.

Chronic Kidney Disease in The Elderly

Chronic Kidney Disease in The Elderly

Renal physiological ageing is characterized by a reduction in the renal glomerular filtration rate. In other words, the kidney does its filtration work in a slower way, in the same way, that the locomotion of an elderly person is also slower, but maintains the preserved function, that is, reaching the same place.

“The elderly are the biggest consumers of medication.”

This situation must be distinguished from the effective presence of kidney disease in the elderly, a situation in which the functioning of the kidneys is not adequate and is not related to the physiological decline of age. In situations of illness, and as in any other young or adult patient, kidney malfunction can be so severe that some interventions are needed. One is the medication review.

The elderly are the biggest consumers of medication, as they also accumulate more pathologies, and some medications can impair kidney function. Pain medications from the group of non-steroidal anti-inflammatory drugs, often taken by the elderly due to their degenerative osteoarticular pathology, can be very harmful and their indications and alternatives reviewed.

The other substantial intervention by the nephrologist is to prepare the patient for renal replacement treatment if and when the kidneys “stop”.

In India, kidney transplant is rarely performed in patients over 65/70 years old, since the risk of intervention and immunosuppression is greater than its benefit. But aging in the elderly is highly heterogeneous: age is of little significance for the decisions to be made, since other more important factors can overlap, such as: associated diseases, functionality, autonomy and independence. Thus, an elderly person may be a candidate for transplantation, despite not being the norm.

“ There are kidney patients who, due to the advanced comorbidities they have, do not benefit, in terms of time or quality of life, from any renal function replacement therapy. “

As for dialysis modalities (hemodialysis or peritoneal dialysis), there is no difference between them, similarly to what happens in young patients. The only point to note is that peritoneal dialysis is a modality that depends on the patient to be performed, unlike hemodialysis that is performed by a nurse in a hemodialysis center. Therefore, if the patient is not able to perform the technique, he may need a caregiver to do it for him, or, if he does not have it, this modality should not be an option.

Finally, there are kidney patients who, due to the advanced comorbidities they present, do not benefit, in terms of time or quality of life, from any renal function replacement therapy. These patients should be offered palliative care. Therefore, patients should be followed up by nephrologist in Delhi in order to control the symptoms of kidney disease, promoting quality of life, but without being subjected to more invasive techniques.

The choice of these options should always be made in conjunction with the assistant kidney specialist in Delhi, who should clarify the particularities of each elderly person, in order to better adapt the treatment to the person in question.