All posts by Dr Vinant Bhargava

Chronic Kidney Disease in The Elderly

Chronic Kidney Disease in The Elderly

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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.

Causes of Renal Failure

Symptoms And Causes of Renal Failure

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Acute renal failure

We say that we are facing acute renal failure when its onset is relatively early, less than three months. It can be reversible if it is treated in an appropriate and timely manner.

Chronic renal failure, acute exacerbation is the installation of acute renal failure in a patient with chronic renal failure.

Chronic renal failure

We say that we are facing chronic kidney failure ( CRF ) when it is possible to determine that kidney failure has existed for more than three months.

The name of this entity was changed to chronic kidney disease as there are situations of kidney disease/injury without failure. Examples of such situations are albuminuria/proteinuria, changes in urinary sediment, renal ultrasound changes, anatomopathological kidney lesions in renal biopsy or even a kidney transplant.

Stages of chronic renal failure

Chronic kidney disease has several stages or phases, causes, and degrees of albuminuria. The stages of chronic renal failure are as follows:

Stage 1 – Glomerular filtrate> = 90 -normal or elevated renal function;

Step 2 –  glomerular filtrate 60-89 – decreased renal function with mild;

Stage 3a –  Glomerular filtrate from 45 to 59 – renal function with mild to moderate decrease;

Stage 3b –  Glomerular filtrate from 30 to 44 – renal function with moderate to severe decrease;

Stage 4 –  Glomerular filtrate from 15 to 29 – renal function with severe decrease;

Stage 5 –  Glomerular filtrate <15 -Renal failure (add D if the patient is on dialysis).

Glomerular filtrate values ​​in (mL / min / 1.73 m2).

Pathophysiology of renal failure

The pathophysiology of renal failure, acute or chronic, can have different levels. If the pathology that damages the kidneys is found “before” the kidneys, it is called the renal failure of a pre-renal cause, as for example in cases associated with heart failure or the removal of volume in the vessels.

In turn, if the pathology is intrinsic to the kidneys, as is the case of acute glomerulonephritis or pyelonephritis, renal failure is considered to be of renal cause.

Finally, if the cause of renal failure is related to obstruction of urinary drainage, such as prostate hypertrophy, it is called post-renal.

Find out below what the symptoms of kidney failure are.

Symptoms in renal failure

The signs and symptoms of kidney failure are usually late, so they appear in the more advanced stages of chronic kidney disease. They can result from decreased glomerular filtration, such as edema (swelling), decreased urinary elimination or high blood pressure.

In stage 4, or more commonly in stage 5, more evident signs or symptoms may appear, such as generalized weakness (asthenia), lack of appetite (anorexia), nausea, vomiting, and changes in the central nervous system (slowness of reasoning, drowsiness) and rarely seizures).

These initial symptoms of chronic renal failure are explained to patients who are already being followed up with nephrologist in Delhi. In most cases, however, kidney disease is detected in routine tests without previous suspicion of its existence.

In India, cases of chronic renal failure that are diagnosed only at stage 5, using the emergency service to start hemodialysis on an emerging basis, have decreased. This improvement is mainly due to the improvement of primary health care with timely referral to kidney specialist in Delhi.

Causes of kidney failure

The causes of renal failure are multiple and vary according to the age group. As an illustrative example, the aetiology of chronic kidney diseases that led to the beginning of regular dialysis in Delhi: diabetes mellitus 33.9%, arterial hypertension 13.1%, glomerulonephritis chronic 11.2%, polycystosis 4.9%, hypoplasia / renal dysplasia 0.7%, other causes 18.5% and unknown causes 17.7%.

Children only reach “normal” kidney function at two years of age, so below that age, the classification of chronic kidney failure at the stages mentioned above cannot be applied.

The vast majority of cases of kidney failure in early stages are, in general, related to congenital kidney diseases. However, the causes of kidney failure in pediatrics, requiring dialysis or kidney transplantation, also include glomerular diseases.

Diagnosis of renal failure

The diagnosis of renal failure can be made by family doctors, taking into account some aspects, namely:

  • The complete absence of diuresis (anuria) is not a characteristic of chronic renal failure, but of acute renal failure or acute chronic kidney failure;
  • Elevated creatinine and serum urea are characteristic of renal failure;
  • To better characterize the stage of chronic renal failure, creatinine clearance is used using 24-hour urine collection (determination of urinary volume and creatinine) and blood (determination of serum creatinine): creatinine clearance = urinary creatinine (mg / dl) / serum creatinine (mg / dl) X urine volume of 24 hours (ml) / 1440 (minutes). It is expressed in ml / minute (normal values: men> 90 ml / minute; women> 80 ml / minute). Formulas can also be used to calculate creatinine clearance, avoiding the 24-hour urine collection that is often not performed correctly or is not feasible;
  • The signs and symptoms of chronic kidney disease should lead to an assessment of renal function (serum creatinine and urea, as well as creatinine clearance using mathematical formulas or with 24-hour urine collection as already described);
  • Elevated serum potassium values ​​are not essential for diagnosis;
  • Other common analytical changes in chronic kidney disease in advanced stages (3 to 5) are anemia, metabolic acidosis, low serum calcium, and elevated parathormone;
  • Summary analysis of urine may reveal albuminuria and urinary sediment may show changes such as hematuria and erythrocyte cylinders;
  • Renal ultrasound is the exam indicated for initial imaging evaluation in suspected chronic kidney disease. It may reveal a decrease in kidney size, although in diabetes mellitus this change may not exist even in advanced stages of CRF. Another echographic abnormality typical of chronic kidney disease is the decrease in differentiation between the cortex and the renal medulla. If multiple bilateral renal cysts appear, we may be in the presence of a polycystic disease.

The early referral of patients with chronic renal failure to the best nephrologist in Delhi has had an impact on improving their follow-up, with implications for delaying their progression as well as for the adequate treatment of the various complications of chronic renal failure.

How to prevent kidney failure?

Renal failure can be prevented, essentially through the following measures:

  • Lifestyle changes to prevent frequent causes of chronic renal failure, such as type 2 diabetes or cardiovascular disease including high blood pressure;
  • Obesity (overweight) can also be associated with chronic kidney failure. Lifestyle should be changed in order to avoid obesity;
  • Avoid exposure to nephrotoxic drugs, especially non-steroidal anti-inflammatory drugs.
Habits That Can Affect Your Kidneys

Surprising Habits That Can Affect Your Kidneys

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A number of habits can damage the health of the kidneys. Thus, in addition to alcohol consumption or insufficient fluid intake, increased protein intake, lack of exercise, vitamin and mineral deficiency can affect the kidneys.

The kidneys have the role of filtering blood, producing hormones, absorbing minerals, neutralizing acids and removing toxins and excess water from the body. Surprisingly, many of the daily behaviors actually affect the proper functioning of the kidneys.

Exaggerated use of analgesics

Medications used for pain, such as non – steroidal anti-inflammatory drugs, can damage the kidneys, especially in people who already have kidney disease. Therefore, it is recommended by nephrologist in Delhi never to exceed the maximum recommended dose.

Increased salt consumption

Salt can increase blood pressure and, in turn, can affect the kidneys. Processed foods are important sources of sodium and phosphorus.

Insufficient fluid intake

Proper hydration helps the kidneys cleanse the body of toxins. Abundant water consumption is also one of the best ways to avoid kidney stones formation. A healthy diet is considered the one in which the water supply rises to two liters per day.

Lack of sleep

Rest at night is very important for general well-being and even for the kidneys.

The functioning of the kidneys is regulated by the sleep-wake cycle, which helps to coordinate their action during the 24 hours. Lack of sleep causes disorders of the functioning of the kidneys.

High meat consumption

Animal protein generates large amounts of acid in the blood, which can be harmful to the kidneys, causing proteinuria.

Foods high in sugar

Sugar contributes to obesity, which increases the risk of high blood pressure and diabetes, two of the main causes of kidney disease.

Beyond desserts, sugar is often added to foods and beverages that are not considered sweet. Breakfast cereals and bread contain significant amounts of carbohydrates.

Smoking

People who smoke are more likely to have protein in their urine, which is a sign of kidney damage.

Diseases that affect the kidneys, such as diabetes and high blood pressure, are also exacerbated by smoking, and smokers have a higher risk of requiring kidney transplants and dialysis.

Excessive alcohol consumption

Kidneys help the body filter out harmful substances, including alcohol. The kidneys of a person who consumes a lot of alcohol are subjected to very high pressure, which can cause damage to the kidney system.

Increased alcohol consumption – over four servings a day – doubles the risk of kidney disease. Alcohol is a dehydrator and interferes with the regulation of blood flow to the kidneys, explains nephrologist in Delhi.

Coffee consumption

Coffee raises blood pressure, which can trigger kidney disease. Also, consumed in large quantities, it increases the level of calcium in the urine.

Health Care for a Chronic Kidney Patient

Health Care for a Chronic Kidney Patient on Hemodialysis

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Why kidney care is important

We know that the kidneys are organs that make up the excretory and osmoregulatory system, performing vital activities for our health. They are responsible for filtering the blood, eliminating toxins from our body through the urine. Avoiding the increase in blood pressure and the appearance of edema, among other functions that contribute to the proper functioning of our body.

How the chronic kidney patient keeps the kidney healthy

The kidney patient, like anyone else, must have a normal life in order to be able to carry out their day-to-day activities without worrying about health. For this, balance is the keyword to keep the kidney healthy

Care that chronic kidney patient should take with food

Care in feeding should start with liquids. The renal patient undergoing hemodialysis should be careful with the excess fluid ingested since it can accumulate in the body and force the activities of the lungs and heart.

Knowing this, some tips for curbing thirst are important;

  • Avoid salty or very sweet foods;
  • Rinse with water;
  • Use a small glass to drink liquids;
  • Suck ice;

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Sodium – The care that chronic kidney patients should take with salt intake

Reducing the amount of salt that is ingested can decrease chronic kidney failure. To reduce salt consumption, it is important to avoid processed foods, such as: preserved foods, sausages (ham, sausage, bologna, salami), ready-made spices and salty cheeses. At mealtime, give preference to natural spices that are healthier and give more flavor to foods: onion, garlic, pepper, bay leaf, basil, etc.

Chronic kidney patient and blood pressure 

The patient with renal failure tends to raise his blood pressure for two reasons. The first occurs because the kidney cannot properly eliminate the ingested salt, and the other happens due to the kidney’s disruption of hormone production, which regulates our blood pressure. Therefore, hypertensive patients or those with chronic kidney disease should avoid salt intake, suggests nephrologist in Delhi.

Renal patient and the consumption of Calcium and Phosphorus

Kidney failure causes the levels of phosphorus and calcium in our body to be altered, so it is important to be aware of their intake. This is because the kidney is unable to expel these elements properly, causing them to accumulate in our body, which can be very harmful to health.

Hyperpotassemia in chronic renal patients

Potassium levels in the blood increase when the kidney cannot eliminate its excess from the body, causing hyperkalemia. Because it is a mineral that acts on muscles and nerves, the accumulation of potassium can cause muscle weakness and change in a heartbeat.

Is carambola toxic to chronic kidney patients?

Chronic kidney patients should not eat star fruit because it is toxic. Research indicated that carambola’s toxicity was due to the presence of oxalate in the fruit. However, new studies show that the fruit is toxic due to the caramboxin toxin. This toxin contributes to the inhibition of GABAergic, the main inhibitory system of the central nervous system, which can cause serious complications for the health of chronic kidney patients, warns kidney specialist in Delhi.

Chronic kidney patient and skincare

Some chronic kidney patients may experience some discomfort due to dry and itchy skin. This can occur due to high levels of minerals and hormones in our body or due to changes in sweat and oil glands. As a way to prevent itching it is important to be aware of the levels of calcium and phosphorus that are being ingested in the diet.

Venous access is done before hemodialysis, which can be permanent or temporary. Chronic kidney patients tend to choose definitive access because it allows treatment to be long-lasting and to have a low rate of complications. To prevent complications from happening some care with the fistula is necessary. In the first sessions, it is important to save as much as possible the member who receives the access, avoiding sudden movements and great efforts. On a daily basis, nephrologist in Delhi recommends avoiding impacts and trauma in the area, so as not to hurt or infect the area.

Physical activity and chronic renal patient

In general, patients with chronic renal failure on hemodialysis have little tolerance for physical activities, due to some weakness or because they are inactive. There are still no in-depth studies on the risk of physical exercise in these patients, but there are no reports of serious problems resulting from physical training. There are descriptions of aerobic training interventions that have been used to increase maximum oxygen capacity in pre-selected patients. Studies suggest that aerobic training can improve blood pressure and mental health in chronic kidney patients. The study also concludes that physical and aerobic exercise benefits the patient in the dialysis and interdialytic phase, benefiting the cardiorespiratory capacity, physical conditioning, muscle strength, and functional capacity.

We can see that the care that the chronic kidney patient must have covered different situations in our life. Following these steps, the quality of life of the chronic renal patient tends to increase considerably. The care, balance, and monitoring of a qualified and specialized medical team is an important differential for effective renal treatment and a happier life for the patient.

Kidney Pain

Kidney Pain May Indicate Infections or the Presence of Calculus

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Back pain is very common and, in most cases, it is not of kidney origin but of spinal diseases, generically called low back pain.

Kidney pains are usually on one side (right or left) and project in the lower back. They are cramps of varying intensity, which can go down the front of the belly to the groin and genital region, in addition to being accompanied by other symptoms such as nausea, vomiting, and changes in the urine.

To be sure that the pain originates from the kidney, it is necessary to look for a sign called Giordano, a situation in which the nephrologist in Delhi gives small pats with the closed fist on the lumbar region (percussion fist), from top to bottom, which provokes the appearance of pain. In this case, the signal is positive, that is, the pain is probably due to kidney disease.

What are the possible causes of this pain?

The most frequent cause is the presence of stones (lithiasis), which clog the urinary tract and dilate the affected kidney (hydronephrosis), causing very severe pain that requires administration of analgesics, antispasmodics, and injectable anti-inflammatories. They are the famous renal colic that, according to popular culture, are maddening and worse than those that women feel during labor.

Also, infections of the upper urinary tract, which directly affect one or both kidneys (pyelonephritis) are causes of pain such as those described. Typical cases are accompanied by changes in urine and general symptoms such as fever, cloudy and dark urine, malaise, poor appetite, nausea, and vomiting.

Acute nephritis due to kidney inflammation can also be responsible for pain. They are bilateral and accompanied by changes in urine and even high blood pressure.

Less frequent causes are real polycystic disease, kidney tumors, and trauma, for example.

kidney pain

When to get the kidney specialist in Delhi?

In the case of pain in the lumbar region of acute appearance, in colic, with the characteristics already described, especially if they are accompanied by dark or cloudy urine, with dust, in addition to pain or burning in urination, the urge to urinate all the time with the leaving small amounts of pee, personal or family history of eliminating stones or polycystic kidneys and the presence of general signs and symptoms are indicative that a nephrologist in Delhi should be sought.

How To Take Care Of The Kidneys

Learn How To Take Care Of The Kidneys And Stay Away From Kidney Diseases

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Kidney Health for All is the theme of World Kidney Day 2019. But, do you know how important this organ is for the proper functioning of the body? First, for those who do not know yet, the word kidney goes to the plural because we have two. And they are in the posterior abdomen, one on the right and one on the left.

Their main function is to filter blood to control the amount of water and salt in the body, eliminate toxins, help control high blood pressure and produce hormones that prevent bone anaemia and decalcification, and eliminate medications and other ingested substances.

It is precisely for its numerous functions that the kidneys need to be healthy. Sick kidneys cause so-called kidney disease, which is a cause of concern worldwide because of the growing number of cases.

According to the best nephrologist in Delhi, 850 million people have kidney disease worldwide. Chronic Kidney Disease causes at least 2.4 million deaths annually, with an increased mortality rate. And the most affected are people living in low- and middle-income countries.

According to Dr. Vinant Bhargava, kidney specialist in Delhi, the main risk factors for kidney disease are hypertension, diabetes, and a family history of kidney disease. But obesity, smoking and the use of toxic medications can also affect kidney health.

“In India, one in 10 Indians will have some kind of kidney disease. He has and does not know, because kidney disease is silent. It has no major symptoms. And since diabetes and hypertension are prevalent diseases in India, and also remembering obesity, these diseases lead to chronic kidney disease. And if the person has a very poor kidney function, below 10%, he will go on hemodialysis, peritoneal dialysis or need a transplant, ”explains the nephrologist

Preventing

Kidney care means staying away from kidney disease. For prevention, one of the main tips is to adopt a less salty diet. “We here in India eat around 12 grams of salt per day when adequate would be around 2 grams of salt/day. Salt has a retaining effect on water. This causes the kidneys to work at higher blood pressure, leading to kidney disease or chronic kidney disease. And for those who are diabetic, the diet should also be controlled, especially in relation to sugar, ”draws the attention of Dr. Vinant Bhargava.

Hydration is indispensable. “We should not wait for thirst to drink water. Thirst already means dehydration. An increased amount of fluid should be taken to further filter the urine. The pathologies that can be harmed by lack of water are those who already have kidney stones, the kidney stone. You have to drink a lot more water, always trying to prevent the crystals from getting too long in the urine, forming increasing leg formation.”

Elderly people, patients with cardiovascular disease and patients with a history of kidney disease in relatives have great potential to develop kidney injury and should be investigated with urine screening and blood creatinine levels. “These are simple tests available that provide valuable information to tell how the kidneys are working. The recommendation is to take the exam once a year. And anyone who already has a family history, hypertension or diabetes is at least every six months.”

Serum Protein Analysis

Serum Protein Analysis

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Definition of serum proteins

The proteins are in some ways the essential building blocks of our cells; they play a role in all the reactions of the body.

There are more than a hundred different proteins circulating in the blood, although albumin accounts for 60% of them.

In addition to transporting many substances (hormones, lipids, etc.), blood proteins are involved in coagulation, immunity, maintenance of blood pressure, and so on.

It is possible to perform a total serum protein assay, which provides information on the functioning of many organs.

Why do serum protein analysis?

The analysis of serum proteins (serum) is useful in many situations to guide diagnosis, specify the severity of a disease or monitor the effectiveness of treatment.

It is a very common examination that can assess the function of certain organs (liver, kidneys) and highlight certain abnormalities (inflammatory syndrome, autoimmune diseases, lymphoma, etc.).

Thus, this dosage may be prescribed, inter alia, in the case of:

  • inflammatory syndrome
  • alteration of the general condition
  • CBC abnormalities (blood test)
  • unexplained bone or joint pain
  • liver problems
  • renal failure

What results can we expect from a serum protein analysis?

The serum or plasma proteins are measured by electrophoresis, after a simple blood test: the blood (serum) is placed in an electric field, which “migrates” the proteins. They separate according to their electrical charge and their weight, which makes it possible to distinguish them from each other and to identify anomalies.

This assay is usually performed at the same time as other basic tests, such as blood count or sedimentation rate. Indeed, the level of proteins in the blood (protidemia) does not only depend on the proteins, but also on the blood volume (the dilution may be greater or smaller).

What results can we expect from a serum protein analysis?

As an indication, the normal value of total serum proteins is between 65 and 80 grams / L. The albumin/globulin ratio is between 1.2 and 1.8.

An increase in total plasma protein (hyperproteinemia) is observed in many situations, such as dehydration (“heat stroke”, diarrhea, vomiting) or during various diseases such as myeloma that cause an increase in the mass of circulating proteins.

Decreases in total protein concentration (hypoproteinemia) may be caused by a lack of intake (malnutrition) or a lack of absorption, a lack of synthesis (liver failure), abnormal loss of kidney or by water overload (hemodilution).

The electrophoretic analysis shows the distribution of the main blood proteins and traces a characteristic “profile”, which can be interpreted by the doctor.

Thus, in the case of an inflammatory syndrome, for example, the “pattern” will be typical, showing an increase in alpha-globulins and a decrease in albumin.

The increase in beta-globulins, meanwhile, may mean the presence of iron deficiency, hypothyroidism or biliary obstruction.

The nephrotic syndrome (kidney dysfunction) will be characterized by hypoalbuminemia and hyperalphaglobulinemia.

Only the nephrologist in Delhi will be able to identify an abnormal line and prescribe the case of complementary examinations to make a diagnosis.

Diabetic Kidney Disease

Diabetic Kidney Disease

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More and more people are suffering from diabetes globally. The prevalence of increasing diabetes means that the prevalence of diabetic kidney disease, one of the dangerous complications that increase mortality worldwide, also increases, explains nephrologist in Delhi.

What is diabetic kidney disease?

If high blood sugar persists, it will damage small blood vessels in the kidney. This can cause the protein to escape into the urine, resulting in symptoms such as hypertension, edema, and kidney damage. Finally, these injuries lead to serious kidney disease, end-stage kidney disease. Kidney disease caused by diabetes is called diabetic kidney disease.

Why is it important to know about diabetic kidney disease?

  • The worldwide prevalence of diabetes is increasing rapidly.
  • Diabetic kidney disease is the most common cause of chronic kidney disease, and 40-45% of newly diagnosed patients with end-stage kidney disease are diabetic.
  • Treatment of end-stage renal disease is more costly for patients in developing countries.
  • Early diagnosis and treatment can prevent diabetic kidney disease. Even with chronic kidney disease, proper treatment can delay the treatment of renal replacement therapy such as dialysis or kidney transplant in Delhi for a considerable period of time.
  • Management of diabetic kidney disease is more important because of the high mortality from cardiovascular disease.

Therefore, early diagnosis of diabetic kidney disease is very important in the treatment of patients, says the best nephrologist in Delhi.

How many diabetic patients lead to diabetic kidney disease?

There are two categories of diabetes, depending on which category it is likely to progress to diabetic kidney disease.

1) Type 1 diabetes-insulin-dependent diabetes mellitus

Type 1 diabetes occurs mainly in children, and insulin is essential for the treatment. Approximately 30-35% of patients are known to lead to diabetic kidney disease.

2) Type 2 diabetes – non-insulin dependent diabetes mellitus

Type 2 diabetes mellitus is predominantly in adults and is often treated without insulin in most patients. It is known that about 10-40% lead to diabetic kidney disease. Type 2 diabetes is the most common cause of chronic kidney disease in more than one of three chronic kidney disease patients, says kidney specialist in Delhi.

What type of diabetes leads to diabetic kidney disease?

Although it is difficult to predict which diabetes will lead to diabetic kidney disease, several key factors are known.

  • Type 1 diabetes mellitus that occurred before the age of 20
  • Unregulated blood sugar (high glycated hemoglobin)
  • Uncontrolled blood pressure
  • In the case of visual impairment such as diabetic retinopathy or nerve damage such as diabetic neuropathy
  • Proteinuria, obesity, smoking, hyperlipidemia

When does diabetes mellitus (diabetes) develop in diabetics?

Diabetic kidney disease (sickness) takes years to develop, so it rarely develops within the first 10 years. In type 1 diabetes, soybean red mildew symptoms occur between 15 and 20 years after the onset, and if it has not progressed to kidney disease for 25 years after the onset, the likelihood of developing kidney disease is lowered, says a doctor for kidney in Delhi.

When should a diabetic patient suspect a diabetic kidney disease?

Diabetic kidney disease (sickness) can be suspected if you have any of the following symptoms.

  • When foamy urine or urinary albumin/protein is present (observable early on)
  • Worsening of high blood pressure or previous hypertension
  • Edema of the ankle, foot or face; Decrease in urine volume or weight gain (due to the accumulation of water)
  • The decrease in insulin or diabetic drug requirements
  • Frequent hypoglycemia, or diabetes that has not been controlled in the past,
  • Drug-free diabetes: Many people think that diabetes has been cured because of good blood-sugar control, but in fact, it can mean kidney disease. In kidney disease, the duration of action of the diabetes drug is long.
  • Symptoms of chronic kidney disease at the end-stage (helplessness, fatigue, anorexia, nausea, vomiting, itching, pale, shortness of breath)
  • Elevation of creatinine and urea nitrogen in the blood test

How do you diagnose diabetes (kidney disease)?

  • Ideal: Diabetic patients should be tested for microalbuminuria and blood creatinine (or glomerular filtration rate) every year.
  • More practical: every three months blood pressure and urine dipstick tests are done. And every year we perform a blood creatinine (or glomerular filtration rate) test.

How can I prevent diabetic kidney disease?

The following are important to prevent diabetes (kidney disease).

  • Receive regular medical care from top nephrologist in Delhi.
  • Blood sugar control thoroughly. It is advisable to keep the glycated haemoglobin below 7%. Maintain blood pressure below 130/80 mmHg. Antihypertensive drugs such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are used to control blood pressure and albuminuria.
  • Sugar, salt, protein and fat intake should be reduced.
  • The microalbuminuria test and blood creatinine test (or glomerular filtration rate) should be performed at least once a year to determine the function of the kidneys.
  • Lifestyle therapy: Regular exercise and maintain ideal body weight. Do not smoke with alcohol, and avoid indiscriminate use of drugs such as an analgesic.

How do I treat diabetes (kidney disease)?

  • Thorough management of diabetes
  • Proper management of blood pressure is most important in protecting the kidneys. Therefore, blood pressure should be routinely measured and maintained below 130/80 mmHg. Treatment of hypertension is known to slow the deterioration of chronic kidney disease.
  • Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are antihypertensive agents that have particular advantages in diabetic patients. These antihypertensive agents have the advantage of slowing the deterioration of nephropathy and should be initiated from early nephropathy in which microalbuminuria is present for maximum benefit.
  • To reduce facial or back swelling, you should administer a drug that increases urine, such as diuretics, with salt and water restriction.
  • Diabetic patients with renal insufficiency have a greater risk of falling into hypoglycemia and need appropriate controls for diabetic agents. Fast-acting insulin is preferred for controlling glucose and persistent oral formulations are contraindicated. Metformin is at increased risk for lactic acidosis and should not be used in patients with plasma creatinine> 1.5 mg / dL.
  • In diabetic patients with high plasma creatinine, all treatments for chronic kidney disease should be performed (listed in Chapter 12).
  • Risk factors that can cause cardiovascular diseases such as smoking, lipid elevation, hyperglycemia, and hypertension should be assessed and managed.
  • Patients with advanced diabetic kidney disease eventually need treatment such as dialysis or kidney transplant in Delhi.

When should a diabetic kidney patient consult a doctor?

Diabetic patients with microalbuminuria must consult the best kidney specialist in Delhi. You should consult your doctor immediately if:

  • The sudden increase in body weight, sudden decrease in urine volume, worsening of the face or leg edema, or difficulty breathing
  • Chest pain, aggravation of hypertension, and very fast or slow heart rate
  • Severe placebo, anorexia, vomiting or pale
  • Persistent fever and chills, and pain or burning fever during urination, urine or hematuria
  • When there is frequent hypoglycemia or reduced demand for insulin or diabetes
  • When confusion, drowsiness or convulsions of consciousness occurs
Diet For Kidney Care

Diet Suggested By Nephrologist in Delhi For Kidney Care

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What you should eat to cleanse and take care of the health of your kidneys

Learn to identify the essential nutrients that help us purify the kidneys, those in charge of “filtering” everything we eat. Between the excesses of summer and the higher caloric intake that we consume in the fall, we have to take care of them.

If we take into account that the main function of the kidneys is the elimination of waste substances from the body through urine and that these are generated mainly from the food we eat every day, imagine how important is the diet to care for these organs.

FOODS THAT TAKE CARE OF YOUR KIDNEYS

And not only that, the main enemies of the kidneys (blood pressure and high blood sugar, which are the leading causes of kidney disease) also have a lot to do with everything we eat or, at least, can stay at bay with an adequate diet. So, Nephrologist in Delhi suggests watching the diet is a guarantee of health for your kidneys.

Keeping cholesterol at bay

Heart and kidney are very related. Therefore, to protect the kidney is essential to control cholesterol, one of the main cardiovascular risk factors. You get it by reducing in your diet the foods rich in saturated fats (red meats, whole milk …) and increasing the unsaturated ones (bluefish, nuts …). Use olive oil to cook, raise the good cholesterol.

Do not overdo the proteins

The kidney cleanses the blood of waste to expel it through the urine, and one of the main ones is urea, which is formed by the decomposition of proteins. Therefore, if you exceed your kidneys have to work more to eliminate urea and this can damage them. According to WHO, only 10-15% of daily calories should come from proteins. Red meats, whole milk products, and eggs are rich in them.

Control the salt

If you take a lot of salt the kidneys have a hard time removing excess sodium and that causes, in addition to thirst, fluid retention and hypertension, which can damage the blood vessels of the kidney. Kidney specialist in Delhi advises not to exceed 1.5 g of sodium per day. And do not forget that there is hidden salt in many foods (sausages, pre-cooked, cured cheeses, pickles …).

Do you control what you drink? This is how fluids affect the kidney

  • Water. To perform well its function is not necessary to drink more than 2 liters per day unless you have calculations because it helps to expel them.
  • Refreshments. The best are natural lemonades. Dark-colored sodas, fruit-flavored drinks or bottled or canned teas can have a lot of phosphorus.
  • Juices. If there is a kidney problem, the doctor for kidney in Delhi may recommend limiting the consumption of orange juice and replace it with apple, grape or pineapple.

Choose hydrates well

They are the main source of energy, but you must reduce the consumption of the simple ones (sugar, honey, jam, pastries, confectionery …) and increase the intake of complexes (whole grains and legumes). The reason? The first ones quickly turn into sugars and increase the risk of type 2 diabetes. And the high blood sugar we have already said is one of the main causes of kidney disease.

PAMPER YOUR KIDNEYS

If you have not hydrated well in the previous weeks, your kidneys may complain. So you can take care of them:

  • They need water to do their job well: Drink two liters of water of low mineralization daily. This helps them mobilize waste to be easily eliminated in the urine.
  • Fresh fruit and vegetables every day: These are the foods that most favor the purification function of the kidneys since, in addition to containing water, they are rich in potassium that increases the production of urine.
  • Go out in moderation and protect the jousts: According to the best nephrologist in Delhi, we should not exceed 5 grams of salt a day. When taken in excess, the kidneys can not eliminate it well and increases the risk of fluid retention and high blood pressure.

As for proteins, in a diet of 2,000 kcal, you should not eat more than 65g per day of this nutrient. It is proven that its excess hinders the work of the kidneys.

THE VEGETABLES RICHEST IN POTASSIUM

  1. Fruits: The banana, the apple, the orange, the apricot, the peach, and the strawberries are the fruits with more potassium.
  2. Vegetables: Potato, onion, celery, broccoli, cauliflower, and eggplant stand out as sources of this mineral.
  3. Legumes and nuts: Take 2 or 3 servings of legumes a week and 25 g of nuts per day.

BEWARE OF PHOSPHORUS

It is also not convenient for you to drink a lot of phosphorus. It is necessary to have strong bones, but if the levels of phosphorus in the blood are high, the kidneys have a hard time eliminating the excess and this increases the risk of cardiovascular disease and osteoporosis. That is why it is not convenient to take it in excess. It is found in protein-rich foods and is also used as an additive in processed foods and soft drinks.

It is important to remember that dairy products provide phosphorus, so you should not take more than 2 a day. Look for ideas to replace them, you can, for example, include 3 pieces of fresh fruit (at breakfast and snack) and 2 servings of vegetables a day to keep your kidneys healthy.

Sexual complaints in men suffering from kidney disease

Kidney Specialist, ,

Many men with chronic kidney damage experience sexual problems. Like less sense of sex and erection problems.

Sex hormones play a role in sexual excitement. The hormone testosterone affects men and women in having (and getting) a sense of sex. In the case of kidney damage, testosterone decreases. The sense of sex can therefore decrease.

In addition, erection problems can arise.

Erection problems

With sexual excitement, more blood goes to the penis. This makes the penis stiff. Approximately 7 out of 10 men with chronic kidney damage or kidney failure get erection problems. This means that it is more difficult to stiffen the penis or keep it stiff.

  • Sometimes an erection is no longer possible at all.
  • Sometimes the sensitivity of the penis is reduced by neuropathy (nerve pain). To get excited then you need stronger sexual stimuli than you might have been used to.
  • If you do not have an erection, sexual intercourse is not possible, but enjoying sex and getting an orgasm is often possible. Due to the reduced feeling, the perception of orgasm can be different.

Sometimes there is orgasm but no ejaculation anymore. The sperm then ends up in the bladder. This is also called dry cumshot. It does not hurt: you just piss out the semen.

Causes of erection problems

There are several causes of erection problems:

  • high blood pressure
  • medicines
  • testosterone deficiency
  • overweight or an unhealthy lifestyle
  • fear of failure or other worrisome thoughts

Kidney damage often involves high blood pressure. That affects the blood vessels. As a result, there is insufficient blood in the penis during sexual excitement. The penis then only gets half stiff, or not at all. It is also possible that there is enough blood to go to the penis, but that it is drained too quickly. Then the penis will swell, but it will not stay stiff for long.

Medications can also prevent erection. Blood pressure-lowering drugs sometimes ensure that there is insufficient blood to the penis during excitement. This also applies to certain sedatives if you use them for a long time.

Sometimes medication for the treatment of kidney disease leads to a shortage of testosterone. Then your penis and your brain are less sensitive to sexual stimuli. Being overweight can worsen testosterone deficiency.

Fear of failure or other worrisome thoughts

In the case of erectile problems caused by kidney damage, emotional problems often arise from fear of failure or other worrisome thoughts. If one fails to get an erection, the man can be afraid in advance that it will not work again next time. If all the attention goes to the erection, there is no attention to the love game. The man is more of a spectator who looks critically at whether the penis stays stiff. As a result, he does not notice sexual stimuli and loses his erection.

In case of fear of failure, there is also a good chance that the man (unwittingly) tightens the muscles of the pelvic floor too much. These are the muscles with which you stop your pee. If the muscle tension in the pelvic floor is too high, the blood circulation of the penis does not start with sexual excitement. Then there is no erection.

If the erection problems persist, there may be guilt that your partner suffers from your problems.

Discuss your problems

Are you less easily sexually stimulated? Or do you have other erection problems? Talk about it with your nephrologist in Delhi. Or discuss it with your best sexologist in Delhi. It can also help you to discuss sexual problems if you find it difficult.

Your best nephrologist in Delhi will talk to you about your problems, or refer you to a urologist or sexologist. Check whether the amount of testosterone in your blood can be measured. In a conversation, you will discuss together what causes your sexual problems. In addition to physical obstacles, emotional matters usually also play a role. Think of anxiety, fatigue, shame or guilt.

Treatment options

There are different treatment options for men with sexual problems.

  • more and stronger stimulation of the penis. For example, with lubricant, hand or mouth
  • a penis ring
  • erection pills
  • injections with a substance into the erectile tissues of the penis
  • good nutrition and enough exercise
  • the lovemaking plan at times when you are not too tired

Erection pills ensure that the erection lasts longer with sexual stimulation. Such medicines are only available on prescription. Erection agents are also offered on the internet, but that is not recommended: these resources are not reliable.

Always consult your kidney specialist in Delhi if you want to use resources to solve your erection problems. Your doctor knows which are safe for you and how to use them.

Solutions for fear of failure and worrisome thoughts

You can prevent fear of failure by (seeing) learning sex as something you enjoy. And not as something for which you have to perform.

  • Relax your body and your pelvic floor muscles.
  • Focus on what feels pleasant in your body.
  • Do not put yourself under pressure, for example with the idea that you should be able to have a community.
  • You and your partner may have just as much pleasure with stimulation by mouth or hand.

Because of worrying thoughts about sex, it is often difficult to pay attention to what you find exciting. It is then more difficult for you and your partner to enjoy sex.

Do you already suffer from fear of failure or other worrying thoughts? And keep it on? Talk about it with your partner. Feel free to ask for help from a healthcare provider if the problems persist. For example your top nephrologist in Delhi, or a sexologist in Delhi.