Symptoms, causes, diagnosis, and treatment

The term hypercalcemia refers to having too much calcium in the blood. For some, the cause is an overactive parathyroid gland, certain medications, too much vitamin D, or underlying health conditions, including cancer.

Calcium plays an essential role in the body. It helps to build strong bones and teeth, while also supporting the muscles, nerves, and heart. However, too much calcium can lead to problems.

In this article, we explore the symptoms, causes, and complications of hypercalcemia. We also describe how it can be diagnosed and treated.

Calcium levels in the blood are mostly controlled by the parathyroid glands. These four tiny glands sit behind the thyroid.

When the body needs calcium, the parathyroid glands secrete a hormone. This hormone signals:

• the bones to release calcium into the blood
• the kidneys to excrete less calcium into the urine
• the kidneys to activate vitamin D, which helps the digestive tract to absorb more calcium

Overactive parathyroid glands or an underlying health condition can disrupt the balance of calcium.

If calcium levels become too high, a person may be diagnosed with hypercalcemia. This condition can impede bodily functions, and may specifically be associated with:

Extremely high levels of calcium in the blood can become life-threatening.

Mild hypercalcemia may not result in symptoms, while more serious hypercalcemia can cause:

• Excessive thirst and frequent urination. Too much calcium means that the kidneys have to work harder. As a result, a person may urinate more often, leading to dehydration and increased thirst.
• Stomach pain and digestive problems. Too much calcium can cause an upset stomach, abdominal pain, nausea, vomiting, and constipation.
• Bone pain and muscle weakness. Hypercalcemia can cause the bones to release too much calcium, leaving them deficient. This abnormal bone activity can lead to pain and muscle weakness.
• Confusion, lethargy, and fatigue. Too much calcium in the blood can affect the brain, causing these symptoms.
• Anxiety and depression. Hypercalcemia may also affect mental health.
• High blood pressure and abnormal heart rhythms. High levels of calcium can increase blood pressure and lead to electrical abnormalities that change the heart’s rhythm, adding strain.

A number of factors and underlying conditions can cause hypercalcemia. These include:

Overactive parathyroid glands

The parathyroid glands control calcium levels. If they work too hard, this can lead to hypercalcemia.

The parathyroid glands may become overactive when one is enlarged or when a noncancerous growth forms on one.

Having overactive parathyroid glands is called hyperparathyroidism. This may be the most common cause of hypercalcemia.

Hyperparathyroidism is usually diagnosed in people aged between 50 and 60. It is also up to three times more common in women than men.

Too much vitamin D

Vitamin D triggers calcium absorption in the gut. Once absorbed, calcium travels into the bloodstream.

Only 10–20 percent of the calcium in the diet is usually absorbed, while the rest is passed in stools. However, excessive amounts of vitamin D cause the body to absorb more calcium, leading to hypercalcemia.

In 2012, some researchers suggested that therapeutic high-dose vitamin D supplementation has the potential to cause hypercalcemia. These supplements can be used in the treatment of multiple sclerosis and other conditions.

The Food and Nutrition Board in the United States defines high doses of vitamin D as more than 4,000 international units (IU) per day. The recommended daily dose for adults is 600–800 IU per day.

Cancer

If a person has cancer, this may cause hypercalcemia. Cancers that commonly lead to this condition include:

In 2013, it was estimated that each year hypercalcemia affects more than 2 percent of all cancer patients in the U.S. Also, up to 30 percent of people with cancer will have high levels of calcium over the course of the disease.

If cancer spreads to the bone, this increases the risk of hypercalcemia.

Other health conditions

Beyond cancer, the following conditions are known to cause high levels of calcium:

Reduced mobility

People who are unable to move around for long periods may also be at risk for hypercalcemia. When the bones have less work to do, they can weaken and release more calcium into the bloodstream.

Severe dehydration

People who are severely dehydrated have less water in their blood, which can increase the concentration of calcium in the bloodstream. However, this imbalance is usually corrected once a person becomes sufficiently hydrated.

In some cases, high levels of calcium can lead to severe hydration. It is important for doctors to identify which came first: the high levels of calcium or the dehydration.

Medications

Some medications can overstimulate the parathyroid gland, and this can lead to hypercalcemia. One example is lithium, which is sometimes used to treat bipolar disorder.

Without proper treatment, hypercalcemia can be associated with:

Osteoporosis

Over time, the bones may release excessive amounts of calcium into the bloodstream. This makes the bones thinner, or less dense. As calcium continues to be released, osteoporosis can develop.

People with osteoporosis have an increased risk of:

• bone fractures
• significant disability
• loss of independence
• prolonged immobility
• a curvature of the spine
• becoming shorter over time

Kidney stones

People with hypercalcemia are at risk of developing calcium crystals in their kidneys. These crystals can become kidney stones, which are often very painful. They can also lead to kidney damage.

Kidney failure

Over time, severe hypercalcemia can stop a person’s kidneys from working correctly. The kidneys may become less effective at cleaning the blood, producing urine, and efficiently removing fluid from the body. This is called kidney failure.

Problems with the nervous system

If left untreated, severe hypercalcemia may impede the nervous system. Possible effects include:

Falling into a coma is serious and can be life-threatening.

An irregular heartbeat

The heart beats when electrical impulses move through it and cause it to contract. Calcium plays a role in regulating this process, and too much calcium can lead to an irregular heartbeat.

Share on PinterestA doctor may order a blood test to check blood calcium and parathyroid hormone levels.

Anyone experiencing symptoms of hypercalcemia should speak with a doctor, who will order a blood test and make a diagnosis based on results.

A person with mild hypercalcemia may have no symptoms, and the condition may only be diagnosed after a routine blood test.

The test will check for blood calcium and parathyroid hormone levels. These can show how well the body’s systems are functioning, such as those involving the blood and kidneys.

After diagnosing hypercalcemia, a doctor may perform further tests, such as:

• an ECG to record of the electrical activity of the heart
• a chest X-ray to check for lung cancer or infections
• a mammogram to check for breast cancer
• a CT or MRI scan to examine the body’s structure and organs
• dual energy X-ray absorptiometry, commonly known as a DEXA scan, to measure bone density

People with mild hypercalcemia may not require treatment, and levels may return to normal over time. The doctor will monitor calcium levels and the health of the kidneys.

If calcium levels continue to rise or do not improve on their own, further testing will likely be recommended.

For people with more severe hypercalcemia, it is important to discover the cause. The doctor may offer treatments to help lower calcium levels and prevent complications. Possible treatments include intravenous fluids and medications such as calcitonin or bisphosphonates.

If overactive parathyroid glands, too much vitamin D, or another health condition is causing hypercalcemia, the doctor will also treat these underlying conditions.

A person with a noncancerous growth on a parathyroid gland may require surgery to remove it.

Certain lifestyle changes can help to keep calcium levels balanced and bones healthy. These include:

• Drinking plenty of water. Staying hydrated may lower blood calcium levels, and it can help to prevent kidney stones.
• Quitting smoking. Smoking can increase bone loss. In addition to improving the health of the bones, quitting will reduce the risk of cancer and other health problems.
• Exercising and strength training. This promotes bone strength and health.
• Following guidelines for medications and supplements. Doing so may decrease the risk of consuming too much vitamin D and developing hypercalcemia.

A person’s outlook depends on the cause and severity of hypercalcemia.

Mild hypercalcemia may not require treatment. If the condition is more serious, a doctor may prescribe medications that lower levels of calcium and treat the underlying cause.

Anyone experiencing symptoms of hypercalcemia should speak with a doctor.

Are You Taking Too Many Calcium Supplements? – Health Essentials from Cleveland Clinic

You eat your yogurt, exercise daily and chew that calcium supplement like a champ. Osteoporosis doesn’t stand a chance — you’re a calcium superstar!

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But, when it comes to calcium, it’s actually possible to have too much of a good thing: Calcium can build up to unhealthy levels in the bloodstream. And this hypercalcemia can cause a variety of problems ranging from not great to very serious.

Don’t toss your calcium supplements just yet, though. Endocrinologist Susan Williams, MD, explains what happens when calcium levels creep too high — and how to strike a healthy balance.

The dangers of high calcium levels

Calcium is key to a sturdy skeleton. “Calcium is so important for the bones and teeth of growing children, but as adults, we sometimes forget how important it is throughout our lifetime,” Dr. Williams says.

Besides beefing up bones, calcium is critical for the healthy function of nerves and muscles, including the heart.

Guidelines recommend a total of 1,000 milligrams per day for women until age 50 and for men until age 70.

Past those birthdays, men and women should aim for 1,200 mg per day. (For context, a cup of milk or a serving of yogurt each has about 300 mg of calcium.)

More is not better, however. Problems linked to excess calcium include:

• Constipation.
• Kidney stones.
• Kidney failure.
• Heart function problems.
• Confusion and cognitive problems.

What causes hypercalcemia?

Soaring calcium levels can be triggered by a variety of diseases,
including parathyroid problems and a number of cancers. Hypercalcemia can also
be a side effect of certain prescription meds.

But over-the-counter calcium medications can push you over the edge, too. It’s surprisingly easy to overdo the calcium supplements — especially if you consume a lot of dairy or otherwise get plenty from your food. Over-the-counter antacid chews and tablets pack a big calcium punch as well.

On top of all that, high doses of vitamins A and D can also cause calcium levels to rise.

Hypercalcemia hints

Many people don’t have obvious symptoms of hypercalcemia. But these
signs hint that your calcium levels might be flying high:

• Bone pain.
• Headaches.
• Fatigue and lethargy.
• Frequent urination and thirst.
• Nausea, constipation and/or loss of appetite.
• Muscle aches, weakness or cramping.
• Memory problems, irritability and depression.

Luckily, hypercalcemia caused by supplements and antacids usually
reverses quickly when you stop taking them, Dr. Williams says. Untreated,
though, long-term hypercalcemia can be serious — maybe even life-threatening.

Avoid calcium overload

How can you make sure you’re getting enough calcium without
going overboard?  

1. Think food first. Foods rich in calcium include dairy products, sardines and leafy greens like kale and broccoli. Unless you’re on an all-dairy diet (note: do not go on an all-dairy diet), you probably won’t get too much calcium from food alone. Consider it a good reason to eat more ice cream.
2. Drink up. Dehydration can lead to mild hypercalcemia, when the amount of fluid in your blood gets too low, so keep your water bottle filled and ready.
3. Do the math. Between multivitamins, supplements, antacids and your morning yogurt, your daily calcium intake can add up faster than you realize. Pay attention to how much you’re really consuming.
4. Schedule a check-up. Most physicians check calcium levels during routine blood tests that you get in an annual exam. It’s one more reason to check in with your doctor on the regular.
5. Supplement with care. Talk to your doctor about whether you should take calcium and vitamin D supplements, and if so, how much you need. “Without a doubt, getting adequate calcium is good for your bones. But taking more than you need won’t make your bones stronger,” Dr. Williams says. Sometimes, enough is enough.

High Calcium Levels or Hypercalcemia

Calcium is a mineral found in different places in the body, including your blood. When you have more calcium in your blood than normal, doctors call it “hypercalcemia.” It is a serious condition. Up to 30% of all people with cancer will develop a high calcium level as a side effect.

A high calcium level can be treated, and it is important to talk with your doctor if you experience any symptoms. Left untreated, a high calcium level can cause severe problems, like kidney failure, and it can even be life-threatening.

Treatment for side effects is an important part of cancer care. This type of treatment is called supportive care or palliative care. Talk with your health care team about any symptoms you have, including new symptoms or changes. This helps them find side effects like a high calcium level as early as possible.

About calcium in your body

Everybody needs calcium for many body functions. It helps form bones and teeth, and it also helps your muscles, nerves, and brain work correctly. Most of the calcium in your body is in your bones. Normally, your blood contains only a small amount. When you are healthy, your body controls the level of calcium in your blood.

Cancer can cause a high calcium level in the blood in several ways. High calcium levels due to cancer are not caused by too much calcium in your diet. Eating fewer dairy products and other high-calcium foods will not lower high blood calcium levels.

Cancers that more commonly cause high calcium levels in your blood include:

Learn more about specific types of cancer.

What are the symptoms of a high calcium level?

Symptoms of a high calcium level often develop slowly. You may not notice them at first, because they can feel like the symptoms of cancer or treatment. Or, you may not have any symptoms.

The severity of your symptoms does not depend on how high your calcium level is. Different people have different reactions. Older people usually have more symptoms than younger people.

If you do have symptoms, they may includes:

• Loss of appetite

• Nausea and vomiting

• Constipation and abdominal (belly) pain

• The need to drink more fluids and urinate more

• Tiredness, weakness, or muscle pain

• Confusion, disorientation, and difficulty thinking

• Headaches

• Depression

Serious symptoms can include:

• Seizure

• Irregular heartbeat

• Heart attack

• Loss of consciousness

• Coma

You and your family should know these serious symptoms. Ask your doctor what you should watch for and when to get treatment.

How are high calcium levels diagnosed and how are they managed?

Your doctor can do a blood test to learn if you have a high calcium level. You may also have blood tests to check how well your kidneys are working. Your doctor will treat a high calcium level if you have it. The treatment depends on how severe the condition is.

Mild hypercalcemia

People who have no symptoms receive extra fluids, usually given through a vein. This will help your kidneys remove extra calcium from your blood.

Moderate or severe hypercalcemia

This can be treated by:

• Continuing cancer treatment.

• Replacing fluids lost through vomiting and urination.

• Taking medication to stop bone from breaking down. You may be prescribed a bisphosphonate, such as zoledronic acid (Zometa), pamidronate (Aredia), or ibandronate (Boniva), or denosumab (Prolia, Xgeva). Talk with your doctor about the risks and benefits of taking such medications.

• Taking medicine called steroids. These can help stop bone from breaking down. They also help your bones take more calcium from your food. Steroids can also raise your risk of bone loss over time. Talk with your doctor about the risks and benefits of taking steroids.

• Taking a hormone called calcitonin. This hormone functions by reducing calcium release from your bones and increase calcium secretion from your kidneys.

• Using dialysis if you haves kidney failure. Dialysis is a machine-based process that cleans your blood when your kidneys are not working properly.

Treating a high calcium level helps relieve your symptoms. When you feel better, it is easier to continue your cancer treatment.

For people with advanced cancer, high calcium levels can occur when they are approaching the last weeks of life. In these cases, the health care team will discuss whether to treat hypercalcemia.

Can high calcium levels be prevented?

There are things you can do to help prevent high calcium levels. The following tips may help keep hypercalcemia from getting worse:

• Drink fluids regularly.

• Talk with your doctor about controlling your nausea and vomiting.

• Walk and be active, which can help stop bone from breaking down.

• Check with your doctor before taking any medication, including over-the-counter supplements. Some may make high calcium levels worse.

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Hypercalcemia (High Calcium) – Managing Side Effects

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Care During Chemotherapy and Beyond

What Is Hypercalcemia?

Hypercalcemia is an electrolyte
imbalance and is indicated by an excess of calcium in the blood. & The
normal adult value for calcium is 8.5-10.2 mg/dL.

There are many reasons for an elevated blood calcium level. Reasons for the
hypercalcemia may include:

• Cancer that started in the bone, or cancer that has spread to the bone.
• Some cancers can cause hypercalcemia themselves, without spread to the bone.
• Other conditions such as; overactive parathyroid gland or Paget’s disease of the
  bone.
• Some medications cause hypercalcemia such as: alkaline antacids, diethylstilbestrol
  (DES), long-term use of diuretics, estrogens and progesterone.

What Happens In Hypercalcemia?

Cancer cells that spread to the bone can secrete substances that can cause cells
found in the bone called osteoclasts to dissolve or “eat away” a portion
of the bone. These tumors or lesions weaken the bone and can lead to complications.
Some of the complications resulting from this bone break down are bone pain, fractures
and less commonly, hypercalcemia.

Hypercalcemia Symptoms:

• Mild hypercalcemia may not produce any symptoms. However,
  symptoms of nausea, poor appetite, vomiting and constipation may be present with
  mild increases in blood calcium levels.
• Moderate high levels of hypercalcemia may produce fatigue or excessive tiredness.
  Heart rhythm abnormalities, increased urinary frequency, and kidney stones may also
  be present.
• With higher levels of hypercalcemia, patients may experience muscle twitching,
  anxiety, depression, personality changes and confusion.
• With very high levels of hypercalcemia excessive sleepiness, coma even death may
  occur.
• The severity of symptoms for hypercalcemia depends not only on how high the calcium
  level is, but also on how fast the rise in serum calcium has occurred.

Things You Can Do:

• It is important that you stay well hydrated. Drink 2 to 3 quarts of fluid
  a every 24 hours, unless you are instructed otherwise.
• Take anti-nausea and anti-diarrhea medications as directed, also follow dietary
  recommendations.
• Keep active, weight-bearing activities such as walking are helpful. Being
  immobile aggravates hypercalcemia.

Drugs That May Be Prescribed By Your Doctor for Hypercalcemia:

• If your blood test results show a seriously high blood calcium level, intravenous
  fluids with diuretics may be used to lower blood calcium levels quickly.
• Bisphosphonates: These drugs, such as pamidronate, or zoledronate work by inhibiting
  bone loss.
  • Cancer cells that spread to the bone can secrete substances that can cause cells
    found in the bone called osteoclasts to dissolve or “eat away” a portion of the
    bone. These tumors or lesions weaken the bone and can lead to complications.
  • Some of the complications resulting from this bone breakdown are bone pain, fractures
    and less commonly, hypercalcemia (increased levels of calcium in the blood).
  • Biphosphonate medications are used to slow down the osteoclast’s effects on the
    bone. In doing this it can be useful in slowing down or preventing the complications
    (bone pain, fractures, or hypercalcemia) of the bone breakdown.
• Antineoplastic agents: Such as gallium nitrate, reduce bone turnover.
• Antihypercalcemic agents: Such as calcitonin, work by inhibiting bone loss, and
  increasing the kidney’s ability to get rid of calcium.

When to Contact Your Doctor or Health Care Provider:

• Nausea that interferes with your ability to eat, and is unrelieved by prescribed
  medication.
• Diarrhea (4-6 episodes in a 24-hour period), unrelieved with taking anti-diarrhea
  medication and diet modification.
• Abdominal pain, sweating, or fever (may be pancreatitis)
• Any new rashes – if on new medications
• Any unusual condition or problem that is concerning to you.

Return to list of Blood
Test Abnormalities

Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.

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High Blood Calcium – Symptoms, Causes, Treatments

The most common cause of high blood calcium is primary hyperparathyroidism, which results in overproduction of parathyroid hormone by the parathyroid glands. The parathyroid glands play a role in the body’s regulation of calcium levels in the blood. In most cases, the causes associated with primary hyperparathyroidism disease are not known.

You can also develop high blood calcium as a result of adrenal failure, too much calcium in your diet, genetic conditions that affect how your body processes calcium, anorexia, hyperthyroidism, kidney disease, reactions to some medications, certain types of tumors, and an excess of vitamin D.

Common causes of high blood calcium

High blood calcium may be caused by a wide variety of conditions and diseases including:

• Adrenal failure
• Anorexia
• Certain medications, especially certain diuretics or lithium
• Dehydration
• Excess vitamin D
• Hyperthyroidism
• Kidney disease or failure
• Primary hyperparathyroidism (overproduction of parathyroid hormone by the parathyroid glands)
• Specific cancers, including some types of lung cancers
• Vomiting associated with eating disorders such as bulimia

Rare causes of high blood calcium

High blood calcium can also be caused by less common conditions including:

• Familial hypocalciuric hypercalcemia (condition in which insufficient calcium is excreted)
• Overabundance of calcium in the diet
• Rare cancers

Serious or life-threatening causes of high blood calcium

In some cases, high blood calcium may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These conditions include:

Questions for diagnosing the cause of high blood calcium

In meeting with you to diagnose your condition, your health care provider will ask a series of questions related to your high blood calcium including:

• When did you first notice your symptoms?
• Do you have any other symptoms?
• Where do you feel your symptoms?
• What medications are you taking?
• What does your typical daily diet include?
• Does anything improve your symptoms?
• Does anything you do cause your symptoms to worsen?
• Do you have any family history of high blood calcium?

What are the potential complications of high blood calcium?

Potential complications of high blood calcium vary in severity and depend upon the underlying cause. These complications can range from minimal to life-threatening. If your high blood calcium is due to a readily treatable condition, such as primary hyperparathyroidism, treatment is usually effective and your risk of potential complications is minimal. When high blood calcium is due to a serious disease, such as cancer, the potential complications from the disease itself can be severe.

Because any of a number of serious diseases may lie at the root of your high blood calcium, it is vitally important to seek medical treatment promptly to minimize risk of potential complications including:

• Arrythmia (abnormal heart rhythm)
• Bone fractures
• Cognitive changes (problems concentrating, changes in behavior, and impaired memory)
• Kidney failure
• Kidney stones
• Osteoporosis
• Spread of cancer
• Unconsciousness and coma

How much calcium is too much? | Nutrition

I am an endocrinologist who specializes in mineral metabolism, and about half the women I see in my practice don’t get enough calcium. But a small minority – about 5 percent of my patients – consume too much calcium.

Calcium is important for the prevention of osteoporosis, a dangerous thinning of bones that is particularly a problem in post-menopausal women. It is best to get your calcium in the food you eat, but many women take calcium supplements to boost their calcium consumption. A few women go overboard with calcium supplements. You probably have heard that taking too much calcium can increase your risk of kidney stones. What you probably don’t know is that excessive calcium intake may, possibly, cause heart problems.

Here’s how that might happen: Some of the excess calcium from supplements could make its way into fatty plaques in your arteries. These plaques narrow arteries, reducing the blood supply to heart muscle. The evidence for this concern is mixed. Some studies have, indeed, found an increased risk of heart problems associated with excessive intake of calcium from supplements, but other studies have found no such increased risk.

What is clear is that there is no benefit to bone health from consuming higher-than-recommended levels of calcium, so it’s best to stay at the recommended level. That means women who take calcium supplements should get in the habit of reading labels on food and calcium supplements and doing the math.

The Institute of Medicine recommended daily allowance of calcium for women ages 19 to 50 is 1,000 milligrams per day, and the upper level (safe) limit is 2,500 milligrams per day. The Institute’s recommended daily allowance of calcium for women ages 51 to 70 is 1,200 milligrams per day, and the upper level limit is 2,000 milligrams per day.

Here are some calcium tips:

• To determine how much calcium is in packaged foods, look at the percent of the recommended daily intake of calcium per serving and then add a zero. For instance, if a frozen pizza package says that a serving supplies 15 percent of the recommended daily calcium intake, you will get 150 milligrams of calcium from a serving of that pizza.
• Choose calcium citrate tablets. Calcium is available in different formulations, but calcium citrate is absorbed best.
• Calcium citrate can be taken with or without food, but it is best not to exceed 500 mg at a time.
• Try to stay close to the recommended daily allowance of calcium for your age, and do not exceed the upper-level limit.
• It’s best to get your calcium from food. Milk, cheese, and dark green leafy vegetables are good sources of calcium.

Could too much calcium cause heart disease?

Get the calcium you need through dietary sources.

Oh, the ruckus a single study raised many years ago. A report about calcium and cardiovascular disease had people from San Diego to Caribou, Maine worriedly calling their doctors worried about calcium supplements.

Here’s what prompted the concern: New Zealand researchers pooled the results of 11 randomized, controlled trials—the so-called gold standard of medical research—comparing the effects of calcium supplements and placebo on preventing osteoporosis or colon cancer. All the trials also had information on the volunteers’ cardiovascular health. As reported online in the BMJ, more of the volunteers taking calcium had heart attacks, stroke, or died suddenly than did those taking the placebo. Media reports duly noted a 30% increased risk of cardiovascular disease with calcium supplements, which sounds scary. Another way to put the findings: 5.8% of those taking calcium had a cardiovascular event, compared with 5.5% of those taking placebo.

This publication is just another piece of the calcium puzzle. It isn’t a practice changer. Some prior studies have shown that taking calcium supplements is linked to cardiovascular disease, others haven’t.

The connection between calcium and cardiovascular disease is plausible. Calcium deposits are part of artery-clogging plaque. They also contribute to stiffening of the arteries and interfere with the action of heart valves. But whether there is a direct connection between the amount of calcium in the bloodstream (calcium supplements increase blood calcium levels) and cardiovascular problems isn’t yet known.

An even bigger unanswered question is how much calcium the average person needs each day to keep bones strong and healthy. At one end of the spectrum, the World Health Organization says 400 to 500 milligrams (mg) of calcium a day are needed to prevent osteoporosis. At the other end, the official recommendation for Americans is 1,000 mg/day from ages 19 to 50 and 1,200 mg/day after that.

Given the uncertainty about the balance of benefits and risks of calcium supplements, it’s probably best to get the calcium you need from dietary sources to keep your bones strong and prevent bone-thinning osteoporosis.

Don’t just rely on calcium for bone health. You should also include:

• Weight-bearing exercise, like walking, running, tennis, and others, is one of the best things you can do for your bones.
• Getting enough vitamin D, from sun and supplements, is also good for bones and overall health. (As with everything, don’t overdo it—no more than 10 to 15 minutes of sunshine without sunscreen, and/or 800 to 1,000 IU of a vitamin D supplement. )
• Vitamin K from green leafy vegetables such as spinach, Swiss chard, and kale is also important for bone health.

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90,000 What is the threat of an overdose of vitamins? – Harmony of health

Before taking vitamin preparations, make sure that your body really needs them. An overdose of vitamins can be more threatening than a lack of them. Hypervitaminosis is a group of symptoms caused by an excess of vitamins in the body, most often as a result of an overdose. It concerns, first of all, fat-soluble vitamins: A, D, E and K. With too much intake of water-soluble vitamins, the body can cope by excreting them along with urine. Another situation arises with an excess of fat-soluble vitamins, they cause hypervitaminosis.

Before taking vitamin preparations, make sure that your body really needs them. An overdose of vitamins can be more threatening than a lack of them. Hypervitaminosis is a group of symptoms caused by an excess of vitamins in the body, most often as a result of an overdose. It concerns, first of all, fat-soluble vitamins: A, D, E and K. With too much intake of water-soluble vitamins, the body can cope by excreting them along with urine.Another situation arises with an excess of fat-soluble vitamins, they cause hypervitaminosis.

Excess vitamin D – has a very dangerous effect. In adults, it manifests itself as nausea, vomiting, itching of the skin, head and eye pain, diarrhea, increased urination, as well as the deposition of excess calcium in soft tissues, in the liver, kidneys, lungs, heart and blood vessels. The consequences of an overdose of vitamin D are dangerous in pregnant women and nursing mothers. They cause fetal deformities, bone disease in newborns.Too large doses of vitamin E can cause gastrointestinal upset, feeling tired and weak, as well as drowsiness, headaches, muscle weakness, and diplopia. The increased supply of vitamin E has fewer side effects compared to many other vitamins. An overdose of this vitamin occurs, but rarely.

Vitamin A in too large doses can cause nausea, blurred vision, fatigue, heaviness, irritability, lack of appetite, vomiting, headache, hair loss, itching, cracked and bleeding lips, stunted growth in children, peeling skin, ulcers, bone damage , bleeding, deformation of the skull and face, dysfunction of the heart, kidneys, fibrosis of the liver and central nervous system.To an excess of vitamin. And most often leads to unlimited use of food additives.

An overdose of vitamin K, which regulates the process of blood clotting, leads to the breakdown of red blood cells and, consequently, to anemia. The consequences of an excess of this element are also sweating and a feeling of heat, and in newborns – jaundice, and even damage to brain tissue! The human body is especially sensitive to an overdose of vitamin C (the so-called ascorbic acid), which is found mainly in vegetables and fruits. Its excess can lead to crystallization of salts and the formation of kidney stones, and taking very large doses can lead to disturbances in the functioning of the gastrointestinal tract and the nervous system. In addition, excess vitamin C causes skin breakouts. Its consumption in large doses has a bad effect, especially on the following category of people: pregnant women with diabetes mellitus, in people with lens cataracts and thrombophlebitis, it causes hypervitaminosis.

In addition to the harmful effects, an excess of some elements provokes a decrease or loss in the body of other substances it needs.Thus, in addition to the consequences of hypervitaminosis, there is a deficiency of minerals and other vitamins that affect the processes occurring in the body. A proper diet will help you avoid taking special supplements, as well as hypervitaminosis. Nutritionists all over the world claim that we can get all the necessary elements for the full functioning of the body with our daily food.

But if proper nutrition is impossible, a general practitioner can prescribe vitamin preparations, usually from domestic manufacturers.These drugs are created for residents of the region who have the same needs for elements. These drugs are strictly controlled and tested so that they do not lead to hypervitaminosis.

There is a category of drugs where the daily intake of vitamins can be ten or even twenty times higher. They cannot be used without consulting a doctor, otherwise an overdose of vitamins cannot be avoided. Therefore, before you include vitamin supplements in your daily diet, you should consult a specialist.You shouldn’t use additional supplements all year round. It is acceptable to use them in winter and autumn: during the rest of the year, our diet does not need to include vitamin supplements. It is also recommended, in taking synthetic vitamins, to take breaks every three to four weeks, since the constant intake of special supplements can provoke hypervitaminosis.

Managing ARV drug side effects

ARV drugs help people with HIV live long and healthy lives.Regular ARV medication reduces the amount of virus in the body to undetectable levels and also helps keep the immune system healthy. However, like most medicines, they can cause side effects. It is very important to know how to deal with them in order for your ARVs to work effectively for the longest possible time and in the greatest comfort for you.

What are the side effects?

Side effects are symptoms or problems that may occur while taking medication.Most drugs used to treat any medical condition can cause side effects. For example, a cold medicine can relieve a runny nose, but it can also make you sleepy. ARV medications can also cause various reactions and make you feel less comfortable: headache, indigestion, nervousness, trouble concentrating, etc. However, you may not be aware of some of them, such as the effect of medications on liver or kidney function.

Some side effects are relatively common and can affect most people taking the drug, while others are extremely rare.Also, how the body tolerates a particular drug can be influenced by age, weight, gender, and general health. This article will discuss the side effects that can occur with different ARV drugs and what to do if they occur.

Why Know About Side Effects When Taking ARVs?

ARV drugs help people with HIV live long and healthy lives. Regular ARV medication reduces the amount of virus in the body to undetectable levels and also helps keep the immune system healthy.However, like most medicines, they can cause side effects. It is very important to know how to deal with them in order for your ARVs to work effectively for the longest possible time and in the greatest comfort for you.

Managing side effects is just as important as taking your medications regularly: if you have a plan and follow it, you are more likely to stay healthy and feel good. Ask your healthcare professional about the side effects your drug may cause, or read the instructions for use yourself.Some side effects can be serious and you need to see a doctor right away, but most of them can be dealt with on your own.

Side effects are one of the main reasons people stop taking ARVs. Remember that even if side effects occur, it takes time for the body to get used to the new drug, so needs to continue taking the drug and in no case reduce the dosage of until your doctor tells you otherwise.If you skip the drug or reduce the dosage, the drug may stop working. However, some drugs, such as abacavir and nevirapine, can cause very serious side effects and you need to stop taking them right away and seek immediate medical attention.

Why are there so many side effects in the instructions for use?

Instructions for the use of any drug contains a large amount of information. By law, drug manufacturing companies are required to indicate all 90,024 possible side effects, even those that occur extremely rarely . The most common side effects are usually listed first, and the rarest ones at the bottom of the list. Don’t worry that might happen. You may have few or no side effects, this is very individual.

What should you ask your doctor if you are prescribed this or that drug for the first time?

First, it is important to know how the drug works and how to take it correctly. Ask your doctor:

• What is the name of the drug? What is its trade name and what analogues exist? For example, “Retrovir” is the brand name of the drug, but there are analogues (“Zidovirin”, “Zido-Eich”, “Azimitem”, “Viro-Zet”).All of these drugs have the same active ingredient – zidovudine.
• How does this drug work?
• How to take this medication correctly? When is it best to take it (for example, before bed or early in the morning)?
• Is the drug taken with or without food?
• Are there any foods or drinks that should not be taken with drugs?
• Are there any drugs that should not be taken with ARVs?
• What are the most common side effects of this drug?
• Is there anything you can do to reduce them?
• Does this drug have serious side effects? Where can you urgently contact when they arise?
• Should I stop taking the drug if this or that side effect occurs?

Most common side effects of all ARV drugs

Side effects that may occur when taking ARV drugs:

• Diarrhea
• Fatigue
• Headache
• Liver problems
• Upset stomach (nausea), stomach pain, vomiting, loss of appetite

Over time, side effects become less pronounced or disappear altogether. However, some of them – the initial stages of liver or kidney disease – cannot be felt, so it is necessary to be tested and examined.

It is very important to carefully read the instructions for use of the drugs you are taking. The appearance of some side effects can be avoided (or significantly reduced in intensity) if you adhere to certain rules of admission. For example, heavy and fatty foods increase the absorption of efavirenz and can lead to increased side effects, so it is recommended that this drug be taken on an empty stomach (or never with a fatty meal), preferably before bed.

The following are the most common side effects that are possible (but not required) with ARVs.

Diarrhea

If antiretroviral drugs cause diarrhea, you need to drink plenty of fluids in order to restore water loss due to diarrhea. There are a number of medications available to replenish minerals and nutrients in the body. Check with your doctor on this matter.

It is also possible to control diarrhea by eating or avoiding certain foods, but the list of these foods may vary.

You can try to balance your diet by considering the following:

• Pectin-containing foods (applesauce, bananas, yoghurts) can help relieve bowel upset.
• Foods rich in potassium will help restore the balance of this trace element (fruit juices, jacketed potatoes, bananas).
• Salty soups, broths, crackers, etc. will help retain water and prevent dehydration.
• Protein-rich foods (lightly fried beef, turkey, chicken or hard-boiled eggs) can help prevent fatigue and fatigue.
• Avoid spices, fatty, starchy or unprocessed foods; caffeine, alcohol, dairy products, and foods that cause gas (beans, broccoli, etc.).
• Take calcium supplements (500 mg twice daily, see information below for details).
• Ask your doctor or dietitian to prescribe digestive enzymes or drugs that normalize your gut flora.

Diarrhea often becomes less severe or disappears completely after you try any of the above methods.However, if diarrhea continues for five days or more, or you have lost more than two kilograms of weight, be sure to tell your doctor.

Fatigue

Feeling tired is one of the most common side effects when you start taking ARVs. It is sometimes difficult to tell whether the drugs are causing the fatigue or the HIV infection itself. As with other side effects, you need to start worrying if this lasts for a while, however, most patients feel less tired after the body gets used to the new drug (usually it takes a few weeks).

You may also feel tired due to anemia – a low number of red blood cells (erythrocytes). Some drugs, such as zidovudine, can cause anemia. If your anemia is severe, you may have to change your regimen or be prescribed drugs that increase your red blood cell count.

Listed below are several ways you can increase energy and reduce feelings of fatigue:

• If fatigue is not caused by anemia, try aerobics, exercises in which you are not too stressed or exhausted (jogging, swimming, cycling). Light-duty exercise can also help (such as lifting moderate weights). It can reduce stress and feel stronger and more resilient. However, don’t overdo it!
• Stick to a sleep schedule; not getting enough sleep or getting too much sleep can also exacerbate fatigue.
• Eat a balanced diet with sufficient calories and protein. Drink plenty of fluids.
• Ask your doctor or dietitian to prescribe vitamins or nutritional supplements to help you maintain or increase your energy levels and improve your well-being.(see information below).

Headache

Headache is also one of the most common side effects of ARVs, especially during the first weeks. The following few actions can help reduce or eliminate headaches:

• Eat regularly and drink plenty of fluids.
• You can sit or lie down in a quiet, dark room and place a cold, damp towel over your forehead and eyes.
• Give a light massage to your temples.
• Take aspirin, acetaminophen, or ibuprofen.

Be sure to tell your doctor about a headache if it occurs very often. This may be a migraine that is not associated with an ARV medication.

Liver problems

The liver is a very important organ as it produces enzymes, proteins that aid in the digestion and absorption of the drugs you are taking. Some ARVs can make your liver function worse, especially if you have both HIV and hepatitis C.Certain herbs and complementary medicines can also affect liver function.

To reduce liver-related side effects:

• Reduce or stop drinking alcohol.
• Get your liver enzymes tested regularly, such as ALT, AST, bilirubin, and alkaline phosphatase.
• Take a hepatitis test. If it is positive, there are medications that can cure it or render it inactive.

Upset stomach (nausea), stomach pain, vomiting, loss of appetite

These side effects usually decrease or disappear within a few weeks after starting the drug. If vomiting or stomach pain persists for several days, be sure to see your doctor. Prescription antiemetic drugs can help control nausea and vomiting.

You need to balance your diet as follows:

• Include bananas, white rice, applesauce, and toasted bread.
• Avoid hot, spicy or greasy foods.
• Sip cold sodas, or try peppermint, chamomile, or ginger tea.

Long-term decreased or no appetite or weight loss can be a serious problem with HIV infection. Taking new drugs can reduce your appetite or lead to an upset stomach, which in turn can lead to you eating less. Try the following steps to restore your appetite and avoid weight loss:

• Eat the food you find appetizing, even if you are not hungry.
• It is better to eat 5-6 times in small portions than 3 times with large amounts of food.
• Avoid foods and drinks that make you feel full but don’t provide enough healthy calories.
• Watch your weight carefully. Is your weight dropping through loss of appetite or vomiting? Did it start after you started taking new drugs? Is it related to exercise, stress, or other factors?

People with HIV infection need to monitor their weight.If you feel that the drugs you are taking are causing your appetite to decrease or weight loss, talk to your doctor or dietitian.

Side effects from taking food supplements and folk remedies

Many people with HIV take over-the-counter medications, herbs, or traditional remedies to help them feel better. They may also take them to reduce the side effects of taking ARVs. It is worth remembering that most of these drugs have not been researched by scientists, and some of them may have their own side effects or may not be safe enough.

It is important to remember that:

• Multivitamins are generally safe and helpful. However, large doses of vitamins can lead to poor health and can damage the liver. Talk to your doctor if you plan on taking a special multi-vitamin with an increased dosage of vitamins or minerals, designed, for example, for people who exercise intensively.
• It is important to remember that certain micronutrients found in multivitamins or other medicines (aluminum, calcium, magnesium) can affect the concentration of some ARVs in the blood.For example, when taking dolutegravir, it is best to take your multivitamin 2 hours after or 6 hours before your ARV therapy. Perhaps this rule can also be useful with other drugs (if you are not sure that there is no interaction with trace elements or vitamins).
• The effect of medicinal plants and folk remedies has not been thoroughly studied: you cannot say how well they work, how much you should take them, or whether they are safe in principle.
• Medicinal plants can interfere with ARV drugs.For example, some ARV drugs stop working if you take St. John’s wort, milk thistle can change the concentration in your blood, and garlic can block the action of saquinavir. Also, experts do not recommend drinking grapefruit juice or milk with ARVs, as they can reduce the effect of drugs. It is optimal to pause between ARVs and grapefruit juice or milk at 2 hours.

In any case, before taking any medicines, including over-the-counter medicines, you must carefully read the instructions for use and be sure to talk to your doctor.

The article was prepared based on the materials of the websites https://www.health.ny.gov, http://i-base.info, http://hivinsite.ucsf.edu, http://www.hiv.va .gov etc.

Also on the topic: Where and how to contact in case of an adverse reaction to a medicinal product

90,000 Nails with a lack of calcium in the body – appearance and reasons for the lack.

In addition, white spots and streaks can be observed on the surface of the nails.Such symptoms, in combination with the above, indicate a significant lack of calcium and vitamins in the body.

How to correct the situation?

There are two ways to compensate for the lack of calcium and improve the condition of the nails: by normalizing nutrition or using special preparations. However, it is quite difficult to replenish the daily requirement for this substance, only by eating right.

This process has a number of features:

• The same food products (eg cottage cheese) can have different calcium content depending on which manufacturer they produced.Therefore, it is quite difficult to determine whether a sufficient amount of this mineral has entered the body or not.
• In order to fully satisfy the need for calcium, it is necessary to consume quite a lot, even those foods in which it is very high. For example, you need to drink a liter of milk every day or eat a kilogram of cottage cheese. This diet is not for everyone.
• There are many other substances in food that can have various (sometimes undesirable) effects on the body.For example, parmesan is one of the main sources of calcium, but it is also high in saturated fat. By consuming 150 g of this product every day, you can compensate for the calcium deficiency. But at the same time, the risk of developing atherosclerosis will also significantly increase.

It is also necessary to take into account the fact of the spread of allergies to dairy products. Compensating for calcium deficiencies with plant-based foods is even more challenging. And in the case of the simultaneous use of foods that contain oxalic and phytic acids (for example, spinach), the absorption of minerals in the intestine may be completely disrupted.Therefore, it is often a much more effective, safe and practical way to get the necessary calcium to strengthen nails by taking medications.

Problems of prescribing modern diuretics in patients with CHF

Vladimir Trofimovich Ivashkin , Academician of the Russian Academy of Medical Sciences, Doctor of Medical Sciences:

– We will ask Professor Grigory Pavlovich Arutyunov to tell us about adequate diuretic therapy for chronic heart failure.Please, Grigory Pavlovich.

00:13

Arutyunov Grigory Pavlovich , Doctor of Medical Sciences, Professor:

– Thank you very much, Vladimir Trofimovich.

Dear colleagues. Chronic heart failure syndrome is a very well known syndrome from ancient times. Times change, but there is always a big problem in the description of this syndrome, in the description of the symptoms characteristic of this syndrome.

(Slide Show).

A modern clinical portrait of a patient suffering from circulatory insufficiency. The green bars represent the opinion of the doctors. Red bars – this is how it occurs in real clinical practice. Like many centuries ago, for many decades in the first positions there is still a feeling of shortness of breath and clear pronounced edema that occurs in these patients.

Whatever new symptoms have appeared in recent years (for example, fatigue is a well-described syndrome in the last decades of the 20th century), the special importance of old symptoms remains, the fight against which, in fact, is clinically significant in saving the lives of our patients.

But the word “edema” in the minds of an internist, a therapist, first of all, is necessarily associated with the word “diuretics”.

As current recommendations say, when diuretics should appear in the treatment regimen for circulatory failure. Let’s take the simplest patients, the lightest. Insufficiency of blood circulation, I-II functional class, also sinus rhythm.

Start-therapy always begins with an ACE inhibitor, in case of intolerance, it is an ARA.Only later, when ACE inhibitors are titrated, in the presence of edema, the therapist has the right to raise the question of diuretic therapy.

If patients with atrial fibrillation, even in this situation, diuretics do not go to the first line. These are all the same drugs that correct the patient’s neurohormonal profile. These are glycosides for atrial fibrillation. Only when the rhythm is controlled with titrated drugs is the question of diuretics on the agenda.

In more severe patients, III-IV functional class, but the sinus rhythm is still preserved, the therapist has the right to supply diuretics for the first time, the first line of drugs.

In patients with atrial fibrillation of the III-IV functional class, three drugs start in treatment. These are ACE inhibitors, diuretics (I pay attention, diuretics in the first line) and glycosides.

02:47

We have discussed the first conditional place for diuretics. Let’s start with the first law of prescribing diuretics for the therapist. There is no diuretic therapy without edema. If there is no material substrate (no edema), the therapist should not think about diuretic therapy in the treatment of CHF.

However, the edema itself requires the therapist to think about what kind of edema it is. Let us describe the edema that diuretics require. Let’s remember Botkin, his description of edema. Patients with circulatory failure must obey the law of symmetry. Symmetrical edema. Feel the swelling – they should be firm, cold. Check their color – they should be blue.

So, dense, cold, symmetrical edema is edema caused by hydrostatic problems, circulatory failure.Then diuretics are on the agenda.

When the law of symmetry is violated, the edema becomes one-sided, there is no place for diuretics. This is a surgical problem that requires a solution, always urgently.

The therapist thoughtfully looked at the swelling, felt, evaluated their color, temperature and decided on the appointment of diuretics.

What do we achieve by prescribing diuretics. First of all, we will influence the excretion of sodium and sodium-bound chlorine from the body.Since the volume of extracellular fluid is mainly regulated by the content of sodium and chlorine in the body, we will influence the exit of fluid from the body with primary, then secondary urine.

04:41

Law of the power of diuretics. The closer to the nephron, the stronger the effect of the diuretic. There are exceptions to this rule. Diacarbus does not obey this rule. It works alongside the nephron. But this is not among the powerful diuretics.

Closest to the level of the loop, loop diuretics (hence their name) will act.Then thiazide diuretics will act. Potassium-sparing diuretics will work even further. So, we have memorized the first basic rule. The closer to the nephron, the more powerful the action of the diuretic, with the only exception for Diacarb.

Let’s look at the second and third laws. They should always be in the therapist’s working memory. Diuretics should not be administered discretely. Prescribing diuretics 1-2 times a week, on odd or even days, does not benefit the patient.On the contrary, the patient’s neurohormonal profile begins to rock.

What happens to the patient when he takes diuretics irregularly. For a certain amount of time, the volume of urine excreted will increase sharply. The neurohormonal profile will change. In response to the withdrawn fluid, over-synthesis of angiotensin II, norepinephrine will begin. You will begin to rock your neurohormonal profile.

Diuretics are prescribed on a daily basis in small doses, but in no case discretely, which today should not be considered at all in treatment regimens for circulatory failure.

The question of the history of the development of diuretics is very interesting. At the dawn of medicine, herbal preparations were diuretics. Then, quite by accident, during the period of syphilis treatment, it was discovered that mercury (mercury ointment was used in the treatment of syphilis) has a diuretic effect. Of course, it turned out to be a surprisingly toxic diuretic.

The era of diuretics is the post-war era. After World War II, when the first effective diuretics were synthesized, which were less toxic, they were clinically highly effective.

The synthesis of new drugs has not been completed. Today, in the 20th century, we are talking about three new classes of diuretics. This is a process that, apparently, will develop all the time.

But we remembered the history of the synthesis of diuretics only in order to come to the fourth law of prescribing diuretics. Diuretics are prescribed by the therapist according to the principle: from the weakest to the strongest. This is justified, because the stronger the diuretic effect, the stronger the diuretic drug, the greater its side effect, the greater its toxic effect.

07:40

So let’s look at a diuretic that is much weaker than loop diuretics.

This is a thiazide diuretic. It will primarily reduce the reabsorption of chlorine. This is his most important thing. Together with chlorine, it will have a passive effect on the excretion of sodium and water associated with sodium.

It is very important to see that the group of thiazide diuretics, which we talk about so easily, is a very large group. It includes the well-known drug Indapamide, Hydrochlorothiazide, Chlorthalidone, which is better known in other countries than here.However, these are completely different drugs.

This difference in diuretic drugs leads to the fact that the therapist must remember about the half-life. These are too different half-lives to say about something uniform for this group. The half-life of a diuretic is the most important indicator of a diuretic. The longer the half-life, the greater the toxic effect of the diuretic, the less its effect on the neurohormonal profile of our patient.

(Slide Show).

Let’s look at thiazide diuretics.

Well defined white line. One of the main side effects of a thiazide diuretic drug (two arrows below the potassium level) is a high potassium excretion. Consequently, high doses of thiazide diuretics will always be fraught with the development of severe rhythm disturbances. Sodium is excreted significantly less than potassium. This is a very significant point.

Finally, thiazide diuretics have a rather toxic effect on the glomerular filtration rate.

09:20

Side effects. Discussion about the dose of thiazide diuretics ended today. It is believed that 12.5 mg together with ACE inhibitors is safe. Doses lower than 12.5 mg are safe. This is a very important find for us. But we remember that thiazide diuretics will interfere with the lipid spectrum, affect cholesterol levels, and, unfortunately, in high doses, have a negative effect on blood glucose levels.

Application. Here the therapist must remember a simple rule.The worse the kidney function, the lower the glomerular filtration rate, the less effective thiazide diuretics. With a figure of 40 ml / min. (glomerular filtration rate calculated by Cockcroft-Gault or MDRD formula) thiazide diuretics are practically ineffective. This is a very important moment when we will build a daily treatment regimen for patients.

Loop diuretics are much more effective than thiazide diuretics. The point of application of the loop diuretic is the thick segment of the ascending part of Henle’s loop.In this area, 25% of the filtered sodium will be reabsorbed. If we block the sodium entry back, then water will leave along with the sodium.

Why loop diuretics have such a high effect. Other electrolytes will be removed along with the sodium. We are talking about calcium, about magnesium. High doses will still interfere with the electrolyte balance and may be fraught with rhythm disturbances in the patient.

A loop diuretic removes sodium much more than a thiazide diuretic, but it also affects the level of potassium excretion.Any diuretic drug, interfering with the electrolyte balance, will be fraught with rhythm disturbances.

Let us not forget that together with the removed sodium a large volume of water leaves. Hence, there will be a direct effect on hematocrit. If you are treating a recumbent patient, the ideal conditions are created for deep vein thrombosis of the lower leg. Loop diuretics in high doses will always produce high levels of excreted water from the body. The therapist should always keep in mind the high probability of not only rhythm disturbances, but also deep vein thrombosis of the leg with possible embolic syndrome in the pulmonary artery.

Toxic effect. The most important indicator, on which the patient’s life expectancy largely depends, is the glomerular filtration rate. Here, at moderate doses, there is no negative effect. However, there will be a sharp decrease in glomerular filtration rate at high doses of loop diuretics.

12:32

Let’s come to the class of loop diuretics.

They are also very different from each other. This is ethacrynic acid, and Furosemide and Torasemide. The principal indicator by which they differ is the half-life.The second indicator is the metabolism of the diuretic. The more diuretic is excreted through the kidney, the more toxic and negative its effect, especially in patients with initially altered kidney function (as in our patients with circulatory failure).

I want to draw your attention to those doses that are recommended by the World Recommendations for the introduction of, for example, Furosemide. Oral, of course, 40 mg, 160 mg is not a daily practice dose, but such a practice exists in the world.We must be prepared that the doses of loop diuretics will not go unnoticed.

Where will the negative effects of high doses be if taken on a daily or occasional basis? If we block the absorption of sodium, then we must clearly remember that after the cessation of circulation of the drug in the blood, unfortunately, rebound syndrome will occur. This will be post-diuretic reabsorption. The amount of sodium that will be absorbed from the primary urine will increase dramatically.

The half-life of the diuretic becomes dominant.We must strive for a long half-life in order to reduce postdiuretic reabsorption syndrome. This is the first thing. But if more sodium is absorbed, and the cells are not ready for this, they will die.

Second moment. We blocked sodium absorption by 25%. This means that the sodium has moved further along the tubules. Unfortunately, cells in the distant regions are not ready for this amount of sodium. This will lead to their direct toxic damage.

The third point that the therapist should always keep in mind is the glomerular filtration rate.The lower it is, the higher the concentration at usual doses of the drug, the greater the direct toxic effect of the diuretic drug. This direct toxic effect of the diuretic must be kept in our operative memory, because it worsens the patient’s condition, shakes his neurohormonal profile.

Finally, remember that Furosemide is the main drug in this group. 65% of it is excreted by the kidneys. Let’s remember this figure. This is a very important figure. It is very high, because Torasemide will be significantly less excreted through the kidney.This becomes essential for the therapist when choosing long-term, lifelong diuretic therapy.

15:21

The main side effects of diuretic drugs. The first and permanent effect is the effect on the activity of the renin-angiotensin-aldosterone system. Diuretic therapy will always result in increased angiotensin II activity and cascades that will cause high angiotensin II levels to follow. The total peripheral vascular resistance will increase, sodium reabsorption will increase, lead to myocardial hypertrophy, hypertrophy of smooth muscle elements.

The second point is the nephrotoxic effect. Any diuretic drug does not remain indifferent to the kidney. It acts on the kidney. Finally, we must remember that we reduce the patient’s quality of life. After the appointment of a diuretic, the amount of urination increases. This is essential.

Imagine a real working class II patient to whom you have prescribed a diuretic. After taking a diuretic in the morning, the amount of urination increases for several hours.At this time, he must move to work. We create parameters that will degrade his quality of life.

For a very long time we knew that diuretics do not increase life expectancy. If we say according to meta-analyzes, they led to an even greater likelihood of deaths, unfortunately.

This was the case prior to the key study carried out with Torasemide. For the first time, diuretics have been shown to reduce the risk of death in patients with circulatory failure.

17:05

So, the patient received a loop diuretic. However, you see that there is a certain characteristic: the therapist cannot achieve adequate urine output. What a therapist should do in a patient with circulatory failure. First of all, think about urine pH. The urine must be acidified.

It is well known that for this there is a diuretic from the “reserve group”. We are talking about the drug Diacarb. The appointment of Diakarb in a short course of 5-7 days changes the pH of urine and increases the effectiveness of diuretic therapy with loop diuretics.

This is also a very interesting story of the emergence of Acetozolamide. It was a drug that came from antibiotics altogether. Now no one will remember him as an antibiotic. But it is a very interesting diuretic that primarily affects urine pH, helping loop diuretics work.

We are approaching the drugs with the weakest diuretic effect. These are mineralocorticoids. There are two drugs. Spironolactone is justified. Eplerenone is a bit arbitrary. Eplerenone is an aldosterone receptor antagonist with a diuretic effect.

They differ in only one thing. Eplerenone differs from Spironolactone in that two radicals that have a sexual effect are cut off. Every tenth man on Spironolactone developed gynecomastia. Eplerenone lacks this effect. This is a very interesting connection.

This is a drug that is considered not as an independent diuretic drug, but as a drug added to an existing diuretic regimen. There is no toxic effect in the usual doses.It is necessary to remember the prescription schemes for this drug.

When large doses are used. When the therapist deliberately goes to the use of large doses. Then, when there is decompensation of blood circulation and the usual therapy with loop diuretics does not allow “soaking” the patient, to achieve a persistent diuretic effect (then large doses are justified).

There are more frequently prescribed small doses (25 – 50 mg). These are doses that are prescribed continuously, for life. For a patient with functional class III-IV, since there we achieve not so much a diuretic effect (I very much ask you to pay attention to this), there we achieve the effect of blocking the D-position of collagen.

We are talking for the first time about the additional action of a diuretic, which is not related to the kidney at all. We are talking about the blockade of the D-position of collagen in the human body suffering from circulatory failure.

19:50

Let’s go back to the class of diuretics. They are all different. First of all, we pay attention to the half-lives. It is shown on volunteers, young people that Torasemide has the highest half-life. The higher the half-life, the safer the diuretic.

What we must remember from the pharmacokinetics of Torasemide. The most important drug. Where the use of, for example, Furosemide is ineffective, Torasemide will be more effective.

The long half-life allows two things to be remembered. It can be used in patients with initially altered kidney function. An elderly patient does not need to change the dosage.

Let’s remember the most important thing. 80% of the administered Torasemide is metabolized in the liver. This means that only 20% is excreted through the kidney.This means that this drug can be used in patients with initially altered kidney function. This distinguishes Torasemide from the whole class of loop diuretics, making it safe and widely used.

What does Torasemid do? Look at the word aldosterone. It’s a hormone. Locally in the kidney, due to the fact that the patient has insufficient blood circulation, the renin-angiotensin-aldosterone system turned on. Aldosterone, in addition to affecting sodium levels, will affect local collagen synthesis and D-position.How serious is this. Let’s ask this question and see the answer a little later.

The concentration of potassium and magnesium does not have a peak-like decrease. This means that one should not expect, or at least the likelihood of severe rhythm disturbances will not be very high.

21:41

One more point. The most important thing for the patient. He knows about the level of potassium and sodium, but he can clearly see the amount of urination that occurs after taking a diuretic. Torasemid has a smooth line.It is very important. There will not be a sharp deterioration in the patient’s quality of life after taking this diuretic.

The mass index of the left ventricular myocardium is decreasing. Let’s ask the question: why? We asked the second question. Why is the mass of the left ventricular myocardium decreasing and why is it necessary to influence the level of collagen? Easy enough to explain. Transmitral blood flow is indeed improved because you are altering the volume of blood circulating. It’s easy to explain. But how to explain the left ventricular myocardial mass index?

Let’s look at one more thing – hormones.The volume of circulating blood changed, the brain natriuretic peptide decreased. It’s clear. But what happened to aldosterone. The diuretic drug Torasemide has, in addition to the diuretic effect, a direct effect on the level of aldosterone activity.

What does this lead to? First of all, to reduce fibrosis. When we were born, then each of us the distance between the capillaries and the muscle bundles of the myocardium was genetically determined. This distance, which guaranteed an even supply of nutrients and oxygen, was guaranteed by the amount of collagen between the muscle bundles.

At a young age, thin and delicate threads are collagen. A patient with circulatory insufficiency has an intravital biopsy. Collagen ropes, which are deposited in the myocardium, push the bundles apart, make the myocardium thick and electrically unstable. This, of course, is extremely bad.

A diuretic that can not only reduce the circulating blood volume, but also affect this D-position of collagen, will be very important for us.

(Slide Show).

Powerful pink fields above are on Furosemide.The absence of pink fields below is on Torasemid. There is no collagen not only in the kidney, but also in the myocardium. What gives such an effect of using Torasemide. We selected Torasemide from a whole class of loop diuretics. Reliably reduces hospitalization. The total number of hospitalizations is decreasing. The most important thing is that simply the average stay of the patient on the bed is reduced.

Why are these numbers important to us? This is not just a mechanical reduction in a patient’s hospital stay. This is less deep vein thrombosis, less effect on nosocomial infections, and less pulmonary embolism.

24:29

The patient was treated with Furosemide, then transferred to Torasemide. Will we succeed? Yes. The use of Torasemide after long-term therapy has led to a sharp decrease in the number of hospitalizations. This is an essential thing.

It was shown for the first time that diuretic therapy led to a decrease not only in total death, but, more importantly, in a decrease in sudden death. By reducing the D-position of collagen, which led to electrical homogenization of the myocardium. There is no disunity, no electrical instability (at least much less of it).Naturally, a decrease in load, volume. This is a very important data for everyday practice.

I am specifically showing, as a contrast, studies that were performed long before our understanding of the half-life of loop diuretics. Before the advent of Diuver, a meta-analysis performed on Furosemide, the placebo line is higher than the Furosemide line. This means that the number of deaths was less on therapy without diuretics.

How then to help a patient with circulatory insufficiency.We still faced the problem of choosing a diuretic. When we took into account the half-life, when we took into account the fact that Diuver interferes with the D-position of collagen, this led to a decrease in mortality and a decrease in hospitalization of patients.

The “TORIC” study is also important for us because we firmly said that a diuretic always leads to an increased excretion of potassium from the body. This means that severe rhythm disturbances are expected. The effect of Torasemide is milder compared to Furosemide on potassium levels.No spike in potassium decline.

26:36

One more point. We now allow ourselves to say that Diuver has a long-lasting effect. It is very important. There is no spike in neurohormone levels. Question two: there is no spike in potassium levels, which suggests that severe rhythm disturbances are unlikely to occur.

The fact is very important for the therapist: sudden death is reduced by almost 70%. This is the first time we are saying that a diuretic can have such powerful antiarrhythmic efficacy.Still, in the everyday practice of the therapist, situations are very common when he has a refractory kidney, when he cannot achieve an adequate amount of urine. How to be.

Let’s start with the most common reason for refractoriness. This is noncompliance. Patients forget to take diuretics or do not drink it regularly. There is concomitant therapy that requires the use of non-steroidal anti-inflammatory drugs.

There is one more thing. This, unfortunately, is a catastrophic decrease in the glomerular filtration rate.If the rate is below 40, then the first thing the therapist should do is to stop prescribing hydrochlorothiazide and think about transferring the patient to a daily loop diuretic.

Another issue that needs attention. Diuretic drugs will never be effective if you do not control the renin-angiotensin-aldosterone system. ACE inhibitors are required in any patient receiving diuretic therapy.

Then the aerobatics of the therapist begins – this is a combined diuretic therapy.If you are not successful with simple therapy, consider a combination.

Combination steps. No effect on simple loop diuretic – increase dose. No effect – think about the route of administration. It is possible that the edema syndrome is such that intramuscular or oral administration will not be effective. Then you need to switch to intravenous administration. If administered intravenously, the therapist should be aware that different rates will have different diuretic effects.

Let’s remember them. Bolus administration will be less effective than drip administration over a long time interval.If you have not achieved an effect on a loop diuretic, combine it either with a thiazide (this is terribly toxic to the kidney, but it will be effective in terms of the volume of excreted water) or combine it with Spironolactone. When adding or removing a diuretic, always keep in mind that Torasemide has the fewest side effects.

29:21

But the most important effect for us will be the law, which sounds like this: having achieved the effect, titrate the diuretic drug into smaller doses.Patients with CHF who receive minimal doses of diuretics live the longest. This is extremely important. This is a snapshot of the modern use of diuretics in the modern treatment of CHF.

What does the future hold for us? Several new drug classes. Adenosine receptor blockers. They have already entered the stage of clinical trials. This is Rolofilin. These are necessarily vasopressin receptor antagonists (selective or non-selective). They have already entered everyday practice. These are peptides with a natriuretic effect.

Therapy with diuretic drugs has been and remains a difficult chapter in the daily practice of the therapist, requiring deep knowledge and high aerobatics of the therapist in prescribing diuretics.

Thank you for the attention and honor you have shown me.

Vladimir Ivashkin : Thank you very much. If you analyze or remember the names of all those who contributed to the creation of this ladder of efficacy of diuretics, do you think a scientist who discovered the diuretic effect of digitalis, and generally found digitalis, would he have received the Nobel Prize? Or was it pushed aside by other more modern manufacturers or creators of diuretics?

Grigory Arutyunov : No, I think he would have been given it, because he turned the vector of clinical thinking.After all, an internist, and his understanding of the patient was turned once and for all. There was a completely different perception of the patient, a completely different vision of the future of this patient. I think that the contribution he made to history cannot be overemphasized.

Vladimir Ivashkin: He did not have a chemical laboratory with a large number of employees. He was just thinking.

Grigory Arutyunov: He was a doctor who looked at the patient, felt, listened, understood.

Vladimir Ivashkin : Thank you very much.

Discontinuation or dose reduction of proton pump inhibitors versus continuous long-term use in adults

Review question

The aim of this review was, building on previous studies, to evaluate the effects of discontinuation or dose reduction of proton pump inhibitors (PPIs; acid-lowering drugs) in adults, compared with normal practice (i.e. continuous long-term (more than four weeks) daily using PPI.Effects include both benefits and harms (eg, pill use, symptom control, and cost).

Relevance

PPIs are used for many different conditions (eg, heartburn, acid reflux, stomach ulcer). Research done on most of these conditions supports only short-term use of these drugs (two to 12 weeks), however, these drugs usually continue to be taken for long periods of time or even indefinitely.Long-term use of PPIs contributes to drug abuse and puts patients at risk of unwanted drug interactions and side effects (eg, diarrhea, headache, bone fractures). It also leads to a high burden of health care costs. “Deprescribing” includes the gradual withdrawal and cessation of medication. The most common approach is on-demand therapy, which allows people to take their medication only when they have symptoms (ie.that is, when heartburn occurs). The overall goal of discontinuation is to minimize the number of drugs taken, thereby reducing the likelihood of drug misuse and preventing side effects.

Characteristics of research

We found six trials involving 1758 people. Five of these studies looked at on-demand withdrawal and one trial looked at abrupt withdrawal from PPIs. The participants were between the ages of 48 and 57, with the exception of one trial (mean age 73).Most of the participants had mild heartburn and acid reflux with mild esophagitis (inflammation of the esophagus that can lead to damage).

Main results

We found that withdrawal methods resulted in poorer symptom control with a significant reduction in pill use. Discontinuation of PPIs can lead to side effects such as inflammation of the esophagus. Very little data were available to conclude on the long-term benefits and harms of dose reduction or discontinuation of PPIs.

Quality of evidence

Overall, the quality of the evidence for this review ranged from very low to moderate. Symptom control results in trials were reported inconsistently. There were also limitations in how the studies were conducted (for example, participants and researchers could know which drug they were receiving), which lowered the quality of the evidence. Other factors influencing quality included small sample sizes in most trials and conflicting research results.

Guidelines for patients with chronic kidney disease

This patient guide is based on the 2017 Estonian treatment guide “Prevention and Management of Patients with Chronic Kidney Disease” and the topics discussed therein together with recommendations. The recommendations of the patient guide were compiled from the analysis of the scientific literature based on the principles of evidence-based medicine. In this patient guide, you will find the recommendations that are most important from the patient’s point of view.The patient manual was compiled in cooperation with nephrologists and takes into account the capabilities of the Estonian health care system. The clarity of the text of the patient guide and the importance of the topics described was appreciated by the patients, and feedback from them helped to complement this guide.

The Patient Guide is intended for people with chronic kidney disease and those who are close to them. The patient guide explains the nature of the disease and its possible causes, diagnosis, treatments and possible complications.The guide also tries to answer questions about nutrition and daily lifestyle.

Chronic kidney disease is a slow-onset disease and does not cause particularly many complaints in the patient in the initial stages. Chronic kidney disease includes a variety of kidney diseases in which kidney function declines over several years or decades. If you have been diagnosed with chronic kidney disease, it may happen that changes in your lifestyle and diet need to be made to keep your kidney function at the proper level.There is so much you can do yourself to help the treatment.

Usually a person has two kidneys, which are shaped like beans and adjoin the posterior abdominal wall under the ribs. Both kidneys are the size of a clenched male fist.

Healthy kidneys:

• are engaged in the removal of metabolic end products and excess fluid from the body
• helps keep blood pressure under control
• help produce red blood cells
• helps keep bones healthy

HEALTHY KIDNEYS

Imagine that your kidneys are a coffee filter. When making coffee, the filter retains the coffee powder, but at the same time allows the liquid to move through it.

The kidneys do something similar – they retain and leave the necessary substances in the body, but at the same time they filter out unnecessary substances from the body. The metabolic waste products that are filtered out by the kidneys are released into the body during the breakdown processes associated with food, drink, medication, and normal muscle function.

Each kidney contains about a million small filters called glomeruli. Primary urine is formed in the glomeruli, which flows through small tubules, where part of the fluid is absorbed back.The functional unit of the kidney is the nephron – a specific structure consisting of a glomerulus and a tubular system. Nephrons remove residual substances and excess fluid from the blood in the form of urine into the renal pelvis, then urine is transferred into the ureters, and then into the bladder.

In the case of chronic kidney disease, renal function deteriorates – the kidneys are no longer able to sufficiently filter residues and purify the blood. The ability of the kidneys to filter is assessed on the basis of a special indicator – the glomerular filtration rate (GFR).

Chronic kidney disease is a slow onset disease and does not cause especially many complaints in the patient in the initial stages. Chronic kidney disease includes a variety of kidney diseases in which kidney function declines over several years or decades. With early diagnosis and treatment, it is possible to slow or even halt the progression of kidney disease.

In the course of international studies of renal function in many people, it was found that almost one in ten had a violation of the kidney function to some extent.

What Causes Chronic Kidney Disease?

The three most common causes of chronic kidney disease are diabetes, high blood pressure and glomerulonephritis.

• Diabetes – In the case of this disease, various organs are damaged, including the kidneys and heart, as well as blood vessels, nerves and eyes. With long-term diabetic kidney damage, many patients have high blood pressure and should be treated accordingly.
• Increased blood pressure (hypertension, primary arterial hypertension) – during hypertension, blood pressure cannot be controlled and it begins to exceed the normal range (more than 140/90 mm Hg). If this condition persists, it can cause chronic kidney disease, brain stroke, or myocardial infarction.
• Glomerulonephritis is a disease resulting from a malfunction of the immune system, during which the filtration function of the kidneys is disturbed by immune inflammation.The disease can affect only the kidneys, but can spread to the entire body (vasculitis, lupus nephritis). Glomerulonephritis is often accompanied by high blood pressure.

Many other conditions can cause chronic kidney disease, for example:

• hereditary diseases – such as polycystic kidney disease, due to which, over the years, a large number of cysts appear in the kidneys, which damage the functioning renal tissue and therefore develop renal failure.Other hereditary kidney diseases are much less common (Alport syndrome, Fabry disease, etc.)
• Problems caused by obstructions in the kidneys and urinary tract – such as congenital malformation of the ureter, kidney stones, tumors or enlargement of the prostate gland in men
• Recurrent urinary tract infections or pyelonephritis.

Can Everyone Get Chronic Kidney Disease?

Chronic kidney disease can develop at any age.People who have one or more of the following risk factors are at greatest risk of getting sick:

• diabetes
• high blood pressure
• family members previously had kidney disease
• age over 50 years
• Long-term use of drugs that can damage the kidneys
• overweight or obese

What are the symptoms of chronic kidney disease?

If chronic kidney disease progresses, the level of metabolic end products in the blood rises.This, in turn, causes poor health. Various health problems can occur, such as high blood pressure, anemia (anemia), bone disease, premature calcification of the cardiovascular system, and changes in the color, composition and volume of urine (see Complications of Chronic Kidney Disease ).

With the progression of the disease, the main symptoms may be:

• weakness, feeling of exhaustion
• shortness of breath
• sleep problems
• no appetite
• dry skin, itchy skin
• muscle cramps, especially at night
• swelling in the legs
• swelling around the eyes, especially in the morning

Stages of Chronic Kidney Disease Severity

There are five severity stages of chronic kidney disease (see table).Table 1). The stage of the severity of kidney damage depends on the glomerular filtration rate (GFR), by which renal function is assessed. Further treatment depends on the severity stage of chronic kidney disease.

Table 1. Stages of kidney disease severity

To diagnose kidney disease, there are two simple tests that your family doctor may prescribe for you.

Blood test: Glomerular filtration rate (GFR) and serum creatinine level. Creatinine is one of those end products of protein metabolism, the level of which in the blood depends on age, sex, muscle mass, diet, physical activity, on what foods were taken before the sample (for example, a lot of meat products were eaten), and some medications.Creatinine is excreted from the body through the kidneys, and if the kidneys slow down, then the level of creatinine in the blood plasma increases. Determining the level of creatinine alone is not enough to diagnose chronic kidney disease, since its value begins to exceed the upper limit of the norm only when GFR has decreased by half. GFR is calculated using a four-parameter formula that takes into account the creatinine reading, age, gender, and race of the patient. GFR measures the level of the kidney’s filtration capacity.In the case of chronic kidney disease, a GFR score of indicates the stage of kidney disease severity (see Table 1).

Urinalysis : The albumin content is determined in the urine, in addition, the relationship to each other of the albumin and creatinine values ​​in the urine is determined. Albumin is a protein in the urine that is usually found in minimal amounts in the urine. Even a small increase in urinary albumin levels in some people can be an early sign of onset kidney disease, especially in those with diabetes and high blood pressure.In the case of normal renal function, albumin in the urine should be no more than 3 mg / mmol (or 30 mg / g). If the release of albumin increases even more, then this already speaks of kidney disease. If the excretion of albumin exceeds 300 mg / g, then other proteins are excreted in the urine, and this condition is called proteinuria.

If, after receiving the results of the urine analysis, the doctor suspects that there is a kidney disease, then an additional urine analysis for albumin is performed. If albuminuria or proteinuria is re-detected within three months, then this indicates chronic kidney disease.

Additional examinations

Y Ultrasound examination of the kidneys: for the diagnosis of chronic kidney disease is the first choice examination.An ultrasound examination allows you to assess the shape of the kidneys, their size, location, and also determine possible changes in kidney tissue and / or other abnormalities that may interfere with the normal functioning of the kidneys. An ultrasound examination of the kidneys does not require special training and does not pose any risks to the patient.

If necessary and if a urological disease is suspected, an ultrasound examination of the urinary tract (as well as an analysis of residual urine) can be prescribed; for men, an ultrasound examination of the prostate gland can also be prescribed and referred to a urologist for consultation.If necessary and if a gynecological disease is suspected, the woman is referred for consultation to a gynecologist.

What do you need to know about contrast media tests if you have chronic kidney disease?

Diagnostic examinations such as magnetic resonance imaging, computed tomography and angiography are used to diagnose and treat various diseases and injuries. In many cases, intravenous and intra-arterial contrast agents (containing iodine or gadolinium) are used to show the organs or blood vessels being examined.

What is especially important to do before conducting a survey with contaminated material ?

If you have been assigned an examination with a contrast agent, then you need to determine your GFR .

Together with your doctor, you can discuss and evaluate the benefits or harms to your health. If the examination is nevertheless necessary, observe the following preparation rules:

• Drink plenty of fluids (water, tea, etc.) the day before the examination and the day after the examination.). If you are being treated in a hospital, the required amount of fluid will be injected through a vein through a vein. When in hospital, after a contrast test (within 48-96 hours), a blood creatinine test is usually prescribed to assess renal function. In an outpatient contrast-medium examination, your renal function can be assessed by your family doctor.
• Talk with your healthcare provider about what medications should not be taken before the contrast test.Some drugs (antibiotics, drugs for high blood pressure, etc.), together with contrast agents, begin to act as poison. The day before and the day after the examination, in no case should you take metformin, a medicine for diabetes.
• Between two examinations with a contrast medium, at the first opportunity, sufficient time should be left so that the contrast medium that was used during the first examination has time to leave the body. It is important to exclude repeated examinations with a large volume of contrast medium.

How does contrast agent work on the kidneys?

Sometimes the contrast medium can damage the kidneys. The greatest risk is kidney damage in people with chronic kidney disease. There are two rare but very serious conditions that can arise from the administration of contrast media: nephropathy and nephrogenic systemic fibrosis.

What is contrast medium nephropathy?

Contrast nephropathy is rare and may occur in about 6% of patients.The risk of getting sick is especially high in diabetics, as well as in people with chronic kidney disease.

In the case of contrast-induced nephropathy, there is a sharp decline in kidney function within 48 to 72 hours after the examination. In most cases, this condition goes away and the person recovers, but in rare cases, serious problems can occur both in the kidneys and in the cardiovascular system.

What is systemic nephrogenic fibrosis?

Systemic nephrogenic fibrosis is a very rare but serious condition that affects the skin and other organs.Nephrogenic systemic fibrosis is present in some patients with advanced chronic kidney disease (4%) who underwent magnetic resonance imaging with contrast medium including gadolinium. The disease can develop over a period of 24 hours to 3 months, starting on the day of exposure with a contrast agent that includes gadolinium.

This disease is very rare and in people with mild renal impairment or normal renal function, the occurrence of nephrogenic systemic fibrosis has not been observed.

Treatment options for chronic kidney disease depend on the stage of kidney disease, comorbidities and other health problems.

Treatment may include:

• Treatment of high blood pressure
• Diabetes care
• In case of excess weight – weight reduction.
• Lifestyle changes: eating a healthy diet, reducing the amount of salt consumed, getting enough physical activity, quitting smoking, limiting alcohol consumption (see How can you help the treatment yourself? ).
• Dialysis treatment and kidney transplant in case of chronic kidney disease in the latter stages of development (stage 5).
• Psychological counseling and support.

Treatment of high blood pressure for chronic kidney disease

What is blood pressure?

Blood pressure is the pressure that is created by the blood flowing in the blood vessels against the walls of the blood vessels.The unit of measurement for blood pressure is millimeter mercury (abbreviated as mmHg) and blood pressure is defined by two numbers – systolic and diastolic blood pressure – for example, 130/80 mmHg. Art. Systolic pressure, or upper pressure value, means the level of blood pressure at the moment when the heart ejects blood from the chamber, i.e. when the heart is compressed.

Diastolic pressure, or lower pressure value, means the level of blood pressure at the moment when the heart is in a moment of relaxation.

High blood pressure (hypertension) is a common disease and often the person himself does not know that his blood pressure is higher than normal. With the progression of the disease, the main symptoms may be:

• headache
• rapid heart rate
• fatigue
• imbalance

Untreated high blood pressure can cause kidney damage, heart disease, stroke, or eye disease.High blood pressure can damage the renal arteries and reduce kidney function. Kidneys with damaged arteries can no longer remove waste products or excess fluid from the body. Due to the excess fluid, the pressure begins to rise even more.

It is important to keep your blood pressure within the normal range. Regardless of age, blood pressure should not exceed 140/90 mm Hg.

If you have chronic kidney disease and additional risk factors are present (eg albuminuria, diabetes, cardiovascular diseases), then the blood pressure should be kept at 130/80 mm Hg.st.

The best way to measure your blood pressure and keep it under control is to measure your blood pressure yourself at home (and at the pharmacy) with a blood pressure monitor.

Discuss your treatment plan with your healthcare provider. If necessary, the doctor will refer you to a cardiologist or ophthalmologist for a follow-up examination. In addition to taking pills and controlling blood pressure, a healthy lifestyle plays an important role in treatment. How can you help the treatment yourself? ).

Diabetes care for chronic kidney disease

What is diabetes?

Diabetes is a chronic disease in which blood sugar levels rise above normal levels. There are also metabolic disorders of carbohydrates, fats and proteins. Normally, in a healthy person, the pancreas secretes enough insulin to balance blood sugar levels.In the case of diabetes, the secretion of insulin from the pancreas is impaired and too little or no insulin is released. Therefore, blood sugar levels begin to rise. This condition begins to disrupt muscles and many other organs, including the kidneys, heart, blood vessels, nerves, and eyes.

Type I diabetes

It usually starts in childhood and occurs when the body cannot produce the required amount of insulin.Insulin therapy is always used to keep blood sugar under control.

Type II diabetes

May form slowly and initially without symptoms. The reasons for the development of type II diabetes are predominantly heredity (the presence of the disease in close relatives), overweight, metabolic syndrome (high blood pressure, obesity in the lumbar region, high blood pressure), as well as pregnancy diabetes.If a person has type II diabetes, their body still produces insulin, but their levels are very low or cannot be used in the correct way.

In the case of type II diabetes, it is sometimes possible to keep blood sugar levels under control through proper nutrition / diet or physical activity, but usually treatment with pills and / or insulin is still necessary.

Keeping blood sugar levels under control is essential to prevent kidney damage and / or slow the progression of disease.According to many surveys, the best glycated hemoglobin (HbA1c) value in people with diabetes was 53 mmol / mol or less than 7%.

The blood level in the blood can be measured by yourself using a glucometer. This way you can measure your own blood sugar and keep track of keeping it at the correct level. Ask your family doctor / nurse, endocrinologist or diabetes nurse for advice and more information.

The best time to measure blood sugar is before a meal (on an empty stomach) or 1.5-2 hours after a meal.Below are the recommended blood sugar values.

What you need to know about medications if you have chronic kidney disease?

Medicines for hypertension

In the case of chronic renal disease, angiotensin-converting enzyme (ACE) inhibitors are used to treat hypertension – enalapril, ramipril, fosinopril, captopril, etc., or angiotensin II receptor blockers (ARBs) – for example, valsartan, telmisartan, losartan, olmesartan, candesartan. Studies have shown that these drugs delay the progression of chronic kidney disease.

At the same time, these drugs increase the risk of hyprekalemia (serum potassium rises to a dangerous level), the risk increases with the simultaneous use of both groups of drugs. The risk of hyperkalemia is increased due to decreased renal function (GFR) scores.

All people with chronic kidney disease are advised to have regular GFR checks with their family doctor or other health care provider, the frequency of which depends on kidney function and associated risks.

Diabetes drugs

The primary drug of choice in the treatment of type II diabetes is metformin. Metformin is used to control blood sugar levels and reduce cholesterol, and in addition, it reduces the risk of cardiovascular disease.In the case of chronic kidney disease due to impaired kidney function, there is a risk of medication-related acidosis.

If your GFR is from 30 to 45 ml / min / 1.73 m2 (stage G3B), then the dose of metformin taken should be reduced, if your GFR is less than 30 ml / min / 1.73 m2 (stage G4 – G5), then taking the medication you need to reduce and use other drugs for this. Discuss your treatment plan with your healthcare provider.

Other common medicines used to treat various diseases

Statins

Statins are used to prevent cardiovascular disease.Statins reduce blood cholesterol levels. The use of statins in patients with chronic kidney disease has shown good results in the prevention of serious cardiovascular disease.

Aspirin

Aspirin is often used in the primary prevention of cardiovascular disease. Aspirin has blood thinning properties and therefore increases the risk of bleeding with the consumption of aspirin. If you have any disease of the cardiovascular system, then when taking aspirin, you should evaluate, together with your doctor, the ratio of the possible benefits and the risk of bleeding, while taking into account your health status and concomitant diseases.

Non-steroidal anti-inflammatory drugs

If you regularly use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, diclofenac, or celecoxib, it is advisable to have your kidney function tested at least once a year. Avoid NSAIDs if your GFR is too low (up to 30 ml / min / 1.73 m2). Do not take NSAIDs with aspirin. If your cardiologist has prescribed aspirin for you, talk to your doctor about what medications for joint disease and pain can be safely taken with it.

Digoxin

Digoxin is a commonly used medicine to treat heart failure and certain types of irregular heart activity. In the case of chronic kidney disease, digoxin should be taken with caution and renal function should be considered. With a decrease in renal function, the concentration of digoxin in the blood may increase and as a result, accumulation of digoxin in the body may occur.

Antibiotics

Aminoglycosides are a specific type of antibiotic that is used to treat a variety of bacterial diseases (for example, pneumonia, acute bronchitis, and other inflammatory diseases).The use of aminoglycosides is a common cause of toxic kidney damage from medication (nephrotoxic drugs). Sometimes it is still necessary to take aminoglycosides. Aminoglycosides are prescribed by a doctor who, using a blood test, also monitors the concentration of the drug in the blood.

Vitamin D

Before taking vitamin D, be sure to check with your family doctor or health care provider.In case of vitamin D deficiency and chronic kidney disease, vitamin D intake is advisable, based on a certain level of vitamin D (25-OH).

To avoid an overdose of vitamin D, it is necessary to monitor the level of vitamin D in the blood, the frequency of control examinations is prescribed by the family doctor.

Source: Haiglate Liit

When taking vitamin D, side effects may occur, which may depend on the severity of chronic kidney disease (excessive amount of calcium in the blood, rapid progression of chronic kidney disease, etc.).).

Complications of chronic kidney disease

The incidence of complications of chronic kidney disease depends directly on the severity of renal impairment, which can be detected by determining the level of GFR and numerical indicators of albuminuria / proteinuria.As GFR decreases, complications are more common and more severe.

Major complications:

• Malnutrition, which may be due to insufficient calories and / or protein in food.
• Metabolic acidosis is an acid-base imbalance caused by impaired renal function. The kidneys do not filter enough blood and, as a result, the production of acid (hydrogen ions) decreases.
• The level of potassium in the blood begins to exceed the norm (hyperkalemia) if the excretion of potassium decreases due to impaired renal function. This may be due to the consumption of foods high in potassium and taking medications that interfere with potassium excretion (for example, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, diuretics, etc.).
• Disorders of the balance of minerals (lack of calcium and vitamin D and excess phosphorus) and diseases of the skeletal system (renal osteodystrophy).The risk of bone disease is greatest when chronic kidney disease reaches severity stages 3a-5. Blood levels of phosphorus, vitamin D, and calcium are assessed by a blood test.

Diseases of the skeletal system are frequent complications of chronic kidney disease, because due to kidney damage, excess phosphates are not excreted from the body through the blood and thus hyperfunction of the parathyroid gland occurs (the level of the parathyroid hormone – parathyroid hormone increases), which, in turn, is cause calcium leaching from bones.

Such imbalances in the balance of calcium and phosphorus lead, in the absence of treatment, to a violation of ossification, bone pain and fractures. In case of imbalance of calcium and phosphorus, bone formation (calcifications) begin to cover the internal organs and blood vessels, which is the reason for the disruption of the functioning of these organs.

• Anemia can result from impaired erythropoiesis (erythropoiesis is the formation of red blood cells or erythrocytes) and low iron levels in the blood.
• Diseases of the cardiovascular system, which contribute to dyslipidemia (an increase in the content of cholesterol in the blood and changes in its structure).

Chronic kidney disease is often associated with heart disease. Low physical activity, poor diet and excess weight can increase blood cholesterol levels, which in turn can damage arterial blood vessels in all organs and increase the risk of cardiovascular disease.

Anemia in case of chronic kidney disease

If the kidneys are diseased or damaged, they do not produce enough erythropoietin (EPO). Erythropoietin, produced by the kidneys, is required for the formation of red blood cells (erythrocytes) in the bone marrow. Red blood cells are involved in the transport of oxygen in the body. If the kidneys do not produce enough erythropoietin, and because of this, the number of red blood cells decreases, then anemia or anemia begins to develop.Anemia occurs in most people with chronic kidney disease.

Another common cause of anemia is inadequate iron, B vitamins and folate.

Anemia symptoms:

• pallor
• feeling tired
• lack of energy in daily activities
• no appetite
• Sleep Disorders
• decreased concentration of attention
• dizziness and headaches
• heart palpitations
• shortness of breath and shortness of breath

Anemia most common in patients:

• with moderate to severely impaired renal function (chronic kidney disease stage 3 or 4)
• with end-stage renal failure (severity stage 5)

Not all people with chronic kidney disease develop symptoms of anemia.If you have chronic kidney disease, the hemoglobin (Hb) level in your blood should be measured at least once a year to check for possible anemia. Hemoglobin is part of the red blood cells that carry oxygen throughout the body. If the hemoglobin level is too low, we are dealing with anemia – it is important to find out the cause of the anemia in order to plan the correct treatment regimen.

Treatment for anemia depends on the types of causes that cause it. Treating anemia is very important as it helps prevent heart disease and other health problems.If you already have a heart condition, treating your anemia will help reduce the risk of heart disease progressing.

Anemia treatment options:

• Specific treatment with erythropoietin stimulating drugs (ESA). Your doctor will discuss the benefits and risks of ESA with you before starting treatment and will monitor how ESA works during treatment. ESA treatment is not always justified, sometimes iron supplementation is sufficient.
• Iron preparations. Iron supplements are safe for most people.If you are allergic to certain medications, tell your doctor. In some rare cases, side effects of iron supplementation can include low blood pressure, nausea, vomiting, diarrhea, and excess iron in the body. Some reactions can be dangerous and damage your health.
• Your doctor will test your blood to monitor its iron content and will decide a safer and more appropriate method for taking iron supplements. Iron can be taken either as food, tablets or injections.
• Vitamin B ₁₂ or folic acid. These drugs help balance the treatment of anemia. For chronic kidney disease and anemia, your doctor may recommend vitamin B ₁₂ and folic acid or add foods containing them to your diet to help ensure consistent and safe treatment.
• Blood transfusion. If the hemoglobin level in your blood drops too low, you may be given a blood (red blood cell) transfusion.Red blood cells are injected into your body through a vein and this will increase their blood levels, which in turn will increase the supply of oxygen to the body.

In the case of chronic kidney disease, there is no specific diet indicated for the disease. Your doctor will advise you on dietary recommendations based on how kidney function changes during illness. Your doctor will assess, based on the results of blood tests, whether you are getting enough nutrients and calories from your food. As chronic kidney disease progresses, certain substances (such as potassium) may accumulate in the body.In the case of chronic kidney disease, it is important to eat well, to monitor the amount of food and its variety. All this will help the kidneys to better cope with their function. Monitoring your diet with your healthcare provider and changing it appropriately will help protect your kidneys and prevent the progression of chronic kidney disease. In the case of mild kidney damage, the so-called food pyramid can be taken as the basis of the diet, but in the case of severe kidney damage, the diet must be agreed with the doctor.

Determine your healthy weight range and try to keep your weight within it. The healthy weight interval can be easily calculated using the body mass index (BMI) formula (a person’s weight in kilograms divided by the person’s height squared in meters). It is better to discuss additionally with your doctor how the obtained values ​​are valid for you.

Body Mass Index:

• to 19 – insufficient body weight
• 19-24.9 – Normal Weight
• 25-29.9 – overweight

90,061 over 30 – obesity

If you are losing too much weight, your doctor may recommend special nutritional supplements.If the body weight is too heavy, it puts a lot of stress on the kidneys. In this case, you need to discuss with your doctor exactly how you can gradually reduce weight, without it being dangerous to your health. If your body weight is increasing too quickly, be sure to inform your doctor about it. A sudden increase in body weight that is accompanied by swelling, breathing problems, and an increase in blood pressure may be a sign that too much fluid is accumulating in your body.

Sodium

Sodium is a mineral that helps regulate the exchange of fluid between blood and tissues in the body, the function of the nervous system, and maintain an acid-base balance.Excess sodium affects the volume of fluid in the body and this can cause an increase in blood pressure as well as swelling in the legs. In the case of chronic kidney disease, dietary sodium should be limited.

Sodium is found in high amounts in salt as well as in foods that have added salt. Most of the salt is found in ready-made sauces (such as soy sauce), in seasonings (garlic or onion salt), in prepared foods (canned soups, canned food, dry soups, broths), in processed foods (for example, ham, bacon, sausages, smoked fish), salty snacks, potato chips, salted nuts and biscuits, and most instant foods.

Some recommendations for reducing salt intake:

• Buy and prepare fresh food at home.
• Choose foods with less salt. Do not use more than one pinch of salt when cooking food.
• Avoid adding salt with meals.
• When adding seasoning, use fresh or dried herbs and spices, lemon juice, aromatic vinegar.
• Do not use salt substitutes unless recommended by your doctor.Most salt substitutes are high in potassium.
• Avoid fast food and ready-to-eat foods as they contain a lot of hidden salt.
• Read labels carefully to select foods with less salt.

Proteins

Protein is essential for normal muscle and tissue function, wound healing and infection. Proteins can be of animal or vegetable origin.Both types of protein are needed for daily activities. Sources of animal protein include, for example, eggs, fish, chicken, red meat, dairy products and cheese. Sources of plant proteins are vegetables and grains, legumes and nuts.

In the case of chronic kidney disease, consuming too much or too little protein can worsen your health. A balanced protein intake will help you to reduce both the burden on the kidneys and the content of metabolic end products in the blood, and thus slow the progression of the disease.At the same time, protein foods cannot be completely excluded from the diet, as a protein-free diet can cause weakness, fatigue and malnutrition. Your doctor can help you determine how much protein your food should contain based on your kidney function. If your diet has a limited protein content due to chronic kidney disease, the source of calories may be significantly reduced. In this case, you must receive the missing calories from other sources that do not contain protein.For example, you can increase your carbohydrate intake or add vegetable fats to your diet.

Some recommendations for wise protein intake:

• You should know how much protein you can consume in one day.
• Explore which foods contain protein and choose the one that works best for you.
• Try to eat a small amount of protein at a time.

Potassium

Potassium is an essential mineral that helps muscles, nerves and heart function properly.Too high or too low amounts of potassium in the blood can be dangerous to the body. Usually, the excess potassium is removed from the body through the kidneys. As chronic kidney disease progresses, blood potassium levels begin to rise because the kidneys are no longer able to remove excess potassium from the body (see Complications of Chronic Kidney Disease ). The potassium level in the blood is checked regularly with a blood test. If your blood potassium is too low, your doctor may prescribe potassium substitutes.In the event that the potassium content is too high, medications are prescribed that can balance the potassium level in the blood. The potassium content in the body can be successfully regulated by dietary changes.

If you must limit your intake of foods containing potassium, then:

• Research which foods contain the most and least potassium and make healthy choices.
• Read labels carefully to select potassium chloride free products.

Phosphorus and Calcium

Phosphorus is a mineral that plays an important role in the functioning of cells, in the regulation of muscle work, the activity of the brain and nervous system, in the formation of teeth and bones. Phosphorus is obtained primarily from animal products. Healthy kidneys excrete excess phosphate from the body, but in the case of chronic kidney disease in advanced stages, the kidneys may not be able to cope with this task.

Calcium is a mineral that is important for the formation of whole, healthy bones and teeth, for blood clotting, and for the functioning of the heart and nerves. Several foods that are good sources of calcium often contain too much phosphorus.

If the phosphorus content in the blood is too high, then the calcium content decreases and calcium is washed out of the bones. Calcium begins to build up in blood vessels, joints, muscles, and the heart – where it shouldn’t normally be (see below). “Complications of chronic kidney disease” ).

In order to prevent calcium leaching from bones and reduce the level of phosphate in the blood, you need to limit the consumption of foods that are high in phosphorus (for example, dairy products, beans, peas, nuts, seeds, cereals, Coca-Cola).

Your doctor may prescribe medications for you called phosphorus binders. The medicine should be taken with meals according to the frequency prescribed by the doctor.The drug binds phosphorus in such a way that it cannot enter the bloodstream.

• Phosphorus has been added to some packaged foods. To avoid consuming excess phosphorus, be sure to read the label.

Liquid consumption

For mild to moderate chronic kidney disease, fluid intake is usually not restricted. Talk to your doctor or nurse about how much fluid you should be drinking.If you feel that fluid begins to accumulate in your body and your legs swell, be sure to inform your doctor. If kidney disease progresses more and more, it may be necessary to limit the amount of water consumed daily.

If your doctor has prescribed you a limited fluid intake, then:

• Specify the maximum amount of liquid you can consume per day. Start each day by filling the jug with the permitted amount of water.If you also drink coffee or tea during the day, pour the appropriate amount of liquid from the jug. If the jug is empty, it means that you have already used the assigned liquid limit.
• It should be remembered that many solid foods also contain liquid; it is also necessary to take into account the liquid in soups to calculate the consumed liquid.
• Try to choose healthy drinks. Control the sugar, phosphorus and calcium content of your drinks.
• If you sometimes eat canned food, then also take into account the liquid from canned food in the calculation of the daily limit or drain excess liquid from the can before eating.

If you are a vegetarian

If you are a vegetarian, be sure to inform your doctor about this. A vegetarian diet may contain foods that are too high in potassium and phosphorus, and at the same time, contain less protein. With everyday food, you need to get a balanced and correctly combined amount of plant proteins and the required amount of calories. At the same time, the level of potassium and phosphorus in the blood must be kept under control.If the food is not high in calories, then the body begins to consume proteins for energy production.

Alcohol consumption and smoking

Smoking can have serious long-term effects on kidney function. Smoking damages blood vessels. People with chronic kidney disease are more likely to have heart disease than healthy people. In this case, smoking plays the role of an auxiliary risk factor. If you have chronic kidney disease, work with your doctor to find the best way to quit smoking.

In the case of chronic kidney disease, alcohol consumption is not completely contraindicated. However, alcohol can only be taken in very moderation. Excessive alcohol consumption can damage the liver, heart and brain and cause serious health problems.

Women are not recommended to consume more than 1-2 units of alcohol, and men – more than 2-3 units per day. Make at least three days in a row alcohol-free for one week.One unit of alcohol is equivalent to 10 grams of absolute alcohol. One unit is, for example, a strong alcoholic beverage (4 cl), a glass of wine (12 cl) or 250 ml of 4% beer.

Physical activity

Physical activity and sports are not contraindicated for chronic kidney disease. On the contrary, getting enough physical activity helps to better cope with the disease.

Moderate physical activity is important because:

• gives you energy
• Improves muscle strength and elasticity
• helps you relax
• helps keep blood pressure under control
• reduces blood cholesterol and triglycerides
• improves sleep, makes it deeper
• helps maintain a healthy weight
• helps prevent the onset of heart disease and diabetes
• increases self-confidence and improves overall well-being

You can only exercise for a short period of time each day, but the impact of the exercise lasts all day.Be sure to talk to your doctor before starting regular exercise. Your doctor can help you choose the right sports based on your health condition and early training experience. If necessary, the attending physician will refer you for a consultation with a restorative medicine physician.

Aerobic training works well – walking, Nordic walking, hiking, swimming, water gymnastics, cycling (both indoor and outdoor), skiing, aerobics, or other activity that requires a large muscle group.If a more relaxed workout is preferred, then yoga is well suited for this.

If you have not previously played sports regularly, then start with light workouts that last 10-15 minutes a day. By gradually increasing the load, you can increase the duration of your workout to 30-60 minutes and you can train on most days of the week. Start your workout with a warm-up and end with a stretch, these exercises will help you prevent injury. Try to integrate your workout schedule into your day plan – workouts can be done, for example, in the morning or in the evening.After the main meal, you need to wait about one hour with training. It is also not recommended to train just before bedtime (approximately one hour).

The easiest way to control how well your workout is for you:

• During exercise, you should be able to speak to your companion without shortness of breath.
• Within about one hour after training, the pulse should be restored, the state of health should be normal.If these points are not met, then the next time you need to train in a more relaxed mode
• Muscles should not hurt so much that it would be an obstacle to the next workout
• The intensity of the workout should be at a comfortable level

Still, there are some signs that you should abandon or interrupt your workouts:

• you feel very tired
• dyspnea occurs during exercise
• Feel chest pain, heart rate increases suddenly or becomes irregular.
• feel stomach pain
• cramps occur in leg muscles
• dizziness or drowsiness occurs

Remember that regular physical activity does not give “permission” for uncontrolled consumption of foods that should be limited. Diet and exercise must work together. If you feel that in addition to increased physical activity, your appetite has increased, discuss this with your doctor or dietitian. They will help you change your diet so that the amount of calories consumed is sufficient.

If you have been diagnosed with chronic kidney disease, then at first it can cause negative feelings.Information about the diagnosis can initially cause shock, it can be difficult to believe in it – anxiety may arise in connection with a specific situation (for example, examination, procedure) or in general (loss of control over one’s life, decreased quality of life).

A person can get angry, blame others and deny the situation – these are the primary normal emotions, but after some time, the person must begin to recognize the disease and get used to it. After that, it is already possible to cope with the necessary life changes emanating from chronic kidney disease.If negative feelings remain strong over time and are the cause of daily problems, you should definitely tell your doctor about them. At the doctor’s appointment it is easier to talk about what is the cause of physical discomfort: fatigue, feeling unwell, dizziness, etc. It is always more difficult to talk about your feelings and they try to avoid it. Caring for the psychological state is also important, the recognition of our feelings and the opportunity to speak about them allows us to free ourselves from them, and the doctor will be able to find an opportunity to help you.

Stress mainly appears due to changes that need to be introduced into your life: changing the diet, depending on the state of renal function, getting used to the disease, remembering to take medications. You can get a lot of new information at the same time, and understanding it can be difficult. The best way to deal with stress is to admit that there is a problem, it needs to be dealt with, and it will take time. General ill health and fatigue (both physical and emotional) can be quite common at some point.You may feel tired and easily vulnerable to the point of tears. Several symptoms may be present – for example, irritability, loss of personality, loss of interest in what is happening around, trouble sleeping. Emotional exhaustion is the cause of general fatigue. This condition can occur and progress slowly and almost imperceptibly. If the feeling of sadness already becomes desperate or hopeless, due to fatigue, there is no longer any motivation to do anything, and this condition lasts longer than 2 weeks, then you need to inform your doctor about this.

Despite the fact that you cannot change the diagnosis, on your part you can do a lot to better cope with the disease:

• Pay attention to your emotions, don’t deny them. Even if you think these emotions are not related to illness, talk about them, as holding on to emotions increases stress. Share them with people you trust – loved ones, friends, your doctor, nurse. No one can read your mind, but people can always come to your aid.
• Find and read information about chronic kidney disease and its treatment, and be proactive in making decisions about your treatment plan. Don’t be afraid to ask questions. Before visiting your doctor, write down any questions you may have. Many patients recognize that being aware of their illness and treatment helps them feel involved in the treatment process. If it seems to you that you cannot remember everything that the doctor said, take a loved one with you to the appointment or write down the important information received.
• Try to actively change your lifestyle and adhere to your doctor’s recommendations.
• Take care of yourself. Treat yourself to your favorite activities: listen to soothing music, read your favorite literature or magazines, go to the theater, and take walks in nature. It’s perfectly okay to let people know that you feel you don’t want or have enough time to participate in social activities.
• If you feel you don’t want to talk about and discuss your concerns, keep a journal.Sometimes writing down your thoughts helps you better deal with your feelings, and this at some point can make it easier to talk about them as well.
• If necessary, seek professional assistance. In case of persistent social problems and mood swings, ask your doctor which specialist you should see.
• Accept help when you need it. If people offer help, then they really want to help you. This gives them the confidence that they are involved in your life and that you need them.Your loved ones and friends can be the main stronghold of your support.
• Local chronic kidney disease patient groups or support groups are good places to connect with other patients. There you can also get practical advice, training courses and emotional support.

Free time and holidays

Do not give up your favorite activities and hobbies. They can help you relax, keep in touch with friends, and keep you distracted.You can decide how much you want to talk about your illness. Rest is important as it is the time you can spend with your loved ones away from your daily responsibilities. If you are planning a trip, inform your doctor. Check if the necessary tests have been done for you, if all the necessary medications are stocked, and find out which medical institutions, if necessary, you can contact.

Operation

Job opportunity is an important source of good self-esteem and life satisfaction for all people.A diagnosis of chronic kidney disease does not mean that your ability to work is lost until the moment when the disease begins to directly affect activities related to work and daily duties (for example, restrictions during replacement treatment for kidney, which become necessary in the last stages of the severity of chronic kidney disease). Of course, you should discuss with your doctor the hours and types of work (eg lifting weights) that are acceptable in the event of an illness.Your healthcare provider will be able to refer you to a rehabilitation doctor who will teach you the correct movement or work technique. Your employer should be informed if you need to change your work schedule.

Health Insurance

Estonia has a health insurance system based on solidarity insurance principles. The principle of solidarity means that all persons with health insurance receive the same health care, regardless of the amount of their monetary contribution, personal health risks or age.People who are permanent residents of Estonia or who are in Estonia on the basis of a temporary residence permit or residence permit have the right to health insurance if social tax is paid for them. In addition to these categories, children under the age of 19, schoolchildren, students, conscripts, pregnant women, the unemployed, on parental leave, dependent spouses, pensioners, guardians of disabled persons, persons with partial or absent work capacity and persons who have entered into a voluntary insurance contract.The costs of medical treatment of the insured person are covered by the Health Insurance Fund. You can check the health insurance status on the state portal www.eesti.ee under the heading “Information on health insurance and family doctor”.

Cash compensation

The Health Insurance Fund pays many monetary benefits to insured persons, such as compensation for incapacity for work, supplementary compensation for medicines and compensation for dental treatment and artificial insemination.You can read detailed information on monetary compensation on the website http://haigekassa.ee/ru/cheloveku/denezhnye-kompensacii

Medicines, medical aids and aids

Preferential medicines

Despite the fact that medicines are now very expensive, the Health Insurance Fund helps to compensate for part of their cost. Preferential discount on medicines, i.e. full and partial payment for drugs is one of the ways to provide the population with affordable drugs.This helps to avoid a situation where a person cannot start the necessary treatment because of the too high price for it. With each prescription purchase, the purchaser must pay a mandatory self-financing share that depends on the preferential rate on that prescription. Its value is about 1-3 euros. The rest of the prescription price is subject to a reduced rate based on the percentage of prescription written out. Thus, the buyer, in addition to the obligatory share of financing, pays the remaining part of the price after deducting the benefit.If a ceiling price is set for a given medicine and the price of the purchased medicine exceeds the maximum price, then in addition to the share of compulsory financing and the share remaining after deducting the benefit, the buyer must pay a part of the price that exceeds the maximum price. The last share refers to the part of the prescription cost that cannot be avoided when choosing an expensive drug package. The buyer of the prescription, with a rational choice of a medicine with the same active ingredient, but with a cost not exceeding the marginal price, can save significant amounts.

Medical aids

The Health Insurance Fund compensates the insured for the necessary medical aids that are used at home and with which illnesses and injuries can be treated or the use of which prevents the deepening of the illness. The need for medical aids is assessed by the attending physician and prepares a digital card for the purchase of a medical aid with a benefit. To purchase a medical aid, you need to contact a pharmacy or a company that has entered into an agreement with the Health Insurance Fund and present an identity document taken with you.

You can read more information about subsidized medicines and medical aids on the website.

Aids

Assistive products are a product or a means by which it is possible to prevent an emerging or congenital defect in health or the progression of a disease, to compensate for functional impairment caused by any damage or defect in health, as well as to maintain physical and social independence, performance and activity.

Assistive products can be purchased or rented on the basis of a personal assistive product card.

The basis for the application for a personal card of assistive products is a certificate from a doctor or the need for an assistive device, which has been identified by the rehabilitation team. The need for an assistive device should not be recorded in a doctor’s certificate or rehabilitation plan with the accuracy of the ISO code, but should be recorded in a form that is understandable to all.From it it should be clear what kind of auxiliary means a person needs. In the case of some assistive devices (for example, lower leg prostheses, wheelchairs, invarollers, etc.), the need can only be determined by a specialist doctor or a rehabilitation team of specialists.

You can find more detailed information on aids on the website.

Performance Assessment

Starting from January 1, 2017, the ability to work is assessed instead of incapacity for work.The ability to work and / or health defect is determined individually for each person, according to his state of health. The work capacity is assessed by the unemployment insurance fund and the health defect is determined by the Social Insurance Board.

The assessment of the working capacity is the final determination of the working capacity of a person, taking into account the state of health of the person and the assessment of his working capacity by the person himself. The unemployment insurance fund confirms partial or no work ability for a period of up to five years, up to no longer than a year of entering the retirement age.You can find more information about the assessment of the work ability on the website of the unemployment fund.

Definition of health defect

A defect, a lack of health is a handicap or deviation caused by a state of health, in which case a person has obstacles and problems with the ability to cope with daily activities and participation in the life of society.

It is possible to apply for the establishment of a health defect if:

• Health problems make it difficult for you to cope with daily activities and participate in the life of society
• Compared to your peers, you need more guidance, supervision and assistance

Health defect is established both for children and people of working age, and for old-age pensioners.Detailed information can be found on the website.

1. About Chronic Kidney Disease: a Guide for Patients. National Kidney Foundation. 2013–2014.
2. Chronic Kidney Disease (CKD). National Institute of Diabetes and Digestive and Kidney Diseases.
3. Description of High Blood Pressure.
4. Diabeet. Patsiendi infomaterjal. Ida-Tallinna Keskhaigla.
5. D-vitamiinist. Patsiendijuhend.TÜ Kliinikum 2014.
6. End Stage Renal Disease. New Patient Education Manual 2012. Carolinas HealthCare System Renal Services. Charlotte, North Carolina.
7. Kidney Disease Education. DaVita Inc.
8. Hidden Health Risks. Kidney Disease, Diabetes, and High Blood Pressure. National Kidney Foundation, 2014.
9. Kroonilise neeruhaiguse ennetus ja käsitlus, RJ-N / 16.1-2017 Ravijuhendite nõukoda. 2017.
10. Kuidas tervislikult toituda.
11. Living with Kidney Disease A comprehensive guide for coping with chronic kidney Disease. Second edition. Ministry of Health and Kidney Health New Zealand. 2014. Wellington: Ministry of Health.
12. National Kidney Foundation. A to Z Health Guide.
13. Rosenberg, M., Luman, M., Kõlvald, K., Telling, K., Lilienthal K., Teor, A., Vainumäe, I., Uhlinova, J., Järv, L. (2010). Krooniline neeruhaigus – vaikne ja salajane haigus. Tartu Ülikooli Kirjastus.
14. Sprague, S.M. (2012). The value of measuring Bone Mineral Density in CKD non-dialysis & dialysis patients. Compact Renal.
15. The Emotional Effects of Kidney Failure.
16. Täiskasvanute kõrgvererõhktõve patsiendijuhend, PJ-I / 4.1-2015 Ravijuhendite Nõukoda. 2015
17. Virtanen, J. Metaboolne atsidoos. Eesti Arst 2016; 95 (10): 650–655.

90,000 What is parathyroid adenoma?

Today we are asking questions to the head of the department of radioisotope diagnostics Ekaterina Igorevna Denisenko-Kankiya.

WHAT IS A PARACHYOID GLAND?

The parathyroid glands are located on the neck, next to the thyroid gland. Most people have four oval, pea-sized parathyroid glands. The parathyroid gland’s job is to produce the parathyroid hormone, which helps regulate the use of calcium in the body. Calcium is needed by cells in many parts of your body: the brain, heart, nerves, bones, and the digestive system.The parathyroid hormone takes calcium from the bone where it is stored and releases it into the bloodstream. The “connection” between the parathyroid glands and the bloodstream helps maintain normal calcium levels.

WHAT IS THE Adenoma of the parathyroid gland?

Sometimes benign growths called adenomas appear on one or more of the parathyroid glands of a person. Adenomas cause the parathyroid gland to produce more parathyroid hormone than the body needs, and this condition is called primary hyperparathyroidism.Too much parathyroid hormone disrupts the body’s normal calcium balance, which increases the amount of calcium in the bloodstream. A similar but less common condition called secondary hyperparathyroidism can occur in people with chronic renal failure. Women are twice as likely to develop parathyroid adenomas as men, and often after menopause.

WHAT SYMPTOMS CAN I SUSPECT PARTHYGLIN ADENOMA?

• Fatigue.
• Deterioration of memory and concentration.
• Depression, irritability, or confusion.
• Kidney stones.
• Pain in bones and joints, osteoporosis of unknown etiology.
• Abdominal pain.
• General pain for no apparent reason.

HOW IS PARTHYGLIN ADENOMA DIAGNOSED?

Parathyroid adenomas are most often found when calcium levels are above normal on routine blood tests, especially in people without symptoms.Doctors then confirm the diagnosis of primary hyperparathyroidism with a test that shows that the level of parathyroid hormone in the blood is higher than normal. It is important to understand that primary parathyroid disease is only diagnosed based on calcium and parathyroid hormone levels.

WHY SCYNTIGRAPHY AND HOW DOES IT WORK?

When the parathyroid gland produces parathyroid hormone (parathyroid hormone or PTH), it uses a lot of energy.The part of the cell that generates energy is called the mitochondria, and the nuclear drug material (RFP) that is injected into the patient is attracted to the actively working mitochondria. The more active he is, the more likely it is that the RFP will attach to him. Thus, in a situation where PTH levels are high, an abnormal gland can be easily found on a scan.

This diagnostic method is highly sensitive for high PTH levels. Detects the parathyroid glands, which are hidden behind the vocal cords, trachea, collarbone, in the upper part of the neck or in the chest (ectopia).

HOW IS THE SCYNTIGRAPHY OF THE PARTHYGROID GLANDS PERFORMED?

Before parathyroid scintigraphy, the attending physician will advise and inform you about the benefits and risks of the study. He will also ask if you have any pre-existing medical conditions or what medications you are taking. Because drugs are used for thyroid pathology and iodine-containing drugs can affect the results of the study, for example, preventing the penetration of the radiopharmaceutical into the thyroid tissue, that is, blocking it and, accordingly, deforming the study results.Therefore, it may be necessary to stop taking these drugs before conducting the study.

Parathyroid scintigraphy is performed in the supine position. The examination is completely painless. The duration of the study is up to 3.5 hours.

ARE THERE ARE SIDE EFFECTS AND CONTRAINDICATIONS?

RFP administered to a patient for research is very well tolerated. No side effects are known from the literature and our experience.