About all

Joint pain kidney disease: 13 Symptoms and Signs of Kidney Failure, Treatment, Causes & Stages

Содержание

Do You Have Intense Joint Pain? You May Have Gout

If painful joints are keeping you up at night, call your doctor and then go to “Gout and Your Health” on kidney.org to learn what questions to ask your healthcare professional about it. The National Kidney Foundation is making it easy to help people understand how to take control of gout with this free, online tool.

Gout is a serious type of arthritis caused by a buildup of uric acid crystals in joints, most commonly in the big toe. People with gout often complain of severe pain, especially at night. It can be managed with diet, medication, and lifestyle changes, but it can also be an early sign of chronic kidney disease (CKD) and shouldn’t be ignored. CKD, if left untreated, can progress to kidney failure, dialysis, or even death.

Gout is most common in middle aged men and men over 65 years old. Chances of the disease in women increase after menopause. Gout is rare in children and young adults. Some of the risk factors for gout are diabetes, high blood pressure, obesity, heart disease, exposure to lead, hypothyroidism, kidney disease or a family history of gout. Certain drugs can also increase your risk for gout, so always let your healthcare team know what medications you take.

Gout can be hard to diagnose because symptoms are so similar to other conditions. You should see a doctor if you have severe pain in a joint with one of these other signs: swelling; tenderness; stiffness; redness.

“Gout is one of those conditions that can mimic several others and knowing specifically what you are dealing with can seriously assist the treatment and management of this condition,” said gout patient Andrea Thompson Adams. “After my diagnosis, I made a point of acquainting myself with gout, it’s treatment and prevention,” Andrea said. “So, with medication, attention to my diet and exercise/movement, I manage to hold the gout at bay, the majority of the time.”

The tool starts with a quick and easy survey to help you assess your risk and guide you to the next steps based on the answers you provide. The tool is part of a new platform on the NKF website called “Kidney Pathways,” which helps people better understand kidney disease by providing individualized information curated from the vast library at NKF.

Based on the answers to the online survey you will be given a list of questions for your healthcare professional that range from basic talking points to much more complex inquires. The tool also gives you basic information about treatments, long-term effects of gout, and how the condition is diagnosed. Take the assessment today. It only takes a few minutes and it could save your life.

Begin here.

Mineral & Bone Disorder in Chronic Kidney Disease

What is mineral and bone disorder in chronic kidney disease (CKD)?

Mineral and bone disorder in CKD occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a person’s blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.

In the past, health care providers used the term “renal osteodystrophy” to describe mineral and hormone disturbances caused by kidney disease. Today, renal osteodystrophy only describes bone problems that result from mineral and bone disorder in CKD. Health care providers might use the phrase “chronic kidney disease mineral and bone disorder,” or CKD-MBD, to describe the condition that affects the bones, heart, and blood vessels.

What is chronic kidney disease?

Chronic kidney disease is kidney damage that occurs slowly over many years, often due to diabetes or high blood pressure. Once damaged, the kidneys can’t filter blood as they should. This damage can cause wastes to build up in the body and other problems that can harm a person’s health, including mineral and bone disorder.

Why are hormones and minerals important?

Hormones and minerals are important because they help bones stay strong. If a person’s hormones and minerals are out of balance, his or her bones can become weak and malformed. Healthy bones continuously rebuild, sometimes taking a slightly altered shape or structure. To grow and rebuild, bones need

  • the hormone calcitriol—the active form of vitamin D
  • calcium
  • phosphorus
  • parathyroid hormone

The kidneys play an important role in maintaining healthy bone mass and structure by balancing phosphorus and calcium levels in the blood. Healthy kidneys activate a form of vitamin D that a person consumes in food, turning it into calcitriol, the active form of the vitamin. Calcitriol helps the kidneys maintain blood calcium levels and promotes the formation of bone.

The kidneys also remove extra phosphorus, helping balance phosphorus and calcium levels in the blood. Keeping the proper level of phosphorus in the blood helps maintain strong bones.

The parathyroid glands, four pea-sized glands in the neck, create parathyroid hormone, or PTH. Parathyroid hormone plays an important role in controlling calcium levels in the blood. When the kidneys do not function properly, extra parathyroid hormone is released into the blood to move calcium from inside the bones into the blood.

What causes mineral and bone disorder in chronic kidney disease?

Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body. The kidneys

  • stop activating calcitriol. The low levels of calcitriol in the body create an imbalance of calcium in the blood.
  • do not remove the phosphorus in the blood properly, so phosphorus levels rise in the blood. The extra phosphorus pulls calcium out of the bones, causing them to weaken.

Another factor contributes to the cause of mineral and bone disorder. When the kidneys are damaged, the parathyroid gland releases parathyroid hormone into the blood to pull calcium from the bones and raise blood calcium levels. This response restores the balance of phosphorus and calcium; however, it also starves the bones of much-needed calcium.

What are the signs and symptoms of mineral and bone disorder in chronic kidney disease?

In adults, symptoms of mineral and bone disorder in CKD may not appear until bone changes have taken place for many years. For this reason, people often refer to the disease as a “silent crippler.” Eventually, a person with the condition may begin to feel bone and joint pain.

Mineral and Bone Disorder in Children with Chronic Kidney Disease

Mineral and bone disorder in CKD is most serious when it occurs in children because their bones are still developing and growing. Growing children can show symptoms of mineral and bone disorder even in the early stages of CKD. Slowed bone growth leads to short stature, which may remain with a child into adulthood. One deformity caused by mineral and bone disorder in CKD occurs when the legs bend inward or outward, a condition often referred to as “renal rickets.” More information is provided in the NIDDK health topic, Growth Failure in Children with Kidney Disease. Find more about children’s bone health on the Eunice Kennedy Shriver National Institute of Child Health and Human Development website at www.nichd.nih.gov.

What are the complications of mineral and bone disorder in chronic kidney disease?

The complications of mineral and bone disorder in CKD include slowed bone growth and deformities, and heart and blood vessel problems.

Slowed Bone Growth and Deformities

Damaged kidneys must work harder to clear phosphorus from the body. High levels of phosphorus cause lower levels of calcium in the blood, resulting in the following series of events:

  • When a person’s blood calcium level becomes too low, the parathyroid glands release parathyroid hormone.
  • Parathyroid hormone removes calcium from bones and places it into the blood, raising a person’s blood calcium level at the risk of harming bones.
  • A low calcitriol level also leads to an increased level of parathyroid hormone.

If mineral and bone disorder in CKD remains untreated in adults, bones gradually become thin and weak, and a person with the condition may begin to feel bone and joint pain. Mineral and bone disorder in CKD also increases a person’s risk of bone fractures.

Heart and Blood Vessel Problems

In addition to harming bones, mineral and bone disorder in CKD can cause problems in the heart and blood vessels:

  • High levels of blood calcium can damage blood vessels and lead to heart problems.
  • High phosphorus levels also can cause blood vessels to become like bone, leading to hardening of the arteries.
  • High phosphorus levels also cause abnormal hormone regulation, even if the calcium level is acceptable.

Parathyroid hormone and another hormone made in the bones called FGF23 can also affect bone and heart health, leading to the following series of problems:

  • When parathyroid hormone or FGF23 levels are high, a person can have heart problems.
  • The complex hormone abnormalities that cause bone deformities can also harm a person’s heart and blood vessels.

How is mineral and bone disorder in chronic kidney disease diagnosed?

A health care provider diagnoses mineral and bone disorder in CKD with

  • a family and medical history
  • a physical exam
  • a blood test
  • a bone biopsy
  • an x-ray

Family and Medical History

Taking a medical and family history is one of the first things a health care provider may do to help diagnose mineral and bone disorder in CKD. He or she will ask the patient or caretaker questions about when the patient was first diagnosed with CKD and whether any family members have also had mineral and bone disorder with or without CKD.

Physical Exam

A physical exam may help diagnose mineral and bone disorder in CKD. During a physical exam, a health care provider usually examines a patient’s body for changes in bone structure.

Blood Test

A blood test involves drawing blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. The blood test shows levels of calcium, phosphorus, parathyroid hormone, and sometimes vitamin D.

Bone Biopsy

A bone biopsy is a procedure that removes a piece of bone tissue for examination with a microscope. A health care provider performs the biopsy in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the hip bone. A pathologist—a doctor who specializes in diagnosing diseases—examines the bone tissue in a lab. The test can show whether a person’s bone cells are building normal bone.

X-ray

An x-ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. A radiographer performs the x-ray at a hospital or an outpatient center, and a radiologist—a doctor who specializes in medical imaging—interprets the images. Patients do not need anesthesia. The patient will lie on a table or stand during the x-ray. The technician will position the x-ray machine over the bone area. The patient will hold his or her breath as the x-ray machine takes the picture so that the picture will not be blurry. The radiographer may ask the patient to change position for additional pictures. An x-ray can show extra calcium in blood vessels.

Each of these tests can help the health care provider determine whether CKD or some other condition is causing the mineral and bone disorder and decide on a course of treatment.

How is mineral and bone disorder in chronic kidney disease treated?

Treating mineral and bone disorder in CKD includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition; medications and supplements; and dialysis. If these treatments do not bring parathyroid hormone levels under control, a health care provider may remove a person’s parathyroid glands surgically, a procedure called a parathyroidectomy.

Eating, Diet, and Nutrition

Changes in diet can treat mineral and bone disorder in CKD. Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease. Most foods contain phosphorus; however, processed and packaged foods contain especially high levels of phosphorus. Food producers use phosphorus as an additive to preserve the food on the shelf. People who have CKD or are on dialysis should avoid packaged foods containing ingredients that include the letters PHOS. A renal dietitian can help develop a dietary plan to control phosphorus levels in the blood. Some drinks and natural foods also contain high amounts of phosphorus, including

  • beer
  • cheese
  • cocoa
  • dark sodas
  • dried beans
  • milk
  • nuts
  • peanut butter
  • peas

More information is provided in the NIDDK health topics, How To Read a Food Label: Tips for People with Chronic Kidney Disease and Phosphorus: Tips for People with Chronic Kidney Disease.

Medications and Supplements

Medications protect the bones by restoring the proper balance of minerals and hormones. If the kidneys do not make adequate amounts of calcitriol, a health care provider may prescribe synthetic calcitriol as a pill (Rocaltrol) or, for dialysis patients, in an injectable form (Calcijex). Calcitriol helps reduce parathyroid hormone levels. Medications called doxercalciferol (Hectorol) and paricalcitol (Zemplar) act like calcitriol because they are also activated forms of vitamin D. A health care provider may prescribe a calcium supplement in addition to calcitriol or another activated form of vitamin D.

Certain forms of vitamin D—available by prescription or as over-the-counter vitamin supplements—require activation by a person’s kidneys before they can act as calcitriol does. However, the benefits of some of these not-yet-activated forms of vitamin D—for example, ergocalciferol (Calciferol, Drisdol) or cholecalciferol (Delta D3)—are unclear. To help ensure coordinated and safe care, people should discuss their use of alternative medications, including use of vitamin and mineral supplements, with their health care provider.

Cinacalcet hydrochloride (Sensipar) belongs to another class of prescription medications called calcimimetics. Cinacalcet lowers parathyroid hormone levels by imitating calcium’s effects on the parathyroid gland. Generally, this medication is used only in people on dialysis.

Often, health care providers will prescribe medications called phosphate binders—such as calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer carbonate (Renvela), or lanthanum carbonate (Fosrenol)—to take with meals and snacks to bind phosphorus in the bowel. These medications decrease the absorption of phosphorus into the blood.

Dialysis

Dialysis is the process of filtering wastes and extra fluid from the body by means other than the kidneys. The two forms of dialysis are hemodialysis and peritoneal dialysis:

  • Hemodialysis uses a machine to circulate a person’s blood through a filter outside the body. The blood passes from a patient’s body through a needle, at nearly 1 pint per minute. The blood then travels through a tube that takes it to the filter, called a dialyzer. Inside the dialyzer, the blood flows through thin fibers that filter out wastes and extra fluid. After the machine filters the blood, it passes back to the body through another tube. More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Hemodialysis.
  • Peritoneal dialysis uses the lining of the abdomen to filter a person’s blood inside the body. A soft tube called a catheter is placed in the patient’s abdomen a few weeks before peritoneal dialysis begins. A person uses the catheter to fill the empty space inside the abdomen with dialysis solution—a kind of salty water—from a plastic bag. While inside the body, the dialysis solution absorbs wastes and extra fluid. After a few hours, the person drains the used dialysis solution into another bag for disposal. The person then restarts the process with a fresh bag of dialysis solution. More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Peritoneal Dialysis.

Increasing a person’s dialysis dose can help control the blood phosphorus level. In hemodialysis, the health care provider can adjust the dose by increasing how quickly the blood flows to and from the dialyzer. Another way to adjust the dose involves increasing the time of a person’s dialysis session or the number of sessions. In peritoneal dialysis, using more dialysis solution in each fill or increasing the number of fills each day increases the dose. More information is provided in the NIDDK health topics:

Parathyroidectomy

If diet, medications, and dialysis can’t control parathyroid hormone levels, a surgeon can remove one or more of the parathyroid glands. He or she performs the procedure using general anesthesia.

A good treatment program, including a low-phosphorus diet, appropriate medications, adequate dialysis, and, if necessary, surgery, can improve the body’s ability to repair bones damaged by mineral and bone disorder in CKD. Overall, people can improve their bone health by exercising and not smoking. People should consult a health care provider before beginning any exercise program.

Points to Remember

  • Mineral and bone disorder in chronic kidney disease (CKD) occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a person’s blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.
  • Chronic kidney disease is kidney damage that occurs slowly over many years, often due to diabetes or high blood pressure. Once damaged, the kidneys can’t filter blood as they should.
  • Hormones and minerals are important because they help bones stay strong. If a person’s hormones and minerals are out of balance, his or her bones can become weak and malformed.
  • Parathyroid hormone plays an important role in controlling calcium levels in the blood. When kidneys do not function properly, extra parathyroid hormone is released in the blood to move calcium from inside the bones into the blood.
  • Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body. The kidneys stop activating calcitriol and do not remove the phosphorus in the blood properly.
  • The complications of mineral and bone disorder in CKD include slowed bone growth and deformities, and heart and blood vessel problems.
  • Treating mineral and bone disorder in CKD includes preventing damage to bones by controlling parathyroid hormone levels through changes in eating, diet, and nutrition; medications and supplements; and dialysis.
  • Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease.
  • If diet, medications, and dialysis can’t control parathyroid hormone levels, a surgeon can remove one or more of the parathyroid glands.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www. ClinicalTrials.gov.

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

About the Kidney Failure Series

You and your doctor will work together to choose a treatment that’s best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.

Booklets

Fact Sheets

Learning as much as you can about your treatment will help make you an important member of your health care team.

Gout Symptoms, Causes, Treatments, and Relation to Kidney Disease

Do you know all the myths & facts about gout?

Take a quick quiz to find out!

What is gout?

Gout is a type of arthritis. Arthritis is a common condition that causes swelling and pain in your joints. Gout is considered a chronic disease, meaning it does not have a cure and will usually last your whole life.

Gout comes in sudden, and sometimes severe attacks, also called flares, or flare-ups. During a gout attack you may have pain, swelling, and/or redness in your joints. Gout attacks often happen in the big toe, but can affect any of your body’s joints like your elbows, knees, hands, or ankles.  Gout is extremely painful and sometimes hard to control. Gout can be either acute or chronic.

Kidney disease can lead to gout, and gout may lead to kidney disease. If you have either condition, talk to your doctor about preventing the other.


What is the difference between acute and chronic gout?

Acute gout

  • Usually only 1-3 joints are affected.
  • You will only feel symptoms during attacks.
  • Attacks may last from a few days to a week.
  • After attacks, you will not feel symptoms.
  • You may start by having acute gout but worsen to chronic gout over time if attacks happen more often.

Chronic gout

  • Chronic gout is having 2 or more gout attacks per year.
  • Often more than one joint is affected.
  • Some people with severe chronic gout have only short breaks in between attacks and feel symptoms of gout most of the time.
  • Chronic gout can lead to permanent joint stiffness, damage, and deformity.

Return to top

What causes gout?

Gout is caused by having too much uric acid in your blood. Uric acid is made when your body breaks down chemicals called purines. Learn more about the causes of gout.

Return to top

Who is at risk for gout?

Anyone can get gout, but it is more common in men than in women. Gout is more common in adults than in children. Learn more about the risks for gout.

Return to top

What are the symptoms of gout?

Although many people have their first gout attack in one of their big toes, gout attacks can also happen in other joints. Learn more about symptoms of gout.

Return to top

How can I manage gout attacks?

Gout attacks, also called flares, or flare-ups, can come on suddenly and be extremely painful. Learn how to manage your gout attacks.

Return to top

Why do gout attacks happen more at night?

Gout attacks happen more at night and in the early morning rather than during the day. You may have an attack start during your sleep.  The reasons this happens are not entirely known, but some of the leading ideas are dehydration, lower body temperature, and changes in hormone levels during sleep.

Talk to your doctor about ways to prevent gout attacks during your sleep.

Return to top

What are the complications of gout?

Gout does not only cause pain. Having gout, and especially chronic gout, can lead to serious health problems over time if left uncontrolled. Learn about the complications of gout.

Return to top

What are the tests for gout?

If you think you might have gout, it is important to get tested and diagnosed by a doctor, so that you can get the treatment you need. Learn about the tests for gout.

Return to top

What are the treatments for gout?

Taking too many medicines or taking certain medicines at the same time can be dangerous, so it is very important to talk to your doctor about how many medicines you can take. Learn about the medicines available to treat gout.

Return to top

Is gout preventable?

Gout is usually not preventable through lifestyle changes alone. Many people with gout need medicines to get their gout under control. Learn more about preventing gout.

Return to top

What is the best diet for gout?

Certain foods and drinks are better than others for controlling gout. Learn more about foods and drinks to avoid when you have gout.

Return to top

Gout and kidney disease

Most commonly, kidney disease can cause gout. However, gout may also lead to kidney disease. Since uric acid is filtered through the kidneys, the two diseases are related. Learn more about gout and kidney disease.

Return to top

Where can I get more information?

Return to top

Find a gout specialist

If you don’t have a gout specialist, use this “Find a Gout Specialist” tool to identify healthcare professionals who are experienced treating chronic gout.

Return to top

Request your Goutful booklet

Learn the truth about gout and kidney disease. Request your free booklet about gout.

Return to top

How Inflammatory Arthritis Affects the Kidneys

Your two kidneys are each the about the size of a fist, the shape of a bean, and packed with a million or so tiny filtering units called nephrons. Their main job: to remove waste and extra water out of your blood to make urine. They also help balance your body’s salts and minerals and produce hormones that regulate blood pressure, make red blood cells, and help keep your bones strong.

So, what does a joint condition like arthritis have to do with these hard-working organs? More than you may think.

People with rheumatoid arthritis (RA) are at a significantly higher risk of developing chronic kidney disease, according to data from a meta-analysis presented at the American College of Rheumatology’s annual meeting in 2018. In one study, researchers found that over a 20-year period, people with RA have a one in four chance of developing chronic kidney disease, compared with a one in five risk among people who don’t have rheumatoid arthritis.

 

How RA Affects the Kidneys

The same chronic, systemic inflammation that targets your joints in arthritis can also affect other parts of your body — such as your heart, lungs, and kidneys. Uncontrolled inflammation may damage cells that line blood vessels and contribute to atherosclerosis, a disease where plaque can build up inside renal arteries (the arteries in your kidneys), explains Brad H. Rovin, MD, director of the division of nephrology and Vice Chairman of Medicine for Research at the Ohio State University Wexner Medical Center in Columbus. Over time, the plaque hardens and narrows the arteries, limiting the flow of oxygen-rich blood to your kidneys, which may lead to kidney disease.

Another potential kidney problem for people with long-standing, poorly controlled rheumatoid arthritis: amyloidosis.

This disease occurs when an abnormal protein — called an amyloid — builds up in your kidneys. “Amyloidosis can develop in patients with chronic inflammatory conditions like RA or chronic infections,” says Dr. Rovin.

Research also shows RA patients have a higher risk of developing glomerulonephritis — an inflammation of the kidney’s filtering units (called glomeruli), which can impair kidney function and lead to chronic kidney disease.

Heart problems play a role as well. “RA patients have more hypertension and other cardiovascular risk factors, which can also be risk factors for chronic kidney disease,” said Dr. Rovin. A study published in the American Journal of Kidney Diseases found obesity, high blood pressure, and high cholesterol can contribute to a higher kidney disease risk for RA patients.

 

How Arthritis Medications Can Impact Kidneys

“Generally, medications used to treat inflammatory conditions like RA have little effect on your kidneys when taken as prescribed,” says Justin Owensby, PharmD, PhD, research pharmacist with the department of clinical immunology and rheumatology at the University of Alabama at Birmingham.

However, if your kidney function is already reduced, your doctor may need to adjust the dosage of a certain medication, or stop it completely. “The role of our kidneys is to help remove waste products from the bloodstream. Kidneys perform this same role with many RA medications,” explains Jared J. Vanderbleek, PharmD, pharmacist at the Kirklin Clinic at the University of Alabama at Birmingham. “If the kidneys are not working properly, more medication stays in your bloodstream longer, which increases the chance of unwanted side effects.”

Potential negative effects on kidney function may occur with specific RA meds, such as:

NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen and naproxen — may worsen kidney function by affecting blood flow within the kidneys, explains Dr. Vanderbleek. Any patient with chronic kidney disease should avoid long-term use of NSAIDs, says Dr. Rovin. “Even patients with good kidney function can develop an allergic response to NSAIDs that can be centered in the kidney and cause inflammation,” he adds.

DMARDs: Disease-modifying drugs such as methotrexate and sulfasalazine may damage the kidneys at very high doses (much higher than the doses recommended to treat RA), says Dr. Owensby. When toxicity is detected early, kidney function recovers after the drug is stopped.

Steroids: While corticosteroids, such as prednisone, don’t have a direct effect on the kidneys, over time, they may cause the body to retain fluid and lead to an increase in blood pressure, says Dr. Owensby. High blood pressure can raise your risk of chronic kidney disease.

Biologics: Changes in kidney function were reported with an anti-TNF drug, tofacitinib (Xeljanz), says Dr. Vanderbleek, “but the changes were not deemed clinically significant and kidney returned to normal after drug discontinuation.” Some good news, adds Dr. Rovin: an article published in the journal Kidney International suggests patients with RA who are treated with biologics had a lower incidence of chronic kidney disease and progressive decline in kidney function than RA patients not treated with biologics.

 

Warning Signs of Kidney Disease

At first, there may be none. That’s because the kidneys are adaptable organs and can compensate for damage or loss of function. In fact, most people with kidney disease have no symptoms in the early stages. Once the disease has progressed, however, some signs may include:

 

  • Nausea or vomiting
  • Loss of appetite
  • Feeling tired or weak
  • Swelling in your legs, feet, or ankles
  • Changes in how much you urinate
  • Trouble concentrating
  • Muscle twitches and cramps
  • Persistent itching
  • Chest pain (if fluid builds up around the lining of the heart)
  • Shortness of breath (if fluid builds up in the lungs)
  • High blood pressure (hypertension) that’s difficult to control

 

How to Keep Your Kidneys Healthy

Protecting your kidneys is important: Kidney disease can get worse over time and may lead to kidney failure, says Dr. Rovin. If your kidneys fail, you will need dialysis or a kidney transplant to maintain your health. People with kidney disease are also at higher risk for heart disease. To help keep your kidneys healthy:

 

1. Keep your RA disease activity under control

“A lot of the toxicity of RA can be related to inflammation in poorly controlled disease,” says Dr. Rovin. “Therefore, good adherence to medical therapy is key.” (You can use our ArthritisPower app to track your symptoms and disease activity and share your results with your doctor.)

 

2. Get your kidney function tested regularly

Your doctor may order a blood test to look for the level of waste products, or take a urine sample, which may show abnormalities that point to chronic kidney disease.

 

3. Review your meds with your doctor

If your kidney function is already reduced, your doctor will consider the severity of the impairment and the drug in question to determine the next step, says Dr. Owensby. NSAIDs may be reduced or removed from your regimen, for example, if your kidney function is poor.

 

4. Manage your blood pressure

Over time, uncontrolled high blood pressure can damage blood vessels in the kidneys, reducing their ability to remove waste and extra fluid from your body. Extra fluid in the blood vessels may then raise blood pressure even more, creating a dangerous cycle. Get your pressure checked regularly, advises Dr. Rovin; “it should be maintained in the 120/80 range, with medications to lower blood pressure if needed.”

 

5. Eat less salt

When your kidneys are not healthy, extra sodium and fluid builds up in your body, which can cause swelling or puffiness, a rise in blood pressure, shortness of breath, or fluid around your heart and lungs. To reduce your salt intake, skip products with lots of added salt, such as frozen dinners, canned soups, and fast foods. And limit salty snack foods, canned veggies, and processed meats.

 

6. Drink more water

It helps remove waste from your blood in the form of urine and helps keep blood vessels open so blood can flow to your kidneys. If you become dehydrated, the system doesn’t work as well. Some research also suggests drinking more fluids may also help protect against chronic kidney disease. Aim for six to eight, eight-ounce glasses a day.

 

Keep Reading

 

Symptoms, Causes, Treatment & Prevention

What Is Acute Kidney Failure?

Acute kidney failure is when your kidneys stop working suddenly. Doctors sometimes call it acute renal failure. It can happen over just a few hours or days.

Acute kidney failure isn’t always permanent. If you get treatment right away — and if you don’t have other serious health problems — your kidneys can go back to working normally.

The main job of your kidneys is to filter waste out of your blood. They also remove extra fluid from your blood (this becomes urine) and control blood pressure. Kidneys help make red blood cells. They regulate electrolytes (a type of nutrient) and activate vitamin D, too.

Kidneys don’t work well when they’re damaged. This could happen because of another health condition, like diabetes. A decrease in kidney function that happens over a longer period of time is called chronic kidney failure.

Acute Kidney Failure Symptoms

You may not have any symptoms of acute kidney failure. Your doctor may discover you have this condition while doing lab tests for another reason.

If you do have symptoms, they’ll depend on how bad your loss of kidney function is, how quickly you lose kidney function, and the reasons for your kidney failure. Symptoms may include:

  • Peeing less than normal
  • Swelling in your legs, ankles, and feet (caused by your body holding on to fluid)
  • Feeling drowsy or very tired
  • Shortness of breath
  • Itching
  • Joint pain, swelling
  • Loss of appetite
  • Confusion
  • Throwing up or feeling like you’re going to
  • Chest pain or pressure
  • Muscle twitching
  • Seizures or coma (in severe cases)
  • Stomach and back pain
  • Fever
  • Rash
  • Nosebleed

Acute Kidney Failure Causes

There are three main reasons your kidneys fail all of a sudden:

  1. Something is stopping blood flow to your kidneys. It could be because of:
  1. You have a condition that’s blocking urine from leaving your kidneys. This could mean:
  1. Something has directly damaged your kidneys, like:

Acute Kidney Failure Risk Factors

Most of the time, kidney failure happens along with another medical condition or event. If you fall into any of the following categories, you may have a greater chance of acute kidney failure:

  • You’ve been hospitalized for a long time, especially in intensive care.
  • You have diabetes.
  • You’re elderly.
  • You have coronary artery disease.
  • You have heart failure or high blood pressure.
  • You have chronic kidney or liver disease.

Acute Kidney Failure Diagnosis

Your doctor will start with a physical exam. Then, they’ll order tests of your blood, urine, and kidneys.

Blood tests. These measure substances in your blood. 

  • Creatinine is a waste product in your blood that’s made by muscle activity. Normally, it’s removed from your blood by your kidneys. But if your kidneys stop working, your creatinine level rises.
  • Urea nitrogen is another waste product in your blood. It’s created when protein from the foods is broken down. Like creatinine, your kidneys remove this from your blood. When your kidneys stop working, your urea nitrogen levels rise.
  • Serum potassium is a substance found in your blood that balances water levels in your bloodstream. Kidney disease can cause either high or low potassium levels. 
  • Serum sodium is another substance in your blood that helps with fluid balance in your body.  High sodium levels can mean that your kidneys aren’t working properly because your body can’t get rid of the right amount of sodium.
Continued

Urine tests. Your doctor will check your pee for blood and protein. They’ll also look for certain electrolytes. The results help your doctor understand what’s causing your kidney failure.

Urine output measurement. This measures how much urine you pass in 24 hours. You will get a container to take home, pee into, and then return to the lab after a full 24 hours. It can help your doctor determine why you’re having kidney failure.

Kidney biopsy (renal biopsy) is a procedure where the doctor pushes a thin needle through your skin and takes a small piece of your kidney to look at under a microscope.  It can show if there is any damage or disease in your kidney.

Imaging tests. Some tests, like ultrasonography or a CT scan, can show whether your kidneys are enlarged or there’s a blockage in your urine flow. An angiogram can tell your doctor if the arteries or veins that lead to your kidneys are blocked. An MRI can show this, too.

Kidney Failure Treatment and Home Remedies

If there aren’t any other problems, the kidneys may heal themselves.

In most other cases, acute kidney failure can be treated if it’s caught early. It may involve changes to your diet, the use of medications, or even dialysis.

  • Diet. Your doctor will limit the amount of salt and potassium you get until your kidneys heal. That’s because both of these substances are removed from your body through your kidneys. Changing how and what you eat won’t reverse acute kidney failure. But your doctor may change your diet while they treat the conditions that caused it. This may mean treating a health problem like heart failure, taking you off certain medications, or giving you fluids through an IV if you’re dehydrated. If your doctor has put you on a low potassium diet, you’ll need to cut back on high-potassium foods like bananas, spinach, oranges, potatoes, and tomatoes.  On the other hand, you can eat more low-potassium foods like apples, strawberries, grapes, and cauliflower.  
  • Medications. Your doctor may prescribe medicines that regulate the amount of phosphorus and potassium in your blood. When your kidneys fail, they can’t remove these substances from your body. Medications won’t help your kidneys, but they may reduce some of the problems kidney failure causes.
  • Dialysis. If your kidney damage is severe enough, you may require hemodialysis until your kidneys can heal. Dialysis does not help kidneys heal but takes over the work of kidneys until they do. If your kidneys don’t heal, dialysis could be long-term.

Acute Kidney Failure Complications

Acute kidney failure can sometimes cause complications. These include:

  • Fluid buildup. Acute kidney failure can sometimes cause a buildup of fluid in your body. If fluid builds up in your lungs, this can cause shortness of breath.
  • Chest pain. If the lining that covers your heart  becomes inflamed, you may have chest pain.
  • Acidic blood (metabolic acidosis). If your blood has too much acid due to acute kidney failure, you can end up with nausea, vomiting, drowsiness, and breathlessness.
  • Muscle weakness. When your body’s fluids and electrolytes are out of balance, you can get  muscle weakness.  In serious cases, this can lead to paralysis and heart rhythm problems.
  • Permanent kidney damage. Acute kidney failure can become chronic and your kidneys will stop working almost entirely or completely. This is called end-stage renal disease. If this happens, you will need to go on permanent dialysis (to filter your blood and remove toxins) or get a kidney transplant.
  • Death. Acute kidney failure can lead to loss of kidney function that is so bad, it can cause death.

Acute Kidney Failure Prevention

You can reduce your risk of getting acute kidney failure by practicing some healthy habits.

  • Be careful when taking over-the-counter (OTC) pain medications. Whether you are taking NSAID medications like aspirin, ibuprofen, and naproxen or other types of OTC pain medications like acetaminophen, it’s important to read and follow the recommended dosing instructions on the package. If you take too much of these meds, you could increase your chances of getting acute kidney failure.
  • Follow your doctor’s advice. If you have a higher risk of getting acute kidney failure because of pre-existing kidney disease or other conditions, make sure to follow your doctor’s advice for treating and managing your condition.  
  • Keep a healthy lifestyle. Exercise, eating right, and drinking little or no alcohol can go a long way to preventing acute kidney failure.

Inflammation and Chronic Kidney Disease

What is inflammation?

Inflammation is an immune response that occurs when the body’s white blood cells and immune-fighting chemicals work to protect it from infective and foreign substances, such as bacteria, viruses and injuries.

There are two types of inflammation: acute, which occurs for a short period of time, and chronic, which occurs over a long time and may never go away.

Inflammation is the natural defense the body takes on when it is under attack. But inflammation can also occur when there is nothing to fight or fend off. In this case inflammation “turns on the body” and can lead to diseases such as rheumatoid arthritis, hay fever and atherosclerosis. People with chronic kidney disease (CKD) can experience chronic inflammation that can lead to cardiovascular disease and even an increased rate of death.

What causes inflammation in people with CKD?

Inflammation in people who have CKD can be caused by:

  • Poor nutrition due to poor appetite
  • Dialysis vascular access infection
  • Gum disease or poor dental health
  • Foot ulcers
  • Anemia
  • Uremia (extra waste in the blood)
  • A transplanted kidney that no longer works

Other causes of inflammation that affect people with or without CKD include:

  • Infections that linger
  • Toxins
  • Pollutants
  • Insomnia
  • Lack of exercise
  • Obesity, especially if large amounts of fat are around the stomach

How do I know if I have inflammation?

Symptoms of acute inflammation can resemble flu-like symptoms and include:

  • Redness
  • Fever
  • Chills
  • Swollen joints, warm to the touch
  • Fatigue
  • Muscle stiffness
  • Loss of appetite
  • Headaches

People with CKD may not experience all of the symptoms. They may have additional problems like anemia, anorexia, muscle wasting and weakness.

To detect chronic inflammation, doctors look at several lab results.

Malnutrition, inflammation and CKD

There is a connection between malnutrition and chronic inflammation in people with kidney disease. Eating problems may occur frequently in kidney disease patients, especially for those with end stage renal disease (ESRD) and on dialysis. Poor appetite results in a lack of calorie and protein intake. Over time, a condition called protein energy malnutrition (PEM) occurs. In addition to weight loss, patients experience muscle wasting, because the body must break down muscles to supply protein for vital functions. Doctors and dietitians check the albumin level to help evaluate the degree of PEM.

How can I prevent and treat inflammation and CKD?

Inflammation prevention and treatment in people with CKD usually begins with a healthy, kidney-friendly diet. To prevent malnutrition, focus on adequate calorie and protein intake and foods that contain antioxidants. Foods that contain high-quality protein are:

  • Fish
  • Poultry (chicken breast)
  • Lean red meat
  • Low cholesterol egg products
  • Eggs or egg whites
  • Soy products (sodium, potassium and phosphorus vary greatly – read labels or check with your dietitian)

Some foods that are high in antioxidants include:

  • Fish high in omega-3 fatty acids
  • Olive oil
  • Red bell peppers
  • Cabbage
  • Cauliflower
  • Garlic
  • Onions
  • Apples
  • Cranberries
  • Blueberries
  • Raspberries
  • Strawberries
  • Cherries
  • Red grapes

Eating fish two to three times a week helps treat inflammation because of the anti-inflammatory effect of omega-3 fatty acids in fish. Albacore tuna, herring, mackerel, rainbow trout and salmon are among the fish highest in omega 3s. Fish oil supplements may also be used to increase omega 3s.

The kidney diet regulates the amount of potassium, phosphorus and sodium you consume, and contains enough protein to prevent malnutrition. A kidney diet providing a variety of foods listed above may help treat inflammation, too.

Medicines may also be prescribed by your doctor to treat inflammation. Although you may read that certain over-the-counter medicines can treat inflammation, talk to your doctor before taking any medicine. Medications such as non-steroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, aspirin and naproxen, aren’t usually recommended for people with kidney disease unless prescribed by their kidney doctor. For those with decreased kidney function, NSAIDs have been associated with acute kidney failure. Your doctor can determine if NSAIDs are the right medicine for you.

Hemodialysis patients who have catheters for their dialysis access are at a greater risk for inflammation. A fistula or graft to replace the catheter is recommended to improve health and lower inflammation risk.

Some additional considerations in treating chronic inflammation include adequate dialysis to remove toxins from the blood, correction of anemia and vitamin D deficiency, and increased exercise. Obesity is known to increase CRP and cytokines. Weight loss in obese people decreases inflammation by decreasing these levels.

Kidney Disease: Signs and Symptoms

Chronic kidney disease (CKD) is an umbrella term used to describe a longstanding disease or condition that causes the progressive loss of kidney (renal) function. The primary functions of the kidneys are to excrete waste and regulate the water and acid-base balance of the body. Without these functions, a person cannot survive. While there are many different causes of CKD—including diabetes, hypertension, infection, and autoimmune diseases—the symptoms will often be similar irrespective of the underlying condition. 

Depending on the stage of the disease, you may experience non-specific symptoms such as fatigue, malaise, nausea, and the loss of appetite alongside more characteristic signs such as kidney pain, foamy urine, and breath that smells of ammonia.

Over time, the progressive loss of kidney function can trigger a domino-like cascade of symptoms affecting the heart, lungs, brain, bones, and other organs.

 Illustration by Verywell 

Frequent Symptoms

Symptoms of CKD are often missed in the early stages of the disease and, in many cases, will be entirely invisible until significant damage has been done. Unlike an acute kidney injury (AKI), in which the symptoms appear abruptly and are often reversible, CKD is characterized by progressive and permanent damage over the course of months and years.

The symptoms of CKD develop as the kidneys are less able to filter water and waste from the blood. The accumulation of these and other excretory substances (such as uric acid, calcium, and albumin) can throw off the normal balance of acids and electrolytes in the body and interfere with circulation, blood pressure, digestion, respiration, and even brain activity.

Moreover, as the kidneys start to fail, they will stop producing a hormone called erythropoietin, which tells the body how to make erythrocytes (red blood cells). The depletion of these oxygen-carrying cells is referred to as anemia.

The impairment of kidney function can cause characteristic symptoms such as:

  • Cold intolerance (feeling cold all the time)
  • Difficulty urinating
  • Dizziness and lightheadedness
  • Dysgeusia (metallic taste)
  • Dyspnea (shortness of breath)
  • Easy bruising
  • Facial edema (swelling of the face)
  • Fatigue
  • Foamy urine (due to excess protein in the urine)
  • Loss of concentration
  • Nausea and vomiting
  • Nocturia (frequent urination at night)
  • Pain in the legs and upper back
  • Peripheral edema (swelling of the extremities, particularly the hands, ankles, and feet)
  • Pruritus (itchiness)
  • Uremia fetor (ammonia breath)

Complications

As CKD progresses and your kidney function falls below 25 percent of its normal value, the range of symptoms will become severe.

As part of an interrelated system, the loss of kidney function will invariably affect all other organs systems. Without the means to filter blood and clear waste, even beneficial substances can accumulate to toxic levels, leading to such metabolic complications as hypercalcemia (excessive calcium), hyperkalemia (excessive potassium), hyperphosphatemia (excessive phosphate), and uremic toxicity (excessive uric acid).

The interrelationship between the kidneys and other organs makes for health concerns that often beget other health concerns.

For example, high blood pressure—a common cause of CKD—can place persistent stress on the kidney, causing damage and the development of renal hypertension (high blood pressure of the kidneys). This, in turn, can further increase blood pressure and promote the development of atherosclerosis (the hardening of the arteries) and coronary artery disease.

The consequences of these metabolic imbalances can be far-ranging and severe. Among them:

  • Hypercalcemia can cause excessive urination, kidney stones, lethargy, loss of appetite, mental confusion, nocturia, weakness, fainting, and coma.
  • Hyperkalemia can cause chest pain, dyspnea, malaise, muscle weakness, nausea, numbness, palpitation, slowed heart rate, weak pulse, and sudden cardiac death.
  • Hyperphosphatemia can cause bone pain, muscle cramps, joint pain, and pruritus.
  • Renal hypertension can cause blurry vision, confusion, double vision, dyspnea, headaches, nausea, nosebleeds, vomiting, wheezing, and pulmonary edema (a build-up of fluid in the lungs).
  • Uremic toxicity can cause abdominal pain, bone demineralization, chest pain, erectile dysfunction, hematuria (blood in the urine), insomnia, irregular periods, loss of libido, memory loss/confusion, peripheral neuropathy (“pins and needles” sensations), pericarditis (inflammation of the heart), personality changes, seizures, and coronary artery disease.

End-Stage Renal Disease

The biggest concern arises when the kidneys start to shut down, a condition referred to as renal failure or end-stage renal disease (ESRD). ESRD requires that a patient get dialysis or a kidney transplant to survive.

Without life-sustaining interventions, toxins can build up quickly, causing a condition called uremia.

Death usually follows within a few days to several weeks. If the decision is made not to pursue dialysis, palliative care is needed to ensure that the individual is as comfortable as possible during his or her final days.

End-stage symptoms typically include:

  • Loss of appetite
  • Restlessness
  • Sleeping throughout most of the day
  • Disorientation and confusion
  • Hallucinations
  • Accumulation of fluid in the lungs
  • Changes in respiration
  • Changes in skin color and temperature

Cardiac arrest is the most common cause of death in people with ESRD. Other possible causes include infection, sepsis, stroke, and hemorrhage.

When to See a Doctor

The symptoms of CKD are often non-specific and generalized, meaning that they can be mistaken for any number of other illnesses. Because your kidneys are highly adaptable and able to compensate for lost function, the signs and symptoms may not be apparent until irreversible damage has occurred.

To this end, it is important to identify your personal risk factors and to see a doctor if you experience any symptoms suggestive of CKD.

Chronic Kidney Disease Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

Email the Guide

Send to yourself or a loved one.

Sign Up

This Doctor Discussion Guide has been sent to {{form.email}}.

There was an error. Please try again.

90,000 No reason joints do not hurt

– E Lena Viktorovna, if a person suddenly has a pain in the hands or knee, what can such a syndrome indicate?
– I do not want to frighten readers from the first lines, but the insidiousness of rheumatic joint lesions and diseases associated with metabolic disorders that rheumatologists deal with is precisely that they begin with similar symptoms – pain. In general, joint pain is only the tip of the iceberg, under which very dangerous diseases can be hidden, which can lead to the death of a person.However, it is often enough for a specialist to examine the patient, and then direct him to the very examination that will confirm or refute the formidable diagnosis. Indeed, in order to be fully examined for all possible types of rheumatic diseases, of which there are a great many, there will be neither time nor money.

– And if a person has a long-forgotten injury, as they say, old wounds will heal. Do not run to be examined in this case?
– Rheumatic diseases are always associated with inflammation, so they are relatively easy to distinguish from traumatic lesions in which pain can be reduced simply by changing posture.For example, with gout, the pain syndrome is so strong and exhausting that it is impossible to find a position in which it will pass. But trauma often has consequences. When cartilage is damaged, the immune system responds with inflammation and osteoarthritis often begins. Without proper treatment, the joint collapses, deforms and the person becomes disabled. When we see elderly people with crooked legs with the letter “O” or “X”, this is precisely the very arthrosis that they did not treat in time.

– Is it correct to relieve pain with anti-inflammatory pills and ointments during articular syndrome?
– That’s right, but just let them not be hormonal, which can “lubricate” the picture of the disease so that it will be very difficult to find the cause.And in no case do not heat, because heating will only increase inflammation. Therefore, in the acute period, woolen knee pads and honey cakes are dangerous, and cabbage leaves are useless. However, the pill only relieves pain and inflammation, but does not eliminate the cause. If the cause is an autoimmune disease, for example, systemic lupus erythematosus, then it will begin to actively damage not only the joint, but also the kidneys, lungs, brain, disabling the entire body. Not so long ago we had a patient whose kidneys seemed to suddenly fail, and then he remembered that about a month ago his fingers began to ache.

– What other diseases are autoimmune and how aggressive are they?
– Another dangerous disease based on an inadequate immune response to native tissue is systemic vasculitis. There are many variants of this disease. But the rate of progression of this disease is often unpredictable. Sometimes it’s years, and sometimes it’s weeks. Moreover, these autoimmune diseases are so insidious and aggressive that they can even affect the brain, causing psychosis and personality changes.

– Is it possible to identify the causes or at least triggers of joint diseases and prevent them?
– Joints can get sick without an obvious reason, they are not characterized by seasonality. Although systemic lupus erythematosus can be provoked by excess sunlight. Coming from the resorts, our patients noticed their first pains in their hands, because for this disease the nature of the defeat of small joints. The sun stimulates the immune system, but in a certain number of people it causes the immune response to malfunction.Joints can react to any changes in the body, even allergic reactions. Intestinal and urogenital infections are often the cause of joint diseases. Psoriasis, which suffers a lot of our fellow citizens, in some cases also affects the joints. Joint pain can occur after a banal flu, tick bite.

– Rheumatoid arthritis and other autoimmune diseases – are these indications for the constant intake of hormonal drugs?
– Not always.With an exacerbation, of course, active therapy is needed, and subsequently a person can take medications in supporting minimal dosages. But if you avoid and be afraid of treatment, the inflammatory process damages the joints so much that a person completely loses the ability to move in the affected joint and becomes disabled.

– Are gout and other metabolic disorders not so dangerous?
– Gout, or as it is also called “royal disease” develops from a good life, when people eat a lot and tasty, without denying themselves and alcohol.In this case, the system responsible for the production of uric acid fails. Untreated gout is visible to the naked eye – uric acid salts begin to be deposited in soft tissues – more often near the joints, ears, but can also be on the thighs, legs, even on the forehead. Excess uric acid also seriously damages the kidneys, leading to stones and chronic kidney failure. So the outcome is unpleasant. And there is also pseudogout with the same symptoms. But this disease has a completely different reason and it must be treated differently – in this case, a strict diet is not required, and only pills will help.

– So, you can’t do without a doctor in any case?
– And without examination, too. It is only important to trust your health to good specialists .

90,000 Kidney pain treatment

  • Evidence-based medicine
  • Patronage of Pain Management Clinic USA
  • Blockades are performed under the control of the C-arm in the X-ray operating room
  • Patient monitoring for 6 months

Do you suffer from excruciating abdominal pain under your ribs?
Do you suspect that the pain syndrome is due to kidney pathologies? Not
postpone your visit to the doctor! Remember that some renal
diseases can threaten with serious complications, up to
lethal outcome.Identify the source of the pain and get rid of it for you
help at the Pain Management Clinic.

Kidney pain symptoms

How to understand that it is the kidneys that hurt? We recommend that you do not
engage in self-diagnosis and self-medication, so
how near the kidneys it finds many other organs: liver, intestines,
spleen and other organs. It may seem to you that your kidneys hurt, but on
in fact, pain is of a completely different nature. Therefore – trust
diagnostics for professionals!

What are the symptoms of kidney pain:

  • Pain occurs just below the lower ribs.It can be sharp
    pulling, stabbing, aching and tormenting the patient constantly or
    attacks.
  • Swelling began to appear on the face and limbs, worsening in the morning.
  • The patient feels general weakness, malaise, increased
    temperature for no apparent reason.
  • The color and smell of urine has changed.

Have you noticed one of the listed symptoms? Hurry on
consultation with a doctor! The earlier the disease is detected, the
the treatment will be easier and faster.

Pain Management Clinic Specialists

Causes of kidney pain

Pain in the kidney area can occur due to the following pathologies:

  • Kidney disease:
    • Kidney stones
    • Pyelonephritis
    • Glomerulonephritis
    • Renal artery stenosis and thrombosis
    • Cyst, kidney tumor
  • Diseases of other body systems (in this case, pain
    does not occur in the kidneys, but resembles kidney pain or radiates to
    kidneys):

    • Spine pathologies:
      • Herniated disc
      • Osteochondrosis
      • Lumbago
    • Acute appendicitis
    • Prostatitis and prostate adenoma

Do not try to diagnose your disease yourself! It threatens
misdiagnosis and, as a result, ineffective
treatment and progression of a real disease.

Diagnosis and treatment of kidney pain

If you feel renal colic or other pain, you should
consult a doctor: therapist, nephrologist, urologist, oncologist or
neurologist. To make a correct diagnosis, you may need
the following diagnostic methods:

Analysis of urine

MRI

Ultrasound

Roentgen, etc.

Only when the source of the pain is identified can a competent
treatment.It usually includes drug therapy, in
difficult cases – surgical intervention.

However, in some cases, to help you get rid of kidney pain
can only be performed by the specialists of the Pain Treatment Clinic using the latest
pain treatment methods:

Kidneys hurt – what to do?

Our recommendation is not to torment your body with unnecessary pills and
do not self-medicate! At the Pain Management Clinic, experienced doctors will help you
help to get rid of pain of any nature with the help of the latest
treatment methods and high-precision equipment.

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.

  • See your doctor regularly and be sure to get your tests done as often as your doctor has prescribed. Know the value of your core metrics – glomerular filtration rate (GFR) and serum creatinine. Ask your doctor to explain their meaning.
  • Strictly follow your treatment plan and talk to your doctor or nurse about any questions or concerns about your illness and its treatment.
  • Use only medicines prescribed and approved by your doctor. Some medicines can damage the kidneys. Know the names and dosages of your medicines. Take them only as directed by your doctor.
  • Use only nutritional supplements and vitamins recommended by your doctor.
  • When visiting doctors, always inform them that you have chronic kidney disease. You must also inform your doctor that another doctor has prescribed a course of treatment for you.
  • If you need to have examinations with contrast media (eg computed tomography, angiography, magnetic resonance imaging), first discuss them with your doctor and follow his instructions.
  • If you have high blood pressure, you should know the recommended blood pressure level and keep it under control. This is very important for the protection of the kidneys.
  • If you have diabetes, control your blood sugar, eat your diet and take medication.
  • Know your cholesterol level. If your cholesterol level rises, follow the recommended lifestyle carefully. For this, it is very important to adhere to a diet, an active lifestyle, maintain weight at a normal level for you and take medications.
  • Follow a healthy diet. If you need to limit your intake of any food, plan the composition of your meal so that you can get all the necessary nutrients and calories from it.
  • If you are overweight, work with your doctor to find safe methods to reduce body weight. Reducing body weight will help the kidneys work normally longer.
  • Do not skip meals or go without food for several hours.
  • Try to eat 4-5 small meals instead of 1-2 main meals.
  • Drink plenty of fluids. If your doctor has prescribed a limited fluid intake for you, it is very important to follow this recommendation.If you still feel thirsty, you can quench it by putting a slice of lemon in your mouth or by rinsing your mouth with water.
  • Reduce dietary salt intake.
  • Be physically active. Physical activity can help reduce blood pressure, blood sugar and cholesterol levels, and help you cope better with illness.
  • If you smoke, find a way to quit the habit.
  • Try to be active in maintaining your health.
  • Search and find information about chronic kidney disease and its treatment.
  • If you have diabetes, control your blood sugar, eat your diet and take medication.
  • Know your cholesterol level. If your cholesterol level rises, follow the recommended lifestyle carefully. For this, it is very important to adhere to a diet, an active lifestyle, maintain weight at a normal level for you and take medications.
  • Follow a healthy diet. If you need to limit your intake of any food, plan the composition of your meal so that you can get all the necessary nutrients and calories from it.
  • If you are overweight, work with your doctor to find safe methods to reduce body weight. Reducing body weight will help the kidneys work normally longer.
  • Do not skip meals or go without food for several hours.
  • Try to eat 4-5 small meals instead of 1-2 main meals.
  • Drink plenty of fluids. If your doctor has prescribed a limited fluid intake for you, it is very important to follow this recommendation. If you still feel thirsty, you can quench it by putting a slice of lemon in your mouth or by rinsing your mouth with water.
  • Reduce dietary salt intake.
  • Be physically active. Physical activity can help reduce blood pressure, blood sugar and cholesterol levels, and help you cope better with illness.
  • If you smoke, find a way to quit the habit.
  • Try to be active in maintaining your health.
  • Search and find information about chronic kidney disease and its 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
  • help 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 filtration capacity of the kidneys is assessed based on 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, it was found in many people that almost one in ten people were found to have impaired renal function to one degree or another.

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.
  • High 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 – a disease resulting from a malfunction of the immune system, during which the filtration function of the kidneys disrupts 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 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
  • over 50 years old
  • Long-term use of drugs that can damage the kidneys
  • overweight or obese

What are the symptoms of chronic kidney disease?

As 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 discoloration, 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 severity of kidney disease

Stage
gravity
Description SKF
1 Kidney damage (albuminuria or protein in urine) occurs, but GFR
within normal limits.
GFR> 90 ml / min
2 Slight decrease in GFR GFR 60–89 ml / min
3A

3B

Moderate decrease in GFR (early symptoms of renal failure occur) GFR 45-59 ml / min

GFR 30-44 ml / min

4 Severe decrease in GFR (ie, predialysis stage, late symptoms of renal failure occur). GFR 15-29 ml / min
5 End, end-stage renal failure
(uremia occurs, renal replacement therapy is necessary).
SKF
  • Visit your doctor regularly and be sure to get your tests done as often as prescribed by your doctor.
  • Mandatory about from from If you have any complaints or problems with your doctor or nurse.Do not under any circumstances self-medicate and self-diagnose.

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 (see Table 1).

Urinalysis : The albumin content is determined in the urine, in addition, the relationship between 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 the kidney is healthy, the albumin does not pass into the urine.
  • In the case of a damaged kidney, albumin begins to enter the urine.

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.Ultrasound examination allows you to evaluate the shape of the kidneys, their size, location, as well as 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 a contrast test if you have chronic kidney disease?

Diagnostic tests 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 cont. with plant matter?

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. Your family doctor will be able to assess your renal function in an outpatient contrast examination.
  • Talk with your healthcare provider about what medications should not be taken prior to 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 earliest opportunity, allow enough time so that the contrast medium used in 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 nephrogenic systemic 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.

  • Know the value of your main indicators – the glomerular filtration rate (GFR) and serum creatinine level. Ask your doctor to explain their meaning.
  • E If you n at you need to have examinations with a contrast agent (e.g. computed tomography, angiography, magnetic resonance imaging), discuss this with your doctor first and follow it. directions.

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 eye doctor 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 begins 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 the results of 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 independently 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.

Blood sugar (mmol / L) Normal Too high
Before meals > 6.5
1.5-2 hours after meals > 8.0
Glycohemoglobin HbA1C (in%) > 8.0
Glycohemoglobin HbA1C (in mmol / mol) > 64
  • E If you have high blood pressure or have been diagnosed with hypertension, you should know the recommended blood pressure level and keep it under control.Take your hypertension medications as prescribed by your doctor.
  • E If you have diabetes, control your blood sugar, stick to a prescribed diet and take your medications correctly.

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 lower cholesterol levels, 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 to 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 checked 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 due to 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

Always check with your family doctor or health care provider prior to taking vitamin D.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.

Serum vitamin D level:
vitamin deficiency
25-50 nmol / L severe hypovitaminosis
50-75 nmol / L hypovitaminosis
> 75 nmol / L sufficient level
> 300 nmol / L toxic level

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.).).

  • AND Use t o Only those drugs that have been prescribed and approved by your doctor. Some medicines can damage the kidneys.
  • Know the names and dosages of your medicines. Take them only as directed by your doctor. Use only nutritional supplements and vitamins recommended by your doctor.
  • Be sure to discuss any questions you might have regarding medicines, vitamins and supplements with your doctor or nurse if you have any questions about .
  • When visiting doctors, always inform them that you have chronic kidney disease. You must also inform your doctor that another doctor has prescribed a course of treatment for you.

Complications of chronic kidney disease

The occurrence of complications of chronic kidney disease depends directly on the severity of renal dysfunction, 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 caloric and / or protein intake.
  • 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 developing skeletal 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, the formation of bone tissue (calcifications) begins 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 levels of iron in the blood.
  • Diseases of the cardiovascular system that 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 can 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.
  • Try to be active in maintaining your health.
  • Search for information on chronic kidney disease and its treatment. Be sure to discuss any questions with your doctor or nurse.

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
  • more than 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, 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 will help you determine how much protein your food should contain based on your kidney function. If the protein content of food is limited due to chronic kidney disease, then this means that the source of calories can 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:

  • Know how much protein you can consume in one day.
  • Investigate which foods contain protein and choose the most suitable 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 blood phosphate levels, 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 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 with your doctor or nurse about how much fluid you should be drinking.If you feel that fluid starts 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 with too much 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.

  • If you have to limit your intake of any food , talk to your doctor or nurse about how to properly structure your diet so that you still get the nutrients and calories you need with your daily meal.
  • Learn to read food packaging labels so you know how much sodium, protein, potassium, phosphorus, and calcium is in different foods.
  • E If you are overweight, try to achieve weight loss. Reducing body weight will help the kidneys work normally longer.
  • E If your body weight increases too quickly, be sure to inform your doctor.
  • P Add enough liquid.
  • Y m Reduce the amount of salt consumed with food.

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 alcohol in the amount of more than 1-2 units, 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 strength and elasticity of muscles
  • helps you to relax
  • helps keep blood pressure under control
  • reduces the content of cholesterol and triglycerides in the blood
  • 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 calmer 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 training schedule into your day plan – training 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 for the next workout
  • the intensity of the workout should be at the comfort level

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

  • you feel very tired
  • shortness of breath occurs during exercise
  • Feel chest pain, heart rate increases suddenly or becomes irregular.
  • feel abdominal pain
  • spasms occur in the 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 you have enough calories.

  • If you smoke, find an opportunity to quit this habit.
  • There must be at least three non-alcoholic days in a row during the week.
  • By Every day you need to find time for physical activity. Take a walk, do light workouts, or take care of your garden or vegetable garden

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: change the diet, depending on the state of renal function, get used to the disease, remember 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 addressed, 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. Nobody 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 follow your doctor’s recommendations.
  • Take care of yourself. Treat yourself to your favorite activities: listen to soothing music, read your favorite literature or magazines, visit the theater, 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 about it. Check whether the necessary tests have been done for you, whether 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 kidney replacement treatment, 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 your 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 mandatory financing and the share remaining after deducting the benefit, the buyer must pay a part of the price that exceeds the maximum price. The latter is the fraction 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 maximum 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 diseases and injuries can be treated or the use of which prevents the deepening of the disease. 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 you can prevent an emerging or congenital health defect or the progression of a disease, compensate for functional impairment caused by any damage or health defect, as well as 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 precision of the ISO code, but should be recorded in a form that is understandable to all.It should be clear from it 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 Pain as a symptom of urological disease

Pain is one of the most frequent and important symptoms of urological diseases.Pain can be localized in the lumbar region, hypochondrium, above the bosom, in the perineum, genitals. They vary in intensity (acute, dull), periodicity (constant, seizures, arising periodically), type of irradiation, may or may not depend on the position of the body.
When asking older children, it is possible to clearly determine the localization of pain and its irradiation. Younger patients for the most part cannot describe the pain that has arisen and express them by crying, fright, whims.At the same time, pain syndrome with irradiation to the abdominal region in children of this age group often occurs with diseases not associated with the genitourinary system or with surgical diseases. Therefore, the correct interpretation of pain in children is possible only when comparing with other symptoms, among which urination disorders play an important role.
Dull persistent pain in the lumbar region is most typical for chronic pyelonephritis, hydronephrosis, sometimes pyonephrosis, non-occlusive kidney stones, including coral stones.Irradiation of pain is little expressed or absent. A change in body position does not affect the intensity of pain caused by these diseases, which makes it possible to differentiate them from osteochondrosis of the thoracic and lumbosacral spine. Sometimes pain during movement, radiating to the groin and to the anterior-inner surface of the thigh, the forced position of the patient (scoliosis in the direction of the lesion, flexion of the lower limb in the hip joint) can be a manifestation of paranephritis, which has spread to the pelvis and through the obturator opening to the thigh.
Renal colic is an acute painful attack caused by a sharp violation of the outflow of urine from the kidney due to acute occlusion of the pelvis or ureter. The mechanism of pain is associated with a sharp increase in intralocal pressure, which causes backflow of urine contained in the pelvis and cups into the renal tissue and its vessels (pyelotubular and pyelovenous reflux). This leads to pronounced edema of the parenchyma, overstretching of the kidney capsule and irritation of the baroreceptors, followed by the transmission of a nerve impulse to the pain centers of the subcortical structures of the brain.
Irritation of receptors in the vessels of the renal parenchyma, the wall of the pelvis and around it at the hilum of the kidney is of lesser importance. The latter react to the stretching of the pelvis and the perspiration of urine into the parapelvic tissue. This explains the renal localization of pain at any level of obstruction from the pelvis to the orifice of the ureter. Rapid stretching of the pelvis leads to a sharp reflex contraction of its muscles and the muscles of the ureter (spastic wave), which also triggers the pain reflex. Pain impulses from the kidney, upper and middle third of the ureter are conducted along sympathetic nerves through the aortic-renal ganglion, celiac ganglion and the small celiac nerve.Irritations from the distal part of the ureter are transmitted along parasympathetic nerves to the aortic-renal ganglion, testicular plexus, hypogastric and pelvic nerve plexuses. Places of pain irradiation are associated with the localization of calculus in the ureter: the mesogastric and iliac region – the upper third of the ureter, the groin region – the middle third, the genitals and perineum – the lower third of the ureter.
The causes of renal colic are very diverse – obstructing stones of the kidneys and upper urinary tract, blood clots, accumulations of mucus and pus, sharp bends of the ureter with nephroptosis, necrotic masses with kidney tuberculosis, necrotizing papillitis, tumor decay, which suddenly occlude the lumen of the urinary tract.Impaired outflow of urine from the kidney, leading to renal colic, can also occur with allergic edema of the ureter. Intermittent hydronephrosis in children can also lead to acute pain. In this case, an attack of renal colic in most cases is short-lived, occurs suddenly, without previous symptoms. The penetration of small (up to 1.0 cm) stones from the renal pelvis or its cups into the ureter causes its spasm and an acute violation of the outflow of urine from the kidney, which leads to renal colic, while larger kidney stones are much less likely to cause the development of this pathological condition.During colic, it is often possible to palpate an enlarged kidney, the size of which decreases as the pain subsides.
The clinical picture of renal colic is characterized by an attack of acute pain in the lower back and lateral parts of the abdomen with pronounced irradiation to the area of ​​the inner thigh, groin and genitals. The patient’s restless behavior is extremely typical: he rushes about, cannot find a position in which the pain decreases, the abdomen is sharply painful on palpation and tense in the hypochondrium.If the obstruction of the ureter occurred in its lower part, then renal colic is accompanied by increased urination or pain in the urethra. Renal colic is accompanied by nausea and vomiting, which is caused by irritation of the solar plexus and peritoneum due to the close connection of the renal and celiac (solar) nerve plexuses.
The duration of an attack of renal colic is from several minutes to several hours. Sometimes the pain causes a fainting or collaptoid state, painful shock.
In most children, an attack of renal colic does not last long (10-15 minutes), sometimes accompanied by an increased urge to urinate (pollakiuria).Pain in renal colic in children is not severe and quickly relieved after taking a warm bath or prescribing drugs with an antispasmodic effect.
Pathological changes in urine in renal colic are different: from minor proteinuria, erythro- and leukocyturia to macrohematuria. However, with complete obstruction of the ureter of the affected kidney, urine from it does not enter the bladder, and urine analysis from the contralateral kidney may be completely normal. Therefore, for reliable confirmation of renal colic, it is necessary to conduct an ultrasound examination of the kidneys.Determined by ultrasound, the expansion of the pyelocaliceal system on the affected side is an indirect sign of occlusion of the upper urinary tract.
Renal colic is recognized by a typical pain attack. Often, the already characteristic restless behavior of the patient makes it possible to suspect renal colic. Despite the brightness of the clinical picture, it must be remembered that under the mask of renal colic there may be acute surgical diseases that require urgent surgery. Therefore, renal colic must be differentiated from acute cholecystitis, pancreatitis, intestinal obstruction, acute appendicitis, perforated gastric ulcer, mesenteric vascular thrombosis, ovarian cyst torsion, ectopic pregnancy, inflammation of the uterine appendages.Ultrasound plays an important role in the differential diagnosis of renal colic and acute surgical diseases. In case of acute pain in the scrotum, examination and palpation of the external genital organs are necessary for the differential diagnosis of renal colic and acute epididymitis, orchitis or torsion of the spermatic cord.
The appearance of pain in the lumbar region during urination is a characteristic symptom of the throwing of urine from the bladder into the renal pelvis (vesicoureteral reflux). Most often, this symptom is observed in childhood: the child cries and complains of pain in the lumbar region during urination, but calms down after it ends.Sometimes two-stage urination is noted: a few minutes after emptying the bladder, patients again feel the urge to urinate, after which they excrete a small amount of urine without pain.
Pain in the ureter region spreads from top to bottom – from the lumbar region along the right or left side of the abdomen to the bladder and genitals (pain irradiation).
Pain in the bladder area can be constant or associated with the act of urination – before, during or at the end of it.Pain impulses from the bladder come along the somatic nerves of the abdominal wall. The pain may occur in the bladder area during movement and stop at rest (characteristic of the presence of stones in the bladder). Intensity – from a feeling of slight heaviness over the bosom to severe pain that does not stop day or night. The pain can radiate to the perineum, anus and the glans penis.
Most often, pain in the bladder is associated with inflammation. In this case, in addition to pain, there is an increase in urination.
Pain in the urethra may be associated with inflammation, injury, discharge of salts or calculus. It can occur during urination or be persistent. When urinating, pain occurs at the beginning or at the end, or continues throughout the entire act. The intensity of pain in the urethra can vary from sharp and pronounced in acute urethritis to a slight “tingling” and burning sensation in chronic inflammation of the urethra.Pain not associated with the act of urination may be due to colliculitis (inflammation of the seminal tubercle). Inflammation of the seminal tubercle can also cause pain in the urethra during and after intercourse.
Pain in the prostate gland is transmitted along the sacral nerves (parasympathetic innervation, LIV-SIV segments) and appears in acute and chronic inflammation of the prostate and seminal vesicles, prostate cancer, and rectal diseases.In chronic prostatitis and vesiculitis, patients complain of aching pain with irradiation to the perineum, sacrum, testicle, penis, rectum. With hypothermia, prolonged sitting, for example, during a car trip, after taking strong alcoholic beverages, beer, and in some patients, even after intercourse, the pain may increase. In acute prostatitis, there is a sharp pain radiating to the anus, perineum, sometimes the pain is pulsating in nature, increases with defecation.With prostate cancer, painful sensations appear under the bosom, in the anus, sacrum, lower back, thighs, there is a feeling of pressure on the perineum. Lumbosacral pain can also be a consequence of the metastasis of prostate cancer to the bone.
Pain in the scrotum radiating to the groin, sacrum, lumbar region is characteristic of diseases and injuries of the external genital organs. Pain impulses from the testicle and its epididymis are transmitted along the sacral, femoral-genital nerves and the testicular plexus.Severe pain in the scrotum, the intensity of which increases with movement, occurs with acute inflammation of the testicle and its epididymis, with torsion of the spermatic cord, with torsion and necrosis of the suspensions (hydatids) of the testicle and epididymis. Pain in oncological and chronic inflammatory diseases of the external genital organs are dull in nature, patients feel heaviness in the scrotum. It must be remembered that pain in diseases of the kidneys, bladder, prostate and seminal vesicles can radiate to the external genital organs, and if the pathology of the scrotum organs is excluded, it is necessary to examine other organs of the genitourinary system.
Aching pains in the penis, combined with its curvature, are observed in Peyronie’s disease (fibroplastic induration of the penis). Inflammation of the corpora cavernosa and the glans penis (cavernitis and balanoposthitis), infringement of the head by the foreskin (paraphimosis) and “fracture” of the penis (rupture of its tunica albuginea), persistent erection, not associated with sexual arousal (priapism), lead to severe pain in the penis.

Order a call ← Our specialists can call you back at a convenient time for you. The call is free!

previous article
next article

90,000 Vision diminishes and back hurts. Doctor On How To Recognize Kidney Disease | HEALTH: Medicine | HEALTH

“Kidney” patients often die from heart attacks and strokes. Their mortality is recorded as cardiovascular pathology. Hence the model of health care: everything is for solving cardiological problems, and nobody cares about kidney diseases, ”said Tatyana Mamkina, head of the nephrology department of the regional clinical hospital, chief nephrologist of the Tver region, .

How to notice in time that the kidneys have malfunctioned and not bring oneself to hemodialysis, Tatyana Yurievna told AIF in Tver.

From ignorance to hemodialysis

Dmitry Boykov, AIF in Tver: Why do people know little about the dangers associated with kidney disease?

chief nephrologist of the Tver region Tatyana Mamkina. Photo: From personal archive / Tatyana Mamkina

Tatyana Mamkina: The trouble is that the country did not understand how important it is to provide such information.The focus is on the diseases from which the most people die, namely, oncological and cardiovascular diseases. Based on this, they train personnel, distribute budgets, conduct medical examinations and open high-tech centers.

But the reduction in mortality will not be successful without treatment of renal diseases, in which the excretion of metabolic products from the blood is slowed down. At risk are diabetics, hypertensive patients, overweight people, metabolic syndrome, and elderly citizens.

Many patients come to see us in the stage of thermal renal failure. She is considered the last, without hemodialysis, such patients can no longer live.

Waste time

– What are the signs of kidney pathology? How to tell when to see a nephrologist?

– Only inflammatory kidney diseases proceed with a bright clinic. They most often occur after colds and hypothermia. There are pains in the lumbar spine, lower abdomen, fever.In such cases, people usually go to a therapist. Therefore, we hold conferences with doctors of this specialty: we teach them to identify kidney pathology at an early stage.

Most of the kidney diseases are latent, do not manifest themselves for the time being. But, even when this happens, a person often does not realize that he has problems with the kidneys. If relatives or friends notice that he has pale skin, the patient goes to the hematologist. Antihypertensive drugs cannot reduce high blood pressure – they turn to a cardiologist.There are pains when urinating – they go to the urologist. Some make an appointment with an ophthalmologist because their eyesight drops sharply. All these doctors, in laboratory tests of urine and blood, ultimately reveal the true cause of poor health, namely kidney disease. But time is wasted, the problem sometimes goes too far, to the stage of renal failure. The organ may have already failed, hemodialysis is required. An alternative method is a donor kidney transplant. But most regions do not have their own transplant centers and you have to go to Moscow.Besides, you have to wait in line there for a year or two.

Renal replacement therapy in the later stages is not only through hemodialysis. There is also peritoneal dialysis. Patients carry out it on their own at home. A special catheter is implanted into the abdominal cavity through which dialysis solution is poured. The kidney function is performed by the peritoneum.

Simple Rules

– What do you need to keep your kidneys in order?

– Follow a few reasonable rules.It is now fashionable to take a large number of drugs for any reason. Painkillers and non-steroidal anti-inflammatory drugs are especially dangerous for the kidneys. Elderly citizens use them every now and then if there are pains in the lower back and joints. Women take medication for headaches. You can understand them, because everyone wants to live without suffering. But few people think about the side effects of medications. They often disrupt kidney function: if you do not stop in time, the results can be disastrous.

We live in a world of abundance. The shops have everything: sausages, a huge amount of cheeses, canned food. These foods are high in salt. The kidneys are just the organ that removes it from the body. Therefore, it is wise to eat homemade foods while limiting the amount of salt added. Her daily intake is 5-6 grams, one teaspoon. Pay attention to how much you drink. Elena Malysheva in her popular TV program says that you need to drink a large amount of liquid, up to four liters a day.However, this rule is true for healthy young people. But Malyshev is also watched by those who are over 50-60 years old. They also begin to take in a lot of fluids, but their body can no longer cope with the water load. By contrast, most older people need to limit their water intake.

But the most important prophylaxis is clinical examination. The tests passed on time allow not to miss sluggish diseases. It is necessary to do a general analysis of blood and urine every 6-7 months, once a year to find out the amount of creatinine in the blood.The earlier problems are identified, the more likely you are to live a long life. Kidney disease goes through several stages – from the first, when only markers in the blood and urine speak about them, to the fifth, when an organ transplant or dialysis is required. Half of our patients go to doctors in serious condition.

Now autumn is the time of viral diseases. After suffering colds, do not be lazy to be examined: do the same urine and blood tests. It’s very simple, but everyone has no time! As a result, we miss mild kidney damage, which then becomes chronic.The danger of kidney failure cannot be underestimated: it is irreversible. Everyone who lives on hemodialysis is given a disability. The procedure is lifelong and cannot be canceled.

“Late to drink Borjomi”

– Is it possible to lead an active lifestyle on hemodialysis?

– It depends at what age the patient gets on renal replacement therapy. Young people in their 20s and 30s usually feel well on dialysis. Many return to their favorite work, some even start a family, a few give birth to children.However, the majority of patients are over 50 years old. Everything goes much harder for them. On average, people are given three hemodialysis sessions per week, four hours each. Only such procedures can increase the quality and duration of the patient’s life. So take care of your health and do not bring the situation to the point when it is “too late to drink Borjomi”. And most importantly – do not neglect the medical examination!

See also:

90,000 What is pyelonephritis?

Pyelonephritis is an inflammatory disease of the kidneys and renal pelvis, which can undermine the health of anyone, regardless of gender or age.Pyelonephritis begins when bacteria living in our body or the environment enter the kidney tissue. The pathogen can be transferred to the kidney with the flow of blood or lymph, for example, from the respiratory tract with angina, pneumonia, or it can enter the so-called ascending pathway, through the ureter with cystitis, urethritis, prostatitis or sexually transmitted diseases. It must be remembered that pyelonephritis often occurs with a decrease in the protective capabilities of the urinary system and the whole body.Chronic diseases such as diabetes mellitus, inflammation of the urogenital tract, intestinal dysbiosis, etc., as well as hypothermia, vitamin deficiency, fatigue – weaken the immune system, contributing to the development of pyelonephritis.

A person of any age can get pyelonephritis, but women 18-30 years old, get sick 5 times more often than men, children under 7 years old also often get sick.

How is pyelonephritis manifested?

Distinguish between acute and chronic pyelonephritis.Chronic, as a rule, is a consequence of an “untreated” acute. Acute pyelonephritis immediately makes itself felt: painful, frequent urination, pain in the lumbar region, fever up to 38-39 ° C, accompanied by chills, weakness. Chronic pyelonephritis can go unnoticed. Often, the only symptoms are constant weakness, rapid fatigability, periodically dull aching pain in the lower back, especially in damp cold weather or a prolonged increase in body temperature to 37.0-37.5 ° C, may be a concern.During periods of exacerbation, all signs of an acute illness appear.

How to make a diagnosis?

On occurrence:
• Painful and frequent urination,
• Constant pain in the lumbar region, accompanied by chills, fever,
• Prolonged increase in body temperature to subfebrile numbers (37.0-37.5 ° C)

you must immediately contact a nephrologist to exclude pyelonephritis! Correct and timely diagnosis is the most important thing to start with in the fight against the disease.The main importance in the diagnosis is a medical examination, the results of clinical blood and urine tests, ultrasound and X-ray data.

What will happen if you do not go to the doctor? If you take your condition lightly and do not start treatment on time, pyelonephritis can result in formidable purulent complications – an abscess or a carbuncle of the kidney, the development of sepsis. The danger of chronic pyelonephritis lies in the fact that each successive exacerbation is accompanied by the involvement of more and more areas of the renal tissue in the inflammatory process, ultimately repeated attacks of inflammation lead to shrinkage of the kidney.

How to be treated?

Treatment of pyelonephritis is always complex and individual. The choice of the most effective antibiotic therapy is carried out according to the results of a microbiological study of urine.
Only a doctor can select the necessary drugs in each case! Taking antibiotics on your own, without a doctor’s special prescription, is not only impractical, but even harmful. This leads to the formation of insensitivity of microorganisms to further therapy, and, in addition, destroys the intestinal flora and provokes the most severe dysbacteriosis.

Prevention of pyelonephritis

In the prevention of the development of inflammatory diseases of the urinary system, it is of great importance: timely started treatment and adherence to the principles of a healthy lifestyle: sports, good rest, adherence to a diet with limited harmful effects on the body of alcohol, spicy, salty or fatty foods, the consumption of vegetables, fruits, natural juices and mineral water. We wish you good health!

For problems with kidney and urinary system diseases, you can visit a nephrologist.

90,000 Arthritis: Causes, Symptoms and Treatment | Health Blog

Pain during movement can be caused by a wide variety of diseases. The reason may be trauma, nerve diseases, tumors, congenital structural anomalies. A common culprit for pain in adults is arthritis, an inflammation of the joints.

What is arthritis?

This name is understood as a whole group of diseases in which inflammation spreads to all parts of the joint.The disease can occur in one joint or in several, with acute pain or in a chronic form, as well as provoke tissue destruction.

The disease has two classifications. By engagement:

  • monoarthritis – inflammation occurs in only one joint;
  • Polyarthritis covers several joints at once (the same on both sides or random in different parts of the body).

U Downstream:

  • Acute – begins suddenly and is accompanied by severe pain;
  • Chronic – develops rather slowly, may appear after an acute form with insufficient treatment.

There is also an international rheumatological classification, in which the following types of arthritis are distinguished:

  • infectious – with the development of the disease after infection;
  • dystrophic – caused by the destruction of joints and bones;
  • traumatic – after mechanical damage to the joint;
  • associated with other diseases of the body – may be caused by tumors, diseases of the digestive tract and others.

Symptoms of arthritis. How to distinguish one species from another?

Despite the various manifestations, some symptoms of arthritis always appear. Regardless of what caused the disease, the patient observes:

  • edema and swelling around the affected joint,
  • redness of the skin and an increase in its temperature,
  • limitation of movement in the joint, accompanied by crunching and pain.

In addition, there are symptoms by which you can distinguish types of arthritis from each other.They depend on the cause and nature of the course:

  • with chronic arthritis deformity of diseased joints begins;
  • Infectious arthritis associated with fever, chills, weakness, and headache;
  • dystrophic arthritis develops slowly, joint pain gradually increases. It can spread not only to the limbs, but also to the spine;
  • traumatic arthritis is similar in symptoms to dystrophic arthritis, but its development is preceded by serious trauma or constant stress on the joint;
  • in case of arthritis caused by allergies, tumors, disorders of the gastrointestinal tract, all the symptoms that caused the disease will be observed.

If, in addition to the listed symptoms, there are tears of muscles and tendons, as well as numbness of the extremities, the disease has started and complications have begun that require immediate treatment.

Causes of the disease

Some causes of arthritis lie in poor lifestyle choices:

  • insufficient amount of nutrients and vitamins,
  • unbalanced diet,
  • alcohol consumption,
  • overweight,
  • stress on the joints.

Others are more serious and are unlikely to be avoided with routine prophylaxis:

  • bacterial, fungal, viral infections;
  • constant interaction with allergens;
  • joint injuries;
  • diseases of the nervous and immune systems;
  • metabolic disorders;
  • endocrine gland pathology;
  • hereditary predisposition;
  • some diseases: gout, gonorrhea, tuberculosis.

Women suffer from arthritis more often than men.Constant stress, past illnesses and surgical interventions often provoke the first attacks of arthritis. Also, the risk of getting sick increases with age.

What does the arthritis diagnosis include?

Arthritis manifests itself very clearly – even a layman will notice it. To accurately determine the causes of the disease, after a visual examination, the doctor may prescribe the following procedures:

  • general analysis of blood and urine will show the presence of infections and the degree of inflammatory processes;
  • analysis of synovial fluid – it can be used to determine the presence of inflammatory and septic processes;
  • arthroscopy – endoscopic insertion of the probe into the articular cavity for visual examination;
  • Ultrasound of the joints will help determine the extent of the lesion and detect the main areas of the disease;
  • X-ray of the joint and limb will show the condition of the bones and joints, reveal the changes caused by arthritis;
  • Computed tomography of the joint is one of the best tools for assessing the condition of bones and joints;
  • Magnetic resonance imaging will help to examine the condition of the bones and joints, as well as the surrounding tissues.

If arthritis is accompanied by abdominal discomfort, headaches, weakness – be sure to tell your doctor about it. This may indicate a serious illness in which joint inflammation is just one of the symptoms.

How is the treatment going?

Therapy includes getting rid of the pain syndrome, eliminating the cause of the disease and restoring the diseased joint.

  • the doctor can prescribe pain relievers and anti-inflammatory drugs,
  • in advanced cases, they perform operations to restore destroyed joints,
  • physiotherapy procedures have proven themselves well: massage, ultrasound therapy, laser therapy,
  • many patients are advised to do light gymnastics: it should be developed by a doctor Exercise therapy taking into account the course of the disease.

Arthritis treatment cannot be complete without lifestyle changes: pay attention to the quality of your diet, avoid weight gain, and avoid alcohol and high amounts of salt.

If you start therapy in the initial stages, the disease can be easily treated. The most important thing is to pay attention to all changes in the body in order to consult a doctor in time and prevent the development of complications.