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Every person has two kidneys through which
urine is secreted. These kidneys maintain the
equilibrium of body fluids and the blood acidity formula and
rid the body of foods and other poisonous substances.
The kidneys by means of certain secretions also control
activation of the marrow to produce red blood cells and to
strengthen bones.
From the above, we realize the importance of
the kidneys to our lives. Any malfunction exposes our lives
to a danger known as renal failure.
Divine Mercy made man capable of living with 25% or less of
his kidney's functioning. When this function drops to
5%, then the patient is in need of an alternate means to
treat this failure.
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Renal failure is divided into two
types:
Acute Renal Failure:
Which happens as a result of prostate
enlargement or crystals blocking the urinary tract or severe
hemorrhage or certain cases of poisoned pregnancy.
Chronic Renal Failure:
This needs months or years to develop and
occurs as a result of bilharzial infection, repeated
streptococcal infection in children, diabetes, gout,
hypertension or ptosed kidneys
.
What are the periodic clinical
tests to ensure healthy kidneys?
1. Urine Analysis:
Urine Color:
The normal color of urine is yellow and
becomes darker upon insufficient drinking of fluids.
Red urine is usually the result of hemorrhage, certain
medication, dyes or overeating of beetroots. Brown
urine (color of licorice) may be an indication of the
patient's infection with hepatitis as a result of
Urobilinogen in the blood. White urine (color of milk)
is an indication of lymph in the blood due to a blockage in
the lymph vessels as a result of infections or tumors.
Turbidity of Urine:
Usually urine is transparent and turbidity is
the result of the presence of blood, iron, bacteria or uric
acid.
PH:
The normal PH of urine is acidic (between 4.5
- 6.5). Urine becomes more acidic with the excessive eating
of meat and animal proteins and becomes more alkaline when
eating vegetables, citrus fruits or keeping the urine for a
long time before examining it.
Specific Gravity:
The specific gravity of urine is considered
an indicator of the kidneys' capacity to concentrate.
The specific gravity decreases in case of
frequent drinking of fluids and in case of failure renal
functions. It increases in case of severe thirst,
diarrhea, continuous vomiting, Diabetes or after the use of
certain dyes for X-ray of the kidneys. The normal
range of specific gravity is between 1015 and 1025.
Albumin:
The normal rate of albumin, which is excreted
in urine is very small and difficult to monitor by regular
tests. The rate increase in case of kidney infection, kidney
TB or tumors.
Diabetes:
In a healthy person, there is no glucose in
urine. Examination of urine cannot be relied on to diagnose
diabetes because blood glucose could be elevated yet the
urine glucose in negative.
Urobilinogen:
Urine is usually negative for Urobilinogen;
however their appearance may be the first indicator of a
viral kidney infection. Urobilinogen also appears when
the bile ducts are blocked or as a result of stone formation
or infection.
Microscopic examination of urine:
Urine is examined under a microscope to
identify the different kinds of cells, crystals, casts and
parasites such as urinary bile ova.
Pus cells and red blood cells range from
1-5 under the magnifying power ofhe microscope.
Actually, the increase in pus cells does not always indicate
there is an accompanying bacterial infection.
For example, there may be a microbe in the urine in cases of
pregnancy and diabetes, without any increase in pus, and the
opposite is true in case of kidney stones or as a result
of the patient taking antibiotics while taking the test or
urine culture. Also, the increase in number of red
blood cells does not mean there is a hemorrhage, but it may
be the result of kidney stone formation or menstruation.
- Usually there are no crystals in normal
urine and if there are, they are an indication of the
formation of stones like calcium crystals or uric acid.
- As for casts, they are divided into
granular casts and red blood cells casts which appear in
cases of chronic kidney infection, and white cell casts
which appear in cases of severe inflammation in the kidney
basin and the fat casts which appear in case of Nephrotic
Syndrome.
2. Urea and Creatinine:
Urea and creatinine are produced by the
proteins we eat such as meats, chicken, eggs etc. They can
be measured chemically in the lab by a blood sample.
It must be noted that urea alone cannot be relied upon since
it is an inaccurate indicator because it may rise in the
case of older persons or with the use of diuretics,
dehydration, vomiting, severe diarrhea, or overeating of
proteins. Also, it can decrease in case of abstention
from meats and increase in fluid intake.
Probably the most accurate method to measure
the rate of glomerular filtration is by creatinine
clearance, which relies on the collection of the amount of
urine secreted by the patient over 24 hours, then a blood
sample is taken and creatinine in the urine and blood are
measured together. Then a simple formula is used to
determine creatinine clearance.
As for the normal ranges of urea, these are
20- 50 ml% and creatinine
0.5 - 1.5 ml.% and creatinine clearance 80 - 150 %.
3. Uric Acid:
This is produced from foods rich in purine
such as liver, kidneys, brain, red meat, shrimp, duck,
geese, nuts and beans. Uric acid is measured chemically in a
blood sample. The normal range is 2-7 ml%. The rate
increases in the blood as a result of increased uric acid
production as in the case of gout - also called the disease
of kings - known for inflammation of the joints particularly
the large toe, or leukemia, multiple myeloma, or
chemotherapy. Uric acid also increases in the blood as a
result of decrease in secretion of this substance from the
kidneys in cases of renal failure.
4. Sodium (Na+):
Sodium is found in food salt, cheeses,
pickles, fish, preserved meat etc. This substance has
a direct role in equalizing the body fluids, transporting
signals from the nerve cells and muscle constriction. Sodium
in the blood or urine is measure by a specific technique
known as ion selective technology. The normal range of
sodium in the blood is 135-150 mmol./litre. If the rate of
sodium in the blood increases, the reason may be increased
salt in food or loss of body fluids due to dehydration or
hyperactivity of the suprarenal gland present above the
kidney which secretes hormones able to lock sodium into the
body and not cause it to be secreted in the urine, or renal
failure. As for decrease in sodium of the blood, this may be
due to severe vomiting, continuous diarrhea, intense
perspiration, burns or decreased activity of the suprarenal
gland.
5. Potassium (K+):
Potassium is found in fruits (bananas,
oranges, tangerines, dates etc.) as well as
certain vegetables such as spinach, tomatoes, lettuce and
watercress. Potassium is strongly connected to sodium which
is also responsible for balancing the body fluids and
transporting signals in the nerve cells, constricting and
relaxing muscles, particularly heart and stomach muscles.
Potassium in the blood and urine is measured by the same
technique used in sodium and normal range of blood is 3.5 -
5.3 mmol./litre. Potassium increases in the blood after
eating potassium- rich foods. It also increases in
case of renal failure or decrease in suprarenal gland
activity. Potassium decreases in case the person does not
eat potassium-rich foods, or in case of severe vomiting,
diarrhea, or taking excessive diuretics, or increase in
suprarenal gland activity.
What are the tests to be done
before a kidney transplant from a donor to a recipient
suffering from renal failure?
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Donor must be over 21 years, in complete
control of his mental powers, and has the freedom to
make decisions.
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Clinical examination of all body organs
particularly urological organs, heart, chest, and blood
pressure.
Laboratory Tests:
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Blood group
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HLA, DR, Cross match, MLC
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Complete blood count
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Hepatitis (B) & (C), CMV, AIDS
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Toxoplasma
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Complete chemical tests of creatinine
clearance, fasting glucose and two hours after meal,
uric acid and liver functions.
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Bacteriological tests including urine
culture.
X-Rays:
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Plain X-ray on chest & kidney
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Abdominal & renal ultrasound
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IVP
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Selective renal angiography
Recipient:
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Recipient must be free of all kinds of
mental retardation, sound-of-mind and capable of making
decisions.
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Recipient is clinically examined to
confirm the non-existence of any septic focus
particularly in the nose, ear, larynx or mouth
cavities.
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The same clinical exams above are to be
done in addition to urine test to ensure he is free of
TB.
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The chest and kidney must be clinically
examined by regular X-ray. The abdomen must be
examined by Ultrasound.
How to Protect your Kidneys:
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The normal person must secrete 1.5 to 1
liter of urine per day, hence the importance of drinking
sufficient amounts of water.
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Avoid medication not prescribed by a
specialized physician, particularly drugs for rheumatism
and antibiotics.
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Eat reasonable amounts of animal protein.
It has been noted for example that vegetarians live
longer and their chances of suffering kidney diseases
are very rare.
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Periodically check blood pressure, urine,
urea, and blood creatinine at least once each year.
Kidney Function Profile:
Creatinine, Urea, Uric Acid, Urine
examination, Na & k
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