Types of Kidney Treatment
Acute Renal Failure (ARF) :
The most important part in treatment of ARF is treatment of the underlying condition that caused ARF. For example, if ARF is due to dehydration and drop in the blood pressure, the dehydration should be rapidly corrected. If the dehydration and low blood pressure persist for a long period, the injury to the kidneys is likely to be severe and kidneys may not recover soon after correction of dehydration and improvement of blood pressure. It might take few days or weeks for the kidneys to recover. Eventually however, the kidneys do recover in most of the cases if the underlying condition has been corrected. During the period that the kidneys do not function, dialysis support may be necessary. Once kidneys recover, dialysis is discontinued.
Chronic Renal Failure (CRF) :
In the early stages, the attempt should be to reduce the rate at which kidney function is declining. This requires certain dietary modification and medicines as follows :
Diet :
Protein :
Most of the waste products normally excreted by the kidney come from the proteins in the diet. Patients with CRF are therefore often advised to restrict proteins in the diet. This is also felt to reduce the rate of decline in kidney function. However, it must be remembered that body uses proteins to build, maintain, and repair body tissues. It is therefore very essential to maintain sufficient protein intake. In the western countries where the dietary protein intake is usually 1-1.5 gm/kg/day dietary protein restriction can be performed without any untoward effects. However, with the form of dietary habits of most of our Indians, particularly vegetarians, it is very uncommon for protein intake to exceed 0.8-1 gm/kg/day and this being low quality protein (bread, cereals, vegetables, fruits), is the minimum amount required to maintain the functions performed by the proteins.
Further, recent studies on the role of dietary protein restriction in reducing the rate of decline in kidney function are controversial. Therefore, most of the Indian patients who are by and large vegetarians may not require protein restriction unless their protein intake exceeds 1 gm/kg/day.
Calories :
Most people with kidney failure need sufficient calories to maintain their weight. If sufficient calories are not taken (about 35 kcal/kg), proteins of the body are used up as a source of calories leading to protein malnutrition. The common sources of calories are sugars (sweets, jam, jelly etc.) and fats (oil, butter and ghee). Taking high calorie food may increase the level of fat in the blood. In fact a high level of fat (triglyceride) has been observed in many cases of CRF. This may predispose to an increased risk of heart attack and paralysis due to clogging of blood vessels by the fat. We have observed that use of fish oil rich in polyunsaturated fats (available in the market as Maxepa) decreases the high level of fat in the blood of patients with CRF.
Sodium :
Diseased kidneys cannot always control sodium excretion. In most kidney diseases, sodium is not normally excreted leading to sodium retention which in turn causes high blood pressure and swelling. In such cases, dietary sodium has to be restricted. However, in some cases, the sodium is lost in excess. These patients do not require any sodium restriction. Therefore, dietary sodium has to be adjusted according to the nature of kidney disease and presence or absence of swelling and high blood pressure. The major sources of sodium in the diet are salt, pickles, papad, salted biscuits, canned foods, cheese, ham, bacon, sausage and hot dog.
Potassium :
With advanced kidney failure, potassium eaten in an average diet cannot be excreted by the kidneys. This can lead to high potassium concentration in the blood which can cause serious heart problems. To prevent this, potassium in the diet must be controlled. The main sources of potassium are milk, fruits, vegetables, coconut and meat.
Fluids :
In most cases of advanced kidney failure, the urine output drops. When this happens, it is necessary to restrict the intake of liquids (fluids). The excessive fluid intake results in swelling, high blood pressure and difficulty in breathing. The fluid intake must not exceed the amount advised by the physician or dietician. Fluids include anything that is liquid at room temperature : water, ice, tea, coffee, milk, dal, soup, fruit juice, ice cream, pudding, custard etc.
These are general diet guidelines that must be followed in patients with CRF. It is important to remember that everyone’s diet will be different because of different forms of kidney diseases. The diet will require further modification when dialysis treatment is started. Remember that following the diet properly is as important as taking the medicines. The physician and the dietician will help as far as possible, but the final responsibility is that of the patient. For a detailed information about diet in CRF, refer to the booklet, Diet in Chronic Renal Failure.
Medications :
Drugs that control blood pressure. This is very important because if one thing has been proved to reduce the rate of decline in kidney function, it is good blood pressure control. The commonly used drugs are atenolol, nifedipine, captopril, enalapril, losartan etc.
Diuretics, which help eliminate excess sodium and water from the body. The most commonly used diuretic is furosemide available as lasix or frusinex. It must be understood that lasix will improve your urine output but not your kidney function.
Phosphate binders – Alludrox, sorbacid, calcium carbonate power or tablets (factocal, shelcal, sandocal etc.), calcium aceate (lophos, phostat etc.) to normalise phosphorus level in the blood.
Calcium and active vitamin D. Since the kidneys cannot activate vitamin D, active vitamin D will be required in most cases. Fortunately, active vitamin D (alpha D3, rocaltrol) is available today.
Sodium Bicarbonate : When the kidney function goes down, the acids produced from the food we eat are not excreted and their level increases. To neutralise the acids, sodium bicarbonate may be required. This is available as sodamint tablets.
Drugs that help to treat anemia. Many patients with CRF have poor appetite leading to iron and vitamin deficiency which may contribute to anemia. Therefore, iron and vitamins will be necessary in most of the cases. However, as explained earlier, the most important cause of anemia is decreased erythropoietin production. Fortunately, with recent advances in genetic technology, erythropoietin (Eprex, Zyrop, Recormon) is now being manufactured and available in the market. This drug however is extremely expensive.
Other drugs depending upon patients condition.
Source : http://www.narmadakidney.org/INDEX.ASP?PAGE=TREATMENT