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Dialysis is usually required for people who develop advanced stage kidney failure. In this procedure, a machine performs the functions of a kidney; i.e. cleansing the blood of impurities. Before a patient goes through dialysis, he/she has to go through a surgical procedure AV fistula or arteriovenous fistula creation. AV fistula makes the performance of dialysis much easier.
Other diagnostic tests required before a dialysis:
Ultrasound scanning of the blood vessels to check their size Venogram in some cases when ultrasound cannot give full information.
What happens during the procedure?
During the surgery, the patient is administered the required anesthesia. This procedure doesn’t require an overnight stay. The purpose of AV fistula is to connect a large vein in the arm to the nearby artery. The surgeon either joins an artery to the vein, or he/she uses an artificial graft so that the fistula is created. This is usually done for patients who are weak or have an advanced vascular disease. After the AV fistula is administered, the new connection starts to strengthen. After a few weeks, the AV fistula is able to take a dialysis needle. This is when dialysis is initiated.
Kidneys are a pair of organs that are located on either side of the spine, each about a size of a fist. The kidneys help in purifying blood by removing toxins, waste materials and excess fluids from the human body. Disorders and dysfunctions of the kidney can lead to severe and often fatal consequences. When the kidneys stop functioning as they are supposed to, dialysis is performed to resume normal functioning in the body.
Dialysis is a type of treatment, which filters and purifies the blood with the aid of a machine. It is an artificial way of purifying blood. There are two types of dialysis, namely hemodialysis and peritoneal dialysis. Hemodialysis, the most common form of dialysis, which involves using a manmade kidney called a hemodialyzer, which removes toxins and waste materials from blood.
Peritoneal Dialysis, on the other hand, is a type of treatment which involves implanting a catheter in the abdomen. During the procedure, a sterile fluid called dialysate flows into the abdomen that absorbs all the waste material, which is consequently drained out of the body.
You may need a dialysis if:
- Your kidneys are dysfunctional
- When waste materials and toxins start to accumulate in the body and cause unwanted effects on your health
- If the GFR (a measure of kidney function) level falls to 10-12 cc/minute
- In an event where the kidneys aren't able to work properly leading to accumulation of toxins, irregular amounts of chemicals in the body and other dysfunctions
Starting dialysis is a big decision and proper preparation with an AV fistula created well in time is important. When kidney failure is due to chronic diseases like diabetes, high blood pressure and nephritis then dialysis will be needed life long or till a kidney transplant is performed. If you wish to discuss about any specific problem, you can consult a nephrologist.
Often, early stages of kidney diseases do not come with specific signs and symptoms and most people will remain unaware of their condition. However, certain symptoms may be perceived that may indicate that a person is suffering from early stages of kidney failure. When you are diagnosed with kidney failure (also known as renal failure) in the initial stages, certain measures can be taken to retard the progression of the renal disease. This can also help reverse the condition and improve the quality of life of the patient. On the basis of a typical cause, the symptoms of kidney failure are grouped into specific categories that are given below. If you notice any of the specified renal failure symptoms, it is recommended to immediately fix up an appointment with your doctor and get your diagnostic tests done.
Symptoms of Renal Failure from the accumulation of waste products in the body:
- Metallic taste in mouth
- Nausea and vomiting
- Facing difficulty in concentrating
- Loss of appetite
- Aversion towards meat (protein aversion)
- Itching or pruritus
Symptoms of Renal Failure from the accumulation of fluid in the body:
- Dyspnoea or shortness of breath (this happens due to the accumulation of fluid in the lungs).
- Swelling is seen in the feet, hands or face.
Symptoms of Kidney Failure from damage to the kidneys:
- The amount of urine production changes, though it is not a reliable sign Haematuria or blood in the urine (usually in microscopic quantity).
- Frothiness or foam in the urine (usually happens when protein is present in the urine).
Symptoms of Kidney Failure due to decreased blood production (anemia):
- Dyspnoea or shortness of breath.
- Fatigue Weakness.
- Confusion If you happen to feel cold all the time.
The following diagnostic tests will be performed by your doctor in order to determine whether the symptoms are the manifestation of a kidney failure or not:
- Urine analysis - In this test, a sample of your urine is tested to find traces of blood, white blood cells or proteins which may indicate a problem in kidney function.
- Blood Tests - This includes tests for BUN and creatinine in the blood which are usually removed from the blood if the kidneys function properly.
Actions must be taken when you show signs and symptoms of kidney failure:
It is common that the symptoms of early renal failure are not always prominent, but if any of the above symptoms are witnessed, it is recommended to consult a physician to determine whether they are caused by a kidney disease. You can pen-down the symptoms that you feel are related and bring it to the doctor when you fix up the next appointment. It is essential to know about your disease at the earliest as it will give you time and the ease of taking measures to retard the damage process and will decrease or delay the probability of undergoing dialysis or kidney transplant.
Kidneys play an important metabolic role and are essential for balancing salt, minerals and water in the body. They also play a significant role in removing waste products from the body. They make urine, which contains all the waste materials that are eliminated from the body. They also play an important role in blood pressure regulation and in maintaining the balance of various minerals in the body. Any suspected kidney damage should be confirmed by a kidney biopsy, which will reveal the exact disease, thereby directing towards the appropriate treatment.
Why and when is it done?
A renal or kidney biopsy is done in the following situations:
- When there is abnormal protein in the blood or urine, which is indicative of a kidney disease, and the exact cause needs to be found out
- When kidney failure is suggested by blood tests but cause is not clear
- To find the cause of bleeding in the urine (haematuria)
- To identify and/or confirm diagnosis after a CT scan or ultrasound
- To check how well a transplanted kidney has been received
Know about the procedure
A renal biopsy is mostly done as an outpatient procedure and is a type of biopsy known as percutaneous biopsy (biopsy where a needle is inserted through the skin into the renal tissue). Very rarely, it may be combined with the CT scan or ultrasound and be done in the radiology department. This may be done on inpatients. The patient is made to lie on his/her back and a local anesthetic is used on the area of the injection. A thin, long needle is directed towards the area of the kidney from where some kidney tissue is removed for sampling.
In some cases, the direction of the needle may be decided by a CT scan or ultrasound. While this is a closed biopsy procedure, in some cases, as a part of the surgery, open biopsies may also be obtained, where a sample of tissue is extracted for analysis.
Recovering from a biopsy
The person would need some time to recover from the procedure, as there would be some discomfort at the site of a needle insertion. Vital signs would be monitored for the next couple of hours during which the person would also be monitored for internal bleeding. A pain reliever can be used if required. Haematuria or blood-tinged urine can be seen disappearing within the next 12 hours. Very rarely the bleeding can be severe and require angiography and further procedures. The person should also avoid strenuous activities for the next few days. If you wish to discuss about any specific problem, you can consult an urologist.