Unfortunately, a kidney disease often shrinks the kidneys by showing an insidious progressive course without showing noisy symptoms such as swelling in the body, blood in the urine, hypertension, and the functioning organs (nephrons) can become inoperable by being covered with connective tissue. In the end, the process ends with what we call "end-stage kidney disease". This situation is not the end of the patient today, but in this period, the patient's life is possible with some methods such as dialysis, kidney transplantation (kidney transplantation) that seriously affect the quality of life of the patient, which are very difficult and expensive to implement. The fact that the insidious feature of this disease is seen quite often forces most patients to go to the hospital with one last drop, at this last point where the serious problem in their kidneys is irreversible, and they learn about their disease too late. Suddenly, the patient and even his entire family are shaken by this painful reality. Unfortunately, at least 60% of the patients in hemodialysis centers learned about their disease the day they had to undergo dialysis.
What is the importance of the subject? According to the records of the Turkish Nephrology Association, as of the end of 2011, there were around 57.000 patients. We know that he is a period patient. This means more than 800 people per million population. Today, according to this rate, which is almost the same as in Western countries, approximately 50,000 patients continue their lives in hemodialysis centers with a number of around 800, 3-4 thousand of them with the method we call peritoneal dialysis, and 7-8 thousand of them with functioning transplant kidneys. It should be noted that these numbers are increasing thanks to these methods that make this life possible. In other words, the number of these patients is increasing because they can continue to live thanks to these methods. However, there is an increase in the number of newly acquired patients in our country and all over the world. Again, in the NHANES study, in 2003, while there were 300,000 patients with stage 5 chronic kidney disease, that is, end stage kidney disease, in the USA, there were 8 million Americans with moderate renal failure. CREDIT study carried out in our country with the support of the Turkish Society of Nephrology. with screening, the rate of last three-stage renal failure (patients with kidney functions below 60%) was found to be 9%. This represents about 3.5-4 million people. In other words, a significant number of our people have this disease that we are not aware of. This disease has gained a social dimension, it is a growing epidemic (epidemic). For this reason, this article has been written.
The most important reason for the increase is diabetes and hypertension: Both foreign epidemiological studies such as the NHANES study mentioned above and Turkish Nephrology Several factors seem to be responsible for this increase in the studies conducted by our association and the registration system. Diabetes mellitus is one of them. In 2011, the diabetic rate among hemodialysis patients in Turkey was 34%, and 40% in Europe. But the most important thing is that these rates have more than doubled in the last 10 years and reached these points. The second underlying cause of disease in dialysis patients is hypertension in our country and in the world. In hypertensive patients, the increase in arteriosclerosis, that is, arteriosclerosis, also makes the kidneys sick. Our population has aged significantly. With advancing age, the rate of kidney failure due to vascular problems also increases. Today, radiological imaging methods (tomography, angiography, etc.) with drugs that we call contrast agents are used extensively. Although these do not directly cause kidney disease, they can aggravate initial kidney problems. Similarly, rheumatic drugs (nonsteroidal anti-inflammatory drugs) may produce such results. Today, urological causes such as nephritis and stones, inflammation, and prostate enlargement seen in advanced age, among the causes of kidney failure seen at young ages, are gradually decreasing because they are diagnosed and treated early.
What are the symptoms? : Edema comes at the beginning of the symptoms that especially suggest a kidney disease. Edema can be seen by the patient or his relatives as swelling under the eyes or swellings on the legs that migrate to finger pressure or on the ring or meat. The tightening of the neck can sometimes be noticed by detecting sudden weight gain. The important thing here is that edema is not always due to kidney disease. While making the differential diagnosis, kidney disease will undoubtedly be considered first. The presence of blood in the urine, which will be noticed as a visible darkening in the color of the urine, may also be a sign of nephritis, apart from urological causes such as some stone tumors. In case of hypertension, especially in the presence of high blood pressure at an early age, a kidney disease should be considered. We regret to see that sometimes a known high blood pressure at an early age is not approached in any way and only blood pressure treatment is given, and then years later, the patient develops kidney failure. Apart from such relatively noisy symptoms, symptoms such as weakness, anemia of unknown cause, unexplained itching, loss of appetite, nausea and vomiting, which may actually exist in many diseases, may also be the first sign of kidney failure. In female patients, edema and high blood pressure in the early stages of pregnancy, pregnancy poisoning, which we call eclampsia in the last months, recurrent low stillbirths, and amenorrhea should also be noted and should be evaluated in terms of kidney disease after pregnancy. Many times, conditions such as weakness or anemia are so mild that patients cannot realize that they are getting sick, even though kidney failure is very advanced. A urinalysis and tests reflecting kidney functions should be performed on a patient who routinely applies to a physician for any reason. Again, if a drug will be used for any reason (especially some antibiotics, nonsteroidal anti-rheumatic drugs), a radiological imaging (such as angiography and CT) will be performed by giving a contrast agent, or if any operation will be performed, an examination of the kidneys should be performed.
The important symptom is the presence of protein in the urine: The protein normally found in the blood is not excreted in the urine. The presence of protein in the urine is the most important indicator of kidney damage. In an edematous patient, in a patient with blood in the urine, in a patient with hypertension, these conditions can be understood to be due to kidney disease, but by the presence of protein in the patient's urine. il. At the beginning of the subject, I stated that these patients do not always come with noisy tables. But a simple urinalysis done correctly and interpreted correctly can reveal the disease. Almost all kidney patients have a urinary finding. There are few exceptions to this rule.
Is early diagnosis important?: During the rapid and exacerbated course of the disease, in general, to treat the disease with some treatment methods or to stop it even if it is not completely cured. at least it can be braked. For example, in the case of acute nephritis that causes loss of kidney function within days to weeks, there may be a chance for a certain rate of treatment depending on the stage of the pathological appearance with early kidney biopsy.
Good sugar control in the early period in diabetic patients, proper treatment of patients with high blood pressure also means the protection of kidney disease. There is a significant number of publications showing that early follow-up of these patients – before the patients reach the dialysis point- by nephrology clinics positively affects the outcome of the disease
Recurrent urinary tract infections of urological events, urinary flow from the bladder to the kidneys during urination Conditions such as reflux, occlusive stones, prostate enlargement are neglected, but if not intervened at the right time, it can lead to chronic kidney failure. However, there is no cure for many kidney diseases. Maybe kidney failure that develops from these diseases can be perceived as a destiny. But the preventable situations I tried to indicate above are never destiny.
Is everything over if chronic kidney failure cannot be prevented?: This type of thinking is left behind for today's nephrology. End-stage kidney disease will be carefully monitored and treated in a process that will one day end with dialysis and/or kidney transplantation. The aim of the treatment here is to slow down the rate of kidney function loss, but more importantly, due to some negativities that kidney failure may cause in this process, even if a kidney transplant is performed in the future, it will never be compensated. is not to know. Here I would like to express the following: for example, an uncontrolled hypertension that causes heart enlargement or cerebral hemorrhage paralysis cannot be compensated later.
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