TREATMENT

DIET
-Low protein diet
Help slow down build up of protein waste (blood urea nitrogen and creatinine) in blood and limit nausea and vomitting
-Avoid foods high in potassium
Banana, apricots,potato, nuts
Leads to abnormal heart rhythms
-Avoid food high in phosphorous
Milk, cheese, nuts
Cause Secondary hyperthyroidism
Excess phosphate in blood reduce levels of blood calcium
Low blood calcium triggers parathyroid gland to release more PTH (Parathyroid hormone)
PTH dissolve bone tissue to release stored calcium to raise level of calcium in blood
Causes osteoporosis and fractures
-Salt restriction
4-6 grams a day to avoid fluid retention (oedema)
Help control high blood pressure
-Decrease fluid intake
Decrease workload for kidney
Consumption based on amount of urine excreted the day before
Only in severe cases of swelling or end stage or renal failure

MEDICATION
Sevelamer (Renagel)
Binds dietary phosphate in intestine, inhibiting absorption
Calcium carbonate (Caltrate)
Normalize phosphate concentrations
Binds with dietary phosphate to form insoluble calcium phosphate to be excreted in faeces
Calcitriol (Rocaltrol)
Suppress parathyroid production and secretion in secondary hyperparathyroidism
Treats hypocalcemia by Increasing intestinal calcium absorption
Ferrous SulfateBuilding block for hemoglobin synthesis
Darbepoetin (Aranesp)
Interacts with stem cell to increase red blood cell production

DIALYSIS
HemodialysisUses a machine filter called dialyzer to remove excess water and salt
This balances the other electrolytes in the body and removes waste products of metabolism
Blood flows through tube into machine, where it passes next to a filter membrane
Dialysate is present on the other side of membrane
Absorbs impurities from blood through membrane
Access to blood vessels is surgically created
Arteriovenous fistula is made
Connection between a large artery and vein in the body, usually the arm
Causes large amount of blood flow into vein
Causes vein to enlarge and thicken to tolerate repeated needle sticks to attach tube
2 needles placed: 1 to withdraw blood, 1 to return
If kidney failure happens acutely and there is no time to build fistula, special catheters inserted into larger blood vessel
Left in place for up to 3 weeks
Act as bridge until fistula can be planned, placed and matured
Side effects
Prone to infections
May cause blood vessels to clot or
narrow
Arteriovenous graft
Patients who have small veins
Fistula fails to develop
Made of artificial material
Polytetrafluoroethylene(PTFE)
Occurs 3 times a week and last 3-5 hours at a time
Travels to outpatient center to have dialysis
If inconvenient, home hemodialysis possible
Patient starts learning at clinic with dialysis nurse
Clinic provides machine or help patient get from supplier
Blood tests taken once a month to ensure HD working and detect problems such as anemia or high potassium levels
Risks
Infection
Blood loss
If cathether may seperate
Air embolism
Air is introduced into blood stream, preventing heart from pumping blood adequately

Peritoneal Dialysis
Uses lining of abdominal cavity (peritoneum) as dialysis filter
Catheter placed in the cavity through the abdominal wall through surgery
2-3 litres of dialysate dripped into cathether and left for few hours and then drained out
Waste products excreted from blood
Two types
Continuous Ambulatory Peritoneal Dialysis
Empties a fresh bag of dialysate into abdomen
After 4-6 hours of dwell time, patient repeats cycle with fresh bag of solution
Does not require machine
Continuous Cycler-Assisted Peritoneal Dialysis
Uses machine to fill and empty abdomen 3-5 times during night while person sleeps.

KIDNEY TRANSPLANT
May come from living related donors, living unrelated donors or cadaveric donors
Extensive testing to ensure compatibility for transplant
Shortage of organs, have to wait for months or years
Requires four to seven days in hospital
Require lifelong immunosuppressant medication to prevent rejection by body