Unfortunately, often a kidney disease shrinks the kidneys by showing an insidious progressive course without showing noisy symptoms such as swelling in the body, blood in the urine, hypertension, functioning organelles connective tissue It may become inoperable by being covered with Eventually, the process ends with what we call “end-stage kidney disease”. This situation is not the end of the patient today, but maintaining the patient’s life in this period is possible with some methods, such as dialysis, kidney transplantation (kidney transplantation), which seriously affect the patient’s quality of life, 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 topic? : According to the records of the Turkish Society of Nephrology, we have around 50,000 end-stage patients as of the end of 2007. This means more than 700 people per million population. Today, according to this rate, which is almost the same as in Western countries, approximately 40,000 of the patients continue their lives in hemodialysis centers with a number of around 750, 5-6 thousand of them with the method we call peritoneal dialysis, and 2-3 thousand of them with functioning kidney transplants. It should be noted that these methods that make this life possible are the factors that increase these numbers. Because these patients can continue to live thanks to these methods, their number is increasing. However, there is also an increase in the number of newly acquired patients in our country and all over the world. Again, in the NHANES study, in 2003, there were about 300,000 patients with stage 5 chronic kidney failure, that is, end stage kidney disease, in the USA, but there were about 8 million Americans with moderate kidney failure. The CREDIT study, which was also carried out in our country with the support of the Turkish Society of Nephrology, determined the rate of last three stage renal failure (patients with kidney functions below 60%) as 9%, with the epidemiological screening performed directly on the normal population in all regions of our country. 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). That’s why this article was written.
The most important reason for the increase is diabetes and hypertension: Several factors seem to be responsible for this increase, both in foreign epidemiological studies such as the NHANES study mentioned above, as well as in the studies conducted by our Turkish Society of Nephrology and the registry system. Diabetes mellitus is one of them. In 2007, the diabetic rate among hemodialysis patients was 30% in Turkey and around 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 cause of underlying 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 in large quantities. 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. Nowadays, urological causes such as nephritis and stones, inflammation, 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 of kidney disease? : Edema is one of the most prominent symptoms suggestive of kidney disease. Edema can be noticed by the patient or their relatives in the form of swelling under the eyes or swellings in the legs that subside under finger pressure, or by the squeezing of the ring or skirt, sometimes 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. Sometimes, no approach is made to a known high blood pressure at an early age, and only antihypertensive treatment is given, and we regret that the patient develops kidney failure years later. Apart from such relatively noisier 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 do not 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. A urinalysis to detect this finding is a very simple and inexpensive method. 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. 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, it may be possible to treat the disease with some treatment methods in general, or to stop the disease, even if it is not completely cured, or at least to slow it down. 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. Unfortunately, most of these patients may be misdiagnosed with end-stage renal disease, and may be immediately referred to a hemodialysis treatment in the city where they live, and the patient may lose the chance of treatment available for this disease. Such patients should definitely be directed to nephrology clinics, which is the branch of internal medicine dealing with kidney diseases, where a kidney biopsy can be possible.
Good sugar control in diabetic patients in the early period, proper treatment of hypertensive patients also means the protection of kidney disease. There is a significant number of publications showing that early follow-up of these patients by nephrology clinics before they reach the dialysis point positively affects the outcome of the disease.
Urological events such as frequently recurring urinary tract infection, reflux of urine (reflux), occlusive stones, prostate enlargement are neglected, but if not intervened at the right time, they 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 point out above are never destiny.
Is it all over if chronic kidney failure cannot be prevented?: This type of thinking is outdated 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, it is not to leave any irreparable damage even if kidney transplantation is performed in the future due to some negativities that kidney failure may cause in this process. I would like to express the following: for example, an uncontrolled hypertension that causes heart enlargement or cerebral hemorrhage, stroke cannot be compensated later. Likewise, metabolic bone diseases that may arise due to inadequate treatment of vitamin D deficiency and parathyroid hormone secretion that regulates calcium metabolism, and related disabilities, but more importantly, vascular calcification and related cardiovascular disease should definitely be tried to be prevented. Despite everything, end-stage renal failure progresses and the patient becomes unable to survive with his own kidneys, but then something else will be done to replace this function, which will be dialysis or kidney transplantation. These methods may be the subject of articles in the future, but I must emphasize here that such life-saving treatment methods have not been developed in any of our organs (such as the heart, liver, brain) in the last period. Yes, these treatments have their own problems, but they give patients the chance to have an acceptable length and quality of life. As long as these methods are put into practice in a timely manner, by choosing the appropriate method for the patient, and they are applied effectively. Our patients who live with this disease should also see the glass half full. They should not forget that the help of physicians will only be possible with their help.
