renal failure | MY SPECIAL DOCTOR

Anemia

20 February 20246 January 2024 by Redazione My Special Doctor

Anemia is the clinical condition in which the hemoglobin rate is less than the third percentile relative to the patient’s age group.

Symptoms appear in relation to the rapidity of onset, severity of anemia, and underlying pathology. If it is a rapid onset, headache, dizziness, tachycardia, and postural hypotension appear. At slow onset, however, pallor, progressive asthenia, irritability, and fatigue appear.

Essential laboratory tests are CBC with leukocyte formula, peripheral blood smear, VCM, reticulitis. In case of trauma or gastrointestinal bleeding, it is necessary to exclude diseases that require surgery. In case of clinical symptomatology with oxygen insufficiency, immediate transfusion therapy is recommended.

Another emergency situation is renal failure during massive intravascular hemolysis. Symptoms include lumbar ligament pain, hemoglobinuria, and progressive oliguria and anuria. Therapy in these cases requires intravenous hyperhydration and furosemide.

Source: Medical Emergencies in Pediatrics by Mediserve edited by Maurizio Vanelli

Always thirsty? It may depend on.

12 February 20246 January 2024 by Redazione My Special Doctor

In general, almost all of us tend to drink too little, or because we do not pay due attention to the thirst stimulus or because we postpone the satisfaction of a primary need for trivial “laziness.” And that’s a big mistake, because our body needs. Of regular fluid intake to function at its best. Sometimes, however, there are situations that make the thirst so strong and constant that it induces drinking much more than it should be. It may happen occasionally after a meal that is too salty or abundant or when the weather is very hot and dry, but also in the presence of various diseases, from kidney failure to diabetes. These are the cases of persistent dry mouth and need to drink that should be brought to the physician’s attention.

Acute renal failure and nutrition

5 February 20246 January 2024 by Alessia Giannino

Acute renal failure is a fearsome condition, as it arises rapidly. It can be classified according to cause into pre-renal, intrinsic renal, or post-renal. Pre-renal IRA is due to renal hypoperfusion and is often identified with Acute Tubular Necrosis, intrinsic IRA is related to intrinsic kidney disease, and post-renal IRA is related to obstructive factors of the excretory tract. Differential diagnosis is certainly important, as nutritional treatment should also be treated according to the diagnosis.

Nutritional therapy

Nutritional intervention aims to rebalance the patient’s catabolic imbalance and energy needs. Through Urea Nitrogen Appearance, which calculates urinary urea excretion, three levels of hypercatabolism are distinguished:

Mild hypercatabolism
Moderate hypercatabolism
Severe hypercatabolism

As for feeding, it should be introduced with caution, in fact in the first 48 hours it is not started because it may have a harmful effect. It starts with an intake of about 50% of what is estimated, gradually increasing over the next few days.

Source: Handbook of Dietetics and Nutrition by Franco Contaldo et al.

Chronic renal failure and nutrition

4 February 20246 January 2024 by Alessia Giannino

When we talk about chronic renal failure , we refer to the progressive decline in glomerular function, with reduced filtering capacity of the kidney. The diseases that promote the occurrence of CRI are hypertension, diabetes, and obesity. Continuous monitoring of blood crasis, protein and hydroelectrolyte balance, and acid-base and metabolic balance is necessary. In patients with CRI, especially in the more advanced stages, gastrointestinal symptoms are often present, which may result in anorexia, vomiting, and nausea. Some important aspects of dietary therapy are restriction of protein intake, adequate energy intake, and control of the hydro-electrolyte balance.

Diet therapy

Dietary intervention plays a key role in the conservative treatment of chronic renal failure. It has the function of:

Check urea levels
Check blood levels of phosphorus and parathormone
Control the acid-base balance
Control cardiovascular risk factors
Maintaining an adequate nutritional status
Slowing the progression of chronic renal failure to terminal uremia

The hypoprotein diet aims to control progression and metabolic complications and varies according to the grade of CDI.

In mild CRI, nutrition should be directed toward controlling hypertension. In moderate CRI, dietary therapy should be aimed at reducing protein intake to0.8- 0.6 g/kg body weight. Finally, in severe CRI, the diet should be aimed at reducing to 0.6 g/kg of ideal body weight.

Source: Handbook of Dietetics and Clinical Nutrition by Franco Contaldo et al.