Thursday, September 23, 2010

7.10 Kidney Failure/Dialysis Prevention 2

Physician's Notebooks 7  - - See Homepage

10. Kidney Failure and Healthy Longevity (Update 23 December 2018)
What would happen if you suddenly lost both kidneys?
 If you continued to drink your usual liter or more of fluid a day, you would die in 1 to 2 days, at the end coughing up bloody foam and gasping for breath due to water-logged lungs from heart failure. The kidneys rid excess water from your body. With loss of kidneys, the water backs up in your pipes. But you can prevent that by limiting water intake to the amount needed to replace water loss from skin, lungs, and GI and GU tracts. No kidney failure patient must die of water logging. What next?
   Assuming you kept your water intake low; then, your heart might go into dangerous arrhythmia or stop suddenly from high blood potassium ion (K+) because of stop of the K+ excretion into the renal tubules. You could prevent that by limiting your potassium intake or using medicine. But, after that, you might almost as quickly die from the increasingly high acidity of your blood from losing the kidneys’ ability to excrete the H+ (as NH4+) and also losing its ability to make bicarbonate (HCO3) to buffer the excess acid produced by diet and body metabolism.
   You could preserve your life by eating bicarbonate to prevent the excess acid from renal failure.
   What next?
   Even if you control the high K+ and acidosis, by diet and medicine, you would not be able to completely substitute diet for the kidneys' fine balancing of sodium ion (Na+) in your blood. Without kidneys your inability to get rid of excess Na+ in food would overload your body with fluid because when excess Na+ is retained it carries water back into the system with it to keep a normal concentration in blood. So you would again become water logged but this time you could not deal with it by limiting water intake. Your over-hydrated blood circulation would show severe high blood pressure and brain bleed with stroke, and heart failure with pulmonary edema. If you got kidney dialysis, this problem could be solved by adjusting the Na+ concentration of the dialysis fluid so that Na+ is leached out of the blood and excess fluid reduced at each dialysis session and the problem would be solved. And even without dialysis a low-sodium diet could keep a renal failure case alive.
   Now you have solved one problem after another but, after 2 weeks, you would be feeling horrible because of  “uremic syndrome,” a severe loss of appetite with nausea, stomach cramp, terrible depression and fatigue, and after another week, muscle-twitching uremic coma and death because without kidneys you cannot excrete the toxic large-molecule nitrogen products of protein metabolism, which can be monitored by the rising blood urea nitrogen (BUN) and creatinine (Cr). This is the final problem in dialysis patients.
   If you survive the first month without kidneys because of good dialysis, two problems of necessary kidney function that the dialyses could not solve would surface: 1) a gradually increasing and eventually terminally very severe red blood cell anemia due to lack of erythropoietin, the bone marrow stimulating red blood cell producing hormone made in the kidneys and 2) the leaching of calcium out of your bones leading to fractures due to stop of the kidneys phosphate-excreting function which would stimulate hyperparathyroidism and destruction of your skeleton.
But erythropoietin can be supplied by injection preventing the anemia of kidneys failure, and bone fractures can be prevented by giving vitamin D and calcium.
END OF CHAPTER.  CONTINUES NEXT SECTION. To read now, click 7.11 Monitors of Kidney Failure/Prevent Dialysis ...

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