Treatment of disorder
You may feel something complicated when you heard of “dialysis”. How about “blood purification”? Collected water is purified at Water Treatment Plant so that tap water come out from home faucet is used for food drink (Fig.1). In the body, blood is circulating from top of head to toe of limb. Treatment for purifying the blood like water treatment plant, is called as “Blood Purification”. How does it purify blood is different depend on onset disease, but amongst “Blood Purification” treatment, the treatment mainly remove urine toxin (Fig. 2) is called as dialysis (Fig. 3).
Urine toxin is continuously reserved in human body through their daily life activities. Kidney works restlessly and excretes urine toxin to urine, but when renal function is deteriorated, urine toxin is reserved inside the body. Therefore, Hemodialysis is the treatment taking place of kidney function and blood purification is the treatment for kidney failure, such as swelling appeared as the result of renal function deterioration, accumulation of potassium or phosphorus, nausea or insomnia caused by urine toxin.
Fig.4 Peritoneal Dialysis: Conducts dialysis at home using Catheter indwelled in the abdominal area.
There are two type of dialysis, the one is hemodialysis visiting hospital three times a week, and the other is peritoneal dialysis conducted every day at home (necessary to visit hospital once a month) (Fig.4). In order to maintain daily life activities, frequent dialysis is necessary. Hemodialysis, as its name suggests, is a treatment which directly dialysis the blood so that it able to detox urine toxin securely and quickly. This brings a prompt relief, but blood pressure becomes unstable.
Peritoneal dialysis is a method to dialyze using own peritonea, and gradually conducting treatment in helping remained kidney power. Gentle to the body is its characteristic, but unfortunately its dialyzability fade out in about 8 years under the current technology. After this period, hemodialysis is conducted.
Complicated disease comes up when continuing the dialysis. Beginning with nephrogenic anemia (Fig.5) or secondary hyperthyroidism, and when getting in long term, they are dialysis amyloidosis (Fig.6) in hemodialysis or encapsulating peritoneal sclerosis in peritoneal dialysis. In the specific infection disease, they are shunt infection (infection disease at punctured area by dialysis) in hemodialysis, and peritoneum inflammation in peritoneal dialysis. Both are prone to blood poisoning and may turn to be a life-threatening case. In addition to these complicated diseases, arterial sclerosis is gradually advanced from the one at chronic kidney disease period, and ischemic cardiac disease or apoplexy are prone to be onset. Blood wall become calcified and blood vessel is pictured like clay pipe. (Fig.7)
ig.5 Nephrogenic anemia (Status where blood is unable to be produced at bone marrow because hematopoietic hormone named erythropoietin has not produced at kidney)
Amyloidosis: Symptom named carpal canal syndrome is that, protein named β2 micro globulin reserved by kidney failure is colligated with a line called carpal canal at the wrist, and it compresses the median nerve. Deformation of vertebra raised by the colligation of same protein on vertebra is called as dialysis spine disease. Both are the symptom of Dialysis Amyloidosis.
Fig. 7: Ectopic Calcification (Arterial Calcification): The state that calcium and phosphorus are deposited on blood vessel wall then become like stone is called as calcification of blood vessel. This is a kind of Ectopic Calcification.
Fig. 8: CKD-MBD: Bone become thinning since kidney failure does not develop vitamin D activation effect which kidney take place.
As the result of weakening of electrolyte control function which kidney takes place, potassium/phosphorus low value is developed and turns into renal anemia because of lowered function of hematopoietic hormone production. Secondary hyperthyroidism is developed when lowered value of calcium excites accessory gland and then produces parathyroid hormone. In case parathyroid hormone value is high, bone becomes friable and ectopic calcification or cardiac valvular disease is set up. Effecting from the unbalance of serum calcium/phosphorus and high value of parathyroid hormone, specific bone lesion (CKD-MBD: Abnormal bone mineral metabolism caused by chronic kidney disease -> Fig.8) is advanced. Also, protein called β2 micro globulin is increased in the blood under the kidney failure. This protein develops the pathological abnormality named as dialysis amyloidosis with colligating at bone or tendon and set up carpal canal syndrome or dialysis spine disease. High value of serum phosphorus directly effects on arterial calcification.
Symptoms like hyposthenia or irregular heart beat appears in hyperpotassemia, cramp of limb or irregular heart beat appears in hypocalcemia, and sense of fatigue appears in renal anemia. Although hyperphosphatemia generates a harmful effect to the body, no subjective symptom is its aspect. When body weight is much increased, a feeling of oppression at exercise caused by edema or cardiac failure, or orthopnea which is unable to lie down and sleep, are recognized. Bone lesion advances slowly, but it is necessary to check carpal canal syndrome for hyposthenia of #1 through #3 maniphalanx, and dialysis spine disease for cramp or walking disorder. Arteriosclerosis lesions has onset as ischemic heart disease, stroke or peripheral artery disease.
Disease developed by vascular disorder advances faster than the patient who do not receive dialysis, and symptom is rather indistinct. Vascular disease is prone to onset because blood is extracorporeally circulated in blood dialysis.
Various type of electrolyte abnormality or efficiency of dialysis is evaluated by blood collection test, and burdens to heart is evaluated by X-ray test. Various type of electrolyte abnormality is questioned with the symptom like unstableness of blood pressure or pulsation, peripheral coldness, arterial tactile difficulties and aching pain, and then examined by electrocardiogram or echo test, when necessary it is examined by angiographic examination. For bone lesion, it is evaluated and diagnosed with repeating several examinations like X-ray or MRI. In peritoneal dialysis, function and characteristic of peritonea is evaluated by peritoneal function test (PET).
For electrolyte abnormality, renal anemia or secondary hyperthyroidism, treatment is performed with dialysis method (called as dialysis condition), artifice of intravenous formulation or adjustment of liquid medication. In case of cardiac disorder, strain of heart is removed by the adjustment of dry weight (body weight after dialysis) for blood dialysis, and with increasing the body water removal amount in changing the dialysate fluid for peritoneal dialysis. For various arteriosclerotic disease, treatment is performed with the cooperation of department of radiology.
Other than that, shunt disorder (unable to take enough blood from shunt, too much blood flow to shunt, shunt infection), which is the vital lifeline to conduct its treatment in blood dialysis, is the one of the complicated diseases. Blood flow should be checked by stethoscope every day whether or not bleeding remains around the puncture area, or there is a symptom like redness, enlargement/oppressive pain.
In peritoneal dialysis, it is important not to neglect the observation of the condition of exit-site surrounding skin for dialysis catheter, and with/without of discharge turbidity. Pay attention for whether or not there exist the redness, enlargement or oppressive pain, or not to flow pus like thing out, and in case peritoneal dialysis solution is joining, treatment should be performed with extra care for virus, which is chronic on the surface of equipment or maniphalanx, not to invade into the body.
Pay special attention for the high value of phosphorus in blood. High phosphorus value advances arterial sclerosis and bone lesion. Once calcified lesion will not become normal again. Please keep the ingestible limit of salt. It becomes the cause of high-blood pressure or cardiac disorder.