The problem of pregnancy complicated by chronic kidney disease

Chronic kidney disease (CKD) in high-risk pregnancies is a challenge for multidisciplinary teams of doctors. Due to the fact that the disease affects both the mother and the fetus, and the course of the pregnancy. The following article reviews the literature about the interaction between pregnancy and CKD and dialysis therapy. Even pregnancy itself can lead to a worsening of kidney dysfunction. The risk of this consequence increases with the degree of renal failure, therefore renal parameters and other pregnancy test results should be monitored. On the other hand, the most common complications of chronic kidney disease in pregnancy described in the literature include pre-eclampsia, preterm labor, intrauterine growth restriction (IUGR) or low birth weight, surgical delivery by caesarean section and miscarriage. Dialysis therapy also leads to abnormalities in the course of pregnancy, and patients require constant monitoring during its course. Attention is also drawn to the high percentage of newborns requiring intensive postpartum care. Due to the risk for the fetus and mother mentioned in the article, nephrologists and gynecologists should cooperate closely from the pre-contraceptive period in order to reduce the risk of sequelae and better control of the underlying disease

Aristolochic acid nephropathy - still real danger

Arystolocholic acid nephropathy is chronic kidney disease caused by the use of substances of natural origin that contain arystolocholic acid. The effects of their use are arystolochic acid nephropathies, which include "Chinese Herbs" nephropathy. The course of the disease is very fast, resulting in progression to end-stage renal disease, and in the future it results in the development of urinary tract cancer. That is why it is so important to recognize it early and start treatment. However, due to disease progression, some patients require dialysis and even kidney transplantation. Although the World Health Organization is trying to stop the spread of the use of harmful substances, there are still reports of this nephropathy appearing in some populations. Despite warnings from the Food and Drug Administration regarding the safety of botanicals containing arystolochic acid and its classification as a human carcinogen, products containing it are still available for purchase online. The purpose of the literature review below is to analyze the latest knowledge on aristolochic acid nephropathy and its associated complication

What does the future look like - home hemodialysis

Home hemodialysis (HHD) is a discovery from 1961 that is now experiencing a revival. It is a convenient and modern method of renal replacement therapy that allows the patient to undergo hemodialysis sessions at home. Due to the growing interest in home hemodialysis, we decided to present the potential of this renal replacement method, show both its benefits and complications resulting from its use. Undoubtedly, HHD has many benefits resulting mainly from the possibility of regulating the duration of the sessions and increasing their frequency. However, this method is also burdened with numerous complications. There are training courses in the use of HHD for patients who have just been diagnosed with end-stage renal disease as well as for patients undergoing dialysis using other methods. Appropriate patient selection is an important factor for the success of home therapy. There is a fierce battle in the home hemodialysis machine market. Manufacturers are outdoing each other in innovative technologies to ensure ease of use, trouble-free operation and minimize complications. The costs of home hemodialysis include more components than the dialysis treatment itself. Home hemodialysis gives patients comfort and independence above all. This is part of nephrology that undoubtedly requires a lot of work and development, but is certainly an invention of the 21st century

Long-time survival of a female with primary amyloidosis treated by peritoneal dialysis

Introduction. Amyloidosis, both primary and secondary, is a systemic disease characterized by extracellular deposition of fibrillar protein in vital organs, leading to their injury and even insufficiency. It results in a poor diagnosis, especially for patients with primary amyloidosis. Kidney involvement is typical and usually manifests by proteinuria, mainly nephrotic range, leading to end-stage renal disease (ESRD). Patients with ESRD need renal replacement therapy (RRT). Some data claim that better results and longer patient, survival are observed in peritoneal dialysed rather than in haemodialysed patients. Case report. The case is described of 19-year-old Caucasian woman with primary amyloidosis. Inherited primary amyloidosis with abnormal apolipoprotein A-I was established. The patient was successfully treated with peritoneal dialysis for 87 months. After this period, she was transferred for haemodialysis. Such a long survival time on peritoneal dialysis (PD) in a patient with primary amyloidosis has not been found. It is believed that the lowering of immunoglobulin levels in blood and normalization of total protein in serum effectively removed, through dialysate, the pathological polyclonal proteins. This effect probably also sustained cardio-circulatory sufficiency of the patient and significantly prolonged her survival. Conclusion. Peritoneal dialysis is an effective and recommended method of treatment in patients suffering from primary amyloidosis. Peritoneal dialysis should be the first choice therapy in ESRD patient; contrary to haemodialysis, peritoneal dialysis removes pathological proteins and allows the avoidance of intra-dialytic hypotension