Pain Killers and Kidney

Pain Killers and Kidney

Analgesics (pain killers) are one of the most important causes of permanent kidney damage. These drugs are grouped as NSAIDs or Non-steroidal anti-inflammatory drugs.

In European countries these form one of the commonest cause of CKD in countries like Belgium, Sweden, Australia and US. With greater awareness of this problem, the incidence is decreasing in the western world while more and more cases are being diagnosed in India.

The vultures, hawks, and raptors, crows and similar birds are on the verge of extinction. A theory postulating the cause of this decline in their numbers is consumption of carcass of dead animals fed analgesics for fattening and milk productions. The analgesics remaining in the dead tissue causes kidney failure in these birds resulting in their premature death.

The commonest drug implicated is phenacetin in combination with aspirin and codeine. Combination drugs are more likely to cause kidney damage. Ingestion of 1000 to 5000 tab is sufficient to cause permanent renal damage.

Most countries have banned phenacetin while in many analgesics are not sold without a prescription.

The disease is more common in a woman suffering from a headache, arthritis or a backache. Psychological dependence and abuse of analgesics is a common problem. This causes further abuse of the drugs and often denial of the same. Underestimation of analgesic abuse is common.

These drugs may also cause edema of feet, high blood pressure, atherosclerosis of blood vessels and damage to the stomach and intestines. These have also caused urinary bladder tumours of malignant variety.

The kidney damage starts in the tip of filtering system called papilla. These are may become thick, calcified and may break off (papillary necrosis). This is a result of less blood supply to this area of the kidney.

Additionally, NSAIDs may also cause AKI (acute kidney injury) by a mechanism akin to allergy.

These diseases can be prevented by limiting analgesic usage to only situations where medically needed while keeping a watch on dosage and regular monitoring of kidney function.

Malaria

Malaria :

Signs and Symptoms

After a mosquito bite, the parasite goes to the liver where it multiplies and matures through different forms.

After 10 to 35 days, the parasites get released in blood in waves and cause fever. Falciparum incubation period is 10 to 14 days.

Fever may be > 40 0 . It comes on alternate days in P vivax and falciparum and every 3rd day in P ovale. However, if many mosquitoes have bitten laden with parasites, fever may come daily and sometimes many times in a day.

There are typically 3 stages. Stage of chills and shivering, the bed might shake if it is pronounced, stage of warmth and finally sweating before temperature settles down. The patient may feel well in between the fever episodes.

Red blood cells release hemoglobin and anemia ensues. The spleen enlarges in most cases. Untreated fever may continue for weeks and then subside as the body develops immunity or recur again and again over months and at times years.

Malaria can be complicated, often in falciparum variety but sometimes in vivax as well. Complications can involve liver, kidney, brain, heart, lungs, intestines etc. There may be bleeding from various sites, glucose in blood may decline and patients without treatment often die of these complications.

It can cause Coma or unconsciousness, fits, jaundice, kidney failure, bleeding from various sites (DIC), loose motions with low BP and shock (algid malaria). Abortions may occur if patient is pregnant.

Diagnosis:

Diagnosis is made by peripheral smear examination. A drop of blood is spread (smeared ) on a slide and seen under a microscope after staining. Parasites may be seen and their no can inform us about the severity of infections. Trained and sincere laboratory technicians are required for this test.

Easier tests include looking for malarial parasite antigen and antibodies. These nowadays are quite accurate.

Blood and urine tests are also done for associated complications if any.

Next Prevention and treatment

Drugs after Renal Transplant: II

Drugs after Renal Transplant: II

There are a number of other drugs used in transplant recipients after they are discharged from the hospital.

In the initial period these include:

Antibiotics to prevent urinary tract infections. These may need to be continued for 6 months. These (Trimethoprim + Sulfas) may prevent pneumocystis infection of the lungs as well.

A common infection in transplant recipients is due to cytomegalovirus. This can be prevented by a drug called Valgancyclovir. It is usually given for 90 – 100 days. It is a costly drug and the total treatment may cost about 25000 to 45000 ₹ depending on the dose and duration of CMV prophylaxis.

Anti Hypertensive drugs, sugar lowering drugs may be required in cases of Hypertensives and diabetics.

Malaria

Malaria Introduction

It is a disease caused by a protozoan parasite named Plasmodium. The various species are

P falciparum, P vivax, P malariae, P ovale and P knowlesi.

First 2 are common in India. P ovale is found only in Africa. P malariae is also rare while it is not certain whether P knowlesi transmission occurs through monkeys.

The disease is spread from one human being to another by the bite of female Anopheles mosquito. This bites during the night (after sunset) till day break.

Transmission is influenced by no of mosquitoes, no of bites, the no of parasites in the blood which is ingested by mosquitoes and the no of parasites in the saliva of mosquitoes injected in man.

Falciparum is usually more dangerous than vivax. However, more and more cases of complicated vivax malaria are being seen now.

After a bite of infected man by mosquitoes, it takes 8 to 30 days before the mosquito can transmit malaria.

Coming up Clinical manifestations and diagnosis.

 

Hypertension in Dialysis Patients

Hypertension in Dialysis Patients I

About ½ of dialysis patients have high BP while on regular dialysis. A pre-dialysis BP > 140/90 mm Hg is required for the diagnosis of hypertension in this group.

Mortality, cardiovascular events including heart attacks, congestive heart failure, strokes are more common in hypertensive dialysis patients.

Systolic BP < 110 mm Hg Or >160 mm Hg is also associated with poor outcome in dialysis patients. Hence the BP has to be optimised and kept somewhere between these two limits.

Causes of high BP in dialysis population:

Expansion of body water and blood volume

Reduced blood supply to kidneys

Salt accumulation

High Calcium level

Thickened arteries

Preexisting essential hypertension

Increased sympathetic nervous activity

Poor water compliance

Poor drug compliance.

BP is measured before and after dialysis. For better overall BP, 24-hour ambulatory recordings are made.

Coming up Treatment of hypertension in the dialysis population.