TANDA- TANDA DAN GEJALA KEGAGALAN BUAH PINGGANG

Tanda-tanda dan gejala kegagalan buah pinggang terdiri daripada:

1.      kegagalan buah pinggang akut.

2.      kegagalan buah pinggang kronik

3.      kegagalan buah pinggang tahap akhir

Tanda-tanda dan gejala kegagalan buah pinggang akut mungkin termasuk:

• Kekurangan pengeluaran air kencing, walaupun kadang-kadang pengeluaran air kencing masih normal

• Pengekalan cecair, menyebabkan bengkak di kaki anda, buku lali atau kaki

• Mengantuk

• Sesak nafas

• Keletihan

• Kekeliruan

• Loya

• Sawan atau koma dalam kes-kes yang teruk

• Sakit dada atau tekanan

Tanda-tanda  dan gejala bagi penyakit buah pinggang kronik adalah:

• Selera kehilangan

• Am perasaan marah dan keletihan

• Sakit Kepala

• Gatal (pruritus) dan kulit kering

• Loya

• Berat badan tanpa cuba untuk mengurangkan berat badan

Gejala-gejala lain yang boleh membangunkan, terutamanya apabila fungsi buah pinggang telah mendapat lebih teruk, termasuk:

•  Kulit yang luar biasa gelap atau cahaya
• Kesakitan tulang
•  Sistem gejala Otak dan saraf:

1. Mengantuk dan kekeliruan
2. Masalah  menumpukan perhatian atau berfikir

• Kebas di tangan, kaki, atau kawasan lain
• Otot bergerak-gerak atau kejang
• Nafas bau
• Mudah lebam, pendarahan, atau darah dalam najis
• Dahaga yang berlebihan
• Rintangan Kerap
• Tahap Rendah kepentingan seksual dan mati pucuk
• Ttempoh haid berhenti (amenorea)
•  Sesak nafas
• Masalah tidur, seperti insomnia, sindrom kaki resah, dan apnea tidur obstruktif
• Bengkak kaki dan tangan (edema)
•  Muntah, biasanya pada waktu pagi

Gambar; tanda- tanda dan gejala biasa bagi pesakit kronik buah pinggang.

Tanda- tanda Peringkat akhir kegagalan buah pinggang (atau lewat kekurangan buah pinggang kronik)

• Anemia

• Pendarahan mudah dan lebam

• Sakit kepala

• Mudah letih  dan mengantuk

• Lemah

• Gejala mental seperti kecerdasan mental diturunkan, masalah menumpukan perhatian, kekeliruan, sawan

• Loya, muntah, dan umumnya kurang keinginan untuk makan

• Dahaga

• Kekejangan otot, otot bergerak-gerak

• Nocturia

• Sensasi kebas di kaki

• Cirit-birit

• Kulit gatal, mata gatal

Gambar: kulit gatal

• Perubahan warna kulit (kulit grayish, kadang-kadang nada kuning-coklat)

• Bengkak dan puffines

• Menurun minat terhadap seks

• Perubahan dalam kitaran haid

• Pengeluaran air kencing berkurangan

• Masalah pencernaan

Terima kasih.

UJIAN UNTUK KEGAGALAN BUAH PINGGANG AKUT

Kegagalan renal akut biasanya dikesan menggunakan beberapa kaedah seperti:

1. ujian air kencing

2. ujian darah

3. ujian computer/ pemgimejan .

4. biopsy

UJIAN AIR KENCING

     

Gambar: contoh air kencing pesakit

Punca-punca kegagalan buah pinggang boleh ditentukan dengan melihat pengeluaran air kencing.

Ujian air kencing boleh menunjukkan warna, jumlah, kejelasan, dan bau. Kegagalan buah pinggang akut biasanya mempunyai warna air kencing yang gelap, menunjukkan bahawa bahan kreatinin dan lain-lain dalam air kencing.

Gambar: analysis bacaan dipstick

Selain itu, air kencing boleh mendedahkan kegagalan buah pinggang dengan menggunakan bacaan dipstik ( seperti gambar diatas) . Kencing adalah untuk mengesan bahan-bahan atau bahan selular dalam air kencing seperti protein (albumin), glukosa, pH, ketone dan lain-lain.

UJIAN DARAH

 

Gambar :ujian darah dan ir kencing

Selain air kencing,  serum creatine dan urea boleh menjadi ujian untuk menentukan kegagalan buah pinggang, ini adalah kerana urea dan creatine akan meningkat jika pesakit mempunyai kegagalan buah pinggang jenis akut.

UJIAN PENGIMEJAN

Ujian pengimejan seperti ultrasound dan tomografi berkomputer (CT) boleh digunakan untuk membantu melihat buah pinggang.

Gambar : mesin computerized tomography (CT).

Gambar : contoh keputusan buah pinggang normal dan buah pinggang bermasaalah menggunakan mesin .

BIOPSI

Gambar: cara melakukan biopsy

Dalam keadaan tertentu, biopsi buah pinggang adalah disyorkan untuk mengeluarkan sampel kecil tisu buah pinggang untuk ujian makmal. Untuk mengeluarkan sampel tisu buah pinggang, doktor mungkin memasukkan jarum halus melalui kulit anda dan ke dalam badan.

DIAGNOSIS TEST FOR ACUTE RENAL FAILURE

Acute Renal Failure is usually diagnosed using:

1. Urine test

2. Blood test

3. Imaginary test

4. Biopsy


URINE TEST

Picture : urine sample

The causes of kidney can be determined by looking urine output.

Urine test or urinalysis can show colour, amount, clarity, and odour. Acute renal failure usually have dark urine colour, indicating that creatinine and other substances are concentrated. 

   

 

Picture : dipstick reading analysis

Beside, Urinalysis may reveal abnormalities that suggest kidney failure by using dipstick reading. Urinalysis is to detect substances or cellular material in the urine such as protein( albumin), glucose, pH , ketone and others.

BLOOD TEST

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Picture: blood sample and urine sample

Beside urinalysis, Serum creatine and urea can be test using blood test, this is because urea and creatine will increase if patient have acute renal failure.

IMAGING TEST

 Imaging tests such as ultrasound and computerized tomography (CT) may be used to help see kidneys.

Picture : computerized tomography (CT) machine.

Picture: example normal kidney and diseased kidney result of CT scan.





BIOPSY

Picture : biopsy procedure.

 In certain situations, kidney biopsy is recommended to remove a small sample of kidney tissue for lab testing. To remove a sample of kidney tissue, doctor may insert a thin needle through your skin and into skin.

DIAGNOSIS OF RENAL FAILURE

The diagnosis of renal failure can be done through the observation of a combination of symptoms ,physical examination and elevated the build up of waste products in the blood such as blood urea nitrogen (BUN),creatinine (Cr) levels, serum potassium, Glomerular filtration rate  and urinalysis. 

Urinalysis

Test to measure the amount of protein, detect the presence of abnormal blood cells, or measure the concentration of electrolytes.

•  Abnormalities of protein concentration in urine can act as indicator that the damage to the kidney has occurred. The most accurate method is  protein to creatinine ratio. Normal(200 mg/gm or less per day).Another test ,albumin to creatinine ratio which normal reading(30 mg/gm per day).More than 30 mg/gm per day or higher is sign of early kidney disease
•  The present of anaemia also related with kidney disease where abnormal aggregations of RBC can be seen in urine.Kidney disease disrupts blood cell production and shortens the survival  the red blood cell count and hemoglobin may be low (anemia)
• Comparing the concentrations of electrolytes in the blood and urine can help decide whether the kidneys are able to appropriately monitor and filter blood. Kidney dysfunction causes imbalances in electrolytes,such hyperkalemia, hypocalcemia (Decreased production of the active form of vitamin D), Hyperphosphatemia (Inability of failing kidneys to excrete phosphorus)

 Glomerular filtration rate  

Estimated from results of a serum (or blood)creatinine test. The GFR show the effciency of kidney to remove wastes from your blood. A serum (or blood) creatinine test alone should not be used to check kidney function. GFR is calculated using the serum creatinine and other factors such as age and gender.(refer GFR table)

A blood urea nitrogen (BUN) test

Measuring the amount of nitrogen in the blood that comes from the waste product urea.. BUN level rises when the kidneys aren't working well enough to remove urea from the blood.

Serum creatinine and creatinine clearance tests

Tests  that measure the level of waste,creatinine in blood & urine.It(creatine) formed when food converted into energy through a process of metabolism. Creatine broken further into creatinine that taken out of your blood by the kidney.

Types of tests on creatinine

Ø  Blood creatinine level

T A high creatinine level may mean your kidneys are not working properly.

Ø  Creatinine clearance test

A creatinine clearance test measures how well creatinine is removed from your blood by your kidneys. A creatinine clearance test is done on both a blood sample and on a sample of urine collected over 24 hours (24-hour urine sample).

Ø  Blood urea nitrogen-to-creatinine ratio (BUN:creatinine)

The levels of blood creatinine and blood urea nitrogen can be used to find the BUN-to-creatinine ratio. A blood urea nitrogen (BUN) test measures the amount of urea in blood.

Other related tests

• Abdominal ultrasound (check size or any obstruction exists)
• Kidney biopsy (tissues of kidney examine under microscope)
• Duplex Dropper study(check restricted of blood flow such renal artery stenosis)

SYMPTOMS OF RENAL FAILURE

Kidney failure usually do not showed of any symptoms (asymptomatic) to the patient.The symptoms start manifest as kidney function decrease with a variety of different clinical presentation.It may effect on kidney(hematuria,flank pain).associated extra renal symptoms such as edema, hypertension, and signs of uremia.Others detected by elevated of plasma creatinine, concentration or an abnormal urinalysis (proteinuria).As the failure continues, kidney was unable to regulate water and electrolytes balance ,to excrete the waste products and to promote the red blood cell production.

•  Low Urine Output

The significant decrease in urine output is the symptom of either chronic or acute renal failure. It effect the odor(strong odor),color(yellow, orange or brown),and concentration. Low urine output also lead to toxin and wastes develop in body and tissues.

• Edema

Due to urine output decrease will lead to fluid retention in the body. Fluids tend to trapped in the tissues hence cause swelling called edema to occur. Location of edema usually occurs in the legs, feet, arms and hands.

• Fatigue

Early stages of renal insufficiency tend to feel more tired or unwell rather than usual. Fatigue and drowsiness are common at this stage .Kidney produce a hormone called erythropoietin(help produce RBC).Kidney insufficiency cause RBC declines, that lead to oxygen flow hence lead to fatigue & energy loss. 

 

• Inflammation

Inflammation, or swelling in parts of the body, is also a sign of kidney disease. Types of inflammation are facial swelling and puffy eyes upon awakening, or swelling in the ankles and feet. When the kidneys are under stress, they are not able to effectively rid the body of toxins and excess fluids. When the amounts of toxins in the body are increased, inflammation occurs, as the body is trying to protect itself from these toxins.

• Hematuria

The condition when blood present in urine. Micro hematuria is condition, the blood is not visible .Hematuria develops due to damage in filtration barrier within the nephron that allows small cells in the blood into the urine.

• Proteinuria

Proteinuria is the present of protein in urine. Kidney disease causes disruption of the filtration barrier(usually prevent chemicals from the blood from leaking into the urine) that allows protein to leak out of the blood to get expelled in the urine.

•  Anorexia and Nausea

Anorexia--loss of appetite--and nausea occur in very advanced kidney disease and in kidney failure. Patients with advanced kidney disease often experience a metallic taste in the mouth that reduces the desire to eat. Severe kidney damage and a lack of filtration also leads to the accumulation of toxins within the body, which causes nausea and vomiting

Others related symptoms

•  Bloody stools
•  Breath odor
• Decrease sensation especially in the hands or feet
• Flank pain (between the ribs and hips)
•  Hand tremor
•   High blood pressure
•   Have muscle cramping at night
•   Have dry, itchy skin, easily bruising (due to anemia)