There should be a regular/periodic check up of the urine, for any infection/pus cells or growth of any bacteria. A CRF kidney is more prone to infection, and if infection is not prevented/ controlled, there is a danger of further kidney damage/failure. The infection should be treated on the lines explained in the topic on urinary tract infection (UTI). However, a word of caution if on culture and sensitivity of the urine, various antibiotics are available for treating the infection, only those should be administered which are least toxic for the kidneys.
(ii) Prevent obstruction in the urinary tract
In case there is an obstruction in the urinary tract, as a result of the benign enlargement of the prostate (BEP), or urinary stones, or some other cause, the obstruction should be removed. Since obstruction in the urinary tract increases the infection in it can further damage the kidneys.
(iii) Avoid unnecessary usage of drugs
A case of CRF should not to be any drugs on his own unnecessarily. He should take only limited drugs, as prescribed by a specialist. Any indiscriminate use of drugs may immediately shift the patient to an unstable condition. If that happens, stop the drug immediately, so that his condition may revert to the stable state.
(iv) Avoid radiographic dyes
Radiographic dyes should also be avoided as far as possible, since these dyes are likely to damage the kidneys. Thus, intravenous pyelography, etc. is least recommended in such cases. Now other tests are available. Moreover radiation has its own side effects.
(v) Strict control of diabetes and hypertension
Both these conditions, if not strictly controlled, will damage the kidneys further. Hence the prevention of further damage to the kidneys requires a rigid control of both these conditions.
Hypertension is usually associated with CRF, and sometimes blood pressure may be markedly elevated, making the condition unstable, which must be brought to normal quickly, so that the condition returns to the stable level.
(vi) Strict control of diet
If this step is not strictly followed, the patient may enter into an unstable stage. And, if taken seriously, an improvement in the condition of the patient may be noticed. The diet of a patient of CRF is prescribed by the specialist. However, broadly speaking, an intake of more protein in the food will elevate the blood urea, which is dependent on protein, and this elevated urea in the blood will further worsen the condition of the patient, which should be avoided. Protein alone makes the condition stable/unstable. A high protein diet may make the condition of the patient so unstable so that a dialysis may become necessary. On the other hand, a low protein diet may make the condition absolutely stable.
(vii) Rigid follow up
A case of CRF has to be monitored strictly and regularly, even constantly. Depending on the condition of the patient, it may be assessed weekly/fortnightly/monthly. At each visit, serum creatinine should be repeated, besides a detailed check up of the patient. It is understood that the patient will get his blood pressure and blood sugar, if diabetic, checked up daily. However, any sudden rise in serum creatinine should be noted carefully, and critically examined. It can be a true sign of uncontrolled diabetes/hypertension, infection, dehydration, necessitating immediate attention, and treatment. Otherwise the condition is likely to become unstable, either temporarily or even permanently. In such a situation, the condition of the patient is somewhat alarming and he may need dialysis at any moment. However, constant vigilance and quick response to any complication may keep the patient stable for years together. Maintenance dialysis is expensive, and may not be within the reach of everyone. Therefore, prevention of the disease is the only way to meet the situation.
It would be ideal if there is some national policy / programme for the over all prevention of this disease. At the same time, all hidden cases must be discovered/ treated. Summing up, early detection, prevention, including mass realization about the various especially serious aspects of the disease, should be the key to such a national programme.
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