Chest pain is usually associated with ischemic heart disease such as a heart attack or angina. However chest pain may occur as a symptom of kidney disease. Chest pain occurring due to renal failure implies an inflammation of the tissues around the heart known as pericarditis. Pericarditis under these circumstances is quite dangerous as the inflammation of the lining of the heart that occurs results in fluid building up around the heart and compressing it preventing normal function. This can be a fatal complication, drainage of the fluid usually results in recollection of the fluid quickly. The best treatment if this is suspected is urgent dialysis. Frequently the patient will need three sessions of dialysis in rapid sequence to gain control of the situation and resolve the chest pain.
Swelling of the feet is also known as pedal oedema this occurs primarily in kidney disease because of retention of fluid. The kidney is responsible for several functions. When the ability of the kidney to remove fluid from the body is decreased fluid is retained. The increased fluids within the blood vessels eventually leak through the walls of the smallest capillaries and enter the soft and sponge like tissues beneath the skin known as the subcutaneous tissue giving rise to the symptom of swelling. Due to the fact that fluid always settles in a dependent position the swelling is usually observed to be in the lower limbs if the patient is standing or around the waste and back if sitting or lying down. Very severe cases of swelling may be seen with swelling of the entire body a situation known as anasarca. This symptom usually occurs in very severe kidney disease or in cases where there is retention of fluid due to losses of protein in the urine.
It is difficult to conceptualize at first that loss of protein in the urine may lead to retention of fluid within the body. However one of the roles of protein is to provide one of the main constituents of blood. This constituent is known as albumin the same albumin that is found in egg white. This protein attracts fluid to itself therefore the more albumin you have in your blood stream the more fluid will want to be attracted to and remain within the blood vessel. If the albumin levels within the blood are low then the fluid will be less attracted to remain within the blood vessels and instead will leak wherever there is a pressure difference such as in the loose tissues beneath the skin where there is relatively low pressure and a willingness to expand to accommodate fluid.
Nephrotic syndrome is a type of kidney disease where there are large quantities of protein leaking into the urine. The first symptom of kidney disease noted in these patients is usually swelling of the feet.
Pain is a common complication during hemaodialysis. It may be related to the procedure itself such as in the case of large fluid shifts that may result in cramping or simply the discomfort of remaining seated for 4 hours. Patients frequently complain of back pain or leg pain however some pain is non specific and may even defy diagnosis. The prevalence of pain among patients on hemodialysis has been reported to be as high as 47%. Unfortunately despite such a high reported prevalence there are no guidelines for the treatment of pain in patients on dialysis.
Overview of calcium regulation (See Wikipedia:Calcium in biology). To discuss image, please see Talk:Human body diagrams References Page 1094 (The Parathyroid Glands and Vitamin D) in: Walter F., PhD. Boron (2003). Medical Physiology: A Cellular And Molecular Approaoch, 1300, Elsevier/Saunders. (Photo credit: Wikipedia)
A study of 100 dialysis patients reported in the clinical journal of the american society of nephrology found that up to 51% of patients experienced chronic pain on hemodialysis. Pain derived from muscle and bone was the most prominent reported cause of pain. Headache was also very common and usually restricted to the dialysis sessions. However some patients did develop chronic headache as well. While patients with diabetic nerve damage of any kind were more likely to have pain on haemodialysis.
Patients with diabetes and chronic pain were most likely to have low vitamin d levels as well as low levels of parathyroid hormone (PTH). This correlation may imply that PTH and Vitamin D may play some role in the pathology of pain in these patients. This was further corroborated by the fact that calcium, which is closely regulated by both vitamin D and PTH, was an independent risk factor for chronic pain. Higher calcium levels were very significant for greater degrees of pain along with higher levels of PTH even if within the range considered normal for haemodialysis patients.
The correlation between pain and mineral metabolism of calcium is very interesting as PTH vitamin D and calcium are very closely related in the maintenance of good bone health on dialysis. It is already well known that disturbances of this important axis of hormones may lead to severe bone disease. However a new role in chronic pain for these markers may need to be explored by further studies.
Acetylsalicylic acid otherwise known as aspirin was a major advance in the treatment of inflammation when it was first discovered in 1853. The chemical compound had been used for centuires before that however in the form of bark and herbs which were found by early man to be helpful for the relief of pain.
The chemical structure above served for the development of many novel drugs with potent anti inflammatory effects and became one of the most prescribed classes of medication in history collectively known as the non steroidal antiinflammatory drugs or NSAIDs. The sideffects of the Aspirin are shown below in this mindmap by maderoh88
NEGATIVE EFFECTS ON THE KIDNEY.
Aspirin reduces renal blood flow this is not usually a problem in a healthy person however in a patient who already has decreased blood volume such as patients with dehydration or blood loss this could precipitate acute renal failure. Several types of kidney disease unified by the loss of protein in the urine, may produce a relative low volume state. Despite the obvious retention of fluid in the skin of the feet and around the eyes, the blood vessels are depleted and hence the kidney is also starved for fluid. In such a setting aspirin will further cause reduction of renal blood flow and tip the patient over into acute renal failure.
Aspirin is an anti inflammatory agent yet it has been known to cause inflammation of the tissues of the kidney a state called an allergic interstitial nephritis. Patients with this disorder may have a skin reaction after administration of aspirin followed by high blood pressure abnormal kidney function and decreased urination, thankfully it is usually self limited.
Aspirin has also been associated with an abnormality of the kidney known as membranous nephropathy. This condition results in thickening of the filter of the kidney and loss of protein in the urine.
BENEFICIAL USES.
Aspirins effect on glomerular blood flow can be beneficial. It would be helpful to understand glomerular function to understand why.
Aspirin has the effect of reducing the flow of blood through the kidney in the areas responsible for filtration. While this may not sound like a good thing, this effect is similar to the effect of angiotensin converting inhibitors or ACEI which are prescribed for delaying progression of renal disease. This effect of aspirin is particularly useful in patients with high degrees of protein loss in the urine. Reduction of pressure within the kidney will lead to decreased filtration of protein by the kidney. Hence at one time aspirin was one of the major drugs used in the treatment of membranous nephropathy and other causes of nephrotic syndrome. The drug has fallen out of use for this indication however because of the negative effects on kidney function produced by aspirin. Inflammatory conditions of the kidney were also thought to be treatable by aspirin, conditions such as membranoproliferative glomerulonephritis which is a very rare form of inflammation of the kidney. However all recent trials have discounted any protective effect of aspirin in this and similar conditions.
Although an anti inflammatory agent aspirin has no role in the treatment of inflammatory disorders of the kidney. At this time superior antiinflammatory agents with less negative effects on the kidney are available.
