Every healthy person has two kidneys. They take over a variety of tasks in the body. The most important function of these organs is detoxification. The kidneys ensure the excretion of metabolic waste products and toxins via the urine. They also regulate the water and electrolyte balance. In addition, vital hormones are produced here. Although the kidneys are arranged in pairs, it is possible to live with only one kidney without any complaints.
The medical specialty that deals with the kidneys is nephrology. The term nephrology comes from the Greek word nephros for the kidney. Another common technical term in everyday nursing care is renal. Renal means “concerning the kidney” and is derived from the Latin word Ren for kidney.
For example, According to current studies, about 80,000 people in Germany are treated with renal replacement procedures (dialysis) because their kidneys are not working properly. It is estimated that at least two million people in Germany suffer from impaired kidney function.
Location: Where are the kidneys located?
The kidneys are located to the left and right of the spine at the level of the eleventh and twelfth rib. The left kidney is about 1.5 centimeters higher than the right one. In adults, these organs are eleven to twelve centimeters long and five to six centimeters wide. They weigh about 150 grams each.
Main function: detoxification of the body
The main task of the kidneys is performed by tiny units called nephrons. They consist of renal corpuscles and renal tubules.
In the blood vessels of the renal corpuscles, the glomeruli, the blood is filtered. This results in the so-called primary urine. Harmful substances are thus removed from the blood and later excreted via the urine. Almost the entire amount of water is then returned to the blood from the primary urine. During this process the body also regains important electrolytes. This reabsorption takes place in the renal tubules (tubule system). If the kidney function is disturbed, the first symptoms of poisoning set in within a short time.
The kidneys are also involved:
the adjustment of blood pressure, on the production of hormones
the regulation of the acid-base balance – they ensure that blood does not become too “acidic” or too “alkaline
the production of other hormones, which among other things stimulate the formation of red blood cells
Diseases: Acute renal failure and chronic renal insufficiency
If the kidneys do not function properly, toxins accumulate in the body. The water, mineral and acid-base balance is disturbed.
Many people live with a slight to moderate restriction of their kidney function without noticing it. Especially in older people who have to take medication regularly, unnoticed kidney failure can lead to overdoses of medication.
Advanced kidney disease causes a number of typical symptoms:
loss of appetite, nausea, vomiting
Lack of concentration
raised blood pressure
gray skin color
shortness of breath and water retention, especially eyelid and lower leg edema
Acute Kidney Failure
In acute renal failure, the kidneys stop working within a maximum of two days. This can occur as a result of various underlying diseases or a disease of the kidneys themselves. Depending on the cause, it can be cured or result in permanent kidney damage. Acute kidney failure is when the detoxification performance of the organs falls below a certain threshold. This is measured by the concentration of the so-called serum creatinine. The amount of urine excreted is also used to assess kidney function.
For the treatment of patients with acute renal failure, it is important to know whether complications have already been observed in addition to the laboratory findings; for example, shortness of breath, confusion and drowsiness. Potassium no longer excreted can accumulate in the body and lead to cardiac arrhythmia. When these indications are detected, doctors immediately start a renal replacement therapy that purifies the blood again.
Chronic renal insufficiency
In chronic diseases, the kidney function decreases gradually. In the early stages, kidney diseases are often not noticed by those affected. Common triggers of chronic kidney failure are diabetes mellitus (diabetes), diseases of the renal corpuscles (glomerulonephritis), the renal tubes (tubulointerstitial diseases). High blood pressure can also cause damage to the renal vessels.
In industrialized countries, the proportion of older people with high blood pressure (hypertension) and diabetes mellitus is increasing. This also leads to an increase in patients with chronic renal insufficiency.
Chronic renal insufficiency: treatment and care
Chronic kidney disease in the early stages is treated with medication. If the kidneys can no longer adequately fulfill their tasks, the blood must be cleaned in some other way. One possibility is the transplantation of a healthy donor kidney. Another form of therapy is the mechanical purification of the blood, known as dialysis.
In dialysis, nephrological nurses not only take care of the technical aspects of treatment. They also help patients to cope with everyday life by providing targeted advice and support.
For dialysis, the patient receives a special vascular access. This must be well maintained and regularly inspected to prevent infections and complications. This text explains in detail what nursing staff have to pay attention to.
GFR and creatinine clearance: Which laboratory values are important?
The most important values for assessing kidney function are the glomerular filtration rate, abbreviated GFR, and creatinine clearance. In simple terms, both measuring methods examine how much of a substance is in the blood – and how much of it is excreted in the urine. As a rule, the amount of creatinine, a breakdown product of muscle metabolism, is checked.
The GFR indicates how much fluid the renal corpuscles filter out in a given time. In a healthy adult this is 135 to 180 litres per day. As a rule of thumb, a low glomerular filtration rate indicates a restriction in renal function. To calculate the GFR, creatinine value, age and sex of the patient are required. To determine the creatinine clearance, body weight is added. (jk)