yulius hermantoThe Use of Golden Snail in Chronic Renal Failure
April 21st 2009 09:59
Introduction
Kidney is a vascular organ that has multiple functions, such as:
- maintain water and electrolytes balanced.
- maintain arterial blood pressure
- maintain plasma osmolality level and electrolytes concentration
- maintain acid-base balanced
- excretes metabolic residue and other chemical substances
- secretes hormones
- gluconeogenesis
A man usually has two kidneys, located in posterior wall of abdomen (retroperitoneal). Adult Kidney is approximately 150 gr. Kidney has functional unit, called nephron, each kidney has about 1 million nephron.
Chronic Renal Failure
Chronic Renal Disease is a complex process with multiple etiologies, resulting in the inexorable attrition of nephron number and function and frequently leading to end-stage renal disease (ESRD). ESRD represents a clinical state or condition in which there has been an irreversible loss of endogenous renal function. Uremia is the clinical and laboratory syndrome, reflecting dysfunction of all organ systems as a result of untreated or undertreated acute or chronic renal failure.
The different between Acute Renal Failure and Chronic Renal Failure is about the reversibility of the condition usually limited by 3 months. But, here in Indonesia, because lack of consciousness, knowledge, administrations, and surveillance, usually when the patient come to the hospital is already in chronic.
Epidemiology
Chronic kidney disease involving about 20 millions American, or one in nine adults. Most are unaware of the condition because they remain asymptomatic until the disease has significantly progressed. Over 70% of cases of late-stage chronic kidney disease are due to diabetes mellitus or hypertension. Glomerulonephritis, cystic diseases, and other urologic diseases account for another 12%, and 15% of patients have other or unknown causes.
Pathophysiology of Uremia
Azotemia refers to the retention of nitrogenous waste products as renal insufficiency develops. Uremia refers to the more advanced stages of progressive renal insufficiency when the complex, multiorgan system derangements become clinically manifest.
As we know, one of kidney is to produce urine and excrete nitrogen degraded product such as urea. Accumulation urea in body may contribute to some of clinical abnormalities, including anorexia, malaise, vomiting, and headache. Others middle Nitrogenous mollecules (urates, benzoates, indole, and etc.) may contribute to morbidity and mortality in kidney failure. Uremia also involved other kidney function not just excretion.
So, uremia being seen as two sets of abnormalities:
- accumulation of products pf protein metabolism
- loss of other renal function, such as fluid and electrolytes homeostasis and hormonal abnormalities.
Signs and Symptoms
The symptoms of chronic kidney disease often develop slowly and are nonspecific. Individuals can remain asymptomatic until renal failure is far advanced (GFR < 10–15 mL/min). Manifestations include fatigue, weakness, and malaise. Gastrointestinal complaints, such as anorexia, nausea, vomiting, a metallic taste in the mouth, and hiccups are common. Neurologic problems include irritability, difficulty in concentrating, insomnia, subtle memory defects, restless legs, and twitching. Pruritus is common and difficult to treat. As uremia progresses, decreased libido, menstrual irregularities, chest pain from pericarditis, and paresthesias can develop. Symptoms of drug toxicity—especially for drugs eliminated by the kidney—increase as renal clearance worsens.
On physical examination, the patient appears chronically ill. Hypertension is common. The skin may be yellow, with signs of easy bruisability. Rarely seen in the dialysis era is uremic frost, a cutaneous reflection of ESRD. Uremic fetor is the characteristic fishy odor of the breath. Cardiopulmonary signs may include rales, cardiomegaly, edema, and a pericardial friction rub. Mental status can vary from decreased concentration to confusion, stupor, and coma. Myoclonus and asterixis are additional signs of uremic effects on the central nervous system.
In any patient with renal failure, it is important to identify and correct all possibly reversible causes. Urinary tract infections, obstruction, extracellular fluid volume depletion, nephrotoxins, hypertension, and congestive heart failure should be excluded.
Laboratory Diagnosis
The diagnosis of renal failure is made by documenting elevations of the BUN and serum creatinine concentrations. Further evaluation is needed to differentiate between acute and chronic renal failure. Evidence of previously elevated BUN and creatinine, abnormal prior urinalyses, and stable but abnormal serum creatinine on successive days is most consistent with a chronic process.
Usually in establishing Renal Failure, GFR estimation is being used. Cockcroft-Gault equation is commonly being used.
(140-age) x body weight (kg)
72 x Pcr (mg/dl)
Multiply result by 0.85 for women.
Anemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, and hyperkalemia can occur with both acute and chronic renal failure. The urinalysis shows isosthenuria if tubular concentrating and diluting ability are impaired. The urinary sediment can show broad waxy casts as a result of dilated, hypertrophic nephrons
Complications
Hyperkalemia
Acid–Base Disorders
Cardiovascular Complications
Hematologic Complications
Neurologic Complications
Disorders of Mineral Metabolism
Endocrine disorders
Treatment
Consists of Dietary Management, Dialysis, and Transplant, also manage the complications well.
Now i will discuss, the role of Golden Snail (Pomacea canaliculata) in Kidney Failure
As we know, one of treatment for Chronic Kidney Management is Dietary Management. In dietary management, especially we do restriction to some minerals and proteins.
Phosphorus restriction is important in kidney failure because, kidney is unable to excrete phosphorus, and also can't produce activated Vitamin D, and can't control calcium excretion in urine. Which leads to hyperphosphatemia and hypocalcemia, that stimulate secondary hyperparathyroidism. PTH from parathyroid, has main function to increase calcium in blood, because kidney unable to produce activated vitamin D that important for Ca absorption in gut, so the only source for calcium is bone. Kidney Failure will cause bone demineralization, this condition is called Osteitis Fibrosa Cystica.
And also Aluminium used in Phosphate binding also can contribute to bone resorption leading to osteomalacia. In general bone over resorption leads to decrease of bone strength that make easy to fracture.
Besides that, increase of bone resorption, later on will contribute to calcification dystrophic of soft tissue and blood vessels.
So we need to limits phosphate intake, about 0,8 - 1,2 gr per day. but it is difficult because almost all animals products have more phosphate to calcium ratio. Golden Snail have Calcium/phosphorus ratio 217/61, so it's good for limiting phosphate intake.
Besides that, Golden snail have high protein content which most of them are essential amino acids.
In Chronic kidney disease, protein is recommended to be restricted. Iincreasing protein intake will increase nitrogen balance, so protein is recommended as low as 0,6 gr/kg per day. And it also recommended to have higher proportion in essential amino acid.
Golden Snail provide that both, low phosphorus and high essential amino acid.
But because, snail may have parasites that it carry, it should be prepare well before eat the snail., also should consult your dietitian about amount of golden snail you can eat.
Benefits of eating Golden Snail:
- Easy and Cheap to obtain
- High Calcium/Phosphate proportion
- High Calorie (83 Cal/100 g)
- Sufficient Protein (12,2 g/100 g)
- High content of essential amino acids
- Potassium (17 mg/100 g), Sodium (0,4 mg/ 100 g)
I'm sorry, if i can provide adequate information. I willing to improve my blog, so please comment about my post.
Thank you Before.
References
1. Guyton, A.C., Hall, J.E. Fisologi Kedokteran 9th Ed. 2002. Jakarta: EGC
2. Hauser, K. et. al. Harrison's Principles of Internal Medicine. 2004. New York: McGraw-Hill
3. McPhee, S.P., PapaDakis, M.A. Current Medical Diagnostic and Treatment 2008. 2007. New York: McGraw-Hill
4. Johnson, D.W. Dietary protein restriction as a treatment for slowing chronic kidney disease progression: The case against (Review Article).oi.wiley.com/10.1111/j.1440-1797.2006.00550.x
5. Pastan, S. Bailey, J. Dialysis Therapy. 1998. NEJM Volume 338:1428-1437
6. Terasaki, P.I, et. al. High Survival Rates of Kidney Transplants from Spousal and Living Unrelated Donors. 1995. NEJM:Volume 333:333-336
7. http://www.applesnail.net/
8. Prof. M.Sja'bani, Lecture in Gadjah Mada University
Kidney is a vascular organ that has multiple functions, such as:
- maintain water and electrolytes balanced.
- maintain arterial blood pressure
- maintain plasma osmolality level and electrolytes concentration
- maintain acid-base balanced
- excretes metabolic residue and other chemical substances
- secretes hormones
- gluconeogenesis
A man usually has two kidneys, located in posterior wall of abdomen (retroperitoneal). Adult Kidney is approximately 150 gr. Kidney has functional unit, called nephron, each kidney has about 1 million nephron.
Chronic Renal Failure
Chronic Renal Disease is a complex process with multiple etiologies, resulting in the inexorable attrition of nephron number and function and frequently leading to end-stage renal disease (ESRD). ESRD represents a clinical state or condition in which there has been an irreversible loss of endogenous renal function. Uremia is the clinical and laboratory syndrome, reflecting dysfunction of all organ systems as a result of untreated or undertreated acute or chronic renal failure.
The different between Acute Renal Failure and Chronic Renal Failure is about the reversibility of the condition usually limited by 3 months. But, here in Indonesia, because lack of consciousness, knowledge, administrations, and surveillance, usually when the patient come to the hospital is already in chronic.
Epidemiology
Chronic kidney disease involving about 20 millions American, or one in nine adults. Most are unaware of the condition because they remain asymptomatic until the disease has significantly progressed. Over 70% of cases of late-stage chronic kidney disease are due to diabetes mellitus or hypertension. Glomerulonephritis, cystic diseases, and other urologic diseases account for another 12%, and 15% of patients have other or unknown causes.
Pathophysiology of Uremia
Azotemia refers to the retention of nitrogenous waste products as renal insufficiency develops. Uremia refers to the more advanced stages of progressive renal insufficiency when the complex, multiorgan system derangements become clinically manifest.
As we know, one of kidney is to produce urine and excrete nitrogen degraded product such as urea. Accumulation urea in body may contribute to some of clinical abnormalities, including anorexia, malaise, vomiting, and headache. Others middle Nitrogenous mollecules (urates, benzoates, indole, and etc.) may contribute to morbidity and mortality in kidney failure. Uremia also involved other kidney function not just excretion.
So, uremia being seen as two sets of abnormalities:
- accumulation of products pf protein metabolism
- loss of other renal function, such as fluid and electrolytes homeostasis and hormonal abnormalities.
Signs and Symptoms
The symptoms of chronic kidney disease often develop slowly and are nonspecific. Individuals can remain asymptomatic until renal failure is far advanced (GFR < 10–15 mL/min). Manifestations include fatigue, weakness, and malaise. Gastrointestinal complaints, such as anorexia, nausea, vomiting, a metallic taste in the mouth, and hiccups are common. Neurologic problems include irritability, difficulty in concentrating, insomnia, subtle memory defects, restless legs, and twitching. Pruritus is common and difficult to treat. As uremia progresses, decreased libido, menstrual irregularities, chest pain from pericarditis, and paresthesias can develop. Symptoms of drug toxicity—especially for drugs eliminated by the kidney—increase as renal clearance worsens.
On physical examination, the patient appears chronically ill. Hypertension is common. The skin may be yellow, with signs of easy bruisability. Rarely seen in the dialysis era is uremic frost, a cutaneous reflection of ESRD. Uremic fetor is the characteristic fishy odor of the breath. Cardiopulmonary signs may include rales, cardiomegaly, edema, and a pericardial friction rub. Mental status can vary from decreased concentration to confusion, stupor, and coma. Myoclonus and asterixis are additional signs of uremic effects on the central nervous system.
In any patient with renal failure, it is important to identify and correct all possibly reversible causes. Urinary tract infections, obstruction, extracellular fluid volume depletion, nephrotoxins, hypertension, and congestive heart failure should be excluded.
Laboratory Diagnosis
The diagnosis of renal failure is made by documenting elevations of the BUN and serum creatinine concentrations. Further evaluation is needed to differentiate between acute and chronic renal failure. Evidence of previously elevated BUN and creatinine, abnormal prior urinalyses, and stable but abnormal serum creatinine on successive days is most consistent with a chronic process.
Usually in establishing Renal Failure, GFR estimation is being used. Cockcroft-Gault equation is commonly being used.
(140-age) x body weight (kg)
72 x Pcr (mg/dl)
Multiply result by 0.85 for women.
Anemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, and hyperkalemia can occur with both acute and chronic renal failure. The urinalysis shows isosthenuria if tubular concentrating and diluting ability are impaired. The urinary sediment can show broad waxy casts as a result of dilated, hypertrophic nephrons
Complications
Hyperkalemia
Acid–Base Disorders
Cardiovascular Complications
Hematologic Complications
Neurologic Complications
Disorders of Mineral Metabolism
Endocrine disorders
Treatment
Consists of Dietary Management, Dialysis, and Transplant, also manage the complications well.
Now i will discuss, the role of Golden Snail (Pomacea canaliculata) in Kidney Failure
As we know, one of treatment for Chronic Kidney Management is Dietary Management. In dietary management, especially we do restriction to some minerals and proteins.
Phosphorus restriction is important in kidney failure because, kidney is unable to excrete phosphorus, and also can't produce activated Vitamin D, and can't control calcium excretion in urine. Which leads to hyperphosphatemia and hypocalcemia, that stimulate secondary hyperparathyroidism. PTH from parathyroid, has main function to increase calcium in blood, because kidney unable to produce activated vitamin D that important for Ca absorption in gut, so the only source for calcium is bone. Kidney Failure will cause bone demineralization, this condition is called Osteitis Fibrosa Cystica.
And also Aluminium used in Phosphate binding also can contribute to bone resorption leading to osteomalacia. In general bone over resorption leads to decrease of bone strength that make easy to fracture.
Besides that, increase of bone resorption, later on will contribute to calcification dystrophic of soft tissue and blood vessels.
So we need to limits phosphate intake, about 0,8 - 1,2 gr per day. but it is difficult because almost all animals products have more phosphate to calcium ratio. Golden Snail have Calcium/phosphorus ratio 217/61, so it's good for limiting phosphate intake.
Besides that, Golden snail have high protein content which most of them are essential amino acids.
In Chronic kidney disease, protein is recommended to be restricted. Iincreasing protein intake will increase nitrogen balance, so protein is recommended as low as 0,6 gr/kg per day. And it also recommended to have higher proportion in essential amino acid.
Golden Snail provide that both, low phosphorus and high essential amino acid.
But because, snail may have parasites that it carry, it should be prepare well before eat the snail., also should consult your dietitian about amount of golden snail you can eat.
Benefits of eating Golden Snail:
- Easy and Cheap to obtain
- High Calcium/Phosphate proportion
- High Calorie (83 Cal/100 g)
- Sufficient Protein (12,2 g/100 g)
- High content of essential amino acids
- Potassium (17 mg/100 g), Sodium (0,4 mg/ 100 g)
I'm sorry, if i can provide adequate information. I willing to improve my blog, so please comment about my post.
Thank you Before.
References
1. Guyton, A.C., Hall, J.E. Fisologi Kedokteran 9th Ed. 2002. Jakarta: EGC
2. Hauser, K. et. al. Harrison's Principles of Internal Medicine. 2004. New York: McGraw-Hill
3. McPhee, S.P., PapaDakis, M.A. Current Medical Diagnostic and Treatment 2008. 2007. New York: McGraw-Hill
4. Johnson, D.W. Dietary protein restriction as a treatment for slowing chronic kidney disease progression: The case against (Review Article).oi.wiley.com/10.1111/j.1440-1797.2006.00550.x
5. Pastan, S. Bailey, J. Dialysis Therapy. 1998. NEJM Volume 338:1428-1437
6. Terasaki, P.I, et. al. High Survival Rates of Kidney Transplants from Spousal and Living Unrelated Donors. 1995. NEJM:Volume 333:333-336
7. http://www.applesnail.net/
8. Prof. M.Sja'bani, Lecture in Gadjah Mada University
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