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Renal Foot


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Last updated on Today, 5:00 PM by OPMA Secretariat
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Last updated on Today, 5:00 PM by OPMA Secretariat
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The ‘renal foot’ is a term loosely used to refer to the feet of patients with stage 4/5 kidney disease. There are 5 stages of renal failure and patients requiring dialysis are classed at level 4 or 5. High levels of self- awareness and careful clinical examination are essential to avoid serious foot complications while receiving dialysis treatment. The potential consequence of poor management of the renal foot are significant and include ulceration, gangrene, amputation, depression and even death.


  Assessment

The risk of developing foot conditions for any patient on dialysis should automatically be considered as being high, even in the absence of any active foot problems. See a podiatrist for expert advice and treatment if an active foot problem is discovered.

  •    For every patient in dialysis, a foot check should be carried out before and after treatment.
  •    Patients need to be attentive to their feet at home and during their time on dialysis.  It is essential to ensure that patients receive a quality foot check from a podiatrist at every appointment.

Causes

The causes of the foot issues in renal failure cases are multiple and inter-related. Three major pathologies--neuropathy, ischemia and infection--are the main contributory factors.  

    Patient Information and Inspection

     All patients should be encouraged to carry out a daily inspection to look for:

    • Damage to the nerves that might be indicated by: 
    • tingling sensation
    • pain
    • inflammation
    • reduced sweat
    • alterations to the shape of the feet
    • tough skin
    • loss of feeling in the feet/legs.
      • Damage to the blood supply which might be indicated by:
      • cramp in the calves
      • loss of hair on the legs and feet
      • cold, pale feet
      • swollen feet.
      • wounds or sores that do not heal



      Symptoms

      Symptoms of the the ‘Renal Foot’ are:

      • Hypoxia
      • Cachexia
      • Immune paresis
      • Anaemia
      • Charcot
      • Ischaemia
      • Deformity
      • Swelling/Oedema
      • Lesions/Infection/Ulcers/Cracks or breaks in the skin
      • Discrete areas of necrosis
      • Discolouration
      • Motor power

        Treatment

      Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary  team approach. Patient education on the measures required to achieve both primary and secondary prevention is also essential. Treatment of the renal foot can really only be done with the treatment of the patients' chronic kidney disease. 


                                                     

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