Chronic kidney disease (CKD) that arises when the kidneys of a person get damaged due to any reason and can’t able to filter the blood properly. It is a slow disease and progresses over a period of a long time. As a result, a patient has to face the disease of permanent kidney failure.
Chronic kidney disease (CKD), also known as chronic renal failure, ceaseless renal disease, or unending kidney failure, is more dangerous as people assume about it. It regularly goes undetected and undiscovered until the disease is very much progressed.
It isn’t unusual for people to acknowledge they have endless kidney failure until their kidney capacity goes down to 25 percent of normal. As kidney failure progresses to an advanced stage and the organ’s capacity is seriously affected. It could be a reason for developing the terrifying level of waste and liquid in the body.
However, the treatment of chronic kidney disease is important to stop the further progress of the disease by controlling the reasons for kidney failure. But it is not possible to cure the damaged part. The patient has to live with the current symptoms and conditions for the rest of life. The only approach to get rid of kidney failure is the transplant of the kidney.
A Quick Overview Of Chronic Kidney Disease
Here are some key focuses on perpetual kidney disease. More detail and supporting data are in the below article.
- A common indication of chronic kidney disease comprises of blood in urine, hypertension, and weakness.
- The causes of this disease include diabetes or any specific kidney disease, including polycystic kidney disease.
- There is no solution for chronic kidney disease, which means treatment is focused on lessening indications.
- Diagnosis generally happens after blood tests, kidney sweeps, or biopsy.
Symptoms of Chronic Kidney Disease
The progression of chronic kidney disease is very slow as compared to acute kidney failure. It grows continuously but gradually over a period of time. Even in some cases, one kidney of a patient stops working while the other remains in good condition with proper working.
Symptoms are usually invisible until the disease is very much progressed. It appears at a time when the condition has turned out to be extreme, and it is easy to recognize the signs and symptoms of the disease.
It is significant for the people to do regular checkups of their kidneys who are at high risk of developing kidney disease. Early diagnosis helps to calm down the progression and avoids permanent damage to the kidney.
The most widely recognized signs and symptoms of chronic kidney disease include:
- Blood in urine
- Dark urine
- Reduced mental activeness
- Decreased urine yield
- Edema swollen hands, feet, and lower legs (face swallows if edema is serious)
- Fatigue (tiredness)
- Hypertension (high blood pressure)
- Itchy skin can become persistent
- Loss of hunger
- Male incapability to get or keep up an erection (erectile dysfunction)
- Frequent urination with short intervals, particularly during the evening
- Muscle cramps
- Muscle twitches
- One-sided pain or mid to lower back
- Panting (shortness of breath)
- Protein in urine
- Sudden change in body weight
- Unexplained headaches
Stages of Chronic Kidney Disease
The GFR rate (Glomerular filtration rate) is a test that is used to calculate the working capacity of kidneys. It helps to assess the condition of kidneys as well as the level of damage to the kidney.
As per the guidelines of the National Kidney Foundation (NKF), chronic kidney disease is categorized into five different stages. It helps the physicians to understand the condition of disease in a patient and treat the disease in a suitable manner. Every stage requires a different type of treatment based on the condition of disease and patient as well.
a) Chronic Kidney Disease Stage 1
People living with kidney disease stage 1 are mostly unaware of the damage to the kidney. Because in the first stage kidney works very well with a minor reduction in working capacity and can’t have a negative impact on the health of the patient.
The GFR remains at 90ml/sec or higher. Therefore, it is not easy for people to feel the minor deduction in the working capacity, and they think that they live a healthy life.
The only way to diagnose kidney disease at this stage is that the patient can do regular tests for related diseases like diabetes and high blood pressure. These two diseases are the main causes of kidney damage.
The following are the few common indications that a patient can feel in stage 1:
- An excessive amount of urea or creatinine in the blood
- Protein or blood in the urine
- Indication of damage to the kidney in other tests like MRI, Ultrasound, CT scan, or contrast X-ray
- Presence of hereditary kidney disease in family (Polycystic Kidney Disease (PKD)
Treatment Of Stage 1 Kidney Disease
It is impossible to cure kidney disease permanently, but it is possible to stop the progression by changing the lifestyle. The change in diet, as per the suggestions of physicians, helps to slow down the progression of the disease if not stoppable permanently.
The following are the few suggestions about change in diet and lifestyle of a patient living with stage 1 kidney disease.
- Eat a healthy diet including various grains, especially whole grains, vegetables, and fresh fruits
- Start using a diet with low cholesterol and saturated fats as well as keeps a moderate level of total fats
- Minimize the use of processed and refined foods with high sugar and sodium level
- Use less salt in cooking the food
- Choose the food with high sodium ingredients
- Maintain a healthy level of protein in the body as per the suggestions of a physician
- Maintain the right weight level and starts physical activity on a regular basis
- Use a moderate level of calories in food
- Try to take the right level of vitamins and minerals as per the recommendation of the doctor
- Use an adequate quantity of phosphorus and potassium in food until unless blood level remains at a normal level
- Control the blood pressure at the right level as per the condition of the body and suggested by the doctor
- Visit the doctor for regular checkups and perform tests to know about the level of damage to the kidney
- Take medicine regularly as prescribed by the physician
- Start exercise regularly and stop smoking
b) Chronic Kidney Disease Stage 2
At stage 2, the GFR level remains in the range of 60 to 89ml/min. Irrespective of a reduction of up to 40% in the working capacity of the kidney, the patient still can’t feel any indication about this disease in the body.
The kidney still purifies enough amount of blood that is enough to meet the body requirements with minor fluctuations. That’s why no symptoms appear, and the diagnosis is only possible through the test of other diseases like in Stage 1.
The symptoms, precautions, and treatment of this stage are similar to that are mentioned above in stage 1.
c) Chronic Kidney Disease Stage 3
Stage 3 indicates the moderate level of damage to the kidney and further categorizes into two parts, i.e., Stage 3A & Stage 3B. The GFR level remains in the range of 45 to 59ml/min in stage 3A, while in stage 3B, it remains in the range of 30 to 44ml/min.
At this stage, the kidney filters the blood by remaining below the average level. As a result, it causes the condition “uremia” due to the collection of waste in the blood. People living with stage 3 are more likely to develop various complications related to kidney disease. For example, high blood pressure, anemia, and early bone diseases are the most common indications at this stage.
Symptoms of CKD Stage 3
Symptoms of CKD start appearing in stage 3. The following are the few most common indications:
- Swelling of extremities (edema)
- Shortness of breath
- Fluid retention
- Change in the texture or color of urine, i.e., foamy, tea-colored, dark orange, brown or red in case blood comes with urine
- More frequent urination than normal
- Issues with the quality of sleep due to restless legs or muscle cramps
Treatment Of CKD Stage 3
After the appearance of indications or symptoms, the patient must have to consult with a kidney specialist (Nephrologist) for a proper checkup. The nephrologist carried out different lab tests of the patient and analyzed the level of damage to the kidney as well as the health condition of the patient.
A lab test helps the nephrologist to find the accurate condition of the kidney so that they can suggest a better treatment. As we mentioned earlier, it is not possible to cure kidney disease, but we can reduce the progression.
Therefore, physicians always try to slow down the progression so that the kidneys remain in working condition as long as possible. Otherwise, the patient has to look for a donor for going in the process of transplantation in case of permanent kidney failure.
Sometime nephrologist also refers to the patient with stage 3 to a dietitian because diet plays an important part to slow down the progression of CKD. Usually, a dietitian suggests a specific meal plan to the patient based on the lab reports and condition of the patient.
The following are the few suggestions related to the diet plan that usually dietitians suggests:
- Increase the intake of high-quality protein as well as potassium, but only if blood levels are above the normal level
- Start using fruits, grains, and vegetables
- Reduce the use of phosphorus to normalize the PTH levels. It is not only beneficial to avoid bone disease but also beneficial in preserving the current kidney function
- Minimize the use of calcium intake
- Reduce the use of carbohydrates for patients with diabetes
- Reduce the level of cholesterol and use limited saturated fats
- Patients with high blood pressure or fluid retention reduce the use of sodium by minimizing the use of pre-packaged and processed food
- Increase the use of soluble vitamins like Vitamin C, B complex and try to completely avoid the use of over the counter dietary supplements until unless prescribed by a nephrologist
It is recommended to consult with a registered renal dietitian because of the diet changes with the change in the CKD stage.
The Medication Of CKD Stage 3
Usually, the medication of stage 3 disease varies from patient to patient based on the level of damage and health condition of the patient. However, the most important is to control the level of glucose as well as the blood pressure of a patient. It helps to preserve the current condition of the kidney.
It is proven from studies that the use of ACE inhibitors (Angiotensin Converting Enzyme) and ARBs (Angiotensin Receptor Blockers). Both these medicines are beneficial to slow down the progression of the disease. But, it is strongly recommended to use medicines as prescribed by the doctor.
Along with the medication and change in diet, a physician also recommends making some necessary changes in lifestyle. For example, it is dangerous to smoke, especially for kidney patients, and exercise is essential for kidney patients.
d) Chronic Kidney Disease Stage 4
In stage 4 of CKD, there is a massive decrease in the function of the kidney, and the GFR rate remains in the range of 15 to 30 ml/min. Most probably, patients living with stage 4 of chronic kidney disease needs a kidney transplant or at least dialysis at some point of stage 4.
As with the decrease in function, a huge amount of waste starts collecting in the blood of the patient and creates complications in the body. As a result, not only the chances of developing other diseases increases but also increases the severeness in current diseases.
Symptoms of CKD Stage 4
The following are the symptoms in addition to symptoms of Stage 3 that appear in the patients living with CKD stage 4:
- Feeling pain in the kidneys
- Vomiting/ nausea
- Change in taste
- Smell in breathing
- Loss of concentration in work at home or at the office
- Loss of hunger
- Change in taste of mouth
- Nerve problems like tingling or numbness in fingers or toes
It is important to visit the doctor once every three months after the appearance of the above-mentioned symptoms. The patient needs a detailed medical examination along with blood tests of different other diseases, including hemoglobin, creatinine, phosphorus, and calcium levels.
Blood tests are important to find the current condition of the patient and prescribed the medicine as per the condition of the patient. The physician has to monitor other related diseases in kidney patients like high blood pressure and diabetes, etc.
Also, after diagnosing the condition of the patient, the physician tries to keep the kidneys in working conditions for a long time. But in case it is not possible, the physician has to mentally prepare the patient for further process, i.e., dialysis or a kidney transplant.
Treatment Of CKD Stage 4
In patients with CKD Stage 4, multiple treatment options are available, and they have to select any of these options to remain alive. Let’s have a look at treatment options in the below section:
Hemodialysis can be done with the help of a dialyzer machine either at the health care center or at home. But the patient needs one assistant to complete the process. In this treatment method, a small amount of blood from the body of the patient by using a needle and passes through the dialyzer.
The dialyzer is also famous as an artificial kidney and helps to remove the toxins from the blood that is not possible to filter through the natural kidneys of the patient. The filtered blood is then transferred into the body of the patient.
The entire process is beneficial to reduce the level of hazardous waste in the blood, and patients have to practice it frequently as per the suggestion of physicians.
Usually, patients have to do the hemodialysis thrice a week by visiting the health care center. Also, different types of dialysis machines are now available for use at home, and patients can buy for their personal use at home. But the patient needs one attendant for the whole process. The entire process takes around 3 hours.
- Peritoneal Dialysis (PD)
Unlike hemodialysis, peritoneal dialysis is a surgical procedure. Instead of needling for taking out the blood, a soft tube (catheter) is placed inside the body of the patient in the belly. It is connectable with a bag filled with cleansing liquid that patients have to pour into the catheter. Once the liquid is transferred in the catheter, patients detach the outer bag and throw it out.
The lining in the abdomen or other organs acts as a filter and helps to remove the waste from the blood. The waste starts mixing with the cleansing fluid in the catheter up to a certain level.
After a specified time, patients have to empty the liquid in the catheter by using a pump and refill the fresh liquid. They have to practice the whole process around 4 to 5 times a day depends on the condition of the patient. The entire process takes around 40 minutes, and patients can perform their other routine tasks in the remaining time.
The national kidney foundation (NKF) recommends going for dialysis or transplant if the kidney functions at less than 15% as compared to normal.
- Kidney Transplant
A kidney transplant is the process of replacement of damaged kidneys with the healthy one.
Physicians prefer kidney transplants over dialysis and dialysate because it doesn’t put any restrictions on a diet like a dialysis. But it is not easy to find a suitable kidney donor, and it is a slightly expensive treatment.
Importance Of Diet For Patients With CKD Stage 4
Diet is one of the most important parts of treatment for patients in stage 4 of CKD. The meal plan of the patient must be suggested by the dietitian as per the condition of the patient. A customized meal plan helps to reduce the creation of waste in the blood and improve the kidney function.
The following are the few suggestions that usually dietitians suggested for patients with CKD Stage 4.
- Maintain the right level of proteins helps to reduce the buildup of waste in the blood
- Increase the use of fruits, grain, and vegetables but keep in mind, the level of phosphorus and potassium must remain at a normal level. Control over phosphorus level helps to maintain the PTH levels and beneficial to preserve the existing function of the kidney. Also, controlled phosphorus levels help to prevent different bone diseases.
- Reduce the use of potassium in case blood levels go higher
- Lower down the use of calcium
- Reduce the use of carbohydrates, especially for patients who are living with diabetes
- Lower down the level of cholesterol by reducing the use of saturated fats
- Kidney patients living with fluid retention or hypertension problems must lessen the use of sodium by avoiding pre-packed and processed food
- Increase the use of water-soluble minerals like vitamin C and vitamin B complex as per the suggestion of nephrologist
Medication For CKD Stage 4 Patients
Still, at stage 4 of CKD, medicines help to prolong the function of the kidney, and patients have to take medicines regularly as per the prescription of physicians. But patients have to control their glucose level, especially if you live with diabetes.
However, there are a few things that patients can do to improve their health conditions. For example, change in lifestyle like regular exercise, and stop smoking, etc. Also, patients can consult with doctors for a suitable exercise plan.
e) Chronic Kidney Disease Stage 5
Stage 5 of chronic kidney disease is the advanced and last stage. In this stage, the kidney of a patient reduces the function level from 15%. The GFR rate remains at 15 ml/min or lesser. The kidneys are near to end at this stage, and patients need dialysis to remove the blood waste on a regular basis. However, a kidney transplant is a better option to go back to normal life.
Symptoms of CKD Stage 5
The following are the main symptoms that appear in the patients living with CKD stage 4.
- Loss of hunger
- Vomiting or nausea
- Frequent headache
- Feeling tired
- Loss of concentration
- Loss of urine
- Swelling around the ankles and eyes
- Muscle cramps
- Tingling in feet and hands
- Change in skin color
- Enhanced skin pigmentation
Treatment of CKD Stage 5
At stage 5, only two options left for patients or nephrologists to keep the patient alive, i.e., dialysis or a kidney transplant. Both of these options are discussed in the above section.
It is necessary to start the treatment of CKD Stage 5 with any of the options. Otherwise, it is not possible for the patient to live for more days.
Diet For Patients With CKD Stage 5
The meal plan of a patient with CKD stage 5 should be suggested by the dietitian, and it includes the same things that we discussed in the diet of stage 4.
Treatment for Kidney Disease
Most of the patients with chronic kidney disease find that they are affected with kidney disease at Stage 2. Therefore, it is significant for kidney disease to be analyzed and treated right on time for serious harm to be avoided.
Patients with diabetes ought to have a yearly test, which measures microalbuminuria (limited quantities of protein) in the urine. This test can distinguish early diabetic nephropathy (early kidney harm connected to diabetes).
There is no proper treatment yet and a flow solution for chronic kidney disease. However, a few treatments can help to control the signs, and side effects decrease the danger of complications and moderate the movement of the disease.
Patients with chronic kidney disease normally need to take various prescriptions for different diseases. Treatments include:
- Anemia Treatment
Hemoglobin is the substance in red platelets that carries oxygen into the different parts of the body. In case the hemoglobin levels are below the standard level, it means the patient is suffered from anemia.
Some kidney disease patients that are also facing anemia disease require blood transfusions. A patient with kidney disease will, as a rule, need to take iron enhancements, either as day by day ferrous sulfate tablets or once in a while as infusions.
- Phosphate Balance
People with kidney disease are unable to remove phosphate from their bodies appropriately. Patients will be encouraged to decrease their wholesome phosphate admission – this typically means minimize the utilization of dairy items, red meat, eggs, and fish.
- High Blood Pressure
Hypertension is a typical issue for patients with chronic kidney disease. It is essential to bring the blood pressure down to a standard level to protect the kidneys and to reduce the increment of the disease.
- Skin Tingling
Antihistamines, for example, chlorphenamine, may help to mitigate the side effects of tingling.
- Anti-Sickness Medications
In case the poisons develop in the body in light of the fact that the kidneys don’t work appropriately, patients may feel wiped out (nausea)—medicines like cyclizine or metoclopramide help to treat the disorder.
- NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDs, for example, headache medicine or ibuprofen, ought to be maintained at a strategic distance from and taken only in case if a doctor prescribes them.
End-Stage Treatment Options
This is the point at which the kidneys are working at under 10-15 percent of the ordinary limit. Measures utilized up until this point – diet, medicines, and treatments controlling basic causes are not enough. The kidneys of patients with final-stage kidney disease can’t keep up the process of waste and liquid disposal anymore. The patient will require dialysis or a kidney transplant so as to survive.
Most doctors attempt to postpone the requirement for dialysis or a kidney transplant for whatever length of time that conceivable in light of the fact that they avoid the risk of possibly serious complications.
1. Kidney dialysis
This is the evacuation of waste items and excessive liquids from the blood when the kidneys can’t carry out the responsibility appropriately anymore. Dialysis has some serious risks, including infection.
There are two primary kinds of kidney dialysis. Each type additionally has subtypes. The two primary sorts are:
- Hemodialysis: Blood is pumped out of the patient’s body and process with a dialyzer (a counterfeit kidney). The patient experiences hemodialysis around three times each week. Every session goes on for almost 3 hours.
Specialists currently perceive that an increase in dialysis sessions bring about superior personal satisfaction for the patient. However, present-day home-use dialysis machines are helpful in the regular utilization of hemodialysis.
- Peritoneal dialysis: The blood is sifted in the patient’s own stomach area, in the peritoneal cavity, which contains an immense system of little veins. A catheter is embedded into the stomach area, into which a dialysis arrangement is implanted and depleted out for whatever length of time that is important to evacuate waste and overabundance liquid.
2. Kidney Transplant
A kidney transplant is a superior choice than dialysis for patients who have no different conditions separated from kidney failure. All things considered, a contender for kidney transplant should experience dialysis until they get another kidney.
The kidney benefactor and beneficiary ought to have a similar blood classification, cell-surface proteins, and antibodies, so as to limit the danger of dismissal of the new kidney. Kin or extremely close relatives are normally the best sorts of benefactors. In the event that a living giver is beyond the realm of imagination, the quest will start for a corpse benefactor (dead individual).
Following appropriate eating the routine is fundamental for compelling kidney failure treatment. Limiting the measure of protein in the eating routine may help to minimize the movement of the disease.
Diet may likewise help reduce the side effects of nausea.
Salt admission must be carefully managed to control blood pressure. Potassium and phosphorus utilization, after some time, may likewise be confined.
- Nutrient D
Patients with kidney disease commonly have low degrees of nutrient D. Nutrient D is basic for solid bones. The nutrient D we acquire from the sun or sustenance must be initiated by the kidneys before the body can utilize it. Patients might be given alfacalcidol or calcitriol.
- Liquid maintenance
People with chronic kidney disease should be cautious with their liquid admission. Most patients will be advised to limit their liquid admission. On the off chance that the kidneys don’t work appropriately, the patient is substantially more defenseless to liquid development.
Causes Of Chronic Kidney Disease
Kidneys complete the intricate arrangement of filtration in our bodies – overabundance waste and liquid material are expelled from the blood and discharged from the body.
Mostly, kidneys can take out most waste materials that our body produces. In any case, if the bloodstream to the kidneys is influenced, they are not working appropriately due to damage or disease, or feeling problem in urination, issues can happen.
Mostly, progressive kidney disease is the consequence of chronic disease (a long haul disease).
The following are the diseases that may cause progressive kidney disease:
- Diabetes – Chronic kidney disease is connected to diabetes types 1 and 2. On the off chance that the patient’s diabetes isn’t all around controlled, abundance sugar (glucose) can aggregate in the blood. Kidney disease isn’t basic during the initial ten years of diabetes; it all the more normally happens 15-25 years after diagnosis of diabetes.
- High Blood Pressure (hypertension) – hypertension can harm the glomeruli – portions of the kidney engaged with sifting waste items.
- Blocked Urine Stream – if urine stream is obstructed, can once more into the kidney from the bladder (vesicoureteral reflux). Blocked urine stream expands weight on the kidneys and undermines their capacity. Potential causes incorporate an amplified prostate, kidney stones, or a tumor.
- Kidney Diseases – including polycystic kidney disease, pyelonephritis, or glomerulonephritis
- Kidney Conduit Stenosis – the renal supply route limits or is hindered before it enters the kidney.
- Certain Toxins – including fuels, solvents, (for example, carbon tetrachloride), and lead (and toxic paint, pipes, and fastening materials). Indeed, even a few kinds of adornments have poisons, which can prompt chronic kidney disease.
- Fetal Formative Issue – if the kidneys don’t grow appropriately in the unborn child while it is creating in the tummy.
- Systemic Lupus Erythematosus – an immune system disease. The body’s immune system assaults the kidneys just as they were outside tissue.
- Malaria And Yellow Fever – known to cause hindered kidney work
- Some Medications – abuse of, for instance, NSAIDs (non-steroidal anti-inflammatory drugs, for example, headache medicine or ibuprofen)
- Illegal Substance Misuse -, for example, heroin or cocaine
- Injury – a sharp blow or physical damage to the kidney(s)
The accompanying conditions or circumstances are connected to a greater danger of creating kidney disease:
- A family ancestry of kidney disease
- Age – incessant kidney disease is substantially more typical among people more than 60
- Bladder check
- Chronic glomerulonephritis
- Congenital kidney disease (kidney disease which is available during childbirth)
- Diabetes – one of the most widely recognized risk factors
- High blood pressure
- Lupus erythematosus
- Overexposure to certain toxins
- Sickle cell disease
- Some prescriptions
A doctor will check for signs and get some information about side effects. The accompanying tests may likewise be requested:
- Blood Test – a blood test might be requested to decide if squander substances are, as a rule enough sifted through. On the off chance that degrees of urea and creatinine are determinedly high, the doctor will, in all likelihood, analyze end-organize kidney disease.
- Urine Test – a pee test helps see if there is either blood or protein in the pee.
- Kidney Filters – kidney outputs may incorporate a magnetic resonance imaging (MRI) check, computed tomography (CT) scan, or an ultrasound filter. The point is to decide if there are any blockages in the urine stream. These sweeps can likewise uncover the size and state of the kidneys – in cutting edge phases of kidney disease, the kidneys are littler and have an uneven shape.
- Kidney Biopsy – a little part of kidney tissue is removed and analyzed for cell harm. An examination of kidney tissue makes it simpler to make an exact conclusion of kidney disease.
- Chest X-Beam – the point here is to check for aspiratory edema (liquid held in the lungs).
- Glomerular Filtration Rate (GFR) – GFR is a test that estimates the glomerular filtration rate – it analyzes the degrees of waste items in the patient’s blood and urine. GFR measures what number of milliliters of waste the kidneys can channel every moment. The kidneys of healthy people can regularly channel more than 90 ml for each moment.
On the off chance that the unending kidney disease advances to kidney failure, the accompanying difficulties are conceivable:
- Central nervous system harm
- Dry skin or skin shading changes
- Fluid maintenance
- Hyperkalemia, when blood potassium levels rise, perhaps bringing about heart harm
- Lower sex drive
- Male erectile dysfunction
- Osteomalacia, when bones become feeble and break effectively
- Pericarditis, when the sac-like layer around the heart winds up excited
- Stomach ulcers
- Weak immune system
Dealing with the ceaseless condition
A few conditions increment the danger of ceaseless kidney disease (for example, diabetes). Controlling the condition can fundamentally lessen the odds of creating kidney failure. People ought to adhere to their doctor’s directions, counsel, and proposals.
A solid eating regimen, including a lot of leafy foods, entire grains, and lean meats or fish, will help keep pulse down.
Normal physical exercise is perfect for keeping up solid pulse levels; it likewise helps control constant conditions, for example, diabetes and coronary illness. People should check with a doctor that an activity program is fit for their age, weight, and wellbeing.
Staying Away From Specific Substances
They are counting manhandling liquor and medications. Maintain a strategic distance from long haul presentation to overwhelming metals, for example, lead. Keep away from long haul introduction to energizes, solvents, and other harmful synthetic substances.