PREVENTION AND CURE OF KIDNEY RELATED DISEASES
Do you know that kidney problems and kidney failure patients are increasing day by day? Of every 2000
family, 1 family is suffering from end stage renal disease requiring renal replacement therapy. Out of
these only 1-2percent of the patients get proper treatment. Treatment of kidney failure is very costly.
Hence the importance that care be taken at every stage and more emphasis be given on prevention.
NOW THE QUESTION ARISES: WHY DO LESS PEOPLE GET TREATMENT?
Top among the reasons are:
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The common person does not have sufficient information about kidney related ailments.
There are only very few hospitals fully equipped to treat these type of patients.
Most people are not able to gather enough finances to get the treatment needed.
Now let us study in details about kidney and its related ailments so that everyone can undertake
precautions.
What is Kidney?
 Kidney is the organ of our body which helps in purification of blood and also removes toxic
materials from our body through the urine.
 Each human being has two kidneys, which are connected to the urinary bladder through the
ureter.
Where are the kidneys located?
 Kidneys are located on both sides of the spinal cord, above the waist and behind the stomach
 Each kidney is of the adult fist-size. 10 – 12cm long, 5 – 6cm wide and 3 – 4cm thick and weighs
approximately 150grams.
FUNCTIONS OF THE KIDNEY
Our kidneys purify around 1,500 litres of blood and convert it into approximately 1.5litres of
urine per day. 1,200ml of blood flows through both kidneys per minute and out of it 1ml of urine
is formed per minute.
Formation of Urine:
Blood goes into kidney
1000 – 1200ml/minute
Filtrate (after being filtered goes into tubules) 100 – 120ml/minute
Urine comes out of body; the rest is absorbed 1 – 1.2ml/minute
in blood via tubules.
 Through the filtrate of blood, dirty and harmful substances such as urea, creatinine, etc are
thrown out of the body.
 Kidneys regulate the amount of water in our body. Therefore, when the kidneys fail the entire
body begins to swell.
 Kidneys regulate the blood pressure and keep it within normal range.
 Kidneys convert vitamin –D from 25-dihydroxy cholecalciferol to 1:25dihydroxy cholecalciferol,
which absorbs calcium from intestine and makes our bones strong.
 Kidneys also helps in formation of red blood cells (which are formed in bone marrow) by
releasing erythropoietin hormone.
Now the question arises; how do such trivial organs perform such ‘heavy-duty’ task?
 Our kidneys constitute millions of filters (Nephrons)and 140 mile long tubules in approximation.
The Nephrons are the main functional units of the kidneys. Each kidney comprises
approximately 1.0 – 1.2 millions nephrons.
 Nephrons filter the blood and the filtered material blood is sent to the tubules.
 The tubules reabsorb useful substances such as sodium, potassium, calcium, etc.
How do kidneys get damaged?
There are many reasons for kidney damage but prominent among them are:
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Diabetes Mellitus
High Blood Pressure.
Some medicines such as pain relievers (pain killers-NSAIDS) and other unnecessary medicines.
Inflammation of the filters of the kidney due to which proteins are lost into urine. This process is
called Glomerulonephritis. Healthy kidney does not allow protein go into urine.
 Formation of stones in kidney and urinary system.
 Obstruction in the flow of urine.
 Dehydration. (ie less amount of water and blood in the body due to vomiting, cholera or
diarrhea.
Types of Kidney failure
There are three main types of kidney disease;
1. Acute Kidney Failure. This can be treated and cured as the kidney is in disease state for a short
time, which results in reversible damage. Its causes include dehydration, low blood pressure,
side effects of medicine, infection, etc.
2. Chronic Kidney Disease. This can be treated but cannot be cured as the kidney is in a disease
state for a long which result in irreversible damage. Its causes are diseases like long duration of
uncontrolled diabetes, high blood pressure, inflammation of nephrons, etc.
3. Nephritic Syndrome. Proteins lost from the kidneys into urine, which leads to swelling of body
and eventually results in kidney failure.
Chronic Kidney Disease has different stages as given below
STAGE
1
2
3
4
DESCRIPTION
Kidney damage with normal or increased GFR
Mild fall in GFR
Kidney insufficiency
Kidney failure
GFR (ML/MIN/1.73 M2
>90
60 - 89
30 - 59
15 – 29
5
Kidney failure or Uremia
<15 or need of dialysis
Normal serum creatinine level: 0.6 – 1.2mg/dl
Normal blood urea level: 10 – 40mg/dl
Normal GFR level: 80 – 120ml/min
CKD Stage V is also known as End Stage renal disease or Stage V Kidney failure which require renal
replacement therapy or long term dialysis.
HOW TO DETECT CHRONIC KIDNEY DISEASE EARLY
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What
Why
Good Score
What
Why
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What
Why
Good Score
What
Why
Good Score
Blood Pressure
Healthy kidneys regulate sodium and water metabolism in body and maintain
blood pressure in normal range.
Blood pressure maintained in the range of 125-130/75-80 mm of Hg.
Protein in urine
In kidney disease excretion of protein into urine occures
Less than 30mg of albumin per gm of urinary creatinine (a normal waste
product)
Creatinine in blood (Serum creatinine)
Healthy kidneys filter creatinine (a waste product from muscle activities) out of
the blood. When kidney function is reduced, creatinine rise.
0.6-1.2mg/dl of serum creatinine, depending on other variables.
Glomerular Filtration Rate (GFR)
This is the most sensitive and accurate measurement of kidney function.
Doctors measure serum creatinine levels and perform a calculation based on
age, race and gender.
Over 90 is good. 60 – 89 could be monitored. Less than 60 for a period of 3
months indicates CKD.
What are the symptoms of kidney failure?
Symptoms of kidney failure develop when both kidneys are damaged. Note that even if one kidney is
removed from a person, the person can still lead his/her normal life with one healthy kidney with
normal renal parameters.
These are some of the symptoms:
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Swelling of the body.
Decrease in appetite.
Recurrent vomiting or nausea.
Reduction in blood haemoglobin level (anaemia).
Weakening of bones (osteoporosis).
Fatigue/weakness.
High blood pressure.
Reduction in urine formation.
Breathlessness.
HOW TO PREVENT A HEALTHY KIDNEY FROM BEING DAMAGED
 Regular intake of plenty of water/fluids.
 Proper control of diabetes or high blood pressure if you are suffering from any of them.
 Take pain relieving medicines only when absolutely necessary and not more than the prescribed
limit.
 Do not take medicines which are not required/avoid unnecessary medication.
 If you feel you have symptoms of kidney failure, consult a Nephrologist immediately because
kidney ailments can be cured only if treatment is done at the earliest.
 Delay in getting the treatment increases the chances of the kidneys ending in irreversible
damage.
CURE AND TREATMENT FOR KIDNEY AILMENTS
1. Nephrotic Syndrome: if the amount of protein going into the urine has increased but the kidneys
have not been contracted and damaged then it can be cured with the help of medicines and
putting proper restrictions on diet as advised by a kidney specialist. To prevent the disease from
further spreading, one should undergo kidney biopsy so that the correct disease can be
detected and treated and the kidneys can henceforth be spared from getting damaged.
2. Acute Kidney Failure: If a person is suffering from acute kidney failure caused by cholera,
infection, etc, then the chances of recovery are quite good and the patient becomes as fit as
before.
3. Chronic Kidney Disease Stage V (End Stage Renal Failure): It is treated in the following ways –
a. By taking proper care of the diet as advised by a kidney specialist.
b. By preparing an alternative for kidney
- Haemodialysis (two or three times a week)
- CAPD (Continuous Ambulatory Peritoneal Dialysis)
- Kidney Transplantation
PRECAUTIONS IN DIET
1. Take less of salt.
2. Take liquids, including milk, tea, water, etc in accordance with the amount of urine being
produced.
3. Avoid fruits that are juicy. Fruits that have pulp such as apple, papaya and guava should be
taken only in small quantity.
4. Take less amount of proteins including meat, pulses, milk, etc.
5. Take only about 1teaspoonful of oil in a day.
6. Avoid bakery products and canned food (high sodium and bicarbonate).
7. Avoid pickles, cheese, salted chips, salted pop corn, etc.
8. Avoid commercial soft drinks.
HAEMODIALYSIS
1. The blood is purified by an artificial kidney through a machine.
2. In this, two needles are used which are inserted in the swollen veins in the same way as a
glucose bottle is inserted.
3. Prior ti this a small operation is done to join the vein and artery which prepares the vein to
swell. Then the swollen veins are ready for needle insertion. The process is called Arterioveinous fistula. Maturation of the veins usually takes 3 - 4 weeks.
4. From one needle, the impure blood goes out of the body through one tube into the machine
and the artificial kidney and from the other needle the purified blood goes back into the body
through another tube.
5. This is done 2 to 3 time in a week and each session takes about four hours.
ADVANTAGES AND DISADVANTAGES OF HAEMODIALYSIS
Advantages
Only 2-3 times dialysis has to be done every week
for 4hours each session. The patient will be strong
rest days of the week to do his/her work.
There is no need of machine or gadget at home.
Doctors and para-medical staff attend to the
patient at the dialysis centre.
Disadvantages
Patient has to go to the dialysis center for the
dialysis each time.
There is certain restrictions on food and liquid
intake.
Two needles are to be inserted in the vein for
every dialysis session.
Sometimes, some who have heart problem,
diabetes, etc and some children are not able to
tolerate haemodialysis well.
CAPD (Continuous Ambulatory Peritoneal Dialysis
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This type of dialysis can be done at home whether it is a city or a village.
In this the peritoneum of the abdomen acts as a filter.
In this procedure, a tube called catheter is embedded on the wall of the abdomen.
A blood purifying solution is flowed via catheter into the peri toneum .
The solution absorbs all the toxic and dirty substances.
This procedure has to be done 3 – 4 times in a day and to solution also has to be continuously
replaced. It takes approximately half an hour each time.
Automated Peritoneal Dialysis (APD)
 This is just like CAPD as describe above but it is done through a special machine.
 In this solutions and catheter are fitted into the machine at night with a fixed programme. The
machine cleans the patient’s blood whole night and he/she can have sound sleep through the
night.
 There is no need to replace the solution manually during the day.
ADVANTAGES AND DISADVANTAGES OF CAPD
Advantages
Patient can do dialysis on himself/herself.
There is no need to insert needles as in
haemodialysis.
This type of dialysis is good for patients who have
heart disease, diabetes and in small children who
are not tolerating haemodialysis. Patients who are
not tolerating haemodialysis can opt for CAPD.
Patient has freedom to go to any place to live and
work.
There is relatively less restrictions of food in
contrast to other methods of dialysis.
Disadvantages
The dialysis solution has to be replaced 3-4 times
in a day by the patient himself/herself.
There are more chances of contracting infection
and getting peritonitis.
A catheter is left fixed to the abdominal wall
permanently which some patients do not like at
all.
All the machines, solution and equipments have to
be stored and ready at home.
KIDNEY TRANSPLANTATION
In kidney transplantation, a healthy kidney is fixed deep below the skin of abdomen in front of hipbone.
A donor who is patient’s near or dear donates the healthy kidney.
In kidney transplantation, matching of the blood group between the donor and recipient is done as
given below:
If Patient’s Blood Group is:
A
B
AB
O
Matching of rhesus factor is not necessary ( + or - )
Donor’s Blood Group should be:
A or O
B or O
A or B or AB or O
O
 A healthy kidney can be obtained from two sourcesz;
1. Live donor from family members, relatives, family friends, etc.
2. Cadaver donor from persons donate their kidneys after brain death.
 After kidney transplant the patient is hospitalized for 8 days or more whereas the donor is
discharged from hospital within 3 – 8 days.
 After donating kidney, the donor is as healthy as before and lives a normal life.
 After kidney transplant, the patient lives a normal life too and can go to his/her work or run
his/her business as before after 2 – 3 months.
 After the operation medicine has to be taken regularly life - long.
KIDNEY TRANSPLANTATION ADVANTAGES AND DISADVANTAGES:
Advantages
Life becomes as normal as it was before kidney
failure.
No need for dialysis any more.
Patient becomes self dependent.
Patient can take normal diet.
Disadvantages
As there are remote chances of rejection of
transplanted kidney, patient has some tension.
Regular medication is required life long.
Body’s power of defending infection is decreased
therefore there are chances of getting infection
particularly in the first few months.
There can be side effects of medicines, though
rarely.
Life routine is as normal as any other person.
WHAT ARE YOUR CHANCES AFTER TOTAL KIDNEY FAILURE?
Choices have to be made keeping in mind the following facts:
1. Life style of patient: If patient has field jobs, tour jobs, and the likes kidney transplant is the best
choice for him/her because facility of haemodialysis is not available everywhere.
2. Family condition: Kidney transplantation is the better option even if there is financial problem
because in the long term there is less expenditure compared to haemodialysis and CAPD. If one
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of the family members is capable and dedicated enough to taking care of the patient then CAPD
and haemodialysis can also be good options, in case kidney transplant is not being considered.
Distance and location of dialysis centre from patient: When dialysis centre is very far then
kidney transplantation or CAPD is the better choice.
Home condition: Hygienic home condition is must for CAPD or else there is great chance of
contracting infection.
Availability of kidney donor: For kidney transplantation, a suitable donor, live or cadaver is must.
Is the patient whole and sole earning member in the family? Kidney transplantation is the best
option. He can then continue to earn his livelihood and look after the family.
Doctor’s opinion: A kidney specialist helps the patient to choose the best option as he takes into
consideration all the problems and diseases the patient is having. For example, some patients of
diabetes, heart diseases and some children may not tolerate haemodialysis. In cases as these,
kidney transplantation or CAPD is preferred.
The emotional status, understanding the attachment of family members: If patient is on CAPD
or haemodialysis, (2 – 3 times a week), the family members should be capable and dedicated
enough for taking care of the patient. Similarly, the kidney donor can donate one of his kidneys
to the patient only when donor is having a true emotional attachment with the patient.
Overall, considering all the pros and cons, kidney transplant is the best choice until unless
medically unfit followed by haemodialysis and peritoneal dialysis in some.
Dr. (Prof.) D. K. Agarwal
MBBS, MD (Medicine), DM (Neph), DNB (Neph), MAMS (Neph), FICP, FISN