Kidney Disease A Rising Epidemic

Introduction Kidneys are bean shaped paired organs situated on either side of spine in back side of abdomen. The principal function of kidneys is removal of water-soluble toxins through formation of urine. These toxins (mainly Urea, Creatinine) are bye-products produced by daily body activities. The other important functions of kidneys are regulation of blood pressure, maintenance of Haemoglobin and bone formation.Due to various reasons, functions of kidneys weaken and they may fail ultimately.

The type of kidney failure may be acute (temporary) or chronic (permanent) in both the types, as kidneys fail to remove toxins (Urea, creatinine) their level in blood rise and can be measured by Laboratory tests.Predominant causes of Acute kidney failure (AKF) are gastroenteritis, various infections, nephrotoxic drugs, heavy metal (toxins), few allergic conditions and blockage of urinary passage.Predominant causes of chronic kidney disease (or CRF) are diabetes mellitus (40%), Hypertension (25%) and glomerulonephritis (25 %) Once a patient develops chronic kidney disease, even though we remove the cause of kidney failure kidneys go on damaging on their own till they are completely damaged, over months to years. This stage is called End stage renal disease.

MAGNITUDE OF THE PROBLEM Recent data has shown that chronic kidney disease is much more common than previously known. About 10% adults have chronic kidney disease. Every year approx 1.5 lakh people in India develop End Stage Renal Disease (ESRD).

ARE KIDNEY DISEASES CURABLE/ TREATABLE?

Yes, many of the kidney diseases are curable and many are treatable. 

• Acute renal failure: Kidney failure appearing over hours to days, if managed in time can be completely cured.
• Chronic renal failure: Common causes of chronic kidney diseases common causes in India are Glomerular nephritis, diabetes, and hypertension. If kidney involvement is managed appropriately, advanced failure can be either avoided or delayed.
• Nephrotic / Nephritic Syndromes: Many of these can be cured.
• Urinary Tract Infections and Urinary Tract stones can be treated and recurrence avoided. 

HOW CAN WE SCREEN FOR CKD? 

Persons who are at risk for CKD must get their Kidney Function tested by the following very simple tests. This will help detect CKD at an early stage so that corrective measures can be taken. 

WHAT ARE THE TESTS TO SCREEN FOR KIDNEY DISEASE?

• Check BP 
• Urine Routine 
• Urine for Micro albumin. Micro albumin in urine in an early sign of CKD
• Blood test for Serum Creatinine: Creatinine is a waste product derived from muscles. Serum Creatinine test is used to calculate the GFR (Glomerular Filtration Rate) which gives an accurate indication of Kidney function.

HOW CAN WE PREVENT KIDNEY DISEASES TO HAPPEN OR TO PROGRESS?

• Good control of Blood sugar 
• Good control of BP
• Avoiding smoking
• Weight reduction
• Low salt low fat diet
• Avoid Analgesics (pain killers)
• Avoid very high protein diet
• Take medications to reduce protein in urine

TREATMENT 

Once a person develops ESRD (advanced renal failure) treatment with drugs is not sufficient and a need of dialysis or renal (kidney) transplant arises.Dialysis is a process by which toxins of body are removed artificially by filtration, diffusion and convection methods. Dialysis is of 2 different types hemodialysis and peritoneal dialysis (CAPD).By hemodialysis technique, biochemical toxins are transferred across a membrane with help of a machine. This process is done in hospital setting and is required 2-3 times per week. This process is required for prolonged periods (life -long for most) or till kidney transplant is done.By peritoneal dialysis (CAPD), the process of toxin removal is done at home and by patient's relatives. This process is done three times per day and most of the symptoms of kidney failure are controlled. Kidney transplantation is a process by which one functioning kidney is implanted into abdomen of the kidney failure patient. The source of implanted kidney is generally a living near relative of patient or a cadaver (brain-dead accident victims).

SYMPTOMS OF CHRONIC KIDNEY DISEASES (CKD)

Most people with early CKD have no symptoms. As the disease progresses, following symptoms may appear: 

• Swelling over face, legs or entire body 
• Urinary abnormalities like red coloured urine, burning while passing urine, decreased urine output, increased frequency of urine especially at bedtime
• Shortness of breath
• Pain in abdomen (flanks or in the groin)
• Unexplained loss of appetite, nausea, vomiting
• Weakness, fatigue, bone pains.