KIDNEY DISEASE (NEPHROPATHY)
WHAT IS KIDNEY DISEASE?
Kidneys are remarkable organs in the body. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood and discard these from the body through urine. Sometimes this filtering system breaks down. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease and retention of the waste in the body. Kidney disease is a major health problem in the world. Kidney and urinary tract diseases together affect a large population all over the world.
Kidney disorders run the gamut from minor infections to total kidney failure. Kidney disease can cause high blood pressure, anemia, and elevated cholesterol. When chronic, it can lead to depression and sexual dysfunction. Kidney stones can be extremely painful and are a significant cause of hospital stays and lost work days. Chronic renal failure is a gradual and progressive loss of the ability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.
The recent developments in medical science have made it possible to get proper diagnosis and treatment of kidney problems. Even people with complete kidney failure can now lead reasonably normal lives because of modern dialysis techniques and new successes in transplantation. These have helped people lead almost normal lives.
WHAT IS THE IMPORTANCE OF KIDNEYS TO THE BODY?
Kidneys keep a large number of elements in the body in balance. Kidney disease affects other organs also, thus creating life-threatening situations. The major functions performed by the kidneys are:
- Remove waste products and excess fluids from the body.
- Maintain a critical balance of salt, potassium and acid.
- Produce a hormone–erythropoietin or EPO–that stimulates the production of red blood cells.
- Help regulate blood pressure and calcium metabolism by producing other hormones.
- Synthesize the hormones that control tissue growth.
Anytime the kidneys’ ability to remove and regulate water and chemicals is impaired by disease or blockage, fluids and waste products accumulate, ultimately resulting in extreme swelling and symptoms of uremia (an overload of toxic byproducts) or kidney failure. The kidneys’ various functions can each be affected separately, so urine output may be normal despite significant kidney disease.
HOW DO THE KIDNEYS WORK?
Kidneys are 2 in number, fist-sized and located on either side of the spine below the rib cage. When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.
Each kidney has large number (approximately one million) nephrons- each containing individualized filtering system called glomerulus. The glomerulus has multiple blood vessels and is attached to a tubule. The blood containing impurities from the body, reaches the blood vessels in the glomerulus. In these vessels the filtration process takes place and the remaining fluid passes along the tubule. In the tubule the chemicals and water are either added or extracted according to the body’s needs. The final product of this process is the urine we eliminate. Each glomerulus functions individually and the total waste is collected and sent to the urinary bladder.
The kidneys filter and return to the bloodstream more than 200 liters of fluid every 24 hours. Approximately two liters are eliminated as urine, which flows from the kidneys through the urethra to the bladder, where it is stored for up to eight hours. The urine carries with it the waste filtered by the kidneys.
WHAT ARE THE TYPES Of KNOWN KIDNEY DISEASES?
Kidneys are likely to suffer from 3 types of diseases- Inherited kidney disorders, congenital kidney diseases and Acquired kidney disorders. Inherited kidney disorders usually begin producing symptoms during the teen to adult years, and are often serious. Inherited Kidney Diseases could be:
- Polycystic kidney disease (PKD).
- Alport’s syndrome.
- Hereditary nephritis.
- Primary hyperoxaluria.
Polycistic Kidney disease (PKD)
stems from appearance of fluid filled cysts in the kidney tubules. These cysts tend to compress the kidney tissues and eventually completely replace it. It is of 2 types:
- Autosomal dominant PKD- This is the most common type of kidney disease and 505 of the patients suffer from chronic kidney failure between 40 to 60 years of age.
- Autosomal recessive PKD- This is a rare disease and affects in early childhood and leads to kidney failure.
In PKD, both kidneys become enlarged. The symptoms of PKD are:
- Back pain.
- Blood in the urine
- Kidney stones.
- Recurring bladder or kidney infections.
- High blood pressure.
It is essential to carefully manage high blood pressure and start immediate antibiotic treatment of kidney or bladder infections. This can not only prolong life but also improve the quality of life of the patient. Exercise is another necessary part of the treatment to help maintain good physical condition. Since PKD is progressive and often leads to kidney failure, patients are counseled, given emotional support, and prepared for the eventuality of dialysis or transplantation.
Congenital kidney diseases-
This form of kidney disease is invariably due to malformation of the genitourinary tract. This can lead to blockages that cause infection and/or destruction of kidney tissue. Tissue destruction may then result in chronic kidney failure.There are two types of congenital kidney disease:
- Malformations- The improper development of the genitor-urinary tract at birth may result in some type of blockage. This blockage disrupts the normal flow of urine. The urine thus collected in the urethra causes it to back up and exert increasing pressure on the kidneys. This sustained pressure over time ultimately causes permanent damage.
- Muscular abnormality- Due to some reason the muscles of the bladder have inadequate power to contract as they should. This could be caused by some abnormality in the muscles or their nerve supply.
Kidney malformations affect around 15% of people but do not cause problems in all cases. There are 3 types of blockages that can lead to serious kidney difficulties:
- Narrowing of the upper urinary tract ( ureteropelvic junction obstruction or ureteral stenosis).
- Congenital contracture of the bladder outlet (vesical neck contracture).
- Narrowing of the channel from the bladder to the outside of the body (urethral stricture).
Urinary tract blockages require early diagnosis to avoid permanent damage to the kidneys. These blockages can be diagnosed by:
- Injecting dye into the bloodstream or the bladder and taking series of X-rays.
- Intravenous urography.
- Retrograde pyelography.
- Non-invasive diagnostic techniques like renal scans, ultrasound, and CT scan.
Retrograde pyelography sometimes actually relieves the blockage, eliminating the need for surgery. Some urinary tract blockages can be treated by abdominal surgery or by surgery through the urethra.
Acquired kidney disorders-
Onset of kidney disease can be attributed to many causes related to infections in other parts of the body. Not everyone with an infection develops kidney disease. Factors that can influence kidney disease development include genetics, blood sugar control, and blood pressure. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting kidney disease. The other causes could be blockages, drugs, and toxins. However, diabetes and high blood pressure are by far the most common culprits.
Inflammation of the kidneys, or nephritis, is the primary characteristic of acquired kidney diseases. In the most common of these, the glomerulus or filtering part of the kidney becomes inflamed. The disease can be brief and severe, mild and protracted, or rapidly progressive. This is known as glomerulonephritis and is of various types:
Acute post-streptococcal glomerulonephritis- This disease starts about 10 days after a strep throat or a skin infection such as impetigo. It is more common in children, but can occur at any age. It is fully curable but in certain cases chronic kidney failure occurs within months.
Symptoms of this are:
- fall in urine output
- “smoke” or “rust”-colored urine
- a burning sensation when urinating.
- Swelling of the face, eyelids, and hands due to fluid retention.
- Shortness of breath and coughing
- High blood pressure.
Acute post-streptococcal glomerulonephritis usually heals completely within three to 12 months after onset. The only treatment is the relief of symptoms and complications.
Chronic glomerulonephritis-– Wide variety of diseases that cause progressive scarring of the kidneys over a long period of time, often without any initial symptoms are termed as chronic glomerulonephritis.
Initially the only symptoms are:
- an abnormal urinalysis
- High blood pressure. Later Edema (fluid retention) and persistent high blood pressure also appear. High blood pressure is treated with medication and a diet restricting protein, sodium, and potassium is also recommended.
Rapidly progressive glomerulonephritis (RPGN)- It develops in a short time often without any known cause and the symptoms are a decrease in urine output and progressive decline in kidney function. Within about 3 to 6 months it may lead to complete kidney failure. The patient can show significant improvement if treated in the initial stages since kidney failure later becomes irreversible.
Nephrotic Syndrome : this disease is result of other diseases like diabetes and lupus erythematosus. Typically this case shows heavy loss of protein in the urine, a low protein level in the blood, an increase in blood cholesterol level, and edema (fluid retention). It may lead to end stage kidney failure and the treatment depends on the underlying cause.
Acquired Kidney Obstructions:
These obstructions cause blockage of the urinary tract and could result from:
- an enlarged prostate gland in older men
- sagging pelvic muscles in older women
- tumors in the genitourinary organs of both males and females
- kidney stones and scar tissue caused by infections, x-ray treatment, and surgery. Some of these obstructions can be cleared by surgery and follow-up medical treatment like radiation, and appropriate medications.
Kidney Stones: Kidneys process certain chemicals also and the same are passed out of the body in the urine. In some cases these may form crystals that stick together to form a mass differing in size from a small grain (ejected through urine) or grow up to the size of a golf ball.
The larger stones obstruct urine flow or irritate the lining of the urinary tract. In some individuals appearance of kidney stones may be asymptomatic but in most cases they cause:
- severe pain
- nausea, and vomiting
- burning and a frequent urge to urinate
- fever, chills, and weakness
- cloudy or foul-smelling urine
- blood in the urine
- blocked flow of urine. A blockage can cause serious infections.
X-rays or ultrasound test are used to diagnose and identify the location and size of kidney stones. In most cases (up to 90 percent) these stones are quite small and drinking a lot of liquid can help in passing them out through urine. Larger stones can be treated by passing a telescopic device into the ureter (uretheroscopy) or bladder and removing the stones after breaking them into small fragments with lasers, sound waves or high-energy shock waves. Surgery is generally the last and a rare option.
Drinking large amounts of fluids, taking certain medications, and changing the diet may help prevent the formation of new stones.
WHAT IS THE LINK BETWEEN DIABETES AND KIDNEY DISEASE?
Diabetes damages renal organs as much as other body systems. Kidneys are made to over exert to filter the high amounts of blood when blood sugar levels are high. The kidney filters are not equipped to handle this extra load over long periods of time. The stress of overwork adversely affects the kidneys filtering ability. Consequently, waste products start to build up in the blood.
In addition, after a few years leaks develop in kidney filters. As a result of these leaks useful protein is also passed out in the urine. This cause 2 types of disease:
- Microalbuminuria- This implies having small amounts of protein in the urine.
- Macroalbuminuria- When large amounts of proteins are found in the urine it is called macroalbuminuria.
Early detection of kidney disease helps in stopping the problem becoming acute. Late detection will generally cause end stage renal disease.
At this stage the kidneys fail and the disease becomes very serious. A person with kidney failure needs to have a kidney transplant or to have the blood filtered by machine (dialysis).
WHAT ARE THE SYMPTOMS OF KIDNEY DISEASE?
Having kidney disease means that your kidneys are unable or less capable to clean your blood of toxins as well as they should. The kidneys have an inherent capacity to work exert extra hard to cope up for the deficiency arising due to an infection. As a result the symptoms of the disease in the kidneys appear very late. The kidney capillaries may fail gradually or the slide may be fast.
Most people with kidney disease do not have symptoms and so they do not realize that they have something wrong with their kidneys. When someone does have symptoms, it may be hard to know if it is due to a problem with the kidneys or not. If you think you might have symptoms of kidney disease, you should be sure to let you doctor know so you can be screened. Some of the symptoms associated with this disease are:
Early stage symptoms:
- Unintentional weight loss
- Nausea and / or vomiting.
- General ill feeling.
- Frequent hiccups.
- Generalised itching (pruritis)
- Increased or decreased urine output.
- Need to urinate at night.
- Easy bruising or bleeding.
- Blood in the vomit or in fecal discharge.
- Decreased alertness.
- drowsiness, somnolence lethargy
- confusion delirium
- Muscle twitching or cramps.
- Uremic frost- deposits of white crystals in and on the skin.
- Decreased sensation in the limbs and other areas.
- Excessive night time urination.
- Abnormal thirst.
- Unusually dark or light skin.
- Abnormalities in the nails.
- Peculiar breath odor.
- High or fluctuating blood pressure.
- Loss of appetite.
- Uneasiness / agitation.
- Fluid build up.
- Loss of or disturbed sleep.
- Upset stomach.
SOME OF THE SYMPTOMS OF KIDNEY DISEASE EXPLAINED IN DETAIL
- Changes in urine- Any change in the urine may not occur till very late in the disease. Certain indicators appear early and these can indicate a problem with the kidneys or urinary tract. Blood or proteins in the urine or making very little urine are the 2 most important changes to be noticed.
- Pain- There are very few nerves to sense pain in the kidneys and that is the reason pain is generally never felt in the kidneys. Most of the time the pain comes from elsewhere, in the urinary tract (urinary bladder and the ureters) or area adjoining the kidneys.
- Swelling and High blood pressure-The kidneys act as filters for the body and help in maintaining the fluid balance in the body. Their malfunction leads to accumulation of salt and fluids or heavy protein loss in the urine. These can result in high blood pressure and swelling.
- Anemia- Erythropoietin is produced in the body by the kidneys and this hormone induces the body to produce red blood cells. Kidney disease may cause low levels of red blood cells in the body or anemia. There are some other conditions also that cause anemia.
- Blood poisoning- Kidneys disease slows down the process of toxin removal from the body. The build up of these toxins can cause uremia or blood poisoning. Uremia affects all body systems and as such its symptoms are non specific.
Kidney failure implies that many of these symptoms will appear but if only a few are there, chances of kidney failure are always less.
HOW IS KIDNEY DISEASE DIAGNOSED?
The symptoms and signs of kidney failure depend on how quickly it happens and how much kidney function is remaining. Most of the time, it is a slow process occurs over many years without any symptoms at all. Once a patient is admitted to a hospital it is not uncommon for it to happen quickly. The symptoms thereafter appear very fast and could be in the form of fluid retention, difficult to control high blood pressure, arrhythmias, decreased mental alertness, muscle twitching, seizures, and coma.
There are a hundreds of screening, diagnostic and monitoring tests for kidney disease available. Knowing about their benefits and limitations will help you become a more informed patient.
- Screening for kidney disease- Timely detection of kidney disease can stop it from progressing to kidney failure and resultant complications. Simple tests help in early detection. These tests are:
- Regular monitoring of blood pressure.
- Urine checking and examination.
- Blood testing.
- To diagnose this disease, tests are most commonly carried out:
- Blood Urea Nitrogen (BUN) test
- Serum creatinine test. BUN comes from the breakdown of both protein and creatinine comes mainly from the muscles. With kidney failure levels of both are elevated.
- There are many other specific blood tests used in kidney disease and many are specifically ordered to diagnose or monitor kidney disease
- Urine Tests- The quantity and quality or urine output is one of the best indicators of kidney failure / disease. Urine tests are generally performed as spot tests but sometimes urine output for 24 hours is collected and measured and tested. A urinalysis may show protein or other abnormalities. An abnormal urinalysis may occur 6 months to 10 or more years before symptoms appear.
- Creatinine levels progressively increase.
- BUN is progressively increased.
- Creatinine clearance progressively decreases.
- Potassium test may show elevated levels.
- Arterial blood gas and blood chemistry analysis may show metabolic acidosis
- X RAY IMAGING TESTS- X ray tests help in identification of a particular kidney disease. The availability of MRI and CT scan has helped in correct assessment of the kidney disease. Changes that indicate chronic renal failure, including both kidneys being smaller than normal, may be seen on:
- Renal or abdominal x ray.
- Abdominal CT scan.
- Abdominal MRI.
- Abdominal ultrasound.
Kidney disease may also alter the results of following tests and as such these are also available as diagnostic tools:
- Urinary casts
- Renal scan
- Serum magnesium – test
To ensure early detection and treatment, it is vital to see a doctor regularly. The doctor can check blood pressure, urine (for protein), blood (for waste products), and organs for other complications of diabetes. There may be mild to severe high blood pressure. A neurologic examination may show polyneuropathy. Abnormal heart or lung sounds may be heard with a stethoscope.
WHAT CAUSES KIDNEY DISEASE?
There are three types of kidney failure and each is identified by the speed at which kidney failures occurs. Kidney failure results from many different causes.
- ACUTE KIDNEY FAILURE- If kidney failure happens very quickly- within hours to a few days. Acute kidney failure is generally due to some sort of insult such as an overwhelming infection, low blood pressure, obstruction, toxin exposure, heart disease, or a reaction to a medication.
- CHRONIC KIDNEY FAILURE- If it occurs slowly over years. Chronic kidney failure is usually due to diabetes, high blood pressure, IgA nephropathy, polycystic kidney disease, or chronic obstruction.
- RAPIDLY PROGRESSIVE KIDNEY FAILURE- If the kidney failure occurs over weeks to months. It is usually due to an autoimmune or inflammatory process called glomeronephritis.
Unlike acute renal failure with its sudden, reversible failure of kidney function, chronic renal failure slowly gets worse. It most often results from any disease that causes gradual loss of kidney function. It can range from mild dysfunction to severe kidney failure. Progression may continue to end-stage renal disease (ESRD).
Chronic renal failure usually occurs over a number of years as the internal structures of the kidney are slowly damaged. In the early stages, there may be no symptoms. In fact, progression may be so gradual that symptoms do not occur until kidney function is less than one-tenth of normal.
Diabetes and hypertension (high blood pressure) are the two most common causes and account for approximately two-thirds of the cases of chronic renal failure and ESRD. Other major causes include the following:
- Glomerulonephritis of any type (one of the most common causes)
- Polycystic kidney disease
- Alport syndrome
- Reflux nephropathy
- Obstructive uropathy
- Kidney stones and infection
- Analgesic nephropathy
Chronic renal failure results in the accumulation of fluid and waste products in the body, causing azotemia and uremia. Azotemia is the buildup of nitrogen waste products in the blood. It may occur without symptoms. Uremia is the state of ill health resulting from renal failure. Most body systems are affected by chronic renal failure. Fluid retention and uremia can cause many complications.
WHAT TREATMENTS ARE AVAILABLE FOR KIDNEY DISEASE?
Many kidney diseases can be successfully treated if they are caught early. Unfortunately, there are a number of diseases where the cause isn’t known or the underlying disease can’t be cured.
Treatment options focus on controlling the symptoms, minimizing complications, and slowing the progression of the disease. Associated diseases that cause or result from chronic kidney failure must be controlled. High blood pressure, congestive heart failure, urinary tract infections, kidney stones, obstructions of the urinary tract, glomerulonephritis, and other disorders should be treated as appropriate.
Blood transfusions or medications such as iron and erythropoietin supplements may be needed to control anemia.
Fluid intake may be restricted, often to an amount equal to the volume of urine produced. Dietary protein restriction may slow the build-up of wastes in the bloodstream and control associated symptoms such as nausea and vomiting. Salt, potassium, phosphorus, and other electrolytes may be restricted.
General Treatment Options-
Some of the general treatments offered for kidney disease are:
- Diet / Lifestyle Changes: A low-protein diet is likely to help prevent the progression of kidney failure in addition to lessening the symptoms of toxin buildup. It is important to avoid use of tobacco or its products. Protein seems to increase how hard the kidneys must work. A low-protein diet can decrease protein loss in the urine and increase protein levels in the blood. Never start a low-protein diet without talking to your health care team.
- Blood Pressure Control: High blood pressure directly affects kidney failure, though it may not the original cause of it. “Sick” kidneys are unable to take the increased pressure and will fail faster if the blood pressure is not adequately controlled.
- ACE Inhibitors / ARB’s: These medications have some benefit for the kidneys and are commonly prescribed. This is however not completely explained by their ability to improve blood pressure. They are recommended for most patients with kidney disease, but they need careful monitoring.
- Immunosuppressive Drugs: A few kidney diseases are caused by an autoimmune or inappropriate inflammatory disease and may respond to suppression of the immune system. These drugs require very careful monitoring.
- Invasive Procedures: Some kidney diseases cannot be treated with medications and require a definitive and invasive procedure. Examples include narrowing of blood vessels, blocking of the ureters, pockets of pus surrounding the kidney, cancerously looking masses, and very symptomatic cysts.
- Dialysis: Many kidney diseases, regardless of their cause, may result in kidney failure. When the kidneys can no longer remove enough toxins and extra fluid to keep your alive, dialysis becomes essential. Once kidneys fail, dialysis is necessary.
- Kidney Transplant: Dialysis is not a cure for kidney failure. The blood isn’t “cleansed” as good and its rapid removal of fluid can make people very sick. Invariably, getting a kidney transplant is a better alternative. The person must choose whether to continue with dialysis or to get a kidney transplant. This choice should be made as a team effort. The team should include the doctor and diabetes educator, a nephrologist (kidney doctor), a kidney transplant surgeon, a social worker, and a psychologist.
Since patients with kidney failure are often anemic, many have to take a substance known as EPO (erythropoietin), the synthetic form of a hormone that helps make red blood cells. Iron supplements are also sometimes required.
The specific treatment depends on what the diagnosis is. However, many times, it involves stopping the offending agent or giving support during a difficult illness. Sometimes immune system suppression is indicated if it is due to inflammation or an autoimmune process. With a chronic disease, you may not be able to stop the process but you can try to slow the progression of the failure. Dialysis can be used to keep someone alive if the kidneys are too badly damaged or destroyed.
There is no cure for chronic renal failure. Untreated, it usually progresses to end-stage renal disease. Lifelong treatment may control the symptoms of chronic renal failure.
WHAT ARE THE RESULTANT COMPLICATIONS OF KIDNEY DISEASE?
Kidney disease is a very broad term and includes dozens of kidney disorders and many diseases affecting the kidney. The type of complications seen in kidney disease depends a lot on what the kidney disease is and how much kidney function remains.
Usually there are no complications of kidney disease in the initial stages. The problems crop up when most of the kidney function has been lost. If this happens there may be problems with fluid overload, high blood pressure, electrolyte disorders, nausea and vomiting, nerve and muscle toxicity and bleeding.
Kidney function is a very important part of excretion of waste from the body. Thus kidney failure/disease that may occur due to any cause may damage any other body part also. The important complications resulting from advanced kidney failure are:
- High Blood Pressure: Kidney failure results from high blood pressure and the blood pressure goes up also because of kidney failure. Blood pressure rises in the initial stage of kidney disease and if left untreated the disease gets aggravated towards kidney failure and may result in heart disease also.
- Anemia: Due to reduced production of erythropoietin because of kidney disease the red blood cell count in blood also goes down. Most people with advanced kidney failure suffer from a low red blood cell count or anemia. The kidneys affected by disease can not zSB(3,3) produce enough of the hormone (erythropoietin) needed to make red blood cells. Iron deficiency is also a common problem causing anemia.
- Malnutrition: Loss of appetite often causes low energy and protein intake. In some ways this can be good since decreased protein intake can help lead to less buildup of toxins created by protein breakdown. Kidney disease also causes loss of proteins in urine. As a result of getting and retaining too little energy and protein malnourishment occurs.
- Bone Disease: Kidney failure can cause disorders of Vitamin D, calcium and phosphorous. This can lead to serious bone disease as well as increased risk for minerals depositing throughout the body. Mineral deposition outside of the bones can lead to diseases of the heart and vascular system.
- Nerve Disorders: Build up of toxins (called uremia) results from kidney disease and the brain and nerves are very sensitive to toxins. This causes symptoms of sleep and memory difficulties to complete confusion and coma. The adverse impact on the nerves is the most important criteria to decide about the necessity of dialysis for a patient.
- General health & Well-Being: Symptoms of worsening physical functioning, depression, disability, and social isolation can be seen in kidney disease. Unfortunately these signs of this disease are not monitored by health care providers.
- Heart Disease: Deposition of certain minerals outside the bones and other body parts due to chronic kidney disease (CKD) and kidney failure causes an increased risk for heart attacks, heart failure, strokes, and blood vessel disease. A patient with CKD is considered in the “highest risk” group for “cardiovascular disease”. Urgent and aggressive treatment for this is essential for kidney patients.
Kidney disease is also likely to cause any of these complications:
- End-stage renal disease
- Cardiac tamponade
- Congestive heart failure
- Platelet dysfunction
- Loss of blood from the gastrointestinal tract
- Hepatitis B, Hepatitis C, liver failure
- Decreased functioning of white blood cells
- Decreased immune response
- Increased incidence of infection
- Peripheral neuropathy
- Encephalopathy, nerve damage, dementia
- Weakening of the bones
- Joint disorders
- Changes in glucose metabolism
- Electrolyte abnormalities including hyperkalemia
- Decreased libido, impotence
- Miscarriage, menstrual irregularities, infertility
- Skin dryness, itching/scratching with resultant skin infection
WHO IS AT RISK FOR KIDNEY DISEASE?
Most people with chronic kidney disease and early kidney failure do not have symptoms and thus do not know they have it. If you have any of the following causes of or risk factors for kidney disease, you should talk to your doctor about undergoing kidney disease screening and how to best protect your kidneys.
Diabetes Mellitus –
Diabetes is the number one cause of or risk factor for chronic kidney disease. It is responsible for 30-40% of new cases of kidney failure requiring dialysis, usually occurring a decade or more after diagnosis. Developing kidney failure from diabetes is not inevitable. Tight control of one’s blood sugar and blood pressure can help slow down, if not prevent kidney failure. Screening and early diagnosis is the key.
High Blood Pressure-
High blood pressure is the second most common cause of or risk factor for kidney disease. Along with diabetes, it is responsible for over two-thirds of kidney failure requiring dialysis. Because it is both a cause and an effect of kidney failure, it can sometimes be difficult to know which came first. Regardless of the cause, once kidney disease is established, uncontrolled high blood pressure leads to blood vessel damage and the acceleration of kidney failure. As a result, tight control of blood pressure is one of the most important things that can be done to prevent or slow down the progression of kidney disease.
If you have one or more family members with kidney disease or on dialysis, particularly if it is a parent or sibling, you are at higher risk for kidney disease. This is particularly true if diabetes, high blood pressure or other illnesses known to affect the kidneys runs in your family. Certain kidney diseases caused by genetic defects, such as polycystic kidney disease, are strongly hereditary. So, if kidney disease runs in your family, you need to let your doctor know so you can be screened and better monitored.
The risk of getting kidney disease increases with age. In fact, the elderly is one of the fastest demographic groups starting dialysis. The main reason that older people are at higher risk for kidney disease is because they tend to be sicker than younger people. They are more likely to have an illness that is associated with kidney disease or receive an insult to their kidneys, such as from an acute illness or a medication.
Another factor is that starting around age 35; the kidneys start to gradually lose some of its function. By the time most people reach age 80, they have lost about 30% of their kidney mass. By itself, aging of the kidney will not lead to severe kidney failure, but it means that you have less reserve if you do develop a kidney problem. So, if you are older, you should take to your doctor about measuring your kidney function and how you can protect your kidneys, even if you don’t actually have a kidney disease.
WHAT STEPS CAN I TAKE TO PREVENT THE ONSET OF KIDNEY DISEASE?
Kidney disease can be prevented up to a large extent by ensuring that the underlying causes for this disease do not manifest or are treated immediately. The disorders for this must be treated without delay to avoid chronic renal failure. Even if the kidney disease has been noticed the treatment of these causes shall help in preventing further deterioration in the condition.
Diabetic kidney disease can be prevented by keeping the blood sugar under strict control. Tight blood sugar control reduces the risk of microalbuminuria by as much as one third. The risk of microalbuminuria condition deteriorating to macroalbuminuria is reduced by half with blood sugar level being kept near normal. Such sugar management in the blood is even likely to reverse the disease.
The other cause- high blood pressure also needs to be managed with adequate medication and strict diet control. A proper diet and exercise regimen is essential for ensuring blood pressure control.
It may not be possible to prevent kidney disease altogether but by proper management of other causes the onset can be avoided and the risk minimized.
WHAT IS DIALYSIS AND HOW DOES IT HELP IN KIDNEY DISEASE?
Sometimes kidneys are damaged so badly that they no longer work. When kidneys fail, the person needs a way to replace their function, which is to clean the blood. Dialysis is a way of cleaning the blood with an artificial kidney. Dialysis is the more common form of kidney replacement therapy. There are two types of dialysis: hemodialysis and peritoneal dialysis.
In hemodialysis, a machine acting as an artificial kidney removes waste from the blood. A surgeon first creates an “access,” a place from where blood can easily be taken from the body and sent to the artificial kidney for cleaning. The access is created in any of the limbs (forearm) and made from the patient’s own blood vessels. Alternatively, a piece of tube is implanted. The access is made inside the body and is not visible from the outside. The surgery to create access is done 2 to 3 months before starting dialysis to enable the body to heal.
The frequency of hemodialysis is up to 2 to 3 days per week, and each time the process lasts for 3 to 5 hours. Blood travels through the artificial kidney (machine), where waste products are filtered out. Filtered blood is then returned to the body. At any time during hemodialysis only about 1/2 cup of blood is out of the body undergoing filtration/cleaning.
The process of hemodialysis may not suit everyone. During the procedure the patient can suffer from high or low blood pressure, an upset stomach or muscle cramps. The patient has to be put on a special diet to stay healthy. Nerve problems, anemia, bone disease, poor nutrition, problems with infection, problems with the access, and difficulty regulating insulin doses can also happen after some time. Diabetics are at a higher risk to suffer from these complications.
Peritoneal dialysis is carried out through the lining inside the abdomen (the peritoneum). For this type of dialysis a soft plastic tube is put into the abdomen by a surgeon. The body is allowed a time lapse to heal. For peritoneal dialysis a cleansing fluid (dialysate) is put into the abdomen through the tube installed earlier. Waste products in the bloodstream are filtered through the peritoneum into the dialysate. Then the dialysate, along with the waste products is drained off. There are two main types of peritoneal dialysis:
- Continuous Ambulatory Peritoneal Dialysis (CAPD): CAPD can be performed by the patient himself by attaching a plastic bag filled with cleansing fluid to the tube in the abdomen and raising it to shoulder level. This causes the fluid to run into the abdomen. The bag is then unhooked or rolled up around the waist. After sometime, the fluid is drained out and thrown away. A fresh bag of fluid is then put into the abdomen to begin cleansing again. This is called an “exchange” and takes about 30-45 minutes. This procedure is repeated 4 to 5 times a day. The patient undergoing this procedure can attend to daily chores.
- Continuous Cycling Peritoneal Dialysis (CCPD): In CCPD, a machine puts the cleansing fluid into the abdomen and drains it automatically. This is usually done at night during sleep.
CAPD and CCPD may be better treatments than hemodialysis for some people. With daily dialysis, the body does not build up too much fluid. This reduces the stress on the heart and blood vessels. A person is able to eat a more normal diet and have more time for work and travel.
Peritoneal dialysis is not for everyone, however. A person must be able to see well and carry out each step correctly to prevent infection in the abdomen. Anemia, bone disease, and poor nutrition can occur, just like in hemodialysis.
No matter which type is chosen, the person undergoing dialysis needs to work closely with the health care team to keep diabetes under control.
WILL KIDNEY DISEASE ALSO AFFECT THE MEDICATION AND THEIR DOSES FOR OTHER DISEASES?
The effect of medication on the body depends on the capability of the system to absorb the drug and to eradicate the chemical bye products of the same. The kidneys (along with the liver) play a major role in breaking down and removing drug from the body. Kidney disease often requires stopping or adjusting the dosages of many medications.
Kidney disease affects the body in myriad ways thus necessitating the change in the patient’s medications. These changes are related to:
- Medicine Absorption: Absorption of drugs by the gastrointestinal (GI) system is likely to be decreased in kidney failure. This problem can be acute for diabetics or for those already taking a large number of medicines.
- Distribution of Drug: After a drug is ingested, it is absorbed for dispersal throughout the body. Some drugs are distributed in the body through the proteins in blood. Patients suffering from protein losing kidney diseases are likely to face this problem since the reduced protein levels in the body will reduce the efficacy or the effect of the medicine.
Other drugs are soluble in body water. Kidneys work to maintain fluid levels and their balance in the body and kidney disease causes dehydration or edema which adversely effects drug distribution in the body.
- Break Down of Drugs: The chemical reactions that break down drugs and their toxic byproducts often slow down with kidney failure. As a result, the active or toxic parts accumulate. This is likely to cause a high rate of drug reactions in kidney failure.
- Elimination: The removal of many drugs and their breakdown products are dependent on the filtering ability (GFR) of the kidneys. When the GFR decreases, less is removed from the body. The kidneys ability to secrete drugs that aren’t easily filtered is often diminished as the GFR falls as well.
It is important to consult your physician at regular intervals to assess the impact of medication and effect changes as required.
WHAT ARE KIDNEY STONES AND WHAT IS THE TREATMENT FOR THESE?
Kidney stone is one of the most popular ailments to be found these days. It has been termed as a highly problematic ailment resulting in other specific complications.
Kidneys act as filters to process out the chemicals and other waste products from the body. Kidneys process certain chemicals also, and the same are passed out of the body in the urine. In some cases these may form crystals that stick together to form a mass differing in size from a small grain (ejected through urine) or grow up to the size of a golf ball. These crystalline formations in the kidneys are called kidney stones.
Kidney stones are hard, solid rocks that form in the kidneys and/or in the urinary tract. Kidney stones are considered as a common problem that affects large number of people every year. Kidney stones are mostly composed of minerals or salts like calcium oxalates that usually pass out of the body through the medium of urine. The main reason of kidney stones formation has been devised as concentration of urine or sometimes due to infection of urinary tract or kidneys.
The larger stones obstruct urine flow or irritate the lining of the urinary tract. In some individuals, appearance of kidney stones may be asymptomatic but in most cases they cause:
- Severe pain in the abdomen or in the sides of waist and shifting down towards the groin area.
- Nausea and vomiting.
- Burning and a frequent urge to urinate.
- Fever, chills, and weakness.
- Cloudy or foul-smelling urine.
- Blood in the urine.
- Blocked flow of urine. A blockage can cause serious infections.
Diagnosing a Kidney Stone-
X-rays or ultrasound test are used to diagnose and identify the location and size of kidney stones. The stone shows out in the x ray and the radiologist can determine the exact location and size.
Treatment for Kidney Stones-
The treatment for kidney stones depends on its size, location and the discomfort caused by it. Following options are available for treating these:
In most cases (up to 90 percent) these stones are quite small and drinking a lot of liquid can help in passing them out through urine. Any liquid that generates more urine output is useful and drinking beer or soda can also help.
Larger stones can be treated by passing a telescopic device into the ureter (uretheroscopy) or bladder and removing the stones. The stones are sucked out from their location after breaking them into smaller portions.
The most commonly given treatment provided in kidney stones is shock wave therapy which was always preferred. This system had a high margin of safety, as shown by the low complication rate. The lithotripter has been observed to be safe and effective. This involves use of precision lasers, sound waves or high-energy shock waves to break / crush the stones in to smaller pieces or dust that is excreted by the body through urine.
Surgery is generally the last and a rare option. In this procedure open surgery or laparoscopic options may be used.
It has been observed that the shock wave therapy treatment for kidney stones may increase one’s risk of diabetes later in life. The risk of diabetes is proportionate to the number and intensity of shocks.
Drinking large amounts of fluids, taking certain medications, and changing the diet may help prevent the formation of new stones. Early treatment is essential for kidney stone since it may lead to blockage of urinary tract and urine may not be passed out resulting in other complications. Kidney stones may cause infections and high blood pressure, especially in diabetics.
IS THERE ANY RELATIONSHIP OF KIDNEY STONE FORMATION WITH STRESS?
Kidney stone is an ailment affecting large number of people and invariably requires immediate medical attention and proper care. It is one of the highly problematic disease causing numerous kinds of complaints like severe pain in abdomen or sides of waist. This excruciating pain may shift down to the groin area.
Findings of various research studies do indicate a strong link between kidney stone formation and stressful events in the patient’s life. Stressful life events increase the formation of lithogenic urinary constituents like calcium oxalate and uric acid. It is these chemicals that play a major role in formation of kidney stones. Mostly kidney stones are formed of calcium oxalate and on a lesser scale are formed by uric acid.
Stress does play an important role in the formation of kidney stones. The kidney stone formation is generally related to a greater number of stressful life events, particularly financial and family problems.
Meditation, YOGA and other stress-fighting / control techniques help in fighting kidney stones. Positive thinking strategies with expert counseling to manage stress and eliminate its root cause are helpful. Stress management techniques can definitely assist in prevention of kidney stone formation.
WHAT IS KIDNEY INFECTION?
Kidney infection may be a precursor to the kidney disease in many cases. The infection (pyelonephritis) invariably starts from the urinary bladder. An individual suffering from any other disease or in old age, when the individual immunity levels are low, the infection from the bladder can move in to the ureters- the pipes connected to the kidneys. The infection causing germs then multiply fast in the kidneys.
Acute kidney infection starts very suddenly and its symptoms are also severe. Within a short span of time this infection generally disappears.
A chronic kidney infection progresses slowly and the condition takes time to deteriorate. This infection progresses in to kidney failure.
WHAT CAUSES KIDNEY INFECTION?
Kidneys can get infected due to various reasons that can lower individual capacity to fight bacteria. Some of these are:
- Kidney stones.
- Poor personal hygiene.
- Urinary tract abnormalities.
- Insertion of Foley Catheters and its use for longer periods.
- Sexual contact.
WHAT ARE THE SYMPTOMS OF KIDNEY INFECTION?
Kidney infection generally manifests itself suddenly, through following symptoms:
- Unexplained fever.
- Abdominal pain or pain radiating in to the groin.
- Upset stomach.
- Low back ache.
- Nausea / vomiting.
- Inability to urinate and or a constant need to urinate.
- Blood in the urine.
- Discomfort- pain / burning sensation during urination.
WHAT TREATMENT IS AVAILABLE FOR KIDNEY INFECTION?
Kidney infection is diagnosed by analysis of urine sample in a pathological laboratory. Recurring infection may require additional tests to identify the cause.
The kidney infection is controlled by antibiotics. Depending on the severity of the infection there may be a need to stay in the hospital for a few days.
Failure to treat the underlying cause of kidney infection may result in repeated infections and even kidney failure after sometime. Under certain circumstances the infection may spread to other parts of the body and create medical emergencies.
WHAT HAPPENS IN THE HOSPITAL DURING MY TREATMENT FOR KIDNEY INFECTION / DISEASE?
Kidney disease requires urgent and immediate medical attention and care to avoid further complications. During your stay the medical personnel may carry out procedures and use equipment listed below:
- Taking Your Vital Signs
At regular intervals the nursing staff or the physician checks and records on a chart your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to assess the condition of your heart and lungs.
kidney disease lowers the level of oxygen in the blood and your body may need extra oxygen at this time. A mask or nasal prongs are used to provide oxygen. If you feel dryness in the nose or throat or feel discomfort with the nasal prongs, inform the medical staff immideately.
- Pulse Oximeter
A pulse oximeter is clipped on your ear, finger, or toe and is connected to a monitor that constantly measures the oxygen in your blood.
- KUB (kidney-ureter-bladder) X-ray
An X-ray of your kidney, bladder and ureters is taken to check for any blockages.
- Renal / Abdominal Ultrasound
A painless test in which sound waves are used to assess the condition of kidneys and adjoining blood vessels. The test is performed while you are lying down.
- Foley Catheter
A tube is inserted to drain the bladder to avoid collection of the same or when you are unable to pass urine.
- Blood Test
Blood is usually taken from a vein in your hand or from the bend in your elbow and sent to a laboratory for testing.
- Intra Venous
An intra venous tube is placed in your vein for giving medicine or liquids. It will be capped or have tubing connected to it.
Cystoscopy is the examination of the urethra and urinary bladder. A tube (cystoscope) with a magnifying glass and light on the end is inserted into the urethra and up into the bladder. This scope may be attached to a camera. This procedure is conducted to confirm the presence of kidney stones or for taking tissue samples for tests. Small tumors’ and stones can be removed and any bleeding stopped with this procedure.
To obviate repeated infections due to a blockage in the ureters, a surgical procedure may also be conducted.
The level of severity of the disease may necessitate dialysis to remove extra water / fluids, chemicals and waste products from the body. This is carried out through the dialysis machine or artificial kidney.
Kidney disease is also related to heart disease. ECG (Electrocardiograph) is taken by attaching electrodes in the form of patches on your chest to a monitor or a portable ECG recorder. The screen on the monitor or the ECG printout shows a recorded tracing of each beat of your heart beat. The condition of your heart is monitored to check for any signs of damage or injury due to your kidney disease.
- Strict Intake and Output Record
The Nursing personnel will keep a close watch on how much liquid you consume orally or through IV and how much you are urinating. This is important to assess the functioning capacity of the kidneys.
Daily record of your weight will be maintained.
- Food / Liquid Intake
If you have been vomiting due to your disease, your food intake will be restricted to liquids only and these will be provided through the IV. This provides rest to your stomach and you start eating orally when you are comfortable doing that.
You will be provided special diet suitable for your disease. Your physician will advise you about this. You must follow this advice even after you leave the hospital.
- Physical Activity
Initially you may be bedridden till your condition improves. You may be able to move around as soon as you are feeling better.
- Drugs, Medicines and vitamins