Kidneys are the body’s cleaning crew. These twin bean-shaped, fist-sized organs make up a filter system for the blood and filter 180 litres of blood per day to form 1.5 litres of urine and reabsorb almost 99 per cent of the filtered fluid back into the blood. Kidneys retain protein, glucose, salts and minerals and remove excess salt, water and toxic materials like urea, creatinine and drugs. They maintain bone strength by forming active vitamin D3, maintain acid-base balance and help in blood production by secreting erythropoietin hormone. Urine forms in kidneys, is stored in the blader and excreted through the urethra. Each day kidneys excrete 1.5 – 2.5 litres of urine.
Blocks on the way
Diabetes mellitus and hypertension are the most common causes of kidney disease. Other causes are chronic glomerulonephritis [damage to the part of kidneys that helps filter waste and fluids], chronic infection in the kidney, kidney stone, analgesic abuse and genetic disease like polycystic kidney.
Symptoms are high blood pressure, pale and sallow complexion, fatigue, shortness of breath, body itch, poor appetite sometimes with nausea/vomiting, frequent urination especially during nights, and a decrease in urine volume.
A majority of patients don’t show symptoms in the early stage except for some patients who may have swelling of face or legs. Symptoms do not occur unless kidneys are mechanically obstructed or infected or until greater than 70 per cent of their function has been lost.
Early kidney disease is usually detected by routine examination of urine, which shows presence of blood and/or protein in it. Methods of assessment include dipstick test of urine, ratio of urinary albumin to urinary creatinine ratio in spot specimen.
Serum creatinine and blood urea nitrogen [BUN] are measured with routine blood tests, which asses overall ability of the kidneys to excrete waste products. These become abnormally elevated when kidneys are damaged. Ultrasonography detects the anatomic abnormality, obstruction and stone in the kidneys.
Road to recovery
In early stage of kidney disease, renoprotective measures help in slowing the progress of kidney disease. These measures include control of diabetes [HbA1C]
Having a low-protein diet, restricting intake of potassium [fruits, leafy vegetables], phosphate [dairy and soy products, legumes and beans] and lowering fluid intake also helps in slowing down kidney disease.
When the kidney functions decrease to less than 15 per cent of normal, it is called end stage renal disease [ESRD] or chronic kidney disease stage 5. At this stage, renal replacement therapy is needed to sustain life. There are two forms of renal replacement therapy—kidney transplant or dialysis. Kidney transplantation, where kidneys are donated by a living related or non-related donor is the most comprehensive solution for kidney failure.
Dialysis is of two types—haemodialysis and peritoneal dialysis. In haemodialysis, the blood is pumped outside the body to a machine [dialyser] that cleans blood and returns it to the body. It is usually carried out three times a week and an average session lasts for 3 – 5 hours. During the cleaning process, patients usually watch TV, read or talk to each other.
In peritoneal dialysis, the blood is cleaned inside the body, by running a dialysis fluid through the peritoneum [the thin membrane that surrounds the outside of the organs in the abdomen] to filter blood.
Things to remember
Few things that you should keep in mind to help keep your kidneys functioning at their best capacity.
- Your kidneys are the vital organ for keeping your blood clean and chemically balanced; take care of them.
- Diabetes and blood pressure are most common causes of kidney damage; pay particular attention to ensure that they do not hamper your kidney function.
- Progression of kidney disease can be slowed [kidney protection] but it cannot always be reversed.
- Chronic kidney disease stage 5 is means complete loss of kidney function. Do not let it come to that stage.
- Chronic kidney disease increases the risk of heart disease and brain stroke.
- See a nephrologist if you develop any kidney disfunction or experience any of the above-mentioned symptoms.