YOUR KIDNEYS AND KIDNEY DISEASE
The kidneys are vital for human survival.
They are 2 bean-shaped organs; each roughly the size of a human fist, located on either side of the spine near the middle of the back, just beneath the rib cage.
The kidneys play a very vital role in human life.
Some people think all the kidneys do is just make urine. Actually, the kidneys do much more! Some of these life-saving functions include:
- Kidneys remove excess water & fluid from the body as urine and dispose of it through the urinary tract. Toxins & waste products from different metabolic processes are also removed from the body through special filtering processes.
- Kidneys help to regulate acid-base-balance of the body, thus preventing excess acidity in the blood.
- Kidneys produce a hormone called Renin which helps to control blood pressure and regulates how much salt and fluid the body keeps.
- Kidneys produce the important hormone Erythropoietin, which tells the bone marrow to make new red blood cells for the body.
- Kidneys produce the hormone Calcitriol (Active Vitamin D), which helps the body absorb healthy amounts of Calcium from food and ensures strong stable bones.
- The kidneys remove excess body water and waste products 24 hours a day.
- Healthy kidneys clean the blood over 300 times every day. This means that on average 1500 liters of blood pass through the kidneys every day!
FUNCTIONS OF THE KIDNEY
The kidneys become diseased when they are not able to carry out their normal functions – removing toxins & excess fluids, controlling blood pressure, keeping bones healthy & strong, keeping the body’s acid-base balance within normal levels and ensuring the body produces enough red blood cells.
Kidney disease can occur very rapidly or over a longer period of time. If it happens very rapidly it is known as Acute Kidney Injury (AKI). Usually AKI is reversible if the cause is discovered quickly and measures taken to reverse the injury.
Kidney disease that occurs over a lengthy period – from several weeks to months to years – is known as Chronic Kidney Disease (CKD). In Chronic Kidney Disease there is a gradual and irreversible loss of kidney function.
The causes of Chronic Kidney Disease (CKD) include:
• High Blood Pressure (Hypertension)
• Kidney Infections (known as Glomerulonephritis)
• Genetic diseases e.g. Polycystic Kidney Disease (PKD)
• Auto-Immune Diseases e.g. Lupus
• Excessive use of some medications that can reduce kidney function e.g. certain painkillers (NSAIDs), antibiotics.
• Long-term exposure to toxins from herbal medications and toxins/chemicals from certain industries e.g. hydrocarbon fuels, solvents, heavy metals – lead, mercury, copper etc.
Chronic Kidney Disease is classified into 5 stages: Stage 1 CKD (Below normal kidney function) to Stage 5 CKD (also called ESRD: End stage Renal Disease or Kidney Failure).
In the early stages of CKD there may be no obvious symptoms or signs. It is thus vital to slow down the progression of the disease in its early stages before kidney function worsen.
In the early stages of kidney disease, there may be no obvious symptoms or signs. However as kidney function starts to decline, certain symptoms may become noticeable. In the advanced stages of chronic kidney disease, kidney function may decline rapidly. Without adequate treatment chronic kidney disease leads to kidney failure, which may lead to death.
Symptoms of Chronic Kidney Disease may include:
• Changes in urine output: Urine volume may become more or less than normal. There may also be a change in the colour of urine, passage of foamy/frothy urine and changes in urination at night
• Difficulty in breathing
• Swelling of the ankles/feet/legs/face
• Loss of appetite, Nausea, Vomiting
• Increased fatigue, weakness, tiredness
• Sleeping problems: Inability to sleep at night, trouble staying awake during the day
• Decreased mental alertness and concentration
• Persistent hiccups, cramps and muscle twitching
• Persistent itchy, dry skin
• Metallic taste in mouth/Ammonia-like breath
• High blood pressure that is difficult to control.
If chronic kidney disease is discovered early, it is possible to slow down the disease progression with appropriate treatment and advice from your doctor.
There are certain factors that increase the risk of developing Chronic Kidney Disease (CKD).
• Age: Persons 65 years old and older are at increased risk.
• Ethnicity: Certain races have a higher risk of developing CKD. These include persons from African, African-American, Native American or Asian descent.
• High Blood Pressure (Hypertension)
• Elevated Cholesterol levels
• Persons with a family history of kidney disease e.g. those with Polycystic Kidney Disease (PKD).
Advanced Chronic Kidney Failure puts an individual at risk of developing complications. Some of these include:
• Heart and Blood vessel disease (Cardiovascular Disease)
• Low blood volume (Anaemia)
• Weak and Brittle bones – which may lead to fractures
• Decreased sex drive or Impotence
• Decreased immune response – increases risk of contracting infections
• Fluid retention in the body – worsens blood pressure and can lead to heart and lung problems
• Irreversible kidney damage (End-stage Renal Disease) – this requires intervention via dialysis or a kidney transplant.
It is possible to slow down the progression of Chronic Kidney Disease in its early stages; scheduling an appointment with your doctor is vital if you are at risk of developing kidney disease to assess your health, getting an early diagnosis and finding the right treatment.
In addition, lifestyle changes should be considered which may help reduce the progression of CKD. Some of these interventions include:
• Strict control of blood pressure and blood glucose levels (if diabetic)
• Eating a healthy, kidney-friendly diet: which focuses on low salt, reduced protein and adequate calories.
• Losing weight (if obese)
• Quitting smoking
• Beginning a moderate exercise/fitness regimen – including exercises like walking and aerobics
• Avoiding over-the-counter drugs and painkillers – always check with your doctor before taking any medication
Always follow advice from your doctor before undergoing any major lifestyle change.
Kidney failure (known as End-Stage Renal Disease, or ESRD) means that the kidneys are not able to perform their normal functions required. Here, the kidney function is noticed to be at below 15% of normal capacity. Treatment now becomes essential to keep such an individual alive.
There are 3 basic types of treatment available for kidney failure:
- Peritoneal Dialysis.
- Kidney Transplant
Haemodialysis is an artificial process of removing waste products & toxins with the aid of a special filter (called a dialyzer) attached to a machine outside the body. Blood is drawn out of the body from a blood vessel and pumped through the dialyzer which filters out the toxins and excess fluid, cleaning the blood before returning it back to the body.
Usually haemodialysis treatments are done three times a week, with each session lasting about 3-4 hours. During each session, the individual is connected to the machine throughout the duration of the treatment.
Peritoneal Dialysis uses the inner lining of the abdomen (called the peritoneal membrane) as a natural filter to remove waste and fluids from the body.
A flexible tube called a catheter is inserted into the abdominal cavity through which a special dialysis fluid is passed into the body to absorb toxins and waste products. The fluid is later drained into a separate bag. This process is repeated several times a day or overnight.
This involves surgically fixing a healthy kidney from a donor to the patient (recipient). Kidneys for transplant can come from either deceased or living donors. Initial tests are carried out to ensure the donor and patient are good candidates for a match, prior to the surgery.
• I HAVE KIDNEY DISEASE – IS DIALYSIS NECESSARY?
Dialysis becomes necessary when kidney function drops to 10-15% of its normal capacity, or when symptoms of severe illness become obvious e.g. nausea, vomiting, fatigue, difficult breathing, reduced urine output, swollen feet, legs, face, etc.
Your doctor will run some laboratory tests to determine your kidney function and use the results – alongside any symptoms you may have – to help you decide when to start dialysis.
• HOW OFTEN WILL DIALYSIS BE NEEDED?
Haemodialysis treatments are usually carried out thrice weekly and can be done in a hospital, at outpatient dialysis facility, or at home. Each session lasts about 3-4 hours.
Peritoneal dialysis is carried out several times daily.
• WILL MY KIDNEY DISEASE BE CURED BY DIALYSIS?
Dialysis is a procedure that helps remove waste products, toxins and excess water from the body when the kidneys can no longer do so.
Dialysis is not a cure for kidney failure.
• IS DIALYSIS PAINFUL?
Dialysis should not be a painful procedure. If you feel any pain during your treatment, you should inform your dialysis team so they can deal with any problems you might have right away.
• DO I HAVE TO STOP WORKING OR SCHOOLING WHILE ON DIALYSIS?
Dialysis should not prevent you from going to work or school.
Some adjustments might be necessary, depending on which modality of treatment is best suited to the individual. On the whole, dialysis enables individuals with kidney failure to continue to live healthy, fulfilling lives while managing their illness.
• WHAT CAN I EAT AND DRINK WHILE ON DIALYSIS?
If you have been diagnosed with kidney disease, a lot of care has to go towards what you eat and drink. It is advisable that you meet with a dietician (a professional who helps suggest and plan meals for patients with kidney disease).
In general, patients on dialysis are advised to cut down on foods high in sodium (salt), potassium, phosphorus, saturated fats and choose moderate intake of high-quality proteins. Diabetic patients who develop kidney failure should be aware of their carbohydrate intake. It is also advisable to be cautious with intake of fluids to avoid swelling in the legs, face and difficulty breathing, as well as heart problems.
Talking with a dietician will help alleviate fears about food choices and improve nutrition and health.
For more information about food and drink choices, you can schedule an appointment with a dietician here.