Love you with both my kidneys

Love you with both my kidneys

By Dr. Aley. H. Bilgrami

Kidneys are like our parents. Although we have two of them, we cannot afford to take either one of them for granted.

Are your kidneys okay? This is a question we seldom ask ourselves but one that is being asked every year, on World Kidney Day, as one out of ten adults suffer some form of kidney damage.

The purpose of world kidney day is to raise awareness about the importance of our kidneys, an amazing organ that plays a crucial role in keeping us alive and well; and also to tell the world that kidney disease is common but can be treated if diagnosed on time.

There are two types of kidney disease, acute and chronic. Acute diseases appear suddenly but are generally short lived and reversible if treated promptly. Chronic diseases appear gradually, last longer, and can only be partially reversed or stabilized. Chronic kidney disease (CKD) is silent and may go unnoticed for a long time as it takes a while for symptoms to appear.

As we all know, this bean shaped organ performs some very essential functions: the elimination of waste products, control of blood pressure, maintaining the level of certain salts present in the bloodstream within a within safe range in and the secretion of different chemicals (hormones).

We make an assessment of kidney functions by measuring the blood level of certain substances normally eliminated by kidneys. Commonly measured substances are urea and creatinine. If the reading is within the normal range, the kidneys are working properly; high levels mean decreased kidney functions. We can also detect kidney malfunction through a simple urine analysis which includes physical, chemical and microscopic examination by a simple lab test

• Sample of blood – creatinine measurement

• Sample of urine – to detect protein (albumin)

• Ultrasound of kidneys

Chronic kidney disease can lead to kidney failure, requiring dialysis or kidney transplant; it also increases the risk of heart disease and premature death.

A few common causes which can damage our kidneys are:

• Congenital kidney disease

• Diabetes mellitus

• High blood pressure

• Infections

• Kidney stones

Diabetes and high blood pressure

Diabetes (along with other diseases like high blood pressure) is one of the common but treatable causes of end stage kidney disease. Diabetes is the leading cause of kidney failure in the industrialised world and most developing countries, including Pakistan and more than 33% of patients on dialysis are diabetics. Currently there are 150 million diabetics in the world; this will go up to 333 million by the year 2025.

Initially there are no symptoms however kidney involvement can be detected early by checking urine for the presence of proteins. Initially protein in urine is in very small quantity and is called microalbuminuria (MAU); this can be checked by a special test. The presence of MAU is an early indicator of kidney disease and allows measures to be taken early to slow or even prevent progression of kidney involvement. It is recommended that maturity onset diabetics (Type II, non insulin dependant) are screened for MAU at the time of diagnosis of diabetes and, from then onwards, on a yearly basis. Juvenile diabetics (Type I, insulin dependant) should be screened for MAU starting five years after their diagnosis.

Kidney stones

While the Stone Age is long past, we still live in a stone belt. The estimated prevalence of stone disease in Pakistan is 8-10%. It is more common in males but affects people of all ages - from three months to 70 years – especially the poor and the malnourished people of rural areas.

While there are many ways of treating kidney stones, one can take a few simple measures to avoid them altogether. Drink plenty of water - at least ten glasses a day under normal conditions; more in hot weather and after exercise as well as in the night.

Our diet should include lemon juice, orange juice and a lot of calcium; milk protects against endemic stones in children and it should be a part of daily diet. Keeping salt intake to minimum and avoiding constipation are also helpful measures against infection and stones.

Kidney stones are of different and rare compositions, and, as such, require different preventive measures. Cystine stones can be dealt with by drinking four litres of fluid per day; prevention of uric acid stones however, requires avoiding red and organ meat. A low purine diet is also advised which restricts consumption of alcoholic beverages, fish, fried beans, soya beans, mushrooms, spinach etc. A high oxalate diet (black tea, chocolate, coca, spinach, coffee) should be avoided as well. High doses of vitamin C and D and vitamin B6 and vitamin E are beneficial for managing excessive oxalate in urine.

Kidney infections in children

The most common, kidney-related problem among the paediatric population is the urinary tract infection, especially in infants, as it can be very non-specific. A high index of suspicion should be emphasized for both parents and physicians. All diagnosed cases should be treated aggressively and investigated for etiology thoroughly.

Among a few causes are:

• Congenital abnormality in urinary tract

• Bladder dysfunction

• Uncircumcised males less than 3 months of age

• Non breast-fed infants

• Exposure to broad spectrum antibiotics

• Constipation

Kidneys are like our parents. Although we have two of them, we cannot afford to take either one of them for granted. Both of them must function well, if we want to live a long, healthy life. Love your kidneys as you love your parents.