There are increasing numbers of cases of Kidney disease are being seen, perhaps similar to trends seen elsewhere in the world. This most probably is due to the fact that Hypertension and Diabetes are on the increase and also because of increasing survival of the individuals in community. Also perhaps due to increase awareness more and more people utilize the services and facilities offered. Chronic renal failure is a devastating illness that has far reaching impact as it affects not only the patient and his family but also society in general. Patients with kidney failure live a life on dialysis until they receive a kidney transplant. With Pakistan being a developing country not many people can afford to get full treatment of dialysis or transplant.
Although there is no formal single, some of studies point to Diabetes and Hypertension as the leading cause of Renal failure. Amongst causes more prevalent are infections, diarreal illnesses, childbirth, medicine and herbal treatments. Stone disease is also quite common.
The kidneys are a pair of bean-shaped organs located at the back of the body about the level of the waist. Each kidney measures 10 - 13 cm in length and weighs approximately 160 gms. The kidney is made up of approximately one million functioning units called nephron. Each nephron consists of the glomerulus and tubule. The tubule is a tube-like structure. The closed end of the tubule forms a cup-shaped structure called a glomerulus capsule which surrounds a network of tiny blood vessels called the glomerulus. The glomerulus serves as a filter. The filtrate then drains into the tubule. The concentration of the filtrate is altered along the length of the tubule by various processes to form urine. The remaining nephron leads into the collecting duct. The collecting ducts drain into a common funnel-shaped sac called the kidney pelvis located on the hollow side of the kidney. The ureter connects the kidney pelvis with the bladder. Urine formed by the kidneys flow through the ureters to the bladder where it is passed out through the urethra.
Each day the two kidneys excrete about 1.5 to 2.5 liters of urine. In doing this, the vital functions of the kidney is to remove toxic and waste products and excess water from the body. The other functions of the kidney are to maintain the body's balance of various salts such as sodium, potassium, calcium, phosphate as well as acid. The kidney is also a producer of hormones. Erythropoietin is responsible for stimulating production of red blood cells in the bone marrow while active Vitamin D is necessary for strong healthy bones.
Kidney diseases alter the structure and function of the kidney. There are many diseases affecting different parts of the kidneys such as glomerulonephritis, pylonephritis, polycystic kidney and lupus nephritis. The treatment and potential for recovery depends on the type of disease. Kidney diseases can lead to the kidney failure.
Features of Kidney Diseases
1. Burning sensation during urination
2. Frequent urination at night
3. Passing blood-stained urine
4. Puffiness around eyes, swelling of hands and feet
5. Pain in the lower back area just below the rib cage
6. High blood pressure
7. Easy fatigueabilty, weakness, loss of appetite
8. Symptom less
If these symptoms are present, consult a doctor. Further investigation need to be carried to find out the cause. There may not be any obvious signs at all and the clue to kidney disease may be abnormal urine findings picked up on urine tests alone.
Kidney failure is a condition where the kidneys are incapable of performing its normal functions. Broadly speaking there are two types of renal failures, Acute, where kidney shuts down suddenly and Chronic, where there is slow progression to end stage kidney failure. In acute cases with treatment which is largely supportive majority of cases will recover, although some will progress to Chronic renal failure. In chronic renal failure exactly opposite is true. In either case when kidneys fail Certain toxic substances which should have been excreted such as urea and creatinine accumulate in the body. These levels if high enough cause symptoms such as tiredness, weakness, loss of appetite and vomiting. These occur much earlier in acute cases, partly because of associated conditions. Creatinine is the breakdown product of muscle and the blood creatinine is often used by doctors as a measure of the degree of kidney failure. Generally, when the creatinine level in the blood reaches a level of 900 umol/L the patient should start on dialysis earlier in some cases).
In kidney failure, the volume of water in the body increases and swelling of the tissues results. Excess salt and water retention may result in high blood pressure, swelling of the legs, face and abdomen and breathlessness. Acid generated during the body's metabolic processes builds up in the body. The kidneys fail to excrete phosphate, causing the blood phosphate level to increase and calcium level to fall. This results in bone disease and may predispose the patient to bone pains and other problems related to bones and muscles. The bone problem is also made worse by a lack of active Vitamin D. Inadequate production of erythropoietin leads to anemia.
The common causes of kidney failure are glomerulonephritis (inflammation of the kidney) Hypertension, and diabetes mellitus. Other causes of kidney failure are kidney stones, infections, diarrhea illnesses, child birth, long term use of some medications, allergic reactions to medicines and herbal medicine etc.
In mild renal failure, no symptoms are present. However, renal tests show some abnormalities. As renal failure worsens the patient has:-
1. pale and sallow complexion
2. easy fatigue ability
3. shortness of breath
4. body itch
5. poor appetite, sometimes accompanied with nausea and vomiting
6. swelling of the face and legs
7. frequent urination at night or
8. passes little urine
Progression of Kidney Failure (How Best To Slow It Down)
1. Control of blood pressure.
Strict control of blood pressure is necessary as high blood pressure damages the kidney. This requires observation of a low salt diet and high blood pressure medications.
Protein restriction: Reducing the intake of protein such as poultry, seafood and Soya products helps to reduce the pressure within the kidneys and therefore protects the kidney. However, one must be cautious not to reduce this to too low or malnutrition will result. The dietician would usually be consulted on this and advise the patient the proportion of foods one should take.
Salt intake: High salt increases the blood pressure and has according to some studies direct toxic effect on Kidneys.
Fluid: If you have a significant amount of swelling, your doctor will instruct you to reduce your fluid intake. Excessive fluid and salt contributes to hypertension. Fluid allowance for the day depends on the fluid status of the patient. It may be restricted to a range of 500 ml to 300 ml a day.
All patients with kidney failure will be referred to a dietician who will give advice on a proper diet.
Medications specific to different kidney diseases may be prescribed depending on the cause of the kidney failure. These may include preventive antibiotics, dipyridamole, steroids and other drugs. Do not take any medication without consulting your Nephrologists, as a simple pain killer might be detrimental to your kidneys.
- http://www.kidney.org (National Kidney Foundation)
- http://www.nlm.nih.gov/medlineplus/ency/article/000457.htm (USA Natiional Library of Medicine and National Institute of Health)
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