Kidneys are crucial organs that maintain the body's internal environment. They help remove waste products and balance fluid and electrolytes. Kidney injury is a better term than kidney failure. It includes acute kidney injury, which is reversible, and chronic kidney disease, which is irreversible. Unlike other organs, kidneys have a significant reserve capacity, and symptoms are not evident until damage has progressed. Early detection of kidney disorders is essential to prevent chronic kidney disease progression. CKD is a global public health problem, particularly in India, where high blood pressure and diabetes are major causes. Early diagnoses through health screening and preventive care are vital to reducing the impact of CKD.
The kidneys filter blood and remove excess salts and toxins while regulating bone strength and blood formation. Both kidneys contribute equally to about 100ml/min of filtration capacity. Kidney function is impacted by most conditions that affect both kidneys simultaneously, reducing filtration capacity. Acute Kidney Injury symptoms can appear early from toxin accumulation, while CKD symptoms appear when kidney function falls below 10ml/min. Kidney health is monitored using two tests: Serum Creatinine measures creatinine concentration in the blood, and Proteinuria measures protein leakage in the urine. Once diagnosed with kidney failure, a Nephrologist orders tests to find the underlying cause and plan treatment.
What function do the kidneys serve?
Specialized kidney cells control the amount of liquid and electrolytes excreted as urine when blood flows to the renal. The kidneys retain water during dehydration and make the urine concentrated. In contrast, when there is enough water in the system, the urine becomes clearer. Renin, a hormone generated in the kidneys, regulates this mechanism. The kidneys produce Erythropoietin, which encourages the bone marrow to produce red blood cells. Special cells in the kidney monitor the oxygen concentration in the plasma. When oxygen levels drop, erythropoietin levels increase, and the body produces more red blood cells. The ureter joins the kidney to the bladder, and the bladder stores urine. The urethra releases the urine during urination.
What is the cause of renal failure?
Kidney failure can occur due to an acute episode that damages the kidneys or chronic disorders that gradually lead to kidney dysfunction. The most prevalent causes of CKD globally are diabetes, high blood pressure, and intrinsic kidney disorders called glomerulonephritis. Several factors, such as dehydration, toxins, infections, medications, and obstruction to urine flow, could cause a sudden decline in kidney function. Evaluation by a nephrologist, a specialist in kidney disorders, is the best approach to diagnose the underlying cause.
and High Blood Pressure (Hypertension) are responsible for more than 2/3rds of cases of CKD and a family doctor can easily diagnose and manage them at an early stage before they can cause kidney damage.
High blood glucose in diabetes damages the kidney's filtering units, causing protein leakage in urine, leading to scarring and irreversible kidney function decline. Hence, detecting low levels of protein leak in urine (Microalbuminuria) is crucial to prevent CKD in diabetic individuals. It also indicates an increased risk of heart disease as the changes in microcirculatory blood vessels impact the heart, kidney, and brain simultaneously. Detecting kidney damage at the albumin leakage stage is potentially reversible, and a specialist (Nephrologist) can perform a unique test to detect albumin.
High blood pressure over time tends to damage vasculature in the kidneys, leading to chronic damage to the filtering units and matrix of the kidney resulting in CKD.
What happens in kidney failure?
Waste and surplus fluid are removed from your blood by healthy kidneys. However, toxins and extra fluid can accumulate in your blood when your kidneys fail, making you feel ill. You may be experiencing some of the
- trouble sleeping
- poor appetite
- weight loss
- muscle cramps (especially in the legs)
- swelling of your feet or ankles
- anaemia (a low blood count)
- trouble sleeping
What can you do to take care of your kidneys?
Kidney illnesses are silent killers that can have a significant impact on your quality of life. There are, however, various strategies to lower your chance of having kidney disease.
Maintain your fitness and stay active:
This can assist you in achieving optimum health, lower your blood pressure, and lessen the overall risk of renal disease. The notion "On the move for kidney health" is a global collaborative march comprising the general population, celebrities, and professionals exercising, running, and cycling across a crowded street. So why not join them – in whatever way works best for you?
Take a balanced diet:
This can aid in the maintenance of a healthy body mass, reduce blood pressure, prevent diabetes, heart disease, and other symptoms associated with chronic kidney disease. Minimize your salt consumption. The daily sodium intake recommendation is 5-6 grams of salt. This encompasses the salt that is already present in your foods (about a teaspoon). To lower your salt intake, restrict your consumption of processed foods and restaurant foods and avoid adding salt to your food. In addition, controlling your salt intake will be easier if you create your cuisine from scratch using organic vegetables.
Monitor and regulate your blood sugar levels:
Approximately half of all people with diabetes are unaware of their condition. As a result, you should monitor your blood sugar level as part of a routine body check-up. This is especially true for people entering middle age or older. However, if hyperglycemia is adequately controlled, this can be avoided or restricted. In addition, blood and urine tests should be performed regularly to monitor your kidney function.
What is the diagnosis and expected life span for kidney failure? Can it be avoided?
The prognosis for kidney failure is determined by the underlying ailment that caused it. However, kidney function may be reversible, especially if the cause was an acute blockage that was removed. Early detection is the greatest way to preserve kidney function, and treating high blood pressure and diabetes throughout one's life can reduce the risk of chronic kidney impairment. Unfortunately, most patients with CKD eventually succumb to coexisting heart disease or end up needing one form of Renal replacement therapies which includes dialysis or kidney transplantation.
CKD is usually a final common pathway of many diseases that affect the kidney that ultimately causes the kidneys to stop working, necessitating Renal replacement therapies. These disorders are initially asymptomatic, but they advance quickly and can become chronic and incurable. However, these disorders are amenable to prevention by early recognition through health screening, attention to leading a healthy lifestyle, and timely referral to a kidney disease specialist once diagnosed with CKD.
Dr. Sudhir Thaduri
MBBS, MD, DNB, Assistant Professor, Division of Nephrology, Transplant, University of Birmingham Alabama.