Kidney Failure: A stitch in time does save nine!

BY Dr. Sudhir Thaduri Published on July 30, 2021

Kidneys are vital organs that help maintain the body's internal milieu by getting rid of waste products and maintaining homeostasis of fluid and electrolytes. The word kidney failure conjures a sad image of an almost terminal illness, which involves lifelong dependency on dialysis or kidney transplantation. To avoid a dramatic view and provide a better public understanding of the spectrum of kidney failure, malfunction of kidneys is referred to as Kidney injury, which could be short-term and reversible (Acute Kidney Injury) or long-term and irreversible (chronic kidney disease). Unlike other organs like the heart or brain, whose symptoms are glaringly manifest with any little abnormality, the kidneys have enormous reserve capacity. Such symptoms are usually not evident until kidney damage has progressed to an advanced stage where treatment options are limited. Most of the patients invariably end up needing dialysis or some form of renal replacement. Against this background, the medical community recognizes the importance of diagnosing kidney disorders at an early stage to prevent chronic kidney disease progression. Chronic Kidney disease or CKD is a major public health problem globally, including India, which has an explosion of risk factors like high blood pressure and diabetes that are the most important causes of CKD. Hence, early diagnoses by health screening and preventive care are key to reducing the impact of CKD.

The kidneys basically filter the blood round the clock and rid the body of excess salts/toxins and water while also performing essential functions of regulating bone strength and blood formation. For an easy understanding, we can assume that both the kidneys together contribute 50%, each amounting to 100%, which is equal to about 100ml/min of filtration capacity. Most conditions that impact kidney function tend to affect both kidneys simultaneously, causing a reduction in the filtration capacity. The symptoms from the accumulation of toxins can become apparent early in Acute Kidney Injury, while the kidney function frequently gets below 10ml/min in CKD before causing clinical symptoms. Kidney health can be easily monitored using two simple tests that measure creatinine concentration in the blood (Serum Creatinine) and leakage of protein in the urine (Proteinuria). Once diagnosed with kidney failure, a specialist (Nephrologist) usually orders a battery of tests focused on finding out the underlying cause of kidney disease and planning treatment.

What function do the kidneys serve?

While blood rushes to the renal, sensors inside specialized kidney cells control how much liquid and electrolytes are excreted as urine. For example, if a person gets dehydrated due to exercise or sickness, the kidneys will retain as much water as possible, causing the urine to become exceedingly concentrated. In contrast, when there is enough water in the system, the urine becomes much more dilute and clearer. Renin, a hormone generated in the kidneys that is the component of the body's fluid and blood pressure monitoring systems, regulates this mechanism. The kidneys are also the body's source of Erythropoietin, a hormone that encourages bone marrow to produce red blood cells. The oxygen concentration in the plasma is monitored by special cells in the kidney. When oxygen levels drop, erythropoietin rates spike and the body begins to produce additional red blood cells. The kidney's urine passes through the ureter, a channel that joins the kidney to the bladder. Urinary is kept in the bladder, and when you urinate, the bladder releases the urine through a tube called the urethra.

What is the cause of renal failure?

Kidney failure can emerge as a result of an acute episode that damages the kidneys or as a result of chronic disorders that progressively lead the kidneys to stop working. The most common cause of CKD worldwide includes Diabetes, High Blood pressure, and disorders intrinsic to the kidney called glomerulonephritis. An acute decline in kidney function could be caused by multiple reasons, including dehydration, toxins, infections, medications, obstruction to flow of urine, among myriad other causes which are best evaluated by a specialist of kidney disorders (Nephrologist).

CKD Causes:

The most prevalent causes of renal disease are Diabetes and High Blood Pressure (Hypertension). Together these account for more than 2/3rds of cases of CKD and can be easily diagnosed and managed by a family doctor at an early stage before they can cause kidney damage.

Diabetes:

High blood glucose in the common health disorder of diabetes tends to damage the kidney's filtering units, leading to leakage of protein in the urine that, over time, leads to a cascade of changes that lead to scarring and irreversible decline in kidney function. Hence, the importance of detecting low levels of protein leak in the urine (Microalbuminuria) is not detected on the usual urine test and needs a unique technique to detect albumin. Detection of kidney damage at the stage of albumin leakage is potentially reversible and is an essential step towards preventing CKD in diabetic individuals. It also signals an increased risk of heart disease in such individuals as the changes in microcirculatory blood vessels called endothelial cells tend to impact the heart, kidney, and brain together, causing major end-organ problems in the same individual.

Hypertension:

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 when your kidneys fail?

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

Symptoms Listed:

  • nausea
  • trouble sleeping
  • poor appetite
  • weakness
  • tiredness
  • itching
  • 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.

Conclusion

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.
Author

Dr. Sudhir Thaduri

MBBS, MD, DNB, Assistant Professor, Division of Nephrology, Transplant, University of Birmingham Alabama.

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