Your Kidney: - Know about it

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Kidney:

The kidneys play key roles in body function. Kidneys are like a 24-hour cleaning machine for our blood. These are located below the rib cage in the middle of our back.
 

Functions of Kidneys

Kidneys perform following important functions to keep us alive

• Remove waste products from blood by filtering it.
• Controlling blood pressure.
• Adjust minerals and other chemicals levels.
• Production of red blood cells.

Types of Kidney Failure

• Acute Renal Failure
• Chronic renal failure

Acute Renal Failure It happens quickly and may be temporary, normal functioning of Kidney can be restored after kidney healing or may need few dialyses. Kidney can stop working due to toxins or loss of blood.

Chronic renal failure develops over months and years.

The most common causes of chronic renal failure are related to:

• Poorly controlled diabetes
• Poorly controlled high blood pressure
• Chronic glomerulonephritis

Less common causes:

• Polycystic Kidney Disease
• Reflux nephropathy
• Kidney stones
• Prostate disease

How to help yourself

•    Awareness and knowledge of disease
•    Patients with high risk should get test done 6 monthly
•    We should take opinion with expert in renal medicine

10 Symptoms of Kidney Disease

Many people who have chronic kidney disease don't know it, because the early signs can be very subtle. It can take many years to go from chronic kidney disease (CKD) to kidney failure. Some people with CKD live out their lives without ever reaching kidney failure. However, for people at any stage of kidney disease, knowledge is power. Knowing the symptoms of kidney disease can help you get the treatment you need to feel your best. If you or someone you know has one or more of the following symptoms of kidney disease, or you are worried about kidney problems, see a doctor for blood and urine tests. Remember, many of the symptoms can be due to reasons other than kidney disease. The only way to know the cause of your symptoms is to see your doctor.

Symptom 1: Changes in Urination
Kidneys make urine, so when the kidneys are failing, the urine may change. How?

• You may have to get up at night to urinate.
• Urine may be foamy or bubbly. You may urinate more often, or in greater amounts than usual, with pale urine.
• You may urinate less often, or in smaller amounts than usual with dark colored urine.
• Your urine may contain blood.
• You may feel pressure or have difficulty urinating.

Symptom 2: Swelling
Failing kidneys don't remove extra fluid, which builds up in your body causing swelling in the legs, ankles, feet, face, and/or hands.

Symptom 3: Fatigue
Healthy kidneys make a hormone called erythropoietin (a-rith'-ro-po'-uh-tin) that tells your body to make oxygen-carrying red blood cells. As the kidneys fail, they make less erythropoietin. With fewer red blood cells to carry oxygen, your muscles and brain become tired very quickly. This condition is called anemia, and it can be treated.

Symptom 4: Skin Rash/Itching
Kidneys remove wastes from the bloodstream. When the kidneys fail, the buildup of wastes in your blood can cause severe itching.

Symptom 5: Metallic Taste in Mouth/Ammonia Breath
A buildup of wastes in the blood (called uremia) can make food taste different and cause bad breath. You may also notice that you stop liking to eat meat, or that you are losing weight because you just don't feel like eating.

Symptom 6: Nausea and Vomiting
A severe buildup of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.

Symptom 7: Shortness of Breath
Trouble catching your breath can be related to the kidneys in two ways. First, extra fluid in the body can build up in the lungs. And second, anemia (a shortage of oxygen-carrying red blood cells) can leave your body oxygen-starved and short of breath.

Symptom 8: Feeling Cold
Anemia can make you feel cold all the time, even in a warm room.

Symptom 9: Dizziness and Trouble Concentrating
Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to memory problems, trouble with concentration, and dizziness.

Symptom 10: Leg/Flank Pain
Some people with kidney problems may have pain in the back or side related to the affected kidney. Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause pain.

Renal (Kidney) Function Test

Renal function, in nephrology, is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate (GFR) describes the flow rate of filtered fluid through the kidney. Creatinine clearance rate (CCr or CrCl) is the volume of blood plasma that is cleared of creatinine per unit time and is a useful measure for approximating the GFR. Both GFR and CCr may be accurately calculated by comparative measurements of substances in the blood and urine, or estimated by formulas using just a blood test result (eGFR and eCCr).

The results of these tests are important in assessing the excretory function of the kidneys. For example, grading of chronic renal insufficiency and dosage of drugs that are primarily excreted via urine are based on GFR (or creatinine clearance).

Most doctors use the plasma concentrations of the waste substances of creatinine and urea, as well as electrolytes to determine renal function. These measures are adequate to determine whether a patient is suffering from kidney disease.

Unfortunately, blood urea nitrogen (BUN) and creatinine will not be raised above the normal range until 60% of total kidney function is lost. Hence, the more accurate Glomerular filtration rate or its approximation of the creatinine clearance are measured whenever renal disease is suspected or careful dosing of nephrotoxic drugs is required.

Understanding different values

People who develop chronic kidney disease may have some or all of the following tests and measurements. If you have kidney disease ask your doctor which tests you will have and how often they will be done. If your numbers are not in the normal range, ask how to improve them.

Serum Creatinine: Creatinine is a waste product in your blood that comes from muscle activity. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises. Your doctor should use the results of your serum creatinine test to calculate your GFR.

Glomerular Filtration Rate (GFR): Your GFR tells how much kidney function you have. It may be estimated from your blood level of creatinine. If your GFR falls below 30 you will need to see a nephrologist. Your kidney doctor will speak to you about treatments for kidney failure like dialysis or kidney transplant. A GFR below 15 indicates that you need to start one of these treatments.

Blood Urea Nitrogen (BUN): Urea nitrogen is a normal waste product in your blood that comes from the breakdown of protein from the foods you eat and from your body metabolism.

Urine Protein: When your kidneys are damaged, protein leaks into your urine. A simple test can be done to detect protein in your urine. Persistent protein in the urine is an early sign of chronic kidney disease.

Urine Creatinine: This test estimates the concentration of your urine and helps to give an accurate protein result.

Hemoglobin: Hemoglobin is the part of red blood cells that carries oxygen from your lungs to all parts of your body. Your hemoglobin level tells your doctor if you have anemia, which makes you feel tired and have little energy. If you have anemia, you may need treatment with iron supplements and a hormone called erythropoietin (EPO). The goal of anemia treatment is to reach and maintain a hemoglobin level of at least 11 to 12.

Hematocrit: Your hematocrit is a measure of the red blood cells your body is making. A low hematocrit can mean you have anemia and need treatment with iron and EPO. You will feel less tired and have more energy when your hematocrit reaches at least 33 to 36 percent.

Parathyroid Hormone (PTH): High levels of parathyroid hormone (PTH) may result from a poor balance of calcium and phosphorus in your body. This can cause bone disease. You should consult doctor to lower your PTH.

Calcium: Calcium is a mineral that is important for strong bones.

Phosphorus: A high phosphorus level can lead to weak bones. If your level is too high then you should reduce your intake of foods that are high in phosphorus and take a type of medication called a phosphate binder with your meals and snacks.

Potassium: Potassium is a mineral in your blood that helps your heart and muscles work properly. A potassium level that is too high or too low may weaken muscles and change your heartbeat. Your dietitian can help you plan your diet to get the right amount of potassium.

Body Weight: Maintaining a healthy weight is important to your overall health. If you are losing weight without even trying, you may not be getting the right nutrition to stay healthy. Your dietitian can suggest how to safely add extra calories to your diet if needed. On the other hand, if you are slowly gaining too much weight, you may need to reduce calories and increase your activity level. A sudden weight gain can also be a problem. If it is accompanied by swelling, shortness of breath and a rise in blood pressure, it may be a sign of too much fluid in your body. Speak to your doctor if your weight changes noticeably.

Blood Pressure: If your blood pressure is high, make sure to follow all the steps in your prescribed treatment, which may include taking high blood pressure medications, cutting down on the amount of salt in your diet, losing excess weight and following a regular exercise program.

5 Stages of Chronic Kidney Disease

How is Chronic Kidney Disease Detected?
Early detection and treatment of chronic kidney disease are the keys to keeping kidney disease from progressing to kidney failure. Some simple tests can be done to detect early kidney disease. They are:

• Blood pressure measurement
• A test for protein in the urine. An excess amount of protein in your urine may mean your kidney's filtering units have been damaged by disease. One positive result could be due to fever or heavy exercise, so your doctor will want to confirm your test over several weeks.
• A test for blood creatinine. Your doctor should use your results, along with your age, race, gender and other factors, to calculate your glomerular filtration rate (GFR). Your GFR tells how much kidney function you have.

What is GFR (Glomerular Filtration Rate)?
GFR - Glomerular Filtration Rate is the best test to measure your level of kidney function and determine your stage of kidney disease. Your doctor can calculate it from the results of your blood creatinine test, your age, race, gender and other factors. It is the volume of fluid filtered from the renal (kidney) glomerular capillaries into the Bowman's capsule per unit time.

Calculation of Glomerular filtration rate (GFR): - Glomerular Filtration Rate (GFR) can be calculated by measuring any chemical that has a steady level in the blood, and is freely filtered but neither reabsorbed nor secreted by the kidneys. The rate therefore measured is the quantity of the substance in the urine that originated from a calculable volume of blood. The GFR is typically recorded in units of volume per time, e.g. milliliters per minute ml/min. Compare to filtration fraction.

The normal range of GFR, adjusted for body surface area, is similar in men and women, and is in the range of 100-130 ml/min/1.73M2. In children, GFR measured by inulin clearance remains close to about 110 ml/min/1.73M2 down to about 2 years of age in both sexes, and then it progressively decreases. After age 40, GFR decreases progressively with age, by about 0.4 - 1.2 mL/min per year.

The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.

What happens if my test results show I may have chronic kidney disease?
Your doctor will want to pinpoint your diagnosis and check kidney function to help plan the treatment. The doctor may do the following:
 

• Calculate your Glomerular Filtration Rate (GFR), which is the best way to tell how much kidney function you have. You do not need to have another test to know your GFR. Your doctor can calculate it from your blood creatinine, your age, race, gender and other factors. Your GFR tells your doctor your stage of kidney disease and helps the doctor plan your treatment.
• Perform an ultrasound or CT scan to get a picture of your kidneys and urinary tract. This tells your doctor whether your kidneys are too large or too small, whether you have a problem like a kidney stone or tumor and whether there are any problems in the structure of your kidneys and urinary tract.

Perform a kidney biopsy, which is done in some cases to check for a specific type of kidney disease, see how much kidney damage has occurred and help plan treatment. To do a biopsy, the doctor removes small pieces of kidney tissue and looks at them under a microscope.

It is especially important that people who have an increased risk for chronic kidney disease have these tests. You may have an increased risk for kidney disease if you:

• are older or have diabetes
• have high blood pressure
• have a family member who has chronic kidney disease
• are an African American, Hispanic American, Asians and Pacific Islander or American Indian.

If you are in one of these groups or think you may have an increased risk for kidney disease, ask your doctor about getting tested.

What is the treatment for kidney failure?
Prevention is always the goal with kidney failure. Chronic disease such as hypertension and diabetes are devastating because of the damage that they can do to kidneys and other organs. Lifelong diligence is important in keeping blood sugar and blood pressure within normal limits.

Once kidney failure is present, the goal is to prevent further deterioration of renal function. If ignored, the kidneys will progress to complete failure, but if underlying illnesses are addressed and treated aggressively, kidney function can be preserved, though not always improved.

Dialysis is a treatment for severe kidney failure (also called renal failure, stage 5 chronic kidney disease, and end-stage renal disease). When the kidneys are no longer working effectively, waste products and fluid build up in the blood. Dialysis takes over a portion of the function of the failing kidneys to remove the fluid and waste.

Which type of Dialysis is best?

Once dialysis becomes necessary, you (along with your physicians) should consider the advantages and disadvantages of the two types of dialysis:

1. Hemodialysis
2. Continuous Ambulatory Peritoneal dialysis (CAPD)

The choice between hemodialysis and peritoneal dialysis is influenced by a number of issues such as availability, convenience, underlying medical problems, home situation, and age. This choice is best made by discussing the risks and benefits of each type of dialysis with a nephrologist.

Doctors recommend that dialysis begin well before kidney disease has advanced to the point where life threatening complications can occur. It is generally possible to be put on a kidney transplant waiting list when kidney function is about 20 percent of normal. Many patients will need to start dialysis when their kidney function is about 8 to 12 percent of normal.

In certain situation, dialysis must be started immediately. If blood tests indicate the kidneys are working very poorly or not at all, or if there are symptoms such as confusion or bleeding that is related to kidney disease, dialysis should be started at once:

1) Hemodialysis
Preparations for hemodialysis should be made at least several months before it will be needed. In particular, you will need to have a procedure to create an "access" several weeks to months before hemodialysis begins.

Vascular access - An access creates a way for blood to be removed from the body, circulate through the dialysis machine, and then return to the body at a rate that is higher than can be achieved through a normal vein. There are three major types of access: primary AV fistula, synthetic AV bridge graft, and central venous catheter. Other names for an access include a fistula.
The access should be created before hemodialysis begins because it needs time to heal before it can be used. The access is usually created in the non-dominant arm; for a right-handed person this would be their left arm.

After the access is placed, it is important to monitor and care for it over time.

Primary AV fistula - A primary AV fistula is the preferred type of vascular access. It requires a surgical procedure that creates a direct connection between an artery and a vein. This is often done in the lower arm, but can be done in the upper arm as well. Sometimes a vein that would not normally be useful for creating an AV fistula can be moved so that it is more accessible; this is often done in the upper arm.

During dialysis, two needles are inserted into the access. Blood flows out of the body through one needle, circulates through the dialysis machine, and flows back into the access through the other needle.

A primary AV fistula is usually created two to four months before it will be used for dialysis. During this time, the area can heal and fully develop or "mature".

Central venous catheter - A central venous catheter uses a thin flexible tube that is placed into a large vein (usually in the neck). It may be recommended if dialysis must be started immediately and the patient does not have a functioning AV fistula. This type of access is usually used only on a temporary basis. In some cases, however, there can be problems maintaining an AV fistula, and the central venous route is used for long-term access.

Catheters have the highest risk of infection and the poorest function compared to other access types; they should be used only if a primary fistula cannot be maintained.

Dietary changes - Some patients, especially those who receive dialysis in a center, will need to make changes in their diet before and during hemodialysis treatment. These changes ensure that you do not become overloaded with fluid and that you consume the right balance of protein, calories, vitamins, and minerals.

A diet that is low in sodium, potassium, and phosphorus may be recommended, and the amount of fluids (in drinks and foods) may be limited. A dietitian can help you to choose foods that are compatible with hemodialysis treatment.

Side Effects
Most patients tolerate hemodialysis well. However, side effects of hemodialysis can occur. Low blood pressure is the most common complication and can be accompanied by lightheadedness, shortness of breath, abdominal cramps, muscle cramps, nausea, or vomiting.

Treatments and preventive measures are available for the discomforts that can occur during dialysis. Many of these side effects are related to excess salt and fluid accumulation between dialysis treatments, which can be minimized by carefully monitoring how much salt and fluid you consume.

Transplantation
Kidney transplant is not suitable for all patients since you need to be fit enough. Only half of dialysis patients are considered suitable. You will need some tests done to enable us to make a decision as to whether to put you forward for a transplant.

Providing you are found to be suitable, the decision whether to have a kidney transplant is not always an easy one to make.

A transplant kidney can come from a relative, partner or friend or from a donor.

The transplant operation takes around 2 hours. Usually you will be able to sit out of bed the day after a transplant and walk two or three days after that. Most people go home about 10 days after their operation and you will probably need 3 months off work after receiving your transplant.

Nutrition & Diet
Patients with kidney failure must give attention to their Nutrition and Renal Diet. Patients are advised to seek information from their dietician for proper diet. The dietician will provide you with good nutrition guide which is easy to follow. They guide on portions, options, swaps, foods to avoid, drinks to avoid, treats etc.

Summation
Know your kidneys, their normal function through early investigations and prevent kidney disease in stage one itself. Kidney Early Education and Prevention (KEEP) is an internationally accepted module.

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