KIDNEY DISEASE: World Kidney Day 2022 – “Kidney Health for All”

Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

The kidneys are a pair of fist-sized organs located at the bottom of the rib cage. There is one kidney on each side of the spine. Kidneys are essential to having a healthy body. They are mainly responsible for filtering waste products, excess water, and other impurities out of the blood. These toxins are stored in the bladder, and then removed during urination.
The kidneys also regulate pH, salt, and potassium levels in the body. They produce hormones that regulate blood pressure and control the production of red blood cells. The kidneys even activate a form of vitamin D, which helps the body absorb calcium.
Kidney disease occurs when the kidneys become damaged and can’t perform their function. Damage may be caused by diabetes, high blood pressure, and various other chronic (long-term) conditions. Kidney disease can lead to other health problems, including weak bones, nerve damage, and malnutrition.
If the disease gets worse, over time, the kidneys may stop working completely. This means that dialysis would be required to perform the function of the kidneys.
Dialysis is a treatment that filters and purifies the blood using a machine. It can’t cure kidney disease, but it can prolong life.

TYPES AND CAUSES OF KIDNEY DISEASES

* Chronic kidney disease
The most common form of kidney disease is chronic kidney disease. Chronic kidney disease is a long-term condition. It’s commonly caused by high blood pressure, because it can increase the pressure on the glomeruli. Over time, the increased pressure damages these vessels, and kidney function begins to decline.
Kidney function would eventually deteriorate to the point at which the kidneys can no longer perform their job properly. In that case, a person would need to go on dialysis. A kidney transplant may be another treatment option, depending on the circumstances.
Diabetes is another major cause of chronic kidney disease. The increased level of sugar in the blood damages the blood vessels in the kidneys over time. This means the kidneys can’t clean the blood properly. Kidney failure can occur when the body becomes overloaded with toxins.

* Kidney stones
Kidney stones are another common kidney problem. They occur when minerals and other substances in the blood crystallise in the kidneys, forming solid masses (stones). Kidney stones usually come out of the body during urination. Passing kidney stones can be extremely painful, but they rarely cause significant problems.

* Glomerulonephritis
Glomerulonephritis is an inflammation of the glomeruli. Glomeruli are extremely small structures situated inside the kidneys; they filter the blood. Glomerulonephritis can be caused by infections, drugs, or congenital abnormalities (disorders that occur during or shortly after birth). It often gets better on its own.

* Polycystic kidney disease
Polycystic kidney disease is a genetic disorder that causes numerous cysts (small sacs of fluid) to grow in the kidneys. These cysts can interfere with kidney function, and cause kidney failure. (It’s important to note that individual kidney cysts are fairly common and are almost always harmless. Polycystic kidney disease is a separate, more serious condition.)

* Urinary tract infections
Urinary tract Infections (UTIs) are bacterial infections of any part of the urinary system. Infections in the bladder and urethra are the most common. They are easily treatable, and rarely lead to more health problems. However, if left untreated, these infections can spread to the kidneys and cause kidney failure.

RISK FACTORS FOR DEVELOPING KIDNEY DISEASE
People with diabetes have a higher risk of developing kidney disease. Diabetes is the leading cause of kidney disease, accounting for about 44 percent of new cases. Other risk factors of kidney disease include:
* Have high blood pressure
* Have other family members with chronic kidney disease
* Elderly
* African, Hispanic, Asian, or American Indian descent

SYMPTOMS OF KIDNEY DISEASE
Kidney disease is a condition that can easily go unnoticed, until the symptoms become severe. The following symptoms are early warning signs that you might be developing kidney disease:
* Fatigue
* Difficulty concentrating
* Trouble sleeping
* Poor appetite
* Muscle cramping
* Swollen feet/ankles
* Puffiness around the eyes in the morning
* Dry, scaly skin
* Frequent urination, especially late at night.

Severe symptoms that could mean the kidney disease is progressing into kidney failure include:
* Nausea
* Vomiting
* Loss of appetite
* Changes in urine output
* Fluid retention
* Anaemia (a decrease in red blood cells)
* Decreased sex drive
* Sudden rise in potassium levels (hyperkalemia)
* Inflammation of the pericardium (a fluid-filled sac that covers the heart)

DIAGNOSIS
The diagnosis is based on a person’s clinical history and on physical exams. Additionally, some tests may be ordered, including:
* Glomerular filtration rate (GFR)
This test will measure how well the kidneys are working, and determine the stage of kidney disease.

* Ultrasound or computed tomography (CT) Scan
Ultrasounds and CT scans produce clear images of the kidneys and urinary tract. The pictures allow the doctor to see if the kidneys are too small or large. They can also show any tumours or structural problems that may be present.

<* Kidney biopsy>
During a kidney biopsy, a small piece of tissue from the kidney is removed while the patient is sedated. The tissue sample can help to determine the type of kidney disease a person has, and how much damage has occurred.

* Urine test
A urine sample is requested to test for albumin. Albumin is a protein that can be passed into the urine when the kidneys are damaged.

* Blood creatinine test
Creatinine is a waste product. It’s released into the blood when creatinine (a molecule stored in muscle) is broken down. The levels of creatinine in the blood would increase if the kidneys aren’t working properly.

TREATMENT
Treatment for kidney disease usually focuses on controlling the underlying causes of the disease. This means the health care workers would help to better manage the blood pressure, blood sugar, and cholesterol levels. They may use one or more of the following methods to treat kidney disease.
* Drugs and medication
* Dietary and lifestyle changes
* Dialysis

OUTLOOK
Kidney disease normally does not go away once it’s diagnosed. The best way to maintain kidney health is to adopt a healthy lifestyle, and follow the doctor’s advice. Kidney disease can get worse over time. It may even lead to kidney failure, which can be life-threatening if left untreated.

<<PREVENTION>>
Some risk factors for kidney disease — such as age, race, or family history — are impossible to control. However, there are measures you can take to help prevent kidney disease:
* Drinking enough water
* Control blood sugar if you have diabetes
* Control blood pressure
* Reduce salt intake
* Quit smoking

To keep kidney problems under control, it is very important to exercise daily and keep the bodyweight under control. At the same time, consuming 8 to 10 glasses of water daily keeps the kidneys healthy. More use of fruits and green vegetables in the diet proves beneficial for the kidneys.