Are your kidneys up to the mark?
By Dr Bilal Jamil (Medical Director)
T HE other day, a couple walked in to my clinic quite worried. What had happened to them was not evenin their wild dreams. About a week ago, they had mentioned, very vague, according to them ‘insigniﬁcant’ complaints to their neighbor, an ultrasound specialist. To oblige, the doctor called them to his clinic. Both the husband and the wife had an ultra- sound to ﬁnd out that the lady had fairly advanced kidney failure. Initially, in a state of denial, they went to various laboratories repeating the same blood test, to make sure there was no error. Once the reality sunk in them, they came to me for advice. On speciﬁc inquiry, the lady admit- ted having high blood pressure for over a decade, which she never took seriously.
I come across such painful stories every other day. It is disturbing that even the educated in this metropolitan are suffering because of lack of awareness about what high blood pressure, diabetes and obesity can do to someone.
I hope the following basic information about chronic kid- ney disease stimulates the readers to seek more knowledge about it, and more importantly about healthy lifestyle – a simple way to avoid many diseases altogether. As a medical practitioner, I hope, one day our main responsibility in clin- ical practice shifts from treating diseases and their complications to preventing them.
What is Chronic Kidney Disease (CKD)?
Chronic kidney disease (CKD) is a gradual and progressive loss of kidney function over months to years. When kid- ney function falls below a certain level, we call it kidney failure. It is estimated that in the West, 8 – 10 per cent of the adult population have some form of kidney damage. CKD is preventable, but once one gets it, it does not go away. If detected timely, the treatment is more effective and the progression of the disease can be slowed down.
The symptoms and signs of CKD are usually non-speciﬁc and vague, especially in the early course of the disease. One must not assume that if there are no symptoms there is nothing wrong.
Causes of CKD
Hypertension or high blood pressure and diabetes mellitus are the most common causes of CKD. High blood pres- sure causes about a quarter of all cases of kidney failure. Similarly diabetes causes around one-third of all cases. Both these diseases are responsible for kidney failure in 65 — 70 per cent patients requiring haemodialysis.
Other less common conditions include inﬂammation and infections of the kidneys, an inherited disease called poly- cystic kidney disease, longstanding blockage to the urinary system because of kidney stones or an enlarged prostate. CKD from the later two diseases is preventable. Drugs espe- cially some pain-killers (analgesics) if taken excessively for a long time can also cause CKD.
Who is at risk?
People with diabetes mellitus; those suffering from, high blood pressure, or any disease known to effect kidneys, those who have had acute kidney injury in the past or have a family member suffering from CKD are at high risk of developing it. Similarly people over 50 years of age and those taking painkillers frequently are also at high risk. These patients must have their kidney function checked by a kidney doctor.
How is kidney function checked?
Physical examination along with a simple blood and urine examination can diagnose CKD. Kidney function is checked by estimating the level of creatinine in the blood. Creatinine is a waste product produced by the muscles and excreted by the kidneys. Similarly presence of proteins or blood in the urine is an indicator of kidney damage.
Depending on these two results and other diseases which someone might have a doctor may advise some more labora- tory or ultrasound test.
Consequences of CKD
As the kidney function deteriorates the person becomes sick, loses weight, feels lethargic and weak, and may develop pufﬁness around the eyes and swelling around the ankles. His hemoglobin decreases, bones become weak and brittle. Eventually reaches a stage when kidney function has to be replaced either by dialysis or by giving him a kid- ney from a healthy living or a deceased donor. CKD can even cause heart attack and stroke.
The main consequence of CKD is end-stage kidney failure requiring dialysis or a kidney transplant. It also increases the risk of heart attack and stroke and may lead to premature death. It may sound strange, but it is a matter of fact that apparently healthy individuals with CKD have an increased risk of dying prematurely from heart attack or a stroke even before developing kidney failure.
How to prevent chronic kidney disease (CKD)
There are several easy ways to reduce the risk of develop- ing CKD.
- Eat healthy
Eat right; avoid excess sugars, fats and calories. Keep weight in check. Monitor Body Mass Index (BMI) and waist circumference. Obesity is a risk factor for diabetes, high blood pressure and several other diseases.
- Keep physically ﬁt and active
Keeping ﬁt also helps to reduce blood pressure and there- fore reduces the risk of Chronic Kidney Disease.
- Reduce salt intake
The recommended intake of salt (sodium chloride) is 5-6 grams per day i.e. about a teaspoon. In order to reduce salt intake, one should limit the amount of processed food and should not add salt after cooking i.e. on the table. A simple way on cutting down on salt is to use fresh ingredients for cooking.
- Maintain a healthy ﬂuid intake
Although not proven scientiﬁcally, it is suggested that one should drink 1.5 to 2 litres (6-8 glasses) of water per day. This requirement may vary depending on physical activity, daily routine, nature of work, and the weather. Impulsively drinking lot of water with a view that it is beneﬁcial for the kidneys is not right. It may be ,in fact, harmful. Those with kidney, heart or liver disease must ask their doctor for advice.
- Keep blood sugar level under control
People with poorly controlled diabetes mellitus are at a higher risk of CKD and other complications of diabetes. About one-third of people who have diabetes develop kid- ney damage, so it is important for people with diabetes to have regular tests to check their kidney functions. Kidney damage from diabetes can be reduced or prevented if detected timely.
- Monitor blood pressure
The normal blood pressure level is 120/80 mm of Hg. Between this level and 139/89 mm of Hg is pre-hyperten- sion. At this stage one should make changes in his lifestyle and diet.
A blood pressure of 140/90 mm of Hg and above must be taken seriously and a doctor must be consulted for advice. One must keep in mind that there is no permanent cure for high blood pressure therefore; treatment once initiated, has to continue long-term. High blood pressure is especially likely to cause kidney damage in the presence of other diseases like diabetes, heart disease and high blood lipids.
- Never smoke
Smoking slows the ﬂow of blood. When less blood reaches the kidneys, they cannot function properly. Smoking also increases the risk of kidney cancer by about 50 per cent.
- Avoid over-the-counter pills
Painkillers especially non-steroidal anti-inﬂammatory drugs, if taken long term, can cause CKD. In case of chronic pain, like pain of arthritis or backache a doctor should be consulted.