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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.

  1. 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.

  1. Keep physically fit and active

Keeping fit also helps to reduce blood pressure and there- fore reduces the risk of Chronic Kidney Disease.

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.

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