Why kidneys are vital?The kidney is the most important organ for waste removal from the body. It acts as a filter or purifying system for blood by removing unwanted materials and excess water. It is also the most important organ in maintaining body salt and water balance. In addition, there are specialised cells in the kidney which produce active compounds like renin (important in blood pressure regulation), erythropoietin (required for making of red blood cells which carry oxygen from lungs to each cell) and activate vitamin D (helps in maintaining calcium balance and bone strength).Manifestations of kidney disease would depend on the severity of disease progression. A person can be totally asymptomatic when his kidney is working at half its capacity. Remember that we can donate one kidney and still be living a normal life. But when things get worse, the body gets swollen up due to reduced urine output. Waste materials get accumulated and lead to various discomforts and problems associated with it.Kidney disease explainedAny disease that affects the functioning of the kidney can be termed as kidney disease. Kidney disease can be sub-categorised as:Acute kidney disease - In this condition, damage to the kidney is caused by an acute attack in the form of an infection, toxin etc. It may sometimes be so severe as to require dialysis. Main differentiating feature here is that the damage is not permanent and usually recovers within a period of 6 months. Sometimes acute kidney damage may progress to chronic disease.Chronic kidney disease - In this condition, the damage is usually permanent and could be progressive. It is the commonest type of kidney damage and would gradually lead to dialysis or renal transplant. Diabetes is the commonest cause of chronic kidney disease followed by hypertension.Kidney stones - Here the minerals get crystallised in the kidney and lead to stone formation. Sometimes these crystals come out through urine. It can be very painful.Glomerulonephritis - Glomeruli are filtering units of the kidney. Any inflammation of glomeruli is called glomerulonephritis. Reason for inflammation could vary from infections to toxins to autoimmunity to even congenital abnormalities.Urinary tract infections - These are usually caused by bacteria and affect the bladder and urethra. Unless treated promptly, the infection may ascend up to the kidneys and cause kidney failure.Diabetes and the kidneyThe impact of Diabetes on kidneys is a very slow but irreversible process. This happens through multiple overlapping pathways with high blood sugar being the key initiating factor. Hyperinsulinemia (high insulin secretion), hyperglycaemia (high blood sugar levels) and insulin resistance act in varying intensity in an individual to produce damage.The most important thing to understand here is that it would take approximately 5 years of uncontrolled blood sugar to produce the first change in the kidney in the form of micro excretion of albumin. A person may not have any symptoms at this time and this can only be diagnosed by multiple urine evaluations. It may take another 5 years before the first symptoms of kidney disease to appear. So it is most important to control blood sugar levels at the initial stage itself so that you don't start the downhill ride towards dialysis and kidney transplant.Stages of kidney diseaseKidney failure is a continuous process of deterioration in kidney function. It has been staged based on the assessment of its filtration capacity called the glomerular filtration rate (GFR) and an excess amount of albumin loss (a variant of protein) in urine called albuminuria (Table 1 G 2). This.helps in easy identification and categorisation of a person. For example: if a doctor writes CKD-G3aA2, it would mean that a person has a chronic kidney disease with a GFR between 45 and 59 and albuminuria between 30 and 300 mg/day.Table 1: Stages of Chronic Kidney Disease based on Glomerular Filtration Rate (GFR).CausesBeing one important organ of the body, the kidney can get affected as a part of any illness that affects the body as a whole.There are a lot of conditions that can affect the filtering system of the kidney and cause glomerulonephritis. IgA nephropathy is the commonest among that group.Unsupervised use of high-risk medicines like painkillers is a very common cause of kidney disease. There are also numerous other drugs, heavy metals and toxins which can cause kidney damage. Toxins produced by an infection or an organism directly can attack the kidneys.There are several genetic diseases or birth defects that can affect kidney like polycystic kidney disease. Another important cause for kidney disease is a condition called autoimmunity in which the body's immune mechanism attacks its own cells. Lupus disease is the most important one in this group.ComplicationsSome of the most important complications of kidney disease are:Fluid build-up due to the inability of kidneys to excrete excess water that is present in the body.Inability to excrete unwanted materials leading to their accumulation such as in gout (uric acid accumulation) and hyperkalaemia (potassium accumulation).Bone disease due to defective vitamin D activation and accumulation of phosphorus.Anaemia due to decreased erythropoietin (a hormone produced by the kidneys and is responsible for red blood cell formation) and due to toxin accumulation.Heart disease due to fluid and toxin accumulation.DiagnosisThere are several tests which are used to diagnose kidney disease:• Urinalysis - This, as the name suggests, is analysing abnormalities in urine such as abnormal protein or sugar excretion, presence of infection, presence of mineral crystals that may lead to stone formation like that of calcium and uric acid, presence of red blood cells, white blood cells and abnormal cellular particles called cellular casts.• Assessment of 24-hour urine collection for quantifying the abnormal volume, amount of protein leak and mineral contents.• Blood urea and serum creatinine is the most well-known test of kidney function. These are substances which are to be excreted by kidneys, failure of which leads to an increase in blood level corresponding to the extent of kidney affection.• Structural imaging of kidneys which could vary from X rays, ultrasonogram, CT scan or MRI scan depending on the suspected reason for the problem. Then there are functional imaging studies and tissue biopsy studies which are used only in very selected cases.PreventionAs with any other organ in the body, some diseases happen by chance and we can do nothing to prevent it. But for the vast majority of the remaining conditions, we can prevent the disease from happening by following a healthy lifestyle. Following are a few general tips to have a healthy kidney.• Good control of blood sugar with HbA1c 7 or less• Blood pressure controlled to a value less than 140 systolic and 90 diastolic• Low salt diet• Regular exercise of a minimum of 30 minutes of brisk walking on at least 5 days a week• Maintain a body mass index (BMI) below 23 Kg/m2• Avoid smoking and alcohol• Drink enough water to maintain a healthy urine output.DietDiet for Diabetes is nothing but a balanced diet devoid of simple sugars. It should have enough calories to keep the person within the range of normal weight and should have enough micronutrients and minerals. Some specific modifications to the above diet have to be practised once a person develops kidney disease. Dietary restrictions are not required in the early stage of the disease.• Restrict high potassium-containing food• Restrict your water intake• Further, reduce the salt you eat to less than 2 g per day• In more severe disease you may also have to restrict phosphorus and protein in diet.• Smoking cessation• Lose weight if you are overweightMedicationMedicines for kidney disease depend on the cause. Also, your doctor may take into consideration several other factors while figuring out the best combination of medicines for you. For people with Diabetes and kidney disease, there are some new group of medicines called SGLT2 inhibitors for Diabetes which reduce the risk of progression of kidney disease by 40 per cent in addition to having a benefit on sugar control and heart. These provide an additional benefit to the already existing drugs for blood pressure and heart. DPP 4 Inhibitor group of drugs also have been shown to reduce protein leak in the kidney in addition to their anti-diabetic effect.To concludePhysical exercise and staying fit is mandatory for everybody, whether you have any disease or not. It would be good to consult your physician and physiotherapist before you start on a new exercise regime. But, in general, a minimum of 30 minutes work out for at least 5 days a week should be on your agenda. Apart from that, regular health check-ups and assessment of health parameters would help identify any changes in the health and receive care in time.
Why kidneys are vital?The kidney is the most important organ for waste removal from the body. It acts as a filter or purifying system for blood by removing unwanted materials and excess water. It is also the most important organ in maintaining body salt and water balance. In addition, there are specialised cells in the kidney which produce active compounds like renin (important in blood pressure regulation), erythropoietin (required for making of red blood cells which carry oxygen from lungs to each cell) and activate vitamin D (helps in maintaining calcium balance and bone strength).Manifestations of kidney disease would depend on the severity of disease progression. A person can be totally asymptomatic when his kidney is working at half its capacity. Remember that we can donate one kidney and still be living a normal life. But when things get worse, the body gets swollen up due to reduced urine output. Waste materials get accumulated and lead to various discomforts and problems associated with it.Kidney disease explainedAny disease that affects the functioning of the kidney can be termed as kidney disease. Kidney disease can be sub-categorised as:Acute kidney disease - In this condition, damage to the kidney is caused by an acute attack in the form of an infection, toxin etc. It may sometimes be so severe as to require dialysis. Main differentiating feature here is that the damage is not permanent and usually recovers within a period of 6 months. Sometimes acute kidney damage may progress to chronic disease.Chronic kidney disease - In this condition, the damage is usually permanent and could be progressive. It is the commonest type of kidney damage and would gradually lead to dialysis or renal transplant. Diabetes is the commonest cause of chronic kidney disease followed by hypertension.Kidney stones - Here the minerals get crystallised in the kidney and lead to stone formation. Sometimes these crystals come out through urine. It can be very painful.Glomerulonephritis - Glomeruli are filtering units of the kidney. Any inflammation of glomeruli is called glomerulonephritis. Reason for inflammation could vary from infections to toxins to autoimmunity to even congenital abnormalities.Urinary tract infections - These are usually caused by bacteria and affect the bladder and urethra. Unless treated promptly, the infection may ascend up to the kidneys and cause kidney failure.Diabetes and the kidneyThe impact of Diabetes on kidneys is a very slow but irreversible process. This happens through multiple overlapping pathways with high blood sugar being the key initiating factor. Hyperinsulinemia (high insulin secretion), hyperglycaemia (high blood sugar levels) and insulin resistance act in varying intensity in an individual to produce damage.The most important thing to understand here is that it would take approximately 5 years of uncontrolled blood sugar to produce the first change in the kidney in the form of micro excretion of albumin. A person may not have any symptoms at this time and this can only be diagnosed by multiple urine evaluations. It may take another 5 years before the first symptoms of kidney disease to appear. So it is most important to control blood sugar levels at the initial stage itself so that you don't start the downhill ride towards dialysis and kidney transplant.Stages of kidney diseaseKidney failure is a continuous process of deterioration in kidney function. It has been staged based on the assessment of its filtration capacity called the glomerular filtration rate (GFR) and an excess amount of albumin loss (a variant of protein) in urine called albuminuria (Table 1 G 2). This.helps in easy identification and categorisation of a person. For example: if a doctor writes CKD-G3aA2, it would mean that a person has a chronic kidney disease with a GFR between 45 and 59 and albuminuria between 30 and 300 mg/day.Table 1: Stages of Chronic Kidney Disease based on Glomerular Filtration Rate (GFR).CausesBeing one important organ of the body, the kidney can get affected as a part of any illness that affects the body as a whole.There are a lot of conditions that can affect the filtering system of the kidney and cause glomerulonephritis. IgA nephropathy is the commonest among that group.Unsupervised use of high-risk medicines like painkillers is a very common cause of kidney disease. There are also numerous other drugs, heavy metals and toxins which can cause kidney damage. Toxins produced by an infection or an organism directly can attack the kidneys.There are several genetic diseases or birth defects that can affect kidney like polycystic kidney disease. Another important cause for kidney disease is a condition called autoimmunity in which the body's immune mechanism attacks its own cells. Lupus disease is the most important one in this group.ComplicationsSome of the most important complications of kidney disease are:Fluid build-up due to the inability of kidneys to excrete excess water that is present in the body.Inability to excrete unwanted materials leading to their accumulation such as in gout (uric acid accumulation) and hyperkalaemia (potassium accumulation).Bone disease due to defective vitamin D activation and accumulation of phosphorus.Anaemia due to decreased erythropoietin (a hormone produced by the kidneys and is responsible for red blood cell formation) and due to toxin accumulation.Heart disease due to fluid and toxin accumulation.DiagnosisThere are several tests which are used to diagnose kidney disease:• Urinalysis - This, as the name suggests, is analysing abnormalities in urine such as abnormal protein or sugar excretion, presence of infection, presence of mineral crystals that may lead to stone formation like that of calcium and uric acid, presence of red blood cells, white blood cells and abnormal cellular particles called cellular casts.• Assessment of 24-hour urine collection for quantifying the abnormal volume, amount of protein leak and mineral contents.• Blood urea and serum creatinine is the most well-known test of kidney function. These are substances which are to be excreted by kidneys, failure of which leads to an increase in blood level corresponding to the extent of kidney affection.• Structural imaging of kidneys which could vary from X rays, ultrasonogram, CT scan or MRI scan depending on the suspected reason for the problem. Then there are functional imaging studies and tissue biopsy studies which are used only in very selected cases.PreventionAs with any other organ in the body, some diseases happen by chance and we can do nothing to prevent it. But for the vast majority of the remaining conditions, we can prevent the disease from happening by following a healthy lifestyle. Following are a few general tips to have a healthy kidney.• Good control of blood sugar with HbA1c 7 or less• Blood pressure controlled to a value less than 140 systolic and 90 diastolic• Low salt diet• Regular exercise of a minimum of 30 minutes of brisk walking on at least 5 days a week• Maintain a body mass index (BMI) below 23 Kg/m2• Avoid smoking and alcohol• Drink enough water to maintain a healthy urine output.DietDiet for Diabetes is nothing but a balanced diet devoid of simple sugars. It should have enough calories to keep the person within the range of normal weight and should have enough micronutrients and minerals. Some specific modifications to the above diet have to be practised once a person develops kidney disease. Dietary restrictions are not required in the early stage of the disease.• Restrict high potassium-containing food• Restrict your water intake• Further, reduce the salt you eat to less than 2 g per day• In more severe disease you may also have to restrict phosphorus and protein in diet.• Smoking cessation• Lose weight if you are overweightMedicationMedicines for kidney disease depend on the cause. Also, your doctor may take into consideration several other factors while figuring out the best combination of medicines for you. For people with Diabetes and kidney disease, there are some new group of medicines called SGLT2 inhibitors for Diabetes which reduce the risk of progression of kidney disease by 40 per cent in addition to having a benefit on sugar control and heart. These provide an additional benefit to the already existing drugs for blood pressure and heart. DPP 4 Inhibitor group of drugs also have been shown to reduce protein leak in the kidney in addition to their anti-diabetic effect.To concludePhysical exercise and staying fit is mandatory for everybody, whether you have any disease or not. It would be good to consult your physician and physiotherapist before you start on a new exercise regime. But, in general, a minimum of 30 minutes work out for at least 5 days a week should be on your agenda. Apart from that, regular health check-ups and assessment of health parameters would help identify any changes in the health and receive care in time.
