World Kidney Day is on March 11. To mark the occasion, Dr Sunil Prakash explains chronic kidney diseases and how one can prevent or treat them
Millions of Indians are affected by Chronic Kidney Diseases (CKD). Various epidemiological studies suggest prevalence of CKD to be around eight to 10 per cent. Multiply this with our population and age is no bar! Though prevalent among the elderly, younger patients are also known to have progressive loss of kidney function. CKD is associated with an increased risk of cardiovascular disease and end-stage renal disease (ESRD).
The various causes of CKD can range from strong medication, Diabetes, obesity, agricultural food chain pollution, water treatment pollution, to dehydration and kidney impact among others. Diabetes Mellitusis the leading cause of CKD. Of every 100 diabetics, nearly 40 land up with CKD. Diabesityis a coinage to emphasise the havoc created by marriage of diabetes with obesity. One plus one becomes eleven here. Of those with high uncontrolled blood pressure, one in five will have CKD. Glomerulonephritis, which is inflammatory condition of kidneys as well as chronic shrinking of kidneys called chronic interstitial nephritis are again factors that can cause CKD. Young people working in farms have a special proclivity. Indiscriminate usage of agricultural pesticidesand fertilisers along with heat dehydration can cause irreversible CKD, robbing the nation of its young working force.
Obstruction to urine flow due to kidney stones, enlarged prostate and gynaecological problems can also be major causes. Congenital causes like polycystic kidneys, reflux of urine and many other diseases target children right from the mother's womb or at birth causing young people to get CKD.
Kidneys filter waste products from the blood. All the nitrogenous end products, sulfuric acid, phosphaturic acid and innumerable organic wastes which are inimical to good health are excreted by our indefatigable friends. Milieu Intérieur, the internal environment of the body, a perquisite to good health is the prime responsibility of kidneys as they regulate blood pressure, enable new blood formation in bone marrow by producing the hormone erythropoietin, maintaining fluid and electrolyte balance and by forming active vitamin D, kidneys keep our strong bones in good humour!
Recognising early kidney damage is imperative and there are many early symptoms that can be a giveaway to kidney health. Paradoxically passing more urine specially at night is a classic symptom. Frothing in the urine, high BP especially in young people, unexplained anemia, muscle aches and bone pains, swelling over feet or face (how so ever slight and transient) and the inability to have a baby are all symptoms to watch out for.
Knowing how to prevent or manage the wellness of our kidneys is equally important. One should keep in mind the seven sins of this disease and keep the following in check — sugar, salt, stress, smoking, sedentary lifestyle, spirits i.e., alcohol and sleep (the lack of it). CKD is associated with an increased risk of cardiovascular diseases like heart attacks and heart failure. Many a times the “seed of disease is in kidneys and the fruits of illness is borne by our heart”. Invest a small sum of money and a little time in your health to reap bumper dividends of good health. Regular BP and blood sugar monitoring at home should be done religiously.
Periodic health checks detect asymptomatic early kidney disease which are amenable to correction. High risk patients above 50 years of age, people with Diabetes or high BP and patients having a family history of kidney diseases, stones and cystic diseases should all opt for periodic health checks. Every person should have a health insurance from first day of their earnings, whether personal or employer supported and people below poverty line should have coverage by schemes like Ayushman Bharat, ESI etc.
Are kidney diseases on the rise? The answer is an unequivocal yes. Ironically early CKD (stage 1 to 4) has no symptoms. Typically, it is not until stages 4-5 where there is severe reduction in Glomerular filtration and kidney functions that water, electrolyte and acids accumulate and cause flooding of lungs leading to cardio respiratory failure.
Dialysis is a process by which a person is hooked up to a dialysis machine which filters out all toxins and acidic wastes from the blood thus reestablishing milieu interior, albeit only for a few days. So, a person will need a four-hour session of dialysis every two to three times a week.
If prepared in advance, dialysis is a seamless and painless procedure which can lend many years of useful life. Getting a small surgery called AV fistula done well in time can enable a safe and a high-quality dialysis. We have patients living well for more than 15 years on dialysis. In fact, dialysis is a lifesaving and life prolonging procedure. Bluntly put, it boils down to ‘either dialysis or death’.
Nearly every person has two healthy kidneys. In the event of someone landing in End-Stage Renal Disease (ESRD), changing one kidney with a healthy kidney from a relative will enable complete recuperation of the patient. The transplanted patient can lead a normal life with some regular medications and checks. The donor also leads a full and fulfilling life capped with the ultimate altruistic deed.
If suffering from CKD, do ask your healthcare specialist about the other relevant advice for ESRD and how to manage medications and routine exercises to stay healthy. A quick visit to the dietician to get tips on managing good nutrition, food suited for the body, and to prevent thirst will go a long way in living well with kidney diseases. Given that kidney diseases are an epidemic,it is important to maintain a positive attitude with self-help and from the family. The treatment of kidney disease is not just medical, but it is about comprehending your life on a daily basis and understanding the choices you can make based on your condition and available therapeutic modalities.
The writer is Senior Director & HOD, Nephrology & Renal Transplantation, BLK Super Speciality Hospital