World Kidney Day : March 8, 2012

“Professor-garu!  What you said in KGH in our third year clinical-rounds is still ringing vividly in my ears: ‘If a patient complains about itching in the fingers, particularly between the fingers, with no accompanying visible symptoms, your hand should immediately reach out for the kidneys.’ How is it, of all the people, you failed to diagnose the breakdown of the functioning of your son’s kidney, that too, when he complained about an itching sensation continuously for a day or two” was what the former student-turned-physician working in the US said unwittingly to his former Professor of Medicine, AMC, Visakhapatnam—whom he visited, when he had come on a vacation, to express his reverence for all the clinical knowledge that he had imparted him— sharing his grief at the sudden loss of the professor’s doctor-son who breathed his last on his way to Chennai for medical aid. Fighting back his tears and holding his hands, the Professor summoned enough energy to mutter: “Perumalu-garu … meekinka avanee gurthunaayaa—you still remember all those lectures … you are such a good student, naakandaru inkolaa chepparu—but I was misled … it’s all quirk of fate … by the time it struck to my mind, it was too late.”

True! Such could be the acuteness of some of the kidney diseases: damage could be so sudden. Symptoms reveal themselves very quickly; but if managed in time, the kidney can regain its normal functioning in many cases. If it goes unnoticed, like in the case of the Professor’s son, it could be fatal, for kidneys perform three critical functions: one, they remove waste products—toxins—from the body; two, they regulate the levels of electrolytes, minerals, and fluid in the body; and three, they release hormones that regulate blood pressure, production of red blood cells and bone metabolism.     

Some kidney diseases are chronic: the decline in the functioning of the kidney is slow and progressive. Unfortunately, in such chronic cases, many a time, symptoms go unnoticed till very late. The most common causes for chronic kidney diseases are: diabetes—the inability of the body to use glucose increases its level in blood that acts as a poison, damaging the nephrons in kidney which filter wastes from the blood; high blood pressure that damages the small blood vessels in the kidneys, which in turn affects their filtering capacity; autoimmune system turning against one’s own kidneys; and damage owing to ingested toxins or drugs, infections causes glomerular diseases, i.e. damage to the tiny blood vessels in the kidneys, leading to excess protein in urine (proteinuria) or blood in urine (hematuria). Even a minor degree of chronic kidney disease makes one vulnerable to heart attacks, stroke and death. If they go untreated for long, kidney function worsens, necessitating dialysis or kidney transplantation, which in medical parlance is known as ‘end stage kidney disease’.         

Some could be inherited and congenital. One such genetic disorder is Polycystic Kidney Disease (PKD) in which many cysts grow in kidneys. In course of time, they replace the very mass of kidneys—nephrons that filter the blood—reducing the filtering capacity, ultimately leading to kidney failure. Some rare forms of kidney diseases—autosomal recessive PKD—may occur when the child is still in the womb. Some of theses diseases in children may throw up symptoms such as slow growth, frequent vomiting, and pain in the back or side, while some remain silent for quite long. Nevertheless, high blood pressure or low number of red blood cells must alert a doctor about a child’s kidney problem. There are some hereditary kidney diseases—adult PKD—that cannot be detected till the child becomes adult. However, the advances in radiology have made their identification possible today, but the question is what will trigger such a test.    

Fortunately, kidney disease can be detected quite early by simple blood and urine tests that cost nothing vis-à-vis today’s many medical tests. It is good for all those—i.e., people with diabetes, high blood pressure and with family history of kidney disease—who are vulnerable to kidney disease to undergo such tests at regular intervals in consultation with a doctor. In any case, a patient of Type I diabetes should get his kidney checked every year, starting five years after being diagnosed for diabetes, while Type II patients should get it done every year. 

As the Chronic Kidney Disease (CKD) is a slow and progressive loss of kidney function over a long period, its symptoms are elusive (non-specific). Which is why it makes sense to be on the lookout for symptoms: general illness, reduced appetite, swelling of legs, puffiness around eyes, fatigue and weakness, high blood pressure, nausea and vomiting, shortness of breath, headaches, numbness in feet or hands, disturbed sleep, altered mental alertness, bleeding, bone pain and fractures, etc.

It is important that CKD patients observe proper nutrition, preferably under the guidance of a registered dietitian. Limiting fluids, eating a low-protein diet, restricting salt, potassium, phosphorous, and other electrolytes are suggested. At the same time, the patient must ensure intake of food that gives enough calories to put up with the usually accompanying loss of weight.  

Doctors usually classify CKD into five stages. Stage I is the mild stage, while Stage V refers to its most severe condition. This ultimately leads to end-stage renal disease (ESRD)—the stage in which the kidneys almost stop functioning. That is when a patient needs dialysis or kidney transplantation. 

Dialysis is of two types: one, haemodialysis—a special filter named dialyser functions as an artificial kidney to clean a patient’s blood; and two, peritoneal dialysis—dialysis solution is induced into the patient’s abdomen which then captures the waste from the person’s blood, and after a few hours, upon its saturation with waste, drains out through a catheter. To continue the cleansing process, fresh fluid is dripped into the abdomen. This can be undertaken by the patients themselves, while haemodialysis is usually performed at a dialysis center. 

The best renal replacement therapy is, of course, kidney transplantation. For, it offers a near normal, longer life, besides being cheap. The kidney can come from a living relative of a patient or from an anonymous donor died recently. But it must be a good match for the patient’s body, and that’s where a living relative’s kidney comes handy. Medical research indicates that kidney donation has little effect on the donor’s health. However, the decision to donate a kidney is purely personal, and it turns out to be the best when the donor feels satisfied of his act. World medical fraternity, therefore, advocates educating people about “the life-saving importance of both living and deceased kidney donation”.

Let us do it.

Imageas courtesy: healthmediconline.com/.../2011/04/kidney.jpg;

                             yobananas.com;

                             en.wikipedia.org

KEY words: Renal failure, World Kidney day,  Dialysis