An unhealthy kidney means a host of ailments. Sudha Umashanker seeks advice from experts on World Kidney Day

Though the kidneys aren't talked about as much as the heart or some of the other organs, they have a far more critical role to play than we can imagine, in numerous body functions. Ask the experts.

Dr. Sunil Shroff, Managing Trustee, MOHAN Foundation, and Professor and Head of the Department of Urology and Renal Transplantation, Sri Ramachandra Medical College and Research Institute, Chennai, says: “The kidney is a vital organ that plays a major role in keeping a person healthy. Putting it simply, the kidneys eliminate waste and excess fluids that we consume in the form of food and liquids. If they do not function, the toxic elements lead to dysfunction of the heart and lungs, fluid accumulation and breathing problems. Usually, there are two kidneys in each of us. They are bean shaped, weigh about 150 gm and are 12cm x 5cm in size. They are located in the middle of the back just below the rib cage. Each kidney is made up of small complex units called nephrons. A nephron can individually produce urine, working continuously to keep the blood clean. Normally 200 litres of water are filtered through the kidney every day but only two-three litres are passed as urine containing the waste and acids. The kidneys eliminate what is not needed, and retain certain substances required by the body in a highly selective manner. In addition, they stimulate the body to produce red blood cells, regulate blood pressure, keep bones healthy by converting inactive Vitamin D into its active form and maintain the water and pH (acidity/alkalinity) balance of the body.”

Formation of RBCs

Elaborating on the complex connection between the kidneys and the production of red blood cells, blood pressure and healthy bones, Dr. Georgi Abraham, Professor of Medicine and Nephrology, Pondicherry Institute of Medical Sciences, says: “The kidneys produce a hormone called Erythropoietin which promotes formation of red blood cells by the bone marrow. When a person has kidney failure, the kidney does not produce Erythropoietin without which the bones cannot produce RBCs and the person becomes anaemic. Secondly, as one gets older especially after the age of 40, one has to reduce salt intake so that the BP stays within limits. The kidneys cannot take excess salt and if a person takes more salt, more water is retained and the body fluid level and BP are likely to go up. The third interesting connection is the role of the kidneys in healthy bones. The kidneys handle a complex combination of calcium, phosphorus, Vitamin D and parathyroid hormones which makes the bones healthy. When there is kidney failure there is derangement in this balanced mechanism and the bones become fragile.”

The common causes

So what are the common causes for kidney related problems?

High on the list are diabetes and hypertension (high blood pressure).

Says Dr. Georgi Abraham, “Uncontrolled high BP can lead to kidney damage and what's worse is people with high BP often have no symptoms at all. Secondly, with diabetes so highly prevalent in our country and again symptoms not being obvious, many patients come with diabetic kidney disease wherein diabetes has already affected the kidney and progressive failure has occurred.”

Adds Dr. Sunil Shroff, “The other causes of kidney disease are infection and inflammation. A major cause of infection is the E. coli (bacteria found in the digestive tract) which finds its way into the urinary tract of women, especially those with diabetes, and the infection ascends upwards. Children and elderly people who have blockages of the urinary tract are also susceptible. Many auto immune disorders and viral infections can also cause inflammation besides other unknown causes. Kidney stones could also be responsible for kidney disorders.”

Stressing on the need to prevent kidney disease, Dr Georgi says, “Once a scar forms in a kidney due to an infection, inflammation, high BP or diabetes, it can never be reversed; it slowly progresses.”

What is truly amazing about the kidneys is evident from a popular saying “one to care and one to share”. As Dr. Sunil Shroff says, “You can function normally with one kidney — there are about 2 million people who have donated a kidney in the last 40 years (you can well imagine the incidence of kidney disease then) and who have had a normal span of life close to 20 years post-donation.”

But usually when kidneys become diseased, both are affected. Unless it is a tumour or block or stone that is specific to one kidney affecting its effective functioning. And when lifestyle diseases take their toll, the results can be catastrophic for those left with one kidney.

Warning signs

* Tiring easily

* Swelling and puffiness of face or feet and lower legs due to water retention (especially if you are young and not on medication)

* High blood pressure

* Anaemia

* Passing less urine

* Nausea / Loss of appetite

* Itching of the skin

* Headaches

* Mild breathing difficulties

Preventive steps

* Have your blood pressure checked regularly.

* Periodic creatinine level check (this is a key indicator of how optimally the kidneys are functioning)

* Undergo a complete urine and blood examination at a reliable lab in consultation with your family physician. Onset of diabetes and other signs of potential problems can be picked up early.

* Exercise regularly to prevent overweight and lifestyle diseases.

* Avoid junk foods, frozen foods, pickles, papads and other snacks high in salt.

* If you have pickles daily bring it down to thrice a week.

* Start preventive checks early if there is a family history of kidney disease.

*Drink plenty of water — if you happen to be working outdoors

consume a little more.

* Most calcium stones can be reduced by restricting salt in the diet. (Salt makes more calcium pass through the urine).

* Women are advised to wash their private parts from front to back. Or else the E. coli from the intestine can get into the urethra.