Nephrology deals with diseases affecting the kidneys and the urinary system. Kidneys are a pair of organs situated in the lumbar area on either side of the vertebral column. 1 in 1000 people in the general population may be born with only one kidney.
The main functions of the kidneys are
1. Excretion of waste products like urea and creatinine from the body
2. Correction of acid- base balance in the body
3. Promote the formation of red blood corpuscles in the blood by secreting a hormone called erythropoeitin
4. Regulation of calcium and phosphorus levels as well as activating vitamin D
5. Regulation of water balance Kidney failure may be reversible or irreversible
Common causes of chronic kidney disease are diabetes mellitus and hypertension.
Diabetes mellitus commonly causes a condition called diabetic nephropathy, but people with diabetes can also have renal failure due to :
1. Urinary tract infections
2. Other infections eg;- respiratory tract, skin etc
3. Glomerulonephritis usually secondary to skin infections
4. Block in the renal artery or vein
5. Medicines causing damage to the kidneys
6. Contrast material used in CT scans or angiography
7. Uncontrolled diabetes and hypertension
This is commonly seen in patients who have been diabetic for more than 5 years, though nephropathy may be present in upto 30 percent patients at the time of diagnosis of diabetes.
The common symptoms are generalized swelling of the body, especially around the face and more on waking up in the morning. Patients may also have decrease in urine volume, breathlessness especially on exertion and on lying down, trotting of urine, visual disturbances and numbness of the legs
More advanced disease may lead to nausea, vomiting, decreased appetite, abdominal distension and bloating and almost absent urine output, with severe breathlessness
Treatment and preventive measures
Presence of microalbumin in urine is the earliest detectable abnormality in diabetic nephropathy. Initiation of treatment at this stage can prevent progression of the disease in more than half of the patients.
Therefore a urine microalbumin test should be done at the time of diagnosis of diabetes, and if negative, should be repeated yearly.
In the next stage, there will be protein in urine on routine testing along with steady and progressive worsening of kidney function
Prevention is by adequate diabetic control FROM THE FIRST DAY
People at risk for diabetes should get a periodic check up done to rule out the onset of diabetes
Management of chronic kidney disease
This involves the regular use of medications and adherence to a strict dietary regime.
Patients who have swelling of the body should restrict their fluid intake to about 800 ml/ day.
People should also generally avoid food with high potassium content like fruits, raw vegetables, tender coconut water, citrus fruits etc
The use of animal protein should be restricted and use of soya protein may be increased.
The intake of food with high phosphorus like cow's milk should be restricted to 1 glass/ day
Along with dietary restrictions, regular medications and periodic follow up with a nephrologist are a must
What is plasmapheresis?
Plasmapheresis is a treatment in which patients who have abnormal antibodies in the blood are treated by removal of plasma and inducing fresh frozen plasma , single donor plasma or albumin instead.
This is used in diseases like Guillain Barre syndrome, Goodpasture's syndrome, postpartum hemolytic uremic syndrome, etc
Continuous renal replacement therapy is used in hemodynamically unstable patients ( those with low BP and cardiac reserve) and may be on ventilator. This helps slow and continuous removal of wastes from the blood over a 24 hour period as against the conventional 4 hour hemodialysis. Once patients are more stable, they can be shifted to regular hemodialysis
A word about prevention of kidney diseases
Patients with diabetes and hypertension should take care to maintain their blood sugars and blood pressure respectively , in the prescribed normal range. Any infections, especially of the respiratory tract, skin or urinary tract should be treated promptly. Periodic health check up should be done by a qualified medical practitioner
Also,one should avoid all over-the-counter drugs and painkillers and try to take only prescription medicines.
Early detection and prompt intervention may help in prevention of progression of kidney disease leading to many more years of productive life
AHRI (ISO9001:2000) at Chacka, NH Bypass, with the right blend of state-of-the-art infrastructure and world class doctors, provides the best of medical treatment with utmost compassion and concern.
No wonder today AHRI is your right destination for world-class health care in the state. The department of Nephrology at AHRI is fully equipped with most modern Nephrology equipments.
AHRI aims to play a predominant role in the development of healthcare services in India by setting new trends and bringing about changes cherished and earnestly sought by the society. For more details visit our web site: www.ananthapurihospitals.com or call us at 2506565.