The most important function of the kidneys is to maintain the internal body environment for the optimum functioning of the various organs.

Kidneys act like a 24-hour cleaning crew for the blood. They filter out waste products. They get rid of excess water. They balance chemicals in the blood such as potassium and sodium. They remove excess acid. They also produce erythropoietin for bone marrow function. Everyday, 180 litres of blood is filtered through the kidneys. There are two types of kidney failure.

The acute, which is reversible and the chronic failure which is irreversible. Once a chronic renal failure patient reaches a stage where he cannot live without dialysis or transplant, he is said to be suffering from end-stage renal disease.

Kidney failure

When you first hear the diagnosis, it is scary and depressing. Estimates shows that more than a million people worldwide have kidney failure. It is one of the deadliest disease. Yet it is least understood.

Causes

Diabetes mellitus is the leading cause of renal failure. Hypertension and glomerulonephritis are the other important causes.

High Blood Pressure can damage kidneys

High blood pressure (hypertension) is increased pressure inside the arteries that carry blood from your heart to all parts of your body. Untreated, high blood pressure can damage your kidneys. All high blood pressure strains the heart and damages arteries. If blood pressure is uncontrolled and remains high, it can damage the vessels that supply blood to your internal organs. The very small vessels are often the first to be affected. If left untreated, this can lead to kidney disease, heart attack, strokes and loss of vision.

There are a number of different causes of high blood pressure but most high blood pressure has no known cause. You are more at risk of high blood pressure if you are older or have a family history of the condition. High blood pressure can also develop as a result of kidney disease or renal artery stenosis (narrowing of the main artery to one or both kidneys). Your kidneys control the amount of fluid in your blood vessels and produce a hormone called rennin that helps to control blood pressure.

Medication and lifestyle changes can lower blood pressure.

A range of medication is available for high blood pressure. Different blood pressure medications work in different ways so it is not unusual for more than one type to be prescribed. The dose may alter according to your needs. Medications that can lower blood pressure include :ACE inhibitors. Angiotensin receptor blocker. Calcium channel blockers. Bea Blockers. Low dose diuretics (fluid tablets). (Alpha blockers)

Symptoms of kidney disease

Kidney disease is called a `silent disease' as there are often few symptoms. Some signs and symptoms include:

Change in frequency and quantity of urine passed, especially at night (usually increase at first) Blood in the urine (haematuria). Foaming urine. Puffiness around the eyes and ankles (oedema). Pain in the back (under the lower ribs, where the kidneys are located). Pain or burning when passing urine.

When the kidneys begin to fail, there is a build-up of waste products and extra fluid in the blood as well as other problems, gradually leading to Tiredness, inability to concentrate. Generally feeling unwell. Loss of appetite. Nausea and vomiting. Shortness of breath.

When kidneys fail

Just one kidney, working at 20% capacity, can keep a person healthy, below that level, you begin to feel tired or weak, lose your appetite. This is because toxic wastes start to build up in the blood. Fluid collects, causing tissue swelling, lung congestion and high blood pressure. To stay healthy, a method is needed to replace lost kidney function.

Treatment options

Dialysis

Kidney Transplantation

Types of Dialysis

Haemodialysis

Blood is pumped outside the body to an artificial kidney machine. The sophisticated machine cleanses the blood and returns it to the body. It involves visiting the hospital 2-3 times a week for four hour sessions each.

This costs between Rs.10,000 - Rs.12,000 per month and some patients, however may not tolerate haemodialysis and hence may not have as optimal quality of life.

Continuos Ambulatory Peritoneal Dialysis (CAPD)

In CAPD, a catheter is implemented in the peritoneal cavity of the patient. The patient can dialysis himself 3-4 times a day. Assist devices help people with problems seeing or with problems wring their hands to do CAPD. The quality of life is better but it costs Rs.20,000 per month. Neither haemodialysis nor peritoneal dialysis offers a cure. The patient deteriorates as soon as the treatment is stopped.

Renal Transplantation

Diabetes mellitus is the leading cause of renal failure. Transplantation is the most "Natural" solution to kidney failure. This is a more stable renal replacement therapy. This helps the younger people achieve full rehabilitation. Transplantation or kidney graft can be done from, Living donors - family members make the closest tissue matches. Cadaver - from people who have decided to donate their organs when they die.

It costs about Rs.2 Lakhs. The annual cost of the life sustaining immuno suppressant drugs, which has to be taken after transplant, costs about Rs.1 Lakh.

The results of a transplantation depend on the degree of tissue matching between the donor and the patient. Locating a donor with the best match may take time and in the interim period the patient has to be on dialysis.

Lifestyle changes can keep your kidneys healthy

Making healthy lifestyle choices can help to keep your kidneys functioning well:

Eat lots of fruit and vegetables including legumes (peas or beans) and grain-based food like bread, pasta, noodles and rice.

Eat some lean meat like chicken and fish each week. Eat only small amounts of salty or fatty food. Drink plenty of water instead of sugary drinks. Maintain a healthy weight. Stay fit. Do at least 30 minutes of physical activity that increases your heart rate on five or more days of the week including walking, lawn mowing, bike riding, swimming or gentle aerobics.

Don't Smoke. Limit your alcohol to two small drinks per day if you are male or one small drink per day if you are female.

Have your blood pressure checked regularly. Do things that help you relax and reduce your stress levels.

Things to remember

You can look after your kidneys by eating healthy food, staying active and maintaining a Healthy weight.

Dr. K. Narayanan, M.D., D.M.(Nephro), DNB (Nephro) Director Kidney Centre, Puducherry

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