Articles on chronic kidney disease

Chronic Kidney Disease - Silent Killer

Dr. Ajay Goyal, Nephrologist
Chronic kidney disease (CKD) is a condition in which kidneys are damaged and their ability to keep a person healthy is decreased. The main role of the kidneys is to filter waste products from the blood before converting them into urine. The kidneys also:Help maintain blood pressureMaintain the correct levels of chemicals in your body which, in turn, will help heart and muscles function properlyProduce the active form of vitamin D that keeps bones healthyProduce a substance called erythropoietin, which stimulates production of red blood cellsCKD is the reduced ability of the kidney to carry out these functions in the long-term. This is most often caused by damage to the kidneys from other conditions, most commonly diabetes and high blood pressure. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia, weak bones, poor nutritional health and nerve damage. People with CKD are known to have an increased risk of a heart attack because of changes that occur to the circulation. These problems may happen slowly over a long period of time. Early detection and treatment can often keep chronic kidney disease from getting worse.Talk to your doctor about your kidneys if you:Have diabetesHave high blood pressureAre obeseSmokeAre over 50years of ageHave a family history of kidney disease, diabetes or high blood pressureHave swelling over feetThree simple tests to check for kidney disease are Blood Pressure, Urine analysis and serum creatinine. Early kidney disease can and should be treated to keep it from getting worse.

Some Devastating Statistics About Chronic Kidney Failure in India

Dr. Prashant C Dheerendra, Nephrologist
Even as we speak chronic kidney failure is taking a huge  toll on  lakhs of families in India. This is unfortunate because kidney failure is the easiest of all organ failures  to manage.  We have dialysis which can replace kidney function to a significant extent and kidney  is the easiest solid organ  to  transplant. This sad situation is because of a number of factors, the most important of which is the lack of awareness at all levels of the society. Compared to similar patients in the developed world or even some other developing countries, kidney failure patients have extremely poor outcomes in India. As things today we are not even addressing the tip of the iceberg. Given below are a few devastating statistics about chronic kidney failure in India.17% of Indians have some form of chronic kidney disease. This figure was reached that in a study conducted by Harvard Medical School in partnership with 13 medical centres  all over India. One third of the above people have advanced stages of the disease. There are  60 million people with diabetes in India, more than any other nation on the planet. Sadly, the majority of them are either  not diagnosed or poorly treated.At least 30% of diabetics will develop chronic kidney disease because of diabetes. People with the last stage of kidney failure (technically called Chronic Kidney Disease Stage 5 or CKD-5) require dialysis and/or kidney transplantation as a life sustaining treatment. 40 % of such patients would have developed kidney failure because of diabetes.2,00,000 new patients need dialysis treatment every year in India.  but the unfortunate reality is that only 10 to 20% of them get proper treatment.  The remaining are either not diagnosed or unable to continue proper treatment.Statistics suggest that there should be almost 20,00,000 people on dialysis in India a sof today. The reality is that there are only about 1,00,000. The rest have been lost due to non-diagnosis and non-treatment.The majority of chronic kidney failure patients are diagnosed in the last stage. Though proper statistics are not available, it is accepted that almost 50%  first see a nephrologist (kidney specialist) only in the last stage.There are 0.4 dialysis centers per million population in India. By contrast, Japan has 20 dialysis  centres  per million  population.Only 4,000 kidney transplants are  performed every year in India. The United States  with one fourth the population of India performs 16,000 such operations per year.Kidney failure can affect people of any age group. While in the west, the majority of patients are elderly, in India kidney failure patients are much younger and affects predominantly the working population.

Is Belly Fat Linked to Kidney Diseases?

Ms. Swati Kapoor, Dietitian/Nutritionist
Have you ever thought whether the processed foods you are eating are causing adverse health effects? Processed foods that are laden with phosphorus might increase the risk for kidney diseases.Researchers from Johns Hopkins claim that, “reducing your waist circumference and cutting down on dietary phosphorus has been linked to lower levels of protein in the urine (albuminuria). The presence of this protein in urine is one of the first indicators of kidney disease.” The study found that every one-unit increase in waist-to-hip ratio was linked to a loss of blood flow through the kidney's tiniest filters, the glomeruli, of about 4 milli litres per minute.Kidneys are the major excretory organs in our body. They are also known as the guardians of our body’s nutritional wealth. Phosphate is widely distributed in all the cells and body fluids, and plays a vital role in enzyme reactions and tissue metabolism. The metabolism of phosphate and calcium is closely linked, and these minerals usually occur together in food. The serum level of phosphorus increases in kidney failure.As dietary phosphorus is readily absorbed by the small intestine, any excess phosphorus absorbed is excreted by the kidneys. The regulation of blood calcium and phosphorus levels is interrelated through the actions of parathyroid hormone and Vitamin D.Some investigators are concerned about the increasing amounts of phosphates in our diet which can be attributed to phosphoric acid in soft drinks and phosphate additives in a number of processed foods. Serum phosphorus increases with a high phosphorus diet. High phosphate levels in the blood reduce the formation of the active form of Vitamin D (Calcitriol) in the kidneys, hence reducing the blood calcium. This further increases PTH released by the parathyroid glands and also decreases the urinary calcium excretion. Parathyroid hormone decreases tubular reabsorption of phosphate in the kidney, leading to increased excretion of phosphates.Processed foods high in phosphorus increase acidity in blood which triggers the release of stress hormones and these stress hormones increase insulin in the body. Increased level of sugar in the blood gets converted to fat and hence gets stored in the adipose tissues throughout the body. Apple-shaped people are at more risk of getting this disease than pear-shaped people.Hence, limiting the intake of processed food may help prevent risks of kidney diseases.

Prevention Of Kidney Stones

Dr. Rajeev Bashetty, Urologist
Kidney stones are known to the mankind since antiquity. Lot of innovations have been done in treating the kidney stones, but there is a very little knowledge regarding the stone formation and how it can be prevented. Daily water intake is one of the important factors in the prevention of kidney stones. Diet is another factor that can promote or inhibit kidney stone formation. Others include environment, body weight and heredity.The dietary advice will be based on the type of kidney stones, which will be recommended by the Urologist. These recommendations mentioned below are general and for the most commonest kidney stone formers.FluidsWater is  inexpensive & easily available. The amount of water a person needs to drink depends on the weather and the person’s activity level. People who have had a kidney stone should drink enough water and other fluids to produce at least 2 litres of urine a day. This can be achieved by drinking about 3-4 litres of water every day. The amount should be consumed on periodic basis about a glass or two every hour. People who work in hot weather need more fluid to replenish fluid they lose through sweat. Drinking enough water helps to keep urine diluted and flushes away materials that might form stones and is the most important thing a person can do to prevent kidney stones. Soft water intake is recommended. Hard water should be boiled and cooled before consumption. Citrus drinks like lemon and orange juice protect against stone formation because they contain citrate, which inhibits stone formation.Fluid like grapefruit juice, colas, beer, wine, coffee, tea should be avoided in excess as they contain substances, which helps in the stone formation. DietThere is a misconception that eating Palak and Tomatoes should be avoided to prevent stone formation. Yes, this is true provided a person consumes them daily in large quantities. Eating palak once in a while or adding tomatoes to the daily food preparation doesn’t really harm or increases the risk of stone formation. Another misconception is to avoid drinking milk as it contains calcium. In fact milk will help in reducing the stone formation. Calcium in the stomach binds to oxalate from food and keeps it from entering the blood, and then to the Urinary Tract, where it can form stones. People who are taking supplementary calcium to maintain the bone density should take the calcium tablets along with the food.Sodium, often from salt, causes the kidneys to excrete more calcium into the urine. High concentrations of calcium in the urine combine with oxalate and phosphorus to form stones. Reducing sodium intake is preferred to reducing calcium intake.The consumption of Meat, fish and egg should be reduced as they contain purines, which break down into uric acid in the urine resulting in uric acid stones.Eating excessive chocolates and nuts like cashew should be avoided as they contain oxalate.Once a person forms a stone, his chances of forming another stone is very high. If the above recommendations are followed, there will be definite reduction in the recurrence. Most of the small stones pass spontaneously, but the larger stone may require treatment. If the stones are not treated at right time, they can cause irreversible damage to the kidney.

Simple Breathing Exercises for Chronic Obstructive Pulmonary Diseases

Dr. Radhika Bharath, Physiotherapist
What is COPD?Chronic Obstructive Pulmonary Disease (COPD) is characterized by breathlessness (short of breath) or getting tired while breathing. COPD is an umbrella term for conditions such as chronic bronchitis, emphysema or a combination of both.Exercises of COPD• Deep breathing exercise:1) Diaphragmatic Breathing:- Sit Upright with back support- Look straight with chin neutral.- Place both your hands (palms one over the other) on your stomach (mid- abdomen)- Now take a deep breath in through your nose and feel your stomach move out (like an air filled balloon)- Make sure your chest does not move while breathing.- Once you have breathed in maximum, slowly breath out only through your mouth (as you blow a whistle) and feel your abdomen going inside.- Repeat this 10 time x 3 times a day2) Collateral Breathing: - Sit upright with back support - Look straight- Place your hands on the side of your chest wall (one hand on either sides)- Now take a deep breath in through your nose and feel the walls of your chest (rib cage) moving outwards as your chest expands.- No upper chest movement to be performed.- Now blow out the air through your mouth (as you blow a whistle) and feel the chest wall coming inside.- Repeat it 10 times x 3 times a day3) Apical Breathing:- Sit upright with a back support- Look straight, chin up- Place your palm across your upper chest (as the tips of your finger touch the collar bone).- Breath in through nose and feel the upper chest moving up.- Now once you have completely breathed in, slowly blow out through your mouth (as you blow a whistle) and feel your chest coming down to normal.- Repeat it 10 times x 3 times a day• Chest Expansion Techniques:1) Sit straight on a chair with back support (can also be done in lying).- Keep both the arms stretched out in front of the chest.- Now take your arms to the side and breath in through nose.- Slowly bring back the arms back in front of the chest and breath out through mouth.- Repeat 10 times 3 times a day.2) Sit on a chair with back support.- Keep both the arms stretched over head.- Bring both the arms to your shoulder level and breath in through nose.- Now gently take the hand back over head and breath out through mouth.- Repeat 10 times x 3 times a day.STAY HEATH WITH REGULAR EXERCISE!! GOOD LUCK!!

Effective Management of Chronic Renal Diseases Through Ayurveda

Dr. Krishna Bhat, Ayurveda
Renal disorders are increasing nowadays, may be reasons are many including self medication, food habits, exposure to certain chemicals, lifestyle etc. As kidney is a very important organ to maintain equilibrium of body by eliminating the waste from our body or filtering blood - its health is must.In case of chronic Kidney disorders, current science doesn't have effective medication, especially to cure the condition. So here by I am giving an insight to Manage such problems with natural way of healing -  "AYURVEDA ".Based on my experience in treating kidney disorders I am suggesting the world to go for Ayurveda in case of such conditions.                                       Few reasons why AYURVEDA is more beneficial in such conditions are:In Ayurveda we use natural medicines ( Organic compounds) which can be easily absorbed and also eliminated without extra efforts.Natural medicines can stimulate Nephrons and help for regaining its function.Researches  prove that natural medicines used in AYURVEDA can improve structural and functional integrity of kidney better than any other medication.In case of kidney disorders any medication containing synthetic chemicals cause further problem as it is the organ filtering those chemicals to eliminate them.As kidney has many functions other than filtration like assistance in blood synthesis, maintaining blood pressure etc, multiple systems are involved in kidney disorders. As Ayurveda treats body as a whole, instead of giving many medicines we can use single medicine acting in multiple systems involved in pathogenesis of  disease.The medicines used are very much safe, instead of side effects we will get side benefits. As we give disease modifying medications for root cause and not symptomatic managements like other systems whatever improvements we get will be long lasting.As all the medicines are natural ones we can use in any age, any severity with certain modifications.In my next articles I will give some practical experience with case presentations so that it will be more convincing than any theoretical explanations. 

Diabetic Kidney Disease - Your Awareness Guide

Dr. Ashwinikumar Khandekar, Nephrologist
India is the capital of kidney diseases in the world. Commonest cause of kidney disease in India is diabetes mellitus (DM).There are two types of diabetes. Type 1 is Insulin Dependent Diabetes Mellitus (IDDM), which manifests in childhood and depends only on insulin administration for sugar control.Type 2 where an adult, usually over 30 years of age is found to have diabetes and can be treated with oral medications (Non Insulin Dependent Diabetes Mellitus [NIDDM]).We will discuss common kidney problems in diabetes and their early detection and treatment.Anatomy and PhysiologyBefore we discuss how diabetes affects the kidney, the reader is suggested to review the pertinent anatomy. Click here for a brief overview.. What is Diabetic Kidney Disease ?When blood sugar levels are abnormally high for a long period of time, they cause changes in the small blood vessels including those that supply the kidneys.These changes significantly affect the blood vessels of the glomerulus altering its functional abilities.The affected filter leaks protein in the urine. If untreated, damage to the filter continues, kidneys begin to fail and when the function falls below 10% of normal, artificial means to purify blood (dialysis) are needed.However, if sugar control is achieved early and consistently, this damage can definitely be delayed by a long period of time.Can we detect it early?Even before protein loss is evident in urine, microscopic changes are already present in the kidney, especially in the glomerulus (the ‘filter’).The protein loss is in very small amounts and is detected by special tests. This stage is called the ‘Microalbuminuria’ stage and precedes the more advanced involvement of kidneys and therefore better amenable to interventions.If filtration capacity is measured at this early stage, it would be found to be paradoxically higher than normal.If intervened at this stage, severe damage can be prevented.How does the disease progress?This stage then evolves into varying degrees of protein losses in the urine, over the subsequent 5 to 10 years, before reaching the final stage where all the glomeruli undergo irreversible damage and manifest itself as advanced kidney failure.If not intervened at this stage, there is usually a steady downhill course hereafter and therein lies the importance of screening patients with diabetes for kidney involvement. In type 1 diabetes, approximately 10 – 20 % patients reach this stage by after 5 to 15 years of diagnosis.Type 2 diabetes patients are usually found to have complications of diabetes at diagnosis and rarely kidney failure may bring diabetes to notice.One symptom that is peculiar to kidney involvement is that, when kidneys begin to fail, sugar control improves. This is because insulin, the hormone that reduces blood sugar level & is normally destroyed by the kidney, is no longer destroyed in failing kidneys. Sometimes the sugar levels go abnormally low, occasionally needing hospitalization.So, when a long standing diabetic patient has an ‘improved’ sugar control or sugar levels fall ‘low’ too frequently, kidney involvement should be suspected.What is the relation with the eyes?Just as small blood vessels of kidney are affected by diabetes, so are the small blood vessels of the retina in eyes. This is detected by an ophthalmologist by a simple eye check done in the out patient department (OPD).Involvement of the eyes and kidney go hand in hand. If eye involvement is noted, evidence for kidney involvement must be actively sought and vice-versa.Conversely, if a diabetic has significant protein loss in urine, but blood vessels of the retina are normal, the involvement is less likely to be because of diabetes and other causes should be searched for.

Kidney Stones: Ideal Diet For Cure

Dr. Anish Kumar Gupta, Andrologist
A high incidence of Kidney stone disease, is seen these days with reports suggesting a prevalence of 1 in 7 people suffering from it.Q: What is single most Important aspect of diet to reduce chance of stonesA: Drinking enough fluid is the most important aspect. As a rough guide one should try to keep urine colourless throughout the day; this equals to a urine output of at least 2 litres per day. All extra loss by sweating must be replaced.Q: What can be taken to drink?A: Water is the best drink. Herbal tea is okay but Caffeinated tea, coffee should be consumed only in moderation Cola drinks and alcoholic beverages are not suitable.Q: Is there a specific dietary advise you give to your patients ?A: A well-balanced diet without excessive amount of calories. A high fibre diet is also important, Most important is a diet low in salt. Avoid high-salt, tinned, packet and processed foods (e.g. soups, salted chips, pickles and papad.Q: Can stone formers eat dairy products and other protein?A: Yes, but intake of protein should be restricted. A high intake of animal protein appears to increase the risk of stone formation. Q: I’ve heard that calcium is a bad thing to have in the diet if you have kidney stones. Is this true?A: Kidney stones usually contain calcium. Traditionally it was thought that it was beneficial to restrict calcium, but it has now been shown better to have a moderate or even slightly higher calcium intake. The reason for this is that calcium binds oxalate in the gut and prevents it being absorbed. A daily intake of up to 1000mg per day is recommended for calcium stone formers. It might be important to reduce the calcium in your diet, in certain specific conditions.Calcium is found in dairy products such as milk, curd, cream and cheese. A normal, varied diet will give the average person about 500mg of calcium before adding in any dairy products. Milk and curd contain about 120mg per 100cc.Q: An age old adage is “Avoid green vegetables, tomatoes and nuts”. Is this true?A: These are oxalate rich food products. It is not necessary to exclude oxalate-rich foods completely; simply eat them in small amounts. Other foods high in oxalate are: Beetroot, Strawberries, Black Tea, Chocolate.Q: Are there any other tests that can be done to investigate why stones form?A: Yes. In all patients who have had a kidney stone blood tests are done to check the kidney function and also ensure that the levels of uric acid or calcium in the blood are not too high. In high risk stone formers, or those who have had recurrent stones, then collection of two 24hr urine specimens for analysis is important. Your doctor can tell you more about this.