Articles on kidney diseases

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.

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.

9 Kidney Damaging Habits

Dr. Richa Garg, Ayurveda
1. Lack of WaterThe kidney’s primary function is detoxification and this is done with the help of water. With insufficient water there is a build-up of toxins in the body, which can affect other functions.2. Excess Salt Salt increases blood pressure which in turn exerts a lot of pressure on your kidneys. Restrict your daily salt intake to around 5 grams a day, which is ideal.3. Restraining UrinationControlling yourself from urinating can increase urine pressure and lead to kidney stones. So be sure to relieve yourself without any delay.4. Excess SugarHigh sugar foods increase the protein content in your system which in turn exerts pressure on your kidneys. Protein amounts in one’s urine is a valid way to check kidney functioning.5. Excess Animal ProteinRed meat in particular increases the metabolic load on your body, especially the kidneys. Regular consumption of red meat can cause dysfunction or failure.6. Lack of SleepSleep deprivation can lead to several health problems including kidney disease. Your body repairs damaged kidney tissue while you sleep, so better sleep means better kidneys.7. Excess CaffeineHigh amounts of caffeine raises blood pressure and exercises the kidneys in excess. Regular consumption of caffeine can cause kidney damage.8. Painkillers They have become a regular in our day to day lives and are used for almost any sort of pain. These pills naturally deteriorate the kidney and liver.9. Alcohol ConsumptionThis legal toxin harshly exercises the kidney and liver so don’t go overboard.

Understanding Kidney Stone Analysis

Dr. Anish Kumar Gupta, Andrologist
Did you recently get your kidney stone removed ?Kidney stones come in many different types and colors. How you treat them and stop new stones from forming depends on what type of stone you have.  Get the stone analysis done to know the type of stone you are having. And, then go back to your doctor to ask for more detailed advise to prevent the same.There are 4 main stone types, discussed below.Calcium stones (80 %)Most common type of kidney stones. They can be calcium oxalate and calcium phosphate. Calcium oxalate is by far the most common type of calcium stone Some people have too much calcium in their urine, raising their risk of calcium stones Even with normal amounts of calcium in the urine, calcium stones may form for other reasons Uric acid stones (5–10 %)Uric acid is a waste product that comes from chemical changes in the body.Uric acid crystals do not dissolve well in acidic urine and instead will form a uric acid stone. Having acidic urine may come fromObesityChronic diarrhoeaType 2 diabetesGoutA diet that is high in animal protein and low in fruits and vegetablesStruvite/infection stones (10 %)Uncommon type of stones. Related to chronic urinary tract infections (UTIs). Some bacteria make the urine less acidic and more basic or alkaline Magnesium ammonium phosphate (struvite) stones form in alkaline urine.These stones are often large, with branches, and they often grow very fast.People who get chronic UTIs, such as those with long-term tubes in their kidneys or bladders, or people with poor bladder emptying due to neurologic disorders are at the highest risk for developing these stones Cystine stones (<1 %)Cystine is an amino acid that is in certain foods; It is a building block of protein  Cystinuria (too much cystine in the urine) is a rare, inherited metabolic disorder. It is when the kidneys do not reabsorb cystine from the urine When high amounts of cystine are in the urine, it causes stones to form Cystine stones often start to form in childhood Stone analysis is only one part of understanding why stones form. For a detailed advise for prevention the patient will also need to undergo urine and blood tests to help decide the need for any specific advise for the same.Ask your Urologist about it in in your next visit.

Q&a About Kidney Failure, Dialysis and Transplantation

Dr. Arvind C, Nephrologist
What are the functions of the Kidneys?Remove extra water: The kidneys filter extra water, which the body does not need, in the form of urine. This water comes from the liquids you drink and the foods you eat. The kidneys have the ability to concentrate or dilute your urine, as your body needs. As they form urine, it is sent to the bladder through tubes called ureters. The urethra is the tube that drains the urine from the bladder to the outside of the body. Remove waste products: Urea and creatinine are examples of waste products that are found in everyone. Urea and creatinine form as the body breaks down food into energy and performs its routine bodily functions. Waste products are harmful if not removed by the kidneys.Restore needed chemicals: The kidneys work to keep the body’s chemicals (electrolytes and minerals) in balance. Two examples of electrolytes are sodium and potassium. An example of a mineral would be calcium. The kidneys keep a proper balance by saving the chemicals the body needs and passing the excess chemicals into the urine.Regulate blood pressure: The kidneys help the body keep a normal blood pressure by passing extra sodium and water. The kidneys also produce a special hormone called renin that helps to control blood pressure. Help in the production of red blood cells: The healthy kidney produces a hormone called erythropoietin.This hormone helps the bone marrow produce red blood cells.Help with calcium and vitamin balance: The kidneys balance calcium, phosphate and Vitamin D. These three chemicals play a key role in bone formation.What is Kidney failure and what are the symptoms of this disease?As kidney failure begins, the kidneys are not able to clean the blood of waste products. Waste products and excess water collect in the body. A build up of waste products in the blood is called uremia.Extreme tirednessNausea and vomitingItchy skinDifficulty sleepingPuffiness & swelling of the feet, legs hands& faceShortness of breathPoor appetiteHigh blood pressureIt must be stressed that early on, in patients with kidney disease there may be no symptoms at all. A common misconception exists with respect to the volume of urine passed. This unfortunately is not a good measure of kidney function; a patient with advanced kidney failure may still be able to pass more than a litre of urine.Chronic renal failure means that the loss of kidney function is permanent. Kidney function may stop quickly, or slowly fail over a number of years. End Stage Renal Disease or ESRD occurs when the kidneys have reached the point where they can no longer work well enough to maintain the balances needed for life. This is usually when dialysis must be started.What are the common causes of CHRONIC KIDNEY FAILURE?There are many causes of chronic (long-standing) kidney failure in an adult and a few of the most common reasons are listed here: Diabetes Mellitus, Chronic Glomerulonephritis, Hypertension, Chronic Pyelonephritis, Lupus Erythematosus, Polycystic Kidney Disease, etcWhat is the most common cause of Chronic Kidney failure in your practice?Diabetic nephropathy is the leading cause of chronic renal failure here. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for more than 50% of all end-stage renal disease (ESRD) cases in India. Although both type 1 diabetes mellitus (insulin-dependent diabetes mellitus [IDDM]) and type 2 diabetes mellitus (non–insulin-dependent diabetes mellitus [NIDDM]) lead to ESRD, the great majority of patients are those with NIDDMWhat is the Advise that you would give to patients at risk for kidney disease?All patients with Diabetes Mellitus and Hypertension (High Blood Pressure) are at risk for developing kidney disease. Patients with glomerulonephritis (kidney inflammation), recurrent urinary tract infections/obstruction are also at risk of developing develop kidney failure. Such patients are advised to undergo regular follow-up with a nephrologist. Regular checks on urine-protein levels (Proteinuria) and kidney function (urea & creatinine levels) are mandatory. Aggressive Blood Pressure control (aim for BP <120/80 mmHg) and the use of newer medicines (ACEI & ARB) holds the key to the management of such patients with a view to prevent progression of kidney disease.How do you treat End-Stage-Renal Failure (ESRF)?Pts with ESRF can be treated by dialysis or kidney transplantation. Dialysis is of two varieties, Hemodialysis or blood dialysis and CAPD or water dialysis.Kidney transplantation is the best treatment that can be offered to a pt with ESRF.What is kidney transplantation?Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with ESRF. The main types of kidney transplant are living donor transplant and cadaveric. In the former, the kidney originates from a deceased (brain-stem-death) person. In the latter, the kidney is being donated by an organ donor. It is possible to transplant a kidney from a living donor because the body can work just as well with one kidney as with two.What are the tests done to evaluate a kidney transplant recipient? A transplant evaluation includes many tests to make sure that the recipient is healthy enough to have a transplant. To make sure that the new kidney will be a good match, tests will be done to find out the blood and tissue type. Other tests include: a check for any active infections, blood clotting profile, a chest x-ray, ECG (electrocardiogram) and cardiac evaluation, and abdominal ultrasound. Women must be cleared by a gynecologist. Other tests may be required depending on the patient’s age and medical history. Can patients with Kidney failure(ESRF) due to diabetes undergo transplantation?Definitely! Infact, patients with diabetic kidney failure form the majority of patients in a Dialysis unit these days. Some diabetics tend to have concurrent heart problems or blood vessel blockages (vascular insufficiency) and this has to be attended to, before they are cleared for transplantationWhat kind of testing does a living donor go through? A person who wants to be a living donor will go through a set of tests. These tests will increase the chances of a successful match. They will also make sure that the donor will not be placed at risk. The tests include blood tests, urine tests, chest x-ray, ultrasound scan of the abdomen and ECG (electrocardiogram). Like the recipient, the donor is also tested for any active infections. Also, a CT/MR scan or arteriogram (an examination of the blood vessels) of the kidneys is done. Potential donors will be examined by a surgeon and a nephrologist (kidney specialist). Anyone with kidney disease, diabetes or high blood pressure would not be considered.Does the transplant recipient have to take special medications after the transplant?Yes, the patient will have to take immunosuppressive medications such as prednisolone, cyclosporine or tacrolimus, mycofenolate, etc indefinitely, but with significant reductions in dosages with time.

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.