Articles on kidney failure

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.

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.

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.

Don't Expose Your Kidney to Acute Renal Failure (ARF)

Dr. Neeraj Gupta, Homeopath
Acute renal failure is a clinical syndrome in which there is rapid reduction of the excretory functions of the kidney. If immediate action is taken derangement caused due to renal failure can be reversed. CausesReduced circulatory blood volume – hemorrhage, dehydration and severe decrease in protein levels in bloodCardiac failure.Acute gastroenteritisIn shock due to septicemia or anaphylaxisThrombosis / embolism in renal arteries or aortic dissections.Accelerated hypertension.Blood poisoning during pregnancy - from toxins formed by bacteria growing in local area of infection.Disseminated intravascular coagulation.Glomerulonephritis.Acute tubular nephritis.Certain drugs which are toxic to the kidney e.g. aminoglycosides, lithium etc.Mismatched blood transfusion.Virulent malaria.Blockage of one ureter when other kidney is absent or non-functioning, usually due to calculi. Neurogenic bladder.Blockage of the urinary bladder neck, urethral stricture. Signs and symptomsScanty Urination. The urinary out put may be as little as 20 - 200 ml per day. High blood pressure or low blood pressure. Potassium excretion is diminished.Serum phosphate and sulphate levels are increased and sodium, calcium and base bicarbonate levels are decreased. Symptoms of acidosis (a condition in which the acidity of body fluids and tissues is abnormally high)Vomiting. Increased rate of breathingMental impairment.Hypertension (high blood pressure). Waste products of protein metabolism get accumulated in blood. Serum urea, nitrogen and creatinine levels are increased. Symptoms of uremia (presence of excessive amounts of urea and other nitrogenous waste compounds in the blood) Lack of appetite.Nausea and vomiting. Gastrointestinal bleeding.Anemia.Lethargy. Confusion and stupor. Inflammation of the pericardium with hemorrhagic effusion and cardiac tamponade. Dietary managementDietary changes are made to correct the fluid and electrolyte imbalance and to maintain proper nutritional status so as to minimize protein catabolism and uraemia. But these dietary changes should be done under guidance of a professional dietitian. AvoidAvoid potassium rich food, as in renal failure potassium excretion is decreased, hence serum potassium level are high which can have deleterious effects on heart, like banana. Foods rich in potassium and to be avoided are restrict potassium intake to 1,000 mg per day.Minimize or avoid protein – (0.5-0.6 gm per kg body weight) if you are not on dialysis and blood urea and nitrogen is increasing. Avoid high sodium diet – Restrict Sodium intake to 500-1,000 mg per day. Avoid phosphorus in diet, in renal disease phosphorus levels increase, which cause blood calcium levels to decrease and can lead to bone loss. avoid prolonged suffer of renal calculi & urinary infection Note:  Avoid  recurrent use gentamicin  and amikacin What can you consume?Fluid intake is regulated on basis of urinary out put, other water loss from vomiting or diarrhea. Total fluid intake should not exceed – 500 ml + previous day`s urine out put + total water loss from vomiting or diarrhea or any other causes. You should consume a minimum of 600-1,000 kcal. Generally 35-50 kilocalories per kg body weight should be consumed to maintain positive nitrogen balance.Have high calorie diet. Increase intakes of fats and carbohydrates. Reduce intake of proteins – (40 gm per day / 1.0-1.5 gm per kg body weight) if you are on dialysis or hemodialysis.Consume at least 100 gms of carbohydrate per day, it minimizes tissue protein breakdown. If on nasogastric tube feeding administer 700 ml of 15 % glucose. Sodium intake is based on measurements of sodium ions in serum and urineIf are not on dialysis you should restrict sodium intake. Restrict sodium intake to 500-1,000 mg per day.If you are on dialysis sodium can be consumed in accordance with the serum levels of sodium ion. In the recovery phase, urine out put is increased and a return of the ability to eliminate wastes. Gradually can increase intake of protein, potassium, phosphorus and sodium. Fluid and electrolyte balance should be monitored and dietary changes should be done accordingly. It will take at least six months to come back to normal routine diet.During kidney disease body`s need for certain vitamins and minerals changes. Normally in healthy condition we get adequate amount of vitamins and minerals form our regular diet, but as in kidney disease diet limits certain food groups, hence one needs to take certain vitamin and mineral supplements. Take these supplements under the guidance of your physician. Vitamin C supplements, helps to increase immunity and combat the infection.Vitamin B complex, certain B vitamins like B6, B12 and folic acid along with iron and EPO (erythropoietin, given in renal failure to avoid anemia) and iron prevents anemia. Other B vitamins like – thiamine, riboflavin, pentothenic acid and niacin helps to convert food into energy. Iron supplements can be taken, but consult your physician. You can also take calcium supplements; it binds the phosphorus from food and serves to provide extra calcium that your body needs. Along with calcium you can take vitamin D supplements, helps to keep bones healthy.Consume 2 table spoon of fresh flax seed oil, reduces / slows the process of further renal damage. Consult physicianConsult physician immediately if any of the above sign and symptoms appear, as timely treatment and management can reverse the changes and prevent any further damage of the kidney. Diet and water intake should be under strict medical guidance.You can safeguard your kidney by avoiding prolonged use of antibiotics. Do not practice self-medication especially for children. Use drugs only according to the instruction of your physician. 

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.

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.

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.