What are the functions of the Kidneys?

  1. 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. 
  2. 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.
  3. 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.
  4. 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. 
  5. 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.
  6. 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 tiredness
  • Nausea and vomiting
  • Itchy skin
  • Difficulty sleeping
  • Puffiness & swelling of the feet, legs hands& face
  • Shortness of breath
  • Poor appetite
  • High blood pressure

It 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, etc

What 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 NIDDM

What 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 transplantation

What 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.