World Kidney Day – Kidney Problems and their Treatments: A Relevant Discussion

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Dr. Shuvomoy Banerjee, PhD; Neucrad Health Desk; March 11, 2021

March 11 -World Kidney Day -Living well with Kidney Disease

About 10% of the world’s population is currently suffering from kidney problems and millions of people are dying annually due to a lack of proper and timely treatments. Hence, the symptoms of kidney disease need proper attention and diagnosis for receiving appropriate and timely treatment.

The kidney is an essential organ for maintaining good health as it excretes nitrogen-containing wastes, excess water, and other metabolic contaminants from the blood through the urine. The kidney also maintains the body’s acid-base balance, sodium-potassium salt levels, produces hormones that regulate blood pressure and the production of RBCs, and activates vitamin D (helps in calcium absorption). Interestingly, the human body’s excretory function can be accomplished with the help of a single kidney. However, we have 2 kidneys because we are two-sided symmetrical animals and the kidneys are of paramount importance in human evolution. 

Scientific studies have shown that diabetes, high blood pressure, and other chronic diseases can cause kidney damage. On the other hand, kidney diseases can lead to major health problems e.g. weakening of bones, nerve damage, etc. In case of severe kidney damage or diseases, the kidney may completely stop functioning.

Types of Kidney Disease

• Chronic kidney disease– It is a long-term and most common type of kidney disease, where the patient’s condition does not improve. Chronic kidney disease is caused by a) high blood pressure, which increases the glomerular pressure and damages the kidneys, and b) Diabetes, where the elevated blood sugar levels damage the glomeruli of the kidneys. As a result, the kidneys fail to purify the blood and the toxins produced by the body’s metabolism accumulate in the body leading to various other diseases.
• Kidney stones- Kidney stones are another common kidney problem. They occur when minerals and other substances (mainly calcium-oxalate) in the blood become crystals and form hard stones. Kidney stones can damage the tissues inside the kidney causing extreme pain. and Kidney stones usually come out of the body during urination or else medicines are needed. 
• Glomerulonephritis- It is an inflammation of the glomeruli. Glomerulonephritis is caused by an infection, medication, or congenital abnormality (a disorder that occurs at or shortly after birth). It often gets better on its own.
• Polycystic kidney disease- It is a genetic disorder caused by the formation of numerous cysts (small sacs of fluid) in the kidneys. These cysts can disrupt the normal functioning of the kidneys. According to the doctors, individual kidney cysts are not always harmful, but polycystic kidney disease creates serious conditions.
• Urinary tract infections (UTI)- UTI is caused due to bacterial infection of any part of the urinary tract. Bladder and urinary tract infections are most common. UTI can be easily cured with antibiotics, but if not timely treated the infections can spread to the kidneys and disrupt their function.

Symptoms of Kidney Disease

Kidney disease is not understood until the symptoms become severe. The following are the symptoms of kidney disease that we should be aware of:

• Fatigue
• Difficulty concentrating
• Problems sleeping
• Decreased appetite
• The feeling of muscle tensions
• Swollen feet or ankles
• Swelling around the eyes in the morning
• Dry and rough skin
• Frequent urination, especially late at night
• Nausea
• Anorexia nervosa
• Frequent changes in the amount of urine
• Anemia
• Decreased sexual desire
• A sudden increase in potassium levels (hyperkalemia)
• Inflammation of the pericardium

Diagnosis of Kidney Disease

Physicians first try to determine if the patient’s kidneys are working properly or not by performing the following tests:

1. Filtration rate (GFR) of glomeruli- This test will measure how well the kidneys are working and what is the level of kidney disease.
2. Ultrasound or computerized tomography (CT) scan- CT scans produce clear images of the kidneys and ureters and determine if the patient’s kidneys are in the right shape or not. This exam can also identify any tumors or structural problems in the kidneys.
3. Kidney biopsy- In this procedure, the doctor takes a small tissue from the patient’s kidney and cultures it to know the nature of the cells e.g. cancerous or not.
4. Urine test- The doctor may check the presence of albumin in the urine because the protein albumin can only come to the urine of a damaged kidney.
5. Blood creatinine test- Creatinine (stored in muscles) is a waste substance that is broken down and mixes in the blood. If the kidneys are not working properly, the level of creatinine in the blood will increase.

Lifestyle changes for Preventing and Managing Kidney Disease:

Some of the risk factors for kidney diseases like age and family history are hard to control. However, adopting a healthy lifestyle and taking the following measures can help one to prevent and manage kidney disease:

• Eliminating high cholesterol foods
• Including fresh fruits, vegetables, whole grains, and low-fat dairy products in the diet.
• Limiting alcohol consumption
• Quitting smoking
• Exercising
• Drinking an adequate amount of water 
• Reducing salt intake
• Keeping a check on blood sugar and in case of diabetes, taking the help of prescribed medicines or insulin injections
• Keeping a check on the blood pressure and managing high blood pressure with prescribed medicines.
• Avoiding excess intake of aspirin (Bayer) or ibuprofen (Advil, Motrin), as they can cause kidney damage.
• Limiting the intake of packaged fish, meat, lemon/grape juice (with citric acid and preservatives), and chocolate (may contain oxalate). 
• Consulting a doctor before taking calcium supplements as some calcium supplements can cause kidney stones. 

Kidney Disease Treatment:

Physicians often recommend angiotensin-converting enzymes (ACE) inhibitors e.g. lisinopril and ramipril, or angiotensin receptor blockers (ARBs) e.g. irbesartan and olmesartan. These are blood pressure medications that can slow the progression of kidney disease. Even if the patient does not have high blood pressure, the doctor may prescribe these drugs to keep the kidneys functioning properly. The patients also get treated with cholesterol drugs such as simvastatin, which can lower blood cholesterol levels and maintain kidney health. In case of severe kidney damage (where the kidney completely stops functioning) kidney’s work can be performed outside the patient’s body through dialysis which is a medical procedure utilizing a machine to purify the blood and return it to the patient. Even though this artificial method cannot cure kidney disease, it can prolong the life of the patient in extreme cases.

In a nutshell, do remember to take care of your kidneys and consult doctors in case any kidney-disease symptoms appear. 

References:

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   1. Grill AK, Brimble S. Approach to the detection and management of chronic kidney disease: What primary care providers need to know. Can Fam Physician. 2018;64(10):728-735.
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