Prevention Only Cure

Lastsummer, I saw an asymptomatic boy from Nepal whose admission in Japan was putin abeyance for want of clearance from a nephrologist. During a routine medicalcheck-up for college admission in Japan, he said his urine showed someabnormality. To save money for a specialized treatment, he landed at SGPGILucknow, where his kidney biopsy revealed IgA nephropathy (a kind of kidneydisease). Had his urine been not screened in Japan, we would have seen him inhis advanced kidney disease.

Aroundthe world we have around 850 million such people who suffer from some kind ofkidney disease which if detected and treated at an early stage can make a hugedifference both medically as well as economically.

   

Why World Kidney Day?

Kidneydisease is on the rise with every 10th person in the world affected. CKD isprojected to become the 5th most common cause of years of life lost globally by2040. CKD incurs huge health expenditure. High-income countries are spending2%–3% of the annual health care budget on dialysis and transplant patientswhich constitute less than 0.03% of the total population in these countries.

Who are at risk of kidney disease?

Isee patients with 90% kidney function lost and still no symptoms to bother.Signs of advancing CKD like swollen ankles, fatigue, difficulty concentrating,decreased appetite, blood in the urine or foamy urine; may not be alwayspresent. Rather than they come to us with symptoms, we should reach them byidentifying their risk factors for kidney disease. The leading risk factors forCKD include diabetes mellitus, hypertension, obesity, family history of CKD,defects in kidney and urinary tract.

What should i do to prevent CKD?

BothDiabetes and high Blood Pressure (BP) significantly increase risk to developkidney damage. It  is important toscreen  blood sugar and blood pressure ingeneral population; even if there are no related symptoms, because half ofpeople who have high blood pressure do not know they have high blood pressure.Similarly, about half of people who have diabetes are undiagnosed. In thosewith hypertension and diabetes, optimizing blood pressure and blood sugarcontrol has shown to be effective in preventing diabetes and hypertensionrelated kidney damage.

Kashmiriphenotype of fatty liver has been seen to be associated with mild renal failurewhich may reverse with treatment of fatty liver.

Personswith solitary kidney should consider it precious and avoid high protein intakeabove 1 gram per kilogram body weight per day.

Patientswith kidney stones and cysts will need to be more careful as these two entitiesmake kidneys weaker.

Astudy recently highlighted that pregnant women who experience hypertensivedisorders or deliver preterm are at increased risk for CKD and kidney failure lateron.

Keep well hydrated

Peoplehave always believed water to prevent kidney diseases, which studies have alsoconfirmed. But how much water should a healthy person take? The most recentofficial recommendation by European Food Safety Authority in 2010 for maleadults is to drink minimum of 2 litres per day, and little less for femaleadults 1.6 litres per day; in a moderate climate and with moderate level ofphysical activity.

I have kidney disease, what should ido ?

Forthose with earlier stages of CKD, the main goal is how to slow diseaseprogression. Again BP and blood sugar control are of utmost importance.Besides, low salt intake and low protein diet have been shown to be effectivein retarding progression.

Reduce salt intake

Lessthan 4 gm of common salt (about 1 teaspoon) in the entire day is what oneshould aim at if suffering from high blood pressure or kidney disease. But aperson on a typical Kashmiri food would consumes about 6-12 gm salt in a day.Then there are  indirect sources of saltwhich we are unaware of, e.g. chips, pickles and chutneys, ketchups and saucesetc.

Easiersaid than done, many people have difficulty in reducing salt intake. Here aresome tips.

Tryand limit the amount of processed food as natural sources of sodium are notthat concentrated as compared to sodium in processed foods. The best ones are:cumin (zeera), chilli, black pepper, cinnamon, ginger, garlic and onion powder.Spice blends like garam masala are nice too.

Thereare choose-the-lesser-evil options in the market as well. Black/rock salt(Pakistaen noon) has lesser amount of sodium than white salt. LONA (availablein market) has low sodium but can increase potassium level in blood in patientswith kidney disease (which can be dangerous).

Low protein diet

Forpeople with kidney disease who are not on dialysis, a diet lower in protein isrecommended. Many studies suggest that limiting the amount of protein andincluding more plant-based foods in the diet may help slow the loss of kidneyfunction.

Iwitness a number of young patients on popular high-protein diet for musclebuilding and weight-reduction with increased levels of creatinine in bloodand/or protein in urine.

Recently,a study favoured consumption of  plantand dairy proteins and showed  highintake of red meat was associated with an increased risk of CKD.

My kidney disease is advanced, should i give up ?

Ofcourse not. Many patients with advanced CKD will eventually need renalreplacement therapy in the form of dialysis therapy or kidney transplantation.While mushrooming of dialysis centres in valley is a step forward; unsupervisedand poor quality dialysis will prove counterproductive.

Pleasedto share that documentation for establishment of kidney transplantation centrein public sector in Kashmir is on.

Bottomline

Thetheme of world kidney day this year ‘kidney health for everyone, everywhere’with emphasis on prevention and early detection should be a policy more prudentand economical. By doing this we will be nipping evil in the bud.

DrAsif SadiqWani is consultant Nephrologist at Government Medical CollegeSrinagar

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