Kidneys are very important organs with multiple lifesaving functions like: removal of waste products and drugs, balancing body fluids, releasing hormones that regulate BP, produce active forms of Vitamin D necessary for bone formation and also controls the production of red blood cells for the blood.
Kidney diseases are frequently seen in our population but persons more than 60 years of age are more likely to develop it. According to several population-based research studies more than half of the population above the age of 75 years have it in some form. Unfortunately, many people don’t realise that as they age the kidney function gradually deteriorates. Chronic kidney disease is the 6th fastest growing cause of death globally and around 8 million people are living with chronic kidney diseases in India.
Kidney disease often develops very slowly and goes unnoticed until it becomes fairly advanced. For this reason, the awareness in those who are especially at risk is the most important step in preventing it or slowing the progression of kidney disease. Advanced states of the disease lead to poor appetite, nausea, frequent vomiting, anaemia and protein loss through urine leading to profound weakness and fatigue.
Risk Factors for chronic kidney disease:
These include; diabetes, high blood pressure, glomerulonephritis and polycystic kidney disease, kidney stones, family history of kidney failure, prolonged use of over-the-counter painkillers and being over the age of 60 years. Once the kidney disease becomes advanced and at the end stage, the need for dialysis and renal transplantation arises. Both are very expensive and highly morbid procedures. Prevention and slowing the progression is thus the best way to go about.
How to diagnose it early and what are the stages of chronic kidney disease?
The simplest method to pick up the earliest abnormality is by a routine urine examination for detecting albumin / protein by a dipstick method. Estimation of serum Creatinine is the most important way to evaluate the function. The serum creatinine is always converted to e GFR (estimated glomerular function rate) by a simple formula available on App which needs the serum creatinine level the age and sex of the person. Besides this Urine albumin to creatinine ratio (ACR) is another very important measure.
Normal GFR is > 90, Stage 2, GFR 60-90 (Mild Decrease) , Stage 3 (a) GFR 45-59 (Mild to moderate decrease), Stage 3 (b) GFR 30-44 , (Moderate to Severe Decrease), Stage 4 GFR 15-29 (Severely Decrease) and Stage 5 GFR < 15 ( kidney Failure).
Ultrasound abdomen, a widely available investigation is important. It besides showing the size of the kidneys also visualises the different layers of the kidney, the Cortex and the medulla. Kidney disease leads to different acoustic features which pick up the damage and call for an aggressive treatment.
How to Keep Kidneys Healthy?
Healthy Diet: Plenty of fresh fruits, vegetables, salads, whole grains, low fat or fat free dairy products and reducing salt intake.
Regular exercise: It helps by reducing or preventing high BP and preventing acquisition of diabetes and bringing down sugar levels in diabetics.
Manage Diabetes Well: It is important to control blood sugar levels effectively and keep the HbA1c < 7%. It is also important how it is controlled. Marinating weight and keeping body mass index < 25 kg/ m2, by good lifestyle, diet and exercise. Choosing drugs like dapagliflozin and empagliflozin not only reduce the sugar but also protect the kidneys and halt the increasing serum creatinine levels and also prevent heart failure in high-risk subjects. All diabetics need to keep cholesterol very low to prevent vascular events like strokes and heart attacks which are common in patients with kidney diseases.
Control Hypertension; Keeping BP to < 130/80 mms Hg is very important and also the choice of drugs to do that also contributes. Drugs belonging to the group of ACEI/ARB’S (Telmisartan, Olmesartan, Enalapril, ramipril etc)are protective for the kidneys.
Good Hydration: It helps prevent stone formation. However, in advanced stages of kidney disease fluid intake needs to be regulated under supervision.
Avoid Pain Killers: Frequent use of analgesics can lead to and also accentuate progression of renal failure. Paracetamol is safer than other newer analgesics in this regard.
Take Home Message:
Kidneys are very important organs for maintaining fluid and electrolyte balance of the body besides excreting unwanted products. Kidney diseases are frequent, especially in the elderly.
Early detection is very important to halt its progression. Presence of protein in urine on a routine test is the earliest sign. Diabetes and high BP are the commonest causes of kidney disease leading to kidney failure. Calculation of glomerular filtration rate is a better diagnostic criterion than just the serum creatinine value. It is easy to calculate.
Good lifestyle, effective treatment of diabetes, high blood pressure, maintaining proper hydration and avoiding pain killers are important measures to prevent chronic kidney disease.
Prof Upendra Kaul Founder Director Gauri Kaul Foundation
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK