Author: Dr. Shubangi,
Globally, kidney disease is the third biggest killer after cancer and cardiac ailments. Chronic Kidney Disease (CKD) has silently afflicted a large number of Indians with more than 200,000 kidney failures occurring in India annually. In six out of 10 chronic kidney disease (CKD) patients, diabetes and hypertension are the underlying cause. Today, nearly five lakh patients are in need of life-long dialysis or transplant.
Most people are born with two kidneys, each one about the size of an adult fist, bean-shaped and weighing around 150 grams each, located at both sides of the backbone, above the small of the back.
Kidneys perform a number of very important jobs
- Blood pressure control – kidneys keep blood pressure normal.
- Water balance – kidneys add excess water to other wastes, which makes urine.
- Cleaning blood – kidneys filter blood to remove waste and toxins. The kidneys make urine from excess fluid and unwanted chemicals or waste in the blood. Urine flows down through narrow tubes called ureters to the bladder where it is stored and passes out of the body through a tube called the urethra. Around one to two litres of waste leaves the body each day as urine. Each day, kidneys process around 200 litres of blood
- Vitamin D activation – kidneys manage body’s production of this essential vitamin, which is vital for strong bones, muscles and overall health. Thus, the kidneys are very important in the way the body works and overall health.
What can you do for your kidney health?
Kidney diseases affect quality of life. There are however several ways to reduce the risk of developing kidney disease.
Keep fit and active
Keeping fit helps to reduce your blood pressure and therefore reduces the risk of Chronic Kidney Disease.
Keep regular control of blood sugar level
About half of people who have diabetes develop kidney damage, so it is important for people with diabetes to have regular tests to check their kidney functions. Kidney damage from diabetes can be reduced or prevented if detected early.
Monitor your blood pressure
Although many people may be aware that high blood pressure can lead to a stroke or heart attack, few know that it is also the most common cause of kidney damage. The normal blood pressure level is 120/80. At 140/90 and above, monitoring blood pressure level regularly, is important. High blood pressure is especially likely to cause kidney damage when associated with other factors like diabetes, high cholesterol and Cardio- Vascular Diseases.
Eat healthy and keep weight in chec
This can help prevent diabetes, heart disease and other conditions associated with Chronic Kidney Disease.
Reduce salt intake.
The recommended sodium intake is 5-6 grams of salt per day (around a teaspoon). To reduce salt intake, try and limit the amount of processed and restaurant food and do not add salt to food.
Maintain a healthy fluid intak
Traditional wisdom has long suggested drinking 1.5 to 2 litres of water per day. Consuming plenty of fluid helps the kidneys clear sodium, urea and toxins from the body which, significantly lowers risk of developing chronic kidney disease. However, the right level of fluid intake for any individual depends on many factors including gender, exercise, climate, health conditions, pregnancy and breast feeding. People who have already had a kidney stone are advised to drink 2 to 3 litres of water daily to lessen the risk of forming a new stone.
Do not smoke
Smoking slows the flow of blood to the kidneys. When less blood reaches the kidneys, it impairs their ability to function properly. Smoking also increases the risk of kidney cancer by about 50 percent.
Do not take over-the-counter pills on a regular basi
Common drugs such non-steroidal anti-inflammatory drugs like ibuprofen are known to cause kidney damage and disease if taken regularly. Please consult your doctor before use.
Get your kidney function checked if you have one or more of the following ‘high risk’ factors
- Diabetes (Blood sugar)
- Hypertension (High blood pressure)
- Obesity (Excessive weight)
- One of the parents or other family members suffers from kidney disease
Routine blood tests for kidney function
The usual blood test which checks that the kidneys are working properly measures the level of urea, creatinine and certain dissolved salts. Dissolved salts that are routinely measured are sodium, potassium, chloride and bicarbonate. They are sometimes referred to as ‘electrolytes’. Abnormal blood levels of any of these may be due to a kidney problem. (Some other conditions may also alter the salt balance in the blood.)
Other tests include Uric acid levels, Cystatin C and e Glomerular Filtration Rate. These tests might be required if further evaluation is needed.
Urea is a waste product formed from the breakdown of proteins. Urea is usually passed out in the urine. A high blood level of urea (‘uremia’) indicates that the kidneys may not be working properly, or that you have a low body water content (are dehydrated).
Creatinine is a waste product made by the muscles. Creatinine passes into the bloodstream, and is usually passed out in urine. A high blood level of creatinine indicates that the kidneys may not be working properly. Creatinine is usually a more accurate marker of kidney function than urea. The effect of muscle mass needs to be taken into account. A person with a lot of muscle and little fat on their body is likely to have a higher creatinine than a person who has a lot of fat and little muscle.
Estimated glomerular filtration rate (eGFR) provides a guide to kidney function. Although the level of creatinine in the blood is a useful guide to kidney function, the eGFR is a more accurate measure. Blood creatinine can be used to estimate the eGFR using age, sex and race. This is often calculated by computer and reported with the creatinine blood test. The normal value for eGFR is 90-120 ml/min. An eGFR below 60 ml/min suggests that some kidney damage has occurred. The value becomes lower with increasing severity of kidney damage.
Cystatin C is an early indicator of drop in GFR and is more sensitive than creatinine.
Routine urine examination including estimation of proteins and minute quantity of protein are also simple tests which can go a long way in early detection of kidney disease.
Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al. What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrol. 2012; 13:10.