The Bean Twins
Kidneys are a pair of bean shaped organs situated on either side of abdomen. It has 9-11cm length and 4-5cm breadth. The specific components of the kidneys are nephrons, collecting duct, and unique microvasculature.
Each kidney contains around 1.2 million nephrons, which is already established during prenatal development hence a lost nephron cannot be replaced. They are the basic functional (filtering) units of kidney. Parts of these nephrons are glomerulus, proximal convoluted tubule, loop of henle, distal convoluted tubule, collecting duct.
Kidneys are highly rich in blood supply. It accounts for about 25% of the cardiac output approximately 1200ml/min. GFR which is the functional measure of kidneys is the total rate at which fluid is filtered into all the nephrons is 120ml/min /1.73 m2 surface area. Results in urine production 1.5-2.5lit/day.
What are the functions of Kidneys
Ø Removal of waste products and drugs
Ø Fluids and electrolyte balance
Ø Acid-base balance
Ø Endocrine functions(Erythropoitin production and regulation of calcium/phosphorous balance and formation of active vitamin d3)
Ø Blood pressure regulation via renin production
How can we protect our kidneys
1. Drink enough water around 2.5-3lit/day
2. Avoid junk foods
3. Reduce salt consumption
4. Avoid nephrotoxics like pain killers and alternative medicines which are harmful to kidney
5. Regular physical activity and weight reduction
6. Strict control of Diabetes mellitus and hypertension
7. Avoid smoking
Kidney diseases are divided based on which compartment inside kidney is affected.
Glomerular diseases present with protein leak in urine, leg swelling, hypertension, cola coloured urine, decreased urine output. Various diseases affecting glomerular compartment includes Nephrotic syndrome, Nephritic syndrome. It can be congenital, acquired (infections, Drugs, autoimmune, idiopathic, genetic, diabetes mellitus)
Tubular diseases can be due to ischaemia or toxin mediated damage which results in acute tubular necrosis. It may be because of blood loss, hypotension, sepsis, drugs
Interstitial diseases due to drugs, toxins and infections. It usually results in non oliguric renal failure.
Vascular diseases affecting kidney can be microvascular or macrovascular. Macrovascular are involvement of large vessels with atherosclerotic, embolic or vasculitic damage. Microvascular damages usually vasculitis or Thrombotic microangiopathies.
Urological diseases are obstructive kidney damage. It can be due to stones, tumors, infections resulting in sloughed papillae, prostate enlargement and UTI
Acute or Chronic
AKI (Acute Kidney Injury) develops over hours to days. Most of the time it can be completely curable once the underlying problem is treated, but it is always a risk factor for Chronic Kidney disease also. So timely and proper management of AKI is always important.
CKD is chronic kidney disease in which damage persists minimum of 3 months or more or there is permanent structural changes in kidney. As the name says it is chronic damage and not completely curable. The treatment mainly directed against retarding the progression.
Ø Hereditary(polycystic kidney disease)
Ø Hypertension related
Ø Diabetes related
Ø Drugs and toxin related
Ø Infections including UTI
Ø Stone disease
How to suspect kidney diseases
· Swollen legs,
· Early morning facial puffiness,
· Frothing of urine,
· Change in colour of urine like cola coloured urine or red colour urine,
· Colicky abdominal pain,
· Decreased urine output
Regular health check-up as most of the time kidney diseases are silent
How to detect kidney diseases
Kidney function test(blood urea, serum creatinine)
Abdominal scan (Ultrasound/CTscan)
Kidney biopsy if indicated
Diabetic Kidney disease
Diabetic Nephropathy is the leading cause of end stage renal disease. It can develop in the course of both Type 1 and type 2 diabetes. Hence any kidney disease discussion cannot be completed without Diabetic nephropathy. Duration of diabetes mellitus an important factor in leading to nephropathy however type 2 diabetes mellitus can present with renal involvement at onset of diabetes itself because its onset may be masked. Type 1 DM leading to nephropathy minimum of 5years after onset of diabetes.
The most important presentation of diabetic nephropathy is proteinuric illness presenting with froth in urine leading to swollen legs and involvement of other organs especially diabetic retinal disease. Also the onset of diabetic nephropathy results in hypertension and if you are already hypertensive your hypertension (BP) getting uncontrolled.
Diabetic nephropathy as any CKD is a progressive illness. Treatment is directed to slow down the progression of illness. Hence the Treatment is directed towards strict diabetes control, control of hypertension and optimisation of other medications. Diet is most important which includes diabetic diet, salt restriction limiting to 4-5gram per day, protein restriction especially animal proteins. Most importantly you need to be on regular follow up with your nephrologist.
Hypertensive kidney disease
Hypertension and kidney very much closely related. Most of the time kidney diseases can present with hypertension also long standing hypertension itself can result in kidney disease. Strict control of Blood pressure is needed to treat kidney disease also.
Kidney disease treatment options
Treatment begins with dietary changes and medicines.
Diet in kidney disease varies for each person depends on his volume and electrolytes status. In general salt restriction 4grams per day and fluids according to the volume status of the person and low protein diet around 0.8-1g/kg/day with preference to vegetable protein also restriction of potassium is needed.
To control diabetes mellitus, hypertension, acid base status, anaemia corrections either iron supplementation or injectable erythropoietin is given.
There are three treatment options for chronic kidney disease which is progressed and reached ESRD:
It can be done in a centre, three to two times per week minimum of 4 hours each, or at home with the help of a care partner. For Hemodialysis an arteriovenous access is required which can be AV fistula, AV Graft, Permanent catheters. Through which blood is drawn out of the patients body and returned back after purification in hemodialysis machine.
2.Peritoneal dialysis (PD)
It can be done at home. It uses the body's own peritoneal membrane — beneath the outer layers of the abdominal wall — to filter the blood. There are two types of PD: continuous ambulatory peritoneal dialysis (CAPD) is done by manually draining and filling the peritoneal cavity in the abdomen, while continuous cycling peritoneal dialysis (CCPD) is performed with a machine at night.
It is an option that provides a more flexible way of life because no need to spend time on dialysis. A kidney can come from a living donor—usually a family member—or someone who has recently died (cadaveric donor), but it must be a match to your body to prevent being rejected. Immunosuppressant medication will be prescribed so that the new kidney is not rejected which along with other medications and lifelong follow up to be continued.