Kidney Info Guide - Other Topics

What are the kidneys? 

Most people have two kidneys. They are located near the middle of your back, just under the ribcage. Each kidney weighs about 150g. and is about the size of an adult fist. They are bean shaped and reddish brown in colour. 

The kidneys perform crucial functions that affect all parts of the body. 

What do the kidneys do? 

The kidneys have four main roles in the body:  

• Remove waste from the body. Nutrients that cannot be used by the body become toxic. The kidneys fibre the blood to remove them from the body via the urine 
  
• Remove excess water from the body 
  
• Make and regulate important hormones in the body. These hormones control red blood cell production. Control blood pressure and help keep the strong
  
• Control body chemistry by regulating the amount of salt, water and other chemicals circulating in the body 

What diseases can cause the kidneys to stop working? 

Various diseases can affect kidney function. These include: 

• High blood pressure
  
• Diabetes 
  
• Hereditary diseases of the kidneys 
   
• Inflammation of the kidneys (called nephritis) 
   
• Scarring of the kidneys (due to back-flow of urine from the bladder) or Enronet Kidney injection 
  
• Lower urinary tract infection e.g. bladder infections 
  
• Kidney damage as a side effect of medication, particularly pain killers taken for headache backache, joint pains etc. 
  
• Use of herbomineral preparations used in indigenous system of medication

The impact of these on kidney function can vary. If you have any of these conditions it is important to seek your doctor's advice about their long-term effects on the kidneys.

What are some of the symptoms of kidney disease?

Signs and symptoms of kidney disease can vary considerably between individuals. The first signs may be general and can include:

• Changes in frequency and quantity of urine passed, especially at night 
  
• Pain or burning when passing urine 
  
• Blood in urine 
  
• Puffiness around the eyes and ankles 
  
• Pain in the kidney area 
  
• Tiredness 
  
• High blood pressure

Kidney disease often causes no symptoms at all It is not uncommon for people to lose up to 70% of their kidney function before developing any symptoms.

Myth 1) Diet for all kidney patients is same

Fact -     Patients with diseases having normal kidney function such as urinary tract infection (UTI), kidney stones can have a liberal diet, and lots of water, coconut water etc but patients with poorly functioning kidneys such as chronic kidney disease need a more restricted diet.

Myth 2) I can use dietary salt substitutes such as Lona to reduce my blood pressure.

Fact - Do not use salt substitutes when kidney function is poor. Most of these use potassium instead of sodium which can lead to heart stoppage in a patient with kidney disease. Normal iodized salt should be used. Amount of salt intake depends on Fluid overload and sodium restriction. Sodium rich foods should also be restricted.

Myth 3) My kidneys are not functioning well hence I should drink more water.

Fact - Some people need to limit their fluids while others can drink any amount they wish or they feel thirsty. As kidney function decreases, the kidneys may not produce as much as urine as before & your body may become overloaded with fluid.

On the other hand, patients with normal kidney function and with kidney stone or UTI need to drink plenty of water. Drinking extra water helps to flush substances that form stones from the kidneys.

Myth 4) I feel very weak, I should have fruits, fruit juices, dry fruits, coconut water, soups, and milk.

Fact – Fruits, fruit juices, coconut water vegetable soups will have lot of potassium, thereby, need a restriction in patients with chronic kidney disease.

Dry fruits, beans, peas, dairy products are rich in phosphorus and thus should be avoided or be consumed in desirable amounts.

But for patients having kidney stone consuming potassium rich foods will be helpful in treating the disease. Consuming excess salt, alcohol, animal protein, and carbonated beverages, oxalate rich foods such as spinach, chocolate, nuts should be avoided.

Myth 5) I have kidney disease I should avoid tomatoes, ladies fingers, brinjals as they contain seeds.

Fact -     Most of the vegetables can be consumed, but if potassium in your blood is high you need to boil the vegetables / dal in water & discard the water.

Even for kidney stone patients most of the vegetables are allowed in desirable amounts.

Myth 6) I should not have dal / pulses at all.

Fact -     Dal / pulses can be consumed in moderate quantity prepared in medium consistency. Whole pulses & sprouts can be consumed occasionally.

Soya has renoprotective properties so should be incorporated in the diet in desirable amounts.

On the other hand, patients on dialysis should consume dal / pulses / curds / chicken / fish to meet their protein requirement. It is also important to eat the right amount of calories and other nutrients when receiving dialysis.

Myth 7) I should eat palak (spinach), beetroot to increase my haemoglobin.

Fact -     The anemia (less blood), is not due to iron deficiency but deficiency of hormone called Erythropoietin, which is available in the market as injections and hence eating these food items is not likely to increase your haemoglobin.

Myth 8) I can’t work / exercise with my kidney disease.

Fact - Moderate exercise/ walk is permitted as per the comfort of each patient.

Normal routine work should be promoted for such patients and is not harmful to the kidney. 

Charul Arora -

(Registered Dietitian)

Anatomy of Kidneys The kidneys are paired organs with several functions. They are seen in many types of animals, including vertebrates and some invertebrates. They are an essential part of the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid-base balance, and regulation of blood pressure. They serve the body as a natural filter of the blood, and remove wastes which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium; the kidneys also are responsible for the reabsorption of water, glucose, and amino acids. The kidneys also produce hormones including calcitriol, renin, and erythropoietin. Located at the rear

of the abdominal cavity in the retroperitoneum, the kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter, itself a paired structure that empties into the urinary bladder. Diseases of the kidney are diverse, but individuals with kidney disease frequently display characteristic clinical features. Common clinical conditions involving the kidney include the nephritic and nephrotic syndromes, renal cysts, acute kidney injury, chronic kidney disease, urinary tract infection, nephrolithiasis, and urinary tract obstruction.[1] Various cancers of the kidney exist; the most common adult renal cancer isrenal cell carcinoma. Cancers, cysts, and some other renal conditions can be managed with removal of the kidney, or nephrectomy.

When renal function, measured by glomerular filtration rate, is persistently poor, dialysis and kidney transplantation may be treatment options. Although they are not severely harmful, kidney stones can be a pain and a nuisance. The removal of kidney stones includes sound wave treatment, which breaks up the stones into smaller pieces which are then passed through the urinary tract. One common symptom of kidney stones is a sharp pain in the medial/lateral segments of the lower back. Generally, humans can live normally with just one kidney, as one has more functioning renal tissue than is needed to survive. Only when the amount of functioning kidney tissue is greatly diminished will chronic kidney disease develop. Renal replacement therapy, in the form of dialysis or kidney transplantation, is indicated when the glomerular filtration rate has fallen very low or if the renal dysfunction leads to severe symptoms.

If your child has been diagnosed with chronic kidney disease, you are no doubt feeling distressed and bewildered. These feelings are normal. And once you realize that your child's illness is a reality the family must accept, you can develop some practical ways to cope with the day-to-day aspects of it. Here are some things others have found helpful.

Physiology of Kidney

 

Renal physiology is the study of kidney function, while nephrology is the medical specialty concerned with kidney diseases.

The kidney participates in whole-body homeostasis, regulating acid-base balance, electrolyte concentrations, extracellular fluid volume, and regulation of blood pressure. The kidney accomplishes these homeostatic functions both independently and in concert with other organs, particularly those of the endocrine system. Various endocrine hormones coordinate these endocrine functions; these include renin, angiotensin II, aldosterone, antidiuretic hormone, and atrial natriuretic peptide, among others.

Many of the kidney's functions are accomplished by relatively simple mechanisms of filtration, reabsorption, and secretion, which take place in the nephron. Filtration, which takes place at the renal corpuscle, is the process by which cells and large proteins are filtered from the blood to make an ultrafiltrate that will eventually become urine. The kidney generates 180 liters of filtrate a day, while reabsorbing a large percentage, allowing for only the generation of approximately 2 liters of urine. Reabsorption is the transport of molecules from this ultrafiltrate and into the blood. Secretion is the reverse process, in which molecules are transported in the opposite direction, from the blood into the urine.

Excretion of wastes

The kidneys excrete a variety of waste products produced by metabolism. These include the nitrogenous wastes urea, from protein catabolism, and uric acid, from nucleic acidmetabolism.

Acid-base homeostasis

Two organ systems, the kidneys and lungs, maintain acid-base homeostasis, which is the maintenance of pH around a relatively stable value. The kidneys contribute to acid-base homeostasis by regulating bicarbonate (HCO₃^-) concentration.

Osmolality regulation

Any significant rise or drop in plasma osmolality is detected by the hypothalamus, which communicates directly with the posterior pituitary gland. An increase in osmolality causes the gland to secrete antidiuretic hormone (ADH), resulting in water reabsorption by the kidney and an increase in urine concentration. The two factors work together to return the plasma osmolality to its normal levels.

Urea is usually excreted as a waste product from the kidneys. However, when plasma blood volume is low and ADH is creating a hyperosmotic solution that 'attracts' water. Urea can then re-enter the nephron and be excreted or recycled again depending on whether ADH is still present or not.

Blood pressure regulation

Long-term regulation of blood pressure predominantly depends upon the kidney. This primarily occurs through maintenance of the extracellular fluid compartment, the size of which depends on the plasma sodium concentration. Although the kidney cannot directly sense blood pressure, changes in the delivery of sodium and chloride to the distal part of the nephronalter the kidney's secretion of the enzyme renin. When the extracellular fluid compartment is expanded and blood pressure is high, the delivery of these ions is increased and renin secretion is decreased. Similarly, when the extracellular fluid compartment is contracted and blood pressure is low, sodium and chloride delivery is decreased and renin secretion is increased in response.

Hormone secretion

The kidneys secrete a variety of hormones, including erythropoietin, calcitriol, and renin. Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the renal circulation. It stimulates erythropoiesis (production of red blood cells) in the bone marrow. Calcitriol, the activated form of vitamin D, promotes intestinal absorption of calcium and the renal reabsorption of phosphate. Part of the renin-angiotensin-aldosterone system, renin is an enzyme involved in the regulation of aldosterone levels.

How common are kidney stones?

Each year, more than half a million people go to emergency rooms for kidney stone problems. lt is thought that one in ten people will have a kidney stone at some time in their lives.

The peak age for stones is between 20 years and 50 years. Men are much more likely to develop stones than women. Other diseases like high blood pressure, diabetes, obesity, osteoporosis, chronic diarrhea, or kidney cysts might increase the risk of stones. Diabetes increases the risk of developing kidney stones, especially in younger women. Only about 25% of kidney stones occur in people with a family history of stones. Doctors say they're seeing increasing numbers of children with kidney stones. After bariatric (weight loss) surgery, in which the digestive tract is altered, kidney stones are more common. Levels of oxylate are much higher after this surgery.

What is a kidney stone?
A kidney stone is a hard object that is made from chemicals in the urine. Urine has various wastes dissolved in it. When there is too much waste in too little liquid, crystals begin to form. The crystals attract other elements and join together to form a solid that will get larger unless it is passed out of the body with the urine. Usually, these chemicals are eliminated in the urine by the kidney. In most people, having enough liquid washes them out or other chemicals in urine stop a stone from forming. The stone-forming chemicals are calcium, oxalate, urate, cystine, xanthine, and phosphate.

After it is formed, the stone may stay in the kidney or travel down the urinary tract into the ureter. Sometimes, tiny stones that move may move out of the body in the urine without causing too much pain. But stones that don't move may cause a back-up of urine in the kidney, ureter, the bladder, or the urethra. This is what causes the pain.

Possible causes include drinking too little water, exercise (too much or too little), obesity, weight loss surgery, or eating food with too much salt or sugar. Infections and family history might be important in some people. Eating too much fructose correlates with increasing risk of developing a kidney stone. Fructose can be found in table sugar and high fructose corn syrup. In some individuals, fructose can be metabolized into oxalate.

These are the usual causes in most people. Kidney stones have been found throughout history. Scientists found evidence of kidney stones in a 7,000-year-old Egyptian mummy.

What are the symptoms of a stone?
Some kidney stones are as small as a grain of sand. Others are as large as a pebble. A few are as large as a golf ball! As a general rule, the larger the stone, the more noticeable are the symptoms.

The symptoms could be one or more of the following:

1   Severe pain on either side of your lower back

2   More vague pain or stomach ache that doesn't go away

3   Blood in the urine

4   Nausea or vomiting

5   Fever and chills

6   Urine that smells bad or looks cloudy

The kidney stone starts to hurt when it causes irritation or blockage. This builds rapidly to extreme pain. In most cases, kidney stones pass without causing damage-but usually not without causing a lot of pain. Pain relievers may be the only treatment needed for small stones. Other treatment may be needed, especially for those stones that cause lasting symptoms or other complications. In severe cases, however, surgery may be required.

What should I do if I have these symptoms and think I have a stone?
See a doctor as soon as possible. You may be asked to drink extra fluid in an attempt to flush out the stone out in the urine.

Kidney transplantation is a surgical procedure in which a healthy, donated kidney is placed into the patient with kidney failure. It is another option for the treatment of End Stage Renal Disease (ESRD) other than dialysis. The donated kidney can perform all the functions that the patient's damaged kidneys are unable to do. Once a patient decides to go through with a kidney transplant, they would begin the transplant evaluation process. Types of Kidney Transplants

Kidneys for transplantation come from two sources:

• Living Donors

   family members (i.e. mother, father, brother or sister), spouse and children who are at least 18 years of age.

  Living donor transplants are encouraged for the following reasons:

  • One of your blood relatives may provide a closer genetic match. The long-term success rate of living donor kidney transplants is excellent.
  • A living donor's kidney will be removed in a scheduled surgery, thus eliminating the wait for a cadaver donor.
  • The likelihood of immediate functioning of your kidney after a living donor transplant is greater because of the short length of time the donor kidney is without blood supply.

    Donors will be evaluated very carefully and only then be accepted as donors.

• Cadaver Donors

   people who have died and donated their organs for transplant. If you have been approved for transplant and do not have any living donors, or if you are unsure about living donors, then you will be placed on the cadaver donor waiting list. Once you are accepted for transplant, your name is placed on the national waiting list. Whenever a kidney becomes available, a search is made for the best genetic match for that kidney. When found, the potential recipient is notified and transplant is carried out.

 All I need to Know about Kidney Transplant :

Kidney transplantation is a surgical procedure in which a healthy, donated kidney is placed into the patient with kidney failure. It is another option for the treatment of End Stage Renal Disease (ESRD) other than dialysis. The donated kidney can perform all the functions that the patient's damaged kidneys are unable to do. Once a patient decides to go through with a kidney transplant, they would begin the transplant evaluation process.

Kidneys for transplantation come from two sources:

• Living Donors
  Family members (i.e. mother, father, brother or sister), spouse and children who are at least 18 years of age. Living donor transplants are encouraged for the following reasons 
  • One of your blood relatives may provide a closer genetic match. The long-term success rate of living donor kidney transplants is excellent.
  • A living donor's kidney will be removed in a scheduled surgery, thus eliminating the wait for a cadaver donor.
  • The likelihood of immediate functioning of your kidney after a living donor transplant is greater because of the short length of time the donor kidney is without blood supply.

    Donors will be evaluated very carefully and only then be accepted as donors.

• Cadaver Donors
  People who have died and donated their organs for transplant. If you have been approved for transplant and do not have any living donors, or if you are unsure about living donors, then you will be placed on the cadaver donor waiting list. Once you are accepted for transplant, your name is placed on the national waiting list. Whenever a kidney becomes available, a search is made for the best genetic match for that kidney. When found, the potential recipient is notified and transplant is carried out

What is Diabetes?

Diabetes mellitus, usually called Diabetes, is a disease in which your body does not make enough insulin (a hormone that regulates the amount of blood sugar) or cannot use normal amounts of insulin properly resulting in a high blood sugar level which can damage many parts of your body. Diabetes is the leading cause of kidney disease.

Different types of Diabetes

Most common ones are Type I and Type II

Type I diabetes usually happens in children. It is also called as: Juvenile Onset diabetes mellitus. In this type, your pancreas does not make enough insulin & you have to take insulin injections.

Type II diabetes is most common one, usually happens in people above 40 & is called adult Onset diabetes mellitus. It is also called as non insulin dependent diabetes mellitus. In this type, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet &/or taking pills, although some patients must take insulin.

How does Diabetes affect your body?

 Uncontrolled diabetes eventually damages small blood vessels throughout the body, affecting organs and tissues such as skin, nerves, muscles, intestines, heart and kidney. Patients with diabetes can develop high blood pressure and hardening of the arteries which could lead to heart disease and eye disorders. Damage to blood vessels can impair kidney function, resulting in diabetic kidney disease.

What does Diabetes do to the kidneys?

After years of diabetes, the filtering units of your kidney become scarred and do not filter blood efficiently. Kidney disease is the deterioration in the ability of your kidneys to perform their regular functions, one of which is filtering waste products from the blood as a result, your body will retain more water & salt than it should, which can result in weight gain & ankle swelling. Protein in urine may be seen.

Diabetes also damages the nerves in your body. This can cause difficulty in emptying your bladder. The pressure that results from your full bladder can back up & injure the kidneys. If urine stays in your bladder for a long time, you may develop a urinary tract infection as bacteria grows rapidly in urine with a high sugar level.

Early & late signs of Kidney disease in Diabetics

• Albumin - protein in the urine
• High blood pressure
• Ankle & leg swelling, leg cramps
• More frequent urination, especially at night
• High levels of BUN & creatinine in blood
• Less need for insulin or anti-diabetic pills
• Morning sickness, nausea & vomiting
• Weakness, pallor & anemia
• Itching

Kidney stones occur when certain substances in the urine form crystals that stick to surfaces inside the kidney; if these remain small enough they can pass out of your body in the urine without even causing any symptoms. Most commonly, kidney stones are made from calcium combined with oxalate or phosphate. A less common type of stone is caused by infection in the urinary tract.

Cause of formation of kidney stones

 Stones are generally caused by any of the following causes,

• An inherited condition that causes you to excrete calcium in your urine.
• A low level of citrate in your urine, which may lead to calcium stones.
• A disorder that causes the parathyroid gland, to be overactive & release more hormone. This results in an increased level of calcium & phosphorus in your urine, which may lead to stone formation.
• Urinary tract infection or obstruction.
• Gout, which causes acid urine & may lead to uric acid or calcium stones.
• Chronic inflammatory bowel disease (Crohn''s disease), which results in an increased level of oxalate in your urine & may lead to calcium oxalate stones.

Please note, more than 40% of cases have no obvious cause.

Symptoms of kidney stones

 Severe pain in the back in the area of the kidney or in lower abdomen. Other symptoms are nausea & Vomiting, blood in the urine, frequency of urine, and fever with chills if there is associated infection.

 

Kidney failure occurs when the kidneys stop working. Most kidney problems happen slowly. You may have SILENT kidney disease for years. Gradual loss of kidney function is called Chronic Renal Failure or Chronic Kidney Disease (CKD), which is followed by End stage renal disease (ESRD). The condition of nearly total & permanent kidney failure where the level of efficiency is less than 10 Percentage is called ESRD. When the Kidney function deteriorates, the waste products & excess fluid remain in the body.

Your skin may begin to itch. Some parts of your body may swell as the result of fluid retention. This retention of fluid is called Odema and will lead to in increase in body weight, high blood pressure & respiratory problems. Kidney failure can also leads to blood deficiency (Anaemia) & brittle bones.

In contrast to chronic or permanent kidney damage, acute renal failure occurs when the kidneys suddenly stop working, this condition is temporary. The cause may be disease, injury, major surgery or toxic agents. It is generally reversible.

Are you at increased risk for CKD ?

Yes if you have,

• High Blood Pressure
• Diabetes
• Stone Disorder
• Obesity
• Family History of CKD
• If you are on painkillers or Ayurvedic Bhasmas

Causes of Kidney Disease

The major cause of kidney failure is Hypertension, Diabetes, ureteric obstruction due to stone, drugs mainly the pain killers & radiation. Many other conditions can harm the kidneys like glomerulonephritis (Inflammation of Kidneys) & inherited diseases like polycystic kidney disease, which causes many cysts to form in the kidneys.

Here's how your body works:
It is the kidneys' job to make urine, which goes down tubes into the bladder. The bladder is like a water balloon that holds the urine. There is a muscle gate that holds the urine in. When the bladder is full it sends a message to the brain and the brain tells the gate to open. In order to be the boss of your urine at night, all the parts need to work together.