Dr Zekolo Koza
Consultant, Department of Medicine
What is the role of your Kidneys?
Your kidneys are two bean-shaped organs, each about the size of your fists. They are located near the middle of your back, just below the rib cage. Inside each kidney about a million tiny structures called nephrons filter blood.They remove waste products like creatinine and extra water, which become urine. The urine flows through tubes called ureters to your bladder, which stores the urine until you go to the bathroom.
The kidneys also regulate electrolytes such as Potassium, Calcium & Magnesium. Moreover, kidneys release three important hormones:
1. Erythropoietin or EPO, which stimulates the bone marrow to make Red blood cells
2. Renin, which regulates Blood Pressure ( so if Kidneys fail, your BP shoots up)
3. Calcitriol, which is essential for ensuring that calcium is absorbed from food that we eat.
What are the common causes of Chronic Kidney Disease (CKD)?
i) Diabetes (High Sugars) & Hypertension (High Blood Pressure)
ii) Obstructions like :Kidney Stones, Cancer or enlarged Prostate gland.
iii) Taking excessive painkillers (eg. Sumo/ Diclonac)
What are the signs of chronic kidney disease (CKD)?
People in the early stages of CKD usually do not feel sick at all. In the later stages, they may experience some of the complaints listed below:
1. Passing less Urine
2. Swelling of feet and face
3. Feeling Tired
4. Loss of Appetite or experience nausea and vomiting
5. Drowsiness or have trouble concentrating
6. Muscle cramps & itchy dry skin
What happens if the kidneys fail completely?
Total or nearly total and permanent kidney failure is called ESRD (End-Stage Renal Disease). Here, the body fills with extra water and waste products.This condition is called uremia. Untreated uremia may lead to seizures, breathlessness or coma and will ultimately result in death. People with ESRD(End-Stage Renal Disease) must undergo dialysis or transplantation to stay alive.Diseased Kidneys can be compared to the Engine of a car; the Car engine gradually worsens over a period of time till finally it breaks down. When that happens, the car engine has to be repaired or replaced with a new one. Likewise, at this stage you will need a new Kidney donated by your relatives ( which is called as Renal/ Kidney Transplantation). If that’s not possible, then you can do Dialysis. Remember there are 2 types of Dialysis: i) Hemo-dialysis which requires a Machine & electricity and ii) Peritoneal dialysis which doesn’t require a machine; it only needs a tube to be placed in your Abdomen.
Are both Kidneys affected ?
Yes, Chronic Kidney Disease affects Both the Kidneys.
How do kidneys fail?
Acute Kidney Injury
Some kidney problems happen quickly, such as blunt trauma to the kidneys. Losing a lot of Blood by Trauma or losing lots of fluid in the form of Diarrhea can also cause sudden kidney failure.These sudden drops in kidney function are called Acute Kidney Injury (AKI). AKI is reversible if prompt treatment is started.
Chronic Kidney Disease (CKD)
Most kidney problems, however, happen slowly. A person may have "silent" kidney disease for years. Gradual loss of kidney function is called chronic kidney disease (CKD).People with CKD may go on to develop permanent kidney failure. They also have a high risk of death from a stroke or heart attack.
What are the stages of CKD (chronic kidney disease) & Treatment options ?
A simple blood test can estimate the volume of blood that is filtered by the glomeruli in your kidneys over a given period of time. This test is called GFR (Glomerular Filtraton Rate). GFR of 90 or above is considered normal. A person whose eGFR stays below 60 for 3 months or longer has CKD. CKD is classified into 5 stages with stage 1 being the least severe & stage 5 being the worst called as ESRD (End-Stage Renal Disease).
Stage GFR Description Treatment options
1 >90 Normal kidney function but with indicator of underlying disease, ie urine abnormalities. control BP/ Sugar, monitor Creatinine, Sodium & Potassium. Stop smoking. Do urine test.
2 60-90 Slightly reduced function. Same as above
3 30-60 Moderately reduced renal function. Continue monitoring, gain diagnosis if not known.Educate on treatment options & cost of treatment.Treat anemia & weak bones.Correct excess Potassium/ Phosphorus levels in blood. Consult a Nephrologist.
4 15-30 Severely reduced function. Educate again on need for Dialysis or Kidney Transplantation. Manage any symptoms and complications.
5 <15 ESRD ie,End-Stage Renal Disease. (>90% of your kidney function is lost) Start Dialysis or Kidney Transplantation. Remember there are 2 types of Dialysis; one is with Machine , another is without Machine.
What can be done about CKD (chronic kidney disease)?
Unfortunately, CKD often cannot be cured. But people in the early stages of CKD may be able to make their kidneys last longer by taking certain steps. The aims of treatment include:
1. If possible, treat any underlying kidney condition.
2. Prevent or slow down the progression of CKD.
3. Reduce the risk of developing Heart disease or Stroke.
4. Relieve symptoms and complications caused by CKD.
What are the treatment options? What are the two types of Dialysis?
i) HEMO-DIALYSIS
Hemodialysis uses a machine that contains a special filter called a Dialyzer to remove Wastes & extra fluid/water from the body. It also maintains proper balance of minerals in the blood. During treatment, patient’s blood filled with waste products is pumped from the body through tubes into the Hemodialysis machine. The machine cleans the blood and pumps back the filtered blood to the patient via another tube that is INSERT IGNOREed into the vein. Hemodialysis is usually performed in the Hospital three times per week for 4 hours.The patient is in effect, connected to a kind of artificial kidney.
Hemo-dialysis is ideal if Patient can come to hospital three times per week (ie, like every Alternate day!). That too for lifelong ! Monthly Dialysis fees may cost approx. Rs.30,000/ Month.
ii) PERITONEAL DIALYSIS
Here, a special catheter (Tube) is placed surgically in the Abdominal cavity. A sterile solution rich in minerals and glucose is run through this tube into the Abdominal (Peritoneal) cavity. Peritoneal dialysis uses the internal lining of the abdomen as a filter to clear waste products and extra fluid from the body. Peritoneal dialysis is done at home by the patient after proper training is given at the Hospital. Researchers have found that both Hemodialysis & Peritoneal dialysis are equally effective. Peritoneal dialysis is ideal if patient wants to go to College/ Office or move about freely without the need to go to Hospital. Especially good if patient is in a remote village where there’s no proper Electricity/hospital since this doesn’t need machine, patient & relatives can do it at home. Cost is approx. Rs.20,000 /month for buying the special Dialysis Solution.
iii) KIDNEY TRANSPLANTATION
Here a kidney has to be donated to the patient by i) living relative ii) living unrelated person iii) or person who has died from whom kidney has been harvested and preserved. In most cases the bad kidneys are not removed.The donated extra kidney is usually placed in the iliac fossa ,the lower most part of the abdomen.
This is the Best option if affordable. Cost is approx. Rs.5 to 8 Lakhs initially . Then a monthly maintenance of approx. Rs. 15,000 on immunosuppressive medicines.
Some Reflections:
Chronic Kidney Disease drains away the whole family both financially & emotionally. It is a tragedy especially if poor people get this disease since the treatment is expensive. They need to weigh options whether to go for definitive treatment or not. For instance if that poor patient has Five other siblings who all want education and the father earns only Rs. 10,000/ month , then comes the dilemma whether he should survive at the cost of other siblings discontinuing their education. And even then, salary will not be enough, the family has to borrow money. Finally the whole family will be in debt; land / house will have to be mortgaged and the other siblings without a future! Can the State Govt. / Church step in? What will be the ideal role of the church when it gives money for missions to far flung areas but neglects its own member who is sick ...Doesn’t charity begin at home? Doesn’t missions begin First in Jerusalem, then to Judea, Samaria & to the ends of the earth? But how to draw the line? For it is impossible for the Church/ Govt./ Private Hospitals to bail out every poor patient. Even the rich find it difficult to sustain definitive treatment for this type of chronic disease. Prevention is the key. Therefore seek early treatment before your kidney disease becomes irreversible. So do Check your BP and Blood Sugar level soon, especially if you are above 40 years. Remember to do for your Aunts, Uncles and Family. If you don’t take pro-active part in screening them, the burden may fall on you to care for them when they fall sick. For a stitch in time saves nine !!
