What is Kidney's function?
There are two kidneys in a body of person. It is a bean shaped organ and situated on both sides of the spinal column at the back. The kidneys are very important organ of the body. The main functions of the kidneys are:
- To excrete waste products of our body along with urine.
- To maintain salt and water balance in the body.
- Helps in control of blood pressure.
- Helps in metabolism and activation of different molecules in the body.
- Helps in maintaining the hemoglobin in the body thus prevents anemia.
- Prevents loosing vital molecules (e.g. protein, salts) from the body.
What are the signs and the symptoms of kidney diseases?
There may not be any symptoms in most of the patients.
Many patients might say: "I was alright till few days back!"
Others may present with:
- Swelling (lower eye lid noticed in the morning to swelling of legs and whole body)
- Weakness
- Reduced appetite
- Nausea/Vomiting
- Altered urinary behavior, either increased or decreased urine output
- Dryness of Skin and itching
- Low Hemoglobin
- No menstrual cycle
- Reduced sexual desire
- Difficult to become pregnant
- Other features of different systemic involvement
What are the kidney diseases?
There are many kinds of kidney diseases. Few are listed below:
- Native kidney diseases like Glomerulonephritis
- Kidney ailments due to other diseases like hypertension, Diabetes, infections, connective tissue disorders
- Kidney damage due to medications like pain killers, some antibiotics
- Kidney damage due to obstruction like stones and prostate
- Stone diseases
- Renal failure (Acute or Chronic)
- Familial like Autosomal Dominant Polycystic kidney disease (ADPKD), Alport's
How to diagnose Kidney disease?
Simple interview of a patient
Thorough examination of a patient
Investigations like Routine Urine Examination, Blood test for Creatinine, Hemoglobin and others, Ultrasound of belly to see the shape and size of the kidneys and other tests including kidney biopsy to find out the causes of the kidney diseases
Your physician can help choose appropriate investigations for you.
What is Kidney biopsy?
This is a special and most of the time diagnostic test that is done to diagnose a kidney disease. This is done as an inpatient procedure so you have to get admitted in the hospital. Before going through this test, patient has to undergo different tests to see whether the test is feasible or not. We explain in detail regarding the procedure and the complications that may occur during and after the procedure. After completing the formalities like signing the consent, the procedure is done under local anesthesia (only the part of the skin is numbed) and real time guidance of an ultrasound. An automated biopsy gun is inserted once kidney is localized and two to three small pieces of kidney tissues are taken out. The tissues thus obtained are sent for histo-pathological examinations. Once the procedure is finished, which usually takes 10-15 mins, patient is advised to be in complete bed rest for next 24hrs. During this period we observe for the complications that may occur. On the next day of the biopsy, we routinely look for the complications with the help of ultrasound. At the time of the discharge, patient is advised to avoid heavy and strenuous activities for 2 weeks. You will get the histo-pathological report after 1-3 weeks of the procedure and can be followed up in OPD with the report.
What is kidney failure?
When both native kidneys are unable to perform their functions, especially excretion of waste products and excess water, then we call kidneys are failing. To reach this stage both the kidneys should be damaged.
Basically, kidney failure can be term as:
Acute Kidney Injury (AKI)
Chronic Kidney Disease (CKD)
AKI:
AKI occurs in short period of time and is almost 100% reversible. Sometimes patient with AKI may also need dialysis for supporting the function of the kidneys till it recovers. There are many causes and some of them are listed below:
- When blood pressure is low due to fluid loss (eg. diarrhea, vomiting) or blood loss
- When patient has severe infection (Sepsis)
- When a patient with weak kidneys are given some drugs like pain killers and alternative medicines.
- When a patient's urine is blocked (Stone, prostate)
- Can be due to native kidney diseases
- Can be due to other systemic diseases like heart, liver ailments
CKD:
CKD occurs over a long period of time and the function gradually decreases. Once the damage reaches to a certain level, patient will need one or other type of renal replacement therapy (RRT) like transplantation, hemodialysis and peritoneal dialysis. During initial period of CKD, nephrologists try if possible to reverse or stabilize or decrease the rate of decline in the function. However, the kidney function deteriorates gradually and reaches the end stage when RRT will be necessary to support the patient. The time frame to reach the end stage depends on primary kidney diseases and differs from patient to patient. Some causes of CKD are listed below:
- Primary kidney disease like glomerulonephritis
- Diabetes Mellitus
- Hypertension
- Infections
- Stones
- Drugs
- Cause not known.
- Hereditary and familial.
What is Renal Replacement Therapy (RRT)?
When a person's both native kidneys are not functioning (temporarily or permanently) then he will need a supportive treatment. This supportive treatment is called renal replacement therapy. This constitutes renal transplantation, hemodialysis and peritoneal dialysis.
Renal transplantation:
This is a best and definitive treatment of chronic renal failure and is the best modality of RRT. After transplantation you remain independent and can assume your previous activities as before. But you need to remain on regular follow up as well as consume pills. Your quality of life will be superior to when you are in dialysis. This is carried out with a surgery. A kidney from a healthy relative of the patient is taken out and transplanted into the body of the patient. Patient needs to take anti-rejection treatment for the life.
Hemodialysis (HD):
This is another method of RRT where blood of the patient is taken out and cleaned with the help of the dialyser (artificial kidney) and is returned back into the body with the help of the dialysis machine. This procedure is done in the dialysis unit and patient has to come to the center twice or thrice a week. This procedure can be done to the patient of acute and chronic kidney failure (temporary and permanent failure). Hemodialysis can be done at home also. When the patient is on HD, he needs to be kept on diet restrictions as per the advice of the physician and has to take medications as needed. Now, portable (wearable) hemodialysis and implantable devices are being developed.
Peritoneal Dialysis (PD):
This is the third method of RRT. In this process special fluid is sent into the abdominal cavity and kept for some time again to drain out through the temporary or permanent tube inserted inside the abdominal cavity. This procedure does not need any machine (except in Automated peritoneal dialysis APD) and can be done in and out of the hospital. Continuous ambulatory peritoneal dialysis (CAPD) is one kind of PD which is done daily and fluid is exchanged three to four times a day. Patient can do this type of dialysis by himself at home without the help of the machine and can pursue his/her daily activities. The patient can observe less stringent diet control. However, these patients also needs to be on regular follow up with the nephrologists and take medications as per prescribed. NMC has been involved with this modality of dialysis for last 10 years and have dedicated nurses to provide services.
Government policy regarding dialysis:
Nepal government has decided to reimburse the cost of RRT (Renal transplantation, hemodialysis and CAPD). NMC is providing this service as per the rule of Nepal government for hemodialysis and CAPD. However, if the patient needs special care like admissions and special dialysis like SLED then the patient has to pay the extra amount by themselves. In order to enjoy this facility, the patient has to undergo certain formalities for which the patient can contact the hemodialysis unit.
What is Slow or sustained Low Efficiency Dialysis (SLED)?
Slow or sustained Low Efficiency Dialysis (SLED) is a special kind of hemodialysis which is done in patients with unstable cardiac status like low blood pressure. Usually this is done in patients with AKI and in ICU. Ideally these sets of patients undergo Continuous renal replacement therapy (CRRT) in western countries but as CRRT is very expensive, SLED is done. SLED is more or less comparable to CRRT in efficacy and is done worldwide. NMC has facility and expertise to do this type of dialysis and is being done in ICU for last 5 years.
What is plasmapheresis?
Plasmapheresis is also a kind of blood related treatment modality like hemodialysis. It is carried out in special conditions and is only done under the prescription of a concerned physician. In this modality plasma, a component blood is cleaned in five sessions or so. NMC has expertise to carry out this procedure. This is done as an inpatient procedure so the patient has to get admitted in the hospital. For details regarding the procedure, please contact hemodialysis unit.
How do you protect your kidneys?
Normal kidneys do not need extra care to protect the kidney. However, if you have some diseases like diabetes and hypertension then you need to take extra care to prevent your kidneys from damaging. You should control blood pressure and blood sugar well. You should not take medications (eg painkillers) that can damage your kidneys without consultation with your physician. Do a regular checkup for kidney function. Your physicians can prescribe some medications for protection of your kidneys esply if you have diabetes, hypertension or some native kidney diseases.
How can you screen for kidney diseases?
There are some tests which can be done to screen kidney diseases. A simple and cheap test like urine routine can pick up most of the kidney diseases. You may need to undergo blood tests like Kidney function tests (urea, creatinine, sodium and potassium) and ultasonography of kidneys. However the results of the tests should be interpreted on the background of your health and physical examination. In NMC, on Fridays we have a kidney disease screening OPD and you are welcome to avail this service.
Do I need to undergo screening for Kidney disease?
Definitely yes, if you have hypertension, diabetes and some native kidney disease. It is also advised to get screened if you have your family members with kidney disease, hypertension and diabetes.
Do I need to take extra care in diet?
Yes if you have kidney disease. But before you observe any kind of diet restrictions you need to talk with your nephrologist and dietician and follow his/her advice. The diet prescription depends on patients' health so sometimes it cannot be generalized.
"SERVING NEPAL, SERVING KIDNEY HEALTH"
