17-03-2022 / Kidney and Nephrology
Kidneys are essential organs involved in removing toxins and extra fluids from the body. They also help in maintaining a balance between water and electrolytes
Since kidneys perform such key functions, kidney disorders and any impairments in kidney health can affect the overall functioning of the human body.
Let's talk briefly about how kidneys work, the symptoms of kidney disorders, common investigations and tests used to assess kidney health and the common treatment lines followed in kidney disorders.
The ureters, urinary bladder and the urethra together constitute the urinary pathway.
A basic understanding of the structure and placement of the kidneys are essential to talk about kidney health and kidney disorders.
The two kidneys are roughly the size of a closed fist, each measuring about 12 cm in size. They are placed in the retroperitoneum of the abdominal cavity, in simple terms meaning they're placed behind your belly, below the ribs on either side of the spine. This is the reason why your physician may inspect and palpate your lower back to examine kidney status.
The kidneys are made up of millions of structural & functional units called nephrons which are the building blocks of the kidneys. Each nephron includes a filter, called the glomerulus, and a renal tubule. The glomerulus receives the blood to the kidney, filters out toxins and certain essential substances like glucose. As this filtrate passes through the renal tubules, further water and essential minerals like sodium, chloride and glucose are conserved back. The ultimate filtrate is voided out as urine.
Kidney disorders can be due to any defect in the nephrons, tubules or even the glomerular filters and the features differ according to the part involved.
Perfect kidney health and functioning is important for having a seamless human body machine.
The kidneys are primarily known as organs of excretion, but they also possess other important functions. They are:
Remove waste products and toxins from the body.
Help in the proper removal of drugs from the body.
Maintain appropriate fluid and electrolyte balance in the body.
Release a hormone called Renin that regulates blood pressure.
Produces the most active form of vitamin D( called 1,25-dihydroxycholecalciferol) that promotes strong, healthy bones..
Control the production of red blood cells by the bone marrow by producing a hormone called Erythropoietin.
Since the kidneys deal with an enormous amount of fluids, electrolytes and even toxins on a daily basis, they are prone for many diseases.
A lot of fluid or waste build-up inside the body can cause damage to the kidneys. The factors that cause such issues generally fall under the characterization of kidney disorders or diseases.
So when such kidney disorders occur, they disrupt all the functions like excretion of toxins, fluid balance, alter blood pressure and vitamin D metabolism etc.
How can you know if you are under risk of developing kidney disorders? Let's go through certain causes and risk factors that could impact kidney health negatively.
Diabetes, both type 1 and type 2
Constant use of drugs that could damage the kidneys
Altered kidney structure (maybe from birth-called congenital renal disorders)
Repeated infections involving the urinary pathway. Men experiencing repeated urinary tract infections should get their prostates checked for any enlargement
Kidney stones can themselves cause further impairment of kidney functions
Like any other systemic disorder, there are certain apparent symptoms of kidney diseases.
Usually, the kidney is a very adaptable organ, and it readjusts with the initial issues that occur. Thus, the early signs of kidney diseases are usually not visible, but the conditions may worsen at a slow pace. Progressively, the signs grow more evident in the advanced stages.
Let's look into certain common symptoms of kidney diseases and the possible reason behind them.
The common symptoms of kidney diseases are:
Change in urinary frequency : This can happen when the glomerular filters of the kidney get damaged and lots of fluids are excreted via urine
Foamy urine: When the kidneys are functioning normally, proteins are not excreted in the urine. But when the filters are damaged, proteins get lost in the urine giving it a foamy nature.
Blood in urine : again, blood cells may leak into the urine if the filters are leaking or if they are damaged irreparably
Puffiness around eyelids: When the kidneys are not functioning properly, there's a buildup of fluid in the body. Since the skin around the eyelids are very thin, it manifests in the form of puffy eyelids.
Swollen ankles and feet: When water gets retained in the body with a failing kidney, it gets accumulated in the dependent portions of the body like feet and ankles.
Fatigue: This is one of the commonest symptoms of kidney disease. As we already saw, kidneys play an important role in the manufacture of red blood cells. When kidney disorders strike, this function takes a hit, thereby causing anemia in the patient. This can manifest as easy fatigability.
Bone disorders: Since Kidneys play a key role in Vitamin D metabolism, in kidney disorders this gets affected leading to loss of integrity of the bones. Can manifest as fractures or poor healing
Altered immune system: Whenever the filtering mechanism of the kidneys get affected, there is a wastage or leakage of essential proteins through these defects into the urine. This includes the immunoglobulins, which are key proteins involved in immunity. When they get lost via the urine and are not immediately replaced, the patient's immune system gets weakened.
Altered sleep patterns: When the kidney disorders affect its filtering capacity, lots of toxins get accumulated in the body. This can affect the overall functioning of the body including sleep patterns.
Nausea & vomiting : These symptoms are due to decreased kidney function. The symptoms occur as a result of waste buildup or as side effects from dialysis or medication. This may lead to loss of appetite and weight.
Concentration impairment :Also happens because of the toxin accumulation
Dry itchy skin: This can be a manifestation of the mineral diseases that accompany kidney disorders. This can affect the integrity of the skin. Further in chronic kidney diseases, the immune system takes a massive blow, thereby paving the way for repeated skin infections.
Loss of appetite : this again is a reflection of the toxin buildup
Muscle cramps : Electrolyte and fluid imbalances caused due to fluid imbalances can easily end up causing muscle cramps
Anemia: Presents as weakness and easy fatigability due to affected erythropoietin production in kidney disorders
Now let's dive into some of the common kidney diseases
"What is kidney failure?"This condition is definitely as ominous as it sounds!
Kidney failure, also known as ESRD- End Stage Renal Disease, is the last and the most severe stage of kidney disease. This stage is reached when the underlying cause of the kidney disorder remains uncorrected and the kidney functions get worse over time, ending up in failure.
There are two types of kidney failure: acute and chronic
This type of renal disorder occurs when the kidneys stop functioning suddenly, usually over hours or days. It's termed acute kidney disease or acute renal injury. It's usually fatal and happens in very sick and critically ill patients. There is an abrupt failure of kidney function, and the toxins build up rapidly affecting the other vital organs like brain, heart and lungs.The patient may go into a sudden shock leading to coma and death.
There are several reasons for such an acute failure of kidneys. These include:
Rapid muscle breakdown as occurs in exercising aggressively after a long period of not exercising
Severe bleeding like as in accidents where blood flow to the kidneys are compromised
Heart diseases which affect blood flow to the kidneys
Any major stress like major surgeries or accidents etc.,
This is one of the commonest manifestations of impaired kidney health. According to a Kidney Disease Data Center Study report from the International Society of Nephrology, 17% of India's population has CKD. This disease has a gradual prolonged course, developing over several years. Accordingly some common causes behind chronic kidney failure are also chronic diseases like:
Diabetes (most common reason behind end stage renal disease. Persistently high blood sugar levels affect the minute vascularity of the kidneys )
Hypertension ( high blood pressure can put a stress over the vascularity of the kidneys)
Autoimmune disorders ( diseases where the body's immune system itself affects the normal renal components) e.g. : lupus
Benign prostate hyperplasia/enlargement (as the prostate keeps enlarging as the make gets older, voiding of urine becomes difficult. So this urine may backflow to the kidneys affecting their functions over time)
Kidney stones blocking the urinary tract: behave in the same way as an enlarged prostate etc.
These are some of the chronic kidney problems causes.
UTIs or Urinary Tract Infections can occur in any portion of the urinary system. These are very common bacterial infections occurring in the urethra or bladder. In most cases, this condition is not hard to treat, and further health complications are rare. However, leaving repeated UTIs untreated can cause the spread of these infections to the kidneys, which could even end up in renal failure.
This is an inflammatory condition that occurs in the glomerular filters inside the kidneys. The common causes of this condition are drugs or infections. Plus, congenital abnormalities can also generate this disorder. This could either resolve by self or could end up in severe complications that could endanger kidney health.
A lot of patients in India and worldwide suffer from kidney stones. This happens due to the crystallization of minerals and other elements inside the blood, thereby becoming into stones. Mainly, this occurs inside the kidney or the urinary tract. The patient may experience pain during urination and vomiting. During urination, very small stones could pass out by themselves. If larger however, they may cause obstruction of the urinary tract, requiring surgical removal. In most cases, kidney stones are not inherently life-threatening.
It is a congenital disorder affecting the kidneys in a limited population. The condition results in the formation of multiple tiny fluid sacs or cysts inside the kidneys. When the functional parts of the kidneys get replaced by nonfunctional cysts, kidney functions get affected severely and may end up in renal failure.
There are two forms of polycystic kidney disease (PKD). Adult and pediatric. In adult forms, the patient usually starts becoming symptomatic later in life around 30 years, usually starting with high blood pressure. The pediatric form is more dangerous and could even be fatal.
However, polycystic kidney disease should not be confused with other milder cystic kidney diseases which could be seen in many people and are nothing to be worried about.
This is something commonly noted in the Indian population. The infection spreads to the kidneys from a primary source in the lungs and could end up in completely nonfunctional kidneys.
Renal cancers are one of the common cancers noted in developing countries. There may be several reasons behind these cancers which are of different types.
These structural defects in the kidneys could be either acquired or inherited. Examples include horseshoe kidney (lower edges of both the kidneys are fused), duplicated ureters (two ureters on same side), renal agenesis (absent development of kidneys) etc.
Whenever your treating physician suspects a kidney disorder, they may subject you to a number of tests, ranging from the most basic to very advanced and invasive tests.
this is the most basic investigation ordered in kidney disorders. It helps to check for the presence of sugars, proteins and pus cells in the urine
These are blood tests measuring blood levels of urea and creatinine which are reflective of the kidney status
This test is ordered to discover the presence of any bacterial growth in the urine
Imaging studies like Xray or CT may be needed to look for renal stones. MRI studies may be needed rarely to check for any soft tissue involvement especially in cancers. Your urologist may also advice a cystoscope ( tube with a camera inserted via your urethra into the bladder to visualize and to perform any procedures), etc
These may be very commonly needed in order to rule many diseases ranging from inflammatory changes to cancers.
The management protocol of different types of kidney diseases are different. Based on the severity of the kidney disease, the management may range from:
Whenever a patient experiences a fault in their kidneys' functioning, the doctor may check if the patient is taking any drugs or alternative medications that could harm the kidneys. Stopping such drugs could sometimes be enough to get better.
Further it’s important to maintain adequate hydration and to avoid eating junk foods with lots of synthetic chemicals and preservative loaded food items to avoid harming your kidneys.
If the patient is on the way to develop chronic kidney diseases due to long standing diseases like diabetes or hypertension, the kidney specialist doctor may prescribe drugs to correct them.
Certain kidney diseases which cannot be managed by conservative methods or by drugs, may need surgical correction or surgical removal of the affected nonfunctional kidneys.
In this process, the excess fluid and waste materials in the blood are taken out artificially. It is effective in the advanced stages when the kidneys cannot manage the task on their own.
RRT includes two arms: Dialysis and Renal transplant. Both are essentially techniques where we try to replace the nonfunctional failed kidney with an alternate.
This includes a machine where the blood from the body is passed through a membrane which resembles the normal kidney filter membrane. This membrane filters out the toxin and extra fluid from the blood, now the clean blood is passed back into the body. If needed, some electrolytes may be infused into the blood. Based on the status of the kidney, the patient may require multiple cycles.
This technique includes the insertion of a thin catheter inside the patient's abdomen. A solution enters the body through it, which absorbs the fluids and the water. In this technique, the patient can stay at home and can be mobile, as opposed to haemodialysis which needs hospitalisation every time.
This involves replacing a damaged kidney in a patient with a healthy donor kidney. Usually, the new kidney comes from either dead or living donors.
This must be a common question in your mind. Apart from certain inherited and congenital disorders, most of the common kidney disorders could be prevented. Prevention is a key kidney disease solution.
Maintain proper hydration
Avoid holding in your pee for prolonged whiles
Try to maintain a proper BMI as obesity could cause lots of complications including kidney diseases
Strictly adhere to your treatment plan if you are diabetic or hypertensive
Avoid abusing painkillers and self-medicating as these drugs could affect your kidney severely
Follow a cleaner, more organic diet without lots of preservatives and synthetic chemicals
Maintain proper hygiene to prevent urinary tract infections
In case of any complaints regarding the urinary system, immediately report to a hospital to get yourself checked at the earliest
Wishes for a happy and healthy pair of kidneys!
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