HEALTHWATCH
Epidemic proportions
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With kidney diseases on the rise, Dr. ABI ABRAHAM suggests ways to control and prevent it.
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THE incidence of kidney disease has increased significantly in recent years. It is estimated that every year, 100,000 people develop severe kidney failure requiring dialysis or transplantation. If patients with mild to moderate disease are included, the number will be higher. Causes: Incidence of diabetes and high blood pressure, which cause higher risk of developing kidney problems, has increased. Often, kidney disease is not diagnosed early. By the time the problem is identified, it is too late.
Increased consumption of painkillers is another cause. Several medications (like Brufen and Voveran) are available without prescription. Regular use of these can cause kidney damage even in healthy individuals. In the elderly and those with mild kidney disease, even a few tablets can precipitate severe renal failure.
Complications: Mid-to-moderate kidney failure may cause other problems like anaemia, which results in fatigue, giddiness, loss of energy and trouble in concentrating. Appetite may decrease and the person may have trouble in sleeping. The person may have the urge to pass urine especially at night (this may be the earliest symptom). The albumin level in the blood may drop causing swelling around the eyes in the morning and swollen feet and legs in the evenings. The bones may become weak leading to pain and brittle bones.
Kidney disease may also cause high blood pressure and increases the risk of developing heart problems.
Several drugs are removed from the body by the kidney. Kidney disease may hamper this and result in drug toxicity.
Anyone can develop kidney disease. However, some people are more at risk — People who have diabetes/high blood pressure; those with a family history of kidney disease; those who consume painkillers regularly; people who have a history of stones; and the elderly.
People at an increased risk should have a complete physical examination and their blood pressure checked at frequent intervals. The following preliminary investigations will pick up early kidney disease.
Urine examination: The presence of protein in the urine suggests damage to the filtering units of the kidney. Persistent values between 30 and 300 mg/day (20 to 200 ug/min) is called microalbuminuria. A value above 30 mg/g (or 0.03 mg/mg) suggests that microalbuminuria is probably present.
Red cells in the urine suggest inflammation of the kidney, stone or infection. Pus cells suggest infection.
Blood Tests: When the kidneys are damaged, the creatinine level in the blood starts rising.
If blood or urine tests show any abnormality, detailed evaluation is required. Glomerular filtration rate (GFR), which tells how much kidney function is present, can be calculated from the creatinine level, age, body weight and gender. Complete blood counts should be checked. The other parameters include blood levels of protein and albumin, sodium, potassium, bicarbonate, calcium, phosphate and uric acid.
An ultrasound scan of the kidney gives information regarding stones, tumours and whether there is any obstruction to the passage of urine.
A kidney biopsy may be required in certain cases to identify the specific disease and to assess the damage. If there is severe kidney failure (end stage renal failure), treatment options are limited to kidney transplantation or lifelong dialysis, both being expensive.
Early detection and treatment can often slow or stop the progression of disease. Frequent follow-up will be required.
In patients with kidney disease, control of blood pressure is very important. Drugs link angiotensin converting enzyme inhibitors (ramipril, enalapril) and angiotensim receptor antagonists (losartan, irbasrtan) are helpful in preventing the development of kidney disease. These are also effective during the early phases and mild kidney failure. However, they can occasionally precipitate a sudden decline in the kidney function in some patients. So caution must be exercised.
Strict control of blood sugars will prevent or slow the progress of renal disease in those with diabetes. Both fasting and after food sugar levels should be kept as close to normal levels as possible.
One of the major complications is wasting and weakness of bones. When the kidneys are not working normally, the phosphorus level in the blood accumulates. This leads to loss of calcium from the bones. A phosphate binder (usually a calcium salt) will reduce this complication. The patient should also be given vitamin D.
Anaemia should be corrected. Avoid or reduce the use of painkillers.
Stop smoking and drinking. Exercise regularly.
Patients with kidney disease should be on a special diet, with a restricted protein, salt and fat content. Fluid intake should be restricted if there is swelling. It is also important to restrict fruits and chocolates, which are rich in potassium.
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