Kidneys are very crucial to one’s health. They filter out waste products from the blood, remove excess fluids and help balance chemicals in the body. When they are damaged by any disease or injury, they lose the ability to do their job efficiently. Unfortunately, they cannot heal by themselves. If 85–90% of kidney functions are lost, the damage is irreversible and the person enters what is called end stage renal disease (ESRD). A person may have a gradual worsening of kidney functions for 10–20 years or more before progressing to ESRD.
End stage kidney disease is the complete or almost complete failure of the kidneys to function. The incidence of ESRD in India is higher than in the West with chronic glomerulonephritis being the most common cause, accounting for more than 1/3rd of patients, while diabetic nephropathy accounts for about ¼th of all patients. Other causes include hypertension and polycystic kidneys.
Recent professional guidelines classify the severity of chronic kidney disease (CKD) into five stages, with stage one being the mildest and causing few symptoms and stage five being a severe illness with poor life expectancy if untreated. Stage five CKD is called End Stage Renal Disease.
Stage 1: Slightly diminished function; kidney damage with normal or relatively high GFR (≥ 90 ml/min/1.73 m2)
Stage 2: Mild reduction in GFR (60–89 ml/min/1.73 m2) with kidney damage
Stage 3: Moderate reduction in GFR (30–59 ml/min/1.73 m2)
Stage 4: Severe reduction in GFR (15–29 ml/min/1.73 m2), preparation for renal replacement therapy
Stage 5: Established kidney failure (GFR <15 ml/min/1.73 m2) or permanent renal replacement therapy
CKD is initially without any specific symptoms and can only be detected as an increase in serum creatinine or protein in the urine. As the kidney function decreases:
- Blood pressure is increased due to the fluid overload and production of vasoactive hormones secreted by the kidney via renin- angiotensin mechanism, thus increasing one’s risk of hypertension and / or congestive heart failure.
- Urea accumulates, leading to azotaemia and ultimately uraemia (symptoms ranging from lethargy to pericarditis and encephalopathy). Urea is excreted by sweating and crystallizes on the skin (uraemic frost).
- Potassium accumulates in blood causing malaise and potentially fatal cardiac arrhythmias.
- Erythropoietin synthesis is decreased leading to anaemia, which causes fatigue. Anaemia is associated with increased cardiovascular mortality.
- Symptoms due to fluid volume overload range from mild oedema to life threatening pulmonary oedema.
- Hyperphosphataemia due to reduced phosphate excretion, associated with hypocalcaemia (due to 1, 25 hydroxyvitamin D3 deficiency) occurs.
- Later on, this progresses to secondary hyperparathyroidism, renal osteodystrophy and vascular calcification that further impairs cardiac function.
- Metabolic acidosis due to accumulation of sulphates and uric acid causing altered enzyme activity and increased excitability of the cardiac and neuronal membranes by promotion of hyperkalaemia.
The medical care of patients should focus on the following:
Delaying or Halting the Progression of Chronic Kidney Disease
- Treatment of the underlying condition if possible
- Aggressive blood pressure control especially systolic B.P. control along with aggressive glycaemic control
- Treatment of hyperlipidaemia to the target levels
- Avoidance of nephrotoxins, including non-steroidal anti-inflammatory agents and aminoglycosides
- Cessation of smoking, as smokers tend to reach ESRD earlier than non-smokers
- Lifestyle changes and massive community education
Timely Planning for Chronic Renal Replacement Therapy
- Early education regarding natural disease progression, dialysis (peritoneal dialysis or haemo-
- dialysis) and renal transplantation
- Timely placement of permanent vascular access (for surgical creation of primary arterio-venous fistula, if possible, and preferably at least 6 months in advance of the anticipated date of dialysis)
- Timely referral for renal transplant
It is alarming that only 5 % of Indians get treatment for CKD and for the remaining, either it is unavailable or one cannot afford it due to limited resources and less money is spent by the government on renal care. Rural patients often have to travel long distances to reach a kidney centre because of the mal-distribution of dialysis centres with most of the centres located in large cities. In addition, because of the virtual absence of health insurance plans, less than 10 % of all patients with ESRD receive any kind of transplant.
People undergoing dialysis have an overall 5-year survival rate of 32%, the elderly and those with diabetes have worse outcomes. Recipients of a kidney transplant from a living related donor have a 2-year survival rate greater than 90 %. Recipients of a kidney from a donor who has died have a 2-year survival rate of 88 %.
World Kidney Day Celebrated on
March 10, 2011
A joint initiative of the International Society of Nephrology and the International Federation of Kidney Foundation, World Kidney Day’s campaign focus is to raise the awareness of the importance of the kidneys to our overall health and to reduce the frequency and impact of kidney diseases and its associated health problems. The slogan for this year’s campaign is Protect Your Kidneys and Save Your Heart as chronic kidney disease is the major risk factor for cardiovascular diseases.
- Protein needs are higher in patients with ESRD due to losses that occur during dialysis. Patients on dialysis may spontaneously reduce protein and calorie intake because of uraemic toxins, elevation in cytokines and delayed gastric emptying.
- Sodium in the diet should be controlled to maintain fluid balance and to avoid fluid retention and high blood pressure
- Bananas, melons, legumes, potatoes, tomatoes, pumpkin, sweet potato, spinach, orange juice and other foods that are rich in potassium should be avoided
- Intake of dairy products should be reduced to control the phosphorous content
- Calcium supplements that bind to phosphorous in the diet are advised
- Fluid intake should be restricted
- Dialysis patients should follow a diet low in saturated fats and cholesterol
- Individuals on dialysis commonly suffer from deficiencies of vitamin C, folate, vitamin B6, calcium, vitamin D, iron, zinc and possibly selenium, which can contribute to an antioxidant-deficient state. Therefore, micronutrient supplements must be included.
The treatment of kidney diseases can be successful with homeopathy. Indicated homeopathic remedies not only reduce the number of dialysis needed but also help in overcoming complications associated with chronic dialysis therapy.
- Useful in cases of uraemia with complete anuria
- Urine consists of granular casts and fatty degenerated epithelium
- A remedy for symptoms depending on deficient kidney action
- Renal insufficiency and uraemia
- Convulsions with diabetes
- Urine contains acetones and odour of garlic
- Suited to diabetic patients with scanty and albuminous urine
- Epithelial cells, cylindrical clots of fibrin and globules of pus and blood in the urine
- Useful in cases with albuminous, scanty and suppressed urine
- Urine contains high phosphoric acid with low total solids
- Urine is hot, burning, scanty or suppressed
- Albuminous urine with stabbing pains extending from urethra into bladder
- Chronic kidney disease, From Wikipedia, the free encyclopedia
- Vinay Sakhuja and Kamal Sud. End-stage Renal Disease in India and Pakistan: Burden of Disease and Management Issues. Kidney International (2003) 63, S115–S118.
- Boericke W. Pocket Manual of Homoeopathic Materia Medica and Repertory. B. Jain Publishers Pvt. Ltd. New Delhi.