Living
Well With Kidney Disease
Recently I consulted Nikhil
a 51-year-old man who was
- Diabetic (sugar levels in
control now but with medications and slight diet modifications)
- Heart patient (3 stents)
- Blood pressure (in control
now with medications)
- Central obesity (all the body
fat was concentrated in the abdominal area)
- Overweight by 15 kgs
To add to this he did not exercise!
Plus a regular drinker
and smoker in the past. Now it has reduced from 5 to 6 cigarettes a day to 1
and from 90 ml thrice a week to once
He has been diabetic for
the past 12 years with uncontrolled sugar levels in the past. This had affected
his kidneys.
His blood reports of concern were:
Serum Creatinine
– 1.56 mg/100 ml (Reference Range 0.5 – 1.2)
Serum Creatinine – 5.5 mEq/L (Reference Range 3.6 –
5.3)
Urine report
Glucose -
(+++)
Protein
– a trace
Urine:
Albumin:Creatinine
ratio – 111.6 mcg/mg Creatinine (Reference Range 30 – 299 -
microalbuminuria)
So here is a man with a Compromised Kidney Function.
And he wanted to enrol for my diet program.
Compromised Kidney Function
Now, there’s a
misconception that any kidney disorder, particularly with high creatinine
levels, means absolutely no protein in the diet. If potassium levels are out of
range, then no fruits also! Only select vegetables are permitted and that too
after leaching. Also, water is restricted to one litre only! High potassium cereals too
are banned.
So, what does he eat? He
is a vegetarian. To make matters worse, pulses and legumes have high protein as
well as potassium content!
Now as I have just
mentioned, Nikhil has a compromised kidney function, he is not a CKD (Chronic
Kidney Disease) patient. So what does one do with someone with a compromised
kidney function?
My Approach
To begin with, I asked
him to stop smoking and drinking completely. Tough but has to be done. The idea
is to stop further damage to the kidney. Also, regular exercise and breathing
exercises is an integral part of the process to improve circulation and improve
the functioning of the kidneys. A kickback would be fat loss.
So coming to his diet, protein
is to be restricted; not eliminated. Low potassium fruits (especially apples
and pears) are allowed. Vegetables with low potassium levels (varieties of
cabbage and gourd except bitter gourd) are recommended while the high potassium
ones are restricted and that too only after leaching. The very high potassium
level veggies like root vegies and greens (though little fenugreek leaves are
allowed sometimes in restricted amounts) are to be eaten very rarely and only after
leaching. Low potassium grains like rice and barnyard millet are allowed. And
water is slightly debatable. It could be a maximum of 2 or the normal 2½ litres.
But there’s a problem! At
times, the protein and potassium content of the pulses, legumes and grains might
leave you confused. A comparatively low-protein cereal or dal may come with
high potassium content and vice versa.
I resolve this by
focusing on the potassium content. The average Indian does not even come close
to the daily requirement of protein (0.8 or 1 gm per kg body weight).
So lentils and, dairy
products in restricted amounts because of their high protein and potassium
content. I recommend Masoor (dal and whole) and Chana (dal and whole). Pulses to
be eaten very occasionally.
Let us look at kidney
disorders in more depth. What exactly is it?
Kidney disease can affect
your body’s ability to clean your blood, filter extra water out of your blood,
and help control your blood pressure. It can also affect red blood cell
production and vitamin D metabolism needed for bone health. When your kidneys
are damaged, waste products and fluid can build up in your body. That can cause
swelling in your ankles, nausea, weakness, poor sleep, and shortness of breath.
Without treatment, the damage can get worse and your kidneys may eventually
stop working. That’s serious, and it can be life-threatening.
So what exactly is the
function of our Kidneys?
Healthy
kidneys:
·
Maintain a balance of water and minerals
(such as sodium, potassium, and phosphorus) in your blood
·
Remove waste from your blood after
digestion, muscle activity, and exposure to chemicals or medications
·
Make renin, which your body uses to help
manage your blood pressure
·
Make a chemical called erythropoietin,
which prompts your body to make red blood cells
·
Make an active form of vitamin D, needed
for bone health and other bodily functions
·
Filter all the blood in your body every 30
minutes
Types
of Kidney Disease
- ·
Chronic kidney disease (CKD)
CKD is a condition where
your kidneys cannot filter toxins or extra fluid from your blood as well as
they should. While the condition can vary in how serious it is, CKD usually
gets worse over time. Treatment, diet and lifestyle can slow the progression of
the disease.
If left untreated, CKD
may lead to kidney failure. At this stage, it is referred to as End-Stage-Renal-Disease
(ESRD). This must be treated by dialysis or kidney transplant. Diabetes and
high blood pressure are the leading causes of CKD.
But 40% of those with
serious chronic kidney disease are unaware that they have the condition.
Other
Common Forms Of Kidney Disease
- ·
Polycystic
Kidney Disease
This genetic disorder
causes cysts (fluid-filled sacs) to grow on your kidneys, limiting their
ability to filter waste from your blood
Lupus is an autoimmune
disease. Lupus nephritis is when your immune system attacks your kidneys
This happens when you
have a bad reaction to a medicine that limits your kidneys’ ability to filter
toxins. If you stop the medicine, your kidney health should improve
This condition damages
the glomeruli and your kidneys cannot function as well.
- ·
Long-lasting Viral iIlnesses
HIV and AIDS, hepatitis
B, and hepatitis C may cause kidney disease.
This is a urinary tract
infection within the kidneys, which can result in scarring as the infection
heals. It can lead to kidney damage if it happens several times.
Alcohol
and Kidney Disease
Your kidneys are
responsible for filtering harmful substances from your blood, including
alcohol. When you drink, your kidneys have to work harder to perform their
function.
Binge
Drinking - which for women is having about four drinks in 2
hours, and for men five drinks in 2 hours can cause serious harm your kidneys.
One risk of binge drinking is acute kidney failure, which is a sudden drop in
kidney function that can damage the organs.
Regular heavy drinking
can increase your chances of developing chronic kidney disease. Even two
alcoholic drinks a day can increase your risk of high blood pressure, a common
cause of kidney disease. Drinking alcohol can also disrupt hormones that help
your kidney function.
Chronic Kidney Disease Causes
When your kidneys don't work well for longer than 3 months, doctors
call it chronic kidney disease. You may not have any symptoms in the early
stages, but that's when it’s simpler to treat.
Diabetes (types 1 and 2)
and high blood pressure are the most common culprits. High blood sugar levels
over time can harm your kidneys. And high blood pressure creates wear and tear
on your blood vessels, including those that go to your kidneys.
Kidney
Disease Symptoms
Your kidneys are very
adaptable. They can compensate for some of the problems that can happen when
you have kidney disease. So if your kidney damage gets worse slowly, your
symptoms will reveal themselves slowly over time. In fact, you may not feel
symptoms until your disease is advanced.
You might have:
- ·
High blood pressure
- ·
Nausea and vomiting
- ·
Loss of appetite
- ·
A metallic taste in your mouth
- ·
Fatigue
- ·
Weakness
- ·
Trouble thinking
- ·
Sleep issues
- ·
Muscle twitches and cramps
- ·
Swelling in your feet and ankles
- ·
Itching that won't go away
- ·
Chest pain if fluid builds up around the
lining of the heart
- · Shortness of breath if fluid builds up in
the lungs
- How
to Diagnose Kidney Disease
- ·
Blood tests to see how much waste product
is in your blood
- ·
Urine tests to check for kidney failure
- ·
Imaging tests, like an ultrasound, to let
the doctor see your kidneys
- ·
A kidney biopsy, where tissue from your
kidney is sent to a lab for testing to figure out the cause of your kidney
issues
Kidney
Disease Treatment
Some forms of kidney
disease are treatable
The goals of these
treatments are:
- ·
To ease symptoms
- ·
Help keep the disease from getting worse
- ·
Lessen complications
In some cases, your
treatment may help restore some of your kidney function. But there is no cure
for chronic kidney disease.
If a condition is
“chronic,” that means it’s a long-term condition. If you have chronic kidney
disease, you and your doctor will manage it together. The goal is to slow it
down so that your kidneys can still do their job.
Steps
in treating CKD
- ·
First, your doctor will work to find out
what caused the kidney disease
- · For instance, kidney disease can happen if
you have diabetes or high blood pressure.
- ·
You have to consult a nephrologist
- ·
You will take medication
- ·
Work on your diet
- ·
If you have diabetes, it needs to be
managed
- ·
If your kidneys don’t work anymore, you
might need dialysis or a kidney transplant
Ways to Keep Your Kidneys
Healthy
- Don’t Overdo Certain
Medications
NSAIDs are nonsteroidal
anti-inflammatory drugs, like ibuprofen and naproxen. They can damage your
kidneys if you take too many at once or take them too often. And using proton
pump inhibitors (PPIs) for an ulcer or GERD for a long time can raise your
chances of chronic kidney disease. You should only take them if your doctor
says you need them.
- Take Care With
Antibiotics
These bacteria-fighting
drugs can damage your kidneys if you use them too often. It can happen even if
you’re perfectly healthy, though it’s more serious if your kidneys don’t work
as well as they should. Some types, like penicillin, sulfonamides, and
cephalosporins, are more likely to cause problems.
Supplement makers don’t
have to prove their products are safe, and some can damage your kidneys. Those
can be especially harmful if you have kidney disease because they can make the
condition worse or affect how some medicines work. Talk with your doctor before
trying any herbal supplement.
Your kidneys process
everything you eat or drink, including anything that’s bad for you, like lots
of fat, salt, and sugar. Over time, a bad diet can lead to high blood pressure,
obesity, diabetes, and other conditions that are hard on your kidneys. A
healthy diet has lots of vegetables, fruits, and whole grains, and few
processed foods.
This mineral affects
people in different ways. For some, it seems to raise the amount of protein in
their urine. That can harm your kidneys or make kidney disease worse if you
already have it. Lots of salt also raises your chances of high blood pressure,
a typical cause of kidney disease, and kidney stones, which can be very painful
and possibly cause damage without treatment.
Water helps get important
nutrients to your kidneys and move waste to your bladder in the form of urine.
If you don’t drink enough, the tiny filters inside your kidneys can get choked
up and lead to kidney stones and infections. Even mild dehydration can damage
your kidneys if it happens often enough. About 2 to 21/2 litres per day is
typically about right, but you might need more if you are out in the heat.
Just like a healthy diet,
this helps prevent conditions like diabetes and heart disease that can lead to
kidney damage. But don’t try to go from couch potato to gym rat in a day. Too
much exercise can also damage your kidneys if you’re not ready for it. Work your
way up to 30 to 60 minutes at least five days a week. Start slow if you haven’t
done it in a while, and check with your doctor first if you have health issues.
It’s important to know
your risk for kidney disease. It’s more likely if you or close relatives have
heart disease, high blood pressure, diabetes, or a family history of kidney
failure. In these cases, your doctor might suggest specific kidney tests as
part of your regular check up. The earlier you catch it, the easier it is to
treat and sometimes even stop.
If you’re healthy, a
drink or two isn’t likely to hurt your kidneys. But binge drinking (having more
than four drinks in less than 2 hours) can cause sudden, serious damage and
possibly lead to long-term problems. And alcohol often can dehydrate you, which
can keep your kidneys from working well and lead to weight gain, liver disease,
high blood pressure, and other conditions that put more stress on them.
Smoking raises your risk
of kidney cancer and damages blood vessels, which affects your kidneys by
slowing blood flow to them. Plus, smoking can affect certain drugs that treat
high blood pressure. This is serious because uncontrolled high blood pressure
is a leading cause of kidney disease.
