Kidney Disease! Is this The End?

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 Nephritis

Lupus is an autoimmune disease. Lupus nephritis is when your immune system attacks your kidneys

• ·        Interstitial Nephritis

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

• ·        Glomerulonephritis

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.

• ·        Pyelonephritis

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
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• 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.

• Skip Herbal Supplements

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.

• Eat Healthy

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.

• Watch Your Salt

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.

•  Drink Enough Water

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.

• Exercise

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.

• Get Screened

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.

• Be Careful With Alcohol

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.

• Quit Smoking

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.