Rohini Acharya donated one of her kidneys to her father, Lalu Prasad Yadav, who was suffering from CKD and other diseases. Lucky Lalu had a willing family donor! Farooq Abdullah is another lucky kidney recipient from his wife. We keep hearing about different kinds of ‘kidney rackets’ in India because of a mismatch of donors in the family, which makes them ‘buy’ a kidney. Thus, the patient unwittingly enters into a nefarious, criminal activity. If donors are not available, managing CKD becomes a challenge for the balance of life.

Yet, CKD or Chronic Kidney Disease is not uncommon. Selena Gomez, the famous Hollywood star has CKD and continues to grow in her career. Charlotte Markle, 82 years old, received her kidney transplant 58 years ago and she is still in good health. However, Arun Jaitley and Amar Singh died quite early despite getting kidneys. Delays in detecting CKD or delays in transplants are the reasons for early mortality, especially in the elderly.

India has 600 kidney transplant centres. In 2023, 13642 kidney transplants took place in India of which 11791 (kidneys) came from living donors. The rest were from noble, registered organ donors who suddenly died due to various ailments or accidents. (Cadaver donation). Over 2 lakh patients in India are waiting to get a kidney transplant. Besides the shortage of family donors, the issue of blood/ tissue matching also delays transplants. The waiting list for kidney transplants keeps increasing, and some patients with CKD keep dying. The survivors, keep spending money and time on dialysis. Money and time are also spent on periodic check-ups and laboratory/other investigations. The deaths in such cases of CKD usually occur due to a heart attack (myocardial infarction) or less commonly due to End Stage Kidney Disease.

Function of Kidneys

Kidneys are two, fist-sized organs, lying on either side of the spine, in our abdomen. They are popularly called the ‘Carburettors of the human machine’.

They remove the waste products of our body which enter the blood. Inside each kidney are millions of tiny filtration units called nephrons. Each nephron has a tiny filter called the glomerulus which has an input of blood from a tiny artery. The wastes and a few minerals are removed, and the balance of blood is returned through a vein. Some of the minerals are, later, reabsorbed by the veins for maintaining a perfect balance of acid-base inside the body. A mind-boggling carburettor produced by God.

PC: https://www.niddk.nih.gov/

Every day, the two kidneys filter 150- 200 litres of our blood expelling the wastes through the liquid called urine. That is just about 1.5 litres to 2 litres per day.

Other Roles of Kidneys?

The kidneys are versatile organs. Masters of multi-tasking. They have many roles:

• Apart from wastes, they remove any excess amount of drugs, toxins or pesticides we accidentally ingest.
• Maintain a balance between fluids and salts inside the blood.
• Release hormones which regulate blood pressure.
• Produce the active form of vitamin D which is used by our bones.
• Control the production of red blood cells (RBC) which carry oxygen in the blood.

Why do We Get Chronic Kidney Disease (CKD)?

CKD means an untreatable abnormality of the kidney. In this, the kidney begins to lose its function and proteins are leaked out in the urine. Wastes accumulate in the body.

This disease is slightly more common in females. Unfortunately, both kidneys are affected together. CKD can occur at any age but is more common in the elderly. One in 10 adults are likely to get CKD. Yet in some people, disease occurs due to congenital abnormality at birth which manifests in childhood. Others may get the disease in their middle age.

Some of the major causes are –

• Diabetes is the most common cause of CKD.
• The second most common cause is Hypertension.
• Cardiovascular diseases, heart attacks and strokes affect the kidneys as well.
• A smaller group of patients have an infection as the starting point. This infection is called glomerulonephritis.
• Polycystic disease of the kidney is a rare congenital disease. It is inherited from a parent. These children develop CKD over a period of time.
• Certain drugs, toxins and pesticides also cause CKD if they are taken for some time. Drugs of the NSAID group like aspirin, brufen, and diclofenic acid (voveran) if taken in high doses or for a long time are harmful to kidneys. Certain Ayurveda/Siddha, unani medicines contain heavy metals and are toxic.
• New evidence has linked air pollution to kidney disease leading to CKD. Even short-term but high air pollution has been found to affect kidneys adversely in some people.
• In animals, microplastics entering the body land up in various organs but many particles end up in the kidneys. The adverse effects of microplastics on the kidneys in humans are still a matter of research.

Warning Signs of CKD

CKD is an enigma for the patient as well as the clinician. It may not show up till the disease has advanced. The symptoms listed below may not be present in all; and when present, may not point out the disease :

• Tiredness, low energy and trouble concentrating.
• Nausea, vomiting and loss of appetite in some.
• Urine issues – passing more or less urine than normal.
• Dry itchy skin.
• Swelling around ankles. Puffiness of the eyes is a sure but late sign and these should never be missed.
• Muscle cramps and low backache.
• Shortness of breath

When a person reports to a clinician, one may be found to have high blood pressure.  Urine will show proteins but sugar may also be seen. Blood will show anaemia. The definitive tests are best left to the treating Physician and will not be discussed here. neither will we discuss the modalities of treatment.

Why CKDs Not Detected at Early Stages?

Most kidney diseases do not present major symptoms in the early stages. In a country with high ignorance levels about our body parts and their functions, patients do not seek proper medical assistance. Even those who do go to their practitioners, the ‘doctors’ may not suspect kidney disease and hence not order required investigations. The delay results in kidney failure and the need for renal dialysis.

CKD can be prevented in most of us who are aware of our kidney functioning and CKD risk factors. Further, those who still go into CKD may be able to limit its ill effects for a long period. How it can be done will require a separate article. Next week. Till then, take good care of yourselves!

IIT Mandi’s study of borewell waters of Punjab and Haryana revealed high uranium concentration in water due to impurities of phosphate fertilizers. Further, this high concentration may cause cancers in different parts of the body as well as toxicity in the kidneys.

The condition of those suffering from CKD is grim for reasons given in the article below. Further, the number of CKD cases is fast increasing because of the triple epidemics of diabetes, hypertension and obesity. Other possible causes are adulterants in food which in turn are due to pesticide and fertilizer residues in food and water.

Prevention of CKD

Prevention of CKD is very essential, particularly in India. Higher cost of dialysis, scarcity of kidney donors, far too low number of nephrologists and low levels of awareness and literacy are some of the factors. It is no surprise that in India, 80% of kidney recipients are male and 75%- 80% of donors are females – often sisters, daughters or wives. It makes sense that we prevent CKD or at least control its ill effects. Uncontrolled CKD leads to the last stage of kidney disease. Patients land up in End Stage Kidney Disease (ESKD). This condition requires an immediate kidney transplant or, at least, urgent dialysis till a transplant is available.

• Food Choices matter much. Healthy food choices are difficult to follow in the era of Fast food. Foods eaten in restaurants ordered at home or reheated ultra-processed foods are becoming the easy way out for working men and women. These foods are eye-catching and tasty to the palate. Children love them immensely and are habit-forming. These foods are precursors of numerous diseases like obesity (yes, obesity is a disease as clarified by WHO), diabetes, hypertension, heart diseases, CKD, certain cancers and rheumatoid arthritis. Salt and sugar fat are in excess. These are the foods we need to limit, perhaps to not more than one meal in the week. While fruits and vegetables should be in abundance in our diet. Nuts (including peanuts) and seeds be added. A balanced diet is ideal. Baking, broiling and air frying are better than deep frying.
• Fend off Lifestyle diseases. Apart from the food we eat, we need to:
  • Adopt physical activities and avoid inactivity of more than 45 minutes.
  • Maintain body mass to 10% of ideal for height and age.
  • Quit tobacco and party drugs. Consume liquor in moderation.
  • Manage stress, and get adequate sleep.
  • Keep our blood pressure under check and control. Also, have a yearly medical check-up in which parameters of diabetes and heart diseases are also tested.
• Drugs. Commonly used pain relieving drugs -aspirin (Disprin), ibuprofen (Brufen), diclofenic acid (Voveran) and many others of the NSAIDS group need to be taken sparingly. Their regular use may cause CKD. There are many drugs of alternative medicine and supplements which are made with heavy metals. These heavy metals cause CKD. Patients as well as consumers of supplements (including those building their bodies) need the know very well about the contents of their drugs/ supplements.
• Drinking water. Keeping the IIT Mandi report in view, those using shallow borewell water for drinking, need to get their water samples checked for metals too. Reverse Osmosis filters are effective in removing most metals and minerals- poisonous as well as beneficial. Select with careful research and expert advice before installing one.
• Find early, treat early. This maxim applies to a small number of cases who are born with rare kidney diseases. This also applies to infections of the urinary tract which lead to CKD. It is not easy to detect them at an early stage. However, children having puffiness under the eyes and swollen ankles or having urinary infections should be under the care of a paediatrician.
• Those already having Diabetes or Hypertension. Such persons need to be under the care of a physician. They shouldn’t avoid periodic checks and tests. Those overweight /obese need to undertake several measures to reduce their weight.

Managing Existing CKD

Of course, such persons will be under the treatment and care of a physician or nephrologist. The would be under drug treatment and periodic testing of various parameters must be going on.

Existing CKD cases can continue to lead their lives without a dialysis or kidney transplant for a longer period as long as they:

• Obey the instructions of their treating doctor.
• Avoid alternative treatment drugs having unknown metals/ chemicals. Also, unknown herbal supplements.
• Observe a good lifestyle for the prevention or treatment of diabetes, hypertension, obesity, and heart disease. Also, avoid tobacco and alcohol. Manage stress and have adequate sleep.
• Have their food and fluid intake monitored by a dietician/ nutritionist. A low protein, low sodium, potassium and phosphorus diet is generally recommended. It is called the RENAL DIET. Read more about ‘Renal Diet’ by clicking HERE.

• Heart health. This is being highlighted separately as some cases of CKD are prone to have a heart attack or a stroke, their close relatives should be aware of providing emergency first aid and early transfer to a well-equipped hospital.
• Water intake. Both, less intake and excess are bad. Less intake may cause dehydration and excess may cause hyponatraemia which is dangerous. Water intake will depend on the season, physical activity, body size and body weight. There is no hard and fast rule of eight glasses for all.
• Immunity. Immunity of persons suffering from CKD starts getting impaired. They become prone to opportunistic infections as well as other diseases. They need to take vaccines and supplements as per the advice of their physicians.

Persons with CKD must be on close monitoring of a personal physician. They should also have close relatives/carers at home who can keep an eye on the patient. The relative or home carer should know the early signs of heart attack and brain stroke, the commonest causes which can have serious consequences. Emergency phone numbers of ambulances and treating physicians should be readily available.

The carburettors of our body should be fed pure fuel. Dirt in the fuel will choke the carburetor and inferior fuel will cause power loss in the body’s engine. Periodic servicing ensures the proper functionality of the vehicle. The same is true for our kidneys and their role in the body. We must learn to treat this amazing God’s creation with respect. Our kidneys should be kept as clean as possible and should be fed with good food.

Organ Donation

NOTTO- National Organ and Tissue Transplant Organisation scored a ‘Six’ by signing up with ICC and BCCI to spread awareness of organ transplants. For a change, the cricket heroes of the Indian team became screen heroes in spreading the message of organ transplants. Hopefully, cricket fans will show courage and sign up for organ donation. A simple QR Code for registration as an organ donor is being given on all tickets for spectators of cricket matches. You can also register as an organ donor while making/ renewing a driving license.

Title image courtesy: https://www.kidneyfund.org/

Disclaimer: The views and opinions expressed by the author do not necessarily reflect the views of the Government of India and Defence Research and Studies

Article Courtesy: https://genkris.wordpress.com/