April 2021
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Kidney disease is becoming more and more common. It is important that everyone understands what are the common kidney diseases, how they occur and what preventive measures can be taken to avoid kidney disease.

Some common kidney disorders are
Diabetic nephropathy
Hypertensive kidney disease
Nephrotic syndrome
Drug induced kidney disease
Acute kidney injury
Dialysis and transplantation can also be considered here
Let us understand these common conditions.

Diabetic kidney disease

This is kidney disease which occurs in upto 40% od diabetics usually after many years of diabetes but can be found sometimes early in the course of diabetes. The first presentation is by excessive amounts of albumin in the urine (called moderately increased albuminuria and previously called microalbuminuria). After this stage, the albuminuria increases, and kidney function starts becoming affected and finally ends in severe kidney failure where we need dialysis or transplantation. This can be prevented by meticulous control of diabetes, control of associated hypertension and use of certain drugs. Everyone with diabetes should check the urine for microalbumin at least once a year for early diagnosis. At this stage, treatment can prevent worsening or, in some cases, cause reversal of the changes.

Hypertensive kidney disease

Long standing high blood pressure can cause kidneys to fail. This usually results in progressive fall in the kidney function leading to a final stage where dialysis or transplant is needed. This can be detected early by checking the urine for protein and by checking the blood for urea and creatinine levels. Early diagnosis and control of hypertension can lead to slowing the progression of kidney disease. The important message is that high blood pressure is a condition not to be taken lightly but to be controlled well, otherwise kidneys will be damaged.

Drug induced kidney disease

Many drugs are capable of kidney damage. Kidney damage can occur due to certain pain killers called NSAIDs or certain antibiotics called aminoglycosides. In addition, a large number of drugs have been known to produce immune mediated kidney damage. Kidney damage has also been seen with ayurvedic preparations and other alternative medicines. Thus unnecessary use of medicines should be avoided. Older people and those with pre-existing kidney disease or other systemic disease should avoid such drugs as far as possible. One should not be led by claims such as ‘free of side-effects’ claimed by practitioners of alternative medicine. Many of these drugs have serious side effects.

Nephrotic syndrome

This is a condition where protein is lost in the urine due to immunity mediated changes in the kidney. Normally the kidney excretes only extremely small amounts of protein. In nephrotic syndrome large quantities of protein are lost in the urine and this leads to decreased protein in the blood. The result is swelling all over the body which increases with time. Usually in adults, this condition will need to be diagnosed as to the cause by means of a test called a kidney biopsy. Treatment is by drugs that suppress the immune system.

Acute kidney injury

Due to various causes, the function of the kidney can completely stop abruptly in a matter of hours to days which is called acute kidney injury. The common causes are severe losses of blood or fluid from the body (as occurs in prolonged diarrhea or vomiting). These fluid losses lead to reduced blood pressure and reduced blood flow to the kidney causing a sudden drop in the function of the kidney. Another important cause is severe bacterial or fungal infections which also lead to shock, a condition where the blood pressure drops alarmingly and the patient becomes extremely ill. The resulting shock causes acute kidney injury. In our part of the world, some specific infections and toxins lead to direct attack on the kidney and acute kidney injury – in leptospirosis, dengue fever, snake envenomation and more recently, COVID 19. All the conditions producing acute kidney injury lead to critically ill state and are all associated with a high rate of death. But these conditions are also treatable to a large extent and aggressive treatment can result in complete recovery.

Chronic kidney disease:

This is a condition where the kidneys irreversibly fail and will need kidney replacement therapy in the form of dialysis and transplantation once the failure becomes extreme. Many of the above disease states such as diabetes, hypertension, primary diseases of the kidney and many others lead to irreversible failure of kidney function. If this is detected early, then certain secondary prevention measures can be instituted to prevent or slow the progression of disease. Continuous treatment and follow up are needed.

Dialysis and transplantation:

Dialysis is a technique to replace the filtering function of the kidney. There are two types of dialysis, peritoneal and hemodialysis. In peritoneal dialysis, a tube made of special plastic is inserted into the peritoneal cavity in the abdomen and fluid

exchanges are done through this tube. The fluid put in will take out the wastes that are present in the blood by a process called diffusion. In hemodialysis, the same principle is used but in this case, an artificial membrane is used and blood is circulated through this membrane and the wastes are diffused into the fluid which is circulated outside the membrane (called dialysis fluid). As a result the patient is kept stable and is able to lead an active life. In end stage kidney disease, the preferred treatment option is kidney transplantation. A kidney can be retrieved from a live related donor or a deceased donor. The results of kidney transplantation are usually good and a life of 20 years or more can be expected from the graft.

Prevention is better than cure. Prevention of kidney disease is by properly managing the conditions which cause kidney disease. These include mainly diabetes and hypertension. Avoiding unnecessary medicines, regular exercise and fluid intake, an maintaining a normal body weight are important general measures in preventing kidney disease.

Dr. Satish Balan
Senior Consultant, Department of Nephrology

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