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KIDNEY DISEASE: EXPLORING THE REALITY AND MYTHS
 
The very mention of the malady of kidney disease is bound to send a shiver down anyone’s spine, given the perilous journey of dialysis and renal transplant that one very often attribute to this ailment. Renal disease is more often than not perceived as cataclysmic and irrevocable, a death sentence as many might decipher it to be. However, as a practicing Nephrologist, I consider it my duty to rid the many afflictions of the kidney of this ignominy, and demystify the very essence of kidney disease to the common man. It is certainly undeniable that chronic kidney disease is a major cause of mortality and morbidity worldwide. Yet, kidney disease has a multitude of sustainable treatments in the current era, which may be entirely curative or largely supportive in alleviating the intensity of disease and prolonging life.

According to western data cited by the CDC, 1 in 7 US adults, which accounts for 37 million Americans live with kidney disease. (1)The recent ICKD study, which is one of the largest studies of patients with mild-to-moderate chronic kidney disease in a lower to middle-income country, identified diabetic kidney disease as the major etiology attributing to 25 % of cases, chronic interstitial nephritis being second, and a relatively newer entity termed CKD of unknown origin being third. Chronic glomerulonephritis, hypertensive nephrosclerosis and polycystic kidney disease were the other common causes of chronic kidney disease. (2)

Not all kidney diseases are chronic in nature and may have been precipitated by a more acute trigger. These comprise a decline in renal perfusion which could have been caused by volume depletion from body fluid loss in many forms such as hemorrhage, diarrhoea or severe vomiting; hypotension arising from sepsis, or cardiac impairment; drug related as in the case of certain well known non-steroidal anti-inflammatory drugs among others. Intrinsic damage to the renal tubules from ischemia due to sepsis, contrast agents, or drugs; obstructive nephropathy from renal calculi, stricture of the ureters, tumours, prostatic hypertrophy are certain other etiologies. (3)

While the burgeoning of kidney disease in a large majority of the population may be attributable to the improved longevity owing to better healthcare facilities and hence better diagnosis, it is a matter of concern that there are several lifestyle associated risk factors that may be the harbinger of this illness. A cross section of our population reveals 1 in 5 individuals being diabetic and 1 in 3 being hypertensive, both of which when uncontrolled and long-standing often lapse into kidney impairment. Habits such as smoking spell doomsday to the kidneys as they do to multiple other organs. The mammoth transformations in our dietary habits, delving into a more meat and oil-based diet, supplemented by sedentary lifestyle is a forerunner of obesity, and secondary renal dysfunction from hyperfiltration injury.

A heavily salt and sugar-based diet, with reliance on meat consumption, and poor fluid intake may be the potential trigger behind renal calculi. Unrestrained and utterly arbitrary consumption of several over- the-counter drugs for pain relief such as non-steroidal anti-inflammatory drugs might pave way for kidney damage in the long run. Other non-modifiable risk factors like genetics, pregnancy. etc. may be the catalyst behind genetically transmissible, immune mediated, and pregnancy related kidney diseases. These facts highlight the impact of a healthy lifestyle on prevention of kidney disease to a great extent, which may be exercised at the level of primordial prevention to eliminate the existence of risk factors altogether.


Kidney disease may often bask in oblivion, one of the major reasons being that symptoms do not always rear their head when the disease first manifests. This is very often true in the case of chronic kidney disease where the patient may harbour absolutely no signs of renal dysfunction and may appear hale and hearty in the initial stages of disease. However, even subtle clues like malaise and lethargy are not to be ignored. Other symptoms may be variation in the quantity of urine, frothing of urine, passage of blood or stones in urine; swelling of the face, limbs, or the entire body; fever; abdominal pain; obstruction to urine flow among several others. Individuals at risk for heritable kidney disease, and ones with risk factors or co-morbid conditions predisposing to kidney damage must certainly watch for any red flag signs and seek evaluation at the earliest. Screening tools for kidney disease need to be employed on a large population-based scale to identify the sleeping giant and take steps to tackle it at the onset.

As enigmatic as kidney disease is, a flurry of myths surrounds this ailment, which may lead to poor outcomes among patients who blindly abide by ill-informed suggestions. A common and rather shocking misconception is that heavy amounts of fluid consumption will ward off kidney disease and cure it among kidney disease patients. This is a rather serious and at times life threatening

misconception, since the fluid consumption of an individual ought to be strictly regulated by the volume status of the body. Several patients with chronic kidney disease might be in a fluid overloaded state which may be critically worsened by surplus fluid intake, and may drive the patient into pulmonary edema and other such catastrophes.

Another far-fetched myth is that kidney disease spells dialysis or renal transplant in every scenario. This could not be further from the truth. While end stage kidney disease does depend on these modalities for survival, there are several cases of acute kidney injury which may be entirely reversible, or assume dialysis independence on the road to recovery. Yet another myth is that kidney donation lowers one’s life expectancy, and forms a major roadblock in the path of dissemination of kidney transplant as a major boon in end stage kidney disease. The fact remains that a single healthy kidney can take up the function of both and hence, kidney donation does not pose any major mortality risk to the donor.

A major myth that probably explains the murky aura surrounding kidney diseases is the belief that kidney disease is untreatable and will eventually result in death. While chronic kidney disease is definitely a progressive one and is incurable, there are multiple therapies in vogue to allay its progression. Following strict dietary restrictions and abiding by a stringent drug regimen with close follow up, one may be able to lead a very productive life. End stage renal disease does not usher in the end of the road, since therapies such as dialysis and kidney transplantation emerge as beacons to end stage patients.

I shall not attempt to debunk all the myriad myths and misconceptions that encompass kidney disease in the purview of this article, but wish to share my perception on the fact that kidney disease is no longer a grim reality but a manageable clinical condition if identified and treated promptly. Beyond the path of treatment lies the door to prevention and unlocking this particular door may metamorphose the very spectrum of kidney disease in the days to come. Let us usher in a new era of public awareness and early recognition of kidney disease. Let today be the forerunner of brighter, healthier tomorrows!
REFERENCES:

(1) Center for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2021. Center for Disease Control and Prevention, US Department of Health and Human Services; 2021
(2) Vivek Kumar, Ashok Kumar Yadav, Jasmine Sethi, Arpita Ghosh, Manisha Sahay, Narayan Prasad et al. The Indian Chronic Kidney Disease (ICKD) study: baseline characteristics, Clinical Kidney Journal, Volume 15, Issue 1, January 2022: 60–69.
(3) Makris K, Spanou L. Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. Clin Biochem Rev. 2016 May;37(2):85-98.

DR. FOUSIYA YOONUS,
ASSOCIATE CONSULTANT, DEPARTMENT OF NEPHROLOGY, KIMSHEALTH, TRIVANDRUM


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