World Kidney Day 2019: Important aspects for Chronic Kidney Disease in Modern time

Chronic Kidney Disease, with its high prevalence, morbidity and mortality, is an important public health problem in India.1 in 10 persons in the general population are estimated to have some form of chronic kidney disorder (CKD). About 175,000 new people have kidney failure (stage V CKD) every year in India and require dialysis. Moreover, CKD and other noncommunicable diseases have often been ignored in the face of persistent challenges from and competition for resources for communicable diseases and high infant and maternal mortality. One reason is the rapidly increasing worldwide incidence of diabetes and hypertension. In India, given its population >1 billion, the rising incidence of CKD is likely to pose major problems for both healthcare and the economy in future years.

Kidneys are a pair of organs located toward lower back. One kidney is on each side of spine. They filter blood and remove toxins from body. The Kidneys send toxins to bladder which the body later removes toxins during urination. Kidney failure occurs when kidneys lose the ability to filter waste from blood sufficiently. Many factors can interfere with kidney health and function, such as toxic exposure to environmental pollutants or certain medications, certain acute and chronic diseases, severe dehydration, kidney trauma etc.

When you know the symptoms of chronic kidney disease (CKD), you can get treatment and feel your best. CKD symptoms can be subtle. Some people don’t have any symptoms or don’t think they do. If you have one or more of the symptoms below, or worry about kidney problems, see a doctor for blood and urine tests.

• Fatigue – being tired all of the time. Healthy kidneys make a hormone called erythropoietin (a-rith’- ro-po’- uh-tin), or EPO, that tells body to make oxygen carrying red blood cells. As the kidneys fail, they make less EPO. With fewer red blood cells to carry oxygen, muscles and brain tire very quickly. This is anemia, and it can be treated
• Feeling cold. Anemia can make you feel cold all the time, even in a warm room.
• Shortness of breath – after very little effort. Being short of breath can be related to the kidneys in two ways. First, extra fluid in the body can build up in the lungs. And second, anemia (a shortage of oxygen-carrying red blood cells) can leave your body oxygen-starved and short of breath.
• Feeling faint, dizzy, or weak. Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to feeling faint, dizzy, or weak.
• Trouble thinking clearly. Anemia related to kidney failure means that your brain is not getting enough oxygen. This can lead to memory problems or trouble with concentration
• Feeling very itchy. Kidneys remove wastes from the bloodstream. When the kidneys fail, the build-up of wastes in your blood can cause severe itching.
• Swelling in hands or feet. Failing kidneys don’t remove extra fluid, which builds up in your body causing swelling in the legs, ankles, feet, and/or hands.
• Swollen or puffy face. Failing kidneys don’t remove extra fluid, which builds up in your body causing swelling in the face.
• Food tastes like metal. A build-up of wastes in the blood (called uremia) can make food taste different and cause bad breath. You may also notice that you stop liking to eat meat, or that you are losing weight because you just don’t feel like eating.
• Ammonia breath. A build-up of wastes in the blood (called uremia) can cause bad breath.
• Upset stomach, nausea, vomiting. A severe build-up of wastes in the blood (uremia) can also cause nausea and vomiting. Loss of appetite can lead to weight loss.
• Getting up during the night to make urine. Kidneys make urine, so when the kidneys are failing, the urine may change. One urinate more often, or in greater amounts than usual, with pale urine. One may feel pressure or have difficulty urinating.
• Foamy or bubbly urine. Kidneys make urine, so when the kidneys are failing, the urine may change. Urine may be foamy or bubbly. This can lead to an above-normal amount of protein in the urine.
• Brown, red, or purple urine. One may urinate less often, or in smaller amounts than usual, with dark-colored urine. Your urine may contain blood.

Diabetes is also a major risk factor for kidney disease with diabetes the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that has a high sugar level.

Like other developing countries, India has unique situations and challenges that influence early diagnosis and management of CKD. Facilities and expertise available in different parts of the country are unequally distributed. Prevention and early detection of CKD mandate involvement of physicians at all levels. Most patients with CKD can be managed by their primary physicians with timely nephrology referrals. In addition, healthy lifestyle changes, such as losing weight and regular exercise, often help to control, and may even help to prevent, high blood pressure. Careful control of blood sugar in diabetics helps to prevent such complications as kidney disease, coronary heart disease and stroke.

Dr.Asit Rushikesh Mehta | Consultant Nephrology |  Narayana Multispeciality Hospital, Ahmedabad