Chronic Kidney Disease that You Should Know About-by Dr Harold Gunatillake

Presenter-Dr. Harold Gunatillake FRCS, MB,BS, AM (Sing), FACS, FIACS

Transcript

WE are all concerned about our heart-health and cholesterol levels, whilst a silent disease may be brewing up in your kidneys, without symptoms for years.

So, how can we find out whether our kidneys are healthy or otherwise.

Chronic Kidney Disease (CKD) affects 11% of the US population- that is 30 million Americans have CKD. Additional millions are at risk.

Early detection can help prevent or control the progression of CDK. In short slow down the disease in moderately advanced situation.

In Sri Lanka, it is referred to as the silent Killer, and is common in the North Central and Uva Provinces, affecting more than 15% of the population. This includes children and females, in addition to affecting farmers using pesticides in the paddy fields

It is important to understand and know the lab values if you suspect chronic kidney disease

Creatinine is a waste product that is formed in the muscles from creatine phosphate and from consumed red meat.

It is excreted in the urine, but in chronic kidney disease it gradually accumulates in your blood.

If you suspect chronic kidney disease your doctor will check on the blood creatinine level.

If the kidneys aren’t working well, the serum creatinine level gradually rise, and gives an estimate of how well your kidneys filter. We call this glomerular filtration rate. Also, we call it GFR which is calculated based on your serum creatinine.

In other words, GFR is the rate at which the kidneys filter toxins from the blood.

Glomerular filtration rate GFR- an important test to assess the functions of your kidneys.

GFR Number correlates with the overall kidney function

This number fluctuates from day to day. In normal kidney functions it is always over 60

If the number is 40, it means that your kidney function is on an average 40 %. This of course is a rough estimate and referred to as stage 3 state.

Normally when you are dehydrated from not drinking enough water, as we all do, creatinine level may rise temporarily. So, drink plenty of water when you go for this test.

Do not eat too much of meat or take certain medications or exercise, when you go
the next morning for your serum creatinine test.

Another test your doctor may request is the blood urea Nitrogen called BUN test.
This is less reliable than the creatinine test.

Kidney failure is also called the End-stage failure.

Diabetes is the most common cause of kidney failure
180 litres of blood are filtered through the kidneys daily, to produce 2 litres of urine.

It is a process of selective filtration which removes waste and potential toxins from
the blood.

If you have one kidney that kidney will filter the same amount of blood.

If a kidney gets damaged, how can the same amount of blood go through the
kidneys when blood vessels are injured?

Yes, the body compensates by raising the blood pressure to force the same amount
of blood through the damaged kidneys.

We say, that damaged kidneys produce high blood pressure. So, the doctors give drugs to lower the blood pressure and then the kidneys may not be able to filter all the waste products and toxins.

How does diabetes cause kidney disease?

Diabetes is the leading cause of kidney disease. About 1 out of 4 adults with  diabetes has kidney disease.

Increasing uncontrolled blood sugar seem to damage blood vessels, including those in the kidneys.

In the kidneys the minute blood vessels get inflamed and the term vasculitis is used. 

Blood vessel damage such as thickening -we call arteriosclerosis can lead to high blood pressure which can also damage your kidneys.

Kidneys don’t show damage during the first 10 years having diabetes. About 15 to 25 years will pass before kidney failure occurs.

Controlling your diabetes, that is monitoring your blood sugar may help you keep your kidneys healthy.

Arrange a diabetic diet plan with a dietitian.

Avoid eating foods with high salt. 
Exercise daily- 10,000 steps walk
Keep your weight at healthy level.
Get enough sleep.

Metabolic functions of the kidneys

Kidneys play an important role in the metabolism of carbs, proteins, lipids and other nutrients.

Kidney tubules generate glucose, clears insulin from the circulation, perform critical steps of the urea cycle and regulate the metabolism of fat- soluble vitamins such as A and D,

In chronic kidney disease, these functions will be disrupted and may cause cardiovascular disease.

Kidney maintains the micronutrients like the minerals within the normal range.

For instance, Calcium and Phosphorus are needed for bone health. High levels of parathyroid hormone can imbalance calcium and phosphorus and lead to bone diseases.

Other minerals like sodium, potassium is important for nerve and muscle functions, including heart muscle.

Bicarbonates maintain acid base balance in blood.

Now you’ll realise the importance of properly functioning kidneys to prevent diseases.

Symptoms of kidney disease.

In the early stages in stage 1 and 2 there are no symptoms, and this may last for 10 years.

During these stages you may need blood tests to check on your creatinine level to check for kidney disease.

So, it is important when you are over 60, to do a kidney function test on your blood sample.

In stages 3 and 4 there are certain symptoms and in stage 5 most symptoms are seen, and this would be the stage that you require dialysis.

Stage 3 is the commonest stage seen by doctors. The GFR would be between 30 and 59.

At this stage you’ll have fatigue, swelling around ankles and frequent urination In stage 4 the GFR is between 15 and 29 when in addition to the symptoms in stage 3, loss of appetite and shortness of breath will be seen.

Stage 5 is the most severe stage when GFR comes down between 5 and 15.

The symptoms in this last stage are

Itching
• Trouble sleeping,
• Worse concentration,
• Nausea,
• metallic taste,
• vomiting and
• muscle cramps.
• Blood pressure will rise at this stage and your doctor may have to add a
second antihypertensive drug.
• Your sugar level will be low at this stage.

The bottom line is be aware that certain drugs and chemicals will damage your kidneys when taken for a long time, such as anti-inflammatory drugs, Aspirin, Panadol, alcohol, antibiotics, certain laxatives, illegal drugs, contrast dyes used in X rays, ulcer medicine such as cimetidine, heartburn medications, pesticides, insecticides and so on.

If you are a diabetic, tightly control your diabetes to prevent diabetic kidneys.

I hope this talk was valuable.

Stay healthy and good luck.