We all have 2 kidneys. Main job of kidneys is to clean our blood. Our kidneys process about 200 liters of blood every day and excrete metabolic waste products through urine. In addition, kidneys also help us control our fluid, salt and acid-base balance, control blood pressure, strengthen bone and maintain hemoglobin level.
When kidneys’ functions deteriorate, we call it kidney failure. Early stages of kidney failure may not give rise to any symptoms. However, late stages may present as loss of appetite, nausea/vomiting, weakness, easy tiredness, body ache, generalised itching, decreased amount of urine, swelling of face/feet/whole body, shortness of breath, and increase in blood pressure. Very advanced stages of kidney failure may result into convulsion, coma and even death.
Kidney failure is of 2 types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute renal failure means kidneys have failed suddenly over a period of hours to days because of some reasons like dehydration, muscle damage, infection, liver disease, complicated pregnancy, difficult and prolonged surgery, different types of drugs and obstruction of urinary tract by stone or tumor.
Treatment of ARF is relatively easy. We withdraw the offending drug and treat the underlying condition that has led to the development of ARF. Sometimes dialysis is also needed for some period of time. With these measures, kidneys regain their functions in majority of cases within two to six weeks and ARF is gone. Some cases of ARF however, may take longer time to recover or may not recover at all. Those unfortunate patients eventually need life long dialysis or kidney transplant.
Chronic renal failure (CRF) develops over a period of weeks to months. Unlike ARF, CRF is irreversible and progressive by nature. However, CRF can be controlled, that is, there are ways and means by which progression of CRF can be halted or slowed down.
Two of the most common causes of CRF are diabetes and hypertension. Other important causes include glomerulonephritis, interstitial nephritis, kidney stone disease, long-term and excessive use of pain killers, hereditary polycystic kidney disease and some others.
Treatment of chronic renal failure depends upon the stage of the disease. Modern classification divides CRF into 5 stages: Chronic Kidney Disease (CKD) stage I to stage V. Stage I means kidney function is 90% or more while stage V means kidney function is 15% or less. A kidney function less than 10-15% is also called End stage renal disease (ESRD). After reaching the stage of ESRD a patient can not do without some kind of external support of kidney functions. These external supports are called renal replacement therapy (RRT). These support mechanisms can be Hemodialysis (HD), Peritoneal Dialysis (CAPD) or kidney transplant (KT).
Treatment of chronic renal failure in early and middle stages (CKD I-IV) aims at slowing down or halting the progression of CRF as well as making patients less symptomatic of kidney problems. These include good control of blood sugars, blood pressure and cholesterol, dietary restrictions, avoidance of certain pain killers and antibiotics, cessation of smoking, use of certain medications and regular follow up with a nephrologist.
It is important to emphasise that above mentioned measures do really work. We have many patients on our follow up, whose kidney functions are stable for last 2 or 3 years because they are strictly maintaining the rules.
Hemodialysis means cleaning of blood by dialyser or artificial kidney. If started at right time and done regularly, hemodialysis offers near normal quality of life and maintains significant longevity as well.
Continuous ambulatory peritoneal dialysis (CAPD) uses patients own peritoneal membrane inside the abdomen as dialyser. Here dialysis happens inside patient’s abdomen. Beauty of CAPD is that it does not need any machine or hospital or doctor. This can be done at home even in a remote village by the patient himself or a person who has been trained to do so. Results of CAPD are similar to that of hemodialysis.
Kidney transplant involves surgical placement of one kidney taken from a donor. Success rate of kidney transplants now-a-days is more than 90%. However, patient has to take special immunosuppressive medications lifelong. These medicines suppress the immune system of body so that transplanted kidney is not rejected.
These medicines are expensive and as a result of suppression of the immune system, they predispose the patients to catch infections easily.
Out of all treatment options for the patients of ESRD, kidney transplant offers the best quality of life to them. A person who donates one of his kidneys, does not develop any medical problem because of kidney donation and continues to lead a perfectly normal life.
Kidney failure can be prevented. Prevention is of two types: Primary prevention means to prevent a disease before it happens while secondary prevention means early diagnosis and treatment of a condition.
As we discussed earlier, diabetes and hypertension are the two most common causes of CRF. Thus if we want to prevent kidney failure, then we need to prevent diabetes and hypertension.
For secondary prevention of kidney failure, first we need to know if we have any kidney problem. As early stages of kidney failure may not give rise to any symptoms, we suggest screening for possible kidney diseases in certain high risk groups (persons older than 35 years of age, persons with family history of kidney disease, and persons with diabetes or hypertension).
Dr Krishna Mohan Sahu, a Consultant Nephrologist in Apollo Hospitals Dhaka.
Source: The Daily Star, January 31, 2008