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ALL ABOUT THE KIDNEYS

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ABOUT THE NKFSA
    • 10% of all people in the world have some form of kidney disease.
    • Anybody with increased micro albumin or protein in the urine has a 5-8 times higher risk of dying from Cardio-Vascular disease than those without. This mortality is nomally at a younger age.
    • Kidney failure in South African adults is mainly due to inherited Hypertension (60-65%) or Type 2 Diabetes (another 20-25%).
    • Kidney failure in the black population is 4 times higher than other groups – due to the high incidence of Hypertension.
    • Hypertension and Diabetes can be:
      • Prevented
      • Diagnosed early
      • Properly treated

           And in doing so, potentially 70-80% of all chronic kidney failure and /or cardio-vascular deaths are PREVENTABLE.

Our hearts function as a pump for pumping blood through our lungs to capture oxygen for the body, and to eliminate carbon dioxide. Our muscles, joints and bones enable us to stand and move, and our bowels and liver digest and absorb nutrients.

 

By contrast, our kidneys are filters which perform the varied functions of all our organs other than the brain. Kidneys manufacture essential chemicals, they break down (metabolize) unnecessary or dangerous chemicals, and they retain necessary substances and eliminate toxic waste.

 

In everyday life, our kidneys:

 

Make 150 litres of urine a day, but keep back (reabsorb) 149 litres of useful substances, like protein, and excrete 2 litres of waste. They can be likened to a huge swimming pool filter which never needs backwashing, and will rarely need an overhaul if you look after your health!

 

Functions of the kidneys:

 

  • Excrete drugs, medicines and poisons.
  • Provide the nutrients to take care of our bones and joints, allowing for a solid and healthy skeleton.
  • Control the amount of acidity and alkalinity (pH) in the body.
  • Produce chemicals which control our blood pressure, and produce other chemicals which produce our red blood cells – which carry oxygen to our whole body.
  • Destroy chemicals and hormones which the body doesn’t need any more – like insulin.

 

When the kidneys do not function optimally the following may occur:

 

  • Kidney failure will eventually poison the body and mind.
  • Swelling of the body
  • Shortness of breath
  • Weakness
  • Poor appetite
  • Insomnia (sleeplessness)
  • Body aches and pains
  • Impairment of thought processes
  • Headaches and high blood pressure

You cannot diagnose kidney disease yourself – it can only be diagnosed by a qualified doctor. If you suspect any problems with your kidneys consult with a doctor who will be able to refer you to a specialist if necessary.

The best advice to the PUBLIC and to DOCTORS is to realize that many of the dangerous kidney disorders (including Hypertension and Diabetes) can be SILENT. Remember: SALT AND HIGH BLOOD PRESSURE – TWO SILENT KILLERS. In other words, by the time many (not all) people present with symptoms and signs of kidney disease (especially Hypertension and Diabetes), it may be too late to have prevented serious kidney and/or cardio-vascular dysfunction. (See also the section on HOW TO AVOID KIDNEY DISEASE below.

Ten thousand South African, men and women, young and old, will die of kidney disease or kidney failure every year. Others are luckier and can be treated by dialysis or a kidney transplant. There are also other kidney conditions which don’t require dialysis, but which adversely affect the lives of thousands of South Africans. All of these conditions require early detection, and many can be prevented.

Causes of kidney disease include:

  • high blood pressure (putting more stress on the blood vessels throughout the body, including the kidneys)
  • diabetes mellitus, inflammation of the kidney (glomerulonephritis), blockage (e.g. kidney stones) (see table below on these conditions)
  • kidney disease may be caused or exacerbated by hereditary aspects (such as the development of cysts in the kidneys or a predisposition to cancer of the kidneys)
  • trauma to the kidneys (accidents and injury caused by medication, drugs, poisons and radiation)

Potentially fatal kidney disorders occur three to four times more commonly in the African population.

Disorder What is it? Is it common? How is it treated
Diabetic Kidney Disease
A kidney disease caused by the deposition of a substance in the kidney filters that gums them up and blocks their capacity to filter, unique in diabetes.
Diabetic kidney disease is the second most common disease, and in many cases is the most common cause of kidney failure.
Much can be done to prevent or slow progression into kidney failure by rigorous control of blood sugar and blood pressure and the use of special medication proven to protect the kidneys from further damage.
Polycystic Kidney Disease
This is an inherited condition associated with the development of thousands of cysts in each kidney. It usually causes kidney failure after the age of 40 and may be complicated by severe hypertension.
Polycystic kidney disease occurs in 1 in 800 live births, and many of those affected would not even be aware that they have the condition.
There is limited treatment options available although rigorous blood pressure control helps to prevent complications.
Glomerulonephritis
A type of kidney disease that damages the kidney filters (nephrons).
A very common cause of kidney failure worldwide.
Specific treatments to cure or control this condition are available in some (normally very few) cases. In the rest, simple measures are used to slow down progression to kidney failure.
IgA Nephropathy
This is the most common type of glomerulonephritis and presents with blood in the urine (often not visible to the naked eye). It is often associated with recurrent sore throats and pain in the loins.
IgA nephropathy accounts for probably about 8 percent of all cases of kidney failure and sometimes runs in families.
There is currently no cure for IgA nephropathy, although much can be done to stabilise the condition and slow down its progression. Many people diagnosed with this do not ever progress into kidney failure.
Kidney stones (nephrolithiasis)
They are hard, rock-like crystals that form when certain chemicals in the urine stick together. They can range in size from as small as a grain of sand to as big as a golf ball.
They are one of the most common disorders of the urinary tract. The likelihood of developing a kidney stone increases with age and family history.
Most stones (90 percent) will pass by themselves. If a stone is too large to pass, is blocking urine flow or is causing bleeding or infection, surgery may be required. Lifestyle adjustments to prevent recurrence is vitally important but will vary according to the type of stones.
Kidney Cancer
There are several types of kidney cancer, and the most common is renal cell carcinoma. As with all cancers, tumours begin small and grow larger over time. Some kidney cancers can spread through the blood stream or lymph vessels to other areas of the body.
Kidney cancers account for about 2.5 percent of all cancers. They occur twice as often in men as women.
There are four types of treatment. These are surgery, chemotherapy, radiation therapy and immunotherapy, with treatments done singularly or in combination.

HOW IS KIDNEY DISEASE TREATED?

The major complication of kidney disease is progression into kidney failure. Recent studies have proved that for most kidney conditions APPROPRIATE TREATMENT can stabilise or significantly slow down the rate of progression by up to half. But, if the kidneys are only working at 5 to 10 percent of their normal rate, DIALYSIS or a KIDNEY TRANSPLANT is the only option. However, before this stage is reached there are different levels of kidney disease measured (normally) through a blood test which shows the eGFR (estimated glomerular filtration rate). The following table gives the eGFR classification of kidney disease stages:

Stages of kidney disease as measured by the eGFR (mL/min/1.73m2)

Stage eGFR Description
1
≥ 90
Normal or high
2
89 – 60
Slightly decreased
3a
59 – 45
Mild to moderately decreased
3b
45 – 30
Moderately to severely decreased
4
30 – 15
Severely decreased
5
< 15
Kidney failure

DIALYSIS

Essentially, dialysis means the replacement of the kidneys’ excretionary role by artificial means. There are two types of dialysis – haemodialysis and peritoneal dialysis. The type of dialysis used depends on many factors – age, access to resources, overall health and lifestyle and will normally be advised by your doctor.

 

Haemodialysis requires a minor operation to allow access to blood circulation, usually through the wrist or chest. Blood is then removed from the body, cleaned by an artificial kidney attached to a machine and then returned. Each treatment lasts for four to six hours, and is required three times a week for life or until a transplant donor is found.

 

 

Peritoneal dialysis also requires a minor operation, but this time a catheter is inserted into the abdomen. Unlike haemodialysis, where waste removal and blood cleansing take place outside the body, during peritoneal dialysis this is done inside the body, using the body’s own peritoneal membrane – the lining of the abdominal cavity – as a filter. The catheter acts as an entrance for a dialysis solution to enter and leave the cavity. Dialysis takes place four times a day, seven days a week, but can be performed almost anywhere. Again, this treatment is for life, or until a transplant donor is found. In some cases it might be advised that a patient should change to haemodialysis for clinical reasons such as recurrent infections.

KIDNEY TRANSPLANT

While kidney transplantation delivers a healthy, functioning kidney to someone suffering from kidney failure, it is important to remember that it is a treatment, not a cure. Transplantation gives people with kidney failure a chance to get their old lives back, free from dialysis. Kidney transplantation is a highly successful alternative to a life-time on dialysis. However, it is not a “quick fix”. A new kidney requires a lifetime of care, including taking anti-rejection medication.

 

Donated kidneys come from either deceased donors or from living donors. Living donors are usually close relatives, but spouses, distant relatives and even close friends can donate a kidney. If there is no established relationship between the donor and the recipient it is known as an altruistic donation and would need to be approved before it can be done. For more information you can contact the NKFSA and ask for the document explaining transplantation.

    • Between 2006 and 2007 a UK study showed that they spent about £10.6 billion on 30 – 50% of patients that did not take their prescription medicines! This cost the UK £100 million per year.
    • Although the medicine expenditure in RSA would be a little lower, it could still mean that we could be “wasting” up to one thousand five hundred million rand per year, i.e. R1.5 billion!
    • Additional costs came, not surprisingly, from patients being admitted to hospital and/or dying directly because of this non-adherence.
    • A Cochrane study (the Cochrane group only accepts medications for all diseases which have been unequivocally scientifically proven) showed that, by improving medication adherence, a far greater impact on clinical outcomes (cure or control) was seen than the degree of improvement from the treatment itself!
    • This applies the most to:
      • Hypertension control
      • Diabetes control

     

     

    So, TAKE YOUR MEDICINES! All medicines prescribed should have clear instructions on how and when to take it. For any problems with your medication, phone your doctor and discuss it!

Early detection:

 

  • All people with a family history (even in old people) of Hypertension or Diabetes (Type 2) should have an ANNUAL Blood Pressure check-up from the age of 20 years and Blood Sugar check-up from the age of 30 years.
  • Also very important, all sick people seeking a doctor’s advice – usually their GP or a nurse in a clinic – should have their URINE examined with a dipstick test. If there is Protein, Blood, White Cells or Glucose shown as present on the dipstick test, they must immediately be referred to their doctors (in the case of nurses doing the test). In many instances with the above problems the patient may have to also be referred to a Kidney Specialist i.e. a Nephrologist.

SMOKING

If you don’t smoke, don’t start. If you do, quit! This is the simplest, most important lifestyle habit to change to reduce the risk of kidney disease. People who smoke are three times more likely to have reduced kidney function, and have a four to five times greater risk of heart attack and stroke.

Tips to help you quit

  • Get the appropriate help, with referral to a smoke-enders or quitting programme.
  • Surround yourself with people who are non-smokers.
  • Talk to your doctor – research shows that spending as little time as three to five minutes talking with your doctor. This will increase your quit rate.
  • Find healthy alternatives to smoking, such as exercise, meditation and yoga.

 

LIMIT ALCOHOL

Excessive alcohol intake can lead to heart disease and high blood pressure, increasing the risk of kidney disease.

Tips to cut down on your alcohol intake

  • Limit alcohol to two standard drinks per day for men, and one per day for women.
  • Ask for ice with your drinks – when the ice melts it will dilute alcohol.
  • Alternate your drinks by having a glass of water in between each alcoholic drink.
  • If you want to participate in a drinking session, fake it – drink your water from a wine glass.

 

ENJOY LIFE

Good health and well-being means that we are healthy from all dimensions of our lives – physically, mentally, socially and spiritually.

Tips for an enjoyable life

  • Have less stress in your life
  • Do the things you love
  • Spend more time with people you enjoy being with – those who challenge you to be more … not less.
  • Balance the load.

 

NUTRITION (See also the dedicated section on Exercise and Diet)

 

The food you eat plays a huge role in the health and well-being of your body. It can help to prevent some diseases, and help to manage others. As well as providing the body with a variety of nutrients, diet can also help in weight reduction and weight control. People who are overweight are at an increased risk of developing diabetes and high blood pressure – major risk factors in kidney disease. In fact, losing as little as five kilograms in most people who are 10 percent over their ideal weight will reduce blood pressure.

 

People with kidney disease may need to make some dietary changes to help manage their condition. Not all people with kidney disease will be able to follow the same diet. Dietary guidelines will need to be made on a personal basis, considering age, lifestyle, health status and body chemistry.

 

Tips for a healthy diet:

  • Eat lots of fruit, vegetables, legumes and wholegrain bread and rice.
  • Eat some lean meat such as chicken and fish at least once a week (less red meat).
  • Eat reduced-fat and low-fat dairy products.
  • Limit the amount of fatty foods you eat, such as fried fish and chips, fried or roast chicken, and potato crisps
  • Lower your salt intake. Buy low- or no-salt products and don’t add salt to food at the dinner table.
  • Eat more at home, not take-aways – less temptation.

If you need extra guidance on a healthy diet, visit your doctor for advice on nutrition and your ideal weight.

 

QUENCH YOUR THIRST

While it has long been thought that 6 to 8 glasses of water a day is beneficial to health, there is no evidence to suggest that drinking in excess of thirst has any extra benefits. Use your thirst as a guide.

Tips for drinking

  • Make water your tipple of choice. Water assists in transporting nutrients around the body, as well as helping to eliminate waste. It contains no kilojoules, and in most areas of South Africa tap water is excellent with good mineral content.

• Limit your intake of caffeine and cola. These can irritate the bladder and can act as a diuretic. Instant coffee has less caffeine than espresso or percolated coffee, while tea has less caffeine than coffee. Rooibos tea has no caffeine, and plenty of healthy anti-oxidants and minerals.

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