Kidneys! Yes, Your kidneys?

The kidneys are a pair of bean-shaped organs on either side of our spine, below our ribs and behind our belly. Each kidney is about 4 or 5 inches long, roughly the size of a large fist. The kidneys’ job is to filter our blood. They remove wastes, control the body’s fluid balance, and keep the right levels of electrolytes. All of the blood in our body passes through them about 40 times a day.

Each of our kidneys has around a million tiny filters called nephrons. You could have only 10% of your kidneys working, and not likely notice any symptoms or problems. If blood stops flowing into a kidney, part, or all of it could die. That can lead to kidney failure.

The incidence of CKD (chronic kidney disease) in Nigeria has been shown by various studies to range between 1.6 and 12.4%. Statistics have further shown that 30 million Nigerians are suffering from kidney disease and currently, patients pay as high as N150, 000 for three sessions of dialysis every week and about N5 million annually; costs of transplant vary from hospitals but ranges between N2m. In Nigeria, kidney failure remains a death sentence if not detected early and managed appropriately. 

Most people know that the primary function of the kidneys is to eliminate waste products from the body by flushing them out with urine. However, did we all know that there are other fabulous functions our kidneys do like?

Controlling acid-base balance: The acids and bases in the human body are always in a state of delicate equilibrium reflected by a parameter known as ph. To maintain the healthy range, the kidneys excrete acids and bases when there’s an excess of them or retain these compounds when the body is lacking them.

Controlling water balance: The kidneys are one of the body’s main ways to maintain a stable water balance. By regulating the volume of urine, they produce, the kidneys adapt to one’s hydration level. When you drink a lot, the kidneys produce more urine, and the opposite happens when you are dehydrated.

Maintaining electrolyte balance: The kidneys filter some electrolytes from the blood, return part of them into circulation, and excrete excess electrolytes into the urine. The levels of electrolytes like sodium and phosphate are largely dependent on the health of one’s kidneys.

Removing toxins and waste products from the body: The kidneys filter out water-soluble waste products and toxins, flushing them out of the body with urine. That’s precisely why kidney failure quickly leads to severe intoxication, as the body’s waste products build up and impair its functions.

Controlling blood pressure: The kidneys produce an enzyme called renin. Renin converts the angiotensinogen produced in the liver into angiotensin I, which is later converted in the lungs into angiotensin II. Angiotensin II constricts the blood vessels and increases blood pressure as a result. On the other hand, when one’s blood pressure is too high, the kidneys produce more urine to reduce the volume of liquid circulating in the body and somewhat compensate for the high blood pressure.

Producing the hormone erythropoietin: The kidneys produce a hormone called erythropoietin. The main function of this hormone is to help the body create more red blood cells (erythrocytes), which are essential for the transport of oxygen throughout all the tissues and organs.

Activating vitamin D: The kidneys transform calcifediol into calcitriol, the active form of vitamin D. Calcitriol circulates in the blood and plays a vital role in regulating calcium and phosphate balance in the body, which is essential for healthy bone growth.

What causes chronic kidney disease?

Chronic Kidney Disease (CKD): happens when 85-90% of our kidney gets damaged and becomes functionally impaired. CKD is caused by a variety of conditions that gradually affect the kidney’s functions over a few to several years.

The conditions that cause chronic kidney disease include:

  • Diabetes (common cause)
  • Hypertension (high blood pressure)
  • Inflammation of the kidney’s structural units
  • Polycystic kidney disease (multiple cysts or fluid-containing sacs in the kidney that occur by birth)
  • Prolonged obstruction of the urinary tract by conditions, such as
  • Pyelonephritis (bacterial infection of the kidney)
  • Abusing the Salt-shaker
  • Eating Processed Foods
  • Not Drinking Enough Water
  • Missing Out on Sleep
  • Eating Too Much Meat
  • Eating Too Many Foods High in Sugar
  • Lighting Up (smoking)
  • Drinking Alcohol in Excess 
  • Sitting for long periods
  • Painkiller consumption over a long time

What are the signs and symptoms of chronic kidney disease?

Patients with CKD stages 1-3 generally do not have symptoms. Typically, signs and symptoms start appearing during the last stages of 4-5 (GFR < 30). These include:

How is chronic kidney disease diagnosed?

The doctor will take your complete medical history along with your family history, such as if anyone in your family has or had diabetes, whether you are on any medications (that can cause kidney damage), and so on. They will perform a thorough physical examination to see if you have any signs or symptoms of CKD.

A few tests will help your doctor confirm the diagnosis of CKD. These are:

Can You Live Without Your Kidneys?

Because our kidneys are so important, one cannot live without them. But it is possible to live a perfectly healthy life with only one working kidney.

Reasons for Having One Kidney

Again, most people are born with two working kidneys. But sometimes, just one kidney works. And some people are born with only one kidney.

The reasons for this may vary and can include:

  • Renal agenesis — a condition where someone is born with only one kidney.
  • Kidney dysplasia — a condition where someone is born with two kidneys but only one of them works.
  • Kidney removal — certain diseases may require you to have one of your kidneys removed.
  • Living-donor kidney transplant — you can donate one of your kidneys to a person who needs a kidney transplant.

Importance of water to our Kidneys

Keep your kidneys healthy by being “water-wise.” This means drinking the right amount of water. A common misconception is that everyone should drink eight glasses of water per day, but since everyone is different, daily water needs will vary by person. How much water you need is based on differences in age, climate, exercise intensity, as well as states of pregnancy, breastfeeding, and illness.

About 60-70% of our body weight is made up of water, and every part of our body needs it to function properly. We have said earlier that, water helps the kidneys remove wastes from your blood in the form of urine. Water also helps keep our blood vessels open so that blood can travel freely to our kidneys and deliver essential nutrients to them. But if we become dehydrated, then it is more difficult for this delivery system to work.

 Mild dehydration can make one feel tired and can impair normal bodily functions. Severe dehydration can lead to kidney damage, so it is important to drink enough when we work or exercise very hard and especially in warm and humid weather.

Tips to make sure we are drinking enough water and to help keep our kidneys healthy:

Eight is great, but not set in stone. There is no hard and fast rule that everyone needs 8 glasses of water a day. This is just a general recommendation based on the fact that we continually lose water from our bodies, and that we need adequate water intake to survive and optimal amounts to thrive. 

Less is more if you have kidney failure (a.k.a. end-stage kidney disease). When the kidneys fail, people don’t excrete enough water, if any at all. For those who are receiving dialysis treatment, water must be greatly restricted.

It’s possible to drink too much water. Though it is not very common for this to happen in the average person, endurance athletes like marathoners may drink large amounts of water and thereby dilute the sodium level in their blood, resulting in a dangerous condition called hyponatremia.

Your urine can reveal a lot. For the average person, “water-wise” means drinking enough water or other healthy fluids, such as unsweetened juice or low-fat milk to quench thirst and to keep your urine light yellow or colourless. When your urine is dark yellow, this indicates that you are dehydrated. You should be making about 1.5 litres of urine daily (about 6 cups).

Water helps prevent kidney stones and UTIs. Kidney stones and urinary tract infections (UTIs) are two common medical conditions that can hurt the kidneys, and for which good hydration is essential. Kidney stones form less easily when there is sufficient water available to prevent stone-forming crystals from sticking together. Water helps dissolve the antibiotics used to treat urinary tract infections, making them more effective. Drinking enough water also helps produce more urine, which helps to flush out infection-causing bacteria.

Beware of pills and procedures. Drinking extra water with certain medications or before and after procedures with contrast dye may help prevent kidney damage. Read medication labels and ask questions before undergoing medical procedures involving contrast dyes. Always consult with your healthcare provider first though, especially if you are on a fluid restriction.

Can chronic kidney disease be cured?

There is no cure for CKD. However, treatments and an appropriate diet (low-protein, low-salt) can help manage its signs and symptoms. They can help you halt the progression of CKD to a certain extent.

Medications given to treat the complications of CKD can help you make feel better.

Treatments for Kidney Treatments

  • Antibiotics: Kidney infections caused by bacteria are treated with antibiotics. Often, cultures of the blood or urine can help guide the choice of antibiotic therapy.
  • Nephrostomy: A tube (catheter) is placed through the skin into the kidney. Urine then drains directly from the kidney, bypassing any blockages in urine flow.
  • Lithotripsy: Some kidney stones may be shattered into small pieces that can pass in the urine. Most often, lithotripsy is done by a machine that projects ultrasound shock waves through the body.
  • Nephrectomy: Surgery to remove a kidney. Nephrectomy is performed for kidney cancer or severe kidney damage.
  • Haemodialysis: A person with complete kidney failure is connected to a dialysis machine, which filters the blood and returns it to the body. Haemodialysis is typically done 3 days per week in people with ESRD.
  • Peritoneal dialysis: Placing large amounts of a special fluid in the abdomen through a catheter allows the body to filter the blood using the natural membrane lining the abdomen. After a while, the fluid with the waste is drained and discarded.
  • Dialysis: Dialysis is a procedure in which a machine placed outside of your body takes the role of a kidney. This procedure needs to be performed at least three times a week.
  • Kidney transplant: Transplanting a kidney into a person with ESRD can restore kidney function. A kidney may be transplanted from a living donor, or a recently deceased organ donor.

Courtesy: Rays of Hope Support Initiative. WebMD, Florida Kidney Physicians, National Kidney Foundation, Et’al

 

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