Kidney disease is a silent killer
The kidney’s function, is to filter waste, toxins and excess fluid from the body, control sodium, release hormones, contribute to regulating blood pressure, stimulate the production of red blood cells and create vitamin D to help with the body’s absorption of calcium.
Chronic renal or kidney disease (CKD) is diagnosed when the kidney starts taking strain and no longer functions optimally. If not detected, the kidneys will progressively deteriorate and possibly lead to end stage renal disease and the need for dialysis or a transplant.
As there are no specific symptoms in the early stages (stages 1,2 and 3a), only a urine test or a sophisticated blood test will detect a problem. A regular blood test will only detect a kidney disease at stage 3b. At this stage the kidney has already lost approximately 50% capacity.
In 66% of cases, if detected during the early stages, the progression of the disease could be halted with proper care – healthy lifestyle, a special diet and medication. Please don’t delay, get tested.
Know your kidney health status
A urine test can detect the early signs of kidney disease by measuring a type of protein called albumin.
150mg per day is normal but a result higher than this, is a sign of possible kidney disease and further investigation would be required. The kidney is still functioning normally in the first stage of kidney disease but the kidney is damaged. This early detection test is important as there are rarely other physical symptoms of CKD until the late stages, after irreversible damage is already done.
If the urine test shows abnormalities, the patient would need to undergo further screening which would include blood tests. A Glomerular filtration rate (GFR) is a blood test that provides an estimated rate at which the kidneys are filtering liquids and waste. This is done by analyzing the serum creatinine, a waste product from normal muscle use, and factoring in the gender, body size, age and weight.
A further blood analysis measuring the levels of urea nitrogen (Blood Urea Nitrogen – BUN)resulting from proteins in foods consumed, could also be performed. BUN levels of greater than 20mmol per litre, could be an indication of kidney disease or dehydration.
A kidney biopsy, ultrasound imaging or CT scans can also be used is the diagnostic process.
High blood pressure, urinary tract infections and abnormal urinalysis are all signs of early kidney disease. As the kidneys deteriorate, further symptoms such as: low blood count, nocturia (urinating 2 x or more per night), pain when urinating, back pain, change in colour of urine, malnutrition, bone pain, abnormal nerve sensations, reduced mental functioning, feeling unwell, swelling, anemia, puffy eyes, decreased appetite, shortness of breath, fatigue, mental slowing, itching caused by waste buildup, and other lab abnormalities, will be presented.
Stage 1 CKD
Normal kidney function and GFR level of 90 to 120 ml/min.
Stage 2 CKD
A mild decrease in kidney function and GFRlevel of 60-89 ml/min.
Stage 3a CKD
Moderate kidney damage and GFR level of 45-59 ml/min.
Stage 3b CKD
Moderate to severe loss of kidney function and GFR level of 30–44 ml/min.
Stage 4 CKD
Severe loss of kidney function and GFR level of 15-29 ml/min.
Stage 5 CKD
Kidney failure, also known as end stage renal disease (ESRD) and GFR level of Less than 15 ml/min.
Hypertension is the leading cause of CKD followed by diabetes and HIV.
According to the SA Renal registry annual report 2015, published 1 September 2017, hypertension (high blood pressure) is the leading cause of kidney failure in South Africa. About 34% of kidney failure cases are caused by high blood pressure.
Weakened blood vessels in the kidneys caused by high blood pressure, results in loss of kidney function and extra fluid in the body. The extra fluid raises the blood pressure even more, creating a cycle and further damage to the blood vessels which eventually leads to kidney failure.
It’s recommended that you keep your blood pressure below 140/90. A healthy diet, exercise, controlled stress levels, abstaining from smoking and in some instances, medication will assist in controlling blood pressure.
Diabetes is the second leading cause of kidney failure in South Africa, according to SA Renal registry annual report 2015, published 1 September 2017.
Diabetes causes poor glucose control and can impact blood circulation in the kidney’s blood-filtering system (glomerulus). Diabetics may also suffer from high blood pressure and have a family history of kidney disease.
Changes in kidney function may begin within 2 to 5 years after diagnosis of diabetes type 1 and up to 40% of people develop late stage kidney disease within three decades of being diagnosed.
Type 2 diabetes usually occurs later in life but follows a similar timeline to diabetes type 1.
A healthy diet and medication to control glucose levels is recommended.
According to SA Renal registry annual report 2015, published 1 September 2017, (move 9 to the next line and correct spacing )9.5% of end stage kidney disease is caused by glomerular disease. Glomeruli, the tiny filters within each kidney, are damaged, waste then builds up in the blood, and protein, (and sometimes red blood cells), leak into the urine.
It is recommended that you consult with a nephrologist to prescribe necessary medication and a care plan to slow the progress of the disease.
Polycystic kidney disease
Polycystic kidney disease (PKD) is genetic and a person with PKD will have it from birth but it may take years for symptoms to show. PKD is caused by a buildup of cysts in the kidneys. The cysts can cause the kidneys to expand and as a result lose function.
A healthy lifestyle can prevent PKD from progressing.
What is sometimes referred to as a “crash landing”, happens when a patient suddenly becomes gravely ill and requires urgent dialysis. The kidneys have deteriorated over many years to a point where they no longer function and urgent dialysis is required to remove waste built up in the bloodstream. This “crash Landing” could be avoided by early detection, implementing a treatment plan and monitoring the kidney health.
Talk to your doctor about an annual CKD test, especially if you are at risk or have family history of kidney disease.
Once diagnosed, it is important to monitor your kidney health with regular tests so that your treatment is adjusted according to your needs.
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If kidney function reduces to less than 10 to 15% of normal kidney function, renal replacement therapy would be required.
Acute renal failure is the sudden loss of kidney function when a patient is in a hyper-catabolic or metabolically stressed state. The kidneys could resume normal function again or acute renal failure could become chronic renal failure through stress, infection, dehydration or drugs.
Chronic renal failure is the slow, irreversible loss of kidney function over a period of time. Once diagnosed, the patient should discuss treatment options with their nephrologist.
In preparation for dialysis, an assessment would be required to ascertain the best surgery and method for vascular access. The vascular access allows the blood to be drawn and filtered without harming the veins. This assessment should be done preferably six months before haemodialysis and four weeks before peritoneal dialysis. This will allow sufficient time for healing and for maturation of the access site which is crucial in reducing the chance of complications and infection. It is also imperative that the patient takes care of their overall wellbeing.
Depending on the patients’ health and needs, dialysis treatment can vary but typically people would undergo dialysis 3 times a week for 3 to 5 hours at a time or every day for 2 to 3 hours at a time. Dialysis can be performed at a dialysis centre, at home or in a hospital.
Peritoneal dialysis could be considered. This is a procedure which uses the lining of the abdominal cavity, peritoneal membrane, and a solution, dialysate, to filter waste and extra fluid from the body. A catheter is inserted into the abdomen and the patient can be taught how to perform the procedure. The advantage of this is that the dialysis can be performed at home or whilst travelling.
Haemodialysis, on the other hand, is the process where waste and extra fluid is filtered outside the body by a man-made membrane (dialyzer).
In the case where a patient is admitted for uraemic emergency, haemodialysis will be required. Unfortunately, this initial haemodialysis destroys residual kidney function which will make conversion to peritoneal dialysis, requiring some renal function, unlikely to succeed.
A surgical procedure where a healthy functioning kidney is removed from a living or brain-dead donor (nephrectomy) and implanted into a patient with non-functioning kidneys. There are different surgical techniques used for nephrectomy surgery, from the traditional open surgery to laparoscopic and hand-assisted laparoscopic nephrectomy.
It is recommended that suitable candidates are put on transplant lists as soon as they are diagnosed with ESRD. Culturally appropriate discussions and counselling of patients and relatives should also commence at this stage.
To determine suitability, potential kidney recipients undergo a comprehensive physical evaluation which include compatibility testing, radiological tests, urine tests and psychological evaluation. A panel reactive test (PRT) involves the study of how a patient’s white blood cells react with 60 randomly selected donors. This reactivity or sensitisation, provides an indication of the likelihood that the recipient would reject the transplanted kidney.
Tissue and blood matching is important which is why a living donor who is a close relative, have the best chance of a match. Potential living donors also undergo a complete medical evaluation. In preparation for the transplant, suitable recipients will be given preventative therapy to control infections as well as immunosuppression and anti-rejection treatment.
Source: KDIGO (Kidney Disease, Improving Global Outcomes)