Kidney Diseases

The onset of different kidney diseases can be gradual in the case of chronic kidney diseases, and can present with the following symptoms:

• High blood pressure
• Breathlessness
• Loss of taste or bad breath
• Loss of appetite
• Weight loss
• Constant thirst (excess thirst)
• Reduced mental sharpness
• Insomnia or difficulty sleeping
• Passing dark coloured urine or UTIs
• Persistent itching and dry skin
• Nausea and vomiting
• Muscle twitching or cramping
• Puffy eyes, swollen hands and feet
• Dry skin
• Reduced sex drive/impotence
• Fluid build-up in the body

Again, the symptoms of kidney diseases can vary depending on the condition and from person to person. The symptoms may also be presenting themselves due to other illnesses as well. One of the dangers of kidney diseases is that the kidneys, being robust by nature, find a way to keep functioning, but more prominent symptoms only emerge once there has been more permanent damage done to the organ.

Typically, diseases of the kidneys are divided into two further sub-categories:

Acute kidney injury: Kidneys sometimes stop working in a very short span of time (less than two days), which is known as acute kidney failure or acute renal failure. It can prove to be fatal if not treated immediately. However, unlike kidney failure that occurs due to damage over time, acute kidney injury can be reversed if attended to on time, and recover its functions either fully or partially.

Causes of acute kidney failure include tissue damage caused by medication or infection, a reason why most acute kidney failures take place while undergoing treatment for other illnesses in hospitals, or due to advanced age of the patient. 

The presence of kidney stones affecting the smooth passage of urine can also lead to acute kidney failure. Traumatic injuries such as car accidents, going into a septic shock (sepsis), or even pregnancy complications such as preeclampsia and eclampsia are also major risk factors behind acute kidney failures.

Chronic kidney disease: This type of kidney disease is gradual and worsens over time, and can lead to complete kidney failure requiring dialysis or transplants, significantly impacting the life expectancy of a patient.

As mentioned above in the article, kidney diseases usually occur due to the presence or emergence of another illness in the body that impairs the functioning of one or both the kidneys. Some of the illnesses that can impair kidney function or cause irreparable damage are:

• High blood pressure
• Diabetes, both types 1 and 2
• Polycystic kidney disease
• Urinary tract infections (UTIs)
• Enlarged prostate
• Kidney stones
• Kidney cancer
• Kidney inflammation, also known as glomerulonephritis
• Interstitial nephritis
• Pyelonephritis or recurrent kidney infection

As discussed before, underlying illnesses such as high blood pressure, diabetes and heart disease put you at a higher risk of kidney disease. If you have any of these illnesses, it is a good idea to tell your doctor your complete medical history and go in for regular checkups.

Similarly, if you have a family history of kidney disease, it is a good idea to go for check-ups and let your doctor know the medical history.

Often, patients don't see symptoms until kidney disease has progressed to an advanced stage. Getting checked by your doctor and specifically asking for a kidney function test or urine test can help you identify markers earlier to be able to prevent the onset of kidney diseases. Also, if you notice symptoms of UTIs, you must visit the doctor as these can lead to kidney disease if not treated in time. 

The nature of kidney diseases also warrants a drastic change in lifestyle, including modifications in your diet as well as regular exercise, as both can go a long way in keeping the symptoms in check. A healthy, balanced diet in this case includes reducing the consumption of salt and added sugars, and low quantities of sodium, along with avoiding trans fats, saturated fats and processed foods.

Foods with whole grains and complex carbohydrates, along with a healthy dose of fruits and vegetables can help in maintaining the vital body balance needed to let the kidneys function smoothly.

In the case of diabetes, monitoring your blood glucose levels regularly and maintaining your blood sugars within healthy limits is important. Similarly, for high blood pressure, a reading of less than 140/90 is considered normal, but the doctor can determine a healthy, sustainable level for you. 

Remember to take the medicines prescribed by your doctors to keep your blood pressure or indeed other conditions in check. Certain over-the-counter drugs like NSAIDs (non-steroidal anti-inflammatory drugs) can be harmful to the kidneys, and it is always wise to check with the doctor before taking them.

As far as exercise is concerned, a minimum of 30 minutes of daily moderate exercise is recommended by health experts, which can include a combination of strength training, flexibility as well as aerobic or cardio exercises.

Smoking greatly increases the odds of heart disease, and even though it is a habit difficult to get out of, there are several resources available that can help you give up smoking. 

Read more: The disadvantages of smoking and benefits of quitting smoking

Limiting the intake of alcohol or consuming it in moderation is also a necessary practise, as excessive alcohol consumption puts a strain on the body and weakens it over time. Your doctor is best placed to advise you on what a healthy amount per day or week is. As a rule of thumb, though, for healthy men, two drinks is the limit and for healthy women, one drink is the daily limit—this limit may be drastically reduced for people with any kind of illness.

A doctor diagnoses kidney disease based on their findings after conducting a physical exam and asking for the patient's medical history, as well as his or her family history. This is followed by questions regarding the symptoms and whether the patient falls under a high risk group with pre-diagnosed diabetes or high blood pressure, as kidney problems can also occur because of certain medications. The patient's urinary habits are also discussed to know more about the patient's symptoms and overall health.

Blood and urine tests are some of the common diagnostic tests that are needed to confirm whether or not the kidneys are functioning well. Kidney function test (KFT) from the blood sample can determine the level of waste or toxicity there is in the body in the form of creatinine or urea. A urine test, on the other hand, can reveal other problems that can signal damaged or compromised kidney function.

Further probes include imaging tests such as ultrasounds to determine if there has been any distention or change in the size of the two kidneys. Further still, a kidney biopsy may be ordered which requires a tiny sample of kidney tissue to be removed with the help of a specialised needle that is inserted through the skin under local anesthesia.

While acute kidney failure can be reversed and treated if dealt with on time, chronic kidney disease is said to be progressive and degenerative, with the treatment only focusing on managing the symptoms of the patient and improving the overall quality of life.

As kidney diseases are also brought on by several different causes and factors, doctors treat the direct cause that is the reason behind the patient's kidney disease. Treatments can range from medications for various illnesses, dialysis or kidney transplant in extreme cases.

Medications to lower blood pressure levels, cholesterol, anaemia, or drugs to reduce swelling or conserve the strength of the bones are prescribed to patients showing the respective symptoms, while a diet low in proteins is also advised as protein produces a high level of waste products that eventually need to be filtered by the kidneys.

In the event of end-stage kidney disease, also known as kidney failure, methods such as dialysis and transplants are required. Dialysis is the use of an external device that helps remove waste and excess fluids from the blood which the kidneys are no longer able to do. In the case of a transplant, a healthy kidney from a donor is taken to replace the damaged one but requires life-long use of medications to ensure the body continues to use the donor kidney.

If you have developed kidney disease or are at risk, you will need to make some dietary changes. These changes can help to mitigate the symptoms of diabetes and hypertension, both of which are strongly linked to the emergence of kidney diseases. Here are some food groups and nutrients that you need to control: 

• Salt and sodium: Having too much salt and sodium in your diet can make it difficult to maintain blood pressure. To cut down on sodium, avoid frozen or preserved foods as they use salts as preservatives. Use herbs and spices for seasoning your food instead of salt. 
• Limit the intake of protein: Consuming proteins leads to the production of waste products that need to be cleaned out by your kidneys. If your kidneys are compromised, it can lead to toxicity in the blood. Cutting down on certain meats—particularly red meat— and dairy products may be necessary. A doctor can advise you on the amount of protein you should have.
• Avoid foods with high amounts of phosphorus: Those with more severe forms of kidney disease are unable to filter out enough phosphorus from the body which can lead to weaker bones and toxicity. Dairy, lentils, meats or drinks that contain added phosphorus should be avoided.
• Avoid foods with high potassium content: Excess potassium is not cleared as efficiently by compromised kidneys. Fruits such as bananas, oranges, dairy products, brown rice, potatoes and tomatoes should be avoided as they contain higher amounts of potassium.

These food choices can be tailored or altered according to each individual patient and the underlying problems they have been experiencing, which can help the doctor understand which foods should be avoided.

As is normally the case, diets that are well-balanced and provide nutrients from different sources are always considered healthier choices. Fast foods and processed foods, foods with artificial or added sugar, high amounts of carbohydrates and trans fat should be avoided. 

As for foods that are suitable for those with kidney disease, it depends on the severity of the disease. The amount of sodium, salt, protein, potassium, and phosphorus should be controlled. To get your dose of protein, lean meats and meat with the skin removed is a better alternative. Controlling the levels of potassium and phosphorus is a more involved process and your dietician can steer you in the right direction.