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Know Your Kidney

What are the kidneys and what do they do?

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters, one on each side of the bladder. The bladder stores urine. The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to find a toilet soon. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short.

Why are the kidneys important?

The kidneys are important because they keep the composition, or makeup, of the blood stable, which lets the body function. They

  • prevent the buildup of wastes and extra
  • keep levels of electrolytes stable, such as sodium, potassium, and phosphate
  • make hormones that help – regulate blood pressure – make red blood cells – bones stay strong

How do the kidneys work?

The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final  product becomes urine.

What is Kidney Disease?

Kidney disease describes a variety of disease and disorders that affect the kidneys. Most disease of the kidney attack the filtering units of the kidneys—the nephrons—and damage their ability to eliminate wastes and excess fluids.

Chronic kidney disease (CKD) is defined as the presence of kidney damage, or a decreased level of kidney function, for a period of three months or more. CKD can be divided into five stages, depending on how severe the damage is to the kidneys, or the level of decrease in kidney function.

Usually, kidney disease starts slowly and silently, and progresses over a number of years. Not everyone progresses from Stage 1 to Stage 5. Stage 5 is also known as End-Stage Renal Disease (ESRD). It may also be called end-stage renal failure. It is important to remember that end-stage refers to the end of your kidney function (your kidneys are working at less than 15% of normal), not the end of your life. To sustain life at this stage, dialysis or kidney transplantation is needed.

When the kidneys fail, wastes and fluids accumulate in your body and you need dialysis treatments (to clean your blood either by machine or in your abdomen), or a kidney transplant. Dialysis and kidney transplantation are known as renal replacement therapies (RRT) because they attempt to “replace” the normal functioning of the kidneys.

Sometimes kidney failure occurs rapidly and this is called acute kidney failure. This may be a result of injury, infection, or other causes. For acute kidney failure, dialysis treatment may be urgently needed for a period of time, but kidney function often recovers.

Conservative care is a treatment option at any stage.

Common Causes of Chronic Kidney Disease

There is no single cause of chronic kidney disease. Some forms of the disease may be inherited, while others are acquired.

The two most common causes are diabetes and high blood pressure. Others are glomerulonephritis (nephritis), polycystic kidney disease, urinary tract obstruction, reflux nephropathy, and drug- or medication-induced kidney problems. Bacteria such as E. coli and bacterial infections, such as strep throat, are other culprits.

Other problems can affect the kidneys. Some of these are kidney stones, Alport syndrome, Fabry disease, and Wilms’ tumor.

Early Detection and Prevention Kidney Disease

Simple laboratory tests such as urinalysis, which looks for protein and blood in the urine, are useful in detecting kidney damage at an early stage. A blood test, the serum creatinine level, is often used as a simple measure of kidney function. It may show a decrease in kidney function long before there are any other signs.

Doctors will often use the serum creatinine test along with other information to calculate the kidneys’ creatinine clearance, or GFR (glomerular filtration rate; it is also called the eGFR or estimated glomerular filtration rate). These results give more accurate information about how much the kidneys are working — specifically, the rate at which the glomeruli are filtering.

  • Have your blood pressure checked regularly. Uncontrolled high blood pressure can speed up the natural course of any underlying kidney disease.
  • If you suffer from diabetes, make sure that your disease is under control. A growing number of kidney patients are people with diabetes.
  • Be very careful about taking non-prescription medications, particularly painkillers. It is wise to discuss all over-the-counter medications with a doctor or pharmacist before they are taken. Certain other medications, toxins, pesticides and illegal drugs (such as heroin and cocaine) can also cause kidney damage. Your doctor can explain the problems associated with long-term use or abuse of these substances.

Warning Signs of Kidney Disease

Kidney disease usually progresses silently, often destroying most of the kidney function before causing any symptoms. Therefore, people at risk of developing kidney disease should be evaluated regularly. These people include those with diabetes, high blood pressure or blood vessel diseases, and close relatives of people with hereditary kidney disease.

Sometimes even people with serious kidney disease may not have any symptoms. That is why a blood or urine test may be necessary to check for kidney problems. However, the signs and symptoms listed below may indicate kidney disease and if they are present, a medical assessment to check out the kidneys would be advisable.

Signs and Symptoms That May Indicate Kidney Disease

  • High blood pressure (hypertension)
  • Puffiness of the eyes, hands and feet
  • Passage of bloody, cloudy or tea-coloured urine
  • Presence of protein in the urine (uremia)
  • Excessive foaming of the urine
  • Frequent passing of urine during the night
  • Passing less urine or difficulty passing urine
  • Fatigue
  • Loss of appetite or weight
  • Persistent generalized itching

Treatment options for Kidney Failure(End Stage Renal Disease)