Kidney Health for All: Preparing for the Unexpected, Supporting the Vulnerable!
Posted on 31 March 2023
1. What is kidney failure?
“Chronic kidney disease or CKD is defined as abnormalities of kidney structure or function that are present for more than three months, irrespective of the cause. This leads to the gradual loss of kidney function,” Dr Tsela explains.
Kidney failure, also known as end-stage renal disease (ESRD), is the last stage of chronic kidney disease which occurs when the kidney function has declined to a point that they can no longer function on their own.
2. Why are healthy kidneys important?
• They filter the blood by removing waste and excreting it via urine.
• They help keep a stable balance of fluids in your body.
• They help maintain electrolyte concentrations by filtering electrolytes and water from blood, returning some to the blood and excreting any excess in the urine.
• They help maintain the acid-base balance in your body.
• Kidneys help keep your blood pressure at a normal level.
• Kidneys produce hormones that aid in the production of red blood cells.
• They produce active vitamin D.
3. What are the symptoms of kidney failure?
According to Dr Tsela, patients with mild to moderate chronic kidney disease are generally asymptomatic, as symptoms tend to develop only during the later stages of CKD. Kidney disease is therefore sometimes referred to as a ‘silent disease’. Patients with kidney failure may present with signs and symptoms of the following:
• Abnormalities in salt and water handling:
– swelling of the lower limbs, generalized body swelling and pulmonary oedema (accumulation of fluid in the lungs) with resultant shortness of breath
– changes in the frequency and volume of urination
– dark or foamy/frothy urine
• Metabolic acidosis:
– protein-energy malnutrition
– loss of lean body mass and muscle weakness
– shortness of breath
– impaired cognitive function
– impaired immune function
– reduced quality of life
– development of cardiovascular disease
• End Stage Renal Disease – manifestations of uremia:
– peripheral neuropathy (pins and needles, burning sensation or numbness in the fingers and toes)
– restless leg syndrome
– bad breath or metallic taste in the mouth
– muscle cramps
– dermatological symptoms (dry skin, itchiness, bruising)
– increased somnolence
– gastrointestinal symptoms (anorexia, nausea, vomiting, diarrhea)
– erectile dysfunction, decreased libido, menstrual abnormalities
4. When should one seek medical intervention relating to kidney failure?
Dr Tsela believes that screening in patients at risk for developing CKD is important for early detection so that therapeutic interventions can be implemented early, to prevent or delay progression of disease. Screening should be done annually in very high-risk patients, for example, diabetics, and up to every three years in patients with a lower risk.
• Early detection of kidney disease includes the following screening methods:
– Urinalysis (testing urine) – a urine dipstick is a readily accessible tool even at primary healthcare level and is important in the early diagnosis of abnormalities in kidney function.
– Measurement of albuminuria – the presence of the protein albumin in the urine.
– A serum creatinine blood test to estimate glomerular filtration rate (GFR), which determines your kidney function.
– Renal ultrasound in selected individuals, for example, those with a family history of polycystic kidney disease.
5. How should one look after their kidneys?
Early diagnosis and treatment of the underlying cause is critical in patients with CKD. Managing the disease involves the following:
• Delaying or halting progression of disease by:
– managing your preexisting disease – e.g., strict glycemic control in diabetic patients
– blood pressure control
– avoiding nephrotic drugs e.g., anti-inflammatory pain medication in patients with risk factors for CKD.
• Lifestyle changes including smoking cessation, limited alcohol intake, regular exercise, maintaining a healthy body mass index (BMI), consuming a balanced healthy diet with a sodium dietary content of less than 100 mmol/day.
• Staying well hydrated – your urine should be straw-colored. Increase fluid intake during hot weather or when exercising strenuously to avoid dehydration.