What is Chronic Kidney Disease?

Chronic Kidney Disease (also known as Chronic Renal Failure) is the progressive loss of kidney function occurring over a span of several months to several years and is characterised by the replacement of kidney architecture with interstitial fibrosis.

Chronic kidney disease is classified into five stages on the basis or proteinuria (presence of protein in large amounts in the urine) or Glomerular Filtration Rate (GFR) - 1 being the mildest with no distinct symptoms and 5 being end stage renal failure.

Causes and Risk Factors of Chronic Kidney Disease-

The various reasons (called risk factors) that can increase chances of Chronic Kidney Diseases are:

Diabetes mellitus, hyperlipidemia (excess fat proteins in the blood)
Hypertension

Family history heritable renal disease

Older age, smoking

Autoimmune disease

Past episodes of acute renal disease

The direct causes of Chronic Kidney Diseases are-

Diabetic nephropathy (leading cause)

Hypertensive nephropathy

Glomerulonephritis (swelling of the glomerulus in the kidneys)

Reno-vascular disease (ischemic nephropathy)

Polycystic kidney disease

HIV-associated nephropathy

Transplant allograft failure

Exposure to drugs and toxins

Diet that you must maintain in Chronic Kidney Disease-

It is essential to make dietary as well as lifestyle amends once you are diagnosed with CKD. The main purpose of this diet is to maintain the levels of carbohydrates, fluids and minerals. This is done to prevent the buildup of waste products in the body as the kidneys are unable to fulfil its function properly.

It is recommended to refer a dietician who can make you a diet chart that helps you adhere to your diet.

Here is a list of food items that you may avoid or may consume if you are suffering from Chronic Kidney Disease:

Carbohydrates : Carbohydrates are a good source of energy. If the intake of protein has been restricted, then it is recommended to replace that with carbohydrates as a source of energy. Fruits, vegetables, grains and bread can be consumed as they are rich source of fibres, minerals and various types of vitamins. You can indulge in some hard candies or sweets as well.

Fats: Fats can provide a good amount of calories as well. Ensure that you only stick to healthy fats such as the monounsaturated and polyunsaturated fats that are good for your cardiac health. 

Reduce your phosphorus intake: A diet with no more than 800 mg of phosphorus can help reduce the risk of too much phosphorus building up in your blood.  Limit intake of foods with high levels of phosphate or phosphate additives such as organ meats, whole grain breads, processed foods, cola beverages, cheese, dried beans, liver, peanut butter, dairy products and chocolate. Many beverages and processed foods have these additives. Other high-phosphorus foods to limit include: 

Cheese
Chocolate
Ice cream
Legumes
Milk
Nuts
Seeds
Yogurt
Monitor your potassium levels: Usually, potassium is not restricted in stage 3 CKD unless lab tests show potassium is too high. Your doctor may make medication changes or prescribe a low-potassium diet. Reduce an elevated potassium level by limiting some high-potassium foods and potassium chloride (found in salt substitute and many low-sodium processed foods), such as avocado, bananas, cantaloupe, honeydew, legumes, milk, nuts, potatoes, seeds, tomato products and yogurt. Some high-potassium foods to limit or avoid include: 
Avocado
Bananas
Cantaloupe and honeydew melon
Dried fruit
Legumes
Milk
Nuts and seeds
Oranges and orange juice
Potatoes
Pumpkin and winter squash
Tomato products (juices, sauces, paste)
Yogurt
Proteins: Usually, before undergoing dialysis, it is recommended to adhere to a low-protein intake diet. However when you are undergoing dialysis, it is necessary to consume a certain amount of protein. This detailed information can be obtained from your dietician.
Fluids: In the early stages of CKD, your fluid intake is not monitored. But as the disease progresses, you need to check your intake of fluids as too much fluids may accumulate in your body and create pressure on your kidneys.

Sodium Or Salt Intake: Keeping a check on your salt intake reduces the risks of high blood pressure. Also, having food low on salt can reduce your thirst and prevent fluid retention in your body.

Diet In Chronic Kidney Disease

When do kidneys need dialysis?

Kidneys are a pair of organs that are located on either side of the spine, each about a size of a fist. The kidneys help in purifying blood by removing toxins, waste materials and excess fluids from the human body. Disorders and dysfunctions of the kidney can lead to severe and often fatal consequences. When the kidneys stop functioning as they are supposed to, dialysis is performed to resume normal functioning in the body.

Dialysis is a type of treatment, which filters and purifies the blood with the aid of a machine. It is an artificial way of purifying blood. There are two types of dialysis, namely hemodialysis and peritoneal dialysis. Hemodialysis, the most common form of dialysis, which involves using a manmade kidney called a hemodialyzer, which removes toxins and waste materials from blood.

Peritoneal Dialysis, on the other hand, is a type of treatment which involves implanting a catheter in the stomach. During the procedure, a fluid called dialysate flows into the abdomen that absorbs all the waste material, which is consequently drained out of the body.

You may need a dialysis if:

- Your kidneys are dysfunctional
- When waste materials and toxins start to accumulate in the body
- In an event of an injury or accident to the kidney such as internal lacerations (wound caused by the tearing of a tissue)
- If the creatinine (a type of a chemical waste product) level falls to 10-12 cc/minute
- In an event where the kidneys aren't able to work properly leading to accumulation of toxins, irregular amounts of chemicals in the body and other dysfunctions

Weakening of the abdominal muscles and weight gain are some of the risks involved in dialysis. Dialysis is a temporary treatment and serves to function till the time the actual kidneys get repaired. In chronic cases of kidney disease, kidney transplant may perhaps be the last resort.



When Do Kidneys Need Dialysis?

Severe disorders in one or more kidneys can be debilitating since the quality of life is severely affected. If you suffer from such a condition, you may already be undergoing dialysis. But, have you considered kidney transplant yet? 

Here is a look at some benefits of kidney transplant over dialysis.

1.Increased life expectancy

You may not know this, but dialysis restricts your life expectancy. For instance, a person undergoing dialysis at 30 will have a life expectancy of 15 more years. However, with a transplant, you can go on to lead a full life. The same 30-year old person will have a life expectancy of 30 additional years in case of a transplant from a brain-dead donor. If the donor is a healthy individual, life expectancy may extend to 40 years as well.
Therefore, if you want to live longer, you need to seek a kidney transplant.
2. Enhanced quality of life
Not only does severe kidney disorder mean relying on dialysis, but it also imposes other major restrictions in regards to diet and lifestyle. However, the kidney transplant is a more permanent solution to the problem. Once the transplant is completed and you recover from the surgery, you can resume a normal life. Additionally, some of the dietary restrictions are also lifted in such a case. 

Why dialysis is more common?
Dialysis is more common for the following reasons-
    The kidney to be transplanted may not be readily available. You would be placed on a list and it may take a while for a suitable kidney to arrive. During this period, you would need to undergo dialysis.
    Since dialysis is a minimally invasive procedure, it is often preferred by patients. However, kidney transplantation is better in the long-term.



Why Should You Opt For Kidney Transplant Instead Of Dialysis?

The presence of blood in urine is known as Haematuria. It is categorized under 2 types:

    Macroscopic haematuria, which means the patient has seen blood.
    Microscopic dipstick haematuria, which means blood is identified by urine microscopy or by dipstick testing either in association with other urological symptoms (symptomatic microscopic haematuria) or during a routine medical examination. It has been variably defined as 3 or more , 5 or more or 10 or more Red Blood Cells (RBCs) per high - power field.

Urological and other Causes of Hematuria

    Cancer: Bladder, Kidney and Prostate Cancer
    Stones: Kidney, Ureteric
    Bladder Infections: Bacterial tuberculosis, infective urethritis Inflammation
    Interstitial Cystitis Trauma : Kidney, bladder, urethra, pelvic fracture causing urethral rupture
    Renal cystic disease: (e.g. medullary sponge kidney)
    Other urological causes: Benign prostatic hyperplasia, vascular malformations
    Other medical causes of haematuria: anticoagulation therapy (e.g. asprin, anti platelet therapy) Nephrological Causes: more likely in children and young adults, proteinuria; red blood cell casts.
    Urological investigations: Urine culture, urine cytology, cystoscopy, renal ultrasonography and intravenous Urography and CT Urography.

Management of haematuria depends on the cause as determined by the urologist.

Causes and Treatment for Hematuria

If you notice blood while urinating, you must visit a urologist to get a clear picture of the health issue. Blood in urine is known as hematuria in medical terms. Such a condition can occur in both men and women. It is a common condition and does not require the patient to panic. Rather immediate tests should be conducted to find out the cause of the blood and treated accordingly. Such conditions are very much treatable with a little care and vigilance following of the doctor s advice. Here are some of the common causes of hematuria in individuals: 

Urine Infections: Urine infections are the common cause of blood in your urine. Most commonly these affect urinary bladder and rarely kidneys also. Prompt identification and treatment can easily revert this problem. 
Urinary Stones: Another major cause of hematuria, usually accompanied by pain in the abdomen. 
Enlarged Prostate: With an enlarged prostate, there can be blood flow with the urine. Rarely this may be a sign of cancer in the prostate. 
Exercise: This might come as a surprise for many of the fitness freaks. While exercises are needed for the body and rightly so; but exercises should be done in a certain limit. Heavy exercises, limitless and vigorous exercises can sometimes cause other health problems in the body. One such problem is the passing of blood in the urine. 
Medications: Quite interesting is the fact that long-term consumption of certain medicines might cause hematuria in individuals. Certain medicines like penicillin and aspirin are absorbed by the body to a certain extent. But overdose or the regular dosage might lead to further problems in the human body. 
Kidney Injury: A kidney injury is a form of internal injury which can be felt and manifested through signs and symptoms. Such injuries occur mostly to those who are in the field of sports. At times, a heavy punch, a hard training session, or an exhaustive fall might lead to kidney injuries. This, in turn, would cause hematuria. 
Tumors of Urinary Tract: Bleeding can occur from tumors arising from kidney, ureter, urinary bladder as well as urethra. These require timely detection and management. Early treatment leads to an excellent long-term outcome. 
Thus, these are some of the common reasons for the development of blood in urine. However, it is a condition which can be best analyzed by the medical practitioner. Therefore, on the occasion of blood, you must get it tested and treated immediately.

What Does Blood In Urine Mean?

Located right under the rib cage, kidneys are a very important organ of the body. They are not only responsible for purifying your blood from wastes and excess fluid but are also involved in maintaining electrolyte balance, regulating blood pressure and producing red blood cell in the body.

In many cases, due to some medical condition, one or both kidneys may stop functioning properly. If not treated in time, it may lead to complete kidney failure and if the kidneys fail completely, dialysis or transplant may be the only treatment options available.

Dialysis is a treatment in which the blood is filtered and purified artificially using machines. This process is beneficial for those whose kidneys are not able to do their job properly.

Need for dialysis

A functioning kidney prevents the accumulation of excess water, impurities, and wastes inside the body. They also work to maintain the blood pressure level and control the presence of certain chemicals like sodium and potassium.

When the kidneys fail to perform these critical functions, maybe because of some disease or injury, dialysis helps to keep up the healthy functioning of the body as much as possible. As without dialysis all the wastes and fluids will accumulate and poison the body, resulting even in death. However, it must be kept in mind that dialysis is not a cure for kidney diseases; it is just an alternative to their functions.

Types of dialysis
Dialysis is an artificial process of purifying your blood using machines. There are two types of dialysis:

Hemodialysis
This is one of the most common types of dialysis, where an artificial kidney, known as a hemodialyzer, is used to remove waste and chemicals from the blood. The doctor surgically creates a vascular access into the blood vessels allowing the artificial kidney to perform.

Peritoneal Dialysis
This is a surgical procedure, where a catheter is implanted in the belly area. The treatment involves a special fluid called dialysate which is flowed into the abdomen to clean the blood. Once the blood is cleaned, the fluid is drained from the abdomen. The benefit of this treatment is that you can perform it in your home, without going to a hospital.

Risks in Dialysis
Even though either of these two treatment procedures is life-saving and there is hardly any alternative, these two can also come with risks. The risks include peritonitis, abdominal muscle weakening, high blood sugar level, weight gain, low blood pressure anemia, muscle cramping, insomnia, itching, depression, increased potassium level and pericarditis. If you experience any of these symptoms of the risks involved, then immediately consult your doctor and explain in details.

A patient who is going through dialysis for a long time also has a chance of succumbing to the medical condition called amyloidosis. When the amyloid proteins, which are produced in bone marrow, collects in kidneys, hearts, liver and other organs, amyloidosis occurs. This results in joint pain, stiffness and even swelling. 

Dialysis May Save Your Life!

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