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

Two kidneys are present on either side of the spine, above the waist. The kidneys perform important functions of cleansing the blood, controlling blood pressure and maintaining salt and mineral balances. Kidney related issues are to be treated as soon as they occur as failing to do so might lead to kidney failure, which is a serious condition.

Ayurvedic approach for treating kidney related problems
Each type of medical treatment has their distinctive approaches towards such treatment and so does Ayurvedic care. The weak body is toned up in a natural way in the first stage. The second stage is the prevention of diseases using natural remedies and the final stage is treatment through ayurvedic care.

Causes for kidney related issues and Ayurvedic care for such issues
The causes for kidney related issues are toxins, anatomical abnormalities, abiotic stress, mental imbalance, the easy entrance of microvita, and side effects of various allopathic medicines. One major reason for kidney related problems is the side effects of modern medicines or over dosage of allopathic medication. On the contrary, the medication system of Ayurveda effectively treats all the issues in a natural way without imposing ill-effects to the human body.

When to seek Ayurvedic care?
A few symptoms, the occurrence of which indicates that you should consult a doctor for checking of kidney related issues are nausea, weakness, ankle swelling, vomiting and shortness of breath. A few other symptoms are high blood pressure or urea and decreased hemoglobin. If these symptoms are due to kidney related problems, Ayurveda cure for kidney related issues is one of the best options for recovery.

Prevention of kidney failure- Ayurveda treatment to avoid dialysis
"Prevention is better than cure." If kidney problems arise, it is best to take preventive measures to avoid kidney failure. A few things that help in preventing kidney failure are controlling blood pressure, controlling blood sugar and improving breathing pattern. Diet plays a major role in preventing kidney failure. Ayurveda approach insists the change of acidic diet to an alkaline one. Diabetes and blood sugar can also lead to kidney failure. According to Ayurveda, natural remedies are available to treat chronic kidney failure patients. Dialysis can be avoided and the kidney functions can be restored with the help of a few herbal remedies in the Ayurveda approach. The level of creatinine and urea are controlled effectively by Ayurveda treatment

Recovery using Ayurveda care for kidney failure patients
Kidney damage for a period of 3 months or more is known as chronic kidney failure. The treatment of underlying cause, treatment of damaged kidneys and treatment of dhatus (body tissues) which makes up the kidneys are done in the case of Ayurvedic care. The kidneys are made up of "Rakta" and "Meda" and treating these two will lead to recovery. The benefits of using Ayurvedic medications for kidney related issues are plenty. The kidney damage is recovered, the risk of death can be reduced to a significant extent and frequency of dialysis can be minimized effectively.

Kidney Issues - How Ayurveda Can Help You?

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

Hunner's ulcers, simply put are painful ulcers in your urinary bladder. These ulcers are inextricably linked to another disorder called the painful bladder syndrome or intestinal cystitis. They occur in 10 to 15 percent of people with interstitia cystitis. These, in fact, are red patches or lesions on the bladder wall which can stiffen tissue and cause reduced bladder capacity. Hunner s ulcers bleed, ooze pus and can be of different sizes. The ulcers in the bladder can be extremely painful and uncomfortable.

These are called Hunner s ulcers because they were first described by Dr. Guy LeRoy Hunner, a Johns Hopkins gynecologist, in 1915. Since Hunner s ulcers are seen only in people with intestinal cystitis, it s important to know more about this painful life-altering bladder disorder before we can even understand how to deal with them.

Interstitial cystitis (IC)
IC is also called painful bladder syndrome. Another important thing to know about IC is that it strikes more women than men. IC is a chronic disorder and there s no cure for it. It causes recurring bouts of pain and pressure in the urinary bladder and the pelvic area. This is often accompanied by an urgent and frequent need to urinate. Sufferers may have to rush to the  loo  as much as 40, 50, or 60 times a day.

Diagnosis
Hunner's ulcers can only be accurately diagnosed by doing a cytoscopy which involves inserting a fibre-optic tube through the urethra to look at the bladder wall closely. During this procedure, a tissue sample from the bladder wall is usually also taken to rule out bladder cancer. Cytoscopy is usually done with hydrodistention under local anesthesia. This involves filling the bladder with a liquid for stretching it to provide a closer view of the bladder wall. Usually, a urologist performs this surgery along with a gynaecologist. IC and also Hunner s ulcers are both a diagnosis of exclusion. This means that they re diagnosed only after a number of other conditions have been ruled out.

Hence, the urologist will first take your thorough medical history, followed by a physical exam and a pelvic exam for women patients and perform tests for ruling out infection, and other disorders like bladder stones and cancer, kidney disease, multiple sclerosis, endometriosis, sexually transmitted diseases amongst others. Only after these tests are inconclusive or uncertain and if there is blood in urine, will the urologist go for cystoscopy.

Treatment
There's no cure for IC, but Hunner s ulcers can be cured by burning them off the bladder wall. Called fulguration, the process uses electricity or laser to burn the ulcers on the bladder wall. Resection is also used in which skin from around the Hunner s ulcer is cut for removing both the ulcer and the inflamed tissue around it. The problem is that ulcers may recur in the same location.
So, managing IC becomes critical. Your doctor can try to treat the patient with one treatment or with a combination of treatment depending on the condition of the patient.

Pain medicines are the first line of treatment to manage Hunner s ulcers and IC both, and many patients do go in for this. Patients also find relief by modifying their diet to remove foods and drinks like caffeinated beverages- tea, coffee, colas etc. Sodas, artificial sugars and fruit juices, especially Cranberry juice can trigger intense pain and discomfort, so these are usually contraindicated. Another important aspect is patient education about normal bladder function and tips on self-care and behavioural modifications like stress control to manage Hunner s ulcers.

Hunner's Ulcer In Urinary Bladder - How They Can Be Treated?

What should you do if you have an overactive bladder?

Overactive bladder, also known as OAB, is a condition where sudden involuntary contractions of the urinary bladder's muscular walls cause bladder storage dysfunction. It leads to sudden and frequent urges to urinate (urinary urgency), as well as unintentional leakage or urine (urinary incontinence).

This is a condition that affects both men and women and causes tremendous discomfort in nearly every aspect of daily life. The specific causes of OAB vary from case to case but it is generally attributed to infection of the urinary tract or dysfunction of the nervous system. The symptoms are intensified by unhealthy lifestyle choices such as overindulging in caffeinated drinks, spicy foods, and alcohol.

There are several ways in which you can deal with the problem of OAB, depending on the nature of the case. It is necessary for you to consult a urologist for a detailed diagnosis to formulate the best treatment option.

Following are the most effective remedies to treat an overactive bladder:

1. Lifestyle Modifications

Also known as behavioral therapy, this is the first step in the treatment of OAB. It involves inculcating simple changes into everyday habits such as avoiding food and drinks that irritate the bladder, scheduling (and in some cases, practice delaying) bathroom visits, exercising the pelvic floor and bladder muscles, keeping a record of urinating habits in a 'bladder diary' for better understanding the problem, etc. You can incorporate these habits into everyday activities for an easy alleviation of the problem with absolutely no side effects.

2. Medication and Surgery

There are several different kinds of medicines and drugs that can treat the problem of OAB. The most common types are muscle relaxants that loosen the muscles of the urinary bladder to prevent involuntary contractions, and antibiotics and anti-inflammatory drugs that treat urinary tract infections. Many types of implants are surgically set into the pelvic area to act as electrical nerve stimulators for neuromodulation therapy. Reconstructive bladder surgery is another remedial option.

3. Devices and Products

Urinary urgency and incontinence can be managed through the external use of various devices and products which collect and hold urine or absorb leakages. These include indwelling catheters, condom catheters (for men), urine drainage bags, absorbent pads and adult diapers, and toilet substitutes such as bedpans and bedside urinals.



What Should You Do if You Have an Overactive Bladder?

The kidneys are the purifiers of the body; they help in removing the waste from the body through the urine. In those suffering from kidney diseases, the function of the kidney is affected, and so their ability to clear out waste from the body is reduced and completely lost gradually. However, waste continues to form, and therefore, such patients have to undergo dialysis, where the blood is purified through an external device.

The frequency and duration of the dialysis would depend on how effectively the kidneys are still functioning and how much waste has been formed from the time of the previous dialysis session. The person s overall body mass index (BMI) and the water weight gained are also considered.

Once it is decided that a person s kidneys are damaged and dialysis is required, the person has to prepare for a long-term process. The following outlines what to expect before, during, and after the dialysis sessions. 

Before the session: 

Since most people prefer to get it done at a dialysis centre, it is preferable to plan for it, three treatments a week on an average, with each session lasting about 4 to 4 hours.

During the session: 

The blood flows through the dialysis device, which acts as an artificial kidney. The sequence of events are as follows:
The Weight is checked
Vital signs, including heart rate, blood pressure, breathing and pulse are checked.
The access areas are washed, and needles are used to connect these areas to the dialysis machine. Anesthesia may be used in the beginning to reduce the pain in this area.
The same access areas are used for each session, and over a period of time, buttonholes are formed which is like a small tunnel.
Though the session would last about 3 to 4 days, normal activities can be done, including reading, working on a laptop, watching television, or even sleeping.
Once the dialysis session is complete, the tube will be removed and a dressing is placed over the site.
After the session

The same site is used each time for the dialysis, so for the first couple of sessions, there could be discomfort. There could also be nausea, diarrhoea, cramping, and headaches.
The treatment needs to be adjusted based on symptoms, so please let the doctor know if you experience any symptoms.

Call the doctor if you are facing the following:

Bleeding from the access site
Inflammatory signs around the site
Persistent fever of over 104 degrees
Numbness or weakness in the arms
Confusion, drowsiness, or cognition problems
Though initially uncomfortable, once you get into the dialysis schedule, you will notice the difference of how cleansed you will feel after each session.

Undergoing Dialysis - What To Expect From It?

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