SENIOR NEPHROLOGIST APOLLO HOSPITALS, NEW DELHI.
know that in our country there are approximately 5 lakh people
suffering from total kidney failure and every year approximately 1
lakh people are added to this growing list. It means that out of
every 2000 family, 1 family is suffering from this disease. Out of
these only 6000-8000 people get treatment, which constitutes only
1-2% of the people suffering from this disease.
question arises why do so less people get treatment ?
Although there are many reasons, the main ones are:
1. The common person does not have sufficient information
about kidney related ailments.
2. There are very few fully
equipped hospitals in our country to treat these types of patients.
3. People are not able to gather enough finances to get the
Now lets study in detail about kidney and
its related ailments so that everyone can undertake precautions.
What is kidney?
- Kidney is that organ of our
body, which helps in purification of blood and also removes toxic
materials from our body through urine.
Each human being has two kidneys, which are connected to the urinary
bladder through the
Where are the
- Kidneys are located on both sides of
the spinal cord, above the waist and behind the stomach.
Each kidney is fist-sized.
- Each kidney is10-12
cm long, 5-6 cm wide and 3-4 cm thick and weigh approximately 150
Functions of kidney:
Our kidneys purify
around 1500 litre of blood and convert it into approximately
1.5-litre urine per day. 1200ml of blood flows through both the
kidneys per minute and out of it 1 ml of urine is formed per minute.
1000-1200 ml /minute
Blood goes into kidneys.
100-120 ml /minute
(after being filtered goes into tubules).
1-1.2 ml /minute
comes out of the body, rest is absorbed in
blood via tubules.
- Through the filtration of blood, dirty
and harmful substances such as urea, creatinine etc are
thrown out of the body.
- Kidneys regulate the
amount of water in our body. Therefore when the kidney fails, the
entire body starts to swell.
- Regulates the blood
pressure and keeps the BP within normal range.
- They convert
vitamin-D from 25-Dihydroxy cholecalciferol to 1:25 Dihydroxy
cholecalciferol, which absorbs calcium from intestine
and makes our bones strong.
- Kidneys also help in formation of
the red blood cells (which are formed in bone marrow) by
releasing erythropoietin hormone.
question arises how do such trivial organs perform such heavy-duty
- Our kidney constitutes lacs of filters and
140-mile long tubules in approximation. The main
functional unit of kidney is nephron. Each kidney
comprises approximately 10 lac nephrons.
- Filters filter the
blood and the filtered blood is sent to the tubules.
tubules reabsorb useful substances such as sodium, potassium,
calcium etc from the liquid and approximately 1.5 litre
urine comes out from the body.
How do kidneys get
There are many reasons for kidney failure but
the prominent ones are the following:
1. Diabetes Mellitus.
2. High Blood Pressure.
3. Some medicines such as taken for
reliving pain(pain killers) and other unnecessary
4. Dehydration that is less
amount of blood and water in the body due to vomiting, cholera and
5. Inflamation of filters
of the kidney due to which proteins are lost in urine and this
process is called Glomerulonephritis.
Healthy kidney does not allow proteins go in urine.
of stones in kidney and urinary system.
7. Obstruction in the
flow of urine.
Types of Kidney Failure
are three main types of kidney failure
1. Acute Renal
Failure - This can be treated and cured as the kidney is in
diseased state for a short time, which results in reversible damage.
Its causes include reduction in level of water in body (dehydration)
due to cholera, excessive diarrhoea and vomiting, low blood
pressure, side effects of medicine and infection etc.
Chronic renal failure - This can be treated but cannot be cured
as the kidney is in diseased state for a long period, which results
in irreversible damage. Its causes are diseases like long duration
of uncontrolled diabetes, high blood pressure, swelling of membrane
etc. It requires life-long dialysis or kidney transplantation.
3. Nephrotic Syndrome - Proteins are lost from the
kidney in urine, which leads to swelling up of body and eventually
results in kidney failure.
What are the symptom of Kidney
- Even if one kidney is removed from a person,
the person can still lead his life with the other
- Symptoms of kidney failure develop
when both the kidneys are damaged. The following can be
some of the symptoms:
1. Swelling of the body.
2. Decrease in appetite.
3. Recurring vomiting or nausea.
4. Reduction in blood haemoglobin level (anaemia).
Weakening of bones (osteoporosis).
6. Fatigue/ weakness.
High blood pressure.
8. Reduction in urine formation.
How to prevent a healthy kidney from
- Increase in intake of water / take
plenty of oral fluids.
- Control diabetes and high blood
pressure if you are suffering from them.
- Take pain relieving
medicines only when absolutely necessary and not more than the
- Don't take medicines,
which are not required /avoid unnecessary medication.
- If you
feel you have symptoms of kidney failure, consult a nephrologist
immediately because kidney ailments can be cured only if
treatment is done at the earliest.
- Delay in getting the
treatment increases the chances of the kidneys lending in
Cure and treatment for
1. Nephrotic Syndrome- If the
amount of protein going into the urine has increased but the kidneys
haven't been damaged then it can be cured with the help of medicines
and putting proper restrictions on the diet as advised by a kidney
specialist. To prevent the disease from further spreading, one
should undergo kidney biopsy so that the correct disease can be
detected and treated and the kidneys can henceforth be spared from
2. Acute renal failure - If the
person is suffering from acute kidney failure caused by cholera,
infection etc then the chances of recovery are quite good and the
patient becomes as fit as before.
3. Chronic renal
failure - It is treated in the following ways
taking proper care of the diet as advised by a kidney specialist.
(B) By preparing an alternative for kidney
Haemodialysis- At least two to three times in a week
CAPD- Continuous Ambulatory Peritoneal Dialysis.
Precautions in diet
1. Take less of salt and take liquids including milk,
tea, and water according to the amount of
2. Avoid fruits that are juicy,
take fruits that have pulp like apple, papaya, and guava only in
3. Take leafy and green
vegetables only after draining the water in which they are boiled.
4. Take fewer amounts of proteins. Pulses, milk etc should not
be taken in excesses.(If protein consumption
of patient is high).
5. Take one teaspoonful of oil or ghee in a
1. The blood is purified by an
artificial kidney through a machine
2. In this two needles are
used which are inserted in the swollen veins in the same way as a
glucose bottle needle is inserted.
Prior to this a small operation is done to join the vein and artery
which prepares the veins to swell. Then the
swollen veins are ready for needle insertion and this process is
Maturation pf veins usually tales 2-4 weeks
4. From one needle,
the impure blood goes out of body through one tube into the machine
the artificial kidney and from the other
needle the purified blood comes back into the body
through another tube.
5. A person gets
dialysis done approximately two - three times in a week and each
takes about four hours.
Advantages and disadvantages of haemodialysis
(Continuous Ambulatory Peritoneal Dialysis)
week only 2-3 times haemodialysis has to be done for four
hours rest of the days of the week are to work.
2.There is no need of a machine or gadget at
3.Doctor and paramedical staff attend to the
has to go to a haemodialysis centre.
2.There is certain
restrictions on food and liquid intake.
two injections has to be injected in the
4.Sometimes people who have heart problem,
diabetes etc and many children are also not able to tolerate
- This type
of dialysis is done at home only whether it is a city or a village.
- In this the peritoneum of the abdomen acts as a filter.
In this procedure, a tube called catheter is embedded on the wall of
- A blood purifying solution is flowed via catheter
into the peritoneum.
- The solution absorbs all the toxic and
- This procedure has to be done 3-4 times in a
day and the solution also has to be continuously
replaced. It takes approximately half an hour each time.
Automated Peritoneal Dialysis (APD) ·
is just like CAPD as described above but it is done through a
special machine. This machine alone costs approximately
- In this, solutions and catheter are fitted with
the machine at night with a fixed programme. This
machine cleans blood whole night and you can have sound
sleep at night.
- There is no need to replace the solution in
Advantage and disadvantage of
himself can do dialysis.
2.There is no need to insert
needle as in haemodialysis.
3.This type of dialysis is
good for patients who have heart disease, diabetes and in
small children who are not tolerating
4.Patient has freedom to go to any place
to live or to work.
5.There is relatively less
restrictions generally in contrast to other method of
dialysis solutions has to be replaced 3-4 times in a day by
2.There is more chances of contracting
infection and getting peritonitis. Patients who cannot
tolerate haemodialysis can opt for CAPD.
is left fixed to abdominal wall permanently,donot like at
4.All the medicines, solution and equipments has
to be kept stored and ready at home.
- In kidney transplantation a healthy kidney
is fixed deep below the skin of abdomen infront of hipbone. A donor
who is patients near and dear donates the healthy kidney.
kidney transplantation matching of blood group between the donor and
recipient is must as given below:
Rh factor is not necessary (+ or -) ?
If patient's blood group is
Donor's blood group should be
|A or O
B or O
A or B or AB or
- A healthy kidney
can be obtained from two sources:
donor-From family members.
2. Cadaver- From
persons who donate their kidney after brain death.
kidney transplant the patient is hospitalized for 10 days where as
the donor is discharged
from hospital within 3-10
- After donating a kidney the donor is as healthy as
before and lives a normal life.
- After kidney transplant the
patient lives a normal life too and can go to his work or run his
business as before after 2-3 months.
expenditure of kidney transplant is approximately 3-4 lac. After the
has to be taken regularly.
KIDNEY TRANSPLANTATION -Advantages and Disadvantages
What are your
choices after total kidney failure?
becomes as normal as it was before kidney failure.
2.No need for dialysis.
4.Patient can take normal diet.
5.Life'routine is as normal as any other
there are remote chances of rejecion of transplanted kidney,
patient has some tension.
2.Regular medication is
required life long.
3.Body's power of defending
infection is decreased therefore there is chances of infection
particularly in first few months.
4.There can be side
effects of medicines rarely.
Choices has to be
made keeping in mind the following facts:
style of patient: If patient has field jobs, tour jobs - Kidney
transplant is the best choice for him because facility of
haemodialysis is not available everywhere.
condition: Kidney transplantation is the better option even if
there is any financial problem because in long term there is less
expenditure in comparision to dialysis and CAPD. If one of the
family members is capable and dedicated enough for taking care of
the patient then CAPD and haemodialysis can be one of better option,
in case we are not opting for kidney transplantation.
Distance and location of dialysis centre from patient: When
dialysis centre is very far then Kidney transplantation or CAPD is
the better choice.
4. Home condition: Hygienic home
condition is must for CAPD or else there is great chance of
5. Availability of kidney
donor: For kidney transplantation, a suitable donor, live or
cadaver is must.
6. Is the patient whole and sole earning
member in the family? Kidney transplantation is the best option.
He can earn his livelihood and look after his family.
Doctor's opinion: A kidney specialist helps the patient to
choose the best option as he takes in consideration all the problem
and diseases the patient is having. For example some patients of
diabetes, heart diseases and some children may not tolerate
haemodialysis. In these cases kidney transplantation or CAPD is
8. The emotional status, understanding and
attachment of family members with patient: If patient is on CAPD
or haemodialysis (2-3 times a week), the family members should be
capable and dedicated enough for taking care of the patient. They
should have true emotional attachment with the patient. Similarly
the kidney donor can donate one of his kidneys to the patient only
when donor is having true emotional attachment with the patient.
9. Overall, considering all the pros and cons, kidney
taansplant is the best choice untill unless medically unfit followed
by heamodialysis and then peritoneal dialysis in some.