KOCHI: The very mention of kidney disease is bound to send a shiver down anyone’s spine, given the perilous journey of dialysis and renal transplant associated with it. Renal disease is often perceived as cataclysmic and irrevocable. However, as a practising nephrologist, I consider it my duty to demystify these misconceptions. While chronic kidney disease is a major cause of morbidity worldwide, it has a multitude of sustainable treatments that can cure or alleviate the intensity and prolong life.
According to data cited by the Centers for Disease Control and Prevention (CDC), one in seven adults in the US lives with kidney disease. The recent Indian Chronic Kidney Disease study, one of the largest studies of patients in a middle-income country, identified diabetes as the major cause for 25% of cases, chronic interstitial nephritis being second and a relatively newer entity termed CKD as third.
Triggers
Not all kidney diseases are chronic and may have been precipitated by an acute trigger. Maybe a decline in renal perfusion which could have been caused by haemorrhage, diarrhoea or severe vomiting; hypotension arising from sepsis, or cardiac impairment; drug-related as in the case of some non-steroidal anti-inflammatory drugs among others. What is concerning is that several lifestyle-associated risk factors may be the harbinger of this illness among the majority. One in five individuals and one in three is hypertensive in our country. If uncontrolled and long-standing, both often lapse into kidney impairment.
Habits such as smoking spell doomsday to the kidneys like multiple other organs. Our more meat and oil-based diet, supplemented by a sedentary lifestyle is a forerunner of obesity and can cause renal dysfunction. If your diet contains more salty and sugary food, with reliance on meat consumption and poor fluid intake, it may be the potential trigger behind renal calculi.
Unrestrained consumption of over-the-counter drugs for pain relief such as non-steroidal anti-inflammatory drugs might pave the way for kidney damage in the long run. Other non-modifiable risk factors are genetics and pregnancy. These facts highlight the impact of a healthy lifestyle on the prevention of kidney disease to a great extent.
Symptoms
The symptoms do not always rear their head when the disease first manifests. A patient may harbour absolutely no signs of renal dysfunction and may appear hale and hearty in the initial stages of the disease. However, even subtle clues like malaise and lethargy are not to be ignored.
Other symptoms may be variation in the quantity of urine, frothing of urine, the passage of blood or stones in urine; swelling of the face, limbs, or the entire body; fever; abdominal pain; obstruction to urine flow among several others. Individuals at risk for heritable kidney disease, and ones with co-morbid conditions must watch out for any red flags. Screening tools for kidney disease need to be employed on a large population —based on a scale to identify the sleeping giant.
Busting myths
A flurry of myths surrounds this ailment, which may lead to poor outcomes among patients. A common and rather shocking misconception is that heavy amounts of fluid consumption will ward off kidney disease and cure it. This is a rather serious and at times life-threatening misconception. The fluid consumption of an individual ought to be strictly regulated by the volume status of the body. Several patients with chronic kidney disease might be in a fluid overloaded state which may be critically worsened by surplus intake and may drive the patient into pulmonary edema and other such catastrophes.
Another myth is that kidney disease spells dialysis or renal transplant in every scenario. This could not be further from the truth. While the end-stage depends on these modalities, there are several cases of acute kidney injury which may be entirely reversible. Yet another myth is that kidney donation lowers one’s life expectancy. The fact is that a single healthy kidney can take up the function of both and hence, kidney donation does not pose any major mortality risk to the donor.
There is also a belief that kidney disease is untreatable and will eventually result in death. While chronic kidney disease is a progressive one and is incurable, there are multiple therapies to allay its progression. Following strict dietary restrictions and abiding by a stringent drug regimen with close follow-up, one may lead a very productive life. The end-stage renal disease is not the end of the road. Here dialysis and kidney transplantation are beacons to patients.
Kidney disease currently is a manageable condition if identified and treated promptly.