Prevention of Kidney Diseases

Kidney diseases are silent killers. They may cause progressive loss of kidney function leading to kidney failure and ultimately requirement of dialysis or kidney transplant to sustain life. Because of the high cost and potential problems of lack of availability in developing countries, only 5 -10% of patients with kidney failure are fortunate enough to get definitive treatment options such as, dialysis and kidney transplantation, while the rest die without getting any definitive therapy. Chronic kidney disease (CKD) is very common and has no cure, so prevention is the only option. Early detection and treatment can often keep CKD from getting worse, and can prevent or delay the need for definitive therapy

How to prevent kidney diseases?

Never ignore your kidneys. Important aspects about care and prevention of kidney diseases are discussed in the following categories.

• Precautions for healthy individuals
• Precautions for individuals with kidney disease.

Precautions for Healthy Person

Seven effective ways to keep the kidney healthy are:

Be fit and active

Regular aerobic exercise and daily physical activity maintains normal blood pressure and helps control blood sugar. Such physical activities cut the risk of diabetes and hypertension and thus reduce the risk of CKD.

Balanced diet

Eat a healthy diet, full of fresh fruits and vegetables. Decrease intake of refined foods, sugars, fats and meats in the diet. For those above 40 years of age, consuming less salt in the diet may help in the prevention of high blood pressure and kidney stones.

Keep your weight in check

Maintain your weight with a balance of healthy food and regular exercise. This can help in preventing diabetes, heart disease and other conditions associated with CKD.

Give up smoking and tobacco products

Smoking can lead to atherosclerosis, which reduces blood flow to the kidneys, thus decrease their ability to function at their best. There have also been studies that demonstrate that smoking leads to faster decline in kidney function in those with underlying kidney disease to begin with.

Beware of OTCs

Do not overuse over-the-counter (OTC) painkillers on a regular basis. Common drugs such as non-steroidal anti-inflammatory drugs like Ibuprofen and Naproxen are known to cause kidney damage and subsequent failure particularly, if taken on a regular basis. Consult a doctor to find the best way to control your pain without putting your kidneys at risk.

Drink lots of water

Drinking sufficient water (about 3 liters per day) helps to dilute urine, eliminate all the toxic waste from the body and prevent kidney stones.

Annual kidney check-up

Kidney diseases are often silent diseases and do not produce any symptoms until they reach an advanced stage. The most powerful and effective but, sadly, underutilized method for early diagnosis and prevention of kidney disease is a regular kidney check-up. Annual kidney check-up is a must for high risk persons who suffer from diabetes, high blood pressure, obesity or have a history of CKD in the family. If you love your kidneys (and, more importantly, yourself), do not forget to get a regular kidney checkup after the age of 40. A simple method for early detection and diagnosis of kidney disease is at least an annual blood pressure measurement, urinalysis and a test to measure creatinine in blood.

Precautions for Kidney Patients

Awareness about kidney diseases and early diagnosis

Stay alert and watch for symptoms of kidney disease. Common symptoms of kidney disease are swelling of face and feet, loss of appetite, nausea, vomiting, pallor, weakness, frequent urination, presence of blood or protein in urine. In the presence of such complaints, it is advisable to consult a doctor and get tests for kidney check up.

Precautions in diabetic patient

For all diabetic patients, prevention of kidney disease is particularly essential because diabetes is the leading cause of CKD and kidney failure throughout the world. About 45% of new cases of end-stage kidney disease (ESKD) are due to diabetic kidney disease (DKD). For early diagnosis of diabetic kidney disease, a simple and effective way is at least a tri-monthly measurement of blood pressure and urinalysis to check for the presence of protein or microalbuminuria (MA) by dipstick .This is the best and ideal test for the earliest diagnosis of diabetic nephropathy, which should be done every year. Measure serum creatinine and estimated glomerular filtration rate (GFR) to assess kidney function at least once every year

High blood pressure, presence of protein in the urine, generalized swelling, frequent fluctuations of blood sugar readings, reduction in insulin requirements and appearance of diabetic eye disease (diabetic retinopathy) are important clues to kidney involvement in the presence of diabetes. Beware of these danger signals and consult your doctor immediately.

To prevent DKD, all diabetics should control diabetes meticulously,maintain blood pressure less than 130/80 mmHg (Angiotensin Converting Enzyme inhibitors, ACE-I or Angiotensin Receptor Blockers, ARB are the preferred antihypertensive drugs), reduce the amount of protein in their diet and control lipids.

Precautions in hypertensive patients

Hypertension is the second most common cause of CKD. As most people with high blood pressure have no symptoms, many hypertensive patients tend to become non complaint with prescribed treatment or some may even discontinue treatment altogether. Some would discontinue treatment as they feel more comfortable without medicine. But this is dangerous. Uncontrolled hypertension for a prolonged period of time can lead to serious problems like CKD, heart attacks and strokes.

To prevent kidney disease, all hypertensive patients should take regularly prescribed blood pressure medications, get their blood pressures checked regularly and consume a proper diet with appropriate salt restriction. The goal of therapy is to keep the blood pressure less than or equal to 130/80 mmHg. For early diagnosis of kidney damage all hypertensive patients should check urine and blood creatinine every year.

Precautions in patients with CKD

CKD is a non-curable disease. But early detection and diagnosis and subsequent dietary restrictions, regular follow up and proper treatment will slow down its progression and may potentially postpone imminent requirement of dialysis or kidney transplantation.

Round the clock proper control of high blood pressure is an effective measure to prevent progression of CKD.

It is highly recommended to keep blood pressure 130/80 mm Hg or below. The best way to attain good control is to monitor the blood. pressure regularly at home and maintain a chart, which would immensely help the doctor in adjusting the blood pressure medications accordingly. In patients with CKD, factors such as hypotension, dehydration, urinary tract obstruction, sepsis, nephrotoxic drugs etc. need to be promptly identified. Prompt management of these factors may lead to maintenance of stable kidney function, and at times, even improvement in kidney function.

Early diagnosis and treatment of polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is a common and serious hereditary disorder of the kidneys, accounting for 6-8% of patients on dialysis. An adult with a family history of polycystic kidney disease is at a high risk and should be considered for screening by an ultrasound examination for early diagnosis of this disease. PKD has no cure but measures such as controlling high blood pressure, treatment of urinary tract infections, dietary restrictions and supportive treatment help to control symptoms, prevent complications and slow down the rate of decline in kidney function.

Early diagnosis and treatment of urinary tract infection (UTI) in children

Urinary tract infection (UTI) should be suspected whenever a child gets unexplained fever, frequent urination, painful burning urination, poor appetite or poor weight gain.

It is important to remember that each bout of UTI, especially with fever carries the potential risk of damage to the kidney, particularly if diagnosed or treated late and inappropriately. Such damage includes scarring of the kidneys, poor kidney growth, high blood pressure and kidney failure later in life. For this reason, it is imperative that UTIs in children are diagnosed early so that appropriate treatment can be rendered immediately; it is also important that when children present with UTIs,identification ofpredisposing abnormalities (congenital and/ or structural/ anatomic) or other risk factors need to be carried out rather expedetiously. Vesico ureteric reflux (VUR) is the most common predisposing cause present in about 50% of UTIs during childhood. Close monitoring and follow up is mandatory particularly in affected children with UTI.

Recurrent urinary tract infections (UTI) in adults

Patients with recurrent UTI or inadequate response to appropriate antibiotic therapy should be evaluated for underlying predisposing factors. Certain underlying causes (e.g. urinary tract obstruction, stone disease etc) carry the risk of permanent damage to the kidney, if it goes untreated.Therefore, early diagnosis and identification of underlying causes is essential.

Proper management of benign prostatic hypertrophy (BPH)

Many elderly males with benign prostatic hypertrophy (BPH) neglect their symptoms for a long period of time, because of the misconception that it is normal to have increased frequency of urination or dribbling of urine as they are part of the normal aging process. Untreated BPH can cause permanent damage to the kidneys as well. Proper follow up and timely treatment will help to preserve remaining kidney function at the time of diagnosis.

Do not ignore hypertension at young age

Hypertension at a young age is uncommon and almost always requires an exhaustive search for the underlying cause. Kidney diseases are among the most common causes of severe hypertension in the young. Therefore, in young individuals with hypertension, prompt evaluation is mandatory for early detection and diagnosis of kidney disease to prevent progression that may lead tomore permanent damage.

Early treatment of acute kidney failure/ acute kidney injury (AKI)

Important causes of acute kidney failure (sudden reduction of kidney function) are diarrhea, vomiting, falciparum malaria, hypotension, sepsis, certain drugs (NSAID’s) etc. Early and prompt identification of these underlying causes can prevent progression and development of permanent kidney failure.

Cautious use of medicine

Be vigilant. Many ‘over-the-counter’ medications (especially analgesics and pain killers) carry the risk of kidney damage, particularly in the elderly. Such medications are widely advertised, but the likely harmful consequences are rarely disclosed. Avoid the indiscriminate use of over the counter analgesics (pain killers) for headache and generalized body aches. Avoid self medication and unnecessary medications or dietary supplementations. Medications taken under the guidance and supervision of a doctor are usually safe. It is a wrong belief that all natural medicines (Ayurvedic medicines, Chinese herbs etc.) and dietary supplements are harmless. Heavy metals in Ayurvedic medicines have been known to cause irreversible damage to the kidney.

Precautions in solitary kidney

Persons with a single kidney can live normal healthy lives. As in patients with two kidneys, they should keep their blood pressures under control at all times, consume generous amounts of fluids, maintain a healthy diet, avoid excessive salt intake, avoid high-protein diets and avoid injury (e.g., direct trauma) to the solitary kidney. The most important precaution is to have regular medical checkups. One definitely must consult a doctor at least once a year to monitor kidney function by checking the blood pressure, urinalysis and blood tests and undergo a baseline renal ultrasonography, if indicated.

Source: Kidney Education Foundation