Nephrologist Dr R Sreedhara explains all that you wanted to know about kidney failure
Patients refuse to accept the diagnosis because "they are alright and making normal quantity of urine”. Although most patients are asymptomatic at the time of diagnosis, abnormalities in blood and urine tests confirm kidney disease. Diabetes and high blood pressure are common causes of kidney failure. Other diseases such as inflammation (glomerulonephritis, interstitial nephritis), hereditary conditions (polycystic kidneys) and poorly–treated stones and infections can lead to kidney failure.
Here below are some of the frequently asked questions that may help patients understand kidney diseases better.
Does kidney failure affect both kidneys?
Most people have two kidneys that work equally. Even after removal of one of these kidneys (when one donates a kidney), blood and urine tests will be normal as the remaining kidney can handle the extra load. Therefore, when a patient is diagnosed with kidney failure, it means both kidneys have failed.
What causes kidney failure?
Kidney disease is often silent initially. The diagnosis is usually made incidentally when patients get blood and urine tested for some other reason. Kidneys function at about 100 per cent in young adults, but decline gradually as one gets older. Symptoms of kidney failure usually appear when function is less than 15 – 20 per cent. Thus, although the diagnosis of kidney disease may happen at a particular time, the disease usually starts developing silently for longer. This is confirmed by an ultrasound scan which shows shrunken and echogenic (brighter) kidneys.
I am passing urine normally. How can I have kidney failure?
Kidneys perform two major functions – cleaning blood and removing water. These are not necessarily one and the same. Kidney failure means inadequate cleaning of the blood, even if the quantity of urine is normal.
Can dialysis work in all cases?
There are two types of kidney failure – acute and chronic.
Acute kidney failure means sudden decrease in kidney function – usually due to a sudden drop in blood pressure, infection (sepsis), side effects of drugs, etc. Kidney function deteriorates rapidly over several days. Although this is a serious life–threatening condition, it is almost always reversible if the patient survives the underlying disease (dehydration, sepsis, etc.). Even if the patient undergoes dialysis for some time, kidneys often recover on their own.
Chronic kidney disease (CKD) is not reversible and kidney function deteriorates slowly over several years associated with scarring. Early detection and treatment may decrease the rate of decline.
Does the collection of creatinine cause kidney failure?
The human body produces waste products such as carbon dioxide, bilirubin, urea, creatinine, etc. Carbon dioxide is removed by the lungs and bilirubin by the liver. Kidneys remove urea, creatinine and several other waste products. Urea and creatinine are not toxic. Thus, urea and creatinine are just messengers that indicate the level of kidney function.
Can you prescribe a diet to cure kidney failure?
Many believe that kidney failure can be cured with diet. Unfortunately, this is not true. However, patients do have to follow certain diet restrictions to control blood pressure, leg swelling, potassium, calcium, phosphorus in the body. Diet recommendations vary from patient to patient, depending on their clinical condition. Patients should avoid excess intake of animal protein as it may make disease progress rapidly.
If the patient’s potassium level is high, certain fruits and vegetables rich in potassium (bananas, oranges, tomatoes, etc.) should be avoided. Leaching vegetables before cooking can remove excess potassium. During leaching, boil vegetables in water, discard the boiled water and then prepare food.
Should I restrict salt?
Salt increases blood pressure leading to worsening of CKD. Most patients should restrict their salt intake to less than four grams a day.
How much water should I take?
Only CKD patients with leg swelling or breathing difficulty should restrict fluid one litre a day. Without these symptoms, water restriction may not be necessary.
I started the dialysis process last month. Why have my kidneys not improved?
Dialysis is not a cure for kidney failure but only a procedure to clean the blood. Impure blood is passed through a machine that removes some of the impurities. Dialysis treatment cannot and will not make kidneys better. Only symptoms of kidney failure may get better with dialysis. Dialysis has to be conducted repeatedly – three times a week – to remove impurities that constantly accumulate in the body.
Can I decrease the dialysis treatment to once a week or less?
No. A good dialysis treatment is approximately equal to about 5 per cent of a normal kidney’s cleaning capacity. Therefore, three dialysis treatments a week correspond to about 15 per cent of a healthy kidney function. This is a bare minimum. In the long term, dialysis less than thrice a week will harm the patient. In fact, scientists are now advocating daily dialysis (six to seven times a week) to improve patient outcomes.
Can I get a kidney for transplant from my grandmother?
Transplantation is the best treatment option for patients with kidney failure. Because kidneys deteriorate with aging, the ideal kidney donor should be healthy and young, preferably less than 50–55 years. Taking a kidney from a donor who is 60 or older is usually not acceptable as the procedure is risky for the donor and not too beneficial for the recipient.