NO KIDDING ABOUT KIDNEYS
The Kidney is a sophisticated processing system which removes waste products from the body. Read on to find out how to take are of tem to avoid life threatening conditions.
The majority or kidney disease either improve spontaneously or can be treated by medicines without impairing patients lives. However, some people develop irreversible kidney disease called CRF-chronic renal failure, the most common type of kidney disease today. Except in a few cases, CRF invariably progresses to a stage at which practically the entire kidney function is lost. This stage is, as mentioned earlier, called End Stage Renal Disease – ESRD.
Reasons for CRF are mainly two Diabetes and High Blood Pressure. Family history has also been identified as a contributory factor for kidney diseases.
SYMPTOMS TO WACH OUT FOR
Swelling of hands and feet and puffiness around the eyes especially in the mornings. Shortness of breathe, frequent urge to urinate especially at night or passing small amount of urine. Bubbly or foamy urine, blood in urine, difficulty or burning sensation when urinating. Persistent fatigue, drowsiness or trouble concentrating. Any change in pattern of urination is also a cause to worry.
Other symptoms to look out for are skin darkening, skin rash or itching, nausea or vomiting, unpleasant taste in the mouth /ammonia breathe, or feeling cold without any valid reason.
BE ON THE SAFE SIDE
Routine blood and urine test is the most common form of testing the normal functioning of Kidneys. Dr.Bhart V. shah, cautions,”A regular urine test, if there is a family history of Kidney disease, or if one has been through one some Kidney disease like a Kidney stone etc, is a must, Check BP and blood sugar constantly if you have high BP or diabetes.”
Kidney disease in children can be inherited and congenital kidney disease can remain silent for months. The first sign of kidney disease in child is high BP, anemia, weak bones and blood or protein in the urine. Research shows that in the area of genetics, effective therapies are worked upon to prevent or treat hereditary kidney disease.
Dialysis is a process where waste products and excess fluids that accumulate in the blood as a result of kidney failure are removed. Dialysis is not a cure but just substitutes for the excretory functions of the kidney.
Two major forms of dialysis are haemodialysis and peritoneal dialysis. In haemodialysis your blood is sent through a filter that removes waste products. The clean blood s then returned back to the body. Haemodialysis is usually performed three times a week for three to four hours.
Peritoneal is where a fluid is put in your abdomen. This fluid captures the waste products from your blood. After a few hours the fluid containing body waste is drained away. Then a fresh bag of fluid is dripped into the abdomen. Patients can perform dialysis by themselves.
TRANSPANTATION
In recent times, kidney transplantation has earned a bad name. Dr Shah says that kidney transplantation is a panacea to the needy. “Many people get ESRD and for them kidney transplantation is the only answer. “He suggests that a registry be maintained of the donor and the donee, so that such procedures are have legal authorization and are over board. He goes further saying that all the donors may be compensated suitably. To clear any doubt, he says that people who donate one kidney can lead a very normal life. The donated kidney must be a good match for your body, or else your immune system will reject it. You may have to take special drugs to trick your immune system.
Center for cheaper dialysis soon
Delhi To House 1st Clinic That Will Charge Patients Less Than Rs. 1,000
Patients suffering from damaged kidneys and needing life-long dialysis to survive now have a reason to cheer. The health ministry is planning to open standalone dialysis centers across the country, much like pathological labs, where patients-both CGHS beneficiaries and the general public—can undergo the life-saving procedure at a minimal rate.
The first such 10-bedded dialysis centre, which will also assess the project’s overall feasibility, will come up by May in Delhi’s Sadiq Nagar area. Each bed will cater to three patients every day. Following a review after eight months, the ministry, under the first phase, plans to start three more such centers in Delhi and few others in Mumbai, Chennai, banglore and Hyderabad.
At present, of the 1.5 lakh new patients who suffer from end -stage renal failure annually, only 3,500 get kidney transplants and 6,000 undergo dialysis. The rest perish, thanks to an acute shortage of dialysis centres in India and nephrologists to man them.
According to Delhi Nephrology Society president Dr. Harsh Johari from Sir Gangaram Hospital, India has just 800 nephrologists for 7.5 lakh people suffering from various degrees of chronic Kidney disease (CKD).
Health minister A Ramadoss told TOI, “National estimates say 1in 10 Indians suffer from some degree of CKD. In India, 5%-7% of stage 5CKD patients will require life-long dialysis. That’s why under the soon to be launched National Organ Transplant Programme , standalone dialysis units for life-long maintenance dialysis are being set up.” At present, the health ministry pays Rs. 850 for every dialysis session that a CGHS beneficiary undergoes in stipulated private hospitals. An official said “ The rates, both for CGHS beneficiaries and common people visiting the dialysis centres, will be less than Rs.1,000 which is almost one-fourth of the cost in private hospitals.
Joint secretary Vineet Chaudhry said while trained staff and equipment in the Delhi centre would be provided by a private partner, the building would be provided by the ministry. The private partner, yet to be finalized, will be given a guaranteed turnover of patients daily.
“Since there is an acute shortage of nephrologists, decided to follow the US model where the standalone dialysis cnetres are run by trained medical personnel and nurses with a nephrologists being on call 24 hours. They visit once a week to ensure quality control. Our ultimate goal is to have one dialysis centre for every district,”Chaudhary said. Dialysis is a method of removing toxic substances from the blood when the kidneys are unable to do so.
Dr. Johari , welcoming the Centre’s move, said: “India’s dialysis programme is awful at presents. Hospitals don’t have stand alone facilities because it isn’t profitable. There is also an acute shortage of nephrologists. The ministry needs shortterm courses to train medical officers in dialysis.” According to Dr. Johri, a patient requiring dialysis, which lasts 4-6 hours, three times a week ends up spending nearly Rs. 10,000.
DIALYSIS CLEANING THE BLOOD
Most Kidney patients have to wait for a transplant and many have to do without it. Dialysis is what keeps them alive and even improves their quality of life.
What is Dialysis?
* Originated from the Greek word, dialusis (dissolution)
* Dialysis is a method of removing toxic substances from the blood when
the kidney are unable to do so due renal failure.
* Dialysis usually lasts 6-8 hours with patients suffering from advanced
renal failure requiring it 5-7 times a week.
Who needs it?
Patients suffering from temporary or permanent loss of their kidney function
and requiring a kidney transplant.
Types
There are two main types of dialysis, Hemodialysis and peritoneal dialysis
Kidney ailment in India
* chronic kidney disease(CKD) is the 3rd most common non-
communicable disease in India.
* Over 7.5 lakh people suffer from CKD
* 1.5 lakh new patients get end-stage renal failure every year. Of these, only
3,500 undergo kidney transplants.
* About 6,000 get dialysis while the rest perish.
History of Dialysis
Thomas Graham of Glasgow, first presented the principles of solute transport across a semipermeable membrane in 1854. Abel, Rountree & Turner developed the first artificial kidney in 1913. The first Peritoneal Dialysis was done by Georg Ganter (1923), first hemodialysis was by Hass(1924) and the artificial kidney was developed into a clinically useful apparatus by Kolff in 1943-45.
Kidney disease on the rise
BANGLORE: Around 10,000 people in Karnataka develop kidney failure every year. And one in ten people in India suffers from some form of mild kidney disease.
“Most of the Kidney related ailments are progressive and if not diagnosed and treated at an early stage, can result in end stage renal failure,” said Dr. H.S. Ballal, director, Manipal Institute of Nephrology and Urology.
The world Kidney Day, which was launched in 2006, is on March 8 this year. “ The day, observed on every second Thursday of March, is to create awareness among people on how to prevent kidney diseases,” he added.
What makes the situation of kidney patients worse is the exorbitant cost of treatment.
“About 90 per cent of kidney patients die a slow death because, either they don’t have access to treatment or they find it extremely expensive. Dialysis costs any where between Rs. two lakh and Rs. four lakh per year,”said the nephrologists.
The lack of availability of nephrologists in small cities and towns is another major issue. “In Karnataka 80 percent of the nephrologists are in Banglore.” he added.
Kidney diseases are often diagnosed at a later stage because in the initial stages, they could remain ‘silent.’ “It’s important that those vulnerable (see box) should get themselves periodically checked, “ said Dr. Ballal.
For patients with end stage renal failure there are only two lines of treatment; dialysis or transplant. “ The cost s prohibitive, and drains the family. Hardly five percent of the patients undergo dialysis and less than two per cent go in for transplant,” said Dr. Venkatesh Krishnamurthy, medical director, N U Trust.
“A transplant could cost between Rs 60,000 and Rs four lakh. There’s very little awareness on transplant, especially cadaver transplant,” he added.
What is also of concern is that a good number of people in their financially active years are coming up with kidney problems, said Senior
Consultant Nephrologists, Sagar Apollo Hospitals, Urmilla Anand. “ We Are now seeing patients as young as 35 and 40 years old with kidney diseases,” she said.
Free dialysis scheme
Manipal Institue of Nephrology and Urology, along with some philanthropists, would launch Mrs. Prema Devi Malimath Memorial Free Dialysis Scheme, for economically weak kidney patients, on Thursday. She was the wife of justice V.S. Malimath.
Deccan Herald spoke to justice Malimath on the eve of the launch. “ My wife was diagnosed with a kidney problem in 2001. She used to go to the Manipal Hospital for dialysis. We lost her on September 16, 2006, at the age of 71. She had a very positive attitude, and remained cheerful till the end. I never thought that she would die so soon,”said Justice Malimath.
“Dialysis is an extremely traumatic experience besides being very expensive. I could afford it because I’m entitled to medical reimbursement.” “ It’s impossible for a common man to meet the treatment cost. People die because the can’t afford dialysis,” he added.
Check List
* People with diabetes, hypertension, family or previous history of kidney ailments are vulnerable to kidney diseases.
*Simple blood (to check creatinine) and urine (albumin) tests can diagnose kidney disease.
*Watch out for symptoms such as puffiness of face, swelling in legs, decrease in urine ouput, anaemia & weakness.
*Kidney diseases, if diagnosed at an early stage, can be treated.
*They can enhance the risk of heart disease by 100 times.
Study Confirms That Many in The Diabetes Capital of the World Also Suffer from Chronic kidney disease
ONE IN 17 INDIANS has impaired Kidney function
Mumbai: Kidney filter 20 buckets-full of blood every day, flushing out toxins and maintaining good health. But this all-important function is impaired in every 17th Indian, says a new study that provides for the first time the prevalence of Chronic Kidney Disease (CKD) in India.
Given the fast-paced life and poor diet discipline in metropolitan cities, CKD is emerging as the latest lifestyle slayer. A whopping 24.3% urban Indians have a diseased kidneys in comparison to 9.2% in rural areas, says the SEEK (Screening and Early Evaluation of Kidney Disease) stud, which concluded in November 2007.
What makes CKD a serious problem is that it in various problems is that it invariably progresses to twice- or thrice-a-week dialysis or a kidney transplant. Not only is there physical discomfort of hospitalisation and operations, there also is a huge price tag attached to treatment.
The SEEK study, conducted by the Indian Society of Nephrology
across 21 centres in collaboration with Harvard Medical School, underlines what doctors always knew: Indians with their genetic disposition for diabetes and hypertension are more susceptible to CKD. Dr. Vidya Acharya, one of the senior most nephrologists in Mumbai who was part of the SEEK study, points out that risk factors for CKD include sedentary occupation obesity, hypertension, diabetes, smoking and consumption of tobacco.
Concurs Dr. Bharat Shah of the Narmada Kidney Foundation,
“India is being called the diabetes capital of the world. So, with diabetes and hypertension increasing due to faulty lifestyle, the burden of kidney diseases too is increasing,” In fact, the theme for this year’s World Kidney Day on Thursday is the disease’s link with diabetes. “ People with diabetes are 17 times more at risk to CKD than the normal population,” says Dr. Hemant Mehta, who heads the Mumbai Nephrology Group.
One of the main findings of the SEEK study is the fact that there is a low awareness of the disease and people hence turn up later for treatment. “Only 8% of the patients who participated in the study knew about their disease,” says Dr. Acharya.
Dr.M Bahadur of Jaslok Hospital believes that better awareness could lead to preventive strategies. “ If people detected with hypertension know about its link with CKD, they can undergo medical treatment to prevent or delay the progress to CKD. Secondly, people can change their dietary patterns, lower their salt and protein in-take,” he explains. Such measures would help them stay healthier for a longer time. Depending on the nature of the disease( whether it’s aggressive or slow), patients can remain on medications for one year or a decade before going in for dialysis.
Doctors recommend that people undergo a urine and blood test every year to detect protein levels. “Doctors should not ignore if the level is more than 1and advise interventions, “ says Dr. Bahadur.
Offering hope for those detected early, Dr. Acharya says that people in the early stages of the five-stage CKD can be managed on drugs for many years before they have to turn to dialysis or transplant. Dr.William Mich of the University of Taxes, who was in the city last week to propagate the relatively-new keto-acid therapy for kidney patients said, “We realised that the nitrogen in proteins worsens CKD and recommended lesser protein in diets. In Indians, however, this is a problem as it could lead to malnutrition further worsening the patient’s condition. So for such patients we now use ketoanalogues supplements.” Dr. shah adds, “One should not only work hard to prevent kidney disease, but also work hard to increase the number of donors.”
Cause & Effect
An annual blood and urine test can help detect the disease early
What is CKD?
The Kidney removes wastes and fluid from the body. CKD decreases the body. CKD decreases the kidney’s ability to pump out the waste, leading to complications such as high blood pressure, anaemia, and heart and blood vessel disease. When kidney disease progresses, it eventually leads to kidney failure, which are requires dialysis or a kidney transplant to maintain life.
Symptoms
Most people may not have any severe symptoms until their kidney disease is advanced, but people may:
* feel more tired and have less energy.
*have trouble concentrating
* have a poor appetite
* have trouble sleeping
* have muscle cramping at night
* have swollen feet and ankles
* have puffiness around the eyes, especially in the morning
* have dry, itchy skin
* need to urinate more than, especially at night
Prevention
* Have your urine, blood and blood pressure checked regularly by your doctor
* Control your blood sugar.
* Control high blood pressure (less than 130/80 * on most reading)
* Stop smoking
* Exercise regularly
* Make the proper food choices
* Avoid excess alcohol
* See your doctor if you think you have a bladder infection
* Get enough sleep
* Ask you doctor about any new developments in the treatment of diabetes.
THE BURDEN
* Chronic kidney disease affects about 175 to 200 millions in India (roughly 17.4%), says the latest study by the Indian Society of Nephrology and University of Harvard. Worldwide, the prevalence is believed to be one in every 10 adults.
* In urban areas, the prevalence is higher-24.3%-and it is 9.2% in rural
areas.
* Nearly 50% of the prevalence is attributed to diabetes and hypertension.
The National Kidney Foundation of Indian in1994 found every fifth
person (between 25 and 45 years of age) had hypertension and every
seventh had diabetes.
PREVALENCE
IN CITIES
Mumbai --- 9.6%
Delhi--------18.2%
Banglore---4%
Cochin-----32.1%
Vizag------48.3%
Kanpur-----41.7%
Ludhiana---36.5%
Nadiad-----6.4%
RISK FACTORS IN
CKD PATIENTS
* Less than 8th grade 38%
Education
* Sedentary lifestyle 48%
* Low income 47%
* Obesity 49%
* Hypertension 63%
* Diabetes 27.4%
* Smoking 21.4%
* Tobacco chewing 15.1%
‘Choose to live with it or die of it’
Mumbai: Kidney disease may slow down your system, but it needn’t dampen your spirits. This is the lesson that yesteryear actor Shammi Kapoor(77) is trying to propagate. Detected with chronic kidney disease five years back, he has not let it overshadow his zest for life.
“You can choose to either live with kidney disease or die of it,” says Kapoor , who has decided to smilingly cope with the condition.
The septuagenarian, who is best identified with his song ‘Yahoo from the movie Junglee, puts it simply: “ I devote three days to hospital (for dialysis) and four days to home (for family).”
Pointing out that it is important to accept that chronic kidney disease is irreversible, he feels it becomes easier when one realises that” you happen to be one among the many suffering from it” and have to adapt to the circumstances.
Kapoor was diagnosed with CKD five years ago when he was admitted to Breach Candy Hospital with pneumonia.” I was on a ventilator for a month and one fine day I realised I was in the dialysis room,” said Kapoor, who has been following the routine ever since.
Hydronephrosis
Swollen kidneys from retained urine. More detailed information about the symptoms, causes, and treatments of Hydronephrosis is available below.
Symptoms of Hydronephrosis
• Swollen kidneys
• Reduced urine output
• Colic
• Symptoms of chronic hydronephrosis with slow onset:
• No early symptoms
• Dull groin ache
List of causes of Hydronephrosis
Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Hydronephrosis) that could possibly cause Hydronephrosis includes:
• Congenital defect of the urinary tract
• Urinary stones
• Kidney tumor
• Urinary tumor
• Urinary scarring
Misdiagnosis of underlying conditions list:
The list of possible underlying conditions mentioned in various sources for Hydronephrosis includes:
• Congenital defect of the urinary tract
• Urinary stones
• Kidney tumor
• Urinary tumor
• Urinary scarring
Other underlying conditions related to Hydronephrosis:
• Renal enlargement
• Renal failure, chronic
Allopathy Treatments for Hydronephrosis
• Surgery
• Kidney shunt
• Kidney surgery
• Kidney removal - satisfactory if only one kidney is affected.
• Treatment of any underlying cause of hydronephrosis
Ayurvedic Treatments for Hydronephrosis for permanent cure
Alternative treatments or home remedies that have been listed in various sources as possibly beneficial for Hydronephrosis may include:
Kerala Ayurvedic Treatment
Age is Secondary to state of Kidney
Trend of 70-plus Donors is Seen Across The World
With longevity and the overall health of Indians improving, there s a small batch of grandparents who are turning donors for their less fortunate family members. A couple of years ago, Ghatkopar resident Lalji Patel, at 72 years of age, donated a kidney to his then eight-year-old grandson Nishit at Lilavati Hospital.
Dr Sandeep Guleria, transplant surgeon of the All-India Institute of Medical Sciences, Delhi and secretary of the Indian Society for Organ Transplantation, points out that several senior citizens have donated kidneys. “It is not t0he chronological age of the person, but the condition of the donor’s kidneys that is important,” he says. The trend of 70-plus donors is also reported elsewhere in the world (See, ‘Age No Bar’).
On Monday, Thane resident Vijaya Bapat,53, with a mask in place, spoke about the unique” gift” she has received, a kidney from her 74-year-old mother Shailaja Joshi. “I was diagnosed with bilateral shrunken kidneys two years back. My creatinine (a serum whose high levels in blood indicate kidney impairment) levels had periodically spiked to 6 and 7.5,” she says. She was advised a transplant and her husband Anand Bapat was ready to donate a kidney, “But our blood groups are different”.
Sensing her dismay, her mother Shailaja volunteered. “My mother kept telling me over the last two years that she would donate her kidney for me, but I didn’t want it that way,” says Bapat. She thought of signing up for a cadaver (brain-dead) donor as “the wait could be a long one”.
“My mother is a mentally as well as physically strong person. No words can match my gratefulness for the gift she has given me,” adds Bapat
It was with much cajoling from the mother-daughter duo that the Jaslok Hospital team of nephrologhist Dr. Rushi Deshpande and transplant surgeon Dr. K Desai decided to evaluate Joshi for the operation. “ I was put through 12 tests or more before the doctors were satisfied,” says Joshi.
Deshpande says he wants to show that older donors who are healthy can be a good operation given the scarcity of donors in India. “If the Kidney is good, then it can increase the donor pool,” he adds.
But a senor doctor who didn’t want to be named says grandparents should be the exception and not the rule. “Many times they are economically dependent on family members. There is no way of establishing if they were emotionally coerced into donating.
LIFE FROM LIFE Live Donors Are Key
India
• There are roughly 4,500 to 5,000 kidney donations a year in India, according to the Indian Society for Organ Transplantation, which runs the Indian Transplant Registry.
• 15 years ago, India passed the Transplantation of Human Organs Act, allowing for organ retrievals from brain-dead patients, but over 90% of transplanted kidneys still some from live donors
• From 1971 to 2009, there have been 18,121 kidney transplants in India according to the Indian Transplant Registry which collected data from 33 hospitals.
Mumbai
There are approximately
1,000 live kidney donations every year.
There have been 33 kidneys transplanted from brain-dead patients so far in 2009
World
• There are about 27,000 living kidney donor transplants worldwide every year, according to a Feb 2009 report in kidney international journal
• Of these, 6,435 take place in the US and 1,768 in brazil. India has been pegged in between these two figures, with about 3,200 transplants.
AGE NO BAR Elderly Donors
Some instances of kidney donations by the elderly
The US
• The oldest brain-dead donor in the US was 87 years old.
• Among live donors, there was a transplant between two 71-year-old spouses.
The UK
• In the UK, the oldest donor was an 83-year-old man who earlier this year donated a kidney to his wife
• In April, an 81-year-old mother donated a kidney to her 51-year-old son.
Singapore
• In July 2009, a 75-year-old mother donated a kidney to her 46-year –old daughter.
City offers cheapest dialysis treatment in India
Mumbai:- While the financial capital is considered one of the most expensive cities in the country, there is a cheerful news for patients with kidney failure. Mumbai’s hospitals and stand-alone dialysis centres---120 in all—offer the cheapest dialysis rated in the country.
According to the findings of three-month-long survey done by the Mumbai Nephrology Group, the average cost of dialysis is Rs. 750 in Mumbai against Rs. 750 in Mumbai against Rs 1,200 in Chennai “in Lilavati Hospital, where I practice, dialysis costs Rs. 1,150, while it costs double in Delhi hospitals, ”said Dr. Hemant Mehta of the Mumbai Nephrology Group.
He recollects a patient’s son who had taken his mother to Benaras for holidays stating that the cost of dialysis in a private hospital in the north India pilgrim city is Rs 1,700.
Why is Mumbai affordable as against the other cities? Nephrologists Dr Umesh Khanna of the Mumbai Kidney Foundation and the group says charity is one of the biggest reasons. “Mumbai has many charity organizations that offer donations to dialysis centres,” he says.
Secondly, there , is the Mumbai dialysis model. Said Dr. Khanna, “Mumbai has many standalone dialysis centres that have an affordable model without the overheads that hospitals actually have to pay,”
The Group’s survey states that “satellite dialysis units essentially offer only dialysis facility. They can offer dialysis at a reasonable price by cutting down the overheads. It comprises a full-fledged dialysis centre with 10-20 dialysis machines with isolated machines for hepatitis B and C,RO plant and a resuscitation trolley with monitor & defibrillator. It has trained nurses, technicians and doctors trained in resuscitation of a serious patient.”
| ZONE AND CITY WISE COST OF PROCEDURE | |
| Zone | Cost per session (RS) |
| North | 1,250 |
| South | 1,100 |
| East | 1,350 |
| West | 1,000 |
| Delhi | 1,600 |
| Mumbai | 750 |
| Chennai | 1,200 |
| Calcutta |
|
