On Kidney Care: Know your Enemy and Know your Ally
Kidney disease now is slowly emerging as one of the most dreadful diseases, perhaps due to stories on end-stage kidney disease and those patients requiring eventual dialysis. Since there is an increasing prevalence of end-stage kidney failure secondary to lifestyle diseases that are potentially modifiable, everyone should know their battles.
Now let’s get acquainted with our ally, our kidneys.
Our kidneys are two bean-shaped organs, about the size of the fist, located below the rib cage, on each side of the spine. They act as a sieve in our body, and as blood passes through the kidneys, they filter around 120 liters of blood per day, to produce two to three liters of urine per day. Kidneys keep the composition of the blood as stable as possible, to keep the body in balance. They prevent the buildup of waste and extra fluid in the body. They also keep sodium, potassium and phosphate, which are the most vital electrolytes in our body, within normal range. The kidneys also manufacture important hormones that regulate growth in our body, such as hormones that regulate blood pressure, make red blood cells, and keep our bones healthy and strong.
If the kidneys malfunction, they will not take out the waste from our body, and may derange electrolytes, causing fluctuating abnormal levels. They will also manifest as generalized weakness, elevated blood pressure, anemia, and weakening of bones. If the kidneys continue to fail, the blood gets filled up with toxin, resulting to failure of other organ systems of the body.
What then would cause kidneys to fail? Certain diseases such as inherited familial kidney diseases, longstanding uncontrolled hypertension, diabetes mellitus, continuous intake of pain medications and herbal medication, recurrent infection, diseases that obstruct the urinary system such as large kidney stones, enlarged prostate in men, and tumors could cause kidney failure. If you have any of these, it is better to consult a nephrologist, and get a baseline kidney examination.
Ten Keypoints for Kidney Care:
- Keep hydrated! Our kidneys are like plants. They need to be “watered” to keep them healthy and well-functioning. This will avoid kidneys to become dehydrated, and diminish the filtering function of our kidneys. But too much water is not recommended for patients with heart and blood pressure problems, and patients with near end-stage kidney disease, as they may note accumulation of edema fluid in the body.
- Control blood pressure and glucose levels. Target goals of blood pressure should be <120/80 mmHg, and fasting blood sugar to be 90-120 mg/dl. If you are a diabetic, and a glycosylated hegmoglobin A1C is being monitored, your goal is HbA1c of <7%. Keep in mind, a low salt, low carbohydrate and low fat diet for your heart and kidney’s delight!
- Limit salt intake. Where the salt goes, the water goes with it. It is expected that if there is increased water retention, it will elevate blood pressure and may cause long-term effects to the kidneys.
- Avoid too much protein in your diet. A high protein diet is an additional “load” to the kidneys and may exhaust the reserves of our kidneys. This explains a “low protein” diet recommendation for patients with kidney failure, not on dialysis. For patients with normal baseline kidney function with none to low risk factors, a balanced diet of fish, meat, and vegetables is always recommended.
- Do not rely on food and herbal supplements. Though it has always been thought that “alternative” treatments are supplements to medical treatments, they are not all kidney-friendly, and may be deleterious to kidney function. They are not all well-studied and not been scientifically proven to be protective to the kidneys.
- Get physical. Do regular exercise to augment effective circulation of blood, also to address metabolic lifestyle diseases such as obesity, hypertension and diabetes.
- Avoid taking too much over-the-counter pain medications such as mefenamic acid, ibuprofen, and celecoxib. Chronic intake of medication for joint pains and other body pains should be further re-evaluated. First seek consult from a doctor for the persistent body pains, then consult which pain medication should be suitable for you.
- Know tests that may use administration of contrast dyes. Especially for imaging procedures, it is always recommended to determine your baseline creatinine function. Contrast dyes may have short and long-term effects to the kidney, that may deplete your renal function.
- Know your baseline kidney function. First is to know your ally… your kidneys. Check your baseline creatinine, with BUN, and urinalysis. Then know your enemy, get a test that may screen you for diabetes, and do a home monitoring of your blood pressure. For elderly males with urinary symptoms such as urinary frequency or incontinence, you may see a urologist for a baseline screening for prostate enlargement.
- Visit your attending nephrologist for a more thorough discussion on kidney care, and modifying risk factors for kidney disease.
Dr. Bienvenido G. Manlutac is an active consultant in Adult Nephrology at St. Luke's Medical Center-Quezon City. He had his fellowship training in nephrology and residency training in Internal Medicine also at St. Luke’s Medical Center-Quezon City. This article is written with contribution from Dr. Erika Bianca Villazor-Isidro, Chief Fellow, St. Luke's Medical Center-Quezon City, Section of Nephrology.
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