Often, kidney diseases are the end result of other chronic diseases. The damage occurs if the existing issue, like kidney stones, is not managed properly.
Dr Mukesh Kumar Shewak Ram, nephrologist and internal medicine specialist
The theme of this year’s World Kidney Day on March 14 is ‘Kidney Health for Everyone Everywhere’. Keeping in tune with the need for awareness on kidney care, Bandana Shah of Yoga & Wellness catches up with Dr Mukesh Kumar Shewak Ram, who is a nephrologist and internal medicine specialist at Canadian Specialist Hospital. Earlier, he worked as specialist registrar nephrology in Dubai Hospital, Dubai Health Authority (DHA) from 2011 to 2015. In this conversation, Dr Mukesh talks about the causes, prevention and treatment options for kidney diseases.
1. What are the first symptoms or warnings signs of unhealthy kidneys?
Unfortunately, the symptoms of kidney-related diseases do not surface until they have reached a certain advanced stage or a patient visits a doctor for other illnesses and the latter suggests a routine check-up of the kidneys’ functioning.
Often, kidney diseases are the end result of other chronic diseases. For instance, a patient suffering from diabetes or hypertension may visit their physician for a routine check-up and learn that their kidneys are not doing well. Sometimes, the damage occurs if the existing issue, like kidney stones, is not managed properly.
Obesity is a major cause for diabetes, hypertension and hyperlipidemia. A majority of the population in this part of the world are obese for which fast food is to blame. However, in several cases where no pre-existing illness occur, diagnosis is delayed. Symptoms like nausea, vomiting, poor diet and anaemia signify poor status of kidneys.
Therefore, when the disease is not giving warning signs, prevention is crucial. Get the level of serum creatinine in your blood measured. If these levels are abnormal, go for other basic assessments like the blood urea nitrogen (BUN) test and the urea and electrolytes (U and E) test. Everyone should get routine urine tests done annually, unless you have common symptoms like dehydration or are suffering from diabetes.
2. What other diseases impact the functioning of the kidneys?
Diabetic people are the most prone to kidney diseases, followed by patients of hypertension and stones. Some genetic or immunological issues also cause kidney problems, but the chances are low.
3. What dietary measures can one adopt to maintain kidneys’ health?
Take plenty of fluids. Normally one must consume 2.5 litres or eight glasses of water daily. Those with kidney stones, however, may be suggested to drink more water. During summer or in this part of the world, you need more fluids to avoid dehydration that affects the kidneys.
Maintain a balanced diet. Those with hypertension should decrease the intake of salt and increase portions of vegetables and fruits along with prescribed medication to maintain the blood pressure. Diabetic patients need to make extra effort towards their diet as the eyes and kidneys are the first organs that the disease targets.
If you have already developed a kidney disease, then you have to cut down on your protein intake. Extra protein may lead to excess production of urea, which is harmful.
4. How can patients suffering from kidney diseases like stones or partial damage maintain their health?
Let’s take a patient has with kidney stones as an example. If one does not have any genetic issue like deficiency of electrolyte, just control the diet avoiding high-oxalate foods, drink plenty of water and workout regularly to facilitate its natural removal. But, one must consider surgery if pain persists. However, if the stones have been surgically removed and the urine test is normal – no electrolyte imbalance and potassium secretion is under control – it is important to investigate what caused the stones to form. In the late stages of kidney disease, lack of water may restrict the production of urine. This leads to swelling in the body, especially the feet.
UAE is teeming with Asians, most of whom are used to taking over-the-counter (OTC) painkillers such as ibuprofen, voltaren, naproxen for minor issues such as headache. These “medicines” are the kidneys’ worst enemies as they directly damage the pair of organs. Most patients are shocked when we discuss their medication history and point that the OTCs they consumed was the reason they were sitting in front of us in the first place. Even though they do not have diabetes or hypertension or immunological disease, their damage is at the severe stage. Therefore, painkillers must not be used without a doctor’s prescription. Even the physicians should avoid prescribing these medicines.
5. What age group is susceptible to kidney diseases?
Sadly, no age is exempt. Even in children, issues such as nephrotic syndrome (protein in the urine, low blood albumin levels, high blood lipids, and significant swelling) are results of damage to the kidneys. However, it is when people are nearing 40s that they may start developing issues like hypertension and diabetes. If these remain uncontrolled, kidney diseases are likely to develop slowly.
6. What would you advise people who consume alcohol?
First of all, do not consume alcohol. For those who do drink, moderation is the key; otherwise alcohol may severely damage the liver and kidneys.
7. Tips for prevention of kidney diseases.
Firstly, drink plenty of water. Secondly, if you have hypertension or diabetes, seriously follow your doctor’s advice. See a nephrologist if you develop a kidney disease. They will suggest you have regular check-ups, help you control blood pressure, adjust medication and give tips on diet and water intake. Go for routine annual check-ups.
8. What treatment options are available for kidney diseases?
There are five stages of kidney disease. In the first stage, there could be structural damage or presence of protein in urine and the functioning is more than 90%. Visit a nephrologist who will be able to explain why you have protein. If you do not have other illnesses, you may be suggested to have a kidney biopsy and immunological workup to facilitate the diagnosis and the correct treatment. In stage two, the kidney functions between 60% to 90%. Thus, you need to control protein (if you have diabetes). If other diseases remain uncontrolled, one is not far from stage five, where the kidney functions less than 15%. Then one needs to prepare for haemodialysis or peritoneal dialysis.
There are two types of treatment: Dialysis and transplantation. During haemodialysis, a patient has to be in the hospital where four-hour sessions are administered. In peritoneal dialysis, a tube is placed on the patient and the exchange of fluids can be done at home via a machine that the attendant or nurses are trained to use. If the damage is to the extent that the kidney needs replacement, renal transplant is the only option.
The best would be to receive the organ from a family member not only because the chances of having the same blood group and antigens are higher, but also the fact that being the organ one of a loved one would make you genuinely care for it. Cadaver donations are also popular. Anyone between the age of 18 to 50 can donate a kidney. The donor, however, needs to take extra care of the remaining kidney.
9. Could you explain this year’s theme for World Kidney Day?
‘For Everyone Everywhere’ stresses on an awareness for everyone, including patients and physicians, so that they can take care of their kidneys. This would facilitate prevention and early diagnosis of kidney diseases.