Kidney health: 8 golden rules that could change your life

All too often, the treatment of chronic diseases in confined to a few "tips" which may not be relevant to the person accessing the information. More than the disease, it is the person/patient's attitude to the disease which determines the outcome.
In this article, instead of focusing on unproductive "tips" , I will provide 8 rules that will help people understand their kidneys and manage their illness.
Dr. Prashant C Dheerendra, Senior Consultant Nephrologist, Apollo Hospitals, Bannerghatta Road, Bangalore.

I have noticed that people don't have an appreciation for what the kidneys do for our health. The kidney is probably the least understood organ. I will encourage everyone to learn more about their kidneys.

The internet is like "wild West" with very little control over the authenticity of information. Also, in our day to day life, everyone from neighbours to friends to relatives to even strangers are eager to dispense medical advice without being qualified to do so. I have seen hundreds of patients who have been harmed by such advice. For people with known kidney disease I will advise them to ONLY take advice from a qualified kidney specialist doctor("nephrologist").

The two most important causes of kidney failure in India are diabetes and high blood pressure. Almost 75% of people with kidney failure will have one or both of these diseases. Anyone with diabetes and/or high BP must get their kidneys checked at least once a year. Symptoms come very late in the course of kidney failure. If we wait for symptoms to show up then we may detect the disease very late. The good thing is that tests to detect are very simple and cheap. A urine test for protein leakage and a blood test for a chemical called "creatinine" (which the kidneys excrete from the body) are all that are needed to give a very good picture of the kidney's health.

The kidneys maintain the internal chemical balance in the body which all the organs need to function optimally. All the vital organs like the brain, heart, liver, lungs, etc depend on the kidney to maintain the balance in their own immediate environments. So, when the kidney fails, the functioning of all these vitals organs is affected. Just to give an example, the kidneys maintain the water balance in the body almost to the last drop. When this is compromised and water starts accumulating, the extra water can flood the lungs and lead to a life threatening situation ("pulmonary edema"). So, kidney health is the foundation of good health.

Chronic kidney disease(CKD) is the commonest kidney disease that is diagnosed. It basically means that the kidney is functioning less than optimal for a duration of more than three months. The disease generally progresses slowly and gives ample time to slow the progression and prepare for a productive life if the stage of kidney failure is reached.

We live in an age of too much information. Separating the signal from noise is almost impossible for the patients and their families. With so many investigations and tests being available, it's easy to become obsessed with them and lose sight of the main aspect -- the quality of life of the patient. The tests are very useful to the doctors to know where we stand and plan the long term treatment. But they should never be an end in themselves.

There is a deficit of trust in almost every sphere of life. It is disheartening to see patients change their doctors frequently in search of impossible cures. At the end of the day, like the name itself conveys, CKD is a chronic disease. It needs to be managed on an ongoing basis over years and even decades. Understanding the nature of the disease is critical. Otherwise, patients end up trying out many things from many doctors, systems of medicine, home remedies, etc. This will affect the long term outcomes adversely.

The ultimate aim is a patient with a good/acceptable quality of life. In the early stages of CKD, basic treatments like blood sugar and BP control, a few basic dietary modifications and regular follow-up with kidney specialist ("nephrologist") may be all that are needed. In the middle stages some more extra medications/dietary changes will be needed. In patients who have "kidney failure" advanced treatments like dialysis and/or kidney transplantation will be needed. At all stages, the quality of life of the patient is THE most important outcome which must be focussed on. With current treatments, most patients even with "kidney failure" can have an active and rewarding life for years and even decades. But only if the nature of disease is understood and one remains a few steps ahead of the disease.


So, these are the eight "meta" (from the Greek word "μετά" (meta), meaning "beyond") rules that I would advise everyone follows for their kidney health. Take care!