KIDNEYS:
Kidneys are two bean-shaped organs present on both sides of the body in front of the spine. Its primary function is to eliminate waste products from the body while regulating other functions like hormonal balance, electrolyte as well as acid base balance in the blood. At Nipro JMI Dialysis Centre Ltd., we provide treatment to patients with acute and chronic kidney failure. Acute kidney injury is an abrupt loss of kidney function that develops within 7 days. Chronic kidney disease or failure is a progressive loss of kidney function that sometimes occurs over many years.
FUNCTION OF KIDNEY (New Added)
• Excretion of metabolic waste products.
• Regulation of water and electrolyte balances
• Regulation of body fluid osmolarity and electrolyte concentration.
• Regulation of acid-base balance.
• Regulation of arterial blood pressure
• Secretion, metabolism and excretion of hormones
• Gluconeogenesis


RENAL FAILURE (New Added)
Renal failure refers to deterioration in renal function, which develops over a period of days, weeks or years.
There are 2 types of renal failure
- Acute renal failure/ Acute kidney injury
- Chronic renal failure/ Chronic kidney disease


ACUTE RENAL FAILURE (New Added)
ARF describes a sudden and usually reversible loss of renal function, which develops over days or weeks and is usually accompanied by a reduction in urine volume.

CAUSES OF ACUTE RENAL FAILURE (New Added)
• Glomerulonephritis
• Sepsis
• Severe fluid loss due to diarrhea, vomiting, burn
• Trauma
• Toxin like bee sting or wasp sting
• Drugs like NSAIDS etc.
• Obstructive uropathy


WHAT IS CHRONIC KIDNEY DISEASE (CKD) or End Stage Renal Disease (ESRD) ?
Chronic kidney disease is characterized by the inability of the kidney to function properly. The function of the kidney is to filter excess wastes & fluids in your body and eliminate them in urine. When the kidneys fail to function, these toxic wastes accumulate in the body. In the advanced stages, the need for dialysis and need of transplant arises, failing which, can cause the fatality.

WHAT ARE THE SIGNS/SYMPTOMS OF CKD ?
Some of the common symptoms of kidney disease are:
• Swelling of Feet/ face/ whole body: One of the most common symptoms of kidney failure is the swelling of feet. It is also followed by pain and swelling in joints.
• Weakness & Fatigue: Kidney disease is characterized by weakness and fatigue. Patients with kidney disease tend to exhaust themselves very quickly.
• Loss of appetite: Patients develop loss of appetite, which results in advanced weakness and nutritional deficiencies.
• Hypertension: Patients with kidney disease have high blood pressure. Usually, their blood pressure remains high despite the medications.
• Skin changes: The skin becomes dry which result in itchiness and scratchy skin.
• Change in Urination: You will notice changes in the frequency and amounts of urine, the colour, and smell. Sometimes pain while urinating or spotting blood can also be an indication of kidney damage.
Some other symptoms include:
• Nausea
• Vomiting
• Leg pain
• Sleep disturbances
• Cramps and muscle pain
• Shortness of breath


RISK FACTORS OF DEVELOPING KIDNEY DISEASE:
There are certain factors which considerably increase the risks of developing a chronic kidney disease. Some of them are:
• Diabetes
• Infection
• Hypertension
• Congenital diseases
• Genetic
• Obesity
• Smoking
Problems associated with KIDNEY DISEASE:
• Low immunity; patients with kidney disease have a very low immunity which makes them prone to infections.
• The retention of fluid in the body leads to the swelling in the arms and legs.
• Kidney disease can also cause pulmonary edema; the accumulation of fluid in lungs.
• Kidney disease potentially increases the risks of cardiovascular diseases.
• Low levels of calcium and hemoglobin in the body can result in weak bones and anaemia respectively.
• There is a sharp decline in the patient’s sex drive
• Acidosis
• Growth retardation in children
• Renal bone disease
• Lipid abnormalities
• Hyperkalemia

CAUSES OF CKD:
• Just like any other disease, the causes of kidney disease vary from person. Most often, kidney disease is a result of other lifestyle diseases. However, in some cases, the causes of a kidney disease are other primary kidney diseases.Some of the main causes of kidney disease are:
1. Diabetes
• According to research and statistics, people with high levels of diabetes are the most likely to develop kidney diseases. Diabetic Nephropathy is a complication caused by both Type1 and Type 2 diabetes.
• 2. Hypertension
• One of the most common causes of kidney disease is hypertension. Elevated levels of blood pressure can result in various kidney problems.
• 3. Glomerulonephritis
• Glomerulonephritis is a medical condition characterized by the inflammation of glomeruli. Glomeruli are the filtering units of kidney whose damage and infection can result in kidney diseases.
• 4. Cysts and other Congenital dieases
• Polycystic kidney disease is a medical condition characterized by the formation of cysts in either or both the kidneys. Mainly, it is hereditary.
• 5. Kidney Stones
• The presence of kidney stones can result in kidney diseases. These stone obstruct the flow of urine, thereby leading to failure.
• 6. Infection
• Kidney diseases can also be a result of recurring kidney infections, or conditions like HIV, sickle cell disease, etc.
• 7. Abnormally Shaped Kidneys
• Sometimes, kidney diseases are also caused by abnormally shaped kidneys. For instance, a person whose kidneys are shrunken since birth is more likely to develop a chronic kidney disease
• in the future.


STAGES OF CHRONIC KIDNEY DISEASE (New Added)

STAGE DESCRIPTION GFR (ml/min/1.73 m2)
1. Mild CKD >90
2. Mild to moderate CKD 60-89
3. Moderate CKD 30-59
4. Severe CKD 15-29
5. ESRD <15

INVESTIGATIONS FOR A PATIENT WITH ESRD (New Added)
* Complete Blood Count with Iron profile, serum folate, vit B12
* Serum Electrolytes
* Calcium, phosphate, Parathyroid Hormone
* Urea, Creatinine
* e GFR
* Lipid, Glucose +/- HbA1c
* Albumin
* Urinanalysis and quantification of proteinuria
* Renal ultrasound
* Hepatitis and HIV serology
* ECG
* Echocardiography


HOW TO PREVENT KIDNEY DISEASE?
There are no rules regarding prevention, but maintaining a disciplined life, one can stay away from few causes of developing CKD. For e.g.
• Regulating diabetes and hypertension since people with diabetes and high blood pressure are the most likely to develop a chronic kidney disease in the future.
• Going for an annual check-up.
• Staying fit by exercising daily and opting for a healthier lifestyle.
• Taking the symptoms seriously: most of the patients do not experience any severe symptoms until the end stage. Thereby, it is very important to take any noticeable symptom seriously.
Consult your doctor immediately if you have any signs or symptoms of kidney disease.
WHEN DOES A PATIENT REQUIRE DIALYSIS?
Around the end stage of chronic kidney stage, the kidneys cease to function without an external support. Levels of creatinine increase considerably. The body refuses to manage with only medications. There is also a sharp increase in the levels of other toxins in your body. To flush these toxins out, a dialysis is required.

MANAGEMENT/ AIM OF TREATMENT
• Diagnosis and treatment of reversible causes
• Slow the progress of renal damage
• Minimizes cardiovascular risk
• B.P control slows the rate of progression of renal damage and minimizes cardiovascular risk
• Control dyslipidemia
• Identify and treat complications
• Prevention of symptoms
• Start planning and education for dialysis or conservative care.
• Start planning and education for transplantation if appropriate.


PREPARATION FOR DIALYSIS
1. If the creatinine levels in your body do not go down, consult your nephrologist and he will ask you to prepare for dialysis.
2. Before the first dialysis, a vascular access will be placed under your skin to get a good access to your bloodstream. The VA will allow the blood to flow to and fro the dialysis machine at a good speed, owing to which more and more toxins, wastes, & extra fluids can be eliminated from your body.
3. The implant of a fistula or graft will require a small surgical process.
4. The process requires less time and you can be discharged on the same day itself.
5. A local anesthesia will be administered before the procedure.
6. The duration between your surgery and first dialysis will be decided by your doctor.
7. Talk to your doctor about the medicines that you should take after dialysis.
8. Follow the diet chart prepared for you by your dietician and doctor.

COMMON RISKS ASSOCIATED WITH DIALYSIS
Although dialysis is a lifesaver for people with chronic kidney disease, it has its own risks. Some common risks of dialysis include:
1. High potassium levels
2. Anaemia of lack of haemoglobin in blood
3. Low blood pressure
4. Muscle cramps and twitch
5. Cardiac arrest
6. Sleep disturbances
7. Fever and sepsis
8. Blood-borne Infection
9. Difficulty in breathing
10. Increased levels of potassium
11. Dryness of skin and itching

Continuing life while on Dialysis

With the procedure of dialysis becoming more advanced over time and people beginning the process earlier in life, a number of people have been able to pursuing schooling, stable work lives while on dialysis. Maintaining a career is crucial to attaining some level of normalcy, which in turn has a positive effect on your medical condition as well.
Going back to work can help take your mind off of all your medical problems because obsessing over your illness will only make you feel worse. The income is also an added advantage as it will help you meet your medical expenses, which contributes towards boosting your self-worth. It will reduce the feeling of being helpless and dependent on others, a feeling that plagues many patients.
Certain factors must be considered carefully before you make the decision to resume work post-dialysis. You must make sure that your work and dialysis schedule are well coordinated, and one does not affect the other
Another important component of having a professional life while on dialysis is discussing your condition with employers and colleagues. You must make it clear that there will be times when you will be able not to make it to work, which is completely normal as all employees take sick leaves, but yours will be more frequent, and that needs to be understood by your employer. However, with a proper plan and the support of your team, you can make it work, without compromising on your daily tasks.
There are several ways in which you can maintain a career while on dialysis. You can also consider part-time work or the work from home option for your convenience. It is important to put your health first. However, that doesn’t mean you forgo your career. All you need to do is find the right balance between your health and your work.
What are the precautions one must take after dialysis?
• Your specialist will prescribe medicines, which must be taken as directed and on time. These medicines are mainly vitamins to enhance your health.
• Follow a proper diet. Your doctor can help you with a correct diet chart with all the necessary food changes.
• Follow the amounts of fluids you are prescribed. And remember, ice cubes or ice chips are also fluids.
• Don’t smoke. It can worsen your condition. If you need help quitting, talk to your doctor today.
• Don’t take medications without your doctor’s permission.
• Check your fistula or graft after 6-7 hours post-dialysis. You can then remove the bandage. You must clean the area every day with mild soap and water. Also, always check if you are bleeding. If you feel a thrilling sensation, it is an indication that it is working, so don’t panic. If you ever notice redness, bleeding, or swelling, talk to your doctor immediately.

Diet While on Dialysis
Healthy and nutritious diet can make a difference in your treatments and also, the way you feel. However, dietary requirements of those with early stages of kidney disease will be different from those with kidney failure, or end-stage renal disease (ESRD). If you suffer from any kind of kidney disease, your doctor will determine the best diet for your individual needs, which will help minimize waste content in the blood. The diet is known as a renal diet and helps maintain kidney functioning while preventing further damage.
While all dietary restrictions vary, certain aspects are common to all patients. This includes avoiding sodium, potassium, and phosphorus as the damaged kidneys are not able to filter it.Some people with kidney disease are asked to avoid protein, however, those with ESRD, undergoing dialysis, have greater protein needs than other kidney disease patients.
The following foods are said to be beneficial for people suffering from kidney diseases;
Cauliflower: It provides vitamins C, K and also anti-inflammatory compounds like insoles.
Blueberries: They are rich in antioxidants like anthocyanin, which protect against heart disease, certain cancers, and cognitive decline.
Sea Bass: It has lower phosphorus content than other seafood options, and is high in omega-3s, which helps reduce the possibilities of metabolic issues, hence, facilitating kidney functions.
Red Grapes: They contain the antioxidant flavonoids and Resveratrol, which helps protect your body from harmful free radicals which can also affect kidney functions.
Egg-whites: They are high in kidney-friendly protein, and do not contain the amount of phosphorous that yolks do.
Garlic: It is a good alternative to salt, which is high in sodium and can provide manganese and vitamin B6.
There are also numerous food items that patients with kidney disease are told to avoid for good health;
Bananas: They are excessively high in potassium content, and should be avoided, as should many other tropical fruits.
Dairy products: For those with kidney disease, dairy products, which are rich in phosphorus and potassium, can be detrimental to bone health, as a phosphorus build-up can cause thinning and weakening of bones over time.
Processed Meats: In addition to being unhealthy for their high preservative content, processed meats also contain excess salt to preserve their taste and flavor, which cannot be processed by damaged kidneys.
Dates, Raisins, and Prunes: When fruits are dried, their nutrition content is concentrated with potassium, which is harmful to good renal health.
Managing potassium, phosphorus and sodium intake is the most crucial part of a renal diet. While this may feel restrictive at times, working on developing a schedule with your doctor can help design a diet that works for your individual needs and preferences.

GOOD MEALS WITH KIDNEY DISEASE
It is important to follow your diet for the control of kidney disease. The food you eat will greatly affect the success of your treatment. One of the main functions of the kidney is to get rid of waste products and fluid. Since your kidneys have lost part or most of this ability, certain items in your diet must be controlled so that they or their waste products do not build up in your blood. These items include protein, sodium, potassium, phosphorus and fluid. However these are needed for healthy tissue. Hence, your diet includes these five nutrients, but in appropriate amounts.

PROTEIN
Protein is the basic building block of living cells. Protein is needed for building and repair body tissues. There are two aspects to protein-restriction in the diet-quantity and quality.
1. Quantity – The amount of protein should be enough A maintain vital body functions. On the other hand, the amount should not be too high, as the excess will result in increased wasate products in the blood.
2. Quality – It is equally important that the correct type of protein is taken. There are two types: complete and incomplete.
• Complete proteins are almost totally used by the body and very little waste is left. These proteins usually come from animal sources such as meat, poultry, fish, egg, milk and cheese.
• Incomplete proteins are found in plant products such as dhals, grams, lentils, vegetables, nuts, wheat and rice. Ideally your diet should contain about 65-75% of complete protein to maintain muscle mass and prevent wasting.

POTASSIUM
Normal blood potassium is 3.8-4.9 mmol/dl. If your blood potassium goes too high, you must limit foods that are high in potassium.
Leaching potassium from vegetables:
– Cut vegetables into small pieces. Soak in water for 1-2 hours and discard the soaking water before cooking.
– Alternatively, cook vegetables in large quantity of water and discard the cooking water before cooking. Do not use a microwave or steamer to cook vegetables. More potassium can be removed if the vegetables are boiled.
• Cooked fruit and vegetables are usually lower in potassium than raw ones.
• Canned fruit is also lower potassium than raw ones but the juice must be discarded.

SODIUM
You may be advised by your doctor to reduce sodium intake if you have high blood pressure, Congestive heart failure or kidney disease. Some of the sodium in your diet occurs naturally in foods and the rest comes from salt added to foods when cooking or processing.
Simple steps in cutting down salt-
Here are some general rules to keep the sodium intake within the recommended guidelines-
– Cut down on convenience foods – many processed and convenience foods are high in sodium
– Limit the salt used in cooking and do not add salt at the table.
– Oct herbs and spices to enhance the flavour of foods in place of salt. For example, a dash of lime, garlic, Onions, vinegar, nutmeg, bay leaf, dry chilies, mustard seeds, pepper, turmeric, Coriander, cinnamon, etc.
– Avoid or limit the following foods, which contain a high amount of sodium: Bacon, ham, baked foods, salted nuts, canned foods, papads, bottled sauces, processed meats, pickles, cheese, dry fish, salt preserved meat, monosodium glutamate (MSG)
Salt substitutes may contain potassium salts which are contraindicated for patients with kidney problems. Consult your dietitian before using the product.

FLUID
The amount of weight gain between dialysis sessions indicates whether you are following your fluid Allowance guidelines. Anything that is liquid at room temperature is considered a liquid ice-Cream, Ice cubes, and jelly.
The amount of fluid allowed in the diet varies from person to person and depends on your urine output. The usual guideline is 500m1+ the previous 24 hours urine output volume.
Tips for controlling your fluid intake:
• Measure your fluid allowance every morning in a special jug. Every time you eat or drink a
• fluid, empty the same amount from the jug. Once it is empty, you have finished the
• day’s allowance.
• Use small cups for beverages
• Rinse your mouth with water, but do not swallow it.
• Such on ice cubes rather than drink water
• Suck on hard candy, mints or chewing gums to keep your mouth moist.
• Add a squeeze of lemon juice in your ice cubes to quench your thirst.

PHOSPHORUS
Normal phosphorus level in blood is 2.7 — 4.5 mg/dl
Since phosphorus is found in so many foods, it is difficult to limit in the diet.
Foods high in phosphorus are:
Liver, fish bones, dairy products, nuts and seeds, cola drinks, beer, lentils, dhals, beans, whole grains, bran, Atta (whole wheat flour), oat bran, chocolate, baking powder.
In most cases, medications are used to help control phosphorus levels. Your phosphorus binding medication should be taken with meals, especially when you are eating meat or dairy products.

ENERGY- CALORIES
If you are underweight, you may need to add energy to your diet. The three nutrients which supply energy (Calories) are protein, fat and carbohydrate. If there are not enough calories in the diet, body proteins may breakdown to provide energy, causing weight loss and muscle loss. You can add extra energy to your Diet by adding more fats/sugars to the foods you eat. Avoid sweet items if you have diabetes!
8 GOLDEN RULES-Diet
• Keep fit, be active
• Eat a healthy diet
• Check and control blood sugar
• Check and control blood pressure
• Appropriate fluid intake
• Don’t smoke
• Don’t take over-the-counter anti-inflammatory drugs
• Regular screening of kidney function