Acute Kidney Injury is the sudden onset kidney impairment occurring over hours to days.
- AKI if treated early will recover in most cases.
- Severe AKI may need dialysis support, which may be stopped once kidneys recover.
- AKI may result in permanent kidney impairment especially if untreated or inadequately treated.
- AKI needs specialist care and careful monitoring by a Nephrologist.
- Dehydration, some infections, certain drugs (especially pain killers), kidney specific diseases (Acute Interstitial Nephritis and Acute Glomerulonephritis) and herbal medicines can cause AKI.
- Consuming leaf juices or vegetable juices has also been associated with AKI.
What is Chronic Kidney Disease (CKD)?
Chronic Kidney Disease is a slow onset progressive kidney impairment occurring over months to years. CKD manifests with symptoms late. So, frequently patients present to doctors in the later stages of the disease. In fact, nearly 50% of patients with CKD get to know their kidney disease when they reach the terminal stage.
The most common causes of CKD worldwide are Diabetes and hypertension. These two diseases contribute to nearly 50% of kidney disease worldwide.
Other causes include glomerulonephritis, interstitial nephritis, congenital kidney and urinary tract abnormalities, chronic kidney disease of unknown origin, also called as CKDu.
CKD affects roughly 10% of our population. Identifying it early helps slow the disease, delaying the need for dialysis or a kidney transplant by several years.
We now have several new drugs that help reduce the progression of kidney disease.
How do we combat CKD?
Screening for kidney disease:
Individuals with an age of more than 50 years, hypertension diabetes, A family history of kidney disease, patients who have heart disease should have their serum creatinine and urine protein checked at least once a year.
Effective treatment of co-morbid illnesses:
- Patients who have diabetes should control their HbA1C to 7% (7.5% if elderly).
- Patients who have hypertension should control their BP to 130/80 or less.
Avoid Kidney-Toxic Meds:
Avoid over the counter pain killers, herbal medications and illicit drug use. Avoid excessive protein supplements and nutraceuticals.
What is dialysis?
Dialysis is a blood purification procedure used in patients with advanced kidney impairment to remove toxins built up in blood due to kidney failure. Several patients maintain their normal life activities and attend regular jobs with the help of dialysis.
How does Dialysis work
Dialysis is of 2 types. Hemodialysis and peritoneal dialysis.
Hemodialysis:
In hemodialysis blood from the patient goes into a machine and gets filtered through a dialysis filter. The filtered blood is returned to the patient.
Hemodialysis session usually lasts 4 hours and is done two to three times a week.
Hemodialysis is a painless procedure.
The procedure helps you maintain an active life style.
Peritoneal Dialysis:
Peritoneal dialysis involves a special solution which is sent into the abdomen through a peritoneal dialysis catheter (CAPD Catheter). The peritoneal membrane present naturally in the abdomen serves as a filter and pushes toxins into the dialysis fluid.
Peritoneal dialysis involves a special solution which is sent into the abdomen through a peritoneal dialysis catheter (CAPD Catheter). The peritoneal membrane present naturally in the abdomen serves as a filter and pushes toxins into the dialysis fluid.
Peritoneal dialysis can be done by the patient or caregiver at home after undergoing basic training.
Which Dialysis modality is better?
Both hemodialysis and peritoneal dialysis (CAPD) are good options. Based on the patient’s overall health, ability to perform CAPD exchanges, heart health and care-giver availability, the modality is chosen by the Nephrologist after discussing pro and cons of both these procedures.
What is kidney transplantation?
Single functioning kidney is transplanted from a suitable donor into a compatible recipient. The new kidney serves the patient and when successful, the patient will no longer require regular dialysis.
Kidney transplantation is the best treatment for kidney failure. It offers the best longevity of life and a vastly better quality of life compared to hemodialysis or peritoneal dialysis.
It is of two types.
Live Related Kidney Transplant
B. Deceased Donor Kidney Transplant
Live related kidney transplantation involves a genetically related donor from family or an extended family. The process involves genetic matching to ensure compatibility between the two individuals. The outcomes are usually good in a live related transplant, with successful outcomes of up to 90% at the end of one year.
A deceased donor transplantation involves a kidney donated from a person who suffered a brain death, while other organs keep functioning for few more hours. This involves state/national registries with organs being allotted according to the seniority of waiting along with several other parameters. A deceased donor transplant also has a reasonably good outcome in most cases, but slightly less successful than a matched live related donor transplantation.
It is important to note that both these types of kidney transplants offer greater longevity and quality of life than being on dialysis.