All About the Kidneys – Functions, Disorders, Treatments

What Is Nephrology?

Nephrology is the specialty that deals with the kidneys and their disorders. It is a super specialty department. A doctor who has passed his/her basic MBBS degree should first specialize in INTERNAL MEDICINE that is a 3-year program and then should further study for 3 years about kidneys and managing kidney diseases medically.

A doctor who has specialized in this subject is called a NEPHROLOGIST – because the basic functional unit of the kidneys are called NEPHRONS.

What Are Kidneys and What Are Their Functions?

Kidneys are two wonderful organs that are located below the rib cage on either side of the spine. They function primarily in removing waste products from the blood and excreting them as urine. Other important functions include maintaining blood pressure, producing hormones like vitamin D3 (thereby controlling the calcium balance) and erythropoietin (that helps in the production of hemoglobin) and maintaining acid-base and electrolyte concentration in the blood.

What Are the Signs of Kidney Diseases?

• Low urine output
• Very frequent urination at night
• Blood in the urine
• Painful urination
• Swelling of the legs
• High blood pressure
• Lack of appetite, vomiting and breathlessness

Common Kidney Problems

• Urinary Tract Infection – This is one of the common problems. The site of infection could be the kidneys, bladder, urethra or prostate (in men). It could be a bacterial infection commonly and is common in women.
• Kidney Failure – This could be temporary called acute kidney failure or permanent referred to as chronic kidney disease. Common causes of temporary kidney failure include vomiting, diarrhea, infections, certain drugs, heart failure, liver failure, kidney-specific diseases, obstructed urinary passage, etc.Long-standing diabetes and hypertension are the main reasons for almost 70% of permanent kidney failure.The severity of these kidney failures could be mild, moderate or severe. The initial stages of kidney failure can be managed with appropriate medications and diet control. Once the kidney failure becomes advanced, the patient needs DIALYSIS.In the case of acute kidney failure, dialysis is temporary whereas it is permanent in chronic kidney failure.
• Nephritis – A group of diseases that are kidney specific. Sometimes, the disease that is causing nephritis can also affect other organs in the body. Commonly, infections and auto-immune diseases are causes.
• Congenital Diseases of the Kidneys – Polycystic diseases, structural abnormalities of the urinary tract, tubular diseases and Alport syndrome are a few examples.

What Are the Types of Dialysis Available?

Hemodialysis

It is a procedure where a patient visits the hospital 2-3 times a week and is connected to the dialysis machine. His blood is removed from his body, purified and sent back. Each dialysis session is for 4-5 hours.

Peritoneal Dialysis

It is done by placing a catheter in the abdomen through which the dialysis fluid is sent inside the abdomen (peritoneal cavity) and the purification happens inside the abdomen. This fluid needs to be changed at the end of 4-6 hours and 3-4 times this exchange process has to be done. The advantage is that it is a home-based procedure and can be done by the patient or by his/her relatives. The elderly with heart diseases, children and those who travel are best suited for this type of dialysis.

CRRT or Continuous Renal Replacement Therapy

It is a type of dialysis done in the intensive care unit for patients with severe kidney failure. Patients are critically ill with unstable blood pressure and they can be dialysed at the bedside even 24 hours a day.

What Is Kidney Transplantation and How Is It Different from Other Surgeries?

When the kidneys fail permanently (an advanced stage), kidney transplantation is performed. One kidney is sufficient to perform all its functions. So, a live donor who is a near relative of the patient donates one of his/her kidneys.

Since our immune system is programmed to reject anything that is a foreign tissue, the transplanted kidney is likely to get rejected. To prevent this from happening, the patient should take immune suppressive medications that prevent the kidney from getting rejected. But this carries a risk of infection too.

Cadaver transplantation is performed when a “braindead” victim’s organs are harvested. Apart from the kidneys, heart, liver, lungs, pancreas, skin and intestines too can be transplanted.

ABO (blood group) incompatible transplants can also be performed with the expanded knowledge of transplant immunology, availability of advanced testing facilities and immune suppressive medications.

What Should We Do to Protect Our Kidneys?

• If any warning signs of kidney diseases, do approach the nephrologist
• Lifestyle changes – so that we don’t pick up diabetes or hypertension
• Don’t self-medicate yourself
• Drink adequate water
• Void urine frequently
• Get your kidney functions checked annually