Copping with Kidney Disease - 3 March, 2002  Panorama

Statistics show that kidney failure is on the rise. These unfortunate people diagnosed with this silent disease will now depend on a machine to keep them alive. It completely changes their life style. It's very hard to accept in the beginning but they eventually realize they have no choice.

The kidneys are two bean-shaped organs located on either side of the spine under the lower ribs. They remove waste and excess water from the blood by running it through tiny filtering units called nephrons.

Normal kidneys filter a fifth of your blood, about a liter, every minute and send the waste to your bladder. They are so efficient that one kidney can take over the whole workload if the other one is damaged or removed. While kidneys can stop working because of physical injury or damage from drug abuse,, the problem is usually a gradual decline in function. Kidney function declines with age, losing about a tenth of their efficiency each decade after the age of 40 or 50.

Kidney disease is a silent illness. It doesn't really show its face until kidney function is about 10 per cent of normal. Older people are more at risk as the two biggest causes of kidney disease, diabetes and cardiovascular disease, are on the rise among the aging population. Diabetes accounts for about a third of all new cases of kidney failure because high blood sugar levels damage the delicate blood vessels in the kidneys' filters.

Hypertension, a cardiovascular disease, is the most common and most potent aggravating factor for kidney disease. Older people are also more likely to get hardening of the kidneys' blood vessels, simi lar to the build up of plaque that leads to heart disease.

Preventing kidney disease
Preventing kidney disease means preventing diabetes, hypertension and cardiovascular problems. And that means a balanced diet with lots of fruits and vegetables, controlling your weight and getting regular exercise. In the early stages of kidney disease, the right diet, medication and blood pressure control can slow the damage, but catching it early is not easy.

You may be at risk if you have swelling in the hands and feet, blood in the urine or trouble urinating. Most often though, it shows up in a urine or blood test. If kidneys are functioning at less than 20 per cent, the only treatments are dialysis or transplant.

Types of treatment
The methods of treatments currently available in well-equipped hospitals, are haemodialysis in which a machine filters the blood and returns it to the body, and peritoneal dialysis in which blood is filtered via a permanent catheter inserted into the membrane lining of the abdominal cavity. Patients can be trained to do peritoneal dialysis themselves, at home.

Transplant option
While dialysis keeps patients alive, transplantation is best because it gives them back a normal life. After transplants, patients have wider food choices and more energy. But there's a lack of donors. Transplanted kidneys can be from living donors, either family members or close relatives, and from donors who have died. Live donations have the highest rate of success because they're usually a Treatment is only part of the story. Healthy kidneys eliminate waste and regulate important chemicals. When they fail, it's important to control those substances through diet. Among those to watch are:

- Protein: Highest in meat, fish and poultry, protein creates a byproduct called urea, which can further damage kidneys if it builds up in the bloodstream. However, patients who go on dialysis often increase protein to compensate for losses caused by the process.

- Phosphorous: Found in proteins and cola drinks. This is damaging to the kidneys in higher concentrations.

- Potassium: Found in bananas, oranges, melons, dried fruit, potatoes, all tomato products, all legumes such as beans, whole wheat bread and cereals. Also found in strong coffee, molasses and chocolate. It is important to control potassium levels especially in the later stages of kidney failure.

- Fluids: It's important to regulate fluid intake in the later stages of kidney failure.

- Renal diet can be a tough diet to follow. The main impact depends on what people were used to eating before they got sick.