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This is the slogan of this year’s World Kidney Day, which is celebrated every second Thursday in March, this year on March 14. Over 600 million people in the world, and over 4 million in Poland, have damaged kidneys. Most of these patients die prematurely without having a transplant or dialysis treatment. The situation may be improved by prophylactic examinations, which facilitate earlier detection of kidney disease. These problems were discussed at the Nephrology Conference, which took place during the Polish Kidney Day – March 8 in Warsaw.
The kidneys play several important roles in the body. They take care of homeostasis, i.e. the stability of water and electrolyte balance, and also have cleansing functions. The kidneys secrete important hormones such as vitamin D and erythropoietin, which stimulate the production of red cells. Due to these and other functions, it is a vital organ.
Asymptomatic kidney disease
The kidneys don’t hurt, with the possible exception of pyelonephritis or kidney colic caused by urolithiasis. These ailments probably underlie the name that was used to describe the kidneys in the Old Polish language: twisted pairs, because the patients literally twisted with pain. However, these kidney diseases are now successfully treated and rarely lead to extreme kidney failure. The most serious diseases of these organs that leave a mark in the form of acute kidney damage do not hurt and develop insidiously. That is why they are dangerous.
– We distinguish between acute kidney disease and chronic disease. Chronic nephritis, requiring treatment with an artificial kidney, is three times less common than acute kidney injury. The latter disease is diagnosed in every third patient admitted to the nephrology department – he explains prof. dr hab. n. with. Ryszard Gellert, head of the Nephrology Clinic of the Medical Center of Postgraduate Education. – Five percent of patients with acute kidney damage are hospitalized for complications from bronchitis or inflammation of the urinary tract. In such a situation, appropriate antibiotics are given – and after 2 weeks it seems that everything is fine. However, just in case, the doctor orders a urine check and it turns out that there is glucose in the urine. How did she get there? After all, the sick person does not have diabetes. In the next test, there is no sugar in the urine, and the first result is most often considered a laboratory error. Mostly wrong, because the first result revealed acute kidney damage that had just been done.
Acute kidney damage
Acute kidney damage can be a complication of certain chronic diseases, especially so-called civilizations that develop most often in old age. Type 2 diabetes, hypertension, heart disease, and obesity are responsible for half of the cases of renal failure in adults requiring treatment with an artificial kidney and transplant. There is a feedback loop between kidney damage and heart disease, one of which leads to the other, and vice versa. Kidney disease increases the risk of cardiovascular disease several times or can significantly worsen its course. In turn, many years of heart failure become the cause of kidney damage over time.
The older the age group, the more common such cases occur. Until recently, medical textbooks wrote that acute kidney damage is a reversible pathological condition. Now it turns out that not always. Only in 2/3 of cases the initial renal function returns. The remaining survivors of this episode end up on dialysis sooner or later and require very expensive specialist treatment. Many of them die prematurely without waiting for these treatments to be applied.
“The problem of acute kidney damage is growing rapidly,” he says prof. Richard gellert The population is aging, and many people with cardiac problems also have kidney problems. Only they are not recognized, because there are no clear signals from the body – the kidneys do not hurt. All of this is compounded by the side effects of drugs and diagnostic procedures that use contrast (coronary angiography, computed tomography, etc.) to harm the kidneys. These treatments are safe for the whole body, but not for the kidneys. Many drugs are very harmful to the kidneys, which is all the more worrying as they can also be bought over the counter. These are mainly non-steroidal anti-inflammatory drugs, taken in large amounts by the elderly due to osteoarticular ailments. They help, reduce pain, heal inflammation, allow the elderly to live an active life, but they harm the kidneys because they reduce the blood flow through the glomeruli. Therefore, you should take these drugs in reasonable amounts and only when absolutely necessary.
Diagnosis of acute kidney injury
We have a tool at our fingertips that can improve the detection of acute kidney injury. It is enough to do a simple basic examination – general urinalysis to detect possible abnormalities in the work of the kidneys. This is indicated by the presence of protein, blood, granular rollers in the urine. The rollers are usually a sign of glomerular disease. Even if the results of the general urinalysis are normal, nephrologists recommend periodic monitoring of the blood creatinine concentration (this is a product of muscle metabolism). The normal serum creatinine level is 62-124 umol (0,7-1,4 mg /%). If your creatinine level is higher than normal, this may be a sign of severe kidney disease. The Polish Society of Nephrology recommends that every healthy adult should perform a general urine and creatinine test once a year. For people suffering from hypertension or diabetes, these tests are mandatory. The above preventive examinations should also be remembered by those who have relatives suffering from diabetes, hypertension or already diagnosed kidney disease. Of course, by treating your diabetes carefully, you can prevent nephropathy. However, despite the lack of symptoms, the kidneys should be actively checked by urinating for analysis. If the treatment causes the pressure to normalize and the sugar level to balance, preventive examinations can be performed less frequently. Just as we periodically examine the breasts in women, and the prostate in men, the work of the kidneys should also be monitored.
How to care for the kidneys
The cause of acute renal failure is often inadequate hydration, either as a result of too little drinking or, for example, as a result of vomiting, diarrhea, fever or massive haemorrhage.
“We forget about the kidneys,” he says prof. Richard Gellert – because it is a deeply hidden organ belonging to the excretory system, which we do not like to deal with. We even avoid drinking liquids so as not to go to the toilet in inconvenient situations. Meanwhile, too little drinking is a serious offense against the kidneys, which, like any other organ, do not like to be overloaded with work and have a certain resistance to harmful factors. If we don’t supply them with enough fluid, the kidneys have to work harder to filter what needs to be excreted from what needs to remain in the body. Moreover, metabolic waste products that are too concentrated can build up in the kidneys in the form of stones.
The kidneys are harmed by salt, which we consume too much. In order to flush the salt out of the body, we need water. Water is needed to flush out high levels of phosphate in food. Meanwhile, we drink too little of it. The daily norm of drinks is 2-3 liters, while men should drink more than women. You should also be aware that the recommended amount of fluid varies depending on the situation. We definitely need to drink more at high air temperature, during physical work or intensive sports. Children and the elderly, in particular, who have a significantly reduced feeling of thirst, drink too little. Therefore, they are primarily at risk of kidney damage. You should not wait for the feeling of thirst, but drink fluids throughout the day, guided by the rationale. In fact, thirst is already a signal of dehydration. We stay well hydrated as long as we do not allow ourselves to be thirsty. Our kidneys are eagerly waiting for water to help them work. That is why we should make sure to drink a lot and, as a consequence, pee a lot – he emphasizes prof. Richard Gellert. The prophylaxis of acute kidney damage also includes testing of creatinine levels before a planned medical procedure with the use of contrast media. This is already commonly required today. It is checked whether the kidneys are working well, because if they already have reduced efficiency, the risk of even greater damage is very high. Modern lifestyle with many hours of sitting, eating concentrated energy and drinking too little – is conducive to kidney disease.
World Kidney Day
Kidney Day similarly to the Day of the Heart or other special days devoted to health, they primarily pursue an educational goal. A strong message will be sent out to the world about the increasing number of patients with damaged kidneys, about the need to deal with this problem, about the need to provide patients with preventive examinations and appropriate medications.
– We want to talk about kidneys to the public, to politicians, administrators, insurers and all non-medics, but we also address doctors who are not nephrologists, especially general practitioners – summarizes prof. Richard Gellert – We want to tell them: there is a problem with the kidneys, if we do not start solving it, we will have to pay for it in a few years. The number of dialysis patients in Poland is already very large, e.g. because we “produce” them ourselves. If a patient goes to a nephrologist with newly diagnosed advanced kidney disease, it means that his kidneys have not been controlled for many years, and that the doctor has not referred him for a urine test for many years. After that, it is too late, the kidneys do not grow back, and the patient may not live to the point where he could be saved by dialysis or a transplant. Patients after acute kidney damage die prematurely of various other diseases associated with kidney diseases. Therefore, we want to sensitize GPs to this problem. Examine your patients’ urine. Avoid chronic kidney damage.
Text: Barbara Skrzypińska based on an interview with prof. Richard Gellert.