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To assess the condition of the kidneys, it is enough to perform literally two simple tests once a year. In this way, dangerous changes can be detected at an early stage and the process stopped. The problem is, we usually forget about the kidneys. First of all, because they remain unnoticed for a long time – even when their condition is really bad. Experts explain how to care for the kidneys.
Why are the kidneys important?
The kidneys are one of those organs whose importance is usually underestimated. While we are relatively eager to check, for example, the condition of our heart or liver, the kidneys are at the bottom of the diagnostic list. This is a serious mistake, because the kidneys play an extremely important role in the proper functioning of the entire body.
The most important task of the kidneys is to cleanse the body of metabolic products – says prof. Magdalena Krajewska – vice-president of the Polish Nephrology Society and member of the coalition for Chronic Kidney Disease. – The kidneys also regulate the water and electrolyte balance, remove excess electrolytes and water, and ensure proper blood pressure. They also have a secretory function and are responsible for the production of many hormones, including erythropoietin. If they do not function properly, severe metabolic and clinical disorders occur and renal replacement therapy is required.
Chronic Kidney Disease. It shows no symptoms for a long time, destroying them silently
When we do not pay attention to our kidneys, chronic conditions can develop in them without any specific symptoms. And these, unlike acute conditions, lead to permanent damage. Over time, you will need dialysis or a transplant. Chronic Kidney Disease can develop virtually anyone.
The most common causes are civilization diseases. Diabetes comes first, and it goes hand in hand with the second culprit – hypertension. The third place is glomerulonephritis. In the fourth – chronic interstitial nephritis, which is most often caused by urolithiasis or recurrent urinary tract infections. The fifth most common cause is a genetically determined disease – polycystic kidney disease – enumerates prof. Beata Naumnik – Head of the Nephrology and Transplantology Clinic with the Dialysis Center, Medical University of Białystok and member of the coalition for Chronic Kidney Disease.
Chronic Kidney Disease does not produce symptoms for a long time, or the symptoms are so subtle that it is easy to overlook or ignore them.
CKD in the initial stages may be sparse or even asymptomatic, which means that we often diagnose the disease only at an advanced stage, when the treatment options are very limited – says Prof. Krajewska. – Unfortunately, there is currently no CKD detection program in Poland, although simple tests – such as general urine tests and serum creatinine measurements – allow for early diagnosis. GPs should be able to measure the concentration of albumin in the urine. The sooner the disease is detected, the greater the chances of slowing progression. I encourage you to perform tests – this way we can save the kidneys.
Once Chronic Kidney Disease takes shape, the damage to your body becomes very serious.
Depending on the cause and severity of chronic kidney disease (CKD), symptoms appear that affect virtually all organs and systems. Patients complain of weakness, decreased exercise tolerance, impaired concentration and memory and sexual function, nausea and vomiting, dry and itchy skin. There are anemia, arterial hypertension, heart rhythm disturbances, gastrointestinal bleeding, disturbances of the nervous system with symptoms of neuropathy and convulsions. There is hyperhydration, electrolyte disturbances with an increased amount of potassium – hyperkalemia, renal osteodystrophy and malnutrition develop. The risk of developing heart and vascular disease increases. The quality of life of patients is significantly reduced – emphasizes prof. Krajewska.
Chronic Kidney Disease – stages of the disease. Beyond the second stage it is very serious
CKD is divided into five stages, which are based on the analysis of the eGFR value (measured during a blood creatinine test). If the eGFR is higher than 60, it can be said that the patient is still on the “safe side”.
CKD advancement classification has five levels and is based on the eGFR value, explains Prof. Naumnik. – Everyone should know this acronym. It is calculated from the blood creatinine concentration and is done by every laboratory. EGFR is an estimated glomerular filtration rate that tells us how our kidneys filter. If our eGFR is above 90, that’s very good. But be careful, because some diseases, such as diabetes, are associated with hyperfiltration. The second degree of CKD is when the eGFR is between 90 and 60. Above 60, we are still on the safe side. If it drops below 60, we are already talking about serious damage to the kidneys. The third stage is divided into stages 3a and 3b. For a nephrologist, from 60 to 45 means that the renal parenchyma is severely damaged, but there may not yet be obvious symptoms of self-poisoning of the body, i.e. uremia. From 45 to 30, i.e. in stage 3b, the matter becomes more complicated, there are obvious symptoms of kidney failure, e.g. anemia. The fourth stage is eGFR between 30 and 15. Then the patient is slowly getting ready for renal replacement therapy techniques. Below 15 we are already thinking about it firmly – we are starting to create an arteriovenous fistula needed as a vascular access for hemodialysis, we prepare the patient for pre-transplant, i.e. one that will take place before the patient enters dialysis therapy, or we set up a Tenckhoff catheter implantation procedure for access to peritoneal dialysis .
Why is eGFR greater than or equal to 60 still a safe limit? When this index decreases, kidney function becomes severely limited. At the same time, the patient may still not be aware that he is sick at all.
eGFR below 60 tells us that we have damaged 50 percent. renal parenchyma. It’s as if we only have one kidney left. At this stage, there are no signs of severe kidney damage yet. Patients do not yet have symptoms of anemia, do not feel tired and feel that they are actually okay. This is a big problem because if these symptoms were severe, the patient would seek help. He doesn’t do it because he just doesn’t feel sick. The kidneys, in turn, are characterized by the fact that if they are chronically damaged, it is usually irreversible. We can only try to stop the progression of CKD – concludes Prof. Naumnik.
What tests should I do to prevent CKD? The two most important
The consequences of Chronic Kidney Disease are dire. Meanwhile, it would be possible to prevent this from happening – and in a very simple way. Kidney disease is detected at an early stage by basic tests, which should be included in our calendar for good. Even if we do not suffer from other chronic diseases.
There are two basic tests that every human being should do once a year – says prof. Naumnik. – This is blood creatinine with calculation of eGFR and urinalysis. In the case of the latter, the reassuring situation is the lack of deviation. However, if red blood cells, leukocytes, protein or sugar appear in the urine, the test should be repeated in 3-4 weeks. And when the abnormality is detected again, you need to consult a doctor. Even the general, who should not underestimate it, only send the patient for a nephrology consultation. An important test, also very simple, is the ultrasound of the abdominal cavity, which can show morphological changes in the kidneys, despite the good results of the two previous studies. I would also add blood pressure measurement to this list – this is very important. Virtually all kidney diseases are associated with high blood pressure. The kidney is sometimes the culprit and sometimes just the victim of hypertension, so the blood pressure test indirectly proves the condition of this organ.
The specialist adds one more study to this package. This time, dedicated mainly to people who suffer from some chronic diseases. In their case, it is also worth getting albuminuria.
I would also recommend another simple test – albuminuria or UACR (albumin to creatinine ratio in a single urine sample) to patients such as diabetics, blood pressure patients or suffering from autoimmune diseases. It is enough to collect two urine samples – one for general examination and the other for UACR determination. But beware: one study is not enough here. You have to do three, within three months. Only two negative results indicate no albuminuria. Normal UACR is below 30. Above 30, we are dealing with albuminuria. We should also remember that this test should be carried out when we are relatively healthy – with regulated diabetes or hypertension. Albuminuria should not be determined during the period of obvious illness, overwork, after exercise or after a sauna.
As the number of patients with chronic kidney disease continues to grow, a coalition for Chronic Kidney Disease has been established, which includes eminent Polish specialists in the field of nephrology, family medicine, pharmacology and public health.
More information: www.otworzsercenanerki.pl