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What You Need to Know About Kidney Problems

Kidney

What You Need to Know About Kidney Problems



What you need to know about kidney problems

Overview 

The kidney is a paired organ, 11-14cm in length, 5-6cm in width, and 3-4cm in-depth in adults. Both kidneys weigh approximately 300g.

The kidneys located against the back muscle and lie retroperitoneally on either side of the vertebral column between T12 and L3.

The right kidney is lower than the left approximately 1.5cm to accommodate the size of the liver.

Both kidneys move up on inspiration and down on expiration. 

What You Need to Know About Kidney Problems

The function of the kidney

The major function of the kidney is to filter wastes from the body and excrete them into the urine, regulation of and compensation of body fluid.

  • Excretion of waste products into the urine: when the blood enters the kidney from the heart it processed on the kidney via filtration, reabsorption, secretion, and excretion by urine. 
  • Control of body fluid volume: the kidney manages to keep our whole-body hemostasis.
  • Hormone secretion: The kidney produces erythropoietin a hormone that stimulates erythropoiesis (production of red blood cells) in the bone marrow. The kidney produces prostaglandin which is important to maintain renal blood flow and regulate blood pressure.
  • Metabolism of vitamin D: calcitriol the activated form of vitamin D normally made on the kidney, calcitriol promotes the intestinal absorption of calcium and renal reabsorption of phosphate.
  • Acid-base balance: the kidney reabsorbs and regenerate bicarbonate from urine, and excrete hydrogen ions into the urine.  

Glomerular filtration rate (GFR) is the most convenient number that indicates kidney health.



GFR is the best way to check kidney health. If GFR is low it indicates that you have kidney problems.

Early detection means early treatment and less complication.

The normal range of GFR in an adult is 90ml/min or higher, the normal range for the elderly from 60 to 89ml/min.

GFR tends to decrease with aging. Below 60ml/min is abnormal and indicates kidney damage and below 15 indicates kidney failure.

If GFR falls below 60 for 3 months or more means chronic kidney disease.

Chronic kidney disease (CKD) definition is a type of kidney disease characterized by a gradual loss of kidney function over some time.

Approximately 30 million people in the United States are living with chronic kidney disease (CKD).

Chronic kidney disease causes more deaths than breast cancer or prostate cancer. It is the under-recognized public health crisis.

It affects an estimated 37 million people in the U.S. (15% of the adult population; more than 1 in 7 adults) and approximately 90% of those with CKD don’t even know they have it. 

1 in 3 American adults (approximately 80 million people) is at risk for CKD. CKD is more common in women (15%) than men (12%).  

CKD is the 9th leading cause of death in the U.S.  In 2016, over 500,000 patients received dialysis treatment, and over 200,000 lived with a kidney transplant.  

The National Kidney Foundation (NKF) has led the way in rallying action on this problem. (For more details: https://www.kidney.org/news/newsroom/factsheets/KidneyDiseaseBasics)

Five stages of kidney disease

Five stages of kidney disease:

  • Stage 1:  with normal or high GFR above 90ml/min
  • Stage 2: mild CKD with GFR from 89 to 60ml/min
  • Stage 3: moderate CKD with GFR from 59 to 30ml/min
  • Stage 4: severe CKD with GFR from 29 to 15ml/min
  • Stage 5: end-stage CKD with GFR below 15ml/min
Kidney Disease: Signs and symptoms

Signs and symptoms 

Sign and symptoms of CKD are often nonspecific, and may not present until irreversible damage occurred.

Sign and symptoms may not initiate, and it usually discovered coincidently by routine screening.



  • Nausea and vomiting due to electrolyte imbalanced.
  • Hypertension due to fluid overload and production of hormones created by the kidney.
  • Loss of appetite
  • Fatigue and weakness due to electrolyte imbalanced.
  • Sleep disturbances 
  • Decreased mental sharpness due to mineral loss.
  • Muscle twitches and cramps due to mineral loss and electrolyte imbalance. 
  • Lower limb edema due to fluid overload and decreased urination.
  • Persistent itching due to minerals loss.
  • Chest pain and shortness of breath due to the accumulation of fluid in the lung and possibly pulmonary edema.
  • Anemia due to erythropoietin reduction.
  • Urge to urinate at night.
Kidney Disease: Causes

Kidney Disease: Causes

Vascular disease such as kidney artery stenosis and ischemic nephropathy.

  • Diabetes mellitus.
  • Hypertension.
  • Diabetic nephropathy, nephritis, and lupus nephritis.
  • Obstructive nephropathy such as bilateral kidney stones and prostate hypertrophy.
  • Reflux nephropathy.
  • Congenital diseases such as polycystic kidney disease.
Kidney Disease: Risk factors

Kidney Disease: Risk factors

  • Cardiovascular disease.
  • Hypertension.
  • Diabetes.
  • Smoker.
  • Old age.
  • Obesity.
  • Positive family history of kidney disease.
  • Abnormal kidney structure.

Diagnosis

The first tool for diagnosis is data collection, medication usage, and urine habit changes, and family history.

The second tool is family history. 3rd tool is a physical exam to determine any changes in cardiovascular function or hypertension.

Specific test and procedure such as: 

  • Kidney function test: the blood sample will be tested for a waste product called creatinine and urea. 
  • Urine analysis: the urine will be tested for the presence of protein, too much protein in the urine is an early sign of kidney damage.
  • Kidney ultrasound: ultrasound may determine the kidney size and structure.
  • Kidney biopsy: the kidney tissue will be tested to determine what caused the kidney disease.

Prevention

Mange the cause that makes the kidney problems to protect your kidney. 

  1. Eat healthy food: to prevent kidney problem you have to decrease salt intake, decrease sugar intake, decrease fat intake, increase veggie toppings and increase grains.
  2. Physical activity: to prevent kidney problems you have to engage with physical activity at least 30 minutes per day to keep your heart healthy and to lower fat and sugar.
  3. Reduce body weight: to prevent kidney problems you have to be in normal weight, the overweight has to create a realistic weight-loss plan.
  4. Get enough sleep: to prevent kidney problems you have to regulate your sleeping cycle at least 7 to 8hours. If you have sleeping issues, try to improve your sleep habits.
  5. Quit smoking: to prevent kidney problems you have to stop smoking.
  6. Manage your blood pressure: to prevent kidney problems you have to keep your blood pressure within normal limits.
  7. Manage your diabetes: to prevent kidney problems you have to regulate your blood sugar by checking your blood sugar level and take your medicine regularly.

Treatment

There is no definite cure for kidney disease, but treatment and reduce the symptoms and stop getting worse. Treatment depends on the disease level.

  • Hypertension treatment.
  • High cholesterol treatment.
  • Anemia treatment.
  • Fluid overload and swelling treatment.
  • Bone protection medication.
  • Protein reduction.
  • Dialysis and kidney transplant for CKD
  • Lifestyle changes: decrease salt intake, decrease protein intake, and decrease potassium intake.

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Written By

Jamil Qaryouti is a nursing specialist who graduated from J.U.S.T University in Jordan. Jamil has a wide verity of experience in cardiac diseases, pulmonary and neurological disease, former ICCU nurse in the Specialty Hospital in Jordan, former CNO of home care, founder of Jamil’s Home Health Corporation. Jamil is a medical educator. He believes spreading the information makes the world better.

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