Cigarette smoking, exposure to certain chemicals and medicines, infections (viruses and bacteria), low water intake, and obesity are the other leading causes of kidney diseases.
Dialysis has two components. In Haemodialysis excess water and waste products are removed from your blood by a machine. This method is the more efficient one, but costs a lot. Haemodialysis is needed once
every 2-3 days.
By Kshalini Nonis
Chronic Kidney Disease (CKD), is a long-term condition where the kidneys do not work as well as they should. It is a common condition that can affect anyone.
We interviewed Dr. Heshan Amarathunge, Medical Officer in Dialysis, at the National Institute of Nephrology, Dialysis and Transplantation on issues related to the kidneys.
Q: What are some of the common kidney diseases?
Kidney diseases occur when there is a loss of normal kidney functions. These kidney diseases can occur suddenly or over a longer period of time. Of all kidney diseases, Chronic Kidney Diseases remains the most common. According to the International Society of Nephrology, approximately 850 million people worldwide were affected by CKD in 2023.
In Sri Lanka, Chronic Kidney Disease is the leading kidney disease, affecting more than 150,000 people, and the actual value is much higher. In addition, genetic and familial kidney diseases, glomerular diseases, renal vascular diseases, and renal carcinomas (cancers) account for a much lesser extent.
Q: What are the causes of the above diseases?
The most common causes of chronic kidney disease are diabetes and high blood pressure. Over the past few decades, a new disease entity called chronic kidney disease of unknown aetiology (CKDu) has emerged in some parts of the country where it is believed to be caused by polluted water and environmental toxins.
Cigarette smoking, exposure to certain chemicals and medicines, infections (viruses and bacteria), low water intake, and obesity are the other leading causes of kidney diseases.
Q: What are the symptoms of these diseases?
Many kidney and urinary tract disorders don’t show any symptoms during the initial period.
Kidney diseases may be present with:
Passing of a smaller amount of urine per day
Swelling of the face, legs, and sometimes even the whole body
Passing frothy urine (protein in urine) and blood
Passing a lot of urine at night
Pain during urination
Stomach pain (tummy pain)
Q: At what stage must a Nephrologist be consulted?
Early detection and treatment are the best ways to prevent further kidney damage. The following cases need urgent nephrology referrals:
eGFR of less than 30.
Rapid deterioration of kidney functions.
High proteinuria (protein in urine).
High blood pressure, not responding to multiple medications.
Suspicion of kidney involvement in other multisystem illnesses.
Q: What are the complications associated with kidney diseases?
Kidney disease will cause a loss of kidney functions. In chronic kidney disease, these complications are permanent. With drugs the complications and progression of the disease can be controlled.
Some of the complications associated with kidney diseases are:
1. Less or no urine production resulting in water retention inside the body
2. Inability to remove body waste products
3. Low red blood cells (anemia)
4. Hormonal diseases
5. High blood pressure
6. Heart diseases
7. Weak bones
Q What are the side effects of treatment for kidney ailments?
Except for a few minor side effects like feeling vomitish and stomach bloating, most of the chronic kidney medications are tolerated by patients.
Following a kidney transplant, drugs are given to suppress the immunity. These drugs will make the patient more prone to infections.
Q: What about food and diet for kidney patients?
The diet should be decided individually by a Nutritionist for each and every patient.
Generally patients are advised to maintain a proper BMI (18.5 to 25) and take a balanced diet to avoid malnutrition. Patients who are on dialysis need additional proteins.
The following is some general advice for Chronic Kidney Disease patients.
1. Take low glycemic index food (avoid simple sugars, eat complex carbohydrates)
2. Low salt diet
3. Low phosphorus diet (limit meat and dairy products)
4. Low potassium diet if your potassium is high (limit fruits and green leaves)
5. Avoid fast food and junk food (which has trans-fat)
Q: What is dialysis and at what stage does it become necessary?
Dialysis has two components. In haemodialysis excess water and waste products are removed from your blood by a machine. This method is the more efficient one, but costs a lot. Haemodialysis is needed once every 2-3 days.
In peritoneal dialysis (which is less efficient) the fluid inside your peritoneal cavity (belly) is used to clean your blood. But this method is needed on a daily basis.
When the eGFR (estimated glomerular filtration rate) is less than 06, dialysis is mandatory. But dialysis may be needed earlier than that if the kidneys are unable to remove excess water and waste products.
Q: Can you also tell us about a kidney transplant and its pros and cons?
When you’re having end stage chronic kidney disease the only permanent solution is replacing your kidney with a suitable kidney from a donor. There are a series of tests to do to find the best matching kidney. Overall a kidney from a blood relative will have more chances for a best match. Kidney transplant is a more complex surgery and each year hundreds of kidney transplants are performed successfully in Sri Lanka giving hope to many kidney patients.
Following the surgery you will need a lifelong follow-up by your Nephrologist.
The most common problem following a kidney transplant is kidney rejection. A good matching kidney would last up to 20-25 years.
Q: What are the different stages of kidney failure?
There are five stages of kidney failure from 1 to 5 and classified according to the eGFR level. Stage 5 indicates more kidney damage. eGFR is a calculated value using a blood test value ( Serum creatinine) considering your age, gender and body surface area.
Q: Anything else you would like to say about issues related to the kidneys?
Chronic kidney disease has a huge burden on financial status and mental well-being. Due to the increase in non-communicable diseases like diabetes and high blood pressure and due to polluted water consumption, chronic kidney disease is rising rapidly. Patients who are diagnosed with diabetes and high blood pressure need to have tight control of their illness while testing for kidney disease at least once a year.
People who are living in high chronic kidney disease areas like the North-central, Uva and North-western provinces need a clean supply of drinking water.
Boiled water won’t save you from kidney disease and you need filtered water (Preferably using a RO system).
People go after quacks and do various home remedies hoping for a permanent cure which will damage their kidneys even further. Once you are diagnosed with kidney disease you are advised to take treatment under the supervision of a medical specialist. Currently almost all the main government hospitals in each province have specialised nephrology units to treat these patients. In addition two specialised national kidney hospitals are located in Colombo 10 and in Polonnaruwa.
The take home message is that once you’re having chronic kidney disease no treatment can regain your already damaged kidney cells. With proper medical treatment, disease progression and complications can be controlled.
