Lets Talk Kidney Diseases Presentatiion By Dr.Sunil Prakash

YOUR KIDNEYS Dr. SUNIL PRAKASH MD (Med), FICP,FIACM,FISN FISPD (Canada), FISN (USA) DM (Nephrology-AIIMS) Consultant Nephrologists Artemis Health Institute, Gurgaon

The Human Kidneys : Anatomy

Did you know?

Every Year 2 lakh Indians go into terminal kidney failure requiring either dialysis or transplant.

Only 3000 get transplant and 5000 - 6000 start dialysis.

Of these over 1.75 lakh patients die each year without any definitive treatment.

1 in 9 adults has chronic kidney disease.

Diabetes is the number one cause of kidney failure.

High blood pressure is number two.

In USA about 470,000 people are on dialysis or kidney transplants to keep them alive.

Functions of the Kidney

Removes Extra fluid as urine by processing blood.

Removes waste products like Urea, Creatinine, Potassium etc. from the body.

Keep chemical balance in body by excreting metabolic acids.

Helps in blood pressure control.

Helps to keep bones and teeth strong by producing vitamin-D.

Synthesize Hormone (erythropoietin) to produce blood.

In 24 hours the kidneys reclaim :

1,300 g of NaCl

400 g NaHCO3

180 g glucose

Almost all of the 180 liters of water that enters the tubules.

Total water in adult male is 35-40 liters & blood has 5 liters water

Types of Renal Failure

Acute Renal Failure (ARF) Blood loss, Dehydration as after diarrhea, vomiting & heat

exposure; Drugs or poisons. ARF is temporary,

and can fully recover with timely treatment.

Gradual loss of kidney function is called Chronic Kidney Disease (CKD) and It may be “silent” for years. People with CKD may eventually go on to dialysis / transplantation

Symptoms of Kidney Disease

Even up to advanced stages of kidney disease, usually patients are asymptomatic.

They have no major issues and carry on their daily activities, without going to a doctor

EARLY SYMPTOMS

Polyuria (Passing more urine)

Nocturia (Passing more urine during night)

Bloody, foamy or dark colored urine.

Pedal Edema, Puffiness of the face

Persistent aches and pains.

High Blood pressure

Unexplained Anemia

Fatigue, lassitude, tiredness.

Inability to complete the family

Causes of Kidney Diseases

Diabetes Mellitus

Hypertension

Nephrotic Syndrome / Glom.Nephritis

Kidney Stones

Kidney Infections

Congenital / Genetic disorders

Kidney Cancers

STAGES OF CHRONIC KIDNEY DISEASE: A clinical action plan

Stage Description GFR (ml/min) Action

Kidney damage ≥90 Diagnosis &Treatment

with N or ↑GFR Treat co- morbidities

Slowing progression

2. Kidney damage 60-89 Estimating

with mild ↓GFR progression

3. Moderate↓ GFR 30-59 Evaluating & treating complications

4. Severe ↓ GFR 15-29 Preparation for RRT

5. Kidney failure < 15 Replacement

(or dialysis) (if uremia present)

Investigations

Urine : Micro albumin / Proteins, WBC/ RBC Casts.

Blood Investigations : Rise in Urea, Creatinine, Electrolyte imbalance.

Ultrasound : Change in Shape and Size.

Kidney Biopsy

Early Detection is Life saving and permits slowing the progression

of Kidney Damage and therefore delay dialysis and transplant .

Preventing Kidney Failure

Control blood pressure.

Control Diabetes.

Stay active, do regular exercise.

Drink adequate amount of water.

Look for changes in colour & frequency of urine.

Regular checkup with doctor.

Take medicines as prescribed by your doctor.

Don’t smoke and use Tobacco.

Avoid excess weight (Obesity)

Specific Interventions to delay disease progression

Diet modification

Hypertension control

Anemia correction

Divalent ION metabolism & rod

Metabolic acidosis

Dyslipidemias

Smoking

Weight reduction

Tobacco (Smoking/Chewing)

50% males & 25 % females use tobacco in some form in INDIA.

This is single most powerful Modifiable Risk Factor. Benefits start within 1 year of its cessation.

Health education in Schools- as age to start Tobacco is <20 yrs in over 90 %.

HIGH BLOOD PRESSURE

DIABETES MELLITUS And Pre diabetics Impaired Glucose tolerance

Hypoglycemia

STONE DISEASE

CALCIUM OXALATE--- 70%

TRIPLE PHOSPHATE --20%

URIC ACID – 5%

OTHER STONES

Take 2.5 to 3 liters of fluid daily

CALCIUM OXALATE STONE

AVOID

Beverages- Tea, coffee, cola

Palaak, Beans, Bhindi,Tomato, amla, cheeku, black grapes, nuts.

TAKE MORE-

Lauki ,Turai Skimmed milk.

Coconut water, Barley, Bananas

Uric acid stones AVOID Red Meat, Wines Cauliflower, Mushroom, Brinjal TAKE MORE Lemons, Karela, Kultha Daal, Carrots

OUR DIET

DIET

SALT INTAKE

Indians habitually consumes more salt;

8-10 gms.(Requirement is 5-6 gms/day)

Endogenous salt in diet is 1-2 gm , so add about 5 gm OR one level tea spoonful per day.

This will lower BP by 5-10 mm Hg & reduce Strokes by 35%, Heart Attacks by 20% & All cause Deaths by 13%

Proteins

Supply the body building materials.

Requirement 50-60 Grams / day

Sources –Milk , Pulses, Cereals, Meat

Quality of Proteins-

Egg & Animal products -1 st class proteins

Vegetarian – No single item contains all proteins, so complementing advised e.g. Cereals and pulses in a ratio of 5:1

Keep it low-fat

Cut out High Fat Foods:

Oils and oily foods

DRY FRUITS/Nuts and seeds

Dressings and high-fat Condiments

High-fat meat and dairy substitutes

Keep it low-fat

No added oils

Cook with vegetable broth or water

Steam instead of fry

Use non-stick cooking spray

Top salads with non-fat dressings

Use mustard instead of mayo on sandwiches

Use bean spreads/ or jam instead of margarine

Use apple sauce in baked recipes

Keep it High-Fiber

Choose whole grains (barley, oats, millet, isabgol, guargum etc)

Load up on beans

Choose high-fiber cereals

Eat abundant amounts of Vegetables and Fruits.

Eat 40 grams a day of Fiber in diet

Choosing Low Glycemic Index (GI) Foods

The glycemic index shows how quickly a food increases blood glucose

Choosing Low-GI Foods

Low-GI examples :

Beans, Beans

Green vegetables

Fruits, except pineapple and watermelon

Pasta

Brown Bread/ Rot/ Rice

CALORIE REQUIREMENT

IDEAL BODY WEIGHT CALCULATION-

Five feet-50 Kg, add 2 Kg for every extra Inch.

Sedentary Executives- 25 Kcal / Kg ideal Wt.

Moderately Active workers 30-35 Kcal / Kg ideal Wt

Manual Labourers 40-45 Kcal / Kg ideal Wt

Calculate total calories for Ideal body Weight.

If weight loss is desired, reduce 300 Kcal/ day

till ideal body weight is achieved.

High Calorie Bombers 400 2 scoops Ice creams 350 2 Gulabjamun 400 1 katori Carrot Halwa 500 1 Sizzler 400 1 Masala Dosa 400 1 serving Papdi Chat/Aloo Tikki 600 100 gm Groundnuts/Kaju 450 1 serving Chole /Bhature(2) 600 Cal. 1 Hamburger

Low Calorie Items 100 30 gm Uncooked Dal/ Rice/ Atta 50 100 gm Grapes/ Orange/ Apple/Guava 100 100 gm Potato (Boiled, Baked) 15 100 gm Water Melon/Kharbooza 10 100 gm Lauki/ Turai/ Kaddu 20 100 gm Tomato/ Lettuce 50 100 gm Onion/ Carrot 25 100 gm Cabbage/ Cauliflower 6 Cal. 100 gm Kheera/ Kakdi/ Radish

How many CALORIES in Food Items? 80 1 Boiled Egg 250 1 piece Tandoori Chicken 150 1 bowl Sweet corn soup 100 1 cup Curd/Milk 100 1 Katori Vegetable 150 1 Katori Dal 200 1 Nan/Roomali roti/Parantha 100 2 Phulka/Bread Slices 20 1 tsf Sugar Calories Quantity Name

CALORIES BURNT/ MINUTE 5.6 Gardening 1 Lying 1.5 Sitting 2.6 Standing 6 Badminton 7 Tennis 15 Squash 15 Football 12 Swimming 10 Cycling 20 Running 15 Jogging 4 Casual Walk 6 Brisk Walk

High Risk Group