1. KNOW YOU KIDNEYS AND YOUR KIDNEY DOCTOR
Kidney isanamazingorgan that playsa majorrole in keepingourbodycleanandhealthybyflushingout
unwantedwaste andtoxicmaterials,outof the body. Italsoplaysa role in regulatingblood
pressure,volumeof fluidandelectrolytesinthe body. Itisalsoinvolvedinmaintaininghemoglobinlevels
and regulatingbloodandbone levelsof calciumandphosphorusinthe body.
In recentyearsthere isa disturbingincrease inpatientssufferingfromdiabetesand hypertensionthat
has leadtoa remarkable increase inthe numberof patientssufferingfromchronickidneydisease.This
callsfor betterawarenessandunderstandingof kidneydiseases,itspreventionandearlytreatment.
Since kidneysare suchvital organsof the body,theyhave to be lookedafterbyspecializeddoctors,who
have beenspecificallytrainedtohandle kidneyproblems.These doctorsare called“Nephrologist”.
Contraryto the commonbelief bymostof the patientsanddoctorsinUAE, that kidneyproblemsare
deltbya Urologistor Cardiologist,neitherof these doctorsare specificallytrainedtodeal withkidney
problems. Urologistare mainlydealingwithkidneystone problemsandare basicallysurgeons.
Cardiologistare dealingwithproblemsrelatedtoheart.
A Nephrologist,aftercompletinghispostgraduationininternal medicine,undergoessuperspeciality
traininginkidneydiseasesforalmost4to 5 years,before he getshispostdoctoral degree in
Nephrology.
DuringhistraininginNephrology,he dealswithall typesof kidneyproblems,aboutdialysisandabout
kidneytransplantandhowtomanage these patients.
Thus all kidneyrelateddiseaseshave tobe seenandmanagedbya Nephrologist, asearlyaspossible ,so
that patientscan get maximumbenefitatthe righttime and save theirkidneysfrompermanent
damage.
Structure of Kidney
Kidneyproducesurine byremovingtoxicwaste productsandexcess waterfromthe body.Urine formed
inkidneypassesthroughureter, flowsintobladderbefore finallybeingexcretedthroughurethra.
Location, structure and functions of the kidneys are the same in males and females.Kidneysare
locatedat upperandback side of the abdomen,on eitherside of the spine (see diagram).Theyare
protectedfromdamage bythe lowerribs. Kidneyslie deepinsidethe abdomensonormallyone cannot
feel them. Kidneysare apairof beanshapedorgans.In adultsa kidneyis about10 cm long,6 cm broad
and 4 cm thick.It weighs approximately150-170 grams.

2. Why is kidney essential for the body?
We consume differentquantityandkindof foodeveryday.The quantityof water,salts,andacidsinour
bodyalsovariesevery day.The continuousprocessof convertingfoodintoenergyproduces harmful
toxicmaterials. These factorsleadtochange inthe amountof fluid,electrolytesand acidsinthe body.
Thisaccumulationof unwantedtoxicmaterials canbe life threatening. Kidneyscarryoutthe extremely
essential cleansingjobof flushing outharmful andpoisonousacidicandtoxicproducts.Atthe same
time,theyalsoregulate andmaintainthe rightbalance andlevelsof water,electrolytesandacidbase.
What are the functions of the kidney?
1. Removal of waste products
Purificationof bloodbyremoval of waste productsisthe mostimportant functionof the kidney.The
foodthat we consume containsprotein.Proteinisnecessaryfor the growthandrepairof the body.But
as proteinisutilizedbythe body itproduceswaste products.Accumulationof these wasteproductsis
like poisonforthe body.Kidneyfiltersblood,andtoxicwaste products are excretedinthe urine.
Creatinine andureaare twoimportantwaste products,the amountof whichin humanbodycan easily
be measured.Their‘value’inblood reflectsthe functionof the kidney.Whenboththe kidneysfail,value
of creatinine andureawill be highinbloodtest.
2. Removal of excessfluid
The secondmost importantfunctionof the kidneyisregulationof fluid balance byexcretingextra
amountof wateras urine andretainingnecessaryamountof waterinthe body.Sothe kidneymaintains
the right amountof waterin the body. Whenkidneysfail theylosethe abilityof removingthisextra
amountof wateras urine. Excesswaterinthe bodyleadstoswelling.

3. 3. Balance mineralsand chemicals
The kidneyplaysanotherimportantrole of regulatingmineralsandchemicalslike sodium,potassium,
hydrogen,calcium,phosphorus,magnesiumandbicarbonate;andmaintains normal compositionof body
fluid.
Change inthe sodiumlevel canaffectsensorium,whilechange inthe potassiumlevelcanhave serious
effectsonthe rhythmof the heartand functioningof the muscles.Maintenance of normal levelof the
calciumand phosphorusis essential forhealthybonesandteeth.
4. Control of blood pressure
The kidneyproducesdifferenthormones(renin, angiotensin,aldosterone,prostaglandinetc) and
regulateswaterandsaltinthe body,whichplays vital role incontrol of bloodpressure.Disturbancesin
hormone productionand regulationof saltandwaterina patientof kidneyfailure causeshighblood
pressure.
5. Red bloodcellsproduction
Erythropoietinproducedinthe kidneyplaysanimportantrole inthe productionof redbloodcells(RBC).
In kidneyfailure productionof erythropoietinisless,whichinturnleadstodecreasedproductionof RBC
resultinginlowhemoglobin(anemia). Because of low productionof erythropoietininpatientswith
renal failure the hemoglobincountdoesnotimprove inspite of supplementationof ironandvitamins.
6. To maintain healthy bones
The kidneyconvertsvitaminDintoitsactive formwhichisessential for the absorptionof calciumfrom
food,growthof the bonesandteeth,andtokeepbone healthy.Inkidneyfailuredue todecreasedactive
vitaminD,growthof bonesisreducedandtheyalsobecome weak. Growthretardationmaybe the first
signof kidneyfailure inchildren.
Symptomsof kidneydiseasesvaryfrompersontoperson.A lotdepends onthe type of underlying
disease anditsseverity.Oftensymptomsare general andvague,andtherefore the diseaseisnot
diagnosedinthe earlystages.
Common symptomsof kidneydiseases:
 Swellingofthe face
 Loss of appetite,nausea,vomiting
 High bloodpressure – Hypertension
 Anemiaand weakness
 Nonspecificcomplains- Lowback pain,bodyache,itchingandlegcramps are frequent
complainsinkidneydisease.Retardationof growth,shortstature andbendingof legbonesare
commonin childrenwithkidneyfailure.

4.  Urinary complains-
Commonurinarycomplainsare :
1. Reductioninurine volume,whichcausesswelling,isverycommon invariouskidneydiseases.
2. Burningsensationinurine,frequenturinationandpassingof blood orpusinurine are symptomsof
urinarytract infection.
3. Obstructionto flowof urine canleadto difficultyandstrainingin ‘voiding’(passingurine),poor
streamof urine ordrop to drop voiding.
In severe conditions,completeinabilitytopassurine isnotuncommon. Althoughapersonmayhave
some of the above mentionedsymptoms andsigns,itdoesnotnecessarilymeanthatthe personis
sufferingfrom kidneydisease.
However,inthe presence of suchsymptoms,itishighly recommendedtoconsultthe Nephrologist and
to rule outany possibilityof kidneydisease bytestsandcheckups. Itisimportanttorememberthat
seriouskidneyproblemmayexistsilently foralongperiodwithoutsignificantsymptomsandsigns.
Writtenby,
Dr Manish Triapthi,
Specialist- A Nephrologist,
GMC Hospital,
Ajman,
UAE.