Kidney STONES and Kidney FAILURE

Our two kidneys varying from 3 to 7 inches in length and weighing some 154g each are located near the spine midway down the back. Each kidney filters about 189 litres of blood, concentrated fluid and waste products into about 1 litre of urine per day.

Our body is capable of surviving on one kidney. Hence, having ONE kidney is sufficient for this primary task to be performed.

Vital functions

The kidneys perform important functions like:

-  Eliminate toxins, extra minerals and extra body fluid
-  Regulate salt (potassium and sodium), water and acid balance in the body
-  Produce hormones and vitamin D to regulate blood pressure
-  Ensure healthy bone respectively and
-  Produce red blood cells to enable circulation of oxygen throughout the body.


KIDNEY FAILURE

Causes

Kidney failure is a severe condition whereby a kidney is rendered totally damaged and another functions below 30% its normal capacity.

Diabetes and hypertension are the leading causes of kidney failure. In Singapore the statistics showed 500 new cases are diagnosed yearly, out of which half is caused by diabetes and 9% by hypertension. 20-30% of the diabetic patients develop kidney disease over a mean duration of 15 years.

Other possibilities include: damage by exposure to certain drugs or toxins, including heavy metals, solvents, chemotherapy agents, snake or insect venom, poisonous mushrooms and pesticides.

Renal failures can also accompany or result from many other disorders, such as congestive heart failure, liver disease, lupus and sickle-cell anemia.

Hypertension can cause kidney disorders and vice versa. 

-  High pressure in the blood vessels of the kidneys cause them to become thickened and rigid.  As blood supply is reduced, this organ is unable to function properly.  Salt is retained,, which causes the body to hold fluid, putting a burden on the heart.
-  The decrease in blood supply also results in dysfunction of kidney tissue, which leads to further decline of kidney function. It may occur with total kidney failure when blood pressure is no longer controllable.

Symptoms

There may be no symptom or few presenting at the same time. Possible ones include:

• a reduced amount of urine
• swelling of your legs, ankles and feet from retention of fluids caused by the failure of your kidneys to eliminate water waste
• unexplained shortness of breath
• excessive drowsiness or chronic fatigue
• persistent nausea
• confusion
• pain or pressure in your chest
• seizures
• coma

Diagnostic tests

Kidney failure can be diagnosed by conducting blood and urine test.

- For blood test, kidney failure can be reflected by the level of waste products, both Creatinine (over 0.6-1.2 mg/dl) and blood urea nitrogen, BUN (over 7-20 mg/d).

- Urine test measures the leakage of protein from the kidney to the urine.

++  BUN is a waste product derived from protein breakdown in the liver. A rise in BUN level can be caused by gout, excessive protein intake, kidney damage, drug diuretics, low fluid intake, intestinal bleeding, exercise, heart failure or decreased digestive enzyme production by the pancreas. Conversely, a decrease is due to inadequate protein intake, malabsorption or liver damage.

++  Creatinine is also a protein breakdown product. Though its level tends to be higher for those with more muscle mass, it can also indicate kidney damage for those not involved in sporting activities. Low levels can be seen in those with inadequate protein intake, liver disease, kidney damage or pregnancy.

A high BUN/creatinine ratio may indicate dehydration, poor blood circulation in the kidneys, urinary tract obstruction, prostatic enlargement, high protein diet.

++  Albumin is a protein produced in the liver and appears abundantly in the blood to protect tissues from free radicals. It binds waste products, toxins and dangerous drugs that might damage the body and transports vitamins, minerals and hormones.

The first sign of diabetic kidney disease is the appearance of abnormal amount of albumin in the urine known as microalbuminuria (normal less than 30mg). Need to take the albumin/creatinine ratio to detect any abnormality.

One important symptoms of kidney problem is edema. Edema results when the kidney produces less urine because they are unable to properly excrete salt and other wastes, and fluids build up in the body. Ankles and hands may swell, and the person is short of breath. Other symptoms are like abdominal pain, appetite loss, back pain, chills, fever, bloating, nausea, urinary urgency and vomiting. The urine may be cloudy or bloody. Back pain may be sudden and intense, occurring just above the waist and running down the groin.

If the early diabetic disease remains untreated, it can progress and develop into macro-albumininuria (less than 300 mg) or proteinuria. At this stage, the patient starts to develop high blood pressure and the kidneys begin to fail. Do not wait till the day dialysis treatment is required.


Treatment

 At an advanced stage, symptoms are headache, nausea and vomiting, blurred vision, convulsions, coma and death. Without treatment, failure of both kidneys can be fatal in merely 2-3 weeks.
 
1.  A dialysis machine takes over the role of filtering and purifying the blood of accumulated waste products. Treatment is carried on 2-3 times weekly with each session lasting up to 10 hours. Meanwhile, a low potassium, low salt diet has to be strictly adhered to. Most patients are able to lead productive lives.

2.  Kidney transplant may be better for patients with chronic kidney disease so that dialysis is no longer required. A compatible donor with two healthy kidneys is required. However the surgery may not be successful at times. Immunosuppressive drugs have to be taken after the surgery which have their own side effects.


KIDNEY STONES


Kidney stones are made of salts and minerals in the urine that stick together to form hard, crystalline mineral material within the kidney or urinary tract. They can be as small as grains of sand or as large as golf balls. They are a common cause of blood in the urine and often severe pain in the abdomen, flank or groin.


Who are the sufferers?

One in every 20 people develops a kidney stone at some point in their lifetime.

Kidney stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s, and it continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, others are more likely to develop.

A small number of pregnant women (about one out of every 1,500-3,000 pregnancies) develop kidney stones, and there is some evidence that pregnancy-related changes may increase the risk of stone formation. Factors that may contribute to stone formation during pregnancy include a slowing of the passage of urine due to increased progesterone levels and diminished fluid intake due to a decreasing bladder capacity from the enlarging uterus.

Symptoms

Kidney stones often cause no pain while they are in the kidneys, but they can cause sudden, severe pain as they travel from the kidneys to the bladder. Symptoms and signs include excruciating, cramping pain in the lower back and/or side, groin or abdomen as well as blood in the urine. It may be so severe that it is often accompanied by nausea and vomiting and has been described by many as the worst pain of their lives.

If infection is present in the urinary tract along with the stones, there may be fever and chills. Sometimes, symptoms such as difficulty urinating, urinary urgency, penile pain, or testicular pain may occur due to kidney stones.

Causes

+ Kidney stones form when a change occurs in the normal balance of water (usually when there is a decrease in urine volume), salts, minerals and other substances found in urine. About 75% of kidney stones are calcium stones, as a result of calcium in combination with either oxalate or phosphate.  Foods containing high oxalic acid like Coca-Cola, tea, beer, coffee, grape juice and spinach cause calcium to leech from the bones. Sugary foods stimulate the pancreas to release insulin, which causes extra calcium to be excreted in the urine.

+ Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine. Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood. Excessive intake of animal protein has damaging effect as it causes the body to excrete calcium, phosphorus and uric acid. 

+ Dehydration through reduced fluid intake and strenuous exercise without adequate fluid replacement increase the risk of kidney stones. Climate may be a risk factor for kidney stone development, since residents of hot and dry areas are more likely to become dehydrated and susceptible to stone formation.

+ People with certain medical conditions, such as gout, and those who take certain medications eg. some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.

+ Kidney stones can also result from infection in the urinary tract known as infection stones. Metabolic abnormalities, including inherited disorders of metabolism, can alter the composition of the urine and increase an individual’s risk of stone formation.

 

+ Calcium supplementation from bone-meal, coral, oyster shell and dolomite are generally known as non-food source of calcium, due to their low bio-availability and poor assimilation in the body, making it hard for digestion and absorption. Prolonged usage may lead to the formation of gallstones and kidney stones. Such calcium are cheaply available but not safe as the significant amount of lead present poses a health risk.

+ Calcium stones often run in the family because the tendency to absorb too much calcium is hereditary. Those who have developed kidney stones and treated should be careful as the risk of occurrence is high.

Prevention

Rather than having to undergo treatment, it is best to avoid kidney stones in the first place when possible. Drinking more water constantly helps, since low fluid intake and dehydration are major risk factors for kidney stone formation. Also holding back urine is bad for the organ.

Depending on the cause of the kidney stones and an individual’s medical history, dietary changes or medications are sometimes recommended to decrease the likelihood of developing further kidney stones. If one has passed a stone, it can be particularly helpful to have it analyzed in a laboratory to determine the precise type of stone so specific prevention measures can be considered.

Recent research done showed that taking right calcium-rich foods or calcium supplements extracted from vegetables can prevent calcium stones because they can bind with oxalates and expel in the stool. This cleared the misunderstanding that excessive intake of calcium causes kidney stones when in fact taking too little calcium and oxalic acid are the main culprits. 99% of our calcium is stored in the bones and teeth and our body draws down when the calcium in the blood is insufficient for its normal functioning. Over a period of time, the bones can turn brittle if calcium level in the bones is not restored (leading to osteoporosis or bone spur)

Diabetic sufferers should avoid milk products and concentrate on calcium supplement.

Always keep pH in the urine alkaline to prevent substances from suspending in the renal area. However, note that the chance of bacteria thriving in such an environment is higher. Taking Vitamin C sporadically can alleviate the situation.

Treatment

Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake and controlling the symptoms. Pain medications can be prescribed for symptom relief.

There are several factors which influence the ability to pass a stone like the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage, while a 5 mm stone has a 20% chance. Stones larger than 9-10 mm rarely pass on their own and usually require treatment.

Symptoms to observe:

Changes in your urinary function: The first symptom of kidney disease is changes the amount, frequency of your urination. There may be an increase or decrease in amount and/or its frequency, especially at night. It may also look more dark colored. You may feel the urge to urinate but are unable to do so when you get to the restroom.

Difficulty or pain during voiding : Sometimes you have difficulty or feel pressure or pain while voiding. Urinary tract infections may cause symptoms such as pain or burning during urination. When these infections spread to the kidneys they may cause fever and pain in your back.

Blood in the urine: This is a symptom of kidney disease which is a definite cause for concern. There may be other reasons, but it is advisable to visit your doctor in case you notice it.

Swelling : Kidneys remove wastes and extra fluid from the body. When they are unable to do so, this extra fluid will build up causing swelling in your hands, feet, ankles and/or your face.

Extreme fatigue and generalized weakness : Your kidneys produce a hormone called erythropoietin which helps make red blood cells that carry oxygen. In kidney disease lower levels of erythropoietin causes decreased red blood cells in your body resulting in anemia. There is decreased oxygen delivery to cells causing generalized weakness and extreme fatigue.

Dizziness & Inability to concentrate : Anemia associated with kidney disease also depletes your brain of oxygen which may cause dizziness, trouble with concentration, etc.

Feeling cold all the time : If you have kidney disease you may feel cold even when in a warm surrounding due to anemia.

Pyelonephritis (kidney infection) may cause fever with chills.

Skin rashes and itching : Kidney failure causes waste build-up in your blood. This can causes severe itching and skin rashes.
Conclusion 
Prevention is better than the cure. 10 best ways to fight kidney failure and stones
1.  Avoid holding back urine.
2.  Maintain good hydration to enable toxins and wastes to be entirely flushed out.
3.  Cut down on sugar intake to reduce the burden of the kidneys
4.  Reduce animal proteins as they boost metabolic load on kidneys
5.  Reduce excess salt intake as it can lead to hypertension and kidney damage
6.  Sleep enough so that the kidneys can refresh.
7.  Have adequate intake of minerals and vitamin. (eg. Magnesium and Vitamin B6)
8.  Cut down on coffee consumption as it does cause some water loss.
9.  Alcohol is known to significantly impact the kidneys and liver.
10. Medicine and painkillers can cause kidney and liver damage.
VIVA corner

Dr Baldev Singh, a consultant cardiologist at Parkway Hospital Singapore (Mind your Body 19-8-2010) commented that the recent study linking calcium intake to heart attack focused on supplement that had only calcium, and not with magnesium and vitamin D added (help in calcium absorption). Dr Lau Kean Wah, a consultant cardiologist at Gleneagles Hospital echoed the same. Similar report by the US Government was reported in 2007 about the benefits of this formula in reducing heart attacks.

VIVA Calmag & D is a big winner for the best combination of Calcium (in the form of calcium lactate and calcium carbonate extracted from vegetables) fortified with Vitamin D3, magnesium (helps to regulate heart beat) and zinc (promotes healthy growth).

VIVA Omega 3 helps to reduce any inflammation and inhibit abnormal growth.

VIVAGuard with its powerful antioxidants, SOD and catalase can neutralise and scavenge harmful substances like free radicals and prevents excessive uric acid build-up.

VIVA Green Barley improves overall acidity and enables uric acid to be excreted. The chromium and amylase contents can promote the metabolism and utilization of carbohydrate and thus help to regulate blood sugar concentration.