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Be kind to your kidneys

by Simone McClenaughan | 03 Mar 2014

One in three Australians has a risk factor for kidney disease, yet most people are unaware their kidneys are on the way out until it is too late. Here’s what you need to know about your kidneys so you don’t become one of the statistics.

What do kidneys do?

Imagine a magic waste disposal machine. It processes rubbish, recyclable goods and also cleans things at the same time. Sounds pretty incredible doesn’t it? You’re thinking: ‘Where can I get one of those?’ Well, guess what? You already have two of them! Located at the small of your back, on either side of your spine, your kidneys are hard at work scrub-a-dub- dubbing, working out what to chuck and what to keep.

Your kidneys are filters; 12 times an hour your entire blood supply runs through them and is cleaned and sorted. The useful clean materials such as nutrients and minerals get recirculated through your body. The unnecessary waste materials such as toxins are excreted in your urine. But your kidneys aren’t just a cleaning epicentre, they also make vital hormones and enzymes that help keep you healthy, too. Kidneys make erythropoietin, a catalyst for the production of red blood cells; renin, which helps manage blood pressure; and active vitamin D, which assists with calcium absorption and contributes to making strong bones.

Healthy kidneys are essential for living a healthy life. But sometimes, something happens and kidneys fall ill. This is called kidney disease and is a life-changing and often debilitating condition that may end lives prematurely.

What is kidney disease?

There are five general types of kidney disease.

“The first is an obstructed kidney, which is caused by a stone or tumour,” says Dr Mathew. Between four and eight per cent of Australians experience this at least once in their life. “The second is vascular disease, where blood can’t get in and out of the kidneys effectively due to blocked vessels.” The major cause of this is high blood pressure. “Then there is the kidney itself which may get inflamed (as in nephritis) or clogged up with an infiltrate (as in diabetes) and as a consequence the filters cannot work effectively.”

Glomerulonephritis is one of the main forms of this, where the immune system attacks the filters. Within glomerulonephritis there is IgA nephropathy, which is the most common form and causes blood in the urine.

“There is also polycystic kidney disease (PKD) where cysts develop over many years and take over the kidney,” Dr Mathew explains. PKD affects more than 35,000 Australians and 50 per cent of people with PKD will experience kidney failure by the time they’re 60.

In addition, there is diabetic kidney disease, which deposits substances in the kidneys’ filters and prevents them from working efficiently. Approximately 30 per cent of people with diabetes will develop diabetic kidney disease.

Chronic kidney disease (CKD) occurs when you lose a third of your kidney function and this continues for more than three months due to any of the types of kidney disease. This may lead to a continuing loss of function and ultimately results in kidney failure.

Silent signs

“Kidney disease is a silent disease. Damage occurs to the kidneys without the patients knowing, with some patients losing up to 90 per cent of their kidney function before they notice something is wrong,” says Dr Emily Farrell of the Royal Australian College of General Practitioners. “It is important not to disregard any changes in your health as you age and to always seek advice from your doctor whenever something changes – no matter how minor you think it may be,” she warns.

The general lack of awareness of kidney disease doesn’t help. “Only 10 per cent of people who have kidney disease actually know they have it,” says Dr Tim Mathew, Medical Director of Kidney Health Australia. “Which means that 90 per cent of people with kidney disease have no idea they have it.”

Symptoms include:

  • High blood pressure
  • Changes in urine – the amount and number of times you urinate, the appearance of urine and the presence of blood
  • Leg and ankle puffiness
  • Pain around your kidneys
  • Headaches
  • Poor concentration
  • Itching
  • Shortness of breath
  • Nausea and vomiting
  • Bad breath and a metallic taste in your mouth

“Kidney disease is very easily picked up via a simple blood or urine test,” says Dr Farrell. “The earlier it is diagnosed the better, because if it’s left too long, it will certainly shorten your lifespan and can even kill you.”

Risk factors include:

  • Age – being over 60 Diabetes
  • A family history of kidney disease
  • Cardiovascular disease, had a heart attack or stroke.
  • High blood pressure
  • Obesity
  • Smoking

Lifelong treatment

“The type of treatment required depends on the type of kidney disease,” says Dr Mathew. “An obstructed kidney will be treated through surgery where the obstruction is removed. Vascular disease is treated in a similar way to cardiovascular disease, for example with angiograms and balloon angioplasty (where a special balloon is inserted into the vessels to widen the passage). There are a number of medications and steroids used to treat the multiple varieties of parenchyma and, in regards to PKD, there is exciting research underway at present investigating ways of inhibiting cyst growth through medications.”

Dialysis and transplants are the two options for kidney failure. Once kidney function drops to less than 10 per cent, treatment is essential.

During dialysis, a machine or special membrane and catheter operates as your kidney, cleaning, processing and recirculating the blood through your body. It’s done a number of times each week, either at a hospital or at home, depending on individual cases. Almost 11,000 Australians are on dialysis.

Transplants tend to be the last  resort, often not done until all other avenues have been exhausted. Only 825 transplants were performed in Australia in 2011. “In Australia, you are not eligible to go on the kidney transplant waiting list until you have actually been on dialysis,” says

Dr Mathew. Around 10 per cent of people on dialysis are waiting for a transplant. The two types of transplants are from a deceased donor or a live donor.

“With a live donor, you can bypass that waiting list – which on average is four years long – and often receive the transplant before going on dialysis,” he says. “A live transplant can also be the better option because it may end in better results – you won’t lose as much kidney function or health in the wait to have it done.”

A live donor can be a friend, family member or spouse; the donor does not have to be a blood- matched relative. Living on one healthy kidney is entirely possible, for both you and the donor. “We only really need one kidney to function normally,” advises Dr Mathew. “Length and quality of life is not affected for people with one healthy kidney.”