Know the structure of this bean shaped vital organ called the kidney!
The kidney is a vital organ; it not only removes the waste products from the body in the form of urine but performs many other functions as well. The kidneys have plenty of spare capacity, yet they can be damaged to the extent that their replacement in the form of either dialysis or transplantation becomes essential. Kidney diseases affect everyone, right from children to the old people. Fortunately, our knowledge and technology has advanced considerably and now it is possible to cure people of many a disease of the kidney which used to be fatal. It is also now possible to salvage a kidney from a very hopeless situation, and even in the event of total failure we can keep the person alive for many years.
It is unfortunate that there are not very many symptoms in early stages of kidney diseases, and this is perhaps the cause for the delay in the institution of the treatment. Most of the chronic problem of the kidney are insidious and take a long time before they exhibit frank symptoms. Therefore, it is essential that people should know the early symptoms and act promptly to save the kidneys.
Normal considerations: Kidneys are paired organs situated in the back of either side of the vertebral column, just underneath the lower ribs. They are bean shaped organs, and each weight about 150 grams. There are minute tubular units in the kidney which filter urea, creatinine and the other waste products from the body round the clock. In 24 hours, approximately 200 liters of fluid are filtered in the kidneys, but only 1½ liters of urine is discharged out of the body. The rest is absorbed back into the blood. The kidneys are connected to the urinary bladder by two tubes knows as ureters where the urine is stored. From here it is periodically urinated through another tube called the urethra.
Besides producing urine, the kidneys help in controlling the blood pressure and they also help in production of red blood cells. It activates natural vitamin D into its active form. Usually, one kidney is enough to maintain life properly and it is only when ore than 95% of the kidney tissue is damaged that the patient needs assistance with dialysis or transplantation for survival.
The Main Diseases
There can be defects in the kidneys during the development in the mother’s womb. They are called congenital defects like Polycystic Kidneys. The commonest affections of the kidney are infections. These infections could be acute or they could be slow and chronic. Acute infection like pyclitis, pyclonephritis etc are quite common. Chronic infections include chronic phclonephritis, tuberculosis, nephritic syndrome etc. Diabetes and high blood pressure damage the kidney in the long run. As a matter of fact, a damaged kidney does cause high blood pressure. Tumors of the kidney are also quite common. Besides cancer, there should benign tumors also that can arise in the kidneys. At times, allergic reaction to drugs and other chemicals may cause kidney damage. Stones are also well known for causing kidney damage.
All these common diseases of the kidney slowly destroy the kidney tissues and finally result in kidney failure called uremia. This is the time when extra help is required to survive.
Out of the few symptoms that manifest themselves when a significant amount of kidney functions are impaired (more than 75%) the main signs and symptoms are related to urine. There may be increased frequency of maturation with burning as in the case of infection. Pain may or may not be there. Stones may be silent or may cause pain, depending on the site of stones. If it is in the kidney, the pain is usually located in the back of the affected site. This is usually colicky in nature, and it may travel in front. A stone in the ureter causes pain in the flank which may travel down towards the testicles or thigh. A stone in the bladder may case pain in the lowermost part of the abdomen. In chronic infections, the pain is not usually severe and it may be a dull ache. In some cases of stones, tuberculosis and tumors, the patient may pass blood in the urine called hematuria. This may be a prominent symptom in the bladder problem.
Besides, there are generalize symptoms which are vaguer and cannot be specifically attributed kidney diseases, but they, in correlation with other specific kidney symptoms may help in reaching a diagnosis. Excessive fatigue, anemia, impaired appetite, vomiting, tiredness, difficulty in breathing particularly on excretion, ankle swelling etc are few of the symptoms. In nephritic syndrome puffiness of the face is quite characteristic.
Hematuria may be painless and in such events people ignore it because it is pain that usually compels them to seek medical advice. Blood in the urine may signify infection and stones, but without pain it may indicate serious disease like cancer and tuberculosis. Therefore, it may be very dangerous to ignore blood in the urine. It should be investigated immediately.
Kidneys can be infected in the conventional way by a variety of germs which may reach them either by the blood, or the germs may ascend up the urinary treat to the kidneys. These infections could be acute if the organisms have the upper hand or the defense is low. It also depends on the type of organism that affects the kidneys. Infections like tuberculosis develop slowly and run a chronic course. Obstructions play a major role in the causation and development of infection it is a well known fact that even stagnant water gets dirty, likewise, any slackening or stoppage in the flow of urine will obviously encourage infection, and that is why stones and infections are complementary to each other.
Besides the conventional method, there is another way of kidney damage. The body defense system under uncommon circumstances, start destroying the kidney tissues resulting in auto immune disease of the kidneys.
Glomerulo nephritis is an example of such process. The net result of all these processes is kidney destructions and finally kidney failure. Besides the kidney, the bladder is the next common site of infection. Infection in the bladder is called cystitis. This could be acute or chronic.
Stones and Infections
We live in a hot climate, and here, if we do not drink enough water, we produce concentrated urine. If obstruction is added to these already concentrated urines, stones precipitate rapidly. In about 5% of the patients, stones can result from diseases of other organs of the body like parathyroid tumor or gout. In the rest of the 95% of the patients, there is no definite cause, but this combination of infection, obstructions and other factors work. Because of the stones lodging at the narrow outlet of the kidney, (pelviureteric junction) the flow of the urine is back pressure and damage to the renal tissues. In the initial stages, the kidneys try to push the stones down, thus explaining the pain. The cessation of pain may indicate of an exhausted kidney. Therefore it should not lure the patient into a false sense of security. As long as pain exists, one can assume, in most of the cases that the kidney is functioning.
Management of Infections and Stones
Before giving antibiotics for infections, it is essential that we know the types of organisms and their sensitivity. For this, urine examination and culture, and sensitivity should be done. To know the working of the kidneys and the damage already caused there, intravenous pyclogram and estimation of blood urea are helpful.
Proper antibiotics, given in proper doses, under medical supervision, for an adequate length of time, control the infections. During the therapy, the patient is encouraged to take plenty of liquids. If one kidney is totally damaged and there is no function in it while other kidney is normal, the useless kidney can easily be removed. The fear that life will be miserable after removal of a kidney is baseless. One can easily survive normally on one kidney.
For stones, the only available method at present is surgery. If the stone is very small and can negotiate the narrow urinary passage then we can wait and expect it to be passed out. However, if it is causing damage it should be removed immediately. In case of multiple stones lodged in one part of the kidney that half can be removed my surgery called partial nephrectomy. There may be claims that there is a known solution that will dissolve stones and would leave the normal tissues intact. Those who claim such miracles only deceive people and people should not fall prey to such quacks.
High Blood Pressure and Diabetes
High blood pressure and kidney disease are inter related. Persistent high blood pressure can cause irreversible kidney damage. At the same time, if the kidneys are diseased and their blood supply is restricted, then such ischemic kidneys can cause high blood pressure. This is known as renal hypertension. Many of these cases of renal hypertension are amenable to surgery.
Diabetes, over a period of years, when not managed properly, can cause kidney damage and this again is permanent damage. Therefore, diabetes should always be treated properly.
Tumors of the Kidney
Painless hematuria, (blood in urine) abdominal tumor or kidney failure can be the symptoms of tumor. It is unfortunate that cancer of the kidneys grows slowly and silently and valuable time is lost before the patient reaches for medical help. It is here that the importance of regular check ups can be emphasize, as during these checkups we can diagnose such serious ailments in the early stages.
The treatment is only removal of that kidney. If it is diagnosed in the early stages, then the operation is easy and patient can survive for many years.
All these diseases, if left unattended, finally culminate in kidney failure called uracmia. The patient can still survive, provided the waste products of this day to day body activities can be removed from the blood.
These people used to die, but now they can live for years on an artificial kidney. The other method of substitution kidney is to transplant them I.e a donor kidney in the patient’s body.
Something about Dialysis
With the advancement of sophisticated machines, the patient’s blood is purified by passing it on one side of cellophane membrane, on the other side of a solution is passed. This solution is constituted in such a way that it attracts the impurities by process of osmosis, and the waste products pass through the membrane from the blood into the solution. The purified blood is then returned into the patient’s body. This has to be done at lest 3 times a week, and each time it takes about 6 to 8 hours.
Another method of purifying the blood is by passing a solution into the peritoneal cavity (abdomen) and leaving it there for some time, so that the impurities can pass into this solution. This is them removed. It is not an affective as blood dialysis, and there are chances of complications. This is a method that does not require an elaborate apparatus and can be done at any hospital.
The replacement of diseased, worn out or injured tissues and organs with sound parts has stimulated the imagination of main for many centuries, and kidney transplantation is a sequel of such thoughts. Among the major organs, kidney transplantation is the most successful and is most commonly done. This is, perhaps, because the patient can be maintained on dialysis prior to the surgery, and the technique of transplantation is not very difficult. The most important aspect of this organ transplant is that a healthy human can donate one kidney without suffering from any damage or serious consequences.
The main obstacle to successful implantation of tissues from one person to another is the rejection phenomenon. Our body normally refuses to accept any foreign tissue and it fights its entry. Slowly and gradually with research, we are overcoming this problem but it still poses a big threat. Rejection is less severe and less frequent if the transplanted kidney matches closely with the patient’s tissues, for example, kidney from blood relatives. In such cases, the success rate is very high.
Before the transplantation is done, the tissues of the donor and the recipient are matched and then only the kidney is accepted for transplantation. Therefore, it is obvious that blood relatives who are in absolutely good health should donate a kidney to the ailing relative. We always make sure that the donor’s health is not jeopardized in any way. No doubt the donor has to undergo a major surgical procedure when his kidney is removed, but it is worth when somebody’s life is at stake.
Once the kidney transplant is accepted, the quality of life for the patient improves dramatically and he resumes his normal life style.
Nature has given plenty of reserve in our kidney. It is mainly through our ignorance and negligence that we push ourselves to the brink of kidney failure. Most of the kidney dieses are now manageable, and even after kidney failure there is hope in the form of dialysis and transplantation.