Frequently Asked Questions

A healthy human being has two kidneys. These are bean-shaped organs located in the rear abdominal cavity, left and right of the spine, slightly beneath the diaphragm under the rib cage, with the left kidney sitting behind the spleen and the right one behind the liver.
Each kidney is encapsulated by a solid cover of connective tissue (renal capsule) and embedded in further layers of fat and connective tissue, which protect the organ from trauma and anchor it to the rear abdominal wall
The inner organ can be divided into three major parts: the outer renal cortex, the inner renal medulla, and the renal pelvis in the area of the hilum.

The kidney tissue (parenchyma) contains about one million little filter units, the so-called nephrons. These nephrons filter the blood and produce urine. Each nephron consists of a so-called renal corpuscle followed by a tubule.
Together, corpuscle and tubule form a functional unit

The functions of a kidney are as follows-

1.       Remove waste products from the blood and for urine which expels these waste products from the body.

2.       Remove drugs/medicines from the body via urine.

3.       Balance the fluids in the body.

4.       Release hormones which regulate the blood pressure of the body.

5.       Produce an active form of Vitamin D which keeps the bones strong and healthy.

6.       Control the balance of hemoglobin by producing a hormone called Erythropoietin.

Kidney failure is loss of the kidney’s ability to filter toxins/waste products leading to an accumulation of waste products in the blood. Kidney failure can be temporary (Acute Kidney Injury-AKI) or permanent (Chronic Kidney Disease-CKD).

Acute Kidney Injury is a sudden loss of kidney function that happens in a few hours or days. It leads to sudden accumulation of fluid (in case of low or no urine output) in the body causing swelling over the face, legs, and abdomen. This may lead to breathing difficulty. AKI also leads to a sudden build-up of toxins in the blood which may lead to vomiting, nausea, low appetite.

AKI is caused due to several conditions like-

1.       Conditions that lead to low blood pressure-Septic shock, hypovolemic shock, heart attack/failure, severe dehydration, burns, blood loss, injury.

2.       Drugs causing damage to kidneys-painkillers (NSAIDs), etc

3.       Certain cancers like multiple myeloma, etc.

4.       Allergic reaction of certain drugs leading to kidney dysfunction-Acute Interstitial Nephritis (AIN)

5.       Conditions that cause inflammation or damage to the kidney tubules, to the small vessels in the kidneys, or to the filtering units in the kidneys (such as tubular necrosis, glomerulonephritis, vasculitis, or thrombotic microangiopathy)

Blockages in the urinary tract due to kidney stones enlarge prostate, bladder, prostate, or cervical cancers.

Chronic kidney disease is a gradual loss of kidney functions over several months to years ultimately leading to end-stage kidney disease, facilitating the need for some form of dialysis or kidney transplantation.

Chronic Kidney Disease can be caused due to-

1.       Uncontrolled hypertension

2.       Uncontrolled diabetes mellitus

3.       Glomerulonephritis-group of disorders which leads to inflammation of the kidney filters (also called glomerulus or nephrons) leading to loss of protein in the urine and progressive loss of kidney function.

4.       Certain autoimmune disorders like Lupus Nephritis

5.       Inherited disorders like Autosomal Dominant Polycystic Kidney Disease (ADPKD)

6.       Chronic or long-term obstructions to the urinary tract due to kidney stones, cancers, and prostate.

7.       Repeated urinary infections leading to chronic pyelonephritis.

Stages of Chronic Kidney Disease (CKD) -NKF KDOQI guidelines

STAGE	DESCRIPTION	GFR (ml/min/1.73m2)
1	Kidney damage with normal or increased GFR	>90
2	Kidney damage with a mild decrease of GFR	60-89
3a	Kidney damage with a moderate decrease of GFR	45-59
3b	Kidney damage with a moderate to severe decrease of GFR	30-44
4	Kidney damage with severe decrease of GFR	15-29
5	End-Stage Kidney Failure	<15

There may be sometimes no symptoms of kidney failure until the very late stages of kidney damage. The earliest symptoms usually are mild puffiness of lower eyelids early in the morning which fades off within an hour, mild swelling over the ankles.

Other symptoms seen in kidney failure are:

• Nausea
• Vomiting
• Loss of appetite
• Fatigue and weakness
• Sleep problems
• Changes in how much you urinate
• Decreased mental sharpness
• Muscle twitches and cramps
• Persistent itching
• Chest pain, if fluid builds up around the lining of the heart
• Shortness of breath, if fluid builds up in the lungs
• High blood pressure (hypertension)
• Decreased cognitive function in later stages.

Kidney failure is diagnosed with the help of very simple blood and urine tests. If your doctor suspects kidney dysfunction based on your symptoms, he will get the following tests done-

1.       Blood Urea/ Serum Creatinine (Blood toxin levels)

2.       Urine routine/microscopy (to check for loss of protein through urine)

3.       Ultrasonography of the kidneys (to check for the size of the kidneys)

Patients with deranged kidney function are diagnosed to have kidney failure. Your doctor will determine whether it's acute or chronic based on the clinical history and other parameters.

Unlike Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) is a progressive disease. If diagnosed at an earlier stage, there are means to slow down the speed of worsening of your kidneys. This may be achieved by the following means-
1. Good control of your Blood Pressure. BP <135/85mmHg is usually targeted to slow down the worsening of kidney function.
2. Good control of blood sugar levels. HbA1C <6.5% is usually targeted to slow down the worsening of kidney function.
3. Restriction of protein in the diet. A normal healthy individual needs to consume 0.8g/kg/d proteins in the diet to meet his/her daily protein requirements. Patients with CKD are advised to reduce protein in the diet to 0.4-0.6g/kg/day depending on the stage of CKD and the nutritional status of the patient. Several studies have shown that restricted protein in the diet has indeed helped in slowing down the progression of chronic kidney disease.
4. Avoid drugs causing damage to your kidneys-such as painkiller tablets/injections and certain antibiotics. Even certain ayurvedic and herbal medicines may damage your kidneys.
5. Avoid getting dehydrated.
6. Despite all measures, your kidneys may reach end-stage renal failure someday. Such patients are advised to start some form of dialysis or undergo a kidney transplant. When the estimated GFR (kidney function) is around 20%, the nephrologist advises construction of AV fistula (a connection between vein and artery at the wrist or elbow) which acts as venous access for hemodialysis. Patients who do not have a proper vascular access are considered for another form of dialysis which is peritoneal dialysis. The best option of Renal Replacement Therapy (RRT) however is kidney transplantation which is offered to all patients with end-stage kidney failure.

Chronic kidney disease (CKD) is a progressive disease-the progression of which can be retarded with suitable measures. They include-
1. Good control of blood pressure and blood sugar.
2. Avoiding medications that could potentially harm your kidneys further. eg. painkillers, ayurvedic medications, herbal remedies, etc.
3. Avoiding dehydration.
4. Controlling the protein intake in your diet esp. red meat.
5. Ask your doctor regarding the role of alfaketoanalogues in retarding the progression of CKD. This works in tandem with protein restriction in your diet.
It should be understood that the progression of CKD cannot be halted but retarded and the patient is going to need some form of Renal Replacement Therapy (RRT) after a few years.

A dialysis is a form of treatment where blood toxins are removed from the body with the help of a machine and a filter (dialyzer). Patients with Chronic kidney disease require initiation of dialysis when-

1.       The estimated GFR (eGFR) is less than 10ml/min/1.73m2 in the case of non-diabetic patients and less than 15ml/min/1.73m2 in the case of diabetic patients.

2.       When the serum potassium levels remain persistently above 5.5mmol/l along with a low eGFR as mentioned in point 1.

3.       Patients develop uremic symptoms viz. low appetite, weight loss, nausea, vomiting, breathlessness, swelling over the body along with a low eGFR as mentioned in point 1.

Dialysis when initiated in patients with chronic kidney disease cannot be stopped since the eGFR is very low to sustain normal life and hence dependent on dialysis for removal of body toxins.

 

 

Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. It is done with the help of a hemodialysis machine and a special filter (dialyzer) which filters the toxins from the patient’s blood. Dialysis comprises of 2 procedures-removal of toxins from the blood and removal of extra fluid from the body (Ultrafiltration-UF). For removing blood from the body, venous access in the form of a hemodialysis catheter or AV fistula (arteriovenous fistula) is necessary.

Hemodialysis is usually done in the hospital; however, the option of home hemodialysis is also available. The optimum frequency of hemodialysis is 3 times a week and each session is 4 hours. A good blood flow of at least 300ml/min from the venous access is crucial for the efficacy of dialysis. It’s important for a dialysis patient to restrict fluid intake to remain dry (free of extra fluid in the body). Drinking excessive fluids in between 2 sessions of dialysis leads to excessive interdialytic weight gain. Removal of this excessive fluid during dialysis may lead to low blood pressure, cramps and weakness on dialysis due to the high fluid removal rate on dialysis.

Yes certainly.
Staying fit and healthy on dialysis is not rocket science at all.
A few important points which help a good healthy life, while on dialysis are as follows-

Adequate dialysis (kt/v 1.2 or a URR 70). Kt/v and URR are dialysis adequacy measures and a minimum target of kt/v of 1.2 or a urea reduction ratio (URR) of around 70 ensures that you are dialyzed adequately. Every patient should try to achieve this adequacy target.
Ensure a good protein intake while on dialysis (1.2-1.5g/kg/day) since you lose protein through dialysis. Your serum albumin level should be around 4g/dl
Make sure your blood pressure control is optimal and that there are no fluctuations while on dialysis.
Make sure your hemoglobin levels are in between 12-13g/dl
Make sure your blood levels of Calcium and phosphorus are well controlled.
Ensure that you have achieved your dry weight and get it reviewed every month by your nephrologist.
Most important, ensure fluid and salt compliance. Stick to your fluid and salt restrictions. The inter-dialytic weight gains should not be more than 2000gms. This avoids intradialytic fall in blood pressure and leg cramps

The fruit is safe in almost any amount, there is no harm with it unless you have any intolerance or on a very low carb/keto diet. The fruit has natural sugar i.e fructose – hence diabetic people should opt for fruits with low to medium GI which are allowed in a Diabetic diet with portion control (Can have up to 2 to 4 servings per day) provided blood sugar monitoring is done regularly.

As per USDA & AHA recommendations – 2 to 5 servings of whole fruit (high fiber, rich in antioxidants) can be taken per day. It lowers the risk of many diseases like Diabetes, Obesity, Heart disease, Stroke, Premature aging, Cancer, etc.

The safe level of caffeine intake in healthy adults is 200mg up to 400mg per day (without any medical condition like HTN/Anxiety/Heart disease/Arrhythmia/Peptic ulcer disease/Gastroesophageal reflux disease/Hyperthyroidism/Medications like decongestants- ephedrine, theophylline (anti-asthmatic), antidepressants.  Pregnant women should limit caffeine intake up to 200mg or less.

Fermented foods are beneficial for heart health when combined with medicines & lifestyle changes. They contain some probiotics or beneficial live microbes particularly lactobacilli which reduce total & bad LDL cholesterol (by preventing their formation, absorption & helping their breakdown), also reduce high blood pressure, reduce chronic inflammation (Inflammatory chemicals - CRP & fibrinogen) – thus ultimately reduce heart disease risk. Fermented foods are also good for gut health & immune system function.

 

Many types of artificial sweeteners exist, but not all are approved for use in every country. The most common ones include aspartame, sucralose, saccharin, neotame, and acesulfame potassium. They are generally considered safe for human consumption when consumed within safe limits (Should be avoided by people who have phenylketonuria or are allergic to sulfonamides).

Overall, the use of artificial sweeteners poses few risks (e.g Sucralose decreases insulin sensitivity, affects gut bacteria) and may even have benefits for weight loss, blood sugar control, and dental health. These sweeteners are especially beneficial if you use them to decrease the amount of added sugar in your diet.

Having said that, the likelihood of negative effects can vary on an individual basis and depend on the type of artificial sweetener consumed. Some people may feel bad or experience negative effects after consuming them, even though they are safe and well-tolerated by most people. If you’d like to avoid artificial sweeteners, try using natural sweeteners instead (Stevia, Erythritol, Xylitol, Yacon syrup) within their safe limits. In the context of a healthy, whole-food-based diet, small amounts of natural sugars (Honey, Coconut Sugar, Molasses, Maple syrup) won't cause any harm when taken in moderation though they are not different from sugar (Provide almost the same calories, the only difference is that they provide some fructose i.e natural form of sugar, some nutrients & minerals).

At whatever stage you are, a Balanced diet is a must which includes all different food groups in reasonable amounts – Cereals, Pulses & Legumes; Milk & milk products, Nuts & Seeds, Vegetables & Fruits, Lean proteins, Healthy fats in addition to regular exercise & lifestyle modifications. (Refer to our you tube video for its significance – The Nutrition Rainbow). Avoid high sugar & salt, processed & packaged food items.

There are many diets in the market with many different names. In any case, nothing beats a Well Balanced Nutritious diet including all different food groups in reasonable amounts (Cereals, Pulses & Legumes; Milk & milk products, Nuts & Seeds, Vegetables & Fruits, Lean proteins, healthy fats). That is the best diet to follow in healthy people without any medical condition.