Kidney Failure, Chronic Kidney Disease, Kidney Stone and Related Diseases

Approximately 16 million Americans have diabetes, and 100,000 people have been diagnosed to kidney failure as a result of Type I and Type 2 diabetes. Diabetes is the most common consequence of kidney failure, followed by hypertension which is another major factor of nephropathy (a final stage of a gradual deterioration of the kidneys), and kidney failure. About 80,000 Americans are found to have a serious condition in which their kidneys are unable to eliminate body waste, such as urea and creatinine from the blood. Kidney disease always progresses silently for months or even decades, before the indication of chronic kidney disease (CKD) is detected.

What are Kidneys?

There are two dark red and bean-shaped (about the size of your fist or a bit larger than a deck of cards) kidneys in your body which form up part of your urinary system. They are located on the dorsal wall of the abdomen (or near the middle of your back, just below the rib cage), one on each side of the backbone.

Your kidneys consume about 20-25% of your body’s supply of oxygen and receive about 25% of the total amount of blood while you’re at rest. Basically, your kidneys take less than 0.5% of your total body weight. Each kidney measures 4-5 inches in length and about one inch thick, with the weight approximately 4.5-5 ounces. There are about 1 million nephrons found in each kidney. Each kidney is supplied with a renal artery (brings blood containing excretory products to the kidneys) and a renal vein (carries away blood which has been filtered by the kidneys).

What do Your Kidneys do for You?

Your kidneys are two amazing trash collectors as they filter about 200 quarts of blood a day in order to sift out 2 quarts of excess water and waste substances, which will turn into a form of urine that stores to your bladder via tubes called ureters (lead out from each kidney). The urine is stored in your bladder until you go for urination. In fact, your kidneys perform many works to clear the excretory products (such as feces, excess mineral salts and water) from your blood to keep your blood clean and chemically balanced.

After your body has taken the food for self-repair and energy, the waste will be returned to the blood. If your kidneys are unhealthy, they’re unable to remove the wastes and protein from the blood and the build up of waste will then clog or even damage your kidneys. Besides that, your kidneys are also unable to filter (the filtration happens in tiny units inside your kidneys called nephrons) urea, a compound containing nitrogen out of the blood and dispatch it back to the bladder in the urine.

Your kidneys do a great job for you by processing or filtering the blood plasma, while allowing sugars, vitamins, water, amino acids and other important substances back into your bloodstream. The excess salts, minerals, urea from protein digestion, water, waste of hormone, certain toxins, urochrome as well as creatinine generated from the muscle breakdown are then eliminated from your body via urination process (quoted from my previous article entitled Is your urine healthy?).

Your kidneys reabsorb useful substances (such as glucose and amino acid) into the blood stream. The reabsorption of substances helps the body to maintain the substances dissolved in the blood plasma, pH level and your body’s fluid composition. Simply put, when 40 gallons (about 150 litres) of filtrate passes through your kidneys on a daily basis, only 1 to 2 litres (or 1 to 2 quarts) will turn into urine. Now, can you see how hard the kidneys have worked for you to make urine?

Your kidneys help to regulate water in the blood which is called water balance (maintain the volume of water in the blood at an almost constant level). If your body loses too much water (such as during diarrhoea), your body will become dehydrated. But if too much water is drunk, the water content in your blood will rise, and your blood becomes more dilute than normal.

Your kidneys help to regulate glucose in the blood. That’s why when you’ve diabetes; you’ll have a very high level of glucose in your blood after a heavy meal. In this situation, your kidneys do not reabsorb all the glucose but let the extra glucose pass out of the body in the urine.

In addition to these functions, your kidneys release three important hormones: (1) Renin which helps regulate blood pressure; (2) Erythroproietin (or EPO) which helps stimulate the bone marrow to make red blood cells, and finally (3) active form of vitamin D which helps maintain calcium in your blood for bone building as well as to maintain the chemical balance for your body.

What do you Understand as “renal function”?

Very often, when you see a doctor or a health care professional, they’ll mention two common words – renal function, to describe the work your kidneys do. What do you understand as “renal function”? If the renal function is evaluated at 100 percent, meaning that both of your kidneys are very healthy and they’re functioning at their optimal level. This level is not the main requirement to survive.  You may come across those who were born with one kidney, or those who only have 50 percent of the renal function (can still lead to a healthy life with the condition that their renal function remains at its stability) are still able to survive.  That means small reduction in renal function, generally causes you no problem at all. Nevertheless, people who already have kidney disease with the remaining 50 percent of renal function may have problem to lead a healthy life if their kidneys become worst. When the renal function drops to less than 20 percent, you’ll have to experience some serious /or underlying health problems.  In short, when renal function has deteriorated to less than 10 to 25 percent of normal capacity, the symptoms associated with kidney failure become prevalence, which is also the final stage of this disease. At a stage in which your renal function declines to well below 10 percent, you may have to rely upon certain form of renal replacement therapy, which can either be kidney transplantation (which is received from a healthy kidney donor) or dialysis (which helps substitute for some of the filtering capacity of the kidneys) to prolong your life.

Why Your Kidneys Fail to Function?

The damage of nephrons has been identified as a main culprit why your kidneys fail to function at the level they should be. When the nephrons are damaged, you’re more prone to kidney disease since the damage can result in poor filtering capacity in your kidneys. Generally, your kidneys will attack the nephrons slowly since apparent damage is only felt years or decades later. Of course, injury or poisoning may also cause the damage of nephrons.

Diabetes and high blood pressure are two main causes of kidney disease. Apart from these two causes, people who have a family record of kidney disease may have high risk in inheriting kidney disease.

At this point, you may ask me, “Chan, why kidney disease is always associated with diabetes and high blood pressure?”  When you have diabetes, your body assimilates the sugar poorly. And for your information, when the sugar is not broken down, it’ll remain in your body as a poison; and this unused sugar in your bloodstream will further damage the nephrons in your kidneys, scientifically, it’s termed as diabetic nephropathy. However, you can prevent and delay this condition by bringing your blood sugar level down.

High blood pressure, or hypertension (high blood pressure exceeds 140 millimeters of mercury-systolic [pressure in the arteries during contraction of the heart] and 90 milimeters of mercury-diastolic [pressure in the arteries between heartbeats], or “140/90 {140 over 90}”), is another common cause and consequence in the development of kidney disease or chronic kidney disease, particularly among those with diabetes. High blood pressure can attack the blood vessels that filter poison from your blood in your kidneys, causing you at higher risk of loss of kidney function and the progress of cardiovascular disease. Apparently, people with family record of hypertension and the presence of hypertension will always have an increase chance of progressing to either kidney disease or kidney failure, and it may also accelerate the progress of already existed kidney disease. As kidney disease progresses, it leads to certain physical changes which may result in the increase rise of the existing blood pressure. The accelerated GFR decline and pathological abnormalities in kidneys are more marked with individual with high blood pressure. When you see a doctor, he/she’ll prescribe the medicines called ACE inhibitors to protect your kidneys, particularly among those who have diabetes.  Since both diabetes and high blood pressure are dangerous spirals for the patients, you’re advised to have early detection, screening or treatment even your hypertension is mild, and this is particularly essential for those who have both diabetes and high blood pressure.

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Besides diabetes and high blood pressure, kidney disease can also be inherited from the family members who have a record of kidney disease. Polycystic kidney disease (PKD) is one of the examples, in which many cysts will be observed growing in your kidneys. These cysts are scary that as they’ll slowly replace the mass of your kidneys by reducing renal function and which eventually leads you to kidney failure. There are reports stating that a rarely seen form of PKD called autosomal recessive PKD can even develop in a child when they’re still in the womb, and this problem will definitely disrupt the formation of nephrons. In the case that your child has shown you protein or blood in their urine, low number of red blood cells (also called anemia), the rise of blood pressure, unusually slow growth, frequent vomiting, or frequent back or/ and side pain, please bring them for blood and urine test, radiology study or for an immediate medical diagnosis. Bear in mind that this symptom cannot be ignored as it shows you the early sign of kidney disease.

Food poisoning, melamine tainted foods, trauma, excessive use of alcohol and other underlying causes can also lead to the development of kidney disease. Certain over counter medications, with the most notably poisonous to your kidneys are painkillers, laxative, ibuprofen, acetaminophen, vitamins, aspirin and certain medications can put you at high risk of kidney disease. Certain drugs or poisons can even make your kidneys stop working, causing acute renal failure (ARF), which shows an obvious decline in kidney function. Therefore, you’re recommended to consult the doctor prior to the intake of the medication. If you’re always using antibiotics, aspirin, paracetamol (or acetaminophen), painkiller, laxative, or other medications without the prior permission from your doctor, you’re advised to check with the doctor to ensure the functionality and condition of your kidneys.

A sudden knock or an accident can also injure the kidneys. Losing a lot of blood due to this unexpected incident can directly cause a sudden kidney failure, in which this so called ARF may lead to permanent loss of renal function. Nonetheless, ARF can be reversed if the kidneys are not badly injured.

In most cases, Chronic Renal Failure progresses very slowly as this “silent” disease can progress for years or decades without showing any significant symptoms or consequences. However, the gradual loss of renal function will then progress into a stage of chronic kidney disease (CKD) if left untreated. At the end-stage renal disease (ESRD), which is a condition of total or nearly total and permanent kidney failure, people must undergo dialysis or transplantation for their lifetime.

What are the Symptoms of Kidney Disease?

Kidney disease is a silent killer as its early sign is very subtle, and it takes years to progress from CKD to kidney failure. Furthermore, kidneys themselves have the ability to compensate for problems in their function. Therefore, people who already have CKD can still live without progressing into a stage of kidney failure. That means CKD can progress for a long time without showing any symptoms until one day you come to realize that your kidneys have minimal function left.

The causes of kidney disease vary greatly among the individuals. Meanwhile, several bodily function and system might be affected in a large number of different ways. Even in a very advanced stage of CKD, notably, most patients show either no symptoms or no decrease in urine output. The best option to diagnose for the possibility of kidney disease is to get your blood and urine examined.

Screening is always prompted at its early stage as early detection and prevention can save life. If you or anyone has the symptoms listed below, I will strongly recommend you to check with a doctor.

• The abnormal changes can be observed in urination. The urine maybe bubbly or foamy, and sometimes the urine may contain blood (the blood may look like a dark red colored grapes). You may have to get up at night to pass urine, and you’ll observe that your urination is more frequent than usual. You may urinate in greater volume of pale urine. In certain condition, you may urinate less frequent than usual, or/and your urine is dark in color in smaller volume than usual (that means your urine may be two to three drops). You may also feel an obvious pain and pressure while passing urine.
• When you’re suffering from kidney failure, your kidneys are unable to eliminate extra fluid. This fluid, which is built up in your body can cause obvious swelling in your face, ankles, feet, or/and hands. Some patients may even have more swelling in their ankles, until they are so big to get their shoes on. You may also observe your hair falling off, unexplainable weight loss and your face may even look puffy. Obviously, you’re not in a good mood since you feel exhausted just to walk for a short distance. When this happens to you, you may be wondering what was going on with you. Well, this is one of the signs of kidney disease, indicating that your kidneys are functioning very weakly.
• You’re always feeling exhausted and tiring even you do nothing. The condition is that you sleep a lot, because the fatigue gets you totally drained. You’d prefer to get right in bed to doing anything else. In other words, you just feel like tired all the time, that make you feeling extremely fatigue. This condition is called anemia, and it’s curable. Anemia is due to that your kidneys produce less erythropoietin, a type of hormone that prompts your body to produce oxygen-carrying red blood cells. With fewer red blood cells to supply oxygen, your cells, tissues, muscles and brain get tired very easily and rapidly.
• You know that kidneys help to remove waste from your bloodstream. In a case of kidneys failure, kidneys cannot remove the buildup of waste in your blood, and thus causing severe itching. The feel of itching is of course not the same as in a skin itch or skin rash, as you’ll feel the itch just right down to your bone. Due to an unbearable itching, certain patients even have their back bleeding due to the act of over scratching. 
• To you, the food that you taste sounds bizarre and strange. You really don’t have a good appetite to eat. The foul/metallic taste in your mouth will definitely stop your liking to eat meat, or you may just feel like no liking to eat. Your poor appetite plus bad breath (your breath smells like Ammonia) is due to a severe buildup of waste in the blood (called uremia), making you feel like drinking/eating iron. This condition causes you losing weight which doesn’t benefit your health at all.
• Not only Uremia causes bad taste and bad breath, but it can also cause nausea and vomiting. This condition doesn’t always keep your food down in your stomach. It’s just like you’re throwing up all the time. When you’re experiencing this consequence, you may have difficulty to eat or/ and drink, and even you may experience hard time to take your blood pressure pills. Despite of poor appetite, it could lead to weight loss that seems not to reward your health.
• You always have a moment of shortness of breath which just fears you as you think you might collapse to the ground, or you may just feel like drowning. When you get the shortness of breath, you may have to sit for a while to refresh yourself. The trouble in catching your breath can cause you unable to sleep at night. When you can’t breathe and can’t walk anywhere you want to go, the feeling can be very bad. The shortness of breath, making you out of breath while climbing a flight of stairs, or causing you tired easily which prompts you to stop doing your work. The condition is due to two reasons – firstly, an insufficient oxygen-carrying red blood cells (also called anemia, as mentioned earlier) leaving your body short of breath ( or oxygen-starving), and secondly, the buildup of extra fluid in your lungs.
• Anemia does not just make your blood circulation circulating badly, but it also makes you feeling cold or chill all the time, even you’re in a warm room. That means it could be hot outside, but you’d feel really cold, or you get chills. 
• Since your brain is lack of supply of oxygen due to kidney failure, you may have trouble with concentration at work or studies. You really have a very bad memory problem plus dizziness, causing you unable to remember what you did two days ago. You may think that this condition is due to your diabetes, blood sugar or blood pressure but instead it’s not the case.
• You may be wondering why the lower parts of your back or side to where your kidneys located always get you feeling pain. This is not just a normal back pain, it’s a kidney problem. People who suffer from polycystic kidney disease may feel extremely pain and hurting. This situation is caused by a large fluid-filled cysts forming on the kidneys and sometimes they’re formed on the liver. You may get up at night due to an unbearable pain which may cause your tears rolling down your cheeks. And then when you’ve to be awaken throughout the night, you may have a hard time experiencing a backache or/ and the side ache, causing you hardly to move around or sleep.

Stages of Chronic Kidney Disease (CKD)

The below stages explain the development of kidney disease, particularly among those with type 1 or type 2 diabetes who have progressed to kidney failure. For them, the progress from stage I to stage IV will take about 17 years if left ignored untreated. Nonetheless, in certain cases, the progress to kidney failure can even take up to 23 years. Scientists reveal that those with untreated blood pressure and blood sugar may have kidney failure occurred earlier with the estimated average length of time in between 5-10 years. But in the case that proteinuria does not develop within 20-30 years, there will be a decrease rate in progressing into CKD.

Stage I: kidney damage (with normal or ↑GFR); ≥ 90 (mL/min/1.73 meter square)

Stage II: kidney damage (with mild or ↓GFR); 60-89 (mL/min/1.73 meter square)

Stage III: moderate↓GFR; 30-59 (mL/min/1.73 meter square)

Stage IV: severe↓GFR; 15-29 (mL/min/1.73 meter square)

Stage V:kidney failure; < 15 (or dialysis)

• At the stage I, the blood flows through the glomeruli in your kidneys, and this is scientifically termed as hyperfiltration. Your kidneys appear larger than normal kidneys. People who’re in stage I may either advance to stage II after many years or just remain at stage I.
• At the stage II, there’s a prevalence damage of glomeruli. Small amount of protein (also known as albumin) is seen leaking into the urine, in which this condition is called microalbuminuria. In the beginning of stage II, almost no microalbuminuria is evaluated. Since at this stage, the rate of filtration remains either near-normal level or elevated, the rate of albumin loss may increase from 20-200 micrograms per minute over the time. (Note: the constant microalbuminuria should be less than 5 micrograms per minute). At this stage II, those who have diabetes either type 1 or type 2 should seriously control their blood pressure and blood sugar levels.
• At the stage III (or sometimes, it’s referred to “dipstick-positive proteinuria”, “overt diabetic nephropathy” or “clinical albuminuria”), the loss of other proteins and albumin into the urine is already exceeded 200 micrograms per minute. Urine test must be carried out for further diagnosis and treatment. Stage III also marks a significant increased damage of glomeruli, some patients even have high blood pressure developed. And very often at stage III, the kidneys have lost its ability to filter waste, and thus resulting in the rise of urea-nitrogen level and blood level of creatinine.
• At the stage IV (also known as “advanced clinical nephropathy”), large amount of protein leaks into the urine, and meanwhile, the glomerular filtration rate drops to well below 75 millimeters per minute, accompanying with the occurrence of high blood pressure. The levels of urea-nitrogen and creatinine increase substantially in the blood.
• At the stage V, it’s a stage that highlights the final phrase of kidney failure, marking apparent symptoms of kidney failure. The glomerular filtration decreases to less than 10 milliliters per minute.

How to Take Good Care of Your Kidneys?

Here are some practical suggestions to take good care of your kidneys:

• Have your urine examined yearly; particularly you should go for a regular check of microalbumin, glucose and a kidney scan. The microalbumin test will help detect any abnormalities for renal function at its very beginning stage. If any abnormal reading is recorded, you’ll have to consult a doctor on the issue of how often you’ve to get your kidneys monitored.
• Control your temper, stress or pressure so that it won’t give rise to your blood pressure. Keep monitoring your daily diet, figure out several relaxation techniques (such as medication, praying, and etc.) and blood pressure medication (such as ACE inhibitor) to keep your blood pressure as normal as possible.
• If you’ve a family record of high blood pressure, kidney disease or diabetes, you should always consult your physician to monitor your blood pressure, blood sugar or renal function. Try spending time to discuss with your doctor with regards to the use of medication like ACE inhibitor to help prevent or delay kidney disease.
• If you’ve come across the abnormal symptoms such as burning when urinating, frequent urination than usual, and your urine has a strong smell or cloudy in appearance, you should consult your doctor for early diagnosis as these symptoms may reveal the infections of urinary tract or bladder.
• If you’re from a family with kidney disease history or you’ve any kidney related disease, make sure that you limit the intake of animal protein in your daily diet.
• You should go on low-salt, low-sugar, low-cholesterol/lipid and low- protein diet. Besides that, you should exercise regularly and live a relaxed life by controlling your emotion, anger and stress.
• You should never stay overnight (stay active up to 3a.m.) as this will wear down your kidneys. The best is to sleep before 11p.m.
• You should never have supper after 10p.m or overeat as this will add to the additional burden to your kidneys to filter out the waste substance.
• You should replenish your body with appropriate and enough fluids (read more on how to maximise your health by drinking water in my previous article here [page 11-12]) so that your kidneys can keep your body clean by continuously eliminating waste materials. This is also important to prevent illness or your kidneys for prematurely wearing down as you age.

What to Do If You’ve Kidney Disease?

Limit the Intake of Protein

You shouldn’t eat too much animal protein. That means you should have a low protein diet (almost “vegetarian” diet), with your daily diet includes 3 -4 ounces of animal products of meat/processed meat, milk or cheese.

Too much protein adds to greater workload on your kidneys, causing them to work helplessly to filter blood urea nitrogen (BUN), a by-product of protein metabolism, out of your blood. The frequent increased workload, undoubtedly, can lead to premature breakdown of the glomeruli in your kidneys. But this is not a case in the healthy kidneys. When protein enters your body, it’ll be broken down into amino acids that contain nitrogen. Urea is formed when the nitrogen combines with other molecules after it’s separated from amino acids. Then, your kidneys take a turn to filter it out of your blood before the excretory product is eliminated out of your body in the form of urine or/ and feces.

For healthy kidneys, the intake of protein is half of the body weight (in pounds) in grams per day. That means you can eat up to 50 grams of protein per day, if your weight is 100 pounds. In contrast, if you’ve problems with your kidneys (kidney failure, kidney disease or any kidney related disease), you should limit the intake of the protein as minimal as possible so that a healthy BUN level can be attained. (Note: The healthy level for BUN is between 4 to 17mg/dL, and the normal blood always contains 7 to 20 miligrams of urea per deciliter of blood. Any reading between 18 to 21 mg/dL indicates that you’ve been eaten too much protein, and your kidneys are under stress and exhausted. The BUN level of more than 21 mg/dL indicates that your kidneys may not be working at full strength, and in this case, you need to seriously reduce your protein intake. The elevated BUN level may also cause by heart failure and dehydration.) Low protein diet has shown to benefit people with stage III or stage IV nephropathy, or people with kidney disease of diabetes and high blood pressure. Excessive consumption of protein has been closely linked with harmful effects in people with diabetes, kidney failure, kidney stone, high blood pressure and other kidney related diseases.

Avoid Taking any Over-the-counter Drugs on a Regular Basis

Certain over-the-counter pain medications such as Acetaminophen (Tylenol and Excedrin), aspirin, naproxen (Aleve), and non-steroidal anti-inflammatory drugs (such as Motrin, Indocin, Vioxx, Naprosyn, Advil) have been identified as the main cause of the kidney failure, kidney damage and other kidney related diseases if used on a regular basis. In contrary, these medications seem not to pose significant health hazard to healthy kidneys if they’re used on time of emergency only. The health professionals have confirmed that the frequent use of anti-inflammatory pain drugs poses significant danger to kidney health than the over-the-counter pain killers.

Control your Blood Pressure

In the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI), it’s recommended that people with renal insufficiency (proteinuria greater than 1gm/24hrs) should maintain their blood pressure at 125/75 or lower, while people with diabetes should keep their blood pressure at 130/85 or lower. I’d recommend you to have your blood pressure checked/ monitored several times in a year to help maintain a healthy blood pressure level. If your blood pressure is high, then you should work out the way with your physician to keep it close to normal levels.

Use Prescribed Drugs to Lower Blood Pressure

Doctor commonly prescribes drugs that have been found to significantly delay the progression of kidney disease. Angiotensin-converting enzyme (ACE) inhibitor or ACE inhibitor (such as captopril) for example, is one of the prescribed drugs that have shown greater benefits in delaying the progression of kidney disease to either stage IV or V, lowering proteinuria, slowing deterioration in people with diabetes who don’t have high blood pressure, and promising result in protecting the kidneys. Captoril has rewarded patient by lowering blood pressure, which may help protect the kidney’s glomeruli. (Note: It’s always recommended to enquire your doctor whether you may benefit from receiving an ACE inhibitor.) Beta-blockers, calcium channel blockers, diuretics, and adrenergic nervous system modulators are some of the excellent drugs that may help enhance blood pressure control, notably in people with diabetes mellitus.

Any medications that help people with diabetes, high blood pressure, kidney failure or kidney disease to obtain a blood pressure level of 125/75, generally bring the utmost rewards. In any case, as in people with persistent microalbuminuria (occurs when trace amounts of a protein called albumin begin to leak through the damaged filtering structures of the kidneys) or mild hypertension should discuss the use of antihypertensive medications with a doctor to help protect kidneys from being harmed or damaged. As in the case of people in stage III and IV of the kidney disease, both combination of low protein diet and the antihypertensive drugs have shown to slow progression of kidney disease when significant nephropathy is present. In other words, reducing the blood pressure has proved to normal slow kidney damage.

Control Your Blood Sugar

The research conducted in England, Ireland, Scotland and Norway showed the improvements in kidney function in people with type 2 diabetes and those who were at the early stage in kidney disease of microalbuminuria by simply controlling their blood sugar and blood pressure. Another studies conducted in Italy and Scandinavia also showed that kidney disease at the early stage could be reversed with intensive blood sugar control. Moreover, the intensive blood glucose or glycemic control has proved to reveal promising result for those in early stage of nephropathy, particularly among individuals with type I and type 2 Diabetes.

Watch Your Diet

It’s also very important to avoid sugar and other simple carbohydrates to keep your blood sugar and insulin stay at healthy level. As mentioned earlier, high protein diet poses greater danger to kidney health, particularly when the protein is cooked. It’s therefore essential to substitute simple carbohydrates packed with moderate amount of healthy protein, non-starchy vegetables and lots of high quality fat. If you’re not sure what to eat, always consult your doctor or a registered dietician to help workout your meal planning.

Have Your Hemoglobin Examined Yearly

If you’ve diabetes, you should have your haemoglobin A-1-c level examined at least twice a year. By doing this examination, you’ll be acknowledged with a weighted average of your blood glucose level for the past 3 months. It’s recommended to keep the level well below 7 percent.

Have Your Urine and Blood Checked Yearly

It’s very important to note that you should have your urine checked for microalbumin and protein once a year, particularly when you’ve diabetes. Meanwhile, you should also prompt your doctor to check your blood for elevated amounts of waste products (such as creatinine).

Creatinine is a waste product created in the blood by the normal breakdown of muscle during activity. Unhealthy kidneys are unable to separate creatinie out of the blood and put it in the urine to leave the body as what the healthy kidneys do. That’s why creatine forms up in the blood. The normal creatinine range is 0.6 to 1.2 mg/dL. Any readings that are slightly above this normal range may tell you that your kidneys are not functioning at full strength. However, the creatinine value is very variable since it can be affected by diet, and thus you’ll have your creatinine examined regularly to confirm whether your renal function is decreasing or not. Bear in mind that when your blood contains too much urea nitrogen, protein or creatinine, it tells you that your kidneys are not fully performing.

Another important test is creatinine clearance test which shows how fast your kidneys separate creatinine from your blood. In this test, you’re required to collect urine for 24 hours. And your doctor will examine your creatinine clearance by observing the amount of creatinine in your blood and the amount of creatinine in your urine. For female, the normal creatinine clearance rate is 88 to 128 ml/min, while for male; the normal rate is 97 to 137 ml/min. If your reading is below the stated normal range, that means your kidneys are not functioning at its full strength.

Go for Other Additional Tests

If your blood and urine tests reveal the possibility of reduced renal function, then you’re advised to go for a renal imaging (taking pictures of the kidneys) test. The test consists of magnetic resonance imaging (MRI), ultrasound and computed tomography (CAT scan). This test is important as it helps the doctor to identify the main cause of the kidney function, while it’s very useful in finding abnormal growths, tumors or blockages that may have blocked the flow of your urine.

In the Proteinuria (protein in the urine which shows a poor kidney functions) test; you’ll be required to collect urine for 24 hours. Then, your doctor will test the presence of the protein from your urine sample using a dipstick, and the color of the lipstick will tell the doctor the presence or absence of proteinuria.

Besides the renal imaging and proteinuria test, renal biopsy is another useful test that doctor performs to identify problems at the cellular level. In this test, the doctor will ask you to lie prone (on your stomach) on a table while receiving local anesthetic to numb the skin. Then, he/she will insert a needle via your skin into the back of your kidney to retrieve about ½ to ¾ of an inch long of a strand of tissue in order to obtain the tissue sample that will be viewed under a microscope.

Dialysis or Kidney Transplantation

When one of your kidneys fails (cannot function anymore), you can still lead a normal life with the remaining renal function. Nevertheless, when both kidneys fail (you’ve lost 85%- 90% of your renal function), you must go for either a kidney transplant or go for regular dialysis for the rest of your life. Both renal replacement therapies will enable you to continue with your daily activity. While undergoing dialysis, you’ll have to be connected to the dialysis machine for several hours, at least 2 or 3 times a week. In dialysis, your blood is drawn from an artery of the body and channelled through a tube into the dialysis machine. In the machine, the tube passes through dialysis fluid which contains dissolved salts and sugar. Small particles such as waste products in the blood diffuse from the blood into the dialysis fluid which will be discarded, while large particles such as blood cells, glucose and amino acids cannot diffuse into the dialysis fluid. The filtered blood is then returned to a vein in your arm.

You may also choose to go for a kidney transplant. In this case, your damaged kidney is replaced with a healthy kidney from a donor. The transplanted kidney must be compatible with you; otherwise it’ll be rejected by your body.

Both renal replacement therapies have seen to prolong the survival of kidney patient. But, in certain cases, people with diabetes who receive either dialysis treatment or a kidney transplant may experience higher risk of morbidity and mortality. This is due to the coexisting complications of the diabetes, with the most notably damage in nerves, eyes and heart.

In conclusion, kidney disease improves with insulin adjustment, meal planning (less salt, less fat, less protein and less oil), blood glucose and blood pressure monitoring, exercise,  and frequent consultation with health care professional. By keeping on top of your condition, you actually have a lower risk of kidney related complications or even have fewer lesions developed in your glomeruli.

What are Kidney Stones?

Kidney stones were first discovered in a 7,000-year-old Egyptian mummy by the scientists. It was estimated that more than 800,000 patients worldwide were sent to the emergency rooms due to the occurrence of chronic kidney stone problems.

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Basically, kidney stones are hard mass formed from crystal that are separated from the urine and their size can be as big as a size of a US $0.25 coin. The formation of stones is linked to pathologic calcification, since the calcium deposits can clog the organs and blood vessels that will eventually damage the major organs (such as kidneys, heart). The stones can also build up in the inner part or inner surface of the kidneys, and they’re also regarded as one of the most dreadfully painful urologic disorders in the modern life. Our urine does contain certain chemicals that inhibit the formation of crystals, but these inhibitors seem not to work for everyone, and thus some people are found to be more prone to have stones formed in their kidneys.

These stones are the most commonly known shortcoming in the delivery of an amino acid, or a building block of protein. The stones are always withdrawn by crushing and eliminating the densely stubborn stones characteristic of cystinuria via a process called percutaneous nephrolithotripsy. However in certain cases, the kidney stones pass out of the body without undergoing such procedure.

What are the Causes of Kidney Stones?

• You’re susceptible to certain foods.
• You’re a family member of a family record of kidney disorders (such as cystic kidney disease), kidney stone, urinary tract infection, metabolic disorder (such as hyperparathyroidism).
• The inhibitors in your urine fail to inhibit the formation of a stone in your kidney.
• You’ve blockage in your urinary tract.
• You take excess of vitamin D.
• You’re suffering from gout, urinary tract infections, or/ and hyperuricosuria (a disorder of uric acid metabolism).
• You take over-the-counter drugs or medicines on a regular basis without the prior permission of your physician.
• The intake of certain calcium-based antacids or diuretics may also increase the risk of stone formation since it can increase the amount of calcium in the urine.
• You drink less water than the amount which is required by your body.
• You tend to suppress your urine whenever you feel you want to pass urine.
• You’ve consumed foods that are tainted with Melamine (read more details from my previous article here).

What are the Symptoms of Kidney Stones?

• You feel an extreme pain while urinating. This condition happens when a stone blocks the flow of urine. And this appears to be the first symptom of a kidney stone.
• You feel like there’s sand in your body.
• You feel a sharp pain or a cramping pain in the lower abdomen, in the back, in the area of the kidney, or the side that near to where your kidneys are located.
• You feel an extreme sudden pain in your urinary tract. This situation occurs when a stone moves in the urinary tract.
• Your urine is foamy, cloudy and smelly.
• You feel the pain in your kidneys which is accompanied by vomiting and nausea. And sometimes, you will have experienced the pain that extends to the groin.

Note: Some kidney stones might not cause any symptoms or complicated consequences.

What to Do If You’ve Kidney Stones?

• Take more fluids, preferably water. It’s recommended that you drink enough fluids throughout the day to help generate at least 2 quarts of urine daily. When large volume of urine is produced, the stone can be pushed downward. Indeed, the diluted urine may help reduce crystal precipitation. To help discharge the stone faster, you’ll have to drink at least 2000 – 3000ml of water in a day. In addition to that, try drink 500ml before going to bed. Get up from the bed to urinate. After urination, drink 300-500 ml water before going back to sleep. When you get up the following morning (before washing up), please drink 500-1000ml water. I’d recommend you to drink 120-240ml every 20-30 minutes throughout the day.
• Avoid taking any foods that contain calcium (such as dairy products)
• Avoid taking calcium in pill or tablet form as this will worsen your existing kidney stone problem. Additionally, you should stop using certain types of antacids that have added calcium.
• Don’t drink milk before going to bed. As milk contains substantial amount of calcium, it’ll give rise to the calcium concentration in your urine, which eventually results in the formation of kidney stone. After 2-3 hours of the milk consumption, the calcium passes through the kidney to be excluded. However, when you’re sleeping, your urine is very concentrated and as a result, the calcium that passes through the kidney becoming very concentrated, which give rise to the formation of kidney stone. (Note: If you want to drink milk, please do so 5 hours before your bedtime.)
• If your urine is very acidic, you should limit the intake of poultry, fish, animal’s heart, bean, spinach, sea foods, and meats. The reason is that these foods may increase the acidity of your urine. Since the metabolic end product is uric acid, and this acid might contribute to calcium oxalate precipitation. That means that the uric acid is precipitated (or solidified) in the kidneys or in the urinary tract to form calcium oxalate crystals.
• Avoid taking foods that have vitamin D added.
• Limit the intake of nuts, peanuts, plums, celery, strawberries, grapes, orange, pear, tomato, spinach, chocolate, potato, green pepper, pepper, cocoa, cashew nuts, almonds, eggplant, tofu, concentrated tea, and etc. These foods have been clinically proven to have contained higher oxalic acid.  Spinach, for example, contains 725.6 mg of oxalic acid. If you eat 200g of spinach at a time, your urine will contain 20-25mg oxalate excretion after 8 hours of spinach consumption, in which this value is equivalent to the average volume of oxalate excretion for normal person in 24 hours.
• Limit the intake of sugar. The study has found that 2 hours after the consumption of 100g sucrose has increased the calcium and oxalate concentration in the urine. The consumption of lactose for example can stimulate calcium absorption, which is more likely to cause the accumulation of calcium oxalate in the body as well as the formation of urinary calculi. This explains that the higher intake of sugar will increase the risk of the formation of kidney stones.
• Limit the intake of protein as the clinical reports reveal that the large proportion of calcium oxalate originates from the source of protein. In addition to the raw materials that contain oxalic acid found in protein, glycine and hydroxyproline are another two substances which promote the intestinal absorption of calcium. If excessive amount of protein is taken, the oxalate, calcium and uric acid will definitely be increased both in urinary tract and in the kidneys. If your kidneys are unable to remove oxalate, calcium and uric acid immediately out of the body, ureteral, urolithiasis (urinary stone) and kidney stones are more likely to form.
• Limit the intake of table salt as it will increase the calcium concentration in your urine. In certain cases, the higher intake of salt might contribute to the occurrence of urinary calculi.
• Limit the intake of soy based foodstuff as it’ll give rise to the crystallization, resulting in kidney stones.
• Increase the intake of black fungus. Since black fungus contains a variety of trace elements and minerals, it can react strongly with renal calculi. Also, the black fungus will stimulate the secretion from grandular urinary tract, which of course, will help to get rid of kidney stone. You’re recommended to eat black fungus (about 50g each time) twice to three times a day for several consecutive days. Under normal circumstances, you’ll feel pain, vomiting and nausea. Just don’t worry about this, the continual consumption of black fungus can cause the stones disappear about 10-20 days.
• Increase the time for outdoor physical activity. When you jump a lot and more frequent, the stones will gradually move downward before eliminating out of your body.
• Limit the intake of alcoholic drink and beers to help prevent the occurrence of urinary calculi. The brewing of beers, in fact, contains nucleotide and purine nucleotide acids, which might have contributed to the rise of uric acid, and thus causing the formation of kidney stone.
• Have your dinner before 8p.m. The peak hour for calcium is usually 4-5 hours after having meal. If you have your dinner too late, and then you go to sleep at the peak of calcium concentration in your body, the kidney stones are more likely to form.
• You’re recommended to go for a vegetarian diet which is usually characterized by low protein, and low cholesterol.
• Eat foods that are rich in vitamin A such as carrots, broccoli and muskmelon. This is important to maintain the health of intestinal tract while preventing the recurrence of kidney stone formation. Nevertheless, too much vitamin A can harm your health.  

Final Remark:

The information contained in this article is not mean to diagnose, mitigate, treat or cure your kidney related disease. Rather, this educational and health information is aimed to help lessen your affliction, and to improve your health condition in particular. Specifically, the intention of writing this article is to create general awareness, and to help you to prevent/ reduce/lessen the occurrence of kidney related disease, so that you can pursue in your fulfilling life while staying healthy well into old age. Since this article doesn’t cover all diseases, ailments, physical conditions or their treatments that might have taken place for other causes and conditions of kidney related disease, you should never disregard the medical advice or delay in seeking medical assistance when you’ve symptoms stated within the article.

Be part of a community on World Kidney Day and World Blind Day on 12 March. And I do hope that this article helps you to care for your kidneys, but most importantly, it’ll help you to take a precautionary step at the early stage of your kidney disease to prevent premature breakdown of your kidneys. And for those who already have kidney disease, kidney failure, or kidney related disease, please do in accordance to the suggestions here and please don’t hesitate to seek for an immediate medical assistance.

Now, you can gain more health knowledge by visiting my health blog entitled HealthAssist. More upcoming updates and latest health information is right on the way!