1.  Your Amazing Kidneys

Every one of us has a pair of kidneys, each about the size of a fist.  They are bean shaped in appearance and are found in the lower back deep underneath layers of muscle, one on each size of the spine

2. Functions Of The Kidney

The main function is to stabilize the body.

Other support functions: To filter each day 5-6 liters of blood, producing at least 60 mls of urine an hour. To produce hormones to control blood pressure. To control the ph (acid/alkaline) level of the blood. To filter excess waste products of protein from the blood. To maintain strong bones and teeth by balancing the phosphorus and calcium in the blood. To allow vitamin D to be absorbed from the bowel. To balance the body’s fluid levels by getting rid of extra fluids in the body.

3. What Happens When Your Kidneys Fail?

Out of the main functions of the kidney you will get a picture of what happens when your kidneys fail.  There is an elevated level of urea creatinine, sodium and potassium in the blood.  The blood pressure is elevated, excess fluid accumulates in the tissues (oedema), anemia, a weakened bone system and an abnormal hormone level produced by the body.

• Your symptoms may include: 
• Feeling sick in your stomach often 
• Feeling tired or dizzy often 
• Swelling of your feet, hands or face as a result of the retention of salt and water.  This retention of fluids will lead to shortness of breath
• Bloody, foamy or dark-colored urine 
• High blood pressure. 
• A change in your urinary patterns.

4. Causes Of Kidney Disease Are:

• Diabetes Mellitus
• Systemic Lupus Erythematosus
• Hypertension
• Trauma/Injury
• Polycystic kidney Infection
• Drugs induction or any condition which causes a reduction of the blood supply to the kidney

5. Treatment Options

• Dialysis with fluid restrictions and a diet restricted in proteins sodium and potassium. There are two types of dialysis peritoneal and haemodialysis.
• Transplantation which may be a kidney donated by a family member or cadaveric.
• Mineral replacement therapy. A person who have had a kidney transplant, having to use antirejection therapy may encounter some resistance to the use of mineral therapy.  Various tests may determine your kidney function GFR (Glomerular filtration Rate), urine test to determine the presence of protein (albumin) in the urine, the blood pressure and the blood sugar level.

6. Hypertension (The Silent Killer)

This Is the medical term for persistent or sustained high blood pressure.  It is the force exerted by the blood against the walls of the arteries.  The pumping action of the heart creates this force.  When the heart contracts, the blood pressure increases.  When the heart relaxes the pressure decreases.  Organic defects such as kidney failure is linked to hypertension.  Untreated hypertension will cause damage to various organs and body systems. This then can lead to strokes, heart attack and permanent damage to the vascular system.  This damage prevents the kidney’s filtering process of waste products from the blood and thereby causes salt and fluids to be retained in the body. Atherosclerosis, narrowing of the arteries by the formation of deposits on the walls of the arteries cause hypertension.

Persons in the high risk category of hypertension are those with family history of hypertension, smokers, abusers of alcohol and obese persons.

Hypertension can be a major cause of kidney failure.

7.Diabetes And The Kidney

Diabetes is a disease that is caused by the lack of insulin in the body or the body’s inability to properly use normal amounts of insulin.  The hormone insulin, produced by the pancreas, regulates the amount of glucose (sugar) in the blood.  The body converts the food we eat into sugar.  Sugar is the form of energy we need to perform various functions.  If the body lacks insulin or does not use the insulin properly then this imbalance results in high blood sugars which bring about unhealthy changes in the body’s organs including the kidneys.

Diabetes causes damage to the delicate blood vessels in the filters of the kidney.  Diabetes can damage the nerves in many parts of the body.  When the nerves to the bladder are affected there is a difficulty to pass urine.  The urine of persons with diabetes has a high sugar content which can encourage the growth of bacteria and can cause kidney infections.  Infections can cause damage to the kidneys.

8. Associated Kidney Diseases

There are other diseases associated with the kidney.  Nephrotic syndrome in children, glomerulonephritis and cancers, kidney stones, anemia, polycystic disease and urinary tract infection are diseases that are not so prevalent but are seen in individuals.

Hemodialysis

Dialysis is a treatment option for a person with chronic renal failure.  This treatment cleans the blood, and removes waste and excess water from the body, which is normally done by the kidneys.  The two types are peritoneal and haemodialysis. 

Haemodialysis means cleaning the blood. This is done by circulating the blood through a machine which contains a dialyzer (artificial kidney).  The blood passes on one side of the membrane and dialysis fluid passes on the other.  The wastes and excess water pass from the blood through the membrane into the dialysis fluid, which is then discarded.  The clean blood is returned to your bloodstream.

Haemodialysis lasts for four to five hours usually two to three times per week.  It can be done at home or in the hospital.

When a patient who requires dialysis is travelling, arrangements must be made to continue the dialysis treatment.  A patient works with the Nephrologist and the Dietitian to regulate treatment times and diet

9. Renal Transplantation As A Treatment Option: By: Ruth A Shorey – BscN . RN Renal Transplant Coordinator.

Renal transplantation is the process by which a suitably matched healthy kidney is removed from one person (recipient).

Persons requiring a Renal Transplant usually are those diagnosed with End Stage Renal Disease (ESRD) or Renal Failure.  This form of Renal Replacement Therapy (RRT) should be offered as a first option or preemptively with the other options of Hemodialysis (HD) or Peritoneal Dialysis (PD) used as temporary options.

Unfortunately, the availability of a ready supply of healthy organs for Transplantation is not forthcoming.  Many of those with ESRD will not receive this life saving procedure.  They either die because they have no donors or there is no transplant programme where they live.

In order for a transplant programme to be viable, there should be an intense public education programme, highlighting the benefits of being a donor.  This should be a partnership between the state and the NGO responsible for kidney awareness.  Persons diagnosed and living with ESRD must be made aware of the benefits of receiving a kidney donation. 

To be considered for kidney donation a potential donor must be: 

• 21 years or older
• Physically fit
• Non smoker
• Non diabetic 

 Have the same blood type Barbados is no stranger to renal Transplantation, in 1984 under the guidance of the late Pro. George Nicholson the first kidney transplants were performed.  There was a lull until 2010 when the pair underwent the procedure

To this date the most recent pair are both doing well and it is anticipated that more Renal Transplants will be done at the QEH.

10. Peritoneal Dialysis

 Peritoneal dialysis (PD) is a type of dialysis where a catheter is introduced into the peritoneum in the abdomen and fluids as well as electrolytes, glucose urea and albumin is exchanged from the blood across the semipermeable membrane.  This procedure is performed mainly at night while the patient is asleep.  It is an alternate to hemodialysis and has a high risk of infection.  It is a less costly type of dialysis and because of the more frequent dialysis the patient’s kidney condition is better manage.  It can be done during the day and is known as continuous ambulatory peritoneal dialysis.

11, Polycystic Disease (PKD)

Polycystic kidney disease is an inherited disease that causes cysts to form in the kidneys.  These cyst are filled with fluid and air formed from normal kidney structures known a kidney tubules.    PKD affects both kidneys, causing them to enlarge. The symptoms include back pain, blood in the urine, kidney stones and recurring bladder or kidney infections.  High blood pressure is very common, however, as the cyst increase in size, some of these patients go on to develop kidney failure requiring dialysis or transplantation.

12. Prevention of Kidney Diseases

 Have regular blood pressure, blood sugar and urine tests by your doctor or clinic. Maintain good control of your blood pressure and blood sugar. Avoid smoking and smoking areas. Exercise regularly Make proper food choices – avoid fried foods and those with high sugar and salt content. Avoid excessive use of alcohol. Get adequate rest Take plenty of fluids and adequate fruits and vegetable.