Dr. Emile Mohammed

Consultant Nephrologist, NWRHA

Medical Director, CKDI

MB ChB (Aberdeen), FRCP (UK), CCT

Nephrology and General Internal Medicine (UK)

Associate Lecturer in Medicine (UWI)

Most people have two kidneys which are located on either side of the spine, just below the ribcage. Each kidney is about the size of a fist. About 190 liters of blood plasma pass through the kidneys every day and about 2 liters are eliminated as urine. Kidneys act as a sieve retaining the ‘good’ substances and removing the waste products and excess water through urine. Kidneys are connected to the bladder by thin tubes called ureters and then to the outside world via a short tube called the urethra.

Overall functions of the kidney

These functions include:

• Removal of waste products such as urea, ammonia and phosphorus through the urine
• Retention of bicarbonate to counteract the acidity caused by acid generated from the body’s metabolism and thereby keeping the body at a constant pH • Retention and reuse of useful substances such as sugar and amino acids. However, if there is excess, it is excreted in the urine (for example sugar in the urine in a poorly controlled diabetic).
• Secretion of important hormones such as erythropoietin and renin. Erythropoeitin helps the production of red blood cells and renin is a crucial hormone for the control of blood pressure
• Production of vitamin D to control calcium and phosphorus levels. The kidneys are therefore responsible for bone health.

Kidney Health – the Golden Rules

• Keep fit and active. Keeping fit helps to reduce your blood pressure and thereby reduce the risk of chronic kidney disease.
• Keep regular control of your blood sugar level. About half of people who have diabetes develop kidney damage and tight sugar control can prevent this damage. Therefore, it is so important for people with diabetes to have regular tests to check their kidney function.
• Monitor your blood pressure. High blood pressure can not only lead to a stroke or heart attack but is one of the commonest causes of kidney damage. • Eat healthy and keep your weight in check. It helps in preventing diabetes, heart disease and other conditions that lead to kidney disease. Being overweight also directly increases the strain on the kidneys
• Maintain a healthy fluid intake. This is especially important in hot climates to prevent kidney stones and urinary tract infections. It is recommended to drink at least 2 liters per day
• Do not smoke. Smoking reduces blood flow to the kidneys and reduces its ability to function properly. It also increases the risk of kidney cancer by 50%.
• Do not take over the counter pills on a regular basis. Common drugs such as Non-steroidal anti-inflammatory drugs can damage the kidneys if taken regularly. Please consult your doctor to prevent long term use.
• Get your kidneys regularly check if you have one or more risk factors for kidney disease.

Kidney Screening and Prevention

Who is at Risk for Kidney Disease? Anyone can develop kidney problems, but the risk is greater with:

• Diabetes
• High blood pressure
• Certain ethnicities such as Afro-Trinidadian and Indo-Trinidadian
• A family member with kidney disease
• Over 60-years of age
• Infectious diseases including HIV/AIDS, hepatitis B and C
• Genetic diseases such as polycystic kidney disease
• Drugs such as non-steroidal anti-inflammatory drugs and proton pump inhibitors
• Autoimmune diseases such as lupus
• Disease of the urinary tract including prostate disease, kidney stones and severe or complicated urinary tract infections.
• Glomerulonephritis which is inflammation of the filters of the kidney
• Smoking
• Small birth weigh
• Obesity and physical inactivity One or more of these risk factors can lead to chronic kidney disease.

What is Chronic Kidney Disease(CKD)?

Chronic Kidney disease is an abnormality in renal function (or structure), for a period of more than 3-months, with or without decreased glomerular filtration rate (GFR). There are 5 stages of CKD as outlined below:

*GFR is glomerular filtration rate, a measure of the kidney’s function

What are the signs of Kidney Disease?

It is important to know that kidney disease often has no symptoms until it is very advanced (stage5) and therefore the only way to know your kidney function is to get tested. The signs of advanced chronic disease are extensive and include:

• Weight loss, loss of appetite, nausea and vomiting
• Itch
• Swollen hands and feet
• The need to urinate more often, including at night and in advanced cases, urinating
  less often.
• Tiredness and dizziness
• Foamy or dark coloured urine
• Restless leg syndrome: uncontrollable desire to move legs because of a tingling sensation
• Neuropathy: damage to nerves causing tingling or burning in the limbs
• Muscle cramps

Some signs are picked up through routine medical testing such as:

• Haematuria: blood in the urine
• Proteinuria: protein in the urine
• Ultrasound changes revealing structural abnormalities
• High blood pressure

Screening for kidney disease

Screening starts with identifying the increased risk of the likelihood of CKD which can be done with consultation with your doctor. The following tests will then be done:

• Urine tests looking for blood or protein in the urine
• Blood creatinine test. This is used to estimate kidney function (GFR) Abnormalities in the above tests can lead to

more detailed testing including further blood and urine testing, as well as imaging such as a kidney ultrasound. Your doctor can use the combination of your history, examination, urine and blood tests to determine whether you need

to be seen by a kidney specialist (nephrologist).

Take charge and protect your kidneys

If you are at risk of kidney disease, it can be prevented. If kidney disease is caught early, it can be treated or its progression can be delayed or halted. Take charge, monitor your health to include doctor visits, healthy diet, adequate fluid intake, exercise, diabetes and high blood pressure medications, urine tests and bloods tests.