WARNING SIGNS OF KIDNEY DISEASE:

1. Burning sensation while urinating.
2. Frequent and excessive urination.
3. Blood in the urine.
4. Puffiness or oedema on face and body.
5. Pain in the lower back.

SYMPTOMS OF KIDNEY FAILURE:

The symptoms of kidney disease are very vague and usually occur when 80% or more of kidneys are damaged. So symptoms are produced very late. These are:

1. Nausea & vomiting
2. Physical weakness
3. Loss of appetite
4. Itching
5. Swelling of face &legs
6. High blood pressure
7. Breathlessness on exertion
8. Anaemia
9. Getting up at night to pass urine

KIDNEY FAILURE

There are two types of kidney failures:

(a) Acute kidney failure

(b) Chronic kidney failure

Acute kidney (Renal) failure

In Acute Kidney failure, kidney fails suddenly over a short time due to some insults - such as Dehydration due to server diarrhoea or vomiting, sudden significance drop in blood pressure, massive bleeding, acute glomerulonephritis, snake bites, burns or drug overdose.

This is generally reversible and kidney recovers in a matter of three days to three-week time. Till kidney function recovers, patient should be under observation and may require hospitalization for few (one to ten) dialysis till kidney recovers fully, without any residual damage.

It is generally believed in India to give excess liquid - milk and soda - or coconut water to person who is not passing enough quantity of urine. This is advisable if the patient has dehydration with no kidney failure still. After kidney fails, liquid intake should be given as per Doctor's instruction as giving more intake will aggravate exiting swelling only. Coconut water should not given in the person with kidney failure as it contain excess potassium. It can give rise to adverse effect on the heart with sudden death.

Chronic kidney failure

In this kidney damage occurs slowly over few years time and in most cases it is irreversible. As mentioned earlier in majority of cases symptoms are produced very late when kidney is damaged to 80% or more.

When patient goes for check up with symptoms, doctors tell him/her that kidney has failed. Most of the patient are surprised by his comments and they tell that I was all right till such a such date and how can I have kidney failure of long standing. Many patients even say that I pass enough quantity or even more urine and how can I have kidney failure? In these cases only the thing is that happens is quanlity of urine is bad (it does not contain any waste material) while quantity is "Normal".

Common causes of chronic Kidney failure are;

	Approxi.
(1) Chronic glomerulonephritis	63%
(2) Chronic infection of kidneys pyelonephritis	17%
(3) Uncontrolled high blood pressure for high time	6%
(4) Long standing diabetes	7%
(5) Polycystic kidneys disease	3%
(6) Frequent stone formation in urinary tract	2%
(7) Enlarged prostate gland	1%
(8) Excessive uses of some medicines over years (mainly pain killers)	1%

Among these causes preventable causes are high blood pressure, diabetes (if controlled well), infection and blockage of urine due to stone, enlarged prostate glands and chronic constipation.

Glomerulonephritis

Glomerulo = A filter in the kidney.
Nephritis = Inflammation of the kidney. This disease involves inflammation of kidney and it is associated with protein in the urine, usually it takes 15 to 20 years for glomerulonephritis to cause kidney failure.

Polycystic kidney disease

This is a hereditary disease which is present at a birth and causes large cysts in the kidney patients however usually do not develop failure until they are in their 40s.

Important tests to know the kidney failure:

Kidney function Tests

Common tests done to find out kidney problems are:

1. Urine Examination - for Proteinuria (Albuminuria), Red blood cells or pus cells.
2. Urine for culture and sensitivity - for infection.
3. Blood urea Nitrogen (BUN) - This is waste products produced from protein metabolism. Normal figures are 7 to 21 mg/dl
4. Serum creatinine - This is produced from muscle metabolism. Normal levels are 0.5 to 1.5 mg/dl
5. Complete Blood Count (CBC) - Generally blood count (Haemoglobin) level falls with onset of kidney failure.
6. Plain X-Ray Abdomen (KUB) - Generally gives information about kidney stones.
7. Ultrasonography (USG) - This is one of the newer modality and is a non invasive test. It gives information to doctors about kidney size, blockage of kidneys, tumors or even whether kidney disease is of long standing or not. Unfortunately it does not tell any thing about kidney function.
8. Intravenous Pyelography (IVP or IVU) - This involves giving injection of iodinated dye in vein followed by kidney X-Rays. It gives valuable information about kidney function, size etc. It is an invasive tests. At times patient can get reaction (rarely fatal) with dye. It is not done if a kidney function is already compromised greatly with creatinine greater than 3 to 4 mg/dl.
9. Renal scan (Nuclear) - It is a good test and can be done safely even in patient with advanced kidney failure. It gives you information about kidney size and function also.
10. CT Scan of kidneys - This is occasionally done when tumour is suspected. This is not commonly used.
11. Kidney panel or Renal package tests - This is commonly done in case of kidney failure. It gives you information about BUN, Creatinine and also about many other parameters like Serum Electrolytes, Calcium, Blood sugar, total protiens etc.
    TYPICAL KIDNEY PANEL (RENAL PACKAGE)
    
    

    Waste Products	Normal Range
    1) Creatinine	0.5 to 1.5 mg/dl
    2) Blood Urea	15 to 45 mg/dl
    3) BUN	7 to 21 mg/dl
    4) Calcium	8.5 to 10.5 mg/dl
    5) Uric acid	2.1 to 7.4 mg/dl
    6) Phosphorous	2.5 to 4.5 mg/dl
    7) Sodium	137 to 148 mEq/L
    8) Potassium	3.5 to 5.6 mEq/L
    9) Chloride	99 to 108 mEq/L
    10) CO2 Comb Power	23.7 to 31.4 mEq/L

    
    
12. Kidney Biopsy - This is done when patient has albuminuria Red cells in urine without any obvious causes, or at times in patient with high blood pressure with renal insufficieny. This guides the doctors about the cause and treatment it require any.
13. Special Tests :-
    a) Creatinine clearance tests - To determine exact percentage of kidney function.
    b) Quantity Proteinuria - Urine is collected to see how much protein is lost in 24 hours urine.