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You may not know you have a problem with your kidneys


December 2011 

KidneysThe scary thing about kidney disease is that you may not know you have a problem for a long time because the early signs can vary enormously and also be very subtle. This is unfortunate, because kidneys perform a vital service in our health and well-being and any deterioration in their performance has wide ranging and serious effect.

Most people know kidneys are shaped like beans but they are bigger than most people realise - about the size of a clenched fist. We have two, one on each side. Another misconception is where they are located; most people think they are low down in the body. In fact our kidneys are quite high, positioned just below the rib cage near the middle of the back. That is why back pain can sometimes be an indicator of kidney problems.

Kidneys perform a number of vital functions, amazing little machines really. For a start, they process around 200 quarts of our blood every day, filtering it and sifting out waste that has entered the blood from a normal deterioration of tissues such as muscles and from food. They also filter out excess water and this waste is passed through to turn into urine.

If the kidneys stop functioning properly, then this waste can build up in the blood causing damaging problems.

It is interesting how these two little organs manage to filter such large quantities so efficiently. Inside each kidney are about a million nephrons. You can imagine how small these are - and inside each nephron is a tiny blood vessel called a glomerulus and an equally tiny urine-collecting tube called a tubule. The glomerulus acts like a sieve, ensuring normal proteins and cells in the blood can pass through but filtering out excess material. The glomerulus is also clever enough to measure the amount of chemicals such as potassium, phosphorus and sodium and let them stay in the blood at the right levels. It really is an extraordinary process working everyday within our bodies.

But that is not the end of it. Along with all this clever filtering, kidneys also produce three important hormones: erthyropoeitin which stimulates the bone marrow to make red blood cells; rennin which regulates blood pressure and calcitriol, an active form of vitamin D which is important for our normal health.

While we are born with two kidneys, our bodies can work well with less than perfect kidney function - sometimes people with a large reduction in kidney function are unaware they have problems and generally kidney problems are picked up by routine blood or urine tests undertaken by doctors as part of general check-ups.

If your doctor suspects you may have a problem, a test to measure the estimated glomerular filtration rate (usually known as eGFR) of your kidneys will probably be suggested. This simply requires giving a blood sample and then waiting for the results. The test measures the levels of a waste product called creatinine which is equated to normal kidney function. A result of 50ml/min indicated only 50% of the normal level of kidney function is taking place.

This of course sounds horrific but surprisingly the body can work well even at that level. A five stage system is used by the medical profession to indicate kidney damage and function:

Stage one: this is when the eGFR rate measures over 90.
Stage two: when the rate is between 60 to 90, indicates kidney function is beginning to become impaired.
Stage three is divided into two sub-stages. Stage 3a, with a measurement of between 45 and 59, and 3b, with a measurement of 30-44, and both levels indicate definite decrease in the function of the kidneys that needs assessment. This doesn’t necessarily mean the kidneys will continue to deteriorate and people can live well with this level of kidney function, but the kidneys will need careful monitoring with at least six month checks to confirm no further deterioration.

Stage four is when the results show a measure of between 15 and 29 and it is usually at this stage that definite symptoms will start to appear. Even at this stage, it is not easy to define exact symptoms and these can vary enormously from person to person, from general tiredness, loss of appetite and nausea to itching, breathlessness and swollen ankles (caused by fluid retention). At this stage further testing will be carried out.

Stage five is when the measurement is below 15, showing the kidneys have lost most of their function.

Along with the eGFR testing, there are other tests that can be undertaken including kidney scans and a kidney biopsy.

Treatment of kidney problems varies enormously and can include examination of possible causes such as high blood pressure and diabetes, which then of course can usually be treated. Despite their complexity, kidneys are surprisingly robust. Today most GPs have good knowledge about kidneys and will often include an eGFR test as part of a routine check-up.

The NHS site has an informative introductory video and also runs an on line kidney check at:

http://www.nhs.uk/Conditions/Kidney-disease-chronic

 


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