Expensive transplants and dialysis machines make it impossible for many to seek proper treatment. But we can avoid all of this by keeping our kidneys healthy

HUMAN body is in a state of constant dynamic balance. There is building up of new tissues (anabolism) and at the same time there is destruction of old ones (catabolism) in order to maintain the body’s growth and shape.

By virtue of this biochemical interaction and state of dynamic internal environment, a lot of waste is produced within the body.

This dynamic state is maintained by what is called “the balance concept”. This concept means that whatever is ingested and produced in the body must be equal to the excreted and consumed amount. And this is important as blood pressure depends upon optimum fluid balance.

Most enzymes for biochemical process function best, over a rather narrow-range acid base balance. Cell membrane potential and excitability, depends on electrolyte, calcium and magnesium concentration. This all is achieved to an extent by a pair of healthy functioning kidneys.

During all this process a lot of waste is produced which, if left inside the body, would kill within a short time. For this reason nature has provided us with a pair of kidneys to filter blood and regulate its content.

Kidneys are vital organs in the body. Each kidney is made up of at least one million filtering units called the nephrons. If these tubular structures were joined together, end-to-end, they would make more than 180 miles.

Blood is passed through these filtering units for purification. During its travel, all essential substances are reabsorbed back into the blood while non-essential substances and material that are in excess are expelled from the body in the form of urine. The best example to explain this concept is the hydration status of the body.

When dehydrated, our kidneys try to retain as much fluid as possible and in doing so we pass concentrated urine, while diluted urine is formed when we drink plenty of fluid.

Kidneys are so efficient that they clean our blood about 50-60 times every day, without fail. This is beyond human imagination. We do not know of any man-made filtering system that could do such accuracy.

Kidneys not only help in cleaning blood, but they perform other important functions without which life may not be possible. Hormones called erythropoietein help regulate red blood cells and haemoglobin concentration in the body. The kidneys produces these important hormones. Deficiency of this hormone causes anaemia.

Another important function is that it contributes towards blood pressure regulating mechanism. This is done by controlling volume of salt and water in the blood and by secreting hormone called rennin. It also contributes towards strengthening bones by controlling calcium content of the body through activation of vitamin D, which is produced in abundance in the body but in an inactive form.

Creatinine, a waste substance, is produced in the body and is cleared by the kidneys. This substance can be measured easily in blood and urine measurement of blood levels of creatinine guide, to the level of kidney function. In simple English, work done by the kidneys is called “kidney function”. Two healthy kidneys equate to 100 per cent kidney function.

This amount of kidney function is in excess of what our body requires for healthy existence. Half of this kidney function is more than enough to maintain a healthy life. Significant health problems arise when this level of function drops down to roughly less than 20 per cent in the absence of any other disease or less than 25-30 per cent in the presence of other associated medical conditions, called co-morbidities. This means that when symptoms are produced, the patient already is on the steep slippery slope leading towards kidney failure. It is therefore important to identify problems before it is too late or at a point of no return.

Regular health check up is vital for this. You will be surprised to know that if 100 people on the street today are screened at least five to seven of them will be those with some sort of kidney problem. This proves that kidney problems remain silent for a long time before making their presence felt, thus emphasizing the importance of regular health screening programme.

Kidney problems arise when filtering units, nephrons, loose their filtering capacity. This can happen in a relatively short time and might even take decades.

There are a number of important common conditions that affect working of the kidneys. Diabetes mellitus, hypertension, stone diseases and inflammation of the kidneys are such conditions.

Both sexes have been affected by an increasing rate in kidney diseases. It can be found in any age group and highest incidence occurs to those over 65.

When kidneys stop functioning the only treatment that can keep the body alive is dialysis and transplant. These treatment modalities are very expensive. Average machine dialysis session costs Rs1500 excluding medicines which means the yearly cost of dialysis alone is Rs78000.

How many of us can afford this type of treatment? According to Dialysis Registry of Pakistan, 2002, there are about 105 dialysis centres in 30 major cities of Pakistan providing dialysis facilities to 2387 patients. Out of these 2387 patients 1196 fall in the 31-50 years age group. More than 36 per cent have kidney failures due to diabetes and hypertension either alone or in combination. In Karachi alone, there are 24 centres dialyzing 1043 patients. Funding for most of these centres comes from generous donations from private sectors and from zakat funds. There is also a small contribution from government, semi-government organizations and NGO’s.

Early intervention, may delay if not prevented progression to established kidney failure. Every effort should be made towards early diagnosis of this silent killer disease that bears the same morbidity and mortality as that of cancer.