Introduction to Kidney Treatment and Management Explained

Kidneys are vital organs that perform many essential functions. They play a major role in filtering blood, balancing fluid and electrolytes, controlling blood pressure, producing red blood cells, and producing hormones. 

Kidney health is important for the body's overall functioning. If the kidneys become damaged, they can’t filter blood, and wastes will start building up in the body, affecting other organs such as the heart and bones. There are many types of kidney diseases, such as acute kidney injury, polycystic kidney disease, kidney stones, lupus nephritis, glomerulonephritis and chronic kidney disease (CKD). The early detection of kidney disease is life-saving and can be treated with various methods. The treatment methods depend on the type of kidney disease, the functioning of the kidneys and GFR values. 

Types of Kidney Diseases and Their Treatments

There are many kidney diseases but the most common diseases are chronic kidney disease, acute kidney injury and kidney stones.

Chronic Kidney Disease (CKD):

It is a progressive condition in which kidneys become damaged over time and are unable to filter toxins or extra fluid from the blood. Doctors can treat the early diagnosis of chronic kidney disease with medicines. If left untreated, CKD leads to renal failure, also termed end-stage renal disease, which doctors can only treat with dialysis or a kidney transplant. The two main causes of CKD are diabetes and hypertension. 

In the early stages of CKD, many people do not face any symptoms. the symptoms usually appear in the advanced stages of CKD. Here are some symptoms of chronic kidney disease (CKD):

• Foamy urine
• Urinating more often or less
• Feeling tired
• Nausea
• Loss of appetite
• Unintentional weight loss

In more severe cases of CKD, patients also complain about these symptoms

• Trouble concentrating
• Numbness or swelling in your arms, legs, ankles, or feet
• Achy muscles or cramping
• Shortness of breath
• Vomiting
• Trouble sleeping
• Breath smells like ammonia 

There are 5 stages of chronic kidney disease (CKD), and the last stage is referred to as end-stage renal disease (ESRD) or renal failure. If CKD is not treated timely, it leads to renal failure.

In advanced stages of CKD, there is no cure. The treatment method helps to lower the symptoms of CKD and slow down the progression of the disease. Lifestyle modification, medications, dialysis and kidney transplant methods are the treatment options for chronic kidney disease (CKD). These treatment methods are also discussed in detail below.

Acute Kidney Injury (AKI):

Acute kidney injury (AKI) results when the kidneys suddenly stop working. In AKI, the kidneys lose their ability to filter blood and temporarily waste products from the blood. It is reversible and can be treated with medicines or dialysis. If left untreated, it leads to chronic kidney disease and renal failure. An accident that damages the kidneys, blockage of the ureter, or any condition that slows down the blood flow to the kidneys commonly causes acute kidney injury.

The common symptoms of acute kidney injury are decreased urine output, nausea, itching, loss of appetite, weakness, chest pain or even seizures. The complications related to acute kidney injury (AKI) are fluid buildup, chest pain, weakness, permanent kidney damage or even death. Sometimes, severe kidney infection also leads to acute kidney injury. 

Doctors can easily diagnose acute kidney injury (AKI) through blood tests, urine output measurements, imaging tests, and kidney biopsy. They treat it with medications to control blood pressure and adjust electrolyte levels. In severe cases, doctors use short-term dialysis to manage complications and help the kidneys regain function.

Kidney Stones: 

Kidney stones, also termed renal calculi or nephrolithiasis, are solid masses or crystals that form in the kidneys. They can be as small as a grain of sand or larger than a golf ball. The smaller stones can quickly be passed through the urinary tract with medicines, but the larger stones are unable to pass on their own.

The diagnosis procedure for kidney stones includes blood tests, urine tests, and imaging such as CT scans or X-rays. The treatment of kidney stones depends on the size of the stone and its location. Small stones in the kidneys with minimal symptoms can easily pass through drinking water, taking pain relievers, and using alpha-blocker medicines.

However, treating large stones that cause symptoms is difficult because they cannot pass independently. Doctors use sound waves, such as extracorporeal shock wave lithotripsy (ESWL), to treat larger kidney stones by breaking them into smaller pieces, which are then excreted through the urinary tract. They also perform a surgical method called percutaneous nephrolithotomy, removing kidney stones using a telescope and instruments.

Diagnosis and Monitoring

Kidney diseases such as acute kidney injury (AKI), chronic kidney disease (CKD) and kidney stones can easily be diagnosed through 

Blood tests: 

Blood tests help to indicate kidney functioning by taking blood samples. The presence of waste substances such as creatine and urea in the blood suggests damage to kidney function due to GFR values. Blood tests reveal abnormalities in kidney function by

• Increased levels of acids (acidosis)
• Anaemia (insufficient red blood cells)
• Decreased levels of salt (hyponatremia)
• Changes to the levels of calcium and phosphate
• High potassium levels in the blood (hyperkalemia)

A GFR value of 90 mL/min/1.73 m2 or higher is considered normal. A 60 mL/min/1.73 m2 decrease for at least three months indicates chronic kidney disease (CKD).

Similarly, blood urea nitrogen (BUN) is also a blood test that measures the amount of urea nitrogen in the blood which helps to diagnose the extent of damaged kidneys. The normal BUN values with healthy kidneys range from 7 to 20 depending on the age and overall health conditions. The values higher than normal (greater than 20) show that kidneys are not working well. The BUN values keep on rising as the kidney disease progresses.

Urine tests:

Urine tests indicate that substances such as blood or protein are present in the urine due to damaged kidneys. The healthcare providers observe the following things in the urine to indicate the extent of damaged kidneys.

Visual exam: Doctors look at the urine sample by observing the color. Dark yellow or brown urine indicates a sign of a problem. Similarly, the foaminess, cloudiness, and unusual smell also show a sign of kidney damage. 

Microscopic exam: Doctors observe a small amount of urine in a microscopic examination. They typically check for bacteria (which infections may cause), crystals (which indicate kidney stones), or red or white blood cells (which signal infection or kidney problems).

Dipstick test: Healthcare providers also perform a dipstick test in which they dip the plastic strip in the urine, and changes in the strip colour show the levels of

• Blood- indicates infection
• Protein- a sign of kidney disease
• Glucose- a sign of diabetes in higher values
• Acidity(pH)- abnormal values may indicate urinary tract infection (UTI).
• Urine culture: Urine culture indicates a type of bacteria present in the urine that helps to diagnose kidney infection or UTI.
• UACR: The urine ACR test (albumin to creatinine ratio) is a preferred test that detects the presence of protein in the urine.

A normal urine albumin-to-ratio value is less than 30mg/g. The uACR values higher than 30 to 300mg/g (microalbuminuria) indicates kidney damage. The chart below highlights the GFR values with albumin categories showing the normal stages with green colour, moderately increased risk with yellow and orange, and red and deep red colour with severe stages that show increased kidney damage.

Imaging tests:

An imaging test is also a beneficial way to diagnose any kidney disease. It also helps to find the cause of kidney disease such as abnormal size or shape of a kidney, irregular blood flow to kidneys, signs of injured kidney, or formation of kidney stones or cysts. Imaging test involves

• Ultrasound: Ultrasound is a safe and painless imaging method that uses sound waves to provide a picture of the kidney. It also shows any abnormality in size, obstructions such as stones or tumours, or the kidneys' position.
• CT scan: Computerized tomography (CT scan) uses X-rays to provide detailed pictures of the kidneys or other organs of the body. Like ultrasound, it also shows structural abnormalities or kidney obstructions. When examining one or both kidneys, CT scans screen for tumours or other lesions, obstructive conditions like kidney stones, congenital anomalies, polycystic kidney disease, fluid buildup around the kidneys, and abscess locations.
• MRI: Magnetic Resonance Imaging helps diagnose chronic kidney disease, kidney cancer, renal vein thrombosis, and the presence of any tumour, stone, or infection. It also helps to visualize obstruction of urine flow, size of kidneys, presence of cysts in PKD, or blood clots in the kidneys. MRI also diagnoses glomerulonephritis. The main difference between a CT scan and an MRI is that the MRI combines radio waves and a magnetic field, while a CT  scan uses ionising radiation in the form of X-rays. MRI is preferable for providing images of soft-tissue contrast, such as kidney perfusion. However, a CT scan is preferable for identifying any specific type of cancer. 

Kidney Biopsy

Kidney biopsy is a surgical method in which a tiny piece (sample) of the kidney is removed to be observed under the microscope. A doctor usually asks for a kidney biopsy test if they need more information after performing blood tests, urine tests, and medical imaging tests. Kidney biopsy may be necessary in some types of kidney diseases such as glomerular disease or nephrotic syndrome. 

In CKD, timely diagnosis and intervention are essential. Those at higher risk of CKD with severe complications must be identified and treated accordingly to prevent further complications. Other comorbidities such as diabetes, hypertension or heart disease should also be monitored in CKD stages.

Lifestyle and Dietary Changes for Kidney Health

Dietary Recommendations for CKD Patients

The management of dietary intake plays a major role in slowing the progression of kidney disease. These are some tips for eating right while maintaining kidney health.

• Select and cook foods with low salt and sodium: Selecting foods that are low in salt is helpful in controlling blood pressure, which is the second leading cause of renal cancer. So, always check the ingredients of processed foods with limited sodium and do not exceed the recommended amounts.  The NIH recommends to consume 2300mg of sodium per day to maintain kidney health.  
• Choose the right type of protein in the right amount: An appropriate amount of protein is essential to protect the kidneys. The WHO recommends that healthy protein intake for kidney function is 0.8 grams per kilogram of body weight per day. Excessive protein consumption stresses the kidneys to work harder. So, always eat small portions of protein foods. Also, people can consult a dietitian to make a customized meal plan with healthy food choices of protein from animal and plant-based sources.
• Select heart-healthy foods: Healthy foods for the heart help prevent fat from building up in blood vessels, heart and kidneys. It includes lean cuts of meat such as loin or round, poultry without skin, fish, beans, fruits and vegetables.
• Choose foods and drinks with less phosphorus: Foods that are low in phosphorus are beneficial to protect the bones and blood vessels. Excessive phosphorus in the blood decreases calcium levels, making the bones weaker, thinner, and more prone to fractures. The recommended dietary allowance (RDA) of phosphorus for healthy adults with normal kidney function is 700 milligrams (mg) daily. So, always look for “PHOS” in the ingredient list of processed and packaged items to avoid over-consumption. Foods that are lower in phosphorus and healthy for kidneys are fresh fruits, vegetables, bread, pasta, corn, rice cereals and light-coloured sodas such as lemon-lime or homemade iced tea. 
• Select foods with the right amount of potassium: Foods with the right amount of potassium helps nerves and muscles to work properly. An adequate amount of potassium should be maintained because excessive and lower amounts cause problems. Damaged kidneys allow potassium to build up in the blood and cause heart problems. The recommended daily potassium intake for healthy adults for men is 3,400 mg and for women is 2,600 mg. Therefore, people with kidney diseases such as CKD should consume lower phosphorus foods such as apples, peaches, carrots, beans, cranberry and wheat cereals. 

Importance of Hydration

Proper hydration in the body is necessary to sustain life. It helps remove waste products through urination and maintaining electrolyte balances of bodily functions. It also allows the excretory system to function well and prevents kidney stone formation. These are some important functions of proper hydration in the body.

• Daily Recommendation: The exact fluid requirement depends on the individual’s age, level of exercise, weather conditions, dehydration status, pregnancy, and breastfeeding practices. The recommended fluid intake is to drink eight glasses per day. Feeling thirsty indicates that the body is dehydrated and needs more water.
• Urine colour indicates hydration status: The light colour of urine indicates that the body is sufficiently hydrated. In contrast, the dark urine colour shows that the body is dehydrated and needs rehydration. The changes in urine color may also be due to some intake of medicines that influence urine color, such as vitamin B or B2.
• Be cautious about excessive hydration: Excess water intake is dangerous and leads to water intoxication. It is more common among psychiatric patients or marathon runners who consume plenty of fluid for rehydration. This condition results when water dilutes down excess sodium in the body and causes hyponatremia, which is a life-threatening condition because of swelling of the brain. 
• Limit hydration in some cases: Patients with CKD or pulmonary edema should limit their fluid intake because it causes shortness of breath due to sodium retention. These patients have a decreased ability to remove water from the body. Therefore, healthcare providers usually recommend restricting their fluids to manage these complications.

Exercise and Physical Activity

There are many ways that physical activity helps manage renal illness. It can enhance both general health and physical well-being. Regular exercise can also help manage kidney disease progression and other health complications. Staying active benefits people in many ways

• It enhances heart health and lowers the risk of stroke, high blood pressure, and heart disease. 
• It helps reduce the risk of type 2 diabetes and aids in blood sugar management. 
• It improves mental health by lowering depression, anxiety, and stress. 
• It helps to maintain weight and prevents weight gain. 
• Preserve bone density and muscle mass. 
• It also supports better sleep. 

Regular physical activity is the potential key to slowing the progression of chronic kidney disease (CKD). Exercise lowers the main risk factors for CKD's advancement by enhancing cardiovascular health, regulating blood pressure, and reducing blood sugar levels. 

Exercise for CKD patients

Regular physical activity is useful for people with chronic kidney disease (CKD). However, the type and level of exercise depends on the disease stage, physical condition, and general health. 

For at least 150 minutes a week, or to a level appropriate for their physical and cardiovascular tolerance, people with chronic kidney disease (CKD) should engage in moderate-intensity physical activity. Patients with early stages of CKD are advised to work hard enough to cause their heart rate to rise, their breathing to become more labored, and to perspire, which is referred to as moderate intensity. Swimming, riding, and fast walking are examples of activities. The 150 minutes can be divided up throughout the week. For instance, you will reach 150 if you engage in moderate-intensity exercise five days a week for 30 minutes each time.  

Consult your healthcare team before beginning any new exercise program to ensure that the exercises suit your particular condition and state of health. Adjust the kind and level of physical activity as per instructions to guarantee safety and optimize the advantages for renal health.

Avoidance of Nephrotoxic Substances (e.g., NSAIDs, excessive alcohol):

Certain medicines such as antibiotics, NSAIDS, antibiotics, and illegal substances are harmful to kidneys. Therefore, before taking any medication, always follow the healthcare provider's instructions and avoid OTC medicines. Excessive alcohol drinking is harmful to both kidneys and livers. People who consume excess alcohol have a high risk of developing both kidney and liver failure. Therefore, people with kidney disease should consume a limited amount of antibiotics, NSAIDS, and OTC medicines than people with healthy kidneys.

Advanced Treatments: Dialysis and Kidney Transplant

There are two treatment methods for the advanced stages of CKD. 

• Dialysis
• Kidney Transplant

Dialysis:

Dialysis is a treatment method that filters the blood through a dialyzer machine. The machine enters the blood, helping the body remove extra fluid and waste products when the kidneys cannot perform their job. It helps treat acute kidney injury (AKI) and kidney failure. Doctors perform dialysis in cases of renal failure when 10-15% of kidney function remains, measured by an estimated glomerular filtration rate (eGFR) of less than 15 mL/min.

Dialysis is not a treatment for renal disease; it can only partially replace the function of healthy kidneys in kidney failure. Dialysis becomes lifetime necessary if the patient has ESKD for the rest of their life or until they receive a kidney transplant.

How Dialysis Works

Dialysis performs many duties that kidneys perform to maintain a body balance by following ways

• Helps in the regulation of blood pressure
• Removes waste and extra fluids in the body to prevent fluid buildup
• Maintains safe level of minerals in the blood such as potassium, sodium, calcium and bicarbonates

Types of Dialysis

There are two types of dialysis

Hemodialysis

Haemodialysis involves filtering waste and excess fluid from the blood using a dialyser and reintroducing the purified blood into the body. Before starting hemodialysis, a minor surgery is performed to provide a vascular access site (opening into one of the blood vessels), generally in the arm. This vascular site is essential for drawing blood from the body, passing it through the dialyser, and then reintroducing it into the body. Haemodialysis can be performed at home or in a dialysis facility. Treatments are performed three times a week and typically take four hours. Depending on their demands, some patients could require more extended therapy periods

Hemodialysis is effective in removing waste, salt, and extra water. It also helps to maintain proper levels of important substances and balances electrolytes in the blood.

However, this treatment method is considerable but it requires regular visits to a dialysis center, usually 3-4 times a week. Besides its advantages, there are also many challenges of hemodialysis. The side effects of hemodialysis include fatigue, low blood pressure, and complications from the access point (fistula, graft, or catheter).

Peritoneal Dialysis

Peritoneal dialysis uses the body to filter blood rather than a dialyser machine. The lining of the abdomen, often known as the peritoneum, is a filter for this kind of dialysis. A small operation is required to insert a catheter (soft tube) into the abdomen before beginning peritoneal dialysis. Dialysate is a cleansing solution of water, salt, and other ingredients. 

It is slowly placed into the abdomen through the catheter with the same procedure. The dialysate absorbs excess fluid and waste products from the blood arteries and into the abdominal region when the blood flows naturally through the area (almost like a magnet). After a few hours, the dialysate is drained from the combination of fluid accumulated in the abdomen. 

Peritoneal dialysis can be done at home, offering more flexibility in daily activities. CKD people usually find peritoneal dialysis more gentler on the body than hemodialysis.

One challenge related to peritoneal dialysis is the proper management. The patient must learn to manage the catheter and process at home. There is also a risk of infections (peritonitis) and weight gain due to the dialysis fluid.

Peritoneal dialysis is of two types

• Continuous ambulatory peritoneal dialysis (CAPD)
• Automated peritoneal dialysis

The main differences between the two types of peritoneal dialysis are

• the schedule of exchanges
• one uses a machine, and the other is done by hand

If one type of peritoneal dialysis doesn’t suit some individuals, they need to consult their healthcare provider to try another type. 

Kidney Transplant

In a kidney transplant, a healthy kidney from a deceased or living donor is surgically replaced by a patient whose kidneys are no longer functioning normally. The recipient can take a healthy kidney from a living or deceased donor. A family member or any other candidate can donate their kidney with a good match. After a successful kidney transplant, the patient is required to take lifetime immunosuppressants to prevent organ rejection.

In case of renal failure, a kidney transplant is a better option than a lifetime on dialysis. End-stage renal disease or chronic kidney disease can be treated with a kidney transplant to improve the quality of life and live longer.

Kidney transplant is a more preferable option than dialysis because it ensures

• Improved quality of life
• Lower risk of death
• Fewer dietary restrictions
• Lower treatment cost as compared to the net cost of lifetime dialysis

Associated Risks of Kidney Transplant: 

Kidney transplantation is not a cure for damaged kidney, but it can treat advanced renal disease and kidney failure. Following a transplant, some types of kidney disease may recur.

A kidney transplant is linked with several health concerns, including those directly related to the surgical procedure and organ rejection. The adverse effects of using immunosuppressants or anti-rejection drugs, which are necessary to stop the body from rejecting the donor kidney, are another risk.

The choice to have a kidney transplant is a personal one that requires careful analysis of the significant risks and advantages. The other risks related to transplant surgery also include

• Infection
• Bleeding
• Leakage of urine or blockage of urine in the ureter
• Blockage of the blood vessels to the new kidney
• Lack of function of the new kidney

Who is Eligible for a Kidney Transplant?

Candidates who are eligible for kidney transplant patients are 

• Patient with end-stage renal failure and on dialysis
• CKD patients with GFR lower than 20 mL/min
• Patient’s understanding of postoperative instructions and care
• Good overall physical health and stable mental health with strong social support.

There is no age limit for kidney transplants. However, people with other diseases and complications are not eligible for kidney transplant procedures such as 

• Certain infections
• Cancer or history of cancer
• Shorter life expectancy
• Poor social support
• Any serious health complication 

Long-Term Recovery Time After Kidney Transplant

Recovery from a kidney transplant typically takes six weeks. However, the recovery time varies from person to person. The recovery time depends on the patient's general health and other factors. After the transplant, monitoring the patient’s health and restrictions on certain things that vary from person to person is important. These are some general guidelines that patients should follow

• Avoid lifting heavy objects for at least eight weeks or longer after surgery
• Avoid driving for at least six weeks after immediate surgery
• Try to avoid contact sports as it can cause injury to the transplanted kidney.

How Long a Person Can Live After Kidney Transplant?

After a kidney transplant, a person can live for many years. A kidney transplant from a living donor usually lasts 12 to 20 years, whereas a deceased donor's kidney lasts about 8 to 12 years. Similarly, some people can also receive more than one transplant in their life.

Managing Kidney Health Long-Term

Maintaining kidney health requires a sustainable, long-term approach, especially for people with kidney disease or at risk of kidney-related diseases. 

Consistent care helps improve and sustain kidney function while addressing other health complications. These are some practical tips for the long-term management of kidney health.

Regular checkups and follow-up appointments

Kidney disease patients need to follow up consistently to prevent the progression of the disease and manage its complications, especially in CKD. Regular checkups help detect early changes and signs of complications. They also ensure the timely management of symptoms to retain kidney health. Patients should follow up with blood tests, urine analysis, and kidney function screenings to track their kidney's performance over time.

Managing comorbidities

Comorbidities like diabetes and hypertension are common with kidney disease. Managing these conditions can reduce the burden on the kidneys. Doctors recommend maintaining blood sugar levels within the normal ranges for people with diabetes and keeping blood pressure healthy through diet, exercise, and prescribed medications. Working closely with your doctor to manage these comorbidities is important for preventing further kidney damage.

Dietary and lifestyle management

A kidney-friendly diet is important for maintaining kidney health. Limiting salt intake, staying hydrated, and avoiding foods high in phosphorus and potassium can protect kidney function. Regular exercise, maintaining a healthy weight, and avoiding smoking contribute to better long-term kidney health.

Psychological and emotional support

Chronic kidney conditions put an emotional burden on patients and their families. Having access to psychological support or counselling services can help manage stress, anxiety, and depression to manage long-term illness. Support groups and therapy ease patients' sense of community, make managing complications easier, and provide emotional support.