Kidney Diseases

Every person has two kidneys. They sit at the back of the abdomen, one on each side of the backbone, just below the ribs. As blood travels round the body it keeps picking up waste and impurities. The kidneys filter this blood. They take out the impurities and any extra water, send them out of the body as urine, and in this way keep the blood clean. This is why the kidneys are often called the body's filters.

• They filter impurities out of the blood and send them out in urine.
• They remove extra water from the body as urine.
• They keep the salt and minerals in the blood in balance.
• Because the salt and minerals stay balanced, blood pressure stays under control.

Urine is made in the kidneys. A thin tube from each kidney, called the ureter, carries the urine down to the urinary bladder, where it is stored. When we pass urine, it leaves the bladder through another tube, the urethra. The kidneys, ureters, bladder and urethra together make the path that urine follows, and different parts of this path can be affected when a person has kidney disease.

This definition is about time. Even a short stop matters, because while the kidneys are not working, the waste that should leave the body stays in the blood. Kidney disease can appear in different forms. Two of them matter most here: stones, which form when minerals collect inside the body, and kidney failure, when the kidneys stop working altogether.

The food we eat and the water we drink carry minerals such as calcium, phosphate and uric acid. Normally the kidneys send any extra amount of these out of the body with the urine. If the kidneys fail to do this, the minerals collect inside the body and slowly harden into lumps. Such lumps can be as small as a grain of sand or a great deal bigger, and their shapes vary too.

A stone is not found only in the kidney. It can appear in these parts of the body:

• the urinary bladder
• the urethra
• the ureter
• the kidney
• the gall bladder

The gall bladder is not part of the path of urine. It is a small sac beside the liver, yet stones can form there as well. A stone that gets stuck in the path of urine can block the flow, and a blocked flow of urine is itself one of the causes of kidney disease.

Kidneys do not fail in a single day. They are damaged little by little when a person goes on for a long time without caring about food, way of life and blood pressure. The damage moves forward in this order:

• When food habits and way of life are not looked after and blood pressure is not controlled, the kidneys begin to be damaged.
• The water and waste that should leave in urine start to collect inside the body.
• Because of this the person feels like vomiting, the hands and feet swell, breathing becomes short and passing urine becomes difficult.
• The kidneys can no longer filter urea and other chemicals out of the blood and send them out in urine.
• In the end the kidneys stop working completely and cannot be made healthy again.

A failed kidney cannot be cured, so its work has to be done another way. When the kidneys have failed, dialysis must be done. In dialysis a machine outside the body does the kidneys' job of cleaning the blood. Where it is possible, a new kidney must be transplanted. In a transplant, a healthy kidney given by a person willing to donate one is placed in the patient's body.

The causes of kidney disease can be understood in four groups:

• Personal causes: having diabetes or high blood pressure, having too little water in the body, losing a lot of fluid or blood through diarrhoea and vomiting or in an accident, and a stone in the urinary path or an enlarged prostate blocking the flow of urine.
• Careless use of medicine: every medicine has some harmful effect. Some antibiotics and other medicines damage the kidneys. The kidneys are harmed when people buy medicine from a shop without a doctor's advice and take it as they please, or when any medicine is taken in large amounts for a long time.
• Infection of the kidney: when the kidney is infected and the infection is not properly diagnosed and treated, or it lasts a long time, the kidney is damaged.
• Environmental causes: working in very strong sun, lack of water in the body, careless use of medicine, injury to the kidney in an accident, and pollution of the surroundings, for example air pollution carrying so much lead that it becomes a poison.

Some causes belong to more than one group. Lack of water in the body, careless use of medicine and injury in an accident count as personal causes and as environmental ones, because they depend both on a person's own habits and on the conditions around them. A labourer working all day in strong sun and losing water from the body is a clear example.

Kidney disease makes itself known through changes a person can notice in the body. Its main symptoms are:

• swelling of the face
• loss of appetite
• nausea and vomiting
• weakness
• a burning feeling when passing urine
• passing less urine than usual
• high blood pressure

Many of these symptoms match what happens as the kidneys are damaged. When water and waste stay in the body, the face swells, the person feels sick and urine becomes less. High blood pressure is both a cause and a symptom, because the kidneys that keep blood pressure under control are no longer working well.

• Have the kidneys checked regularly. If a problem is found early, the kidneys can be kept from getting worse for a long time.
• People who have diabetes or high blood pressure should be checked from time to time and use the medicine they need.
• Exercise and drink plenty of water.
• Use less salt.
• Control what you eat. Too much oily, spicy and sour food should not be eaten.
• Take regular advice from a kidney specialist.
• Spread awareness about kidney disease.

These measures work directly against the causes. Drinking plenty of water stops the body from running short of water. Regular check-ups find infection, diabetes and high blood pressure before they harm the kidneys. Advice from a doctor or specialist replaces the careless use of medicine. Telling family and neighbours what you have learnt helps people who have never heard that their kidneys need care.