DR SHARMILA RAMESSUR CHANDRAN
Consultant Renal Physician
President-Elect RACP
Renal is derived from the Latin word; renes and the French word is ‘rein’. The word ‘kidneys’ is from old English describing the shape.
Kidney specialists are also called nephrologists as well as renal physicians.
Kidneys (les reins) are kidney-bean shaped organs situated between the intestines and the muscles of the back around the level of the belly button.
Kidneys are made up of millions of ‘nephrons’ which are microscopic sieves attached to tiny tubes to filter out waste and excess liquid out of the body.
Kidneys have many important functions;
- They remove waste products from the body.
- Control the level of minerals such as sodium, potassium, magnesium, calcium.
- Control the level of acidity in the body.
- Control how much liquid is in the body.
The kidneys make several substances called enzymes and hormones and through those,
- Control blood pressure.
- Help the body make red blood cells (haemoglobin).
- Keeps our bone at the right thickness by controlling levels of calcium and Vitamin D.
The most common causes of kidney failure are diabetes and high blood pressure (hypertension) and because the damage is coming from the body, both kidneys are affected equally.
Kidney failure due to diabetes and high blood pressure is generally irreversible. The nephrons/microscopic sieves are very delicate and once damaged from diabetes or blood pressure, cannot recover but collapse and scar like a scar on the skin. This leads to a drop in kidney function that cannot be regained.
Once kidney function drops to about 30%, then it is a spiral down, as all the kidney functions I mentioned above, start derailing and none of these issues can be cured, only controlled with a strict diet and an increasing number of tablets.
Kidney disease is mostly silent, that is there are only subtle symptoms to tell you that your kidneys are failing till kidney function has dropped to very low or a serious medical event occurs. Patients who have very low kidney function feel itchy, lack concentration, feel very tired and lethargic. Often the fluid will start building up in the body which cause swelling and shortness of breath.
Patients will often put it down to everything else except a serious medical condition and often they don’t realise that they are passing less urine than they did before. They might be losing weight or putting a lot of weight on due to fluid retention.
Kidney function can drop to less than 20% before symptoms appear and sadly then it is too late to try and stop any further damage and the only option left is dialysis.
This is why it is so important that above the age of 40, everyone has a medical check every 6 months to 1 year. The doctor should check your blood pressure, and you should have some blood tests to check your cholesterol, sugar level, blood count and kidney function.
It is also important to do a urine test once a year, especially if you have diabetes. The first sign of kidney damage is protein in the urine especially in diabetes and at this early stage, the damage can be reversed with strict control.
Blood in the urine is also not normal (in between periods in women) and can be a sign of some serious problem including cancer. A doctor will be able to identify if there is any other kidney issue beyond diabetes and high blood pressure that would require more testing and specific treatment.
Kidney damage can be halted or slowed down and of course the very best and easiest management of kidney disease is PREVENTION.
So, kidney health in most cases is about
- Controlling diabetes.
- Controlling high blood pressure.
- Controlling high cholesterol.
- Keeping a healthy weight.
- Not taking toxins such as herbal powders, protein (creatinine) supplements, excessive amount of anti-inflammatories.
Controlling High Blood Pressure
In most cases, people suffer from high blood pressure due to your genes and poor lifestyle choices. It is called Essential Hypertension.
There is a lot that you can do to control essential hypertension.
- Diet low in added salt
- reduce the amount of salt in your food. Beware of sauces just as soy sauce or oyster sauce which are very high in salt.
- Avoid large snack packets such as chips, ‘moorkoo’, cheese twists, salted peanuts etc.
- It is best to buy the kids size snack packets as then you can control your portions for a snack.
- Don’t go on a zero-salt diet as it is highly likely you won’t be able to maintain it as the food won’t have much taste; low salt not zero salt.
- Reduce the amount of take away food; once a week or fortnight only. Take away food is NEVER healthy. The meat used is generally fatty and of poor quality. The food is always high in unhealthy oil, salt, and sauces. Beware of take away salads; they are rarely healthy as generally they are saturated with oil or creamy seasoning.
- Exercise and keep your weight down. Patients with high body weight are much more likely to have high blood pressure than thin people and high blood pressure in this group is often hard to control. Lose weight by eating healthily and exercise.
What is ideal blood pressure?
- Ideal blood pressure in all age groups is a systolic between 100 to 130 (the top figure) and a diastolic (the bottom figure) between 60-80.
- Sometimes irrespective of your lifestyle, your blood pressure will remain high which is when you need a doctor and medications. If you are on medications, check your blood pressure every fortnight to one month to make sure the tablets are working. Blood pressure medications should be taken everyday. If you skip them, your blood pressure will fluctuate, and this can also cause organ damage.
- Even if you are taking blood pressure medications, you need to have a healthy lifestyle.
Why should you keep your blood pressure well controlled?
- High blood pressure causes kidney disease as well as strokes and heart attacks and if your blood pressure is very high, it can cause sudden severe eye bleeds or brain hemorrhage (bleed) or even coma.
Reducing High Cholesterol
- Reduce the amount of oil you are using. 1-2 tablespoons of oil should be enough to cook a curry for 5 people. There is nothing wrong with spices, ginger and garlic and tomatoes. It is the amount of oil and ghee in curries that is an issue. Remember ‘good’ oil is still oil and must be used in moderation.
- No routine fried food: pakoras/faratas or pastries (massepain, puits d’amour etc)– it should only be eaten once a fortnight and then only a small amount.
- Eliminate oil in your salads or just use a couple of drops.
- Burgers, chips, nuggets, kebabs are all unhealthy, highly processed food that should only be eaten on occasion.
- Beware of the amount of fat in the meat and chicken in Mauritius. Goat meat can be very fatty so eat only in moderation and trim all fat as much as possible. All fat and skin need to be removed from chicken meat before eating. If you can afford it, buy lean meat. You will get more meat for your money.
Avoiding Toxins
- Avoid anti-inflammatories such as Ibuprofen, Diclofenac and Advil. If they are taken most days for several months, they are likely to scar the kidneys permanently or cause stomach inflammation and/or an ulcer. This also applies to young girls who take a lot of Ibuprofen for period pains every month. Anti-inflammatories should only be taken infrequently. It is best to use Panadol as it is one of the safest pain medications if taken at the correct dose and you don’t have a high alcohol intake.
- Avoid oral herbal remedies especially in powder form as they can often cause severe gout as well as rapid and uncontrolled liver and kidney failure. They are often contaminated with other dangerous substances and are too concentrated for the organs to cope.
Protein Intake
Should you restrict your protein intake if you have kidney disease? Absolutely not!
Should you eat an excessive amount of meat? Absolutely not!
The diet of Mauritians seems to be at 2 extremes, both unhealthy in different ways.
The younger population, due to urbanization, are relying more and more on takeaway or packaged food which is highly processed and saturated in salt, fats, and sugars. They also tend to have a diet high in meat with minimal vegetables (potato is not a vegetable). Most meat available in Mauritius tend to be fatty. Excessive amount of meat and highly processed food push the cholesterol level up causing heart, kidney and liver disease and have also been proven to increase the risk of most cancers.
At the other end of the spectrum, the retirees are now mostly vegetarian. They have a diet low in protein and very high in carbohydrate and many have low levels of exercise. In aging people with low level of activity, muscle turn to fat which is why unfit people feel so tired after exercise and it becomes harder and harder to lose weight. This is why as one gets older, it is even more important to exercise; to maintain muscle mass.
Vegetarian sources of protein include milk, yogurt, paneer, tofu, all grains such lentils, beans and chickpeas, and nuts. Nuts are high in protein but also high in fat and for this reason, should be eaten in moderation.
Inadequate level of protein in the diet creates a population of ‘malnourished fatties’.
So, then what is normal amount of protein? Just under 100 g of protein per day for an adult but there is no need to measure:
- A small handful of cooked chicken/lean meat.
- A glass of milk or some yogurt (don’t use powder milk, it is highly processed and high in fat).
- A couple of boiled eggs or a bowl of lentils or beans
basically, add up to enough protein in one day for most adults.
Exercise
Exercise regularly to keep your muscles in shape which helps to control cholesterol level, diabetes, and blood pressure and is very good to keep a healthy mind. Regular exercise will help you maintain a healthy weight. However, gentle exercise will not result in weight loss if you don’t also control what you are eating.
Remember that nobody is too busy for 30 to 45 minutes of exercise everyday. You need to make it a priority and a routine and enjoy the exercise you are doing whether in the morning or afternoon or in your lunchtime break. Exercise is so much easier now that so many people work full time or part time from home. Exercise can be a 30 minutes brisk walk around your workplace, your home or your kids’ school or exercise on a stationary bike, treadmill or a game of badminton or tennis etc. Exercise needs to be most days and it does get easier the more you do. A walk once a week is simply not enough.
Looking After Your Health
Kidney disease is mostly silent and can stay silent till kidney function has dropped to very low, even sometimes 10 to 20% which is why so many people present too late and sadly then require emergency dialysis which is very traumatic for them, and their families and they are more likely to suffer from serious complications.
Kidney disease can be excluded with a simple blood test and urine test.
Similarly high blood pressure and high cholesterol can remain silent till there is a serious adverse event such as a stroke or a heart attack which is why it is so important from the age of 40 onwards, to have regular yearly checks with your doctor.
Kidney disease like diabetes cannot be cured, so the smartest move will be to avoid developing kidney disease because once part of the kidney is scarred, like a scar on the skin, it cannot recover.
At the end of the day, good health is the responsibility of the person not the doctor and it always come down to a healthy, disciplined lifestyle; a regular diet low in added salt/sugar and fat, and daily exercise. It will save you a lot of money in your retirement and you will live longer and better.
