World Kidney Day 2014: 3 good reasons to get a kidney check up done

March 13 is the World Kidney Day 2014.

The status of chronic kidney disease (CKD) all over the world is quite alarming. As per the World Health Organization (WHO) Global Burden of Disease Project, kidney disease along with urinary tract problems account for nearly 850,000 deaths every year. The main reason for increasing incidence of kidney disease is the fact that people are not aware about the impact of unhealthy lifestyle and early diagnosis on their kidney health.

Increasing cases of kidney disease in youth:

There has been a rise in the number of younger people in their 20s showing up with Chronic Kidney Diseases (CKD), say doctors. Factors like obesity, consumption of oily food (leading to early onset of diabetes), consumption of protein-rich supplements for body building without medical advice and smoking are some reasons that have caused the rise in youth. Other reasons for early CKD include:

• Increased use of pain killers
• Obesity
• High blood pressure
• Genetic factors
• Immune disorders

Kidney disease is a silent killer

According to Dr Saurabh Pokhariyal, director, Nephrology and Renal Transplant, FMRI, 10% of the general population suffers from some form of renal impairment, which if not taken care of would eventually lead to a CKD, the prevalence of which is 1% in India. Kidney disease occurs gradually and is not noticed until the damage significantly reduces your kidney function. Therefore it is essential for you to get your kidney function assessed after you cross your 50S.  

‘Illness or injury prevents the blood-filtering units (nephrons) of the kidneys from functioning properly. When the kidneys lose their functionality, fluids, salts and waste can build up in the bloodstream. This is called kidney failure,’ explains Dr Salil Jain, senior consultant, Nephrology and Renal Transplant.

Early diagnosis can prevent the condition from progressing

Dr Jain highlights the need for awareness among people as well as the medical fraternity to detect the disease at an early stage. He explains, ‘The problem is attributed to poor lifestyle practices which increases the incidence of diabetes and high blood pressure and delay in getting regular health checks done.’ If you know the status of your kidney function, you can make lifestyle and dietary changes early and save you kidneys from deteriorating completely.

Here are 8 tests for checking if your kidneys are functioning fine.

Kidney problems do not develop overnight. Your kidney function naturally starts declining after you cross your 30s. And whether you will develop a kidney problem later in life is largely dependent on your lifestyle habits and diet. In most cases, kidney problems are caused as a result of a primary condition like diabetes, hypertension or high cholesterol levels. Because the symptoms of kidney diseases are not evident unless the kidneys are deteriorated to a great extent (to about 15 percent of their normal capacity), you should regularly screen your kidney function (especially if you suffer from heart disease and diabetes). Here are some kidney function tests that can determine whether you are at a risk of kidney disease. (Read about the 12 symptoms of kidney disease you shouldn’t ignore.)

1. Blood pressure: Your kidneys perform the function of filtering blood under pressure to eliminate waste products through the urine. If your blood pressure is higher than normal it will increase the load on your kidneys and may lead to kidney disease. Alternatively, a person is suffering from kidney disease is also likely to have high blood pressure. Read more about the medication for high blood pressure.

2. Blood creatinine test: Creatinine is a waste product that is produced by your muscles. It enters the bloodstream and is filtered by the kidneys to get excreted through the urine. A blood creatinine test will measure the amount of creatinine in your blood. A higher level (greater than 0.8-1.2 mg/dl in men and 0.6-0.9 mg/dl in women) may indicate that the kidneys are not functioning properly. 

3. Blood urea test: Urea is a waste product filtered by the kidneys and excreted through the urine. It is produced by breakdown of proteins. A high level of urea in the blood (greater than 20-40 mg/dL) may indicate altered kidneys function. 

4. Urinalysis: It is one of the recommended kidney function tests by the National Kidney Foundation (NKF). It is used to detect the presence of protein and blood cells (RBCs and WBCs) in the urine. Increased levels of both protein and blood cells indicate early signs of kidney disease. 

5. Urea clearance test: This test is based on a comparison between the amount of urea in the blood and the amount of urea in urine. If the urea clearance is lower than the normal range (64-99 ml/min), it may indicate that the kidneys are not working properly. 

6. Creatinine clearance test: A creatinine clearance test also compares the level of creatinine in blood with creatinine in urine to determine the rate at which the kidneys are filtering creatinine. Altered creatinine clearance range (normal range: 85-125 ml/min in men and 75-115 ml/min in women) indicates altered kidney function. 

7. eGFR (estimated glomerular filtration rate): Glomerular filtration rate is the rate at which your kidneys filter waste products from the blood. eGFR is a value that is derived from a formula based on the amount of blood creatinine, age and gender of the person. According to the NKF, eGFR is the best estimate of determining accurate kidney function. Normal eGFR results range from 90-120 mL/min/1.73 m2.

8. Renal ultrasound test: Renal ultrasound is an imaging test that uses high frequency ultrasonic waves to check the shape and size of the kidneys. It can detect the flow of blood to the kidneys as well as the presence of tumors, cysts and infection around the kidneys. It also helps to detect presence of kidney stones and external damage or injury to the kidneys. 

ps- this is only for information, always consult you physician before having any particular food/ medication/exercise/other remedies.

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‘Mini kidneys’ grown from human stem cells

Scientists have for the first time grown three-dimensional kidney structures from human stem cells.

The research opens new avenues for studying the development and diseases of the kidneys and may lead to new drugs that target human kidney cells.

Scientists had created precursors of kidney cells using stem cells recently, but the team led by Salk Institute for Biological Studies is the first to coax human stem cells into forming three-dimensional cellular structures similar to those found in our kidneys.

“Attempts to differentiate human stem cells into renal cells have had limited success,” said senior study author Juan Carlos Izpisua Belmonte, a professor in Salk’s Gene Expression Laboratory and holder of the Roger Guillemin Chair.

“We have developed a simple and efficient method that allows for the differentiation of human stem cells into well-organised 3D structures of the ureteric bud (UB), which later develops into the collecting duct system,” Belmonte said.

The findings demonstrate for the first time that pluripotent stem cells (PSCs) – cells capable of differentiating into the many cells and tissue types that make up the body – can be made to develop into cells similar to those found in the ureteric bud, an early developmental structure of the kidneys, and then be further differentiated into three-dimensional structures in organ cultures.

UB cells form the early stages of the human urinary and reproductive organs during development and later develop into a conduit for urine drainage from the kidneys.

The scientists accomplished this with both human embryonic stem cells and induced pluripotent stem cells (iPSCs), human cells from the skin that have been reprogrammed into their pluripotent state.

After generating iPSCs that demonstrated pluripotent properties and were able to differentiate into mesoderm, a germ cell layer from which the kidneys develop, the researchers made use of growth factors known to be essential during the natural development of our kidneys for the culturing of both iPSCs and embryonic stem cells.

The combination of signals from these growth factors, molecules that guide the differentiation of stem cells into specific tissues, was sufficient to commit the cells toward progenitors that exhibit clear characteristics of renal cells in only four days.

The researchers then guided these cells to further differentiate into organ structures similar to those found in the ureteric bud by culturing them with kidney cells from mice.

This demonstrated that the mouse cells were able to provide the appropriate developmental cues to allow human stem cells to form three-dimensional structures of the kidney.

The study is published in the journal Nature Cell Biology. 

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High uric acid level

A high uric acid level, or hyperuricemia, is an excess of uric acid in your blood. Uric acid is produced during the breakdown of purine, a substance found in many foods. Once produced, uric acid is carried in your blood and passes through your kidneys, where most of it leaves your body when you urinate.

A high uric acid level may result in attacks of gout, but not everyone who has high uric acid gets gout, and not everyone with gout has high uric acid.

Causes

A high uric acid level can be caused when your body either produces too much uric acid or your kidneys don't eliminate uric acid rapidly enough.

A high uric acid level may cause increasingly frequent attacks of gout, or it may never cause problems. A high uric acid level may also cause some people to develop kidney stones or kidney failure. And some people with a high uric acid level also develop high blood pressure, heart disease or chronic kidney disease, but it's often unclear whether this is a direct cause or merely an early warning sign of these conditions.

Factors that may cause a high uric acid level in your blood include: 

Diuretic medications (water pills) 

Drinking too much alcohol

Genetics (inherited tendencies)

Hypothyroidism (under-active thyroid)

Immune-suppressing drugs

Niacin, or vitamin B-3

Obesity

Psoriasis

Purine-rich diet — organ meat, game meat, anchovies, herring, gravy, dried beans, dried peas, mushrooms and other foods

Renal insufficiency — inability of the kidneys to filter waste

Tumour lysis syndrome — a rapid release of cells into the blood caused by certain cancers or by chemotherapy for those cancers

Also, you may be monitored for high uric acid levels when undergoing chemotherapy or radiation treatment for cancer.

Pl. note that these are common causes, but you need to see your physician for anything to be confirmed.

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Kidney Cancer Drugs Equal in Prolonging Survival

The drug pazopanib (Votrient) works as well as sunitinib (Sutent) for treating advanced kidney cancer, but it has milder side effects, a new study finds.

Although both drugs are approved by the U.S. Food and Drug Administration as first-line treatments for kidney cancer and both boost survival, pazopanib had the edge in improving the quality of life, the researchers reported.

"Kidney cancer has long been considered one of the most difficult-to-treat cancers, and is associated with a poor prognosis when it's metastasized [or spreading]," said lead researcher.

Now there are drugs that attack a gene that is responsible for turning kidney cells into cancer cells, he said. "There has been tremendous progress in the treatment of this disease since 2005 with these targeted drugs,"he said. "The first of these drugs was sunitinib, which is considered the standard in first-line treatment for kidney cancer."

This new trial was a head-to-head comparison of sunitinib and pazopanib. The researchers found both had a similar safety profile and survival benefit, but there were milder side effects with pazopanib, Motzer said. These included less fatigue and fewer sores on the bottom of the feet, he noted.

"The data also suggest that patients on pazopanib have a better quality of life than patients on sunitinib," he said. Both drugs cost about the same -- about $6,500 a month -- and are covered by Medicare and many private insurers.

"Both these drugs are good options for first-line treatment," he said. "They allow for us to individualize treatment for patients. In my own practice, I have changed my preferred drug from sunitinib over to pazopanib, because most patients appear to have a better quality of life with pazopanib compared with sunitinib."

A urologist , said that "this study shows that there is more than one option for first-line therapy for renal [kidney] cancer."

According to him, 65,000 people are diagnosed with kidney cancer each year in the United States. "It's the sixth most common cancer," he said. And because it is often diagnosed late, 30 percent to 50 percent of the patients develop metastasis, he added. "It's one of the top 10 cancer killers," he noted.

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Metals that are wrecking you

Two laboratories come up with shocking results. Experts 

blame pollution, construction activity and ayurvedic 

medicines for toxicity.

It's been 10 years since lead-free petrol was introduced. Lead 

in pencils is gradually being replaced by graphite and clay, 

and most paint and cosmetic companies are now going out 

of their way to convince consumers that their product is 

'metal-free'. And yet, lead poisoning continues to top the 

chart of heavy metal toxicity in humans. Medical experts 

claim extreme level of pollution, construction activity and 

haphazard use of ayurvedic medicines are the culprits.

Figures from the city-based laboratories reveal the 

worrisome trend. Of the 600 odd samples received every 

month by a diagnostics centre for Atomic Absorption 

Spectroscopy, which detects metal content in body fluids, 

about 350 contain lead. It is followed by copper (125), zinc 

(50) and other metals such as arsenic, mercury, aluminium 

and chromium.

Even a small amount of exposure to lead can lead to long-

term health hazards, especially in children. It is known to 

cause anaemia, hypertension, impaired fertility and so on. 

Doctors say foetuses can be affected by lead exposure, as it 

reaches them through the placenta.

In addition, lead does not allow other metals such as zinc 

and copper to be flushed out of the body, leading to their 

build-up as well. The dangerous metal can remain inside the 

body for more than 45 years.

Apart from being carcinogenic or toxic, most metals 

adversely affect the central nervous system, kidneys, liver , 

skin, bones and teeth.

"The number of samples with metal content has gone up 

over the years. We started in 2010 with about 250 samples 

monthly and today we screen around 600," said  a Dr. 

Another laboratory, tests about 250 samples in a month, of 

which 150 contain lead. "Most samples are from people 

working in industrial set-ups, which expose them to such 

metals on a daily basis. Samples with arsenic generally 

come from people who use ayurvedic drugs containing 

heavy metals," said a Dr. 

While advanced technology is available to test the metal 

content, many metals generally go undetected. That is 

because the process to detect each metal is different and 

doctors check only for that metal which is producing 

adverse symptoms. Ayurvedic medicines have been blamed 

for high amount of metals in them. The practitioners, 

however, claim that their medicines were always made with 

various metals but qualified practitioners know how much 

to prescribe.

According to a consultant physician , these metals are 

present in food, water, even the very air we breathe in. 

"They first enter the blood stream. Liver tries to process 

these metals out of our body, which puts pressure on it. It 

can cause jaundice and liver cell disease. These metals can 

cause renal failure and neurological problems too," said 

a Dr.

According to the Dr., if detected in the initial stages, patient 

can be provided with metal chelationtherapy, which helps 

remove these toxins in two-three months.

Heavy metal poisoning 

Heavy metals may enter the body by ingestion, inhalation or 

absorption through the skin or mucous membranes. They 

are then stored in the body's soft tissues. Once absorbed, they 

compete with other ions and bind to proteins, impairing 

enzymatic activity and damaging many organs.