The kidneys are two bean-shaped organs of vital importance. Not only are they responsible for the excretion and elimination of waste substances and urine, but they also have an influence on other health problems, and vice versa: other pathologies and not taking enough care of oneself have an impact on kidney malfunction. On the occasion of World Kidney Day, we have the collaboration of Dr. María Dolores Arenas, head of the Nephrology Department of the Vithas Perpetuo Socorro Hospital in Alicante and member of Top Doctors.
What is the importance of the kidneys? What percentage of Spaniards suffer from kidney pathologies or renal insufficiencies?
Chronic Kidney Disease (CKD) is an important public health problem. According to the results of a study designed to determine the importance of CKD in Spain, promoted by the Spanish Society of Nephrology (SEN) with the support of the Ministry of Health and Consumer Affairs, approximately 11% of the adult population suffers some degree of CKD. The decline in renal function is associated with increased cardiovascular risk, as well as very significant costs (in Spain the annual cost associated with the treatment of the most advanced stages of CKD is estimated at more than 800 million euros).
Hidden” kidney disease, what is it and how important is it?
A significant number of patients with CKD are without a correct diagnosis because renal function controls are not performed, or because they have occult CKD (they have kidney disease even though serum creatinine levels are in the normal laboratory range). In patients followed with diseases as frequent as AHT or diabetes mellitus, renal failure can reach figures of 35-40%, and about 20% of people over 60 years of age have renal failure.
How do we know if we have kidney disease?
The kidneys do not give any warning. Often the only way to know if our kidneys are working properly is through blood and urine tests.
The groups of patients who are most at risk of developing CKD and who should have a renal function study performed are:
- Over 60 years of age
- Hypertensive patients
- Diabetic patients
- Patients with cardiovascular disease
- Relatives of patients with renal failure
Renal function is studied by measuring glomerular filtration rate and albuminuria, at least once a year, with a simple blood and urine test.
What happens if renal failure is detected?
Although kidney disease is thought to be rare and complex, the reality is that, in its early stages, it is frequent and easily treated. Only a small proportion of patients progress to end-stage renal failure requiring renal replacement therapy by dialysis or transplantation. This progression towards total loss of renal function is progressive, and its slowing and arrest can be influenced by acting early on its main causes: arterial hypertension (AHT) and diabetes mellitus.
Early detection of this disease and appropriate referral of patients to nephrology improves long-term prognosis and reduces costs.
The objectives to be taken into account in persons with known renal disease are control of BP less than 130/80 mmHg (125/75 mmHg if there is a lot of proteinuria); control of C-LDL cholesterol 40 mg/dL; control of diabetes: HbA1c less than 7%, adjusting medications to the degree of renal insufficiency, especially in the elderly, avoiding, as far as possible, the use of anti-inflammatory drugs, careful use of renally eliminated oral antidiabetics, avoiding uncontrolled association of potassium-retaining drugs, etc.
Not all the causes of CKD are hypertension and diabetes: CKD and obesity.
Although CKD is associated with arterial hypertension and diabetes, we should not forget other causes of CKD that are perhaps less well known but of great importance. The incidence of renal involvement associated with obesity is reaching high proportions during the last decade. Obesity is an important risk factor for the development of proteinuria and renal failure in the healthy population. The prevention and treatment of obesity should be a primary objective in diabetic and non-diabetic patients with CKD. Furthermore, if overweight or obesity is combined with high blood pressure, the development of CKD is more rapid.
Renal obstruction as a cause of CKD
Obstructive uropathy is a frequent cause of CKD, especially in men over 60 years of age, in whom there is usually prostatic enlargement. It is a treatable cause, in which if the obstruction is corrected, the progression of CKD is delayed. For this reason, an ultrasound scan is recommended for all men over 60 years of age with CKD.
How can chronic kidney disease be prevented?
To prevent renal failure it is important to lead a healthy lifestyle. The same advice and recommendations that help us prevent heart disease are useful for taking care of our kidneys:
- Moderate physical exercise
- Balanced nutrition
- Reduce salt consumption
- Avoid smoking
- Avoid dehydration (drink what you are thirsty, no more and no less).
- Controlling hypertension
- Control diabetes
- Avoid overweight and obesity.
- Moderate consumption of anti-inflammatory drugs and avoid them, especially in the elderly.
The kidneys are two bean-shaped organs of vital importance. Not only are they responsible for the excretion and elimination of waste substances and urine, but they also influence other health problems, and vice versa: other pathologies and not taking sufficient care of oneself have an impact on kidney malfunction. On the occasion of World Kidney Day, we have the collaboration of Dr. Arenas, head of the Nephrology Service at the Vithas Perpetuo Socorro Hospital in Alicante.