‘The primary purpose of the kidneys is to excrete waste products, toxins, and excess fluid from the body.’ *MCT graphic
‘The primary purpose of the kidneys is to excrete waste products, toxins, and excess fluid from the body.’ *MCT graphic

In its earliest stages, kidney disease may be totally asymptomatic and thus is often referred to as a ‘silent’ disease.

If deterioration of kidney function is not diagnosed through screening in a timely manner, and/or is inadequately treated, persons will go on to develop Chronic Kidney Disease (CKD) and eventually End-Stage Renal Failure (ESRF).

Our kidneys are vital, bean-shaped organs, located in the rear of the abdominal cavity on either side of the spine.

They are typically positioned just behind the liver on the right side of the abdomen and the spleen on the left side.

An adult kidney is roughly the size of a fist — approximately four-to-five inches long (10-13cm), two-to-three inches wide (5-7.62cm) and weighs about a third of a pound (150 grams).

The primary purpose of the kidneys is to excrete waste products, toxins, and excess fluid from the body. Each day the kidneys filter about 200 quarts (200 litres) of blood to produce about two quarts (two litres) of waste and excess fluid in the form of urine.

Other important functions include the regulation of body electrolytes (i.e. sodium, potassium etc.) in proper balance and the production of hormones, which regulate blood pressure, calcium levels in the blood, and the production of red blood cells.

The National Kidney Foundation (NKF) criteria for diagnosing kidney disease is as follows: kidney damage for three or more months, as defined by structural or functional abnormalities of the kidney, with or without decreased Glomerular Filtration Rate (GFR), as seen on imagining tests or biopsy, or abnormalities in the composition of the blood or urine or GFR less than 60 ml per minute (per 1.73 m2) for three months or more, with or without kidney damage.

The normal range for GFR, adjusted for body weight, is about 100-130ml/min. There are approximately one million nephrons in each kidney and it is here that the actual filtration process occurs.

While the human body can function very well with one healthy kidney, most kidney diseases attack both kidneys simultaneously.

Unfortunately, function loss may be greater than 40 per cent before our bodies display symptoms.

When function decreases to 10-15 per cent of normal, regular dialysis treatments or a kidney transplant will be necessary to stay alive.

Common causes

The two most common causes of kidney failure are diabetes and high blood pressure. People with a family history of kidney problems, for example, polycystic kidneys, are also at risk for disease.

Additional causes include infections, medications, drug use, prostate or bladder problems, lupus, rheumatoid arthritis, and other autoimmune diseases.

According to Dr Lynette E. Thomas, director of nephrology, and Dr Wendy E. Outerbridge, associate physician, Beresford Swan Dialysis Unit, approximately 12 per cent of the adult Bermuda population suffers from CKD.

 They further estimate that 4-to-6,000 people have mild CKD; 2,800 have moderate CKD, 300 people have severe CKD, and that a further 130 persons have ESRF.

As the majority of people with kidney disease will not be aware of their condition until advanced stages, it is important to have regular annual check-ups.

In addition to monitoring your blood pressure and blood glucose levels, your doctor will order other simple blood and urine tests which may reveal early kidney disease.

If you are already at high risk for developing kidney disease, for example, you have hypertension, diabetes, or a family history, your doctor should test your GFR at least once each year.

While GFR does tend to decrease with age, the decrease should be more gradual.

Currently, annual financial costs for dialysis treatments and maintenance per patient in Bermuda exceed $200,000; but there are also ‘emotional costs’ involved.

Patients must adapt to three-to-four-hourly dialysis sessions three days each week, resulting in increased disability, lost work opportunity, reduced income, and increased stress levels.

While patients may be placed on a transplant list, it can take years before a suitable donor kidney becomes available.

The sooner kidney disease is diagnosed the sooner treatment and lifestyle modifications can be implemented to decrease the rate of disease progression.

Strict adherence to medication, exercise, and diet regimen will then be essential to maintain kidney function for as long as possible.