We all know that it is important to have healthy kidneys and that they are vital to our wellbeing. Having said that, not many of us understand what the kidneys actually do.
I spoke to Dr. Kong Wei Yen, Consultant Nephrologist and Head of the Nephrology and Dialysis Unit at Hospital Canselor Tuanku Muhriz, UKM Medical Centre in Kuala Lumpur to find out more about this vital organ and how we can better maintain its functions.
Q&A with Dr. Kong
1) First off, what are the kidneys?
Dr. Kong: The kidneys are the two bean-shaped organs, located just beneath the rib cage, one on each side. The kidneys are very specialised organs, some say even more specialised than the brain and the each kidney has about 1 million "nephrons", which are the functional units of the kidneys.
2) What are the functions of the kidneys?
Dr. Kong: The main functions of the kidneys are as follows:
a) Excretion of internal and external toxins
b) Maintaining water balance
c) Maintaining electrolyte balance (Sodium, Potassium, Calcium, Phosphate, Magnesium, Chloride, Bicarbonate, Ammonium etc etc)
d) Maintaining acid-base balance
c) Hormone secretion (Erythropoeitin. This hormone will stimulate the bone marrow to produce Haemoglobin, i.e. red blood cell. Hence most, if not all patients with advanced chronic kidney disease will need synthetic erythropoeitin injections routinely)
3) Are there any symptoms or warning signs one could look out for to determine the health of their kidneys?
Dr. Kong: Sadly, kidney diseases do not have any symptoms at early stages, nor do the most common causes of kidney disease, i.e. diabetes and hypertension. All patients with known diabetes and hypertension need to have routine screening of their urine and blood tests and early referral to nephrologists if the results are abnormal.
Contrary to popular belief, "sakit pinggang" (pain in the general area of your kidneys) has nothing to do with kidney diseases. Most kidney diseases won't cause pain because the kidneys have no nerve endings, except the kidney capsules (outer most membrane layer of the kidneys).
Bubbly urine is one of the earliest signs of kidney damage. Other symptoms like leg swelling, skin itching, poor appetite, metallic taste of food, reversal of day-night cycle etc are rather late signs of kidney diseases.
4) How do you measure kidney function?
Dr. Kong: By simply running some blood tests. The main blood test to determine kidney function is "creatinine"
5) What can affect kidney functions?
Dr. Kong: In addition to all of the points previously mentioned, some other medications and/or medical conditions can affect kidney functions. It is always best to consult your doctor should you have any questions. The kidneys are ‘bystanders’ and its functions are usually affected by the performance or failure of another organ or if the patient is critically ill. In these cases, the kidneys may fail also – either temporarily or permanently.
6) What are a few illnesses/diseases that can have detrimental effects on the kidneys?
Dr. Kong: As mentioned above, diabetes mellitus and hypertension. Others include glomerulonephritis (inflammation of the kidneys), obstructive uropathy/nephropathy (obstruction of the kidneys, ureters, urinary bladder or urethra, either by kidney stones or cancer or some rare conditions), and polycystic kidney disease (which is hereditary).
7) Are there any specific foods that one could eat to maintain kidney health? And foods that one should stay away from?
Dr. Kong: No food has been proven to be specifically good for the kidneys. Many foods can either directly or indirectly be harmful to the kidneys, for example processed salty or sugary foods might worsen the control of hypertension and diabetes, which in turn makes the kidney functions worse. Many herbal remedies have been proven to be harmful to the kidneys.
8) What is chronic kidney disease?
Dr. Kong: By definition, chronic kidney disease, or CKD, is a condition characterised by gradual loss of kidney functions over time, usually more than 3 months. The severity of CKD depends on the percentage of kidney function loss.
9) What is the treatment for chronic kidney disease?
Dr. Kong: Unfortunately, when the kidneys are damaged, most of the time we can't reverse it. Akin to getting an injury to the skin where it is going to leave a scar.
What the doctors can do, and should do, is to control the conditions that cause the kidney disease, and to avoid further additional harm to the kidneys, which will halt the kidney damage, or at least slow down the kidney damage, in many cases.
When the kidney damage is advanced, we need to either start haemodialysis, peritoneal dialysis or perform kidney transplant, for life sustainment of the patient. Otherwise, the patient will die of toxin accumulations and/or fluid overload.
10) How would I maintain the health of my kidneys? Is there anything specific I should be doing?
Dr. Kong: As usual, when it comes to your wellbeing, a healthy lifestyle is very important – exercise, avoid smoking, avoid excessive alcohol consumption, have a low-salt diet.
Screening for early detection and early treatment for diabetes and hypertension are also important as these are the two most common causes of chronic kidney diseases in Malaysia (and also worldwide).
And while some may be inclined to turn to traditional medicine, please bear in mind that a few traditional medications have proven to be harmful to the kidneys. Certain pain medications which belong to the NSAIDs group (Non-steroidal anti-inflammatory drugs) such as Ponstan, Ibuprofen, Celebrex etc can also be harmful to the kidneys if taken in large quantities over long periods of time.