The world population as well as the diseases is on the rise which is alarming. Now China, India and United States of America comes in the forefront of the countries with highest population. As per the present scientific research and understanding, India will become number one in the coming years. Death rate following various disease are very high now kidney disease become in the third after the heart second and cancer the first for claiming death.
We know that preventive measures have been started already for the cancer and Heart diseases. Unfortunately so far no meaningful effort was made for the prevention of kidney disease and it is inflicting causes.
In the near future around 40 million people with kidney disease will die, what ever the treatment provided. Besides this catastrophe the kidney disease individuals carry high risk of facing economic and social burden with treatment like dialysis and kidney transplantation and the burning cost of immune suppressive and other drugs. This will results in the grave financial as well as manpower collapse.
When the advanced/ developed countries are facing severe threat due to the this financial crisis and is trembling in front of the kidney disease. This will be graver in the developing nation like India who confronting with various problems like terrorism and racial discrimination and fighting against poverty. Now, it is time for rising the eyebrows of the entire world and think for finding out a solution for the coming menace of kidney disease.
The world as a whole face that the lack of awareness of the disease and disease causation. It is surprising to note that the Keralite who claims having an literacy rate of 90-100% are not aware of this disease. It is high time to have seminars awareness camps and education of the society about the kidney disease and their after effects. The knowledge and awareness about the disease in the society very early stages itself is a great weapon in the prevention. The need for the research in basic subjects at various levels beside the awareness programs and clinical knowledge is warranted. In order to make this success the available infrastructure found insufficient. The need for the development and involvement of public is the most important step. With this purpose all over the world various Kidney foundation started working and doing charitable works. In Kerala Institute of Nova Kidney Foundation (INKF) is functioning for this purpose. All over the world this kidney foundation are jointly made a venture and produced the International Federation of Kidney Federation (IFKF) and work with co-operation for the kidney and related illness. IFKF in association with various other Nephrology societies has decided to make the awareness about the kidney disease, a World Kidney Day is being celebrated. This is fixed as second Thursday of the month of March in everey year. The first was being done on june 2006.
The knowledge about the functions of the kidney is very essential for the understanding of the kidney diseases and its causation. The kidneys are the bean shaped organ situated on either sides of the vertebral column behind the peritoneum below diaphragm. Each is weighing 150 gm, and carrying a blood around 1/5 of the cardiac output in each minute. A small organ handling a large amount of blood in short span of time. In each kidney there are Glomerulus, Blood vessels, Tubules and Mesangium.
The kidneys caters and monitors very important functions of the body. One, Kidneys keep the blood and protein in the body with out leaking into the urine and going out, controlling salt and electrolytes and acid base balance in the body along with water control.
Two, removal of the metabolic waste like urea, creatinin and other waste products of protein metabolism, removal of the phosphorus potassium uric acid etc.
Three, production of hormones like Erythropoietin essential for blood formation, one twenty-five dihydroxi cholicalciferol for bone remodeling and strengthening, the Bradikinin, Prostaglandin and Kallikrin necessary for smooth flow of blood and control of blood vessels, the production of Renin which control the blood pressure.
Four, The control of the metabolism of various important hormones like Insulin, growth hormone, thyroxin etc.
Five, The changes in vessel structure or alteration size of kidneys will produce the blood pressure changes.
The kidney diseases are mainly two types, the first one is primary renal disease. The causes of disease mainly from within the kidneys. The signs symptoms and mode of presentation of the disease are very few like leaking of protein / blood through glomerulus and appear in urine. Sometimes presence with edema and or hypertension, and very rarely renal failure. In the body of these patents loose large amount of protein and they are prone to develop various kinds of infection. The knowledge so far is very minimal in understanding of such diseases resulting in the treatment dilemmas. The mainstay in the treatment of the disease is steroids and then not responding to the treatment may adopt various other immunosuppressant drugs. The present knowledge in this disease through various researches’ and the evidence based medicine which is the defensive medicine now practicing can arrest the disease to some extend. Those diseases needs regular checkup from Nephrologist physician or family doctor for control of disease. To some extend these disease will slowly or fast progress to renal failure.
The kidney diseases secondary to the other illness are mainly due to Hypertension and diabetes and various infections, surgical and due to various trauma, pregnancy and child birth, Vasculities etc. Among the diabetes and hyper-tension takes the major share around to 90 percent of the cases. The understanding of this disease and various researchers in this field understood that these disease are preventable if we detect and treat them early. Kidney failure and kidney diseases due to diabetes are around 20 to 40 percent in the world, the exact statistics in India is still yet to come.
It is not wonderful that the diabetics and hypertension if we detect very early we can prevent the developments of kidney failure and in some cases it delays kidney failure. But unfortunately the majority of the mankind is not accepting or understanding the early disease due to various reasons beyond their knowledge, awareness, or lack of health education. Hence I remember the words of the famous writer, C.P.Snow, “The majority of mankind is nasty brutish and short” for my connivance I change this into the majority of the mankind is ignorant of the health and / or we are not able to provide this to them and short living.
In this context we can look into the facts of the disease and how we can prevent the kidney failure. The diabetes is mainly two groups among this first group is called Type-I Diabetes. In this the individual’s body is not able to produce insulin or is very minimal then the life is miserable so this patient will approach the doctor’s early or die to various problems of health. They develops generalized weakness, increased appetites, increased thirst and large amount of urine and weight loss for this reason the individual approach the doctor and takes the treatment in the form of insulin very early. These groups if they are on strict insulin and other treatment they will not develop complications of kidney failure.
In the next group of diabetes which is known as Type-II Diabetes the above mentioned symptoms are not severe enough to bring the individual into the doctors chamber or hospital in the early stages. They develop most of the symptoms and signs gradually so that very often the involved individual will be unaware of the problems, so this is true in the case of illiterate to the most educated and even among the doctors and other health staffs. This group of persons will visit the concerned doctors when they develop illness like Heart attacks, due to coronary artery diseases, visual disturbances and blindness due to disease of blood vessels of eyes, paralysis of the body due to the disease of the blood vessels in the brain, non healing leg ulcer due to the peripheral blood vessels disease leg peripheral neuropathy due to the nerve disease and edema of the leg due to the fluid overload. Infection, among this most important is pulmonary tuberculosis and other persistent diseases. With this disease the individuals land in various places and departments in hospitals including intensive care units. Sometimes very rarely this individual come for the treatment of Kidney care department. This is most unfortunate and often very grievous situation seen around. These patient will reach to the kidney care department when they are in end stage Kidney failure where they need treatment like dialysis or kidney transplantation for support of further life, or never reaches.
We see what the WHO has to say, about this present scenario of diabetes and allied illness. The burden of disease due to diabetes in the world is 150 billion and in 2025 it will double to 300 billions. The unfortunate situation that patients in India and Kerala is the illness starts at 45 years. This will result in the loss of the working groups who is the one who needs the country in the growth and developments is a dangerous trend.
Diabetes most after results or associated with hypertension and becomes more fatal. It is interesting to note that on the very early stage of the diabetes it itself will affect the kidneys. In the first stage of the illness when there is increased thirst and more water intake the body will increase the size and kidney becomes enlarges and the blood urea and creatin falls rather than increase. The work load of kidneys increases but in this stage no persons will consult doctors or other health staff but rather happy that many have good amount of urine and good thirst often. Persons will be bossing with statement now “I am happy that I am taking large amount of water and passing large amount of urine, it is good for health”. This is the unfortunate sceneries we see most often on and around.
In the second stage of kidney affection the kidney starts leaking protein and glucose in the urine due to incapacity to handle large amount of water and glucose. This stage some times there may be some edema to limbs or dependent parts of edema and starts develop joint pain due fluids in the joint spaces and prone to chronic infection.
Then this goes in to third stage of the disease if untreated where protein loses in urine in large amount and kidney size starts shrinking and person may develop various infection, coronary artery diseases, serebrovascular disease and disease of blood vessels of various points of the body. The disease of limbs become more severe If persons smokes or drinks alcohol this stages, the risk of the disease will increase proportionately. In this stage most often the individual do not seek advise from kidney cure departments.
In the fourth stage the kidney failure and symptom appears like severe anemia, rise of urea, creatinin in the blood, size of kidney starts shrinks on ultra sound examination. This individual becomes more upset and most often seeks medical advice. Some times the urine output also decreases. In this stage individual is prone to develops various infection and majority will succumb.
In the fifth stage of the illness the individual become more week and bed ridden not able to do any activities and needs dialysis for support of life and if overcome they need kidney transplantation but most often it is not possible in them due to damage of most of the other organs. This is the calamity of the illness and in each stage we can present the diseases we can slow the progression of the disease and in and very early stage we can prevent the development of kidney failure.
The role of Kidney Foundation and its unity in the world is the need of the hour. They can provide health education, awareness camps in society and need for the continuing Medical education to health professionals and involvement of the various persons and personalities in to this programmes. Now Institute of Nova Kidney Foundation (INKF) in Trivandrum, Kerala, India, in association with World Kidney Foundation (WKF) under National Federation of Kidney Foundation (IFKF) working in this motive. The seventh IFKF meeting conducted at Sicily Italy and this author participated in 2006,June 7th from India.