Humans have two kidneys. Those bean-shaped or horse-shoe shaped organs located at the flank or backside, with the right kidney lower because of the liver pushing it down.
Each kidney has a ureter which drains urine from the kidneys central collecting area (renal pelvis) into the urinary bladder, then drains into the urethra out of the body through the penis in males and the vulva of females.
The kidneys receive 20% or 1/5 of the total blood volume (cardiac output=5 liters), meaning 1 liter, in which 500 ml goes to each kidney per minute through the renal arteries which are the first major branches of the descending aorta.
The functional unit of the kidneys in the NEPHRON, about 2.4 million; which includes afferent and efferent arterioles which exhibit inherent auto regulation-meaning they can change their luminal diameter depending on the volume of blood coming from the renal arteries for the main purpose of ensuring a normal glomerular filtration rate (GFR) of 120 ml per minute; glomerulus whose membrane has pores which strictly allow the filtering and passage of fluid as well as electrolytes; set of tubules which do a complex process of reabsorption, secretion and excretion with the help of some hormones with the final formation of urine; which in healthy adults is one ml per minute or 60 ml per hour; oliguria is when urine output is less than 30ml per minute and in worse cases, anuria when there is no urine output.
The kidneys are the main excretory organs of the body, responsible for the removal of metabolic waste and other harmful materials, and for the maintenance of normal blood volume, blood pressure as well as the physiologic amounts of electrolytes, especially sodium and potassium. A normal blood pH of 7.38-7.42 is primarily sustained by healthy kidneys.
Although the kidneys are not included in the 13 standard endocrine glands, they secrete a glycoprotein called erythropoietin (aka hemopoietin or erythrocyte stimulating factor) whose target organ is the bone marrow to promote erythropoiesis or the production of red blood cells. At this juncture, this fact explains why patients with advanced kidney disease are anemic or patients on dialysis, with erythropoietin being part of their therapeutic management.
There are many causes of kidney disease that eventually lead to malfunction and renal failure among which are chronic glomerulonephritis, chronic pyelonephritis, and polycystic kidney disease with hypertension and diabetes mellitus with poor control topping the list.
Statistics among medical institutions all over the world reveal the sad reality that despite the massive information program of governments about the complications of kidney diseases, only 10-15% of affected patients take their signs and symptoms seriously enough to get appropriate medical advice and treatment, which by then, the status of the kidneys would have reached problematic clinical levels.
Basic physicians, general practitioners join nephrologists (kidney specialists) in recommending tests like urinalysis, and blood tests like BUN and creatinine as part of routine laboratory tests even among healthy adults, either as part of their annual exam or for employment purposes or simply by their interest to evaluate how their kidneys are doing.
However, for patients with comorbidities like high blood pressure and diabetes mellitus, with other compounding issues like obesity, heart disease and liver concerns, the red flag is raised about the progressive deterioration of kidney functions which now requires the intervention of nephrologists who request more sophisticated tests like measures of GFR, estimated creatinine clearance, the 24-hour collection of urine for creatinine clearance and other tests.
Depending on the results of kidney tests plus the assessment of the presenting signs and symptoms of the patient, the nephrologist institutes active management to avert chronic kidney disease culminating into an ESRD (end-stage renal disease) which requires dialysis or, if available, kidney transplant.
Your columnist consulted his former students, now trained specialists in nephrology who presented, in a stepwise manner, the approach to managing patients with advanced kidney disease; among which is limiting protein intake from the usual 1 gram per kg/body weight to 0.3-0.4 grams and segued into the important crucial role of ketoanalogues.
Ketoanalogues are indicated for the prevention and therapy of damaged kidneys and deficient metabolism leading to chronic renal insufficiency. The administration of ketoanalogues involves the intake of essential amino acids with the purpose of reducing or decreasing the so-called “amino nitrogen intake of proteins” so that when they are trans deaminated-taking nitrogen from non-essential amino acids from the different proteins eaten by the patient with the desired result of significantly decreasing the amount of urea inside the body.
Ketoanalogues are a welcome treat for elderly patients whose keto and hydroxyl analogs are transformed inside the body to essential amino acids leucine, phenylalanine, valine, methionine, lysine threonine, tryptophan, histidine all of which would work synergistically with the hope of slowing down, if not arrest and stop the progression of the kidney disease and avoid its dreaded complications requiring dialysis or a kidney transplant.
Dear readers who are having signs and symptoms referable to a kidney ailment, please consider an immediate consult with your family physician or nephrologist and discuss a comprehensive management of the illness to avert its progression into a chronic kidney disease and end-stage renal disease.
