Q & A

A: Dear Jonathan,

Kidney stones occur when mineral salts crystallise in the kidneys. Tiny crystals pass out of the body in urine but the larger stones cause a back-up of urine in the kidneys, ureter and the bladder, causing pain.

Untreated kidney stones might indeed increase the risk of kidney failure, causing blockage in blood urine flow. This can eventually result in a dilated kidney with minimal function.

However, the percentage of kidney failure related to kidney stone is small compared to diabetes and hypertension. In addition, kidney stones usually cause pain, hence are very seldom left untreated till its deterioration to kidney failure. Kidney stones usually cause damage to one kidney and kidney failure, also known as End-Stage Renal Disease (ESRD) happens only when both kidneys do not function properly.

There is also the likely occurrence of “silent” stones, which cause no pain and symptoms. They are often left untreated for long months to years, occasionally leading to kidney damage. One in 10 people will develop kidney stones at some stage of their lives. It is best to prevent them by drinking 2 to 3 liters of water, reduce the consumption of oxalate-rich foods like spinach, chocolate, nuts, tea, soya products, berries and salt and increase calcium intake. Specific measures to treat kidney stones, depend on the type of kidney stones. It is important to do a chemical analysis of the stone. Prevention is always better than cure as the saying goes.

A: Dear Pravin,

Back pain is not usually a symptom of most types of kidney disease. When kidneys become distended due to blockage of the flow of urine or become infected, it may produce pain. Severe pain may also occur with the presence of kidney stones, especially when the stones move down the ureter. Other causes of back pain also include muscle pain or diseases of the spine.

The term kidney disease does not equate to kidney failure. We say kidney failure only when the functions of the kidneys are compromised and are unable to maintain normal composition of the body fluids which will most likely result in the accumulation of toxins in the body.

Symptoms of kidney failure can vary between different people. Do look for other symptoms:

  • Decreased urination
  • Nausea and vomiting
  • Swollen hands and ankles
  • Puffiness around the eyes
  • Itching
  • Sleep disturbances
  • High blood pressure
  • Loss of appetite

A: Dear James,

Taking statins (medication that blocks the action of an enzyme in the liver that helps produce cholesterol) does not mean you can ignore advice about a cholesterol-lowering diet. There are people who have the misconception that their medication will undo any cholesterol overload, regardless of what they eat. Even while you are on medication, it is important that you watch your diet, especially saturated fat.

A: Dear Indra,

Not everyone with kidney disease needs dialysis. Kidney disease is a general term to describe a wide range of kidney abnormalities. Kidney disease can occur without kidney failure. Chronic kidney disease is a progressive disease. In its early stages, it is usually managed with diet and medication. With this approach, most people can slow or stop the progression of kidney disease and enjoy a normal lifestyle. That is why, it is important to find and treat kidney disease early. Dialysis or a kidney transplant is only needed if your kidney disease gets worse and progresses to kidney failure.

Dear Keith,

Yes, there are tests and procedures for kidney disease diagnosis. The tests include Serum Creatinine which is a key indicator to determine how well the kidneys are functioning and Urine Analysis to find out how much albumin (a type of protein) is in the urine as having too much protein is an early sign of kidney damage. Kidney disease is a progressive disease and there are five Chronic Kidney Disease (CKD) stages. The glomerular filtration rate (GFR) will determine what stage of kidney disease the person is at (see diagram at NKF’s website). You may require additional blood tests and screening depending on your condition.

In its early stages, it is usually managed with diet and medication. With this approach, most people can slow or stop the progression of kidney disease and enjoy a normal lifestyle. Those with medical or family history of diabetes, cardio-vascular disease including hypertension, stroke, obesity or kidney disease are at higher risk of kidney failure. Hence, it is important for one to go for regular health screenings and to consult one’s general practitioner or healthcare provider who will be able to advise on the necessary course of action where needed.

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Dear Fatimah,

A kidney transplant offers best long term survival and quality of life. It is the most optimal solution to kidney failure. The transplanted kidney can substitute almost fully the lost functions of the failed kidneys and it usually begins to function right away, thus allowing the patient to lead a normal life. With a new lease of life, the patient no longer faces day-to-day restrictions due to having to undergo dialysis for the rest of his or her life.

Dear Jessica,

Your kidneys filter excess fluids and waste from your blood. Having diabetes in addition to high blood pressure can worsen the damage.

High blood pressure is one of the most common causes of kidney failure. That is because it can damage both the large arteries leading to your kidneys and the tiny blood vessels (glomeruli) within the kidneys. Damage to either makes it so your kidneys cannot effectively filter waste from your blood. As a result, dangerous levels of fluid and waste can accumulate and cause kidney failure.

You can change your eating habits by adopting the following healthy diet to help lower high blood pressure:

  • Eat more fruits, vegetables, and low-fat dairy foods
  • Cut back on foods that are high in saturated fat, cholesterol, and trans fats
  • Eat more whole-grain foods, fish, poultry, and nuts
  • Limit sodium, sweets, sugary drinks, and red meats

You can also get help from a GP for regular blood pressure checks and take blood pressure lowering medicine as advised.

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Dear Chew Hoong,

Water helps kidneys to filter out waste from the blood in the form of urine. Dehydration can impair this function and in severe cases can lead to serious kidney damage. However, drinking too much water can result in hyponatremia due to abnormally low sodium in the blood. Severe cases may lead to health problems such as coma and even death. The recommended daily intake of water is 8 to 10 glasses of 250 ml each.

Dear Zhenya,

“Kidney disease” does not equate to “kidney failure”. “Kidney disease” is a general term used to describe different types of diseases related to the kidneys. Chronic kidney disease is a progressive disease. Most patients with chronic kidney disease can prevent a deterioration of their conditions and lead normal lives through managing their diet and taking their medication. Hence, not all patients with kidney disease need to go for dialysis. However, if you have kidney failure, it means that 90% or more of your kidney function is lost and your kidneys are unable to maintain the normal composition of body fluids, resulting in the accumulation of toxins in the body. At this stage, you will need to depend on dialysis or transplant for survival. This also highlights how crucial it is to identify the early warning signs of kidney failure and take steps to protect your kidneys.

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Dear Sharul,

Obesity leads to diabetes and high blood pressure, among other chronic diseases, both of which are the two leading causes of kidney failure. Causes include poor diet/food choices, lack of exercise, a family history of being overweight or obese and negative emotions like boredom sadness, or anger, which may influence eating habits.

Some ways to watch your weight:

  • Brisk walk 30 minutes each time, 150 minutes per week
  • Jog or swim three times a week
  • Keep a food diary of everything you eat
  • Shop from a list and do not shop when you are hungry
  • Grill, bake or steam instead of deep-frying
  • Use healthier cooking oils like canola, sunflower or peanut

You may speak to your healthcare provider to help you plan your diet, exercise and behaviour modification.

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