Nephrology (Kidney) - Best Private Hospital in Dubai Al Mankhool | IMH Dubai

It Is Good To “Hydrate Wisely” for Healthy Kidneys.

Keep your kidneys healthy by taking adequate amount of liquids. This means drinking the right amount of water for you. A common misconception is that everyone should drink eight glasses of water per day, but since everyone is different, daily water needs will vary by person. How much water you need is based on differences in age, climate, exercise intensity, as well as states of pregnancy, breastfeeding, and illness.

About 60-70% of your body weight is made up of water, and every part of your body needs it to function properly. Water helps the kidneys remove wastes from your blood in the form of urine. Water also helps keep your blood vessels open so that blood can travel freely to your kidneys, and deliver essential nutrients to them. But if you become dehydrated, then it is more difficult for this delivery system to work. Mild dehydration can make you feel tired, and can impair normal bodily functions. Severe dehydration can lead to kidney damage, so it is important to drink enough when you work or exercise very hard, and especially in warm and humid weather.

Here are 6 tips to make sure you’re drinking enough water and to keep your kidneys healthy:

  1. Eight is great, but not for all. There is no rule that everyone needs at least 8 glasses of water a day. This is just a general recommendation, because we continually lose water from our bodies, and that we need adequate water intake to survive. It is estimated that men need approximately 13 cups (3 liters) of fluid daily, and that women need approximately 9 cups (2.2 liters) of fluid daily on an average.

  2. Less is wise, if you have kidney failure (end stage kidney disease). When the kidneys fail, people don’t excrete enough water, if any at all. For those who are receiving dialysis treatment, water must actually be strictly controlled.

  3. It’s possible to drink lots of water. hydrate_for_healthy_kidneyAthletes and sportsmen / sportswomen may drink large amounts of water and thereby dilute the sodium level in their blood, resulting in a dangerous condition called hyponatremia which may even cause rapid brain damage.

  4. Your urine says it all. Drinking enough water or other healthy fluids, such as unsweetened juice or low fat milk to quench thirst will keep your urine light yellow or colorless. When your urine is dark yellow, this indicates that you are dehydrated. In the ,idle east, especially in hot and humid conditions, one should be making at least 2 liters of urine daily.

  5. H2O helps prevent kidney stones and UTIs. Kidney stones and urinary tract infections (UTIs) are two common medical conditions that can hurt the kidneys, and for which good hydration is very much essential. Kidney stones form less easily when there is sufficient water available to prevent stone-forming crystals from sticking together. Water helps dissolve the antibiotics used to treat urinary tract infections, making them more effective. Drinking enough water also helps produce more urine, which helps to flush out infection-causing bacteria.

  6. Beware of medications. Drinking extra water with certain medications or before and after procedures with contrast dye may help prevent kidney damage. Read medication labels and ask questions before undergoing medical procedures involving contrast dyes. Always consult with your healthcare provider first though, especially if you are on a fluid restriction.

Are women more prone to kidney disease?

Although kidney disease can affect people of all ages and ethnicities, women are prone to face more specific challenges tied to kidney disease. The incidence of Chronic Kidney Disease (CKD) is at least as high in women as in men and may even be higher. Studies have shown that CKD affects approximately 195 million women worldwide and is currently the 8th leading cause of death in women. There is a risk of morbidity associated with CKD and in many cases it progresses towards kidney failure, necessitating kidney replacement therapy i.e. dialysis and/or kidney transplantation.

Types of kidney diseases that are more common in women

Lupus Nephritis is a disease that leads to kidney damage, caused by an autoimmune disease called systemic lupus erythematosus (SLE). The disorder causes the body’s immune system to attack the body’s own cells and tissues. Kidney disease due to lupus may worsen over time and can lead to kidney failure. SLE is much more common in women often striking during the child-bearing years. It is estimated that 9 in 10 people diagnosed with SLE are women.

Pyelonephritis (kidney infection) is a kind of urinary tract infection (UTI) most commonly caused by bacteria which starts in the lower urinary tract. If untreated, it can move upstream to one or both of the kidneys. Kidney infections can cause sepsis, which can be life threatening. Due to their anatomy, UTI is more common in women and girls.

Health challenges that are unique to women

Conception – CKD is considered as a risk factor that affects fertility, especially in its advanced stage, when dialysis is required. While it may be challenging, conception is still possible while on dialysis and the results have been shown to improve with intensive treatment of daily or closely frequent sessions. The use of contraceptive pills as a birth control method is generally discouraged for women with CKD as it may cause an increase in blood pressure and blood clots that can make kidney disease worse.
Pregnancy-related complications – CKD may be caused by both Acute Kidney Injury (AKI) and preeclampsia (PE – a complication in pregnancy which can lead to high blood pressure and kidney damage in the mother). It not only poses a threat to maternal health, but is also associated with fetal mortality, preterm birth and restricted intrauterine growth.
If the mother has any pre-existing kidney disease it can negatively affect the pregnancy and may pose a threat to the health of both the mother and the fetus. Increased chances of adverse pregnancy outcomes including preeclampsia, AKI, progression of CKD, spontaneous abortion, stillbirth, malformations, and other long-term issues have been observed.

While Pregnancy offers an opportunity for diagnosis of kidney disease, it is also a state where acute and chronic kidney diseases may develop which may impact the health of future generations.

As individuals, it is important for women to be aware of how important your kidneys are to your overall health and how you can prevent or slow down the progression of kidney disease.

Key questions to ascertain your risk
  • Do you have high blood pressure?
  • Are you diabetic?
  • Do you smoke?
  • Are you overweight?
  • Do you have a family history of kidney disease?
  • Are you over 50?
  • Are you of African, Hispanic, Asian or Aboriginal descent?

If your answer is yes to one or more of these questions, it is advisable to discuss with your doctor. Early chronic kidney disease is silent and has no signs or symptoms. By treating kidney disease early, you can help delay or prevent kidney failure.

Chronic Kidney Disease (CKD)

Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. The term chronic is used to refer to a condition which is permanent and irreversible. In addition, it progressively worsens even with treatment. This will eventually, over a period of time lead to need for dialysis or renal transplantation.
This is associated with complications such as high blood pressure, weak bones, low blood dialysis-access-management-the-miller-procedure-for-steal-syndromeDialysis-Treatment    hemoglobin and cardiac and nerve and brain damages.
Causes of Chronic Kidney Disease
The two main causes of chronic kidney disease are Diabetes mellitus and High blood pressure. These two diseases together are responsible for up to two-thirds of the cases.
High blood pressure, if uncontrolled, or poorly controlled, can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.
Several other conditions can cause chronic kidney disease.
• Glomerulonephritis:A group of diseases that cause inflammation and damage to the kidney’s filtering units. These are unique diseases which generally affect the kidneys primarily and as a result of kidney damage can cause damage to other organs of the body. These disorders are the third most common type of kidney disease.
• Polycystic kidney disease An Inherited diseases, which causes large cysts to form in the kidneys and damage the surrounding tissue.
• Malformations and developmental abnormalities that occur during intrauterine development.
• Systemic lupus erythematosos and other diseases that affect the body’s immune system.
• Obstructions to urine flowcaused by problems like kidney stones, tumors or an enlarged prostate gland in men.
• Repeated urinary infections.
Most people may not have any symptoms until their kidney disease is advanced. However, the following symptoms occur as the disease progresses.
Tiredness and feeling less energetic in day to day activities; have trouble concentrating have a poor appetite and have difficulty in sleeping. These are non-specific symptoms and occur very slowly and are difficult to recognize in the beginning.
In addition patient may also have certain specific symptoms like swelling in the feet, and puffiness of the face especially around the eyes more so in the morning. Decrease in urination sometimes associated with the need to urinate more often at night occurs.
In severe cases and advanced renal failure patients have breathing difficulty, headache, convulsions, visual disturbances, and loss of consciousness. This warrants emergency treatment.
Detection of chronic kidney disease: Important tests of kidney function.
The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.
Blood Urea Nitrogen: This is a chemical which accumulates in the body during day to day activities. It is normally excreted by the kidney and it accumulates in the blood in patients in whom the kidney function is reduced.
Serum Creatinine: this is also a waste material which accumulates in the body and if not cleared by the kidneys its blood levels raise. A raised blood urea and creatinine levels generally indicate kidney failure; however the values need to be interpreted taking in to account several other variables. Generally both blood urea and serum creatinine levels are to be considered.
If these tests are abnormal then several other chemicals in the body need to be measured to decide on the severity of the disease and to guide the treatment.
It is important to note that these tests indicate the severity of the disease and cannot confirm whether the disease is reversible or permanent.To decide if the damage is permanent or reversible renal scan is necessary
Ultra sound scan or CT scan of the kidneys will give information regarding the size of the kidneys and presence or absence of obstruction
In patients with Chronic kidney disease the kidney size is usually reduced to less than 9cms which is the normal size. In addition the appearance of the kidneys in the scan also is abnormal.
Kidney Biopsy:
In some patients if the kidney size is normal taking a small bit of kidney tissue though a needle and studying the microscopic structure may be necessary
Additional tests may be necessary to detect the complications or response to treatment measures.
Salient points:
Early detection can help prevent the progression of kidney disease to kidney failure.
Heart disease is the major cause of death for all people with Chronic kidney disease.
Hypertension can causechronic kidney disease and chronic kidney disease can cause hypertension
Persistent proteinuria (protein in the urine) means Chronic kidney disease is present and may in some cases lead to kidney failure.
High risk groups include those with diabetes, hypertension and family history of kidney failure.
Two simple tests can detect Chronic kidney disease: blood pressure, urine albumin and serum creatinine.
Treatment options

These include the following:
Supportive treatment in the early stages:
Renal replacement therapy when the disease is advanced:
Supportive treatment:
This is started when the patient has kidney failure but the degree of failure is not severe and the patient can be managed with medications and diet.
The aim of therapy is to
1. Control the symptoms
2. To delay the progression of kidney failure
3. To prepare the patient for eventual dialysis support.
Control of Symptoms:
These include medication to control blood pressure, blood sugars in patients with diabetes, and some medications to alleviate the problems due to alterations in electrolytes, water content of the body and the bone minerals. With strict control of blood pressure the progression of kidney failure can be significantly slowed down.
Salt restriction:to control blood pressure and fluid accumulation in the body.
Fluid restriction: to control swelling and fluid accumulation
Low protein: Protein in the diet acts as an additional burden on the already malfunctioning kidneys. Moderate reduction in dietary protein intake is known to reduce the progression of the kidney failure.
Fruits; generally fruits are very rich in a mineral called potassium. This is normally excreted only through the kidneys. In conditions where kidneys are unable work normally potassium accumulates in the body. High blood potassium levels are harmful to the heart and require urgent treatment.
Dietary advice from an experienced dietician is very helpful.
Renal Replacement therapy:
There are two treatment options for kidney failure:
Dialysis (hemodialysis or peritoneal dialysis) and kidney transplantation
Briefly Dialysis means removing the waste products from the blood periodically with the help of an artificial kidney or the patient’s own abdominal membrane.
Transplantation involves placing a normal kidney surgically from a donor either living or cadaver.

Hemodialysis is a treatment that removes wastes and extra fluid from the blood.During hemodialysis, the blood is pumped through soft tubes to a dialysis machine where it goes through a special filter called a dialyzer (also called an artificial kidney). After the blood is filtered, it is returned to the bloodstream.-peritoneal-dialysis-catheter
Dialysis is necessary if the kidneys no longer remove enough wastes and fluid from your blood to keep the body healthy. This usually happens when there is only 10 to 15 percent of kidney function left. The patient usually has severe symptoms such as nausea, vomiting, swelling and fatigue. However, one can still have a high level of wastes in the blood that may be toxic to the body and yet have minimal symptoms. Your doctor is the best person to tell you when you should start dialysis.
Blood is removed from the body using needles placed in the veins or through tubes inserted in to major veins. This is called dialysis access
For the peripheral veins to give good amount of blood for cleaning a small surgery to connect the vein to the artery is required. This needs to be done several weeks before dialysis is anticipated.
Dialysis is generally required 3 times a week each time lasting for 4-5 hours. This can be done as an outpatient procedure and the patients usually can get back to work after the session is over. Blood tests are done monthly to assess the adequacy of dialysis.
Peritoneal dialysis:
In this process a small soft rubber tube is placed in the abdomen and once the wound heals sterile fluid can be instilled in to the abdominal cavity through this tube. The fluid is left in place for 3-4 hours and during this time it takes up the waste material from the blood and it can then be removed through the same tube. This is called one exchange. Usually 3-4 exchanges are required daily and the patient is trained to do the same at home. The quality of dialysis is assessed monthly by the Nephrologist.
Renal Transplantation:
This is the most physiological way of replacing the kidney function. It involves placing a new kidney in the patient’s body usually the lower abdomen. The kidney can be donated by a close relative or it can also be from a brain dead person. The donor and recipient pair undergo a series of tests to confirm mutual compatibility and matching. The recipient will require medications life long and close and frequent monitoring.

Kidney Disease and Heart Health

CHRONIC KIDNEY DISEASE (CKD) is a worldwide public health problem, both for the number of patients and cost of treatment involved. Diabetes is the leading cause of kidney disease accounting for 30 per cent of these patients. Other causes of kidney disease are chronic glomerulonephritis (19.3 per cent), hypertension (14 per cent), chronic interstitial disease and vesico-ureteral reflux (12.6 per cent), obstruction and stone (9.3 per cent), cystic disease and other hereditary diseases (8.4 per cent), undiagnosed (6.2 per cent). Incidence of CKD has doubled in the past 15 years and is rapidly rising. One reason is the rapidly increasing worldwide incidence of diabetes and hypertension. Approximately 30 per cent of patients with diabetes mellitus develop diabetic kidney disease.


Cardio V ascular Diseases – BURDEN

Many people with CKD would be surprised to learn that the biggest health risk they face is heart disease.But, it’s true! CKD patients have extremely high risk of developing CARDIO VASCULAR DISEASE (CVD, angina, heart attack, heart failure, sudden cardiac death, stroke/paralysis and peripheral vascular diseases) compared with the general population, so much so that in the early stages of CKD patients are more likely to develop CVD and die of CVD than they are to progress to ESRD (stage of advanced kidney disease requiring dialysis or renal transplant). This risk is more apparent in younger patients e.g. a 35 year old man on dialysis has the same risk of a cardiovascular death as an 80 year old not on dialysis. In addition CKD patients have a worse outcome with higher mortality after acute myocardial infarction (MI) and have a higher risk of recurrent MI, heart failure and sudden cardiac death.


Much of the problems come from the fact that people with kidney disease often have many risk factors for CVD. Most CKD patients have a combination of ‘traditional’ and ‘kidney-specific’ risk factors.


Some risk factors have been linked with a higher risk of CVD in the general population. These ‘traditional ‘risk factors include:

• Smoking

• High blood pressure

• Obesity

• High cholesterol

• Poorly controlled diabetes

• Family history of heart disease

• Male gender

There is increased prevalence of many traditional factors for cardiovascular risk in CKD (age, male gender, hypertension, diabetes, dyslipidemia and physical inactivity).


Additional CVD risk factors are the direct result of kidney disease itself. Kidney-specific risk factors include:

• Anaemia

• Inflammation

• Reduced glomerular filtration rate

• Urine protein including albumin

• Abnormal calcium and phosphorus metabolism

• Fluid overload



A comprehensive approach, rather than isolating treatment to a specific indication is required to lower cardiovascular risk. CKD patients with diabetes should achieve a good control of blood sugar levels by testing blood sugar frequently, taking medicines regularly and on time, and following prescribed meal plan. Drug treatment for hyperlipidemia (increased cholesterol), secondary hyperparathyroidism (calcium and phosphorus metabolism) and anaemia is recommended to decreases the CVD mortality. Folic acid and vitamin B supplements in selected group of patients helps in correcting anaemia and also may decrease CVD risk. An important aspect of strategy to decrease CVD risk in renal disease patients is lifestyle modification. A healthy lifestyle should be maintained by all CKD patients, including dialysis