Creatine levels, water consumption, and Kidney Health

Identifying kidney disease before it causes too much of kidney damage is essential. Image courtesy: Marko Aliaksandr / Shutterstock

Kidneys are the main excretory organs of the human body, located inside the abdomen on both sides of the spine. Kidney function is essential to maintain human life. 20% of the blood pumped out by the heart goes through the kidneys, which weigh only 300 grams. The main job of the kidneys is to excrete waste products from the body through urine. Therefore, it is very important to keep the kidneys healthy.

World Kidney Day is observed on the second Thursday of March to raise awareness about the importance of kidney health, the extent of kidney diseases, and how to prevent and manage them. The first symptoms of kidney disease often appear in the urine as the body's waste products are excreted through the urine. Urology and nephrology play the same role in kidney health. Nephrologist Dr. Noble Gracias of Thiruvananthapuram Medical College and Dr. KV Vinod, Consultant Urologist of Vazhuthakkad Cure Urology Hospital explain how kidney damage can affect us, what causes kidney damage, and how lifestyle diseases can damage the kidney if not properly controlled.

Creatine levels are usually the first thing to be checked when the kidney disease is suspected. Can creatine levels be normal to confirm that there is no kidney damage?

It is only a myth that creatine is normal. .8 Creatine levels of 1.2 or 1.5 indicate 50 percent kidney failure. A major problem with kidney failure is that there is no early marker for kidney damage. All that is there is albumin and RBC. There is no marker to detect the extent of kidney damage. Since its discovery, only creatine has existed. Though some markers are there now, none of them are practical.

Similarly, suppose a kidney becomes completely swollen with a stone. And it has almost stopped working, even then, their creatine may be normal. Here, when the patient is told that he has a kidney problem, he will question back pointing out that since the creatine is normal, and he has no issues while urinating how there can be a kidney problem. First, recognize that there is no problem because one kidney is working well. Sometimes the creatine is normal even if the other quarter of the kidney is damaged. The amount of urine will also be correct.

Some patients with complete kidney failure are also able to pass urine properly. The volume of urine is reduced only if filtration is affected. The kidney is an organ that performs several functions such as filtration, reabsorption, and homeostasis. So even if one kidney is damaged, the amount may not decrease. That is, the kidney may not be normal even if the creatinine level is normal. Similarly, even if the urine volume is normal, it does not necessarily mean that the kidneys are working.

It is when we find something unusual in our body that we consult a doctor. What are the symptoms you need to consider when it comes to kidney failure?

It is common for people aged 45-50 years to get small swelling in their feet after some long journeys. Many people ignore it thinking that it is due to travelling. But this could be a sign of protein leakage in the kidney. When you flush after urinating and you find more foam in the commode, you should seek medical attention immediately.

This is a primary symptom. If you see such a symptom, promptly do a urine routine. A difference in urine albumin is a sign that something has changed in the kidney. Don’t deny yourself treatment assuming that creatine is normal.

Albumin and phosphate are the two things that usually cause urine to become foamy. If it contains phosphate, nothing needs to be done. Albumin is absent in the 24-hour urine routine, if less than 150 ml, albumin is not the cause of this foam. If the albumin is normal, there is no problem with the kidney. But diabetes and high blood pressure are two other diseases that also cause protein leakage (change in albumin).

How does diabetes affect the kidney?

Diabetes often goes undiagnosed in the early stage as symptoms are not immediately noticeable. Excessive thirst and weight loss often appear in the advanced stage. By the time diabetes is diagnosed, there will be many disorders caused by it. High blood sugar can do terrible damage to cells. All our cells are in the same state of shrinking like putting a gooseberry in a sugar solution. Once diabetes is diagnosed, it is important to carefully control it and then maintain the same level.

90 percent of people with diabetes will develop high blood pressure after one stage. When your body starts getting swollen, the water starts to control it. With this comes the possibility of kidney stones. And there will be a possibility of urinary infection. All this is affecting the cells of the kidney. It is these remaining factors that make someone who should have kidney disease at age 50 become ill at age 40. It is because of all this that renal failure occurs in foreign countries at the age of 70. Renal failure is seen in our patients in their 50s.

This can quickly cause problems if kidney stone patients also have diabetes. For example, if there is a stone or a small obstruction, it can quickly become an infection, fever, and an elevated creatinine level.

Now there is a 2- or 3-mm stone, no symptoms like pain, how carefully should it be watched? Do you need to see a doctor?

There are almost no problems with this 2- or 3-mm kidney stone. But watch out for occasional pain or kidney blockage. Treatment should be decided only if there is a tendency for kidney stones. A 24-hour urine test can be used to find out if there is a possibility of stone formation. Also look at blood uric acid, creatinine, and calcium levels. After six months or a year, an ultrasound will be done.

Diabetic women aged 55-60 years often have problems like pus in the bladder. How dangerous is this?

Menstruation is a time of notable hormonal changes in women, especially those around the ages of 55–60. The risk of infection is high during this time. There is also a risk of recurrence of the infection. If you also have diabetes, the risk increases again. Another major problem is that many people buy medicines from medical stores. By doing this, these germs become less resistant. There will be a situation where you need to be admitted to the hospital and given higher doses of antibiotics. Some of these can lead to kidney damage. There are even patients in dialysis situations.

How do painkillers lead to kidney failure?

Taking painkillers with certain medications can damage the kidneys. Taking a pain reliever with BP medication can be problematic. There are some important medicines that are given to diabetics. Even if you take painkillers with them, the pumping of blood to the kidney will decrease and the kidney will quickly reach a state of stagnation. Therefore, before taking any painkiller, the patient should inform the doctor about their current medication.

Now we see patients who come for dialysis because of two-day painkillers. Before prescribing painkillers, doctors should also ask the patient if they are taking any medications and take care to prescribe medications that do not affect the kidneys.

A 21-year-old girl has been taking painkillers for a month. In the meantime, she eats pani puri and gets an attack of diarrhea. Medicines given for diarrhea do not go well with pain relievers. When diarrhea occurs, the water in the body decreases. Dehydration reduces the blood supply to the kidney. The pain reliever acts on the same blood vessels as the kidney's blood supply. When the two are combined, the creatine level rises to the point where dialysis is required.

The first thing to do if you have any urinary problems is to drink a lot of water. How can water consumption affect the kidney?

Kidneys need water to keep them healthy. Only those who have kidney failure, a condition where the water we drink cannot be completely eliminated, need to control their water intake. For those who are not, it is important to drink two and a half to three liters of water daily. Water is most important for kidney health as it can reduce the risk of stones, reduce filtration, and prevent infection. Some people will stop drinking water if they take too much creatine. As mentioned earlier, the kidney has filtration, reabsorption, and sieve properties. They might not have issues with the sieve. There will be some minor issues with reabsorption. If he controls water it will be a problem. It is important to recognize this. A person who produces enough urine and does not develop swollen leg should not be told to restrict water, even with creatine supplementation. But if they develop swelling in their legs after one and a half or one litre of water, feel shortness of breath while walking, etc. they should control water consumption.

Likewise, drinking too much water can damage the kidneys. The kidney has a concentrating mechanism. For that to happen, there must be a gradient in the cells of the kidney. Drinking too much water dilutes the gradient. Drinking too much water damages the kidneys.

Sodium intake is important in older people. The kidney is an important organ that regulates sodium. Some people try to flush out the fluid by drinking more water. But here sodium and potassium go with water. Sodium depletion can cause many problems such as fainting, fits, and memory differences.

Sodium balance is just as important as our sugar balance during aging. It is also important to ask your doctor if any of the medications will make a difference to your sodium balance. It is important to be aware of the food and medicine we consume.

Coconut water is as important as drinking water. Should kidney patients restrict its consumption?

A solution with the highest potassium content is tender coconut. Potassium is a double-edged sword. People who consume more potassium are less likely to develop hypertension. What is the specialty of the kidney, whatever is found in excess will be excreted. Potassium levels are balanced between 3.5 and 5.5. If it comes above 5.5, the kidney will be expelled. If it goes above 5.5, the heart will stop. Potassium is something that needs to be regulated in such a small volume. People with normal kidney function can drink tender coconut freely. But those with any defects should not use it. Along with tender coconut, coconut is also important. Coconut milk, coconut milk, and curries are high in potassium content. Coconut is forbidden for people with kidney problems.

Our lifestyles, food, minor illnesses, and medications we take all affect a healthy kidney in many ways. It is better to ask a doctor to understand what we need.

Organ donation is a hotly debated topic these days. Wasn’t it recently decided that people over 65 years of age can accept organs? Tell us about the number of people waiting for a kidney transplant.

The cut-off age was 65 when organ donation first started following death due to brain disease. The reason why it was changed was that now our average life expectancy in Kerala is 79. So it is like a denial of justice to say that a person after 65 years of age will not be given a kidney or a liver. Denying their right to live. That is how it became a discussion and the central government suggested that the organ can be transplanted if it is medically and surgically fit.

About 2500 people are registered and waiting in Kerala only for Mrithasanjeevani. The number of people registered in India as a whole will be close to one lakh. Those who really need it will be ten or fifteen times more than this. According to a study by Dr. Noble Gracious there are about 160 dialysis centres in Kerala and around 36000 people are undergoing dialysis. 80 percent of them are diabetics. In foreign countries, diabetics reach kidney failure at around 65-70 years of age, but in Kerala, they reach complete kidney failure at the age of 45-50 and end up on dialysis. The solution to this problem can be found only if more attention is paid to the treatment of diabetes.

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