An interview with Dr Amit Dias

March 14 is observed as World Kidney Day and on this occasion, we spoke to Dr Amit Dias on how to ensure kidney health for all. “Prioritize your kidney health,” he emphasizes, “The most common cause for kidney disease is diabetes and it can be controlled.”

Read and share this informative interview. You can save a life and contribute to the “Kidney health for all” campaign.

Goan Observer: Doctor let us start by first trying to understand the role of kidneys in our body. Could you enlighten us on this?
Dr Amit Dias:
The kidneys are vital for our existence. They play several crucial roles in maintaining the body’s overall health and function such as:
Filtration of Blood: One of the primary functions of the kidneys is to filter waste products, toxins, and excess fluids from the bloodstream. This process helps maintain a proper balance of electrolytes, such as sodium, potassium and calcium in the body.
Regulation of Blood Pressure: The kidneys produce hormones such as renin, which help regulate blood pressure by controlling blood volume and systemic vascular resistance. Renin acts as part of the renin-angiotensin-aldosterone system (RAAS), which plays a crucial role in maintaining blood pressure homeostasis.
Regulation of Fluid and Electrolyte Balance: The kidneys help regulate the body’s fluid volume by adjusting the amount of water excreted in urine. They also play a vital role in maintaining the balance of electrolytes, which is essential for proper nerve and muscle function, hydration, and blood pressure regulation.
Maintaining Acid-Base Balance: The kidneys help regulate the body’s pH level by excreting hydrogen ions and reabsorbing bicarbonate ions, which helps maintain the blood’s acid-base balance within a narrow range.
Production of Red Blood Cell: The kidneys produce erythropoietin, a hormone that stimulates the production of red blood cells in the bone marrow. Red blood cells are essential for oxygen transport throughout the body, and adequate erythropoietin production is necessary to prevent anemia.
Activation of Vitamin D: The kidneys play a crucial role in converting inactive vitamin D into its active form, calcitriol. Calcitriol helps regulate calcium and phosphate metabolism, which is essential for bone health and various physiological processes.
Overall, the kidneys are vital organs responsible for maintaining fluid and electrolyte balance, regulating blood pressure, producing hormones, and eliminating waste products from the body. Dysfunction or damage to the kidneys can lead to various health problems and serious complications, highlighting the importance of kidney health and proper maintenance. The theme this year urges us to “Prepare for the unexpected and support the vulnerable to assure kidney health for all.”

Q: Can we talk about the kidneys as much as we do about our heart and brain! Are kidney diseases rare?
Kidney disease is not as rare as one might think. It’s quite common, affecting millions of people worldwide. Chronic kidney disease (CKD) particularly is a significant global health issue, with its prevalence steadily increasing. The most common cause of CKD is diabetic nephropathy and Goa is having the highest prevalence of diabetes according to our study.
According to the World Health Organization, CKD affects approximately 10% of the world’s population. There are regions where kidney disease may be higher. For instance in the Canacona taluka in Goa, we are finding a higher proportion of renal problems.

Q: Could you throw light on some of the regions that have a higher proportion of kidney disorders and what are the possible reasons for it?
There are regions in Central America, sub-Saharan Africa, Pacific Islands that have a higher proportion of renal disease. There could be several explanations for this. In countries like El Salvador, Nicaragua, and Guatemala, for example, there has been a significant increase in cases of chronic kidney disease of unknown etiology (CKDu) among agricultural workers, particularly in rural areas. CKDu is characterized by progressive kidney damage that occurs without the typical risk factors such as hypertension or diabetes. Possible reasons for the higher prevalence of CKDu in these regions include occupational exposure to agrochemicals, dehydration due to strenuous labor in hot climates, and poor access to healthcare and preventive services.
In general, it is a combination of socioeconomic, environmental, genetic, and lifestyle factors that contribute to the higher prevalence of kidney disease. Addressing these issues requires comprehensive public health interventions aimed at improving access to clean drinking water, sanitation, desalination, healthcare services, and education about kidney health and preventive measures.

Q: What are the various common kidney diseases that people should be aware of?
The most common kidney diseases include:
Chronic kidney disease (CKD): This is a long-term condition where the kidneys gradually lose function over time.
Renal stones: These are hard deposits of minerals and salts that form in the kidneys and can cause severe pain when passing through the urinary tract.
Urinary tract infections (UTIs): These are bacterial infections that affect the urinary system, including the kidneys, bladder, and urethra.
Acute kidney injury (AKI): This is a sudden loss of kidney function often caused by dehydration, severe infection, or medication toxicity.

Q: If a person does not have problems passing urine, does it mean they don’t have kidney disease?
Not necessarily. While changes in urine frequency or difficulty passing urine can be symptoms of kidney disease, the absence of these symptoms does not necessarily indicate the absence of kidney disease. As mentioned earlier, kidney disease can be asymptomatic, especially in its early stages. Regular screening tests, including blood and urine tests, are essential for detecting kidney disease before symptoms develop.

Q: What are the signs of kidney disease that people should watch out for?
A: S
ymptoms of kidney disease may include:
Swelling in the ankles, legs, or face
Difficulty sleeping
Changes in urine frequency or color
Persistent itching
High blood pressure
Nausea and vomiting
Loss of appetite
However, it’s important to note that kidney disease can often be asymptomatic in its early stages, which is why regular check-ups and screening are crucial.

Q: Can we prevent kidney disease? And how much water should we drink to maintain kidney health?
Yes, there are several steps individuals can take to prevent kidney disease and maintain kidney health. These include:
Stay hydrated: Drinking an adequate amount of water helps the kidneys remove waste and toxins from the body. The general recommendation is to drink about 8 glasses of water per day, but individual needs may vary depending on factors such as climate, physical activity level, and overall health.
Eat a balanced diet: A diet low in sodium, saturated fats, and processed foods, and high in fruits, vegetables, whole grains, and lean proteins can help protect kidney function.
Maintain a healthy weight: Obesity is a risk factor for kidney disease, so maintaining a healthy weight through regular exercise and a balanced diet is important.
Limit alcohol consumption: Excessive alcohol consumption can put a strain on the kidneys and increase the risk of kidney disease.
Avoid smoking: Smoking can damage blood vessels and increase the risk of kidney disease.

Q: Are there any medications that could be harmful to the kidneys? Which drugs could cause harm?
A: Y
es, some medications can be harmful to the kidneys if not used properly or if taken in excessive amounts. These include:
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, when used long-term or in high doses.
Certain antibiotics, such as vancomycin and gentamicin, when used inappropriately or in individuals with kidney impairment.
Some blood pressure medications, such as ACE inhibitors and angiotensin receptor blockers (ARBs), if not monitored closely.
Contrast dyes used in imaging procedures can also cause kidney damage in some individuals, particularly those with pre-existing kidney disease or other risk factors.
It’s essential to always follow the dosage instructions provided by healthcare professionals and to inform them of any pre-existing kidney conditions before starting a new medication.

Q: What are the tests we do to detect kidney disease?
The primary tests for kidney disease include:
Blood tests: These include tests to measure serum creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). Elevated levels of creatinine and BUN and decreased eGFR may indicate kidney dysfunction.
Urine tests: This test examines a urine sample for the presence of protein, blood, or other abnormalities, which can indicate kidney damage or disease.
Imaging tests: Ultrasound, CT scans, and MRI scans can provide detailed images of the kidneys and urinary tract, helping to identify structural abnormalities or blockages.
Kidney biopsy: In some cases, a small sample of kidney tissue may be taken for examination under a microscope to diagnose the specific cause of kidney disease.
Interpreting these tests requires expertise and consideration of the individual’s medical history and other factors. Healthcare professionals use a combination of these tests to diagnose kidney disease accurately and determine the appropriate treatment plan.

Q: This was a very informative interview as usual! Can we end on a positive note, what is your message for our readers on Kidney Day?
My message for World Kidney Day is simple: prioritize your kidney health. Kidneys play a crucial role in maintaining overall health and well-being, so it’s essential to take proactive steps to protect them. This includes staying hydrated, eating a balanced diet, exercising regularly, avoiding harmful substances like tobacco and excessive alcohol, and following up with healthcare professionals for regular check-ups and screenings.
By taking care of our kidneys, we can lead healthier lives and reduce the burden of kidney disease on individuals and society as a whole. Let’s make kidney health a priority today and every day.

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