Frequently Asked Questions (FAQ)- Kidneys

What can I do to reduce damage to my of kidney disease?

• Eating a healthy diet - it may be appropriate for you to see a dietitian with kidney expertise
• Drinking adequate fluid (preferably water) - and less glucose containing (sugar) drinks such as carbonated drinks. This is especially indicated if you have urinary tract infections or kidney stones.
• Not smoking.
• Moderate alcohol consumption - one to two average (an average sized drink = one 300ml beer; or one nip of spirits; or one 150ml of wine) sized drinks per days most days per week. Not binge drinking (large amounts of alcohol at one time, infrequently).
• Keeping fit with regular exercise to help blood pressure, weight control and help prevent vascular disease.
• Maintaining a good body weight - which reduces blood pressure stress of being overweight and diabetes mellitus.

How do I know there is something wrong with my kidneys?

There are very few symptoms of kidney disease until the kidneys are severely affected. Usually kidney disease is picked up early, by early monitoring or screening blood (serum creatinine particularly) and urine tests (to detect blood and protein).

Symptoms may include:

• Nocturia (getting up at night to pass urine)
• Tiredness / lethargy
• Loss of appetite
• Increased or decreased urine volume
• Pain in the loin and groin (especially kidney stones)
• Discomfort over the bladder / lower abdomen area
• Discomfort from passing urine (often urinary infections are not associated with kidney disease)
• High blood pressure.

How do I know I am at risk of kidney disease?

• Presence of hypertension (high blood pressure)
• Having diabetes mellitus
• Being over the age of 50 years
• Being overweight
• Being a smoker
• Family history of kidney disease (reflux nephropathy and polycystic kidney disease in particular)
• Having small birth weight
• Having lupus (Systemic Lupus Erythematosis)
• Having gout
• Urinary tract infections as a child
• Kidney stones
• Bladder stones
• Regular use of anti-inflammatory and pain relief - especially non steroidal anti-inflammatory medications (NSAID), some herbal and Chinese medicine medications.

Where are my kidneys?

Located at the back of the abdomen behind the gut organs, next to the spleen (on the left hand side) and the liver (on the right hand side), either side of the spine protected by the lower ribs.

Click here to see animated anatomy entire Genito-Urinary system.

How much fluid should I drink?

The most important fluid to drink is water. There is, in most cases, no difference between tap water, filtered water or bottled water. It is important to drink a volume of fluid that is healthy.

In some cases, particularly in established moderate to severe kidney disease, there is a need to limit fluid intake.

Most other people who don't have such severe kidney failure, the amount of fluid that should be drunk is that which is required to pass 1½ to 2 litres of urine volume per day.

I do not recommend 8 glasses (each glass 200mls) of fluid to be drunk per day which is often quoted. In the winter when the fluid body loss may not be so great this 8 glasses may be adequate. A similar volume may be adequate in office workers or people who work in a sedentary or similar non-physically demanding job or at home/indoors all year round. People who may have a heavy labouring job, working outside in the heat/sun, or people who are very physically active (e.g. running, sports or regularly attending a gymnasium or fitness centre); or in the summer will lose more fluid from sweat. A higher fluid intake (and certainly more than 8 glasses of water per day) is required to keep the urine output up in such people. Again primarily the fluid replacement should be water.

I encourage people with urinary tract disease (especially stones or infections) to at least once measure their urine volume over a 24 hour period as an indication of how much to drink rather than measure how much they drink per day. The urine output should be a minimum of 1.5litres per 24 hour period. Maintaining the urine output at least 1½ to 2 litres per day is very important in people who are recurrent kidney stone or urinary tract infection sufferers.

Can I drink too much fluid?

Rarely some people do drink excessive amounts of fluid. If this leads to a high urine output (some people may consume as much as 10 litres per day of fluid) the kidneys may not be able to cope and the kidneys maybe temporarily damaged by a 'washing out' of the compounds that the kidney needs to concentrate urine. This causes a condition called hyponatraemia - low blood sodium - which can cause tiredness and other more serious symptoms.

People who have had a kidney transplant need to keep their fluid intake up. Sometimes this can be difficult after they have been on dialysis for a long time when fluid intake is usually restricted.

What about alcohol?

Alcohol per se doesn't usually hurt the kidneys. Heavy alcohol intake can damage the liver and serious liver disease can have an effect on the kidneys. Excessive alcohol can exacerbate high blood pressure (hypertension) and hypertension can damage the kidneys. Most alcohol drinks have a percentage of alcohol (ethanol) greater than 3% and at this level the ethanol has a dehydrating effect (where the fluid loss is greater than the fluid volume taken in). In such situations you can get fluid depleted exacerbating the risk of urinary infections or kidney stones..or worse headaches/hangovers.

How does smoking affect my kidneys?

Smoking may well harm your health more than just your kidneys. From the kidney perspective tar compounds that are in the inhaled smoke, clog up the blood vessels. The blood vessels that supply the kidneys are very fine and only a small amount of deposit in their walls can lead to a significant reduction of blood flow and therefore loss of kidney function.

Avoid smoking.

Does cranberry juice really help kidney infections?

Some infections with bacteria in the urinary tract are reduced because the cranberry juice and D-mannose prevent the bacteria adhering to the cells lining the urinary tract. This reduces the bacteria's ability to "stick around" long enough to cause an infection. Coupled with drinking a large volume of fluid and therefore passing urine frequently flushing the bacteria out from the urinary tract, cranberry juice can reduce infections.

It is important to ensure that bladder is completely emptied to assist such urinary tract infection avoidance.

How does exercise help my kidneys?

"A health heart can mean healthy kidneys". Having regular exercise and keeping healthy:

• Will help control blood pressure
• If you have diabetes mellitus, will help maintain blood sugar control; and good blood sugar control helps reduce kidney damage from diabetes mellitus
• Helps maintain ideal body weight; not being overweight helps maintain blood pressure and reduce high blood pressure (hypertension)
• Helps reduce heart disease

What medications might damage my kidneys?

Prescriptions Medications

Many prescription medications are excreted by the kidney, or their breakdown products are excreted (removed from the body) by the kidney. They can potentially harm the kidney especially if they are concentrated in the kidney. Increasing urine volume by having a high fluid intake can help prevent kidney disease from drugs.

Sometimes prescription medication dosing needs to be adjusted in people who have kidney disease or the elderly.

Common prescription medications that may affect the kidney include:

• Lithium
• NSAIDs (non steroidal anti-inflammatory drugs)
• Some pain relief medication (particularly NSAIDs) Cox II inhibitors (arthritis or anti-inflammatory medications)
• Proton pump inhibitors - e.g. omeprazole, pantoprazole, lansoprazole.
• Some cholesterol lowering agents e.g. fibrates. The statins family of lipid-lowering drugs e.g. simvastatin and atorvastatin are generally "safe" to use in kidney disease.

OTC/non prescription medications.

Medications that can be purchased over the counter (OTC) at health food shops, chemists and supermarkets sometimes have combinations of active ingredients. Most of these are quite safe to use but some may have kidney damaging components, particularly in people who have established kidney disease. Before starting these medications it is worth checking with the person who sells them in the shop, or getting further information from a health professional. Sadly many of the medications are only harmful after a long time of exposure and the damage is then irreversible. This is an important point because often the kidney damage has no symptoms early in the process.

• If you know you have kidney disease it is wise to check with the person supplying the medication if it is safe to use.
• Some agents are marketed as being "safe" or as treatment for kidney disease and yet are harmful.
• Some medications that are marketed are toxic.