Kidney Health: What You Should Know

16 PAGE PULL-OUT HEALTH BOOK
A KIDNEY HEALTH AUSTRALIA AND GOODMEDICINE PROMOTION
KIDNEY
HEALTH
ISSUE #1
WHAT YOU SHOULD KNOW...
PROUDLY SUPPORTED BY:
CONTENTS
Dear Readers,
I am pleased to be introducing this very
interesting booklet on kidney and urinary
tract health!
It is my great pleasure to be working in
partnership with Good Medicine magazine,
I commend this booklet to you and
encourage you to read its pages carefully to
enhance your kidney and urinary tract health.
Kidney Health Australia, formerly
The Australian Kidney Foundation,
was founded in 1968 as the peak national
organisation working towards the vision of
an Australia free of kidney and urinary tract
disease through research, advocacy,
education and health service excellence.
Happy reading!
1. KIDNEYS AND THEIR ROLE
2. HOW COMMON IS
KIDNEY DISEASE?
3. WHAT TREATMENTS ARE
AVAILABLE FOR KIDNEY
FAILURE?
4. WHAT CAN I DO TO KEEP
MY KIDNEYS HEALTHY?
5. HIGH RISK GROUPS
Professor Villis Marshall, Urologist
CHAIRMAN, BOARD OF DIRECTORS
KIDNEY HEALTH AUSTRALIA
Kidney disease is a silent killer because
individuals can often lose up to 90 per cent
of their kidney function before experiencing
6. KIDNEY DISEASE AND
ANAEMIA
7. USEFUL CONTACTS
any symptoms or feeling significantly unwell.
About 1900 Australians commence kidney
failure treatment (dialysis) each year with
the total number on dialysis growing at an
alarming rate of six per cent annually. With
the number of people with diabetes
increasing, it is estimated that kidney
disease will reach epidemic proportions in
years to come.
At Good Medicine we believe that
knowledge is the best tool for
preventing disease, which is why
we’ve teamed up with Kidney Health
Australia to produce this 16-page
booklet on Kidney Health.
1
One in seven Australians is at risk
of developing kidney disease, and
yet it is preventable. In this booklet
we look at some of the risk factors
(for example, did you know that
kidney function begins to decline
after the age of 50?). We also look at
how kidney disease is detected, and
what steps you can take to ensure
good kidney health throughout your
life. In essence, it’s all you ever
wanted – and needed – to know to
keep your kidneys in good health.
ERIN CRAVEN
DEPUTY EDITOR
(NEWS & FEATURES)
GOOD MEDICINE
2
3
CONTRIBUTORS
1. Professor Villis Marshall: Chair
Kidney Health Australia
2. Professor David Harris: Chair Kidney
Health Australia Medical and Scientific
Advisory Committee
3. Anne Wilson, CEO Kidney Health
Australia
4. Professor David Tiller: Chair, Kidney
Check Australia Taskforce
5. Dr Tim Mathew: Medical Director,
Kidney Health Australia
4
5
Ribs
Renal Artery
Kidneys
Aorta
Ureter
Bladder
Urethra
KIDNEYS
AND THEIR ROLE
THE ROLE OF THE KIDNEYS IS OFTEN UNDERRATED WHEN WE THINK
ABOUT OUR HEALTH. BUT, IN FACT, THE KIDNEYS PLAY AN
IMPORTANT ROLE IN THE DAILY WORKINGS OF OUR BODY. THEY ARE
SO IMPORTANT TO HEALTH THAT NATURE GAVE US TWO
KIDNEYS TO COVER THE POSSIBILITY THAT ONE MIGHT BE LOST TO
AN INJURY. THEY ARE SO IMPORTANT THAT WITH NO KIDNEY
FUNCTION DEATH OCCURS WITHIN A FEW DAYS.
Helping to control blood
pressure
Helping with the production of
red blood cells
Helping to keep our bones
strong
Helping the production
of red blood cells
The kidneys play a vital role in the
production of red blood cells in the body
through the secretion of a hormone
called erythropoietin. Eighty-five to 90 per
cent of erythropoietin is produced in the
kidneys. Erythropoietin is released when
there is a low level of oxygen in the
tissues, and then travels to the bone
marrow where it stimulates the
production of red blood cells.
Helping to control blood
pressure
The relationship between blood pressure
and the kidneys is an extremely close
one. It is the role of the kidneys to
monitor blood pressure and to take
action to correct any imbalances.
The kidneys can do this in two ways:
1. If the kidneys sense that the glomeruli
(the filters in each kidney) aren’t getting
adequate blood flow, they can help raise
blood pressure by secreting a hormone
called renin. This hormone release
causes the constriction of blood vessels
throughout the body, which in turn raises
blood pressure. The kidneys can also
raise blood pressure by decreasing the
excretion of salt and water.
2. On the other hand, the kidneys also
have the ability to lower blood pressure.
If blood pressure rises, the kidneys can
increase the excretion of salt and water,
lowering blood volume and bringing
blood pressure back to normal.
Removing waste and
fluid from the body
Of all the different roles that our kidneys
perform, this is the most important one.
Essentially, the kidneys are the body’s
waste-removal system. Inside the
kidneys there are millions of tiny
structures called ‘nephrons’. A nephron
consists of a filtering unit of blood
vessels called a ‘glomerulus’. When the
blood enters the glomerulus, it is filtered
and the remaining fluid passes through
the tubule. Excess wastes and fluids not
required by the body are removed, and
the clean blood then returns to the body.
The waste is then carried from the
kidneys to the bladder, where it is stored
as urine until it is passed out. Around
190 litres of fluid is produced by the
kidneys each day, however, only around
1.5 to 2.5 litres is excreted as urine. The
remainder is reabsorbed into the body.
Helping to keep our
bones strong
As well as storing calcium in the bones,
the body also circulates calcium in the
blood. Again, the kidneys play a role in
restoring the balance, should levels fall.
This occurs through parathyroid
hormone – a hormone released from the
parathyroid glands in the neck – being
secreted. Parathyroid hormone increases
calcium reabsorption from the distal tube
in each nephron to restore the blood
calcium levels.
The kidneys also play the last step in the
absorption of vitamin D. An inactive
precursor to vitamin D, cholecalciferol, is
made in the skin and liver, however, it is
in the nephron where this is transformed
into active vitamin D. Once activated,
vitamin D stimulates calcium absorption
from the nephron, increasing blood
calcium levels.
WHAT CAN
HAPPEN
IF THE KIDNEYS
AREN’T
FUNCTIONING
PROPERLY?
Imagine your body is like the house
you live in … every day at home, your
family creates rubbish, which builds up
over a week until it is put out for the
garbage collection one night. Now, say
you put three bags of garbage out, but
because one of the collectors was sick,
only two bags are collected. So, you
take the leftover bag inside to be put
out again the next week. The following
week you put out another three bags,
plus the leftover bag from last week.
But again, only two bags are collected.
Now imagine this cycle is repeated
over the following weeks – bags remain
around the house, which starts to smell
and gets unbearable to live in.
Eventually disease breaks out, and
everyone gets sick.
It’s the same when your kidneys aren’t
working properly: excess waste
remains around the body, other areas
of the body become unbalanced (such
as blood pressure and red blood cell
production), and kidney failure
develops. Unfortunately though, unlike
the garbage collection scenario, where
the negative effects are almost
immediate, it’s not uncommon for
people to lose up to 90 per cent
of their kidney function without
experiencing any symptoms.
*TEXT BY ANNE WILSON, CEO KIDNEY HEALTH AUSTRALIA
Removing waste and fluid from
the body
*TEXT BY ANNE WILSON
CEO KIDNEY HEALTH AUSTRALIA
FOR ORGANS SO
SMALL, THE KIDNEYS
HAVE A NUMBER OF
VITAL ROLES TO PLAY:
COMMON
HOW
IS KIDNEY DISEASE?
ONE IN SEVEN AUSTRALIAN ADULTS IS AT RISK OF DEVELOPING
KIDNEY DISEASE AND ONE IN 35 ACTUALLY HAS CHRONIC KIDNEY
DISEASE. 13,700 AUSTRALIANS ARE CURRENTLY ALIVE ON DIALYSIS
OR WITH A FUNCTIONING KIDNEY TRANSPLANT.*
Glomerulonephritis
Is it common?
It is the most
common cause of kidney failure
in Australia.
How is it treated?
Specific
treatments to cure or control this
condition are available in only about
five per cent of cases. In the rest,
simple measures are used to slow
down progression into kidney failure.
IgA Nephropathy
What is it?
This is the most
common type of glomerulonephritis
and presents with blood in the urine
(often not visible to the naked eye).
It is often associated with recurrent
sore throats and pain in the loins.
Is it common?
IgA nephropathy
accounts for probably about eight per
cent of all cases of kidney failure and
sometimes runs in families.
How is it treated?
There is
currently no cure for IgA nephropathy,
although much can be done to stabilise
the condition and slow down its
progression. Many people diagnosed
with this do not ever progress into
kidney failure.
e
500,000 Australians ar
at risk of developing
kidney disease and
don’t know it.
Kidney stones
What are they? They’re hard, rocklike crystals that form when certain
chemicals in the urine stick together.
They can range in size from as small as
a grain of sand to as big as a golf ball.
Are they common? They are
one of the most common disorders
of the urinary tract. The likelihood of
developing a kidney stone increases
with age and family history, and is
more common in those living in
tropical areas of Australia.
How are they treated? Most
stones (90 per cent) will pass by
themselves. If a stone is too large to
pass, is blocking urine flow or is
causing bleeding or infection, surgery
may be required.
JENI BROWN, 41
CENTENNIAL PARK , NSW
At 10, Jeni was diagnosed
with juvenile diabetes. As a
result of her diabetes, her
kidneys slowly deteriorated
and when she was in her 30s
she was diagnosed with
complete kidney failure.
After 14 months on dialysis
(see overleaf), she had
a kidney and pancreas
transplant. “It will be eight
years next month since I
received my new kidney and I
feel fantastic. It saved my life
and has completely turned it
around,” she says.
Jeni now takes anti-rejection
drugs daily and keeps a
careful watch of what she
eats. She will have to do so
for the rest of her life, but says
it’s a small price to pay.
“
I feel like I can
live a normal
life now. I’m
really lucky.
*TEXT BY PROFESSOR DAVID HARRIS
A type of kidney disease
that damages the kidney filters.
“
What is it?
FACT : More than 1
million Australians
are
suffering from kidney stones.
What is it?
This is an inherited
condition associated with the
development of thousands of cysts in
each kidney. It usually causes kidney
failure after the age of 40 and may be
complicated by severe hypertension.
Is it common?
Polycystic kidney
disease occurs in 1 in 800 live births
and is believed to affect about 35,000
Australians – many of those affected
would not even be aware that they have
the condition.
How is it treated?
There is no
specific treatment although rigorous
blood pressure control helps to
prevent complications.
SHERRY ROBINS, 35
BEEAC, VIC
At just 35, Sherry has had total kidney
failure for the past six and a half years,
and undergoes peritoneal dialysis (see
overleaf) four times a day.
“I think I was in denial for a long time.
I had high blood pressure and knew that
something wasn’t right.”
Sherry lived on a dairy farm when she
was 13, doctors believe that her kidney
failure is a result of a rare condition called
Leptospirosis contracted from cows.
Kidney cancer
Diabetic kidney disease
What is it?
What is it?
A kidney disease caused
by the deposition of a substance,
unique to diabetics, in the kidney filters
that gums them up and blocks their
capacity to filter.
There are several types
of kidney cancer, and the most
common is renal cell carcinoma. As
with all cancers, tumours begin small
and grow larger over time. Some
kidney cancers can spread through
the blood stream or lymph vessels to
other areas of the body.
Is it common?
Diabetic kidney
disease is the second most common
kidney disease in Australia. However,
in Aboriginal people it is the most
common cause of kidney failure.
Is it common?
Kidney cancers
account for about 2.5 per cent of all
cancers. They occur twice as often in
men as women.
How is it treated?
How is it treated?
There are four
types of treatment. These are surgery,
chemotherapy, radiation therapy and
immunotherapy, with treatments done
singularly or in combination.
Much can be
done to prevent or slow progression
into kidney failure by rigorous control
of blood sugar and blood pressure
and the use of special medication
proven to protect the kidneys from
further damage.
“
Since being on dialysis, Sherry has
gained 10 kilograms, and the selfconfessed ‘water baby’ is unable to go
swimming due to the permanent catheter
in her stomach. Her condition means she
is also unable to have children.
Sherry says she believes she was able
to avoid going on dialysis for a long
period of time by following a strict diet.
Sherry is currently waiting for a
compatible kidney donor.
People need to be
aware of their bodies,
and what they are
putting in to them.
Good healthy, natural
food is really important
for your overall health,
including your kidneys.
“
Polycystic kidney
disease
TREATME
WHAT
ARE AVAILABLE
DIALYSIS
KIDNEY FAILURE.
Essentially, dialysis means the
replacement of the kidney’s
excretionary role by artificial means.
There are two types of dialysis –
haemodialysis and peritoneal dialysis.
The type of dialysis used depends
on many factors – age, access to
resources, overall health and lifestyle.
RECENT STUDIES
Haemodialysis requires a minor
COMPLICATION OF
KIDNEY DISEASE IS
PROGRESSION INTO
HAVE PROVEN THAT
FOR MOST KIDNEY
CONDITIONS
APPROPRIATE
TREATMENT CAN
STABILISE OR
SIGNIFICANTLY SLOW
DOWN THE RATE OF
PROGRESSION BY UP
TO HALF. BUT, IF THE
KIDNEYS ARE ONLY
WORKING AT FIVE
TO 10 PER CENT
OF THEIR NORMAL
RATE, DIALYSIS OR A
KIDNEY TRANSPLANT
IS THE ONLY OPTION.
operation to allow access to blood
circulation, usually through the wrist.
Blood is then removed from the body,
cleaned by an artificial kidney attached
to a machine and then returned. Each
treatment lasts for four to six hours,
and is required three times a week for
life or until a transplant donor is found.
Peritoneal dialysis
also requires
a minor operation, but this time a
catheter is inserted into the abdomen.
Unlike haemodialysis, where waste
removal and blood cleansing takes
place outside the body, during
peritoneal dialysis this is done inside
the body, using the body’s own
peritoneal membrane – the lining of
the abdominal cavity – as a filter. The
catheter acts as an entrance for a
dialysis solution to enter and leave the
cavity. Dialysis takes place four times
a day, seven days a week, but can be
performed almost anywhere. Again,
this treatment is for life, or until a
transplant donor is found.
AMANDA HORNE, 34
NORTH HAVEN , SA
Amanda believes her case is a lesson
in early detection. Amanda suffers
from vesicoureteric reflux, a condition
where each time the bladder is
emptied, urine flows up to the kidneys
causing infection. This infection can
lead to permanent kidney damage.
Amanda was born with the condition,
but it was only diagnosed when she
became sexually active because
intercourse aggravated the condition,
and Amanda found herself with repeat
cases of cystitis.
“I’m really lucky because they caught
it before my kidneys became too
damaged. Because I was diagnosed
so early, I have been able to start
therapy early which means I could
live another 20 years of normal life
without having to go on dialysis. Who
knows, by then I’m sure they will have
developed even better procedures.”
Amanda now takes antibiotics to limit
the number of infections and can live
a relatively normal life.
“
If women are
getting infections
more than once
every 12 months,
then they really
should be getting
it checked out.
“
THE MAJOR
FOR KIDNEY FAILURE?
KIDNEY TRANSPLANT
While kidney transplantation delivers a
healthy, functioning kidney to someone
suffering from kidney failure, it is
important to remember it is a treatment,
not a cure. Transplantation gives people
with kidney failure a chance to get their
old lives back, free from dialysis.
Donated kidneys come from either
deceased donors or from live donors.
Live donors are usually close relatives,
however, spouses, distant relatives and
even close friends can donate a kidney.
Kidney transplantion is successful, with
more than 90 per cent of transplants
working one year on. However, it is not
a ‘quick fix’. A new kidney requires a
lifetime of care, including taking daily
anti-rejection medication.
The average
waiting time
for a new
kidney is
four years.
NARACOORTE, SA
periods of time in between
treatments,” he says.
“The impact on my life has
been huge. Everything now
revolves around the dialysis.
We can’t go away, unless
there’s a dialysis machine, or
we can only go away for short
“
Doctors are unsure what
caused his condition. After
suffering a heart attack when
he was 38, doctors found that
he had only 25 per cent of his
normal kidney function. His
condition continued to decline
over the years until doctors
found a tumour on one
kidney. That kidney was
removed, and Meryvn is
awaiting a kidney donor.
“
NTS
MERYVN HARVEY, 64
Mervyn was diagnosed
with complete kidney failure
12 months ago and needs
haemodialysis three times a
week. He and his wife spent
four months in Adelaide
learning how to use the
dialysis machine.
If there’s one thing I could tell people, it would be to
make sure you take your kidneys seriously. If you have
high blood pressure or pain, or anything …
don’t ignore it. Make sure you see your doctor.
BE
WANT TO N
R?
O
N
O
D
A
AN ORG people die while waiting foroamn organ
two
efit fr
Each week, . Many people can ben
on
organ donati t one person.
ut
jus
ation abo
er inform
h
rt
donation by
fu
r
to
o
F
ur wish
in your
donor card
an
rg
o
an
Carry
ustralian
ter on the A
is
g
re
t,
le
al
w
and /or
or Registr y
Organ Don
ur driver’s
r intent on yo tly,
register you
an
rt
more impo
license, and
your family.
ith
w
r wishes
u
yo
ss
cu
is
d
on visit :
informati
For more
lia at
alth Austra
Kidney He
y.org.au
w w w.kidne
00 682 531.
18
ll
a
or freec
s Donate
Australian
222
(08 ) 8351 5
ister yo
how to reg
ntact:
o
c
,
donate
onation
n Organ D
a
li
a
tr
s
u
A
Register
03
800 777 2
freecall 1
2
15
5 52
TT Y 1800
0
5
4
1
13
TIS
au
r@ hic.gov.
d
o
a
il
a
m
e
an Organ
: Australi
or write to
Registr y
Donation
711q
Reply Paid
7001
S
A
T
Hobart
re office
y Medica
or visit an
nline by
o register o
You can als
on
te
si
HIC web
visiting the
ov.au
w w w.hic.g
Fact: It costs $50,000 to keep one person on haemodialysis
on peritoneal dialysis.
ne
eo
m
so
ep
ke
to
0
00
5,
for one year, and $3
?
Y
H
T
L
A
E
H
KIDNEYS
Y
M
P
E
E
K
O
T
O
WHAT CAN I D
LIMIT ALCOHOL
Excessive alcohol intake can lead to
heart disease and high blood pressure,
increasing the risk of kidney disease.
Tips to cut down on your
alcohol intake:
SMOKING
If you don’t smoke, don’t start. If you
do, quit! This is the simplest, most
important lifestyle habit to change to
reduce the risk of kidney disease.
People who smoke are three times
more likely to have reduced kidney
function, and have a four to five times
greater risk of heart attack and stroke.
Tips to help you quit:
Get the appropriate help. Call the
Quit line on 131 848 or contact your
local community services directory or
health centre for a referral to a smoking
cessation program.
Surround yourself with people
who are non-smokers.
Talk to your GP. Research shows
that spending as little time as three to
five minutes talking with your health
practitioner can increase your quit rate.
Find healthy alternatives to
smoking, such as meditation and yoga.
ENJOY LIFE
Limit alcohol to two standard
drinks per day for men, and one per
day for women.
Good health and wellbeing means that
we are healthy from all dimensions of
our lives – physically, mentally, socially
and spiritually.*
Ask for ice with your drinks –
when the ice melts it will dilute alcohol.
Tips for an enjoyable life:
Alternate your drinks by having
a glass of water in between each
alcoholic drink.
If you want to feel like you’re
partaking in a drinking session, fake it
– drink your water from a wine glass.
Have less stress in your life.
Do the things you love.
Spend more time with people
you enjoy being with – those who
challenge you to be more … not less.
Balance the load.
PHOTO CREDIT: COURTESY OF DAIRY AUSTRALIA’S NEW GOOD HEALTH RECIPE BOOK
CHICKEN AND PEA RISOTTO
NUTRITION
The food you eat plays a huge role in the
health and wellbeing of your body. It can
help to prevent some diseases, and help
to manage others. As well as providing
the body with a variety of nutrients, diet
can also help in weight reduction and
weight control.
People who are overweight are at an
increased risk of developing diabetes
and high blood pressure, major risk
factors for kidney disease. In fact, losing
as little as five kilograms reduces blood
pressure in most people who are 10 per
cent over their ideal weight.
People with kidney disease may need to
make some dietary changes to help
manage their condition. Not all people
with kidney disease will need to follow
the same diet. Dietary guidelines will
need to be made on a personal basis,
taking into account age, lifestyle, health
status and body chemistry.
Eat reduced-fat and low-fat
dairy products
Limit the amount of fatty foods
you eat, such as fried fish and chips,
fried or baked chicken, and potato
crisps.
Tips for a healthy diet:
Lower your salt intake. Buy low- or
no-salt products and don’t add salt to
food or the dinner table setting.
Eat lots of fruit, vegetables,
legumes and wholegrain bread and rice.
Eat more at home, not take-away
– less temptation
Eat some lean meat such as
chicken and fish at least once a week.
If you need extra guidance on a healthy
diet, visit your doctor for advice on
nutrition and your ideal weight.
QUENCH YOUR THIRST
While it’s long been thought that
6-8 glasses of water per day is
beneficial to health, there is no
evidence to suggest that drinking in
excess of thirst has any extra benefits.
So, use your thirst as a guide.
Tips for drinking:
Make water your tipple of choice.
Water assists in transporting nutrients
around the body, as well as helping to
eliminate waste. It contains no
kilojoules, and in most areas of
Australia, tap water has the
added benefit of fluoride, which
protects your teeth from caries.
Limit your intake of
caffeine and cola. These can
irritate the bladder and can act
as a diuretic. Instant coffee has
less caffeine than espresso or
percolated coffee, while tea has
less caffeine than coffee.
PREVENTING
URINARY INFECTIONS
ed ‘honeymooners’
Urinary tract infections, often nicknam
so in women. The
disease’, is extremely common, more
, making it easier
female urethra is shorter than the male’s
infections tend to be
for bacteria to enter the bladder. Mild
ere infections can
restricted to the bladder, while more sev
ey damage.
spread to the kidneys, leading to kidn
Cranberr y juice or tablets
To avoid urinary infections:
n
take daily may help prevent
Maintain a high fluid intake.
bacteria from binding to the
Empty your bladder after sex.
bladder wall.
Bacteria can gain access to the
Maintain good hygiene habits.
female bladder during intercourse.
See your GP and have a urine
If you have the urge to go to
if
test any of the symptoms of
the toilet, don’t ignore it.
urinary tract infection occur.
Go to the toilet before going to
Symptoms include mild discomfort
sleep at night.
when urinating, a desire to urinate
Wipe your bottom from front
more often, discomfort in the lower
to back – most urinary infections are
abdomen, and dark, smelly or
caused by bacteria moving forward
cloudy urine. In severe cases there
from around the bottom (anus) to
may be high temperatures, loss of
the bladder.
appetite, nausea, vomiting and pain
Take your time to urinate.
in the kidneys.
Don’t stop urinating mid-flow.
Repeat a urine test seven to
Stopping the flow of urine can cause
after completing a course of
days
10
it to back-flow into the bladder and
. This helps to ensure the
iotics
antib
cause infection.
infection has completely
tract
ry
urina
Wear cotton underwear, as
gone.
it ‘breathes’ more easily.
EXERCISE
The benefits of regular exercise are
wide-reaching. Not only can it help to
maintain and reduce weight, it can also
reduce the risk of developing heart
disease and diabetes, risk factors for
kidney disease. You only need to
exercise for 30 minutes on at least five
days of the week to reap the benefits.
And you don’t have to sweat it out at
the gym or pound the pavement – a
brisk walk is sufficient.
Tips to get more exercise:
Break your 30 minutes up into
10-minute intervals if time is limited.
Get off the bus one or two stops
earlier and walk the remaining trip to
your destination, walk to the shop
instead of driving the car, and take the
stairs instead of the lift or escalator.
Choose exercise that you enjoy,
such as swimming, walking, aerobics
or bike riding
Get a friend to exercise with you
… not only will you lose track of time as
you work out, you’ll also help to
motivate each other.
Simple daily activities such as
mowing the lawn, or even shopping
can be counted in you daily exercise
quota. If shopping takes your fancy, do
a quick lap of the shopping centre
before actually hitting the shops.
If you have small children, join the
local pram-pushers’ walking club.
Contact your early childhood centre,
or local council’s community services
department to find out if there’s a club in
your area. If there’s not, start your own!
GROUPS
HIGH RISK
diabetes
Diabetes is the second most common
cause of kidney disease in Australia,
except in Aboriginal people, where it
is the leading cause. Diabetes can
cause kidney disease in two ways:
1. The tiny blood vessels in the kidney
filters become thickened and the filters
get clogged with a special deposit
unique to diabetics. This is called
diabetic nephropathy – usually a
steadily progressive kidney disease
leading to increased amounts of
protein in the urine, high blood
pressure and eventually kidney failure.
This is by far the most common way in
which diabetes affects the kidney.
2. By causing nerve damage to the
bladder. Nerve damage in the bladder
makes it harder to pass urine, which as
a result can lead to pressure causing
urine to flow back into the kidneys,
causing scarring. This is common but
only rarely leads to kidney failure.
What can I do to reduce the risk?
Stay at a healthy weight
Exercise moderately for at least
30 minutes, five days each week.
Eat a healthy diet
Fact: You can lose up
to 90 per cent of
kidney function before
symptoms occur.
CHECK YOUR RISK:
If you are already diabetic...
Make sure any urinary infections
are treated immediately.
Have your urine checked for
protein at least once a year by your GP.
Maintain a normal blood pressure.
High blood pressure can increase the risk
of progressive diabetic kidney disease.
Maintain good control of bloodsugar levels. Evidence shows that
careful control of glucose helps prevent
kidney disease in diabetics.
ther
Try this quick quiz to assess whe
you are at risk of kidney disease.
Tick if you:
q Are diabetic
q Have high blood pressure
q Have a family history of
kidney disease
q Are over 50
q Are a smoker
q Are of Aboriginal or Torres
Straight Islander descent
more
If you answered YES to one or
of
risk
at
are
you
then
e
of the abov
kidney disease
What should you do?
Visit your local doctor TODAY and
test.
ask for a Kidney Performance
a:
de
inclu
can
test
The
Blood pressure test
Blood test
Urine test
Lifestyle assessment guidelines
will
Performance-testing your kidneys
help keep your kidneys in top gear
high blood pressure
Severe high blood pressure can
occasionally lead to kidney disease, but it
is the most important factor to control in
those who already have kidney problems.
High blood pressure affects the kidneys
by putting more stress on the blood
vessels throughout the body, including
the kidney filters. If blood pressure
remains unchecked it can cause blood
vessels to become thickened and
narrowed, leading to reduced blood
supply and to a worsening of any
underlying kidney trouble. The final effect
is to reduce kidney function by starving
the kidneys of oxygen and nutrients.
What can I do to reduce the risk?
Keep your blood pressure
below 130/85
Maintain a healthy weight
Ensure a low salt intake
Reduce stress
Moderate alcohol intake
Don’t smoke
If you already have high blood pressure
Correctly take your prescribed
blood pressure medication and work
with your doctor to achieve the blood
pressure target set.
Continue to work on achieving
a balanced lifestyle.
It seems what hurts the heart also
hurts the kidneys. While it’s long
been known that smoking increases
the risk of heart disease in diabetics,
a study published in the American
Journal of Kidney Disease last year
linked smoking to kidney disease,
even in otherwise healthy people.
The study found that people who
smoked were three times more likely
to have reduced kidney function
than people who didn’t smoke.
Researchers have speculated that
smoking damages the kidneys by
hardening the arteries in the kidneys,
and by changing blood circulation in
the kidneys.
What can I do to reduce the risk?
Quit smoking
family history
If you have one or more family
members who have chronic kidney
disease, are on dialysis or have had
a kidney transplant, you may be at a
higher risk. One hereditary kidney
disease is polycystic kidney disease.
Polycystic kidney disease causes
large, fluid-filled cysts in the kidneys
that eventually crowd out normal
kidney tissue. Diabetes and high blood
pressure, major risk factors for kidney
disease, also have a tendency to run
in families.
What can I do to reduce the risk?
Be aware of your family history,
and discuss it with your GP
Have a kidney performance
check each year
Be screened for risk factors
such as diabetes and high blood
pressure
Maintain a healthy lifestyle
PROF. DAVID TILLER
CHAIRMAN , KIDNEY CHECK AUSTRALIA TASKFORCE
The Kidney Check Australia Taskforce, an
initiative of Kidney Health Australia, has
embarked on an innovative, multi-faceted
and multi-disciplinary strategy to screen
at-risk groups for kidney disease. The
target of this program has
been GPs, practice
nurses and
pharmacists, and is
designed with a view
to not only detect
early kidney disease
more efficiently, but also
to ensure it is treated
appropriately.
>>>>>>
smokers
over 50s
A slow decline in the ability of the
kidneys to filter blood occurs as you
get older. Ten per cent of kidney function
is lost each decade after the age of
40 years. By the age of 70 this means
that you may have lost over 30 per cent
of kidney function, and that can affect
the dose of drugs you are prescribed. It
also reduces the reserve of kidney
function should another condition
damage the kidneys.
What can I do to reduce the risk?
Maintain a healthy lifestyle
Be aware that your kidney at-risk
status increases after 50 and discuss
this news with your doctor
Visit your doctor each year and
ask for a kidney performance check
early detection
The good news is that kidney failure
can be prevented if it is detected
early and managed appropriately.
Early detection programs are aimed
at people with an increased risk of
kidney disease. If you fall into any of
the at-risk groups, you should speak
to your doctor about a kidney
performance check. Early detection
and appropriate therapy can reduce
the number of new cases of kidney
disease progressing to dialysis.
The tests used to detect kidney
disease include:
Blood Pressure
Urine: This test measures the
presence of abnormal amounts of
protein in the urine. This can be done
as a ‘dipstick’ test.
Blood creatinine: Creatinine is a waste
product that comes from normal wear
and tear on the body’s muscles. An
increased creatinine level could be an
early sign that the kidneys are not
working properly.
Glomerular filtration rate (GFR): This
provides a better measure than blood
creatinine in determining how well the
kidneys are removing waste and excess
fluid from the blood. It is calculated from
the serum creatinine level using age,
weight, gender and body size. A normal
GFR is about 100ml/min or above, but
as you get older, GFR can decrease.
A GFR below 60 is a sign that the
kidneys are not working properly, while
a GFR of <30 indicates severe kidney
failure and dialysis usually starts when
the GFR is <10ml/min.
aboriginal people and
torres straight islanders
The incidence of kidney failure is six times
higher in people of Aboriginal or Torres
Straight Island descent. And, in some
regions, such as the Tiwi Islands, the
problem is 30 to 40 times higher, to a
level higher than anywhere else in the
world. The reasons for this are multifactorial, and include poor maternal
nutrition, leading to small babies with
small kidneys, multiple infections and a
higher incidence of diabetes associated
with dietary issues.
What can I do to reduce the risk?
All adults should have a kidney
performance check annually
KIDNEY DISEASE &
ANAEMIA
IT’S NOT UNUSUAL FOR PEOPLE WITH KIDNEY DISEASE
TO HAVE ANAEMIA – A CONDITION WHERE THEY HAVE
*TEXT BY DR TIMOTHY MATHEW
A FURTHER
WORD ON
DIABETES
In addition to kidney disease,
having diabetes substantially
increases the risk of cardiovascular
complications, such as stroke and
heart attack.
Studies have shown that people
with diabetes are 2-4 times more
likely to develop cardiovascular
disease than people without
diabetes.
Indeed, about 75 per cent of
people with diabetes will die of
coronary heart disease.
It’s important that people with
diabetes take preventative
measures to reduce their risk of
cardiovascular disease. These
measures include a healthy
diet, plenty of exercise, weight
reduction and the use of some
cholesterol-lowering agents.
A large trial, known as the
Heart Protection Study, showed
that by taking a cholesterollowering medication, you can
reduce the risk of heart attack
and stroke, even if you have
what are considered ‘normal’
cholesterol levels.
LOW LEVELS OF RED BLOOD CELLS IN THEIR BLOOD.
Anaemia is a condition of reduced
circulating haemoglobin (Hb) in the
blood. It may result from many different
factors such as poor diet, congenital
defects, exposure to industrial poisons,
diseases of the bone marrow, or any
other disorders that upset the balance
between blood loss though bleeding
or the destruction of blood cells and
production of blood cells.
Anaemia is on the increase in Australia
as many different diets on the market
fail to address individual needs, placing
young people, women and those over
the age of 50 at greater risk. Anaemia
is more common in women, due to
menstruation and also because blood is
lost during childbirth.
Anaemia in kidney disease is mainly due
to reduced production of the hormone
erythropoietin. Erythropoietin maintains
haemoglobin levels in the blood.
Anaemia may also develop because
blood is lost during dialysis and from
frequent blood tests.
A blood test is necessary to determine
whether anaemia is present or not.
People suffering from anaemia often
complain of feeling tired and lethargic.
They say they feel ‘run down’ and
find it difficult to concentrate for long
periods of time. With anaemia, the body
gets tired because it is not getting the
oxygen it needs.
When a person with kidney disease
becomes anaemic, the first thing to
check is whether there is evidence
of iron, B12 or folate deficiency. Iron
deficiency is more common. If any of
these deficiencies is present, they
may be corrected and the degree of
anaemia reassessed.
If additional iron is required, it’s
important to check whether dietary
intake is adequate. Iron can be found in
green leafy vegetables (spinach, lettuce,
bok choy) and red meat. Tim Mathew,
Medical Director of Kidney Health
Australia says, “a healthy, nutritious,
balanced diet rich in iron is essential
for good health and wellbeing.” Iron
supplements, in the form of tablets,
may also be required.
The absorption of iron from the gut
is limited with kidney failure, which
often leads to the need for iron to be
administered by periodic intramuscular
or intravenous injections. If deficiency
of iron or folate has been corrected, or
is not present and anaemia persists,
then consideration of erythropoietin
therapy should occur, in those with
kidney disease. Erythropoietin hormone
injections stimulate the production of
red blood cells from the bone marrow
and result in additional red blood cells
that can carry more oxygen.
>>>
A KIDNEY HEALTH AUSTRALIA AND GOODMEDICINE PROMOTION
USEFUL CONTACTS
KIDNEY HEALTH
AUSTRALIA
USEFUL
CONTACTS
Kidney Health Australia aims for a
kidney and urinary tract disease free
Australia, by promoting kidney and
urinary tract health through education,
research, advocacy and health
service excellence.
Aboriginal Health Information
www.healthinfonet.ecu.edu.au
Australian Organ Donor Register
Register by calling: 1800 777 203
TTY: 1800 552 152
TIS: 131 450
Email: aodr@hic.gov.au
Educational initiatives, such as forums
and public awareness campaigns,
target those with the disease, plus
health professionals. A broad range of
services for patients, their families and
carers incorporates advocacy and
self-management principles.
Better Health Channel
www.betterhealth.vic.gov.au
Kidney Health Australia also funds
cutting-edge medical kidney
health research.
International Diabetes Institute
www.diabetes.com.au
Phone the Kidney Health Info Line:
1800 682 531 (freecall) or
TTY 1800 005 881
www.kidney.org.au
This website has valuable links to
many other reputable sites and
organisations.
Diabetes Australia 1300 136 588
www.diabetesaustralia.com.au
HealthInsite
www.healthinsite.gov.au
National Heart Foundation
Heartline 1300 362 787
www.heartfoundation.com.au
National Renal Resource
Centre 1800 257 189 (freecall)
or (02) 9362 3995
Nocturnal Home Haemodialysis
www.nocturnaldialysis.org
If you wish to make a
donation, volunteer or start
a workplace giving program,
contact the Kidney Health
Australia office in your State:
New South Wales (02) 9299 4599
nsw@kidney.org.au
Northern Territory (08) 8948 4359
nt@kidney.org.au
Queensland (07) 5591 3040
qld@kidney.org.au
Nth Queensland (07) 4721 3322
fnq@kidney.org.au
South Australia (08) 8334 7555
sa@kidney.org.au
Tasmania (03) 6224 4869
tas@kidney.org.au
Victoria (03) 9866 3300
vic@kidney.org.au
Western Australia (08) 9322 1354
wa@kidney.org.au
Register to receive the latest news on
kidney health via our FREE on-line
publications. Call (03) 9866 3300.
Quitline 131 848
Renal Society of Australasia
www.renalsociety.org
Urological Society of Australasia
www.urosoc.org.au
YOU CAN ALSO
OBTAIN HELP BY
CONTACTING:
Your doctor, community health centre
or early childhood health centre. Look
in the Yellow Pages directory or ring
your local council and ask for the
community services section.
General note: Any material or information
contained in this publication does not constitute
medical advice and is intended for informational
purposes only. Please consult a health care
professional for specific treatment
recommendations.
Photo credits: • GollingsPidgeon
• Dairy Australia • Cuisine Collection
PROUDLY SUPPORTED BY:
PHARMACEUTICALS
PRODUCED BY CREATIVE SOLUTIONS/ACP
Up-to-date kidney and urinary health
information is provided through a
range of resource materials, including
brochures, fact sheets and books.
Australian and New Zealand
Society of Nephrology
www.nephrology.edu.au