 Kidneys are important organs of the body to maintain good health. There are two kidneys. Each kidney weighs 150 to 200 grams and is located below the rib cage. The symptoms of kidney diseases are decrease in urine output, swelling of the legs, swelling of the face, nausea and vomiting sensation, decrease appetite and general feeling of unwell. There are two types of kidney diseases. Acute kidney disease and chronic kidney disease. Acute kidney disease means sudden and rapid worsening of kidney function due to any reason, wherein the kidney function rapidly worsens and urine output drops and patients become sick within a matter of hours or days. This is called acute kidney injury and the factors causing these acute kidney injuries are variable. The combination among them is the infection due to any reason like malaria, pneumonia which can cause sepsis and then sepsis causing low blood pressure and causing acute kidney injury. The second thing is drugs. Many drugs can cause acute kidney injury like strong painkillers, native medicines, heavy antibiotics, heavy metal drugs. Next important cause of acute kidney injury is severe dehydration due to gastroenteritis, wherein rapidly BP falls and then blood supply to the kidney comes down and the kidney function comes down. And other important causes for acute kidney injury are kidney stones causing blockage to the kidneys and then autoimmune kidney diseases like what they call glomeral nefertitis, vasculatitis. They all cause kidney injury which is suddenly non-set and then one-set causative factor is treated like for example if you treat the infection with antibiotics and then dehydrate the patient with eye fluids for dehydration and give steroids for glomeral nefertitis or allergic to the kidney or removal of stone, blockage to the kidneys can all improve the kidney functions and majority of the time the kidney function becomes normal. Like 90-90% of the patients' acute kidney is reversible and kidney function becomes normal. And some patients might require dialysis also during this phase of acute kidney injury and till the recovery some patients will become very sick, they will not pass much urea and they will have a lot of acid in the blood, potassium can go up. When all this happen they might require temporary dialysis and once the kidney function improves the dialysis is stopped and then they will go back to normal life. And rarely maybe in 10-15% of times the kidney disease is not completely reversible, kidney damage is not completely reversible and they may be left with some damage like urea creatinine may be little high, slightly elevated than the normal people. Next come into the another class of kidney disease called chronic kidney disease wherein the kidney function comes down over a period of months to years. Like for example somebody's kidney function is normal today and then their kidney function decreases by 10-20% after one year. So that's called chronic kidney disease. So how to identify chronic kidney disease? So many other times chronic kidney disease is not identifiable unless you do blood test. The blood test of urea and creatinine. You check blood urea, creatinine, urine protein for protein in the urine. So early kidney disease easily can be easily missed. And detection of kidney disease in the early stages is most important to prevent further progression and complete kidney damage. The most common cause of chronic kidney disease are diabetes. That too diabetes is persisting for more than 5-10 years or 15 years and which is not controlled well. Where the hemoglobin A1C is not maintained less than 7.5% or 7%. That is the most common cause of kidney disease is what we see in general practice and also statistics. So in our dialysis center out of 100 patients are undergoing dialysis. 60 patients are diabetic patients. So in India being diabetic capital of the world. So it is very important for people to take care of the diabetes. First in the early stages of diabetes on site and so that further prevention of kidney disease, heart disease can be prevented in the long term. The second important cause of chronic kidney disease is hypertension. Hypertension also which is not controlled. Controlled hypertension is harmless. So BP should be maintained. The target BP for general population is 140 by 90. Less than 140 by 90 should be the BP target and they should try to achieve it immediately after the onset of hypertension rather than waiting for long time and then getting the kidneys damaged. So we are seeing nowadays in practice young people 30 years, 35 years, 25 years coming with high BP and then which is not controlled causing kidney damage. So because a lot of changes in the society, lifestyle have changed, diet has changed, sudden habits have come in, smoking has increased and salt intake has increased. So all this making Indian population, young people getting into hypertension causing kidney problem, heart disease later in the life. The other important cause of chronic kidney disease is repeated unit of infection. This is mostly seen in elderly people because of long standing diabetes and prostate enlargement and then diabetic bladder problem where they unable to feel sensation of bladder fullness or incoming emptying of the bladder. They all get predisposed to developing unit of infection and any unit of infection in elderly with diabetes, compromised kidney function will lead on to chronic kidney damage and repeated infection will definitely cause more and more kidney damage. So avoiding infection in elderly with diabetes is also most important to prevent chronic kidney disease. Another important reason for chronic kidney disease is taking unwanted medicines and over the counter medicines especially pain killers. We have seen many elderly people with joint pain, low back pain and muscle pain, they keep on popping one pill daily so that they feel comfortable. But this will continue for many many years and slowly they lose the kidney function and develop kidney disease and come to dialysis. So avoiding strong pain killer intake and then native medicines, hormone medicines go a long way in preventing chronic kidney disease. So most of the chronic kidney disease what we see in the general population is avoidable. But that cannot be reversible. Once they develop chronic kidney disease it cannot be brought back to normal kidney functions and also inexorably the kidney function will progress and they will develop the land up in chronic kidney disease and to end state disease and then to dialysis. So how long the kidney disease lasts and the kidney function lasts and when they develop dialysis and are difficult to tell. It depends upon the patient person to person how they are maintaining their BP and sugar diet avoiding other unnecessary medicines and avoiding further insert of the kidney and depends upon the kidney disease itself. Some disease progress fast rapidly and some disease progress very slowly. So for example diabetic kidney disease progress very fast. Somebody may be having diabetes for 20 years after they end of 20 years they develop kidney disease within 2 to 3 years they are on dialysis. So it depends on the kidney disease also and also how they maintain the kidney disease and then treatment what they continue how many frequent visits they see a doctor So it depends on many factors for the kidney dysprogration and the treatment for chronic kidney disease is maintain the BP. Once the chronic kidney disease develops we cannot decide to mention it is not reversible. Just maintain the BP less than 140 by 90 and if there is lot of protein in the urine target is still lower it comes to 130 by 80. So low BP maintain hemoglobin A1c at 7% and they have to take cholesterol tablets reducing agents and then they have to take aspirin and then vitamin supplements and calcium and phosphorus metabolism will be altered that has to be maintained and hemoglobin also comes down in patients with chronic kidney disease that has to be improved. So low hemoglobin chronic kidney disease patients is because of the hormone called erythropotin that is normally produced by kidneys the production comes on like diabetes is developing insulin production comes from pancreas same way the insulin is the hormone produced by pancreas so when the insulin production comes the patient will develop diabetes same way the hormone called erythropotin is produced by kidneys the production comes on patient with chronic kidney disease and they will develop anemia so this can be easily corrected with an external supplement of erythropotin injection and that has to be taken weekly once once in two weeks depending upon the response that will maintain the hemoglobin and correction of anemia by vitamin B supplement vitamin B 12 supplement iron and folic acid supplement has to be given prioritized and most of chronic kidney disease patients develop heart disease so there is a connection between kidney disease and heart disease so kidney disease may be the decreasing kidney function itself like the creatinine can go up from normally 1 it goes up to 1.2, 1.3 is also considered as chronic kidney disease means there is so much decreasing kidney function already happened so 20% kidney function the decrease can increase the creatinine by 0.2, 0.3 milligram so decreasing kidney function and then protein leak in the urine very minor protein leak in the urine called microalbumin or high B protein in the urine they all cause damage to the blood vessel and these blood vessel damage can cause heart disease so we have seen patients with young patient diabetics with kidney disease developing heart disease and come to the hospital and static 6 also proves all over the world the incidence of heart disease in kidney patients with protein in the urine or decreased kidney function it tend to 20 times normal higher than the normal population that means the patients developing chronic heart disease in the patient's kidney disease is quite high so one is you have to prevent developing the chronic kidney disease or once they develop chronic disease they have to take care of the heart also by the regular monitoring of the heart condition by doing ECG, echocardiogram and meeting the cardiologist weekly or yearly once in a year 2 years and see what is the heart condition and also along with that they have to maintain the BP, sugar take cholesterol reducing agents, aspirin so all this will go a long way in minimizing the incidence of heart disease another important reason another important organ that is involved with chronic heart disease is muscles and bones muscles become weak and bones become brittle and there are more prone to develop fractures with minimum trauma especially elderly just slip in the bathroom at home they will fall down and suddenly they see the fracture of the hip bone and spine is common this is because chronic kidney disease makes the bones weak so to maintain the bone health normal health they have to take calcium supplements vitamin D supplements and then parathrad hormone which is elevated that has to be controlled well and regular physical exercises and maintaining muscle strength and nutritious food all this will prevent easy fracture and then strengthen the bones and these patients are diabetic especially also develop neuropathy so neuropathy where they cannot the sensation for cold or hot temperature pain is all reduced and perception when they walk on this road or in the home the sensation what they get from the floor will all be less so more chance of developing tripping and falling so neuropathy is important contributor for developing fractures and also the pain what they get CKD patients because of muscle weakness and other things they get accentuated with neuropathy also so how to prevent neuropathy is maintain the blood sugar and good control HBI which is 1% will prevent development of neuropathy and even after develop neuropathy still maintain the blood sugar and there are many medicines available which can control the symptoms of neuropathy and these are some of the main organs which are involved in CKD and how to prevent and what treatment will explain to you and once a patient develop end stage CKD ultimately the choice will be either to go for kidney transplant or go for life long dialysis but the first choice should be always kidney transplant it completely rehabilitates the kidney functions but dialysis will give partial rehabilitation it will give back to the body only 20% kidney function but kidney function become 100% rehabilitation then by kidney transplantation if the donor is available in the family and financial is okay then the first of choice will be always kidney transplantation and people who cannot find a donor or they are not fit for transplant like for some people may be having stroke malignancy liver disease heart disease which is not treatable so elderly and some people are very happy with dialysis they don't want to take chance of kidney transplant so for him we will put them on dialysis and whenever they find donor after few years also they can undergo transplant nowadays the brain dead kidney transplant program is also becoming more active in India and also in Karnataka so more and more people are coming forward to donate their organs after death and the kidney transplant program increases means the waiting period of the kidney transplant comes down