The ageing kidney
With an ageing population, kidney failure is on the rise due to lifestyle factors and age-related diseases like diabetes and hypertension. JUNE CHEONG reports
It is downhill all the way after the age of 40 - at least for your kidneys.
These two bean-shaped vital organs nestled under your ribcage, at the back of your waist, reach their peak efficiency when you are between 30 and 40 years old.
After that, they decline by 1 per cent every year.
In 2006, there were 3,774 patients with end-stage renal disease on dialysis in Singapore. In 2004, that figure was 3,403.
More kidney failures are likely.
Dr Jimmy Teo from the Singapore Society of Nephrology explained: 'As our population ages, there will be more people with kidney failure.'
Dr Teo is an assistant professor at the Yong Loo Lin School of Medicine at the National University of Singapore. Nephrology is the medical study of the kidney and its diseases.
As you age, so do your kidneys. That is why kidney damage and failure is associated with lifestyle and age-related diseases like hypertension and diabetes.
Dr Enoch Gan, a consultant urologist at Urosurgery Mt E in Mount Elizabeth Medical Centre, said the leading cause of kidney failure in Singapore is diabetes mellitus.
This is likely due to the high incidence of diabetes here, which is as high as 10 per cent of the population, he added.
The Singapore Renal Registry's 2004 report said diabetes caused 56.9 per cent of kidney failure cases. Hypertension and glomerulonephritis (inflammation of the kidney) were the other top causes, it said.
Dr Teo said: 'If you control hypertension or diabetes, you can prevent kidney damage. Control for those sufferers from these conditions is everything.'
When a person develops diabetes, the kidney tissue becomes damaged and starts to leak proteins into the urine. These proteins further damage the small tubes in the kidney called tubules.
In uncontrolled diabetes, blood sugar levels are high and this excess blood sugar causes reactions in proteins and cell components to form new molecules, which are harder for the body to remove.
Add hypertension to this dire picture and you get kidney damage which is exacerbated. Consistently high blood pressure over a long time damages the fine blood vessels of the kidneys' filtering mechanism.
When the kidneys malfunction, they are no longer able to fully carry out essential functions like filtering waste products for removal in urine, maintaining blood pressure and producing hormones to help the body make blood.
Every day, kidneys have to filter between 150 and 200l of blood. These organs also control the body's calcium, salt and water balance.
When a person's kidneys become diseased, these functions are interrupted, impaired or disabled.
Dr Gordon Ku of Ku Kidney & Medical Centre said: 'Waste material will accumulate in the blood. Water in the body can't be passed out as urine and accumulates in the skin.
'The person may develop swelling. Water can even go into the lungs and create a drowning effect on dry land.'
Accumulated waste in the body can affect the stomach, giving rise to nausea and vomiting. Even the heart and brain can be affected.
Dr Ku said: 'Too much waste material can affect the beating of the heart, making it faster, slower or even stop. When it affects the brain, the person will become more and more drowsy and may even fall unconscious.'
As diabetes and high blood pressure often lead to kidney disease, one cheap and effective way to prevent kidney failure is to check for diabetes and high blood pressure regularly.
Dr Teo said: 'People think spending hundreds of dollars on diabetes care is costly but if their kidneys become damaged due to diabetes, the cost is much higher.'
FIVE FACTS ABOUT KIDNEYS
1 The kidneys filter up to four million litres of blood in a lifetime.
2 An adult kidney spans between 10 and 13cm while a six-year-old's kidney measures 9cm on average.
3 A kidney transplant is the only cure for kidney disease or failure.
4 Most patients with kidney disease require dialysis, which involves the use of machines to perform the job of a normal kidney such as removal of waste products and regulation of salt and water.
5 Symptoms of kidney disease include fatigue, insomnia, loss of appetite, nausea, swelling of the face, arms and legs and numbness of the hands and feet. As the kidneys are unable to remove waste products efficiently, waste products accumulate in the body, resulting in the patient feeling physically and mentally tired.
The inability of the kidneys to regulate salt and water balance in the blood causes swelling in the face, arms and legs. Toxins can also damage the nerves and cause numbness in the hands and feet as well as impotence.
Your kidneys reach their peak efficiency when you are between 30 & 40 years old
The incidence of diabetes in S'pore is as high as 10% of the population
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