Control blood sugar to prevent kidney disease and other complications

Health Care, Heart Care Foundation of India, Medicine Comments Off

GFR below 10 indicates kidney failure

New Delhi, 16 March 2019: There are about 72 million people with diabetes in India and these numbers are expected to increase to 134 million in the next few years. Nearly a third of people with diabetes develop kidney complications after 15 to 20 years. It is the most common cause of chronic kidney disease and kidney failure in the world. Uncontrolled diabetes can hamper many organs and the kidney is one of the most seriously affected.

Chronic kidney disease or CKD is characterized by a gradual loss of kidney function over time and may eventually lead to kidney failure, causing patients to undergo dialysis or a kidney transplant. The signs and symptoms are not noticeable until the disease is fairly well advanced, and the condition has become severe. By this time, most of the damage is irreversible.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “Kidneys help in filtering out the excess waste and fluid material from the blood. They can eliminate most of the waste materials that our body produces. However, when the blood flow to the kidneys is affected, they cannot work properly. This can happen due to some damage or disease. Problems can occur even when the urine outflow is obstructed. At an advanced stage of CKD, dangerous levels of fluid, electrolytes, and wastes can build up in the body. Those with underlying conditions such as diabetes, high blood pressure, cardiovascular disease, abnormal kidney structure, and a family history of the disease are at more risk. Additionally, those who smoke and are obese can also be potential candidates for CKD over the longer term.”

Without treatment, kidney disease often gets worse. If your GFR drops below 15, you may feel tired and weak, with nausea, vomiting and itching. By that point, you may need a kidney transplant or dialysis.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “If you have these risk factors, it is important to be screened for kidney disease. That usually involves simple laboratory tests: a urine test to look for kidney damage, and a blood test to measure how well the kidneys are working. The urine test checks for a protein called albumin, which is not routinely detected when your kidneys are healthy. The blood test checks your GFR—glomerular filtration rate. GFR is an estimate of filtering ability of your kidney. A GFR below 60 is a sign of chronic kidney disease. A GFR below 15 is described as kidney failure.”

Golden Rules to avoid or delay reaching the point of reaching kidney failure

  • Keep fit and active, as it helps reduce your blood pressure.
  • Monitor your blood pressure: It is also the most common cause of kidney damage. The normal blood pressure level is less than 120/80. A BP reading above 130/80 is high BP.
  • Keep your blood sugar levels controls as about half of people who have diabetes develop kidney damage.
  • Eat healthy and keep your weight in check as this can help prevent diabetes, heart disease and other conditions associated with chronic kidney disease.
  • Reduce your salt intake. The recommended sodium intake is 5-6 g of salt per day (around a teaspoon).
  • Maintain a healthy fluid intake: Traditional wisdom has long suggested drinking 1.5 to 2 liters (3 to 4 pints) of water per day.
  • Do not smoke as it slows the flow of blood to the kidneys. Smoking also increases the risk of kidney cancer by about 50%.
  • Do not take over-the-counter pills on a regular basis: Drugs like ibuprofen are known to cause kidney damage, if taken regularly.

West Nile virus: Another impending outbreak in India?

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Health Ministry takes stock of the public health measures for controlling West Nile Virus

A section of the media has reported that a seven year old boy from Malappuram District of Kerala is suffering from a West Nile Virus (WNV), a mosquito-borne disease, mostly reported in the continental United States.

Union Minister of Health and Family Welfare is closely monitoring the situation and has spoken to the State Health Minister of Kerala in this regard. He has directed for all support to be extended to Kerala in its prevention and management.

Secretary (HFW) held a meeting with Additional Chief Secretary Shri Rajeev Sadanandan, Kerala and reviewed the situation. The Health Ministry has dispatched a multi-disciplinary Central team from National Centre for Disease Control (NCDC). The Central team includes Dr. Ruchi Jain, RHO Trivandrum, Dr Suneet Kaur, Assitant Director, NCDC, Dr E Rajendran, Entomologist, NCDC, Calicut and Dr Binoy Basu, EIS Officer, NCDC. The team will support the State Health Authorities in managing the disease.

The Indian Council of Medical Research (ICMR) has also been alerted and a close watch is being maintained at Central and State level. There are no reports available so far for spread of this virus in other parts of the country… (Press Information Bureau, Ministry of Health and Family Welfare, March 14, 2019)

Facts about West Nile Virus

West Nile Virus is a member of the flavivirus genus and belongs to the Japanese encephalitis antigenic complex of the family Flaviviridae.
The virus was first isolated in a woman in the West Nile district of Uganda in 1937.
It is commonly found in Africa, Europe, the Middle East, North America and West Asia.
Presence of WNV was documented in north- eastern region of India during the year 2006 from four districts (Japanese encephalitis (JE) endemic areas) of Assam; in which 11.6% of serum samples of AES (acute encephalitis syndrome) cases were found positive for IgM against WNV (these samples were negative for IgM against JE virus). During an outbreak of AES in Kerala, in May 2011, presence of WNV was confirmed in clinical specimens. Since then, WNV encephalitis cases have regularly been reported in Kerala (National Health Portal of India).
The virus is maintained in nature in a cycle involving transmission between birds and mosquitoes. Humans, horses and other mammals can be infected.
Transmission: Humans acquire the infection through the bites from infected mosquitoes. The virus may also be transmitted through contact with other infected animals, their blood, or other tissues. Transmission may also occur through organ transplant, blood transfusions and breast milk. There is one reported case of transplacental (mother-to-child) WNV transmission. To date, no human-to-human transmission of WNV through casual contact has been documented.
Incubation period: 3-14 days.
Clinical features: West Nile virus infection may mimic either dengue or chikungunya like illness.
o The infection is asymptomatic in 80% of infected persons; in some cases, the infection may lead to West Nile fever or severe West Nile disease (also called neuroinvasive disease, such as West Nile encephalitis or meningitis or West Nile poliomyelitis).

o Symptoms of West Nile fever include fever, headache, tiredness, body aches, nausea, vomiting, skin rash on the trunk of the body (occasionally) and swollen lymph glands. Most people recover completely, but fatigue and weakness can last for weeks or months

o Symptoms of severe disease include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. Recovery might take several weeks or months. It is potentially fatal.

Diagnosis is by detection of IgM antibodies in CSF and serum specimens via IgM antibody capture ELISA, neutralisation assays, viral detection by RT-PCR assay, and virus isolation by cell culture. Serum IgM antibody may persist for more than a year.
Treatment is supportive for patients with severe infection which involves hospitalization, intravenous fluids, respiratory support, and prevention of secondary infections.
There is no vaccine available for humans.
Prevention: The most effective way to prevent infection is to prevent mosquito bites. Use insect repellent, wear long-sleeved shirts and pants, treat clothing and gear and take steps to control mosquitoes indoors and outdoors.