The body undergoes chemical changes when it is afflicted with a kidney disease which affects hormones, circulation, energy level and nerve function. Meanwhile, physical changes may also make kidney patients feel less sexually attractive. For example, steroids cause water retention resulting to weight gain, acne and hair growth or loss. Surgical scars can also make patients insecure about their bodies. All these contribute to the loss of sexual interest and functioning.

Kidney Transplant and Dialysis Patients

There is also concern that sexual activity may harm the patient by interfering with dialysis access. However, health care professionals contend that as long as no pressure is applied on the access site that will cause damage, sexual activity should not be hampered. Meanwhile, patients who received kidney transplants should wait for the scars to heal before resuming sexual activity. It is best to consult with your doctor when you are uncertain.

In contrast to transplant patients, dialysis patients have more sexual problems because of fatigue and anemia. However, even transplant patients can have concerns because of factors like stress, age, relationship issues and physical conditions. Those on dialysis treatments should maintain their positive attitude on sex to decrease the chances of having severe sexual problems. Interest in sexual activity may return when the patient starts to feel better, physically and emotionally, as a result of the treatment. Sometimes, the interest is no longer there and couples may require the help of a professional sex therapist.

Physical and Psychological Sexual Problems

Health care professionals have these recommendations if the problem is physical in nature. Men who have difficulty maintaining an erection have the option of getting penile implant surgeries that place semi-rigid rods into the penis. Other options are: use of male hormones, use of oral and injectable medications and use of external suction devices. Doctors trained on impotence can provide all the information needed by the patient.

Meanwhile, women kidney patients may suffer from vaginal dryness and pain during sexual activity. Dryness is caused by lower hormone levels. This can be addressed by changing the blood pressure medicine or with extra hormones. Meanwhile, pain associated with intercourse can be addressed with the use of a water-soluble vaginal lubricant. Patients are advised against using petroleum jelly because it may increase the risk of infection. Again, doctors can provide the information on available options.

If the problem is psychological, relaxation and physical exercises will help control anxiety towards sexual function. Kidney failure gives a person a lot of negative emotions like anxiety and depression which cause decreased sexual interest and functioning. These emotions also drain a person’s energy. If relaxation and physical exercises do not help, sex therapy is an option. However, some of the options given for physical sexual problems may also help even if the problem is psychological.

Problems such as low sexual interest, reaching climax too early or too long, painful intercourse, and erection challenges can be addressed by the sex therapist. When sex therapy is sought as a solution, sexual education for the patient or for both partners is the first step. This is followed by communication exercises to help the couple relate better to each other. Stress reduction activities such as relaxation techniques like meditation or yoga may also be recommended. The sex therapist may further introduce ways of improving skills on how to give and receive pleasurable touches. Look for licensed sex therapists with backgrounds in psychiatry, psychology, social work or is a physician.

Purva Karma

There are three phases to the Ayurvedic kidneys cleanse which is recommended at least once a year. The process takes about three weeks to complete. The cleanse starts with Purva Karma, the initial stage which prepares both the body and the mind. This initial phase requires modification of the diet three weeks before the cleansing. All stimulants like coffee and sweets, including dairy, are removed from the diet. A week before starting the cleansing process, the diet should largely comprise seeds and vegetables. A good stew recipe for this diet is Kitchari, made from rice, lentils or mung beans, onions and vegetables, ginger and garlic. To prepare the mind, meanwhile, means to take time off from daily regular activities in order to meditate. This may mean going for a stroll in the park or simply just having an “alone” time to practice deep inhaling that will clean the body of any opposing and destructive energy.

Pancha Karma

The next phase is the Pancha Karma or the cleansing phase itself consisting of cleansing, enemas and laxatives. Enema kits and laxatives may be purchased from any local pharmacy. Through Pancha Karma the body eliminates Dosha (toxins). There are many subtypes of therapies and herbal massages under Pancha Karma that would include Basti (medicated enemas), Vamana (emesis through herbs), Virechana (purgation through herbs), Nasya (nasal administration of oils). These therapies eliminate deep-seated toxins from the body.

Plain Kitchari Recipe

For the 3-day cleansing, you should only consume Kitchari and nothing else. Kitchari should be made fresh every day and can be re-reheated as much as needed to ensure that the meal is full of prana (energy). Wait for genuine hunger before going on the next meal. This means each meal should be taken between 3-4 hours. Though there are a variety of ways of making Kitchari, here is a recipe to follow for plain Kitchari. You will need ¼ cup basmati rice, ¼ cup mung beans, 1 cup water, 1 tablespoon yogurt or kefir, pinch of sea salt, 1 tablespoon butter or ghee. Mix rice, beans, water and yogurt in a pot and soak for 24 hours. In cooking, bring to a boil then turn heat to lowest setting for 35-40 minutes. Add salt and serve with butter or ghee. For variety you might add either cilantro or parsley to your Kitchari.

During the cleansing phase massage your body every morning with oil appropriate for your skin type followed by hot shower. This helps in eliminating toxins from the body. Use a neti pot (for nasal irrigation) and tongue scraper daily. For your psyche, you can read, be creative, listen to quiet and soothing music or do some gardening. Avoid loud music and television. Take time to meditate, do some yoga or go on a nature walk. Enough rest is necessary if the cleansing process makes you tired.

Rejuvenation

The last part is the Rejuvenation phase which lasts for about a week. This is where you slowly return to your regular Ayuverdic diet (rice, vegetables and spices like coriander, turmeric, ginger and cumin). Continue with regular meditation to ensure the rejuvenation of the psyche. Coming out of cleansing can be emotional that it is recommended that you should take time off from work for this last phase.

Basically, the kidneys filter 200 liters of blood daily to remove toxins, waste and water and produce urine. But do you know that the kidneys also produce a hormone which stimulates the production of red blood cells? This hormone is called Erythropoietin. The kidneys also produce hormones that help regulate blood pressure and the metabolism of calcium. Additionally, the kidneys help maintain the chemical balance of salt, potassium and acid.

Even though anyone can get Chronic Kidney Disease, there are certain groups of people who are more likely to develop the disease. These would include: African Americans, Hispanic Americans, Asians, American Indians and Pacific Islanders. Diabetes is more common in these groups and have an inherited tendency to develop CKD. African Americans, meanwhile, have higher incidences of high blood pressure.

Those who are older, have diabetes, have high blood pressure or have a family member who has chronic disease are also most likely to develop kidney diseases. Diabetes and high blood pressure are the leading causes of CKD. Diabetes damages the kidney’s filters causing protein to leak into the urine. On the other hand, HBP increases the pressure on the walls of blood vessels resulting to kidney disease, strokes and heart attacks.

Diagnosis and treatment can slow down CKD progression. Early detection is critical for CKD because physical symptoms do not appear until the end stages, or stage 5 where dialysis or kidney transplant is needed. This is the reason why kidney disease is known as the “silent killer.” Pain is not common with kidney disease, but lower back pain may result from kidney stones, blockages and infections. It is best to consult with your doctor when you have similar symptoms for proper diagnosis.

Upon detection or diagnosis, a change of lifestyle is necessary to slow down the progression and prevent kidney failure. A person diagnosed with CKD has to equip himself with knowledge and therefore know the risks and steps on how to prevent kidney failure. A diet low in salt, sugar, fat and protein is helpful for a person with CKD. Regular exercise also helps.

There are three simple tests to check for kidney disease. These are checking for HBP, having a urinalysis, and checking the Glomerular Filtration Rate (GFR). You have HBP when your blood pressure is 140/90. The target blood pressure for persons with diabetes or CKD is less than 130/80. Meanwhile, urinalysis checks the urine sample for protein, red blood cells and white blood cells. Too much of any of these may mean kidney disease because these three are not normally found in urine. The GFR tests shows how well the kidneys are working to remove wastes from the body and is the best way to check kidney function.

In children, HBP is common among those who are overweight, African American, have CKD and have a family history of high blood pressure. When children are found to have HBP, parents should ensure that they get checked for kidney diseases as these may be an underlying cause. These include: inherited Polycystic Kidney Disease (PKD); Focal Segmental Glomerulosclerosis (FSGS) – referring to damage in the filtering units of the kidneys; and Hemolytic Uremic Syndrome (HUS), which affects the blood and blood vessels; and problems that block urine flow in the urinary tract.

Parents should remember to measure their child’s BP by using a blood pressure cuff that covers 80-100% of the circumference of child’s arm. There is also special equipment designed for infants and newborns. BP reading for children is similar to that of adults where there is the systolic BP (top number) and the diastolic BP (bottom number). As a person gets older and gains more weight his BP also increases. This means that a normal BP for children would be lower than the normal level for adults. A doctor’s pronouncement of HBP should be based on at least two blood pressure checkups. The normal level for children should be less than 130/80. Your child’s doctor can tell you the target BP for the child.

When your child has been diagnosed with both CKD and hypertension it is important that a doctor specializing in both diseases for children get involved in his/her care and treatment plan. The treatment may be a combination of lifestyle changes and taking blood pressure pills for children. The pills would include angiotensis converting enzyme inhibitor (ACE) or angiotensis receptor blocker (ARB). Studies have shown that these drugs also protect kidney function. Water pills may also be given to children who have water and salt retention. Most children with CKD need more than one medicine. Your child’s doctor will adjust the dosage base on his/her age and weight. As for lifestyle changes, an overweight child needs to lose weight, slow down snacking on salty foods like chips, and exercise regularly.

Your child’s BP should be checked every time you visit the doctor. Other important tests for the kidneys include: Glomerular Filtration Rate (to see if the kidneys are functioning properly); and urine protein level to determine if the CKD is getting worse. It also detects the development of heart and blood vessel diseases.

Gout occurs with the buildup of uric acid in the joints and kidneys. While Uric acid is a normal waste product that dissolves in the blood and is passed out of the body through urine, extra uric acid that is not passed out of the body crystallizes and causes gout. To prevent gout attacks the uric acid should ideally remain below 6.0 mg/dL. A condition of having excess uric acid is called hyperuricemia.

Food and drinks that mostly contribute to gout attacks include seafood, red meat, organ meat, high-fructose corn syrup, sugar-sweetened items that are usually popular during the holidays and beer and liquor. Those with high blood pressure, obese, have high blood sugar and high cholesterol may have higher levels of uric acid that leads to gout. Just as gout can cause kidney diseases and kidney failure, the latter can also cause the gout. Other causes are severe illness, stress, hypothyroidism and physical exertion.

Uric acid crystals that are not passed out of the body become large stones that can permanently damage the kidneys in two ways: first by obstructing the passing of wastes and causing infections; and second by wounding the kidneys with the stones’ sharp edges. These can both lead to CKD or kidney failure.

How do you eliminate gout attacks and kidney damage? You can prevent and even eliminate gout attacks by simply changing your lifestyle. High uric acid is caused by obesity and high blood pressure. If you eliminate the causes for these two you are most likely to be free from gout attacks. This would mean consuming a healthy diet of fruits and vegetables, whole grains and low fat dairy products. As mentioned above sugar-sweetened foods and drinks like soda and sugared juices, or those with high fructose syrup should be avoided. Beer and alcoholic beverages should be limited, along with meat and fish – especially shrimp and lobster. Crash diets which make the uric acid harder to dissolve should also be avoided. It is recommended that we drink at least 64 ounces of water daily to minimize the risk of stones forming in the kidneys.

You can monitor how you’re doing by recording your weight, blood pressure, gout symptoms and the causes or triggers for the gout attacks. You will be able to point out the causes of your problems through this record with the help of your doctor. It is also important to strictly follow the treatment plan outlined by your doctor.

However, those who have second thoughts about their treatment plans have the right to seek a second opinion. Patients have the right to be informed about all treatments available, including the alternatives that they have. The other times that patients seek second opinions would be: when they are advised to undergo surgery; when they are diagnosed with cancer; when they do not agree with the treatment plan made for them; and when they are dissatisfied with the health care management they receive from their doctors.

Ideally patients with chronic kidney diseases should have a treatment plan that would consist the following: blood testing, medicines, dietary advice, and physical activities advice.

Most of the time, however, physicians are more interested in giving prescriptions to treat specific symptoms rather than looking at the overall wellbeing of the patient. Patients are also most likely to get prescriptions from drug companies which the doctor have good relationships with. Although these are unethical medical practices, they seem to be the norm. So while a health care professional has all the good intentions in the world of treating patients, he seems to be functioning within these values system that patronize drug companies.

However, as mentioned at the start, patients have an option. If there is any doubt about the treatment plan, diagnosis or surgery,patients have the right to see other doctors.

Things CKD patients should remember when seeking second opinion

Patients should bring their medical records with them for re-assessment. They should also bring all their blood test results and prescriptions. Doctors who see patients for re-evaluation will check these when they make an alternative treatment plan. Don’t be afraid or intimidated to ask doctors questions about the alternative treatment plan they have for you and why they think it will lead to a better prognosis for your health.

Make sure your plan includes the following: blood work, lifestyle advice (diet and exercise); alternative prescriptions, including frequency and purpose; notepad for patients to make notes of their treatment preferences and to list questions for the next appointment.

Visit us today at 257/6 Vij Nagar, near Kishanpura Chowk, Jalandhar City, Punjab. You may also call us to book appointments at 91-9877-000888 or 91-9417-695200.

Looking forward to helping you in the journey back to good health!

How can the use of analgesics hurt the kidneys? The long term use of ibuprofen, naproxen sodium and other higher dose aspirin can cause chronic interstitial nephritis. For this reason, over the counter (OTC) pain relievers should not be used for more than 10 days and fever reducers for more than three days. This is clearly indicated in the warning labels of OTC analgesics. OTC analgesics include aspirin, acetaminophen, ibuprofen, naproxen sodium and ketoprofen.  Prescription analgesics are also available, and are usually stronger than OTC ones.

Additionally, analgesics and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) have been known to contribute to gastrointestinal bleeding and stomach ulcers. The use of NSAIDs also increase the risk of heart attack and stroke. NSAIDs are a group of pain relievers that include ibuprofen, naproxen sodium and ketoprofen.

It is strongly recommended that analgesics be used as prescribed by your doctor, or as stated on the label for OTC drugs; they should be taken at the lowest dose; and used for a short period.

Those with reduced kidney functions are not recommended to take higher dose aspirin and NSAIDs. If necessary, kidney patients should take NSAIDs under a doctor’s care. NSAIDs also have contra-indications for people with heart disease, liver disease, high blood pressure and those over 65. These pills increase the risk of kidney failure and cause progressive kidney damage.

Meanwhile, acetaminophen is the recommended analgesic for kidney patients. Aspirin is not recommended because it acts as a “blood thinner” and may cause bleeding complications. Patients on regular acetaminophen use should be supervised by their doctors. Alcohol should be avoided while on this medication.

The good news is kidney disease caused by the use of analgesics is PREVENTABLE! Here are some guidelines on how to use analgesics without harming your kidneys: Remember what was earlier said about prolonged use? Well OTC analgesics should not be used for more than 10 days for pain, and more than 3 days for fever. Drink at least eight glasses of fluids daily when taking analgesics, and avoid drinking alcohol. Analgesics with a mixture of painkillers and caffeine in one pill should be avoided. These can drastically damage the kidneys. Read the warning labels for all OTC analgesics. Those with underlying medical conditions like high blood pressure, kidney or liver diseases should take NSAIDs under the doctor’s care.  Last but not least, your doctor should be aware of all the medications you’re taking.

As Health Canada revises its food guidelines on introducing iron for babies as young as 6-months-old we take a look at the importance of this mineral on everybody’s health, especially to those with Chronic Kidney Disease (CKD).

Maintaining a healthy iron level is important for everybody because low levels lead to anemia. Iron helps make healthy red blood cells that carry oxygen from your lungs to all parts of the body. Anemia is caused by low red blood cells (RBC) count. A person with this illness would look pale, is usually weaker, have chest pains, faster heart beats, feel light headed, is more tired than usual and is depressed.

The kidneys make erythproprotein (EPO) that gives the signal to the body to make red blood cells. CKD diminishes the capability of the kidney to produce EPO which causes the RBC count to deplete and in turn develop into anemia. Some doctors prescribe erythropoiesis-stimulating agents (ESA) to help the EPO.  When this happens (ESA prescription) more iron is needed to help the EPO.

Measuring Iron Levels 

To measure the iron level of your body you need to know your hemoglobin level, which is made up of iron and oxygen. For women, the normal hemoglobin level is 12.0 and for men, it is at 13.5. A person’s iron level can also be measured through the transferrin saturation (TSAT) and ferritin tests. Normal TSAT level is at least 20 percent, while normal ferritin level is at 100 ng/ml. Doctors recommend the monthly testing of iron levels until the normal hemoglobin level is reached. When the target hemoglobin level is reached testing every three months is recommended.

Recommended Treatments for Low Iron

Your doctor will make a treatment plan if you have a low iron level. He will more likely recommend increasing your intake of iron-rich foods such as eggs, leafy green vegetables and red meat such as steak and tofu. A dietician can help develop meal plans suitable for your CKD condition. Another option is for your doctor to prescribe iron supplements either in tablet or liquid form, or prescribe a multivitamin and mineral supplement that has folic acid, iron and vitamin B. A third option is for your family physician to inject iron medicine into your vein. Just remember that iron supplements ingested by mouth may affect other medicines you are taking so always consult with your doctor or dietician for any contraindications.

There is continuous research for new medications to help iron deficiency in people with CKD. If you come across new treatments always make it a point to consult with your physician before taking any new supplements that are out in the market.

Although more fats and carbohydrates seem to look like an “unhealthy diet,” it will protect you from malnutrition when you’re at the initial stage of kidney failure. Following a special diet will also help control waste products in the blood during the later stages of kidney failure. A renal dietician recommended by your nephrologist can help you draw meal plans.

Protein, phosphorus and sodium intake need to be monitored and controlled at the early stage of the disease.

Large amounts of protein is found in poultry, meat, seafood, eggs, milk and cheese while smaller amounts are found in plant sources like cereals, breads, grains, fruits and vegetables.

Protein is a vital component in muscle building and repairing tissues. Unused protein becomes waste called “urea,” which an impaired kidney will have difficulty of eliminating.  A build up of urea is toxic to the body which is why the protein intake of those in the first stage of kidney disease should be closely monitored.

Meanwhile, there is also a need to keep track of the phosphorus level in your blood since an impaired kidney has difficulties in cleansing high levels of phosphorus. A high level of phosphorus leads to calcium loss from the bones, making them weak and brittle. The right renal diet keeps track of your phosphorus intake.

The following foods have high phosphorus content: cocoa, beer and pop, nuts and peanut butter, milk, yogurt, yogurt, ice cream and pudding, dried beans and peas and lentils.  To lower phosphorus intake it is recommended that you use milk substitutes and non-dairy creamers.

It is common knowledge that too much sodium or salt is bad for the health. This is the reason that even in preserving foods, salting is less likely to be recommended compared to drying or freezing. Too much consumption of sodium causes high blood pressure and kidney diseases.  To stay on track avoid the consumption of the following: canned goods, fast foods, table salts, chips, soups and processed cheese, pickles, smoked and cured foods like spam, luncheon meat, ham and the all time breakfast favorite – bacon.

A low-protein diet means that higher calorie consumption is needed to maintain energy. A renal dietician may recommend the following: increased saturated fats such as olive oil and mayonnaise type salad dressings, sugar or sweets like jam or jelly, honey, marshmallows, jelly beans, gum drops, canned fruits and frozen fruits.  Those who are diabetic or obese should consult with their dietician.

Altering your diet may be difficult but it is essential in slowing down the loss of kidney functions. It will also be beneficial in the later stages of the disease.*

So what are lipids? They are simply the fats in the bloodstream of your body. The common type is called cholesterol which the body makes and comes from foods like meats, poultry (eggs and chicken), and dairy (milk, cheeses, ice cream). Fruits, vegetables and grains are cholesterol free. Teenagers should keep in mind that there are good and bad cholesterols.

There are three major types of lipids: Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) and the triglycerides. LDL is considered the bad cholesterol and is most likely to clog blood vessels and prevent the smooth blood flow in the system. HDL, on the other hand, is the good type of cholesterol which transports cholesterol away from the heart and blood and then back to the liver. From there, the cholesterol breaks down and sent to different parts of the body. Meanwhile, triglycerides are the stored fat in the body. High triglycerides do not clog blood vessels but may lead to diabetes or high blood sugar and can cause pancreas disorder.

LDL builds up in the blood results to the formation of plaque (fatty deposits) in the walls of the arteries. Plaque makes the arteries thicker, harder and narrower which decreases blood flow. Hardening of arteries
in the heart leads to a heart attack or stroke.

People should always maintain a healthy level of cholesterol to prevent hardening of the arteries, high blood sugar or disorder of the pancreas. For teenagers the healthy levels of lipids are the following: total cholesterol is less than 200, LDL is less than 130, HDL is above 40, triglycerides are less than 150.  Doctors measure blood lipids through tests.  Haemodialysis patients are advised to have the lipid tests before dialysis while peritoneal dialysis patients are advised to
have the test in the morning. Another way to checks for healthy lipids is through the non-HDL test where the doctor subtracts the HDL from the total cholesterol. Lipids should be checked yearly or about 2 -3 months after a change in
treatment.

Unhealthy lipids are caused by obesity, history of cholesterol problems or heart disease, diet high in saturated fats and cholesterol, not having enough exercise and excessive alcohol. To improve unhealthy levels just do the opposite of everything that’s causing it! Lose excess weight, follow a low-fat and low cholesterol diet, exercise regularly and minimize alcohol intake.

Teenagers will find it helpful to discuss what they have learned about lipids with their parents, and keep the communication line open especially with CKD issues. It is never easy living with a disease, and it complicates matters when hormones are changing. But awareness is key to remain healthy and continue with activities you enjoy as a teenager.*