Kidneys are the most critical organs of the human body, silently performing their tasks. Kailash Yagnik, Vice President – Strategy, Marketing, Sales Operations, Siemens Healthineers India, gives an insight on how early and accurate diagnosis of abnormalities can prevent possible damage to the kidneys
Sushma Swaraj, External Affairs Minister, had undergone a kidney transplant surgery in December last year, and was away from the Parliament for almost four months. She was suffering from diabetes and after kidney failure diagnosis was put on maintenance dialysis. Just like Swaraj, Chronic Kidney Disease (or CKD) affects one in 10 people worldwide.
CKD is the eighth major cause of deaths in India and 17th worldwide. Besides, the fact that it is incurable, makes it incumbent on the caretaker to provide the patient lifelong care, facilitate dialysis and eventually a transplant. However, donors are hard to come by. It is therefore imperative to achieve early detection and commence treatment.
Early and accurate diagnosis of CKD and other kidney disorders has been a challenge for some time now. However, the technology spotlight on kidney diseases has introduced new ways to help cease a possible damage to the kidneys, via timely diagnosis.
The silent performers
Kidneys are complicated but vital organs that perform many essential tasks like maintaining haemostasis to keep a human body healthy. As a result, a medical condition that damages blood vessels or other structures in the kidney can lead to CKD. Hence, high blood sugar levels (diabetes), hypertension and obesity are all major contributors for the increase in instances of CKD. Other factors include kidney infections, blocked renal artery and long-term usage of certain medicines. Some of the common causes are high blood sugar levels and uncontrolled high blood pressure, which damage the vessels in the kidney, gradually leading to the disease.
Obesity, being a major contributor to diabetes and hypertension, has direct impact on the development of CKD and End Stage Renal Disease (ESRD). CKD is more likely to develop in obese people including those with diabetes and hypertension. In fact, individuals affected by obesity have an 83 per cent increased risk of kidney disease.
According to The Lancet’s latest report, by 2025, it is believed that 18 per cent men and 21 per cent women will be affected by obesity worldwide, of which six per cent men and nine per cent women, will be affected by severe obesity. Recent studies have also shown that obese people have two to seven times more chances of developing CKD.
Novel ways of diagnosis
CKD is largely preventable if it is detected and treated in the initial stages. Early screening for the disease is important, since a person can lose up to 90 per cent of their kidney function before experiencing any symptoms. Luckily, over the years, detection and monitoring of CKD has become comprehensive and detailed. Diagnosis of CKD is now possible through classical clinical findings, supported by laboratory and imaging studies.
Elevated levels of albumin in urine provide an early warning sign that the kidneys are not functioning properly. Screening for increased urinary albumin excretion can be performed by measuring the albumin-to-creatinine ratio (ACR) in a random spot collection. Ratios utilising creatinine account for the variability of urine concentrations, ensuring the accuracy of untimed specimen collections. The analysis of a spot sample for the ACR is strongly recommended by most authorities. The other two alternatives (24-hour collection and timed specimen) are rarely necessary1.
Siemens Healthineers was instrumental in offering ACR testing at the point-of-care by introducing CLINITEK Microalbumin-2 urine strip and is offered on our central lab instrument, the CLNITEK Novus analyser. Our ACR test can detect kidney disease at the earliest stages even for albumin sensitivity as low as 10 mg/L and can provide results in one minute, which further enhances the decision making steps for the treating physician.
CT scanning of kidneys has always been a challenge in the industry. It is very critical to perform a CT scan by reducing the contrast dose. Contrast media dose reduction means preventing contrast-induced renal toxicity, expensive preparations and after care. With conventional CT scanners, the challenge of high doses and vague results hampered early detection in kidneys. Siemens Healthineers was the first to introduce kidney friendly scanning2 in the industry. We introduced the high-end fastest scanner that provides substantially optimized dose efficiency, resulting in more accurate imaging of a growing number of high-risk, asymptomatic individuals.
Up to 20 per cent of patients presented to the radiology departments suffer from renal insufficiency. The high-end CT scanners enable radiologists to routinely perform exams at 70-90 kV, even in adults, substantially reducing the contrast media needed and thus optimising the entire clinical procedure. These techniques do not require medication or preparation before a CT scan and little after care, resulting in significant improvement in clinical results and huge savings for hospitals.
Imaging of kidneys using MRI technology has significantly added value in management of kidney diseases. NATIVE3 (Non-contrast MRA of ArTerIes and VEins) is a contrast-free MR angiography technique for visualising the vessels of the body, for e.g. renal arteries.
Creating awareness on CKD
Education and awareness on the risks of obesity, diabetes,
hypertension, and other factors, which lead to CKD, can dramatically help in preventing kidney diseases. In some countries, free public screening of kidney diseases is done to prevent CKD, whereas in others public awareness camps are set to educate people on kidney health.
Given the vulnerabilities of obese people and kidney diseases, the growth and development of a nation is often compromised. In some nations, one out of three people is obese, which contributes significantly to overall poor health and rising medical costs. Therefore, this year, the recently concluded World Kidney Day (March 9) was dedicated to promoting awareness about the harmful consequences of obesity, and its association with kidney diseases. Efforts were made to promote healthy lifestyles, the in-vivo and in-vitro solutions from Siemens Healthineers and share measures that make prevention of CKD possible, so that the unsung heroes can continue to keep human body healthy.
References:
1. Standard of Medical Care in Diabetes, America Diabetes Association Position Statement, Diabetes Care, Volume 27, Supplement 1, January 2004.
2. Siemens Healthineers was the first to introduce kidney friendly scanning in the industry with its SOMATOM Force CT scanner, which is also the world’s fastest CT scanner.
3. NATIVE is an MRI application introduced by Siemens Healthineers