Rohit Shishodia

Dr (Prof) AK Bhalla is the chairman and Head of the Department of Nephrology, at Delhi’s Sir Ganga Ram Hospital. He is awarded Padma Shri by the President of India and is a BC Roy National awardee.

His area of special interest has been the development of Peritoneal Dialysis as a modality of renal replacement therapy in India. After receiving special training at Singapore General Hospital in 1994 in this area, he pioneered the treatment in India and is a founding member of the Peritoneal Dialysis Society of India.

While sharing his views on rising cases of Chronic Kidney Diseases in India, Dr Bhalla raised an important point about the craze of bodybuilding among youngsters who unknowingly consume excessive protein, especially in the form of supplements for sake of having an attractive physique.

Here are the excerpts…….

DTMT: It has been observed that CKDs are rising among youngsters. Please tell our readers the reasons behind this phenomenon.

Dr AK Bhalla: We are getting a lot of young patients, who consume high protein in gyms, with complaints of kidney problems.

They eat eight to ten eggs with white portions and take protein powders in substantial quantities. They also take anabolic steroids with the hope to develop an attractive body.

These things contain so much protein that the kidneys get damaged. This should be taken very seriously and a strong message should be sent that protein intake should be banned in gyms. We get three new patients between 15 to 25 years of age every month.

DTMT: There are long queues in government hospitals for getting registration for the treatment of kidney diseases. How do you assess this situation?

Dr AK Bhalla: Yes you are right. Cases of Chronic Kidney Diseases are increasing in India. CKD is one of the rising diseases among all non-communicable diseases. There are different causes behind rising CKDs.

The most common factor behind rising CKDs is hypertension and diabetes. The other cause is unhealthy life, which includes obesity, intake of high carbohydrate food, salt, fried food and oil.

Air pollution, water pollution, pesticide and toxin and heavy metals including consuming Bhasam (ash obtained through incineration) damages the kidney.

One in ten Indians is suffering from CKDs while in big cities one in four Indians suffer from CKDs. The situation is very grim in the country as around 2 to 2.5 lakh new kidney patients report every year in India; few of them get treatment while many are left without treatment.

DTMT: What are the early signs and symptoms of CKDs?

Dr Bhalla: Swelling on the face and legs, foam in the urine, frequent or less urine, yellowish skin, low haemoglobin count, low appetite, tiredness, lack of sleep at night, feeling sleepy in day and pain in bones are symptoms of CKDs.

DTMT: What are preventive measures?

Dr Bhalla: Blood pressure should remain in control. People generally ignore their level of blood pressure. Even the general physician does not check blood pressure.

Every diabetic and high blood pressure patient should be screened for kidney disease. He or she should get his urine checked. Glomerular filtration rate (GFR), and creatinine levels should be monitored regularly. Ultrasound can also be done to check the function of the kidney.

DTMT: When does the kidney start damaging and what should be the ideal range of creatinine?

Dr Bhalla: Normal creatinine range is 0.5 to 1.2. If the level crosses 1.2 when fifty per cent of the kidney is damaged, which is very unfortunate. The creatinine does not increase till fifty per cent of the kidney gets damaged. An estimated glomerular filtration rate (EGFR) is recommended for kidney function tests.

DTMT: How does CKD affect our urine system?

Dr Bhalla: There could be both more or less urge to pass urine. There could also be blood and pus in the urine. Usually foaming during urinating means protein discharge is taking place.

DTMT: Which groups of people develop stones in the kidneys?

Dr Bhalla: Brackish water, genetics, coupled with high intake of red meat in the diet are major contributors to developing stones in the kidneys, especially in North India which is also come to be known as 'Stone Capital'. Calcium and uric acid stones are some of the common forms of kidney stones. Kidney stones do not cause pain and they can lie in the kidneys for years. It only pains when they progress to the pipe. It is immediate to remove stones when they travel to pipes.

DTMT: Who is more at risk of developing kidney disease?  

Dr Bhalla: Anyone from the age of one month and above can suffer from CKDs. Different CKDs develop at different ages. Most patients after thirty and fifty years of age with hypertension and diabetes come with CKDs.

DTMT: How does hypertension affect our kidneys?

Dr Bhalla: Arteries of our kidneys get affected due to constant blood pressure. It results in the development of abnormal cells due to high blood pressure, which affects filtering units of the kidney, causing low blood supply and they get damage and resulting in losing their functioning abilities.

DTMT: Why hypertension is increasing among youngsters?

Dr Bhalla: High intake of salt, coupled with eating processed food like chips, patties, namkeens, bhujia, papad and achar is one of the primary reasons behind this. We should control the intake of salt. We should not consume salt more than five grams in a day under any circumstance. The ideal salt intake should range between two to three grams a day.

DTMT: Which diet should be taken to prevent kidney diseases?

Dr Bhalla: Healthy lifestyle is very important. I would tell you eight standard rules for maintaining good kidney health. You should keep yourself fit and active with a forty-five minutes walk.  Control your blood sugar and control your blood pressure. Eat healthy food with a low salt intake. Don’t eat more than two to three grams of salt in a day. Maintain ideal Body Mass Index. Quit smoking and stop over-the-counter medicine. Get early detection of kidney diseases for those who have a family history and have high BP and diabetes. These steps can prevent further damage to CKDs.