3. Lectured Delivered at 4 th World Congress On Alternative Medicines At Gujar Khan, District Rawalpindi Presented by H/Dr.Muhammad Abid Khan Chairman HART Welfare Society President PHEDO(Pb) H.M.O THQ Hospital Gujar Khan

4. The Kidneys The kidneys are paired organs with several functions. They are located behind the abdominal cavity in the retro peritoneum, approximately at the vertebral level T12 to L3.

5. The Nephron Nephron is the basic structural and functional unit of the kidney. Its chief function is to regulate the concentration of water and soluble substances like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest as urine.

6. Functions of the Kidneys The kidneys have the ability to monitor the amount of body fluid, the concentrations of electrolytes like sodium and potassium, and the acid-base balance of the body. Hence Kidneys play three major functions in the body: 1. Filtration of Wastes. 2. Fluid and Blood Pressure Regulation. 3. Stimulation of Bone Marrow.

7. Filtration of Wastes Kidneys filter waste products of body metabolism, like urea from protein metabolism and uric acid from DNA breakdown. Two waste products in the blood can be measured: blood urea nitrogen (BUN) and Creatinine (Cr).

8. Fluid and Blood Pressure Regulation When blood flows to the kidney, sensors within the kidney decide how much water to excrete as urine, along with what concentration of electrolytes. This system is controlled by Renin, a hormone produced in the kidney that is part of the fluid and blood pressure regulation systems of the body.

9. Stimulation of Bone Marrow Kidneys are also the source of erythropoietin in the body, a hormone that stimulates the bone marrow to make red blood cells. Special cells in the kidney monitor the oxygen concentration in blood. If oxygen levels fall, erythropoietin levels rise and the body starts to manufacture more red blood cells.

10. Kidney Failure When kidney function falls below a certain point, it is called kidney failure. Kidney failure can occur from an acute situation or from chronic problems. In acute renal failure, kidney function is lost rapidly and can occur from a variety of insults to the body. Chronic renal failure develops over months and years.

11. Causes of Acute kidney failure The list of causes of acute kidney failure is often categorized based on where the injury has occurred. 1. Prerenal causes (pre=before + renal=kidney) 2. Renal causes (damage directly to the kidney itself) 3. Post renal causes (post=after + renal= kidney)

12. Prerenal causes Prerenal Causes of Kidney Failure are due to decreased blood supply to the kidney. Examples of prerenal causes are: Hypovolemia (low blood volume) due to blood loss. Dehydration from loss of body fluid (vomiting, diarrhea, sweating, fever) Poor intake of fluids. Medication, for example, diuretics (water pills) may cause excessive water loss. Loss of blood supply to the kidney due to obstruction of the renal artery or vein.

13. Renal causes Renal causes include: Sepsis: The body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. Medications: Some medications are toxic to the kidney, including nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen.. Others are antibiotics like aminoglycosides, lithium, iodine-containing medications such as those injected for radiology dye studies. Rhabdomyolysis: This is a situation in which there is significant muscle breakdown in the body, and the degeneration products of muscle fibers clog the filtering system of the kidneys. Often occurring because of trauma and crush injuries, it can also be caused by some medications used to treat high cholesterol. Multiple Myeloma: Acute glomerulonephritis or inflammation of the glomeruli, the filtering system of the kidneys may also cause of acute kidney failure.

14. Post Renal Causes Post renal causes are due to factors that affect outflow of the urine: Obstruction of the bladder or the ureters can cause back pressure when there is no place for the urine to go as the kidneys continue to work. When the pressure increases enough, the kidneys shut down. Prostatic hypertrophy or prostate cancer may block the urethra and prevents the bladder from emptying. Tumors in the abdomen that surround and obstruct the ureter. Kidney stones

15. Causes of Chronic Kidney Failure The most common causes of chronic renal failure are related to: Poorly controlled diabetes Poorly controlled high blood pressure Chronic glomerulonephritis Less common causes: Polycystic Kidney Disease Reflux nephropathy Kidney stones Prostate disease

16. What are the symptoms? Symptoms of kidney failure may start only a few months after the kidneys begin to fail. But most people do not have symptoms early on. In fact, many do not have symptoms for as long as 30 years or more. This is called the "silent" phase of the disease. The symptoms of kidney failure are related to the changes occurring in the body due to malfunctioning of kidneys.

17. Symptoms of Kidney Failure High levels of urea in the blood, which can result in: Vomiting and/or diarrhea, which may lead to dehydration Nausea Weight loss Nocturnal urination Foamy or bubbly urine More frequent urination, or in greater amounts than usual, with pale urine Less frequent urination, or in smaller amounts than usual, with dark colored urine Blood in the urine Pressure, or difficulty urinating

18. Symptoms of Kidney Failure In kidney failure the kidneys produce less erythropoietin resulting in fewer red blood cells being produced. As a result the blood carries less haemoglobin, which is known as anemia. This can result in: Feeling tired and/or weak Memory problems Difficulty concentrating Dizziness Low blood pressure

19. Symptoms of Kidney Failure A build up of phosphates in the blood that diseased kidneys cannot filter out may cause: Itching Bone damage Muscle cramps (caused by low levels of calcium which can cause hypocalcaemia) A build up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause: Abnormal heart rhythms Muscle paralysis

20. Symptoms of Kidney Failure Failure of kidneys to remove excess fluid may cause: Swelling of the legs, ankles, feet, face and/or hands Shortness of breath due to extra fluid on the lungs (may also be caused by anemia) Polycystic kidney disease, which causes large, fluid- filled cysts on the kidneys and sometimes the liver, can cause: Pain in the back or side Other symptoms include: Appetite loss, a bad taste in the mouth Difficulty sleeping Darkening of the skin

21. Diagnosis of Renal Failure In presence of above mentioned symptoms root cause of the disease should be traced out first of all. For this purpose it is necessary to check: Blood Pressure Blood Sugar Urine R/E Hemoglobin level ESR (Erythrocyte Sedimentation Rate)

22. Diagnosis of Renal Failure To conform the kidney function, following tests of Blood are necessary: RFT (Renal Function Test) In RFT values of followings are measured: UreaNormal Range 10 – 50 mg/dl CreatinineNormal RangeUp to 1.1 mg/dl BUNNormal Range4.6 – 23.4 mg/dl Increased values of Urea, Creatinine and BUN in blood show malfunctioning of kidneys. In Creatinine Clearance Test (CrCl) 24 hours urine of a patient is collected and total amount of Creatinine excreted by the kidneys is measured. This test also helps to estimate the working capacity of kidneys.

23. Treatment of Renal Failure Chronic kidney disease is usually caused by another condition. So the first step is to treat the disease that is causing kidney damage. Other then medicines, management of Kidney Failure include: Dialysis Kidney Transplant In Homeopathic way of treatment following medicines may be used, according to their symptoms, to improve the function of kidneys. Serrum Angulia Apis Berberis Velg Canthris Hydrengia Sarsprila Uva Ursi Apocynum Canb