World Kidney Day 2019: Chronic kidney disease and acute kidney injury are the contributors to increased morbidity and mortality from other risk factors and diseases like diabetes, hypertension, cardiovascular disease, obesity as well as infections like HIV, malaria, tuberculosis, and hepatitis.

14th March, World Kidney Day is dedicated towards the awareness, prevention, and treatment of kidney diseases, especially for 850 million people worldwide who are at risk. The World Kidney Day sets out to increase awareness of the increasing burden of kidney diseases worldwide and ways for prevention and management of these diseases. Chronic kidney disease and acute kidney injury are the contributors to increased morbidity and mortality from other risk factors and diseases like diabetes, hypertension, cardiovascular disease, obesity as well as infections like HIV, malaria, tuberculosis, and hepatitis.

Top functions performed by our kidneys:

1. Regulation of water and electrolyte balance

One of the key tasks of kidney is to regulate fluid and electrolyte balance by controlling the value and consumption of urine. These adjustments are essential because the osmolarity of body fluids must be around 300 milliosmoles/litre. These are three hormones responsible for the electrolyte balance. First, Antidiuretic hormone, released from the posterior pituitary. Second, Aldosterone, secreted from the adrenal cortex. Third, Atrial natriuretic peptide, produced by the heart.

2. Excretion of metabolic waste products and foreign chemicals

The kidneys have a major role in excretion of a number of end products of metabolism that is waste for the body. These waste products are metabolites of hormones, end products of haemoglobin metabolism, creatinine, uric acid, and urea (amino acids). The kidney also defines the route for elimination of foreign substances from the body including chemicals, drugs, and pesticides ingested in the food.

3. Regulation of arterial blood pressure and sodium excretion

Kidney secrets water and sodium and an enzyme called renin that activates the renin-angiotensin system. The renin-angiotensin system helps in regulating blood pressure and fluid balance. Neural reflexes in kidneys serve as the principal mechanism for the rapid regulation of arterial pressure. It also exerts a major and long- term role by influencing sodium excretion. The pathways and effectors of arterial baroreflex and atrial pressure-volume reflex are depicted.

4. Regulation of red blood cell production

Kdney plays a pivotal role in the regulation of red blood cells (RBC) mass and red volume by controlling the plasma volume. Kidney coordinates the volumes of blood components and regulates the haematocrit. The production of RBC is regulated by a hormone called erythropoietin. EPO is produced by peritubular cells in the kidney that can detect tissue oxygen content. Increased syntheses of EPO also increase the cells committed to bone marrow which results in producing more RBC.

5. Regulation of vitamin D production

Kidney produces the active form of vitamin D, calcitriol. Vitamin D plays an important role in regulating body levels of calcium and phosphorus, and the mineralization of bone. We get vitamin d from ingested vitamin or sunlight but these are in inactive form. The kidneys convert the inactive form of Vitamin D into their active forms. The damage in the kidney can lead to a reduction in calcium absorption, and thus low calcium in the body leading to bone disorders.

6. Regulation of acid-base balance

The kidney excretes hydrogen ions into the urine and reabsorb bicarbonate from the urine and helps in maintaining the acid-base balance. The pH of blood must be maintained within a narrow range of 7.35-7.45, making it slightly alkaline. Outside that range, pH becomes incompatible with life. Acid-base imbalances that overcome this system are compensated in the short term by changing the rate of ventilation.

7. Gluconeogenesis

Gluconeogenesis is the process of the body to form new glucose from the amino acid in the proteins the body intake in case of non-consumption of carbs. Kidneys release the glucose in the circulation via gluconeogenesis. It satisfies their energy needs and reabsorption of glucose at the level of the proximal tubule. The kidney helps in retrieving as much glucose as possible, rendering the urine virtually glucose free.

It is important to encourage and adopt a healthy lifestyle in order to prevent and control the various types of kidney diseases. Screening of kidney disease is a primary healthcare intervention including access to identification tools. The government should ensure that kidney patients should receive basic health services they need and also there should be transparent policies governing equitable and sustainable access to advance health care services.

Millions of people are suffering from kidney diseases which also affects many other organs of the body and leads to several problems. It is essential to take measures to prevent kidney health and have regular check-ups that can detect any kidney related risks.