Podcast Transcript
The Silent Onset of Kidney Disease
Duration: 00:00:00 – 00:01:23Host: I am 25 years old right now, and my kidneys failed at the age of 20.
IgA Nephropathy may occur somewhere in the second decade of life in about 50% of cases. Within 20 years, it completely damages the kidneys.
That’s a new fact for me. Kidneys are the ones responsible for the production of hemoglobin. If they go on strike, everything takes a hit.
Is CKD a genetic problem? If I see 100 people, roughly 10 will be those who have Autosomal Dominant Polycystic Kidney Disease, which is hereditary.
And the biggest thing is, nobody is talking about it. God has given such a wonderful body; keep it well, keep it protected, and the joy of living is something else.
Host: You know, I never thought much about my kidneys until I found out mine were failing. And trust me, that’s not the moment when you want to start learning about them.
We hear about heart health all the time—cardio workouts, cholesterol, heart attacks—but kidneys? Not so much.
And yet, 14 crore (140 million) Indians are suffering from kidney disease. Quite scary, isn't it? Why am I sitting here leading this conversation? Because I have lived it. But I don’t want this to happen to you.
So take control today.
We are honored to welcome Professor Dr. Dinesh Khullar, a distinguished Nephrologist with over 25 years of experience, currently the Chairman of Nephrology and Renal Transplant Medicine at Max Saket Complex.
Kidneys: More Than Just Filters
Duration: 00:01:23 – 00:04:51Host: We both know that kidneys are very important, but what exactly is the function of the kidneys?
Dr. Dinesh Khullar: See, I am sure everyone knows that kidneys are the organs which produce urine.
But the matter doesn't finish here. Kidneys are not just about getting rid of extra water from the body.
We know they, in the process, are also eliminating various impurities. So they are getting rid of the various toxins from the body.
So that’s one aspect which the majority of us would know. But there are many other interesting things about kidneys, and you will be amazed and start caring more about your kidneys if you know that they are responsible for many other functions.
Host: Like what?
Dr. Dinesh Khullar: Well, you see, they are the ones which create the right kind of environment in the body.
It's by managing the various electrolytes. Let's say one has heard about Sodium, Potassium, Calcium, and Phosphorus.
So who is maintaining the balance? The kidneys. Okay. If they go on strike, everything takes a hit.
And you see, the sodium could go up, it could go low. At the same time, the same will happen with various other electrolytes, and it can play havoc with the body's system.
Now the matter doesn't end here.
You will be surprised that the kidneys are the ones responsible for the production of hemoglobin.
If there is no hemoglobin in our body—which means a deficiency in the amount of blood—you can imagine the condition.
One will become extremely weak, walking becomes difficult, you will start panting, and you will lose interest in your daily activities.
So the process starts from the kidneys because they produce a hormone called Erythropoietin. And this goes to the bone and asks the bone to make hemoglobin for us.
Host: Until today, I only knew that the kidney's function is filtration. Today I learned that besides filtration and removing urine, the kidneys do a lot more.
Dr. Dinesh Khullar: It does one more thing, like giving strength to bones. Everyone has heard "Go in the sun, take Vitamin D."
Host: Yes.
Dr. Dinesh Khullar: You know, that’s a fact. One should sit in the sun, one should take Vitamin D. But this Vitamin D is going to be useless to our body if this Vitamin D doesn't reach the kidneys and get activated or absorbed.
Yes. So kidneys activate this Vitamin D. Okay? And now this activated Vitamin D is going to give strength to our bones.
So it's about getting rid of impurities, maintaining the right kind of balance (acid-base, electrolytes, sodium, potassium, calcium, phosphorus, magnesium, everything), and on top of that, Erythropoietin production so that hemoglobin levels are regulated.
Kidneys maintain blood pressure. Look at the amazing functions the kidneys have.
If they were to go on strike, everything comes to a standstill. So that is the importance of kidneys we must realize.
Kidney Workload and Symptoms of Dysfunction
Duration: 00:04:51 – 00:07:35Host: Honestly, sir, until today, I just thought that the kidney function was limited to filtration. But what you told me today—that kidneys regulate hemoglobin, even Vitamin D—that’s a new fact for me.
Tell me one thing: what is the actual size of a kidney, and how much does a kidney function in a day? Is it working 24/7, or is there rest?
Dr. Dinesh Khullar: In kidneys, there is no rest. I like that curiosity. And you see, you will be surprised, they are working round the clock.
And it is to the tune of 120, approximately 120 milliliters is filtered every minute, which translates to something like anywhere between 150 to 200 liters of blood getting filtered through the kidneys on a daily basis.
Host: Amazing. That’s a lot of blood.
Dr. Dinesh Khullar: That’s a lot of blood. This kind of work is done by two kidneys situated at the back, measuring close to about 9 centimeters.
So, such small bean-shaped kidneys... look at the wonderful work they are doing, sustaining life for us.
And when they trouble us a little, only then do we realize that we should have valued them.
Host: What do you mean by troubling? What are the symptoms of "troubling"?
Dr. Dinesh Khullar: You see, there are so many functions. So obviously, when they get hit, when kidneys reduce their work, symptoms will come.
And now you will have to try to recollect what we already know about kidney functions. Kidneys had to make urine and remove extra water from the body.
If there is extra, it removes it. If you drink more water, it removes more. If you drink less, it conserves.
But if their capacity decreases, extra water starts retaining in the body. Swelling will appear; water will fill up everywhere. That’s one.
Secondly, we said it monitors acid-base, sodium, potassium, and electrolytes. So with the rise or fall of each, symptoms will come.
Appetite can decrease. When toxins increase, toxins won't let a man feel hungry. That’s one. Secondly, if someone’s sodium increase, interestingly, irritability happens.
If sodium decreases, a man behaves like a mad person, becomes unconscious. And if potassium increases, the heart can stop.
So it's at times very scary that if your kidneys are not working properly, what all can happen to your body.
Calcium will decrease, again mental changes occur, and bones become weak. Phosphorus increases, and itching starts.
Hemoglobin decreases, so a man won't feel like working. School-going kids will stop going to school, college-going will stop studies, and office-goers will get scolded daily by their boss.
The "Silent" Nature of Kidney Disease
Duration: 00:07:35 – 00:11:58Host: Let me ask you one thing. Like, I myself have been a patient. I was not facing any such symptoms. What happened to you?
Dr. Dinesh Khullar: So I also... I am a former transplant patient.
Host: Oh my god. I just got my surgery done 6 months ago.
Dr. Dinesh Khullar: Oh, you don't look like a patient at all.
Host: But my question to you is that the symptoms didn't come to me. I just got my blood work done, and in my blood work, my creatinine came straight at 2.
And then I realized there was something there. Before that, I had neither swelling nor irritability, nor did I ever check my BP because I was a strong, healthy, and fit kid.
Dr. Dinesh Khullar: Very important and pertinent question. Now we will talk a little more about this. Okay.
You see, let's see what causes kidney damage first before we come to your question.
We know, in India, and for that matter, the world over, the most common causes are Diabetes, Hypertension, Heart Diseases, Morbid Obesity (very fat), Kidney Stones, Glomerular diseases (where kidney filters get damaged), or some hereditary diseases that pass down through generations.
So these are the people who would have to be alert to the possibility of kidney disease.
Host: But I am completely fit, young, and I always paid attention to my fitness, and still it happened with me.
Dr. Dinesh Khullar: That’s kind of sad. Yes, I am with you there. But then you see, I will tell you the reason.
And that’s very important for those who may believe they have normal kidney function, yet it may not be the case.
So what was I telling you?
If you are diabetic, you will be alert. If you are hypertensive, you will have to control all these things.
If you don't, you are to blame that you got into a problem whereby your kidneys got affected.
But supposing, and especially the commonest cause in people of your age, young people, can be some kind of glomerular disease.
Typically, IgA Nephropathy, whereby the body's own defense system starts fighting with the normal defense system.
Host: So I myself was diagnosed with IgA Nephropathy, chronic.
Dr. Dinesh Khullar: So that’s a very common cause at your age. Unfortunately, the symptoms of chronic kidney disease come up very, very late.
So if you were to pick up 10 people who have chronic kidney disease, almost 8 or 9 will get the symptoms when it's too late.
When the disease has already advanced too much. Which means kidneys are silent sufferers.
They keep on exerting upon themselves, their own cells, trying to compensate for the little loss of function.
So that the remaining whatever is left of the kidney tries to compensate. The work keeps going for a long time, no one realizes.
And by the time you come to know, unfortunately, it's too late. But I will remind you again, if symptoms were to come, as I said: swelling comes.
Appetite decreases. Itching can happen. Fatigue will happen; you won't feel like working. Breathlessness will start just because water fills up the body.
But simultaneously, there is a crosstalk. Kidneys affect the heart, affect the liver, and affect the brain.
So as toxins increase, lethargy increases, appetite decreases, you feel like vomiting, and vomiting happens.
And slowly, if you don't take action at this stage, more serious complications like unconsciousness, fits will start.
And then there can be serious effects on the heart, which can be very, very dangerous.
Host: Sir, like if I talk about myself, in my case, I had a little swelling. So I thought I ate too many carbs.
As a gym guy, I thought I was eating carbs, that is why my body held more water. So I took every symptom related to the kidneys very casually.
Like you say, laziness or irritability, I thought those were mood swings. A little swelling in the body, I thought I ate too much the night before.
So is there only one solution to this? Should we go and get blood and urine tests done first?
Testing: Simple, Cheap, and Vital
Duration: 00:11:58 – 00:16:16Dr. Dinesh Khullar: Absolutely. So that is exactly the point I am wanting to make.
You see, yours is not the age when one would want to go to a doctor. Nobody wants to find out if I have a kidney problem.
See, on one hand, I am saying it is the diabetic's fault, that the hypertensive patient's fault if he or she does not go to the doctor.
I can't blame you. I can't blame you as a youngster who is full of life. He wants to live life as best as one can.
But it's unfortunate there are diseases which, if caught young, we as doctors can make a huge difference.
So, IgA Nephropathy, or for that matter any kidney disease, if caught at the right time and caught early, we as doctors can make a huge difference in the final outcomes.
Same applies for IgA Nephropathy as well. "Are your kidneys okay?"
It is a question which should be asked to each and every person, and we should introspect.
We should ask ourselves this question: Are your kidneys okay? You may believe they are.
And now I have told you the symptoms occur very late. By that time, it's a point of no return.
So certainly you would want to know whether your kidneys are okay or not at the right time.
So the whole theme is Detect Early. And that is how you are going to be able to protect your kidney health.
Host: Sir, I read a lot about kidneys, and I realized that everyone in the 30 to 40-year age group should get yearly blood tests.
I agree with this. But like I am 25 years old now, and my kidneys failed at the age of 20.
This means it started failing 4-5 years before that. Should a 15, 16, or 18-year-old boy/girl also get their regular blood tests done?
Because the environment in India is a bit polluted now.
Dr. Dinesh Khullar: Very valid question. And I think before this, we would want to know, if I have to declare someone's kidneys normal or not, how, as a doctor, can I find out? Right.
So that will now take us to the question which you are asking. If someone comes to me and asks, "Tell me if my kidneys are okay or not," so there are some absolutely basic tests.
Easy, relatively cheap, and easily doable. Okay. It involves just a careful urine examination. A Urine Routine Examination.
And a test where we check the amount of albumin in urine, whether protein is leaking in urine or not—Urine Albumin Creatinine Ratio.
And a Urine Routine. There cannot be an easier test than this.
Host: You are getting a urine test done. Yeah. There is no trick in it, nothing. Anyone can do it.
Dr. Dinesh Khullar: So even if you get this test done, you will get a lot of information. If you combine this with an absolutely basic blood test.
The blood test name is Serum Creatinine. If you join this Creatinine with Albumin, there can be no more basic tests.
It will give me reasonably good enough information, almost as accurately as I want as a doctor, as a Nephrologist, to be able to tell the other person whether your kidneys are affected or not.
Now that takes us to the question you were asking—30 years, 40 years, 20 years. Now, there are diseases like diabetes, where it is said that if an adult gets diabetes, they should get these two urine tests done on the very first day.
Whether he is excreting albumin in the urine or not, and what is his or her Serum Creatinine value. Because so many times, diabetes may have been there for a good 10 years.
Pre-diabetes—the stage before frank diabetes—may have been there for about a good 8 to 10 years. And it will affect your kidneys.
Maybe they are already affected, and you don't know. And we have to advise this: the day you are detected as a diabetic or a hypertensive, for that matter, go get your absolute basic tests.
It is your responsibility towards your own self and towards your family members that you screen yourself.
Screening for Children and Adolescents
Duration: 00:16:16 – 00:19:29Dr. Dinesh Khullar: But that will again take us to the very pertinent question which you were asking.
A 15-year-old child, a 20-year-old child—is it their age to play or to get blood tests done?
Well, I think short of that... and it's a very strong thing because IgA Nephropathy and some hereditary diseases typically come at this age.
You know what? In a typical course, I am sure you have been told about IgA Nephropathy.
I know about people who are listening to us today know that IgA Nephropathy may occur somewhere in the second decade of life.
The second decade is the age between 10 to 20 years.
Host: Like it happened with me.
Dr. Dinesh Khullar: And in about 50% of the cases, within the next 20 years, it completely damages the kidneys.
Now that’s very sad, if we catch this at the age of 15-16, as compared to 15 years later at 30 years, when symptoms have appeared. Right?
For the next 10-15 years, no symptoms will come. No swelling, no blood pressure. Which kid will get his blood pressure checked?
Nobody does. Right?
So the concepts are changing. Now we are believing, and especially the policymakers are believing, that it's very easy to screen school-going children through their urine test.
A child, at the time of going to the next class, has to get a routine urine check done. Urine albumin done. There cannot be a bigger thing than this.
Host: Yeah, it's not even a hassle. There is no price for kids. I think through urine tests, we can relate kidneys and other things too.
Dr. Dinesh Khullar: Right. And Obesity. Earlier, obesity was for adults; now, obesity has come in children. And the food fads that have come, the pizza culture that has come in India.
Parents' love... love is absolutely overflowing these days.
And when it is overflowing, and when the child develops a big paunch, in that pampering, we ignore it.
And by the time this unfortunate unsuspecting child gets to know that he or she has a kidney disease, at times it can be too late.
So again, a urine test. And such children's blood pressure should also be checked.
One blood pressure check, a urine test, and you screen. And wherever there is suspicion, even for children, a basic blood test, Serum Creatinine, is not very expensive.
So that you have screened, and if there is even a slight suspicion, you get their Ultrasound done.
Because in ultrasound, a non-invasive test, you can easily find out what the kidney looks like.
Host: Blood test and urine tell you the "intelligence" (function), ultrasound tells you the "face" (structure).
Dr. Dinesh Khullar: Everything is revealed in ultrasound. So basic things. Why I am saying this is, till about I would say a couple of decades ago, and even a decade ago, we didn't have many weapons in our armamentarium to be able to help.
The medical industry has grown a lot. Many new good medicines have come.
And there has been a bombardment of very, very useful drugs which can make a huge difference.
But if the kidney function is almost lost, which means we said that 120. Let's say, for example, 100 ml every minute it is filtering. 200 liters a day.
And if it's GFR, if we say a good GFR is above 100.
Understanding GFR and Stages of CKD
Duration: 00:19:29 – 00:22:35Host: Sir, let me ask one thing. What exactly is GFR?
Dr. Dinesh Khullar: GFR is a reflection of how much the kidney works. Glomerular Filtration Rate. How much the kidney is filtering in one minute.
If we say a good kidney, both kidneys combined, if the GFR is coming above 100 ml, we are happy.
And as the function decreases, we start giving stages of kidney damage. Stage 1: Function (GFR) is normal, apparently, but there is something wrong.
Now, if caught, very good. If not caught, you will catch it in Stage 2 when the function comes between 60 and 90. Still not caught?
Then it comes between 30 and 60. This is called Stage 3. Then Stage 4 is 15 and 30. Now, trouble starts appearing in the majority of cases.
Host: Sir, which of these stages is CKD?
Dr. Dinesh Khullar: So this stage is called... suppose the function looks good, close to 100%, but there is something wrong with the kidney—protein leaking in urine, any RBCs coming... any problem related to the kidney, if it stays for more than 3 months, sorry 3 months, then this will be labeled as Chronic Kidney Disease (CKD).
And unfortunately, the problem is once you have labeled someone as having Chronic Kidney Disease, it's not good news for the patient because it indirectly means it is permanent damage.
And on top of that, it is progressive damage.
So Stage 1 goes to Stage 2, as I said, 60 to 90 percent function.
Host: If a disease stays with you for more than 3 months, is it Stage 1?
Dr. Dinesh Khullar: No, so sorry, I will again clarify this. I am saying that if someone has any kidney problems.
Chronic Kidney Disease means any kidney problem—urine abnormality, reduced kidney function—that has remained for more than 3 months, then unfortunately, the majority of the time, perhaps this won't reverse. And secondly, it will progress.
So which means you are moving from Stage 1 to Stage 2 to 3.
As the function decreases, doctors have labeled these as stages. Depending on how much your kidneys function, stages come.
Host: And if you have had any disease for more than 3 months, we can call it CKD.
Dr. Dinesh Khullar: Yes. So now the implications of CKD will be that when the function becomes less than 30, symptoms usually start appearing.
It's already late. So if you catch them young—at 1, at 2, at 3A—early, you can make a huge difference.
Not that you were 30, but your priorities change. You see, it is like you are first talking about curing. Alright?
After that, you lose hope and say, "Okay, not a cure, let's slow down."
But slow down also means a lot. If I tell you that when your disease was unfortunately caught, if the same was caught 5-7-8 years ago.
Obesity, Prevention, and Personal Responsibility
Duration: 00:22:35 – 00:26:13Host: Okay, so sorry to interrupt you here, but I wanted to agree with one of your points very much.
You said if you have diabetes, hypertension, or any other problem, or if you are obese.
Now that I look back, I was obese, and I had no other illness. I was obese for 4 years. I mean, till 14 years old, I was 135 kg.
Dr. Dinesh Khullar: Oh my god.
Host: After that, I started reducing weight. But till 135 kg, I never got a blood test done.
And again coming back, if obese people get blood tests, these small problems you mentioned earlier, like diabetes, hypertension.
If blood tests happen in those things, I think my transplant, which happened at 25 years, would have happened somewhere at 30 years.
Dr. Dinesh Khullar: You are right. Absolutely right. Why not? Why 30?
Even longer. We have weapons now which can make a huge difference to the final outcomes. So two different things today.
One is prevention. Okay. That brings us to the magnitude of the problem. Do you know approximately how many people in India have damaged kidneys on a permanent basis (CKD)?
We have discussed about today.
Host: Yes, I just read about it, so I think I know. 140 million.
Dr. Dinesh Khullar: Yes. So it could be that Akbar-Birbal thing, a little here, a little there, but roughly, if India has a 140 crore population, this is a conservative figure that 10% have damaged kidneys.
And the biggest thing is nobody is talking about it.
So 14 crores (140 million), according to me, is the bare minimum. It could be as much as 20-22 crores as well.
This is on paper. Let's not scare the audience today. We say okay, 10 crores.
Does it make a difference? Do you think, as an Indian citizen, I am going to be less scared if someone tells me, "No, no, not 20 crores, sorry, it's 10 crores."
Ten crores is unmanageable.
We are expecting everything from the government all the time—that the government should do this, give us healthcare, do that.
Look within yourself. Are we fair to our own health? What are we doing for ourselves?
Are we again wanting to find out in the context of today's discussion and the theme of this year's World Kidney Day?
Are we trying to find out "Are our kidneys okay?"
Because the whole thing is if picked up at the right stage, it will mean we will have to compulsorily change our lifestyles and prevent the disease from happening.
If you find out about diabetes at the right time, you will not allow yourself to remain an uncontrolled diabetic and end up with a kidney problem.
So you will have to prevent. So rather than expecting everything from the government, everything from the healthcare providers, I think the onus is on the respective individuals.
We collectively have to take care of our health. Lifestyle modification. You see, there are things called Primordial Prevention.
Don't let it happen in the first place. If diabetes happens, control it so well that it doesn't cause any harm.
Unfortunately, if it has happened, then we doctors are sitting too slowly to slow it down.
But for a 14 crore population, a handful of Nephrologists can't do anything. It's very difficult. So it has to be prevention, prevention, and prevention.
So, try to find out about your kidney disease at the right time before it's too late. Alright? Try not to ignore the symptoms at all.
And first, when we say lifestyle modification... which means what you were doing unfortunately didn't benefit you.
You were having a very good life, going to the gym, doing everything. Maybe you were obese, and perhaps the seeds of the problem had already been sown.
And by the time you found out, maybe it was too late. And perhaps in your case, there might not have been a connection between obesity and IgA Nephropathy.
Maybe two things attacked you—one from being overweight, but predominantly IgA Nephropathy.
But I will ask this question to any obese person: brother, what care did you take of your health? If you let yourself get fat at such an early age.
Well, I don't want to blame those children who were genetically predisposed to obesity.
But that should not be taken as an excuse that "Parents were fat, so I had to be fat."
No. You have to go one step further and say parents were fat, but I don't have to be fat.
Lifestyle: Diet, Water, and Habits
Duration: 00:26:13 – 00:28:54Dr. Dinesh Khullar: Secondly, this useless culture of eating and drinking. Eat healthy food. That’s extremely important. Drink plenty of water, don't let dehydration happen.
Don't eat useless things. And again, a caution to people of your age group: children have developed a habit of showing off a lot these days. "Look, he smokes, so I will too.
Am I any less than anyone?
I smoke." "Drink." "Oh, peer pressure." "I drink." They talk about binge drinking. I will come back to that.
Smoking is injurious not just to your lungs. It does not only causes cancer of the lungs, but it also causes so many other things.
Heart disease, ulcers. But I am a Nephrologist, so I will talk about Nephrology. It destroys the kidneys. Okay?
Host: So the three things I have understood so far are: If you want to save your kidney, first do Prevention.
Don't do things you shouldn't do, which have been called 'unhealthy' since old times.
Secondly, take care of Routine Tests. There is no problem in getting urine tests done.
Any child or adult should get it done regularly. Thirdly, if you get any strange symptoms—feel a little irritable—address them properly first and see a doctor.
Fourthly, when you find out you have a problem, take it very seriously and start treatment at that time as soon as possible.
So if we follow these four things, I think 90% of the problems people are having can be avoided.
Dr. Dinesh Khullar: Definitely. And you are doing good for yourself, for your society, for your country.
This country cannot cope up with the increasing burden of kidney disease. Imagine, we said the disease is progressive. Chronic Kidney Disease Stage 1.
If you don't take care, then it will go to Stage 5.
Stage 5 is when the kidneys are completely damaged. Then either dialysis will have to be done or a transplant. All right?
So I am not saying that is a bad thing. And unfortunately, when they end up in that stage, that is the only hope.
People can live on dialysis for a good 30-40 years. People have been doing that in our country.
Now, with successful transplantation, decades of life. But then why go into that stage if that is preventable?
Is CKD Hereditary?
Duration: 00:28:54 – 00:32:51Host: Is CKD a genetic problem? For example, if a parent has it, what are the chances that the problem passed on to their children?
Dr. Dinesh Khullar: I think that’s a very valid question. And a very often asked question to us, and we must know about it in more detail.
There are some diseases that are hereditary. I will tell you there is a disease... I don't know if you have ever heard of a disease named Autosomal Dominant Polycystic Kidney Disease (ADPKD).
This is a hereditary disease, very common.
If I see 100 people whose kidneys are permanently damaged, roughly 10 will be those who have Autosomal Dominant Polycystic Kidney Disease, which is hereditary.
Passed on from parents to the children. This is a very common disease in which cysts form in the kidneys.
Slowly, the size of the cysts increases. They cause pain or bleeding happens or infection happens.
Ultimately, the whole kidney turns into cysts, and the kidneys get damaged. And then you need a transplant.
Host: Is there any genetic disease... so this disease is genetic?
Dr. Dinesh Khullar: This disease is purely genetic. And it will get damaged. We now have new drugs which can bring a little difference, prolong their kidney life.
But eventually, the kidneys will be completely damaged, and a transplant or dialysis will happen.
There are some diseases which are not so obviously hereditary but then have a component.
Including the disease we are talking about—IgA Nephropathy. IgA Nephropathy, Diabetes, some Alport Syndromes.
There are many hereditary diseases where we tell the parents, "Brother, you have it; there is a strong possibility that children can have it."
Among those, there are some diseases... suppose if a hereditary disease is to happen and it has to damage the kidneys of the born child within 10 years, we will be very, very cautious.
But I will give you the other side of the story. There is an Autosomal Dominant Polycystic Kidney Disease.
If we even find out he is going to have it. If the child is born, there are very good chances that he will cross more than 50 years before the kidneys fail.
Some ADPKD patients fail at 70-80 years. But yes, everyone has the right to know.
And there are ways. Genetic tests exist. Blood tests tell whether the child born will have this in coming time or not. We are evolving.
Availability of genetic tests has increased. Our faith in this has increased. And we are getting more and more testing of these kinds of situations done.
It is expensive now. The test is not very expensive, 15-20 thousand, but it is expensive.
For an average Indian, this is quite a lot of money. So we are waiting, maybe tomorrow it becomes cheaper so that we can get more people tested.
Because it is very important to know that a disease can pass on to the next generation, so that due precautions can be taken.
And we leave the decision-making to parents with counseling. But your question is absolutely valid.
Host: So, in short, there are some diseases related to the kidneys which are genetic.
Not all CKD patients will have a genetic problem passed to their children. But some diseases are such that can happen. And we can get them tested, too.
Diabetes: A Family Legacy and Individual Duty
Duration: 00:32:51 – 00:36:24Dr. Dinesh Khullar: Absolutely. Absolutely. I would say a very interesting thing. Suppose there is a diabetic.
There is a chance that he is diabetic; his children can also be diabetic. Now this is what they received as a legacy (inheritance). We have no control over it.
Host: Like diabetes is a common disease. People take it very neutrally that if I have diabetes and I have a baby, he might get it. But it's not a huge problem.
Dr. Dinesh Khullar: Yeah. So this is not a show-off thing that you are sitting in a big crowd and saying, "I am also diabetic."
Oh, brother, come and see the wards sometime, filled with the worst kind of complications of diabetes, including kidney disease.
So what I was saying... suppose a diabetic... his children are also to have diabetes.
If his kidney failed, chances are tomorrow his children will also have diabetes, their kidneys will also fail.
This is something on which we have no control genetically. But forgetting our own responsibility? What did I say? If you are diabetic, prevent it.
From diabetes to become a problem for your kidneys or your heart. Number one.
And secondly, a child's responsibility. If he knows parents had diabetes, then if the child becomes an "athlete" at the right time... not literally, but when I say athlete, it means athlete lifestyle.
Yes.
So if he does that, maintains his proper good lifestyle, there are good enough chances that he won't become diabetic at all. And if someone has become diabetic.
This is a very, very important message, and I will repeat it again and again so that the message should be delivered to everyone who needs to know it: that Diabetes is a Menace.
You can't imagine how many crores (tens of millions) in India have diabetes. Very common disease.
And you know, diabetes and hypertension, it's like every third person has it.
Roughly 10 crore (100 million) people in India have diabetes. The problem doesn't end here. Out of these 10 crores, roughly 4 crores, 40% of the diabetics are going to have some kind of kidney disease.
Look at the magnitude of the problem. We again, I will bring back to, we are expecting from the government, the health sector to save us.
Brother, save yourself first. Why do people don't take kidney problems seriously?
Because they need the two of us to discuss this and spread this message and awareness. Not just the two of us, everyone who takes it upon himself or herself to own up and say that "Yes, we have to strengthen the health system of our country. We have to ensure good health for our countrymen."
Only then will people realize. The results may not be there to be seen today because we have the largest population in the world.
We have the largest population of diabetics in the world. This is not a good thing.
Now, this is not something which we want to be labeled as.
But at times, I am sure discussions like this and a whole lot of efforts by each and every Indian will ensure that we are in the right direction.
And if not now, in times to come, very soon, I would say, we should see the graph declining.
"Look at the number of diabetics declining, number of people with Chronic Kidney Disease declining in our country." Because only then we will talk about something else.
Host: Certainly, only then will we talk about something else. Otherwise, all the resources that India is doing so well, what we are earning, we will give it all through Chronic Kidney Disease.
Dr. Dinesh Khullar: By 2040, it is predicted that it will be the fifth leading cause of death in our country as well.
Crosstalk: How Organs Affect Each Other
Duration: 00:36:24 – 00:38:22Host: So I have another question for you. This kidney problem, this CKD, does it affect other organs too?
Dr. Dinesh Khullar: Yes. I mentioned a little while ago about a very interesting phenomenon called Crosstalk.
Crosstalk is going on inside our organs, too. We are thinking we are talking to each other, but at this time, our respective organs are also talking to each other.
It is saying to the heart, "Hey, you troubled me." Like two siblings do, right? "You wore my pants, you wore my shirt."
It is saying, "Hey, you drank too much water, you caused swelling inside, you are troubling me."
So there is a crosstalk. And because if one affects a particular organ, a disease, it is automatically going to reflect in the other organ as well. Why?
I will tell you. It's like a stream. A river is flowing. If you see that further down, you placed some stones downstream, the one upstream got affected, right?
And on the other hand, if you placed stones upstream, water didn't reach the one downstream. So one is leading to the problem.
Everything is interconnected. The Almighty has made this thing such that when it gets damaged, then we understand what we had received and how we spoiled it.
And this is not a mobile phone that it got damaged today, and like kids, they throw it like this... "Get a new one, get a new one." "Get a new one."
Whatever you have received, use it well. And change your habits. Because by and large, the majority of the diseases which are affecting the kidneys are preventable.
Leave the majority, a little bit left doesn't matter. But what is in our control?
It's like saying we will talk about 100%, but the 90% that is in control... people look at the negative aspect more, that "It's not in our control."
But I think lifestyle change, living a disciplined lifestyle, and with a good upbringing, I think everything can stay great, even if you are prone to it.
Investing in Health: ROI of Testing
Duration: 00:38:22 – 00:41:58Host: You are absolutely right. And I think we see a lot of hope in youngsters, your generation. Because I still remember we struggled that crackers should not be burst on Diwali.
So when finally children were told "Say No to Crackers," then they understood.
Suddenly, a decline came in crackers. Because where this point needed to be said, it hit there, so they understood.
So if we are able to bring home this point to our youngsters, school-going children, and college-going children, we will be able to save the next generation.
Dr. Dinesh Khullar: Yes. We have to tell them the importance of lifestyle modification.
Host: All this awareness we are doing right now for the coming generation... aren't we doing it for this current generation too?
Dr. Dinesh Khullar: Because those who have the problem or are almost about to have it... You tell them, "Try to find out whether your kidneys are healthy or not."
And how easy it is. Okay. All the time, we are talking about tests being very expensive.
I will tell you, even if one has to spend ₹1, you feel "Oh ho, my ₹1 got wasted." As far as I know, KFT (Kidney Function Test)... usually, the bare minimum if you get it done from the best lab, it's ₹800.
In a government hospital, it happens for ₹100 too. Some organizations are doing it for free, too.
So wherever your capacity is, show inclination and go get it done. I mean, "Where there is a will," you will find a way.
Everything is there. Policies are good. There are enough places. Philanthropic organizations, government hospitals, all public hospitals have very cheap tests.
Host: And in the worst case, as you are saying, even the most expensive... even if you have to get an ₹8000 test done once a year... I don't think it's a small thing... investment came in your body...
Dr. Dinesh Khullar: And the right kind of investment. Because God has given such a wonderful body, keep it well, keep it protected, and the joy of living is something else.
Because we as doctors tend to see and we feel so sad that people who did not take good care of their health finally end up in a situation that brings them to the hospital.
It is not a curse for their own selves, it is actually a curse for the rest of their family members as well. It drains the resources out.
And in a country like ours, individuals like us cannot afford to spend too much on diseases like Chronic Kidney Disease.
They drain your resources out. So again, we are coming back to the importance of prevention.
And it's easy. It's doable. And the joy is something else. We look at others, "That country is very good, they play well all day, they invest more in games."
Brother, why not you also? Who stopped you in India from living a healthy lifestyle?
I mean, blaming all the time that "I didn't get this facility," "I got a little pollution outside, so I didn't cycle today," "I didn't play today." So keep on blaming.
As you rightly said, "Where there is a will, there will be a way."
So find that way. Trying to crib about all the time, the loss is your own.
No matter what you say. If you are not taking care, not doing it today, sooner or later, if you saved ₹100 on test today and didn't spend, tomorrow you will have to spend ₹2000-₹5000 extra, whether it is on dialysis, whether it is on transplant, whether it is on doctor's fee.
But it will be spent. So it is better for you to invest your money in the right place at the right time and get a good return.
Host: I believe that if money is being spent, Return on Investment (ROI) should always be good.
Dr. Dinesh Khullar: Absolutely correct. And I think I can't agree with you anymore. And I think it is high time that we start screening more and more people, and let's try to find ways.
Sleep and Kidney Health
Duration: 00:41:58 – 00:43:17Host: Sir, this new trend of today's generation—staying awake at night, sleeping during the day—does this also damage the kidneys?
Dr. Dinesh Khullar: Quite interesting. Well, the honest answer is Yes. You see, our body is made in such a way that everything has rules.
And we need to get proper sleep. 7 hours of sleep at a stretch is what the body deserves and demands.
So we should get this at the right time, properly, on a long-term basis. We should not play around with the circadian rhythm of the body.
Needlessly scrolling something on mobile at night, you are spoiling your eyes, spoiling your mind, but more than that, you are inviting trouble.
You are disrupting your sleep, which is, I think, a legitimate requirement of your body.
If you don't give it due importance, as I said, you are inviting trouble.
So certainly it's not one whole lot of diseases you can expect if you are not maintaining a proper sleep cycle.
Final Message: Take Charge
Duration: 00:43:17 – EndHost: Okay. Thank you, sir. So with that, I want to wrap up, and I just want to ask you, any final message you want to give to today's youth?
Dr. Dinesh Khullar: Well, you see, speaking as a Nephrologist, and I will say that we must acknowledge the fact that kidneys are great organs helping you round the clock.
And in disease, unfortunately, they are silent sufferers. And they keep on suffering till quite late. And then they announce their symptoms.
So do not provoke your kidneys to seek your attention. You should try to help them.
Pick up any kind of kidney disease at the right time so as your doctors and healthcare providers are able to help you.
And first, prevent the disease. And God forbid if it has happened, make sure that there is a proper optimum treatment which slows down the rate of progression.
Even if it has to progress... a disease such as Chronic Kidney Disease, which by definition is a progressive disease, but we can make a huge difference.
A progression within one year or a progression over 20 years, I think, makes a huge difference.
So please accept your responsibility as individuals and try to protect your kidneys from getting damaged.
Host: So in short, we can wrap up by saying this: Your kidneys won't send you a notification when they are in trouble.
But take charge. Get tested. Stay hydrated. Don't ignore your body's signals.
Dr. Dinesh Khullar: Absolutely.