Ashok Sarin's Clinic [ On Call ]

Hello,

I am Dr. Ashok Sarin, Nephrologist. Today I will talk about high blood pressure. Hum log kayi baar sochte hain ki thode bahut high blood pressure se kuch nahi hoga. Agar ye ho bhi gaya hai toh koi baat nahi. But 140/90 BP hai toh humein turant action lena chaiye. Humein salt kam lena chaiye. 2 grams in 24 hours hi humara salt intake hona chaiye. Fir humein apna weight kam hi rakhna hai, smoking band karni hai. Diet simple rakhein, oily and spicy food nahi lena hai. BP ko kam rakhna jaruri hai because BP sirf kidney hi damage nahi karta hai but iska bad affect hota hai heart, brain and eyes ke upar. BP primary essential hota hai jahan koi cause nahi hai and secondary hypertension jahan koi cause hota hai. Kidney disease secondary hypertension karti hai. For eg: chronic GN, chronic pyelonephritis, renal stone disease aur bhi bahut si kidney ki problems ho sakti hai. Us BP ko kaise thik karna hai ye nephrologist aap ko btayega like primary ka pehle treatment hoga toh BP niche ayega.

Humein dhyana rakhna hai ki BP 140/90 ke niche rakhna hai. Agar 140/90 persistent hai toh ye high BP hai. Kabhi aisa bhi hota hai ki patient aata hai and uska BP 180/120 hai but vo patient kehta hai ki mujhe toh koi problem nahi hai aur na hi headache hai toh mai BP ki medicines kyu lun? Jab BP slowly badhta hai toh uske symptoms immediately nahi aate. Ye bahut jaruri hai ki medical check-ups hum 6 months or 1 year mein karayein. Agar Dr ne bola hai BP ka problem hai toh humein iska treatment immediately lena chaiye. Dose kam aur badhani Dr ke suggestion pe chaiye. Apne aap band nahi karna chaiye. Agar hum apne aap band kar denge toh heart, kidney, brain, eyes ka damage hoga. Toh bahut jaruri hai ki timely check-up karayein and jo patients bolte hain ki mujhe koi symptoms nahi hai tih ye ilkul possible hai ki kabhi kabhi symptoms na hon. Agar headache hai and weakness hai toh iska matlab BP high hai. Aap ka lifestyle acha hona important hai ke hum apne khane ka dhyan rakhein, weight control rakhein, weight gain na karein, smoking band kar dein, alcohol kam lein, meetha nahi khayein.

 Thank You.

Hi,

I am Dr. Ashok Sarin, Nephrologist. Today I will talk about diabetes mellitus and how it affects the kidney. It is very common in India and North India. This is the disease which affects the kidney in many ways. The most common condition is the development of a urinary condition. And we also see when sugars are high, the patient can develop urinary tract infection. The other condition which is not very common is papillary necrosis in women where it gets large in the urethra, it forms stone and it can also cause bleeding in urine and other events. Then there is another microalbuminuria which a patient would not be able to appreciate but there are small amounts of protein are excreted by the kidney which they should not be and if we catch the condition early and treat it adequately then the microalbuminuria is reversible and it will prevent further damage to the kidney. After this condition knows as macroalbuminuria where a large number of proteins are excreted via the urine and this result in the fall of the protein concentration within the vascular or the blood compartment where there is puffiness of the face, swelling of the legs, feet and sometimes the in the abdomen as well. Then we have renal failure where the serum creatinine and the blood urea starts growing up gradually.

I will talk about the prevention of kidney disease by diabetes. And the important thing is that who has type 1 diabetes or juvenile diabetes where it starts in the teen and young adults where there is no fall in the patient and it is a genetic and hereditary condition where insulin required where of course renal damage or failure is not a fault of the patient. But type 2 diabetes which actually due to an environment where the patient has been eating too much or eating the wrong food, junk food, saturated fat, a lot of sweets and put on a lot of weight. This is highly avoidable. Because if this patient eats the right food low and saturated fats, low in carbs and indulges in regular exercise and make sure that the weight is down the, of course, diabetes is preventable and the blood sugar can be checked. Now it is very important if there is any indication of diabetes or the person is 40 years or above and if the weight is excessive, we must get a fasting and post fasting blood reports. Then HbA1c which gives us the report of blood sugar for over the last 3 months should be 6%. So, if these factors are maintained then the blood sugar is normal.

If these results are persistently high, the indicates patient is diabetic. And this person requires treatment. I told you about the importance of exercise, lifestyle change, eating pattern. Then smoking in diabetes is disastrous because in this combination patient will develop eye problem, heart disease, kidney disease and of course peripheral disease where the patient can develop gangrene of the toe and this can be a serious condition. We must do a lipid profile. Alcohol should be avoided or should be taken in moderation. The juvenile diabetic should always have a balanced diet and should indulge in exercise and also, take the insulin regularly. If all this is done then all the factors like smoking, alcohol is avoided then the ill effect of diabetics can be minimized to a great extent.

Thank You!

HI,

I am Dr. Ashok Sarin, Nephrologist, Apollo Hospital. I am trained in UK. Aaj me apse dialysis ke bare me baat krunga. Aaj ka iske bare me bhut baat hoti hai ki kab krna chaiye or krna chaiye ya nhi. Me apne cases me dialysis tab tak nhi krta jab tak patient ki condition serious na ho ya reports bhut khrab hon. Kidney damage 2 types ki hain. Temporary and permanent damage. Bachon ko dehydration, burns hone se acute renal failure hota hai, heavy blood loss se bhi acute renal failure hota hai. In cases me hum acute dialysis krte hain. It can either be hemodialysis or intermittent peritoneal dialysis. Hemodialysis machine ke through ki jati hai. And intermittent peritoneal dialysis peat me catheter daal ke or usme hum pani chor ke nikalte hain jis se jo bhi poisonous thing hai vo is procedure se nikal jata hai. Agar Dr apko suggest kr rha hai dialysis ke lia to jrur krana chaiye. And if it is not done then it is a threat to the life.

Chronic case me kidney permanent damage ho jati hai. Isme hum vhi procedure use krte hain or ise week me 2-3 times krana pdta hai jab tak ki successful transplant na ho jaye. Next hamare pass CAPD hai. Isme hum vhi nali dalte hain 4 hours ke lia peat me pani dete hain or vo pani zeher ko khich lete hai. Is procedure ke time patient can lead a normal life. India me ye procedure kam follow hota hai. But in western countries this procedure is very popular. Dialysis ko me last me islia choose krta hun quki iska reversibility ka chances kafi hota hai. High blood pressure, high blood sugar reversible factors hain. Agar patient inka proper treatment leta hai to is disease ka risk kam ho jata hai. What is dialysis? Dialysis is an artificial kidney. Jo hmari kidney kam nhi kr paa rhi hai vo ek nakli kidney kam kr rhi hai. Jab dialysis India me nhi tha to patient ki life ko kafi risk tha. Wiith the help of dialysis, it has become very easy for patient to live a normal life.

Thank You!

Hello,

I want to talk about kidney diseases as more and more people are getting scared of the same. I know it is becoming every relevant today. Kidney diseases can be prevented to the great extent. There is no need to be scared about it. But certain things have to be followed. People come to me and say about trace proteinuria. Now trace is very little protein in urine and they think it is abnormal. Trace proteinuria is as good as normal protein urea. Kidney does excrete in the normal people a small amount of protein about 200 mg in 24 hours. Now people come for red cells in the urine. Now 1-2 cells in urine are normal. We have to be very careful about hypertension.

It should be avoidable at the great extent. And we must maintain our BP at around 120/80 mm. Because hypertension can cause kidney damage. It also causes heart damage, affects the eyes but it is controllable. Now about diabetes, we must maintain our blood sugar level. And HbA1c should be at 6% because diabetes is as like as hypertension can also damage the eyes, heart diseases, and kidney damage. Diabetes also causes the problem with the liver. Causes non-alcoholic hepatitis. And the great contributor to all these diseases is overweight. Obesity should be avoided. Rather than getting worried about kidney disease, follow the rules like controlling your weight, eat healthily.

Take a balanced diet. Indulge in exercises. Exercise is very important as it lowers the blood pressure, blood sugar, keep cholesterol at the check. It also causes the problem of mental well-being. Avoid stress. Exercises are the very important part in preventing kidney diseases. Instead of worrying about kidney disease, let's talk about prevention. And even if kidney disease develops as of today, there is a lot which can be done to reverse it. An immunological disease can also develop. We have IgA nephropathy, FSGS, systemic lupus which is very common in young females. Now immunological disease can be picked up early and treated regularly if we have medical check-ups.

Now if the patient comes up with the symptoms like swelling of the feet, raised blood pressure or swelling of the face, now that is the time when it is late. So, my emphasis is on a regular check-up. Every person should get a check-up once a year before 40. And after 40, once in 6 months or 9 months should get checked-up because in medical check-up, you can detect almost all diseases. And detailed investigation can be done if something has been detected as an abnormality of anything. And that is how you keep diseases under check. Now if you detect any disease like diabetes, kidney disease, hypertension at an early stage than the results of the treatment is much better.

A lot of treatment available like for immunological. So, there is no scope for fear. Things depend on how we look at our health and how we prevent ourselves from getting any serious diseases. Stones in the kidney. I am seeing more and more obese people and sedentary people are more likely to develop renal calculi. We advise them to drink a lot of fluids, so many of the stones can be passed. We also must know that all rise in blood in urea, not an indicator of chronic renal failure. There are lot of indications like dehydration, gastroenteritis, especially in young children, where you can have temporarily renal damage which is reversible by hydration and medication.

A lot of things can be done at early stages to prevent kidney diseases. Smoking is completely not allowed. Stress, alcohol must be avoided. If we go for a regular medical check-up, and to see the kidney stage, urine is normal or if there is some abnormality at the early stage, you can reverse. Even if it is slightly late, today we have a lot of medications, dietary changes which must be performed and lifestyle modification. People in India are very careless about their lifestyle. They put on weight and they don't do regular exercises. Overeating, smoking, should be avoided for better health.

Thank you very much.

I am Dr. Ashok Sarin, senior consultant nephrologist at Apollo Hospital, New Delhi. The reason why I am speaking to you is that nowadays people are very concerned about their kidneys and awareness of kidney problems.

Let me tell you that the commonest causes of kidney disease are diabetes and hypertension. As you know that both these diseases are very common and they can give rise to kidney damage. But, there is a lot of prevention in this, and there are a lot of things we can do so that our kidneys remain intact even though we have diabetes and hypertension. Now, in diabetes we must maintain our blood sugar for our staying 100 mg/dL, postprandial, i.e., two hours after meal at 140 mg/dL.

If you are able to maintain your blood sugar at these levels, it is very unlikely that kidney damage will occur. Now the very important early test for finding out whether the kidneys are involved is Microalbuminuria. If your microalbumin is more than 20, then you can, under the supervision of doctors, take additional drugs known as ACE inhibitors or ARBs. But again this has to be under the consultation of your doctor. Now there are many ways which I want to tell you which can prevent you from becoming a diabetic, for example, your weight.

So, if your weight is well under control according to your height and your BMI is maintained, then this is a positive point. Coming to exercise, you must indulge in regular exercises every day, and we must take a diet which is not rich in sugar, sweets and carbohydrates, but a balanced diet of proteins, carbohydrates and vitamins. One should take a diet of about 1600-2000 calories, if a person is lean, a day. You must combine vegetables and appropriate foods in your diet. Of course, smoking is a complete no-no. So, if we adopt a good lifestyle, this will not only benefit our kidneys but also our heart, our brain and eyes. So the whole body benefits by these measures. And of course, the kidneys will always benefit.

The other common cause of kidney damage is hypertension. Very often, we ignore the idea of having regular checkups. Even after the age of 30 nowadays, regular checkup should be done, and at least once a year. If a person is about 40-50 years, then check up should be done after every six months. And very often, the things that we do not anticipate regarding high blood pressure or greater blood sugar is picked up on our blood test or during medical examination.

Today only I had a patient who was about 75 years old and he never knew that he was a diabetic. He was lean and thin, but his HP seen was 12 percent. Now that is double of what it should be, and he is a severe diabetic. And, this was picked up so late because he never went for a medical checkup. And this is very common in our country although on the other hand, there are a lot of people who are very aware and getting regular checkups done. Now our blood pressure should be around 120 over 80 mm Hg, i.e., the systolic pressure should be 120 mm and diastolic pressure should be 80 mm. And once it is 149 Hg, the blood pressure is high and it should be treated by the doctor.

Of course, the weight is a very important factor of hypertension and we find that these people who have put on weight also suffer from hypertension. In both these diseases, people wonder, “Why it has happened to me?” There may be symptoms to indicate that a person has got hypertension or high blood sugar problems. Blood sugar of 130 or 140 mg may not cause any symptoms to the patient, but it is enough to initiate an arterial pathology like diabetic arterial disease or hypertensive arterial disease.

As the arteries are afflicted with both these conditions, that is why slowly the arteries get damaged and the end organs or the target organs like the kidneys get involved. So, we must get regular checkups and if our blood pressure is well below 149 mm Hg, i.e., 155 mm or 125 mm over 80 mm Hg, then we are very unlikely to develop kidney disease because of hypertension. Of course when hypertension does develop, then blood pressure medication should be taken under the supervision of a doctor; even our diabetes dots should be taken under the supervision of a doctor. Of course, I want to add here again that exercise, i.e., regular exercise will help to mitigate the effects of hypertension and reduce the chances of hypertension and diabetes.

I’m Dr  Ashok Sarin, a senior consultant nephrologist at Apollo Hospital New Delhi. I trained in Kidney Diseases at the Belfast City and Royal Victoria Hospital in Belfast, UK, which is in Northern Ireland. And besides having an MBA I’m also FRCP, Edenborough, fellow of the Royal College of Physicians, Edenborough.

We see a lot of kidney diseases today, and people are very aware. But they get very worried as to what is happening, and there is going to be kidney failure, or kidney damage, and we are going to go on dialysis and transplant. And I want to say here, that there is a lot of prevention we can do so that we do not develop serious kidney diseases. Now the most important is that we must have a good, proper lifestyle. Like,

• We should not be obese.
• We should not have a diet which is rich in saturated fats or very rich in carbohydrate.
• We should maintain our weight, we should maintain our BMI at about 30, and we should also indulge in regular exercise.

This will keep us in a healthy situation and we will not develop serious diseases like diabetes and hypertension. But once we develop diabetes and hypertension, then we must take our treatment for diabetes very regularly, and keep our HPE1C at 6 percent, a fasting sugar of 100 milligrams percent. We should also control our hypertension, and make sure that our blood pressure is 120 by 80 millimetres of mercury. Then we should avoid smoking. As I said we should indulge in exercise.

And there are other conditions which can also cause kidney damage, which is kidney stones, urine tract infection.

So if we treat our kidney stones adequately, and avoid urinary tract infection from developing, or we treat it properly, then we are unlikely to have kidney damage, and that is how we prevent kidney disease. As I said, smoking is a complete no-no, and we should not indulge socially sometimes, but over indulgence of alcohol is forbidden. And when I said that regular medical checkups, say once a year, we will come to know if there is any indication of kidney disease, and if that happens, then we can take prompt action. For example, somebody is excreting a lot of protein, then remedial actions or further tests can be done. And kidney disease, if detected early, we have a wide range of medication at the moment, it can be treated very promptly. And we do not have to go into the stage where we say kidney failure or kidney damage, or dialysis or transplant. Now this is avoidable to a great extent. I will not say completely, but to a great extent it is possible, and that is why I am emphasizing over and over again, that this can be prevented. If we are very aware of kidney disease, and we make sure that we don’t develop kidney diseases at all.

Thank you, and in case you want to consult me, you could get in touch with Lybrate

. Thank you very much indeed.