By Dr David Delvin

Your two kidneys are absolutely vital to you! Without them, you’d die – very rapidly. Yet the extraordinary thing is that very few people know much about their kidneys, or even where they are.

Some years ago, I arranged (and judged) an item on BBC-TV’s ‘The Generation Game’. The idea was that contestants had to stick labels onto live models showing where they thought various bits of the body are located.

Practically nobody knew where the kidneys are! They stuck the labels in all sorts of barmy places, but not the right ones. Like many folk, they got badly mixed up between the kidney and the liver.

Where are your Kidneys?

So where are these mysterious kidneys? Well, they’re at the very back of your abdomen. If you stick the palms of your two hands on your back, just where you can feel your lowest ribs, then your finger-tips will be just over your kidneys.

They’re about four inches (10 cm) long, and about two and a half inches (6.5 centimetres) wide. And yes, they are kidney-shaped! They're dark brown in colour, and have a nice, smooth surface.

In fact, they look exactly like the animal kidneys which you see in butchers’ shop windows. Hope this doesn’t put you off!

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What do they do?

OK, so I've said that the kidneys keep you alive. But how? What do they actually do? 

Well, their vital role is to get all of the impurities and waste products out of your blood. If they didn’t do this, the waste and the poisons would just build up and up and kill you (probably within a few days).

So how do they do this? 

They work as a sort of filter. All of your blood passes through your kidneys. As it does so, the delicate kidney tissues filter out the nasty stuff and get rid of it – in your urine.

How does this happen?

Urine is actually produced by the kidneys. Indeed, you may have noticed that the kidneys which you may buy at the butcher’s often smell slightly of urine…. Yuk!

Cunning mechanisms within the kidney ‘dump’ all the waste products into this fluid. And then it flows down two slim tubes (called the ‘urethers’) which lead to your bladder. Urine is stored within the bladder until you get a chance to go and ‘spend a penny’.

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Disorders of the Kidney.

In a moment, we’ll come to what you can do to protect your kidneys from harm. But first let’s look at some disorders of the kidney – beginning with the common ones, and then the less common afflictions.

Common disorders:

Pyelitis. This is pronounced ‘Pie-ell-eye-tiss’. A lot of people think it’s something to do with piles!

But it isn’t. It’s an inflammation of the kidney, caused by infection. It’s particularly common in women, especially during pregnancy.

Chief symptoms are pain in the kidney area.  Plus fever and often bouts of severe shivering. Treatment is based on antibiotic therapy. Hospital admission may be necessary.

Kidney Stones Little stones – just like pieces of gravel form in many people’s kidneys. Unfortunately, they tend to jam in the tube which carries the urine away from the kidney. The result is really intense pain, which is called ‘renal colic’.

Very often, the stone will pass out in the urine. But it may have to be removed by a surgeon. These days, it’s possible to crush stones by simply directing a shock wave through the body.

Kidney Injuries Kidney injuries mainly occur as a result of contact sports, or as a result of an assault or a road accident. Symptoms include pain in the back and blood in the urine. Anyone who seems to have damaged a kidney should be admitted to hospital for observation.

Dropsy This is an English word which means fluid in the tissues. Medically, its known as ‘oedema’ or (if you're American) ‘edema’. Dropsy is very, very common, especially in older people. The commonest site is the ankle.

It can be due to various causes, but very frequently it happens because the ageing kidneys just lose their power to ‘process’ blood. There are various ways of treating it, but a usual one is the administration of diuretics, which most people call ‘water pills’. These help the kidneys to get rid of more fluid and so draw the water out of the ‘dropsical’ issues. In other words, your ankles get slimmer.

Less Common Disorders:

Acute Kidney Failure (Acute Renal Failure). This is a very serious condition in which the kidneys just stop working. So the person stops producing urine. This means his life is in danger.

There are many possible causes, including burns, crushing road accidents, illegal abortion, accidental poisoning, and overdoses of certain drugs. The patient may have to be put onto an ‘artificial kidney’ (see below).

Chronic Kidney Failure (Chronic Renal Failure) This is a condition in which the kidneys have been permanently damaged by some disease, such as nephritis or diabetes. Treatment is enormously complicated, and may involve either going on an artificial kidney, or having a kidney transplant (see below).

Kidney Tumours Thank heavens, these are rare. They occur mainly in two groups of people; young children and the over-50s. Chief symptom that you should be aware of is passing blood in the urine. Though this can have many causes (for instance, infection) it is a sign which must never be ignored. Always report it to a doctor.

Polycystic Kidneys This is a congenital condition, believed to be caused by a gene defect. So it tends to run in families. The kidney is filled with cysts – that is, little sacs of fluid. 

Most people don’t know they’ve got the condition until middle age or later life. Symptoms include pain around the kidneys, and blood in the urine.

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Protecting Your Kidneys

By now, you'll appreciate that your kidneys are pretty vital! So it’s worth taking care of them. Sensible precautions include the following:

°   Try to avoid any injuries to your kidney region. If you do sustain a heavy blow or kick around there, be on the alert for blood in your urine. If in doubt, consult a doctor.
°   Get urinary infections treated promptly. Infection in the urinary passages – particularly pyelitis (see above) can damage the delicate kidney tissue. If you think you might have such an infection, take a urine sample – in a sterile container – to a doctor.
°   Never exceed the stated dose of any medication. That includes everyday pain-killers like Aspirin and Paracetamol. A lot of medically prescribed pills can damage the kidneys if you take too many of them. This is particularly likely to happen in the elderly.
°  Avoid illegal drugs – particularly injectables.
°  Note: There is a very widespread belief that Alcohol damages your kidneys! This isn’t really true. In fact, it’s the liver that alcohol tends to damage.

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The Artificial Kidney

First developed in the 1950s, artificial kidneys are now widely used. Basically they are machines which filter off the impurities from your blood. So they are used by people whose own kidneys have ‘packed up’.

Unfortunately, the artificial kidney isn’t a neat little device which you can have inserted inside your body. It’s a large assemblage of laboratory equipment, including pumps and filters. Generally, you lie in a bed alongside it. Your body is connected to it by two tubes – one of which takes the blood from your body, and one of which returns it to you (via needles).

A session on an artificial kidney (referred to as a dialysis session) generally takes several hours, and most people need at least two sessions a week.

So it’s time-consuming, very expensive and really not a lot of fun for the patient. A particular problem is that people tend – after a while – to ‘run out of’ suitable veins. Therefore, if possible it is often better to have a kidney transplant (see below).

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Kidney Transplantation

Kidney transplantation was introduced about 50 years ago, and is now highly successful. So if a person’s own kidneys have permanently ceased working, a transplant can prove a wonderful way of saving their life.

What generally happens is that a surgeon opens up the patient’s abdomen, and inserts the ‘donor’ kidney – joining up its ‘plumbing’ to the tubing that is already there. If the transplant is successful, the new kidney will then start filtering the person’s blood, so that he/she produces urine.

Unfortunately there are nowhere near enough donor kidneys. In Britain, there are far more people with kidney failure than there are donors. So carrying a donor card on you is really a good idea.

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Kidney Questions:

Q. Since I turned 50, I keep getting pain in my back. Is this due to my kidneys?

A. Unlikely sir. Most people who have backache turn out to have something wrong with their backs – that is, the spine or its associated discs, muscles and ligaments. But if you are also getting urinary symptoms, it would be well worth checking with your doctor.

Q. I lost a kidney when I was badly hurt in a car crash. Will the other one keep me going?

A. Yes, ma’am. It’s very fortunate that we have two kidneys. If one of them is damaged or has to be removed, then the other one will generally do the work of two – provided that it is healthy.

Q. I’m 65, and have to have a kidney removed next month. I am absolutely terrified that they might take out the wrong one! I have heard that this can happen. Is it possible?

A. Well, I can’t deny that such things do happen, but they are very rare. In one much publicised case not long ago, a man with a badly-diseased kidney was supposed to have it removed. Instead, the surgeon took out the good one. This meant that the patient had no working kidneys at all, and the poor chap died a short time later.

However, the fact is that operating theatre teams try to take every precaution to make sure that such tragedies do not occur. If you want to take your own precautions, then check your pre-operative consent form very carefully before you sign it – in order to make sure that it specifies the correct kidney.

I have also known patients write the words ‘this side’ on their tummies before going to theatre!

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Non-Kidney Questions:

Q.  Sadly, my husband is losing his faculties, thanks to Alzheimer’s. He is lucid most of the time, but the trend is downhill. I am really worried about his finances. Soon there will come a time when he won’t be able to handle cheques and bills and bank accounts. Any ideas?

A. Anyone who has a partner with Alzheimer’s should talk to them about getting what’s called ‘Enduring Power of Attorney’. This is a legal arrangement whereby one person can take responsibility for another’s financial affairs.

If your husband agrees, then the next thing to do would be to consult your solicitor or bank manager. Incidentally, it doesn’t have to be you who takes over the financial reins. You and your husband might prefer to nominate a daughter or son, or a reliable friend.

Q. My doctor has recently put me on medication for blood pressure. Am I right in assuming that these pills will cure the problem after a few months?

A. No, I'm afraid that blood pressure medication generally has to be taken for life. It’s unusual for high blood pressure to be actually cured. However, if you happen to be overweight, you might be able to achieve a ‘fall’ to normal levels by simply slimming down to a good, healthy weight.

Q.  I’ve gone a bit bald since I retired. Would there be any point at my age in trying that anti-baldness drug that you put on your scalp?

A. Yes sir: there are no age limits for using the anti-baldness scalp application. It’s called 'Regaine’, and these days you can buy it, without prescription, at any chemist’s. Costs vary a little, but generally you can get a month’s supply for between £20 and £25.

There is also a newer anti-baldness drug which has to be taken by mouth. It’s called Propecia. It is prescription only, so you would have to get it through a doctor. Also, it does have quite a few side-effects, including possible interference with sexual function.

Q. My husband has always wanted to visit Athens, and wants to take me there in August. We’re both 70, by the way. The only problem is that I don’t tolerate the heat at all well. Do you think it would be all right for my health?

A. No, I do not ma’am. Greece is a beautiful and fascinating country, but in August the Greek mainland is often unbelievably hot. People actually die from heatstroke. Why not postpone the trip till the autumn or the spring, when the weather should be lovely – and the temperatures will be much more bearable for an elderly person?

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