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Table of Content
Preface and Contents

Preface and Contents

Guide for Kidney Patients

Complete Guide for Kidney Patients

Save Your Kidneys

Second Edition

Comprehensive Information About
Prevention and Treatment of Kidney Diseases

Edgar V. Lerma

Chicago USA

Sanjay Pandya

MD, DNB (Nephrology)
Rajkot, India

Elizabeth Angelica Lapid-Roasa

Manila, Philippines

Coralie Therese C. Dioquino-Dimacali

Manila, Philippines

Save Your Kidneys


Samarpan Kidney Foundation,

Samarpan Hospital, Bhutkhana Chowk,
Rajkot 360002( Gujarat, India)
E-mail: [email protected]


© Samarpan Kidney Foundation

All rights are reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems without written permission of publisher. This book is for publication in India and cannot be exported without prior permission in writing from the publisher. In case of dispute all legal matter to be settled under Rajkot jurisdiction only.


First edition: 2012

Second edition: 2015


Edgar V. Lerma, MD, FACP, FASN, FNKF

University of Illinois at Chicago College of Medicine,

Chicago (Illinois, USA)

Sanjay Pandya MD,DNB (Nephrology)
Samarpan Hospital, Bhutkhana Chowk,
Rajkot 360002 (Gujarat, India)

Table of Contents

Part1: Basic Information about Kidney

Chapter 1 Introduction 1
Chapter 2 Kidney and its Function 3
Chapter 3 Symptoms of Kidney Diseases 9
Chapter 4 Diagnosis of Kidney Diseases 11
Chapter 5 Major Kidney Diseases 18
Chapter 6 Myths and Facts about Kidney Diseases 24
Chapter 7 Prevention of Kidney Diseases 28

Part 2: Major Kidney Diseases and their Treatment

Kidney Failure

Chapter 8 What is Kidney Failure? 35
Chapter 9 Acute Kidney Failure 37
Chapter 10 Chronic Kidney Disease: Causes 42
Chapter 11 Chronic Kidney Disease: Symptoms and Diagnosis 44
Chapter 12 Chronic Kidney Disease: Treatment 51
Chapter 13 Dialysis 59
Chapter 14 Kidney Transplantation 80

Other Major Kidney Diseases

Chapter 15 Diabetic Kidney Disease 99
Chapter 16 Polycystic Kidney Disease 109
Chapter 17 Living with a Single Kidney 115
Chapter 18 Urinary Tract Infection 119
Chapter 19 Stone Disease 127
Chapter 20 Benign Prostatic Hyperplasia (BPH) 143
Chapter 21 Kidney and Drugs 157
Chapter 22 Nephrotic Syndrome 162
Chapter 23 Urinary Tract Infection in Children 177
Chapter 24 Bedwetting in Children 189

Diet in Kidney Diseases

Chapter 25 Diet in Chronic Kidney Disease 195
Glossary 212
Abbreviation 219
Common Blood Tests for Kidney Patients 221
Index 223

Preface to Second Edition

In writing the first edition of "Save Your Kidneys," Dr. Sanjay Pandya sought to write 'a book that would provide basic understanding and guidelines to prevent common kidney diseases.' Contrary to common nephrology texts, this book is primarily geared towards the layman.

This second edition is the collaborative result of the work of physicians with interest in further empowering our patients and their families with knowledge pertaining to various issues pertaining to kidney diseases. It is divided into two parts. The first part deals with 'Basic Information about the Kidneys,' which allows the reader to become familiar with the normal structure and function of the kidneys and also introduces the use of several technical terms. The second part deals with more specific kidney ailments, e.g., acute kidney injury, chronic kidney disease, diabetes, dialysis and kidney transplantation, etc.

The last chapter which is the work of Dr. Pandya himself talks about 'Diet in Chronic Kidney Disease.' It must be noted that the recommendations may not necessarily be generalizable to all populations because of various unique cultural and ethnic differences.

There is also a Glossary and Abbreviation List that the readers may find very useful as they read through the text.

Consistent throughout the book, is the use of vernacular that is familiar to lay people. We believe that this is important in bridging the communication gaps between patients and their care providers that can sometimes be brought about by medical jargon.

I am particularly thankful to Dr. Pandya and Dr. Vaccharajani for giving me the opportunity to contribute to this edition. I am also thankful to my colleagues Drs. Coralie Therese Dioquino-Dimacali, Elizabeth Angelica Lapid-Roasa, and Filipina Cevallos Schnabel for their contributions in the arduous task of editing this book. "Think like a wise man but communicate in the language of the people."

- William Butler Yeats

Clinical Professor of Medicine
Section of Nephrology
University of Illinois at Chicago College of Medicine
Associates in Nephrology, SC
Chicago, IL

Preface to First Edition

Let Us Prevent Kidney Diseases...

The book “Save Your Kidney” is an effort to provide basic understanding and guidelines to prevent common kidney diseases.

In the last few decades there has been a dramatic and alarming increase in the incidence of kidney diseases. Chronic kidney disease is common and incurable. Awareness of the causes, symptoms and measures for prevention of these kidney ailments is the best way to counter this disturbing increase. This book is our humble attempt to provide that significant information to a layman in simple words.

Early diagnosis and treatment of this disease is beneficial as it provides long term benefits at low cost. Due to lack of awareness, very few people recognize signs and symptoms indicating a possibility of kidney disease, resulting in hazardous delay in early diagnosis. Treatment of advanced stage of chronic kidney disease such as dialysis and kidney transplantation is prohibitively expensive and in a country like India only less than 10% of patients can afford it. Hence early diagnosis and treatment remains the only and the most feasible option to decrease escalating cases of chronic kidney disease in our country.

When diagnosis reveals that a person is suffering from kidney disease, the patient and his family naturally become seriously worried. The kidney patients and their family members wish to know everything about the disease. But it is not possible for the treating doctor to provide a large volume of detailed information. We hope that this book will provide that missing link between the patient and the doctor. Anyway, it is rather helpful to have an informative book to read at a convenient time and refer to it as often as required. It provides all basic information about symptoms, diagnosis, prevention and treatment of different kidney diseases in simple and easy language. Details of selection and precautions

in dietary recommendations for different kidney diseases are also included here. We need to emphatically and unequivocally state here that the information given in this book is not medical advice; it is for informational purposes only. Self medication or dietary modification by reading the book, without the advice of the doctor can be dangerous and is most certainly not recommended here.

This kidney guide will be useful not only to the kidney patients and their family but also to those at the risk of developing kidney disease. And, indeed, it will also be of educational importance for all those individuals who value awareness. Medical students, doctors, paramedicals are sure to find this book a handy reference guide. We are thankful to Dr Gaurang and Dr. Susmita Dave, Mr. Ayaazkhan Babi and Neha Babi for their valuable suggestions and help to make this kidney guide easy to read and very clear to understand. We take great delight in making a special mention of our dear children Isha and Rohan who enthusiastically shared our sense of fulfillment and happiness in the preparation of “Save Your Kidney”

I hope the readers will find this book useful and informative. Sugestions to further improve this book are always welcome.

Wishing you all sound health,

Dr. Sanjay Pandya
Priti Pandya

Rajkot, India

About the Author of First Edition

Dr. SANJAY PANDYA, MD, DNB (Nephrology),Nephrologist

Dr. Sanjay Pandiya

Dr. Sanjay Pandya is a senior nephrologist practicing in Rajkot (Gujarat - India). M.D. He earned his Doctor of Medicine (Internal Medicine) from M. P. Shah Medical College, Jamnagar (Gujarat) in 1986 and DNB Nephrology from the Institute of Kidney Disease and Research Center, Ahmedabad in 1989. From 1990 onwards he is practicing as Nephrologist at Rajkot (Gujarat), India.

Dr. Pandya is actively involved in kidney disease education. Kidney book for patients in English, Hindi, Gujarati and Kutchi languages is authored by him.

“Kidney Education Foundation” has been formed by Dr. Pandya with the mission to spread awareness amongst a large number of people for prevention and care of kidney disease.

With the help of a team of dedicated nephrologists from different parts of the world, educational books for kidney patients have been prepared in 30 languages.

In order to help maximum number of people and kidney patients in different parts of the world, website has been launched by Dr. Pandya and his team. This website permits free download of 200-paged kidney books in 30 languages. This kidney website is very popular and has received more than 33 million hits in the first 80 months.

About Authors/Editors of Second Edition


Dr. Lerma

Dr. Edgar Lerma earned his Doctor of Medicine from the University of Santo Tomas Faculty of Medicine and Surgery in Manila/ Philippines. He completed his Residency Training in Internal Medicine at the Mercy Hospital and Medical Center and the University of Illinois at Chicago College of Medicine. In addition, Dr. Lerma completed a Fellowship in Nephrology and Hypertension at Northwestern Memorial Hospital, the Feinberg School of Medicine at Northwestern University, and the Veterans Administration (VA) Lakeside Medical Center in Chicago, Illinois.

Currently, Dr. Lerma is the Educational Coordinator for the Section of Nephrology at UIC/ Advocate Christ Medical Center in Oak Lawn, Illinois, USA. He holds the academic rank of Clinical Professor of Medicine with the University of Illinois at Chicago College of Medicine. He is also a member of Associates in Nephrology, S.C.

Dr. Lerma has many international publications at his credit. He has edited and authored many popular books such asNephrology Secrets, Current Diagnosis & Treatment Nephrology & Hypertension, Renal Disease, An Issue of Clinics in Geriatric Medicine, Updates in Geriatric Nephrology, Current Essentials: Nephrology & Hypertension, Diabetes and Kidney Disease, Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation, Kidney Diseases and Hypertension,Kidney Transplantation: Practical Guide to Management, Diseases of the Parathyroid Glands, Dyslipidemias in Kidney Disease, and Dermatological Manifestations of Kidney Disease.



Dr. Lapid-Roasa obtained her medical degree at the University of Santo Tomas, Faculty of Medicine and Surgery in Manila, Philippines. She finished training as a resident in Internal Medicine and fellow in Nephrology at the University of Santo Tomas Hospital. She is a Diplomate and Fellow of the Philippine College of Physicians. She has served as a Board Examiner for the Philippine Specialty Board of Internal Medicine. She is likewise a Diplomate and Fellow of the Philippine Society of Nephrology and is a current member of its National Board of Trustees. She is also a Fellow of the Philippine Society of Hypertension.

Dr. Lapid-Roasa is an Associate Professor at the Faculty of Medicine and Surgery of the University of Santo Tomas. She teaches in the Departments of Physiology and Internal Medicine. She is the Chief of the Section of Nephrology of the UST Faculty and Hospital.

She has chaired the Clusters on Patient Care and Research of the PSN. She has contributed to the Asian Lupus Nephritis Network endeavors on the Asian guidelines and perspective on lupus nephritis management. She has been active in module development for basic immunology, renal physiology and clinical nephrology at the UST Faculty of Medicine.



Dr. Coralie Therese Dioquino-Dimacali earned her Doctor of Medicine from the University of the Philippines College of Medicine (UPCM). She completed her Residency Training in Internal Medicine and Fellowship in Nephrology at the Philippine General Hospital where she served as Chief Resident and Chief Fellow, respectively. She also completed a Fellowship

from the Foundation for the Advancement of International Medical Education and Research (FAIMER), Philadelphia from 2008-2010. Dr. Dimacali served as President of the Philippine Society of Nephrology (PSN) from 2014 to 2015, after serving for several years as Officer and member of its Board of Trustees. She served as Chair of the Subspecialty Board of the PSN and was conferred a Life Fellowship to the PSN in 2008.

She was also conferred a Special Award in Medical Education in 2006 by the PSN for her contribution in ensuring the quality of the Specialty board examinations and nephrology training programs in the Philippines. She is a most sought after lecturer with a special interest in nephrolithiasis, arterial blood gas, and fluids and electrolytes. Currently, Dr. Dimacali is Associate Professor of Medicine and is Associate Dean for Academic Development of the University of the Philippines College of Medicine, a position she has held since 2012. She is also the recipient of the Dr. Victor Jr. and Maria Teresita Nañagas Professorial Chair.


Dr. Filipina

Dr. Filipina Schnabel is a graduate Doctor of Medicine of the University of Santo Tomas Faculty of Medicine and Surgery, Manila, Philippines. She has special interests in research and Public Health thus she pursued Masters of Public Health majoring in Epidemiology and Biostatistics at the University of the Philippines right after medical school. She took her residency in Otolaryngology-Head and Neck Surgery at the University of the Philippines- Philippine General Hospital and had her Fellowship in Laryngology, Voice and Swallowing Disorders at the Grabscheid Voice Center, Department of Otolaryngology, Mount Sinai School of Medicine in New York, New York. She further pursued Advance Laryngology at the Vanderbilt Voice Center in Nashville, TN. She held the position