If you thought diabetes and hypertension lead only to heart attacks, think again. And that smoking causes only lung cancer, think again. Any of these – or all together -- can also cause chronic kidney disease.

Don’t believe this? Hear it from the experts, pinch yourself and think again.

Recent data released by the national CKD (chronic kidney disease) registry has revealed that diabetic nephropathy is the topmost cause of kidney ailment in India. Considered to be even more severe than other life threatening things like cancer, CKD affects as many as 40 per cent diabetics, the registry has said.

Wait, there is more. Figures compiled from 166 kidney centres across the country between 2006 and January 2010 showed that out of the total 45,885 cases of CKD, a whopping 14,331 cases are of diabetic nephropathy.

Dr Suresh C Tiwari, director Fortis Institute of Renal Sciences, says diabetes mellitus is now the commonest cause of chronic kidney disease. High blood sugars cause hyper-filtration and glomerular hypertension, which in turn lead to progressive structural damage to glomeruli and increasing proteinuria (the presence of an excess of serum proteins in the urine).

“Kidneys are the cornerstone of the body and help it to maintain its metabolic balance, body fluids, salts and blood pressure. Many of the renal problems leading to chronic kidney disease in later life begin in the paediatric age group,” points out Sanjeev Bagai, a nephrologist and chief executive officer of Batra Hospital, who led the study conducted by Batra Hospital over a period of 15 years on 300 sick newborn babies. The study found that five per cent of them have acute kidney function derangement.

Says Tiwari: “(In case of women) the kidney diseases start during pregnancy and continue till the old age. So far no study has been done to know the various stages of kidney diseases. We have evidence that approximately 2.5 to 3 lakh people suffer from stage five kidney disease every year.”

He says the common factors that cause kidney disease are hypertension, chronic glomerulonephritis (also known as glomerular nephritis is a renal disease characterised by inflammation of the glomeruli or small blood vessels in the kidneys), diabetes, stones, urinary infections, drugs, smoking, obesity and genetic disorders.

Says Sanjeev Gulati, associate director at Fortis Hospital: “There are two major causes for kidney problems in India. First, blood pressure and second diabetes. Two third of the kidney problems can be cured if these two diseases can be controlled,”

On the rising numbers of infants affected with kidney problems Gulati said, “This is generally because prenatal ultrasound is not done well. And the problem is often found after the birth of child. They generally suffer from urinal infection.”

The most important cause is

the lack of awareness about kidney function and early diagnosis of

kidney disease. A kidney disease is diagnosed by the physician when it reaches stage three. Therefore, regular monitoring of urine examination for protein in the urine and measurement of GFR (glomerular filtration rate) is necessary for early diagnosis of kidney disease.

Tiwari says India reports the largest number of diabetes cases and diabetes is the second important cause of kidney failure, which has been studied at AIIMS by us. There are case studies to suggest that small birth weight babies may have more chances of diabetes and hypertension and later on more kidney disease.

Referring to recent development in the field of kidney treatment, Tiwari says high flux dialysis is being done with ultra-pure water that is believed to improve long term outcomes in kidney patients. Also, newer transplant protocols with drug minimisation (steroid sparing regimens and calcinurin inhibitor minimisation regimens) are being used to ameliorate drug toxicity and decrease adverse effects and improve long term graft outcomes. Recently, stem cell therapy has also been used to cure chronic kidney disease stage IV.

Last week Prof Nadey Hakim, a surgeon at London’s Hammersmith Hospital, performed a surgery where he removed a patient’s kidney using a technique he has pioneered, making a 2.5 cm cut, which is said to be a record for such operations.

To this, Tiwari says in India too laproscopic donor nephrectomy is being done with key-hole technique, where incision is about 2.5 to 3 cm in length.

The new technologies for early diagnosis of renal disease are estimation of Cystatin C in blood, which is a better marker than serum creatinine, assessment of renal reserve, estimation of urinary protein leak when it is minimal (microalbuminuria is a type of Proteinuria).

Another revelation that may change the scenario for kidney donation is a new research published in the March 10 issue of The Journal of American Medical Association. It says having only one kidney does not appear to affect the long-term survival of live kidney donors and the risk of dying from the surgery itself is very low.

The study is one of the first to assess the long term survival of some 80,347 adults in the United States, who donated a kidney to a loved one from April 1994 to March 2009, said Dorry L Segev, a transplant surgeon at John Hopkins and the paper’s lead author.

The live donors were followed for an average of 6.3 years and their survival was compared with a group of 9,364 people who had both kidneys but were similar in age and health status. The study found that the live kidney donors were no more likely to die than the comparison group.

While the risk of dying within 90 days of the transplant surgery was low — with a rate of 3.1 deaths per 10,000 donors — some people were at higher risk than others, with men, blacks and people with high blood pressure at greater risk than women, whites, hispanics and people without high blood pressure.

Tiwari said the active cadavar donor programme is the only answer for coping with the problem of end stage renal diseases. And such studies will have a positive impact.