The Kidneys are the major urinary system each joined to the bladder by a tube called ureter which conveys urine from the kidneys to the bladder for storage. A contraction of the bladder results in urine being expelled through the urethra. Size of kidneys in adult measures about 12-14cm approximately the size of a clinch fist. They are supplied by *blood through renal arteries, branches of the aorta, and blood leaves the kidneys through renal veins. Each kidney contains approximately one million nephrons. These are tiny filters which removes waste materials from the blood. Each nephron has a filter head known as glomerulus, which contain a network of thin-walled capillaries which allow fluid and waste products to filter into the glomerular capsule and the filtrate passes into the tubule of the nephron. This glomerular filtrate may reach 180 litres a day and volume of urine excreted is about 2litres a day. Important salts and substances are reabsorbed by the tubules, except waste products, to prevent excessive loss of fluid. Fluids that emerge from the end of the nephron tubule is urine. It drains into the pelvis of the kidney for passage down the ureter.

 
1) Removal of waste products of metabolism from the body. 
2) Maintaining body fluid from becoming too acid or alkali by excreting or retaining hydrogen ions and thus maintaining the acid alkali of the blood at constant level. 
3) Regulate fluid balance by excreting more urine when more fluid is taken in and retaining fluid when more is loss through perspiration. 
4) The kidneys secrete important hormones into the blood stream which include erythropoietin (which stimulates red blood cell production in the bone marrow) and angiotensin (which help to regulate blood pressure). 
5) Vitamin D, which prevent bone disease, becomes fully active after undergoing changes in the kidney.

When To Treat Renal Failure?

When the kidneys are not functioning properly and when urea and creatinine rise in the blood level. Not always but usually the urine output falls. It can occur suddenly (acute) or gradually (chronic) over a period of time either months or years. 

The above diagram shows the insertion of an endoscope through the urinary tract to detect for symptoms of stones right up to the kidney. This assist the doctor to locate the exact location of the stones in the urinary tract system where doctor can perform operation to have the stones removed. This is only done where the kidneys are still healthy and functioning but if blockage is severed and no action is taken, then it can lead to complications as explained below.

Acute Renal Failure

There are many reasons that leads to acute renal failure but it can be grouped into the followings:-

1. Acute tubular necrosis - may be due to injury to kidney as a result of of an impaired blood supply or due to nephrotoxic substances. There are also several causes, such as:

a) A severe shock which result in the blood pressure falling so low that the blood ceases to flow to the kidneys. Shock may result from severe blood loss, heart failure or infections or blood poisoning (speticaemia).
b) Mismatched blood transfusion. The haemoglobin which is released from red blood cells is highly toxic to the kidney. 
c) Severe muscle injury allows myoglobin to escape from the cells and this like haemoglobin, is toxic. 
d) Wrong intake of drugs such as sulphonamides, gentamicin are known to damage the kidney. 
e) Poisons eg. Mercury salts and paraquat (weed-killer) can damage the kidneys permanently.

2. Damaged blood supply to the kidneys which may be due to both renal arteries or both renal veins. It can happen in patients having with severe atheroma of the aorta (degeneration of the arteries due to the build-up of fatty deposits).

3. An obstruction occur anywhere between the renal pelvis and the urethra above the bladder. This obstruction can be due to kidney stones that are blocking the urine passage thus resulting the kidneys unable to excrete urine. Other obstruction may be tumours in the bladder or tumours of the prostate or cervix which block the flows of urine from the bladder to urethra.

4. Interior renal disease including inflammatory diseases of the glomerulus (glomerulonephritis) or the surrounding tissue (acute interstitial nephritis).

Occasionally patients still pass large volumes of urine but unfiltered properly resulting in the blood levels of the urea and creatinine rise (polyuric renal failure). When conditions worsen, patients has to undergo dialysis. Patients normally would experience vormitting, drowsiness and convulsions due occur.

There are two types of dialysis namely Haemodialysis and  Peritoneal Dialysis. 
 
Haemodialysis - this involves passing the patient's blood through a kidney machine where waste products from metabolism are removed. During the filtering process, the patients must receive anticoagulants (which can be dangerous if the patient is bleeding eg. from peptic ulcer). Haemodialysis is preferable for the severely ill patient. 

Peritoneal Dialysis - involves running dialysis fluid into the peritoneal cavity (the serous (watery) membrane lining the cavity of the abdomen)  via a special cantheter. The peritoneum acts as a dialysis membrane across which potassium and other waste  products can diffuse into the dialysis fluid. The fluid is repeatedly run in and out of of the peritoneal cavity in cycles of 30 to 60 minutes or even longer. It may take several hours to see the improvement of the patients' well-being. This type of dialysis is cheap and simple and can be carried out easily in a clinic or done at home. Dialysis can be withdrawn when the patient begins to pass urine.

It is most important that Dialysis Centre must have qualified personnel and nephrologist to ensure treatment are done safely and patients medical record must be checked periodically. In many countries, some dialysis centres are run by non-governmental organization, some for profit making but it is shocking to learn that many of these centres employs lay people who had neither the medical experience nor qualification to care for kidney patients.

For kidney transplant patients, it is a fact that not all kidneys received by the patients are accepted by the body as these foreign kidney are treated as antigen and it is most likely to be rejected by the body's antibodies produced by lymphocytes. Several approaches are being tried to overcome rejection by means of:-

1. Steroids - a) Prednisone helps to suppressed the antigen-antibody reaction but large dose has to be given. b) Cyclosporin - another alternative drug beside prednisone, also have the similar action.

2. Azathioprine - a cytotoxic drug, prevents the production of antibodies (this is termed as immunosuppression) and because of its toxic effect, it has to be administered properly.

3. Antilymphocytic serum - are use to suppress the lymphocytes which produce antibodies.

With these precautions, organs that are transplanted may function well for a period of time but patients has to take the drugs for the rest of their lives. At present, the organ to be transplanted has to be removed soon after the donor's death or from the living donor who is willing to donate one of his/her kidney during the time of operation as no method is available for preserving. Many patients are 'buying' organs legally or illegally from 'donors' and most of these 'donors' esp. from India (who had to sell their kidney to support their family) and China, where these donors are prisoners awaiting for execution. Patients are notified and are on standby at the military hospital and immediately after the execution, the organ/organs are removed from the prisoners and transplanted into the patients. The condemned prisoner has agreed to sell his body organs where part of the money are given to his family. Though it seems cruel but many are willing to sell as a mean of giving back to their family and giving life to another person. Average cost for a kidney transplant would cost no less than US$20,000 excluding monthly medication of US$500 or more. Many organizations are seeking public donations as most patients have lost lifetime savings as well as jobs.

As cost of treatment keeps on escalating, patients should consider seeking for alternative medicine which may provide some solution and hopefully they might not have to go for transplant and take antibodies drug  which is not cheap and sometimes the possibility of the body rejecting the transplanted kidney within a couple of days or weeks which is life threatening. Nevertheless, for many who had the detection of stones in the early stage, many do go for surgery to remove the stones as they could not stand the pain and it is a faster temporary solution. Although patient has surgery done to removed the stones, they could still take alternative medicine to dissolve and discharged the fine stones that is lodged in their kidneys.

Below are some herbs commonly use to invigorate, tone up or assist in treating  end-renal problem.

Shu Di 熟地	Pienzichow 扁畜草
Gold Coin Grass 金錢草	Cher Qian Chow 車前草
Zhimitechow 祈麥草	Moot Thoon Chow 木通
Sertweichow 石葦草	Wai San 淮 山