WHITE SUGAR AND GL CALCULATIONS FOR SOME HOME MADE SWEETS WITH ADDED SUGARS

GL CALCULATIONS FOR HOMEMADE SWEETS

White sugar or common table sugar is technically known as sucrose. It is a refined sugar prepared by micro crystallization of cane sugar juice. The juice is treated by various stages and finally, before crystallization, it is bleached by concentrated hydrochloric acid to become crystal clear colorless syrup.

Sucrose is a disaccharide carbohydrate that contains

one molecule of glucose and one molecule of fructose.

 Sucrose contains fructose and hence it is sweeter than glucose but yield lesser calories than glucose.

The GL calculations for sucrose:

The GI of sucrose is                       =63

That means a 50gm sucrose would raise the blood glucose level only 63% of that raised by 50gm of pure glucose.

The glycemic load for 10gm (one tablespoon) of sucrose is only 6 (below ten->10) and it is safer than one tablespoon of pure glucose for a diabetic patient.

GL for Table (White) Sugar:

Total carbs                                           =10gm

Fibers                                                   =0

Aailable carbs (n)      10-0                   =10gm

GI                                                        =63

GL=[nxGI]/100 =[10x63]/100            =6.3✔️

Hence a diabetic patient can safely consume table 

sugar 10-15 gm/day.

The following examples are how to calculate the glycemic load (GL) for the specific portion of the homemade sweets that is safe to be taken by a diabetic.

When calculating the GL of the sweet, calculate the GLs of each main carbohydrate and sugar ingredients and leave the noncarbohydrate parts like proteins, fats, and cooking oil.

Nuts and raisins if occupy a considerable major portion then their GLs also should be included according to their weight.

The sum of all these GL values will yield the GL of the sweet.

EXAMPLE-1-ROSOGOLLA (50gm):-

There are two ingredients of carbohydrate part of the sweet.

1.Paneer.  2.white sugar.

GL of Paneer:-(50gm):-

Total carbs                                     =15gm

Fibers                                            = 0gm

Available carbs (n) =15-0             =15gm

GI                                                  =27

GL=[nxGI]/100 =[15x27]/100      =4.05*

GL for white sugar(10gm):-

Total carbs                                     =10gm

Fibers                                             =Nil

Available carbs (n)                        =10gm

GI                                                  =63

GL=[nxGI]/100=[10x63]/100       =6.3*

GL of Rosogolla(50gm)=4.05+6.3 =10.35✔️

Hence a diabetic can take safely up to 50gm on a special occasion.

EXAMPLE-2-GULAB JAMUN:(50gm):-

1.White Sugar (20gm):-

For 10gm the GL                             =6.3

ஃ For 20gm     2x6.3                       =12.6

2.Milk Powder:-

Total carbs                                      =20gm

Fibers                                              =Nil

Available carbs(n)                          =20gm

GI                                                   =45

GL=[nxGI]/100 =[20x45]/100       =9

GL of the gulabjamun(50gm)=12.6+9=21.6❌

ஃFor 20gm  [21.6/50]x20               =8.6✔️

Hence a diabetic can safely take gulabjamun up to 20gm on a special occasion.

EXAMPLE-3-WHEAT HALWA(100gm):-

Total carbs                                          =28gm

Sugars                                                 =20gm

Fibers                                                  =0

Available carbs                      28-20    =08gm

1.White Sugar (20gm):-

GL for 20gm sugar                              =12.6*

2.Wheat (Atta) Flour(08gm):-

Total carbs                                           =8gm

Fibers                                                   =0

Available carbs                                    =8gm

GI (Atta)                                              =54

GL (For 8gm)=[nxGI]/100=[8x54]/100    =4.32*

Total GL (For Halwa) = 12.6+4.32             =16.92❌

For 100gm, the GL is                         =16.92

ஃFor 60gm [16.92/100]x60                =10.1✔️

Hence a diabetic can take wheat halwa upto 60gm on a special occasion.

DIABETIC CARE-HOW TO TAKE FOODS WITH HIGH GI- [3.DAIRY PRODUCTS]

DELICIOUS DIABETIC FORMULAS-[MILK AND MILK PRODUCTS]

A diabetic can deliciously taste and enjoy milk and milk products every day without a miss but in limited quantities. The limits can be calculated very easily by using the glycemic load formulas.
Beware of milk products as they have no dietary fibers in their recipe. Still, you can taste them by using the Glycemic Load formulas.

FULL-FAT MILK (250ml):-

Total carbs                                    =11.65gm

Fibers                                            =0gm

Active carbs(n)    11.65-0              =11.65gm

Glycemic Index                             =41

Glycemic Load [nxGI]/100 

             =[11.65x41]/100  =4.8 (<10)✔️

Hence a diabetic can drink full-fat milk up to 300ml day safely as there are no fiber contents.

ICE CREAM REGULAR (50ml):-

Total carbs  (without added sugar)   =15gm

Fibers                                               =0gm

Active carbs (n)  15-0                       =15gm

GI                                                     =57

GL=[nxGI]/100=[15x57]/100             =8.55✔️

Hence a diabetic can take the cream (Regular) without any added sugar daily.

SKIMMED MILK (250ml):-

Total carbs                                 =12.25gm

Fibers                                         =0gm

Active carbs 12.25-0  (n)             =12.25gm

GI                                               =32

GL [nxGI]/100=[12.25x32]/100  =3.92(<10)✔️

Hence a diabetic patient can safely take 250-300 skimmed milk daily.

ICE CREAM PREMIUM (50ml):-

Total carbs                                 =11gm

Fibers                                         =0gm

Available carbs (n) 20-0             =11gm

GI                                               =38

GL [nxGI]/100=[11x38]/100        ≃4.2✓

Hence a diabetic can take premium ice cream

50-75ml daily.

FRUITY YOGURT WITH LESS FAT(200ml)

Total carbs                                      =18gm

Fibers                                             =0gm

Aailable carbs (n)   18-0                 =18gm

GI                                                    =33

GL [nxGI]/100    [18x33]/100          ≈6✔️

Hence a diabetic can safely consume up to 200ml of fruity yogurt with reduced-fat daily.
1. To see a reference chart for GI and GL for a variety of milk products please click here
2. To learn the fundamentals of GI and GL please click here

DIABETIC CARE-HOW TO TAKE FOODS WITH HIGH GI- [2.FOOD-GRAINS]

DELICIOUS DIABETIC FORMULAS-[2.FOOD-GRAINS] 

BLACK RICE (100gm):-

Total carbs                                         =34gm

Fibers                                                 = 01gm

Available carbs (n)        34-01           =33gm

Glycemic Index (GI)                         =50

ஃ Glycemic Load (GL)=[nxGI]/100

                               =[33x50]/100 =16.50(>10)❌

For 100gms the GL                           =16.5

ஃ  For 60gms the GL =[16.5/100]x60 ==9.6✔️

Hence a diabetic patient can consume 60gms of black rice safely.
WHITE RICE (100gms, Cooked, Long-Grain):
Total carbs                                        =28gm
Fibers                                                = 0.4gm
Active carbs   (n)                28-0.4    =27.6gm
Glycemic Index  (GI)                        =89
Glycemic Load =[nxGI]/100
                          =[27.6x89]/100       =25(>10)❌
For 100gm the GL                            =25
ஃ For 40gm,the GL    [25/100]x40  =10✔️
Hence a diabetic can safely consume upto 40gm of long grain cooked white rice safely.
BROWN RICE (100gm):-
Total carbs                                       =23gm
Fibers                                              = 1.8gm
Available carbs  (n)      23-1.8        =21.2gm
Glycemic Index    (GI)                   =   68
GL (100gm) =[nxGI]/100 
                     =[21.2x68]/100         =14.42(>10)❌
ஃFor 70gm the GL[14.42/100]x70  ≃10✔️
Hence a diabetic can safely take brown rice up to 70gm daily.
WHOLE WHEAT KERNELS (50gm):-
Total carbs                                           =44gm
Fibers                                                  =07gm
Available carbs (n)          44-07          =37gm
Glycemic Index (GI)                          = 30
Glycemic Load (GL) =[nxGI]/100   
                                =[37x30]/100  =11.01(>10)❌
For 50gm the GL                              =11.01
ஃ For 45gm the GL                          =10✔️
Hence a diabetic can safely take up to 45gm of whole wheat kernels.
SWEET CORN ON THE COB(150gm):-
Total carbs                                       =41gm
Fibers                                               =4gm
Available carbs  (n)  =41-4              =37gm
Glycemic Index (GI)                        =60
Glycemic Load (GL) =[nxGI]/100
                                 =[37x60]/100  =22.2(>10)❌
For 150gm the GL                              =22.2
ஃFor 70gm the GL     [22.2/150]x70 = 10.3✔️  
Hence a diabetic can safely take sweet corn on the cob up to 65gm daily.
Hence a diabetic can take up to 6
5gm safely.
PEARL BARLEY (100gm):-
Total carbs                                          =77.7gm
Fibers                                                  =15.6gm
Active or available carbs=77.7-15.6   =62.1gm
Glycemic Index (GI)                           =28
GL (for 100gm)=[nxGI]/100
                          =[62.1x28]/100          ≃17(>10)❌
For 100gm the GL                               =17
ஃ Hence for 55gm=[17/100]x55      =9.35(<10)✔️
Hence a diabetic can take up to 55gm safely.
HULLED BARLEY(WHOLE GRAIN,100gm)
Total carbs                                         =73.5gm
Fibers                                                 =17.3gm
Avail.carbs (n)=    73.5-17.3             =56.2
Glycemic Index                                 =22
GL (for 100gm)=[n x GI]/100         
                          =[56.2x22]/100       =12.4❌
For 100gm the GL                            =12.4
ஃ For 78gm the GL [12.4/100]x78  =9.7✔️
Hence a diabetic can take up to 78gm safely.
For cooked barley the GI              =35-low(<55)
For cracked barley the GI             =50-low(<55)
For barley flakes the GI                =60-med(55-77)
In the above examples, barley has displayed three different values of glycemic indices in different states, such as raw, cooked, and flakes. Hence the total carbohydrates and the fiber contents may differ. This is because when the grains are processed like cooking, polishing, or refining it may affect their fiber contents. Hence the total carbs are changed accordingly. But the active carbs may or may not be affected by the processing albeit the GI values are increased as the affected fiber contents decreased.
FINGER MILLET-(RAGI -100gm):-
Total carbs                                               =30gm
Fibers                                                       =1.7gm
Active carbs (n) =30-1.7                         =28.3gm
Glycemic Index (GI)                              =100
The GL              =[28.3x100]/100 =28.3(>10)❌
For 100gm the GL value               =28.3
ஃ For 30gm the GL value =[28.3/100]x30
                                          ≃9 ✔️
Hence a diabetic can take ragi up to 30gm safely.
But there are a variety of millets with different glycemic indices which you can find out in google search. 
In general, unlike fruits, food grains are subjected to various processes such as refining, polishing cooking, cracking, powdering, etc. All these processes affect glycemic indices.
Finally, grains are available in various forms such as black, brown, white, boiled, genetically modified with different contents of carbs, glycemic indices. 
We should calculate the glycemic load individually and calculate the amount of food in which the glycemic load falls below 10 for safe consumption.
To see a simple reference chart for Glycemic Index please click here.
To have a study about the Glycemic Index (GI) and the Glycemic Load(GL) please click here. 

DIABETIC CARE-HOW TO TAKE FOODS WITH HIGH GI- [1.FRUITS]

DELICIOUS DIABETIC FORMULAS-[1.FRUITS]

Many diabetics are afraid of eating sweets, sweet fruits, or any kind of edibles and foods which contain or make with more sugar. 

Diabetics are afraid of sweets like Halwa, Rossogulla, Gulab Jamun, and fruits like mangos, bananas, and dates as they can cause a sudden and immediate raising of blood glucose level.

A diabetic is not necessarily to avoid sweets and white sugar. They can enjoy any kind of sweets without a miss but to a certain limited quantity.

For example, a diabetic can eat a sweet mango but within a limited serving quantity in grams. Not as a whole but a portion of mango or any sweet whose glycemic load is within the upper limit (ஃ less than or <10) can be safely and freely taken by a sugar patient.

That limit of the amount can be calculated very easily.

For that calculations the required parameters are,

1.Total carbohydrates of the sweet in any serving amount. (By google search)

2. Fiber content.  (By google search)

3. Calculate the available carbohydrates by subtracting the fiber content from the total carbohydrates.

4. Glycemic Index of the sweet. (By google search)

5. Calculate the glycemic load (GL) for that serving quantity.   [ GL= (nxGI)/100,n=the amount of available carbohydrates]

If the GL is higher than the upper limit (>10) then cut the serving portion accordingly. 

(Example) The GL for a certain sweet is 15 for the serving quantity of 150gm.

 For GL 15, the serving quantity               =150gm

then for GL 10, the serving quantity=(150/15)x10 

                                                          =  100gm

That means the sweet can be safely taken by a diabetic up to a limit of 100gm daily.

This formula can be applied to any kind of sweets.

The total carbs in a 50gm pure glucose =50gm

Fibers                                                    =0

Available carbs                      50-0      = 50gm

The GI of pure glucose                         =100

The GL for 50gm   (50x100)/100     =50 (>10)

Hence the GL of 10gm of glucose        10  (=10)

Therefore a diabetic can take pure glucose up to 10gm in alternate days because there is no fiber content.

Many diabetics are afraid of taking fruits like mangos because of their sweetness and more sugar content (High GI). [Sudden and immediate raising (spikes) of blood glucose levels damage the insulin-releasing beta islets in the pancreas. This may cause a healthy person to become diabetic and a diabetic person to become more serious.] But some fruits contain fibers also. Fibers are carbohydrates that are not easily digested and absorbed and hence they restrict and control the rapid absorption of sugar from the intestine into the blood and thus prevent immediate and sudden blood glucose rises. Hence any food that has more fibers is safer to take disregarding its high total carbohydrate contents.

In the following examples, it has been shown how to calculate the grams of fruits with high GI values like mangos to be consumed safely by a diabetic.

1. Mangos-Medium sized (170gms):-  contains,

Total carbohydrates                                   = 28gm

Fibers                                                         = 6gm

Available carbs      28-6                             =  22gm
100 gms of mango contains (22/170)x100=13gm
GI of mango is                                           =56
The GL =(n x GI)/100 = (13 x 56)/100     =8.28
8.28 or 8.3 is less than 10 (<10)
Hence a diabetic can safely take 100gms of whole or sliced mango once in alternate days.
2.Watermelon (120gms)
120 gm of watermelon is a safe serving size for a diabetic.
100 gm watermelon contains sugar =6gm
Total carbohydrates                          = 8gm
Fibers                                                = 0.4gm
Available carbohydrates           8-0.4 = 7.6gm
GI of watermelon                              =72
GL for 100gms of watermelon is     = (7.6x72)/100
                                                          = 5.47
5.47 is lesser than 10 and hence a diabetic can safely consume 100 to 150 gms of watermelon safely.
3.Banana (100 gms):-
Total carbohydrates are                   =23gm/100
Fibers                                              = 2.6gm
Available carbs       23-2.6              ≈ 20gmapprox
GI of banana                 = 62
The GL of 100gm (20x62)/100      =12.4 (>10)
The GL of 80gm   (12.4/100)x80  =9.92 (<10)
hence a diabetic can safely take up to 80gm (<100gm) of banana daily. The glucose content of 100 gms banana is 12gm.
4.Dates (100gm):-
100 gms dates contain                   =100gm sugar
Total carbohydrates                       = 100gm
Fibers                                             =  0
Available carbs 100gm                  =100gm
Available carbs in 23gm                =23gm  
The GI                                            = 42
The GL   = (23x42)/100                 =09.66 (<10)
Hence a diabetic can take up to 23gm of dates in alternate days.
5.Grapes (100gms):-
Total carbs                                        =17gm
Fibers                                                =01gm
Available carbs    (17-01)                 = 16gm
GI of grapes                                      =  59
GL of 100gm grapes = (16x59)/100 =9.44 (<10)
Hence a diabetic can safely take up to 100gm of grapes daily.
6.RAISINS (100gm):-
100gm raisins contain 60gm of sugar.No matter still a diabetic can safely take raisins according to the following calculations.
Total carbs                                                = 79gm
Dietary fibers                                            =3.7gm
Available carbs       79-3.7                       = 75.3gm
GI of raisins                                             =64
∴ GL of 100 gms =(75.3x64)/100            =48.2(>10)
ஃGL of 10gm raisins is                    =4.8 (<10-safe)
and GL of 20gm raisins is                    =9.6 (<10-safe)
Hence a diabetic can safely take up to 20gm of raisins every 1 to 2 days.
In addition to the listed fruits above the following unlisted fruits which are also sweeter in taste and are afraid to take by many diabetics are described below.
7.Jack Fruits (165 gm):-
Total carbs                                               =38gm
Dietary fibers                                           =2.5gm
Available carbs including
32gm sugar        38-2.5                            =35.5gm
The GI of jack fruit                                  =75
The GL of 165gm (35.5x75)/100           =26.6
GL of 55gm (165/3) of jack fruit            =26/3≈9
   9 (less than <10-safe)
Hence up to 55gm of jack fruit can be taken by a diabetic safely.
8.Sapota Fruit (100gm)
Total carbs(including 20gm sugar) =20gm
Fibers                                             =5gm
Available carbs         20-5              =15
The GI of sapota                            =57
The GL for 100gm  (15x57)/100 =8.55 (<10-safe)
Hence sapota or naseberry can be safely taken by a diabetic up to 100gm in a day.
9.Custard Apple(100gm):-
Total carbs                                          =26
Fibers                                                  =05
Available carbs              26-5             =21
The GI of custard apple                     =54
The GL of 100gm custard apple
                     (21x54)/100                 = 11.3(>10)
ஃ The GL of 85    [11.3/100]x85     =9.6 (<10-safe)
Hence custard apple can be safely taken by a diabetic up to 85gm (<100gm) per day which will yield the GL less than 10.
10.Pomegranate (100gm):-
Total carbs                               =19gm
Fibers                                      = 04gm
Available carbs      19-04        = 15gm
The GI of pomegranate           = 53
The GL of the pomegranate
                        (53x15)/100   =  7.95 (<10-safe)
Hence a diabetic can safely take pomegranate seeds up to 100gm daily.
11.Guava Fruit (100gm):-
Total carbs (including 19gm sugar)        =14gm 
Fibers                                                      =5gm
Available carbs        14-05                      =9gm
The GI of guava                                      =65
The GL of 100gm guava (9x65)/100  =5.85 (>10-safe).
Hence a diabetic can safely consume guava 100 to 150gm.
12.Papaya Fruit (100gm)
Sugar content                                      =08gm
Total carbs                                          =11gm
Fibers                                                  =02
Available carbs               11-02           =09
The GI is                                             =60
The GL of 100gm of papaya (09x60)/100=5.4
Hence a diabetic can papaya 100 to 200gm daily.
13.Oranges (100gm):-
Total carbs                                          =12gm
(Including 09gm sugar)
Fibers                                                  =02.5gm
Available carbs           12-02.5            =09.5gm
The GI                                                 =40
The GL                 (09.5x40)/100         =3.8 (<10)
Hence a diabetic can safely take 100-200gm daily
14.Lemon (100gm):-
Total carbs                                         =09gm
Fibers                                                =2.5gm
Available carbs             09-2.5          =6.5gm
The GI                                               =20
The GL                   (6.5x20)/100       =1.3 (<10)
A diabetic can safely take up to800gm lemon daily.
Jamun Fruit (140gm):-
Total carbs                                          =14gm
(included 5gm sugar)
Fibers                                                  =1gm
Available carbs    14-01                      =13gm
The GI                                                 =25
The GL           (13x25)/100                 =3.5 (<10)
Hence a diabetic can safely take 100-300gm daily.




                  




  

TABLE OF SOME FOODS WITH ITS GI AND GL VALUES

FOODS FOR DIABETICS

The following table of Glycemic Index and Glycemic loads is very useful for diabetic patients who wish for a controlled diet with some added delicacy.

The following formula is very useful to calculate the accurate amount of any sweet food to be taken safely from the available Table.

NO     Foods               Size                 GI         GL

1. Mango        ---      medium   ---      56 ---   18.9
2.Watermelon ---       120gm    ---      72 ---    04

3.  Apple                    120gm             39  ----    06

4.  Banana                  120gm             62   ----    16

5. Dates-Dried                 60gm             42  ----   18

6. Grapefruit                    120gm          25  ----    03

7. Grapes                             120 gm       59  ----    11

8. Orange                           120gm          40 ----    04

9. Peach                           120gm          42 ----    05

10.Peach in Canned         120gm        40 ----     05

11. Pear average                   120gm          38 ----     04

12. Pear canned in pear juice      120gm         43 ----     05

13.Raisins                      60 gms           64  ----    28

14. Papaya                    120gms            60 ----   09  

1.Black Rice                  100 gms          50 ---- 16.5
2.White Rice                  150 gms          89 ----    43
3.Whole wheat kernels     50 gms          30 ----    11
4.Sweet corn on the cob 150 gms          60  ----   22
5.Pearled barley              150 gms          28  ----  17
6. White Rice(long grain cooked)      100gms          89  --   25 
7. Brown Rice                  100gm          68 --14.42                                                                                                                                                                 
1.Milk full fat                   250 ml            41  ---- 05
2.Ice cream regular             50 ml            57  ---- 06
3.Skimmed Milk              250 ml             32  ----04
4.Ice Cream Premium        50 ml             38  ----03
5.[Fruity yogurt with 
   reduced fat]                    200 ml            33 ---- 11
                                                                                 
1.Whole wheat bread        30 gms            71 ---- 09
2.White bread                   30 gms            71 ----10
3.Pita Bread                      30 gms            68 ----10
4.[Coarse barley bread
   with 80% kernels]          30 gms            34 ----07
5.Pumpernickel bread       30 gms         56 ---07
6.Hamburger Bun             30 gms          61--- 09
7.Apple cake with sugar   60 gms          44 --- 13
8.Apple.C.without sugar   60 gms          48 --- 09
9.Banana cake with sugar 60 gms          47  --- 14
10.Banana.Without sugar60 gms          55 ---- 12 
                                                                              
1.Vanilla wafers               25 gms          77 ---- 14
2.Shortbread                    25 gms          64 ---- 10
3. Graham crackers         25 gms          74 ---- 14
4.Soda Crackers              25 gms          74 ---- 12
5. Rye crisps average       25 gms          64 ----  11
6. Rice cakes average       25 gms          82  ---- 14
For more items please click here.

                                         

KIDNEY DISEASES-3-CHRONIC KIDNEY DAMAGE(CKD)

CHRONIC KIDNEY DISEASE (CKD) &END STAGE KIDNEY DAMAGE(ESKD)

Fig-1

Chronic Kidney Damage or CKD can be defined as the step by step or slow loss of kidney functions over a long time period of months or years.

The main culprits for this CKD are generally High Blood Pressure(HBP) and Diabetes Mellitus(DM)

.Both uncontrolled high B.P and high sugar can damage the kidneys as follows:-
High B.P. would reduce the amount of blood flow to the kidney and thereby the kidney becomes undernourished.
Similarly high blood sugar will damage the glomerular filter system by sugar deposits. Thus the nephron can gradually lose its filtering capacity.
All causes of acute kidney failure are also fit for chronic kidney damages.

STAGES:-

1. Normal or above the normal stage- GFR (Glomerular Filter Rate)-Above 100 ml/min)

2.Mild stage -(GFR-60 to 99 ml/min)

3A.Moderate- (GFR-49 to 59 ml/min)

3B.Moderate- (GFR-35 to 49 mi/min)

4. Severe stage- (GFR- 19 to 29 ml/min)

5.End-stage   -  (GFR-<19 ml/min)
The first two stages can be reversed if attended in time with proper treatments. But they are asymptomatic and escape silently like thieves from our attention. Once the stage entered the third to fourth level the disease cannot be reversed as almost 50% of the kidney functions are destroyed.

Signs and Symptoms of CKD:-

1.Nausea and vomiting

2.Loss of hungry

3.Weakness and mental swings

4.Fatigue and tiredness

5. Frequent urination followed by reduced urination.

6.Foamy and bloody urine

7.Shortness of breath due to fluid collection in the     lungs

8.Chest tightness and pain due to fluid collection in the heart.

9.High and uncontrolled B.P due to fluid retention.

10.Insomnia

11.Skin itching due to elevated wastes such as uric acid, urea, and phosphorus levels in the blood.

12.Muscle cramps.

Many of the above symptoms are not specifically due to CKD and a proper diagnosis should be done to confirm it.

Causes:-

1.Diabetes mellitus

2.Chronic High B.P.

3.Tubule Infections

4.Glomerular infections (Glomerulonephritis)

5.Vesicoureteral Reflux, a condition in which there is a reverse flow of urine back to the kidney.

6.Renal cysts

7.Prolonged urinary obstruction due to urethral pressure, and enlarged prostate.

8.Recurrent kidney infections.

Risk Factors:-

1.Old age

2.Smoking

3.Alcohol

4.Obesity

5.Uncontrolled cardiovascular diseases

6.Uncontrolled diabetes M 

7.Hereditary Kidney disease

Complications:-

Fig-2

Chronic kidney disease can affect almost all parts of the body due to the following complications.

1. Elevation of potassium levels can affect heart functions.

2. Elevation of phosphorus level can produce skin rashes.

3. Elevation of calcium level can produce kidney stones, and bone weakness and heart problems

4. Fluid retention can cause pulmonary and heart edema, ankles, and leg swellings, and high pressure.

5. Anemia prevails due to lack of erythropoietin production by the kidneys and thereby the production of RBC is reduced.

6.Reduced sexual drive, reduced fertility, and erectile dysfunctions.

7.CNS damages lead to mental health and other complications.

8. Damage to the immune system causes increased vulnerability of the body to infections.

9.Pericarditis-A condition in which more fluid collection in the pericardium, the upper covering of the heart. (See Fig-2) above.

The Concept of Anemia-Erythropoietin:-

Apart from functioning as an excretory organ kidney plays other important roles to maintain our body's health.

Blood needs regular synthesis of Red Blood Cells (RBC) every day to compensate for its loss on aging. Erythropoietin is an important catalyst to synthesize new RBCs by the bone marrow. Erythropoietin is secreted by the kidneys and liver. Liver secretion is predominant in childhood. Afterward kidney secretion of erythropoietin is predominant in adulthood. At  ESKD kidneys lose almost 90% of the ability to produce erythropoietin and hence anemia develops rapidly.

Erythropoietin is produced by the interstitial fibroblasts in close association with the peritubular capillaries and the proximal convoluted tubule See Fig-3 above)
1.EPO is released into the blood circulation from the kidneys.
2.EPO tells the bone marrow to synthesize and release RBC.
3.RBC is released into the circulation. (Fig-3)
The erythropoietin (EPO) production is increased in a low oxygen atmosphere to produce more RBC. People living in high altitudes are subjected to produce high EPO production by the kidney as the availability of oxygen is low there.

TESTS AND DIAGNOSES:-

1.EPO TEST;-
EPO test is not so important to confirm CKD since there are many other factors that cause the irregularities of the EPO level in the blood.
The high altitude where there is low oxygen density would increase the erythropoietin level in the blood.
Polycythemia (abnormal elevation of RBC in the blood due to bone marrow defects would lower the release of erythropoietin by the kidneys.
In the case of end-stage kidney damage (ESKD) the kidneys are fully disabled to produce EPO. Hence the EPO test may be a marker of the presence of ESKD.
The normal EPO level in the blood is 4 to 40 international units per liter (IU/L) of the blood.
Usually in kidneys the proximal convoluted tubule, the peritubular capillaries in the cortex are the areas where the interstitium produces EPO.
For an elaborate study click here
2. Diagnosis for ESKD involves a 24 hours urine test
3.Blood creatinine analysis:-Normal creatinine level is 0.7 to 1.2 mg/dl
4.Blood Urea Nitrogen tests:- Normal urea level is 14 to 25 mg/dl
The best marker to predict any type of kidney damage is the micro protein urea tests which we already described in previous chapters. To see that click  here
KIDNEY INJURY MOLECULE (KIM)TEST:-
The most reliable and accurate diagnostic test to predict AKD and CKD is the KIM-1 test.
KIM is a transmembrane glycoprotein present in the epithelial layer of the proximal tubule.Normal urine contains 0 to 0.7ng/ml.But in the injured kidney the level raises above 3.7 ng/ml which predicts kidney damage.
The test is more accurate to indicate the presence of AKD but can also be used as a reliable marker test to predict CKD.
Diet control, dialysis followed by EPO injections, or kidney transplants are life-saving formulas for those who reached end-stage kidney disease(ESKD).
ERYTHROPOIETIN INJECTIONS:-
These are human recombinant erythropoiesis-stimulating injections that must be given to the kidney patients either in dialysis or not.
The injections should be given at least three times per week and the dosage should be determined by the doctor.
Availability:-1)  2000 units/ml
                     2)  3000 units/ml
                     3)  4000 units/ml
                     4) 10000 units/ml
The initial treatment should be started when the hemoglobin count falls below 10 gram per deciliter of the blood.
As the count raises reduce the dosage accordingly.
Usual Dosage:-50 to 100 units per kg via IV or SC route.
Hemodialysis & Peritoneal dialysis will be presented as separate posts in the future.

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