Gurdyaan dee bamari bari paihri

Main ik wari saun laga tay meray mayday ch aini keh peedh hoi keh
menu paseena ah ghia. menu pukka ho ghia keh main apnay akhri
sahnwaan tay aan. Eh peedh ik minute hoi. Othoon baad kadeen
kadeen peedh da chubka jehya paina tay hut jaana. Eh menu meray
gurday keh rehay see keh koi kharabi ho ghai ah tay toon doctor kol
jah. Main vee aidaan eeh kitta jidaan saday aam lok kerday ah tay
main doctor kol nehn ghia. Main bed tay lama pia hoyaan tay menu
peedh phay hoi jehri keh pasena kehdnay wali nehn seetay ik minute
rehai. Do tin minute baad phay peedh da attack hoya tay khattam ho
ghia. Teesra attack phay hoya tay khattam hunday ee main car tay
baitha tay hospital dee emergency ch chala ghia.. Authay ohna nay
mera muttar tay blood pressure check kitta. Doctor nay mera x ray
kerwaya.. Ohna nu koi vee cheez nehn lubhi .

Meray her rose kadeen kadeen peedh da chubka pai jaana. Main ik
din hospital day diagnostic department ch ghia tay ohna nu gal samjai
tay ohna nay meri ultra sound scanning kitti jehday ch vee koi cheez
nehn lubhi. Phay ohna nay mera Mori kitta tay main kidney specialist
day koll baithghia jidoon oh computer screen tay meray Mori image
nu check ker rehya see. Jiwain jiwain oh check ker rehya see tay
menu vee ohnay chungi tarran samjhaya. Eh vee mera ik ajeeb
experience see. Aus waqat tay koi cheez nehn lubhi tay main sochya
keh kidney nu chungi tarran study karaan. Menu ohnay eh kehya keh
ho sak da ah eh qabaz day pahroon peedh paindi howay. Ik sowal
jehra menu patta naa honay dee wajah toon nehn puchya oh eh see
keh agar glass da koi chota jeha tuckra gurday ch chala jaway tay kia
ohnu ultra sound yaan Mori detect ker lainda? Jay tuseen kittay es
stage tay scanning kerwao tay ohna koloon eh gal zaroor pucho. Agar
 tay tuseen es field naal talaqrakh day ao tay main tuwaday comment da
welcome karaan gha. Menu hospital waliyaan nay constipation khatam
kernay wastay duwai ditti. Tin char haftay tay meray peedh day kadeen
kadeen chubkay painday rehay. Hon menu eh chubkay painay band ho
ghaiay ah. Gurda kih ah ? aam aseen jidoon deekh day aan tay aidaan
eh mass (meat) da tuckra lag da ah pehr eh tay ik choti jehi machine ah
tay jehray eh kum kerda ah deekho tay tuseen haran reh jaanday ao.
Hor  menu jehri harani eh hoi keh eh choti jehi natural machine ah. jay
tuseen eh natural choti machine da kum dialysis machine naa karo tay
oh machine da pahr 40 kilo day lagay tay howay gha. Eh saday gurday
250-300 grams da hunda. Eh dialysis machine aini wadi hunday hoay vee
aina complicated kum nehn kardi jina sadi natural machine gurda
kumkerda ah. Kehnday ah wailay dee namaz tay kuwailay diyaan
tuckraan eh tay gal tuseen zaror suni hoay ghi. Agar tuwanu koi vee
apni seht day barray ch koi problem aah tay doctor nu mil kay ohnu
theek kernay dee koshish karo. Eh buht sasta rehnda ah.
Kadeen vee homeopathic , desi hakeemaan yaan taweez gunday
kernay walyaan day chuker ch na pawo oh es wastay keh aina ch
koi development nehn hoi tay eh authay ee ah jethon shroh hoay see.
Jidoon bamariyaan shreef tay ainiyaan complicated nehn hundiyaan see
aus waqat tay aidaan day allaj yaan totkay kum ker jaanday see pehr
hun tay bamariyaan vee taran taran diyaan aa ghiayaan aan.Es wastay
tuwanu meri eh ee salah ah tuseen sidday doctor kol jaa kay allaj kerwao.
Main tuwanu do cases day baray ch dasaan gha tay agay tuwadi marzi ah .

Mera cousin jehra meri omar da eeh see nearly middle aged oh diabetic
see. Ohday gurday fail ho ghaiay. Ohda allaj homeopathic desi tay
taweezan naal kitta ghia. Oh dar da rehya dialysis kerwaun toon. Jidoon
kissay homeopathic desi hakeem tay peer day tuweezaan nay kum nehn
kitta tay faisal hoya keh hun dialysis kerwai jaway. Ohda aina kay kum
bigar chukya see keh pind toon dialysis wastay lajanday hoay ee ohdi
death ho ghai. Paisay vee buht kharach kittay perh kih faida hoya?
Haan faida ohna lokaan nu hoya jehray lokaan nu hazaran saal paranay
totkian day chuker ch paa kay lut day ah tay tuwaday marnay da zariya
ban day ah. Agar homeopathic allaj aina ee chunga see tay jithoon eh
shroh hoya germany ch eh kiyoun allowed neh. Haan allowed hai germany
ch oh es shart naal jay tuseen real doctor ao tay tuseen naal hpmeopathy
dee vee dowai mareezan nu day sakday ao. Younani jehnu desi allaj vee
kehnday ah eh Greece toon shroh hoya tay halat eh ah keh Greece ch
eh allaj dee practice allowed nehn ah. Ohna nay eh chud kay doctri allaj
apna liay.
Yaad rakho aj kal da zamana krishmiyaan tay mojziyaan da nehn. Agay
bamariyaan vee shreef hundiyaan see tay thoriyaan see. Es wastay
totkay taweez wagaira kum ker jaanday see.Dosra waqia vee meray 
ik hor cousin da ah. Ohnu kitay falaj da attack ho ghia tay ohday kahr 
waliyaan nu kissay nay dasya keh falan hakeem falaj da allaj ker da ah. 
Hakeem nay ohnu ik malsh wastay tay ik khanay wastay duwai ditti. 
Naal taweez wee karwaiay. Bari malash kitti tay duwai khadi pahr koi 
arram n na aya tay hospital ch lai kay ghaiay. Hospital waliyaan nay 
kehya ik do din hor naa aithay aundha tay terra eh passa permanent 
mazoor ho jaana see. Main 
Pakistan ghia hoya see tay oh vee kitay pind jaanda hoya saday ah ghia 
tay ohday naal molaqaat ho ghai. Main ohday koloon puchya keh terri ik 
side nu kih hoya? Ohnay menu phay sari apni aap beeti sanai tay kehya
keh meray allah nay menu hospital paigh kay meri eh side bacha lai. 
Hajjay fully recover tay neh hoi pehr doctor kehnday keh ainu theek 
honay ch time lugay gha. Main machester ch ik maulvi kol baitha hoya 
see tay ohnay menu gallan ch dasya mashalla mera tin wari heart da bi 
pass ho chukya. Main bura haraan tay khush vee hoya maulvi saab dee 
gal sun kay tay sooch rehya see keh saday pind ch tay kissay nu heart 
attack ho jaway tay sher puhnch day punhch ee ohda kum ho jaanda. 
Agar qisma thori chungi howay tay hospital puhnch ghia pehr agay vee ohdi
 kismet chungi ah?  Doctor hospital ch hazar tay ah? Yaan ohnu kissay hor 
sher lajana pau gha.

Gurday kih kerday ah

Gurday jehray  keh bean shaped hunday ah. Aam lokaan day jusay ch do 
gurday hunday ah tay ik gurda moth day size da hunda ah.Gurday saday 
pichay puth day thalay hunday ah. gurday rehr dee huddi (spine) day sajjay 
tay khabay hunday ah. Gurday ik galoon bhut ee chungi insani jism dee
machine ah jehri keh her roj 200 quarts day lag pagh khoon nu filter ker 
kay ehday chon 2 quarts day lagay shagay kachra (waste products)  tay 
ziyad paani kehd day ah. Eh kachra(waste products) tay ziyada paani 
mutar ban jaanda ah tay naliyaan jehna nu ureters kehnday ah choon ho 
kay masanay (bladder) ch challa jaanda. Masana mutar nu audhoon tak 
apnay ch rakh da jidoon tak aseen  mutar neh ker day

Kachra saday khoon ch active tissues i.e muscles  tay khorak dee tut 
pahj  toon aunda ah. Sada jusa khurak  nu taaqat wastay tay apni 
maramat wastay wart da ah. Jusay nu jehri cheej khorak choon chai 
dee hundi ah wart kay rehnda hoya kachra khoon nu phaij dainda ah. 
Agar gurday eh kachray nu khoon chon filter naa kern tay eh khoon ch 
jamaa honday rehnday ah tay saday jusay nu  kharab kerday ah.

Khoon choon kachray dee filtration gurdiyaan day ander chotay units 
jehna noon nephron kehnday ah naal hundi ah. Ik gurday ch das lakh 
day lago phag nephrons hunday ah. Nephron ch ik glomerulus  - jehri  
choti blood vessel or capillary ah jehri interwines hundi ah choti muttar 
(urine) katha kernay wali naal (tube) naa jehnu tubule kehnday ah. 
Glomerulus filtering unit da kum ker da ah tay normal proteins and 
cells nu blood stream ch rakh da ah Es process ch ziyada maya tay
 kachra pass ho jaanda. ah. Aithay ik chemical process hunda ah 
jehday ch kachra tay paani khoon chon nikal  kay masanay ch chala 
jaanda ah.

Sub toon pehlay chemicals naal milya kachra tubules ch aunda ah jehday 
choon  jusaa jo kuch wart sakda ah. Gurday chemicals nu i.e. sodium, 
phosphorus tay potassium naap day ah. Eh chemicals nu wapas khoon 
ch phaij dainday ah jusay day wartnay wastay. Es taran gurday ehna 
chemicals da tanasab barqarar rakh day ah. Ehna chemicals da theek 
tanasab zindgi (life) wastay zarori ah.

gurday khoon chon kachra tay paani dee safai kernay toon alawa ik hor 
kum ve kerda ah. Gurday tin kisam day zaroori hormones chud day ah.

Erythropoietin,  yaan  EPO jehri hadiyan day guday (bone marrow) nu 
stimulate ker dee ah red blood cell banaunay wastay.

Renin – jehri blood pressure nu theek (Regulate) rakh day ah.

Calcitriol – The active form of  vitamin D, jehra hadiyaan wastay calcium 
nu maintain rakh da ah tay body wastay dosray chemical da balance be 
rakh da ah.

Renal function kih ah

Renal da lafaz gurdiyan wastay wartia jaanda ah.  “Renal function” tay 
“kidney function” da ik matlab ah. Seht day naal taalaq rakhnay walay 
lok (health professionals) jidoon “renal function dee term wart day ah 
ehda matlab eh hunda ah keh tuwaday gurday kina chungi taran khoon 
saaf kerday ah. Jehray lokaan day do theek gurday ah tay ohna da 100%
 kidney function hunda ah.Chota yaan thora  kidney function as much as 
30-40% da aina patta nehn lagda. Kidney function khoon day namonay 
(blood sample) toon ik formula wart kay kadhya jaanda ah jehnu 
estimated glomeruler filtration rate (eGFR)  kehnday ah. eGFR da matlab 
hunda tuwaday gurday kinay fee sad (%) kum ker day ah.

Kai lok ik gurday naal jam day ah tay oh aam tay seht mand zindgi gazar 
sakday ah. Her saal hazaraan lok apna ik gurda dainda ah as donation  
transplantation wastay. Kai lok apnay dostan yaraan tay ristay daraan nu 
ik gurda day dainday jehna day gurday kharab ho jaanday ah.agar tay 
guardian day day 25% too kath jaaway tay eh serious hunda ah. Jay 
kidney function 10-15% toon kaht jaway tay aidaan day bandyaan nu 
Blood cleansing treatments wastay jaana chai da yaan kidney transplant 
wastay tah keh oh zinda reh sakan.

Gurday  kiyoun fail hunday ah

Gurdayaan dee bamariyaan  nephron tay hamla kerkay ohna dee 
filtering dee khasyet nu khatam ker daindiyaan. Nephron nu naqsan 
buht jaldi ho sakda yaan tay zakhmi hon naal yaan poisoning naal..
 Aksar gurdyan diyaan bamariyaan nephron nu holi holi naqsan tay 
khmoshi naal tabah ker diyaan. Salaan tay wariyaan baad nephron day
 damage honay da pata lag da. Gurdyaan dee bamari dee aam wajah 
Diebetes  tay high blod pressure ah. Jehray lokaan che gurdiyaan dee 
bamari khandani ah ohna nu lagnay day buht chances hunday ah.

Diabetic Kidney disease

Diabetes bamari ch jehri sugar jusay nu wartni chai dee ah nehn wart da  

tay oh khoon day naal gurdyaan ch ah jaandi ah. Eh gurdyaan wastay  

zehr ah. Nephron nu khoon ch  istmaal na hoi sugar  naal jehra naqsaan 

hunda ah ohnu gurdyaan dee sugar aalli yaan diabetic kidney disease 

kehnday ah. khoon ch sugar (glucose) level nu kaht rakhnay naal tusee 

es bamari nu delay ker sakday yaan bach sakday ao. Dowaiyaan 

angiotensin-converting enzyme (ACE) inhibitors yaan angiotensin receptor 

blockers (ARBs) nu high blood pressure day allaj naal tuseen eh diabetic

kidney disease nu delay yaan wadhnay toon rook sak day ao.

High blood pressure

High blood pressure gurdyaan ch chotiyaan khoon vessels nu naqsaan 
pucha sak da ah.jehna khooni vessels nu nuksaan puhn ch da ah oh jehra 
ohna nu khoon chon kachra kahdna hunda h oh nehn kadh diyaan. 
Tuwada Doctor ho sakda ACE inhibitors tay ARBs tuwaday blood 
pressure wastay likh kay daway jehriyaan dekhya ghia ah gurdyaan nu 
dosriyaan duwaiyaan nalon bachaun diyaan aan tay blood pressure nu 
theek level tay rakh diyaan aan. The National heart, lung, and Blood 
Institute (NHLBI) wallay recommend kerday  ah jehray lok diebetic ah 
yaan  jehna da  reduced kidney fuction ah oh apnay blood pressure nu 
130/80 toon kath rakhan.

Glomerular Diseases

Kai kissam diyaan gurdyaan diyaan bamariyaan ehday ch ah jaandiyaan 
aan., i.e autoimmune diseases, infection related diseases, and scleroric 
diseases.Jiddaan naa toon patta lagda glomerular diseases tiny blood 
vessels (glomeruli ) tay attack ker diyaan gurday day wich. Ziyada tay 
bunyaadi glomerular  bamariyaan ch membranous nephropathy, IgA 
nephropathy tay focal segmental glomerulosclerosis ah. Glomerular 
bamari dee pehli nashani aam tor tay  proteinuria ah, jehra keh muttar 
ch buht zida protein da auna. Ik hor aam  nishani  hematuria ah  jehday
ch khoon da muttar ch auna. Kai lookaan  no donu  proteinuria tay 
hematuria ho sak diyaan. Glomerular  bamariyaan gurday  day function 
nu holi holi tabah ker sakdiyaan. Blood pressure tay control ehna 
gurdyaan diyaan bamariyaan nu control tay wadhnay toon rockney wastay  
buht zaroori ah.  Glomerular bamariyaan da patta  biopsy day naal laya
jaand ah.  Biopsy eh ik gur ah jehday ch piece of kidney tissue lia jaanda 
microscope day naal check kernay wastay. Glomerular bamariyaan wastay 
immunosuppressive drugs yaan steroids duwaiyaan wartyaan jandiyaan 
sauj tay proyeinuria kathaunay watay. Eh bammari tay depend kerda kehri 
ah tay aus hasab naal duwai likh kay ditti jaandi ah.

Microscopic image of PKD

Inherited and Congenital Kidney Diseases
Kai gurdyaan diyaan bamariyaan warasat ch mil diyaan.  Masaal day
 tor tay Polycystic Kidney disease (PKD) ik genetic disorder ah 
jehday ch gurday ch buht phinsyaan (cysts) Nikal aundiyaan.  PKD 
cysts can slowly replace much of the mass of the kidneys, Ehday naal 
kidney function kaht jaanda tay ik stage tay gurday fail ho jaanday ah.
 Kai kidney problems da patta lag jaanda jidoon bacha hajay womb 
ch hunda. Masaal day tor tay autosomal recessive 
PKD, a rare form of  PKD, and other developmental problems that 
interfere with the normal formation of the nephrons. Bachiyaan ch 
gurdiyaan diyan bamariyaan da kai taran pata lagaya jaa sakda. Agar 
bacha aam bachyaan dee taran grow na howay yaan ultiyaan kerda 
rehway  tay ho sakda ehnu koikidney dee bamari howay. Ehda check
 up doctor keray gha tay patta lag jao gha. Doctor bachay da blood 
pressure dekhay gha tay red blood cells dekay gha keh kaht tay nehn 
je anemia, proteinuria, hematuria. Agar doctor nu eh problems nazar 
aun tay oh hor tests keray gha blood tay urine day tay ho sakda ultra 
sound yaan mori recommend karay. Kai cases ch doctor biopsy 
kerday ah jehday. Tuwadat gurday da ik inch tissue lei kay  microscope
 day naal check keray gha.
Bachyaan diyaan kai  kidney bamariyaan da patta nehn lagda jawan
 honay tak. 
Most common type of kidney disease PKD nu pehlay adult pkd
 kehnday see  keh high blood pressure tay renal failure aam tor 
twenties and thirties  toon baad hunday ah. Now advances in science
 doctors can find kidney cysts earlier kissay nashani zahar honay
 toon pehlay

Gurday dee bemari dee hor wajah

Poisons and trauma (zehr tay sadama shock to kidneys) jehday ch
 kidney nu direct sat lugnay naal vee kidney diseas ho sakdi ah. Kai
 over the countermedicines hundyaan jehriyaan kidney wastay zehr 
ah. Agar tuseen koi vee pain killer laga tar wart day ao tay apna 
doctor naal mashwra karo ehday side effects day barray ch.

Gurday kiddan fail hunday ah
Kai cheejan jehriyaa kidney failer nu taiz kerdiyaan ohna da hajay 
pura patta nehn.. science daan hajay taak study ker rehay ah keh 
diet ch protein tay cholesterol levels  kidaan kidney function tay 
effect ker day
Acute Kidney Injury
Kai kidney problems buht jaldi ho jaanday ah. Agar accident ch 
kidney zakhmi ho jaway. Buht khoon da zaya ho jaanay naal kidney
failer ho suk di dee ah. Kai Duwaiyaan  tay zehr gurdyaan day kum 
nu band ker dainday ah. Achanak kidney day function ch drop honey 
nu  Acute kidney Injury (AKI) kehnday ah. Kai doctor ehno Acute
renal failure (ARF) vee kehnday ah. AKI ch ho sakda keh kidney
function khatam ho jaway. Agar kidneys seriously damage neh hoay
tay acute kidney disease may be reversed.
Chronic Kidney Disease
Ziyada kidney problem holi holi hunday ah. Ik admi nu ho sakda 
saalan toon “silent” kidney disease howay. Gradual loss of  kidney 
function  is called  Chronic Kidney disease  
(CKD) or chronic renel insufficiency. Jehray lokaan nu CKD  hundi 
ah ohnay gurday permanent fail honay da khatra Honda ah.. Ehna no 
death by stroke or heart attach da vee khatra hunda ah.
End-stage Renal Disease
Total yaan nearly total tay permanent  kidney failure is called End 
Stage renal disease (ESRD). Jehray lokaan nu ESRD ah ohna nu 
dialysis wastay yaan taransplant wast foran jaana chai da zinda rehn 
wastay.

Chronic Kidney disease (CKD) diyan nishaniyaan

Jehna lokaan nu CKD shroh hundi ah ohna nu pata vee nehn lagda 
keh oh bamar ah pehr jena lokaan dee bamari wadh jaandi ah ohna nu
 ehna nishaniyaan toon patta lag sak da

i    Ohna nu buhta pashab aunda yaan kath aunda

ii   Thakawat lag dee ah

iii   Pukh kath jaandi yaan nausea hunda tay ultiyaan aundiyaan

iv   Hathaan tay pairan tay sauj pai jaandi ah

v    Khujli lag dee ah (feel itchy) yaan sunnay  hoay (numb)

vi   Susti lag dee ah tay tuwaja nehn rakh sakday

vii  Chumri da rung gahra (Darkened Skin) ho jaanda ah

viii Have Muscle cramps (khichaan painiyan)

 

Gurdyaan dee bamari wastay test

Kai lokaan nu pata nehn lagda keh auhna nu gurday dee bamari tay 

Doctor sub toon pehloon khoon tay pashaab nu test kerda ah. 

National kidney foundation kehndi ah keh gurday dee bamari da 

patta launay wastay eh test kerwao

1 Blood pressure dee pamaish

2 pashaab da test protein yaan albumin da patta launay wastay

3 Glomeruler filtration rate (GFR) da hasab (calculation) based on 

serum creatinine  measurement. Urea nitrogen dee khoon ch  

measurement naal hore patta lagda ah

Dialysis

Saday jism ch gurdiyaan da kum ah keh jehra aseen liquid peenday 
an ohday chon Pashab tay khoon nu saaf kerna 
Insaani jism ch uraemia day sign hon tay  ehda matlab ah sadday 

gurday theek kum nehn kerday jindaan kerna chahi da  yaan kum 
kerna chud ghaiay Greek lafaz Haemodialysis toon pata lagda ah 
keh eh bamari da lokaan nu ehda allaj lubnay toon buht pehlay  
es mar dainay wali bamari da pata see.

Haemodialysis allaj es bamari wastay saray jahan ch munniya jaanda 
ah tay ehday ch buht developments hoyaan dialyser technology ch tay 
hollow fibre membranes (filter). Pehlaoon cellulose fibre dee membranes
wartiyaan ghaian tay tajarbay kittay ghaiay Andaza ah keh her saal 
40-50 people per million lokaan nu eh bamari lug dee ah. Eh tay ohna
mulkaan ch hunda pehr agar paani yaan khorak saafnehn tay ehna 
mulkaan ch look ziyada es bimmari da shaker hunday ah. i.e Pakistan,
India, Srilanka, Afghanistan,Nepal Bhutan , Middle east , South 
America tay African countries.

CAPD yaan  Continuous Ambulatory Peritoneal  Dialysis alaj da 
nawaan gur ah jehday ch peritoneal cavity ch catheter laa ditta jaanda
 tay pertitoneum nu exchange barrier wastay wartya jaanda. Es allaj 
day gur no her roj (everyday)  wartya jaanda  holi holi tay lagatar paani
 tay gund  kahdnay wastay. Ehday ch mareez nu aam taran safar ker 
sakda kum ker sakda tay car drive ker sakda while continuing dialysis 
da allaj kahr yaan hor kittay

IPD yaan Intermittent peritoneal dialysis semi automatic system ah. 
Eh gur mareez wastay kath dukh wala tay aram alla kiyou keh mareez
 haftay ch 3-4 wari  dialysis kerda with shorter  gaps  allaj day 
wachalay. Ehda mareez nu faida eh ah keh oh fluid ziya pee sakday ah 

Haemodialysis mareezan  naloon, kiyoun keh allaj frequent hunda tay
fluid day katha honay wastay kaht time. IPD ch waqfay chotay ah perh
actual dialysis da waqat ziyada. Pait ch  catheter dee fitting zarori ah perh
aina aramdeh nehn jidoon nauhna howay . IPD kahr ch wartnay wastay
buht chunga perhehday wastay sterilisation  tay home environment buht
suitable honi chai dee ah.

Haemodialysis: 

.Oh mareez jehna nu Haemodialysis allaj chai da hunda ohna da hospital
 day Renal unit ch allaj hunda ah. Mareez day fistula fit kitta jaanda as 
access point jehhday ch artry tay vain nu joor ditta jaanda tay sui ehday
ch laa kay blood nu dialyse tak tay dialyser toon(aam tor tay hollow fibre
 filter) jehra dialysate ik passay tay khoon dosray passay, khoon Reverse
 osmosis choon pass kerkay waste kahdi jaandi aah treatment day waqat.
 Haemdialysis es taran kum ker da ah tay sari duniyaan ch aidaan ee kitta 
jaanda ah.

References

Cotran, RS S.; Kumar, Vinay; Fausto, Nelson; Robbins, Stanley L.; Abbas, 
Abul K. (2005). Robbins and Cotran pathologic basis of disease. St. Louis, 
MO: Elsevier Saunders

http://science.howstuffworks.com/life/human-biology/kidney.htm