Author name: drmurugananths97@gmail.com

Reflections for the Modern Clinician In today’s medical world, we’ve become increasingly skilled at extending life.But in doing so, have we lost the ability to honor its natural end? Across specialties — from oncology to nephrology, critical care to cardiology — we witness the same dilemma:The tools to prolong life have improved, but our conversations about how and when to stop have not. ⚖️ The Cost of “One More Intervention” Every clinician has faced it: The elderly patient with multiple comorbidities who keeps bouncing back to the ICU. The frail individual on maximal therapy, with no hope of recovery, but still undergoing procedures. The family that asks, “Do everything,” even when the patient is visibly suffering. Sometimes, these efforts don’t extend life in a meaningful way —👉 they only extend dying. 💡 From Doing More to Doing Right Good medicine is not always about doing more.It’s about asking better questions: “What matters most to this patient now?” “Will this intervention bring comfort or just prolong decline?” “Have we offered the choice to step back, not just push forward?” It’s not giving up —👉 it’s giving space for dignity. 🌿 Graceful Dying Is Not a Failure Choosing comfort-focused care, honoring a patient’s wish to decline aggressive treatment, or simply sitting with a family in grief — these are acts of healing too. We must normalize conversations around: Palliative care not as “last resort,” but as core care Withdrawing or withholding interventions when burdens outweigh benefits Supporting patients to live — and die — on their own terms 📢 A Call to All Clinicians In an age of advancing medical frontiers, the most humane act may sometimes be to step back and ask: “Are we saving a life — or are we simply postponing a death that deserves more peace?” “To cure sometimes, to relieve often, to comfort always.” — Hippocrates  

🌙 Bedwetting in Children: What Every Parent Should Know “Every child is different. Some need a little more time — and a little more understanding — to grow out of the nighttime wetting phase.” Bedwetting — medically called nocturnal enuresis — is a common concern among children, especially in early childhood.For parents, it can feel frustrating and worrying. For children, it may be embarrassing or confusing. But here’s the good news: bedwetting is usually not a disease, and most children outgrow it naturally. 🧒 What Is Bedwetting? Bedwetting means involuntary urination during sleep after the age when a child is expected to stay dry at night (usually by age 5). It’s classified into two types: Primary enuresis – The child has never had six months or more of dry nights. Secondary enuresis – The child was dry for at least six months, but has started wetting again. This often points to a medical or emotional cause. 📊 How Common Is It? 15–20% of 5-year-olds wet the bed 5–10% by age 10 1–2% into teenage years 👉 You’re not alone — and neither is your child. 🔍 What Causes Bedwetting? Bedwetting is not due to laziness or bad behavior. Common causes include: Delayed bladder maturity – The bladder and brain aren’t fully in sync yet. Deep sleep – The child doesn’t wake up when the bladder is full. Low ADH hormone at night – Less hormone means more urine production. Constipation – A full bowel presses on the bladder. Family history – Runs in families. UTI or Diabetes – Especially in secondary bedwetting. Emotional stress – New school, sibling birth, or family changes can trigger it. 🩺 When to See a Doctor Seek medical advice if: Bedwetting persists beyond 7 years It starts again after months of dryness There are daytime symptoms (urgency, pain, dribbling) The child snores loudly (possible sleep apnea) There’s weak urine stream or back pain 🧴 Tips to Manage Bedwetting at Home 🚱 Limit evening fluids – Encourage more in the day, less after 6–7 p.m. 🥤 Avoid caffeine/soft drinks – They irritate the bladder. 🚽 Toilet before bedtime – “Double void” to empty fully. 💡 Use a nightlight – Make nighttime bathroom visits easier. 🌟 Praise, don’t punish – Encourage dry nights positively. ⏰ Bedwetting alarms – Help train bladder awareness. 🛏 Mattress protection – Waterproof covers reduce stress. 💊 Is Medication Needed? In select cases, doctors may prescribe Desmopressin to reduce urine production at night — useful during sleepovers or camps.But medication should never be the first step. Always consult a pediatrician. 🧠 Emotional Support Matters Children who wet the bed may feel ashamed or anxious. Reassure them: It’s common. It’s not their fault. With time, most kids outgrow it. 👪 Final Thought for Parents Bedwetting can test patience, but with understanding, reassurance, and simple strategies, most children will grow out of it. “Children are not things to be molded, but people to be unfolded.”— Jess Lair  

🩺 Early Detection & Prevention of Kidney Disease “No terrifying calamity will happen to the wise,who (foresee) and guard against coming evils.”— Thirukkural 429 “The doctor of the future will give no medicine,but will interest his patient in the care of the human frame,in diet and in the cause and prevention of disease.”— Thomas Edison, 1903 ⚠️ The Silent Nature of Kidney Disease Did you know?👉 Up to 90% of kidney function can be lost without any symptoms in some patients. That’s why early detection is the key to prevention. 🧪 Essential Kidney Health Checks Master Health Check-ups – Comprehensive exams help catch problems early. Urine Examination – Detects protein, blood, or sugar — all early signs of kidney damage. Urea & Creatinine – Simple blood tests that indicate kidney function. Ultrasound Scan – Reveals kidney size, structure, and changes. GFR (Glomerular Filtration Rate) – Calculated from creatinine; gives an accurate measure of kidney function.   🔍 Other Important Tests Cholesterol – High cholesterol damages blood vessels, including those in the kidneys. Microalbuminuria – Detects tiny amounts of protein in urine; an early warning sign of kidney disease. HbA1c – Indicates long-term blood sugar control; critical in diabetes-related kidney disease. 💰 Planning for the Future Lifestyle diseases are on the rise, leading to unexpected hospital admissions and skyrocketing medical expenses. ✅ Health Insurance Matters Protects against the high cost of dialysis and kidney transplantation. Most policies cover advanced treatments. Always discuss with your insurance provider to choose a plan that best suits your health risks.   🏀 A Real-Life Reminder “I’m a prime example of the way kidney disease strikes silently.In my experience, you can identify and prevent kidney disease by simple urinary examination.”— Sean Elliott, Legendary Basketball Player & Kidney Transplant Recipient 🌿 Key Takeaways Kidney disease often strikes silently. Regular screening can save lives. Lifestyle management + early detection = prevention. Health insurance provides essential financial protection.  

🌍 Environment, Pollution & Kidney Disease: A Silent Link “We won’t have a society if we destroy the environment.”— Margaret Mead The environment is getting contaminated and the air is getting polluted across the world. Industrialization has improved human progress, but it has also accelerated disease patterns at an alarming rate. In the case of kidney failure, new and concerning patterns are emerging. While genetics cannot be modified, simple preventive measures — including protecting our environment — can go a long way in reducing the burden of kidney disease. ⚠️ Can Diabetes and Hypertension Alone Be Blamed? Diabetes and high blood pressure remain the leading causes of kidney failure.But focusing on only these two risks ignores other critical factors. Research shows that lesser-known contributors — such as pollution, maternal health, and environmental toxins — play a significant role in the rise of kidney disease. Addressing these risks can enormously reduce the incidence of end-stage kidney failure, even in people with diabetes and hypertension. 👶 The Problem Starts in the Womb Vulnerability to kidney disease begins as early as fetal life. Poor maternal nutrition Nutritional deficiencies Certain drugs during pregnancy … all impact birth weight and future kidney function. ➡️ Good pregnancy care with balanced nutrition and proper fetal scans is vital in preventing kidney ailments that may only manifest years after birth. 🌫️ Air Pollution Studies in the USA and China have shown that people in cities with high air pollution have lower kidney function compared to those in less polluted regions. In India, the Air Quality Index (AQI) is often 3x higher than the safe upper limit. If this trend continues, we may soon see drastic public health measures like oxygen parlors becoming mainstream. 💧 Water Pollution Contaminated drinking water accelerates kidney damage. Industrial effluents, excessive fertilizers, and pesticide residues in agricultural products are increasingly implicated in chronic kidney disease (CKD). 📌 Image 1 – The link between contaminated water and kidney damage ❓ Kidney Failure Without a Known Cause Traditionally, diabetes and hypertension accounted for most kidney failures. But in the past decade, something new is happening: 👉 Over 20% of kidney failure cases now have no identifiable cause. This rise in CKD of unknown cause (CKD-u) is becoming a major concern among nephrologists worldwide. Hypotheses include: Industrial pollution Excessive use of fertilizers Contamination in food and water Climate change 🧬 A Comprehensive Approach Genetics plays a role in diabetes, hypertension, and kidney disease. While kidney disease cannot be completely prevented, environmental and lifestyle factors often determine how early and how severely it manifests. “The root cause of each problem should be sought and tackled.” 🌿 Key Takeaways Kidney health is not just about controlling blood sugar and blood pressure. Environmental toxins — in air, water, food, and even during pregnancy — shape future risks. Early detection and prevention strategies must now include environmental health measures. Protecting the environment is also protecting our kidneys.

 Polyphenols: Nature’s Kidney Protectors   These powerful plant antioxidants have been extensively studied for their anti-inflammatory, anti-fibrotic, and cell-protective effects — especially in the kidneys, which are highly vulnerable to oxidative damage. Let’s explore how polyphenols from everyday foods like turmeric, berries, and green tea can silently support kidney health.  What Are Polyphenols?   Polyphenols are micronutrients found in plants with strong antioxidant and anti-inflammatory properties. They are classified into four main groups: Flavonoids – fruits, teas, herbs Phenolic acids – coffee, grains Stilbenes – resveratrol from grapes Lignans – seeds, whole grains These compounds are crucial in fighting the oxidative stress and inflammation that drive chronic kidney disease (CKD).  Top 7 Polyphenol-Rich Foods for Kidney Health Food Key Polyphenol Kidney Benefit Turmeric Curcumin Anti-inflammatory, reduces fibrosis Blueberries Anthocyanins Antioxidant, reduces proteinuria (animal studies) Green Tea EGCG Improves GFR, reduces uremic toxins Pomegranate Ellagitannins Lowers oxidative stress Red Grapes Resveratrol Protects kidney tubules Flaxseeds Lignans Lowers blood pressure, anti-inflammatory Olive Oil Hydroxytyrosol Reduces inflammation, supports blood vessels  What the Research Says Curcumin (Turmeric): A 2022 Nutrients meta-analysis found improvements in serum creatinine and inflammation in early CKD. Green Tea Polyphenols: Kidney International Reports showed reductions in proteinuria in diabetic nephropathy models.  Practical Tips for Everyday Use Add ½ teaspoon turmeric to curries/soups (pair with black pepper for absorption). Drink 1–2 small cups of green tea daily (if not fluid-restricted). Use extra virgin olive oil as your main cooking fat. Snack on ½ cup blueberries or grapes (adjust if potassium is restricted). Mix 1–2 teaspoons ground flaxseeds into yogurt or oatmeal.  Final Word Polyphenols are not just trendy nutrition buzzwords — they are science-backed allies in integrative kidney care. From turmeric’s golden spice to the healing hues of berries and tea, these natural compounds reduce inflammation, fight oxidative stress, and protect kidney cells from silent injury. They don’t replace medications, but when used wisely and consistently, polyphenols can enhance kidney health and overall well-being.

Simple measures to take control of your kidney health Beware if you have risk factors DiabetesHigh blood pressureKidney failure / Dialysis / Kidney Transplantation in family membersStroke / Heart attack / Heart failureSmokingEthnic factors Be watchful regarding the symptoms and signs The previous chapters have dealt elaborately regarding the signs and symptoms which heralds the onset of kidney disease. The importance of a master health checkup in diagnosing kidney disease need not be overemphasised.   Take control of risk factorsConventional risk factors like diabetes and hypertension should be under control all the time. Don’t smokeSmoking slows the flow of blood to your kidneys making it difficult for them to function normally. Smoking also increases your risk of developing kidney cancer. DietNo diet is poisonous to completely avoid them. Moderation is best when absolutely healthy. Take the advice of a renal dietitian and nephrologist right from the diagnosis of kidney disease.Identify the real organic foodsIt is proven that foods and drinking water contaminated with pesticides accelerate kidney disease. Take the effort to identify real organic pulses, cereals and vegetables and use them in your diet especially if you have certain risk factors. Many advocate a plant based diet for the same. When do I see a Nephrologist?If you have any one of the followingCongenital kidney ailmentReduced GFR (Glomerular Filtration Rate)ProteinuriaKidney stonesAcute and chronic kidney failureAs advised by your family physician When you go for a Nephrology Consult…….Write down the important questions you wish to ask.  Give details of your drug intake, duration and dose. Go along with your previous laboratory reports. Get the records of home blood pressure and blood sugar values. Note your previous 24 hour urine output and inform the doctor. Remember to tell about the new onset of symptoms. Accept treatment with full confidence and clarity. Keep your health records up to date. When treatment decision for kidney disease has to be madeAsk your Nephrologist,What are the options available?Which treatment option will best suit me?How can I improve my health with the current treatment plan?