Henry Uche
World Kidney Day (WKD), is commemorated every second Thursday in March, which is today. This year’s edition is raising awareness of the increasing burden of kidney diseases worldwide. The campaign highlights the importance of preventive interventions to avert the onset and progression of kidney disease.
Its theme: “Kidney Health for Everyone Everywhere – from Prevention to Detection and Equitable Access to Care,” is championed in Nigeria by a joint initiative of the International Society of Nephrology (ISN) and International Federation of Kidney Foundations (IFKF). The founder, St. Remmy Foundation, Obetta Remigius, said: “WKD is a global campaign that aims to raise awareness of the importance of our kidneys to our overall health and to reduce the frequency and impact of kidney disease and its associated health problems worldwide.
“Given this, the need for everyone especially the government at all levels to show empathy and compassion to persons affected by kidney disease becomes indispensable.
“The campaign calls on everyone to advocate for concrete measures in every country to promote and advance kidney disease prevention, including; renewed focus on primary care, awareness raising and education including patient empowerment and cross-specialty training.
“Kidney disease is associated with a tremendous economic burden according to World Health Organisation (WHO). High-income countries typically spend more than three per cent of their annual health-care budgets on the treatment of end-stage kidney disease, even though those receiving such treatment represent under 0.03 per cent of the total population.”
Consultant Nephrologist, Lagos University Teaching Hospital (LASUTH), Professor Olugbenga Awobusuyi, said: “Kidney failure occurs when your kidneys lose the ability to sufficiently filter waste from your blood. Many factors can interfere with your kidney health and function, such as: toxic exposure to environmental pollutants or certain medications, certain acute and chronic diseases and severe dehydration.
Causes
Awobusuyi said, the causes of kidney disease are numerous: “The three commonest causes are, diabetes, hypertension and glomerulonephritis. There are other causes especially those with chronic diseases even elderly people with prostate enlargement.
“People with holes in their kidney which in most times is hereditary, we call them, cyscic disease of the kidney. More so, sickle cell anaemia can cause kidney disease, most importantly people who are fond of taking pain relief medicines and antibiotics indiscriminately especially artisans, these can damage the kidney.
“Some people have kidney stones, certain infections like HIV, even altrities and malaria. And number of persons, who also develop acute kidney injuries which makes the kidney to deteriorate within 28 hours caused by excessive blood loss especially during delivery, accidents etc.
“More so, when people lose blood like those with cholera such can lead to kidney failure. Don’t forget the most intakes of herbal substances can damage your kidney within hours. There are other causes yet unknown to us.
Signs and symptoms
“The symptoms are general weakness of the body, difficulty urinating and when that happens, the face starts swelling, the legs and other parts of the body. While some people will experience hiccups then metamorphose into losing consciousness, coma and eventually death.
“Anyone with hypertension, glomerulonephritis and diabetes should go for proper treatment immediately. We should take more of water to avoid dehydration; must beware of herbs and roots we take. Avoid un-prescribed drugs. And ask the doctor anything you don’t understand- health-wise.”
Treatment
The consultant said: “Treatment is divided into two. The first treatment is for those who do not have kidney failure yet and second, for those who already have kidney failure.
“For those who do not have kidney failure yet, we wage war against impending kidney failure by treating those illnesses like malaria, hypertension, diabetes, HIV and glomerulonephritis that have the potential of causing kidney disease.
“We act proactively, it is all serious matter, and must be done thoroughly. We also recommend good diet, reduce salt in food, reduce liquid and fluid in food, we eliminate some drugs from the person if that’s the case. Regular checks are indispensable.
“The second treatment, for those whose kidney is no longer working, we place them on dialysis. And for those who are suitable for kidney transplant, are advised to do so.
“Note that this is not cheap as most families cannot afford it. That is why we implore the government to come to the aid of persons with kidney disease by putting in place infrastructure to support management of kidney disease and failure and dialysis centres in the country.
“The case is becoming unbecoming. Going by statistics of the economic implications of able-bodied, productive men and women who are suffering from kidney disease, they are not only a burden to their families but to country at large.”
Prevention
Awobusuyi said: “There is plenty you can do to help keep your kidneys healthy and help prevent kidney disease; watch your weight. Being overweight increase your risk of diabetes and high blood pressure, which in turn increase your risk of kidney disease. Eat healthy a diet high in fruits and vegetables and low in salt, sugar and fats is best.
“Drink plenty of water, avoid sugary drinks (such as soft drinks). Exercise regularly, don’t smoke, limit your alcohol intake to less than two standard drinks a day. Others include; find ways to help you relax and reduce stress, be aware of your risk factors, that is, if you know you are at risk of kidney disease, you can have your kidneys checked regularly.”
Stages of kidney disease
Experts said there are five stages of kidney disease. These are normal or high GFR (GFR > 90 mL/min); mild CKD (GFR = 60-89 mL/min); moderate CKD (GFR = 45-59 mL/min); moderate CKD (GFR = 30-44 mL/min; severe CKD (GFR = 15-29 mL/min) and end stage CKD (GFR <15 mL/min).
Global burden
The WHO said although often considered a comorbidity of diabetes or hypertension, kidney disease has numerous complex causes: “Importantly, such disease has an indirect impact on global morbidity and mortality by increasing the risks associated with at least five other major killers; cardiovascular diseases, diabetes, hypertension, infection with human immunodeficiency virus (HIV) and malaria”
For example, the Global Burden of Disease (GBD) 2015 study estimated that 1.2 million deaths, 19 million disability-adjusted life-years (DALYs) and 18 million years of life lost from cardiovascular diseases were directly attributable to reduced glomerular filtration rates.
Condition of kidney disease cases in Nigeria
The global prevalence of kidney disease as presented by the WHO states that one in every 10 persons has a form of renal disease. The situation is even higher in Nigeria due to several factors. This includes low economic capacity of appreciable percentage of the country’s population, inadequate well-trained kidney healthcare personnel, lack of kidney health education and insufficient kidney health medical equipment in most health facilities in Nigeria. Presently, between 10 and 14 per cent of Nigerian population is affected by kidney disease.
Way forward
Remigius provided ways out: “There should be grassroots mobilisation to initiate early screening for kidney damage; such as; urinalysis for pro-teninuria, micro-albuminuria, hematuria, hypertension and diabetes in our primary healthcare, schools (primary, secondary and tertiary institutions), antenatal care and pre-employment screening.
“Also, WKD should be marked by all – federal, state and local government health institutions – to create awareness. Health awareness and campaigns on immunization against hepatitis and other preventive measures against spread of infectious diseases such as HIV.
“There should be Public Private Partnership to develop additional capacity for renal transplant should be highly encouraged and supported.
“A major issue facing Nigeria is its inability to appropriately quantify and analyse the kidney disease burden with credible data. There is on going research funded by USA covering so many countries in Africa. It is aimed to provide the base line information on causes of renal diseases.
“Significant external support is required from international development agencies, in terms of technical assistance, as well as advocacy and political will to get the partnerships with India and China to produce high quality generic drugs and other health equipment for Nigerians to avoid the expensive trade mark product.
“It is very obvious that this disease needs to be tamed with full collaboration with government and community at large. There should be emphasis on prevention, early detection and intervention, prompt treatment to prevent progression, while in advanced cases, dialysis and early transplants should be made feasible.
“Remember, prevention is definitely cheaper than cure. Besides, substantial actions should be taken by each state to reduce poverty, increase equity, improve nutrition, advance education, and develop health services and human resources.”