By Uche Nnamani
World Kidney Day is a global campaign aimed at raising awareness of the importance of kidneys. March 10 every year is the day set aside for this important event by the International Society of Nephrology and International Federation of Kidney Foundations.
The annual campaign aims at raising awareness of the importance of the kidneys to the overall health of humans and to reduce the frequency and impact of kidney disease and its associated health problems worldwide. The theme for this year’s observance is “Bridge the Knowledge Gap.”
Dr. Ofon Udoh, nephologist and clinical administrator of Kidney Solutions, in Festac Town, Lagos, spoke to Uche Nnamani, The Sun’s principal manager (production), on several issues associated with the disease, including risk factors, care and management of chronic kidney disease (CKD). Excerpts:
Tell us about World Kidney Day?
World kidney day started in 2006 and is aimed at raising awareness of the importance of the kidneys. Every year, a particular theme is highlighted and this year, as usual, the main theme is kidney health for all but the sub-theme is “bridge the knowledge gap to better kidney care.” This global event aims at raising awareness and knowledge about this amazing human organ.
It also seeks to encourage everyone with risk factors like diabetes or hypertension to go for regular screening. It also encourages preventive behaviour in everyone and wants to let all medical professionals know that they have a role to play in preventing kidney disease.
What factors can be attributed to Nigeria being the country with fourth highest prevalence rate of kidney disease worldwide?
Kidney disease can be acute, or chronic. The chronic disease progresses slowly and most times quietly. Like I noted before now, several risk factor could be attributed to this, they include but are not limited to rising cases of hypertension, diabetes mellitus. An infection called glomerulonephritis is also a cause of CKD. Lifestyle also has a role to play in CKD prevalence. Sedentary lifestyle, intake of processed meals, high salt intake, alcohol intake, caffeine, herbal concoctions, abuse of pain-relief medicines all play a role in the subsequent development of CKD. Other factors of some diseases are inherited, for example, some cystic kidney diseases.
Are these all the factors?
No, they also include conditions like obstruction of the pathway of urine passage, for example in, prostate enlargement or kidney stones or even sometimes huge fibroids.
What is glomerulonephritis and what causes it?
Glomeruli is a network of tiny blood vessels located at the beginning of the microscopic structural and functional unit of the kidney known as nephrons. Hence glomerulonephritis is a condition where there is inflammation of these tiny filters. It is usually caused by bacteria infections.
What is the difference between acute, chronic and severe kidney disease?
Acute is sudden. Someone whose kidney was working well and then, suddenly, because of some assault like an infection or sudden loss of blood, the kidney just stops working, without any previous history of kidney ailment. In this circumstance, the symptoms come suddenly. All of a sudden you can’t urinate again or urine comes in very unusual colour. But chronic is when the disease has been there for a long time. Slowly progressing with little or no symptoms till it’s too late. Very quiet but deadly. All kidney issues can be severe if not handled well; they may progress to CKD, chronic kidney disease, a condition that is usually irreversible.
How do you explain cases of kidney patients who are non-hypertensive, non-diabetic and never take alcohol?
Several other factors, apart from the ones mentioned above, can cause kidney disease. Some are genetic, some from lifestyles like obesity, some from obstruction of the urine flow pathway, others are cystic kidney diseases, which can impair the ability of your kidneys to effectively filter water and waste out the blood. Some are autoimmune, where the body fights the body, some are unexplainable.
What is this autoimmune factor?
There are some diseases where the body produces antibodies (which naturally should fight foreign bodies), but in this case they fight the body. An example is systemic lupus erythematosus.
What is the role of anaemia and hydration in CKD?
Anaemia can be a consequence of CKD, as the kidney aids the body in making blood. Hypertension is a cause and can also be a consequence of CKD. Dehydration can cause kidney disease but this is usually acute.
How is kidney disease diagnosed and treated?
Kidney disease is diagnosed based on symptoms, signs and lab tests. A kidney function test shows abnormalities: an imaging of the kidney too will tell. It’s important to pick this derangement early and halt the progression of the deterioration of kidney function. And once it’s picked, a nephrologist should be alerted and measures to find the cause, stop the progression and do a turnaround. Sometimes, and in fact most times, this disease is discovered late, when there is irreversible damage to the kidneys.
What are the standard stage-based interventions and management in CKD?
When the diagnosis is made, the disease is staged and, based on the stage, intervention processes start. They vary based on the cause and extent of damage and can range from just control of diabetes or hypertension and go as far as a kidney transplant.
What level of care can be accessed locally?
Early to critical level of care can be accessed locally. Unfortunately, there is dearth of qualified medical personnel in this and other specialist areas of medical care. Cry about brain drain is real and the number of doctors has reduced drastically in Nigeria. As you would expect, there are more of these facilities in the urban area than in the rural areas.
What is haemodialysis?
Haemodialysis is a mode of care for patients whose kidneys have failed. Haemodialysis involves utilizing an artificial kidney to remove the wastes and excess water that the kidney should have removed.
Those on haemodialysis need to be hooked onto the machine for a period of time, usually four hours, while the artificial kidney removes the waste.
But it does not do all the other things the kidney does. However the transplant does everything the kidney does because a kidney is put inside the person
Is transplant a cure for CKD?
Transplant can be described as a cure because a new kidney is put inside the person who literally has no kidneys as his kidneys have failed.
People can live with one kidney, so the donor lives with one kidney and the patient is ‘literally’ living with one kidney too.
Can CKD be prevented?
Yes. If one is hypertensive or diabetic: adherence to medications, regular attendance at clinics, regular checks of blood glucose and ensure it is normal. Those with family history of kidney disease should ensure they check and do regular screens.
Avoid toxins, don’t just put anything into your mouth. Alcohol, processed foods, fizzy drinks, sweetened drinks. Don’t be sedentary: exercise regularly. Brisk walk at least three times a week. Do regular checkups with certified doctors, not the roadside ones, please. Don’t abuse pain medicines. Several people who do hard work do this, swallow two or more types of pain meds regularly, and even mix the powder with drinks. Abuse of analgesics causes kidney failure. Creams that bleach contain toxins, which enter the blood stream slowly and accumulate and cause organs to fail.
Many patients complain that their disease progressed to CKD due to wrong diagniosis
Misdiagnosis occurs because symptoms are usually subtle at early stage. But patients should seek the help of a specialist when there is frequent cases of weakness or malaise that usually interpreted as ‘malaria and typhoid’ without proper tests.
Low blood level may be attached to some other illness, same with leg swelling, but there is need to see a specialist, if the causes are unknown. Usually, the trained doctor will take a history, examine the patient and then do tests to make the proper diagnosis.
Kidney treatment is expensive, what can the government do to help?
Government can approve duty waiver or concessions for equipment used for patients with kidney failure like dialysis machines; health insurance coverage for patients on long-term dialysis; investment in production of some of the medicines and consumables used for those with chronic kidney failure in Nigeria.
