Chronic kidney disease: A death sentence?

To Ibrahim, it was like choosing between the devil and the deep blue sea. He is a 35year old mechanic with a wife and six children, all in school. His parent died when he was very young and he had to toil by himself to get where he is. He had no education and no […]

To Ibrahim, it was like choosing between the devil and the deep blue sea. He is a 35year old mechanic with a wife and six children, all in school. His parent died when he was very young and he had to toil by himself to get where he is. He had no education and no rich friends or relations to sponsor him.

He could not afford the transplant, so he commenced the dialysis but could not keep up with the bills as he had sold all his possessions. He eventually died three months after diagnosis.

The story of Ibrahim Yusuf is not real, but it illustrate the real picture of the common Nigerian man and woman whose income cannot stand the test of CKD or even worst, who cannot afford for proper meals.

Chronic kidney disease is becoming more common in our society today, because the capacity to making diagnosis has increased and also the effect of westernisation on our culture, and eating habits. It is a worldwide public health problem and is now recognized as a common condition that is associated with risk of heart disease.

The kidney disease outcomes and quality initiative (K/DOQI) of the National Kidney Foundation (NKF) defines chronic kidney disease as either kidney damage or a decrease in kidney glomerular filtration rate (GFR) of less than 60ml/min/1.73m2 for three months. Whatever the underlying aetiology, the destruction of the main kidney tissue with irreversible sclerosis (hardening) and loss of nephrous (tiny tubes which are structural and functional units of the kidney functioning as filters) which lead to a progressive decline in GFR (decline in the rate of urine formation). Simply put, the person’s kidneys stop functioning in making urine.

Each kidney is made up of about 1million nephrons which help in filtering waste substances from the blood. It weighs 150 gram and measures 11-14 cm in length. It is a paired organ located in the abdomen. Its functions in addition to filtering blood are to maintain balance in the body, produce substances that help in production of blood.

CKD is a major cause of morbidity and mortality in Nigeria today particularly in its later stages. According to studies, the five year survival rate of a patient undergoing treatment in the USA is 35 percent, that is, only 35 percent of those undergoing treatment will still be alive after five years (that is in the United States of America). It affects all races but is four times more common among blacks than in whites, and it is more common in males than in females. It is found in persons of all ages and it can be inherited or acquired later in life.

The commonest causes in our environment are hypertension, diabetes mellitus and chronic glomerulorephritis, all of which damage both kidneys at the same time. Other causes include abuse of analgesics (pain killers) like aspirin, paracetamol, ibuprofen, antibiotics like gentamicin, mercury containing body creams, long standing obstruction of the urinary tract. Inherited diseases include; Alport’s syndrome and Polycystic Kidney Disease and some inflammatory conditions.

In the early phase, there are no symptoms except for some biochemical markers which can be detected through lab test. Symptoms manifest as body and early morning facial swellings, poor appetite, nausea and vomiting, decrease in urine volume, body itching, paleness of skin and rise in blood pressure.

When a person is diagnosed with the disease, the treatment is either transplant of a healthy kidney (one) from a compatible donor through surgery and use of drugs called ‘immunosuppressant’s’ to subdue the recipients’ immunity from fighting the ‘foreign body’. It is not done in this country and it is very expensive, costing about two million naira apart from travel expenses. The other alternative is to undergo dialysis at least three times a week. Here, the person’s blood is drawn into a machine, filtered and returned back. It takes time, as the person has to sit for three to four hours, and complications such as blood loss may arise, pain from use of the canulea and infections are always there.

Prevention

Ways the disease could be prevented if not inherited included regular medical check ups to detect the disease early and commence treatment, imbibing a healthy life style by eating healthy food and exercising, avoid smoking or excessive alcohol, taking drugs only on prescription, avoiding mercury containing body creams and soaps, keeping hypertensive and diabetic patients under good control e.t.c.

The burden of CKD on our society needs proper attention for both government and non-governmental organisations in order to nip it in the bud. The availability of dialysis and transplantation in Nigeria is generally poor. Dialysis and transplant programs in Africa are dependent on the availability of funding and donors. The majority of those with CDK die because of lack of fund as very few can afford regular maintenance dialysis and even the transplant.

We need those in government to stop looting our money and do something for the benefit of all, not for the benefit of few. It is not only our hospitals that are not functional but virtually everything, even our schools.

Remember, you might not always get the opportunity to fly abroad, you might lose your wings someday and your only option is to settle for the less. Why won’t you make the less the best for the benefit of all?   

 Tokara, is an undergraduate student of the Uuniversity of Maiduguri.