‘Chronic kidney disease is an irreversible condition’
To answer this question, I would like to briefly mention the functions of the kidneys so as to put it in proper perspective. The main functions of the kidneys may be briefly categorized as: A. Maintenance of body composition. The kidneys regulate the electrolyte content and the volume of fluid in the body. B. Excretion […]
To answer this question, I would like to briefly mention the functions of the kidneys so as to put it in proper perspective. The main functions of the kidneys may be briefly categorized as: A. Maintenance of body composition. The kidneys regulate the electrolyte content and the volume of fluid in the body. B. Excretion of metabolic end products and foreign substances that we ingest, notably, urea and drugs and toxins. C. Production and secretion of hormones and enzymes.
I- Rennin an enzyme that is important in salt balance and blood pressure regulation. II- Erythropoietin contributes significantly in the process of red cell maturation. III- Vitamin D plays an important role in the regulation of body calcium and phosphate balance.
From the above, it can be deduced that the principal job of the kidneys is the correction of perturbations in the composition and volume of body fluids that occur as a consequence of food intake, metabolism, environmental factors and exercise. Deviation from, or disturbances in the above functions can therefore constitute a disease process.
However, I think kidney disease as it concerns the general public is perhaps the process that results in the complete failure of the kidneys necessitating renal replacement therapy in the form of dialysis or transplantation.
WHAT IS THE CAUSE OF KIDNEY DISEASE?
Well, the causes of kidney disease are many. But for the purposes of this interview, I’d like to first of all classify them into acute causes and chronic causes. Acute kidney disease or acute kidney injury (AKI) as it is currently referred to is, kidney disease, occurring within hours, days or weeks. It is a potentially reversible condition that if detected early and properly managed will usually result in restoration of normal kidney functions. Causes are usually obvious. For example, loss of body fluids as in massive blood loss during child birth, surgical procedures, road traffic accidents; and losses that might occur in a cholera epidemic for instance. Other causes include drugs and toxins that damage or interfere with kidney functions. There are several other causes, but I think these will suffice for the purposes of this interview. Treatment is usually straight forward; replace what the patient is losing or remove or stop the offending drug (s) or toxin(s)!
Chronic kidney disease on the other hand, is by definition, an irreversible condition that usually culminates in the need for dialysis or transplantation. Causes are also many, but of significance for us in this country and indeed globally, because of the opportunities for prevention are: Diabetes mellitus; Hypertension and chronic glomerulonephritis (CGN). CGN is usually the end result of various acute insults to the kidneys that were not detected early or not properly managed or those that progressed to a chronic state. Examples are many, but are usually infective (bacterial, viral, malaria, Hepatitis etc) or immunologic in origin.
Other causes of chronic kidney disease are genetic causes like Autosomal Dominant Polycystic Kidney Disease (ADPKD), a condition in which cysts develop in the kidneys compromising their function; vasculitis, a condition in which the blood vessels are inflamed and could affect the kidneys if the blood vessels supplying them are caught up in the process. Examples include; Wegener’s granulomatosis, Microscopic polyangitis, Churg-Strauss syndrome etc. These, by the way are rare conditions
The human immunodeficiency Virus (HIV) is emerging as a major cause of chronic kidney disease, partly because people are living longer now with the availability of highly active anti-retroviral therapy (HAART). This, in a nutshell is a summary of the causes of chronic kidney disease.
DOES KIDNEY DISEASE VARY?
Yes, as mentioned earlier, it could be acute or chronic. It could also be primary or secondary, but I think it will suffice to just stick to the acute and chronic forms, and they have already been mentioned.
HOW DOES KIDNEY DISEASE AFFECT ITS VICTIMS?
I think by that you mean what are the signs and symptoms of kidney diseases? Well, as I mentioned earlier, the symptoms and signs of acute kidney diseases are usually obvious as attention may be drawn to the precipitating cause. A good history will usually disclose the ingestion of nephrotoxic agents etc.
The symptoms of chronic kidney disease are usually non-specific and may include, general body weakness, nocturia i.e excess urination at night that interferes with sleep, loss of appetite, nausea vomiting, sexual dysfunction, body or facial swelling, menstrual abnormality in women etc. Signs include; Proteinuria i.e. excretion of excessive amounts of protein in the urine—this may be a very early sign as may occur in diabetes, pallor, raised blood pressure leg swelling etc. It is important to note that many patients have no symptoms at all and only come to attention in the course of investigating them for other diseases, emphasizing the need for regular checkups.
IF SOMEONE IS SAID TO HAVE CHRONIC KIDNEY DISEASE, WHAT DOES IT IMPLY?
Well, as I mentioned earlier, chronic kidney disease, by definition is irreversible, and may therefore imply the need for dialysis or transplantation at some stage, in the absence of which, it unfortunately implies death.
However, coma may occur as a complication of kidney disease, when the patient is in End-Stage-Kidney-Disease (ESRD), a state when dialysis becomes mandatory. There are several other reasons that can result in coma, but I think this is beyond the scope of this interview.
CAN THE DISEASE AFFECT THE PERSON’S MENTAL HEALTH?
Yes. The chronic nature of the disease, predisposes some individuals to depression and this can vary in severity with some people becoming so depressed that they refuse treatment, and some actually go on to commit suicide. The clinical state of uraemia, i.e. accumulation of metabolic waste products in the body may actually affect the memory and general function of the nervous system.
TELL US ABOUT TREATMENT ESPECIALLY IF IT GETS CHRONIC?
Well, a detailed description of the treatment options is certainly beyond the scope of this interview. However, as I mentioned earlier, chronic means irreversibility i.e. the condition is inexorably progressive and will at some stage require dialysis or transplantation as definitive treatment.
Dialysis is a process where the functions of the kidneys are taken over by a dialyser i.e. an artificial kidney. The procedure is expensive as it has to be done repetitively; ideally three times a week, and it does not offer a cure. It only ameliorates the symptoms of the condition.
Before you get to the stage where the patient will require dialysis, a lot can be done to slow the rate at which the disease progress to that stage. Such as blood pressure control, tight blood glucose control in diabetics and the use of drugs that protect the kidneys-reno-protective agents etc, life style modification like, reduction of salt intake, cessation of smoking and weight loss for the obese. When all fails, dialysis is instituted or better still, kidney transplantation if the patient is fit and a willing and suitable donor is available.
Our best hope however is to prevent chronic kidney disease, as renal replacement therapy i.e. dialysis or transplantation are very expensive. This actually is the global trend.
We can do a lot to prevent the condition that can predispose people to CGN by improving sanitation and housing. There is need for education for the public to seek help as soon as they notice any abnormality as mentioned earlier. Health workers at the primary and secondary levels of health care delivery need to be aware of optimum blood pressure control etc and to refer patients to the specialist as soon as any abnormality e.g. Proteinuria is detected in a patient .
AS AN EXPERT WHAT IS YOUR ADVICE ON THE DISEASE?
Yes, government should consider offering free dialysis or at least start subsidizing it heavily. It is preposterous that treatment for HIV is being offered free while patients with kidney disease are forced to pay for their care. As a minimum, government can begin by ensuring that part of the proceeds from the planned deregulation of the petroleum sector is channelled towards providing free renal care to Nigerians. Less endowed African countries like Egypt provide it free for their citizens.
The National Health Insurance Scheme (NHIS) should include as a matter of priority and urgency, renal replacement therapy on the scheme.