•Dr. Olumayowa Aderinto
Kidney disease is highly prevalent in Nigeria. It is estimated that 1 in 4 Nigerians have one form of kidney disorder or the other while about 15,000 new cases are diagnosed every year in the country, but very few are receiving specialist care. The reason is not far-fetched. Managing any sort of kidney-related diseases is expensive and complicated. The burden is impoverishing not just to the patient but also the family.
IN the views of Dr. Olumayowa Aderinto, a US trained nephrologist (kidney specialist) and Director, TCNL Healthcare, a dialysis unit and kidney disease prevention outfit in Lagos, initially kidney failure may cause no symptoms. “By the time you are seeing symptoms, it is too late, so keep monitoring your blood pressure and blood sugar levels.”
During an open house activity of the private healthcare outfit located in Gowon Estate, Egbeda, Lagos, Aderinto said symptoms of kidney failure are due to the build-up of waste products in the body that may cause weakness, shortness of breath, lethargy, and confusion.
“Overall, diabetes and hypertension remain the highest risk factors. Prevention is better than cure. It is best to prevent from going into end-stage kidney disease. Things that can be done include checking for blood sugar, blood pressure, and ensuring it is controlled. Also use drugs only with medical guidance and watch what you drink and eat.”
Explaining that the purpose of setting up the facility is to promote preventive kidney care for Nigerians, she pointed out that there are numerous causes of kidney failure, and treatment of the underlying disease may be the first step in correcting the kidney abnormality. “Some causes of kidney failure are treatable and the kidney function may return to normal. Unfortunately, kidney failure may be progressive in other situations and may be irreversible.
The diagnosis of kidney failure usually is made by blood tests measuring certain key parameters. During regular check up, if you are hypertensive, you are checked for protein in the urine. “That is the earliest sign. If we find protein, we might do it again; if it is high you might be prone to kidney failure. Normally there should not be protein in the urine; there could be traces, as a result of conditions such as pregnancy.”
She said treatment of the underlying cause of kidney failure may return kidney function to normal, but lifelong efforts to control blood pressure and diabetes is the best way to prevent chronic kidney disease and its progression to kidney failure.
With age, kidney function gradually decreases over time and if the kidneys fail completely, the only treatment options available may be dialysis or kidney transplant. “As you get older, you lose a degree of kidney function, but it should not be significant. Essentially, your kidneys should last your lifetime.”
An experience as a medical student at the Ladoke Akintola University of Technology, LAUTECH, Ogbomoso, Oyo State, in 1992, motivated Aderinto to pursue a career as a nephrologist.
“When I was in medical school, my uncle’s wife died of kidney disease. She was on dialysis for a while; the family sold their belongings to raise money for the procedure. She was being taken from one place to the other, but she still died. Since then, it has been my dream to do something about this problem. I have had it in my mind, so when I had opportunity to become a nephrologist, I did not hesistate.
“We are factoring in a lot of things at this centre to ensure that the cost is as low as possible. We are campaigning against kidney disease and are reaching out to people to access this facility for such needs. The goal is to provide affordable kidney care services, such as dialysis, hence the focus on patients that cannot afford regular cost of dialysis by going to companies to ask for sponsorship until they can get a transplant for those that require it.”
Kidney failure
“When we say the kidneys have failed, they have dropped below 15 percent functional capacity, so you might need dialysis. If you start having symptoms like poor appetite and weakness, etc, we advise you to go on dialysis. But if you are still walking around, then your kidneys, even though may have failed, still have reserve. For people that still have this reserve, they might still get away with once or twice a week. But not so for those that do not have this reserve.
“In acute kidney failure, you might require dialysis for just a while and the kidneys pick up again. Some illnesses cause the kidneys to shut down, also infection, and sudden drop of the blood pressure can cause the kidneys to fail. However, if adequately supported through dialysis, the kidneys can pick up again, but the patient may become prone to chronic kidney failure in future if care is not taken.”
Kidney disease is classified into stages. In Stage 1, function is normal, but there is blood or protein in the urine. It is still chronic kidney disease, but the mild stage. In stage 2, kidney function is 60-90 percent good; stage 3, 30-60 percent, stage 4, 15-30, stage 5 is below 15 per cent. If you are in Stage 2 or stage 3, you might not know you have kidney disease because there would be no symptoms. But such people need to take precautions and be monitored to ensure they do not go into stage 4 or 5.
Dialysis
Dialysis cleanses the body of waste products in the body by use of filter systems. Hemodialysis uses a machine filter called a dialyzer or artificial kidney to remove excess water and salt, to balance the other electrolytes in the body, and to remove waste products of metabolism. The recommendation is for a patient that requires dialysis is to undergo four hours of dialysis at least three times a week. Dialysis is life-saving.
Without it, patients whose kidneys no longer function would die relatively quickly due to electrolyte abnormalities and the buildup of toxins in the blood stream. While patients may live many years with dialysis, it is often unsustainable as a result of the high cost, even as other underlying and associated illnesses have been known to cause the death of the patient.
Kidney transplantation
If kidney failure occurs and is non-reversible, kidney transplantation is an alternative option to dialysis. Not all hospitals are capable of performing kidney transplants. More patients in Nigeria travel to India to undergo their operation and are often in search of funds for the procedure. Prevention
Kidney failure is a serious matter. Most people with kidney disease aren’t aware of it. So get diagnosed early. Prevention is always the goal with kidney failure. Once kidney failure is present, the goal is to prevent further deterioration of renal function. If ignored, the kidneys will progress to complete failure, but if underlying illnesses are addressed and treated aggressively, kidney function can be preserved, though not always improved.
Tips for kidney health
Drink lots of water to flush out wastes. Drinking water also helps lower the chances of kidney stones and infections. Keep your blood pressure in the target range. Weight control, exercise, and drugs can control blood pressure—and prevent or slow the risk of kidney failure. Eat more fruits and vegetables, stay physically active, keep your blood pressure below 140/90 mm/Hg, but check with your health care provider for your appropriate target.
Stay in your target cholesterol range and try to eat foods lower in sodium. If you have diabetes, meet blood sugar targets as often as you can. Go for medical check up at least twice a year. If your blood pressure is high, check it regularly and get it under control to make sure your kidneys remain healthy. Consult a doctor if you have any or all of these symptoms: cloudy or bloody urine, pain or burning when you urinate, or an urgent need to urinate often.
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