Every year, the second Thursday in March is set aside to commemorate World Kidney Day.
The day set aside by the United Nations is aimed at raising awareness of the importance of kidneys to a healthy life and tackling the prevalence of the disease globally.
The day is also set to mirror the consequences of kidney diseases on not just the health of the patients, but its burden on families and the world in general.
This year, the ever was celebrated with the theme “Kidney Health for All – Advancing equitable access to care and optimal medication practice.”
ASHENEWS spoke to a consultant Nephrologist, otherwise known as a kidney specialist at Ibrahim Badamasi Babangida Specialists Hospital in Minna, the Niger State capital on the disease.
The detailed interview with Dr. Isah Umar Alhaji provides expert insight into the overlooked yet common disease which is impacting the lives of millions globally.
In this interview, the expert shares lifesaving tips and information on preventing the disease and the causes behind its prevalence in our society.
Q: What is the function of the kidney in the human body?
They are a paired organ in the body and on average, they weigh about 150g. Individuals are born with two kidneys and in rare cases, some are born with one.
The kidney serves a very important function in our body. It’s an organ that filters waste in the form of urine, it is also an excretory organ, that is it excretes all unwanted waste substances out of our body.
It gives important chemicals in the body for the formation of certain systems or organs in blood formation, the kidney plays a vital role in maintaining the production of blood by providing what we call electroprotein, which is why people who suffer from kidney diseases or its failure have a recurrent shortage of blood and are almost always in need of blood transfusion,
It also gives chemicals to the body to strengthen the human bone. If there are kidney diseases, part of the presentation (symptoms) is the patient complaining of bone pain because the bone is abnormally being softened because the kidney is not working properly.
It also regulates body water. Your kidney filters almost like 180litres of fluids in 24 hours round the clock. Imagine the kidney cannot filter this fluid adequately, which results in fluid collection and we see our patients with swollen faces, legs and bodies because the kidney function is compromised.
They also have other functions they do in strengthening the system. For example, we have electrolytes which are constituents of the body both fluids and body cells. We have sodium, potassium, bicarbonate etc so the kidney assists in regulating them so that they are not too low or too high because being too low or high can be a problem.
This becomes obvious when the kidney is not working adequately, in some patients we have to start treating them for being high or low.
Q: What leads to Kidney Disease
A: The number one cause is hypertension, which is why it is advised that everybody should have his or her blood pressure checked routinely. The second commonest cause is diabetes. When we have these two combined, it means the risk is even higher.
Uncontrolled diabetes can lead to kidney failure, we also have infections of the kidney, one we call chronic hydronephritis
This occurs during childhood to adolescence when we will have recurrent infections that affect the kidneys. If it keeps going on, the kidney becomes smaller in size and non-functional, it’s another common cause within our environment here.
In men, we have prostate enlargement, where the prostate is enlarged and ignored, which can lead to the kidney.
There are other common things that people do as a habit here, including the use of unprescribed medications, and painkillers, when you wake up in the morning and feel unwell, you go to the pharmaceutical shop and say you are not feeling fine and lot of them there are not trained so they will give you many pain relievers at the same time and those pain relievers can work for you and make you feel very strong but in essence will continue to kill your kidneys.
Another common practice is the use of herbal medications, in the first instance, we don’t know what is inside, it’s only the maker that knows what is inside and we don’t know the constituent.
Those herbal medications can become poison to our bodies and affect our kidneys.
Others more common to women is bleaching of any type that is used for skin lightening can likely cause some form of reaction that can affect the kidney and if one is unlucky, he certainly will develop kidney failure.
Use of hard drugs such as cocaine and Indian hemp. Even here, we have had several patients that have come down with complete kidney failure, we had to maintain on dialysis, few have had kidney transplants and the cause of their kidney problem was smoking Indian hemp.
Others include obesity, cigarette smoking, sedentary lifestyle, all have additional risks.
Severe diarrhoea and vomiting can also cause kidney disease.
When people develop acute food poisoning otherwise known as diarrhoea and vomiting, they lose a lot of body water which leads to a shortage of water volume in the body.
The blood supply to the kidney becomes very short and the kidney can starve. When the kidney starves, for a very long time, it dies either completely or temporarily.
This is where we say someone has acute kidney failure.
If sorted out early, the majority of them will recover immediately and fully but if left for a long time, they may not recover their kidney function.
Q: Is there a pattern you have observed in the patients who have reported at the facility with kidney disease?
A: We have had patients across boards meaning from all nooks and crannies of the state. The common things that we have seen are hypertension, diabetes, prostrate enlargement, use of hard drugs and severe diarrhoea and vomiting.
So the pattern of our people’s presentation is not different from what the generality of kidney patients worldwide have.
Q: What is the burden of the disease in Niger State?
A: Globally, it is estimated to be the eighth cause of death and is projected that in a few years to come, it is likely going to climb up to be the fourth most common cause of death.
Roughly about 10 per cent of the society has one form of kidney disease you can now look at the world population. Out of this 10 per cent, maybe just 1 per cent will get to the point of kidney failure completely.
Coming down to this hospital, we can say the number of people that are admitted because of kidney failure is at the rate of 10 to 12 per cent.
This means the number is not small, out of 10 people that are in admission, we are likely talking about 1 to two people affected by kidney dispute.
The expense that is the treatment burden is very heavy. On individuals and family, it’s almost unbearable.
Q: What role does early detection and prevention play in addressing its prevalence?
A: The best way of avoiding kidney disease is prevention and prevention plays a key role in health systems generally.
Almost 99 per cent of our patients come in at a time they need dialysis meaning they come in very late and this is what happens across Nigeria or probably West Africa.
Q: What are the treatment options for kidney diseases
A: Once the kidney has failed, we have two basic options: dialysis and transplant
Dialysis cleans all the dirt in the body that the kidney due to its state of failure cannot do.
The blood will be cleaned and returned to the patients.
The one we do here is the hemodialysis.
But the best option is a kidney transplant once it is confirmed that your kidney is no longer functioning.
Treatment options are limited somehow because we have to go into renal replacement therapy which means alternative treatment aiming at taking over the function of the failed kidney so we can do either dialysis or a kidney transplant.
The type we have is hemodialysis where we fix the patient to the machine and the machine will clean the blood.
Another form of dialysis is called peritoneal dialysis, which is one in which they put fluid into the patient’s stomach and continue replacing it.
That is not readily available here. It’s supposed to be because it is the cheapest form but because of logistics availability, we don’t do that.
The other modality of treatment is to do a kidney transplant for people who have enough money and are lucky to have a donor.
This is the definitive treatment for kidney failure. Definitive in the sense that the patient’s kidney function will come back to normal and carry out its normal functions.
One kidney is enough for anybody and it is based on that principle that we say someone can donate one and be surviving with one.
Those are the modalities for treatment.
Q: What are the stages of Kidney Disease
A: We classify kidney disease based on stages stage 1 to 5.
Stage 1,2,3,4 does not require dialysis. Only stage 5 requires dialysis. Even in stage 5, as far as our environment is here, the majority of the people may still manage for a while before they commence dialysis.
This staging is based on the kidney function itself: if the kidney function is marginally reduced, moderately or severely reduced. That is the basis for the staging of kidney disease.
Kidney transplantation is the best form of treatment being that it is the definite treatment for kidney failure.
Q: What are the challenges with these treatment options
A: The first challenge is the cost. On average in Nigeria, you require about N11 million Naira to successfully do one kidney transplant and in the range, other things may occur so some patients may end up spending N14 or N15 million Naira based on some peculiarities.
For example, the process of matching the recipient and the donor and some form of screening.
Everything may match but there may be some form of particles that if left untreated and we give that kidney to the recipient, it’s going to cause a lot of problems.
So we have to test the donor first and treat the recipient in some instances in some special form of dialysis to remove excess of those things.
Each of those sessions is expensive so they will add to the cost of a kidney transplant.
Q: What is the cost of Dialysis
The cost of dialysis too is exorbitant. Even though we said kidney transplant is expensive, it’s still cost-saving compared to dialysis.
Dialysis is a continuous expenditure with no end. A patient is expected to do 12 hours of dialysis in one week divided into three sections divided into four hours each.
Each session, we do dialysis here in IBB, each session of dialysis costs between N28,000 to N45,000 depending on some issues. You need to do that dialysis three times a week.
Apart from that, you will also be treating other complications of kidney failure like shortage of blood, either doing blood transfusion or use of Erythropoietin which is another very expensive drug.
So in essence, the money you spend in two or three years for dialysis will have done the transplant for you very comfortably and you will have a guarantee back to full life after the transplant.
Q: What is your call to action to the government and other policymakers?
A: Kidney disease is common and it can affect anybody so we are of the view that the government should have an implementable policy for people with kidney failure so they can allow them to have subsidised dialysis.
They should make available transplant centres and find them so they can do the kidney transplant at an affordable cost.
We can’t say free except if we won’t be realistic, but the government’s intervention can make it cheap enough for the patient to be able to say I want to just remain on dialysis, no transplant.
They can even make it in such a way that the transplantation is easily accessible and affordable to the patients.
Those are the policies the government should look into.
Q: Your advice to Nigerians on protecting the organs
A: People should make their health very important. go for routine medical checkups especially if you are of age. more importantly, if you have some of these risk factors earlier mentioned, then your care for yourself becomes very important.
If you have a family member with any of these problems, you are at risk.
For example, if your father or mother or both are hypertensive, it means you are at high risk of becoming hypertensive. So you need to check your blood pressure regularly.
If you have a blood relation who is diabetic either mum, father or uncle, it means you are at risk of developing diabetes. this makes it mandatory to check your blood sugar and general medical checkups at least once a year or according to your doctor’s advice.
