IN recent times, the spate of kidney (renal) diseases and kidney failure has been a real source of worry. In this chat with Sola Ogundipe, Dr. Olugbenga Awobusuyi, a Consultant Nephrologist (kidney specialist), and member, Nigeria Association of Nephrology, NAN, re-echoes the importance of early detection and proper management in prevention and management of kidney disorders. Awobusuyi, a professor of internal medicine at the Lagos State University Teaching Hospital, LASUTH, and Fellow, National Post-Graduate Medical College, speaks on the need for constant health checks and adoption of healthy lifestyles. Excerpts:
Renal failure affects the rich, poor, young and old, regardless of status. It is a disease that has a very high prevalence in our society. The only reason why people are not aware of renal failure is that most times it doesnt have symptoms until late in the course of the disease.
Someone could be harbouring renal disease for 10 to 15 years and only become symptomatic years after developing the disease fully. At the very early stage, most people are not aware of it until very late in the course of the disease and this is a major issue.
By the time symptoms begin to show, it is very late in the course of the disease and treatment becomes very expensive. This is why we continue to have occasions like the World Kidney Day and the MTN Foundation Screening Exercise and such screening programmes in Nigeria. The emphasis right now is to detect kidney failure and begin early treatment.
Continue reading after the cut....
Prevalence of renal failure
Most studies on the general population of Nigeria of say 18 to 21 percent of the adult population is close to about one fifth of the adult population and that is very close to what we find in hypertension. We must also take into cognisance that there are different stages of kidney failure. The very early stage is common but the very severe stage is what we don’t see. Yes, it is on the rise all over the world because the major factors that are causing kidney diseases are increasing in the entire population.
Chief among them is hypertension which is becoming a lot more rampant and the kidney is a target organ for damage. This is the commonest cause of kidney failure in Nigeria. Another factor is diabetes. Most people visit fast food eateries and ingest a lot of calories that are not needed in the body and at the end become diabetic. Meat has a major role to play in kidney disease. HIV is also a major cause. Although many HIV patients are living longer with the drugs they are taking, some of the drugs also cause kidney failure and so there are quite a number of HIV-related kidney diseases.
Infections such as Hepatitis B and C could also cause kidney damage. There is the Auto Immune Disease in which the body produces substances meant to wade off infection or invasion that could damage some part of the tissue. Ordinarily these substances don’t attack the organs but in people with Synthetic Lupus Erythematosus ( SLE), it tends to have effect on their organs and kidney damage is a problem they encounter.
In elderly patients, especially men with prostate enlargement , obstruction to flow of urine leading to back pressure on the kidneys ultimately causes kidney damage. Common infections such as typhoid and malaria cause acute kidney injury that may lead to chronic kidney disease.
Women who develop very high blood pressure during pregnancy could end up with chronic kidney disease. Patients who have sickle cell disease are also liable to developing chronic kidney disease as a complication.
Drug abuse: Misuse of medication can cause kidney failure. It is not unusual to see people taking paracetamol, with steroids. These drugs tend to cause kidney damage or Analgesic Nephropathy. An analgesic is a drug used to kill pain and when consumed in large quantity over a long period, they can certainly cause damage to the kidneys.
The other aspect is native medication – the herbs people take. We are sure that herbs certainly cause kidney failure; we have seen many people come down with kidney failure after taking these herbs. The “holy water”, which is greenish because it has been made with perfume and all sorts, causes people who take it to come down with renal failure after consuming it.
Shagamu used to be known for its red suya and people have developed Haemolysis- fragments in the red blood cells after taking the suya. It is not exactly the suya that causes the damage but a deficiency in certain enzymes. The red suya causes some sort of stress on their red blood cells and causes the cells to fragment. When the cells fragment, they release a lot of haemoglobin in the blood and that is what damages the kidneys.
Certain injections taken as requirement for certain x-ray procedures can lead to the development of kidney failure, especially in diabetics.
Measures taken by NAN: We have been at the forefront of disseminating information to the community through various channels. One is the MTN partnership, which has bee on for four years now and every year we run community health screening programmes. In the programme, we have an education and interactive session where a member of NAN or somebody in the renal care profession talks to the common man in the language they understand. A member of NAN from Calabar, for instance, will render the session in Efik. We also take advantage of the World Kidney Day. We screen members of a select community.
The screening is usually free but we solicit support and get screening materials for people to get their blood and urine tested. We do their blood pressure and check blood sugar. What we are trying to do basically is to screen and detect kidney diseases early. Not only are we detecting it, we also refer them to hospitals where they can meet professionals, get assistance on the abnormalities detected and get treated.
Early detection: We can treat and cure the patient if the kidney disease is detected early. There are many aspects to kidney disease. One is diagnosis – you can treat the underline cause of that kidney disease. When the cause is treated then it’s not likely that the patient will end up on dialysis. I must quickly say that with kidney disease irrespective of the cause, once you have substantial damage, the tendency is for progression of the disease. We can identify factors that lead to progression of the disease, treat them and more often than not, reduce the rate of its progression.
If someone needs dialysis in six months time we might be able to add four to five or even 10 more years to the time that person would need dialysis. There are times we actually stop the progression. It depends on so many factors.
The other aspect that is also crucial in patients who have renal disease are the heart related problems they might have. Most patients could die of heart related problems and cardio-vascular disease even before getting to any stage where they would require dialysis. The beauty of early detection is that we also screen for cardio-vascular issues and prevent death and deterioration.
Number of cases:After our community health screenings, the hospitals get overwhelmed with the number of people coming in to access their kidneys and those we found to have kidney diseases during the screening. The screening exercise has brought a lot of enlightenment. Another aspect of the MTN screening exercise is to create awareness about the dialysis units in those areas.
There are areas where these dialysis units have made dialysis cheaper. In most places, dialysis treatment is far more expensive than what the MTN Foundation dialysis unit charge which is N15,000. On the average in Lagos, you need about N25,000, so it is about N10,000 cheaper.
NAN and MTNF
NAN gives MTNF professional advice. We tell them what the requirements are for those dialysis units and NAN members are usually the nurses, doctors in those units as well as the hospital staff. For community screenings, NAN provides the logistics in terms of project management or design of screening while MTNF provides financial support.
It is a win-win partnership. MTNF is achieving its main objective and NAN is also playing the role of making the health of Nigerians better with regard to kidney diseases.
The hospital provides whatever is necessary to run and maintain the machines. MTN handles the funds and provides the staff salary. The payments people make during this screening is used to run and maintain the machines used during the process.
Local capacity: We don’t have sufficient local capacity or local expertise in this area of specialization. NAN has drafted a renal care policy and submitted to the National Assembly. We have created awareness, gone to the Ministry of Health and tried to get attention in the high places. In partnership with the MTNF we are looking at influencing policies because that is what will affect a lot more people than dialysis units and public awareness programmes.
- Vanguard
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