Periodic Kidney Medical Check

Are your kidneys OK? Today, I shall discuss the need for a regular kidney check by every adult. Happy reading!

Do you know that Chronic Kidney Disease is on the increase worldwide?
THE occurrence of chronic kidney disease (CKD) is increasing continuously over the last years, especially in developing countries. Some 85 per cent of the world’s populations live in low-income or middle-income countries, where the medical and socio-economic effects of the disease are expected to be the greatest.

With regard to the rise in incidence of diabetes and hypertension as main risk factors for kidney disease, the risk of CKD will further increase. It is estimated that by the year 2030, more than 70 per cent of patients with kidney diseases requiring medical or surgical intervention, will be residents of developing countries, whose collective economies will account for less than 15 per cent of the total world economy.

Even more disturbing is the thought of the organisational and financial resources needed for the prevention and early detection of chronic kidney disease —requirements that are far greater than those for end-stage kidney disease.

What are the common causes of chronic kidney diseases?
Chronic glomerulonephritis and hypertension are currently the principal causes of chronic kidney disease in Nigeria, similar to other developing countries, reflecting the high prevalence of bacterial, viral, and parasitic infections that affect the kidneys.

Of the implicated bacterial infections, tuberculosis ranks high in India and the Arabian Gulf, whereas infections of the throat and skin remain the major causes of glomerulonephritis in Africa.

Viral infections are responsible for the high incidence of glomerulonephritis in some regions, for example, hepatitis B virus in South Africa, hepatitis C virus in Egypt, and the human immuno-deficiency virus in sub-Saharan Africa.

Several parasitic infections cause end-stage kidney disease through ureteric obstruction (e.g. schistosomiasis in most countries of Africa), and glomerulonephritis (e.g. malaria and filariasis in West Africa; and schistosomiasis in Africa and Latin America). Diabetes causes 10 to 30 per cent of the cases of end-stage kidney disease in various developing countries, and hypertension leads to 10 to 20 per cent of the cases.

Early diagnosis improves the outcome of Kidney Disease.
The ultimate outcome of chronic kidney disease in many patients is end-stage kidney disease, which necessitates ever growing dialysis and transplantation programmes. In addition to placing an unaffordable financial burden on poor countries, kidney replacement therapy has negative psycho-social effects on communities.

In most developing countries, the typical patient undergoing regular dialysis is only partially rehabilitated, since dialysis is often inefficient (due to limitations of technical and human resources); other essential medications may be in short supply; co-existing conditions such as hepatitis infection, parasitic infestations, and malnutrition are common; and transportation difficulties often result in non-compliance.

Families must often cope with a chronically depressed, sometimes aggressive, unemployed relative who must be escorted regularly to a possibly distant dialysis centre to receive treatment.

Very few centres in Nigeria offer transplantation services (only 4!), which are unaffordable for most patients, costing between N3 and 5 million! Furthermore, it should be relatively easy to obtain kidneys from living, related donors in Nigeria, a typical African country known for large, tight-knit extended families.

However, calls for kidney donation is often met with a disappointing response, owing to fear, skepticism, or illiteracy. The obvious task ahead for health authorities in the developing world is to detect and treat kidney diseases at the earliest possible stage.

Screening only persons deemed to be at high risk may be a viable option when mass campaigns are impossible. Control of diabetes, hypertension, smoking, overweight, infection, and pollution should be on the agenda of many developing countries.

The earlier kidney problem is recognised, the better are the options to stop or decelerate progression of the disease. Unfortunately, early diagnosis is hampered by the lack of characteristic symptoms or clinical signs that would indicate the commencement of kidney impairment. It is a major challenge for medical doctors to check patients with known risk factors for first signs of chronic kidney disease.

Major Step in Prevention — Lab Testing
The beginning of CKD usually goes unnoticed as the first clinical symptoms are commonly unspecific and often occur at a quite advanced stage of the disease. Laboratory testing for kidney impairment is therefore important in screening and monitoring.

Prevention of kidney failure starts with taking steps to recognise kidney impairment including increase of protein secretion (albumin) and decrease of kidney function (known medically as Glomerular Filtration Rate, GFR). People with diseases associated with high risk for kidney damage should be screened once a year.

These include individuals with diabetes mellitus, hypertension, heart and blood circulating system disease (cardiovascular disease) and diseases such as systemic lupus erythematosus (SLE). Apparently, healthy individuals should also be screened to exclude the beginning of kidney disease!

Till next week, live a healthy kidney life.