In this interview with LARA ADEJORO, a Professor of Medicine (Nephrology) at the Lagos State University College of Medicine and Head of Nephrology and Kidney Transplant, Lagos State University Teaching Hospital, Ikeja, Olugbenga Awobusuyi speaks on how to prevent kidney failures
What is kidney failure?
Kidney failure is a condition in which the kidneys are unable to perform their duties of excretion of waste products, and the accumulation of such waste products leads to deleterious effects on the various organ systems in the body. If an individual develops kidney failure, without intervention, he or she may not survive. The patient may require dialysis or transplantation to replace the function of the damaged kidneys.
What is the difference between acute kidney injury and chronic kidney disease?
When a patient has an abnormality either of function or structure of the kidney which has implications for health and that condition has persisted for more than three months, we call that chronic kidney disease. If it is less than three months, it is an acute kidney disease of which kidney injury is part.
There are five stages of chronic kidney disease: mild, moderate, moderately severe, and end-stage kidney disease. It is the end-stage kidney disease that we call kidney failure.
Several things can damage the kidney. Once damage occurs to the kidney, waste products accumulate in the patient’s body. Some of the products are urea and creatinine. When they are present in high amounts, they indicate kidney injury.
The other thing is that the urine can contain protein or blood, and those connote kidney damage even without the elevation of urea and creatinine. Also, when we do an ultrasound or an X-ray test, we can discover structural damage to the kidney, that is, evidence of kidney damage.
Kindly give further explanation on acute kidney injury and chronic kidney disease
Acute kidney injury is a sudden deterioration of kidney function, occurring within hours to a few days. An individual who has been enjoying good kidney function and suddenly, an injury occurs to the kidney. For instance, if a person loses a lot of fluid or blood and blood flow to the kidneys gets severely compromised, acute kidney injury can occur. For chronic kidney disease to exist, kidney damage must persist for more than three months.
What are the risk factors for kidney damage?
The common ones are infections which could be bacterial, viral, fungal, or other types of infection. Viral infections like HIV, hepatitis B, and hepatitis C are known to cause kidney damage. Also, malaria infection can cause kidney damage. Bacteria like typhoid and other bacterial infections can cause kidney damage.
We also have situations where the patient loses a lot of blood. For example, gunshot injury, women who develop complications of severe blood loss after childbirth, road traffic accident victims with severe blood loss, and other conditions where a significant amount of blood is lost can cause kidney damage and kidney failure.
Somebody who is having profuse diarrhoea can get dehydrated and go into shock and develop kidney damage.
Diseases such as hypertension and diabetes can cause kidney damage. Also, elderly men with enlarged prostate, patients with kidney stones, kidney tumours, and holes (cysts) in the kidney are risk factors for kidney damage.
Obstruction to the urine flow, either due to cancer or stones, can cause kidney damage. Similarly, diseases such as sickle cell disease and Lupus nephritis are also risk factors.
The common ones that we have in our society are hypertension and diabetes. Unfortunately, many people neglect their care to their detriment.
What are the signs and symptoms to look out for?
One can look at it from the perspective of what functions kidneys perform. Kidneys are responsible for the elimination of waste products and excess water from the body. So, if the kidneys are damaged, one of the early signs is that the amount of urine the patient produces will be very low, and if the patient is drinking water or any form of liquid, the legs, face, and abdomen will start swelling within a short time because of fluid accumulation in the body.
Because of waste product accumulation, the patient will start feeling very sick, feel like vomiting most of the time, and can vomit at some point and will have hiccups persistently. The patient also feels weak and tired and may convulse when the kidney is severely damaged. Finally, the patient can go into a coma and die.
One other function of the kidney is to produce some hormones. For example, the kidneys produce the hormones responsible for stimulating the bones to produce red blood cells, but if the kidneys are damaged, the bones will not produce red blood cells, and a shortage of blood result from that.
Also, the patient’s blood becomes acidic (acidosis) because many of the acids excreted in the urine are retained, so patients also feel unwell. The kidneys also produce active Vitamin D, so a patient with kidney failure will have weak bones and be liable to have fractures.
Lastly, many of the patients who have kidney problems have heart diseases. Unfortunately, many of them die because of heart disease that is associated with kidney damage.
Is it when one starts noticing these symptoms that one should report at the hospital?
The kidneys have a large capacity to function, and if the function deteriorates, the kidney copes to a large extent. The symptoms that I have mentioned start appearing when it is getting to a very late stage. One can lose over 70 percent of kidney function by the time he starts noticing symptoms but the earlier the patient gets to the hospital, the better.
The important thing is prevention. If you can prevent kidney damage, you can prevent kidney failure. Prevention entails taking care of the diseases that I have mentioned. The hypertensive patient should ensure that the elevated blood pressure is treated appropriately by a qualified doctor.
Patients with any of the risk factors should always go to the hospital and avoid anything that can further damage the kidney.
Individuals above 40 years should go for checks regularly. The tests are simple -taking urine to check for blood or protein in the urine and blood tests to check for elevated urea and creatinine levels. Also, smoking and alcohol should be stopped, and regular exercise should be embarked on.
Is kidney failure reversible?
For many patients, acute kidney injury is reversible. It reverses back to normal in many people. However, in some patients, kidney injury does not return to normal.
How true is the saying that fasting for long hours, like 10 to 20 hours without drinking water can lead to kidney damage?
Theoretically, if one fasts and get severely dehydrated, and blood flow to the kidney is reduced, the kidney can be damaged. This is, however, an extreme situation that rarely occurs.
What we commonly see in fasting is not to the extent of causing severe dehydration. People who do not have pre-existing kidney disease are not likely to have kidney damage by fasting.
Routine fasting has not been shown to cause kidney damage, but the effect on people with pre-existing kidney damage and kidney failure is of concern. Several things do change when they fast. First, many are on many drugs, and since they are not likely to use them during the day, kidney damage can occur from lack of compliance. Thus, a lot of adjustments will have to be made to the way and manner that they take drugs.
Since they do not tolerate dehydration very well, they need to exercise some caution if they are not going to drink water.
Also, fasting for days without water can stress the kidney. So, one should avoid getting dehydrated. If you are fasting for days without water, then the period you are allowed to take something, you should ensure that you get rehydrated.
Fasting for days without water increases the likelihood of getting dehydrated, but because the kidney has a very large capacity to function, the urine output is equally reduced to prevent dehydration.
To fast continuously for 10 to 20 days without water increases the risk of getting dehydrated, but if you are not dehydrated, the risk of kidney damage is very low.
What are the appropriate ways to fast so as not to affect the kidney?
Most people who fast do not take anything during the day; when they break the fast, they take fluids. I advise that when you break your fast, you should drink appropriately to ensure you do not get dehydrated. If you are on any drug, you should take them as recommended by a qualified medical practitioner who will adjust the dose of the medications. This could be done one to three weeks before fasting commences.
An appointment should be scheduled during the fasting period to review general health and kidney function. If you have any disease condition, if you must fast, kindly see a doctor.
Is it possible that water fasting affects the kidney?
It is very unlikely that water fasting will affect the kidney.
What are the statistics for kidney failure in the country?
It is estimated that about 10-13 percent of the adult population in Nigeria have one form of kidney disease or the other. That is a considerable number considering that we have 218 million population. The burden is high.
What are the treatment options for kidney failure?
It depends on the stage of kidney disease. At the early stage, we look at the different causes of the disease, and if amenable to treatment, then we treat it. We also look at the present or absence of complications of kidney disease and treat them anytime we discover that, and we keep doing this throughout the patient’s ailment.
One of the major concerns is the effect on the heart (the cardiovascular system). So we monitor this regularly, and we also check the cholesterol and see if it is elevated.
Apart from the effect on the heart, we look at co-morbidities, which may worsen kidney disease. We also look at the drugs that the patient is taking to see if they are drugs that can interact with other drugs or food, and we advise appropriately, and we do this continuously for the longevity of the kidney, but if kidney function deteriorates despite all these, there are quite a number of options to replace the function of the kidney.
We have dialysis, which can be haemodialysis with the use of machines, or peritoneal dialysis with the use of the patient’s abdomen. Both are very effective and can keep patients alive for many years. The third option is kidney transplantation which is considered the best option for any patient who has kidney failure.
The transplanted kidney can come from a living person, which is the best, especially if that person is related to the patient. It can come from a dead person. This is presently not done in the country, but it should be encouraged as it is done in many other countries.
My final message is that kidney diseases are common and harmful but often treatable when discovered early. Therefore, we should have regular checks on our kidney health.
