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Renal failure: The hidden epidemic

ealth talk with Dr Johannes Marisa

Quite often during our medical practice, we see a lot of patients with advanced kidney failure where expensive manoeuvres will be required for survival.

The whole world is crying because of this calamity that continues to take lives every day. The World Health Organisation estimates that 10% of the population worldwide (about 850 million people) is affected by chronic kidney disease and more than two million die each year because they do not have access to affordable treatment.

Up to 10,5 million people need dialysis or a kidney transplant, but only two million people are receiving these because of the unbearable costs that are involved.

What is renal failure?

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When the kidneys lose their filtering ability, dangerous levels of waste may accumulate with resultant chemical makeup getting out of control. This can be very fatal and may require intensive treatment.

Symptoms

The following are some of the symptoms:

  • Fluid retention, causing swelling in legs, ankles, feet and sometimes on the face.
  • Decreased urine output sometimes although urine output remains normal.
  • Shortness of breath
  • Fatigue
  • Weakness
  • Nausea
  • Seizures or coma in severe cases
  • Asymptomatic: In some acute renal failure causes no symptoms, but can be detected by doing kidney function tests. Normally, a simple urea and electrolytesand creatinine test is done.

Causes

Kidney failure occurs when:

  • You have a condition that slows blood flow to the kidneys (pre-renal causes). Such conditions include blood loss like heavy bleeding, fluid loss like in extensive diarrhoea, vomiting. Some blood pressure medications, heart disease, liver failure, severe burns, severe allergic reactions can lead to such failure.
  • You experience direct damage to your kidneys (renal causes). So, many things can damage the kidneys and these include blood clots in the veins and arteries in and around the kidneys, Cholesterol deposits that block blood flow in the kidneys, infection of the kidneys. Medications like chemotherapy drugs for some cancers, antibiotics, NSAids like Ibuprofen,
  • Diclofenac. Toxins such as alcohol, heavy metals and cocaine contribute.
  • You have obstruction in the flow of urine (post-renal). Ureters can become blocked from such things as bladder cancer, kidney stones, prostate cancer, enlarged prostate, cervical cancer, colon cancer. All these can cause serious renal failure.Risk factorsBe alert about renal failure if you are a victim of some of the following:
  • When you are hospitalised especially for a serious condition that requires intensive care.
  • Advanced age
  • Diabetes
  • Hypertension
  • HIV and Aids
  • Heart failure
  • Liver disease
  • Certain cancers like cervical, bladder and their treatments.Please advise patients with some of the above conditions to do routine kidney tests. It is advisable to have urea and electrolytes at least twice a year. This test is a simple biochemical test done at both private and public hospitals, but very important one.

    Complications

    In cases of acute renal failure, complications can include the following:

     

  • Fluid build-up: This build can be in the lungs which can cause shortness of breath.
  • Severe chest pains: If the line that covers your heart (pericardium) becomes inflamed, one can experience severe chest pains.
  • Muscle weakness: When one’s blood chemistry is out of balance, muscle weakness can result.
  • Permanent kidney damage: Patients with end-stage renal disease require either permanent dialysis or a kidney transplant to survive. Fewer people, however, can afford the two named processes, especially in poor countries.
  • Death: Acute renal failure can lead to loss of kidney function and ultimately death. Renal failure contributes close to two million deaths a year.
    Prevention
    Reduce risk by taking care of your kidneys. Try to:
  • Pay attention to labels when taking over-the-counter pain medications: Such tablets include aspirin, naproxen, ibuprofen. Taking too much of these can increase risk of kidney injury. This is true if you have pre-existing kidney disease, diabetes or hypertension.
  • Work with your doctor to manage some predisposing conditions: Seek medical care on such conditions as severe dehydration, diabetes, hypertension. Please control these conditions as they are very much fulminant causes of renal failure. Avoid hypovolemic shock by getting adequate fluids like intravenous fluids like Normal Saline, Ringer’s Lactate as plasma expanders. Do not default on medication for hypertension as it is a serious cause of renal failure.
  • Make a healthy lifestyle a priority: Be active, eat a sensible, balanced diet and drink alcohol only in moderation, if at all.
    Attention: Let us not wait to get end-stage renal disease because the management is very expensive and cumbersome as medical manoeuvres like permanent dialysis and kidney transplants are required. How many can afford the three-times-a-week programme for the rest of their lives? Please avoid renal failure. Stay up-to-date with your health. Visit your doctor today and get a simple blood check.
    Dr Marisa is a medical doctor, a public health practitioner, and an educationist who can be accessed on doctormarisa@gmail.com.
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