Cases of Acute Kidney Injury on the rise

A treatable disease that kills hundreds every year due to lack of awareness

Rawalpindi

Acute Kidney Injury has become a major cause of death in population of the country and the number of cases of the problem is on the rise in this region of the country as well.

Data collected by ‘The News’ reveals that in developed countries, the mortality by AKI has declined but in Pakistan, it is still a major health threat that kills hundreds every year due to lack of awareness among public.

The data from emergency departments of the three teaching hospitals in town show that in last month, the allied hospitals received as many as 270 patients with acute kidney injury of which 16 died of the problem.

A total of 90 patients reached Benazir Bhutto Hospital, 62 at District Headquarters Hospital and 118 at Holy Family Hospital with acute kidney injuries of variable levels in June out of which 16 patients died, said Assistant Professor at ICU in HFH Dr. Muhammad Haroon while talking to ‘The News’.

He said the common factors among critical patients of AKI were Chronic Kidney Disease that developed acute kidney injury, diabetes, gastroenteritis, infections and sepsis, drug overdose and hypertension along with patients suffering from congestive heart disease. Many patients were those who used ‘kushtas’ from hakims and quacks containing toxins that caused direct kidney injury, he said.

He added a good number of patients of AKI were suffering from liver disease, glomerulonephritis (inflammation of kidneys), heat exhaustion, heatstroke or dehydration.

It is important that AKI previously called acute renal failure can be termed as an abrupt loss of kidney function that develops within seven days.

Dr. Haroon said the most significant fact is that AKI is a preventable and treatable disease. The most important factor in all 16 patients who expired at the allied hospitals in a month was delayed diagnosis or delayed presentation to hospital, he said.

To a query, he explained that kidney is one of the vital organs of human body that not only maintain water balance but is involved in maintenance of electrolytes like sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphorus and others. Kidneys are involved in formation of red blood, removal of toxins, urea and maintain blood pressure, acid base balance, bones calcium balance, glucose balance and a number of important functions for human body, he said.

He said the first sign of kidney injury is decreased or no urine output. Later as injury progresses, the patient develops shortness of breath, palpitations, rapid shallow breathing, nausea vomiting, swelling of feet and body, inability to lie down flat, headaches, high or low blood pressures, low sugars, chest pain, pain in abdominal sides or flanks, restlessness irritability, clouding of consciousness, and in severe cases coma and death. Potassium levels become dangerously high and if not corrected in time can cause heart arrest, he said.

Dr. Haroon said it has been observed that early recognition of AKI can save life in over 90 per cent of the cases. Public awareness regarding signs and symptoms of AKI can be helpful, he said.

He said in all sick patients, kidney function tests should be done. If someone has vomiting or diarrhoea and his urine volume has decreased, he should immediately take more and more fluids but no ORS. ORS is not indicated if AKI is suspected. If still urine volume does not improve, the patient should get expert opinion and kidney tests immediately, said Dr. Haroon.

He added that doctors too should have a high index of suspicion in all sick patients who come to emergency departments. The concerned government authorities should take necessary measures to make kidney tests available in all healthcare facilities especially in peripheral settings, he suggested.

To a query, Dr. Haroon said patients with AKI need renal replacement therapies like dialysis, ultra-filtration etc. There are many myths about dialysis among population and it has been observed that many attendants and patients refuse dialysis as they think it is dangerous or they may need it for lifetime. Majority of patients just need few sessions and their kidneys recover back to normal, he said.

He explained that in AKI patients, as the primary disease is treated, kidney function improves for example after giving fluids to dehydrated patients or treatment of sepsis etc.

He said the most important thing is prevention from AKI through simple preventive measures. A healthy individual should take 40 ml fluid per kg body weight everyday means a man weighing 70 kg should take about three litres of fluids per day. Intake of Carbonated drinks like cola etc should be kept to as minimum as possible. ‘kushtas’ from ‘hakims’ and quacks should be avoided completely. Any abnormal body swelling particularly of feet should be investigated promptly. All kinds of painkillers damage kidneys if taken regularly. Painkillers should only be used in unbearable pain. Every person above 65 years of age should get kidney tests at least once in a year, said Dr. Haroon.