Can we ignore kidneys?

The incidence and prevalence of kidney-related problems in Pakistan is alarmingly high. The World Health Organisation estimates at least 10% of the world population suffering from chronic kidney disease and every 5th patient in the hospital needs nephrology consultation. Some studies estimate the incidence of chronic kidney disease to be 25% in Pakistan which means every 4th person in Pakistan is suffering from this problem. Among others, diabetes and hypertension, are major risk factors for chronic kidney disease.

In Pakistan, there are about 18 million people suffering from diabetes and at least 40 per cent of them will end up developing a chronic kidney disease. With the sixth largest population of diabetes in the world, Pakistan is encountering a rapid rise in kidney diseases.

Chronic kidney disease is a progressive loss in kidney function over a period of months or years. Each kidney has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well enough to keep you healthy.

When kidney function falls below a certain point, it is called kidney failure. Kidney failure affects your whole body, and can make you feel very ill. Untreated kidney failure can lead to death.

Chronic Kidney Disease has five stages. Treatment for patients in stage five is either dialysis or kidney transplantation.

The first consequence of undetected Chronic Kidney Disease is the risk of developing full kidney failure (also called end-stage renal disease, ESRD) which means regular dialysis treatment or a kidney transplant is needed to survive. The second consequence of Chronic Kidney Disease is that it increases the risk of premature death from associated cardiovascular disease (i.e., heart attacks and strokes). Individuals who appear to be healthy who are then found to have Chronic Kidney Disease have an increased risk of dying prematurely from cardiovascular disease regardless of whether they ever develop kidney failure.

Patients with chronic kidney disease can have nausea, vomiting, aches and pains, chest pain, breathing problems and body swelling. The main indicator of kidney function is your blood level of urea and creatinine, waste products of the body produced by muscles and excreted by the kidneys. If kidney function is reduced, urea and creatinine accumulates in the blood leading to an elevated level when a blood test is checked. When kidney function is poor it can make blood pressure control very difficult and disturb electrolytes and acid base system of the body.

In Pakistan many people know nothing about the kidney disease until it is too late. Because of lack of awareness diagnosis gets delayed. To keep kidneys healthier for longer time, a very important step is to learn about the disease and also get kidneys tested on periodic basis. All this depends on proper awareness and timely diagnosis.

Other main problems related to kidney disease in Pakistan are insufficient funds and unavailability of trained nephrologists. At present there are only about 80-90 formally trained and qualified nephrologists in Pakistan for a population of about 160 million as compared to the United States which has more than 5,000 nephrologists for a population of about 300 million. Nephrology centres are partially established in a few teaching hospitals. Majority of tertiary health care centers and almost all district and tehsil headquarter hospitals lack nephrology facilities and qualified staff.

Concrete steps need to be taken at the government level to increase the awareness of kidney problems and to help manage them. Awareness of kidney diseases, especially related to its progression and consequences is key at the level of common man. Timely diagnosis of kidney damage by qualified nephrologist can help treat the problem at a much earlier stage. And If kidney failure is at an advanced level, then proper dialysis planning and/or arrangement of kidney transplant becomes inevitable.

The author is Consultant Nephrologist and Assistant Professor at Albany Medical School.

Email: mujtaba@ymail.com