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November 18, 2019

Health notes


November 18, 2019

Nephrology is the branch of medicine concerned with the physiology and diseases of the kidneys. The name comes from 'nephron', a functional unit within the kidney (a miniscule filter) consisting of a glomerulus and an associated tubule. In Greek, the word 'nephrus' means kidney, hence the science of kidney diseases and its treatment is known as nephrology.

World Nephrology Day was celebrated in Pakistan in Lahore Pearl Continental Hotel on October 25 this year. It was organised by the Pakistan Society of Nephrology. I had been invited as chief guest by Prof Dr Waqar Ahmed, head of the Dept of Nephrology, Shaikh Zayed Hospital, Lahore. My college-mate, Prof Dr Adibul Rizvi, a very competent urologist, heads the Sindh Institute of Urology and Transplantations (SIUT). This institute is considered to be the largest in the country. When I joined the function, I was pleasantly surprised to see that the hall was packed to capacity and people were even standing against that walls. I was fortunate to meet the pioneers of nephrology in Pakistan, viz Prof Dr Tahir Shafi and Prof Dr Jafar Naqvi. These two specialists sowed the seeds of this discipline.

Prof Dr Waqar Ahmad, beside being head of the department at Shaikh Zayed Hospital, is also president of the Pakistan Society of Nephrology. The following information on the subject was provided by him:

“Renal disease is on the rise in our country. The main reason would be the surge of incidence of diabetes in the country. Limited financial resources and lack of infrastructure put a severe strain on existing health policies in the light of the increasing burden of renal diseases. The Pakistan Society of Nephrology is struggling hard to establish internet-based registries of various renal diseases with the hope of generating adequate information about patients with kidney problems in Pakistan. This would help us to ascertain the impact of kidney diseases in Pakistan."

Overall 850 million people worldwide are now estimated to have kidney diseases from various causes. Chronic kidney diseases (CKD) cause at least 2.4 million deaths per year worldwide and are now the sixth fastest growing cause of death. Acute kidney injury (AKI), an important driver of CKD, affects over 13 million people worldwide and 85 percent of these cases are found in low and middle-income countries like Pakistan. Around 1.7 million people are estimated to die annually because of AKI. Moreover, CKD and AKI are important contributors to increased morbidity and mortality from other diseases and risk factors including cardiovascular disease, diabetes, hypertension and obesity.

Furthermore, CKD and AKI in children not only lead to substantial morbidity and mortality during childhood but also result in medical issues beyond childhood. The data in Pakistan is limited due to the non-availability of any renal registry. However, the Pakistan Society of Nephrology has recently started a renal registry to evaluate the impact of renal disease in Pakistan.

World Kidney Day is celebrated yearly to spread public awareness regarding kidney disorders. The topic of the World Kidney Day this year is ‘Kidney health for every one everywhere.’

Despite the growing burden of kidney diseases worldwide, kidney health disparity and inequity are still widespread. CKD and AKI often arise from the social conditions in which people are born, grow up, live, work and age and include poverty, gender discrimination, lack of education, occupational hazards, pollution, etc.

In Pakistan, like in the rest of the world, diabetes is the most common cause of CKD. About 45-50 percent of End Stage Kidney Disease (ESRD) develop due to diabetes. Presently 6 -7 percent of our population is discovered to be diabetic each year, but this number is increasing tremendously. It is estimated that in the year 2035, each year 11-12 percent of the population will develop diabetes and Pakistan will be in the top ten countries having the highest diabetic population. This is only, and only, because of the lifestyle modification and urbanization in the recent past. High blood pressure is the second most common cause of ESRD. According to an estimate, about 26 percent of our adult population have high blood pressure and most worrying is the fact that 58 percent don’t know it or will be inadequately treated. Only 12.5 percent are getting proper medication in the proper dose.

Transplantation is considered the most cost-effective treatment of CKD. However, it has high setup costs in terms of infrastructure and requires highly specialized teams and availability of organ donors and cannot be done without dialysis backup. Physical and legal infrastructure requirements and cultural bias against organ donation often present barriers in many countries, making dialysis the default option. Transplantation still has a long way to go in Pakistan. Only a few government hospitals are equipped with the infrastructure and technical expertise.

While national policies and strategies for non-communicable diseases are present in many countries, specific policies for screening, prevention and treatment of kidney diseases are often lacking. The importance of timely diagnosis and treatment cannot be stressed enough.

The Pakistan Society of Nephrology is the only professional body of Pakistani nephrologists and has a moral obligation to educate the masses regarding kidney problems and provide effective treatment to everyone everywhere. We still have a long way to go before ideal health standards are achieved as far as nephrology is concerned. The Pakistan Society of Nephrology publishes a monthly scientific journal called “Pakistan Journal of Kidney Diseases”. It contains very useful information on kidney diseases and cures.

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