Found at: http://www.anguillaguide.com/article/articleprint/2795/-1/133/
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ASK YOUR DOCTOR: Kidney Disease by Dr. Brett Hodge
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Many Anguillians have two normally functioning kidneys that last them for their entire lives, but some Anguillians do suffer from one or more types of kidney disease. This is not surprising as the two most common causes of kidney disease - diabetes and high blood pressure - occur in a large number of Anguillians.
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Dr. Brett Hodge
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Kidney disease can result in the loss of kidney function. When an individual’s kidneys function at less than 10 percent of normal capacity they cannot sustain life and need either dialysis or a kidney transplant to stay alive. These individuals can, however, go on to live a normal life for a number of years.
How do your kidneys work?
Kidney function is essential for good health. The kidneys are located near the middle of the back just below the rib cage and act as sophisticated filtering and reprocessing machines. Everyday, these two fist size, bean-shaped organs process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The waste and extra water become urine which flows to the bladder through two tubes called ureters. The bladder stores urine until it is removed by urination. When your kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body - a condition known as kidney failure.
Types of kidney failure
When kidney failure happens suddenly it is known as acute kidney failure. This commonly occurs after complicated surgery or a severe injury.
The majority of individuals with kidney failure in Anguilla have chronic kidney failure. This condition develops very slowly and in the early stages the individual does not have any signs or symptoms that anything is wrong. Many individuals with chronic kidney failure do not realize they have a problem until their kidney function has decreased to less than 25 percent of normal.
What are the common causes of kidney disease?
High blood pressure and diabetes are the most common causes of kidney disease in Anguilla. Persistent high blood sugars can damage the kidney’s filtering mechanism. Uncontrolled or poorly controlled high blood pressure is the second leading cause of chronic kidney failure after diabetes. High blood pressure causes the heart to work harder which, over time, can cause damage to blood vessels in the kidneys. This impairs the kidneys ability to remove extra fluids and waste which, in turn, raises the blood pressure even more and a vicious cycle develops.
Other causes of kidney disease include connective tissue disorders like systemic erythematosus (SLE), untreated infections of the urinary tract, a group of disorders called glomerunephitis and, very rarely, cancer of the kidney.
Some individuals are born with disorders affecting their kidneys. These inherited or congenital kidney diseases include a disorder called polycystic kidney disease where the kidney develops a number of cysts that replace normal kidney tissue.
What are the symptoms and signs of chronic kidney failure?
Chronic kidney failure is the most common kidney disease seen in Anguilla. After a number of years individuals with chronic kidney disease progress to end stage renal disease also called ESRD. In the early stages of kidney failure people do not have any symptoms and do not feel sick. As time progresses they latter develop some of the following signs and symptoms:
• Need to urinate more often or less often
• Tired and itchy feeling
• Lose appetite –nausea and vomiting
• Hands swell or feel numb
• Feel drowsy or have trouble concentrating
• Skin may darken
• Muscle cramps
• Sleep disorders
A number of complications may develop with end-stage kidney disease these include:
• Anaemia
• High blood pressure
• Congestive heart failure
• Bone disease
• Digestive tract problems
• Loss of mental functioning
How do you know if you have kidney disease?
A few simple tests may indicate that you have kidney disease. Individuals should have their blood pressure checked, and have a spot check for protein or albumin in the urine (proteinuria). Calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement will allow your physician to determine if you have kidney disease. The GFR tells how efficiently the kidneys are filtering waste from the blood. Your doctor may arrange other tests to confirm the diagnosis of kidney disease.
Preventing kidney disease
If you have high blood pressure or diabetes you need to have them managed correctly. You should seek regular medical attention. If you are hypertensive you should try to have your blood pressure at 135/85 or less and if you have hypertension and diabetes together you should have your blood pressure at 130/80 or less. Tight control of your blood sugar levels have been shown to reduce the risk of kidney disease. A number of drugs have been shown to decrease kidney disease in diabetic and hypertensive patients. Discuss these with your doctor.
Obesity is a risk factor for a number of diseases including hypertension and diabetes. More children are becoming obese. They should have their blood pressure and urine check regularly.
Do not abuse alcohol or other drugs, including over-the-counter pain killers such as aspirin, acetaminophen and ibuprofen. Avoid long-term exposure to heavy metals such as lead as well as other solvents, fuels and other toxic substances.
Adopting a healthy lifestyle of living can help you maintain two normally functioning kidneys for a lifetime.
What can I do about kidney disease?
Chronic kidney disease cannot be cured, but if you are in the early stages of a kidney disease you may be able to make your kidneys last longer by taking a number of steps.
You should avoid pain killers that may make your kidney disease worse.
Attention to a correct diet is important. You should limit the amount of protein and avoid foods high in sodium (salt) such as canned foods and other common fast foods like hot dogs. You should avoid foods high in potassium as well.
If you are a smoker you should stop as smoking increases the risk of kidney disease.
Treatment
Although not every patient with acute kidney failure can regain normal kidney function, in many cases kidney failure is reversible. In patients with chronic kidney failure there is no cure, but treatment can help control symptoms, reduce complications and even slow the progress of the disease.
Patients with end-stage renal disease must undergo dialysis or a kidney transplant in order to live. There are two types of dialysis: haemodialysis and peritoneal dialysis.
Haemodialysis is the most common type of dialysis. Blood is pumped out of the body and is filtered by a special machine and the clean blood is returned to the body. Typically the dialysis procedure takes 3 - 4 hours and must be repeated 3 - 4 times a week. Haemodialysis is available at the Princess Alexandra Hospital. The staff at the Unit must be complimented for the excellent job they are doing.
With Peritoneal dialysis, a fluid is put into the abdomen and this captures the waste products from the blood. After a few hours the fluid containing the body’s wastes is drained away.
If you have no other serious medical conditions, a kidney transplant is an option, but finding the right donor may be difficult.
Conclusion
Many Anguillians are affected by kidney disease and it is estimated that the numbers could markedly increase in the very near future due to increasing numbers of individuals with diabetes and hypertension which are not controlled adequately. Diabetes and hypertension are the two major disorders (if not managed correctly) that result in kidney disease and end-stage kidney failure. As the number of individuals with chronic kidney failure increases the need for dialysis will also increase. Emphasis on how to prevent and correctly manage diabetes and hypertension will help to decrease the number of cases of chronic kidney disease in Anguilla. Once you have end-stage renal disease, options for treatment include dialysis or kidney transplant, both of which allow patients to go on to live a relatively normal life. Like many other medical disorders, adoption of preventative measures to prevent kidney disease is still the best recommendation.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.