In this interview by SADE OGUNTOLA, President, Nigerian Association of Nephrology, Professor Fatiu Arogundade, explains why kidney disease is rampant, says Nigeria has no renal care policy and not responding to the yearnings of many Nigerians with kidney disease.
How does a person get kidney disease, and how common is it in Nigeria?
Kidney diseases are very common worldwide. We have some that are inherited and others that are acquired. The inherited ones account for about 1 to 3 of every 1000 kidney disease cases. However, the acquired ones are far more common. Some of these acquired kidney problem cases are acute, meaning that they develop within a short time, usually within 48 hours or seven days of the insult to the kidney. Some of them are chronic because they have evolved over a long time, usually three months, or more. Importantly, even after the third month, the disease persists.
The common causes of chronic kidney disease in Nigeria include hypertension and diabetes. All over the world, diabetes remains the commonest cause of kidney disease, particularly in patients that have been transplanted or are on dialysis. In addition, we have a primary kidney disease, which is called glomerulonephritis. It is the third commonest cause of kidney disease. It could be idiopathic (cause unknown), but more usually occurs following other health challenges in the body or infections. Likewise, some inherited diseases, foreign agents and drugs could equally cause kidney disease. For instance, connective tissue diseases like systemic lupus erythematosus or rheumatoid arthritis in the long run can affect the kidneys just as the consumption of drugs, particularly a combination of analgesics, could cause kidney disease. Also, the bleaching creams because of the heavy metals in them could get deposited in the body and could cause kidney disease.
However, talking about acute kidney disease, the majority of them occur as an aftermath of a problem in the body like volume depletion or hypovolemia, whether from losing blood from accidents or from losing fluids from cholera and dehydration. It can equally come from infections, what we call septicaemia. Acute kidney injury could occur as a result of obstruction to the flow of urine if it is not relieved on time or if it becomes recurrent.
There are so many antibiotics and analgesics that in a short time could damage the kidneys. These antibiotics cause reactions that could damage the kidneys which we call acute interstitial nephritis. Also, problems with the heart’s pump could equally lead to acute kidney injury. When the pump function is very poor, the kidney will not be well perfused and that could cause kidney injury.
What is the proportion of Nigerians with kidney disease?
Kidney disease is very common worldwide. It is estimated that about 10 to 11 out of every hundred individuals have kidney disease. Based on studies conducted in Nigeria, we presume that 20 out of every 100 individuals in Nigeria have some overt or covert chronic kidney disease. So, the proportion is huge. However, of this 20%, only about 0.5% attend our hospitals with kidney disease-related complaints. So you cannot use this to estimate the prevalence of chronic kidney disease in Nigeria. However, as small as they are, they constitute about eight to 12 percent of admissions into medical wards in most teaching hospitals in Nigeria. In the Intensive Care Unit, the incidence of acute kidney injury could be as high as 20 to 30 percent.
What has been the contribution of herbal remedies to kidney problems in Nigeria?
Herbal remedies could be good. However, we have found that some of them can cause kidney injury. Herbal remedies have been known to be major contributors to cases of acute kidney injury reported in Ibadan. Whether herbal remedies on their own could cause kidney disease has not been investigated; however, we don’t want to make such an assertion.
IN CASE YOU MISSED THESE FROM NIGERIAN TRIBUNE
- Revealed! Details Of South-West APC Leaders Meeting With Presidential Aspirants
- Supreme Court Has Cleared Civil Servants To Participate In Politics, Falana Tells FG
- Battle For New Alaafin Begins As Ruling Houses Insist On Producing Next Oba
- Court Admits More Evidence Against Alleged Fake Army General, Bolarinwa
- I’m Every Man’s Choice Now, My DM Is Crazy —Eniola Badmus
- It Is Now Bye To Decency: Crazy Fashion Trends At Owambe Parties
It is not uncommon for some men to use sex-enhancement pills. Can these affect their kidneys?
Male sex enhancement pills will usually strengthen them to be able to sustain an erection. If they have heart disease, it can affect the man. However, it does not contribute to kidney disease. We have some local preparations that also enhance libido. I wouldn’t know whether they could cause kidney injury.
What are the common signs and symptoms of kidney disease?
Early in the disease, the patient particularly with chronic kidney disease may not have any symptoms or signs. However, as the disease progresses, a few signs will emerge. They start retaining fluids, which will show as a swelling around the eyes. Usually, later it involves the legs, the abdomen and other parts of the body. Then, they may observe that their urine becomes foamy; the urine may start coming out at odd hours. They pass more urine at night instead of during the day. After this, they develop high blood pressure. The complications of hypertension could equally be seen during this stage. Thereafter, they can develop heart failure, features of uraemia like nausea, vomiting and hiccups. They become pale and very weak because of a reduction in the level of blood. Their bones may become painful and weak. At its advanced stage, they may start bleeding from little cuts or from orifices as the case may be. What will alert them of the problem in the community is the fact that urine volume will reduce; they may observe that they pass urine once a day or they may not pass urine at all and then they start developing some other features, feeling of hiccups, nausea, vomiting and all that.
How can individuals avoid kidney disease?
For chronic kidney disease, we have primary prevention, and it is to prevent a person from even developing kidney disease. Primary kidney disease prevention starts from childhood; living a healthy life, exercising and avoiding obesity, salt consumption or anything that may cause hypertension or diabetes. Also, it is important to ensure adequate fluid intake and avoid local concoctions and intake of a combination of analgesics. In everyday life, avoidance of smoking, overweight, salt consumption and skin bleaching will assist in reducing kidney disease. Good antenatal care for pregnant women and good immunization for children is also part of primary prevention, though some refer to this as primordial prevention.
Secondary prevention entails preventing kidney disease in somebody with a disease that can cause kidney diseases such as hypertension and diabetes. If the blood pressure is well controlled, the chances of developing kidney disease will be remote or will be delayed; the same thing with diabetes, if the blood sugar is well controlled. Patient passing protein in urine equally needs to have this controlled before it results in very serious kidney disease. Tertiary prevention is for those who have developed kidney disease already, and we want to reduce or delay the progression of kidney disease, irrespective of the cause. There are medications to delay the progression of the disease so that the time the patient will eventually need dialysis will be delayed. Dialysis is to help prevent complications of kidney disease.
Can a diet high in salt and protein harm one’s kidneys?
Salt consumption is known to worsen hypertension if it exists and hypertension is a recognized cause of kidney disease. Salt consumption on its own is also known to lead to a more rapid progression of kidney disease. So, salt consumption could harm the kidneys but on its own where a kidney disease does not exist, salt consumption cannot do anything to the kidneys. Diets high in protein could be good for the body; however, if somebody has developed kidney disease, they are usually encouraged to cut down on protein intake to reduce the progression of the kidney disease. However, protein in the diet does not cause kidney disease.
Can you assess Nigeria’s response to the care for kidney disease?
Nigeria has no renal care policy. Even though the care of kidney disease patients occurs in most hospitals, the patients pay out of pocket for this care. We cannot say that we are responding to the yearnings of the teeming population of Nigerians that are afflicted with kidney disease. For patients that require transplantation, the government has not done anything for them, including the provision of free drugs. In many other countries in Africa, even countries that are poorer than Nigeria, renal care is supported. Transplanted patients are given free medications and those that need dialysis are equally supported. However, I must mention that those that enrolled in the NHIS scheme have access to six sessions of dialysis and that can only be used for patients that have acute kidney injuries.
Does dehydration contribute to the incidence of kidney problems in Nigeria?
Dehydration can exacerbate kidney disease, but mild dehydration on its own cannot cause acute kidney injury. The patient will recover after being rehydrated. However, very severe dehydration can cause acute kidney injury or can cause acute exacerbation of chronic kidney disease and then persistent dehydration can cause chronic kidney disease.
A study suggested that the use of bouillon cubes in cooking is contributing to the increasing incidence of hypertension in Africa. Can it also be responsible for increasing cases of kidney problems in Nigeria?
Bouillon cubes contain some salt, and salt can exacerbate the manifestation of hypertension. On its own, it may not directly affect kidney disease but increasing the prevalence or incidence of hypertension could cause kidney disease. However, it is recognized that salt on its own could also induce kidney injury through some pathways, but that will be for a very long duration of consumption.
and then