In this exclusive chat with Temitope Obayendo, Dr Olugbenga Awobusuyi, a consultant nephrologist of high repute with the Lagos state Teaching Hospital (LASUTH) and an associate professor at the Lagos State University College of Medicine (LASUCOM), opens up on the prevalence of Chronic Kidney Disease (CKD) in Nigeria, implicating uncontrolled diabetes and hypertension as the major culprits. Excerpts:
Chronic Kidney Disease (CKD), also known as kidney failure, has become more rampant these days, what could be responsible for this?
The reason for the prevalence of CKD is the surge in conditions that predispose people to renal failure, which are hypertension and diabetes. Nowadays many people are coming down with uncontrolled hypertension and diabetes, thus the prevalence of CKD in our society.
There is the World Kidney Day celebration to create awareness on the disease, but there are further campaigns done by stakeholders in the hospitals during our routine clinic visits, to enlighten patients who might be at risk to come for check-ups.
Our kidneys are endowed with functional reserves, which could prevent a patient from having any symptoms years after the disease might have set in, in fact, this could delay symptoms until after 60 -70 percent of the kidney functions might have been damaged.
Before now, kidney failure used to be associated with the elderly, but it is becoming also common among the younger generation. What predisposes a youth to kidney failure?
Just as hypertension is very common, so is what is called glumerulonephritis also common. Glumerulonephritis is a situation where a patient’s body produces some substances like protein, called antibodies, which attack the kidney to destroy it. Although this condition is not common in our environment, it is a cause of renal failure. We have a lot of diabetics, habitual consumers of native medications, and the analgesics addicts, who are already down with the disease. Some infections like HIV, Hepatitis B, Sickle Cell, patients with cysts in the kidney, prostate enlargement, kidney stones, can also cause CKD. Glumerulonepheritis could be responsible for the disease in young people.
During the celebration of the 2013 World Kidney Day (WKD), President of the Nephrology Association of Nigeria (NAN), Dr Ebun Bamgboye, said 36.8 million Nigerians are suffering from kidney disease at different stages. Two years after, what do you think the statistics will look like now?
We don’t have any hard statistics on the prevalence, although the Nephrology Association of Nigeria (NAN) is taking some steps to have a renal register, though it’s still at the infant stage. Nonetheless, there are a number of studies conducted in some communities, which indicated that the prevalence is still between 17 and 21 per cent of the population.
Can you explain the stages of kidney disease, the symptoms, and at what point patients should seek medical advice?
It actually has five stages, based on what we call Glumerulo Filtrating Rate (GFR), which reflects the overall functions of the kidney. The first stage is 90 or more millimetre per minute; stage two is GFR 60-89; stage three, GFR 30-59; Stage four, GFR 15 -29 and stage five is lower than 15 GFR.
It is at stage five we do dialysis for a patient. What we generally do is to treat the underlying disease. We also consider factors that make kidney functions decline drastically, some of which are uncontrolled diabetes and hypertension. However, when the condition becomes uncontrolled, we do kidney transplant, which is very expensive.
Is it possible to treat the disease if detected earlier?
It is one of the messages we are trying to pass across to the populace – that chronic kidney disease is preventable, and many of the causes are treatable. If patients are diagnosed early enough, their diabetes and hypertension can be well managed to prevent renal failure. This could be done by slowing down the deterioration rate of the kidney, thereby ensuring adequate management of the underlying conditions. Patients must always ensure they meet their doctors at the right time, as well as take their medications as prescribed. If this is done, there are chances that the rate of death associated with kidney failure will be reduced.
For everybody to understand the symptoms of the disease, there is need to know the functions of the kidney. The kidney actually excretes water and other waste products from the body; secondly it regulates the internal environment, by making the system conducive for the internal organs e.g., the electrolytes; and thirdly, it regulates blood pressure. It is also responsible for the production of a very active form of Vitamin D, which makes our bones strong. It produces another substance called erytopoietin which stimulates our bones to be stronger.
Thus, once a kidney start failing in carrying out these functions, then it’s a symptom of an ailment. For instance, when a patient cannot eliminate the water he/she takes in, through sweat and urine, when he finds it difficult to pass out excreta, then there will be an accumulation of waste products in the body, which is an indication of kidney failure.
What we usually tell people during awareness campaign is that they should always check their urine; once it’s foamy, it’s an indication of protein in the urine, which is a symptom of CKD. Diabetics need to be more conscious about their health, because it’s a condition that has more tendencies to damage the kidney. Once these symptoms are detected, patients need to visit the hospital for screening. It’s also worthy of note, that the initial medical tests are not expensive. Urine test costs around N500, while blood screening is around N1000.
How many forms of kidney failure exist?
There are two forms of kidney failure, acute and chronic. Acute kidney failure could occur within an hour or two, due to severe infections, loss of blood through childbirth, severe diarrhoea and cholera – but the system normalises itself few hours later. Diarrhoea and cholera patients could be predisposed to this condition. At times, they lose consciousness and may even convulse. However chronic kidney disease is our focus of discussion.
With your involvement in medical practice so far, can you estimate the cost of a successful kidney transplant?
A kidney transplant goes for about N5 million to N6 million. All over the world, I’m not sure many patients can afford that. However, in most cases where they can access the facility, the government usually pays for the chunk of the fee.
How many nephrology experts do we have in the country?
The ratio of nephrologists in Nigeria to patients is about 150,000 to about 40 million patients.
Can it be said that people without diabetes or hypertension are not at risk of CKD?
Yes, they are not at risk, but if they have a family history of CKD, diabetes or hypertension, they should be going for check at least once a year. Especially if they are above 40 years, regular check up is important.
Considering the state of our health care facilities, is there any hope for Nigeria in overcoming CKD?
It depends on the will of the government of the day. If there is political will in the provision of local facilities, building of good facilities, provision of manpower, and monitoring of the administrative section for effectiveness, then cases of CKD would be drastically reduced.
What is your advice to Nigerians as regards kidney diseases and their general health conditions?
They should always participate in medical screening exercises. Hypertensives and diabetics should keep their appointments with their health care givers and also ensure they meet qualified doctors, not roadside quacks.