PERITONEAL DIALYSIS

I’d really appreciate your kidneys.

I recall with trepidation my peritoneal dialysis assessment at Kenyatta National Hospital. To be fair, practical exams always freaked me out. They still do. No idea how I pass. I am a fairly stable nurse in practice but the idea of following all rules while a towering mount of an assessor is on my neck sends shock waves down my already stiff spine. If that assessor is as thorough and committed as the one we had for peritoneal dialysis, you are bound to swallow your tongue.

Madam O (as we will call her here) together with my mentor Madam R (hail myself, queen of creativity) had drilled to our heads that all that stood between us and the title of Nephrology Nurses was peritonitis. That is infection of the sheet or membrane that surrounds all abdominal organs.

We therefore washed hands. Disinfected them. Washed. Disinfected. If my hands were an emotion, harassed would befittingly describe them. My skin thin as a whisper. We learnt of sterilizing hands. We became connoisseurs at hand wash. Befitting champions. It was needed. It was life-saving.

Imagine my horror then when I recently walked into a room at the far end of our unit’s wide corridor to find a man busy doing a bag exchange! What’s more? He had all the products I struggled to understand back at Renal Nursing School. His hands shimmered with lack of microbes. Kirk (the man) is my mentor in the Renal Unit. I have been a volunteer for a while now and I work under his able guidance. Fellow nurse, suffering end stage renal disease, on peritoneal dialysis. Let. That. Sink. In.

SO WHAT IS THAT?

#TeamPhoenix, the internal organs of the body are covered by a double folded layer of membrane (sheet) called a peritoneum. It is so large that it allows all organs in the abdomen to be invaginated inside it. Invaginated, big word, yes? Ha ha.

Dialysis as a term simply refers to “cleaning of blood”. Some processes apply and the easiest is osmosis. This is a fairly easy term. Okay, shall we revise your primary science lesson? Do you remember your science teacher asking you to scoop out some flesh of a potato and put sugar inside it?

Mr.Mbui (my Class 6 Science teacher nicknamed Mnyama wa porini) went further to talk about a semi-permeable membrane. He outlined how this membrane of my potato allowed water to escape into my sugar overnight. He said, with voice as hard as the canes he used to rain on my cracked feet, that semi meant ‘partially’ while permeable meant ‘to pass.’

Mr.Mbui was the type of teachers who punished you not for getting less than half marks in your Science exam, but for dropping the marks. He kept a record and woe unto you if you ever got 100% at a CAT, you better maintain it till the end of the year. Lest you discover the true meaning of a good deed never goes unpunished.

And I miss him. I miss Mr. Mbui. Who knows of his whereabouts? I know he retired but man oh man, did he not make me love anything scientific! Well, until I discovered literature in high school and decided to be more art than science.

I digress.

The same principle applies with this God-given membrane. It allows for some substances to pass from the blood. All we need is to make sure there is another solution to exchange these substances with.

WHAT HAPPENS?

Peritoneal dialysis involves the surgical creation of a tiny hole in the abdomen near the belly button to access the peritoneal space. Now, remember I mentioned it to be a double fold? Imagine that space between the fold. That is what the surgeon wants to access. They then put a small tube called a catheter. This is the one that we shall use in peritoneal dialysis.  A special fluid (water) is put through that catheter into the peritoneal space. It is allowed to rest for some hours.

Si even the potato was allowed to rest overnight? During his period of rest, the water is in close contact with this semi-permeable membrane which has very many blood vessels on either side to allow for exchange of waste products from the blood to the fluid that we already put inside.

Let me make it palatable. The water acts like the ‘sugar’ in the potato. It pulls out excess fluid, urea and other toxins from the blood and allows it to be manually removed. This removing (draining) of the dirty water in exchange for fresh fluid is what we call a bag exchange. That is what I found Kirk meticulously doing in his special room.

I believe that is better.

HOW NOW?

The fluid we use is commercially produced hence we must buy it from the shops. It is so hard to get it in Kenya that sometimes patients have to wait hours no end to have it imported from India, UK among other nations that are practicing this life changing procedure. The good thing is that anyone can do this procedure if well taught. For my mentor Kirk, he had to be taken through it, despite being a nurse, by the Community Dialysis nurses in this region. End stage renal disease spurred his interest in becoming a renal nurse. It has been three years and he is finally on the way to transplantation after a long wait for a suitable donor.

WHY DO WE NOT DO IT IN KENYA?

#TeamPhoenix, when one talks of dialysis in our setup here in Kenya, we automatically expect it to be hemodialysis. As a matter of fact, many do not even associate the term dialysis with anything else apart from one machine, many tubes and a laborious four hours to boot.

This narrative has been whipped properly by the government’s initiative to install a Renal Unit in each county in Kenya. That has shot with enough steroids to down a horse by the mushrooming of private centers that conduct hemodialysis as long as you have an insurance cover. Or a well-layered wallet. Or both.

Like I have come to appreciate, renal units are not complete unless they are tackling all aspects of the renal replacement therapies. We have largely ignored peritoneal dialysis in Kenya for reasons best known to the powers that be.

We carry peritoneal dialysis out on children who are unfit for hemodialysis. This goes for infants and like my dearly departed friend before he was old enough to be strapped onto the hemodialysis machine (see his story on the previous #KidneyWednesday blog post). Do not get me wrong, children and indeed infants do undergo hemodialysis but not in Kenya. I am yet to see it happen. So in cases of renal failure, we go for the available mode—peritoneal dialysis.

My problem is with the uptake of peritoneal dialysis among the adult population. We can teach adults to properly perform peritoneal dialysis on themselves or their loved ones. We can free up the hemodialysis machines and stop keeping patients on wait for a chance at dialysis by simply teaching them how to do it. Must we sentence people, working people, school going people and their relatives to twice weekly visits to the unit to have hemodialysis? What happened to individualized care?

If we have patients on peritoneal dialysis, we might even lower the cost of the peritoneal dialysis fluid. An adult uses about 8 bags a day and given the average cost of each bag to be 2,000 Kes, I doubt anyone would afford it.

I say this given the socioeconomic dynamics of almost all our patients. National Hospital Fund and other insurance providers could then encourage patients to take up peritoneal dialysis by taking care of the cost of this fluid. This is the beauty of Universal Health Coverage envisioned in the Sustainable development goals and reflected by President Uhuru’s Big Four Agenda for Kenya’s development.

A demand for peritoneal fluid will force our chemists to locally produce this fluid to lower the price of one bag. Surely we have learned industrial pharmacists and chemists? Is Manufacturing not a part of the big Four agenda? We only think cotton, milk and sugar whenever manufacturing is mentioned yet this is a beautiful way of diversification?

#TeamPhoenix, if one is able to understand their illness and manage it, then they become great partners at healthcare. I do my best to give you the knowledge because I believe in empowerment of my audience. Do not approach illness with a nonchalant attitude. It only gives room for exploitation and misinformation. Take an active role in health education especially management of end stage renal disease.

In a country where the rate of kidney transplant is grossly unproportional to the rate of demand, we cannot afford to be apathetic with peritoneal dialysis. In a country where the hemodialysis units mushroom in the name of profit, we really can’t feign ignorance. We must ask and agitate for peritoneal dialysis to be reintroduced in Kenya. Patients can then wait for a transplant (if feasible for one) while on peritoneal dialysis.

I do not understand how Zambia, Tanzania and Malawi are practicing it while we hide in the cocoon of peritonitis.

Granted, peritonitis (infection of the peritoneum) is one of the most life threatening concern with peritoneal dialysis. However, home inspection, rigorous hand hygiene among other factors are considered even before initiation of this procedure.

End stage renal disease is already a terminal illness. We should not make it even worse by choosing for patients the mode of renal replacement therapy. The current ‘one fits all’ approach is an atrocious representation of facts. Each case of end stage renal disease should be examined with merit and patients told about peritoneal dialysis because it is a choice and it is pragmatic.

Yes there are a myriad of hurdles but have we at least tried? What about trying again? And again until something gives?

Thank you for passing by.

IN LOVING MEMORY OF MY FRIEND

Death leaves a heartache nobody can heal and love leaves a memory nobody will steal.

These past few weeks have been heavy. Not only for me but for all those knew and interacted with Eric, my little best friend who passed on after battling kidney failure. He was twelve years confidently and surely. Though the misery of poverty and illness had died a thousand deaths in his spirit, the reality of Alport Syndrome lingered on in his little body like a vengeful zombie. For him and other children, let us demystify this rare and genetic disease called ALPORT SYNDROME.

If you are new to these #KidneyWednesday sections, let me welcome you. The message on health and particularly Kidney health is one I do my very best to speak of in the simplest of terms. My target audience is not the specialists but every other Kenyan without any form of medical knowledge. I hope to speak to you in a language that you can identify with. However, some terms will be highly technical and if you do not understand I really encourage you to interact with me in the comments section. Feel free to contact me on www.facebook.com/catemimi and let me know your concern. @catemimi1772 is another way to talk to me on Twitter.

I do not have all the answers. You letting me know your concerns and questions will help me to seek for the answers from the great nurses that mentor me and doctors and other professionals. In return I will package that information in the simplest terms possible. Deal? Thank you.

ALPORT SYNDROME

This is a genetic condition characterized by kidney disease, hearing loss and eye anomalies. That means the patient will present with some degree of eyesight loss, some degree of deafness and some degree of kidney failure. These symptoms occur in childhood or adolescence for most of the patients. Alport syndrome being genetic means you are born with it. Not everyone gets it though. Let me explain a bit. Alport syndrome is inherited through the X-linked recessive pattern. Wachana na hiyo kiasi…Anyone up for a biology refresher course? Ha ha

X’s AND Y’s.

Males have an X and a Y sex Chromosome while females have an X and another X as their sex Chromosomes. That tells you all Kenyan men, it is not that your wife isn’t giving you sons; it is you who has the chromosome that can result to a son and you need to research more on how to make a baby boy. I digress.

Mutations (changes) of specific genes in the X chromosome lead to manifestation of this disease. There are specific materials needed to make each and every tissue in our body. All the information is contained in genes. There are genes for every part of our body. That explains why my cheeks and those of my siblings will always be full. It is because our parents’ genes decided to carry that information and use it while manufacturing our chubby cheeks. That is why your nose is the way it is. What I don’t know is whether genes are to also blame for my never growing hair.

It has been ten years now and every girl and their cat have long hair. Mine arrived came to the land of menopause and fell in love with the place. Oh the pains of kinky curls!

To filter urine, kidneys are comprised of millions of small structures called nephrons. Within the nephrons, there is a sieve-like membrane that allows waste products to pass through and come out as urine. We already said what urine contains. Right? Eti left? Hehehe you are funny. This membrane is interspersed with a fine network capillaries and together we call it the glomerulus. That is singular. Plural is glomeruli. I would go further and discuss the glomerular basement membrane but we are not here to get medical. We are here to at least get the basics.

Think of a regular kitchen sieve and a handle. The sieve is your glomerulus and the handle is your tube which will allow urine to pass through. Fair enough.

There is a specific protein that is needed in the formation of this glomeruli. This is the type IV collagen protein. Mutations in the genes specific in making type IV collagen cause abnormalities in the glomeruli and subsequent inability of kidneys to properly filter the blood. Type IV collagen is also needed in the making of Organ of Corti in the inner ear. This is an epithelium (membrane or lining) involved in the transformation of sound into nerve impulses for the brain to interpret.

Therefore, abnormalities in type IV collagen will cause hearing loss. Okay medics, it will cause sensorineural hearing loss. Sijawasahau hehehe.

Type IV collagen helps maintain shape of the lens and cells of the retina of the eye. That tells you changes in how this protein looks like will mean changes in the eye lens and retina. The retina is where we find the cells of sight and this will mean different degrees of blindness.

I am now biting my nails in the corner of my room eating last night’s disappointments hoping to my ancestors that you #TeamPhoenix do understand the three relationships. That is, this is not witchcraft like I saw some of you allude to in Eric’s case or a curse from the gods. That it is a genetic condition and the village witches had nothing to do with it. Sorry you alumni of Hogwarts school of witchcraft and wizardry, this isn’t on you.

INHERITANCE

The genes needed to make type IV collagen are within the X sex chromosome. It follows then that women will most likely pass the disease to their offspring while themselves are not affected.

Hold that thought please.

If a man has the mutations in these particular genes in the X chromosome. He too will pass it along and most likely he will already be exhibiting the signs and symptoms we have discussed. This is because, again, women have two X sex chromosomes while men have an X and a Y as their sex chromosomes.

 Dear God, show me a sign that kinaeleweka…

In males (XY) who have one altered copy of COL4A5 (the gene in question) in each cell, it is enough to cause kidney failure and other severe symptoms. In females (XX) who have a mutation in only one copy of the COL4A5 gene, it usually only results in hematuria.

However in some cases, it is inherited in an autosomal recessive pattern. Simply put, parents of this individual have one copy each of the mutated gene (carriers). In this case males and females are affected alike.

DIAGNOSIS

I would be very happy to write text book procedures. However, that would reduce this blog to a site of plagiarism with intelligent insults. See, in the Kenyan set up, such diseases get diagnosed by accident. It means that the parents have time and again presented the child to the hospital with either blood in urine, hearing loss or blindness. These are usually picked by the teachers who notice change of behavior with a child more intimately than parents do.

Sometimes the child will start speaking loudly and saying too many ‘repeat what you said.’

That is just but a clue to what could be happening. Thinking about the above, so many reasons can be attributed to them. It goes to show you that there is no walk in the bright sunny park as far as diagnosis of Alport Syndrome goes. It may take a few months if not years for the doctors to know what they are dealing with. By this time the kidneys will be damaged beyond repair.

A kidney biopsy will indeed detect the scarring of the glomeruli. Specifically it allows for testing of type IV collagen which will be absent in people with Alport syndrome. Genetic testing will confirm the diagnosis and help in determining the inheritance pattern so as to help other family members.

TREATMENT OR IS IT?

You will not treat Alport Syndrome. I wish we could. What management involves is monitoring and deterring progression of the disease as well as supporting the individual in different life skills. Patients will need hearing aids and in the case of blindness, ophthalmic support.

With regards to the inevitable end stage renal failure, dialysis and Kidney transplantation is the way to go.

PREVENTION

It really would be grand if we had some sort of genetic counseling centers in Kenya. That would allow us to seek information regarding our different health conditions. That would inform our decisions on what to do or not do. This is a tentative area pregnant with misinformation so I will shamelessly let it hang in the air like unclaimed Valentine’s roses.

Alport syndrome when detected early will be slowed down in its progression. Management of high blood pressure will be key. There are a wide range of drugs safe in the management of high blood pressure. There is, specifically, a cluster of medications concerned with preventing proteins from leaking through the glomeruli into the urine. These are the ones that the nephrologist will go for.

OUTRO

Funds were available through numerous fund drives for Eric to undergo kidney transplant but he passed on before that could be actualized.

Thank you all of you that empathized with his story and to all the parents, guardians and families and friends dealing with this horrendous illness, from my heart is a warmth of understanding, love and unconditional support.

Till we meet again Eric, Rest in peace.

KIDNEY HOLIDAYS

I am a good cook. At least that is what I tell myself every day before I go to bed. In fact, if you wanted me to fall asleep quickly, remind me how excellent my culinary skills are. I know this sounds like something a horrible cook would say but horrible is not a word I love.

The intention, as I set out to this artistic mission of cooking, is always right. I have my ingredients figured out and my appetite just right. What I conjure up later is always a mystery. My final cuisine taste like Kenyan rainfall in December. What I was to cook this holiday season is good old Chapattis. What I served everyone was something that you could comfortably rekindle a fire with. Crackling dry and impossibly hard.

Forget about ingredients and lectures on how to make the dough. I do all that and just like the main course, my Chapattis always disappoint.

For most Kenyan homes, holidays are tantamount to chapatti, pilau and nyam chom (grilled goat meat) with a crate or two of beer to drown in. It is a tradition passed down from generations. We can’t escape it. Chapatti do get cooked at any other day of the year but it is never really Christmas if you haven’t rolled and unrolled dough and flattened it into different shapes of the African map.

This diet has helped many have sizzling New Year resolutions of losing weight which rightfully belong where they should be–on paper. Friends argue that weight is a state of the mind just like poverty. I differ because I have touched those two things. Obesity and Poverty. Perhaps not in that order but I can tell you they are not in anyone’s mind. They are as real as inflated power bills and disconnected water supply.

Being overweight is a blow to your kidneys. They suffer when elevated cholesterol and blood pressure if not Diabetes Mellitus kick in. We have established that high blood pressure and Diabetes are the two leading causes of chronic kidney disease. If we can do something to run away from these two then we sure should do it and do it now.

Poor dietary intake like I have highlighted will not only give you rumors of New Year’s resolutions but add more wastes to your body for your kidneys. Let me explain.

Red meat must be broken down into proteins whose by product is urea. You are overwhelming the kidneys by increasing the amount of waste without increasing the filtration rate. More to that, alcohol causes you to pass urine more times and this will dehydrate your body. Some may tell me that that in itself is a balance because the more you urinate the more you are filtering the waste. If you are in this WhatsApp group raise your hand up…

Thank you for your honesty class. You are wrong. Now put your hands down.

Alcohol pulls out the water you already have in your body into the nephron tubules hence making you urinate more. It is a case of drawing water from the bloodstream into urine. This explains your morning hangovers to a great extent. What you pass at those urinals will not be well made urine (with all the wastes we have outlined before) but the largest percentage shall be water.

Less water in the bloodstream means we will have less blood (both volume and rate) circulating within the kidney tissues causing low blood pressure within the kidneys which will initiate the process of raising the blood pressure. Are you then surprised why some people must have headaches during or after a drinking spree?

What then is the solution since we must eat and celebrate and drink and have irresponsible sex and such other things? Thank you for asking.

Value the company more than the food. Eat, not to finish but to be full. I must vehemently condemn the conspiracy of all Kenyan mums. You feed us as if the Armageddon is nigh. You create small hills and mountains on the plate and if we decline you get offended. This has been so since eons ago. Please desist from these guilt-evoking love acts. Food served on a plate must not be overwhelming. Let us enjoy the first helping and if we want more we can always get a second helping. After all, we eat that heap of food to finish it and not offend your darling feelings. Please resist this strategy. Ha ha.

Talking about food, potatoes are very high in their glycemic index. Especially because we rarely bake them. Baking does reduce the glycemic index but I am not a Nutritionist now, right? *wink*

That means we can eat them, not as part of stew but part of the main meal. Central Province, am I telling you something? Yes I am smiling…

We have learnt to joke about adding potatoes in everything we cook but the truth should be told with the scathing nakedness it deserves. You can comfortably eat your starch without adding potatoes in them. I mean, do not serve chapos or pilau with a stew of potatoes. Both are starch and will contribute to weight gain. I need an emoji here…

Potatoes with garden peas and highlights of meat (red or white) is a meal by itself. Yes highlights ha ha. Stop calling it a stew with which to serve rice or chapatti.STOP.IT.Thank you. That explains the high cases of lifestyle diseases in Central Kenya and the Coast region. Coast shida yenu ni sukari. You people add sugar to everything!

This should not mean that thin folks are safe. I am concerned about our diet whether thin as rail or thick as the train that passes on it. Desist from horrible diets. Value the company, the laughs, the sharing, more than the heaps upon heaps of food you will eat this festive season.

Protect your kidneys for me if you won’t do it for you.

When you go out drinking, have some water and drink it. I had three Zambian classmates pale School of Nephrology Nursing. When we went out, I noted with astonishment something that not any of us Kenyans had. They drunk gallons of water before we touched any alcohol. I managed to ask one of them why. She replied with the very simple physiology we were learning in class but were too daft to apply it to ourselves. Drink water to cater for the resultant dehydration.

Miguel is a Rotarian friend who has globe-trotted because of his work. He told me in all his wine tasting years, it is only in Kenya where we serve beer at room temperature (pombe moto…very funny) and drink like the alcohol hurt us. My concern is not your fun but your kidneys. Those two organs must remain in top form if we can.

Excessive alcohol damages the liver. We all know this. What they did not tell you is that a damaged liver affects the kidneys and causes what we call a hepatorenal syndrome. Not once or twice have we have to start permanent dialysis on a young man whose alcohol overpowered his kidneys.

Friends, we have very few renal units in Kenya. Furthermore sustaining one is expensive to the family. Adequate dialysis should be thrice a week but we only manage twice a week. The number of patients on the waiting list keep growing in exponential proportions. #TeamPhoenix, if I can have one freer machine, then I can use it on a dire case.

As I talked about alcohol at the Rotary Club of Hurligham sometimes in June this year, I remember mentioning that it is wise to have a salty snack if you must waste yourself at the brewery. Salt retains water and will, though to a very small degree, pull some water from the tubules back into the bloodstream. However, I ask, how much salt would you need to lick for every bottle of Tusker or Guinness? Hehehe…

Protect your kidneys this festive season because I asked you to.

As always, thank you for coming.

WHY KIDNEYS MATTER

The heart may Stop, The brain may sleep but the kidneys never give up. However when the kidneys give up, not even the heart can stand it.

I may have touched on the work of these two bean-shaped organs in our bodies but I will go back to them yet again. I have received diversified questions and I thought if I took you all back to some basic physiology class we may be able to answer these (un)asked questions.

The kidneys are located towards the back of your body.They are on each side on the lower aspect of your ribcage. This is as far as I can make it sound non-medical. We agreed that these articles will not be written in medical jargon,no? Wait,you did not attend that meeting? Surely you had a representative? hehe.

Kidneys contain millions of tiny sieve like cells called nephrons. These small,intricate systems are key in filtering wastes and excess water from the blood.Waste in this case includes in part Urea and Creatinine. Urea is an end product of protein metabolism. It needs to be taken out of the body because excess content interferes with the normal working of the other systems in the body. Actually we get the word ‘urine’ in part from Urea.Creatinine is as a result of muscle breakdown. So, ladies will have less Creatinine in blood than men, got it ?

In addition, the medicines we take need to be removed from the body after they have done what they were meant to do in the body. Majority of these drug metabolites are excreted through the kidneys. #TeamPhoenix, some drugs get converted into inactive forms in the liver and we need to get this ‘inactive’ metabolite out.

Sometimes it is the poisons we ingest in the name of fun. Alcohol is a good example. Alcohol exits the body largely through the kidneys and that explains (albeit vaguely) the numerous trips you take to the washroom after your second beer or so. Imbibe on alcohol and you overload not only the liver but the kidneys too. By and by a hepatorenal syndrome with subsequent kidney failure will be apropos to you.

Kidneys also regulate the amount of salts and electrolytes in the body. We need these salts and electrolytes for muscle coordination, brain cell excitation, heart contraction to highlight but a few of the functions. Kidneys keep these elements within the normal range so that the internal working system of the body stays in some equilibrium.

Potassium is a cation worth mentioning because of its high relevance to renal patients. While normally we evade any catastrophes whether the Potassium in our diet is present or not, renal patients do not afford such a luxury. Kidneys retain and remove potassium from the blood with surgical precision. Too low or too high potassium is enough to cause a cardiac arrhythmia (heart beating abnormally). That explains the stringent dietary Potassium restrictions that renal patients have.

The blood’s PH is neither acidic nor basic and must be maintained within that range of 7.35-7.45. This happens via an acid-base mechanism that primarily is the role of the kidneys. Hormones and blood cells get denatured and destroyed if the PH is altered. This will manifest in various ways.

Kidneys produce an important hormone called Erythropoietin. This hormone stimulates the production of red blood cells in the bone marrow. That is why, when kidney failure sets in, one of the manifestation is anemia which means low blood levels. This hormone is so important that we inject it to the patients on dialysis. Dialysis attempts to replace the functions of the kidneys but this is one function that it can not replace–yet; because who knows the future?

Kidneys also control blood pressure. That means very high or very low blood pressure will have detrimental effects to the kidneys. Note too that high blood pressure can also be as a result of damage to the kidneys from other factors. I hope I have not lost you there.

It automatically follows then that any elevation or decrease in blood pressure is worth looking into. The kidneys play a vital role in activation of vitamin D which we need for strong, healthy bones. Talking of bones, the kidneys maintain Calcium metabolism,a key element in maintaining healthy bones.

In a nut shell, urine is of immense value as it tells us how your kidney health is. Urine is a mixture of excess water, electrolytes, Salts and a horde other waste materials. When other substances like glucose are present in urine, It guides the physician towards a correct diagnosis and management.

I hope these functions are palatable to your non-medical taste buds.

Till next week,cheers.

KIDNEY HEALTH DISCUSSION

More powerful than the best artillery is information in the hands of those who want to use it.

Despite it being among the top ten non-communicable disease killer in our country, kidney disease has continued to receive a wide berth as far as resource allocations go. There is so much the government, present and future could do to make sure that this is rectified. However I believe that the steering wheel of your health, #TeamPhoenix is not one you carelessly leave to other people. It must be your vehicle, your wheel.

The goal of many of these #KidneyWednesday articles are to make you feel empowered enough to approach Kidney Disease from a point of some sort of know-how. There is a need to perceive Kidney Disease as a primary ailment rather than a cause-effect phenomenon. That means we can talk about kidney disease and the disparaging misery it has brought to many households. That means we can now include Urine analysis as a mandatory baseline test for anyone visiting our health facilities.

#TeamPhoenix, my desire is for you to be informed. Shall we start some information therefore?

Basics

I know I have said it before but shall I repeat anyway. There is a major difference between Acute Kidney Injury and Chronic Kidney Disease. Now, the former is easily reversed if the right measures are put in place and I have a thousand and one words to say on this topic on my Facebook Wall before we gave birth to this blog. Most of the patients we handle , however, are suffering chronic kidney disease and unfortunately are in the fifth stage of the illness called End Stage Renal (Kidney) Disease.

Diabetes Mellitus and Hypertension are the two leading causes of this disease and I can’t overemphasize that point. There is however, a rather little known disease called Polycystic Kidney Disease. More often than not this is discovered while one is being treated for a totally different condition. It is a situation where the kidneys develop cysts (water -filled growths). These tiny little monsters compress the normal tissue of the kidneys. The result is reduced surface area for the kidneys to do their work. That increases the blood pressure in the kidneys and the general systemic circulation leading to a further damage to the kidneys.

A feedback cycle from hell you could call it.

That usually presents in the early thirties. I must say I never thought much about it until I went to the Renal Clinic at Kenyatta National Hospital during my training. I encountered so many young people on management for Polycystic Kidney disease, the reality was staggering for me.

It presents with very high blood pressure. Time and again a patient can be mismanaged–albeit genuinely, as having a migraine. Wait, now that I have written that down, I think I need to make some calls…funny how real things appear when one writes them down!

Where were we?

Polycystic kidney disease detected early is managed and the disease progression slowed. We may do little to reverse it as it has everything to do with our genetic make up. The reason I am highlighting this is to make you realize the need for this conversation surrounding Kidney failure.

We need early screening and staging of the disease so as to inform management. Last time I told you a story of a Patient we are dialysing who we shouldn’t be, at least not yet, had the attending consultant identified the staging early enough and referred the patient to a Nephrologist.

See, there is a culture of indomitability within medics circles, and Kenya has not been spared, that really needs to come to an end. This is where a consultant or doctor or another medic delays a referral to specialists in the name of figuring it out. I daresay medicine is dynamic and nobody will have all the answers. What you do is put these patients at risk as you focus on what to do or not do. As you become too afraid to be labelled incompetent just because you referred a patient. This is why we have so many cases of terminally ill patients whose stories look like they were scripted by the same writer.

That is how patients start dialysis and they tell us that they have been undergoing treatment for stomach ulcers, Malaria, Typhoid and a horde of other illnesses which if we take a proper history, were all related to the failing kidneys. The Chronic nature of this type of kidney disease means that it does not befall us as a thief in the night. Surely there are signs.

If your patient isn’t responding to particular management after a set timeline, why on God’s green earth do you want to keep treating them for that same condition till Jesus comes? What happened to effective referrals being part and parcel of management?

Sigh…

#TeamPhoenix, do find out the type of Kidney disease you are dealing with. I always say sometimes you do not know because you do not ask. Please ask the medical team handling your loved one, you or a friend or a neighbor what type of Kidney disease they are dealing with.

If it is Chronic, I want you to be part of the team that supports these families. Please encourage them to attend dialysis sessions because if the kidneys are failing, we are accumulating wastes in the blood and excess water which by and by will lead to complications.

Drop them at the renal unit, provide some eggs for them, ask about their next session, talk about the need for kidney transplant, link them to people who have undergone transplant and are doing well. Link them to people who have been on dialysis for a couple of years. Be there. Be available. If a village brings up a child, then the village should indeed help one to be well again. Let us put to action those community values we boast of as an African village.

It doesn’t need a title but here we are

Let us have conversations about Kidneys and how to keep them healthy. As well as how to manage the disease if it comes to that. End stage renal disease is a terminal illness in itself but it should not be the way life comes to an abrupt halt.

People can dialyse and still attend school, work and be productive. People can undergo kidney transplant and change the whole ballgame altogether. However this is a multi-pronged team effort. I keep saying that the most important player of the medical team is you, #TeamPhoenix–the patient/client.

Ask questions. Seek simple explanations. If not for anything else, for the sake of your consultation fees. That is what you pay for, right? Consultation. Then by all means , Consult.

Next week , we shall talk about functions of the kidneys. I know we had talked about it on my Facebook wall but I have this unsettling need of going through them again.

It has been a pleasure having you today.