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.


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?


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?


#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.