There is medication for your need for medication
Many things happen when we take any form of drug. Be it prescription drugs like antibiotics or common medicstions like painkillers. The processes through which these substances get broken down may vary but the end result invariably touches on the kidneys.
My promise to you has remained to break down medical information to help you absorb it. Let us talk about these many drugs and substances.
Your body and drugs
For the sake of this blogpost, the words ‘medication’, ‘medicine’ and ‘drug’ will be used interchangeably. That does not mean they mean the same thing chemically speaking.
When you take a medicine for example Paracetamol for headache, it must be broken down to a manner that is able to be absorbed by the body. The blood will then need to transport it to wherever the pain is so that it can stop the perception of pain.
Breaking down this paracetamol down is called metabolism. It is just a fancy word medics use to communicate in that complicated language of theirs. Ha ha.
Drug metabolism takes place in many organs and sites in the body but chief among them is the liver. In fact, almost everything we swallow will be fully metabolized in the liver. From food to alcohol and other recreational substances. The problem with paracetamol and other drugs is that some of their end products are substances which are harmful to the body. That is where your kidneys come in.
These harmful products will need to leave the body system and pronto. Please note that some drugs become useful and able to do what they were meant to do in the form of their end products. However even then, the products of that process of metabolism will need to leave the body immediately.
They are transported to the kidneys for elimination by the blood. This happens by being added to urine. Kidneys are the fundamental organs of excretion. That is why when they want to find out if athletes have used any illegal substances, they do a urine test. Well, not just athletes.
In fact, you may have noted that some medications make your urine smell a certain way or change colour. That just goes to show you that indeed, elimination of that drug (or its products) after it has done what it was supposed to do in the body happens through the kidneys.
Having many medications (prescribed and/or unprescribed) at the same time does not only overwhelm the liver but also the kidneys. Whatever goes to the liver will most likely come to the kidneys.
There is a close relationship between these two organs and pressure in one directly or indirectly leads to pressure in the other. Toxic waste build-up from failed kidneys will eventually lead to a failed liver. Excess waste production by the liver will overwhelm the kidneys.
That is why you hear people undergoing dialysis after alcohol poisoning making you wonder what could have happened to the kidneys; while we are always told that alcohol damages the liver.
Taking many medications is common in the elderly or people that take medications for various diseases. For instance, it is not uncommon to find a patient suffering chronic kidney disease being on treatment for both Diabetes and High Blood Pressure.
Further, if they have other issues for example nerve disturbances, chances are they will have even more medicines. Add that to the fact that we are all embracing alternative therapies including herbal medicine. All these chemicals will be metabolized in the liver and the waste products will have to be eliminated by the kidneys.
What happens then is a build up of noxious wastes. Kidneys become overwhelmed because the rate at which you are feeding the liver with “junk” is higher than the rate the kidneys are removing the said “junk.”
Majority of Over-The-Counter (OTC) medications have a direct negative effect on the kidney cells. A good example is the good old Ibuprofen. It is even more sad to find that renal patients still manage to purchase Ibuprofen and other painkillers in the same class as Ibuprofen yet they damage the kidneys even further.
The net effect of continued injury to the kidneys is a decrease in their filtering capacity. This leads to kidney failure in different degrees depending on what you have exposed them to and for how long. For a kidney disease patient, the ugly becomes hideous.
Reconciliation
It is prudent to be transparent with the doctor about medicines which you are using at any given time. This helps them to do something called drug reconciliation. This involves the doctor going through all your current medicines and deciding which ones need combining and which ones need to be removed or added.
Some medications have the same effect, or are composed of the same active ingredient but are sold under different names. That is why it is vital to tell the doctor about everything you are on currently. This includes herbal remedies.
Some herbal supplements and drugs like Mwarubaini (Neem) and all her products interact with some antibiotics and can be fatal if taken together. Some concoctions we dearly call dawa directly insult the kidney cells and should be avoided.
I don’t know who told some of us Kenyans that whatever is bitter and sold by some guy wearing traditional clothes is therapeutic. Some herbal remedies work and I’m not overruling them. I am just wondering who said everything that is sold by some guy in a maasai shuka is indeed beneficial to the body. It remains a mystery. It is up there in the list of mysteries together with the disappearance of one sock. I even have a drawer for them but somehow one sock gets lost.
Toxic overload for the liver is toxic overload for the kidneys. Help us to protect you by being open about what you are on at any particular time.
If the clinician does not ask, please ask the clinician whether it is alright to continue taking whatever you have been taking on top of what he or she has prescribed. That gives you a chance to know and do the right thing. Being forewarned is being forearmed.
Our role
Doctors, clinical officers, pharmacists and anyone else with prescribing authority must actively ask patients what other substances they are on. This is especially important in Kenya where I’m sorry to say that we do not have very robust prescribing laws. Anyone can pop in to any chemist and buy whatever medication they read about on Generous Google or Fancy Facebook.
They can source the most expensive antibiotics including Third generation Cephalosporins. No wonder we are struggling with super bugs due to drug resistance. This is how we are having to deal with unnecessary acute kidney injury.
It is important to be aware that in our setup, by the time a patient comes to you as the clinician, they have tried other things. By the time you prescribe those medications for high blood pressure, they have tried aspirin-containing medications (for example mara moja), Piriton amongst other medications. They will not tell you if you do not ask. They will assume it is alright to top “your” prescription to “their” OTCs.
Harmonizing the list of drugs a patient is on does not only help the kidneys but also improves compliance. It is stressful enough for our patients to have to take medications but it is even worse when the prescription runs from Tunis to Cape town.
I can’t emphasize enough the need for adequate hydration when taking medications. This increases the amount of fluid in the blood hence flushes the urinary system. By so doing, we encourage kidneys to eliminate as many end products of these medications as possible.
That goes for other substances like alcohol as well. We agreed that even alcohol will be metabolized in the liver. The end product will be removed from the body through urine. The more water you take, the better your clearance is of alcoholic end products.
In addition, alcohol itself makes you urinate more so drinking copious amounts of water helps to replace the water you lose through excessive urination.
The fact is that we have very limited number of dialysis machines in Kenya. The demand surpasses the supply in huge proportions. If we can avoid acute kidney injury caused by medicine poisoning, then by God we should! We can then leave the few machines available for the unavoidable cases. That now, ladies and gentlemen, is public partnership in healthcare delivery