The kidneys are two bean-shaped structures located at the posterior (back of) abdomen. They are so important that they receive 25% of the human blood per minute. An adult human has about 5 liters of blood, that is 5000 milliliters (mls), which means the kidneys receive 1250mls per minute. Blood flows to the kidneys via right and left renal(kidney) arteries under a high pressure and moves through smaller blood vessels into a knot of vessels called the glomerulus, which looks like a sponge. The major work of the kidneys is broadly classified under the following:
•Filtration of blood which gets to them.
•Re-absorption of important ions, and
•Secretion of molecules;
All of this contributes to ensuring that the body is kept in good conditions through the following functions;
- Excretion of toxic substance called urea, a nitrogenous substance. If the kidneys get shut down by whatever reason, urea gets accumulated to the level that becomes dangerous to the body. In fact, most of the complications of chronic kidney disease (CKD) and more often than not, death arise from accumulation of urea in the body. The kidneys also excrete creatinine.
- Production of red blood cells: the kidneys produce a substance called erythropoietin which acts on the bone marrow to produce red blood cell. A diseased kidney will not be able to produce this very important substance in a sufficient quantity and so, the individual comes down with anaemia(low red cells).
- Conservation of water and ions: the kidney makes sure that the right quantity of ions (sodium, potassium, glucose, etc) and water at a given period is within the body. It excretes any of these substances if in excess and preserves any if in short quantity. The kidney does the same for water. If there is no enough water in the circulation, it conserves it and the individual excretes little and yellowish urine, and this is what is most commonly mistaken as malaria by people. In this situation, your kidney is telling you there is no enough volume of water in your body. So, drink water and see your urine becomes clear as crystal. However, if there is excess water in the body the kidney excretes a large and clear volume of water. But, of course, passing more 3L of urine per day may signify a disease process.
- Production of Vitamin D: the kidney plays a significant role in the synthesis of Vitamin D which is needed to strengthen the bone and for calcium absorption.
- The kidney does not only excrete nitrogenous substance but also, it excretes waste products of most drugs consumed.
- The kidney is involved in the production of glucose when there is a low level of glucose in the body.
There are various diseases that can afflict the kidney and they can be broadly categorized as ACUTE or CHRONIC. A kidney disease condition is acute if it resolves within three months and chronic if it persists beyond three months. Chronic Kidney Disease from any cause means it may not be reversible, and if nothing is done, the disease may progress and the kidney will shut down and unable to perform the aforementioned functions. At this juncture, it is either the person gets a new kidney by way of kidney transplant or becomes dialysis dependent, which is not definitive.
Dialysis is a medical procure, with the use of a machine that helps in performing some of the enumerated kidney functions. However, the problem here is, the person needs to undergo the procedure three times a week. From experience, most patients are not able to afford a session per week, let alone three.
Nevertheless, it suffices to say that one only needs 25% of one kidney to stay alive, yet God in His mercy gave us two solid kidneys. The import of this is that there is a lot of reserves which the kidney can fall on, in case of any insult to it. However, continuous and irreversible insults to the kidney can result into chronic kidney disease, in which case, most of the reserve if not all is used up, leading to end stage renal disease(ESRD). According to Ulasi and Ijoma, ESRD accounts for 8% of all medical conditions and 42% of all kidney diseases admission in Nigeria.
Chronic kidney disease has become a public health problem with rising incidence and prevalence in the world over. However, in Nigeria, CKD has received little or no attention from government and policy makers despite its debilitating effect in terms of the subsequent high cost of care which a great and major challenge to the individuals, relatives, loss of productivity and economic loss to the country as a whole. It has a huge financial challenge on the families of people with the condition, of which many cannot afford the financial burden, making the disease almost the beginning of the end for the individual.
The disease has no predilection for age as people in their twenties and thirties come down with it, the most commonly affected age groups are those between the third and fifth decade of life, and sadly, many die of it. Young people come down with the disease due to the fact that we are still battling with communicable diseases, some of which can affect the kidneys.
With this disturbing incidence, challenges and un-affordability of cost of management of CKD in the country coupled with the fact that there is no concrete government policies to help those who are down with the conditions, it is not only imperative to protect the kidneys but also the saying that “prevention is better than cure” lends much credence to itself when it comes to CKD.
There are no two ways about it, in Nigeria of today, the individual must protect his or her kidney, as a healthy individual is a wealthy individual. Thus, this takes us to the next discussion;
HOW NOT TO PROTECT THE KIDNEYS
- Not going for follow up and non-compliance with drugs if you are diabetic. Diabetes mellitus is one of the commonest causes of CKD in the world. Apart from having the capability to damage other organ systems in the body, it can cause a great deal of irreversible damage to the kidneys.
- Number one above applies also to hypertension as well. Uncontrolled high blood pressure has a deleterious effect on the kidneys.
- This applies to parents; whenever you see your child having sore throat and skin infection, please, don’t take it with levity hands. Seek adequate medical care for your child. This is because poorly treated streptococcal pharyngitis(sore throat) and streptococcal skin infection may later affect not only the heart but also the kidney, in an attempt by the body to fight the infections. These diseases can lead to chronic glomerulonephritis, a chronic kidney disease which is about the third commonest cause of CKD in Nigeria.
- Prolonged use of non-steroidal anti-inflammatory drugs popularly called NSAIDS. Examples of this class of drugs are ibupain, diclofenac, meloxicam, aspirin, and felvin, which are pain relievers etc. These drugs are mostly abused by people who engage in heavy work, and more sadly, over the counter drug sellers commonly called ‘chemists’ are guilty of mixing two or more of these same class of drugs for a single person who has come to patronise them. It suffices to say that alabukun, another commonly abuse drug, contains aspirin as its active ingredient. Prolonged use of these pain relievers causes what is called analgesia nephropathy, leading to CKD.
- Smoking, of course, serves no good purpose for the body. It negatively affects virtually every organ, including the kidney, in the body.
- Alcohol, no amount of alcohol, no matter how small, has been found to be good for the body.
- Excessive intake of salt: excessive intake of salt can cause high blood pressure which can itself lead to CKD.
- Prolonged use of mercury- and lead- containing cream. You may have to change your cream if the one you are using contains mercury or lead. Heavy metals have been implicated as a cause of CKD.
- Persistent delay in passing urine when you are pressed. This has a back-pressure effect of urine on the kidney, causing accumulation of fluid within the kidney tissues.
- For men who are above the age of 40 years, if you notice you are having difficulty in passing urine, it may be a sign of prostate enlargement, which if not dealt with can in the long run cause CKD.
- Persistent and poorly treated urinary tract infection is another condition that can cause CKD
- Herbal medicines have also been implicated in CKD.
WHEN TO SEE A DOCTOR
- When there is body swelling-facial, abdominal and leg swelling this may- be a pointer to kidney disease, especially early morning facial swelling that resolves as the day goes by.
- Unexplained easy fatigue.
- When there is excessive foaming of urine.
- Shortness of breath.
- When there is high blood pressure.
- When there is low blood level.
Lest I forget, regular checking of blood pressure, blood sugar and urine test can go a long way to prevent or in detecting early CKD.
Written by: Doctor Festus Taiwo
Image: getty images