In this interview with Patrick Ugbechie, our Executive Health writer, DR. (MRS) TOYIN AMIRA, Consultant Nephrologist and Transplant Physician at the University of Lagos Teaching Hospital, LUTH, expounds the need for people to undergo regular medical check especially to guard their kidneys.

Your Background

I am a consultant Nephrologist at LUTH, I had my first degree from the University of Ibadan; almost 30 years ago, and did my postgraduate training at the Lagos University Teaching Hospital from 1991- 1997, I also had some training outside the country at the University of the Witwatersrand, Johannesburg, South Africa, also at Mansoura University in Egypt. So, I’m a Nephrologist and also a transplant physician.

Importance of the Kidney

Most people don’t know much about the kidney; the kidneys are two bean-shaped organs about the size of your fist located at the back of either side of the spine, they are powerful, sophisticated reprocessing organs that keep the inside of the body chemically clean and balanced so that all the other organs of the body; the brain, the eyes et cetera can function very well. Thus they keep the internal environment of the body in a state of homeostasis. But that is not all that the kidneys do, the kidneys have many other functions, viz; the heart and blood vessels generate blood pressure, but the kidneys help to regulate this pressure by producing some chemicals and hormones (like rennin, angiotensin and aldosterone of the RAAS system) that keep the blood pressure within acceptable range.

What is acceptable range of blood pressure?

When the heart beats it generates what is called the systolic blood pressure, and when it’s relaxing, the heart and the tonicity of the vessels generate what is referred to as diastolic blood pressure, thus the normal range for systole (that is during contraction of the heart to pump blood) should be 90- 130 or 135mmHg while the diastolic ( during relaxation of the heart) should be 60- 80 or 85mmHg of pressure. If the blood pressure is falling, the kidney knows how to buffer it, and vice versa; due to its capacity to auto-regulate many crucial body parameters and functions, keeping them within narrow physiological limits. In addition to that, the kidney produces a hormone (hormones are chemical messengers that travel throughout the body coordinating complex processes like growth, metabolism and fertility) called erythropoietin, which helps the bone marrow to produce red blood cells, the kidney also helps to keep the bone strong by the production of hormone which helps the body utilize vitamin D and calcium properly. We are made up of 60% water, thus the water volume of the body has to be maintained at a fixed range, this is achieved by the kidney. They also help in the excretory process of toxins via urine; that’s why we sometimes perceive the odour of drugs we’ve taken in our urine. These processes highlighted above are some of the physiology (normal functioning) of a healthy human kidney, but in the event of a pathology to the kidney, we begin to see a depletion in these processes, viz; the blood pressure gets out of control; which in fact is usually a tell-tale sign; when there is a hypertensive whose blood pressure suddenly becomes uncontrollable, soaring so, so high or when people who are predisposed to kidney disease become very anaemic for no obvious reasons, then we should also suspect a renal failure.

Types of Kidney Failure

There are two types of kidney failure; the acute, and the chronic. The Acute occurs suddenly over several hours or days in somebody who hitherto had a normal kidney function; it is characterized by severe diarrhea and vomiting, massive blood loss, in most cases it is reversible. Chronic type is progressive, develops over months or years, and is irreversible, once it starts, someday the individual will get to the terminal stage referred to as the end stage. How fast a patient gets to that stage depends on (i) management, and (ii) how early it was detected.

Can the Acute Nephropathy degenerate into Chronic?

Certainly, certainly.

Causes of kidney failure       

On the causes of chronic kidney disease and whether there are regional differences, I will say yes, there are regional differences, but generally, all over the world the two most common causes are; hypertension and diabetes. In the developed world, diabetes ranks first as the most common cause, then hypertension and other causes. But down here in Nigeria where we have a huge burden of infectious diseases, what we call Glomerular disease or Glomerulonephritis appears to be a very important cause of chronic kidney disease, especially in the younger age group. Next to that is high blood pressure; which has been aptly tagged the silent killer, because it is asymptomatic in the early stages. Yet it is very easy to detect; just have your blood pressure checked regularly.

For us here in Nigeria I will just mention the five most common causes, they are; Hypertension; Glomerulonephritis; especially in the younger group; Diabetes; (which has come under control as more people with diabetes are living longer and are no longer dying from acute complications of diabetes); surprisingly, obstructive nephrology; obstruction to the outflow of urine from both kidney, and this is a form of kidney disease that if diagnosed early is reversible. Obstruction comes in men mainly from prostrate disease. The man has it and does not know until someday he goes into retention, upon checking, the kidneys are already ballooned out, meanwhile, it is a preventable cause of chronic kidney disease.

The fifth is HIV, then, our multifarious local herbal concoctions (regarded as toxins). There are other less common causes like sickle cell anaemia, excessive ingestion of analgesics, Lupus, heroine (in heroine nephropathy, predominant in the US), et cetera.

What is prostrate disease?

The prostrate is part of the reproductive system, it sits at the base of the bladder, from the base of the bladder there is a pipe that takes the urine out, as men get older, from 40- 45years old, this organ enlarges and once enlarged it obstructs the outflow of urine through a slow process. Firstly, the individual discovers that there are frequent visits to the urinary for urination due to incomplete voiding of the bladder. This can be mistaken for diabetes mellitus. And when passing urine it does not flow freely and its flow is not projectile, rather it flows in trickles. These are some signs and symptoms of prostrate disease, and incomplete voiding continues, then the bladder content backflows to the kidney, and the kidney balloons out. There are two types of this disease;

• The non-cancerous, and
• The cancer-type of prostrate disease

Both of them are very common, so men should cultivate the habit of checking the prostrate regularly from the age of 40, that’s my candid expert advice. For their female counterpart, it is usually from cancer of the cervix and womb.

Signs and symptoms of chronic kidney disease

The early stage of the disease is silent, people don’t know they have it till it’s advanced and the individual begins to exhibit symptoms. That is why we advocate that people should cultivate the habit of routine medical examination; don’t try to by-pass any medical examination whether it’s preschool or pre-employment, make sure you carry out the examination thoroughly. And you can do well to see your doctor at least once a year.

Cost of these check-ups?

Urinalysis goes for as low as N500 –N1000, Kidney functions; electrolyte and urea goes for around N3000- N3500, so with just about N5000 individuals can be checked. But if you want to go further, maybe do a scan, it may be totaling roughly N10,000. So it’s really not expensive to ascertain the state of your kidney.

A lot of persons do not know this…

Yes. When the symptoms begin to appear, they include: waking up several times at night to urinate; individuals wake up in the morning and notice bags (or swelling) around their eyes, swelling around the ankle, or general body swelling referred to as localized or generalized Oedema respectively; frothiness of the urine; excessive tiredness or lethargy; dryness of skin, loss of appetite, and for those with high blood pressure it becomes very difficult to control. In more advanced cases when the patient needs dialysis, the symptoms may include; extreme weakness, vomiting, hiccups, general body itching, and Oedema.