Twins Hugo and Kobus Pienaar have
always been close – yet as kids they
could never have guessed their blood ties
would one day save Hugo’s life.
Kidney problems can sneak up
on anyone. The cause could
be an unrelated disease or
something in your genes – and
then one day you may need
a kidney from a relative
to save your life…By Ilse Salzwedel
A potentially fatal kidney disease can slowly creep up on you or strike out of the blue. One morning
you could jump out of bed, healthy and full of
energy; a few years later you could be waiting
for a life-saving kidney transplant.
severe sore throat or bout of malaria could
damage your kidneys so badly they stop
working. It could happen over a period of
months or years – or overnight.
It gets even scarier…
The first symptoms of kidney failure often appear only when
you’ve already lost 60-70 per cent of kidney
function; when the organs are seriously
damaged and there’s no going back.
Even if you’ve had just one kidney infection
in your life a process may have begun
that could end in a potentially fatal illness. If
you’ve had more than one kidney infection
there is a good chance your kidneys may
have been damaged and it’s recommended
that you see a urologist or kidney specialist
for further tests, says Johannesburg nephrologist
Dr Hendrik Viljoen.
Hugo Pienaar (50) was a strong, healthy
youngster when he developed a throat
infection in matric. He assumed it was a sore
throat like any other associated with winter
colds. ‘‘But the germs that infected my throat
also affected my kidneys so that eventually
they stopped functioning,’’ he says.
The streptococcus bacterium that’s behind
some sore throats is only one of many bugs
that can affect your immune system and make
your organs turn on you. Other culprits include
malaria, diabetes and other diseases, as well as
high dosages of many anti-inflammatory drugs.
This peculiar immune reaction can lead
first to one kidney infection and then to
repeated infections. The condition eventually
becomes chronic and so much havoc is
wrought that the kidneys cease to function,
Dr Viljoen says.
This is exactly what happened to Hugo.
‘‘Throughout my twenties I struggled with
chronic kidney infection accompanied by
high blood pressure, headaches and swelling
as a result of water retention.’’
He was so conscious of his poor health he
tried to work harder than his peers to compensate.
He played sports and won national
colours in judo and tennis while studying law. But by the time he was 29 he had to face
the truth: his kidneys were failing.
A patient can survive with one functioning
kidney or two not-so-healthy ones. But when
the combined function drops below 30 per
cent the situation becomes critical.
Like others with kidney failure, Hugo’s
kidneys had simply stopped working. He had
to start dialysis – or die.
But the problem with dialysis is that even if a patient is connected to
the dialysis machine three or four times a week for hours at a time, the
machine can only perform five per cent of the kidneys’ function – just
enough to filter sufficient toxins from the blood to keep the patient
going until the next dialysis.
For the 11 months Hugo had dialysis he was constantly tired and
sick. He couldn’t eat and his skin was yellow from the urea accumulating
in his body. His health continued to deteriorate.
Doctors say patients on dialysis have a poor quality of life and a
much lower life expectancy than those with healthy kidneys. A kidney
transplant is the only long-term solution. The choice is simple: a transplant
which gives you a 70-80 per cent chance of surviving for another
five years, or kidney failure within a few years. More than 10 000 South
Africans die of kidney disease or failure every year.
The answer came when Hugo’s non-identical twin, Kobus, offered
one of his kidneys – because a healthy person can survive with
just one kidney. The most important requirement is a tissue match
between the donor and recipient. Interestingly, more and more
transplants are now performed with kidneys from a living relative
rather than a brain-dead donor as the approximately 160 organs
received from these donors each year are not nearly enough to help
the thousands of patients who desperately need kidneys.
Like Kobus 70 to 80 people a year take the selfless step of
donating a kidney to a relative. Kidney donation can be from
one sibling to another, as was the case with Kobus and Hugo
and radio personality Evert Snyman and his brother Kevin.
can also be from parent to child. Below are the inspiring stories
of family members who share this very special biological tie.
For the donor a transplant means an anaesthetic, an hour
in the operating theatre and soreness and discomfort for about
For the recipient it literally means life.
For the donor the risk is minimal: he always
keeps the best kidney because the philosophy
is the donor mustn’t be worse off after
Being left with a single kidney isn’t a
problem either – if the donor were to get
a kidney infection it would have damaged
both organs anyway.
Kobus, like most donors, didn’t spend
much time brooding over his decision. He
quite simply saw it as something he had to
do for the brother who was born fi ve minutes
Neither Hugo nor Kobus will ever forget
25 April 1988, two days before their 30th
For Hugo it was the start of a new life:
the kidney from his brother started working
immediately after the transplant. He also felt
better directly after the operation – so much
so he could enjoy a lamb chop that same
evening after a year of struggling to keep
Today Hugo, who would not have made
it much past 30 without his brother’s kidney,
is 50, a father of three, and a professor and trade and labour law consultant at North-
He’ll always be grateful for Kobus’ gift. ‘‘It
gave me a new life and the opportunity to
become a dad again, twice,’’ he says. ‘‘Kobus
offered me the greatest gift anyone can give.
Without him, I would be dead.”
He is living his second life to the full and
feels ‘‘completely normal’’ even though he’ll
always be on medication to prevent his
body from rejecting the new kidney.
He still doesn’t like vegetables but
after the transplant his hair became curly
while his brother’s went straight – as if
the gift of a vital organ was showing on
Kobus, a successful businessman in the
Vaal Triangle, also leads a normal life. His
only daughter was born after the donation
and despite having only one kidney he has
had no health problems whatsoever in the
past two decades.
‘‘It’s not really something I think about,’’
Kobus says. ‘‘I live life to the full – I’m a 4x4
enthusiast and often go on expeditions to
the Kalahari and Namibia, something I’d
never be able to do if I had kidney problems.
‘‘I don’t even use a kidney belt for protection
when I ride my motorbike – that’s how
normal my life is.’’
How does he feel about the precious gift
he gave his brother?
‘‘It was an enriching experience to do
something like that for Hugo, especially
because he’s such a wonderful man.’’
Hugo has been living with his new
kidney for 20 years now. Today, many more
transplants using organs donated by family
members are performed than 20 years ago
– and the success rate is even higher.
- YOU Pulse thanks Johannesburg nephrologist
Dr Hendrik Viljoen and Cape Town surgeon
Dr Elmin Steyn.
- Read more about kidneys, their health and
failure and the healthy diet and lifestyle they
require at www.health24.com, www.nkf.co.za,
www.medicinet.com, www.kidney.org and
For years well-known radio personality Evert Snyman (53) of
Johannesburg was unaware he had a serious kidney problem.
But in the winter of 2006 he went to see his doctor complaining
of exhaustion and swollen legs. He was diagnosed with
the extremely rare kidney disease fibrillary glomerulopathy, of
which there have been only five identified cases in SA.
Evert’s kidneys failed early in 2007. He could no longer eat
and needed dialysis three times a week just to survive. A new
kidney became a necessity. His brother Kevin (50) was a tissue
match and a suitable donor.
It wasn’t a difficult decision, Kevin says. ‘‘If I hadn’t done it
he would have died. And the donation didn’t affect my life at
all. I’m living exactly as I did before.’’
The brothers had their operations on 20 July 2007.
Evert has to take immune suppressants, antibiotics, steroids
and cholesterol medication for the rest of his life to enable his
replacement kidney to function optimally but it’s a small price
to pay for a new life. ‘‘I’m living life to the full,’’ he says, ‘‘even
more than I did before.
In November last year Alfreda Arendse
(47) of Cape Town donated a kidney to
her daughter, Keren-Leigh (21). Keren-
Leigh was 13 when she first complained
of back pain and a sore throat but her
kidney problems were diagnosed only
Eventually a biopsy revealed
the damage and, after various unsuccessful
treatments, her nephrologist
suggested a transplant early in 2007.
Alfreda didn’t think twice and her
daughter says she feels as if she’s ‘‘living
all over again’’ since receiving one of her
Ellen Husselmann (46) of Durbanville,
Cape Town, donated her right kidney to her
brother Bertie de Beer (48) of Hopefield.
He inherited polycystic kidney disease from
their mother, as have all his brothers and
sisters except Ellen. Fortunately her tissue
was a match and the transplant went ahead.
The op was done on 1 April this year
at Cape Town’s Christiaan Barnard Memorial
Hospital where at least one kidney
transplant is performed every week.
new organ started working even before the
operation was over. ‘‘I can’t believe I feel so
much better,’’ he says. ‘‘I have new hope.”
ARE YOU AT RISK?
If you answer ‘‘yes’’ to any of the
questions below you could be a
candidate for kidney failure. Visit
a urologist or nephrologist for further
tests. Kidney problems can be detected
early with a GFR (glomerular
filtration rate) test, which determines
how much waste the kidneys are
able to remove from the blood.
- Do you have diabetes?
35-50 per cent of all kidney failures
occur among diabetics.
- Do you have high blood pressure that isn’t under control?
About 20-25 per cent of all kidney
failures are caused by poorly managed
high blood pressure.
- Have you had more than one kidney infection?
that isn’t properly treated
and monitored (which happens in
some developing countries) causes
up to 20 per cent of all kidney failures.
- Do you have a congenital kidney disease such as IgA nephropathy,
polycystic kidneys or kidney cancer? Pay extra attention
to your health.
- Do you permanently use a catheter?
Be on alert for kidney infections and make sure they’re
treated quickly and thoroughly.
- Have you used anti-inflammatory medication for pain, inflammation or fever every day for years?
- Are you so overweight you
have high blood pressure?
- Is your cholesterol level very high?
- Do you regularly inhale fumes from lead or mercury?
How your kidneys work
Our bean-shaped kidneys are the
body’s filters. They clean the body of its
waste products, secrete the enzymes
and hormones necessary for healthy
blood pressure and the production
of red blood cells, control the volume
and composition of your blood and
regulate the body’s pH balance.
also regulate the levels of calcium and
other minerals needed for healthy
bones and joints and the functioning
of the brain, heart and other organs.
Dangerous chemicals (such as
medication, drugs and even poison)
and substances the body no longer
needs (such as the by-products of proteins)
are broken down in the kidneys
and excreted in the urine.
kidneys produce about 150 litres of
urine a day, of which about 148 litres
of usable substances like proteins are
reabsorbed by the body. About two
litres of urine are excreted daily.
When your kidneys are not functioning
properly toxins accumulate
which can affect your entire body.
Kidney problems are inherited or they
can be the result of various diseases.
The consequence of chronic kidney
disease is usually kidney failure, which can occur suddenly or
gradually over months and years.
One of the most frightening
things about kidney failure is you
become aware of the first symptoms
only when you’ve already
lost 60-70 per cent of kidney function.
By then a transplant is your
only option – dialysis offers only
temporary hope. Four out of five
people with kidney failure who’re
dependent on government health
services don’t even make it to
dialysis and die because there aren’t
enough facilities in South Africa.
Did you know?
- When sportspeople,
such as marathon runners,
become dehydrated while
taking large doses of anti-inflammatories to keep going
in spite of injury, they can
suffer acute kidney failure.
- Dehydration caused by
nausea and diarrhoea can
quickly lead to acute kidney
failure in children. Make sure
a sick child doesn’t become
BE AN ORGAN DONOR
It’s easy: call 0800-22-66-11 or visit www.odf.org.za – after your death your organs could give someone else a second chance at life . . .
KIDNEY DISEASE: IT CAN AFFECT ANYONE
Kidney infection, called
start in the kidneys but develops
after another disease
has weakened the immune
Sore throats caused by
the streptococcus bacterium,
diabetes, high blood pressure
during pregnancy, malaria,
hepatitis B, HIV, syphilis,
lupus, lung or lymph cancer,
the long-term use of anti-inflammatories and drugs such as
heroin can cause kidney disease
and eventually kidney failure.
Glomerulonephritis is a
general term for all kidney
infections, of which immunoglobulin
A (IgA) nephropathy
and nephrotic syndrome are
the most common.
A sore throat and abdominal
pain usually accompany IgA
nephropathy, a condition that’s
often genetic. It’s a common
form of glomerulonephritis and
causes about one in 12 of all
Nephrotic syndrome is
characterised by high protein
levels in the urine and low
protein levels in the blood.
High cholesterol and swelling,
especially around the eyes and
of the feet and hands, are other
The condition can
be treated by lowering protein
in the urine through diet and
medication as well as lowering
cholesterol and high blood
pressure. In adults it’s usually
a sign of more serious kidney
problems and an indication
a kidney transplant could be
required in the future – as was
the case with All Black wing
Jonah Lomu in 2004.
But not all kidney diseases
end in kidney failure
– more than 80 per cent
of children suffering from nephrotic syndrome do get
The underlying disease can
be successfully treated with cortisone.
Thanks to an early diagnosis and
careful treatment redhead Skye Phillips
(8) of Kirkwood in the Eastern
Cape is a lively Grade 2 learner. The
protein levels in her urine are tested
regularly and she gets immediate treatment
if there’s even the slightest
indication her kidneys are under
strain. Her Cape Town paediatric
nephrologist and her Uitenhage paediatrician
keep a watchful eye on her
to ensure she stays well – and there are
many other kids like her who remain
healthy thanks to careful monitoring.
SYMPTOMS: WHAT TO LOOK OUT FOR
Kidney problems have a wide
variety of symptoms and as these
generally appear when there’s very
little kidney function left it’s important
to know what to watch
- Insomnia is an early symptom.
- Swelling, especially of the feet, legs,
hands and around the eyes as a result
of water retention.
- Blood in urine or urine that is smoky or
- Frequent urination during the night
is an early symptom. The frequency decreases
as time goes on.
- Listlessness and tiredness.
- Poor appetite.
- Body and muscle aches (as a result of
- High blood pressure (caused or
exacerbated by water retention).
Anaemia (because the kidneys are
unable to produce a hormone for the
production of red blood cells).
- In advanced cases: shortness of
breath, irregular heartbeat, no
libido and a pale, yellowy skin
colour resulting from urea accumulation.
Hiccups and mental confusion are late
Kidney condition Centre