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.

Even one 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.

It 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 a week.

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 the procedure.

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 before him.

Neither Hugo nor Kobus will ever forget 25 April 1988, two days before their 30th birthday.

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 anything down.

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- West University.

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 the outside.

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 www.nlm.nih.gov.

JULY 2007
Brother-to-brother transplant

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.

NOVEMBER 2007
Mother-to-child transplant

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 years later.

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 mom’s kidneys.

APRIL 2008
Sister-to-brother transplant

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.

Bertie’s 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.

1. Do you have diabetes?
   About 35-50 per cent of all kidney failures occur among diabetics.


2. 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.


3. Have you had more than one kidney infection?
   Glomerulonephritis that isn’t properly treated and monitored (which happens in some developing countries) causes up to 20 per cent of all kidney failures.


4. Do you have a congenital kidney disease such as IgA nephropathy, polycystic kidneys or kidney cancer? Pay extra attention to your health.


5. Do you permanently use a catheter?
   Be on alert for kidney infections and make sure they’re treated quickly and thoroughly.


6. Have you used anti-inflammatory medication for pain, inflammation or fever every day for years?


7. Are you so overweight you have high blood pressure?


8. Is your cholesterol level very high?


9. 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.

They 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.

Healthy 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 dehydrated.

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 glomerulonephritis, doesn’t start in the kidneys but develops after another disease has weakened the immune system.

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 kidney failures.

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 symptoms.

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 better.

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 out for.

• 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 Coke-coloured.


• Frequent urination during the night is an early symptom. The frequency decreases as time goes on.


• Listlessness and tiredness.


• Poor appetite.


• Headaches.


• Body and muscle aches (as a result of chemical imbalances).


• 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 symptoms.

Kidney condition Centre