Kidney disease: are you at risk?

Kidney problems can sneak up on anyone. The cause could be an unrelated disease or something in your genes.

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 diabete?
   About 35-50% of all kidney failures occur among diabetics.
2. Do you have high blood pressure that isn’t under control?
   About 20-25% 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% 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% 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.

Kidney disease 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.

Kidney disease does not end in kidney failure

But not all kidney diseases end in kidney failure – more than 80% 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 decreasesas 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.

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.

(Written by Ilse Salzwedel. This is an edited version of a story that originally appeared in YOU Pulse / Huisgenoot-POLS magazine.)