As a practising specialist physician and nephrologist (kidney doctor), I come across countless patients who present with chronic loss of the functions of the kidneys (chronic kidney disease) and as you explain their condition to them, they ask; ‘Doctor how about the other kidney’.

This question teaches me at least one more thing about my patient that he/she knows that their body has two kidneys. But I break their heart and those of their relatives when I further make them understand that if we pick up from the blood investigations that you have a kidney problem, then it means both kidneys have been affected. Simple!

The truth is, we can live on one kidney and that is why a person can donate one of his/her kidneys and live very well on one. In that case, you should not present with chronic kidney disease if you still have a perfectly functioning single kidney. However, this is not the case in most situations!

What then is chronic kidney disease?
This can be explained as evidence of kidney damage lasting for a period of more than three months with implications for health. This evidence can be picked by your doctor or health care provider by examining your urine sample, taking blood samples and taking videos of your kidneys with an ultrasound machine.

Early in the course of the disease, there may not be any symptoms at all. Patients may, however, experience the passage of decreased amount of urine, frequent passage of urine at night or passage of frothy urine. Patients may also experience dizziness, awareness of their heartbeat and easily getting tired with very little exertion when their blood levels decrease i.e. anaemia. This is because the kidney is responsible for producing a substance that helps your body to produce blood for normal function.

With advanced disease, a patient may also experience swelling around the eyes, fluid may then accumulate around the heart, lungs, in the belly and the feet; which may leave a sustained mark when you press with your fingers. They also experience poor appetite, feel like vomiting and actually vomit. Bone pain and fragile bones are also known manifestations of kidney disease. With worsening renal functions, there may be confusion, drowsiness, convulsions, coma and ultimately death.

My dear reader, this is not to scare you but kidney conditions are here with us and here in Komfo Anokye Teaching Hospital, we see these patients on a daily basis. It’s not surprising as evidence in Africa has it that about 13.5% (Stanifer, Jing et al. 2014) of the population have some form of chronic kidney disease. Meaning if you count about 100 people at least 13 of them have chronic kidney disease. This approximated one out of 10. Some patients end up with end-stage kidney disease where they cannot function but have to be put on a machine (haemodialysis) or get a new kidney (kidney transplantation) to survive. This is very expensive for the average Ghanaian to afford and kidney transplant services are currently unavailable in Ghana. Unfortunately, haemodialysis in Ghana is not covered by the National Health Insurance scheme and patients pay out of pocket.

In my opinion, we need to create awareness on kidney diseases, aiming at prevention drives and call on governmental and non-governmental organisations to help subsidize the cost of therapy for patients living with kidney disease especially in acute situations.

What causes chronic kidney diseases?
Knowledge of the common causes of kidney diseases should be universal. These include diabetes, high blood pressure (hypertension), inflammation of the kidney (glomerulonephritis), and infections such as HIV, Hepatitis B and Hepatitis C. Others include chronic obstruction of the urinary tract for men with enlarged prostate causing urine retention or stones in the kidney, various medication such as herbal medications and even misuse of some orthodox medication. Of note is the chronic misuse of painkillers.

It will surprise you to know that obesity is a known risk factor for the development of chronic kidney disease and this year’s world kidney day celebration on the 9th March 2017 has the theme; ‘kidney disease and obesity; healthy lifestyle for healthy kidneys’. Others are born with abnormalities in their urinary tract that predisposes them to kidney problems later in life.

Globally, diabetes is the most common cause of kidney disease. In Ghana, patients present very late due to ignorance and the preference for alternate medicines before reporting to the hospital. Unfortunately, these alternate medicines have the potential of further injuring the kidneys. We are all at risk of developing chronic kidney disease but the risk is greater for the groups enumerated above especially in diabetic and hypertensive patients.

Prevention of chronic kidney disease
‘Prevention they say is always better than cure’ and I add that prevention of kidney disease is cheaper than cure. Let us be aware of chronic kidney disease and prevent it. Regular check-up of your blood pressure, urine analysis and blood tests are very helpful when you see your physician.

Avoid medications that are harmful to the kidneys like herbal preparations and excessive use of painkillers. They are not as harmless as you think. Aim to control your blood pressure if you are hypertensive and if you develop hypertension at a younger age, ensure you do not already have kidney disease. It is known that hypertension causes kidney disease though kidney disease can manifest with hypertension. It’s a chicken and egg situation as we are sometimes unable to say which came first; hypertension or the kidney disease!

If you are diabetic, ensure your sugar is well controlled as you regularly see your physician or health care provider. Delay in achieving target control of your sugar levels is dangerous. Your sugar control is your responsibility. Good diabetic diet and the use of medications and/or insulin injections can help achieve this. Lifestyle modifications like exercise, healthy balanced diet, decrease in salt intake and weight reduction strategies have all been recommended as good for the kidney.

Regular examination by your physician or health care provider and regular blood and urine test every six months, if you are at risk, is recommended! For those not at risk, I suggest that you give yourself a good birthday medical check-up treat yearly so early warning signs can be picked. You may have been diagnosed with kidney disease already. No worries! You need to see a physician or a nephrologist for a follow-up. With appropriate measures, we can together prevent the progression of your disease and delay as much as possible your need for dialysis or kidney transplant.

Chronic kidney disease is a distressing health condition with an increased economic burden and affects the quality of life immensely. It’s generally given less attention until you, a family member or friend is diagnosed of one. Let all help prevent chronic kidney disease that is wiping out our young and old population with its attendant economic burden.

Dr Elliot Koranteng Tannor
Physician Specialist/Nephrologist
Komfo Anokye Teaching Hospital
Kumasi
Email: elliotktannor@yahoo.co.uk
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