Sometime ago, Nigeria lost a respected music producer and entrepreneur, Babatunde Okungbowa, popularly called OJB Jezreel to complications from kidney disease. He was aged 49 and was first diagnosed a few years ago before he underwent a kidney transplant 4 years ago in India. His donor was his wife who, fortunately, at the time was a match and by her uncommon act of love, gave him 3 more years of life before he eventually passed on. He now joins a list that includes a former Nigerian President and other celebrities like Muna Obiekwe, Chaz B and Steve Kadiri as folks we have lost to end stage kidney disease.
This type of heart breaking news affords us the opportunity to reflect and talk about the health of our kidneys again. With the alarming numbers and the growing prevalence rate, one gets the impression we probably have not talked about it enough. The kidneys are a pair of bean-shaped organs located at the lower back and are vital in the body’s normal functioning. They are critical structures but get very little attention, like many other health-related things in Nigeria. They are responsible for clearing out all the waste products of body metabolism and are also essential in the production of blood cells. This immediately tells you the likely consequences of their dysfunction – waste products will accumulate and the blood cell levels will drop. These are the main components of the phenomenon called kidney failure. The symptoms and signs generally revolve around these two.
The picture is bad. This is not a form of scare-mongering. We should actually be worried by the trend of kidney disease in our region. I have seen quite a number of ailments in my time in medical practice and only few spook me as much as kidney disease. Largely because it is often irreversible when it occurs over time and ultimately, defies even transplantation as we saw in OJB’s case. The treatment is quite complex and dauntingly expensive. Most patients are not even out of the woods even after a transplantation, which is supposed to be the most definitive treatment option. The palliative treatment, dialysis, is just as tasking physically and financially so if I were to ever advice any one about one disease to avoid at all costs, it would be kidney disease. And it is avoidable.
It is said that about 37 million Nigerians are living with some form and some stage of kidney disease. Given that we say that there are about 180 million of us, this means that 1 in every 5 or so Nigerians has some level of kidney dysfunction. That is utterly mind-boggling. Every year, 17,000 new cases will be diagnosed and will require some form of intervention. In monetary terms, the two treatment options are weighty. Dialysis, which only replaces 10 -15% of the functions of the kidneys, averagely costs N25,000 per session and since the waste products keep accumulating given that the person is alive, at least 3 sessions a week are required. This comes to N75,000 per week and about N4 million yearly for a procedure that is not curative and is fraught with side-effects. Eventually, the second treatment option will be required at some point. This is a renal transplant and it averagely costs between N5 and 7 million for the procedure itself. This is where it gets tricky. Because the new kidney is ‘alien’ to the body of the recipient, the natural reaction is for the body to reject such a kidney and so drugs, which are often remarkably pricey, are administered for life to suppress this rejection. This will entail another N150,000 every month for post-surgical care and amounts to about N1.8 million per annum for the rest of the patient’s life. So, you see why the disease is a ‘luxury’ ailment. It often saps families very quickly of already scarce financial resources.
Causes Of Kidney Disease
The commonest cause at the moment is uncontrolled high blood pressure or hypertension. Other common causes here are diabetes, HIV, sickle cell disease, abuse of analgesics or pain killers, mercury containing soaps and creams and herbs. For the more sudden cases, things like significant blood loss from any cause and untreated infections of the urinary system are the usual suspects. Hypertension is now the commonest non-communicable disease in Nigeria, affecting 25% of the population quietly without any symptoms. It is worsened by the fact that over 70% of those afflicted by the problem do not even know and of those that know, 5% are not on any medication to treat the problem. Look at the causes of chronic kidney disease listed above again and ask yourself which of them is not within the control of an individual. The only one that jumps at you is sickle cell disease – you have significant control over all the others.
Hypertension and diabetes are preventable and in the worst case scenario, are manageable. The key is to make the necessary lifestyle adjustments required like eating right, exercise, regular medical checks and knowing one’s numbers. A weekly blood pressure check can be done at home. Other routine tests like fasting blood sugar, blood urea and creatinine and urine proteins can be done at longer intervals but at least they should be known by everyone of us. Urea and creatinine are renal performance indices testable in the blood and deviations from the normal ranges are typical of ongoing kidney damage. When the diagnosis of hypertension or diabetes has been established, it is important that prompt control is achieved by the use of appropriate medication to forestall complications like kidney failure. Our religiosity in this part of the world has contributed to the low uptake of medication in treatment of these dangerous diseases and a paradigm shift in thinking must take place to counter it. Faith as good as it is, is impotent without work. The work here is diligent compliance with prescribed medication.
A renowned nephrologist, Dr Ebun Bamgboye, once asserted that if an individual took up 1gram of paracetamol every day for 2 years, that fellow’s kidneys were very likely to fail. We are not helped by the scourge of self-medication in Nigeria as you find shops, and even hawkers, dispensing all types of medication with such recklessness. There are people who have formed the habit of popping pain killers once they feel the slightest pain in any body part. Some of us even take the pills to prevent pain – the pain has not even started but in anticipation of it such as after a tedious day. A simple nap may just be all you need for body to recover from such stress.
Another funny habit we have in this part of the world is the affinity for herbal mixtures. It is even a sector of the economy in states like Ekiti as the incumbent Governor has implied severally. How we are able to consume unlabelled and chemically untested substances like dongoyaro, waist pain, washing and setting beats me totally. Bleaching agents, soaps and creams, usually contain mercury that can be absorbed by the skin and enters the blood to get to the kidneys. The kidneys are not designed to handle such heavy metals and so considerable damage follows prolonged exposure. We sacrifice our own kidneys on the altar of cosmetic beauty. Folly.
Besides actively keeping track of one’s numbers (BP, blood sugar and blood electrolytes), habits like adequate daily water intake have immense benefits on the kidneys’ wellbeing. Simple science tells us that by flooding the body with water, we reduce the concentration of substances reaching the kidneys for metabolism. Interestingly, water is often a lot cheaper and more available than the other solvents like alcohol and sodas we are quick to consume. Aim for 2 to 3 litres of water every day. The benefits of proper hydration go beyond the kidneys and your body will ultimately thank you for it. Alcohol and tobacco do not help the wellness of the body generally and the kidneys are not exempted. Avoid them if you can.
Prevention is the ultimate panacea for kidney disease. We must do even more to sensitise our populace about this impending epidemic. One in five is alarming! The structure of African families exposes us all to the financial consequences of such an illness and so it is not enough to look out for ourselves only. Imagine having a sibling or a parent with kidney disease at such a time when the economy is in dire straits. We must raise the discourse via every available medium.
Together, we can win. And win, we shall.
Photo Credit – The Lancet