Kidney Disease – You Need to Know More

Dear all Malaysians, kindly take note of the followings.

According to the Ministry of Health Malaysia, among Malaysia’s 26-million population in 2005, the annual newly identified number of people with kidney disease is 2,500. For every one million Malaysians, 100 suffer from kidney problems and this is the highest in the world (The Star 30 May 2007). About 13,000 patients seek dialysis each year (New Straits Times, 12 November 2006).

Located in the back of the abdomen below the diaphragm, the main function of the kidneys is to remove nitrogen-containing wastes (mainly urea) from the blood and adjust the concentration of various salts. Kidneys act as filters of the blood. They produce urine and eliminate it through the urinary system.

According to the web site (www.kidney.org) of the National Kidney Foundation of America, chronic kidney disease (CKD) includes conditions that damage the kidneys. If kidney disease gets worse, wastes can accumulate to high levels in the blood. A person having CKD may develop complications such as high blood pressure, anaemia (low blood count), weak bones and nerve damage. Kidney disease increases the risk of having heart and blood vessel disease. Chronic kidney disease is mainly caused by diabetes and high blood pressure, accounting for two-thirds of the cases. Other conditions affecting the kidney include diseases that cause inflammation and damage to the kidneys’ filtering units, inherited diseases, malformations as a baby develops in the mother’s womb, diseases that affect the body’s immune system, obstruction caused by problems such as kidney stones, tumour or an enlarged prostate gland in men and repeated urinary infections.

Diabetes and high blood pressure are the two leading causes of kidney disease. According to the US National Kidney and Urologic Diseases Information Clearinghouse (kidney.niddk.nih.gov dated 9 November 2006), diabetes is the most common cause of kidney failure, accounting for more than 45% of new cases. Even when diabetes is controlled, the disease can lead to nephropathy and kidney failure.

Analgesic use has been associated with two different forms of kidney damage. Over-the-counter analgesics (medicines bought without a prescription) include aspirin, acetaminophen, ibuprofen, naproxen sodium and others. These drugs present no danger for most people when taken in the recommended dosage. However, long-term use of these analgesics may affect proper functioning of kidneys. A second form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for many years.

Normally, the medicine prescribed prevents kidney weakening (ACE inhibitor), alleviates kidney swelling/inflammation (steroid), prevents artery blockage and kills germs (antibiotics).
If both kidneys stop functioning due to disease, patients are said to have end-stage renal disease (ESRD). At this stage, the body can no longer rid itself of certain toxins and cannot properly regulate blood pressure and critical nutrients. Patients with ESRD have to depend on artificial dialysis or kidney transplant to maintain life. In some cases, those experiencing kidney failures can die within days due to the build-up of toxins and fluid in their blood.

Dialysis is the modern method of treating kidney weakening. The purpose is to detoxify uric toxin out of the body. The method can only reduce the toxin but does not reclaim the normal function of the kidney. Undergoing dialysis over a long period of time leads to reduced kidney blood flow, decline in urine volume and kidney hardening. Consequently, the patients have to depend on dialysis for the rest of their lives. The issue is that dialysis cost is not cheap and certainly beyond the means of the poor and needy. In private clinics in Malaysia, the cost was around RM3,000 to RM5,000 a month in 2009. Long-term dialysis may result in other health problems and in some cases may cause death.

Kidney transplant is like changing a car’s spare parts. In reality, kidney patients face two basic problems in kidney transplant, i.e. finding a suitable kidney and the body responses after the transplant. A transplant is never the same as the natural body organ. Rejection may occur thus threatening the life of kidney patients. In order to sustain the transplant in the human body, the patients have to take medicines to prevent these negative responses. This takes time and the medicines are not cheap. Some patients could afford to finance the transplant but paying the medicine cost for a long period of time is beyond their means.

Many people are of the opinion that kidney transplant would enable them to live a normal life. Is that the case? In 2007, a 45-year-old female kidney patient explains her situation as follows.

“After kidney transplant, a patient cannot expect to live a normal life like others. In reality, it is a different way of life compared to a normal person. In order to take care of the transplanted kidney, I have to monitor my body weight, urine quantity and body temperature from time to time. Besides this, I have to self-examine the extent of pain, the size of the transplant and its extent of hardness. I have to be very careful with the food taken each day. The body could be painful at times. It is not true that transplant solves kidney failure. Transplant is not the same as your own kidneys. After kidney transplant, I have to take various medicines to prevent rejection by the transplant and this cost RM1,000 a month in 2005. Taking medicines for a long time brings side effects. These negative effects could lead to diabetes, high cholesterol and high blood pressure. I also avoid going to public places as I may catch fever and running nose. I worry day and night and I do not know how long the transplant could last. My economic resource is limited. I may die any time. Take care of your kidneys before it is too late.”