World Kidney Day 2010
People with diabetes should get regularly checked for kidney disease as they are more at risk of damaged kidneys. Being diabetic does not mean that a person will get chronic kidney disease (CKD) but they need to control their sugar levels and follow a proper treatment plan. Doctors shared this information while speaking at the World Kidney Day symposium at Aga Khan University Hospital (AKUH) centred on this year’s global theme, Protect Your Kidneys, Control Diabetes.
CKD is a slow, often silent disease in which kidneys gradually lose the ability to remove waste products from the blood. One in three people with diabetes may get CKD, but, as Dr Asma Ahmed, Consultant Endocrinologist, AKUH, pointed out that controlling diabetes reduces the risk of developing kidney disease by 21 per cent.
But in Pakistan, half of all people with diabetes are unaware of kidney disease and the risks of their developing the condition. The World Health Organization, according to Dr Ather Hussain, Consultant Nephrologist, AKUH has estimated that 175 million people worldwide had diabetes in 2003, and the figure will almost double by 2030, with developing nations at greatest risk. Early detection of kidney disease among diabetics, strict control of blood sugar and the use of high blood pressure medication can slow the progression towards CKD. But if the disease is left undetected or untreated, people may develop end stage renal failure and be treated through dialysis or in severe case undergo a kidney transplant.
Dr Waqar Kashif, Consultant Nephrologist, AKUH, discussed the relationship between high blood pressure and kidney disease. In 1994, the National Health Survey of Pakistan revealed that 18 per cent of adults above 15, and 33 per cent above 45, had high blood pressure, and less than 3 per cent were able to maintain normal blood pressure. “Currently, in Pakistan, approximately one third of patients on dialysis have kidney disease as a result of long standing uncontrolled high blood pressure. Patients who have diabetes, in addition to high blood pressure, have higher chances of developing diabetic kidney disease.” Dr Kashif suggested that the ideal blood pressure for people wishing to stay healthy should be less than 140/90, but in someone who has kidney disease or diabetes, the BP should be much lower. Also, lifestyle changes such as reducing weight, quitting smoking and maintaining a balanced, healthy, low salt diet, can benefit those with CDK.
Dr Raziuddin Biyabani, Consultant Urologist, AKUH, spoke about kidney stones. A peculiar problem in Pakistan is silent stones or neglected stones – those that do not cause any symptoms – but are found in patients with renal failure. Stones are more likely to form when people don’t drink enough water, particularly in hot climates like in Pakistan, eat a diet rich in protein and have a family history of kidney stones. Dr Biyabani pointed out that kidney stones are often only detected when a person has severe back pain, accompanied by fever, bloody urine, or even vomiting. Blood or imaging tests can then be used to determine the size, location and type of stone and the treatment options – currently, open surgery is rarely required to treat stones. A person with kidney stones has an up to 50 per cent chance of it recurring within 5 to 10 years, and a 75 per cent chance in 20 years. To reduce the possibility of stones recurring, Dr Biyabani suggested increasing fluids, changing diet – decreasing protein and salt intake – and in some cases, medication.
Information about kidney disease in children was shared by Dr Arshalooz Rahman, Consultant Paediatrician, AKUH. Dr Rahman pointed out that paediatric kidney diseases can usually be detected by routine tests and, if treated on time, promise a full recovery. However, to catch problems early on, community-based screening programmes that monitor high blood pressure, body mass by comparing weight and height, and urine should be made available to detect kidney disease in children, especially those that are overweight. Lifestyle changes at this stage can often lead to a full recovery.