QUOTATIONS

Brethren, let’s tee off with these germane quotable quotes:-

The death of every man diminishes me, for I’m involved in Mankind.

- John Dohne. My people perish for lack of knowledge.

- Hosea 46

Beloved, I pray that all may go well with you and that you may be in health; I know that it is well with your soul.

- 3 John 2.

Prevention of Chronic Kidney Diseases:

A Clarion Call For Sociocultural Changes In Nigeria.

By Dr J. K. L. Osinfade.B.Sc, M.B.Ch.B,MMCP,F.W.A.C.P.,PGD. Theo, MJF.

Consultant Special Grd 1/NephrologistHead of Clinical Services. F.M.C. Abeokuta.

Outline Introduction Classification Epidemiology Common causes of Chronic Kidney

Diseases Harmful socio- cultural practices Clinical Presentations Management Burden of CKD Prevention of Chronic Kidney Diseases Recommendations

Introduction

Chronic kidney disease is a progressive and irreversible loss of kidney function that has lasted more than 3 months.

It is also defined as evidence of kidney damage of greater than 3 months with or without decrease in GFR.

Evidence of kidney damage include: a. pathological abnormalties b.abnormalties in the composition of blood

or urine,or abnormalties in imaging tests.

Introduction[Cont’d] CKD can also be defined as GFR of <60mls/min/

1.73m2 of greater than 3 months. Some of the functions of the kidneys that are lost

include: a. regulation of salt and water b.electrolyte balance c. prostanglandin secretion d. erythropoietin production e. vitamin D metabolism f. blood pressure regulation

Classiffication

STAGE GFR DESCRIPTION 1 >90 Kidney damage with

normal GFR 2 60-89 Kidney damage with

mild decrease in GFR 3 30-59 moderate decrease in

GFR 4 15-29 Severe decrease in GFR 5 <15 Kidney failureNormal GRF (Glumerular Filtration Rate = Creatinine

Clearance) = 120 ml/min.

Epidemiology The burden of CKD is enormous and in fact the incidence

and prevalence of CKD worldwide is increasing at an alarming rate.

Country Incidence Prevalence U.S. 336 1,403 U.K. 101 626 Europe 135- 173 600- 800 Nigeria Unknown 2.5 N.B. Incidence and prevalence are expressed in per million

population 8per year.Endstage Renal Failure however 3 – 4 times more common in

blacks than in caucasians.It is estimated that by 2030 more than 2 million people in the

USA will need dialysis or transplantation for kidney failure.

Impact of CKD In Nigeria

Population figures not available but based on hospital figures

ESRF accounts for 1.6-8% of hospital admission rates.

Mortality is over 90% within 3 months[about 11.4% of all admissions in the medical wards of a tertiary health institution in Nigeria].

Less than 1% are able to afford renal transplant.

Common Causes of CKD- There are many aetiological factors that have been

identified as causes of CKD.- However the prevalence of these factors differ to varying

extents in different parts of the world.- Some of the causes include:- Chronic glomerulonephritis- Hypertension- Diabetes- Ingestion of herbal concoction.- Analgesic nephropathy- Exposure to heavy metals.- HIV –associated nephropathy.- Infections- Sickle cell nephropathy.

Harmful Socio cultural practices] Some sociocultural practices that can lead

directly or indirectly to CKD. Chronic ingestion of herbal concoctions Chronic analgesic abuse. Use of mercury containing soap- soap use

as bleaching agents. Exposure to heavy metals- lead found in

paints and mercury as above. Obesity – which is regarded as a sign of

good living in Africa, obesity associated glomerulonephropathy as now being described.

Harmful Sociocultural Practices[Cont’d]

High salt diet- adding salt to food after cooking.

High protein diet- bukateria people eating all kinds of meat –liver, and assorted meat all at once.Proliferation of fast food joints not helpful.

Scarification marks made with unsterile sharp instruments leading to transmission of hepatitis and HIV with ultimate effect on the kidneys.

Smoking – adolescents smoke cigarettes to feel belong.

Alcohol – Heavy alcohol consumption.

Clinical Presentations CKD is silent & asymptomatic in the early

stage.Most cases therefore present in the advanced stage.

Presentation in early stage:-Incidental finding of abnormalty in renal marker

during health screening exercises i preadmission/preemployment medical testsii during investigation for other disease conditions.- Pain in the loins/renal angles.- Passage of stones or ‘gravel’in urine.- Unexplained growth retardation in the young.- Haematuria.- Polyuria/Nocturia/Enuresis in children.

Clinical Presentations[Cont’d] Presentations in advanced stage Clinical: GIT- Nausea, vomiting,hiccups. CNS-Twitching, flapping tremor,

drowsiness,convulsions,coma. CVS- Severely elevated BP,cardiac damage e.g. LVF, CCF. Laboratory: Deranged E/U/Cr such as excessively high urea & creatinine Hypocalcaemia Hyperphosphataemia Anaemia Abnormal urinalysis

Management

Conservative Control of risk factor- Modifiable- Non- modifiable. .Renal Replacement Therapy.- Haemodialysis- Peritonial dialysis- Transplant.

Burden of CKD

Chronic kidney disease is now a worldwide public health concern.

There is evidence of an increasing incidence and prevalence of kidney failure,with both high costs and poor outcomes of treatment.

It should be noted that CKD is grossly underdiagnosed both in our environment and even in the developed world.

This is due, to a large extent, to its silent and asymptomatic nature in the early stages, as a result of which most patients only present in the advanced stages of disease.

Burden of CKD[Cont’d]

The cost of treatment of ESRD is enormous and cannot be easily accommodated within the government health budgetary allocations in developing countries.

It should be noted that renal diseases is not accommodated in NHIS.

Hence emphasis should be laid on prevention of CKD rather than treatment which is not only expensive but also has poor outcome.

Prevention of CKD

‘Prevention, they say is better than cure’ this is very relevant in the case of CKD.

Successful prevention depends on the knowledge of causation, dynamic of transmission and identified risk factors.

There are 4 levels of prevention viz: Primordial Primary Secondary Tertiary

Primary Prevention

This aim at preventing kidney disease from occuring at all and calls for knowledge of:

- risk factors predisposing to renal disease

- risk factors that initiate renal damage

- modification,removal or avoidance of risk factors.

- Development of a positive health seeking attitude & behaviour.

Secondary Prevention This aim at identifying factors that aid or hasten

progression of kidney disease and/or accelerate loss of kidney function and preventing or removing such factors.

While a few of those factors are not modifiable,majority of them could be modified,controlled or completely avoided.

Some of the factors include:- Increasing proteinuria- Elevated or uncontrolled blood pressure- Poor glycaemic control in diabetics- Smoking- NSAID’S- Herbal preparations- Dehydration- Infections

Tertiary Prevention

A.This aim at preventing the development of complications of CKD such as:

- Cardiovascular events- CCF, MI.- Dyslipidaemia.- Metabolic bone disease.- Anaemia.- Neuropathies.B.Adaptation to incurable diseases.C.Prosthesis provisionD.Rehabilitation.

Recommendations

Targeted screening of at risk population. At risk population are people with one or

more risk factors. Lifestyle modification/ behavioural

changes. Avoidance of physical inactivity-

discourage excessive use of remote control, lift .

Avoidance of stress- economic, financial ,emotional and executive.

Dietary pattern.

Recommendations[Cont’d]

Avoidance of infections- STI[viral],HBV, and UTI.

Non- communicable disease tend to have multifactorial causation usually classified as:

- Modifiable- factors that we have control over e.g. hypertension, diabetes, smoking, alcohol, obesity.

- Non- modifiable- factors that we have no control over e.g. age, gender, family history.

- Need to cultivate positive attitude to routine check up.

Teasers

One million naira question is .How healthy are your kidneys?

Wishing you all Amazing Kidneys for the rest of your life.

Stay healthy and blessed.

THANKS AND GOD BLESS.