Any condition or disease that damages blood vessels or other structures in the kidneys can lead to kidney disease. The most common cause of chronic kidney disease is diabetes. High blood sugar levels caused by diabetes damage blood vessels in the kidneys
The two leading causes of kidney failure, also called end stage kidney disease or ESRD, are diabetes ( Type 2 or adult onset diabetes) and high blood pressure. When these two diseases are controlled by treatment, the associated kidney disease can often be prevented or slowed down. Chronic kidney disease(CKD), also called chronic kidney failure, describes the gradual loss of kidney function. Kidney failure is the last (most severe) stage of chronic kidney disease. This is why kidney failure is also called end-stage renal disease (ESRD) . Diabetes is the most common cause of ESRD. High blood pressure is the second most common cause of ESRD. The function and purpose of the kidneys are to remove excess fluid and waste products from the body. Someone’s kidneys filter wastes and excess fluids from the blood, which are then excreted in the urine. The kidneys are organs that are located in the upper abdominal area against the back muscles on both the left and right side of the body. Causes of kidney pain are mainly urinary tract infections and kidney stones. On the prevalence of kidney disease in Nigeria, Consultant Physician and Nephrologist, Obafemi Awolowo University Teaching Hospital(OAUTH), IIe-Ife, Prof. Fatiu Arogundade, said more patients now present with kidney diseases in the hospitals.” The figures we have show that many more patients now present to the hospitals. It may mean kidney disease is increasing, it may also mean increased awareness of kidney diseases. “In total, when we talk about percentage over the years, it is still the same range of about 8% that we talk about globally in terms of those that present themselves to the hospitals, however, in community studies, we are now seeing figures of 18 per cent of the population, 20 per cent, 26 per cent, so we can say that we have indications that show that kidney disease maybe increasing in prevalence in our communities. “It is assumed that about 0.1 per cent of the population in Nigeria have kidney diseases which is about 90, 000, and less than 5,000 on dialysis, it then means that majority of Nigerians that have renal diseases are dying and we must be able to put a stop to this and we believe that what we can work on its prevention, prevent kidney disease and Nigerians won’t be dying. “Kidney diseases are very common and most causes are hypertension, inflammation of the kidneys. In recent times, we have see many more diabetics come down with kidney diseases and we have seen patients of obstructive urine.” Need for good care Prof Arogundade who spoke at a forum organised by Cedar Group Hospital, Festac Town, in collaboration with Association of General Private Medical Practioners of Nigeria(AGPMPN), to Commenmorate 2017 World Kidney Day, said with good care, 80 to 90 per cent of those with chronic kidney disease should survive , “the problem we have is that chronic is far more common, it is a community thing. With studies done all over the world, about 10 to 15 per cent of the entire world adult population are affected by kidney diseases. So each time we refer to kidney disease, we are talking of chronic. If we want to refer to strictly acute, we will add a prefix to it and say it is acute kidney injury. “CKD is described as a kidney damage persisting for 3 months or longer and manifesting with pathologic abnormalities or markers of kidney damage. The markers of kidney damage are leakage of protein in the proteneria, sometimes, passage of blood in the urine that may not be seen with the naked eyes. Sometimes, the urine might be normal but when you do imaging test, you may find out that that kidney is diseased even though it is presenting as normal.” Kidney disease and obesity Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health. “Generally, we define obesity as body mass index (BMI) of higher than 30kg per meter square. BMI is an index that is used to access whether somebody’s weight is too much or not and it is defined as the weight of that person in kilogram divided by the height square. If a person gets a value that is less than 18.5, then we say that person is underweight, if the value is between 18.5 and 25, we say the person has optimal weight, if the value is between 25 and 29.9, we say the person is overweight but once it is above 30, we say the person is obese.” However, taking a look at geographical zones, for example, the Chinese, because of their size, they have redefined what is obesity, they cut off 4 points for obesity, so, instead of using the 30kg every other people use, they use 27, 27.8 or 28kg and same thing apply in most Asian countries. The prevalence of obesity in Nigeria falls within less than 4 per cent of the population compared to some communities where it is about 30 per cent of the population like in America, Canada, some part of North Africa and some part of South Africa. He said, “In a multicentre study, some young Nigerians came up together and looked at obesity in their environment. Basically, when we talk of studies in Nigeria, we are fond of restricting ourselves to our base but these younger guys –C I Okafor in Enugu, I D Gezawa in Kano, Raheem in Shagamu collaborated, they looked at over 5, 000 Nigerians. They found that 47 per cent had optimal weight, 31 per cent were overweight and 17 per cent were obese, only 5 per cent were underweight. More importantly, as we grow older, we tend to be more obese, the peak of obesity in the study was between the 4th and 6th stages. “Even obesity can be graded. We have classes 1,2 and 3 obesity. Class 1 obesity is when the BMI fall between 30-35 kg/m square. Class 2 is between 35 and 40 and once it is above 40kg/m square, it is class 3 obesity. “Another very high power study, abroad, looked at over 100, 000 patients and they looked at the relationship between BMI and the risk of developing end stage renal disease and they found out that it increases as the BMI increases. So as the BMI increases, the relative risk of developing End Stage Renal Disease increases and it is highest in those above 26.5 kg/m square.” Metabolic syndrome Some people did a mega analysis of studies that looked at the relationship between kidney disease, metabolic syndrome and obesity and they looked at 257 studies and they found 47 useful for the study. The conclusion was that compared with normal weight individuals, overweight individuals, that is those with BMI of above 25, have elevated risk of kidney disease with a relative risk of 1.4. Obese individuals were at much higher risk with relative risk of 1.8. Obesity in women was associated with higher risk than in men 1.92 in women compared with 1.49 in men. While from the same analysis, result from 4 studies retain that 24.2 per cent and 33.9 per cent of kidney disease cases among United States(US) men and women and 13.9 and 28.9 in other industrialised countries are related to overweight and obesity, meaning 24.2 per cent of kidney disease cases among US men are related to overweight. 33.9 per cent of kidney disease cases among US men are related to obesity. Obesity increases the risk for kidney disease in general population and it is stronger in women than men. Obesity adversely affects the progress of kidney diseases among patients. So, even those with kidney diseases, it affect the progression of the disease, meaning, if a person is obese, his progression is far much more backward. A competitor If BMI is between 25 and 29.9, we define the patient as overweight. What we have seen is that those people that are overweight are also exposed to the risk of obesity. Though, we define those with BMI of above 30 as obese, those that are overweight also have the tendency of developing complications that obese individuals would develop. And in terms of renal disease, many of the people that are overweight have what we call Metabolic Syndrome, in other words, they have what we call abdominal obesity, impaired glucose tolerance or diabetes, hyper-lipedemia, and they may have hypertension with these. So, once they have a combination of all these, at least, three out of these, then they are described as having Metabolic Syndrome. The tendency to develop kidney disease in them is higher than the normal individuals. So, people that are overweight, not even described as obese should watch it and make sure they bring their weight down to the optimal weight by achieving a weight that is less than 25kg/m square. Causes of obesity Excessive food intake; lack of physical activities; genetic susceptibility; endocrine disorder; drugs and medication and mental illness. How to prevent CKD There are non-modifiable risk factors, there is nothing anybody can do about them; as you grow older, the kidney function deteriorates, particularly among men who generally have a higher predisposition to it compared to women. Race – blacks are more prone to this diseases; genetic predisposition, what people inherited from their parents stays, there is nothing anybody can do about it, like those that were born with reduction in their nephrone complement, reduced nephrone number; and those that were born premature. However, there are those that you can modify, like those that are hypertensive, those that have protenorial, those that take a lot of salt, those that are diabetic, more importantly, those that are obese should control weight. How to control weight Through food and exercise . The common and strongest method we should use is that energy intake should be equal to energy expenditure, if a person do not want to gain weight. So, people should be conscious of intake calories, when they eat, particularly in the evening before going to bed to sleep. If you tell majority of obese people that they have to reduce their diet, they tell you they don’t eat, but that is not true, their energy expenditure is actually higher than those are not obese and that is from their intake. In spite of that, they still have some reservoir to store, meaning their intake far exceed their energy expenditure. The more intense and prolonged the exercise you take, the more calories are burnt. For example, energy expenditure when you carry out exercise in 15 minutes is lower than expenditure when you carry it out in 30 or 60 minutes. If someone carry load upstairs, he expends some energy but when he does it for one hour, he expends far more energy. Prof Arogundade said, “What happens to many of us is that we say but I do a lot of things in the house, particularly our women. When you do that type of work, walking less than 20m/hour on level ground, srolling very slowly which is what we do at home, the energy expenditure is very low and cannot take care of the height of expenditure needed. So when you say I do a lot of household chores, I go to the kitchen, I serve my husband, take care of my children and even check them when they are asleep, it is not enough. You need to do more regular planned exercise for periods ranging between 30minutes to 1 hour depending on your tolerability, because we may not all be able to sustain exercise for one hour. However, when we start, we may be able to sustain it after some time. You can walk, run, lift things, swim; they are all part of the exercises. So we need to move for the kidneys, so that our weights can come down. Drug “You can also control weight using drug, I wouldn’t want us to introduce using drug because what it means is that you have to use the drug perpetually and you expose the patient to complications of using drug. Surgery You can also do surgery, but of course, we have heard about the complications of surgery. Cost of drugs He said, “We have been working on bringing down the cost of post transplant immune-suppressive drugs. Very recently, we had a conference at Obafemi Awolowo University, Ile-Ife, the minister of health chaired the session and he re-echoed the government’s feeling, that the government is concerned that Nigerians are dying of kidney disease and come next year, post transplant immune suppression for patients that transplanted in Nigeria will be free and we are believing that that will come to be. If it is made free, for these patients, then it will significantly reduce the number of patients that succumb to early death due to unaffordability of these drugs. In actual fact, in countries that are not as rich as Nigeria – Sudan, Egypt, post transplant immune suppression is totally free for their patients. So, we see this as a welcome development that government is trying to provide same thing for Nigerians and we believe it will be possible probably next year. “I will say, St. Nicholas Hospital, Lagos, has done about 70 per cent of the transplants in Nigeria. Zenith Hospital, Abuja, is also doing very well. I will say that government hospitals are not doing as well because of the affordability of the treatment by patients. Most of the times, the patients are unable to sustain the treatments and those you find that go to these private hospitals are the affluent Nigerians and then some of them are supported by NHIS. For government hospitals, for example, I know that Aminu Kano Hospital still transplant fairly regularly, it is not like they do not transplant. In UCH, they did a transplant less than 6 months ago, in Obafemi Awolowo UniversityTeaching Hospital, Ile Ife, they did a transplant less than a year ago. So, the government hospitals are also doing it but the frequency is a little lower and it may improve if there is government support for it.” Sex and burning calories “Frankly speaking, sex is also an exercise and during sex, you burn some energy and calories, but the intensity and duration of the exercise matters. Maybe, most people, by the time they undertake the exercise they engage in during sex, maximum maybe 20 to 30 minutes, a little less or a little more, but we are talking about exercise that one can do maybe one hour and is able to sustain on a regular basis. Someone cannot be having sex on a daily basis, but the other exercises one can engage in them and do them daily or three or four times a week. I’m not sure it is possible to have sex three or four times a week that same way. So, while sex is a form of exercise, it is not an exercise that could be regular enough to burn up all the calories we are talking about. We encourage swimming, running, jogging, brisk walking and others.” Message to Nigerians “The message to Nigerians on the occasion of this year’s World Kidney Day is that we should walk in a bid to reduce our weight, to bring it down to BMI to the optimal level of less than 25kg/m square in a bid to maintain a healthy life. Healthy kidneys, healthy heart, healthy joint, health in all its ramifications, so we need to reduce our weight, we should do this by walking, jogging, swimming, and running.” Contributing, Elizabeth Adanma Akpabio, a Director at Cedar Group Hospitals, Lagos, said,a lot of people have kidney disease without knowing but if you have information, you are better equipped. Many Nigerians go out of the country to treat this kind of thing –India, Dubai. We are letting our people know that that kind of care could be gotten here in the country even at a cheaper rate. Dr. Ogunbor Chukwuma, Consultant Family Physician and Chief Operating Officer of Cedar Group Hospital, Lagos, said, the Cedar Group Hospital was established in 2001 and in 2011, established a dialysis centre. “Kidney disease is a very chronic disease, the person has to be on regular dialysis or may need to go for transplant.” TIPS ON HEALTHY LIVING : Easy snoring remedies (2) By Patience Boulor You may be among the 45 per cent of normal adults who snore at least occasionally or you likely know someone who does. He (or she) may be the brunt of jokes at family gatherings (“Uncle Joe snores so loudly he rattles the windows!”), but snoring is serious business. For one, a snoring spouse often keeps the other person from a good night’s sleep, which can eventually lead to separate bedrooms. “Snoring can create real problems in a marriage,” says expert. Not only is snoring a nuisance, but 75 per cent of people who snore have obstructive sleep apnea (when breathing is disrupted during sleep for short periods), which increases the risk of developing heart disease Use caution before you self-treat with over-the-counter sprays and pills until you’ve checked with your doctor.”Many stop-snoring aids are marketed without scientific studies to support their claims,” Instead, try these natural solutions and lifestyle changes, which may help someone stop snoring. Practice good sleep hygiene Poor sleep habits (also known as poor sleep “hygiene”) can have an effect similar to that of drinking alcohol. Working long hours without enough sleep, for example, means when you finally hit the sack you’re overtired. You sleep hard and deep, and the muscles become floppier, which creates snoring. Open nasal passages If snoring starts in your nose, keeping nasal passages open may help. It allows air to move through slower.Imagine a narrow garden hose with water running through. The narrower the hose, the faster the water rushes through. Your nasal passages work similarly. If your nose is clogged or narrowed due to a cold or other blockage, the fast-moving air is more likely to produce snoring. A hot shower before you go to bed can help open nasal passages. Also, keep a bottle of saltwater rinse in the shower. “Rinse your nose out with it while you’re showering to help open up passages. A neti pot could also be used to rinse out the nasal passages with a salt-water solution. Nasal strips may also work to lift nasal passages and open them up – if the problem exists in your nose and not within the soft palate. Change your pillows Allergens in your bedroom and in your pillow may contribute to snoring. When did you last dust the overhead ceiling fan? Replace your pillows? Dust mites accumulate in pillows and can cause allergic reactions that can lead to snoring. Allowing pets to sleep on the bed causes you to breathe in animal dander, another common irritant. If you feel fine during the day but obstructed at night, these things may be contributing to your snoring.
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