#HEALTHTALK 17: Kidney diseases: Types, Testing and Treatment

From earlier study, we talked about the kidney function test as the best way  to ascertain the health of one's kidney. It consists of different tests done on both urine samples and blood samples of a person. Today, we will discuss some of them, as well as the four main kidney diseases, among other things. 

The four main kidney diseases

The four major diseases of the kidney  include glomerulonephritis, nephrotic syndrome, kidney stones and renal failure. 

Renal failure

Renal failure occurs when the kidneys cannot carryout their functions properly. This leads to poor excretion of waste products. So, they  accumulate in the blood and tissues. 

There are two major types of renal failure, namely: chronic and acute renal failures. Chronic renal failure occurs when other kidney diseases are not well managed. On the other hand, acute renal failure comes up in persons having healthy kidneys as a result of trauma and infections.

The Nigerian Association of Nephrology estimates that about 25 million Nigerians suffer from kidney failure, and are in need of dialysis. 

Treatment

The first treatment is dialysis which makes renal failure less life threatening, and it is repeated at least 2-3times weekly. Dialysis is of two types:

1. Peritoneal dialysis: Here, the sterile dialysing fluid is passed in the peritoneal cavity by means of inserted tube. 

2. Haemodialysis: In haemodialysis, the patient's blood is made to circulate outside the body through coils of semi permeable synthetic membrane.

Dietary treatment 

The dietary approach compliments dialysis. It involves taking low protein, low fluid, low sodium and phosphates, etc. Please speak with your doctor and nutritionist/dietitician for appropriate guidance. 

Kidney stones

Renal or urinary calculi (kidney stone) refer to the presence of salt crystals in a person's urine. It can also consist of uric acid crystals, calcium carbonate, calcium phosphate, or calcium oxalates. 

Dietary treatment

• Increase fluid intake. 
• If the stone is made up of calcium salts, calcium-rich foods should be restricted. 
• If the stone is made up of oxalate salts, fresh vegetables should be restricted. 
• If the stone is made up of uric acid, foods rich in ribonuclei acids should be restricted. 

Glomerulornephritis 

This means the inflammation of the glomerulus. Acute glomerulonephritis is caused by infection and happens more in children than adults.

Chronic glomerulonephritis has no clear cause 

Dietary treatment 

• If protein will be given, it should be protein of high biological value. 
• Mildly restrict protein, especially when there is oedema. 
• Adequate energy from protein and fats where protein is restricted. 
• Restrict fluid intake because of much urine output. 

Nephrotic syndrome

This is another disease common in children. In this type of kidney disease, the capillary basement of the glomerulus is affected. 

Depletion in body tissues protein causes malnutrition to the patient. The malnutrition manifests like fatty liver and oedema. 

Your kidney diserves the best treatment. Did you know that it is better to prevent a harm than to manage it? 

Types of kidney function tests

To test your kidney function, doctors will order a set of tests that can estimate your glomerular filtration rate (GFR). 

Glomerular filtration rate (GFR) helps the doctor to know how quickly your kidneys are clearing waste from your body.

The following tests are done: 

Serum creatinine test

Creatinine is a breakdown product of muscle tissue, and the kidney is responsible to remove it from the blood. 

The creatinine blood test examines the creatinine build up in your blood, because a high creatinine level indicates kidney problem since the kidneys usually completely filter creatinine from the blood. 

This test can also be done using a 24hours urine collection sample to know how fast creatinine is filtered from the blood. 

Urinalysis

Urinalysis refers to tests done on urine samples. The test is best done within a space of few weeks after the first test, to give accurate results. It is also done to assess the presence of protein and blood in the urine. 

Notwithstanding, there are many possible reasons for protein in the urine, not all of which are related to kidney disease. 

Estimated Glomerular Filteration Rate (eGFR)

The test determines the rate by looking at factors such as test results, age of the patient, gender, race, creatinine levels, height and weight.

When any result is lower than 60 milliliters/minutes/1.73m2, it is  a warning-sign of kidney disease.

Blood urea nitrogen (BUN)

Blood urea nitrogen (BUN) test measures the amount of nitrogen in the blood. BUN test is done to check for waste products in your blood. Urea nitrogen is a breakdown product of protein.

Also, take note that common medications, such as some antibiotics, aspirin, and other related drugs can increase blood urea nitrogen. So, it is necessary you tell your doctor about the drugs before taking the test, so he/she can determine the best time for you to take it. 

Results of the blood urea nitrogen test are measured in milligrams per deciliter (mg/dL) in the United States and in millimoles per liter (mmol/L) internationally. Generally , around 7 to 20 mg/dL (2.5 to 7.1 mmol/L) is considered normal.

Treatment and transplant costs

According to a publication in the Nigerian Journal of Health Science, kidney transplantation is the best form of treatment for end-stage renal disease (ESRD). 

It concluded that the greatest challenge to kidney transplantation in Nigeria are the lack of donors and funds, and recommended that both goverement and health insurance practitioners incorporate renal treatment into their policies. 

It recommended the establishment of deceased-donor transplant programme in Nigeria to help facilitate the availability of kidneys for transplantation. However, according to the Chief Medical Director of Lagos University Teaching Hospital, LASUTH, getting a donor from within one's family makes the outcome of the transplant better. 

The second ever kidney transplant done at LASUTH in 2016 cost N4.5million, which is said to be the cheapest in the world. Today, so many health facilities in Nigeria carry out the procedure successfully. 

However, according to a research published by BMC Nephrology, the approximate cost of kidney transplant was 18,000 dollars in India, 32,000 dollars in Nigeria (most active centre), 78,000 dollars in UK and 117,000 dollars in USA.

Lilian Eze is a Nutritionist-Dietitian and teacher in Lagos, Nigeria. She is also a Lead Content Creator at The Paul Anunaso Blog, and can be reached at lilian.thepaulanunasoblog@gmail.com