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A patient receives treatment on a dialysis machine.
THE KINGSTON Public Hospital is rated as one of the Caribbean's best hospitals. We visited recently to speak with Nephrologist Dr. Charmaine Watson-Brown about kidney disease.
In the hospital, the renal unit is small, clean, air-conditioned and quiet. Later, the sound of helpless crying would shatter the silence, as a woman wept when her son who had chronic kidney disease, stopped breathing while undergoing treatment.
Every doctor in the unit, including Dr Watson-Brown and several senior nurses immediately moved to help. However, he died.
CHRONIC KIDNEY DISEASE
What is chronic kidney disease and why is it so serious (more serious, we would say, than hypertension)?
Chronic kidney disease or CKD, is s a clinico-pathological condition related to the loss of nephrons in number and function. The nephron is the smallest functioning entity in the kidney. When there is a loss of nephrons in number and function, the result is a malfunctioning kidney.
Chronic kidney disease which has five stages, the end result of which is end-stage renal disease. End-stage renal disease refers to that state in which the patient requires renal replacement therapy (RRT)for survival. RRT may take the form of dialysis or transplantation.
There are two types of dialysis: Heamodialysis and Peritoneal dialysis. The aim of medical management is to prevent the patient from reaching end-stage kidney disease where RRT is required.
Unfortunately, Dr. Watson-Brown told Outlook, chronic kidney disease has no symptoms, although the causes are well known.
The commonest causes here in Jamaica are hypertension, diabetes mellitus (both type 1 and type two) and glomerulonephritis which refers to an inflammation of the kidney. Hypertension is responsible for 60 per cent of all cases, while diabetes accounts for 30 per cent. Glomerulonephritis is the third major cause, but is responsible for less than 10 per cent.
CYSTIC DISEASE
Other causes of chronic kidney disease include cystic disease of the kidney and other hereditary disorders.
The fact that the disease exists with no symptoms makes it important for frequent assessments of patients with high risk, including those with hypertension, diabetes and a family history of kidney disease, to be done. Even normal patients should be screened by their physicians on an annual basis. Some of the indicators of kidney disease include protein and or red blood cells in the urine.
In order to retard the progress of the disease, doctors will seek to control hypertension, blood sugar (glycemic index) in diabetic patients and managing protein in the urine of diabetic patients.
Patients with kidney disease will be advised to stop smoking. Doctors will also assist in controlling lipid status (including cholesterol levels ) and obesity management.
The function of the kidney is assessed by the glomerulus's filtration rate. This refers to the rate at which the ghlomerula of the kidney filters the blood to produce urine. This is difficult to measure clinically so doctors therefore measure creatinine clearance instead. Creatinine is a protein produced by the muscles.
The rate at which the blood is cleared of creatinine reflects the effectiveness of glomerula filtration.
Next week: Treating kidney disease.
