How to prevent kidney failure

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KIDNEY failure grabs the headlines mainly for two reasons: when it afflicts the famous or a public figure and when it afflicts the poor who launch appeals for help on mass media, especially the television. Yet, in spite of the suffering and economic ruin it brings on many, it is an eminently preventable disease. Indeed, in many instances, the kidneys only happen to suffer collateral damage from other illnesses. In this article, I describe briefly the main causes and, more importantly, how to prevent the eventual fatality of kidney failure.


Most people are born with two kidneys and they are well protected deep inside the abdomen. They are bean-shaped, and receive a chunk of blood supply because they filter waste products from the body which come out as urine. This function is important for our well-being, for when the kidneys fail, the wastes accumulate as toxins, and the body is unable to get rid of excess fluid.   These two problems are responsible for the body swelling and sense of ill-health. The kidney performs an additional function of helping to manufacture blood, and this is why also, kidney disease sufferers lack blood and become weak.
In children, the commonest cause of kidney disease and failure is infection which leads to inflammation within the kidney, whereas in adults who survive this infection, or in whom the inflammation is controlled, the commonest causes are hypertension and diabetes. (Of course, the smoldering inflammation that started in childhood may become manifest in early adulthood or later.) Hypertension is not called a silent killer for nothing. It has no symptoms of its own but it is capable of destroying key organs such as the kidneys, the brain, the heart and the eyes silently over a considerable period of time. The symptoms of hypertension then are symptoms of other organs it has ruined.
One common cause of kidney disease and failure is the indiscriminate use of herbs, drugs, and certain creams. Certain individuals, at the slightest bodily discomfort will take pain killers. A visit to site projects, mechanic workshops and other places of labour will often reveal how men do abuse drugs.  In these palaces we find hawkers of cocktail of gin mixed with ‘buta’ and other assorted pain killers. These drugs do burden the kidneys cumulatively. So, sometimes, we encounter patients whose kidney failure we can’t explain (until we ask about what drugs they have consumed over a long period) because they are neither hypertensive nor diabetic and we can’t easily find obvious causes of their illness. Indeed, they can’t remember having suffered from any kidney disease in the past.
On the other hand, use of certain medicines or herbs can result in a blitzkrieg, a “lightning war”, on the kidneys. This is what we call acute kidney injury. Once in a while, we read of children who die in scores from using Mypikin, or adults who perish with their families after drinking certain materials. Some years ago, a group of religious worshippers were admitted for kidney failure after using ‘Holy Water’, which was made from substances that included cupper sulphate to give it the attractive blue colour.
Therefore, kidneys can fail slowly or suddenly (acutely). But we can prevent the two modes of failure. The theme of this year’s World Kidney Day (WKD) is Stop Acute Kidney Injury or Attack. WKD is organized by a consortium of associations interested in raising public awareness about the epidemic of kidney diseases. They include International Society of Nephrology and International Federation of Kidney Foundations, and it is endorsed by WHO. It is an annual even in which kidney specialists in Nigeria under the umbrella of Nigeria Association of Nephrology participate by carrying out several awareness programmes including screening for kidney diseases. They did this recently in February this year in Abuja, and are planning to do so again on 14th of March which is the World Kidney Day. This arises from firm evidence that kidney failure is eminently preventable by simple measures. Kidney specialists are more interested in prevention than the use of dialysis or even transplantation, which only a few people can afford.
The cost of two weeks on dialysis machines is more than sufficient to buy drugs to treat hypertension for a year in most people. Kidney transplantation costs millions of Naira.
Blood pressure measurement:
The following simple tests will help in taking measures to prevent the catastrophe of kidney failure in most people: regular blood pressure checks, urine tests, blood sugar tests, and a certain test of kidney function. These tests can be done in any clinic in Nigeria. Diseases that lead to kidney failure can be detected and tackled by doing these tests; and most people can afford them annually. Whenever there is a disease within the kidneys, they begin to leak certain proteins or blood in minute amounts invisible to naked eyes, and this is easily detected. For most people, urine test is the most important test of kidney disease. Therefore, if people would make time (everyone is busy now!) to visit a hospital and do a medical checkup which include these tests, kidney failure can be prevented. One expensive test that most people like to do is ultrasound. But ultrasound ought to be recommended after these have been done even though many people come to the hospital with ultrasound reports on the kidney and we have to start from the basics.  In addition, if people would heed NAFDAC’s advice to desist from taking non-recommended drugs and be careful with the use of herbs, our kidneys would live long.
Urine in test tubes:
The government can, through its policy, promote healthy lifestyle, accessible and affordable health care. The National Health Policy could be a framework to do this and it is heartwarming that the National Assembly is working on this. The celebrated and most trusted UK establishment, the NHS, was established by an Act of Parliament with specific functions at every level of care, and it is a recommended reading for our policy makers. It one of the ways that the government has ensured an equitable distribution of resources, because health is wealth; and a few health policies have been implemented through it.
Dr Ajayi is a consultant physician with the University College Hospital (UCH), Ibadan.