Facts about kidney disease in South Africa

High blood pressure, along with uncontrolled diabetes, is one of biggest risk factors for kidney failure. (Photo: Sandy Maytham-Bailey)

High blood pressure, along with uncontrolled diabetes, is one of biggest risk factors for kidney failure. (Photo: Sandy Maytham-Bailey)

A diagnosis of kidney disease often comes as a surprise, because most of us know very little about our kidneys and what they do to keep us healthy. We also don’t know what conditions cause kidney problems. There may be very few symptoms, perhaps even none, until the damage caused to the kidneys is quite severe. This means kidney disease is often diagnosed late, when there is little we can do to reverse the damage. When our kidneys are severely damaged, the symptoms can be quite vague: feeling very tired, not being able to concentrate at work and swelling of the feet. So we may see a nurse or a doctor for help, but they may not think of the kidneys as a cause. We may also be given — or buy — medicines that can cause further damage to these vital organs.

How do our kidneys get damaged?

Briefly, there are two ways in which we can injure our kidneys. One is “short term” or “acute”, for example we have a bad car accident that results in damage to a kidney and the damaged kidney recovers. The second is when something causes kidney damage, but over a longer time period. A good example of this is when we have diabetes for many years, which ultimately scars the kidneys. We call this Chronic Kidney Disease (CKD).

There are different stages of CKD that range from mild to severe. It is good to know whether you have CKD or not, and if so, in what stage. This is because there is a lot that can be done in the early stages to prevent further damage. In its most severe form, CKD is called “end stage” and this is because without treatment, such as dialysis or a kidney transplant, we die.

Unfortunately, both of these treatments are very expensive and in many parts of the world, including South Africa, not all of us who need treatment will be able to receive it. This problem is made worse by the fact that CKD is becoming far more common in South Africa, as it is in the rest of the world.

What causes kidney damage in South Africans?

In South Africa today, the two most common conditions that cause kidney damage — by far — are high blood pressure and uncontrolled diabetes. Many of us are taught by our doctors and nurses that we may have a stroke if our blood pressure is high, but very few of us know that we can also damage our kidneys. Other causes are being overweight and some infections such as HIV, where starting antiretroviral treatment earlier rather than later can prevent kidney problems.

Drugs and toxins may also play a role, with the most common offender probably being the widely used “anti-inflammatory” that’s easily obtained from a clinic or a pharmacy. Most of us don’t know that some traditional medicines, Chinese herbs and illicit substances such as “tik” (crystal meth) can damage our kidneys. We may also inherit kidney diseases from our parents, and we may be born with defects of the kidney and bladder, or may only be born with one kidney, and this can result in damage later on. This is why it is important to know if your family has a history of kidney problems, and we need to ask our parents if we had any problems in childhood.

How do I know if I am at risk of CKD?

We don’t need to screen everyone for CKD, just those of us who are “at risk”. If you have any of the following conditions you may be at risk of CKD and should consider going for screening:

  • Diabetes (type 1 and type 2);
  • Cardiovascular disease: this includes high blood pressure (also known as hypertension) especially if you are young or your blood pressure is hard to control, other conditions of the heart such as a previous heart attack, and whether you have previously had a stroke;
  • Overweight/obese;
  • Infections: HIV positive (irrespective of whether you are on treatment or not); Hepatitis B/C;
  • A family history of kidney disease, such as polycystic kidney disease;
  • Any birth defects or problems in childhood with your kidneys or bladder;
  • Over 60 years of age (as we get older our kidneys don’t function as well);
  • Previous history of kidney failure — any previous illness or contact with a healthcare professional where you have been told that there was a problem with your kidneys (for example, this may happen with problems during pregnancy, or you develop a condition such as Lupus, or you are taking medicine for a condition that may damage your kidneys); and
  • Cancer — either of the kidneys, ureter, bladder, prostate and cervix.  Chemotherapy or radiotherapy may also damage your kidneys.

How do I get screened?

Fortunately, screening is simple and easy to do.  It does not require any painful or expensive medical procedures.  If we have features of kidney disease, we may be asked to go for further testing or we may be referred to a kidney specialist. Its best to be screened once a year, even if the test the year before showed that you did not have kidney disease.

What can I do if I have CKD?

If we have any conditions that place us at risk such as high blood pressure or diabetes, they must be controlled by treatment. Taking our medication regularly and going for regular follow-ups is essential.

You can also take the following steps: reduce salt intake for high blood pressure (this year the South African government has passed laws to reduce the amount of salt in our food); get active, as this reduces blood pressure and brings down glucose levels; lose weight, and stop smoking.

If your friends and family are at risk, get them to join you for screening.

Written by Dr June Fabian