By Gabriel Olawale
A new baby is a joy for any family, but experts have raised alarm over the growing incidence of kidney disease among Nigerians, particularly in pregnant women.
The experts who say they are seeing more cases of kidney disease in pregnant women, have urged women seeking to get pregnant to know their medical history and recognise specific medical indicators that can lead to malfunctioning or total breakdown of their kidneys.
Speaking on this year’s World Kidney Day, themed: “Kidney and Women’s Health” they narrated how pregnancy puts women in situations that impinge negatively on their health, noting that kidney disease is one of such disorders.
Even the Nigeria Association of Nephrology warns of a looming epidemic of kidney diseases in the country, and has urged the Federal Government to prioritise treatment of kidney disorders.
The kidneys excrete water and other waste products from the body; regulate the internal environment but once they start failing to carry out these functions, symptoms of ailments appear.
A damaged kidney can cause wastes to build up in the body and blood and urine tests are the only way to know confirm kidney disease.
Statistics from the World Health Organisation, WHO, show that kidney disease in medical circles means that the kidneys are damaged and cannot filter blood normally.
In Nigeria alone, nephrologists say each year, 17,000 new cases of kidney failures are diagnosed even as around 38 million persons are suffering from various degrees of kidney disease.
Findings by Good Health Weekly show that although kidney disease is preventable and treatable, it is one of the most expensive disorders to treat and manage.
Worse still, with N18,000 as minimum wage, the total lifetime cost of handling kidney disease in Nigeria is huge. For instance, a kidney transplant goes for about N10 million. Unfortunately, not many patients can afford it. Dialysis costs between N30,000 – N40,000 per session, while most patients spend N90,000 – N150,000 a week.
According to Consultant Nephrologist and Head of Clinical Services, Healing Stripes Hospital, Lagos, Dr. Adedamola Akinsiku, hypertension and diabetes either before or during pregnancy can lead to kidney disease if the conditions are not properly managed.
Akinsiku explained that some women are genetically hypertensive while others become hypertensive as a result of their lifestyle, “but when they get pregnant which is additional load on the kidneys, can result in kidney diseases if not properly managed.
“During pregnancy some women, due to pressure and stress, develop gestational hypertension. The good thing about this is that after the baby is born, the blood pressure returns to normal.”
He, however, noted that there are percentages of women who develop hypertension during pregnancy and after delivery continue to be hypertensive.
In his view, Akinsiku said sometimes when a woman has an abortion, or loses a pregnancy, if not properly cared for, could develop acute kidney disease.
“Women can bleed because of placenta problem, it is not the fault of the women, the placenta chooses where it wishes to stay.
“But with qualified personnel, some women take about three to four pints of blood before the placenta is separated.
Imagine a situation where pregnant women consult Traditional Birth Attendants, TBAs who do not understand why the placenta should be separated before the baby comes out, it may result in massive blood loss because TBAs cannot carry out blood transfusion which is one of the reasons for high infant mortality.
“If such women are not properly transfused in a standard hospital where blood transfusion can be done, this can cause the kidneys to shut down. If not properly managed, the affected women could end up with chronic kidney disease, requiring dialysis or transplant.”
Akinsiku also explained that besides pregnancy, other diseases predominant in women could predispose them to kidney diseases.
“For example, lupus occurs about 10 times more in women than in men and it is one of the diseases that can predispose to kidney disease.
“Eclampsia, and pre-eclampsia are major causes of premature death linked to kidney disease in pregnant women.”
Good Health Weekly gathered that in Eclampsia, one or more convulsions occur in a pregnant woman suffering from high blood pressure, often followed by coma and posing a threat to the health of mother and baby.
Preeclampsia is a condition that occurs only during pregnancy and some symptoms may include high blood pressure and protein in the urine, occurring after week 20 of pregnancy.
A Consultant Paediatric Nephrologist, and Vice President, Nigerian Association of Nephrologists, Dr Adaeze Asinobi, said increasing cases of kidney disease in Nigeria had reached epidemic level.
Speaking during a function in Ibadan, Asinobi who stated that about 15 per cent of Nigerians have some form of kidney disease, lamented that many cases are due to undiagnosed and untreated cases of hypertension and diabetes.
“Chronic kidney disease is a major burden and people need to recognise it as a major problem and do everything to prevent it.”
She warns that pregnancy can put a lot of stress on a woman’s body, hence women are more likely to develop kidney disease than men due to factors such as pregnancy-induced hypertension, unwanted pregnancies resulting to abortion, and auto-immune diseases.
Worse still, pregnant women with chronic renal disease adapt poorly to a gestational increase in renal blood flow. This may accelerate their decline in renal function and lead to a poor pregnancy outcome.
Also speaking, a Consultant Nephrologist, Dr. Adewunmi Adebowale, urged women to know their medical history before they get pregnant.
“If you are going into pregnancy and you already know that you are hypertensive the doctor will know what to do so that your kidney can be safe.
“Check your blood sugar level, diabetic is not a reason not to get pregnant it is just that you need to have knowledge of your status so that you can be properly managed.
He however recommends a healthy lifestyle and regular medical check up, “give your kidney enough water to function, avoid self medication such as combination of pain killer drugs which can damage the kidney, exercise and be active, avoid smoking, avoid alcohol, reduce excess salt, manage your weight, have enough rest.
Doctor-in-Charge, Healing Stripe Hospital, Dr. Ezinne Onyemere who also spoke during a free screening, dialysis and health awareness talk organised by the hospital, called for early detection when symptoms have not started manifesting such as uncontrolled blood pressure, leg swelling, facial swelling, forming urine, blood in urine, among others.
“When people present late, all we can offer is renal replacement therapy which encompass dialysis or transplantation.
“But with early presentation we can halt the rate of progression, or reverse them to early stage. Prevention is better than cure, it is important you screen yourself regularly.”
Onyemere however called for government intervention noting that out-of-pocket payment can not address the challenges.
“Managing chronic kidney disease is huge and not many people can afford it. For example, one session of dialysis costs over N30,000 and for the person to function properly, may require dialysis about three times in a week. How many people can afford that?
“Kidney transplant is in the region of N10 million, how many people have such amount in their accounts? How about the drugs to support the care? This is time to urge government to do something about kidney disease, by supporting the service.
“In Cote d’Ivoire, dialysis is free to citizens of the country. In Nigeria every patient pays out of pocket,” she lamented.