Why kidney failure is far from a death sentence
A common misconception about a kidney failure diagnosis is that it translates to a death sentence for the patient. Resident physician Chemai Kirwa, based at the Karen Hospital in Nairobi, says this perception is wrong and misleading. https://shorturl.at/vNX38
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00:00 Now the most common especially in our setup, even in wildlife, is now diabetes and hypertension.
00:07 So if I have these diseases like diabetes and hypertension, it also puts me at risk of having chemotherapy?
00:14 Yes, so those are the risk factors. So some of the common risk factors is diabetes, hypertension,
00:19 and then things like being overweight, that's obviously a risk factor for developing kidney disease.
00:34 Even alcohol is a risk factor. And I said, "Eat a lot of stale and smoking."
00:39 That's why when you now talk about how to manage, now let's say for diabetics, we have to ensure that.
00:52 Because if you don't drink enough water, you're not hydrating enough, can that cause kidney failure?
00:59 Yes, but you see, the body has a regulatory mechanism.
01:03 If you start going towards dehydration, you have a thirst center that lets you drink.
01:10 So it's highly unlikely that you can be hydrated just because of walking.
01:14 But the only people who are at risk factor of being dehydrated are the elderly,
01:18 because you see their thirst mechanism is impaired, so they might not go and drink adequately.
01:24 Or those who have been admitted to the hospital, so they're not able to drink as much.
01:29 But for normal people, the common thing that people usually say is,
01:34 "I can't drink 8 glasses of water." That's around 2 liters.
01:39 So yes, it's ideal, but you see not everyone is able to take 2 liters.
01:43 So it's a variation. Those who take less, they're still okay.
01:47 I think the end goal is just to ensure that you drink enough so that your urine is more clear,
01:52 and just a bit, some change in the food, but not very concentrated.
01:57 So is kidney failure something that runs... is this genetic?
02:02 No, no. So for kidney failure, what we know is that risk factors are very sparsely tuned.
02:09 -Treating the disease? -Yes.
02:11 So what are the risk factors? We've talked about diabetes. We've talked about hypertension.
02:17 So now we talk about genetics. In genetics, we talk about things that have been associated.
02:23 Those conditions like ophthalmology, kidney disease, those are associated with chronic kidney disease.
02:32 You really can't tell fast. When you come here from the hospital at first,
02:37 it's very difficult for me to say things are acute, because you see the difference in the time.
02:43 You have to wait more than 3 months for it to come to a crack.
02:47 So now, let's go back. How do you identify it?
02:50 Once you just come to the hospital, how do we identify that you have a chronic kidney disease?
02:56 So we start with, one, I get your symptoms, and your symptoms are suggestive,
03:01 like the symptoms of 2 weeks now, the test that we do.
03:04 So there are 3 main tests that we usually do.
03:06 So we usually do something called a urine electrolyte test.
03:10 So creatinine is a product of metabolism, so it's a waste product, and it's usually filtered.
03:19 And if your kidneys are healthy, if I mention your levels of creatinine,
03:26 if your kidneys are 4 weeks, and I mention the filtration is affected, so it has a toll cumulative,
03:32 that's how I'm able to tell if the kidneys are getting weaker or not.
03:36 So what are the tests that you should do? So we do that urine electrolyte test.
03:41 And most of the time we do a urine analysis, so that's a urine test.
03:45 So with the urine test, I can guess which are suggestive that the kidney is hurting,
03:50 so presence of proteins. You see proteins are heavy components of blood that are not filtered in the kidneys.
03:57 But if I find proteins in your urine, it means there's a defect in the filtering system.
04:03 So it means that it's leaking, so that's a sign of the kidney not working well.
04:08 And then another test we usually do is ultrasound, just to look at the structural,
04:14 like structure, we'll see that the kidney's size is okay, and we have no issue.
04:19 Then once we do that, then based on the results, that's when I say that the kidneys are hurting.
04:23 But then I really can't tell whether it's acute or chronic.
04:27 Let's say you did a test like 5 months ago in another hospital,
04:32 that shows that your kidneys were weak at that point, and I do it now, and still weak.
04:36 So that's when I can say, "I'm here at this point, you have chronic kidney disease."
04:40 But then if you just come and say your kidney functions were good a week ago,
04:45 and now I do, and I see it is elevated, so that one is an acute kidney injury.
04:52 And then in an acute kidney injury, the only way I treat you is just to identify what has caused this kidney to break.
04:58 So one, if you're dehydrated, we give you fluids,
05:03 and we give you a drug that is making your kidneys weak,
05:06 so things like those headsets, which are big deals, so we need to control that.
05:11 Yes, and then I have to check you regularly to make sure that it doesn't progress to CKD.
05:17 And the other thing is just, as long as we have vascular access, we can clean your blood.
05:24 So as long as you're able to have access, so in most cases, from our end, we do catheters.
05:32 So you can be, there's one that can be fixed in the neck, around there, with a ring.
05:37 And then the other option is we can fashion something called a fistula.
05:43 So a fistula is like a connection between an artery and a vein on the here, on the cubital aspect of the hand.
05:54 So what usually happens is now you connect an artery and a vein, and then it becomes bigger.
06:01 So you develop, without connection, you develop a very big vessel.
06:06 But now it's easier to dialyze through, because you can just fix a little thing, and dialyze through that.
06:11 The advantage of this is you don't have any external, you don't have any foreign material in your body.
06:20 You see, like a catheter is something foreign.
06:22 So the biggest challenge with anything foreign in your body can become a conduit to a bacteriostasis, or you get a infection.
06:31 So this is usually easier, because it means you don't need to carry anything with you.
06:36 Yes.
06:37 Yes. I think there are so many myths around.
06:40 So one is that as long as you have kidney disease, it's equitable to death, you see.
06:47 Nowadays, with the advancement in medical care, dialysis is easily accessible anywhere.
06:54 So once you diagnose with a kidney disease, it's very easy as well.
06:57 Just get yourself a good nephrologist, ensure you adhere to your appointments, and you really have a very good quality of life.
07:05 I've seen patients, even with kidney failure, who've been on dialysis for over 26 years, they're able to do their normal activities, they thrive.
07:13 But someone can stay on dialysis for years.
07:17 See, dialysis is now, dialysis is something that, it's like your external kidney.
07:23 So it means you live your normal life, but you have to go for dialysis like two to three times a week, okay?
07:31 Yes.
07:32 So as long as you're dialysing, you're able to put your health at a good state.
07:38 Yes, so the people who've done it for 10, 20 years, as long as you have discipline and over time, both of them, as long as you have good dialysis centers, they're able to do it.
07:53 Okay.
07:54 Thank you.
07:55 Thank you.
07:56 Thank you.
07:57 [BLANK_AUDIO]