Kidney Disease in Nigeria

Kidney diseases are caused by many factors including injury from exposure to toxins, body fluid depletion due to blood loss or dehydration, sepsis, certain cancers, uncontrolled hypertension and diabetes etc. When these causes of dysfunction are not controlled or reversed, the person losses some of his or her kidney function permanently and can be categorized as having Chronic Kidney Disease (CKD). When most kidney function is lost, and the person cannot adequately clear toxins and waste in the body, the person is said to be in end-stage renal disease (ESRD), and at this point will require mechanical help (dialysis) to clear these toxins.

For persons with CKD who end up with ESRD in Nigeria, the process of health maintenance in this state could be very challenging as the healthcare system is ill-equipped to manage the demand for regular and adequate dialysis, and the cost could be prohibitive. Therefore, the Nigerian government in concert with healthcare leaders in the country must begin to evaluate the process of identifying at-risk and affected persons, and establish methods to ensure early intervention, and improve access to quality healthcare for this population

Identifying Risk Factors and Screening

There are several factors that predispose individuals to the development of kidney disease in Nigeria, and they include:

1. Volume Depletion: this is seen in cases of severe bleeding or when a person is dehydrated due to inadequate fluid intake or from losses such as prolonged diarrhea, vomiting, etc. The affected individual may be noted to be pale from blood loss, or with sunken eyes, dry mouth, low urine output etc. The goal here is to address the cause i.e control the bleeding, transfuse blood if necessary (requires hospitalization), and hydrate those with significant volume depletion (Olowu, 2015). This is the essence of the oral hydration therapy that is often taught to mothers, so that when their children have gastrointestinal illness that cause vomiting and diarrhea, they can hydrate them to prevent complications.
2. Glomerular Injury: glomerular injury is caused by insult to the kidneys due to exposure to toxins or infections. In children, it is often caused by streptococcal infection of the throat or skin, which triggers an immune reaction that results in the proliferation and destruction of the glomerular tissue and surrounding structures of the kidney. This process is known as Post-Streptococcal Glomerulonephritis and is the number 1 cause of kidney disease in Nigerian children. Some children with strep infection may not develop kidney disease. But for those who proceed to have this complication, it is important to identify the signs and symptoms, which includes low urine output, blood in urine, swelling of legs and body, and encourage them to seek healthcare immediately. Upon arrival to the hospital, several test should be carried out, and the most obvious result that will support this diagnosis is the presence of protein in urine (Ugwu, 2015).
3. Hypotension (Low Blood Pressure): hypotension can be caused by several factors including volume depletion which was discussed earlier, and sepsis which is one of the leading causes of death (Olowu, 2015). A person is said to have sepsis when the person begins to show signs of systemic response to an infection, and this will be noted with an increased heart rate, fever, low blood pressure, low urine output etc. When sepsis is not addressed immediately with resuscitation and antibiotics, it could lead to permanent damage of end organs including the kidneys and possibly death.
4. Chronic Uncontrolled Diabetes and Hypertension: these are the two most common causes of CKD in Nigeria. Uncontrolled diabetes is a state in which a person experiences very high blood sugar levels without adequate management with insulin or other anti-diabetic medications. Over 7% or approximately 20.8 million Nigerians are living with diabetes, and the disease burden is so significant because the cost of treatment and self-monitoring cannot be afforded by many, thereby predisposing this high-risk group to periods of significant hyperglycemia (high blood sugar) (Okoronkwo, Ekpemiro, Okwor, Okpala, & Adeyemo, 2015). Diabetes causes CKD because high blood glucose causes increased filtration through the kidneys. Over-time, the kidney tissues become damaged due to overload, resulting in increased passage of protein through the kidneys as it filters the blood, further damaging the kidneys. The end-result of this whole process is irreversible damage to the kidneys and loss of function (Adebamawo et al., 2016).                             Uncontrolled Hypertension on the other hand causes CKD through multiple mechanisms that promote sodium and fluid retention in the body, and neuro-hormonal responses that cause the blood vessels of the kidneys to constrict in an attempt to regulate the blood pressure. Over-time, these processes cause progressive damage to the kidneys and loss in function if not addressed (Collister, Ferguson, Komenda, & Tangri, 2016).                                   These two conditions require long-term and consistent monitoring and management, and present a tremendous demand on the resources of the affected individual and the healthcare system. As part of an effort to address kidney disease in Nigeria, screening for, and improving the management of hypertension and diabetes should be target goals for the Federal Government, Ministry of Health, and healthcare professionals at all levels. We also need more health promotion activities to raise awareness of these risk factors, the importance of screening, treatment, and monitoring, as well as life-style alterations such as diet and exercise that can help modify the disease process and improve outcomes.

Written by Dr. Idongesit Udoh

References

Adebamowo, S. N., Adeyemo, A. A., Tekola-Ayele, F., Doumatey, A. P., Bentley, A. R., Chen, G., … Rotimi, C. N. (2016). Impact of type 2 diabetes on impaired kidney function in sub-Saharan African populations. Frontiers in Endocrinology, 7(50). doi: 10.3389/fendo.20016.00050.

Collister, D., Ferguson, T., Komenda, P., & Tangri, N. (2016). The patterns, risk factors, and prediction of progression in chronic kidney disease; a narrative review. Seminars in Nephrology, 36(4), 273-282.

Okoronkwo, I. L., Ekpemiro, J. N., Okwor, E. U., Okpala, P. U., & Adeyemo, F. O. (2015). Economic burden and catastrophic cost among people living with type2 diabetes mellitus attending a tertiary health institution in south=east zone, Nigeria. BioMed Central Research Notes, 8(527). doi:10.1186/s13104-015-1489-x.

Olowu, W. A. (2015). Acute kidney injury in children in Nigeria. Clinical Nephrology, 83(suppl 1), S70-S74.

Ugwu, G. M. (2015). Acute glomerulonephritis in children of the Niger Delta region of Nigeria. Saudi Journal of Kidney Diseases and Transplantation, 26(5), 1064-1069.