Sonia, the daughter of a former Deputy Senate President, Ike Ekweremadu, is one of the millions of people around the world with kidneys that have failed and require a transplant or continuous dialysis for the rest of their lives.

Sonia is suffering from a condition called Nephrotic Syndrome – where the kidney does not function properly. Her survival depends on continuous dialysis for the rest of her life or a kidney transplant.

The 25-year-old’s parents’ search for a new kidney for her had landed them on the other side of the law in the United Kingdom. The lawmaker and his wife, Beatrice, were arrested in 2022 by the London Metropolitan Police and charged with conspiracy to traffic a child to the UK in order to harvest his organs. Their trouble culminated in the jail terms slammed on them last week by a UK court.

It is lawful to donate a kidney, but it becomes criminal if a reward is involved in the process.

Kidney disease is very common worldwide. It is estimated that 10 out of every hundred individuals have kidney disease.

“Based on studies conducted in Nigeria, we presume that 20 out of every 100 individuals in the country have some overt or covert chronic kidney disease. So, the proportion is huge. However, of this 20 percent, only about 0.5 percent attend our hospitals with kidney disease-related complaints. So, you cannot use this to estimate the prevalence of chronic kidney disease in Nigeria”, said Professor Fatiu Arogundade, a nephrologist at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Osun State.

Professor Arogundade stated that the common causes of chronic kidney disease in Nigeria include hypertension and diabetes. Another cause of kidney disease is called glomerulonephritis. Also, it could be idiopathic (cause unknown) or it could follow infections and other health challenges in the body.

Inherited diseases, foreign agents and drugs, particularly antibiotics and a combination of analgesics, could equally cause kidney disease. Also, the bleaching creams, because of the heavy metals in them, could get deposited in the body and could cause kidney disease.

According to Professor Arogundade, the disease evolves over a period and the patients may not have any symptoms or signs. However, as the disease progresses, a few signs will emerge.

They start retaining fluids, which will show as a swelling around the eyes. Usually, later it involves the legs, the abdomen and other parts of the body. Then, they may observe that their urine becomes foamy; the urine may start coming out at odd hours. They pass more urine at night instead of during the day. After this, they develop high blood pressure.

Thereafter, they can develop heart failure and features of uraemia like nausea, vomiting and hiccups. They become pale and very weak because of a reduction in the level of blood. Their bones may become painful and weak.

At the advanced stage of the disease, they may start bleeding from little cuts or from orifices, as the case may be.

What will alert them to the problem in the community is the fact that urine volume will reduce; they may observe that they pass urine once a day or they may not pass urine at all and then they start developing some other features, feeling of hiccups, nausea, vomiting and all that.

However, Professor Arogundade stated that at the advanced stage of kidney disease, treatment is usually needed to help control the signs and symptoms, reduce complications, and slow progression of the disease.

Individual complications vary but treatment may include high blood pressure medication, diuretics to reduce fluid and swelling, supplements to relieve anemia, statins to lower cholesterol, or medications to protect the bones and prevent blood vessels from becoming hardened. A low-protein diet may also be recommended.

But Professor Arogundade stated that where there is less than 10 percent of kidney function left, which is commonly termed kidney failure, the treatment option required may include dialysis or transplant.

Dialysis does the work of the kidneys, which is the removal of waste and excess water from the blood A kidney transplant involves the transplantation of one kidney from either a living or deceased donor into the body of another person (recipient).

However, dialysis or kidney transplant is out of reach for common Nigerians. It is expensive in the country, and kidney donors are scarce.

“The machines and consumables used are all imported. The talk about the poor being able to afford it will be difficult except if there is a viable health insurance company that is supporting the patient. Even governments in developing countries are complaining about the cost of healthcare, particularly for renal patients, so we cannot say that it will come cheap,” said Professor Arogundade.

A cheaper option to kidney transplantation is peritoneal dialysis. It is a type of dialysis which uses the lining of the abdomen to remove excess fluid, correct electrolyte problems, and remove toxins from the blood of people with kidney failure.

“If the fluid used for peritoneal dialysis is made in Nigeria, that can significantly make the treatment option cheaper,” he added.

However, Professor Arogundade maintained that transplantation, the changing of the kidney, is a more cost effective option in the long-term than dialysis.

President, Nigerian Association of Nephrology, Dr Adanze Asinobi, said children are not exempted from kidney disease or failure, and it is mostly due to congenital anomaly of their kidney and urinary tract.

However, Dr Asinobi declared as wrong, the impression of many that people with kidney disease die as a result of the failure of their kidney.

“The problem with kidney disease is that they (the patients) may not die from the failed kidney; they may die from effects of the chronic kidney problem on organs like the heart, lungs and the brain. Because the kidney is not functioning properly, there will be retention of fluids and salts which can invariably damage various organs in the body,” Dr Asinobi declared.

She lamented that people with kidney problems, including children, die from the condition because cases are not diagnosed early and treatment commenced to reduce complications and slow down the progression of the disease.

Asinobi, a pediatric nephrologist at the University College Hospital (UCH), Ibadan, stated that payment out of pocket for dialysis makes it inaccessible to many people that need it since a session of dialysis cost about N50,000 and it needs to be done at least thrice in a week to ensure good quality of life.

However, she declared that the kidney transplantation option of treatment also has its challenges in Nigeria.

“Kidney transplant is not a cure. It offers a more active life, without needing dialysis, but it requires ongoing care. Medications to ensure the body does not reject the kidney need to be taken for life. The drug is also expensive.

“But the problem is that after surgery, many Nigerians find it difficult to buy the maintenance drug and the implant is rejected, and so they die.

”At a time, UCH was going to give us free kidney transplantation surgery, but we couldn’t get a donor that would guarantee to ensure they retain the in grafted kidney. These are things that have been established in the past decades in developed countries.”

If a kidney transplant stops working, dialysis treatment will be necessary again. Another transplant may also be possible.

Dr Yemi Raji, a consultant nephrologist at the UCH, Ibadan, stated that of great importance to kidney disease is its prevention to reduce its burden in the community. This includes ensuring individuals do not develop the disease; ensuring that people who have it are free of its complications, and rehabilitation for those with kidney failure.

According to Dr Raji, there is the need to increase public awareness on kidney disease, its causes, its signs and symptoms, treatment, as well as how it can be prevented.

Dr Raji said: “For instance, people must know what to do if they have hypertension or diabetes so that it does not lead to kidney problems. They need to know that they shouldn’t be taking painkillers or herbal concoctions on a daily basis because they can cause kidney damage.

“Pregnant women also must know that going for antenatal care and complying with instructions they are given for their wellness to prevent them from having small-for-weight babies. Small-for-weight babies stand high risks of having kidney problems in the future.

“Individuals need to know the importance of screening themselves for kidney disease and what could cause it. It is more rewarding when the problem is picked early.”

Dr Raji said it is also necessary for the government to come up with policies that will make regular kidney screening mandatory so as to encourage people to screen themselves for kidney disease.

He added that the government needs to equip hospitals with facilities for kidney dialysis and to subsidise the cost of dialysis and kidney transplant for individuals with advanced kidney disease, as is the practice in many countries.

“In Nigeria, currently, dialysis centres are only located in urban centres. There is nothing stopping the government from putting the facilities in small towns.

“In Oyo State, for instance, anybody that has kidney disease and requires dialysis will have to come to Ibadan or Ogbomosho. Already, the distance has reduced access. This is aside from the cost of dialysis, which ranges from N30,000 to N50,000 per session and someone with kidney failure must have it three times a week. That is over N400,000 per month.”

According to Dr Raji, presently under the National Health Insurance Scheme, an enrollee has access to six dialysis sessions for free, hence the need to expand the scope the health insurance can cover for individuals with end-stage kidney failure.

“In other climes, people who are rich in the society endow funds to take care of the needy. Again, it means that the government and non-governmental organisations also need to educate rich people on why they need to invest in people who are ill,” the medical expert said.

A consultant psychiatrist at UCH, Dr Haleem Abdulrahman, stated that chronic medical conditions, including kidney disease and failure, tend to predispose individuals to a significantly higher risk of having depression and anxiety which may shorten their lives.

Dr Abdulrahman said depression and anxiety can worsen the health of persons with kidney failure because they might not adhere to treatment. According to him, depression will affect their will to attend follow-up as well as the will and energy to continue to live because they have lost hope. This increases their likelihood of dying very soon.

“Physicians, as they are treating the chronic illness, need to screen for mental health conditions and provide treatment if any be found. Chronic medical conditions on their own can predispose them to developing depression, which will alone increase the likelihood of having more complications and dying,” he stated.

No doubt, without dialysis or a kidney transplant, kidney failure is fatal. But prevention of kidney disease remains the best option. Though kidney failure and chronic kidney disease are not reversible, individuals can still take steps to preserve the kidney function. (Saturday Tribune)

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