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World Kidney Day

The kidney day is celebrated every 2nd Thursday of March since last three years to raise awareness about the importance of our kidneys as amazing organs that play essential role in keeping us alive. Though kidney diseases are common and are harmful but they are mostly treatable at initial steps.

The main job of our kidneys, located beneath our rib cage, is to remove toxins, certain chemicals and excess water from our blood.

Every day our kidneys filter and clean 200 litters of blood equivalent to 20 buckets. Beside this impressive feat, kidneys also help to control blood pressure, facilitate red blood cells formation and play a very important role to make our bones stronger.

Kidney diseases are usually divided into two main groups (a) where precautionary measure, proper and early treatment keeps the progression of kidney diseases in check (b) in which diseases can be cured by offering surgical remedy to the patients.

If the kidneys gradually start loosing their ability to function properly then it is called chronic kidney diseases (CKD), it is silent in character and often goes unnoticed. Studies of different races living in different countries worldwide have consistently shown that one out of 10 adults have some form of kidney damage.

People with chronic kidney disease are 10 times more likely than healthy individuals to die of heart attacks and brain strokes. The health of their kidneys may also progressively worsen to the point where kidneys must be replaced (this is called end stage renal disease). The patient can be kept alive either by kidney transplantation, haemodialysis through machine thrice a week or peritoneal dialysis. Other than the above mentioned methods of treatments of end stage kidney diseases all other claims are hoax, cheating and a lie with patients.

In the changing world chronic, non communicable diseases like heart diseases, hypertension, diabetes mellitus and chronic kidney diseases have now replaced the communicable disease. Death claimed by infectious diseases will decline by three percent over the next decade-in marked contrast to chronic diseases which already account for 72 percent of the total global burden of diseases and in population over 30 will increase by 17 percent.

The cost of treating the chronic kidney disease is already 80 percent of many health care budgets representing a leading threat to public health and healthcare resources worldwide. USA will spend nearly 10 billion dollars by year 2010 only to control and treat kidney diseases.

As Pakistan is a third world country, it is of paramount importance that focal point of the government health policy should be prevention of kidney and other diseases related to kidney. It is also more significant because kidney disease is a disease multiplier, rather than spending huge amounts in purchase of medical equipments and constructing building which is easy and quick way of siphoning kick backs from health budgets.

On the face of earth 500 million individuals, who makes 10 percent of the adult population have some form of kidney damage and every year millions die of heart disease linked to CKD. The main causes of CKD in order of priority are uncontrolled diabetes, uncontrolled high blood pressure, infections and stones of kidney and urinary tract while presence of stones in the renal tract is the leading cause of kidney failure in children. These kidney diseases actually contribute morbidity from cardiovascular disease in 12 million individuals worldwide each year and these numbers are multiplying rapidly due to global epidemic of types 2 diabetes.

The cost of kidney failure treatments are escalating worldwide, over 1.5 million people are kept alive through either haemo or peritoneal dialysis or transplantation and this number is expected to double within the next 10 years.

The cumulative global cost for dialysis and transplantation over the next decade is predicted to exceed US$ 1 trillion. The worst bit of this whole picture is that 80 percent of patients benefiting from renal replacement therapy live in developed countries and only 10 percent of patients in Pakistan and India are benefited by this treatment. In many African countries there is little or no access to renal replacement therapy mean to face the stark reality of death, plain and simple death.

Fortunately we can detect chronic kidney diseases early on. Simple routine tests of urine, blood, ultrasound examination, and symptoms of diabetes, uncontrolled high blood pressure and heart and vessels diseases greatly facilitate the diagnosis, but the positive outcome is that by using correct drugs, certain precautions and change of life style not only brings about control of chronic kidneys diseases but at times can get you rid of it.

Those diseases of kidney and urinary tract, which can be treated with surgical intervention, include urinary stones, congenital urinary diseases, genitourinary cancers and enlargements of prostate gland in old men.

In Pakistan 60 percent of the surgical work of all districts hospital comprises of urological diseases and most of these are with kidney, uretar and bladder stones. The most common causes of these are malnutrition, unbalanced diet, deceased intake of liquids, repeated or chronic urinary tract infection injudicious use of certain drugs especially painkillers and few genetic and familial diseases.

Most kidney and bladder stones can be diagnosed by simple x-ray and ultrasound examinations. Specialised x-ray techniques are used to identify more accurately the size and location of stone and function of the kidney, which facilitate the treatment planning few urine and blood test do help establish the cause of stone formation.

Some kidney diseases of children can be diagnosed before birth with the help of ultrasound. In about one out of 500 births, some abnormality occurs in the development of the kidneys or urinary tract. Most common among these are blockage present at the out flow of urine resulting in swelling of kidneys called pelvic ureteric function obstruction. Another common abnormality is vasico ureteral reflux.
This occurs when a valve like mechanism at the point where urethra joins bladder does not work allowing the urine to flow back up in to the kidneys. Presence of posterior urethral valves in the terminal urinary passage is another congenital disease. All of these diseases can be looked after and treated by surgical intervention providing lasting protection to kidneys.

Urinary tract infections are the 3rd common cause of kidney damage and one in five women will have atleast one such incidence in her lifetime.

By Dr. A. Majid Rana

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