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Kidney disease is an irreversible illness that affects 10% of people across the world, and up to 1 in 8 people in South Africa. This World Kidney Day – on 10 March – let’s really appreciate these vital organs and make sure we’re living in a way that promotes our kidney health. “By the time most people become aware that their kidneys are failing, they will already have lost 50% of their kidney function” The kidneys are a pair of bean-shaped organs found at the back of the body at about the level of the waist. Each kidney holds thousands of filtering units. As our blood moves through them, they filter waste products and extra water out and these are released in our urine. Paediatric nephrologist Professor Errol Gottlich says: “Kidney disease is silent, meaning it often develops without any noticeable symptoms. By the time most people become aware that their kidneys are failing, they will already have lost 50% of their kidney function. “Kidneys also balance our fluid levels ensuring we don’t become over-hydrated or dehydrated. They normalise electrolytes and blood pressure, assist in calcium metabolism and prevent anaemia.” “Our kidneys are essential for a normal, healthy lifestyle. The kidneys fulfil many roles, the most important of which is excreting toxins out of the body in the urine.” – Prof Gottlich also heads up Discovery Health Medical Scheme’s Kidney Care Programme, which is designed to ensure the best quality of care and life for medical scheme members on chronic dialysis. Paediatrician Dr Nokukhanya Ngubane-Mwandla adds, “The kidneys have multiple important functions in the body, including controlling acid-base homeostasis, water and electrolyte balance and blood pressure. They also produce certain hormones important for production of red blood cells and bone mineralization.” – Dr Ngubane-Mwandla is the recipient of a 2020 Discovery Foundation Sub-specialist Award and is using this support to work towards improving the lives of children with congenital and acquired renal pathology. Here’s how you can look after your kidneys Taking care of your kidneys is as simple as leading a healthy lifestyle. Professor Gottlich recommends that people do the following: • Ensure regular exercise. Exercise for 30 minutes, five days a week. Even brisk walk is an excellent form of exercise. • Eat a balanced, healthy diet of unprocessed, fresh foods with no more than a teaspoon of added salt per day. • Regularly check and control your blood sugar. • Regularly check and control your blood pressure. • Drink an appropriate amount of fluids. Your doctor will explain how to adjust your fluid intake if you have kidney, heart or liver disease. • Don’t smoke as smoking slows the flow of blood to the kidneys. • Don’t take over-the-counter pain or anti-inflammatory pills regularly. Long term, frequent use of medicine, like Ibuprofen, can harm your kidneys. • Get your kidney function checked regularly if you have any of the ‘high risk’ factors such as diabetes, high blood pressure, a family history of kidney disease, and being overweight or obese. A silent disease: What damages kidneys and how? Discovery Health’s data show that around 75% of renal (kidney) failure is a result of diabetes or hypertension (high blood pressure). Data from the National Kidney Foundation mirrors this with up to 65% of kidney failure in South African adults being attributed to hypertension and up to 25% due to Type 2 Diabetes.” “Uncontrolled diabetes can damage the blood vessels in your kidneys and can gradually decrease the functionality of this vital organ. And untreated high blood pressure experience damage to their kidney tissue as a result of blood vessels being exposed to a higher than normal blood pressure,” adds Professor Gottlich. – Other causes of kidney disease include living with HIV and other infectious diseases, autoimmune diseases, and structural abnormalities. Dr Ngubane-Mwandla adds, “There is also a relatively high incidence of kidney problems among South African children. Some of these problems are congenital, which means that children are born with them, but several conditions are caused by malnourishment and gastric issues.” This passionate doctor adds, “It would be great to implement screening programs at schools or at primary health care facilities – in particular to ensure blood pressure and urine screening – to detect the early onset of kidney disease, especially those born prematurely, at a low birth weight or who have a family history of kidney disease.” The National Kidney Foundation notes that up to 80% of chronic kidney failure may be preventable, making it vital to keep up regular screening checks that will identify signs of chronic diseases like kidney disease and others, as early as possible, in adults and children alike. Catch the onset of kidney disease early on – simply screen! The good news is that, for most people, screening for kidney disease can be done as part of regular health check-ups. “It’s really as simple as going to your primary healthcare provider and doing a screening test for high blood pressure, blood glucose levels and kidney functionality,” says Professor Gottlich. “Essentially, your urine is an easily accessed window to your kidney health. A dipstick into the urine sample will show markers of possible kidney health issues.” Treating chronic kidney disease Once a person has chronic kidney disease, they will need to undergo chronic dialysis (an average of three sessions per week), explains Professor Gottlich. Patients may either undergo: – Peritoneal dialysis, which uses the lining of their abdomen to filter the blood inside their body. – Haemodialysis, which uses a dialysis machine and a special filter, called an artificial kidney or dialyser, to clean the patient’s blood. “In addition to dialysis treatment, it is critical that patients live a healthier lifestyle and take prescribed medicine to control blood pressure, improve anaemia and bone health,” adds Professor Gottlich. Chronic kidney disease is a complex illness that is expensive to treat. – In 2021, Discovery Health paid out R1.5 billion in kidney treatment related claims for about 3,000 members – of which 0.6% was for members under the age of 18, reflecting the way in which kidney disease affects children too. – Interestingly in 2020 Discovery Health paid out a slightly higher R1.6 billion in claims from about 3,500 medical scheme members for kidney treatment. The 14% drop in members claiming between 2020 and 2021, shows the decrease in screening and treatment for kidney disease and other chronic treatment over the course of the COVID-19 pandemic. This is due to the fact that people have stayed away from healthcare facilities out of fear of exposure to COVID-19, due to stay-at-home measures imposed to curb the spread of infection, and also due to the redirection of resources in healthcare towards COVID-19 care, especially during peaks of infection. Organ donation a lifesaver for people who live with kidney disease “The most ideal therapy for chronic kidney disease is a kidney transplant,” says Professor Gottlich. “However, there’s been a significant decrease in organ donors over the past two years because of COVID-19 and very few kidney transplants have been done during this time.” Dr Ngubane-Mwandla adds, “There is a great need for organ donation and transplantation for kids too, particularly for those children treated in the state sector. Until transplanted, these children must stay on a chronic dialysis programme. Some, we transition to haemodialysis which is both costly and needs regular visits to the hospital so really affects and defines a child’s life. The sooner a child in need receives a kidney transplant, the better for the child and their family.” One organ donor can save seven other lives. Your heart, liver and pancreas can save three lives and your kidneys and lungs can help up to four people. And, one tissue donor can help up to 50 people by donating their corneas, skin, bones, tendons and heart valves. – Sign up to be an organ donor – Organ Donor Foundation of South Africa. References National Kidney Foundation of South Africa Paediatrician puts spotlight on kidney conditions in South African children Discovery Health Medical Scheme Kidney Care Programme Organ Donor Foundation