This is the final in a two-part piece by Dr Romayne Edwards, exploring the reason kidney disease is such a problem.

KIDNEY injury or disease can be acute or chronic.

Acute kidney injury is abrupt loss of kidney function, usually within 48 hours. Chronic kidney disease, on the other hand, is a progressive decline in the functions of the kidney, so that the body is unable to maintain its normal processes. It produces no symptoms in the early stages, but may lead to mild to moderate increases in blood pressure, anaemia, heart enlargement, changes in bone structure, with the most severe stage being characterised by uremia.

Uremia is a life-threatening condition characterised by a build-up of waste products in the body, resulting in various signs and symptoms such as nausea, vomiting, loss of appetite, bad breath, confusion, psychosis, seizures, agitation, abnormal bleeding, chest pain, shortness of breath, irregular heartbeat, and swollen legs and feet.

KIDNEY REPLACEMENT

There are five stages of chronic kidney disease, according to the National Kidney Foundation, and at stage five, where there is advanced kidney disease, kidney replacement becomes necessary through dialysis — which is peritoneal or haemodialysis, where the blood is filtered of waste products and excess water — or kidney transplant.

Listed among the top 20 causes of death in Jamaica, kidney failure is usually due to cardiovascular and infectious complications. It is very common among patients with diabetes, hypertension, polycystic disease, glomerular disease, and obstruction of the urinary system.

Kidney injury may sometimes be due to causes outside the kidney, such as dehydration or severe heart failure or it may be due to causes within the kidney, like infection, diabetes, hypertension, polycystic kidney disease. Kidney injury may also be due to obstruction below the kidney, such as enlarged prostate, bladder or any pelvic tumour, stones or urethral strictures.

Chronic kidney disease often results in exorbitant weekly expenses for patients who have to do twice or thrice weekly dialysis, while also managing their other chronic illnesses and basic costs of living. It affects their ability to work normally, and seriously impacts their quality of life.

Patients, who miss dialysis usually due to financial constraints or lack of available machines, often present to the emergency department with life-threatening complications and evidence of uremia.

To confirm kidney failure, tests of kidney function are done, then the patient is referred to the nephrologist and other specialists, if necessary.

PREVENTING KIDNEY DISEASE

Prevention of kidney failure is paramount. Diet and lifestyle choices impact chronic diseases such as hypertension and diabetes and can be modified to reduce the incidence of chronic kidney disease. Drinking water, refraining from ingesting too much of certain drugs and chemicals, smoking and drinking too much alcohol, as well as engaging in safe sex, taking medication routinely for diabetes and hypertension, exercising regularly and eating a balanced diet are a few measures to prevent chronic kidney disease.

Dr Romayne Edwards is a consultant emergency physician at the University Hospital of the West Indies and an associate lecturer at the University of the West Indies.