March 08, 2009

Chronic non-communicable disease, particularly cardiovascular, hypertension diabetes and chronic kidney diseases have now replaced communicable diseases as a leading threat to public health. Death by infectious diseases will decline by three per cent over the next decade. In marked contrast chronic diseases that already consist of 72 per cent of the total global burden will increase by 17 per cent.

Today, a major concern worldwide is chronic kidney disease which is a result of uncontrolled and improperly managed hypertension, poorly treated diabetes mellitus, presence of stones in kidneys, and repeated urinary tract infections. In fact, stones are the primary cause of kidney failure among children in Pakistan.

Therefore, it is extremely important that the focal point of government health policy (if it ever existed or is ever be conceived) should be prevention of kidney diseases especially since it is a disease multiplier.

The cost of kidney failure is escalating worldwide. Over 1.5 million people are kept alive through dialysis and transplantation. This number may double in the next decade. In Pakistan, almost all dialysis and transplantation activity is regulated by funds generated through philanthropy, which may lead to compromise in medical and ethical standards.

The cumulative global cost for dialysis and transplantation over the next decade is predicted to exceed 1.5 trillion dollars. Eighty per cent beneficiaries of this huge amount receiving renal replacement therapy (that is, dialysis or transplantation) live in developed countries and less than 10 per cent of the patients living in Pakistan and India partially benefit. In most African countries, there is little or no such access to renal replacement therapy meaning that many people are simply left to die.The only feasible global response to this pending health and socio-economic crisis is chronic kidney disease prevention. Fortunately, this disease can be detected early by simple tests like blood and urine for measuring creatinine; protein excretion and ultrasound kidney scan, which are easy, economical and accessible in our country. Clinical assessment of the symptoms of diabetes, uncontrolled blood pressure, heart, vascular and obstructive urinary diseases can greatly help in the diagnosis.

Screening must be high priority in those at risk of kidney diseases which includes individuals with diabetes mellitus and hypertension, obese or smokers over 50 years of age or people with a family history of kidney diseases, renal stones, diabetes and hypertension.

The key preventive measures are now defined and have proved to be successful in protecting renal disease. These comprise reduction of high blood pressure, use of specific drugs to reduce proteinuria and lower blood pressure, reduced salt intake, blood glucose, cholesterol, lipids, anemia and weight control, increased physical activity and quitting smoking.

In Pakistan, 60 per cent of surgical work of all district hospitals revolves around urological diseases and most common among these are urological stones. Most kidney and urinary bladder stones can be diagnosed by simple X-ray and ultrasound examination. Specialised X-ray techniques are used only to measure the size, location and functional status of kidneys more accurately for final treatment.

Ninety-two per cent of the urological stones should be removed by endoscopy while frequent and injudicious use of surgical knife should be cut down. Eighty per cent of urinary stones measuring three to four millimeters pass spontaneously with increased fluid intake, although certain drugs can help in facilitating the passage of stones.

In children most kidney diseases that lead to chronic renal failure can not only be diagnosed before birth with the help of ultrasound examination, but prompt definite treatment can result in life long cure.

Urinary tract infection is the third most common cause of kidney damage, most frequently in females. It complicates in presence of diabetes, urinary stones and urethral narrowing which is a hallmark in post menopausal woman, encouraging large urine residue in the bladder.

Similarly, in men, enlarged prostate gland can result in decreased urine flow and may block passage of urine completely. This affects 44 per cent of men over 70 years. By avoiding treatment one can severely or permanently damage kidneys.