Pic of the month 1

What is it?

Is it a small brain? Intestines? Poo?

No it’s a glomerulus from a mouse. A glomerulus is a little ball of very fine microscopic blood vessels. Each healthy human kidney has just over a million of these glomeruli.

A healthy glomerulus filters blood. The product is filtrated fluid that passes out goes through a long passage (the tubule) where water and essential chemicals are taken back from the fluid into the body as required at the time.

The end result is urine. The urine we pee is therefore the sum of the individual urine of about 2.5 million nephrons. A nephron is a glomerulus and its following tubule.

If you want to learn more about the glomerulus, check the wikipedia entry.

The above beautiful picture is from a mouse imaged by Stimulated Emission Depletion (STED) super-resolution microscopy. It comes from a recent research article “Drug Testing for Residual Progression of Diabetic Kidney Disease in Mice Beyond Therapy with Metformin, Ramipril, and Empagliflozin” by Motrapu et al. Picture is the great work of Maria Lucia Angelotti and Giulia Antonelli.

If the Covid-19 pandemic never existed…

… we would not be approaching 10 million of infected people and half a million deaths. There is no clear easy exit route yet of this tragedy.

The consequence for our Association is of course trivial compared to the global calamity but it was nevertheless a nasty shock for a newly born organisation. There had been a feverish ( of the non-viral type!) preparation for our first annual conference “Let’s Talk Kidneys” and first evening CPD event of a series which we named “The Kidney Club”.

The first 3 cases of Covid-19 came together on March 18 2020. I think everyone will always remember what they were doing at the time of the prime ministerial announcement. We had just completed dinner after an association business meeting full of big plans…

So the best plans went in smoke. There was an excited scramble online for more information but one thing was for sure. We had to put a brave face and get ready for a long crisis. Lockdown and the frontline.

Mauritius has weathered the first wave relatively well but not without tragic losses. We are in a lull but let’s not make any illusions. It’s not over yet. The worse is yet to come.

The silver lining to this pandemic is that I wouldn’t be penning this blog entry just now. My fellow members and I would have been in a bit of a panic on the eve of the first conference. Instead, we are officially launching our website renal.mu and ‘The Kidney Club” has morphed into a Free Online Access Medical Education(FOAMed) intiative of the association.

10 Symptoms of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is a tricky condition. Most people have no symptoms until their kidney disease is advanced. Most people with CKD feel well.

These symptoms often start very gradually and are not noticed until too late. By the time, some people with CKD feel ill, they may already be in a life threatening situation. That’s the big danger of CKD.

Here are the 10 symptoms of CKD.

1

No symptoms

2

Feeling more tired and having less energy

3

Having difficulty to concentrate

4

Having little appetite and possibly some nausea on and off.

5

Finding it hard to have a good night’s sleep.

6

Having muscle cramps at night

7

Having swollen feet and ankles and puffy eyes, especially in the morning (oedema)

8

Having a dry skin which is very itchy

9

Needing to urinate more often, especially at night.

10

Having difficulty breathing, initially on lying flat or climbing stairs. Later, the breathlessness becomes more and more frequent. This is possibly the most serious symptom of CKD.

10 Facts about Kidney Transplant

1

Kidney transplant is the treatment of choice for those who have failing kidney function.

2

Kidney donation is safe. Most people have 2 kidneys and only 1 is needed for survival.

3

Kidney transplant patients do no have to be on dialysis, but they do have to take a few medications, life long.

4

Kidney transplant patients are closely followed by Nephrologists.

5

Kidney transplanted patients live a full, normal and better life than if they are on dialysis treatment.

6

Kidney transplanted patients have 3 kidneys, most of the time, unless there are medical indications to remove any of the 2 native kidneys.

7

Kidneys that are transplanted start to work immediately in the recipient body, hence no more dialysis needed.

8

Kidney transplant has a very good survival rate.

9

Kidney transplant can be done preemptively i.e. no need to wait to be on dialysis before doing a transplant.

10

Kidney donation is life donating life.

10 Facts about Dialysis

1

Dialysis is not a fatality, with the progress in health care over the past decades.

2

Dialysis is not painful. No, the only pain felt is a small pinch when the arteriovenous fistula is needled.

3

Dialysis must be done thrice per week. This is the standard recommendation. We must remember that our kidneys work 24/7.

4

Dialysis means that you have to watch your diet closely.

5

Dialysis is like replacing the work of the kidneys, albeit not up to 100%.

6

Dialysis is offered free of charge in Mauritius.

7

Dialysis helps the patient live a normal life. You only have to come in for treatment thrice weekly for four hours.

8

Dialysis is not a cure for kidney failure, it only helps to keep you alive.

9

Most dialysis patients, if they follow their treatment and dialysis regime well, are fit to work.

10

Dialysis is the start of a new life, for those patients with failing kidney function.

Malade “les reins”

In Mauritius, there is a great misnomer – malade les reins. When someone comes and says that he/she is having ‘ les reins fer mal’, he/she is in fact referring to back ache (‘les dos fer mal’) and not to the kidney disease – per se!

So we need to clarify over and over again what is meant by ‘les reins’ and what we, as doctors, mean when we say that ‘ou les reins pas p travail assez’

Les reins – derived from latin ‘rēnēs’ – means the kidneys, two bean shaped organs found in the abdomen whose main function is to purify blood from toxins.

What to do…?

We are often asked by patients what to do when there is renal disease, how to prevent its progression into End Stage Renal Disease (ESRD), a stage when life sustaining dialysis or a renal transplant would be required. We are also asked if there is “ene comprime ki kapav prend pou pa fer dialyse”. The solution is simple and lies in the hands of the patients themselves.

Firstly a proper lifestyle, with regular exercise, no smoking, no alcohol, healthy eating habits helps greatly to prevent or slow progression into ESRD.

Secondly, if the patient has Diabetes Mellitus, Hypertension or other diseases, these should be treated and controlled.

So, the answer to ” si ena ene comprime….?” is very simple and lies in the hands of the patients itself.

Dialysis…

Dialysis is a life sustaining process whereby the main kidney functions are done by a special machine. It is usually recommended to be done 3 times weekly for four hours.

Dialysis is a frightening word when voiced out to patients. Many patients when told that they will now need dialysis refuse the idea. Despite being explained the benefits of the treatment and the main side effect being that they will stay alive , it is mostly with much reluctance that they finally accept to start dialysis. I often tell them, to consider it as the start of a new life, instead of thinking of it as a fatality.

There are two main types of dialysis, hemodialysis and peritoneal dialysis. Hemodialysis (HD) is a process whereby the blood flows from the arm of the patient via an arteviovenous fistula (avf), through a special machine which filters it and returns the blood via the same arm.Hence, there is no exchange of blood involved, but rather, purification of blood from uremic toxins, and excess water that accumulates in the body.

An avf, is a connection between the artery and vein in the arm that allows a high blood flow for hemodialysis. It is a surgery that should be done at least six months before the Nephrologist decides the patient will need dialysis. It is not “ene l’appareil” that is put in the arm, as it is made up of natural tissues that are surgically connected together.

Peritoneal dialysis(PD) uses the same principles of filtration, but in another way. A special fluid is instilled in the patient’s abdomen via a previously placed artifical tube (peritoneal dialysis catheter) and left to dwell for a few hours. the process is repeated a few times daily to achieve the target, which is clearing the human body from toxins that build up.

The patient is connected via the tube to special bags of medical fluids during the exchange, and once done, packs his tube into a pocket, under sterile conditions and is free to roam about and do his usual business of the day.

10 Facts about Nephrology

1

Nephrology is kidney medicine. This is the best short explanation. Kidney medicine was actually its original name until about 1960.

2

The word Nephrology  was made up from Greek word nephros (kidney) and the suffix -logy (the study of).

3

Nephrology is a specialty of medicine focused on the kidneys, kidney function and kidney disease. Nephrologists are the doctors who have done extra study in that speciality.

4

Nephrology seeks to maintain kidney health and treats kidney disease using lifestyle changes especially diet, medication and kidney replacement therapy.

5

Haemodialysis in the new unit at Jeetoo Hospital

Kidney replacement therapy is required when the kidneys stop working (kidney failure). There are two main options: dialysis and kidney transplantation.

6

Nephrologists treat whole body conditions affecting the kidneys such as diabetes, hypertension and immunological disease like lupus.

7

They also deal with conditions localised to the kidneys like kidney infection, kidney stones and drug toxicity to the kidneys.

8

Nephrology also deals with fluid, electrolytes (like sodium, potassium, calcium and chloride) and acid-base imbalances in the body.

9

Nephrologists treat complications due to kidney disease that affect other parts of the body such as renal bone disease, breathlessness, anaemia, oedema and hypertension.

10

Hypertension leads to kidney disease. Kidney disease causes hypertension. Nephrologists are quite possibly the best doctors to treat hypertension as they treat it every day.

Tribute to Dr Raj Purgus

It is with great sadness that Renal Association wishes to honour the memory of our colleague and friend Dr Raj Purgus. He passed away on the 21st of April after a year long illness. Born in Fond du Sac in the north of Mauritius, he studied at Royal College Port Louis and then went to read medicine in Marseille.

He practised Nephrology in Assistance Publique-Hôpitaux Universitaires de Marseille initially specialising in dialysis then transplantation. He gave nearly 40 years of loyal service to his hospital and patients.

Dr S Gaya, Consultant in Charge at J Nehru Hospital, got to know him quite well. He makes this heart felt tribute:

” Although he settled down in Marseille, he always had his native country close to his heart. I first met him in the early 1990’s during one of his many visits to Mauritius. He was proposing to donate some dialysis machines to the Ministry of Health. “

“He has always wanted to share his knowledge and experience in Nephrology with the local team. Since 2006, he expressed a wish to organize training for local surgeons in kidney transplantation and for MHOs to have full time training in Nephrology with the help of Aix-Marseille University.”

“He has helped in the upgrading of our dialysis services through his yearly “Renal Week” when he would visit all the dialysis units in the regional hospitals. During that week, he would give lectures and talk patiently to patients and relatives. He would discuss tirelessly with the nephrologists and nursing staff on issues related to dialysis, transplantation and nephrology.”

“He was always very enthusiastic and his advice was appreciated by one and all. He was a very kind hearted person, very devoted to his patients and always ready to help. He was a very good friend and he was a great fan of Manchester United Football club. We would often have lengthy discussions on WhatsApp regarding the team performances in certain games!”

“He is sorely missed by his family both in Mauritius and Marseille as well by all his patients and friends. Thank you Raj for all that you have contributed to Renal services in Mauritius. May your soul rest in peace.”

We have lost a great colleague and friend indeed. May we be able to continue the work he started. He leaves behind his wife and two sons. Our deepest sympathies to them and his family.