10 Things Kidneys do…

1 Filtration. 

Just above a litre of blood passes both kidneys every minute and one tenth gets filtered out as fluid. Blood cells, most proteins and fat particles stay in. Water and anything smaller get squeezed out!

2 Reabsorption. 

Next, the kidneys do some fine tuning. They take back in what is useful to the body: the right amount of minerals, glucose, amino-acids and water.

3 Water balance.

Kidneys pee more when we drink more but conserves water by peeing little if we are not drinking enough.

4 Excretion 

Hundreds of waste products like urea, toxins and drugs are filtered out and not taken back. This way, the kidneys keep the inside of the body clean.

5 Acid-base balance

Our bodily functions like food metabolism produce a lot of acid. The kidneys are the only organs that gets rid of excess acid.

6 Homeostasis

The kidneys keep the environment in the body stable. It includes keeping the concentration of many chemicals in the body within a tight range.

7 Blood pressure control. 

The kidneys control blood pressure by getting rid of excess salt and releasing various hormones. If the kidneys are diseased, blood pressure goes up.

8 Erythropoeitin production 

The kidneys produce erythropoeitin (EPO) that makes the bone marrow produce red cells. Without any EPO, we become severely anaemic.

9 Vitamin D activation

Kidneys convert the vitamin D we get from food and the sun into an active form that keep our bones strong and healthy.

10 Glucose control

The kidneys help to stabilise blood sugars by controlling the loss of glucose in the urine and by making new glucose when levels go low. This is why the newest class of drugs for diabetes act on the kidneys.

Kidney Diseases, Treatment, Apprehensions, and Fears.

Kidney (renal) diseases are many and varied. What is commonly encountered in daily practice and what is feared by many patients is End Stage Renal Disease requiring dialysis. There are a lot of myths and half truths that I have encountered in my practice over the years. One of them is that “pou change ou du sang kan fer dialyse”, another one is that “dimoune mort kan fer dialyse” , yet another funny one is ” dimoune dire ki kan fer dialyse ki…” and so on…I shall dispel all these myths and half truths over the next posts.

The main complication of most kidney diseases is End Stage Renal Disease (ESRD), which is as the name suggests, the last stage of kidney failure, and the patient will now require dialysis. The main causes of ESRD are Diabetes Mellitus and Hypertension which are quite prevalent in Mauritius. Almost half of the Mauritian population is diabetic, or pre diabetic and a quarter of the population is hypertensive. This leaves us all at high risk of chronic kidney failure or disease (CKD), a condition in which the kidneys are irreversibly and permanently damaged and eventually renal replacement therapy will be needed.

There are five stages of CKD and that is graded mainly as per kidney function. The last stage of which is ESRD, a situation where renal replacement therapies should be considered. The treatment of choice for ESRD is a kidney transplant. A healthy compatible donor must be found and if all tests are ok, a surgery is done whereby a healthy kidney from the donor is removed and transplanted in the recipient (the patient with ESRD). It is worth pointing out that most people are born with two kidneys and only one is needed as such to maintain life. Hence this enables us to donate one kidney.

However very often, a potential donor is not found in time and thus the patient is left with no choice but starting on dialysis. This will be elaborated in a further post.

10 Facts about Kidneys

1

The kidneys are located deep in the lower back to the left and right of the spine near the lower ribs.

2

Each kidney is shaped like a bean with the size of a fist. It is on average about 11cm long and 6cm wide and 150g in weight. These dimensions are obviously proportional to the person’s height.

3

The right kidney lies lower than the left kidney as a result of being pushed down by the liver. The right kidney is also slightly smaller than the left.

4

Most people are born with 2 kidneys but some healthy people can have 1 or 3 or 4 (click here and here to find out more) kidneys too!

5

The kidneys move up and down by a few centimetres as we breathe in and out.

6

The kidneys receive 20% of all the blood the heart pumps out. That is just above one thousand millilitres every minute!

7

Taking in all that blood flow, the kidneys filter out about 120 millilitres of fluid every minute. Don’t worry, they later reabsorb most of the fluid back in the body. After all, we normally pass just over a litre of urine a day!

8

Each kidney contains just over one million nephrons. A nephron is a miniature filter that receives blood, filters and reabsorbs fluid to produce urine.

9

Each kidney has a cap above upper pole. This is the adrenal gland which functions separately from the kidney and produces important hormones.

10

The kidneys shrink slowly as we get older but this process occurs faster and earlier in kidney disease. A badly shrunken kidney will barely function.

Prof John Cunningham at CardioMeet 2020

Renal Association senior members were well represented at the lecture by Professor John Cunningham – University College London, UK on “The kidney as a driver of cardiovascular disease” at CardioMeet 2020 held by the Cardiovascular Society (Mauritius).

The dramatic impact of kidney disease on cardiovascular mortality.

It was an emphatic and eloquent lecture from Prof J Cunningham who was beating the drum for nephrology at the cardiologists dominated conference.

Renal Association President Dr Fagoonee moderating.
Dr Gaya in the front row while RA Secretary Dr Ip asks a question.

It was a nice tantalising taster to the planned Renal Association conference “Let’s Talk Kidneys” in July.

Guy’s Hospital Transplant Team working visit

During the third week of November, the Guy’s Hospital Transplant team came to Mauritius on a work visit to help to get the local kidney transplant programme reactivated. Kidney transplantlation in Mauritius came to a halt in 2016 with the retirement of the two local transplant surgeons.

This visit was organised by the Ministry of Health and Wellness (MOHW). The team consisted of Professor of Transplant Surgery Nizam Mamode of Mauritius parentage and Mauritius born Transplant Research Fellow Mr Benedict Phillips.

The four full working days consisted of meeting the Honourable Minister Dr K Jagutpal and appraising the potential transplant wards, operating theatres and the diagnostic facilities. There were meetings with various stakeholders and last but not least, workshops on legal framework and clinical protocols and pathways with senior MOHW officials and nephrologists (Dr K Fagoonee, Dr S Gaya, Dr D Ip).

The Guy’s Transplant team are also very eager to help with training local doctors, nurses and laboratory technicians. The local team will need to do further groundwork to meet their high standards before they can come over. Their plan is to help for a few years until the local team becomes autonomous.

Visit of Mr Jonathon Oldsburgh

Mr Jonathon Olsburgh, renal transplant and urology surgeon from Guy’s Hospital London, kindly gave a lecture to the Medical Update Group at the University of Mauritius on the 21st of August 2019 on the subject of Live Donor Kidney a transplant.

It was a succinct and enjoyable talk on a very relevant topic in the context of the developing cooperation between Guy’s and St Thomas NHS Trust and the Ministry of Health and Quality of Life to restart the local kidney transplantation programme.

It was very kind of Mr Olsburgh to sacrifice some of his holiday time to speak to us. It was only right he was presented with a little souvenir. There was a lively and long discussion at the end.

The Founding of the Renal Association

Dialysis came to Mauritius well before the first nephrologist. Even after, the number of nephrologists built up very slowly. An association remained a pipe dream for a long time…

Dr K Fagoonee, the founding president of the Renal Association, explains:

“The idea of the Renal Association germinated five years ago, in March 2015, between two of the present founding members, but at that time, there were too few Nephrologists in Mauritius, so it was pocketed till last year, when we had a greater ‘force de frappe’, in terms of members. After many deliberations, all founding members met on the 26 July 2019 to set up The Renal Association.”

“Here’s hoping that our association will pay tribute to those Father Figures who set the blueprints of Nephrology in Mauritius as early as the 1990’s as well as nurture new generations of Nephrologists. They will drive the future of Nephrology for the centuries to come….”

So, eight Mauritian dedicated nephrologists working in the public hospitals met in Port Louis on a winter evening almost a year ago. The Renal Association was born. There is now the hope that Nephrology in Mauritius will at long last emerge from the shadows. It really needs to.

Chronic Kidney Disease (CKD) unfortunately affects 170,000 of our compatriots. 1,400 of them are on regular dialysis and 350 have functioning renal transplants. Morbidity and mortality are shockingly high and yet CKD is still little known to the public at large.

Although new therapeutic options are being devised to improve the life of those affected, delivery of effective care in Mauritius needs improving a lot. Our main goal has to promote the profession of Nephrology to improve the plight of kidney patients.

We want to facilitate co-operation between all interested parties in Nephrology, to promote continuous professional development of health care providers, to organize regular scientific meetings and seminars and engage eagerly with the Mauritian public on health promotion and education issues.

We want kidney health for all. Kidney health for everyone, everywhere.