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.
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 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.
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.