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.

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.


No symptoms


Feeling more tired and having less energy


Having difficulty to concentrate


Having little appetite and possibly some nausea on and off.


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


Having muscle cramps at night


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


Having a dry skin which is very itchy


Needing to urinate more often, especially at night.


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


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


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


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


Kidney transplant patients are closely followed by Nephrologists.


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


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


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


Kidney transplant has a very good survival rate.


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


Kidney donation is life donating life.

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 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


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


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


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.


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


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.


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


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


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


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


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.

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


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


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.


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.


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!


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


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


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!


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


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


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.