Talking about the Kidneys

By Dr Pang Hoong Chee

Many Malaysians are still unclear about the role and job scope of a nephrologist. Essentially a nephrologist’s role is to investigate and treat the kidneys and all conditions that may affect this important organ in the human body.

As the kidneys are often affected by various ailments, a nephrologist needs to know everything from infections, inflammatory diseases, cancers and various medications that may affect kidney health. Most kidney specialists are also highly involved in the day-to-day care of an ill patient in the Intensive Care Unit as the kidneys are one of the earliest organs to be affected by critical illness.

Main causes of kidney disease

The two main causes of progressive kidney disease in Malaysia are diabetes and high blood pressure. These two conditions account for almost 60-65% of long term kidney disease. Many people worry about the effect of kidney stones but in truth, urinary stones only account for a minute number of kidney diseases.

Symptoms of kidney disease

The prevailing idea is back pain implies ongoing kidney disease. In fact, most people with progressive, life-threatening kidney disease have little back pain. Kidney disease tend to remain silent in early to middle stages. Symptoms of declining kidney health are variable, ranging from poor appetite to leg swelling to shortness of breath and severe itchiness. By the time these symptoms appear, the organs are usually no longer recoverable.

Preventing kidney disease

The people most at risk of kidney diseases are those with diabetes, high blood pressure, gout and those with a previous history of kidney damage from any reason.  Therefore, all diabetics and hypertensives should get a review with a kidney specialist before kidney disease sets in. Some conditions run within the family so anyone with a family member with kidney disease should undergo a check. People suffering from gout deserve a special mention as they tend to self-medicate with over-the-counter painkillers that may damage the kidneys in the long run.

Treating kidney disease

Treatment of any kidney disease is directed at the underlying cause. There is no one-size-fits-all magic bullet. Kidney damage that occurred within a short time and picked up early is potentially reversible, if not curable. Longstanding kidney diseases are more tricky and any medical advice should be customized to the needs of the person.

Talking about dialysis

Dialysis therapy is a life-saving treatment for people with end stage kidney disease, for whom medications are no longer sufficient to preserve health. Dialysis therapy is greatly misunderstood. More than prolonging life, dialysis started in a timely manner generally improves health and grants the person a reasonable quality of life.

What about kidney transplant?

Kidney transplant offers the best deal for most (not all) patients with end stage kidney disease. However, many patients refuse a kidney donation from their loved ones for fear that it will instead end up damaging the health of the donor. Although this risk is actually very low, people may decide to pursue commercial kidney transplants in foreign countries. There are successful as well as horror stories associated with this and it is best to discuss this with your neurologist.

Parting words

Everyone is different and requires different approaches when dealing with kidney disease. A face-to-face discussion with a kidney specialist makes more financial sense than self-medicating with a high risk of damaging one’s kidneys to the extent of requiring dialysis.