RENAL or kidney failure remains among the top 10 causes of morbidity and mortality in the country.
Nephrologists and medical experts who were trained in the diagnosis and management of kidney disease, said Friday the renal failure at its final stage is on the ninth spot out of the top 10 causes of death in the country.
Renal failure (formerly called renal insufficiency or chronic renal insufficiency) is a situation in which the kidneys fail to function adequately.
There are two forms: acute (acute kidney injury) and chronic (chronic kidney disease or CKD); either form may be due to a large number of other medical problems.
Philippine Society of Nephrologists-Mindanao Chapter secretary Dr. Franklin Guillano said in 2009 there were 407 patients in Davao Region who started renal replacement therapy while 18 patients underwent kidney transplants.
Nationwide, there are 8,708 patients who started their therapy in 2009, according to the Philippine Renal Registry in connection with the Department of Health (DOH).
However, Guillano said the figures “are only the tip of the iceberg” as the symptoms of renal failure are not easily felt by the patient.
“Chronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtration rate. Your GFR tells how much kidney function you have. It may be estimated from your blood level of creatinine. If your GFR falls below 30 you will need to see a nephrologist. Your kidney doctor will speak to you about treatments for kidney failure like dialysis or kidney transplant. A GFR below 15 indicates that you need to start one of these treatments. From Stage 1 to 4, mostly kasi hindi ito napapansin,” Guillano said in Friday’s Kapihan sa PIA media forum.
Dr. Michael Jonathan Latayan, diplomat of the Philippine Board of Urology, said at Stage 1, there is kidney damage with normal or increased GFR. The kidney is 90 percent functional and with screening and chronic kidney disease risk reduction, further development may be avoided.
At Stage 2, there is kidney damage with mild decrease in GFR and the kidney is 60-89 functional.
At Stage 3, there is moderate decrease in glomerular filtration rate and the kidney is 30 to 59 percent.
At Stage 4, there is severe decrease in GFR and the kidney is 15 to 29 functional.
By Stage 5, there is kidney failure. The kidney is 15 percent functional. A replacement therapy (dialysis or transplantation) is highly advised.
“Patients in Stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible,” Guillano said.
A kidney transplant recipient, Pastor Ronaldo Flores also recalled his experience in suffering from renal failure and described this as “nightmarish”.
“Parang bangungot talaga ang pinagdaanan ko. I was emotionally, physically, mentally, and financially affected. Pero ang tao talaga, gagawin kahit ano para mag-survive. I suffered for four years before being able to get a transplant. Marami rin namang mga associations that are generous to kidney patients. During that time I relied on prayer and it helped me a lot. I really believe prayers can heal,” Flores said.
Signs and symptoms of a kidney failure include:
- Fluid Retention: As the kidney loses its ability to regulate the amount of fluid and salt in the body, you may notice swelling in the feet and legs, fingers, or around the eyes. Initially treatment usually involves restricting fluid and limiting salt intake. You may also begin taking fluid pills (diuretics).
- Hypertension: High blood pressure can be a cause of kidney disease, and kidney disease can cause high blood pressure. Treatment is with salt restriction, weight reduction if necessary, and sometimes a combination of fluid pills and high blood pressure medications.
- Fatigue: As the kidney loses its ability to remove toxins from the body, they will accumulate and cause symptoms including fatigue, itching, insomnia, irritability, loss of appetite, nausea, and vomiting. Usually more of these symptoms appear as kidney failure worsens, with people experiencing only mild or moderate kidney impairment having few or none of these symptoms. Initially, treatment will be with diet changes, specific medications to treat specific symptoms, and eventually dialysis and kidney transplantation.
- Anemia: Anemia is common in patients with kidney disease and generally is caused by the inability of the failing kidneys to make the hormone erythropoietin, which stimulates the bone marrow to make red blood cells. Symptoms of anemia include weakness and lack of stamina. Erythropoietin has now been genetically engineered, and is now available in drug form to combat the anemia caused by chronic kidney disease.
- Bone Disease: Failure of the kidney to produce vitamin D an lead to bone softening, and eventually bone pain and muscle weakness. Oral and IV forms of vitamin D are available and can be given to slow the development of such problems.
Dr. Theresa Bad-ang said the Department of Health and medical societies are “focused on getting the public’s attention on prevention.”
“There are no particular vitamins that can prevent kidney failure. Kung masobrahan ka pa nga ng vitamins it could cause formations of stones. Ang dapat gawin talaga is umiwas sa sodium or food na maalat. The good thing about renal failure is it can be prevented. Uminom lang talaga ng maraming tubig, most preferably yung distilled,” Bad-ang said.
Bad-ang said the kidneys perform five main functions: (1) Clean waste material from the blood; (2) Retain or excrete salt and water; (3) Regulate blood pressure; (4) Stimulate bone marrow to make red blood cells; and (5) Control the amount of calcium and phosphorous absorbed and excreted.
“Taking care of your kidneys would directly improve the other parts of your body. It’s a matter of controlling your food intake especially on those that have sodium,” she added.