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The 9th of March this year is dedicated for World Kidney Day. The theme for this year is “Kidney Health for All”. I would therefore like to use this opportunity to touch on a few issues regarding chronic kidney disease.

Chronic Kidney Disease (CKD) is defined by the presence of kidney damage or decrease of kidney function for a period of 3 months or more irrespective of the cause. The persistence of the damage or decreased function for at least three months is necessary to distinguish CKD from acute kidney disease. The burden of CKD in Botswana has been on the rise. Due to the asymptomatic nature of CKD during earlier stages, patients tend to present late, missing opportunities for prevention.

As CKD advances then it can become symptomatic. The symptoms are usually due to metabolic derangements and or disturbances in water or electrolyte balance. Some of the symptoms may include muscle weakness and losing muscle mass. There is often swelling of the legs, and this can progress to severe shortness of breath attributed to by water being retained in the lungs. Those who have high blood pressure may have worsening of their blood pressure with poor control. The patients may also have significant fatigue and decrease in exercise tolerance often attributable to the development of anaemia.

In advanced CKD patients may developed symptoms due to accumulation of urea, which is a waste product that is usually excreted by the kidneys. These symptoms may include, dry and itchy skin, poor appetite, nausea, vomiting, diarrhoea, and tiredness. An increase in urea can also lead to sexual dysfunction, as they may be decrease in desire to have sex, and erectile dysfunction. In advanced case it can lead to mental changes, problems with heart function and a tendency to bleed.

There are many causes of CKD. The common causes are diabetes and Hypertension. Other conditions that affect the glomerulus, which is a part of the kidney that filters blood. Diseases that affect blood vessels that supply blood to the kidneys may also cause CKD. Any condition that causes blockage and disturbs flow of urine will eventually result in CKD if untreated. Examples of this include prostate enlargement, kidney stones, tumors and urethral strictures.

The diagnosis of CKD is made by doing blood tests that tests for the kidney function. Other additional tests include doing urine tests, and ultra sound scans of the kidneys. In certain instances it may be necessary to do a biopsy, which means taking as small piece of the kidney and examining it under the microscope to determine the cause of CKD.

When detected the goals of managing CKD are to delay or halt progression of the disease. This can be done by strict control of the risk factors of the disease and avoiding any medications or drugs that can cause further damage to the kidneys. The second important goal of management is to look for all the complications that come as a result of the CKD and manage them adequately. The last component for the management is continuous monitoring of the kidney function and identify those that will need dialysis and plan to start the dialysis before the disease advances.

CKD is a debilitating condition and needs to be detected early and managed appropriately. It is important to screen for conditions that can cause kidney disease and to screen CKD to pick it up early. In so doing hopefully we can achieve “Kidney Health For All”.


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