The kidneys are a part of the renal system basically responsible for blood purification and other physiological functions including control of the volume of various body fluids, fluid osmolality, acid–base balance, electrolyte concentrations, secretion of hormones which regulate blood pressure, and removal of toxins through urine.
In some individuals, renal function may be impaired leading to kidney malfunction and disease (kidney failure). This impairment are caused by a chain of factors which includes congenital factors like polycystic kidney disease, age-related factors that occur over the course of life such as diabetic nephropathy, glomerulonephritis and kidney stones, and physical injury from accidents. In Nigeria, the leading causes of kidney disease are high blood pressure, diabetes and glomerulonephritis (kidney inflammation from a variety of causes). As shown by various studies, the incidence of chronic kidney disease in Nigeria ranges between 1.6 and 12.4%.
There are a number of physical signs of kidney disease, but sometimes these signs are attributed to other conditions. Most people with kidney disease may not experience symptoms until the very late stages when the kidneys start failing or when there is presence of huge amounts of protein in the urine thereby putting the affected person at risk. People with diabetes, high blood pressure, a family history of kidney failure and older age are mostly at risk of having kidney disease.
Diabetes: A diabetic person is at risk of developing kidney disease. High blood sugar from diabetes can damage blood vessels in the kidneys as well as nephrons leading to kidney disease. A person with diabetes may witness any of these following symptoms which may indicate renal disease:
• Presence of Blood in Urine: The kidneys are designed to keep blood cells in the blood while filtering wastes from the blood to form urine. When there is impairment in the filtration function of the kidneys as a result of tumors or renal infection, blood may leak out and passed out along with urine.
• Troubled Sleep: Shortness of breath while sleeping (sleep apnea) is oftentimes related with chronic kidney disease.
• Loss of Concentration, Tiredness and Fatigue: A build up of unfiltered toxins in blood can cause tiredness and sometimes lose concentration and energy.
• Dry and Itchy skin: Healthy kidneys work to maintain the proper amounts of minerals and nutrients in the body thereby keeping the bones strong. Dryness and itchiness of the skin may be a sign of the mineral and bone disease which follows end-stage kidney disease, when the kidneys are no longer able to keep the right balance of minerals and nutrients in your blood.
• Increased Protein in Urine: This is called proteinuria. Proteins may leak out of the kidneys into urine but in small insignificant amounts. Kidney disease can cause leakage of protein into urine in large amounts. This can be indicated by foamy or bubbly urine and puffiness around the eyes.
• Oedema: The build up of fluid in some parts of the body causes swelling in those affected areas. Swelling of the lower extremities such as the ankles and feet can indicate kidney disease resulting from sodium retention and the kidney’s inability to remove excess water.
• Muscle Cramping: Leg cramps are common for those with kidney disease. Cramps can be caused by imbalances in fluid and electrolytes such as poorly controlled calcium and phosphorus levels, which is caused by kidney malfunction.
• Decreased Appetite: A buildup of toxins due to impaired kidney function may cause you to lose your appetite, whether because you feel full or too sick or tired to eat. You may witness a metallic taste in your mouth.
Family History of Kidney Failure: Some people may have a family history of kidney disease. Here, an inherited form of the disease can run in families or be passed down from generation to generation. These hereditary conditions are usually caused by a gene mutation. This does not totally mean that everyone in the affected generation will have kidney disease but they all are at risk of developing it.
High Blood Pressure: High blood pressure can constrict and narrow the blood vessels in your kidneys, which reduces blood flow and the normal kidney function is affected. When this happens, the kidneys loses their ability to remove all wastes and extra fluid from your body. Therefore, kidney disease developed as a result of this may occur in a person with high blood pressure.
Obesity: Being overweight mounts a lot of pressure on the kidneys forcing them to perform extra work while filtering wastes above normal levels (hyperfiltration) in order to meet the increased metabolic demands of the increased body weight. This increase in intraglomerular pressure can damage the kidneys and raise the risk of developing kidney disease in the long term.
Old Age: Kidney disease is more common in people aged 65 years or older (38%) than in people aged 45–64 years (12%) or 18–44 years (6%). It is slightly more common in women (14%) than men (12%). As one ages, age-related problems like diabetes may weaken the kidneys and normal function of the kidney is reduced which may lead to chronic kidney disease.

Prevention and Care
Preventing kidney disease and its complications is possible by managing risk factors and treating the disease to slow its progression and reduce the risk of complications.
Get Tested for Chronic Kidney Disease: It is important to be tested annually especially if one is at risk of kidney disease due to high blood pressure, diabetes or a family history of kidney failure.
Improved Lifestyle: Making healthy food choices, alcohol limitation and smoking stoppage, proper use of medications, engagement in physical activities, staying in best blood pressure range(below 140/90) and personal target blood sugar range, and maintaining normal cholesterol levels can help reduce the risks of developing kidney disease. In older people, kidney disease can be prevented through reduction in use of non-steroidal anti-inflammatory drugs(NSAIDs), reduction in salt intake and abstinence from alcohol and caffeine.
Proper Use of Medication: According to several studies, the possibility for preventing or delaying the start of diabetic kidney disease is by treating patients who have diabetes with blood pressure-lowering drugs. In addition to lowering blood pressure, these medications reduce protein in the urine, a risk factor for developing kidney disease.

Dr Oluchi Okafor MBBS

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