Mulago weighed down by kidney failure patients
MULAGO Hospital’s renal ward registered a total of 953 new cases of kidney failure in 2005/2006, up from 123 in 2000/20001, the head of the unit says. Dr Edward Kigonya, a senior consultant physician and the head of the renal dialysis unit regretted that many patients that present with kidney fail
By Irene Nabusoba
MULAGO Hospital’s renal ward registered a total of 953 new cases of kidney failure in 2005/2006, up from 123 in 2000/20001, the head of the unit says. Dr Edward Kigonya, a senior consultant physician and the head of the renal dialysis unit regretted that many patients that present with kidney failure come when the condition is in advanced stages. “Because of our poor routine-medical-check-up culture, most ‘moving patients’ do not know that they have a kidney problem.†he said.
Kidney (renal) failure is the inability of the organs to adequately filter metabolic waste products from the blood, control the amount and distribution of body water and the levels of electrolytes in the blood.
The kidney functions may decline rapidly — acute kidney failure (AKF), which can be treated, or gradually — chronic kidney failure (CKF), where the patient is kept on a heamodialisis machine or is given a transplant. A heamodialysis machine rids the body of toxins when the kidneys fail. The patient’s blood is pumped into the machine, which clears it of toxins, returning the clean blood to the patient.
Kigonya says the treatment is a short-term measure for AKF in which there is a chance that the kidneys will recover within a week or two. But the condition could become chronic, necessitating the dialysis to be done on a long-term basis awaiting a kidney transplant.
Unfortunately, a transplant, which is a very essential service in dealing with CKF, is not available in Uganda. He says it would greatly decrease the currently high rates of morbidity and mortality, besides saving the country lots of costs on chronic dialysis or sending the patients abroad for treatment and transplants.
In Uganda, dialysis costs about sh1.5m per month, while a transplant in India is costs sh35m. The renal dialysis unit on Mulago’s sixth floor has a capacity of 18 beds, with four modern heamodialysis machines worth sh240m. It is part of the general renal ward on 4C, which has a capacity of 50 beds. For it to offer comprehensive renal care, it needs 12 dialysers (sh60m each), a high dependency unit, laboratory, store and office. It currently survives on two specialised doctors and a few nurses.
Kigonya says the unit has a lot of infrastructural, financial and manpower challenges that cannot meet the increasing number of patients with kidney failure. The ward admits an average of 50 patients weekly, 30% of these suffering from acute/chronic kidney diseases, besides those referred from other clinics. All these need short and long term dialysis. About 100 of those that require chronic dialysis would benefit greatly from a renal transplant.
“We can keep them on the machine for decades but it is very expensive, with many people needing the same service. This greatly curtails the number of patients who should access this service. Less than 5% of patients who would need this treatment access it,†he says.
Causes
Kigonya says the burden is greatly increasing due to diabetes mellitus, hypertension and HIV/AIDS.
He further notes that overcrowding in public institutions like schools, prisons, entertainment theatres, hospitals and workplaces cause sore throat that contributes significantly to cases of kidney failure.
“Some rooms in schools and institutions which were meant for one person, now contain six. Kidney failure is sometimes a result of airborne infections which spread rapidly in congested spaces,†he says, adding that accidents, surgeries and poorly managed deliveries are other causes.
Kiyonga’s deputy, Dr Emmanuel Ssekasanvu, further explains: “When one gets a sore throat, the body’s system fights the kidneys in the process of fighting the sore throat. But not everybody that has a sore throat is developing kidney failure. This particular one may fail to respond to medication. It will be prolonged. After a while, you start urinating blood. It may also look like urine which is cloudy with smoke. Then you develop swollen eyelids, legs, stomach and urine frequency reduces.â€
He says patients may develop malaria, high blood pressure or diabetes and receive the recommended treatment, but with no improvement. These may be causes as well as symptoms of kidney failure. Some people may mistake the swelling for an allergy.
An Internet site on health, www.merc.com reports that acute kidney failure can result from any condition that decreases the blood supply to the kidneys like heart failure, shock and liver failure or that obstructs urine flow anywhere along the urinary tract.
It adds that in many people, no cause of acute kidney failure can be identified, much as it can become chronic if kidney function does not recover after treatment.
Way forward
Kigonya says they are sending a team of six doctors to India to learn about Kidney transplants so that Mulago could start the procedure by the end of next year.
“We also intend to spread our facilities and services to up-country clinics. We shall start with simple treatment but extend to include dialysis so that we reduce on numbers,†he adds.
Kigonya said they are also going to educate people on healthy living and symptoms of kidney failure, so that the cases are identified early for treatment.
He urges people to avoid overcrowding, eat a healthy diet, treat malaria without delay and those with a history of renal disease, to always go for check-up at least twice a year and seek proper medication when symptoms show.
MULAGO Hospital’s renal ward registered a total of 953 new cases of kidney failure in 2005/2006, up from 123 in 2000/20001, the head of the unit says. Dr Edward Kigonya, a senior consultant physician and the head of the renal dialysis unit regretted that many patients that present with kidney failure come when the condition is in advanced stages. “Because of our poor routine-medical-check-up culture, most ‘moving patients’ do not know that they have a kidney problem.†he said.
Kidney (renal) failure is the inability of the organs to adequately filter metabolic waste products from the blood, control the amount and distribution of body water and the levels of electrolytes in the blood.
The kidney functions may decline rapidly — acute kidney failure (AKF), which can be treated, or gradually — chronic kidney failure (CKF), where the patient is kept on a heamodialisis machine or is given a transplant. A heamodialysis machine rids the body of toxins when the kidneys fail. The patient’s blood is pumped into the machine, which clears it of toxins, returning the clean blood to the patient.
Kigonya says the treatment is a short-term measure for AKF in which there is a chance that the kidneys will recover within a week or two. But the condition could become chronic, necessitating the dialysis to be done on a long-term basis awaiting a kidney transplant.
Unfortunately, a transplant, which is a very essential service in dealing with CKF, is not available in Uganda. He says it would greatly decrease the currently high rates of morbidity and mortality, besides saving the country lots of costs on chronic dialysis or sending the patients abroad for treatment and transplants.
In Uganda, dialysis costs about sh1.5m per month, while a transplant in India is costs sh35m. The renal dialysis unit on Mulago’s sixth floor has a capacity of 18 beds, with four modern heamodialysis machines worth sh240m. It is part of the general renal ward on 4C, which has a capacity of 50 beds. For it to offer comprehensive renal care, it needs 12 dialysers (sh60m each), a high dependency unit, laboratory, store and office. It currently survives on two specialised doctors and a few nurses.
Kigonya says the unit has a lot of infrastructural, financial and manpower challenges that cannot meet the increasing number of patients with kidney failure. The ward admits an average of 50 patients weekly, 30% of these suffering from acute/chronic kidney diseases, besides those referred from other clinics. All these need short and long term dialysis. About 100 of those that require chronic dialysis would benefit greatly from a renal transplant.
“We can keep them on the machine for decades but it is very expensive, with many people needing the same service. This greatly curtails the number of patients who should access this service. Less than 5% of patients who would need this treatment access it,†he says.
Causes
Kigonya says the burden is greatly increasing due to diabetes mellitus, hypertension and HIV/AIDS.
He further notes that overcrowding in public institutions like schools, prisons, entertainment theatres, hospitals and workplaces cause sore throat that contributes significantly to cases of kidney failure.
“Some rooms in schools and institutions which were meant for one person, now contain six. Kidney failure is sometimes a result of airborne infections which spread rapidly in congested spaces,†he says, adding that accidents, surgeries and poorly managed deliveries are other causes.
Kiyonga’s deputy, Dr Emmanuel Ssekasanvu, further explains: “When one gets a sore throat, the body’s system fights the kidneys in the process of fighting the sore throat. But not everybody that has a sore throat is developing kidney failure. This particular one may fail to respond to medication. It will be prolonged. After a while, you start urinating blood. It may also look like urine which is cloudy with smoke. Then you develop swollen eyelids, legs, stomach and urine frequency reduces.â€
He says patients may develop malaria, high blood pressure or diabetes and receive the recommended treatment, but with no improvement. These may be causes as well as symptoms of kidney failure. Some people may mistake the swelling for an allergy.
An Internet site on health, www.merc.com reports that acute kidney failure can result from any condition that decreases the blood supply to the kidneys like heart failure, shock and liver failure or that obstructs urine flow anywhere along the urinary tract.
It adds that in many people, no cause of acute kidney failure can be identified, much as it can become chronic if kidney function does not recover after treatment.
Way forward
Kigonya says they are sending a team of six doctors to India to learn about Kidney transplants so that Mulago could start the procedure by the end of next year.
“We also intend to spread our facilities and services to up-country clinics. We shall start with simple treatment but extend to include dialysis so that we reduce on numbers,†he adds.
Kigonya said they are also going to educate people on healthy living and symptoms of kidney failure, so that the cases are identified early for treatment.
He urges people to avoid overcrowding, eat a healthy diet, treat malaria without delay and those with a history of renal disease, to always go for check-up at least twice a year and seek proper medication when symptoms show.