Dr Shubharthi Kar
MBBS ,MD (BSMMU)
Assistant Professor
Department of Nephrology
Sylhet M A G Osmani Medical College
Sylhet, Bangladesh.
Social Media Team Member, International Society of Nephrology ISN
Kidney disease is a burning issue in Bangladesh. It is approximated that around 20 millions of people in Bangladesh are suffering some sorts of kidney diseases. As a low and middle income country Bangladesh has to bear the burden of this chronic disease.
We know the principal cause of Chronic kidney disease is Diabetes Mellitus. The number of Diabetic patients are increasing day by day. The main pathway of involving kidneys among the diabetics is called Diabetic Nephropathy. In its earliest phase patient notices nothing unless they undergo a laboratory measurement of urine albumin called Urinary Albumin Creatinine Ratio the doctors prefer to abbreviate as Urine ACR. Albumin is a protein substance so its a marker of protein leak from the kidneys. Normal healthy kidneys always try to conserve protein or albumin within the body. But when Diabetic Nephropathy develops the leakiness to protein develop in both the kidneys. What is the earliest symptom patient notices in case of Diabetic Nephropathy? Leg swelling or facial swelling will be the answer. So If a diabetic patient finds his leg swollen during a journey or after returning from office he or she should screen him or herself for kidney function including albumin in the urine.
Moreover any leg swelling patient should undergo testing including kidney tests .The second most common cause of Chronic Kidney Disease is Hypertension. Hypertensive Nephropathy or Hypertensive Glomerulosclerosis happens after a certain period of hypertension or High Blood Pressure. Fighting with the Hypertension myth is the cornerstone of Hypertension awareness in the society. The myth is Hypertension or High Blood Pressure always produces Headache, Neck Pain like symptoms. So, when such symptoms are absent they don’t go for Blood Pressure check up and those who were taking Blood pressure medications stop taking drugs. But in reality High Blood Pressure is a silent killer disease and a significant number of patients visit doctors’ chamber and become astonished to learn that they have high Blood Pressure because of the belief in the myth that they will receive High BP signals from body as headache or neck pain. Regular Screening is the cornerstone of combating High Blood Pressure or Hypertension. Uncontrolled hypertension not only leads to Kidney Failure but also Stroke, Myocardial Infarction or Heart Attack, Peripheral Arterial Disease or PAD, Blindness etc.
Glomerulonephritis is a least talked Kidney disease in Bangladesh. It has got many types and affect both Childrens and Adults. The children form is quickly diagnosed in Bangladesh. But it has many adult forms and usually very lately diagnosed. So my suggestion is even least amount of leg swelling or oedema should not be ignored and it demands a renal or kidney disease screening.
Polycystic kidney disease and other genetic diseases also cause chronic kidney disease in Bangladesh. Polycystic Kidney Disease which we abbreviate as PKD runs in the family in an Autosomal Dominant form. So many members of the same family suffer this kidney disease. As a Nephrologist it is sometimes painful to see many members of a family rushing for Renal replacement therapy.
Renal stone or Nephrolithiasis is a common disease in Bangladesh. The disease itself and its complications need both medical and surgical treatment. The problem is even after surgery renal stones trend to recur. They need annual kidney function screening and stone recurrence screening by doing Ultrasonography Kidney system and Plain Xray of Kidney Ureter and Urinary Bladder region of body. This is also another cause of Kidney disease in Bangladesh. Our kidney stone patients should be aware of a regular kidney checkup to detect kidney damage early.
So to combat kidney disease as a whole we have to look at the diseases that cause Chronic Kidney Disease. Early and Regular screening as well as awareness building are necessary to reduce disease burden.