The programme was organised by Healing Stripes
Hospital, Lagos, with the theme, Kidney Disease and children; act early to
prevent it, in line with this year’s global campaign.
The little girl’s case (dad would neither have his
name nor hers mentioned) is just one in a number of cases across the country
that have continued to defeat logic. People have wondered what little children
consume to make them susceptible to renal complications. Not too long ago, this
newspaper published the story of a three-year old who urgently needed N10
million for a kidney transplant.
Anjolaoluwa Oluwole who turned 3 on February 23
could not celebrate her birthday because of her health, which required more
urgent attention. Since last January, she had been undergoing dialysis twice
every week at the cost of N20,000 per dialysis.
The journey to her pain started 11 months ago when
her mother noticed a tiny swelling in her abdomen, precisely on March 28, 2015.
Thankfully, she didn’t take any chances and laboratory tests revealed that the
kidneys of the innocent child were damaged.
Since her first admission on April 1, 2015, Anjola
has been practically in and out of hospital. “She is constantly on antibiotics
and keeps getting blood transfusion because the ailment keeps draining her
blood,” her mother, Kemi, lamented.
The constant hospitalisation has also exposed her to
bacteria, virus and fungi infections, leaving her medically battered. The
hitherto brilliant kid has also dropped out of school in search of medical
solutions. The medical report on her case signed by Dr A.U Solarin, a
Consultant Paediatric Nephrologist at the Lagos State University Teaching
Hospital (LASUTH), stated that she was initially diagnosed of nephritic
syndrome.
The report added that “Her renal function has
progressively deteriorated and estimated glomerular filtration rate is less
than 10%. Kidney is functioning at less than 10%.”
In simple terms, her two kidneys are gone. To stand
the chance of survival, Anjola has to undergo a transplant. The options open to
her parents are unattractive. She needs a donor who must be a sibling from
18-65. The second of three children has no sibling that fits that bill.
Her elder brother is 6 while the younger sister is
just one year, four months. That leaves the family with the other hard
alternative: Either of the parents must donate one of their kidneys. And while
both parents are most willing and have no fuss about paying the price, they are
hampered by the huge financial requirements.
The first has to do with a compatibility test that
will cost N307, 000 per parent. Each has to undergo the test to determine who
is more compatible as a donor. Thereafter Anjola too would go through the test
at the same amount, totalling almost N1million, just to cross the first hurdle.
Next is the cost of transplant itself in either
South Africa or India estimated at N10million. Unfortunately, Anjola’s father,
Olusina, a civil engineer, has been out of job for two years, and Kemi’s little
catering business can just not meet these huge expenses. This has left the
family practically stranded and little Anjola at the brink, leaving them with
little choice but to go public seeking financial assistance.
Right up to the youth
An older case would be that of 28 year old Mistura
Martins, which was reported in one of the national dailies recently. Her
problem first manifested as headache, which later became very severe.
Thereafter sore throat followed, until one morning
when she woke up and realised she couldn’t carry herself for long or do her
usual chores.
“Finally,” she said, “one morning I woke up and
could not lift myself; I was too tired to lift my body. That was when I
realised something was really wrong with me. My dad came and took me to a
hospital in Surulere, where I was referred to Gbagada General Hospital and
later diagnosed of kidney failure.”
Unfortunately for Mistura, by the time she was
diagnosed, she already had end-stage renal disease which required constant
dialysis.
While Mistura’s case may be a bit off the mark in
terms of focus of this piece, it nevertheless raises questions, considering her
youthfulness.
Chronic Kidney Disease (CKD) on the rise amongst
children
A survey by the Department of Paedeatrics,
paediatric Nephrology Unit, University of Nigeria Teaching Hospital, Ituku
Ozalla, Enugu conducted over a five-year period between July 2007 and June 2012
to ascertain the prevalence of CKD among children seen at the university and
also determine the stage of presentation, possible etiology, treatment and
outcome confirmed a rise.
Out of 3002 paediatric admissions, 98 (3.3%) had
CKD, giving incidence of 3.0 new cases per million-child population per year
and a prevalence of 14.9 per million children population. The report also
showed that 54.1% of those with kidney issues were over 10 years of age. It
also showed that Edema, oliguria and hypertension were the most frequent
clinical features. The most common etiology was glomerular disease (63.6%) and
44.9% presented in CKD stage 4 and 5.
Of the 98 that had CKD, renal replacement
(RRT) was offered to 25 (25.5%), six (24%) has haemodialysis, three (12%) had acute
peritoneal dialysis and 16 (64) were damaged conservatively. The result also
showed that eight of the children died on admission while 15 left against
medical advice bothering mainly on financial constraints.
The survey confirmed a prevalence of chronic kidney
diseases in children and the myriads of challenges in its management, with late
presentation and limited parental resources being most prominent.
That finding also sort of aligns with that part of
this year’s theme, which says “act early to prevent it.”
Speaking to The Nation on kidney issues in
children, the Managing Director of Healing Stripes Hospital, Dr. Ezinne
Onyemere advised that people need to ask and check their family background to
prevent this deadly disease.
With particular reference to the six-year old with
polycystic condition, Onyemere said a polycystic kidney is the presence of lots
of cysts developing around the kidneys, which causes damage to it later in
life.
She noted that dehydration can cause acute kidney
injuries, which after a long pile up can cause kidney diseases in the future,
and thus encouraged children to drink lots of water to help the kidneys flush
waste easily.
Onyemere also called on parents to report any
symptoms and complain of any sort in their children to a paediatrician,
especially abdominal pains.
Precautions to be taken
On his part, a Consultant Nephrologist, at the
hospital, Dr Adebowale Adewunmi, who spoke with parents present on the occasion
of that World Kidney Day commemoration said, many parents don’t know how to
care for their children’s kidneys.
“When we were little, our parents didn’t know how to
do certain things. Many of us are today suffering from the ignorance of our
parents. Sometimes our children have skin rash and sore throat and we just feel
they are nothing, but in the real sense some skin rash and sore throat can be a
sign of serious problems.
Streptococcal organisms inherent in some skin
infections and sour throats in children between three and 15 years can lead to
kidney disease.
“During the infection, the streptococcal organism
inject toxins similar to that of the kidneys, hence the anti bodies mob these
similar deadly toxins into the kidneys, which in turn causes infections to the
organ in the near future.
That is why mothers must not waste time in reporting
any symptoms of such infections on their children to the hospital. It is
unfortunate that these streptococcal infections cannot be identified until
examined.
Severe malaria that affects children can lead to
kidney disease; but when we have a fever; our parents will say it is malaria.
If they had seen a children doctor, who checks the child well, they would be
given antibiotics that will prevent the child from developing kidney problems
in future.
Another thing that we should be watchful of is our
male children’s urine projectile. There is a valve that everybody has; the work
of the valve is to close up when the bladder is full and when the person wants
to urinate it opens. In male children especially, they have a high chance of
having a problem with this valve. When the problem is present, it doesn’t open
very well when they want to urinate, so not all the urine is expelled and it
also doesn’t close well. In situations like this, the urine goes back into the
body and can cause damage to the kidney.
If a parent wants to know if their child is having
this problem, they should watch when they urinate. If they have
projectile urine, they are fine but if the urine doesn’t project, there is a
problem and the child should be taken to see the doctor early.
Another thing is foamy urine. Parents should watch
out if their children’s urine is foamy. If a parent finds out any of these
issues, the child can be taught early enough to take things easy.
Diarrhoea can also cause kidney disease. Children
may eat all kinds of infected foods, which may lead to diarrhoea. If the parent
does not help the child return water to their bodies quickly, the kidney will
shut to make sure that the child doesn’t urinate and waste more water. This
shut down may lead to kidney damage.
If a child is not drinking enough water, or eating
well, the child should be taken to the hospital so that liquid can be passed
through drip into his or her system.
Many parents also are fond of giving their children
some chemicals that can hurt them. Some are given concoction very early the day
without eating any food. The worst is that these chemicals don’t have a dosage.
Some children are born with congenital problems,
some are also born with only one kidney and some are born with abnormal kidneys.
What we should know is that it is not their fault or their parent’s fault. All
the parents have to do is be observant, report anything the child complains to
the doctor so that whatever is wrong can be detected early.
To avoid kidney problems in adult, they must stay
away from too much salt and sugar. If it is possible, as soon as they clock 40
years, they should stay away from them completely.
If your father is hypertensive, you have 33 per cent
chance of being hypertensive and if both parents are, there is a 67 per cent
chance. If your parents are hypertensive and you are not, begin to treat
yourself as if you are, so that you will not fall victim as hypertension and
diabetes are the commonest causes of kidney disease.
Another cause of kidney disease in adult is
cholesterol and cholesterol enters our body through the mouth. So we must watch
what we eat.
Our liver and kidneys have different capacities, so
do not take things because you see other people taking them. Their kidneys may
be healthier than yours. Our kidneys manage to function even in bad states;
that is why before our kidneys begin to show that they have problems, 50 per
cent of the kidney is already gone. Dr Adewunmi submitted.
Another doctor, Dr Femi Adedugbe, a
General Medical Practitioner and Managing Director Lives Fountain
Medicare, Ilasa said although the polycystic kidney is not too common in
this part of the world, it however occurs in a few number. It has to do with
too much glucose produced from glands and they block channels. It can also
affect the lungs and pancreas.
He disclosed that some cases of kidney problems in
children are inherited. “There is a high chance of inheritance for quite a
number of children that are known to be predisposed to it if there is someone
in their family who has it.
“It is like this, if someone has diabetes and does
not manage it well, he may come down with kidney failure. But if he has a child
who also has diabetes and manages it well, he may never have the disease
because it is the mismanagement of these chronic diseases that leads to kidney
failures.
“Another thing is if you have high blood pressure
and do not manage it well, it will stress the kidney and cause problems.
“I know that many children now have cases of kidney
failure and it could be from drugs and local herbs that are administered by
parents. Sometimes, even the orthodox medicine like the gentimycine used for a
long time with high dose, can affect the kidney. It is not wrong to use it
because it is a very good antibiotic but people are conscious of using it.”
According to Dr Adedugbe, “Even the doctor that will
prescribe it to you, if he knows his onions, will not recommend that you use it
for more than seven days.
“In some few cases, we also have children with cases
of hypertension and diabetes type 1, which can cause problems in the kidney.”
He said “Kids don’t usually have urinary tract
infections like adults because they are not exposed to sexual activities,
except they are raped. If they are raped, they can be exposed to diseases that
if not well treated can affect them later in life.”
Dr Adedugbe also stressed the need for hygiene,
saying it is very important. “The pants of children should be washed regularly
because if they urinate in the pants, either intentionally or otherwise and it
gets dried up. The germs picked up by the pant while it was wet can create
problems for the child. Although it is not too common but if the child puts on
that pant for two, three or four days, there is an increased probability that
the girl-child can be infected through that blood that comes out from when the
child is still a virgin.”
He concluded therefore that if a parent notice that
their child is urinating too often, even when they have not taken too much
liquid, they should visit the hospital. If they complain of any kind of pains
around the abdomen, they should visit the hospital.
“For the girl child,” he said “check their pants
regularly for stains. As an addition, that can even let you know if one uncle
has tampered with the child.”
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