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Acute Kidney Injury: Risk Factors and Challenges in Sub-Saharan Africa

“I woke up one morning in pain on the left side of my stomach,” said Kemi (not her real name). “I didn’t think it was serious, hoping that the pain will go away,” recalled the 33-year-old, with a stern voice over the phone.

But the pain did not go away, and after a few days, Kemi decided to see her family doctor. Physical examination revealed a lump in her stomach. Her doctor suggested further diagnostic tests, which showed that her kidneys were not functioning properly.

The Burden of Acute Kidney Injury

Like many people, Kemi did not know that she was at risk of Acute Kidney Injury (AKI), a public health problem, with more than 13 million cases globally each year.

The kidneys are two large bean-shaped organs located in the lower back. They act like filters, sieving out toxins and waste from the blood, then removed from the body as urine. Other functions of the kidneys include regulating body fluids, salt and potassium levels, and the production of hormones that regulate blood pressure and control red blood cell production.

Dr. Amisu Mumini, a consultant physician and nephrologist at the Lagos State University Teaching Hospital, explained that AKI is a condition that occurs when there is a problem with the kidneys; they suddenly slow or cease to function.

“AKI can happen when there is direct damage to the kidneys, which can be caused by infection, physical injury, or diseases such as diabetes or high blood pressure,” said Dr. Mumini. AKI can result from complications of hospital admission.

The burden of AKI remains high in low and middle-income countries; 85% of the 13 million annual global cases of AKI are in Africa, Asia, and Latin America, and responsible for more than 2.3 million deaths. In these countries, the lack of access to dialysis machines results in preventable deaths from kidney failure.

The Challenges of Managing Acute Kidney Injury in Africa

A 2019 study in Nigeria found that some of the factors contributing to high mortality from AKI in sub-Saharan Africa include delayed diagnosis, and lack of access to renal replacement therapy, including dialysis. The Lancet Global Health study on AKI outcomes in sub-Saharan Africa found that significant barriers to dialysis access include out-of- pocket costs, erratic hospital resources, and late presentation to a healthcare facility. According to the study, only 64% of children, and just 33% of adults received dialysis when needed. Overall mortality was 34% in children and 32% in adults, increasing to 73% in children and 86% in adults when dialysis was needed but not received.

The risk of AKI is increased by various conditions and situations such as reduced blood flow to the kidneys from dehydration, overuse of certain medications, or excessive blood or fluid loss. The risk of AKI is also increased by damage to the kidneys from bacterial and virus infections including tetanus, cholera, typhoid, HIV, and virus that causes COVID-19. Conditions that cause blockage of the urinary tract, including cervical cancer, prostate cancer, and kidney stone, can also increase the risk of AKI.

“When I heard the diagnosis, that my kidneys were not functioning well, I was quite afraid,” said Kemi. “A friend suggested I use traditional herbs that she said had worked for her stomach pains. Of course, I took the herbs because I was scared, thinking that I will need surgery to remove my kidneys.”

Dr. Mumini noted that many people try to manage their symptoms by self-medicating with various substances, including traditional herbs, which have not been pharmacologically tested for toxicity. Self-medicating may, in fact, increase the risk of AKI.

According to Dr. Mumini, diagnosis and treatment of AKI are challenging, particularly in low-resource settings such as in many parts of Africa. This is a continent where financial and medical resources are scarce, and have inadequate healthcare for a substantial portion of the population.

“Kidney care is expensive, and many patients can’t afford it,” said Dr. Mumini. “On average, a patient spends 100,000 Naira to 150,000 Naira (between US $262 to $394) for dialysis sessions per week. The way around it is more government support in providing equipment and infrastructure to help reduce the burden of the disease on patients and their families.”

“It was a tough time for my family, emotionally, psychologically, and financially, but they managed to find the money for my surgery,” Kemi explained. “As God will have it, the surgery was done successfully,”

Improving Outcomes for Patients with Acute Kidney Injury

Given that AKI is associated with significant morbidity and mortality, early recognition and management are important. Identifying the patients at risk of AKI early will likely result in better outcomes. Therefore, timely diagnosis and prevention should be considered the most essential strategies for reducing preventable deaths from AKI. It is also important to raise public awareness about kidney health.

“We must continue to educate the public about kidney care because prevention is better than cure, urged Dr. Mumini. We must also advise our patients about the dangers of using traditional medicines and the effect they can have on the kidneys,” added Dr. Mumini.

Want to Keep your Kidneys Healthy?

Here’s how:

  • Keep fit and stay active
  • Control your blood sugar
  • Monitor your weight and blood pressure
  • Eat a healthy diet
  • Stay hydrated by drinking plenty of water
  • If you smoke, quit
  • Have regular medical check-ups for kidney function test, especially if you’re at high risks, such as above age 65 years, or have a medical condition such as dehydration or urinary tract infection, or chronic diseases such as prostate or cervical cancer
  • Be mindful of the amount of non-prescription pain medications you take, such as ibuprofen and naproxen. These medicines can damage your kidneys if taken regularly to manage chronic pain, headaches, or arthritis.

Click here to learn more about your kidneys and how to keep them healthy.

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