kidney

Experts explain kidney disease as Dr Anthony Buhangamaiso battles with it

Oyam I Kidney disease in Sub-Saharan Africa is estimated to be between 10 per cent and 13 per cent of the population, depending on the criteria used for definition, the National Library of Medicine says.

Also, the Library says kidney disease in Uganda is increasing and is among the top 10 causes of death, with a case fatality rate of 21 per cent among patients admitted with chronic kidney disease.

Further, a 2022 report titled ‘Global Dialysis Perspective: Uganda’ published in the scientific journal, Kidney360 says the prevalence of chronic kidney disease in Uganda ranges from two per cent to seven per cent, and up to 15 per cent among patients with HIV or hypertension.

Dr Frank Asiimwe a Consultant Urologist and Transplant Surgeon at Mulago National Specialized Hospital says the kidney is one of those two organs God has given to us and it is why one can donate a kidney to another.

Apart from the heart, liver, and others which suck a lot of blood, Dr Asiimwe says kidney takes a lot of blood. “Its main role is to clean up our blood: we eat things in a raw form, we eat things in a potentially toxic form, what we eat, some of it is not required and quite a bigger amount of it is toxic.

“So, the role of filtering, getting these wastes out of our body is down to the kidney and of course liver also does play the role and the skin but the kidney bears the biggest plan. So a lot of blood passes through the kidney to be filtered and then cleaned and continues,” he explains.

Acute kidney injury means the kidney cannot form urine, according to Dr Asiimwe, adding that once urine is being formed it means that the blood which has gone through the kidney has been filtered off the waste and the waste in the urine comes out.

“Once you have little or no urine being formed, then it means a lot of wastes have come through the kidney and have gone back unfiltered. The causes of these are very many. The commonness is shock, or bleeding: another common one is medication, and another one is probably poison – those can cause acute kidney injury.

Other kidney diseases include tumours or cancers and Dr Asiimwe says cancer can be cancerous and non-cancerous.

Sometimes symptoms come pretty late and this is where prevention is a lot better than treatment, he adds.

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Dr Joseph Ogavu is a nephrologist. He says the symptoms everyone can tell are usually late signs, unfortunately. “The first symptom (this is what we tell people) – the first symptom of kidney disease is ‘no symptom’: “ .. they need to see for themselves and check how their kidneys are doing because the kidney is able to support you even after losing 70, 80 up to 90 per cent of its functions and you would have no symptoms until things really get beyond 20, 15 or even 10 per cent for many people.”

“So, for a good number of patients, they actually walk in and their kidneys are literally being torched but we have no symptoms and no signs. The signs are shared by many other diseases. If you have signs like swelling, passing little urine, running out of breath when you walk, being uncomfortable when you go to bed, or feeling weak, a good number of medical conditions can actually give you this: from the heart, liver and even malaria.”

In 2019, Dr Ogavu told Parliament that 21.4 per cent of Ugandans suffer from kidney-related diseases, adding that only 0.05 per cent gets treated due to inadequate dialysis services in the country.


Unfortunately, he said recently, “We get a good number of patients coming only late. As a public, we want everyone to test for their kidney.

“If everyone knew their diabetes and hypertension status, that would be a very big step in curbing kidney disease because those two, world over account for 80 to 90, in many cases 95 per cent of the causes of chronic kidney disease.

Also read: More kidney patients go to Lira Regional Referral Hospital for dialysis

“If one has hypertension, has diabetes, they need to check their kidney status regularly. If you do not have one, then about three years is sufficient for you to check and the checks are simple: a blood test that measures your creatinine levels subject to a calculation: 100mg/dL to 0 – where 100 is good but some younger people may show figures up to 130. And 0 (zero) is not good, not compatible with life. Usually 10 and below may require you to be on dialysis,” Dr Ogavu explains.

The other test he says is a “urine test” which sees if the kidney is working well, if it’s not leaking blood, not leaking protein, not leaking sugar. He says they also measure a small protein in the urine called microalbumin, adding that it should not be there.

“There are patients who are not diabetic, meaning their sugar is normal, they don’t have high blood pressure but this still comes to you. We have a number of conditions that affect other tissues in the body and as a result, the kidney gets caught in the crossfire. These conditions might affect the skin, bones, and cartilage, they might affect your hair, so we called them connective tissue diseases…

“If any country manages hypertension and diabetes, and treats people so well then a lot of kidney disease will be averted, then we shall remain with the inevitable ones where people are born with conditions like sickle-cell disease.

Another cause of kidney disease Dr. Ogavu reveals is self-prescription where some people take medicine prescribed like three years ago. “It is very painful when you come and all evidence is clear that you have been swallowing painkillers for two years for some pains that could have been managed.”

Kidney disease, Dr. Ogavu further says is not far from environmental pollution. “There are many things that pollute the environment, mercury, gold and many things. There are what we call chronic diseases of unknown origin which are increasingly becoming a concern to the kidney world and that is common in areas where people do extensive agriculture but they use a lot of herbicides and some chemicals that are not licensed or don’t wait for the drugs to get withdrawn.

“If you spray your gardens, it should take you some time before using it or you should use appropriate gear,” he warns, adding that some of the gardens are for vegetables and they keep spraying all the time.

“I’m not saying this is the cause but don’t be surprised if some patients are not diabetic, hypertensive and they don’t have related risk factors, they don’t have chronic tissue disease but they have kidney disease we cannot explain,” explains the country’s nephrologist.

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Dr. Anthony Buhangamaiso battles kidney disease

As many kidney patients go unnoticed, Uganda’s surgeon, Dr Anthony Buhangamaiso, 37, has been diabetic for the past 20 years.

According to the available public record, the youthful surgeon is currently seeking both financial and kindness support to overcome the battle.

He’s currently battling ‘End Stage Renal Disease’ – which urgently requires a kidney transplant by September 15, 2023.

His wife, Martha Namugabo has offered one of her kidneys to save her husband. The transplant and treatment are expected to cost UGX150m – half of this has been fund-raised.

According to Dr. Herbert Luswata, the Uganda Medical Association has tried their best to look for money to treat their colleague – Dr Anthony.

“It feels very bad when a person who is providing care finds themselves in such a situation whereby they cannot afford the care they provide to other people.

“In the two years we have had two people, Anthony is the second one. Last year we had a gynecologist whose leg was crushed by a bug truck.

Dr Luswata says when they had a chance to meet President Yoweri Museveni, one of the demands the Uganda Medical Association put before him was to have health insurance for health workers, adding that the decision was based on the fact that judges, Members of Parliament have been supported by the government when things go bad.

In 2021, he says the President was very receptive and said it was ‘okay’ and would work on it. “Unfortunately, when further discussions took place, they gave us a promise that we may not need to have a special or separate insurance for different public servants (or health workers) because the President was going to sign the National Health Insurance Bill.”

He (Luswata) calls it “very unfortunate” that up to today the Bill has not yet been signed, adding that what they are seeing “are more discussions”.

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