Living with KIDNEY DISEASE

       Transplants can get patients back to a normal life When Porntip Puang-ngern became easily tired, began to lose weight and was vomiting frequently 10 years ago, she had no idea what was wrong.
       Even when the doctor diagnosed her with chronic kidney disease, she remained in the dark about the illness.
       "I didn't know much about kidney disease at that time. Information was hard to find, and the illness was so unfamiliar to me," said Ms Porntip, now 60 years old.
       However, after similar symptoms appeared in her two sisters a few years later, kidney disease was no longer a stranger to the Puang-ngern family.
       Back then, the three sisters were in and out of hospital for treatment which was to change as their illnesses progressed.
       Despite oral and injected medication, the disease reached end-stage renal failure so it was necessary to undergo haemodialysis, a treatment which is tiring and time-consuming.
       "It took 4-5 hours for each treatment, twice a week, and often I would feel the side effects like weakness and dizziness when I returned home," said Jongkol Puang-ngern, one of Ms Porntip's sisters.
       The doctor urged them to register for donated kidneys with the Thai Red Cross Society. Finally, luck was on their side. Just a few years after they registered, the three sisters had successful organ transplants.
       "Getting a new kidney and being able to live on with it is like winning the lottery. Now we're happy living life the way we used to. What we need to do is to take better care of ourselves so that our new kidneys can last for a long time," said Ms Jongkol.
       Knowing your kidneys
       The kidneys are a pair of bean-shaped organs on either side of the spine in your lower-middle back.
       Dr Viroon Mavichak, a nephrologist at Praram 9 Hospital, says that the main function of the kidneys is to clean our body by removing waste products and excess water from the blood. All the while our organs such as the heart, lungs and liver are working, waste products are generated from the normal metabolic process. These waste products are released into the blood, and carried to the kidneys, which filter the blood and excrete the waste in the urine.
       "If our kidneys function well, all the waste will be excreted, and our bodies will be fresh and clean. But if the kidneys function poorly, our bodies become polluted. Our blood will be dirty and the body dirty. That results in the malfunction of other organs. If both of your kidneys completely fail or someone took them out, you will be dead within seven days," said Dr Viroon.
       Chronic and acute kidney disease
       The Puang-ngern sisters
       Chronic kidney disease happens when one suffers from gradual and usually permanent loss of kidney function. This happens gradually over time, usually months to years. In the end, patients will suffer end-stage renal failure, when there is total or near-total loss of kidney function and patients need dialysis or a transplant to stay alive.
       Acute kidney disease, meanwhile, develops rapidly over days or weeks. It is a serious condition, but does not cause permanent damage to the kidneys, and still can be cured in time.
       The chronic type, however, is more worrying as the early signs can be very subtle and many people who have the disease don't know it.
       What causes chronic kidney disease?
       Dr Viroon says there are various causes of kidney disease. Diabetes, high blood pressure, kidney stones, occlusion of blood vessels, gout, and kidney infections can result in chronic kidney disease, while factors such as accidents and severe diarrhoea can result in acute kidney failure.
       "Chronic kidney disease that is mostly found in urban people is caused by diabetes. Diabetes can cause arterial occlusive disease which, if it continues for 10-20 years, will lead to damaged kidneys," he said.
       In rural areas, however, kidney disease is mostly a result of "glomerulonephritis", a disease causing an autoimmune reaction to kidney tissue.
       Who can have a kidney disease?
       Dr Viroon says about 10,000 Thai people currently have a kidney disease, with an average of one new patient each day.
       He said kidney disease can happen in people of all ages, even infants who are born with a kidney abnormality. But mostly, it happens to people aged 30-50 years old. People with diabetes or high blood pressure are also among the risk groups. In some cases, kidney disease can be genetically transmitted.
       Dr Viroon Mavichak
       How to know you have chronic kidney disease?
       According to Dr Viroon, people with chronic kidney disease normally experience symptoms when their kidneys are about 80% damaged. This is because kidneys can still function normally even though they have started to deteriorate.
       "Kidney disease is usually in hiding like an unseen murderer. When your kidneys are slightly damaged, you'll never know it unless you have a blood test. It's like your mobile phone battery. You can use it for 48 hours, then the power is gone and your phone will suddenly switch off," he said.
       When the kidneys finally lose their function, patients will experience the following symptoms:
       1. Loss of appetite, fatigue, nausea, and vomiting.
       2. Swelling in the legs, ankles, feet, face or hands because the kidneys don't remove unwanted fluids in your body.
       3. Change in urination. You may urinate more often. Urine may be foamy or bubbly or it may contain blood.
       4. Have anaemia problems.
       5. Poor function of the brain as it is not getting enough oxygen. This can result in memory problems, trouble with concentration and dizziness. If the symptoms are extreme, patients can be in a comatose state.
       6. Shortness of breath and respiratory problems as extra fluid builds up in the lungs.
       7. Waste build-up in the blood can result in skin rashes and itching.
       8. Reduced immunity causing easy infection from germs.
       9. Vomiting blood as a result of waste in the stomach.
       10. Women may experience infertility problems.
       How to treat chronic kidney disease
       Treatment for early stages of chronic kidney disease include oral and injected medication to boost the red blood cell count. When the disease progresses to the end stage, there are normally two major treatment methods. One is haemodialysis. Patients have to spend 4-5 hours per treatment on a kidney machine, two or three times a week, to have their polluted blood filtered and sent back into the body.
       "However, note that haemodialysis can only clean your blood, but it cannot replace other functions of the kidneys, such as the production of certain hormones."
       The best method, he said, is a kidney transplant. There are two major channels for getting the organs. First is from donors who have died in accidents. Second is donated organs from living people, which Thai law only permits from people in the same family, or husbands and wives who can provide evidence of their relationship. The sale of kidneys is illegal.
       After the transplant, patients need to take immune suppressive drugs regularly to stop the body from rejecting the new organ.
       "Getting another kidney is like getting a strange object into the body, which will try and fight that object. If that process is not controlled, the transplanted kidney will fail," said the doctor.
       The risk of this is especially acute in the first three months. Patients must therefore come for a regular examinations, every one or two months.
       The success rate for kidney transplants is 95% if the organs were given from relatives, and 75% from deceased donors. Normally a transplanted kidney can function for 30-40 years.