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Kidney failure is deadly. Are you at risk for this silent disease?
LIN LI CHEN, a sales assistant from Kaohsiung, Taiwan, was an outdoor enthusiast and mountain climber who had always enjoyed excellent health. Then one day, when she was 25, she visited her family doctor complaining of giddiness and a cough. After examining Lin, the doctor diagnosed flu, and gave her medication to ease the symptoms.
BUT THE COUGH persisted and Lin felt increasingly weak. Her doctor referred her to a nephrologist - a kidney specialist --- who ran some tests, including one to check for protein in her urine, often the first indicator of kidney disease. "Lin," the specialist told her gently, "your kidneys have only 20 per cent of their function left."
Lin was shocked. "But I don't feel any pain," she said.
"With kidney failure," the nephrologist explained, "there is no pain until the final stages."
Lin stopped taking the medicine the nephrologist prescribed when she felt better. When the cough returned, she visited a herbalist, who specialised in Chinese medicine, and tried a herbal treatment. However, her condition grew worse. Six months later, she returned to the nephrologist, who immediately put her on dialysis.
For four months, she went to hospital three times a week for the four hour procedure. During each visit, intravenous lines were inserted into her arms. These were attached to a dialysis machine, which cleansed her body of toxins.
In July 1990, ten months after her diagnosis, Lin received a kidney transplant. Today she travels overseas and enjoys rigorous mountain walks. Last year she finished first in a civil service entrance exam. "The transplant gave me a second chance," she says. "Now I'm determined to live a meaningful and healthy life."
Doctors say early detection of kidney disease is vital so they can take steps to delay the need for dialysis or even a transplant. The good news today is that the test doctors perform for kidney disease can now be taken at home. Here's what you and your loved ones need to know about kidney disease and this life-saving test.
Silent Menace
To understand how people like Lin Li Chen can be blindsided by the news that they have kidney disease, it is important to understand how the kidneys function. The two bean-shaped organs, each about the size of a fist, house an elaborate filtering system that processes about 200 litres of blood -- the equivalent of 500 cans of soft drink --- daily. Of that, about two litres are discarded as waste and sent to the bladder.
Most kidney diseases attack the filtering system. Damaged kidneys continue to excrete urine but filter out much less of the body's wastes, which accumulate, poisoning the body.
A sign the kidneys are in the trouble is the presence of excess protein -- one of the basic building blocks in the body --- in the urine. Healthy kidneys retain the protein and excrete the body's waste products. But when the kidneys begin to deteriorate, they can no longer retain the essential protein properly.
The kidneys perform a number of vital functions, and when they become damaged, the whole body is affected. Blood vessels become constricted, and blood pressure rises. The disease can affect the brain and muscles, and interferes with the blood's ability to clot. Severe anaemia is common. A patient's bones will start disolving, says Dr. Khaw Bee Ling, a consultant physician at the Metro Specialist Hospital in Sungai Petani, Malaysia, because the kidneys are no longer getting rid of phosphorus, which causes calcium levels in the blood to decrease. As a result, the body produces a hormone that works on the bones to draw out the needed calcium, seriously weakening those bones further.
An individual only needs one kidney to survive, but by having two, the body has a parts compensate. Eventually the body's built-in reserves are depleted.
"I've seen patients who have endstage renal disease and need dialysis that day," says Dr. Antonio Paraiso, a kidney specialist at the National Kidney and Transplant Institute in Manila. "They don't realise they have a serious problem because they don't associate their symptoms with kidney disease."
According to Dr. Lo Wai Kei, chairman of the Hong Kong Society of Nephrology, millions of Asians are unaware that they may have elevated levels of protein in their urine. Approximately 4200 people in Hong Kong and 3000 in Singapore currently receive life-saving treatments-dialysis and transplants --- for kidney failure. According to Emily Tsuei of the National Kidney Foundation of Taiwan, nearly 27,000 Taiwanese received treatment last year, a 13 per cent increase over 1998.
Most Kidney diseases can't be stopped, and the damage can't be reversed. But new research has shown that, in many cases, kidney disease --- if detected early --- can be slowed dramatically.
Underused
There is a simple, inexpensive way to detect the earliest warning sign of kidney disease: a test strip that measures the presence of protein in the urine.
Some protein is present in everyone's urine. This test, however, picks up protein at higher than normal levels. For decades doctors performed this rest in the office. Now, however, there is an at home test strip, marketed by BioNet Laboratories Asia Pacific in Singapore, Malaysia, South Korea, Taiwan and Thailand, and is due to be released later this year in Hong Kong.
The test works simply. Urine is collected in a sterile cup, and chemically treated strip is dipped in the urine. If it changes colour, there is excessive protein in the urine.
One positive protein reading is no cause for panic. It may mean the patient has just exercised strenously or has a fever. Check with your doctor, though, and take a second test a few weeks later. Persistent excess protein, or protenuria, always points to a kidney problem.
Kidney specialists advocate making the test a regular part of annual physicals. Because the home test is new in most parts of Asia, doctors are concerned that the public doesn't know enough about the correct use or benefits of the test. "It's not being used to its fullest potential yet," says Dr. Cheng Kwang Rhong, a nephrologist at the Taiwan Adventist Hospital in Taipei.
Cheng Wen Ching, who runs his own computer-chip design company in Taipei, had a routine check-up in 1997 during a business trip to China. The doctor told him he had high blood pressure, but Cheng didn't think it was anything serious. Six months later, when he had painful swelling in his legs, his doctor in Taipei diagnosed chronic renal failure.
Cheng had to stop working for a year. "It took me completely by surprise," he says. I had difficulty accepting that my body was breaking down."
Medication and dietary changes brought Cheng's disease into remission and he is now working part time. Still, had the doctor in China given him a urine test, it might have shown his kidneys were in trouble before his symptoms appeared.
This routine test picked up kidney disease in Singapore housewife Hasidah Bite Md Saad in 1989. She was told she had the disease during a medical check-up for a new job and endep up in hospital for a month undergoing daily dialysis.
Hasidah received a kidney transplant last year. She is staying at home while she recovers from the operation, but plans to look for a full-time job when her condition stabilises.
Lifesaver
Recent medical reports reveal a troublesome fact: that people with diabetes and hypertension who have excess protein in their urine are more likely to suffer a heart attack or stroke. In fact, they may die of a heart attack or stroke before their kidney disease progresses.
Dr. Titus Lau, a nephrologist at Singapore's National Kidney Foundation, says that, as a result of this Information, doctors can better tailor regimens to patients in their efforts to control the progression of these diseases. It also points to the importance of regularly monitoring proteinuria in these patients, something that is not always done, he says.
Vincent Han, 29, of Hong Kong knows firsthand the importance of early detection and monitoring. When he started to suffer from swelling at the age of four, his parents took him to see several doctors. The diagnosis: chronic kidney failure.
Different doctors prescribed both Western and Chinese medicines over the years, and he didn't have to go on dialysis until he was 11. Fourteen years later, he received a new kidney.
"The operation gave me a new lease on life," Han says. "Except for some swelling in my legs and a bit of tiredness, I suffered no major problems after my transplant."
Twenty-five years ago, Asian doctors point out, nobody knew the importance of checking cholesterol levels. That's where we are today with kidney disease. Dr. Lo Wai Kei, who is also director of renal service at Tung Wah Hospital in Hong Kong, urges people to have a protein test whenever they go to the doctor, particularly those with diabetes and hypertension. "It's easy and inexpensive," he says.
It may just save their lives.
BUT THE COUGH persisted and Lin felt increasingly weak. Her doctor referred her to a nephrologist - a kidney specialist --- who ran some tests, including one to check for protein in her urine, often the first indicator of kidney disease. "Lin," the specialist told her gently, "your kidneys have only 20 per cent of their function left."
Lin was shocked. "But I don't feel any pain," she said.
"With kidney failure," the nephrologist explained, "there is no pain until the final stages."
For four months, she went to hospital three times a week for the four hour procedure. During each visit, intravenous lines were inserted into her arms. These were attached to a dialysis machine, which cleansed her body of toxins.
In July 1990, ten months after her diagnosis, Lin received a kidney transplant. Today she travels overseas and enjoys rigorous mountain walks. Last year she finished first in a civil service entrance exam. "The transplant gave me a second chance," she says. "Now I'm determined to live a meaningful and healthy life."
Doctors say early detection of kidney disease is vital so they can take steps to delay the need for dialysis or even a transplant. The good news today is that the test doctors perform for kidney disease can now be taken at home. Here's what you and your loved ones need to know about kidney disease and this life-saving test.
Silent Menace
To understand how people like Lin Li Chen can be blindsided by the news that they have kidney disease, it is important to understand how the kidneys function. The two bean-shaped organs, each about the size of a fist, house an elaborate filtering system that processes about 200 litres of blood -- the equivalent of 500 cans of soft drink --- daily. Of that, about two litres are discarded as waste and sent to the bladder.
Most kidney diseases attack the filtering system. Damaged kidneys continue to excrete urine but filter out much less of the body's wastes, which accumulate, poisoning the body.
A sign the kidneys are in the trouble is the presence of excess protein -- one of the basic building blocks in the body --- in the urine. Healthy kidneys retain the protein and excrete the body's waste products. But when the kidneys begin to deteriorate, they can no longer retain the essential protein properly.
The kidneys perform a number of vital functions, and when they become damaged, the whole body is affected. Blood vessels become constricted, and blood pressure rises. The disease can affect the brain and muscles, and interferes with the blood's ability to clot. Severe anaemia is common. A patient's bones will start disolving, says Dr. Khaw Bee Ling, a consultant physician at the Metro Specialist Hospital in Sungai Petani, Malaysia, because the kidneys are no longer getting rid of phosphorus, which causes calcium levels in the blood to decrease. As a result, the body produces a hormone that works on the bones to draw out the needed calcium, seriously weakening those bones further.
An individual only needs one kidney to survive, but by having two, the body has a parts compensate. Eventually the body's built-in reserves are depleted.
"I've seen patients who have endstage renal disease and need dialysis that day," says Dr. Antonio Paraiso, a kidney specialist at the National Kidney and Transplant Institute in Manila. "They don't realise they have a serious problem because they don't associate their symptoms with kidney disease."
According to Dr. Lo Wai Kei, chairman of the Hong Kong Society of Nephrology, millions of Asians are unaware that they may have elevated levels of protein in their urine. Approximately 4200 people in Hong Kong and 3000 in Singapore currently receive life-saving treatments-dialysis and transplants --- for kidney failure. According to Emily Tsuei of the National Kidney Foundation of Taiwan, nearly 27,000 Taiwanese received treatment last year, a 13 per cent increase over 1998.
Most Kidney diseases can't be stopped, and the damage can't be reversed. But new research has shown that, in many cases, kidney disease --- if detected early --- can be slowed dramatically.
Underused
There is a simple, inexpensive way to detect the earliest warning sign of kidney disease: a test strip that measures the presence of protein in the urine.
Some protein is present in everyone's urine. This test, however, picks up protein at higher than normal levels. For decades doctors performed this rest in the office. Now, however, there is an at home test strip, marketed by BioNet Laboratories Asia Pacific in Singapore, Malaysia, South Korea, Taiwan and Thailand, and is due to be released later this year in Hong Kong.
The test works simply. Urine is collected in a sterile cup, and chemically treated strip is dipped in the urine. If it changes colour, there is excessive protein in the urine.
One positive protein reading is no cause for panic. It may mean the patient has just exercised strenously or has a fever. Check with your doctor, though, and take a second test a few weeks later. Persistent excess protein, or protenuria, always points to a kidney problem.
Kidney specialists advocate making the test a regular part of annual physicals. Because the home test is new in most parts of Asia, doctors are concerned that the public doesn't know enough about the correct use or benefits of the test. "It's not being used to its fullest potential yet," says Dr. Cheng Kwang Rhong, a nephrologist at the Taiwan Adventist Hospital in Taipei.
Cheng Wen Ching, who runs his own computer-chip design company in Taipei, had a routine check-up in 1997 during a business trip to China. The doctor told him he had high blood pressure, but Cheng didn't think it was anything serious. Six months later, when he had painful swelling in his legs, his doctor in Taipei diagnosed chronic renal failure.
Cheng had to stop working for a year. "It took me completely by surprise," he says. I had difficulty accepting that my body was breaking down."
Medication and dietary changes brought Cheng's disease into remission and he is now working part time. Still, had the doctor in China given him a urine test, it might have shown his kidneys were in trouble before his symptoms appeared.
This routine test picked up kidney disease in Singapore housewife Hasidah Bite Md Saad in 1989. She was told she had the disease during a medical check-up for a new job and endep up in hospital for a month undergoing daily dialysis.
Hasidah received a kidney transplant last year. She is staying at home while she recovers from the operation, but plans to look for a full-time job when her condition stabilises.
Lifesaver
Recent medical reports reveal a troublesome fact: that people with diabetes and hypertension who have excess protein in their urine are more likely to suffer a heart attack or stroke. In fact, they may die of a heart attack or stroke before their kidney disease progresses.
Dr. Titus Lau, a nephrologist at Singapore's National Kidney Foundation, says that, as a result of this Information, doctors can better tailor regimens to patients in their efforts to control the progression of these diseases. It also points to the importance of regularly monitoring proteinuria in these patients, something that is not always done, he says.
Vincent Han, 29, of Hong Kong knows firsthand the importance of early detection and monitoring. When he started to suffer from swelling at the age of four, his parents took him to see several doctors. The diagnosis: chronic kidney failure.
Different doctors prescribed both Western and Chinese medicines over the years, and he didn't have to go on dialysis until he was 11. Fourteen years later, he received a new kidney.
"The operation gave me a new lease on life," Han says. "Except for some swelling in my legs and a bit of tiredness, I suffered no major problems after my transplant."
Twenty-five years ago, Asian doctors point out, nobody knew the importance of checking cholesterol levels. That's where we are today with kidney disease. Dr. Lo Wai Kei, who is also director of renal service at Tung Wah Hospital in Hong Kong, urges people to have a protein test whenever they go to the doctor, particularly those with diabetes and hypertension. "It's easy and inexpensive," he says.
It may just save their lives.
Who's Most at Risk?
KIDNEY disease can strike anyone, but some people are more prone to the disease than others:
- People with diabetes
- People with high blood pressure
- People with a family history of renal or heart disease
- People who are overweight, especially round the midsection
- People who have taken pain killers over a prolonged period
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