Global Health Asia-Pacific Special Issue - Page 21



Commonest Simplest Cause of Kidney Damage

It is said that if your kidney function drops below 15 percent , you are said to have kidney failure . What ’ s the commonest most frequent problem that are damaging the kidney ?

The one that stand out the most and affects all ages and both genders the most is Pyelonephritis , i . e . Infections that have spread to the kidney are causing swelling and damage to the kidney . Not the sexiest cause but the commonest and probably the easiest to fix . Long term and recurrent infections will cause scarring and loss of functioning glomerulus increasing the chances of kidney failure .
Kidney damage due to Diabetes , Hypertension or NSAIDS will be accelerated in these patients .
The concepts of pyelonephritis are quite straightforward .
1 . Understand that the urine is inherently sterile . It ’ s the cleanest fluid in the body . So where did the bacteria come from ? There must be a source . a . Almost always from the outside , i . e . vagina or skin into the urethra to the bladder and up into the kidney . Very rarely as blood / hematogenous spread from another infection e . g ., pneumonia seen and almost always is in the hospital ICU . b . Sex , Diabetes , STD and conditions that obstructs the flow of urine are going to contribute to infection : e . g . - Enlarged prostates , strictures and stones . Manmade problems like disruption of the vaginal flora by use of antiseptic “ cleansing ” vaginal products or overuse of antibiotics play a big part in recurrent urine infections in women .
2 . What ’ s the difference to UTI ? a . When I think of UTI , most of the time I am referring to a simple bladder infection with symptoms localized to the bladder , i . e . suprapubic pain , frequency or dysuria . b . Pyelonephritis is the next stem with involvement of the ureter and kidneys . The ureters often get edematous reducing drainage and causing swelling of the kidneys . At this stage symptoms are fever , loin pain and on examination tenderness over the ureter and kidney . Often the patients will complain of constipation due to ileus , malaise and fatigue .
3 . Why don ’ t we get it all the time ? a . The body ’ s immune system suppresses most infections at the level of the bladder and the continuous flushing out of urine helps reduce infection . b . Obstruction to flow whether from kidney to bladder , within the kidney or at the level of urethra will cause and aggravate infection . c . Young healthy women often have low levels of infection buy are asymptomatic .
Almost every clinician regardless of their field of practice is going to encounter someone with UTI . If left untreated , UTI can cause fertility issues due to associated pelvic inflammation which can cause scarring in the fallopian tubes or affect the ovulation process .
Dr Muhilan Parameswaran Consultant Urologist Thomson Hospital Kota Damansara TMC Fertility pmsurfer @ gmail . com
GlobalHealthAsiaPacific . com ISSUE 6 | 2022