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What Nigerians must do to reduce incidence of kidney diseases ĖProf Akinkugbe

Posted by By Goddy Ofulue on 2008/03/08 | Views: 1192 |

What Nigerians must do to reduce incidence of kidney diseases ĖProf Akinkugbe


You have just emerged the first recipient of the Honorary Fellowship of the Nigerian Association of Nephrology; what does the honour mean to you?

You have just emerged the first recipient of the Honorary Fellowship of the Nigerian Association of Nephrology; what does the honour mean to you?

Well, indeed, it has a special meaning in the sense that forty years ago, I was privileged to start the first kidney unit in this country as a lecturer/consultant at the University Teaching Hospital at Ibadan.

I believe the association has thought it fit to give me this award, partly because I was the first association president when the association came into being in 1987. Itís a mark of honour and respect that its pioneer president should be bestowed with this honour in recognition of his modest contribution to the association. I have helped to train nephrologists, not only for Ibadan but for many centres in Nigeria, and also helped in promoting research, scientific knowledge in the field.

What was the situation like 40 years ago when you started?

The situation at the time was as it was with many things in the country in the early sixties and mid-sixties; the pattern of diseases had not been clearly defined in many areas of speciality, whether it is liver or kidney or the brain. So, we were overly concerned at that time with defining, what to call in our own language, the natural history of some of these conditions. So, when I started the testing, I was first of all concerned with defining how prevalent and how much of a problem kidney disease was at that time and I soon discovered that it was a definite burden that many Nigerians had to carry. There were lots of young people dying from kidney disease, so we were really at pains to unravel the cause of kidney disease.

Did you have the necessary facilities or equipment to start the assignment?

Well, we did not have the facilities and, in fact, the science of Nephrology had not advanced enough. That time, we were much more concerned with what was actually causing the kidney disease and we knew that infection of the kidneys was a major cause of chronic kidney failure. Apart from this we also know that high blood pressure and hypertension were also very important causes of kidney failure, and thirdly, conditions like diabetes were also important. So, I have mentioned three things now. Infections, hypertension and diabetes and these today constitute the major causes of chronic kidney failures. These causes can be single or, in fact, multiple. You can have hypertension and then you can have it co-existing with diabetes; that is a double dose.

But acute kidney failure can also be caused by a number of other things. For example, if there is a severe blood loss in a road accident, kidney functions may be compromised because a sudden fall in blood pressure means there is not enough blood going into the kidneys. Apart from that, kidney failure can also arise if somebody is severely dehydrated and if you have a lot of severe diarrhoea; and young women who have abortions are likely to experience it.

Readers would be interested in the solution to these various causes.

A very important step forward is to define the size of the problem we have. And this we have done. So, we know, for example, that at least ten per cent of Nigerians between the ages of 50 and 80 have high blood pressure. About five per cent also have diabetes. And so, what is needed is that we should go out and identify these populations early to be able to do something about them. If we can succeed in lowering blood pressure and in treating diabetes as early as possible, once you have detected it in the population, then that would go a long way towards decreasing the incident of kidney failure, because you are then nipping it in the bud.

Forty years after, how would you rate the fight against kidney diseases?

Well, we are beginning to make some impact, though it is not easy, especially in the rural areas. Itís only those who come to the hospital because they have symptoms that we attend to. Majority of those who are affected by hypertension and diabetes do not know that they have these conditions. That is why they, especially hypertension, are called silent killers. They can manifest through heart diseases, a stroke or it may be through kidney failure. These are the situations, in which you try hard to get a cure, but where there is no cure and the kidney is damaged irretrievably, then you must be thinking of how to replace the kidney functions. That is the whole basis of dialysis and transplantation. And Iím very pleased that today, there are many dialysis centres, dotted all over the country. And now, there are also three functioning kidney transplant centres in this country, and this is a major achievement for the country.

Is that a major achievement in a country with a very large population?

But we have got to start somewhere, and these are what I call expensive forms of illness. It costs quite a lot to carry out a transplant on a patient, and the average Nigerian, doesnít have that kind of money. So, we are still a long way from making transplant services available to the generality of the populace. Even dialysis, which is a step before transplant, is expensive enough for an average Nigerian, not to talk of transplant.

But even with the facilities you said we have in Nigeria, some Nigerians still travel abroad for the treatment of kidney-related diseases. Why canít we do it locally?

They should be able to do it locally. Three centres have transplants now, the foremost is St. Nicholas Hospital in Lagos. They have done well over 60 transplants in the last couple of years. We have the teaching hospital in Kano; they have done perhaps more than 20; and there is the University Teaching Hospital at Ile-Ife, which has done a couple of transplants. But it shows that it can be done, and if we have enough resources, there are enough experts to be able to handle transplants. However, the point I must continue to emphasise is that itís an expensive form of therapy, although once a transplant is successful, you put your problems behind you in terms of symptoms. But with dialyses you have to continue indefinitely because you are doing the kidneyís work for it.

Do you have banks for kidneys as we have for blood?

We donít have that; you know kidney transplant means you have to have donors. Those donorsí kidneys will be taken from them as soon as they die. They could be living donors, that is donors which are prepared to give out a kidney even while still alive. Whichever way, people should be aware that they can give a kidney and get by with a lone kidney, because you can actually survive with half of one kidney. So, we are in a way over provided, the good Lord has taken care of that. But many people do not know this and there is this misconception that if I give out one kidney, I may not be able to survive.

Are there rules guiding kidney donation as there are for blood donation?

Of course, the kidney you give out has to be compatible with the patientís; if not compatible, the recipientís body will reject it. And that is why the more successful transplants are those of living donors that are related. But nowadays, you have kidneys that are transplanted from unrelated donors.

Beyond compatibility, are there some other rules?

Well, of course, the donor must be ascertained to be healthy himself, and the kidney he gives must be healthy too. The actual procedure of transplanting a kidney is fairly straightforward, the surgeons who are kidney experts can do it easily, following the laid-down rules.

Canít anything be done to help an average Nigerian afford the treatment of kidney?

Well, itís a task. For a country that has just begun to understand the basis for national health insurance, it might be too much at this point to say that the national health insurance should take care of this. On the other hand, in many countries, there are insurance arrangement to make kidney transplantation available.

It is currently in the news that you have just joined the board of Fidson Healthcare Limited, how do you cope?

Well, first of all, I am a retired professor. This means that I can turn my attention to a number of things. I enjoy what I am doing generally. A couple of months ago, I was invited by Fidson Healthcare Limited to join their board. When I look at the kind of things they have been doing, the achievement in the last couple of years, I had no hesitation in coming on board. I see it as a serious company, well-focused and itís one of the pharmaceutical companies in this country that has a very bright future. So, I felt whatever little expertise I have can be readily made available to such a forward-looking organisation.

What impact are you looking forward to make at Fidson, and how soon?

Iím just joining the board, but Iím really excited by the various possibilities laid on the table, I donít want to go into details but I believe that very soon, if you ask me, you will see quite clearly why it is necessary to give this kind of organisation every support.

Some pharmaceutical companies are enmeshed in scandals, dragging down some reputable names. Have you done a thorough investigation to make sure that your hard-earned name is not soiled?

Well, Iím confident by the nature and the composition of the board that the company would fulfil my highest expectations and Iím really delighted to interact with people of the calibre of Felix Ohiewerei who is one of the captains of the industry in the country. You look at the kinds of people on a board before you join it and the entire management of that organisation fills me with a lot of hope. That these are young Nigerians who are so well focused and committed to best practices with the profession. Really, I think that I have people that will deliver.

How would you assess the pharmaceutical sector of the Nigerian economy?

Well, I think we are beginning to see light at the end of the tunnel. And I must pay special tribute to Dora Akunyili here, because she has done a lot to really launder the pharmaceutical industry. She has a rare combination of strength of character with iron determination and the capacity to deliver, which is not given to many Nigerians. Some see a lot but do little, but we can see from the way she goes about her business that sheís almost messianic.

So, the pharmaceutical industry I think is making good progress when you look at them generally. I think the battle against fake and expired drugs is a battle that must be ongoing, we are winning the battles, but the war is not yet won. It will take time and it will take the support of the generality of the populace and from those within the health industries.

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