By Tedler D. Depaynos, MD
Many patients now appear to have End Stage Renal Disease (ESRD) or simply Renal Failure. This could easily be observed in Dialysis Centers with many patients waiting for their turn to undergo the dialysis procedure. Dialysis machines are actually “artificial kidneys” that remove the accumulated “toxins” in the body because of the no longer functioning kidneys.
Ideally, dialysis should be done 3x/week or more but because of the expense, many of the patients undergo the procedure twice or less per week. Of course the expense is not only due to the procedure but to the numerous prescribed medications for the complications of the disease like hypertension, for the factors that may contribute to other complications like high cholesterol and triglycerides and for the possible causes of the renal failure like diabetis mellitus. In short, having this malady is very expensive and to think that the patient is incapable of working any more or already in his/her senior years. For those who could afford, they are the exceptions because the high expenses may not be a problem.
From the newspapers, there is a petition being organized that the dialysis procedure should be completely shouldered by the government. Will it include also the other expenses? Nevertheless, it would really be a super help to patients with ESRD.
In one of my revealing discussions with a well sought after lady cardiologist, she mentioned that patients with hypertension and other diseases especially diabetis mellitus should undergo microalbuminuria examination or albumin examination of the urine. Diabetis Mellitus is a very insidious disease in the sense that patients may not feel anything even after 10 years of having the disease. When they feel something, it is already a complication and most of the time it is already irreversible. Microalbuminuria or urination of microalbumin may be the start of renal failure and at this stage it may still be reversed. When the albumin becomes macro, it may already be at a later stage. Hence, she routinely advises her diabetic patients as well as those with excessive high blood pressure to undergo this specific examination. Most of the time those with blood pressure reaching 190/110 have an unknown renal problem and maybe the cause of their HPN despite the normal Creatinine and Blood Urea Nitrogen (BUN) blood examinations.
The cardiologist mentioned 2 hypertensive groups of medications that may be effective in treating the early renal defect but from her experience she prefers Losartan 50 mg per day or ½ of the tablet per day if the patient is not hypertensive to be effective. With uncontrolled hypertension (HPN), she adds other anti-hypertensive drugs to make the BP at least 135/80.
Although she was adamant that the treatment should be aggressive, it should not only be with the HPN but also with the diabetis and the other factors that may contribute to other complications like blood cholesterol, triglycerides, etc. She also emphasized that the treatment must be continuous and the patient should have maintenance medicines because the diseases are more or less “permanent”. It is not like those diseases caused by bacteria or viruses that when the organisms disappear, the disease would do likewise. Treatment of course requires discipline, controlled diet and physical exercise.
The point she was actually emphasizing is that there are various causes of Renal Failure but that secondary to diabetis mellitus could be prevented if the impending sign is diagnosed early. The expected mountainous expenses could be prevented.
She ended our discussion by saying that she always advises her patients especially those with more advanced renal problem to consult a Nephrologist.**
