By Tedler D. Depaynos, MD
I am not aware of any formal statistics on the incidence of renal failure but in our locality, there seems to be a surge just by experience and the number of patients undergoing dialysis for the past 2 decades. Dialysis used to be unknown in our locality and patients are referred to neighboring medical centers for the procedure. Nowadays you cannot miss patients undergoing the procedure especially those who have been on it for quite some time or have been irregular on their schedule because of their characteristic smell and darkening looks. There are at present 7 or 8 dialysis centers in our locality and some of these are located in our hospitals. They may be in our government hospitals but are privately owned.
Dialysis is practically an artificial kidney or simply functions like one. The kidney helps clean the body by excreting the unwanted or excess substances manufactured or taken in by the body for if they get accumulated they act like toxins. Hence the procedure should be regular and as often as possible. Because it is expensive patients tend to lengthen their schedule or undertake it irregularly. They even become non-productive because of the complications that ensue. Of course there are exceptions who could really afford like the late Pres. Ferdinand Marcos who allegedly have been undergoing dialysis. He had his private dialysis units in the Palace and even in his private bus like vehicle so he could have his procedure while traveling.
I could recall 2 of my close relatives who have been undergoing the procedure for years. They practically consumed all there was in their bank accounts and even sold many of their properties nearly leaving nothing to their children. One of them volunteered to stop his procedure prematurely because he preferred to have even just in his mind that his children would have something better to remember him by especially if they feel more comfortable from the things he would leave behind.
Renal failure is very insidious. The initial manifestations are very vague and non-specific. Even with some late manifestations, the kidneys after a series of lab and high tech examinations could be proclaimed normal. An engineer of a local electric cooperative has been having difficulty in controlling his hypertension reaching up to 190 to 200 systolic pressure readings. He underwent several hospital work-ups which were even shouldered by his company but the impression of a renal etiology by his cardiologist has never been confirmed. It was only after 2 years that his renal problem was confirmed and had to undergo the needed procedure. This is now a must for almost all medical practitioners. The impression of a renal etiology even with normal renal function tests is entertained when the hypertension is persistently highly elevated.
The appearance of acute renal failure may also be sudden and unexpected. The patient may have an unknown or undiagnosed chronic form which may suddenly appear as an acute form. A nephrologist mentioned that severe dehydration due to severe diarrhea, massive pneumonia and even undergoing a stressful surgery may cause the sudden appearance of undiagnosed renal failure.
Renal failure has many causes. It could be due to infectious or immunologic etiologies. It could be due to tumors or stones obstructing the passage of urine. One common cause which is taken for granted is uncontrolled or poorly treated diabetis mellitus. Just like renal failure it is very insidious. The patient feels nothing initially even if his blood sugar is severely elevated. This is the main reason why these patients do not seek treatment. When they feel something it would already be due to complications which may occur after 5 to 10 years of having the disease and one of them is persistently high blood pressure. Many of the patients have a history of home remedies which they attributed their symptomless years. I could recall another well to do successful engineer who always volunteered to shoulder our coffee whenever he was around even if he was on a distant table. He was always proud of the “advertized medicines” he was taking and sometimes displaying them proudly around which were making him allegedly comfortable despite his severe hypertension and elevated blood sugar. They were foreign to me so I always just congratulated him. As I met him from time to time during his dialysis schedules, I could still feel his deep regret for not seeking proper treatment which could have prevented the complications he is now suffering. **
