Covid-19: In complicated kidney disease, some patients need emergency surgeries

The Standard’s “Hidden Killers” series is supported by The Pulitzer Centre.

The Covid-19 pandemic saw many kidney patients skip hospital visits and now specialists are grappling with more medical and mental complications.

Some patients require emergency surgeries and have to be hospitalised, making their financial burden heavier.

Dr John Ngigi, head of Renal Unit at Kenyatta National Hospital (KNH), says most patients are returning with worsened kidneys than before the pandemic as “catheters are blocked because they did not come for their dialysis or diagnosis on time.”

There are more emergency surgeries to replace the catheters – the tubes inserted into the bladder to drain urine for those who cannot pee in the usual way.

The specialists also observed that most patients were mentally overburdened due to the lockdowns which restricted social interactions.

But it was fear of visiting hospital during the pandemic, which made matters worse.

“What we are handling now are patients at great risk of losing their lives. They stay longer in hospital or cost much more to treat, which the patient cannot afford sometimes,” says Dr Ngigi adding that patients who had kidney transplants before the pandemic were given immunosuppressants, or anti-rejection medicines, as standard post-transplant care.

The medicine is to prevent the patient’s immune system from rejecting the new kidney once the body realises it has an organ belonging to someone else. 

Human Kidney.

Weakened immunity

The medicine, Dr Ngigi explained, works by weakening the patient’s immune system. With a weakened immune system, infections can attack the patient easily, and the reason most stayed away from hospitals.

Some facilities like KNH and the Moi Teaching and Referral Hospital (MTRH) in Eldoret, however, noticed the mental anguish of their patients and began offering online check-in between doctors and patients.

By and large though, kidney disease is hidden but pervasive in Kenya where there is little awareness.

Dr Eva Njenga is a physician and endocrinologist – meaning she deals with all organs that regulate hormones in the body.

During the World Kidney Day on March 11, 2021, she reckoned that Kenya has policies for treating kidney disease but not many are about creating awareness. 

Yet, data from KNH, the country’s largest referral facility, reveal that two in every five (40 per cent) of inpatient there have kidney disease, according to a 2018 study published in the Panafrican Medical Journal.

A quarter of the KNH cases are advanced and may have landed at the hospital unaware their kidneys were failing.

The kidney, the janitor of the body, filters toxins from the body that could poison the blood. Most people do not know their kidneys are failing until they are wheeled into the emergency room with nausea, fatigue and so much fluid in their bodies that they are unable to breathe, a near-fatal condition called “crashing into dialysis”.

Depending on the stage, Dr Ngigi said the patient has three options – medication in case the kidney is salvageable, transplant or dialysis. 

The national insurer, NHIF, pays for dialysis but not the aftermath of the complications and Dr Ngigi says “patients are not able to top up the extra costs of care.”

In a previous interview, kidney specialist Dr Ahmed Twahir from Parklands Kidney Centre in Nairobi said it could be easy to find out the condition of one’s kidneys from a simple urine test considering “a urinalysis which costs as little as Sh150 in public hospitals would have arrested the situation” from deteriorating to the kidney functioning less than 15 per cent of its efficiency that thus needing machines to help it.

For not spending a mere Sh150, the bills hike to more than Sh25,000 a week for the dialysis, medication and special diets required of kidney patients.

“The kidney is resilient and gets diseases slowly that the patient would not feel the pain but by the time your feet are swelling, it is often too late and the doctor has no other option but to put you on dialysis as you wait for a transplant,” explained Dr Twahir who blamed lack of knowledge and poor medical seeking behaviour in the public for long-term kidney issues.