Dr Titilayo Ilori, an assistant professor of Medicine in the Nephrology Division, Boston University School of Medicine, Boston Medical Centre, Massachusetts, United States of America, says that obesity is a potential risk factor for kidney disease.

She said this while discussing kidney failure and other related conditions with Alexander Okere.

Dr. Titilayo Ilori says, “The kidneys are internal organs responsible for getting rid of waste products by acting as a filter and these waste products are excreted in the kidney. The kidney is crucial for survival because once kidney function is lost permanently, it cannot be replaced except by dialysis or transplantation. In 2017, chronic kidney disease or CKD was the 12th leading cause of death worldwide resulting in about 1.2 million deaths. CKD and its complications, end stage renal disease, and cardiovascular disease, impose a huge economic burden, morbidity and mortality on individuals.

“Unfortunately the signs and symptoms of kidney damage are very subtle, and may not manifest until there is advanced kidney failure. Kidney disease may be largely asymptomatic and sometimes when symptoms do occur, it may already be in an advanced state. A patient usually has to have their serum creatinine checked at an annual physical and the estimated glomerular filtration rate calculated (eGFR).

When asked about the common causes of kidney faliures, she says, “Kidney failure can be caused by a range of conditions including chronic diseases, medications, herbs and obstruction. We can divide causes of acute kidney injury or AKI into pre-renal, intra-renal and post-renal. Chronic renal failure typically, but not always, is a downstream effect of chronic diseases.

“The causes of acute kidney injury include re-renal or causes affecting blood supply to the kidney, like extreme volume depletion, excessive bleeding, diarrhoea and vomiting; intra-renal or causes within the kidney, like medications (non-steroidal anti-inflammatory drugs), inflammation in the kidneys (glomerulonephritis), infections for example with viruses such as COVID-19, and muscle breakdown (rhabdomyolysis); post-renal or obstructive, like enlarged prostate, kidney stones, clots in bladder and prostate cancer.

“For chronic kidney disease, high blood pressure and diabetes are the leading causes. Others are inflammation of the kidney or glomerulonephritis, infection of the kidney or pyelonephritis, prolonged obstructive causes, like enlarged prostate, prostate cancer and kidney stones.

An eGFR (estimated glomerular filtration rate) or presence of protein in the urine, are the usual indicators of kidney disease. The body is able to adapt to changes in kidney function so the changes do not overtly manifest until there is a significant drop in kidney function.

Some of the common signs and symptoms of kidney disease include nausea and vomiting, loss of appetite, weakness and tiredness, excessive urination, waking up at night to urinate, foamy urine in some types of kidney disease and high blood pressure which is both a cause and consequence of kidney disease. Others are leg swelling, muscle twitching, itching, chest pain, if there is fluid around the heart, shortness of breath, if fluid builds around the lung.

Dr. Ilori when asked about the connection between kidney failure and obesity, says that “Obesity is a potential risk factor for kidney disease. Most studies have shown that increased obesity increases the risk of getting CKD. We do need more studies in sub-Saharan Africa to explain this association. Swelling of the legs, ankle and feet may manifest as weight gain.

“However, it may be evident that there is fluid in the lower extremity once the individual presses down on the feet and sees a dent (pitting edema). Obesity is derived from calculating the weight and height measurements of an individual.

She added that “One of the most powerful risk factors for kidney disease is the genetic risk factor ApolipoproteinL1 (APOL1) risk variant, which has been found only in individuals of African descent. Individuals with one copy of the risk variant are protected against sleeping sickness but having two copies of the risk variant predisposes people to kidney disease. The APOL1 risk variant is currently being studied by many clinical centres and teaching hospitals in Nigeria, and other parts of Africa.”

And on the effects of COVID-19 have on persons with underlying kidney problems, Dr Titilayo Ilori clearly said that, “Although the mechanisms are not fully understood, the COVID-19 virus may cause acute kidney injury in individuals without prior kidney damage.

“Part of the manifestation of AKI and COVID-19 infection has been protein in the urine. In addition, blacks with the APOL1 risk variants (two copies) and Sars Cov-2 infection may experience an aggressive form of kidney disease with rapid kidney function decline.