Getting the Facts from Prof. Dr. Rashad Barsoum
By Hilary Diack
Diets and fitness regimes, supplements and surgery: tools we are increasingly using to feel and look the picture of health. Working behind the scenes of our daily lifestyle choices are our kidneys, often forgotten and taken for granted. To learn more about these vital little powerhouses and the critical role they play in our health, we visited eminent professor and kidney specialist, Dr. Rashad Barsoum at The Cairo Kidney Center in 6th Oct.
CWM: We have read that Egypt ranks 12th globally in mortality rates from kidney disease, why is that?
RB: In past years schistosomiasis had been responsible for many deaths, but with a massive government backed awareness campaign and effective use of the drug Praziquantel, which is considered to cure 70-80% of people infected with schistosomiasis, it is effectively under control. New cases have been reduced dramatically. Unfortunately this has been replaced by other threats to kidney health, diabetes and hypertension, illnesses linked to changes in our lifestyle and eating habits.
What are the most important points to remember when it comes to kidney health?
So long as you are basically in a normal state of good health the standard guidelines of drinking at least 8 glasses of water a day and keeping sodium consumption to a minimum apply. We must remember that sodium not only comes through table salt added to food, but is also a hidden component in many processed meats and convenience foods and snacks like potato chips. The amount of meat, fish, cheese and eggs consumed should be limited to small portions; the average adult really does not need to consume over 100gm per meal or snack. 15 gm of each portion would be protein, a total of 100gm of actual protein fulfils the daily needs. Vegetarians and vegans may choose to consume quality protein from alternative sources, this can be assimilated with the help of natural gut bacteria.
Are there specific foods that we need to eat to maintain our kidneys and avoid the formation of kidney stones?
So long as you are in general good health a balanced diet with a moderate level of animal protein and sodium is all that should be needed. Small amounts of naturally diuretic fruits, juices and vegetables can be included to boost urine production, but not in excess. For people with impaired kidney function a large amount of vegetables may result in too much potassium in the system, this can be avoided by boiling them first and draining off the water. If a problem exists, such as kidney stones it is important to carry out tests to ascertain which salts are evident, either calcium-oxalate (the most common cause of kidney stones, due to dietary factors, high doses of vitamin D, intestinal bypass surgery or several metabolic disorders which can increase the concentration of calcium or oxalate in urine), struvite (mainly from alkaline urine caused by a urinary tract infection or high magnesium excretion with high magnesium/plant-based diets), or urate (excess uric acid levels caused by a diet high in some types of seafood, organ meats and foods high in purines). Each has specific treatments and dietary adjustment requirements, so it is a mistake to either self-medicate or adjust the diet without identifying the cause. It is key to keep your water intake at the correct level to lubricate and flush the kidneys.
How can we treat kidney stones?
Anyone who has suffered from these can attest to how painful it can be. Smaller stones of less than 4mm can be flushed out through the urinary tract, but may require a painkiller to help. Stones too large to pass are sometimes treatable with ESWL (extracorporeal shock wave lithotripsy), where high-energy radiation or ultrasound is first applied to locate the stone, then shock waves used to break it down so it can be passed. For larger stones lodged in the urethra or kidney, minimally invasive surgery can be used, under general anaesthetic, or rarely, in more some cases, open surgery. Uric acid stones that build up through a dietary imbalance can usually be dealt with by alkalizing the urine with medication and drinking at least three liters of water per day. This usually dissolves them quickly.
What are the worst habits people can have that damage their kidneys?
Simply by neglecting to follow the simple commonsense guidelines for kidney health, or allowing diabetes or high blood pressure to go untreated. Excess protein consumption is another danger, especially with body-building and fitness fans. Whey protein is a good nutritional option, especially after workouts, but again, not in excess, and the body must be well hydrated.
Are there holistic remedies and herbal treatments that can help?
Traditional remedies like herbal teas can be a general tonic when used correctly by someone in normal health, but in the case of a real kidney problem the course of action should be to consult a specialist who has the knowledge to analyze and treat the condition. Medical treatments have advanced to the point where designer drugs are so carefully created they can target and deal with specific problem in one concentrated, focused dose.
Is the quality of drinking water in Egypt a factor in kidney disease?
Contrary to a lot of hype this is not a real factor. Of course, water should be clean and bacteria-free, if not this is more likely to impact the digestive system. Visible sediment is normally passed through the alimentary system, hopefully without creating gastric problems.
Are kidney problems more evident in urban or rural communities?
Both, for different reasons. Urban communities are more prone to problems through incorrect diet, hypertension and diabetes, but benefit from easier access to medical facilities, while rural communities are less likely to have these causes, they are more likely to develop urinary infections due to schistosomiasis . The problem for them lies in having less access to doctors and medical care.
So, how can kidneys fail?
Kidney failure can come as a secondary result of hypertension and diabetes, therefore it is essential to monitor your health regularly. High blood pressure causes artery damage, and the kidneys are packed with arteries as well as being supplied with dense blood vessels, with high volumes of blood flowing through them. The kidneys filter 25% of the blood volume every minute, 24/7. They reabsorb 99.9% of this filtrate. Hypertension hardens the blood vessels of the kidneys and disturbs the pressure gradients, leading to diminished perfusion and impaired filtration. This leads to dysregulation of fluid, so your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood.
A nephrologist will recommend dietary adjustments and prescribe medication to support kidney function for as long as possible. Should that eventually cease to be effective the next step would be blood cleansing by dialysis, carried out regularly while the patient waits for a suitable replacement kidney. This can ideally be from a matched family member, as that lowers the chance of rejection by the patient’s body.
How many kidney transplants are carried out annually in Egypt?
Official figures range around 1400 transplants a year, but it is difficult to assess the full number. There is still a high demand for healthy kidneys for patients undergoing dialysis.
Where do transplant kidneys come from, and what guarantees are there that they are ethically sourced?
As mentioned, kidneys can be donated by family members (up to the 4th degree), who are a match in blood and tissue type. Alternatively they may receive from ‘emotionally’ motivated donors. Despite the law against accepting money directly for organ donation, unrelated paid donation is common in Egypt, mostly from Egyptian donors to Egyptian recipients. However the process is subject to stringent criteria set and audited by the Ministry of Health to avoid organ trading and trafficking as much as possible. Being in the common interest of both the donor and the recipient the illegal practice of organ trading is likely to continue until an efficient deceased donor program is established in the country. There are serious efforts to do so in the near future, once more political and social stability has been secured.
Are there any local organizations supporting sufferers of kidney disease?
The Egyptian Kidney Foundation works as a branch of the Egyptian Society of Nephrology and Renal Transplantation and has detailed information on hospitals and centers providing kidney care and surgery. We are positive about the level of attention kidney care is receiving and look forward to even more progress in the field. And of course, The Cairo Kidney Center branches offer a full range of services for kidney care and treatment.