World kidney day 2018- Woman and kidney health

(This is an article written by Dr Sukant Kishore Das. Dr Das is a renowned Nefrologist of Odisha, currently working in AMRI hospitals)

This year ,World Kidney Day and the International Women’s Day 2018 are commemorated on the same day,that is on 8th March 2018. This gives us an opportunity to reflect on the importance of women’ s health in general and their kidney health in particular .On this day,which happens to be 13th anniversary of World Kidney Day,it gives us an opportunity to promote affordable and equitable access to healthcare, education and prevention for kidney diseases for all women and girls in the world.

Chronic kidney disease (CKD) is a worldwide public health problem with adverse outcomes of kidney failure and premature death . CKD affects approximately 195 million women worldwide and it is currently the 8th leading cause of death in women, with close to 600,000 deaths each year .The risk of developing CKD is at least as high in women as in men, and in some estimates the risk may even be higher. According to some studies, CKD is more likely to develop in women compared with men, with an average 14% prevalence in women and 12% in men.The treatment of CKD in women is very much the same as in men,with specific challenges during pregnancy and child birth. It may be noted that the major deviations here are recognized so far such as CKD progression is slower in women compared to men, either delayed dialysis or no start of dialysis among women due to psycho-socioeconomic barriers such as lower disease awareness and uneven access to care is a major issue in countries with no universal access to healthcare. Therefore, the number of women on dialysis is lower than the number of men mainly in developing and third world countries.

Kidney transplantation is also unequally spread, mostly due to social, cultural and psychological aspects: even in some countries that provide kidney transplantation and equitable treatment for men and women, women tend more often to donate kidneys and are less likely to receive them . This phenomenon is very common in India too, where women are more commonly found as donors either as mothers, sisters and spouses. When a woman herself is the  patient requiring renal transplantation, , there is less likelihood of receiving a kidney from a male donor in the family. There is indeed a clear need to address issues of equitable healthcare access for women where it is currently lacking and increase awareness and education to facilitate women’s access to treatment and better health outcomes.

Some kidney diseases, such as lupus nephropathy or kidney infection (acute or chronic pyelonephritis) typically affect women more often than men.

Lupus nephritis is a kidney disease caused by an autoimmune disease, which is a disorder in which the body’s immune system attacks the own cells and organs. It occurs as an involvement of kidneys in a disease called SLE, which is around eight times more common in woman as compared to man.

Pyelonephritis  is a potentially severe infection that involves one or both kidneys. Kidney infections (as most urinary tract infections) are more common in women and the risk increases in pregnancy. To ensure good results, as most renal diseases, diagnosis and treatment should be timely.

It is important to discuss the complex relation between pregnancy and kidney diseases.CKD reduces fertility in woman, but conception is possible, though  infrequently in patients on, dialysis.  While on dialysis, results improve with intensive (daily or nearly daily) dialysis treatment, thus calling for dedicated programs for women of childbearing age  .CKD is also a risk factor for negatively impacting pregnancy outcomes. Women who have CKD are at increased risk for negative outcomes for the mother and the baby; pregnancies in women with advanced CKD are most challenging with high rates of hypertensive disorders and preterm births .

      In successfully transplanted women, fertility can be restored and chances of successful birth increase. However, as complications are observed more often than in the general population, preconception medical counselling should always be sought.

There is a clear need for higher awareness on CKD in pregnancy, to timely identify CKD in pregnancy, and to follow-up women with CKD during and after pregnancy. In this respect, pregnancy may be also a valuable occasion for early diagnosis of CKD, thus allowing planning of therapeutic interventions.

In turn, pregnancy-related complications increase the risk of kidney disease: pre-eclampsia, a syndrome in which a defect of the implantation of the placenta affects normal kidneys inducing hypertension and proteinuria, is a major cause leading  to maternal mortality. Preeclampsia, septic abortion (infection of the placenta) and post-partum haemorrhage (major bleeding after giving birth) are leading causes of acute kidney injury (AKI) in young women, and may herald future CKD in survivors .

The burden of those maternal complications is particularly high for women in developing countries, due to insufficient access to universal and timely prenatal care, to improper management of women with preeclampsia, and to lack of availability of dialysis for severe Acute kidney injury.

There is a clear need for higher awareness, timely diagnosis and proper follow up of CKD in pregnancy. In turn, pregnancy may be also a valuable occasion for early diagnosis of CKD, allowing planning of therapeutic interventions

The message on World kidney day 2018 is  –Kidneys & Women’s Health: Include, Value, Empower.

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