Category: Top to Toe

Dato’ Dr Amar-Singh HSS  Senior Consultant Paediatrician (Community), Head Paediatric Department, Hospital RPB Ipoh, Perak. Head Clinical Research Centre Perak

Dengue at a Glance

• Dengue is caused by the dengue virus (DENV).
• DENV can be transmitted from an infected person by the Aedes aegypti mosquito. It cannot be directly transmitted from one person to another through skin-to-skin contact or fluids.
• It can affect people of all ages (from infants to the elderly), with signs and symptoms usually showing 4-10 days after being bitten by the infected mosquito.
• There is no specific treatment. Dr Amar explains that early detection can, however, greatly reduce the risk of death.

When Dengue Attacks

According to Dr Amar, dengue is caused by the dengue virus (DENV), which:

• can damage our small blood vessels and make them more prone to leaking.
• can cause dengue shock sydrome (DSS) when fluids from our bloodstream seep into surrounding tissues. 
• can cause failure of various organs in our body when DSS acts together with the failure of heart muscles and dehydration. This can lead to death.
• makes children with dengue especially vulnerable to DSS!

Watch out for signs of dengue!

Symptoms include mild to high fever, severe headache, pain behind the eyes, rashes and pain in the muscles and joints.

The Four Faces of Dengue

Dr Amar-Singh explains that the threat of dengue is complicated by the fact that there are four different variants (or serotypes) of dengue viruses.

DEN-1      DEN-2       DEN-3       DEN-4

• If you get infected with one serotype, you gain lifelong immunity to it.
• The bad news is, there is still a risk of being bitten by an Aedes mosquito carrying any of the three remaining serotypes!
• Infection by another dengue serotype increases the risk of developing severe dengue, especially if more time has passed between the first and second infections.

Thus, it is important to ensure that the Aedes mosquitoes do not breed near you or your loved ones. This is the best way to avoid the threat of dengue.

[1] World Health Organization. Dengue. Retrieved on May 8, 2015, from http://www.who.int/topics/dengue/en/

[2] Rajapakse S. (2011). Dengue shock. J Emerg Trauma Shock. Jan-Mar; 4(1): 120–127. doi:  10.4103/0974-2700.76835

[3] Guzman, MG, et al. (2010). Dengue: a continuing global threat. Nat Rev Microbiol. December; 8(12 0): S7–16. doi:10.1038/nrmicro2460.

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In 2014, the global market research company Ipsos conducted a research on 500 adults across Malaysia on how aware they are about dengue. Here are some of the opinions they received from the people they surveyed. Do you agree with these opinions?

#1 Malaysians believe that they are very knowledgeable about dengue.

PARTIALLY TRUE. With more and more people having access to information, especially with the widespread use of mobile devices, more Malaysians are knowledgeable about dengue than before. However, there are some misconceptions that still persist, and some of these misperceptions, as you will see, can cause Malaysians to become complacent and safe. When, in truth, they are still at risk of dengue!

#2 Only very young and very old people are at risk of dengue infections.

FALSE! Dengue infection can happen to anyone, young or old.1 In fact, if you have a more active lifestyle (due to work or school), there is a higher risk of you being bitten by an infected Aedes mosquito while you are out and about.

#3 Dengue is not life-threatening.

FALSE! The World Health Organization (WHO) estimates that 500,000 people are hospitalized each year due to severe dengue, most of them children, and 2.5% of them will die.1 In Malaysia, as of July 4, there are 59,365 dengue cases in 2015, and 165 deaths. Therefore, dengue can be fatal, especially if not detected early!

#4 The risk of dengue is higher if you live in a village area. In town housing areas, things are cleaner and there are fewer places with stagnant water for Aedes mosquitoes to breed.

FALSE! If we look at the recent dengue cases in Malaysia, most of them actually occurred in towns and cities. There are many spots even in urban areas where standing water can be found – clogged drains, flower pots and even the tray in your air-conditioner!

Furthermore, there are usually more people living in cities, and these people live closer to one another. Therefore, it is easier for infected Aedes mosquitoes to bite more people, transferring dengue from one person to another probably more quickly than in rural areas.

So…

Don’t be complacent or take for granted that you and your loved ones are safe from dengue. Dengue doesn’t pick its victims, so let’s do your part to protect yourself and your loved ones from this potentially fatal disease.

World Health Organization. Dengue situation update number 469: update on the dengue situation in the West Pacific region. Retrieved on May 8, 2015 from http://www.wpro.who.int/emerging_diseases/dengue-biweekly-20150715.pdf

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What is Japanese Encephalitis?

Japanese Encephalitis (JE) is an infectious disease, which is caused by a type of virus called flavivirus. Flavivirus belongs to the same virus sub-family or genus as the dengue virus. Mosquitoes can spread JE virus to people and are called vectors.

When people are infected with JE virus, they usually have mild symptoms including fever and headache. But some, approximately one in 250, may develop severe symptoms as the infection spreads to the brain, with rapid onset of high fever, headache, neck stiffness and disorientation. They will most likely to end up in a coma and  might even die. If they recover from these severe symptoms, 20%-30% are likely to suffer permanent nerve-related problems like paralysis, fits and the inability to speak.

The scary part of JE is that although doctors can detect JE viablood tests, there is no antiviral treatment for now. So, prevention is the best option when it comes to JE.

How does JE spread?

Pigs and water birds such as herons are the main hosts for the JE virus. Infected animals serve as reservoirs for the JE virus; the virus multiplies in huge numbers in these animals, which have been important sources of outbreaks in Malaysia.

Your household mosquito, including three Culex species, is the main vector that transports the JE virus from these animals to humans. When a Culex mosquito bites an animal infected with JE virus, the virus is transferred to the mosquito through the blood. When the infected mosquito bites a person, the person is then infected with the JE virus. The virus subsequently multiplies in the infected person and causes illness.

Prevention tips

1. Do ensure you keep your house and its surroundings clean and clear of mosquito-breeding places. Clear, stagnant water – even as little as one teaspoon – can breed hundreds of those bloodsuckers.
2. Vaccinate yourself against JE. This is especially if you are living near construction sites, swamps, farms or other places that are conducive for mosquito breeding or are sources of JE virus. You may even plan to travel to countries where JE is common. In those cases, it’s best for you to consult your doctor for the vaccination.

References:

1. Centre for Health Protection. Available at www.chp.gov.hk

2. Go YY, et al. (2014). Zoonotic encephalitides caused by arboviruses: transmission and epidemiology of alphaviruses and flaviviruses. Clin Exp Vaccine Res.; 3(1):58-77.

3. WHO. Available at www.who.int

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Dr Eugene Wong   Consultant Orthopaedic & Spine Surgeon

Make no bones about it – arthritis is a prevalent condition that needs to be taken seriously. Over 60% of people over 65 have some form of arthritis, the most common being osteoarthritis (OA). As much as 90% of adults are affected by the age of 40.

Osteoarthritis (OA) occurs when the protective layer at the ends of the bone, called the cartilage, wears out over time. Without a strong layer of cartilage to cushion any friction and pressure that can occur when two bones rub against one another at the joint during movement, a person with OA can experience pain and swelling with each movement involving the affected joint. In time, the person’s mobility becomes restricted.

Currently, arthritis including OA is considered to be a biological process rather than a disease, which may be triggered off by various genetic, biological and environmental factors.

Vulnerable Spots

Do you know? The commonest joints affected by OA include the knees (41%), hands (30%) and hips (19%). The knee is more prone to injury because the entire weight of the body is transferred through the knee to the foot. About 13% of women and 10% of men aged 60 years and older have symptomatic knee OA.

It Starts With the Hand

Recent studies suggest that OA of the hand may predict the later development of OA in the hip or knee.

• Patients with hand osteoarthritis were three times more likely to develop hip arthritis.
• Osteoarthritis of the hand also slightly increased the risk for knee osteoarthritis.

Ladies’ Knees are More at Risk

Studies showed that the prevalence of knee OA in women can be up to as 1.7 times higher compared to men. Although multiple factors may contribute to this increased prevalence, the influence of sex hormones – oestrogen in particular – may be a reason behind this disparity between males and females.  The articular cartilage of the knee has oestrogen receptors, and a decline in oestrogen levels after menopause may contribute to this upsurge in knee OA in older women.

OA Risk Factors for Both Sexes

The hormone leptin may be a factor behind the breaking down of cartilage, the cause of OA

• Chondrocalcinosis, a condition in which a calcium salt called calcium pyrophosphate is deposited in our connective tissues (especially, those in the knees). We are not sure yet what causes this condition, but it has been closely linked to OA.
• Occupational and sports injuries, physical labour that often involves putting great pressure on the knees and obesity can increase the risk of OA.
• Low bone density (often related to an inadequate intake of relevant nutrients such as calcium and vitamin D).

Preventing OA

While OA may seem like an unavoidable result of aging, a healthy lifestyle can help in reducing or even preventing the many risk factors from affecting us. Here are some good practices to adopt:

Keep and maintain a healthy weight.

You can find your healthy weight by calculating your BMI and comparing the result to the normal BMI of people of your age. A healthy weight helps keep extra load off your knees and hips, thus keeping the cartilage in those areas healthy for a little longer. Also, if you are overweight, it is found that your body releases substances called cytokines, some of which would affect and even damage your cartilage, So, eat healthy and balanced meals in just the amount you need – not more, not less. Consult a dietitian if you need more advice.

Control your blood sugar.

A high level of glucose in the blood not only gives rise to type 2 diabetes at bay, it can also cause the cartilage to become stiff and vulnerable to damage. Diabetes can also trigger inflammatory reactions that erode the cartilage. So, let’s cut down on the amount of sugar in your daily meals!

Exercise, exercise, exercise!

People always say that if you don’t use something, you may lose it. When it comes to the joints and cartilage, put them to good use by being physically active at least 30 minutes a day. Such activities strengthen your muscles and help keep your hips and knees stable. If you are usually more sedentary, you can start small by walking more (window shopping a little longer is a good way to do this!), do more housework or gardening and take the steps more. In time, you can step up your activities by joining a gym or an exercise group in your neighbourhood park.

But, exercise wisely.

Take precautions against injuries by wearing protective gear or using exercise equipment correctly. If you also have conditions such as diabetes, heart diseases and such, consult your doctor on the appropriate types of exercise you can take up.

Treating OA

The treatment goals in osteoarthritis include managing pain, preventing disability and improving joint function. The motivation for most OA therapy is pain improvement and relief.

Shedding excess kilos.

Losing weight by monitoring diet is potentially one of the best treatments for controlling pain associated with knee osteoarthritis. Obese people with OA experience a 25% reduction in symptoms just by losing 5% of body weight.

Helpful compounds and food.

Although it has not been proven that glucosamine and chondroitin sulphate can help rebuild cartilage, there is evidence from a small number of patient studies that including these compounds as part of the treatment can reduce pain, usually within several weeks to months after initiating therapy. Some good dietary options include green lipped mussels (which contain omega-3 fatty acids, glycosaminoglycans and marine minerals that can support, repair and provide relief to inflammed joints); fish oil supplements and flaxseed oil (which contain high amounts of omega-3 fatty acids).

Regular exercise.

Exercises should focus on local muscle strengthening, and general aerobic fitness.  Some useful exercises include standing hamstring stretches, straight leg raises, side leg raises, heel raises, seated hip lifts and knee squeezes, chair squats and quadriceps-strengthening exercises concentrating on the vastus medialis oblique muscle.

Swimming is an excellent non-impact exercise.

Regular ‘land’ exercises can also be done underwater. The buoyancy of the water supports most of the body’s weight while the resistance of the water makes the muscles work harder to perform movements.

Keep in mind that activities such as squatting, kneeling, twisting, pivoting, repetitive bending and cycling place excessive pressure on the knee joints and must be limited until knee pain and swelling resolve.

The right support.

Supportive devices, such as finger splints or knee braces, can reduce stress on the joints and ease pain. Canes, crutches, or walkers may be helpful when walking becomes difficult. Shock-absorbing shoes or insoles can be helpful.

Pain relief.

Transcutaneous electrical nerve stimulation, ultrasound and laser are common methods prescribed to relieve pain in OA patients.

Of course, the medications.

Medications are an important strategy for breaking the pain cycle. There are no drugs that can reverse the progression of OA. The main goal of drug therapy is to relieve pain and help patients exercise and keep the joints functioning. There are a variety of treatments that can be applied to the affected joint that will relieve pain such as heat, ice, lidocaine patches, topical non-steroidal anti-inflammatory drugs (NSAIDs) and capsaicin.

Certain herbs such as St. John’s wort, devil’s claw, skullcap, angelica, black and white willows, bogbean, cayenne, dandelion, ginger, wintergreen, Boswellia, and valerian root can be used to reduce pain and inflammation.

NSAIDs can be used to treat pain and reduce inflammation Non-selective NSAIDs include ibuprofen, naproxen and indomethacin. Selective “COX-2” inhibitors are also an option. Diacerein inhibits an inflammatory substance in arthritic joints called interleukin-1b. Botulinum toxin type A injections may provide sustained pain relief for patients with knee osteoarthritis. Hyaluronic acid is used by injection into the joints in patients with severe disease and has many advantages but must also be used sparingly. It is used to replace lost fluid in the joint spaces and keep the joint working to cushion the bones in the joint.

Cartilage repair. Cartilage repair techniques include abrasion, drilling, microfracture and mosaicplasty. Grafting techniques include osteochondral allograft transplantation autologous chondrocyte implantation and autologous matrix induced chondrogenesis. Realignment osteotomy is an option in active patients with symptomatic unicompartmental OA of the knee with malalignment. Arthroscopic lavage and debridement are done for mechanical locking. Knee replacement can be unicompartmental, bicompartmental or total.

Stem cell therapy.

Stem cell usage is experimental as the results are not yet proven and consistently reproducible. The theory behind the action of stem cells is good and if this therapy works would reduce the number of total knee replacements.

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Dr Andrean Husin   Senior Lecturer & Neurosurgeon, Faculty of Dentistry, Universiti Teknologi MARA (UiTM)

Strep throat is a common condition that affects both old and young. According to scientific literature, its many causes include excessive and prolonged use of the voice, common cold and many other causes.

What is it, actually?

Strep throat is actually a type of inflammation of the throat caused by a type of bacteria, the Group A streptococcal. Streptococcal is a type of bacteria that appears round (coccus) when viewed under the microscope in high magnification, usually seen in pairs or chains. See Figure 1 for an example.

Figure 1: Streptococcus pyogene

Common symptoms to watch out for

Common symptoms primarily affect children between 5 to 15 years old. They experience a sudden onset of fever, sore throat and enlarged lymph nodes in the neck region with redness in the throat region. Some children may have swollen and painful tonsils. These presentations may actually overlap with a viral infection such an influenza (known commonly as ‘flu’).

Getting over strep throat

As a general rule, streptococcal sore throat is self-limiting (meaning that they usually resolve without medical intervention) but children and adults with certain systemic diseases (which may weaken their immune system) may need treatment with antibiotics. According to scientific literature (which has discussed strep throat treatment with antibiotics quite intensively for a long time), there is no hard and fast rule when it comes to these antibiotics; healthcare professionals should decide on the best course of treatment on a case by case basis.

Medication

• Antibiotics – There are many articles written proposing and opposing the use of antibiotics in strep throat infection. Taking into consideration individual patients, your doctor may prescribe antibiotics such as penicillin or cephalosporin. The Infectious Disease Society of America updated their Clinical Practice Guideline in 2012 recommending the use of antibiotics between 5 to 10 days (depending on the type of antibiotics) in order to eradicate  bacteria from the throat.

Home remedies

• Lymphatic massage This can improve throat pain in 20 to 40 minutes by helping the natural drainage of lymph. The technique described a gentle, steady pressure starting from under the jaw, moving towards the collarbone.
• Honey. Drinking warm tea with honey or plain honey has been reported to soothe throat pain. Studies have shown that honey has anti-bacterial properties.
• Throat gargle. Mix salt and hot water, and using the solution as a gargle every hour. You can also use antiseptic mouthwash for this purpose.
• Vitamin C is known to shorten the recovery period of any sickness by boosting the immune system. A daily dose of 2-3 gm of vitamin C over a span of several days should be appropriate for an adult with strep throat symptoms. Note that the recommended daily dose of vitamin C is about 40 mg at birth and increases to about in 90 mg in adults. This voluntary ‘overdose’ of vitamin C may work for some people.

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Alan had always considered himself to be healthy. Well, he wasn’t the definition of “fit” but he took pride in the fact that he barely called in sick to work. To him, that was “healthy” enough. So, when he began noticing mucous – and sometimes, blood – in his stools, he brushed it off as a symptom of haemorrhoids. Later, alternating bouts of constipation and diarrhoea set in. Once again, Alan didn’t think they were important enough to warrant a visit to the doctor. When he finally gave in and got himself checked 5 years later, the test results shocked him to the core – he had stage 3 colorectal cancer.

How common is “common”?

“Colorectal cancer is more common than most think,” says Consultant General and Colorectal Surgeon Dr Colin Ng. “It’s the most common cancer among men whereas for women, it’s in third place. More than 90% of cases in Malaysia strike those above the age of 40, with the risk increasing drastically for people above 50.” But Dr Colin is quick to add, “As prevalent as it is, it is highly treatable if detected early. A person’s risk can also be significantly lowered if risk factors are properly managed. Therefore, it’s crucial for Malaysians to be well aware of colorectal cancer.”

Introducing the Double “C”

“The colon is a tube connecting the small intestine to the rectum. It aids the body in reabsorbing nutrients and fluids from waste.  Meanwhile, the rectum which is the chamber linking the colon to the anus acts as a temporary storehouse for waste prior to defaecation. Colorectal cancer refers to cancer occurring in either of these organs,” explains Dr Colin.

Delving further, he says, “The colon and rectum’s inner lining can be breeding ground for polyps (small tumours). Polyps are mostly benign, meaning they are harmless. However, some may turn cancerous (malignant) later on. An example is adenomatous polyps, a type of polyp frequently found in the colorectal area. Other common types include hyperplastic and inflammatory polyps. Polyps aren’t normally cancerous but the larger they are, the higher the possibility of them becoming cancerous. Polyps with a size of less than 1cm have a slightly more than 1% risk of turning cancerous but the risk skyrockets to 40% should their size increase to 2cm or more.”

“What are my chances?”

Asked about the possible causes of colorectal cancer, Dr Colin says, “It’s still unclear what exactly causes colon cancer. However, there are factors which can up someone’s risk of colorectal cancer – or polyps for that matter.”

Runs in the family – sometimes

He says, “Research has found a link between inherited gene mutations and a small portion of colorectal cancer cases.  While inherited gene mutations don’t guarantee cancer, they can significantly heighten someone’s cancer risk.”

Common types of inherited colorectal cancer syndromes include:

Familial adenomatous polyposis (FAP)

It is a disorder whereby hundreds – in some cases, thousands – of polyps form in the colon and rectum lining. This occurs when the APC gene (a type of tumour suppressor gene) undergoes mutation leading to abnormal cell growth. If left untreated, individuals with FAP have a high chance of developing colorectal cancer before they turn 40.

Hereditary nonpolyposis colorectal cancer (HNPCC)

Also known as Lynch syndrome, HNPCC results from the mutation of genes which typically aid our cells’ repair of faulty DNA. When these genes mutate, DNA errors are no longer corrected accordingly. These errors may also affect genes which regulate cell growth, subsequently causing cancer. Individuals with HNPCC are likely to get colorectal cancer before the age of 50.

If you are worried that you are at risk of an inherited type of colorectal cancer, Dr Colin advises, “Consult a colorectal surgeon. There are genetic tests you can take to confirm your suspicions.”

You’re what you eat

“A diet rich in red meat and lacking in fiber has been associated with a higher colorectal cancer risk. Ensure your diet boasts various fruits, whole grains and vegetables so you can obtain as much antioxidants and fiber as possible,” he stresses. “But it isn’t just about your food but your way of cooking it. Frying or grilling meats is a no-no as extreme temperatures can turn meats carcinogenic.”

Excessive drinking is another factor. “Higher colorectal cancer risk is linked to heavy drinking with the link generally stronger in men. So, drink alcohol moderately; 2 units for men and 1 for women daily.”

Let’s get physical!

If you have been leading an inactive lifestyle, now would be a good time to get off the couch and hit the gym. “Sedentary lifestyle increases one’s risk significantly. So, do incorporate more physical activity in your daily routine. Try exercising for at least 30 minutes, 5 days a week.” Some studies have shown physical activity to have an effect on immune and inflammatory factors, which may in turn affect colorectal cancer risk. 

Underlying diseases

“Inflammatory bowel disorders like Crohn’s disease and ulcerative colitis can up your chances of colorectal cancer. The same goes for diabetes. Colorectal cancer has been found to occur more frequently in people with type 2 diabetes.”

Ditch that cigarette

Cigarettes are called cancer sticks for a reason. Colorectal cancer prevalence is significantly higher in former and current smokers compared to life-long non-smokers.  So, it’s not too late to kick the habit because studies have noted a decline in cancer risk among former smokers.

Screen, screen, screen!

“While having the aforementioned risk factors doesn’t mean you’ll definitely develop colorectal cancer, they mustn’t be overlooked.  You need to manage them promptly and accordingly – undergoing screenings being one of the ways,” Dr Colin cautions. “We generally advise people to undergo colorectal cancer screening when they hit 50 years old. However, if your risk is very high (eg. cancer runs in your family), your doctor will recommend earlier or more regular screenings.”

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Do you know that our brain is incapable of feeling pain? This is because there are no pain-detecting structures (called pain receptors) within the brain. These pain receptors can only be found from the coverings around the brain and bones as well as the scalp.

Hence, how and where do headaches come from? And are they any different to migraines? Experts seem to think that the surrounding tissues, brain chemicals, blood vessels and nerves are producing signals which result in a headache. Environmental factors such as loud noises may also be triggers. 

“Argh… headache!”

During a headache, an unpleasant pain may arise from the head or upper neck area. The perceived pain varies among people, ranging from a dull ache to an intense, sharp, throbbing pain –

Some common types of headache are:

• Tension-type headache: A common headache that is described as a feeling of constant pressure and tightness, as if a tight rubber band was placed around the forehead. Common causes include stress, worry, sleep deprivation, or tiredness. These headaches are usually treated with mild to medium strength painkillers.
• Chronic daily headache: A type of headache that occurs for over 15 days in a month and may arise from tension, muscle contraction or over-dosage of painkillers.
• Cluster headache: A rare form of headache that is often mistaken for a migraine or sinus headache. Some common symptoms are extreme head pain which lasts for 15 to 180 minutes. These attacks may occur for up to 8 times per day.

The above are just a brief rundown of the various kinds of headaches out there. Don’t forget that headaches can also be due to excessive drug or alcohol use, strained eyes, poor vision, infections, teeth disorders, stroke and head injury.

“Or is it a migraine…?”

Migraine, on the other hand, is more than just a headache. A migraine attack may last from 4 to 72 hours and it can be disabling. It usually affects one side of the body and may be followed by symptoms such as nausea and increased sensitivity to light and noise.

There are two types of migraine:

• Migraine with aura: Warning symptoms such as flashing lights or weakness from one side of the body before the intense pain sets in.
• Migraine without aura: Started off as symptoms of anxiety, depression or parched throat that lasts for hours prior to migraine.

We still do not know what happens in our head during a migraine, but we do know that the common factors include:

• Hormonal changes
• Anger, shock and other emotional stress
• Change in diet such as having infrequent meals
• Alcohol, drugs or additives consumption
• Environmental stress such as bright lights or loud noises
• Strained eyes
• High blood pressure

So, how’s the head?

Knowing the differences between a mere headache and a migraine is essential when it comes to distinguishing between the two. If you experience frequent pain in the head, you can keep a ‘headache diary’ to better assist the doctor when it comes to diagnosing such pain. Include the following in your diary:

• The day and time (if possible) it started.
• The duration of the headache (e.g. Does it lasts for a while or dissipates almost as quick?).
• The frequency of its occurrence.
• The location or area of the pain.
• The treatment used and if it worked. 

You may also record in your diary if the headache you have seems to be caused by medication, a particular event, or at certain times of the day.

Substance abuse and incorrect use of medication can contribute to pounding in the head. For these people, keeping a ‘headache diary’ will be especially useful as it can help the doctor determine what is happening to them.

References:

BrainFacts. Available at www.brainfacts.org

Healthline. Available at www.healthline.co

MedicineNet. Available at www.medicinemnet.com

NHS choices. Available at www.nhs.uk

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Chronic kidney disease (CKD) is a condition that causes your kidney function to deteriorate over time. At its late stages, you may be forced to undergo dialysis or even kidney transplant.

Fortunately, you can get screened for CKD if you suspect that you are at risk.

Who should get screened?

If you have a family history of kidney problems, diabetes and/or high blood pressure, you are at an increased risk – please consider getting screened as soon as possible.

The screening process is relatively simple and painless, as it involves checking your blood pressure and obtaining a urine sample for further testing and analysis.

The importance of early detection

You should not wait for signs of illness before you go for a screening. CKD may not show symptoms until it has reached an advanced stage, and by that point, your risks of developing various health complications are higher. If your CKD is detected early, your doctor can prescribe necessary treatment and medication to manage the disease and let your kidneys stay healthier for a longer period of time.

As an example, let us take a look at renal anaemia, which commonly develops in people with CKD.

From the kidney to the heart

Renal anaemia may occur in people with early stages of CKD, and it can worsen as the CKD progresses. It develops when the kidneys, damaged as a result of CKD, fail to produce the sufficient amount of erythropoietin (EPO), a hormone necessary to stimulate the production of red blood cells by your bone marrow. These red blood cells are important to transport oxygen to the tissues in your body.

When renal anaemia is left untreated, your heart has to work harder to pump more blood to the rest of your body. In time, the walls of the main pumping chamber, called the left ventricle, would enlarge and thicken, causing them to become less elastic. The ventricle may also increase in size.

Such changes can increase your risk of heart problems, even a potentially fatal heart attack.2 In fact, according to the National Kidney Foundation (US), heart disease is the major cause of death in people with CKD!

If your CKD is detected in its early stage, your doctor would be in a better position to monitor your condition closely. As such, renal anaemia can be detected in its early stage, and treatment can be given to manage the condition. Treatment options include iron pills, injections of modified forms of EPO (such as epoetin beta and methoxy polyethylene glycol) and red blood cell transfusion.

The earlier, the better

Similar to renal anaemia, other complications associated with CKD would be better managed or treated if your CKD is detected early. Therefore, if you believe that you are at risk, don’t hesitate. Talk to your doctor as early as possible to arrange for a screening.

References:

National Kidney Foundation (US). About chronic kidney disease. Retrieved on July 10, 2015 from https://www.kidney.org/kidneydisease/aboutckd

The National Institute of Diabetes and Digestive and Kidney Diseases (US). Anemia in chronic kidney disease. Retrieved on July 10, 2015 from http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/anemia-in-kidney-disease-and-dialysis/Pages/facts.aspx

Locatelli, F, et al. (2003). Effect of anaemia on left ventricular hypertrophy in end-stage renal disease. The European Journal of Heart Failure Supplements 2/2;207-212

[1] National Kidney Foundation (US). About chronic kidney disease. Retrieved on July 10, 2015 from https://www.kidney.org/kidneydisease/aboutckd

[2] The National Institute of Diabetes and Digestive and Kidney Diseases (US). Anemia in chronic kidney disease. Retrieved on July 10, 2015 from http://www.niddk.nih.gov/health-information/health-topics/kidney-disease/anemia-in-kidney-disease-and-dialysis/Pages/facts.aspx

[3] Locatelli, F, et al. (2003). Effect of anaemia on left ventricular hypertrophy in end-stage renal disease. The European Journal of Heart Failure Supplements 2/2;207-212

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Our kidneys deserve real love. Some of their functions include: removing waste products and drugs from our body (which may be dangerous if present in large amounts), ensuring that our body fluids are balanced, regulate the amount of red blood cells in our blood and releasing hormones that control our blood pressure.

Unfortunately, they are vulnerable to diseases. One particular condition of concern is known as chronic kidney disease (CKD). In CKD, the kidneys slowly become less capable of performing their normal functions, causing all kinds of health problems as a result. 

As CKD progresses, various potentially fatal complications can occur, including weak bones, nerve problems, heart problems and anaemia. In fact, heart disease is the main cause of death among people with CKD! Eventually, the disease reaches a late stage where the patient would require dialysis. Your doctor can advise you on more on these complications, but in the meantime, let’s take a look at a common complication: anaemia.

Anaemia and its Implications

In a normal person, the hormone erythropoietin (EPO) is produced in the kidneys to stimulate the bone marrow to produce red blood cells. As CKD progresses, there is less EPO produced, and as a result, the level of red blood cells will also drop, giving rise to anaemia.

Anaemia increases in prevalence as CKD progresses with time. Studies show that nearly all patients with stage 5 CKD – stage 5 is the final stage – have anaemia. In fact, it has been linked to a CKD patient’s poor quality of life, increased risk of cardiovascular diseases, hospitalization, impaired cognitive abilities (such as memory and reasoning) and even death.

Therefore, it is important that anaemia in CKD patients is detected and treated as early as possible.

Improving the situation

Medications containing methoxy polyethylene glycol-epoetin beta (MPG-EPO, a modified form of EPO), can be injected into the patient, to interact with the EPO cell receptors and trigger red blood cell production despite the reduced EPO levels in the body. As a result, the symptoms of anaemia as well as the risk of heart problems are reduced. A study in 2012 suggested that the use of MPG-EPO can reduce the overall time and cost of managing anemia in patients with CKD. Also, it is effective and generally well-tolerated, with only reported mild to moderate side effects. 

[1] National Kidney Foundation (US). How your kidneys work. Retrieved on May 27, 2015 from https://www.kidney.org/kidneydisease/howkidneyswrk

[2] National Kidney Foundation (US). About chronic kidney disease. Retrieved on May 27, 2015 from https://www.kidney.org/kidneydisease/aboutckd

[3] National Kidney Foundation (US). ESA’s and EPO for anemia in kidney disease. Retrieved on May 27, 2015 from https://www.kidney.org/atoz/content/epo

[4] Babitt, JL & Lin HY. (2012). Mechanisms of anemia in CKD. J Am Soc Nephrol 23: 1631–1634, 2012. doi: 10.1681/ASN.2011111078

[5] Ohashi, N, et al. (2012). Methoxy polyethylene glycol-epoetin beta for anemia with chronic kidney disease. Int J Nephrol Renovasc Dis; 5: 53–60.

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