If You Have Diabetes, You Need to Do This for Your Kidneys!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR KENNETH LAI KOAH KIEN
Consultant General Physician and Nephrologist
Bukit Tinggi Medical Centre

Diabetic kidney disease, also known as diabetic nephropathy, develops when one’s kidney has trouble filtering waste from the blood.

An overview of diabetic nephropathy. Click the image to view a larger, clearer version.

When left untreated, the affected kidney may eventually fail and one would need either a kidney transplant or dialysis.

SYMPTOMS USUALLY SHOW UP UNTIL THE DISEASE IS AT AN ADVANCED STAGE, AND BY THEN, IT CAN BE MUCH HARDER TO MANAGE

According to Dr Kenneth Lai Koah Kien, it can take many years for diabetes to substantially damage the kidneys.

“Even then, the symptoms usually don’t show up until late in the course of the disease,” he says.

WHAT ARE THE SYMPTOMS, ANYWAY?
  • Unusual weight gain
  • Swollen ankles
  • Nausea or vomiting
  • Frothy urine
  • Lethargy
  • Urine breath
  • Itching
  • Reduced appetite
  • Swelling of the leg.
  • Blurring of visions and floaters (the eye can also be affected by kidney disease)
SO, WHAT SHOULD SOMEONE WITH TYPE 2 DIABETES DO TO DETECT DIABETIC KIDNEY DISEASE EARLY?

Dr Kenneth recommends the following:

If you have other health conditions alongside type 2 diabetes, keep them well-controlled too along with your diabetes

“These patients would need to monitor their co-morbidities closely with their doctors. These include hypertension, obesity, hypercholesterolemia, and smoking. All these are mercenaries of death together with diabetes,” he says.

Go for kidney disease screening

Recommended screening tests include:

  • A urine test called urine ACR to look for protein leakage
  • A simple blood test called serum creatinine test to look at kidney function

As for when one should start screening:

  • For type 2 diabetes, screening should start on the date of diagnosis.
  • For type 1 diabetes, screening should start 5 years after the onset of type 1 diabetes.

A Cancer Expert Explains What You Should Know About Wilms Tumour

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ENI JURAIDA ABDUL RAHMAN
Consultant Paediatrician, Paediatric Haematologist, and Paediatric Oncologist
Sunway Medical Centre

“Wilms tumour is the most common type of kidney cancer affecting children, usually those that are under 5 years old,” says Dr Eni Juraida Abdul Rahman.

FACTS ABOUT WILMS TUMOUR
  • It is also called Wilms’ tumor or nephroblastoma. The name Wilms came from Max Wilms, a German surgeon that first described this cancer.
  • The tumour is the result of mutations of genetic materials in kidney cells, which typically occur after birth.
  • Usually only one kidney is affected, but in 5% to 7% of cases, it can be found in both kidneys.
WHAT CAUSES WILM TUMOUR?

Just like with most cancers, we still haven’t found the exact causes for this cancer.

However, Dr Eni Juraida points out that there are certain genetic disorders that can increase a child’s risk of developing Wilms tumour, such as:

  • Aniridia, or the abnormal development of the iris of the eye due to genetic mutation, usually along chromosome 11 that led to deleted genes and hence missing genetic information.
  • Hemihypertrophy or hemihyperplasia, a condition in which one side of the body or a part of one side of the body is larger than the other in an extent that is greater than what is considered normal.

“Patients with WAGR syndrome have a 45% to 60% chance of developing Wilms tumour,” says Dr Eni Juraida.  WAGR stands for: Wilms tumour, aniridia, genitourinary malformation, and range of developmental delays.

SYMPTOMS TO WATCH OUT FOR IN A CHILD
  • Painless swelling in the abdomen, occasionally noted by parents while bathing the child; the tumour may cause discomfort
  • Haematuria, or blood in urine
  • Hypertension or high blood pressure
  • Fever
  • Unusual loss of appetite, resulting in weight loss
  • Pain in the abdomen
  • Generally feeling unwell
  • Cough and shortness of breath
HOW IS WILMS TUMOUR TREATED?

Treatment options will depend on the stage of the tumour.

Surgery

The mainstay treatment, usually done upfront for stage I and II tumours and sometimes delayed for stage III, is a surgical procedure called nephrectomy. This surgery removes the affected kidney and hence the tumour from the child’s body.

In the rare cases when tumours are present in both kidneys, partial nephrectomy removing only the parts affected by the tumour will be performed to preserve as much of the kidneys as possible.

Chemotherapy

“Chemotherapy are medications that are given to kill cancer cells,” Dr Eni Juraida explains.

For stage I and II tumours, these medications can be given after a nephrectomy, to kill off any remaining cancer cells.

However, stage III tumours are much larger in size compared to stage I and II ones, and chemotherapy will be prescribed before a surgery to first shrink the tumour. This will allow the surgery to be carried out more safely.

Radiotherapy

This may be prescribed in some cases, usually for tumours that has spread to other organs such as the lungs or are not completely resolved via chemotherapy.

CAN WE HELP PREVENT THE DEVELOPMENT OF WILMS TUMOUR IN OUR CHILD?

“Since we don’t know the cause, it is difficult to have any preventive measure,” Dr Eni Juraida points out.

However, for children with WAGR syndrome, having them undergo a surveillance ultrasound of the abdomen on a periodic basis—such as every 6 months—can help detect Wilms tumour.

NKF Offers Kidney Transplant Subsidy to Needy Organ Donors & Patients

WORDS LIM TECK CHOON

GOOD NEWS FOR MALAYSIANS THAT REQUIRE FINANCIAL ASSISTANCE TO UNDERGO KIDNEY TRANSPLANT

The National Kidney Foundation (NKF) of Malaysia has launched its Kidney Transplant Subsidy.

This subsidy aims to help underprivileged patients and organ donors with their financial burden of kidney transplantation.

The subsidy will cover various costs from pre- to post-kidney transplantation, including income loss replacement for the workup and recuperating period.

“The subsidy accounts for the many costs that are prevalent in the process of transplantation, which can discourage organ donors and patients from following through especially for those that are underprivileged. With over 8,000 Malaysians being diagnosed with kidney disease annually, it’s imperative that we help facilitate transplantation to the best of our ability,” says Khor Xin Yun, the Chief Executive Officer of NKF Malaysia.

WHAT THE KIDNEY TRANSPLANT SUBSIDY COVERS
BEFORE THE KIDNEY TRANSPLANT
  • Blood tests
  • Traveling expenses for out-of-town patients
  • Lodging expenses for out-of-town patients
  • Income loss replacement during organ donor’s workup
  • Other pre-kidney transplant workups, should services/facilities are not available at government hospitals and are needed in private settings
  • Other areas, where the need for kidney transplant screening is not available in government hospitals or being referred by government hospitals to private medical centres
DURING THE KIDNEY TRANSPLANT
  • Traveling expenses
  • Lodging expenses for the patient, organ donor, and carer
  • Subsistence for the poor, from pre to post-kidney transplant, as needed
  • Income loss for the organ donor during the recuperating stage
AFTER THE KIDNEY TRANSPLANT
  • Traveling expenses for follow-up
  • Lodging
  • Subsistence
  • Income loss
HOW TO APPLY FOR THE KIDNEY TRANSPLANT SUBSIDY
Government or university hospitals

To apply for the kidney transplant subsidy, the consultant nephrologist from a government hospital refers and recommends a patient along with a detailed medical summary and a list of items required for the subsidy.

If a government or university hospital does not have the capacity to tend to the patient

The nephrologist can refer the patient to a private hospital for pre-transplant screening and workups under the subsidy. However, the subsidy does not include the cost of surgical fees, as government hospitals have the capacity to perform kidney transplant surgery and provide immunosuppression therapy.

For more information about the NKF Kidney Transplant Subsidy, visit their website (link opens in a new tab) call 03-7954 9048 ext 208. 

Have Diabetes? Here’s an Improved Way to Track Your Blood Sugars

WORDS LIM TECK CHOON

Continuous glucose monitoring (often abbreviated as CGM) is basically a system that allows one’s blood glucose levels to be monitored automatically.

HELPS TO IMPROVE YOUR DIABETES MANAGEMENT

This system opens up a world of opportunities for better blood glucose management for people with type 1 diabetes as well as those on type 2 diabetes that require insulin.

After all, with information of their blood glucose levels that can be obtained immediately, they can make quick informed decisions about their food choices and the dosage of their insulin as well as when to administer it.

LETS YOU ANTICIPATE A POTENTIAL INCOMING MEDICAL EMERGENCY

The ability to observe the pattern of the rise and fall of their blood glucose also allows them to be alert of the possibility of a hypo- or hyperglycaemic episode, and take prompt measures accordingly.

NOT JUST FOR PEOPLE WITH DIABETES

Additionally, continuous glucose monitoring can also benefit people with kidney problems as well as pregnant women worried about gestational diabetes.

RECOMMENDED BY EXPERTS 

It’s really not surprising, therefore, that the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors—East Meets West Symposium reported a growing consensus on the definitions and targets of continuous glucose monitoring metrics to allow healthcare professionals and people with diabetes to make full use of this system in diabetes management.

Indeed, the United Kingdom has already taken steps to do this.

All in all, this is a remarkable example of how technology is making diabetes management, which can be complex and confusing to some people, considerably easier to figure out and implement correctly!

Continuous glucose monitoring is a feature in certain types of blood glucose monitor or glucometer. You can talk to your doctor or your pharmacist for more information on continuous glucose monitoring and whether you can benefit from using a glucometer that comes with this feature.

Reference: Oliver, N., Chow, E., Luk, A. O. Y., & Murphy, H. (2023). Applications of continuous glucose monitoring across settings and populations: report from the 23rd Hong Kong Diabetes and Cardiovascular Risk Factors – East Meets West Symposium. Diabetic medicine : a journal of the British Diabetic Association, e15038. Advance online publication. https://doi.org/10.1111/dme.15038

A Call to Pledge Your Organs to a Noble Cause

WORDS DR MOHAMAD ZAIMI ABDUL WAHAB

FEATURED EXPERT
DR MOHAMAD ZAIMI ABDUL WAHAB
Vice President
Malaysian Society of Transplantation
THE URGENT NEED FOR KIDNEY DONORS
  • Malaysia has an estimated number of 48,000 patients on dialysis and awaiting kidney transplant.
  • Each patient has an average waiting period of 13 years to get a transplant done due to the low donation rate.
  • A scoring system is put in place because of this and with it, only about 10,000 patients are eligible to receive a kidney from a deceased donor.

The current statistics of organ donation and organ transplant could be even better if many stepped forward to help advocate this cause.

Although a 2% rise was seen since 2020 with 77 transplants conducted from 16 deceased donors this year, the numbers could certainly get better.

WILL ORGAN DONATION LEAD TO MUTILATION OF THE DECEASED’S BODY?

The permissibility of organ transplant has been a cause for concern and a challenge in changing mindsets.

While most religions in Malaysia encourage organ donation, some beliefs like Jehovah’s Witness and Shinto do not permit organ donation.

Based on the statistics provided by the National Transplant Resource Centre (NTRC), bodily mutilation and the lack of knowledge as to what the deceased would have wanted are two of the most common reasons why families refused to give consent for organ donations from a deceased.

Mutilation of the deceased body is a misconception.

In order to successfully conduct a transplant, the deceased would also have to undergo a surgery similar to that of the living.

This procedure is done in the very best of manner to preserve the anatomy of the deceased so that no obvious disfigurement is seen after the retrieval process.

HAVE YOU PLEDGED TO BE AN ORGAN DONOR? HERE’S WHY YOU SHOULD
  • The self-satisfaction you can get in stepping forward to do an altruistic act through this pledge either for their loved ones, or any recipient in need.
  • Discovery of your risk of developing certain diseases or any undiagnosed diseases during the process of being a potential donor. You have the benefit of getting diagnosis and management earlier depending on their case if they are found to have something concerning.

So, have you asked yourself if you have the courage to pledge your kidney for the support of another and to give a fuller life to a patient with kidney failure? If you have done so, kudos to you, but if you have not, ask yourself what is stopping you and address those doubts scientifically.

Have the courage; make a pledge to be an organ donor now via your MySejahtera app.