World Kidney Day, observed on the second Thursday of March every year, is a global campaign with focus on the health and importance of kidneys. It also aims to reduce the occurrence of kidney diseases. The theme of World Kidney Day 2018 is ‘Kidneys and Women’s Health: Include, Value, Empower.’ Chronic kidney disease (CKD) has adverse outcomes such as kidney failure and premature death. CKD is currently the 8th leading cause of death in women who have a higher risk of developing it. The average prevalence of CKD is 14 per cent in women and 12 per cent in men. However, fewer women are on dialysis. The reasons could be many.
The progression of CKD is slower in women compared to men. Psycho-socio-economic barriers such as lower disease awareness lead to late or no start of dialysis among women. Unequal access to care is a major issue in countries with no universal access to health care. Kidney transplantation is also unequally spread, mostly due to social, cultural and psychological aspects. Women tend more often to donate kidneys and are less likely to receive them.
Kidney Diseases in Women
Many kidney diseases, such as lupus nephritis or urinary tract infection (urethritis, cystitis and pyelonephritis) typically affect women. Lupus nephritis is caused by an autoimmune disease, which is a disorder in which the body’s immune system attacks own cells and organs. Pyelonephritis is a severe infection of the kidneys. Urinary tract infections (UTI) are more common in women and the risk increases in pregnancy.
Menstrual irregularities: Women with CKD commonly experience menstrual irregularities. This can include excessive bleeding, missed periods and even early onset of meno-pause. These women may develop meno-pause 3 to 5 years earlier than patients wit-hout CKD. Treat-ment can be very challenging. Hormone replacement therapy can increase the risk of heart disease and blood clotting disorders. Kidney transplantation will usually correct these abnormalities.
Kidney Disease & Pregnancy: CKD is associated with decreased fertility and adverse pregnancy outcome, both for the mother and the baby. Pregnancies in women with advanced stages of CKD have high rates of hypertensive complications and preterm births. They usually have reduced fertility, but conception is possible. Women with CKD who become pregnant may lose significant amounts of kidney function during pregnancy and need dialysis treatment. In women on dialysis, results improve with intensive (daily or nearly daily) dialysis treatment. Thus there is a need for dedicated programmes for women of childbearing age. In successfully transplanted women, fertility can be restored. The chances of successful birth are increased. However, they have a higher chance of complications than in the general population. It is important to have preconception medical counselling. 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.
Similarly, pregnancy-related complications can increase the risk of kidney diseases. Pre-eclampsia is a condition in which a defect of the implantation of the placenta affects kidney function causing high blood pressure (hypertension) and protein leak in the urine (proteinuria). It is one of the three leading causes of 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 lack of availability of dialysis for severe AKI. There is a clear need for higher awareness, timely diagnosis and proper follow up of CKD in pregnancy. In turn, pregnancy may also be a valuable occasion for early diagnosis of CKD, allowing planning of therapeutic interventions.
Urinary ract infections (UTI) are responsible for a large number of healthcare visits each year. Women have a lifetime risk of over 50 per cent of developing a urinary tract infection. UTIs are given different names depending on where they occur. Bladder infection is called cystitis; urethra infection is called urethritis and kidney infection is called pyelonephritis. Common symptoms include a strong, frequent urge to urinate and a painful and burning sensation when urinating. A UTI is usually diagnosed based on symptoms and testing of a urine sample.
A urine culture will identify the organism causing the infection and help in choosing the appropriate antibiotic. Simple UTIs can be cured with two to three days of treatment. If not treated promptly, the bacteria can travel up to the kidneys and cause a more serious type of infection, called pyelonephritis.
Systemic lupus erythemotosus (SLE) is an autoimmune, chronic inflammatory disease. The antibodies aren’t able to tell the difference between harmful foreign substances and the body’s own healthy cells and tissue. As a result, the immune system attacks its own body parts, causing varying degrees of inflammation and organ damage. It is called systemic because it can affect the whole body. Around 90 per cent of the people who get lupus are women and it primarily targets women in their childbearing years.
Women’s health comes with unique considerations. One thing we know for certain is that women of reproductive age face different complications than men when it comes to kidney disease. Women with CKD are generally discouraged from using “the pill” as a birth control method due to a potential increase in blood pressure and blood clots that can negatively impact kidney disease. Women with CKD may have additional complications with pregnancy and those with later stage kidney disease may have an increased risk to the mother and the child.
Kidney ailments high among women
As World Kidney day and International Women’s day fall on the same day on Thursday, medical experts stress the need for increased awareness among women on kidney diseases as the risk and prevalence of kidney ailments are high among them. Indian population, especially women are highly vulnerable to kidney disease due to high prevalence of diabetes. There are 60 million people with diabetes in the country and 30 percent of them will develop chronic kidney disease.
“Urinary tract infection is very common among women and girls and the risk increases during pregnancy. If not diagnosed early and treated promptly, it can cause permanent damage to kidneys. Diagnosis of chronic kidney disease can be made with simple tests of serum creatinine and urine routine along with checking blood pressure. Drinking two litres of water per day, will help to reduce incidence of urinary tract infection and to maintain the health of kidneys,” said Dr Anil Mathew, nephrologist, Amrita Institute of Medical Sciences, Kochi.
“Most of the autoimmune diseases like rheumatoid arthritis, systemic sclerosis and lupus affect functioning of kidneys in many ways. Since autoimmune diseases are more prevalent among women, they are at higher risk,” he added.
Progression of chronic kidney disease is slower in women and the number of women on dialysis is lesser compared to men. Number of women undergoing renal transplant also is less. While 75 per cent of kidney donors are women, the number of women recipients is only 25 per cent.
(Dr Jayant Thomas Mathew MD, DM, FISN, FRCP Professor & Head of Nephrology, Amala Medical College, Thrissur)
