By SeeFoon Chan-Koppen
World Kidney Day Awareness & Healthy Lifestyle Campaign – 15th April 2017
“Bones can break, muscles can atrophy, glands can loaf, even the brain can go to sleep without immediate danger to survival. But should the kidneys fail, neither bones, muscles, glands nor could brain carry on.”
— Dr Homer W. Smith, From Fish to Philosopher
As the whole field of medicine gets more and more sophisticated, medical subspecialties are springing up like mushrooms after the rain and nephrology is one of these. A nephrologist is a medical doctor who specialises in kidney care and treating diseases of the kidneys. The term nephrologist comes from the Greek word “nephros”, which means kidney or renal and “ologist” refers to someone who studies. Nephrologists are also called kidney doctors. Nephrologists are educated in internal medicine and then undergo more training to specialise in treating patients with kidney diseases.
Dr Lim Wei Mei is one of these. After receiving her Bachelor of Medicine and Surgery (MBBS) from University of Malaya, Kuala Lumpur in 2004, she became a Member of Royal Colleges of Physicians, (MCRP) UK in 2008, an Internal Medicine Specialist in 2010 and a full-fledged Nephrologist in 2014 after having sat for her Board Exam in 2014.
In private practice at KPJ Ipoh Specialist Hospital Ipoh since ten months, having moved from Hospital Raja Permaisuri Bainun, Ipoh where she worked as nephrologist from 2014, Dr Lim has worked in hospitals in Kuala Lumpur, Seremban and Teluk Intan where she was born.
“The kidneys are vital for maintaining normal fluid and electrolyte balance in the body. We nephrologists are trained to be knowledgeable about medications and clinical pharmacology, high blood pressure management, diabetes management and its complications, epidemiology of diseases and infections as well as nutritional management for prevention and treatment of kidney diseases,” Dr Lim shared.
“One of the primary diseases that has a devastating effect on the kidneys is diabetes. As a result, many diabetic patients end up requiring dialysis which is the artificial process for removing waste and excess water from the blood,” she added.
Another disease causing kidney inflammation is SLE or systemic lupus erythematosus, an autoimmune disease that can cause leakage of protein into the urine, fluid retention, high blood pressure, and even kidney failure, again requiring dialysis.
“Although the causes of SLE are unknown, Type 2 diabetes can be prevented or controlled through various means without necessarily resorting to medication,” she emphasised.
High on the list for keeping the kidneys healthy and prevention of diabetes is through diet, followed by exercise, drinking lots of water, having annual check-ups (or even a simple urine test), not smoking, and avoiding the frequent use of common analgesics for pain relief which causes constriction of blood vessels.
An interesting link to kidney disease is obesity. A person is considered obese when he/she has a BMI (body mass index measured by dividing your weight in kilogrammes (kg) by your height in metres (m) and then dividing the answer by your height again to get your BMI) of more than 28 by Asian norms and slightly higher by western ones.
“People generally don’t relate obesity to kidney disease,” she chided, “but if a person is obese, there is more oxidative stress in the body and causes inflammation which forces the kidneys to work overtime, eventually leading to kidney failure. So weight control is an integral part of keeping your kidneys healthy.”
Dr Lim’s advice for people over 40 is to have a Renal Function blood test and urine test as a baseline to avoid kidney disease. Add to this is to lead a healthy lifestyle, and to follow her admonitions mentioned above for keeping the kidneys healthy.
But what about those who are prone to forming kidney stones either from genetic reasons or otherwise? Depending on whether the stones are from calcium deposits or uric acid, the latter being susceptible to drug treatment to lower uric acid levels, stones are treated by urologists using Shock Wave Lithotripsy (SWL), the most common treatment for kidney stones.
Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces which are then passed out with urine. SWL works better with some stones than others. Very large stones cannot be treated this way. The size and shape of a stone, where it is lodged in your urinary tract, your health, and your kidneys’ health will be part of the decision to use it. Stones that are smaller than 2cm in diameter are the best size for SWL. The treatment might not be effective in very large ones, in which case surgical intervention may be called for.
This is where the urologist comes in. A nephrologist like Dr Lim does not perform surgical interventions other than inserting a catheter for dialysis. Her job is to monitor and maintain balance of your kidney function to ensure that your ‘filtration’ system is working at optimum given your medical condition. After all your kidneys are the ‘master’ chemists of your body and taking care of them is Dr Lim’s top priority.