Dr. Saleshando laments lack of donors for kidney transplants

03rd November 2017
Dr Saleshando Source:The Midweek Sun


By Sun Reporter - Reporter

Tell us a little about yourself and why you chose this specialty?

I am a doctor who graduated from the University College of Dublin. I am a specialist physician and member of the Royal College of Physicians of Ireland. I specialised in Nephrology at the University of the Witswatersrand in South Africa. Upon my return to Botswana in 2004, I found that there was very little to offer patients with Kidney Diseases in the country and felt more can be done with the right skills, hence my decision to specialise in Nephrology.

What does your job as a Nephrologist entail? My job entails diagnosing different kinds of kidney diseases and managing/treating them. I see both out patients and those admitted to hospital. We use lab tests and imaging tests to make diagnosis.

Tell us about the rise in kidney diseases?

Kidney diseases are on the increase internationally. On average one in ten people have some level of chronic kidney disease, internationally. Same applies to Botswana though we have not done the kind of research to demonstrate that. Certainly the risk factors for kidney disease such as hypertension, diabetes and Obesity are on the increase even in Botswana. Risk factors for acute kidney injury include chronic kidney disease which many people don’t even know they have, diet and blood pressure.

What else should people be mindful of?

Hypertension, Diabetes and HIV are felt to be the top three causes of Chronic Kidney diseases in our region. Other causes include those that start in the kidneys such as Glomerulonephritis, hereditary diseases like Polycystic Kidney Diseases, Medications like Non-Steroidal pain killers like Ibrufen, traditional medicines etc.

What exactly does the term “dialysis” mean?

Dialysis is the process of artificially removing waste products and excess fluids from the body. This is done when the kidneys fail in their function of removing these waste products from the body.
What is the difference between haemodialysis and peritoneal dialysis? ‘Haemo’ means blood: haemodialysis uses blood to directly remove waste products from the body. It is usually done in a hospital setting. Peritoneum is the lining of the bowels: Peritoneal dialysis uses this lining to remove waste products from the body. It is done in a home setting.

What causes kidney malfunction in children?

Sudden malfunction (Acute Kidney Injury) in children is commonly caused by diarrhea diseases, malaria, urinary tract infections and toxins. Longstanding malfunction (Chronic Kidney diseases) are commonly caused by primary kidney diseases such as glomerulonephritis, hereditary or genetic diseases, recurrent urinary infections

How can you tell if a child is affected by kidney disease? When and how can action be taken? Common manifestations include swollen legs, puffy face in the morning to generalised swelling of the body. Urine volume may decrease together with non-specific listlessness. It is best to seek medical attention with these symptoms as soon as possible

What are the risks for children affected by kidney disorders and undergoing dialysis?

Kidneys affect a number of functions in the body such as the manufacture of red blood cells, hormones, water balance and electrolyte regulation. Hence the children become anaemic, have reduced growth rates, are short of breath and swollen due to fluid excess in the lungs etc.

What are the criteria for undergoing kidney transplantation?

Kidney Transplantation is considered for End Stage Kidney Disease, when the kidneys can no longer recover to perform their function. It is the preferred option of treatment, but dialysis is often done where transplant is not possible. It is a major operation and one has to be fit enough for the surgery. One should not have infections that may worsen with the immunosuppressant medications used to prevent your body from rejecting the transplanted kidney. One should also not have diseases that will greatly reduce their life-expectancy like cancer.

What is the hardest thing about your job?

The part I find the most stressful is talking to someone who has been suddenly diagnosed with end stage kidney disease. At that moment they have had no warning about the problem, although it has been present for a long time. They are then told that they have to go onto dialysis and their life expectancy is seriously reduced.

Some patients on dialysis will get kidney transplants but every year one in six patients waiting will die. It emphasises why we need to improve the early diagnosis of kidney disease. This will allow the kidney problem to be assessed and complications, such as anaemia, to be treated.

How has the role of Nephrology within the renal care team evolved over the last five years or so?

How do you think the field will change in the future?

Nephrologists play a central role in the renal care team and guide policy makers, administrators and clinical members such as nurses and dieticians. In some countries Nephrologists have chosen aspects of Nephrology to further specialise in, such as looking after ICU patients with renal failure, doing transplants only or doing dialysis only. Perhaps that is where we will also move when we have enough Nephrologists in Botswana!

What are the greatest challenges facing the field?

The greatest challenge facing the field is lack of donors for kidney transplants. As our families become more insular, we fail to make sacrifices for the extended family members! Hence even with the Botswana Government sponsoring kidney transplants, only a few patients have benefitted.

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