Doctors alarmed over rise in renal failure cases

VISAKHAPATNAM: Setting alarm bells ringing, doctors in the city have noted that the condition of many patients suffering from dengue, malaria and other fevers has been taking a turn for the worse with 40-50% of them suffering from renal failure. Around 60% of those with fever, especially people from north coastal Andhra, are in need temporary dialysis and renal therapy, said general physicians and nephrologists of Vizag.
Dr S Srinivas, consultant intensive care expert at Manipal Hospital, and Dr Kalyan Chakravarthy, the head of the department of nephrology at Care Hospital, attributed this to the indiscriminate use of over-the-counter analgesics and antibiotics even in rural regions, which they said is a recent trend.
Another factor is improper diagnosis, according to Dr Ramesh Chandra, nephrologist and assistant professor at King George Hospital, and Dr T Ravi Raju, nephrologist at Apollo Hospital and a former director of medical education of Andhra Pradesh.
Of the cases of renal failure, 5-10% patients develop chronic kidney failure and require lifelong dialysis or transplant for survival, said the doctors. "We are increasingly coming across renal failure cases in malaria or dengue patients, most of whom are from the north coastal districts. Even if they come on time for the treatment, they end up with kidney problems and require renal replacement therapy, fluid management and temporary dialysis. Without timely intervention, these can even turn fatal," said Dr Srinivas.
"Around 60% of patients with fever are developing renal failure and 5-10% of them are developing chronic kidney ailments over time. Abuse and overuse of painkillers are possibly the main reason for renal failure in cases of fever," said the doctor.
"Besides self-medication, patients from the coastal districts widely use a local herbal preparation for jaundice called pasaramandu, which has components toxic for the kidneys. They also frequent quacks. Some are already prone to kidney problems if they have diabetes or hypertension," said Dr Chandra.
"Besides irrational use of analgesics or antibiotics that adversely affect the kidneys, sometimes severe malaria, chikungunya, dengue or other fevers are misdiagnosed as jaundice and accordingly treated with local herbal drugs, which harm the kidneys," said Dr Raju.
"Moreover, north coastal Andhra, especially Srikakulam, is endemic to kidney failures and thus the predisposed people from these areas develop kidney problems after being affected by malaria or dengue and around 5-10% cases turn chronic. Also, certain new kinds of viruses such as hantavirus lead to renal failure," he said.
Dr Chakravarthy said that around 40% of the viral fever, malaria and leptospira patients are found to be developing renal failure and in need of dialysis, with most of the cases being reported from peripheral regions and north coastal districts such as Vizianagaram and Srikakulam.
"Any infection requires timely treatment and monitoring. However, in the peripheral set up, proper blood test facilities and other relevant diagnosis are not available and patients rely on unscientific medicines prescribed by quacks. Also, many patients even from rural areas opt for self-medication and use too many painkillers or antibiotics without consulting doctors. Only when the urine output comes down or stops do they visit the hospitals or tertiary care centres but by then, the damage is done," he said.