Tuesday , September 25 2018

Chronic kidney diseases prevalent in Kuwait – Peritoneal dialysis gentler, better for pediatrics

Dr Faisal Al-Kandari
Dr Faisal Al-Kandari
Dr Faisal Al-Kandari is a Pediatrician with specialty in infant kidney at the Dar Al-Shifa Hospital. He sat with Arab Times to give an insight into a host of issues that affect the child in general. He talked particularly about the kidneys and how it affects the child’s wellbeing.

Question: Can you please tell me about yourself, sir?

Answer: My name is Dr Faisal Al-Kandari, Pediatric Nephrologist. I graduated from Miguel University in Montreal, Canada and hold the Canadian Board of General Pediatrics as well as Pediatric Nephrology from the American Board of Pediatrics. I graduated in 2000 and have been back since 2002 working in Mubarak Hospital as Head of Pediatric Nephrology Unit there. Then I just recently moved to Kuwait Oil Company (KOC), been there for almost a year and have just also joined Dar Al-Shifa Hospital for the past one month.

Q: How long have you been practicing?

A: I have been practicing since 1996, 20 years and Pediatric Nephrology for 16 years.

Q: What is Pediatric Nephrology?

A: Pediatric Nephrology is the specialty that deals with infant kidneys. Any diseases related to the kidneys and the urinary system in children is Pediatric Nephrology. It is a little bit different from Pediatric Urology. Urology is more surgical and a mainly deal with the urinary system, bladder and urethras but Nephrology is the medical part which takes care of the kidneys as well as the medical issues of the urethras and the bladder. And there is a big range of diseases that we cover. The most common ones in Pediatrics being the urinary tract infections, infection of the kidneys, we also deal with congenital abnormalities of the kidneys.

Some kids are born with single kidneys, half kidney, enlargement of the kidney, some we also deal with acute and renal failure, for different reasons they go into renal failure and we have to manage them and the management could be just medical or go to dialysis or transplantation. We deal with any protein in the urine, which we call “nephrotic syndrome”. We have also pediatric hypertension which usually has something to do with the kidneys. The doctors who are involved with hypertension in children are mainly Nephrologists. Then we have electrolyte disturbances with sodium, potassium etc. we also deal with patients who have enuresis who are unable to control their urination.

Q: How prevalent is it in Kuwait?

A: Some of them are really prevalent. In children, urine tract infection is one of the main reasons for admitting them to the hospitals. Then you have some diseases which are least common, for example the fortics-syndrome and proteins in the urine. They are least common but available. We have chronic kidney disease and acute kidney disease acute renal failure you can see it in the hospitals mainly. Patients with dehydration because of the gastroenteritis, diarrhea, vomiting become dehydrated and go into renal failure.

And some of the patients we have in Kuwait, a country where chronic kidney disease is very prevalent compared to European and North American countries are so many. One of the main reason for it is that we have congenital abnormalities of the urinary system and that is why we have more patients with kidney disease compared to North America and Europe. And maybe this is related to intra family intermarriages. It could be hereditary diseases causing renal impairment or it could be congenital anomalies causing renal diseases.

Q: What percentage of children in Kuwait has it?

A: Unfortunately we don’t have the percentage but it is usually per million. To be honest with you I cannot remember the exact numbers but I can tell you it is more common here in Kuwait than in Europe and North America.

Q: And why did you choose this line of work?

A: When I started my training I worked with a doctor who was more interested dealing with kidney diseases, then I just got interested in that part. When I got specialized in it there were one or two people who were specialists in that field here in Kuwait. When I came back from Canada, there were only two or three specialists in that field; now we have up to only six qualifying as pediatric nephrologists.

Q: Have there ever been kidney failures in children?

A: Sure we have kidney failures, and there are two different types, the acute which happens all of a sudden and chronic which comes as a result of kidney diseases later. The acute is not uncommon, and usually as I told you whenever there is dehydration, they’re sick after surgeries the kidneys don’t get enough fluid or blood or sometimes they don’t get enough oxygenation and they go into renal failure. And things get back to normal just by hydration. Sometimes they might require medical treatment and sometimes they might go for dialysis. For the chronic renal failure most of the cases are congenital problems. Children who are born with abnormal kidneys have some abnormalities and by the time they lose their kidney function they require medical management.

As they progress and the kidney fails, then they have to go for dialysis or for renal transplantation. We always have patients who are on dialysis. Right now there are on average 10-15 patients on dialysis in Mubarak hospital which is the main unit covering Kuwait. And then there is also yearly patients who undergo transplantation after dialysis. The kidney transplantation is done at Hamed Al Issa. Transplantation is a highly specialized procedure so we can only see those patients here, medically treat them until they reach that point that they need dialysis at Mubarak Hospital and when it comes to transplantation they are transferred to Hamed Al Issa.

Q: What type of dialysis do you recommend for such children to go through?

A: Usually there are two main types of dialysis; there is the hemo dialysis and peritoneal dialysis. Hemo dialysis is done through a machine that connects the child to the machine, and the blood will go through the machine to be cleaned and sent back to the body. Then there is peritoneal dialysis which is done through the abdomen, we put up a line inside the abdomen, put fluid inside, the fluid clears toxins from the body and then you just take it out. We prefer the peritoneal dialysis as the management of choice for pediatrics because it is gentler, easier and can be done at home.

But with the hemo dialysis the patient has to come to the hospital, have a line connected to the vessels which connects the heart, and they have to be in the hospital for several hours to be dialyzed. And during that dialysis period they might have hypertension, they might have major complications developing. Although we do the hemodialysis, we prefer the peritoneal dialysis which is gentler and better for pediatrics. Both hemo dialysis and peritoneal dialysis are just a transition for transplantation, because the main treatment for renal failure is transplantation.  When you undergo transplantation it means that you have taken another kidney in the body which almost works like the kidney replaced. Yes they have to continue medication to suppress immunity but they will be living the normal life.

Q: What dietary changes do you recommend for such children?

A: Okay, different diseases require different kinds of dietary management. With renal failure some of the patients will be on low salt diet, some on low potassium diet, and some on low protein diet. So the dietary restriction depends on the diseases. With some kids who suffer Battery syndrome lose sodium and potassium in the urine, have to be on high salt and potassium diet. Not all diseases will require the same restriction. Patients with hypertension are usually asked to be on low salt diet. But in general the main problem now in pediatrics is obesity. We see more and more kids obese which puts them at the risk of hypertension.

Hypertension used to be seen in people who are like 40s and 50s, unfortunately, because of the increase in children’s weights we are seeing hypertension in 10 year olds, 14 year olds. They are so obese they develop hypertension and need to be treated as adults. Sometimes they also become type2 diabetic which is not the usual type in pediatrics. This is actually a major issue as they grow up and because of the persistent hypertension all their blood vessels will be affected and at the end they develop kidney diseases and renal failure. If you look at the renal failure in adults the most important cause and the common cause are diabetes, hypertension and vascular diseases. Now the number of patients on dialysis is increasing year by year. We are facing really a major epidemic of child obesity and hypertension. This really needs to be tackled, not just by doctors, but society, schools, the media and so forth to solve this issue otherwise in the next twenty years we’ll have major issues of renal failures in adults and pediatrics.

Q: What are the complications that come along with child kidney issues?

A: It depends on the problem at hand. If it is a patient with renal failure, usually the child will be having less activity, will not be able to do the usually activities, the exercises, it will affect the learning abilities and concentration and as it progresses more and more, it affects the appetite so they start to lose weight. It affects their growth and this is a major issue in pediatrics compared to adults who have already gained their heights. They will have a problem going into normal puberty, ending up short. They might also have problems with the bones-osteoporosis. Our aim is to make sure that these kids although have renal failure to treat them with the proper medication and proper diet, so they go into normal growth, to be as much as possible like other kids without the problem.

If you are dealing with patients with hypertension you have to make sure they have well controlled blood pressure, so that they will not have the complications of hypertension which mainly affects all the vessels of the body, causing eye problems, heart problems, kidney problems, and all the organs will be affected so we make sure that they don’t reach that point. And if their hypertension is due to obesity we have to put them through a certain diet so they lose their weight and not gain excess weight. If you are dealing with patients with urinary tract infection for example, we make sure we can treat these infections promptly and make sure to administer anything to reverse it. If you are dealing with patients with enuresis who are unable to control urine during day and night times, the major issue will be the self esteem. If it affects their self-esteem, it will be a burden on the family and kids so we treat this problem so as to improve their self-esteem while they are kids and also when they become adults.

Q: Your area of expertise is Pediatric Nephrology (child kidney). What are the most common illnesses that come along with it?

A: We talk about diseases being hereditary or congenital, with hereditary diseases they might have other problems that come in syndromes. Some syndromes will affect the kidneys as well as other organs and systems in the body. So you might have a disease or syndrome which affects the kidney, heart, bones, urinary system. With the congenital anomalies they have kidney problems as well as urinary and renal problems.

Q: What symptoms should alarm parents that something may be wrong with their child’s kidneys?

A: Any changes in urine, sometimes urine becoming red, decrease in urine, burning sensation when passing urine, lower abdominal pain mean that there is some infections going on. In patients who develop protein urea or “Nephrotic syndrome”, become puffy and get oedema which might be around the eyes. If the child is not passing urine the fluid will be accumulated in the body. And sometimes there are more subtle changes, a child will start to have decreased activity, poor appetite, stunted growth. These should prompt the parent to do some investigation. And one of them should be renal function and urine analysis to make sure that we are not dealing with renal diseases.

Q: What is your general advice for treating a child’s cold?

A: This is very common. It more common than renal pediatrics, we have a big number of people who come to our clinics with cold. The main thing that everybody should understand is that most of the cold in pediatrics is viral infection which is self limiting and takes 5-7 days to disappear. Unfortunately most people who bring their children to the hospital are always looking to be given medication, especially antibiotics which is not the reason to take the child to the hospital, you take the child to the hospital just to be evaluated and to make sure it is just a cold, a self limiting diseases, so that you are reassured it is nothing serious going on. Sometimes it could start like a cold but could be a more serious disease like meningitis, infection in the blood.

For the cold you don’t need antibiotics, just simple medication to lower the temperature, sometimes we give medication to suppress the cough although it is not always recommended. If it’s a mild cough you can just tolerate it and no need for medication and it will go away by itself. Even with patients who have gastroenteritis, you need just hydration and something to lower the temperature. The child should be evaluated by the doctor to make sure he is not dehydrated or inflicted by some other disease which might be serious.

Q: Will you discuss my child’s general growth and issues like discipline and social development?

A: Part of the kid’s evaluation in the clinic is the growth which is very important in pediatrics. If a child is not growing well there is a long list of problems he could be facing. Each time the child shows up at the hospital we check their weight and height to see and put them on the growth chart. We assist them to make sure that the child is growing well. If the child is not growing well then we do further investigation to find out why. The other part is the psychosocial development, interaction, speech, motor functions. A child passes through milestones in his development. He sits at six months of age, stands at 10 months of age, walks at around 12 months of age etc. Of course if you have a child that doesn’t sit by one year old, this is alarming and we have to look into why he is not walking and do further investigations.

Q: What are your views on … Bottle feeding? Circumcision?, Alternative medicine? Antibiotics?, Immunizations?

A: Regarding bottle feeding, of course we always encourage breastfeeding which is the best way to feed the kid. Number one, it will make strong bonding between the mother and the kid, which is what the kid really needs. Number two, all the content in the milk is the best compared to other formulas and it also gives the kid immunity which doesn’t happen in the other types of milks. But in cases where breastfeeding might be contra indicated or the mother doesn’t have enough milk then we recommend supplement with formulas. Apart from the religious value for circumcision, there is enough literature which shows that it reduces urinary tract infections in boys as well as sexually transmitted diseases in adulthood.

On alternative medicine, we don’t have enough information and studies for them. So it is not always safe to give alternative medicine especially in pediatrics. Personally, I will try to avoid them as much as possible because you don’t know the content, the concentration that you are giving. Sometimes it might be okay for a child with normal kidneys but you have a child with defective kidneys and liver that the medicine might be harmful for. Immunization is very important. We have the government schedule for immunization and Kuwait is one of the best countries maintaining immunizations for pediatrics. Starting from two months of age and there’s a list of vaccines that are given. The ones which are not available in the government program called “Rota Risk”, which is a vaccination given for the Rota virus that causes gastroenteritis, and it is given at one month of age and again given one month later, and it’s given through the mouth. It has been proven to be effective in reducing the number of gastroenteritis infections which is one of the main causes of death in pediatrics because of the dehydration. Chicken pox vaccination is also available in Dar Shifa which is not available in the public sector.

Q: What do you love about your job?

A: I like dealing with kids. While you work with kids you don’t feel that you are coming to work, you just enjoy the time with them. Yes, it’s heartbreaking to see them sick, but the good thing about pediatrics is that they recover quickly and then when you see them smiling it gives you happiness.

Q: What do you like to do outside of work?

A: I am a family person with children who are now growing up. I do some other activities like traveling, walking around, and going to the gym.

Q: What challenges are you looking for in this pediatric medical position?

A: Our main challenge in Kuwait is that we don’t have a pediatric hospital, so our services are all fragmented in different hospitals. What I will like to see in the future is to have a pediatric hospital with all sort of specialties all in one hospital taking care of the kids.

Q: Describe a typical work week for pediatric medical position?

A: It is mainly that you come to the hospital, you have the inpatients, you go do your rounds, seeing the patients who are admitted to the hospital, manage them or you have your clinic that you see patients coming to you from outside. When dealing with the hospital which has dialysis unit, then you have to deal with patients on dialysis, peritoneal or hemo dialysis or transplantation, plus paperwork that you have to deal with as well as dealing with parents and families.

biography

Dr Faisal Al-Kandari

Consultant Pediatrician and Consultant Pediatric Nephrologist

* Name: Dr Faisal Abdullah Al-Kandari

* E.mail: drkandari1@gmail.com

* Instagram : @drkandari

* Twitter : @drkandari

* Specialty: Consultant Pediatrician & Consultant Pediatric Nephrologist

* Department: Dar Al Shifa Hospital

Certifications:

* Bachelor of Medicine & Surgery, Faculty of Medicine, Kuwait University.

* American Board of Pediatrics: October, 1999.

* Canadian Board of Pediatrics: 2000

* Candian Board of Pediatric Nephrology: 2001

Previous positions:

* Head of Pediatric Nephrology unit, Mubarak AlKabeer Hospital 2004-2014

By Iddris Seidu

Arab Times Staff

 

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