By Bae Ji-sook
Renal disorder is currently regarded as one of the most unpleasant diseases, because patients may undergo painful kidney dialysis for the rest of their lives.
The two bean-shaped organs in the body are small, and few realize where they are until they study human biology ― but their power is beyond imagination. They maintain the homeostatic balance of bodily fluids by filtering and secreting metabolites and minerals from the blood and excreting them, along with water, as urine.
Dr. Han Dae-suk
of Dr. Han’s Clinic
Dr. Han Dae-suk of Dr. Han's Clinic said ``May be it won't kill you like cancer. But it will still give you constant stress and you will have to endure the pain and bother of having to visit hospital nearly every day to get the dialysis done.''
However, kidney health is a great risk for many. According to the National Kidney Foundation, about 13 percent of adults have kidney problems. There are about 42,000 patients receiving hemodialysis or peritoneal dialysis, which equals about 854 in every million. The figure is the 10th highest in the world, and is increasing by 10 percent every year.
There are two kinds of kidney disease common here: glomerulonephritis, which means inflammation in the glomeruli, or small blood vessels in the kidneys; and renal failure, meaning overall disorder in the kidney area.
Glomerulonephritis is less severe. There are about one million capillaries per kidney and when they get damaged and inflamed, the kidney cannot filter protein and other nutrients.
It can be detected by determining whether too much protein is in the urine. If left untreated, it could facilitate other kidney disorders and cause more serious problems.
Renal failure is one of them. When the glomeruli's filtering function is from 15 percent to 90 percent of full capacity, one is considered to be suffering from renal failure. Function below 15 percent is labeled ``severe.''
There is not yet a verified cause for the disease. Han says genetics may be a factor but most cases are due to unidentified factors.
Kidney diseases are said to be quite complicated since many people do not detect any changes until advanced stages.
``If your body gets swollen often, you see blood or foam in your urine; urinate during sleep, suffer from reduced urine or feels pain around the back of the waist, you are likely to suffer from kidney disease. However, when you notice these symptoms, I say it is too late. You must have already lost about 80 percent of kidney function,'' Han says.
Han stresses links between kidney disease, diabetes and hypertension. The three usually come together, affecting each other by aggravating or triggering each symptom.
``A kidney patient should always watch his or her blood pressure. It could suddenly rise and decrease.
Hypertension complicates kidney disease,'' he says. About half of chronic renal failure patients have diabetes and Han explains diabetes causes glomeruli disorder in many cases. Therefore, those who suffer from either of the two other diseases should visit their doctors regularly for detailed checkups.
Several types of treatment are available.
The most basic step is taking medication. Patients can be prescribed from hypertension drugs to diuretics. However, dosages should accompany a strict diet and other lifestyle changes.
Then comes dialysis for renal failure patients, most of whom have lost more than 85 percent of kidney function. It is insufficient to resume partial kidney function through diffusion (waste removal) and ultrafiltration (fluid removal).
There are two common types of dialysis. Hemodialysis makes the patient's blood pump through the blood compartment of a dialyzer, exposing it to a semipermeable membrane. The cleansed blood is then returned via the circuit to the body. Patients undergo the treatment about three times a week.
In peritoneal dialysis, a sterile solution containing minerals and glucose is run through a tube into the peritoneal around cavity. The dialysate is then left to absorb waste and is then drained through the tube and discarded.
Transplants are possible. However, finding the right kidney is quite difficult and it is also difficult to find a donor ― fewer than 900 patients get such treatment annually.
Han says future study in the field will increase survival rates. He admits that 22 percent of those taking dialysis die annually here, and the rate is much higher than in other countries ― Japan marks 8 percent.
``Taking into account that Japanese people suffer less from hypertension or diabetes, the figure is still too high. We need to find out how to let more people survive with various types of treatment,'' he says. Preventing complications is another goal of the Korean medical circle, he says.
Of course there are talks about developing effective artificial kidneys in the field. Eventually, Han forecasts that transplanting other animals' kidneys will open new doors to kidney patients. Pigs are the most likely candidates but there are several obstacles such as resistance, technical problems and ethical issues. ``But we will figure it out in the future, I hope,'' he says.
Han graduated from Yonsei University, interned in the Saint Joseph Hospital and resident course at Bronx VA Medical Center. He has also studied at several other universities abroad and served in numerous lucrative positions here, including chief of the kidney center at Yonsei Severance Hospital, president of the Korean Society of Nephrology and president of the Korean Society of Hypertension.
Han is well known for being the first person in the world to have reported C-Reactive protein index as a criterion for predicting death or complication odds in peritoneal dialysis in 1998. He retired from Severance Hospital this September and opened his own clinic.