Fe­males Kid­neys & Women’s Health

Dr. Divya Kumar MBBS | DNB - Ob­stet­rics and Gyne­col­ogy FEL­LOW­SHIP IN ART Con­sul­tant ART, Asian-kjivf cen­tre for ART |

Woman's Era - - Con­tents -

con­trib­ute to more than 50% of world’s pop­u­la­tion. The so called “Fairer sex” has al­ways been a vic­tim of gen­der bias, be it ed­u­ca­tion, ba­sic hu­man rights, med­i­cal care or even par­tic­i­pa­tion in clin­i­cal stud­ies.

As world Kid­ney day and women’s day co­in­cided in 2018, it gave us an op­por­tu­nity to re­it­er­ate the im­por­tance of women’s health, es­pe­cially their kid­ney health to the com­mu­nity and the next gen­er­a­tion. The In­ter­na­tional so­ci­ety of nephrol­ogy rightly chose the theme Kid­neys & Women’s health: In­clude, Value, Em­power !

The bur­den: CKD af­fects ap­prox­i­mately 195 mil­lion women world­wide and it is cur­rently the 8th lead­ing cause of death in women. The risk of de­vel­op­ing CKD is more likely in women with an av­er­age 14% of preva­lence. How­ever, the irony is, the num­ber of women on dial­y­sis is much lower than the num­ber of men on dial­y­sis. This is shock­ing to know that, in live re­lated kid­ney trans­plant pro­grams, most of the re­cip­i­ents are males and donors are fe­males.

Preg­nancy which is unique to women, may pre­dis­pose to many com­pli­ca­tions in­clud­ing kid­ney prob­lems. In ad­di­tion some un­der­ly­ing kid­ney dis­or­ders may flare up dur­ing preg­nancy.

In­ter­na­tional so­ci­ety of nephrol­ogy felt that there is in­deed a clear need to ad­dress is­sues of eq­ui­table health­care ac­cess for women where it is cur­rently lack­ing and in­crease aware­ness and ed­u­ca­tion to fa­cil­i­tate women’s ac­cess to treat­ment and bet­ter health out­comes.

Uri­nary tract in­fec­tions in women(uti): 1.2% of all clinic vis­its by women is due to uri­nary tract in­fec­tion. 50% of all women will ex­pe­ri­ence UTI dur­ing their life­time. It is more com­mon in re­pro­duc­tive age group. When not treated ad­e­quately, it has a very high re­cur­rence rate caus­ing much agony . Some­times UTI may her­ald the on­set of bliss­ful mar­i­tal/sex­ual ac­tiv­ity but on other oc­ca­sions, this can be a re­sult of Sper­mi­ci­dal use, ha­bit­ual and post- coitial de­layed uri­na­tion. Douch­ing and wear­ing oc­clu­sive un­der­wear, wip­ing from be­hind for­ward af­ter defe­ca­tion or us­ing un­hy­gienic wa­ter jets in western seats in­stead of health faucets, may in­crease the chance of catching UTI. Ad­e­quate hy­dra­tion ( 2- 3 litres/ day) is a sim­ple pre­ven­tive mea­sure to stay away from UTI. While sim­ple UTI can

UTI and Preg­nancy UTI dur­ing preg­nancy is man­aged sim­i­larly as in non preg­nant state with pre­cau­tion of us­ing an­tibi­otics which are safe for mother and fe­tus. Some­times urine rou­tine ex­am­i­na­tion shows in­fec­tion but the pa­tient is asymp­to­matic (asymp­to­matic bac­tri­urea). This oth­er­wise does not re­quire treat­ment in non-preg­nant state but must be treated ag­gres­sively with an­tibi­otics in preg­nancy as it is as­so­ci­ated with an in­creased risk of pre­ma­ture de­liv­ery, IUGR, and peri­na­tal mor­tal­ity

Preg­nancy and Acute kid­ney in­jury (AKI)

Preg­nant ladies are also prone to de­velop acute kid­ney fail­ure/ in­jury ( AKI). Though good an­te­na­tal care has brought down its in­ci­dence in de­vel­oped coun­tries(< 1 in 20,000 preg­nan­cies), the in­ci­dence re­mains high in de­vel­op­ing world (1 in 2000 to 5000 preg­nan­cies).

Com­mon cause in early preg­nancy are sep­tic abor­tion ( Quacks and dais ) and ex­ces­sive vom­it­ing. Most cases oc­cur be­tween ges­ta­tional week 35 and af­ter de­liv­ery. Com­mon causes be­ing Preeclamp­sia/eclamp­sia - (15%) ,Post Par­tum Hae­m­or­rhage ( 26%), pla­cen­tal abrup­tion re­nal im­pair­ment, have a lower chance of hav­ing a live baby and a greater risk for ma­ter­nal com­pli­ca­tions. He­modial­y­sis, if re­quired should be done un­der close su­per­vi­sion by an ex­pe­ri­enced nephrol­o­gist. Var­i­ous women have be­come preg­nant af­ter get­ting kid­ney trans­plant. But ide­ally a fe­male should do­nate her kid­ney only af­ter com­plet­ing her fam­ily.

Preg­nancy fur­ther adds to the bur­den

With good pre­con­cep­tion, an­te­na­tal and post­na­tal care most of the dis­or­der can be ei­ther pre­vented or man­aged with no long term se­ri­ous con­se­quences. Early de­tec­tion and timely in­ter­ven­tion can not only pre­vent kid­ney diseases, but also limit the com­pli­ca­tion and some­times even save a kid­ney.

To con­clude

Women are at a greater risk to de­velop kid­ney dis­ease in their life­time but their ac­cess to dial­y­sis, trans­plant and other health care is ex­tremely poor due to bias to­wards treat­ing males.

This is high time when so­ci­ety should think be­yond its male chau­vin­is­tic mind set and give women equal ac­cess to health and kid­ney care.

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