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-1 - Traditional African Clinic February/March 2013

African Traditional Herbal Research Clinic

Volume 8, Issue 2 NEWSLETTER February/March 2013

2 Nigeria: Kidney Disease - 32M Young People on Danger List
3 Afrikan Spirituality Oshun and Chango- Match in Heaven
4 Feature E Coli that cause UTI are Resistant to Antibiotics
6 Feature Urinary Tract Infections U.T.I. in Men
8 Feature Kidney Disease and Your Heart The Hidden Link
12 Irregular Heart Rhythms Increases Kidney Failure Risk
16 Kidney Disease Increases Risk of Early Death in Diabetics
18 Feature Kidney Stones (Renal Stones, Nephrolithiasis)
23 Role-Uric Acid in Hypertension, Renal and Metabolic Disease
27 Feature The Kidney Network: Properties and Functions
36 The Metaphysical Functioning of the Kidneys
39 Feature Pesticides: Health Effects in Drinking Water
50 Thousands of Sugar Cane Workers Die
57 UNEP Reports Highlights Risk of Mercury Emissions Africa
60 Feature Nigeria: The Rate of Kidney Disease
63 Acute Renal Failure as a Complication of Cholera
66 Mercury in Skin Lightening Products
73 Feature Kidney Failure: Causes, Treatment and Prevention
77 Herbal Therapies and the Patient with Kidney Diseases
88 What is Corn Silk?
92 Herb of the Month Cranberry for UTI and E Coli
African-Americans and
Kidney Disease
The African American Community Health
Advisory Committee
One out of every three people with kidney failure is
African- American, compared to only one in eight in the
general population. When a person's kidneys are working
at only 5 to 10 percent of normal, he or she must have
regular dialysis treatments or a kidney transplant in order
to live. Kidneys perform many vital functions including
filtering waste products from the blood, controlling fluid
balance, regulating blood pressure and stimulating red
blood cell production.
High blood pressure and diabetes are the leading causes
of kidney failure. African-Americans, for reasons we
don't entirely understand, are at high risk for both of
these conditions. High blood pressure, also called
hypertension, often doesn't have any obvious symptoms.
That's why it's important to have regular medical check-
ups and have your blood pressure checked often, even if
you feel well.
Diabetes symptoms include thirst, passing more urine
than usual, hunger, unintended weight loss and fatigue.
What is the African Traditional
Herbal Research Clinic?
We can make you healthy and wise
Nakato Lewis
Blackherbals at the Source of the Nile, UG Ltd.

The African Traditional Herbal Research Clinic located
in Ntinda, Uganda is a modern clinic facility
established to create a model space whereby
indigenous herbal practitioners and healers can upgrade
and update their skills through training and certification
and respond to common diseases using African healing
methods and traditions in a modern clinical
Traditional healers are the major health labor resource
in Africa as a whole. In Uganda, indigenous traditional
healers are the only source of health services for the
majority of the population. An estimated 80% of the
population receives its health education and health care
from practitioners of traditional medicine. They are
knowledgeable of the culture, the local languages and
local traditions. Our purpose is to raise public
awareness and understanding on the value of African
traditional herbal medicine and other healing practices
in todays world.
The Clinic is open and operational. Some of the
services we offer are African herbal medicine,
reflexology, acupressure, hot and cold hydrotherapy,
body massage, herbal tonics, patient counseling, blood
pressure checks, urine testing (sugar), and nutritional
profiles. We believe in spirit, mind and body. Spiritual
counseling upon request.
Visit us also at www.Blackherbals.com
Hours: 10:00 am to 6:00 pm Monday thru Friday
Saturday by Appointment, Sundays Closed

Continued on page 2
-2 - Traditional African Clinic February/March 2013

However, diabetes also sometimes has no symptoms.
This is another reason why checkups are important.
Fortunately, you can help prevent both diabetes and
hypertension and their complications if you eat a low-fat,
low-salt diet, exercise regularly, limit alcohol intake and
don't smoke. If you have either diabetes or high blood
pressure, take your prescribed medication and monitor
your condition often.
Swelling of parts of the body, especially around the
eyes or ankles
Pain in the lower back
Burning or unusual sensation during urination
Bloody or coffee colored urine
Urinating more often, especially at night
Listless or tired feeling
High blood pressure
You can feel fine and still have kidney disease
African-Americans are 2.5 to 5.6 times more likely to
suffer from kidney disease with more than 4,000 new
cases annually of renal disease requiring either kidney
transplant or regular dialysis.
Lupus is an autoimmune disorder -- a rheumatic disease
that belongs to the arthritis family.
Lupus can strike different parts of the body. When it
damages the kidneys, it is called lupus nephritis.
Lupus occurs much more often among African-
Americans than whites. African-American women are
three times more likely to be affected than white

Nigeria: Kidney Disease - 32
Million Young People on
Danger List
By Solomon Chung, Ruby Leo, Ibrahim Musa
Giginyu and Rakiya A. Mohammed
8 December 2012
over increase in the number of young persons with
chronic kidney disease (CKD). The figure by the
National Association of Nephrology of those currently
down with the ailment is frightening. More worrisome is
the revelation that those mostly hit are the young and
active segment of the society.
Sunday Elekwa's kidneys are damaged; they can no
longer remove waste products from his blood. He has to
rely on dialysis machine to stay alive, and he has to do so
twice every week at N50,000. For up to four hours a
session, the dialysis machine does the job, and will need
to do so three times a week to be as effective as his
kidneys would have been.
Elekwa has what nephrologists call end-stage renal
disease. Elekwa is a young man, and not just him, it
include much younger people than he is.
Like Elekwa, Fidelis Putnang, a 27-year-old graduate of
the University of Abuja is suffering from the same
condition, thus needs money for dialysis forth nightly.
Unlike Elekwa, Putnang did not know he is suffering
from the ailment until he visited the National Hospital in
Abuja after series of malaria and typhoid symptoms.
According to Michael Putnang, his elder brother, "He was
shocked the first day he learnt he has kidney ailment. He
had regular fever off and on and then later diagnoses to
have hepatitis B. It persisted even after treatment, until
the kidney ailment was discovered."
Like the two above, millions of young men, experts fear,
are living with the ailment. The National Association of
Nephrology put the figure of those diagnosed with the
ailment at 35 million. Thirty two million out of this
number are said to be on danger list, because their
kidneys are already failing. The body fears that greater
percentage of those currently living with the disease is
the active segment of the society. It attributed the rising
cases of the ailment among younger people to hereditary
and other factors.
"More and more [of the] younger population are getting
affected," Dr. Kiran Kumar of the Internal Medicine
Consultant at Primus Hospital, Abuja told Weekly Trust.
He attributed the major causes of this to a "wide
prevalence of unidentified hypertension," accounting for
nearly 60 per cent of patients with CKD, while also not
ruling out HIV and hepatitis B also.
For Dr. Oluseyi Oniyango, Consultant Paediatrician at
the National Hospital, Abuja, "lifestyles that young
people have adopted over time are also to blame,
especially when they become sedentary, engage in little
exercise and indulge in sugary, calorie-densed foods that
modern conveniences afford.
Continued on page 9
Contd from page 1 African-Americans and Kidney
-3 - Traditional African Clinic February/March 2013

New African Spirituality
Oshun, Chango, Yin, Yang,
Orisha, Orishas
Oshun and Chango, A Match Made In

November 30, 2011
Everyone has heard of the phrase, opposites attract. That is
the case in many situations in scenarios. Legend has it that
Chango was the king of the Oyo, a great city in West Africa.
He had numerous wives, but he was particularly fond of
Oshun, the river goddess. Their marriage symbolizes a union
of two great basic forces known as the feminine essence and
the masculine power. This concept is similar to yin and yang
and the ability of opposite forces to unite and same forces to
repel and detract.
Chango is a representation of the ultimate masculine force.
He is dynamic, stimulating, and logical. He is a deity of great
height and represents the skies and the heavens. His color is
red, and he is considered hot, and is able to produce heat by
breathing fireballs from his mouth.
Managing Editor: Nakato Lewis
Published monthly and freely by BHSN for the ATHR Clinic

The traditional shrine as a symbol of our cultural history

The goddess Oshun, on the other hand represents
yin. She is the ultimate female essence. She is
static, calming, and intuitive, much like the rivers
she resides in. Chango and Oshun, much like yin
and yang characterize two different types of energy,
also known as chi, or in Yoruba, ashe.
In Chinese philosophy as well as in African
practices, everything in nature is perfectly balanced.
If things become unbalanced then illness and
malady may occur. Too much of Changos heat
underlies pain and inflammation. Too much of
Oshuns coolness may cause blockages and
stagnation. Both forces complement each other, and
each force is needed to generate the spark needed
for creation.
Changos heat can drive out Oshuns cold. While
Oshuns cold can reduce Changos heat. Oshun and
Chango, much like yin and yang are relative to each
other and there is always a relationship fostering a
certain condition. One flows into the other and then
returns. Their partnerships gives people the ability
to understand that they cannot comprehend cold
without feeling heat. Their relationship evolves and
becomes stronger because there is in inherent
checks and balance system that allows them to feed
off of each others strength.
Oshuns ice, when warmed by Chango can become
water. When Chango breathes out balls of fire,
Oshuns water becomes steam. In the Chinese
system, as well as in African practice, all of life is a
cycle of yin and yang, masculine and feminine,
light and dark. When these forces come together,
they generate an electric charge, or an unified
supreme energy that sparked the creation of earth.

-4 - Traditional African Clinic February/March 2013
African Traditional Herbal Research Clinic
Volume 8, Issue 2 NEWSLETTER February/March 2013
E. Coli That Cause Urinary Tract Infections are Now
Resistant to Antibiotics
By Veronique Greenwood
Discover Magazine, May 2, 2012

Some of this growing resistance in E. coli and other
bacteria is due to the fact that antibiotics are being
overprescribed, handed out to patients who have no
bacterial infections. There is also evidence that the
genes that give bacteria resistance to drugs are being
spread in livestock farming operations, where
antibiotics are a common ingredient in animal feed.
Ciprofloxacin is one of those antibiotics, and
researchers have found that E. coli resistant to it are
thriving in poultry farms. Very closely related strains of
drug-resistant E. coli have been found in people,
suggesting that the bugs spread from the birds to
In this chart from the report, the trends in resistance are
People suffered from UTIs long before antibiotics were
discovered in the early twentieth century, of course.
Should these drugs cease to be effective, well have to
go back to what we were doing before. The truth is,
though, before antibiotics we had no real treatment.
Sicknesses resembling UTIs have been described in
medical texts for thousands of years, by everyone from
the ancient Greeks and Chinese to the pioneers of
evidence-based medicine in the early 1900s. Some of
these doctors prescribed various tinctures, ointments,
and special diets to deal with the symptoms, but in
cases in which the infection spread to the bladder and
Continued on page 5
Thanks to antibiotics, we tend to think of urinary tract
infections as no big deal. Pop some cipro, and youre
done. A good thing, tooif the E. coli that usually cause
UTIs crawl up the urinary tract, they can cause kidney
failure and fatal blood poisoning.
But antibiotics may not be saving us from UTIs for very
much longer. Scientists tracking UTIs from 2000 to 2010
found a dramatic uptick in cases caused by E. coli that do
not respond to the drugs that are our first line of defense.
In examining more than 12 million urine analyses from
that period, they found that cases caused by E. coli
resistant to ciprofloxacin grew five-fold, from 3% to
17.1% of cases. And E. coli resistant to the drug
trimethoprim-sulfame-thoxazole jumped from 17.9% to
24.2%. These are two of the most commonly prescribed
antibiotics used to treat UTIs. When they are not
effective, doctors must turn to more toxic drugs, and the
more those drugs are used, the less effective they in turn
become. When those drugs stop working, doctors will be
left with a drastically reduced toolkit with which to fight
-5 - Traditional African Clinic February/March 2013

Continued from page 4 E. Coli That Cause Urinary Tract
Infections are Now Resistant to Antibiotics
kidneys and beyond, they were fairly helpless. As a last-
ditch effort, they operated to drain puss from the infected
kidneys and hoped the patient would survive. Treatment
did not fundamentally change until antibiotics arrived on
the scene.
In a world without antibiotics, many peoples UTIs
would doubtless subside under attack from the immune
system. But some fraction of them would not, and those
people would find themselves in dire straits. And about
the common idea that cranberry juice can prevent or treat
UTIs: evidence is pretty spotty. Better to try to reduce
the irresponsible use of antibiotics than rely on juice.

Urinary Tract Infections (UTI)
By Andrew Weil, MD
About 10 to 20 percent of women will develop a urinary
tract infection (UTI) at some point in their lives. Cystitis
(a bladder infection) is a common type of UTI, and is far
more prevalent among women than men. It is reported to
be one of the most frequent medical complaints among
women in their reproductive years.
Causes and Symptoms
The urinary system helps to eliminate waste products
and maintain proper water and salt balance in the body.
The waste products are filtered from circulating blood by
the kidneys, which are attached to the bladder by thin
tubes called the ureters. The bladder is responsible for
storing urine, which then flows out of the body through
another tube called the urethra.
Normally, the bladder is sterile - completely free of
bacteria and other infectious organisms. When an
infection occurs, it is typically found in either the lower
urinary tract - affecting the bladder and urethra - or the
upper urinary tract, which affects the kidneys and
ureters. When an organism invades the urinary tract, it
enters by one of two routes: the lower end of the urinary
tract or through the bloodstream.
Bacterial infections arising from the lower tract are very
common, particularly among women, whose urinary
anatomy makes them much more susceptible than men.
The bacterium Escherichia coli (E. Coli) is responsible
for most urinary tract infections. E. Coli is actually
harmless in the small intestine where it normally resides,
but becomes a problem when it spreads to the urinary
Risk Factors
Age and gender. Women are 30 times more likely to
develop a bladder infection than men. After
menopause, the risk for recurrent infections increases
substantially. This may be due to a decrease in
estrogen, which may result in a reduction of the
number of beneficial bacteria in the vagina that help
keep harmful bacteria in check. The bladder also
tends to become less elastic with age and may not
empty completely.
Sexual activity. Frequent or traumatic sexual
intercourse can increase the risk of urinary tract
Pregnancy. Up to 10 percent of pregnant women
tend to have bacteria in their urine, which increases
the risk for urinary tract infections.
Antibiotics. Some antibiotics can actually eliminate
the good bacteria, cause an overgrowth of E. Coli in
the vagina and increase risk of UTIs.
Addiction to coffee and other forms of caffeine, as
well as alcohol addiction and dehydration, are
aggravating to the urinary tract.
Typical symptoms of a UTI include:
Bladder infections. These are marked by a frequent,
urgent need to urinate or a painful or burning
sensation during urination. Frequent urination may
also occur during the night. Urine is typically cloudy.
Urethritis (inflammation of the urethra). Marked by
painful urination and a frequent need to urinate.
Kidney infection. A bladder infection with pain
spreading to the lower back or flanks may indicate
that the infection is moving to the upper tract. Fever
is common and blood in the urine may be visible as a
pink tinge. Medical help should be sought
immediately if this occurs.
Suggested Lifestyle Changes
Avoid wearing tight-fitting pants. Also, wear
cotton-crotch underwear and pantyhose, and use mild
detergents when washing underwear.
Don't hold your urine. Be sure to urinate frequently
and when you have the urge.
Drink the right fluids. Increase your intake of fluids
so that you urinate more frequently. Plain water is
best, and it is also important to avoid alcohol and
Good hygiene before and after sex. Keep the
Continued on page 11
-6 - Traditional African Clinic February/March 2013
African Traditional Herbal Research Clinic
Volume 8 Issue 2 NEWSLETTER February/March 2013
Urinary Tract Infections - U.T.I. in Men
By Liberator Medical
Urinary tract infections (UTIs) are a serious health
issue that affects millions of men each year. It is
important that men with a urinary tract infection
understand the causes and treatments for their infection.
Urinary tract infections are the second most common
type of infection in males and females. Urinary tract
infections account for approximately 8.3 million doctor
visits each year
, with approximately 20% of all urinary
tract infections occurring in men. The overall lifetime
prevalence of male urinary tract infections between
1988 to 1994 was estimated to be 13,689 cases per
100,000 adult men, based on the National Health and
Nutrition Examination Survey.
Rates of urinary tract infections increase with age and
are 1.5 times higher in African American men than in
other racial/ethnic groups such as Caucasian or
Hispanic. Asian men have the lowest rates of inpatient
hospitalization for UTI care, followed by Hispanics and
The Causes of UTIs in Men
Normally, urine is sterile and free from bacteria,
viruses, and fungi; however, it usually contains fluids,
salts, and waste products. An infection occurs when
tiny organisms, usually bacteria from the digestive
tract, adhere to the opening of the urethra and begin to
reproduce. The urethra is the tube that carries urine
from the bladder to be expelled outside the body. Most
infections are caused by Escherichia coli (E. coli)
bacteria, which normally live in the colon.
If bacteria attach to the urethra and begin to multiply,
an infection can occur. An infection confined to the
urethra is called "urethritis." If the infection moves to
the bladder, a bladder infection occurs, called "cystitis."
If the infection is not treated immediately, bacteria
could travel farther up the ureters to infect the kidneys,
which may result in a kidney infection called
Chlamydia and Mycoplasma, both microorganisms, can
also cause urinary tract infections in men, but the trend
of these types of infections is to remain limited to the
urethra and reproductive system. Unlike E. coli,
Chlamydia and Mycoplasma can be sexually transmitted
and infections require treatment of both male and female
The urinary system is biologically structured to help
ward off infection. The ureters and bladder are supposed
to prevent urine from backing up toward the kidneys and
the flow of urine from the bladder is designed to wash
bacteria out of the body. In men, the prostate gland
produces secretions that slow bacterial growth, and
immune defenses also help avoid infection. Despite
these physiological safeguards, infections can still occur.
Bladder outlet obstruction due to benign prostatic
hyperplasia (BPH) may be associated with urinary
stasis. Although a causal relationship has been difficult
to prove, chronic prostatic obstruction is considered to
increase the risk of urinary tract infections in older men
with BPH.
Men who are uncircumcised are more at risk to become
infected because the bacteria can build up much more
easily in the folds of the extra skin on the penis, as are
men who engage in anal intercourse.
The Risk Factor for Men
Some men are more prone to getting a urinary tract
infection than others. Any irregularity of the urinary
tract that obstructs the flow of urine (e.g., a kidney
stone) increases the risk for an infection. An enlarged
prostate gland can also impede and slow the flow of
urine, thus raising the risk of infection. A common
source of infection is catheters, or tubes, placed in the
urethra and bladder. A man who cannot void or is
unconscious or critically ill might use a catheter that
stays in place for a prolonged period. Some men,
especially the elderly and those with nervous system
disorders that cause loss of bladder control, may need a
catheter for life.
Men with diabetes have a higher risk of developing a
UTI because of changes in the immune system. Any
other disorder that suppresses the immune system raises
the risk of a urinary tract infection. Urinary tract
Continued on page 7

7-- Traditional African Clinic February/March 2013

Continued from page 6 Urinary Tract Infections - U.T.I. in
infections may occur in infant boys who are born with
abnormal urinary tracts that sometimes need to be
corrected with surgery. Urinary tract infections occur less
frequently in boys and young men than girls and young
Recurrent Infections in Men
In recurrent infections in men, the latest infection stems
from a strain or type of bacteria that is different from the
previous infection, indicating a separate infection. Even
when several urinary tract infections in a row are caused
by E. coli, slight differences in the bacteria indicate
distinct infections.
Research funded by the National Institutes of Health
(NIH) suggests that one factor behind recurrent urinary
tract infections may be the ability of bacteria to attach to
cells lining the urinary tract. A recent study found that
bacteria created a protective film on the inner lining of
the bladder in mice. If a similar occurrence can be
demonstrated in humans, the discovery may lead to new
treatments that will be able to prevent recurrent urinary
tract infections.
Male UTIs are often a result of an obstruction such as a
urinary stone or enlarged prostate or a medical
procedure involving a catheter. The first step is to
identify the infecting organism and the drugs to which it
is sensitive. Doctors recommend longer therapy in men
than in women to prevent the infection from spreading to
the prostate gland.
Prostate infections (chronic bacterial prostatitis) are
harder to cure because antibiotics are unable to treat
infected prostate tissue effectively. Men with prostatitis
often need long-term treatment with a carefully selected
antibiotic. Urinary tract infections in older men are
frequently associated with acute bacterial prostatitis,
which can have serious consequences if not treated
The Symptoms of UTI
Though most men show signs of a UTI and will
experience some discomfort, not all males display
symptoms. Symptoms may include a frequent urge to
urinate and a painful, burning feeling in the vicinity of
the bladder or urethra during urination. It is not unusual
to generally feel tired, shaky, washed out, and feels pain
even when not urinating. It has been documented that
some men have experienced the feeling of fullness in the
rectum. It is common for a man with a urinary infection
to, despite the urge to urinate, pass only a small amount
of urine. The urine itself may look cloudy, milky, or even
reddish if blood is present. Normally, a UTI does not
cause fever if it is in the urethra or bladder. A fever may
indicate that the infection has spread to the kidneys.
Symptoms of a kidney infection include pain in the back
or side below the ribs, nausea, or vomiting.
UTI Diagnosis
To find out whether your urinary tract has been infected,
your doctor will test a sample of your urine for bacteria
and pus. The general practice is to ask for a "clean catch"
urine sample by washing the genital area and collecting a
"midstream" sample in a sterile container. This method of
collecting urine prevents bacteria around the genital area
from getting into the sample that may complicate the test
results. The sample is then sent to a laboratory, if the
doctor's office is not equipped to perform the testing.
In the urinalysis test, the urine is tested for red and white
blood cells and bacteria. If bacteria are present, it is then
grown in a culture and tested against different antibiotics
to see which drug is most effective against it. Some
microbes, like Mycoplasma and Chlamydia, can be
detected only with specific bacterial cultures. A doctor
suspects a microbial infection when a man displays
symptoms of a UTI, but a standard culture doesn't display
any bacterial growth.
When treatment does not clear up infection and is traced
to the same strain of bacteria, the doctor may order more
tests to help determine if your system is normal. One of
these tests is an intravenous pyelogram, which allows for
X-ray images of the kidneys, bladder, and ureters. An
opaque dye visible on X-ray film is injected into a vein
and a series of X-rays are taken. The film maps the
urinary tract, revealing even the minutest changes in the
structure of the tract.
If infections continue to recur, your doctor also may
recommend an ultrasound exam that produces pictures
from the echo patterns of sound waves bouncing off
internal organs. Another useful test is a cystoscopy. A
cystoscope is an instrument made of a hollow tube with
several lenses and a light source that allows the doctor to
see the inside of the bladder via the urethra.
UTI Treatment
The general treatment of urinary tract infections is the use
of antibacterial drugs. The length of treatment and choice
of drug depend on the patient's medical history and the
midstream urine tests that help identify the offending
bacteria. The drugs most often used to treat routine,
uncomplicated UTIs are trimethoprim/sulfamethoxazole
(Bactrim, Septra, Cotrim), trimethoprim (Trimpex),
nitrofurantoin (Macrodantin, Furadantin), ampicillin
(Omnipen, Polycillin, Principen, Totacillin), and
amoxicillin (Amoxil, Trimox, Wymox). A class of drugs
called quinolones includes four drugs approved in recent
Continued on page 11

8-- Traditional African Clinic February/March 2013
African Traditional Herbal Research Clinic
Volume 8, Issue 2 NEWSLETTER February/March 2013
Kidney Disease and Your Heart: The Hidden Link
By KidneyTrust.Org

raising blood pressure. This renin-angiotensin system
(RAS) acts on your heart and your kidneys. An
overactive RAS can lead to kidney problems. Cells
may grow too fast or too slowly, causing inflammation,
hardening of the arteries, and blood clots.

High blood pressure is quite common in the United
States, and can damage your heart and your kidneys.
High blood pressure causes tiny tears in the flexible
lining of your blood vessels. The scars that form make
vessels walls stiff.
When this happens, your heart has
to work much harder to pump blood through the
damaged vessels. These damaged vessels may not be
able to deliver enough blood to organs so this can lead
to both heart and kidney failure.
Whats Blood got to do with it?
A number of health problems that involve your blood
can harm both your heart and your kidneys. One is
anemiaa shortage of oxygen-carrying red blood
cells. Kidneys make erythropoietin (EPO), the
hormone that tells your bone marrow to make red blood
cells. As the kidneys fail, less EPO is made, so you
make fewer red blood cells. With fewer red blood
cells, your body does not get enough oxygen. Anemia
can speed up the rate of kidney failure.
Other blood-related risk factors for heart and kidney
problems include:
1. High blood levels of cholesterol a waxy fat that
can clog your arteries and lead to blood clots that
can damage your heart or kidneys
2. Inflammation your bodys response to infection
or other injury, which can cause swelling and
damage in your blood vessels
3. Blood vessel calcification a build up of stone-
like crystals that can occur when kidney disease
throws off the balance of calcium and phosphorus
in your blood
The human body is very complex, and doctors are
actively studying even more reasons why the heart and
kidneys affect each other. Continued on page 9

When you have kidney disease, it might not occur to
you to have your heart checked out. Or, if you have
heart disease, you might not think to have your kidneys
tested. As it turns out, checking both your heart and
your kidneys is a good idea if you have either kind of
health problem.
Why? Because diseases that affect the kidneys can also
damage your heartand vice versa. In fact, many
doctors think of the heart and kidneys as one
interlinked body system rather than separate organs.

Having both heart and kidney disease can cause 20
times the risk of death from heart problems than either
problem alone.
In looking at more than 18,000 people,
a decline in kidney function predicted a 62% higher
risk of death from heart failure.
Heart disease happens
very early in the course of kidney diseaseso even just
a small decline in kidney function should trigger efforts
to help protect your heart.

Your Heart and Kidneys Never Sleep
While you can take a break after a hard day, your heart
cant. Its job is to pump oxygen-rich blood from your
lungs to each cell in your body, minute after minute,
day after day. If your heart beats at the average rate of
about 75 times a minute, this means more than 39
million beats a year!
With each heartbeat, blood is pushed through your
kidneys for filtering. Though your two kidneys are
each just about the size of your closed fist, they process
about 200 quarts of blood per day to make about two
liters of urine.
To do their work, your kidneys need a
constant supply of blood at a normal pressure. Too
little blood or too little pressure can cause acute,
sudden kidney failure. Too much blood or too much
pressure can lead to scarring that can cause chronic,
permanent kidney disease.
The Low Side of High Blood Pressure
Healthy kidneys work with your heart to control your
blood pressure. Any time your blood pressure falls,
kidneys release the enzyme renin into your blood.
Renin signals your liver to make the hormone
angiotensin, which tells blood vessels to constrict

9-- Traditional African Clinic February/March 2013
Continued from page 8 Kidney Disease and Your Heart:
the Hidden Link
What You Can Do
To help your kidneys and your heart work as well as
possible, do what you can to keep the normal balance
inside your body.
The main job of your kidneys is to maintain
homeostasisa constant environment inside your
body. Kidneys have built in sensors. At any given
moment, healthy kidneys ensure that blood levels of
water, salts, and other key chemicals are in perfect
balance. When they begin to fail, this very precise
system starts to fall apart. While we may not yet know
exactly why this affects the heart, we know that it
does. Here are some things you can do:
1. Control your blood pressure. Blood pressure
pills, diet, and exercise can help reduce the stress
on your blood vessels. This can help keep both
your kidneys and your heart healthy. You may
find that a low-salt diet can help make it easier to
hit the blood pressure target your doctor gives you.
2. Learn your glomerular filtration rate (GFR).
Based on your age, race, sex, and blood level of
creatinine (a waste removed by healthy kidneys),
your GFR is an estimate of how well your kidneys
work. GFR is used to put chronic kidney disease
into one of five stages. Finding out that you have
loss of kidney function can give you time to get
treatment so to protect your kidneys and heart at
the same time. In many cases when kidney disease
is found early enough kidney failure can be
delayed or prevented.
3. Keep your phosphorus in line. If you have
kidney disease, your doctor may prescribe
phosphate binders for you to take with meals and
snacks. These drugs attach to phosphorus
molecules like magnets and pull them out of your
bodyso you can keep the right balance of
calcium and a low-salt diet can help make it easier
to hit the blood pressure target your doctor gives
4. Ask your doctor to test you for anemia. Most
people who have some level of kidney problem
also have anemia, which can be found with a
simple blood test. Sometimes the symptoms of
anemiafeeling very tired, weak, or cold all the
time; fuzzy thinking; pale skin, lips, gums, and
nail beds, etc. These symptoms can come on so
slowly that you dont really notice. If you have
anemia, getting treatment can give you more
energy and help your heart and kidneys.
Forewarned is Forearmed
Knowing that kidney disease and heart disease go hand-in-
hand can help you know what to look for. You and your
doctor can work together and take action to prevent health
The good news is that both kidney disease and heart disease
can be treated to help you stay healthy.
Part 2 of Kidney Disease and Your Heart: The Hidden Link
focuses on diabetes.
i Tsagalis G, Zerefos S, Zerefos N. Cardiorenal syndrome at
different stages of chronic kidney disease. Int J Artif Organs.
2007 Jul;30(7):654-76
ii Efstratiadis G, Tziomalos K, Mikhailidis DP, Athyros VG,
Hatzitolios A. Atherogenesis in renal patients: a model of
vascular disease? Curr Vasc Pharmacol. 2008 Apr; 6(2):93-107
iii Damman K, Navis G, Voors AA, Asselbergs FW, Smilde TD,
Cleland JG, van Veldhuisen DJ, Hillege HL. Worsening renal
function and prognosis in heart failure: systematic review and
meta-analysis. J Card Fail. 2007 Oct;13(8):599-608
iv Stenvinkel P, Carrero JJ, Axelsson J, Lindholm B, Heimburger
O, Massy Z. Emerging biomarkers for evaluating cardiovascular
risk in the chronic kidney disease patient: how do new pieces fit
into the uremic puzzle? Clin J Am Soc Nephrol. 2008, 3:503-
v http://kidney.niddk.nih.gov/kudiseases/pubs/yourkidneys/
vi Raizada V, Skipper B, Luo W, Griffith J. Intracardiac and
intrarenal renin-angiotensin systems: mechanisms of
cardiovascular and renal effects. J Investig Med. 2007
vii ORourke MF, Hashimoto J. Mechanical factors in arterial
aging: a clinical perspective. J Am Coll Cardiol. 2007 Jul

Continued from page 2 Kidney Disease - 32 Million
Young People on Danger List
"There are now younger people who have hypertension and
diabetes, which are very important risk factors for
developing chronic kidney disease."
In Sokoto State, medical experts said there is rise in the
cases of kidney ailment among young population with
studies showing that those affected are particularly between
15 and 40 years of age.
Dr. Hamidu Liman, Consultant Nephrologists with the
Usmanu Danfodiyo University Teaching Hospital, UDUTH
and a lecturer with the Usmanu Danfodiyo University
Sokoto disclosed that at UDUTH, they see many patients
coming with what they call 'end-stage' kidney disease daily.
Continued on page 10

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Continued from page 9 Kidney Disease - 32 Million Young
People on Danger List
"End-stage means that the kidney has totally failed and
that the only solution is to temporarily take over the
function of the kidney and we have been observing a
trend over the last five years and noticed that about 8-10
per cent of all our medical admissions, that means
patients admitted into the medical ward, have some form
of kidney problem."
He said "in children, the commonest form of kidney
disease we see is just simple urinary tract infection then
followed by what we call the nephritic syndrome and
those that come with chronic renal failure.
The Consultant said recently, they did a small community
study as part of the World Kidney Day and realized that
evidence for early kidney diseases is also prevalent in the
population that they were able to explore.
"We explored people in Sokoto North during the World
Kidney Day celebration of March 2012 and realized also
that about 15 per cent of the people who appeared at the
free screening have some form of evidence of renal
damage that means it is a condition that is quite prevalent
in the hospital as well as in the community.
"What we noticed from our study is that the young
population is affected particularly between 15 and 40
years of age and this is the reproduction age group.
"We are also having a little high incidence of
schistosomiasis; it is a form of infection that can also
affect the kidney, it is fairly prevalent in children here
and it is unrecognized.
"In Sokoto State, the weather is fairly hot and people
become easily dehydrated and that is also an important
risk factor for the formation of kidney stones."
Dr. Liman said recently, they have noticed the use of
herbal medication also is on the rise and that somehow
directly or indirectly, it is also contributing to the kidney
Within Sokoto, Kebbi and Zamfara region, Weekly Trust
gathered that there are three dialysis centers for people
whose kidneys had failed.
In Kano, a physician at the Aminu Kano Teaching
Hospital, Dr. Usman Bashir told Weekly Trust that the
hospital has recorded kidney related ailments in those
below 15 years old, adding that some of these cases were
hereditary while others were due to drugs abuses, among
other habits.
A relative of a patient undergoing dialysis at AKTH,
Alhaji Dauda Suleiman of Hotoro GRA told Weekly
Trust that the hospital management has done a great job
by relatively reducing the dialysis fee from what the
hospital was charging years back. Though he declined
mentioning the amount charged, Suleiman said it is
affordable to an average salary earner.
So far, AKTH has the best diagnostic and dialysis
machines in the state. Similarly, it was gathered that the
state owned Muhammadu Abdullahi Wase Specialist
Hospital has recently acquired additional dialysis
machine as part of the state government efforts in
enhancing the hospitals capability and capacity.
Though there are other specialist hospitals in the state
such as the state Urology Hospital that carter for
kidney-related ailments.
According to Dr. Olatise Olalekan , an Abuja-based
Consultant Nephrologists and the CEO of Zenith
Kidney Center in Abuja, most of the risks factors,
especially as they affects young patients are coming
from common diseases and social behavior of people in
that age bracket, although he affirmed that there is also
a hereditary factor.
Among the young patients, kidney diseases associated
with HIV/AIDS is more common because of
widespread prevalence of the virus among young
people. Also obesity, which leads to hypertension is an
independent risk factor for developing Chronic Kidney
"Young people become obese these days which leads to
hypertension and also diabetes. All these are risks
He said over- the - counter drugs can also be a risks
factor, especially antibiotics and pain killers. Frequent
usage of such drugs without experts' advice may cause
kidney damage. He also said some herbal concoctions
taken without proper recommendation, control or
authorisation may also be toxic to the kidneys, causing
damages that mark the start of CKD or worsen existing
problems with kidney function.
He called for regular exercise to maintain ideal body
weight in obese people; non smoking, abstaining from
alcohol and drugs abuse; avoiding over-the-counter
pain killers; eating healthy and more of natural food,
regular kidney and urine tests at least once every year
as an antidote to managing the risks."

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Continued from page 5 - Urinary Tract Infections (UTI)
genital and anal areas clean, and urinate before and
after intercourse to cleanse the urethra of bacteria.
Always wipe front to back after a bowel
Try an estrogen vaginal cream. This may be best
for post-menopausal women, who have lower
levels of estrogen. Some research suggests that
estrogen may help increase the number of
beneficial bacteria that help fight infections.
Nutrition and Supplements
Cranberry juice and cranberry extract. Cranberries
contain a substance that helps prevent bacteria from
adhering to the bladder walls. Drink unsweetened
cranberry juice concentrate diluted with water, or take
powdered cranberry extract in capsules.

Continued from page 7 Urinary Tract
Infections - U.T.I. in Men
years for treating a UTI. These drugs include
ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin
(Noroxin), and trovafloxin (Trovan).
A UTI can be cured within one or two days of
treatment if the infection is not complicated by an
obstruction or other disorder. As a precaution, many
doctors ask their patients to continue antibiotics for a
week or more to make sure that the infection has been
cured. Single-dose treatment is not recommended for
some patients, such as those who neglected immediate
treatment or display signs of kidney infection, diabetic
patients, patients with structural abnormalities, or men
with prostate infections. Longer treatment is also
needed for men with infections caused by Chlamydia or
Mycoplasma, which are generally treated with
tetracycline, trimethoprim/sulfa methoxazole (TMP/
SMZ), or doxycycline. A follow-up urinalysis test
confirms that the urinary tract is free of infection.
Symptoms may disappear before the infection is fully
cleared so it is important to take the full course of
Severely ill men with kidney infections may be
hospitalized until they can take fluids and necessary
drugs on their own. Kidney infections typically require
several weeks of antibiotic treatment. Researchers at
the University of Washington found that two-week
therapy with TMP/SMZ was as effective as six weeks
of treatment with the same drug in women with kidney

infections that did not involve an obstruction or nervous
system disorder. In such cases, kidney infections rarely lead
to kidney damage or kidney failure unless untreated.
Several drugs are available to help relieve the pain of a
UTI. A heating pad may help and most doctors recommend
drinking more water because it helps purify the urinary
tract of bacteria. While undergoing treatment, it helps to
avoid alcohol, coffee, and spicy foods. One of the most
beneficial things a smoker can do for his bladder is to quit
smoking, as it is one of the major causes of bladder cancer.
Curing infections caused by a urinary obstruction or other
systemic disorder depends on diagnosing and fixing the
underlying problem, sometimes even surgically. If the root
cause is untreated, there is an increased risk of kidney
damage. Such infections tend to stem from a wider range of
bacteria, and sometimes infections can occur from more
than one type of bacteria at a time.
The National Institute of Health
(Book)-Urinary Tract Infection in Men
Tomas L. Griebling, MD
Associate Professor & Vice Chair of Urology
University of Kansas
Kansas City, Kansas
Ambulatory Care Visits to Physician Offices, Hospital
Outpatient Departments, and Emergency Departments: United
States, 1999-2000. Vital and Health Statistics. Series 13, No. 157.
Hyattsville, MD: National Center for Health Statistics, Centers
for Disease Control and Prevention, U.S. Dept. of Health and
Human Services; September 2004.

What Your Urine Is Telling You
19 November 2010
The color of your urine can denote a lot of things; the
urinary system is a storehouse of information regarding
your state of health. Odor and color are key urine
characteristics that determine the health of the urinary
system as well as indicate possible urinary tract infection,
dehydration, abnormal blood sugar levels, and your food as
well as medicine intake.
Regular urine tests are mandatory to ensure that the kidneys
are functioning normally. Here are some characteristics you
need to watch out for:
Colorless urine: Urologists have stated that clear or
colorless urine is produced when a persons water intake is
very high. In other cases, there might be some kind of
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Continued from page 11 - What your Urine is telling you
chronic renal failure that prevents the kidneys from
absorbing the necessary nutrients and causes them to
excrete water as urine. Remember, numerous restroom
trips throughout the day are okay. They become a
matter of concern only if you feel uncomfortable during
the process.
Bright yellow urine: Not all urine colors are indicators
of poor health. Bright yellow or deep amber colored
urine indicates that the body is dehydrated and is not
getting sufficient fluids or water intake. The body is
under stress to retain the maximum amount of water
that it needs, causing the urine to become more
concentrated. Apart from this, people who are on
certain medications may have bright yellow urine.
Hypervitaminosis also results in the production of
amber-colored urine.
Brown urine: Brown-colored urine that has the color
of tea is a clear indicator of a problem with the urinary
tract. More often than not, it indicates the presence of
old blood in the urinary tract. It is also a sign of severe
dehydration. A lighter shade of urine (the color of
straw) that is odorless and spotless proves that the body
is healthy and problem-free.
Blood in urine: More serious medical conditions like
hematuria, characterized by the presence of blood in the
urine, may need urgent medical attention. They may
also indicate possible urinary tract infection and other
health problems including cancer, kidney stones, or
enlarged blood vessels.
Odor of urine: Sweet odor indicates diabetes, while
foul odor implies the need for medical diagnosis.
Diabetes causes blood sugar levels in the urine to rise,
which result in sweetish urine odor. Research indicates
that foods like asparagus cause the production of
smelly urine due to the production of sulfur-containing
amino acid.
People tend to develop complications related to their
urinary system as part of the aging process. So, as you
grow older, it is recommended that you get your urine
tested regularly. Pregnant women also need to be
cautious and get regular urine tests.

Irregular Heart Rhythm
Increases Kidney Failure Risk
By VR Sreeraman
January 20, 2013
People with chronic kidney disease who also have atrial
fibrillation, the most common forms of irregular heart
rhythm, are at an increased risk of developing kidney
The finding by researchers at the University of California,
San Francisco (UCSF) and the Kaiser Permanente Northern
California Division of Research opens the way for further
studies into the relationship between the two factors, which
could lead to new treatment approaches that would improve
outcomes for people with chronic kidney disease.
Doctors have known that patients with chronic kidney
disease or end-stage renal disease commonly have atrial
fibrillation and as a result are more likely to have a stroke
or to die. However, the long-term impact of atrial
fibrillation on kidney function among patients with known
chronic kidney disease has been unknown.
The new study involved 206,229 adults with chronic kidney
disease who were drawn from members of Kaiser
Permanente Northern California, a large integrated health
care delivery system. Over the course of about five years,
approximately 16,400 patients developed atrial fibrillation,
and those who did were 67 percent more likely to progress
to end-stage renal disease compared with patients who had
chronic kidney disease but did not develop atrial
"These novel findings expand on previous knowledge by
highlighting that atrial fibrillation is linked to a worse
kidney prognosis in patients with underlying kidney
dysfunction," said kidney specialist Nisha Bansal, MD, an
assistant professor in the Division of Nephrology at UCSF.
"There is a knowledge gap about the long-term impact of
atrial fibrillation on the risk of adverse kidney-related
outcomes in patients with chronic kidney disease," said
senior author Alan S. Go, MD, director of the
Comprehensive Clinical Research Unit at the Kaiser
Permanente Division of Research.
"This study addresses that gap and may have important
implications for clinical management by providing better
prognostic information and leading to future work
determining how to improve outcomes in this high-risk
group of patients," the researcher added.
Bansal added, however, that while the two conditions are
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Continued from page 12 Irregular Heart Rhythm Increases
Kidney Failure Risk
intertwined, scientists do not know exactly which specific
genes, pathways and biological mechanisms connect
irregular heartbeat to declines in kidney function.
Neither do they yet know the extent to which treating
atrial fibrillation will improve outcomes for people with
chronic kidney disease.
The study was published online by the journal Circulation
last month.

Mineral Metabolism
Abnormalities may increase
Risk of Kidney Failure among
African Americans
December 14, 2012
Abnormalities of mineral metabolism worsen with
progressive chronic kidney disease (CKD) and are linked
with a higher risk for kidney failure among African
Americans, according to a study appearing in an
upcoming issue of the Journal of the American Society of
Nephrology (JASN). The findings suggest that measuring
mineral metabolites may be a useful way to determine a
CKD patient's prognosis, and targeting mineral
metabolites may help slow progression of the disease.
It is often difficult for physicians to differentiate which
patients with CKD will go on to develop advanced stages
of the disease and which will remain more stable over
time. They do know that CKD tends to progress more
rapidly to kidney failure in African Americans than in
Caucasians and that disordered mineral metabolism
which occurs when failing kidneys do not maintain the
proper levels of minerals in the bloodis more severe
among African Americans with CKD. This might
partially explain the accelerated progression of their
To investigate, Julia Scialla, MD, Myles Wolf, MD
(University of Miami Miller School of Medicine) and
their colleagues measured blood levels of various mineral
metabolites over an average of four years in 420 CKD
patients who participated in the African American Study
of Kidney Disease and Hypertension. "We were hoping
to determine whether abnormal blood levels of calcium
and phosphate, and the hormones that regulate them
fibroblast growth factor 23, vitamin D, and parathyroid

hormoneare risk factors for kidney disease progression in
African Americans," said Dr. Wolf. The researchers also
looked for a potential link between levels of these mineral
metabolites at the start of the study and risk for kidney
failure or death in 809 participants.
Among the major findings:
FGF23, PTH, and phosphate levels rose over time; the
greatest increases occurred in participants with faster rates
of kidney function decline.
Patients with the highest levels of FGF23 at the start of the
study had more than a two-fold increased risk of kidney
failure or death independent of kidney function compared
with patients with the lowest levels. Higher blood levels of
PTH and phosphate were associated with a more modestly
increased risk.
Vitamin D insufficiency was present in 95% of
participants, but lower levels were not independently linked
with kidney failure or death.
The findings suggest that abnormal levels of mineral
metabolites convey clinically relevant information for
assessing the likely progression of CKD beyond
measurements of kidney function that clinicians already
monitor routinely.
"Also, it might be possible to slow kidney disease
progression in African Americans using treatments that
normalize mineral levels and the hormones that regulate
them. Clinical trials are needed to prove this hypothesis,"
said Dr. Scialla.
Source: American Society of Nephrology

What Role Does Vitamin D
Play in Kidney Function?
By Karen Hellesvig-Gaskell
May 19, 2011
The primary function of vitamin D is to help the body
maintain sufficient blood levels of calcium and
phosphorous. Vitamin D also may guard against high blood
pressure, certain autoimmune diseases and even cancer.
Vitamin D plays a role in kidney function as well.
Healthy kidneys produce a form of vitamin D called
calcitrol that helps the body absorb calcium, which in turn
promotes strong bones. Insufficient levels of calcitrol can
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Continued from page 13 What Role Does Vitamin D Play in
Kidney Function?
take away calcium from the bones. If the kidney's fail, the
body may stop producing calcitrol, explains the National
Kidney and Urologic and Diseases Information

BPA Adversely affects
Kidney Function in Children
By Helen Albert
January 16, 2013
Children with high levels of exposure to bisphenol A
(BPA) are at increased risk for low-grade albuminuria,
report researchers.
These findings add to those of previous research showing
an association between BPA exposure and adverse
cardiometabolic and renal symptoms in adults, as well as
an increased risk for obesity in children.
"While our cross-sectional study cannot definitively
confirm that BPA contributes to heart disease or kidney
dysfunction in children, together with our previous study
of BPA and obesity, this new data adds to already
existing concerns about BPA as a contributor to
cardiovascular risk in children and adolescents," said
study author Leonardo Trasande (New York University
School of Medicine, USA) in a press statement.
The researchers analyzed data from 710 children and
adolescents, aged 6-19 years, who took part in the
National Health and Nutrition Examination Survey 2009-
2010 and had measures of urinary BPA and degree of
albuminuria, from morning urine samples of creatinine,
calculated. Children with pre-existing kidney disease
were excluded from the study.
As reported in Kidney International, the team found that
children in the highest quartile of BPA exposure (4.3
ng/mL) had a significant 0.91 mg/g higher albumin-to-
creatinine ratio than children in the lowest quartile of
exposure (<1.1 ng/mL) after adjusting for insulin
resistance, elevated cholesterol, and various environ-
mental and sociodemographic risk factors.
The authors also estimated that each log unit increase in
urinary BPA was associated with a significant 0.28 mg/g
increase in the albumin-to-creatinine ratio.
Commenting to the press, study co-author Howard
Trachtman, also from New York University School of
Medicine, noted that BPA exposure may have an even
greater effect on children with kidney disease.
"Because their kidneys are already working harder to
compensate and have limited functional reserve, they may
be more susceptible to the adverse effects of environmental
toxins," he explained.
Trasande adds that the results of this study further support
calls to limit BPA exposure in the USA, especially in
"Removing it from aluminum cans is probably one of the
best ways we can limit exposure. There are alternatives that
manufacturers can use to line aluminum cans," he

NSAIDs pose Kidney Risk in
Some Children
By Helen Albert
January 29, 2013
A small but significant percentage of children develop
acute kidney injury (AKI) after taking nonsteroidal anti-
inflammatory drugs (NSAIDs) such as ibuprofen, show
study findings published in the Journal of Pediatrics.
The researchers, led by Jason Misurac, from Indiana
University School of Medicine in Indianapolis, USA,
analyzed International Classification of Diseases, Ninth
Revision screening data from 1015 children with AKI to
assess the impact of NSAID use.
Of this group, 27 (2.7%) had clinical, laboratory, and
radiographic signs of NSAID-associated injury, with 21
cases of acute tubular necrosis and six cases of acute
interstitial nephritis.
Although the absolute numbers of these children are small,
the damage caused can be considerable, notes the team.
Indeed, at least seven sustained damage that was likely to
be permanent.
"These cases, including some in which patients' kidney
function will need to be monitored for years, as well as the
cost of treatment, are quite significant, especially when you
consider that alternatives are available and acute kidney
injury from NSAIDs is avoidable," said Misurac in a press
The mean age of the children with NSAID-induced AKI
was 14.7 years, with only four patients younger than 5
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Continued from page 14 NSAIDs pose Kidney Risk in Some
years old at the time of injury. All four of these patients
required dialysis, compared with none of the older
children. They were also more likely to need intensive
care unit admission than older children (75 vs 9%) and
had a longer median stay in the hospital (10 vs 7 days).
The majority (75%) of the children with dosing data
available (n=20) had received an NSAID dose within the
recommended dosing limits for their age. The most
common NSAID taken by the children was ibuprofen
(67%), followed by naproxen (11%) and ketorolac (7%);
the rest of the children took a combination of ibuprofen
and naproxen or ketorolac.
"This study underscores the importance of understanding
the natural history of NSAID-associated AKI, including
the potential for development of chronic kidney disease,"
commented Misurac. "Providers should continue to
provide careful NSAID education to parents and

Kidney Disease & Diabetes
One of the more common long-term complications of
diabetes is diabetic renal disease ("renal" refers to the
kidneys). Also known as diabetic nephropathy, this
condition is a result of direct vascular abnormalities that
accompany diabetes. Furthermore, diabetes mellitus is the
main cause of end-stage renal disease (ESRD), the most
advanced stage of kidney disease.
Stages of Chronic Kidney Disease (CKD)
There are some of the progressive stages chronic of
kidney disease.
Chronic renal insufficiency
Even in the first stage of kidney disease, the organ suffers
damage. While there is impaired kidney function, during
this stage there are only minimal effects to the entire
Chronic renal failure
In stage two of the disease, damage to the kidneys has
progressed to a level that causes problems throughout the
body. One such problem is an increase in the amount of
waste products in the blood such as urea, creatinine and
phosphate. When the body functions normally, the
kidneys are able to remove these waste products. Other
effects of chronic renal failure include anemia, bone
disease, acidosis, and salt and fluid retention. Most
patients with chronic renal failure progress to the final or

end-stage of kidney disease.
End-stage renal disease (ESRD)
By the time a patient reaches end-stage renal disease, the
condition and its effects are generally irreversible. To
sustain life, the patient requires renal replacement
therapy, which includes dialysis or a kidney transplant.
Why does diabetes increase the risk for kidney
High blood sugar can overwork the kidneys, which over
time damage them. After many years, they start to leak
small amounts of protein (albumin) into the urine, which
indicates that the kidneys are damaged. Not everyone
with diabetes develops kidney disease. Factors that can
influence kidney disease development include genetics,
blood sugar control, and blood pressure. The better a
person keeps diabetes and blood pressure under control,
the lower the chance of getting kidney disease.
How are cardiovascular disease (CVD) and kidney
disease related?
Chronic kidney disease can lead to cardiovascular disease
(CVD). Conversely, CVD can lead to kidney disease, so
the two diseases are strongly intertwined. According to
studies, CVD begins to have an effect on the body as
early as the first stage of kidney disease, and most people
with ESRD die as a result of cardiovascular
Risks that are often associated with kidney disease also
contribute to the development of cardiovascular disease.
High blood pressure (hypertension)
High LDL ("bad") cholesterol
Low HDL ("good") cholesterol
Physical Activity
Older age
What should I do if I have diabetes?
Many of the risk factors for kidney disease and CVD are
treatable. If you have diabetes, take these steps:
Keep your blood sugar levels in the normal range.
Control your blood pressure.
Manage your weight.
Work closely with your health care team to ensure your
urine albumin levels are being monitored. (The American
Diabetes Association suggests that people with type 2
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Continued from page 15 Kidney Disease & Diabetes
diabetes should be screened for urine albumin levels at
the time of diagnosis and once a year thereafter.)

Kidney Disease increases
Risk of Premature Death in
Diabetic Patients
January 25, 2013
One in every 10 Americans has diabetes, and a third or
more of those with the condition will develop kidney
disease. It may be possible to live a long and healthy
life with diabetes, but once kidney disease develops,
the risk of dying prematurely increases significantly,
according to a study appearing in an upcoming issue of
the Journal of the American Society of Nephrology
(JASN). The findings have significant clinical
implications for the prevention and treatment of kidney
disease in people with diabetes.
Because people with diabetes have an increased
likelihood of dying prematurely as well as an increased
likelihood of developing kidney disease, Maryam
Afkarian, MD, PhD (University of Washington) and
her colleagues looked to see how the former affects the
latter. In other words, how much does kidney disease
contribute to diabetics' increased risk of dying early?
The researchers examined 10-year mortality rates in
15,046 US adults. Kidney disease was present in 9.4%
and 42.3% of individuals without and with type 2
diabetes, respectively.
Among the major findings:
Among people without diabetes or kidney disease,
10-year mortality was 7.7%
Among individuals with diabetes but without
kidney disease, mortality was 11.5%.
Among individuals with both diabetes and kidney
disease, mortality was 31.1%.
"People with type 2 diabetes have many other risk
factors for cardiovascular disease and mortality, so we
expected that kidney disease would predict a part, but
not a majority, of higher mortality associated with type
2 diabetes. To our surprise, we found that even in the
medically complex patients with type 2 diabetes,
kidney disease is a very powerful predictor of pre-
mature death," said Dr. Afkarian.
She noted that the findings have important implications.
"First, among people with type 2 diabetes, the subgroup
with kidney disease carries most of the mortality risk, so
targeting intensive risk factor modification on this
subgroup is likely to have the highest impact on overall
mortality of people with diabetes. Secondly, preventing
kidney disease may be a powerful way of reducing
mortality in people with diabetes," said Dr. Afkarian.
Source: American Society of Nephrology (ASN)

Wellbeing & Healing
The Kidney as the Root of the
By Dr. S. X. Ke
August 9, 2005
In Chinese Medicine, the kidney is considered the most
important organ in the body. Physiologically, as we all
know, it is the key organ involved in purifying the blood,
eliminating toxins from the body by means of urination.
It is also, as is often forgotten, the rejuvenating recycling
source of the body.
Every four minutes the total volume of blood in ones
body passes through and is filtered by the kidney. This
process not only clears away toxins, but also helps
recycle nutrients carried in the blood, such as sugar,
vitamins and minerals etc. Pathologically, many chronic
illnesses are caused by the failure of such recycling
processes of the kidneys. In Chinese Medicine, this is
diagnosed as kidney deficiency.
Osteoporosis, for example, is a common problem
amongst the elderly. As is widely known, the problem
here lies in the decalcification of the bone: the lack of
calcium. Western medicine addresses the problem by
increasing the patients daily dose of calcium. They are
advised to drink more milk, or take supplementary
calcium tablets. But the results are often dissatisfactory.
There are cases where a patient is already taking five or
ten times the recommended daily allowance of calcium
but continues to display symptoms of calcium deficiency;
the patients body continues to dissolve its own bone (the
process of decalcification) to increase the level of
calcium in the blood, in order to maintain calcium levels
for certain vital organs of the body to function normally
Continued to page 17

17-- Traditional African Clinic February/March 2013

Continued from page 16 The Kidney as the Root
of the Body
(for the beating of the heart for example), resulting in
the deterioration of osteoporosis.
So why does taking more calcium not help solve the
problem of osteoporosis? This is because the
treatment prescribed by western medicine focuses on
the superficial cause of calcium deficiency. It does
not deal with why the body lacks calcium in the first
place, the cause and root of the problem; the kidneys
inability to retain calcium, resulting in its leaking
away. The kidneys of elderly people are normally
weak, through natural wear and tear, or misuse: the
result of drinking too much coffee or alcohol for
example etc. These weak kidneys are constantly
leaking any nutrients, such as calcium, ingested.
Thus, you can never replace the leakage fast enough
this is not to mention the slow absorption rate of the
digestive systems of the elderly, which exacerbates
the condition. I often describe such a condition with
the help of an analogy; its no use trying desperately
to run a car on a leaking tank; it does not matter how
much petrol you put in, for the leakage ensures that
there will never be enough for the car to run
normally. Therefore we must focus on the root of the
problem. We can only treat such decalcification by
treating the leaking of calcium by the kidneys.
Thanks to thousands of years of experience, Chinese
Medicine has developed the concept of strengthening
kidneys. By consulting an experienced Chinese
Doctor, the particular kind of kidney deficiency can
be determined and herbal pills prescribed to
strengthen the kidney against that particular kind of
deficiency and the kidney leakage stopped.
Balancing this with some sort of physical exercise,
whether it be weight training or Qi Gong, at least
three to four times per week will be helpful. Also
important is making sure to have a good healthy diet.
Maybe including fresh walnuts which are especially
nutritious for the kidneys and black sesame seeds for
calcium and bones. With this, the osteoporosis can
then be halted and even reversed and healed.
Dr. S.X.Ke has many specialities and deals with treatments
of kidney problems realizing the kidney is considered one
of the most important organs in the body. He is involved
with the Asanti Academy of Traditional Chinese Medicine,
combining Eastern and Western medicine.

Diet Soda now promoted as
Medicine to Stop Kidney
Stones (Opinion)
By Mike Adams
May 18, 2010
(NaturalNews) The "most retarded science journal of the
year" award goes to the Journal of Urology which has
published an article suggesting that diet soda is actually an
effective type of medicine for preventing kidney stones
(April 19, 2010 issue). The research was led by Dr Brian H.
Eisner, a urologist at Massachusetts General Hospital in
Boston, who is apparently completely clueless about human
nutrition and the toxicity of aspartame.
According to Dr Eisner, diet sodas are not only good
medicine for preventing kidney stones; they're also a good
source of water hydration. Noting that patients need to
consume 2-3 liters of water each day, Dr Eisner said in a
Reuters article, "If drinking these sodas helps people reach
that goal, then that may be a good thing."
If you're thinking this is some sort of April Fools joke, it
isn't. Dr Eisner and the Journal of Urology are somehow
convinced this is good research and that diet sodas may
actually have a positive medicinal effect on the human body.
Instances of such "scientific" stupidity appear to be
increasing in western medicine where doctors remain wildly
ignorant of the effects on the human body caused by
processed ingredients or toxic chemical additives.
Aspartame, used as the primary sweetener in diet sodas, is
a potent neurotoxin according to experts like Dr Russell
Blaylock. Many believe it promotes headaches, vision
problems, endocrine system problems and nervous system
disorders. It has never been proven safe for human
consumption by any honest testing.
Most diet sodas also contain alarmingly high levels of
phosphoric acid, a substance that causes a huge increase in
acidity throughout the body, suppressing immune function,
weakening bones and contributing to kidney stones (not
preventing them).
The truth about diet soda
There is absolutely no question that drinking diet soda is
atrocious for your health. That a mainstream western
doctor would somehow conclude diet soda to be a medicine
for preventing kidney stones is equivalent to declaring
"pizza prevents heart disease" or that smoking cigarettes
prevents cancer. It shows not merely the shocking
nutritional ignorance of Dr Eisner himself, but the utter lack
Continue on page 37

18-- Traditional African Clinic February/March 2013

African Traditional Herbal Research Clinic
Volume 8, Issue 2 NEWSLETTER February/March 2013
Kidney Stones
(Renal Stones, Nephrolithiasis)
By Melissa Conrad Stppler, MD

Kidney stone facts
A kidney stone is a hard, crystalline mineral
material formed within the kidney or urinary
Nephrolithiasis is the medical term for kidney
Symptoms of a kidney stone include flank pain
(which can be quite severe) and blood in the
urine (hematuria).
Kidney stones form when there is a decrease in
urine volume and/or an excess of stone-forming
substances in the urine.
Dehydration is a major risk factor for kidney
stone formation.
People with certain medical conditions, such as
gout, and those who take certain medications or
supplements are at risk for kidney stones.
Dietary and hereditary factors are also related to
stone formation.
Diagnosis of kidney stones is best accomplished
using a CT scan.
Most kidney stones will pass through the ureter to the
bladder on their own with time.
Treatment includes pain control medications and, in
some cases, medications to facilitate the passage of
If needed, lithotripsy or surgical techniques may be
used for stones which do not pass through the ureter
to the bladder on their own.
What is a kidney stone?
A kidney stone is a hard, crystalline mineral material
formed within the kidney or urinary tract. Kidney
stones are a common cause of blood in the urine
(hematuria) and often severe pain in the abdomen,
flank, or groin. Kidney stones are sometimes called
renal calculi.
The condition of having kidney stones is termed
nephrolithiasis. Having stones at any location in the
urinary tract is referred to as urolithiasis, and the term
ureterolithiasis is used to refer to stones located in the
Who is at risk for kidney stones?
Anyone may develop a kidney stone, but people with
certain diseases and conditions (see below) or those
who are taking certain medications are more
susceptible to their development. Urinary tract stones
are more common in men than in women. It is
estimated that about 12% of men and 7% of women
in the U.S. will develop stones in the urinary tract at
some point in their lives. About 20 million people
seek medical care each year because of kidney
stones. Most urinary stones develop in people 20-49
years of age, and those who are prone to multiple
attacks of kidney stones usually develop their first
stones during the second or third decade of life.
People who have already had more than one kidney
stone are prone to developing further stones.
In residents of industrialized countries, kidney stones
are more common than stones in the bladder. The
opposite is true for residents of developing areas of
the world, where bladder stones are the most
common. This difference is believed to be related to
dietary factors. People who live in the southern or
southwestern regions of the U.S. have a higher rate of
kidney stone formation than those living in other
areas. Over the last few decades, the percentage of
people with kidney stones in the U.S. has been
increasing; the reason for this is not well understood.
Continued on page 19

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Continued from page 18 Kidney Stones
A family history of kidney stones is also a risk factor
for developing kidney stones. Kidney stones are more
common in Asians and Caucasians than in Native
Americans, Africans, or African Americans.
Uric acid kidney stones are more common in people
with chronically elevated uric acid levels in their blood
A small number of pregnant women (about one out of
every 1,500-3,000 pregnancies) develop kidney stones,
and there is some evidence that pregnancy-related
changes may increase the risk of stone formation.
Factors that may contribute to stone formation during
pregnancy include a slowing of the passage of urine
due to increased progesterone levels and diminished
fluid intake due to a decreasing bladder capacity from
the enlarging uterus. Healthy pregnant women also
have a mild increase in their urinary calcium excretion.
However, it remains unclear whether the changes of
pregnancy are directly responsible for kidney stone
formation or if these women have another underlying
factor that predisposes them to kidney stone formation.
What causes kidney stones?
Kidney stones form when there is a decrease in urine
volume and/or an excess of stone-forming substances in
the urine. The most common type of kidney stone
contains calcium in combination with either oxalate or
phosphate. About 75% of kidney stones are calcium
stones. Other chemical compounds that can form stones
in the urinary tract include uric acid, magnesium
ammonium phosphate (which forms struvite stones; see
below), and the amino acid cystine.
Dehydration from reduced fluid intake or strenuous
exercise without adequate fluid replacement increases
the risk of kidney stones. Obstruction to the flow of
urine can also lead to stone formation. In this regard,
climate may be a risk factor for kidney stone
development, since residents of hot and dry areas are
more likely to become dehydrated and susceptible to
stone formation.
Kidney stones can also result from infection in the
urinary tract; these are known as struvite or infection
stones. Metabolic abnormalities, including inherited
disorders of metabolism, can alter the composition of
the urine and increase an individual's risk of stone
A number of different medical conditions can lead to an
increased risk for developing kidney stones:
Gout results in chronically increased amount of uric
acid in the blood and urine and can lead to the forma-
tion of uric acid stones.
Hypercalciuria (high calcium in the urine), another
inherited condition, causes stones in more than half of
cases. In this condition, too much calcium is absorbed
from food and excreted into the urine, where it may
form calcium phosphate or calcium oxalate stones.
Other conditions associated with an increased risk of
kidney stones include hyperparathyroidism, kidney
diseases such as renal tubular acidosis, and other
inherited metabolic conditions, including cystinuria
and hyperoxaluria.
Chronic diseases such as diabetes and high blood
pressure (hypertension) are also associated with an
increased risk of developing kidney stones.
People with inflammatory bowel disease are also
more likely to develop kidney stones.
Those who have undergone intestinal bypass or
ostomy surgery are also at increased risk for kidney
Some medications also raise the risk of kidney
stones. These medications include some diuretics,
calcium-containing antacids, and the protease
inhibitor indinavir (Crixivan), a drug used to treat
HIV infection.
Dietary factors and practices may increase the risk of
stone formation in susceptible individuals. In
particular, inadequate fluid intake predisposes to
dehydration, which is a major risk factor for stone
formation. Other dietary practices that may increase
an individual's risk of forming kidney stones include a
high intake of animal protein, a high-salt diet,
excessive sugar consumption, excessive vitamin D
supplementation, and possible excessive intake of
oxalate-containing foods such as spinach.
Interestingly, low levels of dietary calcium intake
may alter the calcium-oxalate balance and result in
the increased excretion of oxalate and a propensity to
form oxalate stones.
What are kidney stones symptoms and signs?
While some kidney stones may not produce symptoms
(known as "silent" stones), people who have kidney
stones often report the sudden onset of excruciating,
cramping pain in their low back and/or side, groin, or
abdomen. Changes in body position do not relieve this
pain. The abdominal, groin, and/or back pain typically
waxes and wanes in severity, characteristic of colicky
pain (the pain is sometimes referred to as renal colic). It
may be so severe that it is often accompanied by nausea
and vomiting. Continued on page 20

20-- Traditional African Clinic February/March 2013

Continued from page 19 Kidney Stones

Pictures of kidney and kidney stone
The pain has been described by many as the worst pain of
their lives, even worse than the pain of childbirth or broken
bones. Kidney stones also characteristically cause blood in
the urine. If infection is present in the urinary tract along
with the stones, there may be fever and chills. Sometimes,
symptoms such as difficulty urinating, urinary urgency,
penile pain, or testicular pain may occur due to kidney
How are kidney stones diagnosed?
The diagnosis of kidney stones is suspected when the
typical pattern of symptoms is noted and when other
possible causes of the abdominal or flank pain are
excluded. Imaging tests are usually done to confirm the
diagnosis. A helical CT scan without contrast material is
the most common test to detect stones or obstruction
within the urinary tract. Formerly, an intravenous
pyelogram (IVP; an X-ray of the abdomen along with the
administration of contrast dye into the bloodstream) was
the test most commonly used to detect urinary tract stones,
but this test has a greater risk of complications, takes
longer, and involves higher radiation exposure than the
non-contrasted helical CT scan. Helical CT scans have
been shown to be a significantly more effective diagnostic
tool than the IVP in the diagnosis of kidney or urinary tract
In pregnant women or those who should avoid radiation
exposure, an ultrasound examination may be done to help
establish the diagnosis.
What is the treatment for kidney stones? How long
does it take to pass a kidney stone?
Most kidney stones eventually pass through the urinary
tract on their own within 48 hours, with ample fluid intake.
Ketorolac (Toradol), an injectable anti-inflammatory drug,
and narcotics may be used for pain control when over-the-
counter pain control medications are not effective.
Intravenous pain medications can be given when nausea
and vomiting are present.
Although there are no proven home remedies to dissolve
kidney stones, home treatment may be considered for
patients who have a known history of kidney stones. Since
most kidney stones, given time, will pass through the
ureter to the bladder on their own, treatment is directed
toward control of symptoms. Home care in this case
includes the consumption of plenty of fluids. Ibuprofen
(Advil) may be used as an anti-inflammatory medication if
there is no contraindication to its use. If further pain
medication is needed, stronger narcotic pain medications
may be recommended.
There are several factors which influence the ability to
pass a stone. These include the size of the person, prior
stone passage, prostate enlargement, pregnancy, and the
size of the stone. A 4 mm stone has an 80% chance of
passage while a 5 mm stone has a 20% chance. Stones
larger than 9 mm-10 mm rarely pass without specific
Some medications have been used to increase the passage
rates of kidney stones. These include calcium channel
blockers such as nifedipine (Adalat, Procardia, Afeditab,
Nifediac) and alpha blockers such as tamsulosin (Flomax).
These drugs may be prescribed to some people who have
stones that do not rapidly pass through the urinary tract.
For kidney stones that do not pass on their own, a
procedure called lithotripsy is often used. In this
procedure, shock waves are used to break up a large stone
into smaller pieces that can then pass through the urinary
Surgical techniques have also been developed to remove
kidney stones when other treatment methods are not
effective. This may be done through a small incision in the
skin (percutaneous nephrolithotomy) or through an
instrument known as an ureteroscope passed through the
urethra and bladder up into the ureter.
How can kidney stones be prevented?
Rather than having to undergo treatment, it is best to avoid
kidney stones in the first place when possible. It can be
especially helpful to drink more water, since low fluid
intake and dehydration are major risk factors for kidney
stone formation.
Depending on the cause of the kidney stones and an
individual's medical history, dietary changes or
medications are sometimes recommended to decrease the
Continued on page 21

21-- Traditional African Clinic February/March 2013

Continued from page 20 - Kidney Stones
likelihood of developing further kidney stones. If one has
passed a stone, it can be particularly helpful to have it
analyzed in a laboratory to determine the precise type of
stone so specific prevention measures can be considered.
People who have a tendency to form calcium oxalate
kidney stones may be advised to limit their consumption
of foods high in oxalate, such as spinach, rhubarb, Swiss
chard, beets, wheat germ, and peanuts.
What is the outlook (prognosis) for kidney stones?
Most kidney stones will pass on their own, and successful
treatments have been developed to remove larger stones
or stones that do not pass. People who have had a kidney
stone remain at risk for future stones throughout their
"Kidney Stones in Adults." National Kidney & Urologic
Diseases Information Clearinghouse. Sept. 2, 2010.

Wolf Jr., J. Stuart. "Nephrolithiasis." Medscape.com. June 16,
2011. http://emedicine.medscape.com/article/437096-overview

By Jessica Bruso
November 21, 2010
There are five different types of kidney stones: calcium
oxalate stones, calcium phosphate stones, uric acid
stones, struvite stones and cystine stones. Your diet may
cause some types of stones but not all of them.
Once your doctor determines which type of stone you
have, she may be able to recommend dietary changes to
help you avoid getting more.
Increasing the amount of insoluble fiber and fluid in your
diet, and decreasing the amount of calcium, oxalate,
protein, sugar and salt can limit your risk for certain types
of kidney stones. Not everyone who gets kidney stones
needs to make all of these changes, however. Which
changes will be helpful depends on the type of kidney
Decreasing sodium in the diet lowers the amount of
calcium in the blood, and so does consuming less
calcium. This is helpful in preventing stones that contain
calcium. Reducing your consumption of foods that
contain oxalate, such as beets, chocolate, nuts, rhubarb,
spinach, strawberries, tea and wheat bran, can help
prevent stones containing oxalate. Eating less protein
decreases the formation of uric acid which, along with
purines, increases your risk for uric acid stones.
Insoluble fiber helps to lower the amount of calcium in
the blood, and drinking lots of fluid can help prevent
most types of kidney stones since it makes the urine less
You don't want to reduce your calcium intake too much,
or you may be at higher risk for osteoporosis. Grapefruit
juice, cranberry juice and dark colas all increase the risk
of forming calcium oxalate stones. Certain vitamin
supplements, including vitamin C and vitamin D, can
increase your chances of developing kidney stones, so
speak to your doctor about any supplements you may
Diet is one of the risk factors for kidney stones -- except
for struvite stones, which are associated with kidney
infections -- but it is not the only risk factor. Age,
obesity, being male, having a family or personal history
of kidney stones, being dehydrated and having had
gastric bypass surgery can all affect your risk for kidney
stones. Changing your diet therefore may not eliminate
all kidney stones.
Although small stones can be treated with pain relievers
and an increased fluid intake, larger stones may require
shock wave treatment to break them up or surgical
removal. Medications may be necessary to help prevent
National Kidney and Urologic Diseases Information
Clearinghouse: Diet for Kidney Stone Prevention
National Kidney Foundation: Diet and Kidney Stones
MayoClinic.com: Kidney Stones
Jackson Siegelbaum Gastroenterology: Kidney Stone Diet

22-- Traditional African Clinic February/March 2013

High-Dose Vitamin C 'doubles
Kidney Stone Risk'
Regularly taking high-dose vitamin C pills can double the
risk of kidney stones, say researchers.
By Stephen Adams
05 February 2013
They made their finding after looking at the incidence of
kidney stones over 11 years in 23,355 men.
Those who took vitamin C supplements - which typically
contain 1,000 milligrammes per tablet - were at twice the
risk of developing the stones compared to men who took
no vitamins.
Those who took the high-dose pills most regularly were
at the highest risk.
But taking vitamin C as part of a multi-vitamin - which
tend to contain much lower doses of the vitamin - did not
raise the risk, found the researchers from the Karolinska
Institute in Sweden.
Kidney stones are small crystals of waste matter that
form and can block a part of the organ or the urinary
tract, causing intense pain. They affect 10 to 20 per cent
of men and three to five per cent of women.
According to the Department of Health, adults need just
40mg of vitamin C a day. Its advice notes that taking high
doses can cause stomach pain, flatulence and diarrhoea,
but it does not mention kidney stones.
While widely believed to fight off colds, recent trials
have shown it has no discernable effect as a preventive
agent. However, it does have a modest effect in
shortening colds, if taken as a therapeutic medicine once
the infection has begun.
Professor Agneta Akesson, who led the Karolinskas
study, published in the journal JAMA Internal Medicine,
said: Given that there are no well-documented benefits
of taking high doses of vitamin C in the form of dietary
supplements, the wisest thing might be not to take them
at all, especially if you have suffered kidney stones
Dr Carrie Ruxton, from the Health Supplements
Information Service, said as the study only looked at men
results could not be assumed to be the same for women.
She added: "Since higher dose vitamin C - 500mg per
day or more - is proven to reduce the duration of a cold
orflu, it is worth taking these in the short-term when
"This study looked at people who were habitually taking
around 1000mg several times a week.
"It is likely that short-term, sporadic use of higher dose
vitamin C does not constitute a risk for kidney stones and
can be helpful when people have a cold."

High Uric Acid Level
By Mayo Clinic Staff
A high uric acid level, or hyperuricemia, is an excess of
uric acid in your blood. Uric acid is produced during the
breakdown of purine, a substance found in many foods.
Once produced, uric acid is carried in your blood and
passes through your kidneys, where most of it leaves your
body when you urinate.
A high uric acid level may result in attacks of gout, but
not everyone who has high uric acid gets gout, and not
everyone with gout has high uric acid.
A high uric acid level can be caused when your body
either produces too much uric acid or your kidneys don't
eliminate uric acid rapidly enough.
A high uric acid level may cause increasingly frequent
attacks of gout, or it may never cause problems. A high
uric acid level may also cause some people to develop
kidney stones or kidney failure. And some people with a
high uric acid level also develop high blood pressure,
heart disease or chronic kidney disease, but it's often
unclear whether this is a direct cause or merely an early
warning sign of these conditions.
Factors that may cause a high uric acid level in your
blood include:
Diuretic medications (water pills)
Drinking too much alcohol
Genetics (inherited tendencies)
Hypothyroidism (underactive thyroid)
Immune-suppressing drugs
Niacin, or vitamin B-3
Purine-rich diet organ meat, game meat,
Continued on page 26

23-- Traditional African Clinic February/March 2013

Role of Uric Acid in
Hypertension, Renal Disease,
and Metabolic Syndrome
Hyperuricemia has long been known to be associated
with cardiovascular disease, and it is particularly
common in people with hypertension, metabolic
syndrome, or kidney disease. Most authorities have
viewed elevated uric acid as a secondary phenomenon
that is either innocuous or perhaps even beneficial, since
uric acid can be an antioxidant. However, recent
experiments have challenged this viewpoint. In this paper
we argue that uric acid is a true risk factor for
cardiovascular disease. Furthermore, we suggest that the
recent increased intake in the American diet of fructose,
which is a known cause of hyperuricemia, may be
contributing to the current epidemic of obesity and
MOST AUTHORITIES do not consider hyperuricemia to
be an important risk factor for cardiovascular or renal
disease. The Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood
does not recognize it as a risk factor, and
neither does the American Heart Association nor the
National Kidney Foundation.

However, emerging data suggest that elevated uric acid is
actually one of the most important risk factors for
cardiovascular disease and that it plays a significant role
in the development of renal disease and metabolic
syndrome as well.
Granted, much of this new evidence is based on
preliminary animal studies, and the theory is provocative.
But as the German philosopher Arthur Schopenhauer
(17881860) said, All truth passes through three stages.
First, it is ridiculed. Second, it is violently opposed.
Third, it is accepted as being self-evident.
The goal of this article is to lay out the new evidence and
make the case that we need to begin taking uric acid
Nearly 15 million years ago, one of our hominid
ancestors acquired a mutation in the gene for uricase,
the hepatic enzyme that degrades uric acid into
As a consequence, both humans and the great apes,
such as chimpanzees and gorillas, have higher uric
acid levels than most other mammals.
The muta-
tion affected the ability to regulate uric acid levels,
and so changes in diet can cause marked variations
in serum uric acid levels, which can range in humans
from as low as 2 mg/dL to as high as 12 mg/dL.

This wide serum urate range in humans is
determined by the balance between purine intake and
urate production on the one hand and urate
elimination by renal and extrarenal routes on the
other. High serum urate levels usually are associated
with defects of uric acid transport in the nephron, but
until now none of these defects has been
unequivocally demonstrated.
Sir Alfred Garrod in the 1800s provided the first evidence
that gout was associated with increased levels of uric acid
in the blood.

Shortly thereafter, Frederick Akbar Mohamed
described essential hypertension, and noted that it was
often associated with gout. Writing in the Lancet, he said:
People who are subject to this high blood pressure
frequently belong to gouty families or have themselves
suffered from the symptoms of the disease.7 In
subsequent articles, Mohamed proposed that uric acid
might be one of the causes of hypertension.
After that, many papers reported on the association of
gout with hypertension, obesity, and cardiovascular
disease. Indeed, in the days before effective therapy was
available to lower serum uric acid, more than 70% of
patients with gout were obese, more than 50% had
hypertension, nearly all had some degree of renal disease
(and 10% to 25% died of it),
and approximately 90%
developed some degree of heart disease (and 20% died of
a cardiac complication). Thus, gout seemed to be a major
risk factor for cardiovascular disease.
And clinically evident gout is only the tip of the iceberg.
Many patients have hyperuricemia (uric acid > 7.0 mg/dL
in men and >6.5 mg/dL in women) but do not have gout.
Studies in people with asymptomatic hyperuricemia
have also demonstrated a remarkable association with
hypertension, obesity, metabolic syndrome, kidney
disease, and cardiovascular disease.

The key question, however, is whether the hyperuricemia
has a causal role in these syndromes or whether it is a
secondary phenomenon.
Several epidemiologic studies have tried to determine if
uric acid is an independent risk factor for cardiovascular
11, 12
; some found that it was, but others did not.
Continued on page 24

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Continued from page 23 Role of Uric Acid in Hypertension,
Renal Disease, and Metabolic Syndrome
The inability to resolve these issues, coupled with the
lack of a mechanism by which uric acid might cause
cardiovascular disease, has up to now led most authorities
to conclude that uric acid is not a true risk factor for
cardiovascular disease.
Uric acid rediscovered
While the idea that hyperuricemia may be a secondary
phenomenon appears reasonable, a number of
observations argue against it. For one thing, the elevated
uric acid often precedes the hypertension,

or kidney disease.
Until recently, however, no one had
evaluated the effect of raising uric acid levels in animals.
In studies in our laboratory, we found that rats develop
high blood pressure 3 to 5 weeks after we mildly raise
their uric acid level by giving them an inhibitor of
uricase, oxonic acid.

The mechanism of hypertension is by lowering
endothelial nitric oxide levels, reducing neuronal nitric
oxide synthase in the macula densa of the kidney, and
stimulating the renin-angiotensin system.
Over time, the
rats develop renal microvascular disease in which the
afferent arterioles thicken and occasionally develop
hyalinosis. The renal microvascular disease develops
independently of hypertension and is likely due to direct
effects of uric acid, which stimulates vascular smooth
muscle cell proliferation.

Additional studies demonstrated that once the micro-
vascular lesion occurs, the hypertension is self-
Further evidence has now come from studies in humans.
Hyperuricemia is strongly associated with endothelial
and lowering uric acid improves
endothelial dysfunction markedly in a variety of
Also, hyperuricemia has now been found
to be an independent risk factor for hypertension in
several studies.

Many patients with new-onset hypertension have elevated
uric acid. We found a uric acid level higher than 5.5
mg/dL in 89% of untreated adolescents with essential
hypertension, but in 0% of controls.
The hyperuricemia
was not secondary to hypertension in that study, as the
patients with secondary hypertension (mostly due to renal
parenchymal disease) had uric acid levels significantly
lower than those who had essential hypertension.
The relationship of uric acid to hypertension was also
independent of obesity or renal function. After pilot
studies suggested that lowering uric acid might lower
blood pressure in these patients,
several trials funded
by the National Institutes of Health were launched to
explore the role of uric acid in hypertension.
In other studies in rats, experimental hyperuricemia
(again induced by oxonic acid) was also associated
with the development of mild renal disease,
characterized by mild proteinuria, renal arteriolar
changes, glomerular hypertrophy, tubulointerstitial
fibrosis, and eventually glomerulosclerosis.

Interestingly, when hyperuricemia was induced in rats
with preexisting renal disease (ie, in which one entire
kidney and two thirds of the other kidney had been
removed), their renal lesions were dramatically worse
than in similar rats without hyperuricemia.
suggests that the hyperuricemia may not only cause
renal disease, but may also exacerbate preexistent renal
The mechanism by which uric acid might cause renal
disease was revealed by micropuncture studies, which
demonstrated that elevated uric acid (3.1 0.2 mg/dL)
caused glomerular hypertension and cortical vaso-
These changes would be expected to
induce glomerular damage and tubular ischemia. In
addition, uric acid stimulated inflammatory mediators
in vascular cells, including C-reactive protein and
monocyte chemoattractant protein-
vasoconstrictive factors such as thromboxane.35
Recent studies in humans also suggest that uric acid is a
true risk factor for kidney disease. Numerous recent
papers have reported elevated uric acid is an
independent risk factor for kidney disease in the
general population
and in patients with preexistent
renal disease.
Elevated uric acid has also been
reported to be more common in patients with diabetes
with progressive renal disease.

While earlier studies have reported mixed results from
lowering uric acid in patients with renal disease
(reviewed by Johnson et al
), a recent clinical study
found that lowering uric acid in patients with renal
disease and asymptomatic hyperuricemia resulted in
less progression of their renal disease.

While these findings need to be confirmed, these
studies, as well as reports by others, suggest that
lowering uric acid may be another way to help slow the
progression of renal disease.
Since the 1970s, the prevalence of obesity has risen
dramatically. Perhaps not coincidentally, the 1970s was
Continued on page 25

25-- Traditional African Clinic February/March 2013

Recent studies in humans found that elevated uric acid
predicts the development of hyperinsulinemia,

and type 2 diabetes.
Elevated uric acid is
also common in the metabolic syndrome and other
insulinresistant states.
Interestingly, uricosuric
agents have been reported to lower serum
However, studies to formally test the
effect of lowering uric acid on features of the metabolic
syndrome in humans have yet to be performed.
The mean uric acid level in the United States has
steadily increased over the past 60 years. The reason
may relate to the Western diet, and particularly to its
fructose content.
Indeed, Yudkin
reported in the 1960s that there was a
striking relationship between the rise in cardiovascular
disease and the dietary intake of sugar. He and others
later showed that diets high in sugar, and in particular
fructose, can induce features of the metabolic syndrome
in humans.
Given that fructose increases uric acid
levels, it is tempting to link the rise in cardiovascular
disease in part to this pathway.
Renal mechanisms, not yet well established, are
responsible for the hyperuricemia in most patients with
gout, but secondary events such as high dietary intake
of fructose may contribute to an increased production
of uric acid in those cases as well. Combined
mechanisms commonly cause hyperuricemia; another
example is high alcohol consumption, which
accelerates the hepatic breakdown of adenosine
triphosphate, contributing to the higher urate levels
frequently seen in those patients.
This theory does not negate the importance of other key
factors, including excessive caloric intake, excessive
salt intake, physical inactivity, increased societal stress,
and genetic mechanisms. However, together, the data
do suggest that a reappraisal of the role of uric acid in
cardiovascular disease is indicated, and that studies
should be performed to address the potential role of this
factor in cardiovascular disease.
In 1882, Robert Koch presented his evidence that
Mycobacterium tuberculosis was the cause of
His studies were based on the
demonstration that M tuberculosis was present in
patients with tuberculosis, and that this organism could
be cultured and subsequently inoculated in
experimental animals in which manifestations of the
disease could be reproduced.

It is now apparent that the evidence that uric acid is a
Continued on page 26
Continued from page 24 - Role of Uric Acid in Hypertension,
Renal Disease, and Metabolic Syndrome
also the decade in which Japanese investigators developed
a method to create high fructose corn syrup.
Ordinary corn syrup is composed mainly of glucose, but
when it is treated with an enzyme called glucose
isomerase, 42% to 55% of the glucose is converted to
Because fructose is less expensive, is more soluble at
lower temperatures, and has a longer shelf life than other
sweeteners, it soon became the most common type of
artificial sweetener. Today, most sweetened processed
foods, such as soft drinks and pastries, are laden with high-
fructose corn syrup. In addition, table sugar (sucrose) also
contains 50% fructose. Between corn syrup and table
sugar, Americans are consuming much more fructose than
before, and the trend corresponds with the increase in
obesity over the past 25 years.
Fruit juices have been
linked to obesity in children, and the consumption of soft
drinks has been linked to diabetes, hypertension, and
weight gain.
Fructose may be uniquely unhealthy because it is the only
sugar that raises uric acid levels.
Both humans (who lack
uricase) and rodents (which express uricase) show a
marked rise in uric acid after ingesting fructose.
These levels peak within 30 minutes, remain elevated
for90 minutes, and then tend to return to baseline.
Normally, when we eat, blood glucose levels rise,
stimulating insulin release and a rise in endothelial nitric
oxide that enhances blood flow to the skeletal muscle,
effects that are critical for the efficient uptake of glucose.

However, by raising uric acid levels, fructose reduces
endothelial nitric oxide and hence interferes with glucose
uptake by skeletal muscle. As a consequence, the insulin
level rises as the body attempts to overcome the blockade
of glucose uptake: hyperinsulinemia due to insulin
But uric acid can be lowered. Recently, Nakagawa et al

(our group) reported what happened when we fed rats
fructose with or without the uric acid-lowering drugs
allopurinol or benzbromarone. The rats that did not receive
the drugs developed the metabolic syndrome, with
elevated insulin, triglycerides, blood pressure, uric acid,
and body weight.
Lowering the uric acid level prevented or reversed these
effects. In particular, when allopurinol was started early, it
prevented hyperinsulinemia, systolic hypertension,
hypertriglyceridemia, and weight gain. The rats did not eat
less if they received the drugs, so dietary intake could not
account for the differences.

26-- Traditional African Clinic February/March 2013

Continued from page 24 - Role of Uric Acid in Hypertension,
Renal Disease, and Metabolic Syndrome
mediator of hypertension is as strong as the evidence
presented by Koch that M tuberculosis is a cause of
tuberculosis. In the case of tuberculosis, the key proof of
causationthat eradicating the organism would cure the
diseasedid not come until the 1950s with the
introduction of streptomycin and isoniazid.
In the case of uric acid, the effect of lowering uric acid on
blood pressure in humans is only now being tested.

Continued from page 22 - High Uric Acid Level
anchovies, herring, gravy, dried beans, dried peas,
mushrooms and other foods
Renal insufficiency inability of the kidneys to
filter waste
Tumor lysis syndrome a rapid release of cells into
the blood caused by certain cancers or by
chemotherapy for those cancers
Also, you may be monitored for high uric acid levels
when undergoing chemotherapy or radiation
treatment for cancer.

Calcium Deficiency causes
Bone Fractures, Kidney
By J. D. Heyes
November 17, 2012
(NaturalNews) Not enough calcium in their diet can
increase the risk in women of a hormone condition that
causes bone fractures and kidney stones, according to
The condition, primary hyperparathyroidism (PHPT), can
affect one in 800 people during their lifetime, but it's
occurrence is most common in post-menopausal women,
said researchers, who wrote about their findings in the
British Medical Journal. The research team suggested
that increasing calcium intake cuts the risk of developing
the disease.
"Primary hyperparathyroidism is the most common
cause of hypercalcemia and the third most common
endocrine disorder, with 100,000 new cases in the
United States each year," said the team of Dr. Julie
Paik, Dr. Gary Curhan and Dr. Eric Taylor, of the
Brigham and Women's Hospital at Boston's Harvard
Medical School wrote, noting that as many as two
percent of post-menopausal women could have the
Hypercalcemia is defined as "too much calcium in the
blood," according to the National Institutes of Health.
Dietary guidelines call for adults to consume around
700 mg of calcium daily.
44 percent reduced risk
Calcium is readily available in milk and other dairy
products, nuts and fish such as sardines and pilchards
(where the bones are also eaten), and in oral
supplements. But taking too much could cause stomach
pains and diarrhea, say doctors and dieticians.
Researchers say PHPT is caused by overactive
parathyroid glands that secrete too much parathyroid
In addition to bone and kidney problems, there are also
suggestions that PHPT is linked to an increased risk of
high blood pressure, heart attack and stroke.
The team examined 58,300 women who were taking
part in a much broader, ongoing piece of research
called the Nurses' Health Study, the BBC reported. All
of the women were between the ages of 39 and 66 in
1986, when the study launched. None had a history of
The participating women completed food
questionnaires to let researchers know how often they
consumed specific foods or supplements, including
calcium, every four years. The last year data was
collected was 2008.
Women were divided into five groups, depending on
their calcium intake. The participant groups accounted
for such factors as age, body mass and ethnicity.

Over the period of time of study, 277 cases of PHPT
were discovered, the team said, noting that those
women with the highest intake of dietary calcium had a
44 percent reduced risk of developing PHPT when
compared to the group with the lowest intake.
"Increased calcium intake, including both dietary and
supplemental calcium, is independently associated with
a reduced risk of developing primary
hyperparathyroidism in women," Paik wrote in the
journal Continued on page 27

27-- Traditional African Clinic February/March 2013

Continued from page 26 Calcium Deficiency causes Bone
Fractures, Kidney Stones
James Norman of the Norman Parathyroid Center in
Florida added that "modest doses" of daily calcium
supplements could like provide "more benefits than risks."
Calcium, the primary mineral in building strong bones and
teeth, also helps regulate muscle contraction and works to
ensure blood clots normally.
Improve your diet to improve your levels of calcium
Vitamin D is also important because it helps you absorb
and retain calcium in the bones. Other experts say you are
better off getting your calcium from the foods you eat.
A previous meta analysis of several studies involving the
benefits of calcium have found that taking supplemental
calcium tablets doesn't necessarily work to prevent
osteoporosis - a disease that results in weakened bones.
Writing in Natural News, Dr. David Jockers said:
The best forms of calcium and bone building nutrients come
from leafy green vegetables and fermented, raw milk
products from 100-green fed cows and goats. Pasteurized
forms of milk and grain-fed animals provide inflammatory
fatty-acids and other metabolites that promote calcium
mineralization into arterioles.
The point? A better diet will provide better, more effective
levels of calcium in your body.


Eating Hot Foods on Melamine
Dishes Increases Risk of
Kidney Stones
By Sarah Glynn
24 January 2013
Eating hot foods on melamine dishes increases the risk of
developing kidney stones.
The finding came from a new study conducted by Taiwan-
ese researchers and was published in the journal JAMA
Internal Medicine.
The researchers discovered that the amount of melamine we
are exposed to increases with hot temperatures, therefore,

the chance of developing kidney stones rises.
The team, led by Chia-Fang Wu, M.S., Ph.D., of
Kaohsiung Medical University, Taiwan, performed a
crossover investigation of consumption of noodle soup in
melamine bowls and total melamine excretion in urine.
According to background information in the report, a
constant exposure to low doses of melamine may be
linked to urolithiasis (urinary system stones) in kids and
A previous report demonstrated that there was an increase
in the number of children experiencing urinary stones due
to melamine-tainted formula.
There were twelve healthy people, six were males and six
were females, who took part in the research. The 12
participants were split up into 2 groups:
one group ate 500 ml of hot noodle soup in melamine
the other group ate soup in ceramic bowls
Twelve hours after the subjects consumed the soup, they
were asked to give samples of their urine.
After a "three-week washout", the group who ate from
the ceramic bowls ate from the melamine bowls and the
group who ate from the melamine bowls ate from the
ceramic bowls.
The participants were asked to give urine samples a
second time so that the researchers could compare.
The results showed that total melamine excretion in
urine for 12 hours was 8.35 micrograms in melamine
bowls and total melamine excretion in urine for 12
hours was 1.31 micrograms in ceramic bowls.
The scientists concluded:
"Melamine tableware may release large amounts of
melamine when used to serve high-temperature foods.
The amount of melamine released into food and
beverages from melamine tableware varies by brand, so
the results of this study of one brand may not be
generalized to other brands.
Although the clinical significance of what levels of
urinary melamine concentration has not yet been
established, the consequences of long-term melamine
exposure still should be of concern."
The research received support from the National Science
Council, the Taiwan National Health Research Institutes,
and Kaohsiung Medical University Hospital.

28-- Traditional African Clinic February/March 2013

Statin Drugs cause Liver
Damage, Kidney Failure and
Cataracts, says BMJ
By David Gutierrez

November 07, 2010
(NaturalNews) Cholesterol-lowering statin drugs
significantly increase a person's risk of cataracts, muscle
weakness, liver dysfunction and kidney failure, according
to a study in the British Medical Journal.
The study also confirmed that the drugs lower the risk of
heart disease and esophageal cancer, but claims of other
health benefits were unsupported.
Researchers from Nottingham University in the United
Kingdom examined data on more than 2 million patients
between the ages of 30 and 84, seen at 38 different
general practices, who had been prescribed the
cholesterol-lowering drugs. More than 70 percent were
taking simvastatin (Zocor), 22.3 percent were taking
atorvastatin (Lipitor), 3.6 percent were taking pravastatin
(Pravachol, Selektine), 1.9 percent were taking
rosuvastatin (Crestor) and 1.4 percent were taking
fluvastatin (Canef, Lescol, Lochol, Vastin).
The researchers confirmed prior data suggesting that
statins increase patients' risk of cataracts, liver
dysfunction, kidney failure and a form of muscle
weakness known as myopathy. They found that for every
10,000 women treated with the drugs, 23 would develop
acute kidney (renal) failure, 39 would develop myopathy,
74 would develop liver dysfunction and 309 would
develop cataracts. Men suffered an even higher risk of
myopathy, but their risks of the other three conditions
were similar to those suffered by women.
Putting it in different terms, the researchers found that
only 434 people would need to be treated with the drugs
for five years for one case of acute renal failure to
develop. It would take only 136 treated for each case of
liver dysfunction and 33 for each case of cataracts.
Among women, 259 would need to be treated for each
case of myopathy; among men, the number was only 91.
The risk of developing all conditions was highest during
the first year of treatment, but continued throughout the
course of the study. Risk of liver and kidney problems
increased proportionally with the dose of statins being
All drugs appeared to pose a similar risk of all conditions,
with the exception of fluvastatin, which increased the risk

of liver dysfunction more than its competitors. Men
taking fluvastatin were twice as likely to develop liver
dysfunction as those not taking statins, while women's
risk increased by 2.5 times.
The researchers did find, however, that the risk of
cataracts returned to normal within one year of stopping
statin treatment, while the risk of liver and kidney
problems returned to normal within one to three years.
Additionally, they found no connection between statin
use and the risk of dementia, osteoporotic fracture,
Parkinson's disease, rheumatoid arthritis or venous
Examining the purported benefits of the drugs,
researchers found that they did in fact lower the risk of
heart disease, averting 271 cases for every 10,000 high-
risk patients treated. Put another way, 33 high-risk men
or 37 high-risk women would need to be treated with the
drugs to avert one case of the disease.
Although advocates of the drugs have claimed that they
may also reduce the risk cancer, the researchers found
almost no data supporting these claims. The study
"largely confirmed other studies that reported no clear
association between statins and risk of cancers," the
researchers wrote.
The only cancer-fighting effect uncovered in the study
was a slightly lower risk of esophageal cancer, with eight
cases averted for every 10,000 high-risk women treated.
In other words, 1,266 high-risk women or 1,082 high-
risk men would need to be treated with the drugs to
prevent one case of esophageal cancer.
Although sales of the blockbuster drugs are unlikely to
be reduced as a result of the study, the researchers
encouraged closer monitoring of patients for side effects
and said their findings "would tend to support a policy of
using lower doses of statins in people at high risk of the
adverse event."

29-- Traditional African Clinic February/March 2013

African Traditional Herbal Research Clinic
Volume 8, Issue 2 NEWSLETTER February/March 2013
THE KIDNEY NETWORK: Properties and Functions
a common admonition that spans two thousand years of
Chinese medical literature.
While most Daoist and medical writings take up both
the general topic and the detailed techniques of
safeguarding jing, it is the realm of literature which best
reflects the Chinese fear of continuous jing loss by way
of sexual indulgence. The epic Ming Dynasty novel,
Flower In the Golden Vase (Jin Ping Mei), narrates
the story of the erotomaniac Ximen Qing who peddles
his money and political influence to assemble a harem
of six women, then resorts to tonic drugs to bolster his
flagging virility, and finally comes to a horrid end after
a final ejaculation of "mercury-like fluid, followed by
blood and a gust of cold air." A Daoist physician who is
called to the deathbed comments: "The candle flickers
once the oil is used up." Both mercury and lamp oil are
often used metaphors for the kidney jing. To avoid such
a gruesome death, the handsome protagonist of the
second moralist novel of the Ming dynasty, Prayer
Mat of Flesh (Rou Putuan), decided to become a
Buddhist hermit, cut off his surgically amplified penis,
and utilize his jing for spiritual cultivation.
Although the word jing is synonymous with the
Chinese word semen, the seminal fluid represents only
one form of jing. Other dense fluid essences such as
saliva (particularly the kind that gets spontaneously
excreted during meditation), vaginal fluids, breast milk,
or blood are all regarded to be different transformations
of one and the same jing; these are refined essences.
Female "leakage" problems, such as metrorrhagia or
leukorrhea occurring in older women, are therefore
taken seriously for the same reasons as loss of semen in
men. Daoist body science even features a special
category called female alchemy (nu dan), wherein
adepts are instructed in the conservation of (menstrual)
blood and its transformation into physical and spiritual
The jing stored in the kidney can be differentiated into
prenatal jing and postnatal jing. Prenatal jing contains
the information that is given to us before birth (we
Continued on page 30
1, The Kidney Stores the Jing (Essences)
Jing is the Chinese designation for the essential fluid of
our physical body. The archaic Chinese character for
jing denoted the most refined essence obtained from
rice (which is the main staple of the Oriental diet, so
this means the refined essence from food). The basic
yin (matter) from which all yang (physical action)
springs is jing. In classical Chinese medical texts, jing
is sometimes referred to as the body's "original water"
with water representing the ultimate yin ("original fire"
being the ultimate yang).
Water has a tendency to drain downward. The kidney,
the lowest of the organ networks, is where the body's
water assembles and goes into storage until needed
elsewhere. If the kidney function is weak, its storage
capability will become inhibited and jing will leak
from the body. Due to the Daoist belief that the jing is
lost when a man excretes semen (of particular concern,
when an elderly man, who already had deficiency of
jing through aging, excretes semen), virtually all of the
ancient medical texts mention spermatorrhea (a code
for release during the disallowed practice of
masturbation, wet dreams, and ejaculation during
intercourse when the attempt is being made to prevent
it) as a condition to be treated, since it indicates a
breach of the kidney's function of safeguarding and
storing jing. According to the Daoist ideal, except
during early adulthood, men should refrain from
releasing semen or, at the very least, experience this
Therefore, excessive sexual indulgence by males is
considered to be a major health hazard in all genres of
traditional Chinese writing. Since most men cannot
control their urge to ejaculate, every intercourse means
an irrevocable giving away of jing. Although Chinese
medical texts consent that this may be affordable for
young men (who have a rich supply of jing and who
can easily replenish jing through post-natal sources),
they generally warn that the health of elderly males
will suffer serious consequences from frequent
ejaculations. "What gives life will take life" is therefore

30-- Traditional African Clinic February/March 2013

Continued from page 29 THE KIDNEY NETWORK:
Properties and Functions
would today describe it as genetic information) that is
intimately linked to the growth and maturation of an
individual, which differs for men and women. The
defining passage in the Neijing for women reads: "At the
age of seven, the kidney qi [the physical action generated
by the material basis of kidney jing] in females is strong,
and the teeth come in. At the age of two times seven, the
tiangui (stage of hormonal and reproductive maturity)
arrives, the conception vessel opens, the penetrating
vessel flourishes, menstruation is regular, and pregnancy
becomes possible." With regard to male physiology: "At
the age of eight, the kidney qi solidifies in males and
teeth develop. At the age of two times eight, the kidney qi
flourishes, the tiangui arrives, ejaculation occurs, and it
becomes possible to have intercourse with females and
beget children...; at the age of seven times eight, the liver
qi is exhausted, the tendons are unable to facilitate
smooth movement, the tiangui is dried up, jing is sparse,
the kidney system is exhausted, and symptoms of
physical aging are plentiful."
Postnatal jing is the nutritive essence distilled from food
by the spleen/stomach, and used to provide a constant
flow of nourishing dew to the other organ networks. If all
the networks are plentifully supplied, the surplus of the
body's vital fluid transformation is stored in the kidney.
The Neijing states: "The kidney is in charge of water, and
it receives the essences of the other zang and fu organ
networks and stores it." Before birth, prenatal jing forms
the material basis for the development of postnatal jing.
Once born, postnatal jing continuously boosts the body's
limited supply of prenatal jing. Both forms of essence
compose an indivisible entity.
Kidney jing encompasses both kidney yin and kidney
yang, often referred to as the body's original yin and
original yang. Kidney qi is produced by the dynamic
interaction between the two, specifically the action of
functional/warming kidney yang steaming the material
kidney yin. Kidney yin is the source of all material body
fluids, in charge of nourishing and moistening all organ
networks. Kidney yang, sometimes also called true yang,
is the source of all types of yang qi. It is the driving force
behind all processes of warming, generation, and
transformation. The yin and yang aspects of the kidney
both rely on each other and control each other. The
proper balance between kidney yin and kidney yang is an
important precondition for health.
2. The Kidneys contains the Will/Determination
Will, determination, and power of memory are attributed
to the kidney. The ability to keep a secret is attributed to
the kidney's power of retention and safeguarding against
leakage. The Neijing defined that "the kidney stores jing,
and jing houses will power." In turn, if kidney jing
becomes exhausted, a weak will and poor memory will
3. The Kidney is in Charge of Water
Fluids reach the kidney after they have been absorbed by
the stomach, raised upwards by the spleen, and sprinkled
downwards by the lung. At this point they become
differentiated into clear and turbid aspects by virtue of
the transformative powers of kidney yang. The clear part
of fluid essence returns to the lung, from where it
moistens each one of the zang organs. From the lung, it
turns into nasal discharge, or sweat, or saliva, or tears;
and it differentiates into jing, blood, jin (liquids, that is
the thinner fluids moistening the muscles), and ye (the
denser fluids lubricating the joints and bone marrow).
The turbid part feeds into the bladder, where it is being
transformed into urine, and excreted.
4. The Kidney is in Charge of the Bones and
Generates Marrow: its External Manifestation is in
the Hair
Bone marrow is considered to be a transformation of
kidney jing that has the specific task of nourishing the
bones. It is differentiated into bone marrow, spinal
marrow, and brain marrow. Spinal marrow feeds into the
brain, where the densest concentration of "marrow" can
be observed. The brain is therefore also called the sea of
If kidney jing is plentiful, both the bone (supporting the
body) and the brain (supporting the mind) will be at a
level of ideal strength. On the other hand, a deficiency of
kidney jing will bring about brittle bones and a listless
spirit. As the Neijing puts it: "The kidney is the master of
physical strength; it produces exquisite movements/
Since the teeth are considered to be the "surplus of the
bones," they also rely on the nourishment of the kidney.
If the jing is plentiful, the teeth are firm; if not, they come
loose or fall out.
The hair's growth process is governed by the waxing
and waning of kidney qi. Again the crucial Neijing quote:
"At the age of seven, a female's kidney qi is in high gear,
the second teeth come in and the hair grows." Ancient
texts often consider the head's hair to be a direct
outgrowth of the brain, which would relate it to the
kidney. The growth pattern and general luster of the hair
is an important indication for the condition of prenatal
5. The Kidneys is in Charge of Grasping (Containing)
Qi Continued on page 31

31-- Traditional African Clinic February/March 2013

Continued from page 30 THE KIDNEY NETWORK:
Properties and Functions
Although the process of breathing is governed by the
lung, the containment of incoming qi within the lower
burner is governed by kidney qi. Only if kidney qi is
plentiful and its grasping power sufficient, can the qi
passages of the lung be unobstructed and the breathing be
harmonious. If the kidney is weak and the breath cannot
"root" in the kidney, disease will eventually arise.
Shallow breathing, particularly in patients suffering from
chronic asthma, is therefore often associated with a
kidney qi deficiency. In this situation, the breath gets
stuck above the diaphragm and cannot descend into its
rightful abode, the lower dantian. This aspect of the
kidney is one reason why there is such an intent focus on
abdominal breathing in Oriental cultures.
6. The Kidney is connected to the Bladder
The kidney and bladder form a zang-fu pair: "The kidney
is connected with the bladder," states the Neijing; "the
bladder is the store house of the liquids and humors."
This statement reminds us that the bladder, similar to the
gallbladder and the small intestine, not only excretes
unwanted waste materials, but comprises a temporary
station along the body's complex highway of vital fluid
transformation. Bladder function, particular its function
of "opening and closing," is largely dependent on the
power of kidney qi. If kidney qi is strong, normal water
metabolism will take place. The storage and excretion
process of water through the bladder is thus intimately
related to the general functioning of the kidney.
7. The Kidney has its Opening in the Ears and Two
Private Parts (Anus and Genitalia)
The ears, which faintly resemble the kidneys in shape, are
thought to reflect the condition of kidney jing. Large ears
and sharp hearing indicate an excellent condition of
kidney jing. As people grow older, they not only become
more forgetful, but their power of hearing decreases (and
sometimes their ears shrivel up) as their jing depletes. As
the original statement of the Neijing goes: "The kidney qi
communicates with the ears; if the kidney functions
properly, the ears can distinguish the five essential
Kidney qi, due to its mother organ's close proximity to
the openings in the lower burner, governs the opening
and closing function of the "two private parts," including
sexual functions like erection, ejaculation, and lubrication
of the vaginal tract, and maintenance of fecal continence
(as well as urinary continence via the control of the
8. The Fire of Mingmen is stored in Between the

The concept of mingmen, the vital gate of life, is an
integral part of the kidney system. The Nanjing (Classic
of Difficulties) elaborated on basic Neijing theory by
figuratively differentiating these two aspects of the
kidney in structural terms, thereby initiating a medical
theory that was later referred to as the mingmen school:
"There are two kidney parts. Actually, not both of them
are kidneys. The left one is the kidney, the right one is
mingmen." The classic then goes on to elaborate that
mingmen is the place "where the entirety of bodily jing
and shen is at home, and where the original qi is
generated." "It is the root of all zang-fu networks, the
foundation of the twelve channels, the gate of breath, and
the source of all three burning spaces." Later medical
scholars argued that mingmen is an immaterial force that
could not be physically located in the right kidney.
Rather, its location is the central point on the spine
between the two anatomical kidneys and opposite the
umbilicus, thus forming a "posterior dantian." The
Chinese name for the acupuncture point located there is
mingmen (GV-4).
The fire lodged within kidney water is often referred to as
the body's ministerial fire (xiang huo), as opposed to the
imperial fire (jun huo) of the heart. In its role of the
"minister" serving the higher centers, it warms the spleen,
ripens food, grasps lung qi, and gives volume to a
person's voice.
9. The Kidney Cooperates with the Triple Burner to
Transform Qi and Move Water
The triple burner, a fu organ that is said to pass through
and connect all of the body's three burning spaces,
stimulates qi transformation with a specific focus on
water metabolism. It keeps the body's water ways
unobstructed and smoothly operating. These functions of
the triple burner are intimately tied to the kidney and
bladder. The Neijing says: "The upper burner is like a
mist, the middle burner is like a swamp, and the lower
burner is like a ditch," referring to the essence misting
activity of the lung on top, the fermenting action of the
spleen/stomach at the center, and the canalization of
water in the lowest part of the torso.
The Kidney Network: Pathogenesis
Injury to Kidney (Yin) and Mingmen (Yang) Fire: if
the kidney's ability to store jing becomes disturbed, a
person's growth patterns and reproductive ability will be
affected; infertility, hair and tooth loss, slow physical
development, or softness and malformation of the bones
may result.
If within the kidney jing the crucial controlling/
generating balance between kidney yin and kidney yang
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Properties and Functions
becomes disturbed, different symptom patterns may arise.
Typical manifestations of hyperactivity of yang due to
kidney yin deficiency are burning sensation in the palms
and soles, tidal heat sensations, night sweats,
spermatorrhea, or sexual dreams. When the kidney yang
is exhausted and thus unable to execute its ministerial
warming function, symptoms of listless spirit may result:
sore lower back and knees; cold sensations in the body
and its extremities; inhibited urination or frequent and
profuse urination; early morning diarrhea; asthmatic
panting upon slight physical exertion; difficult breathing;
impotence and premature ejaculation; or infertility due to
a "cold uterus." If there is evidence of kidney deficiency
without obvious cold or heat symptoms, this symptom
complex is usually referred to as kidney qi (or kidney
jing) deficiency.
It is important to understand the intimate relationship of
kidney yin and kidney yang, and that prolonged kidney
yin deficiency will eventually influence kidney yang and
vice versa. This phenomenon is usually called a
deficiency of kidney yin implicating kidney yang, or a
deficiency of kidney yang implicating kidney yin.
Changes in Water Metabolism: since the kidney is said
to be in charge of water, all pathological changes
involving water are in some way associated with the
kidney. If there is a lack of kidney yang, the body's
general process of qi transformation will suffer, and
consequently water metabolism will be inhibited. As the
Treatise on Blood Diseases (Xuezheng Lun) explains:
"If there is not enough yang qi, pathological water
accumulations will turn into phlegm and distress the heart
or attack the lung, or cause symptoms of edema,
abdominal pain accompanied by a sensation of qi rushing
upwards, or diarrhea and intense cold."
Most cases of phlegm or edema occur when the yang fire
is unable to transform yin water. Figuratively speaking,
the kidney is the general commanding the two water fu
organs which are mainly involved in the transportation
and transformation of water, namely the triple burner and
the bladder. As the Neijing says: "The shaoyang [triple
burner] belongs to the kidney; above, the kidney connects
with the lung, and thus has two fu organs under its
command [triple burner and bladder]."
Therefore, if there is not enough kidney yang, the upper
burner cannot properly distribute fluids, the middle
burner cannot properly steam and ripen food and separate
the clear from the turbid, and the lower burner cannot
properly transform qi, thus influencing the opening and

closing ability of the bladder (causing excessive or
inhibited urination, as in bed wetting, frequent urination,
nocturia, etc.).
Moreover, since urine is manufactured from body fluids
which are in part produced by the kidney, a deficiency of
kidney water will always involve a deficiency of fluids,
causing inhibited urination. Along the same lines, too
much urination will eventually harm the body's fluid
Emotional Influences on Proper Kidney Function: the
kidney is said to house the force of will power and
determination. Will power, therefore, relies on
nourishment by kidney jing. If jing is weak, then will
power and its sustained expression (memory) will also be
Intense or prolonged fear, the emotion associated with the
kidney, will cause injury to the kidney qi, resulting in
impotence, spermatorrhea, or the gradual development of
cowardly behavior. The other way around, a physical
deficiency of kidney jing can cause a disposition for
panicky and fearful behavior.
Kidney Disorders Causing Pathological Changes in
the Bones, the Marrow, the Hair, and the Ears: if
kidney jing is sufficient, the continuous production of
high quality marrow is assured, resulting in properly
nourished and, thus, firm and strong bones. Otherwise the
skeletal structure will be weak, or structural changes such
as osteoporosis might occur.
If the kidney is harmed by pernicious qi affecting the
kidney jing and consequently the marrow and bones,
there will be symptoms of weak and sore waist and legs,
or even atrophy of the legs causing severely limited
mobility. As the Neijing states: "If kidney qi is
pathologically hot, the lumbar spine will be inhibited, the
bones will become brittle and the marrow scorched, and
atrophy of the bones will result."
For the same reasons, symptoms of loosening and
deteriorating teeth, or the drying, greying, and gradual
falling out of hair are related to the state of the kidney's
jing qi. Since the ears and the associated sense of hearing
also depend on nourishment by the kidney's jing qi,
ringing in the ears, loss of hearing, or deafness are typical
symptoms for various aspects of kidney deficiency.
Representative Substances for the Treatment of
Kidney Disorders
Moisten the kidney (tonify kidney yin) (zi yin; bu shen
yin): rehmannia (dihuang), tortoise shell (guiban),
asparagus root (tianmendong), lycium fruit (gouqizi),
morus fruit (sangshenzi), ligustrum (nuzhenzi).
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Warm the kidney (strengthen yang; tonify the vital
flame of life) (wen shen; zhuang yang; bu ming huo):
aconite (fuzi), cinnamon bark (rougui), sulphur
(liuhuang), morinda (bajitian), deer antler (lurong),
cnidium fruit (shechuangzi), cistanche (roucongrong).
Complement jing and tonify the marrow (tian jing bu
sui): animal bone marrow (dongwu jisui), animal brain
(naosui), placenta (ziheche), deer antler (lurong), antler
gelatin (lujiaojiao), tortoise plaster gelatin (guijiao),
cordyceps (dongchong xiacao).
Restore the storing action of the kidney (astringe jing;
stop vaginal discharge; curb frequent and profuse
urination) (gu shen; se jing; zhi dai; shou se xiao bian):
schizandra (wuweizi), cornus (shanzhuyu), alpinia
(yizhiren), rubia (fupenzi), mantis egg case
(sangpiaoxiao), rose hips (jinyingzi).
Restore the kidney's function of grasping and
retaining qi (na qi gui shen): schizandra (wuweizi),
psoralea (buguzhi), gecko (gejie), cornus (shanzhuyu),
aquilaria (chenxiang).
Aid the transformation of bladder qi (hua pangguang
qi): cinnamon twig (guizhi) and hoelen (fuling),
cinnamon bark (rougui), lindera (wuyao), fennel (xiao
huixiang), saussurea (muxiang), citrus seed (juhe), litchi
seed (lizhihe).
Open and disinhibit the water passages of the bladder
and the triple burner (tongli pangguang, sanjiao):
alisma (zexie), hoelen (fuling), polyporus (zhuling), talc
(huashi), akebia (mutong), tetrapanax (tongcao), tokoro
(pixie), polygonum (bianxu), lygodium (haijinsha).
Clear kidney heat (moisten yin and descend deficiency
fire) (qing shen re; zi yin jiang huo): anemarrhena
(zhimu), phellodendron (huangbai), morus bark (digupi),
eclipta (hanliancao).
Discharge kidney fire (purge fire with salty and cold
materials) (xie shen huo; xian han xie huo): salt
(qingyan), halite (qingyan), urine (tongbian), calcitum
The Kidney Network: Basic Guidelines for the
Treatment of Kidney Disorders
Since the kidney is the representative lower burner organ,
it generally needs to be addressed with high amounts of
heavy and sticky substances. The 18th century fever
school authority Wu Jutong once described this
characteristic in graphic terms: "Lower burner therapy is
like a weight-if it is not heavy enough, it does not reach
the bottom."
Kidney disorders are generally of a cold and deficient
nature. Kidney therapy, therefore, needs to focus
primarily on the tonification of deficiency; purging of
excess is a definite taboo. If kidney water is deficient,
the kidney needs to be tonified by moistening yin. If
kidney jing is deficient, it needs to be replenished by
supplementing jing and tonifying the bone marrow. If
kidney yang is deficient, the kidney needs to be tonified
by using modalities that strengthen yang. In the more
advanced scenario of mingmen fire exhaustion,
materials that warm and tonify the vital flame of life
need to be employed.
Since the kidney has both yin and yang aspects,
pathological situations may arise from an imbalance in
the ratio of kidney yin and kidney yang. The most
typical example is the upflaring of deficiency fire due
to a deficiency in kidney water, which calls for a
descending action that re-anchors the floating fire in the
yin waters of the kidney. This is primarily achieved by
the use of yin tonics which will bring the diminished
yin level back to full capacity and thus naturally
extinguish the deficiency type of pathological heat. If
yang deficiency has begun to implicate yin, both jing
and marrow should be supplemented and the vital
flame of life be warmed and tonified. If both kidney yin
and yang are deficient, both the various aspects of the
kidney and the vital flame of life should be tonified.
In the common scenario of spleen and kidney
deficiency, both spleen and kidney yang need to be
tonified. In case of lung and kidney deficiency, both
lung and kidney yin need to be moistened. In chronic
asthma patients where kidney deficiency results in an
inability of the kidney to grasp the descending qi from
the lung, the kidney needs to be warmed with
substances that specifically assist with the action of
grasping and retaining qi, such as gecko (gejie) and
schizandra (wuweizi). If lung metal fails to properly
generate kidney water, kidney yin needs to be
moistened indirectly by nourishing the yin of its mother
system, the lung. If kidney water fails to nourish its
son, liver wood, the liver needs to be supported by
moistening kidney yin and/or kidney jing. In the case
that kidney deficiency has caused an exhaustion of the
earth network, the lower burner's vital flame of life
needs to be rekindled with warming substances in order
to provide the transformative forces of the middle
burner above with the activating heat they require.
If the extended water network (including the kidney,
the bladder, and the triple burner) is compromised by a
damp heat condition, the dampness should be
disinhibited with materials of a cooling nature that have
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Properties and Functions
a specific affinity to the lower burner, such as alisma
(zexie), polyporus (zhuling), and talc (huashi). If the
transformative powers of the bladder and the triple burner
fail due to an exhaustion of the kidney's vital flame of
life, then this type of pathological water accumulation
needs to be transformed by primarily warming kidney qi,
and secondarily by adding several herbs that directly
move out the pathological water. If phlegm, dampness, or
water rheum stagnate internally, phlegm damp needs to
be disinhibited, and water rheum driven out.
If the kidney has been damaged due to chronic illness,
exaggerated emotions, or excessive sexual activity, a
change of the situation or life style that has originally
caused the condition is imperative. Simultaneously, the
recovery of the kidney system can be supported by
prescribing a selection of tonic agents that moisten yin,
strengthen yang, or nourish jing and marrow.
As the water network, the kidney has an aversion to dry
influences. It would be particularly detrimental to
exclusively employ bitter and drying substances in a
situation where the kidney yin is deficient. Perhaps
unexpectedly, the Neijing recommends pungent flavors
to counteract dryness in the kidney; these pungent flavors
aid the lung in distributing moisture to the kidney. In
clinical reality, herbs like cuscuta (tusizi) and cnidium
fruit (shechuangzi) fit this category. The kidney strives
for a state of guarded firmness and tight solidity. If the
storage fortress of the kidney is properly buttressed,
precious essence will not leak out. Many bitter materials,
although they should be used cautiously for the reasons
just mentioned, have a stabilizing affect on kidney yin.
Anemarrhena (zhimu), an herb that is both bitter and
moistening, and phellodendron (huangbai) are the prime
substances used in situations of continuous jing leakage,
particularly lower burner deficiency fire fueling obsessive
sexual urges, excessive masturbation, recurrent sexual
dreams, spermatorrhea, or certain types of leucorrhea.
Salty flavors have a direct affinity to the kidney network,
and are generally beneficial when used in moderation.
"Salty flavors generate the kidney," comments the
Neijing. Increased dietary intake of salt, usually obtained
from stored foods with salt as the preserving element,
taken during the water season (winter) contributes to
preserving the kidney against the cold. On the other hand,
salt has a percolating and leakage-promoting affect that is
overall unsuitable for an organ system that is in charge of
storing and metabolizing physiological jing, humors, and
Therefore, excessive consumption of salty foods is
discouraged, as it will harm the kidney and its affiliated
body layer. "If the disease is in the bone layer," the Neijing
points out elsewhere, "do not eat salty foods."
If the kidney root is damaged, many of the body's stem and
branch organs have already entered a pathological state first.
If kidney yin-that is the base substance from which liver yin,
stomach yin, heart yin, lung yin, and the body's humors and
fluids are formed-is deficient, it usually means that the
condition is preceded by a yin deficiency in other organs.
Similarly, the essential flame of the lower burner only
flickers after the light in the upper levels has grown dim.
This situation has given rise to a school of medicine that
favors kidney tonification in most deficiency situations.
Tonifying kidney yin and kidney yang, proponents have
argued since the 13th century, means to moisten and
strengthen the body's source yin/yang and thereby the
yin/yang of all organ networks. However, the root status of
the kidney also implies that kidney deficiency is often
accompanied by inadequate spleen/stomach function. This
poses a problem in light of the fact that herbal kidney
therapy requires heavy amounts of sticky substances that are
generally hard to digest. One attempt to remedy this
situation was the addition of herbal "digestive aids" to
kidney formulas such as Rehmannia Six Formula (Liuwei
Dihuang Wan). Pharmacists at the renowned Beijing herb
emporium Tongren Tang, for instance, used to automatically
add small amounts of the aromatic cardamon (sharen) if the
patient's prescription called for large amounts of the greasy
kidney tonic rehmannia (dihuang). Proponents of the
spleen/stomach school, on the other hand, have argued that
kidney deficiency is often the result of a deficiency of its
controlling network, namely spleen earth. Spleen
tonification advocates have said for more than half a
millennium that this should be the primary modality to
regenerate the kidney system. In any case, caution needs to
be exercised regarding the prescription of heavy "water"
substances to patients who show signs of digestive
weakness, such as poor appetite, bloating, and tendency to
experience diarrhea or loose stool. A safe method for the
direct tonification of lower burner source qi has been
developed by the ancestors of Chinese medicine, namely
Daoist practitioners of "inner alchemy." The term inner
alchemy refers to Qigong exercises of the quiet, meditative
kind that focus on generating warmth and fullness in the
lower dantian.
The Kidney Network: Typical Disease Patterns
KIDNEY YIN DEFICIENCY (shen yin xu): primary
symptoms are dizziness; blurry vision; ringing in the ears;
sore and weak lower back or knees; burning in palms and
soles; tidal heat sensations; night sweats. Secondary
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symptoms include dry mouth and throat; flushed face;
emaciated features; premature graying of hair; low sperm
count in males; decreased menstrual flow and infertility
in females; forgetfulness; insomnia; spermatorrhea;
premature ejaculation; heel pain; yellow urination; dry
stool. The tongue typically presents with a red body and
little or no coating; the pulse tends to be fine and rapid.
Representative Herbs: rehmannia (dihuang), cornus
(shanzhuyu), asparagus root (tianmendong), ho-shou-wu
(heshouwu), lycium fruit (gouqizi), ligustrum (nuzhenzi),
tortoise shell (guiban), turtle shell (biejia), scrophularia
(xuanshen), eclipta (hanliancao), anemarrhena (zhimu).
Representative Formulas: Return the Left Decoction;
Achyranthes and Rehmannia Formula (Zuogui Yin);
Rehmannia Six Formula (Liuwei Dihuang Wan).
primary symptoms are pale or dark complexion; listless
spirit; obvious aversion to cold; cold extremities; low sex
drive; weak or cold and painful lower back and knees;
early morning diarrhea; frequent urination or clear and
profuse urination. Secondary symptoms include
impotence; premature ejaculation; infertility; clear
vaginal discharge; inhibited urination and edema;
dizziness; ringing in the ears. The tongue typically
presents with a pale, tender, and often toothmarked body,
and a white and slippery coating; the pulse tends to be
deep, slow, and forceless.
Representative Herbs: aconite (fuzi), cinnamon bark
(rougui), epimedium (yinyanghuo), morinda (bajitian),
psoralea (buguzhi), deer antler (lurong), curculigo
(xianmao), fenugreek (huluba), cistanche (roucongrong),
cynomorium (suoyang).
Representative Formulas: Return the Right Pill (Yougui
KIDNEY QI DEFICIENCY (shen qi xu): primary
symptoms are dizziness; ringing in the ears; weak or sore
lower back and knees; physical and mental fatigue;
shortness of breath. Secondary symptoms include pale
complexion; spontaneous sweating; decreased mental and
physical growth rate in children; frequent urination;
nocturia; spermatorrhea; premature ejaculation; asthmatic
panting upon exertion. The tongue typically presents with
a pale body and a white coating; the pulse tends to be fine
and weak.
Representative Herbs: walnut (hutaorou), dioscorea
(shanyao), eucommia (duzhong), cuscuta (tusizi),
schizandra (wuweizi), cornus (shanzhuyu), morinda
Representative Formula: Rehmannia Eight Formula
(Shenqi Wan).
KIDNEY JING DEPLETION (shen jing bu zu):
primary symptoms are dizziness; ringing in the ears;
weak or sore lower back and knees; low sperm count in
males; amenorrhea and infertility in females; delayed
mental and physical development in children. Secondary
symptoms include decreased memory; slow and clumsy
body movements; dull facial expressions; emaciated body
structure; hair loss; loose teeth; late closing of fontanella
in babies; muscular atrophy.
Representative Herbs: placenta (ziheche), deer antler
(lurong), tortoise shell gelatin (guijiaojiao), cordyceps
(dongchong xiacao), cooked rehmannia (shu dihuang),
lycium fruit (gouqizi), cornus (shanzhuyu), eucommia
(duzhong), cistanche (roucongrong).
Representative Formula: Placenta Restorative Pills
(Heche Dazao Wan).
YANG (shen yin yang liang xu): primary symptoms are
dizziness; ringing in the ears; weak, sore, or painful lower
back and knees; cold fingers and toes and/or burning
sensations in palms and soles; night sweats or
spontaneous sweating. Secondary symptoms include pale
complexion and/or flushed face; poor memory; insomnia;
vivid dreaming; listless spirit; loose teeth; dry and split
hair; unsteady walk; swollen feet; asthmatic panting upon
physical exertion. The tongue typically presents with a
red body and little or no coating, or with a pale body and
white coa ting; the pulse tends to be fine and rapid, or
deep, slow, and weak.
Representative Herbs: cooked rehmannia (shu
dihuang), ho-shou-wu (heshouwu), lycium fruit (gouqizi),
ligustrum (nuzhenzi), cornus (shanzhuyu), cuscuta
(tusizi), schizandra (wuweizi).
Representative Formulas: Rehmannia Eight Formula
(Shenqi Wan); Five Seed Fertilize the Ancestral Force
Pill (Wuzi Yanzong Wan).
STORING ACTION (shen qi bu gu): primary
symptoms include clear, frequent, and dribbling
urination; enuresis; bedwetting; spermatorrhea; premature
ejaculation; tendency to miscarry; clear vaginal
discharge. Secondary symptoms include pale
complexion; mental and physical fatigue; weak or sore
back; loss of hearing; spontaneous sweating. The tongue
typically presents with a pale body and a white coating;
the pulse tends to be fine and weak.
Representative Herbs: schizandra (wuweizi), Euryale
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Properties and Functions
(qianshi), rose hips (jinyingzi), mantis egg cases
(sangpiaoxiao), dioscorea (shanyao), alpinia (yizhiren),
dragon bone (longgu), oyster shell (muli), cuscuta
Representative Formulas: Golden Lock Shore Up the
Jing Pill (Jinsuo Gujing Wan); Mantis Formula
(Sangpiaoxiao San); Retract the Source Pill (Suoquan
QI (shen bu na qi): primary symptoms are shortness of
breath or asthmatic panting (brief inhale, longer
exhale), especially following physical exertion.
Secondary symptoms include pale complexion; puffy
face; blue lips; emission of small amounts of urine
when coughing; spontaneous sweating; general
aversion to cold; cold extremities; weak or sore lower
back and knees; mental and physical fatigue. The
tongue typically presents with a pale body and a white
coating; the pulse tends to be fine and weak, or floating
and uprooted.
Representative Herbs: walnut (hutaorou), gecko
(gejie), psoralea (buguzhi), schizandra (wuweizi),
cooked reh mannia (shu dihuang), ginseng (renshen),
codonopsis (dangshen), aquilaria (chenxiang), amethystum
Representative Formulas: Ginseng and Walnut
Decoction (Renshen Hutao Tang); Ginseng and
Gecko Powder (Shen Jie San); All Encompassing
Qi Pill (Du Qi Wan).
EFFULGENCE (yin xu huo wang): primary
symptoms are flushed face and red lips; restlessness;
difficulty falling asleep; dry mouth and throat; burning
sensation in palms and soles; tidal heat sensations;
night sweats. Secondary symptoms include obsessive
sexual fantasies; excessive urge to masturbate; frequent
sexual dreams; dark urination; constipation. The tongue
typically presents with a red body and little or no
coating; the pulse tends to be fine and rapid.
Representative Herbs: anemarrhena (zhimu),
phellodendron (huangbai), coptis (huanglian), raw
rehmannia ( sheng dihuang), peony (baishao),
cynanchum (baiwei), eclipta (hanliancao), lycium bark
Representative Formulas: Anemarrhena,
Phellodendron, and Rehmannia Formula (Zhi Bai
Dihuang Wan); Lock in the Marrow Pellet (Fengsui
EFFUSION (shen yang xu shui fan): primary
symptoms are puffiness and edema (especially prominent
in lower extremities). Secondary symptoms include ashen
or waxen face color; inhibited urination; obvious aversion
to cold; cold extremities; palpitations; stuffy sensation in
chest; shortness of breath; cough or asthmatic panting
accompanied by expectoration of runny and clear
phlegm; heavy and painful waist; abdominal fullness;
scrotal edema. The tongue typically presents with a fat,
pale, and toothmarked body, and a white and slippery
coating; the pulse tends to be deep and wiry; or deep and
Representative Herbs: aconite (fuzi), cinnamon twig
(guizhi), hoelen (fuling), curculigo (xianmao), alisma
(zexie), plantago seed (cheqianzi), polyporus (zhuling).
Representative Formula: Vitality Combination (Zhenwu

The Metaphysical
Functioning of the Kidneys
October 10, 2011
Occult Anatomy
For you created my inmost being;
you knit me together in my mothers womb.I praise you
because I am fearfully and wonderfully made; your works
are wonderful I know that full well.
~ Psalm 139:13-14
The Kidneys are a pair of organs whose shape looks very
similar to beans. They are located in the posterior part of
the abdomen, and they are the motor force behind the
urinary tract system. They perform the function of highly
specialized filters, selectively purifying the blood and
eliminating impurities.
By the end of the cleaning process, the Kidneys will have
filtered all the fluids that belong to the human body,
which represents 60 to 75% of the weight of an adult
It is important to remember that there is a spirited and
symbolic relationship between all the liquids, or fluids,
and the emotional aspect of our lives. In truth, all the
situations that lead us to cry are ultimately processed by
the action process of the Kidneys. Metaphysically, the
process of filtration alludes to the ability to exercise
discernment; the selection of what can be used and what
should be sifted out in order to be eliminated from the
system. All the substances that enter the blood stream
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the Kidneys
have to pass through a selection process. This is also a
metabolic process that is intimately interconnected with
the internal capability to detach from and eliminate
disagreeable facts and situations of life; such as past
behaviors and thought patterns that do not align with the
demands and needs of the present time.
The Kidneys, always used in the plural (kelayot), are
mentioned more than 30 times in the Bible. In the
Pentateuch, the Kidneys are cited 11 times in the detailed
instructions given for the sacrificial offering of animals
at the altar. Whereas those instructions were for
purification ceremonies at the Temple, sacrificial
offerings were made subsequently in seeking Divine
intervention for the relief of medical problems. In the
books of the Bible that follow the Pentateuch, mostly in
Jeremiah and Psalms, the human Kidneys are cited
figuratively as the site of temperament, emotions,
prudence, vigor, and wisdom.
The Kidneys are the fundamental cornerstones for the
energies of the Yang and Yin. They are the organs that
allow us to anchor the energies of Xing (Zhi) or Jing [2],
the congenital essence inherited from our parents, which
determine our constitution, our strength and vitality, and
are responsible for our growth and development, and
how we process aging.

The Chinese character Zhi means beliefs, awareness,
intensive will, sentiment, purpose, record, or
remembrance. The Zhi energy is also related with the
heart. We can interpret the image of the Chinese
character Zhi as footprint in the heart.
Zhi is the spiritual energy of the Kidneys, is the
hereditary memory or imprint of your past life and the
ancestral energy of human beings, which records who
we are and where we come from. It is the reservoir of
life energy. The spiritual name of the Kidneys, Yuying,
literally meaning rear a baby, emphasizes that the
kidney organ system is related to the origin of our life.
The Kidneys have the primordial function to control the
distribution and circulation of fluids along with the
bladder. Some problems can arise from the malfunction
of the Kidneys such as constipation, dark urine, noc-
turnal perspirations, dry mouth, edema and diarrhea. It
can also be responsible for other disturbances with teeth,
bones, asthma, ear pains and disorders of the nervous

They are the organ responsible for the power that arises
from the natural genetic abilities, and capabilities. In
short we can say that our Kidneys can be the activators of
our genetic potentialities.
On the other hand, the weakness of this organ can be
manifested by individuals that are controlled by their
fears, which can damage their motivation and their will;
slowing their thought process, and generating the
tendency of getting stuck in various life situational
Metaphysically the Kidneys can crystallize the criticism
disappointed and failures. They are intimately related to
fear, low self-esteem, insecurities, and apathy for the
present moment, isolation and indifference.
It is believed that just one of the Kidneys do the heavy
work for the purification of the body, while the other one
concentrates its functionality on keeping the lightness of
the spiritual life and the sustenance of the other bodies.
The Kidneys sometimes get involved with the functions
related to the lungs through the metabolism of the water,
through respiration. They can be also connected with the
bones, teeth, ears and hair on the head. When out of
balance, they can cause the collapse of the entire urinary
tract system and also the lymphatic system; and can cause
lack of memory, temporary hearing loss, accelerating
graying of the hair, and osteoporosis.
[1] Bible Dictionary - REINS - Or KIDNEYS. The Hebrews
often make the reins the seat of the affections, and ascribe to
them knowledge, joy, pain, pleasure; hence in Scripture it is
said that God searches the heart and tries the reins.

[2] Jing is the Chinese word for essence,specifically kidney
essence. Along with q and shn, it is considered one of the
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the Kidneys
Three Treasures Sanbao of Traditional Chinese
Medicine or TCM. Jing is stored in the kidneys and is the
densest physical matter within the body (as opposed to
shn which is the most volatile). It is said to be the
material basis for the physical body and is yin in nature,
which means it nourishes, fuels, and cools the body. As
such it is an important concept in the internal martial
arts. Jing is also believed by some to be the carrier of our
heritage (similar to DNA). Produc tion of semen, in the
man, and menstrual blood (or pregnancy), in the woman,
are believed to place the biggest strains on jing. One is
said to be born with a set amount of jing (pre-natal jing,
also sometimes called yuan qi) and also can acquire jing
from food and various forms of stimulation (exercise,
study, meditation.)
Theoretically, jing is consumed continuously in life; by
everyday stress, illness, substance abuse, sexual
intemperance, etc. Pre-natal jing by definition cannot be
renewed, and it is said it is completely consumed upon

Continued from page 17 Diet soda now promoted
as Medicine to stop Kidney Stones
of nutritional knowledge among his peers at the Journal
of Urology who somehow saw fit to publish his study.
This is called science? Keep in mind that the entire claim
is based on the idea that certain diet sodas contain citrate
and that frequent consumption of citrate from natural
sources (lemonade, lime juice, etc.) is well known to
prevent kidney stones. Consuming natural lemonade
actually does prevent kidney stones, but you can't
extrapolate from that and claim a lemon-flavored diet
soda will accomplish the same thing. That's like saying
that since fruit helps prevent cancer, then drinking fruit
punch must prevent cancer, too.
This research, by the way, never even tested diet sodas on
human subjects. It's really just a "thought experiment"
from someone who isn't even very good at thinking. The
entire paper is the scientific equivalent of saying, "Hey, I
betcha that thar diet soda might prevent them kidney
stones 'cuz there's citrate in it!"
And the Journal of Urology was just silly enough to
actually publish it as science. It makes you wonder: What
are the requirements for having a scientific paper rejected
by the Journal of Urology?

No coverage of medicinal herbs
I bet a paper touting the very real benefits of the Amazon
rainforest herb Chanca Piedra would be rejected by the
journal. Chanca Piedra is known as the "stonebreaker" herb
throughout South America. It really works to dissolve and
eliminate kidney stones, but you'd never see that in a
science journal in North America. No, they're too busy
touting the "medicinal benefits" of diet soda, if you can
believe that.
At this point in the article, I would normally point out how
little credibility remains in the world of western medicine
and its loony research conclusions. This is an industry that
calls homeopathy "witchcraft", that thinks medicinal herbs
are dangerous, and that now apparently believes diet sodas
are a form of medicine. Any discussion of "credibility"
about such an industry is frankly just pointless.
If aspartame and phosphoric acid was somehow good for
you, America would be the healthiest nation in the world!
And if diet sodas actually worked, then all the people
drinking them wouldn't be so obese, would they? And if
diet soda prevents kidney stones, they why are most of the
people suffering from kidney stones the very same people
who drink a lot of soda? If anything, diet soda causes
kidney stones. But I suppose the Journal of Urology can
print exactly the opposite and call it "science" if they want,
That's exactly why modern "science" has lost so much
credibility these days. Because practically any corporate-
sponsored idea, no matter how ridiculous, can end up being
printed in a "scientific journal" even if its conclusions
violate the laws of the known biological universe. If diet
soda prevents kidney stones, then mammogram radiation
prevents cancer, too.

The Disease Cholera and
Kidney Failure
Cholera is a life-threatening diarrhea induced by a toxin
secreted by bacteria called Vibrio cholerae. (There are
other bacterial diseases caused by toxins released by non-
invasive bacteria. The disease caused by the
enterotoxigenic -- remember that term? -- strains of
Escherichia coli are probably the most important of these
Although shock and severe dehydration are the most
devastating complications of cholera, other problems can
occur, such as:
Continued on page 63

39-- Traditional African Clinic February/March 2013

African Traditional Herbal Research Clinic
Volume 8, Issue 2 NEWSLETTER February/March 2013
Pesticides: Health Effects in Drinking Water
By Nancy M. Trautmann and Keith S. Porter
Center for Environmental Research
Robert J. Wagenet, Dept. of Agronomy
Cornell University

Traditionally, groundwater has been assumed to be a
relatively pristine source of water, cleaner and better
protected than surface water supplies. Although nitrate
and bacterial contamination were known to occur in
some locations, groundwater was thought to be immune
from more serious forms of pollution such as industrial
discharges, hazardous waste dumps, or leaching of
pesticides from agricultural operations. Within the past
decade, however, a variety of synthetic organic
compounds have been discovered in the nation's
groundwater, often at concentrations far exceeding
those in surface water supplies.
Synthetic organic compounds are chemicals
synthesized from carbon and other elements such as
hydrogen, nitrogen, or chlorine. They do not occur
naturally, but are manufactured to meet hundreds of
needs in our daily lives, ranging from moth balls to hair
sprays, from solvents to pesticides. Why have they only
recently been discovered in groundwater? One reason is
that use of synthetic organic compounds has greatly
increased within the past 40 years, and some of these
gradually have made their way into groundwater.
Another reason for the recent discoveries of organic
contaminants in groundwater is that the laboratory
capability to detect these chemicals has greatly
improved within the past decade. A classic example of
this occurred in Bedford, Massachusetts, where severe
organic chemical contamination of the town
groundwater supply was discovered in 1978 only
because a resident engineer took a sample of his home
tap water with him to work where he was developing
and testing a new laboratory instrument for analyzing
organic chemicals. A total of nine toxic organic
compounds were discovered in this drinking water
sample, resulting in permanent closure of the town's
water supply wells. The Bedford contamination event-
ually was traced to several local industries that were
improperly disposing of their chemical wastes.
Now that people are aware of organic contaminants
in drinking water, sampling for such chemicals has
increased, and more than 700 synthetic organic
compounds have been identified in various U.S.
drinking water supplies. This contamination
originates from a variety of sources, including
household products and leakage or improper disposal
of chemical wastes from commercial and industrial
establishments. By-products of industrial
manufacturing or cleaning operations have been
disposed of in unrecorded dump sites across the
nation, and some of these chemicals have leached to
groundwater. Pesticides constitute another, smaller
category of synthetic organic compounds, some of
which have been found in groundwater.
Between 1950 and 1980 production of synthetic
organic pesticides more than tripled in the United
States, from about 400 million pounds in 1950 to
over 1.4 billion pounds in 1980. Although most of
these compounds have not been detected in
groundwater, a few have become significant
contaminants. Twenty- two pesticides have been
detected in U.S. wells, and up to 80 are estimated to
have the potential for movement to groundwater
under favorable conditions. One area with conditions
highly conducive to leaching is Long Island, New
York, where soils are sandy, the water table is
shallow, and agriculture is intensive. A total of 13
pesticides have been detected at least once in Long
Island groundwater, and 8 of these have been found
multiple times through continued monitoring. In
upstate New York, sampling for pesticides has
been limited to measurement of aldicarb in wells
Continued on page 40

40-- Traditional African Clinic February/March 2013

Health Effects of Pesticides
Studies of the health effects of pesticides on humans
focus on two aspects, the acute toxicity, or immediate
effects resulting from short-term exposure, and the
chronic toxicity, or effects resulting from more-
prolonged exposures. Acute toxicity typically is
expressed as the concentration required to kill 50
percent of a population of test animals such as
laboratory rats, either through ingestion or through
contact with the skin. These lethal concentrations can
vary greatly from one pesticide to another. Aldicarb,
for example, is considered to be highly toxic because
the oral lethal dose is less than 1 milligram per
kilogram (mg/kg) of body weight, compared with 500
mg/kg for carbaryl, or 5,000 mg/kg for methoxychlor.
When pesticides are found in water supplies, they
normally are not present in high enough concentrations
to cause acute health effects such as chemical burns,
nausea, or convulsions. Instead, they typically occur in
trace levels, and the concern is primarily for their
potential for causing chronic health problems. To
estimate chronic toxicity, laboratory animals are
exposed to lower than lethal concentrations for
extended periods of time. Measurements are made of
the incidence of cancer, birth defects, genetic
mutations, or other problems such as damage to the
liver or central nervous system .
Although we may encounter many toxic substances in
our daily lives, in low enough concentrations they do
not impair our health. Caffeine, for example, is
regularly consumed in coffee, tea, chocolate, and soft
drinks. Although the amount of caffeine consumed in a
normal diet does not cause illness, just 50 times this
amount is sufficient to kill a human. Similarly, the
oxalic acid found in rhubarb and spinach is harmless at
low concentrations found in these foods, but will lead
to kidney damage or death at higher doses.
Laboratory measurements of a pesticide's toxicity must
be interpreted in the context of its potential hazard
under actual field conditions. Pesticides by definition
are toxic to at least some forms of life, but whether or
not a particular pesticide in groundwater is hazardous
to human health depends on its concentration, how
much is absorbed from water or other sources. The
duration of exposure to the chemical, and how quickly
the compound is metabolized and excreted from the
body. Drinking water guidelines are aimed at keeping
pesticides at levels below those that are considered to
cause any health effects in humans. They are derived
from laboratory data using one of two methods,
Continued on page 41
Continued from page 39 - Pesticides: Health Effects in
Drinking Water
near treated fields. Low concentrations of aldicarb have
been detected in 30 percent of the 76 wells sampled.
Twenty-two other states, including Maine, Maryland, and
New Jersey, also have reported some pesticide
contamination of groundwater.
This bulletin focuses on the health effects of pesticides in
drinking water, although the same concepts also apply to
the much wider range of synthetic organic compounds
contaminating groundwater supplies.
Types of Pesticides in Groundwater
The health effects of pesticides depend upon their chemical
characteristics. Before the 1940s most pesticides were
compounds of arsenic, mercury, copper, or lead. Although
these compounds may have made their way into drinking
water, they were not highly soluble, and the residues
ingested in foods were of far greater concern. Synthetic
organic pesticides were introduced during World War II
and were thought to be far safer and more effective. These
included chlorinated hydrocarbons such as DDT, aldrin,
dieldrin, chlordane, heptachlor, lindane, endrin, and
toxaphene. Because of their low solubility in water and
their strong tendency to chemically attach to soil particles,
these compounds have rarely contaminated groundwater.
They originally were thought to be safe to humans and the
environment, but later were discovered to accumulate in the
environment and build up to toxic concentrations in food
chains. Use of most of the chlorinated hydrocarbon
pesticides, consequently, has been restricted, suspended, or
canceled. One group replacing them has been the
organophosphorous compounds such as malathion and
diazinon. Although some organophosphorous compounds
are highly toxic to humans, they generally break down
rapidly in the environment and rarely have been found in
groundwater. Another group replacing the chlorinated
hydrocarbons are carbamate pesticides including aldicarb,
carbofuran, and oxamyl. These compounds tend to be
soluble in water and weakly adsorbed to soil.
Consequently, if not degraded in the upper soil layers, they
have a tendency to migrate to groundwater. The most
significant occurrences of groundwater contamination have
been with the carbamate pesticides. Aldicarb has been
detected in over 2,000 wells on Long Island as well as in 12
other states including Maine and New Jersey. As awareness
has grown of the potential for pesticides to leach to
groundwater, attention has focused on ways of changing
registration and monitoring requirements to prevent such
contamination from occurring in the future. Intensive
studies have also been carried out in an attempt to
determine what levels of pesticides are acceptable in water

41-- Traditional African Clinic February/March 2013

20% of daily intake in drinking water 0.07 x 0.2
= 0.014 mg/person/day
Average intake of 2 liters water per day 0.014/2 =
0.007 mg/liter
Drinking water guideline 0.007 mg/l = 7 ug/l or 7
ppb (parts per billion)
Although this appears to be a precise calculation, there
actually is quite a bit of estimation and human judgment
involved. Estimates must be made, for example, of the
average weight of a person and the amount of water
consumed per day. The percentage of the daily intake of
pesticide that would be consumed in drinking water must
also be estimated, based on factors such as how much is
contained in foods and whether the compound can also
be absorbed through the skin while bathing. Although
aldicarb has a high dermal toxicity, probably only
negligible amounts would be absorbed through skin
unless the pesticide is dissolved in oil or an organic
solvent rather than water.
The U.S. Environmental Protection Agency calculated
drinking water guidelines differently, basing the
calculation on the amount that would be consumed by a
10-kilogram (22-pound) child who drinks 1 liter
(approximately 1 quart) of water per day:
Drinking water guideline = 0.001 mg/kg/day x 10 kg
1 liter/day = 0.0l mg/l, or 10 ppb (parts per billion)
The resulting guideline is not intended to indicate a
toxicity threshold, above which an imminent threat to
human health exists. Instead, it is a health advisory that
simply indicates a conservative estimate of the
concentration that can be consumed in drinking water
with no adverse health effects. Other sources of
exposure, such as pesticides consumed in food, inhaled,
or absorbed through the skin, are not included. The
Environmental Protection Agency currently is attempting
to revise this system to provide a more realistic
assessment of total exposure from all sources.
Carcinogenic Compounds
Drinking water standards are set in a different manner for
carcinogenic pesticides. For compounds shown to cause
cancer in laboratory animals, no NOEL or ADI is set.
Current regulatory policy is that there is no specific
threshold below which these chemicals do not cause an
effect, although this is a matter of considerable scientific
controversy. Instead of setting a threshold value, analysis
focuses on the relationship between concentration and
the risk of causing a specified number of cancer cases in
Continued on page 42
Continued from page 40 - Pesticides: Health Effects in
Drinking Water
depending on whether or not the compound causes
Noncarcinogenic Compounds
For chemicals that do not cause cancer, a variety of tests
are conducted on laboratory animals, bacteria, and tissue
cultures to determine what daily dose produces no
indications of toxicity. The lowest level from all these
tests is defined to be the NOEL (no observed effect level)
and is used as the starting point from which drinking
water standards are derived. The NOEL for aldicarb is 7
mg/person/day, based on measurement of inhibition of an
enzyme called cholinesterase in rats fed various doses for
6 months. Although aldicarb is the most acutely toxic
pesticide registered by the Environmental Protection
Agency, its hazard at levels typically found in
groundwater is relatively low because it is rapidly
metabolized and excreted. It does not accumulate in body
tissues and has not been found to cause cancer, birth
defects, genetic changes, or other chronic health
problems in laboratory animals.
In setting drinking water guidelines, the acceptable daily
intake (ADI) for a pesticide is calculated by dividing the
NOEL by a "safety factor" determined by the level of
uncertainty in the experimental data. If valid
experimental results are available from studies on
prolonged ingestion by humans, for example, a minimum
safety factor of 10 might be chosen. This could increase
to as much as several thousand if human data were
lacking and laboratory data inconclusive. Most
commonly, long-term animal feeding data are available,
and a safety factor of 100 is used. This is based on the
assumption that humans are roughly 10 times more
sensitive to toxic substances than laboratory animals and
that the susceptibility between different individuals can
vary by another lO-fold. The resulting ADI represents an
estimate of the amount of a pesticide that a typical person
can consume daily for a lifetime with no adverse health
effects. For aldicarb, the currently accepted NOEL is 0.1
mg/kg/day, and a safety factor of 100 is used, resulting in
an ADI of 0.001 mg/kg/day.
The method for conversion from an ADI to a drinking
water guideline varies form one agency to another. In
New York State the 7 ppb guideline for aldicarb was
derived in the following manner:
No Observed Effect Level (NOEL) 0.1 mg/kg/day =
7 mg/70 kg person/day
Acceptable Daily Intake (ADI = NOEL/safety factor
of 100) 7/100 = 0.07 mg/person/day

42-- Traditional African Clinic February/March 2013

Continued from page 41 - Pesticides: Health Effects in
Drinking Water
a population of a specified size. Experiments with
laboratory animals are used to correlate dose with
expected frequency of cancer occurrence. These data
are then extrapolated to humans, and regulatory
decisions are made about the level of risk considered
acceptable to human populations. Whether this level of
risk is acceptable to an individual is a highly subjective
and complex issue. Studies have shown, for example,
that the public is willing to accept a risk as high as 1 in
10,000 from eating peanut butter, which may be
contaminated with aflatoxin, a natural mold and one of
the most potent carcinogens known to man, but would
reject using a synthetic chemical with a cancer risk
factor 100 times lower.
Federal regulatory agencies commonly define
acceptable risk in drinking water to be one that causes
no more than one additional case of cancer in a popula
tion of a million people who drink the water over the
course of a lifetime. This risk is roughly the same as
that of dying from diptheria, polio, or German measles,
or of being in a fatal plane accident. For pesticides that
are carcinogenic, the concentrations causing no more
than one cancer per million people typically are in the
range of a few parts per trillion. In some cases these
concentrations are so low that they exceed our
capability for accurate laboratory measurement.
For most pesticides, drinking water standards have yet
to be set. The Environmental Protection Agency has
authority to develop nationwide standards, and some of
the states are setting local standards as well. The New
York State Department of Health has set advisory
guidelines for aldicarb and carbofuran. Other organic
pesticides are covered by a guideline limiting the
concentration of any single organic chemical to no more
than 50 parts per million and the combined
concentration of all organics found to no higher than
100 parts per million. One of the complicating factors in
setting standards for the individual chemicals is that it
generally is not known how a given compound might
interact with other chemicals to affect human health.
Often when one organic compound is found in
groundwater, others are there also, and their effects
together may be either greater or less than that observed
when any one is ingested individually. The number of
possible interactions makes thorough analysis of them
all an impossible task. Health studies have been
conducted of people drinking contaminated water
supplies, but these studies are limited by the fact that
many health problems are difficult to trace to a specific
cause, especially since some cancers can remain latent

for up to 40 years.
Approximately 50,000 different pesticide products are
used in this country, composed of over 600 active
ingredients. Although the acute health effects of ingesting
large amounts of a pesticide can readily be measured, the
chronic effects of long-term exposure to low levels are
much harder to define. Extensive laboratory experiments
are required, and in many cases these experiments are
incomplete or inconclusive. The Environmental Protection
Agency is currently working on reevaluation of all
pesticides registered before 1972 to bring them up to
modern health standards and is requiring extensive testing
of new products before they come on the market. Many
questions remain, however, about the chronic health
effects of pesticides and other synthetic organic
contaminants in drinking water.
Establishment of drinking water standards is an inexact
science, with many assumptions and value judgments
needed in the conversion from laboratory animal data to an
estimate of health effects in humans. The resulting
standards represent the best judgment of regulatory
authorities about the acceptable level of risk to people
exposed to chemicals in drinking water.
Many pesticides and other synthetic organic compounds
are potent chemicals with potential health effects in
humans even at very low concentrations. The drinking
water standard for aldicarb, for example, is 7 parts per
billion, meaning that a single pound of this compound
could contaminate the entire amount of water needed to
supply the yearly needs of over 2,000 people. Clearly, it is
of primary importance to keep such chemicals out of our
water supplies. Following articles in this series will
address issues important in preventing pesticide
contamination of water supplies: protection of
groundwater recharge, careful management of pesticides
on the farm, government screening and regulation of
pesticides, and use of farming methods that minimize
damage to the environment.
See Table Below
SCAMP computerized data base maintained by Cornell
University, and Drinking Water and Health, vol. 5,
National Research Council, Washington, D.C., 1983.
*Acute toxicity is defined to be the amount needed to kill
50 percent of a population of laboratory rats. It is
expressed as milligrams of pesticide per kilogram of body
weight. Ranges are defined as follows: high: <500 mg/kg
moderate: 500 - 5000 mg/kg; low: >5000 mg/kg
Continued on page 43

43-- Traditional African Clinic February/March 2013

Health effects of some pesticides found in groundwater
Chemical name Representative Chronic effects Acute toxicity* Acute effects
trade name at high
alachlor Lasso Growth depres- moderate
sion in labor-
atory animals

aldicarb Temik None observed high Diarrhea,
pain, profuse
and blurred

atrazine Atranex None observed moderate Mildly
irritating to
skin, eyes,
and upper

carbofuran Furadan None observed high Diarrhea,
pain, profuse
and blurred
chlorothalonil Bravo None observed low
in laboratory

DCPA Dacthal None observed moderate
in dogs or
loropropane D-D Possible liver high Acute gastro-
and kidney intestinal
damage distress, with
congestion and
edema of lungs
(EDB) Bromofume Causes cancer, high Headache,
genetic dizziness,
mutations, and nausea,
fetal deform- drowsiness,
aties in some tremors,
lab animals. seizures
Possible injury Continued on page 44

44-- Traditional African Clinic February/March 2013

to lungs, liver
and kidneys
from prolonged

oxamyl Vydate None observed high Diarrhea,
pain, profuse
and blurred

El Salvador: Pesticides Fill
Graveyards in Rural Villages
By Edgardo Ayala
16 January 2012
(IPS) - Sitting in the shade under a tree at a careful
distance, Francisco Sosa watches his son prepare the land
for planting by spraying the weeds with an herbicide
from a tank carried on his back.
The 60-year-old Salvadoran farmer would like to help his
son Sal, 25, but on doctor's orders, he can't. Like many
other peasant farmers in this rural community in the
southeast of El Salvador, he suffers from chronic renal
"The doctors told me not to spray poison anymore, that it
could complicate my illness further," Sosa told IPS on his
farm in Nueva Esperanza, a rural community of around
500 people that was settled in the 1990s in the Bajo
Lempa region in the province of Usulutn on El
Salvadors Pacific coast.
For years, local residents and the media have denounced
the alarming increase in cases of kidney failure in the
Bajo Lempa region, which for over a century was a
cotton-growing area where pesticides and herbicides were
heavily used.
Although cotton gave way to other crops in the 1970s,
highly toxic agrochemicals continue to be used by the
local farmers, who take no safety measures, on their corn,
beans and vegetable crops.
In some communities in the Bajo Lempa region, like
Ciudad Romero, over 20 percent of the population suffers
from chronic kidney disease, with the proportion rising to
one out of four among adult men.

This prevalence rate is alarmingly higher than those found
in other countries, says a health ministry study titled
Nefrolempa, which began to be carried out in 2009, when
moderate left-wing President Mauricio Funes took power
with the backing of the insurgency-turned-political party
Farabundo Marti National Liberation Front (FMLN).
The prevalence of chronic kidney disease found by similar
epidemiological studies in other countries in Latin America
and in other regions ranged between 1.4 and 6.3 percent,
the Nefrolempa study says.
The report, whose final results were released in October,
does not conclusively establish a cause-effect relationship
between the wide use of pesticides and herbicides and the
high incidence of renal failure. But the data it provides
backs up the argument of local farmers and
environmentalists that there is a link.
Among the risk factors, the study points out that 82.5
percent of local men in the area are in contact with
"The disease has to do with all of the chemicals
contaminating the area, especially the agricultural zone
along the coast," Health Minister Mara Isabel Rodrguez
told IPS.
"We have appalling statistics that are not found anywhere
else in the world," she said, explaining that among those
with kidney disease, "there is an occupational factor, with
farmers between the ages of 18 and 60 most heavily
Environmentalist Mauricio Sermeo with the Unidad
Ecolgica Salvadorea (Salvadoran Ecological Unit), a
local NGO, told IPS that "When all of these people with
renal insufficiency started to appear, it became clear that
there was a direct link between the disease and the
Continued on page 45

45-- Traditional African Clinic February/March 2013

Continued from page 44 El Salvador: Pesticides Fill
Graveyards in Rural Villages
extensive use of chemical insecticides."
Sermeo was referring to the heavy exposure to
pesticides and herbicides in this area during the cotton
boom period, when chemicals like DDT an
insecticide that has now been widely banned - were
heavily used. But other highly toxic chemicals like
gramoxone or hedonal continue to be sold in El
Salvador, he pointed out.
Most of the pesticides are sold by foreign companies
like the Germany-based Bayer AG, which Sermeo
largely blames for the high levels of toxicity in the Bajo
Lempa region.
IPS received no response to repeated requests for a
comment on this question from the offices of Bayer in
El Salvador.
In the communities of the Bajo Lempa region, virtually
everyone has a family member or friend who died of
renal failure, activists and peasant farmers say.
"Just over there lived Chunguito, thats what we called
him. And Isidro also died from that, so did Lidia Sorto,
and Ton too, and Neftal and Abrahn so many
people have died of that," said Donato Santos, who
years ago was hospitalised for pesticide poisoning after
spraying his corn field.
Rosa Mara Colindres, a nurse in the first public health
clinic for kidney patients opened in this area, told IPS
that 95 percent of the graves in the Nueva Esperanza
cemetery are of people who have died of renal failure.
The clinic offers treatment for patients at all five stages
of kidney disease. The patients with end-stage renal
disease must go to a nearby hospital to receive training
in how to do hemodialysis at home, including how to
insert the needles and operate a home dialysis machine.
"If I didnt get dialysis, I would be dead by now,"
Wilfredo Ordoo, another local farmer, told IPS. He
remembers how, years ago, the pesticide he carried in a
backpack sprayer "would run all down my back. I think
thats what did me in," he says.
The Bajo Lempa region is a broad flood plain where
the Lempa river - Central Americas longest - runs into
the Pacific Ocean. Every year, the area has been hit
harder and harder by floods that destroy the crops and
force local residents, mainly poor farmers, to evacuate
to shelters.
After El Salvador's bloody 12-year civil war came to an
end in 1992, the land in this area, which once belonged
to large landholders who grew cotton and sugar cane, was
parcelled out to former guerrillas and their families, to
help them settle back into civilian life, as farmers.
The local population is markedly leftist, and for that
reason some believe that previous governments, of the
right-wing Nationalist Republican Alliance (ARENA) -
which governed the country from 1989 to 2009 - were not
interested in detecting or combating the epidemic or in
establishing legal mechanisms to ensure that
agrochemicals were properly sold and handled.
A 2004 executive order established regulations to control
the use of agrochemicals. But they are not enforced. For
example, article 5 of the executive order holds crop-
owners and importers, sellers and end-users of
agrochemicals responsible for ensuring that those who
handle pesticides and herbicides have received the
necessary training, and use the safety gear recommended
for each product.
But the farmers of Bajo Lempa rarely receive instructions
on how to use pesticides, and very few wear gloves or
Indeed, as this reporter chats with Francisco Sosa in the
shade of a tree on his farm, his son Sal is spraying
pesticide wearing only a Barcelona Football Club
neckerchief as a mask.

SRI LANKA: Drought Link
with Kidney Disease Risk
COLOMBO, 28 August 2012 (IRIN) - Soaring
temperatures in Sri Lankas dry zone in the northeast of
the country are likely to heighten the risk of chronic
kidney disease as residents increasingly consume poor
quality drinking water, experts warn.
More than a decade since the first cases of the fatal
disease were reported, health experts are now blaming
contaminated groundwater as the main cause. The illness
slowly destroys kidneys, making it impossible to get rid
of body waste or excess water, eventually requiring
dialysis or a transplant.
Wide areas of Sri Lankas North Central, Northern and
Eastern provinces have recorded a high prevalence of
chronic kidney disease in the last two decades. Recently
published research by the New Delhi-based Centre for
Science and Environment (CSE) estimated affected areas
cover 17,000sqkm where 2.2 million people live.
Continued on page 46

46-- Traditional African Clinic February/March 2013

Continued from page 45 SRI LANKA: Drought Link with
Kidney Disease Risk
These provinces are also the islands main rice-
producing regions. CSE found male farmers at highest
risk with at least 15,000 currently affected.
From 2009-2011 in the north-central Anuradhapura
District, health officials reported that the number of
registered patients with chronic kidney disease
diagnoses increased by 25 percent to 1,424. The district
reported some 1,600 chronic kidney-disease-related
deaths from 2003-2010.
Drinking water
CSE officials told IRIN that water consumption is high
in the dry zone and likely to increase during droughts.
Research carried out in 2011 by Sri Lankas University
of Peradeniya, Central Province, found the farmers
most at risk spent long hours working alone without
hired help.
Dhammika Dissanayake, a researcher at the university
who co-authored the November 2011 report, said farm-
ers sometimes spent 12 hours a day in extreme heat.
Field studies showed that they did not take enough
water. If the temperatures are going up, the situation is
likely to worsen.
According to the Ministry of Environment, there were
1,400 reported droughts nationwide between 1985 and
2004, mainly in the dry zone, with the most severe
being in 2001, 2004 and this year when the monsoon
rains arrived almost one month later than usual. The
country has two monsoons annually, with the next one
expected to arrive in December and ending next March.
[Farmers] need to take in more water to flush out the
chemicals, but they dont. Sometimes we just cant
imagine the extreme heat they work in, Dissanayake
The water farmers are drinking is contaminated with
high levels of calcium, fluoride and dissolved solids
due, in part, to geography, CSE reported.
High temperatures in Sri Lanka and long working
hours in the paddy field mean that there is a high
consumption of [contaminated] water, which is readily
filtered by the kidney but not readily secreted by the
renal tubules.
According to the National Water Supply and Drainage
Board, 80 percent of the population has access to safe
water sources, but only 30 percent has access to piped
water, which health experts say is safer than the more
commonly used hand-dug wells.
Sri Lanka has been going through a severe dry spell since
mid-April with temperatures in some of the areas
reporting chronic kidney disease, including the north-
central Pollonnaruwa District, reaching 34-35 Celsius.
Though rains have arrived in the countrys south, they
have yet to reach the central-northern dry zone.
Temperatures are on the rise and will keep rising, even
after this dry spell is over, said Malika Wimalasooriya,
head of the climate change unit at the Department of
Meteorology, who attributed rising temperatures to
changing global weather patterns.
The more extreme heat has sped up surface water
evaporation and shrunk groundwater resources, he added.
Other researchers point to unregulated use of fertilizer
and pesticide as causes. But water is at the heart of the
problem, said Channa Jayasumana from the faculty of
medicine at Rajarata University in North Central
Province, who explained how farmers try to salvage heat-
withered crops with often incorrectly used fertilizer and
Since the leading causes of chronic kidney disease
worldwide are diabetes and hypertension, the fact that
doctors reported the cases in Sri Lankas dry zone as
water-related makes comparisons with other outbreaks
difficult, said CSE's deputy director, Chandra Bushan.
The closest comparison he noted is Balkan Endemic
Nephropathy, a kidney disease (the causes of which
remain unconfirmed) affecting farmers in parts of the
former Yugoslavia. No new cases have been reported
since the 1990s.
What to do?
Bushan calls for providing clean water through water
purification units in the short term and piped water in the
long term to the population at risk as well as improving
medical facilities to handle kidney complications.
Though doctors conduct mobile clinics in high-risk areas,
researchers say early detection is still weak overall.
Treatment at government hospitals is free.
There are renal units at North Central Provinces main
Anuradhapura Hospital, smaller units at two city
hospitals in the province, a larger facility at Kandy
hospital in neighbouring Central Province and a
standalone national kidney unit in the capital, Colombo.
Jayasumana from Rajarata University told IRIN the
government should regulate fertilizer and pesticide
imports and use nationwide due to what he calls
rampant unrestrained use of the products - an idea that
has not received official backing.
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Continued from page 46 SRI LANKA: Drought Link
with Kidney Disease Risk
On 22 August the Sri Lankan government announced
it will begin distribution of water purification units in
affected areas.
The most effective way to curb the spread quickly
would be to educate those at risk [on a regional level]
on the dangers and the importance of water quality and
water intake, said Dissanayake.

The Worlds Kidneys: Why
Forests Matter for World
Water Day and Rio+20
By Karin Holzknecht
BOGOR, Indonesia (22 March, 2012)_The fact that
trees play a critical role in supplying clean water is a
point yet to be fully grasped by many cities in the
world. Not New York City, which is actively
protecting a forest 100 miles away for the role its trees
play in providing the Big Apple with a clean water
The surprising role of forests in supplying clean water
for one of the most densely populated cities on the
planet reminds us that forests also deserve applause for
their vital role in sustainable water and food resources
as we celebrate World Water Day and the 2012 theme,
water and food security.
Water is one of seven critical issues to be discussed at
Rio+20, and the link between water and food security
is immediately made on the campaign website: Water
scarcity, poor water quality and inadequate sanitation
negatively impact food security, livelihood choices and
educational opportunities for poor families across the
What is not mentioned by the Rio+20 website is the
vital role that forests play in water availability, water
quality, climate regulation and food security,
highlighted in recent research by CIFOR and others. A
recent report by the International Water Management
Institute and UN Environment Programme discusses
how a new focus on ecosystems, such as forests, can
deliver improved food and water security.
Forests help sustain the soil and water base that
underpins agriculture. According to the UN Food and
Agriculture Organization (FAO), eight percent of the
worlds forests play a primary role in soil and water
conservation. Forested catchments supply a vital source of
clean water for human use: an estimated 75% of usable
water worldwide.
Forests provide a range of watershed services, such as the
protection of water quality, the reduction of flows during
storms, the recharge of groundwater aquifers and the
conservation of water flow during dry seasons, said
CIFOR and CIRAD scientist Bruno Locatelli.
These services are essential to many of us: for example,
the conservation of dry season stream flows is essential for
drinking water supply, agriculture, navigation, hydropower,
freshwater wildlife, or recreation. The reduction of storm
flow benefits housing, infrastructure, or agriculture in
flood-prone areas.
Forests may even help attract rain. While there are many
uncertainties surrounding the links between deforestation
and declining rainfall, recent research (also discussed by
CIFOR scientists Daniel Murdiyarso and Douglas Sheil in
their 2009 paper) suggests that forest cover plays a much
greater role in determining rainfall than previously
recognised by climatologists.
According to Locatelli, these hydrological services are
particularly crucial for rural communities in the tropics,
where livelihoods depend directly on seasonal rainfall and
river flows, for example for agriculture, fishing or
And the hydrological services of forests are equally
important for urban populations. According to a report
published by the World Wildlife Fund in 2003, around a
third (33 of 105) of the worlds largest cities get a
significant proportion of their drinking water directly from
forest protected areas. Eight more cities get their water
from forests that are managed in a way that prioritises their
functions in providing water
One of the major functions forests provide in this respect is
improving water quality. Water pollution is a main cause of
reduced water availability and can have serious impacts on
the environment and on human health, particularly in
developing countries where 70 percent of industrial wastes
are pumped, untreated, into the water system not to
mention the two million tonnes of sewage and other
effluents draining into the worlds waters every day.
Scientists refer to wetlands as the worlds kidneys
because they purify and slow the flow of water to the sea,
helping to control floods and water pollution. But our world
is experiencing kidney failure according to UN Water,
half of the worlds wetlands have been lost since 1900.
When forests around lakes and streams are intact, they act
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Continued from page 47 The Worlds Kidneys: Why
Forests Matter for World Water Day and Rio+20
as a filtering system, reducing the amount of sediment,
agricultural chemicals and pesticides in the water table.
Apart from being the worlds kidneys, forests are also
often called the worlds lungs because they take carbon
from the atmosphere and produce oxygen, and it is this
function has attracted growing attention in recent years
as the world faces the challenge of climate change.
Forests are instrumental to efforts to help communities
and agriculture handle the more frequent droughts and
floods that come with an increasingly variable climate.
While the role of forests in mitigating large-scale floods
is still under debate, a study by CIFOR and FAO has
shown that forests mitigate small and local floods, and
appear to slow down the floodwaters from bigger floods
as they run downstream.
Forests can also act as emergency supplies in disaster
situations. For example, when rural communities in
Indonesia were recently devastated by a catastrophic
flash flood, a CIFOR study found that nearby forests
helped provide vulnerable communities with basic
subsistence for many months following the disaster. And
they provide a similar function during drought.
But it is not only in times of crisis that people depend on
forests more than a billion of the worlds poorest
people live in and around forested areas and depend on
the resources forests supply. Forest fruits and greens
supply many of the micronutrients that keep rural
communities nourished and healthy. Meat hunted in
forests is a crucial source of protein for forest-dependent
people (for example, many rural communities in the
Congo Basin depend on bushmeat for up to 80 percent of
the fats and proteins in their diets). Communities even
use forests as their medicine cabinets.
In short, having only scratched the surface of all the
ways in which forests benefit water and food security,
future food and water supplies cannot be secured without
But even as demand for food and water is increasing,
remaining forest lands are disappearing due to land
use change, climate change, insect or disease epidemics
and more frequent fires affecting the vitality of
ecosystems and compromising their hydrological
buffering function.
To preserve the essential services and safety net
functions forest ecosystems provide to the livelihoods of
local communities, and to preserve those forest services
of which the world may not yet be aware, forests need to
be kept on the global agenda at events like Rio+20.
It is right to avoid considering forests as a panacea for
all water-related problems, but we also cannot avoid the
fact that forest management and conservation are key to
water management, said Locatelli.

Cadmium Dietary Exposure in
the European Population
European Food Safety Authority
18 January 2012
Cadmium can cause kidney failure and has been
statistically associated with an increased risk of cancer.
Food is the dominating source of human exposure in the
non-smoking population. The Joint FAO/WHO Expert
Committee on Food Additives established a provisional
tolerable monthly intake of 25 g/kg body weight,
whereas the EFSA Panel on Contaminants in the Food
Chain nominated a tolerable weekly intake of 2.5 g/kg
body weight to ensure sufficient protection of all
To better identify major dietary sources, cadmium levels
in food on the European market were reviewed and
exposure estimated using detailed individual food
consumption data. High levels of cadmium were found in
algal formulations, cocoa-based products, crustaceans,
edible offal, fungi, oilseeds, seaweeds and water
molluscs. In an attempt to calculate lifetime cadmium
dietary exposure, a middle bound overall weekly average
was estimated at 2.04 g/kg body weight and a potential
percentile at 3.66 g/kg body weight. Individual
dietary survey results varied between a weekly minimum
lower bound average of 1.15 to a maximum upper bound
average of 7.84 g/kg body weight and a minimum lower
bound 95
percentile of 2.01 and a maximum upper
bound 95
percentile of 12.1 g/kg body weight
reflecting different dietary habits and survey
methodologies. Food consumed in larger quantities had
the greatest impact on dietary exposure to cadmium. This
was true for the broad food categories of grains and grain
products (26.9%), vegetables and vegetable products
(16.0%) and starchy roots and tubers (13.2%). Looking at
the food categories in more detail, potatoes (13.2%),
bread and rolls (11.7%), fine bakery wares (5.1%),
chocolate products (4.3%), leafy vegetables (3.9%) and
water molluscs (3.2%) contributed the most to cadmium
dietary exposure across age groups.
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Continued from page 48 - Cadmium Dietary Exposure in the
European Population
The current review confirmed that children and adults at
the 95
percentile exposure could exceed health-based
guidance values.
Cadmium occurs naturally in the environment in its
inorganic form, and anthropogenic sources have further
contributed to background levels of cadmium in soil,
water and living organisms. The general population is
exposed to cadmium from multiple sources, including
smoking, but in the non-smoking general population
food is the dominant source. Cadmium is primarily toxic
to the kidney, but can also cause bone demineralisation
and has been statistically associated with increased risk
of cancer in the lung, endometrium, bladder, and breast.
A Provisional Tolerable Weekly Intake (PTWI) for
cadmium of 7 g/kg body weight was established by the
Joint FAO/WHO Expert Committee on Food Additives
(JECFA) in 1988. In 2010, the JECFA reviewed its
previous evaluation and established a provisional
tolerable monthly intake (PTMI) of 25 g/kg body
weight corresponding to a weekly intake of 5.8 g/kg
body weight. In 2009 and subsequently confirmed in
2011, the Panel on Contaminants in the Food Chain
issued an opinion in which they recommended that the
PTWI should be reduced to a tolerable weekly intake
(TWI) of 2.5 g/kg body weight in order to ensure a
high level of protection of all consumers, including
exposed and vulnerable subgroups of the population.
A number of studies have investigated cadmium levels
in a range of foods. In light of the recommended
lowering of the health based guidance value, it was
considered important to better identify major dietary
sources by reviewing cadmium levels in food on the
European market and estimate cadmium exposure using
detailed individual data from the EFSA Comprehensive
European Food Consumption Database.
In about half of the food samples available to EFSA
cadmium was not detected or levels were below the limit
of quantification, Individual quantified values ranged
from a low of 0.001 g/kg for drinking water to a high of
61,000 g/kg for horse kidney. Tap water had the lowest
average cadmium levels while algal supplements and
seaweeds used as a vegetable had the highest average
cadmium levels.
Thirteen out of 144 food categories had a middle bound
mean above 100 g/kg including algal formulations,
cocoa powder, bitter and bitter-sweet chocolate,
crustaceans, edible offal, fish and seafood not specified
beyond FoodEx Level 1, frogs legs, cultivated fungi,
wild fungi, oilseeds, seaweeds and water molluscs.
By using the more detailed and refined food
consumption information now available through the
EFSA Comprehensive European Food Consumption
Database and weighting results from the different age
groups in the survey population according to the number
of years they include, average middle bound lifetime
cadmium dietary exposure for the European population
as a whole was estimated at 2.04 g/kg body weight per
week. It was highest in toddlers with an average of 4.85
g/kg body weight per week and lowest in the elderly
population group at 1.56 g/kg body weight per week.
Potential 95
percentile middle bound lifetime
exposure, with the assumption that the same individuals
retained high exposure throughout life, was estimated at
3.66 g/kg body weight per week with a high of 8.19
g/kg body weight per week for toddlers and a low of
2.82 g/kg body weight per week for the elderly.
Individual dietary survey results varied between a
minimum lower bound mean of 1.15 and a maximum
upper bound of 7.84 g/kg body weight per week and a
minimum 95
percentile lower bound of 2.01 and a
maximum upper bound of 12.1 g/kg body weight per
week reflecting different dietary habits but also likely
differences in survey methodologies and the countries
covered for the different age classes.
Often it is not the food with the highest cadmium levels,
but foods that are consumed in larger quantities that
have the greatest impact on cadmium dietary exposure.
This was true as the broad food categories of grains and
grain products (26.9%), vegetables and vegetable
products (16.0%) and starchy roots and tubers (13.2%)
were identified as major contributors. Looking at the
food categories in more detail, potatoes (13.2%), bread
and rolls (11.7%), fine bakery wares (5.1%), chocolate
products (4.3%), leafy vegetables (3.9%) and water
molluscs (3.2%) contributed the most to cadmium
dietary exposure across age groups. At the finest level of
detail given for the food consumption information,
wheat bread and rolls (6.4%), boiled potatoes (5.7%),
pastries and cakes (4.0%), potatoes without preparation
specified (3.1%), rice (3.0%) and carrots (2.2%) were
important contributors.
Both the Chemicals Branch in the Division of
Technology, Industry and Economics of the United
Nations Environment Programme and the EFSA Panel
on Contaminants in the Food Chain have expressed
concern that the margin between the average weekly
intake of cadmium from food by the general population
and the health-based guidance values is small. The
EFSA Panel concluded that although adverse effects are
unlikely to occur in an individual with current dietary
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Continued from page 49- Cadmium Dietary Exposure in the
European Population
exposure, there is a need to reduce exposure to cadmium at
the population level because of the limited safety margin.
The current review confirmed that children on average and
adults at the 95
percentile dietary exposure could exceed
health-based guidance values.

Thousands of Sugar Cane
Workers die as Wealthy
Nations Stall on Solutions
By Sasha Chavkin & Ronnie Green
Center for Public Integrity
12 December 2011

A truck full of sugar cane workers leaves the Nicaraguan
plantation Ingenio San Antonio at the end of a days work.
Kate Sheehy and Sasha Chavkin
LA ISLA, Nicaragua Maudiel Martinez is 19 years old
and has a shy smile, a tangle of curly black hair and a lean,
muscular build shaped by years of work in the sugarcane
fields. For most of his adolescence, he was healthy and
strong and spent his days chopping tall stalks of cane with
his machete.
Now Martinez is suffering from a deadly disease that is
devastating his community along with scores of others in
Central America, where it has decimated the ranks of
sugarcane workers. The same illness killed his father and
his grandfather and affects all three of his older brothers.
This disease eats our kidneys from inside us, Martinez
said. We dont want to die, and we feel grief because we
already know that were hopeless.
Martinez illness stands at the heart of a lethal mystery
and legacy of neglect by industry and governments,
including the United States, which have resisted pleas
for aggressive action to spotlight the malady and find a
remedy. Wealthier nations are more focused on spurring
biofuels production in the regions sugarcane industry
and keeping up the heavy flow of sugar to U.S.
consumers and food manufacturers than the plight of
those who harvest it.
Little noticed by the rest of the world, chronic kidney
disease (CKD) is cutting a swath through one of the
worlds poorest populations, along a stretch of Central
Americas Pacific Coast that spans six countries and
nearly 700 miles. Its victims are manual laborers, mostly
sugarcane workers.
Each year from 2005 to 2009, kidney failure killed more
than 2,800 men in Central America, according to the
International Consortium of Investigative Journalists
analysis of the latest World Health Organization data. In
El Salvador and Nicaragua alone over the last two
decades, the number of men dying from kidney disease
has risen fivefold. Now more men are dying from the
ailment than from HIV/AIDS, diabetes and leukemia
combined. In the 21st Century, nobody should die of
kidney disease, said Ramon Trabanino, a physician
from El Salvador who has studied the epidemic for a
The surge of kidney disease is overwhelming hospitals,
depleting health budgets, and leaving a trail of widows
and children in rural communities. In El Salvador, CKD
is the second leading cause of death for men. In the
province of Guanacaste, Costa Rica, the regional
hospital had to start a home dialysis program because it
was overwhelmed with so many CKD victims that it
began running out of beds to treat patients with other
So many men have died in some parts of rural
Nicaragua that Maudiel Martinezs community, called
The Island, now is known as the Island of the Widows
La Isla de las Viudas.
At first glance, the lush community bounded by vast
sugarcane fields looks like many places in Latin
America: children ride bicycles over dirt roads and play
alongside dogs, pigs and chickens. But now there are
few men in the front yards. Indoors, framed photographs
of dead husbands, fathers and brothers adorn tables and
countertops. No older men converge in small groups,
trading gossip and news, as one often sees in
communities farther inland from the Pacific coast.

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Workers die as Wealthy Nations Stall on Solutions
Here, women struggle to make at least a little money
doing odd jobs. Some are now in the sugar-cane fields
they believe claimed their husbands.
My children have suffered a lot, said Paula Chevez
Ruiz, a widow from La Isla whose husband Virgilio died
in 2009, leaving her to support four children on her own.
When she can find customers, she sells fruit and
enchiladas. It is sad to want to give to your children,
but not to have anything. Sometimes not even enough to
buy a bag of salt.
Deadly enigma and a handful of researchers
In the U.S., leading causes of chronic kidney disease are
diabetes and hypertension. But the ailment leading to
a progressive decline in kidney function is typically a
manageable condition that can be effectively controlled
with treatment. Doctors understand its causes and cures.
In Central America, the diseases origins are more of an
enigma, and more frequently lethal. Afflicted laborers in
the sugar cane fields near the Pacific generally have
neither diabetes nor hypertension.
Some scientists suspect that exposure to an unknown
toxin, potentially on the job, may trigger onset of the
disease. Researchers agree that dehydration and heat
stress from strenuous labor are likely contributing
factors and they may even be causing the illness.
Laborers, typically paid not by the hour or day but based
on the amount they harvest, often work to the point of
severe dehydration or collapse, potentially harming their
kidneys with each shift.
CKD usually attacks small blood vessels in the kidney
called the glomeruli; the Central American epidemic
attacks the kidneys tubules. CKD generally affects older
people with equal distribution between sexes; this
epidemic overwhelmingly affects working-age men,
mostly sugarcane workers but also miners and other
agricultural laborers.
A growing community of researchers is calling for
recognition of a new illness not yet included in medical
manuals: Mesoamerican nephropathy, endemic
agricultural nephropathy or sugarcane
nephropathy. The director of El Salvadors national
CKD program has written of a Mesoamerican Regional
Nephropathy that would one day be internationally
It is important that the chronic kidney disease afflicting
thousands of rural workers in Central America be
recognized as what it is: a major epidemic with a

tremendous population impact, said Victor
Penchaszadeh, a clinical epidemiologist at Columbia
University and frequent consultant to the Pan American
Health Organization on chronic diseases in Latin
Dr. Ramon Vanegas, a nephrologist who assesses
applications by workers to Nicaraguas Institute of Social
Security for occupational illness pensions, said cases
which he defines as occupational CKD follow a pattern
of tubular kidney damage combined with a history of heat
Usually they have been working, and they had muscle
spasms, theyve gotten fever, they have collapsed,
Vanegas said of the patients whose applications he
approves. Then they return to work, they face the same
exposures, and the cycle repeats. Then, two or three years
later, the patient has [CKD].
While physicians mull labels and diagnoses, the mystery
persists: Why does this particular form of CKD attack
men in a particular way and in this specific region?
Some studies suggest risk factors, from pesticide
exposure to alcohol abuse to frequent use of anti-
inflammatory drugs, may play important roles in CKDs
onset. Others show that miners, stevedores and field
workers in affected regions also have high CKD rates; a
study in Nicaragua found a mining town to have one of
the highest prevalence rates in the country.
The evidence points us most strongly to a hypothesis
that perhaps heat stress hard work in a hot climate
without sufficient replacement of fluids might be a
cause of this disease, said Daniel Brooks, lead
researcher of a scientific team from Boston University
that is among a handful of groups conducting early
During days the team observed sugar cane workers, mean
temperature in the fields was 96 degrees. Their report
noted that the U.S. Occupational Safety and Health
Administration, which oversees safety at U.S.
workplaces, calls for 45 minutes of rest for every 15
minutes of work at that heat stress level.
The teams preliminary research bolsters the heat stress
hypothesis; blood and urine samples taken from different
types of sugarcane workers during the course of a harvest
season show more evidence of kidney damage among
those who did strenuous labor outside. Earlier, the team
identified a number of work practices and chemicals at
the company that could potentially damage the kidneys.
Brooks said more research is needed before conclusions
can be drawn.
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Continued from page 51 Thousands of Sugar cane
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Internal studies by Nicaragua Sugar, owners of one of
Central Americas largest sugar plantations, provided by
the company to ICIJ, show that the company has long
had evidence of an epidemic tied to heat stress and
dehydration. In 2001, company doctor Felix Zelaya
conducted an internal study on the causes of CKD
among Brooks said more research is needed before
conclusions can be drawn.
Internal studies by Nicaragua Sugar, owners of one of
Central Americas largest sugar plantations, provided by
the company to ICIJ, show that the company has long
had evidence of an epidemic tied to heat stress and
dehydration. In 2001, company doctor Felix Zelaya
conducted an internal study on the causes of CKD
among its workers. Strenuous labor with exposure to
high environmental temperatures without an adequate
hydration program predisposes workers to heat stress
syndrome [heat stroke], which is an important factor in
the development of CKD, Zelaya concluded.
Nicaragua Sugar and other companies say they have
acted voluntarily to protect workers by improving
hydration, reducing work hours, and strengthening
oversight of labor contractors.
Even so, Nicaragua Sugar disputes the existence of a
unique kidney ailment affecting its workers. Were
convinced that we have nothing to do with kidney
disease, said spokesman Ariel Granera. Our
productive practices do not generate and are not causal
factors for CKD.
Signs of trouble
In 2000, Salvadoran physician Trabanino noticed large
numbers of young and middle-aged men coming into his
hospital in El Salvador, all with advanced cases of
chronic kidney disease. For some reason, to the rest of
the world this seemed normal, he recalled. To me it
seemed strange and curious.
In 2002, Trabanino published one of the first studies of
the disease, a profile of 205 new patients admitted to his
hospital with end-stage renal disease. Two thirds of
these cases lacked the usual risk factors for chronic
kidney disease and had some common features.
They were almost all men who lived in the low-lying
zones of the country, close to the coast, near a major
river, Trabanino wrote in the Pan American Journal of
Public Health. A large group of these patients also
described frequent occupational contact without
adequate protection with insecticides and pesticides.
Another study of kidney patients from northern Costa
Rica again from a sweltering, low-lying region near
the Pacific Coast described a similar pattern.
All are young men, between the ages of 20 and 40
years, wrote Dr. Manuel Cerdas of Costa Rica in the
journal Kidney International. The most interesting
feature of these patients is epidemiologicall of them are
long-term sugar-cane workers.
Cerdas later found that victims of the epidemic shared
another condition: the disease attacked a part of their
kidneys called the tubules. Tubulo-interstitial disease is
usually rare accounting for only 3.7 percent of cases
of end-stage renal disease in the United States. Known
causes include toxic exposure and dehydration.
Today El Salvador promotes blood testing in hard-hit
rural areas to try to catch cases in treatable stages.
Trabanino, who has studied the epidemic for over a
decade, said he believes screening, public education
campaigns and improved worker safety could stop the
ailments spread if only resources were available.
Researchers in Central America, meanwhile, face an
uphill battle. The few CKD studies done so far had been
conducted in hospitals and affected communities, where
people were already sick. Theories about the role toxic
chemicals may play in causing the disease are difficult to
test because scientists need access to the epidemics
victims as they are falling ill.
Silence on CKD; fast action on biofuel
Central American sugar companies have been reluctant to
open their doors to outside health researchers. Advocates
believe the industry fears designation of the disease as an
occupational illness. Resistance has begun to soften
notably at Nicaragua Sugars Ingenio San Antonio
plantation, where the Boston University team is working.
But the industry typically has barred independent
scientists from company property, employees or records.
Aurora Aragon, an occupational health specialist at the
University of Leon in Nicaragua, said that in 2004
researchers from an international NGO called SALTRA
asked Nicaraguas leading sugar companies to collaborate
on a study of worker safety. She said that the Ingenio San
Antonio and Ingenio Monte Rosa ignored the request.
In 2007, Aragon said another request for access by her
colleagues was rejected by the Ingenio San Antonio.
Ultimately, that was the conclusion, she said. Not one
sugar company gave us permission to study the problem.
Mario Amador, a spokesman for the Nicaraguan sugar
industry trade group that represents plantations
approached by SALTRA, said the industry has allowed
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die as Wealthy Nations Stall on Solutions
studies by doctors, medical students and health authorities,
but must exercise caution in sharing information with
People with bad intentions have tried to connect CKD
with work in the sugar industry, because this industry was
the first to find high rates of CKD in the labor force that
came to the plantations seeking work, Amador said. It is
because of these constant attacks that plantations and their
staff are very careful about the information they provide to
any person or institution.
Central American producers play a significant role in the
global sugar business; in 2011 the US imported more than
330,000 metric tons of sugar from the region, representing
23% of total raw sugar imports.
Beyond the kitchen table, the U.S. government has heavily
promoted the sugar industry in the areas affected by the
epidemic as a source of biofuel from ethanol. The U.S.
funded conferences to promote biofuels in both Nicaragua
and El Salvador as late as 2008, according to embassy
cables released by WikiLeaks. Its ambassadors met
repeatedly with the leaders of both nations sugar
industries, and fretted that failure to develop ethanol
production would drive these nations toward dependence
on oil imports from Hugo Chavezs Venezuela.
In 2007, then-Ambassador Paul Trivelli notified the U.S.
State Department of Ingenio San Antonios first ethanol
shipment and wrote that the company had embraced the
potential to develop the industry and the positive aspects
of biofuels. But he expressed concern that Nicaraguas
leftist president, Daniel Ortega, might be swayed by
Venezuelan President Hugo Chavezs opposition to
The following year, Trivelli wrote that the State
Department had designated Nicaragua as a high-priority
country for biofuels. The embassy in El Salvador,
Nicaraguas northern neighbor, also forcefully promoted
ethanol: ambassadors met with sugar industry leaders,
shared concerns with the State Department about the
political effects of oil imports from Venezuela, and
sponsored a conference to promote biofuels.
The World Bank, meanwhile, has provided more than
$100 million in loans to promote biofuel production at two
heavily affected plantations, which it approved without
formal consideration of kidney disease. After workers
complained, the Bank granted $1 million to sponsor the
ongoing Boston University study.
Before receiving the loans, the companies needed to assure
the Bank that they lived up to social and environmental

standards. Appraisal teams published glowing
assessments of the Ingenio San Antonio and Monte
Rosas practices in September 2006 and May 2007.
Neither report mentioned CKD.
In October 2006, the board of the International Finance
Corporation (IFC) the World Banks lender for
private-sector projects approved a $55 million loan to
Ingenio San Antonio. A $50 million loan to Monte Rosa
was approved in June 2007.
With the money, the companies expanded, sending more
workers into the cane fields.
Edgar Restrepo, a senior investment officer for the IFC,
said his team did consider CKD when it appraised the
Ingenio San Antonio, but that the content of its
deliberations is privileged. IFC spokeswoman Adriana
Gomez said the IFC had complied with its strict social
and environmental standards in the due diligence
A standoff in Mexico City
While governments in Central America have committed
few resources to combating CKD, they have begun
sounding alarms.
El Salvadors government has been forceful in calling for
international research help. At a United Nations summit
of health ministers this February in Mexico City, El
Salvador Health Minister Maria Isabel Rodriguez
declared that chronic kidney disease was wasting away
our populations across Central America. She called on
fellow health ministers to include CKD among the top
chronic illnesses in the Americas, a step that could attract
U.N. funding for studies.
Rodriguezs proposal ran into strong opposition from the
summits most powerful participant: the United States.
Rodriguez said the U.S. delegation refused either to
include the disease on the list of the continents most
serious chronic illnesses, or to accept language
suggesting that the epidemic had distinct causes related to
exposure to toxic chemicals.
Central American representatives said they felt so
strongly they refused to sign the conferences final
declaration unless CKD was included. For several tense
moments, the dispute threatened to derail the consensus
of the summit. Result: A single phrase mentioning
chronic kidney disease in Central America.
David McQueen, a United States delegate from the
the U.S. opposed mentioning CKD to keep the focus on
diabetes, heart disease and cancer.
Declarations that are made are rarely successful unless
they are very targeted, he said. Continued on page 54

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Continued from page 53 Thousands of sugar cane workers
die as wealthy nations stall on solutions
McQueen, who has since retired, said he wasnt aware
of the dramatic spread of chronic kidney disease until it
was raised at the conference. The chronic kidney thing
sort of caught everybody by surprise, he said. Why is
this being pushed so hard? McQueen learned at the
meeting that it is a significant problem, spurring a
major drain on resources for physicians and hospitals in
Central America.
Yet even after learning of the issue, the U.S. has taken
little action. CDC spokeswoman Kathryn Harben said
that at a dinner on the night of the Mexico City summit,
the CDC informally offered to help Central American
health ministries. It has not yet done so, she said,
because those ministries have not submitted a formal
request. The top U.S. health official at the summit, Dr.
Howard K. Koh, assistant secretary for health at the
Department of Health and Human Services, declined to
be interviewed for this story.
Get sick, lose your job
Ingenio San Antonio and Ingenio Monte Rosa,
Nicaraguas largest plantations, now regularly test
workers blood to measure creatinine, a chemical that
indicates kidney function. Workers with elevated
creatinine levels are dismissed, a step the companies say
is necessary to prevent sick workers from further risking
their health in the fields.
Dismissal also cuts off workers from care at company
hospitals, and often from company pensions.
The Ingenio San Antonio said it has reduced work hours,
provided more water and hydrating solution and hired
social workers to accompany contractors in the fields to
ensure adequate hydration. Currently, the workday is no
more than eight hours for demanding physical jobs, and
the company provides eight liters of water and 2700
milliliters of hydrating solutions daily to each field
worker, said spokesman Granera.
In November 2009, Maudiel Martinez boarded a
company bus one morning and headed for the fields. He
was 17 and starting his fourth year with the Ingenio San
Antonio. Harvest season was about to begin and,
following routine, the company had conducted blood
tests to see if workers were healthy enough for field
work. the U.S. opposed mentioning CKD to keep the
focus on diabetes, heart disease and cancer.
Martinez was on the bus when he got the news: hed
failed the creatinine test. He had the disease.
I cried because of my grief, Martinez said. I was such
a child at the age of 17 youre still an adolescent.
The diagnosis meant that Martinez was formally
prohibited from working for the company. With his
family struggling financially and no alternative job in
sight, Martinez assumed a fake name and Social Security
number and went back to work in the same fields, for
independent labor contractors who, he said, dont care
that he provides a womans name and Social Security
At least some contract workers are still going out on
longer, riskier shifts. An ICIJ reporter in June 2011 noted
that buses picking up Ingenio San Antonio contract
workers started at 5:25 a.m. and returned at 5:31 p.m.
Workers said about 10 of those hours were spent in the
A collapse in the fields
On June 10, 2011, Martinez was assigned to cut four
rows of cane. His task was to strip off the leaves, chop
them into pieces, and tie them into bundles. About forty
pieces make up a bundle. For this labor, he earned one
cordoba per bundle less than a nickel.
By 8:30 in the morning, he had cut two rows. He was
starting to feel sick, but continued to cut in the sweltering
heat. The sun was too strong, and I had sweated through
my shirt like someone had thrown water on me,
Martinez recalled.
By the time he finished his rows, at about 11, Martinez
was feverish and nauseous. He rested some 15 minutes,
but still had to tie his pieces into bundles. Another worker
came to help.
Martinez said they finished about 1 p.m., and the bus
came to bring the workers home about half an hour later.
When it arrived, Martinez felt desperately ill. I got onto
the bus and I couldnt walk anymore, he said.
Since Martinez was a contract worker, he could not go to
the company hospital. He took the bus toward home and
on board began to vomit. The bus did not stop. The guys
gave me a chance to stick my head out the bus window,
he said.
The road where the bus left him is separated from his
home by a shallow river. His mother and brother carried
him across the river to bring him to his bed.
Soon after his collapse, Martinez learned that his
creatinine levels were up. He had gone for days with no
appetite, wanting only cold drinks to soothe the sensation
of fever.
If death is coming, we have to resign ourselves to wait
for it, Martinez said. Resigning yourself means waiting
for what the disease is going to give you.
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Continued from page 54 - Thousands of sugar cane workers
die as wealthy nations stall on solutions
Because you look at me and I look normal now, but
inside I feel like Im burning.
Kidney disease deaths in Central America, 2009


In India, Verdant Terrain
conceals Clues to a Fatal
Kidney Disease
By Sasha Chavkin
19 September 2012
UDDANAM, India A tangle of green blankets the
land amid thick tropical heat. Shady groves of cashew
trees strew the ground with juicy, perfume-scented
fruits. Men can be seen climbing coconut palms to tap
into the trunks for wine. The regions name, Uddanam,
comes from a word in Sanskrit that means Beautiful
Garden or Paradise.
Uddanams rich terrain seems an unlikely place for the
mysterious strain of illness tormenting the area. For
more than a decade, a rash of chronic kidney disease has
been striking down the villagers of this remote
agricultural belt in the state of Andhra Pradesh, India. In
some villages, the disease has impacted from 24 to 37
percent of the population, two to three times higher than
elsewhere in the district, according to unpublished
results from a study by Harvard Medical School.
As the death toll mounts, the seemingly idyllic region
has become stigmatized. In contrast to Nicaraguas
Island of the Widows, which is named for the
alarming rate of chronic kidney deaths among the
communitys husbands, residents of Uddanam say they
now have trouble getting married at all.
Other people, they dont want to come for marriage,
said Dr. Priya Prathibha, the state medical officer in the
hard-hit village of Varaka. They are not giving any bride
or bridegroom to this area, this Uddanam area.
Uddanams victims have much in common with those of
the unexplained epidemics in Sri Lanka and Central
America. They come from farming communities and are
mostly poor. Few suffer from diabetes or hypertension.
The climate is sweltering, toxic pesticides are used
liberally, and biopsies show the rare pattern of tubulo-
interstitial kidney damage. This type of damage accounts
for less than 4 percent of end-stage renal disease in the
United States, and is consistent with severe dehydration
and toxic poisoning.
Yet in other ways Uddanam is different. The research to
date suggests the disease is confined to a single belt of
villages that spans less than 100 miles. Despite mens
traditional role in the fields, both sexes are affected
almost equally, teams from Harvard and Stony Brook
University found. Farmers of several different types of
crops coconuts, cashews and rice are all affected.
The known impact is also smaller: from 2007 to 2012, a
total of 1,520 people required treatment for kidney
disease through the state health program. Even if several
times as many are in the latent early stages of the disease,
its geographic and humanitarian scope is more contained
than in Central America or Sri Lanka. Our hypothesis is
that an exposure to something in the environment,
whether its in the soil or in the water or both, is
responsible for this, said Dr. Ajay Singh, a nephrologist
at Harvard Medical School and the co-leader of the
Harvard study.
The research has yet to offer definitive answers. Not a
single study has been published on Uddanam CKD, nor
do any official statistics measure its scale or reach.
Among the scientists and the villagers, confusion and
frustration reign.
They come to you and they dont understand whats
happening to them, Singh said of Uddanams residents.
But they do understand that theyre dying from the
disease and there are no resources to help them out and
something needs to happen there.
A Family Tragedy
Hyamavathi and Prameela Bendalam have lived the
tragedy that has left many Uddanam families frightened
of consenting to marriages. Both were in their early
twenties when they married and moved to a village in the
region called Varaka. Hyamavathi was about 23 when
she married her husband, a coconut and rice farmer
named Venkataramana Bendalam, in 1990.
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Continued from page 55 In India, Verdant Terrain
conceals Clues to a Fatal Kidney Disease
Prameela was about 20 when she married
Venkataramanas brother Rama Rao, also a rice farmer.
The marriages made the women co-sisters, and they
began living together in the Bendalam family compound.
For more than a decade, their husbands worked the five
acres of rice paddy and coconut fields owned by the
In 2005, their husbands began to experience difficulty
urinating. Both were initially diagnosed with urinary
tract infections before traveling to visit doctors in
Visakhapatnam, also known as Vizag, a city more than
100 miles away.
They were unwell, but we didnt know a disease had
hit, Prameela said. Then we found out that they had
kidney condition, when we went to Vizag.
The illness left the two brothers feverish and nauseous,
and eventually too sick to work. Both took medicines to
relieve the diseases symptoms, but the family could not
afford dialysis. Prameela said the cost of the treatment
her husband did receive was more than 60,000 rupees,
close to $1,100 at the current exchange rate.
The family had to take out loans, and then to gradually
sell off their land. Prameela and Hyamavathi took care
of the two terminally ill brothers. The both of us were
in a lot of pain and misery, Prameela said.
In 2007, Venkataramana and Rama Rao died less than a
month apart on November 25 and December 23,
Prameela and Hyamavathi remain in the compound, and
now work the single acre that remains of the land
cultivated by their husbands. This labor provides their
only income beside the thousand rupees (roughly $18)
each month that Prameelas son Siva earns as a teacher
in a private institute.
I borrowed money thinking that he would survive,
Prameela said of her husband. But he died, and now the
loans have to be paid back as well. This is bad karma,
full of suffering.
Since their deaths, the state government of Andhra
Pradesh has established new programs that assist
Uddanams victims. A statewide health insurance
program for the poor now covers the costs of dialysis.
State-of-the-art dialysis centers have been established in
several cities through a public-private initiative led by
Dr. Ravi Raju Tatapudi, a leading nephrologist who
served three years as Andhra Pradeshs director of
medical education.
But almost all of the areas nephrology and dialysis
several cities through a public-private initiative led by Dr.
Ravi Raju Tatapudi, a leading nephrologist who served
three years as Andhra Pradeshs director of medical
But almost all of the areas nephrology and dialysis
services are in Vizag. The costs of travel and of
medicines that are not covered by the insurance program
are still prohibitive for many families in Uddanam.
They have dialysis but they are 200 kilometers away,
said Sham Sundar Puriya, the village head in Patha-
Varaka, a sub-community in Varaka village. The
residents cannot go to that place because of lack of
money, so they are staying here and dying here.
Uddanam lacks doctors. There are no full time
nephrologists stationed within 100 miles of the region,
and local medical officers must refer their patients to
distant urban facilities. Dr. Prathibha, the medical officer
who lives in Varaka, says the fear surrounding the disease
has left even doctors scared to live in Uddanam. If
they are not coming, she asked, who will?
Frustration and Fear
Since the 1990s, when Tatapudi and other nephrologists
began noticing the unusual strain of CKD in Uddanam,
various theories of the diseases origins have emerged.

Accordingly to unpublished results from a Harvard University
study, chronic kidney disease affects 24-37% percent of the
population in some villages in Uddanam, 2 to 3 times higher
than other parts of the district. Anna Barry Jesler
Most have centered on toxic exposure. An unpublished
study by a team of researchers from Uddanam and Stony
Brook University concluded that the disease is most
likely to be the result of a chronic exposure to an
environmental agent.
Dehydration, another possible factor, has received less
attention. The Uddanam area is brutally hot, and farmers
spend long hours in the fields. Continued on page 57

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Continued from page 56 In India, Verdant Terrain
conceals Clues to a Fatal Kidney Disease
Dr. Goru Krishna Babu, a researcher who conducted
door-to-door surveys in Uddanam for the Harvard study
and grew up nearby in Andhra Pradesh, said the heat
was so overwhelming one day, he had to stop and lie
down while carrying out the surveys. One of the things
I took pride in was that whatever the temperature was I
could sustain myself, he said. But one of the days I
literally had to lie down on the bed.
So far, the efforts of the Stony Brook, Harvard and state
government researchers remain tied up in delay. None
have published studies that point toward specific
suspects. A lab test by Stony Brook that tested local
water for contamination by any of 42 toxic chemicals,
including heavy metals such as arsenic and cadmium,
revealed nothing out of the ordinary, said Kate Dickman,
a pharmacologist with the Stony Brook team.
The most visible sentiment in Uddanam is frustration:
that the years of research and promises havent brought
results. As the deaths continue, many residents have
become fearful of living in a land so beautiful it was
named after Paradise.
So many people are leaving, said Siva Bendalam,
Prameelas 20-year-old son who helps support his
family. If the disease continues, no one will be here.

UNEP Report highlights Risk
of Mercury Emission in
13 January 2013
SUB-SAHARAN African communities face the worlds
second-highest emission of mercury, a highly-toxic
element used in small-scale mining and in several
industrial processes, putting themselves and their
environment at risk, the United Nations Environment
Programme (UNEP) said in Nairobi, Kenya, on Thurs-
day when it released two new studies on mercury and
mercury poisoning.
Mercury poisoning leads to sensory impairment,
disturbed sensation and a lack of co-ordination, kidney
lung and brain dysfunction and even death. Mercury can
also contaminate soils and rivers, and much of human
exposure to mercury is through the consumption of
contaminated fish, with the UNEP studies for the first
time assessing at a global level the release of mercury into
rivers and lakes. Sub-Saharan Africas emissions were in
the 168-154 tons/year range, 16.1% of the global average of
1,960 tons/year (range 1,010-4,070), topped only by East
and Southeast Asia, with a range of 395-1,690 tons/year, or
39.7% of the total. After South Africa came South America,
with an emission range of 128- 465 tons/ year (12.5% of the
total), according to UNEPs Global Mercury Assessment
The report noted that artisanal and small-scale gold mining
emissions are, in the 2010 inventory, the major source of
emissions to air, at 727 tons per year globally. Artisanal and
small-scale gold mining and coal burning are the major
sources of anthropogenic mercury emissions into the air,
accounting for more than 35% of total anthropogenic
emissions. This is more than twice the figure from this
sector in 2005, however, most of the increase is attributed
to some new and better information, UNEP said in a
Mineral Resources Minister Susan Shabangu said last year
the high price of gold in recent years has seen the
proliferation of illegal mining activities, especially in the
Free State and Gauteng, costing South Africa an estimated
R5bn a year.
South Africa is party to the International Negotiating
Committee on Mercury that is to hold discussions in
Geneva, Switzerland, on January 13-18 in a bid to conclude
a global, legally-binding treaty to minimise mercury
According to UNEP anthropogenic sources are responsible
for about 30% of annual emissions of mercury to air,
another 10% comes from natural geological sources, and
the rest (60%) is from re-emissions of previously released
mercury that has built up in surface soils and oceans. It
(illegal mining on the surface) is a major problem and it is
extensive in the old gold mining areas, except Barberton (in
Mpumalanga). The only way to eradicate it is to rehabilitate
the area, said Col Hennie Flynn from the SAPS.

Mercury is a chemical (element) that occurs naturally in the
environment in several forms. In the metallic or elemental
form, mercury is a shiny, silver-white, odorless liquid with
a metallic taste. Mercury can also combine with other
elements, such as chlorine, carbon, or oxygen, to form
mercury compounds. These compounds are called "organic
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Continued from page 57 Mercury
mercury" if they contain carbon, and inorganic
mercury" if they do not. In pure form, these mercury
compounds are usually white powders or crystals. All
forms of mercury are considered poisonous. One organic
form of mercury, methylmercury, is of particular
concern because it can build up in certain fish. For this
reason, rather low levels of mercury in the oceans and
lakes can contaminate these fish.
Mercury released into the environment stays there for a
long time. Once in the environment, mercury can slowly
be changed from organic to inorganic forms and vice
versa by microorganisms and natural chemical
processes. Methylmercury is the organic form of
mercury created by these natural processes.
There are many different uses for and sources of
mercury. Metallic mercury is mined and is also a waste
product of gold mining. Chemical factories that make
chlorine use mercury and may release metallic mercury
into the air. Thermometers, barometers, batteries, and
tooth fillings all contain metallic mercury. Inorganic
mercury compounds are commonly used in electrical
equipment (for example, batteries, lamps) and skin care
and medicinal products. Some inorganic mercury
compounds are used in fungicides. Methylmercury is
generally produced in the environment, rather than made
by human activity. Fungicides and paints may contain
other organic mercury compounds. Mercury compounds
may be found in the air, soil, and water near hazardous
waste sites.
Fate & Transport
Mercury is a naturally occurring metal found throughout
the environment as a result of normal breakdown of the
earth's crust by wind and water. The total amount of
mercury in the environment caused by natural processes
throughout the world is far greater than the total amount
caused by human activities. However, the amount of
mercury that exists in any one place through natural
processes is usually very low. In contrast, the amount of
mercury that may be at a particular waste site because of
human activity can be very high. Air, water, and soil can
contain mercury from both natural sources and human
The mercury in air, water, and soil is thought to be
mostly inorganic mercury. This inorganic mercury can
enter the air from deposits of ore that contain mercury,
from the burning of fuels or garbage, and from the
emissions of factories that use mercury. Inorganic
mercury may also enter water or soil from rocks that
contain mercury, releases of water containing mercury
from factories or water treatment facilities, and the
disposal of wastes. Organic compounds of mercury may be
released in the soil through the use of mercury-containing
Metallic mercury is a liquid at room temperature. It can
evaporate easily into the air and be carried a long distance
before returning to water or soil in rain or snow. As
mentioned before, some microorganisms in the water or soil
can change inorganic forms of mercury to organic forms.
Organic forms of mercury can enter the water and remain
there for a long time, particularly if there are particles in the
water to which they can attach. If mercury enters the water
in any form, it is likely to settle to the bottom where it can
remain a long time. Mercury also remains in soil for a long
time. Mercury usually stays on the surface of the sediments
or soil and does not move through the soil to underground
Small fish and other organisms living in the water can take
up the organic forms of mercury. When larger fish eat these
small fish or other organisms that contain organic mercury,
their bodies will store most of it. In this way, large fish
living in contaminated waters can collect a relatively large
amount of organic mercury. Plants may also have a greater
concentration of mercury in them if they are grown in soil
that contains higher than normal amounts of mercury.
Exposure Pathways
Because mercury occurs naturally in the environment,
everyone is exposed to very low levels of mercury in air,
water, and food. Sources of higher exposure to metallic
mercury include breathing air containing mercury in the
workplace or any place where mercury might have been
spilled. Also, since amalgam dental fillings are about half
metallic mercury, if you have them you can be exposed to
mercury levels that are higher than the levels normally
found in the environment. People with dental fillings
containing mercury generally have more mercury in their
breath than those who do not have these fillings. However,
there is not enough evidence to prove that the mercury in
amalgam fillings is causing health effects in humans.
Sources of exposure to inorganic mercury include
swallowing or inhaling dust that contains mercury particles
in the workplace and using skin care and medicinal
products with small amounts of mercury in them. You can
also be exposed to inorganic mercury by drinking water that
is contaminated with mercury. For most people, eating
contaminated fish is the major source of organic mercury
exposure. Some fish contain such high levels of mercury
that eating them has been prohibited. Other foods typically
contain very little mercury. A greater risk of mercury
exposure may occur in fetuses exposed to mercury in their
mother's blood and in nursing children who may be exposed
to mercury in their mother's milk. Exposure near hazardous
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Continued from page 58 Mercury
waste sites is likely to occur by breathing contaminated
air, having contact with contaminated soil, or drinking
contaminated water.
The background or natural level of mercury found in
outdoor air is generally between 10 and 20 nanograms of
mercury per cubic meter of air (ng/m3). Mercury levels
found in surface water are generally less than 5 ng per
liter of water. Levels normally found in soil range from
20 to 625 ng of mercury per gram of soil. The Food and
Drug Administration (FDA) has estimated that, on
average, most people are exposed to about 50 ng of
mercury per kilogram of body weight per day in the food
they eat. This translates to about 3.5 micrograms of
mercury per day for an average weight adult. A large
proportion of this mercury is likely to come from fish.
Furthermore, people who eat a lot of fish are likely to
have higher exposure to mercury.
Exposure to mercury can occur in many jobs. Most
exposures on the job occur as a result of breathing air
that contains mercury. Exposure occurs in the medical,
dental, and other health services, and in the chemical,
metal processing, electrical equipment, automotive,
building, and other industries. Families of workers may
be exposed to mercury in the home if the workers have
mercury dust on their clothing. Dentists and their
assistants may also be exposed to mercury from skin
contact with dental fillings and breathing metallic
mercury vapor released from these fillings.
Exposure to mercury can be determined by measuring
amounts in blood and urine. Levels found in blood and
urine may show whether health effects are expected.
Mercury can easily enter your body when you breathe in
air containing metallic mercury. Most of the mercury that
gets into your lungs as metallic mercury goes rapidly to
other parts of the body. Metallic mercury that you might
swallow does not enter your bloodstream very easily, and
most of it leaves the body in the feces. Some metallic
mercury may stay in your body, mostly in the kidney and
brain. Metallic mercury can also reach the fetuses of
pregnant women easily. Metallic mercury that you
breathe in will leave your body in the urine, feces, and
Inorganic salts of mercury (mercurous or mercuric
chloride, for example) that are inhaled do not enter your
body as easily. However, these inorganic forms of
mercury, if swallowed, enter the body more easily than
metallic mercury. Inorganic mercury can also enter the
bloodstream directly through the skin. However, only a
small amount would pass through your skin compared

with breathing or swallowing inorganic mercury. After
entering the body, inorganic compounds of mercury can
also reach many tissues. Some may stay in your body,
mostly in the kidneys. However, inorganic mercury cannot
reach the brain as easily as metallic mercury. Inorganic
mercury leaves your body in the urine or feces after
several weeks or months.
Organic compounds of mercury can probably enter your
body easily through the lungs. Organic mercury in
contaminated fish or other foods that you might eat enters
your bloodstream easily and goes rapidly to other parts of
your body. It can also enter the bloodstream
directly through the skin, but only a small amount would
pass through your skin. Organic mercury in the body is
similar to metallic mercury because it can reach most
tissues including the brain and fetus. Organic mercury can
change to inorganic mercury in the brain and remain there
for a long time. Organic mercury that you swallow or
breathe leaves your body in the feces, mostly as inorganic
mercury, within weeks.
Health Effects
Long-term exposure to either inorganic or organic
mercury can permanently damage the brain, kidneys, and
developing fetus. The most sensitive target of low level
exposure to metallic and organic mercury following short
or long term exposures appears to be the nervous system.
The most sensitive target of low level exposure to
inorganic mercury appears to be the kidneys. Short term
exposure to high levels of mercury can have similar
effects. Full recovery is more likely after short term
exposures than long term exposures, once the body clears
itself of the contamination.
Short term exposure to high levels of metallic mercury in
the air can cause skin rashes and effects on the lungs and
eyes. Long term exposure to metallic mercury has been
studied in workers at chlorine facilities. Some of them
developed symptoms such as memory loss and shakiness.
Levels of metallic mercury in air were greater than the
levels normally encountered by the general population.
Current levels of mercury in workplace air are lower than
in the past. Because of this reduction, fewer workers have
symptoms from mercury exposure. Studies in humans
found there were no effects on the ability to reproduce
after breathing metallic mercury for a long time.
Short and long term exposure to low levels of inorganic
mercury in animals can also cause kidney and brain
effects. Long term exposure to higher than normal levels
of inorganic mercury from eating or drinking
contaminated foods or water can lead to brain and kidney
damage in some people. Long term exposure to inorganic
mercury has caused effects to the fetus in animals. The
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60-- Traditional African Clinic February/March 2013

African Traditional Herbal Research Clinic
Volume 8, Issue 2 NEWSLETTER February/March 2013
Nigeria: The Rate of Kidney Disease
Daily Champion
19 July 2011
Recent revelation by the National Association of
Nephrology that an estimated 30 million Nigerians
suffer from kidney problems is indeed worrisome and
another sad story from our health sector which must be
written in the interest of those who currently have these
problems and those who may, if something is not
urgently done, come down with this debilitating
Going by the figure declared by the president of the
association, Dr. Chinwuba Ijeoma, at the recent 23rd
general meeting and scientific conference of the
International Society of Nephrology (ISN) in Benin
City, Edo State, no less than 20 per cent of Nigerians
have kidney problems.
Indeed, and at an awareness campaign also organised
by the group to mark this year's World Kidney Day, it
was also revealed that every year many Nigerians die
prematurely of cardiovascular diseases linked to kidney
Before this time however, specifically in 1998 during
their 10th Annual Scientific Conference on kidney
disease, nephrologists at the University College
Hospital, Ibadan, had equally raised alarm over the
increase in incidences of kidney failure, stressing that
teaching hospitals in the country were recording
between 16 and 60 new patients seeking dialysis every
At the moment, the number of new patients seeking
dialysis every month in these institutions is said to have
risen astronomically to between 200 and 300, a
situation that no doubt calls for intensification of public
enlightenment campaigns concerning the different
kinds of chronic kidney diseases (CKD) that people
suffer from, their causes and how to manage them.
Among factors identified as contributing to the
development of the disease in Nigeria include ingestion
of fake, expired and adulterated drugs; high blood
pressure; poor Western-style diet low in natural food,
overuse of certain simple medications, including analgesics
and uncertified herbal preparations; stress, obesity and lack
of exercise.
Self-medication and failure to undergo regular medical
check-ups also contribute to the escalation of the disease,
just as the dearth of medical equipment for diagnosis and
funds for treatment lead to deterioration of simpler ailments
to serious kidney diseases.
But as worrisome as the rate of prevalence is, it must be
noted that the situation is not peculiar to Nigeria. It is
obviously a global problem. According to the United States
Renal Data System (USRDS) for instance, "each year in the
US, more than 100,000 people are diagnosed with kidney
failure, a serious condition in which the kidneys fail to rid
the body of wastes."
Also, the World Health Report 2002 and Global Burden of
Disease project reports indicate that diseases of the kidney
and urinary tract account for approximately 850,000 deaths
every year, representing the 12th cause of death and the
17th cause of disability.
As medical experts would have it, the functions of the
kidney basically include regulating the body's fluid balance
by adjusting the amount of urine that is excreted daily and
removing waste products that the body produces throughout
the day.
But while advanced nations are constantly pursuing
measures to combat the scourge of CKD, the situation in
Nigeria has been allowed to progress to a frightening level,
even when most forms of the disease are treatable.
For instance, the disease's progression can be lessened if
detected and treated early, thus preventing the need for
dialysis and kidney transplant.
But since the nation's ailing health care system cannot
provide adequate facilities for the management of the
disease, it becomes imperative for the relevant authorities
to embark on extensive enlightenment campaigns as a
Continued on page 61

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Continued from page 60 Nigeria: The Rate of Kidney
measure to prevent people getting the disease that today
constitutes a serious danger to Nigerians.
In most hospitals, there is an acute shortage of equipment
for diagnosis and because dialysis machines required to
manage the disease are very few in the country, the cost
is beyond what an average Nigerian patient can afford.
For instance, one dialysis session is said to cost about
N30, 000 and a patient requires about two sessions per
week. Thus, dialysis, a procedure put in place as
substitute for many of the normal duties of the kidneys, is
only available for a few rich patients.
Also, as very few hospitals in the country do kidney
transplant, which is the last resort for patients, many
Nigerian patients have had to find themselves in different
hospitals abroad, particularly in India, for the transplants.
Considering that many prominent persons, including
former President Umaru Yar'Adua, have been lost to
kidney-related ailments, no responsible government
should take the matter lightly.
Government at all levels must, as a matter of urgency,
educate their people on the causes, symptoms and how to
prevent the disease.
Government must also do more by way of providing
diagnostic equipment and dialysis machines for treatment
of the condition to save many patients the trauma of
seeking medical assistance abroad.
We join other concerned Nigerians to call on the
authorities to not only set up specialized kidney centres in
all the states of the federation, but to also ensure that
treatment is heavily subsidized to afford the growing
number of Nigerian patients access to such facilities.
Poverty, which has been identified as one of the factor
responsible for the disease should be tackled head-on and
the public health sector must be strengthened to
discourage self-medication. That way, people can be sure
of receiving the right medical treatment at all times.
We also call for the strengthening of the National Agency
for Food and Drug Administration and Control
(NAFDAC), which says 40 per cent of drugs supply in
the country is counterfeit, by reviewing the penalties for
drug counterfeiting.
Nigerians on their part must begin to show more interest
in matters pertaining to their health by obtaining and
heeding medical advice on the prevention of kidney
ailments as well as paying more attention to what
they consume.


Coping With Challenges of
Renal Disease
6 January 2013
For patients with renal diseases, Life indeed is quite
challenging. However, the will to live gives them the
strength of fight on. It is these challenges that led to the
establishment of The Kidney Care and Support
Initiative, an NGO that promotes care and awareness on
renal diseases.
Sharing his experience on the ailment, the Chairman,
Board of Trustees of the organisation, Mr. Swani B.
Gandu appealed for a more compassionate approach to
issues related to renal disease stressing the challenging
life which the patients encounter.
According to him, most Nigerians who have lost their
lives to kidney diseases died not because there is no
treatment but for the financial burden that has been
placed on them in the course of getting the treatment.
The idea to set up this organisation came to me four
years ago when I lost my kidney and have to be placed
on dialysis for survival. The treatment has taken me to
various cities and it was during these trips that I saw the
sufferings of my fellow Nigerians.
Though dialysis has been improved upon in Nigeria,
the prices still differ in various dialysis centers and
there are people who cannot afford them. Some of these
people need this dialysis three or four times in a week.
Most of these people are dying, not because there is no
treatment, but because of the financial burden which
has been placed on them.
Speaking more on the financial challenges that these
people are faced with, Mrs. Comfort Gandu whose
husband has suffered from disease for four years
acknowledged finance as part of the major challenges
of people with renal disease.
In managing renal disease, finance is a major factor.
For instance, patients of renal disease do not drink
water rather they lick ice. This means that you have to
have ice every time of the day and with the state of
power supply in the country, one may have to depend
on generator. That is finance.
Stressing further on how capital intensive renal disease
is, Mrs. Gandu disclosed the high cost of managing
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Continued from page 61 Coping with Challenges of Renal
renal diseases which includes buying blood for
transfusion as well as affording the costs of kidney
In the course of treating my husband, I have come to
realise that patients with renal disease need blood
transfusion always.
There was a month when my husband took six pints of
blood just in a month. For people that do not have the
money to buy, how would they get to pay for blood?
Even if there are relations who are willing to donate
blood for a patient, one fact remains clear; those relations
would one day get tired of donating blood, even if they
dont get tired, blood is not what you give often, you do it
at least once every six months thus the need for money to
buy this, thus living with people with renal disease is
indeed capital intensive.
With the above highlights, one may wonder on what
actually are the causes of kidney failure? It is an ailment
that develops gradually with time. Whereas various
factors contribute to it worldwide, it is established that
the major causes in Nigeria are hypertension as well as
drug abuse are the commonest causes.
Stating the reason for the high rate of kidney diseases in
Nigeria, a Nephrologist with the department of
Nephrology, Jos University Teaching Hospital, Dr.
Gimba Mark affirmed that hypertension, as well as drug
abuse are the commonest causes of kidney diseases in
The risk factors for kidney diseases are hypertensions,
diabetes, and chronic glomerulusnephritis are usually the
three commonest and diabetes is the commonest cause of
kidney diseases worldwide, but hypertension and chronic
[diabetes]are the most common in Nigeria. Also are lots
of things that we do like use of drugs without
prescriptions such as the pain killers, herbal medicines.
Dr. Gimba therefore urged Nigerians to abstain from
those practice that encourage renal disease which
includes drug abuse. Throwing more lights on the issue,
he said that it is better to avoid the ailment than to treat it.
It is usually said that prevention is better than cure and
that applies mostly to renal diseases. One of the chal-
lenging issues about the cure is that the dialysis centers in
Nigeria where kidney patients could be attended to are
very few.
We have about 50 dialysis center to a nation of about
200million [people, that is grossly inadequate, like where
I come from in Jos, we have patients coming from
Kaduna state, Taraba states to do dialysis, that is very far.
Before Bauchi was opened, people were coming from
Bauchi. We have people coming from Markurdi, Lokoja
to Jos to do Dialysis.
That is very far. We are talking of distances of four hours
and more, now any problem could happen like the patient
could suddenly develop a problem and if he is far from a
center, he could die before getting to the hospital. So
there are not enough dialysis centers. That is the reason
we advocate for kidney transplantation, of course, it is
going to be very difficult for individuals to fund but if
there is government assistance and support, as is
obtained in other countries, a patient who has kidney
failure can just go for a transplant.
That notwithstanding, he urged Nigerians to take their
health seriously and guard against renal diseases which
he said could be prevented or managed best if identified
at the earliest stage.
A Kidney disease is in stages. When in other stages,
they could be treated but if it enters to the stage where the
kidney has failed, there is nothing he can do except to do
dialysis or kidney transplant because as sad as it is, even
if drugs are given are given at this stage, it is just for a
while as you are only treating the surface, not yet
addressing the main issue.
But if it was detected at an early stage, the person may
not need dialysis once the patient was able to keep his
Blood Pressure normal, have the level of his blood sugar
controlled; chances are that he will not get to the stage 5
which is the critical stage.
So these are things to do, so people who have factors for
kidney diseases need to check and have those factors
corrected as soon as possible but once it gets to the
chronic diseases, it just goes on and on until it reaches the
terminal stage.

UN rejects Haiti Cholera
Damages Claim
Global body will not pay compensation to families of
those who died in 2010 epidemic blamed on UN
23 February 2013
The UN has formally rejected claims for damages over a
cholera epidemic in Haiti that has been widely blamed on
UN peacekeepers.
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Continued from page 62 - UN rejects Haiti Cholera
Damages Claim
About 8,000 people died in the epidemic but Martin
Nesirky, UN spokesman, said on Thursday that the
global body had told lawyers the damages claim was
"non-receivable" under a 1946 convention laying out
the UN's immunities for its actions.
In November 2011, the Boston-based Institute for
Justice and Democracy in Haiti filed a petition at UN
headquarters in New York seeking a minimum of
$100,000 for the families or next-of-kin of each person
killed by cholera and at least
$50,000 for each victim who suffered illness or injury
from cholera.
Ban Ki-moon, UN secretary-general, telephoned Haiti's
President Michel Martelly "to inform him of the
decision and to reiterate the commitment of the United
Nations to the elimination of cholera in Haiti", Nesirky
Certain health experts have said the cholera epidemic,
which erupted in late 2010, was introduced to Haiti by
Nepalese peacekeepers. The UN has never
acknowledged responsibility, insisting it was impossible
to pinpoint blame definitively.
Lawyers for the families of some of the dead and the
635,000 people estimated to have been made sick by the
cholera had predicted a damages award could cost the
UN more than $1bn.
"The secretary-general again expresses his profound
sympathy for the terrible suffering caused by the cholera
epidemic, and calls on all partners in Haiti and the
international community to work together to ensure
better health and a better future for the people of Haiti,"
Nesirky said.

Continued from page 37 - The Disease Cholera
and Kidney Failure
Low blood sugar (hypoglycemia).
Dangerously low levels of blood sugar (glucose) the
body's main energy source may occur when people
become too ill to eat. Children are at greatest risk of this
complication, which can cause seizures, uncon-
sciousness and even death.
Low potassium levels (hypokalemia). People
withcholera lose large quantities of minerals, including
potassium, in their stools. Very low potassium levels
interfere with heart and nerve function and are life-
Kidney (renal) failure. When the kidneys lose their
filtering ability, excess amounts of fluids, some
electrolytes and wastes build up in your body a
potentially life-threatening condition. In people with
cholera, kidney failure often accompanies shock. Internet

Acute Renal Failure as a
Complication of Cholera
[Article in Hebrew]
By Knobel B, Rudman M, Smetana S.
Dept. of Medicine B and Institute of Nephrology,
Wolfson Medical Center, Holon.
Harefuah. 1995 Dec 15;129(12):552-5, 615.
We present a 72-year-old man who had episodes of
severe, acute renal failure during severe attacks of
diarrhea caused by Vibrio cholerae. Patterns of acute
tubular necrosis and tubulointerstitial nephritis developed
following hypotension and decrease in renal blood flow,
causing secondary renal ischemia. There was severe
dehydration with profound hypovolemia and infection.
The clinical picture included fever, weakness, arthralgia,
pedal edema, mild bilateral pleural effusions, anemia,
leukocytosis, azotemia with a maximum of 330 mg/dl of
urea, creatine to a maximum of 9.8 mg/dl,
hypoproteinemia, severe metabolic acidosis, marked
increase in lactate dehydrogenase (LDH) and creatine
phosphokinase (CPK), microscopic hematuria, sterile
leukocyturia, normoglycemic glucosuria and
phosphaturia with diminished tubular reabsorption of
phosphorus. A short oliguric phase was followed by a
polyuric phase lasting about 10 days, and glomerular and
tubular function became normal after about 3 weeks.
Treatment was by intensive infusions of fluids,
electrolytes, sodium bicarbonate, salt-free albumin and
antibiotics. To the best of our knowledge, this renal
complication of cholera has not yet been described in
Israel. PMID:8682355

Change in Causes of Kidney
Infections; Research
By Rebecca Rwakabukoza
September 10, 2012 Continued on page 64

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Continued from 63 - Change in Causes of Kidney
Infections; Research
In Summary
As doctors look for several ways to control kidney
infections, so are the causes of the infections changing,
research shows.
There is an increase in Uganda of people needing
kidney transplants. There are radio adverts and
newspaper articles,telling the never-ending story of
dialysis and a much-needed trip to New Delhi for a
Dr Eyoku Simon Peter, a nephrologist (kidney doctor)
at Mulago National Referral Hospital, says there is
evidence of a change in the causes of kidney injury.
Change in causes
Acute kidney infection to the glomeruli, located in the
cortex, where the first filtration in our bodies takes
place, used to be the most common and when not
diagnosed early and managed, sent a lot of people to
theatres for kidney transplants.
Acute glomerulo-nephritis is mostly caused by
ischaemia, a loss of oxygen supply. Therefore, anaemic
and sicklers (people with sickle cell anaemia) were at
risk. Also, there were a lot of cases following
operations, and accidents due to the intensive blood
Today, diabetes and hypertension, usually occurring
together, are the most common, accounting for 47 per
cent of AKI while HIV/Aids accounts for 29 per cent.
The remaining 24 per cent is AKI due to damage to the
Verdict on recovery
AKI is reversible when diagnosed early. There is
feasible total remission here, Dr Eyoku says. He insists
that natural kidneys are the best option for a person and
that no transplant is as good as the natural kidney.
AKI can occur in as little time as a few hours or in a
time as long as 12 weeks. It is basically damage to
kidney tissue and the doctor has to, first of all, figure
out if there is a lesion (visible abnormality), where it is
and what it is. With answers to all these questions, AKI
can be treated and its progression stopped.
However, when not caught early, it is irreversible and
progresses to chronic kidney disease (CKD). CKD is
when damage has persisted past 12 weeks, kidney
function is compromised and the lesions are irreversible.
At this stage, the nephrologist tries to slow down
progression to end-stage renal disease.

Food intake is controlled and an affected person cannot
have foods containing potassium (bananas, tomatoes,
matooke) and protein. Also, their fluid in-take is closely
monitored, in such a way that each days fluid in-take
should be equivalent to that of the output of the previous
day plus 500mlfor instance if you take out 500ml of
urine today, you should drink 1000ml of liquid tomorrow.
This is to control oedema (swelling due to fluid retention
in the body) since the kidneys help with water regulation.
Kidney disease and HIV
In a research report, HIV-related drug nephrotoxicity in
Sub-Saharan Africa, published in The Internet Journal of
Nephrology, Dr Robert Kalyesubula and Dr Mark
Perazella look at the role of antiretroviral medications in
kidney infections.
Aside from the economic constraints that limit access to
antiretroviral medications and also account for poor
laboratory monitoring that, the report says, delays
identification of toxicities, they look at use of anti-
tuberculosis therapy and herbal medications. Incidence in
Uganda has not been studied and documented but a
review of epidemiology of AKI in South Africa showed
that 17.4 per cent (122 of 700 patients) were HIV positive
and mortality was noted in 20 per cent (25 of 122).
Another study, by Emem et al, found an 11.5 per cent
prevalence (43 of 373 patients) of CKD and attributed it
to low CD4 counts in the affected patients.
With HIV/Aids affected patients, the immunity levels are
low and the body not as capable of dealing with infection.
This, combined with the toxicities from the drugs that are
routine to the HIV-positive individual, there is a higher
risk of seeing AKIs which, when not detected early, lead
to kidney failure.
The drug cocktail for HIV-infected people often includes
non-steroidal anti-inflammatory drugs (NSAIDs) and
these are known to cause injury to the kidney. Acute
interstitial nephritis (AIN), for instance, is usually caused
by NSAIDs.
However, the report by Drs Kalyesubula and Perazella
stress that there is no need to treat HIV-infected patients
and HIV-negative ones separately. The routine remains
the same, but there is need to look at all the other issues
that affect the HIV-positive patient, when trying to locate
and manage a kidney injury.
The rise in AKI in HIV-positive individuals that has been
noted by the doctors only serves to inform the doctors
and the patients to take extra caution. Dr Eyoku
recommends regular check-ups, even when one feels
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Continued from 64 - Change in Causes of Kidney
Infections; Research
healthy. For kidney injuries caused by medications or
surgical procedures, the doctors and other medical
personnel are to be more vigilant and consult each other,
as often as needed.

Cases of Kidney Disease in
Children on the Rise
By Agatha Ayebazibwe
January 19, 2012
Doctors say that we can live quite well with only one
kidney, and some people live a healthy life even when
born with one missing. But while bones can break and
muscles can waste away without causing a major risk to
life, if both of your kidneys fail, as happens in end stage
kidney failure, bone, muscle or brain cannot carry on.
Without any kidney function, the body dies which
means one ought to act immediately once they discover
they have a kidney problem. Why are kidney diseases
on the rise among children? For a long time, kidney
diseases were associated with adults, particularly those
that have HIV, smokers and the diabetic. The trend has
however changed. Statistics show that the number of
children suffering from kidney failures has been
increasing over time.
According to Dr Violet Kayom, a resident pediatrician
at Mulago Hospital, 10-15 cases of new kidney failures
in children are registered every month. Over 800
children were admitted at the pediatric ward last year,
240 of these had kidney complications. 14 per cent of
them died and 50 per cent had nephrotic syndrome
which is the commonest cause of death in kidney
disorders, Dr Kayom said.
Dr Amos Odiit, an expert in kidney diseases says,
When a child suffers from kidney failure, they tend to
pass very little urine or none at all. This is because most
kidney diseases attack the nephrons whose chief
function is filtering the blood, reabsorbing what is
needed and excreting the rest as urine.
A normal person has two kidneys doing the same thing.
When one fails, the other can still work. But when both
fail, the nephrologist explains, the toxins in the blood
remain and accumulate to harm the person.
Data from World Health Organisation shows that for
children below four years, birth defects and hereditary
diseases are by far the leading causes of kidney failure.
Between ages five and 14, hereditary diseases continue to
be the most common causes.
Also, severe malaria and pneumonia have been identified
by doctors as causes of kidney failures among children
except those that are borne with it. Children with chronic
kidney failure are more likely not have any symptoms
until about 80 per cent of their kidney function is lost.
Then, they may feel tired, have nausea or vomiting, have
difficulty concentrating, or experience confusion.
Accumulated fluid appears as swelling around the eyes,
legs, and belly, fluid congestion in the lungs, and high
blood pressure. Children with renal failures are advised to
have a restricted intake of sodium, which is found in table
salt and salt substitutes. Many salt substitutes have
potassium in them, which can cause renal failure.
The deputy In charge at the paediatric ward, Mulago
hospital says, sick kidneys cannot easily remove excess
water, salt, or potassium, so their intake should be
limited. In kids with more severe kidney failure,
reducing the intake of dairy products and other protein-
rich foods (such as meat, fish, or eggs) can make the
filtering work of the kidneys easier, she said.
However, while experts advise regulating protein and
phosphorus intake, its important to remember that
children do need enough protein for growth. Thus basic
protein should be allowed.
Treatment for kidney failure
Dr Robert Kalyesubula, a nephrologist at the Renal unit,
Mulago hospital says there are two forms of treatment
available in Uganda. We use dialysis to give the
patients life but it does not cure the disease, he says.
This is a process to remove waste products and extra
water from patients with chronic kidney failure. It can be
done by lining the childs abdominal cavity with a filter
and placing a tube containing sugar solution in the childs
belly, the solution then pulls wastes and extra fluid from
the blood.
It can also be done using a machine that carries the
childs blood through a tube to a dialyser, a canister that
contains thousands of fibre that filter out the wastes and
extra fluid. The cleaned blood is then returned to the child
through a different tube.
The high cost
This procedure is costly in terms of time and money. Its
done three times a week for four hours and costs between
Shs350,000- Shs450,000 per visit, which most patients
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Continued from page 65- Cases of Kidney Disease in
Children on the Rise
can not afford, Dr Robert Kalyesubula, a nephrologist
says. However, the dialysis can only prolong the
patients time as it doesnt guarantee cure. But without
it, patients will eventually die.
Aside from having very few experts in the country to
deal with the disease, Mulago hospital, Panaroma
Medical Centre and Case clinic are the only facilities
that offer dialysis to patients with kidney failure. Most
hospitals lack the necessary equipment to screen for
kidney disease. Doctors detect it in its advanced stages
and it becomes difficult to save the situation.
Transplant option+
Dr Odiit says, The other viable option is a transplant
where a healthy kidney is planted in the childs body.
Kidney transplant is very expensive. In India it
costs$15,000 (Shs36m), UK, 60,000 pounds (sh228m)
and in South Africa, $30,000 (shs72m).
This procedure largely depends on the availability of a
kidney donor with similar blood group and funds. The
experts advise that people who have transplants must
take drugs to keep the bodys immune system from
rejecting the new organ. These immune suppressive
drugs can help maintain good function in the
transplanted kidney for many years.
However, they may have some undesirable side effects
such as making a child vulnerable to infections. Stella
Nkanjako, a mother to Joel, a kidney disease patient,
says, she can only pray that God helps him survive the
disease. She says it has crippled her rather jolly son
since she can neither afford a dialysis nor a transplant.
For now, medics can only manage his condition with
pain killers and anti-hypertensive drugs to reduce the
fluids in the body. Mulago hospital registers 40-60 new
cases of kidney disease every Tuesday of the week.
Renal transplants are not performed in Uganda. Most
patients who can afford the transplants seek medication
in India, South Africa and Nairobi of late.

Mercury is a common ingredient found in skin
lightening soaps and creams. It is also found in other
cosmetics, such as eye makeup cleansing products and
Skin lightening soaps and creams are commonly used in
certain African and Asian nations.
They are also used
among dark-skinned populations in Europe and North
Mercury salts inhibit the formation of
melanin, resulting in a lighter skin tone.
Mercury in
cosmetics exists in two forms: inorganic and organic.

Inorganic mercury (e.g. ammoniated mercury) is used in
skin lightening soaps and creams.
Organic mercury compounds (thiomersal [ethyl mercury]
and phenyl mercuric salts) are used as cosmetic
preservatives in eye makeup cleansing products and

Use, production and availability
In Mali, Nigeria, Senegal, South Africa and Togo, 25%,
77%, 27%, 35% and 59% of women, respectively, are
reported to use skin lightening products on a regular

In 2004, nearly 40% of women surveyed in China
(Province of Taiwan and Hong Kong Special
Administrative Region), Malaysia, the Philippines and the
Republic of Korea reported using skin lighteners

In India, 61% of the dermatological market consists of
skin lightening products.

Skin lightening products are manufactured in many
countries; for example, consumer protection agencies
Skin lightening products are manufactured in many
countries; for example, consumer protection agencies
in the European Union

and the United States of
America (USA)

have identified mercury-
containing products made in China,

Dominican Republic,




the Philippines,


the USA.

Mercury-containing skin lightening products are
available for sale over the Internet. A 2011 survey
funded by the German Federal Ministry for the
Environment, Nature Conservation and Nuclear
Safety noted that individuals from Brazil,
Kyrgyzstan, Mexico and the Russian Federation
believe that mercury-containing skin lightening
products are easy to obtain.

Some manufacturers are no longer using mercury as a
preservative in mascara and eye makeup cleansing
products as a result of consumer pressure. However,
most jurisdictions still allow the sale of makeup
products containing mercury compounds.

Products, packaging and ingredients
Skin lightening products come in different forms,

Continued on page 67

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Continued from page 66 - MERCURY IN SKIN
including soaps and creams; the soap is often sold
as antiseptic soap.

These products are supposed
to be applied to the skin to dry overnight.

use the soap to wash their hair, arms or face or their
entire body.

It is reported that some women use
these products for as long as 20 years

The soaps come in bar form and are sold
individually in boxes.
The creams are generally
packaged in tubes or jars.

The soaps contain
approximately 13% mercury iodide, and the
creams are composed of 110% mercury
Some soap products tested contained
mercury at concentrations up to 31 mg/kg, whereas
cream products had mercury concentrations as high
as 33 000 mg/kg.

Products with very high levels of mercury
contamination look grey or cream coloured.

The amount or concentration of mercury in a
product may be labelled on the packaging or in the
ingredient list. Names to look for include mercury,
Hg, mercuric iodide, mercurous chloride,
ammoniated mercury, amide chloride of mercury,
quicksilver, cinnabaris (mercury sulfide),
hydrargyri oxydum rubrum (mercury oxide),
mercury iodide or poison; directions to avoid
contact with silver, gold, rubber, aluminum and
jewellery may also indicate the presence of

However, companies selling products
that contain mercury, do not always list it as an
Health effects and how to measure exposure

The main adverse effect of the inorganic mercury

contained in skin lightening soaps and creams is
kidney damage.

Mercury in skin lightening
products may also cause skin rashes, skin
discoloration and scarring, as well as a reduction in
the skins resistance to bacterial and fungal

Other effects include anxiety,
depression or psychosis and peripheral

The medical literature reports specific instances of
individuals suffering from the aforementioned
health effects following exposure to mercury
through skin lightening creams and soaps. One case
report describes a 34-year-old Chinese woman who
developed nephrotic syndrome, a condition marked
by high levels of protein in the urine. The mercury
levels in her blood and urine returned to normal one
month and nine months, respectively, after she
stopped using the skin lightening cream.

One study indicated a large proportion of nephrotic
syndrome among African women using ammoniated
mercuric chloridecontaining skin lightening creams
for periods ranging from one month to three years.
Over three quarters of the women who stopped using
the creams went into remission.

Mercury in soaps, creams and other cosmetic
products is eventually discharged into wastewater.
The mercury then enters the environment, where it
becomes methylated and enters the food-chain as the
highly toxic methylmercury in fish. Pregnant women
who consume fish containing methylmercury
transfer the mercury to their fetuses, which can later
result in neurodevelopmental deficits in the

Exposure to inorganic mercury can be quantified
through measurements in blood and urine.

Distribution of mercury-containing creams and soaps
is banned in the European Union and numerous
African nations.

A European Union Directive specifies that mercury
and mercury compounds are not allowed as
ingredients in cosmetics (including soaps, lotions,
shampoos and skin bleaching products). However,
phenyl mercuric salts for use as a preservative in eye
makeup and eye makeup removal products are
allowed at concentrations equal to or less than
0.007% by weight.

The United States Food and Drug Administration
allows mercury compounds in eye area cosmetics at
concentrations at or below 65 mg/kg expressed as
mercury (approximately 100 mg/kg expressed as
phenylmercuric acetate or nitrate).

All other
cosmetics must contain mercury at a concentration
less than 1 mg/kg. The presence of mercury must be
unavoidable under good manufacturing practice.

Health Canadas draft guidance on heavy metal
impurities in cosmetics specifies a limit of 3 mg/kg
for mercury as an impurity in cosmetic products.

The Philippines is reported to have banned skin

lightening products with mercury levels exceeding
the national regulatory limit of 1 mg/kg in 2011.

Mercury-containing skin lightening products are
hazardous to health and as a result have been banned
Continued on page 68

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Continued from page 67- MERCURY IN SKIN
in many countries. However, there are reports of such
products still being available to consumers, and they
are advertised on the Internet. For example, the Texas
Department of State Health Services reported the
availability of a mercury-containing beauty cream on
1 September 2011.

Public awareness needs to be raised regarding the
types of products and the specific products that
contain mercury and the risks associated with
mercury exposure.
The 2011 survey described previously states that
Consumers gravitated to known mercury-free
choices in countries that had government seals and/or
regulation about mercury content.

Information on alternatives must also be provided,
because skin lightening products that do not contain
mercury may contain other hazardous substances.
Regulatory body Limits for cosmetics
other than eye area
European Union Banned

Many African nations

United States Food and Drug
< 1 mg/kg

Health Canada
3 mg/kg

Philippines Food and Drug
1 mg/kg

Regulatory body Limits for eye area
European Union
0.007% by weight

United States Food and Drug
65 mg/kg expressed
as mercury
(approximately 100
mg/kg expressed as
phenylmercuric acetate
or nitrate)

12. UNEP (2008). Mercury in products and wastes. Geneva,
United Nations Environment Programme, Division of
Technology, Industry and Economics, Chemicals
1. Glahder CM, Appel PWU, Asmund G (1999). Mercury in
soap in Tanzania. Copenhagen, Ministry of Environment
and Energy, National Environmental Research Institute
(NERI Technical Report No. 306;
2. Ladizinski B, Mistry N, Kundu RV (2011). Widespread use
of toxic skin lightening compounds: medical and psycho-
social aspects. Dermatologic Clinics, 29:111123.
3. UNEP/WHO (2008). Guidance for identifying populations
at risk from mercury exposure. Geneva, World Health
4. Lindsey K, Balagizi I, Hirt HM (2009). Be black and
beautiful. Winnenden, anamed international. New York
City Department of Health and Mental Hygiene (2011).
Mercury in soaps and creams. New York, NY, Department
of Health and Mental Hygiene
5. McKelvey W, Jeffery N, Clark N, Kass D, Parsons PJ
(2011). Population-based inorganic mercury
biomonitoring and the identification of skin care products
as a source of exposure in New York City. Environmental
Health Perspectives, 119(2):203209.
6. Engler DE (2005). Letter to the editor: Mercury
bleaching creams. Journal of the American Academy of
Dermatology, 52(6):11131114. Continued on page 60
7. IPCS (2003). Elemental mercury and inorganic mercury
compounds: human health aspects. Geneva, World Health
Organization, International Programme on Chemical
Safety (Concise International Chemical Assessment
Document 50;
8. ATSDR (1999). Toxicological profile for mercury. Atlanta,
GA, Agency for Toxic Substances & Disease Registry
9. WHO (2007). Exposure to mercury: a major public health
concern. Geneva, World Health Organization (Preventing
disease through healthy environments series;
10. Al-Saleh I, Al-Doush I (1997). Mercury content in skin-
lightening creams and potential hazards to the health of
Saudi women. Journal of Toxicology and Environmental
Health, 51(2):123130.
11. RAPEX (2007). The Rapid Alert System for Non-Food
Products, 2007 week 29, No. 22, Reference 0732/07
14. RAPEX (2009). The Rapid Alert System for Non-Food
Continued on page 69

69-- Traditional African Clinic February/March 2013

Continued from page 68- MERCURY IN SKIN
Products, 2009 week 49, No. 8, Reference 1625/09
15. RAPEX (2009). The Rapid Alert System for Non-Food
Products, 2009 week 28, No. 3, Reference 0954/09
16. RAPEX (2009). The Rapid Alert System for Non-Food
Products, 2009 week 28, No. 3, Reference RAPEX
(2009). The Rapid Alert System for Non-Food Products,
2009 week 28, No. 3, Reference 0954/09

17. RAPEX (2006). The Rapid Alert System for Non-Food
Products, 2006 week 31, No. 13, Reference 0491/06
18. USFDA (2011). Import alert: Detention without physical
examination of skin whitening creams containing
mercury. Silver Spring, MD, United States Department of
Health and Human Services, Food and Drug
Administration (Import Alert No. 53-18;
17. RAPEX (2009). The Rapid Alert System for Non-Food
Products, 2009 week 49, No. 8, Reference 1625/09

18. RAPEX (2009). The Rapid Alert System for Non-Food
Products, 2009 week 28, No. 3, Reference

19. RAPEX (2009). The Rapid Alert System for Non-Food
Products, 2009 week 28, No. 3, Reference
20. RAPEX (2006). The Rapid Alert System for Non-Food
Products, 2006 week 31, No. 13, Reference 0491/06
21. USFDA (2011). Import alert: Detention without physical
examination of skin whitening creams containing
mercury. Silver Spring, MD, United States Department of
Health and Human Services, Food and Drug
Administration (Import Alert No. 53-18;
22. USFDA (2011). Import alert: Detention without physical
examination of unapproved new drugs promoted in the
U.S. Silver Spring, MD, United States Department of
Health and Human Services, Food and Drug Administration
(Import Alert No. 66-41;
23. RAPEX (2006). The Rapid Alert System for Non-Food
Products, 2006 week 24, No. 16, Reference 0356/06
24. Peregrino CP, Moreno MV, Miranda SV, Rubio AD, Leal LO
(2011). Mercury levels in locally manufactured Mexican skin-
lightening creams. International due-to-mercury-
25. Anonymous (2011). FDA bans skin whitening products due to
mercury content. The Manila Paper, 6 August 2011
Journal of Environmental Research and Public Health,
26. Market analysis of some mercury-containing products and
their mercury-free alternatives in selected regions.
Gesellschaft fr Anlagenund Reaktorsicherheit (GRS) mbH,
27. Weinberg J (2010). An NGO introduction to mercury(GRS-
253; pollution. International POPs Elimination Network
28. MDH (2011). Skin-lightening products found to contain
mercury. Minnesota Department of Health
29. Texas DSHS (2011). DSHS warns of mercury poisoning
linked to Mexican beauty cream. News release, 1 September
2011. Texas Department of State Health Services
30. Tang HL, Chu KH, Mak YF, Lee W, Cheuk A, Yim KF, Fung
KS, Chan HWH, Tong KL (2006). Minimal change disease
following exposure to mercury-containing skin lightening
cream. Hong Kong Medical Journal, 12(4):316318.
31. Barr RD, Rees PH, Cordy PE, Kungu A, Woodger BA,
Cameron HM (1972). Nephrotic syndrome in adult Africans
in Nairobi. British Medical Journal, 2(5806):131134.
32. IPCS (1991). Mercury-containing cream and soap. In:
Inorganic mercury. Geneva, World Health Organization,
International Programme on Chemical Safety
(Environmental Health Criteria 118;
33. USFDA (2000). Cosmetics: ingredients prohibited &
restricted by FDA regulations. Updated May 30, 2000. Silver
Spring, MD, United States Department of Health and Human
Services, Food and Drug Administration
Continued on page 70

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Continued from page 69 - MERCURY IN SKIN
34. IPCS (1991). Mercury-containing cream and soap. In:
Inorganic mercury. Geneva, World Health Organization,
International Programme on Chemical
Safety(Environmental Health Criteria 118;
World Health Organization 2011
For further WHO information on mercury, please visit:
Financial support for this publication was provided by the
German Ministry of Environment, Nature Conservation and
Nuclear Safety.

Continued from page 59- Mercury
general population is generally not exposed to levels high
enough to produce these effects.
People who eat fish containing organic mercury or grains
treated with organic mercury for a long time can have
permanent damage to the brain, kidneys, and the growing
fetus. The amounts of organic mercury that cause these
effects are higher than the amounts to which the general
population is exposed daily. Exposure to organic
mercury may cause brain damage in developing fetus.
Exposure to organic mercury is also dangerous for young
children because their nervous systems are more
sensitive to these compounds. Kidney effects occur in
animals exposed to low levels of organic mercury. Low
level exposure to organic mercury may also reduce the
ability of animals to have babies. However, no studies
are available to determine if this effect can occur in
There is no information to show that mercury causes
cancer in humans or animals. National Toxicology
Program (NTP), EPA, and the International Agency for
Research on Cancer (IARC) have not classified mercury
as to its human carcinogenicity.
Information excerpted from: Toxicological Profile for
Mercury October 1992 Draft Update, Agency for Toxic
Substances and Disease Registry United States Public
Health Service

Epidemiology of Acute Kidney
Injury in Africa
By Naicker S, Aboud O, Gharbi MB.
Semin Nephrol. 2008 Jul;28(4):348-53. doi:
Johannesburg Hospital, University of the Witwatersrand,
Johannesburg, South Africa. Saraldevi.Naicker@wits.ac.za
Acute kidney injury (AKI) is a challenging problem in
Africa because of the burden of disease (especially human
immunodeficiency virus [HIV]-related AKI in sub-Saharan
Africa, diarrheal disease, malaria, and nephrotoxins), late
presentation of patients to health care facilities, and the lack
of resources to support patients with established AKI in
many countries. The pattern of AKI is vastly different from
that in more developed countries. There are no reliable
statistics about the incidence of AKI in Africa. Infections
(malaria, HIV, diarrheal diseases, and others), nephrotoxins,
and obstetric and surgical complications are the major
etiologies in Africa. AKI in hospitalized antiretroviral
therapy (ART)-naive HIV-1-infected patients is associated
with a 6-fold higher risk of in-hospital mortality. The most
common risk factors are severe immunosuppression (CD4
count, <200 cells/mm(3)) and opportunistic infection. The
most common causes are acute tubular necrosis and
thrombotic microangiopathy. In the post-ART era, HIV-1-
infected patients with AKI still have an increased risk of in-
hospital mortality and these episodes of AKI seem more
frequent in the first year of ART. Subsequently, survival is
comparable in those with and without HIV infection. More
resources are required to prevent AKI and to provide renal
support for those patients requiring dialytic therapy.

Side Effects of Antiretroviral
Treatment: HIV and Kidney
Disease (AIDS 2010)
By Abby Horstmann and Caitlin McHugh
August 27, 2010
People with HIV should be screened regularly for kidney
disease because even slight kidney damage can lead to an
increased risk of heart problems, according to a presentation
Continued on page 71

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Continued from page 70 Side Effects of Antiretroviral
Treatment: HIV And Kidney Disease (AIDS 2010)
at the 2010 International AIDS Conference in Vienna,
Dr. Mohamed Atta, an Associate Professor of Medicine
in nephrology at the Johns Hopkins School of Medicine
and medical director of the Dialysis Center at DaVita
Health Care in Baltimore, spoke about kidney
complications and deferred versus early HIV treatment
at a session on side effects of antiretroviral therapy.
Kidney disease is a common problem in HIV-positive
adults, with chronic kidney disease affecting an
estimated 15 percent to 20 percent of people with HIV.
Kidney damage can be caused either by HIV itself if
left untreated, which is called HIV-associated
nephropathy (HIVAN), or by antiretrovirals used to
treat HIV.
Both types of kidney damage are worrisome because
studies have shown that even slight kidney malfunction
is a significant predictor of heart complications and
death due to heart disease.
When investigators actually started looking at the best
predictor of cardiovascular outcome, it was
microalbuminuria, said Dr. Atta. Microalbuminuria is
the presence of a small amount of a protein, called
albumin, in the urine and is an early sign of kidney
Protein in the urine is often a sign of kidney
malfunction. Studies have found that even the smallest
indication of protein in the urine is associated with
increased heart failure and mortality, regardless of HIV
Treatment and prevention of kidney disease depends on
its cause. HIV-associated nephropathy is usually a sign
that HIV has progressed to the point that antiretroviral
treatment is needed. It rarely shows up in people who
do not have advanced HIV infections.
We showedthat patients [with HIVAN] who were
treated with antiretroviral therapy have better [kidney]
survival versus those who were not treated with
HAART [highly active antiretroviral therapy]. This is
why now the guidelines recommend that HIVAN is an
indication to start HAART, said Dr. Atta.
However, there is some evidence that antiretroviral
therapy itself can also lead to kidney damage. Crixivan
(indinavir) has been associated with formation of
kidney stones. Viread (tenofovir) has also been linked
to kidney damage, although the reason for the damage
is not yet clear.

Dr. Atta also discussed a recent European study that
found an association between chronic kidney disease and
use of Viread, Crixivan, Reyataz (atazanavir), or Kaletra
The potential for antiretrovirals to cause kidney damage
leads to the question of whether treatment should be
delayed to help spare the kidneys.
In my mind, as a nephrocentric [kidney-focused] person,
the deferred treatment carries the risk of heightened HIV-
associated nephropathy; the early treatment is associated
with heart toxicity and metabolic derangement, said Dr.
In the end, he said, There is no evidence of benefit from
the [kidney] standpoint of early HIV treatment unless it
is necessary to treat HIVAN. However, he said, HIVAN
is usually a late manifestation of HIV.
Dr. Atta concluded by stating that physicians should
screen all HIV patients for kidney function, whether
taking antiretrovirals or not, and that high-risk patients
should be monitored for kidney disease on a regular basis.

Kidney Dialysis
By Dr Andrew Stein
Dialysis, from the Greek word meaning to separate, is a
technique that separates the good and bad things in
the blood; then cleans the bad wastes from the body. This
is usually the function performed by the kidney.
What is dialysis?
Healthy kidneys clean the blood by removing excess
fluid, salt and wastes. When they fail, harmful wastes
build up, blood pressure may rise, and the body may
retain excess fluid. When this happens, treatment
dialysis or a kidney transplant - is needed to replace the
work of the failed kidneys, which is known as end-stage
renal failure (ESRF).
There are two main types of dialysis in ESRF:
Peritoneal dialysis
Each provides about five per cent of the function of two
normal kidneys.
Haemodialysis (HD) is the most common method used to
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Continued from page 71 Kidney Dialysis
treat ESRF and has been available since the 1960s.
Despite some advances in dialysis machines in recent
years, HD is still a complicated and inconvenient
therapy requiring a coordinated effort from a large
healthcare team, including:
Nephrologist (kidney doctor)
Dialysis nurse
Dialysis technician
Social worker
One important step before starting HD is a small
operation to prepare a site on the body. One of the
arteries in your arm is re-routed to join a vein, forming
a fistula. Blood is removed from the fistula, cleaned and
returned to it, allowing dialysis process to take place.
Needles are inserted into a fistula (the point of access to
the bloodstream) at the start of HD. You may find this
one of the hardest parts, although most people report
getting used to them after a few sessions. If its painful,
an anesthetic cream or spray can be applied to the skin.
In HD, blood is allowed to flow, a small amount at a
time, through a special filter (the dialyser or artificial
kidney) that removes wastes and extra fluids. The clean
blood is then returned to your body via the fistula. This
helps to keep the correct amount of water in the body,
control blood pressure - and keep the proper balance of
chemicals such as potassium, sodium and acid.
Most people have HD three times a week for three to
five hours, with a morning, afternoon or evening slot;
depending on availability and capacity at a dialysis unit,
usually in a large hospital. Some receive it at a smaller
satellite unit nearer home, and a few have HD in their
own homes.
By learning about the treatment, and working with your
healthcare team, its possible to have a full, active life.
Peritoneal dialysis
Peritoneal dialysis (PD) became an alternative to HD in
the 1980s, with many preferring the independence it
brings them. It means you dont have to have dialysis
sessions at a unit, but can give treatments at home, at
work or on holiday. Like HD, by learning about the
treatment, and working with the medical team, its
possible to have a full and active life.
In PD, a soft tube called a catheter is used to fill the
abdomen with a cleansing liquid called dialysis
The abdominal cavity is lined with a layer called the
peritoneum. Waste products and extra fluid (and salt) then
pass through the peritoneum from the blood into the
dialysis solution. They then leave the body when the
dialysis solution is drained. This used solution is then
thrown away.
The process of draining and filling is called an exchange
and takes about 30 to 40 minutes. The period the dialysis
solution is in the abdomen is called the dwell time. A
typical schedule is four exchanges a day, each with a
dwell time of four to eight hours.
There are many forms of PD. One doesnt even require a
machine and its possible to walk around with the dialysis
solution in your abdomen. Talk to your specialist about
whats best for your particular situation.
Whatever form is chosen, an operation is needed to have
the soft catheter placed in the abdomen, which will carry
the dialysis solution in and out of the abdomen. Its
usually inserted two weeks before dialysis proceeds, to
allow scar tissue to build up that will hold it in place.

Patient killed by Rabies from
Organ Transplant, CDC says
By Maggie Fox
March 16, 2013
Rabies killed a patient who got a kidney transplant more
than a year ago, federal officials said Friday. Now they
are treating three other people who got a second kidney, a
heart and a liver from the same patient who apparently
died either of undiagonosed rabies, or who had the virus
without showing any symptoms.
The donor died in Florida, and the heart, kidneys and liver
from the patient were transplanted into three other people,
the Centers for Disease Control and Prevention said.
Doctors did not suspect rabies killed the donor and did
not test for the virus, the CDC said. "Rabies was only
recently confirmed as the cause of death after the current
investigation began in Maryland," the CDC said.
"Shortly before becoming ill, the donor had moved to
Florida, but was a previous resident of North Carolina
where it is believed the exposure may have
occurred. How the donor may have gotten rabies is
currently under investigation," the CDC said in a
Continued on page 75

73-- Traditional African Clinic February/March 2013

African Traditional Herbal Research Clinic
Volume 8, Issue 2 NEWSLETTER February/March 2013
Kidney Failure: Causes, Treatment and Prevention
28 July 2009
The Kidneys are two bean-shaped organs located close to
the back. Although this pair of organs is relatively small,
they are responsible for ensuring that the blood circulating
in our body is free from harmful organisms, waste
products and excess water. Your kidneys work extra hard
to ensure your continued well-being. Every day, 20% of
the blood pumped by the heart or approximately 200
quarts of blood passes through your kidneys for cleansing
purposes. Every day, at least 2 quarts of unwanted waste
materials are sifted from the blood before it is even
allowed to return to general circulation.
Each of these tiny organs is composed of about a million
tinier units called "nephrons". Inside these nephrons, a
tiny blood vessel ("glomerulus") is intertwined with a tiny
urine-collecting tube (tubule). As blood passes through
these nephrons, a complex interaction occurs between the
glomerulus and the tubule which results in the elimination
of wastes in the blood. These waste materials then enter
the urinary tract and end up being excreted in the urine.
Aside from sifting the unwanted materials from the blood,
the kidneys also take charge of the following functions:
Regulation of the composition of the blood.
Maintenance of the ideal concentrations of vital
substances and ions in the blood
Sustaining the proper volume of water in the body
Eliminating toxic wastes from the body
Maintaining the acid-base concentration of the blood
Normalizing blood pressure
Promoting the production of red blood cells
Maintaining the ideal calcium level in the body
Despite the numerous tasks performed by the kidneys to
ensure our safety, it is sad to note that there are a lot of
people who neglect to take care of their kidneys properly.
World Health Organization (WHO) statistics reveal that
the death rate from intrinsic kidney and urinary tract
disease was one million in the year 2002; ranking twelfth
on the list of major causes of death In sub-Saharan
Africa, and indeed also in Nigeria, hypertension and
diabetes mellitus are among the leading causes of end-
stage renal disease. By 2020, the burden of diabetes and
cardiovascular disease will have increased by 130% in
Africa alone.
This refers to diseases that damage the glomeruli
structures (inflammation) within the kidney
responsible for the filtration in the kidneys. Diseases
that are not properly treated help the body to produce
antibodies and the kidneys in a bid to deal with them
may get overburdened.
Analgesic Nephropathy
This does damage to the kidneys as a result of wrong
or misuse of analgesics without proper prescription
over a long time. Bleaching Creams and soaps
containing heavy metal (mercury) may overburden
the kidneys.
Polycystic Kidney Disease
An inherited kidney disease that causes large fluid
filled cysts to develop in the kidney. These cysts
may eventually crowd out normal kidney tissues,
thus reducing its effectiveness or even or even cause
its functions to cease. Other diseases may include:
Sickle Cell Disease
Through reduced blood flow and oxygen, which will
stress kidney functioning.
Drug Nephropathy
Damage to the kidneys because drugs and use of
medications have destroyed the kidneys.
Indiscriminate use of anti-malaria drugs can damage
the kidney.
Continued on page 74

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Continued from page 73 Kidney Failure: Causes,
Treatment and Prevention
Other Causes
Kidney disease also has other causes, which
include collagen vascular disease such as lupus,
cancer, congenital defects.
Kidney failure may show no symptoms until it reaches
an advanced stage. However, some identified causes
Is the leading cause of kidney failure in Nigeria.
This refers to a higher than normal amount of
blood pressure. It may cause no symptoms until it
is advanced. This is why it is often referred to as a
silent killer. Because hypertension causes no
symptoms and medications are expensive and may
cause unwanted side effects, many find
compliance with required treatment difficult and
this further compound the problem of
hypertension related kidney disease.
This is the second leading course of kidney failure
in Nigeria. This in general means that blood
glucose levels are excessively high.
Type I diabetes occurs when the body's immune
system destroys the insulin producing cells in the
pancreases. Type II diabetes, the body does not
make enough insulin or cannot use insulin
Tiny amounts of proteins in urine are an early sign
of kidney damage in patients with diabetes.
This is fast becoming one of the major causes of
kidney failure in Nigeria. HIV/AIDS will increase
load on the kidneys and may lead eventually to its
So, what can we do to prevent this from happening?
We need to start taking care of our health and to pay
attention to our kidneys as well. To avoid developing
kidney troubles, it is therefore necessary to maintain a
healthy lifestyle. You may start by considering the
following tips:
A kidney transplant, which costs at least N4.5 million,
provides the patient with a healthy kidney from a
donor but it often requires a lot more in terms of
finances. When donors (which so far in Nigeria have
been living relatives, spouses or friends) is found, their

suitability for surgery is determined and they are tested to
determine if their blood suitability for surgery is
determined and they are tested to determine if their blood
type and other issue factors match the patients. Some of
these investigations are done abroad and this helps to
compound the cost of the surgeries. After the surgery,
transplant patients must take immunosuppressant drugs,
which keep their bodies from fighting and destroying the
transplanted organ and these drugs must be taken for life
with a combination of other drugs, which are usually not
in stock by regular pharmacists due to their high cost.
When required, they are often imported specially for the
patients' use.
Natural Remedies
Protein is restricted to decrease the protein load on the
kidney and slow down the progression of kidney disease.
Sodium may be restricted to improve blood pressure
control and to avoid fluid accumulation.
Potassium is restricted if it is not excreted effectively and
levels in the blood are high. When you have too much
potassium in your blood, dangerous heart rhythms may
When you have kidney failure, the amount of urine your
body produces may decrease. The amount of fluids you
can drink each day is based on the amount of urine you
produce in a 24-hour period. Other considerations on
whether fluid must be restricted are the amount of fluid
you retain, the level of sodium in your diet, whether you
use diuretics, and whether you have congestive heart
Your diet will determine whether you survive kidney
disease or not. Limit the amount of sodium [salt, common
in canned food, fast-foods, processed cheese, and smoked
meats. Instead, use lemon, herbs, and other spices to
improve the flavor of your meals.
Kidney patients should limit the amount of protein they
eat. Learn about the sources of protein. Most people know
that meats, fish, and dairy products contain protein. They
may not know that foods such as breads, cereals, beans
and vegetables also contain protein. As a general rule,
avoid processed food. Keep away from milk, yogurt, or
ice cream. Avoid nuts, peanut butter, seeds, lentils, peas,
and beans. Avoid drinks such as beer, cola drinks, and
cocoa. Since the kidney is a sensitive organ in the body,
consult your health care provider for prescription of
herbal remedies. Self-medication could be fatal.
1. Drink plenty of fluids.
We've all heard that drinking eight to ten glasses of water
each day promotes better health, but do you know why?
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Continued from page 74 Kidney Failure: Causes,
Treatment and Prevention
Although the kidneys act as more of a filter than a
reservoir, toxins can build up if there isn't enough
water pressure to push them through to the urinary
tract for excretion
2. Avoid caffeine.
Don't get hooked on drinking multiple cups of
caffeine beverages each day. Your kidneys will be
forced to work harder and pump out fluid and a
toxin when they become dehydrated by caffeine's
purging effect and more active by its metabolism-
boosting powers. If you find that you are urinating
several times a day more than you used to, try
cutting back on caffeine products to see if that
helps. Too much caffeine isn't good for your body
in many ways, and kidney stress is one of them.
3. Cut back on bumpy road rides.
Long-distance truck drivers may have a higher
incidence of kidney bruising or damage than people
in other occupations. Until the possible link is
confirmed or disproved, try to take long rides in
comfortable seats, and stop for frequent breaks to
get out of the vehicle and stretch your legs, which
will be good for your back as well as your kidneys
and other organs.
4. Eat cleansing foods.
Nigeria is full of good, nourishing foods. Water
melon juice helps to reduce bacteria in the urinary
tract by keeping it from sticking to tissues where it
can build up and cause an infection. A few glasses
of this refreshing beverage each week might be
enough to promote better kidney health. Some
practitioners claim that white rice is a good food
for cleansing the body. You may want to include
this in your diet on occasion, as well.
You will feel better about taking control of your
health when you use tips like these to protect your
5. Treatment
The typical renal patient has a 3 to 5 hour dialysis
treatment; three times per week and dialysis can
only replace only about 10% to 15% of the function
of healthy kidneys. In Nigeria, each session of
dialysis treatment will cost an average of N25,
000.00 (twenty- five thousand naira) or N75, 000
per week or N900, 000 per year, a cost much more
than the average Nigerian worker can bear.
The incidence of kidney disease cuts across most ages
and the prevalence is among patients aged between 20

and 50 years. This means that a significant number falls
within the working population and may pose a serious
threat to the future of Nigeria's economy. This means that
something must be done now. All hands must be on deck
to offer solutions to this problem.
Kidney failure or end stage renal disease is becoming a
major issue in Nigeria due to increase in its incidence.
Available statistics indicate that kidney failure is
increasing world -wide by approximately 7% annually and
incidence in Nigeria could be as high as 10 per million

Continued from page 72 Patient killed by Rabies
from Organ Transplant, CDC says
The agency is not naming any of the patients involved.
"In 2011, the donor became ill and was admitted to a
healthcare facility in Florida and then died. At that time,
the donors organs, including the kidneys, heart, and liver,
were recovered and sent to recipients in Florida, Georgia,
Illinois, and Maryland," the CDC said.
Potential organ donors in the United States are screened
and tested for viruses, bacteria and other infections. But
rabies isn't one of the usual microbes that is tested for, in
part because the test takes too long and in part because
rabies is so rare in people.
People can become infected with rabies without knowing
it. It is transmitted in saliva -- which is why animal bites
are dangerous -- and blood. But vaccination after a bite can
prevent symptoms. Once a patient develops symptoms
from rabies, it is almost always fatal.
Bats are the most common cause of rabies infection, while
raccoons, skunks, and foxes are the most commonly
reported rabid animals.
"CDCs preliminary laboratory analysis indicates that the
recipient and the donor both had the same type of rabies
virusa raccoon type. This type of rabies virus can infect
not only raccoons, but also other wild and domestic
animals. In the United States, only one other person is
reported to have died from a raccoon-type rabies virus,' the
CDC said. Genetic testing can reveal what strain of virus
has infected someone and advanced testing that looks for
genetic mutation scan show whether someone was directly
infected by someone else.
"The three other people who received organs from the
donor have been identified and are currently being
evaluated by their healthcare teams and receiving rabies
anti-rabies shots (immune globulin and anti-rabies
vaccination)," the CDC said. Continued on page 76

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Continued from page 75 Patient killed by Rabies from
Organ Transplant
"CDC is working with public health officials and
healthcare facilities in five states (Fla., Ga., Ill., Md.,
and N.C.) to identify people who were in close
contact with the initial donor or the four organ
recipients and might need rabies post-exposure
treatment," the agency says.
Doctors perform 40,000 organ transplants annually
worldwide. In 2011, a team at Northwestern
Universitys school of medicine estimated that fewer
than 1 percent of all organ transplants also
transmitted an infection.
More than 28,000 organ transplants are performed in
the U.S. each year, while more than 114,000 people
are waiting for organ transplants, according to the
United Organ Sharing Network. In 2011, 6,669
people died waiting for organ transplants.
Organ donors are routinely tested for hepatitis
viruses, HIV, a virus called HTLV that can cause
leukemia, the syphilis bacteria, West Nile virus and
the parasite that causes Chagas disease. But other
infections have been transmitted by organ, tissue and
other transplants including the deadly brain
disease called Creutzfeldt Jakob disease or CJD;
herpes, cytomegalovirus and a variety of bacterial
and fungal infections.
Rabies is also known to have been transmitted both
by cornea transplants and organ transplants most
recently a batch of three organ recipients treated at
Baylor University in Texas in 2004. Officials ended
up treating hundreds of people who had been in
contact with the organ donor and the recipients.
But last August, Melissa Greenwald, chief of the
Tissue and Reproduction Branch at the Food and
Drug Administration raised concerns about the lack
of a systematic protocol for testing organs and tissue
used for transplant.
Disease transmission through organ and tissue
transplantation has been documented. Recognizing
emerging infectious diseases in organ and tissue
transplantation is challenging because of
nonstandardization of donor evaluations and data
collection, pathogen characteristics, and recipient
surveillance, Greenwald and colleagues wrote in
Emerging Infectious Diseases.
Because organs, cells, and some tissue grafts cannot
be subjected to sterilization steps, the risk of
infectious disease transmission remains and thorough
donor screening and testing is especially important.

Organ recipients are especially vulnerable because theyve
usually been ill for a long time, and then must take drugs to
suppress their immune systems so their bodies will tolerate
the donated organ.

Political Mafias behind Human
Organ Trafficking
By Isa Ssenkumba
03 February 2011
When a man wants to murder a tiger he calls it sport, and
when the tiger wants to murder him he calls it ferocity. So
the distinction between crime and justice is no greater. And
now when a man plans to murder a fellow man he calls it
This automatically places murder among man's economic
activities. Human trafficking and sacrifice has become a
lucrative business. In fact international trafficking of body
parts is the fastest growing business of organized crime
fetching about $7 billion.
Traffickers have turned Uganda into a gangster paradise. In
2007 the US placed Uganda on its watch list of countries
dogged by human trafficking and we qualified to fall in
'Tier 2'.
The Uganda Youth Development Link established that
Ugandan children were being exchanged for guns and
medicine in Kenya. Most of the victims are taken for
marriage, sacrifice, cross border trade, domestic servitude,
sex slaves or used to claim government benefits.
A UK based charity AFRUCA - Africans Unite against
Child Abuse estimated that between April and December
2009 over 200 Africans had been victims of human
trafficking. These are mainly children from Nigeria, Sierra
Leone, Kenya, Ghana, Zimbabwe, Uganda, Somalia and
Human body organs are highly demanded and people are
ready to pay handsomely for these organs that include
kidneys, lungs, hearts, liver, pancreases and many others.
Victims of trafficking for purposes of organ removal are
often recruited from vulnerable groups especially those who
live in extreme poverty.
Organized crime groups lure people abroad under false
promises and jobs that never materialize and later convince
them to sell their organs.
Victims are required to take oaths of allegiance, secrecy
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Continued from page 76- Political Mafias behind Human
Organ Trafficking
and confidentiality to bind them to their traffickers. This
means that the trade is shrouded by a code of silence
where people are fearful of speaking out allowing the
practice to continue with little or no consequences for
the perpetrators.
In the US the federal law makes it illegal to buy and sell
human body parts but private companies are actively
but silently involved in the business. In Los Angeles a
man accused of buying and selling human parts
confessed in court having made $1.5 M through
trafficking human organs in 2009.
Through his donations to the University of California
Medical School he managed to conspire with the school
official when they realized that the scheme was
profitable. People reportedly involved in this organized
crime network always include brokers, surgeons,
hospitals directors, doctors, ambulance drivers,
mortuary workers and politicians.
Medical and healthcare practitioners have received
patients who go to hospitals for unrelated illnesses or
accidents but the person's kidney is removed without
their knowledge or consent.
Organs are also removed from people who have been
declared brain dead prematurely especially after a fatal
accident Sometimes a person's death may be quickened
in order to get the organs from the person. The kidnaps,
killings and sale of people for purposes of organ
removal is a silent undertaking by mafia politicians.
Mysterious disappearance of citizens and arrests made
during strikes or political violence are linked to this
human organ trade from which politicians are the major
beneficiaries. If a relative permanently disappears after
a political strike he may have fallen victim of human
organ trafficking.
The Human Rights League in Mozambique and Child
Line South Africa attach the increasing trafficking of
human body organs to the cultural beliefs that human
organs make the medicine more effective and it can
solve any problem from poverty to health issues. Witch
doctors always assign people with the duty of looking
for human body parts.
These parts are also used to ensure business prosperity
like in the mills, constructions and other businesses. On
5th May 2010 a 12 year old boy was mutilated in
Mozambique. His genitals and eyes were removed. The
attackers confessed having been promised a pay of $
266 if they brought the boy's parts that were to be
transported to Malawi.
Patrick Makonzi in Uganda decided to chop the head off
his 12 year old nephew Eriya Kalule of Namusita village
in kamuli district to receive 50,000 Uganda shillings ($
People visit witch doctors who are said to communicate
directly with the spirit for help. Ritual murderers believe
that human sacrifice appeases these ancestral spirits. In
Uganda witch crafty is a business advertised over radios,
televisions and other media houses. Moreover this is
occurring at the peak of unemployment.
There is a need for countries to implement comprehensive
anti-trafficking legislations, increase efforts to prosecute,
convict and punish trafficking offenders, institute unified
systems of documenting and collecting data on human
trafficking cases for use by law enforcement.
Labour and social welfare officials should be investigated
and punish recruiters responsible for knowingly sending
Ugandan into forced labour abroad. A national wide anti-
trafficking public awareness campaign should be
launched with particular focus on forced labour, human
sacrifice and sale of human body parts.

Herbal Therapies and the
Patient with Kidney Disease
By Mariana S. Markell
The primary importance of the passage of urine for
maintenance of health was recognized by early students of
physiology, including Dioscorides and Pliny the Elder, 1st
century scholars with broad knowledge of medicinal
Dioscorides mentioned 12 plants which could be
used for treatment of diseases of the kidneys in his De
Materia Medica, while Pliny details 130 plants in his
famous treatise Naturalis Historia. Unfortunately, we have
not progressed much in our knowledge of the place for
botanical therapy in renal diseases since that time.
In this article, I will attempt to briefly review the main
function(s) of the kidneys, and then discuss the potential
hazards of using herbs in patients with compromised renal
function. Finally, I will discuss potential benefits which
could be derived from using herbs in this population and
the data (meager that it is) which supports my
Review of Kidney Function
The two kidneys, which together weigh 200 to 320 grams,
are truly the seat of homeostasis in the body. Kidney
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Continued from page 77- Herbal Therapies and the
Patient with Kidney Disease
damage leads to disorders, not only of salt and
water, but of blood and bone as well.
Kidney function
can be broken clown into several parts: control of salt
and water balance, filtration of solute, and
maintenance of acid-base equilibrium and endocrine
functions (see Table 1). Each function can be affected
separately by therapies or, in the case of disease or
toxic insult, all three may be affected.
Salt and Water Balance
The basic working unit of the kidney is the nephron,
which contains a tuft of capillaries, called the
glomerulus, and a system of tubules. Plasma is
ultrafiltered across the glomerular surfaces at a rate of
135 to 180 L/day, which would result in death by
dehydration if it were not largely reabsorbed. Initially,
the ultrafiltrate enters the first part of the tubules, the
proximal tubule, where 70% of the filtered water and
sodium are reabsorbed. Further regulation occurs at
the loop of Henle, where more sodium is reabsorbed
and finally, at the collecting system, the final
regulation of salt and water balance occurs. Sodium
can be reabsorbed in the cortical collecting duct until
almost none remains in the urine, and, under the
control of antidiuretic hormone (ADH), water can be
reabsorbed or allowed to remain in the ultrafiltrate,
resulting in either a concentrated or dilute urine.
Abnormal volume regulation is a major component of
most renal diseases, resulting in fluid overload with
secondary hypertension and, often, edema. Many
herbs which have been used historically to treat
diseases of the kidneys, including dandelion leaves
and/or root (Taraxacum officinale), bearberry
(Archtostaphylus uvaursi), parsley (Petroselinum
crispum), and broom (Cytisus scoparius) have diuretic
properties and probably function through alteration of
sodium reabsorption or ADH action. Interestingly,
dandelion root contains large quantities of inulin, an
insoluble carbohydrate which is cleared similarly to
creatinine (see below) and could act as an osmotic
diuretic. Broom is known to contain scoparin, a
glycoside which is believed to be responsible for its
diuretic action.

Filtration of Solute/Maintenance of Acid-Base
The glomerular capillary wall serves as a barrier
which determines which solutes are filtered. Filtration
is determined by size-selectivity, as well as ionic
Solutes smaller than molecular weight of 6,000 are
freely filtered, whereas those as large as albumin (or bound
to albumin) are not (M.W. 70,000), unless the glomerulus
becomes diseased. Filtration of highly negatively charged
substances, regardless of size, is retarded by electrostatic
repulsion due to the anionic charge on sialoproteins which
are present in the glomerular basement membrane and
epithelial foot processes. The glomerular filtration rate
(GFR) determines the clearance, not only of sodium, but
also of toxic waste products of metabolism including blood
urea nitrogen (BUN) and creatinine which, in addition to
filtration, undergoes active secretion at the proximal
Control of GFR is multifactorial, depending on the
hydrostatic pressure gradient within the glomerulus which
drives fluid out (and which in turn depends on renal
plasma flow rate), the plasma oncotic pressure, which
counteracts the hydrostatic forces, as well as surface area
of the glomerular capillary tuft and its permeability
characteristics. If any of these factors are altered, through
disease or administration of a drug or herb, the GFR will
fall, eventually leading to renal insufficiency and retention
of waste products.
The kidney plays an important role in maintenance of acid-
base balance. Ninety percent of filtered bicarbonate is
reabsorbed in the proximal tubule through a complex series
of steps involving active transport of hydrogen ions into
the lumen of the tubule. The remainder is reabsorbed in the
distal tubule and collecting duct. Anything which deranges
tubular function (substances which are toxic or cause
fibrosis) may cause acidosis through loss of bicarbonate in
the urine.
Control of potassium secretion occurs both in the distal
tubule and (predominantly) in the collecting duct.
Potassium secretion is mediated through the actions of the
adrenal hormone aldosterone which is under the control of
renin (see below) and serum potassium concentration.
Damage to the collecting tubules rendering them
insensitive to aldosterone, decreased aldosterone release
due to adrenal disease or deficient renin release and
decreased GFR all can cause hyperkalemia which can be
life-threatening. For this reason, it is imperative to AVOID
potassium-containing botanical products in patients with
known tendency toward hyperkalemia.
Conversely, overuse of diuretics can contribute to
hypokalemia through increased delivery of sodium to the
distal and collecting tubules.
The kidney also controls levels of phosphate, calcium
(both mediated in part via the actions of parathyroid
hormone), magnesium, uric acid and various amino acids
through complex mechanisms which are beyond the
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Continued from page 78 Herbal Therapies and the
Patient with Kidney Disease
scope of this article, but which, when deranged, can
lead to abnormal concentrations of these substances in
the blood and/or urine.
Endocrine Functions of the Kidney
The glomerular blood flow is under auto-regulatory
control via at least two substances: renin, released
from the juxtaglomerular apparatus, and
prostaglandins, which have important effects on
moderating regional renal blood flow. Renin, which is
stimulated in situations where renal blood flow is
decreased (decreased renal mass, hypotension, renal
artery stenosis, heart or liver failure, true volume
depletion) acts on renin-substrate to produce
angiotensin I, which is converted to angiotensin II via
angiotensin-converting enzyme (ACE). Renal
prostaglandins have many effects on kidney function,
which differ depending on the prostaglandin type
involved, and also serve to maintain GFR when renal
blood flow is compromised by preferentially shunting
blood to the renal cortex, which has the highest
concentration of glomeruli. The result is that any
substance, be it a pharmaceutical agent or herb, that
depresses either angiotensin conversion or
prostaglandin synthesis, can decrease renal function in
the settings of compromised renal function or severe
volume depletion.
The proximal tubule plays a role in the maintenance of
red cell volume and the conversion of vitamin D to its
active metabolite. Specialized tubule cells secrete a
hormone, erythropoietin, which stimulates the
erythroid progenitor cells of the bone marrow to
mature in response to anemia or hypoxia.
synthesis secondary to kidney disease results in
anemia, and requires replacement by the synthetic
recombinant hormone. Vitamin D (cholecalciferol),
following synthesis in the skin, undergoes 25-
hydroxylation in the liver, followed by conversion to
1,25-cholecalciferol in the proximal convoluted tubule
of the kidney. Synthesis of active vitamin D is
stimulated by parathyroid hormone and
hypophosphatemia and when it is insufficient,
hypocalcemia can occur, predominantly because of
deficient absorption from the intestine.
Treatment of Kidney Diseases
Diseases which affect the kidney are many and varied
(see Table 2), as can be surmised by its myriad
functions. Diseases of the glomerulus are either
glomerulonephritides, which may be accompanied by
blood in the urine, hypertension and inflammatory
response within the kidney and glomerulonephroses,
which are always accompanied by loss of protein into the
urine, often accompanied by hypertension and edema. The
former diseases usually result in a loss of kidney function
which may or may not be reversible, while the latter are
more variable in their effect on kidney function, but carry a
great morbidity due to accompanying hypoalbuminemia.
Diseases of the tubules are generally secondary to toxic
insult, ischemia or interstitial inflammation (interstitial
nephritis) which can follow exposure to pharmaceutical
agents, most commonly antibiotics and nonsteroidal anti-
inflammatory agents (NSAIDs). Diseases of the collecting
system tend to be infectious or neoplastic in nature, or
mechanical, such as obstruction by stone or blood clot.
Because the kidney is a highly vascular organ, diseases of
the blood vessels (vasculitides) can also affect the kidney,
compromising blood flow. Constriction of the blood
vessels leading to the glomerulus can alter kidney function,
as can decreased blood flow due to volume depletion,
sepsis, heart failure or other shock situations.
Unfortunately, traditional allopathic medicine has little to
offer once kidney disease occurs. Some glomerular
diseases are treated with highly toxic immunosuppressive
medications, but few respond. Most tubular diseases will
either get better on their own, or the patient will develop
end-stage renal disease (ESRD). Once ESRD occurs, the
patient is given an option of hemodialysis, which requires
attachment to a machine which passes the blood by a
dialysis membrane through which dialysate flows in a
counter-current direction. This requires on average, three
to four hours per session, three times weekly. The patient
may also undergo peritoneal dialysis, in which case a
special catheter is implanted into the patient's peritoneal
cavity and dialysate solution instilled and removed up to
six times daily. Neither hemo- nor peritoneal dialysis
restores the endocrine functions of the kidneys, which
requires the patient to take medications for maintenance of
calcium balance and avoidance of anemia. Finally, the
patient may undergo transplantation of a cadaveric or
living-donor kidney, which requires continuous
immunosuppression, but restores all of the functions of the
patient's native kidneys.
Until the 1960s, there was no treatment for ESRD and all
patients died from the buildup of toxic waste products
which accumulated in the blood. Since that time dialysis
and transplantation have become readily available in the
United States, but very few references are available which
address using herbal therapy to prevent progression of
kidney disease. In many areas throughout the world today,
however, including the Caribbean, South America and
most of Asia, dialysis is only available for the wealthy or
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Continued from page 79 Herbal Therapies and the
Patient with Kidney Disease
politically connected, and a strong tradition of
treating renal disease with herbal medicines exists.
Unfortunately for us, the treatments have been
known mostly to local shamans or practitioners of
traditional herbal medicine who closely guard their
Herbal Therapies
In a recent review of the data available on "Medline"
there were only seven references which appeared
upon cross-search in "kidney" or "renal" and "herbs."
Four of these references were negative and discussed
recent outbreaks of severe interstitial fibrosis in a
Belgian population following ingestion of a Chinese
"slimming herb" mixture.( 6, 7, 8) The other
references were published in Chinese journals and
hinted at the possibility of affecting not only
nephroses (see above) but also slowing the progress
of established kidney disease.( 9, 10) The dearth of
modern research stands in contrast to the interest
expressed historically by herbologists; in the
previously mentioned work by Pliny the Elder with
130 herbs and in a compendium of herbal medicines
published in 1931, no fewer than 99 herbs were listed
for the treatment of "kidney disorders or dropsy"
(edema). Even a recent review of the NAPRALERT
database revealed 28 herbs or classes or herbs with
purported "antinephritic" or "antinephrotoxic"
effects.( 11)
In the sections which follow, I will discuss specific
concerns which must be borne in mind when faced
with a patient with compromised kidney function as
well as potential areas of use for herbs in patients
with kidney disease. At this point, I would state that,
because of the complexity of the interplay of the
kidney and many other body systems, unless one has
been trained in nephrology, an herbalist or herbal
practitioner should NOT prescribe herbs for a patient
with renal insufficiency without discussion with the
patient's primary physician.
as potential areas of use for herbs in patients with
kidney disease. At this point, I would state that,
because of the complexity of the interplay of the
kidney and many other body systems, unless one has
been trained in nephrology, an herbalist or herbal
practitioner should NOT prescribe herbs for a patient
with renal insufficiency without discussion with the
patient's primary physician.
Potential Hazards of Using Botanicals in the
Patient with Renal Disease
As can be surmised from a review of peer-reviewed
literature, there have been no controlled research projects
focusing on the use of botanicals in the treatment of kidney
disease, at least in the English literature. Part of the
problem lies in the potential hazards of using botanicals in
this population (Table 3), which are unique to the patient
with renal impairment. Because the pharmacokinetic
characteristics of many herbal products are not readily
available, it is impossible to know whether the major route
of elimination is through hepatic metabolism or renal
excretion. In the latter situation, overdosing could occur
once the patient has developed renal insufficiency, because
of retention of metabolites or parent compounds.
Many patients with renal disease, especially those who
have received a kidney transplant, are on potent
medications. Any herb (or drug for that matter) which
affects the hepatic cytochrome p450 system, will alter the
level of the fungal immuno-suppressants, cyclosporine or
tacrolimus, with potentially disastrous results. Again, for
that reason, a transplant physician should always be aware
when an herb is administered to a transplant recipient, so
that drug levels can be monitored and doses adjusted if
Herbs can have direct toxicity for kidney tissue. The
aforementioned "Chinese herb nephropathy" is believed to
result from progressive fibrosis of the renal interstitium
believed to be secondary to aristolochic acid affecting
intrarenal DNA.
Herbs which have not been widely used,
or are used in high doses, should definitely be avoided in
the renal population. In addition, renal function could be
affected by changes in intrarenal autoregulatory
hemodynamics (see above), similar to the effects of
NSAIDS or angiotensin-converting enzyme (ACE)
inhibitors, resulting in loss of kidney function.
Theoretically, as some herbs may have anti-inflammatory
properties mediated through alteration of prostaglandin
synthesis, and even affect ACE inhibition, patients who
unwittingly take large quantities of herbs with these
properties might experience a decline in renal function.
It should be remembered that most renal patients are taking
a variety of pharmaceutical agents for blood pressure, and
often for blood glucose control. Any herb which might
potentiate the effects of the patient's medications, although
it may be beneficial in allowing the patient to taper
pharmaceutical agents, should be used with caution, and
with the knowledge of the patient's primary physician. This
is especially true in the case of patients with diabetes,
whose insulin requirements fall as uremia (kidney failure)
approaches due to the decreasing ability of the kidney to
metabolize insulin.
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Patient with Kidney Disease
As mentioned previously, patients whose kidneys are
failing or who are on dialysis often have a host of
electrolyte abnormalities. Many of the herbs which
have traditionally been used in the treatment of kidney
disorders have diuretic properties, and some (e.g.
dandelion leaf) are high in potassium. Ingestion of
licorice (Glycyrrhiza glabra) has been associated with
pseudo-hyperaldo-steronism, manifested by decreased
potassium levels, sodium and water retention and
It is imperative that patients taking
such herbs have serum electrolytes measured at routine
intervals in order to avoid potentially fatal hyper- or
A special concern of patients who are already on
dialysis is the unpredictable effect dialysis will have on
the clearance of the herb itself. Large substances
(M.W. 500 to 40,000 daltons) and charged smaller
substances are not cleared well by the dialysis
membrane and may accumulate, but smaller
substances, especially if they are water soluble, will be
rapidly cleared, leading to unpredictable plasma
Finally, patients who have received a kidney transplant
must be concerned not only with alteration of essential
drug metabolism but also with potential hepatotoxicity,
as the fungally derived immunosuppressants,
cyclosporine and tacrolimus, have hepatotoxic
properties, especially when administered at high
These patients should also be concerned with
any herb which might stimulate the immune system.
Although graft rejection occurs, for the most part
through alloantigen recognition and activation of
helper T-cells, B-cells and macrophages also play a
role in antigen presentation and theoretically herbs
such as Echinacea purpurea or Japanese mushrooms,
such as shiitake, maitake and reishi, could be
detrimental, especially in the immediate post-
transplant period.
Potential Benefits of Using Herbs in the Patient
with Renal Disease
Despite these concerns, I believe that botanical
products could produce tremendous benefit in the
patient with renal impairment/failure, if used
judiciously, and in conjunction with a sympathetic
allopathic kidney specialist. Table 4 lists areas in
which herbs might be of benefit. Table 5 lists specific
herbs which have been studied or have been reported
to have renoprotective effects.

As the progressive nature of many renal diseases is
believed to be secondary to inflammatory responses and
platelet activation,
herbs which act as anti-inflammatory
agents could have long-term beneficial effects. This is
believed to be the mode of action (if the preliminary data
can be reproduced) of the combination of Astragalus sp.
and Rehmannia glutinosa (Men-shen-ling) which has been
used to treat chronic glomerulonephritis in China.
herbs such as wintergreen contain methyl salicytate, which
has anti-inflammatory properties.

The herbs which have been traditionally used, as listed in
early herbals such as the 1931 A Modern Herbal of Mrs.
or the more "modern" herbals such as the CD-
ROM developed by Genusys
have unclear activity (if any). Theoretically,
herbs with ACE-inhibitory effects might be used to
decrease proteinuria, and other herbal preparations could
be used as adjunctive therapy for diabetes, such as those
used in diabetic patients without kidney disease
(see also
Case Report 2) or hypertension and hyperlipidemia,

which often accompany kidney disease.
Herbal therapies, including corn silk (Zea mays) and
marshmallow (Althea officinalis), which are used as
demulcents, and the aptly named gravel root (Eupatorium
purpureum) and stone root (Collinsonia canadensis), as
well as ellitory of the wall (Parietaria officinalis) which are
purported to have "anti-lithic" and diuretic properties, have
long been employed in the treatment of renal stones
These may have tremendous potential in the treatment of
these disorders. Unfortunately, the efficacy of these herbs
in the treatment of various stone disorders (calcium based
vs. uric acid vs. struvite) has not been systematically
studied, nor are the mechanisms of action known. In a rat
model, Verbena officinalis, Lithospermum officianale,
Taraxacum officianale, Equisetum arvense, Arctostaphylos
uva-ursi and Arctium lappa were found to have mild
antibacterial action and the ability to alkalinize the urine,
which resulted in solvent action on uric acid stones.
patients with stone disease accompanied by renal
insufficiency, it would probably be wise to avoid herbal
therapies because of uncertainty regarding the pharmaco-
compounds which undergo renal excretion (or they
wouldn't act on renal stones!).
For hemodialysis patients, botanical approaches may turn
out to be excellent substitute therapies in this population,
which requires multiple pharmaceutical agents with
frequent side effects. Adjunctive therapy for blood
pressure control (both for hypo- and hypertension),
improvement of uremic bruising via improvement of
capillary fragility using bilberry

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Continued from page 81 Herbal Therapies and the
Patient with Kidney Disease
(Vaccinium myrtillus) or other herbs rich in bio-
flavonoids, improvement or maintenance of energy
levels with adaptogens or identification of herbs
which enhance iron or calcium absorption might be
fruitful areas for research. One of my colleagues
reports that he has used150 mg of a standardized
(0.5% essential oils) extract of valerian root
(VaIeriana officinalis) to calm overly anxious
patients during hemodialysis and allow them to
complete the procedure without the drowsiness
which occurs following benzodiazepine use.
In renal transplant recipients, I have successfully
used bilberry extract (see Case Report 1) for the
treatment of prednisone-associated bruising.
Cyclosporine-treated patients are at increased risk for
gout, which is extremely resistant to treatment. As
NSAIDs are typically contraindicated in this
population because of the potential for decreasing
renal function, we have utilized botanical products
rich in linolenic acid (e.g. oil of evening primrose or
flaxseed oil), without untoward effects (see Case
Reports 2 and 3). Again, the "adaptogenic" potential
of the ginsengs might be of use in these patients who
undergo chronic corticosteroid therapy, although the
potential for immune stimulation must be borne in
mind, and such therapy should probably be reserved
for stable patients in the late post-transplant period
(see Case Report 2).
An interesting and potentially beneficial herb for
renal transplant recipients with hepatitis B or C is
milk thistle (Silybum marianum). I have used this
herb, at a dose of 420 mg (80% silymarin content)
taken in three divided doses, in several patients. In
one patient we observed a complete reversal of her
liver dysfunction, which is very uncommon in
immunosuppressed patients (Case Report 3). As this
herb has proven hepatoprotective effects,
and the
drugs cyclosporine and tacrolimus undergo extensive
hepatic metabolism and have hepatotoxic
it might be prudent to include milk
thistle extract in every patient's regimen.
Renal transplant recipients commonly develop
urinary tract infection, and may require chronic
antibiotic prophylaxis. Use of herbs which have
antibacterial or demulcent activity (e.g. cranberry,
corn silk) may be helpful in this regard.
Finally, the drugs which we use as primary
immunosuppressants, cyclosporine and tacrolimus,
have nephrotoxic effects.
An isolate of ginkgolides
from Ginkgo biloba, BN52063, has been shown in a rat
model to protect against acute cyclosporine nephrotoxicity.
In addition, the same isolate has been reported to
decrease the incidence of early delayed graft function in a
human trial.
It is not known whether a standardized
ginkgo extract would be as effective.
Finally, several herbs
25, 26, 27
have been shown to be
renoprotective in animal models of drug toxicity. After
administration of a tubulotoxin such as cisplatinum or
cyclosporine, it is believed that tubule cells die and the
medulla becomes ischemic, resulting in the generation of
free radicals by the remaining viable cells.
Herbs such as
the ones mentioned above, and other with potent
antioxidant properties, may be able to prevent damage by
oxygen radicals in known situations where nephrotoxicity
may result (e.g. administration of nephrotoxic drugs,
exposure to radiocontrast agents).
Summary and Conclusions
Obviously, botanical medicine use in the patient with
kidney disease is a potentially fruitful area for research. In
reviewing the data available for this paper and in talking
with many patients and colleagues, several observations
become apparent. Although herbs have been used both in
this country and in others for centuries for the treatment of
kidney diseases, actual data regarding efficacy and safety
are close to nonexistent. As Pliny the Elder astutely
observed almost 2,000 years ago, "Experience, the most
efficient teacher of all things especially in medicine,
gradually degenerated into mere words and verbage. For it
was pleasanter to sit diligently listening in lecture-rooms
than to go into the fields and look for different plants at
different seasons of the year."
As the potential for patient benefit and the interest on the
part both of patients and nephrologists alike are both
tremendous, ideally, nephrologists, nurses, naturopaths,
pharmacognosists, herbalists and others with an interest in
both herbs and kidney patients will form a collaboration in
order to answer some of the questions I have raised here
and allow us to judiciously use herbs in this very complex
patient population. Until that time, I will close by advising
that the practitioner trained in herbal medicine should not
consider administering botanicals to a patient with renal
disease without collaborating with the patient's primary
physician. I would also advise renal specialists to become
familiar with herbs so that we can carefully begin to
enlarge our clinical and research experience for the benefit
of our patients.
(1) De Matteis Tortora M. Some plants described by Dioscorides
for the treatment of renal diseases. Am I Nephrology 1994;
Continued on page 83

83-- Traditional African Clinic January 2012

Continued from page 82 Herbal Therapies and the
Patient with Kidney Disease
(2) Aliotta G, Pollio A. Useful plants in renal therapy
according to Pliny the Elder. Am I Nephrology 1994;
(3) Rose B. Clinical Physiology of Acid-Base and Electrolyte
Disorders. New York McGraw-Hill Company, 1984.
(4) Greive M. A Modern Herbal, Vols. 1, 2. New York Dover
Publications, 1971.
(5) Dunn CJ, Markham A. Epoetin beta. A review of its
pharmacologic properties and clinical use in the treatment of
anaemia associated with chronic renal failure. Drugs 1996;
(6) Depierrieux M, Van Damme B, Vanden Houte K,
Vanherweghem JL. Pathologic aspects of a newly described
nephropathy related to the prolonged use of Chinese herbs.
Am J Kidney Dis 1994; 24(2):172-80.
(7) Schmeiser HH, Bieler CA, Wiessler M, van Ypersele de
Strihou C, Cosyns JP. Detection of DNA adducts formed by
aristolochic acid in renal tissue from patients with Chinese
herbs nephropathy. Cancer Res 1996; 56(9):2025-8.
(8) Cosyns JP, Jadoul M, Squifflet JP, De Plaen IF, Ferluga
D, van Ypersele de Strihou C. Chinese herbs nephropathy: a
clue to Balkan endemic nephropathy? Kidney Int 1994;
(9) Su ZZ, He YY, Chen G. [Clinical and experimental study
on effects of man-shen-ling oral liquid in the treatment of
100 cases of chronic nephritis] [Chinese]. Chiung-Kuo
Chung Hsi Chieh Ho Tsa Chih 1993; 13(5):269-72, 259-260.
(10) Li L, Wang H, Zhu S. [Hepatic albumin's m-RNA in
nephrotic syndrome rats treated with Chinese herbs]
[Chinese]. Chung-Hua Hsueh Tsa Chih [Chinese Medical
Journal] 1995; 75(5):276-9.
(11) NAPRALERT database. A natural products database
maintained at the Program for Collaborative Research in the
Pharmaceutical Sciences, College of Pharmacy, University
of Illinois, Chicago, IL 60612.
(12) DeFronzo RA, Castellino P. Metabolic and endocrine
disturbances in uremia. In: Massry SG, Glassock RJ, eds.
Textbook of Nephrology, 2nd ed. New York Williams and
Wilkins, 1989, 1221-7.
(13) Anon. Medical Letter on Drugs and Therapeutics 1979;
21 (7):30.
(14) Van Stone JC, Daugirdas IT. Physiologic principles. In:
Daugirdas IT, Ing TS, eds. Handbook of Dialysis. New York
Little Brown Publishing, 1994, 13-35.
(15) Gruber SA, Chan GLC, Canafax DM, Matas AI.
Immunosuppression in renal transplantation. Clin
Transplantation 1991; 5:65-85.
(16) Couser WG, Johnson RJ. Mechanisms of progressive
renal disease in glomerulonephritis. Am J Kidney Diseases
1994; 23(2):193-8.
17) Genusys Pharmacopoeia of Herbs, CD-ROM, publishers
Genusys labs, Solebury, PA 18963, 1996.
(18) Sotaniemi EA, Hapakoski E, Rautio A. Ginseng therapy in
non-insulin-dependent diabetic patients. Diabetes Care 1995;
(19) Silagy C, Neil A. Garlic as a lipid-lowering agent: a meta-
analysis. J Royal College(Physicians London 1994; 28(1):39-45.
(20) Hoffman D. The Complete Illustrated Holistic Herbal.
Rockport, MA: Element Books, 1996.
(21) Grases F, Melero G, Costa-Bauza A, Prieto R, March JG.
Urolithiasis and phytotherapy. Int Urol Nephrol 1994;
(22) Palasciano G, Portincasa P. The effect of silymarin on
plasma levels of malondealdehyde in patients receiving long-
term treatment with psychotropic drugs. Curr Ther Res 1994;
(23) Priotzky E, Colliez P, Guilmard C, Schaeverbeke J, Braquet
P. Cyclosporine-induced nephrotoxicity: preventive effect of a
PAF-acether antagonist, BN52063. Trans Proc 1988; 20(suppl
(24) Grino JM. BN 52021: a platelet activating factor antagonist
for preventing post-transplant renal failure. Ann Intern Med
1994; 121(5):345-7.
(25) Inselmann G., Blohmer A., Kottny W, Nellessen U, Hanel H,
Heidemann HT. Modification of cisplatin-induced renal p-
aminohippurate uptake alteration and lipid peroxidation by
thiols, Ginkgo biloba extract, deferoxamine and torbafylline.
Nephron 1995; 70:425-9.
(26) Xuan W, Dong M, Dong M. Effects of a compound injection
of Pyrola rotundifolia and Astragalus membranaceus Bge on
experimental guinea pigs' gentamycin ototoxicity. Ann Otology
Rhinol Laryngol 1995; 104(5):374-80.
(27) Gaedeke J, Fels LM, Bokemeyer C, et al. Cisplatin
nephrotoxicity and protection by silibinin. Nephrol Dial
Transplant 1996; 11:55-62.
(28) Baliga R, Ueda N, Walker PD, Shah SV. Oxidant
mechanisms in toxic acute renal failure. Am J Kidney Diseases
1997; 29(3):465-77
Table 1: Functions of the normal kidneys (summarized)
Maintenance of blood pressure
Filtration and reabsorption of sodium
Maintenance of appropriate volume (water balance)
Synthesis of active hormones and autocoids (renin,
kinins, prostaglandins)
Maintenance of electrolyte homeostasis
Filtration, reabsorption and secretion of potassium
Continued on page 84

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Continued from page 83 Herbal Therapies and the
Patient with Kidney Disease
Filtration and reabsorption of magnesium,
chloride and other electrolytes
Maintenance of acid-base balance (bicarbonate
reabsorption, hydrogen ion secretion)
Filtration and elimination of metabolic waste
products (BUN, creatinine -- also secreted)
Filtration, secretion and reabsorption of other
solutes (amino acids, glucose)
Maintenance of calcium and phosphorous
Final hydroxylation (activation) of vitamin D
Filtration and reabsorption of phosphate and
calcium (PTH dependent) Maintenance of
hematocrit/hemoglobin Synthesis of
Table 2: General diseases of the kidneys (by no
means all-inclusive)
Acute glomerulonephritis
Rapidly progressive glomerulonephritis
Chronic glomerulonephritis
Nephrotic syndrome (nephrosis)
Toxic insult (drugs, poisons, radiocontrast dye)
Ischemia (hypotension, blood loss, volume
Allergic interstitial nephritis
Vasculitis (e.g., systemic lupus, polyarteritis
nodosa, primary vasculitis)
Hemodynamic disorders
Thrombosis of the renal artery or vein
Renal artery stenosis
Overuse (or misuse) of NSAIDs or ACE
Hepatorenal syndrome
Obstructive disorders
Renal stones
Papillary necrosis (diabetes, pyelonephritis, sickle cell
Tumors (extrinsic or intrinsic)
Prostate disease
Table 3: Potential hazards of using botanicals in
patients with renal disease
Unpredictable pharmacokinetics (under- or
Interactions with patient's pharmaceutical agents
Negative effect on kidney function
Toxicity for kidney tissue
Hemodynamic alterations leading to decreased GFR
Unpredictable effects on blood pressure or blood
Potentiation of electrolyte abnormalities (especially
herbs with high potassium content or diuretic function)
Dialysis patients (in addition to general concerns):
Potential dialyzability of active compounds or
metabolites -- under- or overdosing
Renal transplant recipients (in addition to general
Unpredictable effects on immune function
Synergistic hepatotoxicity
Table 4: Areas in which herbs might benefit patients
with renal disease
Decreased inflammatory response
Decreased proteinuria
Control of hypertension, hyperglycemia and/or
Decreased rate of progression to end-stage renal
Improved diuresis
Management of renal stone disease
Treatment of chronic urinary tract infection
Continued on page 85

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Continued from page 84 Herbal Therapies and the Patient
with Kidney Disease
Dialysis patients:
Improved blood pressure control (hypo- or
Decreased uremic bruising
Increased energy
Maintenance of calcium and iron balance
Anti-anxiety therapy during hemodialysis treatment
Renal transplant recipients: (in addition to general
Decreased prednisone-induced bruising
Treatment of gout
Adaptogen effect in chronic steroid use
Adaptogen effect in chronic steroid use
Hepatoprotection during use of fungally derived
Treatment of hepatitis B and C
Case Reports
Case 1
Ms. F, a 61 year old woman with Addison's disease
(adrenal insufficiency), history of a myocardial
infarction, type I diabetes and a living-related kidney
transplant over 15 years previously was plagued with
severe bruising secondary to prolonged corticosteroid use
and low dose aspirin. She had normal coagulation
parameters (prothrombin and partial-thromboplastin time)
and platelet count. Three weeks after starting bilberry
extract (250 mg twice daily), she experienced lessening
of her bruising. Now almost six months later, she has
minimal bruising and has experienced no untoward
effects of the bilberry. She also takes azathioprine,
furosemide, losartan, amlodipine, erythropoietin,
lovastatin, calcium, magnesium and zinc supplements.
Case 2
Mr. F, a 40 year old man, with type I diabetes since
childhood, received a cadaveric kidney with excellent
renal function. Despite tapering the doses of his
medications, his blood glucose control was erratic and he
was frustrated and felt unwell at two years post-
transplant. He was started on Asian ginseng extract (100
mg twice daily) and Gingko biloba extract (30 mg twice
daily). Within one month, his blood glocuses improved,
with glycosylated hemaglobin dropping from 8.6% to
7.9%. Two months later he developed worsening of
hisblood glucose after "running out of the herbs."
Resumption of therapy resulted again in improvement
in his blood sugars and well-being. In addition to taking
the ginseng on a six week on, two week off schedule, as
well as the ginkgo, he takes garlic (1500 mg softgel),
vitamin E (400 IU) and lecithin (1200 mg). He takes the
lecithin for gout. He also takes prednisone,
cyclosporine, furosemide, enalapril, cisapride,
ranitidine, insulin and simvastatin. We have noted no
interactions between his pharmaceutical and his
botanical products.
Case 3
Ms. G, a 36 year old woman, developed fulminant
hepatitis C after receiving a cadaveric kidney
transplant. She was given interferon but did not tolerate
it and slowly recovered hepatic function, with bilirubins
in the 2.5 to 3.5 mg/dl range. Her transaminases
remained elevated continuously. At 11 months post-
transplant, she was started on milk thistle extract
standardized to 80% silymarin (175 mg twice daily).
Within nine months, her transaminases normalized and
her albumin increased from 2.9 to 3.4 mg/dl (despite
nephrotic range proteinuria). One year following
initiation of therapy with milk thistle, her bilirubins and
transaminases were normal and her gastroenterologist
sent her blood for a measurement of viral load and
found that hepatitis C was no longer detectable in her
serum. She has remained on cyclosporine and
prednisone throughout the time and not required a
change in her dose of cyclosporine in order to maintain
adequate levels. In addition to milk thistle, she takes
Ginkgo biloba extract standardized to 24% ginkgo
flavone glycosides (50 mg twice daily), 1,000 mg of
flaxseed oil (standardized to contain 594 mg alpha-
linolenic acid, 144 mg linolenic acid, and 165 mg oleic
acid) once daily for gout, which has been incapacitating
and for which she also takes lecithin ( 1,000 mg),
vitamin E (400 IU), and selenium (50 mcg).
Pharmaceutical agents taken by the patient, in addition
to immunosuppressive drugs, include erythropoietin,
furosemide and clonidine. She also takes an iron
preparation, magnesium and calcium supplementation
and feels well at this time.
Natural Product Research Consultants, Inc.

86-- Traditional African Clinic January 2012

Drinking too much Water
called Latest Threat to
By The Gazette (Montreal)
Canadian doctors are warning drinking too much
water may cause loss of kidney function - something
they discovered purely by accident.
January 18, 2008
Canadian doctors are warning drinking too much
water may cause loss of kidney function - something
they discovered purely by accident.
Researchers have been studying the health of
residents of Walkerton, Ont., since the water supply
was contaminated with E. coli in 2000. They
identified 100 otherwise healthy adults who had a
condition called proteinuria, or abnormal amounts of
protein in their urine. None had any medical
conditions or were on medications that would
explain why.
Proteinuria can cause kidney failure and is a sign of
microvascular disease, where the heart's tiny arteries
are damaged, causing cardiac disease and death. Of
the 100 people, 56 agreed to follow-up testing and to
reduce their fluid intake to fewer than eight large
glasses per day for one week. The result? The cases
of proteinuria were "largely reversed."
"When we were in Walkerton we were surprised that
almost five per cent of the population were drinking
very large volumes of fluid," said Dr. William Clark,
a scientist at Lawson Health Research Institute in
London, Ont., and professor of medicine at the
University of Western Ontario.
"We went on the supposition that this must be
because of the water contamination," meaning that
when people moved to bottled water, they drank
more. But Clark, project leader of the Walkerton
Health Study, said most admitted to drinking vast
amounts of water even before the contamination
crisis, ostensibly for health reasons.
They were drinking, on average, at least four litres
per day. "That would be about 18 large glasses of
fluid per day," he said. Some people were drinking
six litres. One woman, a health-care worker, was
drinking eight.
"They didn't like it when we asked them to reduce
their fluid intake, although they did do it," Clark
said. "Most corrected their kidney abnormality.

Some did not correct completely, meaning they may have a
permanent bit of damage."
The study is published in this week's issue of the Canadian
Medical Association Journal.
"If you go on the Internet you'll get at least 500 hits on how
healthy it is to drink as much water as humanly possible,"
Clark said. "Some health magazines recommend people
drink a minimum of 12 to 15 glasses of fluid per day."
But Clark said flushing the kidneys doesn't help kidney
function. Even doctors believe the medical myth that people
should drink at least eight glasses of water a day, according
to an article published last month in the British Medical
Journal, which traced the notion back to a 1945
recommendation from the U.S. Nutrition Council.
Ignored in the original statement was that most of the fluid
people need is found in food, especially fruits and
vegetables, the researchers said.
Clark's team has been screening the population of
Walkerton to track for health syndromes associated with E.
coli damage. The big, silent problem is kidney damage. The
researchers measured urine protein levels from 2,253 adults
who later attend ed a follow-up clinic annually between
2003 and 2005.
Clark noticed many had increased protein excretion in the
urine. The condition causes progressive loss of kidney
After excluding diabetes or any other explanation for the
problem, "we still ended up with 100 people who had no
explanation whatsoever," he said. On average, they were
excreting almost three times the normal rate.
Treatment was simple, Clark said. "When they drank less
water, the problem went away." "This was something we've
never conceived of. It's not reported anywhere," Clark said.
And he doesn't think the data is unique to Walkerton. "We're
drinking lots of water, and people think it's healthy."
"We would recommend until we know better that maybe
eight glasses of fluid a day is fine but probably less than six
is better, unless you're in a very arid climate or carrying out
marathon running or massive exertion or have a particular
kind of kidney damage and you lose salt." Fluid means "all
fluids," including coffee, tea and juice.
What's not known is "whether the proteinuria associated
with excessive fluid intake in these otherwise healthy people
will affect their kidney function in the long term," the
researchers wrote in this week's journal article.

87-- Traditional African Clinic January 2012

Risk of Water Wars rises
with Scarcity
Almost half of humanity will face water scarcity by
2030 and strategists from Israel to Central Asia
prepare for strife.
By Chris Arsenault
26 August 2012
The author Mark Twain once remarked that "whisky
is for drinking; water is for fighting over" and a series
of reports from intelligence agencies and research
groups indicate the prospect of a water war is
becoming increasingly likely.
In March, a report from the office of the US Director
of National Intelligence said the risk of conflict would
grow as water demand is set to outstrip sustainable
current supplies by 40 per cent by 2030.
"These threats are real and they do raise serious
national security concerns," Hillary Clinton, the US
secretary of state, said after the report's release.
Internationally, 780 million people lack access to safe
drinking water, according to the United Nations. By
2030, 47 per cent of the worlds population will be
living in areas of high water stress, according to the
Organisation for Economic Co-operation and
Development's Environmental Outlook to 2030
Some analysts worry that wars of the future will be
fought over blue gold, as thirsty people, opportunistic
politicians and powerful corporations battle for
dwindling resources.
Dangerous warnings
Governments and military planners around the world
are aware of the impending problem; with the US
senate issuing reports with names like Avoiding Water
Wars: Water Scarcity and Central Asias growing
Importance for Stability in Afghanistan and Pakistan.
With rapid population growth, and increased
industrial demand, water withdrawals have tripled
over the last 50 years, according to UN figures.
"Water scarcity is an issue exacerbated by
demographic pressures, climate change and
pollution," said Ignacio Saiz, director of Centre for
Economic and Social Rights, a social justice group.
"The world's water supplies should guarantee every
member of the population to cover their personal and
domestic needs."

"Fundamentally, these are issues of poverty and inequality,
man-made problems," he told Al Jazeera.
Of all the water on earth, 97 per cent is salt water and the
remaining three per cent is fresh, with less than one per cent
of the planet's drinkable water readily accessible for direct
human uses. Scarcity is defined as each person in an area
having access to less than 1,000 cubic meters of water a
The areas where water scarcity is the biggest problem are
some of the same places where political conflicts are rife,
leading to potentially explosive situations.
Some experts believe the only documented case of a "water
war" happened about 4,500 years ago, when the city-states
of Lagash and Umma went to war in the Tigris-Euphrates
But Adel Darwish, a journalist and co-author of Water
Wars: Coming Conflicts in the Middle East, says modern
history has already seen at least two water wars.
"I have [former Israeli prime minister] Ariel Sharon
speaking on record saying the reason for going to war
[against Arab armies] in 1967 was for water," Darwish told
Al Jazeera.
Some analysts believe Israel continues to occupy the Golan
heights, seized from Syria in 1967, due to issues of water
control, while others think the occupation is about
maintaining high ground in case of future conflicts.
Senegal and Mauritania also fought a war starting in 1989
over grazing rights on the River Senegal. And Syria and
Iraq have fought minor skirmishes over the Euphrates
Middle East hit hard
UN studies project that 30 nations will be water scarce in
2025, up from 20 in 1990. Eighteen of them are in the
Middle East and North Africa, including Egypt, Israel,
Somalia, Libya and Yemen.
Darwish bets that a battle between south and north Yemen
will probably be the scene of the next water conflict, with
other countries in the region following suit if the situation is
not improved.
Water shortages could cost the unstable country 750,000
jobs, slashing incomes in the poorest Arab country by as
much as 25 per cent over the next decade, according to a
report from the consulting firm McKinsey and Company
produced for the Yemeni government in 2010.
Commentators frequently blame Yemen's problems on
tribal differences, but environmental scarcity may be
underpinning secessionist struggles in the country's south
and some general communal violence. Continued on page 88

88-- Traditional African Clinic January 2012

Continued from page 87 Risk of Water Wars rises with
"My experience in the first gulf war [when Iraq
invaded Kuwait] is that natural resources are always at
the heart of tribal conflicts," Darwish told Al Jazeera.
The Nile is another potential flash point. In 1989,
former Egyptian president Hosni Mubarak threatened
to send demolition squads to a dam project in Ethiopia.
"The Egyptian army still has jungle warfare brigades,
even though they have no jungle," Darwish said.
On the Nile, cooperation would benefit all countries
involved, as they could jointly construct dams and
lower the amount of water lost to evaporation, says
Anton Earle, director of the Stockholm International
Water Institute think-tank.
"If you had an agreement between the parties, there
would be more water in the system," he told Al
Jazeera. The likelihood of outright war is low, he says,
but there is still "a lot of conflict" which "prevents
joint infrastructure projects from going ahead".
Differing views
Water scarcity, and potential conflicts arising from it,
is linked to larger issues of population growth,
increasing food prices and global warming.
There are two general views about how these problems
could unfold. The first dates back to the work of
Thomas Malthus, an eighteenth century British
clergyman and author who believed that: "The power
of population is so superior to the power of the earth to
produce subsistence for man, that premature death
must in some shape or other visit the human race."
In other words, more people and scant resources will
invariably lead to discord and violence. Recent
scholars, including Thomas Homer-Dixon, have
analysed various case studies on environmental
degradation to conclude that there is not a direct link
between scarcity and violence. Instead, he
believes inequality, social inclusion and other factors
determine the nature and ferocity of strife.
"Unequal power relations within states and conflicts
between ethnic groups and social classes will be the
greatest source of social tensions rising from
deprivation," said Ignacio Saiz from the social justice
group. "Water too often is treated as a commodity, as
an instrument with which one population group can
suppress another."
Bolivia, South Africa, India, Botswana, Mexico and
even parts of the US have seen vigorous water related
protests, says Maude Barlow, author of 16 books and a

former senior adviser to the UN on water issues.
"The fight over water privatisation in Cochobamba, Bolivia
did turn into a bit of a water war and the army was called in,"
Barlow told Al Jazeera. "In Botswana, the government
smashed bore holes as part of a terrible move to remove
[indigenous bushmen] from the Kalahari desert. Mexico City
has been forcibly taking water from the countryside,
confiscating water sources from other areas and building
fotresses around it, like it's a gold mine. In India, Coke will
get contracts and then build fortresses around the water
sources," taking drinking and irrigation water away from
local people. "In Detroit 45,000, officially, have already had
their water cut off."
Human rights
Strife over water, like conflicts more generally, will
increasingly happen within states, rather than between them,
Barlow says, with large scale agribusiness, mining and
energy production taking control over resources at the
expense of other users.
The IPPC, the UN panel which analyses climate science,
concluded that: "Water and its availability and quality will be
the main pressures on and issues for, societies and the
environment under climate change."
Dealing with these pressures will require improved
technologies, political will and new ideas about how humans
view their relationship with the substance that sustains life.
"People have the right to expect access to a basic life resource
like water by virtue of being human, regardless of the social
situation they are born into," Saiz said. "Alongside the
worrying development of water scarcity, I am hopeful that we
will see increasing struggles to see access to water as a right,
and not a privilege."

What is Cornsilk? Information
& Medicinal Properties of
What is Cornsilk?
Corn Silk is a collection of the stigmas (fine, soft, yellowish
threads or tassels) from the female flowers of Corn (maize),
and they are four to eight inches long with a faintly sweetish
taste. Cornsilk (Zea mays) is an herbal remedy made from
stigmas, the yellowish thread-like strands found inside the
husks of corn. The stigmas are found on the female flower of
corn, a grain that is also known as maize and is a member of
the grass family (Gramineae or Poaceae). The stigmas
Continued on page 89

89-- Traditional African Clinic January 2012

Continued from page 88 What is Cornsilk?
measure 4-8 in (10-20 cm) long and are collected for
medicinal use before the plant is pollinated.

Cornsilk can also be removed from corn cobs for use
as a remedy. If fertilized, the stigmas dry and
become brown. Then yellow corn kernels develop.
Corn is native to North America and now grows
around the world in warm climates. Cornsilk is also
known as mother's hair, Indian corn, maize jagnog,
Turkish corn, yu mi xu, and stigmata maydis. Corn is
a grass which can grow up to 3 meter. Corn forms
thick stems with long leaves. The flowers of corn are
monoecious: each corn plant forms male and female
flowers. The male flowers form the tassel at the top
and produce yellow pollen. The female flowers are
situated in leave axils and form stigmas or corn silk
(yellow soft threads). The purpose of the cornsilk is
to catch the pollen. The cornsilk is normally light
green but can have other colours such as yellow,
yellow or light brown.
Only cornsilk (styles and stigmas) is harvested for
medicinal properties. Cornsilk should be harvested
just before pollination occurs. Cornsilk can be used
fresh or dried. The corn kernels (or corn) are a well
known food.
Cornsilk Medicinal Properties
Cornsilk has detoxifying, relaxing and diuretic
activity. Cornsilk is used to treat infections of the
urinary and genital system, such as cystitis,
prostatitis and urethritis. Cornsilk helps to reduce
frequent urination caused by irritation of the bladder
and is used to treat bed wetting problems. Cornsilk is
found to reduce kidney stones. In China, cornsilk is
traditionally used to treat oedema and jaundice.
Studies indicate that cornsilk can reduces blood
clotting time and reduce high blood pressure.
Cornsilk Facts
Corn originates from Central America but is
cultivated in many countries as a food crop and as

fodder. In countries with colder climate the whole corn
plant is used a cattle feed.
Health Benefits of Cornsilk
Corn Silk is an old remedy for urinary tract ailments,
including bed-wetting, painful and frequent urination,
stones, bloating, gravel in the bladder and chronic cystitis
and prostatitis. It is also thought to help relieve edema and
the painful swelling of carpal tunnel syndrome and gout.
Corn Silk is an old-fashioned, gentle, but effective, diuretic
without the loss of potassium. Some new research claims
that Corn Silk may help to lower blood sugar levels and
reduce blood-clotting time.
Cornsilk also served as a remedy for heart trouble,
jaundice, malaria, and obesity. Cornsilk is rich in vitamin
K, making it useful in controlling bleeding during
childbirth. It has also been used to treat gonorrhea. For
more than a century, cornsilk has been a remedy for
urinary conditions such as acute and inflamed bladders and
painful urination. It was also used to treat the prostate.
Some of those uses have continued into modern times;
cornsilk is a contemporary remedy for all conditions of the
urinary passage.
Corn Silk is an old and effective diuretic that promotes the
flow of urine, relieving excess water retention, and it has
been used to treat acute and chronic bladder infection,
cystitis, urethritis, prostatitis (and other prostate disorders)
and also combat urinary stones. Unlike other diuretics,
however, the high level of potassium in Corn Silk offsets
potassium loss caused by the increased urination when
used as directed.
The herb is also believed to relieve bladder irritation
caused by the accumulation of uric acid and gravel and
eases the pain of burning urination. When Corn Silk is
given to children (or adults) several hours prior to bedtime,
it is said to diminish the occurrence of enuresis
(bedwetting). Because it soothes bladder irritation, Corn
Silk generally helps to reduce the occurrence of frequent
urination problems.
Corn Silk helps to ease edema and swelling caused by
many inflammatory conditions, such as gout and carpal
tunnel syndrome, and as a demulcent, it helps to soothe
inflammation, especially inflamed mucous membranes. It
is also used to alleviate the bloating and discomforts of
premenstrual syndrome (PMS).
Drinking cornsilk tea is a remedy to help children stop
wetting their beds, a condition known as enuresis. It is also
a remedy for urinary conditions experienced by the elderly.
Cornsilk is used to treat urinary tract infections and kidney
stones in adults. Cornsilk is regarded as a soothing diuretic
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90-- Traditional African Clinic January 2012

Continued from page 89 What is Cornsilk?
and useful for irritation in the urinary system. This
gives it added importance, since today, physicians are
more concerned about the increased use of antibiotics
to treat infections, especially in children. Eventually,
overuse can lead to drug-resistant bacteria. Also,
these drugs can cause complications in children.
Furthermore, cornsilk is used in combination with
other herbs to treat conditions such as cystitis
(inflammation of the urinary bladder), urethritis
(inflammation of the urethra), and parostitis
Cornsilk is said to prevent and remedy infections of
the bladder and kidney. The tea is also believed to
diminish prostate inflammation and the accom-
panying pain when urinating.
Since cornsilk is used as a kidney remedy and in the
regulation of fluids, the herb is believed to be helpful
in treating high blood pressure and water retention.
Corn-silk is also used as a remedy for edema (the
abnormal accumulation of fluids).
Cornsilk is used to treat urinary conditions in
countries including the United Sates, China, Haiti,
Turkey, and Trinidad. Furthermore, in China,
cornsilk as a component in an herbal formula is used
to treat diabetes.
In addition, cornsilk has some nonmedical uses.
Cornsilk is an ingredient in cosmetic face powder.
The herb used for centuries to treat urinary conditions
acquired another modern-day use.
Cornsilk is safe when taken in proper dosages.
Before beginning herbal treatment, people should
consult a physician, practitioner, or herbalist.
If a person decides to collect fresh cornsilk, attention
should be paid to whether the plants were sprayed
with pesticides.
Cornsilk Side Effects
There are no known side effects when cornsilk is
taken in designated therapeutic dosages.

Urinalysis is a test that evaluates a sample of your

Urinalysis is used to detect and assess a wide range of
disorders, including urinary tract infection, kidney disease
and diabetes.
Urinalysis involves examining the appearance, concen-
tration and content of urine. Abnormal urinalysis results
may point to a disease or illness. For example, a urinary
tract infection can make urine look cloudy instead of clear.
Increased levels of protein in urine can be a sign of kidney
Abnormal results of a urinalysis often require additional
testing and further evaluation to uncover the source of the
Why it's done
Urinalysis is a common test that's done for several reasons:
To assess your overall health. Your doctor may
recommend urinalysis as part of a routine medical
examination, pregnancy checkup, pre-surgery
preparation, or on hospital admission to screen for a
variety of disorders, such as diabetes, kidney disease
and liver disease.
To diagnose a medical condition. Your doctor may
suggest urinalysis if you're experiencing abdominal
pain, back pain, frequent or painful urination, blood in
your urine or other urinary problems. Urinalysis may
help diagnose the cause of these symptoms.
To monitor a medical condition. If you've been
diagnosed with a medical condition, such as kidney
disease or urinary tract disease, your doctor may
recommend urinalysis on a regular basis to monitor
your condition and treatment.
Other tests, such as pregnancy testing and drug screening,
also may require a sample of urine. These tests are separate
from urinalysis. They test for substances in the urine that
urinalysis typically doesn't include. For example,
pregnancy testing measures the hormone human chorionic
gonadotropin (HCG). Drug screening tests are tailored to
detect specific drugs or their metabolic products,
depending on the purpose of the testing.
For urinalysis, your urine sample will be evaluated in three
Visual exam
A laboratory technician will examine the urine's
appearance. Urine is typically clear. Cloudiness or unusual
odor may indicate a problem. Blood in the urine may make
it look red or brown. A cloudy appearance may indicate an
Continued on page 91

91-- Traditional African Clinic January 2012

Continued from page 90 - Urinalysis
Dipstick test
A dipstick a thin, plastic stick with strips of
chemicals on it is placed in the urine to detect
abnormalities. The chemical strips change color if
certain substances are present or if their levels are
above normal. A dipstick test checks for the
Acidity (pH). The pH level indicates the amount
of acid in urine. Abnormal pH levels may indicate a
kidney or urinary tract disorder.
Concentration. A measure of concentration, or
specific gravity, shows how concentrated particles
are in your urine. Higher than normal concentration
often is a result of dehydration, rather than another
underlying medical condition. But, it may indicate a
kidney disorder.
Protein. Urine protein levels are normally low
and aren't detected by a dipstick test. Small increases
in protein usually aren't a cause for concern. Larger
amounts of protein in the urine may indicate a
kidney problem.
Sugar. Normally the amount of sugar (glucose)
in urine is too low to be detected. Any detection of
sugar on this test usually calls for follow-up testing
for diabetes.
Ketones. As with sugar, any amount of ketones
detected in your urine could be a sign of diabetes and
requires follow-up testing.
Bilirubin. Bilirubin is a product of red blood cell
breakdown. Normally, bilirubin is carried in the
blood and passes into your liver, where it's removed
and becomes part of bile. Bilirubin in your urine may
indicate liver damage or disease.
Evidence of infection. Nitrites and leukocyte
esterase are produced as a result of an infection. If
either nitrites or leukocyte esterase a product of
white blood cells is detected in your urine, it may
be a sign of a urinary tract infection.
Blood. The dipstick test can identify if red blood
cells or other components of blood, such as
hemoglobin or myoglobin, are present in your urine.
Blood in your urine requires additional testing, as it
may be a sign of kidney damage, infection, kidney or
bladder stones, kidney or bladder cancer or blood
disorders, among other conditions.
Microscopic exam
Several drops of the urine are examined with a

If any of the following are observed in above-average levels,
additional testing may be necessary:
White blood cells (leukocytes) may be a sign of an
Red blood cells (erythrocytes) may be a sign of kidney
diseases, blood disorders or another underlying medical
condition, such as bladder cancer.
Epithelial cells cells that line your hollow organs and
form your skin in your urine may be a sign of a tumor. But
more often, they indicate that the urine sample was
contaminated during the test, and a new sample is needed.
Bacteria or yeasts may indicate an infection.
Casts tube-shaped proteins may form as a result of
kidney disorders.
Crystals that form from chemicals in urine may be a sign
of kidney stones.
Urinalysis is not a test that provides a definitive diagnosis.
Depending on the reason your doctor recommended this test,
abnormal results may or may not require follow-up. Your
doctor may need to evaluate the results along with those of
other tests, or additional tests may be necessary to determine
next steps.
For example, if you are otherwise healthy and have no signs or
symptoms of illness, results slightly above normal on a
urinalysis may not be a cause for concern and follow-up may
not be needed. However, if you've been diagnosed with kidney
or urinary tract disease, elevated levels may indicate a need to
alter your treatment plan.

The Kidneys (Duality - Ying and Yang)
Kidney disease can be avoided by eating a healthy diet and
drinking clean water. In many cases, it is a preventable disease.
The kidneys, as filters, play a vital role in the body. Herbs such
as corn silk, cranberry, dandelion root, and burdock root, etc.
help to flush toxins from urinary tract. Although we can live
with one kidney, losing two means certain death. Kidney
dialysis and transplants are not cures. The high rate of acute and
chronic kidney disease and UTIS in communities worldwide is
alarming. But whether it is because of diet or environment, we
can do something to prevent and protect our kidneys from
Blackherbals A Marcus Garvey Pan-African Universitys
Community Site of Knowledge

92-- Traditional African Clinic January 2012

Herbs of the Month
Cranberry for Urinary Tract Infection
(UTI) and E coli

Long before researchers started investigating, people
believe that cranberries and cranberry juice have the
ability to help prevent and treat urinary tract infections
(UTIs). Recently, scientists found that cranberries
contain the unusual nature of their proanthocyanidins
(PACs) that is related to prevention of UTIs.
The urinary tract includes two kidneys, two ureters, a
bladder, and a urethra. Urinary tract infections are
caused by microbes, including fungi, viruses, and
bacteria. Bacteria are the most common cause of UTIs.
Most urinary tract infections (UTIs) are caused by one
type of bacteria, Escherichia coli (E. coli). It is reported
that E. coli is the cause of 8085% of urinary tract
Researchers found that the PACs in cranberry have a
special structure (called A-type linkages) that blocks
adhesion of bacteria, such as E. coli, to the urinary tract
linings. In some studies, UTIs have been reduced by
more than one-third through dietary consumption of
cranberry. It is recommended to eat a handful of
cranberries, or drink 2 to 3 cups of cranberry juice per
day for prevention of UTI.


Afrikan Traditional Herbal Research Clinic
54 Muwafu Road, P.O. Box 29974
Ntinda, Kampala, Uganda East Africa
Phone: +256 (0) 702 414 530
Email: clinic@blackherbals.com

Mission Statement
Our aim at The African Traditional Herbal
Research Clinic is to propagate and promote the
awareness in Afrikan peoples at home and abroad of
their health, biodiversity, history and cultural
richness. We gather pertinent information on these
issues and disseminate these freely to our people in
Uganda, the rest of the continent, and anywhere in
the Diaspora where Afrikans are located. One of
the main ingredients for increasing poverty, sickness,
exploitation and domination is ignorance of one's
self, and the environment in which we live.
Knowledge is power and the forces that control our
lives don't want to lose control, so they won't stop at
anything to keep certain knowledge from the people.
Therefore, we are expecting a fight and opposition to
our mission. However, we will endeavor to carry
forward this work in grace and perfect ways.
Where there is no God, there is no culture.
Where there is no culture, there is no
indigenous knowledge. Where there is no
indigenous knowledge, there is no history.
Where there is no history, there is no science
or technology. The existing nature is made
by our past. Let us protect and conserve our
indigenous knowledge.