How Can We Save Kidneys | Cardiovascular Case Study

Last week, I had the task of opening a new bank account for Expert Consult Clinic in Lahore. After a lot of effort, we finally managed to get the account opened. However, something far more significant happened during this process, which I believe is worth sharing. While dealing with the formalities and various meetings involved in opening the account, I came across a patient suffering from Cardiovascular Kidney Metabolic Syndrome. Fortunately, I was able to alert him in time, potentially saving him from more serious complications.

This experience reminded me of a key point I discussed in a previous episode: When a patient comes into your healthcare encounter, you must not overlook them. In this episode, I will elaborate on how you can become a walking healthcare provider. Once you understand metabolic syndrome, you'll find yourself constantly scanning people around you, guiding them away from unhealthy lifestyles, and steering them towards healthier living. It’s about saving their hearts, kidneys, and eyes from potential damage.

Introduction

Assalamualaikum, I am Dr. Avka from Expert Consult Clinic in Lahore. I am speaking from my nephrology seat in a travel studio. Today, I want to discuss a case that brings me immense satisfaction for two main reasons. Like in previous cases, I will try to share some unique insights from our healthcare system. I’ll also discuss certain behaviors that might not be well-regarded in our society or considered standard, but are actions you can learn to improve others' lives and guide them towards better health. The key is to do all of this in a healthy and respectful manner.

A Fortunate Encounter

So, what happened last week? I finally had the chance to open a bank account for Expert Consult Clinic at a nearby bank. During the discussions with various team members, I spent some time with the branch manager, who was assisting us with the account opening process. After completing all the documentation, the manager told me I could go home, and he would send me the necessary details via WhatsApp.

Later that night, when I received his WhatsApp message, I noticed something that caught my attention. The manager’s profile picture was of a much heavier man, almost twice his size from what I had seen earlier. This discrepancy surprised me, but I didn’t mention anything at the time. However, the next morning, when I returned to the clinic and switched into my "doctor mode," I sent him a respectful message asking whose picture he had on his WhatsApp.

He replied that it was his own picture. This was a pivotal moment where I had to tactfully approach the subject of obesity. I didn’t insult him or make any derogatory remarks. Instead, I asked him politely, "What happened? You used to be so good-looking, smart, and healthy, and now look at where you are." Thankfully, he didn’t take offense. He responded respectfully, explaining his story.

Understanding Obesity and Health

The manager shared that until 2018-19, he was in the same healthy state as seen in the picture. However, during the COVID-19 pandemic, some irregularities occurred. He had to take steroids, which led to significant weight gain. Following that, he got married, and since then, his health has been on a downward spiral. He confessed that he had never fully recovered.

Before diving into the case, let’s discuss obesity, a condition that hasn’t been thoroughly explored in Pakistan yet. First, let me clarify that you will never hear me directly associate insulin resistance, metabolic syndrome, diabetes, or poor health solely with obesity in my videos, blogs, or any of my content. Obesity can indeed contribute to these diseases, but that doesn’t mean every obese person is destined to suffer from them, nor does it mean that every thin person is immune.

Obesity is undoubtedly a health risk, but it’s not the sole determinant of one’s health. A person might be thin and still suffer from metabolic syndrome, insulin resistance, or diabetes due to various factors. This misconception is particularly prevalent in our region, including among Asians, such as Chinese, Indians, and Nepalese. In our population, the relationship between BMI, obesity, metabolic syndrome, and insulin resistance differs from that of Western populations. For instance, even a slight increase in abdominal fat in our region could indicate significant liver issues or the onset of insulin resistance.

There is a common misunderstanding that if someone is thin, they are less likely to develop diabetes or insulin resistance. This is entirely false. You can have an unhealthy lifestyle, appear thin and smart, and still be at risk for insulin resistance, metabolic syndrome, diabetes, and kidney disease without even realizing it. This is something you must remember.

Addressing Obesity Respectfully

Now, let’s talk about how to address obesity. Obesity is evidently a health condition and should be avoided. Regardless of your gender, whether you are male, female, young, or old, extra weight has no role in a healthy life. It’s essential to eliminate it as soon as possible and encourage others to do the same in a respectful manner.

Obesity is not just a health condition; it’s also a stigma. But, speaking about obesity is an even bigger stigma, especially in our society where negativity and mistrust prevail. You can’t comfortably call someone obese, even in a respectful way, without them taking offense. Try calling your mother, father, brother, or spouse obese, and you’ll see the reaction within two minutes. Even if you’re approaching the subject with positivity, trying to tell them that this extra weight isn’t healthy and it’s affecting their heart, kidneys, and brain, they’re likely to take it negatively.

In the future, we will develop this topic further and explore it in greater detail. For now, let’s return to the case. The manager accepted that he was heading in the wrong direction. He scheduled an appointment with us and had a long discussion when he came in.

The Case at Hand

My suspicion was correct. The manager had reached a certain limit of metabolic syndrome. When we checked his blood pressure, it was 140/90, whereas, at his age (30s), it should have been around 120/80. His fasting blood sugar was also high, within the pre-diabetic range. When we measured his weight, it was 202 kilos, which was definitely more than what was appropriate for his height.

I guided him on the basics of a healthy lifestyle. When he came to us, he had no exercise routine as a banker, his diet was unhealthy, sometimes eating, sometimes skipping meals, and eating out three to four times a week. He mentioned that he actually oversleeps rather than undersleeps because he feels tired all the time. After returning home from the bank, he would just lie down, and then it was hard for him to get up. He would either watch TV or eat something without engaging in any meaningful activity. He was stuck in his 9 to 5 job, and this had become his daily routine. A major source of stress for him was also a sick family member he had to take care of, which added to his stress.

You can see that this is a textbook example of a lifestyle that can lead to insulin resistance, metabolic syndrome, and overall poor health. He had everything that could go wrong in terms of health, except for the one unmodifiable factor—his stress due to a family member's illness. However, the modifiable factors—exercise, sleep, diet—were completely out of control.

We recommended some basic lab tests, which I will share with you. The broad results showed that his cell count was normal, and his kidney function was normal, but his liver function was impaired. His liver enzymes were elevated. You can see in the picture that his ALT and AST levels were in the 80s and 90s.

Conclusion

Understanding and managing obesity, especially in our region, is crucial for preventing a host of metabolic issues. It’s not just about losing weight; it’s about understanding the complexities of how our bodies respond to lifestyle choices and taking steps to correct them before they spiral out of control. The manager's case is a reminder that even small changes in lifestyle can make a significant difference. We will continue to explore this topic in future discussions, offering more insights into how to tackle these issues effectively.