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Yar”Adua’s Health: Facts and Fibs

August 31, 2008
  Prof. Edward OparaojiDirector, Global Medical AffairsNephrology SectionShire Pharmaceuticals USA[email protected]  Recent reports indicate that President Musa Yar”Adua may have undergone kidney transplantation in a Saudi Arabia hospital, resulting from severe kidney damage caused by a rare disease called Churg Strauss Syndrome (CSS). If these reports are correct, it is important that Nigerians know the basic facts about CSS and Kidney transplantation in order to correctly access the political implications. Shiel and Stoppler wrote an article in www.medicinnet.com, succinctly describing CSS. It is rare and one of many forms of vasculitis- diseases characterized by inflammation of blood vessels, especially small arteries and veins. It occurs in patients with a history of asthma or allergyand20features inflammation of blood vessels in the lungs, skin, nerves, and abdomen and very rarely the kidneys and brain. The cause of the syndrome is not known, but it involves an abnormal over-activation of the immune system in a person with underlying bronchospastic lung disease such as asthma. Although certain asthma medications, called leukotriene modifiers, has been associated with CSS, whether they actually cause the disease or exacerbates it is not yet clear. It is a serious disease that can be fatal. Untreated it is extremely dangerous and threatens the organs that are affected. With aggressive treatment and monitoring it can be quieted and total inactivation of the disease (remission) is possible. If reports of hemo-dialysis and kidney transplantation are accurate it means that Yar’Adua’s CSS was not controlled with medications (usually comprising high dose steroids and cytoxan- a chemotherapeutic agent), thus resulting in destruction of the blood vessels leading to/supplying the kidneys and the Kidneys themselves. It is also conceivable that since the kidneys are rare targets in CSS, his disease was at an advanced stage, and likely has severely affected other more vulnerable organs such as the lungs, abdomen, skin, prostate, nerves and or muscles.   Furthermore, there is a high likelihood of infections (bacterial, fungal and/or viral), due to the medicines used in CSS, which depresses the body’s ability to fight infections. If the above conditions exist Yar’Adua may not have qualified for kidney transplant, especially in any transplant center in the West. Kidney transplantation is possible when one has no other severe or life threatening condition such as CSS (a badly managed one for that matter), that may hinder transplant success. It is therefore, proper to ask, did he actually undergo renal transplantation? Was it ethical? Whose kidney? Was it a living or a cadaver donor? What is his prognosis?   What is timeline for recuperation? What is his mental status? Can he effectively execute state functions? Did he properly hand over power to the Vic e President- Jonathan Goodluck, prior to this major surgery?     While not familiar with the practice in Saudi Arabia , I will be surprised if any credible transplant center will risk a donor's life or jump over a potential recipient on the list to give precious kidney to a poor transplant candidate. That would be unethical. There are two types of donors- a living donor or a diseased (cadaver) donor. The prognosis or survival rateis better with living donor transplantation. A cadaver donor for a case such as Yar’Adua’s will further compromise his post transplant prognosis. In a best case scenario kidney transplantation requires at least 3-4 days hospital stay, and an additional 3-4 weeks monitoring, requiring proximity to the transplant center. Baring any act of political desperation, he may not be expected back in the country in good health, within 4 weeks po st kidney transplantation. Subsequently, Yar”adua may encounter other medical and socio-political challenges. He may require regular mental evaluation to detect any loss of mentation due to the CSS and steroid psychosis (from high dose steroids which are an integral part of life long treatment in kidney transplant patients). Steroid Psychosis occurs as an adverse reaction to taking large doses of steroids, the most common symptoms emotional lability, anxiety, distractibility, pressured speech, sensory flooding, insomnia, depression, perplexity, agitation, auditory and visual hallucinations, intermittent memory impairment, mutism, disturbances of body image, delusions, apathy and hypomania. Other classes of medications used post transplant such as calcineurine inhibitors (cyclosporine), antiproliferative agents (mycophenylate mofetil, azathioprine, or sirolimus), monoclonal antibodies (muromonab-CD3) and polyclonal antibodies (antithymocytes globuline eqine) come with significant side effects as well as other medical, financial and social burden.   Renal transplantation is major surgery which usually requires general anesthesia and could lead to death. If this was an elective/planned surgery, we would expect Yar’Adua to properly hand over power to his VP. If he didn’t, the National Assembly may investigate and possibly consider impeachment-if he is competent on return. If the little bits from the media are accurate, President Yar’Adua’s prognosis, with or without kidney transplant is not encouraging. He may well be advised to return to Katsina, to take care of himself. A sick nation needs a competent leader.  

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