Kidney Diseases

Kidney diseases are illnesses or disorders that affect the functioning of kidneys with respect to filtration, re-absorption and secretion.

Causes

General

  1. Secondary and Systemic Disorder
  • Systemic lupus erythematosus
  • Diabetes
  • Goodpasture’s syndrome
  • Bronchiectasis

2. Anti-hypertensive medicines

  • Angiotensin-converting enzyme inhibitors
  • Angiotensin receptor blockers

3. Hereditary

  • Alport Syndrome
  • Thin membrane basement disease
  • Familial clusters

4. Infection

  • Viral
    • Hepatitis B
    • HIV
    • Echovirus
    • Mumps
    • Varicella
    • Cytomegalovirus
  • Bacteria
    • Haemolytic streptococcus
    • Pneumococcus
    • Klebsiella
    • Gonococcus
    • Staphylo
    • Salmonella
    • Yersinia
    • Syphilis
    • Leprosy
    • Tuberculosis

5. Gold — Consuming impure gold preparations for a long time period is also one of the causes of kidney diseases.

Symptoms and signs of kidney diseases

  1. Proteinuria
  2. Hematuria
  3. Reduced glomerular filtration rate
  4. Hypoproteinemia
  5. Oedema ( hands and ankles- at the end of the day; around the eyes –early morning)

Acute Renal Failure (ARF)

It is the sudden loss of kidney function. It occurs when the kidneys stop working over a period of hours, days, or in some cases, weeks. ARF develops from 5% to 7% of all patients in the hospital.  

Causes

Pre-renal

  • Hypovolemia
  • Dehydration
  1. Vomiting
  2. Diarrhoea
  3. Sweating
  4. Fever
  5. Poor intake of fluids
  • Medication(diuretics )
  • Abnormal blood flow to and from the kidney due to obstruction of the renal artery or vein.

Renal

  • Sepsis
  • Medications
  1. NSAID’s(ibuprofen,naproxen)
  2. Antibiotics (aminoglycosides)
  3. Iodine-containing medications
  4. Lithium
  • Rhabdomyolysis
  • Multiple myeloma
  • Acute glomerulonephritis
  • Systemic lupus erythematosus
  • Wegener’s granulomatosis
  • Goodpasture syndrome

Post renal

  • Obstruction of the bladder or the ureters
  • Prostrate –hypertrophy/cancer
  • Tumours in the abdomen
  • Kidney stones(if a single kidney is present)   

Symptoms and signs

  • Anuria
  • Bloody stools
  • Breath odour
  • Bruising easily
  • Changes in mental status or mood
  • Decreased appetite
  • Decreased sensation (hands or feet)
  • Fatigue
  • Flank pain (between the ribs and hips)
  • Frequent urination
  • Hand tremor
  • Hypertension
  • Metallic taste in the mouth
  • Nausea or vomiting may last for days
  • Nosebleeds
  • Oliguria
  • Persistent hiccups
  • Prolonged bleeding
  • Seizures
  • Slow, sluggish movements
  • Swelling(generalized)
  • Swelling of the ankle, feet, and leg swelling

Investigations

  • Blood tests—
  1. creatinine
  2. BUN (Blood urea nitrogen)
  3. CBC
  • Urine C/E
  • USG

Treatment                   

  • Diet (high in carbohydrates and low in protein, salt and potassium)
  • Ayurvedic Medicines
  • Dialysis

Complications

  • Recurrent Infection
  • Uremic syndrome (uremia)
  • Increased potassium in the blood

Chronic Renal Failure (CRF)

Chronic renal failure is defined as a glomerular filtration rate (GFR) below 30 ml/min. Symptoms of uremia often occur when the GFR is less than 15 ml/minute.

Causes

  • Autoimmune disorders( systemic lupus erythematosus and scleroderma)
  • Chronic glomerulonephritis
  • Diabetes
  • Hypertension
  • Injury or trauma
  • kidney stones
  • Polycystic kidney disease
  • Reflux nephropathy
  • Toxic chemicals

Symptoms and signs

  •  Restless leg syndrome
  • Abnormally dark or light skin
  • Amenorrhea
  •  Bleeding
  •  Blood in the stool
  • Bone pain
  • Breath odour
  •  Confusion
  • Drowsiness
  • Easy bruising
  • Oedema
  • Excessive thirst
  • Fatigue                       
  • Frequent hiccups
  • Headaches
  • Insomnia
  • Loss of appetite
  • Low level of sexual interest and impotence
  •  Malaise
  • Muscle twitching or cramps
  • Nausea
  • Numbness in the hands, feet, or other areas
  •  Obstructive sleep apnea
  • Pruritus and dry skin
  • Unintentional weight loss
  • Vomiting, typically in the morning

Investigations

  • BUN
  • S. Creatinine
  • GFR
  • CT scan-abdomen
  • MRI-Abdomen
  • USG-Abdomen
  • Renal scan

Treatment

  • Ayurvedic Medications
  • Dialysis

Dialysis cleanses the body of waste products by the body by use of filter systems. Dialysis is life-saving in many kidney diseases. Without it, patients whose kidneys no longer function would die relatively quickly due to electrolyte abnormalities and the buildup of toxins in the bloodstream.

There are two types of dialysis done for kidney diseases-

  • Hemodialysis
  • Peritoneal dialysis

Hemodialysis

Hemodialysis uses a machine filter called a dialyzer or artificial kidney to remove excess water and salt, balance the other electrolytes in the body, and remove waste products of metabolism. Blood is removed from the body and flows through tubing into the machine, where it passes next to a filter membrane. A specialized chemical solution (dialysate) flows on the other side of the membrane. The dialysate is formulated to draw impurities from the blood through the filter membrane. Blood and dialysate are never touched in the artificial kidney machine.

For this type of dialysis, access to the blood vessels needs to be surgically created so that large amounts of blood can flow into the machine and back to the body. Surgeons can build a fistula, a connection between a large artery and vein in the body, usually in the arm, that causes a large amount of blood flow into the vein. This makes the vein larger and its walls thicker so that it can tolerate repeated needle sticks to attach tubing from the body to the machine. Since it takes many weeks for a fistula to mature enough to be used, significant planning is required if hemodialysis is to be considered as an option.

If the kidney failure happens acutely and there is no time to build a fistula, special catheters may be inserted into the larger blood vessels of the arm, leg, or chest. These catheters may be left in place for up to three weeks. In some diseases, the need for dialysis will be temporary, but if the expectation is that dialysis will continue for a prolonged period of time, these catheters act as a bridge until a fistula can be planned, placed, and matured.

Dialysis treatments normally occur three times a week and last a few hours at a time. Most commonly, patients travel to an outpatient centre to have dialysis, but home dialysis therapy is becoming an option for some.

Peritoneal dialysis

Peritoneal dialysis uses the lining of the abdominal cavity as the dialysis filter to rid the body of waste and balance electrolyte levels. A catheter is placed in the abdominal cavity through the abdominal wall by a surgeon and is expected to remain there for the long term. The dialysis solution is then dripped in through the catheter and left in the abdominal cavity for a few hours and then is drained out. During that time, waste products leech from the blood normally flowing through the lining of the abdomen (peritoneum).

Kidney transplantation

This is required for irreversible kidney diseases. Sometimes, family members have compatible tissue types and, if they are willing, may donate a kidney. Otherwise, the patient will be placed on the organ transplant list.

Complications

  • Anaemia
  • Bleeding from the stomach or intestines
  • Bone, joint, and muscle pain
  • Changes in blood sugar
  • Congestive heart failure
  • Coronary artery disease
  • Dementia
  • Fractures
  • High phosphorous, and potassium levels
  • Hyperparathyroidism
  • Hypertension
  • Infections
  • Infertility
  • Liver damage or failure
  • Malnutrition
  • Miscarriages
  • Pericarditis
  • Peripheral neuropathy
  • Pleural effusion
  • Seizures
  • Stroke

Prevention

               Treating the underlying disease/cause.

Polycystic Disease Of Kidney

Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys. These clusters of fluid-filled sacs interfere with the ability of kidneys to filter waste products from the blood.

Types

  1. Autosomal dominant PKD
  2. Autosomal recessive PKD
  3. Acquired polycystic kidney diseases

Autosomal dominant PKD

Autosomal dominant PKD means that if one parent has the disease, there is a 50 per cent chance that the disease gene will pass to a child. The polycystic kidney roughly retains the same shape as the healthy kidney.

Symptoms and signs

  • Pain in the back and between the ribs and hips (temporary or persistent, mild or severe.)
  • Headaches

Complications

  • Urinary tract infections
  • Hematuria
  • Liver and pancreatic cysts
  • Abnormal heart valves
  • High blood pressure
  • Kidney stones
  • Aneurysms in the brain
  • Diverticulosis

Autosomal recessive PKD

Autosomal recessive PKD is caused by a mutation in the autosomal recessive PKD gene. Parents who do not have PKD can have a child with the disease if both parents carry one copy of the abnormal gene and both pass that gene copy to their baby. If only one parent carries the abnormal gene, the baby cannot get autosomal recessive PKD but could ultimately pass the abnormal gene to his or her children.

Symptoms and signs

  • Developmental delay
  • Frequent urination
  • Haemorrhoids
  • Hypertension
  • Kidney failure before reaching adulthood.
  • Liver scarring
  • Low blood cell counts
  • Respiratory distress/failure
  • Urinary tract infections
  • Varicose veins

Investigations

  • Urine test
  • Blood test— FBC, Hematocrit
  • Cerebral angiography
  • USG-Abdomen
  • CT scan-Abdomen
  • MRI-Abdomen.
  • IVP
  • Genetic tests.

Treatment

  • Medications
  • Drainage of cysts
  • Surgery
  • Dialysis
  • Renal transplant

 Complications

  • Anaemia
  • Cysts(bleeding/rupture )
  • End-stage kidney disease
  • Hypertension
  • Infection of liver cysts
  • Kidney failure
  • Kidney stones
  • Liver failure( mild to severe)
  • Recurrent infections (urinary tract, kidneys, cysts)

Renal Calculi

Kidney stones (renal calculi) are hard, crystalline mineral materials formed within the kidney or urinary tract. As these are stones somewhere in the kidney system, renal calculi are clubbed under kidney diseases.

  • Stones in kidneys—Nephrolithiasis
  • Stones in the urinary tract—Urolithiasis
  • Stones in ureters–Ureterolithiasis

Causes

  • Hyper excretion of relatively insoluble urinary constituents
  1. Oxalates
  2.  Calcium
  3. Uric acid
  4.  Cysteine
  5. Magnesium trisilicate
  • Physiological changes in urine
  1. Urinary pH
  2. Colloid content
  3. Decreased concentration of crystalloids
  4. Urinary magnesium/calcium ratio.
  • Altered urinary crystalloids and colloids
  1. Increase in the crystalloid level
  2. Fall in the colloid level
  3. Loss of solvent action of colloids
  4. Loss of adhesive property of colloids
  • Decreased urinary output of citrate
  • Hyperparathyroidism
  • Nidus of stone formation
  • Prolonged immobilization
  • Urinary infection
  • Urinary stasis
  • Vitamin A deficiency

 Types

  • Calcium stones

Calcium can combine with other substances, such as oxalate, phosphate, or carbonate to form the stone

  • Cystine stones

This disorder runs in families and affects both men and women.

  • Struvite stones

Common in women with UTI. These stones can grow very large and block the kidney, ureter, or bladder.

  • Uric acid stones

They occur with gout or chemotherapy

Symptoms and signs

  • Pain
  1. Severe and sudden
  2. Felt in the belly area or side of the back
  3. Move to groin or testicles
  4. Fixed (ureteric colic/referred pain)
  • Abdominal distension
  • Chills
  • Diminished peristalsis
  • Fever
  • Haematuria
  • Hydronephrosis
  • Muscle rigidity over the kidney
  • Nausea
  • Pyuria
  • Swelling in the flank
  • Tenderness (renal angle posteriorly)
  • Vomiting

Investigations

  • Blood examination
  • Urinalysis
  • Radiography
  1. Straight X-ray
  2. Excretory urogram
  • Ultrasonography
  • Computed tomography
  • Renal Scan
  • Cystoscopy
  • Stone Analysis

Treatment

                 Kidney stones that are small enough usually pass on their own.

  • Self-Care

Drink at least 6 – 8 glasses of water per day to produce a large amount of urine. Some people might need to get fluids through a vein (intravenous).

  • Ayurvedic Medicines provide a quick and complete cure.
  • Surgery-
  1. Lithotripsy (shock wave lithotripsy)
  2. Endoscopic treatment
  3. Percutaneous removal (PCNL)
  4. Laparotomy

Complications

  1. Decrease or loss of function in the affected kidney
  2. Kidney damage
  3. Scarring
  4. Acute unilateral obstructive uropathy
  5. Recurrence of stones
  6. Urinary tract infection

Prevention

  1. Drink more water (8 to 10 glasses per day).
  2. Dietary changes –Avoid calculi-forming foods, such as those high in purines, and calcium.

Acute nephritic syndrome

Acute Nephritic Syndrome (acute glomerulonephritis) is a one of the kidney diseases in which glomeruli inflammation causes abrupt blood appearance in the urine with variable protein amounts and casts.

Causes

  • Abdominal abscesses
  • Goodpasture syndrome
  • Hemolytic uremic syndrome
  • Henoch-Schonlein purpura
  • Hepatitis
  • IgA nephropathy
  • Infective endocarditis
  • Klebsiella pneumonia
  • Membranoproliferative GN
  • Post-streptococcal glomerulonephritis
  • Rapidly progressive glomerulonephritis
  • SLE
  • Syphilis and other sexually transmitted diseases
  • Typhoid fever
  • Vasculitis
  • Viral diseases (mononucleosis, measles, mumps)

Symptoms and signs

  • Blurred Vision
  • Confusion
  • Cough (mucus or pink, frothy material)
  • Decreased alertness
  • Drowsiness
  • Oedema
  • Exertional Dyspnea
  • Flank Pain
  • Headache
  • Hematuria
  • Joint pain
  • Muscle ache
  • Lethargy
  • Malaise
  • Oliguria

Investigations

  • Blood tests-
  1. BUN
  2. Creatinine
  3. Creatinine clearance
  4. Potassium test
  5. Culture
  6. ANA titer (for lupus)
  7. ANCA ( for vasculitis)
  8. Anti-glomerular basement membrane antibody
  9. Serum complement (C3 and C4)
  • kidney biopsy
  • Urine c/e
  • Culture of the throat or skin

Treatment

  1. Limit salt, fluids and potassium in the diet
  2. Ayurvedic Medicines offer a complete cure in the initial stages of most kidney diseases.

Complications

  1. Congestive heart failure
  2. Pulmonary oedema
  3. Chronic glomerulonephritis
  4. Nephrotic syndrome

Asymptomatic haematuria/Proteinuria

Hematuria can be gross (i.e., the urine is overtly bloody, smoky, or tea coloured) or microscopic. It may be symptomatic or asymptomatic, transient or persistent, and either isolated or associated with proteinuria and other urinary abnormalities.

Classification

  • Glomerular origin hematuria

Characterized by Brown-colored urine, RBC casts, dysmorphic RBCs and proteinuria

  • Non-glomerular origin hematuria

Characterized by reddish or pink urine, the passage of blood clots, and eumorphic erythrocytes

Causes

Glomerular hematuria

  • Thin basement membrane disease
  • Alport syndrome
  • IgA nephropathy
  • Hemolytic-uremic syndrome
  • Postinfectious glomerulonephritis
  • Membranoproliferative glomerulonephritis
  • Lupus nephritis
  • Anaphylactoid purpura (Henoch-Schönlein purpura)

Nonglomerular hematuria

  • Coagulopathy
  • Anatomic abnormalities
  1. Hydronephrosis
  2. Polycystic kidney diseases
  3. Vascular malformations
  • Fever
  • Foreign bodies
  • Hypercalciuria/urolithiasis
  • Hyperuricosuria
  • Mechanical trauma (masturbation)
  • Menstruation
  • Sickle cell disease/trait
  • Strenuous exercise
  • Tumours
  • Urinary tract infection
  • Drugs/toxins
  1. Anticoagulants
  2. Cyclophosphamide
  3. Indinavir
  4. NSAID’s
  5. Ritonavir

Symptoms and signs

  • Abdominal pain
  • Arthritis
  • Dark-coloured urine
  • Dysuria
  • Early-morning periorbital puffiness
  • Oedema
  • Fever
  • Frequency
  • Hypertension
  • Joint pains
  • Oliguria
  • Passage of clots in urine
  • Enuresis
  • Skin rashes
  • Throat or skin infection
  • Weight gain

Investigations

  • Urine C/E
  • IVU
  • USG
  • Kidney biopsy

Treatment

 Asymptomatic hematuria generally does not require treatment. In conditions associated with abnormal clinical, laboratory, or imaging studies, treatment may be necessary, as appropriate, with the primary diagnosis.

Chronic glomerulonephritis

Chronic glomerulonephritis is a slowly progressive disease. The disease normally remains subclinical until the progressive phase begins. By the time it produces symptoms, chronic glomerulonephritis is usually irreversible.

Causes

 Chronic glomerulonephritis is caused when there is slow progressive destruction of the glomeruli of the kidney, with progressive loss of kidney function. Some cases are caused by specific stimuli to the body’s immune system, but the precise cause of most is unknown.

Signs and symptoms

  • Blood in the vomit or stools
  • Coma
  • Confusion
  • Dark, rust-coloured, or brown urine
  • Decreased alertness
  • Decreased sensation in the hands, feet, or other areas
  • Decreased urine output
  • Delirium
  • Drowsiness
  • Easy bruising or bleeding
  • Fatigue
  • Foamy urine
  • Frequent urination
  • Frequent hiccups
  • Generalized itching
  • Headache
  • Hypertension
  • Increased skin pigmentation (yellow or brown)
  • Lethargy
  • Malaise
  • Muscle cramps
  • Muscle twitching
  • Nausea and vomiting
  • Nocturnal urination
  • Nosebleed
  • Seizures
  • Somnolence
  • Unintentional weight loss

Investigations

  • Blood test
  1. BUN
  2. Hb
  3. creatinine
  • Urine c/e
  • X-rays (pelvis)
  • Renal biopsy

Treatment

  • Ayurvedic Medicines
  • Dietary restrictions ( salt, fluids, protein)
  • Dialysis
  • kidney transplantation

Complications

  • Renal failure
  • Death

Hypertension

Nephrotic syndrome

A nephrotic syndrome is a group of symptoms including protein in the urine (more than 3.5 grams per day), low blood protein levels, high cholesterol levels, high triglyceride levels, and swelling.

Causes

  • Minimal change disease(children)
  • Membranous glomerulonephritis (adults)
  • Infection (strep throat, hepatitis, mononucleosis)
  • Genetic disorders
  • Immune disorders
  • Diseases
  1. Diabetes
  2. Systemic lupus erythematosus
  3. Multiple myeloma
  4. Amyloidosis.

Symptoms and signs

  • Oedema
  • Hypercholesterolemia
  • Hypertension
  • Hypoalbuminemia
  • Proteinuria
  • Unintentional weight gain

Investigations

  • Blood test—
  1. cholesterol
  2. albumin
  3. BUN
  4. S. creatinine
  • Urine test—
  1. Protein
  2. Fats
  • Kidney biopsy

Treatment

  Treatment may be needed for a lifetime.

  • Ayurvedic Medicines
  • Vitamin D

Complications

  • Atherosclerosis
  • Drugs induced Osteoporosis, Cataract
  • Increased risk of infection
  • Diabetes

Rapidly progressive glomerulonephritis

Rapidly progressive glomerulonephritis (RPGN) is a syndrome of the kidney diseases with many of the glomeruli containing characteristic glomerular crescents (crescent-shaped scars). Because of this microscopic feature, RPGN is also called crescentic glomerulonephritis.

Causes

  • Goodpasture syndrome
  • Systemic lupus erythematosus
  • Wegener granulomatosis
  • idiopathic

 Signs and Symptoms

  • Hematuria
  • Rapid loss of renal function
  • Proteinuria
  • Hypertension
  • Oedema.

Investigations

  • Urine tests( protein and red blood cells)
  • kidney biopsy
  • blood culture

Treatment

  • Ayurvedic Medicines
  • Plasmapheresis( blood filtering)
  • Bed rest
  • Restricted fluid and salt intake

 Complications

  • Oliguria( poor kidney function)
  • Acute renal failure
  • Death (within months)

Recurrent macroscopic haematuria

Other kidney diseases are —

  1. Non-Proliferative
  • Minimal change nephropathy
  • Membranous nephropathy
  • Focal and segmental Glomerulosclerosis 

2. Proliferative

  • Diffuse mesangial proliferation with IgM deposition
  • Diffuse membrane proliferation with IgA deposition
  • Diffuse endothelial proliferative glomerulonephritis
  • Mesangiocapillary glomerulonephritis
  • Anti-GBM disease
  • Crescentic glomerulonephritis

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