Kidney Disease

Kidney diseases manifest as pain in flank or lower abdomen, abnormal urine output, hematuria, proteinuria, edema, fever, and urinary incontinence [6].

The diagnosis can be done by physical examination and by other investigations. In each and every case urine examination is done. Urine may show erythrocytes, leukocytes, protein, cell cast, and solid material like crystals.

Kidney function tests are required to assess functional status of kidney based on creatinine, and electrolytes. X-ray is important to examine kidney location, size, and obstruction, and same need to be confirmed by USG.

Intravenous urography is better than USG for defining papillae, stones, and urothelial malignancy. Pyelography gives best view of collecting system and upper tract, particularly in obstruction. CT scans are done for detecting mass lesions, cysts and vasculature. Radionuclide studies are important for perfusion [7].

Renal artery stenosis requires treatment with antihypertensive drugs, aspirin and lipid lowering agents. Glomerular and interstitial diseases may require immunosuppressant drugs. Urinary tract infections can be treated by antibiotics. Renal and ureteric calculi may be treated with hydrotherapy, centrally acting analgesics or might require surgical intervention like electric shock wave lithotripsy.

Acute renal failure is managed by diet, electrolyte balance and treatment of underlying condition like shock or obstruction. Chronic kidney failure is managed by diet, lipid control, electrolyte and fluid balance, erythropoietin, and vitamin D.

When urea level exceeds 30mmol/l or creatinine 600 mmol/l, either hemodialysis or renal replacement is indicated [8].

Immunological and inherited conditions like polycystic kidney disease or Alport syndrome have poor prognosis often progressing to chronic kidney failure. Tubulo-interestitial disorders have moderate to good prognosis if causative drugs are withdrawn or if infections are treated. Conditions like renal calculi and pyelonephritis have good prognosis as these are curable by medicines or surgery [5].

Diseases of renal vessels are due to stenosis of renal arteries or small intrarenal vessels. Glomerular diseases may be due to Alport syndrome, Goodpasture syndrome, glomerulonephritis, minimal change nephropathy, IgA nephropathy, and post-infectious glomerulonephritis.

Tubulo-interestitial diseses may be due to drugs like penicillin or allopurinol, autoimmune pathology, or due to infections like tuberculosis or leptospirosis. It may be a chronic condition secondary to excess use of non-steroidal anti-inflammatory drugs (NSAIDs), sickle cell disease or chronic pyelonephritis. Polycystic diseases are mostly genetic.

Kidneys are affected by systemic disorders like shock, diabetes, vasculitis, systemic lupus erythematosus and malignancy. Infections of lower urinary tract, upper urinary tract and kidney are mostly due to Escherichia coli, proteus, pseudomonas, staphylococcus and streptococci [2].

Concentrated urine and other factors and mechanisms result in stone formation in urinary tract. Renal adenocarcinoma is commonest tumor of adults whereas nephroblastoma is a common in children. 

One in 10 and a total of 20 million Americans are suffering from chronic kidney disease. Incidence increases with age ranging from 18.8 to 24.5% above age of 60 years. Mortality pertaining to kidney diseases is decreasing because of improved dialysis or kidney transplantation [3].

Renal stenosis causes decrease in lumen of vessel and thus leading to hypertension. Glomerular diseases are characterized by leukocyte infiltration, mesangial proliferation, and accumulation of extracellular matrix.

Tubulo-interestitial diseses are characterized by inflammatory infiltrate. Sickle cell nephropathy by papillary necrosis. Polycystic kidney disease shows multiple cysts lined by proximal tubular epithelium. Diabetes causes glomerulosclerosis.

Since kidney is elimination route for many drugs and toxins, their effect is obvious on kidneys most of the time. These may cause hemodynamic changes (eg. ACE inhibitors), tubular necrosis (eg. aminoglycosides, amphoteracin), immunological reaction (eg. penicillamine), and crystal formation (eg. acyclovir) [4].

Diabetes, blood pressure and drug relateds condition are preventable by control of respective cause. Infections and stones could be prevented by proper hygiene and hydration [9].

The symptoms of kidney diseases range from alteration of urine output, hematuria, proteinuria, edema, retention of urine, urinary incontinence to renal failure. Conditions are diagnosed by urine analysis, kidney function tests, kidney, ureter, and bladder (KUB) X-ray, ultrasonogram, intravenous urography, pyelography, CT, MRI, and radionuclide studies. Management is pharmacological or surgical [1].

• Definition: Kidney diseases are diseases affecting one or both kidneys. The cause widely varies, and same is with various forms of kidney diseases. They can be congenital or acquired, localized or systemic in origin.
• Smptoms: Kidney diseases manifest as abnormal urine output, blood and protein in urine, edema, and pain in flank or lower abdomen, fever and urinary incontinence.
• Diagnosis: The diagnosis can be done by physical examination, and other investigations like urine examination, kidney function tests, X-ray, intravenous urography, pyelography, and CT.
• Treatment: Medical treatment with the help of antihypertensive drugs, immunsuppressants, antibiotics, diet, fluid and electrolyte balance can be done most of the cases. Serious conditions require dialysis or renal transplantation as final resort [10]. 

1. Fox CS, Larson MG, Leip EP, et al. Predictors of new-onset kidney disease in a community-based population. JAMA 2004; 291:844.
2. Rennke HG, Anderson S, Brenner BM. Structural and functional correlations in the progression of renal disease. In: Renal Pathology, Tisher CC, Brenner BM (Eds), Lippincott, Philadelphia 1989. p.43.
3. Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis 2006; 13:199.
4. Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000; 35:S1.
5. Kessler M, Frimat L, Panescu V, Briançon S. Impact of nephrology referral on early and midterm outcomes in ESRD: EPidémiologie de l'Insuffisance REnale chronique terminale en Lorraine (EPIREL): results of a 2-year, prospective, community-based study. Am J Kidney Dis 2003; 42:474.
6. Curtis BM, Ravani P, Malberti F, et al. The short- and long-term impact of multi-disciplinary clinics in addition to standard nephrology care on patient outcomes. Nephrol Dial Transplant 2005; 20:147. 
7. United States Renal Data System. USRDS 2009 Annual Data Report. U.S. Department of Health and Human Services. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Am J Kidney Dis 2010; 55(Suppl 1):S1.
8. Delmez JA, Slatopolsky E. Hyperphosphatemia: its consequences and treatment in patients with chronic renal disease. Am J Kidney Dis 1992; 19:303.
9. Gonick HC, Kleeman CR, Rubini ME, Maxwell MH. Functional impairment in chronic renal disease. 3. Studies of potassium excretion. Am J Med Sci 1971; 261:281.
10. Gómez CG, Valido P, Celadilla O, et al. Validity of a standard information protocol provided to end-stage renal disease patients and its effect on treatment selection. Perit Dial Int 1999; 19:471.

• Giltleman syndrome
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