Kidney diseases are one the leading causes of morbidity and mortality worldwide. Kidney pathology could be due to congenital, genetic, aquired, drug induced or due to manifestation of various systemic diseases.
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 .
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 .
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 Tubulo-interestitial disorders have moderate to good prognosis if causative drugs are withdrawn or if infections are treated.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 .
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 .
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 .
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) .
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 .
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 .