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

• Fatigue

  General symptoms of CKD include: Fatigue, weakness, lack of energy and pale skin due to anemia Loss of appetite, nausea, and vomiting Frequent urination, especially at night Fluid retention, swelling around legs and eyes Itching Headaches Numbness in [kibowbiotech.com]

  Some of the symptoms, such as fatigue and appetite loss, mimic those of RA. Always tell your doctor about any new or worsening symptoms. [arthritis.org]

  Blockage of urinary collecting system (e.g. kidney stones) Chronic infections (e.g. pyelonephritis) Rare genetic disorders (e.g. polycystic kidney disease) Early Stage No clear signs with possible bubbles/blood in urine Mid Stage Loss of appetite Swelling Fatigue [nkfs.org]

  This causes kidney disease and leads to poor appetite, muscle cramps, swollen feet, fatigue and increased urination. The two main causes of chronic kidney disease are diabetes and hypertension. [ahchealthenews.com]

  Symptoms can include urinating at night, fatigue, nausea, itching, muscle twitching and cramps, loss of sensation, confusion, difficulty breathing, and yellow-brown skin. Diagnosis is by blood and urine tests. [merckmanuals.com]

• Weakness

  Symptoms of anemia include feeling tired and weak. Weak bones. CKD can change the way your body uses minerals, such as calcium and phosphorus. This can cause your bones to weaken. People who have CKD may lose their appetite. [familydoctor.org]

  Neurologic ailments ranging from encephalopathy with dizziness and mental change to peripheral neuropathies (restless leg or burning feet syndromes) and muscle weakness. [kibowbiotech.com]

  Anemia also contributes to fatigue and generalized weakness. The buildup of metabolic waste also causes nausea, vomiting, and an unpleasant taste in the mouth, which may lead to undernutrition and weight loss. [merckmanuals.com]

  Symptoms of Kidney Disease If you have kidney disease you may feel weak, tired or sick to your stomach. You may lose your appetite, feel irritable or have trouble thinking clearly. [umm.edu]

• Nausea

  General symptoms of CKD include: Fatigue, weakness, lack of energy and pale skin due to anemia Loss of appetite, nausea, and vomiting Frequent urination, especially at night Fluid retention, swelling around legs and eyes Itching Headaches Numbness in [kibowbiotech.com]

  Symptoms of developed kidney damage can include: Swelling of the lower leg - caused by water retention Darker coloured urine Lethargy and shortage of breath Nausea or vomiting People with diabetes should be screened for kidney function at least once each [diabetes.co.uk]

  […] pyelonephritis) Rare genetic disorders (e.g. polycystic kidney disease) Early Stage No clear signs with possible bubbles/blood in urine Mid Stage Loss of appetite Swelling Fatigue Late Stage Ammonia breath Loss of appetite/diarrhoea Difficulty breathing Swelling Nausea [nkfs.org]

  Kidney Disease Symptoms More frequent urination, especially at night Feeling tired and having less energy Trouble sleeping Nausea Headaches Weight loss and/or loss of appetite Swelling in feet, ankles or around the eyes due to fluid buildup There are [mottchildren.org]

  Later symptoms can include changes in your urine, nausea and appetite loss, itchiness, swollen or numb hands and feet, darkened skin and muscle cramps. [healthdirect.gov.au]

• Loss of Appetite

  […] of appetite Swelling Fatigue Late Stage Ammonia breath Loss of appetite/diarrhoea Difficulty breathing Swelling Nausea/vomiting Loss of consciousness Anaemia If the kidney damage is in the early stages, it can be controlled with medication and diet. [nkfs.org]

  Kidney Disease Symptoms More frequent urination, especially at night Feeling tired and having less energy Trouble sleeping Nausea Headaches Weight loss and/or loss of appetite Swelling in feet, ankles or around the eyes due to fluid buildup There are [mottchildren.org]

  Loss of appetite. Swelling of hands and feet. A feeling of itchiness. Numbness. Feeling of nausea or vomiting. Muscle cramps. Darkness of skin. Cleveland Clinic News & More Cleveland Clinic News & More [my.clevelandclinic.org]

  General symptoms of CKD include: Fatigue, weakness, lack of energy and pale skin due to anemia Loss of appetite, nausea, and vomiting Frequent urination, especially at night Fluid retention, swelling around legs and eyes Itching Headaches Numbness in [kibowbiotech.com]

• Failure to Thrive

  […] to thrive, leaky gut syndrome, autism and food allergies. [truth-out.org]

• Abdominal Pain

  pain produced by enlarged kidneys Prevent cardiac valve infection in patients with intrinsic valve disease Reduce kidney function decline in adults at risk of rapidly progressive ADPKD (tolvaptan [Jynarque]) Surgical intervention in ADPKD includes the [emedicine.medscape.com]

• Hypertension

  AMP-activated protein kinase (AMPK) plays a key role in normal renal physiology and the pathogenesis of hypertension and kidney disease. [ncbi.nlm.nih.gov]

  The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension. 2004;44(4):398-40415326093 Google Scholar Crossref 8. Hajjar I, Kotchen TA. [doi.org]

  In the Dietary Approaches to Stop Hypertension trial, the hypertension was improved within eight weeks by the DASH diet. [mydaytondailynews.com]

• Back Pain

  Contact your physician immediately if any of these symptoms occur: Swelling of parts of the body, particularly eyes, ankles or wrists Burning or abnormal discharge during urination Changes in the frequency of urination, especially at night Lower back [umm.edu]

  pain Diarrhea Fever Nosebleeds Rash Vomiting Having one or more of any of the symptoms above may be a sign of serious kidney problems. [kidneyfund.org]

  pain in the renal area, especially if there is fever Anaemia Tiredness or feeling unwell without apparent cause Widespread itchy skin (pruritus) These signs can indicate other problems besides kidney disease. [kidneyresearchuk.org]

  Vormann J, Goedecke T (2001) Supplementation with alkaline minerals reduces symptoms in patients with chronic low back pain. Trace Elem Med Biol 1:179–183 CrossRef Google Scholar 12. [doi.org]

  In some people, spinal problems require surgery or cause health problems, such as back pain of varying severity, throughout life. Sixty to 90 percent of individuals with VACTERL association have narrowing or blockage of the anus (anal atresia). [ghr.nlm.nih.gov]

• Osteoporosis

  The Bone Disease Clinic at UofL Physicians-Kidney Disease Program diagnoses and treats osteoporosis and related bone diseases using advanced tests and medical therapies. [uoflphysicians.com]

  Wachmann A, Bernstein DS (1968) Diet and osteoporosis. Lancet 1:958–959 Google Scholar 6. [doi.org]

  While you wait for a kidney, you may face other health challenges from kidney disease, such as sleep problems, osteoporosis or heart disease. [loyolamedicine.org]

  For those taking prednisone for long periods of time, these effects can be significant, including weight gain (especially around the face and trunk), moodiness, sleep disturbances, cataracts, and osteoporosis (weakening of the bones). [kidshealth.org]

• Bone Pain

  pain and fractures Decreased sexual interest and erectile dysfunction Change in energy level or strength Lightheadedness High blood pressure – (although high blood pressure is a sign and not a symptom, it can lead to symptoms) Clearly, these symptoms [kibowbiotech.com]

  Renal osteodystrophy may lead to bone pain and an increased risk of fractures. Drugs Mentioned In This Article sodium polystyrene sulfonate KALEXATE No US brand name ALDACTONE DDAVP, STIMATE DYRENIUM MIDAMOR RENAGEL ZETIA FOSRENOL [merckmanuals.com]

  Under 6.05B1, “severe bone pain” means frequent or intractable (resistant to treatment) bone pain that interferes with physical activity or mental functioning. Peripheral neuropathy. [ssa.gov]

  pain and fractures; and decreased sexual interest and erectile dysfunction. [emedicinehealth.com]

• Low Back Pain

  Vormann J, Goedecke T (2001) Supplementation with alkaline minerals reduces symptoms in patients with chronic low back pain. Trace Elem Med Biol 1:179–183 CrossRef Google Scholar 12. [doi.org]

• Kidney Failure

  Having one of the health problems that can lead to kidney failure does not mean that you will definitely have kidney failure. [kidneyfund.org]

  Leading Causes of Kidney Failure Singapore has one of the highest rates of kidney failure in the world. Every 5 hours, one person is diagnosed with kidney failure. [nkfs.org]

  Here we report a case of successful treatment of highly advanced immunoglobulin G4-related kidney disease presenting renal mass-like regions with end-stage kidney failure. [ncbi.nlm.nih.gov]

  Kidney disease usually causes a loss of kidney function to some degree and can result in kidney failure, the complete loss of kidney function. [en.wikipedia.org]

  Over time, kidney disease can lead to kidney failure. African Americans are nearly four times more likely to develop kidney failure than Caucasians. The body has two kidneys, which filter extra water and waste from blood to make urine. [theweeklychallenger.com]

• Hematuria

  AFP BY TOPIC Editors' Choice of Best Available Content This collection features the best content from AFP, as identified by the AFP editors, on kidney disease and related issues, including acute renal failure, chronic kidney disease, dialysis, hematuria [aafp.org]

  Reflux Glycosuria Goodpasture Syndrome Green Smoothie Cleanse Nephropathy HANAC Syndrome Harvoni (Ledipasvir with Sofosbuvir)-Induced Renal Injury Hair Dye Ingestion and Acute Kidney Injury Hantavirus Infection Podocytopathy Heat Stress Nephropathy Hematuria [kidney.nyc]

  For example, hematuria with severe, colicky pain suggests obstruction by a kidney stone; hematuria without pain may indicate renal carcinoma; proteinuria is generally a sign of disease in the glomerulus, or filtration unit, of the kidney; pyuria indicates [medical-dictionary.thefreedictionary.com]

  The classic presentation (in 40-50% of the cases) is episodic frank hematuria which usually starts within a day or two of a non-specific upper respiratory tract infection (hence synpharyngitic) as opposed to post-streptococcal glomerulonephritis which [en.wikipedia.org]

• Nocturia

  Mild to moderate loss of kidney function may cause only mild symptoms, such as the need to urinate several times during the night (nocturia). [merckmanuals.com]

  Signs and symptoms of chronic kidney disease include: need to urinate frequently, especially at night (nocturia); swelling of the legs and puffiness around the eyes (fluid retention); high blood pressure; fatigue and weakness (from anemia or accumulation [emedicinehealth.com]

  […] symptoms is termed uraemia. [16] Symptoms of kidney failure include the following: [16] [17] [18] [19] High levels of urea in the blood, which can result in: Vomiting or diarrhea (or both) may lead to dehydration Nausea Weight loss Nocturnal urination ( nocturia [en.wikipedia.org]

• Dysuria

  Characteristics of kidney disease are hematuria, persistent proteinuria, pyuria, edema, dysuria, and pain in the flank. Specific symptoms vary with the type of disorder. [medical-dictionary.thefreedictionary.com]

• Amenorrhea

  […] chronic kidney disease include: Appetite loss Chronic itching Fatigue Headaches Nausea Unexplained weight loss/gain Later symptoms of chronic kidney disease include: Aching bones Bad breath Concentration issues Cramps Disruption of menstrual cycles (amenorrhea [loyolamedicine.org]

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].

• Hyponatremia

  Hypercalcemia Hyperkalemia Hypermagnesemia Hypernatremia Hyperoxaluria Hyperphosphatemia Hypocalcemia Hypocomplementemic Urticarial Vasculitic Syndrome Hypokalemia, Hypokalemia-induced renal dysfunction Hypokalemic Periodic Paralysis Hypomagnesemia Hyponatremia [kidney.nyc]

• Creatinine Increased

  As kidney function declines, the levels of creatinine increase. An equation is used to determine GFR. In addition to serum creatinine, factors such as age, race, and gender are included in the equation. [nephcure.org]

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]. 

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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.
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