Kidney & Its Common Diseases

Neuro Workgroup SIG

12 June 2008
Suhaila Mohamed Usuludin
 Content
• Kidneys & Functions
• Kidney Failure/ESRD
– Risk factors
– Symptoms
– Treatment
• Hemodialysis
• Peritoneal Dialysis
• Common Kidney Diseases
• In the wards…
 The Kidneys
• A pair of bean-shaped organs located at the
posterior wall of the abdomen
• Dimensions
– 11 cm long, 6 cm wide and 3 cm thick
– weighs about 160g
 The Kidneys
• Made up of functioning units called nephrons

Nephron

Tubules Glomerulus
The Kidneys
 Functions
• Removal of waste and excess water from body
 Functions

• Normal kidneys release several hormones

– Renin (regulates blood pressure)
– Erythropoietin (stimulates production of red blood
cells)
– Activated form of Vitamin D (maintain normal bone
structure)
 Kidney Failure or End-stage Renal
Disease (ESRD)
• Occurs when the kidneys do not function
properly or sufficiently, resulting in the
accumulation of waste products and toxic
materials
– may cause permanent and irreversible damage to
body cells, tissues and organs
– kidneys that function <20% of required capacity
• need renal replacement therapy
 Risk Factors
• Chronic diseases
• Inflammatory diseases
• Blockage of urinary collecting system
• Chronic infections
• Rare genetic disorders
 Symptoms
• Decreased urination
• Blood in the urine
• Nausea and vomiting
• Swollen hands and ankles
• Puffiness around the eyes
• Itching
• Sleep disturbances
• High blood pressure
• Loss of appetite
 Treatment of Kidney Failure
Blood creatinine rises to 900 µmol/ L
• Dialysis
– Hemodialysis
– Peritoneal Dialysis
• Transplant
– the best means of treatment
 Hemodialysis
• A process by which excess waste products and
water are removed from the blood
• Requires an access to the patient's blood
stream and the use of a haemodialysis machine
 Hemodialysis
• Vascular Access
– arterio-venous (AV) fistula
– AV graft
 Hemodialysis
• AV grafts
 Hemodialysis

• 3 times a week (on alternate days) for 3 to 5 or

more hours each visit
 Hemodialysis
• “Washout Syndrome”
– feels weak, tremulous, extreme fatigue
– syndrome may begin toward the end of treatment
or minutes following the treatment
– may last 30 minutes or 12-14 hours in a dissipating
form
 Hemodialysis
• Advantages
– Staff performs treatment in the dialysis centre
– Three treatments per week in the dialysis centre
– Permanent internal access required
– Regular contact with people in the centre
 Hemodialysis
• Disadvantages
– Requires travel to a dialysis centre
– Fixed treatment schedule
– Two needle sticks for each treatment; tie onto a
machine and cannot move about during treatment
– Diet and fluid intake restriction
 Peritoneal Dialysis
• Dialysis solution flow into the peritoneal
(abdominal) cavity through a catheter
• Petrionuem acts as a filter
 Peritoneal Dialysis
• 2 forms
– CAPD (Continuous Ambulatory Peritoneal Dialysis)
• 4 exchanges during the day, 45 min each
– APD (Automated Peritoneal Dialysis)
• exchanges are performed by the machine during the
night while the patient is asleep
 Peritoneal Dialysis
• Advantages
– Patient's involvement in self-care
– Control over schedule
– Less diet & fluid restriction
– More steady physical condition as it provides slow,
continuous therapy
– Most similar to original kidneys. Can be done in the
night as in automated peritoneal dialysis
– Provide less severe cardiovascular instabilities in
patients with underlying heart disease
 Peritoneal Dialysis
• Disadvantages
– Four exchanges per day
– Permanent external catheter
– Change of body image
– Some risks of infection
– If on automated peritoneal dialysis, one will be tie
onto a machine in the night
– Storage space is needed for supplies
 Kidney Transplant
• A kidney from either a living related or a brain
dead person is removed and surgically placed
into the kidney failure patient.
• Not all kidney failure patients are fit to
undergo transplantation.
– Medication to suppress their immunity given for
the transplant may worsen their general health
 Kidney Transplant
• Advantages
– Absence of need for frequent dialysis treatment
– Better quality of life
– Better health
– Reduced medical cost after first year
– No diet and fluid intake restriction
– Provide less severe cardiovascular instabilities in
patients with underlying heart disease
 Kidney Transplant
• Disadvantages
– Need for frequent physician visits
– Pain, discomfort of surgery
– Risk of transplant rejection
– Prone to infections
– On lifelong medications
Common Kidney Diseases
Polycystic Kidney Disease
Hypertensive Nephrosclerosis
Glomerulonephritis / Glomerulosclerosis
Urinary Tract Infection (UTI)
Kidney Stones
Diabetic Kidney Disease
Analgesic nephropathy
 Polycystic Kidney Disease

• Genetically acquired
• 2 forms - dominant and recessive
• In the dominant PKD form, one parent has the
disease and passes it to the child. The chance of
passing the gene to the offspring is 50%.
• Cysts are abnormal pouches containing fluid.
Eventually the cysts replace normal kidney
tissue -> suffers ESRD
 Polycystic Kidney Disease

Signs and Symptoms

• Dull pain at the side of the abdomen and back
• Blood in the urine
• Frequent urine tract infection
• High blood pressure (often before cysts
appear)
• Upper abdominal discomfort (liver and
pancreatic cysts)
 Polycystic Kidney Disease

Treatment
• Blood pressure - controlled and treated
• Kidney failure - supportive therapy until end-
stage is reached when dialysis or
transplantation is then required
• Urine tract infection - treatment with
antibiotics
• Pain - analgesics are used. Alternatively, surgery
to shrink or resect the cysts.
 Hypertensive Nephrosclerosis
• Poorly controlled high blood pressure
(hypertension) can lead to kidney failure
– Thickening of blood vessels
 Hypertensive Nephrosclerosis
Signs and Symptoms
• Headache
• Giddiness (sometimes related to posture)
• Neck discomfort
• Easily tired
• Nauseous and/or vomiting
• Protein in urine
 Hypertensive Nephrosclerosis
Treatment
• Medications to control blood pressure (anti-
hypertensive)
• Lowering of dietary salt (2g/day)
• Exercise regularly
 Glomerulonephritis /
Glomerulosclerosis
• Glomerulonephritis - An inflammatory
condition that affects predominantly the
glomeruli.
• Causes
– IgA nephropathy
– Streptococcus bacteria
– Autoimmune
• Glomerulosclerosis - scarring of the glomeruli
 Glomerulonephritis /
Glomerulosclerosis
Signs and Symptoms
• Blood or protein in urine
• Frothy urine (signifying protein in urine)
• Dark or pink-coloured urine
• Leg swelling
• Systemic disease like diabetes or autoimmune
disease will have systemic manifestations, e.g.
weight loss, arthritis, or skin rash
 Glomerulonephritis /
Glomerulosclerosis
Treatment
Specific
• Suppression of inflammation may be achieved
by certain medications (eg steroids).
General
• Medications to decrease excretion of urinary
protein
• Control of blood pressure
• Dietary modifications
 Urinary Tract Infection (UTI)
• Disease of the urinary tract
– Infection occurs when microorganisms attach
themselves to the urethra and begins to multiply.
• May lead to infection of the kidneys
(pyelonephritis) and cause permanent kidney
damage, if left untreated.
• Women are especially prone to get urinary
tract infection.
 Urinary Tract Infection (UTI)
• Conditions that increases risk of UTI
– Diabetes
– Situations where a urine catheter is needed
– Abnormalities of the urinary tract
– Obstructed urine flow (large prostate or stone)
– Being pregnant
 Urinary Tract Infection (UTI)
Signs and Symptoms
• Painful urination (burning sensation)
• Hot and foul smelling urine
• Blood in urine
• Fever (sometimes with chills)
• Painful lower abdomen
• Increased urgency/frequency of wanting to
pass urine
• Nausea and/or vomiting
 Urinary Tract Infection (UTI)
Treatment
• Appropriate antibiotics
• Drink plenty of water
 Kidney Stones
• Start as salt/chemical crystals that precipitate
out from urine
• Occurs when substance in urine that prevents
crystalisation are ineffective
 Kidney Stones
• Various forms of kidney stones - the most
common is calcium in combination with either
phosphate or oxalate
• More common in
– Males
– 20-40 yo
 Kidney Stones
Signs and Symptoms
• Extreme pain at the site where the stone is
causing the irritation
• Blood in the urine (abrasion along the urinary
tract as the stone travels)
• Painful and/or difficult urination
• Unable to pass urine if the stone is large
enough to obstruct the outlet completely
 Kidney Stones
Treatment
• With plenty of water, most stones can pass
through if small
• Pain-killers (as prescribed by the doctor)
• Some medications may help 'breakdown' larger
stone
• Shockwave therapy (F-SWL) to break the stone
• Surgical intervention - cystoscopy or open
surgery
 Diabetic Kidney Disease
• Common in chronic and poorly controlled
diabetics
• Diabetes damages blood vessels in the kidneys
• Occurs in both types of diabetes
• Occurrence of high blood pressure in diabetics
is a strong predictor for diabetic nephropathy
• Most common cause of ESRD in many
developed countries
 Diabetic Kidney Disease
Signs and Symptoms
• Frothy urine (signifying protein in urine)
• Leg swelling (worse after walking/standing)
• High blood pressure
• Itching
• Nausea and/or vomiting
• Losing weight
• Lethargy
• Increased need to urinate at night
 Diabetic Kidney Disease
Treatment
• Good control of diabetes
• Good control of blood pressure (aiming for <
130/85 or lower in younger patients)
• Medications to decrease protein excretion and
preserve the function of kidneys
• Lower protein diet
• Treat any urine tract infection (which is
common in diabetics)
 Analgesic Nephropathy
• Chronic kidney disease that occurs when there
is a long period of painkiller/s ingestion (usually
years)
• Associated with conditions which require
constant need for painkiller medications
• May lead to ESRD
 Analgesic Nephropathy
Signs and Symptoms
• Blood in the urine
• Protein in the urine
• Signs and symptoms related to kidney failure
such as nausea, vomiting, lethargy, swelling,
and poor appetite.
 Analgesic Nephropathy
Treatment
• Avoid long-term consumption of analgesics
• Those already with kidney disease of other
kinds should certainly refrain from harmful
analgesics as much as possible.
 In the wards…
• Look out for…
– Vital signs – Other electrolyte
• BP values
• Temp • Na
• HR • K
• Creatinine
– Catheterisation?
• Urea
– Dialysis
• Etc
• When?
– Blood count
• Eventful?
– Hb
 References
Kidney Dialysis Foundation (2007). Normal Kidney Functions. Health Guide
[Online]. Available: http://www.kdf.org.sg/health.php (2008, June 01).

National Kidney Foundation (2007). Common Kidney Diseases. Education

[Online]. Available: http://www.nkfs.org/index.php (2008, June 01).