KIDNEY DISEASES

• Classified according to degree of severity:

a) kidney stones
b) acute kidney injury (AKI)
c) chronic kidney disease (CKD)
d) end-stage renal disease (ESRD)
Nephrolithiasis (Kidney stones)
• Abnormal crystallization of mineral salts
• During fourth and fifth decade of life
• Risk Factors
Family history
Previous stone formation
Medical conditions
Excess vitamin D intake
UTIs
Obesity, diabetes, metabolic syndrome
Pathophysiology
• Complex process
• Calcium stones are the most common
• Obesity  predictor of stone recurrence
• Uric acid stones  common in type 2 diabetes
• Risk declines in postmenopausal women
• Weight control
• Bariatric procedures
• Agents added to food
o Calcium stones
• Accounts for majority of the cases of stone formation
• Hypercalciuria
• Idiopathic hypercalciuria
• Stone formation triggered by calcium
• Bone loss high in patients with IH
• Use of calcium supplements
o Oxalate stones
• Hyperoxaluria
• Patients with inflammatory bowel disease and gastric bypass
• Oxalate comes from endogenous synthesis
o Uric acid stones
• End product of purine metabolism
• From endogenous and exogenous sources
• Low urine pH
• Diabetes, obesity and hypertension
• Animal proteins rich in purines
o Cysteine stones
• High cysteine in urine
• Cysteine solubility increases with alkalinity
• High fluid, low sodium, less animal protein, high fruits and vegetables
o Melamine and Indinavir stones
• In young children, who were fed infant formula
• Synthesized from urea
• Increases protein content of milk
• Precipitates in distal renal tubules
• Hypocalcitraturia
o Struvite stones
• Composed of magnesium ammonium phosphate and carbonate apatite
• Form in the presence of bacteria
• Breakdown results in ammonia and carbon dioxide; raised pH
• Extracorporeal shock wave lithotripsy