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Kidney Disease


OVERVIEW OF Kidney Disease :

In kidney failure the filtration capability of the kidney is lost. There are various reasons for the kidney failure


STRUCTURE of Kidney Disease :

The nephrons are the functional unit of the kidney. The kidney consists of proximal convoluted kidney, distal convoluted kidney, collecting duct.  A nephron consists of the two parts namely the corpuscles and tubules. The tubules aids the kidney in monitoring the passasges of fluids and chemicals. The tubules includes the distal convoluted tubule, proximal convoluted tubule, loop of henle and the collecting duct. The cortex is the outer covering structure of the kidney. It leads to medulla where the renal pyramids are located. The renal pyramids consists of collecting ducts


CAUSES :

  • Type 1 or type 2 diabetes
  • High blood pressure
  • Glomerulonephritis (gloe-mer-u-low-nuh-FRY-tis), an inflammation of the kidney's filtering units (glomeruli)
  • Interstitial nephritis (in-tur-STISH-ul nuh-FRY-tis), an inflammation of the kidney's tubules and surrounding structures
  • Polycystic kidney disease
  • Prolonged obstruction of the urinary tract, from conditions such as enlarged prostate, kidney stones and some cancers
  • Vesicoureteral (ves-ih-koe-yoo-REE-tur-ul) reflux, a condition that causes urine to back up into your kidneys
  • Recurrent kidney infection, also called pyelonephritis (pie-uh-low-nuh-FRY-tis)

Risk factors

Factors that may increase your risk of chronic kidney disease include:

  • Diabetes
  • High blood pressure
  • Heart and blood vessel (cardiovascular) disease
  • Smoking
  • Obesity
  • Being African-American, Native American or Asian-American
  • Family history of kidney disease
  • Abnormal kidney structure
  • Older age


COMMON CLINICAL SIGNS AND SYMPTOMS :

Nausea

Vomiting

Loss of appetite

Fatigue and weakness

Sleep problems

Changes in how much you urinate

Decreased mental sharpness

Muscle twitches and cramps

Swelling of feet and ankles

Persistent itching

Chest pain, if fluid builds up around the lining of the heart

Shortness of breath, if fluid builds up in the lungs

High blood pressure (hypertension) that's difficult to control


DIAGNOSTIC :

The different stages of CKD form a continuum. The stages of CKD are classified as follows [3]

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m 2)

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m 2)

Stage 3a: Moderate reduction in GFR (45-59 mL/min/1.73 m 2)

Stage 3b: Moderate reduction in GFR (30-44 mL/min/1.73 m 2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m 2)

Stage 5: Kidney failure (GFR < 15 mL/min/1.73 m 2 or dialysis)

 

Diagnosis:

Tests and procedures used to diagnose bladder cancer may include:

  • Cystoscopy:

It is the small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens and also it emits light and what happens in the inside of your urethra and bladder, to examine these structures for signs of disease.

Biopsy:

It is the procedure of removing the tissue from the kidney

In cystoscopic procedure , it has some specialized  tool through which the scope and into your bladder to collect a cell sample (biopsy) .

Examining a urine sample (urine cytology). A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.

  • Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, are used to reveal the structures in the urinary tract.

During a CT urogram, a contrast dye is injected intravenously by the hand and eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract

Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. The threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.

After determining  the above mentioned test the doctor might suggest the following diagnostic test:

Tests may include:

  • CT scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Bone scan
  • Chest X-ray

certain cases, the following tests may be ordered as part of the evaluation of patients with CKD:

  • Serum and urine protein electrophoresis, serum and urine free light chains: Screen for a monoclonal protein possibly representing multiple myeloma
  • Antinuclear antibodies (ANA), double-stranded DNA antibody levels: Screen for systemic lupus erythematosus
  • Serum complement levels: Results may be depressed with some glomerulonephritides
  • Cytoplasmic and perinuclear pattern antineutrophil cytoplasmic antibody (C-ANCA and P-ANCA) levels: Positive findings are helpful in the diagnosis of granulomatosis with polyangiitis (Wegener granulomatosis); a positive P-ANCA result is also helpful in the diagnosis of microscopic polyangiitis
  • Anti–glomerular basement membrane (anti-GBM) antibodies: Their presence is highly suggestive of underlying Goodpasture syndrome
  • Hepatitis B and C, human immunodeficiency virus (HIV), Venereal Disease Research Laboratory (VDRL) serology: These conditions are associated with some glomerulonephritides .
  • Imaging studies and consideration of bladder function studies: These evaluate for possible obstruction and other urologic abnormalities

 

Urinalysis:

The urine dipstick method is used to evaluate the presence of chronic kidney disease. The patient is asked to investigate the presence of proteinuria. There is also presence albumin specific dipstick method to detect the presence of albumin the urine.  Urine sediments suggestive of  red blood cells and RBC casts suggest of proliferative glomerulonephritis.

 


TREATMENT AND PROGNOSIS :

The treatment for the kidney failure includes

Kidney transplant

Dialysis

Other supportive care

Kidney transplant:

It is a surgical procedure to place the healthy kidney from a liver or deceased donor into the person whose kidneys no longer able to function properly. A kidney transplant is often the treatment of choice for the end stage kidney disease when compared with the lifetime on dialysis.  A

The kidney transplant process takes time. It involves finding a donor, living or deceased, whose kidney best matches your own. A surgical procedure to place the new kidney in your lower abdomen and attach the blood vessels and ureter — the tube that links the kidney to the bladder — that will allow the new kidney to function.

Dialysis:

It does the kidney function when the kidney is not able to perform proper function. This include removing extra fluids and waste products from the blood, restoring electrolyte levels and helps the kidney in controlling the blood pressure. Dialysis option includes hemodialysis and peritoneal dialysis.

Peritoneal dialysis:

During this dialysis the blood vessels in the abdominal lining which is called as peritoneum fill the kidneys with the help of the fluid that washes in and out of the peritoneal space.

Hemodialysis:

A machine does some work of the kidneys by filtering the harmful watse , salts and fluid from the blood. The liestyle changes is necessary in the prognosis of the disease and results.


PREVENTION :

Avoid products that are abundance in salt

Take lower potassium diet

Limit the amount of the protein intake