Kidney & Its Common Diseases

Neuro Workgroup SIG12 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

NephronNephron

GlomerulusGlomerulusTubulesTubules

The Kidneys

Functions

• Removal of waste and excess water from body

• 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)

Functions

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 DiseasesPolycystic Kidney Disease

Hypertensive Nephrosclerosis Glomerulonephritis / Glomerulosclerosis

Urinary Tract Infection (UTI) Kidney Stones

Diabetic Kidney DiseaseAnalgesic nephropathy

• 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

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

TreatmentSpecific• 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 DiseaseSigns 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

• BP• Temp• HR

– Catheterisation?– Dialysis

• When?• Eventful?

– Other electrolyte values

• Na• K• Creatinine• Urea• Etc

– Blood count– 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).