Nephrology

The kidneys are one of the most important organs in the human body. The kidneys help to detox and filter impurities from the blood, as well as waste products from your urine. Kidney stones form when the kidneys are not able to process toxins efficiently. Specifically, a crystallization of unprocessed minerals builds up. Kidney stones cause pain and possible blockage of urine flow.

Diseases affecting the kidneys

Diseases including diabetes and high blood pressure also affect the kidney adversely and it is a nephrologist who deals with preventing and treating renal damage caused by these systemic or whole body diseases as well.

• Fluid and electrolyte disorders
• Acid-base disorders
• Kidney stones
• Glomerular diseases
• Tubulointerstitial diseases
• Mineral metabolism

• Acute kidney disease
• Acute renal failure
• Chronic kidney diseases
• Chronic renal failure
• End stage renal disease and dialysis

Classification of the Diseases of the Kidney

Classification of the Diseases of the Kidney Glomerules- Primarily Nephrotic

Classification of the Diseases of the Kidney- General

Summary of Kidney Disease:

Most kidney diseases attack the nephrons. This damage may leave kidneys unable to remove wastes. Causes can include genetic problems, injuries, or medicines. You have a higher risk of kidney disease if you have diabetes, high blood pressure, or a close family member with kidney disease. Chronic kidney disease damages the nephrons slowly over several years. Other kidney problems include

• Cancer
• Cysts
• Stones
• Infections

Your doctor can do blood and urine tests to check if you have kidney disease. If your kidneys fail, you will need dialysis or a kidney transplant.

Kidney Disease Kidney disease is classified as any disease or disorder that affects the function of the kidneys. This may include:

Tests and Proceduresin the diagnosis and treatment of kidney diseases.

Some Kidney Diseases as Acute tubular necrosis (ATN)

Acute tubular necrosis (ATN) is often caused by a lack of blood flow and oxygen to the kidney tissues (ischemia of the kidneys). It may also occur if the kidney cells are damaged by a poison or harmful substance.

The internal structures of the kidney, particularly the tissues of the kidney tubule, become damaged or destroyed. ATN is one of the most common structural changes that can lead to acute renal failure.

ATN is a common cause of kidney failure in hospitalized people. Risks for ATN include:
Blood transfusion reaction
Injury or trauma that damages the muscles
Low blood pressure (hypotension) that lasts longer than 30 minutes
Recent major surgery

Septic shock due to severe infection
ATN can also be caused by:
Dye (contrast) used for x-ray (radiology) studies
Medicines that are toxic to the kidneys (such as aminoglycoside antibiotics or amphotericin)

Acute kidney failure

Acute kidney failure is the rapid (less than 2 days) loss of your kidneys’ ability to remove waste and help balance fluids and electrolytes in your body.

Causes

There are many possible causes of kidney damage. They include:

• Acute tubular necrosis (ATN)
• Autoimmune kidney disease
• Blood clot from cholesterol (cholesterol emboli)
• Decreased blood flow due to very low blood pressure, which can result from burns, dehydration, hemorrhage, injury, septic shock, serious illness, or surgery
• Disorders that cause clotting within the kidney blood vessels
• Infections that directly injure the kidney, such as acute pyelonephritis or septicemia
• Pregnancy complications, including placenta abruption or placenta previa
• Urinary tract blockage
• Illicit drugs such as cocaine and heroine</li
• Medicines including non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics and blood pressure medicines, intravenous contrast (dye), some cancer and HIV drugs

Kidney Disease of Diabetes

The Burden of Kidney Failure

• Kidney failure is the final stage of chronic kidney disease (CKD).
• Diabetes is the most common cause of kidney failure
• People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor.
• High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will progress to kidney failure.

Dialysis and Transplantation

When people with diabetes experience kidney failure, they must undergo either dialysis or a kidney transplant. As recently as the 1970s, medical experts commonly excluded people with diabetes from dialysis and transplantation, in part because the experts felt damage caused by diabetes would offset benefits of the treatments. Today, because of better control of diabetes and improved rates of survival following treatment, doctors do not hesitate to offer dialysis and kidney transplantation to people with diabetes.

Currently, the survival of kidneys transplanted into people with diabetes is about the same as the survival of transplants in people without diabetes. Dialysis for people with diabetes also works well in the short run. Even so, people with diabetes who receive transplants or dialysis experience higher morbidity and mortality because of coexisting complications of diabetes—such as damage to the heart, eyes, and nerves.

What is diabetes insipidus?

Diabetes insipidus is a rare disorder that occurs when a person’s kidneys pass an abnormally large volume of urine that is insipid—dilute and odorless. In most people, the kidneys pass about 1 to 2 quarts of urine a day. In people with diabetes insipidus, the kidneys can pass 3 to 20 quarts of urine a day. As a result, a person with diabetes insipidus may feel the need to drink large amounts of liquids.

Diabetes insipidus and diabetes mellitus—which includes both type 1 and type 2 diabetes—are unrelated, although both conditions cause frequent urination and constant thirst. Diabetes mellitus causes high blood glucose, or blood sugar, resulting from the body’s inability to use blood glucose for energy. People with diabetes insipidus have normal blood glucose levels; however, their kidneys cannot balance fluid in the body.

Primary Amyloidosis

Primary amyloidosis is a disorder in which abnormal proteins build up in tissues and organs. Clumps of the abnormal proteins are called amyloid deposits.

Causes

The cause of primary amyloidosis is not well understood. Genes may play a role.
The condition is related to abnormal and excess production of proteins. Clumps of abnormal proteins build up in certain organs. This makes it harder for the organs to work correctly.
Primary amyloidosis can lead to conditions that include:
Carpal tunnel syndrome
Heart muscle damage (cardiomyopathy) leading to congestive heart failure
Intestinal malabsorption
Liver swelling
Kidney failure
Nephrotic syndrome
Nerve problems (neuropathy)
Orthostatic hypotension (drop in blood pressure when you stand up)

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What are the kidneys and what do they do?

The two kidneys are bean-shaped organs located just below the rib cage, one on each side of the spine. Everyday, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.

Blood enters the kidneys through arteries that branch inside the kidneys into tiny clusters of looping blood vessels. Each cluster is called a glomerulus, which comes from the Greek word meaning filter. The plural form of the word is glomeruli. There are approximately 1 million glomeruli, or filters, in each kidney. The glomerulus is attached to the opening of a small fluid-collecting tube called a tubule. Blood is filtered in the glomerulus, and extra fluid and wastes pass into the tubule and become urine. Eventually, the urine drains from the kidneys into the bladder through larger tubes called ureters.

What are the kidneys and what do they do?

Points to Remember

1. Renal tubular acidosis (RTA) is a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a person’s blood to remain too acidic.
2. Without proper treatment, chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, chronic kidney disease, and possibly total kidney failure.
3. If RTA is suspected, additional information about the sodium, potassium, and chloride levels in the urine and the potassium level in the blood will help identify which type of RTA a person has.
4. In all cases, the first goal of therapy is to neutralize acid in the blood, but different treatments may be needed to address the different underlying causes of acidosis.