Acquired Kidney DiseaseAcquired Kidney Disease

By:By:

Glenda A. EstorbaGlenda A. Estorba

Diabetic NephropathyDiabetic Nephropathy

Diabetic nephropathy is kidney Diabetic nephropathy is kidney disease that is a complication of disease that is a complication of diabetes. It can occur in people with diabetes. It can occur in people with type 2 diabetes, the diabetes type that type 2 diabetes, the diabetes type that is most common and is caused by is most common and is caused by resistance to insulin, or in people with resistance to insulin, or in people with type 1 diabetes, the type that more type 1 diabetes, the type that more often begins at an early age and results often begins at an early age and results from decreased insulin production. from decreased insulin production.

Symptoms:Symptoms:

There are usually no symptoms in There are usually no symptoms in the early stages of diabetic the early stages of diabetic nephropathy. When symptoms do nephropathy. When symptoms do begin to appear, they may include begin to appear, they may include ankle swelling and mild fatigue. Later ankle swelling and mild fatigue. Later symptoms include extreme fatigue, symptoms include extreme fatigue, nausea, vomiting and urinating less nausea, vomiting and urinating less than usual. than usual.

Prevention

•The best way to prevent diabetic nephropathy is to control your blood sugar.

•Two types of blood pressure medicines protect against kidney damage in ways that go beyond lowering your blood pressure. Any person who has diabetes and who also has high blood pressure should regularly take one of these medications.

TreatmentTreatment

If you have diabetes with high blood pressure, microalbuminuria or blood test evidence of kidney disease, it is important for you to take a medication from the ACE inhibitor or ARB group.

GlomerulonephritisGlomerulonephritis Glomerulonephritis is a disease of the Glomerulonephritis is a disease of the

kidneys in which there is inflammation of kidneys in which there is inflammation of the filtering units, called glomeruli.the filtering units, called glomeruli.

Types and Causes of Glomerulonephritis:

• Prior infection- after a streptococcal infection (such as strep throat), kidney failure may develop with associated problems of high blood pressure, dark urine, and swelling in the legs.

• Autoimmune- conditions such as systemic lupus erythematosus (SLE) or blood vessel inflammation (vasculitis)

Antibody-mediatedAntibody-mediated- The most common type is - The most common type is called IgA nephropathy. While this can be associated with called IgA nephropathy. While this can be associated with liver disease, celiac disease or HIV infection, many cases liver disease, celiac disease or HIV infection, many cases are of unknown cause.are of unknown cause.

Symptoms:Symptoms: If glomerulonephritis is mild, it may not cause any symptoms. If symptoms appear, they can include swelling around the feet, ankles, lower legs, and eyes, reduced urination and dark urine (due to the presence of red blood cells in the urine).

Expected Duration

How long glomerulonephritis lasts depends on its cause and on the severity of kidney damage. When glomerulonephritis follows an infection, the problem usually goes away within weeks to months. In other cases, glomerulonephritis becomes a chronic (long-lasting) condition that lasts for years and eventually can lead to renal failure..

Prevention

Most forms of glomerulonephritis cannot be prevented. Once kidney disease, such as glomerulonephritis is present, avoiding certain medications (such as ibuprofen, naproxen or other anti-inflammatory drugs) can prevent sudden worsening.

HydronephrosisHydronephrosis: : Hydronephrosis Classification and external resources

Specimen of a kidney that has undergone extensive dilation due to hydronephrosis. Note the extensive atrophy and thinning of the renal cortex.

Hydronephrosis is distension and dilation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney, leading to progressive atrophy of the kidney.[1] In case of hydroureteronephrosis, there is distention of both the ureter and the renal pelvis and calices.

Signs and Symptoms

The signs and symptoms of hydronephrosis depend upon whether the obstruction is acute or chronic, partial or complete, unilateral or bilateral. Unilateral hydronephrosis may occur without any symptoms, while acute obstruction can cause intense pain.

Treatment

Treatment of hydronephrosis focuses upon the removal of the obstruction and drainage of the urine that has accumulated behind the obstruction. Therefore, the specific treatment depends upon where the obstruction lies, and whether it is acute or chronic.

Interstitial Interstitial Nephritis Nephritis :: Interstitial nephritis is a kidney Interstitial nephritis is a kidney

disorder in which the spaces between disorder in which the spaces between the kidney tubules become swollen the kidney tubules become swollen (inflammed). The inflammation can (inflammed). The inflammation can affect the kidneys' ability to filter waste.affect the kidneys' ability to filter waste.

Alternative Names :•Tubulointerstitial nephritis

• Nephritis - interstitial

Causes, incidence, and risk Causes, incidence, and risk factorsfactors Interstitial nephritis may be temporary Interstitial nephritis may be temporary

((acuteacute) or it may be ) or it may be chronicchronic and get worse and get worse over time.over time.

The acute form of interstitial nephritis is common. It is most often caused by side effects of certain drugs. This disorder may be more severe and more likely to lead to chronic or permanent kidney damage in elderly people.

Symptoms :Symptoms : Interstitial nephritis can cause mild to Interstitial nephritis can cause mild to

severe kidney problems, severe kidney problems, includingincluding acute kidney failureacute kidney failure. In about half of cases, . In about half of cases, people will have people will have decreased urine outputdecreased urine output and and other signs of acute kidney failureother signs of acute kidney failure.. Treatment :

Treatment focuses on the cause of the problem. Avoiding medications that lead to this condition may

relieve the symptoms quickly.Limiting salt (sodium) and fluid in the diet can control

swelling and high blood pressure . Also limiting protein can help control the buildup of waste products in the blood (azotemia) that can lead to acute kidney

failure.

Prevention Prevention Treatment of chronic kidney failure may Treatment of chronic kidney failure may

delay or prevent progression to ESRD. delay or prevent progression to ESRD. Some cases may not be preventable.Some cases may not be preventable.

What are kidney stones? Kidney stones are made of salts and minerals in the urine that stick together, creating small "pebbles" formed within the kidney or urinary tract. They can be as small as grains of sand or as large as golf balls. Kidney stones are a common cause of blood in the urine and often severe pain in the abdomen, flank, or groin. One in every 20 people develops a kidney stone at some point in their life.

Kidney Stones Causes:Kidney Stones Causes:•Heredity- The predisposition to high levels of calcium in the urine may be passed on from generation to generation. Some rare hereditary diseases also predispose some people to form kidney stones.

•Geographical location -There may be a geographic predisposition to form kidney stones. The hot climate and poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.

•Diet - stones, diet Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk; however, if a person isn't susceptible to forming will not change that risk.

Medications-Medications- People taking diuretics (or "water pills") and People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase the amount of calcium in their urine and potentially

increase their risk of forming stones.increase their risk of forming stones. Underlying illnesses: Some chronic illnesses are associated Underlying illnesses: Some chronic illnesses are associated

with kidney stone formation, including with kidney stone formation, including cystic fibrosiscystic fibrosis, renal , renal tubular acidosis, and tubular acidosis, and inflammatory bowel diseaseinflammatory bowel disease..

Kidney Stones in ChildrenKidney Stones in Children :: The occurrence of a kidney stone in a child is a The occurrence of a kidney stone in a child is a

relatively rare event. In countries in which protein in the relatively rare event. In countries in which protein in the diet comes from plant sources.diet comes from plant sources.

Symptoms of stones are similar to that of an adult, although the younger the child or infant, the harder it may be to initially understand the complaint. The initial finding in an infant may be a crying and inconsolable baby.

Kidney Stones Symptoms and Signs:

• Renal colic (renal is the medical term for things related to the kidney) has a classic presentation

when a kidney stone is being passed.

•SweatingSweating, , nausea, and vomitingnausea, and vomiting are common. are common.

• Blood may be visible in the urine because the Blood may be visible in the urine because the stone has irritated the ureter. stone has irritated the ureter. Blood in the urineBlood in the urine (hematuria), however, does not always mean a (hematuria), however, does not always mean a person has a kidney stone. person has a kidney stone.

Prevention:

While kidney stones and renal colic probably cannot be prevented, the risk of forming a stone can be minimized by

avoiding dehydration. Keeping the urine dilute will not allow the chemical crystals to come out of solution and form the nidus of

a stone. Making certain that the urine remains clear and not concentrated (yellow) will help minimize stone formation.

Kidney TumorKidney Tumor : : A kidney tumor is an abnormal mass that develops in a A kidney tumor is an abnormal mass that develops in a

kidney. The kidney is a bean-shaped organ that functions kidney. The kidney is a bean-shaped organ that functions

as part of a person's urinary system.as part of a person's urinary system. Signs & Symptoms of a Kidney Tumor

The early stages of a kidney tumor may generate no symptoms at all. As the tumor grows and the condition progresses, the tumor may begin to exhibit symptoms that result mostly from pressure put on other organs and the pain associated with the location of the tumor

•Abdominal Symptoms•Fatigue•Blood Flow Symptoms•Flu-Like Symptoms

Renal cell carcinomaRenal cell carcinomacell carcinoma (clear cell) - on right of the image; non-tumour kidney is on the left of the image. Nephrectomy specimen.

Renal cell carcinoma (RCC, also known as hypernephroma) is a kidney cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products.

Signs and symptoms:Signs and symptoms:

A wide range of symptoms can be A wide range of symptoms can be present with renal carcinoma depending present with renal carcinoma depending on which areas of the body have been on which areas of the body have been affectedaffected. . The classic triad is The classic triad is hematuriahematuria (blood in the urine), flank pain and an (blood in the urine), flank pain and an abdominal mass. This triad only occurs in abdominal mass. This triad only occurs in 10-15% of cases, and is generally 10-15% of cases, and is generally indicative of more advanced disease. indicative of more advanced disease. Today, the majority of renal tumors are Today, the majority of renal tumors are asymptomatic and are detected asymptomatic and are detected incidentally on imaging, usually for an incidentally on imaging, usually for an unrelated cause.unrelated cause.

Wilms' tumor Wilms' tumor Classification and Classification and external resources.external resources.

Wilms' tumor

Cut section showing two halves of a nephroblastoma specimen. Note the prominent septa subdividing the sectioned surface and the protrusion of tumor into the renal pelvis, resembling botryoid rhabdomyosarcoma.ternal resources.

Wilms' tumor or nephroblastoma is cancer of the kidneys that typically occurs in children, rarely in adults. Its common name is an eponym, referring to Dr. Max Wilms, the German surgeon (1867–1918) who first described this kind of tumor.

Wilms' tumor is a malignant tumor containing Wilms' tumor is a malignant tumor containing metanephricmetanephric blastemablastema, stromal and epithelial derivatives. , stromal and epithelial derivatives. Characteristic is the presence of abortive tubules and Characteristic is the presence of abortive tubules and glomeruli surrounded by a spindled cell stroma. The stroma glomeruli surrounded by a spindled cell stroma. The stroma may include striated may include striated musclemuscle, , cartilagecartilage, bone, fat tissue, , bone, fat tissue, fibrous tissue. The tumor is compressing the normal kidney fibrous tissue. The tumor is compressing the normal kidney parenchymaparenchyma

Wilms' tumors may be separated into 2 prognostic groups based on pathologic characteristics:

• Favorable - Contains well developed components mentioned above.

• Anaplastic - Contains diffuse anaplasia (poorly developed cells).

Treatment strategyTreatment strategy : :Stage I (43% of patients)

Stage III (23% of patients)

Stage II (23% of patients)

Stage IV (10% of patients)

Stage V (5% of patients)

Stage I-IV Anaplasia

TreatmentTreatment Once a kidney tumor is found, a Once a kidney tumor is found, a

surgical biopsy is done. A sample of surgical biopsy is done. A sample of tissue from the tumor is sent to a tissue from the tumor is sent to a pathologist, who looks at it under a pathologist, who looks at it under a microscope to check for signs of microscope to check for signs of cancer. If the tumor is only in the cancer. If the tumor is only in the kidney (typical), it can be removed kidney (typical), it can be removed along with the whole kidney (a along with the whole kidney (a nephrectomy) nephrectomy)

Minimal change diseaseMinimal change disease Minimal change disease or nil disease (lipoid nephrosis) Minimal change disease or nil disease (lipoid nephrosis)

is a disease of the kidney that causes nephrotic syndrome and is a disease of the kidney that causes nephrotic syndrome and usually affects children (peak incidence at 2–3 years of age)usually affects children (peak incidence at 2–3 years of age)

Symptoms:

The symptoms are proteinuria (leakage of protein into the urine) and edema (water retention). Nephrotic syndrome (NS) is a general term that refers to the loss of protein in the urine, hypercholesterolemia, and edema. Many conditions are categorized as nephrotic syndromes—minimal change disease is unique, because it is the only one lacking any evidence of pathology on light microscopy.

Treatment:Treatment: Minimal change disease usually Minimal change disease usually

responds well to initial treatment, with the responds well to initial treatment, with the symptoms of nephrotic syndrome (NS) symptoms of nephrotic syndrome (NS) typically going away, but this can take typically going away, but this can take weeks to months. Younger children, who are weeks to months. Younger children, who are more likely to develop minimal change more likely to develop minimal change disease, usually respond faster than adults. disease, usually respond faster than adults. In 2 out of 3 children with minimal change In 2 out of 3 children with minimal change disease, however, the symptoms of NS can disease, however, the symptoms of NS can reoccur, called a relapse, particularly after reoccur, called a relapse, particularly after an infection or an allergic reaction. an infection or an allergic reaction.

Kidney failureKidney failure In kidney failure, the kidneys lose their ability to filter In kidney failure, the kidneys lose their ability to filter

enough waste products from the blood and to regulate the enough waste products from the blood and to regulate the body's balance of salt and water. Eventually, the kidneys slow body's balance of salt and water. Eventually, the kidneys slow their production of urine, or stop producing it completely. their production of urine, or stop producing it completely.

Acute renal failure — Kidney function stops or is abruptly reduced because of a sudden illness

Chronic renal failure — Kidney function gradually declines, usually over a period of years. It is most commonly caused by illnesses such as diabetes, uncontrolled high blood pressure or chronic kidney inflammation.

End-stage renal disease —End-stage renal disease — This also is called end-This also is called end-stage renal failure. This occurs when kidney function has stage renal failure. This occurs when kidney function has deteriorated to the point that if dialysis treatments do not deteriorated to the point that if dialysis treatments do not

begin, the person will diebegin, the person will die Symptoms :

Chronic renal failure and end stage renal disease

Acute renal failure

Prevention :Prevention :

Many forms of kidney failure cannot be Many forms of kidney failure cannot be prevented. People who have diabetes, high prevented. People who have diabetes, high blood pressure or coronary artery disease blood pressure or coronary artery disease should try to control the illness with should try to control the illness with appropriate diet, medication and lifestyle appropriate diet, medication and lifestyle changes. Before a computed tomography changes. Before a computed tomography (CT) scan or angiogram procedure that uses (CT) scan or angiogram procedure that uses contrast dye, your doctor may prescribe a contrast dye, your doctor may prescribe a protective medication, acetylcysteine protective medication, acetylcysteine (Mucomyst), if there are special concerns (Mucomyst), if there are special concerns about your risk for kidney damage. about your risk for kidney damage.

Treatment : Treatment :

Acute renal failureAcute renal failure — — Treatment begins Treatment begins with measures to correct the cause of renal with measures to correct the cause of renal failure (shock, hemorrhage, burns, heart attack, failure (shock, hemorrhage, burns, heart attack, etc.). etc.).

Chronic renal failure — People with chronic renal failure are monitored closely with frequent physical examinations, blood pressure checks and blood testing.

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