What is kidney disease or renal disease?

Renal failure

What is kidney disease or renal disease?

The kidneys are a pair of bean shaped organs located in abdomen along spnie. The main functions of Kidneys are:
• Kidneys are main excretory organs to excrete waste products of body. They play a major role in filtering waste products, excess water, and other impurities out of the blood into urine.
• Regulate pH, blood volume, minerals and electrolytes like sodium, potassium, calcium, phosphorus etc.
• Production of hormones that regulate blood pressure and control the production of red blood cells such as Renin, Erythropoietin. Vitamin D is also activated by kidneys.
• Normal urine output is maintained between 400 to 2000 ml/day. If urine output is less than 100 ml/day it is called anuria, 100 to 400 ml oliguria and more than 3000 ml polyuria.
Kidney diseases occur when kidneys become damaged and cannot perform their function. Other diseases may cause kidney damage or diseases such as diabetes mellitus, high blood pressure and kidney disease may lead to other health problems like high blood pressure, bones weakness, cardiac diseases, malnutrition etc.
Despite the diversity of initial causes of injury to kidneys, progression of kidney disease leads to loss of function and ultimately to kidney failure. Proteinuria is one of the most important risk factor for the progression of kidney disease.
Kidney diseases are classified as:
• Acute kidney disease/ acute kidney failure/ acute renal failure
• Chronic kidney disease/ chronic kidney failure/ chronic renal failure

What are the causes of acute kidney disease/ acute kidney failure/ acute renal failure?

Acute kidney injury AKI term has replaced acute renal failure and is described as sudden decline in kidney function over hours and days. Causes of acute kidney injury are:
1. Prerenal:
o Hemorrhage
o Diarrhea
o Postoperative fluid and blood loss
o Sepsis
o Acute cardiac failure
2. Intrinsic renal diseases:
o Tubular
o Glomerular
o Vascular

• Tubular causes are:
o Acute tubular necrosis (ATN)-
-Drug nephropathy- NSAIDs, ACE inhibitors, aminogycosides
-Prerenal causes lead to ATN
o Tubulointerstitial nephritis (TIN)-
-Allergic TIN
-Sarcoidosis
-Pyelonephritis
• Renal parenchymal diseases:
o Rapidly progressive glomerulonephritis
o Thrombotic microangiopathy
o Cryoglobulinemia
• Myeloma
• Vascular causes:
o Acute dissection
o Renal vein thrombosis
3. Post renal AKI:
• Bladder outflow obstruction:
o Benign and malignant prostate diseases
o Invasive bladder carcinoma
• Renal Calculi or stone
• Retroperitoneal fibrosis

Stages of acute kidney disease or injury AKI:
Stage 1: Increased serum creatinine about 1.5 to 2 fold and urine output le than 0.5 ml/kg/hr for more than 6 hrs.
Stage 2: Increased serum creatinine about 2 to 3 fold and urine output le than 0.5 ml/kg/hr for more than 12 hrs.
Stage 3: Increased serum creatinine more than 3 fold or serum creatinine more than 4 mg/dl and urine output less than 0.3 ml/kg/hr for more than 24 hrs. or anuria for 12 hrs.

What are the causes of chronic kidney disease/ chronic kidney failure/ chronic renal failure?

Criteria for definition of chronic kidney disease CKD is decreased urine output for at least 3 months. The main causes of CKD are:
• Diabetes
• Hypertension: High blood pressure
• Glomerulonephritis
• Inections
• Obstructive kidney diseases
• Cystic kidney disease

Stages of chronic kidney disease CKD
• Stage 1: Normal Kidney Function >90 ml/min
• Stage 2: Mild Loss of Kidney Function 60-89 ml/min
• Stage 3a: Mild to Moderate Loss of Kidney Function 45-59 ml/min
• Stage 3b: Moderate to Severe Loss of Kidney Function 30-44 ml/min
• Stage 4: Severe Loss of Kidney Function 15-29 ml/min
• Stage 5: Kidney Failure <15 ml/min.

What are the symptoms of kidney disease/ kidney failure/ renal failure?

Kidney disease can usually remain unnoticed until disease become severe. The following symptoms are early warnings:
• Fatigue
• Lack of concentration
• Sleeping disturbances
• Loss of appetite
• Muscular cramps
• Puffiness/ swelling around the eyes in the morning
• Dry, scaly skin
• Frequent urination
Severe symptoms that associated with kidney failure include:
• Nausea
• Vomiting
• Loss of appetite
• changes in urine output
• fluid retention/ edema
• Swelling abdomen, feet or face or generalized
• Anemia
• Loss sexual desire

What are the risk factors of kidney disease/ kidney failure/ renal failure?

• Diabetics are more likely to develop CKD.
• Hypertension increases the risk of development of kidney diseases.
• Family history of chronic kidney disease increases the risk.
• Elderly are more prone to kidney diseases as GFR decreases with age.
• Smoking and drug abuse increases the risk for kidney disease.
• Proteinuria

What are the lab tests to diagnose kidney disease/ kidney failure/ renal failure?

• Urine testing:
o Urine protein
o Microscopy and culture
o Red cell casts
o Urine electrophoresis
• 24 hrs urine protein, creatinine and GFR estimation
• Blood tests:
o Serum creatinine
o Blood urea
o Serum electrolytes
o Serum calcium
o Serum phosphorus
o Serum albumin
o Lipid profile
o Liver function tests
o Acid base studies: pH, bicarbonate estimation
o CBC- complete blood count
o Coagulation studies
o Iron studies
o Vitamin D and PTH levels
• Selected addition investigations:
o Creatine kinase
o LDH
o ANCA
o AGBMA
o ANA
o Anti dsDNA
o Serum protein electrophoresis
o Anti- HCV
o HBsAg
o HIV
• Imaging
o Chest Xray
o Abdominal Xray
o Sonography
o CT scan
o MRI
o Angiograpgy
• Kidney biopsy

What are the lab tests to diagnose kidney disease/ kidney failure/ renal failure?

• Urine testing:
o Urine protein
o Microscopy and culture
o Red cell casts
o Urine electrophoresis
• 24 hrs urine protein, creatinine and GFR estimation
• Blood tests:
o Serum creatinine
o Blood urea
o Serum electrolytes
o Serum calcium
o Serum phosphorus
o Serum albumin
o Lipid profile
o Liver function tests
o Acid base studies: pH, bicarbonate estimation
o CBC- complete blood count
o Coagulation studies
o Iron studies
o Vitamin D and PTH levels
• Selected addition investigations:
o Creatine kinase
o LDH
o ANCA
o AGBMA
o ANA
o Anti dsDNA
o Serum protein electrophoresis
o Anti- HCV
o HBsAg
o HIV
• Imaging
o Chest Xray
o Abdominal Xray
o Sonography
o CT scan
o MRI
o Angiograpgy
• Kidney biopsy