Kidney & Its Common Diseases Neuro Workgroup SIG 12 June 2008 Suhaila Mohamed Usuludin

Content Kidneys & Functions Kidney Failure/ESRD Risk factors Symptoms Treatment Hemodialysis Peritoneal Dialysis Common Kidney Diseases In the wards…

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

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 Nephron Glomerulus Tubules

Made up of functioning units called nephrons

The Kidneys

Functions Removal of waste and excess water from body

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

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)

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

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

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

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

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

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

Vascular Access

arterio-venous (AV) fistula

AV graft

Hemodialysis AV grafts

AV grafts

Hemodialysis 3 times a week (on alternate days) for 3 to 5 or more hours each visit

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

“ 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

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

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

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

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

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

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

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

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

Disadvantages

Need for frequent physician visits

Pain, discomfort of surgery

Risk of transplant rejection

Prone to infections

On lifelong medications

Common Kidney Diseases Polycystic Kidney Disease Hypertensive Nephrosclerosis Glomerulonephritis / Glomerulosclerosis Urinary Tract Infection (UTI) Kidney Stones Diabetic Kidney Disease Analgesic 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

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 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)

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.

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

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

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

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 - 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

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 Treatment Specific 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

Treatment

Specific

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.

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

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

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

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

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

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

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

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

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 Disease Signs 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

Signs 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)

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

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.

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.

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

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).