Common Kidney Diseases


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  • Common Kidney Diseases

    1. 1. Kidney & Its Common Diseases Neuro Workgroup SIG 12 June 2008 Suhaila Mohamed Usuludin
    2. 2. Content <ul><li>Kidneys & Functions </li></ul><ul><li>Kidney Failure/ESRD </li></ul><ul><ul><li>Risk factors </li></ul></ul><ul><ul><li>Symptoms </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><ul><ul><li>Hemodialysis </li></ul></ul></ul><ul><ul><ul><li>Peritoneal Dialysis </li></ul></ul></ul><ul><li>Common Kidney Diseases </li></ul><ul><li>In the wards… </li></ul>
    3. 3. The Kidneys <ul><li>A pair of bean-shaped organs located at the posterior wall of the abdomen </li></ul><ul><li>Dimensions </li></ul><ul><ul><li>11 cm long, 6 cm wide and 3 cm thick </li></ul></ul><ul><ul><li>weighs about 160g </li></ul></ul>
    4. 4. The Kidneys <ul><li>Made up of functioning units called nephrons </li></ul>Nephron Glomerulus Tubules
    5. 5. The Kidneys
    6. 6. Functions <ul><li>Removal of waste and excess water from body </li></ul>
    7. 7. <ul><li>Normal kidneys release several hormones </li></ul><ul><ul><li>Renin (regulates blood pressure) </li></ul></ul><ul><ul><li>Erythropoietin (stimulates production of red blood cells) </li></ul></ul><ul><ul><li>Activated form of Vitamin D (maintain normal bone structure) </li></ul></ul>Functions
    8. 8. Kidney Failure or End-stage Renal Disease (ESRD) <ul><li>Occurs when the kidneys do not function properly or sufficiently, resulting in the accumulation of waste products and toxic materials </li></ul><ul><ul><li>may cause permanent and irreversible damage to body cells, tissues and organs </li></ul></ul><ul><ul><li>kidneys that function <20% of required capacity </li></ul></ul><ul><ul><ul><li>need renal replacement therapy </li></ul></ul></ul>
    9. 9. Risk Factors <ul><li>Chronic diseases </li></ul><ul><li>Inflammatory diseases </li></ul><ul><li>Blockage of urinary collecting system </li></ul><ul><li>Chronic infections </li></ul><ul><li>Rare genetic disorders </li></ul>
    10. 10. Symptoms <ul><li>Decreased urination </li></ul><ul><li>Blood in the urine </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Swollen hands and ankles </li></ul><ul><li>Puffiness around the eyes </li></ul><ul><li>Itching </li></ul><ul><li>Sleep disturbances </li></ul><ul><li>High blood pressure </li></ul><ul><li>Loss of appetite </li></ul>
    11. 11. Treatment of Kidney Failure <ul><li>Blood creatinine rises to 900 µmol/ L </li></ul><ul><li>Dialysis </li></ul><ul><ul><li>Hemodialysis </li></ul></ul><ul><ul><li>Peritoneal Dialysis </li></ul></ul><ul><li>Transplant </li></ul><ul><ul><li>the best means of treatment </li></ul></ul>
    12. 12. Hemodialysis <ul><li>A process by which excess waste products and water are removed from the blood </li></ul><ul><li>Requires an access to the patient's blood stream and the use of a haemodialysis machine </li></ul>
    13. 13. Hemodialysis <ul><li>Vascular Access </li></ul><ul><ul><li>arterio-venous (AV) fistula </li></ul></ul><ul><ul><li>AV graft </li></ul></ul>
    14. 14. Hemodialysis <ul><li>AV grafts </li></ul>
    15. 15. Hemodialysis <ul><li>3 times a week (on alternate days) for 3 to 5 or more hours each visit </li></ul>
    16. 16. Hemodialysis <ul><li>“ Washout Syndrome” </li></ul><ul><ul><li>feels weak, tremulous, extreme fatigue </li></ul></ul><ul><ul><li>syndrome may begin toward the end of treatment or minutes following the treatment </li></ul></ul><ul><ul><li>may last 30 minutes or 12-14 hours in a dissipating form </li></ul></ul>
    17. 17. Hemodialysis <ul><li>Advantages </li></ul><ul><ul><li>Staff performs treatment in the dialysis centre </li></ul></ul><ul><ul><li>Three treatments per week in the dialysis centre </li></ul></ul><ul><ul><li>Permanent internal access required </li></ul></ul><ul><ul><li>Regular contact with people in the centre </li></ul></ul>
    18. 18. Hemodialysis <ul><li>Disadvantages </li></ul><ul><ul><li>Requires travel to a dialysis centre </li></ul></ul><ul><ul><li>Fixed treatment schedule </li></ul></ul><ul><ul><li>Two needle sticks for each treatment; tie onto a machine and cannot move about during treatment </li></ul></ul><ul><ul><li>Diet and fluid intake restriction </li></ul></ul>
    19. 19. Peritoneal Dialysis <ul><li>Dialysis solution flow into the peritoneal (abdominal) cavity through a catheter </li></ul><ul><li>Petrionuem acts as a filter </li></ul>
    20. 20. Peritoneal Dialysis <ul><li>2 forms </li></ul><ul><ul><li>CAPD (Continuous Ambulatory Peritoneal Dialysis) </li></ul></ul><ul><ul><ul><li>4 exchanges during the day, 45 min each </li></ul></ul></ul><ul><ul><li>APD (Automated Peritoneal Dialysis) </li></ul></ul><ul><ul><ul><li>exchanges are performed by the machine during the night while the patient is asleep </li></ul></ul></ul>
    21. 21. Peritoneal Dialysis <ul><li>Advantages </li></ul><ul><ul><li>Patient's involvement in self-care </li></ul></ul><ul><ul><li>Control over schedule </li></ul></ul><ul><ul><li>Less diet & fluid restriction </li></ul></ul><ul><ul><li>More steady physical condition as it provides slow, continuous therapy </li></ul></ul><ul><ul><li>Most similar to original kidneys. Can be done in the night as in automated peritoneal dialysis </li></ul></ul><ul><ul><li>Provide less severe cardiovascular instabilities in patients with underlying heart disease </li></ul></ul>
    22. 22. Peritoneal Dialysis <ul><li>Disadvantages </li></ul><ul><ul><li>Four exchanges per day </li></ul></ul><ul><ul><li>Permanent external catheter </li></ul></ul><ul><ul><li>Change of body image </li></ul></ul><ul><ul><li>Some risks of infection </li></ul></ul><ul><ul><li>If on automated peritoneal dialysis, one will be tie onto a machine in the night </li></ul></ul><ul><ul><li>Storage space is needed for supplies </li></ul></ul>
    23. 23. Kidney Transplant <ul><li>A kidney from either a living related or a brain dead person is removed and surgically placed into the kidney failure patient.  </li></ul><ul><li>Not all kidney failure patients are fit to undergo transplantation.  </li></ul><ul><ul><li>Medication to suppress their immunity given for the transplant may worsen their general health </li></ul></ul>
    24. 24. Kidney Transplant <ul><li>Advantages </li></ul><ul><ul><li>Absence of need for frequent dialysis treatment </li></ul></ul><ul><ul><li>Better quality of life </li></ul></ul><ul><ul><li>Better health </li></ul></ul><ul><ul><li>Reduced medical cost after first year </li></ul></ul><ul><ul><li>No diet and fluid intake restriction </li></ul></ul><ul><ul><li>Provide less severe cardiovascular instabilities in patients with underlying heart disease </li></ul></ul>
    25. 25. Kidney Transplant <ul><li>Disadvantages </li></ul><ul><ul><li>Need for frequent physician visits </li></ul></ul><ul><ul><li>Pain, discomfort of surgery </li></ul></ul><ul><ul><li>Risk of transplant rejection </li></ul></ul><ul><ul><li>Prone to infections </li></ul></ul><ul><ul><li>On lifelong medications </li></ul></ul>
    26. 26. Common Kidney Diseases Polycystic Kidney Disease Hypertensive Nephrosclerosis Glomerulonephritis / Glomerulosclerosis Urinary Tract Infection (UTI) Kidney Stones Diabetic Kidney Disease Analgesic nephropathy
    27. 27. <ul><li>Genetically acquired </li></ul><ul><li>2 forms - dominant and recessive </li></ul><ul><li>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%. </li></ul><ul><li>Cysts are abnormal pouches containing fluid. Eventually the cysts replace normal kidney tissue -> suffers ESRD </li></ul>Polycystic Kidney Disease
    28. 28. Polycystic Kidney Disease <ul><li>Signs and Symptoms </li></ul><ul><li>Dull pain at the side of the abdomen and back </li></ul><ul><li>Blood in the urine </li></ul><ul><li>Frequent urine tract infection </li></ul><ul><li>High blood pressure (often before cysts appear) </li></ul><ul><li>Upper abdominal discomfort (liver and pancreatic cysts) </li></ul>
    29. 29. Polycystic Kidney Disease <ul><li>Treatment </li></ul><ul><li>Blood pressure - controlled and treated </li></ul><ul><li>Kidney failure - supportive therapy until end-stage is reached when dialysis or transplantation is then required </li></ul><ul><li>Urine tract infection - treatment with antibiotics </li></ul><ul><li>Pain - analgesics are used. Alternatively, surgery to shrink or resect the cysts. </li></ul>
    30. 30. Hypertensive Nephrosclerosis <ul><li>Poorly controlled high blood pressure (hypertension) can lead to kidney failure </li></ul><ul><ul><li>Thickening of blood vessels </li></ul></ul>
    31. 31. Hypertensive Nephrosclerosis <ul><li>Signs and Symptoms </li></ul><ul><li>Headache </li></ul><ul><li>Giddiness (sometimes related to posture) </li></ul><ul><li>Neck discomfort </li></ul><ul><li>Easily tired </li></ul><ul><li>Nauseous and/or vomiting </li></ul><ul><li>Protein in urine </li></ul>
    32. 32. Hypertensive Nephrosclerosis <ul><li>Treatment </li></ul><ul><li>Medications to control blood pressure (anti-hypertensive) </li></ul><ul><li>Lowering of dietary salt (2g/day) </li></ul><ul><li>Exercise regularly </li></ul>
    33. 33. Glomerulonephritis / Glomerulosclerosis <ul><li>Glomerulonephritis - An inflammatory condition that affects predominantly the glomeruli. </li></ul><ul><li>Causes </li></ul><ul><ul><li>IgA nephropathy </li></ul></ul><ul><ul><li>Streptococcus bacteria </li></ul></ul><ul><ul><li>Autoimmune </li></ul></ul><ul><li>Glomerulosclerosis - scarring of the glomeruli </li></ul>
    34. 34. Glomerulonephritis / Glomerulosclerosis <ul><li>Signs and Symptoms </li></ul><ul><li>Blood or protein in urine </li></ul><ul><li>Frothy urine (signifying protein in urine) </li></ul><ul><li>Dark or pink-coloured urine </li></ul><ul><li>Leg swelling </li></ul><ul><li>Systemic disease like diabetes or autoimmune disease will have systemic manifestations, e.g. weight loss, arthritis, or skin rash </li></ul>
    35. 35. Glomerulonephritis / Glomerulosclerosis <ul><li>Treatment </li></ul><ul><li>Specific </li></ul><ul><li>Suppression of inflammation may be achieved by certain medications (eg steroids). </li></ul><ul><li>General </li></ul><ul><li>Medications to decrease excretion of urinary protein </li></ul><ul><li>Control of blood pressure </li></ul><ul><li>Dietary modifications </li></ul>
    36. 36. Urinary Tract Infection (UTI) <ul><li>Disease of the urinary tract </li></ul><ul><ul><li>Infection occurs when microorganisms attach themselves to the urethra and begins to multiply. </li></ul></ul><ul><li>May lead to infection of the kidneys (pyelonephritis) and cause permanent kidney damage, if left untreated. </li></ul><ul><li>Women are especially prone to get urinary tract infection. </li></ul>
    37. 37. Urinary Tract Infection (UTI) <ul><li>Conditions that increases risk of UTI </li></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Situations where a urine catheter is needed </li></ul></ul><ul><ul><li>Abnormalities of the urinary tract </li></ul></ul><ul><ul><li>Obstructed urine flow (large prostate or stone) </li></ul></ul><ul><ul><li>Being pregnant </li></ul></ul>
    38. 38. Urinary Tract Infection (UTI) <ul><li>Signs and Symptoms </li></ul><ul><li>Painful urination (burning sensation) </li></ul><ul><li>Hot and foul smelling urine </li></ul><ul><li>Blood in urine </li></ul><ul><li>Fever (sometimes with chills) </li></ul><ul><li>Painful lower abdomen </li></ul><ul><li>Increased urgency/frequency of wanting to pass urine </li></ul><ul><li>Nausea and/or vomiting </li></ul>
    39. 39. Urinary Tract Infection (UTI) <ul><li>Treatment </li></ul><ul><li>Appropriate antibiotics </li></ul><ul><li>Drink plenty of water </li></ul>
    40. 40. Kidney Stones <ul><li>Start as salt/chemical crystals that precipitate out from urine </li></ul><ul><li>Occurs when substance in urine that prevents crystalisation are ineffective </li></ul>
    41. 41. Kidney Stones <ul><li>Various forms of kidney stones - the most common is calcium in combination with either phosphate or oxalate </li></ul><ul><li>More common in </li></ul><ul><ul><li>Males </li></ul></ul><ul><ul><li>20-40 yo </li></ul></ul>
    42. 42. Kidney Stones <ul><li>Signs and Symptoms </li></ul><ul><li>Extreme pain at the site where the stone is causing the irritation </li></ul><ul><li>Blood in the urine (abrasion along the urinary tract as the stone travels) </li></ul><ul><li>Painful and/or difficult urination </li></ul><ul><li>Unable to pass urine if the stone is large enough to obstruct the outlet completely </li></ul>
    43. 43. Kidney Stones <ul><li>Treatment </li></ul><ul><li>With plenty of water, most stones can pass through if small </li></ul><ul><li>Pain-killers (as prescribed by the doctor) </li></ul><ul><li>Some medications may help 'breakdown' larger stone </li></ul><ul><li>Shockwave therapy (F-SWL) to break the stone </li></ul><ul><li>Surgical intervention - cystoscopy or open surgery </li></ul>
    44. 44. Diabetic Kidney Disease <ul><li>Common in chronic and poorly controlled diabetics </li></ul><ul><li>Diabetes damages blood vessels in the kidneys </li></ul><ul><li>Occurs in both types of diabetes </li></ul><ul><li>Occurrence of high blood pressure in diabetics is a strong predictor for diabetic nephropathy </li></ul><ul><li>Most common cause of ESRD in many developed countries </li></ul>
    45. 45. Diabetic Kidney Disease <ul><li>Signs and Symptoms </li></ul><ul><li>Frothy urine (signifying protein in urine) </li></ul><ul><li>Leg swelling (worse after walking/standing) </li></ul><ul><li>High blood pressure </li></ul><ul><li>Itching </li></ul><ul><li>Nausea and/or vomiting </li></ul><ul><li>Losing weight </li></ul><ul><li>Lethargy </li></ul><ul><li>Increased need to urinate at night </li></ul>
    46. 46. Diabetic Kidney Disease <ul><li>Treatment </li></ul><ul><li>Good control of diabetes </li></ul><ul><li>Good control of blood pressure (aiming for < 130/85 or lower in younger patients) </li></ul><ul><li>Medications to decrease protein excretion and preserve the function of kidneys </li></ul><ul><li>Lower protein diet </li></ul><ul><li>Treat any urine tract infection (which is common in diabetics) </li></ul>
    47. 47. Analgesic Nephropathy <ul><li>Chronic kidney disease that occurs when there is a long period of painkiller/s ingestion (usually years) </li></ul><ul><li>Associated with conditions which require constant need for painkiller medications </li></ul><ul><li>May lead to ESRD </li></ul>
    48. 48. Analgesic Nephropathy <ul><li>Signs and Symptoms </li></ul><ul><li>Blood in the urine </li></ul><ul><li>Protein in the urine </li></ul><ul><li>Signs and symptoms related to kidney failure such as nausea, vomiting, lethargy, swelling, and poor appetite. </li></ul>
    49. 49. Analgesic Nephropathy <ul><li>Treatment </li></ul><ul><li>Avoid long-term consumption of analgesics </li></ul><ul><li>Those already with kidney disease of other kinds should certainly refrain from harmful analgesics as much as possible. </li></ul>
    50. 50. In the wards… <ul><li>Look out for… </li></ul><ul><ul><li>Vital signs </li></ul></ul><ul><ul><ul><li>BP </li></ul></ul></ul><ul><ul><ul><li>Temp </li></ul></ul></ul><ul><ul><ul><li>HR </li></ul></ul></ul><ul><ul><li>Catheterisation? </li></ul></ul><ul><ul><li>Dialysis </li></ul></ul><ul><ul><ul><li>When? </li></ul></ul></ul><ul><ul><ul><li>Eventful? </li></ul></ul></ul><ul><ul><li>Other electrolyte values </li></ul></ul><ul><ul><ul><li>Na </li></ul></ul></ul><ul><ul><ul><li>K </li></ul></ul></ul><ul><ul><ul><li>Creatinine </li></ul></ul></ul><ul><ul><ul><li>Urea </li></ul></ul></ul><ul><ul><ul><li>Etc </li></ul></ul></ul><ul><ul><li>Blood count </li></ul></ul><ul><ul><ul><li>Hb </li></ul></ul></ul>
    51. 51. References Kidney Dialysis Foundation (2007). Normal Kidney Functions. Health Guide [Online]. Available: (2008, June 01). National Kidney Foundation (2007). Common Kidney Diseases. Education [Online]. Available: (2008, June 01).