About kidney and the global market

1. SSS – Human Health & Diseases
Kidney Disorders & Diseases
Dr.R.Sankar
AssistantProfessor,
Department ofAnimalBehaviour andPhysiology
SchoolofBiological Sciences,
MaduraiKamarajIniversity, Madurai- 21
P. Joseph Antony Reneese
Research Scholar,
Department ofAnimalBehaviour andPhysiology
SchoolofBiological Sciences,
MaduraiKamarajIniversity, Madurai- 21

2. Content
• Kidneys & Functions
• Presenting Features of Renal Disease
• Kidney Failure/ESRD
– Riskfactors
– Symptoms
– Treatment
•
•
Hemodialysis
Peritoneal Dialysis
•
•
Common Kidney Diseases
Laboratory Investigation of Kidney Disorders
 Urine Examination
-routine
-microscopic
 Renal Function Test
-Glomerular Function tests
-Renal blood flow test
 Renal Biopsy
References
•

3. TheKidneys
• Apair 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

4. TheKidneys
• Made up of functioning units called nephrons
Nephron
Glomerulus
Tubules

5. Functions
• Removal of waste and excesswater from
body; Regulation of fluid, electrolyte and acid-
base balance

7. 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)

8. Presenting features of renal disease
1. Dysuria
- urethritis(inflammation of urethra) and
cystitis(inflammation of bladder due to
infection)
- inflammation of vagina and penis
2. Polyuria and nocturia(increased urine flow at
night)
- >3 L/ day
- solute diuresis, diabetes insipidus, CRF(Chronic
Renal Failure)

9. 3.Oliguria
- Decreased urinary output i.e. <300 ml/ day
- hypotension, hypovolaemia(decreased
volume of circulating blood in body)
- intrinsic renal disease
- urinary tract obstruction

10. 4. Haematuria.
- blood in the urine, arises anywhere in renal
tract
- micturition- urethral disease- tendency to
urinate

11. 5. Renal pain.
- dull constant pain in the loin.
- renal obstruction, acute pyelonephritis (bacterial
infection causing inflammation), acute nephritic
syndrome (swelling and inflammation of the
glomeruli), polycystic kidney.
6.Ureteric colic.
- Severe loin pain, waxes and wanes, a/w fever,
vomiting, radiate to abdomen, groin, upper thigh.
- Renal calculus, clot.

12. 5. Renal pain.
- dull constant pain in the loin.
- renal obstruction, acute pyelonephritis, acute
nephritic syndrome, polycystic kidney, renal infart.
6.Ureteric colic.
- Severe loin pain, waxes and wanes, a/w fever,
vomiting, radiate to abdomen, groin, upper thigh.
- Renal calculus, clot.

13. 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

14. RiskFactors
• Chronic diseases
• Inflammatory diseases
• Blockageof urinary collecting system
• Chronic infections
• Rare genetic disorders

15. Symptoms
• Decreased urination
• Blood in the urine
• Nausea and vomiting
• Swollen hands and ankles
• Puffiness around the eyes
• Itching
• Sleep disturbances
• High blood pressure
• Lossof appetite

16. Treatment of Kidney Failure
Blood creatinine rises to 900 µmol/ L
• Dialysis
– Hemodialysis
– Peritoneal Dialysis
• Transplant
– the best means of treatment

17. Hemodialysis
• Aprocess by which excesswaste products and
water are removed from the blood
• Requires an accessto the patient's blood
stream and the use of ahaemodialysis
machine

18. Hemodialysis
• Vascular Access
– arterio-venous (AV) fistula
– AVgraft

19. Hemodialysis
• AVgrafts

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

21. 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

22. Hemodialysis
• Advantages
– Staff performs treatment in the dialysis centre
– Three treatments per week in the dialysis
centre
– Permanent internal accessrequired
– Regular contact with people in the centre

23. 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

24. Peritoneal Dialysis
• Dialysis solution flow into the peritoneal
(abdominal) cavity through a catheter
• Petrionuem acts asafilter

25. 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

26. Peritoneal Dialysis
• Advantages
– Patient's involvement in self-care
– Control over schedule
– Lessdiet & fluid restriction
– More steady physical condition asit provides
slow, continuous therapy
– Most similar to original kidneys. Canbe done at
night asin automated peritoneal dialysis
– Provide less severe cardiovascular instabilities in
patients with underlying heart disease

27. Peritoneal Dialysis
• Disadvantages
– Four exchanges per day
– Permanent external catheter
– Change of body image
– Somerisks of infection
– If on automated peritoneal dialysis, one will be tie
onto a machine in the night
– Storage space is needed for supplies

28. Kidney Transplant
• Akidney 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

29. 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

30. Kidney Transplant
• Disadvantages
– Need for frequent physician visits
– Pain, discomfort of surgery
– Riskof transplant rejection
– Prone to infections
– On lifelong medications

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

32. Polycystic Kidney Disease
• Genetically acquired
• 2 forms - dominant and recessive
• In the dominant PKDform, one parent hasthe
diseaseand passesit to the child. The chance
of passing the gene to the offspring is 50%.
• Cystsare abnormal pouches containing fluid.
Eventually the cysts replace normal kidney
tissue -> suffers ESRD

33. Polycystic Kidney Disease
Signsand 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)

34. 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.

35. Hypertensive Nephrosclerosis
• Poorly controlled high blood pressure
(hypertension) can lead to kidney failure
– Thickening of blood vessels

36. Hypertensive Nephrosclerosis
Signsand Symptoms
• Headache
• Giddiness (sometimes related to posture)
• Neck discomfort
• Easily tired
• Nauseousand/or vomiting
• Protein in urine

37. Hypertensive Nephrosclerosis
Treatment
• Medications to control blood pressure (anti-
hypertensive)
• Lowering of dietary salt (2g/day)
• Exerciseregularly

38. Glomerulonephritis /
Glomerulosclerosis
• Glomerulonephritis - An inflammatory
condition that affects predominantly the
glomeruli.
• Causes
– IgA nephropathy
– Streptococcus bacteria
– Autoimmune
• Glomerulosclerosis - scarring of the glomeruli

39. Glomerulonephritis /
Glomerulosclerosis
Signsand Symptoms
• Blood or protein in urine
• Frothy urine (signifying protein in urine)
• Dark or pink-coloured urine
• Legswelling
• Systemic disease like diabetes or autoimmune
disease will have systemic manifestations, e.g.
weight loss, arthritis, or skin rash

40. 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

41. Urinary Tract Infection (UTI)
• Diseaseof 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 causepermanent kidney
damage, if left untreated.
• Women are especially prone to get urinary
tract infection.

42. 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

43. Urinary Tract Infection (UTI)
Signsand 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
passurine
• Nauseaand/or vomiting

44. Urinary Tract Infection (UTI)
Treatment
• Appropriate antibiotics
• Drink plenty of water

45. Kidney Stones
• Start assalt/chemical crystals that precipitate
out from urine
• Occurs when substance in urine that prevents
crystalization are ineffective

46. 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

47. Kidney Stones
Signsand Symptoms
• Extreme pain at the site where the stone is
causing the irritation
• Blood in the urine (abrasion along the urinary
tract asthe stone travels)
• Painful and/or difficult urination
• Unable to pass urine if the stone is large
enough to obstruct the outlet completely

48. Kidney Stones
Treatment
• With plenty of water, most stones can pass
through if small
• Pain-killers (as prescribed by the doctor)
• Somemedications may help 'breakdown' larger
stone
• Shockwave therapy (F-SWL)to break the stone
• Surgical intervention - cystoscopy or open
surgery

49. Diabetic Kidney Disease
• Common in chronic and poorly controlled
diabetics
• Diabetes damages blood vesselsin the kidneys
• Occurs in both types of diabetes
• Occurrence of high blood pressure in diabetics
is a strong predictor for diabetic nephropathy
• Most common causeof ESRDin many
developed countries

50. Diabetic Kidney Disease
Signsand Symptoms
• Frothy urine (signifying protein in urine)
• Legswelling (worse after walking/standing)
• High blood pressure
• Itching
• Nauseaand/or vomiting
• Losing weight
• Lethargy
• Increased need to urinate at night

51. 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)

52. Analgesic Nephropathy
• Chronic kidney disease that occurs when there
is along period of painkiller/s ingestion
(usually years)
• Associated with conditions which require
constant need for painkiller medications
• May lead to ESRD

53. 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.

54. Analgesic Nephropathy
Treatment
• Avoid long-term consumption of analgesics
• Those already with kidney disease of other
kinds should certainly refrain from harmful
analgesics asmuch aspossible.