Renal Diseases II

Renal Diseases II

• This presentation covers various kidney diseases, their causes, clinical features, and lab results
• It includes Renal Tubular Acidosis, Nephrogenic Diabetes Insipidus, Fanconi's Syndrome, Renal Calculi, Acute Renal Failure, and Chronic Renal Failure
• The presentation divides the kidney diseases into different categories for easier understanding.

Tubular Diseases

• Tubular defects cause decreased excretion/reabsorption of substances in urine.
• This can result in reduced concentrating capability of the kidneys
• Includes Renal Tubular Acidosis (RTA), Nephrogenic Diabetes Insipidus (NDI), and Fanconi's Syndrome.

Renal Tubular Acidosis (RTA)

• Clinically, RTA is the most significant type of tubule diseases.
• It's caused by inherited or acquired disorders.
• These disorders affect either the proximal or distal convoluted tubules.
• Failure to retain bicarbonate, or inability of tubules to secrete hydrogen ions results in RTA.
• RTA subtypes are classified based on the type of tubular defect.
• Distal RTA (type 1) has impaired hydrogen ion excretion resulting in inability to acidify urine.
• Proximal RTA (type II) has decreased bicarbonate reabsorption causing acidosis.
• Type IV RTA is hyperkalemic and secondary to aldosterone resistance or deficiency.

Nephrogenic Diabetes Insipidus (NDI)

• NDI is a disorder with excessive thirst and excretion of large volumes of severely diluted urine.
• The kidneys' tubules are not responsive to Antidiuretic hormone (ADH).

Fanconi's Syndrome

• Fanconi's syndrome involves inherited or acquired disorders of kidney's tubule function.
• The main symptoms include generalized aminoaciduria, glycosuria, phosphaturia, and acidosis.

Renal Calculi (Kidney Stones)

• Kidney stones are formed from various crystallized substances.
• They are caused by decreased fluid intake, dehydration, and urine saturation with insoluble substances.
• Kidney stones can lead to obstruction, hematuria (blood in urine), urinary tract infections (UTIs), and abdominal pain.

Types of Renal Calculi

• Calcium oxalate stones are associated with hyperparathyroidism, calciuria, vitamin D toxicity, and osteoporosis.
• Calcium phosphate stones form due to excessive alkali consumption, and infections like urease-producing organisms.
• Uric acid stones are associated with gout and hyperuricemia.
• Magnesium ammonium phosphate stones form due to infectious processes.
• Cystine stones result from inherited cystinuria.

Renal Failure

• Renal failure is categorized based on the rate of kidney damage.
• It includes Acute Renal Failure and Chronic Renal Failure.

Acute Renal Failure

• Acute Renal Failure (ARF) is a sudden decline in renal function due to acute toxic or hypoxic damage to the kidneys.
• Diagnosis is made when excretory kidney function falls in hours to days.
• ARF can be reversible (recovery) or progress to chronic renal failure.
• ARF can be divided into three types: pre-renal, primary/intra-renal, and post-renal.

Pre-renal Failure

• Pre-renal failure results from reduced blood flow to the kidneys due to hypovolemia (e.g., haemorrhage, dehydration, shock), or decreased cardiac output (e.g., congestive cardiac failure).

Primary (Intra) Renal Failure

• Intra-renal failure's cause is damage within the kidneys themselves.
• Causes include acute glomerulonephritis, acute tubular necrosis, heavy metal/solvent poisoning, and analgesic/aminoglycoside toxicities.

Post-Renal Failure

• Post-renal failure is caused by blockages in the urinary tract after the kidney, like calculi (kidney stones), prostatic enlargement, or bladder/prostate tumors.

Chronic Renal Failure (CKD)

• Chronic Renal Failure, or Chronic Kidney Disease (CKD), involves a gradual decline in renal function over time.
• CKD is irreversible.
• Common causes include uncontrolled diabetes mellitus, hypertension, chronic glomerulonephritis, inflammatory diseases like pyelonephritis, radiation nephritis, renal obstruction, and polycystic kidney disease.

Clinical Features of Kidney Failure (general)

• Symptoms such as oliguria (low urine output) and anuria (no urine output).
• Decreased ability to excrete electrolytes and water leads to fluid buildup and edema.
• Hypertension and congestive heart failure can develop.
• Elevated BUN (blood urea nitrogen) and serum creatinine levels are often observed.

Clinical Features of CKD

• Polyuria (high urine output), hypertension, nausea, vomiting, muscle and bone weakness.
• Abnormal levels of Na, K, Ca, and PO4 are common findings.
• Anemia is also a common result.
• Metabolic acidosis is a clinical feature in advanced CKD.

Stages of Chronic Kidney Disease

• Kidney function is assessed using GFR (glomerular filtration rate).
• GFRs are used to determine the stage of kidney disease, from risk factors to complete failure.

Risk Factors for Kidney Disease

• Significant risk factors for kidney disease include high blood pressure, diabetes, heart disease, smoking, obesity, and a family history of kidney disease.

Best Foods for Healthy Kidneys

• The presentation suggests fish, bran bread, apple, watermelon, pumpkin, and herbs as beneficial for kidney health.

Renal Replacement Therapy

• Renal replacement therapy is a treatment option for kidney disease.