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Kidney diseases
Medical Background
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Medical Background
Epidemiology
Kidney disease is a widespread condition. Kidney
disease develops in around 1 in 2,000 people (United Kingdom). Near 8 million
Americans, or 4 percent of U.S. adults have lost more than half of their kidney
function. Another 6 percent have the persistent presence of proteins in their
urine, one of the first signs of kidney disease.
Diabetes mellitus is the commonest cause of
kidney disease. About 40 percent of kidney failure is due to diabetic nephropathy.
Hypertension accounts for another 30 percent. Depending on race and region in
the world every year about 100 to 500 in 1 million people develop end-stage
renal failure.
Causes of dialysis and kidney transplants in Europe
| Disesases |
Frequency |
 |
| Glomerulonephritis |
25.6 percent |
| Pyelonephritis / interstitial nephritis |
18.0 percent |
| Unclear origin |
14.6 percent |
| Diabetes |
10.3 percent |
| Hypertension |
10.2 percent |
| Cystic/polcystic kidney diseases |
7.5 percent |
| Others |
10.9 percent |
Causes and Risk Factors
The risk factors for chronic kidney disease
are compounded by many of the risk factors for coronary
heart disease:
Risk factors and compounding factors for chronic kidney disease (CKD)
| CKD risk factors |
Cardiac risk factors |
General risk factors |
|
| Diabetes mellitus |
Obesity |
Age - increases as age increases |
| Hypertension |
Hyperlipidemia |
Race -nonwhite |
| NSAIDs use |
Cigarette smoking |
High protein diet |
Generally speaking, four clinical syndromes are of importance for the general
practitioner.
Nephrotic syndrome
A symptom complex which occurs in many primary and secondary kidney diseases
such as inflammatory and non-inflammatory glomerulopathy, renal vein thrombosis
or infections. It is characterized by pronounced edema, significant proteinuria
and hypoproteinemia.
Nephritic syndrome
This inflammatory glomerular disease, often of unclear etiology, involves the
simultaneous occurrence of hypertension, renal failure and flank pain. It is
frequently associated with a sudden onset. Glomerulopathies (glomerulonephritis)
- in Europe the most common cause of chronic renal failure - may clinically
present both as nephrotic and/or nephritic syndrome.
Etiology of glomerulopathies clinically presenting as nephritic syndrome:
- Immune complex glomerulonephritis (idiopathic, postinfectious, systemic
lupus erythematodes, subacute bacterial endocarditis, cryoglobulinemia,
IgA nephropathy, Henoch-Schönlein purpura, fibrillary glomerulonephritis,
visceral abscess)
- Anti-glomerular basement membrane disease, Goodpasture's syndrome
- Wegener's granulomatosis, microscopic polyareriitis nodosa, renal-limited
crescentic glomerulonephritis
- Malignant hypertension, haemolytic-uremic syndromes, interstitial nephritis,
scleroderma crisis, toxemia, atheroemboli
Renal edema: Differential diagnosis of nephritic syndrome and nephrotic
syndrome
| Symptom |
Nephritic syndrome |
Nephrotic syndrome |
|
| Edema |
Especially eyelid edema |
Often pronounced peripheral edema |
| Proteinuria |
Moderate |
Significant (≥ 3 g / 24 hours) |
| Serum protein |
Normal (or moderate reduction) |
Significant hypoproteinemia |
| Urine sediment |
(Macroscopic) hematuria, casts, and dysmorph erythrocytes |
Rarely microscopic hematuria |
| Cholesterol |
Normal |
Hyperlipoproteinemia |
| Hypertension |
Often |
Rarely |
Renal failure
Chronic renal failure
Chronic deterioration in renal functions that usually progresses slowly along
with a variety of underlying disorders. Its clinical manifestation depends on
the stage of the renal failure in accordance with the impairment of the excretory
and hormonal renal functions. Symptoms like fatigue, peripheral edema, pruritus,
hypertension and symptoms of hyperkalemia usually become more obvious with a
creatinine of 3 to 6 mg/dl (265.2 to 530.4 µmol/l).
Acute renal failure
A sudden decrease of renal function associated with oliguria or anuria (in about
15 percent normouria or polyuria) and an increase of substances usually eliminated
with urine. Symptoms include retention of urine, shortness of breath, edema
and lung edema and cardiac problems caused by hyperkalemia and metabolic acidosis.
In 75 percent it is of pre-renal etiology due to reduction of the renal blood
flow, e.g. caused by bleeding or hypovolemic conditions.
Urolithiasis
Urolithiasis is a common cause of both hematuria and abdominal pain, or groin
pain. Stones can be composed of calcium (80 percent of all stones), oxalate,
urate, cystine, xanthine, phosphate, or all of these. Main risk factors are
dietary factors, pre-existing diseases (e.g.
urinary
tract infections) and environmental factors (regions with a hot and dry
climate). Up to 75 percent of the stones are localized in the ureter, 80 percent
of which are in the distal ureter, and 10 to 15 percent are bilateral. Up to
80 percent of stones pass spontaneously.
Watch out!
- An acute renal failure is not often seen by general practitioners. Nevertheless
it is of utmost importance to be in a position to recognize it
- Urolithiasis and urinary tract infections tend to favour each other. Therefore
a urinary tract infection has to be recognized and treated with antibiotics
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