Uploaded by Tahira Bibi


Kidney & Its Common Diseases
Neuro Workgroup SIG
12 June 2008
Suhaila Mohamed Usuludin
• 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
The Kidneys
• Made up of functioning units called nephrons
The Kidneys
• Removal of waste and excess water from body
• Normal kidneys release several hormones
– Renin (regulates blood pressure)
– Erythropoietin (stimulates production of red blood
– Activated form of Vitamin D (maintain normal bone
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
– 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
Decreased urination
Blood in the urine
Nausea and vomiting
Swollen hands and ankles
Puffiness around the eyes
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
• 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
• Vascular Access
– arterio-venous (AV) fistula
– AV graft
• AV grafts
• 3 times a week (on alternate days) for 3 to 5 or
more hours each visit
• “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
• 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
• 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
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
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
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
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
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
Kidney Transplant
• 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
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
• Upper abdominal discomfort (liver and
pancreatic cysts)
Polycystic Kidney Disease
• Blood pressure - controlled and treated
• Kidney failure - supportive therapy until endstage is reached when dialysis or
transplantation is then required
• Urine tract infection - treatment with
• 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
Hypertensive Nephrosclerosis
Signs and Symptoms
• Headache
• Giddiness (sometimes related to posture)
• Neck discomfort
• Easily tired
• Nauseous and/or vomiting
• Protein in urine
Hypertensive Nephrosclerosis
• Medications to control blood pressure (antihypertensive)
• Lowering of dietary salt (2g/day)
• Exercise regularly
Glomerulonephritis /
• Glomerulonephritis - An inflammatory
condition that affects predominantly the
• Causes
– IgA nephropathy
– Streptococcus bacteria
– Autoimmune
• Glomerulosclerosis - scarring of the glomeruli
Glomerulonephritis /
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 /
• Suppression of inflammation may be achieved
by certain medications (eg steroids).
• Medications to decrease excretion of urinary
• 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.
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
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
Urinary Tract Infection (UTI)
• 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
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
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
Kidney Stones
• With plenty of water, most stones can pass
through if small
• Pain-killers (as prescribed by the doctor)
• Some medications may help 'breakdown' larger
• Shockwave therapy (F-SWL) to break the stone
• Surgical intervention - cystoscopy or open
Diabetic Kidney Disease
• Common in chronic and poorly controlled
• 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
Diabetic Kidney Disease
• 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
• 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.
Analgesic Nephropathy
• 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
– Blood count
– Hb
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).