Chronic kidney disease, diabetic nephropathy, glomerulonephritis, nephrotic syndrome, nephritic syndrome, hypertensive nephropathy
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Definition:
- Gradual loss of kidney function - Advanced disease can cause dangerous levels of fluid, electrolytes & wastes build up in the body - Also called chronic kidney failure - Black, Native American & Asian American are more at risk |
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Risk factors/causes:
- Diabetes - Hypertension & cardiovascular diseases - Glomerulonephritis - Polycystic kidney disease (inherited) - Smoking & drug abuse - Obesity - Age - Family Hx of kidney disease |
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Pathophysiology & mechanism: Causes → ↓ number of nephrons → activation of vasoactive mediators, cytokines, RAAS, growth factors → structural & functional changes of surviving nephrons → hyperfiltration → ↑ intraglomerular capillary pressure → accelerated sclerosis of remaining nephrons → ↓ number of nephrons
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Signs & symptoms:
- Nausea/vomiting - Loss of appetite - Frequent/difficulty urinating - Foamy urine - Ammonia-smelling breath - Fatigue & weakness - Ankle & feet swelling - Anaemia - Hypocalcaemia (↓ calcium) - Hyperphosphatemia (↑ phosphate) - Metabolic acidosis - Hyperkalaemia (↑ potassium) |
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Treatment: Medication or surgery (kidney transplant)
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Definition: Inflammation & damage of the tiny filters (glomeruli) in the kidneys (autoimmune origin)
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Risk factors/causes:
- Infections - Autoimmune - Vasculitis - Sclerotic conditions - Inherited - Cancers |
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Signs & symptoms:
- Nausea/vomiting - Fatigue - Less urination - Pink or cola-coloured urine - Foamy urine - Hypertension - Oedema (fluid retention) |
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Complications:
- Accumulation of wastes or toxins in the bloodstream - Poor regulation of essential minerals & nutrients - Loss of red blood cells - Loss of blood proteins |
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Treatment: Therapies for associated kidney failure
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Definition: Inflammation of the glomeruli (glomerulonephritis) & renal dysfunction
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Risk factors/causes:
- Immunological (IgA nephropathy, tend to occur post-infection) - Within the course of autoimmune disease (Lupus nephritis) - Kidney disease (causes by many different bacteria, viruses, fungi, parasites, systemic, etc.) |
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Pathophysiology & mechanism: Deposition of immune complexes (antibody + antigen) or antibodies triggers inflammation with leukocyte infiltration → injurs cells & degrades the glomerular basement membrane (GBM) → leakage of erythrocytes (RBC) + some proteinuria → S/Sx
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Signs & symptoms:
- Blurred vision - Hypertension - Oliguria (low urine output) - Haematuria (blood in urine) - Proteinuria - Azotemia (↑levels of nitrogen-containing substance) |
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Treatment: Medication & surgery (kidney transplant)
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Definition: Glomerular loss (glomeruli [filtration] malfunction) & secondary disease to diabetes
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Risk factors/causes:
- Hyperglycaemia (↑ blood sugar) - Hypertension - Smoking - Obesity - Family Hx of diabetes & kidney disease - ↑ blood cholesterol |
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Pathophysiology & mechanism: ↑glucose levels → ↑blood volume, pressure & renal perfusion → damages the blood vessels (form glomeruli) → leaky vessels → extravasation of blood proteins (spilt into the capsule)
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Signs & symptoms:
- Nausea - Loss of appetite - Fatigue/insomnia - Swollen ankles, feet & hands - Dry/itchy skin - Difficulty concentrating |
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Treatment: Medication or surgery (kidney transplant)
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Definition: [Sate of kidney failure] Kidney disorder that causes the body to pass too much protein in the urine (heavy proteinuria 3.0g/24 hours)
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Risk factors/causes:
- Metabolic - Immunological - Idiopathic/primary - Neoplastic - Medication/drug use - Infection - Allergic - Genetic syndromes |
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Pathophysiology & mechanism: Podocyte injury → podocyte damage, effacement (thinning), & detachment from the basement membrane → proteins leak through the filtration membrane → enter urine → S/Sx
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Signs & symptoms:
- Oedema (starts in the face, spreads peripheral) - Vomiting - Pale skin/fissures - Foamy urine (excess protein) - Fatigue - Loss of appetite - Weight gain (fluid retention) |
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Complications:
- Tachycardia (↑BPM) - Hyperlipidemia (↑lipid levels) - Proteinuria (↑protein in urine) - Blood clots (blood proteins help prevent them) |
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Treatment: Medication & surgery (kidney transplant)
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Definition: Progressive kidney damage due to long-term, poorly controlled high blood pressure
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Risk factors/causes: Hypertension & lesion = arteriolar nephrosclerosis
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Pathophysiology & mechanism: Hypertension → thickening of Bowman's capsule & nephron capillaries due to cell proliferation (accumulation) & collagen deposition → ↑glomerular pressure → ↓renal blood flow → alteration in inflammatory profile of different cells → ↓permeability & filtration → glomerular sclerosis → hypertensive nephropathy
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Signs & symptoms:
- Nausea/vomiting - Loss of appetite - Itching - Confusion |
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Complications of persistent ↑ BP:
- Brain (strokes, hypertensive encephalopathy) - Blood (↑ sugar levels) - Eye retina (Hypertensive retinopathy) - Heart (MI, hypertensive cardiomyopathy) - Kidneys (hypertensive nephropathy) |
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