Major Kidney Diseases

Kidney diseases are divided into two major groups

• Medical diseases: Medical kidney diseases such as kidney failure, urinary tract infection and nephrotic syndrome are treated by nephrologists. Patients with advance kidney failure need treatment such as dialysis and kidney transplantation.
• Surgical diseases: Urologists treat surgical kidney diseases such as kidney stones, prostate problems and cancer of the urinary tract by surgery, endoscopy, and lithotripsy.

How do nephrologists and urologists differ?

Nephrologists are experts in the treatment of medical kidney diseases, slowing progression of kidney diseases dialysis and kidney transplantation; whereas, urologists are experts in the treatment of surgical diseases, such as surgical removal of stones, tumors, kidney and prostate cancer, etc.

Kidney Failure

Significant reduction in the ability of the kidneys to filter and excrete waste products and to maintain the electrolyte balance is called kidney failure. An increase in the values of serum creatinine and blood urea nitrogen (BUN) usually implies kidney malfunction and disease.

Kidney failure is usually divided into two types: acute kidney failure and chronic kidney disease (chronic renal failure).

Acute Kidney Failure

A sudden reduction or loss of kidney function is called acute kidney (renal) failure or acute kidney injury (AKI).The volume of urine decreases in the majority of patients with AKI. Important causes of AKI include intractable diarrhea, intractable vomiting, falciparum malaria, intractable hypotension, sepsis, certain medications (NSAIDs) etc. With proper medical treatment kidney function may be restored in most cases.

Chronic Kidney Disease

Gradual, progressive and irreversible loss of kidney function over several months to years is called chronic kidney disease or – CKD (chronic renal failure). In CKD, kidney function decreases rather slowly but continuously. After a long period of time, it progresses to a stage whereby, the kidneys stop working almost completely. This advanced and life threatening stage of disease is called the end stage kidney (renal) disease (ESKD/ ESRD).

CKD is a silent disease and often goes unnoticed. In the early stages of CKD, signs or symptoms are few and non-specific. Common symptoms of CKD may include generalized weakness, loss of appetite, nausea and vomiting, generalized swelling, high blood pressure, etc. Two most important and common causes of CKD are diabetes and hypertension.

The presence of protein during urinalysis, high creatinine in the blood and small contracted kidneys on ultrasound are important diagnostic clues of underlying CKD. The value of serum creatinine reflects kidney disease and this value increases progressively over time.

In the early stages of CKD, the patient needs appropriate medications and dietary modifications. There is no specific treatment which can cure this disease. One has to realize that as one gets older, the kidney function also decreases. Concomitant illnesses such as diabetes and hypertension, if uncontrolled can contribute to faster and progressive decline of kidney function, along with age.

The aim of the treatment is to slow down the progression of the disease, prevent complications and thereby keep the patient well for a longer period, despite the severity or stage of the illness.

When the disease progresses to an advanced stage (End Stage Kidney Disease) more than 90% of kidney function is lost (serum creatinine is usually more than 8-10 mg/dl). The only treatment options available at this stage are dialysis (hemodialysis and peritoneal dialysis) and kidney transplantation.

Dialysis is a filtering process to remove waste products and excess fluid from the body that may accumulate in the body when the kidney stops functioning. Dialysis is not a cure for CKD. In the advanced stage of CKD (ESKD), the patient needs lifelong regular dialysis treatment (unless kidney is transplanted successfully). Two methods of dialysis are hemodialysis and peritoneal dialysis.

Hemodialysis (HD) is the most widely used form of dialysis. In HD, with the use of a special machine, waste products, excess fluid and salt are removed. Continuous ambulatory peritoneal dialysis (CAPD) isanother form of dialysis modality which can be carried out at home or at work place without the help of the machine.

Kidney transplant is the most ideal treatment option and the only curative treatment modality of end stage kidney disease (advanced stage of CKD).

Urinary Tract Infection

Burning and frequent urination, pain in lower abdomen and fever are common presentations of urinary tract infection (UTI). Presence of pus cells in urine test may suggest UTI.

Most of the patients with UTI respond well to appropriate antibiotic therapy. UTI in children needs special consideration. Delay or inadequate treatment of UTI in children can cause irreversible damage to the growing kidney.

In patients with recurrent UTI, it is important to exclude urinary tract obstruction, stone disease, abnormality of urinary tract and genito- urinary tuberculosis by thorough investigation. The most important cause of recurrence of UTI in children is Vesicoureteric reflux (VUR). VUR is a congenital abnormality, in which urine flows backwards from the bladder into one or both of the ureters, and up to the kidneys, instead of the other way around, i.e. from the kidneys towards the bladder.

Nephrotic Syndrome

Nephrotic syndrome consists of a constellation of findings namely: edema (swelling of feet), massive proteinuria (more than 3.5 grams protein in the urine per day), hypoalbuminemia (low albumin in the blood) and high blood cholesterol levels. Such patients can present with normal or elevated blood pressure as well as varying degrees of kidney dysfunction as measured by creatinine levels in the blood.

This disease shows varying responses to treatment so that it is important to establish the underlying diagnosis early on. A few patients may remain symptom free after discontinuation of the treatment but in most cases the disease recurs, i.e., there may be periods of remission alternating with relapses depending on the stage of treatment.

It is important to realize that the long term outcome is excellent in treated children with nephrotic syndrome. They live healthy lives with normal kidney function

Kidney Stones

Kidney stones are common and important kidney problems. The kidneys, ureters and bladder are common sites where stones may be found. Common symptoms of having kidney stones are severe, unbearable pain, nausea and vomiting, blood in urine, etc. However, some people who have had kidney stones, even for a long time, may not have any symptoms (silent stone), at all.

For the diagnosis of stones, abdominal X-rays and ultrasonography are the most commonly used investigations.

Most of the small sized stones pass out naturally with urine by consuming increased amounts of liquids. If a stone causes recurrent severe pain, recurrent infection, obstruction of urinary tract or damage to kidney, its removal may be necessary. The ideal method for removal of the stone depends on the size, location and the type of stone. Most common methods for the removal of stones are lithotripsy, endoscopy (PCNL, cystoscopy and ureteroscopy) and open surgery.

As the risk of recurrence of stone is as high as 50 - 80%, increasing fluid intake, dietary restriction and periodic check up are necessary for all.

Kidney stones can exist without symptoms for years.

Benign Prostatic Hyperplasia (BPH)

The prostate gland is present only in males. It is situated just underneath the bladder and surrounds the initial portion of urethra. The prostate gland begins to enlarge after the age of 50. An enlarged prostate gland compresses the urethra and causes problems in urination particularly in elderly males.

The main symptoms of benign prostatic hyperplasia (BPH) are frequent urination (especially at night) and dribbling at the end of the urination. Examination by inserting a finger in rectum (digital rectal examination, DRE) and ultrasound are two most important diagnostic methods for BPH.

A large number of patients with mild to moderate symptoms of BPH can be treated effectively for a long period with medicine. Many patients with severe symptoms and very large prostate may require endoscopic removal of the prostate gland (TURP).

Source: Kidney Education Foundation