Damage to or disease of a kidney
Medical condition
Kidney disease
, or
renal disease
, technically referred to as
nephropathy
, is damage to or
disease
of a
kidney
.
Nephritis
is an
inflammatory
kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by
blood tests
.
Nephrosis
is non-inflammatory kidney disease. Nephritis and nephrosis can give rise to
nephritic syndrome
and
nephrotic syndrome
respectively. Kidney disease usually causes a loss of
kidney function
to some degree and can result in
kidney failure
, the complete loss of kidney function. Kidney failure is known as the end-stage of kidney disease, where
dialysis
or a
kidney transplant
is the only treatment option.
Chronic kidney disease
is defined as prolonged kidney abnormalities (functional and/or structural in nature) that last for more than three months.
[1]
Acute kidney disease is now termed
acute kidney injury
and is marked by the sudden reduction in kidney function over seven days. In 2007, about one in eight Americans had chronic kidney disease.
[2]
This rate is increasing over time
[1]
to where about 1 in 7 Americans are estimated to have CKD as of 2021.
[3]
Causes
[
edit
]
Causes of kidney disease include deposition of the
Immunoglobulin A
antibodies
in the
glomerulus
, administration of
analgesics
,
xanthine oxidase deficiency
,
toxicity
of
chemotherapy agents
, and a long-term exposure to
lead
or its salts. Chronic conditions that can produce nephropathy include
systemic lupus erythematosus
,
diabetes mellitus
and
high blood pressure
(hypertension), which lead to
diabetic nephropathy
and
hypertensive nephropathy
, respectively.
Analgesics
[
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]
One cause of nephropathy is the long term usage of pain medications known as
analgesics
. The pain medicines which can cause kidney problems include
aspirin
,
acetaminophen
, and
nonsteroidal anti-inflammatory drugs
(NSAIDs). This form of nephropathy is "chronic analgesic nephritis," a chronic inflammatory change characterized by loss and atrophy of tubules and interstitial fibrosis and inflammation (BRS Pathology, 2nd ed.).
Specifically, long-term use of the analgesic
phenacetin
has been linked to
renal papillary necrosis
(necrotizing papillitis).
Diabetes
[
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]
Diabetic nephropathy is a progressive kidney disease caused by
angiopathy
of the
capillaries
in the
glomeruli
. It is characterized by
nephrotic syndrome
and diffuse
scarring of the glomeruli
. It is particularly associated with poorly managed
diabetes mellitus
and is a primary reason for
dialysis
in many developed countries. It is classified as a
small blood vessel complication
of diabetes.
[4]
Autosomal dominant polycystic kidney disease
[
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]
Gabow 1990 talks about Autosomal Dominant Polycystic Kidney disease and how this disease is genetic. They go on to say "Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disease, affecting a half million Americans. The clinical phenotype can result from at least two different gene defects. One gene that can cause ADPKD has been located on the short arm of chromosome 16."
[5]
The same article also goes on to say that millions of Americans are effected by this disease and is very common.
COVID-19
[
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]
COVID-19
is associated with kidney disease. In patients hospitalized with COVID-19, the prevalence of acute kidney injury is estimated to be 28%, and the prevalence of
renal replacement therapy
is estimated to be 9%.
[6]
Diet
[
edit
]
Higher dietary intake of animal protein, animal fat, and cholesterol may increase risk for
microalbuminuria
, a sign of kidney function decline,
[7]
and generally, diets higher in fruits, vegetables, and whole grains but lower in meat and
sweets
may be protective against kidney function decline.
[8]
This may be because sources of animal protein, animal fat, and cholesterol, and sweets are more acid-producing, while fruits, vegetables, legumes, and whole grains are more
base-producing
.
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
IgA nephropathy
[
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]
IgA nephropathy is the most common
glomerulonephritis
throughout the world
[19]
Primary IgA nephropathy is characterized by deposition of the
IgA
antibody
in the glomerulus. The classic presentation (in 40?50% of the cases) is episodic frank
hematuria
which usually starts within a day or two of a non-specific
upper respiratory tract infection
(hence
synpharyngitic
) as opposed to
post-streptococcal glomerulonephritis
which occurs some time (weeks) after initial infection. Less commonly gastrointestinal or urinary infection can be the inciting agent. All of these infections have in common the activation of mucosal defenses and hence IgA antibody production.
Iodinated contrast media
[
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]
Kidney disease induced by iodinated contrast media (ICM) is called
contrast induced nephropathy
(CIN) or contrast-induced
acute kidney injury
(AKI). Currently, the underlying mechanisms are unclear. But there is a body of evidence that several factors including
apoptosis
-induction seem to play a role.
[20]
Lithium
[
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]
Lithium
, a medication commonly used to treat
bipolar disorder
and
schizoaffective disorders
, can cause
nephrogenic diabetes insipidus
; its long-term use can lead to nephropathy.
[21]
Lupus
[
edit
]
Despite expensive treatments,
lupus nephritis
remains a major cause of morbidity and mortality in people with relapsing or refractory lupus nephritis.
[22]
Xanthine oxidase deficiency
[
edit
]
Another possible cause of Kidney disease is due to decreased function of
xanthine oxidase
in the
purine
degradation pathway. Xanthine oxidase will degrade
hypoxanthine
to
xanthine
and then to
uric acid
. Xanthine is not very soluble in water; therefore, an increase in xanthine forms crystals (which can lead to
kidney stones
) and result in damage to the kidney.
Xanthine oxidase
inhibitors, like
allopurinol
, can cause nephropathy.
Polycystic disease of the kidneys
[
edit
]
Additional possible cause of nephropathy is due to the formation of cysts or pockets containing fluid within the kidneys. These cysts become enlarged with the progression of aging causing renal failure. Cysts may also form in other organs including the liver, brain, and ovaries. Polycystic kidney disease is a genetic disease caused by mutations in the PKD1, PKD2, and PKHD1 genes. This disease affects about half a million people in the US. Polycystic kidneys are susceptible to infections and cancer.
Toxicity of chemotherapy agents
[
edit
]
Nephropathy can be associated with some therapies used to treat cancer. The most common form of kidney disease in cancer patients is
acute kidney injury
(AKI) which can usually be due to volume depletion from vomiting and diarrhea that occur following chemotherapy or occasionally due to kidney toxicities of chemotherapeutic agents. Kidney failure from break down of cancer cells, usually after chemotherapy, is unique to
onconephrology
. Several chemotherapeutic agents, for example
cisplatin
, are associated with acute and chronic kidney injuries.
[23]
Newer agents such as
anti-vascular endothelial growth factor
(anti-VEGF) are also associated with similar injuries, as well as
proteinuria
,
hypertension
, and
thrombotic microangiopathy
.
[24]
Diagnosis
[
edit
]
The standard
diagnostic workup
of suspected kidney disease includes a
medical history
,
physical examination
, a
urine test
, and an
ultrasound
of the kidneys (
renal ultrasonography
). An ultrasound is essential in the diagnosis and management of kidney disease.
[25]
Treatment
[
edit
]
Treatment approaches for kidney disease focus on managing the symptoms, controlling the progression, and also treating co-morbidities that a person may have.
[1]
Dialysis
[
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]
Transplantation
[
edit
]
Millions of people across the world have kidney disease. Of those millions, several thousand will need
dialysis
or a
kidney transplant
at its
end-stage
.
[26]
In the United States, as of 2008, 16,500 people needed a kidney transplant.
[26]
Of those, 5,000 died while waiting for a transplant.
[26]
Currently, there is a shortage of donors, and in 2007 there were only 64,606 kidney transplants in the world.
[26]
This shortage of donors is causing countries to place monetary value on kidneys. Countries such as Iran and Singapore are eliminating their lists by paying their citizens to donate. Also, the black market accounts for 5?10 percent of transplants that occur worldwide.
[26]
The act of buying an organ through the black market is illegal in the United States.
[27]
To be put on the waiting list for a kidney transplant, patients must first be referred by a physician, then they must choose and contact a donor hospital. Once they choose a donor hospital, patients must then receive an evaluation to make sure they are sustainable to receive a transplant. In order to be a match for a kidney transplant, patients must match blood type and
human leukocyte antigen
factors with their donors. They must also have no reactions to the
antibodies
from the donor's kidneys.
[28]
[26]
Prognosis
[
edit
]
Kidney disease can have serious consequences if it cannot be controlled effectively. Generally, the progression of kidney disease is from mild to serious. Some kidney diseases can cause
kidney failure
.
See also
[
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]
References
[
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]
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External links
[
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]