Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an Inflammation kidney disease and has several types according to the location of the inflammation. Inflammation can be diagnosed by . 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 Kidney 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.
Rates for both chronic kidney disease and mortality have increased, associated with the rising prevalence of diabetes and the ageing global population.
Causes
Causes of kidney disease include deposition of the
Immunoglobulin A Antibody in the glomerulus, administration of
, xanthine oxidase deficiency,
Cytotoxicity 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
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) such as ibuprofen and naproxen. 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
Diabetic nephropathy is a progressive kidney disease caused by
angiopathy of the
capillary 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
Kidney dialysis in many developed countries. It is classified as a
Microangiopathy of diabetes.
[Longo et al., Harrison's Principles of Internal Medicine, 18th ed., p. 2982]
Autosomal dominant polycystic kidney disease
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."
The same article also goes on to say that millions of Americans are affected by this disease and it is very common.
COVID-19
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%.
Diet
Higher dietary intake of animal protein, animal fat, and cholesterol may increase risk for
microalbuminuria, a sign of kidney function decline,
and generally, diets higher in fruits, vegetables, and whole grains but lower in meat and
Candy may be protective against kidney function decline.
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.
IgA nephropathy
IgA nephropathy is the most common glomerulonephritis throughout the world
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
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.
Lithium
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.
Lupus
Despite expensive treatments,
lupus nephritis remains a major cause of morbidity and mortality in people with relapsing or refractory lupus nephritis.
Xanthine oxidase deficiency
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
) and result in damage to the kidney.
Xanthine oxidase inhibitors, like
allopurinol, can cause nephropathy.
Polycystic disease of the kidneys
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
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.
[Portilla D, Safar AM, Shannon ML, Penson RT. "Cisplatin nephrotoxicity". In: UpToDate, Palevsky PM (Ed), UpToDate, Waltham, MA, 2013. http://www.uptodate.com/contents/cisplatin-nephrotoxicity] Newer agents such as
Anti-VEGF (anti-VEGF) are also associated with similar injuries, as well as
proteinuria,
hypertension, and thrombotic microangiopathy.
Diagnosis
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.
Treatment
Treatment approaches for kidney disease focus on managing the symptoms, controlling the progression, and also treating co-morbidities that a person may have.
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Dialysis
Transplantation
Millions of people across the world have kidney disease. Of those millions, several thousand will need dialysis or a kidney transplant at its kidney failure.[ Of those, 5,000 died while waiting for a transplant.][ Currently, there is a shortage of donors, and in 2007 there were only 64,606 kidney transplants in the world.][ 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.][ The act of buying an organ through the black market is illegal in the United States.][
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Prognosis
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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Hematologic Diseases Information Service
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Mesoamerican nephropathy, an enigmatic chronic kidney disease of Central America
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Protein toxicity
External links
