Kidney disease
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Kidney diseases, or renal diseases, technically referred to as nephropathies, are pathological conditions affecting the kidneys—the organs that facilitate removal of waste products and toxins from the bloodstream, regulate the body's concentration of electrolytes, maintain the appropriate acid-base balance of plasma, and produce urine as a byproduct of metabolism.<ref name=":1">Template:Cite book</ref>
When used colloquially, the term kidney disease may refer to chronic kidney disease (CKD), an umbrella term for any progressive loss of kidney function over at least three months, from any cause.<ref>Template:Cite web</ref> In contrast, kidney damage over a shorter period of time is known as acute kidney injury.<ref name=":1" />
From a technical standpoint, the heterogenous group of kidney diseases is heterogenous can be broadly divided into categories based on which anatomical structures are involved: the glomeruli, the filtering capillaries of the kidney; tubules, which carry filtered blood; the renal interstitium, the fluid-filled space between these structures; and the renal blood vessels, which deliver blood towards and away from the kidney.<ref name=":1" /> Glomerular disease, or glomerulonephritis, can be further divided into the nephritic and nephrotic syndromes, which are respectively characterized by blood and protein leaking into the urine.<ref>Template:Cite web</ref>
All forms of kidney disease, glomerular or otherwise, have the potential to damage all four components of the kidney, culminating in end-stage renal disease—the stage of disease at which dialysis or a kidney transplant are necessary.<ref>Template:Cite web</ref>
Rates for both chronic kidney disease and mortality have increased, associated with the rising prevalence of diabetes and the aging global population.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> The World Health Organization has reported that "kidney diseases have risen from the world's nineteenth leading cause of death to the ninth, with the number of deaths increasing by 95% between 2000 and 2021."<ref>Template:Cite web</ref> In the United States, prevalence has risen from about one in eight in 2007,<ref>Template:Cite journal</ref> to one in seven in 2021.<ref>Template:Cite web</ref>
Causes
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
Template:Main article Template:No footnotes 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
Template:Main article 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.<ref>Longo et al., Harrison's Principles of Internal Medicine, 18th ed., p. 2982</ref>
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."<ref>Template:Cite journal</ref> 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%.<ref>Template:Cite journal</ref>
Diet
Higher dietary intake of animal protein, animal fat, and cholesterol may increase risk for microalbuminuria, a sign of kidney function decline,<ref>Template:Cite journal</ref> and generally, diets higher in fruits, vegetables, and whole grains but lower in meat and sweets may be protective against kidney function decline.<ref>Template:Cite journal</ref> 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.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref>Template:Excessive citations inline
IgA nephropathy
Template:Main article IgA nephropathy is the most common glomerulonephritis throughout the world <ref>Template:Cite journal</ref> 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
Template:Main article 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.<ref>Template:Cite journal</ref>
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.<ref>Template:Cite journal</ref>
Lupus
Despite expensive treatments, lupus nephritis remains a major cause of morbidity and mortality in people with relapsing or refractory lupus nephritis.<ref>Template:Cite journal</ref>
Xanthine oxidase deficiency
Template:Main article 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
Template:Main article 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
Template:Main article 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.<ref>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</ref> 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.<ref name="pmid21146124">Template:Cite journal</ref>
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.<ref>Template:Cite journal</ref>
Treatment
Treatment approaches for kidney disease focus on managing the symptoms, controlling the progression, and also treating co-morbidities that a person may have.<ref name=":0">Template:Cite journal</ref>
Dialysis
Transplantation
Template:Main 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.<ref name="MeatMarketWSJ">Template:Cite news</ref> In the United States, as of 2008, 16,500 people needed a kidney transplant.<ref name="MeatMarketWSJ" /> Of those, 5,000 died while waiting for a transplant.<ref name="MeatMarketWSJ" /> Currently, there is a shortage of donors, and in 2007 there were only 64,606 kidney transplants in the world.<ref name="MeatMarketWSJ" /> 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.<ref name="MeatMarketWSJ" /> The act of buying an organ through the black market is illegal in the United States.<ref>Template:Cite web</ref> 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.<ref name="kidneylink">Template:Cite web</ref><ref name="MeatMarketWSJ" />
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
- Hematologic Diseases Information Service
- Mesoamerican nephropathy, an enigmatic chronic kidney disease of Central America
- Protein toxicity
References
External links
Template:Medical resources Template:Nephrology Template:Glomerular disease