Kidney diseases

Polycystic kidney disease

Polycystic kidney disease is a condition where cysts (cavities) form in the kidney. Some of the cysts do not cause any progressive kidney failure. Other cysts are of the inherited type, which may enlarge and slowly crowd out the normal kidney. Eventually, after a long period of time, the patient may need artificial kidney treatment or transplantation. Symptoms of this disease range from no symptoms at all to blood appearing in the urine.

The inherited type of this disease is autosomal dominant. This means that if one parent has the gene in his/her family there is a 50% chance that each child will develop the disorder. However, even if the child does develop it, there are cases when the condition can be so mild that it would not be detected and would have no significant effect on the patient's health throughout life.

Pyelonephritis

Pyelonephritis refers to infection of the kidney. It is usually caused by a bacterial infection, but it can also be caused by viruses. Most of these can be treated with medication taken in the right dosage for the full time. There are many potential causes of pyelonephritis. The most common cause is some form of obstruction to urine flow. The obstruction could be in the ureter (the tube connecting the kidney to the bladder) or to the outflow of urine from the bladder. Other causes of obstruction include stones, swelling and scarring of the ureter, chronic infection, and tumors. Recurrent infections can also occur when the organisms causing your discomfort become resistant to the drugs that usually destroy them, particularly if patients do not take all of the medication prescribed. If the medication is not taken for the full length of time it was prescribed, it may not kill off the heartiest organisms. These organisms will become even more resistant and the symptoms will come back.

Kidney reflux

Reflux refers to a condition where the urine in the bladder passes back up the ureter to the kidney instead of out through the urethra during the process of urination. The muscles that usually close off the ureter to the bladder do not function normally. The process itself has no specific symptoms. If there is a bladder infection, reflux could cause a kidney infection, which may result in back pain. Reflux is usually not associated with incontinence unless there is associated urinary tract infection, congenital abnormalities associated with the drainage of the kidney, or problems with bladder function.

Systemic lupus and the kidneys

Systemic lupus (an autoimmune disorder) can cause the body to produce antibodies directed against the kidney membranes. Normally, the filtering membranes do not permit albumin and other blood proteins to be lost in the urine. However, when systemic lupus attacks the kidney, the filtering membranes are disrupted, resulting in the finding of protein in the urine. This antibody production can be altered by using immune suppressive drugs such as steroids, immuran, and cytoxine.

Renal acidosis

Renal acidosis refers to the accumulation of acid products in the blood that are not being properly excreted by the kidney. As the acid products accumulate the acidity of the blood goes up. This stimulates the receptors in the brain to speed up the rate of breathing. This can cause the sensation of shortness of breath. It also speeds up the heart rate so the pulse goes up. These are two of the most common symptoms and signs of metabolic acidosis caused by kidney failure.

Mesangial proliferative glomerulonephritis

This disease is noted to be present, but without symptoms, for long periods of time. It is important to have routine urine tests done at least once a year, as well as your blood pressure checked. Less than 30% of patients with this diagnosis progress to end stage renal disease. There are excellent treatments for high blood pressure, swelling, and anemia, all signs that may relate to glomerulonephritis. When such therapy is started early there is good evidence that they are very effective in delaying progression of the kidney disease. Therapies include diet, weight control, progressing on to artificial kidney or transplant over a long time period.

Membranoproliferative glomerulonephritis

Membranoproliferative glomerulonephritis is a form of glomerulonephritis that is classified as an autoimmune disease. Antibodies to some unknown protein, called an antigen, get trapped in the filtering bed of the kidney, called the glomerulus. Once there, this antigen sets up a reaction in the normal cells that activates the so-called "killer cells." These cells are very destructive and result in walling off the antigen. This produces a scar, which destroys the normal architecture of the glomerulus. This condition can be treated with immunosuppressive drugs.

Hemangiomas

Hemangiomas are common tumors usually found on the skin and commonly called 'birth marks'. They can occur in any organ or tissue. When they are located in the kidney they may cause hematuria (visible blood in the urine). This, in turn, may cause the dipstick test for protein to show a very weakly positive reaction that should not need investigating.

Parenchymal kidney disease

Renal parenchymal disease as seen by ultrasound means that the kidney is damaged and scarred and has lost part of its ability to function. There are many, many types of kidney disease that lead to scarring. Any time that scar tissue forms, kidney function in that area is lost and cannot be regained. Consultation with a nephrologist is very important in order to find out the cause the kidney disease, how severe the damage is, and what can be done to prevent the loss of any more kidney function.

The diagnosis of this disease by ultrasound is confirmed by elevated blood urea nitrogen concentration and serum creatinine concentrations (BUN normal range 10-20 mg%, creatinine .9-1.2 mg%). However, diagnosis is sometimes delayed because there are several types of parenchymal kidney diseases that are very silent in their progression. Some of these diseases are reversible; others can be treated to stop further progression.

Alport's Disease

Alport's disease is believed to be a form of auto-immune disease. The patient's immune system has set up antibodies that act on the tissues of the capillaries in the kidney. Alport's disease goes under other names also. The 2 most typical are Berger's Disease and IgA Nephropathy. The diagnosis of which form of Alport's disease a patient has can only be made from studies of kidney tissue removed by biopsy. The treatment is immuno-suppressive therapy, which is usually very effective in controlling the progression of the disease.

Diabetes Insipidus

Diabetes Insipidus is a disease that has symptoms that resemble diabetes mellitus but it is a far different condition. Its major symptom is very frequent urination. This condition may be the result of a deficiency of anti-diuretic hormone (ADH), a hormone that causes the kidney to retain water during times of dehydration. However, it may also be the result of kidney failure to respond to ADH. Under these circumstances, the individual was born without the biochemical receptors in the kidney that respond to the hormone. The disease is treatable. With proper management patients with this problem can lead a normal life.