DISEASES OF THE KIDNEYS

BY ARINANYE APOLLO
 SCOPE
• Introduction
• Kidney and urine
• Acute renal failure
• Kidney damage
• Chronic kidney disease(CKD)
• Diabetic nephropathy
• Kidney stones
• Conclusion
• References
 INTRODUCTION
• The kidneys are a pair of fist-sized organs
located at the bottom of the rib cage. They
are located at the back of the abdominal
cavity, one on each side of the spine. Due to
the asymmetry caused by the liver, the right
kidney is generally slightly smaller and lower
than the left.
• Each kidney weighs 125 to 170 grams (g) in
males and 115 to 155 g in females.
Surrounding each kidney is a tough, fibrous
renal capsule and, beyond that, two layers of
fat that serve as protection. On top of each
kidney are the adrenal glands. Inside the
kidneys are a number of pyramid-shaped
lobes
• Each consists of an outer renal cortex and an inner
renal medulla. Each kidney has around a million
tiny filters called nephrons, the urine-producing
structures of the kidneys. Blood enters the kidneys
through the renal arteries and leaves through the
renal veins. The kidneys are relatively small organs,
but they receive up to 25 percent of the heart's
output. Each kidney excretes urine through a tube
called the ureter that leads to the bladder.
Structure of the Kidneys
 Functions of kidneys
• Besides Urine Formation, the kidney has the
following functions
• Plays a major role in regulating blood volume
because it controls the amount of water to be
excreted and the amount of water to be
reabsorbed
• Regulates electrolytes in the blood by
controlling the secretion and reabsorption of
sodium and potassium ions
• Regulates the pH of the blood by controlling
the secretion and reabsorption of hydrogen
ions. When more hydrogen ions are excreted
from the blood, it renders the blood less acidic
(more alkaline). But if more hydrogen ions are
retained in the blood, this renders the blood
more acidic (less alkaline)
• Regulates blood pressure by regulating to amount
of water excreted and the amount of water
reabsorbed back into the blood. When the kidneys
excrete less water and reabsorb more water, the
blood volume will increase. An increase blood
volume will lead to an increase blood pressure. On
the other hand, if the kidneys excrete more water
and reabsorb less water, the blood volume will
reduce. This will lead to reduced blood pressure. 
• Plays a role in the regulation of red blood cell
production. When the number of red blood cells
decreases, the level of oxygen in the blood will
also decrease. This causes the kidney to secrete a
substance called erythropoietin. Erythropoietin
travels to the bone marrow and causes it to
produce more red blood cells. When enough red
blood cells have been produced, this process is
shut down via a negative feedback mechanism. 
 Kidney and urine formation

• The nephron is the functional unit of the kidney. The

primary function of the nephron is to remove waste
products from the body before they build up to toxic
levels
• The nephrons of the kidneys process blood and create
urine through a process of filtration, reabsorption, and
secretion. Urine is about 95% water and 5% waste
products. Nitrogenous wastes excreted in urine include
urea, creatinine, ammonia, and uric acid. Ions such as
sodium, potassium, hydrogen, and calcium are also
excreted. 
Structure of the nephron
 From the glomerulus, the filtrate passes through 4
segments of the nephron:
• Proximal convoluted tubule: reabsorption of nutrients
and substances that the body needs takes place
• Loop of henle: thin-lobed structure that controls the
concentration of the urine
• Distal convoluted tubule: regulates sodium, potassium
and pH
• Collecting duct: regulates water and sodium
reabsorption.
 KIDNEY DISEASES
Acute renal failure(kidney failure)
• A sudden worsening in how well your kidneys
work. Dehydration, a blockage in the urinary
tract, or kidney damage can cause acute renal
failure, which may be reversible.
 Stages of Kidney damage
• Stage 1: Kidney damage present but normal
kidney function; GFR above 90
• Stage 2: Kidney damage with some loss of
kidney function; GFR between 60 and 89
• Stage 3: Mild to severe loss of kidney function;
GFR between 30 and 59
• Stage 4: Severe loss of kidney function; GFR
between 15 and 29
• Stage 5: Kidney failure; GFR less than 15kidney
disease. People with ESRD require
regular dialysis for survival
 Causes of Acute renal failure
• Acute tubular necrosis (ATN)
• Inside your kidneys are small tube-shaped
structures that remove salt, excess fluids, and
waste products from your blood. When these
tubules are damaged or destroyed, you develop
acute tubular necrosis (ATN), a type of acute
kidney injury. The damage may result in 
acute kidney failure
• severe or sudden dehydration
• Toxic kidney injury from poisons or certain
medications
• Autoimmune kidney diseases, such as 
acute nephritic syndrome and 
interstitial nephritis
• Urinary tract obstruction:Obstructive
uropathy is when your urine can’t flow (either
partially or completely) through your ureter,
bladder, or urethra due to some type of
obstruction. Instead of flowing from your
kidneys to your bladder, urine flows backward,
or refluxes, into your kidneys.
• The ureters are two tubes that carry urine
from each of your kidneys to your bladder.
Obstructive uropathy can cause swelling and
other damage to one or both of your kidneys.
This condition can affect men and women of
any age. It can also be a problem for an
unborn child during pregnancy
 CHRONIC KIDNEY DISEASE (CKD)
• CKD is defined as the presence of kidney
damage, manifested by abnormal albumin
excretion or decreased kidney function,
quantified by measured or estimated
glomerular filtration rate (eGFR) that persists
for more than 3 months.
 CKD is typically a progressive disease. It is
defined as
• Reduction of kidney function is defined as an
eGFR<60ml/min/1.73m2 for > 3 months
• And/ or
• Evidence of kidney damage, including persistent
albuminuria is defined as >30mg of urine
albumin per gram of urine creatine for >3
months.
 You are at risk for kidney disease if you have;
• Diabetes. Diabetes is the leading cause of
CKD. High blood glucose, also called blood
sugar, from diabetes can damage the blood
vessels in your kidneys. Almost 1 in 3 people
with diabetes has CKD.
• High blood pressure; High blood pressure is
the second leading cause of CKD. Like high
blood glucose, high blood pressure also can
damage the blood vessels in your kidneys.
Almost 1 in 5 adults with high blood pressure
has CKD.
• Heart disease; People with heart disease are at
higher risk for kidney disease, and people with
kidney disease are at higher risk for heart disease
• Family history of kidney failure; If your mother,
father, sister, or brother has kidney failure, you
are at risk for CKD. Kidney disease tends to run in
families. If you have kidney disease, encourage
family members to get tested
• Your chances of having kidney disease
increase with age
• African Americans, Hispanics, and American
Indians tend to have a greater risk for CKD.
The greater risk is due mostly to higher rates
of diabetes and high blood pressure among
these groups.
 Symptoms of advanced CKD
• Muscle cramps
• Nausea
• Shortness of breath
• Sleep problems
• Trouble concentrating
• Vomiting
• Weight loss
• People with CKD can also develop anemia, bone
disease, and malnutrition
• Chest pain
• Dry skin
• Itching or numbness
• Feeling tired
• Headaches
• Increased or decreased urination
• Loss of appetite
 Diagnosis of CKD
Blood test for GFR
• Glomerular filtration Rate: Glomerular
filtration rate (GFR) is a test used to check how
well the kidneys are working. It estimates how
much blood passes through the glomeruli
each minute. Glomeruli are the tiny filters in
the kidneys that filter waste from the blood.
 The results of the test mean the following:
• A GFR of 60 or more is in the normal range
• A GFR of less than 60 may mean you have
kidney disease
• A GFR of 15 or less is called kidney failure.
Most people below this level need dialysis or a
kidney transplant
Urine Test for Albumin
• Albumin is a protein found in your blood. A
healthy kidney doesn’t let albumin pass into
the urine.
• A damaged kidney lets some albumin pass
into the urine. The less albumin in your urine,
the better. Having albumin in the urine is
called albuminuria
 Creatinine
• Creatinine is a waste product from the normal
breakdown of muscles in your body. Your
kidneys remove creatinine from your blood.
• Health Providers use the amount of creatinine
in your blood to estimate your Glomerular
filtration rate. As kidney disease gets worse,
the level of creatinine goes up.
 Treatment of CKD
To replace your lost kidney function, you may
have one of three treatment options;
• Life style changes
• Hemodialysis
• Peritoneal dialysis
• Kidney transplant
• End-stage renal disease (ESRD) is kidney failure
that is treated by dialysis or kidney transplant
• However, some people with kidney failure
choose not to have dialysis or a transplant but
continue to receive care from their health care
team, take medicines, and monitor their diet
and lifestyle choices
 Hemodialysis
• Hemodialysis is a treatment to filter wastes
and water from your blood, as your kidneys
did when they were healthy
• Hemodialysis helps control blood pressure and
balance important minerals, such as
potassium, sodium, and calcium, in your blood
• Hemodialysis can help you feel better and live
longer, but it’s not a cure for kidney failure. 
 Peritoneal dialysis
• Peritoneal dialysis is a treatment for kidney
failure that uses the lining of your abdomen,
or belly, to filter your blood inside your body.
Health care providers call this lining the
peritoneum
• A few weeks before you start peritoneal
dialysis, a surgeon places a soft tube, called a
catheter, in your belly
• Dialysis solution water with salt and other
additives flows from a bag through the catheter
into your belly
• When the bag is empty, you disconnect it and
place a cap on your catheter so you can move
around and do your normal activities
• While the dialysis solution is inside your belly, it
absorbs wastes and extra fluid from your body
• After a few hours, the solution and the wastes
are drained out of your belly into the empty
bag.
• One can throw away the used solution in a
toilet or tub. Then, you start over with a fresh
bag of dialysis solution.
• Some people with kidney failure may be able
to have a kidney transplant. During transplant
surgery, a healthy kidney from a donor is
placed into your body. The new, donated
kidney does the work that your two kidneys
used to do.
Preventing or slowing down progress of CKD
 Other preventive measures

• Stop smoking: Smoking increases your risk of

cardiovascular disease, including heart attacks or
strokes, which is associated with a higher risk of
kidney disease.
• Healthy diet: eat a balanced diet with a plenty of
fruit and vegetables, low levels of saturated fat, salt
and sugar.
• Exercise regularly: Regular exercise should help
lower your blood pressure and reduce your risk of
developing kidney disease
• Be careful with pain killers: Kidney disease can be caused
by taking too many non-steroidal anti-inflammatories such
as aspirin and ibuprofen or taking them for longer than
recommended
• Cut down on alcohol: Drinking excessive amounts of
alcohol can cause your blood pressure and cholesterol
levels to rise to unhealthy levels
-Men and women are advised not to regularly drink more
than 14 units a week
-Spread your drinking over three days or more if you drink
as much as 14 units a week
 General principles of nutritional therapy in
CKD patients
• Restrict protein intake to <0.8 gm/kg of body
weight/day for patients not on dialysis. Patients
already on dialysis require an increased amount of
protein (1.0 -1.2 gm/kg body weight/day) to replace
protein that may be lost during the procedure.
• Supply adequate carbohydrates to provide energy
• Supply a moderate amount of fats. Cut down the
intake of butter, ghee and oil. Patients with CKD
should reduce their intake of saturated fats and
cholesterol, as these can cause heart disease
CKD AND CARDIOVASCULAR DISEASES

• Cardiovascular disease includes all diseases

and conditions of the heart and blood vessels,
such as arteries and veins. The most common
diseases and conditions include heart attack,
heart failure, stroke, blockages in the blood
vessels and vascular kidney disease. People at
every stage of chronic kidney disease are at
increased risk of cardiovascular disease.
• People with kidney disease are up to 20 times
more likely to die from a heart attack or
stroke. Cardiovascular disease remains the
leading cause of death for people on dialysis
and for people who have a transplanted
kidney.
Risk factors for cardiovascular disease

• Age - your risk increases with age.

• Women are more at risk after menopause as
their cholesterol levels increase
• Gender - men are at increased risk
• Family history of cardiovascular disease
• Race - people of Aboriginal and Torres Strait
Islander origin are at higher risk
• Chronic health conditions (for example,
kidney disease, high blood pressure, high
cholesterol, obesity, diabetes)
• Health of your heart and kidneys Salt & water
in your body Health of your blood vessels. The
amount of salt and water in your body and the
health of your blood vessels will also affect
 Why does kidney disease increase your risk of
disease?
• If your kidneys aren’t working properly, your blood
pressure can rise. If high blood pressure is left
untreated, it can cause the blood vessels to narrow.
High blood pressure can also damage the small
blood vessels that carry blood to the kidney filters. It
can also damage the kidney filters themselves. Very
high blood pressure can weaken and enlarge the
heart muscle, and this can cause kidney failure.
• Your kidneys control the acid level in your
body plus the levels of minerals and salts such
as potassium, chloride, bicarbonate,
phosphate, sulphates, magnesium, sodium
(salt), calcium and potassium. These minerals
and salts are called electrolytes.
• Electrolytes are found in the food that you eat.
Electrolytes are important as they keep you
healthy, but too much or too little can make
you sick. For instance, too much potassium
may cause an abnormal heart rhythm and not
enough magnesium can cause an irregular
heartbeat.
• The balance of calcium and phosphate levels
in your blood is also changed by chronic
kidney disease. This eventually causes calcium
deposits to build up in your blood vessels and
heart, also known as atherosclerosis. Poor
control of calcium and phosphate levels
increases the risk of cardiovascular.
 Lifestyle changes to treat cardiovascular
disease
• Healthy lifestyle choices can help to improve your
overall health and lower your risk of cardiovascular
disease. They can also reduce the amount of
medication you need or make your medication
work better. Healthy lifestyle choices include:
• Being a non-smoker
• Eating a healthy diet with plenty of fruit and
vegetables plus foods low in salt and saturated fat
(unless otherwise directed by your doctor)
• maintaining a healthy weight.
• Doing things that help you to relax and reduce
stress.
• Drinking alcohol only in moderation.
• staying fit by doing at least 30 minutes of physical
activity on most days of the week. Regular
physical activity or exercise can help lower your
risk of cardiovascular disease by: lowering your
‘bad’ and increasing your ‘good’ cholesterol
• Limit the intake of fluid and water in case of
swelling (edema).
• Restrict the amount of sodium, potassium and
phosphorus in the diet.
• Supply vitamins and trace elements in
adequate amounts. A high fiber diet is
recommended.
 DIABETIC NEPHROPATHY
• Diabetic nephropathy: refers to kidney disease
that occurs in people with diabetes.
• Nephropathy is the term used when the
kidneys start to incur damage, which can
ultimately lead to kidney failure. In other
words, the kidney excretes large amounts of
protein in the urine. It is caused by damage in
the cluster of blood vessels in the kidney that
filter waste materials from the blood.
• It causes swelling (edema) in ankles, legs and
feet. If left untreated, this can lead to
problems with breathing, eating and
infections.
• It is estimated that around 40% of people who
have type 2 diabetes develop nephropathy,
though it can also occur in people with type 1.
• Diabetic nephropathy is a significant cause of
long-term kidney disease and end-stage renal
disease (ESRD), which is when the kidneys no
longer work well enough to meet the needs of
daily life
 Nephrotic syndrome includes the following:
• Proteinuria: - Urine contains large amount of
protein
• Hyperlipidemia: Fat and cholesterol level in the
blood is higher than normal level
• Edema or swelling; commonly in legs, feet or
ankles and much in legs and face
• Hypoalbuminia: the level of albumin in the blood
is low
 Causes
• Diabetic nephropathy occurs when the
kidneys become leaky, allowing albumin (a
protein made by the liver) to pass into the
urine. The condition worsens as the level of
albumin increases
• Diabetic nephropathy develops slowly and is
more common in people who have had
diabetes for 20 years or more
• Diabetic nephropathy is more likely to develop
in people with diabetes and have higher blood
glucose levels
• Nephropathy is directly influenced by high
blood pressure(hypertension), which may
make an individual go through the stages of
diabetic nephropathy more rapidly. 
 Other risk factors for diabetic nephropathy include:

• Smoking
• Age, as it is more common in older people
• Sex, as it is more common in men
• Race, as it is more common in African
Americans and Mexican Americans
• Obesity
 Symptoms and clinical signs
• In the early stages, there are changes in blood
pressure 
• Swollen ankles, feet, lower legs, or hands
caused by water retention
• Darker urine, due to blood in the urine
• Shortness of breath
• Fatigue, caused by lack of oxygen in the blood
• Nausea or vomiting
• Metallic taste
 Complications of nephrotic syndrome
Nephrotic syndrome reduces your body protein level in blood
through urine. Proteins do many functions in the body. When
the protein level gets reduced, then your body starts to create
other problems such as blood clots and infections. Other
complications such as;
• Anemia
• Heart disease
• High blood pressure
• Fluid up
• Acute kidney injury
• Kidney failure/ESRD
 Management and treatment of Diabetic
nephropathy
Treatment
• Blood pressure medications such as
angiotensin which cover the enzyme inhibitor
that reduce blood pressure and also reduce
the amount of protein released in the blood
• Water pills(Diuretics): Water pills control
swelling by increasing your kidney fluid output
these include: Aldactone and Lasix
• Blood thinners: to reduce the risk of blood
clotting anticoagulants can be used to reduce
clots these include Heparin or warfarin
 Prevention
• The nephrotic disease can be prevented by avoiding
situations that cause it.
• Blood pressure should be maintained
• Diabetic patients should have glucose level
• Quit using tobacco products or smoking
• Avoid alcoholic beverages that increase urine output and
increase dehydration
• Donot use medicines that harm the kidney
• Avoid X-ray tests that use contrast materialsPrevent heart
disease and stroke by life style changes, eat low fat diet
 KIDNEY STONES

• Kidney stones are small masses of salts and

minerals that form inside the kidneys and may
travel down the urinary tract. Kidney stones
range in size;
• Ureters are small and delicate, and the stones
may be too large to pass smoothly down the
ureter to the bladder
• Passage of stones down the ureter can cause
spasms and irritation of the ureters as they
pass
• This causes blood to appear in the urine.
Sometimes stones block the flow of urine. This
is called a urinary obstruction. Urinary
obstructions can lead to kidney infection and
kidney damage
 Types of kidney stone

• Struvite: This type of stone is found mostly in

women with urinary tract infections (UTIs).
These stones can be large and cause urinary
obstruction. They result from a kidney
infection. Treating an underlying infection can
prevent the development of struvite stones.
• Cystine: Cystine stones are rare. They occur in
both men and women who have the genetic
disorder cystinuria. With this type of stone,
cystine an acid that occurs naturally in the
body leaks from the kidneys into the urine.
• Calcium: Calcium stones are the most
common. They’re often made of calcium
oxalate (though they can consist of calcium
phosphate or maleate).
• Uric acid: This type of kidney stone is more
common in men than in women. They can
occur in people with gout or those going
through chemotherapy. This type of stone
develops when urine is too acidic. A diet rich
in purines can increase urine’s acidic level.
Purine is a colorless substance in animal
proteins, such as fish, shellfish, and meats.
 Symptoms and signs of a kidney stone

• Symptoms of kidney stones may not occur until

the stone begins to move down the ureters. This
severe pain is called renal colic. You may have pain
on one side of your back or abdomen.
• In men, pain may radiate to the groin area. The
pain of renal colic comes and goes, but can be
intense. People with renal colic tend to be restless.
• Other symptoms of kidney stones can include:
• Blood in the urine (red, pink, or brown urine)
• Vomiting
• Nausea
• Discolored or foul-smelling urine
• Chills
• Fever
• Frequent need to urinate
• Urinating small amounts of urine
• In the case of a small kidney stone, you may not have any
pain or symptoms as the stone passes through your
urinary tract.
 Causes of kidney stones

• The greatest risk factor for kidney stones is making

less than one liter of urine per day. This is why
kidney stones are common in premature infants
who have kidney problems. However, kidney stones
are most likely to occur in people between the ages
of 20 and 50
• Different factors can increase your risk of developing
a stone. Typically, Caucasians are more likely to have
kidney stones than those of African descent.
• Sex also plays a role. More men than women
develop kidney stones, according to the A
history of kidney stones can increase your risk.
So does a family history of kidney stones.
• Other risk factors include:
• Dehydration
• Obesity
• A diet with high levels of protein, salt, or
glucose
• Hyper parathyroid condition
• Hastric bypass surgery
• Inflammatory bowel diseases that increase
calcium absorption
• Taking medications such as diuretics, anti-
seizure drugs, and calcium-based antacids
 Diagnosis of kidney stones

• Diagnosis of kidney stones requires a complete health

history assessment and a physical exam. Other tests
include:
• Blood tests for calcium, phosphorus, uric acid, and
electrolytes
• Blood urea nitrogen (BUN) and creatinine to assess
kidney functioning
• Urinalysis to check for crystals, bacteria, blood, and
white cells
• Examination of passed stones to determine their type
 The following tests can rule out obstruction:
• Abdominal X-rays
• Intravenous pyelogram (IVP)
• Retrograde pyelogram
• Ultrasound of the kidney (the preferred study)
• MRI scan of the abdomen and kidneys
• Abdominal CT scan
 Treatment of kidney stones

• Pain relief may require narcotic medications. The

presence of infection requires treatment with antibiotics.
Other medications include:
• Allopurinol (Zyloprim) for uric acid stones
• Diuretics
• Sodium bicarbonate or sodium citrate
• Phosphorus solutions
• Ibuprofen (Advil)
• Acetaminophen (Tylenol)
• Naproxen sodium (Aleve)
 Other treatments

Lithotripsy
• This method of treatment uses sound waves
to break up large stones so they can more
easily pass down the ureters into your bladder.
This procedure can be uncomfortable and may
require light anesthesia. It can cause bruising
on the abdomen and back and bleeding
around the kidney and nearby organs.
 Tunnel surgery (percutaneous
nephrolithotomy
• Stones are removed through a small incision in
your back. This procedure and may be needed
when:
• the stone causes obstruction and infection or
is damaging the kidneys
• the stone has grown too large to pass
• pain can’t be controlled
 Ureterostomy

• When a stone is stuck in the ureter or bladder,

your doctor may use an instrument called a
ureterscope to remove it. A small wire with a
camera attached is inserted into the urethra
and passed into the bladder. The doctor then
uses a small cage to snag the stone and
remove it. The stone is then sent to the
laboratory for analysis.
 Kidney stone prevention
• Proper hydration is a key preventive measure.
Drinking enough water to pass about 2.6
quarts of urine each day. Increasing the
amount of urine, you pass helps flush the
kidneys.
• Eating oxalate-rich foods in moderation and
reducing your intake of salt and animal
proteins can also lower your risk of kidney
stones.
• You can substitute ginger ale, lemon-lime
soda, and fruit juice for water to help you
increase your fluid intake. If the stones are
related to low citrate levels, citrate juices
could help prevent the formation of stones.
 CONCLUSION
• In the U.S., millions of people are living with
chronic kidney disease. Unlike some other
illnesses, CKD can be treated, and you can live
a good life. As you have learned, knowledge is
power. You have options for treatment that
can help you live the life you want.
• Chronic kidney failure represents a critical
period in the evolution of kidney diseases and
is associated with complications and
comorbidities that begin early in the course of
the disease. These conditions are initially
subclinical but progress relentlessly and may
eventually become symptomatic and
irreversible.
• Early in the course of chronic kidney failure,
these conditions are amenable to
interventions with relatively simple
treatments that have the potential to prevent
adverse outcomes.
• Globally, millions of people are living with
kidney diseases. As the saying goes,
‘Knowledge is power’. We have options for
treatment and prevention that can help us
live the life we want, or help others as well.
 REFERENCES
•  National Kidney Foundation—K/DOQI. Clinical
practice guidelines for chronic kidney disease:
evaluation, classification and stratification. Am J
Kidney Dis. 2002;39(suppl 1):S1–266
• 2. Ruth M. Ayling, Clinical Biochemistry: Metabolic
and Clinical Aspects. Third Edition 2014.
• http://vikaspedia.in/health/diseases/kidney-rela
ted/basic-information-about-kidney/major-kidne
y-diseases
• Renin-angiotensin-aldosterone system http://
www.merckmanuals.com/home/heart_and_blood