The #1 cause of kidney failure is diabetes. Kidney damage develops in about 20% of patients with both type 1 and type 2 diabetes. Problems start after 10-15 years of diabetes, and the kidney problems are usually seen in patients with diabetic eye disease. Poor control of blood glucose and high blood pressure are factors that lead to this problem, and make it worse once it starts. Recent work has shown that lowering blood pressure, particularly using ACE Inhibitors or ARBs at the earliest stages, can have a major impact on reducing the progression of kidney disease.
Edema is swelling caused by excess fluid trapped in the body’s tissues (fluid retention). Edema may be generalized or local. Swelling caused by edema commonly occurs in the hands, arms, ankles, legs and feet. It can appear suddenly, but usually develops subtly. You may first gain weight, or wake up with puffy eyes.
Damage to the kidneys can cause decreased levels of protein in your blood. This can contribute to capillary leaking and swelling. The edema associated with kidney disease usually occurs in your legs and around your eyes. Many patients wait until symptoms are well advanced before seeking medical help.
Nephrotic Syndrome is not a single underlying disease, but develops alongside other processes such as glomerulonephritis or diabetes. The kidneys pass large amounts of protein (the urine may be “frothy”) into the urine and this means the water in the blood stream passes into the tissues, particularly the feet and around the eyes. Usually it is caused by a glomerulonephritis such as minimal change nephropathy (the most common in children) or membranous glomerulonephritis.
The kidney function may be absolutely normal and the only problem is the protein leak. Treatment is by restricting the fluid intake, using diuretics and perhaps aspirin and cholesterol lowering drugs. A kidney biopsy will be done to determine the exact nature of the problem and to decide if treatment with steroids or other drugs is needed. Each patient’s case is unique and our experts will determine the optimal treatment in your case.
Glomerulonephritis can develop in an acute (sudden, rapid onset) or a chronic (slow) form, and is caused by a painless inflammation of the glomerulus (the kidney filter). It can occur by itself or as part of a more general problem such as systemic lupus erythematosus (SLE). Testing of the urine shows the presence of blood and protein. It is associated with high blood pressure and progressive decline of kidney function. It is diagnosed by blood tests and a kidney biopsy. High blood pressure and the presence of protein in the urine may predict the tendency towards progression. Many patient with glomerulonephritis will simply need to be followed-up each year in an outpatient setting. Others may need treatment with specific drugs to reduce inflammation, such as steroids, cyclophosphamide, mycophenolate mofetil, cyclosporine, rituximab and azatioprine.
Systemic Lupus Erythematosus
Lupus is an inflammatory disease resulting from an abnormality in the body’s immune system regulation. It is an unpredictable disease, varying a great deal from one case to another. A potentially serious disorder, systemic lupus erythematosus affects women much more often than men. In about 80% of SLE cases, joint inflammation occurs. The inflammation may affect connective tissues throughout the body and cause problems in one or more of the body’s organs, including eyes, muscles, heart, lungs, and kidneys. In some people, systemic lupus erythematosus can produce potentially life-threatening complications, including kidney failure.
Renal bone disease (Renal Osteodystrophy) is due to changes in mineral metabolism and bone structure, and occurs to some degree in everyone with progressive renal disease. Renal bone disease can be slowed or perhaps even prevented with early intervention using dietary measures and medications such as phosphate binders and calcitriol. Recently, new phosphate binders and a new class of drugs, the calcimimetics, have been introduced. Sometimes sugery (parathyroidectomy) is needed.
It is not unusual for people with chronic kidney failure to have low levels of Vitamin D. Your doctor may check your Vitamin D level and if it is low, order a supplement. The amount prescribed to rebuild Vitamin D levels may sound like an enormous amount – a typical dose is 50,000 IU Ergocalcierol (Vitamin D2) once a week for 6-12 weeks. Very large disease such as this are needed to rebuild stores of Vitamin D when there is a deficiency. Healthy kidneys are rich with Vitamin D receptors and play a major role in turning Vitamin D into its active form 1,25-dihydroxyVitamin D or Calciferol. When Vitamin D is in its active form, it helps balance calcium and phosphorous in your body by controlling absorption of calcium and phosphorous from the food you eat and regulates parathyroid hormone (PTH). When kidneys fail, their ability to activate Vitamin D is lost. Without activated Vitamin D to control calcium and phosphorous levels in the blood, parathyroid hormone (PTH) will try to over compensate and go out of range.
Hematuria is defined as the presence of red blood cells in the urine. It can be characterized as either “gross” (visible to the naked eye) or “microscopic” (visible only under the microscope). Microscopic hematuria is an incidental finding often discovered on urine tests as part of a routine medical evaluation, whereas gross hematuria could prompt you to visit the doctor. Hematuria can originate from any site along the urinary tract, including the kidneys, ureters, bladder, prostate and urethra.
Kidney stones are one of the most common disorders of the urinary tract. High concentrations of natural chemicals in the urine can lead to crystal formation. Under special circumstances, these small crystals may “clump” together to form a kidney stone. The majority of kidney stones create no symptoms. Kidney stones vary in size, and a stone may stay in the kidney or travel down the urinary tract. A small stone may pass on its own causing little or no pain. A larger stone may get stuck along the urinary tract and block the flow of urine causing symptoms that include back pain, lower abdominal pain, urinary tract infection or blood in the urine.
It is estimated that 60-80% of people with a kidney stone will form another stone within 10 years of the first episode. Removal of an existing stone does not prevent further stone formation. Medications, changes in diet and lifestyle modification may prevent kidney stone formation. A Nephrologist can help you determine the treatment to prevent new stone formation, while a Urologist can remove existing stones if needed.
Polycystic Kidney Disease:
PKD is a very common genetic problem (1 in 400 to 1 in 1000 people) leading to the development of large kidneys, which are enlarged by the presence of cysts. These cysts can also develop in other organs, such as the liver and the pancreas. There is a variable expression of the problem within families, and not everybody with PKD will develop kidney failure (maybe 50-75% will progress). The genes responsible for this disease have been found. Often polycystic kidney disease will not cause anemia, as the kidneys still produce erythropoietin. PKD can cause pain, urinary infections, kidney stones, and blood in the urine.
Renal Artery Stenosis/Renovascular Disease:
A narrowing of the kidney blood vessels will lead to the kidney being starved of a good enough blood supply. This leads to the kidney becoming smaller. Often it presents with high blood pressure. If this problem eists in both kidneys, it can lead to kidney failure and pulmonary edema (fluid in the lungs causing shortness of breath).
The problem may be suggested by a kidney ultrasonogram which shows one kidney is smaller than the other, but can only be diagnosed with certainty by an angiogram of the kidney blood vessels.
Sometimes it may be felt that the narrowing should be stretched open using a fine, narrow balloon (angioplasty) and then kept open with a tube inserted into the blood vessel (a stent). All of this can be done from the “inside,” during a procedure similar to an angiogram. In everybody with this problem, the blood pressure will be controlled, the cholesterol level checked and normazlied and aspirin may be given.