the detection of kidney disease
understanding its severity
making decisions about diagnosis, prognosis and treatment
2013/06/25
The importance of glomerular filtration rate
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GFR (glomerular filtration rate) is the optimal way to measure kidney function and determine a person's stage of kidney disease. The level of GFR and its magnitude of change over time are vital to :
the detection of kidney disease
understanding its severity
making decisions about diagnosis, prognosis and treatment
the detection of kidney disease
understanding its severity
making decisions about diagnosis, prognosis and treatment
2013/06/22
What Is Kidney Failure? and Brief introduction
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Chronic kidney failure, also known as end stage renal disease or ESRD, is a condition where the kidneys lose their ability to filter waste from the bloodstream to convert into urine. Once the kidneys are so damaged that they cannot filter the blood, the patient will require dialysis or a kidney transplant in order to live. When the kidneys fail, dialysis -- a treatment where the blood is filtered and cleaned to do the work the kidneys cannot -- is performed. While dialysis can do the essential work of the kidneys, the treatment is expensive and time-consuming, requiring a minimum of three 3-hour treatments per week. Kidney transplant surgery is the only "cure" for end stage renal disease, as a functional kidney transplant will remove the need for dialysis. A transplant poses its own challenges, but provides a great improvement in overall health when the surgery is successful.
Diabetic Nephropathy problem
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Uncontrolled diabetes is the #1 cause of kidney failure in the worldwide countries, responsible for over 30% of the patients with the disease. The majority of kidney transplant recipients have either type 1 or type 2 diabetes.
Over time, high levels of glucose in the blood destroys the kidney’s ability to filter toxins and waste from the blood. The glucose molecule is larger than the molecules that the kidney is supposed to filter. The filtering mechanism is damaged as glucose is forced into the urine, and thus the kidney loses the ability to filter small molecules. The damage continues until it is so severe that waste begins to build up in the bloodstream.
Blood tests will typically show both elevated creatinine and BUN levels. When the waste begins to build up, dialysis or a kidney transplant is the next step for treatment.
Uncontrolled diabetes is the #1 cause of kidney failure in the worldwide countries, responsible for over 30% of the patients with the disease. The majority of kidney transplant recipients have either type 1 or type 2 diabetes.Over time, high levels of glucose in the blood destroys the kidney’s ability to filter toxins and waste from the blood. The glucose molecule is larger than the molecules that the kidney is supposed to filter. The filtering mechanism is damaged as glucose is forced into the urine, and thus the kidney loses the ability to filter small molecules. The damage continues until it is so severe that waste begins to build up in the bloodstream.
Blood tests will typically show both elevated creatinine and BUN levels. When the waste begins to build up, dialysis or a kidney transplant is the next step for treatment.
Hypertensive Nephropathy problem and Complication
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Hypertension, or high blood pressure, causes scarring of the kidney tissues. As the blood pressure rises, the kidneys try to compensate for the increasing pressure. Scar tissue accumulates over the course of months and years until the kidneys' ability to filter the blood is impaired.
Left untreated, high blood pressure continues to cause scarring in the kidneys until they fail and dialysis or a kidney transplant becomes necessary.
Causes of Kidney Failure : 26.8% caused by high blood pressure.
Hypertension, or high blood pressure, causes scarring of the kidney tissues. As the blood pressure rises, the kidneys try to compensate for the increasing pressure. Scar tissue accumulates over the course of months and years until the kidneys' ability to filter the blood is impaired.Left untreated, high blood pressure continues to cause scarring in the kidneys until they fail and dialysis or a kidney transplant becomes necessary.
Causes of Kidney Failure : 26.8% caused by high blood pressure.
Chronic Kidney Failure Brief introduction
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Chronic kidney infections cause scarring of the kidneys, similar to the scarring caused by high blood pressure and diabetes. With each infection, the damage is increased, until the kidneys lose the ability to filter small particles from the bloodstream.
The more frequent and more serious the infections, the greater the likelihood that kidney failure will result. Urinary tract infections that are ignored can lead to kidney infections that persist until treated with antibiotics.
If enough infections are severe enough, or ignored and untreated, the result can be the need for dialysis or a kidney transplant.
Chronic kidney infections cause scarring of the kidneys, similar to the scarring caused by high blood pressure and diabetes. With each infection, the damage is increased, until the kidneys lose the ability to filter small particles from the bloodstream.The more frequent and more serious the infections, the greater the likelihood that kidney failure will result. Urinary tract infections that are ignored can lead to kidney infections that persist until treated with antibiotics.
If enough infections are severe enough, or ignored and untreated, the result can be the need for dialysis or a kidney transplant.
Polycystic kidney disease hazards
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There are two types of polycystic kidney disease (PKD). The first, Autosomal Dominant PKD (ADPKD), is a very common inherited disease -- a child has a 50% chance of inheriting the disease if either parent carries it. One in 500 newborns has ADPKD, which causes cysts to grow on the kidneys and leads to kidney failure in 50% of cases.
Autosomal Recessive PKD (ARPKD) is less common, but is a far more severe form of the disease. Both parents must be a carrier for the disease, and their children have a 25% chance of having ARPKD. Approximately 1 in 20,000 newborns have the disease.
In this form of the disease, cysts grow inside the kidney, causing such severe damage that many patients die in the first month of life.
For those who survive, one-third will require dialysis by the age of 10. To make matters worse, children with ARPKD also have associated liver disease that can also cause life-threatening problems.
Autosomal Recessive PKD (ARPKD) is less common, but is a far more severe form of the disease. Both parents must be a carrier for the disease, and their children have a 25% chance of having ARPKD. Approximately 1 in 20,000 newborns have the disease.
In this form of the disease, cysts grow inside the kidney, causing such severe damage that many patients die in the first month of life.
For those who survive, one-third will require dialysis by the age of 10. To make matters worse, children with ARPKD also have associated liver disease that can also cause life-threatening problems.
Kidney Cancer problem
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The growth of a tumor in the kidney, either cancerous or benign, can cause tremendous damage to the structures of the kidney. A typical adult kidney measures approximately 10 centimeters by 5 centimeters, yet tumors within the kidney can reach 10 centimeters in diameter or larger before the patient feels the slightest effects.
By the time the tumor is found, even if it is non-cancerous, the kidney may no longer be functioning. In some cases, the damage is so severe that the kidney must be removed to prevent damage to other organs, including the heart. If the remaining kidney is also not functioning well, dialysis or a kidney transplant may be required.
You may have no symptoms at first. They may appear as the cancer grows. See your health care provider if you notice :
Blood in your urine
A lump in your abdomen and pain in your side that does not go away
Loss of appetite and weight loss
The growth of a tumor in the kidney, either cancerous or benign, can cause tremendous damage to the structures of the kidney. A typical adult kidney measures approximately 10 centimeters by 5 centimeters, yet tumors within the kidney can reach 10 centimeters in diameter or larger before the patient feels the slightest effects.
By the time the tumor is found, even if it is non-cancerous, the kidney may no longer be functioning. In some cases, the damage is so severe that the kidney must be removed to prevent damage to other organs, including the heart. If the remaining kidney is also not functioning well, dialysis or a kidney transplant may be required.
You may have no symptoms at first. They may appear as the cancer grows. See your health care provider if you notice :
Blood in your urine
A lump in your abdomen and pain in your side that does not go away
Loss of appetite and weight loss
Congenital kidney disease
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A congenital kidney abnormality is a problem with the kidney that is present at birth. Abnormalities range from abnormal structures, blocked urine flow, unusual position of the kidneys that impairs function, or even being born with only one kidney. If the problem is severe enough, kidney failure may result.
Types of congenital abnormalities of kidneys
Absence of one kidney: Also called agenesis when there is absence of one kidney the corresponding ureter is also absent. In this case the single kidney increases to almost twice its normal size and takes over the function of two kidneys
Supernumary kidney: There may be more than one kidney on one or both sides.
Hypoplasia: When a kidney attains a smaller size than normal or functions less it is called hypoplasia.
A congenital kidney abnormality is a problem with the kidney that is present at birth. Abnormalities range from abnormal structures, blocked urine flow, unusual position of the kidneys that impairs function, or even being born with only one kidney. If the problem is severe enough, kidney failure may result.Types of congenital abnormalities of kidneys
Absence of one kidney: Also called agenesis when there is absence of one kidney the corresponding ureter is also absent. In this case the single kidney increases to almost twice its normal size and takes over the function of two kidneys
Supernumary kidney: There may be more than one kidney on one or both sides.
Hypoplasia: When a kidney attains a smaller size than normal or functions less it is called hypoplasia.
Kidney stones problems
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Kidney stones, problems with the ureters (the tubes that allow urine to flow out of the kidney and into the bladder), and other conditions can prevent urine from draining from the kidneys. Typically, the problem begins in the kidney, but in some rare cases, the bladder cannot empty and urine will back up into the ureters, then into the kidneys.
Once the blockage is severe, the kidney become damaged as urine continues to be produced, but cannot flow out of the kidney. This condition can be extremely painful and may result in surgery to release the build-up of urine.
If the problem is left untreated, the kidney may no longer function and may even need to be surgically removed. In most cases, the undamaged kidney will be able to compensate; however, if the other kidney is also damaged, dialysis or a kidney transplant may be necessary.
Kidney stones, problems with the ureters (the tubes that allow urine to flow out of the kidney and into the bladder), and other conditions can prevent urine from draining from the kidneys. Typically, the problem begins in the kidney, but in some rare cases, the bladder cannot empty and urine will back up into the ureters, then into the kidneys.
Once the blockage is severe, the kidney become damaged as urine continues to be produced, but cannot flow out of the kidney. This condition can be extremely painful and may result in surgery to release the build-up of urine.
If the problem is left untreated, the kidney may no longer function and may even need to be surgically removed. In most cases, the undamaged kidney will be able to compensate; however, if the other kidney is also damaged, dialysis or a kidney transplant may be necessary.
Lupus nephritis and Complications
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Lupus nephritis is a kidney disorder that is a complication of systemic lupus erythematosus.
Systemic lupus erythematosus (SLE, or lupus) is an autoimmune disease. This means there is a problem with the body's immune system. Normally, the immune system helps protect the body from infection or harmful substances. But in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. As a result, the immune system attacks otherwise healthy cells and tissue.
SLE may damage different parts of the kidney, leading to interstitial nephritis, nephrotic syndrome, and membranous GN. It may rapidly worsen to kidney failure.
Lupus nephritis affects approximately 3 out of every 10,000 people. In children with SLE, about half will have some form or degree of kidney involvement.
More than half of patients have not had other symptoms of SLE when they are diagnosed with lupus nephritis. SLE is most common in women ages 20 - 40.
Symptoms of lupus nephritis include:
Blood in the urine
Foamy appearance to urine
High blood pressure
Swelling of any area of the body
Medicines may include corticosteroids or other medications that suppress the immune system, such as cyclophosphamide, mycophenolate mofetil, or azathioprine.
You may need dialysis to control symptoms of kidney failure, sometimes for only a while. A kidney transplant may be recommended. People with active lupus should not have a transplant because the condition can occur in the transplanted kidney.
Possible Complications
Acute renal failure
Chronic renal failure
End-stage renal disease
Nephrotic syndrome
Lupus nephritis is a kidney disorder that is a complication of systemic lupus erythematosus.
Systemic lupus erythematosus (SLE, or lupus) is an autoimmune disease. This means there is a problem with the body's immune system. Normally, the immune system helps protect the body from infection or harmful substances. But in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. As a result, the immune system attacks otherwise healthy cells and tissue.
SLE may damage different parts of the kidney, leading to interstitial nephritis, nephrotic syndrome, and membranous GN. It may rapidly worsen to kidney failure.
Lupus nephritis affects approximately 3 out of every 10,000 people. In children with SLE, about half will have some form or degree of kidney involvement.
More than half of patients have not had other symptoms of SLE when they are diagnosed with lupus nephritis. SLE is most common in women ages 20 - 40.
Symptoms of lupus nephritis include:
Blood in the urine
Foamy appearance to urine
High blood pressure
Swelling of any area of the body
Medicines may include corticosteroids or other medications that suppress the immune system, such as cyclophosphamide, mycophenolate mofetil, or azathioprine.
You may need dialysis to control symptoms of kidney failure, sometimes for only a while. A kidney transplant may be recommended. People with active lupus should not have a transplant because the condition can occur in the transplanted kidney.
Possible Complications
Acute renal failure
Chronic renal failure
End-stage renal disease
Nephrotic syndrome
2013/06/18
The relationship between the kidneys and blood pressure
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The blood pressure in your body depends upon the following conditions:
The force of contraction of the heart -- related to how much the heart muscle gets stretched by the incoming blood.
The degree to which the arteries and arterioles constrict -- increases the resistance to blood flow, thus requiring a higher blood pressure.
The circulating blood volume -- the higher the circulating blood volume, the more the heart muscle gets stretched by the incoming blood.
The kidney influences blood pressure by:
Causing the arteries and veins to constrict
Increasing the circulating blood volume
The blood pressure in your body depends upon the following conditions:
The force of contraction of the heart -- related to how much the heart muscle gets stretched by the incoming blood.
The degree to which the arteries and arterioles constrict -- increases the resistance to blood flow, thus requiring a higher blood pressure.
The circulating blood volume -- the higher the circulating blood volume, the more the heart muscle gets stretched by the incoming blood.
The kidney influences blood pressure by:
Causing the arteries and veins to constrict
Increasing the circulating blood volume
Examples to explain the regulating role of the kidneys
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The kidney can correct any imbalances by:
Removing excess acid (hydrogen ion) or bases (bicarbonate) in the urine and
Restoring the bicarbonate concentration in the blood to normal
The kidney cells produce a constant amount of hydrogen ion and bicarbonate because of their own cellular metabolism (production of carbon dioxide). Through a carbonic anhydrase reaction similar to the red blood cells, hydrogen ions get produced and secreted into the lumen of the nephron. Also, bicarbonate ions get produced and secreted into the blood. In the lumen of the nephron, filtered bicarbonate combines with secreted hydrogen ions to form carbon dioxide and water (carbonic anhydrase is also present on the luminal surface of the kidney cells). Whether the kidney removes hydrogen ions or bicarbonate ions in the urine depends upon the amount of bicarbonate filtered in the glomerulus from the blood relative to the amount of hydrogen ions secreted by the kidney cells. If the amount of filtered bicarbonate is greater than the amount of secreted hydrogen ions, then bicarbonate will be lost in the urine. Likewise, If the amount of secreted hydrogen ion is greater than the amount of filtered bicarbonate, then hydrogen ions will be lost in the urine (i.e. acidic urine).
The kidney can correct any imbalances by:Removing excess acid (hydrogen ion) or bases (bicarbonate) in the urine and
Restoring the bicarbonate concentration in the blood to normal
The kidney cells produce a constant amount of hydrogen ion and bicarbonate because of their own cellular metabolism (production of carbon dioxide). Through a carbonic anhydrase reaction similar to the red blood cells, hydrogen ions get produced and secreted into the lumen of the nephron. Also, bicarbonate ions get produced and secreted into the blood. In the lumen of the nephron, filtered bicarbonate combines with secreted hydrogen ions to form carbon dioxide and water (carbonic anhydrase is also present on the luminal surface of the kidney cells). Whether the kidney removes hydrogen ions or bicarbonate ions in the urine depends upon the amount of bicarbonate filtered in the glomerulus from the blood relative to the amount of hydrogen ions secreted by the kidney cells. If the amount of filtered bicarbonate is greater than the amount of secreted hydrogen ions, then bicarbonate will be lost in the urine. Likewise, If the amount of secreted hydrogen ion is greater than the amount of filtered bicarbonate, then hydrogen ions will be lost in the urine (i.e. acidic urine).
Renal acid-base balance
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When you drink a large glass of water, the water gets absorbed into the blood and the following happens:
The absorbed water increases the amount of water filtered in the glomerulus.
The absorbed water in the blood reduces the Na concentration a little.
The reduced Na concentration lowers the amount of Na filtered in the glomerulus.
The nephron reabsorbs all of the reduced Na load and some of the accompanying water, leaving excess water in the filtrate.
The reduced Na concentration is sensed by the osmoreceptors.
The osmoreceptors do not secrete as much ADH.
When you drink a large glass of water, the water gets absorbed into the blood and the following happens:The absorbed water increases the amount of water filtered in the glomerulus.
The absorbed water in the blood reduces the Na concentration a little.
The reduced Na concentration lowers the amount of Na filtered in the glomerulus.
The nephron reabsorbs all of the reduced Na load and some of the accompanying water, leaving excess water in the filtrate.
The reduced Na concentration is sensed by the osmoreceptors.
The osmoreceptors do not secrete as much ADH.
Between water and kidneys
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Your kidneys have the ability to conserve or waste water. For example, if you drink a large glass of water, you'll find that you will have the urge to urinate within an hour or so. In contrast, if you don't drink for a while, such as overnight, you will not produce much urine and it will usually be very concentrated (i.e. darker). How does your kidney know the difference? The answer to this question involves two mechanisms:
The structure and transport properties of the loop of Henle in the nephron.
The anti-diuretic hormone (ADH), also called vasopressin, secreted by the pituitary gland.
The loop of Henle has a descending limb and an ascending limb. As filtrate moves down the loop of Henle, water is reabsorbed, but ions (Na,Cl) aren't.
Your kidneys have the ability to conserve or waste water. For example, if you drink a large glass of water, you'll find that you will have the urge to urinate within an hour or so. In contrast, if you don't drink for a while, such as overnight, you will not produce much urine and it will usually be very concentrated (i.e. darker). How does your kidney know the difference? The answer to this question involves two mechanisms:
The structure and transport properties of the loop of Henle in the nephron.
The anti-diuretic hormone (ADH), also called vasopressin, secreted by the pituitary gland.
The loop of Henle has a descending limb and an ascending limb. As filtrate moves down the loop of Henle, water is reabsorbed, but ions (Na,Cl) aren't.
Nephron work
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Some substances are secreted from the plasma into the lumen by the cells of the nephron. Examples of such substances are ammonia (NH3). As in reabsorption, there are transporters on the cells that can move these specific substances into the lumen.
Now let's put all of these processes -- filtration, reabsorption and secretion -- together to understand how the kidneys maintain a constant composition of the blood. Let's say that you decide to eat several bags of salty (NaCl) potato chips at one sitting. The Na will be absorbed into your blood by your intestines, increasing the concentration of Na in your blood.
Some substances are secreted from the plasma into the lumen by the cells of the nephron. Examples of such substances are ammonia (NH3). As in reabsorption, there are transporters on the cells that can move these specific substances into the lumen.
Now let's put all of these processes -- filtration, reabsorption and secretion -- together to understand how the kidneys maintain a constant composition of the blood. Let's say that you decide to eat several bags of salty (NaCl) potato chips at one sitting. The Na will be absorbed into your blood by your intestines, increasing the concentration of Na in your blood.
2013/06/17
Glomerular work
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Once inside the lumen of the nephron, small molecules, such as ions, glucose and amino acids, get reabsorbed from the filtrate:
Once inside the lumen of the nephron, small molecules, such as ions, glucose and amino acids, get reabsorbed from the filtrate:
- Specialized proteins called transporters are located on the membranes of the various cells of the nephron.
- These transporters grab the small molecules from the filtrate as it flows by them.
- Each transporter grabs only one or two types of molecules. For example, glucose is reabsorbed by a transporter that also grabs sodium.
- Transporters are concentrated in different parts of the nephron. For example, most of the Na transporters are located in the proximal tubule, while fewer ones are spread out through other segments.
The function of glomerular
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In the nephron, approximately 20 percent of the blood gets filtered under pressure through the walls of the glomerular capillaries and Bowman's capsule. The filtrate is composed of water, ions (sodium, potassium, chloride), glucose and small proteins (less than 30,000 daltons -- a dalton is a unit of molecular weight). The rate of filtration is approximately 125 ml/min or 45 gallons (180 liters) each day. Considering that you have 7 to 8 liters of blood in your body, this means that your entire blood volume gets filtered approximately 20 to 25 times each day! Also, the amount of any substance that gets filtered is the product of the concentration of that substance in the blood and the rate of filtration.
In the nephron, approximately 20 percent of the blood gets filtered under pressure through the walls of the glomerular capillaries and Bowman's capsule. The filtrate is composed of water, ions (sodium, potassium, chloride), glucose and small proteins (less than 30,000 daltons -- a dalton is a unit of molecular weight). The rate of filtration is approximately 125 ml/min or 45 gallons (180 liters) each day. Considering that you have 7 to 8 liters of blood in your body, this means that your entire blood volume gets filtered approximately 20 to 25 times each day! Also, the amount of any substance that gets filtered is the product of the concentration of that substance in the blood and the rate of filtration.
The internal structure of the kidney
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If you were to cut a kidney in half, you would see the following parts:
If you were to cut a kidney in half, you would see the following parts:
- Renal Capsule - a thin, outer membrane that helps protect the kidney
- Cortex - a lightly colored outer region
- Medulla - a darker, reddish-brown, inner region
- Renal Pelvis - a flat, funnel-shaped cavity that collects the urine into the ureters
If you look closely at the cortex and medulla, you can see many tiny, tubular structures that stretch across both regions perpendicular to the surface of the kidney. In each kidney, there are one million of these structures, called nephrons. The nephron is the basic unit of the kidney. It's a long, thin tube that is closed at one end, has two twisted regions interspaced with a long hairpin loop, ends in a long straight portion and is surrounded by capillaries.
Kidney function
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Your kidneys are two bean-shaped organs, each about the size of your fist. They are located in the middle of your back, just below your rib cage, on either side of your spine. Your kidney weigh about 0.5 percent of your total body weight. Although the kidneys are small organs by weight, they receive a huge amount -- 20 percent -- of the blood pumped by the heart. The large blood supply to your kidney enable them to do the following tasks :
Your kidneys are two bean-shaped organs, each about the size of your fist. They are located in the middle of your back, just below your rib cage, on either side of your spine. Your kidney weigh about 0.5 percent of your total body weight. Although the kidneys are small organs by weight, they receive a huge amount -- 20 percent -- of the blood pumped by the heart. The large blood supply to your kidney enable them to do the following tasks :
2013/06/15
Renal Failure Treatments
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How to treat Renal Failure effectively? Renal Failure, the shorten form of Chronic Renal Failure, that is a process of renal fibrosis. As for patients with Renal Failure, with the renal functional cells damaged, the excretion function of kidney will be blocked, which will lead to serious waste product accumulation，and then affect renal function seriously. Then, How to treat Renal Failure effectively? Here, specialists introduce some medical knowledge to you:First, protopathy treatment: patients should insist on long-term treatments for Primary or Secondary Glomerulus Nephritis, Hypertension, Diabetes Mellitus and Kidney Disease.
How to treat Renal Failure effectively? Renal Failure, the shorten form of Chronic Renal Failure, that is a process of renal fibrosis. As for patients with Renal Failure, with the renal functional cells damaged, the excretion function of kidney will be blocked, which will lead to serious waste product accumulation，and then affect renal function seriously. Then, How to treat Renal Failure effectively? Here, specialists introduce some medical knowledge to you:First, protopathy treatment: patients should insist on long-term treatments for Primary or Secondary Glomerulus Nephritis, Hypertension, Diabetes Mellitus and Kidney Disease.
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