Monday, January 30, 2023

Diseases Of The Kidney And Urinary Tract

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What Is The Urinary Tract

Acute pyelonephritis (urinary tract infection) – causes, symptoms & pathology

The urinary tract includes the organ system primarily responsible for cleaning and filtering excess fluid and waste material from the blood. The urinary system is made up of the following:

The kidneys also function as glands that produce hormones necessary for building red blood cells and regulating blood pressure.

Nihr Biomedical Research Centres

NIHR Biomedical Research Centres are collaborations between world-leading universities and NHS organisations that bring together academics and clinicians to translate lab-based scientific breakthroughs into potential new treatments, diagnostics and medical technologies.

The following BRCs undertake research in kidney disorders:

Diseases Of Kidney And Urinary Tract

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The following points highlight the four main diseases of kidney and urinary tract. The diseases are: 1. Acute Glomerulonephritis 2. Nephrotic Syndrome 3. Acute Renal Failure 4. Chronic Renal Failure .

Disease # 1. Acute Glomerulonephritis:

This is characterized by acute inflammation of the glomeruli with congestion. Renal blood flow and glomerular filtration rate are reduced by 50 per cent. The urine volume falls and sodium excretion is greatly reduced. The urine contains moderate amounts of protein, red and white cells in abundance and casts of the renal tubules formed by precipitation of protein and red cells in the tubular system.

When the patient continues to ingest normal quantities of sodium and water, oedema develops and the blood pressure rises leading to headaches and swelling of the face and hands in the morning and of the ankles at night.

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Treatment:

Fluid intake should be restricted to 500 ml daily. During the first few days of treatment, the fluid given should be less. Sodium intake can be relaxed when oedema resolves and the blood pressure falls. Protein is restricted only when the blood urea is raised.

Disease # 2. Nephrotic Syndrome:

This is characterised by heavy proteinuria, hypoalbuminaemia and peripheral oedema. It occurs when glomerular capillaries are damaged resulting in the increased losses of plasma proteins from the body into the urine. This syndrome can arise in diabetes mellitus, amyloidosis, multiple myeloma.

Diet:

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Dietary And Lifestyle Changes

Making changes to your diet is just as important as taking medication. Adopting a lifestyle with health-promoting benefits can help prevent many of the underlying causes of kidney disease. Your doctor may recommend that you:

  • manage diabetes through insulin injections
  • limit foods high in cholesterol
  • reduce salt intake

Dialysis is an artificial method of filtering the blood. Its used when the kidneys have failed or are close to failing. Many people with late-stage kidney disease must go on dialysis permanently or until a donor kidney is found.

There are two types of dialysis: hemodialysis and peritoneal dialysis.

Supporting Kidney And Urinary Tract Disorders Research

Urinary system diseases: Infographics to understand

There are around three million people in the United Kingdom living with chronic kidney disease, with over 60,000 people being treated for kidney failure. Every year in the United Kingdom, more than 5,000 people are waiting for kidney transplants, and almost 30,000 people are on dialysis.

  • Research into kidney and urinary tract disorders matters. It has meant:
  • development of medications to slow deterioration in kidney function, preventing or delaying the need for dialysis
  • ground-breaking investigations into the optimum amount of intravenous iron that can be given to patients on haemodialysis
  • improved treatments for rare kidney disease
  • reducing the risk of chronic kidney disease patients developing heart attacks and strokes
  • the launch of the ‘Help BEAT Kidney Disease’ campaign to make it easier for kidney patients to take part in research.

We support and oversee a wide range of kidney studies, from single-centre early stage evaluation of medical technology, through to larger multi-centre observational studies and randomised controlled trials of medical and surgical interventions.

Since 2015 we have recruited over 136,000 participants to renal studies, including a first global patient recruited in 2017/18 to an IgA Nephropathy study.

Urology Representatives Subspecialty

Research involving benign conditions of the urinary tract are also managed as part of the Kidney Disorder specialty group.

UK Renal Research Strategy

Who we are

  • Find the local specialty lead in your region

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Interventions To Delay Ckd

During the past 20 years, human and animal research has developed our understanding of CKD and led to preventive measures. The notion of renoprotection has resulted in a dual approach to renal diseases based on effective and sustained pharmacological control of blood pressure and reduction of proteinuria. Lowering blood lipids, stopping smoking, and maintaining tight glucose control for diabetes form part of the multimodal protocol for managing renal patients monitored by specific biological markers .

Abnormal urinary excretion of protein is strongly associated with the progression of CKD in both diabetic and nondiabetic renal diseases. Clinical studies have established that a reduction in proteinuria is associated with a decreased rate of kidney function loss. A specific category of drugs that lower blood pressure, the angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, appear to be more effective than other antihypertensive drugs in slowing the progression of both diabetic and nondiabetic CKDs . The administration of an ACE inhibitor is an important treatment for controlling blood pressure and slowing the rate of progression of chronic kidney failure. Other drugs to lower blood pressure are added as necessary to achieve current targets of 120/80 to 130/80 millimeters of mercury. Concurrent diuretic therapy is often necessary in patients with renal insufficiency, because fluid overload is an important determinant of in such cases.

Keeping Your Kidneys Healthy

There are a number of things you can do to keep your kidneys healthy, including:

  • If you have diabetes, make sure that your blood sugar control is excellent. Follow your doctors advice about insulin injections, medicines, diet, physical activity and monitoring your blood sugar.
  • Control high blood pressure. Have your blood pressure checked regularly. Medications used to lower blood pressure , such as ACE inhibitors or angiotensin blockers, can slow the development of kidney disease.
  • If you have one of the risk factors for kidney disease, have a kidney health check at least every two years .
  • Treat urinary tract infections immediately.
  • Control blood cholesterol levels with diet and medications if necessary.
  • Drink plenty of water and choose foods that are low in sugar, fat and salt, but high in fibre. Stick to moderate serving sizes.
  • Do not smoke.
  • Drink alcohol in moderation only.
  • Stay at a healthy weight for your height and age.
  • Try to exercise moderately for at least 30 minutes a day.

A reduction in kidney filtration is common in older people but can also indicate kidney damage and should be checked by your GP.

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What Is Chronic Kidney Disease

Kidney disease is a general term for when the kidneys are damaged and do not function as they should. If you have kidney disease that lasts for more than 3 months, it is called chronic kidney disease .

When the kidneys do not work properly, wastes and fluids build up inside the body. Chronic kidney disease can lead to other problems like heart disease and high blood pressure, and eventually to complete kidney failure, so getting treatment early is vital.

About 1 in 10 Australian adults has signs of chronic kidney disease. Aboriginal and Torres Strait Islander people are twice as likely to have chronic kidney disease than non-Indigenous Australians.

Learn more here about kidneys and their function.

Diagnosis Of Chronic Kidney Disease

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  • Blood and urine tests

  • Sometimes biopsy

Blood and urine tests are essential. They confirm the decline in kidney function.

When loss of kidney function reaches a certain level in chronic kidney disease, the levels of chemicals in the blood typically become abnormal.

  • Urea and creatinine, metabolic waste products that are normally filtered out by the kidneys, are increased.

  • Blood becomes moderately acidic.

  • Potassium in the blood is often normal or only slightly increased but can become dangerously high.

  • Calcium and calcitriol in the blood decrease.

  • Phosphate and parathyroid hormone levels increase.

  • Hemoglobin is usually lower .

Potassium can become dangerously high when kidney failure reaches an advanced stage or if people ingest large amounts of potassium or take a drug that prevents the kidneys from excreting the potassium.

Analysis of the urine may detect many abnormalities, including protein and abnormal cells.

Ultrasonography is often done to rule out obstruction and check the size of the kidneys. Small, scarred kidneys often indicate that loss of kidney function is chronic. Determining a precise cause becomes increasingly difficult as chronic kidney disease reaches an advanced stage.

Removing a sample of tissue from a kidney for examination may be the most accurate test, but it is not recommended if results of an ultrasound examination show that the kidneys are small and scarred.

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How Is Chronic Kidney Disease Diagnosed

If your doctor suspects you have kidney disease, they will talk to you about your health and the health of your family, and run some tests.

Tests that help to diagnose kidney disease include:

  • urine tests
  • blood tests
  • an Estimated Glomerular Filtration Rate test
  • imaging tests

If these tests show you have kidney damage, you may be referred to a specialist kidney doctor, called a nephrologist. They will try to work out the cause of your chronic kidney disease.

What Lifestyle Changes Can I Make

Chronic kidney disease will gradually get worse, but there is plenty you can do to slow the progression and improve your quality of life. Changes you should make include:

  • stop smoking
  • eat a healthy diet. That means eating a variety of vegetables, fruits, wholegrain cereals, lean meats, poultry, fish, eggs, nuts and seeds, legumes and beans, and low-fat dairy products. Make sure you limit salt to less than 6g a day and limit your intake of saturated and trans fats. In the later stages of chronic kidney disease, you may need to follow specific instructions from your doctor on what you can eat or drink
  • maintaining a healthy weight. If you have chronic kidney disease, you should ideally have a BMI of 25 or less
  • limit alcohol to less than 2 standard drinks a day
  • be physically active on most, preferably all, days of the week. Aim for 150 to 300 minutes of moderate or 75 to 150 minutes of vigorous physical activity each week, and make sure you do some muscle strengthening exercises
  • take medicines to treat high blood pressure, diabetes, high cholesterol or other underlying conditions

If you are being treated for chronic kidney disease, your doctors may need to change other medicines you are on, since many medicines can affect the kidneys, such as blood pressure drugs and anti-inflammatories. Some medicines which leave the body through the kidneys may need to have their dose adjusted.

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Symptoms Of Kidney Disease

Kidney disease is called a silent disease as there are often no warning signs. People may lose up to 90 per cent of their kidney function before getting any symptoms. The first signs of kidney disease may be general and can include:

  • changes in the amount and number of times urine is passed
  • changes in the appearance of urine
  • blood in the urine
  • puffiness of the legs and ankles
  • pain in the kidney area
  • have a family history of kidney failure
  • have a history of acute kidney injury
  • are of Aboriginal or Torres Strait Islander origin and 18 years and older.

Implementation Of Control Strategies: Lessons Of Experience

Urinary system diseases: Infographics to understand

Measures for primary and secondary prevention of CKD are now well documented and will eventually reduce the number of patients requiring dialysis. Until recently, the focus has been on RRT to save lives, and considerable efforts are being made to improve the quality of dialysis. In the United States, guidelines derived from the Kidney Disease Outcomes Quality Initiative have added greatly to the quality of dialysis in terms of access , adequacy, treatment of anemia, treatment of secondary hyperparathyroidism, andâmore recentlyâgreater emphasis on CVD, all of which contribute to quality-of-life outcomes, but at an increased cost .

The high mortality rate of dialysis approximates 10 percent per year and has changed little over the past decade however, new approaches are emerging for dealing with CVD in RRT facilities. More patients with kidney disease die before they get to the point at which they need treatment for renal failure, because early kidney disease is a major marker for CVD and reinfarction, congestive heart failure, and stroke.

Middle-income countries may have both public academic centers and private hospitals that offer specialized equipment, such as lithotripters and imaging technology, and dialysis and transplant programs. Although facilities and trained staff for RRT are more limited than in developed countries, some developing countries, such as Turkey, have excellent facilities.

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Disorders Of The Kidneys

play such vital roles in eliminating wastes and toxins and in maintaining body-wide homeostasis that disorders of the kidneys may be life threatening. Gradual loss of normal kidney function commonly occurs with a number of disorders, including diabetes mellitus and high blood pressure. Other disorders of the kidneys are caused by faulty inherited genes. Loss of kidney function may eventually progress to kidney failure.

Effects Of Abnormal Renal Function On Body Fluid

Renal disease in its diverse forms can lead to bodily deficits or excesses of water, sodium, potassium, and magnesium, and also to protein deficits occasioned by great losses of protein in the urine. Inability of the kidney to function normally may lead to retention in the blood of the waste products of protein metabolism, such as urea and uric acid, and of other nitrogenous compounds such as creatinine. There may be abnormally high levels of phosphates in the blood, which in turn can lead to low blood levels of calcium. The calcium deficiency can cause tetany, a condition marked by muscular spasms and pain, and calcium may be lost from the bones in the process of restoring normal calcium levels in the blood and tissue fluid. For descriptive purposes, changes in volume, changes in composition, and protein depletion of renal origin will be discussed separately, but these disturbances can and often do coexist.

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How The Kidneys Work

The kidneys are like the body’s garbage collection and disposal system. Through microscopic units called nephrons, the kidneys remove waste products and extra water from the food a person eats, returning chemicals the body needs back into the bloodstream. The extra water combines with other waste to become urine, which flows through thin tubes called ureters to the bladder, where it stays until it exits through the urethra when someone goes to the bathroom.

The kidneys also produce three important hormones:

  • erythropoietin, which stimulates the bone marrow to make red blood cells
  • renin, which helps regulate blood pressure and
  • the active form of vitamin D, which helps control the calcium balance in the body and maintain healthy bones.

Kidney failure, which is also called renal failure, is when the kidneys slow down or stop properly filtering wastes from the body, which can cause buildups of waste products and toxic substances in the blood. Kidney failure can be acute or chronic .

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Kidney And Urinary Tract Disorders

Urinary Tract Infection – Overview (signs and symptoms, pathophysiology, causes and treatment)
  • Symptoms of Kidney and Urinary Tract DisordersKidney and urinary tract disorders can involve one or both kidneys, one or both ureters, the bladder, or the urethra, and in men, the prostate, one or both testes, or the epididymis. Problems with the male reproductive system often manifest as persistent erection, scrotal pain, scrotal swelling, or blood in the semen.
  • Diagnosis of Kidney and Urinary Tract DisordersUrinalysis, the testing of urine, may be necessary in the evaluation of kidney and urinary tract disorders and can also help evaluate bodywide disorders such as diabetes or liver problems. A urine sample is usually collected using the clean-catch method or another sterile method. For example, a method to obtain an uncontaminated urine sample involves passing a catheter through the urethra into the bladder.
  • Blood Vessel Disorders of the KidneysThe blood flow to the kidneys needs to be intact for the kidneys to function properly. Any interruption of or reduction in the blood flow can cause kidney damage or dysfunction and, if long-standing, increased blood pressure . When blood flow in the arteries supplying the kidneys is completely blocked, the entire kidney or a portion of the kidney supplied by that artery dies . Kidney infarction can lead to the inability of the kidneys to process and excrete the body’s waste products .
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    Diagnosis Of Kidney Infection

    Imaging tests Imaging Tests of the Urinary Tract There are a variety of tests that can be used in the evaluation of a suspected kidney or urinary tract disorder. X-rays are usually not helpful in evaluating… read more are done in people who have intense back pain typical of renal colic, in those who do not respond to antibiotic treatment within 72 hours, in those whose symptoms return shortly after antibiotic treatment is finished, in those with long-standing or recurring pyelonephritis, in those whose blood test results indicate kidney damage, and in men . Ultrasonography or helical computed tomography studies done in these situations may reveal kidney stones, Stones in the Urinary Tract Stones are hard masses that form in the urinary tract and may cause pain, bleeding, or an infection or block of the flow of urine. Tiny stones may cause no symptoms, but larger stones… read more structural abnormalities, or other causes of urinary obstruction.

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