The kidneys are two organs, each about the size of a fist, located in the upper part of a person's abdomen, one on each side of the spine toward the middle of the back. Your kidneys filter extra water and wastes out of your blood and form urine. Every minute, a person’s kidneys filter about 3 ounces of blood, removing wastes and extra water. Approximately 25% of your blood passes through your kidneys each minute. Your kidneys also help control blood pressure so that your body can stay healthy. They also regulate amounts of certain vital substances in the body.The kidneys work to:
Kidney disease means that the kidneys are damaged and can't filter blood like they should. This damage can cause wastes to build up in the body. It can also cause other problems that can harm your health.
For most people, kidney damage occurs slowly over many years, often due to diabetes or high blood pressure. This is called chronic kidney disease. When someone has a sudden change in kidney function—because of illness, or injury, or have taken certain medications—this is called acute kidney injury. This can occur in a person with normal kidneys or in someone who already has kidney problems.
Kidney disease is a growing problem. More than 20 million Americans may have kidney disease and many more are at risk. Anyone can develop kidney disease, regardless of age or race. The main risk factors for developing kidney disease are:
Renal failure (also kidney failure or renal insufficiency) is a medical condition in which the kidneys fail to adequately filter waste products from the blood. The two main forms are acute kidney injury, which is often reversible with adequate treatment, and chronic kidney disease, which is often not reversible. In both cases, there is usually an underlying cause.
Chronic kidney disease (CKD) is a condition in which the small blood vessels in the kidneys are damaged, making the kidneys unable to do their job. Waste then builds up in the blood, harming the body.
Chronic Kidney Disease is most often caused by diabetes or high blood pressure.
Diabetes and high blood pressure damage the blood vessels in the kidneys, so the kidneys are not able to filter the blood as well as they used to. Usually this damage happens slowly, over many years. As more and more blood vessels are damaged, the kidneys eventually stop working.
Other risk factors for kidney disease are cardiovascular (heart) disease and a family history of kidney failure. If you have any of these risk factors, you should get tested for kidney disease.
Early kidney disease has no symptoms.
That means you can’t feel that you have it. In fact, you might feel just fine until your kidneys have almost stopped working. Don’t wait for symptoms. Blood and urine tests are the only way to know if you have kidney disease. A blood test measures your GFR and a urine test checks for protein.
Kidney disease can be treated if detected early.
The right treatment can help prevent further kidney damage and slow down kidney disease. The earlier kidney disease is found, the sooner you can take medications and other steps that can keep your kidneys healthy longer.
Kidney disease is progressive.
Kidney disease does not go away. Instead, it usually gets worse over time. Kidney disease can turn into kidney failure, at which point dialysis or a kidney transplant is needed. Kidney disease can also lead to heart disease.
Take the first step
If you are at risk, get your blood and urine checked for kidney disease.
Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. Blood pressure is summarised by two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). This equals the maximum and minimum pressure, respectively. There are different definitions of the normal range of blood pressure. Normal blood pressure at rest is within the range of 100–140mmHg systolic (top reading) and 60–90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is often at or above 140/90 mmHg.
Kidney transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is considered the treatment of choice for many people with severe chronic kidney disease because quality of life and survival are often better than in people who use dialysis. However, there is a shortage of organs available for donation. Many people who are candidates for kidney transplantation are put on a transplant waiting list and require dialysis until an organ is available.
A kidney can come from a living relative, a living unrelated person, or from a person who has died (deceased or cadaver donor); only one kidney is required to survive. In general, organs from living donors function better and for longer periods of time than those from donors who are deceased.
Some people with renal failure are not candidates for a kidney transplant. Older age and severe heart or vascular disease may mean that it is safer to remain on dialysis rather than undergo kidney transplantation. Other conditions that might prevent a person from being eligible for kidney transplantation include:
Hematuria is blood in the urine. Two types of blood in the urine exist. Blood that can be seen in the urine is called gross hematuria. Blood that cannot be seen in the urine, except when examined with a microscope, is called microscopic hematuria. Most people with microscopic hematuria do not have symptoms. People with gross hematuria have urine that is pink, red, or cola-colored due to the presence of red blood cells (RBCs). Even a small amount of blood in the urine can cause urine to change color. In most cases, people with gross hematuria do not have other symptoms. However, people with gross hematuria that includes blood clots in the urine may have pain.
Edema means swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles and legs, but it can involve your entire body.
Causes of edema include
• Eating too much salt
• Heart failure
• Kidney disease
• Liver problems from cirrhosis
• Problems with lymph nodes, especially after mastectomy
• Some medicines
• Standing or walking a lot when the weather is warm
To keep swelling down, your health care provider may recommend keeping your legs raised when sitting, wearing support stockings, limiting how much salt you eat, or taking a medicine called a diuretic - also called a water pill.
Many diseases affect kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. Glomerular diseases include many conditions with a variety of genetic and environmental causes, but they fall into two major categories:
• Glomerulonephritis (gloh-MEHR-yoo-loh-nef-RY-tis) describes the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood.
• Glomerulosclerosis (gloh-MEHR-yoo-loh-skleh-ROH-sis) describes the scarring or hardening of the tiny blood vessels within the kidney.
Although glomerulonephritis and glomerulosclerosis have different causes, they can both lead to kidney failure.
Hydronephrosis is swelling (dilation) of the urine-collecting structures of one or both kidneys due to obstruction of urine flow from the kidney. This can impair kidney function. Hydronephrosis isn't a specific disease, but a sign of an underlying problem.
• Blockage of the urinary system present at birth (congenital)
• A kidney or ureteral stone (nephrolithiasis)
• A blood clot
• Scarring of the ureter, usually from injury, radiation therapy or previous surgery
• A tumor in or around the ureter
• Prostate gland enlargement (benign prostatic hyperplasia)
Hydronephrosis may develop suddenly — due to, for example, passing a kidney stone — and cause severe pain in the back, lower abdomen and groin on the side of the blockage. It may also develop so gradually over weeks or months — due to, for example, a slow-growing tumor — that it causes no symptoms. Urine output usually remains normal as long as one kidney functions properly.
Secondary Hyperparathyroidism: Secondary hyperparathyroidism is associated with high bone turnover. Hypercalcemia, hyperphosphatemia and elevated levels of iPTH, and alkaline phosphatase may be seen. Vascular calcification is associated with secondary hyperparathyroidism in CKD.
Kidney Cancer: Cancer that forms in tissues of the kidneys. Kidney cancer includes renal cell carcinoma (cancer that forms in the lining of very small tubes in the kidney that filter the blood and remove waste products) and renal pelvis carcinoma (cancer that forms in the center of the kidney where urine collects). It also includes Wilms tumor, which is a type of kidney cancer that usually develops in children under the age of 5
Berger's disease (IgA Nephropathy): IgA nephropathy is a kidney disorder that occurs when IgA—a protein that helps the body fight infections—settles in the kidneys. After many years, the IgA deposits may cause the kidneys to leak blood and sometimes protein in the urine.
Many people with IgA nephropathy leak blood in the urine, but this leakage does not mean they will have long-term problems. Others leak both blood and protein in the urine. If too much protein leaks into the urine, the hands and feet can swell. After 10 to 20 years with IgA nephropathy, the kidneys may show signs of damage. About 25 percent of adults with IgA nephropathy develop total kidney failure. Only 5 to 10 percent of children develop total kidney failure. Symptoms of kidney failure include swelling in the hands and feet, nausea, fatigue, headaches, and sleep problems. By the time these symptoms occur, total kidney failure is near. Total kidney failure means the kidney damage is permanent. People with kidney failure need dialysis or a kidney transplant.
Simple kidney cysts are abnormal, fluid-filled sacs that form in the kidneys. Simple kidney cysts are different from the cysts that develop when a person has polycystic kidney disease (PKD), which is a genetic disorder. Simple kidney cysts do not enlarge the kidneys, replace their normal structure, or cause reduced kidney function like cysts do in people with PKD.
Simple kidney cysts are more common as people age. An estimated 25 percent of people 40 years of age and 50 percent of people 50 years of age have simple kidney cysts.1
A UTI is an infection in the urinary tract. Infections are caused by microbes—organisms too small to be seen without a microscope—including fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the body’s natural defenses and cause infection. An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may travel up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis.
The urinary tract is the body's drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. . The wastes and extra water make up the 1 to 2 quarts of urine a person produces each day. The urine travels from the kidneys down two narrow tubes called the ureters. The urine is then stored in a balloonlike organ called the bladder and emptied through the urethra, a tube at the bottom of the bladder. A UTI is an infection in the urinary tract. Infections are caused by microbes—organisms too small to be seen without a microscope—including fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the body’s natural defenses and cause infection. An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may travel up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis.
A kidney* stone is a solid piece of material that forms in a kidney when there are high levels of certain substances in the urine. These substances are normally found in the urine and do not cause problems at lower levels.
A stone may stay in the kidney or travel down the urinary tract. Kidney stones vary in size. A small stone may pass on its own, causing little or no pain. A larger stone may get stuck along the urinary tract. A stone that gets stuck can block the flow of urine, causing severe pain or bleeding.
Lupus nephritis is kidney inflammation caused by systemic lupus erythematosus (SLE or lupus). SLE is an autoimmune disease—a disorder in which the body’s immune system attacks the body’s own cells and organs. Up to 60 percent of people with SLE are diagnosed with lupus nephritis, which can lead to significant illness and even death.
Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys.When cysts form in the kidneys, they are filled with fluid. PKD cysts can profoundly enlarge the kidneys while replacing much of the normal structure, resulting in reduced kidney function and leading to kidney failure.
When PKD causes kidneys to fail—which usually happens after many years—the patient requires dialysis or kidney transplantation. About one-half of people with the most common type of PKD progress to kidney failure, also called end-stage renal disease (ESRD).
The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss. Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function.
Sjögren's syndrome is an autoimmune disorder in which immune cells attack and destroy the glands that produce tears and saliva. Sjögren's syndrome is also associated with rheumatic disorders such as rheumatoid arthritis. The hallmark symptoms of the disorder are dry mouth and dry eyes. In addition, Sjogren's syndrome may cause skin, nose, and vaginal dryness, and may affect other organs of the body including the kidneys, blood vessels, lungs, liver, pancreas, and brain.
What is rhabdomyolysis?
Rhabdomyolysis literally means break down of muscles. It is a serious condition in which the muscle cells are damaged to a point where the contents from inside the muscle cells spill over into the circulation.
The damage to the muscles themselves may cause severe pain and cramps in the muscles. As the contents of muscle cells spill into the circulation, serious fluid and electrolyte abnormalities develop.
Some of the substances released as a result of muscle cell damage are injurious to the kidneys. If the damage to the muscles is severe enough, the toxicity to the kidney may be severe enough to cause the kidneys to fail, a condition called acute renal failure. Some patients with severe rhabdomyolysis may even require dialysis to treat their renal failure.
Left untreated, rhabdomyolysis may become a potentially fatal condition.
What causes rhabdomyolysis?
Anything that causes muscle damage directly or indirectly may cause rhabdomyolysis.
Two major scenarios commonly lead to Rhabdomyolysis:
What are the symptoms of rhabdomyolysis?
Patients with mild rhabdomyolysis may not notice any symptoms. In these cases, only some blood tests detect the abnormality.
With more severe damage, patients note that their muscles are quite sore. They may experience frank pain and cramps. Their urine turns dar, sometimes taking on a muddy brown color. The amount of utine they are making drops sharply.
Should I see a doctor or nurse? — Yes. Call your doctor or nurse if you have the above symptoms, especially after getting hurt or exercising very hard.
Is there a test for rhabdomyolysis? — Yes. Your doctor or nurse can do blood tests and urine tests to check for rhabdomyolysis and any problems it has caused.
How is rhabdomyolysis treated?
Treatment depends on what's causing your rhabdomyolysis and how severe your condition is. Most people are treated in the hospital.
The first and foremost goal is to avoid further damage. Your doctors will take all steps to relieve any factors that may be causing injury. This includes correction of acid-base and electrolyte disorders that may have developed (common in this disorder) as well as aggressive correction of dehydration.
Correction of dehydration also promotes excretion of injurious toxic substances released by the muscles via the urine. This protects against injury to the kidneys.
The most serious cases of rhabdomyolysis have such extensive injury that the sheer burden of toxins released damage the kidney to such an extent that the kidney shuts down. This is called acute kidney injury (AKI) and this may require dialysis to support the body as the kidney recovers from the insult. The good news is that with adequate supportive care and dialysis, most patients with rhabdomyolysis induced AKI recover and are able to come off dialysis.
How can we prevent exertional rhabdomyolysis:
• Avaoid heavy exertion in hot and humid conditions
• Train carefully and pace yourself by gradually escalating the severity of exercise.
• Stretch and warm up before embarking on exercise.
• Maintain adequate hydration before, during and after heavy exertion. It is better to take electrolyte containing water (lemonade with salt and sugar, sports drinks) rather than straight water in those anticipating to engage in very heavy exertion. We lose both salts and water during these activities. Replacing just water may lower body sodium levels, sometimes dangerously.
• Wear loose, breathable fabrics.
• Pay attention to symptoms. If in any doubt, consult your physician.
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