Disorders of kidney are described as follows:-

1. Glomerulonephritis (GN)

This is an inflammatory condition of glomerulus. It has an autoimmune component which leads to the production of immune complexes that may enter the glomerular capillaries and cause inflammation and impairment of glomerular filtration.  Effects to GN includes-

• Hematuria: During routine urinalysis, the RBCs passes through the damaged glomeruli into the filtrate.
• Asymptomatic proteinuria–  damaged glomeruli may allow the protein to escape from the blood into the filtrate and only found during routine urinalysis.
• Acute nephritis– its characteristics includes- oliguria (<400ml urine/ day in adults), hypertension, hematuria and uremia.

Causes:– throat infection, kidney failure, body’s weak immune system, high BP, dark urine, family disease

Treatment:-angiotensin-converting enzyme (ACE) inhibitors, diuretics, calcium channel blockers, beta-adrenergic blockers, and alpha-adrenergic agonists.

2. Nephrotic syndrome

This is not a disease but is an important feature of several kidney disorders. When the glomeruli is damaged, the permeability of the glomerular membrane increases and plasma proteins passes through into filtrate. Albumin is the most lost plasma protein because it is the smallest and most common plasma protein. When the loss exceeds the production level by liver, there is fall in the total plasma protein level. The resulting low osmotic pressure increase the oedema  and reduced plasma volume. This disturb the whole cycle.

Causes:- damage of glomeruli, heart failure, blood clot in kidney vein, diabetic kidney diseases etc.

Treatment;- beta channel blockers, calcium channel blockers, ACE inhibitors, diuretics, cholesterol lowering drugs

3. Hypertension and Kidneys

This can be the cause or the result of several renal diseases. Essential and secondary hypertension effects the kidney when the renal blood vessels are damaged; hence causes Ischaemia. The reduced blood flow stimulates the renin-angiotensin aldosterone system which further increases the blood pressure. High blood pressure can cause gradual damage to the glomeruli; which may lead to renal failure after the renal reserve has been lost.

Causes:- retention of sodium and water, excretion of renin.

Treatment:- ACE inhibitors, angiotensin 11 receptor blockers

4. Renal failure

Renal failure is of two types:-

• acute renal failure- There is sudden and severe reduction in the glomerular filtration rate and the kidney functions. It is often reversible after some days or week after treatment.

Causes: reduced renal blood flow, damage to the kidneys, obstruction to the outflow of urine , tumor in blood and acute tubular necrosis(damage to the tubular epithelial cell caused by ischaemia).

• Chronic renal failure-  also known as chronic kidney disease. This disorder occurs when the glomerular filtration rate become 20% of the normal rate. selective reabsorption and tubular secretion is also reduced. Reduced GFR results in allowing the waste substances to stay in the blood, especially urea and creatinine. When the blood urea level rises, it is known as uremia. Its symptoms include:- nausea, vomiting, anemia, GIT bleeding, hypertension etc.

Causes: diabetes mellitus, hypertension and glomerulonephritis, nephrotic syndrome

Treatment:– diuretics, antibiotics, anti-viral, drugs to lower the stomach acid, sevelamer(to lower blood phosphate levels), drugs to control anemia.

5. Renal calculi

Calculi(stones) form in the kidney and urinary bladder. when the constituents of urine especially oxalate and phosphate salts are precipitated, this disorder occurs. This is most common in males and after 30 years of age. These originate in collecting ducts and renal papillae.

These stones then pass into renal pelvis where they increases in size. some stones become too large in size and cannot pass further; hence stops the outflow of urine and causes kidney damage. Other which are small in size, either are excreted through urine; or they increases in size and obstructs the urethra.

Causes:– lack of water in the body

Treatment:- narcotic painkillers, non-steroidal anti-inflammatory drugs, antiemetics, alpha blockers, calcium blockers

6. Malignant tumors

These tumors are most common in urinary bladder and kidney

• Renal adenocarcinoma:- This is tumor of tubular epithelium and is more common after the age of 50 and in males. Its feature includes: hematuria, back pain, anemia, weight loss and fever. It spreads in the renal vein; the tumor frangments mixes with blood and reaches to the lungs and bones
• Wilms’ tumor:- this is most common in children below 10 years of age. Its features includes- hematuria, hypertension, abdominal pain and intestinal obstruction.

Causes:– smoking, obesity, old age, hypertension, long term treatment of kidney diseases by dialysis.

Treatment:- immunotherapy drugs(helps immune system fight against cancer), targeted therapy drugs(reduces the multiple growing of tumor cells)

Multiple choice questions(MCQs)

1. What happens during nephritic syndrome?
A. stones in kidney B. reduction in glomerular filtration rate
C. inflammation of glomerulus D. plasma proteins pass through damage glomeruli to the filtrate

2. Which of the following is the cause for renal calculi?
A. lack of water B. obesity
C. smoking D. inflammation of glomerulus

3. Which of the following is the treatment for renal failure?
A. diuretics B. drugs lowering blood phosphate level
C. drugs controlling anemia D. all of the above

4. Which of the following statement is NOT true?
A. renal calculi is destruction of kidney functions
B. glomeruli means tiny blood vessels of kidney
C. malignant tumors occurs in kidney and bladder
D. hematuria is a effect of glomerulonephritis

5. What is glomerulonephritis?
A. stones in kidney B. reduction in glomerular filtration rate
C. inflammation of glomerulus D. plasma proteins pass through damage glomeruli to the filtrate

6. What is the main cause for kidney tumors?
A. smoking B. obesity
C. lack of water in body D. kidney stones

7. Match the following cause with its disorder-
a. nephritic syndrome 1. Damage of glomeruli
b. renal failure 2. Diabetes mellitus
c. hypertension and kidney 3. Excretion of renin
d. renal calculi 4. Lack of water

8. What happens during renal failure?
A. stones in kidney B. reduction in glomerular filtration rate
C. inflammation of glomerulus D. plasma proteins pass through damage glomeruli to the filtrate

9. which of the following is the effect of kidney tumors?
A. hematuria B. acute nephritis
C. asymptomatic proteinuria D. none of the above

10. Which disease requires narcotic painkillers for the treatment?
A. renal failure B. renal calculi
C. hypertension D. kidney cancer

ANSWERS:-

1. plasma proteins pass through damage glomeruli to the filtrate
2. lack of water
3. all of the above
4. kidney stones is destruction kidney functions
5. inflammation of glomerulus
6. smoking
7. a – 1 b – 2 c – 3 d – 4
8. reduction of glomerular filtration rate
9. none of the above
10. renal calculi

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REFERENCE:–  Ross and Wilson-Anatomy and physiology in health and illness;  12^th edition; page no.-: 350-355.