Renal System Diseases

Acute Renal Failure

• Definition: Also known as acute kidney failure or acute kidney injury, it involves a rapid loss of kidney function, leading to the retention of nitrogenous (urea & creatinine) and non-nitrogenous waste products, lasting less than 3 months.
• Pathogenesis:
  • Prerenal
  • Renal
  • Postrenal
• Diagnosis: Based on patient condition, including:
  1. History of renal signs (dysuria, hematuria, oliguria)
  2. Medication use (anticholinergics)
  3. Age
  4. Sex
  5. Weight
  6. Serum creatinine levels (male: 0.6-1.2 mg/dL, female: 0.5-1.1 mg/dL)
• Para-clinic Investigations:
  1. Urea
  2. Creatinine
  3. eGFR (estimated glomerular filtration rate)
  4. Urine analysis
  5. Renal biopsy
  6. Electrolyte levels
  7. Arterial blood gas (ABG)
  8. Ultrasound (to rule out/rule in)
• Differential Diagnosis (DD):
  1. Prerenal
  2. Renal
  3. Postrenal
• Management:
  1. Dialysis
     • Peripheral dialysis
     • Abdominal dialysis
  2. Kidney transplant

Chronic Renal Failure

• Definition: Chronic renal disease (CRD) is the loss of kidney function lasting more than 3 months, leading to end-stage renal disease (ESRD), which is irreversible.
• Cause, mechanism, pathophysiology: similar to acute renal disease.
• Management of ARF & CRF:
  1. Acute
  2. Chronic
     • Dialysis
     • Kidney transplant

Nephrotic Syndrome

• Definition: Characterized by:
  • Proteinuria >3.5g/24h
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia
• Causes:
  1. Primary or Idiopathic:
     • Minimal change disease
     • Focal segmental glomerulosclerosis
     • Membranous nephropathy
     • Membranoproliferative glomerulonephritis
     • Proliferative and sclerosis of glomerolonephritides
  2. Secondary:
     • SLE (Systemic Lupus Erythematosus), DM (Diabetes Mellitus)
     • Infections
     • Medications
     • Allergens, venoms, and immunization
     • Neoplasm
• Pathophysiology:
  • Proteinuria >3.5g/24h
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia
• Diagnosis:
  1. History taking related to renal disease
  2. Renal biopsy
  • Proteinuria >3.5g/day
  • Hypoalbuminemia <30g/l
• Treatment:
  1. Supportive care:
     *Limitation of protein intake: 0.8-1.0g/kg/day and salt <3g/day
  2. Diuretic therapy
  3. Diminishing proteinuria: ACEI (Angiotensin-Converting Enzyme Inhibitors) & ARB (Angiotensin II Receptor Blockers)
  4. Corticosteroid therapy
• Complication:
  1. ARF (Acute Renal Failure)
  2. Dyslipidemia
  3. Infection

Nephritis

• Definition: Nephritis refers to inflammation of one or both kidneys. Characterized by:
  • Hematuria
  • Proteinuria <3.5g/day
  • Mild hypertension
  • Peripheral edema
• Causes:
  1. Most common autoimmune disorder
  2. Post infection:
     • Group A beta hemolytic streptococci
  3. IgA nephropathy
  4. SLE
  5. Crescentic glomerulonephritis
  6. DM2 (Diabetes Mellitus Type 2)
• Subtypes:
  1. Glomerulonephritis (cause)
  2. Interstitial nephritis or Tubulo-interstitial nephritis
     • Urinary reflex
  3. Pyelonephritis
     • E. coli
     • Pregnancy
     • Trauma
     • DM
     • HTN kidney disease
  4. Lupus nephritis (SLE)
     • There are 6 classes
     • Darker foamy urine
     • Arthritis + fever
     • Limited sodium intake 2g/day
     • Treatment:
       • Mild disease  corticosteroid
       • Severe disease  Chemo
• Signs and Symptoms (S/S):
  1. Hematuria (macroscopic)
  2. Oliguria
  3. Edema
  4. Hypertension
  • Proteinuria <3.5g/day
  1. Fluid overload
  2. Reduced eGFR
  3. Butterfly shape (SLE)
• Diagnosis:
  1. History taking related with renal disease
  2. Renal biopsy
  • Proteinuria <3.5g/day
  1. eGFR
  2. Throat swap (post infected?)
  3. Serology
  4. Electrolyte
  5. Urine analysis
• Treatment:
  1. Minimal change disease
     • Prednisone 16 weeks
     • Prednisone + cyclophosphamide
  2. FSGS
     • Prednisone
     • Prednisone + cyclophosphamide
  3. Membranous
     • Ponticelli Regimen
     • Prednisone + cyclophosphamide
• Complication:
  1. Hypertension encephalopathy (uremia)
  2. OAP (Orthopnea or pulmonary edema) cardiogenic
  3. Dialysis
• Prognosis:
  1. 95% completed recovery
  2. Chronic rare in children
  3. Bad prognosis: proteinuria & hypertension +++