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INFECTION AND KIDNEY DAMAGE

  • Causes of Direct Damage to the Kidneys
      - Infection
      - Liver failure
      - Serious burns
      - Dehydration
      - Severe allergic reaction

  • Conditions Leading to Direct Kidney Damage
      - Blood clots in or around the kidneys
      - Diseases affecting the kidneys:
        - Glomerulonephritis
          - A disease group causing inflammation and damage to the kidney's filtering units
        - Lupus
      - Certain medicines, including
        - Some chemotherapy drugs
        - Some antibiotics
      - Alcohol or drug abuse
      - Blood or blood vessel disorders

  • Blockage Causes in Urinary Tract
      - Some cancers
      - Blood clots in or around the kidneys
      - Kidney stones
      - Bladder problems
      - Enlarged prostate (in men)
      - Chronic kidney diseases

CHRONIC KIDNEY DISEASE (CKD)

  • Main Causes
      - Diabetes
        - Responsible for up to two-thirds of CKD cases
        - Damages multiple body organs, including kidneys, heart, blood vessels, nerves, and eyes
      - High Blood Pressure (Hypertension)
        - Defined as increased pressure of blood against vessel walls
        - Can lead to heart attacks, strokes, and CKD if uncontrolled
        - CKD itself can cause hypertension

  • Other Conditions Affecting Kidneys
      - Glomerulonephritis: most common kidney disease type
      - Inherited diseases:
        - Polycystic Kidney Disease: results in large cysts forming in kidneys, damaging surrounding tissue

SYMPTOMS OF CHRONIC KIDNEY DISEASE (CKD)

  • Many individuals exhibit no severe symptoms until advanced stages

  • Common symptoms include:
      - Extreme tiredness
      - Lack of concentration
      - Anorexia
      - Sleep apnea
      - Muscle cramping
      - Edema at feet and ankles
      - Facial puffiness
      - Dry, itchy skin
      - Increased urination frequency, especially at night

RISK FACTORS FOR CKD

  • Anyone can develop CKD at any age, but risks increase for those who:
      - Have diabetes
      - Have high blood pressure
      - Have a family history of kidney failure
      - Are older

NUTRITIONAL MANAGEMENT OF KIDNEY DISEASES

  • Dietary Adjustments
      - Tailored to support diminished renal function while fulfilling nutrient needs
      - Modifications to limit kidney's excretory load
      - Prevent or correct nutritional deficiencies associated with advancing uremia

  • Daily Caloric Requirements
      - For stable dialysis patients, caloric intake should range between 35 to 45 cal/kg/d
      - Importance of caloric source selection due to high incidence of hyperlipidemia and vascular disease in chronic dialysis patients

SUPPLEMENTATION IN KIDNEY DISEASE

  • Vitamin D Supplementation
      - Should be withheld until hyperphosphatemia is controlled to avoid metastatic calcification

  • Zinc Deficiency
      - Common in uremic and dialysis patients, affecting taste and sexual function
      - Supplementation should only be provided when plasma levels are low due to potential toxicity

FUNCTIONS OF THE KIDNEY

  • The kidneys play multiple vital roles, including:
      1. Regulating osmotic pressure (osmolality) of body fluids
      2. Controlling concentrations of ions in blood plasma:
         - Sodium (Na+), Potassium (K+), Calcium (Ca2+), Magnesium (Mg2+), Chloride (Cl-), Bicarbonate (HCO3), Phosphate, and Sulfate
      3. Maintaining acid-base balance by excreting H+ and HCO3
      4. Regulating extracellular fluid (ECF) volume
      5. Helping to regulate arterial blood pressure
      6. Eliminating waste products of metabolism:
         - Urea, Uric acid, Creatinine
      7. Removing drugs and toxic compounds
      8. Major hormone production sites: Erythropoietin and 1,25-dihydroxy vitamin D3
      9. Degrading several polypeptide hormones
      10. Synthesizing ammonia for acid-base balance

ACUTE KIDNEY INJURY (AKI)

  • Definition
      - Abrupt decrease in kidney function occurring within hours
      - Encompasses injury (structural damage) and impairment (loss of function)

  • Classification of AKI
      - Pre-renal AKI
      - Post-renal obstructive nephr opathy


  •   - Intrinsic acute kidney diseases (true kidney disease)

  • Current Diagnostic Approach
      - Identified throuf ex is gh acute rise in serum creatinine (sCr) levels and/or de cline in urinye output (UO)

  • Pathophysiology of AKI
      - Multifactorial and complex, with common causes being Ischaemia due to:
        - Volume depletion
        - Hypotensio
        - Severe diseases or acute infections

  • Drug-induced AKI
      - Many medications exert toxic effects on the kidneys, resulting from high concentrations in renal tubular cells every time the kidney processes them.