In normal renal physiology, the kidneys remove waste and excess water from the body and release hormones such as renin (which regulates blood pressure), erythropoietin (which stimulates red blood cell production), and vitamin D (which promotes normal bone structure). However, when kidney disease is involved, renal function becomes compromised and waste products and toxic materials start to accumulate rather than get excreted. This may cause permanent irreversible damage to the body’s cells, tissues, and organs. In this blogpost we are going to go through the most common kidney diseases.
Common Kidney Diseases
- Polycystic Kidney Disease
- Hypertensive Nephrosclerosis
- Glomerulonephritis / Glomeruloscleroisis
- Urinary Tract Infections
- Kidney Stones
- Diabetic Kidney Disease
- Analgesic Nephropathy
Polycystic Kidney Disease
One of the most common kidney diseases is polycystic kidney disease, which is acquired genetically. In polycystic kidney disease, fluid-filled cysts develop within the kidneys. These cysts replace normal kidney tissue, leading to end-stage renal disease.
Polycystic Kidney Disease can be either DOMINANT or RECESSIVE. In the Dominant form, a parent who has the genetic disease passes it to the child (50% chance).
Signs & Symptoms
- dull pain at the side of the abdomen and the back
- upper abdominal discomfort
- frequent UTIs
- haematuria (blood in the urine)
- hypertension
Treatment
- control hypertension
- treat UTIs with antibiotics
- maintain kidney health if diagnosed with chronic kidney disease
- provide dialysis or opt for kidney transplantation if diagnosed with end-stage renal disease
- administer analgesics for pain relief or opt for the shrinking or resection of the cysts through surgery
Hypertensive Nephrosclerosis
Hypertensive Nephrosclerosis is progressive kidney damage resulting from untreated longstanding hypertension due to blood vessel thickening.
Signs & Symptoms
- headaches
- neck discomfort
- nausea
- vomiting
- easily tired
- proteinuria (protein in the urine)
Treatment
- encourage regular exercise
- encourage decrease in dietary salt (maximum 2g daily)
- administer hypertensives to control hypertension
Glomerulonephritis & Glomerulosclerosis
Glomerulonephritis is the inflammation of the glomeruli (where filtration takes place) in the kidneys. The onset of glomerulonephritis can be either chronic or acute. It can be caused by IgA nephropathy (inflammation in the kidney tissue), Streptococcus bacteria, and autoimmune disease. Similarly, Glomerulosclerosis is the scarring of the glomeruli in the kidneys.
Signs & Symptoms
- swelling in the leg/s
- haematuria
- proteinuria (produces frothy urine)
- dark or pink-coloured urine
- additional signs in relation to comorbidities such as diabetes or autoimmune disease eg. weight loss, skin rash, arthritis…
Treatment
- control hypertension
- suggest dietary modifications
- promote a better lifestyle
- administer medication for the reduction of urinary protein
- administer medication for inflammation suppression eg. steroids
Urinary Tract Infections (UTI)
Urinary Tract Infections occur when microorganisms attach to the urethra and start multiplying. This is a common occurrence in women. If left untreated, urinary tract infections may result in pyelonephritis – an infection of the kidneys, which can cause permanent kidney damage.
Conditions such as diabetes, use of a urinary catheter, abnormalities of the urinary tract, pregnancy, or obstructed urine flow (due to kidney stones or an enlarged prostate) increase the risk of acquiring a urinary tract infection.
Signs & Symptoms
- increased frequency of urination
- increased urgency to urinate
- painful urination
- pain in the lower abdomen
- hot foul-smelling urine
- nausea
- vomiting
- haematuria
- fever
Treatment
- encourage increased fluid intake
- administer antibiotics to treat infection
Kidney Stones
Kidney stones a.k.a. renal calculi, nephrolithiasis or urolithiasis, are hard deposits of minerals and salts which form within the kidneys. Kidney stones are more common in men between 20-40 years of age.
Signs & Symptoms
- extreme localised pain
- painful and/or difficult urination
- inability to pass urine (if kidney stone obstructs urine outlet completely due to large size)
- haematuria (due to abrasion caused by the traveling kidney stone)
Treatment
- encourage increased water intake (most stones may pass through if not too big)
- administer pain relief
- administer medication to break down large kidney stones
- shockwave therapy
- surgery (cystoscopy or open surgery)
Diabetic Kidney Disease
One of the most common kidney diseases is Diabetic Kidney Disease. Diabetes is the most common cause of end-stage renal disease. Diabetes (type 1 and type 2) damage the blood vessels in the kidneys. Additionally, hypertension in diabetics increase the risk for diabetic nephropathy. Diabetic Kidney Disease is most commonly found in chronic and poorly controlled diabetics.
Signs & Symptoms
- itching
- lethargy
- nausea
- vomiting
- weight loss
- nocturia (increased need for urination at night)
- swelling in the leg/s
- proteinuria (produces frothy urine)
- hypertension
Treatment
- treat urinary tract infections if present (common occurrence in diabetics)
- diabetes control
- blood pressure control
- encourage low protein diet
- administer medication to reduce protein excretion
Analgesic Nephropathy
Long-standing analgesic ingestion is a risk factor for chronic kidney disease. Analgesics such as NSAIDs are commonly used by individuals with conditions that require constant need of pain relief, but such medications increase the risk of end-stage renal disease.
Signs & Symptoms
- haematuria
- proteinuria (produces frothy urine)
- lethargy
- lack of appetite
- nausea
- vomiting
- swelling of the leg/s
Treatment
- reduce as much as possible the use of analgesics
- special precaution should be taken by individuals with known kidney disease so as to reduce or possibly eliminate the use of analgesics
Additional Notes…
In patients with kidney disease:
- teach patient about the importance of fluid restriction – patient should not drink more than 1.5ltr per day
- teach patient about sodium restriction
- with regards to nursing documentation, food charting as well as intake & output charting are important
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