Disease of the Renal System

DISEASES OF THE KIDNEY

nephrotic syndrome nephritic syndrome renal failure tubular defects renal stones end-stage renal disease (ESRD)

Diseases of the Tubules and Interstitium

Acute Renal Failure (ARF) Chronic Renal Failure (CRF) End-stage Renal Disease (ESRD) Nephrolithiasis (Kidney Stones) Transplantation Dialysis

Nephrolithiasis (Kidney Stones)

Nephrolithiasis (Kidney Stones)

Kidney stones are formed when the concentration of components in the urine reaches a level in which crystallisation is possible. They generally are composed of: Calcium salts Uric acid Cystine Struvite (triple salt of ammonium, magnesium, and phosphate). Although the clinical manifestations of these stones are similar, their pathogenesis and treatment differ

Nephrolithiasis (Kidney Stones)

Most of patients who pass a single stone will have stone recurrence. Regardless of the type of stone or its cause, the encouragement of large volumes of oral fluid intake (1.5 2 l/d) to produce high amount of urine is an essential component of effective prophylactic treatment. The goal or rigorous hydration is to keep the urine dilute, preventing the crystallisation of stoneforming minerals.

Nephrolithiasis (Kidney Stones)

Calcium Oxalate and Calcium Phosphate Stones
These stones account for the majority (75%) of stones Most common in middle-aged men. Calcium oxalate stones occur most frequently. Their causes are multiple, including hyperparathyroidism, hypercitraturia, and hyperoxaluria.

Nephrolithiasis (Kidney Stones)

Cystinine Stone
Cystinine stones caused by a rare hereditary disorder of amino acid transport. Treatment consists of extremely high oral intakes of fluid (>4 L/d). An alkaline ash diet is also required to raise the urinary pH to 7.5.

Nephrolithiasis (Kidney Stones)

Uric Acid Stones

Uric acid stones are associated with gout and malignant disease as well as some GI diseases characterized by diarrhoea. The most important factor involved in forming uric acid stones appears to be the production of an acid urine. Aspirin or probenecid can increase uric acid excretion and thus can lead to stone formation. The cornerstone of management of uric acid stones involves raising the pH to 6.0-6.5 by a high alkaline ash diet.

Nephrolithiasis (Kidney Stones)

Struvite Stones
Struvite stone containing ammonium, magnesium, and phosphate Usually seen in women. They are formed when the urinary tract is infected with ureasesplitting organisms. Treatment consists of long-term effective antibiotics as well as surgical or ultrasonic removal of stones. Dietary management has no significant role in this form of stone disease.

Consequences of Kidney Stones

Renal Colic Urinary Tract Complications

Frequent urination Urgency of urination Dysuria Hematuria

Prevention and Treatment of Kidney Stones

Diet Management
Oxalate or oxalic acid is the end product of glyoxylin and ascorbic acid.
Found in Plane origins. (beer, ovaltine, tea, chocolate, cocoa, baked beans, tofu, eggplant, okra, pepper, potatoes, blackberries, watercress, spinach)

restrict vit C 1 g/d Phosphate binding agent are not successful.

Nephrolithiasis (Kidney Stones)

Diet Management
Purine
Specific types of meat and exchange are high in purine. Brains, kidneys, herring, liver, sardines, scallops) limit: (bread and cereals, cauliflower, fish, meat and meat soups and broths, mushrooms, oatmeal, peas, poultry, shellfish, spinach, wheat germ and bran)

Nephrolithiasis (Kidney Stones)

Diet Management
Acid-ash diet Render urine acid, since ash remains after metabolism of these foods. (meat, fish, shellfish, all types of cheese, peanut butter, nut) all breads , corn, lentile, plain cake, cookies. Alkaline-ash foods Milk and products, cream, buttermilk, nuts (almonds, chestnut, coconut) All vegetables, and fruits except prunes plums

Nephrotic Syndrome

Nephrotic Syndrome
Nephrotic syndrome describes a heterogeneous group of diseases whose common manifestations derive from a loss of the glomerular barrier to protein. More than 95% of cases seen with this syndrome are accounted for by three systemic diseases:
diabetes mellitus systemic lupus erythematosus amyloidosis

Nephrotic Syndrome
Massive proteinuria, which leads to: Hypoproteinemia Hypoalbunemia Hyperlipidemia Elevated cholesterols, triglicerides and other lipids Edema

Nephrotic Syndrome

The edema results not only from the hypoosmolar state caused by the loss of plasma proteins, but also from abnormal salt and water retention.

Nephrotic Syndrome
The Goal of dietary management: Control HTN Minimize edema Decrease albumin loss Offset protein malnutrition Slow progression of renal disease Prevent muscle catabolism Supply adequate kcal

Nephrotic Syndrome
Diet ---- Control intake of Na, Protein, and kcal.

Protein

0.8-1 g/kg (40 gm) if creatinine and urea level is normal .. up to 1.5 g/kg/day to increase serum albumin Sufficient for wt maintenance (30-35 kcal/kg) 100 to 150 kcal/kg/day for children 60-90 mEq Restriction is not necessary

kcal

Na Cholesterol

Nephritic Syndrome

Nephritic Syndrome
Describes the clinical manifestations of a group of disease characterized by inflammations of the capillary loops of the glomerulus. These diseases also glomerulonepheritis. referred to as acute

This syndrome is characterized by hypertension and by mild loss of renal function.

Nephritic Syndrome
The primary manifestation of these diseases:
haematuria (blood in the urine) a consequent of the capillary inflammation that damages the glomerular barrier to blood cells.

The most common presentation follows a streptococcal infection and is usually self-limiting.

Nephritic Syndrome
The Goal of dietary management: The treatment of acute glomerulonepheritis attempts to maintain good nutritional status while allowing time for the disease to resolve spontaneously. When hypertension is present, it is related mainly to extra-cellular volume excess and should be treated with sodium restriction.