Disease of the Renal System

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) .

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

Regardless of the type of stone or its cause.5 –2 l/d) to produce high amount of urine is an essential component of effective prophylactic treatment. the encouragement of large volumes of oral fluid intake (1. The goal or rigorous hydration is to keep the urine dilute. . preventing the crystallisation of stoneforming minerals.Nephrolithiasis (Kidney Stones) Most of patients who pass a single stone will have stone recurrence.

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

.5. Treatment consists of extremely high oral intakes of fluid (>4 L/d).Nephrolithiasis (Kidney Stones) Cystinine Stone Cystinine stones caused by a rare hereditary disorder of amino acid transport. An alkaline ash diet is also required to raise the urinary pH to 7.

0-6.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. Aspirin or probenecid can increase uric acid excretion and thus can lead to stone formation. The most important factor involved in forming uric acid stones appears to be the production of an acid urine.5 by a high alkaline ash diet. . The cornerstone of management of uric acid stones involves raising the pH to 6.

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

Consequences of Kidney Stones Renal Colic Urinary Tract Complications Frequent urination Urgency of urination Dysuria Hematuria .

cocoa. potatoes. pepper. baked beans. . tofu. okra. Found in Plane origins. (beer. watercress. eggplant. tea.Prevention and Treatment of Kidney Stones Diet Management Oxalate or oxalic acid is the end product of glyoxylin and ascorbic acid. chocolate. blackberries. ovaltine. spinach) restrict vit C 1 g/d Phosphate binding agent are not successful.

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

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

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 .

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

.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 .

. and kcal.8-1 g/kg (40 gm) if creatinine and urea level is normal .Control intake of Na. Protein 0.Nephrotic Syndrome Diet ---. Protein. 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.

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