ONLINE ASSIGNMENT

Topic: KIDNEY - DISEASES

Submitted by
Syam.O.s
Dept.of NaturalScience
S N TC Nedunganda

INTRODUCTION
The role of the kidneys is often underrated when we think about
our health.
In fact, the kidneys play a vital role in the daily workings of your
body. They are so important that nature gave us two kidneys, to
cover the possibility that one might be lost to an injury.
We can live quite well with only one kidney and some people live
a healthy life even though born with one missing. However, with
no kidney function death occurs within a few days!
Kidneys are the unsung heroes of our bodies and perform a
number of very important jobs:

Blood pressure control kidneys keep your blood pressure

regular.

Water balance kidneys add excess water to other wastes,

which makes your urine.

Cleaning blood kidneys filter your blood to remove wastes

and toxins.

Vitamin D activation kidneys manage your bodys

production of this essential vitamin, which is vital for strong
bones, muscles and overall health.

All this makes the kidneys a very important player in the way your
body works and your overall health. One of a pair of organs
located in the right and left side of the abdomen. The kidneys
remove waste products from the blood and produce urine. As
blood flows through the kidneys, the kidneys filter waste products,
chemicals, and unneeded water from the blood. Urine collects in
the middle of each kidney, in an area called the renal pelvis. It
then drains from the kidney through a long tube, the ureter, to
the bladder, where it is stored until elimination. The kidneys also
make substances that help control blood pressure and regulate
the formation of red blood cells.Unhealthy habits and life style
influence the health of Kidneys to a great extent. Kidneys may fail
due to several reasons and life itself may be in danger.

Kidneys Structure and Function

The kidneys are bean-shaped organs that serve several essential
regulatory roles in vertebrates. They remove excess organic
molecules from the blood, and it is by this action that their bestknown function is performed: the removal of waste products of
metabolism. Kidneys are essential to the urinary system and also
serve homeostatic functions such as the regulation of electrolytes,
maintenance of acidbase balance, and regulation of blood
pressure (via maintaining the salt and water balance). They serve
the body as a natural filter of the blood, and remove water-soluble
wastes which are diverted to the bladder. In producing urine, the
kidneys excrete wastes such as urea and ammonium. They are
also responsible for the reabsorption of water, glucose, and amino
acids. The kidneys also produce hormones
including calcitriol and erythropoietin. An
important enzyme renin is also produced in the kidney which acts
in negative feedback.

Renal hilus:
The renal hilus is an indentation near to the centre of the concave
area of the kidney. This is the area of the kidney through which
the ureter leaves the kidney and the other structures including
blood vessels (illustrated), lymphatic vessels, and nerves
enter/leave the kidney.
Renal capsule:
The renal capsule is a smooth, transparent, fibrous membrane
that surrounds, encloses, and protects the kidney. Each kidney
has its own renal capsule (outer layer), which helps to maintain
the shape of the kidney as well as protecting it from damage.
The renal capsule is itself surrounded by a mass of fatty tissue
that also helps to protect the kidney by damage by cushioning it
in cases of impact or sudden movement.

Renal cortex:
The renal cortex is the outer part of the kidney and has a reddish
colour (shown as very pale brown above). It has a smooth texture
and is the location of the Bowman's Capsules and the glomeruli,
in addition to the proximal and distal convoluted tubules and
their associated blood supplies (these structures are part of the
kidney nephrons - described in further detail on the page
about kidney nephrons).

Renal medulla:
The renal medulla is the inner part of the kidney. "Medulla"
means "inner portion". This area is a striated (striped) red-brown
colour.
Renal pyramids:
There are approx. 5 - 18 striated triangular structures called
"Renal Pyramids" within the renal medulla of each kidney. The
apperance of striations is due to many straight tubules and blood
vessels within the renal pyramids.
Renal pelvis:
The renal pelvis is the funnel-shaped basin (cavity) that receives
the urine drained from the kidney nephrons via the collecting
ducts and then the (larger) papillary ducts..
Renal artery:

The renal artery delivers oxygenated blood to the kidney. This

main artery divides into many smaller branches as it enters the
kidney via the renal hilus. These smaller arteries divide into
vessels such as the segmental artery, the interlobar artery, the
arcuate artery and the interlobular artery. These eventually
seperate into afferent arterioles, one of which serves
each nephron in the kidney.
Renal vein:
The renal vein receives deoxygenated blood from the peritubular
veins within the kidney. These merge into the interlobular,
arcuate, interlobar and segmental veins, which, in turn, deliver
deoxygenated blood to the renal vein, through which it is
returned to the systemic blood circulation system.
Interlobular artery:
The interlobular artery delivers oxygenated blood at high
pressure to the glomerular capillaries.
Interlobular vein:
The interlobular vein receives deoxygenated blood (at lower
pressure) that it drains away from the glomerular filteration units
and from the Loops of Henle.
Kidney nephron:

Kidney nephrons are the functional units of the kidneys. That this,
it is the kidney nephrons that actually perform the kidney's main
functions. There are approx. a million nephrons within each
kidney. To find out more about these, visit the page about Kidney
Nephrons.

Collecting Duct (Kidney):

The collecting duct labelled in the diagram above is part of the
kidney nephron (shown much enlarged). The distal convoluted
tubules (term explain on the page about kidney nephrons) of
many nephrons empty into a single collecting duct. Many such
collecting ducts unite to drain urine extracted by the kidney into
papillary ducts, then into a minor calyx, then the major calyx (at
the centre of the kidney), and finally into the ureter through
which the urine leaves the kidney en-route to the urinary bladder.

Ureter:
The ureter is the structure through which urine is conveyed
from the kidney to the urinary bladder.

Kidneys - Diseases
Most kidney diseases attack the nephrons. This damage may
leave kidneys unable to remove wastes. Causes can include
genetic problems, injuries, or medicines. You are at greater risk
for kidney disease if you have diabetes, high blood pressure, or a
close family member with kidney disease.Chronic kidney
disease damages the nephrons slowly over several years. Other
kidney problems include:

Nephritis

Nephritis can produce glomerular injury, by disturbing the

glomerular structure with inflammatory cell proliferation. This can
lead to reduced glomerular blood flow, leading to reduced urine
output (oliguria) and retention of waste products (uremia). [As a
result, red blood cells may leak out of damaged glomeruli,
causing blood to appear in the urine (hematuria).Low renal blood
flow activates the renin-angiotensin-aldosterone system (RAAS),
causing fluid retention and mild hypertension.

Causes and Symptoms

Nephritis is often caused by infections, and toxins, but is most
commonly caused by autoimmune disorders that affect the major
organs like kidneys.

Pyelonephritis is inflammation that results from a urinary

tract infection that reaches the renal pelvis of the kidney.

Lupus nephritis is inflammation of the kidney caused

by systemic lupus erythematosus (SLE), a disease of
the immune system.

Athletic nephritis is nephritis resulting from strenuous

exercise. Bloody urine after strenuous exercise may also result
frommarch hemoglobinuria, which is caused by trauma to red
blood cells, causing their rupture, which leads to the release of
hemoglobin into the blood.

As the kidneys inflame, they begin to excrete needed protein from

the body into the urine stream. This condition is
calledproteinuria.Loss of necessary protein due to nephritis can
result in several life-threatening symptoms. The most serious
complication of nephritis can occur if there is significant loss of
the proteins that keep blood from clotting excessively. Loss of
these proteins can result in blood clots causing sudden stroke.

DIagnosis

Urine test. A urinalysis may show red blood cells and red
cell casts in your urine, an indicator of possible damage to the
glomeruli. Urinalysis results may also show white blood cells, a
common indicator of infection or inflammation, and increased
protein, which may indicate nephron damage. Other indicators,
such as increased blood levels of creatinine or urea, are red
flags.

Blood tests. These can provide information about kidney

damage and impairment of the glomeruli by measuring levels
of waste products, such as creatinine and blood urea nitrogen.

Imaging tests. If your doctor detects evidence of damage,

he or she may recommend diagnostic studies that allow
visualization of your kidneys, such as a kidney X-ray, an
ultrasound examination or a computerized tomography (CT)
scan.

Kidney biopsy. This procedure involves using a special

needle to extract small pieces of kidney tissue for microscopic
examination to help determine the cause of the inflammation.
A kidney biopsy is almost always necessary to confirm a
diagnosis of glomerulonephritis.

Chronic renal disease

Chronic kidney disease (CKD), also known as chronic renal
disease, is a progressive loss in renal function over a period of
months or years. The symptoms of worsening kidney function are
not specific, and might include feelinggenerally unwell and
experiencing a reduced appetite. Often, chronic kidney disease is
diagnosed as a result ofscreening of people known to be at risk of
kidney problems, such as those with high blood
pressure or diabetes and those with a blood relative with CKD.
This disease may also be identified when it leads to one of its
recognized complications, such as cardiovascular
disease, anemia, or pericarditis.It is differentiated from acute
kidney disease in that the reduction in kidney function must be
present for over 3 months.

Causes
Chronic kidney disease occurs when a disease or condition
impairs kidney function, causing kidney damage to worsen over
several months or years.
Diseases and conditions that commonly cause chronic kidney
disease include:

Type 1 or type 2 diabetes

High blood pressure

Glomerulonephritis an inflammation of the kidney's filtering

units (glomeruli)

Interstitial nephritis, an inflammation of the kidney's tubules

and surrounding structures

Polycystic kidney disease

Prolonged obstruction of the urinary tract, from conditions

such as enlarged prostate, kidney stones and some cancers

Vesicoureteral reflux, a condition that causes urine to back

up into your kidneys

Recurrent kidney infection, also called pyelonephritis

Symptoms

Signs and symptoms of chronic kidney disease develop over time

if kidney damage progresses slowly. Signs and symptoms of
kidney disease may include:
Nausea
Vomiting
Loss of appetite
Fatigue and weakness
Sleep problems
Changes in urine output
Decreased mental sharpness
Muscle twitches and cramps
Hiccups
Swelling of feet and ankles
Persistent itching
Chest pain, if fluid builds up around the lining of the heart
Shortness of breath, if fluid builds up in the lungs
High blood pressure (hypertension) that's difficult to control
Signs and symptoms of kidney disease are often nonspecific,
meaning they can also be caused by other illnesses. And because
your kidneys are highly adaptable and able to compensate for lost
function, signs and symptoms may not appear until irreversible
damage has occurred.

DIagnosis

To determine whether you have chronic kidney disease, you may

need tests and procedures such as:

Blood tests. Kidney function tests look for the level of

waste products, such as creatinine and urea, in your blood.

Urine tests. Analyzing a sample of your urine may reveal

abnormalities that point to chronic kidney failure and help
identify the cause of chronic kidney disease.

Imaging tests. Your doctor may use ultrasound to assess

your kidneys' structure and size. Other imaging tests may be
used in some cases.

Removing a sample of kidney tissue for testing. Your

doctor may recommend a kidney biopsy to remove a sample of
kidney tissue. Kidney biopsy is often done with local anesthesia
using a long, thin needle that's inserted through your skin and
into your kidney. The biopsy sample is sent to a lab for testing
to help determine what's causing your kidney problem.

kidney stone
A kidney stone, also known as a renal calculus or nephrolith,
is a solid piece of material which is formed in
thekidneys from minerals in urine.Kidney stones typically leave
the body in the urine stream, and a small stone may pass without
causing symptoms.If stones grow to sufficient size (usually at
least 3 millimeters (0.12 in)) they can cause blockage of

the ureter. This leads to pain, most commonly beginning in

the flank or lower back and often radiating to the groin. This pain
is often known as renal colic and typically comes in waves lasting
20 to 60 minutes. Other associated symptoms
include: nausea, vomiting, fever, blood in the urine, pus in the
urine, and painful urination. Blockage of the ureter can
cause decreased kidney function and dilation of the kidney.

Causes
Kidney stones often have no definite, single cause, although
several factors may increase your risk.

Kidney stones form when your urine contains more crystalforming substances such as calcium, oxalate and uric acid
than the fluid in your urine can dilute. At the same time, your
urine may lack substances that prevent crystals from sticking
together, creating an ideal environment for kidney stones to form.

Symptoms
A kidney stone may not cause symptoms until it moves around
within your kidney or passes into your ureter the tube
connecting the kidney and bladder. At that point, you may
experience these signs and symptoms:

Severe pain in the side and back, below the ribs

Pain that spreads to the lower abdomen and groin

Pain that comes in waves and fluctuates in intensity

Pain on urination

Pink, red or brown urine

Cloudy or foul-smelling urine

Nausea and vomiting

Persistent need to urinate

Urinating more often than usual

Fever and chills if an infection is present

Urinating small amounts of urine

Types of kidney stones

Knowing the type of kidney stone helps determine the cause and
may give clues on how to reduce your risk of getting more kidney
stones. Types of kidney stones include:

Calcium stones. Most kidney stones are calcium stones,

usually in the form of calcium oxalate. Oxalate is a naturally
occurring substance found in food. Some fruits and vegetables,
as well as nuts and chocolate, have high oxalate levels. Your
liver also produces oxalate. Dietary factors, high doses of
vitamin D, intestinal bypass surgery and several metabolic
disorders can increase the concentration of calcium or oxalate
in urine. Calcium stones may also occur in the form of calcium
phosphate.

Struvite stones. Struvite stones form in response to an

infection, such as a urinary tract infection. These stones can
grow quickly and become quite large, sometimes with few
symptoms or little warning.

Uric acid stones. Uric acid stones can form in people who
don't drink enough fluids or who lose too much fluid, those who
eat a high-protein diet, and those who have gout. Certain
genetic factors also may increase your risk of uric acid stones.

Cystine stones. These stones form in people with a

hereditary disorder that causes the kidneys to excrete too
much of certain amino acids (cystinuria).

Other stones. Other, rarer types of kidney stones also can

occur.

DIagnosis

Blood testing. Blood tests may reveal too much calcium or

uric acid in your blood. Blood test results help monitor the

health of your kidneys and may lead your doctor to check for
other medical conditions.

Urine testing. The 24-hour urine collection test may show

that you're excreting too many stone-forming minerals or too
few stone-preventing substances. For this test, your doctor may
request that you perform two urine collections over two
consecutive days.

Imaging. Imaging tests may show kidney stones in your

urinary tract. Options range from simple abdominal X-rays,
which can miss small kidney stones, to high-speed or dual
energy computerized tomography (CT) that may reveal even
tiny stones.
Other imaging options include an ultrasound, a noninvasive
test, and intravenous urography, which involves injecting dye
into an arm vein and taking X-rays (intravenous pyelogram) or
obtaining CT images (CT urogram) as the dye travels through
your kidneys and bladder.

Analysis of passed stones. You may be asked to urinate

through a strainer to catch stones that you pass. Lab analysis
will reveal the makeup of your kidney stones. Your doctor uses
this information to determine what's causing your kidney
stones and to form a plan to prevent more kidney stones.

REFERENCES

1. Longo et al., Harrison's Principles of Internal Medicine, 18th

ed., p.2982

2. D'Amico, G (1987). "The commonest glomerulonephritis in

the world: IgA nephropathy." Q J Med 64 (245): 709
727. PMID 3329736.

3. Idee, J.-; Boehm, J.; Prigent, P.; Ballet, S.; Corot, C. (2006).
"Role of Apoptosis in the Pathogenesis of Contrast Mediainduced Nephropathy and Hints for its Possible Prevention
by Drug Treatment". Anti-Inflammatory & Anti-Allergy
Agents in Medicinal Chemistry 5 (2):
139. doi:10.2174/187152306776872442.

4. Portilla D, Safar AM, Shannon ML, Penson RT. Cisplatin

nephrotoxicity. In: UpToDate, Palevsky PM (Ed), UpToDate,
Waltham, MA,
2013.http://www.uptodate.com/contents/cisplatinnephrotoxicity

5. Robinson, Emily S.; Khankin, Eliyahu V.; Karumanchi, S.

Ananth; Humphreys, Benjamin D. (1 November
2010). "Hypertension Induced by Vascular Endothelial
Growth Factor Signaling Pathway Inhibition: Mechanisms
and Potential Use as a Biomarker". Seminars in
Nephrology 30 (6): 591
601. doi:10.1016/j.semnephrol.2010.09.007.PMC 3058726. P
MID 21146124.