Kidney Disease, Treatment, and Transplants (Jane)

overview


For a reminder of how the kidneys work, watch this video or read the summary in the Study Help section. The video goes into more detail than necessary, but is helpful to understand the kidney diseases.

Description:

The kidneys are two kidney shaped organs located against the back muscles in the upper abdominal area. The right kidney is located slightly lower than the left because of the location of the liver. The kidney consists of a cortex which protects the internal section of the kidney called the medulla. Blood enters the kidneys through the renal artery, which branches into the interlobular arteries and then the arcuate arteries. These smaller arteries bring blood to the tiny functional units called the nephrons. The nephrons filter the blood of substances such as toxins and water. The nephrons are gathered in pyramid-like structures called medulla. The waste that they remove from the blood forms urine, which drains into collecting ducts. The urine collects in the minor calyxes, then major calyxes, then the renal pelvis. Finally, the urine is removed from the kidney through the ureter. Clean, filtered blood is returned to the bloodstream through the arcuate veins, leading to the interlobular veins, and then to the renal vein.

Animation:

Function:

The main task of the kidneys is aiding the body with waste excretion. By filtering blood, the kidneys also help regulate other bodily functions, including water balancing; and blood pressure, red blood cell, and acid regulation. The following summary was taken from: http://www.healthline.com/human-body-maps/kidney

Waste excretion: There are many things your body doesn’t want inside of it. The kidneys filter out toxins, excess salts, and urea, a nitrogen-based waste created by cell metabolism. Urea is synthesized in the liver and transported through the blood to the kidneys for removal.

Water level balancing: As the kidneys are key in the chemical breakdown of urine, they react to changes in the body’s water level throughout the day. As water intake decreases, the kidneys adjust accordingly and leave water in the body instead of helping excrete it.

Blood pressure regulation: The kidneys need constant pressure to filter the blood. When it drops too low, the kidneys increase the pressure. One way is by producing a blood vessel-constricting protein (angiotensin) that also signals the body to retain sodium and water. Both the constriction and retention help restore normal blood pressure.

Red blood cell regulation: When the kidneys don’t get enough oxygen, they send out a distress call in the form of erythropoietin, a hormone that stimulates the bone marrow to produce more oxygen-carrying red blood cells.

Acid regulation: As cells metabolize, they produce acids. Foods we eat can either increase the acid in our body or neutralize it. If the body is to function properly, it needs to keep a healthy balance of these chemicals. The kidneys do that, too.

Diseases

Bright's disease

Also called kidney disease, nephritis, glomerulonephritis

Acute (First Stage)

The nephrons, or, more specifically, the glomerulus (a cluster of capillaries in the nephron) become inflamed. The inflammation leads to many small hemorrages and the renal capsule is being stretched by the increased pressure in the cortex of the kidney.

Subacute (Second Stage)

This stage can occur months or years after an acute episode of the disease. The kidney becomes much bigger due to the collection of fat and epithelial cells, which collect in the Bouwman's capsule, a section of the nephron. This leads to the restriction of blood flow in the entire kidney and kidney tissue starts to break down.

Chronic (Third Stage)

This stage usually follows the others, but can occur without the previous stages. It is not very common since most people do not survive stage two unless they are cured. The kidney is reduced to scar tissue and barely functions anymore.

Causes:

  • diseases that interrupt the normal function of the immune system
  • damage to the glomeruli (eg. high blood pressure)
  • streptococcal infections (eg. strept throat)
  • sometimes the cause is unknown

Symptoms:

  • severe inflammation
  • increased blood pressure
  • back pain
  • blood and larger amounts of proteins passed in urine
  • temperature increase
  • swollen kidney
  • anemia

Treatment:

  • control blood pressure
  • dialysis
  • diet change
  • anti-inflammatory drugs

This is a summary taken from https://www.britannica.com/science/Bright-disease. For more detail, visit this site.

disabetes mellitus

Commonly known as Diabetes

Diabetes is a disease in the pancreas where it cannot produce enough insulin. Insulin helps glucose to be used by the cells in the body. When there isn't enough insulin, glucose can't enter the cells and causes high blood sugar levels.

Type 1

Causes: occurs when the beta cells (insulin producing cells) are damaged

Treatment: insulin injections through a pump or daily needles

Type 2

Causes: occurs when the pancreas doesn't create enough insulin or the insulin doesn't work correctly

Treatment: healthier lifestyle (diet and exercise), oral glucose-lowering medications

Causes:

  • family history
  • high blood pressure
  • physical stress
  • being overweight
  • alcohol
  • smoking

diabetes insipidus

Healthy kidneys remove water from the blood in proportion to the concentration of water present. The kidneys try to avoid dehydration in this way. In this uncommon disorder, however, the body can't regulate its fluid levels.

Causes:

    • The body doesn't know how to regulate fluid levels because of:
      • damage to the hypothalamus or pituitary gland (the hypothalamus, which is in your brain, makes a chemical called ADH which helps control dehydration, and the pituitary gland stores the ADH)
      • defect in the kidney tubules
      • an enzyme from pregnancy destroys ADH
      • taking in excessive fluids

Symptoms:

    • frequent urination
    • constant, intense thirst
    • weight loss
    • delayed growth in youth

Treatment:

    • no cure, but symptoms can be treated
    • synthetic hormone called desmopressin that replaces ADH
    • drug hydrochlorothiazide is a diuretic, which sometimes will decrease urine flow

This summary was taken from:

http://www.mayoclinic.org/diseases-conditions/diabetes-insipidus/home/ovc-20182403

For more details or clarification, visit this site.

kidney stones

Kidney stones are hard, tiny compact mineral deposits which can form in the kidney and cause severe pain.

Causes:

      • not drinking enough water, genetics, diet low in fibre and high in protein, receiving treatment for kidney disease or cancer
      • build up of toxins: ammonia, calcium, uric acid, and cystine (amino acid)

Symptoms:

      • severe pain, nausea, frequent/painful/bloody urination
      • large stones might need to be removed or broken down surgically
      • can result in an infection in the ureter (because bacteria builds up), which is recognized by a high fever

Diagnosis and Treatment:

      • Passing the stone (small or large, rough or smooth)
      • Imaging and blood tests can diagnose kidney stones
      • Surgically remove/ break down if larger than 4 mm
      • Can control the symptoms with medications:
        • Anti-emetics control nausea and vomiting
        • Painkillers
      • Extracorporeal Shock Wave Lithotripsy (ESWL)
        • uses shock waves to break down the stone into smaller pieces


This is an animation of what a kidney stone would look like.

Transplants

The kidneys, because of their many functions and their constant contact with both blood and waste, are very susceptible to disease and injury. God, in his wisdom, created us with two kidneys and we are able to live with only one kidney. But, in the unfortunate instance when both kidneys have failed or are failing, transplants are possible. Dialysis, a machine that can filter blood for the kidneys, is a temporary fix but a transplant is usually pursued.

The first successful kidney transplant involved identical twins in 1954, but attempts had been made before then to transplant kidneys in dogs, from dogs to humans, and from human to human.

Finding a match:

Donors:

  • Living: This is usually a close friend or family member in excellent health.
  • Deceased: This is someone who is brain-dead and they or their family has given consent to donate their organs.

Tests:

In any organ transplant surgery, there is the possibility that the body will reject the organ and try to destroy it. Therefore multiple tests have to be performed to limit this possibility.

  1. Blood testing: The blood types of the patient and the donor must be the same or compatible.
  2. Tissue Typing: This test looks at antigens, which are markers that distinguish each person as unique from all others. They are inherited from parents. A perfect match is most likely to result in a successful transplant.
  3. Cross-matching: Your body makes antibodies every time you experience an infection or surgery, etc. If there are antibodies on the donor kidney, the recipient might reject the kidney. This is performed by mixing blood from the patient with cells from the donor. If the test is positive, the donor has antibodies and, unless treatment of the organ takes place, the patient can't receive that kidney.
  4. Serology: Testing for viruses

This is a heterotopic surgery, meaning the new kidney is placed in a different location from the original. Usually the patient's kidneys are not removed, which avoids complications such as high blood pressure.

Anti-rejection and anti-inflammatory medications must be taken after surgery and recovery in hospital usually lasts between 3 and 7 days.

Possible complications include blood clots, rejection, and even failure of the donated kidney. If complications arrive, the patient will be put on dialysis if there is zero kidney function.

Dialysis, or Renal Replacement Therapy (RRT) is a machine that filters the blood to keep it clean. Otherwise, waste would build up in the blood and lead to a coma and even death.

This summary was taken from:

http://transplant.surgery.ucsf.edu/conditions--procedures/kidney-transplant.aspx

Study Help:

Description:

    • What are the main structures of the kidney?
    • What is the path of the blood and urine through the kidney?

My Summary

    • kidney-bean shaped
    • against the the back muscles
    • renal artery > interlobular arteries > arcuate arteries > nephrons (in medulla) > minor calyxes > major calyxes >
    • a million nephrons per kidney

Kidney Functions:

    • What are the 5 main functions of the kidney?

Diseases

    • Describe each disease briefly, listing causes, symptoms, and treatment.

Bright's Disease

Diabetes Mellitus

    • Type 1 and 2 diabetes

Diabetes Insipidus

    • Tip: InSIPidus has to do with water

Kidney Stones

Transplants

    • How do doctors find a match?
    • What happens if complications arise?


This video briefly explains how the kidneys work, and four diseases that affect the kidneys. Elianna Van Raalte - January 2018

References:

Websites

Bradford, A. (2016, June 08). Kidneys: Facts, Function & Diseases. Retrieved from http://www.livescience.com/52047-kidneys.html

Hoffman, M. (n.d.). Picture of the Kidneys. Retrieved from http://www.webmd.com/urinary-incontinence-oab/picture-of-the-kidneys#1

Hyperarts, R. M. (n.d.). Kidney Transplant. Retrieved from http://transplant.surgery.ucsf.edu/conditions--procedures/kidney-transplant.aspx

M. (2014, January 07). Bright's Disease - Hereditary, Symptoms, Causes, Treatment. Retrieved from https://hubpages.com/health/Brights-Disease-Hereditary-Symptoms-Causes-Treatment

(n.d.). Kidney. Retrieved from http://www.healthline.com/human-body-maps/kidney

(n.d.). Kidney Stones. Retrieved from http://conditions.healthgrove.com/l/586/Kidney-Stones?utm_source=google&utm_medium=search.ad&utm_campaign=ao.sa.go.vse.healthgrove.4553#Living%20With&s=b76yP

(n.d.). Medical Definition of Glomerulus. Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=19009

(n.d.). RLO: The Anatomy of the Kidneys. Retrieved from http://www.nottingham.ac.uk/nmp/sonet/rlos/bioproc/kidneyanatomy/index.html

Nordqvist, C. (n.d.). Dialysis: All You Need to Know. Retrieved April 10, 2017, from http://www.medicalnewstoday.com/articles/152902.php

PhD, C. P. (n.d.). Kidney Pain Symptoms, Treatment, Causes - Where are the kidneys located? Retrieved from http://www.medicinenet.com/kidney_pain/page3.htm

The Editors of Encyclopædia Britannica. (2015, April 27). Bright disease. Retrieved from https://www.britannica.com/science/Bright-disease

(2016, June 24). Risks. Retrieved from http://www.mayoclinic.org/tests-procedures/kidney-transplant/details/risks/cmc-20203626

(2017, February 14). Kidney Transplant. Retrieved from https://www.kidney.org/atoz/content/kidney-transplant

(n.d.). A Timeline of Kidney Transplantation. Retrieved from http://waring.library.musc.edu/exhibits/kidney/Transplantation.php


Book

Fraser, D., & DiGiuseppe, M. (2012). Nelson Biology 12: University Preparation. Toronto, Ont.: Nelson Education.


Pictures

(n.d.). Glomerulonephritis - Google Search. Retrieved from https://www.google.ca/search?q=glomerulonephritis&espv=2&site=webhp&source=lnms&tbm=isch&sa=X&sqi=2&pjf=1&ved=0ahUKEwj3t-qcmprTAhXH6oMKHcuAAvkQ_AUIBigB&biw=1366&bih=662#imgrc=5SyaTf8plQEUSM:

(n.d.). Kidney - Google Search. Retrieved from https://www.google.ca/search?q=kidney&espv=2&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjuhKL1mprTAhVI9IMKHT4XBzEQ_AUIBigB&biw=1366&bih=662#imgrc=jjTgTOyS4TFi2M:

(n.d.). Kidney transplant - Google Search. Retrieved from https://www.google.ca/search?q=kidney%2Btransplant&espv=2&site=webhp&source=lnms&tbm=isch&sa=X&sqi=2&pjf=1&ved=0ahUKEwipuobHmprTAhUM0oMKHai7DesQ_AUIBigB&biw=1366&bih=662#imgrc=3QRBimQhOAfBqM

(n.d.). Kidney stones - Google Search. Retrieved from https://www.google.ca/search?q=kidney%2Bstones&rlz=1C1CHBF_

(n.d.). Picture of a water bottle - Google Search. Retrieved from https://www.google.ca/search?q=picture%2Bof%2Ba%2Bwater%2Bbottle&rlz=1C1CHBF_enCA734CA734&espv=2&site=webhp&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiQ3qTkm5vTAhVB6IMKHdrODNQQ_AUIBigB&biw=1366&bih=662#tbm=isch&q=plastic water bottle&imgrc=2CEeUmKxz4BqQM: