Chronic kidney diseases (that exist)

Chronic kidney diseases

Introduction

Nephropathy is the medical term for diseases of the kidney. The causes of kidney diseases can be Diabetes mellitus, high blood pressure, immune disorders, congenital diseases (e.g. cystic kidneys), urinary flow disorders, medications/drugs, and others.

Chronic kidney failure can develop from various causes. Prolonged or repeated inflammation of the kidney can cause permanent damage to the kidney. The long-term consequences of diabetes can destroy the fine blood vessels of the renal corpuscles through arteriosclerosis. Congenital malformations can remain undetected for a long time and lead to a gradual loss of kidney function. Pollutants such as painkillers or environmental toxins can also affect the kidney in the long term.

The most important goal for patients with chronic kidney failure is to delay the development of the disease for as long as possible, to address the specific characteristics of the disease in dialysis patients and transplant patients, and to take timely preventive measures.

Recognizing the disease is quite simple. Two methods are available for this purpose. The urine test and the blood test.

The most common kidney diseases that exist (source: QuaSi Kidney Report 2005, Diagnosis Distribution of Dialysis Patients) are

Diabetes type I (23%) and type II (4%)
Glomerulonephritis (20%)
Vascular nephropathy (15%)
Interstitial nephritis (13%)
Unknown genesis (10%)
Cystic kidneys (7%)
Systemic diseases (3%)
Various (5%)

What is chronic kidney disease?

The hallmark of many chronic diseases is a slow and often unnoticed course. In contrast to most acute diseases, which are accompanied by pain or other clear symptoms such as fever, a chronic disease requires less frequent visits to a doctor.

Chronic diseases often remain undetected or are under-treated over time. There is a risk that they will develop into a terminal or permanent disease, which means that damage to an organ or part of the body has progressed to such an extent that even medical treatment cannot restore its function.

What causes chronic kidney disease?

For a disease state to occur, a trigger is usually required. This trigger can come from within the person, e.g. in the form of a genetic defect, or it can affect the patient from outside, as is the case with pathogens (bacteria, viruses) or through a lifestyle that promotes the disease (e.g. obesity, smoking and high blood pressure).

Another possibility is that an already existing disease triggers another disease. This already existing illness is called a pre-existing condition or a basic illness.

Diabetes type I and type II

(Diabetic nephropathy)

Diabetic nephropathy is widespread, which is the term used to describe changes in the kidneys that occur as so-called late complications after years of diabetes. Diabetic nephropathy is not a clearly defined clinical picture, but the sum of the most varied changes that can occur in the kidneys as a result of the diabetic metabolic condition: Inflammations, vascular changes, diseases of the filtering apparatus of the kidney. About 40 percent of patients with diabetes are affected. Over time, permanently high blood sugar levels damage the blood vessels in the body. The first sign of diabetic nephropathy is the loss of albumin, a type of protein. Diabetic nephropathy usually occurs 10 to 15 years after the onset of diabetes.

Glomerulonephritis

The term glomerulonephritis (plural: glomerulonephritides) refers to a group of inflammatory diseases of the kidneys in which the renal filters (glomerular) are affected. IgA nephropathy is the most common form of glomerulonephritis.

Glomerulonephritis is not an infectious inflammation, but mostly autoimmune inflammatory processes are present. Glomerulus refers to the glomerular of the kidney, small capillary balls in which urine is produced. Nephritis (from Greek nephros = kidney) stands for an inflammation of the kidney.

Glomerulonephritis is one of the main causes of chronic kidney failure requiring dialysis. A distinction is made between primary and secondary glomerulonephritis. While secondary glomerulonephritides are caused by a disease outside the kidneys, such as infections, poisoning, medication, etc., primary glomerulonephritis is an autoimmune disease whose causes are still largely unknown.

The inflammatory processes can lead to loss of kidney function within a short period of time. Sometimes the disease progresses slowly over years. The chronic inflammation causes the kidney to shrink (shrunken kidney). Glomerulonephritis is diagnosed on the basis of laboratory tests of blood and urine, but is only confirmed by a kidney biopsy.

Vascular Nephropathy

Vascular nephropathy is a secondary kidney damage caused by a change in the blood flow in the kidneys. Both the large (unilateral or bilateral) and the small renal vessels (bilateral) can be affected.

Interstitial nephritis

Interstitial means intermediate and thus refers to kidney inflammations that are in the tissue between glomeruli (renal corpuscles) and tubules. A distinction is made between inflammations of bacterial and non-bacterial (abacterial) origin, and acute and chronic diseases.

There are two causes of interstitial nephritis. First, a bacterially caused form and second, an abacterial form.

Cystic kidneys

There are different types of cystic kidney disease. The most frequent is ADPKD (autosomal dominant polycystic kidney disease) and the much less frequent ARPKD (autosomal recessive polycystic kidney disease). Common to all cystic kidney diseases is the genetic cause and the fact that this disease is the most common hereditary disease. The disease occurs once in about 500 inhabitants. In contrast to individual kidney cysts, which are completely harmless accidental findings, cystic kidneys are a serious disease.

The disease is based on a cystic degeneration of the so-called tubules (small urinary tubules) in the kidneys. The growth of the cysts can lead to a functional impairment or even complete loss of renal function. The disease remains asymptomatic for a long time. Individually, this disease develops quite differently. Approximately 50% are on dialysis at the age of 50 years. The disease is of great importance because of its frequency; about 10% of all dialysis patients suffer from it.

Systemic diseases

This includes, for example, systemic lupus erythematosus: a connective tissue disease that also affects the kidneys; (vasculitis = disease of the renal blood vessels)

Miscellaneous

In the shrunken kidney, a scarred reduction of the kidney occurs due to the loss of kidney tissue and the formation of scar tissue. The kidneys then weigh only 80g or less. The main causes are chronic inflammation (due to disorders of the immune system as well as bacteria), circulatory problems, high blood pressure, diabetes, and kidney-damaging drugs.

A horseshoe kidney is a pathological fusion of both kidneys (eponymous form of a horseshoe). It is assumed that they are formed in the embryonic stage by the union of the kidneys on both sides, at the time when the two organs are still very close together in the pelvis at the age of five weeks. The two kidneys are most often connected at the lower pole. The ureters are not malformed. However, the horseshoe kidney lies further down than usual.

Alport syndrome is the most common hereditary chronic progressive nephropathy with kidney failure. The prevalence is about 1:7500. 80% of those affected are male.

Bartter syndrome is a rare autosomal recessive inherited disease of the ascending branch of the Henle loop in the kidney.

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