Each year hundreds of thousands of patients begin dialysis due to kidney failure. A review of diseases that cause kidney failure can help build an understanding. Glomerulonephritis, polycystic kidney disease and tumors are some of the many diseases that may affect the kidney. They have similarities between them in terms of symptoms and may have an association with malignancy. The epidemiology, pathology, and pathogenesis of these diseases are of importance to help differentiate between them.
Renal Disease Leading to Kidney Failure
The kidney is a bean shaped organ responsible for regulating blood composition and excretion or urine. A human’s kidney consists of an outer cortex and an inner medulla with about one million tubules or nephrons. Nephrons contain numerous capillaries, which filter the blood entering from the renal artery. Some substances are reabsorbed into the blood while other substances, such as urine or other wastes, remain and are passed. Only one healthy kidney is needed to maintain life; however, when a serious kidney disease affects the normal function of both kidneys renal replacement therapy is needed.
Glomerulonephritis (GN) can be an acute or chronic inflammation of the glomeruli of the kidneys (Youngson, 2005). Glomeruli are the blood vessels within the nephrons. GN is not race or gender specific, and is often a silent disease so the incidence of GN remains unknown. It is, however, more commonly found in children and young adults than older adults (Larson, 2003). The patient normally presents with fever, headache, loss of appetite, vomiting and puffiness of the face and body (Youngson, 2005). Acute GN frequently follows infections, especially those of the upper respiratory tract (Davis, 2009).
With chronic GN the symptoms develop slowly, and the patient can be asymptomatic for years. The disease then progresses to kidney failure. Edema and hypertension are frequently noted. Laboratory findings typically show proteinuria and hematuria (Mosby, Inc., an affiliate of Elsevier Inc., 2009).
GN has been found in patients with malignant tumors and lymphomas. However the relationship between these conditions have yet to be found (Rose, 2009).
Sonographically acute GN will present itself in both kidneys. The bilateral renal parenchyma is usually thickened, with normal or slightly reduced echogenicity. No major changes will be noticed with color or power Doppler. From time to time there may be slight hypervascularity. The resistive index (RI) is generally normal in acute GN (Barozzi & Pavlica).
On the other hand, chronic GN will present opposite findings. Ultrasound will show uniform shrinking of the kidneys, in which the parenchyma is thinned and becomes hyperechoic. Color or power Doppler will show diffusely decrease vascularization; however, spectra Doppler analysis could show a normal RI. The RI can show an increase in patients with long-standing GN because there is a decrease in renal blood flow and elevation in renal vascular impedance (Barozzi & Pavlica).
Post-infectious GN disease generally resolves in 2–4 weeks. Treatments that may be used are doses of an oral steroid or a combination of steroids. Children respond better to steroid treatment than adults. Those who do not respond well, they in addition to steroids are also treated with immunosuppressant drugs (Appel & Kaplan, 2009).
Polycystic kidney disease (PKD) is an inherited renal disease that causes an irreversible decline in kidney function (Chapman, Rahbari-Oskoui, & Bennett, 2009). PKD is an inherited trait and can be autosomal dominant or recessive. In genetics, both parents must contribute the recessive trait in order to appear in the offspring. On the contrary, autosomal dominant PKD (ADPKD) is where the trait or abnormal gene only needs to be passed down from one parent in order...
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