The physical aspects of kidney failure
There are many causes of chronic kidney failure which can lead to the need for dialysis. These can be diagnosed by a variety of blood tests, X-rays and perhaps, a kidney biopsy. In all of these conditions, high blood pressure is a major factor causing progression of the problems and needs to be controlled very carefully (140/80 or less). All of the problems associated with kidney failure may develop and need to be managed carefully in the follow-up clinic.
Chronic pyelonephritis This is a painless inflammation of the part of the kidney surrounding the renal tubules, rather than the glomerulus. It is related to the effects of urine infection spreading up to the kidney and the most damage is done by infections early in childhood. The problem tends to run in families and can be diagnosed by the presence of scars in the kidneys on an ultrasound scan. Not all patients with chronic pyelonephritis will progress to more severe kidney damage – high blood pressure and the passing out of large amounts of protein in the urine tend to be associated with progression.
Chronic glomerulonephritis Glomerulonephritis can develop in an acute (sudden, rapid onset) or a chronic (slow) form and is caused by a painless inflammation of the glomerulus. It can occur by itself or as part of a more general problem such as systemic lupus erythematosus (SLE). Testing of the urine shows the presence of blood and protein. It is associated with high blood pressure and progressive decline of kidney function. It is diagnosed by blood tests and a kidney biopsy where the pathologist describes the appearances – many different types are described which have specific associated problems. Some of these include – proliferative glomerulonephritis, mesangio-capillary glomerulonephritis and focal segmental glomerulosclerosis . One of the commonest is IgA glomerulonephritis which presents often with blood in the urine, sometimes visibly at the time of a throat infection. Some patients with IgA glomerulonephritis will progress to more severe damage – once again, high blood pressure and presence of protein in the urine may predict the tendency to progression. Many patients with IgA glomerulonephritis will simply need to be followed up each year in the out-patient clinic.
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