A person’s body regulates fluid by balancing liquid intake and removing extra fluid. Thirst usually controls a person’s rate of liquid intake, while urination removes most fluid, although people also lose fluid through sweating, breathing, or diarrhea. The hormone vasopressin, also called antidiuretic hormone, controls the fluid removal rate through urination. The hypothalamus, a small gland located at the base of the brain, produces vasopressin. The nearby pituitary gland stores the vasopressin and releases it into the bloodstream when the body has a low fluid level. Vasopressin signals the kidneys to absorb less fluid from the bloodstream, resulting in less urine. When the body has extra fluid, the pituitary gland releases smaller amounts of vasopressin, and sometimes none, so the kidneys remove more fluid from the bloodstream and produce more urine.

What are the types of diabetes insipidus?

The types of diabetes insipidus include

• central
• nephrogenic
• dipsogenic
• gestational

Each type of diabetes insipidus has a different cause.

Central Diabetes Insipidus

Central diabetes insipidus happens when damage to a person’s hypothalamus or pituitary gland causes disruptions in the normal production, storage, and release of vasopressin. The disruption of vasopressin causes the kidneys to remove too much fluid from the body, leading to an increase in urination. Damage to the hypothalamus or pituitary gland can result from the following:

• surgery
• infection
• inflammation
• a tumor
• head injury

Central diabetes insipidus can also result from an inherited defect in the gene that produces vasopressin, although this cause is rare. In some cases, the cause is unknown.

Nephrogenic Diabetes Insipidus

Nephrogenic diabetes insipidus occurs when the kidneys do not respond normally to vasopressin and continue to remove too much fluid from a person’s bloodstream. Nephrogenic diabetes insipidus can result from inherited gene changes, or mutations, that prevent the kidneys from responding to vasopressin. Other causes of nephrogenic diabetes insipidus include:

• chronic kidney disease
• certain medications, particularly lithium
• low potassium levels in the blood
• high calcium levels in the blood
• blockage of the urinary tract

The causes of nephrogenic diabetes insipidus can also be unknown.

Dipsogenic Diabetes Insipidus

A defect in the thirst mechanism, located in a person’s hypothalamus, causes dipsogenic diabetes insipidus. This defect results in an abnormal increase in thirst and liquid intake that suppresses vasopressin secretion and increases urine output. The same events and conditions that damage the hypothalamus or pituitary—surgery, infection, inflammation, a tumor, head injury—can also damage the thirst mechanism. Certain medications or mental health problems may predispose a person to dipsogenic diabetes insipidus.

Gestational Diabetes Insipidus

Gestational diabetes insipidus occurs only during pregnancy. In some cases, an enzyme made by the placenta—a temporary organ joining mother and baby—breaks down the mother’s vasopressin. In other cases, pregnant women produce more prostaglandin, a hormone-like chemical that reduces kidney sensitivity to vasopressin. Most pregnant women who develop gestational diabetes insipidus have a mild case that does not cause noticeable symptoms. Gestational diabetes insipidus usually goes away after the mother delivers the baby; however, it may return if the mother becomes pregnant again.

The main complication of diabetes insipidus is dehydration if fluid loss is greater than liquid intake. Signs of dehydration include: thirst,
dry skin, fatigue, sluggishness, dizziness, confusion, and nausea.

Severe dehydration can lead to seizures, permanent brain damage, and even death.

Seek Immediate Care

Usually, people can prevent dehydration by increasing the amount of liquids they drink. However, some people may not realize they need to drink more liquids, which can lead to dehydration. People should seek immediate care if they experience symptoms of more severe dehydration, such as

confusion dizziness and sluggishness.

How is diabetes insipidus diagnosed?

A health care provider can diagnose a person with diabetes insipidus based on the following:

• medical and family history
• physical exam
• urinalysis
• blood tests
• fluid deprivation test
• magnetic resonance imaging (MRI)

Medical and Family History

Taking a medical and family history can help a health care provider diagnose diabetes insipidus. A health care provider will ask the patient to review his or her symptoms and ask whether the patient’s family has a history of diabetes insipidus or its symptoms.

Physical Exam

A physical exam can help diagnose diabetes insipidus. During a physical exam, a health care provider usually examines the patient’s skin and appearance, checking for signs of dehydration.

Urinalysis

Urinalysis tests a urine sample. A patient collects the urine sample in a special container at home, in a health care provider’s office, or at a commercial facility. A health care provider tests the sample in the same location or sends it to a lab for analysis. The test can show whether the urine is diluted or concentrated. The test can also show the presence of glucose, which can distinguish between diabetes insipidus and diabetes mellitus. The health care provider may also have the patient collect urine in a special container over a 24-hour period to measure the total amount of urine produced by the kidneys.

Blood Tests

A blood test involves drawing a patient’s blood at a health care provider’s office or a commercial facility and sending the sample to a lab for analysis. The blood test measures sodium levels, which can help diagnose diabetes insipidus and in some cases, determine the type.

Fluid Deprivation Test

A fluid deprivation test measures changes in a patient’s body weight and urine concentration after restricting liquid intake. A health care provider can perform two types of fluid deprivation tests:

• A short form of the deprivation test. A health care provider instructs the patient to stop drinking all liquids for a specific period of time, usually during dinner. The next morning, the patient will collect a urine sample at home. The patient then returns the urine sample to his or her health care provider or takes it to a lab where a technician measures the concentration of the urine sample.
• A formal fluid deprivation test. A health care provider performs this test in a hospital to continuously monitor the patient for signs of dehydration. Patients do not need anesthesia. A health care provider weighs the patient and analyzes a urine sample. The health care provider repeats the tests and measures the patient’s blood pressure every 1 to 2 hours until one of the following happens:
  • The patient’s blood pressure drops too low or the patient has a rapid heartbeat when standing.
  • The patient loses 5 percent or more of his or her initial body weight.
  • Urine concentration increases only slightly in two to three consecutive measurements.

At the end of the test, a health care provider will compare the patient’s blood sodium, vasopressin levels, and urine concentration to determine whether the patient has diabetes insipidus. Sometimes, the health care provider may administer medications during the test to see if they increase a patient’s urine concentration. In other cases, the health care provider may give the patient a concentrated sodium solution intravenously at the end of the test to increase the patient’s blood sodium level and determine if he or she has diabetes insipidus.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is a test that takes pictures of the body’s internal organs and soft tissues without using x-rays. A specially trained technician performs the procedure in an outpatient center or a hospital, and a radiologist—a doctor who specializes in medical imaging—interprets the images. A patient does not need anesthesia, although people with a fear of confined spaces may receive light sedation. An MRI may include an injection of a special dye, called contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end. Some MRI machines allow the patient to lie in a more open space. MRIs cannot diagnose diabetes insipidus. Instead, an MRI can show if the patient has problems with his or her hypothalamus or pituitary gland or help the health care provider determine if diabetes insipidus is the possible cause of the patient’s symptoms.

How is diabetes insipidus treated?

The primary treatment for diabetes insipidus involves drinking enough liquid to prevent dehydration. A health care provider may refer a person with diabetes insipidus to a nephrologist—a doctor who specializes in treating kidney problems—or to an endocrinologist —a doctor who specializes in treating disorders of the hormone-producing glands.

Treatment for frequent urination or constant thirst depends on the patient’s type of diabetes insipidus:

• Central diabetes insipidus. A synthetic, or man-made, hormone called desmopressin treats central diabetes insipidus. The medication comes as an injection, a nasal spray, or a pill. The medication works by replacing the vasopressin that a patient’s body normally produces. This treatment helps a patient manage symptoms of central diabetes insipidus; however, it does not cure the disease.
• Nephrogenic diabetes insipidus. In some cases, nephrogenic diabetes insipidus goes away after treatment of the cause. For example, switching medications or taking steps to balance the amount of calcium or potassium in the patient’s body may resolve the problem. Medications for nephrogenic diabetes insipidus include diuretics, either alone or combined with aspirin or ibuprofen. Health care providers commonly prescribe diuretics to help patients’ kidneys remove fluid from the body. Paradoxically, in people with nephrogenic diabetes insipidus, a class of diuretics called thiazides reduces urine production and helps patients’ kidneys concentrate urine. Aspirin or ibuprofen also helps reduce urine volume.
• Dipsogenic diabetes insipidus. Researchers have not yet found an elective treatment for dipsogenic diabetes insipidus. People can try sucking on ice chips or sour candies to moisten their mouths and increase saliva flow, which may reduce the desire to drink. For a person who wakes multiple times at night to urinate because of dipsogenic diabetes insipidus, taking a small dose of desmopressin at bedtime may help. Initially, the health care provider will monitor the patient’s blood sodium levels to prevent hyponatremia, or low sodium levels in the blood.
• Gestational diabetes insipidus. A health care provider can prescribe desmopressin for women with gestational diabetes insipidus. An expecting mother’s placenta does not destroy desmopressin as it does vasopressin. Most women will not need treatment after delivery.

Most people with diabetes insipidus can prevent serious problems and live a normal life if they follow the health care provider’s recommendations and keep their symptoms under control.

Source: https://www.niddk.nih.gov/health-information/kidney-disease/diabetes-insipidus

The Nephrotic Syndrome

• The nephrotic syndrome is a condition marked by very high levels of protein in the urine; low levels
of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol.
• The nephrotic syndrome is a set of symptoms, not a disease in itself.
It can occur with many diseases, so prevention relies on controlling the diseases that cause it.
• Treatment of the nephrotic syndrome focuses on identifying and treating the underlying cause, if possible,
and reducing high cholesterol, blood pressure, and protein in the urine through diet, medication, or both.
• The nephrotic syndrome may go away once the underlying cause,
if known, is treated. However, often a kidney disease is the underlying cause and cannot be cured. In these cases, the kidneys may gradually lose their ability to filter wastes
and excess water from the blood.
If kidney failure occurs, the patient will need to be on dialysis or have a kidney transplant.

Source: https://www.niddk.nih.gov/health-information/kidney-disease/nephrotic-syndrome-adults

Many diseases affect kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. Glomerular diseases include many conditions with a variety of genetic and environmental causes, but they fall into two major categories:

Glomerulonephritis (gloh-MEHR- yoo-loh-nef-RY-tis) describes the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood.

Glomerulosclerosis (gloh-MEHR- yoo-loh-skleh-ROH-sis) describes the scarring or hardening of the tiny blood vessels within the kidney. 
Although glomerulonephritis and glomerulosclerosis have different causes, they can both lead to kidney failure.

Glomerular diseases damage the glomeruli, letting protein and sometimes red blood cells leak into the urine. Sometimes a glomerular disease also interferes with the clearance of waste products by the kidney, so they begin to build up in the blood. Furthermore, loss of blood proteins like albumin in the urine can result in a fall in their level in the bloodstream. In normal blood, albumin acts like a sponge, drawing extra fluid from the body into the bloodstream, where it remains until the kidneys remove it. But when albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Fluid can accumulate outside the circulatory system in the face, hands, feet, or ankles and cause swelling.

What are the symptoms of glomerular disease?

The signs and symptoms of glomerular disease include

• albuminuria: large amounts of protein in the urine
• hematuria: blood in the urine
• reduced glomerular filtration rate: inefficient filtering of wastes from the blood
• hypoproteinemia: low blood protein
• edema: swelling in parts of the body

One or more of these symptoms can be the first sign of kidney disease. But how would you know, for example, whether you have proteinuria? Before seeing a doctor, you may not. But some of these symptoms have signs, or visible manifestations:

• Proteinuria may cause foamy urine.
• Blood may cause the urine to be pink or cola-colored.
• Edema may be obvious in hands and ankles, especially at the end of the day, or around the eyes when awakening in the morning, for example.

Patients with glomerular disease have significant amounts of protein in the urine, which may be referred to as “nephrotic range” if levels are very high. Red blood cells in the urine are a frequent finding as well, particularly in some forms of glomerular disease. Urinalysis provides information about kidney damage by indicating levels of protein and red blood cells in the urine. Blood tests measure the levels of waste products such as creatinine and urea nitrogen to determine whether the filtering capacity of the kidneys is impaired. If these lab tests indicate kidney damage, the doctor may recommend ultrasound or an x ray to see whether the shape or
size of the kidneys is abnormal. These
tests are called renal imaging. But since glomerular disease causes problems at the cellular level, the doctor will probably also recommend a kidney biopsy—a procedure in which a needle is used to extract small pieces of tissue for examination with different types of microscopes, each of which shows a different aspect of the tissue. A biopsy may be helpful in confirming glomerular disease and identifying the cause.

A number of different diseases can result
in glomerular disease. It may be the direct result of an infection or a drug toxic to the kidneys, or it may result from a disease
that affects the entire body, like diabetes or lupus. Many different kinds of diseases can cause swelling or scarring of the nephron or glomerulus. Sometimes glomerular disease is idiopathic, meaning that it occurs without an apparent associated disease.

The categories presented below can overlap: that is, a disease might belong
to two or more of the categories. For example, diabetic nephropathy is a form of glomerular disease that can be placed in two categories: systemic diseases, since diabetes itself is a systemic disease, and sclerotic diseases, because the specific damage done to the kidneys is associated with scarring.

Autoimmune Diseases

When the body’s immune system functions properly, it creates protein-like substances called antibodies and immunoglobulins
to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions.

Systemic lupus erythematosus (SLE) affects many parts of the body: primarily the skin and joints, but also the kidneys. Because women are more likely to develop SLE than men, some researchers believe that a sex-linked genetic factor may play a part in making a person susceptible, although viral infection has also been implicated as a triggering factor.

Lupus nephritis is the name given to the kidney disease caused by SLE, and it occurs when autoantibodies form or are deposited in the glomeruli, causing inflammation. Ultimately, the inflammation may create scars that keep the kidneys from functioning properly. Conventional treatment for lupus nephritis includes a combination of two drugs, cyclophosphamide, a cytotoxic agent that suppresses the immune system, and prednisolone, a corticosteroid used to reduce inflammation. A newer immunosuppressant, mychophenolate mofetil (MMF), has been used instead of cyclophosphamide. Preliminary studies indicate that MMF may be as effective as cyclophosphamide and has milder side effects.

Goodpasture’s syndrome involves an autoantibody that specifically targets
the kidneys and the lungs. Often, the
first indication that patients have the autoantibody is when they cough up
blood. But lung damage in Goodpasture’s syndrome is usually superficial compared with progressive and permanent damage
to the kidneys. Goodpasture’s syndrome is a rare condition that affects mostly young men but also occurs in women, children, and older adults. Treatments include immunosuppressive drugs and a blood- cleaning therapy called plasmapheresis that removes the autoantibodies.

IgA nephropathy is a form of glomerular disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation. IgA nephropathy was not recognized as a cause of glomerular disease until the late 1960s, when sophisticated biopsy techniques were developed that could identify IgA deposits in kidney tissue.

The most common symptom of IgA nephropathy is blood in the urine, but
it is often a silent disease that may go undetected for many years. The silent nature of the disease makes it difficult to determine how many people are in the early stages of IgA nephropathy, when specific medical tests are the only way
to detect it. This disease is estimated to
be the most common cause of primary glomerulonephritis—that is, glomerular disease not caused by a systemic disease like lupus or diabetes mellitus. It appears to affect men more than women. Although IgA nephropathy is found in all age groups, young people rarely display signs of kidney failure because the disease usually takes several years to progress to the stage where it causes detectable complications.

No treatment is recommended for early
or mild cases of IgA nephropathy when
the patient has normal blood pressure and less than 1 gram of protein in a 24-hour urine output. When proteinuria exceeds 1 gram/day, treatment is aimed at protecting kidney function by reducing proteinuria and controlling blood pressure. Blood pressure medicines—angiotensin- converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)—that block a hormone called angiotensin are most effective at achieving those two goals simultaneously.

Hereditary Nephritis— Alport Syndrome

The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss. Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function.

Infection-related Glomerular Disease

Glomerular disease sometimes develops rapidly after an infection in other parts of the body. Acute post-streptococcal glomerulonephritis (PSGN) can occur after an episode of strep throat or, in rare cases, impetigo (a skin infection). The Streptococcus bacteria do not attack the kidney directly, but an infection may stimulate the immune system to overproduce antibodies, which are circulated in the blood and finally deposited in the glomeruli, causing damage. PSGN can bring on sudden symptoms of swelling (edema), reduced urine output (oliguria), and blood in the urine (hematuria). Tests will show large amounts of protein in the urine and elevated levels of creatinine and urea nitrogen in the blood, thus indicating reduced kidney function. High blood pressure frequently accompanies reduced kidney function in this disease.

PSGN is most common in children between the ages of 3 and 7, although it can strike at any age, and it most often affects boys. It lasts only a brief time and usually allows the kidneys to recover. In a few cases, however, kidney damage may be permanent, requiring dialysis or transplantation to replace renal function.

Bacterial endocarditis, infection of the tissues inside the heart, is also associated with subsequent glomerular disease. Researchers are not sure whether the
renal lesions that form after a heart infection are caused entirely by the immune response or whether some other disease mechanism contributes to kidney damage. Treating the heart infection is the most effective way of minimizing kidney damage. Endocarditis sometimes produces chronic kidney disease (CKD).

HIV, the virus that leads to AIDS, can
also cause glomerular disease. Between
5 and 10 percent of people with HIV experience kidney failure, even before developing full-blown AIDS. HIV- associated nephropathy usually begins
with heavy proteinuria and progresses rapidly (within a year of detection) to total kidney failure. Researchers are looking
for therapies that can slow down or reverse this rapid deterioration of renal function, but some possible solutions involving immunosuppression are risky because of the patient’s already compromised immune system.

Sclerotic Diseases

Glomerulosclerosis is scarring (sclerosis)
of the glomeruli. In several sclerotic conditions, a systemic disease like lupus or diabetes is responsible. Glomerulosclerosis is caused by the activation of glomerular cells to produce scar material. This may be stimulated by molecules called growth factors, which may be made by glomerular cells themselves or may be brought to the glomerulus by the circulating blood that enters the glomerular filter.

Diabetic nephropathy is the leading cause of glomerular disease and of total kidney failure in the United States. Kidney disease is one of several problems caused by elevated levels of blood glucose, the central feature of diabetes. In addition to scarring the kidney, elevated glucose levels appear to increase the speed of blood flow into the kidney, putting a strain on the filtering glomeruli and raising blood pressure.

Diabetic nephropathy usually takes many years to develop. People with diabetes
can slow down damage to their kidneys by controlling their blood glucose through healthy eating with moderate protein intake, physical activity, and medications. People with diabetes should also be careful to keep their blood pressure at a level below 140/90 mm Hg, if possible. Blood pressure medications called ACE inhibitors and ARBs are particularly effective at minimizing kidney damage and are now frequently prescribed to control blood pressure in patients with diabetes and in patients with many forms of kidney disease.

Focal segmental glomerulosclerosis (FSGS) describes scarring in scattered regions of the kidney, typically limited to one part of the glomerulus and to a minority of glomeruli in the affected region. FSGS may result from a
systemic disorder or it may develop as an idiopathic kidney disease, without a known cause. Proteinuria is the most common symptom of FSGS, but, since proteinuria is associated with several other kidney conditions, the doctor cannot diagnose FSGS on the basis of proteinuria alone. Biopsy may confirm the presence of glomerular scarring if the tissue is taken from the affected section of the kidney. But finding the affected section is a matter of chance, especially early in the disease process, when lesions may be scattered.

Confirming a diagnosis of FSGS may require repeat kidney biopsies. Arriving
at a diagnosis of idiopathic FSGS requires the identification of focal scarring and the elimination of possible systemic causes such as diabetes or an immune response
to infection. Since idiopathic FSGS is, by definition, of unknown cause, it is difficult to treat. No universal remedy has been found, and most patients with FSGS progress to total kidney failure over 5 to
20 years. Some patients with an aggressive form of FSGS reach total kidney failure
in 2 to 3 years. Treatments involving steroids or other immunosuppressive drugs appear to help some patients by decreasing proteinuria and improving kidney function. But these treatments are beneficial to only a minority of those in whom they are tried, and some patients experience even poorer kidney function as a result. ACE inhibitors and ARBs may also be used in FSGS to decrease proteinuria. Treatment should focus on controlling blood pressure and blood cholesterol levels, factors that may contribute to kidney scarring.

Other Glomerular Diseases

Membranous nephropathy, also called membranous glomerulopathy, is the second most common cause of the nephrotic syndrome (proteinuria, edema, high cholesterol) in U.S. adults after diabetic nephropathy. Diagnosis of membranous nephropathy requires a kidney biopsy, which reveals unusual deposits of immunoglobulin G and complement C3, substances created by the body’s immune system. Fully 75 percent of cases are idiopathic, which means that the cause of the disease is unknown. The remaining 25 percent of cases are the result of other diseases like systemic lupus erythematosus, hepatitis B or C infection, or some forms of cancer.

Drug therapies involving penicillamine, gold, or captopril have also been associated with membranous nephropathy. About 20 to 40 percent of patients with membranous nephropathy progress, usually over decades, to total kidney failure, but most patients experience either complete remission or continued symptoms without progressive kidney failure. Doctors disagree about how aggressively to treat this condition, since about 20 percent of patients recover without treatment. ACE inhibitors and ARBs are generally used to reduce proteinuria. Additional medication to control high blood pressure and edema is frequently required. Some patients benefit from steroids, but this treatment does not work for everyone. Additional immunosuppressive medications are helpful for some patients with progressive disease.

Minimal change disease (MCD) is the diagnosis given when a patient has the nephrotic syndrome and the kidney biopsy reveals little or no change to the structure of glomeruli or surrounding tissues when examined by a light microscope. Tiny drops of a fatty substance called a lipid may be present, but no scarring has taken place within the kidney. MCD may occur at any age, but it is most common in childhood. A small percentage of patients with idiopathic nephrotic syndrome do not respond to steroid therapy. For these patients, the doctor may recommend a low-sodium diet and prescribe a diuretic to control edema. The doctor may recommend the use of nonsteroidal anti-inflammatory drugs to reduce proteinuria. ACE inhibitors
and ARBs have also been used to reduce proteinuria in patients with steroid-resistant MCD. These patients may respond to larger doses of steroids, more prolonged use of steroids, or steroids in combination with immunosuppressant drugs, such
as chlorambucil, cyclophosphamide, or cyclosporine.

Renal failure is any acute or chronic loss
of kidney function and is the term used when some kidney function remains. Total kidney failure, sometimes called end-stage renal disease (ESRD), indicates permanent loss of kidney function. Depending on the form of glomerular disease, renal function may be lost in a matter of days or weeks or may deteriorate slowly and gradually over the course of decades.

Acute Renal Failure

A few forms of glomerular disease cause very rapid deterioration of kidney function. For example, PSGN can cause severe symptoms (hematuria, proteinuria, edema) within 2 to 3 weeks after a sore throat or skin infection develops. The patient may temporarily require dialysis to replace
renal function. This rapid loss of kidney function is called acute renal failure (ARF). Although ARF can be life-threatening while it lasts, kidney function usually returns after the cause of the kidney failure has been treated. In many patients, ARF is not associated with any permanent damage. However, some patients may recover from ARF and subsequently develop CKD.

Chronic Kidney Disease

Most forms of glomerular disease develop gradually, often causing no symptoms for many years. CKD is the slow, gradual loss of kidney function. Some forms of CKD can be controlled or slowed down. For example, diabetic nephropathy can be delayed by tightly controlling blood glucose levels and using ACE inhibitors and ARBs to reduce proteinuria and control blood pressure. But CKD cannot be cured. Partial loss of renal function means that some portion of the patient’s nephrons have been scarred, and scarred nephrons cannot be repaired. In many cases, CKD leads to total kidney failure.

Total Kidney Failure

To stay alive, a patient with total kidney failure must go on dialysis—hemodialysis or peritoneal dialysis—or receive a new kidney through transplantation. Patients with CKD who are approaching total kidney failure should learn as much about their treatment options as possible, so they can make an informed decision when the time comes. With the help of dialysis or transplantation, many people continue to lead full, productive lives after reaching total kidney failure.

Source: https://www.niddk.nih.gov/health-information/kidney-disease/glomerular-diseases

A kidney infection is a type of urinary tract infection (UTI). Most kidney infections are caused by bacteria or viruses that first infect your lower urinary tract, usually your bladder. Then, the infection moves upstream to one or both of your kidneys, which are part of the upper urinary tract.

In some cases, you can get a kidney infection after surgery if bacteria enter your body during the procedure and travel through your blood to the kidneys.

Your body has ways to defend against infections in the urinary tract. For example, urine normally flows one way from your kidneys to your bladder. Viruses or bacteria that enter are flushed out by urinating. This one-way flow of urine usually prevents an infection in your urinary tract. Learn more about your urinary tract and how it works.

Sometimes your body’s defenses fail, and bacteria or viruses cause a UTI in the bladder. If you have symptoms of a bladder infection, see a health care professional. You may need treatment to prevent the infection from spreading to your kidneys. Kidney infections are often very painful and can cause serious health problems.

Kidney infections cause most of the 100,000 hospital visits for UTIs in the United States each year.1

Risks

You are more likely to develop a kidney infection if you:

• are a woman.²
• have a UTI in the bladder.
• had a UTI during the past 12 months.
• are pregnant. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel to the kidneys and cause infection.
• have a problem in your urinary tract that blocks or changes the normal flow of urine. The flow of urine may be blocked if you have a defect in the structure of your urinary tract, such as a narrowed urethra, an enlarged prostate, or a kidney stone.
• have vesicoureteral reflux (VUR), which is when urine can back up, or reflux, into one or both kidneys. Health care professionals most commonly diagnose VUR in children.3
• have diabetes or problems with your body’s immune, or natural defense, system.
• have a spinal cord injury or nerve damage around the bladder.
• have trouble emptying your bladder completely, called urinary retention.

Complications

In rare cases, kidney infections may cause:

• high blood pressure
• kidney failure
• permanent kidney scars, called renal scarring, which can lead to chronic kidney disease

Your chance of a complication is slightly greater if you have:

• kidney disease from other causes
• a problem with the structure of your urinary tract
• repeated episodes of kidney infection

Complications from a kidney infection are rare if a health care professional prescribes

antibiotics to treat your infection.

Symptoms & Causes

Symptoms of kidney infections vary by age. Symptoms may include:

• chills
• fever
• pain in your back, side, or groin
• nausea
• vomiting
• cloudy, dark, bloody, or foul-smelling urine
• frequent, painful urination

A child younger than 2 years old with a kidney infection may only have a high fever.

An adult older than age 65 with a kidney infection may have none of the typical symptoms. An older person may only have problems with thinking, such as:

• confusion
• hallucinations
• jumbled speech

Seek Care Right Away

Seek care right away if you have kidney infection symptoms. A kidney infection can sometimes lead to a dangerous condition called sepsis, which can be life threatening. Symptoms of sepsis include fever, chills, rapid breathing and heart rate, rash, and confusion.

A kidney infection that becomes chronic, or long lasting, can cause permanent damage to your kidneys.

Causes

Kidney infections are caused by bacteria or viruses.

Scientists believe that most kidney infections start as a bladder infection that moves

upstream to infect one or both of your kidneys. Most often, the infection is caused by bacteria

that normally live in your bowel. The urinary tract has several ways to prevent infection from

moving up the urinary tract. For example, urination most often flushes out bacteria before it reaches the bladder. Sometimes your body can’t fight the bacteria and the bacteria cause a UTI. If you don’t get medical treatment to stop the infection, the bacteria may infect your kidneys.

In some cases, your blood can carry bacteria or viruses from another part of your body to your kidneys.

Diagnosis

Health care professionals use your medical history, a physical exam, and tests to diagnose a kidney infection.

A health care professional will ask if you have a history of health conditions that make you more likely to develop a kidney infection. During a physical exam, the health care professional will ask you about your symptoms.

If you are a man and the health care professional suspects you have a kidney infection, he or she may perform a digital rectal examination (DRE). During a DRE, the health care professional has you bend over a table or lie on your side while holding your knees close to your chest. After putting on a glove, the health care professional slides a lubricated finger into your anus to check for a swollen or enlarged prostate blocking the neck of your bladder.

Lab tests

• For a urinalysis, you will collect a urine sample in a special container at a doctor’s office or at a lab. A health care professional will look at the sample under a microscope for bacteria and white blood cells, which the body produces to fight infection. Bacteria also can

be found in the urine of healthy people, so a kidney infection is diagnosed based both on your symptoms and a lab test.

• Urine culture. A health care professional may culture your urine to find out what type of bacteria is causing the infection. A health care professional can see how the bacteria have multiplied, usually in 1 to 3 days, and can then determine the best treatment.

Imaging tests

A health care professional may use imaging tests, such as a computed tomography (CT) scan,

magnetic resonance imaging (MRI), or ultrasound, to help diagnose a kidney infection. A

technician performs these tests in an outpatient center or a hospital. A technician may perform an ultrasound in a doctor’s office as well. A radiologist reads and reports on the images. You don’t need anesthesia for these tests. Read more about imaging tests for your urinary tract.

Treatment

If you have a kidney infection, a health care professional will prescribe antibiotics. Even before your test results are in, the health care professional may prescribe an antibiotic that fights the most common types of bacteria. Although you may feel relief from your symptoms, make sure to take the entire antibiotic treatment that your health care professional prescribes.

Once your lab results are in, the health care professional may switch the antibiotic to one that better treats the type of infection you have. You may take these antibiotics by mouth, through a vein in your arm, called by IV, or both.

If you are very sick from your kidney infection, you may go to a hospital for bed rest. A health care professional may give you fluids through an IV.

If something such as a kidney stone or an enlarged prostate is blocking your urinary tract, a

doctor can sometimes treat the problem with surgery or another procedure.

If you recently had a kidney infection, the health care professional will often repeat urine cultures after your treatment ends to make sure your infection has completely gone away and has not come back. If a repeat test shows infection, you may take another round of antibiotics. If your infection comes back again, he or she may prescribe antibiotics for a longer time period.

If your health care professional prescribes antibiotics, take all of the antibiotics as prescribed and follow the advice of the health care professional. Even if you start to feel better, you should finish all of your medicine.

Prevention

Many kidney infections start as a bladder infection, so preventing bladder infections may help prevent kidney infections. Scientists are still trying to understand the best ways to prevent bladder infections, but these small changes in your daily habits may help:

• Drink lots of liquid, especially water – Liquids can help flush bacteria from the urinary system. Water is best. Most healthy people should try to drink six to eight, 8-ounce glasses of liquid each day. If you need to drink less water because of other health conditions, such as bladder control problems, kidney failure or heart disease, ask your health care provider how much liquid is healthy for you.
• Wipe from front to back after using the toilet – Women should wipe from front to back to keep bacteria from getting into the urethra. This step is most important after a bowel movement.
• Urinate often and when the urge arises – Try to urinate at least every 3 to 4 hours. Bacteria are more likely to grow in the bladder when urine stays in the bladder too long.
• Urinate after sex – Both women and men should urinate shortly after sex to flush away bacteria that may have entered the urethra during sex.

Source: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults

Kidney stones (Nephrolithiasis)

Kidney stones are hard, pebble-like pieces of material that form in one or both of your kidneys when high levels of certain minerals are in your urine. Kidney stones rarely cause permanent damage if treated by a health care professional.

Kidney stones vary in size and shape. They may be as small as a grain of sand or as large as a pea. Rarely, some kidney stones are as big as golf balls. Kidney stones may be smooth or jagged and are usually yellow or brown.

A small kidney stone may pass through your urinary tract on its own, causing little or no pain. A larger kidney stone may get stuck along the way. A kidney stone that gets stuck can block your flow of urine, causing severe pain or bleeding. Learn more about your urinary tract and how it works.

If you have symptoms of kidney stones, including severe pain or bleeding, seek care right away. A doctor, such as a urologist, can treat any pain and prevent further problems, such as a urinary tract infection (UTI).

Types of Kidney Stones

You probably have one of four main types of kidney stones. Treatment for kidney stones usually depends on their size, location, and what they are made of.

• Calcium stones – Calcium stones, including calcium oxalate stones and calcium phosphate stones, are the most common types of kidney stones. Calcium oxalate stones are more common than calcium phosphate stones. Calcium from food does not increase your chance of having calcium oxalate stones. Normally, extra calcium that isn’t used by your bones and muscles goes to your kidneys and is flushed out with urine. When this doesn’t happen, the calcium stays in the kidneys and joins with other waste products to form a kidney stone.
• Uric acid stones – A uric acid stone may form when your urine contains too much acid. Eating a lot of fish, shellfish, and meat—especially organ meat—may increase uric acid in urine.
• Struvite stones – Struvite stones may form after you have a UTI. They can develop suddenly and become large quickly.
• Cystine stones – Cystine stones result from a disorder called cystinuria that is passed down through families. Cystinuria causes the amino acid cystine to leak through your kidneys and into the urine.

How common are kidney stones?

Kidney stones are common and are on the rise. About 11 percent of men and 6 percent of women in the United States have kidney stones at least once during their lifetime.1

Risks

Men are more likely to develop kidney stones than women. If you have a family history of kidney stones, you are more likely to develop them. You are also more likely to develop kidney stones again if you’ve had them once. You may also be more likely to develop a kidney stone if you don’t drink enough liquids.

People with certain conditions

You are more likely to develop kidney stones if you have certain conditions, including

• a blockage of the urinary tract
• chronic, or long-lasting, inflammation of the bowel
• cystic kidney diseases, which are disorders that cause fluid-filled sacs to form on the kidneys
• cystinuria
• digestive problems or a history of gastrointestinal tract surgery
• gout, a disorder that causes painful swelling of the joints
• hypercalciuria, a condition that runs in families in which urine contains unusually large amounts of calcium; this is the most common condition found in people who form calcium stones
• hyperoxaluria, a condition in which urine contains unusually large amounts of oxalate
• hyperparathyroidism, a condition in which the parathyroid glands release too much parathyroid hormone, causing extra calcium in the blood
• hyperuricosuria, a disorder in which too much uric acid is in the urine
• obesity
• repeated, or recurrent, UTIs
• renal tubular acidosis, a disease that occurs when the kidneys fail to remove acids into the urine, which causes a person’s blood to remain too acidic

People who take certain medicines

You are more likely to develop kidney stones if you are taking one or more of the following medicines over a long period of time:

• diuretics, often called water pills, which help rid your body of water calcium-based antacids
• indinavir, a protease inhibitor used to treat HIV infection
• topiramate, an anti-seizure medication

Complications

Complications of kidney stones are rare if you seek treatment from a health care professional before problems occur.

If kidney stones are not treated, they can cause

• hematuria, or blood in the urine
• severe pain
• UTIs, including kidney infections
• loss of kidney function

Symptoms

Symptoms of kidney stones include

• sharp pains in your back, side, lower abdomen, or groin
• pink, red, or brown blood in your urine, also called hematuria a constant need to urinate
pain while urinating
inability to urinate or can only urinate a small amount
• cloudy or bad-smelling urine

See a health care professional right away if you have any of these symptoms. These symptoms may mean you have a kidney stone or a more serious condition.

Your pain may last for a short or long time or may come and go in waves. Along with pain, you may have

• nausea
• vomiting

Other symptoms include

• fever
• chills

Causes

Kidney stones are caused by high levels of calcium, oxalate, and phosphorus in the urine.

These minerals are normally found in urine and do not cause problems at low levels.

Certain foods may increase the chances of having a kidney stone in people who are more likely to develop them.

Diagnosis

Health care professionals use your medical history, a physical exam, and lab and imaging tests to diagnose kidney stones.

A health care professional will ask if you have a history of health conditions that make you more likely to develop kidney stones. The health care professional also may ask if you have a family history of kidney stones and about what you typically eat. During a physical exam, the health care professional usually examines your body. The health care professional will ask you about your symptoms.

Lab tests

Urine tests can show whether your urine contains high levels of minerals that form kidney stones. Urine and blood tests can also help a health care professional find out what type of kidney stones you have.

• Urinalysis involves a health care professional testing your urine sample. You will collect a urine sample at a doctor’s office or at a lab, and a health care professional will test the sample. Urinalysis can show whether your urine has blood in it and minerals that can form kidney stones. White blood cells and bacteria in the urine mean you may have a urinary tract infection.
• Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test. The blood test can show if you have high levels of certain minerals in your blood that can lead to kidney stones.

Imaging tests

Health care professionals use imaging tests to find kidney stones. The tests may also show problems that caused a kidney stone to form, such as a blockage in the urinary tract or a birth defect. You do not need anesthesia for these imaging tests.

• Abdominal x-ray. An abdominal x-ray is a picture of the abdomen that uses low levels of radiation and is recorded on film or on a computer. An x-ray technician takes an abdominal x-ray at a hospital or outpatient center, and a radiologist reads the images. During an abdominal x-ray, you will lie on a table or stand up. The x-ray technician will position the x-ray machine over or in front of your abdomen and ask you to hold your breath, so the picture won’t be blurry. The x-ray technician then may ask you to change position for additional pictures. Abdominal x-rays can show the location of kidney stones in the urinary tract. Not all stones are visible on abdominal x-ray.
• Computed tomography (CT) scans. CT scans use a combination of x-rays and computer technology to create images of your urinary tract. Although a CT scan without contrast medium is most commonly used to view your urinary tract, a health care professional may give you an injection of contrast medium. Contrast medium is a dye or other substance that makes structures inside your body easier to see during imaging tests. You’ll lie on a table that slides into a tunnel-shaped device that takes the x-rays. CT scans can show the size and location of a kidney stone, if the stone is blocking the urinary tract, and conditions that may have caused the kidney stone to form.

Treatment

Health care professionals usually treat kidney stones based on their size, location, and what type they are.

Small kidney stones may pass through your urinary tract without treatment. If you’re able to pass a kidney stone, a health care professional may ask you to catch the kidney stone in a special container. A health care professional will send the kidney stone to a lab to find out what type it is. A health care professional may advise you to drink plenty of liquids if you are able to help move a kidney stone along. The health care professional also may prescribe pain medicine.

Larger kidney stones or kidney stones that block your urinary tract or cause great pain may need urgent treatment. If you are vomiting and dehydrated, you may need to go to the hospital and get fluids through an IV.

Kidney stone removal

A urologist can remove the kidney stone or break it into small pieces with the following

treatments:

• Shock wave lithotripsy. The doctor can use shock wave lithotripsy to blast the kidney stone into small pieces. The smaller pieces of the kidney stone then pass through your urinary tract. A doctor can give you anesthesia during this outpatient procedure.
• Cystoscopy and ureteroscopy. During cystoscopy, the doctor uses a cystoscope to look inside the urethra and bladder to find a stone in your urethra or bladder. During ureteroscopy, the doctor uses a ureteroscope, which is longer and thinner than a cystoscope, to see detailed images of the lining of the ureters and kidneys. The doctor inserts the cystoscope or ureteroscope through the urethra to see the rest of the urinary tract. Once the stone is found, the doctor can remove it or break it into smaller pieces. The doctor performs these procedures in the hospital with anesthesia. You can typically go home the same day.
• Percutaneous nephrolithotomy. The doctor uses a thin viewing tool, called a nephroscope, to locate and remove the kidney stone. The doctor inserts the tool directly into your kidney through a small cut made in your back. For larger kidney stones, the doctor also may use a laser to break the kidney stones into smaller pieces. The doctor performs percutaneous nephrolithotomy in a hospital with anesthesia. You may have to stay in the hospital for several days after the procedure.

After these procedures, sometimes the urologist may leave a thin flexible tube, called a ureteral stent, in your urinary tract to help urine flow or a stone to pass. Once the kidney stone is removed, your doctor sends the kidney stone or its pieces to a lab to find out what type it is.

The health care professional also may ask you to collect your urine for 24 hours after the kidney stone has passed or been removed. The health care professional can then measure how much urine you produce in a day, along with mineral levels in your urine. You are more likely to form stones if you don’t make enough urine each day or have a problem with high mineral levels.

Prevention

To help prevent future kidney stones, you also need to know what caused your previous kidney stones. Once you know what type of kidney stone you had, a health care professional can help you make changes to your eating, diet, and nutrition to prevent future kidney stones.

• Drinking liquids – In most cases, drinking enough liquids each day is the best way to help prevent most types of kidney stones. Drinking enough liquids keeps your urine diluted and helps flush away minerals that might form stones. Though water is best, other liquids such as citrus drinks may also help prevent kidney stones. Some studies show that citrus drinks, such as lemonade and orange juice, protect against kidney stones because they contain citrate, which stops crystals from turning into stones. Unless you have kidney failure, you should drink six to eight, 8-ounce glasses a day. If you previously had cystine stones, you may need to drink even more. Talk with a health care professional if you can’t drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure. The amount of liquid you need to drink depends on the weather and your activity level. If you live, work, or exercise in hot weather, you may need more liquid to replace the fluid you lose through sweat. A health care professional may ask you to collect your urine for 24 hours to determine the amount of urine you produce a day. If the amount of urine is too low, the health care professional may advise you to increase your liquid intake.
• Medicines – If you have had a kidney stone, a health care professional also may prescribe medicines to prevent future kidney stones. Depending on the type of kidney stone you had and what type of medicine the health care professional prescribes, you may have to take the medicine for a few weeks, several months, or longer. For example, if you had struvite stones, you may have to take an oral antibiotic for 1 to 6 weeks, or possibly longer. If you had another type of stone, you may have to take a potassium citrate tablet 1 to 3 times daily. You may have to take potassium citrate for months or even longer until a health care professional says you are no longer at risk for kidney stones. Talk with a health care professional about your health history prior to taking kidney stone medicines. Some kidney stone medicines have minor to serious side eff Side effects are more likely to occur the longer you take the medicine and the higher the dose. Tell the health care professional about any side effects that occur when you take kidney stone medicine.
• Hyperparathyroidism surgery – People with hyperparathyroidism, a condition that results in too much calcium in the blood, sometimes develop calcium stones. Treatment for hyperparathyroidism may include surgery to remove the abnormal parathyroid gland. Removing the parathyroid gland cures hyperparathyroidism and can prevent kidney stones. Surgery sometimes causes complications, including infection.

Source: https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones

Medullary Sponge Kidney (Nephrocalcinosis)

Medullary sponge kidney, also known as Cacchi-Ricci disease, is a birth defect where changes occur in the tubules, or tiny tubes, inside a fetus’ kidneys.

In a normal kidney, urine flows through these tubules as the kidney is being formed during a fetus’ growth. In medullary sponge kidney, tiny, fluid-filled sacs called cysts form in the tubules within the medulla—the inner part of the kidney—creating a sponge like appearance. The cysts keep urine from owing freely through the tubules.

Symptoms of medullary sponge kidney do not usually appear until the teenage years or the 20s. Medullary sponge kidney can affect one or both kidneys.

Complications

Complications of medullary sponge kidney include:

• hematuria, or blood in the urine
• kidney stones
• urinary tract infections (UTIs)

Medullary sponge kidney rarely leads to more serious problems, such as chronic kidney disease or kidney failure. 
 

Causes

Scientists do not fully understand the cause of medullary sponge kidney or why cysts form in the tubules during fetal development. Even though medullary sponge kidney is present at birth, most cases do not appear to be inherited. Medullary sponge kidney affects about one person per 5,000 people in the United States. Researchers have reported that 12 to 20 percent of people who develop calcium-based kidney stones have medullary sponge kidney.1

Risks

Medullary sponge kidney affects all races and geographic regions. Among people who are more likely to develop calcium-based kidney stones, women are more likely than men to have medullary sponge kidney.2

Symptoms

Many people with medullary sponge kidney have no symptoms. The first sign that a person has medullary sponge kidney is usually a UTI or a kidney stone. UTIs and kidney stones share many of the same signs and symptoms:

• burning or painful urination
• pain in the back, lower abdomen, or groin
• cloudy, dark, or bloody urine
• foul-smelling urine
• fever and chills
• vomiting

People who experience these symptoms should see or call a health care provider as soon as possible.

Diagnosis

Medical and Family History -
Taking a medical and family history can help diagnose medullary sponge kidney. A health care provider will suspect medullary sponge kidney when a person has repeated UTIs or kidney stones.

Physical Exam – No physical signs are usually present in a patient with medullary sponge kidney, except for blood in the urine. Health care providers usually confirm a diagnosis of medullary sponge kidney with imaging studies.

Imaging Studies – Imaging is the medical term for tests that use different methods to see bones, tissues, and organs inside the body. Health care providers commonly choose one or more of three imaging techniques to diagnose medullary sponge kidney:

• intravenous pyelogram
• computerized tomography (CT) scan
• ultrasound

A radiologist—a doctor who specializes in medical imaging—interprets the images from these studies, and patients do not need anesthesia.

• Intravenous Pyelogram – In an intravenous pyelogram, a health care provider injects a special dye, called contrast medium, into a vein in the patient’s arm.
The contrast medium travels through the body to the kidneys. The kidneys excrete the contrast medium into urine, which makes the urine visible on an x ray. An x-ray technician performs this procedure at a health care provider’s office, an outpatient center, or 
a hospital. An intravenous pyelogram can show any blockage in the urinary tract, and the cysts show up as clusters of light.
• Computerized Tomography Scans – Computerized tomography scans use
a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the x rays are taken. An x-ray technician performs the procedure in an outpatient center or a hospital. CT scans can show expanded or stretched tubules.
• Ultrasound – Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital. Ultrasound can show kidney stones and calcium deposits within the kidney.

Treatment

Scientists have not discovered a way to reverse medullary sponge kidney. Once a health care provider is sure a person has medullary sponge kidney, treatment focuses on

Curing an Existing Urinary Tract Infection – To treat a UTI, the health care provider may prescribe a medication called an antibiotic that kills bacteria. The choice of medication and length of treatment depend on the person’s medical history and the type of bacteria causing the infection. Read more in Urinary Tract Infections in Adults at www.urologic.niddk.nih.gov.

Removing Kidney Stones – Treatment for kidney stones usually depends on their size and what they are made of,
as well as whether they are causing pain or obstructing the urinary tract. Kidney stones may be treated by a general practitioner or by a urologist—a doctor who specializes in the urinary tract. 
Small stones usually pass through the urinary tract without treatment. Still, the person may need pain medication and should drink lots of liquids to help move the stone along. Pain control may consist of oral or intravenous (IV) medication, depending on the duration and severity of the pain. People may need 
IV fluids if they become dehydrated from vomiting or an inability to drink. 
A person with a larger stone, or one that blocks urine ow and causes great pain, may need more urgent treatment, such as:

• shock wave lithotripsy. A machine called a lithotripter is used to break up the kidney stone into smaller pieces to pass more easily through the urinary tract. The patient may need local or general anesthesia.
• A ureteroscope—a long, tube like instrument with an eyepiece— is used to and retrieve the stone with a small basket or to break the stone up with laser energy. Local or general anesthesia may be required.
• percutaneous nephrolithotomy. In this procedure, a wire-thin viewing instrument, called a nephroscope, is used to locate and remove the stones. During the procedure, which requires general anesthesia, a tube is inserted directly into the kidney through a small incision in the patient’s back.

Read more in Kidney Stones in Adults at www.kidney.niddk.nih.gov.

Prevention

Scientists have not yet found a way to prevent medullary sponge kidney. However, health care providers can recommend medications and dietary changes to prevent future UTIs and kidney stones.

Medications to Prevent Future Urinary Tract Infections and Kidney Stones

Health care providers may prescribe certain medications to prevent UTIs and kidney stones:

• A person with medullary sponge kidney may need to continue taking a low- dose antibiotic to prevent recurrent infections.
• Medications that reduce calcium in the urine may help prevent calcium kidney stones. These medications may include
• potassium citrate
• thiazide

Eating, Diet, and Nutrition

The following changes in diet may help prevent UTIs and kidney stone formation:

• Drinking plenty of water and other liquids can help push bacteria from the urinary tract and dilute urine so kidney stones cannot form. A person should drink enough liquid to produce about 2 to 2.5 quarts of urine every day.3
• Reducing sodium intake, mostly from salt, may help prevent kidney stones. Diets high in sodium can increase the excretion of calcium into the urine and thus increase the chance of calcium- containing kidney stones forming.
• Foods rich in animal proteins such as meat, eggs, and shellfish can increase the chance of uric acid stones and calcium stones forming. People who form stones should limit their meat consumption to 6 to 8 ounces a day.4
• People who are more likely to develop calcium oxalate stones should include 1,000 milligrams of calcium in their diet every day. Adults older than 50 years should consume 1,200 milligrams of calcium daily.3 Calcium in the digestive tract binds to oxalate from food and keeps it from entering the blood and the urinary tract, where it can form stones.

People with medullary sponge kidney should talk with their health care provider or a dietitian before making any dietary changes. A dietitian can help a person plan healthy meals.

Source: https://www.niddk.nih.gov/health-information/kidney-disease/children/medullary-sponge-kidney

Acute Interstitial Nephritis / Chronic Interstitial Nephritis

Acute interstitial nephritis is the temporary swelling of the area between the tubules of the kidney. Chronic interstitial nephritis is long-term swelling of the areas.

This can be caused by

• A reaction or side effects of certain medications
• Side effects of antibiotics
• Prolonged use of pain relievers such as aspirin, acetaminophen, and NSAIDS
• Infections
• Over-abundance of uric acid or calcium in the blood
• Insufficient potassium in the blood

Vesicoureteral Reflux and Reflux Nephropathy

Vesicoureteral Reflux is a common condition in children where urine backs up to the kidneys. Most of the time the child will not need any treatment, but should be monitored. In some instances where the reflux is worse, treatment is needed.

VUR can cause urinary tract infections, kidney infection, and bladder problems.

In instances where patients with VUR develop kidney infections, reflux nephropathy may be developed as well. Reflux nephropathy is scarring on one or both of the kidneys. This condition cannot be treated.

Reflux nephropathy can cause high blood pressure and protein in the urine.

Renal failure is any acute or chronic loss
of kidney function and is the term used when some kidney function remains. Total kidney failure, sometimes called end-stage renal disease (ESRD), indicates permanent loss of kidney function. Depending on the form of glomerular disease, renal function may be lost in a matter of days or weeks or may deteriorate slowly and gradually over the course of decades.

Acute Renal Failure

A few forms of glomerular disease cause very rapid deterioration of kidney function. For example, PSGN can cause severe symptoms (hematuria, proteinuria, edema) within 2 to 3 weeks after a sore throat or skin infection develops. The patient may temporarily require dialysis to replace
renal function. This rapid loss of kidney function is called acute renal failure (ARF). Although ARF can be life-threatening while it lasts, kidney function usually returns after the cause of the kidney failure has been treated. In many patients, ARF is not associated with any permanent damage. However, some patients may recover from ARF and subsequently develop CKD.

Chronic Kidney Disease

Most forms of glomerular disease develop gradually, often causing no symptoms for many years. CKD is the slow, gradual loss of kidney function. Some forms of CKD can be controlled or slowed down. For example, diabetic nephropathy can be delayed by tightly controlling blood glucose levels and using ACE inhibitors and ARBs to reduce proteinuria and control blood pressure. But CKD cannot be cured. Partial loss of renal function means that some portion of the patient’s nephrons have been scarred, and scarred nephrons cannot be repaired. In many cases, CKD leads to total kidney failure.

Total Kidney Failure

To stay alive, a patient with total kidney failure must go on dialysis—hemodialysis or peritoneal dialysis—or receive a new kidney through transplantation. Patients with CKD who are approaching total kidney failure should learn as much about their treatment options as possible, so they can make an informed decision when the time comes. With the help of dialysis or transplantation, many people continue to lead full, productive lives after reaching total kidney failure.

Source: https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd

Kidney stones vary in size and shape. A small kidney stone may pass through your urinary tract on its own, causing little or no pain. A larger kidney stone may get stuck along the way. A kidney stone that gets stuck can block your flow of urine, causing severe pain or bleeding. Here are three different kidney stone removal methods.

• Shock wave lithotripsy blasts the kidney stone into small pieces. The smaller pieces of the kidney stone then pass through your urinary tract. A doctor can give you anesthesia during this outpatient procedure.
• Cystoscopy and ureteroscopy. During cystoscopy, the doctor uses a cystoscope to look inside the urethra and bladder to find a stone in your urethra or bladder. During ureteroscopy, the doctor uses a ureteroscope, which is longer and thinner than a cystoscope, to see detailed images of the lining of the ureters and kidneys. The doctor inserts the cystoscope or ureteroscope through the urethra to see the rest of the urinary tract. Once the stone is found, the doctor can remove it or break it into smaller pieces. The doctor performs these procedures in the hospital with anesthesia. You can typically go home the same day.
• Percutaneous nephrolithotomy is a procedure in which the doctor uses a thin viewing tool, called a nephroscope, to locate and remove the kidney stone. The doctor inserts the tool directly into your kidney through a small cut made in your back. For larger kidney stones, the doctor also may use a laser to break the kidney stones into smaller pieces. The doctor performs percutaneous nephrolithotomy in a hospital with anesthesia. You may have to stay in the hospital for several days after the procedure.

Hemodialysis is a treatment for kidney failure that uses a machine to filter your blood outside your body. At the start of a hemodialysis treatment, a dialysis nurse places two needles into your arm. A pump on the hemodialysis machine draws your blood through one of the needles into a tube, a few ounces at a time. Your blood travels through the tube to the filter, called a dialyzer. Inside the dialyzer, your blood flows through thin fibers that filter out wastes, extra salt, and extra fluid. After the dialyzer filters your blood, a different tube carries your blood back to your body through the second needle.

Staff-Assisted Home Dialysis

Many people choose to have dialysis at home, which can be much more convenient. We recommend Liberty Home Dialysis who will provide a nurse who will come to you and deliver treatment in the privacy and comfort of your own home, at a time that works for you. We recognize that it’s not convenient for everyone to come to a dialysis facility three times per week. Liberty Home Dialysis works to remove all barriers to receiving dialysis by bringing the treatment to you.

In-Clinic

We have several dialysis clinic locations around the Dallas-Fort Worth area. Each and every facility we partner with is state-of-the-art and staffed with caring, licensed renal nurses.

Preparing for Dialysis

Preparations for hemodialysis should be made at least several weeks in advance. You will need to have a procedure to create an “access” several weeks or months before treatment begins, as it needs time to heal or “mature.” The Dallas Renal Group works with the Dallas Vascular Center, a state of the art, Joint Commission Gold Seal-Approved facility.

Vascular access creates a way for blood to be removed from the body, circulate through the dialysis machine, and then return to the body at a rate that is higher than can be achieved through a normal vein. There are three major types of access. Your kidney doctor will recommend which option is best for you.

• Primary AV Fistula: This is the preferred type of vascular access. It requires a surgical procedure that creates a direct connection between an artery and a vein. This is often done in the lower arm but can be done in the upper arm as well. A primary AV fistula is usually created two to four months before it will be used for dialysis. During this time, the area can heal and fully develop.
• Synthetic AV Bridge Graft: The graft sits under the skin and is used in much the same way as the fistula, except that the needles used for hemodialysis are placed into the graft material rather than the patient’s own vein. Grafts heal more quickly than fistulas and can often be used about two weeks after they are created. However, complications such as narrowing of the blood vessels and infection are more common with grafts than with AV fistulas.
• Central Venous Catheter: This method uses a thin flexible tube that is placed into a large vein, usually in the neck. Catheters have the highest risk of infection and the poorest function compared to other access types. They should be used only if a primary AV fistula or synthetic bridge graft cannot be maintained.

PERITONEAL DIALYSIS

Peritoneal dialysis is an alternative to hemodialysis that utilizes the membrane that lines the peritoneal cavity within your abdomen. With this method, you will have a catheter placed in your abdominal cavity which is used to fill your abdomen with dialysis solution. Once the dialysis solution fills your abdominal cavity, the membrane lining, called the peritoneum, allows wastes and excess fluid to pass from your blood into the dialysis solution. The wastes and excess fluid then leaves your body when the dialysis solution is drained.

There are two methods of peritoneal dialysis. One can be done manually, in a method called Continuous Ambulatory Peritoneal Dialysis (CAPD). The other uses a machine while you sleep, called Continuous Cycling Peritoneal Dialysis (CCPD). Both methods are done 7 days per week, and are performed by the patient following a several week training program. This peritoneal dialysis has comparable risks and benefits. Your kidney doctor will review the treatment options with you to determine the best solution.

Transplantation is the only treatment for chronic kidney disease and end-stage renal failure. Since kidney function cannot be restored, people with the disease must maintain their health through dialysis treatments. That’s why we encourage our patients who qualify to join the transplant waiting list. Some of our patients who have received a transplant were only on the waiting list for a matter of months. While that varies from patient to patient, we see great success in transplantation. Our physicians and care team have excellent resources for those who are interested in and qualify for a kidney transplant. Learn more about transplantation here.

https://www.kidney.org/transplantation

https://www.unos.org