Polycystic Kidney Disease Basics,Symptoms and Complications

Polycystic kidney disease (PKD) is a genetic disorder characterized by the growth of numerous cysts in the kidneys. The kidneys are two organs, each about the size of a fist, located in the upper part of a person's abdomen, toward the back. The kidneys filter wastes and extra fluid from the blood to form urine. They also regulate amounts of certain vital substances in the body. When cysts form in the kidneys, they are filled with fluid. PKD cysts can profoundly enlarge the kidneys while replacing much of the normal structure, resulting in reduced kidney function and leading to kidney failure.

When PKD causes kidneys to fail-which usually happens after many years-the patient requires dialysis or kidney transplantation. About one-half of people with the most common type of PKD progress to kidney failure, also called end-stage renal disease (ESRD).

PKD can also cause cysts in the liver and problems in other organs, such as blood vessels in the brain and heart. The number of cysts as well as the complications they cause help doctors distinguish PKD from the usually harmless "simple" cysts that often form in the kidneys in later years of life.

Two major inherited forms of PKD exist:

Autosomal dominant PKD is the most common inherited form. Symptoms usually develop between the ages of 30 and 40, but they can begin earlier, even in childhood. About 90 percent of all PKD cases are autosomal dominant PKD.

Autosomal recessive PKD is a rare inherited form. Symptoms of autosomal recessive PKD begin in the earliest months of life, even in the womb.

Polycystic kidney disease symptoms may include:

• High blood pressure
• Back or side pain
• Headache
• Increase in the size of your abdomen
• Blood in your urine
• Frequent urination
• Kidney stones
• Kidney failure

There are numerous complications associated with polycystic kidney disease including:

High blood pressure. Elevated blood pressure is a common complication of polycystic kidney disease. Untreated, high blood pressure can cause further damage to your kidneys and increase your risk of heart disease and stroke.
Loss of kidney function.

Progressive loss of kidney function is one of the most serious complications of polycystic kidney disease. Nearly half of those with the disease have kidney failure by age 60. If you have high blood pressure or blood or protein in your urine, you have a greater risk of kidney failure.

Pregnancy complications. Pregnancy is successful for most women with polycystic kidney disease. In some cases, however, women may develop a life-threatening disorder called preeclampsia. Those most at risk are women who have high blood pressure before they become pregnant.

Growth of cysts in the liver. The likelihood of developing liver cysts for someone with polycystic kidney disease increases with age. While both men and women develop cysts, women often develop larger cysts. Cyst growth may be aided by female hormones.

Development of an aneurysm in the brain. Localized enlargement of an artery in your brain can cause bleeding (hemorrhage) if it ruptures. People with polycystic kidney disease have a higher risk of aneurysm, especially those younger than age 50. The risk is higher if you have a family history of aneurysm or if you have uncontrolled high blood pressure.

Heart valve abnormalities. As many as one-quarter of adults with polycystic kidney disease develop mitral valve prolapse. When this happens, the valve no longer closes properly, which allows blood to leak backward.

Colon problems. Weaknesses and pouches or sacs in the wall of the colon (diverticulosis) may develop in people with polycystic kidney disease.

Chronic pain. Pain is a common symptom for people with polycystic kidney disease. It often occurs in your side or back. The pain can also be associated with a urinary tract infection or a kidney stone.

Informations of Uremia

What is uremia?

Uremia is a state in which the blood urea nitrogen level, an indicator of nitrogen waste products, is elevated. In uremia, the kidneys’ failure to filter nitrogen waste properly leads to excessively high levels of nitrogen wastes in the bloodstream. Uremia is life-threatening because too much nitrogen in the blood is toxic to the body. Symptoms of uremia include confusion, loss of consciousness, low urine production, dry mouth, fatigue, weakness, pale skin or pallor, rapid heart rate (tachycardia), edema (swelling), and excessive thirst. Uremia may also be painful.

Uremia is reversible if treated quickly; however, permanent damage to the kidneys may occur. Kidney failure may also result from the underlying processes that cause uremia.

Treatment for uremia frequently requires hospitalization. It begins with treating the cause of the kidney injury so that nitrogen waste will not continue to build up in the blood. Treatment may require dialysis, which filters the waste out of the blood. Fluid therapy, blood transfusions, and blood pressure medications may also be administered. Ongoing treatment after the acute symptoms of uremia have been addressed may include medication, dialysis, or dietary modification.
General symptoms of uremia

Some of the symptoms of uremia may be generalized. These are serious symptoms, and when present with other symptoms of uremia, should be evaluated in a medical setting.

General symptoms of uremia include:

• Abdominal pain
• Confusion or loss of consciousness for even a brief moment
• Dry mouth and nose
• Edema (swelling)
• Excessive thirst
• Fatigue
• Low blood pressure (hypotension)
• Pale skin or pallor
• Rapid heart rate (tachycardia)
• Weakness (loss of strength)

In some cases, uremia can be life threatening. if you, or someone you are with,
have any of these life-threatening symptoms including:

• Confusion or loss of consciousness for even a brief moment
• Low urine output
• Renal causes of uremia
• Uremia may arise from any condition that damages the kidney including:
• Certain medications, such as high doses of nonsteroidal anti-inflammatory drugs (NSAIDs) or intravenous contrast material
• Injury to the kidney
• Kidney damage from hypertension or diabetes
• Kidney disease (includes any type of kidney problem, such as kidney stones, kidney failure and kidney anomalies)
• Renal artery embolism or occlusion (blockage of blood flow to the kidney)
• Surgery

Other causes of uremia

Uremia may also arise from a number of other conditions that cause low blood volume or decreased blood flow including:

• Burns
• Congestive heart failure (deterioration of the heart’s ability to pump blood)
• Dehydration (loss of body fluids and electrolytes, which can be life threatening when severe and untreated)
• Excessive bleeding
• Excessive diarrhea
• Excessive vomiting
• Shock

What are the risk factors for uremia?

• A number of factors increase the risk of developing uremia. Not all people with risk factors will get uremia. Risk factors include:
• Low blood pressure (hypotension)
• Recent infection
• Recent injury
• Recent surgery
• Taking certain medications, such as nonsteroidal anti-inflammatory drugs or intravenous contrast material

Chronic Kidney Disease (CKD)

Chronic Kidney Disease (CKD) means lasting damage to the kidneys that can get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). If your kidneys fail, you will need dialysis or a kidney transplant in order to live.

The stages of chronic kidney disease, as follows:

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2)

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2)

Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)

Stage 5: Kidney failure (GFR < 15 mL/min/1.73 m2 or dialysis)

In stage 1 and stage 2 chronic kidney disease, GFR alone does not clinch the diagnosis. Other markers of kidney damage, including abnormalities in the composition of blood or urine or abnormalities on imaging studies, should also be present in establishing a diagnosis of stage 1 and stage 2 chronic kidney disease.

Patients with chronic kidney disease stages 1-3 are generally asymptomatic; clinically manifestations typically appear in stages 4-5 (see Clinical). Early diagnosis and treatment of the underlying cause and/or institution of secondary preventive measures is imperative in patients with chronic kidney disease. These may delay, or possibly halt, progression.

What is acute renal failure?

Acute renal failure (also called acute kidney injury) means that your kidneys
have suddenly stopped working. Your kidneys remove waste products and help balance water and salt and other minerals (electrolytes) in your blood. When your kidneys stop working, waste products, fluids, and electrolytes build up in your body. This can cause problems that can be deadly.

What causes acute renal failure?

Acute renal failure has three main causes:

A sudden, serious drop in blood flow to the kidneys. Heavy blood loss, an injury, or a bad infection called sepsis can reduce blood flow to the kidneys. Not enough fluid in the body (dehydration) also can harm the kidneys.

Damage from some medicines, poisons, or infections. Most people don't have any kidney problems from taking medicines. But people who have serious, long-term health problems are more likely than other people to have a kidney problem from medicines. Examples of medicines that can sometimes harm the kidneys include:
Antibiotics, such as gentamicin and streptomycin.

Pain medicines, such as aspirin and ibuprofen.

Some blood pressure medicines, such as ACE inhibitors.

The dyes used in some X-ray tests.

A sudden blockage that stops urine from flowing out of the kidneys.Kidney stones, a tumor, an injury, or an enlarged prostate gland can cause a blockage.
You have a greater chance of getting acute renal failure if:

You are an older adult.

You have a long-term health problem such as kidney or liver disease, diabetes,high blood pressure, heart failure, or obesity.

You are already very ill and are in the hospital or intensive care (ICU). Heart or belly surgery or a bone marrow transplant can make you more likely to havekidney failure.

Acute Renal Failure Symptoms

Symptoms of acute renal failure may include:

Little or no urine when you urinate.

Swelling, especially in your legs and feet.

Not feeling like eating.

Nausea and vomiting.

Feeling confused, anxious and restless, or sleepy.

Pain in the back just below the rib cage. This is called flank pain.

Some people may not have any symptoms. And for people who are already quite ill, the problem that's causing the kidney failure may be causing other symptoms.

Basic Knowledge of End-stage Renal Disease

ESRD is when the kidneys stop working well enough for you to live without dialysis or a transplant. This kind of kidney failure is permanent. It cannot be fixed. Most cases of ESRD are caused by diabetes or high blood pressure. Some problems you are born with, some reactions to medicines, and some injuries can also cause ESRD. If you have ESRD, you will need dialysis or a kidney transplant to live.

Symptoms of ESRD

General ill feeling and fatigue

• Generalized itching (pruritus) and dry skin
• Headaches
• Weight loss without trying
• Loss of appetite
• Nausea

Other symptoms may develop, including:

• Abnormally dark or light skin and changes in nails
• Bone pain
• Brain and nervous system symptoms
• Drowsiness and confusion
• Problems concentrating or thinking
• Numbness in the hands, feet, or other areas
• Muscle twitching or cramps
• Breath odor
• Easy bruising, nosebleeds, or blood in the stool
• Excessive thirst
• Frequent hiccups
• Low level of sexual interest and impotence
• Menstrual periods stop (amenorrhea)
• Sleep problems, such as insomnia, restless leg syndrome, orobstructive sleep apnea
• Swelling of the feet and hands (edema)
• Vomiting, especially in the morning

Prevention of ESRD

The best way to prevent ESRD is to prevent CKD. Diabetes and high blood pressure are the two leading causes of CKD. You can help to protect your kidneys by keeping these in control. Get your blood sugar and blood pressure checked often.
You an also help protect your kidneys with other healthy habits. You should:
Have regular check-ups with your doctor

• Eat a low-fat, low-salt diet
• Exercise most days of the week
• Avoid tobacco
• Drink alcohol only in moderation

Also, take medicines the way your doctor tells you. Talk to your doctor before you start any new medicine or supplement.

Possible Complications

• Anemia
• Bleeding from the stomach or intestines
• Bone, joint, and muscle pain
• Brain dysfunction, confusion, and dementia
• Changes in electrolyte levels
• Changes in blood sugar (glucose)
• Damage to nerves of the legs and arms
• Fluid buildup around the lungs
• Heart and blood vessel complications
• Congestive heart failure
• Coronary artery disease
• High blood pressure
• Pericarditis
• Stroke
• Hepatitis B, hepatitis C, liver failure
• Hyperparathyroidism
• Increased risk of infections
• Malnutrition
• Phosphorous levels become too high
• Potassium levels become too high
• Seizures
• Skin dryness, itching/scratching, leading to skin infection
• Weakening of the bones, fractures, joint disorders

A Brief Overview Kidney Failure

Healthy kidneys clean your blood by removing excess fluid, minerals and wastes. They also make hormones that keep your bones strong and your blood healthy. But if the kidneys are damaged, they don't work properly. Harmful wastes can build up in your body. Your blood pressure may rise. Your body may retain excess fluid and not make enough red blood cells. This is called kidney failure.

Types of kidney failure

Renal failure can broadly be divided into two categories: acute kidney injury or chronic kidney disease. The type of renal failure is determined by the trend in the serumcreatinine.

Causes of kidney failure

Kidney failure can occur from an acute situation or from chronic problems.
In acute renal failure, kidney function is lost rapidly and can occur from a variety of insults to the body. The list of causes is often categorized based on where the injury has occurred.

Prerenal causes (pre=before + renal=kidney) causes are due to decreased blood supply to the kidney. Examples ofprerenal causes of kidney failure are:
hypovolemia (low blood volume) due to blood loss;

dehydration from loss of body fluid (for example, vomiting, diarrhea, sweating,fever);

poor intake of fluids;

medication, for example, diuretics ("water pills") may cause excessive water loss;

and abnormal blood flow to and from the kidney due to obstruction of the renal artery or vein.

Symptoms of kidney failure include:

High levels of urea in the blood, which can result in:

Vomiting and/or diarrhea, which may lead to dehydration

Nausea

Weight loss

Nocturnal urination

Foamy or bubbly urine

More frequent urination, or in greater amounts than usual, with pale urine

Less frequent urination, or in smaller amounts than usual, with dark coloured urine

Blood in the urine

Pressure, or difficulty urinating

A build up of phosphates in the blood that diseased kidneys cannot filter out may cause:

Itching

Bone damage

Muscle cramps (caused by low levels of calcium which can cause hypocalcaemia)

A build up of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:

Abnormal heart rhythms

Muscle paralysis

Failure of kidneys to remove excess fluid may cause:

Swelling of the legs, ankles, feet, face and/or hands

Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)

Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:

Pain in the back or side

Healthy kidneys produce the hormone erythropoietin which stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail they produce less erythropoietin resulting in fewer red blood cells being produced to replace the natural breakdown of old red blood cells. As a result the blood carries less haemoglobin, which is known as anemia. This can result in:

Feeling tired and/or weak

Memory problems

Difficulty concentrating

Dizziness

Low blood pressure

Other symptoms include:

Appetite loss, a bad taste in the mouth

Difficulty sleeping

Darkening of the skin