(A) General Kidney Conditions

What is proteinuria ?

Proteinuria is the condition where the protein leaks out from the kidney into the urine and the urine contains an abnormal amount of protein. The severity of proteinuria is determined by the extent of protein leak and this can be broadly classified into microalbuminuria, mild to heavy proteinuria and nephrotic range proteinuria. Some patients developed nephrotic syndrome as characterized by generalized body swelling (especially lower limbs), elevated blood cholesterol level and massive proteinuria. Proteinuria is not a disease by itself. However; it is an early and sensitive marker of kidney damage in many types of chronic kidney diseases. The common causes of proteinuria are diabetes, hypertension, glomerulonephritis and autoimmune diseases. Tests need to be done to quantify the amount of protein leak in the urine per day (this usually is done via a 24-hour urine collection or a random urine sample). Often, a kidney biopsy is needed to determine the type of glomerular disease. Treatment usually consist of angiotensin-converting enzymes (ACE) inhibitors or angiotensin receptor blockers (ARBs). In more serious glomerular diseases, immunosuppressive agents are required to control the conditions. (to read more...)

What is hematuria ?

“Hematuria” is the presence of red blood cells in the urine. Under normal conditions, urine would not contain any red blood cells. Microscopic hematuria refers to the presence of very small quantities of blood in the urine and this can only be detected by a dipstick test or when the urine is examined under the microscope. When blood is visible, this is called macro- or gross hematuria. The causes of hematuria are kidney stones, urinary tract infection, tumors (benign or cancerous), glomerular disease, cystic diseases and medication. Investigations normally involved urine tests (looking for red blood cells and protein, blood kidney function test and radiological tests (such as ultrasound scan or CT scan). Sometimes, cystoscopy (this involves inserting a flexible tube with a camera at the tip to examine the urinary tract) or a kidney biopsy is performed. The prognosis and treatment of this condition depend on the cause found.

What is urinary tract infection (UTI)?

UTI refers to an infection in the urinary tract and this is commonly caused by bacteria. It can be broadly classified into uncomplicated UTI and complicated UTI (occurs in person with obstruction, underlying urinary tract structural abnormalities or kidney failure). Conditions that predispose one to getting UTI include use of urinary catheter(tube), recent urinary instrumentation or surgery, obstruction of the urinary tract (such as kidney stones, uterine prolapse in elderly ladies, prostate hypertrophy or enlargement in elderly man), kidney or bladder stones, tumors, pregnancy, diabetes and vesicoureteral reflux (a developmental abnormality that resulting in backflow of urine from the bladder back into the kidney. Patients with UTI may experience pain and increase in frequency in passing urine, hematuria, fever, foul smelling and cloudy urine and lower back pain. Management involves the use of antibiotics and determining any underlying causes of those with recurrent UTI . (to read more...)

What is glomerulonephritis (GN)?

GN is a kidney disease in which the filtering system (known as glomeruli) of the kidneys become inflamed and eventually scarred, and hence resulting in kidney failure. If GN occurs on its own, it's known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it's called secondary glomerulonephritis. Common causes of GN are Ig A nephropathy, focal segmental global sclerosis (FSGS), membranous GN, systemic lupus erythematosus (SLE), vasculitis, drugs and certain cancers. GN often presents with proteinuria, hematuria, hypertension and symptoms associated with kidney failure. In early stage of GN, most are asymptomatic and are routinely detected during health screening. A kidney biopsy is often required to make a diagnosis of GN. In certain types of GN, immunosuppressive medications are required. The prognosis of GN is determined by the type and severity of GN which can be determined by the kidney biopsy. (read more...)

What is Lupus nephritis?

Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system. SLE ( 9 times more common in female than male) typically causes harm to the skin, joints, kidneys, and brain. Lupus nephritis may cause weight gain, high blood pressure, dark urine, frothy urine or swelling around the eyes, legs, ankles, or fingers. Some may even present with rapid worsening of kidney failure. However, some people with SLE have no overt symptoms of kidney disease, which must be diagnosed by blood and urine tests. A kidney biopsy is almost always indicated to confirm and classify the various subtypes of lupus nephritis so that appropriate treatment can be given. Medicines called corticosteroids can decrease swelling and inflammation by suppressing the immune system. Additional immunosuppressive drugs (eg. cyclophosphamide, mycophenolate, azathioprine, ciclosporin or rituximab) are indicated in more aggressive lupus nephritis.

Kidney Stones

A kidney stone is a solid mass which forms in the urinary tract due to crystallisation of substances present in the urine and can be found along any part of the urinary tract. Kidney stones may stay in the kidneys or break loose and travel down the urinary tract. A small stone may pass out of the body spontaneously. On the other hand, a larger stone may become lodged in the ureter, bladder or urethra. Stones may also obstruct the flow of urine and cause pain although many can exist without symptoms. Stones that obstruct or cause repeated or severe infections may lead to kidney failure. Certain factors predispose patients to stones formation and these include drinking insufficient water, family history of stones, previous history of stones and urinary tract infections and certain metabolic disorders. Ultrasound scan of the kidneys is a very sensitive and specific radiological test to detect kidney stones. Surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water—2 to 3 quarts a day—to help move the stone along. In complicating cases of kidney stones, surgery maybe indicated. (to read more...)

What are kidney cysts?

As people get older, sacs filled with fluid can form in the kidneys. These sacs are called "cysts." They are usually small oval or round thin-walled sacs with watery fluid in them. Simple kidney cysts are often benign (not cancer). Usually, the cysts don't cause any problems. In fact, people can go through life without even knowing that they have them. Some people have kidney cysts caused by an inherited disease called polycystic kidney disease. If a cyst on the kidney isn’t causing any problems, it probably won't need to be removed. Simple kidney cyst just need regular radiological assessment. For complex cyst or if the kidney cyst is getting larger or if it’s causing problems, your doctor may recommend surgical intervention. (to read more...)

What is polycystic kidney disease (PCKD)?

PCKD is a genetic disorder characterized by the growth of numerous cysts in the kidneys. Adult PCKD is inherited in a dominant fashion i.e. if one parent has the defective gene, this gene is passed down to the next generation and the disease will manifest itself. Therefore, there is a 50% chance the offspring will be affected. In early stages of the disease, many people are asymptomatic. As the cysts enlarge, they replace much of the normal kidney tissue hence resulting in kidney failure. Most of the affected people do not develop kidney failure until they are in their 40s. Patients with PCKD can also experience various complications such as hypertension, hematuria, urinary tract infection, liver and pancreatic cysts, kidney stones, aneurysms (bulges in the walls of blood vessels) in the brain and abnormal heart valves. There is currently no medication to reverse the formation of cysts; however, optimal blood pressure control, reduction in proteinuria and dietary restriction have been beneficial to halt the progression of the kidney failure. All the direct blood relative of an affected individual are at risk of developing PCKD and should be encouraged to screen via ultrasound scan of the kidneys one a regular basis. Most cysts will be evident by 30 years old in an individual. (read more...)