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Kidney

The kidneys are a pair of bean-shaped organs that are found in all vertebrates. They remove waste products from the body, maintain the balance of electrolyte levels, and regulate blood pressure.

In this session we have the following topics:

  • Kidney
  • Clinical Nephrology-General Aspects
  • Nephroptosis
  • Nephronophthisis
  • Kidney Stones
  • Inherited Kidney Diseases
  • Kidney and Anemia
  • New Kidney Diseases
  • Minimal Change Disease
  • Alport Syndrome
  • IgA nephropathy
  • Nephrotoxicity
  • Kidney Failure
  • Infection and Renal Disease

 

More than 30 million American adults are living with kidney disease and most don’t know it. “There are a number of physical signs of kidney disease, but sometimes people attribute them to other conditions. Also, those with kidney disease tend not to experience symptoms until the very late stages, when the kidneys are failing or when there are large amounts of protein in the urine. This is one of the reasons why only 10% of people with chronic kidney disease know that they have it.

Kidney Conditions

  1. Pyelonephritis (infection of kidney pelvis): Bacteria may infect the kidney, usually causing back pain and fever. A spread of bacteria from an untreated bladder infection is the most common cause of pyelonephritis.
  2. Glomerulonephritis: An overactive immune system may attack the kidney, causing inflammation and some damage. Blood and protein in the urine are common problems that occur with glomerulonephritis. It can also result in kidney failure.
  3. Kidney stones (nephrolithiasis): Minerals in urine form crystals (stones), which may grow large enough to block urine flow. It's considered one of the most painful conditions. Most kidney stones pass on their own, but some are too large and need to be treated.
  4. Nephrotic syndrome: Damage to the kidneys causes them to spill large amounts of protein into the urine. Leg swelling (edema) may be a symptom.
  5. Polycystic kidney disease: A genetic condition resulting in large cysts in both kidneys that hinder their work.
  6. Acute renal failure (kidney failure): A sudden worsening in how well your kidneys work. Dehydration, a blockage in the urinary tract, or kidney damage can cause acute renal failure, which may be reversible.
  7. Chronic renal failure: A permanent partial loss of how well your kidneys work. Diabetes and high blood pressure are the most common causes.
  8. End-stage renal disease (ESRD): Complete loss of kidney strength, usually due to progressive chronic kidney disease. People with ESRD require regular dialysis for survival.
  9. Papillary necrosis: Severe damage to the kidneys can cause chunks of kidney tissue to break off internally and clog the kidneys. If untreated, the resulting damage can lead to total kidney failure.
  10. Diabetic nephropathy: High blood sugar from diabetes progressively damages the kidneys, eventually causing chronic kidney disease. Protein in the urine (nephrotic syndrome) may also result.
  11. Hypertensive nephropathy: Kidney damage caused by high blood pressure. Chronic renal failure may eventually result.
  12. Kidney cancer: Renal cell carcinoma is the most common cancer affecting the kidney. Smoking is the most common cause of kidney cancer.
  13. Interstitial nephritis: Inflammation of the connective tissue inside the kidney, often causing acute renal failure. Allergic reactions and drug side effects are the usual causes.
  14. Minimal change disease: A form of nephrotic syndrome in which kidney cells look almost normal under the microscope. The disease can cause significant leg swelling (edema). Steroids are used to treat minimal change disease.
  15. Nephrogenic diabetes insipidus: The kidneys lose the ability to concentrate the urine, usually due to a drug reaction. Although it's rarely dangerous, diabetes insipidus causes constant thirst and frequent urination.
  16. Renal cyst: A hollowed-out space in the kidney. Isolated kidney cysts often happen as people age, and they almost never cause a problem. Complex cysts and masses can be cancerous.

Kidney Tests

  • Urinalysis: A routine test of the urine by a machine and often by a person looking through a microscope. Urinalysis can help detect infections, inflammation, microscopic bleeding, and kidney damage.
  • Kidney ultrasound: A probe placed on the skin reflects sound waves off the kidneys, creating images on a screen. Ultrasound can reveal blockages in urine flow, stones, cysts, or suspicious masses in the kidneys.
  • Computed tomography (CT) scan: A CT scanner takes a series of X-rays, and a computer creates detailed images of the kidneys.
  • Magnetic resonance imaging (MRI) scan: A scanner uses radio waves in a magnetic field to make high-resolution images of the kidneys.
  • Urine and blood cultures: If an infection is suspected, cultures of the blood and urine may identify the bacteria responsible. This can help target antibiotic therapy.
  • Ureteroscopy: An endoscope (flexible tube with a camera on its end) is passed through the urethra into the bladder and ureters. Ureteroscopy generally cannot reach the kidneys themselves, but can help treat conditions that also affect the ureters.
  • Kidney biopsy: Using a needle inserted into the back, a small piece of kidney tissue is removed. Examining the kidney tissue under a microscope may help diagnose a kidney problem.

10 possible signs you may have kidney disease

  1. You're more tired, have less energy or are having trouble concentrating. A severe decrease in kidney function can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired, weak and can make it hard to concentrate. Another complication of kidney disease is anemia, which can cause weakness and fatigue.
  2. You're having trouble sleeping. When the kidneys aren't filtering properly, toxins stay in the blood rather than leaving the body through the urine. This can make it difficult to sleep. There is also a link between obesity and chronic kidney disease, and sleep apnea is more common in those with chronic kidney disease, compared with the general population.
  3. You have dry and itchy skin. Healthy kidneys do many important jobs. They remove wastes and extra fluid from your body, help make red blood cells, help keep bones strong and work to maintain the right amount of minerals in your blood. Dry and itchy skin can be a sign of the mineral and bone disease that often accompanies advanced kidney disease, when the kidneys are no longer able to keep the right balance of minerals and nutrients in your blood.
  4. You feel the need to urinate more often. If you feel the need to urinate more often, especially at night, this can be a sign of kidney disease. When the kidneys filters are damaged, it can cause an increase in the urge to urinate. Sometimes this can also be a sign of a urinary infection or enlarged prostate in men.
  5. You see blood in your urine. Healthy kidneys typically keep the blood cells in the body when filtering wastes from the blood to create urine, but when the kidney's filters have been damaged, these blood cells can start to "leak" out into the urine. In addition to signaling kidney disease, blood in the urine can be indicative of tumors, kidney stones or an infection.
  6. Your urine is foamy. Excessive bubbles in the urine – especially those that require you to flush several times before they go away—indicate protein in the urine. This foam may look like the foam you see when scrambling eggs, as the common protein found in urine, albumin, is the same protein that is found in eggs.
  7. You're experiencing persistent puffiness around your eyes. Protein in the urine is an early sign that the kidneys’ filters have been damaged, allowing protein to leak into the urine. This puffiness around your eyes can be due to the fact that your kidneys are leaking a large amount of protein in the urine, rather than keeping it in the body.
  8. Your ankles and feet are swollen. Decreased kidney function can lead to sodium retention, causing swelling in your feet and ankles. Swelling in the lower extremities can also be a sign of heart disease, liver disease and chronic leg vein problems.
  9. You have a poor appetite. This is a very general symptom, but a buildup of toxins resulting from reduced kidney function can be one of the causes.
  10. Your muscles are cramping. Electrolyte imbalances can result from impaired kidney function. For example, low calcium levels and poorly controlled phosphorus may contribute to muscle cramping.

 

List of nephrology Journals

  • Plos one
  • American journal of kidney diseases
  • Kidney international
  • Clinical journal of the american soeiety of nephrology
  • Journal of the american society of nephrology
  • Advances in cronic kidney diseases
  • Clinical kidney journal
  • Nephrology dialysis transplantation
  • The turkish nephrology dialysis and transplantation journal (tndt)
  • Hemodialysis international
  • Journal of renal care
  • Nephrology
  • Seminars in dialysis
  • Journal of renal nutrition
  • Journal of pediatric nephrology
  • Pediatric nephrology
  • Der nephrologe
  • Renal replacement therapy
  • Clinical and experimental nephrology
  • Clinical and experimental nephrology case reports
  • International urology and nephrology
  • Journal of nephrology
  • Journal of clinical and experimental nephrology
  • Journal of renal medicine
  • Journal of nephrology & therapeutics
  • Journal of kidney
  • Bmc nephrology
  • Canadian journal of kidney health and disease
  • Clinical queries: nephrology
  • Hong kong journal of nephrology
  • Néphrologie & thérapeutique
  • Seminars in nephrology
  • Kidney international reports
  • Kidney international supplements
  • Kidney research and clinical practice
  • Nefrología
  • Nefrología english edition
  • Open journal of nephrology
  • Brazilian journal of nephrology
  • American journal of physiology: renal physiology
  • Journal of renal injury prevention
  • Peritoneal dialysis international
  • American journal of nephrology
  • Kidney and blood pressure research
  • Case reports in nephrology and dialysis
  • Kidney diseases
  • Nephron
  • Nephron extra
  • The open journal of urology & nephrology
  • Sage journals
  • New england journal of medicine
  • Japanees journal of pediatric nephrology
  • European medical journal: nephrology
  • Blood purification
  • Journal of the balkan cities association of nephrology, dialysis, transplantation and artificial organs
  • Indian journal of nephrology
  • Saudi journal of kidney diseases and transplantation
  • Chinese journal of nephrology
  • Clinical nephrology
  • Clinical nephrology – case studies
  • Kidney and hypertension diseases
  • Iranian journal of kidney diseases
  • Therapeutic apheresis and dialysis
  • Advances in peritoneal dialysis
  • Indian journal of peritoneal dialysis
  • Renal society of australia journal
  • International journal of nephrology
  • Case reports in nephrology
  • International journal of nephrology and renovascular disease
  • Nephro-urology monthly
  • Portuguese journal of nephrology and hypertension
  • Cardiorenal medicine
  • Journal of nephropathology  supports only in mozilla
  • Open journal of organ transplant surgery
  • American journal of transplantation
  • Clinical transplantation
  • Transplant international
  • Indian journal of transplantation
  • International journal of organ transplantation medicine
  • Hsoa journal of nephrology & renal therapy
  • Pediatric transplantation
  • Transplantation proceedings
  • Transplantation reports
  • Transplantation reviews
  • Journal of vascular access
  • Urolithiasis
  • Journal of nephrology, dialysis and transplantation
  • Experimental and clinical transplantation
  • Journal of integrative nephrology & andrology
  • Journal of the egyptian society of nephrology and transplantation
  • Nephrology @ point of care
  • Transplantation
  • Italiana di nefrologia
  • Medicine
  • Transplantation direct
  • Journal of urology & nephrology
  • Open access journal of urology & nephrology
  • World journal of nephrology and urology
  • World journal of nephrology
  • World journal of transplantataion
  • International journal of nephrology and kidney failure
  • Transplantation research journal
  • Archives of renal diseases and management
  • Journal of nephropharmacology
  • Internet journal of nephrology
  • Electrolytes and blood pressure
  • Tropical journal of nephrology
  • Journal of nephrology research
  • Journal of dialysis
  • Renal failure
  • Kidney cancer journal
  • Journal of nephrology advances
  • Journal of nephrology and renal transplantation
  • Journal of kidney cancer and vhl
  • Journal of clinical nephrology and research
  • Jsm renal medicine
  • Journal of urology and research
  • Journal of clinical nephrology and renal care
  • Clinical nephrology and urology science
  • Nephrology open journal
  • Archives of clinical nephrology
  • Journal of urology and nephrology open access
  • Joj urology & nephrology
  • Jacobs journal of nephrology and urology
  • Childhood kidney diseases
  • Enliven nephrology and renal studies
  • Journal of kidney care
  • Kidneys
  • News in nephrology
  • Current opinion in nephrology & hypertension
  • Minerva urologica e nefrologica
  • Oa nephrology
  • Nephrology and dialysis poland
  • Ukrainian journal of nephrology and dialysis
  • Nefrología latinoamericana
  • Journal of onconephrology
  • African journal of nephrology
  • Nephrology nursing
  • Journal of the association for vascular access (java)
  • Baoj urology & nephrology
  • Organ transplantation journal
  • Clinical nephrology
  • Journal of urology and renal diseases
  • Kidney disease and transplantation
  • Sm journal of nephrology and kidney diseases
  • Sm journal of nephrology and therapeutics (smjnt)
  • Sm journal of renal medicine
  • Journal of nephrology and urology
  • Annals of clinical nephrology
  • Journal of clinical nephrology
  • Journal of clinical nephrology and kidney diseases
  • Renal medicine
  • Frontiers in medicine: nephrology
  • British open journal of urology & nephrology
  • British open journal of nephrology
  • British open journal of advanced nephrology
  • Journal of nephrology & kidney diseases
  • Translational kidney research
  • European advances journal of nephrology and urology
  • Kidney and urological research: open access
  • American journal of urology and nephrology
  • International journal of kidney & urology (ijku)
  • Advances in renal replacement therapy
  • Nephrology dialysis transplantation supliments
  • Indian journal of radiology and imaging
  • Translational research journal
  • International journal of urology
  • Bmc urology
  • Open journal of urology
  • Diabetic care
  • Rsna radiology
  • Journal of the american medical association
  • Seminars in vascular surgery
  • Journal of vascular and interventional radiology
  • European journal of vascular and endovascular surgery
  • Journal of cardiothoracic-renal research
  • World journal of urology
  • Current urology reports
  • Current hypertension reports
  • Journal of artificial organs
  • The international journal of artificial organs
  • African journal of urology
  • Arab journal of urology
  • Asian journal of urology
  • British journal of medical and surgical urology
  • European urology focus
  • European urology supplements
  • Journal of pediatric urology
  • The journal of urology
  • Urology
  • Urology case reports
  • Urology practice
  • Yearbook of urology
  • Canadian journal of diabetes
  • Diabetes & metabolic syndrome: clinical research & reviews
  • Diabetes & metabolism
  • Diabetes research and clinical practice
  • International journal of diabetes mellitus
  • Journal of diabetes and its complications
  • American journal of hypertension
  • Journal of the american society of hypertension
  • Asbmt biology of blood and marrow transplantation
  • Cell transplantation
  • Urología colombiana
  • Urologic oncology: seminars and original investigations
  • Journal of evidence based medicine and healthcare
  • International jurnal of diabetes investigation
  • Bmj open
  • Journal of vascular surgery
  • Annals of vascular surgery
  • Transplant infectious disease

 

  • Track 1-1Kidney
  • Track 1-2Kidney Failure
  • Track 1-3Nephrotoxicity
  • Track 1-4IgA nephropathy
  • Track 1-5Alport Syndrome
  • Track 1-6Minimal Change Disease
  • Track 1-7New Kidney Diseases
  • Track 1-8Kidney and Anemia
  • Track 1-9Inherited Kidney Diseases
  • Track 1-10Kidney Stones
  • Track 1-11Nephronophthisis
  • Track 1-12Nephroptosis
  • Track 1-13Clinical Nephrology-General Aspects
  • Track 1-14Infection and Renal Disease

The session has the following topics:

  • Acute Kidney Injury–Experimental Models
  • Clinical Studies including Toxic Nephropathy
  • Biomarkers for Acute Kidney Injury
  • Acute Renal Failure–Clinical
  • Acute Kidney Injury-Onco-Nephrology (Diseases)
  • Acute Kidney Injury–Onco-Nephrology (Drugs)
  • Acute Kidney Injury–Pregnancy (Pre-Eclampsia, TMA, HELLP, Other Causes)
  • Acute Kidney Injury–Update on CRRT, SLED, etc.
  • Extracorporeal Therapies - Intoxications, Overdoses, Liver Failure, etc.

When your kidneys stop working suddenly, over a very short period of time (usually two days or less), it is called acute kidney injury (AKI). AKI is sometimes called acute kidney failure or acute renal failure. It is very serious and requires immediate treatment.

Unlike kidney failure that results from kidney damage that gets worse slowly, AKI is often reversible if it is found and treated quickly. If you were healthy before your kidneys suddenly failed and you were treated for AKI right away, your kidneys may work normally or almost normally after your AKI is treated. Some people have lasting kidney damage after AKI. This is called chronic kidney disease, and it could lead to kidney failure if steps are not taken to prevent the kidney damage from getting worse.

Symptoms

Signs and symptoms of acute kidney failure may include:

  • Decreased urine output, although occasionally urine output remains normal
  • Fluid retention, causing swelling in your legs, ankles or feet
  • Shortness of breath
  • Fatigue
  • Confusion
  • Nausea
  • Weakness
  • Irregular heartbeat
  • Chest pain or pressure
  • Seizures or coma in severe cases

Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.

Causes

Acute kidney failure can occur when:

  • You have a condition that slows blood flow to your kidneys
  • You experience direct damage to your kidneys
  • Your kidneys' urine drainage tubes (ureters) become blocked and wastes can't leave your body through your urine

Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the kidneys and lead to kidney injury include:

  • Blood or fluid loss
  • Blood pressure medications
  • Heart attack
  • Heart disease
  • Infection
  • Liver failure
  • Use of aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others) or related drugs
  • Severe allergic reaction (anaphylaxis)
  • Severe burns
  • Severe dehydration

Damage to the kidneys

These diseases, conditions and agents may damage the kidneys and lead to acute kidney failure:

  • Blood clots in the veins and arteries in and around the kidneys
  • Cholesterol deposits that block blood flow in the kidneys
  • Glomerulonephritis (gloe-mer-u-loe-nuh-FRY-tis), inflammation of the tiny filters in the kidneys (glomeruli)
  • Hemolytic uremic syndrome, a condition that results from premature destruction of red blood cells
  • Infection
  • Lupus, an immune system disorder causing glomerulonephritis
  • Medications, such as certain chemotherapy drugs, antibiotics and dyes used during imaging tests
  • Scleroderma, a group of rare diseases affecting the skin and connective tissues
  • Thrombotic thrombocytopenic purpura, a rare blood disorder
  • Toxins, such as alcohol, heavy metals and cocaine
  • Muscle tissue breakdown (rhabdomyolysis) that leads to kidney damage caused by toxins from muscle tissue destruction
  • Breakdown of tumor cells (tumor lysis syndrome), which leads to the release of toxins that can cause kidney injury

Urine blockage in the kidneys

Diseases and conditions that block the passage of urine out of the body (urinary obstructions) and can lead to acute kidney injury include:

  • Bladder cancer
  • Blood clots in the urinary tract
  • Cervical cancer
  • Colon cancer
  • Enlarged prostate
  • Kidney stones
  • Nerve damage involving the nerves that control the bladder
  • Prostate cancer

Risk factors

Acute kidney failure almost always occurs in connection with another medical condition or event. Conditions that can increase your risk of acute kidney failure include:

  • Being hospitalized, especially for a serious condition that requires intensive care
  • Advanced age
  • Blockages in the blood vessels in your arms or legs (peripheral artery disease)
  • Diabetes
  • High blood pressure
  • Heart failure
  • Kidney diseases
  • Liver diseases
  • Certain cancers and their treatments

Complications

Potential complications of acute kidney failure include:

  • Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your lungs, which can cause shortness of breath.
  • Chest pain. If the lining that covers your heart (pericardium) becomes inflamed, you may experience chest pain.
  • Muscle weakness. When your body's fluids and electrolytes — your body's blood chemistry — are out of balance, muscle weakness can result.
  • Permanent kidney damage. Occasionally, acute kidney failure causes permanent loss of kidney function, or end-stage renal disease. People with end-stage renal disease require either permanent dialysis — a mechanical filtration process used to remove toxins and wastes from the body — or a kidney transplant to survive.
  • Death. Acute kidney failure can lead to loss of kidney function and, ultimately, death.

Prevention

Acute kidney failure is often difficult to predict or prevent. But you may reduce your risk by taking care of your kidneys. Try to:

  • Pay attention to labels when taking over-the-counter (OTC) pain medications.Follow the instructions for OTC pain medications, such as aspirin, acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve, others). Taking too much of these medications may increase your risk of kidney injury. This is especially true if you have pre-existing kidney disease, diabetes or high blood pressure.
  • Work with your doctor to manage kidney and other chronic conditions. If you have kidney disease or another condition that increases your risk of acute kidney failure, such as diabetes or high blood pressure, stay on track with treatment goals and follow your doctor's recommendations to manage your condition.
  • Make a healthy lifestyle a priority. Be active; eat a sensible, balanced diet; and drink alcohol only in moderation — if at all.

 

List of Nephrology Societies

 

  1. AAMI Standards for Haemodialysis
  2. African Association of Nephrology (AFRAN)
  3. Albanian Society of Nephrology
  4. American Association of Kidney Patients
  5. American Nephrology Nurses Association (ANNA)
  6. American Renal Associates
  7. American Society of Nephrology
  8. American Society of Nephrology
  9. American Society of Pediatric Nephrology
  10. American Society of Transplant Surgeons
  11. American Society of Transplantation
  12. Arab Society of Nephrology & Renal Transplantation
  13. Argentina Society of Nephrology
  14. Asian Pacific Society of Nephrology
  15. Asian Pediatric Nephrology Association
  16. Association for nephrology, dialysis and transplantation of Bosnia and Herzegovina
  17. Association of Cardionephrology of Serbia
  18. Association of Nephrology and Hypertension of El Salvador
  19. Australian and New Zealand Society of Nephrology
  20. Austrian Society of Nephrology
  21. Bangladesh Renal Association
  22. Belgian Transplantation Society
  23. Belgian-Dutch Speaking Society of Nephrology
  24. BKPA - British Kidney Patient Association
  25. Bolivian Society of Nephrology
  26. Brazilian Society of Nephrology
  27. British Association of Pediatric Nephrology
  28. British Renal Society
  29. British Transplantation Society
  30. Bulgarian Society of Nephrology
  31. Canadian Association of Nephrology Nurses and Technologists
  32. Canadian Society of Nephrology
  33. Canadian Society of Transplantation
  34. Cardio Renal Society of America
  35. Cardio Renal Society of America
  36. Chile Society of Nephrology
  37. Chinese Society of Nephrology
  38. Colombian Society of Nephrology
  39. Costarican Society of Nephrology
  40. Croatian Society of Nephrology, Dialysis & Transplantation
  41. Cuban Society of Nephrology
  42. Danish Society of Nephrology
  43. Dialysis, Nephrology and Kidney Transplantation Union of Georgia
  44. Dutch Federation of Nephrology
  45. Ecuadorian Society of Nephrology
  46. Egyptian Society of Nephrology
  47. Emirates Medical Association Nephrology Society
  48. ERA-EDTA (The European Renal Association – European Dialysis and Transplant Association)
  49. Estonian Society of Nephrology
  50. European Society for Paediatric Nephrology
  51. Forum of end stage renal disease networks
  52. French Society of Nephrology
  53. German Society of Nephrology
  54. Guatemalan Society of Nephrology
  55. Hellenic Society of Nephrology
  56. Hong Kong Society of Nephrology
  57. Hungarian Society of Nephrology
  58. Hypertension, dialysis and clinical nephrology (HDCN)
  59. India Renal Foundation
  60. Indian Society of Nephrology
  61. Indian Society of Pediatric Nephrology
  62. Indonesian Society of Nephrology
  63. International Pediatric Nephrology Association (IPNA)
  64. International Society For Apheresis (ISFA)
  65. International Society for Hemodialysis
  66. International Society for Peritoneal Dialysis (ISPD)
  67. International Society of Nephrology (ISN)
  68. International Society of Renal Nutrition and Metabolism
  69. Iranian Society of Nephrology
  70. Iraqi Society of Nephology
  71. Iraqi Society of Nephrology
  72. Irish Kidney Association
  73. Irish Nephrology Society
  74. Israel Society of Nephrology and Hypertension
  75. Italian Society of nephrology
  76. Japanese Society of Nephrology
  77. Jivana Organ Donation Society's
  78. Jordan Society of Nephrology and Renal Transplantation
  79. Kenya Renal Association
  80. Kidney Cancer Association
  81. kidney society
  82. Kidney Transplant/Dialysis Association
  83. Korean Society of Nephrology
  84. Kuwait Nephrology Association
  85. Latin-American Society of Nephrology and Hypertension
  86. Latvian Association of Nephrology
  87. Lebanese Society of Nephrology & Hypertension
  88. Lebanese Society of Nephrology and Hypertension
  89. Macedonian Soc. of Nephrology, Dialysis, Transplantation and Artificial Organs
  90. Malaysian Society of Nephrology
  91. Mexican College of Nephrologists
  92. Mexican Institute for Nephrologycal Research
  93. Midwest Pediatric Nephrology Consortium
  94. Moldavian Society of Nephrology
  95. Mongolian Society of Nephrology and Urology
  96. Montenegrin Association of Nephrologists
  97. Moroccan Society of Nephrology
  98. Myanmar NephroUro Society
  99. National Association of Dialysis and Transplantation
  100. National Renal Administrators Association
  101. Nephrology Society of Tanzania
  102. Nephrology Society of Thailand
  103. New York Society of Nephrology
  104. Nigerian Association of Nephrology
  105. Norwegian Society of Nephrology
  106. Ohio Renal Association
  107. Pakistan Society of Nephrology and Urology
  108. Panamanian Society of Nephrology
  109. Paraguayan Society of Nephrology
  110. Peritoneal Dialysis Society of India
  111. Peruvian Society of Nephrology
  112. Philippine Society of Nephrology
  113. Polish Society of Nephrology
  114. Portuguese Society of Nephrology
  115. Puerto Rican Society of Nephrology and Hypertension
  116. Renal and Transplant Associates of New England
  117. Renal Association
  118. Renal Association
  119. Renal Nutrition Group
  120. Renal Pathology Society
  121. Renal Physicians Association (RPA)
  122. Renal Society of Australasia
  123. Romanian Society of Nephrology
  124. Russian Dialysis Society
  125. Saudi Society of Nephrology
  126. Saudi Society of Nephroloty & Transplantation
  127. Senegalese Society of Nephrology
  128. Singapore Society of Nephrology
  129. Slovenian Society of Nephrology
  130. Society for Transplant Social Workers
  131. Society of Nephrologists, Dialysis and Transplant Physicians of Kazakhstan
  132. South African Renal Society
  133. Spanish Society of Nephrology/Fundacion Senefro
  134. Sri Lanka Society of Nephrology
  135. Sudanese Society of Nephrology
  136. Swedish Society of Nephrology
  137. Swiss Society of Nephrology
  138. Syrian Society of Nephrology & Transplantation
  139. Taiwan Society of Nephrology
  140. The European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA)
  141. The Hong Kong Association of Renal Nurses (HKARN)
  142. The National Kidney Foundation
  143. The Swedish Nephrology Nurses' Association
  144. The Transplantation Society
  145. Tunisian Society of Nephrology
  146. Turkish Society of Nephrology
  147. UK Renal Registry
  148. Ukranian Nephrology Association
  149. Uruguayan Society of Nephrology
  150. Venezuelan Society of Nephrology
  151. Yemen Society for Nephrology and Transplantation
  152. National Renal Administrators Association

 

  • Track 2-1Acute Kidney Injury–Experimental Models
  • Track 2-2Clinical Studies including Toxic Nephropathy
  • Track 2-3Biomarkers for Acute Kidney Injury
  • Track 2-4Acute Renal Failure–Clinical
  • Track 2-5Acute Kidney Injury-Onco-Nephrology (Diseases)
  • Track 2-6Acute Kidney Injury–Onco-Nephrology (Drugs)
  • Track 2-7Acute Kidney Injury–Pregnancy (Pre-Eclampsia, TMA, HELLP, Other Causes)
  • Track 2-8Acute Kidney Injury–Update on CRRT, SLED, etc.
  • Track 2-9Extracorporeal Therapies - Intoxications, Overdoses, Liver Failure, etc.

The session Chronic Kidney Disease covers

  • CKD: Fibrosis and Extracellular Matrix CKD
  • Chronic Kidney Disease–Mesoamerican Nephropathy
  • Anemia
  • Bone and Mineral Metabolism
  • Epidemiology, Outcomes and Health Service Research in CKD
  • Chronic Kidney Disease Diagnosis, Classification and Progression
  • Cardiovascular Complications of CKD 3-5
  • Acid Base and Electrolyte Abnormalities
  • CKD Mineral and Bone Disorder
  • Chronic Kidney Disease–Diseases and Drugs

 

Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid, electrolytes and wastes can build up in your body.

In the early stages of chronic kidney disease, you may have few signs or symptoms. Chronic kidney disease may not become apparent until your kidney function is significantly impaired.

Treatment for chronic kidney disease focuses on slowing the progression of the kidney damage, usually by controlling the underlying cause. Chronic kidney disease can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant.

Symptoms

Chronic kidney failure, as opposed to acute kidney failure, is a slow and gradually progressive disease. Even if one kidney stops functioning, the other can carry out normal functions. It is not usually until the disease is fairly well advanced and the condition has become severe that signs and symptoms are noticeable; by which time most of the damage is irreversible.

It is important that people who are at high risk of developing kidney disease have their kidney functions regularly checked. Early detection can significantly help prevent serious kidney damage.

The most common signs and symptoms of chronic kidney disease include:

 

Anemia

Blood in urine

Dark urine

Decreased mental alertness

Decreased urine output

Edema - swollen feet, hands, and ankles (face if edema is severe)

Fatigue (tiredness)

Hypertension (high blood pressure)

Insomnia

Itchy skin, can become persistent

Loss of appetite

Male inability to get or maintain an erection (erectile dysfunction)

More frequent urination, especially at night

Muscle cramps

Muscle twitches

Nausea

Pain on the side or mid to lower back

Panting (shortness of breath)

Protein in urine

Sudden change in bodyweight

Unexplained headaches

Stages

Changes in the GFR rate can assess how advanced the kidney disease is. In the UK, and many other countries, kidney disease stages are classified as follows:

 

Stage 1 - GFR rate is normal. However, evidence of kidney disease has been detected.

 

Stage 2 - GFR rate is lower than 90 milliliters, and evidence of kidney disease has been detected.

 

Stage 3 - GFR rate is lower than 60 milliliters, regardless of whether evidence of kidney disease has been detected.

 

Stage 4 - GRF rate is lower than 30 milliliters, regardless of whether evidence of kidney disease has been detected.

 

Stage 5 - GFR rate is lower than 15 milliliters. Renal failure has occurred.

 

The majority of patients with chronic kidney disease rarely progress beyond Stage 2. It is important for kidney disease to be diagnosed and treated early for serious damage to be prevented.

 

Patients with diabetes should have an annual test, which measures microalbuminuria (small amounts of protein) in urine. This test can detect early diabetic nephropathy (early kidney damage linked to diabetes).

 

What causes chronic kidney disease (CKD)?

Anyone can get CKD. Some people are more at risk than others. Some things that increase your risk for CKD include:

 

Diabetes

High blood pressure (hypertension)

Heart disease

Having a family member with kidney disease

Being African-American, Hispanic, Native American or Asian

Being over 60 years old

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Symptoms of chronic kidney disease

Chronic kidney disease (CKD) usually gets worse slowly, and symptoms may not appear until your kidneys are badly damaged. In the late stages of CKD, as you are nearing kidney failure (ESRD), you may notice symptoms that are caused by waste and extra fluid building up in your body.

 

You may notice one or more of the following symptoms if your kidneys are beginning to fail:

 

Itching

Muscle cramps

Nausea and vomiting

Not feeling hungry

Swelling in your feet and ankles

Too much urine (pee) or not enough urine

Trouble catching your breath

Trouble sleeping

If your kidneys stop working suddenly (acute kidney failure), you may notice one or more of the following symptoms:

 

Abdominal (belly) pain

Back pain

Diarrhea

Fever

Nosebleeds

Rash

Vomiting

Having one or more of any of the symptoms above may be a sign of serious kidney problems. If you notice any of these symptoms, you should contact your doctor right away.

Complications of CKD

Your kidneys help your whole body work properly. When you have CKD, you can also have problems with how the rest of your body is working. Some of the common complications of CKD include anemia, bone disease, heart disease, high potassium, high calcium and fluid buildup. Learn more about the complications of CKD.

Stages of CKD

Chronic kidney disease (CKD) refers to all 5 stages of kidney damage, from very mild damage in Stage 1 to complete kidney failure in Stage 5. The stages of kidney disease are based on how well the kidneys can do their job – to filter waste and extra fluid out of the blood. Learn more about the stages of CKD.

 

How can I prevent CKD?

Diabetes and high blood pressure are the most common causes of CKD. If you have diabetes or high blood pressure, working with your doctor to keep your blood sugar and blood pressure under control is the best way to prevent kidney disease.

 

Living a healthy lifestyle can help prevent diabetes, high blood pressure and kidney disease, or help keep them under control. Follow these tips to lower your risk for kidney disease and the problems that cause it:

 

Follow a low-salt, low-fat diet

Exercise at least 30 minutes on most days of the week

Have regular check-ups with your doctor

Do not smoke or use tobacco

Limit alcohol

 

How do I know if I have CKD?

CKD usually does not have any symptoms until your kidneys are badly damaged. The only way to know how well your kidneys are working is to get tested. Being tested for kidney disease is simple. Ask your doctor about these tests for kidney health:

eGFR (estimated glomerular filtration rate)

The eGFR is a sign of how well your kidneys are cleaning your blood.

Your body makes waste all the time. This waste goes into your blood. Healthy kidneys take the waste out of your blood. One type of waste is called creatinine. If you have too much creatinine in your blood, it might be a sign that your kidneys are having trouble filtering your blood.

You will have a blood test to find out how much creatinine is in your blood. Your doctor will use this information to figure out your eGFR. If your eGFR is less than 60 for three months or more, you might have kidney disease.

 

Urine test

 

This test is done to see if there is blood or protein in your urine (pee).

Your kidneys make your urine. If you have blood or protein in your urine, it may be a sign that your kidneys are not working well.

Your doctor may ask you for a sample of your urine in the clinic or ask you to collect your urine at home and bring it to your appointment.

 

Blood pressure

 

This test is done to see how hard your heart is working to pump your blood.

High blood pressure can cause kidney disease, but kidney disease can also cause high blood pressure. Sometimes high blood pressure is a sign that your kidneys are not working well.

For most people a normal blood pressure is less than 120/80 (120 over 80). Ask your doctor what your blood pressure should be.

How is CKD treated?

Damage to your kidneys is usually permanent. Although the damage cannot be fixed, you can take steps to keep your kidneys as healthy as possible for as long as possible. You may even be able to stop the damage from getting worse.

 

Control your blood sugar if you have diabetes.

Keep a healthy blood pressure.

Follow a low-salt, low-fat diet.

Exercise at least 30 minutes on most days of the week.

Keep a healthy weight.

Do not smoke or use tobacco.

Limit alcohol.

Talk to your doctor about medicines that can help protect your kidneys.

If you catch kidney disease early, you may be able to prevent kidney failure. If your kidneys fail, you will need dialysis or a kidney transplant to survive.

Kidney-friendly diet for CKD

You need to have a kidney-friendly meal plan when you have chronic kidney disease (CKD). Watching what you eat and drink will help you stay healthier. A kidney-friendly diet may also help protect your kidney from further damage by limiting certain foods to prevent the minerals in those foods from building up in your body. Learn more about the kidney-friendly diet for CKD.

 

Other Kidney Organizations

 

  • American Association of Kidney Patients
  • UKD Foundation, Inc.
  • The Nephron Information Center
  • The Nephcure Foundation
  • The Kidney Transplant Dialysis Association
  • Renal Support Network
  • Polycystic Kidney Disease Foundation
  • National Kidney Disease Education Program
  • National Kidney & Urologic Diseases Information Clearinghouse
  • National Institute of Diabetes and Digestive and Kidney Diseases
  • Kidney School
  • Kidney Options
  • Home Dialysis Central
  • Fresenius Medical Care
  • Dialysis Patient Citizens
  • Davita
  • American Transplant Foundation
  • American Renal Associates
  • American Kidney Fund
  • Academy of Nutrition and Dietetics (AND)
  • Agency for Healthcare Research and Quality (AHRQ)
  • AHRQ Patient Safety Network (PSNet)
  • American College of Nutrition (ACN)
  • American Kidney Fund (AKF)
  • American Nephrology Nurses' Association (ANNA)
  • American Society for Artificial Internal Organs (ASAIO)
  • American Society of Diagnostic & Interventional Nephrology (ASDIN)
  • American Society of Nephrology (ASN)
  • American Society for Parenteral and Enternal Nutrition (ASPEN)
  • American Society of Pediatric Nephrology (ASPN)
  • American Society of Transplantation (AST)
  • American Society of Transplant Surgeons (ASTS)
  • Arbor Research Collaborative for Health (formally the URREA)
  • Association for the Advancement of Medical Instrumentation (AAMI)
  • AV Fistula First Breakthrough Coalition (FFBI)
  • Board of Nephrology Examiners, Inc. Nursing and Technology (BONENT)
  • California Dialysis Council (CDC)
  • Canadian Association of Nephrology Nurses and Technologists (CANNT)
  • Canadian Institute for Health Information (CIHI)
  • Center for Practical Bioethics
  • Centers for Disease Control and Prevention (CDC)
  • Dialysis Safety
  • Division of Laboratory Systems (DLS)
  • Healthcare-associated Infections (HAI)
  • Morbidity and Mortality Weekly Report (MMWR)
  • National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)
  • National Institutes for Occupational Safety and Health (NIOSH)
  • Viral Hepatitis
  • Centers for Medicare and Medicaid Services (CMS)
  • Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb)
  • DialysisData.org
  • ESRD Clinical Performance Measures Project (CPM)
  • Centre for Health Evidence (CHE)
  • Chronic Disease Research Group (CDRG)
  • Department of Health - UK (DH)
  • The Dialysis Outcomes and Practice Patterns Study (DOPPS)
  • ECRI - (Healthcare Technology Assessment)
  • eHealth Initiative
  • End-Stage Renal Disease (ESRD) Networks
  • ESRD Network Organizations Background from CMS
  • Environmental Protection Agency (EPA)
  • European Renal Association - European Dialysis and Transplant Association (ERA-EDTA)
  • European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA)
  • European Society for Paediatric Nephrology (ESPN)
  • Food and Drug Administration (FDA)
  • Vaccines, Blood & Biologics
  • Center for Devices and Radiological Health
  • Healthcare Information and Management Systems (HIMSS)
  • Health Insurance Portability and Accountability Act (HIPPA)
  • Understanding HIPAA Privacy
  • International Health Care Worker Safety Center (also EPINet™)
  • International Society for Hemodialysis (ISHD)
  • International Society for Nephrology Technicians and Technologists (ISNTT)
  • International Society of Nephrology (ISN)
  • International Society for Peritoneal Dialysis (ISPD)
  • Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
  • Keeping Kidney Patients Safe
  • The Kidney & Urology Foundation of America (KUFA)
  • Kidney Disease: Improving Global Outcomes (KDIGO™)
  • Kidney Disease Outcomes Quality Initiative (K/DOQI™)
  • Kidney Disease Quality of Life Working Group (KDQOL)
  • Kidney Foundation of Canada
  • Lupus Foundation of America (LFA)
  • Management Sciences for Health (MSH)
  • Medicare
  • Medicare and Kidney Disease Education
  • Coverage of Kidney Dialysis and Kidney Transplant Services (Adobe Acrobat Reader required)
  • Medicare Payment Advisory Commission (MedPAC)
  • The National Anemia Action Council (NAAC)
  • National Association for Nephrology Technicians/Technologists (NANT)
  • National Center for Complementary and Alternative Medicine (NCCAM)
  • National Foundation for Transplants
  • National Guideline Clearinghouse  (evidence-based clinical practice guidelines)
  • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
  • National Institutes of Health (NIH)
  • National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
  • National Institutes for Occumpational Safety and Health (NIOSH)
  • National Kidney Foundation (NKF)
  • National Kidney Foundation (UK site)
  • National Kidney Registry
  • National Kidney Research Fund (UK site)
  • National Patient Safety Agency (UK site)
  • National Patient Safety Foundation
  • National Quality Forum (NQF)
  • National Renal Administrators Association (NRAA)
  • National Vascular Access Improvement Initiative (Fistula First)
  • Nephrology Nursing Certification Commission (NNCC)
  • North American Transplant Coordinators Organization (NATCO)
  • Occupational Safety and Health Administration (OSHA)
  • Bloodborne Pathogens and Needlestick Prevention
  • Workplace Violence
  • OrganDonor.gov
  • Organ Procurement and Transplantation Network (OPTN)
  • Polycystic Kidney Disease Foundation
  • Quackwatch
  • Renal Physicians Association (RPA)
  • Scientific Registry of Transplant Recipients (SRTR)
  • Sepsis Alliance
  • S.L.E. Lupus Foundation
  • Spanish Society of Dialysis and Transplantation (Sociedad Española de Diálisis y Trasplante) (SEDYT)
  • TransWeb (All about transplantation and donation) (opens new browser window)
  • UK Renal Registry
  • United Network for Organ Sharing (UNOS)
  • U.S. Federal Government:  President,  Senate,  House of Representatives,  Thomas
  • U.S. Department of Health and Human Services
  • Senate Finance Committee, Subcommittee on Health
  • House of Representatives Ways and Means Committee, Subcommittee on Health
  • US Renal Data System (USRDS)
  • Vascular Access Society

 

  • Track 3-1CKD: Fibrosis and Extracellular Matrix CKD
  • Track 3-2CKD Mineral and Bone Disorder
  • Track 3-3Acid Base and Electrolyte Abnormalities
  • Track 3-4Cardiovascular Complications of CKD 3-5
  • Track 3-5Chronic Kidney Disease Diagnosis, Classification and Progression
  • Track 3-6Epidemiology, Outcomes and Health Service Research in CKD
  • Track 3-7Bone and Mineral Metabolism
  • Track 3-8Anemia
  • Track 3-9Chronic Kidney Disease–Mesoamerican Nephropathy
  • Track 3-10Chronic Kidney Disease–Diseases and Drugs

When kidneys fail, your body may have difficulty filtering your blood and keeping your body chemically balanced. Dialysis is a treatment process that cleans the body of unwanted toxins, waste products and excess fluids. Dialysis can take the place of some kidney function and, along with medication and proper care, help people live longer.

The session covers

  • Haemodialysis
  • Peritoneal Dialysis
  • Vascular Access in Dialysis
  • Membrane Function
  • Membrane Biology
  • Dialysis Solutions
  • Palliative Care for CKD/ESRD
  • Conservative Management of Advanced CKD (Vs. Dialysis)
  • Clinical Studies in Renal Transplantation
  • Transplantation: Basic Science and Immune Tolerance
  • Epidemiology, Outcomes and Health Services Research in Dialysis
  • Complications of Dialysis
  • Extracorporeal Dialysis: Techniques and Adequacy
  • Quality of Life in Dialysis

 

Who needs dialysis?

When a person with chronic kidney disease (CKD) reaches end stage renal disease (ESRD), also known as kidney failure or stage 5 CKD, the kidneys are no longer functioning to filter and clean the blood the way healthy kidneys normally would. Without treatment, life-threatening waste and toxins will build up in the body. At this point, dialysis treatment or a kidney transplant is needed to prolong life.

Doctors use a number of kidney function tests when determining kidney health. Early diagnosis of CKD and regular monitoring can help you keep kidney function for as long as possible—and allow you and your doctor to plan for ESRD treatment when necessary.

How does dialysis work?

Dialysis works by filtering toxins, waste and fluid from the blood through a semipermeable membrane. There are different methods of dialysis that filter blood in different ways.

Dialysis treatment is prescribed by your doctor. Together, you and your doctor will discuss treatment options and determine what's right for you. If you decide to go on dialysis, your doctor will prescribe your treatment amount and frequency based on your unique health needs. It's important to complete your dialysis treatment exactly as prescribed to feel your best.

Types of dialysis

There are 2 main kinds of dialysis—and several kidney failure treatment options—to discuss with your doctor. Depending on which type of dialysis you choose, you may also have options for treating in a center or at home.

 

Peritoneal dialysis—uses the blood vessels in the lining of your abdomen—the body's natural filter—along with a special solution via a peritoneal catheter to filter blood. With this method, blood never leaves the body. At-home peritoneal dialysis can be done with a machine or manually at home, at work or even while traveling.

Hemodialysis—filters the blood with a machine called a dialyzer. Once you are connected to the dialyzer via your hemodialysis access, blood flows into the machine, gets filtered and is returned to the body. There is a choice in where you do hemodialysis and who performs the treatment. In-center hemodialysis is done at the center by a team of medical professionals. At-home hemodialysis can be performed in the comfort of your own home with or without a care partner, depending on your therapy choice.

Which type of dialysis is best?

In many cases, you'll be able to choose which type of dialysis you want to have.

 

The 2 techniques are equally effective for most people, but each has its own advantages and drawbacks.

 

For example:

 

haemodialysis means you'll have 4 treatment-free days a week, but the treatment sessions last longer and you may need to visit hospital each time

peritoneal dialysis can be done quite easily at home and can sometimes be done while you sleep, but it needs to be done every day

If you're able to choose the type of dialysis you prefer, your care team will discuss the pros and cons of each option with you to help you make a decision.

 

Read more about the advantages and disadvantages of both types of dialysis.

 

Side effects of dialysis

Haemodialysis can cause itchy skin and muscle cramps. Peritoneal dialysis can put you at risk of developing peritonitis, an infection of the thin membrane that surrounds your abdomen.

 

Both types of dialysis can make you feel exhausted.

 

Read more about the possible side effects of dialysis.

 

Life on dialysis

Many people on dialysis have a good quality of life.

 

If you're otherwise well, you should be able to:

 

Continue working or studying

Drive

Exercise

Go swimming

Go on holiday

Most people can remain on dialysis for many years, although the treatment can only partially compensate for the loss of kidney function.

 

Having kidneys that don't work properly can place a significant strain on the body.

 

Sadly, this means that people can die while on dialysis if they don't have a kidney transplant, particularly elderly people and those with other health problems.

 

Someone who starts dialysis in their late 20s can expect to live for up to 20 years or longer, but adults over 75 may only survive for 2 to 3 years.

 

But survival rates of people on dialysis have improved over the past decade and are expected to continue improving in the future.

 

Dialysis facts

  • Dialysis can substitute many normal functions of healthy kidneys.
  • Dialysis empowers people with kidney failure to live full, productive lives.
  • There are 2 types of kidney dialysis: hemodialysis and peritoneal dialysis.
  • More and more people are choosing at-home dialysis, which can offer greater flexibility and better outcomes.
  • Many people switch dialysis types to fit a changing lifestyle at some point during long-term treatment.
  • The best dialysis option for you is the one that best fits your lifestyle and health needs.

Resources for Dialysis Patients

  1. Aging with Dignity
  2. Alliance for Home Dialysis
  3. Alliance for Paired Donation
  4. American Association of Kidney Patients (AAKP)
  5. American Kidney Fund (AKF)
  6. BenefitsCheckUpRx
  7. CaregiverStress
  8. Cleveland Clinic Foundation Renal Diet Cookbooks
  9. DaVita Diet Helper
  10. DaVita Patient Citizens (DPC)
  11. Dialysis Facility Compare (from the Medicare web site)
  12. Dialysisfinder™  Travel help for patients/social workers
  13. Dialysis Units in the USA™ (from Nephron Information Center)
  14. Disabled Living Foundation (DLF)
  15. European Kidney Patients’ Federation CEAPIR
  16. Financial Assistance for Living Donors
  17. Green Dialysis
  18. HealthWell Foundation
  19. Help Hope Live
  20. Home Dialysis Central
  21. Home Dialyzors United web site
  22. Jewish Kidney & Transplant Support Center
  23. Kidney Care Partners
  24. Kidney Community Emergency Response
  25. Kidney End-of-life Coalition
  26. Kidney Options™
  27. Kidney Patient's Guide (UK site)
  28. Kidney Patient News
  29. Kidney School™
  30. Kidney & Urology Foundation of America, Inc.
  31. Life Options Rehabilitation Program
  32. Living Kidney Donor Network
  33. Living Kidney Donor Search
  34. Living Kidney Donor Search Tools and Tips
  35. National Association of Professional Home Care
  36. National Donor Memorial
  37. National Family Caregivers Association (NFCA)
  38. National Kidney Federation (UK site)
  39. National Kidney Foundation (USA)
  40. K/DOQI™ Educational Materials
  41. National Patient Safety Agency (UK site)
  42. National Patient Safety Foundation
  43. Nephron Information Center
  44. NIDDK Publications On-line - Easy-to-read publication: Eat Right to Feel Right on Hemodialysis
  45. Nocturnal Home Haemodialysis
  46. Patient Access Network Foundation - medication assistance
  47. Patient Education Institute
  48. PatientsLikeMe
  49. Quackwatch
  50. Renal Family Cookbook
  51. Healthy Life Info
  52. renalinfo.com
  53. Renal Nutrition Resouces (from NKF - CRN)
  54. Renal Support Network (Southern California)
  55. Restless Legs Syndrome Foundation (RLS)
  56. S.L.E. Lupus Foundation
  57. Small Comforts Foundation
  58. Supportive Care Coalition
  59. Transplant Living
  • Track 4-1Haemodialysis
  • Track 4-2Extracorporeal Dialysis: Techniques and Adequacy
  • Track 4-3Complications of Dialysis
  • Track 4-4Epidemiology, Outcomes and Health Services Research in Dialysis
  • Track 4-5Transplantation: Basic Science and Immune Tolerance
  • Track 4-6Clinical Studies in Renal Transplantation
  • Track 4-7Conservative Management of Advanced CKD (Vs. Dialysis)
  • Track 4-8Palliative Care for CKD/ESRD
  • Track 4-9Dialysis Solutions
  • Track 4-10Membrane Biology
  • Track 4-11Membrane Function
  • Track 4-12Vascular Access in Dialysis
  • Track 4-13Peritoneal Dialysis
  • Track 4-14Quality of Life in Dialysis

Session Covers

 

  • Advances in Kidney Transplantation
  • Transplantation - Outcomes
  • Transplantation – Immunosuppression
  • Transplantation – Epidemiology
  • Screening Tests
  • Stem Cell Transplantation
  • Acute Renal Allograft Rejection
  • Post-Transplant Complications
  • Pregnancy after Transplantation
  • Dual Kidney Transplantation
  • Pediatric Renal Transplantation
  • Transplantation Techniques
  • Transplantation – Surgery

 

Some people with kidney failure may be able to have a kidney transplant. During transplant surgery, a healthy kidney from a donor is placed into your body. The new, donated kidney does the work that your two kidneys used to do.

The donated kidney can come from someone you don’t know who has recently died (deceased donor), or from a living person—a relative, spouse, or friend. Due to the shortage of kidneys, patients on the waiting list for a deceased donor kidney may wait many years.

A kidney transplant is a treatment for kidney failure; it’s not a cure. You will need to take medicines every day to make sure your immune system doesn't reject the new kidney . You will also need to see your health care provider regularly.

A working transplanted kidney does a better job of filtering wastes and keeping you healthy than dialysis. However, a kidney transplant isn’t for everyone. Your doctor may tell you that you’re not healthy enough for transplant surgery.

The Living Donor

Sometimes family members, including brothers, sisters, parents, children (18 years or older), uncles, aunts, cousins, or a spouse or close friend may wish to donate a kidney. That person is called a "living donor." The donor must be in excellent health, well informed about transplantation, and able to give informed consent. Any healthy person can donate a kidney safely.

Deceased Donor

A deceased donor kidney comes from a person who has suffered brain death. The Uniform Anatomical Gift Act allows everyone to consent to organ donation for transplantation at the time of death and allows families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected.

Transplant Evaluation Process

Regardless of the type of kidney transplant-living donor or deceased donor-special blood tests are needed to find out what type of blood and tissue is present. These test results help to match a donor kidney to the recipient.

Blood Type Testing

The first test establishes the blood type. There are four blood types: A, B, AB, and O. Everyone fits into one of these inherited groups. The recipient and donor should have either the same blood type or compatible ones, unless they are participating in a special program that allow donation across blood types. The list below shows compatible types:

  • If the recipient blood type is A Donor blood type must be A or O
  • If the recipient blood type is B Donor blood type must be B or O
  • If the recipient blood type is O Donor blood type must be O
  • If the recipient blood type is AB Donor blood type can be A, B, AB, or O

The AB blood type is the easiest to match because that individual accepts all other blood types.

Blood type O is the hardest to match. Although people with blood type O can donate to all types, they can only receive kidneys from blood type O donors. For example, if a patient with blood type O received a kidney from a donor with blood type A, the body would recognize the donor kidney as foreign and destroy it.

Tissue Typing

The second test, which is a blood test for human leukocyte antigens (HLA), is called tissue typing. Antigens are markers found on many cells of the body that distinguish each individual as unique. These markers are inherited from the parents. Both recipients and any potential donors have tissue typing performed during the evaluation process.

To receive a kidney where recipient's markers and the donor's markers all are the same is a "perfect match" kidney. Perfect match transplants have the best chance of working for many years. Most perfect match kidney transplants come from siblings.

Although tissue typing is done despite partial or absent HLA match with some degree of "mismatch" between the recipient and donor.

Crossmatch

Throughout life, the body makes substances called antibodies that act to destroy foreign materials. Individuals may make antibodies each time there is an infection, with pregnancy, have a blood transfusion, or undergo a kidney transplant. If there are antibodies to the donor kidney, the body may destroy the kidney. For this reason, when a donor kidney is available, a test called a crossmatch is done to ensure the recipient does not have pre-formed antibodies to the donor .

The crossmatch is done by mixing the recipient's blood with cells from the donor. If the crossmatch is positive, it means that there are antibodies against the donor. The recipient should not receive this particular kidney unless a special treatment is done before transplantation to reduce the antibody levels. If the crossmatch is negative, it means the recipient does not have antibodies to the donor and that they are eligible to receive this kidney.

Crossmatches are performed several times during preparation for a living donor transplant, and a final crossmatch is performed within 48 hours before this type of transplant.

Serology

Testing is also done for viruses, such as HIV (human immunodeficiency virus), hepatitis, and CMV (cytomegalovirus) to select the proper preventive medications after transplant. These viruses are checked in any potential donor to help prevent spreading disease to the recipient.

Phases of Transplant

Pre-transplant Period

This period refers to the time that a patient is on the deceased donor waiting list or prior to the completion of the evaluation of a potential living donor. The recipient undergoes testing to ensure the safety of the operation and the ability to tolerate the anti-rejection medication necessary after transplantation. The type of tests varies by age, gender, cause of renal disease, and other concomitant medical conditions. These may include, but are not limited to:

  • General Health Maintenance: general metabolic laboratory tests, coagulation studies, complete blood count, colonoscopy, pap smear and mammogram (women) and prostate (men)
  • Cardiovascular Evaluation: electrocardiogram, stress test, echocardiogram, cardiac catheterization
  • Pulmonary Evaluation: chest x-ray, spirometry

Potential Reasons of Excluding Transplant Recipient

  • Uncorrectable cardiovascular disease
  • History of metastatic cancer or ongoing chemotherapy
  • Active systemic infections
  • Uncontrollable psychiatric illness
  • Current substance abuse
  • Current neurological impairment with significant cognitive impairment and no surrogate decision maker

Transplant Surgery

The transplant surgery is performed under general anesthesia. The operation usually takes 2-4 hours. This type of operation is a heterotopic transplant meaning the kidney is placed in a different location than the existing kidneys. (Liver and heart transplants are orthotopic transplants, in which the diseased organ is removed and the transplanted organ is placed in the same location.) The kidney transplant is placed in the front (anterior) part of the lower abdomen, in the pelvis.

The original kidneys are not usually removed unless they are causing severe problems such as uncontrollable high blood pressure, frequent kidney infections, or are greatly enlarged. The artery that carries blood to the kidney and the vein that carries blood away is surgically connected to the artery and vein already existing in the pelvis of the recipient. The ureter, or tube, that carries urine from the kidney is connected to the bladder. Recovery in the hospital is usually 3-7 days.

Complications can occur with any surgery. The following complications do not occur often but can include:

  • Bleeding, infection, or wound healing problems.
  • Difficulty with blood circulation to the kidney or problem with flow of urine from the kidney.

 

Post Transplant Period

The post transplant period requires close monitoring of the kidney function, early signs of rejection, adjustments of the various medications, and vigilance for the increased incidence of immunosuppression-related effects such as infections and cancer.

Just as the body fights off bacteria and viruses (germs) that cause illness, it also can fight off the transplanted organ because it is a "foreign object." When the body fights off the transplanted kidney, rejection occurs.

Rejection is an expected side effect of transplantation and up to 30% of people who receive a kidney transplant will experience some degree of rejection. Most rejections occur within six months after transplantation, but can occur at any time, even years later. Prompt treatment can reverse the rejection in most cases.

Anti-Rejection Medications

Anti-rejection medications, also known as immunosuppressive agents, help to prevent and treat rejection. They are necessary for the "lifetime" of the transplant. If these medications are stopped, rejection may occur and the kidney transplant will fail.

Below is a list of medications that might be used after a kidney transplant. A combination of these drugs will be prescribed dependent on the specific transplant needs.

Anti-inflammatory Medication

Prednisone is taken orally or intravenously. Most side effects of prednisone are related to drug dosage levels. Prednisone is used at low dosages to minimize side effects. The possible side effects of prednisone are:

  • Changes in physical appearance such as puffiness of the face and weight gain.
  • Irritation to the stomach lining.
  • Increased risk of bruising and decreased rate of healing.
  • Increased sugar level in the blood (steroid-induced diabetes).
  • Unexplained mood changes. This may mean depression, irritability, or high spirits.
  • General muscle weakness or pain in knees or joints.
  • Formation of cataracts. A clouding of the lens of the eye occurs infrequently with long-term use of prednisone.

Anti-proliferative Medications

Azathioprine (Imuran®) is taken orally or intravenously. The most common side effects associated with azathioprine are:

  • Thinning of hair
  • Irritation of the liver
  • Decreased white blood cell count

Mycophenolate mofetil (CellCept®) is taken orally. The most common side effects of mycophenolate mofetil are:

  • Abdominal aches and/or diarrhea
  • Decreased white blood cell count
  • Decreased red blood cell count

Mycophenolate sodium (Myfortic®) is taken orally. It provides the same active ingredient as mycophenolate mofetil and generally has the same side effect profile. It is enterically coated to potentially reduce abdominal aches and diarrhea.
Sirolimus (Rapamune®) is taken orally. The most common side effects of sirolimus are:

  • Decreased platelet count
  • Decreased white blood cell count
  • Decreased red blood cell count
  • Elevated cholesterol and triglycerides

Cytokine Inhibitors

Cyclosporine (Neoral®, Gengraf®) is taken orally. The most common side effects of cyclosporine therapy are:

  • Kidney dysfunction
  • Tremors
  • Irritation of the liver
  • Excessive body hair growth
  • High blood pressure
  • Swollen/bleeding gums
  • High potassium in the blood
  • Increased sugar level in the blood (drug-induced diabetes)

Tacrolimus (Prograf®) is taken orally. The most common side effects of tacrolimus therapy are:

  • Kidney dysfunction
  • High blood pressure
  • High potassium in the blood
  • Increased sugar level in the blood (drug-induced diabetes)
  • Tremors
  • Headaches
  • Insomnia

Antilymphocyte Medications

Antithymocyte globulin (Thymoglobulin®) is given intravenously. Thymoglobulin can cause:

  • Decreased white blood cell and platelet counts
  • Sweating
  • Itching
  • Rash
  • Fever

Muromonab-CD3 (OKT3®) is given intravenously and can cause:

  • Chills
  • Fever
  • Diarrhea
  • Headache
  • Shortness of breath

Anti-interleukin-2 Receptor Antibody (Zenapax® or Simulect®) These two drugs are given intravenously. These medications rarely cause side effects but can include:

  • Chills
  • Headache
  • Allergic reaction

Alemtuzumab (Campath®)

  • Fever
  • Chills
  • Rash
  • Shortness of breath
  • Decreased white blood cell counts

Living Donor Kidney Transplantation

Living donor kidney transplants are the best option for many patients for several reasons.

  • Better long-term results
  • No need to wait on the transplant waiting list for a kidney from a deceased donor
  • Surgery can be planned at a time convenient for both the donor and recipient
  • Lower risks of complications or rejection, and better early function of the transplanted kidney

Any healthy person can donate a kidney. When a living person donates a kidney the remaining kidney will enlarge slightly as it takes over the work of two kidneys. Donors do not need medication or special diets once they recover from surgery. As with any major operation, there is a chance of complications, but kidney donors have the same life expectancy, general health, and kidney function as most other people. The kidney loss does not interfere with a woman's ability to have children.

Potential Barriers to Living Donation

  • Age < 18 years unless an emancipated minor
  • Uncontrollable hypertension
  • History of pulmonary embolism or recurrent thrombosis
  • Bleeding disorders
  • Uncontrollable psychiatric illness
  • Morbid obesity
  • Uncontrollable cardiovascular disease
  • Conronic lung disease with impairment of oxygenation or ventilation
  • History of melanoma
  • History of metastatic cancer
  • Bilateral or recurrent nephrolithiasis (kidney stones)
  • Chronic Kidney Disease (CKD) stage 3 or less
  • Proteinuria > 300 mg/d excluding postural proteinuria
  • HIV infection

If a person successfully completes a full medical, surgical, and psychosocial evaluation they will undergo the removal of one kidney. Most transplant centers in the United States use a laparoscopic surgical technique for the kidney removal. This form of surgery, performed under general anesthesia, uses very small incisions, a thin scope with a camera to view inside of the body, and wand-like instruments to remove the kidney. Compared with the large incision operation used in the past, laparoscopic surgery has greatly improved the donor's recovery process in several ways:

  • Decreased need for strong pain medications
  • Shorter recovery time in the hospital
  • Quicker return to normal activities
  • Very low complication rate

The operation takes 2-3 hours. Recovery time in the hospital is typically 1-3 days. Donors often are able to return to work as soon as 2-3 weeks after the procedure.

Occasionally the kidney needs to be removed through an open incision in the flank region. Prior to the use of the laparoscopic technique, this surgery was the standard for the removal of the donated kidney. It involves a 5-7 inch incision on the side, division of muscle and removal of the tip of the twelfth rib. The operation typically lasts 3 hours and the recovery in the hospital averages 4-5 days with time out of work of 6-8 weeks.

Although laparoscopy is increasingly used over open surgery, from time to time, the surgeon may elect to do an open procedure when individual anatomic differences in the donor suggest that this will be a better surgical approach.

The quality and function of the kidneys recovered with either technique work equally well. Regardless of technique all donors will require lifelong monitoring of their overall health, blood pressure and kidney function.

 

Live Donor to Deceased Donor Waiting List Exchange

This program is a way for a living donor to benefit a loved one, even if their blood or tissue types do not match. The donor gives a kidney to another patient who has a compatible blood type and is at the top of the kidney waiting list for a "deceased donor" kidney. In exchange, that donor's relative or friend would move to a higher position on the deceased donor waiting list, a position equal to that of the patient who received the donor's kidney.

For example, if the donor's kidney went to the fourth patient on the deceased donor waiting list, the recipient would move to the fourth spot on the list for his or her blood group and would receive kidney offers once at the top of the list.

Paired Exchange Kidney Transplant

This program is another way for a living donor to benefit a loved one even if their blood or tissue types do not match. A "paired exchange" allows patients who have willing but incompatible donors to "exchange" kidneys with one another-the kidneys just go to different recipients than usually expected.

An example of how this works would be if Mary wanted to give her sister Susan a kidney, but differences in blood type made it impossible, and Kevin wanted to give his sister Sarah a kidney, but differences in blood type made that impossible (see picture below). A paired exchange would be arranged so that Mary would donate to Sarah and Kevin would donate to Susan. The two pairs can thus "exchange" kidneys so that both donors give kidneys and both patients receive kidneys.

That means that two kidney transplants and two donor surgeries will take place on the same day at the same time.

 

Blood Type Incompatible Kidney Transplant

This is a program that lets patients receive a kidney from a living donor who has an incompatible blood type. To be able to receive such a kidney, patients must undergo several treatments before and after the transplant to remove the harmful antibodies that can lead to rejection of the transplanted kidney.

A special process called plasmapheresis, which is similar to dialysis, is used to remove these harmful antibodies from the patient's blood.

Patients require multiple treatments with plasmapheresis before transplant, and may require several more after transplant to keep their antibody levels down. Some patients may also need to have their spleens removed at the time of transplant surgery to lower the number of cells that produce antibodies. The spleen, a spongy organ about as big as a person's fist, produces blood cells. Located in the upper left part of the abdomen under the rib cage, the spleen can be removed laparoscopically.

Positive Crossmatch and Sensitized Patient Kidney Transplant

This program makes it possible to perform kidney transplants in patients who have developed antibodies against their kidney donors-a situation known as "positive crossmatch."

The process is similar to that for blood type-incompatible kidney transplants. Patients receive medications to decrease their antibody level or they may undergo plasmapheresis treatments to remove the harmful antibodies from their blood. If their antibody levels to their donors are successfully reduced, they can then go ahead with the transplants.

Blood type-incompatible kidney transplants and positive crossmatch/sensitized patient kidney transplants have been very successful in the United States and internationally. Success rates are close to those for transplants from compatible living donors and are better than success rates for deceased donor transplants.

Deceased Donor Kidney Transplantation

When an individual does not have a living donor but is an acceptable transplant candidate, he/she will be placed on a waiting list. In 1984, Congress passed the National Organ Transplant Act. This act prohibited the sale of human organs and mandated a national Organ Procurement and Transplantation Network (OPTN) to oversee organ recovery and placement and equitable organ distribution policies. The United Network for Organ Sharing (UNOS) is an independent, non-profit organization. It was awarded the national OPTN contract in 1986. It is the only organization ever to operate the OPTN.

Organ Procurement Organizations (OPO) are non-profit agencies operating in designated service areas covering whole states or just parts of a state. OPOs are responsible for: approaching families about the option of donation, evaluating suitability of potential donors, coordinating the recovery and transportation of donated organs and educating the public about the need for organ donation.

Most deceased donor kidneys are transplanted to recipients in the same service area as the deceased donor. Although there are recommended guidelines for organ allocation, each OPO may request a "variance" to fit the special needs to the patients waiting for kidney transplantation in their service area.

Whenever a donor is identified within an OPO the HLA tissue typing results are entered into the UNOS national computer system. UNOS has the HLA tissue typing information of all patients awaiting kidney transplantation in the United States. If a waiting list patient has the identical HLA tissue type as the donor the kidney will be given to him/her regardless of the geography.

Unfortunately, many more patients are medically suitable for transplants than organs available. The waiting times are many years and growing longer. Many patients develop medical and surgical complications while waiting which may prevent them from receiving a deceased donor kidney transplant in the future.

Special Programs For Deceased Donor Transplantation

Expanded Criteria Donor Program

Although the most commonly transplanted deceased donor kidneys come from previously healthy donors between the ages of 18 and 60, kidneys from other deceased donors have been successfully transplanted. The goal of this program is to use organs from less traditional donors more effectively so that more patients can receive kidney transplants.

Kidney Transplants from Less Traditional Deceased Donor Category

  • Age 60 or older
  • Between the ages of 50-59 with at least two of the following conditions:
  1. History of high blood pressure
  2. A serum creatinine (kidney function test) level greater than 1.5 (normal is 0.8-1.4)
  3. Cause of death was from a stroke or a brain aneurysm

Patients who are most likely to benefit from a kidney through this program are dialysis patients who are older and have a greater risk of problems, including death, while waiting for a transplant. Accepting a kidney from an expanded criteria donor may shorten the waiting period for a transplant. Patients who are considered for this type of transplant also remain on the waiting list for standard kidney offers.

Hepatitis C Donor Program

About 8% of patients on the deceased donor waiting list have the Hepatitis C virus. By accepting a kidney from a deceased donor who also had Hepatitis C, these patients could shorten the waiting time for a deceased donor kidney.

The use of kidneys from donors who had Hepatitis C does not appear to have a harmful effect on the survival of the transplanted kidney or on the overall health of the patient, provided that he or she has been evaluated carefully before receiving the transplant.

HIV Program

A growing number of patients with end-stage renal disease are infected with the HIV virus. Through the use of effective antiviral therapy, these patients are surviving on dialysis with their HIV disease and are being considered more and more frequently for kidney transplantation.

 

Current Issues in Kidney Transplantation

Kidney Allocation Policies

Currently the organ supply cannot meet the demand and there is no foreseeable end to the problem. Patients wait many years for a transplant. People are dying or becoming medically unsuitable for transplantation as these waiting times grow longer. Also, there are significant geographic differences in access to transplantation and wait times.

As each organ is a precious resource that should be utilized for maximum efficiency, the transplant community is changing the way kidneys are distributed to patients on the waiting list. Some patients may benefit, others are disadvantaged, and a delicate balance must be struck between fairness and equality.

On one hand, organs are a scarce resource and could be given to patients who would maximize the duration of the transplanted organ. In contrast organs are a societal resource that could be distributed to all potential patients based on waiting time. These two views represent utility versus equity in organ allocation. The final decision regarding the allocation policy will likely fall somewhere in between the two viewpoints.

Xenotransplantation (transplant across species)

Even with creative ways to utilize more living and deceased donors, another source of kidneys is most likely necessary. Xenotransplantation has already occurred from non-human primate donors such as chimpanzees, monkeys and baboons.

However these animals are endangered species and the size and blood type differences as well as the concern of transmission of infectious diseases has led to a ban of these transplants by the Food and Drug Administration. Currently most of the research in this field is centered on the pig as the potential xenograft donor. Pigs have desirable characteristics: multiple offspring, rapid maturity to adult age, lower risk of transmissible infectious diseases and appropriate size.

The many barriers to successful xenotransplantation are under study and continued advances may lead to this type of transplantation solving the organ shortage crisis.

Transplant Tourism

With the short supply of organs and long waiting times, patients are now traveling outside of the United States to receive a kidney transplant. Commercialism and poor regulation can undermine the true nature of transplantation and put patient's lives at risk.

Tolerance

Lifelong immunosuppression is a tremendous burden on patients. Tolerance, or the ability of the body to "accept" an organ without daily anti-rejection medication has been the "Holy Grail" of transplantation. Many animal models as well as isolated reports of patients being withdrawn from these medications are encouraging.

Most of the successful models incorporate intensive medication at the time of transplant with bone marrow infusions from the donor that supplied the organ. The recipient incorporates the bone marrow cells, becomes "chimeric" and the new bone marrow cells re-educate the recipient to accept the organ. There are many issues to be refined in human transplantation but scientists and clinicians are working together to eliminate the need for lifelong immunosuppression.

Kidney Transplantation Clinical Trials

Continued advances in our understanding of the mechanisms involved in the acceptance of a kidney transplant has led to new and exciting medications. After testing the new medications in animal models, these drugs move into human clinical trials. The great success of transplantation has occurred as a result of basic science research, careful testing of innovative medications and patients' willingness to participate in controlled studies of new medications. Even tolerance protocols will require short term administration of new immunosuppressive medication. The cooperation and participation of patients in clinical trials is essential to keep the field of kidney transplantation moving forward.

  • Track 5-1Advances in Kidney Transplantation
  • Track 5-2Transplantation Techniques
  • Track 5-3Pediatric Renal Transplantation
  • Track 5-4Dual Kidney Transplantation
  • Track 5-5Pregnancy after Transplantation
  • Track 5-6Post-Transplant Complications
  • Track 5-7Acute Renal Allograft Rejection
  • Track 5-8Stem Cell Transplantation
  • Track 5-9Screening Tests
  • Track 5-10Transplantation – Epidemiology
  • Track 5-11Transplantation – Immunosuppression
  • Track 5-12Transplantation - Outcomes
  • Track 5-13Transplantation – Surgery

Paediatric Nephrology covers

  • Comprehensive Pediatric Nephrology
  • Clinical Pediatric Nephrology
  • Pediatric Renal Failure
  • Diagnostic Techniques
  • Pediatric Renal Transplantation
  • Advances in Kidney Operation
  • Pediatric Kidney Dialysis
  • Pediatric Kidney Care
  • Pediatric Kidney Failure Diet

Conditions & Treatments

Acute kidney failure – the sudden loss of the kidney’s ability to remove waste from the body

Acute nephritic syndrome – a set of kidney disorders that can lead to swelling or inflammation of internal parts of the kidney

Analgesic nephropathy – damage caused to one or both kidneys due to too much of a mixture of medications, commonly seen when there is an overexposure to over-the-counter pain medications

Congenital nephrotic syndrome – a genetically-passed disorder in which a baby develops protein in the urine that causes swelling in the body

Chronic renal failure - the gradual loss of the kidney's ability to remove body waste

Goodpasture syndrome – a rare disease that causes kidney failure and lung disease

Hypertension - high blood pressure

Interstitial nephritis – a disorder in which the areas between the kidney tubes become inflamed, which can affect the kidney’s ability to manage the body’s waste

Kidney removal – surgery performed to remove all or part of a person’s kidney

Kidney stone – a group of tiny crystals that are difficult to pass through the body

Kidney transplant – the placement of a healthy kidney in a patient with kidney failure

Lithotripsy – the use of shock waves to break up stones that have formed in the kidney, bladder or the tubes that drain urine from the kidneys to the bladder

Lupus nephritis – a kidney disorder, caused by the autoimmune disease, systemic lupus erythematosus

Membranoproliferative glomerulonephritis – a kidney disorder that leads to inflammation of the kidney, as well as tiny changes to the kidney’s cells that lead to disruption of the kidney’s normal processes

Membranous nephropathy – a kidney disorder that causes inflammation and structural changes inside the kidney, leading to problems with the kidney’s normal processes

Nephrocalcinosis – a kidney disorder in which an excess amount of calcium is left in the kidneys

Polycystic kidney disease – a genetically-passed kidney disorder in which multiple cysts form on the kidneys, causing them to enlarge

Post-streptococcal GN – a kidney disorder caused by infection with particular strains of the Streptococcus (strep) bacteria

Posterior urethral valve - the presence of valves within the urethra that block the urine flowing out of the bladder

Vesicoureteral reflux - The back-up of urine toward the kidney

Reflux nephropathy – Kidney damage due to vesicoureteral reflux

Renal papillary necrosis – a condition in which all or part of the openings of the kidney’s collecting ducts die

Renal artery or vein thrombosis – a blood clot in the artery or vein in which blood passes from the kidney

Renal tubular acidosis - the build-up of body acid caused when kidneys fail to excrete body acids 

More

 

Acute renal failure

  • Acute kidney injury in children: Clinical features, etiology, evaluation, and diagnosis 
  • Fractional excretion of sodium, urea, and other molecules in acute kidney injury 
  • Neonatal acute kidney injury: Evaluation, management, and prognosis
  • Neonatal acute kidney injury: Pathogenesis, etiology, clinical presentation, and diagnosis 
  • Pediatric acute kidney injury: Indications, timing, and choice of modality for renal replacement therapy (RRT) 
  • Prevention and management of acute kidney injury (acute renal failure) in children 

Chronic kidney disease

  • Chronic kidney disease in children: Definition, epidemiology, etiology, and course 
  • Clinical presentation and evaluation of chronic kidney disease in children 
  • Growth hormone treatment in children with chronic kidney disease and postrenal transplantation 
  • Overview of the management of chronic kidney disease in children 
  • Pediatric chronic kidney disease-mineral and bone disorder (CKD-MBD) 
  • Uremic toxins 

Chronic Renal Failure

  • Chronic peritoneal dialysis in children 
  • Hemodialysis for children with chronic kidney disease 
  • Overview of renal replacement therapy (RRT) for children with chronic kidney disease 
  • Pathogenesis, evaluation and diagnosis of growth impairment in children with chronic kidney disease 
  • Prevention and management of growth failure in children with chronic kidney disease 

Congenital and genetic disorders

  • Autosomal dominant polycystic kidney disease in children 
  • Autosomal dominant tubulointerstitial kidney disease (medullary cystic kidney disease) 
  • Autosomal recessive polycystic kidney disease in children 
  • Clinical manifestations, diagnosis, and treatment of Alport syndrome (hereditary nephritis) 
  • Clinical manifestations, diagnosis, and treatment of nephronophthisis 
  • Congenital and infantile nephrotic syndrome 
  • Cystinosis 
  • Evaluation of congenital anomalies of the kidney and urinary tract (CAKUT) 
  • Genetics and pathogenesis of nephronophthisis 
  • Genetics, pathogenesis, and pathology of Alport syndrome (hereditary nephritis) 
  • Nail-patella syndrome 
  • Overview of congenital anomalies of the kidney and urinary tract (CAKUT) 
  • Primary hyperoxaluria 
  • Renal agenesis: Prenatal diagnosis 
  • Renal cystic diseases in children 
  • Renal ectopic and fusion anomalies 
  • Renal hypodysplasia 
  • Renal involvement in the mitochondrial cytopathies
  • Williams-Beuren syndrome: Renal manifestations

Fluid and electrolyte disorders

  • Approach to the child with metabolic acidosis 
  • Causes, clinical manifestations, diagnosis, and evaluation of hyperkalemia in children 
  • Clinical assessment and diagnosis of hypovolemia (dehydration) in children
  • Clinical features and diagnosis of diabetic ketoacidosis in children and adolescents 
  • Clinical manifestations and causes of central diabetes insipidus 
  • Clinical manifestations and causes of nephrogenic diabetes insipidus 
  • Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis 
  • Etiology and clinical manifestations of renal tubular acidosis in infants and children 
  • General principles of disorders of water balance (hyponatremia and hypernatremia) and sodium balance (hypovolemia and edema) 
  • Hypernatremia in children 
  • Hypokalemia in children 
  • Hyponatremia in children 
  • Maintenance fluid therapy in children 
  • Management of hyperkalemia in children 
  • Oral rehydration therapy
  • Pathophysiology and etiology of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) 
  • Simple and mixed acid-base disorders 
  • The delta anion gap/delta HCO3 ratio in patients with a high anion gap metabolic acidosis 
  • Treatment and complications of diabetic ketoacidosis in children and adolescents 
  • Treatment of central diabetes insipidus 
  • Treatment of hypovolemia (dehydration) in children
  • Treatment of nephrogenic diabetes insipidus 
  • Urine anion and osmolal gaps in metabolic acidosis 
  • Urine output in diabetes insipidus 

Glomerular disease

  • Complications of nephrotic syndrome in children 
  • Etiology, clinical manifestations, and diagnosis of nephrotic syndrome in children 
  • Evaluation and management of edema in children 
  • Evaluation of a child with glomerular disease 
  • Evaluation of microscopic hematuria in children 
  • Evaluation of proteinuria in children 
  • Focal segmental glomerulosclerosis: Epidemiology, classification, clinical features, and diagnosis 
  • Focal segmental glomerulosclerosis: Genetic causes
  • Focal segmental glomerulosclerosis: Pathogenesis
  • Overview of the pathogenesis and causes of glomerulonephritis in children 
  • Pathophysiology and etiology of edema in children 
  • Poststreptococcal glomerulonephritis 
  • Steroid-resistant idiopathic nephrotic syndrome in children 
  • Symptomatic management of nephrotic syndrome in children 
  • Treatment of idiopathic nephrotic syndrome in children 

Hemolytic-uremic syndrome

  • Clinical manifestations and diagnosis of Shiga toxin-producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children 
  • Complement-mediated hemolytic uremic syndrome 
  • Overview of hemolytic uremic syndrome in children 
  • Treatment and prognosis of Shiga toxin-producing Escherichia coli (STEC) hemolytic uremic syndrome (HUS) in children 

Hypertension

  • Ambulatory blood pressure monitoring in children 
  • Approach to hypertensive emergencies and urgencies in children 
  • Definition and diagnosis of hypertension in children and adolescents 
  • Epidemiology, risk factors, and etiology of hypertension in children and adolescents 
  • Etiology, clinical features, and diagnosis of neonatal hypertension 
  • Evaluation and diagnosis of hypertension in infants between one month and one year of age 
  • Evaluation of hypertension in children and adolescents 
  • Genetic factors in the pathogenesis of hypertension 
  • Management of hypertension in infants 
  • Nonemergent treatment of hypertension in children and adolescents 
  • The metabolic syndrome (insulin resistance syndrome or syndrome X) 

Nephrolithiasis

  • Acute management of nephrolithiasis in children
  • Clinical features and diagnosis of nephrolithiasis in children 
  • Epidemiology of and risk factors for nephrolithiasis in children 
  • Nephrocalcinosis in neonates
  • Prevention of recurrent nephrolithiasis in children 

Other

  • Evaluation and management of edema in children 
  • Pathophysiology and etiology of edema in children 

Transplantation

  • Complications of renal transplantation in children 
  • General principles of renal transplantation in children 
  • Immunosuppression in renal transplantation in children
  • Outcomes of renal transplantation in children 

Urinary abnormalities

  • Evaluation of gross hematuria in children 
  • Evaluation of microscopic hematuria in children 
  • Evaluation of proteinuria in children 

Urinary tract infections

  • Clinical presentation, diagnosis, and course of primary vesicoureteral reflux 
  • Management of vesicoureteral reflux 
  • Urinary tract infections in children: Epidemiology and risk factors 
  • Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis 
  • Urinary tract infections in neonates 

Urologic disorders

  • Clinical manifestations and initial management of infants with bladder exstrophy 
  • Etiology and clinical features of bladder dysfunction in children 
  • Evaluation and diagnosis of bladder dysfunction in children 
  • Management of bladder dysfunction in children 
  • Overview of fetal hydronephrosis 
  • Postnatal management of fetal hydronephrosis 

 

  1. 16th International Conference on Nephrology & Therapeutics
  2. Annual Dialysis Conference
  3. World Nephrology Congress (WCN)
  4. Kidney Week
  5. International Conference on Nephrology
  6. ISN World Congress of Nephrology
  7. 20th International Conference on Dialysis
  8. 37th Annual Advanced Nephrology: Nephrology for the Consultant
  9. Glomerular Disease, Updates 2018 - 7th Annual
  10. The 7th Annual Glomerular Conference
  11. Cutting Edge of Transplantation - Transplant Summit 2018
  12. 16th Annual Mayo Clinic Update in Nephrology and Transplantation 2018
  13. 23rd International Conference on Advances in Critical Care Nephrology (AKI & CRRT 2018)
  14. Nephrology 2018
  15. Update in Nephrology and Hypertension 2018
  16. American Transplant Congress (ATC)
  17. 17th Congress of the International Society of Peritoneal Dialysis (ISPD 2018)
  18. 2017 Onco-Nephrology Symposium
  19. American Urological Association (AUA) 2018 Annual Meeting
  20. 18th Annual Meeting of the Society of Urologic Oncology
  21. EDGE Endourology and Enucleation Symposium 2018
  22. National Kidney Foundation Spring Clinical Meeting (SCM 2018)
  23. National Family Medicine Board Review 2018
  24. 16th Annual Update in Nephrology and Kidney Transplantation 2018
  25. Controversies in Dialysis Access (CiDA) 2018
  26. Kidney Cancer Association (KCA) Patient and Survivor Conference 2017
  27. Continuous Renal Replacement Therapy (CRRT) University Pediatric Centered Care Conference 2017
  28. Advanced Practices in Acute Kidney Injury (APAKI) 2018
  29. American Society of Diagnostic and Interventional Nephrology (ASDIN) 14th Annual Scientific Meeting
  30. Volhard-Fahr Nephropathy Course 2018
  31.  International Society of Nephrology (ISN) Frontiers Symposium 2018
  32. Renal Physicians Association (RPA) Annual Meeting 2018
  33. Harvard Medical School (HMS) Nephrology 2018
  34. American Nephrology Nurses Association (ANNA) 49th National Symposium
  35. Update on Chronic Kidney Disease 2018
  36. Nephrology Update 2018
  37. 12th International Podocyte (IPC) Conference
  38. Updates in Kidney Transplant and Donation 2018
  39. 41st Annual Postgraduate Medicine Course: The Columbia Renal Biopsy Course
  40. Nephrology Nursing Practice, Management, & Leadership Conference
  41. National Renal Administrators Association (NRAA) Annual Fall Conference 2018
  42. Canadian Society of Nephrology (CSN) Conference in America 2018
  43. Florida Society of Nephrology (FSN) Annual Meeting 2019
  44. American Nephrology Nurses Association (ANNA) 50th National Symposium
  45. Polycystic Kidney Disease
  46. Treating to Target in Patients with Gout and Chronic Kidney Disease: A Patient Simulation
  47. Continuous Renal Replacement Therapy: Case Vignettes
  48. Fabry Disease: When to Treat
  49. Kidney and Kidney-Pancreas Transplantation: Evaluation and Management
  50. Virtual Symposium: Evolving Therapeutic Paradigms for the Management of Hyperkalemia
  51. Pediatric Hypertension - UC Davis Pediatric Nephrology series
  52. 2017 Memorial Sloan Kettering Cancer Center Onco-Nephrology Symposium
  53. Inaugural Jefferson Urology Symposium: Innovations in the Endoscopic Use of the Holmium Laser
  54. National Association of Nephrology Technicians/Technologists (NANT)

 

  • Track 6-1Comprehensive Pediatric Nephrology
  • Track 6-2Clinical Pediatric Nephrology
  • Track 6-3Pediatric Renal Failure
  • Track 6-4Diagnostic Techniques
  • Track 6-5Pediatric Renal Transplantation
  • Track 6-6Advances in Kidney Operation
  • Track 6-7Pediatric Kidney Dialysis
  • Track 6-8Pediatric Kidney Care
  • Track 6-9Pediatric Kidney Failure Diet

Kidney, or renal, cancer refers to any type of cancer that involves the kidney. Older age, obesity, smoking, and high blood pressure increase the risk of developing kidney cancer.

The kidneys are part of the urinary system, which eliminates waste and excess fluid and electrolytes from the blood. They also control the production of red blood cells and regulate blood pressure.

Kidney cancers mainly originate in two parts of the kidney, the renal tubule and the renal pelvis. A cancer that starts outside the kidney and metastasizes to the kidney is not normally called kidney cancer.

Around 63,990 new cases of kidney cancer are diagnosed in the United States each year, causing over 14,000 deaths annually. In 2017, 40,610 American men and 23,380 women were expected to receive a diagnosis of kidney cancer.

Kidney cancer is one of the 10 most common cancers, affecting about 1 in every 63 people over a lifetime. It occurs more frequently among adults aged between 50 and 80 years.

Worldwide, North America has the highest rate of kidney cancer, but in developing countries, the incidence has been steadily increasing over the last three decades. This increase may be linked to a parallel rise in obesity rates, or it could be due to improved detection and diagnosis.

Symptoms

Kidney cancer rarely causes signs or symptoms in its early stages. And currently there are no routine tests used to screen for kidney cancer in the absence of symptoms. In the later stages, kidney cancer signs and symptoms may include:

Blood in your urine, which may appear pink, red or cola colored

Pain in your back or side that doesn't go away

Loss of appetite

Unexplained weight loss

Tiredness

Fever, which usually comes and goes (intermittent)

Types of kidney cancer

The most common form of kidney cancer is renal cell carcinoma or RCC for short. About 90 per cent of kidney cancers are RCCs. There are several different sub-types of RCC, which are named according to the type of cell that is affected, or the appearance of the cancer cells under the microscope. The most common of these is clear cell, which account for about 75 per cent of RCCs. Other subtypes include papillary, chromophobe, and collecting duct carcinoma.

Subtypes of renal cell carcinoma (RCC):

  • Conventional or clear cell RCC – this can also be called non-papillary RCC and accounts for 75 per cent of RCC cases. The cancer cells appear clear under the microscope and have large nuclei.
  • Papillary or chromophilic RCC accounts for about 10-15 per cent of RCC cases. The tumours have characteristic papillae or nodules on the surface.
  • Chromophobe RCC accounts for about 5 per cent of cases
  • Collecting duct carcinoma
  • Renal medullary carcinoma
  • Mucinous tubular and spindle-cell carcinoma
  • Renal translocation carcinomas
  • Unclassified RCC, the latter five of which together make up the remaining 5-10 per cent of RCC tumours

Tests for kidney cancer

The tests you might need may include:

  • An ultrasound scan – a scan that uses high frequency sound waves to create an image of your kidneys so your doctor can spot any problems
  • a computerised tomography (CT) scan – a detailed scan where several X-rays are taken and then put together by a computer; you may be given an injection of a special dye beforehand so your kidneys show up more clearly
  • a magnetic resonance imaging (MRI) scan – a scan that uses strong magnetic fields and radio waves to produce a detailed image of your kidneys
  • a cystoscopy – where a thin tube is passed up your urethra (the tube that carries urine out of the body) so your doctor can spot any problems in your bladder
  • a biopsy – where a needle is inserted into your kidney to remove a small tissue sample for analysis in a laboratory; local anaesthetic is used to numb the area so the procedure doesn't hurt
  • These tests can confirm or rule out kidney cancer. If you have cancer, they can help show whether it has spread to other parts of your body.

Stages of kidney cancer

If you're diagnosed with kidney cancer, it will usually be given a "stage". This is a number that describes how far the cancer has spread.

Doctors use the TNM system to stage kidney cancer. This consists of three numbers:

  • T (tumour) – given from 1 to 4, depending on the size of the tumour
  • N (node) – given from 0 to 2, depending on whether the cancer has spread to nearby lymph glands
  • M (metastases) – given as either 0 or 1, depending on whether the cancer has spread to another part of the body

Treatment

The treatment for kidney cancer depends on the size of the cancer and whether it has spread to other parts of the body.

The main treatments are:

  • surgery to remove part or all of the affected kidney – this the main treatment for most people
  • ablation therapies – where the cancerous cells are destroyed by freezing or heating them
  • biological therapies – medications that help stop the cancer growing or spreading
  • embolisation – a procedure to cut off the blood supply to the cancer
  • radiotherapy – where high-energy radiation is used to target cancer cells and relieve symptoms

Cancer that hasn't spread out of the kidney can usually be cured by removing some or all of the kidney, although sometimes cryotherapy or radiofrequency ablation may be used instead.

A complete cure may not be possible if the cancer has spread, but it may be possible to slow its progression and treat any symptoms with surgery, medication and/or radiotherapy.

Surgery

There are two main types of surgery for kidney cancer:

  • an operation to just remove part of the kidney containing the cancer – called a partial nephrectomy
  • an operation to remove the entire affected kidney – called a radical nephrectomy

A partial nephrectomy is usually done if the cancer is small and easy for the surgeon to access. A radical nephrectomy may be necessary for larger cancers or if the cancer has spread beyond the kidney.

It's possible to live a normal life with only one kidney. Your other kidney can usually make up for the kidney that was removed.

Surgery for kidney cancer can be carried out in one of two ways:

  • through a single large incision (cut) in the tummy or back – known as "open" surgery
  • using special surgical tools inserted through smaller incisions – known as laparoscopic or "keyhole" surgery

Keyhole surgery tends to have a faster recovery time, but can only be done by surgeons with special training and it isn't always suitable. Talk to your surgeon about the pros and cons of each method.

Ablation therapies

Ablation therapies are treatments that involve either:

  • destroying cancer cells by freezing them (cryotherapy)
  • destroying cancer cells by heating them (radiofrequency ablation)

Either technique may be recommended in special circumstances (for example, to ensure your kidney keeps working), or if your tumour is small. Both treatments are only available in specialist centres, so you may need to travel to another hospital to have it.

Radiofreqency ablation is carried out by inserting a needle-like probe through your skin, so no large incisions are needed.

Cryotherapy is carried out using needles inserted into the tumour. This can be done through your skin (percutaneous cryotherapy) or through a small incision (laparoscopic cryotherapy).

Side effects of ablation therapies can include bleeding around the kidney and damage to the tube that carries urine from the kidney to the bladder (the ureter).

Biological therapies

If your cancer is advanced, treatment with biological therapies may be offered. These are medications, usually taken once or twice a day, that help stop the cancer growing and spreading.

There are many different biological therapies, including:

  • sunitinib
  • pazopanib
  • axitinib
  • everolimus
  • bevacizumab and interferon
  • nivolumab
  • tivozanib

At present, sunitinib, pazopanib, axitinib, everolimus, nivolumab and tivozanib are recommended for routine use on the NHS.

Some people with advanced kidney cancer may be offered a medication called lenvatinib, to take along with everolimus.

Side effects

Sunitinib, pazopanib, axitinib and tivozanib are all taken as regular tablets. Possible side effects include:

  • feeling and being sick
  • indigestion
  • diarrhoea
  • high blood pressure
  • a sore mouth
  • loss of appetite and weight loss
  • tiredness
  • infertility

Nivolumab is given as a drip directly into a vein every two weeks. It works by helping the body's immune system destroy the cancer cells. Side effects are uncommon, but can include:

  • a rash
  • diarrhoea
  • a cough and shortness of breath
  • tiredness

Embolisation

Embolisation is a procedure to block off the blood supply to the tumour, causing it to shrink.

It's sometimes recommended if you have advanced kidney cancer and you're not in good enough health to have surgery to remove the affected kidney.

During embolisation, the surgeon will insert a small tube called a catheter into a blood vessel in your groin and then guide it to the blood vessel supplying the tumour.

A substance will be injected through the catheter to block the blood vessel.

Radiotherapy

Radiotherapy is a treatment where radiation is used to target or destroy cancerous cells. It can't usually cure kidney cancer, but it can slow down its progress and help control your symptoms.

It may be recommended if you have advanced kidney cancer that has spread to other parts of the body, such as your bones or brain.

The treatment involves a large machine directing a carefully aimed beam of radiation at the cancerous cells. It's often carried out for a few minutes every day, over a few weeks.

Side effects of radiotherapy can include:

  • tiredness
  • feeling and being sick
  • diarrhoea
  • reddening of the skin in the treatment area

Care and support

If you're diagnosed with cancer, your treatment and medical care will be of utmost importance.

But other aspects of your life are also important. You'll need to think about the kind of support you need, and know what assistance is available and where you can get it.

Support is also available for people who care for ill partners, children, relatives or friends.

  • Track 7-1Renal cell carcinoma
  • Track 7-2Types of renal cell carcinoma
  • Track 7-3Renal cell carcinoma risk factors
  • Track 7-4Pathophysiology
  • Track 7-5Treatment and Outcomes
  • Track 7-6Chemotherapy
  • Track 7-7Immunotherapy
  • Track 7-8Targeted Therapy

Diabetic kidney disease develops in approximately 40% of patients who are diabetic and is the leading cause of CKD worldwide. Although ESRD may be the most recognizable consequence of diabetic kidney disease, the majority of patients actually die from cardiovascular diseases and infections before needing kidney replacement therapy. The natural history of diabetic kidney disease includes glomerular hyperfiltration, progressive albuminuria, declining GFR, and ultimately, ESRD. Metabolic changes associated with diabetes lead to glomerular hypertrophy, glomerulosclerosis, and tubulointerstitial inflammation and fibrosis. Despite current therapies, there is large residual risk of diabetic kidney disease onset and progression. Therefore, widespread innovation is urgently needed to improve health outcomes for patients with diabetic kidney disease. Achieving this goal will require characterization of new biomarkers, designing clinical trials that evaluate clinically pertinent end points, and development of therapeutic agents targeting kidney-specific disease mechanisms (e.g., glomerular hyperfiltration, inflammation, and fibrosis). Additionally, greater attention to dissemination and implementation of best practices is needed in both clinical and community settings.Introduction

 

Diabetic nephropathy -- kidney disease that results from diabetes -- is the number one cause of kidney failure. Almost a third of people with diabetes develop diabetic nephropathy.

People with diabetes and kidney disease do worse overall than people with kidney disease alone. This is because people with diabetes tend to have other long-standing medical conditions, like high blood pressure, high cholesterol, and blood vessel disease (atherosclerosis). People with diabetes also are more likely to have other kidney-related problems, such as bladder infections and nerve damage to the bladder.

Kidney disease in type 1 diabetes is slightly different than in type 2 diabetes. In type 1 diabetes, kidney disease rarely begins in the first 10 years after diagnosis of diabetes. In type 2 diabetes, some patients already have kidney disease by the time they are diagnosed with diabetes.

How Does Diabetes Cause Kidney Disease?

When our bodies digest the protein we eat, the process creates waste products. In the kidneys, millions of tiny blood vessels (capillaries) with even tinier holes in them act as filters. As blood flows through the blood vessels, small molecules such as waste products squeeze through the holes. These waste products become part of the urine. Useful substances, such as protein and red blood cells, are too big to pass through the holes in the filter and stay in the blood.

Diabetes can damage this system. High levels of blood glucose make the kidneys filter too much blood. All this extra work is hard on the filters. After many years, they start to leak and useful protein is lost in the urine. Having small amounts of protein in the urine is called microalbuminuria.

When kidney disease is diagnosed early, during microalbuminuria, several treatments may keep kidney disease from getting worse. Having larger amounts of protein in the urine is called macroalbuminuria. When kidney disease is caught later during macroalbuminuria, end-stage renal disease, or ESRD, usually follows.

 

In time, the stress of overwork causes the kidneys to lose their filtering ability. Waste products then start to build up in the blood. Finally, the kidneys fail. This failure, ESRD, is very serious. A person with ESRD needs to have a kidney transplant or to have the blood filtered by machine (dialysis).

What Are the Symptoms of Diabetic Nephropathy?

There are often no symptoms with early diabetic nephropathy. As the kidney function worsens, symptoms may include:

  • Swelling of the hands, feet, and face
  • Trouble sleeping or concentrating
  • Poor appetite
  • Nausea
  • Weakness
  • Itching (end-stage kidney disease) and extremely dry skin
  • Drowsiness (end-stage kidney disease)
  • Abnormalities in the hearts' regular rhythm, because of increased potassium in the blood
  • Muscle twitching

How Is Diabetic Nephropathy Diagnosed?

Certain blood tests that look for specific blood chemistry can be used to diagnose kidney damage. It also can be detected early by finding protein in the urine. Treatments are available that can help slow progression to kidney failure. That's why you should have your urine tested every year if you have diabetes.

 

How Is Diabetic Nephropathy Treated?

Lowering blood pressure and maintaining blood sugar control are absolutely necessary to slow the progression of diabetic nephropathy. Some medicines called angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage. Although ACE inhibitors -- including ramipril (Altace), quinapril (Accupril) , and lisinopril (Prinivil, Zestril) -- are usually used to treat high blood pressure and other medical problems, they are often given to people with diabetes to prevent complications, even if their blood pressure is normal.

If a person has side effects from taking ACE inhibitors, another class of drugs called angiotensin receptor blockers (ARBs) can often be given instead.

If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure requires treatment with dialysis or a kidney transplant.

  • Track 8-1Diabetic Nephropathy
  • Track 8-2Diabetes Mellitus (Clinical)
  • Track 8-3Diabetic Nephropathy–Biomarkers of Disease
  • Track 8-4Intensive Management of Blood Glucose
  • Track 8-5Genetics of Kidney Disease–Diabetic Kidney Disease
  • Track 8-6Hypertension-Clinical and Experimental Models
  • Track 8-7Renal Hemodynamics and Vascular Physiology

According to the Center for Disease Control (CDC), heart disease is the leading cause of death in the United States and stroke is the third leading cause. Both of these conditions are caused by cardiovascular disease. Cardiovascular disease is common in people with chronic kidney disease (CKD) regardless of age, stage of kidney disease or if they’ve had a transplant. In addition, underlying conditions that cause renal disease, such as high blood pressure and diabetes, put people at risk for cardiovascular disease

Complications that develop from chronic kidney disease, as well as the underlying conditions that cause chronic kidney disease, can put you at risk for cardiovascular disease. The following are complications that develop from renal disease and can lead to cardiovascular disease:

Anemia: Anemia is when your body does not have enough red blood cells. The kidneys manufacture a hormone called erythropoietin, which tells the bone marrow to make more red blood cells. If your kidneys are damaged, your erythropoietin levels can fall, and your body will not make enough red blood cells.

Several studies have shown that anemia can be related to cardiovascular disease. Red blood cells contain a protein called hemoglobin, which helps transport oxygen throughout the body. Fewer red blood cells mean less oxygen goes to the body’s tissues and organs. If a body is not getting enough oxygen, the heart is not getting enough oxygen either. Without adequate oxygen to the heart muscles, a person may be susceptible to a heart attack. Anemia can also cause the heart to pump more blood in order to circulate enough oxygen throughout the body. As the heart works harder, the muscle in the left lower chamber of the heart can develop thick walls. This is a condition called left ventricular hypertrophy (LVH). LVH can increase the chance of heart failure.

High blood pressure: The kidneys make renin, which is an enzyme that helps control blood pressure. When blood pressure is too low, healthy kidneys release renin to stimulate different hormones that increase blood pressure. Damaged kidneys may release too much renin, which can lead to high blood pressure. High blood pressure increases the risk of heart attack, congestive heart failure and stroke.

High homocysteine levels: Homocysteine is an amino acid normally found in blood. Healthy kidneys regulate the amount of homocysteine in the blood and remove any excess. But damaged kidneys cannot remove the extra homocysteine. High levels of homocysteine have been linked to the build up of plaque in the blood vessels, which can lead to cardiovascular diseases such as atherosclerosis (when fatty material deposited along the artery walls gets hard and blocks the blood flow) and coronary artery disease. High levels of homocysteine may also damage the lining of the blood vessels, making a person prone to blood clots which increase the risk of stroke and heart attack.

Calcium-phosphate levels: Different studies have suggested a link between the calcium and phosphorus levels in patients undergoing dialysis and the hardening of the coronary arteries. Healthy kidneys help keep calcium and phosphorus levels in balance. But damaged kidneys cannot do this. Often, there is too much phosphorus and calcium in the blood. When this happens, there is a risk for coronary artery disease.

Diabetes and high blood pressure are the two leading causes of kidney disease. Here is how each can affect your heart and lead to cardiovascular disease:

Diabetes: Diabetes is a condition where excess sugar remains in the bloodstream. This sugar can damage the blood vessels not only in the kidneys but elsewhere in the body, including the major blood vessels that feed the muscles of the heart.

High blood pressure: Not only is high blood pressure a complication from diabetes, it is also a cause of kidney disease. Too much pressure can weaken the walls of the blood vessels, which can lead to a stroke.

Treating cardiovascular disease in people with kidney disease

Whether your cardiovascular disease is caused by complications of your kidney disease or by the underlying cause of your kidney disease, it's important to be aware of the impact it can have on your overall health. Treating the cause of your cardiovascular disease and keeping other conditions like chronic kidney disease, diabetes and high blood pressure under control will help you feel better.

Your kidney doctor will monitor the health of your kidneys and check for signs of cardiovascular disease. You will also be monitored for complications like anemia and high blood pressure. Part of your treatment program may include taking certain medications to treat these complications, as well as treating any calcium or phosphorus imbalances in the body. Your doctor will also refer you to a renal dietitian, who will work with you to create a kidney-friendly and heart-friendly diet that is low in cholesterol and saturated fats.

If you have diabetes and/or high blood pressure, your kidney doctor will work with your family doctor and renal dietitian to treat both conditions. Your treatment plan may include a combination of medication and diet. Managing your diabetes and blood pressure levels in the early stages of kidney disease will help slow the damage to your kidneys as well as reduce your risk for cardiovascular disease.

Your doctor may also recommend exercise as part of your treatment program. Based on your physical condition, age and other factors, your doctor will suggest activities that are right for you. If you smoke, your doctor will recommend that you stop. Smoking increases your risk of cardiovascular disease, and can cause other complications.  

Chronic kidney disease affects more than your kidneys; it can put vital organs such as your heart at risk. Managing your renal disease and the underlying causes of your kidney disease, such as diabetes and high blood pressure, can reduce your chances of developing cardiovascular disease.

 

How can I keep my heart and kidneys healthy?

These tips can help keep your kidney and heart health on track. You should always speak with your healthcare provider before making any changes to your diet and lifestyle.

  • Regular physical activity
  • Lose weight, if you need to
  • Eat less fat
  • Keep your blood pressure, blood sugar, and blood fats under control
  • Stop smoking
  • Reduce stress

A good way to keep the heart and kidney connection in mind is to remember, what is good for your kidneys is good for your heart. Keeping up the health of your heart is good for the health of your kidneys.

Nephrology Resources

 

  1. Centers Watch
  2. Dialysis & Transplantation
  3. Dialysis Facility Compare from Medicare
  4. Hypertension, Dialysis and Clinical Nephrology (HDCN) ASN Education
  5. Kidney Epidemiology and Cost Center at the University of Michigan
  6. Medical Historical Library Internet Resources (SIR) from Cushing/Whitney Medical Library (Yale)
  7. Medicare and Kidney Disease Education from Medicare
  8. National Academies
  9. National Library of Medicine (NLM) (Home Page - MEDLINE Database/PubMed Search)
  10. NLM MEDLINE plus Health Information (Kidney Failure and Dialysis)
  11. Nephron Information Center
  12. Renal Fellow Network
  13. Renal Research Institute (RRI)
  14. RenalWEB
  15. RenalWEB Current Monthly Journals
  • Track 9-1Cardiorenal syndrome
  • Track 9-2Effects of Cardiovascular Diseases on the Kidney
  • Track 9-3Diseases Affecting both Organs
  • Track 9-4Modification of Cardiac Drugs in Renal Disease
  • Track 9-5Hypertension
  • Track 9-6Kidney and Vascular Diseases
  • Track 9-7Hypophosphatemia, Hyperuricemia, Hyperkalemia
  • Track 9-8Hypertension, CKD and Diabetes
  • Track 9-9Reno vascular hypertension, Anti hypersensitive therapy
  • Track 9-10Recent Advances in Glomerular Disorders and Hypertension
  • Track 9-11Anemia and Erythropoietin, Renal Osteodystrophy

Tubulointerstitial diseases are clinically heterogeneous disorders that share similar features of tubular and interstitial injury. In severe and prolonged cases, the entire kidney may become involved, with glomerular dysfunction and even renal failure. The primary categories of tubulointerstitial disease are

  • Acute tubular necrosis
  • Acute or chronic tubulointerstitial nephritis

Contrast nephropathy is acute tubular necrosis caused by an iodinated radiocontrast agent.

 

Analgesic nephropathy is a type of chronic interstitial nephritis, and reflux nephropathy and myeloma kidney can involve chronic tubulointerstitial nephritis.

Tubulointerstitial disorders can also result from metabolic disturbances and exposure to toxins.

Pathophysiology

The kidneys are exposed to unusually high concentrations of toxins. The kidneys have the highest blood supply of all tissues (about 1.25 L/min or 25% of cardiac output), and unbound solutes leave the circulation via glomerular filtration at ≥ 100 mL/min; as a result, toxic agents are delivered at a rate 50 times that of other tissues and in much higher concentrations. When urine is concentrated, the luminal surfaces of tubular cells may be exposed to molecule concentrations 300 to 1000 times greater than those of plasma. The fine brush border of proximal tubular cells exposes an enormous surface area. A countercurrent flow mechanism increases ionic concentration of the interstitial fluid of the medulla (and thereby increases urine concentration) up to 4 times the plasma concentration.

In addition, factors can affect cellular vulnerability after exposure to toxins:

  • Tubular transport mechanisms separate drugs from their binding proteins, which normally protect cells from toxicity.
  • Transcellular transport exposes the interior of the cell and its organelles to newly encountered chemicals.
  • Binding sites of some agents (eg, sulfhydryl groups) may facilitate entry but retard exit (eg, heavy metals).
  • Chemical reactions (eg, alkalinization, acidification) may alter transport in either direction.
  • Blockade of transport receptors may alter tissue exposure (eg, diuresis from blockade of adenosine A1 receptors, such as with aminophylline, may decrease exposure).
  • The kidneys have the highest oxygen and glucose consumption per gram of tissue and are therefore vulnerable to toxins affecting cell energy metabolism.

 

Acute tubular necrosis (ATN)

Acute tubular necrosis (ATN) is kidney injury characterized by acute tubular cell injury and dysfunction. Common causes are hypotension or sepsis that causes renal hypoperfusion and nephrotoxic drugs. The condition is asymptomatic unless it causes renal failure. The diagnosis is suspected when azotemia develops after a hypotensive event, severe sepsis, or drug exposure and is distinguished from prerenal azotemia by laboratory testing and response to volume expansion. Treatment is supportive.

Analgesic nephropathy

Analgesic nephropathy is chronic tubulointerstitial nephritis caused by cumulative lifetime use of large amounts (eg, ≥ 2 kg) of certain analgesics. Patients present with kidney injury and usually non-nephrotic proteinuria and bland urinary sediment or sterile pyuria. Hypertension, anemia, and impaired urinary concentration occur as renal insufficiency develops. Papillary necrosis occurs late. Diagnosis is based on a history of analgesic use and results of noncontrast CT. Treatment is stopping the causative analgesic.

 

Contrast nephropathy

Contrast nephropathy is worsening of renal function after IV administration of radiocontrast and is usually temporary. Diagnosis is based on a progressive rise in serum creatinine 24 to 48 h after contrast is given. Treatment is supportive. Volume loading with isotonic saline before and after contrast administration may help in prevention.

Others

  • Heavy Metal Nephropathy
  • Metabolic Nephropathies
  • Myeloma-Related Kidney Disease
  • Tubulointerstitial Nephritis
  • Vesicoureteral Reflux and Reflux Nephropathy
  • Track 10-1Glomerulonephritis
  • Track 10-2Other Tubular Changes
  • Track 10-3Glomerulopathy
  • Track 10-4Acute Pyelonephritis
  • Track 10-5Chronic Pyelonephritis
  • Track 10-6Acute Infectious Tubulointerstitial Nephritis
  • Track 10-7Tin Associated with Systemic Infection
  • Track 10-8Chronic Infectious Tin (Chronic Pyelonephritis)
  • Track 10-9Specific Renal Infections
  • Track 10-10Xanthogranulomatous Pyelonephritis
  • Track 10-11Acute Interstitial Nephritis Associated to Drugs
  • Track 10-12Acute Tubular Necrosis
  • Track 10-13Respiratory Alkalosis

The renal system maintain homeostasis in the body avoiding significant modifications in the balance of fluid electrolyte or acid–base parity until the Glomerular filtration rates reduced to below 25 ml/min because of  a series of versatile changes, both Renal and extra renal. With dynamic decrease in renal capacity these components are overpowered bringing about unsettling influences in water digestion system adding to hypernatremia and hypernatremia. The modified control of sodium transport causes irritated volume status including volume over-burden and exhaustion. The rate of Hyperkalemia and metabolic acidosis is more incessant in Chronic Kidney Disease (CKD) with GFR beneath 10 ml/min. In this survey article we will endeavor to audit the renal and additional renal adjustment components looking after liquid, electrolyte and corrosive base equalization in endless kidney illness alongside variables which cause disappointment of these instruments. The article will likewise highlight the normal liquid electrolyte and corrosive base issue in interminable kidney ailment and their treatment.

Fluids and Electrolytes

  1. List the normal range of Na+, K+, HCO3-, Cl- in serum and indicate how these ranges change in perspiration, gastric juice, bile and ileostomy contents.
  2. List at least four endogenous factors that affect renal control of sodium and water excretion.
  3. List least six symptoms or physical findings of dehydration.
  4. List and describe the objective ways of measuring fluid balance.
  5. List the electrolyte composition of the following solutions:
    1. normal (0.9%) saline
    2. 1/2 normal saline
    3. 1/3 normal saline
    4. 5% dextrose in water
    5. Ringer’s lactate
  6. In the following situations, indicate whether serum Na, K, HCO3, Cl and blood pH will remain stable, rise considerably, rise moderately, fall moderately, or fall considerably:
    1. excessive gastric losses
    2. high volume pancreatic fistula
    3. small intestine fistula
    4. biliary fistula
    5. diarrhea
  7. In the following situations, indicate whether serum and urine Na, K, HCO3, Cl and osmolality will remain stable, rise considerably, rise moderately, fall moderately, or fall considerably:
    1. acute tubular necrosis
    2. dehydration
    3. inappropriate ADH secretion (SIADH)
    4. diabetes insipidus
    5. congestive heart failure
  8. Describe the possible causes, appropriate laboratory studies needed, and treatment of the following conditions:
    1. hypernatremia
    2. hyponatremia
    3. hyperkalemia
    4. hypokalemia
    5. hyperchloremia
    6. hypochloremia
  9. Describe the concept of a "third space" and list those conditions that can cause fluid sequestration of this type.

Acid Base Balance

  1. List the physiological limits of normal blood gases.
  2. List the factors that effect oxygen delivery and consumption.
  3. Indicate the mechanisms, methods of compensation, differential diagnosis, and treatment of the following acid base disorders:
    1. acute metabolic acidosis
    2. acute respiratory acidosis
    3. acute metabolic alkalosis
    4. acute respiratory alkalosis
  • Track 11-1Disorders of Plasma Osmolality
  • Track 11-2Electrolyte Disorders in Diabetes Mellitus
  • Track 11-3Hydration in Kidney Disease Prevention
  • Track 11-4Disturbances of Plasma Sodium Concentration
  • Track 11-5Disturbances of Plasma Potassium Concentration
  • Track 11-6Disturbances of Plasma Calcium Concentration
  • Track 11-7Physiology of Acid-Base System
  • Track 11-8Metabolic Acidosis
  • Track 11-9Respiratory Acidosis
  • Track 11-10Metabolic Alkalosis
  • Track 11-11Cardiovascular Calcification

Bone disorders in chronic kidney disease (CKD) are associated with heightened risks of fractures, vascular calcification, poor quality of life and mortality compared to the general population.

How does CKD affect my bones?

Calcium and phosphorus are two important minerals for healthy bones. These minerals are found in many foods you eat. In chronic kidney disease, calcium and phosphorus get out of balance. If the kidneys are not working at full capacity, they may not be able to get rid of enough phosphorus to keep the balance. Over time, phosphorus can build up in the blood and calcium can get too low.

When this happens, the parathyroid glands make too much of a hormone called PTH. High PTH pulls calcium out of the bones making them weak and some of the calcium may end up in the heart and blood vessels which may lead to heart and blood vessel disease. At the same time levels of vitamin D can drop, which can contribute to abnormal levels of calcium, phosphorus, and parathyroid hormone.

What are the symptoms of bone disease in CKD?

Most people do not have symptoms in the early stages of CKD. Even though no symptoms are felt, bone disease needs to be treated. Itching may be a sign that phosphorus levels are too high. With more advanced disease, other symptoms may appear:

  • Bone pain

  • Muscle weakness

  • Fractures

  • Joint pain

How do I know if my bones have been affected by CKD?

Simple blood tests will tell us. This should be done every 1-12 months depending on your stage of CKD. Phosphorus levels should range from 2.7 to 4.6. The normal range for calcium will vary at different labs. Your parathyroid hormone (PTH) levels are evaluated on an individual basis.

Will I need treatment if my numbers are not in the right range?

You may. If your phosphorus or PTH numbers are too high, you will need to follow a diet that is low in phosphorus. We can refer you to a registered dietician who has special training in diets for kidney disease.

What if diet is not enough to control my phosphorus and PTH?

If your phosphorus and PTH are still too high, your doctor may also ask you to take a medication called a phosphate binder. These pills (some examples are Phoslo, TUMS, Fosrenol, and Renvela) help keep phosphorus from going into your blood by binding to the phosphorus in the foods you eat. The bound phosphorus cannot get into your blood and is passed out of your body in the stool when you have a bowel movement. To work best, phosphate binders should be taken with food or within 10-15 minutes of eating. If you take the phosphate binders between meals, they will not work.

Will I need to take vitamin D?

You may. Vitamin D is very important in affecting your calcium and parathyroid hormone balance. Your doctor or nurse practitioner will help to decide which form if Vitamin D is right for you.

Is exercise important?

Yes. Exercise is important to overall good health and to bone health, too. Many people with kidney disease find that a simple exercise program can increase strength and energy in addition to protecting your bones and helping your blood pressure. Please speak to your doctor or nurse practitioner before beginning an exercise program.

How is bone disease related to heart & blood vessel problems?

When calcium and phosphorus are not in balance and the bone is diseased, calcium can be deposited in body tissues where it does not belong. Some deposits may be in the heart and blood vessels. Over time, this can increase your chances of developing heart disease.

Is osteoporosis similar to bone disease in CKD?

Both cause bones to become weak and break more easily. However the cause and treatment are different. Osteoporosis happens to some people as they age. Is is common in women after menopause. Some medications commonly used for osteoporosis may not be right for you, or may need to be adjusted if you have CKD.

 

Web Sites for Nephrologists
 

  1. Barbara's Kidney Web Site
  2. Bryan's Kidney Page
  3. Claire's Web Site
  4. Dialysis & Kidney Disease Face Book discussion page
  5. Care-Partners for Home Dialysis Face Book discussion page
  6. Home Dialysis Central Face Book discussion page
  7. Home Dialyzors United Face Book discussion page
  8. I Hate Dialysis web site
  9. I Hate Dialysis Face Book discussion page
  10. Kidney Disease, Dialysis, and Transplantation Face Book discussion page
  11. Living Donors Online Message Board discussion page
  12. MedWish web site for donating medical supplies
  13. My Twenty-Eight Years on Dialysis
  14. Polycystic Kidney Disease Face Book discussion page
  15. Presumed Consent Foundation
  16. The Renal Gourmet
  17. Women's Renal Failure Support Face Book discussion page

 

  • Track 12-1Mineral and Bone Disorder in Chronic Kidney Disease
  • Track 12-2Mineral and Bone Disorder in Children with Chronic Kidney Disease
  • Track 12-3Treatment with Active Forms of Vitamin D

Kidney or bladder stones are solid build-ups of crystals made from minerals and proteins found in urine. Bladder diverticulum, enlarged prostate, neurogenic bladder and urinary tract infection can cause an individual to have a greater chance of developing bladder stones.

If a kidney stone becomes lodged in the ureter or urethra, it can cause constant severe pain in the back or side, vomiting, hematuria (blood in the urine), fever, or chills.

If bladder stones are small enough, they can pass on their own with no noticeable symptoms. However, once they become larger, bladder stones can cause frequent urges to urinate, painful or difficult urination and hematuria.

Stones are made of minerals in the urine that form crystals. Sometimes the crystals grow into stones. About 85% of the stones are composed of calcium, and the remainder are composed of various substances, including uric acid, cystine, or struvite. Struvite stones—a mixture of magnesium, ammonium, and phosphate—are also called infection stones, because they form only in infected urine.

How are kidney and bladder stones diagnosed and evaluated?

Imaging is used to provide your doctor with valuable information about the kidney or bladder stones, such as location, size and effect on the function of the kidneys. Some types of imaging that your doctor may order include:

  • Abdominal and pelvic CT: This is the most rapid scanning method for locating a stone. This procedure can provide detailed images of the kidneys, ureters, bladder and urethra, identify a stone and reveal whether it is blocking urinary flow. See the Safety page for more information about CT procedures.
  • Intravenous pyelogram (IVP): This is an x-ray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins to evaluate the urinary system. See the Safety page for more information about x-rays.
  • Abdominal and Pelvic ultrasound: These exams use sound waves to provide pictures of the kidneys and bladder and can identify blockage of urinary flow and help identify stones.

How are kidney and bladder stones treated?

If a stone blocks urine flow and drainage of the kidney, there are a variety of possible treatments. An option that your doctor may choose is:

  • Ureteral stenting or nephrostomy: A ureteral stent is a thin, flexible tube threaded into the ureter by a urologist to restore the flow of urine to the bladder from the kidney.
  • A nephrostomy is performed by an interventional radiologist when ureteral stenting is not possible or desirable. A tube is placed through the skin on the patient's back into the kidney and the tube is connected to an external drainage bag. The procedure is usually performed with fluoroscopy.

 

  • Track 13-1Kidney stones
  • Track 13-2Bladder Stones
  • Track 13-3Treatment
  • Track 13-4Surgery
  • Track 13-5Surgery
  • Track 13-6Artificial Kidney
  • Track 13-7Nutrition
  • Track 13-8Natural Remedies

Urology is a part of health care that deals with diseases of the male and female urinary tract (kidneys, ureters, bladder and urethra). It also deals with the male organs that are able to make babies (penis, testes, scrotum, prostate, etc.). Since health problems in these body parts can happen to everyone, urologic health is important.

Urology is known as a surgical specialty. Besides surgery, a urologist is a doctor with wisdom of internal medicine, pediatrics, gynecology and other parts of health care. This is because a urologist encounters a wide range of clinical problems. The scope of urology is big and the American Urological Association has named seven subspecialty parts:

  • Pediatric Urology (children's urology)
  • Urologic Oncology (urologic cancers)
  • Renal (kidney) Transplant
  • Male Infertility
  • Calculi (urinary tract stones)
  • Female Urology
  • Neurourology (nervous system control of genitourinary organs)

 

The urinary tract is your body’s drainage system for removing urine. Urine is composed of wastes and water. The urinary tract includes your kidneys, ureters, and bladder. To urinate normally, the urinary tract needs to work together in the correct order.

Urologic diseases or conditions include urinary tract infections, kidney stones, bladder control problems, and prostate problems, among others. Some urologic conditions last only a short time, while others are long-lasting.

A UTI is when bacteria gets into your urine and travels up to your bladder. UTIs cause more than 8.1 million visits to health care providers each year. About 10 in 25 women and 3 in 25 men will have symptoms of at least 1 UTI during their lifetime.

  • Track 14-1Urethritis
  • Track 14-2Pyelonephritis
  • Track 14-3Disorders of Urination
  • Track 14-4Obstruction of the Urinary Tract
  • Track 14-5Stones in the Urinary Tract
  • Track 14-6Prostate cancer
  • Track 14-7Kidney and urology
  • Track 14-8Female Urology
  • Track 14-9Imaging and Radiology
  • Track 14-10Infection and Inflammation
  • Track 14-11Oncology: Adrenal, Kidney, Prostate, Bladder, Urothelium and Urethra
  • Track 14-12Pediatric Urology
  • Track 14-13Sexual Function and Infertility
  • Track 14-14Technology and Instruments
  • Track 14-15Transplantation/Vascular Surgery
  • Track 14-16Trauma and Reconstruction
  • Track 14-17Urolithiasis and Endourology
  • Track 14-18Voiding Dysfunction/BPH
  • Track 15-1Inherited Kidney Diseases
  • Track 15-2Vascular Disease in the Elderly
  • Track 15-3Cardiovascular Disease in the Elderly with Kidney Disease
  • Track 15-4Hypertension, Chronic Kidney Disease, and the Elderly
  • Track 15-5Glomerular Disease in the Elderly
  • Track 15-6Drug Dosing and Renal Toxicity in the Elderly Patient
  • Track 15-7Kidney Disease in Elderly Diabetic Patients
  • Track 15-8Polycystic Kidney Disease (PKD)
  • Track 15-9Renal Cystic Diseases
  • Track 15-10Physical Exercise

Renal nutrition is concerned with the special nutritional needs of kidney patients. Renal nutrition is concerned with ensuring that kidney patients eat the right foods to make dialysis efficient and improve health. Dialysis clinics have dieticians on staff that who help patients plan meals. Standard guidelines are: eating more high protein foods, and less high salt, high potassium, and high phosphorus foods. Patients are also advised on safe fluid intake levels.

Most patients on haemodialysis need to adjust their diet. The major change in diet is usually a reduction in foods high in potassium, phosphate and sodium (salt). The dietician will give you individual guidance about how to achieve you dietary needs. Assessment of dietary intake, especially protein, is monitored from time to time to ensure an adequate protein and calorie intake, which is an important part of maintains a good quality of life and good health. However, if you are overweight an attempt to achieve an ideal body weight may be undertaken working within the restrictions of a renal diet.

 

Society

International Society of Renal Nutrition and Metabolism

Society of Renal Nutrition and Metabolism

 

Journal:

Journal of Renal Nutrition

Renal Nutrition Conferences | Kidney diet meetings | Nephrology dieticians congress | International dietetics events

  • Track 16-1Nutrition Therapy
  • Track 16-2Chronic Kidney Disease Diet
  • Track 16-3Renal Supplements
  • Track 16-4Fluid Intake
  • Track 16-5Low Sodium
  • Track 16-6Low Potassium
  • Track 16-7Low Phosphorous Diet
  • Track 16-8Low Protein Diet
  • Track 16-9Loss of Kidney Function Linked to Obesity

The conference main scientific session nephrology nursing includes the following topics:

  • Nephrology Nursing
  • Nursing Management
  • Critical care and Emergency Nursing
  • Nursing education
  • Clinical Nursing
  • Rehabilitation Nursing
  • Surgical Nursing
  • Pediatric Nursing
  • Kidney Cancer & Tumor Nursing
  • Health Care and Management
  • Kidney care Nursing
  • Home dialysis nursing
  • Cannulation
  • Dialysis nursing
  • Nurse Practitioner Updates

 

The nephrology nursing conference provides the all aspects of nursing education advanveces in nephrology, dialysis, renal and kidney care nursing.

The international conference is a rich mix of exhibitions, symposium, networking meetings, keynote and plenary sessions.

 

List of Nursing Organizations

NATIONAL

Alabama

Alaska

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Jersey State Nurses Association

New Mexico

New York

North Carolina

North Dakota

Ohio

Oklahoma

Oregon

Pennsylvania

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

Vermont

Virginia

Washington

Washington DC

West Virginia

Wisconsin

Wyoming

 

  • Track 17-1Nephrology Nursing
  • Track 17-2Dialysis nursing
  • Track 17-3Cannulation
  • Track 17-4Home dialysis nursing
  • Track 17-5Kidney care Nursing
  • Track 17-6Health Care and Management
  • Track 17-7Kidney Cancer & Tumor Nursing
  • Track 17-8Pediatric Nursing
  • Track 17-9Surgical Nursing
  • Track 17-10Rehabilitation Nursing
  • Track 17-11Clinical Nursing
  • Track 17-12Nursing education
  • Track 17-13Critical care and Emergency Nursing
  • Track 17-14Nursing Management
  • Track 17-15Nurse Practitioner Updates

For kidney disease diagnosis, you may also need certain tests and procedures, such as:

  • Blood tests. Kidney function tests look for the level of waste products, such as creatinine and urea, in your blood.
  • Urine tests. Analyzing a sample of your urine may reveal abnormalities that point to chronic kidney failure and help identify the cause of chronic kidney disease.
  • Imaging tests. Your doctor may use ultrasound to assess your kidneys' structure and size. Other imaging tests may be used in some cases.
  • Removing a sample of kidney tissue for testing. Your doctor may recommend a kidney biopsy to remove a sample of kidney tissue. Kidney biopsy is often done with local anesthesia using a long, thin needle that's inserted through your skin and into your kidney. The biopsy sample is sent to a lab for testing to help determine what's causing your kidney problem.

Kidney Diseases List

  • Track 20-1ACE Inhibitors
  • Track 20-2Angiotensin II Receptor Blockers (Arbs)
  • Track 20-3Beta-Blockers
  • Track 20-4Calcium Channel Blockers
  • Track 20-5Direct Renin Inhibitors
  • Track 20-6Diuretics
  • Track 20-7Vasodilator