Kidney biopsy

A kidney biopsy is often recommended for those who notice blood in the urine (hematuria), excess protein in the urine (proteinuria) or progressive kidney failure. Kidney biopsy might reveal the causes for improper functioning or rejection of a transplanted kidney. If urine tests, ultrasound or CT scan reveal possible kidney problems, kidney biopsy can aid in determining the cause.

A patient undergoing kidney biopsy is given sedation through IV. The biopsy needle is inserted through the skin with the aid of ultrasound. A small sample tissue is taken for examination. There is likely to be mild soreness in the muscle and some blood in the urine for the next 24 hours. Serious complications include puncture of a major blood vessel or bleeding into the kidney. Abnormal results of kidney biopsy show signs of scarring or inadequate blood flow or signs of disease such as renal cancer. Patients with blood clotting disorder are not advised to undergo this diagnostic test. Obesity, UTI, hypertension are some factors that can affect the accuracy of kidney biopsy results.

Uremia

Uremia is regarded as the end stage of Kidney Failure. Uremia is also called the 'second cancer'. Uremia is related to the second point filtering blood. The kidney is impaired and does not filter the waste products that result from the body's metabolism. When this function fails, the waste products and blood urea nitrogen accumulate in the bloodstream. This build-up is Azotaemia. Mild levels of azotaemia may not show symptoms. But continued kidney failure to filter the waste result in symptoms and this condition is called uremia.

Uremic patients show varied signs and symptoms collectively called as uremic syndrome.

Gastrointestinal tract: Loss of appetite, discomfort in the abdomen, nausea, vomiting, diarrhea, severe dehydration, oral ulcer, Glossitis (inflammation of the tongue) and urine taste in breath.

Nerves related: Headache, dizziness, lethargy, drowsiness, weakness, fatigue. In advanced stage symptoms such as irritability, muscle trembling, seizures and convulsions may be experienced.

Cardiovascular system: Hypertension and arrhythmia and in the advanced stage heart failure can happen.

Blood forming or hematopoietic system: Serious anemia and in the advanced stage bleeding can happen.

Respiratory system: Shortness of breath, difficulty breathing, chronic cough, respiratory disorders such as pleural effusion (fluid accumulation in the lungs), pneumonia, uremic bronchitis, pleurisy.

To decide on the course of treatment the cause of Uremia is of great significance. As Uremia can be life-threatening, quick and proper treatment may reverse the illness condition. The chief cause is of course, kidney failure or damage to kidneys.

Diseases that affect kidney function:

• Bright disease - Glomerulonephritis
  
  
• Chronic hypertension
  
  
• Diabetes mellitus
  
  
• Kidney diseases (Kidney failure, Kidney anomalies)
  
  
• Bladder cancer
  

Body conditions:

• Urinary stones that block flow of urine
  
  
• Enlarged prostate glands (in males)
  
  
• Injury to kidney
  
  
• Renal artery occlusion or embolism
  
  
• Cardio vascular problems (excessive bleeding, congestive heart failure)
  
  
• Gastro-metabolic disorder (diarrhea, vomiting, severe dehydration)
  
  
• Burns
  
  
• Lupus
  

How is Uremia diagnosed?

Most renal disease including Uremia do not cause symptoms in the early stages. Uremia is likely to be noticed incidentally from blood or urine tests done for other health issues. Urinalysis is done to detect protein and blood in urine. Blood clotting test, kidney biopsy and stool culture to ascertain presence of a certain type of E.coli bacteria or other bacteria.

• A normal hemoglobin level is below 80g/L. In persons with symptoms of Uremia, the level may decline to 40-60g/L. Also, the platelets or leukocyte levels may be high.
  
  
• In persons with symptoms of Uremia, BUN increases from its normal value of less than 20 mg/dL to approximately 80-100.
  
  
• A 24-hour urine sample for creatinine clearance is taken. If the test result shows below the normal of less than 1.0 mg/dL to approximately 10, there is a high possibility of renal failure.
  
  
• Estimated Glomerular Filtration Rate or eGFR is a measure that filtering and waste removal function of the kidneys. eGFR falls to less than 10-15 ml/1.73 m2.
  
  
• Calcium, phosphate, parathyroid hormone, albumin, potassium and Bicarbone- abnormalities prevalent in these are also observed as part of blood tests.

How is Uremia treated?

If the diagnosis is confirmed, the patient would be hospitalized for observation and treatment. The cause determines the treatment.

• Patients with diarrhea require intravenous fluids or re hydration and rebalancing of electrolytes like sodium and potassium which is lost with diarrhea. This is the immediate supportive care.
  
  
• Severely anemic patients are given blood transfusion when the hemoglobin falls below 6 or 7 gdL.
  
  
• Plasma exchange or plasmapherisis is usually for adults patients who are likely to have an abnormal chemical in the plasma stimulating abnormal clot formation. To rectify and balance, the plasma is removed and replaced with donor plasma.
  
  
• is done to filter the waste out of the blood while the kidneys recover.
  
  
• Kidney transplant is another choice.
  
  
• Eculizumab (Soliris) is an intravenous infusion approved by the FDA for the treatment of pediatric and adult patients with atypical hemolytic uremic syndrome (aHUS). Atypical Hemolytic-uremic syndrome is a syndrome characterized by three major problem areas, progressive renal failure, problems associated with red blood cell and platelet counts and problems that occur in the vascular system.

Nephrologist

Nephrologists are specialists who specialize in diagnosing and treating diseases related to the kidney. They are trained to mange kidney disorders too. Pediatric nephrologists treat the same conditions in infants, children, and young adults. Nephrologists should complete medical school and then complete three years in internal medicine and further specialize for two years in the field of nephrology. Pediatric nephrologists have to further take special certification to qualify as pediatric Nephrologist. Nephrologists also termed as renal physicians treat diseases related to the kidney, any malfunctioning in the kidney can affect other organs of the body.

• Conditions that can lead to kidney disorders such as hypertension and diabetes mellitus.
  
• Check the functioning of the kidney.
  
• They treat Polycystic kidney diseases.
  
• Prescribe medications for kidney disorders.
  
• Support kidney transplantation.
  
• Treat patients who have kidney failure also called as renal failure / uremia.
  
• Treat patients with kidney stones.
  
• Removes sample from the tissues of the kidney for biopsy purposes.