Health Tip Category: Nephrology

What is lupus nephritis?
There are two types of lupus. Systemic lupus erythematosus (SLE) is the form of lupus that can harm your skin, joints, kidneys and brain and may be fatal. The other form of lupus is called “discoid” lupus erythematosus, which affects only your skin. Systemic lupus erythematosus (SLE) that affects the kidneys is called lupus nephritis. Lupus is an “autoimmune” disease. With lupus, the body’s immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys.

Up to 60% of lupus patients will develop lupus nephritis. When the kidneys are inflamed, they can’t function normally and can leak protein. If not controlled, lupus nephritis can lead to kidney failure.

What causes lupus nephritis?
No one knows what causes the disease. Your family history and things in your environment such as infections, viruses, toxic chemicals or pollutants (car fumes, factory smoke) may play a role in causing the disease. Men and women of all ages and races get lupus. However, about 90 percent of people diagnosed with lupus are women.

What are the symptoms of lupus nephritis?
Lupus nephritis can cause many signs and symptoms and may be different for everyone. It is a serious problem. Its symptoms, though, are not always dramatic Signs of lupus nephritis include:

• Blood in the urine (hematuria)
• Edema
• Weight gain
• High blood pressure
• Dark urine
• Foamy, frothy urine
• The need to urinate during the night

Not all urinary or kidney problems in people with lupus are due to lupus nephritis. People with lupus may also be prone to urinary tract infections. These cause burning on urination and require treatment with antibiotics.

What tests are done to find out if I have lupus nephritis?
Your doctor will do a physical examination, get your medical history, and do special tests. These tests include:

• Urine test to check for protein and blood
• Blood tests
• Check your levels of protein and cholesterol
• Check your GFR (glomerular filtration rate) to show how well your kidneys are filtering wastes
• Check for antiphospholipid antibodies and antinuclear antibodies (ANA) at least once during your disease.
• Kidney biopsy to look at a tiny piece of the kidney under a microscope

How is lupus treated?
Lupus is treated with drugs that block your body’s immune system. These include drugs like steroids (corticosteroid) and antimalarial drugs. Everyone is different and your doctor will make a treatment plan that is right for you. Usually, treatment for lupus nephritis include:

• Corticosteroids (often called “steroids”)
• Immunosuppressive drugs
• ACE inhibitors and ARBs
• Diuretics
• Diet change

Even with treatment, loss of kidney function sometimes progresses. If both kidneys fail, people with lupus nephritis may need dialysis. Dialysis involves filtering the blood through a machine to remove waste products from the body.

Ultimately, it may be necessary to have a kidney transplant. In those cases, people will need additional drugs to keep their immune system from rejecting the transplanted kidney.

Do these treatments have side effects?
You should always speak with your doctor about the risks and benefits of any of the treatments you receive. Each of the drugs during any of these treatments can have their own side effects. Fortunately, these side effects usually are manageable for most patients. Discuss your treatment with your healthcare provider. Your overall health and the health of your kidneys should always be considered. There are times when the side effects of certain treatments are not worth the risk to your health.

If you are a woman with lupus nephritis and want to have children, you should discuss with your healthcare provider the effect your treatment may have on that process. There are ways to make sure that treatment is less harmful to this process.

The kidneys play several vital roles in maintaining good health. One of their most important jobs is to filter waste materials from the blood and expel them from the body as urine. The kidneys also help control the levels of water and various essential minerals in the body.

There is also need kidney function testing done if you have other conditions that can harm the kidneys, such as diabetes or high blood pressure.

Healthy kidneys remove wastes and excess fluid from the blood. Blood and urine tests show how well the kidneys are doing their job. Urine tests can show how quickly body wastes are being removed and whether the kidneys are leaking abnormal amounts of protein.

• Blood Tests
• Serum Creatinine

Creatinine is a waste product that comes from the normal wear and tear on muscles of the body. This blood test examines whether creatinine is building up in your blood. The kidneys usually completely filter creatinine from the blood. A high level of creatinine suggests a kidney problem. Creatinine levels in the blood can vary depending on age, race and body size. In many labs the normal range is 0.6 to 1.2 mg/dl. Higher levels may be a sign that the kidneys are not working properly. As kidney disease progresses, the level of creatinine in the blood increases.

• Blood Urea Nitrogen (BUN)

Urea nitrogen is produced from the breakdown of food protein. A normal BUN level is between 7 and 20 mg/dl. As kidney function decreases, the BUN level increases.

• Estimated Glomerular Filtration Rate (GFR)

This test estimates how well your kidneys are filtering waste. The test determines the rate by looking at factors, such as:

• test results, specifically creatinine levels
• age
• gender
• race
• height
• weight

Normal GFR can vary according to age (as you get older it can decrease). The normal value for GFR is 90 or above. A GFR below 60 is a sign that the kidneys are not working properly. A GFR below 15 indicates that a treatment for kidney failure, such as dialysis or a kidney transplant, will be needed.

• Urine Tests

Some urine tests require only a few ounces of urine. But some tests require collection of all urine produced for a full 24 hours. A 24-hour urine test shows how much urine your kidneys produce in 1 day. The test also can give an accurate measurement of how much protein leaks from the kidney into the urine in 1 day.

• Urinalysis

Includes microscopic examination of a urine sample as well as a dipstick test. The dipstick is a chemically treated strip, which is dipped into a urine sample. The strip changes color in the presence of abnormalities such as an excess amount of protein, blood, pus, bacteria and sugar. A urinalysis can help to detect a variety of kidney and urinary tract disorders, including chronic kidney disease, diabetes, bladder infections and kidney stones.
A urinalysis screens for the presence of protein and blood in the urine. There are many possible reasons for protein in your urine, not all of which are related to disease. Infection increases urine protein, but so does a heavy physical workout. Your doctor may want to repeat this test after a few weeks to see if the results are similar.

• Creatinine Clearance

A creatinine clearance test compares the creatinine in a 24-hour sample of urine to the creatinine level in the blood, to show how many milliliters of blood the kidneys are filtering out each minute (ml/min).

• Imaging Tests
• Ultrasound

This test uses sound waves to get a picture of the kidney. It may be used to look for abnormalities in size or position of the kidneys or for obstructions such as stones or tumors.

• CT scan

This imaging technique uses contrast dye to picture the kidneys. It may also be used to look for structural abnormalities and the presence of obstructions.

• Kidney Biopsy

A biopsy may be done occasionally for one of the following reasons:

• to identify a specific disease process and determine whether it will respond to treatment
• to evaluate the amount of damage that has occurred in the kidney
• to find out why a kidney transplant may not be doing well

A kidney biopsy is performed by using a thin needle with a sharp cutting edge to slice small pieces of kidney tissue for examination under a microscope.

6 Foods to avoid

The following 6 foods (and food components) can actually harm your bones or your kidneys (especially when consumed in large quantities) and some of them may surprise you.

• Animal Protein (Meat and Dairy)

For one thing, milk contains animal protein. This protein is highly acidifying, whether it comes from a goat, sheep, or cow. This is why the consumption of milk and other dairy products increases calcium secretion in the urine – the body must take calcium from the bones to neutralise the acid in your system before your kidneys get bombarded with the excess protein.
Meat is, of course, straight animal protein, meat-rich diets increase the risk of uric acid kidney stones. This is direct evidence that animal protein harms your kidneys.
A balanced vegetarian diet with a moderate animal protein results in the lowest risk of uric acid crystallisation compared to the omnivorous diets

• Caffeine

It is to become caffeine dependent. But while this stimulant may make you feel more energy temporarily, it ultimately makes you feel older and more tired.
Long-term caffeine use can increase your risk of renal failure. Even brief caffeine consumption increases your risk of developing kidney stones, especially on an empty stomach. So have caffeine in moderation.

• Synthetic Sweeteners

While it’s true that sugar is bad for your bones, the “fake stuff” will rapidly decrease your kidney function. The fact is, these artificial sweeteners are synthetic chemicals that are toxic and acidifying.

• Sodas

Beverages rob your bones of their youthful vitality in other ways besides crippling your kidneys. They literally melt your bones because of the enormous amount of caustic phosphoric acid they contain. This acid dissolves calcium, making it just about impossible to prevent bone loss.

• Salt

Table salt contains sodium chloride (NaCl), anti-caking agents, and often dextrose. It’s also bleached and processed for uniform color and crystal size.The kidneys must try to keep up with the resulting salt levels in the blood, increasing the need for water to keep intercellular fluids balanced. The body then holds the water as it tries to correct for the excess salt, creating excessive blood volume. The cardiovascular and renal systems must work very hard under this pressure.

• GMOs (Genetically Modified Organisms)

Some very common foods like corn, canola, and soy are almost always genetically modified these days, while evidence mounts that these foods cause kidney damage.

Kidneys and bone health
Healthy kidneys do many important jobs. They remove wastes and extra fluid from your body, help make red blood cells, and help keep bones strong. They also help to keep the right amount of minerals in your blood. Minerals are nutrients that your body needs to stay healthy.

When you have kidney disease or kidney failure, your kidneys cannot do these important jobs well. As a result, you may develop mineral and bone disorder. It is a common problem in people with kidney disease, and it affects almost everyone with kidney failure.

Mineral and Bone disorder
Mineral and bone disorder related to kidney disease happens when there is an imbalance in your blood levels of calcium and phosphorus. This mineral imbalance can affect your bones, heart and blood vessels.

Kidney disease and kidney failure lead to bone and heart disease?
When too much kidney function is lost, your kidneys can no longer filter out extra phosphorus and remove it from the body in the urine. Over time, phosphorus from the foods you eat can build up to high levels in your blood.

Healthy kidneys also change vitamin D from sunlight and the foods you eat into active vitamin D that your body can use. When kidneys fail there is a short supply of active vitamin D. This causes calcium and phosphorus to get out of balance.

When the blood phosphorus level goes up and blood vitamin D level goes down, your body makes too much parathyroid hormone (PTH). High PTH levels cause calcium to move from your bones into your blood. As calcium leaves your bones they become weaker, more brittle, and are more likely to break. Some calcium may also end up in the heart and blood vessels. This may cause or worsen heart disease.

Mineral and Bone disorder in Chronic Kidney Disease (CKD)
Mineral and bone disorder in CKD occurs when damaged kidneys and abnormal hormone levels cause calcium and phosphorus levels in a person’s blood to be out of balance. Mineral and bone disorder commonly occurs in people with CKD and affects most people with kidney failure receiving dialysis.

Causes of Mineral and Bone disorder in CKD
Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body. The kidneys:

• • Stop activating calcitriol. The low levels of calcitriol in the body create an imbalance of calcium in the blood.
  • Do not remove the phosphorus in the blood properly, so phosphorus levels rise in the blood. The extra phosphorus pulls calcium out of the bones, causing them to weaken.

Signs and Symptoms of Mineral and Bone disorder
Mineral and bone disorder can cause you to have:

• • • Itchy skin
    • Bone pain
    • Weak bones that break easily
    • Blocked blood vessels
    • Heart problems
    • Anemia
    • Nerve problems
    • Difficulty fighting off germs

Diagnosis

• • • You will have blood tests to check your blood levels of calcium, phosphorus, PTH and vitamin D.
    • Some people may need to have a bone biopsy. A bone biopsy is a sample of bone taken for study.
    • Your healthcare provider may order an x-ray of your abdomen, or an echocardiogram of your heart to check if mineral imbalance has affected your heart and blood vessels.

People with simple kidney cysts have sacs that are filled with fluid within their kidneys. It is possible to have one or more cysts in one or both kidneys. The exact cause of simple kidney cysts is not known but they tend to be more common as people age. Simple kidney cysts rarely cause problems and are different from polycystic kidney disease, which tends to run in families and can be more serious.

Causes:
The cause of simple kidney cysts is not fully understood. Obstruction of tubules tiny structures within the kidneys that collect urine or deficiency of blood supply to the kidneys may play a role. Diverticula sacs that form on the tubules may detach and become simple kidney cysts.

Symptoms:
Simple kidney cysts usually do not cause symptoms. In most cases, a doctor finds them during an ultrasound or computerized tomography (CT) scan done for another reason. However, simple kidney cysts may:

• Cause pain in your side, back, or upper abdomen if they enlarge and press on other organs
• Bleed
• Become infected, causing fever, chills, or other signs of infection
• Impair kidney function (rare)

Simple kidney cysts have been associated with high blood pressure, but it is unclear what the relationship is between the two.

Diagnosis:
Tests and procedures used to diagnose simple kidney cysts include:

• Imaging tests. Imaging tests, such as an ultrasound, a computerized tomography (CT) scan and magnetic resonance imaging (MRI), are often used to investigate simple kidney cysts. Imaging tests can help your doctor determine whether a kidney mass is a cyst or a tumor.
• Kidney function tests. Testing a sample of your blood may reveal whether a kidney cyst is impairing your kidney function.

The hemodialysis diet is an eating plan tailored to patients who are on hemodialysis. It’s designed to reduce the amount of fluid and waste that builds up between hemodialysis treatments so that you can feel your best.

• Eat more high protein foods.
• Eat less high salt, high potassium, and high phosphorus foods.
• Learn how much fluid you can safely drink (including coffee, tea, and water).

Salt & Sodium

• Use less salt and eat fewer salty foods: this may help to control blood pressure and reduce weight gains between dialysis sessions.
• Use herbs, spices, and low-salt flavor enhancers in place of salt.
• Avoid salt substitutes made with potassium.

Meat/Protein
People on dialysis need to eat more protein. Protein can help maintain blood protein levels and improve health. Eat a high protein food (meat, fish, poultry, fresh pork, or eggs) at every meal, or about 8-10 ounces of high protein foods every day.

Grains/Cereals/Bread
Unless you need to limit your calorie intake for weight loss and/or manage carbohydrate intake for blood sugar control, you may eat, as you desire from this food group. Grains, cereals, and breads are a good source of calories. Most people need 6 -11 servings from this group each day.

Milk/Yogurt/Cheese
Limit your intake of milk, yogurt, and cheese to ½-cup milk or ½-cup yogurt or 1-ounce cheese per day. Most dairy foods are very high in phosphorus. The phosphorus content is the same for all types of milk – skim, low fat, and whole!If you do eat any high-phosphorus foods, take a phosphate binder with that meal.

Dairy foods “low” in phosphorus:

• Butter and tub margarine
• Cream cheese
• Heavy cream
• Ricotta cheese
• Brie cheese
• Non-dairy whipped topping
• Sherbet

If you have or are at risk for heart disease, some of the high-fat foods listed above may not be good choices for you.

Fruit/Juice
All fruits have some potassium, but certain fruits have more than others and should be limited or totally avoided. Limiting potassium protects your heart.

Drinks:

• Apple cider
• Grape juice
• Cranberry juice cocktail
• Lemonade

Vegetables/Salads
All vegetables have some potassium, but certain vegetables have more than others and should be limited or totally avoided. Limiting potassium intake protects your heart.Your hemodialysis diet will include a balance of nutrients to help keep your body healthy and strong while allowing the amount of potassium, phosphorus and sodium your body can safely handle.

Glomerulonephritis (GN), also known as glomerular nephritis, is a term used to refer to several kidney diseases (usually affecting both kidneys). Many of the diseases are characterized by inflammation either of the glomeruli or of the small blood vessels in the kidneys, hence the name, but not all diseases necessarily have an inflammatory component.

As it is not strictly a single disease, its presentation depends on the specific disease entity: it may present with isolated hematuria and/or proteinuria (blood or protein in the urine); or as a nephrotic syndrome, a nephritic syndrome, acute kidney injury, or chronic kidney disease.

There are two types of glomerulonephritis—acute and chronic. The acute form develops suddenly. The chronic form may develop silently (without symptoms) over several years. It often leads to complete kidney failure.

Causes acute glomerulonephritis
The acute disease may be caused by infections such as strep throat. It may also be caused by other illnesses, including lupus, Goodpasture’s syndrome, Wegener’s disease, and polyarteritis nodosa. Early diagnosis and prompt treatment are important to prevent kidney failure.

Causes chronic glomerulonephritis
Sometimes, the disease runs in the family. This kind often shows up in young men who may also have hearing loss and vision loss. Some forms are caused by changes in the immune system. However, in many cases, the cause is not known. Sometimes, you will have one acute attack of the disease and develop the chronic form years later.

Symptoms of Glomerulonephritis
Acute GN
Early symptoms of acute GN include:

• puffiness in the face (edema)
• urinating less often
• blood in your urine (dark, rust-colored urine)
• extra fluid in your lungs, causing coughing
• high blood pressure

Chronic GN
The chronic form of glomerulonephritis can creep up without any symptoms. There may be slow development of symptoms similar to the acute form. Some symptoms include:

• blood or excess protein in your urine, which may be microscopic and show up in urine tests
• high blood pressure
• swelling in ankles and face (edema)
• frequent nighttime urination
• bubbly or foamy urine (from excess protein)
• abdominal pain
• frequent nosebleeds

Alport syndrome is a genetic condition characterized by kidney disease, hearing loss, and eye abnormalities. People with Alport syndrome experience progressive loss of kidney function.

Causes
Alport Syndrome is an inherited disease of the kidney. It is caused by genetic mutations that affect the type IV collagen family of proteins. Type IV collagen is a major part of important tissue structures called basement membranes that are present in all tissues including the kidney, inner ear, and eye.

Types of Alport Syndrome
There are three genetic types:

• X-linked Alport Syndrome (XLAS) is the most common; in these families affected males typically have more severe disease than affected females.
• In autosomal recessive Alport Syndrome (ARAS) the severity of disease in affected males and females is similar.
• There is also an autosomal dominant form (ADAS) which affects males and females with equal severity.

Signs and symptoms
With all types of Alport syndrome the kidneys are affected. The tiny blood vessels in the glomeruli of the kidneys are damaged and cannot filter the wastes and extra fluid in your body. Many people with Alport syndrome also have hearing problems and abnormalities with their eyes.

Other signs and symptoms may include:

• Blood in the urine (hematuria), the most common and earliest sign of Alport syndrome
• Protein in the urine (proteinuria)
• High blood pressure (hypertension)
• Swelling in the legs, ankle, feet and around the eyes (called edema)

These signs and symptoms may differ, based on age, gender and inherited type of Alport syndrome. For example, hearing and vision problems tend to be more common in males than females and high blood pressure is usually found later in life.

Hyperkalemia is the medical term that describes a potassium level in your blood that’s higher than normal. Your body needs potassium. It is an important nutrient that is found in many of the foods you eat. Potassium helps your nerves and muscles, including your heart, work the right way. But too much potassium in your blood can be dangerous. Your blood potassium level is normally 3.6 to 5.2 millimoles per liter (mmol/L).

Causes:
A report of high blood potassium isn’t true hyperkalemia. Instead, it may be caused by the rupture of blood cells in the blood sample during or shortly after the blood draw. The ruptured cells leak their potassium into the sample. This falsely raises the amount of potassium in the blood sample, even though the potassium level in your body is actually normal. When this is suspected, a repeat blood sample is done.
The most common cause of genuinely high potassium (hyperkalemia) is related to your kidneys, such as:

• Acute kidney failure
• Chronic kidney disease

Other causes of hyperkalemia include:

• Addison’s disease (adrenal failure)
• Alcoholism or heavy drug use that causes rhabdomyolysis, a breakdown of muscle fibers that results in the release of potassium into the bloodstream
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Destruction of red blood cells due to severe injury or burns
• Excessive use of potassium supplements
• Type 1 diabetes

Symptoms:
The symptoms of an elevated potassium level are nonspecific, and generally include malaise, palpitations, and muscle weakness. If symptoms do appear, they are usually mild and non-specific. You may feel some muscle weakness, numbness, tingling, nausea, or other unusual feelings. It usually develops slowly over many weeks or months and is often mild. It can recur.

If hyperkalemia comes on suddenly and you have very high levels of potassium, you may feel heart palpitations, shortness of breath, chest pain, nausea, or vomiting. Sudden or severe hyperkalemia is a life-threatening condition. It requires immediate medical care.

Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys’ filtering system. The damaged red blood cells clog the filtering system in the kidneys, which can lead to life-threatening kidney failure. If the kidneys stop functioning, a child can develop acute kidney injury. The sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children. Red blood cells contain hemoglobin—an iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body.

HUS usually develops in children after five to 10 days of diarrhoea — often bloody — caused by infection with certain strains of Escherichia coli (E. coli) bacteria. Adults also can develop HUS due to E. coli or other types of infection, certain medications, or pregnancy.

HUS is a serious condition. But timely and appropriate treatment leads to a full recovery for most people, especially young children.

Symptoms
Signs and symptoms of HUS can include:

• Bloody diarrhea
• Decreased urination or blood in the urine
• Abdominal pain, vomiting and occasionally fever
• Pallor
• Small, unexplained bruises or bleeding from the nose and
• Fatigue and irritability
• Confusion or seizures
• High blood pressure
• Swelling of the face, hands, feet or entire body

Symptoms of hemolytic uremic syndrome in children:
A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritis—an inflammation of the lining of the stomach, small intestine, and large intestine such as,

• Vomiting
• Bloody diarrhea
• Abdominal pain
• Fever and chills
• Headache

Risk Factors
The risk of developing HUS is highest for:

• Children under 5 years of age
• People over 75
• People with certain genetic changes that make them more susceptible

Complications
HUS can cause life-threatening complications, including:

• Kidney failure, which can be sudden (acute) or develop over time (chronic)
• High blood pressure
• Stroke
• Coma
• Intestinl problems, such as inflammatory colitis
• Heart problems

Diagnosis
A health care provider diagnoses hemolytic uremic syndrome with

• A medical and family history
• A physical exam
• Urine tests
• A blood test
• A stool test
• Kidney biopsy