Tag Archives: Acute kidney injury

Interstitial nephritis

Alternative Names: Tubulointerstitial nephritis; Nephritis – interstitial; Acute interstitial (allergic) nephritis

Definition:
Interstitial nephritis (or Tubulo-interstitial nephritis) is a form of nephritis affecting the interstitium of the kidneys surrounding the tubules  in which the spaces between the kidney tubules become swollen (inflamed).The inflammation can affect the kidneys’ function, including their ability to filter waste.
This disease can be either acute, meaning it occurs suddenly, or chronic, meaning it is ongoing and eventually ends in kidney failure.

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Acute interstitial nephritis is a kidney disorder in which the kidneys become unable to filter waste materials and fluid properly. This is a potentially serious condition that requires care from your doctor.

 

In chronic interstitial nephritis the kidney becomes small and granular with thickening of arteries and arterioles and proliferation of interstitial tissue. There may be functional abnormalities, such as urea retention, hematuria, and casts.

 

Symptoms:
Interstitial nephritis can cause mild to severe kidney problems, including acute kidney failure. In about half of cases, people will have decreased urine output and other signs of acute kidney failure.

Symptoms of this condition may include:

•Blood in the urine
•Fever
•Increased or decreased urine output
•Mental status changes (drowsiness, confusion, coma)
•Nausea, vomiting
•Rash
•Swelling of the body, any area
•Weight gain (from retaining fluid)

Causes:
Interstitial nephritis may be temporary (acute) or it may be long-lasting ( chronic) and get worse over time.

The following can cause interstitial nephritis:

•Allergic reaction to a drug (acute interstitial allergic nephritis)
•Analgesic nephropathy
•Long-term use of medications such as acetaminophen (Tylenol), aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDS). This is called analgesic nephropathy
•Side effect of certain antibiotics (penicillin, ampicillin, methicillin, sulfonamide medications, and others)
•Side effect of medications such as NSAIDs, furosemide, and thiazide diuretics

The acute form of interstitial nephritis is common. It is most often caused by side effects of certain drugs. This disorder may be more severe and more likely to lead to chronic or permanent kidney damage in elderly people.

Complications:
Metabolic acidosis can occur because the kidneys aren’t able to remove enough acid. The disorder can lead to acute or chronic kidney failure or end-stage kidney disease.

Diagnosis:
At times there are no symptoms of this disease, but when they do occur they are widely varied and can occur rapidly or gradually.  When caused by an allergic reaction, the symptoms of acute tubulointerstitial nephritis are fever (27% of patients), rash (15% of patients),  and enlarged kidneys. Some people experience dysuria, and lower back pain. In chronic tubulointerstitial nephritis the patient can experience symptoms such as nausea, vomiting, fatigue, and weight loss. Other conditions that may develop include hyperkalemia, metabolic acidosis, and kidney failure.

Blood tests:
About 23% of patients have eosinophilia.

Urinary findings:
Urinary findings include:
*Eosinophiluria: sensitivity is 67% and specificity is 83%.  The sensitivity is higher in patients with interstitial nephritis induced by methicillin or when the Hansel’s stain is used.

*Isosthenuria.

*Hematuria

*Sterile pyuria: white blood cells and no bacteria

Gallium scan
The sensitivity of an abnormal gallium scan has been reported to range from 60% to 100%.

Treatment:
Treatment focuses on the cause of the problem. Avoiding medications that lead to this condition may relieve the symptoms quickly.

Nutrition therapy consists of adequate fluid intake, which can require several liters of extra fluid.

Limiting salt and fluid in the diet can improve swelling and high blood pressure. Limiting protein in the diet can help control the buildup of waste products in the blood (azotemia) that can lead to symptoms of acute kidney failure.

If dialysis is necessary, it usually is required for only a short time.
Corticosteroids or anti-inflammatory medications can help in some cases.

Prognosis:
The kidneys are the only body system that are directly affected by tubulointerstitial nephritis. Kidney function is usually reduced; the kidneys can be just slightly dysfunctional, or fail completely.

In chronic tubulointerstitial nephritis, the most serious long-term effect is kidney failure. When the proximal tube is injured, sodium, potassium, bicarbonate, uric acid, and phosphate reabsorption may be reduced or changed, resulting in low bicarbonate, known as metabolic acidosis, low potassium, low uric acid known as hypouricemia, and low phosphate known as hypophosphatemia. Damage to the distal tubule may cause loss of urine-concentrating ability and polyuria.

In most cases of acute tubulointerstitial nephritis, the function of the kidneys will return after the harmful drug is not taken anymore, or when the underlying disease is cured by treatment. If the illness is caused by an allergic reaction, a corticosteroid may speed the recovery kidney function; however, this is often not the case.

Chronic tubulointerstitial nephritis has no cure. Some patients may require dialysis. Eventually, a kidney transplant may be needed.

Prevention:
In many cases, the disorder can’t be prevented. Avoiding or reducing your use of medications that can cause this condition can help reduce your risk.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Interstitial_nephritis
http://www.nlm.nih.gov/medlineplus/ency/article/000464.htm
http://www.empowher.com/condition/acute-interstitial-nephritis
http://medical-dictionary.thefreedictionary.com/chronic+nephritis
http://www.humpath.com/spip.php?article2778&id_document=113#documents_portfolio

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Kidney Failure

Kidney failure is a serious disease which can have a major impact on life, and can ultimately be fatal. However, it can be successfully treated.

What do the kidneys do?

In order for blood to perform its essential functions of bringing nutrients and oxygen to the cells of the body, and carrying waste materials away from those cells, the chemical composition of the blood must be carefully controlled.

CLICK & SEE

The kidneys play a crucial role in this process by filtering the blood under high pressure and removing potential toxins, which are excreted from the body in the urine.

Every day the kidneys filter the body’s entire blood volume seven or eight times.

What is kidney failure?.....CLICK & SEE

When the kidneys start to fail, toxins are not f & iltered out of the blood, and start accumulate in the tissues. This can lead to a range of problems.

Build up of two waste products, urea and creatinine, can lead to tiredness, weakness, loss of appetite and vomiting.

Accumulation of acid generated during the body’s metabolic processes can lead to a condition called metabolic acidosis.

Failure to get rid of phosphate, causes the blood phosphate level to increase and calcium level to fall.

When calcium level is low, bones will become brittle.

The kidney may also lose its ability to produce erythropoietin, resulting in anaemia.

Kidney failure is also associated with an increase in the volume of water in the body which can result in a swelling of the tissues.

Excess salt and water retention may cause high blood pressure, swelling of the legs, face, abdomen and breathlessness.

What causes kidney failure?

There are many possible causes of kidney damage or kidney failure. They include:

* Decreased blood flow, which may occur with extremely low blood pressure caused by trauma, surgery, serious illnesses, septic shock, hemorrhage, burns, or dehydration
* Acute tubular necrosis (ATN)
* Infections that directly injury the kidney such as acute pyelonephritis or septicemia
* Urinary tract obstruction (obstructive uropathy)
* Autoimmune kidney disease such as interstitial nephritis or acute nephritic syndrome
* Disorders that cause clotting within the thin blood vessels of the kidney
o Idiopathic thrombocytopenic thrombotic purpura (ITTP)
o Transfusion reaction
o Malignant hypertension
o Scleroderma,
o Hemolytic-uremic syndrome
o Disorders of childbirth, such as bleeding placenta abruptio or placenta previa

The most common causes of kidney failure are glomerulonephritis (inflammation of the kidney) and diabetes mellitus.

Other causes of kidney failure are kidney stones, kidney cysts, an immune disorder called systemic lupus erythematosus, uncontrolled high blood pressure and drugs.

What are the symptoms?

As the kidneys begin to fail the following symptoms can begin develop:

* Decrease in amount of urine (oliguria)
* Urination stops (anuria)
* Excessive urination at night
* Ankle, feet, and leg swelling
* Generalized swelling, fluid retention
* Decreased sensation, especially in the hands or feet
* Decreased appetite
* Metallic taste in mouth
* Persistent hiccups
* Changes in mental status or mood
o Agitation
o Drowsiness
o Lethargy
o Delirium or confusion
o Coma
o Mood changes
o Trouble paying attention
o Hallucinations
* Slow, sluggish, movements
* Seizures
* Hand tremor (shaking)
* Nausea or vomiting, may last for days
* Brusing easily
* Prolonged bleeding
* Nosebleeds
* Bloody stools
* Flank pain (between the ribs and hips)
* Fatigue
* Breath odor
* High blood pressure

* pale and sallow complexion
* fatigue
* shortness of breath
* body itch
* sometimes nausea and vomiting
* swelling of the face and legs
* disruption of urination patterns

How it is diagnosed?
Exams and Tests:

Examination and testing can help diagnose acute kidney failure and help rule out other problems that can affect kidney function.

Many patients have generalized swelling caused by fluid retention. The doctor will use a stethoscope to listen to the heart and lungs. A heart murmur, crackles in the lungs, inflammation of the lining of the heart (pericarditis), or other related to extra fluid may be heard.

The results of laboratory tests may change suddenly (within a few days to 2 weeks).

* Urine tests (urinalysis) may be abnormal.
* Serum creatinine, BUN, creatinine clearance, and serum potassium levels may increase.
* Arterial blood gas and blood chemistries may show metabolic acidosis.
* Kidney or abdominal ultrasound are preferred tests, but abdominal x-ray, abdominal CT scan, or abdominal MRI can tell if there is a blockage in the urinary tract.
* Blood tests may help reveal the underlying cause of kidney failure.

How is it treated?

Once the cause is found, the goal of treatment is to restore kidney function and prevent fluid and waste from building up in the body while the kidneys heal. Usually, you have to stay overnight in the hospital for treatment.

The amount of liquid you eat (such as soup) or drink will be limited to the amount of urine you can produce. You will be told what you may and may not eat to reduce the build-up of toxins normally handled by the kidneys. This diet may be high in carbohydrates and low in protein, salt, and potassium.

You may need antibiotics to treat or prevent infection. Diuretics (“water pills”) may be used to help the kidneys lose fluid.

It will be very important to avoid dangerous hyperkalemia (increased blood potassium levels) by using IV (intravenous) calcium, glucose/insulin, or potassium exchange resin (Kayexalate).

Dialysis may be needed, and can make you feel better. It is not always necessary, but it can save your life if your serum potassium is dangerously high. Dialysis will also be used if your mental status changes, your potassium level starts to rise, you stop urinating, develop pericarditis, become overloaded with fluid, or cannot eliminate nitrogen waste products from your body.
The most common treatment is by dialysis, a technique which artificially mimics the action of the kidneys.

What is dialysis?

There are two types of dialysis.

Haemodialysis is the most frequently prescribed type of dialysis treatment….CLICK & SEE

It involves circulating the patient’s blood outside of the body through a series of tubes.

The blood is filtered in a way similar to that used by the kidneys by using a chemical bath to draw out waste products.

Most haemodialysis patients require treatment three times a week, for an average of 3-4 hours per dialysis.

Less common is a technique known as peritoneal dialysis, in which the lining of the abdomen acts a blood filter.….CLICK & SEE

>Kidney Failure Herbs

Is a transplant an option?….CLICK & SEE

For the right patient at the right time, a transplant is the best treatment for kidney failure.

If it works well the patient will be totally free from dialysis. Many patients with kidney failure are suitable for a transplant.

Prognosis:
While acute kidney failure is potentially life-threatening and may require intensive treatment, the kidneys usually start working again within several weeks to months after the underlying cause has been treated.

In cases where this does not happen, chronic renal failure or end-stage renal disease develops. Death can occur, but is most common when kidney failure is caused by surgery, trauma, or severe infection in someone with heart disease, lung disease, or recent stroke. Old age, infection, loss of blood from the intestinal tract, and progression of kidney failure also increase the risk of death.


Possible Complications :

* Loss of blood in the intestines
* Chronic (ongoing) kidney failure
* End-stage renal disease
* Damage to the heart or nervous system
* Hypertension (high blood pressure)

Prevention: Treating disorders such as high blood pressure can help prevent acute kidney failure. Unfortunately, prevention is not always possible.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

 

Resources:
BBC NEWS:OCT 15, 2001
http://www.nlm.nih.gov/medlineplus/ency/article/000501.htm#Definition

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LSD

LSD, aka “acid,” is odorless, colorless, and has a slightly bitter taste and is usually taken by mouth. Often LSD is added to absorbent paper, such as blotter paper, and divided into small, decorated squares, with each square representing one dose.

Health Hazards

Physical Psychological short-term effects. The effects of LSD are unpredictable. They depend on the amount taken; the user‘s personality, mood, and expectations; and the surroundings in which the drug is used. Usually, the user feels the first effects of the drug 30 to 90 minutes after taking it. The physical effects include dilated pupils, higher body temperature, increased heart rate and blood pressure, sweating, loss of appetite, sleeplessness, dry mouth, and tremors.

Sensations and feelings change much more dramatically than the physical signs.
The user may feel several different emotions at once or swing rapidly from one emotion to another. If taken in a large enough dose, the drug produces delusions and visual hallucinations. The user’s sense of time and self changes. Sensations may seem to “cross over,” giving the user the feeling of hearing colors and seeing sounds. These changes can be frightening and can cause panic.

LSD trips are long – typically they begin to clear after about 12 hours. Some users experience severe, terrifying thoughts and feelings, fear of losing control, fear of insanity and death, and despair while using LSD. In some cases, fatal accidents have occurred during states of LSD intoxication.

Flashbacks. Many LSD users experience flashbacks, recurrence of certain aspects of a person’s experience, without the user having taken the drug again. A flashback occurs suddenly, often without warning, and may occur within a few days or more than a year after LSD use. Flashbacks usually occur in people who use hallucinogens chronically or have an underlying personality problem; however, otherwise healthy people who use LSD occasionally may also have flashbacks. Bad trips and flashbacks are only part of the risks of LSD use. LSD users may manifest relatively long-lasting psychoses, such as schizophrenia or severe depression. It is difficult to determine the extent and mechanism of the LSD involvement in these illnesses.

Information provided by the National Institute on Drug Abuse.