5^th Global Nephrologists Annual Meeting April 01-02, 2016 Valencia, Spain

Renal pertaining to the kidney; called also nephric. Renal clearance tests laboratory tests that determine the ability of the kidney to remove certain substances from the blood. The most commonly used is the creatinine clearance test, which is a measure of the glomerular filtration rate.

Renal failure inability of the kidney to maintain normal function, so that waste products and metabolites accumulate in the blood. This affects most of the body's systems because of its important role in maintaining fluid balance, regulating the electrochemical composition of body fluids, providing constant protection against acid-base imbalance, and controlling blood pressure called also kidney failure.

Acute renal failure occurs suddenly and may be caused by physical trauma, infection, inflammation, or exposure to nephrotoxic chemicals. Nephrotoxic agents include drugs such as penicillins, sulfonamides, aminoglycosides, and tetracyclines; radiographic iodine contrast materials; and heavy metals. These agents inflict damage on the renal tubules, causing tubular necrosis, and may also indirectly harm the tubules by producing severe vasoconstriction of renal blood vessels with ischemia of kidney tissue. Other causes of tubular ischemia include circulatory collapse, severe dehydration, and hypotension in certain compromised surgical patients. Acute renal failure may be classified as: prerenal, associated with poor systemic perfusion and decreased renal blood flow; intrarenal, associated with renal ischemia or toxins; or postrenal, resulting from the obstruction of urine flow out of the kidneys.

Dialysis, the more common form of kidney-replacement therapy, is a way of cleaning the blood with an artificial kidney. There are two types of dialysis: haemodialysis and peritoneal dialysis. No matter which type is chosen, the person undergoing dialysis needs to work closely with the health care team to keep diabetes under control.

Haemodialysis

In hemodialysis, an artificial kidney removes waste from the blood. A surgeon must first create an "access," a place where blood can easily be taken from the body and sent to the artificial kidney for cleaning. The access, usually in the forearm, can be made from the patient's own blood vessels or from a piece of implanted tubing. The access is inside the body and cannot be seen from the outside. Usually, this surgery is done 2 to 3 months before dialysis starts so the body has time to heal.

Peritoneal dialysis

Another form of dialysis is called peritoneal dialysis. The lining inside your abdomen (the peritoneum) becomes the filter. A soft plastic tube is put into the abdomen by a surgeon. When the body heals, cleansing fluid (dialysate) is put into the abdomen through this tube. Waste products in the bloodstream pass through the peritoneum into the dialysate. Then the dialysate, along with the waste products is drained off.

The two main types of peritoneal dialysis are continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). People perform CAPD themselves by attaching a plastic bag filled with cleansing fluid to the tube in the abdomen and raising it to shoulder level. In CCPD, a machine puts the cleansing fluid into the abdomen and drains it automatically. This is usually done at night during sleep.

Glomerular disease can occur by itself (eg, affecting only the kidney), or may be associated with an underlying medical condition that affects other organ systems, such as lupus, diabetes, or certain infections. Glomerular disease can develop suddenly (called Acute), or develop slowly over a period of years (called Chronic). Treatment of glomerular disease depends upon its cause and type. Many diseases affect kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. Glomerular diseases include many conditions with a variety of genetic and environmental causes, but they fall into two major categories:

Glomerulonephritis (gloh-MEHR-yoo-loh-nef-RY-tis) describes the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood.

Glomerulosclerosis (gloh-MEHR-yoo-loh-skleh-ROH-sis) describes the scarring or hardening of the tiny blood vessels within the kidney.

Although glomerulonephritis and glomerulosclerosis have different causes, they can both lead to kidney failure.

Acute kidney injury (AKI), previously called Acute renal failure ( ARF), is an abrupt loss of kidney function that develops within 7 days. Acute kidney injury (formerly known as acute renal failure) is a syndrome characterised by the rapid loss of the kidney's excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both. It is the clinical manifestation of several disorders that affect the kidney acutely. Its causes are numerous. Generally it occurs because of damage to the kidney tissue caused by decreased renal blood flow (renalischemia) from any cause (e.g. low blood pressure), exposure to substances harmful to the kidney, an inflammatory process in the kidney, or an obstruction of the urinary tract which impedes the flow of urine. AKI is diagnosed on the basis of characteristic laboratory findings, such as elevated blood urea nitrogen and creatinine, or inability of the kidneys to produce sufficient amounts of urine.

High blood pressure (hypertension) is a leading cause of disease and kidney failure (end-stage renal disease)Hypertension can cause damage to the blood vessels and filters in the kidney, making removal of waste from the body difficult. Once a person is diagnosed with end-stage renal disease, dialysis a blood cleansing process or kidney transplantation are necessary. Kidneys are remarkable organs. Inside them are millions of tiny blood vessels that act as filters. Their job is to remove waste products from the blood. Sometimes this filtering system breaks down.

Diabetes can damage the kidneys and cause them to fail. Failing kidneys lose their ability to filter out waste products, resulting in kidney disease. Diabetes can damage this system. High levels of blood sugar 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. 

Ultrasound is used to evaluate a person’s native kidneys (the ones you were born with) as well as transplanted kidneys. It can measure the size and appearance of the kidneys and detect tumors, congenital anomalies, swelling and blockage of urine flow. A newer technique called Color Doppler is used to assess clots, narrowing, pseudo-aneurysms—in the arteries and veins—of the original and transplanted kidneys. Renal scintigraphy uses small amounts of radioactive materials called radiotracers, a special camera and a computer to evaluate your kidneys’ function and anatomy and determine whether they are working properly. It can provide unique information that is often unattainable using other imaging procedures.

MRI involves a large and powerful magnet. Hydrogen ions in the body are used to obtain pictures of the body parts. But in regard to the kidney, an MRI gives the same information as a CT scan. In the past it was thought that the advantage was that the contrast material called gadolinium, used in an MRI, had no risk of kidney damage. However, gadolinium has now been associated with nephrogenic systemic fibrosis (NSF), a potentially fatal skin disease in people with decreased kidney function. And, in a small fraction of patients, separate from NSF, gandolinium may decrease glomerular filtration rate (GFR), similar to other contrast dyes. Talk to your physician to find out if an angiogram or CT scan would be a better choice than an MRI.

Angiography is the test of choice for the renal hypertension or high blood pressure caused by narrowing of the renal arteries that carry blood to the kidneys. Initial evaluation could be done by the use of ultrasound. The size of the kidneys and, in expert hands, the Doppler sonography of the renal arteries can help in evaluating narrowing of the arteries (stenosis). CT angiography can also help identify the stenosis, but it is limited in use because of the contrast (dye) agent and the risk of kidney damage with it. Magnetic Resonance Angiography (MRA) is fast evolving as a pre-screen for angiography. As the technology develops the MRA might be the way to go for renal artery stenosis as this has no risk of contrast nephropathy and it is non-invasive.

A kidney transplant is an operation in which a person with kidney failure receives a new kidney. The new kidney takes over the work of cleaning the blood. There are two types of kidney transplants: those that come from living donors and those that come from unrelated donors who have died (non-living donors). A living donor may be someone in your family. It may also be your spouse or close friend. In some cases, it may be a stranger who wishes to donate a kidney to anyone in need of a transplant. There are advantages and disadvantages to both types of kidney transplants.

If you have advanced and permanent kidney failure, kidney transplantation may be the treatment option that allows you to live much like you lived before your kidneys failed. Since the 1950s, when the first kidney transplants were performed, much has been learned about how to prevent rejection and minimize the side effects of medicines. But transplantation is not a cure; it's an on going treatment that requires you to take medicines for the rest of your life. And the wait for a donated kidney can be years long. A successful transplant takes a coordinated effort from your whole health care team, including your nephrologist, transplant surgeon, transplant coordinator, pharmacist, dietician, and social worker. But the most important members of your health care team are you and your family. By learning about your treatment, you can work with your health care team to give yourself the best possible results, and you can lead a full, active life.

Nephrology is the medical specialty which focuses on kidney conditions and abnormalities, involving the study of normal kidney function, kidney problems, the treatment of kidney problems and renal replacement therapy i.e dialysis and kidney transplantation. A Nephrologist, also called a renal physician, is a medical doctor who specializes in diseases and conditions related to human kidneys. In most cases, patients are referred to Nephrologists by other physicians. Though Nephrology is a subspecialty of internal general medicine, the branch of medicine involved in diagnosing and treating diseases mainly in adults, it also deals with kidney abnormalities in children. Nephrologists diagnose and treat a variety of conditions such as kidney disease, electrolyte disorders, renal failure, high blood pressure and kidney stones. They perform various tests like blood tests, urine tests and biopsies to find out diseases that affect the kidney. Their treatment includes regulation of electrolyte and blood pressure, medication and dialysis. Excluding procedures such as kidney biopsies and catheter placements, they do not do surgery, though they often work closely with urologists who perform medical as well as surgical intervention. Nephrologists must have a solid understanding of nephrology and the diagnosis and treatment of a variety of conditions.