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Chronic kidney disease (CKD) is accompanied by interstitial fibrosis and tubular atrophy (IFTA), irrespective of the underlying cause. Disorders of the vasculature, glomeruli or urinary drainage all culminate in chronic tubulo-interstitial injury, the severity of which is the histological feature that correlates best with progression to end-stage renal disease (ESRD). However, there are diverse conditions...
Renal transplantation improves quality of life and usually increases longevity in individuals with end stage renal failure (ESRF), and is the preferred form of renal replacement therapy. Unfortunately, owing to excessive co-morbidities, only 30% of patients who develop ESRF are fit enough to be listed for transplantation. Early attempts at kidney transplantation were blighted by immunological rejection...
The glomerular basement membrane (GBM) is the vital barrier between blood and glomerular filtrate. Diseases that damage it generally cause haematuria initially, but as architecture becomes disordered proteinuria becomes an increasing feature. Inflammatory glomerulonephritis most commonly does this, but genetic abnormalities of GBM components are another important mechanism. Alport's syndrome, a hereditary...
This article reviews the clinical features, pathogenesis, investigation and management of glomerulonephritis (GN). This can occur as a primary isolated renal disease, as a manifestation of systemic diseases such as vasculitis or lupus, or secondary to drugs, infections or tumours. It is an important cause of morbidity and mortality and a potentially preventable cause of end-stage renal disease, so...
Paraproteins are most commonly produced by plasma cell dyscrasias. A paraprotein is frequently an incidental finding in patients with renal disease but can cause renal dysfunction directly through a variety of underlying pathological processes. Diagnosis is usually through the detection of a monoclonal protein in combination with a renal biopsy. The general supportive management of all paraprotein-related...
Multi-system autoimmune diseases, including systemic lupus erythematosus (SLE) and vasculitis, are inflammatory conditions of unknown cause. Renal involvement can occur in a variety of forms and usually represents a severe disease manifestation. SLE is complicated by renal involvement (lupus nephritis) in over one-third of patients. Small vessel vasculitides, including anti-neutrophil cytoplasmic...
Secondary glomerular diseases are common worldwide and can manifest in many ways. Bacterial and viral infections, especially hepatitis and HIV, can cause a variety of patterns of glomerular injury often presenting with nephrotic syndrome, as can tumours and drugs. Diabetes mellitus and systemic lupus erythematosus are also important causes. Identifying underlying agents leads to specific treatments...
Diabetic kidney disease is the leading cause of end-stage kidney disease in the Western world. It accounts for up to 40% of patients requiring renal replacement therapy. Currently, achieving optimal glycaemic and blood pressure control are the only strategies that have been shown to prevent and retard the progression of diabetic kidney disease. Recently, the elucidation of pathophysiological mechanisms...
Women with kidney disease should be counselled about the risks pregnancy may pose to mother and fetus before they conceive. Although impaired baseline function and hypertension are associated with worse outcome, all women with renal disease should be advised that they may suffer irreversible kidney damage, may well need to change their medications in advance of pregnancy and face a higher risk of...
Renal dysfunction is a relatively frequent complication of liver disease. Acute kidney injury and chronic kidney disease can co-exist with acute or chronic liver disease, or occur sequentially. These patients have increased morbidity and reduced survival and so there is renewed emphasis on improving definitions of renal dysfunction in this patient population to facilitate early recognition and prompt...
Thrombotic microangiopathies are rare and carry a high morbidity and mortality. Recent research has helped to clarify their aetiology. A high index of suspicion is required in patients presenting with renal impairment and features of microangiopathy such as a low platelet count and Coomb's test-negative haemolytic anaemia. In Shiga toxin-mediated haemolytic—uraemic syndrome (HUS), bacteria such as...
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