Kidney Problems – Types, Causes and Symptoms

The kidneys filters the blood to remove wastes, balance the electrolytes in the bloodstream and manages fluid volume in the body. If the kidney function is disturbed either by intrinsic or extrinsic factors, certain early signs and symptoms may become evident. With time this can progress to more generalized signs and symptoms as kidney functioning diminishes due to disease progression.

The kidney does not exist in isolation within the body. Other systems impact upon kidney (renal) functioning and the kidneys are also dependent on the rest of the urinary tract to excrete urine efficiently in order to continue with its activities. Any disruption may result in acute renal failure.

Types of Kidney Problems

The kidneys play a number of important roles in the body beyond the formation and excretion of urine to expel wastes in the body. Without adequate kidney function, homeostasis cannot be maintained in the body. The kidney also has the following functions :

  • Regulates the blood pressure.
  • Controls the acid-base balance of the body fluids including the blood, intracellular (within cells) and interstitial (tissues) fluid.
  • Influences the osmotic gradient (osmolality) between fluids in different compartments thereby impacting on fluid distribution.
  • Hormone secretion which influences several processes including calcium and phosphate levels and red blood cell production. These hormonal functions are separate to the adrenal glands located at the top of each kidney, which may also be affected with certain types of kidney diseases.

Therefore kidney diseases will also cause of a host of signs, symptoms and secondary disorders of various other systems. Severe kidney diseases can be divided into :

  • Acute renal failure where the kidneys suddenly stop working completely or almost entirely but normal functioning can be restored with proper treatment and time. With acute renal failure the production and flitering of urine is not possible and there is little or no urine passed (oliguria or anuria). Urea and other nitrogenous wastes build up in the blood stream (uremia).
  • Chronic renal failure where there is a gradual loss of kidney function due to a diminishing number of competent nephrons (the basic filtration unit of the kidney). This is often irreversible. Uremia also arises along with a host of generalized signs and symptoms.

Kidney diseases are categorized in several ways based on the effect of kidney and manner in which kidney function is disrupted. This extends beyond acute and chronic renal failure and may give rise to a host of different signs and symptoms.

  • Nephritic syndrome arises with glomerular inflammation (glomerulonephritis) and typically seen in acute conditions like an infection.
    • Hematuria – blood in urine
    • Proteinuria – protein in urine
    • Hypertension – high blood pressure
    • Edema – swelling
  • Nephrotic syndrome arises with damage to the glomerulus as may be seen with glomerulonephritis or several disorders that either directly or indirectly damage the kidney.
    • Heavy proteinuria – excessive protein in urine
    • Hypoalbuminemia – low blood proteins
    • Severe edema – excessive swelling
  • Renal tubular disease may be due to structural defects of the tubules or functional disturbances in the renal tubule. It can arise due to a number of causes including inherited and acquired factors.
    • Polyuria – large volume urination
    • Nocturia – waking at night to pass urine
    • Acidosis/alkalosis – acid-base balance in blood affected

Other kidney diseases include :

  • Kidney infections
  • Kidney stones
  • Urinary tract obstruction
  • Renal tumors

Generalized Symptoms

These signs and symptoms may not always be indicative of a kidney problem and some are more likely to occur over time rather than in the early stages.

  • Edema – swelling in the legs, arms, face, abdomen or throughout the entire body
  • Itchy skin and skin rashes
  • Shortness of breath (dyspnea)
  • Dizziness
  • Fatigue
  • Nausea and vomiting
  • Flank or loin pain
  • Changes in blood pressure
  • Changes in heart rate
  • Difficulty concentrating
  • Confusion
  • Diarrhea
  • Abdominal pain
  • Metallic taste in the mouth

Kidney Symptoms

Kidneys upper urinary tract :

Lower urinary tract :

  • Dysuria – pain when passing urine.
  • Urinary frequency – passing urine often more frequently than normal.
  • Polyuria – passing more urine than normal (high daily volume).
  • Oliguria – passing less urine than normal (low daily volume).
  • Anuria – total absence of urine output.
  • Pneumaturia – gas in the urine.
  • Urethral discharge – pus and/or mucus from the urethra.
  • Urgency – urgent need to urinate.
  • Nocturia – waking at night to pass urine.
  • Hesitancy – delay in starting urination.
  • Post-micturition dribbling – passing of small quantities of urine after urination.
  • Urinary incontinence – involuntary passing of urine.

Causes of Kidney Problems

The causes can be divided into the following categories :

Pre-renal

This may indicate a cause outside of the kidney (not the urinary tract) and accounts for 40% to 70% of kidney problems.

Some early signs and symptoms include :

  • Urine output – oliguria, anuria, urinary frequency, polyuria.
  • Concentrated or ‘dilute’ urine.
  • Hematuria – blood in the urine
  • Proteinuria – protein in the urine

Some of the causes include :

  • Hypertension
  • Heart failure
  • Diabetes (insipidus/mellitus)
  • Liver disease (cirrhosis)
  • Dehydration
  • Loss of fluid/blood (shock)
  • Sepsis
  • Renal artery stenosis

Renal

This indicates a problem within the kidney itself and accounts for 20% to 50% of kidney problems.

Some early signs and symptoms include :

  • Kidney pain (flank or loin pain)
  • Hematuria
  • Proteinuria
  • Leukocyturia – white blood cells in the urine

Some of the causes include :

  • Muscle breakdown after trauma
  • Blood transfusion
  • Sepsis
  • Recent surgery
  • Shock
  • Autoimmune diseases like SLE (lupus), Goodpasture’s syndrome
  • HIV/AIDS
  • Diabetes mellitus
  • Drugs like NSAIDs, certain antibiotics, diuretics and ACE inhibitors.

Post-renal

This may indicate a problem within theĀ  ureter, bladder or urethra. In men, the prostate gland may also be responsible. This accounts for 10% to 20% of kidney problems.

Some early signs and symptoms include :

Ureter

  • Hematuria
  • Renal colic
  • Loin pain

Bladder

  • Hematuria
  • Urinary retention – oliguria/anuria
  • Pain/discomfort (suprapubic)
  • Incontinence
  • Dysuria – painful urination
  • Recurrent UTI’s (urinary tract infections)

Urethra

  • Hematuria
  • Urinary retention – oliguria/anuria
  • Dysuria – painful urination
  • Recurrent UTI’s (urinary tract infections)

Prostate (Men)

  • Frequent urination or urinary retention
  • Post-micturition dribble, hesitancy, straining
  • Recurrent UTI’s (urinary tract infections)

Some of the causes include :

  • Urinary stones
  • Bladder or prostate tumor
  • Benign prostatic hyperplasia
  • Sexually transmitted diseases (STD’s)

References

  1. Kidney diseases. NIH.gov

Last updated on September 3, 2018.

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