1.Acute kidney injury – can be avoided with knowledge and most of which can recover with simple
care and supportive management.
2.Chronic kidney disease – is irreversible but can be treated to retard the progression.
3.Nephrotic syndrome – means protein in urine and is very common kidney problem at all ages. It can be treated to remission in many cases.
4.Nephritic syndrome – presents with swelling, hypertension, proteinuria, oliguria and / or renal failure. It is missed very often, especially in its early part and if not treated in time can lead to irreversible kidney damage and CKD.
5.Stones – is very common problem in general population. It can run in families. Most of the stones can be managed medically and recurrence can be avoided with simple treatment. Very few stones (like large stones, infected stones or obstructing stones) require intervention. These days, almost no stones require open surgery and most can be managed by per urethral or per cutaneous interventions.
6.Urinary tract infections – is more common in females. If it is recurrent, it can cause lots of morbidity and at times mortality. UTIs should be evaluated in detail, if it is recurrent or complicated (obstructed system, reflux, with other comorbidities in a patient).
7.Others like – asymptomatic urinary abnormalities – hematuria – is always abnormal and requires evaluation for the cause and appropriate management.
The management of kidney diseases depends on the diagnosis. Patients usually presents with swelling, decreased urine output, urinary complaints like, burning, red colored urine, frequency of urination or night time urination, shortness of breath, loss of appetite, nausea, vomiting, fatigue, unexplained anemia, etc. The usual tests include renal function, urine routine, and ultrasound for KUB. Most of the gross abnormalities can be picked up in these tests and working diagnosis can be made. Depending upon the lead from these results, further specific tests can be ordered to short list or make the final diagnosis. AKI – mostly is because of hemodynamic compromise like diarrhea, vomiting, low blood pressure, certain drugs like NSAIDs, Contrast media, antibiotics, etc and then kidney specific causes like Glomerulonephritis, obstruction, etc. In cases of pre-renal causes, one should attempt to restore the hemodynamics, treat the cause, and avoid nephrotoxic drugs. In case of drug induced kidney injury, stop the offending drug and if the damage is significant as per results, should be sent to a Nephrologist for
further management. All other kidney specific causes should have a consult from Nephrologist to plan the management or it may be too late for the kidneys to come back. CKD – all attempts should be made to stabilize the renal function by adequate control of blood pressure, blood sugar, and by drugs like ACEI and ARBs. These patients should be managed mostly locally by physicians and have periodic follow up with Nephrologist and one should not hesitate to call up the respective Nephrologist to give opinion, when in doubt or new development occurs. Nephrotic syndrome – all adults should undergo biopsy and workup of NS because many of these are curable and most are treatable.
Nephritic syndrome – should be picked early and physicians should have low threshold for ordering renal tests when in doubt. This condition is also treatable and negligence can induce fibrosis and loss of renal function permanently.
Stones – Most small stones (<6 mm) pass spontaneously and patient should be encouraged to drink enough water to keep the urine dilute and prevent further growth of the stone. If the stone is recurrent, or obstructing or large, should be seen by Nephrologist in Pune / urologist. UTIs – mostly can be managed with routine antibiotics, but if recurrent, may require workup to rule out tuberculosis, structural abnormalities in urinary system, etc. If one gets any of the above symptoms or proven disease, early Nephrology opinion is mandatory to get appropriate treatment to either cure or retard the progression of the disease.