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Kidney disease

Category: Illnesses and disabilities

Type

Involuntary

Introduction and description

 

The Kidneys are bean-shaped organs that are located at the rear of the abdominal cavity in the retroperitoneal space. 

Kidney disease, also known as nephropathy or renal disease, is damage to or disease of a kidney.

The kidneys receive blood from the paired renal arteries, and drain into the paired renal veins. Each kidney excretes urine into a ureter which empties into the bladder. 

The kidney communicates with the endocrine system in general using various endocrine hormones including renin, angiotensin II, aldosterone, antidiuretic hormone, and atrial natriuretic peptide, among others.  From this you can see that disease of the endocrine system will affect the kidneys.

The kidneys serve several essential regulatory roles:

  • Maintaining blood balance – They regulate the balance of electrolytes, including salts in the blood, along with maintaining pH homeostasis, that is the acid-base balance.  
  • Cleaning the blood - They remove excess organic molecules from the blood, and it is by this action that their best-known function is performed: the removal of the waste products of metabolism.  These waste products are flushed away using water and sent to the urinary system.  The kidneys serve the body as a natural filter of the blood, and remove water-soluble wastes which are diverted to the bladder. In producing urine, the kidneys excrete nitrogenous wastes such as urea and ammonium.  As you can see, however, anything in the blood which is not water soluble could get stuck in the kidney leading to disease.  This is why it is not a good idea to inject things directly into your blood stream which are not water soluble.
  •  
    Maintenance of fluid balance and regulation of blood pressure  - via the salt and water balance.  Any significant rise in plasma ‘osmolality’ is detected by the hypothalamus, which communicates directly with the posterior pituitary gland. An increase in osmolality causes the gland to secrete antidiuretic hormone (ADH), resulting in water reabsorption by the kidney and an increase in urine concentration. The two factors work together to return the plasma osmolality to its normal levels.  As such you can see that any disease in the hypothalamus or pituitary gland will have its effects.
  • Reabsorption of useful products – The kidneys are responsible for the reabsorption of water, glucose, and amino acids.  Many of the kidney's functions are accomplished by relatively simple mechanisms of filtration, reabsorption, and secretion, which take place in the nephron.   As you can see however, if glucose levels spike or go out of control damage to the kidneys could result.
  • Hormone production - The kidneys also produce hormones including calcitriol and erythropoietin. An important enzyme, renin, is also produced in the kidneys; it acts in negative feedback.  Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the renal circulation. It stimulates erythropoiesis (production of red blood cells) in the bone marrow. Calcitriol, the activated form of vitamin D, promotes intestinal absorption of calcium and the renal reabsorption of phosphate.

Names names names

There are any number of different complex names that doctors have invented to describe failure, inflammation, pathogen attack, and malfunction of the kidney, here are but a few:

  •  
    Nephrosis is any of various forms of kidney disease (nephropathy).
  • Nephritis  - is inflammation of the kidneys and may involve the glomeruli, tubules, or interstitial tissue surrounding the glomeruli and tubules.  Nephritis represents the ninth most common cause of death among all women in the US
  • Glomerulonephritis  - is inflammation of the glomeruli.
  • Glomerulopathy  - is a set of diseases affecting the glomeruli of the nephron. Such diseases can include processes that are inflammatory or noninflammatory. Because the term glomerulitis exists for inflammatory conditions, glomerulopathy sometimes carries a noninflammatory implication.
  • Interstitial nephritis or tubulo-interstitial nephritis is inflammation of the spaces between renal tubules.
  • Pyelonephritis  - A urinary tract infection (UTI) is an infection that affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as pyelonephritis.
  •  
    Kidney stones – a kidney stone, also known as a renal calculus or nephrolith, is a solid piece of material which is formed in the kidneys from minerals in the urine. Kidney stones typically leave the body in the urine stream, and a small stone may pass without causing symptoms. If stones grow to sufficient size they can cause blockage of the ureter. This leads to pain, most commonly beginning in the flank or lower back and often radiating to the groin. This pain is often known as renal colic and typically comes in waves lasting 20 to 60 minutes. Other associated symptoms include: nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination.   In 2013, 49 million cases of kidney stones occurred, resulting in about 15,000 deaths globally. In the United States, about 9% of the population has had a kidney stone. Generally, slightly more men are affected than women.
  • Nephrocalcinosis, once known as Albright's calcinosis after Fuller Albright, or Anderson-Carr kidneys, is a term originally used to describe deposition of calcium salts in the renal parenchyma due to a diseased Thyroid [hyperparathyroidism].  Thus the cause in this case is malfunction of another organ.
  • Nephroptosis (also called floating kidney or renal ptosis) is when the kidney drops down into the pelvis when the patient stands up. It is more common in women than in men. It can be caused by the removal of other organs – hysterectomies, gall bladder removal, intestinal bands etc or damage to supporting fasciae as a result of surgery or physical damage.  There is a very tentative link with badly handled childbirth.
  • Proteinuria – is loss of protein due to an increase in permeability of the filtering membrane of the kidney. Alterations in their capacity to filter the substances transported in the blood mean that proteins but not cells pass into the urine
  •  
    Kidney cysts - a small pocket filled with fluid possibly indicating a pathogen – often a parasite that has been trapped and ‘engulfed’. Many renal cysts are benign, and people can live out their entire lives without any knowledge of a cyst. Over time, some cysts increase and enlarge when the pathogen has not been conquered [or an immunosuppressant is used allowing the pathogen to re-emerge].
  • Uremia or uraemia -  or "urea in the blood" [Urea is one of the primary components of urine] is a clinical manifestation of kidney failure (also called renal failure).  It shows the kidneys have lost their  excretory, regulatory and endocrine function.  It is a symptom rather than a cause, but is confusingly classified as an illness.
  • Acute kidney injury (AKI), previously called acute renal failure (ARF), is an abrupt loss of kidney function that develops within 7 days.  Its causes are numerous. Generally it occurs because of damage to the kidney tissue caused by decreased renal blood flow from for example 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.
  • Analgesic nephropathy - is injury to the kidney specifically caused by analgesic medications such as aspirin, phenacetin, and paracetamol.  It was once a common cause of kidney injury and end-stage kidney disease in parts of Europe, Australia, and the United States. In most areas, its incidence has declined since the use of phenacetin fell in the 1970s and 1980s.  The specific kidney injuries induced by analgesics are renal papillary necrosis and chronic interstitial nephritis. They appear to result from decreased blood flow to the kidney, rapid consumption of antioxidants, and subsequent oxidative damage to the kidney. This kidney damage may lead to progressive chronic kidney failure, high blood pressure, and anaemia. A small proportion of individuals with analgesic nephropathy may develop end-stage kidney disease.
  • Polycystic kidney disease (PKD or PCKD) is in theory an inherited disorder.  It is characterized by the presence of multiple cysts (hence, "polycystic") typically in both kidneys.  As we have seen with many of these so called inherited diseases, however, the assumption is based only on familial clustering not on genetic tests meaning that a parasite could be shared between family members, especially if they have a cat or dog as a pet.  Tapeworms can cause kidney cysts as we shall see.  Polycystic kidney disease is one of the most common ‘inherited’ diseases in the United States, affecting more than 600,000 people. It is the cause of nearly 10% of end-stage renal disease and affects men, women, and all races equally. 
  •  
    Diabetic nephropathy (or diabetic kidney disease) is caused by damage to the capillaries in the kidneys' glomeruli. It is due to longstanding diabetes mellitus.  It is thought that the high blood sugar resulting from diabetes acts as a toxin and damages the kidneys, gradually reducing their function.  Diabetic kidney disease is the most common cause of chronic kidney disease, leading to end-stage renal disease (ESRD) and premature death.  During its early course, diabetic nephropathy often has no symptoms. Symptoms can take 5 to 10 years to appear after the kidney damage begins.
  • Goodpasture syndrome (GPS); is a rare disease in which antibodies attack the basement membrane in lungs and kidneys, leading to bleeding from the lungs and kidney failure. What they are attacking is unknown and appears not to have been investigated.  Since medics do not know the cause, it has been classified as an autoimmune disorder which is less than helpful, as it discourages researchers from finding out what the body is attacking.   Goodpasture syndrome may quickly result in permanent lung and kidney damage, often leading to death, as such not knowing the cause is doubly unforgivable.  Many of the causes listed below have been postulated including the influenza virus, which then brings the interesting possibility of vaccines being the cause.
  •  
    Renal tubular acidosis (RTA) is an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. In renal physiology, when blood is filtered by the kidney, the filtrate passes through the tubules of the nephron, allowing for exchange of salts, acid equivalents, and other solutes before it drains into the bladder as urine. The metabolic acidosis that results from RTA may be caused either by failure to reabsorb sufficient bicarbonate ions (which are alkaline) from the filtrate in the early portion of the nephron (the proximal tubule) or by insufficient secretion of hydrogen ions (which are acidic) into the latter portions of the nephron (the distal tubule). Although a metabolic acidosis also occurs in those with renal insufficiency, the term RTA is reserved for individuals with poor urinary acidification in otherwise well-functioning kidneys.
  • Contrast induced nephropathy - Kidney disease induced by iodinated contrast media (ICM) is called CIN (= contrast induced nephropathy) or contrast-induced AKI (= Acute kidney injury). Currently, the underlying mechanisms are unclear. But there is a body of evidence that several factors including apoptosis-induction seem to play a role.
  • Lithium-induced nephropathy - The long term use of lithium, a medication commonly used to treat bipolar disorder and schizoaffective disorders, is known to cause nephropathy
  • Cancer-  Various cancers of the kidney exist. The most common adult renal cancer is renal cell carcinoma. Cancers, cysts, and some other renal conditions are managed in conventional medicine with removal of the kidney. This is known as nephrectomy.

Symptoms

In cases of inflammation, or kidney stones, one symptom can be back pain in roughly the area that the kidneys are located.  Where a person actually has some form of pathogen causing the problem, there can be fever, and there may be a rash, so there is a link here with skin diseases.  Some people experience painful urination.  Occasionally there may be blood in the urine.  When the disease is far advanced then there may be nausea, vomiting, fatigue, and weight loss. 

Kidney disease, however, can often be symptom less, which makes the disease particularly nasty as the knock on effects of having a diseased kidney or kidneys are extremely serious.  If the blood is not being filtered properly, then any toxin or pathogen in the blood, parasite, virus, fungus or bacteria will travel around affecting numerous organs with its only opposition the immune system.  So let us look at some examples of the knock on effects.

Heart disease and high blood pressure

 

If the kidneys cannot filter the blood properly because they are damaged or malfunctioning, then the knock on effects are likely to affect the blood circulatory system and the heart.  Atherosclerosis, hypertension , endothelial dysfunction and many forms of heart failure can be caused by a malfunctioning kidney or kidneys.   -

Renal dysfunction, even mild, is a strong independent predictor for poor prognosis in CVD patients. Developing therapeutic interventions targeting acute kidney injury (AKI) has been limited due mainly to lack of effective tools to accurately detect AKI in a timely manner. …… further validation of AKI biomarkers is needed …, especially acute decompensated heart failure and acute myocardial infarction where AKI commonly occurs. ….Pre-clininal studies have shown that activation of renal inflammation-fibrosis processes, probably triggered by haemodynamic derangement, underlies CVD-associated renal dysfunction. On the other hand, it is postulated that there still are missing links in the heart-kidney connection PMID: 24907309

Skin disease

The immune system in its valiant attempts to fight all the pathogens and toxins in the unfiltered blood, may simply push the pathogen to the surface of the skin and excrude it.  Then we might see pustules, psoriasis, boils, sores and all sorts of unpleasant looking bumps and warty looking nodules appearing.

Constipation

When cysts become big they often press on the surrounding organs and one of those organs is the bowel. Once the cysts begin to press, then the bowel movements are affected and constipation occurs.  Constipation can thus be a symptom of kidney disease.

Oedema

The symptoms for a failing heart and those for a failing
kidney are identical simply because they are part of the
same system.  The heart pumps the blood, the kidneys
clean it.

As cysts grow bigger and bigger, they not only interfere with kidney function but they can also lead to generalised swelling.  A malfunctioning kidney will do the same thing.

Put very simply, the kidney is responsible for ridding the body of excess water and waste products. When the kidney function declines, water may retain in the body, leading to swelling

A bloated belly or tummy is usually due to severe fluid retention in the abdomen. Less obvious may be the fluid retention occurring in the liver and even the heart.

The belly can swell, but the most obvious signs are swelling of the ankles and legs, hands and face.  In serious cases, the person may become very short of breath as fluid accumulates in the lungs as a result of pulmonary oedema.

Note that it is not a sensible course of action to reduce fluids or mineral intake.  To eliminate oedema radically, the most important step is to shrink the enlarged cysts and protect kidney function.

Bone and skeletal diseases

Patients with chronic kidney disease (CKD) frequently have mineral and bone disorders (CKD-MBD).  Renal osteodystrophy is currently defined as an alteration of bone morphology in patients with chronic kidney disease (CKD). The term "renal osteodystrophy" was coined in 1943, 60 years after an association was identified between bone disease and renal failure.

Recent research has suggested that uremic toxins from the gut such as p-cresyl sulfate (PCS) and indoxyl sulfate (IS) in cases where the intestinal flora has been compromised, could be involved in the development of bone disease in patients with CKD.

IS and PCS are produced by microbiota in the gut, carried into the plasma bound to serum albumin, and are normally excreted into the urine. However, in patients with CKD, there is an accumulation of high levels of these uremic toxins. The exact mechanisms of action of uremic toxins in bone disease remain unclear. PMID: 25944654


But it appears to exist.

Causes

 

There is not one cause, but many due to the various routes by which any pathogen may enter the kidney.

Antibiotics and other pharmaceuticals

Interstitial nephritis (or tubulo-interstitial nephritis) affects the interstitium of the kidneys surrounding the tubules. This disease can be either acute, meaning it occurs suddenly, or chronic, meaning it is ongoing and eventually ends in kidney failure. According to Wikipedia “Reaction to medications causes 71% to 92% of cases”.

And the causes can be direct and indirect.  The use of anti-histamines for example suppresses the immune system, thus allowing pathogens that have entered the blood stream to thrive.  And immunosuppressants do exactly the same thing. 

Wikipedia
The drugs that are known to cause this sort of reaction are antibiotics such as penicillin and cephalexin, and nonsteroidal anti-inflammatory drugs (aspirin less frequently than others), as well as proton-pump inhibitors, rifampicin, sulfa drugs, fluoroquinolones, diuretics, allopurinol, and phenytoin. The time between exposure to the drug and the development of nephritis can be anywhere from 5 days to 5 months.

Here are some other examples

  • Mouthwashes - As pathogens and food enter our system via the mouth or nose, the first line of defence is the mouth and ‘friendly bacteria’.  If we use a mouthwash that is an antibacterial, then the friendly bacteria are killed and all the pathogens travel with the food down to the stomach. 
  • PPIs and antacids - The second line of defence is the stomach acid.  If we use PPIs, or antacids in the mistaken belief that indigestion and heartburn is caused by too much acid, when it is actually caused by stress and not enough acid, we then destroy the second line of defence.  Now it is the last line of defence – the intestines. 
  • Antibiotics - If we now use antibiotics or eat food with growth promoting antibiotics, the antibiotics destroy our intestinal flora.  As a consequence, every pathogen entering the system can enter the blood stream.  And they do.  And it is not just the pathogens, all sorts of toxins enter the bloodstream, for example:

[renal dysfunction can be caused by] protein-bound uraemic toxins (PBUTs)…. Evidence of the causal role of PBUTs .. has been increasingly demonstrated, mainly focusing on indoxyl sulfate (IS) and p-cresyl sulfate (pCS). Both IS and pCS are derived from colonic microbiotic metabolism of dietary amino acids,  PMID: 24907309

  • Xanthine oxidase inhibitors, like allopurinol, can cause nephropathy because Xanthine is not very soluble in water; therefore, an increase in xanthine forms crystals (which can lead to kidney stones) and result in damage of the kidney.
  • Blood thinners – or more properly anticoagulants, especially heparins, warfarin and coumarin derivatives (vitamin K antagonists) have been implicated in causing general bleeding, bleeding from the gastrointestinal tract and kidney disorders, simply because they thin the blood and thus disrupt kidney function.  “Up on 33 patients kidney function disorder were found--exacerbated chronic renal failure and urinary tract infection. PMID: 26827569
  • Chemotherapy drugs - Nephropathy can be associated with some pharmaceuticals used to treat cancer. The most common form of kidney disease in cancer patients is Acute Kidney Injury (AKI) which can occur following chemotherapy and may be due to the toxicities of chemotherapeutic agents. Several chemotherapeutic agents, for example Cisplatin, are associated with acute and chronic kidney injuries.
  • Angiotensin II receptor blockers are used primarily for the treatment of hypertension where the patient is intolerant of ACE inhibitor therapy.   But they seem to disrupt the system itself.

The intrarenal renin-angiotensin system (RAS) has many well-documented pathophysiologic functions in both blood pressure regulation and renal disease development. Angiotensin II (Ang II) is the major bioactive product of the RAS. ….Activation of the Ang II type 1 (AT1) receptor pathway results in the production of proinflammatory mediators, intracellular formation of reactive oxygen species, cell proliferation, and extracellular matrix synthesis, which in turn facilities renal injury.  PMID:  27380400

Using the eHealthme website which gathers Adverse drug reports submitted from doctors, and taking a typical AIIRB, we find that the most common Valsartan side effects are as follows

  • Weakness - (640 reports)
  • Dizziness - (631 reports)
  • High blood pressure - (623 reports)
  • Nausea - (564 reports)
  • Renal failure acute - (544 reports)
  • Breathing difficulty - (541 reports)
  • Hypotension - (497 reports)
  • Chest pain - (441 reports)
  • Drug ineffective - (411 reports)
  • Fatigue - (384 reports)

All these are also symptoms of kidney failure.  Thus one is entitled to ask, did the person have kidney failure and it was not spotted and all the pharmaceutical did was make it worse, or did the pharmaceutical itself cause kidney failure?

Dietary supplements, vitamin supplements and mineral supplements

For reasons we are unable to understand, some people appear to believe that it is better to get minerals and vitamins from a pill than food.  From food it is extremely difficult to overdose, from pills it is easy to overdose.  Calcium is one component of the most common type of human kidney stones.  There are studies that show that people who take calcium or vitamin D as a dietary supplement have a higher risk of developing kidney stones. In the early 1990s, a study conducted for the Women's Health Initiative in the US found that postmenopausal women who consumed 1000mg of supplemental calcium and 400international units of vitamin D per day for seven years had a 17% higher risk of developing kidney stones than subjects taking a placebo. The Nurses' Health Study also showed an association between supplemental calcium intake and kidney stone formation.

Toxins

 

Pesticides, heavy metals, nanoparticles, insecticides and a range of other toxic chemicals have all been associated with various forms of kidney disease.  In fact, toxins as a whole play a very significant role in kidney disease in general, for example:

Chronic kidney disease (CKD) of unknown etiology represents about 16% of CKD patients in Indian subcontinents and 10% worldwide. ……epidemiological studies indicate the involvement of environmental toxins. Organochlorine pesticides (OCPs) have been detected in general population in India.  ….In this [study] we intend to find out blood levels of OCPs in CKD patients …. Blood levels of HCH, endosulfan and total pesticides were significantly higher in CKD patients.  PMID:  24216264

And

we identified 320 ESRD [end-stage renal disease ] cases diagnosed between enrolment (1993-1997) and December 2011 among 55 580 male licensed pesticide applicators. Participants provided information on use of pesticides via self-administered questionnaires. …Positive exposure-response trends were observed for the herbicides alachlor, atrazine, metolachlor, paraquat, and pendimethalin, and the insecticide permethrin.  PMID: 26177651

There is evidence that direct exposure [spraying by farm workers, inhalation] causes disease, but there is also evidence that indirect exposure [via foodstuffs etc] also does the same.  For example

Pesticide exposure has been found to cause renal damage and dysfunction …… but epidemiological research on the renal effects of chronic low-level pesticide exposure is limited. We investigated the relationships between end-stage renal disease (ESRD) among wives of licensed pesticide applicators (N=31,142) in the Agricultural Health Study (AHS) and

  • personal pesticide use
  • exposure to the husband's pesticide use, and
  • other pesticide-associated farming and household activities.

Conclusions: ESRD may be associated with direct and/or indirect exposure to pesticides among farm women. Future studies should evaluate indirect exposure risk among other rural populations.  PMID: 26505650


 

Paraquat was specifically mentioned in this study as one of the pesticides, “Among wives who never applied pesticides, ESRD was associated with husbands' use of paraquat and butylate

Links between environmental chemicals such as heavy metals, phthalates, arsenic, phenols, and pesticides and human health are well known, but the effects from polyaromatic hydrocarbons (PAH) is also now being evaluated:

……..Of 5560 American adults aged 20-80 and included in the statistical analysis, urinary 4-hydroxyphenanthrene was significantly associated with celiac disease. In addition, urinary 2-hydroxyfluorene, 3-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, and 2-hydroxynapthalene were significantly associated with kidney stones, although not necessarily failing kidney. PMID:  26728287

It may be worth adding that these chemicals can also be used as a marker for PAH pollution in marine fish.

There are some quite unusual and perhaps unsuspected toxins that have also been implicated in kidney disease.  For example, Balkan endemic nephropathy (BEN) is a chronic tubulointerstitial nephritis seen primarily in countries in the Balkan Peninsula. The disease, which was first described in Romania 50 years ago, often manifests as a form of chronic nephritis that is also associated with upper urothelial cancers (UUC).

 …. this paper analyzes the main etiological factors suspected to play a role in BEN: … mycotoxins, toxic substances from pliocene lignite, genetic factors, and viruses. PMID:  21176749

It is known that the Pliocene lignite of the Kosovo Basin, Serbia has high nickel and chromium concentrations, which brings us neatly on to the next cause – heavy metals.

Heavy metals

Heavy metals are a very known risk – of all sorts – cadmium, lead, arsenic, nickel, chromium, mercury [and hence the mercury from leaking dental amalgam fillings].  This paper should send shivers down your back

In a recent study published by the National Project team on chronic kidney diseases of unknown origin in Sri Lanka, we believe there to be flaws in the design, analysis, and conclusions, … The authors wanted to emphasis Cadmium as the major risk factor for chronic kidney disease of unknown etiology in Sri Lanka while undermining the importance of Arsenic and nephrotoxic pesticides. ….. The enormous pressure applied by the agrochemical industry .. may be a factor. PMID:  25069452

Oh dear.

Physical damage  and surgery

Thenboxing 'kidney punch'

Blows to the kidney, or other physical damage from accidents are another cause, but so can surgery and not just surgery to the kidney itself.  This interesting paper shows that kidney damage canbe a side effect of cardiac surgery

Acute kidney injury (AKI) complicates recovery from cardiac surgery in up to 30 % of patients, injures and impairs the function of the brain, lungs, and gut, and places patients at a 5-fold increased risk of death during hospitalization. Renal ischemia, reperfusion, inflammation, hemolysis, oxidative stress, cholesterol emboli, and toxins contribute to the development and progression of AKI.  AKI that requires renal replacement therapy occurs in 2-5 % of patients following cardiac surgery and is associated with 50 % mortality. For those who recover from renal replacement therapy or even mild AKI, progression to chronic kidney disease in the ensuing months and years is more likely than for those who do not develop AKI. PMID:  27373799

 Viral infection

If the intestinal wall is damaged, any number of different viruses can enter the blood stream as such one can say that viruses of all sorts have the potential to cause kidney disease, if that is where they decide to stay.  There is a very strong link between kidney diseases and the various hepatitis viruses – many of them not just hepatitis C.  For example

Hepatitis C virus infection may induce renal disease, i.e., cryoglobulinemic membrano-proliferative glomerulopathy and non-cryoglobulinemic nephropathy. Hepatitis C virus impacts general outcomes in chronic kidney disease, dialysis or transplanted patients. PMID:  27388502

This paper is especially interesting as it highlights the fact that kidney donors may actually have hepatitis without knowing it:

Iran is known as an endemic country for hepatitis E virus (HEV) infection, while there are variations in the epidemiology of HEV infection throughout the country. The available epidemiological studies in different regions of Iran show HEV seroprevalence of 1.1%-14.2% among general population, and …. 30.8% among kidney transplant recipient patients.  PMID:  27298557

And

The year 2009 was characterized by a pandemic with a new virus, the 2009 H1N1 influenza virus. This pandemic was responsible for thousands of deaths worldwide, …...As part of such a critical illness, a percentage of patients developed acute kidney injury (AKI) which complicated their clinical course and, in some patients, required support by renal replacement therapy. In a case series from Mexico, the incidence of severe AKI was reported in about 30% of the patients. Similarly, at the Austin Hospital, of 13 cases, 8 developed AKI with 3 being classified in the failure category ..... Among the patients with AKI, hospital mortality was approximately 25%.... PMID: 20427982

Parasites

 

Parasites are often the cause of cysts.  Echinococcosis, for example, is a parasitic disease of tapeworms and causes what are called Hydatid cysts

In this study it is aimed to contribute in determination of geographic distribution of Hydatid Cysts in Turkey ….. [for] cases diagnosed as Hydatid Cysts in Atatürk University Medical Faculty Pathology Department/Erzurum laboratories between 2003-2013…. In our study, 459 Hydatid Cysts cases are defined. The most common localizations of cases are determined as liver (n:280, 61%) and lung (n:86, 18,7%). Those are followed by the kidney (n:12, 2,6%), brain (n:12, 2,6%) and spleen (n:9, 2.3%). Multi-organ involvement is observed in 31 cases (6.7%)  PMID:  26081882

Bacterial infection

Bacterial infection by both the natural bacteria of the intestinal flora leaking into the blood stream and unconquered bacteria from wounds, bleeding gums and so on are known to cause kidney disease

Kidneys obtained by nephrectomy from 85 patients with chronic nephropathy were examined by bacterial culture and by immunofluorescence for a content of E. coli antigen. ….Bacteria could be cultured from the nephrectomy specimens in 24 cases, mainly in cases of obstructive chronic pyelonephritis, analgesic nephropathy and congenital renal disease. PMID:  343494

About 10–15% of kidney stones are composed of struvite (ammonium magnesium phosphate, NH4MgPO4·6H2O). Struvite stones form most often in the presence of infection by urea-splitting bacteria. Using the enzyme urease, these organisms metabolize urea into ammonia and carbon dioxide. This alkalinizes the urine, resulting in favourable conditions for the formation of struvite stones. Proteus mirabilis, Proteus vulgaris, and Morganella morganii are the most common organisms isolated; less common organisms include Ureaplasma urealyticum, and some species of Providencia, Klebsiella, Serratia, and Enterobacter. These infection stones are commonly observed in people who have factors that predispose them to urinary tract infections. They are also commonly seen in people with underlying metabolic disorders, such as hyperparathyroidism, and gout.

Postdiarrheal hemolytic uremic syndrome (HUS) affects children under 5 years old and is responsible for the development of acute and chronic renal failure, particularly in Argentina. This pathology is a complication of Shiga toxin (Stx)-producing Escherichia coli infection and renal damage is attributed to Stx types 1 and 2 (Stx1, Stx2) produced by Escherichia coli O157:H7 and many other STEC serotypes. … The human kidney is the most affected organ because very Stx-sensitive cells express high amounts of biologically active receptor. PMID:  27336788

Fungal infection

 

Fungi may enter the blood stream via a compromised intestinal system, but they can also travel up the ureter if the person has a urinary tract or bladder infection.   The Candida yeasts are able to do this, although in the following very interesting case study, it is clear the use of antibiotics resulted in the yeast getting into the bloodstream via the intestinal wall and up the ureter. 

Although candiduria is becoming increasingly common among hospitalized patients, Candida lusitaniae is a rare pathogen. … We report herein on a case of acute pyelonephritis and candidemia due to C. lusitaniae. A 66-year-old man presented with a high fever during hospitalization following septic shock due to ischial osteomyelitis treated with tazobactam/piperacillin for 29 days. … The next day, blood culture and urine culture tested positive and showed yeast-like fungi. We diagnosed acute pyelonephritis and candidemia due to Candida species…. C. lusitaniae was identified on the hospital day 34 …. Candida albicans was the most prevalent species isolated from the urinary tract PMID:  27197441

Another route is via food, and a compromised intestinal system.  For example, Ochratoxins are produced by fungi.

Ochratoxins are a group of mycotoxins produced by some Aspergillus species (mainly A. ochraceus, but also by 33% of A. niger industrial strains) and some Penicillium species, especially P. verrucosum and P. carbonarius .  Ochratoxin A is the most prevalent and relevant fungal toxin of this group, while ochratoxins B and C are of lesser importance.  Ochratoxin A is known to occur in commodities such as cereals, coffee, dried fruit, and red wine. It is of special interest as it can be accumulated in the meat of animals. Thus, meat and meat products can be contaminated with this toxin. Exposure to ochratoxins through diet can cause acute toxicity in mammalian kidneys.

Since ochratoxin A (OTA) was discovered, it has been ubiquitous as a natural contaminant of moldy food and feed. The multiple toxic effects of OTA are a real threat for human beings and animal health. For example, OTA can cause porcine nephropathy but can also damage poultries. Humans exposed to OTA can develop (notably by inhalation in the development of acute renal failure within 24 h) a range of chronic disorders such as upper urothelial carcinoma. OTA plays the main role in the pathogenesis of some renal diseases including Balkan endemic nephropathy, kidney tumors occurring in certain endemic regions of the Balkan Peninsula, and chronic interstitial nephropathy occurring in Northern African countries and likely in other parts of the world. … Careful analyses of the data show that OTA carcinogenic effects are due to combined direct and indirect mechanisms (e.g., genotoxicity, oxidative stress, epigenetic factors). Altogether this provides strong evidence that OTA carcinogenicity can also occur in humans.  PMID:  27384585

One interesting finding is that combinations of toxins – each supposedly within legal limits for consumption – are lethal, almost as if they boost each other

At concentrations representing legal limits of each individual contaminant in maize …. the mixtures (tertiary mycotoxins plus Cd/As) and (tertiary mycotoxins plus Cd/As/CP/PM) were cytotoxic .  …. The most cytotoxic mixture was (tertiary mycotoxins plus Cd/As/CP/PM) across all 4 endpoints.   ….. Governmental regulatory bodies must begin to contemplate how to safeguard the population when such mixtures of contaminants are found in foods.   PMID:  26196220

 

Treatments

Symptom based treatment

Millions of people across the world suffer from kidney disease. Of those millions, several thousand will eventually or do need kidney transplants. Out of those millions in the world, 16,500 in the United States needed a kidney transplant in 2008. Of those 16,500 people, 5,000 died while waiting for a transplant. Currently, there is a shortage of donors, and in 2007 there were only 64,606 kidney transplants in the world.

This shortage of donors is causing countries to place monetary value on kidneys. Countries such as Iran and Singapore are eliminating their lists by paying their citizens to donate. Also, the black market accounts for 5-10 percent of transplants that occur worldwide. The act of buying an organ through the black market is illegal in the United States – but it still happens.

Dialysis treatment in severe cases is effective for a time, but may not remove all the pathogens from the blood.  And

ESKD [end stage kidney disease] patients are at risk of cumulative exposure to significant levels of diagnostic radiation. The majority of this exposure is imparted as a result of CT examinations to patients in the HD [hemodialysis ] group.  PMID: 21842156

Might we suggest it is far far better to tackle the cause of kidney disease.

Cause based treatment

  • Stop using all these harmful pharmaceuticals
  • Get your minerals and vitamins from food – obtain all minerals and vitamins from your food.  Kidney stones are more likely to develop, and to grow larger, if a person has low dietary magnesium. Magnesium inhibits stone formation.  DO NOT OVERDOSE on magnesium.  Simply ensure your diet has enough magnesium in it.  Generally, a low-sodium diet is thought to reduce the stress on kidneys.
  • Adjust your diet - Generally, a diet omitting spicy and fatty foods is also thought to reduce the stress on kidneys, principally because it is believed [and it is a belief] they ‘stimulate the growth of renal cysts’.  No alcohol either, this too is said to damage an already weakened kidney.  Frequent and binge drinking can lead to dehydration, which can in turn lead to stress on the kidneys because there is not enough water to flush the toxins out.
  • Drink water – not gallons and gallons.  Drink enough so you are not dehydrated.  Always drink between meals not after them.  This way you don’t dilute the acids in your stomach and promote indigestion or heartburn.
  • Investigate new non intrusive therapies - The Chinese are experimenting with a number of non intrusive therapies whose efficacy we are not in a position to judge, but are certainly worth monitoring.  Osmotherapy is but one and hot compress therapy.  The hot compress is placed on the back.  The logic of using this can be proven as it helps the immune system get troops to the affected area, assuming the cause is a pathogen.
  • Use plants to repair the damage - Try to repair the kidney using plant based medicines and food.  Dr Duke’s phytochemical database lists very few plants that deal with nephrosis as a whole – the herbs listed are used in Chinese medicine:

Dr Duke’s list of plants that help with Nephrosis

Aralia elata ( Tara-No-Ki )

Catalpa ovata ( Ki-Sasage )

Orthosiphon spiralis

 But we have put in a number of observations from Dr Duke and from other sources in PubMed that provide help with specific complaints.  And there are a great number of foods that help with kidney disease.

  • Eat Polyunsaturated fatty acids (PUFAs)  - are fatty acids that contain more than one double bond in their backbone. This class includes many important compounds, such as essential fatty acids.  According to Dr Duke’s phytochemical database, which itself was based on the results in Martindale's 28th PUFAs are Antipolyneuritic
  • Go organic - Dietary strategies are already an accepted part of the treatment in the more enlightened parts of the world, go organic, avoid all foods from factory farmed animals.  For example

Dietary therapy represents an important tool in the management of chronic kidney disease (CKD), mainly through a balanced reduction of protein intake aimed at giving the remnant nephrons in damaged kidneys a "functional rest". …. Diet is one of the oldest CKD treatments, and it is usually considered a part of "mainstream" management.. ……There is no gold-standard, low-protein diet for all CKD patients: from among a relatively vast choice, the best compliance is probably obtained by personalization. …..PMID:  27391228

In serious cases go vegetarian and ONLY organically produced vegetables.
  • Grow your own -  grow your own fruit and vegetables.  We have lots of help on this site to enable you to do so.
  • Restore balance in the intestines - There is also every reason to try to restore balance in the intestines.  Please note this does NOT involve stuffing yourself full of prebiotics  or probiotics, as you have no idea what flora you have destroyed by taking the pharmaceuticals.  Simply feed your intestinal garden using good organic food.

It is well-established that uremic toxins are positively correlated with the risk of developing chronic kidney disease and cardiovascular disease. In addition, emerging data suggest that gut bacteria exert an influence over ….. the development of chronic kidney disease. As such, modifying the gut microbiota may have the potential as a treatment for chronic kidney disease. This is supported by data that suggest that rescuing microbiota dysbiosis may: reduce uremic toxin production; and prevent toxins and pathogens from crossing the intestinal barrier  PMID:  26965149

 

References and further reading

  • Clin Chem. 1999 Sep;45(9):1548-56. Aluminum, iron, lead, cadmium, copper, zinc, chromium, magnesium, strontium, and calcium content in bone of end-stage renal failure patients.  D'Haese PC1, Couttenye MM, Lamberts LV, Elseviers MM, Goodman WG, Schrooten I, Cabrera WE, De Broe ME.
  • Crit Care. 2016 Jul 4;20(1):187. doi: 10.1186/s13054-016-1352-z.  Acute kidney injury following cardiac surgery: current understanding and future directions.  O'Neal JB1, Shaw AD2, Billings FT 4th2.
  • Environ Res. 2015 Nov;143(Pt A):198-210. doi: 10.1016/j.envres.2015.10.002. Epub 2015 Oct 24. Pesticide exposure and end-stage renal disease risk among wives of pesticide applicators in the Agricultural Health Study.  Lebov JF1, Engel LS2, Richardson D3, Hogan SL4, Sandler DP5, Hoppin JA6. - Department of Epidemiology, and Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, USA.
  • J Physiol. 2014 Sep 15;592(18):3969-83. doi: 10.1113/jphysiol.2014.273078. Epub 2014 Jun 6.  Cardiorenal syndrome: acute kidney injury secondary to cardiovascular disease and role of protein-bound uraemic toxins. Lekawanvijit S1, Krum H2.
  • BMC Nephrol. 2016 Jul 8;17(1):76. Low protein diets in patients with chronic kidney disease: a bridge between mainstream and complementary-alternative medicines? Piccoli GB1,2, Capizzi I3,4, Vigotti FN3,4, Leone F5, D'Alessandro C6, Giuffrida D5, Nazha M3,4, Roggero S3,4, Colombi N7, Mauro G7, Castelluccia N7, Cupisti A6, Avagnina P8.
  • BMC Nephrol. 2014 Jul 28;15:124. doi: 10.1186/1471-2369-15-124.  Importance of Arsenic and pesticides in epidemic chronic kidney disease in Sri Lanka.  Jayasumana C1, Gajanayake R, Siribaddana S.
  • Chemosphere. 2014 Feb;96:174-9. doi: 10.1016/j.chemosphere.2013.10.029. Epub 2013 Nov 9. Increased level of organochlorine pesticides in chronic kidney disease patients of unknown etiology: role of GSTM1/GSTT1 polymorphism. Siddarth M1, Datta SK, Mustafa M, Ahmed RS, Banerjee BD, Kalra OP, Tripathi AK.
  • Clin Exp Nephrol. 2016 Mar 10. [Epub ahead of print]  The role of the gastrointestinal tract and microbiota on uremic toxins and chronic kidney disease development.  Briskey D1, Tucker P2, Johnson DW3, Coombes JS4.
  • Clin Nephrol. 2011 Jan;75(1):34-48.  Fifty years of Balkan endemic nephropathy in Romania: some aspects of the endemic focus in the Mehedinti county.  Gluhovschi G1, Margineanu F, Velciov S, Gluhovschi C, Bob F, Petrica L, Bozdog G, Trandafirescu V, Modalca M.
  • Environ Sci Pollut Res Int. 2016 Feb;23(4):3971-7. doi: 10.1007/s11356-015-5980-7. Epub 2016 Jan 5.  Urinary polyaromatic hydrocarbons are associated with adult celiac disease and kidney stones: USA NHANES, 2011-2012.  Shiue I1,2.
  • World J Gastroenterol. 2016 Jun 14;22(22):5143-53. doi: 10.3748/wjg.v22.i22.5143. Epidemiology of hepatitis E virus in Iran. Taherkhani R1, Farshadpour F1.
  • Turkiye Parazitol Derg. 2015 Jun;39(2):103-7. doi: 10.5152/tpd.2015.3590. [Hydatid Cyst Cases with Different Localization: Region of Erzurum].  [Article in Turkish]  Demirci E1, Altun E, Çalık M, Durur Subaşı I, Şipal S, Gündoğdu ÖB.
  • Toxins (Basel). 2016 Jul 4;8(7). pii: E191. Ochratoxin A: 50 Years of Research. Malir F1, Ostry V2, Pfohl-Leszkowicz A3, Malir J4, Toman J5.
  • Toxicol Lett. 2015 Oct 1;238(1):54-64. doi: 10.1016/j.toxlet.2015.07.006. Epub 2015 Jul 18. Challenging conventional risk assessment with respect to human exposure to multiple food contaminants in food: A case study using maize.  Clarke R1, Connolly L2, Frizzell C2, Elliott CT2  Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Ireland.
  • Acta Pathol Microbiol Scand B. 1977 Dec;85B(6):440-8.  Bacteria and bacterial antigen in the kidney in human chronic renal disease. Bacteriological and immunofluorescence Studies.  Thomsen OF, Olsen TS.
  • Toxicol Appl Pharmacol. 2016 Jan 27. pii: S0041-008X(16)30018-7. doi: 10.1016/j.taap.2016.01.018.Urinary microRNAs as potential biomarkers of pesticide exposure.  Weldon BA1, Shubin SP1, Smith MN1, Workman T1, Artemenko A1, Griffith WC1, Thompson B2, Faustman EM3.  PMID:  26826490
  • Infect Dis Ther. 2016 Jul 7. [Epub ahead of print]  Hepatitis C Therapy in Renal Patients: Who, How, When? Isnard Bagnis C1,2, Cacoub P3,4,5,6.
  • Kansenshogaku Zasshi. 2016 Mar;90(2):134-7.  [Acute Pyelonephritis and Candidemia Due to Candida lusitaniae: A Case Report].  [Article in Japanese]  Tsuboi M, Uno S, Hase R, Yano Y, Sando E, Otsuka Y, Hosokawa N.
  • Late-onset effects of radiation and chronic kidney disease.  Cohen EP, Fish BL, Moulder JE. Lancet. 2015 Oct 31;386(10005):1737-8. doi: 10.1016/S0140-6736(15)00697-2.  PMID: 26545436
  • Occup Environ Med. 2016 Jan;73(1):3-12. doi: 10.1136/oemed-2014-102615. Epub 2015 Jul 15.  Pesticide use and risk of end-stage renal disease among licensed pesticide applicators in the Agricultural Health Study. Lebov JF1, Engel LS1, Richardson D1, Hogan SL2, Hoppin JA3, Sandler DP4.
  • Pediatr Nephrol. 2016 Jul 5. [Epub ahead of print]  Role of the intrarenal renin-angiotensin system in the progression of renal disease.  Urushihara M1, Kagami S2.
  • PLoS One. 2016 Jun 23;11(6):e0158180. doi: 10.1371/journal.pone.0158180. eCollection 2016. Comparative Characterization of Shiga Toxin Type 2 and Subtilase Cytotoxin Effects on Human Renal Epithelial and Endothelial Cells Grown in Monolayer and Bilayer Conditions. Álvarez RS1, Sacerdoti F1, Jancic C2, Paton AW3, Paton JC3, Ibarra C1, Amaral MM1.
  • PLoS One. 2016 Jun 30;11(6):e0158683. doi: 10.1371/journal.pone.0158683. eCollection 2016.  Host-Imposed Copper Poisoning Impacts Fungal Micronutrient Acquisition during Systemic Candida albicans Infections.  Mackie J1, Szabo EK1, Urgast DS2, Ballou ER1, Childers DS1, MacCallum DM1, Feldmann J2, Brown AJ1. [Nutritional immunity is a process whereby an infected host manipulates essential micronutrients to defend against an invading pathogen. … we show that readjustments in hepatic, splenic and renal copper homeostasis accompany disseminated Candida albicans infections] PMID: 27362522
  • Ther Apher Dial. 2015 Oct;19(5):436-40. doi: 10.1111/1744-9987.12307. Epub 2015 May 5.  Effects of Uremic Toxins from the Gut Microbiota on Bone: A Brief Look at Chronic Kidney Disease.  Black AP1, Cardozo LF2, Mafra D1,2.

Observations

A number of famous people have suffered from kidney stones, though one doubts whether the stones had much effect spiritually!  On the other hand the medications for pain relief such as opium, may have.  Famous people include Napoleon I, Epicurus, Napoleon III, Peter the Great, Louis XIV, George IV, Oliver Cromwell, Lyndon B. Johnson, Benjamin Franklin, Michel de Montaigne, Francis Bacon, Isaac Newton, Samuel Pepys, William Harvey, Herman Boerhaave, and Antonio Scarpa.

Related observations