Category Archives: Renal disease

Renal disease in the elderly

Renal disease and renal failure are common in the elderly. Acceptance of patients aged 65 years and over for renal replacement therapy approximately doubles the number of such patients in whom renal replacement is initiated. Renal failure in the elderly more often results from renal vascular disease or urinary tract obstruction than in younger age groups. In males, obstruction is most often due to benign or


Benign enlargement of the prostate gland Benign prostatic enlargement occurs most often in men over the age of 60 years. Such enlargement is much less common in African and Asian individuals. It is unknown in eunuchs. The aetiology of the condition is unknown. Microscopically, hyperplasia affects the glandular and connective tissue elements of the prostate. Enlargement of the gland stretches and distorts the

Turnours Of the kidney and genitourinary tract

MALIGNANT RENAL TUMOURS These comprise 1-2% of all malignant tumours, and the male/female ratio is 2 : 1. Renal cell carcinoma Renal cell carcinomas (previously called hypernephromas or Grawitz tumours) arise from proximal tubular epithelium. They are the commonest renal tumour in adults. They rarely present before the age of 40 years, the average age of presentation being 55 years. PATHOLOGY  The tumours may

Cystic, congenital and familial disease

Cystic renal disease Solitary or multiple renal cysts are common, especially with advancing age: 50% of those aged 50 years or more have one or more such cysts. They have no special significance except in the differential diagnosis of renal tumours . Such cysts are often asymptomatic and are found on excretion urography or ultrasound examination performed for some other reason. Occasionally they may cause pa

Complications of long-term dialysis

Cardiovascular disease and sepsis are the leading causes of death in long-term dialysis patients. Causes of fatal sepsis include peritonitis complicating peritoneal dialysis and Staph. aureus infection (including endocarditis) complicating the use of indwelling access devices for haemodialysis. DIALYSIS AMYLOIDOSIS is caused by the accumulation of amyloid protein as a result of failure of clearance of f32-mi

Peritoneal dialysis

Peritoneal dialysis utilizes the peritoneal membrane as a semi-permeable membrane, avoiding the need for extracorporeal circulation of blood. This is a very simple, low technology treatment compared to haemodialysis. The principles are simple : 1 A tube is placed into the peritoneal cavity through the anterior abdominal wall. 2 Dialysate is run into the peritoneal cavity, usually under gravity. 3 Urea, creati

Patient education

Involvement at an early stage in various aspects of treatment helps prepare the way for the complicated training that may lie ahead. Dietary and drug therapy should be explained. As dialysis and/or transplantation may be required in the future, forward planning may be necessary. The patient’s home may need to be assessed and converted to take dialysis equipment. Job prospects and economic resources nee


The principles of management are outlined in Information box 9.2 and Practical box 9.4. Obviously, treatment should be directed at the underlying disease. However, many causes of acute renal failure result in the ‘final common path’ of acute tubular necrosis. No treatment has been shown to affect the natural history of acute tubular necrosis. Clearly as many of the factors leading to hypoperfusion


Anaemia Anaemia is present in the great majority of patients with chronic renal failure. Several factors have been implicated: ERYTHROPOIETIN DEFICIENCY is the most important BONE MARROW TOXINS such as polyamines, aluminium, arsenic, copper, lead BONE MARROW FIBROSIS secondary to hyperparathyroidism HAEMATINIC DEFICIENCy-iron, vitamin B12′ folate INCREASED RED CELL DESTRUCTION due to mechanical, oxidan


A list of causes of chronic renal failure, together with their relative frequencies in European patients starting dialysis, is given in Table 9.23. In the early stages, a specific diagnosis is often possible but with near end-stage renal failure with small kidneys a specific diagnosis is often impossible even with a renal biopsy. Hypertension is frequently found, but whether this is the cause or the result o