renal impairment

• 腎機能障害、腎機能低下、腎障害

関

impaired renal function、kidney disorder、kidney dysfunction、nephropathia、nephropathic、nephropathy、renal damage、renal disorder、renal dysfunction

WordNet

1. damage that results in a reduction of strength or quality

PrepTutorEJDIC

1. 腎臓の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/06/08 01:06:39」(JST)

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Kidney failure
A hemodialysis machine, used to replace the function of the kidneys in renal failure
Classification and external resources
Specialty	Nephrology
ICD-10	N17-N19
ICD-9-CM	584-585
DiseasesDB	26060
MeSH	C12.777.419.780.500

Kidney failure, also known as renal failure or renal insufficiency, is a medical condition in which the kidneys fail to adequately filter waste products from the blood. The two main forms are acute kidney injury, which is often reversible with adequate treatment, and chronic kidney disease, which is often not reversible. In both cases, there is usually an underlying cause.

Kidney failure is mainly determined by a decrease in glomerular filtration rate, which is the rate at which blood is filtered in the glomeruli of the kidney. The condition is detected by a decrease in or absence of urine production or determination of waste products (creatinine or urea) in the blood. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may be noted.

In kidney failure, there may be problems with increased fluid in the body (leading to swelling), increased acid levels, raised levels of potassium, decreased levels of calcium, increased levels of phosphate, and in later stages anemia. Bone health may also be affected. Long-term kidney problems are associated with an increased risk of cardiovascular disease.

Classification

Kidney failure can be divided into two categories: acute kidney injury or chronic kidney disease. The type of renal failure is differentiated by the trend in the serum creatinine; other factors that may help differentiate acute kidney injury from chronic kidney disease include anemia and the kidney size on sonography as chronic kidney disease generally leads to anemia and small kidney size.

Acute kidney injury

Main article: Acute kidney injury

Acute kidney injury (AKI), previously called acute renal failure (ARF), is a rapidly progressive loss of renal function, generally characterized by oliguria (decreased urine production, quantified as less than 400 mL per day in adults, less than 0.5 mL/kg/h in children or less than 1 mL/kg/h in infants); and fluid and electrolyte imbalance. AKI can result from a variety of causes, generally classified as prerenal, intrinsic, and postrenal. The underlying cause must be identified and treated to arrest the progress, and dialysis may be necessary to bridge the time gap required for treating these fundamental causes.

Chronic kidney disease

Main article: Chronic kidney disease

Chronic kidney disease (CKD) can also develop slowly and, initially, show few symptoms. CKD can be the long term consequence of irreversible acute disease or part of a disease progression.

Acute-on-chronic kidney failure

Acute kidney injuries can be present on top of chronic kidney disease, a condition called acute-on-chronic kidney failure (AoCRF). The acute part of AoCRF may be reversible, and the goal of treatment, as with AKI, is to return the patient to baseline kidney function, typically measured by serum creatinine. Like AKI, AoCRF can be difficult to distinguish from chronic kidney disease if the patient has not been monitored by a physician and no baseline (i.e., past) blood work is available for comparison.

Signs and symptoms

Symptoms can vary from person to person. Someone in early stage kidney disease may not feel sick or notice symptoms as they occur. When kidneys fail to filter properly, waste accumulates in the blood and the body, a condition called azotemia. Very low levels of azotaemia may produce few, if any, symptoms. If the disease progresses, symptoms become noticeable (if the failure is of sufficient degree to cause symptoms). Kidney failure accompanied by noticeable symptoms is termed uraemia.

Symptoms of kidney failure include the following:

• High levels of urea in the blood, which can result in:
  • Vomiting and/or diarrhea, which may lead to dehydration
  • Nausea
  • Weight loss
  • Nocturnal urination
  • More frequent urination, or in greater amounts than usual, with pale urine
  • Less frequent urination, or in smaller amounts than usual, with dark coloured urine
  • Blood in the urine
  • Pressure, or difficulty urinating
  • Unusual amounts of urination, usually in large quantities
• A buildup of phosphates in the blood that diseased kidneys cannot filter out may cause:
  • Itching
  • Bone damage
  • Nonunion in broken bones
  • Muscle cramps (caused by low levels of calcium which can be associated with hyperphosphatemia)
• A buildup of potassium in the blood that diseased kidneys cannot filter out (called hyperkalemia) may cause:
  • Abnormal heart rhythms
  • Muscle paralysis
• Failure of kidneys to remove excess fluid may cause:
  • Swelling of the legs, ankles, feet, face and/or hands
  • Shortness of breath due to extra fluid on the lungs (may also be caused by anemia)
• Polycystic kidney disease, which causes large, fluid-filled cysts on the kidneys and sometimes the liver, can cause:
  • Pain in the back or side
• Healthy kidneys produce the hormone erythropoietin that stimulates the bone marrow to make oxygen-carrying red blood cells. As the kidneys fail, they produce less erythropoietin, resulting in decreased production of red blood cells to replace the natural breakdown of old red blood cells. As a result, the blood carries less hemoglobin, a condition known as anemia. This can result in:
  • Feeling tired and/or weak
  • Memory problems
  • Difficulty concentrating
  • Dizziness
  • Low blood pressure
• Normally, proteins are too large to pass through the kidneys, however, they are able to pass through when the glomeruli are damaged. This does not cause symptoms until extensive kidney damage has occurred, after which symptoms include:
  • Foamy or bubbly urine
  • Swelling in the hands, feet, abdomen, or face
• Other symptoms include:
  • Appetite loss, a bad taste in the mouth
  • Difficulty sleeping
  • Darkening of the skin
  • Excess protein in the blood
  • With high dose penicillin, people with kidney failure may experience seizures

Causes

Acute kidney injury

Acute kidney injury (previously known as acute renal failure) - or AKI - usually occurs when the blood supply to the kidneys is suddenly interrupted or when the kidneys become overloaded with toxins. Causes of acute kidney injury include accidents, injuries, or complications from surgeries in which the kidneys are deprived of normal blood flow for extended periods of time. Heart-bypass surgery is an example of one such procedure.

Drug overdoses, accidental or from chemical overloads of drugs such as antibiotics or chemotherapy, may also cause the onset of acute kidney injury. Unlike chronic kidney disease, however, the kidneys can often recover from acute kidney injury, allowing the patient to resume a normal life. People suffering from acute kidney injury require supportive treatment until their kidneys recover function, and they often remain at increased risk of developing future kidney failure.

Among the accidental causes of renal failure is the crush syndrome, when large amounts of toxins are suddenly released in the blood circulation after a long compressed limb is suddenly relieved from the pressure obstructing the blood flow through its tissues, causing ischemia. The resulting overload can lead to the clogging and the destruction of the kidneys. It is a reperfusion injury that appears after the release of the crushing pressure. The mechanism is believed to be the release into the bloodstream of muscle breakdown products – notably myoglobin, potassium, and phosphorus – that are the products of rhabdomyolysis (the breakdown of skeletal muscle damaged by ischemic conditions). The specific action on the kidneys is not fully understood, but may be due in part to nephrotoxic metabolites of myoglobin.

Chronic kidney disease

Chronic kidney disease (CKD) has numerous causes. The most common causes of CKD are diabetes mellitus and long-term, uncontrolled hypertension. Polycystic kidney disease is another well-known cause of CKD. The majority of people afflicted with polycystic kidney disease have a family history of the disease. Other genetic illnesses affect kidney function, as well.

Overuse of common drugs such as ibuprofen, and acetaminophen (paracetamol) can also cause chronic kidney damage.

Some infectious disease agents, such as hantavirus, can attack the kidneys, causing kidney failure.

Genetic predisposition

The APOL1 gene has been proposed as a major genetic risk locus for a spectrum of nondiabetic renal failure in individuals of African origin, these include HIV-associated nephropathy (HIVAN), primary nonmonogenic forms of focal segmental glomerulosclerosis, and hypertension affiliated chronic kidney disease not attributed to other etiologies. Two western African variants in APOL1 have been shown to be associated with end stage kidney disease in African Americans and Hispanic Americans.

Diagnostic approach

Measurement for CKD

Stages of kidney failure

Chronic kidney failure is measured in five stages, which are calculated using a patient’s GFR, or glomerular filtration rate. Stage 1 CKD is mildly diminished renal function, with few overt symptoms. Stages 2 and 3 need increasing levels of supportive care from their medical providers to slow and treat their renal dysfunction. Patients in stages 4 and 5 usually require preparation of the patient towards active treatment in order to survive. Stage 5 CKD is considered a severe illness and requires some form of renal replacement therapy (dialysis) or kidney transplant whenever feasible.

Glomerular filtration rate

A normal GFR varies according to many factors, including sex, age, body size and ethnic background. Renal professionals consider the glomerular filtration rate (GFR) to be the best overall index of kidney function. The National Kidney Foundation offers an easy to use on-line GFR calculator for anyone who is interested in knowing their glomerular filtration rate. (A serum creatinine level, a simple blood test, is needed to use the calculator.)

Use of the term uremia

Before the advancement of modern medicine, renal failure was often referred to as uremic poisoning. Uremia was the term for the contamination of the blood with urine. It is the presence of an excessive amount of urea in blood. Starting around 1847, this included reduced urine output, which was thought to be caused by the urine mixing with the blood instead of being voided through the urethra. The term uremia is now used for the illness accompanying kidney failure.

References

External links

• Connecting dialysis community around the World (US)
• National Kidney Foundation (US)
• The Kidney Foundation of Canada(CA)

UpToDate Contents

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• 1. 成人における慢性腎臓病マネージメントの概要 overview of the management of chronic kidney disease in adults
• 2. 腎機能の評価 assessment of kidney function
• 3. 腎機能障害を有する成人における慢性C型肝炎感染症の治療 treatment of chronic hepatitis c infection in adults with renal impairment
• 4. 小児における慢性腎臓病の臨床症状および評価 clinical presentation and evaluation of chronic kidney disease in children
• 5. Recurrence of C3 glomerulopathies after transplantation

English Journal

• Renal impairment among postmenopausal women with osteoporosis from a large health plan in Israel.

• Yu J1, Goldshtein I, Shalev V, Chodick G, Ish-Shalom S, Sharon O, Modi A.
• Archives of osteoporosis.Arch Osteoporos.2015 Dec;10(1):210. doi: 10.1007/s11657-015-0210-y. Epub 2015 Mar 10.
• Bisphosphonates are a first-line treatment for osteoporosis but require adequate renal function. We estimated the prevalence of renal impairment among osteoporotic women in Israeli. Approximately 2.3 % of women had renal impairment at a level that makes them inappropriate for bisphosphonate use, dem
• PMID 25753617

• Calcitriol ameliorates renal damage in a pre‑established proteinuria model.

• Maquigussa E1, Arnoni CP1, Pereira LG1, Boim MA1.
• Molecular medicine reports.Mol Med Rep.2015 Jul;12(1):1009-15. doi: 10.3892/mmr.2015.3555. Epub 2015 Mar 27.
• Proteinuria is critical in the tubulointerstitial changes that ultimately lead to renal insufficiency. Increased protein filtration has direct toxic effects on tubular epithelial cells, leading to epithelial mesenchymal transition (EMT) to a myofibroblast phenotype. Angiotensin II and transforming
• PMID 25823676

• A health record integrated clinical decision support system to support prescriptions of pharmaceutical drugs in patients with reduced renal function: Design, development and proof of concept.

• Shemeikka T1, Bastholm-Rahmner P2, Elinder CG3, Vég A4, Törnqvist E5, Cornelius B5, Korkmaz S6.
• International journal of medical informatics.Int J Med Inform.2015 Jun;84(6):387-95. doi: 10.1016/j.ijmedinf.2015.02.005. Epub 2015 Feb 21.
• OBJECTIVES: To develop and verify proof of concept for a clinical decision support system (CDSS) to support prescriptions of pharmaceutical drugs in patients with reduced renal function, integrated in an electronic health record system (EHR) used in both hospitals and primary care.METHODS: A pilot s
• PMID 25765963

Japanese Journal

• B型肝炎に対するアデホビル長期投与による腎機能障害と低P血症の検討

• 肝臓 57(9), 468-474, 2016-09
• NAID 40020941550

• 多発性骨髄腫の腎病変とMGRS (特集 多発性骨髄腫 : 診断のポイントから最新の治療まで)

• 日本内科学会雑誌 105(7), 1224-1230, 2016-07-10
• NAID 40020913440

• Relationship between Estimated Glomerular Filtration Rate and Cardiovascular Mortality in a Japanese Cohort with Long-Term Follow-Up

• PLoS ONE 11(6), e0156792, 2016-06
• NAID 120005820921

Related Links

• Renal failure - Wikipedia, the free encyclopedia

Renal failure or kidney failure (formerly called renal insufficiency) is a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. The two forms are acute (acute kidney injury) and chronic ( chronic ...

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★リンクテーブル★

リンク元	「renal dysfunction」「renal disorder」「nephropathic」「nephropathia」「腎機能障害」
関連記事	「impairment」「renal」

「renal dysfunction」

　　[★]

• n.

• 腎障害、腎機能障害、腎機能不全

関

impaired renal function、kidney disorder、kidney dysfunction、nephropathia、nephropathic、nephropathy、renal damage、renal disorder、renal impairment、renal insufficiency

「renal disorder」

　　[★]

• 腎障害、腎疾患、腎臓病、腎臓疾患

関

kidney disease、kidney disorder、nephropathia、nephropathic、nephropathy、renal damage、renal disease、renal dysfunction、renal impairment

「nephropathic」

　　[★]

• 腎症の、腎障害の

関

kidney disorder、nephropathia、nephropathy、nephrosis、renal damage、renal disorder、renal dysfunction、renal impairment

「nephropathia」

　　[★]

腎症、腎障害

関

kidney disorder、nephropathic、nephropathy、nephrosis、renal damage、renal disorder、renal dysfunction、renal impairment

「腎機能障害」

　　[★]

英

renal dysfunction、renal impairment、impaired renal function、kidney dysfunction

関

腎障害、腎機能低下、腎機能不全

「impairment」

　　[★]

• n.

• 機能障害、障害

関

barrier、damage、difficulty、disorder、disturbance、dysfunction、foe、functional disorder、functional impairment、hindrance、impair、impediment、lesion、malfunction、obstacle

　

「renal」

　　[★]

• adj.

• 腎臓の、腎性の、腎の

関

kidney、renally