Dr. Kunal Raj Gandhi

When your kidney function falls below a certain point, it is referred to as a kidney failure or renal failure. Fortunately, you can still continue to lead a normal life with the right treatment for renal failure. Here are the three best treatments that you can choose depending on your condition and lifestyle:

1. Dialysis: Dialysis is the process that takes over the function of your kidneys to filter out the waste from your blood and maintain the proper balance of chemicals in the blood. You may use dialysis for many years or as a short-term treatment while waitinRenal Failureg for a kidney transplant. Dialysis is not a cure for kidney disease, rather it helps you deal with renal failure. It is life-saving and without it, the kidneys will no longer function.

There are two types of dialysis treatments that you can choose from:

• Hemodialysis – This type uses a machine to remove waste from the blood and sends it back to your body. It can be done at home or at a dialysis center.
• Peritoneal Dialysis – This type uses the lining of your belly called the Peritoneum to do the work of your kidneys. A catheter and dialysis solution is used to carry out the function.

There are benefits and complications for each type of dialysis. The treatment decision will largely depend on the patient’s illness and their past medical history. Discuss with your doctor to decide the best option for you.

2. Kidney Transplant: Kidney transplants can provide a better quality of life than dialysis and can be seen as a potential cure for kidney failure. A healthy kidney from a live donor or deceased donor is surgically placed in your body as a replacement to the failed kidneys. Although this may be a better option for you, it has certain shortcomings. There is an element of rejection and you may have to wait for a long time to get a donor. Extensive testing and anti-rejection medications are prescribed with this treatment.

3. Palliative Care: Rather than cure, it is the care that people with serious illness need. With so much to deal with, the patients have an array of tough questions and challenges to deal with. Patients need to take into account all medical options and care options based on their condition and severity of the renal failure.

Making the right treatment choice is difficult and that too when you are ill. It is normal to be fearful and worried about the risks involved. Get support from your family and doctor to help you make the right treatment choice. It may also be helpful to visit a dialysis or transplant center to talks to others who have been through these treatments. In case you have a concern or query you can always consult an expert & get answers to your questions!

Tubulo-interstitial diseases of the kidney is a heterogeneous group of disorders affecting the kidney that share similar features of both tubular and interstitial injury. Primary categories of this disease includes, acute and chronic interstitial nephritis.

Acute interstitial nephritis is an acute form of kidney injury characterized by an inflammation reaction in the interstitial tissues of kidney and presence of edema, which usually spares the glomeruli. The hallmark of interstitial nephritis is the infiltration of inflammatory cells into the interstitial compartment. Infiltrating cells are mainly T cells and monocytes, plasma cells and eosinophils. An acute inflammatory reaction is most commonly caused by a hypersensitivity reaction of a drug.

Other causes include

• Infections
• Idiopathic or immune mediated
• Medications that most commonly cause allergic reactions are antibiotics (Ampicillin, Oxacillin)
• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Proton pump inhibitors
• Bacteria implicated in causing this disease are Legionella, Brucella, Mycoplasma, Rickettsia, Leptospira and Chlamydia.
• There is a presence of swelling in between the kidney tubules.

Kidneys function to filter the circulating blood and remove toxins. Water and certain organic materials are re-absorbed from the filtered blood and unwanted products are released from the body via urine. Swelling of the tubules disrupts the normal filtration function of the kidneys. 

Symptoms 

• Most common symptom of interstitial nephritis is decreased urine output. It may increase in some cases. People can be symptomless in some cases. Other symptoms of interstitial nephritis include fever, presence of blood in urine, fatigue, mental confusion, nausea, vomiting, water retention and bloating sensation in the body.
• This disease does not have racial, age or gender predilection. It can affect anyone, of any age group. However, kidney toxicity depends on cumulative effects of toxic substances which means more the kidney is damaged due to toxic substances, the higher the risk of the kidney suffering from subsequent damage. With advancing age, the general functioning of the kidney is affected. This makes advanced age a risk factor for acute interstitial nephritis.

Clinical features

• Sudden decrement in the renal function is a typical presentation. It is most commonly seen in an asymptomatic patient or a patient who has been put on a new medication.
• It may occasionally present as renal failure.
• In the presence of an infection, a maculopapular rash, fever and eosinophilia are characteristically seen.
• Occurrence of skin rash >50 % of patients, fever > 75 % of patients and eosinophilia > 80% of patients.
• Pain in the lumbar and pelvic region.

Investigations:

• Presence of mild to moderate proteinuria
• Gross hematuria
• Sedimentation of red and white blood cells
• WBC casts, occasionally RBC casts are also present
• Increased serum creatinine levels
• Oliguria
• Confirmation of the diagnosis can be done by renal biopsy.

Treatment: Removal of the offending agents, discontinuation of the etiologic drug is the most important treatment modality. Complete recovery is inversely proportional to the duration of renal failure.
 

Chronic interstitial nephritis
The tubule cells undergo atrophy and there is a flattening of the epithelium. Basement membrane of tubules are frequently thickened. Cellular infiltrate is composed of lymphocytes, with only occasional neutrophils, plasma cells and eosinophils. There is a relative preservation of glomerular function until late in the disease, but an impairment of tubular functions like urine concentration, dilution, acidification and potassium excretion is seen early.