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CHRONIC KIDNEY DISEASE CAUSES
Causes of
Chronic Kidney Disease
Miscellaneous
Many kidney conditions, some primary and others secondary to
systemic diseases, can cause chronic kidney disease.
Drugs
Analgesic nephropathy is declining in incidence but is still
common in Australia and parts of Europe (5 per cent).
Ciclosporin toxicity can cause chronic renal failure in patients
who have received cardiac, liver, and lung allografts. A few
patients on long-term lithium medication for bipolar affective
disorder develop chronic
kidney
disease.
Long-term, non-steroidal anti-inflammatory drugs (NSAIDs) use is
also associated with chronic
kidney
disease.
Obstructive uropathy
Neglected or unrecognized obstruction, associated sometimes with
calculi, infection, or malignancy, accounts for a small but
significant number of patients requiring dialysis. Any manoeuvre
(for example, ureteric stenting) which relieves obstruction, is
worthwhile for the preservation of
kidney
function.
Dysproteinaemias
Primary amyloid, myeloma kidney, and the other immunoglobulin
deposition diseases are relatively rare. The patients, usually
elderly, generally have a poor prognosis, having to cope with
the consequences and treatment not only of the underlying
disease, but also the hazards and inconvenience of dialysis.
Survival on dialysis is seldom longer than 2 years.
Pregnancy
Irreversible postpartum
kidney
failure is now rare in developed countries but is still a
problem in the developing world.
Unknown
In
a significant proportion of patients no confident diagnosis of
the cause of chronic
kidney
disease
can be made. There are no clues in the history, although a
kidney
condition may have been suspected because of long-standing minor
urinary abnormalities (such as asymptomatic proteinuria or
haematuria). Imaging reveals small echogenic kidneys, which
cannot safely be biopsied, and even if tissue does become
available it seldom reveals a specific diagnosis. The glomeruli
are sclerosed and there is widespread interstitial fibrosis and
vascular changes, which are probably secondary. It may be that
there are unrecognized
kidney
diseases caused by environmental toxins, but this is
speculation. The recent description of the development of
kidney
failure after the consumption of Chinese herbal remedies
containing aristocholic acid shows the need to be agnostic on
causality. Some patients do probably have unrecognized
glomerulonephritis (as shown by the development of IgA
nephropathy in subsequent kidney allografts). Others may have
silent cholesterol emboli, analgesic nephropathy, or 'burnt out'
tuberculosis.
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