What is intrinsic renal disease?

From the Guidelines

Intrinsic renal disease should be managed based on the specific cause, with a focus on controlling blood pressure, treating the underlying condition, and managing complications to prevent further kidney damage and improve quality of life. Intrinsic renal disease refers to conditions that directly damage the kidney tissue itself, as opposed to pre-renal (problems before blood reaches the kidneys) or post-renal (problems after urine leaves the kidneys) causes. Common types include acute tubular necrosis, glomerulonephritis, interstitial nephritis, and vascular diseases affecting the kidneys. Management depends on the specific cause but generally includes treating the underlying condition, controlling blood pressure, and managing complications.

Key Considerations

• For acute tubular necrosis, supportive care is essential while the kidneys recover.
• For glomerulonephritis, immunosuppressive medications like corticosteroids (prednisone 1 mg/kg/day), cyclophosphamide, or rituximab may be needed depending on the type 1.
• Interstitial nephritis often requires removing the offending agent (typically a medication) and sometimes corticosteroid therapy.
• Blood pressure control using ACE inhibitors or ARBs (such as lisinopril 10-40 mg daily or losartan 25-100 mg daily) is crucial for most intrinsic renal diseases to prevent further kidney damage.
• Dietary modifications including sodium restriction (<2g/day), protein moderation, and potassium restriction may be necessary depending on kidney function.
• Regular monitoring of kidney function through blood tests (creatinine, BUN) and urine studies is essential. The prognosis varies widely based on the specific condition, with some forms being reversible while others may progress to chronic kidney disease requiring dialysis or transplantation. According to the most recent guidelines, early detection and treatment of chronic kidney disease can prevent or delay adverse outcomes 1.

Recent Guidelines

The National Kidney Foundation recommends that patients with chronic kidney disease be considered in the highest risk group for subsequent cardiovascular disease events and that most interventions that are effective in the general population should also be applied to patients with chronic kidney disease 1.

Treatment Approach

A comprehensive treatment approach should include:

• Controlling blood pressure to slow the progression of kidney disease
• Managing proteinuria and hematuria
• Treating anemia and bone disease
• Preventing cardiovascular disease
• Dietary modifications to slow disease progression
• Regular monitoring of kidney function and adjustment of treatment as needed By following these guidelines and tailoring treatment to the individual patient's needs, healthcare providers can help improve outcomes and quality of life for patients with intrinsic renal disease.

From the Research

Intrinsic Renal Disease

Intrinsic renal disease refers to a condition where the kidneys are damaged due to a problem within the kidneys themselves, rather than a problem elsewhere in the body. This can include conditions such as chronic kidney disease (CKD) and end-stage renal disease.

Causes and Risk Factors

• Diabetes and hypertension are the most common causes of CKD in developed countries 2
• Other risk factors include obesity, aging, and family history of kidney disease
• CKD can also be caused by other conditions such as glomerulonephritis and polycystic kidney disease

Diagnosis and Management

• CKD is defined as a persistent abnormality in kidney structure or function for more than 3 months 2
• Diagnosis is typically made using a combination of physical examination, medical history, and laboratory tests such as serum creatinine and urine albumin
• Management of CKD includes cardiovascular risk reduction, treatment of albuminuria, and avoidance of potential nephrotoxins 2
• Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are commonly used to slow the progression of CKD 3, 4

Treatment Outcomes

• ACEi and ARB have been shown to reduce the risk of end-stage renal disease and slow the progression of nephropathy 3, 4
• However, they do not appear to decrease all-cause or cardiovascular mortality in people with Type 2 diabetes and proteinuria 3
• Initiating ACEi or ARB therapy has been shown to protect against kidney failure with replacement therapy (KFRT) in people with advanced CKD 4

Future Directions

• Novel therapeutic approaches are being developed to target the progression of CKD, including targeting cytokines, transcription factors, and epigenetic modulators 5
• Preventing tubular cell injury and anti-fibrotic therapies that target activated myofibroblasts are also being explored as potential treatments for CKD 5