Several other well-known causes may produce progressive renal destruction.
In recent years one of the most notorious has been the overuse of analgesics (pain-killers). This originally concentrated on phenacetin, but it seems that other widely used analgesics are almost as potent, such as aspirin, probably paracetamol, and others when used in combination. The continued use of these easy-to-obtain drugs over a period of years can gradually destroy the fine filtering mechanism of the renal system. It may give rise to recurring infections with foul smelling urine containing blood.
The usual symptoms of urinary-tract infection exist. As well, there may be anaemia and pallor, due to the continual blood loss. Recurring fevers and aches and pains arc common symptoms.
There is a history of regular intake of analgesic compounds, often APC powders or tablets, either containing drug compounds or single drugs. If left, the gradual kidney destruction may lead to renal failure. In Australia about 15 per cent of the kidney transplant operations are attributed to phenacetin nephropathy. All could have been totally avoidable.
Women are cautioned against taking analgesics unless there is a definite medical reason. It is now generally conceded that drug combinations may produce trouble, and for this reason compounds (two or more drugs taken together) arc not recommended. It seems that use of a single drug (such as aspirin or paracetamol alone) will not cause serious harm. Nevertheless, the fewer drugs taken the better, and ideally any should be taken fbr the minimum period of time to alleviate symptoms.
Fortunately in the early stages, if drug taking is discontinued, the disorder is quite reversible. But if left, it will lead to serious kidney destruction and may be life-endangering.
Other disorders may also lead to renal damage. It may take place when lead is persistently ingested. This may occur in children eating lead-containing paint, although this is now much less common than in years past.
This may lead to permanent kidney impairment as crystals of uric acid are laid down, gradually destroying the delicate kidney substance. Stones may form, producing attacks of renal colic. Most patients with gout have some renal involvement. Bouts of renal colic, blood in the urine, and uraemia may finally occur.
Elevated Blood Pressure
So often this is closely associated with renal disease. It may rarely cause symptoms. Treatment is the management of the elevated blood pressure.
Diabetes Mellitus (Sugar Diabetes)
This disorder is commonly associated with serious renal disease. If the diabetes is kept under control, the patient will live much longer, reaching an age group where vascular complications are becoming more common. Often the renal blood-vessel pathology runs in parallel with similar complications in other organs of the body, such as the heart, brain and limbs.
Renal disease is now one of the most common fatal complications of the diabetic. Careful therapy of the diabetic offers the best chance of prolonging life, but the beneficial effect of therapy is not as dramatic on the renal system as on the underlying disease.
Congenital Renal Disease
Many congenital anomalies occur in the kidney, but they are of little clinical importance in the total picture. There is some evidence that they are more prone to recurring infections, and if discovered and symptomatic, are best surgically corrected if possible. Solitary cysts or many cysts (fluid-filled spaces) may occur in the surface of the kidney or in its substance. The treatment is symptomatic.
This condition occurs if there is some obstruction to the outflow of urine that banks up, causing dilation of the kidney spaces. Often there are no symptoms, the condition being found accidentally when a kidney X-ray is taken (intravenous pyelogram, or IVP) or other investigation carried out such as CT scan or ultrasound investigation. There may be blood in the urine, or symptoms of a urinary-tract infection leading to investigation. Renal infections may result, and these may cause the patient to seek treatment.