Renal Fibrosis - The Silent Threat

Introduction

The term fibrosis describes the evolution of fibrous connective tissue as an injury or repair response to injury. Fibrosis can refer to the deposition of connective tissue that occurs as part of normal healing or the excess deposition of tissue that occurs as a pathological process. Fibrosis in response to injury is called scarring.

What Is Renal Fibrosis?

Renal fibrosis is a failure of the wound-healing process in renal tissue following chronic, long-term injury. Cellular pathways cause the major production of cell-matrix.

The end-stage renal disease presents as fibrotic lesions affecting all compartments. Glomerulosclerosis (scarring of the filtering part of the kidney), angiosclerosis (buildup of fat and cholesterol in artery walls), and tubulointerstitial fibrosis (fibrosis in the interstitial space of the kidney). Matrix synthesis is part of the normal repair process that occurs after an injury, but excessive extracellular matrix synthesis is destructive, exacerbating injury in a vicious circle. The kidneys often fail to repair completely after acute kidney injury. Renal cells can get stuck at a point in the cell cycle that releases profibrotic factors.

What Are the Causes of Renal Fibrosis?

Diabetes and hypertension are the two most common causes of chronic kidney disease, alongside other causes such as infectious glomerulonephritis, renal vasculitis, ureteral obstruction, genetic mutations, autoimmune diseases, and drugs. There are two main causes. In general, diabetes causes glomerular hypertension by stimulating arteries that contain blood outgoing from glomerulus while decreasing blood supply to the glomerulus. Elevated glomerular capillary pressure is one of the main factors in progressive nephrosclerosis. Diabetes and hypertension gradually cause glomerular dilatation, leading to dysfunction of the inner lining of blood vessels and imbalance in blood circulation. Renal tissue's response to injury mimics the normal wound-healing response in other tissues. However, repair and restoration of tissue function do not always occur.

What Are the Risk Factors for Renal Fibrosis?

Age, weight, family history, general health, and even ethnicity can increase the risk of chronic kidney disease and renal fibrosis. If any of the risk factors listed are present, talk to the doctor about kidney health and get the necessary tests as soon as possible.

1. Family History or Background -

• Having a family member with kidney disease.

• Age is over 50.

2. Health Problems -

• Increased blood sugar.

• High blood pressure.

• Cardiovascular disease.

• Obstruction of the kidneys or ureters.

• Obesity.

• Lupus.

3. Ethnicity - Some ethnic groups, such as African Americans, Hispanics, and Native Americans, are more prone to diabetes and hypertension, which are risk factors for chronic kidney disease and renal fibrosis.

4. Lifestyle -

• Overuse of drugs containing Ibuprofen, Naproxen, or Acetaminophen.

• Drug abuse.

What Are the Symptoms of Renal Fibrosis?

The symptoms of renal fibrosis are listed below:

• Changes in Urination- Healthy kidneys help filter blood to make urine. If the kidneys are not working well, a person may experience problems urinating, such as urinating more often or having blood in the urine. People may also notice foamy urine. This may be an early sign indicating kidney damage.

• Malaise - Poor kidney function can cause toxins to build up in the blood, leading to a lack of energy and excessive fatigue. Chronic kidney disease can also cause anemia, which makes people tired and weak because due to the deficiency of redblood cells.

• Itchy Skin - Dry, itchy skin can indicate an imbalance of minerals and nutrients in the blood due to kidney disease. Itching is often caused by high levels of phosphate in the blood.

• Swelling of Hands and Feet - When the kidneys do not remove excess water and sodium from the body, swelling (also called edema) in the feet and other lower extremities may occur.

• Difficulty Breathing - If the kidneys don't remove enough water, excess water builds up in the lungs and can cause shortness of breath.

• Chronic Kidney Disease - Induced Anemia- A deficiency of oxygen-carrying red blood cells can also cause shortness of breath.

• Pain in the Lower Back - One may feel localized pain near the kidney that stays the same or worsens with movement or stretching. The kidneys are located on the either side of the spine in the lower back, and kidney problems can cause pain in this area. Back pain can be due to an infection or blockage in the kidneys, which can lead to damage to the kidneys.

• Loss of Appetite - Accumulation of toxins due to decreased kidney function can cause loss of appetite.

• Swelling Around the Eyes - Proteins that enter the urine as a result of kidney damage can cause persistent puffiness around the eyes, an early sign of kidney disease.

• Abnormal Levels of Phosphorus, Calcium, or Vitamin D- Renal dysfunction can cause electrolyte imbalances such as low calcium levels or high phosphate levels that can cause muscle cramps.

• Abnormal Urinalysis - High levels of protein in the urine, called proteinuria, can be a sign of kidney disease. Healthy kidneys filter waste products and fluids, allowing the protein to return to the blood. If it isn't working properly, protein will be excreted in the urine.

• High Blood Pressure - Excess water and sodium buildup as a result of kidney disease can cause high blood pressure. High blood pressure can also damage blood vessels in the kidneys, making kidney disease worse over time.

When to Get Help for Renal Fibrosis?

The sooner people report the signs and symptoms to the doctor, the sooner they can get a diagnosis and take steps to slow the progression of kidney disease. Physicians can determine kidney function with a simple blood test used to calculate an estimated glomerular filtration rate (eGFR). Knowing the eGFR is key to understanding the stages of kidney disease and optimally managing kidney health.

A general physician can help decide when to see a nephrologist (nephrologist) who specializes in treating kidney disease. If having stage 3 late renal disease (eGFR ≤ 44), doctors refer the patient to a nephrologist. A nephrologist can help develop a customized treatment plan, talk about managing kidney disease, and improve the quality of life.

How Is Renal Fibrosis Diagnosed?

Renal fibrosis is diagnosed in the ways mentioned below:

• Magnetic resonance imaging (MRI) - It is a non-invasive imaging technique that produces detailed three-dimensional anatomical images.

• Renal Biopsy - It is an invasive procedure where a small portion of the kidney is removed to check for fibrosis under the microscope.

What Is the Treatment of Renal Fibrosis?

Currently, the standard treatment for slowing the progression of chronic kidney disease is the blockade of the renin-angiotensin-aldosterone system (RAAS) by angiotensin-converting enzyme inhibitor drugs. In combination with an angiotensin-converting enzyme inhibitor, angiotensin II receptor type 1 (AT1) antagonist, or direct renin blocker. These drugs also mainly act against fibrosis.

Renal fibrosis is often irreversible and leads to end-stage renal collapse requiring dialysis or renal transplantation.

How to Prevent Renal Fibrosis?

Renal fibrosis can be prevented in the ways listed below:

• Follow the Directions for Over-The-Counter Medications - When using over-the-counter pain relievers such as Aspirin, Ibuprofen, and Acetaminophen, follow the directions on the package. Excessive use of pain relievers over a long period of time can lead to kidney damage.

• Maintain a Healthy Weight - It is important not only to have a healthy weight but also, to keep the weight maintained. If there is a need to lose weight, talk to the doctor about healthy weight-loss strategies.

• Do Not Smoke - Smoking can damage the kidneys and exacerbate existing kidney damage. Talk to the doctor about smoking cessation strategies. Support groups, counseling, and medication can help quit smoking.

Manage medical conditions with the help of a doctor. If people have any illnesses or conditions that increase the risk of kidney disease, they should work with the doctor to keep them under control. Talk to the doctor about tests to look for signs of kidney damage.

Conclusion

Renal fibrosis is characterized as an excessive accumulation and deposition of extracellular matrix components in the kidney. The final common endpoint of chronic kidney disease is fibrosis, the formation of internal scar tissue that can be devastating. Eventually, end-stage renal failure can develop in the kidneys. Recent studies have shown that the kidneys often fail to repair completely after acute kidney injury. Drugs acting against fibrosis can help manage the fibrosis and reduce it markedly but they can also help people live a long and good quality life.