Introduction
Renal tubular degeneration is a renal disorder causing damage and degeneration of the tubular cells of the kidneys that can lead to acute renal failure. The renal tubules are small ducts in the kidneys that filter the nutrients, fluids, and other substances from the blood through the kidneys. This condition occurs when there is a lack of oxygen and vascular supply to the kidney tubules.
What Are the Causes of Renal Tubular Degeneration?
Renal tubular degeneration is often associated with a lack of blood supply and oxygen to the kidney tissues. The frequent causes may be a stroke or a heart attack. It may also occur if a poisonous or chemically harmful substance damages and degenerates the renal cells.
The internal structures of the kidney, particularly the tissues and renal cortical epithelial cells of the kidney tubule, become damaged or degenerated. Renal tubular degeneration is one of the most common cytoplasmic structural changes in the renal tubular epithelial cells that might lead to vacuolation of the cytoplasm and pyknosis (necrosis) of the cell nuclei. These degenerative changes might lead to acute renal failure.
What Is the Pathogenesis of Renal Tubular Degeneration?
Renal tubular degeneration is a nonspecific entity that can arise from many etiologies that alter cell function. It is often considered an early indicator of acute renal necrosis. Degeneration is usually preceded by cytoplasmic vacuolation. In particular, degeneration is characterized by many morphological and variable cellular features. These features include cellular swelling with or without cytoplasmic vacuolation, pale staining, and degenerated cytoplasm. However, it is important to differentiate degeneration from apoptosis, representing the normal cell turnover process in the kidneys.
On the other hand, renal necrosis generally includes cell swelling, nuclear pyknosis and karyorrhexis (destructive fragmentation of the nuclei), and sloughing of cells. Degeneration can be either reversible or irreversible.
Clear, empty vacuoles characterize cytoplasmic vacuolation in the cortical epithelial cells in renal tubules. Pathologic vacuolation can be observed anywhere along the length of the renal tubule segments and collecting ducts. However, this morphological phenomenon is more commonly observed in the proximal convoluted renal tubular epithelium. This type of vacuolation may be associated with the macrovesicular or microvesicular phenomenon. Cytoplasmic vacuolation in the renal tubules may be related to phospholipidosis-inducing chemicals. In most cases, the condition is reversible.
Who Is at Risk for Renal Tubular Degeneration?
Renal tubular degeneration is a leading cause of renal failure in patients who are hospitalized. Risk factors for renal tubular degeneration include
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Muscular injury or trauma that degenerates the muscles.
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Hypotension (low blood pressure) lasts for a longer duration of time.
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Major surgery on the affected patient has been done recently.
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Septic shock (a fatal condition that occurs when an infection spreads widely in the body). This often leads to dangerously remarkable low blood pressure.
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Certain liver diseases occurring due to diabetes may lead to diabetic nephropathy, thereby making a person more prone to renal tubular degeneration.
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A few pharmacological drugs or medicines that are toxic to the kidneys can cause renal tubular degeneration. These drugs include aminoglycoside antibiotics and Amphotericin (an antifungal drug).
What Are the Symptoms of Renal Tubular Degeneration?
Symptoms may include any of the following:
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Reduced urine output.
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Loss of consciousness, coma, rapid confusion, drowsiness, and lethargy.
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General swelling, fluid retention, edema, or bloating.
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Nausea, and vomiting.
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Tiredness and delirium.
How Is the Diagnosis of Renal Tubular Degeneration Made?
The healthcare professional usually performs a medical exam. Abnormal sounds may be heard by the doctor when a stethoscope is placed on the heart and lungs. This occurs due to excessive fluid accumulation in the body.
The following tests may be carried out:
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Blood Urea Nitrogen- It measures the amount of urea nitrogen present in the blood.
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Serum Creatinine- The serum creatinine level is in the normal range of 0.74 to 1.35 milligrams per deciliter for a normal male.
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Kidney Biopsy- The biopsy of the affected kidney will reveal cytoplasmic vacuolation of the renal tubular cells along with pyknotic nuclei in most cases.
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Urinalysis- It is the morphological, chemical, and histological examination of urine.
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Urine sodium- This test measures the amount of sodium in the urine.
What Is the Treatment of Renal Tubular Degeneration?
In most people, renal tubular degeneration is reversible. The treatment aims to prevent acute renal failure's fatal complications. Treatment mainly focuses on preventing the buildup of fluids and toxic wastes while allowing the kidneys to heal. Diuretics (medicines to increase urination) and potassium-controlling drugs are usually prescribed to help eliminate fluid from the body. Certain dietary restrictions are made, such as limiting dietary salt intake and restricting fluid intake. The underlying pathology should be treated. Also, temporary renal dialysis can be deployed to eliminate excessive waste products and fluids. This helps to alleviate the symptoms. Dialysis is generally not required for all people but is often lifesaving in patients if the potassium level is dangerously high.
Therefore, dialysis might be preferred in the following cases:
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State of delirium or confusion.
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Excessive fluid deposition.
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Increased potassium levels.
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Removal of waste products that are dangerous to the kidneys.
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Absence of urine production.
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Excessive buildup of nitrogen waste products.
What Is the Prognosis of Renal Tubular Regeneration?
Renal tubular degeneration is a reversible condition that can last a few days to seven weeks or more. Kidney function usually returns to normal, but many other severe problems and complications may occur if the condition is not treated.
Conclusion
Renal tubular degeneration is a nonspecific pathological entity that can occur due to several causes. Reduced oxygen and blood supply often lead to degeneration of the renal tubular cells.
Therefore, prompt efforts to improve the oxygen and blood supply should be made to reverse the condition. Diabetes, liver problems, and heart issues must be managed well to reduce the risk of renal tubular degeneration. The healthcare provider should immediately perform certain tests to diagnose the disease and start immediate treatment modalities. Also, more research should be carried out at the molecular and clinical levels to detect more effective therapeutic procedures.
