oct ewj 24 online - Flipbook - Page 50
Think About the Kidneys in
Your Medico-legal Practice
by Dr. Adnan Sharif, Consultant Nephrologist and Transplant Physician
Honorary Associate Professor (Institute of Immunology and Immunotherapy, College of
Medical and Dental Sciences, University of Birmingham)
The spectrum of kidney disease
Patients with kidney disease can have different clinical
presentations. Some have symptoms or signs that are
directly related to the kidney (such as visible blood in
the urine) or due to a reduction in kidney function
(fluid retention, hypertension, kidney failure symptoms). However, the majority of patients have no symptoms and are incidentally found to have kidney
problems because of a detectable abnormality in their
blood tests, urine samples or radiological scans. As these
investigations are commonly performed in healthcare,
kidney problems may exist which are easy to detect but
frequently overlooked in medico-legal cases.
the production of urine to remove excess water and
toxins, but they also have other important hormonal
roles. In summary, our kidneys:
Kidney problems will generally cause acute, sub-acute,
or chronic health problems. When a kidney abnormality is detected, often a detailed investigation of
records is required to determine whether the kidney
injury is acute or more common (referred to as
chronic kidney disease which affects 10-15% of the
general population). Acute kidney injury (AKI) is an
important medical problem that develops over hours
to days and can be diagnosed in the community or
after hospitalisation. AKI is very common and can be
seen in over a quarter of hospital episodes. Therefore,
AKI is likely to occur in many medical-legal cases, either as the main complication or more commonly as
a co-existing complication. However, despite their importance, the kidneys are frequently ignored or overlooked in these cases.
• Control blood pressure through different mechanisms to ensure blood pressure is not too high or low
That is why AKI, as a sudden and recent reduction in
a person’s kidney function, can have dramatic implications and consequences for good health. AKI is important from a medico-legal perspective because it is
common, associated with bad outcomes and has lots of
risk factors. AKI may be the main problem or (more
commonly) occur as a consequence of other medical
or surgical problems.
What do our kidneys do?
Kidneys are critically important for healthy wellbeing.
Their primary job is to look after our bodies through
Who is at risk of developing AKI?
AKI should be considered for individuals with acute
illness. Guidance from the National Institute for
EXPERT WITNESS JOURNAL
• Get rid of waste products and many other toxins
through production of urine
• Regulate water balance to ensure we never have too
much or too little water in our body
• Help control your heart rhythm by maintaining
a balance of electrolytes (e.g. potassium, sodium,
calcium) that are important for heart rhythm
• Regulate acid-base balance to ensure blood is never
too acidic or alkaline
• Help your bones by activating vitamin D to help
bone absorb calcium
• Make blood by releasing the hormone erythropoietin which tells bone marrow to make red blood cells
48
O C TO B E R 2 0 2 4
