Renal disease and its limitations on driving

There are many renal diseases of varying types, whose symptoms, both during acute episodes and their progressive evolution, interfere with driving

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There are many renal diseases of varying types, whose symptoms, both during acute episodes and their progressive evolution, interfere with driving.

Acute glomerulonephritis (AGN)

It is characterised by the rapid onset of hypertension, oedema, haematuria, proteinuria, hyperazoemia and, sometimes, oliguria.

Produced by infectious, bacterial, viral or parasitic infections, that affect the other organs, multi-systemic diseases such as LES, vasculitis, Henoch-Schönlein purpura, etc, and primary glomerular conditions, among others.

Clinical presentations

  • AGN caused by LES is characterised by arthralgia, serositis, central nervous system disease, etc. The prognosis is poor and treatment is based on the use of cytotoxic drugs and glucocorticoids.
  • AGN caused by vasculitis such as nodal polyarthritis causes hypertension, arthralgia, neuropathy and renal failure. In the case of hypersensitive angeitis, this is associated with asthma.

Some medications such as penicillamine, hydralacine, allopurinol and rifampicin can cause AGN, which progresses quickly, meaning half of all patients need to be put on dialysis within a short period of time.

Advices

  • The patient will be advised not to drive until the clinical symptoms have resolved, and until he has permission from the specialist.
  • If the underlying cause of the ANG is not controlled, the patient will be advised not to drive.

Nephritic syndrome (NS)

This is characterised by albuminuria or hypoalbumineria, with oedema and hyperlipidaemia.

In the majority of cases, this is due to glomerular disease, with remaining cases caused by systemic diseases such as diabetes mellitus, SEL, amyliodois, medications, neoplasia, etc.

Complications: renal venous thrombosis, thromboembolism, proteic malnutrition, infections, hypertension, oedema, renal failure, etc.

Advices

  • Patients with nephritic syndrome secondary to systemic diseases should not drive until the underlying disease has been correctly treated and is improving to an extent that there is no increased risk involved in driving.
  • Patients with NS due to glomerular disease could have symptoms of the disease which make it impossible for them to drive, such as difficult-to-control hypertension, progressive loss of kidney function, oedema, venous thrombosis, etc.
  • When necessary the doctor will advise against driving in all clinical situations existing alongside advanced kidney failure and its added complications.

Membranous glomerulonephritis

The patients initial symptoms are oedema, then later hypertension or mild kidney failure sets in, and is frequent in venous renal thrombosis.

It is associated with SEL, hepatitis B, tumours and drugs such as captopril and penicillamine. Glucocorticoids can improve cases of renal failure.

Some patients get worse, developing terminal renal failure.

Focal glomerulosclerosis

Hypertension and haematuria of varying evolution are frequent.

In some cases they are due to heroin use, AIDS or vesicouretral reflux.

Membranoproliferative glomerulonephritis

Renal function diminishes throughout a period of several years.

Diabetic nephropathy

This is a frequent cause of NS, which is characterized by hypertension, proteinuria, bacteriuria, hyperazotemia and the development of kidney failure.

There is a high rate of mortality in dialysis and transplants have a less favourable prognosis in this type of patients.

Chronic glomerulonephritis

This produces slow deterioration of renal function, and quickly progresses into terminal renal failure in the presence of hypertension or long-term infection.

Advices

  • The progressive loss of renal function and its added complications oblige the patient to stop driving.

Acute interstitial nephritis (IN)

This type of renal failure (RF) is characterized by acute oliguria, arthralgia, exanthema and sometimes fever.

It is mainly produced by drugs such as metacyline, sulphamides, diuretics, rifampine, cymetidine, cephalosporin, allopurinol, etc. The renal failure usually responds the discontinuation of the medication.

Advices

  • While the patient is suffering from acute renal failure he may not drive.
  • If the clinical conditions resolve and the patient gets better without sequelae, the doctor will advise the patient when he can once again drive.

Chronic interstitial Nephritis

The causes for this type of renal failure (RF) are very varied, and include the prolonged use of analgesics such as phenacetine and acetylsalicylic acid.

It usually affects women with headaches, anaemia and digestive symptoms. Renal function is restored when the drug treatment is discontinued.

Other drugs that can cause chronic renal failure are lithium, cisplatin and semustin.

The most frequent metabolic causes are chronic hypocalcaemia, hypopostassemia, and uric acid nephropathy accompanied by hypertension and uric acid calculus.

Neoplasia such as lymphoma, multiple myeloma and leukaemia, as well as immune disorders, amyliodois, AIDS and polycystic kidneys can encourage the development of interstitial nephritis.

Advices

  • The patient must be advised not to drive is he has symptomatic renal failure, headaches, poorly controlled hypertension, added metabolic causes or tumours.
  • The specialist will decide when the patient has recovered enough to go back to driving when he has treated the condition and associated pathologies.