Avoiding kidney Failure Risks

Although most people do not notice very early, they carry risks of kidney failure in the future of their lives if they have other health conditions without being treated or controlled. For example if you are found to be dietetic and it remains untreated for reasonable period of time it could lead to problems in the kidneys. Sometimes certain medicines you take can cause your kidney to function abnormally. If these conditions are not detected and treated at the right time, it can damage your kidney. If you reach to a certain stage of kidney damage, the treatment can be painful. time consuming and costly. It may require you to make frequent visits to the dialysis centers or even do surgeries to transplant a new kidney.

Another issue with kidney problems is that the symptoms produced by certain kidney disease are very common symptoms which can be found in other illnesses. In some cases the patient does not show any symptoms. Therefore we would like to discuss about very common health issues related to kidney and increase your awareness about those health conditions.

Common Kidney problems

IgA nephropathy

IgA nephropathy is a condition resulted by the buildup of “IgA” protein in the kidneys. This is a type of protein which is known as an antibody which helps to fight infections. This condition damages the kidney in a way that it cannot function normal. As a result the filtering of waste, excess salt and water may not happen properly.
This condition doesn’t show symptoms on many people .But some may have blood in urine or protein in urine which is detected in a routine exam/well visit. Some people develop this after a cold or sore throat.
The definite test to find out if an individual has this condition is a kidney biopsy; a procedure which involves taking a small sample of tissue from the kidney to look at under the microscope.

This is an excellent example of why it is emphasized to have routine check of urine/blood is required at least once a year during your well visit.
Some of the treatments that are recommended to patients who have IgA nephropathy include,

 

• ACE inhibitors or angiotensin receptor blockers: helps to lower blood pressure and help protect the kidney from further damage.


• Statins : These medicines lower cholesterol and reduce the risk of heart attacks and strokes. That’s important because people with kidney damage have a high risk of having those conditions.


• Steroids : These medicines help reduce inflammation in the kidneys and help reduce scar formation in the kidneys.


• Fish oil : This fish oil is different from the fish oil you can get at a health food store. The fish oil you get from your doctor is prescription-strength fish oil. It might help reduce inflammation in the kidneys.

 

Pregnancy and IgA nephropathy

If the patient has signs of IgA nephropathy but does not have kidney damage then the risk of having problems during pregnancy is only slightly higher than a woman without that condition. But if the patient’s kidney has been damaged by this condition then pregnancy can have harmful effects for both the mother and the baby.
Some medicines prescribed for IgA nephropathy can cause birth defects. Therefore, if you are pregnant you will most likely be advised to not to take certain medicines during that period.

If you are pregnant or planning to be pregnant you should inform that to your doctor.

Interstitial nephritis

Certain medicines we take to treat pain, infections etc. can initiate an inflammatory/immune reaction of the kidneys. Acute interstitial nephritis is a rare condition that causes inflammation of the kidneys.

Some of the symptoms and signs you may experience are following ,
 

• Feeling sick to your stomach (nausea)


• Throwing up (vomiting)


• Feeling very tired


• Rash – This looks like small, flat red bumps and can happen anywhere in the body.


• Urine that looks cloudy or red

 

With the symptoms and signs as above in the presence of blood and urine tests suggestive of this condition usually diagnosis is made.
If this condition occurred as a result of taking certain type of medicine; after discontinuing that medicine condition resolves. In some instances steroids may be prescribed for a short period of time.

Diabetic kidney disease

DIABETIC NEPHROPATHY

People with diabetes have a lot to juggle when it comes to their healthcare. Having diabetes puts you at risk of other health problems including heart attacks, strokes, vision loss, nerve damage, and kidney disease. While all of that may sound overwhelming, there is some good news; many of the steps you need to take to prevent one of those complications may actually help to prevent them all.

People who develop diabetic nephropathy usually have no symptoms early on, although the condition puts them at risk of developing kidney disease in later stages of their life.

The kidneys play an important role in the body: they filter the blood, removing waste products and excess salt and water. If the kidneys become diseased, they falter in their task, leaving these functions done at a lesser degree.
Finding out that you have early diabetic nephropathy can alert you that your kidneys are in danger. It is important to take steps to protect your kidneys before the problem advances.).
If diabetic kidney disease continue to progress to advance stages , diabetic nephropathy can eventually cause the kidneys to stop working altogether. If that happens, kidney transplant or dialysis, a procedure that filters the blood artificially several times a week is needed.)

SYMPTOMS

Diabetic nephropathy usually causes no symptoms, and people who have the condition often produce normal amounts of urine. To detect diabetic nephropathy, healthcare providers rely on tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function.
When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine is one of the sign that indicate that the kidneys may have been affected by diabetes.

RISK FACTORS

There are several factors that can increase your risk of developing diabetic nephropathy. These include:
 

• Having chronically elevated blood sugar levels


• Being overweight or obese


• Smoking


• Having a diabetes-related vision problems (diabetic retinopathy) or nerve damage (diabetic nephropathy)

 

Above risk factors are called modifiable risk factors: that is they are the ones you can do something about.

Having a family history of kidney disease or belonging to certain ethnic groups (eg, African American, Mexican, Pima Indian) can also increase your risk of diabetic nephropathy.

DIAGNOSIS

Urine tests are recommended once per year in people with type 1 diabetes, beginning about five years after diagnosis, and in people with type 2 diabetes, starting at the time of diagnosis.

The urine test is looking for a protein called albumin. You may be told that you have "microalbuminuria." That simply means that you have trace amounts of protein in your urine, but it still means that you have nephropathy, assuming you do not have kidney disease caused by another condition.
The same urine test that is used to diagnose diabetic nephropathy will also be used to monitor your condition over time.

COMPLICATIONS

The key complication of diabetic nephropathy is more advanced kidney disease, called chronic kidney disease. which may progress even further, eventually leading to kidney failure and the need for dialysis or kidney transplantation.

TREATMENT

People with diabetes need to focus on keeping their blood sugar levels in the right range. While it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That's because high blood sugar and high blood pressure work in concert to damage the blood vessels and organ systems
For these reasons, the most important things you can do to stall kidney disease and protect against other diabetes complications are to:

 

 

• Make healthy lifestyle choices


• Keep your blood sugar as close to normal as possible


• Keep your blood pressure below 130/80mmHg, if possible
• Lifestyle changes — Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have diabetic nephropathy:


• Limit the amount of salt you eat


• If you smoke, quit smoking


• Lose weight if you are overweight


• Manage blood sugar levels — Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL (4.4 to 6.6 mmol/L)
  A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 percent or less is usually recommended; this corresponds to an average blood glucose of 150 mg/dL (8.3 mmol/L) Even small decreases in the A1C lower the risk of diabetes-related complications to some degree.


• Manage high blood pressure — Many people with diabetes have high blood pressure (hypertension). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye.
  A healthcare provider can diagnose high blood pressure by measuring blood pressure on a regular basis.
  The treatment of high blood pressure varies. If you have mild hypertension, your doctor may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal.
  If these measures are not effective or your blood pressure needs to be lowered within a shorter period of time, your provider will likely recommend one of several high blood pressure medications. Your provider will discuss the pros and cons of each medication and the goals of treatment.
  A blood pressure reading below 130/80mmHg is the recommended goal for most people with diabetic nephropathy.
  Blood pressure medications — Most people with diabetic nephropathy need at least one medication to lower their blood pressure. Several medications can be used for this purpose, but a medication known as an angiotensin-converting enzyme inhibitor (abbreviated ACE inhibitor) or a related drug known as an angiotensin receptor blocker (ARB) are used most commonly. ACE inhibitors are generally used first because they have been available longer than ARBs.
  ACE inhibitors and ARBs are particularly useful for people with diabetic nephropathy because they decrease the amount of protein in the urine and therefore help prevent or slow the progression of diabetes-related kidney disease. In fact, the kidney benefits of ACE inhibitors and ARBs are so robust that healthcare providers sometimes prescribe them for people with diabetic nephropathy who have normal blood pressure.
  Some of the side effects of ACE inhibitors and ARBs are a persistent dry cough in 5 to 20 percent of the people who take them. Some people get used to the cough; others find it so disruptive that they cannot continue taking an ACE inhibitor. For them, ARBs are often a good alternative, because ARBs are less likely to cause a cough.
  In some instances ACE inhibitors and ARBs may cause decrease in kidney function or a condition called hyperkalemia, in which too much potassium accumulates in the blood. To monitor for these your doctor will recommend repeat blood tests after starting these medications. In some instances, the medications will need to be stopped.
• Monitor for signs of change — After beginning treatment and lifestyle changes to stall kidney disease, you will need to have repeat urine and blood tests to determine if urine protein levels have improved. If the urine protein levels have not improved or your kidney function has worsened, your healthcare provider may need to adjust your medications or recommend other strategies to protect your kidneys.


 

PREGNANCY AND DIABETIC NEPHROPATHY

If you have diabetes and are interested in getting pregnant, it is important to talk with your healthcare provider well in advance, especially if you have diabetic nephropathy. Diabetes and its attendant problems can increase the risk of complications in pregnancy, especially in women with decreased kidney function. However, many women with mild diabetic nephropathy have normal pregnancies and healthy babies.

To ensure the best outcome with a pregnancy, the most important thing you can do is to keep your blood sugar and blood pressure under tight control. However, women who are pregnant or attempting to get pregnant should not take ACE inhibitors or ARBs, as these drugs can cause birth defects. Instead, other medications (such as calcium channel blockers) are used during pregnancy to keep the blood pressure in check.

OTHER DIABETES COMPLICATIONS

If the steps you need to take to protect your kidneys sound overwhelming, keep this in mind; controlling your blood sugar and blood pressure can help to reduce the risk or severity of several other debilitating complications related to diabetes.

 

• Vision loss (due to diabetic retinopathy)


• Nerve damage (called diabetic neuropathy)


• Stroke and heart attack (both of which can be fatal)

 

 

DIABETIC NEPHROPATHY PREVENTION — The same measures that are used in the treatment of diabetic kidney disease are also useful in preventing it. That's true for the lifestyle choices mentioned above, as well as for the tight control of blood sugar levels and blood pressure.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

KIDNEY CANCER

What is kidney cancer?

 

 

Kidney cancer happens when normal cells in the kidney change into abnormal cells and grow out of control.Humans have 2 kidneys, 1 on each side of the mid-back. The kidneys’ job is to filter the blood and remove waste and excess salt and water. Urine is made up of these ingredients.

 

What are the symptoms of kidney cancer? — Smaller kidney tumors do not always cause symptoms. But larger tumors and tumors that have spread outside the kidney can cause symptoms, such as:

 

• Blood in the urine


• Pain on either side of your lower back, in your side, or in your stomach


• A lump in your belly or on the side of your back


• Weight loss that you cannot explain(unintentional weight loss)

 

These symptoms can also be caused by conditions that are not cancer. But if you have these symptoms, you should make your health care provider aware.
Is there a test for kidney cancer? — Yes. If you have symptoms of kidney cancer, your doctor might order one of several tests that are available to check your kidneys. These tests can show tumors or abnormal growths. They create images of your kidneys in different ways, these include:

 

• Ultrasound (uses sound waves to create images)


• CT scan (a type of X-ray)


• MRI (uses magnets to create images)

 

Most people find out they have kidney cancer after having an imaging test for an unrelated symptom. For example, sometimes you may get a CT scan because of an abdominal pain and tumor in a kidney may have been an incidental finding.

What is kidney cancer staging? — Cancer staging is a way in which doctors find out how far a cancer has spread. The right treatment for you will depend on the stage of your cancer.

How is kidney cancer treated? — People with kidney cancer often have 1 or both of the following treatment modalities:

 

• Surgery – When cancer is confined to the kidney, it is usually treated with surgery with the aim for cure. This can involve removing all or part of the affected kidney. The decision about how much of the affected kidney to remove depends on different things, including how well the other kidney works.


• Medical treatment – Different medicines can also be used to treat kidney cancer, particularly if it cannot be removed or if there is evidence it has spread. This might include:Medicines that stimulate your body’s infection fighting system to attack the cancer.


• Biologic treatments that block blood vessels or proteins in your body that help the cancer grow.

 

What happens after treatment? — After treatment, patient will be followed up periodically to monitor for recurrence of tumor. Follow up tests can include exams, lab tests, and X-ray tests.

What happens if the cancer comes back or spreads? — If the cancer comes back or spreads, patient might need more surgical or medical treatment.

What else should be done? — It is important to follow up with regular visits and tests. It’s also important to talk to your doctor about any side effects or problems you may have during treatment.

Getting treated for kidney cancer involves making many choices, such as which type of surgery to have or which medicine to take.
Always let the doctor know how you feel about a treatment. Any time you are offered a treatment, ask:

 

 

RENAL CELL CARCINOMA

• What are the benefits of this treatment? Is it likely to help me live longer? Will it reduce or prevent symptoms?


• What are the downsides to this treatment?


• Are there other options besides this treatment?


• What happens if I do not have this treatment?

( common type of Kidney Cancer )

 

The kidneys are bean-shaped, approximately fist-sized organs that are located on each side the mid back, just below the rib cage. The kidneys filter the blood and get rid of excess water and waste in the urine.

 

The most common form of kidney cancer in adults is renal cell carcinoma. Renal cell carcinoma usually does not cause obvious symptoms, especially in the early stages. As a result, the cancer may not be discovered until it is advanced.

Treatment of renal cell carcinoma may include surgery to remove part or all of a kidney. In some people, a medicine is used to slow the growth of the cancer.

SYMPTOMS — Most people with renal cell carcinoma (RCC) do not have obvious symptoms. This means that RCC is sometimes not found until the cancer is advanced. When symptoms do occur, the most common ones include:

 

• Blood in the urine (hematuria)


• Pain in the sides of the mid back (the flank)


• A palpable mass in the abdomen or side of the back


• Weight loss, night sweats, and/or unexplained fever

 

If you have any of these symptoms, talk to your doctor .

 

DIAGNOSIS — If you have symptoms of renal cell carcinoma, your doctor may order a test, such as an ultrasound or computed tomography (CT) scan, to look at the kidneys. In many cases, however, the cancer is found when one of these tests is done for another reason and incidentally identifies an abnormal mass or growth in the kidney.
If you have an ultrasound that shows a growth on your kidney, a CT scan will be done. The CT scan may also tell if the growth appears cancerous and/or has spread outside the kidney (called metastasis).

 

Unlike other cancers, a biopsy is not always needed to be sure that you have renal cell carcinoma. Instead, the diagnosis may be based upon how the tumor looks on the CT scan. Later, the diagnosis is confirmed when the tumor or kidney is removed during surgery.
Staging — Once renal cell carcinoma cancer is diagnosed, the next step is to determine its stage. Staging is a system used to describe the size, aggressiveness, and spread of a cancer. A cancer's stage helps to guide treatment and can help predict the long-term outlook.

A renal cell carcinoma's stage is based upon:
 

Renal cell carcinoma stages range from stage I (the tumor is smaller than 7 cm [about 3 inches] and has not spread outside the kidney) to stage IV (the tumor has spread to the outer layers of the kidney or has spread to distant lymph node(s) or other organ(s)).

In general, lower stage cancers are less aggressive and less likely to come back after treatment compared to higher stage cancers. Stage I, II, and III renal cell carcinomas (RCCs) are referred to as localized RCCs while stage IV is referred to as an advanced or metastatic RCC.

LOCALIZED RENAL CELL CARCINOMA TREATMENT

The preferred treatment for most individuals with localized renal cell carcinoma is surgery to remove part or all of the kidney and if necessary, the regional lymph nodes.
The decision to remove part or all of the kidney depends upon your cancer's size, where it is located in your kidney, whether there are one or multiple tumors, and how well one’s kidneys work.

 

• The size of the tumor


• Spread of the cancer to the nearby lymph nodes


• If there are signs of cancer in other organs (liver, lung, bone)
• If you have multiple tumors or your tumor is large or located centrally within the kidney, complete removal of the kidney may be necessary, especially if your other kidney works normally .

In other instances where kidneys do not work well, removing part of the kidney may be a better option.
Radical nephrectomy — Radical nephrectomy is the medical term for a surgery that removes the entire kidney and surrounding tissues. Most people can live with only one kidney.
Nephron-sparing treatments — Nephron-sparing treatments are treatments for renal cell carcinoma that do not remove the entire kidney. Normally, the kidneys filter waste out of the blood with tiny structures, known as nephrons. Nephron-sparing treatments allow some of the nephrons to continue working. This treatment is generally preferred if it is feasible and especially if your kidneys do not work well, a situation where preservation of as many nephrons as possible is a priority.
Nephron-sparing treatments include:

 

• Surgery to remove part of the kidney (called partial nephrectomy); this is the more common treatment


• A treatment that destroys the cancer by burning it (called radiofrequency ablation) or freezing it (called cryoablation)

 

Treatment after surgery —
For people with localized renal cell carcinoma, further treatment is not usually provided after surgery. Further treatment has not been proven to decrease the chance of the cancer returning.

However, it is important to see your doctor on a regular basis after being treated for cancer to monitor for signs that the cancer has returned.
TREATMENT OF ADVANCED RENAL CELL CARCINOMA — For people with advanced or metastatic renal cell carcinoma (RCC), treatment with a medicine (called medical treatment) may be recommended instead of or along with surgery. Medical treatment may also be recommended if your cancer recurs after surgery.
Surgery to remove the kidney or areas outside the kidney where the cancer has spread (metastases) may be done before medical treatment. For someone with advanced RCC, surgery does not usually cure the cancer, but it can reduce symptoms or delay systemic medical treatment.
The three most commonly used medical treatments for advanced RCC are:

• Interleukin-2 (called IL-2, an immune therapy)


• Anti-angiogenic therapies, a class of medicines that reduce the blood supply to the tumor, slowing or stopping growth of the tumor


• Targeted therapies, a class of medicines that directly inhibit the growth of the cancer
  Advanced RCC is hard to cure. When possible, people with advanced RCC are encouraged to enroll in a clinical trial as optimal use of approved treatments and several promising not yet approved agents are still being investigated.


• Interleukin-2 — Interleukin-2 (IL-2) is a treatment that works by triggering your immune system to attack the cancer cells. The treatment is given by IV over five days while you are in the hospital. The treatment is typically repeated in 15 to 22 days, and may be repeated again 12 to 14 weeks after the first dose. IL-2 therapy can produce long term cancer control in 5 to 10 percent of patients.
  
  Treatment with IL-2 can cause severe and even life-threatening side effects. Side effects can include low blood pressure, fever, kidney failure, and an irregular heart rhythm. As a result, IL-2 is only recommended if you are healthy enough to tolerate the side effects and are being treated in a facility with experience in its administration.


• Anti-angiogenic therapies — These therapies target the vascular endothelial growth factor (VEGF) pathway, which partly controls the growth of blood vessels. The blood vessels feeding RCC tumors are particularly dependent on VEGF, so treatment with anti-VEGF therapies may slow or stop the tumor from growing for long periods of time.


• Targeted therapies — Targeted therapies are medicines designed to slow the growth of tumor cells. The medicines are called "targeted" because they work by interfering with a step in the cancer's growth process. Targeted therapies cannot cure the cancer, but they may allow you to live longer and have fewer symptoms. A primary target for treatment of RCC involves blocking a specific protein, called the mammalian target of rapamycin (mTOR).
  Anti-angiogenic and targeted therapies are an option for people with advanced or metastatic RCC, either as an alternative to or after failing IL-2 therapy.
  The most commonly used anti-angiogenic therapies for RCC include:

 

• Sunitinib (brand name: Sutent)


• Sorafenib (brand name: Nexavar)


• Pazopanib (brand name: Votrient)


• Bevacizumab (brand name: Avastin)


• Axitinib (brand name: Inlyta)


• While targeted therapies include:


• Temsirolimus (brand name: Torisel)


• Everolimus (brand name: Afinitor)

 

Some of these medicines are available as a pill that you take by mouth while others are given into an IV. These medicines are given one at a time rather than in combination. The most common side effects include rashes, fatigue, and high blood pressure.
FOLLOW UP AFTER LOCAL TREATMENT — Close follow-up after local treatment (radical nephrectomy or nephron sparing treatment) is important for anyone with renal cell carcinoma. Follow-up visits allow your doctor to look for signs that the cancer has returned.
During a follow-up visit, you will have an exam, lab tests, and x-ray tests. Depending upon the stage of your cancer, these tests are recommended every 6 to 12 months for at least five years.
CLINICAL TRIALS — Progress in treating renal cell carcinoma requires that better treatments be identified through clinical trials, which are conducted all over the world. A clinical trial is a carefully controlled way to study new treatments or new treatment combinations. Ask for more information about clinical trials, or read about clinical trials at:
www.cancer.gov/clinicaltrials/learningabout
http://clinicaltrials.gov/

KIDNEY FAILURE

 

 

There are two types of kidney failure

1. Acute kidney failure

2. Chronic kidney failure

 

ACUTE KIDNEY FAILURE (Acute Kidney Injury)

What is acute kidney failure? — Acute kidney failure is when the kidneys suddenly stop working. Normally, the kidneys filter the blood and remove waste and excess salt and water. The word “acute” means sudden.

Another term for acute kidney failure is:

“Acute Kidney Injury.”

What causes acute kidney failure? — Acute kidney failure can have different causes. It can happen when:
 

• Less blood than usual flows to the kidneys. Different things can cause this to happen. For example, in a condition called heart failure, the heart might not be able to pump enough blood to the kidneys.


• The kidneys get damaged. Some causes of kidney damage are infections, cancer, certain medicines, and some autoimmune conditions. In an autoimmune condition, a person’s infection-fighting system attacks his or her body.


• The path the urine takes to leave the body is blocked. Some causes of blockages are prostate problems (in men) and cancer.
  What are the symptoms of acute kidney failure? — Some people do not have any symptoms at first. People who are in the hospital might learn that they have acute kidney failure after they have blood tests for another reason.
  When people do have symptoms, the symptoms can include:
  
  
  • Urinating less, or not urinating at all
  
  
  • Blood in the urine, or urine that is red or brown
  
  
  • Swelling, especially in the legs or feet
  
  
  • Vomiting, or not feeling hungry
  
  
  • Feeling weak, or getting tired easily
  
  
  • Acting confused, or not acting like themselves
  
  
  • Seizures – Seizures are caused due to waves of abnormal electrical activity in the brain. They can make people pass out, or move or behave strangely.
    Should I call my doctor ? — Call your doctor if you have any of the above symptoms. If you are already in the hospital, let your doctor know if you have any of these symptoms.
    Is there a test for acute kidney failure? — Yes. Your doctor will ask about your symptoms and do an exam. To check how well your kidneys are working, he or she will do blood and urine tests.
    
    Most people will have an imaging test called an ultrasound to look for blockages in the urinary system. Imaging tests can create pictures of the inside of the body.
    Your doctor might do other tests to look for other causes of your acute kidney failure. These can include X-rays or other imaging tests of your belly or kidneys.
    If these tests don’t show what’s causing your acute kidney failure, your doctor might do a test called a biopsy in order to obtain a tiny sample of tissue from either kidney to look under a microscope.
  
   

How is acute kidney failure treated?

— Treatment depends on what’s causing your acute kidney failure and how severe the kidney failure is.

 

If acute kidney failure is caused by a medicine, doctor will recommend stop taking that medicine. Plus, to help your kidneys heal, he or she might also give you medicines called steroids. (These steroids are different from the ones athletes take to build muscle.)
If acute kidney failure has another cause that can be treated, your doctor will treat it. For example, doctors can treat infections with antibiotics.
Most of the time, a person’s kidneys will heal and work normally again. But it can take weeks to months for the kidneys to heal completely.
Until your kidneys can work normally again, you might need treatments to help make sure your body has the right amount of fluid, salt, and nutrients. These treatments can include:

• Medicines


• Changes in your diet


• Renal replacement therapy – This treatment takes over the job of your kidneys until they can heal. It involves either:


• Hemodialysis – Hemodialysis is a procedure in which a machine takes over the job of the kidneys. The machine pumps blood out of the body, filters it, and returns it to the body. People have hemodialysis at least three times a week.


• Peritoneal dialysis – Peritoneal dialysis is a procedure that people do at home every day. It involves piping a special fluid into the belly. This fluid collects waste and excess salt and water from the blood. Then the used fluid drains out of the belly.

 

Chronic kidney Failure(Chronic kidney disease)

 

What is chronic kidney failure or chronic kidney disease? — Chronic kidney disease is when the kidneys stop working as well as they should. When they are working normally, the kidneys filter the blood and remove waste and excess salt and water.

 

In people with chronic kidney disease, the kidneys slowly lose the ability to filter the blood. In time, the kidneys can stop working completely. That is why it is so important to keep chronic kidney disease from getting worse.

What are the symptoms of chronic kidney disease? — At first, chronic kidney disease causes no symptoms. As the disease gets worse, it can:

 

• Make your feet, ankles, or legs swell (doctors call this "edema")
• Give you high blood pressure
• Make you very tired
• Damage your bones
  Is there anything I can do to keep my kidneys from getting worse if I have chronic kidney disease? — Yes, you can protect your kidneys by:
• Taking blood pressure and other medicines every day, if your doctor or nurse prescribes them to you.
• Keeping your blood sugar in a healthy range, if you have diabetes.
• Changing your diet, if your doctor or nurse says you should.
• Avoiding medicines known as "nonsteroidal antiinflammatory drugs," or NSAIDs. These medicines include ibuprofen (sample brand names: Advil, Motrin) and naproxen (sample brand name: Aleve). Check with your doctor, nurse, or kidney specialist before starting any new medicines—even over-the-counter ones.
  What are the treatments for chronic kidney disease? — People in the early stages of chronic kidney disease can take medicines to keep the disease from getting worse. For example, many people with chronic kidney disease should take medicines known as "ACE inhibitors" or "angiotensin receptor blockers." If your doctor or nurse prescribes these medicines, it is very important that you take them every day as directed. If they cause side effects or cost too much, speak to your doctor or nurse about it. He or she might have solutions to offer.

  What happens if my kidneys stop working completely? — If your kidneys stop working completely, you can choose between 3 different treatments to take over the job of your kidneys. Your choices are described below.

• You can have kidney transplant surgery. That way, the new kidney can do the job of your own kidneys. If you have a kidney transplant, you will need to take medicines for the rest of your life to keep your body from reacting badly to the new kidney. (You only need 1 kidney to live.)


• You can have your blood filtered by a machine. This treatment is called "hemodialysis," but many people call it just "dialysis." If you choose this approach, you will need to be hooked up to the machine at least 3 times a week for a few hours for the rest of your life. Before you start, you will also need to have surgery to prepare a blood vessel for attachment to the machine.


• You can learn to use a special fluid that has to be piped in and out of your belly every day. This treatment is called "peritoneal dialysis." If you choose this type of dialysis, you will need surgery to have a tube implanted in your belly. Then you will have to learn how to pipe the fluid in and out through that tube.
  How do I choose between the different treatment options? — You and your doctor will need to work together to find a treatment that's right for you. Kidney transplant surgery is usually the best option for most people. But often there are no kidneys available for transplant.
  
  Ask your doctor to explain all of your options and how they might work for you. Then talk openly with him or her about how you feel about all of the options. You might even decide that you do not want any treatment. That is your choice.

 

BONE PROBLEMS CAUSED BY KIDNEY DISEASE

What is kidney disease? — Kidney disease is when the kidneys don’t work well. Normally, the kidneys filter the blood and remove waste and excess salt and water.
What bone problems can be caused by kidney disease? — Kidney disease can cause different types of bone problems. These problems usually start early on in kidney disease. If they are not treated, they will get worse as the kidney disease worsens.

Terms that doctors might use for the bone problems caused by kidney disease are “renal osteodystrophy” or “chronic kidney disease bone mineral disorder.”
How does kidney disease cause bone problems? — When the kidneys don’t work normally, the levels of certain substances in the body can get too high or too low.
Kidney disease commonly causes:

• High levels of phosphate (also called phosphorus) – Phosphate is a mineral found in many foods. Foods with high levels of phosphate include milk, other dairy foods, nuts, meat, eggs, beans, liver, and chocolate.


• Low levels of vitamin D


• Low levels of calcium


• High levels of parathyroid hormone – Parathyroid hormone (also called “PTH”) is a hormone made by a gland in the neck called the parathyroid.
  Phosphate, vitamin D, calcium, and parathyroid hormone all have effects on each other. Bone problems happen when the levels of these substances get abnormal and out of balance.


• What are the symptoms of bone problems caused by kidney disease? — Early on, people usually have no symptoms from their bone disease. But they do have an increased chance of breaking a bone. Later on, people who get a treatment for kidney disease called dialysis might have symptoms from their bone disease such as:


• Bone, joint, or muscle pain


• Weakness
  Will I need tests? — Yes. Your doctor will order blood tests to measure the levels of phosphate, calcium, vitamin D, and parathyroid hormone in your blood. People usually need to have these blood tests repeated on a regular basis.
  Other tests that people might have include:
  
  
  • An X-ray
  
  
  • A bone density test – Bone density testing is a way to measure how strong your bones are. It involves a special kind of X-ray.
  
  
  • A bone biopsy – For this test, a doctor takes a small sample of your bone (usually from your hip). Then another doctor looks at it under a microscope. This is the only test that can tell for sure if you have bone problems caused by kidney disease.
  
   
  
  How are bone problems caused by kidney disease treated? — Your treatment will depend on different factors, such as:
  
  
  • How severe your kidney disease is
  
  
  • Your age
  
  
  • Whether you get dialysis treatment for your kidney disease
  
  
  • Your levels of phosphate, calcium, vitamin D, and parathyroid hormone
  
   

 

In general, treatment for bone disease involves different parts.
The first part of treatment usually involves lowering your phosphate level. This can include:

• Diet changes – You should avoid eating foods that are high in phosphorus. But your doctor might recommend that you keep eating meat and eggs. Even though these foods are high in phosphorus, they are a good source of protein. To help you plan your meals, you will probably work with a dietitian (food expert).


• Medicines – Medicines called “phosphate binders” can help lower phosphate levels in the blood. There are different types of phosphate binders. Some contain calcium. Examples of these include calcium carbonate and calcium acetate. Others do not contain calcium. Examples of these include sevelamer (brand names: Renagel®, Renvela®) and lanthanum. Phosphate binders should be taken with food.
  Other treatments for bone problems caused by kidney disease can include:


• Vitamin D medicines, to treat or prevent low levels of vitamin D


• A “calcimimetic” medicine – This is a type of medicine that works like calcium in the body.


• Extra calcium, to treat low levels of calcium
  These treatments will usually help lower the level of parathyroid hormone in your body. But if they don’t, your doctor will talk with you about other treatment. This might involve surgery to remove your parathyroid glands.

 

KIDNEY STONES IN ADULTS

 

What are kidney stones? — Kidney stones are just what they sound like: small stones that form inside the kidneys. They form when salts and minerals that are normally in the urine build up and harden.

 

Kidney stones usually get carried out of the body when you urinate. But sometimes they can get stuck on the way out. If that happens, the stones can cause:

 

• Pain in your side or in the lower part of your belly


• Blood in the urine (which can make urine pink or red)


• Nausea or vomiting


• Pain when you urinate


• The need to urinate in a hurry

How do I know if I have kidney stones? — If your doctor thinks you have kidney stones, he or she can order an imaging test that can show the stones.
How are kidney stones treated? — Each person’s treatment is a little different. The right treatment for you will depend on:

• The size, type, and location of your stone


• How much pain you have


• How much you are vomiting

 

If your stone is big or causes severe symptoms, you might need to stay in the hospital. If your stone is small and causes only mild symptoms, you might be able to stay home and wait for it to pass in the urine. If you stay home, you will probably need to drink a lot of fluids. Plus, you might need to take pain medicines or medicines that make it easier to pass the stone.

Stones that do not pass on their own can be treated with:
 

• • A machine that uses sound waves to break up stones into smaller pieces. This is called “shock wave lithotripsy.” This procedure does not involve surgery, but it can be painful.
  • A special kind of surgery that makes very small holes in your skin. During this surgery, the doctor passes tiny tools through the holes and into the kidney. Then he or she removes the stone. This is called “percutaneous nephrolithotomy.”
  • A thin tube that goes into your body the same way urine comes out. Doctors use tools at the end the tube to break up or remove stones. This is called “ureteroscopy.”
  What can I do to keep from getting kidney stones again? — One simple thing you can do is to drink plenty of water. You might also need to change what you eat, depending on what your kidney stones were made of. If so, your doctor or nurse can tell you which foods to avoid. Your doctor or nurse might also prescribe you new medicines to keep you from having another kidney stone
  
  Kidney Stones in Children
  How are kidney stones treated in children? — Treatment is different for each child. The right treatment depends on:
   
  
  
  • The size, type, and location of the stone
  
  
  • How much pain the child has
  
  
  • If the child is vomiting, and how much
  
  
  • If the child can drink large amounts of fluids
  
  If the stone is small and causes only mild symptoms, the child might be able to stay home and wait for it to pass in the urine on its own. If your child stays home, he or she will probably need to drink a lot of fluids. He or she might also need an over-the-counter medicine for pain, such as ibuprofen (sample brand names: Advil®, Motrin®). The doctor might ask you to have your child urinate through a strainer so you can catch the stone when it comes out. The doctor or nurse can tell you how to do this.
  A child might need treatment in the hospital if:
  
  
  • The stone is blocking urine flow
  
  
  • The child has severe pain or is vomiting
  
  
  • The child cannot drink large amounts of fluid
  
  
  • Hospital treatment can include:
  
  
  • Pain medicine, either in pills or into a vein through an “IV(intra venous route)” if the child is vomiting too much to keep pills down. An IV is a thin tube put into a vein through the skin.
  
  
  • Medicine to help pass the stone
  
  
  • Fluids given into a vein through an IV
  
  
  • Treatment to remove the stone, or break it into smaller pieces so it can pass more easily. Doctors can do this with:
  
  
  • A machine that uses sound waves to break up stones into smaller pieces – called “shock wave lithotripsy.”
  
  
  • A special kind of surgery that is done through tiny holes in the skin -- During this surgery, the doctor puts tiny tools through the holes and into the child’s urinary tract or kidney. Then he or she removes the stone.
  
  
  • A thin tube that goes into the body where the urine comes out – The tube has special tools on the end that doctors can use to break up stones or take them out.
    Will my child have another kidney stone? — Maybe. If your child gets a kidney stone, he or she has a higher risk of getting another one later. To help keep this from happening, make sure your child drinks plenty of water.
    Your doctor will do tests to find out what caused the first stone. Depending on the results, you might need to change what your child eats. If so, the doctor or nurse can tell you which foods your child should not eat. He or she might also prescribe new medicines to keep your child from having another kidney stone.
  
   
  
  
  
  NEPHROTIC SYNDROME
  
  The term nephrotic syndrome refers to a group of symptoms and laboratory findings that may occur in people with certain kinds of kidney (renal) disease.
  
  
  • High levels of protein (albumin) in the urine
  
  
  • Low levels of the protein (albumin) in the blood
  
  
  • Swelling (also called edema) of the face, legs, or ankles due to the abnormal collection of fluids in the tissues, usually accompanied by weight gain
  
   
  
  HOW DOES NEPHROTIC SYNDROME DEVELOP?

  Nephrotic syndrome develops when there is damage to the glomeruli, the structures in the kidneys that work to filter the blood. This damage allows proteins in the blood (such as albumin) to leak into the urine, causing increased excretion of protein in the urine. Eventually, blood levels of albumin become reduced. Accompanying abnormalities of kidney function lead to accumulation of fluid in the tissues (edema).

  How are glomeruli damaged? — Many different disorders can cause damage to the glomeruli, resulting in nephrotic syndrome. In some cases, damage is confined to the kidneys alone. In other cases, organs other than the kidney are also affected (such as in diabetes mellitus or systemic lupus erythematosus).

   

  
  
  • In children, the most common cause of glomerular damage is a condition known as minimal change disease.
  
  
  • In adults, approximately 30 percent of people with nephrotic syndrome have an underlying medical problem, such as diabetes or lupus; the remaining cases are due to kidney disorders such as minimal change disease, focal segmental glomerulosclerosis, or membranous nephropathy.
    Minimal change disease — Minimal change disease is a kidney disease that can occur in both adults and children. People with minimal change disease have normal or very mild abnormalities of kidneys.
    Focal segmental glomerulosclerosis — Focal segmental glomerulosclerosis (FSGS) is the most common cause of nephrotic syndrome in adults. FSGS causes collapse and scarring of some glomeruli. The cause of primary FSGS is unknown, although some cases (usually in children or young adults) are the result of a genetic defect, an infection, or a toxic response to a drug.
    Membranous nephropathy — Membranous nephropathy is a condition in which the walls of the glomerular blood vessels become thickened from the accumulation of protein deposits, causing increased "leakiness". It is not clear why membranous nephropathy develops in most people, but an “auto-immune” mechanism is suspected (“auto-immune” = reaction )
    Diabetes mellitus — Kidney disease is common in people with diabetes who have chronically elevated blood glucose levels and/or high blood pressure. Some patients with more advanced disease can develop the nephrotic syndrome.
    Lupus — Lupus is a disease that can affect multiple organs of the body, including the kidney. Nephrotic syndrome is common in people with lupus.
  
   
  
  SYMPTOMS
  
  The most common symptoms of nephrotic syndrome are swelling, weight gain, fatigue, blood clots, and infections. Kidney failure may develop in some people. Increased excretion of protein may lead to "frothy" appearing urine in the toilet bowel.
  
  Swelling (edema) — Swelling that occurs in people with nephrotic syndrome commonly affects the lining of the eye socket, which often causes swelling around the eyes upon waking in the morning. Swelling (edema) can also occur in the feet or ankles after sitting or standing for any period of time.
  
  Weight gain — Weight gain can occur in people who develop swelling. Weight gain can occur rapidly.
  
  Uncommonly, weight loss can occur in people who are losing large quantities of protein in the urine. This may be due to malnutrition or an underlying conditions, such as poorly controlled diabetes mellitus, a chronic viral infection, or cancer.
  
  Kidney failure — Some people with nephrotic syndrome have a gradual decline in kidney function, which causes no symptoms in the early stages. However, as kidney function continues to worsen, symptoms of kidney failure can develop, including shortness of breath, weakness and easy fatigability (from anemia) and loss of appetite.
  
  Blood lipids — The concentration of lipids (cholesterol and/or triglycerides) can become greatly elevated in nephrotic syndrome. If persistent, this may increase the risk of coronary artery disease.
  
  Blood clots — People with nephrotic syndrome are at an increased risk of blood clots in the veins or arteries. Clots in the veins can travel to the lungs. This can be dangerous, or even fatal.
  
  Infection — People with severe nephrotic syndrome are at increased risk for infections (particularly children with minimal change disease), although the reasons for this are not well understood.
  
  DIAGNOSIS — Nephrotic syndrome is diagnosed based upon a number of laboratory tests,
  
  Urine tests — Urine tests are often done to determine the amount of protein in the urine.
  
  Blood tests — A number of blood tests may be recommended to help determine the underlying cause of nephrotic syndrome to assess the risk of complications and to evaluate overall kidney function.
  
  Renal biopsy — Renal (kidney) biopsy is the standard procedure for determining the underlying cause of nephrotic syndrome when a cause cannot be identified by noninvasive laboratory testing.
  
  TREATMENT

  Treat the underlying disease — The first line of treatment in nephrotic syndrome is to treat the underlying cause, if the cause is found. In addition, almost all patients are given an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), which lower blood pressure, prevent worsening of kidney disease, and reduce the amount of protein excreted in the urine.

  Diabetes mellitus — The optimal treatment for diabetic kidney disease is not well understood, although the best approach likely includes intensive management of blood sugar levels, cholesterol, and blood pressure.

  Lupus — People with lupus who have nephrotic syndrome or evidence of worsening kidney function can be treated with steroids and other medications that suppress the immune system. Most people respond well to such a regimen.

  Minimal change disease — People with minimal change disease almost always respond initially to treatment with glucocorticoids (steroids). However, relapses are common, and additional treatments are often required.

  Focal segmental glomerulosclerosis — Prolonged treatment with glucocorticoids (steroids) is often recommended for people with primary focal segmental glomerulosclerosis (FSGS). Secondary FSGS is treated primarily with ACE inhibitors or ARBs
  membranous nephropathy — The best treatment for membranous nephropathy is a source of debate. In many people, a period of "watch and wait" is recommended initially to determine if the condition is worsening or causing complications. During this time, an ACE inhibitor or ARB is recommended and it is important to keep blood pressure and cholesterol levels controlled. Additional treatment, including medications that suppress the immune system, may be needed if membranous nephropathy progresses.
  Without immunosuppressive treatment, approximately 10 to 30 percent of people with membranous nephropathy have a complete resolution of symptoms over several years; a further 10 to 30 percent of people have a partial remission; approximately 40 percent of people slowly lose renal function. As a result, most people with mild symptoms are advised to delay immunosuppressive treatment until/unless symptoms worsen. In addition to treating the underlying cause of nephrotic syndrome, the signs and symptoms of nephrotic syndrome can sometimes be treated.

  Proteinuria — An ACE inhibitor or angiotensin receptor blocker (ARB) is often recommended to reduce the loss of protein in the urine (proteinuria).
  Edema — Swelling in the lower legs (edema) and collection of fluid in the abdomen (ascites) can occur in people with nephrotic syndrome. Edema and ascites often improve in people who follow a low sodium diet and take a "water pill" (diuretic)

  High cholesterol — High cholesterol levels are often seen in people with nephrotic syndrome. If nephrotic syndrome persists, treatment is needed to lower blood cholesterol. Most people are initially treated with a cholesterol-lowering medication called a statin

  Blood clots — If a blood clot forms in a blood vessel, treatment may include a blood thinner, such as warfarin (Coumadin), for as long as the nephrotic syndrome persists.

  POLYCYSTIC KIDNEY DISEASE

  What is polycystic kidney disease? — Polycystic kidney disease (PKD) is a condition that affects the kidneys.. When people have PKD, abnormal fluid-filled sacs called “cysts” grow in the kidneys.

  The cysts cause the kidneys to get bigger than normal. The cysts can also keep the kidneys from working normally. This can lead to problems, such as high blood pressure, kidney infections, and kidney failure. Kidney failure is when the kidneys stop working completely. Besides kidney problems, PKD can cause problems in other parts of the body.

  PKD usually runs in families.
  
  What are the symptoms of PKD? — Some people with PKD have no symptoms. When people do have symptoms, they can have:
   

  
  
  • Pain in the lower half of the back or on the side, with or without a fever
  • Pain in the belly
  • Blood in the urine
  • Kidney stones – These are small, stone-like objects that form inside the kidneys. They can cause belly or side pain, or blood in the urine.
    PKD can also cause problems in other parts of the body, such as:
  • A bulging blood vessel in the brain – If the blood vessel bursts, it can cause a sudden, severe headache and nausea and vomiting. A burst blood vessel can lead to brain damage and even death.
  • Cysts in the liver – These can cause belly pain.
  
  
  • A weak area in the belly muscles (called a “hernia”) – This can cause an area of the belly to bulge out.
  
  
  • Heart problems – These do not usually cause symptoms.
    Is there a test for PKD? — Yes. To find out if you have PKD, your doctor can do:
    • An imaging test, such as an ultrasound, CT, or MRI scan – Imaging tests create pictures of the inside of the body.
    •  
    • Blood tests to check for the abnormal genes that cause the disease
  
  
  • How is PKD treated? — Doctors treat PKD by treating the symptoms and problems the disease causes.
    For example, doctors can:
    • Treat high blood pressure with lifestyle changes, diet changes, and medicines – Treating high blood pressure can help the kidneys stay healthy for a longer time.
    •  
    • Treat kidney infections with antibiotic medicines
    •  
    • Treat pain with pain-relieving medicines
    •  
    • Do surgery to fix a bulging blood vessel in the brain
    •  
    • Do surgery to fix a hernia
    
    What happens if my kidneys stop working completely? — If your kidneys stop working completely, you will need treatment that takes over the job of your kidneys. Normally, the kidneys make urine by removing waste and excess salt and water from the blood.
    There are 2 treatments for people whose kidneys stop working completely. They are:
    
    
    • A procedure called dialysis – There are 2 types of dialysis, but most people with PKD have a type called “hemodialysis.” During hemodialysis, a machine removes waste and excess salt and water from the blood. People who get hemodialysis need to be hooked up to a machine for a few hours at least 3 times a week. They will need hemodialysis for the rest of their life or until they can get a kidney transplant.
    
    
    • Kidney transplant surgery – During this surgery, a doctor replaces your diseased kidney with a healthy kidney. That way, the new kidney can do the job of your kidneys. (People need only 1 healthy kidney to live.)
      If you have questions about the different options, talk with your doctor .
      Should my family members get tested? — If you have PKD, your adult family members should talk with their doctor about getting tested for it. There are benefits and downsides to getting tested.
      Doctors do not usually recommend that children get tested unless they have symptoms. But children should see their doctor every year to have their blood pressure checked.
    
     
    
    VESICOURETERAL REFLUX IN ADULTS
    
    What is vesicoureteral reflux?

    Vesicoureteral reflux is a condition that causes some urine to flow in the wrong direction inside the body. Normally, urine that the kidneys make flows to the bladder through tubes called “ureters.” It then flows from the bladder out of the body. (All the organs that handle urine are called the “urinary tract.”)

    In people with vesicoureteral reflux, some of the urine flows backward from the bladder through the ureters to the kidneys. This can happen in 1 or both of the ureters.
    This problem is most common in babies and young children. It often gets better or goes away as the child gets older. But it can also happen in older children and in adults.
    What causes vesicoureteral reflux?

    Vesicoureteral reflux is caused by problems with the ureters or bladder. Most of the time, people are born with these problems. But the problems might not be found until the person is an adult. Other times, people who weren’t born with vesicoureteral reflux get it later in life because of different conditions that affect the urinary tract.

    What are the symptoms of vesicoureteral reflux?
    
    — There are no symptoms.

    Why would a doctor think I have vesicoureteral reflux?
    
    — Your doctor might think you have vesicoureteral reflux for different reasons, including:
     

    
    
    • Frequent urinary tract infections (or “UTIs”)
      - These infections are usually caused by bacteria in the bladder or kidneys. If you get UTIs often, your doctor might want test you for vesicoureteral reflux. If you have both conditions at the same time, infected urine could flow backwards to the kidney and cause damage.
    
    
    • Abnormal findings on an imaging test
      – People get imaging tests that take pictures of the inside of the body for different reasons. These tests include ultrasounds and MRIs. If some part of your urinary tract does not look normal on one of these tests, your doctor might want to test you for vesicoureteral reflux.
    
    
    • High blood pressure
      – High blood pressure is very common, especially in older people and people who are over weight. It usually has nothing to do with vesicoureteral reflux, but in a few people, the 2 conditions are related. If your doctor thinks your high blood pressure is not caused by the usual problems, he or she might want to test you for vesicoureteral reflux.
    
    
    • Kidney disease
      – Some people with kidney disease also have vesicoureteral reflux.
      Is there a test for vesicoureteral reflux?
      — Yes, there is a test called a “voiding cystourethrogram” or “VCUG.”
      For this test, the doctor puts a small, flexible tube inside your bladder. Next the doctor fills the bladder with a special fluid that shows up on X-rays. You then urinate while an X-ray is taken. X-rays taken during this test show if the urine is flowing the wrong way.
    
     

    How is vesicoureteral reflux treated?
    
    — Treatments include:
     

    
    
    • Antibiotics – Your doctor might want you to take antibiotics every day, but at a lower dose than if you really had an infection. These medicines can help keep you from getting a urinary tract infection.
    
    
    • Surgery - Different kinds of surgery can stop the backflow of urine from the bladder to the kidney