Tag Archives: kidney disease

Who Is At Risk For Renal Disease

Chronic kidney disease often is not felt or recognized until kidney function is almost completely gone. Although it gets progressively worse over a period of months, symptoms don’t generally appear until around three-fourths of the function has already been lost. However, even though there are no noticeable symptoms of renal disease in the early stages, there is still damage occurring. While generally the value of screening is negligible in people who don’t already show signs of kidney trouble, regular screening is recommended for people who are at risk. That means obese people, smokers, people with high blood pressure or heart problems, people with a family history of kidney failure, people over 60, diabetics, and black, Asian, and Native American people.

Not only are people from racial minority backgrounds more prone to kidney disease due to genetics, studies now suggest that socioeconomically disadvantaged people—poor people and members of racial minorities—are more prone to kidney disease and tend to have worse outcomes when they do have kidney disease, with it being far more likely to lead to complete kidney failure than for the population overall. The researchers say this study is a first step towards shrinking this gap by improving outcomes for these population.

Treating renal disease is next to impossible, especially in the later stages. Most patients who progress all the way to kidney failure are forced to manage the disease by periodically using a dialysis machine, essentially a mechanical kidney. Instead of treatment, the primary focus is on prevention. Quitting smoking lowers risk of kidney disease, as does moderation in alcohol and over-the-counter pain medications—these can affect the digestive system, kidneys included, if taken too much. Maintaining a healthy weight can help, with one study suggesting the "Mediterranean diet," high in plant foods and low in red meat, lowers kidney disease risk.

However, possible treatments are being investigated, particularly to arrest the progress of the disease before the kidneys shut down entirely. Statins, used to lower cholesterol, are now being recommended to kidney patients as well. A separate research team found tat kidney disease is associated with poor metabolism, and fixing the metabolism might stop the disease from worsening.

UTIs And You

One of the common symptoms of a urinary tract infection—a bacterial infection in the kidneys, the bladder, or the urethra—is none whatsoever. Fortunately, there often is some indication, such as frequent urination and a persistent urge to urinate despite a burning sensation when urinating. UTIs can also make themselves known through the appearance of the urine. Cloudiness is one sign, and another is red or pink blood in the urine; blood may also give urine a dark color. UTIs also can cause urine to have an unusually strong odor. Bladder infections can cause pain in the lower abdomen.

Perhaps unsurprisingly, UTIs can present differently in men and women. Women with UTIs often experience pelvic pain, while for men the equivalent pain will be felt in the rectum. A broader difference is that, while women suffer UTIs more frequently, men are more likely to be hospitalized as a result. Part of the reason for this may be social—because UTIs are more unusual among men, men are more likely to seek hospital care rather than treat it on their own, as women for whom UTIs are more or less routine might do. Differences in male and female anatomy may also be a factor in which patients can be treated on an outpatient basis and which patients must be hospitalized.

There are several ways the urinary tract might become infected, and sometimes the cause is simply unknown. Sometimes gut bacteria normally expelled as waste get into the urethra and infect the urinary tract that way. Sexual activity can be a causative factor, particularly in women. Sometimes, certain STDs can lead to UTIs, or increase vulnerability to such infections. UTIs can be treated by a course of antibiotics—though this can make further infections more likely. Cranberry juice is often suggested as a treatment, and it demonstrably effective as a preventative measure.

Another preventative measure, especially for relapses, has been tested in laboratory animals and is expected to be effective in humans as well. A compound called chitosan was found to help eliminate what are called reservoir populations of bacteria. Antibiotics are effective against bacteria causing the infection, but leave behind their dormant brethren nestled in the inner layers of the bladder; in tests, chitosan appeared to eliminate even these.

Seafood And Your Kidneys

Hypertension and heart disease can cause damage to the kidneys. So can diabetes, kidney stones, some cancers, prostate enlargement that blocks the urinary tract, and a number of rarer conditions: vesicoureteral reflux, urine backing up into the kidneys; glomerulonephritis, an inflammation of the parts of the kidney used for the organ’s filtering function; and polycystic kidney disease in which cysts develop on the kidneys. Between these conditions, recurrent kidney infection, and plain bad luck, kidney disease affects ten percent of the global population.

Sometimes, the source can e hard to pin down. A chemical called domosic acid, produced in the ocean by algae and frequently found in shellfish, has long been known to be a neurotoxin, damaging the brain, at high doses, but was believed to be safe enough in smaller quantities. Now, however, scientists have found that these much lower amounts are nonetheless high enough to cause toxicity in the kidneys, which, filtering the blood, get the brunt of these amounts.

Unfortunately, left untreated, kidney disease can be fatal, either through the kidney itself failing or when the damage to the kidney and consequent diminished function leads to cardiovascular disease. That is why early detection is so important. The good news is that tests for kidney disease are simple and reliable, even if there are no symptoms. A doctor may test a patient’s blood or urine, looking for telltale signs of damage, or an ultrasound scan is used to detect changes in the size or density of the kidneys that point to health problems. Testing is particularly important not only for early detection, but because the symptoms of kidney disease—persistent itching nausea, vomiting, loss of appetite, and changes in the amount and quality of urine—could be caused by a number of other conditions as well.

Knowing the cause is also important to proper treatment, because treatment often involves addressing the cause of the damage. In addition, dietary changes may be recommended so as to give the kidneys less work to do. Other treatments are directed at the symptoms. In severe cases, when one or both kidneys has failed entirely, a transplant or dialysis with a machine that functions as an artificial kidney may be necessary.

Tiny Tim’s Ailment

"Will the child die?" Ebeneezer Scrooge asked of Tim Cratchit in Charles Dickens’s A Christmas Carol. Since the book was published in 1843, readers have asked a different question: "What is Tiny Tim dying of?" The character was based on the author’s own ailing nephew, Henry Burnett, Jr., but it is not clear that the fictional child had similar symptoms, let alone the same disease. It’s possible that Dickens was trying to describe an ailing child without having a specific condition in mind, but the symptoms described are consistent with particular diseases common among poor children in Victorian England.

What is known about Tiny Tim’s illness:

  • It was treatable in Victorian England
  • Treatment required financial resources
  • It would have been fatal left untreated
  • It stunted his growth
  • It affected his ability to walk unaided.
    • On this basis, several theories have been advanced as to what Tim had. The most common is a kidney disease called renal tubular acidosis. In healthy people, acid in the body is filtered out of the blood by tubes in the kidneys and passed with urine. When this process is interrupted, renal tubular acidosis results in too much acid in the blood. This can lead to inhibited growth, kidney stones, and bone disease—all symptoms Tiny Tim exhibited in the book—and left untreated, results in chronic kidney disease and possibly total failure, which can be fatal. Treatment with citrus and sodium bicarbonate was known and available in the mid-19th century.

      Another possibility is rickets, or vitamin D deficiency. Rickets is rare in the United States nowadays because of fortified milk, but, like other forms of malnutrition, was common among the Victorian poor. Symptoms include skeletal deformity, stunted growth, weakness, muscle spasms, and general sickliness. People with rickets are also particularly prone to tuberculosis, which is epidemic in times and places where sanitation is poor and also fits Tiny Tim’s symptoms.

Kidney Stones

Kidney stones in women are reportedly on the rise, researchers say. Obesity is a risk factor for kidney stones, and as obesity rises, incidence of kidney does as well. Since obesity is more of a contributing factor in women than in men, the effects of this increase are more often felt by women. The good news is that improved diagnostic and treatment techniques mean fewer patients—man or women—need to be admitted to the hospital for kidney stones; they can be treated on an outpatient basis.

The cause of kidney stones is high levels of calcium, phosphorous, and other substances that form crystals in the urine. Calcium and oxalate are the most common culprits, and are found in many foods. Chocolate and nuts are sources of oxalate, but it’s also produced in the liver; calcium is found in dairy foods. A diet high in animal proteins is also associated with the formation of kidney stones. In addition to obesity, risk factors include a family history of kidney stones, dehydration, a diet high in sodium, and digestive diseases. In addition, risk of kidney stones increases with age, occurring most often in adults over age 40.

There are things you can do to control your risk. Make sure to drink enough water, and beware of excess sodium. If you take calcium or vitamin C or D supplements, let your doctor know so that you can be monitored. Calcium-rich foods are usually safe, though foods with oxalates can cause problems, so if you are prone to kidney stones, be wary of chocolate, nuts, spinach, Swiss chard, sweet potatoes, tea, and soy products.

A lithotripsy to break up kidney stones

A lithotripsy to break up kidney stones

The treatment for small stones generally involves waiting it out, drinking lots of fluids to pass it and taking pain medication for when you do. Larger stones require more drastic measures, because there’s a risk of a blockage causing permanent kidney damage. One technique is shock wave lithotripsy, in which an ultrasound-like device creates vibrations that break the stone into smaller pieces which can go through the urethra. These then pass the way smaller stones do.

Possible New Technique In Kidney Transplant

One of the biggest dangers of organ transplants is rejection: the body regards the transplanted organ as an infection and the immune system destroys it, leaving the recipient without a functioning organ as well the immune response itself giving rise to symptoms. The usual solution to this problem is to use a drug regimen to suppress the immune system, but these drugs are nonspecific, and suppress the immune system across the board, leaving the patient vulnerable to opportunistic infections. In addition, the drug regimen has to be used for the patient’s entire life. Stem cell techniques are beginning to be used to prevent rejection by mimicking the transplant recipient’s own organs, but this isn’t always feasible.

Now a new technique has been successful in animal studies and is being investigated for suitability in human transplants. Called dendritic cell therapy, it approaches the problem from the other side: instead of persuading the immune system that the organ is the body’s own, dendritic cell treatments use donor immune cells to sort of spread the word about the new arrival, preparing the immune system to receive the transplanted organ by getting the recipient’s body to recognize it as friendly. Dendritic cells are the cells responsible for bringing possible infectious agents to the attention of the T-cells that are responsible for determining whether an immune response is needed. By using dendritic cells already acclimated to the donated organ—a kidney, in the studies—researchers hope to prevent a response to the kidney without suppressing it overall.

In the study, conducted at the University of Pittsburgh, researchers were able to achieve successful results in rhesus macaques with only a single dendritic cell treatment. Not only were the transplanted kidneys not rejected, the animals proved to be healthier overall. The researchers say that if the technique proves to be workable in human beings, it will initially only be likely to be used for planned kidney donations from living relatives, though there is some possibility of it being modified for use for transplants from people who have passed on but arranged for their organs to be donated posthumously.

Keeping Your Kidneys Healthy

One in ten people worldwide have some form of kidney damage. Hypertension and heart disease are the most common reasons for chronic kidney disease, which can also result from diabetes, kidney stones, or certain types of cancer. Other conditions that damage the kidneys include an inflammation of the filtering mechanism in the kidney called glomerulonephritis, a condition called polycystic kidney disease in which cysts develop on the kidneys, enlarged prostate obstructing the urinary tract, a condition in which urine backs up into the kidneys called vesicoureteral reflux, and recurrent kidney infection.

Regardless of the cause, early detection of chronic kidney disease is the best way to ensure you get the treatment you need to avoid loss of kidney function—and death from cardiovascular disease, a frequent consequence of chronic kidney disease even when renal failure doesn’t develop. Fortunately, kidney disease is both easily detected and easily treated. Blood and urine tests can detect signs of kidney disease even in the absence of symptoms. Ultrasound can indicate changes in the size or density of the kidneys that point to health problems. Symptoms of chronic kidney disease include nausea, vomiting, loss of appetite, changes in the amount and quality of urine, persistent itching, and sometimes chest pain. However, kidney disease symptoms can be nonspecific and without any obvious connection to kidney function, and there may not be any symptoms at all.

Treatment for kidney disease generally involves treating the underlying cause—if it’s cancer, hypertension enlarged prostate, or something like that, treating that condition will also help the kidneys. Most commonly, reducing blood pressure, lowering cholesterol, quitting smoking, and in general taking steps to reduce heart disease are also beneficial for kidney disease. In addition, the effects of kidney disease can be addressed with medication as well. For example, kidney disease can cause swelling and anemia, and those can be treated with medicines. Some lifestyle changes, such as a reducing the amount of protein in the diet, can lessen the burden on the kidneys and protect them that way.

UTI Prevention

The urinary tract comprises the kidneys, the bladder, the ureters which connect them, and the urethra. This system is prone to infection; it’s most common, and painful, in the bladder and urethra, but when a UTI spreads to the kidneys it can cause serious and permanent damage. Infectious microbes can enter the urinary tract through the urethra in several ways. Often these are gut bacteria expelled as waste in stool. Bladder infections can be caused by sexual intercourse, but many have no easily discoverable cause. Similarly, while STIs can lie behind infections of the urethra, it is not the cause of many of them. Women are particularly prone to UTIs, because the female urethra is typically shorter, but they can happen to anyone.

UTIs are sometimes asymptomatic. When there are symptoms, one of the most prominent is a burning sensation when urinating. Unfortunately, another symptom is frequent urination and a persistent urge to urinate. The appearance of urine can also be a sign. Cloudiness is an indicator, as is blood in the urine– it will be red or pink, or sometimes dark. UTIs also can cause urine to have an unusually strong smell. Women with UTIs may experience pelvic pain, though men experience it in the rectum. Bladder infections can cause pain in the lower abdomen.

Fortunately, UTIs are preventable. One important tip is to drink plenty of fluids. This means more frequent urination, which gets bacteria out before they can cause problems, and also dilutes urine, weakening the bacteria. However, citrus, alcohol, and caffeine can irritate the bladder and actually aggravate incipient infections. Wiping front to back can prevent stool from getting into the urinary tract, where it can introduce E. coli and other microbes. For women, it should be noted that douches and other caustic chemicals don’t help; in fact, they can irritate the urethra and change the environment in a way that encourages the growth of infections. These products should be avoided.

Antibiotics are a common medical treatment for UTIs, though recent studies say antibiotics can actually raise the risk of a recurrence– patients who’d taken a long course of antibiotics were 25 percent more likely to have another infection within a year. Beyond that, cranberry juice is a well-known and, anecdotally, effective preventative measure, though how it fares as a treatment is less clear. It’s particularly effective in adult women.

Robot Surgery

Robots have long been touted as the next step in medical care. In particular, robot surgery is being tested for more and more procedures. Robots can’t (yet) make decisions, but they are smaller and more precise than human hands, as well as easier to sterilize, and they can be manufactured in the optimal shape for the procedure. All that means that robot surgery is less invasive, because a large incision is not needed to give access; this in turn means less blood loss or risk of infection, meaning the surgery doesn’t have to be rushed, and it also means a faster recovery time.

Now researchers have announced the development of a new technique called intracorporeal cooling and extraction which entails the use of robots to perform a type of kidney surgery in cancer patients. The procedure is known as a partial nephrectomy, or removal of the part of the kidney affected by the cancer. Unlike traditional surgery, the robot surgery doesn’t cause significant damage to healthy tissue. In tests, it was found that while the robots need to remove a smaller portion of the kidney than human surgeons do, they actually remove more of the tumor.

In fact, for many patients, robots make it possible to only excise part of the kidney when conventional techniques would require removal of the whole thing.

“Unfortunately, the majority of people today diagnosed with kidney cancer get their entire kidney removed,” said Dr. Craig Rogers, a developer of the technique, in a statement. “Not only that, they’re getting it removed through an open approach, though a large incision that often requires removal a rib, when there are minimally invasive approaches, such as robotic surgery, available.”

When the surgeon is able to perform the partial removal procedure, it needs to be done quickly. Since blood flow to the kidney has to be stopped for the surgery, permanent damage is a risk; if the surgeon takes more than half an hour—for example, if there’s some question about whether the entire tumor has been removed, or if it’s difficult to even find—damage is nearly certain. That means a human surgeon has to focus on speed, often at the expense of thoroughness. The robotic procedure uses ice to prevent permanent damage. This can only be done with conventional techniques when a large incision is made, which means a long and sometimes difficult recovery process.

Fighting Kidney Failure

About one third of the 1.5 million Americans with lupus will develop kidney disease at the time they’re diagnosed, and another 25 percent will develop it in the first ten years after diagnosis. The American College of Rheumatology recently issued new guidelines to help doctors diagnose and treat lupus nephritis and improve patients’ lives.

Lupus affects not only the skin, but the internal organs as well, notably the kidneys. Most lupus patients develop kidney disease, a condition called lupus nephritis, and it can significantly lower chances of survival, particularly in African-American men. There is no known way to prevent kidney damage, though flares can be minimized Medical treatment can help slow or even stop kidney failure from deteriorating once it has been detected.

The ACR’s guidelines were developed after reviewing nearly half a century of research on kidney failure due to lupus. Recommendations include diagnostic testing for vascular disease in nephritis patients, aggressively treating kidney problems in pregnant women, and the use of blood pressure medication in lupus patients with signs of protein in urine. Although lupus can raise blood pressure, certain hypertension drugs also have a protective effect on the kidneys that can help lessen the severity of and danger from lupus nephritis.

The organization also recommended biopsies for previously untreated patients with nephritis. That means doctors are encouraged to study tissue samples in patients who have kidney disease to help determine the proper course of treatment.

Incidence of end-stage renal disease due to lupus has been on the rise over the past 30 years. Doctors aren’t sure what is behind this, but it is hoped that the new guidelines will help reverse the trend.

It is particularly important for patients with lupus nephritis to pay attention to heart health. That means no smoking, watching LDL cholesterol levels, eating right, and getting proper exercise.

If you have foamy or bloody urine, swelling, or signs of high blood pressure, contact a healthcare professional. Doctors can test for signs of lupus nephritis or other conditions and help you get proper treatment.