BFH-Blog For Health

Down Syndrome Cause, Signs, and Treatment

2010-09-23T17:37:00.000+08:00

Down syndrome is a group of mental and physical symptoms that occurs when a person has an extra copy of Chromosome 21.

Once an egg is fertilized by a sperm, the new combination already has 23 pairs of chromosomes. In Down syndrome, however, there is presence of an extra copy of Chromosome 21. This is sometimes called trisomy 21 because there are three copies instead of having two copies of this chromosome. As a result, this can affect the body's and brain's normal development.

The chance of having of the baby developing the condition increases as a woman gets older. Many healthcare providers recommend that women over age 35 have prenatal testing for the condition. Testing the baby before it is born to see if he or she is likely to have Down syndrome allows parents and families to prepare for the baby’s special needs.

Parents who have already have a baby with Down syndrome or who have abnormalities in their own chromosome 21 are also at higher risk for having a baby with Down Syndrome.

Signs and Symptoms

Signs and symptoms of Down syndrome ranges from mild to severe. Commonly, mental and physical development are slower in those people with the condition.

Some common physical signs of Down syndrome include:

Flat face with an upward slant to the eye, short neck, and abnormally shaped ears
Deep crease in the palm of the hand
White spots on the iris of the eye
Poor muscle tone, loose ligaments
Small hands and feet

Sometimes other health problems may be seen in people with the condition including:

Congenital heart disease
Hearing problems
Intestinal problems, such as blocked small bowel or esophagus
Celiac disease
Eye problems, such as cataracts
Thyroid dysfunctions
Skeletal problems
Dementia—similar to Alzheimer’s

Treatment

Unfortunately, there is no cure for Down syndrome. However, many people with the condition can live productive lives with early intervention.

Children with Down syndrome can often benefit from speech therapy, occupational therapy, and exercises for gross and fine motor skills. They might also be helped by special education and attention at school. Many children can integrate well into regular classes at school.

Source:
Information courtesy of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) . Accessed on September 23, 2010.

Simple Kidney Cysts

2008-02-29T18:10:00.003+08:00

A cyst, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), is a closed pocket or pouch of tissue that can form anywhere in the body. Cysts can be filled with air or fluid. Cysts that form on the kidneys usually contain fluid. One or more cysts may develop on small tubes in the kidneys.

The simple kidney cyst is different from the cysts that develop when a person has polycystic kidney disease, which is a genetic disease. Although its cause is not fully understood, the simple cyst is not an inherited condition. Simple kidney cysts become more common as people age. The National Diabetes and Digestive and Kidney Diseases estimates that nearly 30 percent of people over the age of 70 have at least one simple kidney cyst.

Most often, simple cysts do not cause symptoms or harm the kidney. In some cases, however, pain can occur when cysts enlarge and press on other organs. Sometimes cysts become infected or suddenly start to bleed. Less often the cysts impair kidney function. People with simple cysts are often found to have high blood pressure, although the cause-and-effect relationship is not well understood.

Kidney cysts are found by taking pictures of the kidneys using computerized tomography (CT) scans and ultrasonography. When simple cysts are found but no complications are present, no treatment is needed.

If cysts cause symptoms, treatment may be needed The doctor uses ultrasonography to guide the needle to the cyst.. One procedure involves puncturing the cyst using a long needle inserted through the skin. The doctor uses ultrasonography to guide the needle to the cyst. The cyst is drained and then filled with a solution containing alcohol to make the tissue harder.

If the cyst is large, surgery may be needed. Most procedures can be performed using a laparoscope, which allows for a smaller incision and quicker recovery. The surgeon drains the cyst then removes or burns away its outer tissue. Most patients stay in the hospital 1 or 2 days.

Source: National Digestive Diseases Information Clearinghouse (NDDIC) (February 2007). Simple Kidney Cysts (NIH Publication No. 07–4618). Retrieved February 27, 2008, from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health of the U.S. Department of Health and Human Services. Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/cysts/index.htm

Hemolytic Uremic Syndrome

2008-02-29T17:52:00.003+08:00

Hemolytic uremic syndrome, or HUS, is one of the most common causes of sudden, short-term kidney failure in children. In severe cases, this acute kidney failure may require several sessions of dialysis to temporarily take over the kidneys' job of filtering wastes from the blood, but most children recover without permanent damage to their health.

Course of the Disease

Most cases of HUS occur after an infection of the digestive system by Escherichia coli (E. coli) bacterium, which is found in foods like meat, dairy products, and juice when they are contaminated. Some people have contracted HUS after swimming in pools or lakes contaminated with feces. Washing and cooking foods adequately, avoiding undercooked meats, and avoiding unclean swimming areas are the best ways to protect your child from this disease.

Infection of the digestive tract is called gastroenteritis and may cause your child to vomit and have stomach cramps and bloody diarrhea. Most children who experience gastroenteritis recover fully in 2 or 3 days and do not develop HUS. In a few children, however, HUS develops when the bacteria lodged in the digestive system make toxins that enter the bloodstream and start to destroy red blood cells.

Signs and Symptoms

Symptoms of HUS may not become apparent until a week after the digestive problems. With HUS, the child remains pale, tired, and irritable. Other signs include small, unexplained bruises or bleeding from the nose or mouth that may occur because the toxins also destroy the platelets, cells that normally help the blood to clot.

You may notice that your child's urine output decreases. The urine may also appear red. Urine formation slows because the damaged red blood cells clog the tiny blood vessels in the kidneys, making them work harder to remove wastes and extra fluid from the blood. The body's inability to rid itself of excess fluid and wastes may in turn cause high blood pressure or swelling of the face, hands, feet, or entire body. This progression to acute kidney failure occurs in about half of HUS cases.

Call your child's doctor immediately if you notice unexplained bruises, unusual bleeding, swollen limbs or generalized swelling, extreme fatigue, or decreased urine output in your child. You should call your doctor or visit an emergency room if your child goes 12 hours without urinating.

Treatment

Treatments, which consist of maintaining normal salt and water levels in the body, are aimed at easing the immediate symptoms and preventing further problems. Your child may need a transfusion of red blood cells delivered intravenously—that is, through an I.V. needle. Only the most severe cases require dialysis. Some children may sustain significant kidney damage that slowly develops into permanent kidney failure and will then require long-term dialysis or a kidney transplant. Some studies suggest that limiting protein in the child’s diet and treating blood pressure with a medicine from a class of drugs called angiotensin-converting enzyme inhibitors, usually called ACE inhibitors, helps delay or prevent the onset of permanent kidney failure. Most children recover completely with no long-term consequences.

Some parents feel a sense of responsibility for their child's illness after a case of HUS. While the disease may have been preventable, caregivers should not feel guilty because the invisible course of the disease cannot be predicted from the initial bacterial infection, which many children experience without developing HUS. Caregivers who get their children the appropriate medical care should rest assured that they have done all that any caring parent could do.

Source: National Digestive Diseases Information Clearinghouse (NDDIC) (December 2005). Hemolytic Uremic Syndrome (NIH Publication No. 06–4570). Retrieved February 27, 2008, from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health of the U.S. Department of Health and Human Services.
Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/childkidneydiseases/hemolytic_uremic_syndrome/index.htm

Page Last Revised: February 24, 2009

Urinary Retention

2008-02-05T14:46:00.003+08:00

Urinary retention is the inability to empty the bladder or difficulty in urinating. With chronic urinary retention, you may be able to urinate, but you have trouble starting a stream or emptying your bladder completely. You may urinate frequently; you may feel an urgent need to urinate but have little success when you get to the toilet; or you may feel you still have to go after you’ve finished urinating. With acute urinary retention, you can’t urinate at all, even though you have a full bladder. Acute urinary retention is a medical emergency requiring prompt action. Chronic urinary retention may not seem life threatening, but it can lead to serious problems and should also receive attention from a health professional.

Anyone can experience urinary retention, but it is most common in men in their fifties and sixties because of prostate enlargement. A woman may experience urinary retention if her bladder sags or moves out of the normal position, a condition called cystocele. The bladder can also sag or be pulled out of position by a sagging of the lower part of the colon, a condition called rectocele. Some people have urinary retention from rectoceles. People of all ages and both sexes can have nerve disease or nerve damage that interferes with bladder function.

I I Causes >>>

Information Source: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (October 2007). Urinary Retention (NIH Publication No. 08–6089). Retrieved February 5, 2008 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, U.S. Department of Health and Human Services. Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/UrinaryRetention/index.htm

Urinary Retention: Causes

2008-02-05T14:35:00.002+08:00

What causes urinary retention?

Urinary retention can be caused by an obstruction in the urinary tract or by nerve problems that interfere with signals between the brain and the bladder. If the nerves aren’t working properly, the brain may not get the message that the bladder is full.

Even if you know that your bladder is full, the bladder muscle that squeezes urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is time to relax. A weak bladder muscle can also cause retention.

Nerve Disease or Spinal Cord Injury

Many events or conditions can damage nerves and nerve pathways. Some of the most common causes are

 vaginal childbirth

 infections of the brain or spinal cord

 diabetes

 stroke

 accidents that injure the brain or spinal cord

 multiple sclerosis

 heavy metal poisoning

 pelvic injury or trauma

In addition, some children are born with nerve problems that can keep the bladder from releasing urine.

Prostate Enlargement: Benign Prostatic Hyperplasia

As a man ages, his prostate gland may enlarge. Doctors call the condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. As a result, the bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so urine remains in the bladder.

Infection

Infections cause swelling and irritation, or inflammation. A urinary tract infection (UTI) may cause retention if the urethra becomes inflamed and swells shut.

Surgery

During surgery, anesthesia is often administered to block pain signals, and fluid is given intravenously to compensate for possible blood loss. The combination may result in a full bladder with impaired nerve function. Consequently, many patients have urinary retention after surgery.

Medication

Many medicines work by calming overactive nerve signals. Various classes of drugs that block various signals may be used to treat allergies, stomach cramps, muscle spasms, anxiety, or depression. Some medicines are used to treat urinary incontinence and overactive bladder. The drugs that may cause urinary retention include

 antihistamines to treat allergies
 fexofenadine (Allegra)
 diphenhydramine (Benadryl)
 chlorpheniramine (Chlor-Trimeton)
 cetirizine (Zyrtec)
 anticholinergics/antispasmodics to treat stomach cramps, muscle spasms, and urinary incontinence
 hyoscyamine (Levbid, Cystospaz, Anaspaz, Gastrosed)
 oxybutynin (Ditropan, Ditropan XL, Oxytrol)
 tolterodine (Detrol, Detrol LA)
 propantheline (Pro-Banthine)
 tricyclic antidepressants to treat anxiety and depression
 imipramine (Tofranil)
 amitriptyline (Elavil, Endep)
 nortriptyline (Aventyl, Pamelor)
 doxepin (Novo-Doxepin, Sinequan)
(Source: National Kidney and Urologic Diseases Information Clearinghouse, October 2007)

Bladder Stone

A stone formed anywhere in the urinary tract may become lodged in the bladder. If the stone is large enough, it can block the opening to the urethra like a bathtub plug.

Cystocele and Rectocele

A cystocele occurs when the wall between a woman’s bladder and her vagina weakens and allows the bladder to droop into the vagina. The abnormal position of the bladder may cause urine to remain trapped. In a rectocele, the rectum droops into the back wall of the vagina.

Cystocele and rectocele are often the results of a dropping of the pelvic support floor for the bladder. This sagging can pull the bladder out of position and cause urinary problems such as incontinence or urinary retention.

Constipation

A hard stool in the rectum may push against the bladder and urethra, causing the urethra to be pinched shut, especially if a rectocele is present.

Urethral Stricture

A stricture is a narrowing or closure of a tube. Men may have a narrowing of the urethra, usually caused by scarring after a trauma to the penis. Infection is a less common cause of scarring and closure in the urethra.

Overview I I Signs and Symptoms

Information Source: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (October 2007). Urinary Retention (NIH Publication No. 08–6089). Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/UrinaryRetention/index.htm. Retrieved June 2008.

Page Last Revised: July 2, 2010

Urinary Retention: Signs and Symptoms

2008-02-05T14:30:00.001+08:00

What are the symptoms of urinary retention?

Acute urinary retention causes great discomfort, and even pain. You feel an urgent need to urinate but you simply can’t. The lower belly is bloated.

Chronic urinary retention, by comparison, causes mild but constant discomfort. You have difficulty starting a stream of urine. Once started, the flow is weak. You may need to go frequently, and once you finish, you still feel the need to urinate. You may dribble between trips to the toilet because your bladder is constantly full, a condition called overflow incontinence.

<<< Causes I I Diagnosis >>>

Urinary Retention: Diagnosis

2008-02-05T14:23:00.001+08:00

How is urinary retention diagnosed?

Your doctor will order a number of tests to diagnose your condition.

History of Complaints and Physical Examination

A physician will suspect urinary retention by your symptoms and will attempt to confirm the diagnosis with a physical examination of the lower abdomen. The physician may be able to feel the distended bladder by lightly tapping on your lower belly. Tapping or striking for diagnostic purposes is called percussing.

Urine Sample

A urine sample will be examined for signs of infection, which may be a cause or a result of urinary retention.

Bladder Scan

A bladder scan uses a portable ultrasound device that can determine how much urine is in your bladder. You will be asked to urinate, and then your doctor or nurse will use the bladder scan to determine the post-void residual (PVR). The word residual refers to the amount of urine left in the bladder after urination. If you typically have a PVR of 100 milliliters or more, you are considered to have chronic urinary retention.

Cystoscopy

Your doctor may use a cystoscope to see inside your bladder and urethra. The cystoscope has lenses like a telescope or microscope. These lenses let the doctor focus on the inner surfaces of the urinary tract.

Some cystoscopes use optical fibers made of flexible glass that carry an image from the tip of the instrument to a viewing piece at the other end. The fiber-optic cystoscope is as thin as a pencil and has a light at the tip. The doctor can use the cystoscope to find and perhaps remove a stone that may be blocking the bladder opening. The device can help the doctor identify narrowing of the urethra from prostate enlargement or UTI.

X Ray and Computerized Tomography (CT) Scan

A conventional x ray may show a spot where the urinary tract is narrowed or obstructed. It may show that the bladder is out of its normal position. CT scans use multiple x-ray images to construct a better view of internal organs, which may help find stones or other obstructions.

Blood Test for Prostate-specific Antigen (PSA)

Men may be given a blood test to measure their PSA, a substance in the blood that may indicate prostate cancer or other prostate problems. A high PSA score may prompt further tests, such as a transrectal ultrasound, with or without biopsy of the prostate.

Prostate Fluid Sample

The doctor may ask for a prostate fluid sample to check for prostatitis—inflammation of the prostate—a condition that can cause the prostate to swell and pinch the urethra. The doctor will obtain the sample by inserting a gloved finger into the rectum and massaging the prostate until fluid drains through the urethra. A doctor will not massage a prostate for prostatic fluid if urinary retention is suspected as the primary diagnosis. Only when urinary retention is ruled out would the doctor do this test.

Urodynamic Tests

Urodynamic tests include different techniques to measure the bladder’s ability to empty steadily and completely. In a pressure flow study, you will be asked to empty your bladder so that a special catheter can measure the pressure required to start a stream. This pressure flow study helps to identify bladder outlet obstruction from prostate enlargement or cystocele.

If your doctor or nurse thinks your urinary problem is related to nerve damage, you may be given an electromyography. This test measures the muscle activity in the urethral sphincter using sensors placed on the skin near the urethra and rectum. Sometimes the sensors are on the urethral or rectal catheter. A catheter is a thin, flexible tube that can be guided into openings of the body. Muscle activity is recorded on a machine. The patterns of the impulses will show whether the messages sent to the bladder and urethra are coordinated correctly.

<<< Signs and Symptoms I I Treatment >>>

Urinary Retention: Treatment

2008-02-05T14:11:00.001+08:00

How is urinary retention treated?

Catheterization

With acute urinary retention, treatment begins with the insertion of a catheter through the urethra to drain the bladder. This initial treatment relieves the immediate distress of a full bladder and prevents permanent bladder damage. Long-term treatment for any case of urinary retention depends on the cause.

The cause of acute urinary retention may be temporary. For example, if you have retention after surgery, you will probably regain your ability to urinate after the effects of the anesthesia wear off. In such cases, you may need to have a catheter inserted once or twice with no other treatment required after you have shown you can urinate on your own.

If you have chronic urinary retention, or if acute retention appears to become chronic, further treatment will be necessary. You may need to continue using a catheter if other options do not work for you. You may be taught to catheterize yourself as needed. You will need to learn sterile technique to avoid UTIs.

Treatments to Relieve Prostate Enlargement

The treatments for prostate enlargement range from medication to surgery. For more information, see the fact sheet Prostate Enlargement: Benign Prostatic Hyperplasia from the National Kidney and Urologic Diseases Information Clearinghouse.

Surgery for Women with Cystocele or Rectocele

Women may need surgery to lift a fallen bladder or rectum. The most common procedure for cystocele and rectocele repair is for the surgeon to make an incision in the wall of the vagina to find the defect or hole in the membrane—a wall of tissue called fascia—that normally separates the vagina from the other pelvic organs. The surgeon places sutures in the fascia to close up the defect, then closes the incision in the vaginal wall with more stitches, removing any excess tissue. These suturing steps tighten the layers of tissue that separate the organs, creating more support for the pelvic organs.

Treatments for Men with Urethral Stricture

If a man is diagnosed with urethral stricture, a doctor can perform a procedure called dilation, in which increasingly wider tubes are inserted into the urethra to widen the stricture. An alternate method is to inflate a small balloon at the end of a catheter inside the urethra.

A surgeon can repair a stricture by performing an internal urethrotomy. The surgeon advances a catheter up to the stricture and uses a knife or laser to make an incision that opens the stricture.

Another treatment for urethral stricture in men is placement of a wire mesh tube, called a stent, to keep the passage open.

The BFH: Blog For Health web site and its source for this topic, NKUDIC, does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.

For updates or for questions about any medications, please contact the U.S. Food and Drug Administration at 1–888–INFO–FDA (463–6332), a toll-free call, or visit their website at http://www.fda.gov/. Consult your doctor for more information.

<<< Diagnosis I I Complications >>>

Urinary Retention: Complications

2008-02-05T13:51:00.001+08:00

What are the complications of urinary retention?

Urinary Tract Infection

Urine is normally sterile, and the normal flow of urine usually prevents bacteria from growing in the urinary tract. When urine stays in the bladder, however, bacteria have a chance to grow and infect the urinary tract.

Bladder Damage

If the bladder becomes stretched too far or for long periods, the muscle may be permanently damaged and lose its ability to contract.

Chronic Kidney Disease

If urine backs up into the kidneys, permanent kidney damage can lead to reduced kidney function and chronic kidney disease. If you lose too much of your kidney function, you will need dialysis or a kidney transplant to stay alive.

What are the complications of treatments for urinary retention?

UTI from Catheter Use

Placement of a urinary catheter provides an opportunity for bacteria to enter the urinary tract. Bacteria may come from the patient’s anus and perineum or from the health worker’s hands. Health workers must take great care, using sterile technique, when placing a catheter. If you are performing clean intermittent catheterization, you must follow the same sterile procedures every time you handle the catheter.

Incontinence and Erectile Dysfunction After Prostate Surgery

Transurethral surgery to treat an enlarged prostate may result in loss of bladder control or erection problems in some men. These problems are usually temporary. Most men recover their bladder control in a few weeks or months, and most recover their sexual function within 1 year after the operation.

<<< Treatment I I

Information Source: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (October 2007). Urinary Retention (NIH Publication No. 08–6089). Retrieved February 5, 2008 from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, U.S. Department of Health and Human Services. Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/UrinaryRetention/index.htm

Ectopic Kidney

2008-02-03T15:11:00.000+08:00

An ectopic kidney is a birth defect in which a kidney is located in an abnormal position. In most cases, people with an ectopic kidney have no complaints. In other cases, the ectopic kidney may create urinary problems, such as urine blockage, infection, or urinary stones. Researchers estimate that ectopic kidney occurs once in every 1,000 births.

Kidneys are bean-shaped organs, each about the size of your fist. Most people have two kidneys located near the middle of the back, just below the rib cage. The kidneys filter wastes and extra fluid from your blood. The wastes and extra fluid become urine, which drains from the kidneys to the bladder through tubes called ureters. Urine is stored in the bladder until it is released from the body when you urinate.

What causes an ectopic kidney?

During fetal development, a baby’s kidneys first appear as buds inside the pelvis, near the bladder. As the fetal kidneys develop, they climb gradually toward their normal position near the rib cage in the back. Sometimes, one of the kidneys fails to make the climb. It may stop after making part of the climb. Or it may remain in the pelvis. Rarely does a child have two ectopic kidneys.

An ectopic kidney may remain in the pelvis, close to the bladder.

An ectopic kidney may cross over and become fused with the other kidney.

Some kidneys climb toward the rib cage, but one may cross over so that both kidneys are on the same side of the body. When a crossover occurs, the two kidneys may grow together and become fused.

What are the symptoms of an ectopic kidney?

An ectopic kidney may not cause any symptoms and may function normally, even though it is not in its usual position. Many people have an ectopic kidney and do not discover it until they have tests done for other reasons. Sometimes, a doctor may discover an ectopic kidney after feeling a lump in the abdomen during an examination. In other cases, an ectopic kidney may cause abdominal pain or urinary problems.

What are the possible complications of an ectopic kidney?

When a kidney is out of the normal position, drainage problems are likely. Sometimes, urine can even flow backwards from the bladder to the kidney, a problem called vesicoureteral reflux, or simply reflux. Abnormal urine flow can set the stage for a number of problems.

Infection. Normally, urine flow washes out bacteria and keeps them from growing in the kidneys and urinary tract. When a kidney is out of the normal position, urine may get trapped in the ureter or in the kidney itself. Urine that remains in the urinary tract gives bacteria the chance to grow and spread. Symptoms of a urinary tract infection include frequent or painful urination, back or abdominal pain, fever, and chills. The urine may be cloudy or have an unusual smell.
Stones. Urinary stones form from substances found in the urine, such as calcium and oxalate. Urine that remains too long in the urinary tract increases the risk that these substances will have time to form stones. Symptoms of urinary stones include extreme pain in the back, side, or pelvis; blood in the urine; fever or chills; vomiting; and burning during urination.
Kidney failure. If urine backs up all the way to the kidneys, damage to the kidneys can occur. As a result, the kidneys can’t filter wastes and extra fluid from the blood. Symptoms of kidney failure include swelling in the legs or abdomen, feeling very tired, headaches, or nausea. If total kidney failure occurs, you will need dialysis or a kidney transplant. Total kidney failure happens only when both kidneys are damaged. One ectopic kidney, even when it has no function, won’t cause kidney failure.
Trauma. If the ectopic kidney is in the lower abdomen, or pelvis, it may be susceptible to injury from blunt trauma. People with ectopic kidney who want to participate in body contact sports may wish to wear protective gear.

What tests will the doctor order?

Your doctor can get the most information about your condition by looking at pictures of the ectopic kidney. Several different imaging tests are available.

Ultrasound. During an ultrasound examination, a medical technician will glide a device called a transducer over your skin—either on your side, your abdomen, or your pelvis—depending on the location of the kidney. The transducer sends harmless sound waves into your body. The sound waves bounce off your kidney and back to the transducer. The equipment reads the sound waves and creates a black and white image of the kidney on a television screen.
X ray. Your doctor may use conventional x-ray equipment to perform an intravenous pyelogram (IVP) or a voiding cystourethrogram (VCUG). In an IVP, a special dye is injected into a vein, usually in the arm. The radiologist takes a series of snapshots as the dye circulates through the blood and reaches the kidneys. The structures of the kidneys show up on the x rays as the dye is filtered from the blood and passes through the kidneys to the ureters. An IVP can show whether urine is backing up into the ectopic kidney. In children, ultrasounds are usually done instead of IVPs.

In a VCUG, a thin hollow tube called a catheter is placed into the bladder so that it can be filled with x-ray contrast material. X rays are then taken as the patient urinates. The VCUG gives information about the bladder and reveals whether urine is backing up toward the kidneys during urination.
Nuclear scan. In a nuclear scan, a small amount of a radioactive drug is injected into a vein, and pictures are taken of the kidney over a period of time after the injection. Sometimes a diuretic medicine is also given to increase urine flow. This test can reveal whether the ureters—tubes that drain urine from the kidneys—are blocked and how well the kidneys work. Sometimes, a nuclear scan may be done to find the location of an ectopic kidney.
Computerized tomography (CT) scan. A CT scan uses multiple x-ray images to create a cross-section view of your body on a computer screen. You will lie on a table that passes through a doughnut-shaped machine where the scanning takes place. CT scans aren’t usually needed in the evaluation of an ectopic kidney, but they may be done in a few cases.
Magnetic resonance imaging (MRI). MRI technology uses radio waves and magnets to create pictures of internal organs. No exposure to radiation is required. With most MRI machines, you lie on a table that slides into a tunnel that may be open-ended or closed at one end. Some newer machines are designed to allow you to lie in a more open space. Like CT scans, MRIs are rarely needed to evaluate an ectopic kidney.

In addition to imaging tests, the doctor may order blood tests to determine how well your kidneys are working. These tests are almost always normal in patients with an ectopic kidney, even if it is badly damaged, because the other kidney usually has completely normal function.

What are the treatments for an ectopic kidney?

If your urinary function is normal and the doctor finds no blockage, no treatment for ectopic kidney is needed. Your doctor should continue to monitor your condition in case a change occurs.

If tests show that obstruction is present, you may need surgery to correct the position of the kidney to allow for better drainage of urine. To correct reflux, the surgeon may reattach the ureter to the bladder so that urine can’t reflux into the kidney.

If extensive kidney damage has occurred, the surgeon may need to remove the kidney. As long as the other kidney is working properly, losing one kidney is not a problem. Many people live a normal life after donating a kidney for transplant. Some people are even born with only one kidney and lead full, healthy lives without discovering their condition.

With the right testing and treatment, if needed, an ectopic kidney should cause no serious long-term health problems.

Source:
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (April 2007). Ectopic Kidney (NIH Publication No. 07–5869). Retrieved February 3, 2008, from the NKUDIC, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services. Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/ectopicKidney/index.htm

Prostate Problems

2008-01-20T14:19:00.000+08:00

What Men Need To Know About Prostatitis and Benign Prostatic Hyperplasia.

Frequent need to urinate or painful urination could be caused by a problem with your prostate.

The prostate or prostate gland is part of a man’s sex organs. It is a gland about the size of a walnut that surrounds the urethra. The urethra is the tube that carries urine and semen out of the body. The prostate adds fluid to the semen when you ejaculate.

What are prostate problems?

For men under age 50, the most common prostate problem is prostatitis, meaning the prostate is inflamed. For men over age 50, the most common prostate problem is prostate enlargement. This condition is also called benign prostatic hyperplasia or BPH.

What are the symptoms of prostatitis?

Prostatitis can cause painful, burning, or frequent urination. You may have a fever or pain in your lower back or genital area.

What causes prostatitis?

Prostatitis is sometimes caused by bacteria. But usually no bacteria are present and doctors will look for other possible causes of urinary symptoms, such as a kidney stone or cancer. If no other causes are found, your doctor may decide you have nonbacterial prostatitis.

How is prostatitis treated?

If you have bacterial prostatitis, your doctor can give you an antibiotic to fight the infection. If you keep getting infections, you may have a defect in your prostate that allows bacteria to grow. This defect can usually be corrected with surgery.

Antibiotics will not help nonbacterial prostatitis. Instead, your doctor may give you a medicine to relax the muscle tissue in the prostate. Changing your diet or taking warm baths may help too.

What are the symptoms of BPH?

Some symptoms of BPH include

a frequent and urgent need to urinate
trouble starting a urine stream
a weak stream of urine
the feeling you still have to urinate, even when you have just finished
small amounts of blood in your urine

What causes BPH?

As men get older, their prostate keeps growing. As it grows it squeezes the urethra. Since urine travels from the bladder through the urethra, the pressure from the enlarged prostate may affect bladder control.

How is BPH treated?

You’ll have to work with your doctor to find the best treatment for you. Some options are

living with your symptoms, if they don’t bother you too much, and regular checkups to make sure your condition isn’t getting worse
medicines to shrink or relax the prostate
a nonsurgical procedure to remove parts of the prostate
surgery to remove part of the prostate

What else could cause the same symptoms?

Frequent or painful urination, especially with blood in the urine, could be signs of bladder cancer. If you have these symptoms, see your doctor right away.

Information Provided by The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)(November, 2007). Prostate Problems: What Men Need To Know - NIH Publication No. 08–6183. Retrieved January 20, 2007, from NKUDIC, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Web Site: http://kidney.niddk.nih.gov/kudiseases/pubs/prostate_ES/index.htm

Bladder Control Problems in Men

2008-01-20T11:39:00.000+08:00

What Men Need To Know About Bladder Control Problems.

According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), many men develop bladder control problems as they get older.

But urine leakage, frequent urination, or the urgent need to urinate don’t have to be unavoidable parts of aging. Bladder control problems can be treated.

What kind of bladder control problems do men have?

Men can have several types of bladder control problems.

 Urinary incontinence (UI) is the accidental leakage of urine. Urine can leak in three ways:
 when you cough, sneeze, or lift—actions that put pressure on the bladder
 following a sudden, strong urge to urinate
 as a constant dribbling; men with this problem usually need to urinate often and only pass small amounts of urine each time.
 Overactive bladder is a condition in which the bladder squeezes urine out at the wrong time. You may have overactive bladder if you have two or more of these symptoms:
 urination eight or more times a day or two or more times at night
 the sudden, strong need to urinate immediately
 urine leakage that follows a sudden, strong urge to urinate

Learn More About Urinary Incontinence In Men

What causes bladder control problems in men?

UI and overactive bladder may be caused by prostate or nerve problems. Sometimes the cause of overactive bladder is not clear.

Prostate problems. The prostate is a male gland about the size of a walnut that surrounds the urethra, the tube that carries urine and semen out of the body.

 An enlarged prostate, common among older men, may squeeze the urethra and result in a weak urine stream, an urgent need to urinate followed by leakage, and frequent urination, especially at night.
 Surgery or radiation to treat prostate cancer can lead to temporary or permanent bladder control problems.

Nerve problems. Damaged nerves may send signals to the bladder at the wrong time or send no signals at all, leading to bladder control problems. Spinal cord injuries or conditions such as diabetes or stroke may cause nerve problems.

What can I do about bladder control problems?

Just changing some daily habits may help. For example, you could limit fluids at certain times of the day or plan regular trips to the bathroom to avoid an accident.

Don’t be embarrassed to talk with your doctor about your problem. Your doctor may prescribe medicine to calm abnormal nerve signals to the bladder. Other medicines relax the bladder or shrink the prostate. Surgery can help bladder control problems caused by nerve damage.

Frequent or painful urination, especially with blood in the urine, could be signs of bladder cancer. If you have these symptoms, see your doctor.

Information Provided by The National Kidney and Urologic Diseases Information Clearinghouse (November, 2007). Bladder Control: What Men Need To Know (NIH Publication No. 08–6178). Retrieved January 20, 2008, from NKUDIC, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Web Site: http://kidney.niddk.nih.gov/kudiseases/pubs/bcm_ES/index.htm

Bladder Control Problems in Women

2008-01-20T10:56:00.000+08:00

What Women Need to Know About Bladder Control Problems.

By: David Mangusan Jr., PTRP

According to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), urine leakage is a common problem for women of all ages.

About half of adult women say they have had urine leakage at one tome or the other. Many women even say that the problem occurs daily.

Women often experience urine leakage during pregnancy or after they have given birth.

Women often report bladder control problems when they have stopped having their periods-clinically termed as menopause.

Accidental leakage may also occur when women exercise, laugh hard, cough or sneeze.

Causes of Bladder Control Problems in Women:(NKUDIC, 2007)

 Weak muscles. Most bladder control problems are caused by weak pelvic muscles—the muscles that hold the bladder in place. These muscles may become stretched and weak during pregnancy and childbirth. The sphincters—muscles that keep the bladder closed until you urinate—may also be weakened.

 Nerve damage. Damaged nerves may send signals to the bladder at the wrong time, causing the bladder to push out urine without warning. Or damaged nerves send no signals at all, so the brain can’t tell when the bladder is full. Trauma or diseases such as diabetes can cause nerve damage.

 Medicines, alcohol, and caffeine. Leaking can happen when medicines or alcohol affect the nerves or muscles. Caffeinated drinks such as coffee or cola cause the bladder to fill quickly, which may cause the bladder to leak.

 Infection. A urinary tract infection can irritate bladder nerves and cause the bladder to squeeze without warning.

 Excess weight. Being overweight can put pressure on the bladder and contribute to leakage.

What you can do about bladder control problems.

Sometimes a simple change in daily habits may help. For example, if you tend to leak urine at certain times of the day, you can go to the bathroom ahead of time to avoid accidental leakage. If certain foods and drinks cause you to urinate more often, try avoiding them.

Don't hesitate to talk to your healthcare provider about your problem. Your doctor may prescribe a medicine that can calm muscles and nerves to treat an overactive bladder.

Your healthcare provider can teach you exercises to strengthen your pelvic muscles if the problem is caused by weak muscles. Or your doctor may fit you with a device worn in the vagina that helps lift the urinary bladder. Your doctor may suggest surgery to improve bladder control if other treatments fail.

Though urine leakage is a common problem in women, it doesn't have to be an unavoidable part of a woman's life. Bladder control problems can be treated. It can be managed through changes in daily habits, medications, or surgery.

Reference: National Kidney and Urologic Diseases Information Clearinghouse (October, 2007). Bladder Control: What Women Need To Know. Retrieved January 20, 2008, from NKUDIC, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health. Web Site: http://kidney.niddk.nih.gov/kudiseases/pubs/bladdercontrol_ES/index.htm

Tests For Prostate Problems

2008-01-17T21:25:00.000+08:00

The prostate is a walnut-sized gland in men that produces fluid that is a component of semen. The gland has two or more lobes—or sections—enclosed by an outer layer of tissue. Located in front of the rectum and just below the bladder, where urine is stored, the prostate surrounds the urethra, which is the canal through which urine passes out of the body.

The most common prostate problem in men under 50 is inflammation or infection, which is called prostatitis. Prostate enlargement is another common problem. Because the prostate normally continues to grow as a man matures, prostate enlargement, also called benign prostatic hyperplasia or BPH, is the most common prostate problem for men over 50. Older men are at risk for prostate cancer as well, but it is much less common than BPH.

Sometimes, different prostate problems have similar symptoms. For example, one man with prostatitis and another with BPH may both have a frequent, urgent need to urinate. Other men with BPH may have different symptoms. For example, one man may have trouble beginning a stream of urine, while another may have to get up to go to the bathroom frequently at night. A man in the early stages of prostate cancer may have no symptoms at all. This confusing array of symptoms makes a thorough medical examination and testing very important. Diagnosing the problem may require a series of tests.

Talking With Your Doctor or Healthcare Provider

Letting your doctor or nurse know you have a problem is the first step. Try to give as many details about the problem as you can, including when it began and how often it occurs. Tell the doctor or nurse whether you have had recurrent urinary tract infections or symptoms such as pain after ejaculation or during urination, sudden strong urges to urinate, or hesitancy and a weak urine stream. You should talk about the medicines you take, both prescription medicines and those you can buy over the counter, because they might be part of the problem. You should also talk about how much fluid you typically drink each day, whether you use caffeine or alcohol, and whether your urine has an unusual color or odor. In turn, the doctor or nurse will ask you about your general medical history, including any major illnesses or surgeries.

Other typical questions are as follows:

Over the past month or so, how often have you had to urinate again in less than 2 hours?
Over the past month, from the time you went to bed at night until the time you got up in the morning, how many times a night did you typically get up to urinate?
Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
Over the past month or so, how often have you had a weak urinary stream?
Over the past month or so, how often have you had to push or strain to begin urinating?

Your answers to these questions may help your doctor or nurse identify the problem or determine what tests are needed. You may also receive a symptom score evaluation that can be used as a baseline to see how effective later treatments are at relieving those symptoms.

Preparing for the Exam

The common tests your doctor or nurse will perform first require no special preparation. Digital rectal exams (DRE) and blood tests for prostate-specific antigen (PSA) are often included in routine physical examinations for men over 50. For African-American men and men with a family history of prostate cancer, it is recommended that tests be given starting at age 40. Some organizations even recommend that these tests be given to all men starting at age 40.

If you have urination problems or if the DRE or PSA test indicates that you might have a problem, you will probably be given additional tests that may require some preparation. Ask your doctor or nurse whether you should change your diet or fluid intake or stop taking any medications. If the tests involve inserting instruments into the urethra or rectum, you may be given antibiotics before and after the test to prevent infection.

Procedures

DRE (Picture)

This exam is usually done first. Many doctors perform a DRE as part of a routine physical exam for any man over 50, some even at 40, whether the man has urinary problems or not. You may be asked to bend over a table or to lie on your side holding your knees close to your chest. The doctor slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies next to it. You may find the DRE slightly uncomfortable, but it is very brief. This exam tells the doctor whether the gland has any bumps, irregularities, soft spots, or hard spots that require additional tests. If a prostate infection is suspected, the doctor might massage the prostate during the DRE to obtain fluid for examination with a microscope.

PSA Blood Test

To rule out cancer, your doctor may recommend a PSA blood test. The amount of PSA, a protein produced by prostate cells, is often higher in the blood of men who have prostate cancer. However, an elevated level of PSA does not necessarily mean you have cancer. The Food and Drug Administration has approved a PSA test for use in conjunction with a DRE to help detect prostate cancer in men age 50 or older and for monitoring men with prostate cancer after treatment. However, much remains unknown about how to interpret the PSA test, its ability to discriminate between cancer and benign prostate conditions, and the best course of action if the PSA is high.

Because so many questions are unanswered, the relative magnitude of the test’s potential risks and benefits is unknown. When added to DRE screening, PSA enhances detection, but PSA tests are known to have relatively high false-positive rates, and they also may identify a greater number of medically insignificant tumors.

The PSA test first became available in the 1980s, and its use led to an increase in the detection of prostate cancer between 1986 and 1991. In the mid-1990s, deaths from prostate cancer began to decrease, and some observers credit PSA testing for this trend. Others, however, point out that statistical trends do not necessarily prove a cause-and-effect relationship. The benefits of prostate cancer screening are still being studied. The National Cancer Institute is conducting the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, or PLCO Trial, to determine whether certain screening tests reduce the number of deaths from these cancers. DRE and PSA exams are being studied to see whether yearly screening will decrease the risk of dying from prostate cancer.

Until a definitive answer is found, doctors and patients should weigh the benefits of PSA testing against the risks of followup diagnostic tests and cancer treatments. The procedures used to diagnose prostate cancer may cause significant side effects, including bleeding and infection. Treatment for prostate cancer often causes erectile dysfunction, or impotence, and may cause urinary incontinence.

Urinalysis

Your doctor or nurse may ask for a urine sample to test with a dipstick or to examine with a microscope. A chemically treated dipstick will change color if the urine contains nitrite, a byproduct of bacterial infection. Traces of blood in the urine may indicate that a kidney stone or infection is present, or the sample might reveal bacteria or infection-fighting white blood cells. You might be asked to urinate into two or three containers to help locate the infection site. If signs of infection appear in the first container but not in the others, the infection is likely to be in the urethra. Your doctor or nurse might ask you to urinate into the first container, then stop the stream for a prostate massage before completing the test. If urine taken after prostate massage or the prostate fluid itself contains significantly more bacteria, it is a strong sign that you have bacterial prostatitis.

Transrectal Ultrasound and Prostate Biopsy (Picture)

If prostate cancer is suspected, your doctor may recommend a transrectal ultrasound. In this procedure, the doctor or technician inserts a probe slightly larger than a pen into the rectum. The probe directs high-frequency sound waves at the prostate, and the echo patterns form an image of the gland on a television monitor. The image shows how big the prostate is and whether there are any irregularities, but it cannot unequivocally identify tumors.

To determine whether an abnormal-looking area is indeed a tumor, the doctor can use the probe and the ultrasound images to guide a biopsy needle to the suspected tumor. The needle collects a few pieces of prostate tissue for examination with a microscope.

Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) Scans

MRI and CT scans both use computers to create three-dimensional or cross-sectional images of internal organs. These tests can help identify abnormal structures, but they cannot distinguish between cancerous tumors and noncancerous prostate enlargement. Once a biopsy has confirmed cancer, a doctor might use these imaging techniques to determine how far the cancer has spread. Experts caution, however, that MRI and CT scans are very expensive and rarely add useful information. They recommend using these techniques only when the PSA score is very high or the DRE suggests an extensive cancer, or both.

Urodynamic Tests

If your problem appears to be related to blockage, your doctor or nurse may recommend tests that measure bladder pressure and urine flow rate. You may be asked to urinate into a special device that measures how quickly the urine is flowing and records how many seconds it takes for the peak flow rate to be reached. Another test measures postvoid residual, the amount of urine left in your bladder when you have finished urinating. A weak stream and difficulty emptying the bladder completely may be signs of urine blockage caused by an enlarged prostate that is squeezing the urethra.

Abdominal Ultrasound

For an abdominal ultrasound exam, a technician will apply gel to your lower abdomen and sweep a handheld transducer across the area to receive a picture of your entire urinary tract. An abdominal ultrasound can show damage in the upper urinary tract that results from urine blockage at the prostate.

Cystoscopy

After a solution numbs the inside of the penis, the doctor inserts a small tube through the urethral opening at the tip of the penis. The tube, called a cystoscope, contains a lens and a light system, which allow the doctor to see the inside of the urethra and the bladder. The doctor can then determine the location and degree of the obstruction.

After the Test

You may have mild discomfort for a few hours after urodynamics and cystoscopy. Drinking an 8-ounce glass of water each half-hour for 2 hours should help. Ask your doctor whether you can take a warm bath. If not, you may be able to hold a warm, damp washcloth over the urethral opening to relieve the discomfort. A prostate biopsy may also produce pain in the area of the rectum and the perineum, which is between the rectum and the scrotum.

Your doctor may give you an antibiotic to take for 1 or 2 days to prevent an infection, but not always. If you have signs of infection—including pain, chills, or fever—call your doctor at once.

Information Provided by National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (October, 2006). Medical Tests for Prostate Problems. Retrieved January 17, 2008, from NKUDIC, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Web site: http://kidney.niddk.nih.gov/kudiseases/pubs/medtestprostate/index.htm

Kidney and Urologic Diseases

2007-05-20T11:10:00.010+08:00

Acidosis
Amyloidosis and Kidney Disease
Analgesic Nephropathy
Anatomy of the Kidneys
Bedwetting
Bladder Control Problems in Men
Bladder Control Problems in Women
Cystocele
Cysts
Diabetes and the Kidneys
Diseases Involving the Urinary System (Overview)
Fallen Bladder
Glomerular Diseases
Glomerular Diseases and Kidney Function
Glomerulonephritis
Glomerulosclerosis
Goodpasture's Syndrome
Hematuria: Blood in the Urine
Kidney Diseases in Children (Overview)
Kidney Stones
Kidneys: Structure and Function
Nephrotic Syndrome
Prostate Problems
Renal Failure
Renal Tubular Acidosis
Simple Kidney Cysts
Tests for Prostate Problems
Urinary Incontinence in Men
Urinary Tract Infection
Urinary System: Structures and Functions

Page Last Revised: November 7, 2009
By: David Mangusan Jr, PTRP

Urinary Incontinence in Men - Overview

2007-05-20T09:08:00.000+08:00

Urinary incontinence (UI) is the accidental leakage of urine. Over a lifespan, there are gender differences in the frequency of UI. In childhood, girls usually develop bladder control at an earlier age than boys, and bedwetting (nocturnal enuresis) is less common in girls than in boys. However, adult women are far more likely to experience UI because of the anatomy of their urinary tract and the stresses caused by pregnancy and childbirth. Nevertheless, men may experience UI as a result of prostate problems, and both men and women can experience nerve damage that leads to UI. Its prevalence increases with age, but it is not an inevitable part of aging.

UI is a medical problem. To find a treatment that addresses the root of the problem, you need to talk to your health care provider. The four forms of UI are

temporary or reversible incontinence related to urinary tract infection, constipation, or delirium
stress incontinence caused by weak pelvic and sphincter muscles
urge incontinence caused by damaged or irritable nerves
overflow incontinence that results when an individual is unable to empty the bladder

Male urinary tract, front and side views

Overview

Causes

Diagnosis

Treatment

Sources: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Urinary Incontinence in Men. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 04–5280: March 2004

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Causes of Urinary Incontinence in Men

2007-05-19T20:28:00.000+08:00

What causes UI in men?

For the urinary system to do its job, muscles and nerves must work together to hold urine in the bladder and then release it at the right time. Babies are not born with the ability to control urination. As children grow, they learn to interpret nerve signals and develop the muscle control required to stay dry. In children between the ages of 5 and 10, some incontinence may result from limited bladder capacity or delayed development of the nerve pathways that signal a full or emptying bladder. This form of incontinence fades away as the bladder grows and nerves become mature. Other types of nerve problems, however, can cause urination problems that are more difficult to overcome.

Nerve Problems

Any disease, condition, or injury that damages nerves can lead to urination problems. Nerve problems can occur at any age.

Men who have had diabetes for many years may develop nerve damage that affects their bladder control as well as their sexual function.
Stroke, Parkinson's disease, and multiple sclerosis all affect the brain and nervous system, so they can also cause incontinence.
Overactive bladder is a condition in which the bladder squeezes at the wrong time. The condition may be caused by nerve problems, or it may occur without any clear cause. A personwith overactive bladder may have any two or all three of the following symptoms:

**urinary frequency—urination eight or more times a day or two or more times at
night
**urinary urgency—the sudden, strong need to urinate immediately
**urge incontinence—urine leakage that follows a sudden, strong urge

Spinal cord injury can cause incontinence by interrupting the nerve signals required for bladder control.
In neural birth defects such as spina bifida or myelomeningocele, the backbone and spinal canal do not close before birth. In severe cases, nerve damage can result in many problems, including lack of control over urination.

Prostate Problems

The prostate is a male gland about the size and shape of a walnut. It surrounds the urethra just below the bladder, where it adds fluid to semen before ejaculation.

BPH: The prostate gland commonly becomes enlarged as a man ages. This condition is called benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy. As the prostate enlarges, it may squeeze the urethra. The bladder wall thickens and becomes irritable, and the bladder begins to contract even when it contains only small amounts of urine. This results in more frequent urination. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and up to 90 percent in their seventies and eighties have some symptoms of BPH. The symptoms vary, but the most common ones involve changes or problems with urination, such as a hesitant, interrupted, weak stream; urgency and leaking or dribbling; more frequent urination, especially at night; and urge incontinence. Problems with urination do not necessarily signal blockage caused by an enlarged prostate. Other changes associated with aging can cause urination problems experienced by both men and women.
Radical prostatectomy: The surgical removal of the entire prostate gland—called radical prostatectomy—may be recommended to treat prostate cancer. The surgeon may approach the prostate through the abdomen or through the perineal area (between the scrotum and the anus). The surgery may lead to erection problems and UI, although nerve-sparing procedures in the abdominal approach may make these side effects less likely.

External beam radiation: This therapy uses an x-ray machine to deliver radiation to the prostate gland. The treatment is not painful but can cause loss of bladder control as well as fatigue, skin redness and irritation, rectal burning or injury, diarrhea, inflammation of the bladder wall (cystitis), blood in the urine, loss of sexual function, and loss of appetite.

Prostate Symptom Scores
If your prostate could be involved in your incontinence, you may be asked a series of standardized questions, either the International Prostate Symptom Score or the American Urological Association (AUA) Symptom Scale. Some of the questions you will be asked for the AUA Symptom Scale will be the following:

Over the past month or so, how often have you had to urinate again in less than 2 hours?
Over the past month or so, from the time you went to bed at night until the time you got up in the morning, how many times did you typically get up to urinate?
Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?
Over the past month or so, how often have you had a weak urinary stream?
Over the past month or so, how often have you had to push or strain to begin urinating?

Your answers to these questions may help identify the problem or determine which tests are needed. Your symptom score evaluation can be used as a baseline to see how effective later treatments are at relieving those symptoms.

Overview

Causes

Diagnosis

Treatment

Resources: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Urinary Incontinence in Men. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 04–5280: March 2004

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Diagnosis of Urinary Incontinence in Men

2007-05-19T19:52:00.000+08:00

How is UI diagnosed?

Medical History

The first step in solving a urinary problem is talking to your health care provider. Your general medical history, including any major illnesses or surgeries, and details about your continence problem and when it started will help your doctor determine the cause. You should talk about how much fluid you drink a day and whether you use alcohol or caffeine. You should also talk about the medicines you take, both prescription and nonprescription, because they might be part of the problem.

Voiding Diary

You may be asked to keep a voiding diary, which is a record of fluid intake and trips to the bathroom, plus any episodes of leakage. Studying the diary will give your health care provider a better idea of your problem and help direct additional tests.

Physical Examination
A physical exam will check for prostate enlargement or nerve damage. In a digital rectal exam, the doctor inserts a gloved finger into the rectum and feels the part of the prostate next to it. This exam gives the doctor a general idea of the size and condition of the gland. To check for nerve damage, the doctor may ask about tingling sensations or feelings of numbness and may check for changes in sensation, muscle tone, and reflexes.

EEG and EMG
An electroencephalogram (EEG), a test where wires are taped to the forehead, can sense dysfunction in the brain. An electromyogram (EMG) measures nerve activity in muscles and muscular activity that may be related to loss of bladder control.

Ultrasound
For an ultrasound, or sonography, a technician holds a device, called a transducer, that sends harmless sound waves into the body and catches them as they bounce back off the organs inside to create a picture on a monitor. In abdominal ultrasound, the technician slides the transducer over the surface of your abdomen for images of the bladder and kidneys. In transrectal ultrasound, the technician uses a wand inserted in the rectum for images of the prostate. Depending on your symptoms, your doctor may recommend one of these tests.

Urodynamics
Urodynamic testing focuses on the bladder's ability to store urine and empty steadily and completely, and on your sphincter control mechanism. It can also show whether the bladder is having abnormal contractions that cause leakage. The testing involves measuring pressure in the bladder as it is filled with fluid through a small catheter. This test can help identify limited bladder capacity, bladder overactivity or underactivity, weak sphincter muscles, or urinary obstruction. If the test is performed with EMG surface pads, it can also detect abnormal nerve signals and uncontrolled bladder contractions.

Blog For Health does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.

Information Courtesy of The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 04–5280: March 2004

Treatment of Urinary Incontinence in Men

2007-05-19T18:29:00.000+08:00

How is UI treated?

No single treatment works for everyone. Your treatment will depend on the type and severity of your problem, your lifestyle, and your preferences, starting with the simpler treatment options. Many men regain urinary control by changing a few habits and doing exercises to strengthen the muscles that hold urine in the bladder. If these behavioral treatments do not work, you may choose to try medicines or a continence device—either an artificial sphincter or a catheter. Finally, for some men, surgery is the best choice.

Behavioral Treatments

For some men, avoiding incontinence is as simple as limiting fluids at certain times of the day or planning regular trips to the bathroom—a therapy called timed voiding or bladder training. As you gain control, you can extend the time between trips. Bladder training also includes Kegel exercises to strengthen the pelvic muscles, which help hold urine in the bladder. Extensive studies have not yet shown that Kegel exercises are effective in reducing incontinence in men, but many clinicians find them to be an important element in therapy for men.

Some people with nerve damage cannot tell whether they are doing Kegel exercises correctly or not. If you are not sure, you may still be able to learn proper Kegel exercises by doing special training with biofeedback, electrical stimulation, or both. Biofeedback uses sensors to detect muscle activity and create a visual or audio signal when the appropriate muscles are being used. A small probe, about the size of a pen, is inserted in the anus to record muscle contractions during the exercises. If you squeeze the right muscle, you will see a change on a television screen or hear a tone from a speaker.

Mild electrical pulses delivered to the pelvic muscles cause them to contract and grow stronger. This technique can also help you locate the right muscles to use during Kegel exercises.

How do you do Kegel exercises?

The first step is to find the right muscles. Imagine that you are trying to stop yourself from passing gas. Squeeze the muscles you would use. If you sense a "pulling" feeling, those are the right muscles for pelvic exercises.

It is important not to squeeze other muscles at the same time and not to hold your breath. Also, be careful not to tighten your stomach, leg, or buttock muscles. Squeezing the wrong muscles can put more pressure on your bladder control muscles. Squeeze just the pelvic muscles.

Repeat, but do not overdo it. Pull in the pelvic muscles and hold for a count of 3. Then relax for a count of 3. Work up to 3 sets of 10 repeats. Start doing your pelvic muscle exercises lying down. This is the easiest because the muscles then do not need to work against gravity. When your muscles get stronger, do your exercises sitting or standing. Working against gravity is like adding more weight.

Be patient. Do not give up. It takes just 5 minutes, three times a day. Your bladder control may not improve for 3 to 6 weeks, although most people notice an improvement after a few weeks.

Medications

Medicines can affect bladder control in different ways. Some medicines help prevent incontinence by blocking abnormal nerve signals that make the bladder contract at the wrong time, while others slow the production of urine. Still others relax the bladder or shrink the prostate. Before prescribing a medicine to treat incontinence, your doctor may consider changing a prescription you already take. For example, diuretics are often prescribed to treat high blood pressure because they reduce fluid in the body by increasing urine production. Some men may find that switching from a diuretic to another kind of blood pressure medicine takes care of their incontinence.

If changing medicines is not an option, your doctor may choose from the following types of drugs for incontinence:

Alpha-blockers: Terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax), and alfzosin (Uroxatral) are used to treat problems caused by prostate enlargement and bladder outlet obstruction. They act by relaxing the smooth muscle of the prostate and bladder neck, allowing normal urine flow and preventing abnormal bladder contractions that can lead to urge incontinence.

5-alpha reductase inhibitors: Finasteride (Proscar) and dutasteride (Avodart) work by inhibiting the production of the male hormone DHT, which is thought to be responsible for prostate enlargement. These 5-alpha reductase inhibitors relieve voiding problems by shrinking an enlarged prostate.

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored the Medical Therapy of Prostate Symptoms (MTOPS) trial, a multicenter study that found that doxazosin and finasteride taken together reduced the risk of BPH progression by 67 percent compared with placebo. The risk of progression was reduced by 39 percent with doxazosin alone and by 34 percent with finasteride alone.

Imipramine: Marketed as Tofranil, this drug belongs to a class of drugs called tricyclic antidepressants. It relaxes muscles and blocks nerve signals that might cause bladder spasms. Imipramine is also used to treat bedwetting in children.

Antispasmodics: Propantheline (Pro-Banthine), tolterodine (Detrol LA), and oxybutynin (Ditropan XL) belong to a class of drugs that work by relaxing the bladder muscle and relieving spasms. Their most common side effect is dry mouth, although larger doses may cause blurred vision, constipation, a faster heartbeat, headache, and flushing.

Catheters

If all other methods fail or are found unacceptable, you may consider controlling incontinence by using a catheter, a thin tube inserted through the urethra to drain the bladder. Catheters must be managed with great care to avoid infection and stone formation.

Clean intermittent catheterization: If you have problems emptying your bladder because of an enlarged prostate or because of nerve damage, you may use a catheter at regular times, or as needed, to drain urine and prevent overflow incontinence. Depending on your situation, the catheterization may be done for you, or you may learn to do it yourself. You will need to learn sterile technique to avoid urinary tract infections.

Condom catheter: Some men may prefer a drainage system that fits over the penis like a condom. You must take the same care to avoid infection as you do with other catheters. Condom catheters can also carry a risk of skin breakdown.

Urethral Injections

Another method to help keep the urethra closed is to inject a fat-like substance into the area that surrounds the opening of the bladder into the urethra. A variety of bulking agents are available for injection. Your doctor will discuss which one may be best for you. Collagen, for example, is a natural tissue from cows. After using local anesthesia or sedation, a doctor can inject the material in about half an hour. Over time, the body slowly eliminates the collagen, so you may need repeat injections. Before you receive collagen, a doctor will perform a skin test to determine whether you could have an allergic reaction to the material.

Some men may eliminate urine leakage with an artificial sphincter, an implanted device that keeps the urethra closed until you are ready to urinate. This device can help people who have incontinence because of weak sphincter muscles or because of nerve damage that interferes with sphincter muscle function. It does not solve incontinence caused by uncontrolled bladder contractions.

Artificial sphincter

Surgery to place the artificial sphincter requires general or spinal anesthesia. The device has three parts: a cuff that fits around the urethra, a small balloon reservoir placed in the abdomen, and a pump placed in the scrotum. The cuff is filled with liquid that makes it fit tightly around the urethra to prevent urine from leaking. When it is time to urinate, you squeeze the pump with your fingers to deflate the cuff so that the liquid moves to the balloon reservoir and urine can flow through the urethra. When your bladder is empty, the cuff automatically refills in the next 2 to 5 minutes to keep the urethra tightly closed.

Male Sling

Surgery can improve some types of urinary incontinence in men. In a sling procedure, the surgeon creates a support for the urethra by wrapping a strip of material around the urethra and attaching the ends of the strip to the pelvic bone. The sling keeps constant pressure on the urethra so that it does not open until the patient consciously releases the urine.

Urinary Diversion

If the bladder must be removed or all bladder function is lost because of nerve damage, you may consider surgery to create a urinary diversion. In this procedure, the surgeon creates a reservoir by removing a piece of the small intestine and directing the ureters to the reservoir. The surgeon also creates a stoma, an opening on the lower abdomen where the urine can be drained through a catheter or into a bag.

Social Support

UI should not cause embarrassment. It is a medical problem like arthritis or diabetes. Your health care provider can help you find a solution. You may also find it helpful to join a support group. In many areas, men dealing with the aftereffects of prostate cancer treatment have organized support groups. Other organizations to help people with incontinence exist as well.

Information courtesy of The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Urinary Incontinence in Men. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 04–5280: March 2004

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Simple Kidney Cysts

2007-05-19T17:46:00.000+08:00

Definition:

cyst (SIST): An abnormal sac containing gas, fluid, or a semisolid material.

Description:

A cyst is a closed pocket or pouch of tissue that can form anywhere in the body. Cysts can be filled with air or fluid. Cysts that form on the kidneys usually contain fluid. One or more cysts may develop on small tubes in the kidneys. The simple kidney cyst is different from the cysts that develop when a person has polycystic kidney disease, which is a genetic disease. Although its cause is not fully understood, the simple cyst is not an inherited condition. Simple kidney cysts become more common as people age. Nearly 30 percent of people over the age of 70 have at least one simple kidney cyst.

Symptoms:

Most often, simple cysts do not cause symptoms or harm the kidney. In some cases, however, pain can occur when cysts enlarge and press on other organs. Sometimes cysts become infected or suddenly start to bleed. Less often the cysts impair kidney function. People with simple cysts are often found to have high blood pressure, although the cause-and-effect relationship is not well understood.

Diagnosis:

Kidney cysts are found by taking pictures of the kidneys using computerized tomography (CT) scans and ultrasonography. When simple cysts are found but no complications are present, no treatment is needed.

Treatment:

If cysts cause symptoms, treatment may be needed. One procedure involves puncturing the cyst using a long needle inserted through the skin. The doctor uses ultrasonography to guide the needle to the cyst. The cyst is drained and then filled with a solution containing alcohol to make the tissue harder.

If the cyst is large, surgery may be needed. Most procedures can be performed using a laparoscope, which allows for a smaller incision and quicker recovery. The surgeon drains the cyst then removes or burns away its outer tissue. Most patients stay in the hospital 1 or 2 days.

Resources:
Kidney Diseases Dictionary. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03-4359: May 2003

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Simple Kidney Cysts. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 07–4618: February 2007

Cystocele (Fallen Bladder)

2007-05-19T17:37:00.000+08:00

A cystocele (SIS-tuh-seal) occurs when the wall between a woman's bladder and her vagina weakens and allows the bladder to droop into the vagina. This condition may cause discomfort and problems with emptying the bladder.

A bladder that has dropped from its normal position may cause two kinds of problems—unwanted urine leakage and incomplete emptying of the bladder. In some women, a fallen bladder stretches the opening into the urethra, causing urine leakage when the woman coughs, sneezes, laughs, or moves in any way that puts pressure on the bladder.

A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. With more severe (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina.

Causes:

A cystocele may result from muscle straining while giving birth. Other kinds of straining—such as heavy lifting or repeated straining during bowel movements—may also cause the bladder to fall. The hormone estrogen helps keep the muscles around the vagina strong. When women go through menopause (when they stop having periods), their bodies stop making estrogen, so the muscles around the vagina and bladder may grow weak.

Diagnosis:

A doctor may be able to diagnose a grade 2 or grade 3 cystocele from a description of symptoms and from physical examination of the vagina because the fallen part of the bladder will be visible. A voiding cystourethrogram (sis-toe-yoo-REETH-roe-gram) is a test that involves taking x rays of the bladder during urination. This x ray shows the shape of the bladder and lets the doctor see any problems that might block the normal flow of urine. Other tests may be needed to find or rule out problems in other parts of the urinary system.

Treatment:

Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele. If a cystocele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocele to worsen. If symptoms are moderately bothersome, the doctor may recommend a pessary—a device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers.

Large cystoceles may require surgery to move the bladder back into a more normal position and keep it there. This operation may be performed by a gynecologist, a urologist, or a urogynecologist. The patient should be prepared to stay in the hospital for several days and take 4 to 6 weeks to recover fully.

Source:National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Cytocele. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health. NIH Publication No. 05–4557: November 2004

Bedwetting: What you need to know.

2007-05-19T17:06:00.000+08:00

Why does my child wet the bed?

Many children wet the bed until they are 5 years old, or even older. In most cases, the cause is physical and not the child’s fault. The child’s bladder might be too small. Or the amount of urine produced overnight is too much for the bladder to hold. As a result, the bladder fills up before the night is over. Some children sleep too deeply or take longer to learn bladder control. Children don’t wet the bed on purpose. Bedwetting is a medical problem, not a behavior problem. Scolding and punishment will not help a child stay dry.

Bedwetting may run in the family. If both parents wet the bed as children, their child is likely to have the same problem. If only one parent has a history of bedwetting, the child has about a fifty-fifty chance of having the problem. Some children wet the bed even if neither parent ever did.

Bedwetting may be caused by an infection or a nerve disease. Children with nerve disease often also have daytime wetting.

A child who has been dry for several months or even years may return to wetting the bed. The cause might be emotional stress, such as loss of a loved one, problems at school, a new sibling, or even training too early.

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How can I help my child stay dry?

The answer is rarely easy. Try skipping drinks before bedtime. Avoid drinks with caffeine, like colas or tea. These drinks speed up urine production. Give your child one drink with dinner. Explain that it will be the last drink before going to bed. Make sure your child uses the bathroom just before bed. Many children will still wet the bed, but these steps are a place to start.

Your child may feel bad about wetting the bed. Let your child know he isn’t to blame. Let her help take off the wet sheets and put them in the washer, but don’t make this a punishment. Be supportive. Praise your child for dry nights.

Be patient. Most children grow out of bedwetting. Some children just take more time than others.

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Should I take my child to the doctor?

If your child is younger than 5, don’t worry about bedwetting. Many children do not stay dry at night until age 7. Most children outgrow wetting the bed. A single episode of bedwetting should not cause alarm, even in an older child.

If your child is 7 years old or older and wets the bed more than two or three times in a week, a doctor may be able to help. If both day and night wetting occur after age 5, your child should see a doctor before age 7.

The doctor will ask questions about your child’s health and the wetting problem. Your child will likely be asked for a urine sample. The doctor uses the sample to look for signs of infection. By testing the reflexes in the child’s legs and feet, the doctor can check for nerve damage. Sometimes bedwetting is a sign of diabetes, a condition that can cause frequent urination.

If your child has an infection, the doctor can prescribe medicine. In most cases, the doctor finds that the child is normal and healthy. If your child is basically healthy, a variety of ways are available to help your child stop wetting the bed.

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What treatments can help my child stay dry?

Talk with your doctor about ways to help your child. Many choices exist. Let your child help decide which ones to try.

Bladder Training

Bladder training can help your child hold urine longer. Write down what times your child urinates during the day. Then figure out the times between trips to the bathroom. After a day or two, have your child try to wait an extra 15 minutes before using the bathroom. If the child usually goes to the bathroom at 3:30 p.m., have him wait until 3:45. Slowly make the times longer and longer. This method is designed for children with small bladders. It helps stretch the bladder to hold more urine. Be patient. Bladder training can take several weeks, or even months.

Moisture Alarm

A small moisture alarm can be put in the child’s bed or underwear. The alarm triggers a bell or buzzer with the first drops of urine. The sound wakes the child. Your child can then stop the flow of urine, get up, and use the bathroom. Waking also teaches the child how a full bladder feels.

Medicine

Two kinds of medicine are available for treating bedwetting. One medicine slows down how fast your body makes urine. The other medicine helps the bladder relax so it can hold more urine. These medicines often work well. Remember wetting may return when the child stops taking the medicine. If this occurs, keeping the child on medicine for a longer time helps.

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Points to Remember:

Normal, healthy children may wet the bed.
Bedwetting may be a sign of infection or other problems.
Many children are dry at night by the time they are 5 years old. Others take longer to stay dry.
Scolding and punishment do not help a child stop bedwetting.
If your child is 7 or older and wets the bed more than two or three times a week, a doctor may be able to help.
Treatments include bladder training, alarms, and medicines.
Most children grow out of bedwetting naturally.

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Source: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). What I need to know about My Child's Bedwetting. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–5631: April 2006

Renal Tubular Acidosis

2007-05-19T16:28:00.000+08:00

Background Physiology:

Your body's cells use chemical reactions to carry out tasks such as turning food into energy and repairing tissue. These chemical reactions generate acids. But too much acid in the blood—acidosis—can disturb many bodily functions. Healthy kidneys help maintain acid-base balance by excreting acids into the urine and returning bicarbonate—an alkaline, or base, substance—to the blood. This "reclaimed" bicarbonate neutralizes much of the acid that is created when food is broken down in the body.

What is Renal Tubular Acidosis (RTA)?

Renal tubular acidosis (RTA) is a disease that occurs when the kidneys fail to excrete acids into the urine, which causes a person's blood to remain too acidic. Without proper treatment, chronic acidity of the blood leads to growth retardation, kidney stones, bone disease, and progressive renal failure.

One researcher, pediatric neurologist Donald Lewis, has theorized that Charles Dickens may have been describing a child with RTA when he created the character of Tiny Tim in his famous story, "A Christmas Carol." Tiny Tim's small stature, malformed limbs, and periods of weakness are all possible consequences of the chemical imbalance caused by RTA. Among the evidence cited to support this theory is the fact that Tiny Tim's condition, while fatal in one scenario, is reversible when Scrooge pays for medical treatments, which in those times would likely have included sodium bicarbonate and sodium citrate, which are alkaline agents that would neutralize the acid in Tiny Tim's blood. Whether the literary diagnosis of Tiny Tim is correct or not, the good news is that medical treatment can indeed reverse the effects of RTA.

Diagnosis and Treatment Therapy:

To diagnose RTA, your doctor will check the acid-base balance in samples of your blood and urine. If the blood is more acidic than it should be and the urine less acidic than it should be, RTA may be the reason, but additional information is needed first to rule out other causes. If RTA is suspected, additional information about the sodium, potassium, and chloride levels in the urine and the potassium level in the blood will help identify which of the three types of RTA you have. In all cases, the first goal of therapy is to neutralize acid in the blood, but different treatments may be needed to address the different underlying causes of acidosis.

See: Types of Renal Tubular Acidosis

Source: National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Renal Tubular Acidosis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 05–4696: August 2005

Types of Renal Tubular Acidosis

2007-05-19T16:02:00.000+08:00

At one time, doctors divided RTA into four types.

Type 1 is also called classic distal RTA. "Distal," which means distant, refers to the point in the urine-forming tube where the defect occurs. It is relatively distant from the point where fluid from the blood enters the tiny tube, or tubule, that collects fluid and wastes to form urine.

Type 2 is called proximal RTA. The word "proximal," which means near, indicates that the defect is closer to the point where fluid and wastes from the blood enter the tubule.

Type 3 is rarely used as a classification today because it is now thought to be a combination of type 1 and type 2.

Type 4 RTA is caused by another defect in the distal tubule, but it is different from classic distal RTA and proximal RTA because it results in high levels of potassium in the blood instead of low levels. Either low potassium (hypokalemia) or high potassium (hyperkalemia) can be a problem because potassium is important in regulating heart rate.

Type 1: Classic Distal RTA

This disorder may be inherited as a primary disorder or may be one symptom of a disease that affects many parts of the body. Researchers have now discovered the abnormal gene responsible for the inherited form. More often, however, classic distal RTA is a complication of diseases that affect many organ systems (systemic diseases), like the autoimmune disorders Sjögren's syndrome and lupus.

Other diseases and conditions associated with distal RTA include hyperparathyroidism, a hereditary form of deafness, analgesic nephropathy, rejection of a transplanted kidney, renal medullary cystic disease, obstructive uropathy, and chronic urinary tract infections.

A major consequence of classic distal RTA is low blood-potassium. The level drops if the kidneys excrete potassium into urine instead of returning it to the blood supply. Since potassium helps regulate nerve and muscle health and heart rate, low levels can cause extreme weakness, cardiac arrhythmias, paralysis, and even death.

Untreated distal RTA causes growth retardation in children and progressive renal and bone disease in adults. Restoring normal growth and preventing kidney stones, another common problem in this disorder, are the major goals of therapy. If acidosis is corrected with sodium bicarbonate or sodium citrate, then low blood-potassium, salt depletion, and calcium leakage into urine will be corrected. Alkali therapy also helps decrease the development of kidney stones. Potassium supplements are rarely needed except in infants, since alkali therapy prevents the kidney from excreting potassium into the urine.

Type 2: Proximal RTA

This form of RTA occurs most frequently in children as part of a disorder called Fanconi's syndrome. The symptoms of Fanconi's syndrome include high levels of glucose, amino acids, citrate, and phosphate in the urine, as well as vitamin D deficiency and low blood-potassium.

Proximal RTA can also result from inherited disorders that disrupt the body's normal breakdown and use of nutrients. Examples include the rare disease cystinosis (in which cystine crystals are deposited in bones and other tissues), hereditary fructose intolerance, and Wilson's disease.

Proximal RTA also occurs in patients treated with ifosfamide, a drug used in chemotherapy. A few older drugs—such as acetazolamide or outdated tetracycline—can also cause proximal RTA. In adults, proximal RTA may complicate diseases like multiple myeloma, or it may occur in people who experience chronic rejection of a transplanted kidney.

When possible, identifying and correcting the underlying causes are important steps in treating the acquired forms of proximal RTA. The diagnosis is based on the chemical analysis of blood and urine samples. Children with this disorder would likely receive large doses of oral alkali, such as sodium bicarbonate or potassium citrate, to treat acidosis and prevent bone disorders, kidney stones, and growth failure. Correcting acidosis and low potassium levels restores normal growth patterns, allowing bone to mature while preventing further renal disease. Vitamin D supplements may also be needed to help prevent bone problems.

Type 4: Hyperkalemic RTA

This form of RTA is most often referred to as type 4. It occurs when blood levels of the hormone aldosterone are low or when the kidneys do not respond to it. Aldosterone directs the kidneys to regulate the levels of sodium, potassium, and chloride in the blood. Type 4 RTA is distinguished by a high blood-potassium level.

Hyperkalemic distal RTA may result from sickle cell disease, urinary tract obstruction, lupus, amyloidosis, or transplantation.

Aldosterone's action may be impeded by drugs, including

diuretics used to treat congestive heart failure such as spironolactone or eplerenone
blood pressure drugs called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
the antibiotic trimethoprim
an agent called heparin that keeps blood from clotting
the antibiotic pentamidine, which is used used to treat pneumonia
a class of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs)
some immunosuppressive drugs used to prevent transplant rejection

For people who produce aldosterone but cannot use it, researchers have now identified the genetic basis for their body's resistance to the hormone. To treat type 4 RTA successfully, patients may require alkaline agents to correct acidosis as well as medication to lower the potassium in their blood.

If treated early, most people with RTA will not develop permanent kidney failure. Therefore, the goal is early recognition and adequate therapy, which will need to be maintained and monitored throughout the patient's lifetime.

See: Background on Renal Tubular Acidosis

Source: National Kidney and Urologic Diseases Information Clearinghouse. Renal Tubular Acidosis. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 05–4696: August 2005

Goodpasture’s Syndrome

2007-05-19T15:49:00.000+08:00

What is Goodpasture’s syndrome?

Goodpasture’s syndrome is a rare disease that can affect the lungs and kidneys. Also called anti-glomerular basement antibody disease, it is an autoimmune disease—a condition in which the body’s own defense system reacts against some part of the body itself. When the immune system is working normally, it creates antibodies to fight off germs. In Goodpasture’s syndrome, the immune system makes antibodies that attack the lungs and kidneys. Why this happens is not fully understood. Researchers have identified a number of possible causes, among them the presence of an inherited component; exposure to certain chemicals, including hydrocarbon solvents and the weed killer Paraquat; and viral infections.

Signs and Symptoms:

Goodpasture’s syndrome can cause people to cough up blood or feel a burning sensation when urinating. But its first signs may be vague, such as fatigue, nausea, difficulty breathing, or paleness. These signs are followed by kidney involvement, represented first by small amounts of blood in the urine, protein in the urine, and other clinical and laboratory findings.

Diagnosis:

To diagnose Goodpasture’s syndrome, doctors use a blood test, but a kidney or lung biopsy may be necessary to check for the presence of the harmful antibodies.

Treatment:

Goodpasture’s syndrome is treated with oral immunosuppressive drugs—cyclophosphamide and corticosteroids—to keep the immune system from making antibodies. Corticosteroid drugs may be given intravenously to control bleeding in the lungs. A process called plasmapheresis may be helpful and necessary to remove the harmful antibodies from the blood. In plasmapheresis, a patient’s blood is drawn, about 300 ml at a time, and placed in a centrifuge to separate the red and white blood cells from the plasma. The cells are then placed in a plasma substitute and returned to the body. This procedure is usually done in combination with immunosuppressive drug treatment.

Goodpasture’s syndrome may last only a few weeks or as long as 2 years. Bleeding in the lungs can be very serious and even fatal in some cases. But Goodpasture’s syndrome does not usually lead to permanent lung damage. Damage to the kidneys, however, may be long-lasting. If the kidneys fail, dialysis to remove waste products and extra fluid from the blood, or kidney transplantation, may become necessary.

Source: National Kidney and Urologic Diseases Information Clearinghouse. Goodpasture's Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 07–4558 : April 2007

Sprain and Strain: What is it?

2007-05-13T18:39:00.001+08:00

By: David Mangusan Jr., PTRP

Sprain and strain are two different conditions. These two terms are often interchanged and for this reason, I am publishing this information to further educate others about these conditions as to the body structures involved, their common causes, signs and symptoms, and treatment.

SPRAIN:

A sprain is an injury to a ligament (tissue that connects two or more bones at a joint). In a sprain, one or more ligaments is stretched or torn.

Causes of Sprain:

Many things can cause a sprain. Falling, twisting, or getting hit can force a joint out of its normal position. This can cause ligaments around the joint to stretch or tear. Sprains can occur if people fall and land on their hand (wrist sprain), fall on the side of their foot (most common cause of sprain), and twist a knee. A sprain to the thumb is common is skiing and other sports.

Signs and Symptoms of Sprain:

The usual signs and symptoms of a sprain are:

Pain
Swelling
Bruising
Inability to move or use the joint.
Sometimes a feeling of popping or tearing when the injury happens.

Depending on the severity of the injury, a sprain can be mild, moderate, or severe.

STRAIN

A strain is an injury to a muscle or a tendon (the tissue that connects a muscle to a bone). In a strain, a muscle or tendon is stretched or torn.

Causes of Strain:

Twisting or pulling a muscle or tendon causes a strain. Strains can happen suddenly or develop over days or weeks.

A sudden (acute) strain is caused by:

A recent injury
Lifting heavy objects the wrong way
Overstressing the muscles.

Chronic strains are usually caused by moving the muscles and tendons the same way over and over.

There are two common sites for a strain: the back and the hamstring muscle in the back of the thigh. Sports such as soccer, football, hockey, boxing, and wrestling put people at risk for strains in the back or legs. Improper lifting of heavy objects may also cause straining of the back muscles. People who play some sports use their hands and arms a lot. Examples are gymnastics, tennis, rowing, and golf. People who play these sports sometimes strain their hand or arm.

Signs and Symptoms of Strain:

A strain can cause:

Pain
Muscle spasms
Muscle weakness
Swelling
Cramping

If a muscle or tendon is torn completely, it is often very painful and hard to move.

Treatment of Sprain and Strain:

For mild injuries treatments for sprains and strains are the same. To reduce swelling and pain in the first day or two, doctors usually say to:

Rest the injured area and protect it from further injury. If the ankle or knee is hurt, the doctor might tell you to use crutches or a cane. Put ice on the injured area for about 20 minutes at a time. The doctor might say to do this 4 to 8 times a day. Compress (squeeze) the injury using special bandages, casts, boots, or splints. Your doctor will tell you which one is best for you. Put the injured ankle, knee, elbow, or wrist up on a pillow. Take medicines, such as aspirin or ibuprofen.

During the recovery period, after the pain and swelling subsides, it is important to be active using an alternative fitness program that does not worsen the original injury. This helps to prevent stiffness and increase strength. Your doctor may suggest physical therapy sessions for proper retraining of the injured area. Your doctor or physical therapist will tell you when you can start to do normal activities, including sports. If you begin too soon, you can injure the area again.

For severe injuries it is important to see a doctor for proper medical care as tears to ligaments and tendons usually take longer time to heal because of its poor blood supply.

Prevention:

To help prevent sprains and strains, you can:

Perform warm up and stretching exercises before playing a sport.
Avoid exercising or playing sports when tired or in pain.
To prevent falling on icy spots on your front step or sidewalks, you can put sand or salt on the icy spots.
Wear shoes that fit well.
Get new shoes if the heel wears down on one side.
Exercise every day.
Wear protective equipment when playing.
Run on flat surfaces.
Eat a well-balanced diet to keep muscles strong.
Maintain a healthy weight.

The Physical Therapy (PT) Notes website has more information about ankle sprain and other rehabilitation topics.

Source:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Page Last Updated: August 29, 2010

How People Get Malaria (Transmission)

2007-05-09T20:26:00.000+08:00

How is malaria transmitted?

According to the Centers for Disease Control and Prevention, people usually get malaria by being bitten by an infected female Anopheles mosquito. Only Anopheles mosquitoes can transmit malaria and they must have been infected through a previous blood meal taken on an infected person.

When a mosquito bites, a small amount of blood is taken in which contains the microscopic malaria parasites. The parasite grows and matures in the mosquito’s gut for a week or more, then travels to the mosquito’s salivary glands. When the mosquito next takes a blood meal, these parasites mix with the saliva and are injected into the bite.

Once in the blood, the parasites travel to the liver and enter liver cells to grow and multiply. During this "incubation period", the infected person has no symptoms. After as few as 8 days or as long as several months, the parasites leave the liver cells and enter red blood cells. Once in the cells, they continue to grow and multiply. After they mature, the infected red blood cells rupture, freeing the parasites to attack and enter other red blood cells. Toxins released when the red cells burst are what cause the typical fever, chills, and flu-like malaria symptoms.

If a mosquito bites this infected person and ingests certain types of malaria parasites ("gametocytes"), the cycle of transmission continues.

Because the malaria parasite is found in red blood cells, malaria can also be transmitted through blood transfusion, organ transplant, or the shared use of needles or syringes contaminated with blood. Malaria may also be transmitted from a mother to her fetus before or during delivery ("congenital" malaria).

Malaria is not transmitted from person to person like a cold or the flu. You cannot get malaria from casual contact with malaria-infected people.

See Also: Malaria - Facts

Reference: Frequently Asked Questions About Malaria - National Center for Infectious Diseases, Division of Parasitic Diseases. Centers for Disease Control and Prevention (CDC). February 2, 2005

Analgesic Nephropathy (Painkillers and the Kidneys)

2007-05-09T12:05:00.000+08:00

An analgesic (AN-ul-JEE-zik) is any medicine intended to relieve pain. Over-the-counter analgesics (medicines bought without a prescription) include aspirin, acetaminophen, ibuprofen, naproxen sodium, and others. These drugs present no danger for most people when taken in the recommended dosage. But some conditions make taking even these common painkillers dangerous for the kidneys. Also, taking one or a combination of these drugs regularly over a long period of time may increase the risk for kidney problems. Most drugs that can cause kidney damage are excreted only through the kidneys.

Analgesic use has been associated with two different forms of kidney damage. Some patient case reports have attributed incidents of sudden-onset acute kidney failure to the use of over-the-counter painkillers, including aspirin, ibuprofen, and naproxen. The patients in these reports had risk factors such as systemic lupus erythematosus, advanced age, chronic kidney disease, or recent heavy alcohol consumption. These cases involved a single dose in some instances and generally short-term analgesic use of not more than 10 days. Acute kidney failure requires emergency dialysis to clean the blood. Kidney damage is frequently reversible, with normal kidney function returning after the emergency is over and the analgesic use is stopped.

A second form of kidney damage, called analgesic nephropathy, can result from taking painkillers every day for several years. Analgesic nephropathy is a chronic kidney disease that over years gradually leads to irreversible kidney failure and the permanent need for dialysis or a kidney transplant to restore renal function.

Longstanding daily use of painkillers composed of two or more analgesics (particularly aspirin and acetaminophen together) with caffeine or codeine are most likely to damage the kidneys. These mixtures are often sold as powders or tablets. Recent studies have suggested that longstanding daily use of single analgesics such as acetaminophen or ibuprofen may also increase the risk of chronic kidney damage, but this evidence is not as clear.

In view of these findings, patients with conditions that put them at risk for acute kidney failure should check with their doctors before taking any analgesic medicine. People who take over-the-counter painkillers on an ongoing and regular basis should check with their doctors to make sure the drugs are not hurting their kidneys. The doctor may be able to recommend a safer alternative.

Content Courtesy of The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 04–4573: April 2004

An Overview of Kidney Diseases in Children

2007-05-05T10:43:00.000+08:00

An overview on the Kidneys:

The kidneys are two bean-shaped organs located near the middle of the back, just below the rib cage. When blood flows through the kidneys, waste products and extra water are removed from the blood and sent to the bladder as urine. The kidneys also regulate blood pressure, balance chemicals like sodium and potassium, and make hormones to help bones grow and keep the blood healthy by making new red blood cells. (Learn More About the Kidneys - The Kidneys: Structure and Function)

Who is at risk?

In the general population, slightly more than 30 people in every 100,000 develop kidney failure each year. In the pediatric population—age 19 and under—the annual rate is only 1 or 2 new cases in every 100,000 children. In other words, adults are about 20 times more likely to develop kidney failure than children. The risk increases steadily with age.

African Americans in their late teens are three times more likely than Caucasians in the same age group to develop kidney failure. Diseases that damage the tiny blood vessels in the kidney are also more common in children of color. Moreover, boys are nearly twice as likely as girls to develop kidney failure from birth defects, polycystic kidney disease, or other hereditary diseases.

Causes of kidney failure in children

Kidney failure may be acute or chronic. Acute diseases develop quickly and can be very serious. Although an acute disease may have long-lasting consequences, it usually lasts for only a short time and then goes away once the underlying cause has been treated. Chronic diseases, however, do not go away and tend to get worse over time. When the kidneys stop working, doctors use a treatment called dialysis to remove waste products and extra water from patients with chronic kidney failure.

Acute Kidney Diseases

Acute kidney disease may result from an injury or from poisoning. Any injury that results in loss of blood may reduce kidney function temporarily, but once the blood supply is replenished, the kidneys usually return to normal. Other kinds of acute kidney disease in children are

Hemolytic uremic syndrome. This rare disease affects mostly children under 10 years of age and can result in kidney failure. Eating foods contaminated by bacteria leads to an infection in the digestive system, which in the first stages causes vomiting and diarrhea. When these symptoms subside, the child is still listless and pale. Poisons produced by the bacteria can damage the kidneys, causing acute kidney failure. Children with hemolytic uremic syndrome may need blood transfusion or dialysis for a short time. Most children, however, return to normal after a few weeks. Only a small percentage of children (mostly those who have severe acute kidney disease) will develop chronic kidney disease.
Nephrotic syndrome. A child with this syndrome will urinate less often, so the water left in the body causes swelling around the eyes, legs, and belly. The small amount of urine the body makes contains high levels of protein. Healthy kidneys keep protein in the blood, but damaged kidneys let it leak from the blood into the urine. Nephrotic syndrome can usually be treated with prednisone to stop protein leakage, and sometimes a diuretic is used to help the child urinate and reduce the swelling. Usually, the child can take smaller and smaller doses of prednisone and eventually return to normal with no lasting kidney damage. This temporary condition is called minimal change disease. Relapses are common but usually respond to prednisone treatment.

Chronic Kidney Diseases

Unfortunately, the conditions that lead to chronic kidney failure in children cannot be easily fixed. Often, the condition will develop so slowly that it goes unnoticed until the kidneys have been permanently damaged. Treatment may slow down the progression of some diseases, but in many cases the child will eventually need dialysis or transplantation.

Birth defects. Some babies are born without kidneys or with abnormally formed kidneys. The kidney abnormality is sometimes part of a syndrome that affects many parts of the body.
Blocked urine flow and reflux. If blockage develops between the kidneys and the opening where urine leaves the body, the urine can back up and damage the kidney.
Hereditary diseases. In polycystic kidney disease (PKD), children inherit defective genes that cause the kidneys to develop many cysts, sacs of fluid that replace healthy tissue and keep the kidneys from doing their job. In Alport syndrome, the defective gene that causes kidney disease may also cause hearing or vision loss.
Glomerular diseases. Some diseases attack the individual filtering units in the kidney. When damaged, these filters—which are called glomeruli—leak blood and protein into the urine. If the damage to the glomeruli is severe, kidney failure may develop.
Systemic diseases. Diabetes and lupus can affect many parts of the body, including the kidneys in some people. In lupus, the immune system becomes overactive and attacks the body’s own tissues. Diabetes leads to high levels of blood glucose that damage the glomeruli. Diabetes is the leading cause of kidney failure in adults. In children, however, diabetes is low on the list of causes because it usually takes many years of high blood glucose for the kidney disease of diabetes to develop. However, an increasing number of children have type 2 diabetes, which is usually associated with adults. As a result, we may see more children with chronic kidney failure caused by diabetes in the future.

From birth to age 4 years, birth defects and hereditary diseases are by far the leading causes of kidney failure. Between ages 5 and 14 years, hereditary diseases continue to be the most common causes, followed closely by glomerular diseases. In the 15- to 19-year-old age group, glomerular diseases are the leading cause, and hereditary diseases become rarer.

Treatment for Kidney Failure

A child whose kidneys fail completely must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation.

Dialysis
Dialysis is a way to remove the waste products and extra water from the blood of patients with kidney failure. The two main types of dialysis are peritoneal dialysis and hemodialysis.

Peritoneal dialysis. This method uses the lining of the child’s abdominal cavity, the peritoneum, as a filter. A catheter placed in the child’s belly is used to pour a solution containing dextrose (a sugar) into the abdominal cavity. While the solution is there, it pulls wastes and extra fluid from the blood. Later, the solution is drained from the belly, along with the wastes and extra fluid. The cavity is then refilled, and the cleaning process continues. Peritoneal dialysis can be performed in the home, usually while the child sleeps, without a health professional present. You and your child will receive extensive training before you start home treatments.
Hemodialysis. This method uses a machine that carries the child’s blood through a tube to a dialyzer, a canister that contains thousands of fibers that filter out the wastes and extra fluid. The cleaned blood is then returned to the child through a different tube. Hemodialysis is usually performed in a clinic under the supervision of a nurse and kidney specialist. It is generally required three times a week for about 3 to 4 hours each time.

Transplantation
Transplantation provides the closest thing to a cure for kidney failure. In this procedure, a surgeon places a healthy kidney in the child’s body. The kidney may come either from a living donor or from someone who has just died.

Living donor. Most people can donate a kidney without hurting their health. Many children receive a kidney from one of their parents, but the donor does not have to be a family member.
Deceased donor. If no living donors are available, a child may be placed on a waiting list to receive a kidney from someone who has just died. The United Network for Organ Sharing (UNOS) maintains a computerized system for matching kidneys with appropriate recipients.

People who have transplants must take drugs to keep the body’s immune system from rejecting the new organ. These immunosuppressive drugs can help maintain good function in the transplanted kidney for many years. However, they may have some undesirable side effects such as making a child vulnerable to infections.

For more information about dialysis and transplantation, see the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact sheet Treatment Methods for Kidney Failure in Children.

Topic Excerpted from - Overview of Kidney Diseases in Children. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–5167: June 2006

The Urinary System: Structures and Functions

2007-05-03T17:40:00.000+08:00

By: David Mangusan Jr., PTRP

The urinary system consists of the two kidneys, two ureters, the urinary bladder, two sphincter muscles, and the urethra.

After the kidneys filter the blood plasma, most of the water and solutes are returned to the bloodstream. The remaining water and waste products become a part of the urine. The urinary system works with the lungs, skin, and intestines—all of which also excrete wastes—to keep the chemicals and water in your body balanced. Adults eliminate about a quart and a half of urine each day. The amount depends on many factors, especially the amounts of fluid and food a person consumes and how much fluid is lost through sweat and breathing. Certain types of medications can also affect the amount of urine eliminated.

The urinary system removes wastes such as ammonia, urea and uric acid from your blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.

The kidneys are bean-shaped organs about the size of your fists. They are near the middle of the back, just below the rib cage. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney. (See Topic: The Kidneys: Structure and Function)

From the kidneys, urine travels down two thin tubes called ureters from the renal pelvis of one kidney to the urinary bladder. The ureters are about 8 to 10 inches long. Muscles in the ureter walls constantly tighten and relax to force urine downward to the urinary bladder away from the kidneys. If urine is allowed to stand still, or back up, a kidney infection can develop.

There is no actual valve or sphincter at the opening of the ureters into the urinary bladder that prevents backflow of urine. But whenever the urinary bladder fills with urine the pressure within it would compress the openings of the ureters thus preventing the backflow of urine. Small amounts of urine are emptied into the bladder from the ureters about every 10 to 15 seconds.

The urinary bladder is a hollow muscular organ shaped like a balloon. It sits in your pelvis and is held in place by ligaments attached to other organs and the pelvic bones. The bladder stores urine until you are ready to go to the bathroom to empty it. It swells into a round shape when it is full and gets smaller when empty. If the urinary system is healthy, the bladder can hold up to 16 ounces (2 cups) of urine comfortably for 2 to 5 hours.

Circular muscles called sphincters help keep urine from leaking. The sphincter muscles close tightly like a rubber band around the opening of the bladder into the urethra, the tube that allows urine to pass outside the body.

Nerves in the bladder tell you when it is time to urinate, or empty your bladder. As the bladder first fills with urine, pressure increases in the urinary bladder and you may notice a feeling that you need to urinate. The sensation to urinate becomes stronger as the bladder continues to fill thus increasing further the pressure in the bladder until it reaches its limit. At that point, nerves from the bladder send a message (nerve impulse) to the brain that the bladder is full, and your urge to empty your bladder intensifies.

When you urinate, the brain signals the bladder muscles to tighten, squeezing urine out of the bladder. At the same time, the brain signals the sphincter muscles (external urethral sphincter) to relax. As these muscles relax, urine exits the bladder through the urethra. When all the signals occur in the correct order, normal urination (micturation*) occurs.

*Micturation: the discharge of urine from the urinary bladder; also known as
voiding or urination.

References:
Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Your Urinary System and How It Works. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 07–3195: October 2006

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

This Post Updated: May 09, 2007

Overview of the disorders/diseases involving the Urinary System

2007-05-03T16:18:00.000+08:00

Disorders of the urinary system range in severity from easy to treat to life threatening.

Benign prostatic hyperplasia (BPH) is a condition in men that affects the prostate gland, which is part of the male reproductive system. The prostate is located at the bottom of the bladder and surrounds the urethra. BPH is an enlargement of the prostate gland that can interfere with urinary function in older men. It causes blockage by squeezing the urethra, which can make it difficult to urinate. Men with BPH frequently have other bladder symptoms including an increase in frequency of bladder emptying both during the day and at night. Most men over age 60 have some BPH, but not all have problems with blockage. There are many different treatment options for BPH.

Painful bladder syndrome/Interstitial cystitis (PBS/IC) is a chronic bladder disorder also known as frequency-urgency-dysuria syndrome. In this disorder, the bladder wall can become inflamed and irritated. The inflammation can lead to scarring and stiffening of the bladder, decreased bladder capacity, pinpoint bleeding, and, in rare cases, ulcers in the bladder lining. The cause of IC is unknown at this time.

Kidney stones is the term commonly used to refer to stones, or calculi, in the urinary system. Stones form in the kidneys and may be found anywhere in the urinary system. They vary in size. Some stones cause great pain while others cause very little. The aim of treatment is to remove the stones, prevent infection, and prevent recurrence. Both nonsurgical and surgical treatments are used. Kidney stones affect men more often than women. (View Topic on: How to prevent the formation of Kidney Stones)

Prostatitis is inflammation of the prostate gland that results in urinary frequency and urgency, burning or painful urination, a condition called dysuria, and pain in the lower back and genital area, among other symptoms. In some cases, prostatitis is caused by bacterial infection and can be treated with antibiotics. But the more common forms of prostatitis are not associated with any known infecting organism. Antibiotics are often ineffective in treating the nonbacterial forms of prostatitis.

Proteinuria is the presence of abnormal amounts of protein in the urine. Healthy kidneys take wastes out of the blood but leave in protein. Protein in the urine does not cause a problem by itself. But it may be a sign that your kidneys are not working properly.

Renal (kidney) failure results when the kidneys are not able to regulate water and chemicals in the body or remove waste products from your blood. Acute renal failure (ARF) is the sudden onset of kidney failure. This condition can be caused by an accident that injures the kidneys, loss of a lot of blood, or some drugs or poisons. ARF may lead to permanent loss of kidney function. But if the kidneys are not seriously damaged, they may recover. Chronic kidney disease (CKD) is the gradual reduction of kidney function that may lead to permanent kidney failure, or end-stage renal disease (ESRD). You may go several years without knowing you have CKD. (View topics: Renal Failure and End-Stage Renal Disease, What are to be expected from a kidney failure?)

Urinary tract infections (UTIs) are caused by bacteria in the urinary tract. Women get UTIs more often than men. UTIs are treated with antibiotics. Drinking lots of fluids also helps by flushing out the bacteria.

The name of the UTI depends on its location in the urinary tract. An infection in the bladder is called cystitis. If the infection is in one or both of the kidneys, the infection is called pyelonephritis. This type of UTI can cause serious damage to the kidneys if it is not adequately treated. [View topics: UTI: Urinary Tract Infection, Prevention of Urinary Tract Infection (UTI)]

Urinary incontinence, loss of bladder control, is the involuntary passage of urine. There are many causes and types of incontinence, and many treatment options. Treatments range from simple exercises to surgery. Women are affected by urinary incontinence more often than men.

Urinary retention, or bladder-emptying problems, is a common urological problem with many possible causes. Normally, urination can be initiated voluntarily and the bladder empties completely. Urinary retention is the abnormal holding of urine in the bladder. Acute urinary retention is the sudden inability to urinate, causing pain and discomfort. Causes can include an obstruction in the urinary system, stress, or neurologic problems. Chronic urinary retention refers to the persistent presence of urine left in the bladder after incomplete emptying. Common causes of chronic urinary retention are bladder muscle failure, nerve damage, or obstructions in the urinary tract. Treatment for urinary retention depends on the cause.

See Also Background Anatomy: The Kidneys:Structure and Function

Sources:
Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Your Urinary System and How It Works. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 07–3195: October 2006

FDA Warns Consumers about Counterfeit Drugs from Multiple Internet Sellers

2007-05-02T10:54:00.000+08:00

The Food and Drug Administration (FDA) is cautioning U.S. consumers about dangers associated with buying prescription drugs over the Internet. This alert is being issued based on information the agency received showing that 24 apparently related Web sites may be involved in the distribution of counterfeit prescription drugs.

On three occasions during recent months, FDA received information that counterfeit versions of Xenical 120 mg capsules, a drug manufactured by Hoffmann-La Roche Inc. (Roche), were obtained by three consumers from two different Web sites. Xenical is an FDA-approved drug used to help obese individuals who meet certain weight and height requirements lose weight and maintain weight loss.

None of the capsules ordered off the Web sites contained orlistat, the active ingredient in authentic Xenical. In fact, laboratory analysis conducted by Roche and submitted to the FDA confirmed that one capsule contained sibutramine, which is the active ingredient in Meridia, an FDA-approved prescription drug manufactured by Abbott Laboratories.

While this product is also used to help people lose weight and maintain that loss, it should not be used in certain patient populations and therefore is not a substitute for other weight loss products. In addition the drug interactions profile is different between Xenical and sibutramine, as is the dosing frequency; sibutramine is administered once daily while Xenical is dosed three times a day.

See full details of the news and the list of 24 apparently related Web sites involved in the distribution of counterfeit prescription drugs at FDA News. US Food and Drug Administration.

Content Source: FDA News. US Food and Drug Administration. P07-76May 1, 2007

The Parathyroid Glands

2007-05-01T16:34:00.000+08:00

By: David Mangusan Jr., PTRP

The parathyroid glands are four pea-sized glands attached on the posterior (back) surface of the thyroid gland in the neck. Occasionally, a person is born with one or more of the parathyroid glands embedded in the thyroid, in the thymus, or located elsewhere around this area. In most such cases, however, the glands function normally.

Variations in the location and color as well as the small size of the parathyroid glands make identification very difficult and may result in accidental removal during surgery of the thyroid glands.

The thyroid and the parathyroid glands are different both in structure and function. Though their names are somewhat similar, the thyroid and parathyroid glands are entirely different glands, each producing distinct hormones with specific functions.

The parathyroid glands secrete PTH, a substance that helps maintain the correct balance of calcium and phosphorous in the body. PTH regulates the level of calcium in the blood, release of calcium from bone, absorption of calcium in the intestine, and excretion of calcium in the urine.

When the level of calcium in the blood falls too low (hypocalcemia), the parathyroid glands secrete just enough PTH to restore the blood calcium level.

Why are calcium and phosphorous so important?

Calcium is essential for good health. It plays an important role in bone and tooth development and in maintaining bone strength. Calcium is also important in nerve transmission and muscle contraction.

Phosphorous is found in all bodily tissue. It is a main part of every cell with many roles in each. Combined with calcium, phosphorous gives strength and rigidity to your bones and teeth.

Disorder of the Parathyroid Glands: Hyperparathyroidism

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health (NIH).

Post Updated: May 2, 2007

Hyperparathyroidism

2007-05-01T16:03:00.000+08:00

Primary hyperparathyroidism is a disorder of the parathyroid glands, also called parathyroids. "Primary" means this disorder originates in the parathyroids: One or more enlarged, overactive parathyroid glands secretes too much parathyroid hormone (PTH). In secondary hyperparathyroidism, a problem such as kidney failure causes the parathyroids to be overactive. This topic focuses on primary hyperparathyroidism.

What is hyperparathyroidism?

If the parathyroid glands secrete too much hormone, as happens in primary hyperparathyroidism, the balance is disrupted: Blood calcium rises. This condition of excessive calcium in the blood, called hypercalcaemia, is what usually signals the doctor that something may be wrong with the parathyroid glands. In 85 percent of people with primary hyperparathyroidism, a benign tumor called an adenoma has formed on one of the parathyroid glands, causing it to become overactive. Benign tumors are noncancerous. In most other cases, the excess hormone comes from two or more enlarged parathyroid glands, a condition called hyperplasia. Very rarely, hyperparathyroidism is caused by cancer of a parathyroid gland.

In the United States, about 100,000 people develop the disorder each year. Women outnumber men two to one, and risk increases with age. In women 60 years and older, two out of 1,000 will develop hyperparathyroidism each year.

This excess PTH triggers the release of too much calcium into the bloodstream. The bones may lose calcium, and too much calcium may be absorbed from food. The levels of calcium may increase in the urine, causing kidney stones. PTH also lowers blood phosphorous levels by increasing excretion of phosphorus in the urine.

Causes of Hyperparathyroidism

In most cases doctors don't know the cause. The vast majority of cases occur in people with no family history of the disorder. Only about 5 percent of cases can be linked to an inherited problem. Familial multiple endocrine neoplasia type 1 is a rare, inherited syndrome that affects the parathyroids as well as the pancreas and the pituitary gland. Another rare genetic disorder, familial hypocalciuric hypercalcaemia, is sometimes confused with typical hyperparathyroidism. Each accounts for about 2 percent of primary hyperparathyroidism cases.

Signs and Symptoms of Hyperparathyroidism

A person with hyperparathyroidism may have severe symptoms, subtle ones, or none at all. Increasingly, routine blood tests that screen for a wide range of conditions, including high calcium levels, are alerting doctors to people who have mild forms of the disorder even though they are symptom-free.

When symptoms do appear, they are often mild and nonspecific, such as a feeling of weakness and fatigue, depression, or aches and pains. With more severe disease, a person may have a loss of appetite, nausea, vomiting, constipation, confusion or impaired thinking and memory, and increased thirst and urination. Patients may have thinning of the bones without symptoms, but with risk of fractures. Increased calcium and phosphorous excretion in the urine may cause kidney stones.

Diagnosis of Hyperparathyroidism

Hyperparathyroidism is diagnosed when tests show that blood levels of calcium and parathyroid hormone are too high. Other diseases can cause high blood calcium levels, but only in hyperparathyroidism is the elevated calcium the result of too much parathyroid hormone. A blood test that accurately measures the amount of parathyroid hormone has simplified the diagnosis of hyperparathyroidism.

Once the diagnosis is established, other tests may be done to assess complications. Because high PTH levels can cause bones to weaken from calcium loss, a measurement of bone density can help assess bone loss and the risk of fractures. Abdominal images may reveal the presence of kidney stones and a 24-hour urine collection may provide information on kidney damage, the risk of stone formation, and the risk of familial hypocalciuric hypercalcaemia.

Treatment of Hyperparathyroidism
Surgery to remove the enlarged gland (or glands) is the main treatment for the disorder and cures it in 95 percent of operations.

Calcimimetics are a new class of drug that turns off secretion of PTH. They have been approved by the Food and Drug Administration for the treatment of hyperparathyroidism secondary to kidney failure with dialysis, and primary hyperparathyroidism caused by parathyroid cancer. They have not been approved for primary hyperparathyroidism, but some physicians have begun prescribing calcimimetics for some patients with this condition. Patients can discuss this class of drug in more detail with their physicians.

Some patients who have mild disease may not need immediate treatment, according to panels convened by the National Institutes of Health (NIH) in 2002. Patients who are symptom-free, whose blood calcium is only slightly elevated, and whose kidneys and bones are normal may wish to talk with their physicians about long-term monitoring. In the 2002 recommendation, periodic monitoring would consist of clinical evaluation, measurement of serum calcium levels, and bone mass measurement. If the patient and physician choose long-term follow-up, the patient should try to drink lots of water, get plenty of exercise, and avoid certain diuretics, such as the thiazides. Immobilization (unable to move) and gastrointestinal illness with vomiting or diarrhea can cause calcium levels to rise. Patients with hyperparathyroidism should seek medical attention if they find themselves immobilized, vomiting, or having diarrhea.

Are there any complications associated with parathyroid surgery?

Surgery for hyperparathyroidism is highly successful with a low complication rate when performed by surgeons experienced with this condition. About 1 percent of patients undergoing surgery experience damage to the nerves controlling the vocal cords, which can affect speech. One to 5 percent of patients lose all their parathyroid tissue and thus develop chronic low calcium levels, which may require treatment with calcium or vitamin D. The complication rate is slightly higher for hyperplasia than it is for adenoma since more extensive surgery is needed.

Are parathyroid imaging tests needed before surgery?

The NIH panels recommended against the use of expensive imaging tests to locate benign tumors before initial surgery. Such tests are not likely to improve the success rate of surgery, which is about 95 percent when performed by experienced surgeons. Simple imaging tests before surgery are preferred by some surgeons. Localization tests are useful in patients having a second operation for recurrent or persistent hyperparathyroidism.

Source:
Hyperparathyroidism. Endocrine and Metabolic Diseases Information Service. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health (NIH). NIH Publication No. 6–3425: May 2006

Post Updated: May 2, 2007

Glomerular Diseases: Home

2007-04-22T19:28:00.000+08:00

Many diseases affect kidney function by attacking the glomeruli, the tiny units within the kidney where blood is cleaned. Glomerular diseases include many conditions with a variety of genetic and environmental causes, but they fall into two major categories(1):

Glomerulonephritis (gloh-MEHR-yoo-loh-nef-RY-tis) describes the inflammation of the membrane tissue in the kidney that serves as a filter, separating wastes and extra fluid from the blood(2).
Glomerulosclerosis (gloh-MEHR-yoo-loh-skleh-ROH-sis) describes the scarring or hardening of the tiny blood vessels within the kidney(3).
Although glomerulonephritis and glomerulosclerosis have different causes, they can both lead to kidney failure(4).

Topics: Glomerular Disease
(Click on the links below to view the specific topics about Glomerular Disease)

Sources:

1. Glomerular Diseases. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

2. Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

3. Ibid.

4. Glomerular Diseases. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National 4. Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

5. Ibid.

6. Ibid.

7. Ibid.

8. Ibid.

9. Ibid.

10. Ibid.

11. Ibid.

Page Last Revised: January 19, 2007

The Kidneys: Structure and Function

2007-04-22T18:31:00.000+08:00

By: David Mangusan Jr., PTRP

The two kidneys are bean-shaped organs located near the middle of the back, just below the rib cage or just above the waist to the left and right of the vertebral column (spine). Each kidney is about the size of a tightly clenched fist, these organs act as sophisticated filters for the body. They process about 200 quarts of blood a day to sift out about 1 - 2 quarts of waste products and extra water that eventually leave the body as urine.

Here are some of the major functions of the kidneys:

The kidneys are the major excretory organs of the body. They remove waste products from the blood.
The kidneys help to regulate the concentration of ions, such: as sodium, calcium, potassium and phosphate ions, in body fluids.
The kidneys play a very important role in regulating blood volume by regulating the volume of water removed from the blood.
The kidneys also help in regulating the pH of body fluids.
Along with the skin and the liver, the kidneys also participate in the formation of vitamin D. Vitamin D is important for the absorption of calcium by the intestine.

Blood enters the kidneys through arteries that branch inside the kidneys into tiny clusters of looping blood vessels. Each cluster is called a glomerulus (Greek word meaning filter).

There are approximately 1 million glomeruli (plural form of glomerulus) in each kidney. The glomerulus is attached to the opening of a small fluid-collecting tube called the renal tubule. Blood is filtered in the glomerulus, and extra water and wastes pass into the renal tubule and become urine. Eventually, the urine drains from the kidneys into the urinary bladder through larger tubes called ureters.

Each glomerulus-and- renal tubule unit is called a nephron. Nephrons are the functional units of the kidneys. Each kidney is composed of about 1 million nephrons. In healthy nephrons, the glomerular membrane (glomerular or Bowman’s Capsule) that separates the blood vessel from the tubule allows waste products and extra water to pass into the tubule while keeping blood cells and protein in the bloodstream.

Glomerular Disease: Home (Topic Index)

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

David Mangusan Jr. is a licensed Physical Therapist and an instructor of Anatomy and Physiology at the University of the Cordilleras, Baguio City, Philippines.

Page Last Revised: January 19, 2008

How Do Glomerular Diseases Interfere With Kidney Function?

2007-04-22T18:09:00.000+08:00

Glomerular diseases damage the glomeruli, letting protein and sometimes red blood cells leak into the urine. Sometimes a glomerular disease also interferes with the clearance of waste products by the kidney, so they begin to build up in the blood. Furthermore, loss of blood proteins like albumin in the urine can result in a fall in their level in the bloodstream. In normal blood, albumin acts like a sponge, drawing extra fluid from the body into the bloodstream, where it remains until the kidneys remove it. But when albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Fluid can accumulate outside the circulatory system in the face, hands, feet, or ankles and cause swelling.

Glomerular Diseases: Home (Topic Index)

Source:
Glomerular Diseases: How do glomerular diseases interfere with kidney function?. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

Page Last Revised: January 19, 2008

Symptoms of Glomerular Disease

2007-04-22T17:58:00.000+08:00

The signs and symptoms of glomerular disease include:

proteinuria: large amounts of protein in the urine
hematuria: blood in the urine
reduced glomerular filtration rate: inefficient filtering of wastes from the blood
hypoproteinemia: low blood protein
edema: swelling in parts of the body

One or more of these symptoms can be the first sign of kidney disease. But how would you know, for example, whether you have proteinuria? Before seeing a doctor, you may not. But some of these symptoms have signs, or visible manifestations:

Proteinuria may cause foamy urine.
Blood may cause the urine to be pink or cola-colored.
Edema may be obvious in hands and ankles, especially at the end of the day, or around the eyes when awakening in the morning, for example.

Glomerular Diseases: Home (Topic Index)

Source:
Glomerular Diseases. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

Page Last Revised: January 19, 2008

Diagnosis of Glomerular Disease

2007-04-22T17:51:00.000+08:00

Patients with glomerular disease have significant amounts of protein in the urine, which may be referred to as "nephrotic range" if levels are very high. Red blood cells in the urine are a frequent finding as well, particularly in some forms of glomerular disease.

Urinalysis provides information about kidney damage by indicating levels of protein and red blood cells in the urine.

Blood tests measure the levels of waste products such as creatinine and urea nitrogen to determine whether the filtering capacity of the kidneys is impaired.

If these lab tests indicate kidney damage, the doctor may recommend ultrasound or an x ray to see whether the shape or size of the kidneys is abnormal. These tests are called renal imaging. But since glomerular disease causes problems at the cellular level, the doctor will probably also recommend a kidney biopsy—a procedure in which a needle is used to extract small pieces of tissue for examination with different types of microscopes, each of which shows a different aspect of the tissue. A biopsy may be helpful in confirming glomerular disease and identifying the cause.

Glomerular Diseases: Home (Topic Index)

Content Source:
Glomerular Diseases: How is glomerular disease diagnosed. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

Page Last Revised: January 19, 2008

Causes of glomerular disease

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A number of different diseases can result in glomerular disease. It may be the direct result of an infection or a drug toxic to the kidneys, or it may result from a disease that affects the entire body, like diabetes or lupus. Many different kinds of diseases can cause swelling or scarring of the nephron or glomerulus. Sometimes glomerular disease is idiopathic, meaning that it occurs without an apparent associated disease.

The categories presented below can overlap: that is, a disease might belong to two or more of the categories. For example, diabetic nephropathy is a form of glomerular disease that can be placed in two categories: systemic diseases, since diabetes itself is a systemic disease, and sclerotic diseases, because the specific damage done to the kidneys is associated with scarring.

Autoimmune Diseases

When the body’s immune system functions properly, it creates protein-like substances called antibodies and immunoglobulins to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions.

Systemic lupus erythematosus (SLE) affects many parts of the body: primarily the skin and joints, but also the kidneys. Because women are more likely to develop SLE than men, some researchers believe that a sex-linked genetic factor may play a part in making a person susceptible, although viral infection has also been implicated as a triggering factor. Lupus nephritis is the name given to the kidney disease caused by SLE, and it occurs when autoantibodies form or are deposited in the glomeruli, causing inflammation. Ultimately, the inflammation may create scars that keep the kidneys from functioning properly. Conventional treatment for lupus nephritis includes a combination of two drugs, cyclophosphamide, a cytotoxic agent that suppresses the immune system, and prednisolone, a corticosteroid used to reduce inflammation. A newer immunosuppressant, mychophenolate mofetil (MMF), has been used instead of cyclophosphamide. Preliminary studies indicate that MMF may be as effective as cyclophosphamide and has milder side effects.

Goodpasture’s syndrome involves an autoantibody that specifically targets the kidneys and the lungs. Often, the first indication that patients have the autoantibody is when they cough up blood. But lung damage in Goodpasture’s syndrome is usually superficial compared with progressive and permanent damage to the kidneys. Goodpasture’s syndrome is a rare condition that affects mostly young men but also occurs in women, children, and older adults. Treatments include immunosuppressive drugs and a blood-cleaning therapy called plasmapheresis that removes the autoantibodies.

IgA nephropathy is a form of glomerular disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation. IgA nephropathy was not recognized as a cause of glomerular disease until the late 1960s, when sophisticated biopsy techniques were developed that could identify IgA deposits in kidney tissue.

The most common symptom of IgA nephropathy is blood in the urine, but it is often a silent disease that may go undetected for many years. The silent nature of the disease makes it difficult to determine how many people are in the early stages of IgA nephropathy, when specific medical tests are the only way to detect it. This disease is estimated to be the most common cause of primary glomerulonephritis—that is, glomerular disease not caused by a systemic disease like lupus or diabetes mellitus. It appears to affect men more than women. Although IgA nephropathy is found in all age groups, young people rarely display signs of kidney failure because the disease usually takes several years to progress to the stage where it causes detectable complications.

No treatment is recommended for early or mild cases of IgA nephropathy when the patient has normal blood pressure and less than 1 gram of protein in a 24-hour urine output. When proteinuria exceeds 1 gram/day, treatment is aimed at protecting kidney function by reducing proteinuria and controlling blood pressure. Blood pressure medicines—angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)—that block a hormone called angiotensin are most effective at achieving those two goals simultaneously.

Hereditary Nephritis—Alport Syndrome

The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss.
Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function.

Infection-related Glomerular Disease

Glomerular disease sometimes develops rapidly after an infection in other parts of the body.

Acute post-streptococcal glomerulonephritis (PSGN) can occur after an episode of strep throat or, in rare cases, impetigo (a skin infection). The Streptococcus bacteria do not attack the kidney directly, but an infection may stimulate the immune system to overproduce antibodies, which are circulated in the blood and finally deposited in the glomeruli, causing damage. PSGN can bring on sudden symptoms of swelling (edema), reduced urine output (oliguria), and blood in the urine (hematuria). Tests will show large amounts of protein in the urine and elevated levels of creatinine and urea nitrogen in the blood, thus indicating reduced kidney function. High blood pressure frequently accompanies reduced kidney function in this disease.

PSGN is most common in children between the ages of 3 and 7, although it can strike at any age, and it most often affects boys. It lasts only a brief time and usually allows the kidneys to recover. In a few cases, however, kidney damage may be permanent, requiring dialysis or transplantation to replace renal function.

Bacterial endocarditis, infection of the tissues inside the heart, is also associated with subsequent glomerular disease. Researchers are not sure whether the renal lesions that form after a heart infection are caused entirely by the immune response or whether some other disease mechanism contributes to kidney damage. Treating the heart infection is the most effective way of minimizing kidney damage. Endocarditis sometimes produces chronic kidney disease (CKD).

HIV, the virus that leads to AIDS, can also cause glomerular disease. Between 5 and 10 percent of people with HIV experience kidney failure, even before developing full-blown AIDS. HIV-associated nephropathy usually begins with heavy proteinuria and progresses rapidly (within a year of detection) to total kidney failure. Researchers are looking for therapies that can slow down or reverse this rapid deterioration of renal function, but some possible solutions involving immunosuppression are risky because of the patients’ already compromised immune system.

Sclerotic Diseases

Glomerulosclerosis is scarring (sclerosis) of the glomeruli. In several sclerotic conditions, a systemic disease like lupus or diabetes is responsible. Glomerulosclerosis is caused by the activation of glomerular cells to produce scar material. This may be stimulated by molecules called growth factors, which may be made by glomerular cells themselves or may be brought to the glomerulus by the circulating blood that enters the glomerular filter.

Diabetic nephropathy is the leading cause of glomerular disease and of total kidney failure in the United States. Kidney disease is one of several problems caused by elevated levels of blood glucose, the central feature of diabetes. In addition to scarring the kidney, elevated glucose levels appear to increase the speed of blood flow into the kidney, putting a strain on the filtering glomeruli and raising blood pressure.

Diabetic nephropathy usually takes many years to develop. People with diabetes can slow down damage to their kidneys by controlling their blood glucose through healthy eating with moderate protein intake, physical activity, and medications. People with diabetes should also be careful to keep their blood pressure at a level below 130/85 mm Hg, if possible. Blood pressure medications called ACE inhibitors and ARBs are particularly effective at minimizing kidney damage and are now frequently prescribed to control blood pressure in patients with diabetes and in patients with many forms of kidney disease.

Focal segmental glomerulosclerosis (FSGS) describes scarring in scattered regions of the kidney, typically limited to one part of the glomerulus and to a minority of glomeruli in the affected region. FSGS may result from a systemic disorder or it may develop as an idiopathic kidney disease, without a known cause. Proteinuria is the most common symptom of FSGS, but, since proteinuria is associated with several other kidney conditions, the doctor cannot diagnose FSGS on the basis of proteinuria alone. Biopsy may confirm the presence of glomerular scarring if the tissue is taken from the affected section of the kidney. But finding the affected section is a matter of chance, especially early in the disease process, when lesions may be scattered.

Confirming a diagnosis of FSGS may require repeat kidney biopsies. Arriving at a diagnosis of idiopathic FSGS requires the identification of focal scarring and the elimination of possible systemic causes such as diabetes or an immune response to infection. Since idiopathic FSGS is, by definition, of unknown cause, it is difficult to treat. No universal remedy has been found, and most patients with FSGS progress to total kidney failure over 5 to 20 years. Some patients with an aggressive form of FSGS reach total kidney failure in 2 to 3 years. Treatments involving steroids or other immunosuppressive drugs appear to help some patients by decreasing proteinuria and improving kidney function. But these treatments are beneficial to only a minority of those in whom they are tried, and some patients experience even poorer kidney function as a result. ACE inhibitors and ARBs may also be used in FSGS to decrease proteinuria. Treatment should focus on controlling blood pressure and blood cholesterol levels, factors that may contribute to kidney scarring.

Other Glomerular Diseases

Membranous nephropathy, also called membranous glomerulopathy, is the second most common cause of the nephrotic syndrome (proteinuria, edema, high cholesterol) in U.S. adults after diabetic nephropathy. Diagnosis of membranous nephropathy requires a kidney biopsy, which reveals unusual deposits of immunoglobulin G and complement C3, substances created by the body’s immune system. Fully 75 percent of cases are idiopathic, which means that the cause of the disease is unknown. The remaining 25 percent of cases are the result of other diseases like systemic lupus erythematosus, hepatitis B or C infection, or some forms of cancer. Drug therapies involving penicillamine, gold, or captopril have also been associated with membranous nephropathy. About 20 to 40 percent of patients with membranous nephropathy progress, usually over decades, to total kidney failure, but most patients experience either complete remission or continued symptoms without progressive kidney failure. Doctors disagree about how aggressively to treat this condition, since about 20 percent of patients recover without treatment. ACE inhibitors and ARBs are generally used to reduce proteinuria. Additional medication to control high blood pressure and edema is frequently required. Some patients benefit from steroids, but this treatment does not work for everyone. Additional immunosuppressive medications are helpful for some patients with progressive disease.

Minimal change disease (MCD) is the diagnosis given when a patient has the nephrotic syndrome and the kidney biopsy reveals little or no change to the structure of glomeruli or surrounding tissues when examined by a light microscope. Tiny drops of a fatty substance called a lipid may be present, but no scarring has taken place within the kidney. MCD may occur at any age, but it is most common in childhood. A small percentage of patients with idiopathic nephrotic syndrome do not respond to steroid therapy. For these patients, the doctor may recommend a low-sodium diet and prescribe a diuretic to control edema. The doctor may recommend the use of nonsteroidal anti-inflammatory drugs to reduce proteinuria. ACE inhibitors and ARBs have also been used to reduce proteinuria in patients with steroid-resistant MCD. These patients may respond to larger doses of steroids, more prolonged use of steroids, or steroids in combination with immunosuppressant drugs, such as chlorambucil, cyclophosphamide, or cyclosporine.

Glomerular Diseases: Home (Topic Index)

Content Source:
National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). Glomerular Diseases: What causes glomerular disease. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

Page Last Revised: January 19, 2008

Renal failure and End-Stage renal disease

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Renal failure is any acute or chronic loss of kidney function and is the term used when some kidney function remains. Total kidney failure, sometimes called end-stage renal disease (ESRD), indicates permanent loss of kidney function. Depending on the form of glomerular disease, renal function may be lost in a matter of days or weeks or may deteriorate slowly and gradually over the course of decades.

Acute Renal Failure

A few forms of glomerular disease cause very rapid deterioration of kidney function. For example, PSGN can cause severe symptoms (hematuria, proteinuria, edema) within 2 to 3 weeks after a sore throat or skin infection develops. The patient may temporarily require dialysis to replace renal function. This rapid loss of kidney function is called acute renal failure (ARF). Although ARF can be life-threatening while it lasts, kidney function usually returns after the cause of the kidney failure has been treated. In many patients, ARF is not associated with any permanent damage. However, some patients may recover from ARF and subsequently develop CKD.

Chronic Kidney Disease

Most forms of glomerular disease develop gradually, often causing no symptoms for many years. CKD is the slow, gradual loss of kidney function. Some forms of CKD can be controlled or slowed down. For example, diabetic nephropathy can be delayed by tightly controlling blood glucose levels and using ACE inhibitors and ARBs to reduce proteinuria and control blood pressure. But CKD cannot be cured. Partial loss of renal function means that some portion of the patient’s nephrons have been scarred, and scarred nephrons cannot be repaired. In many cases, CKD leads to total kidney failure.

Total Kidney Failure

To stay alive, a patient with total kidney failure must go on dialysis—hemodialysis or peritoneal dialysis—or receive a new kidney through transplantation. Patients with CKD who are approaching total kidney failure should learn as much about their treatment options as possible so they can make an informed decision when the time comes. With the help of dialysis or transplantation, many people continue to lead full, productive lives after reaching total kidney failure.

Glomerular Diseases: Home (Topic Index)

Content Source:
Glomerular Diseases: What are renal failure and end-stage renal disease. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

Page Last Revised: January 19, 2008

The Nephrotic Syndrome

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The nephrotic syndrome is a condition marked by very high levels of protein in the urine; low levels of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol.
The nephrotic syndrome is a set of symptoms, not a disease in itself. It can occur with many diseases, so prevention relies on controlling the diseases that cause it.
Treatment of the nephrotic syndrome focuses on identifying and treating the underlying cause, if possible, and reducing high cholesterol, blood pressure, and protein in the urine through diet, medication, or both.
The nephrotic syndrome may go away once the underlying cause, if known, is treated. However, often a kidney disease is the underlying cause and cannot be cured. In these cases, the kidneys may gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the patient will need to be on dialysis or have a kidney transplant.

Glomerular Diseases: Home (Topic Index)

Content Source:
Glomerular Diseases. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

Page Last Revise: January 2008

Definition of Terms: Glomerular Diseases

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Signs and Symptoms of Glomerulonephritis:

edema (eh-DEE-muh): Swelling caused by the accumulation of fluid in cells and tissues. In kidney failure, fluid may collect in the feet, hands, abdomen, or face.
hematuria (HEE-muh-TOOR-ee-uh): Blood in the urine. Blood may turn the urine pink or cola-colored.
hypoproteinemia (HY-po-PRO-teen-EE-mee-uh): Reduced levels of protein in the blood.
proteinuria (PRO-tee-NOOR-ee-uh): Large amounts of protein in the urine.
uremia (yoo-REE-mee-uh): Accumulation of urea and other wastes in the blood. These wastes, which become toxic in large amounts, are normally eliminated through urination.

Diseases and Conditions:

autoimmune (AW-toh-ih-MYOON) disease: A disease in which the body’s own disease-fighting cells attack the body itself.
hypertension (HY-per-TEN-shun): High blood pressure, a condition that can cause kidney damage or be caused by kidney disease.
idiopathic (id-ee-o-PATH-ik) disease: A disease that occurs without a known cause.
nephrotoxic (NEF-ro-TOKS-ik): Damaging to the kidneys.
sclerotic (skleh-ROT-ik) disease: A disease in which tissues become hardened or scarred.
systemic (sis-TEM-ik) disease: A disease that affects multiple parts of the body, often as a result of substances circulating in the blood.

Treatments and Procedures:

biopsy (BY-op-see): A procedure in which a needle is used to obtain small pieces of tissue from an organ for examination under different types of microscopes, each of which shows a different aspect of the tissue.
dialysis (dy-AL-ih-sis): A medical treatment that removes wastes and extra fluid from the blood after the kidneys have stopped working.
immunosuppressant (im-YOON-oh-suh-PRESS-unt): A medicine given to block the body’s immune system.
plasmapheresis (PLAZ-muh-fer-EE-sis): A medical treatment in which the blood is treated outside the body to remove harmful antibodies, and then returned to the patient.

Kidney Parts and Organic Substances:

antibody (AN-tee-BOD-ee): A molecule that protects the body against disease by attacking foreign tissues or organisms. Antibodies are also called immunoglobulins.
antigen (AN-tih-jen): A substance that triggers a response from the body’s immune system.
autoantibody (AW-toh-AN-tee-bod-ee): An antibody that attacks the body itself.
creatinine (kree-AT-ih-nin): A waste product in the blood that results from the normal breakdown of muscle. Healthy kidneys filter creatinine from the blood.
glomerulus (gloh-MEHR-yoo-lus): The tiny cluster of looping blood vessels in the nephron, where wastes are filtered from the blood.
lipid (LIP-id): One of several fatty substances used in cells. Excess lipids in the blood may result in harmful deposits in blood vessels.
nephron (NEF-rahn): One of a million tiny filtering units in each kidney. Each nephron is made up of both a glomerulus and a fluid-collecting tubule that processes extra water and wastes.
protein (PRO-teen): A substance found in food and used by the body to grow, repair tissue, and fight disease.
urea (yoo-REE-uh): A waste material found in blood after protein has been broken down. Healthy kidneys remove urea from the blood. Damaged kidneys may allow urea to accumulate in the blood, thus causing uremia.

Glomerular Diseases: Home (Topic Index)

Sources:

Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Glomerular Diseases. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4358: April 2006

Page Last Revised: January 19, 2008

DI: Diabetes Insipidus

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Diabetes insipidus (DI) causes frequent urination. The large volume of urine is diluted, mostly water. To make up for lost water, you may feel the need to drink large amounts. You are likely to urinate frequently, even at night, which can disrupt sleep or, on occasion, cause bedwetting. Because of the excretion of abnormally large volumes of dilute urine, you may quickly become dehydrated if you do not drink enough water. Children with DI may be irritable or listless and may have fever, vomiting, or diarrhea. In its clinically significant forms, DI is a rare disease.

Diabetes Insipidus versus Diabetes Mellitus:

DI should not be confused with diabetes mellitus, which results from insulin deficiency or resistance leading to high blood glucose. Diabetes insipidus and diabetes mellitus are unrelated, although they can have similar signs and symptoms, like excessive thirst and excessive urination.

Diabetes mellitus (DM) is far more common than DI and receives more news coverage. DM has two forms, referred to as type 1 diabetes (formerly called juvenile diabetes, or insulin-dependent diabetes mellitus, or IDDM) and type 2 diabetes (formerly called adult-onset diabetes, or noninsulin-dependent diabetes mellitus, or NIDDM). DI is a different form of illness altogether.

Forms of Diabetes Insipidus:

Central DI

Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, you should drink fluids or water only when you are thirsty and not at other times. This is because the drug prevents water excretion and water can build up now that your kidneys are making less urine and are less responsive to changes in body fluids.

Nephrogenic DI

The kidneys' ability to respond to ADH can be impaired by drugs (like lithium, for example) and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic DI is never discovered.

Desmopressin will not work for this form of DI. Instead, you may be given a drug called hydrochlorothiazide (also called HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, you should drink fluids only when you are thirsty and not at other times.

Dipsogenic DI

A third type of DI is caused by a defect in or damage to the thirst mechanism, which is located in the hypothalamus. This defect results in an abnormal increase in thirst and fluid intake that suppresses ADH secretion and increases urine output. Desmopressin or other drugs should not be used to treat dipsogenic DI because they may decrease urine output but not thirst and fluid intake. This fluid "overload" can lead to water intoxication, a condition that lowers the concentration of sodium in the blood and can seriously damage the brain.

Gestational DI

A fourth type of DI occurs only during pregnancy. Gestational DI occurs when an enzyme made by the placenta destroys ADH in the mother. The placenta is the system of blood vessels and other tissue that develops with the fetus. The placenta allows exchange of nutrients and waste products between mother and fetus.

Most cases of gestational DI can be treated with desmopressin. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used.

Diagnosis of Diabetes Insipidus:

Because DM is more common and because DM and DI have similar symptoms, a health care provider may suspect that a patient with DI has DM. But testing should make the diagnosis clear.

Your physician must determine which type of DI is involved before proper treatment can begin. Diagnosis is based on a series of tests, including urinalysis and a fluid deprivation test.

Urinalysis is the physical and chemical examination of urine. The urine of a person with DI will be less concentrated. Therefore, the salt and waste concentrations are low, and the amount of water excreted is high. A physician evaluates the concentration of urine by measuring how many particles are in a kilogram of water (osmolality) or by comparing the weight of the urine to an equal volume of distilled water (specific gravity).

A fluid deprivation test helps determine whether DI is caused by (1) excessive intake of fluid, (2) a defect in ADH production, or (3) a defect in the kidneys' response to ADH. This test measures changes in body weight, urine output, and urine composition when fluids are withheld. Sometimes measuring blood levels of ADH during this test is also necessary.
In some patients, an MRI (magnetic resonance imaging) of the brain may be necessary as well.

Sources:
Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Diabetes Insipidus. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 05–4620August 2005

For more information about Diabetes Insipidus visit the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website.

Page Last Revised: January 19, 2008

Attention-Deficit / Hyperactivity Disorder (ADHD)

2007-04-22T12:01:00.000+08:00

ADHD is a neurobehavioral disorder characterized by pervasive inattention and/or hyperactivity-impulsivity and resulting in significant functional impairment. CDC estimates 4.4 million youth ages 4-17 have been diagnosed with ADHD by a healthcare professional, and as of 2003, 2.5 million youth ages 4-17 are currently receiving medication treatment for the disorder. In 2003 7.8% of school-aged children were reported to have an ADHD diagnosis by their parent.

RESOURCES:
Visit the National Center on Birth Defects and Developmental Disabilities (NCBDDD) which promotes the health of babies, children, and adults, and enhances the potential for full, productive living.

Their work includes identifying the causes of and preventing birth defects and developmental disabilities, helping children to develop and reach their full potential, and promoting health and well-being among people of all ages with disabilities.

Visit the "Learn the Signs. Act Early." website for information about childhood developmental milestones and delays. You'll be able to track the developmental milestones your child should be reaching, see how milestones change as your child grows, and download fact sheets on developmental milestones for children from 3 months to 5 years, along with information on developmental screening and developmental disabilities.

Content Source: National Center on Birth Defects and Developmental Disabilities. Centers for Disease Control and Prevention. September 20, 2005

Page Last Revised: January 19, 2008

Human Influenza Viruses and Avian Influenza A Viruses

2007-04-21T20:57:00.000+08:00

Humans can be infected with influenza types A, B, and C viruses. Subtypes of influenza A that are currently circulating among people worldwide include H1N1, H1N2, and H3N2 viruses(1).

Wild birds are the natural host for all known subtypes of influenza A viruses. Typically, wild birds do not become sick when they are infected with avian influenza A viruses. However, domestic poultry, such as turkeys and chickens, can become very sick and die from avian influenza, and some avian influenza A viruses also can cause serious disease and death in wild birds(2).

Types, Subtypes, and Strains

Influenza Type A and Its Subtypes

Influenza type A viruses can infect people, birds, pigs, horses, and other animals, but wild birds are the natural hosts for these viruses. Influenza type A viruses are divided into subtypes and named on the basis of two proteins on the surface of the virus: hemagglutinin (HA) and neuraminidase (NA). For example, an “H7N2 virus” designates an influenza A subtype that has an HA 7 protein and an NA 2 protein. Similarly an “H5N1” virus has an HA 5 protein and an NA 1 protein. There are 16 known HA subtypes and 9 known NA subtypes. Many different combinations of HA and NA proteins are possible. Only some influenza A subtypes (i.e., H1N1, H1N2, and H3N2) are currently in general circulation among people. Other subtypes are found most commonly in other animal species. For example, H7N7 and H3N8 viruses cause illness in horses, and H3N8 also has recently been shown to cause illness in dogs.

Only influenza A viruses infect birds, and all known subtypes of influenza A viruses can infect birds. However, there are substantial genetic differences between the influenza A subtypes that typically infect birds and those that infect both people and birds. Three prominent subtypes of the avian influenza A viruses that are known to infect both birds and people are:

Influenza A H5

Nine potential subtypes of H5 are known. H5 infections, such as HPAI H5N1 viruses currently circulating in Asia and Europe, have been documented among humans and sometimes cause severe illness or death.

Influenza A H7

Nine potential subtypes of H7 are known. H7 infection in humans is rare but can occur among persons who have direct contact with infected birds. Symptoms may include conjunctivitis and/or upper respiratory symptoms. H7 viruses have been associated with both LPAI (e.g., H7N2, H7N7) and HPAI (e.g., H7N3, H7N7), and have caused mild to severe and fatal illness in humans.

Influenza A H9

Nine potential subtypes of H9 are known; influenza A H9 has rarely been reported to infect humans. However, this subtype has been documented only in a low pathogenic form.

Influenza Type B

Influenza B viruses are usually found only in humans. Unlike influenza A viruses, these viruses are not classified according to subtype. Influenza B viruses can cause morbidity and mortality among humans, but in general are associated with less severe epidemics than influenza A viruses. Although influenza type B viruses can cause human epidemics, they have not caused pandemics.

Influenza Type C

Influenza type C viruses cause mild illness in humans and do not cause epidemics or pandemics. These viruses are not classified according to subtype.

Strains

Influenza B viruses and subtypes of influenza A virus are further characterized into strains. There are many different strains of influenza B viruses and of influenza A subtypes. New strains of influenza viruses appear and replace older strains. This process occurs through antigenic drift. When a new strain of human influenza virus emerges, antibody protection that may have developed after infection or vaccination with an older strain may not provide protection against the new strain. Therefore, the influenza vaccine is updated on a yearly basis to keep up with the changes in influenza viruses.

Content Source:
Avian Influenza (Flu): Influenza Viruses. Centers for Disease Control and Prevention. Department of Health and Human Services. November 18, 2005

Page Last Revised: January 19, 2008

UTI: Urinary Tract Infection

2007-04-21T16:22:00.000+08:00

A UTI is an infection anywhere in the urinary tract. Your urinary tract includes the organs that collect and store urine and release it from your body. They are the kidneys, ureters, bladder, and the urethra

Kidney. Your kidneys collect wastes and extra water from your blood to make urine.
Ureter. The ureters carry the urine from your kidneys to your bladder.
Bladder. Your bladder stores the urine and squeezes it out when full.
Urethra. The urethra carries the urine out of your bladder when you urinate.
Prostate. The prostate adds fluid to semen.

Causes:

Usually, a UTI is caused by bacteria that can also live in the digestive tract, in the vagina, or around the urethra, which is at the entrance to the urinary tract. Most often these bacteria enter the urethra and travel to the bladder and kidneys. Usually, your body removes the bacteria, and you have no symptoms. However, some people seem to be prone to infection, including women and older people.

You should see your doctor if you have any of these signs or symptoms:

burning feeling when you urinate
frequent or intense urges to urinate, even when you have little urine to pass
pain in your back or lower abdomen
cloudy, dark, bloody, or unusual-smelling urine
fever or chills

Women are more likely to get UTIs than men are. When men get UTIs, however, they're often serious and hard to treat. UTIs can be especially dangerous for older people and pregnant women, as well as for those with diabetes and those who have difficulty urinating.

What will happen at the doctor's office?

The doctor may ask you how much fluid you drink, and if you have pain or a burning feeling when you urinate, or if you have difficulty urinating. Women may be asked about the type of birth control they use. You'll need to urinate into a cup so the urine can be tested. In addition, your doctor may need to take pictures of your kidneys with an x ray or ultrasound and look into your bladder with an instrument called a cystoscope.

Urine tests. Your urine will be checked under a microscope for bacteria and infection-fighting cells. The doctor may order a urine culture. In this test, bacteria from the urine are allowed to grow in a lab dish so the exact type of bacteria can be seen and the precise type of medicine you need can be chosen.

Images. The doctor may use either x rays, sound waves (ultrasound), or CT scan to view your bladder or kidneys. These pictures can show stones, blockage, or swelling.

Cystoscope. The urethra and bladder can be seen from the inside with a cystoscope, which is a thin tube with lenses like a microscope. The tube is inserted into the urinary tract through the urethra.

Treatment:

Once it is determined that your symptoms have been caused by an infection, your doctor will prescribe an antibiotic. Antibiotics can kill the bacteria causing the infection. The antibiotic prescribed will depend on the type of bacteria found.

For simple infections, you'll be given 3 days of therapy. For more serious infections, you'll be given a prescription for 7 days or longer. Be sure to follow your instructions carefully and completely. If you have any allergies to drugs, be sure your doctor knows what they are.

Will UTIs come back?

Sometimes. Most healthy women don't have repeat infections. However, about one out of every five women who get a UTI will get another one. Some women get three or more UTIs a year. Men frequently get repeat infections. Anyone who has diabetes or a problem that makes it difficult to urinate may get repeat infections.

If you get repeat infections, talk with your doctor about special treatment plans. Your doctor may refer you to a urologist, a doctor who specializes in urinary problems. Your doctor may have you take antibiotics over a longer period to help prevent repeat infections. Some doctors give patients who get frequent UTIs a supply of antibiotics to be taken at the first sign of infection. Make sure you understand what your doctor tells you about taking the antibiotic and do exactly that.

Men may need to take antibiotics for a longer time. Bacteria can hide deep in prostate tissue. Men shouldn't take their spouse's pills and think they will cure the infection. See a doctor for treatment that fits your needs.

RELATED TOPIC: Prevention of Urinary Tract Infection (UTI)

Sources:
Kidney Diseases Dictionary A-Z. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

What I need to know about Urinary Tract Infections. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 04–4807: March 2004

Image Credit: NIDDK Image Library. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Page Last Revised: January 19, 2008

Prevention of Urinary Tract Infection (UTI)

2007-04-21T16:06:00.000+08:00

Urinary tract infection is an illness caused by harmful bacteria growing in the urinary tract.

Changing some of your daily habits may help you avoid UTIs.

Drink lots of fluid to flush the bacteria from your system. Water is best. Try for 6 to 8 glasses a day.
Drink cranberry juice or take vitamin C. Both increase the acid in your urine so bacteria can't grow easily. Cranberry juice also makes your bladder wall slippery, so bacteria can't stick to it.
Urinate frequently and go when you first feel the urge. Bacteria can grow when urine stays in the bladder too long.
Urinate shortly after sex. This can flush away bacteria that might have entered your urethra during sex.
After using the toilet, always wipe from front to back, especially after a bowel movement.
Wear cotton underwear and loose-fitting clothes so that air can keep the area dry. Avoid tight-fitting jeans and nylon underwear, which trap moisture and can help bacteria grow.
For women, using a diaphragm or spermicide for birth control can lead to UTIs by increasing bacteria growth. If you have trouble with UTIs, consider modifying your birth control method. Unlubricated condoms or spermicidal condoms increase irritation and help bacteria cause symptoms. Consider switching to lubricated condoms without spermicide or using a nonspermicidal lubricant.

Excerpted from: What I need to know about Urinary Tract Infections. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 04–4807: March 2004

Page Last Revised: January 19, 2008

Hematuria: Blood in the Urine

2007-04-20T18:24:00.000+08:00

Definition:

hematuria (HEE-muh-TOOR-ee-uh):
Blood in the urine, which can be a sign of a kidney stone, glomerulonephritis, or other kidney problem.

Description:

Hematuria is the presence of red blood cells (RBCs) in the urine. In microscopic hematuria, the urine appears normal to the naked eye, but examination with a microscope shows a high number of RBCs. Gross hematuria can be seen with the naked eye—the urine is red or the color of cola.

Causes:

Several conditions can cause hematuria, most of them not serious. For example, exercise may cause hematuria that goes away in 24 hours. Many people have hematuria without any other related problems. Often no specific cause can be found. But because hematuria may be the result of a tumor or other serious problem, a doctor should be consulted.

Diagnosis:

To find the cause of hematuria, or to rule out certain causes, the doctor may order a series of tests, including urinalysis, blood tests, kidney imaging studies, and cystoscopic examination.

Urinalysis is the examination of urine for various cells and chemicals. In addition to finding RBCs, the doctor may find white blood cells that signal a urinary tract infection or casts, which are groups of cells molded together in the shape of the kidneys' tiny filtering tubes, that signal kidney disease. Excessive protein in the urine also signals kidney disease.
Blood tests may reveal kidney disease if the blood contains high levels of wastes that the kidneys are supposed to remove.
Kidney imaging studies include ultrasound, computerized tomography (CT) scan, or intravenous pyelogram (IVP). An IVP is an x ray of the urinary tract. Imaging studies may reveal a tumor, a kidney or bladder stone, an enlarged prostate, or other blockage to the normal flow of urine.
A cystoscope can be used to take pictures of the inside of the bladder. It has a tiny camera at the end of a thin tube, which is inserted through the urethra. A cystoscope may provide a better view of a tumor or bladder stone than can be seen in an IVP.

Treatment:

Treatment for hematuria depends on the cause. If no serious condition is causing the hematuria, no treatment is necessary.

Sources:
Kidney Diseases Dictionary F-J. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 03–4359: May 2003

Hematuria (Blood in the Urine). National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 07–4559: February 2007

hematuria

Page Last Revised: January 19, 2008

FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1

2007-04-18T10:35:00.000+08:00

The U.S. Food and Drug Administration (FDA) yesterday announced the first approval in the United States of a vaccine for humans against the H5N1 influenza virus, commonly known as avian or bird flu.

The vaccine could be used in the event the current H5N1 avian virus were to develop the capability to efficiently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such an influenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced.

"The threat of an influenza pandemic is, at present, one of the most significant public health issues our nation and world faces," said Andrew C. von Eschenbach, M.D., Commissioner of Food and Drugs. "The approval of this vaccine is an important step forward in our protection against a pandemic."

The H5N1 virus is one version of the influenza A virus commonly found in birds. Unlike seasonal influenza, where infection ranges from mild to serious symptoms in most people, the disease caused by H5N1 is far more severe and happens quickly, with pneumonia and multi-organ failure commonly seen.

While there have been no reported human cases of H5N1 infection in the United States, almost 300 people worldwide have been infected with this virus since 2003 and more than half of them have died. To date, H5N1 influenza has remained primarily an animal disease but should the virus acquire the ability for sustained transmission among humans, people will have little immunity to this virus and the potential for an influenza pandemic would have grave consequences for global public health.

"The timing and severity of an influenza pandemic is uncertain, but the danger remains very real," said Jesse L. Goodman, M.D., M.P.H., Director of FDA's Center for Biologics Evaluation and Research. "We are working closely with other government agencies, global partners and the vaccine industry to facilitate the development, licensure and availability of needed supplies of safe and effective vaccines to protect against the pandemic threat."

The vaccine was obtained from a human strain and is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 influenza virus contained in the vaccine. H5N1 influenza vaccine immunization consists of two intramuscular injections, given approximately one month apart. The manufacturer, sanofi pasteur Inc., will not sell the vaccine commercially. Instead, the vaccine has been purchased by the federal government for inclusion within the U.S. Strategic National Stockpile for distribution by public health officials if needed. The vaccine will be manufactured at sanofi pasteur's Swiftwater, Pa., facility.

A clinical study was conducted to collect safety information and information on recipient's immune responses and to determine the appropriate vaccine dose. A total of 103 healthy adults received a 90 microgram dose of the vaccine by injection followed by another 90 microgram dose 28 days later. In addition, there were approximately 300 healthy adults who received the vaccine at doses lower than 90 micrograms and a total of 48 who received a placebo injection.

The vaccine was generally well tolerated, with the most common side effects reported as pain at the injection site, headache, general ill feeling and muscle pain. The study showed that 45 percent of individuals who received the 90 microgram, two-dose regimen developed antibodies at a level that is expected to reduce the risk of getting influenza. Although the level of antibodies seen in the remaining individuals did not reach that level, current scientific information on other influenza vaccines suggests that less than optimal antibody levels may still have the potential to help reduce disease severity and influenza-related hospitalizations and deaths. Additional information on this H5N1 influenza vaccine is being collected on safety and effectiveness in other age groups and will be available to FDA in the near future.

With the support of FDA, the U.S. National Institutes of Health and other government agencies, sanofi pasteur and other manufacturers are working to develop a next generation of influenza vaccines for enhanced immune responses at lower doses, using technologies intended to boost the immune response. Meanwhile, the approval and availability of this vaccine will enhance national readiness and the nation's ability to protect those at increased risk of exposure.

The U.S. Strategic National Stockpile is maintained by the U.S. Centers for Disease Control and Prevention. It contains large quantities of medicine and medical supplies to protect the American public if there is a public health emergency, which can be delivered to any state in the United States within 12 hours. For more information on the government's preparedness efforts, visit: www.pandemicflu.gov.

Source: FDA News.US Food and Drug Administration.P07-68: April 17, 2007

Amyloidosis and Kidney Disease

2007-04-16T13:42:00.000+08:00

Proteins are important building blocks for all body parts, including muscles, bones, hair, and nails. Proteins circulate throughout the body in the blood and are normally harmless. Occasionally, cells produce abnormal proteins that can settle in body tissue, forming deposits and causing disease. When these deposits of abnormal proteins were first discovered, they were called amyloid, and the disease process amyloidosis.

In recent years, researchers have discovered that different kinds of proteins can form amyloid deposits and have identified several types of amyloidosis. Two of these types are closely related to kidney disease. In primary amyloidosis, abnormal protein production occurs as a first step and can lead to kidney disease. Dialysis-related amyloidosis (DRA), on the other hand, is a result of kidney disease.

Primary Amyloidosis

Primary amyloidosis occurs when the body's antibody-producing cells do not function properly and produce abnormal protein fibers made of antibody fragments. Some people with primary amyloidosis have a condition called multiple myeloma. The antibody fragments come together to form amyloid deposits in different organs, including the kidneys, where they cause serious damage. Injured kidneys can't function effectively and may be unable to remove urea and other wastes from the blood. Elevated levels of these protein fibers can also damage the heart, lungs, brain, and digestive system.

One common sign of kidney amyloidosis is the presence of abnormally high levels of protein in the urine, a condition known as proteinuria. Healthy kidneys prevent protein from entering the urine, so the presence of protein may be a sign that the kidneys aren't working properly. A physician who finds large amounts of protein in the urine may also perform a biopsy—take a small sample of tissue for examination with a microscope—to confirm amyloidosis.

Current treatments are aimed at slowing the progression of amyloid build-up. Combination drug therapy with melphalan, a cancer drug, and prednisone, an anti-inflammatory steroid drug, may improve organ function and survival rates by interrupting the growth of the abnormal cells that produce amyloid protein. These are the same drugs used in chemotherapy to treat certain cancers, such as multiple myeloma, and they may have serious side effects, such as nausea and vomiting, hair loss, and fatigue.

Some clinics have reported promising results treating amyloidosis by transplanting the patient’s own blood stem cells to replace diseased or damaged bone marrow. The therapy also requires high doses of melphalan, so side effects can be serious. Patients with heart problems may not be considered for this treatment.

Dialysis-Related Amyloidosis

Normal kidneys filter and remove excess small proteins from the blood, thus keeping blood levels normal. When the kidneys don't work properly, as in patients receiving dialysis, one type of small protein calle beta-2-microglobulin builds up in the blood. When this occurs, beta-2-microglobulin molecules may join together, like the links of a chain, forming a few very large molecules from many smaller ones. These large molecules can form deposits and eventually damage the surrounding tissues and cause great discomfort. This condition is called dialysis-related amyloidosis (DRA).

DRA is relatively common in patients, especially older adults, who have been on hemodialysis for more than 5 years. Hemodialysis membranes that have been used for many years don't effectively remove the large, complex beta-2-microglobulin proteins from the bloodstream. Newer hemodialysis membranes, as well as peritoneal dialysis, remove beta-2-microglobulin more effectively, but not enough to keep blood levels normal. As a result, blood levels remain elevated, and deposits form in bone, joints, and tendons (the tissue that connects the muscle to the bone). DRA may result in pain, stiffness, and fluid in the joints. Patients with DRA may also develop hollow cavities, or cysts, in some of their bones; these may lead to unexpected bone fractures. Amyloid deposits may cause tears in ligaments and tendons. Most patients with these problems can be helped by surgical intervention.

Half of the people with DRA also develop a condition called carpal tunnel syndrome, which results from the unusual buildup of protein in the wrists. Patients with this condition may experience numbness or tingling, sometimes associated with muscle weakness, in their fingers and hands. This is a treatable condition.

Unfortunately, no cure for DRA has been found, although a successful kidney transplant may stop the disease from progressing. However, DRA has caught the attention of dialysis engineers, who are attempting to develop new dialysis membranes that can remove larger amounts of beta-2-microglobulin from the blood.

Resources:

Kidney Diseases Dictionary. National Kidney and Urologic Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. NIH Publication No. 03-4359: May 2003

Amyloidosis and Kidney Disease. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health. NIH Publication No. 06–4694: May 2006

NIDDK Image Library. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). National Institutes of Health.

Page Last Reviewed: May 22, 2007
By: D.K. Mangusan Jr., PTRP

What are to be expected from a kidney failure?

2007-04-15T15:56:00.000+08:00

Definition:
kidney failure:
Loss of kidney function. (See also end-stage renal disease, acute renal failure, and chronic kidney disease.)

Related Terms:

acute renal (REE-nul) failure: Sudden and temporary loss of kidney function.
end-stage renal (REE-nul) disease (ESRD): Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys.
chronic kidney disease (CKD): Any condition that causes reduced kidney function over a period of time. CKD is present when a patient's glomerular filtration rate remains below 60 mL/min/1.73 m2 for more than 3 months.

Kidney failure can hit you in surprising ways. You may get headaches and other pains. You may be tired all the time and lose your appetite. But what do the kidneys have to do with these conditions?

Healthy kidneys remove waste products from your blood. When your kidneys stop working waste products build up in your blood. These waste products are called uremic toxins. This condition is known as uremia. Your kidneys also make hormones and balance chemicals in your system. When your kidneys stop working many problems can happen. You may develop anemia (low blood count) or conditions that affect your bones, nerves, and skin. Some of the more common conditions caused by kidney failure are fatigue, bone problems, joint problems, itching, and "restless legs."

Anemia and Fatigue

Anemia is a condition in which the red blood cells in the body are low. Red blood cells carry oxygen to the cells in the body. Without oxygen, cells can’t use the energy from food. Someone with anemia may tire easily and look pale. Anemia can also add to heart problems.

Anemia is common in people with kidney disease because the kidneys produce the hormone erythropoietin (EPO). EPO helps the bone marrow to make red blood cells. People with kidney disease often don’t make enough EPO. Their bone marrow makes fewer red blood cells so they get anemia. EPO is available by prescription. EPO is commonly given to patients who are on dialysis.

Loss of Appetite and Nausea

Having uremia can change the way food tastes to you. You may no longer like foods you used to crave. In fact, sometimes you may feel sick to your stomach at the thought of eating. But getting enough protein and calories is important for staying healthy. Work with your clinic’s dietitian to find meals that appeal to you and provide the nutrients you need.

Itching (Pruritus)

Many people treated with hemodialysis complain of itchy skin. This is often worse during or just after the dialysis treatment. Itching is common even in people who do not have kidney disease. If you have kidney failure the itching can be made worse by uremic toxins that aren't removed from the blood during dialysis. The problem can also be related to high levels of parathyroid hormone (PTH). This is also common in kidney failure. Some people feel much better after having their parathyroid glands removed. But a cure for itching that works for everyone has not been found. Phosphate binders seem to help some people. Others find relief after exposure to ultraviolet light. Still others improve with EPO shots. A few antihistamines (Benadryl, Atarax, Vistaril) have been found to help. Capsaicin cream applied to the skin may relieve itching by deadening nerve impulses. Whatever treatment you choose, taking care of dry skin is important. Applying creams with lanolin or camphor may help keep your skin moist.

Sleep Disorders

Patients on dialysis often have insomnia (trouble getting to sleep). Some people have a special problem called the sleep apnea syndrome. Episodes of apnea are breaks in breathing during sleep. Over time, these sleep disturbances can lead to "day-night reversal" (insomnia at night, sleepiness during the day). This can cause headaches, depression, and decreased alertness. The apnea may be related to the effects advanced kidney failure has on the control of breathing.

Some treatments may work with people who have sleep apnea, whether they have kidney failure or not. These include losing weight, changing sleeping position, and wearing a mask that gently pumps air continuously into the nose (nasal continuous positive airway pressure, or CPAP).

Many people on dialysis have trouble sleeping at night because of aching, uncomfortable, jittery, or "restless" legs. You may feel a strong impulse to kick or thrash your legs. Kicking may occur during sleep and disturb a bed partner throughout the night. Theories about the causes of this syndrome include nerve damage and chemical imbalances.

Moderate exercise during the day may help, but exercising a few hours before bedtime can make restless legs worse. People with restless leg syndrome should reduce or avoid caffeine, alcohol, and tobacco. Some people also find relief through massages or warm baths. A class of drugs called benzodiazepines may also help. They are often used to treat insomnia or anxiety. These prescription drugs include Klonopin, Librium, Valium, and Halcion. A newer and sometimes more effective therapy is levodopa (Sinemet). This drug is also used to treat Parkinson’s disease.

Sleep disorders may not seem important, but they can make your quality of life worse. Make sure to bring these problems up with your nurse, doctor, or social worker.

Renal Osteodystrophy

The term "renal" describes things related to the kidneys. Renal osteodystrophy means bone disease of kidney failure. It affects 90 percent of dialysis patients, both children and adults, causing bones to become thin, weak, or malformed. Symptoms can be seen in growing children with kidney disease even before they start dialysis. Older patients and women who have gone through menopause are at greater risk for this disease.

Amyloidosis
Dialysis-related amyloidosis (DRA) is common in people who have been on dialysis for more than 5 years. DRA develops when proteins in the blood deposit on joints and tendons. This causes pain, stiffness, and fluid in the joints, as is the case with arthritis. Working kidneys filter out these proteins. With kidney disease these proteins can build up. Dialysis filters are not as good as the kidney. That is why DRA can happen in dialysis patients.

Depression

Adjusting to the effects of kidney failure and the time you spend on dialysis can be difficult. Aside from the "lost time," you may have less energy. You may need to make changes in your work or home life, giving up some activities and responsibilities. Keeping the same schedule you kept when your kidneys were working can be very difficult now that your kidneys have failed. Accepting this new reality can be very hard on you and your family. A counselor or social worker can help you cope.

Many patients feel depressed when starting dialysis, or after several months of treatment. If you feel depressed, you should talk with your social worker, nurse, or doctor. This is a common problem that can often be treated effectively.

Your treatment should do more than just keep you alive. It should also give you the best quality of life possible. Don't assume that you have to live with fatigue and pain. Talk with your health care team so they can help you get the most from your treatments.

Note: Do not self-medicate. Always consult your doctor regarding medications.

Resources:
Kidney Diseases Dictionary A-Z. National Kidney and Urologic Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. NIH Publication No. 03-4359: May 2003

Kidney Failure: What to expect. National Kidney and Urologic Information Clearinghouse. National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health. NIH Publication No. 06–6059: July 2006

This Page Last Revised: February 1, 2008

Malaria: Facts

2007-04-15T11:41:00.000+08:00

Introduction:

Malaria is a mosquito-borne disease caused by a parasite. People with malaria often experience fever, chills, and flu-like illness. Left untreated, they may develop severe complications and die. Each year 350-500 million cases of malaria occur worldwide, and over one million people die, most of them young children in sub-Saharan Africa.

This sometimes fatal disease can be prevented and cured. Bednets, insecticides, and antimalarial drugs are effective tools to fight malaria in areas where it is transmitted. Travelers to a malaria-risk area should avoid mosquito bites and take a preventive antimalarial drug.

Malaria: Facts

Malaria in the United States

1,337 cases of malaria, including 8 deaths, were reported for 2002 in the United States, even though malaria has been eradicated in this country since the early 1950's
Of the 1,337 malaria cases reported for 2002 in the United States, all but five were imported, i.e., acquired in malaria-endemic countries.
Between 1957 and 2003, in the United States, 63 outbreaks of locally transmitted mosquito-borne malaria have occurred; in such outbreaks, local mosquitoes become infected by biting persons carrying malaria parasites (acquired in endemic areas) and then transmit malaria to local residents.
Of the ten species of Anopheles mosquitoes found in the United States, the two species that were responsible for malaria transmission prior to eradication (Anopheles quadrimaculatus in the east and An. freeborni in the west) are still widely prevalent; thus there is a constant risk that malaria could be reintroduced in the United States.
During 1963-1999, 93 cases of transfusion-transmitted malaria were reported in the United States; approximately two thirds of these cases could have been prevented if the implicated donors had been deferred according to established guidelines.

Malaria Worldwide

Forty-one percent of the world's population live in areas where malaria is transmitted (e.g., parts of Africa, Asia, the Middle East, Central and South America, Hispaniola, and Oceania).
Each year 350–500 million cases of malaria occur worldwide, and over one million people die, most of them young children in sub-Saharan Africa.
In areas of Africa with high malaria transmission, an estimated 990,000 people died of malaria in 1995 – over 2700 deaths per day, or 2 deaths per minute.
In 2002, malaria was the fourth cause of death in children in developing countries, after perinatal conditions (conditions occurring around the time of birth), lower respiratory infections (pneumonias), and diarrheal diseases. Malaria caused 10.7% of all children's deaths in developing countries.
In Malawi in 2001, malaria accounted for 22% of all hospital admissions, 26% of all outpatient visits, and 28% of all hospital deaths. Not all people go to hospitals when sick or having a baby, and many die at home. Thus the true numbers of death and disease caused by malaria are likely much higher.

Biology, Pathology, Epidemiology

Residents of Asembo Bay (Western Kenya) were bitten 60-300 times a year by a malaria-carrying mosquito in the 1990's, before control measures (including the use of insecticide-treated bed nets) were put in place.
Among the four malaria species that infect humans, Plasmodium vivax and P. ovale can develop dormant liver stages that can reactivate after symptomless intervals of up to 2 (P. vivax) to 4 years (P. ovale).
84% of the blood transfusions given in March-June 2000 in a major hospital in Kinshasa (Democratic Republic of Congo) were for anemia caused by malaria.
Pregnant women have increased susceptibility to Plasmodium falciparum malaria; in malaria-endemic countries, P. falciparum contributes to 8-14% of low birth weight, which in turn decreases the chance of a baby’s survival
After a single sporozoite (the parasite form inoculated by the female mosquito) of Plasmodium falciparum invades a liver cell, the parasite grows in 6 days and produces 30,000-40,000 daughter cells (merozoites) which are released into the blood when the liver cell ruptures. In the blood, after a single merozoite invades a red blood cell, the parasite grows in 48 hours and produces 8-24 daughter cells, which are released into the blood when the red blood cell ruptures.

Prevention and Treatment

Four Nobel prizes have been awarded for work associated with malaria, to Sir Ronald Ross (1902), Charles Louis Alphonse Laveran (1907), Julius Wagner-Jauregg (1927) and Paul Hermann Muller (1948).
Two important currently used antimalarial drugs are derived from plants whose medicinal values had been noted for centuries: artemisinin from the Qinghao plant (Artemisia annua L, China, 4th century) and quinine from the cinchona tree (South America, 17th century).
Insecticide-treated bed nets decreased the mortality of children aged 1-11 months in a trial in western Kenya in 1997-1999.
A survey in Southeast Asia in 1999-2000 showed that of 104 shop-bought samples purportedly containing the antimalarial drug artesunate, 38% contained no artesunate.
The average cost for potentially life-saving treatments of malaria are estimated to be US$0.13 for chloroquine, US$0.14 for sulfadoxine-pyrimethamine, and US$2.68 for a 7-day course of quinine.

See Also: How People Get Malaria (Transmission)

Content source: Malaria. National Center for Infectious Diseases, Division of Parasitic Diseases. Centers for Disease Control Prevention. April 11, 2007

This Page Last Revised: February 1, 2008

Acute Pancreatitis: Causes, Signs and Symptoms, Diagnosis and Treatment

2007-04-15T09:58:00.000+08:00

Acute Pancreatitis

Pancreatitis is the inflammation of the pancreas. In acute pancreatitis, some people have more than one attack and recover completely after each, but acute pancreatitis can be a severe, life-threatening illness with many complications. About 80,000 cases occur in the United States each year; some 20 percent of them are severe. Acute pancreatitis occurs more often in men than women.

Acute pancreatitis is usually caused by gallstones or by drinking too much alcohol, but these aren't the only causes. If alcohol use and gallstones are ruled out, other possible causes of pancreatitis should be carefully examined so that appropriate treatment—if available—can begin. See Causes, Signs and Symptoms, Diagnosis and Treatment at: DSD-Digestive System Disorders: Acute Pancreatitis: Causes, Signs and Symptoms, Diagnosis and Treatment

About Blog For Health

2007-04-13T17:04:00.004+08:00

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Privacy Statement, Mission and Disclaimer, Advertisement Policy, Pop-Up Advertisements, and Site Maintenance: Updated: September 18, 2010.

How does Diabetes hurt or affect my Kidneys?

2007-04-13T16:23:00.000+08:00

Diabetes (dy-uh-BEE-teez) Mellitus (MELL-ih-tus):

A condition characterized by high blood glucose (sugar) resulting from the body's inability to use glucose efficiently. In type 1 diabetes, the pancreas makes little or no insulin; in type 2 diabetes, the body is resistant to the effects of available insulin.

How does Diabetes hurt or affect my Kidneys?

When kidneys are working well, the tiny filters in your kidneys, the glomeruli, keep protein inside your body. You need the protein to stay healthy.

High blood glucose and high blood pressure damage the kidneys’ filters. When the kidneys are damaged, the protein leaks out of the kidneys into the urine. Damaged kidneys do not do a good job of cleaning out waste and extra fluids. Waste and fluids build up in your blood instead of leaving the body in urine.

Kidney damage begins long before you notice any symptoms. An early sign of kidney damage is when your kidneys leak small amounts of a protein called albumin into the urine. But the only way to know about this leakage is to have your urine tested.

With more damage, the kidneys leak more and more protein. This problem is called proteinuria. More and more wastes build up in the blood. This damage gets worse until the kidneys fail.

Diabetic nephropathy is the medical term for kidney problems caused by diabetes. Nephropathy affects both kidneys at the same time.

Related Topics:
Diabetes Information

Type 2 Diabetes

Prevention of Diabetes Complications

How does Diabetes hurt or affect my Kidneys? (Current Page)

To learn more about Diabetes visit: UD-IA: Understanding Diabetes-Increasing Awareness

Sources:
1. Kidney Diseases Dictionary D-E. National Diabetes Information Clearinghouse (NDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).NIH Publication No. 03–4359: May 2003

2. Prevent diabetes problems: Keep your kidneys healthy. National Diabetes Information Clearinghouse (NDIC). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).NIH Publication No. 06–4281:March 2006

This Page Last Revised: February 1, 2008

How to Prevent the Formation of Kidney Stones

2007-04-13T15:55:00.000+08:00

Kidney stones, one of the most painful of the urologic disorders, are not a product of modern life. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. In 2000, patients made 2.7 million visits to health care providers and more than 600,000 patients went to emergency rooms for kidney stone problems. Men tend to be affected more frequently than women.

A kidney stone is a hard mass developed from crystals that separate from the urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.

Here are some points to remember to prevent the formation of Kidney Stones.

If you have a family history of stones or have had more than one stone, you are likely to develop more stones.
A good first step to prevent the formation of any type of stone is to drink plenty of liquids—water is best.
If you are at risk for developing stones, your doctor may perform certain blood and urine tests to determine which factors can best be altered to reduce that risk.
Some people will need medicines to prevent stones from forming.
People with chronic urinary tract infections and stones will often need the stone removed if the doctor determines that the infection results from the stone's presence. Patients must receive careful followup to be sure that the infection has cleared.

Gallstones and kidney stones are not related. They form in different areas of the body. If you have a gallstone, you are not necessarily more likely to develop kidney stones.

See also Blog for Health: Gallstones

Sources:

1. Kidney Diseases Dictionary K-O. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC).National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH Publication No. 03–4359: May 2003

2. Kidney Stones in Adults. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC).National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH Publication No. 05–2495: December 2004

This Page Last Revised: February 1, 2008

Swimmer's Itch: Should I be Worried about it?

2007-04-13T14:58:00.000+08:00

What is swimmer's itch?

Swimmer's itch, also called cercarial dermatitis, appears as a skin rash caused by an allergic reaction to certain parasites found in certain birds and mammals . These microscopic parasites are released from infected snails into fresh and salt water (such as lakes, ponds, and oceans). Rather than finding a host bird or mammal, the parasite instead burrows into the nearby swimmer's skin, causing an allergic reaction and rash. Swimmer's itch is found throughout the world and is more frequent during summer months.

What are the signs and symptoms of swimmer's itch?
Symptoms of swimmer's itch may include:

tingling, burning, or itching of the skin
small reddish pimples
small blisters

Within minutes to days after swimming in contaminated water, you may experience tingling,
burning, or itching of the skin. Small reddish pimples appear within twelve hours. Pimples may develop into small blisters. Scratching the areas may result in secondary bacterial infections. Itching may last up to a week or more, but will gradually go away.

Because swimmer's itch is caused by an allergic reaction to infection, the more often you swim or wade in contaminated water, the more likely you are to develop more serious symptoms. The greater the number of exposures to contaminated water, the more intense and immediate symptoms of swimmer's itch will be.

Be aware that swimmer's itch is not the only rash that may occur after swimming in fresh and salt water.

Do I need to see my health care provider for treatment?
Most cases of swimmer's itch do not require medical attention. If you have a rash, you may try the following for relief:

Use corticosteroid cream
Apply cool compresses to the affected areas
Bathe in Epson salts or baking soda
Soak in colloidal oatmeal baths, such as Aveeno*
Apply baking soda paste to the rash (made by stirring water into baking soda until it reaches a paste-like consistency)
Use an anti-itch lotion, such as Calamine* lotion

* Use of trade names is for identification only and does not
imply endorsement by Blog for Health.

Though difficult, try not to scratch. Scratching may cause the
rash to become infected. If itching is severe, your health care provider may
suggest prescription-strength lotions or creams to lessen your symptoms.

Can swimmer's itch be spread from person-to-person?

Swimmer's itch is not contagious and cannot be spread from one person to another.

Who is at risk for swimmer's itch?

Anyone who swims or wades in infested water may be at risk. Larvae are more likely to be present in shallow water by the shoreline. Children are most often affected because they tend to swim, wade, and play in the shallow water more than adults. Also, they are less likely to towel dry themselves when leaving the water.

Is it safe to swim in my swimming pool?

Yes. As long as your swimming pool is well maintained and chlorinated, there is no risk of swimmer's itch.

Source:
Excerpted: Circarial Dermatitis Fact Sheet. Division of Parasitic Diseases. Centers for Disease Control and Prevention. Revised Summer 2004

This Page Last Revised: February 1, 2008

FDA Re-Emphasizes Warnings to Consumers on Risks of Pet Turtles

2007-04-09T20:17:00.000+08:00

The Food and Drug Administration (FDA) is urgently reminding the public that contact with baby turtles can pose a serious health risk to infants, small children, and adults with impaired immune systems as they can be natural hosts to Salmonella, a group of bacteria that can cause severe illness and death. Recently, a four-week old infant in Florida died of infection traced to Salmonella pomona, a bacteria that was also found in a pet turtle in the home.

Salmonella is the genus name of a number of bacteria commonly associated with food poisoning from contaminated or undercooked foods, and salmonellosis is the disease the bacteria can cause. Salmonella can be found on the outer skin and shell surfaces of the turtles causing salmonellosis for those handling turtles without properly washing their hands after handling the animals.

FDA is reminding parents and others who care for children of the following:

The sale of turtles with a shell less than four inches long is illegal. Exceptions to FDA's regulation include sales of these turtles intended for export only or for bona fide scientific, educational, or exhibitional purpose;
Salmonella infection can be caused by contact with turtles in petting zoos, parks, child day care facilities and other locations; and
It is important to wash hands thoroughly with soap and water after handling or touching turtles and their housing.

In the early 1970's, it was determined that pet turtles, particularly red-eared sliders, were responsible for an estimated 280,000 cases of salmonellosis each year in the United States. In 1975, FDA banned the sale of turtles with a shell less than four inches long as a necessary public health measure. FDA has repeatedly emphasized the risks of turtle-associated salmonellosis because of a resurgence in the sales of such turtles in the last four years. The public health impact of turtle-associated salmonellosis in humans is an estimated 74,000 cases in the United States per year.

Salmonella infection can be transmitted either directly from contact with the turtle or its feces, or indirectly through the animal's water. Turtles with Salmonella usually do not appear to be sick. Their feces do not always contain the bacteria, therefore a single negative test does not prove they are Salmonella-free.

Although anyone can acquire a salmonellosis infection, the risk is highest in infants, young children, the elderly, and others with lowered natural resistance to disease. Pregnancy, cancer, chemotherapy, organ transplant, diabetes, and liver problems pose particular risks. Gastrointestinal symptoms following Salmonella exposure begin in 6 to 72 hours (usually 12 to 36 hours) and generally last for two to seven days.

____________________________

Source:
FDA Re-Emphasizes Warnings to Consumers on Risks of Pet Turtles. FDA News. US Food and Drugs Administration. P07-62: April 6, 2007. http://www.fda.gov/bbs/topics/NEWS/2007/NEW01604.html
________________________________

Related Topics:
Tips for Preventing Salmonella Poisoning

Common Bacteria that Causes Foodborne Illnesses

This Page Last Revised: February 1, 2008

Gallstones

2007-04-06T13:36:00.000+08:00

What are gallstones?
Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, is used to help the body digest fats.

Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube—called the common bile duct—that carries it to the small intestine, where it helps with digestion.

Bile contains water, cholesterol, fats, bile salts, proteins, and bilirubin. Bile salts break up fat, and bilirubin gives bile and stool a yellowish color. If the liquid bile contains too much cholesterol, bile salts, or bilirubin, under certain conditions it can harden into stones.

The two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin. Gallstones can be as small as a grain of sand or as large as a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.

Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas. If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called gallstone pancreatitis.

If any of these ducts remain blocked for a significant period of time, severe—possibly fatal—damage or infections affecting the gallbladder, liver, or pancreas can occur. Warning signs of a serious problem are fever, jaundice, and persistent pain.

What causes gallstones?
Cholesterol Stones
Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.

Pigment Stones
The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders, such as sickle cell anemia, in which too much bilirubin is formed.

Other Factors
It is believed that the mere presence of gallstones may cause more gallstones to develop. However, other factors that contribute to gallstones have been identified, especially for cholesterol stones.

Obesity. Obesity is a major risk factor for gallstones, especially in women. A large clinical study showed that being even moderately overweight increases the risk for developing gallstones. The most likely reason is that obesity tends to reduce the amount of bile salts in bile, resulting in more cholesterol. Obesity also decreases gallbladder emptying.
Estrogen. Excess estrogen from pregnancy, hormone replacement therapy, or birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones.
Ethnicity. Native Americans have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rate of gallstones in the United States. A majority of Native American men have gallstones by age 60. Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30. Mexican American men and women of all ages also have high rates of gallstones.
Gender. Women between 20 and 60 years of age are twice as likely to develop gallstones as men.
Age. People over age 60 are more likely to develop gallstones than younger people.
Cholesterol-lowering drugs. Drugs that lower cholesterol levels in blood actually increase the amount of cholesterol secreted in bile. This in turn can increase the risk of gallstones.
Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids increase the risk of gallstones.
Rapid weight loss. As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones.
Fasting. Fasting decreases gallbladder movement, causing the bile to become overconcentrated with cholesterol, which can lead to gallstones.

What are the symptoms?
Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly. A typical attack can cause

steady pain in the upper abdomen that increases rapidly and lasts from 30
minutes to several hours
pain in the back between the shoulder blades
pain under the right shoulder
nausea or vomiting

Gallstone attacks often follow fatty meals, and they may occur during the night.

Other gallstone symptoms include

abdominal bloating
recurring intolerance of fatty foods
colic
belching
gas
indigestion

People who also have the above and any of following symptoms should see a doctor right away:

chills
low-grade fever
yellowish color of the skin or whites of the eyes
clay-colored stools

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." They do not interfere with gallbladder, liver, or pancreas function, and do not need treatment.

How are gallstones diagnosed?

Many gallstones, especially silent stones, are discovered by accident during tests for other problems. But when gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam. Ultrasound uses sound waves to create images of organs. Sound waves are sent toward the gallbladder through a handheld device that a technician glides over the abdomen. The sound waves bounce off the gallbladder, liver, and other organs such as a pregnant uterus, and their echoes make electrical impulses that create a picture of the organ on a video monitor. If stones are present, the sound waves will bounce off them, too, showing their location. Ultrasound is the most sensitive and specific test for gallstones.

Other tests may also be used.
Computed tomography (CT) scan may show the gallstones or complications.

Magnetic resonance cholangiogram may diagnose blocked bile ducts.

Cholescintigraphy (HIDA scan) is used to diagnose abnormal contraction of the gallbladder or obstruction. The patient is injected with a radioactive material that is taken up in the gallbladder, which is then stimulated to contract.

Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope—a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts.

Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundice.

Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.

What is the treatment?

Surgery
Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. (Asymptomatic gallstones usually do not need treatment.) Each year more than 500,000 Americans have gallbladder surgery. The surgery is called cholecystectomy.

The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a closeup view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures. Then the cystic duct is cut and the gallbladder removed through one of the small incisions.

Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen. Recovery usually involves only one night in the hospital, followed by several days of restricted activity at home.

If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. In some cases the obstacles are known before surgery, and an open surgery is planned. It is called "open" surgery because the surgeon has to make a 5- to 8-inch incision in the abdomen to remove the gallbladder. This is a major surgery and may require about a 2- to 7-day stay in the hospital and several more weeks at home to recover. Open surgery is required in about 5 percent of gallbladder operations.

The most common complication in gallbladder surgery is injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated nonsurgically. Major injury, however, is more serious and requires additional surgery.

If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery. In ERCP, the patient swallows an endoscope—a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. Then the affected bile duct is located and an instrument on the endoscope is used to cut the duct. The stone is captured in a tiny basket and removed with the endoscope.

Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery. The two-step ERCP procedure is usually successful in removing the stone.

Nonsurgical Treatment

Nonsurgical approaches are used only in special situations—such as when a patient has a serious medical condition preventing surgery—and only for cholesterol stones. Stones usually recur after nonsurgical treatment.

Oral dissolution therapy. Drugs made from bile acid are used to dissolve the stones. The drugs, ursodiol (Actigall) and chenodiol (Chenix), work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.

Contact dissolution therapy. This experimental procedure involves injecting a drug directly into the gallbladder to dissolve stones. The drug—methyl tertbutyl ether—can dissolve some stones in 1 to 3 days, but it must be used very carefully because it is a flammable anesthetic that can be toxic. The procedure is being tested in patients with symptomatic, noncalcified cholesterol stones.

Don't people need their gallbladder?

Fortunately, the gallbladder is an organ that people can live without. Losing it won't even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder. However, because the bile isn't stored in the gallbladder, it flows into the small intestine more frequently, causing diarrhea in about 1 percent of people.

Points to Remember

Gallstones form when substances in the bile harden.
Gallstones are more common among older adults, women, Native
Americans, Mexican Americans, and people who are overweight.
Gallstone attacks often occur after eating a meal.
Symptoms can mimic those of other problems, including heart attack, so
accurate diagnosis is important.
Gallstones can cause serious problems if they become trapped in the bile ducts.
Laparoscopic surgery to remove the gallbladder is the most common treatment.

________________________
"Blog for Health" does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.
________________________

Sources:
1. Gallstones. National Digestive Diseases Information Clearinghouse (NDDIC). National Institutes of Health. NIH Publication No. 05–2897: November 2004

2. Image Credit: National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health

This Page Last Revised: February 1, 2008

Eat Healthy to Help Prevent Heart Disease

2007-04-04T17:05:00.000+08:00

What kills Americans most? Heart disease. It’s the No.1 cause of death in this country.

You can lower your chances of getting heart disease. One way is to choose foods carefully. For a healthy heart, eat:

less fat
less sodium
fewer calories
more fiber.

Eat less Fat

Some fats are more likely to cause heart disease—saturated fats and trans fats. These fats are usually found in foods from animals, such as meat, milk, cheese, and butter. They also are found in foods with palm and coconut oils. Eat less of these foods.

Eat less Sodium
Eating less sodium can help lower some people’s blood pressure. This can help reduce the risk of heart disease.

Sodium is something we need in our diets, but most of us eat too much of it. Much of the sodium we eat comes from salt we add to our food at the table or that food companies add to their foods. So, avoid adding salt to foods at the table.

Eat fewer Calories
When we eat more calories than we need, we gain weight. Being overweight can cause heart disease. When we eat fewer calories than we need, we lose weight.

Eat more Fiber
Eating fiber from fruits, vegetables, and grains may help lower your chances of getting heart disease.

Diet Tips for a Healthy Heart

Eat a diet low in saturated fat, especially animal fats and palm and coconut oils.
Add foods to your diet that are high in monounsaturated fats, such as olive oil, canola oil, and seafood.
Eat foods containing polyunsaturated fats found in plants and seafood.
Safflower oil and corn oil are high in polyunsaturated fats.
Choose a diet moderate in salt and sodium.
Maintain or improve your weight.
Eat plenty of grain products, fruits, and vegetables.

Read the Food Label
The food label can help you eat less fat and sodium, fewer calories, and more fiber.

Look for certain words on food labels. The words can help you spot foods that may help reduce your chances of getting heart disease. The FDA has set rules on how these words can be used. So, if the label says “low-fat,” the food must be low in fat.

Look at the side or back of the package. Here, you will find “Nutrition Facts.”

Look for these words:

Total fat
Saturated fat
Cholesterol
Sodium.

Look at the % Daily Value listed next to each term. If it is 5% or less for fat, saturated fat, cholesterol, and sodium, the food is low in these nutrients.
That’s good. It means the food fits in with a diet that may help reduce your chances of getting heart disease.

Tips for Losing Weight

Eat smaller portions.
Avoid second helpings.
Eat less fat by staying away from fried foods, rich desserts, and chocolate candy. Foods with a lot of fat have a lot of calories.
Eat more fruits and vegetables.

Eating for a Healthy Heart
You can lower your chances of getting heart disease. One way is through your diet.Remember:

Eat less fat and sodium.
Reduce your calories if you’re -over--weight.
Eat more fiber.
Eat a variety of foods including plenty of bread, rice, cereal, fruit and vegetables.
If you drink beer, wine, or other alcoholic beverages, do so in moderation.

Some Other Things You Can Do
Ask your doctor to check your cholesterol level. This is done with a blood test. The test will show the amount of cholesterol in your blood with a number. Below 200 is good. The test will also show the amount of “good” and “bad” cholesterol. Your doctor can tell you more about what these numbers mean.

If your cholesterol is high, your doctor may suggest diet changes, exercise, or drugs to bring it down.

Regular exercise–such as walking, swimming, or gardening–can help you keep your weight and cholesterol down.

____________________________

Topic Source: Eating for a Healthy Heart. The Food and Drug Administration. U.S. Department of Health and Human Services. FDA05-1110C

This Page Last Revised: February 1, 2008

Inguinal Hernia

2007-04-02T12:12:00.000+08:00

By: David Mangusan Jr., PTRP

Definition:
Inguinal Hernia (IN-gwuh-nul HUR-nee-uh) A small part of the large or small intestine or bladder that pushes into the groin. May cause pain and feelings of pressure or burning in the groin. Often requires surgery(1).

Description:
A hernia is a condition in which part of the intestine bulges through a weak area in muscles in the abdomen. An inguinal hernia occurs in the groin (the area between the abdomen and thigh). It is called "inguinal" because the intestines push through a weak spot in the inguinal canal, which is a triangle-shaped opening between layers of abdominal muscle near the groin. Obesity, pregnancy, heavy lifting, and straining to pass stool can cause the intestine to push against the inguinal canal (2).

This herniation can be quite painful and very dangerous, especially if the inguinal canal compresses the intestine and cuts off blood its blood supply.

Signs and Symptoms:
Signs and symptoms of inguinal hernia may include a lump in the groin near the thigh; pain in the groin; and, in severe cases, partial or complete blockage of the intestine. The doctor diagnoses hernia by doing a physical exam and by taking x rays and blood tests to check for blockage in the intestine (3).

Treatment:

The main treatment for inguinal hernia is surgery to repair the opening in the muscle wall. This surgery is called herniorrhaphy. Sometimes the weak area is reinforced with steel mesh or wire. This operation is called hernioplasty. If the protruding intestine becomes twisted or traps stool, part of the intestine might need to be removed. This surgery is called bowel resection (4).

Sources:
1. Digestive Diseases Dictionary E – K. National Digestive Diseases Clearinghouse. National Institutes of Health. NIH Publication No. 00–2750 - February 2000
2. Inguinal Hernia. National Digestive Diseases Clearinghouse. National Institutes of Health. NIH Publication No. 02–4634 - January 2002
3. Ibid.
4. Ibid.

5. Image Credit: Digestive Diseases Dictionary E – K. National Digestive Diseases Clearinghouse. National Institutes of Health. NIH Publication No. 00–2750 - February 2000

Gouty Arthritis: Description, Signs and Symptoms, and Treatment Options

2007-04-02T10:27:00.000+08:00

What Is Gout?

Gout is one of the most painful forms of arthritis. It occurs when too much uric acid is produced excessively in the body or is not excreted as much as normal.

The buildup of uric acid can lead to:

Sharp uric acid crystal deposits in joints, often in the big toe. The crystals irritate and erode the joint cartilage, causing inflammation, swelling, and acute pain.
Deposits of uric acid (called tophi) that look like lumps under the skin
Kidney stones from uric acid crystals in the kidneys.

For many people, the first attack of gout occurs in the big toe. Often, the attack wakes a person from sleep. The toe is very sore, red, warm, and swollen(1).

Gout can cause:

Pain
Swelling
Redness
Heat
Stiffness in joints.

In addition to the big toe, gout can also affect the:
Instep, Ankles, Heels, Knees, Wrists, Fingers, Elbows.

A gout attack can be brought on by stressful events, alcohol or drugs, or another illness. Early attacks usually get better within 3 to 10 days, even without treatment. The next attack may not occur for months or even years.

What Causes Gout?

Gout is caused by the buildup of too much uric acid in the body. Uric acid comes from the breakdown of substances called purines. Purines are found in all of your body's tissues.

Gout attacks often follow eating foods like shellfish, liver, dried beans, peas, anchovies, or gravy. Using alcohol, being overweight, and certain medications may also make gout worse. In older people, some blood pressure medicines can also increase your chance of a gout attack(2).

Normally, uric acid dissolves in the blood. It passes through the kidneys and out of the body in urine. But uric acid can build up in the blood when:

The body increases the amount of uric acid it makes.
The kidneys do not get rid of enough uric acid.
A person eats too many foods high in purines.

When uric acid levels in the blood become too high, it is termed as hyperuricemia. Most people with hyperuricemia do not develop gout. But if excess uric acid crystals form in the body, gout can develop.

You are more likely to have gout if you:

Have family members with the disease
Are a man
Are overweight
Drink too much alcohol
Eat too many foods rich in purines
Have an enzyme defect that makes it hard for the body to break down purines
Are exposed to lead in the environment
Have had an organ transplant
Use some medicines such as diuretics, aspirin, cyclosporine, or levodopa
Take the vitamin niacin2.

Signs and symptoms of gout include:

Hyperuricemia (high level of uric acid in the blood)
Uric acid crystals in joint fluid
More than one attack of acute arthritis Arthritis that develops in 1 day, producing a swollen, red, and warm joint
Attack of arthritis in only one joint, usually the toe, ankle, or knee(3).

Treatment:

Doctors use medicines to treat an acute attack of gout, including:

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin*
Corticosteroids, such as prednisone
Colchicine, which works best when taken within the first 12 hours of an acute attack.

Sometimes doctors prescribe NSAIDs or colchicine in small daily doses to prevent future attacks. There are also medicines that lower the level of uric acid in the blood(4).

* Brand names included in this topic are provided as examples only,
and their inclusion does not mean that these products are endorsed by the Blog
for Health website. Also, if a particular brand name is not mentioned, this does
not mean or imply that the product is unsatisfactory.

What Can People With Gout Do to Stay Healthy?

Some things that you can do to stay healthy are:

Take the medicines your doctor prescribes as directed.
Tell your doctor about all the medicines and vitamins you take.
Plan follow-up visits with your doctor.
Maintain a healthy, balanced diet.
Avoid foods that are high in purines, and drink plenty of water.
Exercise regularly and maintain a healthy body weight.
Ask your doctor about how to lose weight safely.
Fast or extreme weight loss can increase uric acid levels in the blood(5).

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For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at 1–888–INFO–FDA (1–888–463–6332, a toll-free call) or visit their Web site at www.fda.gov.

Sources:

1.Arthritis Advice. National Institute on Aging. US National Institutes of Health
2. What Is Gout?: Fast Facts. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). National Institutes of Health. Publication Date: March 2005
3. Ibid.
4. Ibid.
5. Ibid.

Page Last Modified: December 28, 2007
By: David Mangusan Jr., PTRP

Respiratory Distress Syndrome (RDS)

2007-04-01T23:01:00.000+08:00

By: David Mangusan Jr., PTRP

Other Names:

Hyaline membrane disease (HMD); Neonatal respiratory distress syndrome; Infant respiratory distress syndrome (IRDS); RDS – infants

Description:

Respiratory Distress Syndrome (RDS) is a respiratory disease of unknown etiology (cause), which occurs, in newborn premature infants due to lack of surfactant coating the inner surface of the lungs. Surfactant greatly reduces the tendency of the lungs to collapse and thus is essential for the expansion of the alveoli or air sacs of the lungs.
.
RDS is common in infants delivered before the seventh month of pregnancy, as surfactant is not produced in adequate quantities until about the seventh month of gestation. Thereafter the amount of surfactant produced increases as the fetus matures.

If too little surfactant has been produced by the time of birth, the lungs tend to collapse making it hard for the infant to breath and a great deal of energy must be exerted by the muscle of respiration to keep the lungs inflated. Even with the extra effort, inadequate ventilation occurs. Without specialized treatment the infant may die as a result of inadequate ventilation of the lungs and fatigue of the respiratory muscles.

Treatment strategies include forcing enough oxygen rich-air into the lungs and administering an artificial lung surfactant produced through genetic engineering.

Running Injuries

2007-04-01T15:33:00.000+08:00

By David Mangusan Jr., PTRP

Many people around the world love to jog or run but nearly 70% of them will at some time sustain a running related injury. Even though most sustained injuries are minor, some are quite serious. Moreover, these minor running injuries may become chronic if left untreated or inappropriately treated. The common sites of running injuries include the knee, Achilles (calcaneal) tendon, hip and groin, foot and ankle and back. Among these, the knee is the most commonly affected area.

The Cause:

Most running injuries are frequently attributed to improper or faulty training techniques. This may involve inadequate or lack of warm-up routines. Beginning runners, sometimes too enthusiastic and out of shape, are often hurt when they initially run too much or run too soon. Running on hard or uneven surfaces for extended periods and wearing poorly constructed or worn out running shoes are some factors that contribute to running injuries. Other factors also inlcude improper running posture and structural abnormalities such as flat footedness, unequal leg length and muscle imbalance.

Conservative Treatment Measures:

Most minor injuries may be treated initially by PRICEMS Therapy, which stands for Protection, Rest, Ice application, Compression, Elevation, Medications, and Support. Immediately apply ice, rest and elevate the injured part. You may also apply an elastic bandage, if possible, to compress the injured tissue. Avoid applying heat during the acute stage of injury as this will worsen the swelling. It is also helpful to take nonsteroidal anti-inflammatory drugs (NSAIDS) to minimize the pain. Continue using PRICEMS Therapy for 2 - 3 days until swelling subsides. Follow-up treatment may include alternating moist heat and ice massage. (If there is still swelling, don't apply heat.)

For severe cases, consult your doctor for proper treatment as torn ligaments and tendons take longer time to heal due to poor blood supply to these types of tissues.

It is important that during the recovery period to be active using an alternative fitness program that does not worsen the original injury. Ask your healthcare provider about these alternative fitness program.

Training for the Injured Runner:

When symptoms are no longer felt (asymptomatic), graduated training program can be performed. For the first 2 weeks, the patient should do alternate walking and running every other day and on alternate days, other types of exercises can be substituted. Prior to walking or running, patient should do warm-up with calisthenics for low back and limbs and stretching exercises. Your healthcare provider (Physician or Physical Therapist) can provide you with a proper graduated training program.

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Always consult your healthcare provider for any injuries or health concerns.

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This Post Last Updated: May 13, 2007

How swimming can make you sick

2007-03-31T20:54:00.000+08:00

How can swimming make you sick?

Most recreational water illness (RWI) reported is diarrheal illness, which is spread by swallowing contaminated water.

In addition, swimming in water contaminated with germs can also cause infections in your eyes, nose, ears, and in cuts and scrapes.

People in the pool share the water with everyone else in the pool. If someone with diarrhea contaminates the water, swallowing the water can make people sick. Recreational water can also be contaminated by fecal matter rinsed off of the bodies of swimmers. When people are ill with diarrhea their stool can contain millions of germs. Therefore, swimming when ill with diarrhea can easily contaminate the water and, if the pool water is swallowed, can make you sick.

How does water get contaminated?

Pools can be contaminated by persons who swim while experiencing diarrhea and have a fecal accident.

Swimming pools, waterparks, hot tubs, and spas can also be contaminated by germs that are rinsed off swimmer's bodies including their rear ends. In addition, lakes, rivers, and the ocean can be contaminated by sewage spills, animal waste, and water runoff.

Diarrrheal accidents are not easily noticed and as a result could contaminate even the best-maintained pool. Plus, some germs like Crypto (short for Cryptosporidium) are resistant to chlorine and can live in even the best-maintained pools for several days.

What kinds of illnesses can people get from swimming?

Diarrheal illness
Skin rashes
Ear infections
Eye infections
Respiratory infections

These recreational water illnesses (RWIs) have been linked to swimming. However, reports to CDC show that diarrhea is one of the most common RWIs. Diarrheal illness is spread when infected germs from human or animal feces gets into the water. If the contaminated water is swallowed it can cause people to become ill.

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Content Excerpts: Centers for Disease Control and Prevention

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Sudden Infant Death Syndrome (SIDS)

2007-03-19T13:51:00.000+08:00

Sudden Infant Death Syndrome (SIDS)
What you should know about SIDS

By: D. K. Mangusan Jr., PTRP

What is Sudden Infant Death Syndrome (SIDS)?

According to the Centers for Disease Control and Prevention (CDC) SIDS is the sudden death of an infant less than one year of age that cannot be explained by information collected during a thorough investigation. An investigation should include a complete autopsy, examination of the death scene, and a review of the clinical history.

Although the overall rate of SIDS in the United States has declined by more than 50% since 1990, rates have declined less among non-Hispanic Black and American Indian/Alaska Native infants. Moreover, SIDS is still the third leading cause of infant mortality in the United States and the first leading cause of death among infants 28-364 days.

Each year in the United States, more than 4,500 infants die suddenly of no obvious cause. Half of these sudden, unexplained infant deaths
(SUID) are due to sudden infant death syndrome (SIDS), the leading cause of SUID
and of all deaths among infants aged 1-12 months. Largely because of the
national Back to Sleep campaign's effort to reduce prone sleeping rates, SIDS
rates have declined by more than 50% since 1990. However, studies have shown
that since 1999, some deaths previously classified as SIDS are now classified as
due to accidental suffocation or unknown/unspecified cause. This finding
suggests that changes in reporting of cause of death may account for part of the
recent decrease in SIDS rates.

By definition, SIDS can only be diagnosed after a thorough examination of the death
scene, a review of the clinical history, and performance of an autopsy fail to
find an explanation for the death. And yet we know that some SUID are not
investigated and, when they are, cause-of-death data are not collected and
reported consistently. This is concerning because inaccurate classification of
cause and manner of death ultimately impedes prevention efforts because
researchers cannot adequately monitor national trends or evaluate prevention
programs. (Excerpts From Centers For Disease Control and Prevention: SUIDI)

Risk Factors:

The cause of SIDS is currently unknown. Several factors have been identified that increase an infant's risk for SIDS.

Risk Factors for SIDS:

Tummy (prone) or side sleeping

Infants who are put to sleep on their tummy or side are more likely to die from SIDS than infants who sleep on their backs.

Soft sleep surfaces
Sleeping on a waterbed, couch, sofa, or pillows, or sleeping with stuffed toys has been associated with an increased risk for SIDS.

Loose bedding

Sleeping with pillows or loose bedding such as comforters, quilts, and blankets increases an infants risk for SIDS.

Overheating

Infants who overheat because they are overdressed, have too many blankets on, or are in a room that is too hot are at a higher risk of SIDS.

Smoking
Infants born to mothers who smoke during pregnancy are at increased of SIDS. Also, infants exposed to smoke at home or at daycare are more likely to die from SIDS.

Bed sharing
Sharing a bed with anyone other than the parents or caregivers and with people who smoke or are under the influence of alcohol or drugs, increases an infant's risk for SIDS. The safest place for an infant to sleep is in their own crib or other separate safe sleep surface next to the parent or caregiver's bed.

Preterm and low birth weight infants

Infants born premature or low birth weight are more likely to die from SIDS.

Safe Sleep Environment
How can you help your infant sleep and nap safely?

Infants should ALWAYS be placed on their backs (face up) when they are resting, sleeping, or left alone.
Infants should be placed on their tummies (tummy time) ONLY when they are awake and supervised by someone responsible. Supervised tummy time is encouraged to help make your infant's neck and back muscles strong.
When infants are napping or sleeping they should ONLY be placed in cribs approved by the Consumer Product Safety Commission (CPSC).
Mattresses should ALWAYS fit snugly into the crib's frame.
Cribs made after 1982 and sold in the United States by a retailer should, by law, meet the CPSC safety standards for cribs.
If you do not have a crib, your infant can be placed to sleep on another safe, firm sleep surface such as a bassinet, cradle, or co-sleeper that does not have any soft or fluffy items on its sleep surface
Infants should ALWAYS be placed on a firm surface or mattress.
Dress your infant in a sleeper or warm pajama instead of covering infant with a blanket.
If you choose to cover your infant, ALWAYS make sure the blanket stays at or lower than the infant's waist.
ALWAYS dress your infant the way that you would want to be dressed for the temperature around you.
Parents or caregivers who choose to share a bed with their infant should NEVER smoke or be under the influence of alcohol or drugs while sleeping with their infant.
Parents or caregivers who want to be close to their infant while they are sleeping can move the crib, bassinet, or co-sleeper next to their bed.
NO ONE other than the infant's parents or caregivers should ever sleep with the infant.
NEVER place your infant on a sofa, couch, pillow, or waterbed.
NEVER place your infant to sleep or to nap with any pillows, stuffed toys, bumper pads, comforters, quilts, or sheepskin.
NEVER smoke in the same room as an infant or child.
NEVER let anybody else smoke in the same room as your infant or child

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Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

Image Source: National Institutes of Health - National Cancer Institute

This Page Last Revised: February 1, 2008

Fat Words

2007-03-18T13:53:00.000+08:00

Here are brief definitions of the key terms important to an understanding of the role of fat in the diet.

Cholesterol
A chemical compound manufactured in the body. It is used to build cell membranes and brain and nerve tissues. Cholesterol also helps the body make steroid hormones and bile acids.

Dietary cholesterol
Cholesterol found in animal products that are part of the human diet. Egg yolks, liver, meat, some shellfish, and whole-milk dairy products are all sources of dietary cholesterol.

Fatty acid
A molecule composed mostly of carbon and hydrogen atoms. Fatty acids are the building blocks of fats.

Fat
A chemical compound containing one or more fatty acids. Fat is one of the three main constituents of food (the others are protein and carbohydrate). It is also the principal form in which energy is stored in the body.

Hydrogenated fat
A fat that has been chemically altered by the addition of hydrogen atoms (see trans fatty acid). Vegetable shortening and margarine are hydrogenated fats.

Lipid
A chemical compound characterized by the fact that it is insoluble in water. Both fat and cholesterol are members of the lipid family.

Lipoprotein
A chemical compound made of fat and protein. Lipoproteins that have more fat than protein are called low-density lipoproteins (LDLs). Lipoproteins that have more protein than fat are called high-density lipoproteins (HDLs). Lipoproteins are found in the blood, where their main function is to carry cholesterol.

Monounsaturated fatty acid
A fatty acid that is missing one pair of hydrogen atoms in the middle of the molecule. The gap is called an "unsaturation." Monounsaturated fatty acids are found mostly in plant and sea foods. Olive oil and canola oil are high in monounsaturated fatty acids. Monounsaturated fatty acids tend to lower levels of LDL-cholesterol in the blood.

A fatty acid that is missing more than one pair of hydrogen atoms. Polyunsaturated fatty acids are mostly found in plant and sea foods. Safflower oil and corn oil are high in polyunsaturated fatty acids. Polyunsaturated fatty acids tend to lower levels of both HDL-cholesterol and LDL-cholesterol in the blood.

Saturated fatty acid
A fatty acid that has the maximum possible number of hydrogen atoms attached to every carbon atom. It is said to be "saturated" with hydrogen atoms. Saturated fatty acids are mostly found in animal products such as meat and whole milk. Butter and lard are high in saturated fatty acids. Saturated fatty acids tend to raise levels of LDL-cholesterol ("bad" cholesterol) in the blood. Elevated levels of LDL-cholesterol are associated with heart disease.

Trans fatty acid
A polyunsaturated fatty acid in which some of the missing hydrogen atoms have been put back in a chemical process called hydrogenation, resulting in "straighter" fatty acids that solidify at higher temperatures. Trans fatty acids are under study to determine their effects on cholesterol.

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Excerpts From: U. S. Food and Drug Administration FDA ConsumerMay 1994; Revised November 1994, January 1996, & January 1999

This Page Last Revised: February 1, 2008

Are You Overweight?

2007-03-18T13:38:00.001+08:00

Overweight refers to an excess of body weight, but not necessarily body fat. Obesity means an excessively high proportion of body fat. Health professionals use a measurement called body mass index (BMI) to classify an adult's weight as healthy, overweight, or obese. BMI describes body weight relative to height and is correlated with total body fat content in most adults.

To get your approximate BMI, multiply your weight in pounds by 703, then divide the result by your height in inches, and divide that result by your height in inches a second time.

A BMI from 18.5 up to 25 is considered in the healthy range, from 25 up to 30 is overweight, and 30 or higher is obese. Generally, the higher a person's BMI, the greater the risk for health problems, according to the National Heart, Lung and Blood Institute (NHLBI). However, there are some exceptions. For example, very muscular people, like body builders, may have a BMI greater than 25 or even 30, but this reflects increased muscle rather than fat. "It is excess body fat that leads to the health problems such as type 2 diabetes, high blood pressure, and high cholesterol," says Eric Colman, M.D., of the FDA's Division of Metabolic and Endocrine Drug Products.

In addition to a high BMI, having excess abdominal body fat is a health risk. Men with a waist of more than 40 inches around and women with a waist of 35 inches or more are at risk for health problems.

Obesity, once thought by many to be a moral failing, is now often classified as a disease. The NHLBI calls it a complex chronic disease involving social, behavioral, cultural, physiological, metabolic, and genetic factors. Although experts may have different theories on how and why people become overweight, they generally agree that the key to losing weight is a simple message: Eat less and move more. Your body needs to burn more calories than you take in.

The BMI ranges shown above are for adults. They are not exact ranges of healthy and unhealthy weights. However, they show that health risk increases at higher levels of overweight and obesity. Even within the healthy BMI range, weight gains can carry health risks for adults.

Directions: Find your weight on the bottom of the graph. Go straight up from that point until you come to the line that matches your height. Then look to find your weight group.

Healthy Weight: BMI from 18.5 up to 25 refers to healthy weight.
Overweight: BMI from 25 up to 30 refers to overweight.

Obese: BMI 30 or higher refers to obesity. Obese persons are also overweight.

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Description of BMI chart:

Are You at a Healthy Weight?

The BMI ranges for adults are shown in this chart. They are not exact ranges of healthy and unhealthy weights. However, they show that health risk increases at higher levels of overweight and obesity. Even within the healthy BMI range, weight gains can carry health risks for adults.

The chart shows heights (without shoes) ranging from 4 feet 10 inches to 6 feet 6 inches on one axis, and weights (without clothes) from 50 pounds to 275 pounds on the other axis. The range of Body Mass Index (BMI) from 18.5 to 30 is shown on the chart so that if you find the point where your height and weight intersect you can determine your BMI.

Healthy Weight: BMI from 18.5 up to 25 refers to healthy weight.

Overweight: BMI from 25 up to 30 refers to overweight.

Obese: BMI 30 or higher refers to obesity. Obese persons are also overweight.

Source: Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2000

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Topic Excerpt: US Food and Drugs Administration: Losing Weight: Start By Counting Calories By Linda Bren. FDA ConsumerJanuary-February 2002; revised April 2002, March 2003, and April 2004

Pandemic Flu and Avian (Bird) Flu

2007-03-17T12:03:00.000+08:00

What Is the Difference Between Pandemic Flu and Avian (Bird) Flu?

Pandemic Flu

A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity and for which there is no vaccine. The disease spreads easily person-to-person, causes serious illness, and can sweep across the country and around the world in a very short time.

It is difficult to predict when the next influenza pandemic will occur or how severe it will be. In the past century pandemics occurred in 1918-1919, 1957-1958 and 1968-1969.

Wherever and whenever a pandemic starts, everyone around the world is at risk. Countries might delay arrival of the virus, through measures such as border closures and travel restrictions, but they cannot stop it.

Avian (Bird) Flu

Avian (bird) flu is caused by influenza A avian viruses that occur naturally among birds. There are many different subtypes of type A influenza viruses. All known subtypes can be found in birds. The avian flu currently of concern is the H5N1 subtype. Avian H5N1 flu in humans is currently very limited and not a pandemic.

Although H5N1 probably poses the greatest current pandemic threat, other avian influenza A subtypes also have infected people in recent years. For example, in 1999, H9N2 infections were identified in Hong Kong; in 2002; and 2003, H7N7 infections occurred in the Netherlands and H7N3 infections occurred in Canada. These viruses also have the potential to give rise to the next pandemic.

For more information on pandemic or avian flu, go to www.pandemicflu.gov.

Source: U.S. Department of Health and Human Services

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