Large Kidneys What Do They Mean?

Usually kidney disease is associated with small kidneys. The process that shrinks the kidney is scarring otherwise known as fibrosis which is the end point of any damage to the kidney. However from time to time a disease process will come along that causes enlargement of the kidney as it proceeds to damage the kidney. Some of the diseases that may cause this are as follows.

• Infiltrative diseases such as sarcoidosis and amyloidosis both cause this. Amyloidosis is a disease of the blood which bears certain similarities with multiple myeloma and may coexist with this condition. There is deposition of large quantities of abnormal protein in amyloidosis which are laid down around the blood vessels and other structures of the kidney leading to abnormal function.


• HIV kidney disease is associated with kidneys that are larger than expected for the degree of kidney failure that exists.


• In acute renal failure due to acute tubular necrosis or a severe inflammation of  the kidneys.


• In diabetic kidney disease there is enlargement of the organ in the early stages of diabetic kidney disease. However the kidney subsequently shrinks to roughly normal size by the time end stage renal disease occurs. The finding of normal size kidneys in patients with chronic renal failure is therefore not uncommon.


• Polycystic kidney disease as expected.

Other problems in Polycystic Kidney Disease

[caption id="attachment_642" align="alignright" width="199" caption="Polycystic Kidney Disease"][/caption]

Autosomal Dominant Polycystic Kidney Disease has several manifestations which are not confined to the kidney. These manifestations include the following.
It is very common for patients to have cysts on other organs of the body. The most common organ to find cysts other than in the kidney is the liver. Cysts in the liver may produce pain and patients may have bleeding into these cysts however the liver function is not usually affected. However in patients who have the recessive type of polycystic kidney disease usually seen in children there may be fibrosis of the liver. Cysts may also be found in the pancreas intestine and in the muscles.

Patients with polycystic kidney disease may also have a floppy heart valve known as mitral valve prolapse. This is usually detected as an unsual sound heard when a physician listens to the heart beat.

Symptoms of Mitral valve prolapse tend to develop gradually and include.

• A racing or irregular heartbeat.


• Dizziness or lightheadedness.


• Difficulty breathing.


• Fatigue.


• Chest pain.

However the vast majority of patients with mitral valve prolapse have no symptoms, lead perfectly normal lives and will never know they have this condition.

Patients with polycystic kidney disease may also have dilation of the main artery the aorta this is called an aneurysm. Symptoms of an aortic aneurysm include a pulsatile mass within the abdomen and abdominal pain. If the aortic dilatation involves the aortic valve they may have a more serious presentation including acute heart failure.

The dilatations of blood vessels are a feature of polycystic kidney disease and may also occur in the brain and heart. When occurring in the brain patients are at increased risk of stroke. Stroke may occur at any age although usually a devastating complication the aneurysm may be detected by a special type of MRI. The question however is who should receive screening for these aneurysms and when. Few Guidelines exist however a reasonable approach would be to screen patients who have a family history of stroke, patients who have to be on a blood thinner for any reason or who have an acquired disorder of clotting that would increase their risk of bleeding and those with severe hypertension as that increases the risk of bleeding.

Kidney Cancer Treatment-Medical therapy of Renal Cell Cancer.

Gross appearance of the cut surface of a nephrectomy specimen containing a large renal cell carcinoma (the large yellowish tumour in the upper half of the kidney). (Photo credit: Wikipedia)

Non surgical therapy for renal cell carcinoma is offered when the cancer has already spread to other organs or when the cancer has advanced to nearby tissues in the vicinity of the kidney. Under these circumstances treatment of the cancer is not expected to result in a cure.

Chemotherapy
Depending on the type of renal cell carcinoma you have the rate of response to chemotherapy varies. Individuals may also differ in terms of there genetic make up and hence their response to chemotherapy.
On the average the response rate to chemotherapy is low.


Immunomodulatory Therapies

These are therapies aimed at modifying components of the immune system to alter the growth of cancer cells by forcing the body to destroy the cells. There are reports of remissions which may occur spontaneously using these types of therapies.
The include such methods as

• Stem cell transplantation


• Vaccination against tumors.


• Interferon therapy

Interferon is a substance produced by cells of the immune system. Its function is to tell other cells to resist viral infection. A small percentage of a subtype of renal cell cancer will respond to interferon alone.However interferon therapy is associated with significant side effects.

Interferon signalling (Photo credit: AJC1)

Interleukin-2 is considered standard therapy for renal cell carcinoma that is advanced. Patients do very well when there is a complete response to the drug.
Research is ongoing in this area and there is the hope that patients who are likely to have a good response will one day be identified by blood test.

The Future

The identification of the major gene that underlies renal cell cancer has allowed for theoretical constructs with which to drive research.
Research is advanced in the area of exploiting bone marrow transplantation and the use of vaccines. New drug types that inhibit the growth of blood vessels within the tumour are also
in development as adjunctive or "add on" therapy that will further add to the possibility of producing a durable remission.

Until then a combination of therapy surgical and medical may be the best approach to the treatment of Renal cell Carcinoma that is locally advanced or with distant spread. The use of interferon after surgical resection was shown to be superior to interferon alone for this patient group.

Kidney Cancer and Cysts Information

photo credit: euthman
Renal masses and cysts are a cause of anxiety for many patients that automatically assume any mass or cyst of the kidney must be due to cancer. However the vast majority of these cysts are benign simple cysts of the kidney. They are predominantly seen in patients over the age of 50 years. They are usually asymptomatic and are an incidental finding in the majority of cases. No one really knows why simple cysts occur but the fact that they are usually seen in older persons may imply that this is one of the effects of normal aging of the kidney.

A simple renal cyst has a characteristic appearance on ultrasound that differentiates it from cysts which may be suspicious for cancer. This method of testing has all but replaced older methods that relied on imaging the blood vessels of the kidney and examining the picture for any disturbance of the normal pattern, which may imply a mass or cyst splaying the blood vessels apart. With the advent of CT and MRI the mass or cyst can be directly visualized and a determination made as to how likely it is to be due to cancer.


There are some genetic conditions that predispose to the formation of cysts in the kidney. The most common such condition is known as Autosomal Dominant Polycystic Kidney Disease or ADPK for short. This disease is associated with development of cysts in the kidney which progressively destroys the substance of the kidney decreasing its ability to filter blood and form urine. MRI, Ultrasound and CT scan are both able to make a possible diagnosis of polycystic kidney disease by examining the distribution of the cysts their number and the individual characteristics of the cysts. True polycystic kidney disease is not associated with transformation to cancer.

A very similar pattern of cysts may be seen in individuals who are on dialysis who do not have ADPK. The cysts in these patients tend to increase in number and volume as the number of years on dialysis increases. These cysts are usually present in small shrunken kidneys unlike ADPK where the kidney is quite massively enlarged in most cases. These cysts have to be monitored very carefully as the have a chance of transforming to cancer. As such patients on dialysis are routinely monitored for the development of cysts with yearly ultrasound after 3 to 4 years on dialysis.

The combination of kidney cysts and stones is seen in medullary cystic disease of the kidney. In this condition the tiny tubes that carry urine from the individual filter in the kidney tissue are supposed to join together like tributaries of a great river ultimately leading into the bladder through the ureter. In this disease the smaller tributaries develop cystic dilations which pool the fluid which will become urine. These pools of fluid have low flow and sediments eventually settle which form concretions and ultimately stones in the tissue of the kidney. Therefore many small stones tend to be present within the kidney. This condition develops due to a problem with formation of the kidney and is not transmitted genetically.

As has been shown the causes of cysts on the kidney are diverse and this was not a complete list. There exists very well established means of determining the danger of cancer in any situation where cysts are found on the kidney. A detailed history and family history as well as a routine examination and blood tests with the required imaging tests will lead to speedy diagnosis with relief of anxiety or rapid and timely treatment should the diagnosis be cancer.

Diabetes Symptoms! act early to Prevent Kidney Disease

Diabetes symptoms are more serious than you think!

It's important for you to know the symptoms as a first line indication as to whether you or your children have contracted it? If you are aware that you have any of these symptoms then you need to take action right away. Diabetes is a highly debilitating illness which often ends in death and it needs to be taken seriously.

Overview of the most significant possible symptoms of diabetes. See Wikipedia:Diabetes#Signs_and_symptoms for references. Model: Mikael Häggström. To discuss image, please see Template talk:Häggström diagrams (Photo credit: Wikipedia)

Alkaline water has been discovered to be very effective in alleviating the symptoms of diabetes and assisting sufferers get off their prescriptions... but before you do anything else,it is very critical to seek professional medical consultation first and foremost.

In Type 1 diabetes, the symptoms can often come on suddenly and dramatically. It mostly shows up in childhood or early teens often after an illness, virus or injury. The extra stress can cause diabetic ketoacidosis. Without treatment, ketoacidosis can lead to coma and death.

Symptoms of Type 2 diabetes are often not obvious and you may think they are due to aging or obesity. It's possible to have Diabetes 2 for many years without being aware that you have it. Steroids and stress can be big factors in the onset of Diabetes 2. It's important to take this illness seriously; it can lead to unpleasant outcomes like blindness, kidney failure, heart disease, and nerve damage.

Here are some common symptoms of diabetes 1 and diabetes 2

Excessive and Unusual Tiredness:

When you contract diabetes the body is mostly unable to use glucose for fuel. It begins instead to metabolize fat to get the extra fuel it needs. This process is not very efficient. You have less energy than before and you feel tired.

Weight Loss You Just Can't Explain:

Because you can't metabolize sugar, much of the fuel in your food is excreted in your urine via the kidneys. You may find yourself eating way more food than normal and still losing weight. You become dehydrated and lose even more weight.

Excessive thirst:

The high concentration of sugar in your bloodstream overcomes your normal kidney function. Instead of being re-absorbed for future use the sugar is passed out in your urine. The brain senses a need to dilute the blood and you experience this as thirst. As a result you find yourself drinking more water as the body tries to correct this sugar imbalance.

Increased Urination:

The body tries to excrete the excess sugar via the kidneys. As a result you pass more water and feel thirsty.

Overeating:

The body will try to increase its levels of insulin production to reduce the excess blood sugar. Insulin is the key that opens the muscles and lean tissue to receive the sugar. But in Type 2 Diabetes you become insulin resistant. Your muscles refuse to take up the sugar.

One of the other jobs of insulin is to make you hungry... it isn't possible for you to absorb this extra insulin so your forced to eat more.

Wounds Refuse to Heal:

If your blood sugar levels are high then your white blood cells are not able to do their respected job. As a result to this your wounds heal slower than normal and your more susceptible to infection.

Thickening of the Arteries

SEELOW, BRANDENBURG - AUGUST 08: Country doctor Dieter Baermann measures the blood sugar level of an elderly patient in the patient's home on August 8, 2011 in Sachsendorf near Seelow, Germany. Baermann works in the state of Brandenburg in eastern Germany, a region that is struggling with a shortage of doctors in rural areas. Critics charge that current laws actually discourage doctors from taking up posts in rural areas, and the German government is debating a new law intended to reverse the trend. Many doctors across Germany complain about a legal system that they claim burdens them with too many costs and hampers their ability to provide the best care. (Image credit: Getty Images via @daylife)

Long term diabetes can cause your arteries to thicken, reducing blood flow.

You catch more Infections:

Because your immune system is no longer functioning as well as it should you'll often find you are contracting skin and yeast infections as well as urinary tract infections.

Mood Swings:

You may very well find yourself incapable of concentrating, irritated, or agitated- all are symptoms of very high blood sugar levels

Impaired Vision: You may find you have difficulty focusing and things appear blurry.

Don`t give up! There are herbal methods available .

Education: High Blood Pressure Prevention.

Main complications of persistent high blood pressure. Sources are found in main article: Wikipedia:Hypertension#Complications. To discuss image, please see Template_talk:Häggström diagrams. To edit, please use the svg version, convert to png and update both versions online. (Photo credit: Wikipedia)

Most of people with hypertension do not know they have it. In fact it has been estimated that about 50 percent are not aware of it. It is estimated by the year of 2025, one and half billion of people will live with High Blood Pressure.

High blood pressure can be caused by a malfunctioning kidney and adrenal gland dysfunction; yet, about ninety to ninety five percent of all cases have an unknown nature.

Even though, medicine is still searching for the right answers for cure of the silent disease, it is up to the patients to find remedies and cures to keep up their health. There are several ways to reduce your blood pressure. This article will focus on how to lower your blood pressure by losing weight.

Losing weight can be very challenging because it involves change in the lifestyle. However, once the individual is able to make few changes in the lifestyle losing weight becomes automatic.

Based on review from to British Hypertension Society, low intensity aerobic exercise can aid in lowering your blood pressure drastically. A low intensity aerobic exercise can be 20-30 min walk to a park or grocery store, slow movement yoga class, cardio workout class. It is important to maintain the routine and to exercise minimum three times a week.

The results do not show for the first 2 weeks. However, drastic results can be seen after one month. Losing weight happens in stages and an individual should be patient with him/herself. Even if the person will not see instant results in weight loss, the hypertension will be treated from the first day of exercise. Even low intensity activity will increase blood flow and improve cardiovascular system by flushing the bad cholesterol out of the body.

//

Find more Ways to treat High Blood Pressure

Eating the right type of foods is just as essential as the exercising. It is critical to eat everything in moderation and to avoid cravings. Many fitness instructors recommend taking small meals up to 6 times a day. When picking groceries chose chicken breast over a thigh or drumstick, very soon it will becomes natural picking the foods that are lower in cholesterol and a lot healthier for the body.

Consuming high amounts of water stimulates detoxification of body and helps healing processes to take place faster. By avoiding pops, fast food, processed foods one can eliminate about 30% of empty calorie intake.

While there is no precise explanation on the onset of hypertension, there are ways available to control and to prevent this disease. Maintaining a healthy weight by exercising and eating the right foods is one of many ways to battle high blood pressure.

While there is no perfet explanation to Hypertension, there are natural ways available to control and prevent this disease. Keeping a healthy weight by exercising and eating right is one of many ways to combat hypertension.

Kidney Symptoms: Kidney infection or UTI

Bacteriuria and pyuria demonstrated at urinary microscopy. (Photo credit: Wikipedia)

Infection of the kidney usually occurs as a consequence of an ascending urinary tract infection or UTI. The bacteria gain access to the bladder and multiply overcoming the defenses of the host and migrating up to the kidney where they produce the syndrome of pyelonephritis or kidney infection.

When a simple urinary tract infection ascends to become a kidney infection there is usually worsening of the fever and generalized weakness and lethargy associated with back pain and vomiting. There may also be tenderness of the back over the kidneys which are approximately mid way up the back on either side of the spine. The pain produced by tapping over this area is usually excruciating in nature. A severe kidney infection may also spread to the lungs and produces symptoms of pneumonia in some cases. Once the infection enters the blood stream the kidney infection is said to have caused sepsis. Sepsis is both the presence of the infecting bacteria within the blood as well as the reaction of the body to the bacteria which is usually associated with increased respiratory rate, increased pulse rate and decreased blood pressure.

Women are at increased risk of kidney infections as they have a higher overall prevalance of urinary tract infection. Because men are not predisposed to urinary tract infection the presence of a kidney infection should prompt a detailed search for the cause of the infection as it is not unusual to find an anatomical abnormality that has caused the kidney infection in a male or the presence of kidney stones.

Recurrent kidney infection in either sex should result in a detailed investigation of the urinary tract. The goal being to correct any abnormality predisposing to kidney infection. Thus preventing permanent kidney damage from the repeated healing of the inflammation produced by bacteria.

Kidney Symptoms: Shortness of breath

http://www.flickr.com/photos/aidan_jones/ / CC BY-SA 2.0

Shortness of breath or breathlessness is a common kidney symptom in advanced renal failure. The presence of breathlessness may be multifactorial. Retention of fluid may result in fluid accumulating within the lungs and reducing the available area for exchange of gases such as oxygen giving rise to the sensation of being unable to catch your breath. This is called pulmonary oedema and may occur as a direct consequence of fluid retention or as a result of another cardiovascular disease such as fluid around the heart due to renal failure, myocardial infarction or heart attack. Angina or an arrythmia which is an unusual and bizarre beating of the heart both may result in diminished ability of the heart to pump. This can be further worsened by anemia which is common in advanced kidney disease.

Related articles

• Flash pulmonary edema in renal artery stenosis (Pickering Syndrome) - mechanism (cardiophile.org)

Kidney Symptoms: Chest Pain

http://www.flickr.com/photos/face_it/ / CC BY-NC 2.0

Chest pain is usually associated with ischemic heart disease such as a heart attack or angina. However chest pain may occur as a symptom of kidney disease. Chest pain occurring due to renal failure implies an inflammation of the tissues around the heart known as pericarditis. Pericarditis under these circumstances is quite dangerous as the inflammation of the lining of the heart that occurs results in fluid building up around the heart and compressing it preventing normal function. This can be a fatal complication, drainage of the fluid usually results in recollection of the fluid quickly. The best treatment if this is suspected is urgent dialysis. Frequently the patient will need three sessions of dialysis in rapid sequence to gain control of the situation and resolve the chest pain.

Related articles

• Mayo Clinic: Tool helps chest pain patients decide on tests, cuts ER costs (eurekalert.org)
• Does Asthma cause Chest Pain (after50health.com)
• Causes Of Chest Pain (answers.com)

Kidney Symptoms: Swelling of the feet.

http://www.flickr.com/photos/ulybug/ / CC BY 2.0

Swelling of the feet is also known as pedal oedema this occurs primarily in kidney disease because of retention of fluid. The kidney is responsible for several functions. When the ability of the kidney to remove fluid from the body is decreased fluid is retained. The increased fluids within the blood vessels eventually leak through the walls of the smallest capillaries and enter the soft and sponge like tissues beneath the skin known as the subcutaneous tissue giving rise to the symptom of swelling. Due to the fact that fluid always settles in a dependent position the swelling is usually observed to be in the lower limbs if the patient is standing or around the waste and back if sitting or lying down. Very severe cases of swelling may be seen with swelling of the entire body a situation known as anasarca. This symptom usually occurs in very severe kidney disease or in cases where there is retention of fluid due to losses of protein in the urine.

It is difficult to conceptualize at first that loss of protein in the urine may lead to retention of fluid within the body. However one of the roles of protein is to provide one of the main constituents of blood. This constituent is known as albumin the same albumin that is found in egg white. This protein attracts fluid to itself therefore the more albumin you have in your blood stream the more fluid will want to be attracted to and remain within the blood vessel. If the albumin levels within the blood are low then the fluid will be less attracted to remain within the blood vessels and instead will leak wherever there is a pressure difference such as in the loose tissues beneath the skin where there is relatively low pressure and a willingness to expand to accommodate fluid.

Nephrotic syndrome is a type of kidney disease where there are large quantities of protein leaking into the urine. The first symptom of kidney disease noted in these patients is usually swelling of the feet.

Aspirin and Kidney Disease a Love Hate relationship.

Image by Benjah-bmm27

Acetylsalicylic acid otherwise known as aspirin was a major advance in the treatment of inflammation when it was first discovered in 1853. The chemical compound had been used for centuires before that however in the form of bark and herbs which were found by early man to be helpful for the relief of pain.

The chemical structure above served for the development of many novel drugs with potent anti inflammatory effects and became one of the most prescribed classes of medication in history collectively known as the non steroidal antiinflammatory drugs or NSAIDs. The sideffects of the Aspirin are shown below in this mindmap by maderoh88

NEGATIVE EFFECTS ON THE KIDNEY.

Aspirin reduces renal blood flow this is not usually a problem in a healthy person however in a patient who already has decreased blood volume such as patients with dehydration or blood loss this could precipitate acute renal failure. Several types of kidney disease unified by the loss of protein in the urine, may produce a relative low volume state. Despite the obvious retention of fluid in the skin of the feet and around the eyes, the blood vessels are depleted and hence the kidney is also starved for fluid. In such a setting aspirin will further cause reduction of renal blood flow and tip the patient over into acute renal failure.

Aspirin is an anti inflammatory agent yet it has been known to cause inflammation of the tissues of the kidney a state called an allergic interstitial nephritis. Patients with this disorder may have a skin reaction after administration of aspirin followed by high blood pressure abnormal kidney function and decreased urination, thankfully it is usually self limited.

Aspirin has also been associated with an abnormality of the kidney known as membranous nephropathy. This condition results in thickening of the filter of the kidney and loss of protein in the urine.

BENEFICIAL USES.

Aspirins effect on glomerular blood flow can be beneficial. It would be helpful to understand glomerular function to understand why.

Aspirin has the effect of reducing the flow of blood through the kidney in the areas responsible for filtration. While this may not sound like a good thing, this effect is similar to the effect of angiotensin converting inhibitors or ACEI which are prescribed for delaying progression of renal disease. This effect of aspirin is particularly useful in patients with high degrees of protein loss in the urine. Reduction of pressure within the kidney will lead to decreased filtration of protein by the kidney. Hence at one time aspirin was one of the major drugs used in the treatment of membranous nephropathy and other causes of nephrotic syndrome. The drug has fallen out of use for this indication however because of the negative effects on kidney function produced by aspirin. Inflammatory conditions of the kidney were also thought to be treatable by aspirin, conditions such as membranoproliferative glomerulonephritis which is a very rare form of inflammation of the kidney. However all recent trials have discounted any protective effect of aspirin in this and similar conditions.

Although an anti inflammatory agent aspirin has no role in the treatment of inflammatory disorders of the kidney. At this time superior antiinflammatory agents with less negative effects on the kidney are available.

Patient Education: Testing for kidney disease.

Physiology of Nephron (Photo credit: Wikipedia)

The kidney is a highly selective filter than receives a large supply of blood from the circulatory system. The entire blood volume passes through the kidney several times over per day. The kidney selectively removes toxins from the blood and in the process forms urine which leaves the body through the ureters bladder and urethra.

The Ultimate goal of the diverse functions of the kidney is to preserve a careful balance of electrolytes minerals and water in order to maintain the finely tuned processes which give rise to life. The ultimate result of kidney failure is break down of the myriad pathways which rely on this balance. Every organ system therefore relies to some extent on the daily functions of the kidney and the kidney relies on feedback from these systems to determine how well its doing its job. When the system works as it ought to there is a perfect balance between intake of nutrient and excretion of waste products.

The functions of the kidney are still being determined by scientists everyday. What has been learned so far is as follows:-

• The kidney detects the level of oxygen in the blood and stimulates the bone marrow to produce oxygen carrying blood cells as necessary to most efficiently maintain the oxygen level of the blood. It does this by producing a hormone known as erythropoeitin.

• The kidney receives and contributes critical information to important parts of the brain which determine if there is enough fluid within the body. If fluid is deemed to be in excess urine volume is increased and water is excreted to return the body to a state of fluid balance. If the body is dehydrated the kidney conserves water by decreasing urine formation to the minimum required to still excrete wastes.

• The kidney removes waste products by allowing them to filter into the urine and sometimes actively excreting them into the urine.

• The kidney constantly monitors urine that is being formed and reabsorbs from the urine anything that is still useful before it leaves the body.

• The kidney senses the flow through it and determines and instructs centers in the brain to increase or decrease blood pressure to maintain an appropriate flow rate to perform its function.

• The kidney removes acid from the body and is the most important source by which acidic compounds generated by daily activity is removed.

• The kidney plays an important role in bone formation as it is the last step in the synthesis of vitamin D.

Any test of kidney function should be able to to test individually these functions and determine if there is kidney disease present or not.

Some of these tests are as follows:-

• The ability of the kidney to filter is expressed by the term GFR or glomerular filtration rate. This is an index of all the fluid passing across the filter per minute of every day. This number can be determined by a series of calculations performed using the ratios of concentrations of various substances in the blood vs the urine.

1. This may be measured by a 24 hour collection of all urine passed. The GFR being calculated from the ratio of creatinine in the urine and blood.
2. A radioactive material may be injected and the rate of the excretion of the radioactive material in the urine determined using a collector or counter for radiation. This is termed a renal scan.
3. The concentration of a substance that is generated within the body, that we know should be promptly excreted by the kidney could be measured with a single blood test. This is the basis of the measurement of creatinine and blood urea nitrogen. When the kidney is functioning normally it should be within the normal range. Unfortunately these tests are not as accurate as the above more direct methods of determining GFR. They should really be considered markers of function vs dysfunction.
4. The GFR may be calculated based on a single test for creatinine by using a formula that takes into account the age, weight, gender and race of the subject. This is more reliable that relying on the BUN or creatinine alone.

• The ability of the kidney to detect and respond to the oxygen carrying content of the blood is determined by measuring the blood count on a routine blood test. But there are many causes for a low blood count. Only after excluding all the most common causes can we directly say that the kidney is the reason why the blood count is low and thus prompt a more thorough work up for kidney disease

• Regularly checking the blood pressure is a good way to detect kidney disease. As one of the functions of the kidney is blood pressure regulation patients with high blood pressure should have one of the above tests of kidney function done.

• Testing the urine for protein blood and any abnormal constituent of urine. There are substances that do not enter urine under normal circumstances because the kidney reabsorbs them during the process of forming urine or selectively does not allow the them to be filtered in the first place. The most important of these is protein, persistent levels of protein in the urine may imply damage to the filtration apparatus of the kidney. This is one area where early intervention is very important. This is why a dipstick of the urine is a standard procedure when you see your physician.

• Testing the level of acid in the blood or urine may draw attention to a previously unknown kidney disease.

• Low vitamin D levels or low calcium levels may be due to kidney disease.

• Testing the level of various electrolytes whose concentrations are determined by kidney function may also highlight previously unknown kidney disease

Patient Education: What are the symptoms and signs of Chronic Kidney Disease.

The symptoms and signs of Chronic Kidney Disease include:

1. Weakness and tiredness just feeling generally unwell
2. Puffiness around the eyes particularly in the morning
3. Swelling of the feet usually noticed in the evenings
4. Loss of appetite
5. Recurrent vomiting and nausea
6. History of very difficult to control blood pressure.
7. Blood sugar repeatedly going low while on tablets for diabetes or long acting insulin
8. Shortness of breath
9. Having trouble concentrating
10. Constant drowsiness
11. Insomnia
12. Decreased responsiveness
13. Ultimately coma followed by death in severe cases

The earlier these symptoms are noticed the better chance for halting or slowing progression. Unfortunately these symptoms can be very nonspecific and in some cases easily ignored.

Patient Education: What causes Chronic Kidney Disease (CKD).

Studies done on the population of patients with CKD suggests that the two main causes are diabetes and hypertension. Together accounting for 30% of cases. When we look at patients who are already on dialysis the number jumps to almost 50%.

Diabetes is a condition where there is excess sugar in the blood stream, as a result of this the high concentrations of sugar damage the cells of the kidney leading to scarring of the delicate structures responsible for filtering the blood.

In hypertension the increased pressures that occur stress the the walls of the blood vessels within the body causing them to lose there elasticity or ability to stretch in response to increased pressures. This results in hardening of the blood vessels and decreased blood flow within the kidney which ultimately damages it.

Other causes of chronic kidney disease exist such as:

• Inflammation of the kidneys such as due to glomerulonephritis a long name for...you guessed it "inflammation of the kidney".
• Chronic infections of the kidney.
• Inherited problems with kidney development such as polycystic kidney disease.
• Obstruction of the flow of urine from the kidney such as in enlargement of the prostate.
• Cancer.

....and this is by no means an exhaustive list.

Patient Education: What is chronic kidney disease (CKD)

Chronic kidney disease refers to any process that damages your kidneys over a period of more than three months and as a consequence of that damage reduces the ability of your kidney to carry out its primary functions. This results in health related problems due to increased blood pressure and increased stress on the circulatory system, which puts you at risk for stroke and heart attack.

Decreased blood count (a situation known as anemia), poor bone health, damage to the nerves of the body and weightloss due to poor nutrition may also occur.

Chronic kidney disease can be detected early and appropriate treatment commenced which may stop this problem from getting worse. Unfortunately kidney disease can be a progressive thing and as such therapy will be directed to slowing th eprogression of your kidney disease. If it is progressive however preparations need to be made for eventual transplantation or dialysis in some cases.

Patient Education: The Function of Your Kidneys

The kidneys each of which has 1.2 million functional subunits called nephrons function as a highly selective active filtration system. The purpose of which is to maintain health.

Life requires the expenditure of energy. Energy is produce by burning fuel which is derived from the foods we eat. During the process lots of waste products are produced within the cells of our body. In order for life to continue these waste products must be removed to allow the machinery of the cell to continue to function.

The primary means of removal consists of the liver and the kidney. The kidney produces urine as a result of it primary function, this urine is rich in the substances that need to be removed for the cells in your body to function properly.

The kidney is capable of regulating the content of urine to enable removal of different substances at different rates, it is also capable of stimulating the marrow of your bones to produce blood. This function of the kidney is of vital importance as it is the primary source of the hormone that stimulates your bone marrow to form red blood cells, which in turn carries oxygen to the parts of your body that need it most.

The kidney also regulates the amount of calcium in your body by producing vitamin D. This is very important to the health of your bones.

The major constituent of urine is in fact water, it is vitally important that excess water is removed from the body. It is the kidneys job to determine how much water needs to be retained within the body and how much should be removed in the urine. Disturbance of this vital function leads to a state known as fluid overload which is essentially the accumulation of excess water in the tissues of the body. This strains the heart and the lungs because of increased blood pressure and can lead to significant ill health.

In summary the functions of the kidneys are.

• Regulate your body water and other chemicals in your blood such as sodium, potassium, phosphorus and calcium.

• Remove drugs and toxins introduced into your body.

• Release hormones into your blood to help your body:regulate blood pressure make red blood cells

• Promote bone health.

Patient Education: The Facts about Chronic Kidney disease

The Facts About Chronic Kidney Disease (CKD)

• Recent data suggests that up to 26 million American adults have CKD and this is just the tip of the iceberg.

• Early detection by simple screening tests can help slow progression of chronic kidney disease and renal failure.

• Disease of the circulatory system such as Stroke and Heart attack are the most common killers in people with CKD. Therefore if you have CKD you must have a thorough consultation for heart disease as well for the best outcome.

• A simple blood test is sometimes inaccurate ask your doctor what percentage of kidney function you have. This will require a measure of what is called G. F.R. which can either be calculated at no additional cost or can be measured by a simple procedure an thus detect previously undetectable kidney disease.

• If you are hypertensive you should be aware that you are at increased risk of CKD even if your blood pressure is 140/90 and "controlled".

• The reason that you are hypertensive maybe due to undiagnosed kidney disease.

• Although protein levels in the urine may fluctuate, persistent levels of protein in the urine should prompt an immediate evaluation for possible kidney disease, acute or chronic.

• Patient groups at the highest risk of CKD include those with diabetes, hypertension and family history of kidney disease.