Symptoms Treatment & Prevention of Kidney Disease

 Symptoms of Kidney

Early detection is the first step in treating chronic kidney disease. The symptoms of kidney disease may include:

• Nausea and vomiting
• Passing only small amounts of urine
• Swelling, particularly of the ankles, and puffiness around the eyes
• Unpleasant taste in the mouth and urine-like odor to the breath
• Persistent fatigue or shortness of breath
• Loss of appetite
• Increasingly higher blood pressure
• Muscle cramps, especially in the legs
• Pale skin
• Excessively dry, itchy skin
• In children: increased fatigue and sleepiness, decrease in appetite, and poor growth

See Your Doctor About Kidney Disease If:

You experience any of these symptoms, which could be a warning sign of kidney disease. Unfortunately, some people have no symptoms of chronic kidney disease until the majority of kidney function is lost; that is why prevention -- through diet, exercise, and medication -- is key.

Treatment

Blood and urine tests can help uncover signs of early kidney disease and monitor the condition.

• Blood pressure. Your health care provider will devise a plan, which may include diet changes and medications, to keep your blood pressure as close to normal as possible. Target blood pressure is defined as less than 130/80.
• Blood electrolytes. When the kidneys are not working correctly, you can develop high potassium and low calcium, phosphorus, bicarbonate, which can affect your heart’s conduction system and cause muscle aches and other complications.
• Urine protein or albumin in the urine. Albumin is the main protein in the blood. When the kidneys become damaged, the holes in the filtering system of your kidneys become enlarged, allowing protein to leak into the urine. In the early stages of kidney damage, only small amounts of albumin (microalbuminuria) are found. This test is very important for people with diabetes because at this early stage of kidney damage, further deterioration can often be prevented by diet, exercise, and medications.
• GFR (glomerular filtration rate). This is a measure of how well the kidneys are filtering blood. An estimate of your "filtering rate" is determined by a blood test called a blood creatinine test, which measures the amount of creatinine -- a waste product -- in your blood. This test, along with your age, body size, and gender, provides an estimate of your GFR. The GFR, or "filtering rate," helps confirm normal or low kidney function. A score of 90 or above is normal; a score below 15 indicates kidney damage that will require dialysis or a kidney transplant. Another commonly used test to estimate GFR is a creatinine clearance. This test measures the creatinine in the blood and urine to determine kidney function.

Your health care provider may also refer you to a kidney specialist, called a nephrologist, for more specialized testing. A kidney biopsy may also be performed. During a kidney biopsy a small amount of kidney tissue is removed for microscopic exam to pinpoint the cause of kidney damage and plan treatment.

How Can You Prevent Kidney Disease?

The key to prevention or delay of severe kidney disease is early detection and aggressive intervention -- while there's still time to slow down the progression to kidney failure. Medical care with early intervention can change the course of chronic kidney disease and help prevent the need for dialysis or a kidney transplant.
Diabetes and high blood pressure account for two thirds of all cases of chronic kidney disease. By aggressively managing diabetes and high blood pressure with diet, exercise, and medications, you may be able to prevent kidney failure and help keep as much kidney function as possible.
Know Your Risks for Kidney Disease
Since diabetes and high blood pressure put you at risk of kidney disease, know where you stand with these risks. Do you have diabetes or high blood pressure? If so, are they under control?
If you can, find out if diabetes, hypertension, or kidney disease runs in your family. Certain ethnic groups, such as African-Americans, Hispanics, Pacific Islanders, and Native Americans are at higher risk of chronic kidney disease, as are senior citizens.
Get Tested Regularly
At your next checkup, and at least within the next year if you haven't had these tests done:

• Ask for a urine test to see if you have excess protein, glucose, or blood in the urine.
• Ask for a blood pressure reading, to see if your blood pressure is elevated.
• Ask for a fasting blood glucose test, to see if you have too much glucose (sugar) in your blood. Another blood test that can be used to determine diabetes is a hemoglobin A1C which will indicate your average blood glucose level over the past two to three months.
• Ask for a creatinine test. This blood test measures the amount of waste from muscle activity. When the kidneys are not working properly, the creatinine rises.

If any of these tests are abnormal, your health care provider will need to do other tests to more clearly define the problem.
Control Diabetes
If you have diabetes, work with your health care provider to keep your blood sugar levels under the best possible control. A program of diet, regular exercise, glucose monitoring, and medications to control blood sugars and protect kidney function can help.

 

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Understanding Kidney Disease -- the Basics

What Is Kidney Disease?

The kidneys are two organs located in your abdominal cavity on either side of your spine in the middle of your back, just above the waist. They perform several life-sustaining roles: They cleanse your blood by removing waste and excess fluid, maintain the balance of salt and minerals in your blood, and help
regulate blood pressure.
When the kidneys become damaged, waste products and fluid can build up in the body, causing swelling in your ankles, vomiting, weakness, poor sleep, and shortness of breath. If left untreated, diseased kidneys may eventually stop functioning completely. Loss of kidney function is a serious -- and potentially fatal -- condition

Healthy kidneys handle several specific roles. Healthy kidneys:

• Maintain a balance of water and concentration of minerals, such as sodium, potassium, and phosphorus, in your blood
• Remove waste by-products from the blood after digestion, muscle activity, and exposure to chemicals or medications
• Produce renin, an enzyme that helps regulate blood pressure
• Produce erythropoietin, which stimulates red blood cell production
• Produce an active form of vitamin D, needed for bone health

  What Causes Acute Kidney Injury?

  The sudden loss of kidney function is called acute kidney injury, also known as acute renal failure (ARF). ARF has three main causes:
• Lack of blood flow to the kidneys
• Direct damage to the kidneys themselves
• Blockage of urine from the kidneys

Common causes include:

• A traumatic injury with blood loss
• Dehydration
• Damage to the kidneys from shock during a severe infection called sepsis
• Obstruction of urine flow, such as with an enlarged prostate
• Damage from certain drugs or toxins
• Pregnancy complications, such as eclampsia and pre-eclampsia, or related HELLP Syndrome

Marathon runners and other athletes who don't drink enough fluids while competing in long-distance endurance events may suffer acute renal failure due to a sudden breakdown of muscle tissue. This muscle breakdown releases a large amount of protein into the bloodstream called myoglobin that can damage the kidneys.

What Causes Chronic Kidney Disease?

Kidney damage and decreased function that lasts longer than 3 months is called chronic kidney disease (CKD). Chronic kidney disease is particularly dangerous, because you may not have any symptoms until considerable, often irreparable, kidney damage has occurred. Diabetes (types 1 and 2) and high blood pressure are the most common causes of CKD. Other causes are:

• Immune system conditions such as lupus and chronic viral illnesses such as HIV/AIDS, hepatitis B, and hepatitis C
• Urinary tract infectionswithin the kidneys themselves, called pyelonephritis, can lead to scarring as the infection heals. Multiple episodes can lead to kidney damage.
• Inflammation in the tiny filters (glomeruli) within the kidneys; this can happen after strep infection and other conditions of unknown cause.
• Polycystic kidney disease, in which fluid-filled cysts form in the kidneys over time. This is the most common form of inherited kidney disease.
• Congenital defects, present at birth, are often the result of a urinary tract obstruction or malformation that affects the kidneys; one of the most common involves a valve-like mechanism between the bladder and urethra. These defects, sometimes found while a baby is still in the womb, can often be surgically repaired by an urologist.
• Drugs and toxins, including long-term exposure to some medications and chemicals, such as NSAIDs (nonsteroidal anti-inflammatory drugs), like ibuprofen and naproxen, and use of intravenous “street” drugs.

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Stroke: What You Should Know

What Is a Stroke?

Stroke is a medical emergency and a leading cause of death in the U.S. It occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops. Without treatment, cells in the brain quickly begin to die. The result can be serious disability or death. If a loved one is having stroke symptoms, seek emergency medical attention without delay.

    Stroke Symptoms

     Signs of a stroke may include:

 side effect of stroke

• Sudden numbness or weakness of the body, especially on one side.
• Sudden vision changes in one or both eyes, or difficulty swallowing.
• Sudden, severe headache with unknown cause.
• Sudden problems with dizziness, walking, or balance.
• Sudden confusion, difficulty speaking or understanding others.

Stroke Test: Talk, Wave, Smile

The F.A.S.T. test helps spot symptoms of stroke. It stands for:
Face. Ask for a smile. Does one side droop?
Arms. When raised, does one side drift down?
Speech. Can the person repeat a simple sentence? Does he or she have trouble or slur words?
Time. Time is critical. Go to hospital immediately if any symptoms are present.

Stroke: Time = Brain Damage

Every second counts when seeking treatment for a stroke. When deprived of oxygen, brain cells begin dying within minutes. There are clot-busting drugs that can curb brain damage, but they need to be used within three hours -- up to 4.5 hours in some people -- of the initial stroke symptoms. Once brain tissue has died, the body parts controlled by that area won't work properly. This is why stroke is a top cause of long-term disability.

Diagnosing a Stroke

When someone with stroke symptoms arrives in the ER, the first step is to determine which type of stroke is occurring. There are two main types and they are not treated the same way. A CT scan can help doctors determine whether the symptoms are coming from a blocked blood vessel or a bleeding vessel. Additional tests may also be used to find the location of a blood clot or bleeding within the brain.

Ischemic Stroke

The most common type of stroke is known as an ischemic stroke. Nearly nine out of 10 strokes fall into this category. The culprit is a blood clot that obstructs a blood vessel inside the brain. The clot may develop on the spot or travel through the blood from elsewhere in the body.

 Hemorrhagic Stroke

Hemorrhagic strokes are less common but far more likely to be fatal. They occur when a weakened blood vessel in the brain bursts. The result is bleeding inside the brain that can be difficult to stop.

'Mini-Stroke' (TIA)

A transient ischemic attack, often called a "mini-stroke," is more like a close call. Blood flow is temporarily impaired to part of the brain, causing symptoms similar to an actual stroke. When the blood flows again, the symptoms disappear. A TIA is a warning sign that a stroke may happen soon. It's critical to seek emergency medical help if you think you've had a TIA. There are therapies to reduce the risk of stroke.

What Causes a Stroke

A common cause of stroke is atherosclerosis -- hardening of the arteries. Plaque made of fat, cholesterol, calcium, and other substances builds up in the arteries, leaving less space for blood to flow. A blood clot may lodge in this narrow space and cause an ischemic stroke. Atherosclerosis also makes it easier for a clot to form. Hemorrhagic strokes often result from uncontrolled high blood pressure that causes a weakened artery to burst.

Risk Factors: Chronic Conditions

Certain chronic conditions increase your risk of stroke. These include:

• High blood pressure
• High cholesterol
• Diabetes
• Obesity

Taking steps to control these conditions may reduce your risk.

Risk Factors: Behaviors                                  

Certain behaviors also increase the risk of stroke:

• Smoking
• Getting too little exercise
• Heavy use of alcohol

Risk Factors: Diet

A poor diet may increase the risk for stroke in a few significant ways. Eating too much fat and cholesterol can lead to arteries that are narrowed by plaque. Too much salt may contribute to high blood pressure. And too many calories can lead to obesity. A diet high in fruits, vegetables, whole grains, and fish may help lower stroke risk.

Risk Factors You Can't Control

Some stroke risk factors are beyond your control, such as getting older or having a family history of strokes. Gender plays a role, too, with men being more likely to have a stroke. However, more stroke deaths occur in women. Finally, race is an important risk factor. African-Americans, Native Americans, and Alaskan Natives are at greater risk compared to people of other ethnicities.

Stroke: Emergency Treatment

For an ischemic stroke, emergency treatment focuses on medicine to restore blood flow. A clot-busting drug is highly effective at dissolving clots and minimizing long-term damage, but it must be as soon as possible, within three -- or much as 4.5 hours for some people -- of the initial stroke symptoms Hemorrhagic strokes are more difficult to manage. Treatment usually involves attempting to control high blood pressure, bleeding, and brain swelling.

Stroke: Long-Term Damage

Whether a stroke causes long-term damage depends on its severity and how quickly treatment stabilizes the brain. The type of damage depends on where in the brain the stroke occurs. Common problems after a stroke include numbness and/or weakness in the arms or legs, difficulty walking, vision problems, trouble swallowing, and problems with speech and comprehension. These problems can be permanent, but many people regain most of their abilities.

Stroke Rehab: Speech Therapy

Rehabilitation is the centerpiece of the stroke recovery process. It helps patients regain lost skills and learn to compensate for damage that can't be undone. The goal is to help restore as much independence as possible. For people who have trouble speaking, speech and language therapy is essential. A speech therapist can also help patients who have trouble swallowing.

Stroke Rehab: Physical Therapy

Muscle weakness, as well as balance problems, are very common after a stroke. This can interfere with walking and other daily activities. Physical therapy is an effective way to regain strength, balance, and coordination. For fine motor skills, such as using a knife and fork, writing, and buttoning a shirt, occupational therapy can help.

Stroke Rehab: Talk Therapy

It's common for stroke survivors and their loved ones to experience a wide range of intense emotions, such as fear, anger, worry, and grief. A psychologist or mental health counselor can provide strategies for coping with these emotions. A therapist can also watch for signs of depression, which frequently strikes people who are recovering from a stroke.

Stroke Prevention: Lifestyle

People who have had a stroke or TIA can take steps to prevent a recurrence:

• Quit smoking.
• Exercise and maintain a healthy weight.
• Limit alcohol and salt intake.
• Eat a healthier diet with more veggies, fish, and whole grains.

  Stroke Prevention: Medications

  For people with a high risk of stroke, doctors often recommend medications to lower this risk. Anti-platelet drugs, including aspirin, keep platelets in the blood from sticking together and forming clots. Anti-clotting drugs, such as warfarin, may be needed to help ward off stroke in some patients. Finally, if you have high blood pressure, your doctor will prescribe medication to lower it.
  

  Stroke Prevention: Surgery

  In some cases, a stroke results from a narrowed carotid artery -- the blood vessels that travel up each side of the neck to bring blood to the brain. People who have had a mild stroke or TIA due to this problem may benefit from surgery known as carotid endarterectomy. This procedure removes plaque from the lining of the carotid arteries and can help prevent additional strokes.
  

  Stroke Prevention: Balloon and Stent

  Doctors can also treat a clogged carotid artery without major surgery in some cases. The procedure, called angioplasty, involves temporarily inserting a catheter into the artery and inflating a tiny balloon to widen the area that is narrowed by plaque. A metal tube, called a stent, can be inserted and left in place to keep the artery open.
  
  

  Life After a Stroke

  Many people who have a stroke regain the ability to take care of themselves if they follow their rehabilitation plan. Those who get clot-busting drugs soon enough may recover completely. And those who experience disability can often learn to function independently through therapy. It has been shown that 3% to 4% of all patients that experience a stroke will subsequently experience a second stroke.
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