Wish the patients with kidney disease a happy Christmas day ahead of time

2011年11月26日星期六

Prognosis of IgA Nephropathy

IgA nephropathy (also known as IgA nephritis, IgAN, Berger's disease and synpharyngitic glomerulonephritis) is a form of glomerulonephritis (inflammation of the glomeruli of the kidney). This should not be confused with Buerger's disease, an unrelated condition.
IgA nephropathy is the most common glomerulonephritis throughout the world [1] Primary IgA nephropathy is characterized by deposition of the IgA antibody in the glomerulus. There are other diseases associated with glomerular IgA deposits, the most common being Henoch-Schönlein purpura (HSP), which is considered by many to be a systemic form of IgA nephropathy. HSP presents with a characteristic purpuric skin rash, arthritis, and abdominal pain and occurs more commonly in young adults (16-35 yrs old). HSP is associated with a more benign prognosis than IgA nephropathy. In IgA nephropathy there is a slow progression to chronic renal failure in 25-30% of cases during a period of 20 years.
But what are the Prognosis of IgA Nephropathy?
IgA Nephropathy is a rapidly progressive disease, so we should pay much attention to it. We have studied the mechanism of its progression with the most advance theory of renal fibrosis so as to interfere in the therapeutic measures. Clinical indexes of delaying and reversing the prognosis of IgA Nephropathy include proteinuria, level of hematuria, Hpertension and level of creatinine. Therefore we try to adopt a method combining TCM (Traditional Chinese Medicine) with western medicine to reduce these indexes to an ideal level.
Pathological indexes that influence the prognosis are also important. Pathological changes of IgA Nephropathy involve the glomeruli, renal rubules, renal interstitium and renal blood vessel and show great variety in degree and complexity. Pathological changes by renal biopsy are related to the clinical manifestations of the time and they are dynamic and developing with time. Reversibility and irreversibility are relatively spoken.
The following three aspects have certain influence on prognosis of IgA Nephropathy.
1. Pathological changes of the glomeruli: global sclerosis of the glomeruli is a recognized index of a poor prognosis. Proliferation of mesangial cells and matrix as well as deposition of IgA in mesangial area can remit and disappear after treatment, so they don’t have much influence on long-term prognosis. While periodic glomerulosclerosis, glomeruli-capsule adhesion, crescent formation and deposition of immune complex along the capillary loop are all indexes of a poor prognosis but it is without certainty on the basis of a multiplicity. It reminds us that the above changes are still reversible and should be treated positively instead of giving up.
2. Pathological changes of the tubule-interstitium: interstitial fibrosis and tubular atrophy are the index of a poor diagnosis, while infiltration of the interstitial inflammatory cells can be reduced or disappear after positive treatment and doesn’t have much influence on the prognosis.
3. Pathological changes of the tubules: with aggravating of the changes, reduction of blood capillary around the tubules also has direct influence on the prognosis.

Live A Better Life with Diabetes

Everyone hope have a better life. But We all know that Diabetes is a lifelong disease and it can really threaten your life if you don’t take good care of it.
Then what should you do to better care for yourselves?

From a research which shows that Diabetes does shorten people’s lifespan we can know that what we should do includes the following aspects:
If you don’t have Diabetes, do what you can to prevent Diabetes. Know more about the risk factors of Diabetes and try to avoid them by developing a good living habit. For example, the most well known risk factors of Diabetes include obesity, less physical exercise, or unhealthy lifestyle. To avoid getting Diabetes, you should try to lose weight if you are overweight and do regular physical exercise, eat healthy and balanced diet and so on. These are all helpful in reducing your risk of getting Diabetes.
If you have Diabetes, the most important thing for you is to maintain tight control of blood sugar. The premise for this is to have a close monitoring of your condition. Pay regular visit to your doctor and know the specific condition of yourself. You can take important measures to reduce your risk of further health problems.
Change your eating habit to a healthier mode. Choose a diet that helps you to lose excess weight. Your diet also should be high in whole grains and fiber and low in saturated fat. Also, limit your intake of concentrated sweets, cholesterol and total calories. It may be helpful to meet with a nutritionist.
Exercise regularly. This is both good for you to lose weight and also helpful in building up your body resistance. You need to keep this as a part of your daily life and not just do it when you think of it.
Have regular eye and foot checkups. Diabetes may easily cause many complications, most of which are related to a bad blood sugar control. The problems can involve your eyes and your feet, so it is necessary for you to have regular examination of your eyes and your feet. In addition, you should try to protect them from being influenced by factors like infection or injury.
Apart from keeping your blood sugar at normal range, you should also pay attention to your blood pressure as well as cholesterol. Sometimes when there is anything abnormal, you may need to take more medicines under the guidance of your doctor.
Talk to your doctor about whether you should take low-dose aspirin to prevent blood clots and an ACE inhibitor to protect your kidneys.

2011年11月11日星期五

Chronic Kidney Disease Overview

The kidneys are a pair of bean-shaped organs that lie on either side of the spine in the lower middle of the back. Each kidney weighs about ¼ pound and contains approximately one million filtering units called nephrons. Each nephron is made of a glomerulus and a tubule. The glomerulus is a miniature filtering or sieving device while the tubule is a tiny tube like structure attached to the glomerulus.
The kidneys are connected to the urinary bladder by tubes called ureters. Urine is stored in the urinary bladder until the bladder is emptied by urinating. The bladder is connected to the outside of the body by another tube like structure called the urethra.

The main function of the kidneys is to remove waste products and excess water from the blood. The kidneys process about 200 liters of blood every day and produce about two liters of urine. The waste products are generated from normal metabolic processes including the breakdown of active tissues, ingested foods, and other substances. The kidneys allow consumption of a variety of foods, drugs, vitamins and supplements, additives, and excess fluids without worry that toxic by-products will build up to harmful levels. The kidney also plays a major role in regulating levels of various minerals such as calcium, sodium, and potassium in the blood.
As the first step in filtration, blood is delivered into the glomeruli by microscopic leaky blood vessels called capillaries. Here, blood is filtered of waste products and fluid while red blood cells, proteins, and large molecules are retained in the capillaries. In addition to wastes, some useful substances are also filtered out. The filtrate collects in a sac called Bowman's capsule.
The tubules are the next step in the filtration process. The tubules are lined with highly functional cells which process the filtrate, reabsorbing water and chemicals useful to the body while secreting some additional waste products into the tubule.
The kidneys also produce certain hormones that have important functions in the body, including the following:
Active form of vitamin D (calcitriol or 1,25 dihydroxy-vitamin D), which regulates absorption of calcium and phosphorus from foods, promoting formation of strong bone.
Erythropoietin (EPO), which stimulates the bone marrow to produce red blood cells.
Renin, which regulates blood volume and blood pressure.
Chronic kidney disease
Chronic kidney disease occurs when one suffers from gradual and usually permanent loss of kidney function over time. This happens gradually, usually months to years. Chronic kidney disease is divided into five stages of increasing severity (see Table 1 below). The term "renal" refers to the kidney, so another name for kidney failure is "renal failure." Mild kidney disease is often called renal insufficiency.
With loss of kidney function, there is an accumulation of water; waste; and toxic substances, in the body, that are normally excreted by the kidney. Loss of kidney function also causes other problems such as anemia, high blood pressure, acidosis (excessive acidity of body fluids), disorders of cholesterol and fatty acids, and bone disease.
Stage 5 chronic kidney disease is also referred to as kidney failure, end-stage kidney disease, or end-stage renal disease, wherein there is total or near-total loss of kidney function. There is dangerous accumulation of water, waste, and toxic substances, and most individuals in this stage of kidney disease need dialysis or transplantation to stay alive.
Unlike chronic kidney disease, acute kidney failure develops rapidly, over days or weeks.
Acute kidney failure usually develops in response to a disorder that directly affects the kidney, its blood supply, or urine flow from it.
Acute kidney failure is often reversible, with complete recovery of kidney function.
Some patients are left with residual damage and can have a progressive decline in kidney function in the future.
Others may develop irreversible kidney failure after an acute injury and remain dialysis-dependent.

What causes kidney failure?

Renal failure or kidney failure (formerly called renal insufficiency) describes a medical condition in which thekidneys fail to adequately filter toxins and waste products from the blood. The two forms are acute (acute kidney injury) and chronic (chronic kidney disease); a number of other diseases or health problems may cause either form of renal failure to occur.

Examples of prerenal causes of kidney failure are:
  1. hypovolemia (low blood volume) due to blood loss;
  2. dehydration from loss of body fluid (for example, vomiting, diarrhea, sweating, fever);
  3. poor intake of fluids;
  4. medication, for example, diuretics ("water pills") may cause excessive water loss; and
  5. abnormal blood flow to and from the kidney due to obstruction of the renal artery or vein.
Renal causes of kidney failure (damage directly to the kidney itself) include:
  1. Sepsis: The body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually does not occur with urinary tract infections.
  2. Medications: Some medications are toxic to the kidney, includingnonsteroidal anti-inflammatory drugs like ibuprofen and naproxen. Others potentially toxic medications include antibiotics like aminoglycosides [gentamicin (Garamycin), tobramycin], lithium(Eskalith, Lithobid), iodine-containing medications such as those injected for radiology dye studies.
  3. Rhabdomyolysis: This is a situation in which there is significant muscle breakdown in the body, and the damaged muscle fibers clog the filtering system of the kidneys. this can occur because of trauma, crush injuries, and burns. Some medications used to treat high cholesterolcan cause rhabdomyolysis.
  4. Multiple myeloma
  5. Acute glomerulonephritis or inflammation of the glomeruli, the filtering system of the kidneys. Many diseases can cause this inflammation including systemic lupus erythematosus, Wegener's granulomatosis, and Goodpasture syndrome.
Post renal causes of kidney failure (post=after + renal= kidney) are due to factors that affect outflow of the urine:
  1. Obstruction of the bladder or the ureters can cause back pressure because the kidneys continue to produce urine, but the obstruction acts like a dam, and urine backs up into the kidneys. When the pressure increases high enough, the kidneys are damaged and shut down.
  2. Prostatic hypertrophy or prostate cancer may block the urethra and prevents the bladder from emptying.
  3. Tumors in the abdomen that surround and obstruct the ureters.
  4. Kidney stones. Usually, kidney stones affect only one kidney and do not cause kidney failure. However, if there is only one kidney present, a kidney stone may cause the lone kidney to fail

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