Tag Archives: Renal failure

Amyloidosis

Alternative Names: Amyloid – primary

Definition:
In medicine, amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. A protein is described as being amyloid if, due to an alteration in its secondary structure, it takes on a particular aggregated insoluble form similar to the beta-pleated sheet.  Symptoms vary widely depending upon the site of amyloid deposition. Amyloidosis may be inherited or acquired.

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The collection of these abnormal proteins interferes with the normal functioning of the organ affected.

Since there are more than 20 different proteins that may form amyloid, there are also many different types of amyloidosis.

Classification of amyloid:
The modern classification of amyloid disease tends to use an abbreviation of the protein that makes the majority of deposits, prefixed with the letter A. For example amyloidosis caused by transthyretin is termed “ATTR.” Deposition patterns vary between patients but are almost always composed of just one amyloidogenic protein. Deposition can be systemic (affecting many different organ systems) or organ-specific. Many amyloidoses are inherited, due to mutations in the precursor protein. Other forms are due to different diseases causing overabundant or abnormal protein production – such as with over production of immunoglobulin light chains in multiple myeloma (termed AL amyloid), or with continuous overproduction of acute phase proteins in chronic inflammation (which can lead to AA amyloid).

Out of the approximately 60 amyloid proteins that have been identified so far,  at least 36 have been associated in some way with a human disease.

Amyloidosis is rare, being diagnosed in between one and five in every 100,000 people every year. It’s more common in older people and is also slightly more common in men than in women.

Causes:
The cause of primary amyloidosis is unknown, but the condition is related to abnormal production of antibodies by a type of immune cell called plasma cells.

The symptoms depend on the organs affected by the deposits. These organs can include the tongue, intestines, skeletal and smooth muscles, nerves, skin, ligaments, heart, liver, spleen, and kidneys.

Primary amyloidosis can result in conditions that include:

•Carpal tunnel syndrome
•Gastrointestinal reflux (GERD)
•Heart muscle damage (cardiomyopathy)
•Kidney failure
•Malabsorption
The deposits build up in the affected organs, causing them to become stiff, which decreases their ability to function.

Risk factors have not been identified. Primary amyloidosis is rare. It is similar to multiple myeloma, and is treated the same way.

Symptoms:

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•Enlarged tongue
•Fatigue
•Irregular heart rhythm
•Numbness of hands and feet
•Shortness of breath
•Skin changes
•Swallowing difficulties
•Swelling in the arms and legs
•Weak hand grip
•Weight loss

Additional symptoms that may be associated with this disease:
•Clay-colored stools
•Decreased urine output
•Diarrhea
•Hoarseness or changing voice
•Joint pain
•Other tongue problems
•Weakness

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Diagnosis:
Exams and Tests
Your doctor may discover that you have an enlarged liver or spleen.

If specific organ damage is suspected, your doctor may order tests to confirm amyloidosis of that organ. For example:

•Abdominal ultrasound may reveal a swollen liver or spleen.
•An abdominal fat pad biopsy, rectal mucosa biopsy, or a bone marrow biopsy can help confirm the diagnosis.
•A heart evaluation, including an ECG,may reveal arrhythmias, abnormal heart sounds, or signs of congestive heart failure. An echocardiogram shows poor motion of the heart wall, due to a stiff heart muscle.
•A carpal tunnel syndrome evaluation may show that hand grips are weak.Nerve conduction velocity shows abnormalities.
•Kidney function tests may show signs of kidney failure or too much protein in the urine ( nephrotic syndrome).
?BUN level is increased.
?Serum creatinine is increased.
?Urinalysis shows protein, casts, or fat bodies.

This disease may also alter the results of the following tests:
•Bence-Jones protein (quantitative)
•Carpal tunnel biopsy
•Gum biopsy
•Immunoelectrophoresis – serum
•Myocardial biopsy
•Nerve biopsy
•Quantitative immunoglobulins
•Tongue biopsy
•Urine protein

Treatment:
It isn’t always easy to treat amyloidosis, and there is no treatment yet that specifically targets the amyloid depositing in the tissues. In cases where it’s secondary to another problem (AA amyloidosis), such as rheumatoid arthritis, treating that original problem may stop the progress of amyloidosis or may even reverse it.

In cases of primary amyloidosis (AL amyloidosis), chemotherapy drugs may be given to suppress production of new amyloid and cause regression of existing amyloid deposits.

In secondary amyloidosis, aggressive treatment of the underlying disease can improve symptoms and/or slow progression of disease. Complications such as heart failure, kidney failure, and other problems can sometimes be treated as necessary.

Occasionally, transplantation of a damaged organ is necessary. However, even after this has been carried out the new organ may become affected by amyloidosis.

Treatment may also be aimed at supporting the function of damaged tissues and treating complications such as heart or kidney failure.

Overall, many types of amyloidosis follow a steadily progressive course and may prove fatal within a year or two.

Prognosis :
The severity of the disease depends upon the organs affected. Heart and kidney involvement may lead to organ failure and death. Systemic involvement is associated with death within 1 to 3 years.

Possible Complications:
•Congestive heart failure
•Death
•Endocrine failure (hormonal disorder)
•Kidney failure
•Respiratory failure

Prevention : There is no known prevention.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/amyloidosis1.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/000533.htm
http://en.wikipedia.org/wiki/Amyloidosis

http://health.allrefer.com/pictures-images/amyloidosis-on-the-face.html

http://health.allrefer.com/health/cardiac-amyloidosis-dilated-cardiomyopathy.html

http://morningreporttgh.blogspot.com/2010/04/amyloidosis.html

http://gsm.utmck.edu/research/HICP/overview.cfm

http://www.pathologyatlas.ro/amyloidosis-kidney-pathology.php

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Excessive Calcium Could be Harmful

Excessive intake of calcium supplements may have adverse effect on health, notes a study.
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Postmenopausal and pregnant women, transplant recipients, patients with bulimia (an eating disorder) and individuals on dialysis face the highest risk of developing the calcium-alkali syndrome.

The incidence of the calcium-alkali or the milk-alkali syndrome is growing in large parts, because of widespread use of over-the-counter calcium and vitamin D supplements.

Study authors Stanley Goldfarb and Ami Patel from the University of Pennsylvania School of Medicine (UPSM) recommend changing milk-alkali syndrome’s name to calcium-alkali syndrome because it is now associated with a large calcium intake, not just milk.

The syndrome arose in the early 1900s when patients ingested abundant amounts of milk and (alkaline) antacids to control their ulcers.

This practice increased individual risk of developing dangerously high levels of calcium in the blood, which could cause high blood pressure and even kidney failure.

The incidence of the milk-alkali syndrome declined when newer ulcer medications became available, but it appears to be on the rise again.

Thanks to the increased use of over-the-counter calcium and vitamin D supplements, used mainly as preventive and treatment measures for osteoporosis, many patients with the syndrome now require hospitalisation.

The obvious preventive strategy against the calcium-alkali syndrome is to limit the intake of calcium to no more than 1.2 to 1.5 grams per day, the study co-authors said.

“Calcium supplements taken in the recommended amounts are not only safe but are quite beneficial. Taken to excess is the problem,” said Goldfarb, according to a University of Pennsylvania School of Medicine release.

“Even at the recommended dose, careful monitoring of any medication is wise and yearly determinations of blood calcium levels for those patients taking calcium supplements or vitamin D is a wise approach,” he added.

These findings will appear in the Journal of the American Society Nephrology (JASN).

Source:The Times Of India

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Daily Dose of Baking Soda Can Save Kidney

A daily dose baking soda or sodium bicarbonate, used in baking, cleaning, acid indigestion, sunburn and more slows the decline of kidney function in some patients with advanced chronic kidney disease (CKD), a new study has found.

“This cheap and simple strategy also improves patients’ nutritional status, and has the potential of translating into significant economic, quality of life, and clinical outcome benefits,” comments Magdi Yaqoob, of the Royal London Hospital (RLH), who led the study.

Researchers studied 134 patients with advanced CKD and low bicarbonate levels, also called metabolic acidosis. One group received a small daily dose of sodium bicarbonate in tablet form, in addition to their usual care.

For this group, the rate of decline in kidney function was greatly reduced — about two-thirds slower than in patients. “In fact, in patients taking sodium bicarbonate, the rate of decline in kidney function was similar to the normal age-related decline,” says Yaqoob.

Rapid progression of kidney disease occurred in just nine percent of patients taking sodium bicarbonate, compared to 45 percent of the other group. Patients taking sodium bicarbonate were also less likely to develop end-stage renal disease (ESRD) requiring dialysis.

Patients taking sodium bicarbonate also had improvement in several measures of nutrition. Although their sodium levels went up, this didn’t lead to any problems with increased blood pressure.

Low bicarbonate levels are common in patients with CKD and can lead to a wide range of other problems. “This is the first randomised controlled study of its kind,” says Yaqoob.

“A simple remedy like sodium bicarbonate (baking soda), when used appropriately, can be very effective,” he adds, according to an RLH release.

These findings were published in the Journal of the American Society of Nephrology (JASN).

Source: The Times Of India

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Urinalysis

Definition :
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds that pass through the urine.

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It is a routine examination of the urine for cells, tiny structures, bacteria, and chemicals that suggest various illnesses. A urine culture attempts to grow large numbers of bacteria from a urine sample to diagnose a bacterial urine infection.


How the Test is Performed

A urine sample is needed. Your health care provider will tell you what type of urine sample is needed. For information on how to collect a urine sample, see:

*24-hour urine collection
*Clean catch urine specimen

There are three basic steps to a complete urinalysis:

1. Physical color and appearance:

*What does the urine look like to the naked eye?
*Is it clear or cloudy?
*Is it pale or dark yellow or another color?

The urine specific gravity test reveals how concentrated or dilute the urine is.

2.Microscopic appearance:

The urine sample is examined under a microscope. This is done to look at cells, urine crystals, mucus, and other substances, and to identify any bacteria or other microorganisms that might be present.

3,Chemical appearance:

A special stick (“dipstick”) tests for various substances in the urine. The stick contains little pads of chemicals that change color when they come in contact with the substances of interest.

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How to Prepare for the Test:
For a regular urinalysis, you are asked to urinate briefly into a plastic cup. When urine is collected for a urine culture, you must provide a “clean catch” sample – one that is not contaminated by skin cells and skin bacteria. This is so the doctor can obtain a sample of urine from inside your bladder, where normally there should be no bacteria. In contrast, there are many bacteria on the skin of a penis or in a vagina. The trick (harder for a woman than a man) is to pee directly into a sterile container without having the stream of urine first touch your skin or the nonsterile tissues of the vagina.

To collect a clean catch sample, you are given a sterile plastic container and asked to wipe off the area around your urethra (where urine exits) with an antiseptic cloth. For women, it’s also helpful to hold the two labia (outer walls) of the vagina apart with one hand when you urinate, so that the stream of urine passes directly into the sterile container. Since the first flow of urine is most likely to be contaminated by bacteria from around the opening of the urethra, first urinate for a moment into the toilet and then use the cup to collect the “middle” portion of your urine stream.

Certain medicines change the color of urine, but this is not a sign of disease. Your doctor may tell you to stop taking any medicines that can affect test results.

Medicines that can change your urine color include:

*Chloroquine
*Iron supplements
*Levodopa
*Nitrofurantoin
*Phenazopyridine
*Phenothiazines
*Phenytoin
*Riboflavin
*Triamterene

Why the Test is Performed :-

A urinalysis may be done:

As part of a routine medical exam to screen for early signs of disease
If you have signs of diabetes or kidney disease, or to monitor you if you are being treated for these conditions
To check for blood in the urine
To diagnose a urinary tract infection
Additional conditions under which the test may be performed:

*Acute bilateral obstructive uropathy
*Acute nephritic syndrome
*Acute tubular necrosis
*Acute unilateral obstructive uropathy
*Alkalosis
*Alport syndrome
*Analgesic nephropathy
*Anorexia nervosa
*Atheroembolic renal disease
*Atrial myxoma
*Bladder stones
*Chronic bilateral obstructive uropathy
*Chronic glomerulonephritis
*Chronic or recurrent urinary tract infection
*Chronic renal failure
*Chronic unilateral obstructive uropathy
*Chronic urethritis
*Complicated UTI (pyelonephritis)
*Congenital nephrotic syndrome
*Cystinuria
*Delirium
*Dementia
*Dementia due to metabolic causes
*Diabetes insipidus — central
*Diabetic nephropathy/sclerosis
*Enuresis
*Epididymitis
*Failure to thrive
*Focal segmental glomerulosclerosis
*Goodpasture’s syndrome
*Heart failure
*Hemolytic-uremic syndrome (HUS)
*Henoch-Schonlein purpura
*Insulin-dependent diabetes (IDD)
*IgA nephropathy (Berger’s disease)
*Injury of the kidney and ureter
*Interstitial nephritis
*Irritable bladder
*Left-sided heart failure
*Lupus nephritis
*Malignant hypertension (arteriolar nephrosclerosis)
*Medullary cystic kidney disease
*Membranoproliferative GN I
*Membranoproliferative GN II
*Membranous nephropathy
*Myelomeningocele (children)
*Necrotizing vasculitis
*Nephrotic syndrome
*Noninsulin-dependent diabetes (NIDD)
*Orchitis
*Ovarian cancer
*Paroxysmal nocturnal hemoglobinuria (PNH)
*Polycystic kidney disease
*Post-streptococcal GN
*Prerenal azotemia
*Primary amyloid
*Prostate cancer
*Prostatitis, acute
*Prostatitis, chronic
*Prostatitis, non-bacterial
*Pyelonephritis; acute
*Rapidly progressive (crescentic) glomerulonephritis
*Reflux nephropathy
*Renal papillary necrosis
*Renal tubular acidosis; distal
*Renal tubular acidosis; proximal
*Renal vein thrombosis
*Retrograde ejaculation
*Rhabdomyolysis
*Right-sided heart failure
*Secondary systemic amyloid
*Stress incontinence
*Systemic lupus erythematosus
*Systemic sclerosis (scleroderma)
*Thrombotic thrombocytopenic purpura
*Traumatic injury of the bladder and urethra
*Ureterocele
*Urethral stricture
*Urethritis
*Wegener’s granulomatosis
*Wilms’ tumor

RESULTS:

Normal Results
Normal urine may vary in color from almost colorless to dark yellow. Some foods (like beets and blackberries) may turn the urine a red color.

Usually, glucose, ketones, protein, bilirubin, are not detectable in urine. The following are not normally found in urine:

*Hemoglobin
*Nitrites
*Red blood cells
*White blood cells
Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean
For specific results, see the individual test article:

*Bilirubin – urine
*Glucose – urine
*Protein – urine
*Red blood cells in urine test
*Urine ketones
*Urine pH
*Urine protein
*Urine specific gravity

How long is it before the result of the test is known?
Your doctor might be able to do a urinalysis in his or her office and can give you the results within 10-15 minutes. If the urine is sent to a separate laboratory, it usually takes several hours to get results, so you may not hear from your doctor until the next day. A urine culture takes 24 to 72 hours to complete, so you may not hear results for several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/urinalysis.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm

http://www.hallvet.com.au/services/urinalysis.html

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Radionuclide Scan of the Kidneys

Definition
A radionuclide scan of the kidneys shows a picture of your kidneys while they are at work making urine.A kidney radionuclide scan, also called a kidney scan or renal scan, is a diagnostic imaging test that involves administering a small amount of radionuclide, also called a radioactive tracer, into the body and then imaging the kidneys with a gamma camera. The images obtained can help in the diagnosis and treatment of various kidney diseases and conditions. This test can be useful to evaluate infection, blockages, injury to the kidneys, and some causes of high blood pressure.

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Precautions
A kidney scan requires the use of a radioactive material; therefore, patients who are pregnant or suspect they may be pregnant are cautioned not to have the test unless the benefits outweigh the risks. Women should inform their doctor if they are breast feeding. The doctor will recommend the woman stop breast feeding for a specified period of time, depending on the particular tracer and dose used.

Description
Kidney scans are performed either in a hospital nuclear medicine department or in an outpatient radiology or nuclear medicine facility. The patient is positioned in front of, or under, a gamma camera—a special piece of equipment that detects the radiation emitted from the body and produces an image. An intravenous injection of the radionuclide is administered. Immediately after the injection imaging begins, and, in most studies, the flow of blood to each kidney is evaluated. Serial images of the kidneys are obtained over a specified period of time, depending upon the particular radiopharmaceutical used. Kidney scans may be performed to determine the rate at which the kidneys are filtering a patient’s blood. These studies use a radiopharmaceutical called technetium DTPA (Tc99m DTPA). This radiopharmaceutical also can identify obstruction in the renal collecting system. To establish the function of the renal tubules, the radiopharmaceutical Technetium DMSA (Tc99m DMSA) is used.

A kidney scan ranges from 45 minutes to three hours in length, depending upon the goals of the test, but the test typically takes about an hour to an hour and a half. It is important to understand that kidney scans can reveal an abnormality, but they do not always identify the specific problem. They are very useful in providing information about how the various parts of the kidneys function, which, in turn, can assist in making a diagnosis.

Typically, posterior images are obtained but images are also obtained at oblique angles. If indicated, the patient may be positioned so that mobility of the kidney is demonstrated by sitting up or lying down for the images. If obstruction or renal function is being evaluated, a diuretic (drug to induce urination), such as Lasix, may be injected. If hypertension or renal artery sterosis is being evaluated, Captopril or Enalapril (ACE inhibitors) may be injected.
Preparation
No special preparation is necessary for a kidney scan. In some instances the patient may be required to drink additional liquids and to empty their bladder before the exam. If another nuclear medicine study was recently performed, the patient may have to wait for a specified period to avoid any interference from residual radioactivity in the body. The patient is instructed to remove metal items from the area to be scanned.

Let your doctor know if you could be pregnant or if you are breast-feeding a baby. The medicine used in this test would expose your baby to radiation.

What happens when the test is performed.
You have an IV (intravenous) line placed into a vein. A slightly radioactive version of a substance called sodium pertechnetate is injected through the IV. This substance helps your kidneys and urine show up on pictures.

A camera that is specially designed to detect radioactivity is placed against your back or abdomen. A number of pictures are taken over time. The camera itself does not expose you to any additional radiation, so the number of pictures is not harmful in any way. The test is usually completed within an hour.

Risk Factors:
Many people worry when they hear that the medicine used in this test is slightly radioactive. In truth, this test exposes you to a very small amount of radiation-no greater than that of routine xrays.

Moreover, Nuclear medicine procedures are very safe. Unlike some of the dyes that may be used in x-ray studies, radioactive tracers rarely cause side effects. There are no long-lasting effects of the tracers themselves, because they have no functional effects on the body’s tissues. If pharmaceuticals are injected these can temporarily raise or lower blood pressure, or cause one to urinate.

Aftercare
Patients can resume their normal daily activities immediately after the test. Most radioactive tracers are excreted through the urinary system, so drinking fluids after a kidney scan can help flush the tracer out of the body more quickly.

Results
The scan should reveal normal kidney function for the patient’s age and medical status, as well as show normal relative position, size, configuration, and location of the kidneys. Initial blood flow images should reflect that blood circulation to both kidneys is equal. Patients whose images suggest a space-occupying lesion or obstruction may require other imaging procedures, such as CT or ultrasound, to provide more information. Also, if the kidneys appear to be abnormal in size, have an unusual contour, or are unusually positioned, other imaging procedures may be required.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/radionuclide-scan-of-the-kidneys.shtml
http://www.enotes.com/nursing-encyclopedia/kidney-radionuclide-scan

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