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  جديد Kidney

اذهب الى الأسفل 
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كاتب الموضوعرسالة
المنياوى
المدير العام
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وسام التميز عدد المساهمات : 274
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تاريخ التسجيل : 05/03/2011
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  جديد  Kidney Empty
مُساهمةموضوع: جديد Kidney     جديد  Kidney Emptyالأحد مارس 13, 2011 8:27 am






Your two kidneys are vital organs that
perform many functions to keep your blood clean and chemically
balanced. Understanding how your kidneys work can help you to keep them
healthy

  جديد  Kidney Kidneyandnephron
  جديد  Kidney Kidneyposition

Renal function

So Your kidneys are bean-shaped organs, each about the size of your
fist. They are located near the middle of your back, just below the rib
cage. The kidneys are sophisticated reprocessing machines. Every day,
your kidneys process about 200 quarts of blood to sift out about 2
quarts of waste products and extra water. The waste and extra water
become urine, which flows to your bladder through tubes called ureters.
Your bladder stores urine until you go to the bathroom

The wastes in your blood come from the normal breakdown of active
tissues and from the food you eat. Your body uses the food for energy
and self-repair. After your body has taken what it needs from the food,
waste is sent to the blood. If your kidneys did not remove these
wastes, the wastes would build up in the blood and damage your body

The actual filtering occurs in tiny units inside your kidneys called nephrons. Every kidney has about a million nephrons.
In the nephron, a glomerulus—which is a tiny blood vessel, or
capillary—intertwines with a tiny urine-collecting tube called a
tubule. A complicated chemical exchange takes place, as waste materials
and water leave your blood and enter your urinary system

At first, the tubules receive a combination of waste materials and
chemicals that your body can still use. Your kidneys measure out
chemicals like sodium, phosphorus, and potassium and release them back
to the blood to return to the body. In this way, your kidneys regulate
the body’s level of these substances. The right balance is necessary
for life, but excess levels can be harmful

In addition to removing wastes, your kidneys release three important hormones

*erythropoietin (eh-RITH-ro-POY-eh-tin), or EPO, which stimulates the bone marrow to make red blood cells

*renin (REE-nin), which regulates blood pressure

*calcitriol (kal-suh-TRY-ul), the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

Your health care team may talk about the work your kidneys do as renal
function. If you have two healthy kidneys, you have 100 percent of your
renal function. This is more renal function than you really need. Some
people are born with only one kidney, and these people are able to lead
normal, healthy lives. Many people donate a kidney for transplantation
to a family member or friend. Small declines in renal function may not
cause a problem
But many people with reduced renal function have a kidney disease that
will get worse. You will have serious health problems if you have less
than 25 percent of your renal function. If
your renal function drops below 10 to 15 percent, you cannot live long
without some form of renal replacement therapy—either dialysis or
transplantation


Kidneys fail

Why
Most kidney diseases attack the nephrons,
causing them to lose their filtering capacity. Damage to the nephrons
may happen quickly, often as the result of injury or poisoning. But
most kidney diseases destroy the nephrons slowly and silently. Only
after years or even decades will the damage become apparent. Most
kidney diseases attack both kidneys simultaneously

The two most common causes of kidney disease are diabetes and high blood pressure. If your family has a history of any kind of kidney problems, you may be at risk for kidney disease

Diabetic Nephropathy
Diabetes is a disease that keeps the body from using glucose (sugar) as
it should. If glucose stays in your blood instead of breaking down, it
can act like a poison. Damage to the nephrons from unused glucose in
the blood is called diabetic nephropathy. If you keep your blood
glucose levels down, you can delay or prevent diabetic nephropathy

High Blood Pressure
High blood pressure can damage the small blood vessels in your kidneys.
The damaged vessels cannot filter wastes from your blood as they are
supposed to

Your doctor may prescribe blood pressure medication. Blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) have been found to protect the kidneys even more than other medicines that lower blood pressure to similar levels. The National Heart, Lung, and Blood Institute (NHLBI), one
of the National Institutes of Health, recommends that people with
diabetes or reduced kidney function should keep their blood pressure below 130/80 mm Hg

Glomerular Diseases
Several different types of kidney disease are grouped together under
this category, including autoimmune diseases, infection-related
diseases, and sclerotic diseases. As the name indicates, glomerular
diseases attack the tiny blood vessels (glomeruli) within the kidney.
The most common primary glomerular diseases include membranous
nephropathy, IgA nephropathy, and focal segmental glomerulosclerosis.
Protein, blood, or both in the urine are often the first signs of these
diseases. They can slowly destroy kidney function. Blood pressure
control is important with any kidney disease. Treatments for glomerular
diseases may include immunosuppressive drugs or steroids to reduce
inflammation and proteinuria, depending on the specific disease

Inherited and Congenital Kidney Diseases
Some kidney diseases result from hereditary factors. Polycystic kidney
disease (PKD), for example, is a genetic disorder in which many cysts
grow in the kidneys. PKD cysts can slowly replace much of the mass of
the kidneys, reducing kidney function and leading to kidney failure

Some kidney problems may show up when a child is still developing in
the womb. Examples include autosomal recessive PKD, a rare form of PKD,
and other developmental problems that interfere with the normal
formation of the nephrons. The signs of kidney disease in children
vary. A child may grow unusually slowly, may vomit often, or may have
back or side pain. Some kidney diseases may be “silent” for months or
even years

If your child has a kidney disease, your child’s doctor should find it
during a regular checkup. Be sure your child sees a doctor regularly. The first sign of a kidney problem may be high blood pressure, a low number of red blood cells (anemia), or blood or protein in the child’s urine. If the doctor finds any of these problems, further tests may be necessary, including additional blood
and urine tests or radiology studies. In some cases, the doctor may
need to perform a biopsy—removing a tiny piece of the kidney to examine
under a microscope

Some hereditary kidney diseases may not be detected until adulthood.
The most common form of PKD was once called "adult PKD" because the
symptoms of high blood pressure and renal failure usually do not occur
until patients are in their twenties or thirties. But with advances in
diagnostic imaging technology, doctors have found cysts in children and
adolescents before any symptoms appear

Other Causes of Kidney Disease
Poisons and trauma, for example a direct and forceful blow to your kidneys, can lead to kidney disease
Some over-the-counter medicines can be poisonous to your kidneys if
taken regularly over a long period of time. Products that combine
aspirin, acetaminophen, and other medicines such as ibuprofen have been
found to be the most dangerous to the kidneys. If you take painkillers
regularly, check with your doctor to make sure you are not putting your
kidneys at risk

How
Many factors that influence the speed of kidney failure are not
completely understood. Researchers are still studying how protein in
the diet and cholesterol levels in the blood affect kidney function

Acute Renal Failure
Some kidney problems happen quickly, like an accident that injures the
kidneys. Losing a lot of blood can cause sudden kidney failure. Some
drugs or poisons can make your kidneys stop working. These sudden drops
in kidney function are called acute renal failure (ARF(

ARF may lead to permanent loss of kidney function. But if your kidneys are not seriously damaged, acute renal failure may be reversed

Chronic Kidney Disease
Most kidney problems, however, happen slowly. You may have “silent”
kidney disease for years. Gradual loss of kidney function is called
chronic kidney disease (CKD) or chronic renal insufficiency. People
with CKD may go on to permanent kidney failure. They also have a high
risk of dying from a stroke or heart attack

End-Stage Renal Disease
Total or nearly total and permanent kidney failure is called end-stage
renal disease (ESRD). People with ESRD must undergo dialysis or
transplantation to stay alive


Signs of kidney disease

People in the early stages of kidney disease usually do not feel sick at all
If your kidney disease gets worse, you may need to urinate more often
or less often. You may feel tired or itchy. You may lose your appetite
or experience nausea and vomiting. Your hands or feet may swell or feel
numb. You may get drowsy or have trouble concentrating. Your skin may
darken. You may have muscle cramps


Medical tests used to detect kidney disease

Since you can have kidney disease without any symptoms, your doctor may
first detect the condition through routine blood and urine tests. The
National Kidney Foundation recommends three simple tests to screen for
kidney disease: a blood pressure measurement, a spot check for protein
or albumin in the urine (proteinuria), and a calculation of glomerular
filtration rate (GFR) based on a serum creatinine measurement.
Measuring urea nitrogen in the blood provides additional information

Blood Pressure Measurement
High blood pressure can lead to kidney disease. It can also be a sign
that your kidneys are already impaired. The only way to know whether
your blood pressure is high is to have a health professional measure it
with a blood pressure cuff. The result is expressed as two numbers. The
top number, which is called the systolic pressure, represents the
pressure when your heart is beating. The bottom number, which is called
the diastolic pressure, shows the pressure when your heart is resting
between beats. Your blood pressure is considered normal if it stays
below 120/80 (expressed as “120 over 80”). The NHLBI recommends that
people with kidney disease use whatever therapy is necessary, including
lifestyle changes and medicines, to keep their blood pressure below
130/80

Microalbuminuria and Proteinuria
Healthy kidneys take wastes out of the blood but leave protein.
Impaired kidneys may fail to separate a blood protein called albumin
from the wastes. At first, only small amounts of albumin may leak into
the urine, a condition known as microalbuminuria, a sign of
deteriorating kidney function. As kidney function worsens, the amount
of albumin and other proteins in the urine increases, and the condition
is called proteinuria. Your doctor may test for protein using a
dipstick in a small sample of your urine taken in the doctor’s office.
The color of the dipstick indicates the presence or absence of
proteinuria

A more sensitive test for protein or albumin in the urine involves
laboratory measurement and calculation of the protein-to-creatinine or
albumin-to-creatinine ratio. This test should be used to detect kidney
disease in people at high risk, especially those with diabetes. If your
first laboratory test shows high levels of protein, another test should
be done 1 to 2 weeks later. If the second test also shows high levels
of protein, you have persistent proteinuria and should have additional
tests to evaluate your kidney function

Glomerular Filtration Rate (GFR) Based on Creatinine Measurement
GFR is a calculation of how efficiently the kidneys are filtering
wastes from the blood. A traditional GFR calculation requires an
injection into the bloodstream of a substance that is later measured in
a 24-hour urine collection. Recently, scientists found they could
calculate GFR without an injection or urine collection. The new
calculation requires only a measurement of the creatinine in a blood
sample

Creatinine is a waste product in the blood created by the normal
breakdown of muscle cells during activity. Healthy kidneys take
creatinine out of the blood and put it into the urine to leave the
body. When kidneys are not working well, creatinine builds up in the
blood

In the lab, your blood will be tested to see how many milligrams of
creatinine are in one deciliter of blood (mg/dL). Creatinine levels in
the blood can vary, and each laboratory has its own normal range,
usually 0.6 to 1.2 mg/dL. If your creatinine level is only slightly
above this range, you probably will not feel sick, but the elevation is
a sign that your kidneys are not working at full strength. One formula
for estimating kidney function equates a creatinine level of 1.7 mg/dL
for most men and 1.4 mg/dL for most women to 50 percent of normal
kidney function. But because creatinine values are so variable and can
be affected by diet, a GFR calculation is more accurate for determining
whether a person has reduced kidney function

The new GFR calculation uses the patient’s creatinine measurement along
with weight, age, and values assigned for sex and race. Some medical
laboratories may make the GFR calculation when a creatinine value is
measured and include it on their lab report

Blood Urea Nitrogen (BUN)
Blood carries protein to cells throughout the body. After the cells use
the protein, the remaining waste product is returned to the blood as
urea, a compound that contains nitrogen. Healthy kidneys take urea out
of the blood and put it in the urine. If your kidneys are not working
well, the urea will stay in the blood
A deciliter of normal blood contains 7 to 20 milligrams of urea.
If your BUN is more than 20 mg/dL, your kidneys may not be working at
full strength. Other possible causes of an elevated BUN include
dehydration and heart failure.

Additional Tests for Kidney Disease
If blood and urine tests indicate reduced kidney function, your doctor
may recommend additional tests to help identify the cause of the problem

Renal imaging. Methods of renal imaging
(taking pictures of the kidneys) include ultrasound, computed
tomography (CT scan), and magnetic resonance imaging (MRI). These tools
are most helpful in finding unusual growths or blockages to the flow of
urine

Renal biopsy. Your doctor may want to see a
tiny piece of your kidney tissue under a microscope. To obtain this
tissue sample, the doctor will perform a renal biopsy—a hospital
procedure in which the doctor inserts a needle through your skin into
the back of the kidney. The needle retrieves a strand of tissue about
1/2 to 3/4 of an inch long. For the procedure, you will lie on your
stomach on a table and receive local anesthetic to numb the skin. The
sample tissue will help the doctor identify problems at the cellular
level


Stages of kidney disease

Your GFR is the best indicator of how
well your kidneys are working. In 2002, the National Kidney Foundation
published treatment guidelines that identified five stages of CKD based
on declining GFR measurements. The guidelines recommend different
actions based on the stage of kidney disease
Increased risk of CKD. A GFR of 90 or above is considered normal. Even
with a normal GFR, you may be at increased risk for developing CKD if
you have diabetes, high blood pressure, or a family history of kidney
disease. The risk increases with age: People over 65 are more than
twice as likely to develop CKD as people between the ages of 45 and 65.
African Americans also have a higher risk of developing CKD

Stage 1: Kidney damage with normal GFR (90 or
above). Kidney damage may be detected before the GFR begins to decline.
In this first stage of kidney disease, the goals of treatment are to
slow the progression of CKD and reduce the risk of heart and blood
vessel disease

Stage 2: Kidney damage with mild decrease in
GFR (60 to 89). When kidney function starts to decline, your health
care provider will estimate the progression of your CKD and continue
treatment to reduce the risk of other health problems

Stage 3: Moderate decrease in GFR (30 to 59).
When CKD has advanced to this stage, anemia and bone problems become
more common. Work with your health care provider to prevent or treat
these complications

Stage 4: Severe reduction in GFR (15 to 29).
Continue following the treatment for complications of CKD and learn as
much as you can about the treatments for kidney failure. Each treatment
requires preparation. If you choose hemodialysis, you will need to have
a procedure to make a vein in your arm larger and stronger for repeated
needle insertions. For peritoneal dialysis, you will need to have a
catheter placed in your abdomen. Or you may want to ask family or
friends to consider donating a kidney for transplantation

Stage 5: Kidney failure (GFR less than 15).
When the kidneys do not work well enough to maintain life, you will
need dialysis or a kidney transplant

In addition to tracking your GFR, blood tests can show when substances
in your blood are out of balance. If phosphorus or potassium levels
start to climb, a blood test will prompt your health care provider to
address these issues before they permanently affect your health


In kidney disease you must do

Unfortunately, chronic kidney disease often cannot be cured. But if you
are in the early stages of a kidney disease, you may be able to make
your kidneys last longer by taking certain steps. You will also want to
be sure that risks for heart attack and stroke are minimized, since CKD
patients are susceptible to these problems
If you have diabetes, watch your blood glucose closely to keep it under control. Consult your doctor for the latest in treatment

Avoid pain pills that may make your kidney disease worse. Check with your doctor before taking any medicine

Blood Pressure
People with reduced kidney function (a high creatinine level in the
blood or a low creatinine clearance) should have their blood pressure
controlled, and an ACE inhibitor or an ARB should be one of their
medications. Many people will require two or more types of medication
to keep their blood pressure below 130/80 mm Hg. A diuretic is an
important addition to the ACE inhibitor or ARB

Diet
People with reduced kidney function need to be aware that some parts of a normal diet may speed their kidney failure

Protein. Protein is important to your body.
It helps your body repair muscles and fight disease. Protein comes
mostly from meat. As discussed in an earlier section, healthy kidneys
take wastes out of the blood but leave protein. Impaired kidneys may
fail to separate the protein from the wastes
Some doctors tell their kidney patients to limit the amount of protein they eat so that the kidneys have less work to do. But you cannot avoid protein entirely. You may need to work with a dietitian to find the right food plan

Cholesterol. Another problem that may be
associated with kidney failure is too much cholesterol
(koh-LES-tuh-rawl) in your blood. High levels of cholesterol may result
from a high-fat diet

Cholesterol can build up on the inside walls of your blood vessels. The
buildup makes pumping blood through the vessels harder for your heart
and can cause heart attacks and strokes

Smoking. Smoking not only increases the risk
of kidney disease, it contributes to deaths from strokes and heart
attacks in people with CKD. You should try your best to stop smoking

Sodium. Sodium is a chemical found in salt
and other foods. Sodium in your diet may raise your blood pressure, so
you should limit foods that contain high levels of sodium. High-sodium
foods include canned or processed foods like frozen dinners and hot dogs

Potassium. Potassium is a mineral found
naturally in many fruits and vegetables, like oranges, potatoes,
bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys
measure potassium in your blood and remove excess amounts. Diseased
kidneys may fail to remove excess potassium, and with very poor kidney
function, high potassium levels can affect the heart rhythm

Treating Anemia
Anemia is a condition in which the blood does not contain enough red
blood cells. These cells are important because they carry oxygen
throughout the body. If you are anemic, you will feel tired and look
pale. Healthy kidneys make the hormone EPO, which stimulates the bones
to make red blood cells. Diseased kidneys may not make enough EPO. You
may need to take injections of a man-made form of EPO

Preparing for End-Stage Renal Disease
As your kidney disease progresses, you will need to make several
decisions. You will need to learn about your options for treating ESRD
so that you can make an informed choice between hemodialysis,
peritoneal dialysis, and transplantation


completly kidney fail

Complete and irreversible kidney failure is sometimes called end-stage
renal disease, or ESRD. If your kidneys stop working completely, your
body fills with extra water and waste products. This condition is
called uremia. Your hands or feet may swell. You will feel tired and
weak because your body needs clean blood to function properly

Untreated uremia may lead to seizures or coma and will ultimately
result in death. If your kidneys stop working completely, you will need
to undergo dialysis or kidney transplantation

Dialysis
The two major forms of dialysis are hemodialysis and peritoneal dialysis
In hemodialysis, your blood is sent through a
filter that removes waste products. The clean blood is returned to your
body. Hemodialysis is usually performed at a dialysis center three times per week for 3 to 4 hours

  جديد  Kidney Dialysis1

In peritoneal dialysis, a fluid is put into your abdomen.
This fluid captures the waste products from your blood. After a few
hours, the fluid containing your body’s wastes is drained away. Then, a
fresh bag of fluid is dripped into the abdomen. Patients can perform
peritoneal dialysis themselves. Patients using continuous ambulatory
peritoneal dialysis (CAPD) change fluid four times a day. Another form
of peritoneal dialysis, called continuous cycling peritoneal dialysis (CCPD), can be performed at night with a machine that drains and refills the abdomen automatically

  جديد  Kidney Dialys

Transplantation
A donated kidney may come from an anonymous donor who has recently died
or from a living person, usually a relative. The kidney that you
receive must be a good match for your body. The more the new kidney is
like you, the less likely your immune system is to reject it. Your
immune system protects you from disease by attacking anything that is
not recognized as a normal part of your body. So your immune system
will attack a kidney that appears too “foreign.” You will take special
drugs to help trick your immune system so it does not reject the
transplanted kidney

  جديد  Kidney Kidneytransplant
Hope Through Research

As our understanding of the causes of kidney failure increases, so will
our ability to predict and prevent these diseases. Recent studies have
shown that intensive control of diabetes and high blood pressure can
prevent or delay the onset of kidney disease

In the area of genetics, researchers supported by the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) have
located two genes that cause the most common form of PKD and learned
that a person must have two defective copies of the PKD1 gene to
develop PKD. Researchers have also found a gene in the roundworm that
is identical to the PKD1 gene. This new knowledge will be used in the
search for effective therapies to prevent or treat PKD

In the area of transplantation, new drugs to help the body accept
foreign tissue increase the likelihood that a transplanted kidney will
survive and function properly. Scientists at NIDDK are also developing
new techniques to induce tolerance for foreign tissue in patients
before they receive transplanted organs. This technique will eliminate
or reduce the need for immunosuppressive drugs and thereby reduce
expense and complications. In the future, scientists may develop an
artificial kidney for implantation



Points to Remember
Your kidneys are vital organs that keep your blood clean and chemically balanced

The progression of kidney disease can be slowed, but it cannot always be reversed

End-stage renal disease (ESRD) is the total loss of kidney function

Dialysis and transplantation can extend the lives of people with ESRD

Diabetes and high blood pressure are the two leading causes of kidney failure

You should see a nephrologist regularly if you have renal disease

Chronic kidney disease (CKD) increases the risk of heart attacks and strokes

If you are in the early stages of renal disease, you may be able to save your remaining renal function for many years by

*controlling your blood glucose
*controlling your blood pressure
*following a low-protein diet
*maintaining healthy levels of cholesterol in your blood
*taking an ACE inhibitor or an ARB
*quitting smoking
الرجوع الى أعلى الصفحة اذهب الى الأسفل
66
أميرة الأدب العربى
عضو جديد
عضو جديد
أميرة الأدب العربى


عدد المساهمات : 2
نقاط : 12
السٌّمعَة : 4
تاريخ التسجيل : 06/04/2011
العمر : 30

  جديد  Kidney Empty
مُساهمةموضوع: رد: جديد Kidney     جديد  Kidney Emptyالأربعاء أبريل 06, 2011 2:15 am

شكراااااااااااااااااااااااا
الرجوع الى أعلى الصفحة اذهب الى الأسفل
المنياوى
المدير العام
المدير العام
المنياوى


وسام التميز عدد المساهمات : 274
نقاط : 39720
السٌّمعَة : 30000
تاريخ التسجيل : 05/03/2011
العمر : 37

  جديد  Kidney Empty
مُساهمةموضوع: رد: جديد Kidney     جديد  Kidney Emptyالجمعة أبريل 15, 2011 4:59 am

لقد اسعدنى مرورك العطر اختى الكريمة وان شاء الله تنبسطى وسط اسرتك الجديده
الرجوع الى أعلى الصفحة اذهب الى الأسفل
66
 
جديد Kidney
الرجوع الى أعلى الصفحة 
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