Why kidneys stop working?

Kidneys taken from the blood excess water and unnecessary materials and turn them into urine. Urine (urine) is then released from the body. Most people have two kidneys. A person can live and be healthy with one kidney.
Renal function:
release excess water and unnecessary matter,
processed liquid and chemical substances to the human body,
control blood pressure,
controlling the body's hormones that create new red blood cells.

Kidney failure is also called renal failure. If the kidneys cease to perform its function, excess body fluids and unnecessary substances can not get rid of the body. This may occur because of illness or damages incurred due to injury. There are two types of kidney failure: acute and chronic.
Acute kidney failure
Acute kidney failure is the sudden loss of kidney function that takes a few hours or days. The causes may be:
severe inflammation (infection)
severe burns,
injury or decrease blood flow to the kidneys,
low blood pressure,
blockage of the urinary tract,
heart failure,
chemical poisoning or drug intoxication.
Often the condition of the kidneys can be improved if the cause of the problem is detected and treated promptly.
Chronic Kidney Failure
To chronic kidney failure occurs when the kidneys gradually lose their function. It is a lifelong disease that can not be improved.
The causes may be:
diseases such as diabetes, high blood pressure and heart disease,
kidney stones
problems or blockage in the urinary tract,
lupus - an autoimmune disease,
scleroderma - a disease of the skin and connective tissue,
chronic inflammation (infection)
drug use,
poisons.
The signs of chronic kidney failure include:
swelling of the hands, face or feet
changes in the frequency of urination,
feeling very tired or exhaustion,
headache, confusion,
nausea or vomiting;
loss of appetite,
shortness of breath,
itching of the skin.
Chronic kidney failure can not be cured but can be treated with diet changes and medication. When the kidneys lose most of their functions, called end stage renal failure, a few days a week dialysis is needed.A kidney transplant may also be an option for the treatment of this disease. 

Acute renal failure

Acute renal failure is defined as a clinical syndrome characterized by a rapid, severe reduction of renal filtration, usually with a reduced excretion of urine.

Definition
Acute renal failure is defined as a clinical syndrome characterized by a rapid, severe reduction of renal filtration, usually with a reduced excretion of urine. It occurs due to ischemic or toxic lesions that operates in renal blood vessels, glomeruli and / or tubules causing a reduction in glomerular filtration rate and increase intratubularnog pressure.

Invasion of extracellular fluid causes the formation of islands, high blood pressure and chronic heart failure. Often the increase of potassium, sodium, and acidity of the cell can be fluid . Etiology of kidney problem can be prerenal, renal and postrenal  and potentially reversible if the disorder is diagnosed in time and treated.

The clinical picture
Symptoms related to loss of function and secretion depend on the level of renal dysfunction, the degree of renal damage, and the cause. In outpatients only clinical indication may be oliguria or anuria after use of contrast. In hospitalized patients, acute renal failure is usually associated with recent trauma, surgical, medical events, therefore, depend on it, and the signs and symptoms. Normal daily urine output was 1 to 2.4 liters per day. This could result in oliguria; anuria leads to mutual suspicion of renal artery occlusion, obstructive uropathy, acute cortical necrosis or rapid progressive

Forecast
Acute renal failure with immediate complications (eg hypervolaemia, metabolic acidosis, hyperkalemia, uremia, hemorrhagic diathesis) may be treated, but the percentage of survival remains about 60% despite aggressive nutrition  and dialysis therapy. Further improvement seems impossible because normally associated sepsis, pulmonary failure, coagulopathy, surgical complications.

Diagnostic evaluation
The diagnosis of acute renal failure is determined by a progressive increase in serum creatinine daily.Currently back prerenal and postrenal causes must first be excluded. Correction of the disturbances that reduce renal confirms prerenal causes. For postrenal causes, the possibility of recovery of renal function is often irreversible depending on the duration of obstruction. Early urinary and serum chemical analysis in the case of acute renal failure may facilitate the determination of the cause.Typical laboratory findings are progressive azotemia, acidosis, hyperkalemia, and hyponatremia.

Treatment
Acute renal failure can be prevented by proper maintenance of fluid balance in the body, blood volume and blood pressure during and after major surgery; appropriate isotonic fluid infusion in patients with severe burns, and the current blood transfusion in blood pressure due to bleeding. If you need a vasoconstrictive drug, dopamine 1 to 3 micrograms / kg / min intravenously may improve renal blood flow and urine output, but no clinical indicator to stop and acute. In the early stage of acute renal failure, furosemide with mannitol or dopamine can restore the normal flow of urine or reverse oliguric to nonoliguric acute renal failure, but there is little evidence that mortality thereby reduced. Dialysis improves the balance of fluids and electrolytes and provides an adequate supply. No single rule when to start dialysis, to what frequency is conducted, or whether improved recovery or survival. Acute renal failure without dialysis should be treated only if it is not possible or the development of renal uncomplicated and present less than 5 days. In postliguric stage, it is necessary to pay special attention to fluid and electrolyte balance in order to prevent potentially lethal disorder of the extracellular fluid volume, plasma osmolality, acid-base status and potassium levels. 

Diabetes and kidney

The course of renal disease

Diabetic kidney disease develops over the years. Extensive studies in animals and humans have shown that the progression of various chronic kidney diseases, including nephropathy diabetic mainly due to secondary hemodynamic and metabolic disorders, not the activity of the underlying disease.
In some patients in the early years of diabetes, kidney filtration capacity is higher than in healthy individuals.
After several years of diabetes may occur in a small amount of urine albumin. This is the first stage of chronic kidney disease, which is characterized by microalbuminuria. At this stage it is preserved kidney filtration ability.

As the disease progresses, more albumin in the urine is due. This stage is called macroalbuminuria or proteinuria. How to increase the amount of albumin in the urine, thereby reducing renal filtration ability. With decreasing filtration ability more and more waste products of protein metabolism in the body reserves. With the development of renal impairment, there was an increase in blood pressure.
Impairment of renal function rarely occurs in the first 10 years of diabetes and usually take 15-25 years to the appearance of renal impairment. The risk of developing renal disease was lower in patients with diabetes live longer than 25 years without signs of renal impairment.

Diagnosis of CKD
In people with diabetes should be conducted regularly screened for kidney disease. Two key indicators of kidney disease are pGFR and albumin in the urine.
• pGFR. pGFR the estimated glomerular filtration rate. Each kidney contains about the billion tiny filters that are composed of blood vessels. These filters are called glomeruli. Renal function can be examined by the assessment of the amount of blood filtered by the glomeruli in one minute.Calculating pGFR based on the determination of creatinine in a blood sample. The higher the value of creatinine in the blood, the lower the value pGFR.
Renal disease is present when pGFR less than 60 milliliters per minute.
According to a physician diabetologist and nephrologist in patients with diabetes mellitus pGFR be determined from the serum creatinine at least once a year.
• albumin in the urine. Albumin in the urine is determined by comparing the amounts of albumin to the amount of creatinine in a single urine sample. When it comes to healthy kidneys urine will contain large amounts of creatinine, albumin and almost nothing. Even a minimal increase in the proportion of albumin in relation to creatinine is a sign of kidney damage.
Renal disease is present when the urine contains more than 30 milligrams of albumin per gram of creatinine, with or without reducing pGFR.
According to the recommendations of diabetologists and nephrologists at least once a year to determine the excretion of albumin in the urine of patients with type 2 diabetes and in patients with type 1 diabetes also need to do every 5 years to evaluate kidney damage.
The effects of high blood pressure
Elevated blood pressure or hypertension is a key factor in the development of kidney damage in people with diabetes. A family history of hypertension and the presence of hypertension in patients increases the risk of developing kidney disease. Hypertension also accelerates the progress of kidney disease when it is already present.
Arterial pressure is expressed using two numerical values. The first figure is the systolic pressure and represents the pressure in the arteries during cardiac contraction. The second value is the value of diastolic pressure and represents the pressure between the two cardiac contraction. It is common to hypertension defined as permanently elevated blood pressure greater than 140/90 mmHg.
According to the latest recommendations of the ideal blood pressure for people with diabetes is less than or equal to 130/80 mmHg.
Hypertension is not always the cause of kidney disease, it may be the result of kidney damage caused due to diabetes. With progression of renal disease in the kidney, changes occur that cause an increase in blood pressure. Early detection and treatment of even mild hypertension is of crucial importance for people with diabetes.

Prevention and slowing renal disease
Medications to reduce the pressure
Thanks to the work of scientists has made a significant progress in the development of methods by which it is possible to postpone the onset and slow the progression of kidney disease in people with diabetes. Medicines used to reduce blood pressure can significantly slow the progression of kidney disease. Demonstrated the effectiveness of two classes of drugs in slowing progression of renal disease.These are the angiotensin-converting (ACE-I) and angiotensin receptor blockers (ARB's). In many patients, a combination of two or more drugs to achieve adequate pressurization. With ACE-I and ARB-e can be used and diuretics, and drugs such as beta blockers, calcium channel blockers and other antihypertensives.
An example of an effective ACE and Lisinopril is often used in the treatment of diabetic kidney disease.With the effect of reducing blood pressure lisinopril has a direct protective effect on renal glomeruli. It has been shown that ACE and reduce proteinuria and slow down kidney damage in diabetic patients who did not have hypertension.

An example of an effective ARB is losartan, that has been shown to act protectively on renal function and reduces the risk of cardiovascular complications.
Any drug that helps to achieve target blood pressure levels or less jednako130/80 mmHg has a positive effect. Each patient even with mild hypertension or microalbuminuria should consult a doctor about the introduction of antihypertensive drugs in therapy.
A child deficient in protein
Excessive intake of protein may be harmful for diabetics. As recommended by dietitians with advanced diabetic kidney disease should not take sufficient amounts of protein, but definitely avoid foods with high protein content. In patients with significantly impaired renal function, a diet with reduced protein content can help delay the occurrence of renal failure. Adherence restricted diet protein requires consultation with the dietitian to ensure adequate nutrition.
Intensive control of blood sugar levels
Antihypertensive medications and a diet with low protein content may slow the development of CKD.The third measure that has shown promise for diabetics, especially those who present with early-stage CKD, intensive control of blood sugar levels.
The human body converts food into glucose, a simple sugar that is the main energy source for the body's cells. To enter the station to help glucose insulin, a hormone produced by the pancreas. When the body does not produce enough insulin, or absent response to the insulin that is present, the body can not use glucose, and it builds up in the bloodstream. The diagnosis of diabetes is made based on high levels of glucose in the blood. Intensive control of blood glucose levels is aiming to maintain normal blood glucose levels. Regime often includes controlling blood glucose, insulin delivery during the day depending on food intake and physical activity, adherence to the child, appropriate level of physical activity and regular consultation of the medical team. Some patients using insulin pump of insulin throughout the day.
Numerous studies have pointed to the positive effects of intensive control of blood glucose levels. In one study noted the delay in emergence and slow progression of early diabetic kidney disease in 50% of patients who adhered to the intensive regime for the control of blood glucose levels. Patients who adhered to an intensive regime had average blood glucose 8.3 mmol / l, which is about 4.4 mmol / l lower than the levels recorded in patients treated with the standard method. Good glycemic control reduces the risk of early-stage renal disease by a third. Numerous RESEARCH conducted over the last few decades have made it clear that any program that the end result of a decrease in the blood glucose level has a positive effect in patients with early-stage CKD.

Dialysis and transplantation
When the diabetic patients develop end-stage renal failure in the account comes dialysis or a kidney transplant. Back in the 1970s, diabetics often are not offered this method of treatment because it was believed that the damage caused by the diabetes undo the positive effects of treatment. Today, thanks to better control of diabetes and poboljšnom survival, doctors are reluctant to offer diabetic dialysis and kidney transplantation as a treatment method.
There kidney transplant survival for people with diabetes about the same survival rate for kidney transplants to people without the disease. Dialysis is also a good method of treatment for diabetics, but in the short term. Diabetics with kidney transplant or who are treated with dialysis have higher rates of morbidity and mortality due to complications associated with diabetes such as damage to the heart, eyes and nerves.
Good care makes a difference

People with diabetes should:
• determine the level of A1C at least twice a year. The test shows the average blood glucose levels over the previous three months. The target value is less than 7%;

• Work with your doctor about the inzulna injections, medications, meal planning, physical activity, and monitoring blood glucose levels;

• Check blood pressure several times a year or even a month if blood pressure are not well regulated. If the high pressure values ​​should follow the instructions of your doctor to achieve normal values. The target pressure value is less than or equal to 130/80 mmHg;

• Consult with your doctor about the possible benefits of ACE-I and ARBs;

• determine pGFR at least once a year to assess renal function;

• determine the level of protein in the urine at least once a year to assess kidney damage, consult with your doctor or dietitian about the need to reduce the intake of protein food.

Remember
Diabetes is the leading cause of CKD and kidney failure.
Diabetics should regularly perform screening for kidney disease. The two key markers for kidney disease are pGFR and albuminuria.
Medicines used to reduce the pressure can significantly slow the progression of kidney disease. Two groups of drugs, ACE-I and ARBs, and proved to be effective in slowing progression of renal disease.
Excessive intake of protein may be harmful for diabetics.
Intensive control of blood glucose levels is very important for diabetics, especially those with already developed at early stages of CKD.

Conclusion
Number of people with diabetes is increasing. Consequently, an increasing number of people with diabetic kidney disease. According to the predictions of some experts diabetes could soon become the cause of 50% of chronic liver damage. In light of the more common illnesses and deaths associated with diabetes and renal disease, patients, researchers, and health professionals must continue to work towards improving the final outcome of these patients. 

Dynamic renal scintigraphy

What is dynamic scintigraphy?

Dynamic renal scintigraphy is a diagnostic procedure for the pictorial representation of the morphology and function of the kidney using radiopharmaceuticals that are excreted by the kidneys.
Radiopharmaceutical: Tc-99m DTPA, T1 / 2 6 hours.
The goal of search is to evaluate the morphology and function of the kidney-elimination ability of the canal system. It is used in unilateral or bilateral drainage faults or enlargement of renal duct system in terms hidrokalkuloze, stenosis Ureteropelvic neck or urethra, or hidronefoze hidrouretera.

Preparation of the patient prior to the examination

Before the tests should drink about 1 liter of liquid
The patient need not be fasting
Warn your doctor or medical engineers the possibility of pregnancy, or breast-feeding
It is recommended that jewelry and metal ornaments left at home or removed prior to recording
After scanning the patient should drink more fluids and urinate more often
Dynamic renal scintigraphy in renovascular hypertension

A week before the test omitted from an ACE inhibitor and A2 receptors (except for the express contraindications), consult a competent liječnkom which are drugs
Two days earlier and omit beta blockers, calcium channel blockers, diuretics and anti-rheumatic drugs
What to bring to your search?

It is necessary to make a referral to the previous one, on the basis of which the search is indicated (diagnostic and specialists who are starting. Recommends search).

Search procedure

Radiopharmaceutical: Tc-99m DTPA, T 6 ½ hours.
The patient is injected into the cubital vein radiopharmaceutical, while lying on her back on the bed and immediately after the start of injection, dynamic studies lasting 20-30 minutes.
It takes the rest of the time in bed. The camera is below the patient.
Sometimes it is necessary to make one additional recording after giving diuretics also injected intravenously (diuretic dynamic renal scintigraphy).

Treatment of dynamic renal scintigraphy with captopril

Before you search the patient receives pill captopril (25 mg)
After that should be enough to drink and urinate
After 1h receive intravenous radiopharmaceutical (Tc-99m DTPA) while lying on her back on the bed and under the gamma camera
Immediately after the injection begins recording for 20 minutes and during that time should stand still
If the search finds this normal finding, then the search ends. If the result of abnormal, then the patient has to come to another record (basal study - without captopril). The aim of the search is the detection and monitoring of renovascular hypertension.

What can be expected after the shooting?

After the search has no impediments to normal activities.
It is recommended that 24 hours after the examination to avoid close contact with others, especially children and pregnant women. 

How to preserve the healthy kidneys?

Diabetes and high blood pressure are common causes of kidney disease. However, most people with kidney disease are not aware of their condition. If you have diabetes, talk to your doctor about being tested for kidney disease and maintain healthy kidneys so that you control your blood sugar and blood pressure.

If you have diabetes or hypertension, you are faced with chronic kidney disease, which represents a decrease of renal function.


Because chronic kidney disease often develops gradually, and with few symptoms, many people with this disease do not realize that they are sick until the disease has progressed and no dialysis is not necessary.

Kidney disease is the ninth leading cause of death in the United States, responsible for the deaths of more than 48,000 people in the 2008th year. 2000th year, more than 26 million adults in the U.S. had chronic kidney disease and most of them had not been aware of.

How can you prevent or control renal disease?

Diabetes is the leading cause of chronic kidney disease. High levels of sugar in the blood can cause kidney damage. If you have diabetes, controlling blood sugar and blood pressure reduces the risk of developing kidney disease and slowing its progression. People with diabetes should do the A1C test measures average blood glucose levels over the past three months, at least twice a year, and ideally four times a year.

High blood pressure can also damage the kidneys. If you suffer from hypertension, regularly measure blood pressure and put it under control to ensure that your kidneys remain healthy. Regarding medication to reduce blood pressure, consult your doctor.

Prevention of type 2 diabetes is another important step in the prevention of kidney disease. Recent studies have shown that obese people are at a higher risk of type 2 diabetes can prevent or delay the development of kidney disease by reducing your body weight by 5 to 7%, and this can be achieved by including a healthier diet and 150 minutes of physical activity per week.

Injuries and infections can also damage the kidneys

Infections - such as those that affect the bladder and kidneys - may also damage the kidneys. Consult with your doctor if you experience any of these symptoms of inflammation of the urinary bladder:

blurred or bloody urine
pain or burning sensation during urination
feeling the urgent need to urinate frequently
Also, ask your doctor if you experience any of the following symptoms of kidney infections:

backache
chills
temperature
Chronic kidney disease can lead to dialysis and kidney transplantation

 The final stage of chronic kidney disease requiring renal dialysis (filtering blood through a special device) or transplantation. However, people with chronic kidney disease often die from a cardiovascular disease before they reach the end stage renal disease.
2008th year, more than 110,000 people in the U.S. were treated for end-stage renal disease. For every 10 new cases of seven as diabetes or high blood pressure is listed as the primary cause. In the same year, more than half a million people in the U.S. were living with chronic dialysis or a kidney transplant.

CDC Survey

Centers for Disease Control and Prevention in the United States conducted a survey 2008th year and the results were as follows:

In the period from 1999 to 2006. years, among the participants of the National Survey of Health and Nutrition, less than 5% of people with mild kidney disease (stages 1 and 2) reported that they were aware that they have chronic kidney from subjects with moderate severe form of disease (stage 3), awareness was only 7.5%, and even of those with severe disease (stage 4), only 40% were aware of their condition.
Rates of awareness when it comes to medium heavy and severe kidney disease were higher in patients diagnosed with diabetes and high blood pressure, although the total was still quite low (20% and 12%).
People with chronic kidney disease in zajedici most are unaware of their disease and do not seek proper treatment. 

Dialysis or a kidney transplant?

Dialysis and kidney transplantation are the treatments for renal replacement applied in end-stage renal disease. There are two types of dialysis: hemodialysis and peritoneal dialysis.

When the kidneys are not working efficiently enough, the waste products (toxins) and fluid build up in the blood. Dialysis takes over the function of the kidneys are failing and removes liquid and wastes.Kidney transplantation is fully recovered renal function.

Here we talk about the pros and cons of these treatment options. You and your family with your doctor should talk about all the options that you have made the appropriate decision about your future medical treatment.

WHEN kidney dialysis or a kidney transplant be necessary? - At the beginning of the disease using drugs which preserves renal function and delay the need for dialysis and transplantation. These early treatment effect on renal disease, secondary factors (such as hypertension) that accelerate the development of renal disease and complications of chronic kidney disease.

As the kidneys lose their function, fluid and waste material began to accumulate in the blood. Dialysis should be started before the disease has progressed so much to report life-threatening complications.The need for dialysis / transplant occurs usually after months or even years of diagnosis of chronic renal disease, although severe kidney failure is sometimes the first time revealed in people who previously did not know they are suffering from chronic kidney disease.

Dialysis is best to start when the disease is advanced, but while still feeling unwell. About when you start dialysis decide together with the physician after considering several factors, including renal function (as measured by blood tests and urine tests), overall health and personal preferences.

KIDNEY TRANSPLANTATION - Kidney transplantation is considered the best treatment for all patients with renal failure because of the quality of life and survival are often better than in people treated with dialysis. However, due to lack of organs for transplantation, many patients who are candidates for a kidney transplant are waiting lists and dialysis they need until they find a suitable organ for transplantation.

The kidney can be obtained from living relatives, living person with whom the patient is not related by blood or cadaver (donor kadaverski) In general, life donor organs function better and longer than when coming from deceased donors.

Some people with kidney failure are not candidates for transplantation. For the elderly or patients with severe heart and vascular disease is safer to remain on dialysis than to undergo the transplant. Other conditions that prevent kidney transplant may include:

Active or recently treated for cancer
Severe chronic ooljenja other organs
Poorly controlled mental illness (psychosis)
Severe obesity (body mass index over 40)
The current abuse of drugs or alcohol
Some chronic viral infections
The majority of centers in the world off from the transplant program people who are HIV-positive. In some cases, however, people with HIV may be eligible for a kidney transplant if the disease is well controlled.

People with other medical conditions are assessed on a case by case basis to determine whether kidney transplantation is a viable option.

Benefits - Kidney transplantation is the best treatment for many patients with end-stage renal disease.Successful kidney transplantation can improve quality of life and reduce the risk of death due to kidney disease. In addition, people who undergo kidney transplantation will not waste time on daily dialysis.

Disadvantages - Kidney transplantation is a major surgical procedure that has risks both during surgery and afterwards. Risks of the surgery include infection, bleeding and damage to surrounding organs. Can come to death, although this rarely happens.

After kidney transplantation, the patient needs to take medication and go on frequent monitoring to reduce the risk of rejection; goes with it throughout life. Medications that the patient must be taken to have a significant and serious side effects.

HEMODIALYSIS - In hemodialysis, the patient's blood is pumped through a dialysis machine to remove waste products and excess fluid. The patient is connected to the machine via surgical napravljenog vascular access, which is commonly called fistula or graft. It allows taking blood from the body of the patient, blood flow through the machine where it purifies the blood and return blood to the body of the patient.

Hemodialysis can be done at home or in the center. When performed in the center is usually done three times a week and lasts for three to five hours. Home dialysis is usually performed three to seven times a week and lasts from three to ten hours after the procedure (often while the patient is asleep).

Advantages - It is unclear whether hemodialysis has clear advantages over other type of dialysis (peritoneal dialysis) when it comes to survival. The choice between these two types of dialysis is usually based on other factors such as personal preferences, support at home and basic medical problems. You need to start dialysis that you and your doctor think is best, although it's possible switch to another type of dialysis if the circumstances and preferences change.

Disadvantages - The most common complication of hemodialysis is low blood pressure, and may be accompanied by lightheadedness, shortness of breath, stomach cramps, nausea and vomiting. In the case of these problems, there are treatments and preventive measures. In addition, vascular access may be infected, or it may appear blood clots.

Peritoneal dialysis - Peritoneal dialysis (PD) is usually performed at home. To perform PD abdominal cavity is filled with dialysis fluid (called dialysate) through a catheter (flexible tube). The catheter is surgically introduced into the stomach, near the navel.

The liquid is a certain time (called the retention time) leaves the stomach. The tissue that lines the abdominal cavity (peritoneal membrane) acts as a membrane that allows the diffusion of excess fluid and waste products from the bloodstream into the dialysate. The used dialysate is then derived from the stomach and discarded. The peritoneal cavity is then filled again dialysate. This process is called an exchange.

Editing can be done manually, four to five times a day. Editing can also be done automatically by the device (called a cycler) while you sleep.

Benefits - Advantages of peritoneal dialysis compared to hemodialysis include fewer withdrawal time for work, family and social obligations. Most patients using PD can continue to work at least part-time, especially if the changes are working in a dream.

Disadvantages - People who use PD must know how to use the equipment for PD and how to do change fluid in the abdomen. If you can not do that, you need the help of a family or household who has previously trained to perform this procedure.

Disadvantages of peritoneal dialysis include an increased risk of hernia (hernia) due to the fluid pressure within the abdominal cavity. In addition, you can gain weight and a higher risk of infection in the catheter and inside the abdomen (peritonitis - inflammation of the peritoneum).

Which treatment is best for me? - Kidney transplantation is the optimal treatment for most patients.Patients who are not candidates for a kidney transplant or who have to wait for a kidney is usually treated either by hemodialysis or peritoneal dialysis.

The choice between hemodialysis and peritoneal dialysis is a complex problem that can best solve together with the doctor, and often consult family members or caregivers after careful consideration of all other factors.

For example, hemodialysis involves rapid changes in fluid balance in the body and not all patients can tolerate that. Some patients are not suitable candidates for a kidney transplant, while others do not have support at home or the necessary skills to perform peritoneal dialysis. Overall health status, personal preferences and situations in the home are only part of the factors that must be taken into account. It is possible to switch from one type of dialysis to another over time if options or preferences change.

Polycystic Kidney Disease

Normally, the kidneys filter toxic substances and fluid from the blood. In people with polycystic kidney disease, they become enlarged with multiple cysts that interfere with normal kidney function.This can sometimes lead to kidney failure and need for dialysis or kidney transplantation.

There are two major forms of polycystic kidney disease: autosomal dominant polycystic kidney disease and autosomal recessive polycystic kidney disease.

Autosomal dominant polycystic kidney disease (ADBPB) is a common disorder that occurs in 1 in every 400 to 1,000 people. With only about half ADBPB will be diagnosed because the disease usually runs its course without symptoms. Autosomal dominant means there is a 50 per cent risk that the parent transmitted the mutated gene to the child.
Autosomal recessive polycystic kidney disease (ARBPB, also called the children polycystic kidney disease) is more commonly diagnosed in infants, although milder forms may be diagnosed later in childhood or adolescence. The estimated incidence is 1 in 10,000 to 20,000 people. Autosomal recessive means that the mutated gene must be present in both parents; person who has only one mutated gene carrier. If both parents are carriers (each with one normal and one abnormal copy of the gene), there is a 25 percent chance that the child will inherit the mutated gene from each parent and will become ill.
Genetics of polycystic kidney disease - Approximately 85 percent of families with autosomal dominant polycystic kidney disease (ADBPB) has an abnormality on chromosome 16; these people have BPB1 disease. The remaining 15 percent have a defect that affects gene on chromosome 4: it is called BPB2 disease. In some cases it is not possible to determine which gene is mutated.

In about 25 to 40 percent of cases ADBPB occurs in people with no family history of the disease. To the 10 percent of a new gene mutation. Often, especially in families with no BPB1, a disease that progresses slowly and can never lead to the onset of symptoms.

Cysts and renal failure occurring earlier in the case of PKD1 disease, the average age of the last stage occurs when kidney disease (or if they need dialysis or a transplant) is about 57 years for PKD1 disease and 69 with non-PKD1 disease.

Cyst formation - autosomal dominant polycystic kidney disease (ADBPB) causes abnormal cell growth, leading to the formation of cysts in the kidneys, but the way in which cysts form is not clear.

The basic unit of the kidney is the nephron, and each kidney has about a million nephrons. Each nephron consists of a glomerulus, a set of very small arteries intermingled with tubules. Glomeruli and tubules together to filter waste products from the blood stream and put them out in the urine.

With ADBPB, cyst begins to expand tubules. Tubules increased over time, usually due to accumulation of fluid in the cyst. Cells that are clean and multiply it grows. Cysts may grow in the liver, pancreas and / or spleen.

EFFECT OF KIDNEY - autosomal dominant polycystic kidney disease (ADBPB) often leads to progressive kidney failure, partly because of the constant enlargement clean. May occur, and other effects such as high blood pressure, kidney infections, blood in the urine (hematuria) and kidney stones. Pain in the lower back and abdomen is also possible.

Kidney failure - Kidney failure hard enough to require dialysis or a kidney transplant is called the last stage renal disease (ESRD). Although ADBPB may cause ESRD in childhood, usually occurring in middle age or later. Likely need for dialysis in patients with ADBPB is estimated at less than 2 per cent in people under 40 years of age and increases to 50 to 75 percent by the age of 70 to 75 years. Kidney failure does not occur in all patients with ADBPB.

Risk Factors - Risk of chronic kidney disease (a precursor to end-stage renal disease) in ADBPB depends on a number of risk factors. Factors that increase risk include younger age at diagnosis, male sex, presence BPB1, frequent episodes of visible blood in the urine, high blood pressure and enlarged kidneys. Having more than one risk factor further increases the risk of worsening kidney disease whatever men and women.

High blood pressure - High blood pressure often occurs in the case of autosomal dominant polycystic kidney disease (ADBPB) and is diagnosed in 60 to 70 percent of patients. It is often diagnosed early in the disease, before any sign of kidney failure.

Kidney infection - Approximately 30 to 50 percent of patients with ADBPB will have more of a kidney infection.

The primary symptoms of kidney infection in people with ADBPB as fever and back pain. The infection can affect kidney or cyst. In case of infection cysts are not all antibiotics are equally effective. As it is not easy to determine the site of infection, most doctors will recommend an oral antibiotic that can penetrate the cyst. Some patients with very high fever or severe pain should be treated by intravenous antibiotics.

Blood in the urine - hematuria (blood in urine) occurs in 35 to 50 percent of patients with ADBPB and may be the first sign of illness. With hematuria, the urine may be pink or red. Often there are repeated episodes of hematuria.

Hematuria usually causes bleeding into the cyst due to the rupture as a result of a urinary tract infection or with effort; bleeding can cause pain from the lumbar (low back pain). Patients with ADBPB can develop and stones buburezima, which can also lead to hematuria and pain in the hips.

Hematuria associated with ruptured cysts usually stop after two to seven days. Treatment usually involves rest and large amounts of fluid until the bleeding stops. If bleeding does not stop with bed rest and increased intake of fluids, you may need treatment to stop the bleeding.

Buburezima stones - Kidney stones occur in about 20 percent of people with polycystic kidney disease.Kidney stones can cause pain and sometimes can block the path of urine without symptoms.

Treatment of kidney stones blocking the road when the urine is more difficult in patients with ADBPB.Surgical removal of the cyst hinders the use of stone or shock wave to break his (extracorporeal shock wave therapy or lithotripsy ESWL).

Pain in the lower back and abdomen - Patients with autosomal dominant polycystic kidney disease (ADBPB) often feel pain in my stomach and lower back which is not associated with infection, bleeding into cysts or stones. The pain is often dull and plodding, and is thought to be due to stretching of the wall cysts, or pressure on other organs as the kidneys and / or liver enlarged. In contrast, sudden pain is often caused by bleeding or infection in the cyst, torsion of the kidney or kidney stone.

Most people with persistent, dull pain in the abdomen or lower back is not usually needed therapy, often recommended analgesics such as acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen are also sometimes recommended, although patients with polycystic kidney disease should consult with your doctor about the risks and benefits of NSAIDs and before you start to use them. NSAIDs are not recommended when renal function is reduced.

Some people have pain persistent enough to limit their daily functioning. Severe pain is usually estimated by ultrasound to see if the painful part of a large cyst. If there is, it is possible to introduce a needle into the cyst ultrasound and draw liquid from it. Most patients felt pain relief after draining.However, the pain usually occurs again and sometimes surgery is needed to reduce the pressure of the cysts.

VAN RENAL COMPLICATIONS - In patients with autosomal dominant polycystic kidney disease (ADPKD) is the possible emergence of a large number of complications outside the kidney. Of these complications is thought to arise from the same abnormality responsible for the formation of cysts in the kidneys.

Cerebral aneurysm - The most serious complication of polycystic kidney disease is cerebral or brain aneurysm (a blood vessel due to weakening of its wall). Aneurysms can rupture and cause bleeding in the brain. If not treated quickly, the bleeding can cause irreversible brain damage or death. Shooting anerurizme often occurs in patients with larger aneurysms and / or poorly controlled high blood pressure. The most common symptom is bleeding, rash, severe headache, often accompanied by nausea and vomiting.

About 4 percent of young adults with ADBPB may have brain aneurysms, and the frequency increases with age to about 10 percent. People with a family history of cerebral aneurysm or cerebral hemorrhage have the highest risk of aneurysm formation.

For high risk patients recommended early diagnosis of cerebral aneurysms. Test (search for aneurysm) is usually performed using different scanners such as CT scan or magnetic resonance angiography (MRA).

Currently, routine testing is recommended only in case of high-risk patients, such as patients who have had ruptured aneurysms, patients with a family history of brain hemorrhage, patients with warning symptoms, or patients with high-risk activity (eg pilot), when loss of consciousness may that seriously endangers the patient or another person.

Testing of patients at low risk are not recommended because they are rare aneurysm in the group, and most of detected aneurysms has a low risk of rupture. In addition, there is a risk of serious neurologic complications related to corrective surgeries, this means that the risk of removing the aneurysm outweigh the benefits of avoiding the rupture. Therefore, most patients with low risk would benefit from the invention of the aneurysm, especially because the operation of small aneurysms is not recommended.

Aneurysms that are greater than 7 to 10 mm have a high risk of rupture (up to 2 per cent gorišnje).Cerebral aneurysms and size as those that cause the symptoms can be corrected with surgery or a procedure that sets the coil inside the aneurysm to reduce the risk of cracking. Smaller aneurysms that do not cause symptoms rarely break and are adjusted routinely, except in patients with a history of bleeding.

Cysts in the liver - liver cysts are common in patients with autosomal dominant polycystic kidney disease (ADBPB), the affected 30 to 40 percent of patients younger than 30 years to more than 80 to 90 percent of people older than 60 years.

Cysts in the liver are more common in people with advanced chronic kidney disease. Although the incidence of polycystic liver disease is similar in men and women, very large cysts occur exclusively in women and more common in women who have had multiple pregnancies.

Most patients with cysts in the liver have no symptoms and have normal or nearly normal liver function. However, some individuals may occur pain (if persistent or very strong it may be necessary to drain the cyst) and / or infection of the cyst (which requires antibiotic therapy and, in some cases, drainage).

Valvular heart disease - Abnormalities of the heart valves occur in 25 to 30 percent of patients with ADBPB. The majority of patients with valvular heart disease have no symptoms and require no treatment. However, valvular heart disease over time can worsen and become severe enough to be required to replace them.

Diverticula column - a pocket diverticulum (expand outwards) that can occur in the colon wall, especially at the point where it enters the blood vessel. Divertikulozis indicates the presence of diverticula in the colon; Diverticulitis refers to inflammation of the diverticula. People with autosomal dominant polycystic kidney disease (ADBPB) have an increased likelihood of complications of diverticula in the colon, especially after renal transplantation.

Symptoms of diverticulitis include abdominal pain (which may be similar to the pain caused by cysts in the kidneys), diarrhea, and blood in the stool. People with the disease have no symptoms of diverticula that do not need specific treatment. Treatment of diverticulitis depends on the severity of symptoms and clinical findings.

Abdominal wall hernia - hernia occurs where muscles are weakened. Part can be enhanced if pressed bodies behind the muscle, especially if a person increase pressure on the abdomen (such as during coughing or while carrying a heavy load). Abdominal wall hernias are relatively common, affecting about 45 percent of patients with autosomal dominant polycystic kidney disease (ADBPB).

Surgery is the best treatment of abdominal wall hernias, but surgical treatment is required for all chemistry. Small hernia and can only be monitored.

Diagnosis of polycystic kidney disease - autosomal dominant polycystic kidney disease (ADBPB) is usually easy to diagnose in patients with pain in the hips or abdomen and who have a family history ADBPB. It is usually recommended examinations such as ultrasound, magnetic resonance imaging scan (MRI) or CT scan, and such statements can be seen enlarged kidneys with multiple cysts in both kidneys. Cysts can be found in the liver, pancreas and spleen.

For people without a family history ADBPB is a little harder to diagnose. At polycystic kidney disease can be suspected after a scan, for example, ultrasound, done for some other reason. Family history may be negative because the family members developed symptoms later died from some other cause before ADBPB diagnosed, or did not have any symptoms.

TREATMENT polycystic kidney disease - autosomal dominant polycystic kidney disease (ADBPB) often leads to kidney failure due to continued enlargement of the cysts. Therefore, treatment focuses on slowing the progression of kidney failure and treatment of kidney infections or kidney stones and pain in the lower back or abdomen.

High blood pressure - treatment of high blood pressure can have a double meaning in people with polycystic kidney disease because it can slow the loss of kidney function and the risk of rupture of cerebral aneurysms is minimized. People with high blood pressure have a higher risk of kidney failure.

Angiotensin converting enzyme (ACE) and angiotensin receptor blockers (ARB) can effectively lower blood pressure in most patients with ADBPB.

Restriction of dietary protein - There are conflicting findings regarding the benefits of a low-protein diet in patients with ADBPB. Due to the limited evidence for the benefits we do not recommend lowering protein intake of 1 to 1.1 g / kg per day. In this example, a man of 82 kg would need about 90 grams of protein per day.

End-stage renal disease - Patients with ADBPB who progress to end-stage renal disease are or dialysis or kidney transplantation.

People with ADBPB requiring dialysis is usually treated with hemodialysis. People with ADBPB undergoing dialysis live longer than people with the last-stage renal disease other cause.

Peritoneal dialysis, a form of dialysis that involves infusing fluid in the abdomen and draining the fluid over time, rarely performed because of the presence of enlarged kidneys.

Prognosis after renal transplantation is usually excellent.

Testing for polycystic kidney disease - relatives of patients with autosomal dominant polycystic kidney disease (ADBPB) enabled testing. The decision about testing the BPB should be made after consultation with an experienced doctor, and that will include all the pros and cons of such testing.

Testing in children - child patient with ADBPB can be tested for the disease before symptoms develop.The chance of a child being hit by ADBPB included when a parent is ill one in two (50 percent). When both parents are born out of a chance than three in four cases (75 per cent) that the child will be affected.

However, testing is not usually recommended as a child, unless the child shows no symptoms of the disease, because ultrasound testing in children is not reliable. Most people with BPB does not develop cysts to a later time. In addition, the diagnosis of disease in children does not affect the subsequent treatment, and can lead to the child's anxiety and fear.

A patient who has ADBPB should follow the child's blood pressure once a year, starting from the third year. Although it is recommended for all children, it is not always.

Examination of polycystic kidneys in adults - adult with a family history of polycystic kidney disease, but who have no symptoms, may be subject to testing. However, it is important to understand that people who have no symptoms do not need treatment. In addition, the diagnosis of BPB can potentially affect the possibility that the person gets life insurance.

Ultrasound - tests such as ultrasound can be used to diagnose ADBPB's, using the criteria described below. These criteria are very sensitive with respect to the detection BPB1: and less sensitive in patients with non-BPB1 disease in which cysts occur later in life. To be diagnosed ADBPB:

For people younger than 30 years at least two cysts (in one or both kidneys) must be detected by ultrasound.
In patients aged 30 to 59 have at least two cysts that are detected in each kidney ultrasound.
In patients older than 60 years, four or more cysts must be found in each kidney ultrasound.
Negative ultrasound or CT scan does not mean that a person does BPB1, unless the age of 30. It is not clear when after ultrasound BPB2 can be turned off.

For example, a person older than 30 years and has a negative ultrasound can develop non-BPB1 disease. However, people with non-BPB1 have a lower risk of kidney failure than people with BPB1.That some people can provide comfort.

Genetic Testing - Genetic testing can be used to test for BPB1 or BPB2 mutations, although their use is limited due to cost and lack of diagnosis in 30 percent of cases. Genetic tests can be used:

In the case of young adults with a family history ADBPB and negative ultrasound, which is a potential kidney donor
In the case of a person with that diagnosis ADBPB after other tests is not clear.
It seems that the formation of cysts in ADBPB begins in the fetus. However, the disease usually does not cause symptoms in young children. Genetic testing can be done during pregnancy to see if the child is affected, although it is not recommended for several important reasons:
The test is not perfect and may show that the child was positive for ADPBP when it is not.
The test may be negative, and ADBPB still be present.
Some people with mutations in genes never develop symptoms ADBPB a
ADBPB the majority of patients does not cause symptoms until middle age (and by then it may be found effective therapy that will prevent the growth of cysts).

Hemodialysis

Dialysis is a method of treatment of terminal renal failure. When the kidneys are no longer working effectively, waste products (toxins) and fluid builds up in the body. Dialysis takes over the functions of the kidneys are failing and removes waste products and fluid.

Dialysis is usually required when the lost 90 percent or more of kidney function. This behavior usually occurs several months or years after the diagnosis of chronic kidney disease. At the beginning of kidney disease used other types of therapies that help maintain kidney function and delay the need for renal replacement therapy.

What type DIALYSIS BEST? - When dialysis becomes necessary, the patient (with the doctors) examine the pros and cons of the two types of dialysis:

Hemodialysis (in the center or at home)
Peritoneal Dialysis
The choice between hemodialysis and hemodialysis peritonumske influenced by many factors such as availability, convenience, underlying medical problems, the situation in the home and age. This decision is best made after discussion with your doctor about the risks and benefits of both types of dialysis.

When you start dialysis - Together with the doctor, the patient decides on the time of starting dialysis, according to the kidney failure. The decision affect renal function (as measured by blood tests and urine tests), overall health, nutritional status, symptoms, quality of life, personal preferences and other factors. Doctors recommend that dialysis begin much before the kidney disease has progressed so much that can be life-threatening complications.

Many patients have to start dialysis when renal function is 8 to 12 percent of normal, even though it varies from patient to patient.

In some situations, dialysis must immediately begin. If the blood tests suggest that this is a very poor kidney function or non-existent, or if there are symptoms such as confusion or bleeding associated with kidney disease, the application of dialysis should be started immediately.

Preparation for hemodialysis - Preparation for hemodialysis should be made at least a few months before it becomes necessary. In particular, the procedures needed "vascular access" (described below) for a few weeks or months before treatment.

Vascular access - Vascular access to collect blood from the bodies of patients, its treatment in the dialysis machine and back into the body of the patient. There are three main types of vascular access: primary AV fistula, synthetic AV grafts and central venous catheter. Other names for access to the fistula or shunt.

The approach needs to be made before the start of dialysis because of the time needed for its "maturity". Consultation on Access to begin even earlier, because he has to avoid injury to the vessels that will be used for it. Intravenous infusion or frequent blood sampling from the arm that will be used to create vascular access can damage veins, which subsequently makes it impossible to use those for vascular access. Access is usually on the right hand that is not dominant; lefthanded people will have access to the left hand.

After the formation of vascular access is very important to monitor it and take care of him.

Primary AV fistula - Primary AV fistula is the most common type of vascular access. Requires a surgical procedure that makes a direct connection between arteries and veins. This is often done on the forearm, but it can on the upper arm. Sometimes, the veins that normally would not be useful for creating AV fistulas may be moved so that it is accessible and this can often be performed on the upper arm.

Regardless of the position or the way in which it is made, access under the skin. During dialysis, the approach introduces two pins. Through a needle of blood out of the body, passes through the dialysis machine and back into the body through another needle.

Primary AV fistulae usually makes two to four months before they will be used for dialysis. During this time, the wound will heal and access will be fully developed and "mature."

Synthetic graft - Sometimes the veins in the hand of the patient are not suitable for the creation of the fistula. In this case, the surgeon can use a flexible rubber tube in order to make a path between arteries and veins. This is called a synthetic graft. Graft under the skin and is used in the same way as the fistula.

Graft heals faster than fistulas can often be used for two weeks after installation. However, complications such as narrowing of the blood vessels and infection occur more frequently than in the case of graft AV fistula.

Central venous catheter - Central venous catheter using a thin flexible tube that is inserted into a large vein (usually a door). Recommended if dialysis must immediately begin, and the patient does not have a functioning AV fistula or graft. This type of approach is usually used only temporarily. In some cases, however, there may be problems with the maintenance of AV fistula or graft, and central venous catheter permanent access.

Catheters have the highest risk of infection and the worst position in comparison with other approaches; should be used only if the primary fistula or synthetic graft can not be sustained.

Changes in diet - Some patients, especially those made in the dialysis center, it will have to make changes in your diet before and during treatment. These changes are provided to prevent overloading and liquids to enter a balanced amount of protein, calories, vitamins and minerals.

Can you recommend a diet low in sodium, potassium and phosphorus, and fluids (drinks and food) may be limited. A dietitian can help patients when choosing foods that are compatible with dialysis treatment.

LOCATION hemodialysis treatment - hemodialysis can be performed at home or in the center.

Home treatment - treatment for pets is essential that the patient and members of his / her family educated and constant support physicians experienced in the treatment of patients on home hemodialysis. This usually means nephrologist (kidney specialist) and too specialized nurse.

Patients treated with hemodialysis at home usually can lead an independent life and often have longer survival compared to patients treated in a dialysis center. This is partly due to the fact that patients on home hemodialysis have more frequent and longer dialysis treatments of patients at the center.

Home hemodialysis is generally performed three to seven times a week and lasts between three and ten hours after treatment. Hemodialysis, which is done during the day usually takes three to four hours a day, four to seven times a week. Hemodialysis, which is done at night (nocturnal hemodialysis takzvana) is usually performed three to seven times a week while the patient sleeps. Preparation and cleaning needed more time.

Home dialysis can be done at a time that suits the patient. Usually require the participation of another person (family member, friend or technician) who helps the patient before, during and after dialysis.The doctor has to be a phone available in case of problems or issues; daily (or nightly) dialysis schedule provides additional benefit compared to treatment at the center, which is done three times a week. More frequent dialysis results in a significant increase in health, reduce symptoms during and between dialysis and improves the quality of žifvota. Home dialysis can improve quality of life as to download more responsibilities related to care of themselves and to staying in the comfort of the apartment during the treatment. In addition, patients who use home hemodialysis can usually keep their job.

Equipment - For home dialysis is necessary that the patient has a dialysis machine at home. In addition, the system is required for the preparation of water for hemodialysis (reverse osmosis), dialyzers, dialysis solutions, disinfectants, syringes, needles, drugs, blood lines and sets to test the waters. Some devices need electrical and plumbing modifications of the house in which dialysis is performed. Currently available equipment for the size of night-table.

Treatment center for dialysis - Dialysis can be performed in a hospital, clinic associated with a hospital or an independent clinic. The centers employ doctors, nurses and carers and all involved in the care.Generally, the dialysis center takes between three and five hours (an average of three and a half to four hours) and is performed three times a week. During treatment the patient can sleep or read and usually has access to a television. The HD unit consumption of food and beverages, as well as visits are usually limited.

Travel Tools - Dialysis centers are located all over the world. Patients who need dialysis, but who want to travel scheduling consultations in the center of the village in which they want to travel (temporary center). Many dialysis centers have an employee, nurse or social worker, to help in organizing the visit; planning should be done six to eight weeks prior to travel to ensure a place.

Dialysis center where the patient has regular treatments temporary center must provide the patient's medical history, including the results of recent tests and information about treatment, list of medications, insurance information, and any other necessary information.

Patients with chronic medical problems, including those requiring dialysis, the trip must be carefully planned.

Monitoring the quality HEMODIALYSIS

In patients treated with hemodialysis are regularly doing lab tests to check the quality or adequacy of hemodialysis. Modern dialysis machines have all the modules during dialysis showed the same quality.Based on the results of these tests are set conditions hemodialysis (blood flow velocity, length of dialysis, type of dialysis filter, etc.).. Numerous clinical studies have shown that the efficiency and adequacy of hemodialysis affect survival of patients as well as in the quality of life. Assessing the adequacy of dialysis should be done at least once a month.

Monitoring body weight - After failing kidneys that can not remove the required amount of fluid from the body, the task must be performed dialysis. Accumulation of fluid between two hemodialysis treatments can lead to complications. Most patients measure the weight before and after dialysis and are looking for an everyday weight control at home. If the patient's weight between the two treatments increased more than normal, he must contact his or her doctor.

Care Access - It is very important to take care of vascular access in order to prevent complications.Complications can occur even when the patient is alert, but less if you take certain precautions:

Access daily washing with soap and water, and always before starting. The patient should not be slate or removes scabs.
Every day check whether there are symptoms of infection such as redness or to the temperature.
Daily check to see if there is access to the blood flow. You need to feel the vibrations through access.Tell your doctor if there is none, or change. Blood flow is sometimes controlled by ultrasound (Doppler). Monitoring the flow and velocity of blood flow through the access during treatment.
Hand with approach must not be violated; patient should not wear tight clothes, jewelry, or heavy things to sleep on that arm. You should not allow blood tests or blood pressure in the arm.

Unwanted effects on hemodialysis - Most patients well tolerated hemodialysis. However, I can report adverse events. Low blood pressure is the most common complication and may be accompanied by dizziness, shortness of breath, abdominal cramps and muscle pain, nausea and vomiting.

For any inconvenience that may occur during hemodialysis, treatments and preventive measures.Many side effects are associated with excess salt and fluid accumulation between treatments, which is minimized by carefully monitoring the amount of salt and fluid enters the patient between two dialysis.

Kidney stones

The presence of kidney stones (nephrolithiasis Latin) is a common disease and it is such. in the U.S. occurs in about 12% of men and 5% of women younger than 70 years. The disease is three times more common in men than in women which can be explained by hormonal and metabolic differences between the sexes. Also, the disease is more common in developed countries and in people of higher social status, which is associated with the diet. In some areas of the country uečstalost occurrence of kidney stones was higher (lithogenic areas) which are associated with water quality and diet.

What causes kidney stones?

There are several theories about the pathogenesis of kidney stones. The most common reason for the occurrence of kidney stones is increased excretion in the urine of minerals (calcium, phosphorus, oxalate, cystine, uric acid) or impaired balance and promoters of the aforementioned inhibitors (magnesium, citrate, pyrophosphate and glycosaminoglycans) crystallization of minerals in the urine.The urine is a saturated solution of various salts. In situations where it becomes saturated due to increased excretion of minerals or lack of fluids in the body and situations to reduce the concentration of inhibitor crystallization occurs fomiranja crystals in the urine that can grow into a stone.

What contributes to kidney stones?

The factors that contribute to the formation of kidney stones include urinary tract infections, urinary tract diseases in which there is stasis of urine (anatomical anomalies of the kidney, ureteral stricture, urinary reflux, prostate enlargement, etc..), Endocrine and metabolic disorders (hyperparathyroidism, uric diathesis) genetic predisposition, diet and insufficient fluid intake or dehydration status (loss of fluids from the body), prolonged immobilization, a bowel disease and systemic diseases such as Crohn's disease, jejunal-ileal bypass and sarcoidosis, and taking certain medications (calcium, vitamin preparations D, sulfonamides).

Size of the stone varies from a few millimeters when you use the term sand up to several centimeters.Smaller stones usually spontaneously leave the kidney and eliminated out of the body without any medical intervention. When the stone is greater than 7 mm is likely that he stopped in the urinary tract and cause stagnation of urine, often with associated infection. Larger stones can not always get into the urethra and remain in the kidney where usually gradually growing.

What constitutes a kidney stone?

Kidney stones have a different chemical composition. In 75% of cases are composed of calcium salts (calcium oxalate, phosphate or carbonate), and rarely are composed of uric acid, cystine or struivita.

What are the symptoms of kidney stones and how it reveals?

Clinical symptoms depend on the localization scale. Kidney stones usually cause a dull lumbar pain.Joining stone mokraćovog characterized by severe pain (renal colic), which extends from the loin to groin and was accompanied by frequent urination, nausea and vomiting and sometimes blood in the urine, and urinary tract symptoms. The pain usually lasts 20 to 60 minutes, but sometimes a few hours and can be so intense that requires hospitalization.

The presence of kidney stones reveals the ultrasound and X-ray (intravenous urography).

How to treat kidney stones?

For smaller stones which are expected spontaneous elimination of therapeutic measures include increased fluid intake by mouth or through an IV, analgesics, and physical activity. In gallstone stuck in the urinary tract (usually stones larger than 9 mm) or larger stones in the kidney apply various treatment methods such as extracorporeal lithotripsy (extracorporeal shock wave breaking), ureterolitotripsija (introduction of a special instrument into the ureter or kidney and in situ breaking stone), percutaneous nefrolitotomija (introducing an instrument through the skin into the renal pelvis and in situ breaking stone) and operative treatment. Surgical treatment is rarely applied and is generally reserved for larger concre (3 cm and above).

How to prevent the recurrence of kidney stones?

A patient once had a stone has a good chance (to 70%) to get the stone back. In this sense, especially in patients with recurrent stones or stones on both sides, it is nephrology and urology examination in order to detect the possible cause of kidney stones and predisposing factors. Depending on the results of the tests and the composition of revealed determined by medical therapy and diet. Sometimes, as is the case for example with increased parathyroid gland function, it is necessary to surgically treat them.

In general, all patients with stones should drink more fluids (non-carbonated water, cranberry, lemonade, urological tea), especially during summer months when the fluid lost through sweating or evaporation. Daily amount of urine izulučene should be more than 2 liters. Do not take grapefruit juice because it promotes stone formation. In patients with stones composed of calcium oxalate in the diet to avoid spinach, cabbage, lettuce, peas, green beans, beets. When phosphate stones should avoid fish, egg yolk, milk and dairy products, and uric acid stones offal, red meat, peas, green beans, beans, almonds, peanuts and mushrooms. All patients with gallstones should avoid salt in your diet.

A person can be infected when bacteria invade the mucous membrane of the mouth, throat, anus, urethra or vagina. Ejaculation is not necessary to avoid infection. Risk factors for infection are a number of partners, a new partner, or a history of sexually transmitted diseases.

Chlamydia symptoms - Chlamydia infection can cause mild to severe symptoms. However, some sick people do not show symptoms, which allows transmission of the disease from one person to another before it is diagnosed.