Author: KidneySolutions

KidneySolutions was established in 2012 by a group of practicing nephrologists, pharamacists and business professionals and is the Partner of choice in the provision of high quality chronic kidney disease and dialysis care services in the Lagos area. Our Mission: To provide the highest quality service by transforming the promise of science, technology and medicine into service that transforms, prolongs and saves the lives of patients with all stages of kidney disease. Our Values: Service Excellence Quality Accountability Operational Efficiency Evidence Based Medicine

An Important Genetic Cause of Kidney Disease in Nigeria- APOL1 Mediated Kidney Disease


Ever wonder why so many people are falling victim to the problems of kidney failure in Nigeria and sub saharan Africa? Well, recent scientific advances show that the cause of this survival disadvantage in Africa is not only inherited from our parents but is part of our defensive response to overcome African sleeping sickness transmitted by the Tsetse fly. The genetic code to resist sleeping sickness that increases risk for kidney disease is called the APOL1 gene

The growing problem of kidney disease around the world and in West Africa in particular is alarming. A casual look at social media pages very often show people reaching out for help to deal with the catastrophic physical and financial burden of kidney failure. Many Nigerians know someone personally who has or is suffering from the burden of kidney disease.

What is the reason for this? Well, for decades, the common medical advice has been that high blood pressure, high blood sugar and lifestyle choices like high alcohol intake, smoking and taking toxic herbal medications and remedies are the major causes of kidney disease and kidney failure in Nigeria. However, recent medical advances in genetic testing and computational science in the last 20 years since the completion of the genome project have indicated that the cause of the plague of kidney disease in Nigeria and the broader sub saharan region is more complicated than just lifestyle choices or blood pressure. The cause seems to be in our cells and this cause has been part of our evolution as a people to survive against things in our environment that could kill us. What in our environment could kill us and make us have to adapt in such a way that we now suffer from kidney disease? Well, the answer has been linked to the story of our relationship with the Tsetse fly.

The Tsetse fly in Western and Sub Saharan Africa causes African sleeping sickness also called African trypanosomiasis. A bite from the tsetse fly releases the parasite into the blood that causes the disease. One of the first historical records of trypanosomiasis is by the famous Arabian geographer Abu Abdallah Yaqut (1179–1229). During his journey into Africa he found in the “Country of Gold” an underground village whose inhabitants and even their dogs were just skin and bones and asleep! The World Health Organization (WHO) in a 1998 report estimated the number of people infected to be about 300 000- likely an underestimation.

The Tsetse fly transmits a very serious and deadly disease called African trypanosomiasis or African sleeping sickness. The first stage of African sleeping sickness, known as the hemolymphatic phase, is characterized by fever, headaches, joint pains, and itching. Invasion of the circulatory and lymphatic systems by the parasites is associated with severe swelling of the lymph nodes, often to tremendous sizes. If left untreated, the disease overcomes the host’s defenses and can cause more extensive damage. The second phase of the disease, the neurological phase, begins when the parasite invades the brain and spinal cord. Disruption of the sleep cycle is a leading symptom of this stage and is the one that gave the disease the name ‘sleeping sickness.’ Infected individuals experience a disorganized and fragmented 24-hour rhythm of the sleep-wake cycle, resulting in daytime sleepiness and nighttime periods of wakefulness.

Human African Trypanosomiasis is causes by trypanosomes transmitted by the tsetse fly. The 2 main species of the parasite Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense are most common in sub saharan Africa (B). The APOL1 gene is key to natural defenses to this infection and over time Africans have evolved even more effective gene variants to kill trypanosomes that resist the ancestral gene G0. These evolved gene variants are called G1 and G2 with a high prevalence in West Africa. You can see in the middle panel that Nigeria is ground zero and a hot spot for a high number of people with the G1 variant of APOL1.

So what has this history of the tsetse fly and African sleeping sickness got to do with kidney disease in Nigeria and other African countries? Well the story gets more interesting and the picture above tells part of the story where you can see an overlap in the occurrence of African sleeping sickness caused by trypanosomiasis with the defense against the illness. Simply speaking, we humans started competing with the tsetse fly. Over time, people affected by African sleeping sickness developed a resistance coded by a gene on chromosome 22 called the APOL1 gene. This gene produces a protein called APOL1 which circulates in the blood and is the tool the body uses to destroy the parasite injected into the body by the tsetse fly. Over hundreds of years the parasite evolved resistance to this ancestral APOL1 gene (G0) and in response humans developed even more effective APOL1 called G1 and G2 variants. People with G1 and G2 variants of the APOL1 gene are able to resist infection transmitted by the tsetse fly. Approximately 23-46% of Nigerians have 2 alleles with either G1 and/or G2 while approximately 60% of Nigerians have at least 1 of the 2 genetic variants of APOL1 that also confers resistance to the infection. However, this survival advantage for people with 2 genetic variants of the APOL1 gene has been found to be a 12 times higher risk for progressive kidney disease.

The burden of kidney disease and kidney failure is now so common that several celebrities- a past president, musicians, actors, journalists have succumbed to the complications of this truly devastating disease. We do not know if APOL1 was the cause of their kidney disease but the chances are high that it may have been involved based on emerging research findings

But why does having an APOL1 gene variant increase the risk for kidney disease? Well, that has taken some time to figure out and scientists first figured out how APOL1 kills the trypanosome parasite. Essentially, the parasite while feeding on nutrients in the blood takes in the APOL1. The APOL1 then binds to structures in the parasite causing it to swell up, burst and die. APOL1 protein is also produced in other tissues as well as part of the defense against sleeping sickness infection and most importantly it is produced in the kidney. In the kidney, a special cell called the podocyte that helps in filtering the blood is damaged whenever APOL1 is activated in the kidney. What can activate APOL1 production in the kidney? Anything that injures the kidney or makes it think it is under attack by the parasite transmitted by the tsetse fly. This activated APOL1 in the kidney then kills the podocyte cell in the kidney in very much the same way that it kills the parasite leading to damage to the kidney filtration system of the kidney and eventually to rapidly progressive kidney problems and kidney failure. In fact is has been documented that patients with 2 APOL1 gene variants with kidney disease progress 2-3 times faster to kidney failure than patients with only 1 or no gene variants for the APOL1 gene.

QUESTIONS

  1. Is there a test for APOL1 gene variants? The answer is yes. However, it is not easy to get by walking into any lab and it is only becoming more commonly available in places like the US. For now it is expensive.
  2. Does everyone with 2 APOL1 genetic variants develop kidney disease? The answer is No and we do not yet know why. However, we do know that something can happen in the life of people with 2 APOL1 gene variants like infection, taking toxins contained in many of our herbal medicines that can hurt the kidney or other health problems that triggers increased production of APOL1 and that leads to accelerated kidney injury.
  3. Does this mean that controlling blood pressure, body weight, blood sugar and avoiding excessive alcohol and smoking are no longer important? Absolutely not. These are still very important causes of kidney disease and can make the kidney disease in many of us who have 2 APOL1 gene variants progress much faster. So please continue to exercise, eat healthy, avoid excess alcohol, avoid smoking, get BP checks and take medication when prescribed.
  4. Can the risk for APOL1 mediated kidney disease be inherited? Yes. If only one parent has a risk gene, it may be inherited by offspring but people with only one gene variant do not appear to be at increased risk for kidney disease. If both parents have the genetic variants, then the children can inherit the genetic variants and be at risk. Remember not all people with 2 variants will develop kidney disease and we do not yet know why.
  5. Can APOL1 mediated kidney disease be treated? Well there are no specific treatments yet for this yet but efforts are under way in the US to develop treatments for this problem.

Identifying And Dealing With Psychological Factors Associated With Chronic Kidney Disease And Dialysis


Introduction

Around the middle of the 20th century, dialysis appeared as a safe and efficient form of renal replacement therapy for those patients with kidney failure. Being capable of extending the life of multiple individuals who previously only had death as an answer, dialysis arrived with its life-sustaining function to bring hope for them.

Even though dialysis produces a significant and positive increase in the patients´ function and life expectancy compared to no treatment, some major complications need to be addressed such as the psychological effects the treatment process generates not only to the patient, but also to the family and social group that surrounds patients. Depression is quite common among patients with kidney disease and particularly so among patients with kidney disease on dialysis. Knowing what the causes are and the strategies that are known to help can improve outcomes for patients

It is important to note that in this article, the psychological complications produced by the kidney disease per se will not be discussed, instead, only the mental ramifications that come from the long term use of the dialysis machine, such as depression, mental stress, low quality of life, and related symptoms, will be talked about. At the end of the article, a list of possible solutions or tips will be provided in order to enable readers cope with these psychological factors and try to adopt dialysis into the day-to-day life as best as possible.

Chronic kidney disease is known for its capacity to progressively debilitate all the systems of the human body. Even if dialysis therapy prevents the rapid establishment of these systemic complications, it is only a matter of time for renal failure to decide the patient´s destiny.

In fact, the decisive nature of this chronic disease is one of the main factors that produce so many psychological problems to these patients, because, in the end, dialysis is only a treatment with a limited fix to many of the complications to the disease. Kidney transplant is a more final solution, but the opportunity of meeting the clinical, social and financial criteria for receiving a kidney transplant are very challenging, which increases the mental stress of remaining on dialysis treatment.

As a result of renal failure, depression is considered to be the most common psychological complication affecting these patients. This is strongly attached to low self-esteem and confidence, especially if the patient was previously highly functional and now feels like being a burden for the people around them. Pessimistic statements about the disease, feelings of loss of self worth, diminished concerns regarding personal appearance, reluctance to make decisions, and increased social isolation are some of the factors that accompany depression.

Talking to your medical team, family and friends can help reduce the stress and anxiety associated with kidney disease and dialysis. Do not go through the challenge alone. Talk about it.

Clinical experience suggests that these patients and relatives exist in a world of mental stress, living and coping with a chronic disease that is associated with episodes of acute and often life-threatening events. Of course, in the long run, mental stress is worsened by the huge financial burden that kidney failure and the dialysis treatment entails.

Anxiety and panic symptoms also can appear in both the patients and the surrounding family and social group, presenting clinical signs, such as palpitations, breathlessness, chest pain, sweating, and fear of dying.

In addition, having to be attached to a machine for several hours a week in order to live is in itself an unexpected event in most people´s lives. Obviously, this produces a diminished quality of life, which gets even more aggravated when other factors like sleep and sexual dysfunction problems appear.

Strategies to reduce depression and anxiety associated with kidney disease and dialysis

Considering the above, several studies have demonstrated the effectiveness of some medical interventions to cope with these psychological complications, such as:

Find a support group. Exercise with others. Talk to others. Avoid being isolated. Try even if you don’t feel so great.
  • Seeking an understanding and professional team of healthcare providers that have experience in the care of patients with kidney disease. There is no shame in telling your doctor that you are stressed out or depressed. Your team should be understanding and know what to do to help.
  • Pharmacological treatment, which is mainly based on selective serotonin reuptake inhibitors (SSRIs), has been very useful for dialysis patients with depression or anxiety due to its low side effects profile compared to other pharmaceutical options.
  • Psychotherapy is recommended for a wide range of chronic diseases, kidney disease included, improving sleep quality, fatigue, depression, and anxiety.
  • Social support and education to both patients, family and friends involved may be helpful to improve emotional disturbances. These methods should be based on improving the patient’s social life, using the option of familiar and marital counseling, and increasing the involvement of the community.
  • A proper nutritional plan should be designed for every single dialysis patient, including products that not only enhance energy levels, but also improve general health.
  • Performing regular exercise programs may have a beneficial effect on these patients.
  • Reaching out to friends and family to help relive stresses of the situation as necessary. Getting help at home to do things that might be too difficult, getting a partner to exercise with, visiting friends, talking with other dialysis patients and seeking support where available with financial challenges helps improve general mood and reduce anxiety.

Exercise for patients on dialysis


This post is meant to help you the dialysis patient live strong and well and overcome challenges you may be facing

Why is exercise important to me?
No matter how old you are, exercise can make you stronger, more flexible. If you stay fit, you will be more able to do things, like go food shopping or visit friends. Think of your body as a rechargeable battery. It helps control blood pressure, too. If you are diabetic, exercise can lower blood sugar. It aids circulation and helps you sleep. Exercise can also help keep your bones healthy. Exercise can fight depression and help you feel more positive about your life.


How should I start to exercise?
First, tell your doctor that you want to exercise. He or she can make sure you do not have any special problems that would be made worse by a workout.  After checking with your doctor, write down a goal you would like to reach. Goals might be walking around the street without stopping, bike riding with your family, shopping at the mall with a friend, or going dancing. Make an exercise plan that will work for you. Write down how often you will exercise, what time of day, and for how long. Start with small blocks of time, like 10 minutes every other day. Increase it by a minute or two each week.


How will I know exercise is helping?
It can take a few weeks or a few months—to feel better with exercise. Keep track of when you exercised, what you did, and how it felt. You will be able to see your progress. This can keep you from getting discouraged. Once you reach your goal, set a new one. Exercise should become a long-term habit.


Can people in wheelchairs exercise?
Yes. There are many stretching and strengthening exercises that can be done in a chair.

Travel Advice for kidney disease, dialysis and transplant patients


Are you a patient with kidney disease or a kidney transplant or a patient on dialysis thinking about travelling? Are you a business person wishing to travel for a meeting or are you interested in attending the wedding of a family member, or being with family for a ceremony like a graduation or simply want to get a break and go on a holiday?

 

Whether you are traveling within the country or traveling internationally, patients with kidney disease, on dialysis or with a kidney transplant can travel if they are stable.  There are a few things you need to consider and plan for to remain safe, maintain your self-esteem and enjoy your life.

 

Advice No 1: Plan ahead and talk to your doctor early about your plans

Give yourself time to decide on your travel plans. Talk to your family and friends and doctor early. They will share ideas with you and if there are any special consideration your doctor can inform you in time and help make arrangements that may involve another doctor or center at your travel destination. If you are planning on travelling to multiple destinations, a plan for every destination is necessary so even more time is needed.

 

Advice No 2: Find and communicate with a doctor or center that can care for you at your destination.

Your doctor can help you find a dialysis center or kidney disease or transplant doctor that can care for you. Family and friends at your destination may be able to make a good recommendation for you and a search online for your options can help

The receiving doctor or center will need some basic information about your medical condition.

If you have kidney disease or have a kidney transplant, being armed with an updated report from your home doctor that outlines your medical issues and lists your recent medications and lab tests will be important.

If you are on dialysis, a medical report, your dialysis prescription, your medication lists and recent lab tests will be required. Depending on your doctors other information may be required. Put your doctors in touch with each other.

 

Advice No 3: Try and get some information for yourself on the quality of care offered by the doctor or center

The experience of the doctor in caring for patients with kidney disease or with a kidney transplant will be useful if you have any of these conditions.

If you are a dialysis patient, find out if the center you are going to be working with at your destination has experience with your kind of dialysis ie hemodialysis or peritoneal dialysis. Also ask

  • What is the cost of dialysis and is your insurance accepted at the destination center?
  • Does the unit reuse dialysis filters or blood lines?
  • How far is the unit from where you will be staying at your destination?
  • Can they provide a convenient treatment time and treat you for the duration you need?
  • What kind and size of dialyzer filters are used at the center?
  • Can you get all the medications or supplies you usually use at your home center?
  • If you fall ill and need to be hospitalized, where do you go? You may or may not need to investigate the hospital offered.

 

Advice No 4: If you are waiting to get a transplant, just let your doctors know.

They may have to make alternative plans that you should be aware of. You can then make a decision if you should travel or not.

 

Advice No 5: Diabetics need extra plans to be made.

If you are also diabetic, make plans to have adequate supply of insulin, medications and readily available sources of sugar if needed

10 habits to keep your kidneys healthy


Kidney disease and kidney failure requiring dialysis or transplant can be a bad experience in many ways.

Here are 10 good habits you can adopt to keep your kidneys healthy. These habits will likely protect many other aspects of your health like your heart, brain, blood vessels and other organs

  1. Eat healthy foods. Food rich in fibers, plant protein and vegetables and low in starch, animal protein are generally considered healthy food
  2. Control your weight. Some use sophisticated measures such as body mass index to determine if someone is overweight. However a simple measure for adults is waist circumference. For adult males a waist circumference below 40 inches and in females below 35 inches is a rough way to determine if you are overweight.
  3. Exercise. Yes, we know you work hard every day and are tired so that should count as exercise, right? The answer to that is NO. The kind of exercise we are talking about is aerobic exercise that works out the heart and muscles continuously for at least 30 minutes every day. Exercise has several benefits for blood pressure, blood sugar, mood and energy levels.   
  4. Avoid tobacco products and consume alcohol very lightly if at all. Tobacco has absolutely no healthy benefit and is known to cause over 50 diseases. Alcohol in small quantities may offer some benefits but in large quantities causes several diseases including kidney damage as well.
  5. Get enough sleep. Lack of sleep increases stress levels and increased stress levels have effects on blood pressure, the heart and the kidneys. Try to get at least 8 hours of uninterrupted sleep every day.
  6. Drink lots of water but don’t take too much. At least 3-4 liters a day will keep you hydrated and flush your kidneys. Taking much more than that can actually get you in trouble. Remember, too much of anything is bad.
  7. Keep your intake of salt low. Remember that salt may already be added to food while it is being cooked and many foods and snacks contain salt. At least try not to add salt at prepared food and ask the food preparer to keep the salt content low.
  8. Make sure your blood pressure is controlled. High blood pressure is one of the major causes of kidney disease in the entire world. Get your blood pressure checked at least once a year. If you are placed on blood pressure medication, do not stop it without the advice of your doctor.
  9. Be very careful about taking supplements and herbal medications. If you eat a healthy diet and exercise, a multivitamin tablet everyday should suffice. Anything else can only increase your risk of a medical problem. Traditional or even western herbal medication and supplements have a track record of causing kidney failure. Beware.
  10. Get a medical check up at least once a year. Sometimes, even if we do all the right things, it might not be enough and detecting problems early with the kidney can save us lots of money and discomfort. Get a checkup once a year. Tests for kidney disease are simple and cheap and involve taking small samples of blood and urine and testing them for kidney function.

Urinary Tract Infections: An Introduction


A urinary tract infection (UTI) is an infection in any part of your system responsible for making and passing urine — your kidneys, ureters, bladder and urethra. In men the prostate may be involved in urinary tract infections. Most infections involve the lower urinary tract — the bladder and the urethra.

Urinary-tract-anatomy

Women are at greater risk of developing a UTI than are men. Infection limited to your bladder can be painful and annoying. However, serious consequences can occur if a UTI spreads to your kidneys.

Symptoms

Urinary tract infections don’t always cause signs and symptoms, but when they do they may include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
  • Pelvic pain, in men when the prostate is involved.

UTIs may be overlooked or mistaken for other conditions in older adults. Sometimes especially in the elderly the beginning of a UTI can present as confusion and decreased appetite.

Types of urinary tract infection

Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.

Part of urinary tract affected Signs and symptoms
Kidneys (also called pyelonephritis) ·       Upper back and side (flank) pain

·       High fever

·       Shaking and chills

·       Nausea

·       Vomiting

Bladder (cystitis) ·       Pelvic pressure

·       Lower abdomen discomfort

·       Frequent, painful urination

·       Blood in urine

Urethra (urethritis) ·       Burning with urination

·       Discharge

When to see a doctor

Contact your doctor if you have signs and symptoms of a UTI. It may be really serious  with complications or it might be a sign of something else that needs medical attention

Causes

Urinary tract infections can be caused by bacteria, parasites, viruses or fungi. The most common infections are causes by bacteria which are typically treated with antibiotics. If you have a UTI causes by other organisms such as viruses, parasites or fungi, other special medication or anti-microbials will be necessary to treat the infection and may take a longer time to cure. You can take steps to reduce your chances of getting a UTI in the first place.

UTI’s typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract. On the other hand infections of the urinary tract may occur from a blood infection that settles directly in the kidneys. In men, an infection of the prostate can start when bacteria in urine leak into your prostate. Antibiotics are used to treat the infection. If they don’t eliminate the bacteria, prostatitis (prostate infection) might recur or be difficult to treat

The most common UTIs occur mainly in women and affect the bladder and urethra.

  • Infection of the bladder (cystitis).This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.

Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.

  • Infection of the urethra (urethritis).This type of UTI can occur when intestinal bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Risk factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

  • Female anatomy.A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder.
  • Sexual activity.Sexually active women tend to have more UTIs than do women who aren’t sexually active. Having a new sexual partner also increases your risk.
  • Certain types of birth control.Women who use diaphragms for birth control may be at higher risk, as well as women who use spermicidal agents.
  • After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.

Other risk factors for UTIs include:

  • Urinary tract abnormalities.Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
  • Blockages in the urinary tract.Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
  • A suppressed immune system.Diabetes and other diseases that impair the immune system — the body’s defense against germs — can increase the risk of UTIs.
  • Catheter use.People who can’t urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
  • A recent urinary tract procedure.Urinary surgery or an examination of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.

Complications of a UTI may include:

  • Recurrent infections, especially in women who experience two or more UTIs in a six-month period or four or more within a year.
  • Permanent kidney damage leading to kidney disease or even kidney failure from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
  • Increased risk in pregnant women of delivering low birth weight or premature infants.
  • Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
  • Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

Prevention

You can take these steps to reduce your risk of urinary tract infections:

  • Drink plenty of liquids, especially water.Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.
  • Drink cranberry juice.Although studies are not conclusive that cranberry juice prevents UTIs, it is likely not harmful.
  • Wipe from front to back.Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
  • Empty your bladder soon after intercourse.Also, drink a full glass of water to help flush bacteria.
  • Avoid potentially irritating feminine products.Using deodorant sprays or other feminine products, such as douches and powders, in the genital area can irritate the urethra.
  • Change your birth control method.Diaphragms, or unlubricated or spermicide-treated condoms, can all contribute to bacterial growth.

Diagnosis

Tests and procedures used to diagnose urinary tract infections include:

  • Analyzing a urine sample.Your doctor may ask for a urine sample for lab analysis to look for white blood cells, red blood cells or bacteria. To avoid potential contamination of the sample, you may be instructed to first wipe your genital area with an antiseptic pad and to collect the urine midstream.
  • Growing urinary tract bacteria in a lab.Lab analysis of the urine is sometimes followed by a urine culture. This test tells your doctor what bacteria are causing your infection and which medications will be most effective.
  • Creating images of your urinary tract.If you are having frequent infections that your doctor thinks may be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Your doctor may also use a contrast dye to highlight structures in your urinary tract.
  • Using a scope to see inside your bladder and urinary tract.If you have recurrent UTIs, your doctor may perform a cystoscopy, using a long, thin tube with a lens (cystoscope) to see inside your urethra and bladder. The cystoscope is inserted in your urethra and passed through to your bladder.

Treatment

Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

Simple infection

Drugs commonly recommended for simple UTIs include:

  • Trimethoprim/sulfamethoxazole (Bactrim, Septra)
  • Fosfomycin (Monurol)
  • Nitrofurantoin (Macrodantin, Macrobid)
  • Cephalexin (Keflex)
  • Ceftriaxone

GET IN TOUCH WITH YOUR DOCTOR BEFORE STARTING ANY ANTIBIOTICS. YOU MAY NEED TESTS DONE BEFORE STARTING TREATMENT. THE DOCTOR WILL HELP YOU SELECT THE SAFE AND APPROPRIATE OPTION FOR YOUR SITUATION.

The group of antibiotic medicines known as fluoroquinolones — such as ciprofloxacin (Cipro), levofloxacin (Levaquin) and others — isn’t commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs. In some cases, such as a complicated UTI or kidney infection, your doctor might prescribe a fluoroquinolone medicine if no other treatment options exist.

Often, symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. Take the entire course of antibiotics as prescribed.

For an uncomplicated UTI that occurs when you’re otherwise healthy, your doctor may recommend a shorter course of treatment, such as taking an antibiotic for one to three days. But whether this short course of treatment is enough to treat your infection depends on your particular symptoms and medical history.

Your doctor may also prescribe a pain medication (analgesic) that numbs your bladder and urethra to relieve burning while urinating, but pain usually is relieved soon after starting an antibiotic.

Frequent infections

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

  • Low-dose antibiotics, initially for six months but sometimes longer
  • Self-diagnosis and treatment, if you stay in touch with your doctor
  • A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity
  • Vaginal estrogen therapy if you’re postmenopausal

 

Severe infection

For a severe UTI, you may need special tests to determine the cause of the infection and treatment with intravenous antibiotics in a hospital.

 

World Kidney Day 2016- Childhood Kidney Diseases.


March 10th 2016 was world kidney day with a specific focus on childhood kidney disease. 

Kidney disease affects millions of people worldwide, including many children who may be at risk at an early age. It is therefore crucial that we encourage and facilitate education, early detection and a healthy life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide.

Kidney disease can affect children in various ways, ranging from treatable disorders without long-term effects to life-threatening conditions. Acute kidney disease develops suddenly, lasts a short time, and can be serious with long-lasting effects or may go away completely once the underlying cause has been treated. Chronic kidney disease (CKD) does not go away with treatment and tends to get worse over time. CKD eventually leads to kidney failure, described as end-stage kidney disease or ESRD when treated with a kidney transplant or blood-filtering treatments called dialysis.
Children with CKD or kidney failure face many challenges, which can include

  • a negative self-image
  • relationship problems
  • behavior problems
  • learning problems
  • trouble concentrating
  • delayed language skills development
  • delayed motor skills development

Children with CKD may grow at a slower rate than their mates, and urinary incontinence—the loss of bladder control, which results in the accidental loss of urine—is common.

  
Urinary tract inside the outline of the upper half of a human body. Every day, the two kidneys filter about 120 to 150 liters of blood to produce about 1 to 2 liters of urine, composed of wastes and extra fluid.

The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the back. Every day, the two kidneys filter about 120 to 150 liters of blood to produce about 1 to 2liters of urine, composed of wastes and extra fluid. Children produce less urine than adults and the amount produced depends on their age. The kidneys work around the clock; a person does not control what the kidneys do. Ureters are the thin tubes of muscle—one on each side of the bladder—that carry urine from each of the kidneys to the bladder. The bladder stores urine until the person finds a time and place to urinate.

The kidney is not one large filter. Each kidney is made up of about a million filter units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called a glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which changes the fluid by sending needed minerals back to the blood and removing wastes. The final product becomes urine.

The kidneys also control the level of minerals such as sodium, phosphorus, and potassium in the body, and produce an important hormone to signal to the bone to create blood. A low level of red blood cells is called anemia and can be a result of kidney disease. 

  
Picture above of a kidney with an inset of a nephron. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called a glomerulus, and a tubule.

What are the causes of kidney disease in children?

Kidney disease in children can be caused by

  • birth defects
  • hereditary diseases
  • infection
  • nephrotic syndrome
  • systemic diseases
  • trauma
  • urine blockage or reflux

From birth to age 4, birth defects and hereditary diseases are the leading causes of kidney failure. Between ages 5 and 14, kidney failure is most commonly caused by hereditary diseases, nephrotic syndrome, and systemic diseases. Between ages 15 and 19, diseases that affect the glomeruli are the leading cause of kidney failure, and hereditary diseases become less common.

Birth Defects

A birth defect is a problem that happens while a baby is developing in the mother’s womb. Birth defects that affect the kidneys include renal agenesis, renal dysplasia, and ectopic kidney, to name a few. These defects are abnormalities of size, structure, or position of the kidneys:

  • renal agenesis—children born with only one kidney
  • renal dysplasia—children born with both kidneys, yet one does not function
  • ectopic kidney—children born with a kidney that is located below, above, or on the opposite side of its usual position
  • Some children are born without kidneys. They usually are born dead or die soon after birth

In general, children with these conditions  except being born without kidneys lead full, healthy lives. However, some children with renal agenesis or renal dysplasia are at increased risk for developing kidney disease.

Hereditary Diseases:  Hereditary kidney diseases are illnesses passed from parent to child through the genes. One example is polycystic kidney disease (PKD), characterized by many grapelike clusters of fluid-filled cysts—abnormal sacs—that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. 

 

a picture of a normal kidney to the left and a diseased polycystic kidney on the right

 
Another hereditary disease is Alport syndrome, which is caused by a mutation in a gene for a type of protein called collagen that makes up the glomeruli. The condition leads to scarring of the kidneys. Alport syndrome generally develops in early childhood and is more serious in boys than in girls. The condition can lead to hearing and vision problems in addition to kidney disease.

Infection

Hemolytic uremic syndrome and acute post-streptococcal glomerulonephritis are kidney diseases that can develop in a child after an infection.
Hemolytic uremic syndrome is a rare disease that is often caused by the Escherichia coli (E. coli) bacterium found in contaminated foods, such as meat, milk products, and juice. Hemolytic uremic syndrome develops when E. coli bacteria lodged in the digestive tract make toxins that enter the bloodstream. The toxins start to destroy red blood cells and damage the lining of the blood vessels, including the glomeruli. Most children who get an E. coli infection have vomiting, stomach cramps, and bloody diarrhea for 2 to 3 days. Children who develop hemolytic uremic syndrome become pale, tired, and irritable. Hemolytic uremic syndrome can lead to kidney failure in some children.

Post-streptococcal glomerulonephritis can occur after an episode of strep throat or a skin infection. The Streptococcus bacterium does not attack the kidneys directly; instead, the infection may stimulate the immune system to overproduce antibodies. Antibodies are proteins made by the immune system. The immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. When the extra antibodies circulate in the blood and finally deposit in the glomeruli, the kidneys can be damaged. Most cases of post-streptococcal glomerulonephritis develop 1 to 3 weeks after an untreated infection, though it may be as long as 6 weeks. Post-streptococcal glomerulonephritis lasts only a brief time and the kidneys usually recover. In a few cases, kidney damage may be permanent.

Nephrotic Syndrome

Nephrotic syndrome is a collection of symptoms that indicate kidney damage. Nephrotic syndrome includes all of the following conditions:
albuminuria—when a person’s urine contains an elevated level of albumin, a protein typically found in the blood

  • hyperlipidemia—higher-than-normal fat and cholesterol levels in the blood
  • edema—swelling, usually in the legs, feet, or ankles and less often in the hands or face
  • hypoalbuminemia—low levels of albumin in the blood

 

child with swollen eyes and face from nephrotic syndrome affecting the kidneys

 

Nephrotic syndrome in children can be caused by the following conditions:
Minimal change disease is a condition characterized by damage to the glomeruli that can be seen only with an electron microscope, which shows tiny details better than any other type of microscope. The cause of minimal change disease is unknown; some health care providers think it may occur after allergic reactions, vaccinations, and viral infections.

Focal segmental glomerulosclerosis is scarring in scattered regions of the kidney, typically limited to a small number of glomeruli.

Membranoproliferative glomerulonephritis is a group of autoimmune diseases that cause antibodies to build up on a membrane in the kidney. Autoimmune diseases cause the body’s immune system to attack the body’s own cells and organs.

Systemic Diseases

Systemic diseases, such as systemic lupus erythematosus (SLE or lupus) and diabetes, involve many organs or the whole body, including the kidneys:
Lupus nephritis is kidney inflammation caused by SLE, which is an autoimmune disease.

Diabetes leads to elevated levels of blood glucose, also called blood sugar, which scar the kidneys and increase the speed at which blood flows into the kidneys. Faster blood flow strains the glomeruli, decreasing their ability to filter blood, and raises blood pressure. Kidney disease caused by diabetes is called diabetic kidney disease. While diabetes is the number one cause of kidney failure in adults, it is an uncommon cause during childhood.

Trauma: Traumas such as burns, dehydration, bleeding, injury, or surgery can cause very low blood pressure, which decreases blood flow to the kidneys. Low blood flow can result in acute kidney failure.

Urine Blockage or Reflux: When a blockage develops between the kidneys and the urethra, urine can back up into the kidneys and cause damage. Reflux—urine flowing from the bladder up to the kidney—happens when the valve between the bladder and the ureter does not close all the way.

How is kidney disease in children diagnosed?

A health care provider diagnoses kidney disease in children by completing a physical exam, asking for a medical history, and reviewing signs and symptoms. To confirm diagnosis, the health care provider may order one or more of the following tests:

Urine Tests
Dipstick test for albumin. The presence of albumin in urine is a sign that the kidneys may be damaged. Albumin in urine can be detected with a dipstick test performed on a urine sample. The urine sample is collected in a special container in a health care provider’s office or a commercial facility and can be tested in the same location or sent to a lab for analysis. With a dipstick test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the person’s urine sample. Patches on the dipstick change color when albumin is present in urine.

Urine albumin-to-creatinine ratio. A more precise measurement, such as a urine albumin-to-creatinine ratio, may be necessary to confirm kidney disease. Unlike a dipstick test for albumin, a urine albumin-to-creatinine ratio—the ratio between the amount of albumin and the amount of creatinine in urine—is not affected by variation in urine concentration.

Blood test: Blood drawn in a health care provider’s office and sent to a lab for analysis can be tested to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate or eGFR. This is a simple test not expensive and results can be available in a few hours

Imaging studies: Imaging studies provide pictures of the kidneys. The pictures help the health care provider see the size and shape of the kidneys and identify any abnormalities. This may be an ultrasound or CT scan or special type of x-ray 

Kidney biopsy: Kidney biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. Biopsy results show the cause of the kidney disease and extent of damage to the kidneys.

How is kidney disease in children treated?

Treatment for kidney disease in children depends on the cause of the illness. A child may be referred to a pediatric nephrologist—a doctor who specializes in treating kidney diseases and kidney failure in children—for treatment.

Children with a kidney disease that is causing high blood pressure may need to take medications to lower their blood pressure. Improving blood pressure can significantly slow the progression of kidney disease. The health care provider may prescribe

angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) which help relax blood vessels, reduce blood pressure and make it easier for the heart to pump blood

diuretics, medications that increase urine output and reduce body swelling

Many children require two or more medications to control their blood pressure; other types of blood pressure medications may also be needed.

As kidney function declines, children may need treatment for anemia and growth failure. Anemia is treated with a hormone called erythropoietin, which stimulates the bone marrow to produce red blood cells. Children with growth failure may need to make dietary changes and take food supplements or growth hormone injections.

Children with kidney disease that leads to kidney failure must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation. 

Birth Defects: Children with renal agenesis or renal dysplasia should be monitored for signs of kidney damage. Treatment is not needed unless damage to the kidney occurs. 
Ectopic kidney does not need to be treated unless it causes a blockage in the urinary tract or damage to the kidney. When a blockage is present, surgery may be needed to correct the position of the kidney for better drainage of urine. If extensive kidney damage has occurred, surgery may be needed to remove the kidney. 

Hereditary Diseases: Children with PKD tend to have frequent urinary tract infections, which are treated with bacteria-fighting medications called antibiotics. PKD cannot be cured, so children with the condition receive treatment to slow the progression of kidney disease and treat the complications of PKD. 
Alport syndrome also has no cure. Children with the condition receive treatment to slow disease progression and treat complications until the kidneys fail. 

Infection: Treatment for hemolytic uremic syndrome includes maintaining normal salt and fluid levels in the body to ease symptoms and prevent further problems. A child may need a transfusion of red blood cells delivered through an intravenous (IV) tube. Some children may need dialysis for a short time to take over the work the kidneys usually do. Most children recover completely with no long-term consequences. 
Children with post-streptococcal glomerulonephritis may be treated with antibiotics to destroy any bacteria that remain in the body and with medications to control swelling and high blood pressure. They may also need dialysis for a short period of time. 

Nephrotic Syndrome: Nephrotic syndrome due to minimal change disease can often be successfully treated with corticosteroids. Corticosteroids decrease swelling and reduce the activity of the immune system. The dosage of the medication is decreased over time. Relapses are common; however, they usually respond to treatment. Corticosteroids are less effective in treating nephrotic syndrome due to focal segmental glomerulosclerosis or membranoproliferative glomerulonephritis. Children with these conditions may be given other immunosuppressive medications in addition to corticosteroids. Immunosuppressive medications prevent the body from making antibodies. 

Systemic Diseases.                              

Lupus nephritis is treated with corticosteroids and other immunosuppressive medications. A child with lupus nephritis may also be treated with blood pressure-lowering medications. In many cases, treatment is effective in completely or partially controlling lupus nephritis. 

Diabetic kidney disease usually takes many years to develop. Children with diabetes can prevent or slow the progression of diabetic kidney disease by taking medications to control high blood pressure and maintaining normal blood glucose levels. 

Trauma: The types of trauma described above can be medically treated, though dialysis may be needed for a short time until blood flow and blood pressure return to normal.

Urine Blockage and Reflux: Treatment for urine blockage depends on the cause and severity of the blockage. In some cases, the blockage goes away without treatment. For children who continue to have urine blockage, surgery may be needed to remove the obstruction and restore urine flow. After surgery, a small tube, called a stent, may be placed in the ureter or urethra to keep it open temporarily while healing occurs. 
Treatment for reflux may include prompt treatment of urinary tract infections and long-term use of antibiotics to prevent infections until reflux goes away on its own. Surgery has also been used in certain cases. 

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Eating, Diet, and Nutrition
For children with CKD, learning about nutrition is vital because their diet can affect how well their kidneys work. Parents or guardians should always consult with their child’s health care team before making any dietary changes. Staying healthy with CKD requires paying close attention to the following elements of a diet:

Protein. Children with CKD should eat enough protein for growth while limiting high protein intake. Too much protein can put an extra burden on the kidneys and cause kidney function to decline faster. Protein needs increase when a child is on dialysis because the dialysis process removes protein from the child’s blood. The health care team recommends the amount of protein needed for the child. Foods with protein include

  • eggs
  • milk
  • cheese
  • chicken
  • fish
  • red meats
  • beans
  • yogurt
  • cottage cheese

Sodium. The amount of sodium children need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care team may recommend limiting or adding sodium and salt to the diet. Foods high in sodium include

  • canned foods
  • some frozen foods
  • most processed foods
  • some snack foods, such as chips and crackers

Potassium. Potassium levels need to stay in the normal range for children with CKD, because too little or too much potassium can cause heart and muscle problems. Children may need to stay away from some fruits and vegetables or reduce the number of servings and portion sizes to make sure they do not take in too much potassium. The health care team recommends the amount of potassium a child needs. Low-potassium fruits and vegetables include

  • apples
  • cranberries
  • strawberries
  • blueberries
  • raspberries
  • pineapple
  • cabbage
  • boiled cauliflower
  • mustard greens
  • uncooked broccoli

High-potassium fruits and vegetables include

  • oranges
  • melons
  • apricots
  • bananas
  • potatoes
  • tomatoes
  • sweet potatoes
  • cooked spinach
  • cooked broccoli

Phosphorus. Children with CKD need to control the level of phosphorus in their blood because too much phosphorus pulls calcium from the bones, making them weaker and more likely to break. Too much phosphorus also can cause itchy skin and red eyes. As CKD progresses, a child may need to take a phosphate binder with meals to lower the concentration of phosphorus in the blood. Phosphorus is found in high-protein foods. Foods with low levels of phosphorus include

  • liquid non milk creamer
  • green beans
  • popcorn
  • unprocessed meats from a butcher
  • lemon-lime soda
  • root beer
  • powdered iced tea and lemonade mixes
  • rice and corn cereals
  • egg white
  • sorbet

Fluids. Early in CKD, a child’s damaged kidneys may produce either too much or too little urine, which can lead to swelling or dehydration. As CKD progresses, children may need to limit fluid intake. The health care provider will tell the child and parents or guardians the goal for fluid intake.

  

Kidney disease, children and the responsibility we have to protect them. The two purple colored images on the back of the little baby boy below with yellow lines represent the kidneys. To learn more about kidney disease, visit us at www.kidney-solutions.com/faq 

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