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Kidney failure signs

Important Kidney for us Kidneys are the organs that help filter waste products from the blood. They are also involved in regulating bl... thumbnail 1 summary

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Important Kidney for us

Kidneys are the organs that help filter waste products from the blood. They are also involved in regulating blood pressure, electrolyte balance, and red blood cell production in the body. Symptoms of kidney failure are due to the build-up of waste products in the body that may cause weakness, shortness of breath, lethargy, and confusion. Inability to remove potassium from the bloodstream may lead to abnormal heart rhythms and sudden death. Initially kidney failure may cause no symptoms. There are numerous causes of kidney failure, and treatment of the underlying disease may be the first step in correcting the kidney abnormality. Some causes of kidney failure are treatable and the kidney function may return to normal. Unfortunately, kidney failure may be progressive in other situations and may be irreversible.
The diagnosis of kidney failure usually is made by blood tests measuring BUN, creatinine, and glomerular filtration rate (GFR).

Treatment of the underlying cause of kidney failure may return kidney function to normal. Lifelong efforts to control blood pressure and diabetes may be the best way to prevent chronic kidney disease and its progression to kidney failure signs. As we age kidney function gradually decreases over time.
If the kidneys fail completely, the only treatment options available.

Kidney in our body

The kidneys play key roles in body function, not only by filtering the blood and getting rid of waste products, but also by balancing the electrolyte levels in the body, controlling blood pressure, and stimulating the production of red blood cells.

The kidneys are located in the abdomen toward the back, normally one on each side of the spine. They get their blood supply through the renal arteries directly from the aorta and send blood back to the heart via the renal veins to the vena cava. (The term "renal" is derived from the Latin name for kidney.)

The kidneys have the ability to monitor the amount of body fluid, the concentrations of electrolytes like sodium and potassium, and the acid-base balance of the body. They filter waste products of body metabolism, like urea from protein metabolism and uric acid from DNA breakdown. Two waste products in the blood usually are measured; 1) blood urea nitrogen (BUN), and 2) creatinine (Cr).

When blood flows to the kidney, sensors within specialized kidney cells regulate how much water to excrete as urine, along with what concentration of electrolytes. For example, if a person is dehydrated from exercise or from an illness, the kidneys will hold onto as much water as possible and the urine becomes very concentrated. When adequate water is present in the body, the urine is much more dilute, and the urine becomes clear. This system is controlled by renin, a hormone produced in the kidney that is part of the fluid and blood pressure regulation systems of the body.

Kidneys are also the source of erythropoietin in the body, a hormone that stimulates the bone marrow to make red blood cells. Special cells in the kidney monitor the oxygen concentration in blood. If oxygen levels fall, erythropoietin levels rise and the body starts to manufacture more red blood cells.

Urine that is made by each kidney flows through the ureter, a tube that connects the kidney to the bladder. Urine is stored within the bladder, and when urination occurs, the bladder empties urine through a tube called the urethra.

Causes of Kidney failure

Kidney failure may occur from an acute situation that injures the kidneys or from chronic diseases that gradually cause the kidneys to stop functioning kidney failure signs.

In acute renal failure, kidney function is lost rapidly and can occur from a variety of insults to the body. Since most people have two kidneys, both kidneys must be damaged for complete kidney failure to occur. Fortunately, if only one kidney fails or is diseased it can be removed, and the remaining kidney may continue to have normal kidney (renal) function. If a both patient's kidneys are injured or diseased, a donor kidney(s) may transplanted.

The list of causes of kidney failure is often categorized based on where the injury has occurred.

Prerenal causes (pre=before + renal=kidney) causes are due to decreased blood supply to the kidney. Examples of prerenal causes of kidney failure are:

Hypovolemia (low blood volume) due to blood loss
Dehydration from loss of body fluid (for example, vomiting, diarrhea, sweating, fever)
Poor intake of fluids
Medication, for example, diuretics ("water pills") may cause excessive water loss
Abnormal blood flow to and from the kidney due to obstruction of the renal artery or vein.

Renal causes of kidney failure (damage directly to the kidney itself) include:

Sepsis: The body's immune system is overwhelmed from infection and causes inflammation and shutdown of the kidneys. This usually does not occur with simple urinary tract infections.

Medications: Some medications are toxic to the kidney including:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin, and others), and naproxen (Aleve, Naprosyn)
Antibiotics like aminoglycosides gentamicin (Garamycin), tobramycin
lithium (Eskalith, Lithobid)
Iodine-containing medications such as those injected for radiology dye studies

Rhabdomyolysis: This is a situation in which there is significant muscle breakdown in the body, and the damaged muscle fibers clog the filtering system of the kidneys. Massive muscle injury may occur because of trauma, crush injuries, and burns. Some medications used to treat highcholesterol may causerhabdomyolysis.

Multiple myeloma and kidney failure signs

Acute glomerulonephritis or inflammation of the glomeruli, the filtering system of the kidneys. Many diseases can cause this inflammation including:

Systemic lupus erythematosus
Wegener's granulomatosis
Goodpasture syndrome.

Hemolytic uremic syndrome: This condition results from abnormal destruction of red blood cells. It most often occurs in children after certain infections, but also may be caused by medications, pregnancy, or can occur for unknown reasons.

Post renal causes of kidney failure (post=after + renal= kidney) are due to factors that affect outflow of the urine:

    Obstruction of the bladder or the ureters can cause back pressure because the kidneys continue to produce urine, but the obstruction acts like a dam, and urine backs up into the kidneys. When the pressure increases high enough, the kidneys are damaged and shut down.
    Prostatic hypertrophy or prostate cancer may block the urethra and prevents the bladder from emptying.
    Tumors in the abdomen that surround and obstruct the ureters.
    Kidney stones. Usually, kidney stones affect only one kidney and do not cause kidney failure. However, if there is only one kidney present, a kidney stone may cause the remaining kidney to fail.

Chronic renal failure develops over months and years. The most common causes of chronic renal failure are related to:

poorly controlled diabetes,
poorly controlled high blood pressure, and
chronic glomerulonephritis.

Less common causes of chronic renal failure include:

Polycystic kidney disease
Reflux nephropathy (damage caused by urine backflow from the bladder into the ureters and kidney)
Nephrotic syndrome
Alport's disease
Interstitial nephritis
Kidney stones
Prostate disease.

Sign of Failure to your kidney.

Initially, kidney failure may be not produce any symptoms (asymptomatic). As kidney function decreases, the symptoms are related to the inability to regulate water and electrolyte balances, clear waste products from the body, and promote red blood cell production.

If unrecognized or untreated, the following symptoms of kidney failure may develop into life-threatening circumstances.

Lethargy
Weakness
Shortness of breath
Generalized swelling (edema)
Generalized weakness due to anemia
Loss of appetite
Lethargy
Fatigue
Congestive heart failure
Metabolic acidosis
High blood potassium (hyperkalemia)
Fatal heart rhythm disturbances (arrhythmias) including ventricular tachycardia and ventricular fibrillation
Rising urea levels in the blood (uremia) may lead to brain encephalopathy, pericarditis (inflammation of the heart lining), or low calcium blood levels (hypocalcemia).

Feel pain in beginning of kidney failure sign?

Kidney failure in itself does not cause pain. However, the consequences of kidney failure may cause pain and discomfort in different parts of the body.
Amyloid proteins

Normal functioning kidneys filter amyloid (a protein) from the blood stream. In kidney failure amyloid proteins in the blood rise, and can separate and clump together forming amyloid deposits into a variety of tissue and organs, including joints and tendons. This can result in symptoms of:

joint stiffness,
pain, and
swelling.

Procedure related pain

Patients who are on dialysis may have discomfort when on the dialysis machine.

Underlying chronic disease pain

Pain is often a consequence of the underlying chronic disease that led to kidney failure, for example:
People with poorly controlled diabetes may develop diabetic neuropathy pain.
People who have peripheral vascular disease also may have pain in their extremities, and may develop claudication (leg pain that occurs with walking).

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Hepatitis C symptoms

Hepatitis C Symptoms Hepatitis C is a liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatiti... thumbnail 1 summary

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Hepatitis C Symptoms

Hepatitis C is a liver disease caused by the hepatitis C virus: the virus can cause both acute and chronic hepatitis infection, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness.
The hepatitis C virus is a bloodborne virus and the most common modes of infection are through unsafe injection practices; inadequate sterilization of medical equipment; and the transfusion of unscreened blood and blood products.
130–150 million people globally have chronic hepatitis C infection. A significant number of those who are chronically infected will develop liver cirrhosis or liver cancer.
Approximately 500 000 people die each year from hepatitis C-related liver diseases1.
Antiviral medicines can cure approximately 90% of persons with hepatitis C infection, thereby reducing the risk of death from liver cancer and cirrhosis, but access to diagnosis and treatment is low.
There is currently no vaccine for hepatitis C; however research in this area is ongoing.

Hepatitis C virus (HCV) causes both acute and chronic infection. Acute HCV infection is usually asymptomatic, and is only very rarely associated with life-threatening disease. About 15–45% of infected persons spontaneously clear the virus within 6 months of infection without any treatment.
The remaining 55–85% of persons will develop chronic HCV infection. Of those with chronic HCV infection, the risk of cirrhosis of the liver is 15–30% within 20 years.
Geographical distribution

Hepatitis C is found worldwide. The most affected regions are Africa and Central and East Asia. Depending on the country, hepatitis C infection can be concentrated in certain populations (for example, among people who inject drugs); and/or in general populations. There are multiple strains (or genotypes) of the HCV virus and their distribution varies by region.

Transmission

The hepatitis C symptoms virus is a bloodborne virus. It is most commonly transmitted through:

injecting drug use through the sharing of injection equipment;
in health care settings due to the reuse or inadequate sterilization of medical equipment, especially syringes and needles;
the transfusion of unscreened blood and blood products;
HCV can also be transmitted sexually and can be passed from an infected mother to her baby; however these modes of transmission are much less common.

Hepatitis C is not spread through breast milk, food or water or by casual contact such as hugging, kissing and sharing food or drinks with an infected person.
Symptoms

The incubation period for hepatitis C is 2 weeks to 6 months. Following initial infection, approximately 80% of people do not exhibit any symptoms. Those who are acutely symptomatic may exhibit fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).
Screening and diagnosis

Due to the fact that acute HCV infection is usually asymptomatic, few people are diagnosed during the acute phase. In those people who go on to develop chronic HCV infection, the infection is also often undiagnosed because the infection remains asymptomatic until decades after infection when symptoms develop secondary to serious liver damage.

Cause of Hepatitis C

2 steps to detect HVC infections

Screening for anti-HCV antibodies with a serological test identifies people who have been infected with the virus.
If the test is positive for anti-HCV antibodies, a nucleic acid test for HCV RNA is needed to confirm chronic HCV infection because about 15–45% of people infected with HCV spontaneously clear the infection by a strong immune response without the need for treatment. Although no longer infected, they will still test positive for anti-HCV antibodies.

After a person has been diagnosed with chronic hepatitis C infection, they should have an assessment of the degree of liver damage (fibrosis and cirrhosis). This can be done by liver biopsy or through a variety of non-invasive tests.

In addition, these people should have a laboratory test to identify the genotype of the hepatitis C strain. There are 6 genotypes of the HCV and they respond differently to treatment. Furthermore, it is possible for a person to be infected with more than one genotype. The degree of liver damage and virus genotype are used to guide treatment decisions and management of the disease.
Getting tested

Early diagnosis can prevent health problems that may result from infection and prevent transmission of the virus. WHO recommends screening for people who may be at increased risk of infection.

Populations at increased risk of HCV infection include:

people who inject drugs
recipients of infected blood products or invasive procedures in health-care facilities with inadequate infection control practices
children born to mothers infected with HCV
people with sexual partners who are HCV-infected
people with HIV infection
prisoners or previously incarcerated persons
people who have used intranasal drugs
people who have had tattoos or piercings.

Treatment Hepatitis C

Hepatitis C symptoms does not always require treatment as the immune response in some people will clear the infection, and some people with chronic infection do not develop liver damage. When treatment is necessary, the goal of hepatitis C treatment is cure. The cure rate depends on several factors including the strain of the virus and the type of treatment given.

The standard of care for hepatitis C is changing rapidly. Until recently, hepatitis C treatment was based on therapy with interferon and ribavirin, which required weekly injections for 48 weeks, cured approximately half of treated patients, but caused frequent and sometimes life-threatening adverse reactions.

Recently, new antiviral drugs have been developed. These medicines, called direct antiviral agents (DAA) are much more effective, safer and better-tolerated than the older therapies. Therapy with DAAs result can cure most persons with HCV infection and treatment is shorter (usually 12 weeks) and safer. Although the production cost of DAAs is low, the initial prices are very high and likely to make access to these drugs difficult even in high-income countries.

Much needs to be done to ensure that these advances lead to greater access to treatment globally.
Prevention
Primary prevention

There is no vaccine for hepatitis C, therefore prevention of HCV infection depends upon reducing the risk of exposure to the virus in health-care settings, in higher risk populations, for example, people who inject drugs, and through sexual contact.

The following list provides a limited example of primary prevention interventions recommended by WHO:

hand hygiene: including surgical hand preparation, hand washing and use of gloves;
safe handling and disposal of sharps and waste;
provision of comprehensive harm-reduction services to people who inject drugs including sterile injecting equipment;
testing of donated blood for hepatitis B and C (as well as HIV and syphilis);
training of health personnel;
promotion of correct and consistent use of condoms.

Secondary and tertiary prevention

For people infected with the hepatitis C virus, WHO recommends for?;

education and counseling on options for care and treatment;
immunization with the hepatitis A and B vaccines to prevent coinfection from these hepatitis viruses to protect their liver;
early and appropriate medical management including antiviral therapy if appropriate; and
regular monitoring for early diagnosis of chronic liver disease.

Screening, care and treatment of persons with hepatitis C infection

In April 2014, WHO launched "Guidelines for the screening, care and treatment of persons with hepatitis C".

These are the first guidelines dealing with hepatitis C treatment produced by WHO and complement existing guidance on the prevention of transmission of bloodborne viruses, including HCV.

They are intended for policy-makers, government officials, and others working in low- and middle-income countries who are developing programmes for the screening, care and treatment of people with HCV infection. These guidelines will help expand of treatment services to patients with HCV infection, as they provide key recommendations in these areas and discuss considerations for implementation.
Summary of key recommendations
Recommendations on screening for HCV infection

1. Screening to identify persons with HCV infection

It is recommended that HCV serology testing be offered to individuals who are part of a population with high HCV prevalence or who have a history of HCV risk exposure/ behaviour.

2. When to confirm the diagnosis of chronic HCV infection

It is suggested that nucleic acid testing (NAT) for the detection of HCV ribonucleic acid (RNA) be performed directly following a positive HCV serological test to establish the diagnosis of chronic HCV infection, in addition to NAT for HCV RNA as part of the assessment for starting treatment for HCV infection.
Recommendations on care of people infected with HCV

3. Screening for alcohol use and counselling to reduce moderate and high levels of alcohol intake

An alcohol intake assessment is recommended for all persons with HCV infection followed by the offer of a behavioural alcohol reduction intervention for persons with moderate-to-high alcohol intake.

4. Assessing degree of liver fibrosis and cirrhosis

In resource-limited settings, it is suggested that the aminotransferase/platelet ratio index (APRI) or FIB4 tests be used for the assessment of hepatic fibrosis rather than other non-invasive tests that require more resources such as elastography or Fibrotest.
Recommendations on treatment of HCV infection

5. Assessing for HCV treatment

All adults and children with chronic HCV infection, including people who inject drugs, should be assessed for antiviral treatment.
6. Treatment with pegylated interferon and ribavirin

Pegylated interferon in combination with ribavirin is recommended for the treatment of chronic HCV infection rather than standard non-pegylated interferon with ribavirin.
7. Treatment with telaprevir or boceprevir

Treatment with the direct-acting antivirals telaprevir or boceprevir, given in combination with pegylated interferon and ribavirin, is suggested for genotype 1 chronic HCV infection rather than pegylated interferon and ribavirin alone.
8. Treatment with sofosbuvir

Sofosbuvir, given in combination with ribavirin with or without pegylated interferon (depending on the HCV genotype), is recommended in genotypes 1, 2, 3 and 4 HCV infection rather than pegylated interferon and ribavirin alone, or no treatment for persons who cannot tolerate interferon.
9. Treatment with simeprevir

Simeprevir, given in combination with pegylated interferon and ribavirin, is recommended for persons with genotype 1b HCV infection and for persons with genotype 1a HCV infection without the Q80K polymorphism rather than pegylated interferon and ribavirin alone.

Note: Recommendations 8 and 9 were made without taking resource use into consideration, as pricing information was not available for any country other than the United States at the time this recommendation was formulated.
WHO response

WHO is working in the following areas to prevent and control viral hepatitis C symptoms: