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What are the treatments for Perineal Injury in Males ? | Treatments for perineal injury vary with the severity and type of injury. Tears or incisions may require stitches. Traumatic or piercing injuries may require surgery to repair damaged pelvic floor muscles, blood vessels, and nerves. Treatment for these acute injuries may also include antibiotics to prevent infection. After a health care provider stabilizes an acute injury so blood loss is no longer a concern, a person may still face some long-term effects of the injury, such as bladder control and sexual function problems. A health care provider can treat high-flow priapism caused by a blunt injury to the perineum with medication, blockage of the burst blood vessel under x-ray guidance, or surgery.
In people with a chronic perineal injury, a health care provider will treat the complications of the condition. More information is provided in the NIDDK health topics:
- Erectile Dysfunction - Urinary Incontinence in Men
More information about the lower urinary tract is provided in the NIDDK health topic, The Urinary Tract and How It Works. | NIDDK | Perineal Injury in Males |
How to prevent Perineal Injury in Males ? | Preventing perineal injury requires being aware of and taking steps to minimize the dangers of activities such as construction work or bike riding:
- People should talk with their health care provider about the benefits and risks of perineal surgery well before the operation. - People who play or work around moving equipment or sharp objects should wear protective gear whenever possible. - People who ride bikes, motorcycles, or horses should find seats or saddles designed to place the most pressure on the buttocks and minimize pressure on the perineum. Many health care providers advise bike riders to use noseless bike seats and to ride in an upright position rather than lean over the handle bars. The National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, recommends noseless seats for people who ride bikes as part of their job.1 - People with constipation should talk with their health care provider about whether to take a laxative or stool softener to minimize straining during a bowel movement. | NIDDK | Perineal Injury in Males |
What to do for Perineal Injury in Males ? | To prevent constipation, a diet with 20 to 35 grams of fiber each day helps the body form soft, bulky stool that is easier to pass. High-fiber foods include beans, whole grains and bran cereals, fresh fruits, and vegetables such as asparagus, brussels sprouts, cabbage, and carrots. For people prone to constipation, limiting foods that have little or no fiber, such as ice cream, cheese, meat, and processed foods, is also important. A health care provider can give information about how changes in eating, diet, and nutrition could help with constipation. | NIDDK | Perineal Injury in Males |
What to do for Perineal Injury in Males ? | - Perineal injury is an injury to the perineum, the part of the body between the anus and the genitals, or sex organs. In males, the perineum is the area between the anus and the scrotum, the external pouch of skin that holds the testicles. - Injury to the blood vessels, nerves, and muscles in the perineum can lead to complications such as - bladder control problems - sexual problems - Common causes of acute perineal injury in males include - perineal surgery - straddle injuries - sexual abuse - impalement - Chronic perineal injury most often results from a job- or sport-related practicesuch as bike, motorcycle, or horseback ridingor a long-term condition such as chronic constipation. - Traumatic or piercing injuries may require surgery to repair damaged pelvic floor muscles, blood vessels, and nerves. Treatment for these acute injuries may also include antibiotics to prevent infection. - In people with a chronic perineal injury, a health care provider will treat the complications of the condition, such as erectile dysfunction (ED) and urinary incontinence. - Preventing perineal injury requires being aware of and taking steps to minimize the dangers of activities such as construction work or bike riding. - The National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, recommends noseless seats for people who ride bikes as part of their job. | NIDDK | Perineal Injury in Males |
What is (are) Ectopic Kidney ? | An ectopic kidney is a birth defect in which a kidney is located below, above, or on the opposite side of its usual position. About one in 900 people has an ectopic kidney.1 | NIDDK | Ectopic Kidney |
What is (are) Ectopic Kidney ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. Every minute, a persons kidneys filter about 3 ounces of blood, removing wastes and extra water. The wastes and extra water make up the 1 to 2 quarts of urine a person produces each day. The urine flows to the bladder through tubes called ureters where it is stored until being released through urination. | NIDDK | Ectopic Kidney |
What causes Ectopic Kidney ? | During fetal development, a babys kidneys first appear as buds inside the pelvisthe bowl-shaped bone that supports the spine and holds up the digestive, urinary, and reproductive organsnear the bladder. As the kidneys develop, they move gradually toward their usual position in the back near the rib cage. Sometimes, one of the kidneys remains in the pelvis or stops moving before it reaches its usual position. In other cases, the kidney moves higher than the usual position. Rarely does a child have two ectopic kidneys.
Most kidneys move toward the rib cage, but one may cross over so that both kidneys are on the same side of the body. When a crossover occurs, the two kidneys often grow together and become fused.
Factors that may lead to an ectopic kidney include
- poor development of a kidney bud - a defect in the kidney tissue responsible for prompting the kidney to move to its usual position - genetic abnormalities - the mother being sick or being exposed to an agent, such as a drug or chemical, that causes birth defects | NIDDK | Ectopic Kidney |
What are the symptoms of Ectopic Kidney ? | An ectopic kidney may not cause any symptoms and may function normally, even though it is not in its usual position. Many people have an ectopic kidney and do not discover it until they have tests done for other reasons. Sometimes, a health care provider may discover an ectopic kidney after feeling a lump in the abdomen during an examination. In other cases, an ectopic kidney may cause abdominal pain or urinary problems. | NIDDK | Ectopic Kidney |
What are the complications of Ectopic Kidney ? | Possible complications of an ectopic kidney include problems with urine drainage from that kidney. Sometimes, urine can even flow backwards from the bladder to the kidney, a problem called vesicoureteral reflux (VUR). More information about VUR is provided in the NIDDK health topic, Vesicoureteral Reflux.
Abnormal urine flow and the placement of the ectopic kidney can lead to various problems:
- Infection. Normally, urine flow washes out bacteria and keeps them from growing in the kidneys and urinary tract. When a kidney is out of the usual position, urine may get trapped in the ureter or in the kidney itself. Urine that remains in the urinary tract gives bacteria the chance to grow and spread. Symptoms of a urinary tract infection include frequent or painful urination, back or abdominal pain, fever, chills, and cloudy or foul-smelling urine. - Stones. Urinary stones form from substances found in the urine, such as calcium and oxalate. When urine remains in the urinary tract for too long, the risk that these substances will have time to form stones is increased. Symptoms of urinary stones include extreme pain in the back, side, or pelvis; blood in the urine; fever or chills; vomiting; and a burning feeling during urination. - Kidney damage. If urine backs up all the way to the kidney, damage to the kidney can occur. As a result, the kidney cant filter wastes and extra water from the blood. One ectopic kidney, even when it has no function, will not cause kidney failure. The other kidney can usually perform the functions of two healthy kidneys. Total kidney failure happens only in rare cases when both kidneys are damaged. - Trauma. If the ectopic kidney is in the lower abdomen or pelvis, it may be susceptible to injury from blunt trauma. People with an ectopic kidney who want to participate in body contact sports may want to wear protective gear. | NIDDK | Ectopic Kidney |
How to diagnose Ectopic Kidney ? | A health care provider may use one or more of the following imaging tests to diagnose an ectopic kidney:
- Ultrasound. An ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging; anesthesia is not needed. The images can show the location of the kidneys. - Intravenous pyelogram (IVP). An IVP is an x ray of the urinary tract. A special dye, called contrast medium, is injected into a vein in the persons arm, travels through the body to the kidneys, and makes urine visible on the x ray. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician, and the images are interpreted by a radiologist; anesthesia is not needed. An IVP can show a blockage in the urinary tract. In children, ultrasounds are usually done instead of IVPs. - Voiding cystourethrogram (VCUG). A VCUG is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The bladder and urethra are filled with contrast medium to make the structures clearly visible on the x-ray images. The x-ray machine captures images of the contrast medium while the bladder is full and when the person urinates. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used for some people. The test can show abnormalities of the inside of the urethra and bladder and whether urine is backing up toward the kidneys during urination. - Radionuclide scan. A radionuclide scan is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive chemicals. Because the dose of the radioactive chemicals is small, the risk of causing damage to cells is low. Special cameras and computers are used to create images of the radioactive chemicals as they pass through the kidneys. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. This test can show the location of an ectopic kidney and whether the ureters are blocked. - Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. An MRI may include the injection of contrast medium. With most MRI machines, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines are designed to allow the person to lie in a more open space. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed though light sedation may be used for people with a fear of confined spaces. MRIs can show the location of the kidneys.
In addition to imaging tests, blood tests may be done to determine how well the kidneys are working. These tests are almost always normal in people with an ectopic kidney, even if it is badly damaged, because the other kidney usually has completely normal function. | NIDDK | Ectopic Kidney |
What are the treatments for Ectopic Kidney ? | No treatment for an ectopic kidney is needed if urinary function is normal and no blockage of the urinary tract is present.
If tests show an obstruction, surgery may be needed to correct the position of the kidney to allow for better drainage of urine. Reflux can be corrected by surgery to alter the ureter or injection of a gellike liquid into the bladder wall near the opening of the ureter.
If extensive kidney damage has occurred, surgery may be needed to remove the kidney. As long as the other kidney is working properly, losing one kidney should have no adverse health effects. More information is provided in the NIDDK health topic, Solitary Kidney.
With the right testing and treatment, if needed, an ectopic kidney should cause no serious long-term health problems. | NIDDK | Ectopic Kidney |
What to do for Ectopic Kidney ? | Eating, diet, and nutrition have not been shown to play a role in causing or preventing an ectopic kidney. | NIDDK | Ectopic Kidney |
What to do for Ectopic Kidney ? | - An ectopic kidney is a birth defect in which a kidney is located below, above, or on the opposite side of its usual position. - Factors that may lead to an ectopic kidney include - poor development of a kidney bud - a defect in the kidney tissue responsible for prompting the kidney to move to its usual position - genetic abnormalities - the mother being sick or being exposed to an agent, such as a drug or chemical, that causes birth defects - An ectopic kidney may not cause any symptoms and may function normally, even though it is not in its usual position. - Possible complications of an ectopic kidney include problems with urine drainage from that kidney. Abnormal urine flow and the placement of the ectopic kidney can lead to various problems such as infection, stones, kidney damage, and injury from trauma. - No treatment for an ectopic kidney is needed if urinary function is normal and no blockage of the urinary tract is present. Surgery or other treatment may be needed if there is an obstruction, reflux, or extensive damage to the kidney. | NIDDK | Ectopic Kidney |
What is (are) Multiple Endocrine Neoplasia Type 1 ? | MEN1 is an inherited disorder that causes tumors in the endocrine glands and the duodenum, the first part of the small intestine. MEN1 is sometimes called multiple endocrine adenomatosis or Wermer's syndrome, after one of the first doctors to recognize it. MEN1 is rare, occurring in about one in 30,000 people.1 The disorder affects both sexes equally and shows no geographical, racial, or ethnic preferences.
Endocrine glands release hormones into the bloodstream. Hormones are powerful chemicals that travel through the blood, controlling and instructing the functions of various organs. Normally, the hormones released by endocrine glands are carefully balanced to meet the body's needs.
In people with MEN1, multiple endocrine glands form tumors and become hormonally overactive, often at the same time. The overactive glands may include the parathyroids, pancreas, or pituitary. Most people who develop overactivity of only one endocrine gland do not have MEN1. | NIDDK | Multiple Endocrine Neoplasia Type 1 |
What to do for Multiple Endocrine Neoplasia Type 1 ? | - Multiple endocrine neoplasia type 1 (MEN1) is an inherited disorder that causes hormone-secreting tumors in the duodenum and the endocrine glands-most often the parathyroid, pancreas, and pituitary. - Overactive parathyroid glands can lead to tiredness, weakness, muscle or bone pain, constipation, indigestion, kidney stones, or thinning of bones. - Pancreatic and duodenal endocrine tumors called gastrinomas can cause dangerous stomach or intestinal ulcers. - Pituitary tumors called prolactinomas can cause excessive production of breast milk or interfere with fertility in women or with sex drive and fertility in men. - Although many tumors associated with MEN1 are benign, about half of people with MEN1 will eventually develop a cancerous tumor. - MEN1 carriers can be detected through gene testing or other laboratory tests. - MEN1 cannot be cured, but regular testing can detect the problems caused by MEN1 tumors many years before serious complications develop. Careful monitoring enables doctors to adjust an individual's treatment as needed. | NIDDK | Multiple Endocrine Neoplasia Type 1 |
What is (are) Hematuria (Blood in the Urine) ? | Hematuria is blood in the urine. Two types of blood in the urine exist. Blood that can be seen in the urine is called gross hematuria. Blood that cannot be seen in the urine, except when examined with a microscope, is called microscopic hematuria. | NIDDK | Hematuria (Blood in the Urine) |
What are the symptoms of Hematuria (Blood in the Urine) ? | Most people with microscopic hematuria do not have symptoms. People with gross hematuria have urine that is pink, red, or cola-colored due to the presence of red blood cells (RBCs). Even a small amount of blood in the urine can cause urine to change color. In most cases, people with gross hematuria do not have other symptoms. However, people with gross hematuria that includes blood clots in the urine may have pain. | NIDDK | Hematuria (Blood in the Urine) |
What is (are) Hematuria (Blood in the Urine) ? | The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are two bean-shaped organs, each about the size of a fist. They are located near the middle of the back, just below the rib cage, one on each side of the spine. Every day, the two kidneys process about 200 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra water. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder. | NIDDK | Hematuria (Blood in the Urine) |
What causes Hematuria (Blood in the Urine) ? | Hematuria can be caused by menstruation, vigorous exercise, sexual activity, viral illness, trauma, or infection, such as a urinary tract infection (UTI). More serious causes of hematuria include
- cancer of the kidney or bladder - inflammation of the kidney, urethra, bladder, or prostatea walnut-shaped gland in men that surrounds the urethra at the neck of the bladder and supplies fluid that goes into semen - polycystic kidney diseasean inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time, taking over and destroying working kidney tissue - blood clots - blood clotting disorders, such as hemophilia - sickle cell diseasean inherited disorder in which RBCs form an abnormal crescent shape, resulting in less oxygen delivered to the bodys tissues, clogging of small blood vessels, and disruption of healthy blood flow | NIDDK | Hematuria (Blood in the Urine) |
Who is at risk for Hematuria (Blood in the Urine)? ? | Almost anyone, including children and teens, can have hematuria. Factors that increase the chance a person will have hematuria include
- a family history of kidney disease - an enlarged prostate, which typically occurs in men age 50 or older - urinary stone disease - certain medications including aspirin and other pain relievers, blood thinners, and antibiotics - strenuous exercise such as long-distance running - a recent bacterial or viral infection | NIDDK | Hematuria (Blood in the Urine) |
How to diagnose Hematuria (Blood in the Urine) ? | Hematuria is diagnosed with urinalysis, which is testing of a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when RBCs are present in urine. When blood is visible in the urine or a dipstick test of the urine indicates the presence of RBCs, a health care provider examines the urine with a microscope to make an initial diagnosis of hematuria. The next step is to diagnose the cause of the hematuria.
The health care provider will take a thorough medical history. If the history suggests a cause that does not require treatment, the urine should be tested again after 48 hours for the presence of RBCs. If two of three urine samples show too many RBCs when viewed with a microscope, more serious causes should be explored. The health care provider may order one or more of the following tests:
- Urinalysis. Further testing of the urine may be done to check for problems that can cause hematuria, such as infection, kidney disease, and cancer. The presence of white blood cells signals a UTI. RBCs that are misshapen or clumped together to form little tubes, called casts, may indicate kidney disease. Large amounts of protein in the urine, called proteinuria, may also indicate kidney disease. The urine can also be tested for the presence of cancer cells. - Blood test. A blood test involves drawing blood at a health care providers office or commercial facility and sending the sample to a lab for analysis. A blood test can show the presence of high levels of creatinine, a waste product of normal muscle breakdown, which may indicate kidney disease. - Biopsy. A biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. The biopsyis performed by a health care provider in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography (CT) scan to guide the biopsy needle into the kidney. The kidney tissue is examined in a lab by a pathologista doctor who specializes in diagnosing diseases. The test helps diagnose the type of kidney disease causing hematuria. - Cystoscopy. Cystoscopy is a procedure that uses a tubelike instrument to look inside the urethra and bladder. Cystoscopy is performed by a health care provider in the office, an outpatient facility, or a hospital with local anesthesia. However, in some cases, sedation and regional or general anesthesia are needed. Cystoscopy may be used to look for cancer cells in the bladder, particularly if cancer cells are found with urinalysis. More information is provided in the NIDDK health topic,Cystoscopy and Ureteroscopy. - Kidney imaging tests. Intravenous pyelogram (IVP) is an x ray of the urinary tract. A special dye, called contrast medium, is injected into a vein in the persons arm, travels through the body to the kidneys, and makes urine visible on the x ray. The contrast medium also shows any blockage in the urinary tract. When a small mass is found with IVP, another imaging test, such as an ultrasound, CT scan, or magnetic resonance imaging (MRI), can be used to further study the mass. Imaging tests are performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging. Anesthesia is not needed, though light sedation may be used in some cases. Imaging tests may show a tumor, a kidney or bladder stone, an enlarged prostate, or other blockage of the normal flow of urine. More information is provided in the NIDDK health topic, Imaging of the Urinary Tract. | NIDDK | Hematuria (Blood in the Urine) |
What are the treatments for Hematuria (Blood in the Urine) ? | Hematuria is treated by treating its underlying cause. If no serious condition is causing hematuria, no treatment is needed. Hematuria caused by a UTI is treated with antibiotics; urinalysis should be repeated 6 weeks after antibiotic treatment ends to be sure the infection has resolved. | NIDDK | Hematuria (Blood in the Urine) |
What to do for Hematuria (Blood in the Urine) ? | Eating, diet, and nutrition have not been shown to play a role in causing or preventing hematuria. | NIDDK | Hematuria (Blood in the Urine) |
What to do for Hematuria (Blood in the Urine) ? | - Hematuria is blood in the urine. - Most people with microscopic hematuria do not have symptoms. People with gross hematuria have urine that is pink, red, or cola-colored due to the presence of red blood cells (RBCs). - Hematuria can be caused by menstruation, vigorous exercise, sexual activity, viral illness, trauma, or infection, such as a urinary tract infection (UTI). More serious causes of hematuria include - cancer of the kidney or bladder - inflammation of the kidney, urethra, bladder, or prostate - polycystic kidney disease - blood clots - blood clotting disorders, such as hemophilia - sickle cell disease - When blood is visible in the urine or a dipstick test of the urine indicates the presence of RBCs, the urine is examined with a microscope to make an initial diagnosis of hematuria. The next step is to diagnose the cause of the hematuria. - If a thorough medical history suggests a cause that does not require treatment, the urine should be tested again after 48 hours for the presence of RBCs. If two of three urine samples show too many RBCs when viewed with a microscope, more serious causes should be explored. - One or more of the following tests may be ordered: urinalysis, blood test, biopsy, cytoscopy, and kidney imaging tests. - Hematuria is treated by treating its underlying cause. | NIDDK | Hematuria (Blood in the Urine) |
What is (are) Urine Blockage in Newborns ? | The urinary tract is the bodys drainage system for removing wastes and extra fluid. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. 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 spine. Every day, the kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. Children produce less urine than adults. The amount produced depends on their age. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine until releasing it through urination. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder.
The kidneys and urinary system keep fluids and natural chemicals in the body balanced. While a baby is developing in the mothers womb, called prenatal development, the placentaa temporary organ joining mother and babycontrols much of that balance. The babys kidneys begin to produce urine at about 10 to 12 weeks after conception. However, the mothers placenta continues to do most of the work until the last few weeks of the pregnancy. Wastes and extra water are removed from the babys body through the umbilical cord. The babys urine is released into the amniotic sac and becomes part of the amniotic fluid. This fluid plays a role in the babys lung development. | NIDDK | Urine Blockage in Newborns |
What causes Urine Blockage in Newborns ? | Many types of defects in the urinary tract can cause urine blockage:
- Vesicoureteral reflux (VUR). Most children with VUR are born with a ureter that did not grow long enough during development in the womb. The valve formed by the ureter pressing against the bladder wall does not close properly, so urine backs uprefluxesfrom the bladder to the ureter and eventually to the kidney. Severe reflux may prevent a kidney from developing normally and may increase the risk for damage from infections after birth. VUR usually affects only one ureter and kidney, though it can affect both ureters and kidneys. - Ureteropelvic junction (UPJ) obstruction. If urine is blocked where the ureter joins the kidney, only the kidney swells. The ureter remains a normal size. UPJ obstruction usually occurs in only one kidney.
- Bladder outlet obstruction (BOO). BOO describes any blockage in the urethra or at the opening of the bladder.Posterior urethral valves (PUV), the most common form of BOO seen in newborns and during prenatal ultrasound exams, is a birth defect in boys in which an abnormal fold of tissue in the urethra keeps urine from flowing freely out of the bladder. This defect may cause swelling in the entire urinary tract, including the urethra, bladder, ureters, and kidneys. - Ureterocele. If the end of the ureter does not develop normally, it can bulge, creating a ureterocele. The ureterocele may obstruct part of the ureter or the bladder.
Some babies are born with genetic conditions that affect several different systems in the body, including the urinary tract:
- Prune belly syndrome (PBS). PBS is a group of birth defects involving poor development of the abdominal muscles, enlargement of the ureters and bladder, and both testicles remaining inside the body instead of descending into the scrotum. The skin over the abdomen is wrinkled, giving the appearance of a prune. PBS usually occurs in boys, and most children with PBS have hydronephrosisswelling in the kidneyand VUR. - Esophageal atresia (EA). EA is a birth defect in which the esophagusthe muscular tube that carries food and liquids from the mouth to the stomachlacks the opening for food to pass into the stomach. Babies born with EA may also have problems with their spinal columns, digestive systems, hearts, and urinary tracts. - Congenital heart defects. Heart defects range from mild to life threatening. Children born with heart defects also have a higher rate of problems in the urinary tract than children in the general population, suggesting that some types of heart and urinary defects may have a common genetic cause.
Urine blockage can also be caused by spina bifida and other birth defects that affect the spinal cord. These defects may interrupt nerve signals between the bladder, spinal cord, and brain, which are needed for urination, and lead to urinary retentionthe inability to empty the bladder completelyin newborns. Urine that remains in the bladder can reflux into the ureters and kidneys, causing swelling. | NIDDK | Urine Blockage in Newborns |
What are the symptoms of Urine Blockage in Newborns ? | Before leaving the hospital, a baby with urine blockage may urinate only small amounts or may not urinate at all. As part of the routine newborn exam, the health care provider may feel an enlarged kidney or find a closed urethra, which may indicate urine blockage. Sometimes urine blockage is not apparent until a child develops symptoms of a urinary tract infection (UTI), including
- fever - irritability - not eating - nausea - diarrhea - vomiting - cloudy, dark, bloody, or foul-smelling urine - urinating often
If these symptoms persist, the child should see a health care provider. A child 2 months of age or younger with a fever should see a health care provider immediately. The health care provider will ask for a urine sample to test for bacteria. | NIDDK | Urine Blockage in Newborns |
What are the complications of Urine Blockage in Newborns ? | When a defect in the urinary tract blocks the flow of urine, the urine backs up and causes the ureters to swell, called hydroureter, and hydronephrosis.
Hydronephrosis is the most common problem found during prenatal ultrasound of a baby in the womb. The swelling may be easy to see or barely detectable. The results of hydronephrosis may be mild or severe, yet the long-term outcome for the childs health cannot always be predicted by the severity of swelling. Urine blockage may damage the developing kidneys and reduce their ability to filter. In the most severe cases of urine blockage, where little or no urine leaves the babys bladder, the amount of amniotic fluid is reduced to the point that the babys lung development is threatened.
After birth, urine blockage may raise a childs risk of developing a UTI. Recurring UTIs can lead to more permanent kidney damage. | NIDDK | Urine Blockage in Newborns |
How to diagnose Urine Blockage in Newborns ? | Defects of the urinary tract may be diagnosed before or after the baby is born.
Diagnosis before Birth
Tests during pregnancy can help determine if the baby is developing normally in the womb.
- Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A prenatal ultrasound can show internal organs within the baby. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by - a radiologista doctor who specializes in medical imaging, or - an obstetriciana doctor who delivers babies
The images can show enlarged kidneys, ureters, or bladders in babies.
- Amniocentesis. Amniocentesis is a procedure in which amniotic fluid is removed from the mothers womb for testing. The procedure can be performed in the health care providers office, and local anesthetic may be used. The health care provider inserts a thin needle through the abdomen into the uterus to obtain a small amount of amniotic fluid. Cells from the fluid are grown in a lab and then analyzed. The health care provider usually uses ultrasound to find the exact location of the baby. The test can show whether the baby has certain birth defects and how well the babys lungs are developing. - Chorionic villus sampling (CVS). CVS is the removal of a small piece of tissue from the placenta for testing. The procedure can be performed in the health care providers office; anesthesia is not needed. The health care provider uses ultrasound to guide a thin tube or needle through the vagina or abdomen into the placenta. Cells are removed from the placenta and then analyzed. The test can show whether the baby has certain genetic defects.
Most healthy women do not need all of these tests. Ultrasound exams during pregnancy are routine. Amniocentesis and CVS are recommended only when a risk of genetic problems exists because of family history or a problem is detected during an ultrasound. Amniocentesis and CVS carry a slight risk of harming the baby and mother or ending the pregnancy in miscarriage, so the risks should be carefully considered.
Diagnosis after Birth
Different imaging techniques can be used in infants and children to determine the cause of urine blockage.
- Ultrasound. Ultrasound can be used to view the childs urinary tract. For infants, the image is clearer than could be achieved while the baby was in the womb. - Voiding cystourethrogram (VCUG). VCUG is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The procedure is performed in an outpatient center or hospital by an x-ray technician supervised by a radiologist, who then interprets the images. While anesthesia is not needed, sedation may be used for some children. The bladder and urethra are filled with a special dye, called contrast medium, to make the structures clearly visible on the x-ray images. The x-ray machine captures images of the contrast medium while the bladder is full and when the child urinates. The test can show reflux or blockage of the bladder due to an obstruction, such as PUV. - Radionuclide scan. A radionuclide scan is an imaging technique that detects small amounts of radiation after a person is injected with radioactive chemicals. The dose of the radioactive chemicals is small; therefore, the risk of causing damage to cells is low. Radionuclide scans are performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed. Special cameras and computers are used to create images of the radioactive chemicals as they pass through the kidneys. Radioactive chemicals injected into the blood can provide information about kidney function. | NIDDK | Urine Blockage in Newborns |
What are the treatments for Urine Blockage in Newborns ? | Treatment for urine blockage depends on the cause and severity of the blockage. Hydronephrosis discovered before the baby is born rarely requires immediate action, especially if it is only on one side. The condition often goes away without any treatment before or after birth. The health care provider should keep track of the condition with frequent ultrasounds.
Surgery
If the urine blockage threatens the life of the unborn baby, a fetal surgeon may recommend surgery to insert a shunt or correct the problem causing the blockage. A shunt is a small tube that can be inserted into the babys bladder to release urine into the amniotic sac. The procedure is similar to amniocentesis, in that a needle is inserted through the mothers abdomen. Ultrasound guides placement of the shunt, which is attached to the end of the needle. Alternatively, an endoscopea small, flexible tube with a lightcan be used to place a shunt or to repair the problem causing the blockage. Fetal surgery carries many risks, so it is performed only in special circumstances, such as when the amniotic fluid is absent and the babys lungs are not developing or when the kidneys are severely damaged.
If the urinary defect does not correct itself after the child is born, and the child continues to have urine blockage, surgery may be needed to remove the obstruction and restore urine flow. The decision to operate depends on the degree of blockage. After surgery, a small tube, called a stent, may be placed in the ureter or urethra to keep it open temporarily while healing occurs.
Antibiotics
Antibiotics are bacteria-fighting medications. A child with possible urine blockage or VUR may be given antibiotics to prevent UTIs from developing until the urinary defect corrects itself or is corrected with surgery.
Intermittent Catheterization
Intermittent catheterization may be used for a child with urinary retention due to a nerve disease. The parent or guardian, and later the child, is taught to drain the bladder by inserting a thin tube, called a catheter, through the urethra to the bladder. Emptying the bladder in this way helps to decrease kidney damage, urine leakage, and UTIs. | NIDDK | Urine Blockage in Newborns |
What to do for Urine Blockage in Newborns ? | Researchers have not found that a mothers eating, diet, and nutrition play a role in causing or preventing urine blockage in newborns. | NIDDK | Urine Blockage in Newborns |
What to do for Urine Blockage in Newborns ? | - Many types of defects in the urinary tract can cause urine blockage: - vesicoureteral reflux (VUR) - ureteropelvic junction (UPJ) obstruction - bladder outlet obstruction (BOO), such as posterior urethral valves (PUV) - ureterocele - Some babies are born with genetic conditions that affect several different systems in the body, including the urinary tract: - prune belly syndrome (PBS) - esophageal atresia (EA) - congenital heart defects - Urine blockage can also be caused by spina bifida and other birth defects that affect the spinal cord. - Before leaving the hospital, a baby with urine blockage may urinate only small amounts or may not urinate at all. As part of the routine newborn exam, the health care provider may feel an enlarged kidney or find a closed urethra, which may indicate urine blockage. Sometimes urine blockage is not apparent until a child develops symptoms of a urinary tract infection (UTI). - When a defect in the urinary tract blocks the flow of urine, the urine backs up and causes the ureters to swell, called hydroureter, and hydronephrosis. - Defects of the urinary tract may be discovered before or after the baby is born. - Prenatal tests include ultrasound, amniocentesis, and chorionic villus sampling (CVS). - Different imaging techniques, including ultrasound, voiding cystourethrogram (VCUG), and radionuclide scan, can be used in infants and children to determine the cause of urine blockage. - Treatment for urine blockage depends on the cause and severity of the blockage. Hydronephrosis discovered before the baby is born rarely requires immediate action, especially if it is only on one side. Treatments for more serious conditions include - surgery - antibiotics - intermittent catheterization | NIDDK | Urine Blockage in Newborns |
What is (are) What I need to know about Bladder Control for Women ? | Not all bladder control problems are alike. Some problems are caused by weak muscles, while others are caused by damaged nerves. Sometimes the cause may be a medicine that dulls the nerves.
To help solve your problem, your doctor or nurse will try to identify the type of incontinence you have. It may be one or more of the following six types. | NIDDK | What I need to know about Bladder Control for Women |
What causes What I need to know about Bladder Control for Women ? | Urine leakage has many possible causes. | NIDDK | What I need to know about Bladder Control for Women |
What is (are) What I need to know about Bladder Control for Women ? | Talking about bladder control problems is not easy for some people. You may feel embarrassed to tell your doctor. But talking about the problem is the first step in finding an answer. Also, you can be sure your doctor has heard it all before. You will not shock or embarrass your doctor or nurse.
Medical History
You can prepare for your visit to the doctor's office by gathering the information your doctor will need to understand your problem. Make a list of the medicines you are taking. Include prescription medicines and those you buy over the counter, like aspirin or antacid. List the fluids you drink regularly, including sodas, coffee, tea, and alcohol. Tell the doctor how much of each drink you have in an average day.
Finding a Doctor
You will need to find a doctor who is skilled in helping women with urine leakage. If your primary doctor shrugs off your problem as normal aging, for example, ask for a referral to a specialist-a urogynecologist or a urologist who specializes in treating female urinary problems. You may need to be persistent, or you may need to look to organizations to help locate a doctor in your area. See For More Information for a list of organizations.
Make a note of any recent surgeries or illnesses you have had. Let the doctor know how many children you have had. These events may or may not be related to your bladder control problem.
Finally, keep track of the times when you have urine leakage. Note what you were doing at the time. Were you coughing, laughing, sneezing, or exercising? Did you have an uncontrollable urge to urinate when you heard running water?
You can use What Your Doctor Needs to Know (Item A) and Your Daily Bladder Diary (Item B) to prepare for your appointment.
Physical Exam
The doctor will give you a physical exam to look for any health issues that may be causing your bladder control problem. Checking your reflexes can show possible nerve damage. You will give a urine sample so the doctor can check for a urinary tract infection. For women, the exam may include a pelvic exam. Tests may also include taking an ultrasound picture of your bladder. Or the doctor may examine the inside of your bladder using a cystoscope, a long, thin tube that slides up into the bladder through the urethra.
Bladder Function Tests
Any medical test can be uncomfortable. Bladder testing may sound embarrassing, but the health professionals who perform the tests will try to make you feel comfortable and give you as much privacy as possible. | NIDDK | What I need to know about Bladder Control for Women |
What are the treatments for What I need to know about Bladder Control for Women ? | Your doctor will likely offer several treatment choices. Some treatments are as simple as changing some daily habits. Other treatments require taking medicine or using a device. If nothing else seems to work, surgery may help a woman with stress incontinence regain her bladder control.
Talk with your doctor about which treatments might work best for you.
Pelvic Muscle Strengthening
Many women prefer to try the simplest treatment choices first. Kegel exercises strengthen the pelvic muscles and don't require any equipment. Once you learn how to "Kegel," you can Kegel anywhere. The trick is finding the right muscles to squeeze. Your doctor or nurse can help make sure you are squeezing the right muscles. Your doctor may refer you to a specially trained physical therapist who will teach you to find and strengthen the sphincter muscles. Learning when to squeeze these muscles can also help stop the bladder spasms that cause urge incontinence. After about 6 to 8 weeks, you should notice that you have fewer leaks and more bladder control. Use the pelvic muscle exercise log included with the Kegel Exercise Tips sheet (Item C) to keep track of your progress.
Changing Habits
Timed voiding. By keeping track of the times you leak urine, you may notice certain times of day when you are most likely to have an accident. You can use that information to make planned trips to the bathroom ahead of time to avoid the accident. Once you have established a safe pattern, you can build your bladder control by stretching out the time between trips to the bathroom. By forcing your pelvic muscles to hold on longer, you make those muscles stronger.
Diet changes. You may notice that certain foods and drinks cause you to urinate more often. You may find that avoiding caffeinated drinks like coffee, tea, or cola helps your bladder control. You can choose the decaf version of your favorite drink. Make sure you are not drinking too much fluid because that will cause you to make a large amount of urine. If you are bothered by nighttime urination, drink most of your fluids during the day and limit your drinking after dinner. You should not, however, avoid drinking fluids for fear of having an accident. Some foods may irritate your bladder and cause urgency. Talk with your doctor about diet changes that might affect your bladder.
Weight loss. Extra body weight puts extra pressure on your bladder. By losing weight, you may be able to relieve some of that pressure and regain your bladder control.
Medicines
No medications are approved to treat stress urinary incontinence. But if you have an overactive bladder, your doctor may prescribe a medicine that can calm muscles and nerves. Medicines for overactive bladder come as pills, liquid, or a patch.
Medicines to treat overactive bladder can cause your eyes to become dry. These medicines can also cause dry mouth and constipation. If you take medicine to treat an overactive bladder, you may need to take steps to deal with the side effects.
- Use eye drops to keep your eyes moist. - Chew gum or suck on hard candy if dry mouth bothers you. Make it sugarless gum or candy to avoid tooth decay. - Take small sips of water throughout the day.
Medicines for other conditions also can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling-edema-or high blood pressure may increase urine output and contribute to bladder control problems.
Talk with your doctor; you may find that taking a different medicine solves the problem without adding another prescription. The list of Medicines for Bladder Control (Item D) will give you more information about specific medicines.
Pessaries
A pessary is a plastic ring, similar to a contraceptive diaphragm, that is worn in the vagina. It will help support the walls of the vagina, lifting the bladder and nearby urethra, leading to less stress leakage. A doctor or nurse can fit you with the best shape and size pessary for you and teach you how to care for it. Many women use a pessary only during exercise while others wear their pessary all day to reduce stress leakage. If you use a pessary, you should see your doctor regularly to check for small scrapes in the vagina that can result from using the device.
Nerve Stimulation
Electrical stimulation of the nerves that control the bladder can improve symptoms of urgency, frequency, and urge incontinence, as well as bladder emptying problems, in some people. This treatment is usually offered to patients who cannot tolerate or do not benefit from medications. At first, your doctor will use a device outside your body to deliver stimulation through a wire implanted under your skin to see if the treatment relieves your symptoms. If the temporary treatment works well for you, you may be able to have a permanent device implanted that delivers stimulation to the nerves in your back, much like a pacemaker. The electrodes in the permanent device are placed in your lower back through a minor surgical procedure. You may need to return to the doctor for adjustments to find the right setting that controls your bladder symptoms.
Surgery
Doctors may suggest surgery to improve bladder control if other treatments have failed. Surgery helps only stress incontinence. It won't work for urge incontinence. Many surgical options have high rates of success.
Most stress incontinence problems are caused by the bladder neck dropping toward the vagina. To correct this problem, the surgeon raises the bladder neck or urethra and supports it with a ribbon-like sling or web of strings attached to a muscle or bone. The sling holds up the bottom of the bladder and the top of the urethra to stop leakage.
Catheterization
If your bladder does not empty well as a result of nerve damage, you might leak urine. This condition is called overflow incontinence. You might use a catheter to empty your bladder. A catheter is a thin tube you can learn to insert through the urethra into the bladder to drain urine. You may use a catheter once in a while, a few times a day, or all of the time. If you use the catheter all the time, it will drain urine from your bladder into a bag you can hang from your leg. If you use a catheter all the time, you should watch for possible infections. | NIDDK | What I need to know about Bladder Control for Women |
What is (are) Glomerular Diseases ? | The two kidneys are bean-shaped organs located just below the rib cage, one on each side of the spine. Everyday, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.
Blood enters the kidneys through arteries that branch inside the kidneys into tiny clusters of looping blood vessels. Each cluster is called a glomerulus, which comes from the Greek word meaning filter. The plural form of the word is glomeruli. There are approximately 1 million glomeruli, or filters, in each kidney. The glomerulus is attached to the opening of a small fluid-collecting tube called a tubule. Blood is filtered in the glomerulus, and extra fluid and wastes pass into the tubule and become urine. Eventually, the urine drains from the kidneys into the bladder through larger tubes called ureters.
Each glomerulus-and-tubule unit is called a nephron. Each kidney is composed of about 1 million nephrons. In healthy nephrons, the glomerular membrane that separates the blood vessel from the tubule allows waste products and extra water to pass into the tubule while keeping blood cells and protein in the bloodstream. | NIDDK | Glomerular Diseases |
What is (are) Glomerular Diseases ? | The two kidneys are bean-shaped organs located just below the rib cage, one on each side of the spine. Everyday, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid.
Blood enters the kidneys through arteries that branch inside the kidneys into tiny clusters of looping blood vessels. Each cluster is called a glomerulus, which comes from the Greek word meaning filter. The plural form of the word is glomeruli. There are approximately 1 million glomeruli, or filters, in each kidney. The glomerulus is attached to the opening of a small fluid-collecting tube called a tubule. Blood is filtered in the glomerulus, and extra fluid and wastes pass into the tubule and become urine. Eventually, the urine drains from the kidneys into the bladder through larger tubes called ureters.
Each glomerulus-and-tubule unit is called a nephron. Each kidney is composed of about 1 million nephrons. In healthy nephrons, the glomerular membrane that separates the blood vessel from the tubule allows waste products and extra water to pass into the tubule while keeping blood cells and protein in the bloodstream. | NIDDK | Glomerular Diseases |
What are the symptoms of Glomerular Diseases ? | The signs and symptoms of glomerular disease include
- albuminuria: large amounts of protein in the urine - hematuria: blood in the urine - reduced glomerular filtration rate: inefficient filtering of wastes from the blood - hypoproteinemia: low blood protein - edema: swelling in parts of the body
One or more of these symptoms can be the first sign of kidney disease. But how would you know, for example, whether you have proteinuria? Before seeing a doctor, you may not. But some of these symptoms have signs, or visible manifestations:
- Proteinuria may cause foamy urine. - Blood may cause the urine to be pink or cola-colored. - Edema may be obvious in hands and ankles, especially at the end of the day, or around the eyes when awakening in the morning, for example. | NIDDK | Glomerular Diseases |
How to diagnose Glomerular Diseases ? | Patients with glomerular disease have significant amounts of protein in the urine, which may be referred to as "nephrotic range" if levels are very high. Red blood cells in the urine are a frequent finding as well, particularly in some forms of glomerular disease. Urinalysis provides information about kidney damage by indicating levels of protein and red blood cells in the urine. Blood tests measure the levels of waste products such as creatinine and urea nitrogen to determine whether the filtering capacity of the kidneys is impaired. If these lab tests indicate kidney damage, the doctor may recommend ultrasound or an x ray to see whether the shape or size of the kidneys is abnormal. These tests are called renal imaging. But since glomerular disease causes problems at the cellular level, the doctor will probably also recommend a kidney biopsya procedure in which a needle is used to extract small pieces of tissue for examination with different types of microscopes, each of which shows a different aspect of the tissue. A biopsy may be helpful in confirming glomerular disease and identifying the cause. | NIDDK | Glomerular Diseases |
How to diagnose Glomerular Diseases ? | Patients with glomerular disease have significant amounts of protein in the urine, which may be referred to as "nephrotic range" if levels are very high. Red blood cells in the urine are a frequent finding as well, particularly in some forms of glomerular disease. Urinalysis provides information about kidney damage by indicating levels of protein and red blood cells in the urine. Blood tests measure the levels of waste products such as creatinine and urea nitrogen to determine whether the filtering capacity of the kidneys is impaired. If these lab tests indicate kidney damage, the doctor may recommend ultrasound or an x ray to see whether the shape or size of the kidneys is abnormal. These tests are called renal imaging. But since glomerular disease causes problems at the cellular level, the doctor will probably also recommend a kidney biopsya procedure in which a needle is used to extract small pieces of tissue for examination with different types of microscopes, each of which shows a different aspect of the tissue. A biopsy may be helpful in confirming glomerular disease and identifying the cause. | NIDDK | Glomerular Diseases |
What causes Glomerular Diseases ? | A number of different diseases can result in glomerular disease. It may be the direct result of an infection or a drug toxic to the kidneys, or it may result from a disease that affects the entire body, like diabetes or lupus. Many different kinds of diseases can cause swelling or scarring of the nephron or glomerulus. Sometimes glomerular disease is idiopathic, meaning that it occurs without an apparent associated disease.
The categories presented below can overlap: that is, a disease might belong to two or more of the categories. For example, diabetic nephropathy is a form of glomerular disease that can be placed in two categories: systemic diseases, since diabetes itself is a systemic disease, and sclerotic diseases, because the specific damage done to the kidneys is associated with scarring.
Autoimmune Diseases
When the body's immune system functions properly, it creates protein-like substances called antibodies and immunoglobulins to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions.
Systemic lupus erythematosus (SLE) affects many parts of the body: primarily the skin and joints, but also the kidneys. Because women are more likely to develop SLE than men, some researchers believe that a sex-linked genetic factor may play a part in making a person susceptible, although viral infection has also been implicated as a triggering factor. Lupus nephritis is the name given to the kidney disease caused by SLE, and it occurs when autoantibodies form or are deposited in the glomeruli, causing inflammation. Ultimately, the inflammation may create scars that keep the kidneys from functioning properly. Conventional treatment for lupus nephritis includes a combination of two drugs, cyclophosphamide, a cytotoxic agent that suppresses the immune system, and prednisolone, a corticosteroid used to reduce inflammation. A newer immunosuppressant, mychophenolate mofetil (MMF), has been used instead of cyclophosphamide. Preliminary studies indicate that MMF may be as effective as cyclophosphamide and has milder side effects.
Goodpasture's Syndrome involves an autoantibody that specifically targets the kidneys and the lungs. Often, the first indication that patients have the autoantibody is when they cough up blood. But lung damage in Goodpasture's Syndrome is usually superficial compared with progressive and permanent damage to the kidneys. Goodpasture's Syndrome is a rare condition that affects mostly young men but also occurs in women, children, and older adults. Treatments include immunosuppressive drugs and a blood-cleaning therapy called plasmapheresis that removes the autoantibodies.
IgA nephropathy is a form of glomerular disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation. IgA nephropathy was not recognized as a cause of glomerular disease until the late 1960s, when sophisticated biopsy techniques were developed that could identify IgA deposits in kidney tissue.
The most common symptom of IgA nephropathy is blood in the urine, but it is often a silent disease that may go undetected for many years. The silent nature of the disease makes it difficult to determine how many people are in the early stages of IgA nephropathy, when specific medical tests are the only way to detect it. This disease is estimated to be the most common cause of primary glomerulonephritisthat is, glomerular disease not caused by a systemic disease like lupus or diabetes mellitus. It appears to affect men more than women. Although IgA nephropathy is found in all age groups, young people rarely display signs of kidney failure because the disease usually takes several years to progress to the stage where it causes detectable complications.
No treatment is recommended for early or mild cases of IgA nephropathy when the patient has normal blood pressure and less than 1 gram of protein in a 24-hour urine output. When proteinuria exceeds 1 gram/day, treatment is aimed at protecting kidney function by reducing proteinuria and controlling blood pressure. Blood pressure medicinesangiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)that block a hormone called angiotensin are most effective at achieving those two goals simultaneously.
Hereditary NephritisAlport Syndrome
The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss. Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function.
Infection-related Glomerular Disease
Glomerular disease sometimes develops rapidly after an infection in other parts of the body. Acute post-streptococcal glomerulonephritis (PSGN) can occur after an episode of strep throat or, in rare cases, impetigo (a skin infection). The Streptococcus bacteria do not attack the kidney directly, but an infection may stimulate the immune system to overproduce antibodies, which are circulated in the blood and finally deposited in the glomeruli, causing damage. PSGN can bring on sudden symptoms of swelling (edema), reduced urine output (oliguria), and blood in the urine (hematuria). Tests will show large amounts of protein in the urine and elevated levels of creatinine and urea nitrogen in the blood, thus indicating reduced kidney function. High blood pressure frequently accompanies reduced kidney function in this disease.
PSGN is most common in children between the ages of 3 and 7, although it can strike at any age, and it most often affects boys. It lasts only a brief time and usually allows the kidneys to recover. In a few cases, however, kidney damage may be permanent, requiring dialysis or transplantation to replace renal function.
Bacterial endocarditis, infection of the tissues inside the heart, is also associated with subsequent glomerular disease. Researchers are not sure whether the renal lesions that form after a heart infection are caused entirely by the immune response or whether some other disease mechanism contributes to kidney damage. Treating the heart infection is the most effective way of minimizing kidney damage. Endocarditis sometimes produces chronic kidney disease (CKD).
HIV, the virus that leads to AIDS, can also cause glomerular disease. Between 5 and 10 percent of people with HIV experience kidney failure, even before developing full-blown AIDS. HIV-associated nephropathy usually begins with heavy proteinuria and progresses rapidly (within a year of detection) to total kidney failure. Researchers are looking for therapies that can slow down or reverse this rapid deterioration of renal function, but some possible solutions involving immunosuppression are risky because of the patients' already compromised immune system.
Sclerotic Diseases
Glomerulosclerosis is scarring (sclerosis) of the glomeruli. In several sclerotic conditions, a systemic disease like lupus or diabetes is responsible. Glomerulosclerosis is caused by the activation of glomerular cells to produce scar material. This may be stimulated by molecules called growth factors, which may be made by glomerular cells themselves or may be brought to the glomerulus by the circulating blood that enters the glomerular filter.
Diabetic nephropathy is the leading cause of glomerular disease and of total kidney failure in the United States. Kidney disease is one of several problems caused by elevated levels of blood glucose, the central feature of diabetes. In addition to scarring the kidney, elevated glucose levels appear to increase the speed of blood flow into the kidney, putting a strain on the filtering glomeruli and raising blood pressure.
Diabetic nephropathy usually takes many years to develop. People with diabetes can slow down damage to their kidneys by controlling their blood glucose through healthy eating with moderate protein intake, physical activity, and medications. People with diabetes should also be careful to keep their blood pressure at a level below 140/90 mm Hg, if possible. Blood pressure medications called ACE inhibitors and ARBs are particularly effective at minimizing kidney damage and are now frequently prescribed to control blood pressure in patients with diabetes and in patients with many forms of kidney disease.
Focal segmental glomerulosclerosis (FSGS) describes scarring in scattered regions of the kidney, typically limited to one part of the glomerulus and to a minority of glomeruli in the affected region. FSGS may result from a systemic disorder or it may develop as an idiopathic kidney disease, without a known cause. Proteinuria is the most common symptom of FSGS, but, since proteinuria is associated with several other kidney conditions, the doctor cannot diagnose FSGS on the basis of proteinuria alone. Biopsy may confirm the presence of glomerular scarring if the tissue is taken from the affected section of the kidney. But finding the affected section is a matter of chance, especially early in the disease process, when lesions may be scattered.
Confirming a diagnosis of FSGS may require repeat kidney biopsies. Arriving at a diagnosis of idiopathic FSGS requires the identification of focal scarring and the elimination of possible systemic causes such as diabetes or an immune response to infection. Since idiopathic FSGS is, by definition, of unknown cause, it is difficult to treat. No universal remedy has been found, and most patients with FSGS progress to total kidney failure over 5 to 20 years. Some patients with an aggressive form of FSGS reach total kidney failure in 2 to 3 years. Treatments involving steroids or other immunosuppressive drugs appear to help some patients by decreasing proteinuria and improving kidney function. But these treatments are beneficial to only a minority of those in whom they are tried, and some patients experience even poorer kidney function as a result. ACE inhibitors and ARBs may also be used in FSGS to decrease proteinuria. Treatment should focus on controlling blood pressure and blood cholesterol levels, factors that may contribute to kidney scarring.
Other Glomerular Diseases
Membranous nephropathy, also called membranous glomerulopathy, is the second most common cause of the nephrotic syndrome (proteinuria, edema, high cholesterol) in U.S. adults after diabetic nephropathy. Diagnosis of membranous nephropathy requires a kidney biopsy, which reveals unusual deposits of immunoglobulin G and complement C3, substances created by the body's immune system. Fully 75 percent of cases are idiopathic, which means that the cause of the disease is unknown. The remaining 25 percent of cases are the result of other diseases like systemic lupus erythematosus, hepatitis B or C infection, or some forms of cancer. Drug therapies involving penicillamine, gold, or captopril have also been associated with membranous nephropathy. About 20 to 40 percent of patients with membranous nephropathy progress, usually over decades, to total kidney failure, but most patients experience either complete remission or continued symptoms without progressive kidney failure. Doctors disagree about how aggressively to treat this condition, since about 20 percent of patients recover without treatment. ACE inhibitors and ARBs are generally used to reduce proteinuria. Additional medication to control high blood pressure and edema is frequently required. Some patients benefit from steroids, but this treatment does not work for everyone. Additional immunosuppressive medications are helpful for some patients with progressive disease.
Minimal change disease (MCD) is the diagnosis given when a patient has the nephrotic syndrome and the kidney biopsy reveals little or no change to the structure of glomeruli or surrounding tissues when examined by a light microscope. Tiny drops of a fatty substance called a lipid may be present, but no scarring has taken place within the kidney. MCD may occur at any age, but it is most common in childhood. A small percentage of patients with idiopathic nephrotic syndrome do not respond to steroid therapy. For these patients, the doctor may recommend a low-sodium diet and prescribe a diuretic to control edema. The doctor may recommend the use of nonsteroidal anti-inflammatory drugs to reduce proteinuria. ACE inhibitors and ARBs have also been used to reduce proteinuria in patients with steroid-resistant MCD. These patients may respond to larger doses of steroids, more prolonged use of steroids, or steroids in combination with immunosuppressant drugs, such as chlorambucil, cyclophosphamide, or cyclosporine. | NIDDK | Glomerular Diseases |
What causes Glomerular Diseases ? | A number of different diseases can result in glomerular disease. It may be the direct result of an infection or a drug toxic to the kidneys, or it may result from a disease that affects the entire body, like diabetes or lupus. Many different kinds of diseases can cause swelling or scarring of the nephron or glomerulus. Sometimes glomerular disease is idiopathic, meaning that it occurs without an apparent associated disease.
The categories presented below can overlap: that is, a disease might belong to two or more of the categories. For example, diabetic nephropathy is a form of glomerular disease that can be placed in two categories: systemic diseases, since diabetes itself is a systemic disease, and sclerotic diseases, because the specific damage done to the kidneys is associated with scarring.
Autoimmune Diseases
When the body's immune system functions properly, it creates protein-like substances called antibodies and immunoglobulins to protect the body against invading organisms. In an autoimmune disease, the immune system creates autoantibodies, which are antibodies or immunoglobulins that attack the body itself. Autoimmune diseases may be systemic and affect many parts of the body, or they may affect only specific organs or regions.
Systemic lupus erythematosus (SLE) affects many parts of the body: primarily the skin and joints, but also the kidneys. Because women are more likely to develop SLE than men, some researchers believe that a sex-linked genetic factor may play a part in making a person susceptible, although viral infection has also been implicated as a triggering factor. Lupus nephritis is the name given to the kidney disease caused by SLE, and it occurs when autoantibodies form or are deposited in the glomeruli, causing inflammation. Ultimately, the inflammation may create scars that keep the kidneys from functioning properly. Conventional treatment for lupus nephritis includes a combination of two drugs, cyclophosphamide, a cytotoxic agent that suppresses the immune system, and prednisolone, a corticosteroid used to reduce inflammation. A newer immunosuppressant, mychophenolate mofetil (MMF), has been used instead of cyclophosphamide. Preliminary studies indicate that MMF may be as effective as cyclophosphamide and has milder side effects.
Goodpasture's Syndrome involves an autoantibody that specifically targets the kidneys and the lungs. Often, the first indication that patients have the autoantibody is when they cough up blood. But lung damage in Goodpasture's Syndrome is usually superficial compared with progressive and permanent damage to the kidneys. Goodpasture's Syndrome is a rare condition that affects mostly young men but also occurs in women, children, and older adults. Treatments include immunosuppressive drugs and a blood-cleaning therapy called plasmapheresis that removes the autoantibodies.
IgA nephropathy is a form of glomerular disease that results when immunoglobulin A (IgA) forms deposits in the glomeruli, where it creates inflammation. IgA nephropathy was not recognized as a cause of glomerular disease until the late 1960s, when sophisticated biopsy techniques were developed that could identify IgA deposits in kidney tissue.
The most common symptom of IgA nephropathy is blood in the urine, but it is often a silent disease that may go undetected for many years. The silent nature of the disease makes it difficult to determine how many people are in the early stages of IgA nephropathy, when specific medical tests are the only way to detect it. This disease is estimated to be the most common cause of primary glomerulonephritisthat is, glomerular disease not caused by a systemic disease like lupus or diabetes mellitus. It appears to affect men more than women. Although IgA nephropathy is found in all age groups, young people rarely display signs of kidney failure because the disease usually takes several years to progress to the stage where it causes detectable complications.
No treatment is recommended for early or mild cases of IgA nephropathy when the patient has normal blood pressure and less than 1 gram of protein in a 24-hour urine output. When proteinuria exceeds 1 gram/day, treatment is aimed at protecting kidney function by reducing proteinuria and controlling blood pressure. Blood pressure medicinesangiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs)that block a hormone called angiotensin are most effective at achieving those two goals simultaneously.
Hereditary NephritisAlport Syndrome
The primary indicator of Alport syndrome is a family history of chronic glomerular disease, although it may also involve hearing or vision impairment. This syndrome affects both men and women, but men are more likely to experience chronic kidney disease and sensory loss. Men with Alport syndrome usually first show evidence of renal insufficiency while in their twenties and reach total kidney failure by age 40. Women rarely have significant renal impairment, and hearing loss may be so slight that it can be detected only through testing with special equipment. Usually men can pass the disease only to their daughters. Women can transmit the disease to either their sons or their daughters. Treatment focuses on controlling blood pressure to maintain kidney function.
Infection-related Glomerular Disease
Glomerular disease sometimes develops rapidly after an infection in other parts of the body. Acute post-streptococcal glomerulonephritis (PSGN) can occur after an episode of strep throat or, in rare cases, impetigo (a skin infection). The Streptococcus bacteria do not attack the kidney directly, but an infection may stimulate the immune system to overproduce antibodies, which are circulated in the blood and finally deposited in the glomeruli, causing damage. PSGN can bring on sudden symptoms of swelling (edema), reduced urine output (oliguria), and blood in the urine (hematuria). Tests will show large amounts of protein in the urine and elevated levels of creatinine and urea nitrogen in the blood, thus indicating reduced kidney function. High blood pressure frequently accompanies reduced kidney function in this disease.
PSGN is most common in children between the ages of 3 and 7, although it can strike at any age, and it most often affects boys. It lasts only a brief time and usually allows the kidneys to recover. In a few cases, however, kidney damage may be permanent, requiring dialysis or transplantation to replace renal function.
Bacterial endocarditis, infection of the tissues inside the heart, is also associated with subsequent glomerular disease. Researchers are not sure whether the renal lesions that form after a heart infection are caused entirely by the immune response or whether some other disease mechanism contributes to kidney damage. Treating the heart infection is the most effective way of minimizing kidney damage. Endocarditis sometimes produces chronic kidney disease (CKD).
HIV, the virus that leads to AIDS, can also cause glomerular disease. Between 5 and 10 percent of people with HIV experience kidney failure, even before developing full-blown AIDS. HIV-associated nephropathy usually begins with heavy proteinuria and progresses rapidly (within a year of detection) to total kidney failure. Researchers are looking for therapies that can slow down or reverse this rapid deterioration of renal function, but some possible solutions involving immunosuppression are risky because of the patients' already compromised immune system.
Sclerotic Diseases
Glomerulosclerosis is scarring (sclerosis) of the glomeruli. In several sclerotic conditions, a systemic disease like lupus or diabetes is responsible. Glomerulosclerosis is caused by the activation of glomerular cells to produce scar material. This may be stimulated by molecules called growth factors, which may be made by glomerular cells themselves or may be brought to the glomerulus by the circulating blood that enters the glomerular filter.
Diabetic nephropathy is the leading cause of glomerular disease and of total kidney failure in the United States. Kidney disease is one of several problems caused by elevated levels of blood glucose, the central feature of diabetes. In addition to scarring the kidney, elevated glucose levels appear to increase the speed of blood flow into the kidney, putting a strain on the filtering glomeruli and raising blood pressure.
Diabetic nephropathy usually takes many years to develop. People with diabetes can slow down damage to their kidneys by controlling their blood glucose through healthy eating with moderate protein intake, physical activity, and medications. People with diabetes should also be careful to keep their blood pressure at a level below 140/90 mm Hg, if possible. Blood pressure medications called ACE inhibitors and ARBs are particularly effective at minimizing kidney damage and are now frequently prescribed to control blood pressure in patients with diabetes and in patients with many forms of kidney disease.
Focal segmental glomerulosclerosis (FSGS) describes scarring in scattered regions of the kidney, typically limited to one part of the glomerulus and to a minority of glomeruli in the affected region. FSGS may result from a systemic disorder or it may develop as an idiopathic kidney disease, without a known cause. Proteinuria is the most common symptom of FSGS, but, since proteinuria is associated with several other kidney conditions, the doctor cannot diagnose FSGS on the basis of proteinuria alone. Biopsy may confirm the presence of glomerular scarring if the tissue is taken from the affected section of the kidney. But finding the affected section is a matter of chance, especially early in the disease process, when lesions may be scattered.
Confirming a diagnosis of FSGS may require repeat kidney biopsies. Arriving at a diagnosis of idiopathic FSGS requires the identification of focal scarring and the elimination of possible systemic causes such as diabetes or an immune response to infection. Since idiopathic FSGS is, by definition, of unknown cause, it is difficult to treat. No universal remedy has been found, and most patients with FSGS progress to total kidney failure over 5 to 20 years. Some patients with an aggressive form of FSGS reach total kidney failure in 2 to 3 years. Treatments involving steroids or other immunosuppressive drugs appear to help some patients by decreasing proteinuria and improving kidney function. But these treatments are beneficial to only a minority of those in whom they are tried, and some patients experience even poorer kidney function as a result. ACE inhibitors and ARBs may also be used in FSGS to decrease proteinuria. Treatment should focus on controlling blood pressure and blood cholesterol levels, factors that may contribute to kidney scarring.
Other Glomerular Diseases
Membranous nephropathy, also called membranous glomerulopathy, is the second most common cause of the nephrotic syndrome (proteinuria, edema, high cholesterol) in U.S. adults after diabetic nephropathy. Diagnosis of membranous nephropathy requires a kidney biopsy, which reveals unusual deposits of immunoglobulin G and complement C3, substances created by the body's immune system. Fully 75 percent of cases are idiopathic, which means that the cause of the disease is unknown. The remaining 25 percent of cases are the result of other diseases like systemic lupus erythematosus, hepatitis B or C infection, or some forms of cancer. Drug therapies involving penicillamine, gold, or captopril have also been associated with membranous nephropathy. About 20 to 40 percent of patients with membranous nephropathy progress, usually over decades, to total kidney failure, but most patients experience either complete remission or continued symptoms without progressive kidney failure. Doctors disagree about how aggressively to treat this condition, since about 20 percent of patients recover without treatment. ACE inhibitors and ARBs are generally used to reduce proteinuria. Additional medication to control high blood pressure and edema is frequently required. Some patients benefit from steroids, but this treatment does not work for everyone. Additional immunosuppressive medications are helpful for some patients with progressive disease.
Minimal change disease (MCD) is the diagnosis given when a patient has the nephrotic syndrome and the kidney biopsy reveals little or no change to the structure of glomeruli or surrounding tissues when examined by a light microscope. Tiny drops of a fatty substance called a lipid may be present, but no scarring has taken place within the kidney. MCD may occur at any age, but it is most common in childhood. A small percentage of patients with idiopathic nephrotic syndrome do not respond to steroid therapy. For these patients, the doctor may recommend a low-sodium diet and prescribe a diuretic to control edema. The doctor may recommend the use of nonsteroidal anti-inflammatory drugs to reduce proteinuria. ACE inhibitors and ARBs have also been used to reduce proteinuria in patients with steroid-resistant MCD. These patients may respond to larger doses of steroids, more prolonged use of steroids, or steroids in combination with immunosuppressant drugs, such as chlorambucil, cyclophosphamide, or cyclosporine. | NIDDK | Glomerular Diseases |
What is (are) Glomerular Diseases ? | Renal failure is any acute or chronic loss of kidney function and is the term used when some kidney function remains. Total kidney failure, sometimes called end-stage renal disease (ESRD), indicates permanent loss of kidney function. Depending on the form of glomerular disease, renal function may be lost in a matter of days or weeks or may deteriorate slowly and gradually over the course of decades.
Acute Renal Failure
A few forms of glomerular disease cause very rapid deterioration of kidney function. For example, PSGN can cause severe symptoms (hematuria, proteinuria, edema) within 2 to 3 weeks after a sore throat or skin infection develops. The patient may temporarily require dialysis to replace renal function. This rapid loss of kidney function is called acute renal failure (ARF). Although ARF can be life-threatening while it lasts, kidney function usually returns after the cause of the kidney failure has been treated. In many patients, ARF is not associated with any permanent damage. However, some patients may recover from ARF and subsequently develop CKD.
Chronic Kidney Disease
Most forms of glomerular disease develop gradually, often causing no symptoms for many years. CKD is the slow, gradual loss of kidney function. Some forms of CKD can be controlled or slowed down. For example, diabetic nephropathy can be delayed by tightly controlling blood glucose levels and using ACE inhibitors and ARBs to reduce proteinuria and control blood pressure. But CKD cannot be cured. Partial loss of renal function means that some portion of the patient's nephrons have been scarred, and scarred nephrons cannot be repaired. In many cases, CKD leads to total kidney failure.
Total Kidney Failure
To stay alive, a patient with total kidney failure must go on dialysishemodialysis or peritoneal dialysisor receive a new kidney through transplantation. Patients with CKD who are approaching total kidney failure should learn as much about their treatment options as possible so they can make an informed decision when the time comes. With the help of dialysis or transplantation, many people continue to lead full, productive lives after reaching total kidney failure. | NIDDK | Glomerular Diseases |
What to do for Glomerular Diseases ? | - The kidneys filter waste and extra fluid from the blood. - The filtering process takes place in the nephron, where microscopic blood vessel filters, called glomeruli, are attached to fluid-collecting tubules. - A number of different disease processes can damage the glomeruli and thereby cause kidney failure. Glomerulonephritis and glomerulosclerosis are broad terms that include many forms of damage to the glomeruli. - Some forms of kidney failure can be slowed down, but scarred glomeruli can never be repaired. - Treatment for the early stages of kidney failure depends on the disease causing the damage. - Early signs of kidney failure include blood or protein in the urine and swelling in the hands, feet, abdomen, or face. Kidney failure may be silent for many years.
The Nephrotic Syndrome
- The nephrotic syndrome is a condition marked by very high levels of protein in the urine; low levels of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol. - The nephrotic syndrome is a set of symptoms, not a disease in itself. It can occur with many diseases, so prevention relies on controlling the diseases that cause it. - Treatment of the nephrotic syndrome focuses on identifying and treating the underlying cause, if possible, and reducing high cholesterol, blood pressure, and protein in the urine through diet, medication, or both. - The nephrotic syndrome may go away once the underlying cause, if known, is treated. However, often a kidney disease is the underlying cause and cannot be cured. In these cases, the kidneys may gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the patient will need to be on dialysis or have a kidney transplant. | NIDDK | Glomerular Diseases |
What to do for Glomerular Diseases ? | - The kidneys filter waste and extra fluid from the blood. - The filtering process takes place in the nephron, where microscopic blood vessel filters, called glomeruli, are attached to fluid-collecting tubules. - A number of different disease processes can damage the glomeruli and thereby cause kidney failure. Glomerulonephritis and glomerulosclerosis are broad terms that include many forms of damage to the glomeruli. - Some forms of kidney failure can be slowed down, but scarred glomeruli can never be repaired. - Treatment for the early stages of kidney failure depends on the disease causing the damage. - Early signs of kidney failure include blood or protein in the urine and swelling in the hands, feet, abdomen, or face. Kidney failure may be silent for many years.
The Nephrotic Syndrome
- The nephrotic syndrome is a condition marked by very high levels of protein in the urine; low levels of protein in the blood; swelling, especially around the eyes, feet, and hands; and high cholesterol. - The nephrotic syndrome is a set of symptoms, not a disease in itself. It can occur with many diseases, so prevention relies on controlling the diseases that cause it. - Treatment of the nephrotic syndrome focuses on identifying and treating the underlying cause, if possible, and reducing high cholesterol, blood pressure, and protein in the urine through diet, medication, or both. - The nephrotic syndrome may go away once the underlying cause, if known, is treated. However, often a kidney disease is the underlying cause and cannot be cured. In these cases, the kidneys may gradually lose their ability to filter wastes and excess water from the blood. If kidney failure occurs, the patient will need to be on dialysis or have a kidney transplant. | NIDDK | Glomerular Diseases |
What is (are) Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes ? | Type 2 diabetes, formerly called adult-onset diabetes, is the most common type of diabetes. About 95 percent of people with diabetes have type 2. People can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes develops most often in middle-aged and older people. People who are overweight and inactive are also more likely to develop type 2 diabetes.
In type 2 and other types of diabetes, you have too much glucose, also called sugar, in your blood. People with diabetes have problems converting food to energy. After a meal, food is broken down into glucose, which is carried by your blood to cells throughout your body. With the help of the hormone insulin, cells absorb glucose from your blood and use it for energy. Insulin is made in the pancreas, an organ located behind the stomach.
Type 2 diabetes usually begins with insulin resistance, a condition linked to excess weight in which your bodys cells do not use insulin properly. As a result, your body needs more insulin to help glucose enter cells. At first, your pancreas keeps up with the added demand by producing more insulin. But in time, your pancreas loses its ability to produce enough insulin, and blood glucose levels rise.
Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, kidney disease, blindness, dental disease, and amputations. Other problems of diabetes may include increased risk of getting other diseases, loss of mobility with aging, depression, and pregnancy problems.
Treatment includes taking diabetes medicines, making wise food choices, being physically active on a regular basis, controlling blood pressure and cholesterol, and for some, taking aspirin daily. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
How to prevent Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes ? | Yes. The results of the Diabetes Prevention Program (DPP) proved that weight loss through moderate diet changes and physical activity can delay or prevent type 2 diabetes. The DPP was a federally funded study of 3,234 people at high risk for diabetes. This study showed that a 5-to 7-percent weight loss, which for a 200-pound person would be 10 to 14 pounds, slowed development of type 2 diabetes.
People at High Risk for Diabetes
DPP study participants were overweight and had higher than normal levels of blood glucose, a condition called prediabetes. Many had family members with type 2 diabetes. Prediabetes, obesity, and a family history of diabetes are strong risk factors for type 2 diabetes. About half of the DPP participants were from minority groups with high rates of diabetes, including African Americans, Alaska Natives, American Indians, Asian Americans, Hispanics/Latinos, and Pacific Islander Americans.
DPP participants also included others at high risk for developing type 2 diabetes, such as women with a history of gestational diabetes and people age 60 and older.
Approaches to Preventing Diabetes
The DPP tested three approaches to preventing diabetes:
- Making lifestyle changes. People in the lifestyle change group exercised, usually by walking 5 days a week for about 30 minutes a day, and lowered their intake of fat and calories. - Taking the diabetes medicine metformin. Those who took metformin also received information about physical activity and diet. - Receiving education about diabetes. The third group only received information about physical activity and diet and took a placeboa pill without medicine in it.
People in the lifestyle change group showed the best outcomes. But people who took metformin also benefited. The results showed that by losing an average of 15 pounds in the first year of the study, people in the lifestyle change group reduced their risk of developing type 2 diabetes by 58 percent over 3 years. Lifestyle change was even more effective in those age 60 and older. People in this group reduced their risk by 71 percent. But people in the metformin group also benefited, reducing their risk by 31 percent. More information about the DPP, funded under National Institutes of Health (NIH) clinical trial number NCT00004992, is available at www.bsc.gwu.edu/dpp.
Lasting Results
The Diabetes Prevention Program Outcomes Study (DPPOS) has shown that the benefits of weight loss and metformin last for at least 10 years. The DPPOS has continued to follow most DPP participants since the DPP ended in 2001. The DPPOS showed that 10 years after enrolling in the DPP,
- people in the lifestyle change group reduced their risk for developing diabetes by 34 percent - those in the lifestyle change group age 60 or older had even greater benefit, reducing their risk of developing diabetes by 49 percent - participants in the lifestyle change group also had fewer heart and blood vessel disease risk factors, including lower blood pressure and triglyceride levels, even though they took fewer medicines to control their heart disease risk - the metformin group reduced the risk of developing diabetes by 18 percent
Even though controlling your weight with lifestyle changes is challenging, it produces long-term health rewards by lowering your risk for type 2 diabetes, lowering your blood glucose levels, and reducing other heart disease risk factors. More information about the DPPOS, funded under NIH clinical trial number NCT00038727, can be found at www.bsc.gwu.edu/dpp.
Other Types of Diabetes In addition to type 2, the other main types of diabetes are type 1 diabetes and gestational diabetes. Type 1 Diabetes Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, and young adults. In this type of diabetes, your pancreas can no longer make insulin because your bodys immune system has attacked and destroyed the cells that make it. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, being physically active on a regular basis, controlling blood pressure and cholesterol, and, for some, taking aspirin daily. Gestational Diabetes Gestational diabetes is a type of diabetes that develops only during pregnancy. Hormones produced by your placenta and other pregnancy-related factors contribute to insulin resistance, which occurs in all women during late pregnancy. Insulin resistance increases the amount of insulin needed to control blood glucose levels. If your pancreas cant produce enough insulin, gestational diabetes occurs. As with type 2 diabetes, excess weight is linked to gestational diabetes. Overweight or obese women are at particularly high risk for gestational diabetes because they start pregnancy with a higher need for insulin due to insulin resistance. Excessive weight gain during pregnancy may also increase risk. Gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes. Although gestational diabetes usually goes away after the baby is born, a woman who has had gestational diabetes is more likely to develop type 2 diabetes later in life. Babies born to mothers who had gestational diabetes are also more likely to develop obesity and type 2 diabetes as they grow up. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
What is (are) Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes ? | In addition to type 2, the other main types of diabetes are type 1 diabetes and gestational diabetes.
Type 1 Diabetes
Type 1 diabetes, formerly called juvenile diabetes, is usually first diagnosed in children, teenagers, and young adults. In this type of diabetes, your pancreas can no longer make insulin because your bodys immune system has attacked and destroyed the cells that make it. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, being physically active on a regular basis, controlling blood pressure and cholesterol, and, for some, taking aspirin daily.
Gestational Diabetes
Gestational diabetes is a type of diabetes that develops only during pregnancy. Hormones produced by your placenta and other pregnancy-related factors contribute to insulin resistance, which occurs in all women during late pregnancy. Insulin resistance increases the amount of insulin needed to control blood glucose levels. If your pancreas cant produce enough insulin, gestational diabetes occurs.
As with type 2 diabetes, excess weight is linked to gestational diabetes. Overweight or obese women are at particularly high risk for gestational diabetes because they start pregnancy with a higher need for insulin due to insulin resistance. Excessive weight gain during pregnancy may also increase risk. Gestational diabetes occurs more often in some ethnic groups and among women with a family history of diabetes.
Although gestational diabetes usually goes away after the baby is born, a woman who has had gestational diabetes is more likely to develop type 2 diabetes later in life. Babies born to mothers who had gestational diabetes are also more likely to develop obesity and type 2 diabetes as they grow up. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
What are the symptoms of Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes ? | The signs and symptoms of type 2 diabetes can be so mild that you might not even notice them. Nearly 7 million people in the United States have type 2 diabetes and dont know they have the disease. Many have no signs or symptoms. Some people have symptoms but do not suspect diabetes.
Symptoms include
- increased thirst - increased hunger - fatigue - increased urination, especially at night - unexplained weight loss - blurred vision - numbness or tingling in the feet or hands - sores that do not heal
Many people do not find out they have the disease until they have diabetes problems, such as blurred vision or heart trouble. If you find out early that you have diabetes, you can get treatment to prevent damage to your body. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
Who is at risk for Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes? ? | To find out your risk for type 2 diabetes, check each item that applies to you.
- I am age 45 or older. - I am overweight or obese. - I have a parent, brother, or sister with diabetes. - My family background is African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander American. - I have had gestational diabetes. - I gave birth to at least one baby weighing more than 9 pounds. - My blood pressure is 140/90 or higher, or I have been told that I have high blood pressure. - My cholesterol levels are higher than normal. My HDL, or good, cholesterol is below 35, or my triglyceride level is above 250. - I am fairly inactive. - I have polycystic ovary syndrome, also called PCOS. - On previous testing, I had prediabetesan A1C level of 5.7 to 6.4 percent, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT). - I have other clinical conditions associated with insulin resistance, such as a condition called acanthosis nigricans, characterized by a dark, velvety rash around my neck or armpits. - I have a history of cardiovascular disease.
The more items you checked, the higher your risk.
Does sleep matter? Yes. Studies show that untreated sleep problems, especially sleep apnea, can increase the risk of type 2 diabetes. Sleep apnea is a common disorder in which you have pauses in breathing or shallow breaths while you sleep. Most people who have sleep apnea dont know they have it and it often goes undiagnosed. Night shift workers who have problems with sleepiness may also be at increased risk for obesity and type 2 diabetes. If you think you might have sleep problems, ask your doctor for help. More information about sleep problems is available from the National Heart Lung and Blood Institute at http://www.nhlbi.nih.gov/health/resources/sleep. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
Who is at risk for Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes? ? | You can do a lot to reduce your risk of getting type 2 diabetes. Being more physically active, reducing fat and calorie intake, and losing a little weight can help you lower your chances of developing type 2 diabetes. Taking the diabetes medicine metformin can also reduce risk, particularly in younger and heavier people with prediabetes and women who have had gestational diabetes. Lowering blood pressure and cholesterol levels also helps you stay healthy.
If you are overweight, then take these steps:
- Reach and maintain a reasonable body weight. Even a 10 or 15 pound weight loss makes a big difference. - Make wise food choices most of the time. - Be physically active every day.
If you are fairly inactive, then take this step:
- Be physically active every day.
If your blood pressure is too high, then take these steps:
- Reach and maintain a reasonable body weight. - Make wise food choices most of the time. - Reduce your sodium and alcohol intake. - Be physically active every day. - Talk with your doctor about whether you need medicine to control your blood pressure.
If your cholesterol or triglyceride levels are too high, then take these steps:
- Make wise food choices most of the time. - Be physically active every day. - Talk with your doctor about whether you need medicine to control your cholesterol levels. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
Who is at risk for Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes? ? | Making big changes in your life is hard, especially if you are faced with more than one change. You can make it easier by taking these steps:
- Make a plan to change behavior. - Decide exactly what you will do and give yourself a time frame. - Plan what you need to get ready. - Track your goals and activity on a food and activity tracker, available at http://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/game-plan/small-steps/Documents/GP_FoodActTracker.pdf (PDF, 349 KB) - Think about what might prevent you from reaching your goals. - Find family and friends who will support and encourage you. - Decide how you will reward yourselfa shopping trip, movie tickets, an afternoon in the parkwhen you do what you have planned.
Your doctor, a dietitian, or a counselor can help you make a plan.
Be Physically Active Every Day
Regular physical activity tackles several risk factors at once. Activity helps you lose weight; keeps your blood glucose, blood pressure, and cholesterol under control; and helps your body use insulin. People in the DPP who were physically active for 30 minutes a day, 5 days a week, reduced their risk of type 2 diabetes. Many chose brisk walking as their physical activity.
If you are not fairly active, you should start slowly. First, talk with your doctor about what kinds of physical activity are safe for you. Make a plan to increase your activity level toward the goal of being active at least 30 minutes a day most days of the week. You can increase your level of physical activity in two main ways:
1. Start an exercise program. 2. Increase your daily activity.
Start an exercise program. Pick exercises that suit you. Find a friend to walk with you or join an exercise class that will help you keep going.
- Do aerobic activities, which use your large muscles to make your heart beat faster. The large muscles are those of the upper and lower arms; upper and lower legs; and those that control head, shoulder, and hip movements. - Do activities to strengthen muscles and bone, such as lifting weights or sit-ups, two to three times a week. Find helpsuch as a video or a classto learn how to do these exercises properly.
Increase your daily activity. Choose activities you enjoy. You can work extra activity into your daily routine by doing the following:
- Increase daily activity by decreasing time spent watching TV or at the computer. Set up a reminder on your computer to take an activity break. - Take the stairs rather than an elevator or escalator. - Park at the far end of the parking lot and walk. - Get off the bus a few stops early and walk the rest of the way. - Walk or bicycle whenever you can.
Take Your Prescribed Medicines
Some people need medicine to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor if you should take metformin to prevent type 2 diabetes. Metformin is a medicine that makes insulin work better and can reduce the risk of type 2 diabetes. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
What to do for Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes ? | Your eating, diet, and nutrition choices play an important role in preventing or delaying diabetes. Follow the suggestions below to reach and maintain a reasonable weight and make wise food choices most of the time. Remember that it can take time to change your habits and be patient with yourself. You can also get help from a dietitian or join a weight-loss program to support you while you reach your goals.
Reach and Maintain a Reasonable Body Weight
Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin properly. Excess body weight can also cause high blood pressure. Every pound you lose lowers your risk of getting diabetes.
In addition to weight, the location of excess fat on the body can be important. A waist measurement of 40 inches or more for men and 35 inches or more for women is linked to insulin resistance and increases a persons risk for type 2 diabetes. This is true even if your BMI falls within the normal range.
Find Your BMI
The BMI is a measure of body weight relative to height. The BMI can help you find out whether you are normal weight, overweight, or obese. Use the table on pages 24 and 25 to find your BMI.
- Find your height in the left-hand column. - Move across in the same row to the number closest to your weight. - The number at the top of that column is your BMI. Check the word above your BMI to see whether you are normal weight, overweight, or obese.
The BMI has certain limitations. The BMI may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle.
The BMI for children and teens must be determined based on age, height, weight, and sex. The Centers for Disease Control and Prevention (CDC) has information about BMI in children and teens, including a BMI calculator, at www.cdc.gov/nccdphp/dnpa/bmi. The CDC website also has a BMI calculator for adults. A BMI calculator from the NIH is available at www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.
The NIH also has a free smartphone app for calculating BMI. You can search My BMI Calculator on your phone to find the app. The app also provides links to information about steps you can take to bring your BMI into a healthy range. | NIDDK | Am I at Risk for Type 2 Diabetes? Taking Steps to Lower Your Risk of Getting Diabetes |
What is (are) Insulin Resistance and Prediabetes ? | Insulin is a hormone made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.
Insulin plays a major role in metabolismthe way the body uses digested food for energy. The digestive tract breaks down carbohydratessugars and starches found in many foodsinto glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, cells throughout the body absorb glucose and use it for energy.
Insulin's Role in Blood Glucose Control
When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to cells throughout the body.
- Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels. - Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen. - Insulin also lowers blood glucose levels by reducing glucose production in the liver.
In a healthy person, these functions allow blood glucose and insulin levels to remain in the normal range. | NIDDK | Insulin Resistance and Prediabetes |
What is (are) Insulin Resistance and Prediabetes ? | Insulin resistance is a condition in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells, leading to type 2 diabetes or prediabetes.
Most people with insulin resistance don't know they have it for many yearsuntil they develop type 2 diabetes, a serious, lifelong disease. The good news is that if people learn they have insulin resistance early on, they can often prevent or delay diabetes by making changes to their lifestyle.
Insulin resistance can lead to a variety of serious health disorders. The section "What is metabolic syndrome?" provides more information about other health disorders linked to insulin resistance. | NIDDK | Insulin Resistance and Prediabetes |
What causes Insulin Resistance and Prediabetes ? | Although the exact causes of insulin resistance are not completely understood, scientists think the major contributors to insulin resistance are excess weight and physical inactivity.
Excess Weight
Some experts believe obesity, especially excess fat around the waist, is a primary cause of insulin resistance. Scientists used to think that fat tissue functioned solely as energy storage. However, studies have shown that belly fat produces hormones and other substances that can cause serious health problems such as insulin resistance, high blood pressure, imbalanced cholesterol, and cardiovascular disease (CVD).
Belly fat plays a part in developing chronic, or long-lasting, inflammation in the body. Chronic inflammation can damage the body over time, without any signs or symptoms. Scientists have found that complex interactions in fat tissue draw immune cells to the area and trigger low-level chronic inflammation. This inflammation can contribute to the development of insulin resistance, type 2 diabetes, and CVD. Studies show that losing the weight can reduce insulin resistance and prevent or delay type 2 diabetes.
Physical Inactivity
Many studies have shown that physical inactivity is associated with insulin resistance, often leading to type 2 diabetes. In the body, more glucose is used by muscle than other tissues. Normally, active muscles burn their stored glucose for energy and refill their reserves with glucose taken from the bloodstream, keeping blood glucose levels in balance.
Studies show that after exercising, muscles become more sensitive to insulin, reversing insulin resistance and lowering blood glucose levels. Exercise also helps muscles absorb more glucose without the need for insulin. The more muscle a body has, the more glucose it can burn to control blood glucose levels.
Other Causes
Other causes of insulin resistance may include ethnicity; certain diseases; hormones; steroid use; some medications; older age; sleep problems, especially sleep apnea; and cigarette smoking.
Does sleep matter? Yes. Studies show that untreated sleep problems, especially sleep apnea, can increase the risk of obesity, insulin resistance, and type 2 diabetes. Night shift workers may also be at increased risk for these problems. Sleep apnea is a common disorder in which a person's breathing is interrupted during sleep. People may often move out of deep sleep and into light sleep when their breathing pauses or becomes shallow. This results in poor sleep quality that causes problem sleepiness, or excessive tiredness, during the day. Many people aren't aware of their symptoms and aren't diagnosed. People who think they might have sleep problems should talk with their health care provider. More information about sleep problems is available from the National Heart, Lung, and Blood Institute at http://www.nhlbi.nih.gov/health/resources/sleep. | NIDDK | Insulin Resistance and Prediabetes |
What is (are) Insulin Resistance and Prediabetes ? | Prediabetes is a condition in which blood glucose or A1C levelswhich reflect average blood glucose levelsare higher than normal but not high enough for a diagnosis of diabetes. Prediabetes is becoming more common in the United States. The U.S. Department of Health and Human Services estimates that at least 86 million U.S. adults ages 20 or older had prediabetes in 2012.1 People with prediabetes are at increased risk of developing type 2 diabetes and CVD, which can lead to heart attack or stroke. | NIDDK | Insulin Resistance and Prediabetes |
What are the symptoms of Insulin Resistance and Prediabetes ? | Insulin resistance and prediabetes usually have no symptoms. People may have one or both conditions for several years without knowing they have them. Even without symptoms, health care providers can identify people at high risk by their physical characteristics, also known as risk factors. The section "Who should be tested for prediabetes?" lists these risk factors.
People with a severe form of insulin resistance may have dark patches of skin, usually on the back of the neck. Sometimes people have a dark ring around their neck. Dark patches may also appear on elbows, knees, knuckles, and armpits. This condition is called acanthosis nigricans. | NIDDK | Insulin Resistance and Prediabetes |
What is (are) Insulin Resistance and Prediabetes ? | Metabolic syndrome, also called insulin resistance syndrome, is a group of traits and medical conditions linked to overweight and obesity that puts people at risk for both CVD and type 2 diabetes. Metabolic syndrome is defined* as the presence of any three of the following2:
- large waist sizewaist measurement of 40 inches or more for men and 35 inches or more for women - high triglycerides in the bloodtriglyceride level of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride level - abnormal levels of cholesterol in the bloodHDL, or good, cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL - high blood pressureblood pressure level of 130/85 or above, or taking medication for elevated blood pressure - higher than normal blood glucose levelsfasting blood glucose level of 100 mg/dL or above, or taking medication for elevated blood glucose
In addition to type 2 diabetes, metabolic syndrome has been linked to the following health disorders:
- obesity - CVD - PCOS - nonalcoholic fatty liver disease - chronic kidney disease
However, not everyone with these disorders has insulin resistance, and some people may have insulin resistance without getting these disorders.
People who are obese or who have metabolic syndrome, insulin resistance, type 2 diabetes, or prediabetes often also have low-level inflammation throughout the body and blood clotting defects that increase the risk of developing blood clots in the arteries. These conditions contribute to increased risk for CVD.
*Similar definitions have been developed by the World Health Organization and the American Association of Clinical Endocrinologists. | NIDDK | Insulin Resistance and Prediabetes |
How to diagnose Insulin Resistance and Prediabetes ? | Health care providers use blood tests to determine whether a person has prediabetes, but they do not usually test specifically for insulin resistance. Insulin resistance can be assessed by measuring the level of insulin in the blood.
However, the test that most accurately measures insulin resistance, called the euglycemic clamp, is too costly and complicated to be used in most health care providers' offices. The clamp is a research tool used by scientists to learn more about glucose metabolism. Research has shown that if blood tests indicate prediabetes, insulin resistance most likely is present.
Blood Tests for Prediabetes
All blood tests involve drawing blood at a health care provider's office or commercial facility and sending the sample to a lab for analysis. Lab analysis of blood is needed to ensure test results are accurate. Glucose measuring devices used in a health care provider's office, such as finger-stick devices, are not accurate enough for diagnosis but may be used as a quick indicator of high blood glucose.
Prediabetes can be detected with one of the following blood tests:
- the A1C test - the fasting plasma glucose (FPG) test - the oral glucose tolerance test (OGTT)
A1C test. Sometimes called hemoglobin A1c, HbA1c, or glycohemoglobin test, this test reflects average blood glucose levels over the past 3 months. This test is the most reliable test for prediabetes, but it is not as sensitive as the other tests. In some individuals, it may miss prediabetes that could be caught by glucose tests.
Although some health care providers can quickly measure A1C in their office, that type of measurementcalled a point-of-care testis not considered reliable for diagnosis. For diagnosis of prediabetes, the A1C test should be analyzed in a laboratory using a method that is certified by the NGSP.
The A1C test can be unreliable for diagnosing prediabetes in people with certain conditions that are known to interfere with the results. Interference should be suspected when A1C results seem very different from the results of a blood glucose test. People of African, Mediterranean, or Southeast Asian descent, or people with family members with sickle cell anemia or a thalassemia, are particularly at risk of interference. People in these groups may have a less common type of hemoglobin, known as a hemoglobin variant, that can interfere with some A1C tests.
An A1C of 5.7 to 6.4 percent indicates prediabetes.
More information about the A1C test is provided in the NIDDK health topic, The A1C Test and Diabetes.
Fasting plasma glucose test. This test measures blood glucose in people who have not eaten anything for at least 8 hours. This test is most reliable when done in the morning. Prediabetes found with this test is called IFG.
Fasting glucose levels of 100 to 125 mg/dL indicate prediabetes.
OGTT. This test measures blood glucose after people have not eaten for at least 8 hours and 2 hours after they drink a sweet liquid provided by a health care provider or laboratory. Prediabetes found with this test is called IGT.
A blood glucose level between 140 and 199 mg/dL indicates prediabetes.
The following table lists the blood test levels for a diagnosis of prediabetes. | NIDDK | Insulin Resistance and Prediabetes |
What to do for Insulin Resistance and Prediabetes ? | Adopting healthy eating habits can help people lose a modest amount of weight and reverse insulin resistance. Experts encourage people to slowly adopt healthy eating habits that they can maintain, rather than trying extreme weight-loss solutions. People may need to get help from a dietitian or join a weight-loss program for support.
In general, people should lose weight by choosing healthy foods, controlling portions, eating less fat, and increasing physical activity. People are better able to lose weight and keep it off when they learn how to adapt their favorite foods to a healthy eating plan.
The DASH (Dietary Approaches to Stop Hypertension) eating plan, developed by the NIH, has been shown to be effective in decreasing insulin resistance when combined with weight loss and physical activity. More information on DASH is available at www.nhlbi.nih.gov/health/health-topics/topics/dash.
The U.S. Dietary Guidelines for Americans also offers healthy eating advice and tools for changing eating habits at www.choosemyplate.gov.
Dietary Supplements
Vitamin D studies show a link between people's ability to maintain healthy blood glucose levels and having enough vitamin D in their blood. However, studies to determine the proper vitamin D levels for preventing diabetes are ongoing; no special recommendations have been made about vitamin D levels or supplements for people with prediabetes.
Currently, the Institute of Medicine (IOM), the agency that recommends supplementation levels based on current science, provides the following guidelines for daily vitamin D intake:
- People ages 1 to 70 years may require 600 International Units (IUs). - People ages 71 and older may require as much as 800 IUs.
The IOM also recommended that no more than 4,000 IUs of vitamin D be taken per day.
To help ensure coordinated and safe care, people should discuss use of complementary and alternative medicine practices, including the use of dietary supplements, with their health care provider.
More information about using dietary supplements to help with diabetes is provided in the NIDDK health topic, Complementary and Alternative Medical Therapies for Diabetes.
Physical Activity
Regular physical activity tackles several risk factors at once. Regular physical activity helps the body use insulin properly.
Regular physical activity also helps a person
- lose weight - control blood glucose levels - control blood pressure - control cholesterol levels
People in the DPP who were physically active for 30 minutes a day, 5 days a week, reduced their risk of type 2 diabetes. Many chose brisk walking as their physical activity.
Most people should aim for at least 30 minutes of exercise most days of the week. For best results, people should do both aerobic activities, which use large muscle groups and make the heart beat faster, and muscle strengthening activities.
Aerobic activities include brisk walking, climbing stairs, swimming, dancing, and other activities that increase the heart rate.
Muscle strengthening activities include lifting weights and doing sit-ups or push-ups.
People who haven't been physically active recently should talk with their health care provider about which activities are best for them and have a checkup before starting an exercise program.
Not Smoking
Those who smoke should quit. A health care provider can help people find ways to quit smoking. Studies show that people who get help have a better chance of quitting.
For more information about how to reverse insulin resistance and prediabetes with diet and increased physical activity, see the following National Diabetes Education Program publications at www.yourdiabetesinfo.org: - Get Real! You Don't Have to Knock Yourself Out to Prevent Diabetes! - More Than 50 Ways to Prevent Diabetes - Small Steps. Big Rewards. Your Game Plan to Prevent Type 2 Diabetes.
Medication
The medication metformin is recommended for treatment of some individuals at very high risk of developing type 2 diabetes. In the DPP, metformin was shown to be most effective in preventing or delaying the development of type 2 diabetes in younger, heavier people with prediabetes. In general, metformin is recommend for those who are younger than age 60 and have
- combined IGT and IFG - A1C above 6 percent - low HDL cholesterol - elevated triglycerides - a parent or sibling with diabetes - a BMI of at least 35
Metformin also lowers the risk of diabetes in women who have had gestational diabetes. People at high risk should ask their health care provider if they should take metformin to prevent type 2 diabetes.
Several medications have been shown to reduce type 2 diabetes risk to varying degrees, but the only medication recommended by the ADA for type 2 diabetes prevention is metformin. Other medications that have delayed diabetes have side effects or haven't shown long-lasting benefits. No medication, including metformin, is approved by the U.S. Food and Drug Administration to treat insulin resistance or prediabetes or to prevent type 2 diabetes. | NIDDK | Insulin Resistance and Prediabetes |
What to do for Insulin Resistance and Prediabetes ? | - Insulin is a hormone that helps cells throughout the body absorb glucose and use it for energy. Insulin resistance is a condition in which the body produces insulin but does not use it effectively. - Insulin resistance increases the risk of developing type 2 diabetes and prediabetes. - The major contributors to insulin resistance are excess weight, especially around the waist, and physical inactivity. - Prediabetes is a condition in which blood glucose or A1C levelswhich reflect average blood glucose levelsare higher than normal but not high enough for a diagnosis of diabetes. - The Diabetes Prevention Program (DPP) study and its follow-up study, the Diabetes Prevention Program Outcomes Study (DPPOS), confirmed that people with prediabetes can often prevent or delay diabetes if they lose a modest amount of weight by cutting fat and calorie intake and increasing physical activity. - By losing weight and being more physically active, people can reverse insulin resistance and prediabetes, thus preventing or delaying type 2 diabetes. - People with insulin resistance and prediabetes can decrease their risk for diabetes by eating a healthy diet and reaching and maintaining a healthy weight, increasing physical activity, not smoking, and taking medication. - The DPP showed the diabetes medication metformin to be most effective in preventing or delaying the development of type 2 diabetes in younger and heavier people with prediabetes and women who have had gestational diabetes. | NIDDK | Insulin Resistance and Prediabetes |
What is (are) I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians ? | Diabetes causes blood glucose levels to be above normal. People with diabetes have problems converting food to energy. After food is eaten, it is broken down into a sugar called glucose. Glucose is then carried by the blood to cells throughout the body. The hormone insulin, made in the pancreas, helps the body change blood glucose into energy. People with diabetes, however, either no longer make enough insulin, or their insulin doesn't work properly, or both.
Type 2 diabetes
Type 2 diabetes is the most common type in American Indians. This type of diabetes can occur at any age, even during childhood. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the body cannot make enough insulin. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, blindness, kidney failure, and amputation.
Other kinds of diabetes
Type 1 diabetes
Type 1 diabetes is rare in American Indians. People develop type 1 diabetes when their bodies no longer make any insulin. Type 1 is usually first diagnosed in children or young adults but can develop at any age.
Gestational diabetes
Gestational diabetes is first diagnosed during pregnancy. It occurs when the body doesn't use insulin properly. Having an American Indian family background raises the risk of developing gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. | NIDDK | I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians |
What are the symptoms of I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians ? | Many people have no visible signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. More than 5 million people in the United States have type 2 diabetes and do not know it.
- increased thirst - increased hunger - fatigue - increased urination, especially at night - unexplained weight loss - blurred vision - sores that do not heal | NIDDK | I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians |
Who is at risk for I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians? ? | - My mother had diabetes when I was born. - I am overweight. - I have a parent, brother, or sister with diabetes. - My family background is American Indian. - I have had gestational diabetes, or I gave birth to at least one baby weighing more than 9 pounds. - My blood pressure is 140/90 mmHg or higher, or I have been told that I have high blood pressure. - My cholesterol levels are higher than normal. My HDL cholesterol"good" cholesterolis below 35 mg/dL, or my triglyceride level is above 250 mg/dL. - I am fairly inactive. I exercise fewer than three times a week. | NIDDK | I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians |
Who is at risk for I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians? ? | - Reach and maintain a reasonable body weight. - Make wise food choices most of the time. - Be physically active every day. - Take your prescribed medicines.
Doing these things can reduce your risk of developing type 2 diabetes. Keeping your blood pressure and cholesterol on target also helps you stay healthy.
If you are pregnant, plan to breastfeed your baby. Ask your health care provider for the names of people to call for help learning to breastfeed. Besides being good for your baby, breastfeeding is good for you. Studies done with the help of Pima Indian volunteers have shown that breastfeeding may lower the baby's risk of becoming overweight and getting diabetes.
Getting Started.
Making changes in your life such as eating less can be hard. You can make the changes easier by taking these steps:
- Make a plan to change something that you do. - Decide exactly what you will do and when you will do it. - Plan what you need to get ready. - Think about what might prevent you from reaching your goal. - Find family and friends who will support and encourage you. - Decide how you will reward yourselfwith a nonfood itemor activitywhen you do what you have planned.
Your health care provider, a registered dietitian, or a counselor can help you make a plan.
Reach and Maintain a Reasonable Body Weight.
Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin correctly. The extra weight may also cause high blood pressure. The DPP study showed that losing even a few pounds can help lower your risk of developing type 2 diabetes, because weight loss helps your body use insulin more effectively. Every pound you lose lowers your risk of getting diabetes. In the DPP, people who lost 5 to 7 percent of their body weight lowered their risk of developing type 2 diabetes. They had less than half the risk of developing diabetes as people who didn't make lifestyle changes. A 5- to 7-percent weight loss for a 150-pound person, for example, would be about 7 to 10 pounds. If you're overweight, choose sensible ways to lose weight.
- Don't use crash diets. Instead, eat smaller servings of the foods you usually have, and limit the amount of fat you eat. - Increase your physical activity. Aim for at least 30 minutes of exercise most days of the week. Do something you enjoy, like biking or walking with a friend. - Set a reasonable weight-loss goal, such as losing about a pound a week. Aim for a long-term goal of losing the number of pounds that's right for you.
Choosing My Weight Loss Goal.
Losing 5 to 7 percent of your total weight can help lower your risk of getting type 2 diabetes. You are more likely to lose weight if:
- you're physically active - you cut down on fat and calories - Use these steps to choose a goal. Talk with your health care provider and your dietitian about your goal and how to reach it.
To find your weight loss goal for losing about 5 to 7 percent of your weight, find the weight closest to yours on the chart below. Follow the row across to see how many pounds you need to lose.
Your weight in pounds 5 percent loss in pounds* 7 percent loss in pounds** 150 8 11 175 9 12 200 10 14 225 11 16 250 13 18 275 14 19 300 15 21 325 16 23 350 18 25
*To find your exact weight loss goal in pounds for a 5 percent loss, multiply your weight by .05.
**To find your exact weight loss goal in pounds for a 7 percent loss, multiply your weight by .07.
Write your weight loss goal here:
To lower my risk of getting type 2 diabetes, my goal is to lose about ___________ pounds.
Write down what you will do to lose weight. I will:
Choose a date to start your plan for losing weight and write it here:
Start date: ___________________
Look ahead to when you think you can meet your goal. Allow about a week for each pound or half-pound you'd like to lose. Write the date for meeting your goal here:
End date: ___________________
Make Wise Food Choices Most of The Time
What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood glucose, blood pressure, and cholesterol.
- Keep track of what you eat and drink. People who keep track are more successful in losing weight. You can use the Daily Food and Drink Tracker to write down what you eat and drink. - Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses, meat, desserts, and other foods high in fat. Increase the amount of fruits and vegetables at every meal. Below is a chart for choosing sensible serving sizes using your hand as a measuring guide. Because your hand is proportioned to the rest of your body, it can be used to measure a healthy serving size for your body. Remember, the chart is only a guide. Choose your serving sizes and foods wisely. - Limit your fat intake to about 25 percent of your total calories. Your health care provider or dietitian can help you figure out how many grams of fat to have every day. You can check food labels for fat content. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. See Ways to Lower The Amount of Fat in Your Meals and Snacks. - Cut down on calories by eating smaller servings and by cutting back on fat. People in the DPP lifestyle change group lowered their daily calorie total by an average of about 450 calories. Your health care provider or dietitian can work with you to develop a meal plan that helps you lose weight. - Choose healthy commodity foods (items provided by the government to help people consume a nutritious diet), including those lower in fat. - When you meet your goal, reward yourself with something special, like a new outfit or a movie.
Choose Sensible Serving Sizes
Amount of food Types of food Size of one serving (the same size as:) 3 ounces meat, chicken, turkey, or fish the palm of a hand or a deck of cards 1 cup cooked vegetables salads casseroles or stews, such as chili with beans milk an average-sized fist 1/2 cup fruit or fruit juice starchy vegetables, such as potatoes or corn pinto beans and other dried beans rice or noodles cereal half of an average-sized fist 1 ounce snack food one handful 1 Tablespoon salad dressing the tip of a thumb 1 teaspoon margarine a fingertip
Ways to Lower The Amount of Fat in Your Meals and Snacks
- Choose lower-fat foods. Example: Instead of sunflower seeds (20 grams of fat), choose pretzels (1 gram). Savings: 19 grams. - Use low-fat versions of foods. Example: Instead of regular margarine (5 grams of fat), use low-fat margarine (2 grams). Savings: 3 grams. - Use low-fat seasonings. Example: Instead of putting butter and sour cream on your baked potato (20 grams of fat), have salsa (0 grams). Savings: 20 grams. - Cook with less fat. Example: Instead of making fried chicken (31 grams of fat), roast or grill the chicken (9 grams). Savings: 22 grams.
Remember that low-fat or fat-free products still contain calories. Be careful about how much you eat. In fact, some low-fat or fat-free products are high in calories. Check the food label
Be Physically Active Every Day
- Keep track of what you do for exercise and how long you do it. Use the Daily Physical Activity Tracker to keep track of your physical activity. - Aim for at least 30 minutes of physical activity a day most days of the week. - Incorporate physical activity into plans with family and friends. Set a good example for your children. Play softball on weekends. Go on a family hike. - Be active every day. For example, walk to the store, clean the house, or work in the garden, rather than watch TV.
Getting Started on a Walking Routine
Walking is a great way to be physically active. Before you get started, talk with your health care provider about whether it's OK for you to walk for exercise. Then get comfortable shoes that provide good support. You can use the Daily Physical Activity Tracker to start your routine gradually. Try to walk at least 5 times a week. Build up little by little to 30 minutes a day of brisk walking.
My Walking Program
Week number Warm-up time (minutes) Walk slowly Fast walk time (minutes) Walk briskly Cool-down time (minutes) Walk slowly Total (minutes) 1 5 5 5 15 2 5 8 5 18 3 5 11 5 21 4 5 14 5 24 5 5 17 5 27 6 5 20 5 30 7 5 23 5 33 8 5 26 5 36 9+ 5 30 5 40
Take Your Prescribed Medicines
Daily Food and Drink Tracker
Use the Daily Food and Drink Tracker to keep track of everything you eat and drink. Make a copy of the form for each day. Write down the time, the name of the food or drink, and how much you had. For a free booklet with information on fat grams and calories, call the National Diabetes Education Program at 1888693NDEP (18886936337) and request a copy of the Game Plan Fat and Calorie Counter(PDF, 405.05 KB).
Sample
Daily Food and Drink TrackerDate: _____________
Time Name Amount Fat Grams Calories 8:00 am oatmeal 1/2 cup 1 80 fat-free milk 1 cup 0 90
Daily Physical Activity Tracker
Use the Daily Physical Activity Tracker to keep track of your physical activity. Make a copy of the form for each day. Write down what you do and for how long.
Sample
Daily Physical Activity TrackerDate: _____________
Type of Activity Minutes Walking 20 Gardening 10
Daily Food and Drink TrackerDate: _____________
Time Name Amount Fat Grams Calories TOTALS
Daily Physical Activity TrackerDate: _____________ Type of Activity Minutes TOTAL | NIDDK | I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians |
What is (are) Renal Artery Stenosis ? | Renal artery stenosis is the narrowing of one or both renal arteries. Renal means kidney and stenosis means narrowing. The renal arteries are blood vessels that carry blood to the kidneys from the aortathe main blood vessel that carries blood from the heart to arteries throughout the body.
RVH is high blood pressure caused by RAS. Blood pressure is written with two numbers separated by a slash, 120/80, and is said as 120 over 80. The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats. A persons blood pressure is considered normal if it stays at or below 120/80. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.1 | NIDDK | Renal Artery Stenosis |
What is (are) Renal Artery Stenosis ? | 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 spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. | NIDDK | Renal Artery Stenosis |
What causes Renal Artery Stenosis ? | About 90 percent of RAS is caused by atherosclerosisclogging, narrowing, and hardening of the renal arteries.2 In these cases, RAS develops when plaquea sticky substance made up of fat, cholesterol, calcium, and other material found in the bloodbuilds up on the inner wall of one or both renal arteries. Plaque buildup is what makes the artery wall hard and narrow.
Most other cases of RAS are caused by fibromuscular dysplasia (FMD)the abnormal development or growth of cells on the renal artery wallswhich can cause blood vessels to narrow. Rarely, RAS is caused by other conditions. | NIDDK | Renal Artery Stenosis |
Who is at risk for Renal Artery Stenosis? ? | People at risk for artherosclerosis are also at risk for RAS. Risk factors for RAS caused by artherosclerosis include
- high blood cholesterol levels - high blood pressure - smoking - insulin resistance - diabetes - being overweight or obese - lack of physical activity - a diet high in fat, cholesterol, sodium, and sugar - being a man older than 45 or a woman older than 55 - a family history of early heart disease
The risk factors for RAS caused by FMD are unknown, but FMD is most common in women and people 25 to 50 years of age.3 FMD can affect more than one person in a family, indicating that it may be caused by an inherited gene. | NIDDK | Renal Artery Stenosis |
What are the symptoms of Renal Artery Stenosis ? | In many cases, RAS has no symptoms until it becomes severe.
The signs of RAS are usually either high blood pressure or decreased kidney function, or both, but RAS is often overlooked as a cause of high blood pressure. RAS should be considered as a cause of high blood pressure in people who
- are older than age 50 when they develop high blood pressure or have a marked increase in blood pressure - have no family history of high blood pressure - cannot be successfully treated with at least three or more different types of blood pressure medications
Symptoms of a significant decrease in kidney function include
- increase or decrease in urination - edemaswelling, usually in the legs, feet, or ankles and less often in the hands or face - drowsiness or tiredness - generalized itching or numbness - dry skin - headaches - weight loss - appetite loss - nausea - vomiting - sleep problems - trouble concentrating - darkened skin - muscle cramps | NIDDK | Renal Artery Stenosis |
What are the complications of Renal Artery Stenosis ? | People with RAS are at increased risk for complications resulting from loss of kidney function or atherosclerosis occurring in other blood vessels, such as
- chronic kidney disease (CKD)reduced kidney function over a period of time - coronary artery diseasenarrowing and hardening of arteries that supply blood to the heart - strokebrain damage caused by lack of blood flow to the brain - peripheral vascular diseaseblockage of blood vessels that restricts flow of blood from the heart to other parts of the body, particularly the legs
RAS can lead to kidney failure, described as end-stage renal disease when treated with blood-filtering treatments called dialysis or a kidney transplant, though this is uncommon in people who receive ongoing treatment for RAS. | NIDDK | Renal Artery Stenosis |
How to diagnose Renal Artery Stenosis ? | A health care provider can diagnose RAS by listening to the abdomen with a stethoscope and performing imaging tests. When blood flows through a narrow artery, it sometimes makes a whooshing sound, called a bruit. The health care provider may place a stethoscope on the front or the side of the abdomen to listen for this sound. The absence of this sound, however, does not exclude the possibility of RAS.
In some cases, RAS is found when a person has a test for another reason. For example, a health care provider may find RAS during a coronary angiogram for diagnosis of heart problems. A coronary angiogram is a procedure that uses a special dye, called contrast medium, and x rays to see how blood flows through the heart.
The following imaging tests are used to diagnose RAS:
- Duplex ultrasound. Duplex ultrasound combines traditional ultrasound with Doppler ultrasonography. Traditional ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. Doppler ultrasonography records sound waves reflected off of moving objects, such as blood, to measure their speed and other aspects of how they flow. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging. Anesthesia is not needed. The images can show blockage in the renal artery or blood moving through nearby arteries at a lower-than-normal speed. Ultrasound is noninvasive and low cost. - Catheter angiogram. A catheter angiogram, also called a traditional angiogram, is a special kind of x ray in which a thin, flexible tube called a catheter is threaded through the large arteries, often from the groin, to the artery of interestin this case, the renal artery. The procedure is performed in a hospital or outpatient center by a radiologist. Anesthesia is not needed though a sedative may be given to lessen anxiety during the procedure. Contrast medium is injected through the catheter so the renal artery shows up more clearly on the x ray. Catheter angiogram is the gold standard for diagnosing RAS due to the high quality of the image produced. In addition, severe RAS can be treated during the same visit. However, a catheter angiogram is an invasive procedure, and a person may have side effects from the sedative or contrast medium or may have bleeding or injury to the artery from the catheter. The procedure is also more expensive than other imaging tests. - Computerized tomographic angiography (CTA) scan. CTA scans use a combination of x rays and computer technology to create images. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. Contrast medium is injected into a vein in the persons arm to better see the structure of the arteries. CTA scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. CTA scans are less invasive than catheter angiograms and take less time. However, the risks from the x-ray radiation still exist, and the test often requires more contrast medium than a catheter angiogram, so it may not be recommended for a person with poor kidney function. - Magnetic resonance angiogram (MRA). MRA uses radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed though light sedation may be used for people with a fear of confined spaces. Contrast medium may be injected into a vein in the persons arm to better see the structure of the arteries. With most MRA scans, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines are designed to allow the person to lie in a more open space. In addition to providing high-quality images noninvasively, MRA can provide a functional assessment of blood flow and organ function. However, the use of contrast medium for an MRA is not advised for people with poor kidney function because of the risk of complications to the skin and other organs if the kidneys do not remove the contrast medium well enough. | NIDDK | Renal Artery Stenosis |
What are the treatments for Renal Artery Stenosis ? | Treatment for RAS includes lifestyle changes, medications, and surgery and aims to
- prevent RAS from getting worse - treat RVH - relieve the blockage of the renal arteries
RAS that has not led to RVH or caused a significant blockage of the artery may not need treatment. RAS that needs to be treated, also called critical RAS, is defined by the American Heart Association as a reduction by more than 60 percent in the diameter of the renal artery.1 However, health care providers are not exactly sure what degree of blockage will cause significant problems.
Lifestyle Changes
The first step in treating RAS is making lifestyle changes that promote healthy blood vessels throughout the body, including the renal arteries. The best ways to keep plaque from building up in the arteries are to exercise, maintain a healthy body weight, and choose healthy foods. People who smoke should quit to help protect their kidneys and other internal organs.
Medications
People with RVH may need to take medications thatwhen taken as prescribed by their health care providerlower blood pressure and can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretica medication that helps the kidneys remove fluid from the bloodmay be prescribed. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed. Some people with RAS cannot take an ACE inhibitor or ARB due to the effects on the kidneys. People with RAS who are prescribed an ACE inhibitor or ARB should have their kidney function checked within a few weeks of starting the medication.
A cholesterol-lowering medication to prevent plaque from building up in the arteries and a blood-thinner, such as aspirin, to help the blood flow more easily through the arteries may also be prescribed.
Surgery
Although surgery has been used in the past for treatment of RAS due to atherosclerosis, recent studies have not shown improved outcomes with surgery compared with medication. However, surgery may be recommended for people with RAS caused by FMD or RAS that does not improve with medication. Different types of surgery for RAS include the following. The procedures are performed in a hospital by a vascular surgeona doctor who specializes in repairing blood vessels. Anesthesia is needed.
- Angioplasty and stenting. Angioplasty is a procedure in which a catheter is put into the renal artery, usually through the groin, just as in a catheter angiogram. In addition, for angioplasty, a tiny balloon at the end of the catheter can be inflated to flatten the plaque against the artery wall. A small mesh tube, called a stent, may then be positioned inside the artery to keep plaque flattened and the artery open. People with RAS caused by FMD may be successfully treated with angioplasty alone, while angioplasty with stenting has a better outcome for people with RAS caused by atherosclerosis. - Endarterectomy or bypass surgery. In an endarterectomy, the plaque is cleaned out of the artery, leaving the inside lining smooth and clear. To create a bypass, a vein or synthetic tube is used to connect the kidney to the aorta. This new path serves as an alternate route for blood to flow around the blocked artery into the kidney. These procedures are not performed as often as in the past due to a high risk of complications during and after the procedure. | NIDDK | Renal Artery Stenosis |
What to do for Renal Artery Stenosis ? | Limiting intake of fats, cholesterol, sodium, and sugar can help prevent atherosclerosis, which can lead to RAS. Most sodium in the diet comes from salt. A healthy diet that prevents people from becoming overweight or obese can also help prevent atherosclerosis. People with RAS that has caused decreased kidney function should limit their intake of protein, cholesterol, sodium, and potassium to slow the progression of kidney failure. More information about nutrition for CKD is provided in the NIDDK health topics, Nutrition for Early Chronic Kidney Disease in Adults and Nutrition for Advanced Chronic Kidney Disease in Adults. People should talk with their health care provider about what diet is right for them. | NIDDK | Renal Artery Stenosis |
What to do for Renal Artery Stenosis ? | - Renal artery stenosis (RAS) is the narrowing of one or both renal arteries. The renal arteries are blood vessels that carry blood to the kidneys from the aortathe main blood vessel that carries blood from the heart to arteries throughout the body. - Renovascular hypertension (RVH) is high blood pressure caused by RAS. - About 90 percent of RAS is caused by atherosclerosis. Most other cases of RAS are caused by fibromuscular dysplasia (FMD), which can cause blood vessels to narrow. - RAS often has no symptoms until it becomes severe. The first symptoms of RAS are usually either high blood pressure or decreased kidney function, or both, but RAS is often overlooked as a cause of high blood pressure. - People with RAS are at increased risk for chronic kidney disease (CKD), coronary artery disease, stroke, and peripheral vascular disease. - Imaging tests used to diagnose RAS include duplex ultrasound, catheter angiogram, computerized tomographic angiography (CTA) scan, and magnetic resonance angiogram (MRA). - Treatment for RAS includes lifestyle changes, medications, and surgery. | NIDDK | Renal Artery Stenosis |
What is (are) Amyloidosis and Kidney Disease ? | Amyloidosis is a rare disease that occurs when amyloid proteins are deposited in tissues and organs. Amyloid proteins are abnormal proteins that the body cannot break down and recycle, as it does with normal proteins. When amyloid proteins clump together, they form amyloid deposits. The buildup of these deposits damages a persons organs and tissues. Amyloidosis can affect different organs and tissues in different people and can affect more than one organ at the same time. Amyloidosis most frequently affects the kidneys, heart, nervous system, liver, and digestive tract. The symptoms and severity of amyloidosis depend on the organs and tissues affected. | NIDDK | Amyloidosis and Kidney Disease |
What is (are) Amyloidosis and Kidney Disease ? | 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 spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men, the urethra is long, while in women it is short. | NIDDK | Amyloidosis and Kidney Disease |
What is (are) Amyloidosis and Kidney Disease ? | Primary amyloidosis and dialysis-related amyloidosis are the types of amyloidosis that can affect the kidneys.
Primary Amyloidosis of the Kidneys
The kidneys are the organs most commonly affected by primary amyloidosis. Amyloid deposits damage the kidneys and make it harder for them to filter wastes and break down proteins. When the kidneys become too damaged, they may no longer be able to function well enough to maintain health, resulting in kidney failure. Kidney failure can lead to problems such as high blood pressure, bone disease, and anemiaa condition in which the body has fewer red blood cells than normal.
Dialysis-related Amyloidosis
People who suffer from kidney failure and have been on long-term dialysis may develop dialysis-related amyloidosis. This type of amyloidosis occurs when a certain protein, called beta-2 microglobulin, builds up in the blood because dialysis does not remove it completely. The two types of dialysis are
- hemodialysis. Hemodialysis uses a special filter called a dialyzer to remove wastes and extra fluid from the blood. - peritoneal dialysis. Peritoneal dialysis uses the lining of the abdominal cavitythe space in the body that holds organs such as the stomach, intestines, and liverto filter the blood.
Dialysis-related amyloidosis is a complication of kidney failure because neither hemodialysis nor peritoneal dialysis effectively filters beta-2 microglobulin from the blood. As a result, elevated amounts of beta-2 microglobulin remain in the blood. Dialysis-related amyloidosis is relatively common in people with kidney failure, especially adults older than 60 years of age, who have been on dialysis for more than 5 years.1
More information is provided in the NIDDK health topics:
- Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis | NIDDK | Amyloidosis and Kidney Disease |
What are the symptoms of Amyloidosis and Kidney Disease ? | The most common sign of primary amyloidosis of the kidneys is nephrotic syndromea collection of signs that indicate kidney damage. The signs of nephrotic syndrome include
- albuminuriaan increased amount of albumin, a protein, in the urine. A person with nephrotic syndrome excretes more than half a teaspoon of albumin per day. - hyperlipidemiaa condition in which a persons blood has more-than-normal amounts of fats and cholesterol. - edemaswelling, typically in a persons legs, feet, or ankles and less often in the hands or face. - hypoalbuminemiaa condition in which a persons blood has less-than-normal amounts of albumin.
More information is provided in the NIDDK health topic, Nephrotic Syndrome in Adults.
Other signs and symptoms of primary amyloidosis may include
- fatigue, or feeling tired - shortness of breath - low blood pressure - numbness, tingling, or a burning sensation in the hands or feet - weight loss | NIDDK | Amyloidosis and Kidney Disease |
What are the symptoms of Amyloidosis and Kidney Disease ? | The symptoms of dialysis-related amyloidosis may include
- pain, stiffness, and fluid in the joints. - abnormal, fluid-containing sacs, called cysts, in some bones. - carpal tunnel syndrome, caused by unusual buildup of amyloid proteins in the wrists. The symptoms of carpal tunnel syndrome include numbness or tingling, sometimes associated with muscle weakness, in the fingers and hands.
Dialysis-related amyloidosis most often affects bones, joints, and the tissues that connect muscle to bone, called tendons. The disease may also affect the digestive tract and organs such as the heart and lungs. Bone cysts caused by dialysis-related amyloidosis can lead to bone fractures. Dialysis-related amyloidosis can also cause tears in tendons and ligaments. Ligaments are tissues that connect bones to other bones. | NIDDK | Amyloidosis and Kidney Disease |
How to diagnose Amyloidosis and Kidney Disease ? | A health care provider diagnoses primary amyloidosis of the kidneys with
- a medical and family history - a physical exam - urinalysis - blood tests - a kidney biopsy
Medical and Family History
Taking a medical and family history may help a health care provider diagnose amyloidosis of the kidneys. He or she will ask the patient to provide a medical and family history.
Physical Exam
A physical exam may help diagnose primary amyloidosis of the kidneys. During a physical exam, a health care provider usually
- examines a patients body to check for swelling - uses a stethoscope to listen to the lungs - taps on specific areas of the patients body
Urinalysis
A health care provider may use urinalysisthe testing of a urine sampleto check for albumin and amyloid proteins in urine. The patient provides a urine sample in a special container at a health care providers office or a commercial facility. A nurse or technician can test the sample in the same location or send it to a lab for analysis. More-than-normal amounts of albumin in urine may indicate kidney damage due to primary amyloidosis. Amyloid proteins in urine may indicate amyloidosis.
Blood Tests
The health care provider may use blood tests to see how well the kidneys are working and to check for amyloid proteins and hyperlipidemia. A blood test involves drawing a patients blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. Blood tests for kidney function measure the waste products in the blood that healthy kidneys normally filter out. Hyperlipidemia may indicate nephrotic syndrome. Amyloid proteins in blood may indicate amyloidosis.
Kidney Biopsy
Only a biopsy can show the amyloid protein deposits in the kidneys. A health care provider may recommend a kidney biopsy if other tests show kidney damage. A kidney biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. A health care provider performs a kidney biopsy in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography (CT) scan to guide the biopsy needle into the kidney and take the tissue sample. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab for amyloid proteins and kidney damage.
The biopsy results can help the health care provider determine the best course of treatment. More information is provided in the NIDDK health topic, Kidney Biopsy. | NIDDK | Amyloidosis and Kidney Disease |
How to diagnose Amyloidosis and Kidney Disease ? | A health care provider diagnoses dialysis-related amyloidosis with
- urinalysis - blood tests - imaging tests
A health care provider can use urinalysis and blood tests to detect the amount of amyloid proteins in urine and blood. Imaging tests, such as x-rays and CT scans, can provide pictures of bone cysts and amyloid deposits in bones, joints, tendons, and ligaments. An x-ray technician performs imaging tests in a health care providers office, an outpatient center, or a hospital. A radiologista doctor who specializes in medical imaginginterprets the images. A patient does not require anesthesia. | NIDDK | Amyloidosis and Kidney Disease |
What are the treatments for Amyloidosis and Kidney Disease ? | A health care provider treats primary amyloidosis of the kidneys with the following:
- medication therapy, including chemotherapy - a stem cell transplant - treating other conditions
Medication therapy. The goal of medication therapy, including chemotherapy, is to reduce amyloid protein levels in the blood. Many health care providers recommend combination medication therapy such as
- melphalan (Alkeran), a type of chemotherapy - dexamethasone (Decadron), an anti-inflammatory steroid medication
These medications can stop the growth of the cells that make amyloid proteins. These medications may cause hair loss and serious side effects, such as nausea, vomiting, and fatigue.
Stem cell transplant. A stem cell transplant is a procedure that replaces a patients damaged stem cells with healthy ones. Stem cells are found in the bone marrow and develop into three types of blood cells the body needs. To prepare for a stem cell transplant, the patient receives high doses of chemotherapy. The actual transplant is like a blood transfusion. The transplanted stem cells travel to the bone marrow to make healthy new blood cells. The chemotherapy a patient receives to prepare for the transplant can have serious side effects, so it is important to talk with the health care provider about the risks of this procedure.
Read more in What Is a Blood and Marrow Stem Cell Transplant? at www.nhlbi.nih.gov/health/health-topics/topics/bmsct.
Treating other conditions. Primary amyloidosis has no cure, so treating some of the side effects and other conditions seen with the disease is essential. Other conditions may include
- anemiatreatment may include medications - depressiontreatment may include talking with a mental health counselor and taking medications - fatiguetreatment may include changes in diet and activity level - kidney diseasetreatment may include medications to help maintain kidney function or slow the progression of kidney disease
A patient and his or her family should talk with the health care provider about resources for support and treatment options.
More information about kidney disease is provided in the NIDDK health topic, niddk-kidney disease. | NIDDK | Amyloidosis and Kidney Disease |
What are the treatments for Amyloidosis and Kidney Disease ? | A health care provider treats dialysis-related amyloidosis with
- medication therapy - newer, more effective hemodialysis filters - surgery - a kidney transplant
The goal of medication therapy and the use of newer, more effective hemodialysis filters is to reduce amyloid protein levels in the blood. Medication therapy can help reduce symptoms such as pain and inflammation. A health care provider may treat a person with dialysis-related amyloidosis who has bone, joint, and tendon problems, such as bone cysts and carpal tunnel syndrome, using surgery.
Dialysis-related amyloidosis has no cure; however, a successful kidney transplant may stop the disease from progressing.
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Transplantation. | NIDDK | Amyloidosis and Kidney Disease |
What to do for Amyloidosis and Kidney Disease ? | Researchers have not found that eating, diet, and nutrition play a role in causing or preventing primary amyloidosis of the kidneys or dialysis-related amyloidosis. People with nephrotic syndrome may make dietary changes such as
- limiting dietary sodium, often from salt, to help reduce edema and lower blood pressure - decreasing liquid intake to help reduce edema and lower blood pressure - eating a diet low in saturated fat and cholesterol to help control more-than-normal amounts of fats and cholesterol in the blood
Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein. Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients.
People with kidney disease on a restricted protein diet should receive blood tests that can show low nutrient levels. People with primary amyloidosis of the kidneys or dialysis-related amyloidosis should talk with a health care provider about dietary restrictions to best manage their individual needs. | NIDDK | Amyloidosis and Kidney Disease |
What to do for Amyloidosis and Kidney Disease ? | - Amyloidosis is a rare disease that occurs when amyloid proteins are deposited in tissues and organs. - Primary amyloidosis and dialysis-related amyloidosis are the types of amyloidosis that can affect the kidneys. - The most common sign of primary amyloidosis of the kidneys is nephrotic syndrome. - The signs of nephrotic syndrome include - albuminuriaan elevated amount of albumin in the urine. A person with nephrotic syndrome excretes more than half a teaspoon of albumin per day. - hyperlipidemiaa condition in which a persons blood has more-than-normal amounts of fats and cholesterol. - edemaswelling, typically in a persons legs, feet, or ankles and less often in the hands or face. - hypoalbuminemiaa condition in which a persons blood has less-than-normal amounts of albumin. - Other signs and symptoms of primary amyloidosis may include - fatigue, or feeling tired - shortness of breath - low blood pressure - numbness, tingling, or a burning sensation in the hands or feet - weight loss - The symptoms of dialysis-related amyloidosis may include - pain, stiffness, and fluid in the joints. - abnormal, fluid-containing sacs, called cysts, in some bones. - carpal tunnel syndrome, caused by unusual buildup of amyloid proteins in the wrists. The symptoms of carpal tunnel syndrome include numbness or tingling, sometimes associated with muscle weakness, in the fingers and hands. - A health care provider diagnoses primary amyloidosis of the kidneys with - a medical and family history - a physical exam - urinalysis - blood tests - a kidney biopsy - A health care provider diagnoses dialysis-related amyloidosis with - urinalysis - blood tests - imaging tests - A health care provider treats primary amyloidosis of the kidneys with the following: - medication therapy, including chemotherapy - a stem cell transplant - treating other conditions - A health care provider treats dialysis-related amyloidosis with - medication therapy - newer, more effective hemodialysis filters - surgery - a kidney transplant | NIDDK | Amyloidosis and Kidney Disease |
What is (are) Amyloidosis and Kidney Disease ? | You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.
Booklets
- What I need to know about Kidney Failure and How its Treated - Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis - Treatment Methods for Kidney Failure: Kidney Transplantation - Kidney Failure: Eat Right to Feel Right on Hemodialysis
Fact Sheets
- Kidney Failure: What to Expect - Vascular Access for Hemodialysis - Hemodialysis Dose and Adequacy - Peritoneal Dialysis Dose and Adequacy - Amyloidosis and Kidney Disease - Anemia in Chronic Kidney Disease - Chronic Kidney Disease-Mineral and Bone Disorder - Financial Help for Treatment of Kidney Failure
Learning as much as you can about your treatment will help make you an important member of your health care team.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank: Glenn Chertow, M.D., University of California at San Francisco; William J. Stone, M.D., Vanderbilt University; Morie A. Gertz, M.D., Mayo Clinic
This information is not copyrighted. The NIDDK encourages people to share this content freely.
September 2014 | NIDDK | Amyloidosis and Kidney Disease |
What is (are) Primary Biliary Cirrhosis ? | Primary biliary cirrhosis is a chronic, or long lasting, disease that causes the small bile ducts in the liver to become inflamed and damaged and ultimately disappear.
The bile ducts carry a fluid called bile from the liver to the gallbladder, where it is stored. When food enters the stomach after a meal, the gallbladder contracts, and the bile ducts carry bile to the duodenum, the first part of the small intestine, for use in digestion. The liver makes bile, which is made up of bile acids, cholesterol, fats, and fluids. Bile helps the body absorb fats, cholesterol, and fat-soluble vitamins. Bile also carries cholesterol, toxins, and waste products to the intestines, where the body removes them. When chronic inflammation, or swelling, damages the bile ducts, bile and toxic wastes build up in the liver, damaging liver tissue.
This damage to the liver tissue can lead to cirrhosis, a condition in which the liver slowly deteriorates and is unable to function normally. In cirrhosis, scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver.
The liver is the bodys largest internal organ. The liver is called the bodys metabolic factory because of the important role it plays in metabolismthe way cells change food into energy after food is digested and absorbed into the blood. The liver has many functions, including
- taking up, storing, and processing nutrients from foodincluding fat, sugar, and proteinand delivering them to the rest of the body when needed - making new proteins, such as clotting factors and immune factors - producing bile - removing waste products the kidneys cannot remove, such as fats, cholesterol, toxins, and medications
A healthy liver is necessary for survival. The liver can regenerate most of its own cells when they become damaged. However, if injury to the liver is too severe or long lasting, regeneration is incomplete, and the liver creates scar tissue. Scarring of the liver may lead to cirrhosis.
The buildup of scar tissue that causes cirrhosis is usually a slow and gradual process. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse and scar tissue replaces more healthy tissue, the liver will begin to fail. Chronic liver failure, which is also called end-stage liver disease, progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or effectively replace damaged cells.
Primary biliary cirrhosis usually occurs between the ages of 30 and 65 and affects women more often than men.1 | NIDDK | Primary Biliary Cirrhosis |
What causes Primary Biliary Cirrhosis ? | The causes of primary biliary cirrhosis are unknown. Most research suggests it is an autoimmune disease. The immune system protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. An autoimmune disease is a disorder in which the bodys immune system attacks the bodys own cells and organs. In primary biliary cirrhosis, the immune system attacks the small bile ducts in the liver.
Genetics, or inherited genes, can make a person more likely to develop primary biliary cirrhosis. Primary biliary cirrhosis is more common in people who have a parent or siblingparticularly an identical twinwith the disease. In people who are genetically more likely to develop primary biliary cirrhosis, environmental factors may trigger or worsen the disease, including
- exposure to toxic chemicals - smoking - infections
Genetics can also make some people more likely to develop other autoimmune diseases, such as
- autoimmune hepatitis, a disease in which the bodys immune system attacks liver cells - Sjgrens syndrome, a condition in which the immune system attacks the glands that produce tears and saliva - autoimmune thyroid dysfunctions, conditions in which the immune system attacks the thyroid gland | NIDDK | Primary Biliary Cirrhosis |
What are the symptoms of Primary Biliary Cirrhosis ? | The first and most common symptoms of primary biliary cirrhosis are
- fatigue, or feeling tired - itching skin, and darkened skin in itching areas due to scratching - dry eyes and mouth
Some people may have jaundice, a condition that causes the skin and whites of the eyes to turn yellow. Health care providers diagnose up to 60 percent of people with primary biliary cirrhosis before symptoms begin.2 Routine blood tests showing abnormal liver enzyme levels may lead a health care provider to suspect that a person without symptoms has primary biliary cirrhosis. | NIDDK | Primary Biliary Cirrhosis |
What are the complications of Primary Biliary Cirrhosis ? | Most complications of primary biliary cirrhosis are related to cirrhosis and start after primary biliary cirrhosis progresses to cirrhosis. In some cases, portal hypertension and esophageal varices may develop before cirrhosis.
Portal hypertension. The portal vein carries blood from the stomach, intestines, spleen, gallbladder, and pancreas to the liver. In cirrhosis, scar tissue partially blocks the normal flow of blood, which increases the pressure in the portal vein. This condition is called portal hypertension. Portal hypertension is a common complication of cirrhosis. This condition may lead to other complications, such as
- edemaswelling due to a buildup of fluidin the feet, ankles, or legs, and ascitesa buildup of fluid in the abdomen - enlarged blood vessels, called varices, in the esophagus, stomach, or both - an enlarged spleen, called splenomegaly - mental confusion due to a buildup of toxins that are ordinarily removed by the liver, a condition called hepatic encephalopathy
Edema and ascites. Liver failure causes fluid buildup that results in edema and ascites. Ascites can lead to spontaneous bacterial peritonitis, a serious infection that requires immediate medical attention.
Varices. Portal hypertension may cause enlarged blood vessels in the esophagus, stomach, or both. These enlarged blood vessels, called esophageal or gastric varices, cause the vessel walls to become thin and blood pressure to increase, making the blood vessels more likely to burst. If they burst, serious bleeding can occur in the esophagus or upper stomach, requiring immediate medical attention.
Splenomegaly. Portal hypertension may cause the spleen to enlarge and retain white blood cells and platelets, reducing the numbers of these cells and platelets in the blood. A low platelet count may be the first evidence that a person has developed cirrhosis.
Hepatic encephalopathy. A failing liver cannot remove toxins from the blood, so they eventually accumulate in the brain. The buildup of toxins in the brain is called hepatic encephalopathy. This condition can decrease mental function and cause stupor and even coma. Stupor is an unconscious, sleeplike state from which a person can only be aroused briefly by a strong stimulus, such as a sharp pain. Coma is an unconscious, sleeplike state from which a person cannot be aroused. Signs of decreased mental function include
- confusion - personality changes - memory loss - trouble concentrating - a change in sleep habits
Metabolic bone diseases. Some people with cirrhosis develop a metabolic bone disease, which is a disorder of bone strength usually caused by abnormalities of vitamin D, bone mass, bone structure, or minerals, such as calcium and phosphorous. Osteopenia is a condition in which the bones become less dense, making them weaker. When bone loss becomes more severe, the condition is referred to as osteoporosis. People with these conditions are more likely to develop bone fractures.
Gallstones and bile duct stones. If cirrhosis prevents bile from flowing freely to and from the gallbladder, the bile hardens into gallstones. Symptoms of gallstones include abdominal pain and recurrent bacterial cholangitisirritated or infected bile ducts. Stones may also form in and block the bile ducts, causing pain, jaundice, and bacterial cholangitis.
Steatorrhea. Steatorrhea is a condition in which the body cannot absorb fat, causing a buildup of fat in the stool and loose, greasy, and foul-smelling bowel movements. Steatorrhea may be caused by impairment of bile delivery to the small intestine or by the pancreas not producing enough digestive enzymes.
Liver cancer. Liver cancer is common in people with cirrhosis. Liver cancer has a high mortality rate. Current treatments are limited and only fully successful if a health care provider detects the cancer early, before the tumor is too large. For this reason, health care providers should check people with cirrhosis for signs of liver cancer every 6 to 12 months. Health care providers use blood tests, ultrasound, or both to check for signs of liver cancer. | NIDDK | Primary Biliary Cirrhosis |
How to diagnose Primary Biliary Cirrhosis ? | A health care provider may use the following tests to diagnose primary biliary cirrhosis:
- a medical and family history - a physical exam - blood tests - imaging tests - a liver biopsy
A health care provider usually bases a diagnosis of primary biliary cirrhosis on two out of three of the following criteria:
- a blood test showing elevated liver enzymes - a blood test showing the presence of anti-mitochondrial antibodies (AMA) - a liver biopsy showing signs of the disease
Health care providers may order additional tests to rule out other causes of symptoms. Health care providers diagnose the majority of people with primary biliary cirrhosis early in the course of the disease.
Medical and family history. Taking a medical and family history is one of the first things a health care provider may do to help diagnose primary biliary cirrhosis. He or she will ask a patient to provide a medical and family history.
Physical exam. A physical exam may help diagnose primary biliary cirrhosis. During a physical exam, a health care provider usually
- examines a patients body - uses a stethoscope to listen to sounds in the abdomen - taps on specific areas of the patients body
The health care provider will perform a physical exam to look for signs of the disease. For example, the liver may feel hard or ascites may cause the abdomen to enlarge.
Blood test. A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. The blood test can show elevated levels of liver enzymes, such as alkaline phosphatase. A routine blood test may show high levels of the liver enzyme alkaline phosphatase in people who have primary biliary cirrhosis and are not yet showing symptoms.
The health care provider will perform an AMA blood test to help confirm the diagnosis. A blood test will detect the presence of AMA in 90 to 95 percent of people with primary biliary cirrhosis.3
Imaging tests. A health care provider may use the following imaging tests to examine the bile ducts. These tests can distinguish between primary biliary cirrhosis and other conditions that affect the bile ducts.
- Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital, and a radiologista doctor who specializes in medical imaging interprets the images. A patient does not need anesthesia. In addition to showing problems with the bile ducts, the images can show signs of advanced cirrhosis or complications. - Magnetic resonance cholangiopancreatography uses magnetic resonance imaging (MRI) to examine the bile ducts. MRI machines use radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. A specially trained technician performs magnetic resonance cholangiopancreatography in an outpatient center or a hospital, and a radiologist interprets the images. A patient does not need anesthesia, though a health care provider may use light sedation for patients with a fear of confined spaces. With most MRI machines, the patient lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some machines allow the patient to lie in a more open space. - Endoscopic retrograde cholangiopancreatography uses an x ray to look at the bile ducts. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. After lightly sedating the patient, the gastroenterologist inserts an endoscopea small, flexible tube with a light and a camera on the endthrough the mouth into the duodenum and bile ducts. The endoscope is connected to a computer and video monitor. The gastroenterologist injects a special dye, called contrast medium, through the tube into the bile ducts, which makes the ducts show up on the monitor. This test is more invasive than other imaging tests, and health care providers do not routinely need the test to make the diagnosis of primary biliary cirrhosis. A health care provider uses the test selectively when he or she is concerned that the blockage of the bile ducts has another cause, such as a gallstone or a narrowing of the large bile ducts due to inflammation or cancer. Patients may have pain, nausea, or vomiting after the test or may develop bacterial cholangitis or pancreatitisinflammation of the pancreas.
Liver biopsy. A liver biopsy is a procedure that involves taking a piece of liver tissue for examination with a microscope for signs of damage or disease. The health care provider may ask the patient to stop taking certain medications temporarily before the liver biopsy. The health care provider may ask the patient to fast for 8 hours before the procedure.
During the procedure, the patient lies on a table, right hand resting above the head. The health care provider applies a local anesthetic to the area where he or she will insert the biopsy needle. If needed, a health care provider will also give sedatives and pain medication. The health care provider uses a needle to take a small piece of liver tissue. He or she may use ultrasound, computerized tomography scans, or other imaging techniques to guide the needle. After the biopsy, the patient must lie on the right side for up to 2 hours and is monitored an additional 2 to 4 hours before being sent home.
A health care provider performs a liver biopsy at a hospital or an outpatient center. The health care provider sends the liver sample to a pathology lab, where the pathologista doctor who specializes in diagnosing diseaseslooks at the tissue with a microscope and sends a report to the patients health care provider.
A liver biopsy can confirm the diagnosis of primary biliary cirrhosis; however, a person does not always need this test. A health care provider will perform a biopsy if the AMA blood test is negative and the person shows other signs of primary biliary cirrhosis. Sometimes a health care provider finds a cause of liver damage other than primary biliary cirrhosis during biopsy. | NIDDK | Primary Biliary Cirrhosis |
What are the treatments for Primary Biliary Cirrhosis ? | Treatment for primary biliary cirrhosis depends on how early a health care provider diagnoses the disease and whether complications are present. In the early stages of primary biliary cirrhosis, treatment can slow the progression of liver damage to cirrhosis. In the early stages of cirrhosis, the goals of treatment are to slow the progression of tissue scarring in the liver and prevent complications. As cirrhosis progresses, a person may need additional treatments and hospitalization to manage complications.
Medications
Health care providers prescribe ursodiol (Actigall, Urso) to treat primary biliary cirrhosis. Ursodiol is a nontoxic bile acid that people can take orally. Ursodiol replaces the bile acids that are normally produced by the liver, which are more toxic and can harm the liver. Treatment with ursodiol can reduce levels of bilirubin and liver enzymes in the blood. Early treatment with this medication reduces the likelihood of needing a liver transplant and improves survival.3 Early treatment provides the most benefit; however, ursodiol treatment late in the course of the disease can still slow the progression of liver damage. While ursodiol treatment improves the outcome of primary biliary cirrhosis, it does not cure the disease.
Researchers are studying the effects of several other medications on the progression of primary biliary cirrhosis. To date, none has shown the positive effects of ursodiol.
Avoiding Alcohol and Other Substances
People with cirrhosis should not drink any alcohol or take any illegal substances, as both will cause more liver damage. People with cirrhosis should avoid complementary and alternative medications, such as herbs. People with cirrhosis should be careful about starting new medications and should consult a health care provider before taking prescription medications, over-the-counter medications, or vitamins. Many vitamins and prescription and over-the-counter medications can affect liver function.
Treatment of Symptoms and Complications
Health care providers treat symptoms and complications as follows:
Itching. Antihistamines may help with mild itching. However, antihistamines often cause drowsiness, and a person should take antihistamines just before bedtime to help with nighttime itching. A health care provider will treat more problematic itching with cholestyramine (Locholest, Questran), which reduces cholesterol in the blood. Experts believe high levels of cholesterol let substances that cause itching build up in tissues.
Dry eyes and mouth. Health care providers usually treat dry eyes and mouth with artificial tears and saliva substitutes, respectively. These products are available without a prescription. A health care provider may treat people whose symptoms do not improve with pilocarpine (Salagen) or cevimeline (Evoxac). People who have difficulty with dry eyes should see an ophthalmologista doctor who diagnoses and treats all eye diseases and eye disordersregularly. People with dry mouth should have regular dental exams.
Portal hypertension. A health care provider may prescribe a beta-blocker or nitrate to treat portal hypertension. Beta-blockers lower blood pressure by helping the heart beat slower and with less force, and nitrates relax and widen blood vessels to let more blood flow to the heart and reduce the hearts workload.
Varices. Beta-blockers can lower the pressure in varices and reduce the likelihood of bleeding. Bleeding in the stomach or esophagus requires an immediate upper endoscopy. This procedure involves using an endoscope to look for varices. The health care provider may use the endoscope to perform a band ligation, a procedure that involves placing a special rubber band around the varices that causes the tissue to die and fall off. A gastroenterologist performs the procedure at a hospital or an outpatient center. People who have had varices in the past may need to take medication to prevent future episodes.
Edema and ascites. Health care providers prescribe diureticsmedications that remove fluid from the bodyto treat edema and ascites. A health care provider may remove large amounts of ascitic fluid from the abdomen and check for spontaneous bacterial peritonitis. A health care provider may prescribe bacteria-fighting medications called antibiotics to prevent infection. He or she may prescribe oral antibiotics; however, severe infection with ascites requires intravenous (IV) antibiotics.
Hepatic encephalopathy. A health care provider will treat hepatic encephalopathy by cleansing the bowel with lactulose, a laxative given orally or as an enemaa liquid put into the rectum. A health care provider may also add antibiotics to the treatment. Hepatic encephalopathy may improve as other complications of cirrhosis are controlled.
Osteoporosis. A health care provider may prescribe bisphosphonate medications to improve bone density.
Gallstones and bile duct stones. A health care provider may use surgery to remove gallstones. He or she may use endoscopic retrograde cholangiopancreatography, which uses balloons and basketlike devices, to retrieve the bile duct stones.
Liver cancer. A health care provider may recommend screening tests every 6 to 12 months to check for signs of liver cancer. Screening tests can find cancer before the person has symptoms of the disease. Cancer treatment is usually more effective when the health care provider finds the disease early. Health care providers use blood tests, ultrasound, or both to screen for liver cancer in people with cirrhosis. He or she may treat cancer with a combination of surgery, radiation, and chemotherapy. | NIDDK | Primary Biliary Cirrhosis |
What to do for Primary Biliary Cirrhosis ? | A healthy diet is important in all stages of cirrhosis because malnutrition is common in people with this disease. Malnutrition is a condition that occurs when the body does not get enough nutrients. Cirrhosis may lead to malnutrition because it can cause
- people to eat less because of symptoms such as loss of appetite - changes in metabolism - reduced absorption of vitamins and minerals
Health care providers can recommend a meal plan that is well balanced and provides enough calories and protein. If ascites develops, a health care provider or dietitian may recommend a sodium-restricted diet. To improve nutrition, the health care provider may prescribe a liquid supplement. A person may take the liquid by mouth or through a nasogastric tubea tiny tube inserted through the nose and throat that reaches into the stomach.
A person with cirrhosis should not eat raw shellfish, which can contain a bacterium that causes serious infection. Cirrhosis affects the immune system, making people with cirrhosis more likely than healthy people to develop an infection after eating shellfish that contain this bacterium.
A health care provider may recommend calcium and vitamin D supplements to help prevent osteoporosis. | NIDDK | Primary Biliary Cirrhosis |
What to do for Primary Biliary Cirrhosis ? | - Primary biliary cirrhosis is a chronic disease that causes the small bile ducts in the liver to become inflamed and damaged and ultimately disappear. - When chronic inflammation damages the bile ducts, bile and toxic wastes build up in the liver, damaging liver tissue. This damage to the liver tissue can lead to cirrhosis. - The causes of primary biliary cirrhosis are unknown. Most research suggests it is an autoimmune disease. - Primary biliary cirrhosis is more common in people who have a parent or siblingparticularly an identical twinwith the disease. - The first and most common symptoms of primary biliary cirrhosis are fatigue, itching, and dry eyes and mouth. Some people may have jaundice, a condition that causes the skin and whites of the eyes to turn yellow. Health care providers diagnose up to 60 percent of people with primary biliary cirrhosis before symptoms begin. - Most complications of primary biliary cirrhosis are related to cirrhosis and start after primary biliary cirrhosis progresses to cirrhosis. - A health care provider may use the following tests to diagnose primary biliary cirrhosis: - a medical and family history - a physical exam - blood tests - imaging tests - a liver biopsy - Health care providers prescribe ursodiol (Actigall, Urso) to treat primary biliary cirrhosis. Early treatment with this medication reduces the likelihood of needing a liver transplant and improves survival. - A health care provider may consider a liver transplant when cirrhosis leads to liver failure or treatment for complications is ineffective. | NIDDK | Primary Biliary Cirrhosis |
What is (are) Proteinuria ? | Proteinuriaalso called albuminuria or urine albuminis a condition in which urine contains an abnormal amount of protein. Albumin is the main protein in the blood. Proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions. They protect the body from infection, help blood clot, and keep the right amount of fluid circulating throughout the body.
As blood passes through healthy kidneys, they filter out the waste products and leave in the things the body needs, like albumin and other proteins. Most proteins are too big to pass through the kidneys' filters into the urine. However, proteins from the blood can leak into the urine when the filters of the kidney, called glomeruli, are damaged.
Proteinuria is a sign of chronic kidney disease (CKD), which can result from diabetes, high blood pressure, and diseases that cause inflammation in the kidneys. For this reason, testing for albumin in the urine is part of a routine medical assessment for everyone. Kidney disease is sometimes called renal disease. If CKD progresses, it can lead to end-stage renal disease (ESRD), when the kidneys fail completely. A person with ESRD must receive a kidney transplant or regular blood-cleansing treatments called dialysis. | NIDDK | Proteinuria |
Who is at risk for Proteinuria? ? | People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. In the United States, diabetes is the leading cause of ESRD.1 In both type 1 and type 2 diabetes, albumin in the urine is one of the first signs of deteriorating kidney function. As kidney function declines, the amount of albumin in the urine increases.
Another risk factor for developing proteinuria is hypertension, or high blood pressure. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. If the hypertension is not controlled, the person can progress to full kidney failure.
African Americans are more likely than Caucasians to have high blood pressure and to develop kidney problems from it, even when their blood pressure is only mildly elevated. In fact, African Americans are six times more likely than Caucasians to develop hypertension-related kidney failure.2
Other groups at risk for proteinuria are American Indians, Hispanics/Latinos, Pacific Islander Americans, older adults, and overweight people. These at-risk groups and people who have a family history of kidney disease should have their urine tested regularly. | NIDDK | Proteinuria |
What are the symptoms of Proteinuria ? | Proteinuria has no signs or symptoms in the early stages. Large amounts of protein in the urine may cause it to look foamy in the toilet. Also, because protein has left the body, the blood can no longer soak up enough fluid, so swelling in the hands, feet, abdomen, or face may occur. This swelling is called edema. These are signs of large protein loss and indicate that kidney disease has progressed. Laboratory testing is the only way to find out whether protein is in a persons urine before extensive kidney damage occurs.
Several health organizations recommend regular urine checks for people at risk for CKD. A 1996 study sponsored by the National Institutes of Health determined that proteinuria is the best predictor of progressive kidney failure in people with type 2 diabetes. The American Diabetes Association recommends regular urine testing for proteinuria for people with type 1 or type 2 diabetes. The National Kidney Foundation recommends that routine checkups include testing for excess protein in the urine, especially for people in high-risk groups. | NIDDK | Proteinuria |