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How to diagnose What I need to know about Hepatitis C ? | A blood test will show if you have hepatitis C. Blood tests are done at a doctors office or outpatient facility. A blood sample is taken using a needle inserted into a vein in your arm or hand. The blood sample is sent to a lab to test for hepatitis C.
If you are at higher risk of getting hepatitis C, get tested. Many people with hepatitis C do not know they are infected.
Your doctor may suggest getting a liver biopsy if chronic hepatitis C is suspected. A liver biopsy is a test to take a small piece of your liver to look for liver damage. The doctor may ask you to stop taking certain medicines before the test. You may be asked to fast for 8 hours before the test.
During the test, you lie on a table with your right hand resting above your head. Medicine is applied to numb the area where the biopsy needle will be inserted. If needed, sedatives and pain medicine are also given. The doctor uses a needle to take a small piece of liver tissue. After the test, you must lie on your right side for up to 2 hours. You will stay 2 to 4 hours after the test before being sent home.
A liver biopsy is performed at a hospital or outpatient center by a doctor. The liver sample is sent to a special lab where a doctor looks at the tissue with a microscope and sends a report to your doctor. | NIDDK | What I need to know about Hepatitis C |
What are the treatments for What I need to know about Hepatitis C ? | Hepatitis C is usually not treated unless it becomes chronic. Chronic hepatitis C is treated with medicines that slow or stop the virus from damaging the liver. Your doctor will closely watch your symptoms and schedule regular blood tests to make sure the treatment is working.
Medicines for Chronic Hepatitis C
Chronic hepatitis C is most often treated with a medicine combination that attacks the hepatitis C virus. Treatment may last from 24 to 48 weeks.
Today, newer treatments with medicine for chronic hepatitis C are appearing quickly. Talk with your doctor if you have questions about treatment.
Talk with your doctor before taking other prescription medicines and over-the-counter medicines.
Liver Transplant
A liver transplant may be necessary if chronic hepatitis C causes severe liver damage that leads to liver failure. Symptoms of severe liver damage include the symptoms of hepatitis C and
- generalized itching - a longer than usual amount of time for bleeding to stop - easy bruising - swollen stomach or ankles - spiderlike blood vessels, called spider angiomas, that develop on the skin
Liver transplant is surgery to remove a diseased or injured liver and replace it with a healthy one from another person, called a donor. If your doctors tell you that you need a transplant, you should talk with them about the long-term demands of living with a liver transplant.
A team of surgeonsdoctors who specialize in surgeryperforms a liver transplant in a hospital. You will learn how to take care of yourself after you go home and about the medicines youll need to take to protect your new liver. You will continue to take medicines because hepatitis C may come back after surgery.
Testing for Liver Cancer
Having hepatitis C increases your risk for liver cancer, so your doctor may suggest an ultrasound test of the liver every 6 to 12 months. Finding cancer early makes it more treatable. Ultrasound is a machine that uses sound waves to create a picture of your liver. Ultrasound is performed at a hospital or radiology center by a specially trained technician. The image, called a sonogram, can show the livers size and the presence of cancerous tumors. | NIDDK | What I need to know about Hepatitis C |
What to do for What I need to know about Hepatitis C ? | If you have chronic hepatitis C, you should do things to take care of yourself, including eating a healthy diet. Avoid drinking alcohol, which can harm the liver. Talk with your doctor before taking vitamins and other supplements. | NIDDK | What I need to know about Hepatitis C |
What to do for What I need to know about Hepatitis C ? | - Hepatitis C is a virus, or infection, that causes inflammation of the liver. - Anyone can get hepatitis C, but some people are more likely to than others. - You could get hepatitis C through contact with an infected persons blood. - Most people do not have any symptoms until the hepatitis C virus causes liver damage, which can take 10 or more years to happen. - See a doctor right away if you or a child in your care has symptoms of hepatitis C. - Acute hepatitis C is a short-term infection with the hepatitis C virus. - Chronic hepatitis C is a long-lasting infection with the hepatitis C virus. Chronic hepatitis C occurs when the body cant get rid of the hepatitis C virus. - A blood test will show if you have hepatitis C. - If you are at higher risk of getting hepatitis C, get tested. Many people with hepatitis C do not know they are infected. - Hepatitis C usually is not treated unless it becomes chronic. Chronic hepatitis C is treated with medicines that slow or stop the virus from damaging the liver. - Tell your doctor and your dentist if you have hepatitis C. - See your doctor right away if you think you have been in contact with the hepatitis C virus. Early diagnosis and treatment of chronic hepatitis C can help prevent liver damage. | NIDDK | What I need to know about Hepatitis C |
What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | Before scientists learned how to make synthetic hormones, many animal hormones, such as insulin, were used to treat human disorders. Growth hormone from animals did not work in humans. Human growth hormone (pituitary hGH) was therefore made from human pituitary glands by the National Hormone and Pituitary Program (NHPP), funded by the U.S. Department of Health and Human Services (HHS). From 1963 to 1985, the NHPP sent pituitary hGH to hundreds of doctors across the country. As a part of research studies, doctors used the hormone to treat nearly 7,700 children for failure to grow.
In 1985, the HHS learned that three young men treated with pituitary hGH died of Creutzfeldt-Jakob disease (CJD), a rare and incurable brain disease. The HHS believed these illnesses were related to pituitary hGH. The HHS immediately stopped the distribution of the hormone and began a national study to learn more about how pituitary hGH treatment may have caused this problem. The HHS continues to monitor individuals who received pituitary hGH through the NHPP for CJD. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | The HHS has identified 29 cases of CJD among the nearly 7,700 people in the United States who received NHPP pituitary hGH. None of the 29 people who got CJD began treatment with pituitary hGH after 1977, the year that the NHPP began producing pituitary hGH in a laboratory (headed by Dr. Albert Parlow) using a new purification step. Today, the growth hormone used to treat patients is made biosynthetically and not from human pituitary glands. Biosynthetic growth hormone (bGH), also known as recombinant human growth hormone (rhGH), poses no threat of infection with CJD.
Based on NHPP records, the HHS estimated 7,700 people were treated with pituitary hGH from the NHPP. Of these, the HHS got the names and addresses of 6,272 from their doctors and treatment centers so that their health could be monitored. Another 1,400 people are believed to have been treated with pituitary hGH; however, the HHS does not have their names and addresses. The HHS hoped to learn about CJD and other health problems in the unmonitored group of 1,400 and notified many doctors about the problem of CJD, asking them to report CJD among people treated with pituitary hGH. The HHS has learned that five of the 29 people with confirmed CJD were among the 1,400 people the HHS was not able to identify and study.
Some U.S. laboratories that made pituitary hGH for the NHPP also made hGH for use in other countries. The HHS learned that six people in New Zealand and two people in Brazil who received U.S.-made pituitary hGH may also have gotten CJD. A total of 37 people who were treated with pituitary hGH made in the United States may have gotten CJD.
Before bGH was available, several pharmaceutical companies made pituitary hGH. Some children treated in the U.S. received hormone produced by these companies when NHPP hGH was not available to them. Some of the 29 people with confirmed CJD received hGH from both the NHPP and a pharmaceutical company. Recently, the HHS has learned of an individual treated in the U.S. who developed CJD and received only commercial pituitary hGH. That person was not eligible for NHPP hGH and received pituitary hGH made by two pharmaceutical companies. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | People treated with pituitary hGH in other countries also got CJD. HHS doctors share information with doctors around the world about health issues such as CJD and read reports about CJD and other health problems related to pituitary hGH treatment.
Country Number of CJD Cases Reported* Number of Individuals Treated Source of hGH in Reported Cases New Zealand*** 6 159 United States France 119 1,700 France United Kingdom 75 1,849 United Kingdom Holland 2 unpublished Holland Brazil 2 unpublished United States Australia 1** 608 Australia Austria 1 unpublished pharmaceutical (commercial) Qatar 1 unpublished France Ireland 1 unpublished Not known
*as of November 2014
**This case has been recognized by the Australian surveillance authorities as a "possible" (albeit unlikely) CJD case.
***New Zealand has reported six people with CJD among 159 who received pituitary hGH. All six were among 49 people who received pituitary hGH made by the U.S. lab that supplied most NHPP pituitary hGH before 1977. We don't know why this ratesix out of 49 (12.2 percent)is so high in those in New Zealand who received American hormone. HHS scientists believe that this U.S.-made hormone did not undergo the same filtering process used in the United States when the hormone was put into vials. In addition, some hormone preparations sent to New Zealand were not distributed in the United States.
New Zealand has little information on the hormone preparations used to treat the people who got CJD. Information provided to the HHS from medical authorities in New Zealand indicated the following dates of pituitary hGH treatment for the six New Zealand patients who developed CJD: 1964 to 1966, 1964 to 1970, 1965 to 1972, 1966 to 1972, 1967 to 1969, and 1970 to 1973. With no common period of treatment, it is unlikely that a single preparation exposed all six patients to CJD.
There is some information on the hormone sent to New Zealand from the lab that also produced hormone for the NHPP before 1977. Some preparations and components of preparations were used in both countries and others were distributed only in the United States or in New Zealand.
The time between the start of pituitary hGH treatment and the first sign of CJD symptoms was similar in the 29 United States patients (14 to 44 years) and the six New Zealand patients (17 to 37 years). The New Zealand patients who got CJD were treated with pituitary hGH for an average of 4.3 years. In the United States, average treatment time was 8.4 years in patients who got CJD.
In France, 119 people with CJD were among the 1,700 treated with pituitary hGH. The pattern of exposure to CJD in France is very different from the pattern in the United States. In France, people who received pituitary hGH in 1984 and 1985 appear to be at highest risk for CJD. We have learned from animal studies that when scientists injected a greater amount of CJD infectious agent into an animal, it took less time for CJD to develop. Because of the larger number of people with CJD and shorter times between treatment and CJD onset in France, the level of infection in French hormone was probably higher than in the U.S. hormone. The purification procedure used in France differed from that begun in 1977 in the United States.
The United Kingdom has reported 75 people with CJD among 1,849 who received pituitary hGH. Experts have also found CJD in two people in Holland, two people in Brazil, and one each in Australia, Austria, Qatar, and Ireland. France, the United Kingdom, Holland, and Australia made their own hormone. The Brazilian patients got pituitary hGH from a U.S. lab that also made NHPP hormone before 1977. This was a different lab than the U.S. lab that made hormone for New Zealand. The Qatar patient received pituitary hGH made in France. The Austrian patient received pituitary hGH made by a pharmaceutical company. Four Australian women developed CJD after receiving other human pituitary hormones as fertility treatments. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | Most people were treated with pituitary hGH because their pituitary glands did not make enough of their own GH. Some of these people also had problems making other pituitary hormones. One of these hormones tells the adrenal glands to make cortisol, a hormone needed for life. People lacking this hormone are at risk of death from adrenal crisis, but adrenal crisis can be prevented. More pituitary hGH recipients have died from adrenal crisis than from CJD. Pituitary hGH did not cause adrenal problems, but some people who received hGH have a pituitary problem that puts them at risk for adrenal crisis. Please read the health alert and discuss this information with your doctor.
Besides CJD, no other serious or fatal health risks from pituitary hGH treatment have been found.
Mad Cow Disease
Starting in 1996, reports of a new form of CJD in young people who lived in the United Kingdom have raised concerns worldwide.
Since at least 1985, some cattle in the United Kingdom have developed a disease called bovine spongiform encephalopathy (BSE), or "mad cow" disease. "Mad cow" disease is a sickness in cattle that is caused by an agent that is similar, but not identical, to the agents that cause the most common forms of CJD in people. Individuals who consume products made from cattle infected with the agent that causes "mad cow" disease can become infected with the agent themselves and develop the human form of "mad cow" disease, called variant CJD (vCJD). In humans, vCJD and the more common forms of CJD (those without the word "variant") are separate diseases. As of November 2012, 227 cases of vCJD were confirmed worldwide, mostly from the United Kingdom. Researchers believe all but three of these 227 individuals got vCJD by eating beef from animals with "mad cow" disease. The three exceptions were persons who are believed to have developed vCJD because they received infected blood from a donor who had acquired the agent by eating beef from animals with "mad cow" disease.
In the United States, three cases of vCJD have been found. According to the Centers for Disease Control and Prevention (CDC), the investigation of these three cases indicated that they most likely acquired their infection in the United Kingdom (two cases) and Saudi Arabia (one case).
People who received pituitary hGH are not at higher risk for vCJD.
AIDS
HIV, also known as the human immunodeficiency virus, causes AIDS. Pituitary hGH does not cause AIDS. HIV is destroyed by the methods used to make pituitary hGH. People who have been treated with pituitary hGH do not have a higher risk for AIDS.
Low Levels of GH in Adults
Some people who received pituitary hGH as children may have low levels of GH as adults and might therefore benefit from bGH as adults. People with low levels of growth hormone as adults may have symptoms or changes like these:
- more body fat - less muscle - less bone mass - less strength - less energy
If you lacked GH as a child and have these problems as an adult, ask your doctor whether they might be due to low GH. Because these conditions are common in many people, they are not always due to low GH. Studies have shown that GH treatment in adults with low GH reduces fat and increases muscle mass. Effects on strength, energy, and bone fractures in GH-deficient adults receiving GH replacement are not as clear.
Today, GH is completely synthetic. It is not made from human pituitaries. It poses no threat of contamination. The Human Growth Foundation (HGF) is one source of information about growth-related disorders. The Foundation can be reached at 18004516434.
Cancer
HHS studies of people treated with pituitary hGH supplied by the NHPP show no increased risk of cancer in those who did not have tumors before pituitary hGH treatment. Many people who received NHPP pituitary hGH had brain tumors that caused their lack of GH. People who have had one tumor have an increased risk for getting other tumors.
In previous updates, we reported that in 1988, Japanese doctors reported an increased risk of leukemia in people treated with GH. Subsequent studies of individuals who were given pituitary hGH in the United States, Japan, and the United Kingdom found no higher rate of leukemia among those who did not have tumors and/or radiation before treatment with pituitary hGH.
Emotional Problems
No studies have shown that pituitary hGH causes changes in personality, emotional problems, or suicide. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What are the symptoms of National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | CJD does not cause the same symptoms in everyone. In most people who got CJD from pituitary hGH, the first signs they noticed were difficulty with walking and balance, dizziness, and/or clumsiness. Later, some began to slur words and have jerky movements. They also had trouble seeing, remembering, and/or thinking clearly. The disease becomes worse very quickly. When individuals have symptoms like these over a long period of time (such as a year) without getting much worse, they do not have CJD. Occasional forgetfulness, clumsiness, or headaches do not mean one has CJD. You should discuss concerns with your doctor if you are not sure.
CJD is a rare disease. Most cases of CJD are not linked to pituitary hGH. When CJD is not linked to pituitary hGH, the first symptoms are usually mental changes such as confusion, problems thinking clearly, memory loss, behavior changes, and dementia. Though symptoms may differ, there are similar changes in the brain tissue of all patients with CJD. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
Who is at risk for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report)? ? | No one can say what an individual person's risk is. Of the approximately 7,700 people who received NHPP pituitary hGH, 29 people got CJD. The two things that seem to be connected with getting CJD after pituitary hGH treatment are
1. How long a person was treated:
- In the United States, the average length of time for pituitary hGH treatment through the NHPP was about 3 years. For those individuals who developed CJD, the average length of treatment was about 8.4 years. - Even though longer treatment time increased the risk for CJD in the United States, in other countries CJD has developed after shorter treatment periods.
2. When a person was treated:
- All of the 29 individuals treated with NHPP hGH who got CJD in the United States started pituitary hGH before 1977. No CJD has been reported in Americans who began treatment with NHPP hormone after 1977, when production of NHPP hormone was moved to a laboratory (headed by Dr. Albert Parlow) that used a new method of purifying pituitary hGH. Research in animals showed the newer purification steps introduced in 1977 reduced the risk of CJD transmission. Recently, an analysis of NHPP hGH recipients was completed taking into account the differences in follow-up time and the duration of treatment of recipients starting treatment before or after 1977. That analysis found that the new purification steps greatly reduced and may have eliminated the risk for CJD infection. - Two cases of CJD have been reported in individuals who received commercially prepared pituitary hGH. An Austrian person was treated with pituitary hGH (Crescormon, from Kabi Pharma) for 14 months and died from CJD 22 years later. An American who was too tall to be eligible for NHPP hormone was treated with pituitary hGH made by two pharmaceutical companies (Asellacrin, from Serono, and Crescormon, from Kabi Pharma). This individual was treated with commercial hGH for 23 months and died just over 26 years later. The methods used to produce these commercial hormone preparations were not identical to the method used in Dr. Parlow's laboratory but did include a version of the important new purification step that has been shown to reduce CJD infectivity. - Overall, one out of about 265 people (29 out of about 7,700 people) who were treated with NHPP pituitary hGH got CJD. - However, one in about 91 people who began treatment before 1977 got CJD. - People who started treatment before 1970 are at even higher risk. In that early group, one in about every 48 people (about 2.1 percent) got CJD. - The appearance of new cases is decreasing, as there has only been one new case in the past 5 years. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | The best source for details on your treatment is the doctor or center that gave you pituitary hGH. To protect patient privacy, the HHS did not ask for the names of those treated with pituitary hGH until 1985, when the first CJD cases were reported. In 1985, the HHS asked doctors and treatment centers for the names and addresses of recipients to inform them of the risk of CJD.
We know which pituitary hGH preparations were sent to each treatment center and when they were sent. However, because individual doctors administered the pituitary hGH, we don't know which preparation each person might have gotten. We have tried to find this information in the medical records of patients who developed CJD, but many doctors did not note the specific preparation in their records. When records were incomplete, it was assumed that patients who got CJD might have been exposed to all preparations sent to their treatment center during the time they were treated. Since it is impossible to confidently identify high-risk or risk-free hormone, we do not think that details on the hormone preparations that individuals received will help to clarify individual level of risk. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What causes National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | We have not found any particular preparation of pituitary hGH that is especially likely to carry CJD. We believe that CJD did not come from a single infected pituitary gland or preparation. Prior to 1977, in an effort to extract as much hormone as possible from the pituitary glands, the glands were often processed repeatedly. Hormone extracted from the same pituitaries was often included in many hormone preparations. Also, patients who got CJD were treated on average for 8.4 years and received many different hormone preparations. This makes it very difficult to identify any preparation associated with transmitting CJD.
Doctors wanted to see if a specific preparation of pituitary hGH could transmit CJD. To try to find the pituitary hGH that could have caused CJD, HHS researchers did two things:
1. They set up a test in animals, injecting samples of all available preparations of pituitary hGH directly into the brains of monkeys. CJD develops more rapidly if injected into the brain than under the skin, as hGH was used in people. The animals were watched for 10 years. The brains of all animals were examined for signs of CJD. If an animal got sick with CJD, it would help researchers to understand which vials of pituitary hGH were contaminated with the agent that causes CJD.
2. They studied people treated with pituitary hGH to see who got CJD and which hormone preparation they might have received based on which preparations were sent to their doctor.
Results:
- The animal tests did not help find the pituitary hGH that might have caused CJD. One animal developed the disease 5 years after injection of pituitary hGH. Two other animals that received injections from different vials of the same pituitary hGH preparation did not develop CJD. - None of the people who developed CJD are known to have received the hormone preparation that made the animal sick. At most, two patients (whose records are incomplete) may have received this pituitary hGH preparation. Because of this, we do not believe that the patients who received the hormone preparation that transmitted CJD to the animal have a greater risk of developing CJD than others treated with pituitary hGH. Because each preparation of pituitary hGH was used to fill multiple vials, it is not known if CJD contamination was spread evenly among all vials of pituitary hGH that came from a particular preparation. It's possible that one vial got more contamination and another got little or none from the same preparation of pituitary hGH. It is believed that multiple preparations of pituitary hGH probably had very low levels of the CJD infectious agent. With such low levels of contamination, some vials of a preparation might carry CJD while other vials would not. Further, most of the people who got CJD received pituitary hGH for long periods of time and received many different preparations. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
How to diagnose National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | CJD is usually diagnosed based on signs and symptoms of the illness, how severe they are, and how quickly they become worse. However, doctors must study brain tissue from a biopsy or autopsy in order to make a definite diagnosis of CJD.
Other tests can suggest CJD. In 1996, researchers developed a test that helps doctors diagnose CJD in patients with symptoms. This test detects an abnormal protein in a sample of spinal fluid. When this protein is found, it helps make a diagnosis of CJD. It is much easier and safer to take a sample of spinal fluid than to do a brain biopsy. Unfortunately, this test cannot identify CJD in patients who do not have symptoms. The test cannot predict who may develop CJD in the future.
Researchers from many countries, including the United States, have reported success using MRI to diagnose CJD and vCJD in people with symptoms of the disease. MRI is a safe and painless tool that allows doctors to look at images of the brain and does not involve the collection of brain or spinal fluid samples. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
what research (or clinical trials) is being done for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | Although CJD is a rare disorder, some of the world's leading researchers are working hard to learn more about this disease.
About 10 percent of the people who get CJD have the inherited type. Some people have gotten CJD from medical procedures such as pituitary hGH injections, tissue grafts, or corneal transplants. Scientists don't fully understand what causes CJD. Evidence suggests that a unique infectious agent called a prion [PREE-on] may be the cause. A prion is an unusual infectious agent because it contains no genetic material. It is a protein that takes on different forms. In its normal, harmless form, the protein is curled into a spiral. In its infectious form, the protein folds into an abnormal shape. Somehow, these abnormal proteins change the shape of normal proteins. This change begins a serious chain reaction that results in brain problems.
People with inherited CJD have an abnormal gene that leads to changes in their prion protein. This gene makes the protein likely to assume the abnormal shape. Exposure to the abnormal form of the protein can also occur through injection of contaminated pituitary hGH, tissue grafts, and corneal transplants and through exposures to infected brain tissue.
If CJD results from a defect in protein folding, it may be possible to identify drugs that can help the prion protein assume its proper shape. Such drugs would slow or stop the progress of the disease. Treatments like these are being studied by researchers. Researchers in both Europe and the United States are also trying to develop a test that will identify CJD before symptoms appear.
More information and medical journal articles about CJD and growth hormone therapy can be found on the National Endocrine and Metabolic Diseases Information Service web page Human Growth Hormone and Creutzfeldt-Jakob Disease Resource List. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What are the treatments for National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | Some parents did not tell their children about receiving treatment with pituitary hGH and the possible risk of CJD. These children are now adults. Although the HHS no longer sends annual information about the problem of CJD in pituitary hGH recipients, the HHS does maintain a mailing list should any important new information become available. If parents are no longer available to receive HHS mailings, their adult children may not have access to important new information. Some pituitary hGH recipients have learned about the risk of CJD from newspaper stories. Others heard about it when they tried to give blood. Those who were not told by their parents are often angry when they hear about it outside the family. Any parent of an individual who received pituitary hGH who has not received any mailings from the HHSthe last correspondence was sent in June 1999should contact the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) with the adult child's current address. Knowledgeable staff members are glad to answer any questions that parents or recipients may have. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What is (are) National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) ? | The Creutzfeldt-Jakob Disease Foundation, Inc. (www.cjdfoundation.org) was created in 1993 by two families who lost relatives to CJD and the neurologist who treated their family members. This nonprofit corporation seeks to promote awareness of CJD through research and education and to reach out to people who have lost loved ones to this illness. For information on CJD from the NIH, see www.ninds.nih.gov.
The Human Growth Foundation (HGF) (www.hgfound.org) is a nonprofit organization concerned with children's growth disorders and adult GH deficiency. The HGF has information available online and through its toll-free number, 18004516434. The HGF also supports an Internet mailing list to help the exchange of information about adult GH deficiency and adult GH replacement therapy. | NIDDK | National Hormone and Pituitary Program (NHPP): Information for People Treated with Pituitary Human Growth Hormone (Comprehensive Report) |
What is (are) High Blood Pressure and Kidney Disease ? | Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. Factors that can increase this force include higher blood volume due to extra fluid in the blood and blood vessels that are narrow, stiff, or clogged.
Blood pressure test results are written with two numbers separated by a slash. For example, a health care provider will write a blood pressure result as 120/80. A health care provider will say this blood pressure result 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.
Most people without chronic health conditions have a normal blood pressure if it stays below 120/80. Prehypertension is a systolic pressure of 120 to 139 or a diastolic pressure of 80 to 89. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.1
People should talk with their health care provider about their individual blood pressure goals and how often they should have their blood pressure checked. | NIDDK | High Blood Pressure and Kidney Disease |
What is (are) High Blood Pressure 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.
Kidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final product becomes urine. | NIDDK | High Blood Pressure and Kidney Disease |
What are the symptoms of High Blood Pressure and Kidney Disease ? | Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches.
Kidney disease also does not have symptoms in the early stages. A person may have swelling called edema, which happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, or ankles and less often in the hands or face. Once kidney function decreases further, symptoms can include
- appetite loss - nausea - vomiting - drowsiness or feeling tired - trouble concentrating - sleep problems - increased or decreased urination - generalized itching or numbness - dry skin - headaches - weight loss - darkened skin - muscle cramps - shortness of breath - chest pain | NIDDK | High Blood Pressure and Kidney Disease |
How to diagnose High Blood Pressure and Kidney Disease ? | A health care provider diagnoses high blood pressure when multiple blood pressure testsoften repeated over several visits to a health care providers officeshow that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90. Health care providers measure blood pressure with a blood pressure cuff. People can also buy blood pressure cuffs at discount chain stores and drugstores to monitor their blood pressure at home.
Kidney disease is diagnosed with urine and blood tests.
Urine Tests
Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. Albumin is a protein in the blood that can pass into the urine when the kidneys are damaged. A patient collects the urine sample in a special container in a health care providers office or a commercial facility. The office or facility tests the sample onsite or sends it 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 blood or protein is present in urine.
Urine albumin-to-creatinine ratio. A health care provider uses the albumin and creatinine measurement to determine the ratio between the albumin and creatinine in the urine. Creatinine is a waste product in the blood that is filtered in the kidneys and excreted in the urine. A urine albumin-to-creatinine ratio above 30 mg/g may be a sign of kidney disease.
Blood Test
A blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate (eGFR). The results of the test indicate the following:
- eGFR of 60 or above is in the normal range - eGFR below 60 may indicate kidney damage - eGFR of 15 or below may indicate kidney failure
Get Screened for Kidney Disease Kidney disease, when found early, can be treated to prevent more serious disease and other complications. The National Kidney Foundation recommends people with high blood pressure receive the following regular screenings: - blood pressure tests - urine albumin - eGFR Health care providers will help determine how often people with high blood pressure should be screened. | NIDDK | High Blood Pressure and Kidney Disease |
How to prevent High Blood Pressure and Kidney Disease ? | The best way to slow or prevent kidney disease from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as
- healthy eating - physical activity - maintaining a healthy weight - quitting smoking - managing stress
No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90.4
Medication
Medications that lower blood pressure 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 been shown 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 health care provider may prescribe a diuretica medication that helps the kidneys remove fluid from the blood. A person may also need beta blockers, calcium channel blockers, and other blood pressure medications. | NIDDK | High Blood Pressure and Kidney Disease |
What to do for High Blood Pressure and Kidney Disease ? | Following a healthy eating plan can help lower blood pressure. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan. DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan
- is low in fat and cholesterol - features fat-free or low-fat milk and dairy products, fish, poultry, and nuts - suggests less red meat, sweets, added sugars, and sugar-containing beverages - is rich in nutrients, protein, and fiber
Read more about DASH at www.nhlbi.nih.gov/health/resources/heart/hbp-dash-index.htm.
A dietitian may also recommend this type of diet for people who have already developed kidney disease. A diet low in sodium and liquid intake can help reduce edema and lower blood pressure. Reducing saturated fat and cholesterol can help control high levels of lipids, or fats, in the blood.
Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein, though the benefits of reducing protein in a persons diet is still being researched. 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 who are on a restricted protein diet should be monitored with blood tests that can show low nutrient levels.
In addition, consuming too much alcohol raises blood pressure, so people should limit alcoholic drinkstwo per day for men and one per day for women.
A health care provider can help people change their diet to meet their individual needs.
Physical Activity
Regular physical activity can lower blood pressure and reduce the chances of other health problems. A health care provider can provide information about how much and what kinds of activity are safe. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house.
Body Weight
People who are overweight or obese should aim to reduce their weight by 7 to 10 percent during the first year of treatment for high blood pressure. This amount of weight loss can lower the chance of health problems related to high blood pressure. Overweight is defined as a body mass index (BMI)a measurement of weight in relation to heightof 25 to 29. A BMI of 30 or higher is considered obese. A BMI lower than 25 is the goal for keeping blood pressure under control.5
Smoking
People who smoke should quit. Smoking can damage blood vessels, raise the chance of high blood pressure, and worsen health problems related to high blood pressure. People with high blood pressure should talk with their health care provider about programs and products they can use to quit smoking.
Stress
Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Some activities that may help reduce stress include
- exercising - practicing yoga or tai chi - listening to music - focusing on something calm or peaceful - meditating | NIDDK | High Blood Pressure and Kidney Disease |
What to do for High Blood Pressure and Kidney Disease ? | - Blood pressure is the force of blood pushing against blood vessel walls as the heart pumps out blood, and high blood pressure, also called hypertension, is an increase in the amount of force that blood places on blood vessels as it moves through the body. - High blood pressure can damage blood vessels in the kidneys, reducing their ability to work properly. When the force of blood flow is high, blood vessels stretch so blood flows more easily. Eventually, this stretching scars and weakens blood vessels throughout the body, including those in the kidneys. - High blood pressure is the second leading cause of kidney failure in the United States after diabetes. - A health care provider diagnoses high blood pressure when multiple blood pressure testsoften repeated over several visits to a health care providers officeshow that a systolic blood pressure is consistently above 140 or a diastolic blood pressure is consistently above 90. - Kidney disease is diagnosed with urine and blood tests. - The best way to slow or prevent kidney damage from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as - healthy eating - physical activity - maintaining a healthy weight - quitting smoking - managing stress - No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90. | NIDDK | High Blood Pressure and Kidney Disease |
What is (are) Goodpasture Syndrome ? | Goodpasture syndrome is a pulmonary-renal syndrome, which is a group of acute illnesses involving the kidneys and lungs. Goodpasture syndrome includes all of the following conditions:
- glomerulonephritisinflammation of the glomeruli, which are tiny clusters of looping blood vessels in the kidneys that help filter wastes and extra water from the blood - the presence of anti-glomerular basement membrane (GBM) antibodies; the GBM is part of the glomeruli and is composed of collagen and other proteins - bleeding in the lungs
In Goodpasture syndrome, immune cells produce antibodies against a specific region of collagen. The antibodies attack the collagen in the lungs and kidneys.
Ernest Goodpasture first described the syndrome during the influenza pandemic of 1919 when he reported on a patient who died from bleeding in the lungs and kidney failure. Diagnostic tools to confirm Goodpasture syndrome were not available at that time, so it is not known whether the patient had true Goodpasture syndrome or vasculitis. Vasculitis is an autoimmune conditiona disorder in which the bodys immune system attacks the bodys own cells and organsthat involves inflammation in the blood vessels and can cause similar lung and kidney problems.
Goodpasture syndrome is sometimes called anti-GBM disease. However, anti-GBM disease is only one cause of pulmonary-renal syndromes, including Goodpasture syndrome.
Goodpasture syndrome is fatal unless quickly diagnosed and treated. | NIDDK | Goodpasture Syndrome |
What causes Goodpasture Syndrome ? | The causes of Goodpasture syndrome are not fully understood. People who smoke or use hair dyes appear to be at increased risk for this condition. Exposure to hydrocarbon fumes, metallic dust, and certain drugs, such as cocaine, may also raise a persons risk. Genetics may also play a part, as a small number of cases have been reported in more than one family member. | NIDDK | Goodpasture Syndrome |
What are the symptoms of Goodpasture Syndrome ? | The symptoms of Goodpasture syndrome may initially include fatigue, nausea, vomiting, and weakness. The lungs are usually affected before or at the same time as the kidneys, and symptoms can include shortness of breath and coughing, sometimes with blood. The progression from initial symptoms to the lungs being affected may be very rapid. Symptoms that occur when the kidneys are affected include blood in the urine or foamy urine, swelling in the legs, and high blood pressure. | NIDDK | Goodpasture Syndrome |
How to diagnose Goodpasture Syndrome ? | A health care provider may order the following tests to diagnose Goodpasture syndrome:
- Urinalysis. Urinalysis 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 protein or blood are present in urine. A high number of red blood cells and high levels of protein in the urine indicate kidney damage. - 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. The blood test can show the presence of anti-GBM antibodies. - Chest x ray. An x ray of the chest is performed in a health care providers office, outpatient center, or hospital by an x-ray technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging. Abnormalities in the lungs, if present, can be seen on the x ray. - Biopsy. A biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. The biopsy is 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 scan to guide the biopsy needle into the kidney. The tissue is examined in a lab by a pathologista doctor who specializes in diagnosing diseases. The test can show crescent-shaped changes in the glomeruli and lines of antibodies attached to the GBM. | NIDDK | Goodpasture Syndrome |
What are the treatments for Goodpasture Syndrome ? | Goodpasture syndrome is usually treated with
- immunosuppressive medications, such as cyclophosphamide, to keep the immune system from making antibodies - corticosteroid medications to suppress the bodys autoimmune response - plasmapheresisa procedure that uses a machine to remove blood from the body, separate certain cells from the plasma, and return just the cells to the persons body; the anti-GBM antibodies remain in the plasma and are not returned to the persons body
Plasmapheresis is usually continued for several weeks, and immunosuppressive medications may be given for 6 to 12 months, depending on the response to therapy. In most cases, bleeding in the lungs stops and no permanent lung damage occurs. Damage to the kidneys, however, may be long lasting. If the kidneys fail, blood-filtering treatments called dialysis or kidney transplantation may become necessary. | NIDDK | Goodpasture Syndrome |
What to do for Goodpasture Syndrome ? | Eating, diet, and nutrition have not been shown to play a role in causing or preventing Goodpasture syndrome. | NIDDK | Goodpasture Syndrome |
What to do for Goodpasture Syndrome ? | - Goodpasture syndrome is a pulmonary-renal syndrome, which is a group of acute illnesses involving the kidneys and lungs. Goodpasture syndrome includes all of the following conditions: - glomerulonephritis - the presence of anti-glomerular basement membrane (GBM) antibodies - bleeding in the lungs - Goodpasture syndrome is fatal unless quickly diagnosed and treated. - People who smoke or use hair dyes appear to be at increased risk for this condition. Exposure to hydrocarbon fumes, metallic dust, and certain drugs may also raise a persons risk. - The symptoms of Goodpasture syndrome may initially include fatigue, nausea, vomiting, and weakness. The lungs are usually affected before or at the same time as the kidneys, and symptoms can include shortness of breath and coughing, sometimes with blood. Symptoms that occur when the kidneys are affected include blood in the urine or foamy urine, swelling in the legs, and high blood pressure. - A urinalysis, blood test, chest x ray, and kidney biopsy are used to diagnose Goodpasture syndrome. - Goodpasture syndrome is usually treated with immunosuppressive medications, corticosteroid medications, and plasmapheresis. | NIDDK | Goodpasture Syndrome |
What are the symptoms of Prevent diabetes problems: Keep your eyes healthy ? | Often, no symptoms appear during the early stages of diabetes retina problems. As retina problems worsen, your symptoms might include
- blurry or double vision - rings, flashing lights, or blank spots in your vision - dark or floating spots in your vision - pain or pressure in one or both of your eyes - trouble seeing things out of the corners of your eyes | NIDDK | Prevent diabetes problems: Keep your eyes healthy |
What are the treatments for Prevent diabetes problems: Keep your eyes healthy ? | You can help your diabetes retina problems by controlling your
- blood glucose - blood pressure - cholesterol and triglycerides, or types of blood fat
If your retinopathy still does not improve, then you may need other treatments. You will need to see an ophthalmologist who can decide whether you need one of these treatments:
- Medicines. Your doctor treats macular edema with injections of medicines into the eye. These medicines block a protein in the body that causes abnormal blood vessel growth and fluid leakage. Reducing the fluid leakage often allows the retina to return to normal thickness. The ophthalmologist will numb your eye and then insert a tiny needle to deliver the medicine. - Laser treatment. Your doctor can also treat macular edema with focal laser treatment. In one visit, the ophthalmologist will numb your eye and place many small laser burns in the areas leaking fluid near the macula. These burns slow the leakage of fluid and reduce the amount of fluid in your retina. Sometimes your doctor also treats diabetic retinopathy with scatter laser treatment. In two or more visits, the ophthalmologist will numb your eye and place thousands of laser burns around the new, weak blood vessels away from the macula, causing them to shrink. Laser treatment can greatly reduce your chances of blindness from retina damage. However, laser treatment often cannot restore vision that has already been lost. Treatment with medicines or lasers can be performed in your ophthalmologists office. - Vitrectomy. If the bleeding in your eye is severe, you may need to go to the hospital for a surgery called a vitrectomy. Your ophthalmologist will numb your eye or give you general anesthesia to help you fall asleep. The ophthalmologist will make a tiny cut in your eye and remove the vitreous gel that is clouded with blood. The ophthalmologist replaces the vitreous gel with a salt solution. | NIDDK | Prevent diabetes problems: Keep your eyes healthy |
What is (are) Urinary Tract Infections in Children ? | A UTI is an infection in the urinary tract. Infections are caused by microbesorganisms too small to be seen without a microscopeincluding fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the bodys natural defenses and cause infection. An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may travel up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis. | NIDDK | Urinary Tract Infections in Children |
What is (are) Urinary Tract Infections in Children ? | 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 a pair of bean-shaped organs, each about the size of a fist and located below the ribs, one on each side of the spine, toward the middle of the back. 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 an adult produces each day. Children produce less urine each day; the amount produced depends on their age. The urine travels from the kidneys down two narrow tubes called the ureters. The urine is then stored in a balloonlike organ called the bladder. Routinely, urine drains in only one directionfrom the kidneys to the bladder. The bladder fills with urine until it is full enough to signal the need to urinate. In children, the bladder can hold about 2 ounces of urine plus 1 ounce for each year of age. For example, an 8-year-olds bladder can hold about 10 ounces of urine.
When the bladder empties, a muscle called the sphincter relaxes and urine flows out of the body through a tube called the urethra at the bottom of the bladder. The opening of the urethra is at the end of the penis in boys and in front of the vagina in girls. | NIDDK | Urinary Tract Infections in Children |
What causes Urinary Tract Infections in Children ? | Most UTIs are caused by bacteria that live in the bowel. The bacterium Escherichia coli (E. coli) causes the vast majority of UTIs. The urinary tract has several systems to prevent infection. The points where the ureters attach to the bladder act like one-way valves to prevent urine from backing up, or refluxing, toward the kidneys, and urination washes microbes out of the body. Immune defenses also prevent infection. But despite these safeguards, infections still occur. Certain bacteria have a strong ability to attach themselves to the lining of the urinary tract.
Children who often delay urination are more likely to develop UTIs. Regular urination helps keep the urinary tract sterile by flushing away bacteria. Holding in urine allows bacteria to grow. Producing too little urine because of inadequate fluid intake can also increase the risk of developing a UTI. Chronic constipationa condition in which a child has fewer than two bowel movements a weekcan add to the risk of developing a UTI. When the bowel is full of hard stool, it presses against the bladder and bladder neck, blocking the flow of urine and allowing bacteria to grow.
Some children develop UTIs because they are prone to such infections, just as other children are prone to getting coughs, colds, or ear infections. | NIDDK | Urinary Tract Infections in Children |
How many people are affected by Urinary Tract Infections in Children ? | Urinary tract infections affect about 3 percent of children in the United States every year. UTIs account for more than 1 million visits to pediatricians offices every year.1 | NIDDK | Urinary Tract Infections in Children |
Who is at risk for Urinary Tract Infections in Children? ? | Throughout childhood, the risk of having a UTI is 2 percent for boys and 8 percent for girls. Having an anomaly of the urinary tract, such as urine reflux from the bladder back into the ureters, increases the risk of a UTI. Boys who are younger than 6 months old who are not circumcised are at greater risk for a UTI than circumcised boys the same age.1 | NIDDK | Urinary Tract Infections in Children |
What are the symptoms of Urinary Tract Infections in Children ? | Symptoms of a UTI range from slight burning with urination or unusual-smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms. A UTI causes irritation of the lining of the bladder, urethra, ureters, and kidneys, just as the inside of the nose or the throat becomes irritated with a cold. In infants or children who are only a few years old, the signs of a UTI may not be clear because children that young cannot express exactly how they feel. Children may have a high fever, be irritable, or not eat.
On the other hand, children may have only a low-grade fever; experience nausea, vomiting, and diarrhea; or just not seem healthy. Children who have a high fever and appear sick for more than a day without signs of a runny nose or other obvious cause for discomfort should be checked for a UTI.
Older children with UTIs may complain of pain in the middle and lower abdomen. They may urinate often. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of a UTI. Children may leak urine into clothing or bedsheets. The urine may look cloudy or bloody. If a kidney is infected, children may complain of pain in the back or side below the ribs.
Parents should talk with their health care provider if they suspect their child has a UTI. | NIDDK | Urinary Tract Infections in Children |
How to diagnose Urinary Tract Infections in Children ? | Only a health care provider can determine whether a child has a UTI.
A urine sample will be collected and examined. The way urine is collected depends on the childs age:
- If the child is not yet toilet trained, the health care provider may place a plastic collection bag over the childs genital area. The bag will be sealed to the skin with an adhesive strip. If this method is used, the bag should be removed right after the child has urinated, and the urine sample should be processed immediately. Because bacteria from the skin can contaminate this sample, the methods listed below are more accurate. - A health care provider may need to pass a small tube called a catheter into the urethra of an infant. Urine will drain directly from the bladder into a clean container. - Sometimes the best way to collect a urine sample from an infant is by placing a needle directly into the bladder through the skin of the lower abdomen. Getting urine through a catheter or needle will ensure that the urine collected does not contain bacteria from the skin. - An older child may be asked to urinate into a container. The sample needs to come as directly into the container as possible to avoid picking up bacteria from the skin or rectal area.
Some of the urine will be examined with a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. A urine culture should also be performed on some of the urine. The culture is performed by placing part of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified.
The reliability of the culture depends on how the urine is collected and how long the urine stands before the culture is started. If the urine sample is collected at home, it should be refrigerated as soon as it is collected. The container should be carried to the health care provider or lab in a plastic bag filled with ice.
The health care provider may also order a sensitivity test, which tests the bacteria for sensitivity to different antibiotics to see which medication is best for treating the infection. | NIDDK | Urinary Tract Infections in Children |
What are the treatments for Urinary Tract Infections in Children ? | Most UTIs are caused by bacteria, which are treated with bacteria-fighting medications called antibiotics or antimicrobials. While a urine sample is sent to a laboratory, the health care provider may begin treatment with an antibiotic that treats the bacteria most likely to be causing the infection. Once culture results are known, the health care provider may decide to switch the childs antibiotic.
The choice of medication and length of treatment depend on the childs history and the type of bacteria causing the infection. When a child is sick or unable to drink fluids, the antibiotic may need to be put directly into the bloodstream through a vein in the arm or hand or be given as an injection. Otherwise, the medicationliquid or pillsmay be given by mouth. The medication is given for at least 3 to 5 days and possibly for as long as several weeks. The daily treatment schedule recommended depends on the specific medication prescribed: The schedule may call for a single dose each day or up to four doses each day. In some cases, a child will need to take the medication until further tests are finished.
After a few doses of the antibiotic, a child may appear much better, but often several days may pass before all symptoms are gone. In any case, the medication should be taken for as long as the health care provider recommends. Medications should not be stopped because the symptoms have gone away. Infections may return, and bacteria can resist future treatment if the medication is stopped too soon.
If needed, the health care provider may recommend an appropriate over-the-counter medication to relieve the pain of a UTI. A heating pad on the back or abdomen may also help. | NIDDK | Urinary Tract Infections in Children |
How to diagnose Urinary Tract Infections in Children ? | Once the infection has cleared, more tests may be recommended to check for abnormalities in the urinary tract. Repeated infections in an abnormal urinary tract may cause kidney damage. The kinds of tests ordered will depend on the child and the type of urinary infection. Because no single test can tell everything about the urinary tract that might be important, more than one of the tests listed below may be needed.
- Kidney and bladder ultrasound. 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 certain abnormalities in the kidneys and bladder. However, this test cannot reveal all important urinary abnormalities or measure how well the kidneys work. - Voiding cystourethrogram. This test is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The childs 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 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 children. This test can show abnormalities of the inside of the urethra and bladder. The test can also determine whether the flow of urine is normal when the bladder empties. - Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. A CT scan may include the injection of contrast medium. CT scans require the child to lie on a table that slides into a tunnel-shaped device where the x rays are taken. 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. CT scans can provide clearer, more detailed images to help the health care provider understand the problem. - 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 child 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 child 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 children with a fear of confined spaces. Like CT scans, MRIs can provide clearer, more detailed images. - 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. Radionuclide scans are 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. Radioactive chemicals injected into the blood can provide information about kidney function. Radioactive chemicals can also be put into the fluids used to fill the bladder and urethra for x ray, MRI, and CT imaging. Radionuclide scans expose a child to about the same amount or less of radiation as a conventional x ray. - Urodynamics. Urodynamic testing is any procedure that looks at how well the bladder, sphincters, and urethra are storing and releasing urine. Most of these tests are performed in the office of a urologista doctor who specializes in urinary problemsby a urologist, physician assistant, or nurse practitioner. Some procedures may require light sedation to keep the child calm. Most urodynamic tests focus on the bladders ability to hold urine and empty steadily and completely. Urodynamic tests can also show whether the bladder is having abnormal contractions that cause leakage. A health care provider may order these tests if there is evidence that the child has some kind of nerve damage or dysfunctional voidingunhealthy urination habits such as holding in urine when the bladder is full. | NIDDK | Urinary Tract Infections in Children |
What are the treatments for Urinary Tract Infections in Children ? | Some abnormalities in the urinary tract correct themselves as the child grows, but some may require surgical correction. While milder forms of VUR may resolve on their own, one common procedure to correct VUR is the reimplantation of the ureters. During this procedure, the surgeon repositions the connection between the ureters and the bladder so that urine will not reflux into the ureters and kidneys. This procedure may be performed through an incision that gives the surgeon a direct view of the bladder and ureters or laparoscopically. Laparoscopy is a procedure that uses a scope inserted through a small incision.
In recent years, health care providers have treated some cases of VUR by injecting substances into the bladder wall, just below the opening where the ureter joins the bladder. This injection creates a kind of narrowing or valve that keeps urine from refluxing into the ureters. The injection is delivered to the inside of the bladder through a catheter passed through the urethra, so there is no surgical incision. Evidence of clinically significant obstruction may indicate the need for surgery. | NIDDK | Urinary Tract Infections in Children |
How to prevent Urinary Tract Infections in Children ? | If a child has a normal urinary tract, parents can help the child avoid UTIs by encouraging regular trips to the bathroom. The parents should make sure the child gets enough to drink if infrequent urination is a problem. The child should be taught proper cleaning techniques after using the bathroom to keep bacteria from entering the urinary tract. Loose-fitting clothes and cotton underwear allow air to dry the area. Parents should consult a health care provider about the best ways to treat constipation. | NIDDK | Urinary Tract Infections in Children |
What to do for Urinary Tract Infections in Children ? | Children with a UTI should drink as much as they wish and not be forced to drink large amounts of fluid. The health care provider needs to know if a child is not interested in drinking or is unable to drink. | NIDDK | Urinary Tract Infections in Children |
What to do for Urinary Tract Infections in Children ? | - Urinary tract infections (UTIs) usually occur when the body fails to remove bacteria rapidly from the urinary tract. - UTIs affect about 3 percent of children in the United States every year. - Most UTIs are not serious, but chronic kidney infections can cause permanent damage. - A UTI in a young child may be a sign of an abnormality in the urinary tract that could lead to repeated problems. - Symptoms of a UTI range from slight burning with urination or unusual-smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms. - Parents should talk with their health care provider if they suspect their child has a UTI. | NIDDK | Urinary Tract Infections in Children |
What to do for Facing the Challenges of Chronic Kidney Disease in Children ? | For children with CKD, learning about nutrition is vital because their diet can affect how well their kidneys work. Parents or guardians should always consult with their childs health care team before making any dietary changes. Staying healthy with CKD requires paying close attention to the following elements of a diet:
- Protein. Children with CKD should eat enough protein for growth while limiting high protein intake. Too much protein can put an extra burden on the kidneys and cause kidney function to decline faster. Protein needs increase when a child is on dialysis because the dialysis process removes protein from the childs blood. The health care team recommends the amount of protein needed for the child. Foods with protein include - eggs - milk - cheese - chicken - fish - red meats - beans - yogurt - cottage cheese - Sodium. The amount of sodium children need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care team may recommend limiting or adding sodium and salt to the diet. Foods high in sodium include - canned foods - some frozen foods - most processed foods - some snack foods, such as chips and crackers - Potassium. Potassium levels need to stay in the normal range for children with CKD, because too little or too much potassium can cause heart and muscle problems. Children may need to stay away from some fruits and vegetables or reduce the number of servings and portion sizes to make sure they do not take in too much potassium. The health care team recommends the amount of potassium a child needs. Low-potassium fruits and vegetables include - apples - cranberries - strawberries - blueberries - raspberries - pineapple - cabbage - boiled cauliflower - mustard greens - uncooked broccoli High-potassium fruits and vegetables include - oranges - melons - apricots - bananas - potatoes - tomatoes - sweet potatoes - cooked spinach - cooked broccoli - Phosphorus. Children with CKD need to control the level of phosphorus in their blood because too much phosphorus pulls calcium from the bones, making them weaker and more likely to break. Too much phosphorus also can cause itchy skin and red eyes. As CKD progresses, a child may need to take a phosphate binder with meals to lower the concentration of phosphorus in the blood. Phosphorus is found in high-protein foods. Foods with low levels of phosphorus include - liquid nondairy creamer - green beans - popcorn - unprocessed meats from a butcher - lemon-lime soda - root beer - powdered iced tea and lemonade mixes - rice and corn cereals - egg whites - sorbet - Fluids. Early in CKD, a childs damaged kidneys may produce either too much or too little urine, which can lead to swelling or dehydration. As CKD progresses, children may need to limit fluid intake. The health care provider will tell the child and parents or guardians the goal for fluid intake.
More information is provided in the NIDDK health topics, Nutrition for Chronic Kidney Disease in Children and Kidney Failure: Eat Right to Feel Right on Hemodialysis. | NIDDK | Facing the Challenges of Chronic Kidney Disease in Children |
What to do for Facing the Challenges of Chronic Kidney Disease in Children ? | - Children with chronic kidney disease (CKD) may have a negative self-image and may have relationship problems with family members due to the stress of living with a chronic disease. The condition can lead to behavior problems and make participating in school and extracurricular activities more difficult. - CKD can cause learning problems because the buildup of wastes in the body can slow down nerve and brain function. Children with CKD may have trouble concentrating and may develop language and motor skills more slowly than their peers. - Parents and other adults can help children with CKD fit in at school, deal with low self-esteem, make friends, be physically active, and follow their treatment regimen. As children with CKD approach adulthood, they may need help with preparing to enter the workforce. - School attendance is vital in helping children with CKD lead the best life possible. - One way to help children feel empowered is to give them as much control and responsibility over their own care as possible: - Children can learn more about their medications, including doses. - Children on dialysis should be encouraged to take an active part in their treatments. - Parents or guardians should allow children to participate in treatment decision making. - Participating in regular classroom and extracurricular activities may help children improve their social skills. Summer camps and recreational programs for children with special needs can be a good place to make new friends. - Parents or guardians may feel protective of children with CKD; however, they should not try to limit activities unless instructed to by a health care provider. - Children with CKD may need to take multiple medications, eat a specific diet, and follow their health care providers orders to help control their disease. Many children have a hard time following the treatment regimen. Health care providers use the term nonadherence to describe the failure or refusal to take prescribed medications or follow a health care providers directions. - Adherence can be improved with a combination of health education, motivational techniques, and behavioral skill methods. - Many skilled professionals are available to ensure that children with CKD get the best possible care. The family may want to talk with a social worker, mental health professional, financial counselor, and dietitian. If a child reaches kidney failure, the medical staff at the dialysis center or transplantation clinic can provide help. - For children with CKD, learning about nutrition is vital because their diet can affect how well their kidneys work. Parents or guardians should always consult with their childs health care team before making any dietary changes. | NIDDK | Facing the Challenges of Chronic Kidney Disease in Children |
What is (are) Foodborne Illnesses ? | Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Common symptoms of foodborne illnesses include vomiting, diarrhea, abdominal pain, fever, and chills.
Most foodborne illnesses are acute, meaning they happen suddenly and last a short time, and most people recover on their own without treatment. Rarely, foodborne illnesses may lead to more serious complications. Each year, an estimated 48 million people in the United States experience a foodborne illness. Foodborne illnesses cause about 3,000 deaths in the United States annually.1 | NIDDK | Foodborne Illnesses |
What causes Foodborne Illnesses ? | The majority of foodborne illnesses are caused by harmful bacteria and viruses.2 Some parasites and chemicals also cause foodborne illnesses.
Bacteria
Bacteria are tiny organisms that can cause infections of the GI tract. Not all bacteria are harmful to humans.
Some harmful bacteria may already be present in foods when they are purchased. Raw foods including meat, poultry, fish and shellfish, eggs, unpasteurized milk and dairy products, and fresh produce often contain bacteria that cause foodborne illnesses. Bacteria can contaminate foodmaking it harmful to eatat any time during growth, harvesting or slaughter, processing, storage, and shipping.
Foods may also be contaminated with bacteria during food preparation in a restaurant or home kitchen. If food preparers do not thoroughly wash their hands, kitchen utensils, cutting boards, and other kitchen surfaces that come into contact with raw foods, cross-contaminationthe spread of bacteria from contaminated food to uncontaminated foodmay occur.
If hot food is not kept hot enough or cold food is not kept cold enough, bacteria may multiply. Bacteria multiply quickly when the temperature of food is between 40 and 140 degrees. Cold food should be kept below 40 degrees and hot food should be kept above 140 degrees. Bacteria multiply more slowly when food is refrigerated, and freezing food can further slow or even stop the spread of bacteria. However, bacteria in refrigerated or frozen foods become active again when food is brought to room temperature. Thoroughly cooking food kills bacteria.
Many types of bacteria cause foodborne illnesses. Examples include
- Salmonella, a bacterium found in many foods, including raw and undercooked meat, poultry, dairy products, and seafood. Salmonella may also be present on egg shells and inside eggs. - Campylobacter jejuni (C. jejuni), found in raw or undercooked chicken and unpasteurized milk. - Shigella, a bacterium spread from person to person. These bacteria are present in the stools of people who are infected. If people who are infected do not wash their hands thoroughly after using the bathroom, they can contaminate food that they handle or prepare. Water contaminated with infected stools can also contaminate produce in the field. - Escherichia coli (E. coli), which includes several different strains, only a few of which cause illness in humans. E. coli O157:H7 is the strain that causes the most severe illness. Common sources of E. coli include raw or undercooked hamburger, unpasteurized fruit juices and milk, and fresh produce. - Listeria monocytogenes (L. monocytogenes), which has been found in raw and undercooked meats, unpasteurized milk, soft cheeses, and ready-to-eat deli meats and hot dogs. - Vibrio, a bacterium that may contaminate fish or shellfish. - Clostridium botulinum (C. botulinum), a bacterium that may contaminate improperly canned foods and smoked and salted fish.
Viruses
Viruses are tiny capsules, much smaller than bacteria, that contain genetic material. Viruses cause infections that can lead to sickness. People can pass viruses to each other. Viruses are present in the stool or vomit of people who are infected. People who are infected with a virus may contaminate food and drinks, especially if they do not wash their hands thoroughly after using the bathroom.
Common sources of foodborne viruses include
- food prepared by a person infected with a virus - shellfish from contaminated water - produce irrigated with contaminated water
Common foodborne viruses include
- norovirus, which causes inflammation of the stomach and intestines - hepatitis A, which causes inflammation of the liver
Parasites
Parasites are tiny organisms that live inside another organism. In developed countries such as the United States, parasitic infections are relatively rare.
Cryptosporidium parvum and Giardia intestinalis are parasites that are spread through water contaminated with the stools of people or animals who are infected. Foods that come into contact with contaminated water during growth or preparation can become contaminated with these parasites. Food preparers who are infected with these parasites can also contaminate foods if they do not thoroughly wash their hands after using the bathroom and before handling food.
Trichinella spiralis is a type of roundworm parasite. People may be infected with this parasite by consuming raw or undercooked pork or wild game.
Chemicals
Harmful chemicals that cause illness may contaminate foods such as
- fish or shellfish, which may feed on algae that produce toxins, leading to high concentrations of toxins in their bodies. Some types of fish, including tuna and mahi mahi, may be contaminated with bacteria that produce toxins if the fish are not properly refrigerated before they are cooked or served. - certain types of wild mushrooms. - unwashed fruits and vegetables that contain high concentrations of pesticides. | NIDDK | Foodborne Illnesses |
Who is at risk for Foodborne Illnesses? ? | Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including
- infants and children - pregnant women and their fetuses - older adults - people with weak immune systems
These groups also have a greater risk of developing severe symptoms or complications of foodborne illnesses. | NIDDK | Foodborne Illnesses |
What are the symptoms of Foodborne Illnesses ? | Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include
- vomiting - diarrhea or bloody diarrhea - abdominal pain - fever - chills
Symptoms can range from mild to serious and can last from a few hours to several days.
C. botulinum and some chemicals affect the nervous system, causing symptoms such as
- headache - tingling or numbness of the skin - blurred vision - weakness - dizziness - paralysis | NIDDK | Foodborne Illnesses |
What are the complications of Foodborne Illnesses ? | Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronicor long lastinghealth problems.
Dehydration
When someone does not drink enough fluids to replace those that are lost through vomiting and diarrhea, dehydration can result. When dehydrated, the body lacks enough fluid and electrolytesminerals in salts, including sodium, potassium, and chlorideto function properly. Infants, children, older adults, and people with weak immune systems have the greatest risk of becoming dehydrated.
Signs of dehydration are
- excessive thirst - infrequent urination - dark-colored urine - lethargy, dizziness, or faintness
Signs of dehydration in infants and young children are
- dry mouth and tongue - lack of tears when crying - no wet diapers for 3 hours or more - high fever - unusually cranky or drowsy behavior - sunken eyes, cheeks, or soft spot in the skull
Also, when people are dehydrated, their skin does not flatten back to normal right away after being gently pinched and released.
Severe dehydration may require intravenous fluids and hospitalization. Untreated severe dehydration can cause serious health problems such as organ damage, shock, or comaa sleeplike state in which a person is not conscious.
HUS
Hemolytic uremic syndrome is a rare disease that mostly affects children younger than 10 years of age. HUS develops when E. coli bacteria lodged in the digestive tract make toxins that enter the bloodstream. The toxins start to destroy red blood cells, which help the blood to clot, and the lining of the blood vessels.
In the United States, E. coli O157:H7 infection is the most common cause of HUS, but infection with other strains of E. coli, other bacteria, and viruses may also cause HUS. A recent study found that about 6 percent of people with E. coli O157:H7 infections developed HUS. Children younger than age 5 have the highest risk, but females and people age 60 and older also have increased risk.3
Symptoms of E. coli O157:H7 infection include diarrhea, which may be bloody, and abdominal pain, often accompanied by nausea, vomiting, and fever. Up to a week after E. coli symptoms appear, symptoms of HUS may develop, including irritability, paleness, and decreased urination. HUS may lead to acute renal failure, which is a sudden and temporary loss of kidney function. HUS may also affect other organs and the central nervous system. Most people who develop HUS recover with treatment. Research shows that in the United States between 2000 and 2006, fewer than 5 percent of people who developed HUS died of the disorder. Older adults had the highest mortality rateabout one-third of people age 60 and older who developed HUS died.3
Studies have shown that some children who recover from HUS develop chronic complications, including kidney problems, high blood pressure, and diabetes.
Other Complications
Some foodborne illnesses lead to other serious complications. For example, C. botulinum and certain chemicals in fish and seafood can paralyze the muscles that control breathing. L. monocytogenes can cause spontaneous abortion or stillbirth in pregnant women.
Research suggests that acute foodborne illnesses may lead to chronic disorders, including
- reactive arthritis, a type of joint inflammation that usually affects the knees, ankles, or feet. Some people develop this disorder following foodborne illnesses caused by certain bacteria, including C. jejuni and Salmonella. Reactive arthritis usually lasts fewer than 6 months, but this condition may recur or become chronic arthritis.4 - irritable bowel syndrome (IBS), a disorder of unknown cause that is associated with abdominal pain, bloating, and diarrhea or constipation or both. Foodborne illnesses caused by bacteria increase the risk of developing IBS.5 - Guillain-Barr syndrome, a disorder characterized by muscle weakness or paralysis that begins in the lower body and progresses to the upper body. This syndrome may occur after foodborne illnesses caused by bacteria, most commonly C. jejuni. Most people recover in 6 to 12 months.6
A recent study found that adults who had recovered from E. coli O157:H7 infections had increased risks of high blood pressure, kidney problems, and cardiovascular disease.7 | NIDDK | Foodborne Illnesses |
How to diagnose Foodborne Illnesses ? | To diagnose foodborne illnesses, health care providers ask about symptoms, foods and beverages recently consumed, and medical history. Health care providers will also perform a physical examination to look for signs of illness.
Diagnostic tests for foodborne illnesses may include a stool culture, in which a sample of stool is analyzed in a laboratory to check for signs of infections or diseases. A sample of vomit or a sample of the suspected food, if available, may also be tested. A health care provider may perform additional medical tests to rule out diseases and disorders that cause symptoms similar to the symptoms of foodborne illnesses.
If symptoms of foodborne illnesses are mild and last only a short time, diagnostic tests are usually not necessary. | NIDDK | Foodborne Illnesses |
What are the treatments for Foodborne Illnesses ? | The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration.
Over-the-counter medications such as loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol and Kaopectate) may help stop diarrhea in adults. However, people with bloody diarrheaa sign of bacterial or parasitic infectionshould not use these medications. If diarrhea is caused by bacteria or parasites, over-the-counter medications may prolong the problem. Medications to treat diarrhea in adults can be dangerous for infants and children and should only be given with a health care providers guidance.
If the specific cause of the foodborne illness is diagnosed, a health care provider may prescribe medications, such as antibiotics, to treat the illness.
Hospitalization may be required to treat lifethreatening symptoms and complications, such as paralysis, severe dehydration, and HUS. | NIDDK | Foodborne Illnesses |
What to do for Foodborne Illnesses ? | The following steps may help relieve the symptoms of foodborne illnesses and prevent dehydration in adults:
- drinking plenty of liquids such as fruit juices, sports drinks, caffeine-free soft drinks, and broths to replace fluids and electrolytes - sipping small amounts of clear liquids or sucking on ice chips if vomiting is still a problem - gradually reintroducing food, starting with bland, easy-to-digest foods such as rice, potatoes, toast or bread, cereal, lean meat, applesauce, and bananas - avoiding fatty foods, sugary foods, dairy products, caffeine, and alcohol until recovery is complete
Infants and children present special concerns. Infants and children are likely to become dehydrated more quickly from diarrhea and vomiting because of their smaller body size. The following steps may help relieve symptoms and prevent dehydration in infants and children:
- giving oral rehydration solutions such as Pedialyte, Naturalyte, Infalyte, and CeraLyte to prevent dehydration - giving food as soon as the child is hungry - giving infants breast milk or fullstrength formula, as usual, along with oral rehydration solutions
Older adults and adults with weak immune systems should also drink oral rehydration solutions to prevent dehydration. | NIDDK | Foodborne Illnesses |
How to prevent Foodborne Illnesses ? | Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods.
- Raw and cooked perishable foodsfoods that can spoilshould be refrigerated or frozen promptly. If perishable foods stand at room temperature for more than 2 hours, they may not be safe to eat. Refrigerators should be set at 40 degrees or lower and freezers should be set at 0 degrees. - Foods should be cooked long enough and at a high enough temperature to kill the harmful bacteria that cause illnesses. A meat thermometer should be used to ensure foods are cooked to the appropriate internal temperature: - 145 degrees for roasts, steaks, and chops of beef, veal, pork, and lamb, followed by 3 minutes of rest time after the meat is removed from the heat source - 160 degrees for ground beef, veal, pork, and lamb - 165 degrees for poultry - Cold foods should be kept cold and hot foods should be kept hot. - Fruits and vegetables should be washed under running water just before eating, cutting, or cooking. A produce brush can be used under running water to clean fruits and vegetables with firm skin. - Raw meat, poultry, seafood, and their juices should be kept away from other foods. - People should wash their hands for at least 20 seconds with warm, soapy water before and after handling raw meat, poultry, fish, shellfish, produce, or eggs. People should also wash their hands after using the bathroom, changing diapers, or touching animals. - Utensils and surfaces should be washed with hot, soapy water before and after they are used to prepare food. Diluted bleach1 teaspoon of bleach to 1 quart of hot watercan also be used to sanitize utensils and surfaces.
More information about preventing foodborne illnesses is available at www.foodsafety.gov. | NIDDK | Foodborne Illnesses |
What to do for Foodborne Illnesses ? | - Foodborne illnesses are infections or irritations of the gastrointestinal (GI) tract caused by food or beverages that contain harmful bacteria, parasites, viruses, or chemicals. - Anyone can get a foodborne illness. However, some people are more likely to develop foodborne illnesses than others, including infants and children, pregnant women and their fetuses, older adults, and people with weakened immune systems. - Symptoms of foodborne illnesses depend on the cause. Common symptoms of many foodborne illnesses include vomiting, diarrhea or bloody diarrhea, abdominal pain, fever, and chills. - Foodborne illnesses may lead to dehydration, hemolytic uremic syndrome (HUS), and other complications. Acute foodborne illnesses may also lead to chronicor long lastinghealth problems. - The only treatment needed for most foodborne illnesses is replacing lost fluids and electrolytes to prevent dehydration. - Foodborne illnesses can be prevented by properly storing, cooking, cleaning, and handling foods. | NIDDK | Foodborne Illnesses |
What is (are) Hypothyroidism ? | Hypothyroidism is a disorder that occurs when the thyroid gland does not make enough thyroid hormone to meet the bodys needs. Thyroid hormone regulates metabolismthe way the body uses energyand affects nearly every organ in the body. Without enough thyroid hormone, many of the bodys functions slow down. About 4.6 percent of the U.S. population age 12 and older has hypothyroidism.1 | NIDDK | Hypothyroidism |
What is (are) Hypothyroidism ? | The thyroid is a 2-inch-long, butterfly-shaped gland weighing less than 1 ounce. Located in the front of the neck below the larynx, or voice box, it has two lobes, one on each side of the windpipe. The thyroid is one of the glands that make up the endocrine system. The glands of the endocrine system produce and store hormones and release them into the bloodstream. The hormones then travel through the body and direct the activity of the bodys cells.
The thyroid gland makes two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). T3 is made from T4 and is the more active hormone, directly affecting the tissues. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels. | NIDDK | Hypothyroidism |
What causes Hypothyroidism ? | Hypothyroidism has several causes, including
- Hashimotos disease - thyroiditis, or inflammation of the thyroid - congenital hypothyroidism, or hypothyroidism that is present at birth - surgical removal of part or all of the thyroid - radiation treatment of the thyroid - some medications
Less commonly, hypothyroidism is caused by too much or too little iodine in the diet or by abnormalities of the pituitary gland.
Hashimotos Disease
Hashimotos disease, also called chronic lymphocytic thyroiditis, is the most common cause of hypothyroidism in the United States.1 Hashimotos disease is a form of chronic inflammation of the thyroid gland. Hashimotos disease is also an autoimmune disorder.
Normally, the immune system protects the body against foreign invaderssuch as viruses and bacteriathat can cause illness. But in autoimmune diseases, the immune system attacks the bodys own cells and organs. With Hashimotos disease, the immune system attacks the thyroid, causing inflammation and interfering with its ability to produce thyroid hormones.
More information is provided in the NIDDK health topic, Hashimotos Disease.
Thyroiditis
Thyroiditis causes stored thyroid hormone to leak out of the thyroid gland. At first, the leakage raises hormone levels in the blood, leading to hyperthyroidismwhen thyroid hormone levels are too highthat lasts for 1 or 2 months. Most people then develop hypothyroidism before the thyroid is completely healed.
Several types of thyroiditis can cause hyperthyroidism followed by hypothyroidism:
- Subacute thyroiditis. This condition involves painful inflammation and enlargement of the thyroid. Experts are not sure what causes subacute thyroiditis, but it may be related to a viral or bacterial infection. The condition usually goes away on its own in a few months. - Postpartum thyroiditis. This type of thyroiditis develops after a woman gives birth. For more information, see the section titled What happens with pregnancy and thyroid conditions? - Silent thyroiditis. This type of thyroiditis is called silent because it is painless, as is postpartum thyroiditis, even though the thyroid may be enlarged. Like postpartum thyroiditis, silent thyroiditis is probably an autoimmune condition and sometimes develops into permanent hypothyroidism.
Congenital Hypothyroidism
Some babies are born with a thyroid that is not fully developed or does not function properly. If untreated, congenital hypothyroidism can lead to mental retardation and growth failure. Early treatment can prevent these complications, so most newborns in the United States are screened for hypothyroidism.
Surgical Removal of the Thyroid
When part of the thyroid is removed, the remaining part may produce normal amounts of thyroid hormone, but some people who have this surgery develop hypothyroidism. Removal of the entire thyroid always results in hypothyroidism.
Part or all of the thyroid may be surgically removed as a treatment for
- hyperthyroidism - a large goiter, which is an enlarged thyroid that may cause the neck to appear swollen and can interfere with normal breathing and swallowing - thyroid nodules, which are noncancerous tumors, called adenomas, or lumps in the thyroid that can produce excess thyroid hormone - thyroid cancer
Radiation Treatment of the Thyroid
Radioactive iodine, a common treatment for hyperthyroidism, gradually destroys the cells of the thyroid. Most people who receive radioactive iodine treatment eventually develop hypothyroidism. People with Hodgkins disease, other lymphomas, and head or neck cancers are treated with radiation, which can also damage the thyroid.
Medications
Some drugs can interfere with thyroid hormone production and lead to hypothyroidism, including
- amiodarone, a heart medication - interferon alpha, a cancer medication - lithium, a bipolar disorder medication - interleukin-2, a kidney cancer medication | NIDDK | Hypothyroidism |
What are the symptoms of Hypothyroidism ? | Hypothyroidism has many symptoms that can vary from person to person. Some common symptoms of hypothyroidism are
- fatigue - weight gain - a puffy face - cold intolerance - joint and muscle pain - constipation - dry skin - dry, thinning hair - decreased sweating - heavy or irregular menstrual periods and impaired fertility - depression - slowed heart rate
However, hypothyroidism develops slowly, so many people dont notice symptoms of the disease.
Symptoms more specific to Hashimotos disease are a goiter and a feeling of fullness in the throat.
Hypothyroidism can contribute to high cholesterol, so people with high cholesterol should be tested for hypothyroidism. Rarely, severe, untreated hypothyroidism may lead to myxedema coma, an extreme form of hypothyroidism in which the bodys functions slow to the point that it becomes life threatening. Myxedema requires immediate medical treatment. | NIDDK | Hypothyroidism |
How to diagnose Hypothyroidism ? | Many symptoms of hypothyroidism are the same as those of other diseases, so hypothyroidism usually cannot be diagnosed based on symptoms alone. With suspected hypothyroidism, health care providers take a medical history and perform a thorough physical examination. Health care providers may then use several blood tests to confirm a diagnosis of hypothyroidism and find its cause:
TSH test. The ultrasensitive TSH test is usually the first test a health care provider performs. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available. Generally, a TSH reading above normal means a person has hypothyroidism and a reading below normal means a person has hyperthyroidism.
Mildly elevated TSH without symptoms indicates subclinical hypothyroidism. Some health care providers treat subclinical hypothyroidism immediately. Others prefer to leave it untreated but monitor their patients for signs that the condition is worsening.
Health care providers may conduct additional tests to help confirm the diagnosis or determine the cause of hypothyroidism.
T4 test. This test measures the actual amount of circulating thyroid hormone in the blood. In hypothyroidism, the level of T4 in the blood is lower than normal.
Thyroid autoantibody test. This test looks for the presence of thyroid autoantibodies. Most people with Hashimotos disease have these antibodies, but people whose hypothyroidism is caused by other conditions do not.
More information about testing for thyroid problems is provided in the NIDDK health topic, Thyroid Tests. | NIDDK | Hypothyroidism |
What are the treatments for Hypothyroidism ? | Health care providers treat hypothyroidism with synthetic thyroxine, a medication that is identical to the hormone T4. The exact dose will depend on the patients age and weight, the severity of the hypothyroidism, the presence of other health problems, and whether the person is taking other drugs that might interfere with how well the body uses thyroid hormone.
Health care providers test TSH levels about 6 to 8 weeks after a patient begins taking thyroid hormone and make any necessary adjustments to the dose. Each time the dose is adjusted, the blood is tested again. Once a stable dose is reached, blood tests are normally repeated in 6 months and then once a year.
Hypothyroidism can almost always be completely controlled with synthetic thyroxine, as long as the recommended dose is taken every day as instructed. | NIDDK | Hypothyroidism |
What to do for Hypothyroidism ? | Experts recommend that people eat a balanced diet to obtain most nutrients. More information about diet and nutrition can be found on the National Agricultural Library website at www.nutrition.gov.
Dietary Supplements
Iodine is an essential mineral for the thyroid. However, people with autoimmune thyroid disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodinesuch as seaweed, dulse, or kelpmay cause or worsen hypothyroidism or hyperthyroidism. More information about iodine can be found in the National Library of Medicine fact sheet Iodine in diet, available at www.nlm.nih.gov/medlineplus/ency/article/002421.htm.
Women need more iodine when they are pregnantabout 250 micrograms a day because the baby gets iodine from the mothers diet. In the United States, about 7 percent of pregnant women may not get enough iodine in their diet or through prenatal vitamins.3 Choosing iodized salt salt supplemented with iodineover plain salt and prenatal vitamins containing iodine will ensure this need is met.
To help ensure coordinated and safe care, people should discuss their use of dietary supplements, such as iodine, with their health care provider. Tips for talking with health care providers are available through the National Center for Complementary and Integrative Health. | NIDDK | Hypothyroidism |
What to do for Hypothyroidism ? | - Hypothyroidism is a disorder that occurs when the thyroid gland does not make enough thyroid hormone to meet the bodys needs. Thyroid hormone regulates metabolism. Without enough thyroid hormone, many of the bodys functions slow down. - Hypothyroidism has several causes, including - Hashimotos disease - thyroiditis - congenital hypothyroidism - surgical removal of part or all of the thyroid - radiation treatment of the thyroid - some medications - Hypothyroidism has many symptoms that can vary from person to person. Some common symptoms of hypothyroidism are fatigue, weight gain, cold intolerance, constipation, impaired fertility, and depression. - Women are much more likely than men to develop hypothyroidism. - Women with hypothyroidism should discuss their condition with their health care provider before becoming pregnant. - Hypothyroidism can almost always be completely controlled with synthetic thyroxine, as long as the recommended dose is taken every day as instructed. | NIDDK | Hypothyroidism |
What is (are) Medullary Sponge Kidney ? | Medullary sponge kidney, also known as Cacchi-Ricci disease, is a birth defect where changes occur in the tubules, or tiny tubes, inside a fetus kidneys.
In a normal kidney, urine flows through these tubules as the kidney is being formed during a fetus growth. In medullary sponge kidney, tiny, fluid-filled sacs called cysts form in the tubules within the medullathe inner part of the kidneycreating a spongelike appearance. The cysts keep urine from flowing freely through the tubules.
Symptoms of medullary sponge kidney do not usually appear until the teenage years or the 20s. Medullary sponge kidney can affect one or both kidneys. | NIDDK | Medullary Sponge Kidney |
What are the complications of Medullary Sponge Kidney ? | Complications of medullary sponge kidney include
- hematuria, or blood in the urine - kidney stones - urinary tract infections (UTIs)
Medullary sponge kidney rarely leads to more serious problems, such as chronic kidney disease or kidney failure. | NIDDK | Medullary Sponge Kidney |
What causes Medullary Sponge Kidney ? | Scientists do not fully understand the cause of medullary sponge kidney or why cysts form in the tubules during fetal development. Even though medullary sponge kidney is present at birth, most cases do not appear to be inherited. | NIDDK | Medullary Sponge Kidney |
How many people are affected by Medullary Sponge Kidney ? | Medullary sponge kidney affects about one person per 5,000 people in the United States. Researchers have reported that 12 to 20 percent of people who develop calcium-based kidney stones have medullary sponge kidney1. | NIDDK | Medullary Sponge Kidney |
What are the symptoms of Medullary Sponge Kidney ? | Many people with medullary sponge kidney have no symptoms. The first sign that a person has medullary sponge kidney is usually a UTI or a kidney stone. UTIs and kidney stones share many of the same signs and symptoms:
- burning or painful urination - pain in the back, lower abdomen, or groin - cloudy, dark, or bloody urine - foul-smelling urine - fever and chills - vomiting
People who experience these symptoms should see or call a health care provider as soon as possible. | NIDDK | Medullary Sponge Kidney |
How to diagnose Medullary Sponge Kidney ? | A health care provider diagnoses medullary sponge kidney based on
- a medical and family history - a physical exam - imaging studies
Medical and Family History
Taking a medical and family history can help diagnose medullary sponge kidney. A health care provider will suspect medullary sponge kidney when a person has repeated UTIs or kidney stones.
Physical Exam
No physical signs are usually present in a patient with medullary sponge kidney, except for blood in the urine. Health care providers usually confirm a diagnosis of medullary sponge kidney with imaging studies.
Imaging Studies
Imaging is the medical term for tests that use different methods to see bones, tissues, and organs inside the body. Health care providers commonly choose one or more of three imaging techniques to diagnose medullary sponge kidney:
- intravenous pyelogram - computerized tomography (CT) scan - ultrasound
A radiologista doctor who specializes in medical imaginginterprets the images from these studies, and patients do not need anesthesia.
Intravenous Pyelogram
In an intravenous pyelogram, a health care provider injects a special dye, called contrast medium, into a vein in the patients arm. The contrast medium travels through the body to the kidneys. The kidneys excrete the contrast medium into urine, which makes the urine visible on an x-ray. An x-ray technician performs this procedure at a health care providers office, an outpatient center, or a hospital. An intravenous pyelogram can show any blockage in the urinary tract, and the cysts show up as clusters of light.
Computerized Tomography Scans
Computerized tomography scans use a combination of x-rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the x-rays are taken. An x-ray technician performs the procedure in an outpatient center or a hospital. CT scans can show expanded or stretched tubules.
Ultrasound
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. Ultrasound can show kidney stones and calcium deposits within the kidney. | NIDDK | Medullary Sponge Kidney |
What are the treatments for Medullary Sponge Kidney ? | Scientists have not discovered a way to reverse medullary sponge kidney. Once a health care provider is sure a person has medullary sponge kidney, treatment focuses on
- curing an existing UTI - removing any kidney stones
Curing an Existing Urinary Tract Infection
To treat a UTI, the health care provider may prescribe a medication called an antibiotic that kills bacteria. The choice of medication and length of treatment depend on the persons medical history and the type of bacteria causing the infection. More information is provided in the NIDDK health topic, Urinary Tract Infections in Adults.
Removing Kidney Stones
Treatment for kidney stones usually depends on their size and what they are made of, as well as whether they are causing pain or obstructing the urinary tract. Kidney stones may be treated by a general practitioner or by a urologista doctor who specializes in the urinary tract.
Small stones usually pass through the urinary tract without treatment. Still, the person may need pain medication and should drink lots of liquids to help move the stone along. Pain control may consist of oral or intravenous (IV) medication, depending on the duration and severity of the pain. People may need IV fluids if they become dehydrated from vomiting or an inability to drink.
A person with a larger stone, or one that blocks urine flow and causes great pain, may need more urgent treatment, such as
- shock wave lithotripsy. A machine called a lithotripter is used to break up the kidney stone into smaller pieces to pass more easily through the urinary tract. The patient may need local or general anesthesia. - ureteroscopy. A ureteroscopea long, tubelike instrument with an eyepieceis used to find and retrieve the stone with a small basket or to break the stone up with laser energy. Local or general anesthesia may be required. - percutaneous nephrolithotomy. In this procedure, a wire-thin viewing instrument, called a nephroscope, is used to locate and remove the stones. During the procedure, which requires general anesthesia, a tube is inserted directly into the kidney through a small incision in the patients back.
More information is provided in the NIDDK health topic, Kidney Stones in Adults. | NIDDK | Medullary Sponge Kidney |
How to prevent Medullary Sponge Kidney ? | Scientists have not yet found a way to prevent medullary sponge kidney. However, health care providers can recommend medications and dietary changes to prevent future UTIs and kidney stones. | NIDDK | Medullary Sponge Kidney |
How to prevent Medullary Sponge Kidney ? | Health care providers may prescribe certain medications to prevent UTIs and kidney stones:
- A person with medullary sponge kidney may need to continue taking a low-dose antibiotic to prevent recurrent infections. - Medications that reduce calcium in the urine may help prevent calcium kidney stones. These medications may include - potassium citrate - thiazide | NIDDK | Medullary Sponge Kidney |
What to do for Medullary Sponge Kidney ? | The following changes in diet may help prevent UTIs and kidney stone formation:
- Drinking plenty of water and other liquids can help flush bacteria from the urinary tract and dilute urine so kidney stones cannot form. A person should drink enough liquid to produce about 2 to 2.5 quarts of urine every day.3 - Reducing sodium intake, mostly from salt, may help prevent kidney stones. Diets high in sodium can increase the excretion of calcium into the urine and thus increase the chance of calciumcontaining kidney stones forming. - Foods rich in animal proteins such as meat, eggs, and fish can increase the chance of uric acid stones and calcium stones forming. People who form stones should limit their meat consumption to 6 to 8 ounces a day.4 - People who are more likely to develop calcium oxalate stones should include 1,000 milligrams of calcium in their diet every day. Adults older than 50 years should consume 1,200 milligrams of calcium daily.3 Calcium in the digestive tract binds to oxalate from food and keeps it from entering the blood and the urinary tract, where it can form stones.
People with medullary sponge kidney should talk with their health care provider or a dietitian before making any dietary changes. A dietitian can help a person plan healthy meals. | NIDDK | Medullary Sponge Kidney |
What to do for Medullary Sponge Kidney ? | - Medullary sponge kidney, also known as Cacchi-Ricci disease, is a birth defect where changes occur in the tubules, or tiny tubes, inside a fetus kidneys. - Symptoms of medullary sponge kidney do not usually appear until the teenage years or the 20s. Medullary sponge kidney can affect one or both kidneys. - Complications of medullary sponge kidney include - hematuria, or blood in the urine - kidney stones - urinary tract infections (UTIs) - Many people with medullary sponge kidney have no symptoms. The first sign that a person has medullary sponge kidney is usually a UTI or a kidney stone. UTIs and kidney stones share many of the same signs and symptoms: - burning or painful urination - pain in the back, lower abdomen, or groin - cloudy, dark, or bloody urine - foul-smelling urine - fever and chills - vomiting - Health care providers commonly choose one or more of three imaging techniques to diagnose medullary sponge kidney: - intravenous pyelogram - computerized tomography (CT) scan - ultrasound - Scientists have not discovered a way to reverse medullary sponge kidney. Once a health care provider is sure a person has medullary sponge kidney, treatment focuses on - curing an existing UTI - removing any kidney stones - Scientists have not yet found a way to prevent medullary sponge kidney. However, health care providers can recommend medications and dietary changes to prevent future UTIs and kidney stones. | NIDDK | Medullary Sponge Kidney |
What is (are) Lupus Nephritis ? | Lupus nephritis is kidney inflammation caused by systemic lupus erythematosus (SLE or lupus). SLE is an autoimmune diseasea disorder in which the bodys immune system attacks the bodys own cells and organs. Up to 60 percent of people with SLE are diagnosed with lupus nephritis, which can lead to significant illness and even death.1 | NIDDK | Lupus Nephritis |
What is (are) Lupus Nephritis ? | 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 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 until releasing it through urination. | NIDDK | Lupus Nephritis |
What are the symptoms of Lupus Nephritis ? | The symptoms of lupus nephritis may include high blood pressure, foamy urine, and edemaswelling, usually in the legs, feet, or ankles and less often in the hands or face.
Kidney problems often develop at the same time or shortly after lupus symptoms appear and can include
- joint pain or swelling - muscle pain - fever with no known cause - red rashes, often on the face, which are also called butterfly rashes because of their shape | NIDDK | Lupus Nephritis |
How to diagnose Lupus Nephritis ? | Lupus nephritis is diagnosed through urine and blood tests and a kidney biopsy:
- Urinalysis. Urinalysis 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 blood or protein is present. A high number of red blood cells or high levels of protein in the urine indicate kidney damage. - 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. The blood test can show high levels of creatinine, a waste product of normal muscle breakdown excreted by the kidneys, which increases when the kidneys are not functioning well. - Biopsy. A biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. The biopsy is 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 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 can confirm a diagnosis of lupus nephritis, determine how far the disease has progressed, and guide treatment. The American College of Rheumatology recommends biopsies for all people with evidence of active lupus nephritis that has not been previously treated. | NIDDK | Lupus Nephritis |
What are the treatments for Lupus Nephritis ? | Lupus nephritis is treated with medications that suppress the immune system, so it stops attacking and damaging the kidneys. Standard treatment includes a corticosteroid, usually prednisone, to reduce inflammation in the kidneys. An immunosuppressive medication, such as cyclophosphamide or mycophenolate mofetil, is typically used with prednisone. These medicationswhen taken as prescribed by a health care providerfurther decrease the activity of the immune system and block the bodys immune cells from attacking the kidneys directly or making antibodies that attack the kidneys. Antibodies are proteins made by the immune system to protect the body from foreign substances such as bacteria or viruses. Hydroxychloroquine, a medication for treating SLE, should also be prescribed or continued for people with lupus nephritis.
People with lupus nephritis that is causing high blood pressure may need to take medications that lower their 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 bodymay be prescribed. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed.
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. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.2 | NIDDK | Lupus Nephritis |
What are the complications of Lupus Nephritis ? | In many cases, treatment is effective in completely or partially controlling lupus nephritis, resulting in few, if any, further complications. However, even with treatment, 10 to 30 percent of people with lupus nephritis develop kidney failure, described as end-stage renal disease when treated with blood-filtering treatments called dialysis or a kidney transplant.3 Scientists cannot predict who will or will not respond to treatment. The most severe form of lupus nephritis is called diffuse proliferative nephritis. With this type of illness, the kidneys are inflamed, many white blood cells invade the kidneys, and kidney cells increase in number, which can cause such severe damage that scars form in the kidneys. Scars are difficult to treat, and kidney function often declines as more scars form. People with suspected lupus nephritis should get diagnosed and treated as early as possible to prevent such chronic, or long lasting, damage.
People with lupus nephritis are at a high risk for cancer, primarily B-cell lymphomaa type of cancer that begins in the cells of the immune system. They are also at a high risk for heart and blood vessel problems. | NIDDK | Lupus Nephritis |
What to do for Lupus Nephritis ? | Eating, diet, and nutrition have not been shown to play a role in causing or preventing lupus nephritis. People with kidney disease that progresses may need to talk with a health care provider about changes they may need to make to their diet. People with lupus nephritis and high blood pressure may benefit from reducing sodium intake, often from salt. More information about nutrition in people with kidney disease is provided in the NIDDK health topics, Nutrition for Early Chronic Kidney Disease in Adults and Nutrition for Advanced Chronic Kidney Disease in Adults. | NIDDK | Lupus Nephritis |
What to do for Lupus Nephritis ? | - Lupus nephritis is kidney inflammation caused by systemic lupus erythematosus (SLE or lupus). - The symptoms of lupus nephritis may include high blood pressure, foamy urine, and edema. - Lupus nephritis is diagnosed through urine and blood tests and a kidney biopsy. - Lupus nephritis is treated with medications that suppress the immune system, so it stops attacking and damaging the kidneys. Standard treatment includes a corticosteroid, usually prednisone, to reduce inflammation in the kidneys. An immunosuppressive medication, such as cyclophosphamide or mycophenolate mofetil, is typically used with prednisone. - People with lupus nephritis that is causing high blood pressure may need to take medications that lower their blood pressure, which can also significantly slow the progression of kidney disease. - In many cases, treatment is effective in completely or partially controlling lupus nephritis, resulting in few, if any, further complications. However, even with treatment, 10 to 30 percent of people with lupus nephritis develop kidney failure. | NIDDK | Lupus Nephritis |
What is (are) What I need to know about Interstitial Cystitis/Painful Bladder Syndrome ? | Interstitial cystitis*painful bladder syndrome (IC/PBS) is one of several conditions that causes bladder pain and a need to urinate frequently and urgently. Some doctors have started using the term bladder pain syndrome (BPS) to describe this condition.
Your bladder is a balloon-shaped organ where your body holds urine. When you have a bladder problem, you may notice certain signs or symptoms.
*See Pronounciation Guide for tips on how to say the words in bold type. | NIDDK | What I need to know about Interstitial Cystitis/Painful Bladder Syndrome |
What are the symptoms of What I need to know about Interstitial Cystitis/Painful Bladder Syndrome ? | Signs of bladder problems include
- Urgency. The feeling that you need to go right now! Urgency is normal if you haven't been near a bathroom for a few hours or if you have been drinking a lot of fluids. But you may have a problem if you have strong urges before your bladder has had time to fill. All of a sudden, you feel a strong urge to go. At times, you may even have an accident because the urge strikes so quickly you don't have time to find a bathroom. - Frequency. The feeling that you need to go much more often than anyone else. Doctors and nurses use the term void, which means to empty the bladder. Most people void between four and seven times a day. Drinking large amounts of fluid can cause more frequent voiding. Taking blood pressure medicines called diuretics, or water pills, can also cause more frequent voiding. If you void more than eight times a day, and you dont take diuretics or drink large amounts of fluid, it may be the sign of a problem. - Pain. The feeling of more than discomfort when you need to go. Having a full bladder may be uncomfortable, but it should not be painful. You may have a problem if you feel burning or sharp pain in your bladder or urethrathe opening where urine leaves the body.
Some people may have pain without urgency or frequency. Others have urgency and frequency without pain. | NIDDK | What I need to know about Interstitial Cystitis/Painful Bladder Syndrome |
What causes What I need to know about Interstitial Cystitis/Painful Bladder Syndrome ? | Many different problems can cause urgency, frequency, and bladder pain. Just a few of them are
- infections - bowel disorders - endometriosistissue that normally lines the womb that appears in other places outside of the womb - bladder cancer
Your doctor will ask you questions and run tests to find the cause of your bladder problems. Usually, the doctor will find that you have either an infection or an overactive bladder. But urgency, frequency, and pain are not always caused by infection.
Sometimes the cause is hard to find. If all the test results are normal and all other diseases are ruled out, your doctor may find that you have IC/PBS. | NIDDK | What I need to know about Interstitial Cystitis/Painful Bladder Syndrome |
Who is at risk for What I need to know about Interstitial Cystitis/Painful Bladder Syndrome? ? | Both men and women can get IC/PBS, though twice as many women are affected as men. It can occur at any age, but it is most common in middle age.
People with IC/PBS rarely have bladder pain all the time. The pain usually comes and goes as the bladder fills and then empties. The pain may go away for weeks or months and then return. People with IC/PBS sometimes refer to an attack of bladder pain as a flare or flare-up. Stress may bring on a flare-up of symptoms in someone who has IC/PBS. But stress does not cause a person to get IC/PBS. | NIDDK | What I need to know about Interstitial Cystitis/Painful Bladder Syndrome |
How to diagnose What I need to know about Interstitial Cystitis/Painful Bladder Syndrome ? | Finding the cause of bladder pain may require several tests.
While tests may aid your doctor in making a diagnosis of IC/PBS, a careful review of your symptoms and a physical exam in the office are generally the most important parts of the evaluation. | NIDDK | What I need to know about Interstitial Cystitis/Painful Bladder Syndrome |
What are the treatments for What I need to know about Interstitial Cystitis/Painful Bladder Syndrome ? | No one treatment for IC/PBS has been found that works for everyone. Your doctor or nurse will work with you to find a treatment plan that meets your special needs. The plan may include diet and lifestyle changes, bladder retraining, activity and exercise, physical therapy, and various types of medicines. You should expect some treatment failures along the way, but, with time, you and your doctor or nurse should find a treatment that gives you some relief and helps you cope with your disease.
Diet and Lifestyle Changes
Some people with IC/PBS find that certain foods or drinks bring on their symptoms. Others find no link between symptoms and what they eat.
Learning what foods cause symptoms for you may require some trial and error. Keep a food diary and note the times you have bladder pain. The diary might reveal that your flare-ups always happen, for example, after you eat tomatoes or oranges.
Some doctors recommend taking an antacid medicine with meals. The medicine reduces the amount of acid that gets into the urine.
If you make changes to your diet, remember to eat a variety of healthy foods.
Bladder Retraining
Bladder retraining is a way to help your bladder hold more urine. People with bladder pain often get in the habit of using the bathroom as soon as they feel pain or urgency. They then feel the need to go before the bladder is really full. The body may get used to frequent voiding. Bladder retraining helps your bladder hold more urine before signaling the urge to urinate.
Keep a bladder diary to track how you are doing. Start by noting the times when you void. Note how much time goes by between voids. For example, you may find that you return to the bathroom every 40 minutes.
Try to stretch out the time between voids. If you usually void every 40 minutes, try to wait at least 50 minutes before you go to the bathroom.
If your bladder becomes painful, you may use the bathroom. But you may find that your first urge to use the bathroom goes away if you ignore it. Find ways to relax or distract yourself when the first urge strikes.
After a few days, you may be able to stretch the time out to 60 or 70 minutes, and you may find that the urge to urinate does not return as soon.
Activity
If you have IC/PBS, you may feel the last thing you want to do is exercise. But many people feel that easy activities like walking or gentle stretching exercises help relieve symptoms.
Physical Therapy
Your doctor or nurse may suggest pelvic exercises. The pelvic muscles hold the bladder in place and help control urination. The first step is to find the right muscle to squeeze. A doctor, nurse, or physical therapist can help you. One way to find the muscles is to imagine that you are trying to stop passing gas. Squeeze the muscles you would use. If you sense a "pulling" feeling, you have found the right muscles for pelvic exercises.
You may need exercises to strengthen those muscles so that it's easier to hold in urine. Or you may need to learn to relax your pelvic muscles if tense muscles are part of your bladder pain.
Some physical therapists specialize in helping people with pelvic pain. Ask your doctor or nurse to help you find a professional trained in pelvic floor physical therapy.
Reducing Stress
Stress doesn't cause IC/PBS. But stress can trigger painful flare-ups in someone who has IC/PBS. Learning to reduce stress in your life by making time for relaxation every day may help control some symptoms of IC/PBS.
Oral Medicines
Pain pills like aspirin, ibuprofen, or acetominophen can help control mild bladder pain. Advil and Motrin are examples of ibuprofen. Tylenol is an example of acetominophen. Talk with your doctor if you feel you need a stronger pain medicine.
Your doctor may recommend a medication, pentosan polysulfate sodium, sold as Elmiron, which is approved for treating the pain of IC/PBS. You may need to take this medicine for up to 6 months before you notice improvement. Elmiron does not work for everyone, but some people with IC/PBS have found relief taking it. You need a doctor's order for Elmiron. If you don't notice improvement of your symptoms in 6 months, this medicine is not likely to work.
Researchers are also looking at other kinds of medicines. Medicines that treat heartburn might help bladder symptoms by reducing the amount of acid made in the body. Muscle relaxants can keep the bladder from squeezing at the wrong time. Keeping the bladder muscle relaxed helps ease the symptoms of IC/PBS.
Bladder Stretching
The doctor may stretch the bladder by filling it with liquid. You will be given an anesthetic to prevent pain and help relax your bladder muscles. Some patients have said their symptoms were helped after this treatment.
Bladder Medicines
Many patients who have IC/PBS find relief after a treatment in which their bladders are filled with a liquid medicine. The doctor guides a tube into your bladder and slowly fills the bladder with a liquid that eases irritation of the bladder wall. The liquid may be a compound called DMSO or a solution that contains heparin and a pain medicine called lidocaine.
You will keep the liquid in your bladder for about 15 minutes and then release it. You can have this treatment once every week or every other week for 1 or 2 months. You may not feel any better until the third or fourth treatment.
Nerve Stimulation
If you have tried diet changes, exercise, and medicines and nothing seems to help, you may wish to think about nerve stimulation. This treatment sends mild electrical pulses to the nerves that control the bladder.
At first, you may try a system that sends the pulses through electrodes placed on your skin. If this therapy works for you, you may consider having a device put in your body. The device delivers small pulses of electricity to the nerves around the bladder.
For some patients, nerve stimulation relieves bladder pain as well as urinary frequency and urgency. For others, the treatment relieves frequency and urgency but not pain. For still other patients, it does not work.
Scientists are not sure why nerve stimulation works. Some believe that the electrical pulses block the pain signals carried in the nerves. If your brain doesn't receive the nerve signal, you don't feel the pain. Others believe that the electricity releases endorphins, which are hormones that block pain naturally.
Surgery
As a last resort, your doctor might suggest surgery to remove part or all of the bladder. Surgery does not cure the pain of IC/PBS in all cases, but if you have tried every other option and your pain is still unbearable, surgery might be considered.
Talk with your doctor and family about the possible benefits and side effects. | NIDDK | What I need to know about Interstitial Cystitis/Painful Bladder Syndrome |
What to do for What I need to know about Interstitial Cystitis/Painful Bladder Syndrome ? | - Bladder problems have many possible causes. - Your doctor will need to do tests to find the cause of your bladder problems. If all the test results are normal, you may have IC/PBS. - No one treatment option for IC/PBS works for everybody. - Treatments for IC/PBS may include changing your diet and exercising. - Medicines for IC/PBS may be taken by mouth or put directly into the bladder through a tube by a doctor. - Nerve stimulation helps some people with IC/PBS. - Surgery is a last resort for treating IC/PBS. | NIDDK | What I need to know about Interstitial Cystitis/Painful Bladder Syndrome |
What is (are) What I need to know about Gestational Diabetes ? | Gestational* diabetes is a type of diabetes that develops only during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. Your body uses glucose for energy. Too much glucose in your blood is not good for you or your baby.
Gestational diabetes is usually diagnosed during late pregnancy. If you are diagnosed with diabetes earlier in your pregnancy, you may have had diabetes before you became pregnant.
Treating gestational diabetes can help both you and your baby stay healthy. You can protect your baby and yourself by taking action right away to control your blood glucose levels.
If you have gestational diabetes, a health care team will likely be part of your care. In addition to your obstetrician-gynecologist, or OB/GYNthe doctor who will deliver your babyyour team might include a doctor who treats diabetes, a diabetes educator, and a dietitian to help you plan meals.
For Women with Type 1 or Type 2 Diabetes If you already have type 1 or type 2 diabetes and are thinking about having a baby, talk with your doctor before you get pregnant. Untreated or poorly controlled diabetes can cause serious problems for your baby. More information is provided in the NIDDK health topic, What I need to know about Preparing for Pregnancy if I Have Diabetes or call 18008608747 and request a copy.
*See the Pronunciation Guide for tips on how to say the words in bold type. | NIDDK | What I need to know about Gestational Diabetes |
What causes What I need to know about Gestational Diabetes ? | Gestational diabetes happens when your body can't make enough insulin during pregnancy. Insulin is a hormone made in your pancreas, an organ located behind your stomach. Insulin helps your body use glucose for energy and helps control your blood glucose levels.
During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body's cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body's need for insulin. If your pancreas can't make enough insulin, you will have gestational diabetes.
All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant, usually because they are overweight. These women start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.
What are my chances of getting gestational diabetes? Your chances of getting gestational diabetes are higher if you - are overweight - have had gestational diabetes before - have given birth to a baby weighing more than 9 pounds - have a parent, brother, or sister with type 2 diabetes - have prediabetes, meaning your blood glucose levels are higher than normal yet not high enough for a diagnosis of diabetes - are African American, American Indian, Asian American, Hispanic/Latina, or Pacific Islander American - have a hormonal disorder called polycystic ovary syndrome, also known as PCOS | NIDDK | What I need to know about Gestational Diabetes |
What is (are) What I need to know about Gestational Diabetes ? | Your chances of getting gestational diabetes are higher if you
- are overweight - have had gestational diabetes before - have given birth to a baby weighing more than 9 pounds - have a parent, brother, or sister with type 2 diabetes - have prediabetes, meaning your blood glucose levels are higher than normal yet not high enough for a diagnosis of diabetes - are African American, American Indian, Asian American, Hispanic/Latina, or Pacific Islander American - have a hormonal disorder called polycystic ovary syndrome, also known as PCOS | NIDDK | What I need to know about Gestational Diabetes |
How to diagnose What I need to know about Gestational Diabetes ? | Doctors use blood tests to diagnose gestational diabetes. All diabetes blood tests involve drawing blood at a doctor's office or a commercial facility. Blood samples are sent to a lab for analysis.
Screening Glucose Challenge Test
For this test, you will drink a sugary beverage and have your blood glucose level checked an hour later. This test can be done at any time of the day. If the results are above normal, you may need to have an oral glucose tolerance test.
Oral Glucose Tolerance Test
You will need to fast for at least 8 hours before the test. Fasting means having nothing to eat or drink except water. Your doctor will give you other instructions to follow before the test.
Your fasting blood glucose level will be checked before the test begins. Then you will drink a sugary beverage. Your blood glucose levels will be checked 1 hour, 2 hours, and possibly 3 hours later. Your doctor will use your test results to find out whether you have gestational diabetes. | NIDDK | What I need to know about Gestational Diabetes |
How to diagnose What I need to know about Gestational Diabetes ? | If you have gestational diabetes, your doctor may recommend that you have some extra tests to check your baby's health, such as
- ultrasound exams, which use sound waves to make images that show your baby's growth and whether your baby is larger than normal - a nonstress test, which uses a monitor placed on your abdomen to check whether your baby's heart rate increases as it should when your baby is active - kick counts to check the time between your baby's movements | NIDDK | What I need to know about Gestational Diabetes |
What are the treatments for What I need to know about Gestational Diabetes ? | Treating gestational diabetes means taking steps to keep your blood glucose levels in a target range. Targets are numbers you aim for. Your doctor will help you set your targets. You will learn how to control your blood glucose using
- healthy eating - physical activity - insulin shots, if needed | NIDDK | What I need to know about Gestational Diabetes |
What to do for What I need to know about Gestational Diabetes ? | Your health care team will help you make a healthy eating plan with food choices that are good for both you and your baby. These choices are good for you to follow throughout pregnancy and after, as you raise your family.
Using a healthy eating plan will help your blood glucose stay in your target range. The plan will help you know which foods to eat, how much to eat, and when to eat. Food choices, amounts, and timing are all important in keeping your blood glucose levels in your target range.
More information is provided in the NIDDK health topic, What I need to know about Eating and Diabetes.
Physical Activity
Physical activity can help you reach your blood glucose targets. Talk with your doctor about the type of activity that is best for you. If you are already active, tell your doctor what you do. Being physically active will also help lower your chances of having type 2 diabetesand its problemsin the future. Now is the time to develop good habits for you and your baby.
For more information about physical activity and pregnancy, visit www.womenshealth.gov/pregnancy.
Insulin Shots
If you have trouble meeting your blood glucose targets, you may need to take a medicine called insulin, along with following a healthy meal plan and being physically active. Your health care team will show you how to give yourself insulin shots. Insulin will not harm your baby. | NIDDK | What I need to know about Gestational Diabetes |
How to diagnose What I need to know about Gestational Diabetes ? | Your health care team may teach you how to test for chemicals called ketones in your morning urine or in your blood. High levels of ketones are a sign that your body is using your body fat for energy instead of the food you eat. Using fat for energy is not recommended during pregnancy. Ketones may be harmful for your baby.
If your ketone levels are high, your doctor may suggest that you change the type or amount of food you eat. Or you may need to change your meal or snack times. | NIDDK | What I need to know about Gestational Diabetes |
How to prevent What I need to know about Gestational Diabetes ? | You can do a lot to prevent or delay type 2 diabetes by making these lifestyle changes:
- Reach and stay at a healthy weight. Try to reach your prepregnancy weight 6 to 12 months after your baby is born. Then, if you still weigh too much, work to lose at least 5 to 7 percent of your body weight and keep it off. For example, if you weigh 200 pounds, losing 10 to 14 pounds can greatly reduce your chance of getting diabetes. - Be physically active for at least 30 minutes most days of the week. - Follow a healthy eating plan. Eat more grains, fruits, and vegetables. Cut down on fat and calories. Your health care team can help you design a meal plan. - Ask your doctor if you should take the diabetes medicine metformin. Metformin can lower your chances of having type 2 diabetes, especially if you are younger and heavier and have prediabetes or if you have had gestational diabetes.
These changes can help you enjoy a longer, healthier life. Your health care team can give you information and support to help you make these changes.
By delaying or preventing type 2 diabetes, you will also lower your chances of having heart and blood vessel disease and other problems as you get older.
Talk with your doctor if you are thinking about having another baby. For the safety of your baby, your blood glucose needs to be at healthy levels before you get pregnant again. Your doctor can help ensure you are ready for your next child. | NIDDK | What I need to know about Gestational Diabetes |