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| What are the symptoms of Hemolytic Uremic Syndrome in Children ? | A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritisan inflammation of the lining of the stomach, small intestine, and large intestine such as
- vomiting - bloody diarrhea - abdominal pain - fever and chills - headache
As the infection progresses, the toxins released in the intestine begin to destroy red blood cells. When the red blood cells are destroyed, the child may experience the signs and symptoms of anemiaa condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen.
Signs and symptoms of anemia may include
- fatigue, or feeling tired - weakness - fainting - paleness
As the damaged red blood cells clog the glomeruli, the kidneys may become damaged and make less urine. When damaged, the kidneys work harder to remove wastes and extra fluid from the blood, sometimes leading to acute kidney injury.
Other signs and symptoms of hemolytic uremic syndrome may include bruising and seizures.
When hemolytic uremic syndrome causes acute kidney injury, a child may have the following signs and symptoms:
- edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face - albuminuriawhen a child's urine has high levels of albumin, the main protein in the blood - decreased urine output - hypoalbuminemiawhen a child's blood has low levels of albumin - blood in the urine
Seek Immediate Care Parents or caretakers should seek immediate care for a child experiencing any urgent symptoms, such as - unusual bleeding - swelling - extreme fatigue - decreased urine output - unexplained bruises |
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| How to diagnose Hemolytic Uremic Syndrome in Children ? | A health care provider diagnoses hemolytic uremic syndrome with
- a medical and family history - a physical exam - urine tests - a blood test - a stool test - kidney biopsy
Medical and Family History
Taking a medical and family history is one of the first things a health care provider may do to help diagnose hemolytic uremic syndrome.
Physical Exam
A physical exam may help diagnose hemolytic uremic syndrome. During a physical exam, a health care provider most often
- examines a child's body - taps on specific areas of the child's body
Urine Tests
A health care provider may order the following urine tests to help determine if a child has kidney damage from hemolytic uremic syndrome.
Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine, which could mean kidney damage. The child or caretaker collects a urine sample in a special container in a health care provider's office or a commercial facility. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the child's urine sample. Patches on the dipstick change color when albumin is present in the urine.
Urine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The child provides a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed in the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine.
Blood Test
A blood test involves drawing blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. A health care provider will test the blood sample to
- estimate how much blood the kidneys filter eachminute, called the estimated glomerular filtrationrate, or eGFR. The test results help the healthcare provider determine the amount of kidneydamage from hemolytic uremic syndrome. - check red blood cell and platelet levels. - check for liver and kidney function. - assess protein levels in the blood.
Stool Test
A stool test is the analysis of a sample of stool. The health care provider will give the child's parent or caretaker a container for catching and storing the stool. The parent or caretaker returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Stool tests can show the presence of E. coli O157:H7.
Kidney Biopsy
Biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The health care provider will give the child light sedation and local anesthetic; however, in some cases, the child will require general anesthesia. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab. The pathologist looks for signs of kidney disease and infection. The test can help diagnose hemolytic uremic syndrome. |
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| What are the complications of Hemolytic Uremic Syndrome in Children ? | Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health.1
However, children with hemolytic uremic syndrome may have serious and sometimes life-threatening complications, including
- acute kidney injury - high blood pressure - blood-clotting problems that can lead to bleeding - seizures - heart problems - chronic, or long lasting, kidney disease - stroke - coma |
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| What are the treatments for Hemolytic Uremic Syndrome in Children ? | A health care provider will treat a child with hemolytic uremic syndrome by addressing
- urgent symptoms and preventing complications - acute kidney injury - chronic kidney disease (CKD)
In most cases, health care providers do not treat children with hemolytic uremic syndrome with antibiotics unless they have infections in other areas of the body. With proper management, most children recover without long-term health problems.2
Treating Urgent Symptoms and Preventing Complications
A health care provider will treat a child's urgent symptoms and try to prevent complications by
- observing the child closely in the hospital - replacing minerals, such as potassium and salt, and fluids through an intravenous (IV) tube - giving the child red blood cells and platelets cells in the blood that help with clottingthrough an IV - giving the child IV nutrition - treating high blood pressure with medications
Treating Acute Kidney Injury
If necessary, a health care provider will treat acute kidney injury with dialysisthe process of filtering wastes and extra fluid from the body with an artificial kidney. The two forms of dialysis are hemodialysis and peritoneal dialysis. Most children with acute kidney injury need dialysis for a short time only.
Treating Chronic Kidney Disease
Some children may sustain significant kidney damage that slowly develops into CKD. Children who develop CKD must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation.
In most cases, health care providers treat CKD with a kidney transplant. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a person's body to take over the job of the failing kidney. Though some children receive a kidney transplant before their kidneys fail completely, many children begin with dialysis to stay healthy until they can have a transplant.
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children. |
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| How to prevent Hemolytic Uremic Syndrome in Children ? | Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by
- avoiding unclean swimming areas - avoiding unpasteurized milk, juice, and cider - cleaning utensils and food surfaces often - cooking meat to an internal temperature of at least 160 F - defrosting meat in the microwave or refrigerator - keeping children out of pools if they have had diarrhea - keeping raw foods separate - washing hands before eating - washing hands well after using the restroom and after changing diapers
When a child is taking medications that may cause hemolytic uremic syndrome, it is important that the parent or caretaker watch for symptoms and report any changes in the child's condition to the health care provider as soon as possible. |
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| What to do for Hemolytic Uremic Syndrome in Children ? | At the beginning of the illness, children with hemolytic uremic syndrome may need IV nutrition or supplements to help maintain fluid balance in the body. Some children may need to follow a low-salt diet to help prevent swelling and high blood pressure.
Health care providers will encourage children with hemolytic uremic syndrome to eat when they are hungry. Most children who completely recover and do not have permanent kidney damage can return to their usual diet. |
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| What to do for Hemolytic Uremic Syndrome in Children ? | - Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system. - The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system. - Normally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream. - A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritis, an inflammation of the lining of the stomach, small intestine, and large intestine. - Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health. - Some children may sustain significant kidney damage that slowly develops into chronic kidney disease (CKD). - Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by - avoiding unclean swimming areas - avoiding unpasteurized milk, juice, and cider - cleaning utensils and food surfaces often - cooking meat to an internal temperature of at least 160 F - defrosting meat in the microwave or refrigerator - keeping children out of pools if they have had diarrhea - keeping raw foods separate - washing hands before eating - washing hands well after using the restroom and after changing diapers |
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| What is (are) Multiple Endocrine Neoplasia Type 1 ? | MEN1 is an inherited disorder that causes tumors in the endocrine glands and the duodenum, the first part of the small intestine. MEN1 is sometimes called multiple endocrine adenomatosis or Wermer's syndrome, after one of the first doctors to recognize it. MEN1 is rare, occurring in about one in 30,000 people.1 The disorder affects both sexes equally and shows no geographical, racial, or ethnic preferences.
Endocrine glands release hormones into the bloodstream. Hormones are powerful chemicals that travel through the blood, controlling and instructing the functions of various organs. Normally, the hormones released by endocrine glands are carefully balanced to meet the body's needs.
In people with MEN1, multiple endocrine glands form tumors and become hormonally overactive, often at the same time. The overactive glands may include the parathyroids, pancreas, or pituitary. Most people who develop overactivity of only one endocrine gland do not have MEN1. |
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| What to do for Multiple Endocrine Neoplasia Type 1 ? | - Multiple endocrine neoplasia type 1 (MEN1) is an inherited disorder that causes hormone-secreting tumors in the duodenum and the endocrine glands-most often the parathyroid, pancreas, and pituitary. - Overactive parathyroid glands can lead to tiredness, weakness, muscle or bone pain, constipation, indigestion, kidney stones, or thinning of bones. - Pancreatic and duodenal endocrine tumors called gastrinomas can cause dangerous stomach or intestinal ulcers. - Pituitary tumors called prolactinomas can cause excessive production of breast milk or interfere with fertility in women or with sex drive and fertility in men. - Although many tumors associated with MEN1 are benign, about half of people with MEN1 will eventually develop a cancerous tumor. - MEN1 carriers can be detected through gene testing or other laboratory tests. - MEN1 cannot be cured, but regular testing can detect the problems caused by MEN1 tumors many years before serious complications develop. Careful monitoring enables doctors to adjust an individual's treatment as needed. |
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| What are the treatments for Kidney Failure: Choosing a Treatment That's Right for You ? | If you have advanced chronic kidney disease (CKD), you may soon need treatment to do the work your kidneys can no longer do. Learning about your treatment options for kidney failure will help you make the best choice for you. Each treatment has pros and cons. Your choice of treatment will have a big effect on your daily life, such as continuing to work if you do so currently. Talking with your doctor ahead of time about your options can help you take control of your care. Understanding the treatment you choose and getting used to the idea that you need to have this treatment takes time. If you find your choice of treatment does not fit your lifestyle, talk with your doctor about picking another treatment that fits your needs better. |
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| What is (are) Kidney Failure: Choosing a Treatment That's Right for You ? | 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 two thin tubes of muscle called ureters, one on each side of the bladder. The bladder stores urine. The muscles of the bladder wall remain relaxed while the bladder fills with urine. As the bladder fills to capacity, signals sent to the brain tell a person to find a toilet soon. 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. |
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| What is (are) Kidney Failure: Choosing a Treatment That's Right for You ? | Chronic kidney disease means you have damaged kidneys that cannot filter blood normally. Wastes then build up in your blood, harming your body. Kidney disease usually does not get better and may lead to kidney failure. If your kidneys fail, current treatment options can help you live a longer, healthier life. Some people live with kidney disease for years without needing treatment. Others progress quickly to kidney failure. |
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| What are the treatments for Kidney Failure: Choosing a Treatment That's Right for You ? | You have three treatment options to choose from to filter your blood. A fourth option offers care without replacing the work of the kidneys. None of these treatments helps the kidneys get better. However, they all can help you feel better.
- Hemodialysis uses a machine to move your blood through a filter outside your body, removing wastes. - Peritoneal dialysis uses the lining of your belly to filter your blood inside your body, removing wastes. - Kidney transplantation is surgery to place a healthy kidney from a person who has just died or a living person, usually a family member, into your body to take over the job of filtering your blood. - Conservative management is the choice not to treat kidney failure with dialysis or a transplant. Instead, the focus is on using medicines to keep you comfortable, preserving kidney function through diet, and treating the problems of kidney failure, such as anemiaa shortage of red blood cells that can make you tiredand weak bones. |
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| What is (are) Kidney Failure: Choosing a Treatment That's Right for You ? | Purpose of Hemodialysis
The purpose of hemodialysis is to filter your blood. This type of dialysis uses a machine to remove harmful wastes and extra fluid, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, calcium, and bicarbonate, in your blood. Hemodialysis is not a cure for kidney failure; however, it can help you feel better and live longer.
How Hemodialysis Works
Before you can begin dialysis, a surgeon will create a vascular access, usually in your arm. A vascular access lets high volumes of blood flow continuously during hemodialysis treatments to filter the largest possible amounts of blood per treatment.
Hemodialysis uses a machine to move your blood through a filter, called a dialyzer, outside your body. A pump on the hemodialysis machine draws your blood through a needle into a tube, a few ounces at a time. Your blood then travels through the tube, which takes it to the dialyzer. Inside the dialyzer, your blood flows through thin fibers that filter out wastes and extra fluid. After the dialyzer filters your blood, another tube carries your blood back to your body. You can do hemodialysis at a dialysis center or in your home.
Hemodialysis can replace part of your kidney function. You will also need dietary changes, medicines, and limits on water and other liquids you drink and get from food. Your dietary changes, the number of medicines you need, and limits on liquid will depend on where you receive your treatmentsat a dialysis center or at homeand how often you receive treatmentsthree or more times a week.
Pros and Cons of Hemodialysis
The pros and cons of hemodialysis differ for each person. What may be bad for one person may be good for another. Following is a list of the general pros and cons of dialysis center and home hemodialysis.
Dialysis Center Hemodialysis
Pros
- Dialysis centers are widely available. - Trained health care providers are with you at all times and help administer the treatment. - You can get to know other people with kidney failure who also need hemodialysis. - You dont have to have a trained partner or keep equipment in your home.
Cons
- The center arranges everyones treatments and allows few exceptions to the schedule. - You need to travel to the center for treatment. - This treatment has the strictest diet and limits on liquids because the longer time between treatments means wastes and extra fluid can build up in your body. - You may have more frequent ups and downs in how you feel from day to day because of the longer time between sessions. - Feeling better after a treatment may take a few hours.
Home Hemodialysis
Pros
- You can do the treatment at the times you choose; however, you should follow your doctors orders about how many times a week you need treatment. - You dont have to travel to a dialysis center. - You gain a sense of control over your treatment. - You will have fewer ups and downs in how you feel from day to day because of more frequent sessions. - You can do your treatments at times that will let you work outside the home. - You will have a more manageable diet and fewer limits on liquids because the shorter time between sessions prevents the buildup of wastes and extra fluid. - You can take along a hemodialysis machine when traveling. - You can spend more time with your loved ones because you dont have to go to the dialysis center three times a week.
Cons
- Not all dialysis centers offer home hemodialysis training and support. - You and a family member or friend will have to set aside a week or more at the beginning for training. - Helping with treatments may be stressful for your family or friend. - You need space for storing the hemodialysis machine and supplies at home. - You will need to learn to put dialysis needles into your vascular access. - Medicare and private insurance companies may limit the number of treatments they will pay for when you use home hemodialysis. Few people can afford the costs for additional treatments.
Questions to Ask My Doctor
You may want to ask your doctor these questions:
- Is hemodialysis the best treatment choice for me? Why? - If Im treated at a dialysis center, can I go to the center of my choice? - What should I look for in a dialysis center? - Will my kidney doctor see me at the dialysis center? - What does hemodialysis feel like? - How will hemodialysis affect my ____ [blood pressure, diabetes, other conditions]? - Is home hemodialysis available in my area? What type of training will I need? Who will train my partner and me? - Will I be able to keep working? Can I have treatments at night? Will I be able to care for my children? - How much should I exercise? - Whom do I contact if I have problems? - Who will be on my health care team? How can the members of my health care team help me? - If I do home hemodialysis, will my insurance pay for more than three sessions a week? - With whom can I talk about finances, sex, or family concerns? - How/where can I talk with other people who have faced this decision?
More information about Hemodialysis and Home Hemodialysis is provided in the NIDDK health topics, Treatment Methods for Kidney Failure: Hemodialysis and Home Hemodialysis. See also the Kidney Failure Treatment Comparison Chart in this booklet, which compares hemodialysis, peritoneal dialysis, and transplantation. |
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| What is (are) Kidney Failure: Choosing a Treatment That's Right for You ? | Purpose of Peritoneal Dialysis
The purpose of peritoneal dialysis is to filter wastes and extra fluid from your body. This type of dialysis uses the lining of your bellythe space in your body that holds your stomach, bowels, and liverto filter your blood. This lining, called the peritoneum, acts to do the work of your kidneys.
How Peritoneal Dialysis Works
A doctor will place a soft tube, called a catheter, in your belly a few weeks before you start treatment. The catheter stays in your belly permanently. When you start peritoneal dialysis, you will empty a kind of salty water, called dialysis solution, from a plastic bag through the catheter into your belly. When the bag is empty, you can disconnect your catheter from the bag so you can move around and do your normal activities. While the dialysis solution is inside your belly, it soaks up wastes and extra fluid from your body. After a few hours, you drain the used dialysis solution through another tube into a drain bag. You can throw away the used dialysis solution, now filled with wastes and extra fluid, in a toilet or tub. Then you start over with a fresh bag of dialysis solution. The process of emptying the used dialysis solution and refilling your belly with fresh solution is called an exchange. The process goes on continuously, so you always have dialysis solution in your belly soaking up wastes and extra fluid from your body.
Types of Peritoneal Dialysis
Two types of peritoneal dialysis are available. After you have learned about the types of peritoneal dialysis, you can choose the type that best fits your life. If one schedule or type of peritoneal dialysis does not suit you, talk with your doctor about trying the other type.
- Continuous ambulatory peritoneal dialysis does not require a machine and you can do it in any clean, well-lit place. The time period that the dialysis solution is in your belly is the dwell time. With continuous ambulatory peritoneal dialysis, the dialysis solution stays in your belly for a dwell time of 4 to 6 hours, or more. The process of draining the used dialysis solution and replacing it with fresh solution takes about 30 to 40 minutes. Most people change the dialysis solution at least four times a day and sleep with solution in their belly at night. With continuous ambulatory peritoneal dialysis, you do not have to wake up and perform dialysis tasks during the night. - Continuous cycler-assisted peritoneal dialysis uses a machine called a cycler to fill and empty your belly three to five times during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day. You may do an additional exchange in the middle of the afternoon without the cycler to increase the amount of waste removed and to reduce the amount of fluid left behind in your body.
You may need a combination of continuous ambulatory peritoneal dialysis and continuous cycler-assisted peritoneal dialysis if you weigh more than 175 pounds or if your peritoneum filters wastes slowly. For example, some people use a cycler at night and perform one exchange during the day. Others do four exchanges during the day and use a minicycler to perform one or more exchanges during the night. Youll work with your health care team to find the best schedule for you.
Pros and Cons of Peritoneal Dialysis
Each type of peritoneal dialysis has pros and cons.
Continuous Ambulatory Peritoneal Dialysis
Pros
- You can do continuous ambulatory peritoneal dialysis alone. - You can do continuous ambulatory peritoneal dialysis at the times you choose, as long as you perform the required number of exchanges each day. - You can do continuous ambulatory peritoneal dialysis in many locations. - You can travel as long as you bring dialysis bags with you or have them delivered to your destination. - You dont need a machine for continuous ambulatory peritoneal dialysis. - You gain a sense of control over your treatment.
Cons
- Continuous ambulatory peritoneal dialysis can disrupt your daily schedule. - Continuous ambulatory peritoneal dialysis is a continuous treatment, and you should do all exchanges 7 days a week. - Boxes of dialysis solution will take up space in your home.
Continuous Cycler-assisted Peritoneal Dialysis
Pros
- You can do exchanges at night, while you sleep. - You may not have to perform exchanges during the day.
Cons
- You need a machine. - Your connection to the cycler limits your movement at night.
Questions to Ask My Doctor
- Is peritoneal dialysis the best treatment choice for me? Why? If yes, which type is best? - What type of training do I need, and how long will it take? - What does peritoneal dialysis feel like? - How will peritoneal dialysis affect my ____ [blood pressure, diabetes, other conditions]? - Will I be able to keep working? Will I be able to care for my children? - How much should I exercise? - Where do I store supplies? - How often do I see my doctor? - Who will be on my health care team? How can the members of my health care team help me? - Whom do I contact if I have problems? - With whom can I talk about finances, sex, or family concerns? - How/where can I talk with other people who have faced this decision?
More information about Peritoneal Dialysis is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Peritoneal Dialysis. See also the Kidney Failure Treatment Comparison Chart, which compares peritoneal dialysis, hemodialysis, and transplantation. |
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| What is (are) Kidney Failure: Choosing a Treatment That's Right for You ? | What should I know about kidney transplantation?
The purpose of kidney transplantation is to surgically place a healthy kidney from a donora person who has just died or a living person, most often a family memberinto your body. A kidney from someone who has just died is a deceased donor kidney. A kidney from a living person is a living donor kidney. A functioning kidney transplant does a better job of filtering wastes and keeping you healthy than dialysis.
How Kidney Transplantation Works
Surgeonsdoctors who specialize in surgeryplace most transplanted kidneys in the lower front part of your abdomen. The kidney is connected to an artery, which brings unfiltered blood into the kidney, and a vein, which takes filtered blood out of the kidney. The surgeon also transplants the ureter from the donor to let urine from the new kidney flow to your bladder. Unless your damaged kidneys cause problems such as infection, they can remain in their normal position. The transplanted kidney takes over the job of filtering your blood. Your body normally attacks anything it sees as foreign, so to keep your body from attacking the kidney you need to take medicines called immunosuppressants for as long as the transplanted kidney functions.
Pros and Cons of Kidney Transplantation
Following is a list of the pros and cons of kidney transplantation.
Kidney Transplantation
Pros
- A transplanted kidney works like a healthy kidney. - If you have a living donor, you can choose the time of your operation. - You may feel healthier and have an improved quality of life. - You have fewer dietary restrictions. - You wont need dialysis. - People who receive a donated kidney have a greater chance of living a longer life than those who stay on dialysis.
Cons
- Transplantation requires surgery. - You will go through extensive medical testing at the transplant clinic. - You may need to wait years for a deceased donor kidney. - Your body may reject the new kidney, so one transplant may not last a lifetime. - Youll need to take immunosuppressants, which may cause other health problems, for as long as the transplanted kidney functions.
Questions to Ask My Doctor
You may want to ask your doctor these questions:
- Is transplantation the best treatment choice for me? Why? - What are my chances of having a successful transplant? - How do I find out whether a family member or friend can donate? - What are the risks to a family member or friend who donates? - If a family member or friend does not donate, who will place me on a waiting list for a kidney? How long will I have to wait? - How will I know if my donor kidney is working? - How long does a transplanted kidney function? - What side effects do immunosuppressants cause? - Who will be on my transplant team? How can the members of my transplant team help me? - With whom can I talk about finances, sex, or family concerns? - How/where can I talk with other people who have faced this decision?
More information about Transplantation is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Transplantation. See also the Kidney Failure Treatment Comparison Chart, which compares peritoneal dialysis, hemodialysis, and transplantation. |
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| What are the treatments for Kidney Failure: Choosing a Treatment That's Right for You ? | Conservative management for kidney failure is the choice to say no to or stop dialysis treatments. For many people, dialysis not only extends life, it also improves the quality of life. For others who have serious conditions in addition to kidney failure, dialysis may seem like a burden that only prolongs suffering. If you have serious conditions in addition to kidney failure, dialysis may not prolong your life or improve the quality of your life.
You have the right to say no to or stop dialysis. You may want to speak with your doctor, spouse, family, counselor, or renal social worker, who helps people with kidney disease, to help you make this decision.
If you stop dialysis treatments or say you do not want to begin them, you may live for a few weeks or for several months, depending on your health and your remaining kidney function. You may choose to receive care from a hospicea facility or home program designed to meet the physical and emotional needs of the terminally illduring this time. Hospice care focuses on relief of pain and other symptoms. Whether or not you choose to use a hospice, your doctor can give you medicines to make you more comfortable. Your doctor can also give you medicines to treat the problems of kidney failure, such as anemia or weak bones. You may restart dialysis treatment if you change your mind.
Advance Directives
An advance directive is a statement or document in which you give instructions either to withhold certain treatments, such as dialysis, or to provide them, depending on your wishes and the specific circumstances. Even if you are happy with your quality of life on dialysis, you should think about circumstances that might make you want to stop dialysis treatments. At some point in a medical crisis, you might lose the ability to tell your health care team and loved ones what you want. Advance directives may include
- a living will - a durable power of attorney for health care decisions - a do not resuscitate (DNR) ordera legal form that tells your health care team you do not want cardiopulmonary resuscitation (CPR) or other life-sustaining treatment if your heart were to stop or if you were to stop breathing.
A living will is a document that details the conditions under which you would want to refuse treatment. You may state that you want your health care team to use all available means to sustain your life, or you may direct that you be withdrawn from dialysis if you fall into a coma from which you most likely wont wake up. In addition to dialysis, you may choose or refuse the following life-sustaining treatments:
- CPR - feedings through a tube in your stomach - mechanical or artificial means to help you breathe - medicines to treat infections - surgery - receiving blood
Refusing to have CPR is the same as a DNR order. If you choose to have a DNR order, your doctor will place the order in your medical chart.
A durable power of attorney for health care decisions or a health care proxy is a document you use to assign a person to make health care decisions for you in the event you cannot make them for yourself. Make sure the person you name understands your values and will follow your instructions.
Each state has its own laws on advance directives. You can obtain a form for an advance medical directive thats valid in your state from the National Hospice and Palliative Care Organizationsee For More Information. |
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| What to do for Kidney Failure: Choosing a Treatment That's Right for You ? | All of the treatment options for kidney failure require changes and restrictions in your diet.
Hemodialysis
Hemodialysis has the most restrictions. You should watch how much water and other liquids you get from food and drinks and avoid getting too much sodium, often from salt; potassium; and phosphorus. You may find it difficult to limit phosphorus because many foods that are high in phosphorus also provide the protein you need. Hemodialysis can remove protein from the body, so you should eat foods with high-quality protein, such as meat, fish, and eggs. Limit your phosphorus by avoiding foods such as beans, peas, nuts, tea, and colas. You may also need to take a pill called a phosphate binder that keeps phosphorus in your food from entering your bloodstream. Talk with your dialysis centers dietitian to find a hemodialysis meal plan that works for you.
More information about nutrition for people who are on hemodialysis is provided in the NIDDK health topic, Eat Right to Feel Right on Hemodialysis.
Peritoneal Dialysis
Like hemodialysis, peritoneal dialysis requires limits on sodium and phosphorus. You may need to take a phosphate binder. The liquid limitations in peritoneal dialysis may not be as strict as those for hemodialysis. In fact, you may need to drink more water and other liquids if your peritoneal dialysis treatments remove too much fluid from your body. Peritoneal dialysis removes potassium from the body, so you may need to eat potassium-rich foods such as potatoes, tomatoes, oranges, and bananas. However, be careful not to eat too much potassium because it can cause an unsteady heartbeat. Peritoneal dialysis removes even more protein than hemodialysis, so eating foods with high-quality protein is important. You may need to limit calories because your body absorbs sugar from the dialysis solution.
Kidney Transplantation
Kidney transplantation has the fewest restrictions on your diet. You should limit sodium because it can raise your blood pressure. Medicines that you take after the transplant can cause you to gain weight, so you may need to limit calories.
Conservative Management
The diet for conservative management limits protein. Protein breaks down into waste products the kidneys must remove. Limiting protein may reduce the amount of work the kidneys have to do so they will last longer.
Hemodialysis Peritoneal Dialysis Kidney Transplantation In Center Home CAPD CCPD Deceased Living Schedule Three treatments a week for 3 to 5 hours or more. More flexibility in determining your schedule of treatments. Four to six exchanges a day, every day. Three to five exchanges a night, every night, with an additional exchange begun first thing in the morning. You may wait several years before a suitable kidney is available. If a friend or family member is donating, you can schedule the operation when you're both ready. After the operation, you'll have regular checkups with your doctor. Location Dialysis center. Home. Any clean environment that allows solution exchanges. The transplant operation takes place in a hospital. Availability Available in most communities; may require travel in some rural areas. Generally available, but not widely used because of equipment requirements. Widely available. Widely available. Transplant centers are located throughout the country. However, the demand for kidneys is far greater than the supply. Equipment and Supplies No equipment or supplies in the home. Hemodialysis machine connected to plumbing; chair. Bags of dialysis solution take up storage space. Cycling machine; bags of dialysis solution. No equipment or supplies needed. Training Required Little training required; clinic staff perform most tasks. You and a helper must attend several training sessions. You'll need to attend several training sessions. You'll need to learn about your medications and when to take them. Diet Must limit fluids, sodium, potassium, and phosphorus. Must limit sodium and calories. Fewer dietary restrictions. Level of Freedom Little freedom during treatments. Greater freedom on non-treatment days. More freedom to set your own schedule. You're still linked to a machine for several hours a week. You can move around, exercise, work, drive, etc., with solution in your abdomen. You're linked to a machine during the night. You're free from exchanges during the day. Offers the greatest amount of freedom. Level of Responsibility Some patients prefer to let clinic staff perform all tasks. You and your helper are responsible for cleaning and setting up equipment and monitoring vital signs. Can be stressful on family helpers. You must perform exchanges four to six times a day, every day. You must set up your cycler every night. You must take immunosuppressants every day for as long as the transplanted kidney functions.
More information about the treatments for kidney failure is provided in the NIDDK health communication program, National Kidney Disease Education Program. |
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| What to do for Kidney Failure: Choosing a Treatment That's Right for You ? | - You have three treatment options to choose from to filter your blood. A fourth option offers care without replacing the work of the kidneys. - Hemodialysis - Peritoneal dialysis - Kidney transplantation - Conservative management - None of these treatments helps the kidneys get better. However, they all can help you feel better. - Hemodialysis uses a machine to move your blood through a filter outside your body, removing wastes. - Peritoneal dialysis uses the lining of your belly to filter your blood inside your body, removing wastes. - Kidney transplantation is surgery to place a healthy kidney from a person who has just died or a living person, usually a family member, into your body to take over the job of filtering your blood. - Conservative management is the choice not to treat kidney failure with dialysis or a transplant. - All of the treatment options for kidney failure require changes and restrictions in your diet. |
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| What is (are) Henoch-Schnlein Purpura ? | Henoch-Schnlein purpura is a disease that causes small blood vessels in the body to become inflamed and leak. The primary symptom is a rash that looks like many small raised bruises. HSP can also affect the kidneys, digestive tract, and joints. HSP can occur any time in life, but it is most common in children between 2 and 6 years of age.1 Most people recover from HSP completely, though kidney damage is the most likely long-term complication. In adults, HSP can lead to chronic kidney disease (CKD) and kidney failure, described as end-stage renal disease when treated with blood-filtering treatments called dialysis or a kidney transplant. |
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| What causes Henoch-Schnlein Purpura ? | Henoch-Schnlein purpura is caused by an abnormal immune system response in which the bodys immune system attacks the bodys own cells and organs. Usually, the immune system makes antibodies, or proteins, to protect the body from foreign substances such as bacteria or viruses. In HSP, these antibodies attack the blood vessels. The factors that cause this immune system response are not known. However, in 30 to 50 percent of cases, people have an upper respiratory tract infection, such as a cold, before getting HSP.2 HSP has also been associated with
- infectious agents such as chickenpox, measles, hepatitis, and HIV viruses - medications - foods - insect bites - exposure to cold weather - trauma
Genetics may increase the risk of HSP, as it has occurred in different members of the same family, including in twins. |
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| What are the symptoms of Henoch-Schnlein Purpura ? | The symptoms of HSP include the following:
- Rash. Leaking blood vessels in the skin cause a rash that looks like bruises or small red dots on the legs, arms, and buttocks. The rash may first look like hives and then change to look like bruises, and it may spread to the chest, back, and face. The rash does not disappear or turn pale when pressed. - Digestive tract problems. HSP can cause vomiting and abdominal pain, which can range from mild to severe. Blood may also appear in the stool, though severe bleeding is rare. - Arthritis. Pain and swelling can occur in the joints, usually in the knees and ankles and less frequently in the elbows and wrists. - Kidney involvement. Hematuria blood in the urineis a common sign that HSP has affected the kidneys. Proteinurialarge amounts of protein in the urineor development of high blood pressure suggests more severe kidney problems. - Other symptoms. In some cases, boys with HSP develop swelling of the testicles. Symptoms affecting the central nervous system, such as seizures, and lungs, such as pneumonia, have been seen in rare cases.
Though the rash affects all people with HSP, pain in the joints or abdomen precedes the rash in about one-third of cases by as many as 14 days.1 |
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| What are the complications of Henoch-Schnlein Purpura ? | In children, the risk of kidney damage leading to long-term problems may be as high as 15 percent, but kidney failure affects only about 1 percent of children with HSP.1 Up to 40 percent of adults with HSP will have CKD or kidney failure within 15 years after diagnosis.3
A rare complication of HSP is intussusception of the bowel, which includes the small and large intestines. With this condition, a section of the bowel folds into itself like a telescope, causing the bowel to become blocked.
Women with a history of HSP who become pregnant are at higher risk for high blood pressure and proteinuria during pregnancy. |
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| How to diagnose Henoch-Schnlein Purpura ? | A diagnosis of HSP is suspected when a person has the characteristic rash and one of the following:
- abdominal pain - joint pain - antibody deposits on the skin - hematuria or proteinuria
Antibody deposits on the skin can confirm the diagnosis of HSP. These deposits can be detected using a skin biopsy, a procedure that involves taking a piece of skin tissue for examination with a microscope. A skin biopsy is performed by a health care provider in a hospital with little or no sedation and local anesthetic. The skin tissue is examined in a lab by a pathologista doctor who specializes in diagnosing diseases.
A kidney biopsy may also be needed. A kidney 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 organ. The kidney tissue is examined in a lab by a pathologist. The test can confirm diagnosis and be used to determine the extent of kidney involvement, which will help guide treatment decisions.
Hematuria and proteinuria are detected using urinalysis, which is testing of a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine sample. Patches on the dipstick change color when blood or protein are present in urine. |
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| What are the treatments for Henoch-Schnlein Purpura ? | No specific treatment for HSP exists. The main goal of treatment is to relieve symptoms such as joint pain, abdominal pain, and swelling. People with kidney involvement may receive treatment aimed at preventing long-term kidney disease.
Treatment is rarely required for the rash. Joint pain is often treated with nonsteroidal anti-inflammatory medications, such as aspirin or ibuprofen. Recent research has shown corticosteroidsmedications that decrease swelling and reduce the activity of the immune systemto be even more effective in treating joint pain. Corticosteroids are also used to treat abdominal pain.
Though rare, surgery may be needed to treat intussusception or to determine the cause of swollen testicles.
HSP that affects the kidneys may be treated with corticosteroid and immunosuppressive medications. Immunosuppressive medications prevent the body from making antibodies. Adults with severe, acute kidney failure are treated with high-dose corticosteroids and the immunosuppressive cyclophosphamide (Cytoxan).
People with HSP that is causing high blood pressure may need to take medications thatwhen taken as prescribed by their health care providerlower 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 bloodmay be prescribed. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed.
Blood and urine tests are used to check the kidney function of people with HSP for at least 6 months after the main symptoms disappear. |
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| What to do for Henoch-Schnlein Purpura ? | Eating, diet, and nutrition have not been shown to play a role in causing or preventing HSP. |
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| What to do for Henoch-Schnlein Purpura ? | - Henoch-Schnlein purpura (HSP) is a disease that causes small blood vessels in the body to become inflamed and leak. - HSP is caused by an abnormal immune system response in which the bodys immune system attacks the bodys own cells and organs. The factors that cause this immune system response are not known. - The symptoms of HSP include the following: - rash - digestive tract problems - arthritis - kidney involvement - In children, the risk of kidney damage leading to long-term problems may be as high as 15 percent, but kidney failure affects only about 1 percent of children with HSP. Up to 40 percent of adults with HSP will have CKD or kidney failure within 15 years after diagnosis. - A diagnosis of HSP is suspected when a person has the characteristic rash and one of the following: - abdominal pain - joint pain - antibody deposits on the skin - hematuria or proteinuria - Antibody deposits on the skin can confirm the diagnosis of HSP. - No specific treatment for HSP exists. The main goal of treatment is to relieve symptoms such as joint pain, abdominal pain, and swelling. People with kidney involvement may receive treatment aimed at preventing long-term kidney disease. |
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| What is (are) Pregnancy and Thyroid Disease ? | Thyroid disease is a disorder that affects the thyroid gland. Sometimes the body produces too much or too little thyroid hormone. Thyroid hormones regulate metabolismthe way the body uses energyand affect nearly every organ in the body. Too much thyroid hormone is called hyperthyroidism and can cause many of the bodys functions to speed up. Too little thyroid hormone is called hypothyroidism and can cause many of the bodys functions to slow down.
Thyroid hormone plays a critical role during pregnancy both in the development of a healthy baby and in maintaining the health of the mother.
Women with thyroid problems can have a healthy pregnancy and protect their fetuses health by learning about pregnancys effect on the thyroid, keeping current on their thyroid function testing, and taking the required medications. |
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| What is (are) Pregnancy and Thyroid Disease ? | 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 either side of the windpipe. The thyroid is one of the glands that make up the endocrine system. The glands of the endocrine system produce, store, and release hormones 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 the active hormone and is made from T4. Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels.
Thyroid hormone production is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary responds by decreasing TSH production. |
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| What to do for Pregnancy and Thyroid Disease ? | During pregnancy, the body requires higher amounts of some nutrients to support the health of the mother and growing baby. Experts recommend pregnant women maintain a balanced diet and take a prenatal multivitamin and mineral supplement containing iodine to receive most nutrients necessary for thyroid health. More information about diet and nutrition during pregnancy is provided by the National Agricultural Library available at www.choosemyplate.gov/nutritional-needs-during-pregnancy.
Dietary Supplements
Because the thyroid uses iodine to make thyroid hormone, iodine is an important mineral for a mother during pregnancy. During pregnancy, the baby gets iodine from the mothers diet. Women need more iodine when they are pregnantabout 250 micrograms a day. 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 saltsalt supplemented with iodineover plain salt and prenatal vitamins containing iodine will ensure this need is met.
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 hyperthyroidism and hypothyroidism. More information about iodine is provided by the National Library of Medicine in the fact sheet, Iodine in diet.
To help ensure coordinated and safe care, people should discuss their use of dietary supplements with their health care provider. Tips for talking with health care providers are available at the National Center for Complementary and Integrative Health's Time to Talk campaign. |
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| What to do for Pregnancy and Thyroid Disease ? | - Thyroid disease is a disorder that results when the thyroid gland produces more or less thyroid hormone than the body needs. - Pregnancy causes normal changes in thyroid function but can also lead to thyroid disease. - Uncontrolled hyperthyroidism during pregnancy can lead to serious health problems in the mother and the unborn baby. - During pregnancy, mild hyperthyroidism does not require treatment. More severe hyperthyroidism is treated with antithyroid medications, which act by interfering with thyroid hormone production. - Uncontrolled hypothyroidism during pregnancy can lead to serious health problems in the mother and can affect the unborn babys growth and brain development. - Hypothyroidism during pregnancy is treated with synthetic thyroid hormone, thyroxine (T4). - Postpartum thyroiditisinflammation of the thyroid glandcauses a brief period of hyperthyroidism, often followed by hypothyroidism that usually goes away within a year. Sometimes the hypothyroidism is permanent. |
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| What is (are) Renal Artery Stenosis ? | Renal artery stenosis is the narrowing of one or both renal arteries. Renal means kidney and stenosis means narrowing. The renal arteries are blood vessels that carry blood to the kidneys from the aortathe main blood vessel that carries blood from the heart to arteries throughout the body.
RVH is high blood pressure caused by RAS. Blood pressure is written with two numbers separated by a slash, 120/80, and is said as 120 over 80. The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats. A persons blood pressure is considered normal if it stays at or below 120/80. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.1 |
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| What is (are) Renal Artery Stenosis ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. |
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| What causes Renal Artery Stenosis ? | About 90 percent of RAS is caused by atherosclerosisclogging, narrowing, and hardening of the renal arteries.2 In these cases, RAS develops when plaquea sticky substance made up of fat, cholesterol, calcium, and other material found in the bloodbuilds up on the inner wall of one or both renal arteries. Plaque buildup is what makes the artery wall hard and narrow.
Most other cases of RAS are caused by fibromuscular dysplasia (FMD)the abnormal development or growth of cells on the renal artery wallswhich can cause blood vessels to narrow. Rarely, RAS is caused by other conditions. |
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| Who is at risk for Renal Artery Stenosis? ? | People at risk for artherosclerosis are also at risk for RAS. Risk factors for RAS caused by artherosclerosis include
- high blood cholesterol levels - high blood pressure - smoking - insulin resistance - diabetes - being overweight or obese - lack of physical activity - a diet high in fat, cholesterol, sodium, and sugar - being a man older than 45 or a woman older than 55 - a family history of early heart disease
The risk factors for RAS caused by FMD are unknown, but FMD is most common in women and people 25 to 50 years of age.3 FMD can affect more than one person in a family, indicating that it may be caused by an inherited gene. |
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| What are the symptoms of Renal Artery Stenosis ? | In many cases, RAS has no symptoms until it becomes severe.
The signs of RAS are usually either high blood pressure or decreased kidney function, or both, but RAS is often overlooked as a cause of high blood pressure. RAS should be considered as a cause of high blood pressure in people who
- are older than age 50 when they develop high blood pressure or have a marked increase in blood pressure - have no family history of high blood pressure - cannot be successfully treated with at least three or more different types of blood pressure medications
Symptoms of a significant decrease in kidney function include
- increase or decrease in urination - edemaswelling, usually in the legs, feet, or ankles and less often in the hands or face - drowsiness or tiredness - generalized itching or numbness - dry skin - headaches - weight loss - appetite loss - nausea - vomiting - sleep problems - trouble concentrating - darkened skin - muscle cramps |
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| What are the complications of Renal Artery Stenosis ? | People with RAS are at increased risk for complications resulting from loss of kidney function or atherosclerosis occurring in other blood vessels, such as
- chronic kidney disease (CKD)reduced kidney function over a period of time - coronary artery diseasenarrowing and hardening of arteries that supply blood to the heart - strokebrain damage caused by lack of blood flow to the brain - peripheral vascular diseaseblockage of blood vessels that restricts flow of blood from the heart to other parts of the body, particularly the legs
RAS can lead to kidney failure, described as end-stage renal disease when treated with blood-filtering treatments called dialysis or a kidney transplant, though this is uncommon in people who receive ongoing treatment for RAS. |
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| How to diagnose Renal Artery Stenosis ? | A health care provider can diagnose RAS by listening to the abdomen with a stethoscope and performing imaging tests. When blood flows through a narrow artery, it sometimes makes a whooshing sound, called a bruit. The health care provider may place a stethoscope on the front or the side of the abdomen to listen for this sound. The absence of this sound, however, does not exclude the possibility of RAS.
In some cases, RAS is found when a person has a test for another reason. For example, a health care provider may find RAS during a coronary angiogram for diagnosis of heart problems. A coronary angiogram is a procedure that uses a special dye, called contrast medium, and x rays to see how blood flows through the heart.
The following imaging tests are used to diagnose RAS:
- Duplex ultrasound. Duplex ultrasound combines traditional ultrasound with Doppler ultrasonography. Traditional ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. Doppler ultrasonography records sound waves reflected off of moving objects, such as blood, to measure their speed and other aspects of how they flow. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging. Anesthesia is not needed. The images can show blockage in the renal artery or blood moving through nearby arteries at a lower-than-normal speed. Ultrasound is noninvasive and low cost. - Catheter angiogram. A catheter angiogram, also called a traditional angiogram, is a special kind of x ray in which a thin, flexible tube called a catheter is threaded through the large arteries, often from the groin, to the artery of interestin this case, the renal artery. The procedure is performed in a hospital or outpatient center by a radiologist. Anesthesia is not needed though a sedative may be given to lessen anxiety during the procedure. Contrast medium is injected through the catheter so the renal artery shows up more clearly on the x ray. Catheter angiogram is the gold standard for diagnosing RAS due to the high quality of the image produced. In addition, severe RAS can be treated during the same visit. However, a catheter angiogram is an invasive procedure, and a person may have side effects from the sedative or contrast medium or may have bleeding or injury to the artery from the catheter. The procedure is also more expensive than other imaging tests. - Computerized tomographic angiography (CTA) scan. CTA scans use a combination of x rays and computer technology to create images. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. Contrast medium is injected into a vein in the persons arm to better see the structure of the arteries. CTA scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. CTA scans are less invasive than catheter angiograms and take less time. However, the risks from the x-ray radiation still exist, and the test often requires more contrast medium than a catheter angiogram, so it may not be recommended for a person with poor kidney function. - Magnetic resonance angiogram (MRA). MRA uses radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed though light sedation may be used for people with a fear of confined spaces. Contrast medium may be injected into a vein in the persons arm to better see the structure of the arteries. With most MRA scans, the person lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines are designed to allow the person to lie in a more open space. In addition to providing high-quality images noninvasively, MRA can provide a functional assessment of blood flow and organ function. However, the use of contrast medium for an MRA is not advised for people with poor kidney function because of the risk of complications to the skin and other organs if the kidneys do not remove the contrast medium well enough. |
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| What are the treatments for Renal Artery Stenosis ? | Treatment for RAS includes lifestyle changes, medications, and surgery and aims to
- prevent RAS from getting worse - treat RVH - relieve the blockage of the renal arteries
RAS that has not led to RVH or caused a significant blockage of the artery may not need treatment. RAS that needs to be treated, also called critical RAS, is defined by the American Heart Association as a reduction by more than 60 percent in the diameter of the renal artery.1 However, health care providers are not exactly sure what degree of blockage will cause significant problems.
Lifestyle Changes
The first step in treating RAS is making lifestyle changes that promote healthy blood vessels throughout the body, including the renal arteries. The best ways to keep plaque from building up in the arteries are to exercise, maintain a healthy body weight, and choose healthy foods. People who smoke should quit to help protect their kidneys and other internal organs.
Medications
People with RVH may need to take medications thatwhen taken as prescribed by their health care providerlower blood pressure and can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretica medication that helps the kidneys remove fluid from the bloodmay be prescribed. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed. Some people with RAS cannot take an ACE inhibitor or ARB due to the effects on the kidneys. People with RAS who are prescribed an ACE inhibitor or ARB should have their kidney function checked within a few weeks of starting the medication.
A cholesterol-lowering medication to prevent plaque from building up in the arteries and a blood-thinner, such as aspirin, to help the blood flow more easily through the arteries may also be prescribed.
Surgery
Although surgery has been used in the past for treatment of RAS due to atherosclerosis, recent studies have not shown improved outcomes with surgery compared with medication. However, surgery may be recommended for people with RAS caused by FMD or RAS that does not improve with medication. Different types of surgery for RAS include the following. The procedures are performed in a hospital by a vascular surgeona doctor who specializes in repairing blood vessels. Anesthesia is needed.
- Angioplasty and stenting. Angioplasty is a procedure in which a catheter is put into the renal artery, usually through the groin, just as in a catheter angiogram. In addition, for angioplasty, a tiny balloon at the end of the catheter can be inflated to flatten the plaque against the artery wall. A small mesh tube, called a stent, may then be positioned inside the artery to keep plaque flattened and the artery open. People with RAS caused by FMD may be successfully treated with angioplasty alone, while angioplasty with stenting has a better outcome for people with RAS caused by atherosclerosis. - Endarterectomy or bypass surgery. In an endarterectomy, the plaque is cleaned out of the artery, leaving the inside lining smooth and clear. To create a bypass, a vein or synthetic tube is used to connect the kidney to the aorta. This new path serves as an alternate route for blood to flow around the blocked artery into the kidney. These procedures are not performed as often as in the past due to a high risk of complications during and after the procedure. |
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| What to do for Renal Artery Stenosis ? | Limiting intake of fats, cholesterol, sodium, and sugar can help prevent atherosclerosis, which can lead to RAS. Most sodium in the diet comes from salt. A healthy diet that prevents people from becoming overweight or obese can also help prevent atherosclerosis. People with RAS that has caused decreased kidney function should limit their intake of protein, cholesterol, sodium, and potassium to slow the progression of kidney failure. More information about nutrition for CKD is provided in the NIDDK health topics, Nutrition for Early Chronic Kidney Disease in Adults and Nutrition for Advanced Chronic Kidney Disease in Adults. People should talk with their health care provider about what diet is right for them. |
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| What to do for Renal Artery Stenosis ? | - Renal artery stenosis (RAS) is the narrowing of one or both renal arteries. The renal arteries are blood vessels that carry blood to the kidneys from the aortathe main blood vessel that carries blood from the heart to arteries throughout the body. - Renovascular hypertension (RVH) is high blood pressure caused by RAS. - About 90 percent of RAS is caused by atherosclerosis. Most other cases of RAS are caused by fibromuscular dysplasia (FMD), which can cause blood vessels to narrow. - RAS often has no symptoms until it becomes severe. The first symptoms of RAS are usually either high blood pressure or decreased kidney function, or both, but RAS is often overlooked as a cause of high blood pressure. - People with RAS are at increased risk for chronic kidney disease (CKD), coronary artery disease, stroke, and peripheral vascular disease. - Imaging tests used to diagnose RAS include duplex ultrasound, catheter angiogram, computerized tomographic angiography (CTA) scan, and magnetic resonance angiogram (MRA). - Treatment for RAS includes lifestyle changes, medications, and surgery. |
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| What is (are) What I need to know about Kidney Failure and How Its Treated ? | You have two kidneys. The kidneys are shaped like beans. Each kidney is about the size of a fist. They are located just below your ribcage, one on each side of your spine. Your kidneys filter your blood. Each kidney is made of 1 million little filters. During every minute of every day, these filters take out waste materials that can hurt you. They also take out extra fluid from your blood. The wastes and extra fluid make urine. The urine flows from your kidneys to your bladder through tubes called ureters.The bladder stores urine until you urinate. Then, urine leaves the body through a tube called the urethra.
*See the Pronunciation Guide for tips on how to say the the words in bold type. |
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| What is (are) What I need to know about Kidney Failure and How Its Treated ? | Kidney failure means your kidneys no longer filter your blood well enough to keep you healthy. Failing kidneys do a poor job of removing wastes and extra fluid from your blood. Wastes and extra fluid begin to build up. The buildup of wastes can make you sick. You may have the following symptoms:
- ankle, face, or belly swelling - stomach sickness - throwing up - loss of appetite - loss of sense of taste - feeling tired - weakness - confusion - headaches |
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| What causes What I need to know about Kidney Failure and How Its Treated ? | Diabetes and high blood pressure are the most common causes of kidney failure. Other factors include heart and blood vessel disease and a family history of kidney failure. African Americans, Hispanics/Latinos, and American Indians are more likely to have kidney failure. |
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| What are the treatments for What I need to know about Kidney Failure and How Its Treated ? | The treatments for kidney failure are
- hemodialysis - peritoneal dialysis - a kidney transplant - conservative management |
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| What is (are) What I need to know about Kidney Failure and How Its Treated ? | Hemodialysis is a treatment for kidney failure that is done in a center several times per week. Some people learn to do hemodialysis in their homes. Hemodialysis uses a machine to filter your blood when your kidneys are too sick to filter any more. With hemodialysis, your blood is filtered outside of your body. Unfiltered blood is removed from the body and flows to the dialyzer to be cleaned. Filtered blood flows back to the body. First, a dialysis nurse places two needles into your arm. A pump on the hemodialysis machine draws your blood through one of the needles into a tube. The tube takes the blood to a filter, called a dialyzer. Inside the dialyzer, your blood flows through thin fibers that are like straws. The wastes and extra fluid leave the blood through tiny holes in the fibers. Then, a different tube carries the filtered blood back to your body through the second needle. The hemodialysis machine throws out the wastes and extra fluid, just like how your body makes urine. Hemodialysis does not make the kidneys better. However, it may help you feel better by filtering your blood when your kidneys fail. |
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| What is (are) What I need to know about Kidney Failure and How Its Treated ? | Peritoneal dialysis uses the lining of your belly to filter your blood inside your body. You can do peritoneal dialysis at home because it uses your body to filter. A doctor will place a soft tube called a catheter in your belly a few weeks before you start treatment. The catheter stays in your belly permanently.
The catheter lets you put a kind of salty water from a plastic bag into your belly. Then, you can move around and go about your day. While the salty water is inside your belly, it soaks up wastes and extra fluid from your body. After a few hours, you drain the salty water from your belly into a drain bag. The salty water removes wastes and extra fluid from your body. The salty water can be thrown away into a toilet or tub. Then you start over with a fresh bag of salty water. You will empty and fill your belly four to six times a day.
The salty water is always in your belly soaking up wastes and extra fluid. Peritoneal dialysis does not make the kidneys better. However, it may help you feel better by filtering your blood when your kidneys fail.
Is dialysis a cure for kidney failure? No. Hemodialysis and peritoneal dialysis help you feel better and live longer; however, they do not cure kidney failure. Although people with kidney failure are now living longer than ever, over the years kidney disease can cause problems such as heart disease, bone disease, arthritis, nerve damage, infertility, and malnutrition. These problems wont go away with dialysis; however, doctors now have new and better ways to prevent or treat them. You should discuss these problems and their treatments with your doctor. |
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| What is (are) What I need to know about Kidney Failure and How Its Treated ? | A kidney transplant places a healthy kidney from another person into your body. The kidney may come from someone who has just died. Your doctor will place your name on a waiting list for a kidney. A family member or friend might be able to give you a kidney. Then you dont have to wait.
Once it is placed inside your body, the new kidney takes over filtering your blood. The damaged kidneys usually stay where they are. The new kidney is placed in the front-lower abdomen, on one side of the bladder. Your body normally attacks anything that shouldnt be there, such as bacteria. The body will think the new kidney shouldnt be there. You will take medicines called immunosuppressants to keep your body from attacking the new kidney.
More information is provided in the NIDDK health topics:
- Treatment Methods for Kidney Failure: Hemodialysis - Home Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis - Treatment Methods for Kidney Failure: Transplantation |
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| What are the treatments for What I need to know about Kidney Failure and How Its Treated ? | Conservative management means your doctors take care of you without dialysis or a transplant. The doctors may give you medicines that make you feel more comfortable. You can have conservative management in your home. You may want to go to a hospice, a special place where you receive nursing care. Some people choose conservative management when dialysis or a transplant would not help them live longer or would make them suffer longer. Without dialysis or a transplant, you may live for a few weeks or several months. |
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| What are the treatments for What I need to know about Kidney Failure and How Its Treated ? | If you have kidney failure, learn about the treatments and think about which one best fits you. Talk with people who are on hemodialysis or peritoneal dialysis. Ask what is good and bad about each treatment. If you make a choice and find you dont like it, talk with your doctor about trying something else. Ask your doctor about the transplant waiting list and the medicines needed after a transplant. Talk with people who have had kidney transplants and ask how it has changed their lives.
If you plan to keep working, think about which treatment choice would make working easier. If spending time with family and friends means a lot to you, ask which treatment gives you the most free time. Find out which treatment will give you the best chance to be healthy and live longer.
If you are thinking about conservative management, you may wish to speak with your family, friends, doctor, or mental health counselor as you decide.
You can take control of your care by talking with your doctor. You may need time to get used to your new treatment. Kidney failure can make your life harder. Treatments can help improve your life. |
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| What to do for What I need to know about Kidney Failure and How Its Treated ? | Eating healthy foods can help you keep up your energy and strength. All dialysis and transplant centers have a dietitian. The dietitian helps people with kidney failure learn about healthy food choices. You should talk with your centers dietitian to make a meal plan.
The best diet for you will depend on which kidney failure treatment you choose after talking with your doctor.
- Hemodialysis - Limit how much liquid and water you drink. Fluid can build up in your body between hemodialysis sessions. Also, many foods contain water. The extra fluid in your body can cause swelling and high blood pressure. Extra fluid in your body makes your heart work harder.
- - Limit sodium, or salt. Watch out for sodium in frozen foods and prepared meals. You can also find sodium in canned foods, hot dogs, and fast food. Sodium makes you thirsty, which makes you drink more water and other liquids than you should. - Read more in the National Kidney Disease Education Program (NKDEP) fact sheet Sodium. - Limit potassium. Potassium is found in many fruits and vegetables such as potatoes, tomatoes, oranges, and bananas. Too much potassium can make your heart beat unevenly. Hemodialysis does not remove potassium from your body well. - Read more in the NKDEP fact sheet Potassium. - Eat protein-rich foods such as meat, fish, and eggs. Hemodialysis removes protein from your body. - Read more in the NKDEP fact sheet Protein. - Limit phosphorus. Phosphorus helps your bones, blood vessels, and muscles work. - However, too much phosphorus can make your bones weak. Limiting phosphorus can be hard. Foods that contain phosphorus, such as meat and milk, also contain protein that you need. You should be careful to eat enough protein, yet not so much that you get too much phosphorus. You can avoid other foods that contain phosphorus, such as cola, tea, beans, and nuts. - Read more in the NKDEP fact sheet Phosphorus. - Find healthy ways to add calories to your diet. Calories are found in all foods and give your body energy. Many people on hemodialysis do not have a good appetite and do not get enough calories. Vegetable oils are good sources of calories. Vegetable oils include olive oil, canola oil, and safflower oil. Use them on breads, rice, and noodles. Hard candy, sugar, honey, jam, and jelly provide calories and energy. However, if you have diabetes, speak with your doctor or dietitian before eating extra sweets. - More information about nutrition for people who are on hemodialysis is provided in the NIDDK health topic, Eat Right to Feel Right on Hemodialysis. - Peritoneal dialysis - Drink as much water and other liquids as you need. If you are holding too much fluid or too little fluid, your doctor needs to know. - Limit sodium to control your thirst and help prevent heart problems. You can use spices other than salt to flavor your food.
- - You may need to eat more potassium-rich foods. Peritoneal dialysis removes potassium from your body. Talk with your doctor or dietitian about the right amount of potassium for you. - Eat protein-rich foods. Peritoneal dialysis removes even more protein from your body than hemodialysis. - Limit phosphorus to keep your bones strong. - You may need to limit your calorie intake. The salty water also contains some sugar. Your body absorbs the sugar, which can cause you to gain weight. - Kidney transplant - Limit sodium to help prevent heart problems. - You should be able to eat normal amounts of phosphorus and potassium. You may need to adjust the amounts if blood tests show a problem.
- - Eat protein-rich foods to repair muscle breakdown and protect against infection. - You may need to limit your calories. The medicines you take can make you gain weight. - Conservative management - Limit protein to prevent the buildup of wastes in your blood.
You may have other needs and limits, depending on how well your treatments work. |
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| What to do for What I need to know about Kidney Failure and How Its Treated ? | - Kidney failure means your kidneys no longer filter your blood well enough to keep you healthy. - The treatments for kidney failure are - hemodialysis - peritoneal dialysis - a kidney transplant - conservative management - Hemodialysis uses a machine to filter your blood when your kidneys are too sick to filter any more. - Peritoneal dialysis uses the lining of your belly to filter your blood inside your body. - A kidney transplant places a healthy kidney from another person into your body. - Conservative management means your doctors take care of you without dialysis or a transplant. The doctors may give you medicines that make you feel more comfortable. - All dialysis and transplant centers have a dietitian. The dietitian helps people with kidney failure learn about healthy food choices. |
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| What is (are) What I need to know about Kidney Failure and How Its Treated ? | You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.
Booklets
- What I need to know about Kidney Failure and How its Treated - Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis - Treatment Methods for Kidney Failure: Kidney Transplantation - Kidney Failure: Eat Right to Feel Right on Hemodialysis
Fact Sheets
- Kidney Failure: What to Expect - Vascular Access for Hemodialysis - Hemodialysis Dose and Adequacy - Peritoneal Dialysis Dose and Adequacy - Amyloidosis and Kidney Disease - Anemia in Chronic Kidney Disease - Chronic Kidney Disease-Mineral and Bone Disorder - Financial Help for Treatment of Kidney Failure
Learning as much as you can about your treatment will help make you an important member of your health care team.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank: Neil R. Powe, M.D., M.P.H., M.B.A., University of California, San Francisco; Delphine Tuot, M.D.C.M., M.A.S., University of California, San Francisco; Vicki McClelland and Brian Testerman, both of the Free Medical Clinic of Northern Shenandoah Valley in Winchester, VA
This information is not copyrighted. The NIDDK encourages people to share this content freely.
September 2014 |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What is (are) Gastroparesis ? | Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What causes Gastroparesis ? | Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinsons disease or multiple sclerosis. For reasons that are still unclear, gastroparesis is more commonly found in women than in men. |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What are the symptoms of Gastroparesis ? | The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested foodsometimes several hours after a meal. Other symptoms of gastroparesis include
- gastroesophageal reflux (GER), also called acid reflux or acid regurgitationa condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomach - pain in the stomach area - abdominal bloating - lack of appetite
Symptoms may be aggravated by eating greasy or rich foods, large quantities of foods with fibersuch as raw fruits and vegetablesor drinking beverages high in fat or carbonation. Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases. |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| How to diagnose Gastroparesis ? | Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests:
- Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenumthe first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologista doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoarssolid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomachthat are sometimes softened, dissolved, or broken up during an upper GI endoscopy. - Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test. - 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 radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a persons digestive symptoms, rather than gastroparesis. - Gastric emptying scintigraphy. The test involves eating a bland mealsuch as eggs or an egg substitutethat contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed. - SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the persons waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract. - Gastric emptying breath test. With this test, the person eats a special test meal that includes a natural material with a special type of carbon in it. Then, breath samples are taken over a period of several hours to measure the amount of the material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying. |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What are the treatments for Gastroparesis ? | Treatment of gastroparesis depends on the severity of the persons symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing conditionthe symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible. |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What to do for Gastroparesis ? | Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking or sitting for 2 hours after a mealinstead of lying downmay assist with gastric emptying.
A health care provider may also recommend avoiding high-fat and fibrous foods. Fat naturally slows digestion and some raw vegetables and fruits are more difficult to digest than other foods. Some foods, such as oranges and broccoli, contain fibrous parts that do not digest well. People with gastroparesis should minimize their intake of large portions of these foods because the undigested parts may remain in the stomach too long. Sometimes, the undigested parts form bezoars.
When a person has severe symptoms, a liquid or pured diet may be prescribed. As liquids tend to empty more quickly from the stomach, some people may find a pured diet helps improve symptoms. Pured fresh or cooked fruits and vegetables can be incorporated into shakes and soups. A health care provider may recommend a dietitian to help a person plan meals that minimize symptoms and ensure all nutritional needs are met.
When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and dehydration, urgent care may be required at a medical facility where IV fluids can be given.
Medications
Several prescription medications are available to treat gastroparesis. A combination of medications may be used to find the most effective treatment.
Metoclopramide (Reglan). This medication stimulates stomach muscle contractions to help with gastric emptying. Metoclopramide also helps reduce nausea and vomiting. The medication is taken 20 to 30 minutes before meals and at bedtime. Possible side effects of metoclopramide include fatigue, sleepiness, and depression. Currently, this is the only medication approved by the FDA for treatment of gastroparesis. However, the FDA has placed a black box warning on this medication because of rare reports of it causing an irreversible neurologic side effect called tardive dyskinesiaa disorder that affects movement.
Erythromycin. This antibiotic, prescribed at low doses, may improve gastric emptying. Like metaclopramide, erythromycin works by increasing the contractions that move food through the stomach. Possible side effects of erythromycin include nausea, vomiting, and abdominal cramps.
Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, medications known as antiemetics are used to help control nausea and vomiting.
Botulinum Toxin
Botulinum toxin is a nerve blocking agent also known as Botox. After passing an endoscope into the stomach, a health care provider injects the Botox into the pylorus, the opening from the stomach into the duodenum. Botox is supposed to help keep the pylorus open for longer periods of time and improve symptoms of gastroparesis. Although some initial research trials showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to show the same degree of effectiveness of the Botox injections.1
Gastric Electrical Stimulation
This treatment alternative may be effective for some people whose nausea and vomiting do not improve with dietary changes or medications. A gastric neurostimulator is a surgically implanted battery-operated device that sends mild electrical pulses to the stomach muscles to help control nausea and vomiting. The procedure may be performed at a hospital or outpatient center by a gastroenterologist. General anesthesia may be required. The gastroenterologist makes several tiny incisions in the abdomen and inserts a laparoscopea thin tube with a tiny video camera attached. The camera sends a magnified image from inside the stomach to a video monitor, giving the gastroenterologist a close-up view of the tissues. Once implanted, the settings on the battery-operated device can be adjusted to determine the settings that best control symptoms.
Jejunostomy
If medications and dietary changes dont work, and the person is losing weight or requires frequent hospitalization for dehydration, a health care provider may recommend surgically placing a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum. The surgical procedure is known as a jejunostomy. The procedure is performed by a surgeon at a hospital or outpatient center. Anesthesia is needed. The feeding tube bypasses the stomach and delivers a special liquid food with nutrients directly into the jejunum. The jejunostomy is used only when gastroparesis is extremely severe.
Parenteral Nutrition
When gastroparesis is so severe that dietary measures and other treatments are not helping, a health care provider may recommend parenteral nutritionan IV liquid food mixture supplied through a special tube in the chest. The procedure is performed by a surgeon at a hospital or outpatient center; anesthesia is needed. The surgeon inserts a thin, flexible tube called a catheter into a chest vein, with the catheter opening outside the skin. A bag containing liquid nutrients is attached to the catheter, and the nutrients are transported through the catheter into the chest vein and into the bloodstream. This approach is a less preferable alternative to a jejunostomy and is usually a temporary treatment to get through a difficult period of gastroparesis. |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What are the treatments for Gastroparesis ? | An elevated blood glucose level directly interferes with normal stomach emptying, so good blood glucose control in people with diabetes is important. However, gastroparesis can make blood glucose control difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a persons blood glucose levels to be erratic and difficult to control.
The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the persons insulin regimen.
To better control blood glucose, people with diabetes and gastroparesis may need to
- take insulin more often or change the type of insulin they take - take insulin after meals, instead of before - check blood glucose levels frequently after eating and administer insulin when necessary
A health care provider will give specific instructions for taking insulin based on the individuals needs and the severity of gastroparesis.
In some cases, the dietitian may suggest eating several liquid or pured meals a day until gastroparesis symptoms improve and blood glucose levels are more stable. |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What is (are) Gastroparesis ? | The problems of gastroparesis can include
- severe dehydration due to persistent vomiting - gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis irritation of the esophagus - bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form - difficulty managing blood glucose levels in people with diabetes - malnutrition due to poor absorption of nutrients or a low calorie intake - decreased quality of life, including work absences due to severe symptoms |
Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most common known cause of gastroparesis. Doctors diagnose gastroparesis based on your medical history, a physical exam, symptoms, and medical tests, such as tests to measure stomach emptying. Your doctor may use medical tests to look for gastroparesis complications. How doctors treat gastroparesis depends on the cause, how bad your symptoms and complications are, and how well you respond to different treatments. If diabetes is causing your gastroparesis, your doctor will help you control your blood glucose levels. What you eat can help relieve gastroparesis symptoms. What you eat can also help make sure you get the right amount of nutrients, calories, and liquids if you are malnourished or dehydrated due to gastroparesis. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
The NIDDK would like to thank:
Michael Camilleri, M.D., Mayo Clinic, Rochester
| What to do for Gastroparesis ? | - Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. - Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. - Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. - Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. - The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food sometimes several hours after a meal. Other common symptoms include gastroesophageal reflux (GER), pain in the stomach area, abdominal bloating, and lack of appetite. - Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests. - Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or pured diet may be prescribed. - Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition. - For people with gastroparesis and diabetes, a health care provider will likely adjust the persons insulin regimen. |
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| How to diagnose Your Diabetes Care Records ? | Test Instructions Results or Dates A1C test - Have this blood test at least twice a year. Your result will tell you what your average blood glucose level was for the past 2 to 3 months. Date: __________ A1C: __________ Next test: __________ Blood lipid (fats) lab tests - Get a blood test to check your - total cholesterolaim for below 200 - LDL, or bad, cholesterolaim for below 100 - HDL, or good, cholesterolmen: aim for above 40; women: aim for above 50 - triglyceridesaim for below 150 Date: __________ Total cholesterol: __________ LDL: __________ HDL: __________ Triglycerides: __________ Next test: __________ Kidney function tests - Once a year, get a urine test to check for protein. - At least once a year, get a blood test to check for creatinine. Date: __________ Urine protein: __________ Creatinine: __________ Next test: __________ Dilated eye exam - See an eye doctor once a year for a complete eye exam that includes using drops in your eyes to dilate your pupils. - If you are pregnant, have a complete eye exam in your first 3 months of pregnancy. Have another complete eye exam 1 year after your baby is born. Date: __________ Result: __________ Next test: __________ Dental exam - See your dentist twice a year for a cleaning and checkup. Date: __________ Result: __________ Next test: __________ Pneumonia vaccine (recommended by the Centers for Disease Control and Prevention [CDC]) - Get the vaccine if you are younger than 64. - If youre older than 64 and your shot was more than 5 years ago, get another vaccine. Date received: __________ Flu vaccine (recommended by the CDC) - Get a flu shot each year. Date received: __________ Hepatitis B vaccine (recommended by the CDC) - Get this vaccine if you are age 19 to 59 and have not had this vaccine. - Consider getting this vaccine if you are 60 or older and have not had this vaccine. Date of 1st dose: __________ Date of 2nd dose: __________ Date of 3rd dose: __________
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| What is (are) Gastritis ? | Gastritis is a condition in which the stomachliningknown as the mucosais inflamed, or swollen. The stomach lining contains glands that produce stomach acid and an enzyme called pepsin. The stomach acid breaks down food and pepsin digests protein. A thick layer of mucus coats the stomach lining and helps prevent the acidic digestive juice from dissolving the stomach tissue. When the stomach lining is inflamed, it produces less acid and fewer enzymes. However, the stomach lining also produces less mucus and other substances that normally protect the stomach lining from acidic digestive juice.
Gastritis may be acute or chronic:
- Acute gastritis starts suddenly and lasts for a short time. - Chronic gastritis is long lasting. If chronic gastritis is not treated, it may last for years or even a lifetime.
Gastritis can be erosive or nonerosive:
- Erosive gastritis can cause the stomach lining to wear away, causing erosionsshallow breaks in the stomach liningor ulcersdeep sores in the stomach lining. - Nonerosive gastritis causes inflammation in the stomach lining; however, erosions or ulcers do not accompany nonerosive gastritis.
A health care provider may refer a person with gastritis to a gastroenterologista doctor who specializes in digestive diseases. |
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| What causes Gastritis ? | Common causes of gastritis include
- Helicobacter pylori (H. pylori) infection - damage to the stomach lining, which leads to reactive gastritis - an autoimmune response
H. pylori infection. H. pylori is a type of bacteriaorganisms that may cause an infection. H. pylori infection
- causes most cases of gastritis - typically causes nonerosive gastritis - may cause acute or chronic gastritis
H. pylori infection is common, particularly in developing countries, and the infection often begins in childhood. Many people who are infected with H. pylori never have any symptoms. Adults are more likely to show symptoms when symptoms do occur.
Researchers are not sure how the H. pylori infection spreads, although they think contaminated food, water, or eating utensils may transmit the bacteria. Some infected people have H. pylori in their saliva, which suggests that infection can spread through direct contact with saliva or other body fluids.
More information about Peptic Ulcer Disease and H. pylori is provided in the NIDDK health topic, Peptic Ulcer Disease.
Damage to the stomach lining, which leads to reactive gastritis. Some people who have damage to the stomach lining can develop reactive gastritis.
Reactive gastritis
- may be acute or chronic - may cause erosions - may cause little or no inflammation
Reactive gastritis may also be called reactive gastropathy when it causes little or no inflammation.
The causes of reactive gastritis may include
- nonsteroidal anti-inflammatory drugs (NSAIDs), a type of over-the-counter medication. Aspirin and ibuprofen are common types of NSAIDs. - drinking alcohol. - using cocaine. - exposure to radiation or having radiation treatments. - reflux of bile from the small intestine into the stomach. Bile reflux may occur in people who have had part of their stomach removed. - a reaction to stress caused by traumatic injuries, critical illness, severe burns, and major surgery. This type of reactive gastritis is called stress gastritis.
An autoimmune response. In autoimmune gastritis, the immune system attacks healthy cells in the stomach lining. The immune system normally protects people from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Autoimmune gastritis is chronic and typically nonerosive.
Less common causes of gastritis may include
- Crohn's disease, which causes inflammation and irritation of any part of the gastrointestinal (GI) tract. - sarcoidosis, a disease that causes inflammation that will not go away. The chronic inflammation causes tiny clumps of abnormal tissue to form in various organs in the body. The disease typically starts in the lungs, skin, and lymph nodes. - allergies to food, such as cow's milk and soy, especially in children. - infections with viruses, parasites, fungi, and bacteria other than H. pylori, typically in people with weakened immune systems. |
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| What are the symptoms of Gastritis ? | Some people who have gastritis have pain or discomfort in the upper part of the abdomenthe area between the chest and hips. However, many people with gastritis do not have any signs and symptoms. The relationship between gastritis and a person's symptoms is not clear. The term gastritis is sometimes mistakenly used to describe any symptoms of pain or discomfort in the upper abdomen.
When symptoms are present, they may include
- upper abdominal discomfort or pain - nausea - vomiting
Seek Help for Symptoms of Bleeding in the Stomach Erosive gastritis may cause ulcers or erosions in the stomach lining that can bleed. Signs and symptoms of bleeding in the stomach include - shortness of breath - dizziness or feeling faint - red blood in vomit - black, tarry stools - red blood in the stool - weakness - paleness A person with any signs or symptoms of bleeding in the stomach should call or see a health care provider right away. More information is provided in the NIDDK health topic, Bleeding in the Digestive Tract. |
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| What are the symptoms of Gastritis ? | Erosive gastritis may cause ulcers or erosions in the stomach lining that can bleed. Signs and symptoms of bleeding in the stomach include
- shortness of breath - dizziness or feeling faint - red blood in vomit - black, tarry stools - red blood in the stool - weakness - paleness
A person with any signs or symptoms of bleeding in the stomach should call or see a health care provider right away.
More information is provided in the NIDDK health topic, Bleeding in the Digestive Tract. |
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| What are the complications of Gastritis ? | The complications of chronic gastritis may include
- peptic ulcers. Peptic ulcers are sores involving the lining of the stomach or duodenum, the first part of the small intestine. NSAID use and H. pylori gastritis increase the chance of developing peptic ulcers. - atrophic gastritis. Atrophic gastritis happens when chronic inflammation of the stomach lining causes the loss of the stomach lining and glands. Chronic gastritis can progress to atrophic gastritis. - anemia. Erosive gastritis can cause chronic bleeding in the stomach, and the blood loss can lead to anemia. Anemia is a condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen. Red blood cells contain hemoglobin, an iron-rich protein that gives blood its red color and enables the red blood cells to transport oxygen from the lungs to the tissues of the body. Research suggests that H. pylori gastritis and autoimmune atrophic gastritis can interfere with the body's ability to absorb iron from food, which may also cause anemia. Read more about anemia at www.nhlbi.nih.gov. - vitamin B12 deficiency and pernicious anemia. People with autoimmune atrophic gastritis do not produce enough intrinsic factor. Intrinsic factor is a protein made in the stomach and helps the intestines absorb vitamin B12. The body needs vitamin B12 to make red blood cells and nerve cells. Poor absorption of vitamin B12 may lead to a type of anemia called pernicious anemia. Read more about pernicious anemia at www.nhlbi.nih.gov. - growths in the stomach lining. Chronic gastritis increases the chance of developing benign, or noncancerous, and malignant, or cancerous, growths in the stomach lining. Chronic H. pylori gastritis increases the chance of developing a type of cancer called gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Read more about MALT lymphoma and gastric cancer at www.cancer.gov.
In most cases, acute gastritis does not lead to complications. In rare cases, acute stress gastritis can cause severe bleeding that can be life threatening. |
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| How to diagnose Gastritis ? | A health care provider diagnoses gastritis based on the following:
- medical history - physical exam - upper GI endoscopy - other tests
Medical History
Taking a medical history may help the health care provider diagnose gastritis. He or she will ask the patient to provide a medical history. The history may include questions about chronic symptoms and travel to developing countries.
Physical Exam
A physical exam may help diagnose gastritis. During a physical exam, a health care provider usually
- examines a patient's body - uses a stethoscope to listen to sounds in the abdomen - taps on the abdomen checking for tenderness or pain
Upper Gastrointestinal Endoscopy
Upper GI endoscopy is a procedure that uses an endoscopea small, flexible camera with a lightto see the upper GI tract. A health care provider performs the test at a hospital or an outpatient center. The health care provider carefully feeds the endoscope down the esophagus and into the stomach and duodenum. The small camera built into the endoscope transmits a video image to a monitor, allowing close examination of the GI lining. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patient's throat before inserting the endoscope. A health care provider will place an intravenous (IV) needle in a vein in the arm to administer sedation. Sedatives help patients stay relaxed and comfortable. The test may show signs of inflammation or erosions in the stomach lining.
The health care provider can use tiny tools passed through the endoscope to perform biopsies. A biopsy is a procedure that involves taking a piece of tissue for examination with a microscope by a pathologista doctor who specializes in examining tissues to diagnose diseases. A health care provider may use the biopsy to diagnose gastritis, find the cause of gastritis, and find out if chronic gastritis has progressed to atrophic gastritis. More information is provided in the NIDDK health topic, Upper GI Endoscopy.
Other Tests
A health care provider may have a patient complete other tests to identify the cause of gastritis or any complications. These tests may include the following:
- Upper GI series. Upper GI series is an x-ray exam that provides a look at the shape of the upper GI tract. An x-ray technician performs this test at a hospital or an outpatient center, and a radiologista doctor who specializes in medical imaginginterprets the images. This test does not require anesthesia. A patient should not eat or drink before the procedure, as directed by the health care provider. Patients should check with their health care provider about what to do to prepare for an upper GI series. During the procedure, the patient will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the esophagus, stomach, and small intestine so the radiologist and health care provider can see these organs' shapes more clearly on x-rays. A patient may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract may cause white or light-colored stools. A health care provider will give the patient specific instructions about eating and drinking after the test. More information is provided in the NIDDK health topic, Upper GI Series. - Blood tests. A health care provider may use blood tests to check for anemia or H. pylori. A health care provider draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. - Stool test. A health care provider may use a stool test to check for blood in the stool, another sign of bleeding in the stomach, and for H. pylori infection. A stool test is an analysis of a sample of stool. The health care provider will give the patient a container for catching and storing the stool. The patient returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. - Urea breath test. A health care provider may use a urea breath test to check for H. pylori infection. The patient swallows a capsule, liquid, or pudding that contains ureaa waste product the body produces as it breaks down protein. The urea is labeled with a special carbon atom. If H. pylori are present, the bacteria will convert the urea into carbon dioxide. After a few minutes, the patient breathes into a container, exhaling carbon dioxide. A nurse or technician will perform this test at a health care provider's office or a commercial facility and send the samples to a lab. If the test detects the labeled carbon atoms in the exhaled breath, the health care provider will confirm an H. pylori infection in the GI tract. |
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| What are the treatments for Gastritis ? | Health care providers treat gastritis with medications to
- reduce the amount of acid in the stomach - treat the underlying cause
Reduce the Amount of Acid in the Stomach
The stomach lining of a person with gastritis may have less protection from acidic digestive juice. Reducing acid can promote healing of the stomach lining. Medications that reduce acid include
- antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan. Many brands use different combinations of three basic saltsmagnesium, aluminum, and calciumalong with hydroxide or bicarbonate ions to neutralize stomach acid. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt can cause constipation. Magnesium and aluminum salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can cause constipation. - H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75). H2 blockers decrease acid production. They are available in both over-the-counter and prescription strengths. - proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), dexlansoprazole (Dexilant), pantoprazole (Protonix), rabeprazole (AcipHex), and esomeprazole (Nexium). PPIs decrease acid production more effectively than H2 blockers. All of these medications are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.
Treat the Underlying Cause
Depending on the cause of gastritis, a health care provider may recommend additional treatments.
- Treating H. pylori infection with antibiotics is important, even if a person does not have symptoms from the infection. Curing the infection often cures the gastritis and decreases the chance of developing complications, such as peptic ulcer disease, MALT lymphoma, and gastric cancer. - Avoiding the cause of reactive gastritis can provide some people with a cure. For example, if prolonged NSAID use is the cause of the gastritis, a health care provider may advise the patient to stop taking the NSAIDs, reduce the dose, or change pain medications. - Health care providers may prescribe medications to prevent or treat stress gastritis in a patient who is critically ill or injured. Medications to protect the stomach lining include sucralfate (Carafate), H2 blockers, and PPIs. Treating the underlying illness or injury most often cures stress gastritis. - Health care providers may treat people with pernicious anemia due to autoimmune atrophic gastritis with vitamin B12 injections. |
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| How to prevent Gastritis ? | People may be able to reduce their chances of getting gastritis by preventing H. pylori infection. No one knows for sure how H. pylori infection spreads, so prevention is difficult. To help prevent infection, health care providers advise people to
- wash their hands with soap and water after using the bathroom and before eating - eat food that has been washed well and cooked properly - drink water from a clean, safe source |
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| What to do for Gastritis ? | Researchers have not found that eating, diet, and nutrition play a major role in causing or preventing gastritis. |
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| What to do for Gastritis ? | - Gastritis is a condition in which the stomach liningknown as the mucosais inflamed, or swollen. - Common causes of gastritis include Helicobacter pylori (H. pylori) infection, damage to the stomach lining, and an autoimmune response. - Some people who have gastritis have pain or discomfort in the upper part of the abdomen. However, many people with gastritis do not have any signs and symptoms. - Erosive gastritis may cause ulcers or erosions in the stomach lining that can bleed. A person with any signs or symptoms of bleeding in the stomach should call or see a health care provider right away. - A health care provider diagnoses gastritis based on a medical history, a physical exam, upper GI endoscopy, and other tests. - Health care providers treat gastritis with medications to reduce the amount of acid in the stomach and treat the underlying cause. |
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| What is (are) Proctitis ? | Proctitis is inflammation of the lining of the rectum, the lower end of the large intestine leading to the anus. The large intestine and anus are part of the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. With proctitis, inflammation of the rectal liningcalled the rectal mucosais uncomfortable and sometimes painful. The condition may lead to bleeding or mucous discharge from the rectum, among other symptoms. |
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| What is (are) Proctitis ? | Proctitis is inflammation of the lining of the rectum, the lower end of the large intestine leading to the anus. The large intestine and anus are part of the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. With proctitis, inflammation of the rectal liningcalled the rectal mucosais uncomfortable and sometimes painful. The condition may lead to bleeding or mucous discharge from the rectum, among other symptoms. |
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| What causes Proctitis ? | Proctitis has many causes, including acute, or sudden and short-term, and chronic, or long-lasting, conditions. Among the causes are the following:
- Sexually transmitted diseases (STDs). STDs that can be passed when a person is receiving anal sex are a common cause of proctitis. Common STD infections that can cause proctitis include gonorrhea, chlamydia, syphilis, and herpes. Herpes-induced proctitis may be particularly severe in people who are also infected with the HIV virus. - Non-STD infections. Infections that are not sexually transmitted also can cause proctitis. Salmonella and Shigella are examples of foodborne bacteria that can cause proctitis. Streptococcal proctitis sometimes occurs in children who have strep throat. - Anorectal trauma. Proctitis can be caused by trauma to the anorectal areawhich includes the rectum and anusfrom anal sex or the insertion of objects or harmful substances into the rectum, including the chemicals in some enemas. - Ulcerative colitis and Crohns disease. Two forms of inflammatory bowel disease (IBD)ulcerative colitis and Crohns diseasecan cause proctitis. Ulcerative colitis causes irritation and ulcers, also called sores, in the inner lining of the colonpart of the large intestineand rectum. Crohns disease usually causes irritation in the lower small intestinealso called the ileumor the colon, but it can affect any part of the GI tract. - Radiation therapy. People who have had radiation therapy that targets the pelvic area also may develop proctitis. Examples of those at risk are people with rectal, ovarian, or prostate cancer who have received radiation treatment directed to those areas. Symptoms of radiation proctitis, most commonly rectal bleeding, will typically occur within 6 weeks after beginning radiation therapy or more than 9 months after its completion. - Antibiotics. Use of antibiotics may be associated with proctitis in some people. While meant to kill infectioncausing bacteria, antibiotics can also kill nonharmful, or commensal, bacteria in the GI tract. The loss of commensal bacteria can then allow other harmful bacteria known as Clostridium difficile to cause an infection in the colon and rectum. |
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| What causes Proctitis ? | Proctitis has many causes, including acute, or sudden and short-term, and chronic, or long-lasting, conditions. Among the causes are the following:
- Sexually transmitted diseases (STDs). STDs that can be passed when a person is receiving anal sex are a common cause of proctitis. Common STD infections that can cause proctitis include gonorrhea, chlamydia, syphilis, and herpes. Herpes-induced proctitis may be particularly severe in people who are also infected with the HIV virus. - Non-STD infections. Infections that are not sexually transmitted also can cause proctitis. Salmonella and Shigella are examples of foodborne bacteria that can cause proctitis. Streptococcal proctitis sometimes occurs in children who have strep throat. - Anorectal trauma. Proctitis can be caused by trauma to the anorectal areawhich includes the rectum and anusfrom anal sex or the insertion of objects or harmful substances into the rectum, including the chemicals in some enemas. - Ulcerative colitis and Crohns disease. Two forms of inflammatory bowel disease (IBD)ulcerative colitis and Crohns diseasecan cause proctitis. Ulcerative colitis causes irritation and ulcers, also called sores, in the inner lining of the colonpart of the large intestineand rectum. Crohns disease usually causes irritation in the lower small intestinealso called the ileumor the colon, but it can affect any part of the GI tract. - Radiation therapy. People who have had radiation therapy that targets the pelvic area also may develop proctitis. Examples of those at risk are people with rectal, ovarian, or prostate cancer who have received radiation treatment directed to those areas. Symptoms of radiation proctitis, most commonly rectal bleeding, will typically occur within 6 weeks after beginning radiation therapy or more than 9 months after its completion. - Antibiotics. Use of antibiotics may be associated with proctitis in some people. While meant to kill infectioncausing bacteria, antibiotics can also kill nonharmful, or commensal, bacteria in the GI tract. The loss of commensal bacteria can then allow other harmful bacteria known as Clostridium difficile to cause an infection in the colon and rectum. |
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| What are the symptoms of Proctitis ? | Tenesmusan uncomfortable and frequent urge to have a bowel movementis one of the most common symptoms of proctitis. Other symptoms may include
- bloody bowel movements - rectal bleeding - a feeling of rectal fullness - anal or rectal pain - crampy abdominal pain - rectal discharge of mucus or pus - diarrhea or frequent passage of loose or liquid stools |
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| How to diagnose Proctitis ? | To diagnose proctitis, a health care provider will take a complete medical history and do a physical exam. The health care provider will ask the patient about symptoms, current and past medical conditions, family history, and sexual behavior that increases the risk of STD-induced proctitis. The physical exam will include an assessment of the patients vital signs, an abdominal exam, and a rectal exam.
Based on the patients physical exam, symptoms, and other medical information, the doctor will decide which lab tests and diagnostic tests are needed. Lab tests may include blood tests such as a complete blood count to evaluate for blood loss or infection, stool tests to isolate and identify bacteria that may cause disease, and an STD screening. The doctor also may use one of the following diagnostic tests:
- Rectal culture. A cotton swab is inserted into the rectum to obtain a sample that can be used in tests that isolate and identify organisms that may cause disease. - Anoscopy. This test allows examination of the anal canal and lower rectum by opening the anus using a special instrument called an anoscope. - Flexible sigmoidoscopy and colonoscopy. These tests are used to help diagnose Crohns disease. The tests are similar, but colonoscopy is used to view the entire colon and rectum, while flexible sigmoidoscopy is used to view just the lower colon and rectum. For both tests, a health care provider will provide written bowel prep instructions to follow at home before the test. The person may be asked to follow a clear liquid diet for 1 to 3 days before the test. A laxative may be required the night before the test. One or more enemas may be required the night before and about 2 hours before the test. |
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| What are the treatments for Proctitis ? | Treatment of proctitis depends on its cause. The goal of treatment is to reduce inflammation, control symptoms, and eliminate infection, if it is present. Only a doctor can determine the cause of proctitis and the best course of treatment. With proper medical attention, proctitis can be successfully treated.
Proctitis from Infection
If lab tests confirm that an STD or non-STD infection is present, medication is prescribed based on the type of infection found. Antibiotics are prescribed to kill bacteria; antiviral medications are prescribed to treat viruses. Although some STD viruses cannot be eliminated, antivirals can control their symptoms.
Proctitis from Other Causes
If antibiotic use triggered proctitis, the doctor may prescribe a different antibiotic designed to destroy the harmful bacteria that have developed in the intestines.
If proctitis is caused by anorectal trauma, the activity causing the inflammation should be stopped. Healing usually occurs in 4 to 6 weeks. The doctor may recommend over-the-counter medications such as antidiarrheals and those used for pain relief, such as aspirin and ibuprofen.
Treatment of radiation proctitis is based on symptoms. Radiation proctitis causing only mild symptoms such as occasional bleeding or tenesmus may heal without treatment. For people with persistent or severe bleeding, thermal therapy may be used to stop bleeding and inflammation. Thermal therapy is done during flexible sigmoidoscopy or colonoscopy and targets the rectal lining with a heat probe, electric current, or laser. Argon plasma coagulation is the most common thermal therapy used to control bleeding in radiation proctitis. In many cases, several treatments are required. Obstruction that results from a stricturea narrowing of the rectumcaused by radiation proctitis may be treated with stool softeners in mild cases. In people with narrower strictures, dilation to enlarge the narrow area may be required. Sucralfate, 5-aminosalicylic acidknown as 5-ASAor corticosteroid enemas can also be used to ease pain and reduce inflammation from radiation proctitis, although their effectiveness is limited.
When a chronic IBD such as ulcerative colitis or Crohns disease causes proctitis, treatment aims to reduce inflammation, control symptoms, and induce and maintain remissiona period when the person is symptom-free. Treatment depends on the extent and severity of the disease.
Anti-inflammation medications. Mild proctitis can often be effectively treated with topical mesalamine, either suppositories or enemas.
Some people with IBD and proctitis cannot tolerateor may have an incomplete response torectal therapy with 5-ASA suppositories or enemas. For these people, the doctor may prescribe oral medications alone or in combination with rectal therapy. Oral medications commonly used for proctitis contain salicylate. These include sulfasalazine- or mesalamine-containing medications, such as Asacol, Dipentum, or Pentasa. Possible side effects of oral administration of sulfasalazine- or mesalaminecontaining medications include nausea, vomiting, heartburn, diarrhea, and headache. Improvement in symptoms, including a decrease in bleeding, can occur within a few days, although complete healing requires 4 to 6 weeks of therapy.
Cortisone or steroids. These medications, also called corticosteroids, are effective at reducing inflammation. Prednisone and budesonide are generic names of two medications in this group. Corticosteroids for proctitis may be taken in pill, suppository, or enema form. When symptoms are at their worst, corticosteroids are usually prescribed in a large dose. The dosage is then gradually lowered once symptoms are controlled. Corticosteroids can cause serious side effects, including greater susceptibility to infection and osteoporosis, or weakening of the bones.
Immune system suppressors. Medications that suppress the immune systemcalled immunosuppressive medicationsare also used to treat proctitis. The most commonly prescribed medication is 6-mercaptopurine or a related medication, azathioprine. Immunosuppressive medications work by blocking the immune reaction that contributes to inflammation. These medications may cause side effects such as nausea, vomiting, and diarrhea and may lower a persons resistance to infection. Some patients are treated with a combination of corticosteroids and immunosuppressive medications. Some studies suggest that immunosuppressive medications may enhance the effectiveness of corticosteroids.
Infliximab (Remicade). Researchers have found that high levels of a protein produced by the immune system, called tumor necrosis factor (TNF), are present in people with Crohns disease. Infliximab is the first of a group of medications that bind to TNF substances to block the bodys inflammation response. The U.S. Food and Drug Administration approved the medication for the treatment of moderate to severe Crohns disease that does not respond to standard therapiesmesalamine substances, corticosteroids, immunosuppressive medicationsand for the treatment of open, draining fistulas. The medication is also given to people who have Crohns disease with proctitis. Some studies suggest that infliximab may enhance the effectiveness of immunosuppressive medications.
Bacterial infection can occur with flare-ups of ulcerative colitis or Crohns disease. Antibiotics may also be used to treat flare-ups in people with IBD and proctitis.
More information about the treatment of IBD is provided in the NIDDK health topics, Ulcerative Colitis and Crohns Disease. |
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| What to do for Proctitis ? | Drinking plenty of fluids is important when diarrhea or frequent passage of loose or liquid stools occurs.
Avoiding caffeine and foods that are greasy, high in fiber, or sweet may lessen diarrhea symptoms. Some people also have problems digesting lactosethe sugar found in milk and milk productsduring or after a bout of diarrhea. Yogurt, which has less lactose than milk, is often better tolerated. Yogurt with active, live bacterial cultures may even help people recover from diarrhea more quickly.
If diarrhea symptoms improve, soft, bland foods can be added to the diet, including bananas, plain rice, boiled potatoes, toast, crackers, cooked carrots, and baked chicken without the skin or fat. If the diarrhea stops, a normal diet may be resumed if tolerated. |
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| What are the treatments for Proctitis ? | Proctitis that is not treated or does not respond to treatment may lead to complications, including
- severe bleeding and anemiaa condition in which red blood cells are fewer or smaller than normal, which means less oxygen is carried to the bodys cells - abscessespainful, swollen, pus-filled areas caused by infection - ulcers on the intestinal lining - fistulasabnormal connections between two parts inside the body |
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| How to prevent Proctitis ? | People who receive anal sex can avoid getting STD-related proctitis by having their partner use a condom. If anorectal trauma caused proctitis, stopping the activity that triggered inflammation often will stop the inflammation and prevent recurrence.
Other causes of proctitis cannot always be prevented. However, their symptoms can be treated by a doctor. |
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| What to do for Proctitis ? | - Proctitis is inflammation of the lining of the rectum, the lower end of the large intestine leading to the anus. - Common causes of proctitis are sexually transmitted diseases (STDs), non-STD infections, anorectal trauma, ulcerative colitis and Crohns disease, radiation therapy, and antibiotic use. - Treatment of proctitis depends on its cause; the goal of treatment is to reduce inflammation, control symptoms, and eliminate infection, if present. - With proper medical attention, proctitis can be successfully treated. - If infection is present with proctitis, antibiotics can be used to kill bacteria and antiviral medications can treat viral infections. - People who receive anal sex can avoid getting STD-related proctitis by having their partner use a condom. - If anorectal trauma caused proctitis, stopping the activity that triggered inflammation often will stop the inflammation and prevent recurrence. - Some causes of proctitis cannot always be prevented, but their symptoms can be treated by a doctor. |
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| 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. |
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| 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. |
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| What is (are) Inguinal Hernia ? | An inguinal hernia happens when contents of the abdomenusually fat or part of the small intestinebulge through a weak area in the lower abdominal wall. The abdomen is the area between the chest and the hips. The area of the lower abdominal wall is also called the inguinal or groin region.
Two types of inguinal hernias are
- indirect inguinal hernias, which are caused by a defect in the abdominal wall that is congenital, or present at birth - direct inguinal hernias, which usually occur only in male adults and are caused by a weakness in the muscles of the abdominal wall that develops over time
Inguinal hernias occur at the inguinal canal in the groin region. |
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| What is (are) Inguinal Hernia ? | The inguinal canal is a passage through the lower abdominal wall. People have two inguinal canalsone on each side of the lower abdomen. In males, the spermatic cords pass through the inguinal canals and connect to the testicles in the scrotumthe sac around the testicles. The spermatic cords contain blood vessels, nerves, and a duct, called the spermatic duct, that carries sperm from the testicles to the penis. In females, the round ligaments, which support the uterus, pass through the inguinal canals. |
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| What causes Inguinal Hernia ? | The cause of inguinal hernias depends on the type of inguinal hernia.
Indirect inguinal hernias. A defect in the abdominal wall that is present at birth causes an indirect inguinal hernia.
During the development of the fetus in the womb, the lining of the abdominal cavity forms and extends into the inguinal canal. In males, the spermatic cord and testicles descend out from inside the abdomen and through the abdominal lining to the scrotum through the inguinal canal. Next, the abdominal lining usually closes off the entrance to the inguinal canal a few weeks before or after birth. In females, the ovaries do not descend out from inside the abdomen, and the abdominal lining usually closes a couple of months before birth.1
Sometimes the lining of the abdomen does not close as it should, leaving an opening in the abdominal wall at the upper part of the inguinal canal. Fat or part of the small intestine may slide into the inguinal canal through this opening, causing a hernia. In females, the ovaries may also slide into the inguinal canal and cause a hernia.
Indirect hernias are the most common type of inguinal hernia.2 Indirect inguinal hernias may appear in 2 to 3 percent of male children; however, they are much less common in female children, occurring in less than 1 percent.3
Direct inguinal hernias. Direct inguinal hernias usually occur only in male adults as aging and stress or strain weaken the abdominal muscles around the inguinal canal. Previous surgery in the lower abdomen can also weaken the abdominal muscles.
Females rarely form this type of inguinal hernia. In females, the broad ligament of the uterus acts as an additional barrier behind the muscle layer of the lower abdominal wall. The broad ligament of the uterus is a sheet of tissue that supports the uterus and other reproductive organs. |
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| What are the symptoms of Inguinal Hernia ? | The first sign of an inguinal hernia is a small bulge on one or, rarely, on both sides of the grointhe area just above the groin crease between the lower abdomen and the thigh. The bulge may increase in size over time and usually disappears when lying down.
Other signs and symptoms can include
- discomfort or pain in the groinespecially when straining, lifting, coughing, or exercisingthat improves when resting - feelings such as weakness, heaviness, burning, or aching in the groin - a swollen or an enlarged scrotum in men or boys
Indirect and direct inguinal hernias may slide in and out of the abdomen into the inguinal canal. A health care provider can often move them back into the abdomen with gentle massage. |
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| What are the complications of Inguinal Hernia ? | Inguinal hernias can cause the following complications:
- Incarceration. An incarcerated hernia happens when part of the fat or small intestine from inside the abdomen becomes stuck in the groin or scrotum and cannot go back into the abdomen. A health care provider is unable to massage the hernia back into the abdomen. - Strangulation. When an incarcerated hernia is not treated, the blood supply to the small intestine may become obstructed, causing strangulation of the small intestine. This lack of blood supply is an emergency situation and can cause the section of the intestine to die.
Seek Immediate Care People who have symptoms of an incarcerated or a strangulated hernia should seek emergency medical help immediately. A strangulated hernia is a life-threatening condition. Symptoms of an incarcerated or a strangulated hernia include - extreme tenderness or painful redness in the area of the bulge in the groin - sudden pain that worsens quickly and does not go away - the inability to have a bowel movement and pass gas - nausea and vomiting - fever |
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| How to diagnose Inguinal Hernia ? | A health care provider diagnoses an inguinal hernia with
- a medical and family history - a physical exam - imaging tests, including x rays
Medical and family history. Taking a medical and family history may help a health care provider diagnose an inguinal hernia. Often the symptoms that the patient describes will be signs of an inguinal hernia.
Physical exam. A physical exam may help diagnose an inguinal hernia. During a physical exam, a health care provider usually examines the patients body. The health care provider may ask the patient to stand and cough or strain so the health care provider can feel for a bulge caused by the hernia as it moves into the groin or scrotum. The health care provider may gently try to massage the hernia back into its proper position in the abdomen.
Imaging tests. A health care provider does not usually use imaging tests, including x rays, to diagnose an inguinal hernia unless he or she
- is trying to diagnose a strangulation or an incarceration - cannot feel the inguinal hernia during a physical exam, especially in patients who are overweight - is uncertain if the hernia or another condition is causing the swelling in the groin or other symptoms
Specially trained technicians perform imaging tests at a health care providers office, an outpatient center, or a hospital.
A radiologista doctor who specializes in medical imaginginterprets the images. A patient does not usually need anesthesia.
Tests may include the following:
- Abdominal x ray. An x ray is a picture recorded on film or on a computer using a small amount of radiation. The patient will lie on a table or stand during the x ray. The technician positions the x-ray machine over the abdominal area. The patient will hold his or her breath as the technician takes the picture so that the picture will not be blurry. The technician may ask the patient to change position for additional pictures. - Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create images. For a CT scan, the technician may give the patient a solution to drink and an injection of a special dye, called contrast medium. A health care provider injects the contrast medium into a vein, and the injection will make the patient feel warm all over for a minute or two. The contrast medium allows the health care provider to see the blood vessels and blood flow on the x rays. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the technician takes the x rays. A health care provider may give children a sedative to help them fall asleep for the test. - Abdominal ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. |
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| What are the treatments for Inguinal Hernia ? | Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incarceration and strangulation. Health care providers recommend surgery for most people with inguinal hernias and especially for people with hernias that cause symptoms. Research suggests that men with hernias that cause few or no symptoms may be able to safely delay surgery until their symptoms increase.3,6 Men who delay surgery should watch for symptoms and see a health care provider regularly. Health care providers usually recommend surgery for infants and children to prevent incarceration.1 Emergent, or immediate, surgery is necessary for incarcerated or strangulated hernias.
A general surgeona doctor who specializes in abdominal surgeryperforms hernia surgery at a hospital or surgery center, usually on an outpatient basis. Recovery time varies depending on the size of the hernia, the technique used, and the age and health of the person.
Hernia surgery is also called herniorrhaphy. The two main types of surgery for hernias are
- Open hernia repair. During an open hernia repair, a health care provider usually gives a patient local anesthesia in the abdomen with sedation; however, some patients may have - sedation with a spinal block, in which a health care provider injects anesthetics around the nerves in the spine, making the body numb from the waist down - general anesthesia
- The surgeon makes an incision in the groin, moves the hernia back into the abdomen, and reinforces the abdominal wall with stitches. Usually the surgeon also reinforces the weak area with a synthetic mesh or screen to provide additional support.
- Laparoscopic hernia repair. A surgeon performs laparoscopic hernia repair with the patient under general anesthesia. The surgeon makes several small, half-inch incisions in the lower abdomen and inserts a laparoscopea thin tube with a tiny video camera attached. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the hernia and surrounding tissue. While watching the monitor, the surgeon repairs the hernia using synthetic mesh or screen.
People who undergo laparoscopic hernia repair generally experience a shorter recovery time than those who have an open hernia repair. However, the surgeon may determine that laparoscopy is not the best option if the hernia is large or if the person has had previous pelvic surgery.
Most adults experience discomfort and require pain medication after either an open hernia repair or a laparoscopic hernia repair. Intense activity and heavy lifting are restricted for several weeks. The surgeon will discuss when a person may safely return to work. Infants and children also experience some discomfort; however, they usually resume normal activities after several days.
Surgery to repair an inguinal hernia is quite safe, and complications are uncommon. People should contact their health care provider if any of the following symptoms appear:
- redness around or drainage from the incision - fever - bleeding from the incision - pain that is not relieved by medication or pain that suddenly worsens
Possible long-term complications include
- long-lasting pain in the groin - recurrence of the hernia, requiring a second surgery - damage to nerves near the hernia |
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| How to prevent Inguinal Hernia ? | People cannot prevent the weakness in the abdominal wall that causes indirect inguinal hernias. However, people may be able to prevent direct inguinal hernias by maintaining a healthy weight and not smoking.
People can keep inguinal hernias from getting worse or keep inguinal hernias from recurring after surgery by
- avoiding heavy lifting - using the legs, not the back, when lifting objects - preventing constipation and straining during bowel movements - maintaining a healthy weight - not smoking |
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| What to do for Inguinal Hernia ? | Researchers have not found that eating, diet, and nutrition play a role in causing inguinal hernias. A person with an inguinal hernia may be able to prevent symptoms by eating high-fiber foods. Fresh fruits, vegetables, and whole grains are high in fiber and may help prevent the constipation and straining that cause some of the painful symptoms of a hernia.
The surgeon will provide instructions on eating, diet, and nutrition after inguinal hernia surgery. Most people drink liquids and eat a light diet the day of the operation and then resume their usual diet the next day. |
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| What to do for Inguinal Hernia ? | - An inguinal hernia happens when contents of the abdomenusually fat or part of the small intestinebulge through a weak area in the lower abdominal wall. - A defect in the abdominal wall that is present at birth causes an indirect inguinal hernia. - Direct inguinal hernias usually occur only in male adults as aging and stress or strain weaken the abdominal muscles around the inguinal canal. Females rarely form this type of inguinal hernia. - The first sign of an inguinal hernia is a small bulge on one or, rarely, on both sides of the grointhe area just above the groin crease between the lower abdomen and the thigh. - An incarcerated hernia happens when part of the fat or small intestine from inside the abdomen becomes stuck in the groin or scrotum and cannot go back into the abdomen. - When an incarcerated hernia is not treated, the blood supply to the small intestine may become obstructed, causing strangulation of the small intestine. - People who have symptoms of an incarcerated or a strangulated hernia should seek emergency medical help immediately. A strangulated hernia is a life-threatening condition. - Repair of an inguinal hernia via surgery is the only treatment for inguinal hernias and can prevent incarceration and strangulation. |
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| What is (are) Growth Failure in Children with Chronic Kidney Disease ? | Growth failure is a complication of CKD in which children do not grow as expected. When a child is below the third percentilemeaning 97 percent of children the same age and gender are tallerhe or she has growth failure.1 CKD is kidney disease that does not go away with treatment and tends to get worse over time.
Health care providers use charts to monitor the growth of children with CKD and look for signs of growth failure. Growth charts for children use percentiles to compare a particular childs height with the height of children the same age and gender. For example, a child whose height is at the 50th percentile on a growth chart means half the children in the United States are taller than that child and half the children are shorter.
About one-third of children with CKD have growth failure.1 Children diagnosed with CKD at a younger age
- have a higher chance of developing growth failure - have more health issues related to growth failure and CKD |
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| What is (are) Growth Failure in Children with Chronic 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. Children produce less urine than adults and the amount produced depends on their age. 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. |
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| What causes Growth Failure in Children with Chronic Kidney Disease ? | Researchers have found that many factors cause growth failure in children with CKD. In addition to removing wastes and extra fluid from the blood, the kidneys perform important functions for a childs growth. Understanding normal kidney function and growth helps families understand what causes growth failure in children with CKD.
Normal kidney function helps maintain the
- balance of nutrients and minerals, such as calcium and phosphorus, in the blood. These minerals are essential for normal bone growth. The kidneys use a hormone called calcitriol, a form of vitamin D, to help bones absorb the right amount of calcium from the blood. The kidneys also remove extra phosphorus, helping balance phosphorus and calcium levels in the blood. - bodys ability to use growth hormone. Growth hormone is necessary during childhood to help bones grow and stay healthy. The pituitary gland naturally produces growth hormone, which acts as a messenger to help the body grow. Growth hormone tells the liver to produce another hormone, called insulin-like growth factor, that travels to muscles, organs, and bones and tells them to grow. - correct levels of erythropoietin in the body. Erythropoietin is a hormone that helps bone marrow make red blood cells. - proper balance of sodium, also called salt; potassium; and acid-base levels in the blood. Acid-base balance refers to the amount of acid in the blood.
Damaged kidneys can slow a childs growth by
- causing mineral and bone disorder, which occurs when - vitamin D is not turned into calcitriol, which starves the bones of calcium. - phosphorus levels rise in the blood and draw calcium out of the bones and into the blood, causing the bones to weaken. - creating an imbalance of sodium, potassium, and acid-base levels in the blood, also called acidosis. When blood is not balanced, the body slows growth to focus energy on restoring the balance. - decreasing appetite. A child with CKD may not be hungry, or he or she may not have the energy to eat, which may lead to poor nutrition and slower growth. - decreasing the production of erythropoietin. When erythropoietin levels are low, a child may develop anemiaa condition that develops when the blood does not have enough healthy red blood cells to carry oxygen to cells throughout the body. Anemia can cause growth to slow or stop. - making an abnormally large amount of urine, called polyuria, which disrupts the bodys fluid balance. A child with polyuria loses minerals as well. The body slows growth to make up for the lost fluid and minerals. - preventing the body from correctly using growth hormone. When the kidneys are damaged, waste builds up in the blood and the body does not properly process growth hormone. |
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| What are the treatments for Growth Failure in Children with Chronic Kidney Disease ? | Health care providers treat growth failure in children with CKD with
- changes in eating, diet, and nutrition - medications - growth hormone therapy
Most children with growth failure grow to about one-third of their adult height within the first two years of life; therefore, it is important to start treatment for growth failure early.1 |
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