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| What causes Acquired Cystic Kidney Disease ? | Researchers do not fully understand what causes cysts to grow in the kidneys of people with CKD. The fact that these cysts occur only in the kidneys and not in other parts of the body, as in PKD, indicates that the processes that lead to cyst formation take place primarily inside the kidneys.2 |
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| What are the symptoms of Acquired Cystic Kidney Disease ? | A person with acquired cystic kidney disease often has no symptoms. However, the complications of acquired cystic kidney disease can have signs and symptoms. |
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| What are the complications of Acquired Cystic Kidney Disease ? | People with acquired cystic kidney disease may develop the following complications:
- an infected cyst, which can cause fever and back pain. - blood in the urine, which can signal that a cyst in the kidney is bleeding. - tumors in the kidneys. People with acquired cystic kidney disease are more likely than people in the general population to have cancerous kidney tumors. However, the chance of cancer spreading is lower in people with acquired cystic kidney disease than that of other kidney cancers not associated with acquired cystic kidney disease, and the long-term outlook is better.1 |
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| How to diagnose Acquired Cystic Kidney Disease ? | A health care provider may diagnose a person with acquired cystic kidney disease based on
- medical history - imaging tests
Medical History
Taking a medical history may help a health care provider diagnose acquired cystic kidney disease. A health care provider may suspect acquired cystic kidney disease if a person who has been on dialysis for several years develops symptoms such as fever, back pain, or blood in the urine.
Imaging Tests
To confirm the diagnosis, the health care provider may order one or more imaging tests. A radiologista doctor who specializes in medical imaginginterprets the images from these tests, and the patient does not need anesthesia.
- Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider's office, an outpatient center, or a hospital. The images can show cysts in the kidneys as well as the kidneys' size and shape. - Computerized tomography (CT) scans use a combination of x rays and computer technology to create images. For a CT scan, a nurse or technician may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes the x-rays. An x-ray technician performs the procedure in an outpatient center or a hospital. CT scans can show cysts and tumors in the kidneys. - Magnetic resonance imaging (MRI) is a test that takes pictures of the body's internal organs and soft tissues without using x-rays. A specially trained technician performs the procedure in an outpatient center or a hospital. Although the patient does not need anesthesia, a health care provider may give people with a fear of confined spaces light sedation, taken by mouth. An MRI may include the injection of contrast medium. With most MRI machines, the patient will lie on a table that slides into a tunnel-shaped device that may be open-ended or closed at one end. Some machines allow the patient to lie in a more open space. During an MRI, the patient, although usually awake, must remain perfectly still while the technician takes the images, which usually takes only a few minutes. The technician will take a sequence of images from different angles to create a detailed picture of the kidneys. During the test, the patient will hear loud mechanical knocking and humming noises from the machine.
Sometimes a health care provider may discover acquired cystic kidney disease during an imaging exam for another condition. Images of the kidneys may help the health care provider distinguish acquired cystic kidney disease from PKD. |
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| What are the treatments for Acquired Cystic Kidney Disease ? | If acquired cystic kidney disease is not causing complications, a person does not need treatment. A health care provider will treat infections with antibioticsmedications that kill bacteria. If large cysts are causing pain, a health care provider may drain the cyst using a long needle inserted into the cyst through the skin.
When a surgeon transplants a new kidney into a patient's body to treat kidney failure, acquired cystic kidney disease in the damaged kidneys, which usually remain in place after a transplant, often disappears.
A surgeon may perform an operation to remove tumors or suspected tumors. In rare cases, a surgeon performs an operation to stop cysts from bleeding.
Have Regular Screenings to Look for Cyst or Tumor Growth Some health care providers recommend all people with end-stage kidney disease get screened for kidney cancer using CT scans or MRIs after 3 years of dialysis. People with acquired cystic kidney disease should talk with their health care provider about when to begin screening. |
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| What to do for Acquired Cystic Kidney Disease ? | No specific diet will prevent or delay acquired cystic kidney disease. In general, a diet designed for people on hemodialysis or peritoneal dialysis reduces the amount of wastes that accumulate in the body between dialysis sessions.
More information is provided in the NIDDK health topics, Eat Right to Feel Right on Hemodialysis and Nutrition for Advanced Chronic Kidney Disease in Adults. |
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| What to do for Acquired Cystic Kidney Disease ? | - Acquired cystic kidney disease happens when a person's kidneys develop fluid-filled sacs, called cysts, over time. - Acquired cystic kidney disease occurs in children and adults who have - chronic kidney disease (CKD) - end-stage kidney disease (ESRD) - People with acquired cystic kidney disease may develop the following complications: - an infected cyst, which can cause fever and back pain - blood in the urine, which can signal that a cyst in the kidney is bleeding - tumors in the kidneys - To confirm the diagnosis, the health care provider may order one or more imaging tests: - Ultrasound - Computerized tomography (CT) scan - Magnetic resonance imaging (MRI) - If acquired cystic kidney disease is not causing complications, a person does not need treatment. - A health care provider will treat infections with antibioticsmedications that kill bacteria. - If large cysts are causing pain, a health care provider may drain the cyst using a long needle inserted into the cyst through the skin. - A surgeon may perform an operation to remove tumors or suspected tumors. In rare cases, a surgeon performs an operation to stop cysts from bleeding. |
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| How to diagnose Nonalcoholic Steatohepatitis ? | NASH is usually first suspected in a person who is found to have elevations in liver tests that are included in routine blood test panels, such as alanine aminotransferase (ALT) or aspartate aminotransferase (AST). When further evaluation shows no apparent reason for liver disease (such as medications, viral hepatitis, or excessive use of alcohol) and when x rays or imaging studies of the liver show fat, NASH is suspected. The only means of proving a diagnosis of NASH and separating it from simple fatty liver is a liver biopsy. For a liver biopsy, a needle is inserted through the skin to remove a small piece of the liver. NASH is diagnosed when examination of the tissue with a microscope shows fat along with inflammation and damage to liver cells. If the tissue shows fat without inflammation and damage, simple fatty liver or NAFLD is diagnosed. An important piece of information learned from the biopsy is whether scar tissue has developed in the liver. Currently, no blood tests or scans can reliably provide this information. |
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| What are the symptoms of Nonalcoholic Steatohepatitis ? | NASH is usually a silent disease with few or no symptoms. Patients generally feel well in the early stages and only begin to have symptomssuch as fatigue, weight loss, and weaknessonce the disease is more advanced or cirrhosis develops. The progression of NASH can take years, even decades. The process can stop and, in some cases, reverse on its own without specific therapy. Or NASH can slowly worsen, causing scarring or fibrosis to appear and accumulate in the liver. As fibrosis worsens, cirrhosis develops; the liver becomes seriously scarred, hardened, and unable to function normally. Not every person with NASH develops cirrhosis, but once serious scarring or cirrhosis is present, few treatments can halt the progression. A person with cirrhosis experiences fluid retention, muscle wasting, bleeding from the intestines, and liver failure. Liver transplantation is the only treatment for advanced cirrhosis with liver failure, and transplantation is increasingly performed in people with NASH. NASH ranks as one of the major causes of cirrhosis in America, behind hepatitis C and alcoholic liver disease. |
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| What causes Nonalcoholic Steatohepatitis ? | Although NASH has become more common, its underlying cause is still not clear. It most often occurs in persons who are middle-aged and overweight or obese. Many patients with NASH have elevated blood lipids, such as cholesterol and triglycerides, and many have diabetes or prediabetes, but not every obese person or every patient with diabetes has NASH. Furthermore, some patients with NASH are not obese, do not have diabetes, and have normal blood cholesterol and lipids. NASH can occur without any apparent risk factor and can even occur in children. Thus, NASH is not simply obesity that affects the liver.
While the underlying reason for the liver injury that causes NASH is not known, several factors are possible candidates:
- insulin resistance - release of toxic inflammatory proteins by fat cells (cytokines) - oxidative stress (deterioration of cells) inside liver cells |
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| What are the treatments for Nonalcoholic Steatohepatitis ? | Currently, no specific therapies for NASH exist. The most important recommendations given to persons with this disease are to
- reduce their weight (if obese or overweight) - follow a balanced and healthy diet - increase physical activity - avoid alcohol - avoid unnecessary medications
These are standard recommendations, but they can make a difference. They are also helpful for other conditions, such as heart disease, diabetes, and high cholesterol.
A major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease to some extent. Research at present is focusing on how much weight loss improves the liver in patients with NASH and whether this improvement lasts over a period of time.
People with NASH often have other medical conditions, such as diabetes, high blood pressure, or elevated cholesterol. These conditions should be treated with medication and adequately controlled; having NASH or elevated liver enzymes should not lead people to avoid treating these other conditions.
Experimental approaches under evaluation in patients with NASH include antioxidants, such as vitamin E, selenium, and betaine. These medications act by reducing the oxidative stress that appears to increase inside the liver in patients with NASH. Whether these substances actually help treat the disease is not known, but the results of clinical trials should become available in the next few years.
Another experimental approach to treating NASH is the use of newer antidiabetic medicationseven in persons without diabetes. Most patients with NASH have insulin resistance, meaning that the insulin normally present in the bloodstream is less effective for them in controlling blood glucose and fatty acids in the blood than it is for people who do not have NASH. The newer antidiabetic medications make the body more sensitive to insulin and may help reduce liver injury in patients with NASH. Studies of these medicationsincluding metformin, rosiglitazone, and pioglitazoneare being sponsored by the National Institutes of Health and should answer the question of whether these medications are beneficial in NASH. |
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| What to do for Nonalcoholic Steatohepatitis ? | - Nonalcoholic steatohepatitis (NASH) is fat in the liver, with inflammation and damage. - NASH occurs in people who drink little or no alcohol and affects 2 to 5 percent of Americans, especially people who are middle-aged and overweight or obese. - NASH can occur in children. - People who have NASH may feel well and may not know that they have a liver disease. - NASH can lead to cirrhosis, a condition in which the liver is permanently damaged and cannot work properly. - Fatigue can occur at any stage of NASH. - Weight loss and weakness may begin once the disease is advanced or cirrhosis is present. - NASH may be suspected if blood tests show high levels of liver enzymes or if scans show fatty liver. - NASH is diagnosed by examining a small piece of the liver taken through a needle, a procedure called biopsy. - People who have NASH should reduce their weight, eat a balanced diet, engage in physical activity, and avoid alcohol and unnecessary medications. - No specific therapies for NASH exist. Experimental therapies being studied include antioxidants and antidiabetes medications. |
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| What to do for Kidney Failure: What to Expect ? | For people who are on dialysis or approaching total kidney failure, adequate nutrition is important for maintaining energy, strength, healthy sleep patterns, bone health, heart health, and good mental health. A persons treatment will dictate the type of diet that should be followed:
- People on hemodialysis must watch how much fluid they drink and avoid eating foods with too much sodium, potassium, and phosphorus. - In contrast, people on peritoneal dialysisa type of dialysis that uses the lining of the abdomen, or belly, to filter the blood inside the bodymay be able to eat more potassium-rich foods because peritoneal dialysis removes potassium from the body more efficiently than hemodialysis. - Both hemodialysis and peritoneal dialysis can remove proteins from the body, so anyone on either form of dialysis should eat protein-rich foods such as meat, fish, and eggs.
All dialysis centers and transplant clinics have a renal dietitian who specializes in helping people with kidney failure. People who are on dialysis or have a kidney transplant should talk with their clinics renal dietitian to develop a meal plan that will enhance the effectiveness of their treatment.
For more information about nutrition for people with advanced CKD or who are on dialysis, see NIDDK health topics, Nutrition for Advanced Chronic Kidney Disease in Adults or Kidney Failure: Eat Right to Feel Right on Hemodialysis. |
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| What to do for Kidney Failure: What to Expect ? | - Kidney failure can affect a persons health in several ways. - When the kidneys stop working, waste products build up in the blood, a condition known as uremia. - People with kidney failure can avoid most of the problems of uremia by having regular dialysis treatments and limiting foods that contain sodium, potassium, and phosphorus. - Anemia is common in people with chronic kidney disease (CKD), as well as those on dialysis, because the damaged kidneys slow the produc-tion of the hormone erythropoietin (EPO), which helps the bone marrow make red blood cells. - People with kidney failure, particularly dialysis patients, have far higher rates of heart and blood vessel problems than people without kidney problems. - People who have uremia often lose their appetite. - Many people treated with hemodialysis complain of itchy skin. - Kidney failure weakens the bones due to a condition called chronic kidney disease-mineral and bone disorder. - Kidney failure can cause pain, stiffness, and fluid in the joints. These symptoms result from amyloidosis, a condition in which an abnormal protein in the blood called amyloid is deposited in tissues and organs, including the joints and tendons. - People on dialysis often have insomnia, sleep apnea syndrome, and restless legs syndrome. - People who have kidney failure and depression should tell their health care provider because depression can often be treated with adjustments to the diet and dialysis dose, medications, counseling, and cognitive behavioral therapy. - For people who are on dialysis or approaching total kidney failure, adequate nutrition is important for maintaining energy, strength, healthy sleep patterns, bone health, heart health, and good mental health. - All dialysis centers and transplant clinics have a renal dietitian who specializes in helping people with kidney failure. People who are on dialysis or have a kidney transplant should talk with their clinics renal dietitian to develop a meal plan that will enhance the effectiveness of their treatment. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| What is (are) Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | Microscopic colitis is an inflammation of the colon that a health care provider can see only with a microscope. Inflammation is the bodys normal response to injury, irritation, or infection of tissues. Microscopic colitis is a type of inflammatory bowel diseasethe general name for diseases that cause irritation and inflammation in the intestines.
The two types of microscopic colitis are collagenous colitis and lymphocytic colitis. Health care providers often use the term microscopic colitis to describe both types because their symptoms and treatments are the same. Some scientists believe that collagenous colitis and lymphocytic colitis may be different phases of the same condition rather than separate conditions.
In both types of microscopic colitis, an increase in the number of lymphocytes, a type of white blood cell, can be seen in the epitheliumthe layer of cells that lines the colon. An increase in the number of white blood cells is a sign of inflammation. The two types of colitis affect the colon tissue in slightly different ways:
- Lymphocytic colitis. The number of lymphocytes is higher, and the tissues and lining of the colon are of normal thickness. - Collagenous colitis. The layer of collagen, a threadlike protein, underneath the epithelium builds up and becomes thicker than normal.
When looking through a microscope, the health care provider may find variations in lymphocyte numbers and collagen thickness in different parts of the colon. These variations may indicate an overlap of the two types of microscopic colitis. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| What is (are) Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | The colon is part of the gastrointestinal (GI) tract, a series of hollow organs joined in a long, twisting tube from the mouth to the anusa 1-inch-long opening through which stool leaves the body. Organs that make up the GI tract are the
- mouth - esophagus - stomach - small intestine - large intestine - anus
The first part of the GI tract, called the upper GI tract, includes the mouth, esophagus, stomach, and small intestine. The last part of the GI tract, called the lower GI tract, consists of the large intestine and anus. The intestines are sometimes called the bowel.
The large intestine is about 5 feet long in adults and includes the colon and rectum. The large intestine changes waste from liquid to a solid matter called stool. Stool passes from the colon to the rectum. The rectum is 6 to 8 inches long in adults and is between the last part of the coloncalled the sigmoid colonand the anus. During a bowel movement, stool moves from the rectum to the anus and out of the body. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| What causes Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | The exact cause of microscopic colitis is unknown. Several factors may play a role in causing microscopic colitis. However, most scientists believe that microscopic colitis results from an abnormal immune-system response to bacteria that normally live in the colon. Scientists have proposed other causes, including
- autoimmune diseases - medications - infections - genetic factors - bile acid malabsorption
Autoimmune Diseases
Sometimes people with microscopic colitis also have autoimmune diseasesdisorders in which the bodys immune system attacks the bodys own cells and organs. Autoimmune diseases associated with microscopic colitis include
- celiac diseasea condition in which people cannot tolerate gluten because it damages the lining of the small intestine and prevents absorption of nutrients. Gluten is a protein found in wheat, rye, and barley. - thyroid diseases such as - Hashimotos diseasea form of chronic, or long lasting, inflammation of the thyroid. - Graves diseasea disease that causes hyperthyroidism. Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs. - rheumatoid arthritisa disease that causes pain, swelling, stiffness, and loss of function in the joints when the immune system attacks the membrane lining the joints. - psoriasisa skin disease that causes thick, red skin with flaky, silver-white patches called scales.
More information is provided in the NIDDK health topics:
- Celiac Disease - Hashimotos Disease - Graves Disease
Medications
Researchers have not found that medications cause microscopic colitis. However, they have found links between microscopic colitis and certain medications, most commonly
- nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen - lansoprazole (Prevacid) - acarbose (Prandase, Precose) - ranitidine (Tritec, Zantac) - sertraline (Zoloft) - ticlopidine (Ticlid)
Other medications linked to microscopic colitis include
- carbamazepine - clozapine (Clozaril, FazaClo) - dexlansoprazole (Kapidex, Dexilant) - entacapone (Comtan) - esomeprazole (Nexium) - flutamide (Eulexin) - lisinopril (Prinivil, Zestril) - omeprazole (Prilosec) - pantoprazole (Protonix) - paroxetine (Paxil, Pexeva) - rabeprazole (AcipHex) - simvastatin (Zocor) - vinorelbine (Navelbine)
Infections
Bacteria. Some people get microscopic colitis after an infection with certain harmful bacteria. Harmful bacteria may produce toxins that irritate the lining of the colon.
Viruses. Some scientists believe that viral infections that cause inflammation in the GI tract may play a role in causing microscopic colitis.
Genetic Factors
Some scientists believe that genetic factors may play a role in microscopic colitis. Although researchers have not yet found a gene unique to microscopic colitis, scientists have linked dozens of genes to other types of inflammatory bowel disease, including
- Crohns diseasea disorder that causes inflammation and irritation of any part of the GI tract - ulcerative colitisa chronic disease that causes inflammation and ulcers in the inner lining of the large intestine
More information is provided in the NIDDK health topics:
- Crohns Disease - Ulcerative Colitis
Bile Acid Malabsorption
Some scientists believe that bile acid malabsorption plays a role in microscopic colitis. Bile acid malabsorption is the intestines inability to completely reabsorb bile acidsacids made by the liver that work with bile to break down fats. Bile is a fluid made by the liver that carries toxins and waste products out of the body and helps the body digest fats. Bile acids that reach the colon can lead to diarrhea. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| What are the symptoms of Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | The most common symptom of microscopic colitis is chronic, watery, nonbloody diarrhea. Episodes of diarrhea can last for weeks, months, or even years. However, many people with microscopic colitis may have long periods without diarrhea. Other signs and symptoms of microscopic colitis can include
- a strong urgency to have a bowel movement or a need to go to the bathroom quickly - pain, cramping, or bloating in the abdomenthe area between the chest and the hipsthat is usually mild - weight loss - fecal incontinenceaccidental passing of stool or fluid from the rectumespecially at night - nausea - dehydrationa condition that results from not taking in enough liquids to replace fluids lost through diarrhea
The symptoms of microscopic colitis can come and go frequently. Sometimes, the symptoms go away without treatment. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| How to diagnose Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | A pathologista doctor who specializes in examining tissues to diagnose diseasesdiagnoses microscopic colitis based on the findings of multiple biopsies taken throughout the colon. Biopsy is a procedure that involves taking small pieces of tissue for examination with a microscope. The pathologist examines the colon tissue samples in a lab. Many patients can have both lymphocytic colitis and collagenous colitis in different parts of their colon.
To help diagnose microscopic colitis, a gastroenterologista doctor who specializes in digestive diseasesbegins with
- a medical and family history - a physical exam
The gastroenterologist may perform a series of medical tests to rule out other bowel diseasessuch as irritable bowel syndrome, celiac disease, Crohns disease, ulcerative colitis, and infectious colitisthat cause symptoms similar to those of microscopic colitis. These medical tests include
- lab tests - imaging tests of the intestines - endoscopy of the intestines
Medical and Family History
The gastroenterologist will ask the patient to provide a medical and family history, a review of the symptoms, a description of eating habits, and a list of prescription and over-the-counter medications in order to help diagnose microscopic colitis. The gastroenterologist will also ask the patient about current and past medical conditions.
Physical Exam
A physical exam may help diagnose microscopic colitis and rule out other diseases. During a physical exam, the gastroenterologist usually
- examines the patients body - taps on specific areas of the patients abdomen
Lab Tests
Lab tests may include
- blood tests - stool tests
Blood tests. A blood test involves drawing blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may use blood tests to help look for changes in red and white blood cell counts.
- Red blood cells. When red blood cells are fewer or smaller than normal, a person may have anemiaa condition that prevents the bodys cells from getting enough oxygen. - White blood cells. When the white blood cell count is higher than normal, a person may have inflammation or infection somewhere in the body.
Stool tests. A stool test is the analysis of a sample of stool. A 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. Health care providers commonly order stool tests to rule out other causes of GI diseases, such as different types of infectionsincluding bacteria or parasitesor bleeding, and help determine the cause of symptoms.
Imaging Tests of the Intestines
Imaging tests of the intestines may include the following:
- computerized tomography (CT) scan - magnetic resonance imaging (MRI) - upper GI series
Specially trained technicians perform these tests at an outpatient center or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. A patient does not need anesthesia. Health care providers use imaging tests to show physical abnormalities and to diagnose certain bowel diseases, in some cases.
CT scan. CT scans use a combination of x rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of a special dye, called contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the technician takes the x rays.
MRI. MRI is a test that takes pictures of the bodys internal organs and soft tissues without using x rays. Although a patient does not need anesthesia for an MRI, some patients with a fear of confined spaces may receive light sedation, taken by mouth. An MRI may include a solution to drink and injection of contrast medium. With most MRI machines, the patient will lie on a table that slides into a tunnel-shaped device that may be open ended or closed at one end. Some machines allow the patient to lie in a more open space. During an MRI, the patient, although usually awake, must remain perfectly still while the technician takes the images, which usually takes only a few minutes. The technician will take a sequence of images to create a detailed picture of the intestines. During sequencing, the patient will hear loud mechanical knocking and humming noises.
Upper GI series. This test is an x-ray exam that provides a look at the shape of the upper GI tract. A patient should not eat or drink before the procedure, as directed by the health care provider. Patients should ask their health care provider about how 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 upper GI tract so the radiologist and gastroenterologist can see the 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 causes 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.
Endoscopy of the Intestines
Endoscopy of the intestines may include
- colonoscopy with biopsy - flexible sigmoidoscopy with biopsy - upper GI endoscopy with biopsy
A gastroenterologist performs these tests at a hospital or an outpatient center.
Colonoscopy with biopsy. Colonoscopy is a test that uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or scope, to look inside the rectum and entire colon. In most cases, light anesthesia and pain medication help patients relax for the test. The medical staff will monitor a patients vital signs and try to make him or her as comfortable as possible. A nurse or technician places an intravenous (IV) needle in a vein in the arm or hand to give anesthesia.
For the test, the patient will lie on a table while the gastroenterologist inserts a colonoscope into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with air to give the gastroenterologist a better view. The camera sends a video image of the intestinal lining to a computer screen, allowing the gastroenterologist to carefully examine the tissues lining the colon and rectum. The gastroenterologist may move the patient several times and adjust the scope for better viewing. Once the scope has reached the opening to the small intestine, the gastroenterologist slowly withdraws it and examines the lining of the colon and rectum again. A colonoscopy can show irritated and swollen tissue, ulcers, and abnormal growths such as polypsextra pieces of tissue that grow on the lining of the intestine. If the lining of the rectum and colon appears normal, the gastroenterologist may suspect microscopic colitis and will biopsy multiple areas of the colon.
A health care provider will provide written bowel prep instructions to follow at home before the test. The health care provider will also explain what the patient can expect after the test and give discharge instructions.
Flexible sigmoidoscopy with biopsy. Flexible sigmoidoscopy is a test that uses a flexible, narrow tube with a light and tiny camera on one end, called a sigmoidoscope or scope, to look inside the rectum and the sigmoid colon. A patient does not usually need anesthesia.
For the test, the patient will lie on a table while the gastroenterologist inserts the sigmoidoscope into the anus and slowly guides it through the rectum and into the sigmoid colon. The scope inflates the large intestine with air to give the gastroenterologist a better view. The camera sends a video image of the intestinal lining to a computer screen, allowing the gastroenterologist to carefully examine the tissues lining the sigmoid colon and rectum. The gastroenterologist may ask the patient to move several times and adjust the scope for better viewing. Once the scope reaches the end of the sigmoid colon, the gastroenterologist slowly withdraws it while carefully examining the lining of the sigmoid colon and rectum again.
The gastroenterologist will look for signs of bowel diseases and conditions such as irritated and swollen tissue, ulcers, and polyps. If the lining of the rectum and colon appears normal, the gastroenterologist may suspect microscopic colitis and will biopsy multiple areas of the colon.
A health care provider will provide written bowel prep instructions to follow at home before the test. The health care provider will also explain what the patient can expect after the test and give discharge instructions.
Upper GI endoscopy with biopsy. Upper GI endoscopy is a test that uses a flexible, narrow tube with a light and tiny camera on one end, called an endoscope or a scope, to look inside the upper GI tract. The gastroenterologist carefully feeds the endoscope down the esophagus and into the stomach and first part of the small intestine, called the duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A health care provider may give a patient a liquid anesthetic to gargle or may spray anesthetic on the back of the patients throat. A health care provider will place an IV needle in a vein in the arm or hand to administer sedation. Sedatives help patients stay relaxed and comfortable. This test can show blockages or other conditions in the upper small intestine. A gastroenterologist may biopsy the lining of the small intestine during an upper GI endoscopy. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| What are the treatments for Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | Treatment depends on the severity of symptoms. The gastroenterologist will
- review the medications the person is taking - make recommendations to change or stop certain medications - recommend that the person quit smoking
The gastroenterologist may prescribe medications to help control symptoms. Medications are almost always effective in treating microscopic colitis. The gastroenterologist may recommend eating, diet, and nutrition changes. In rare cases, the gastroenterologist may recommend surgery.
Medications
The gastroenterologist may prescribe one or more of the following:
- antidiarrheal medications such as bismuth subsalicylate (Kaopectate, Pepto-Bismol), diphenoxylate/atropine (Lomotil), and loperamide - corticosteroids such as budesonide (Entocort) and prednisone - anti-inflammatory medications such as mesalamine and sulfasalazine (Azulfidine) - cholestyramine resin (Locholest, Questran)a medication that blocks bile acids - antibiotics such as metronidazole (Flagyl) and erythromycin - immunomodulators such as mercaptopurine (Purinethol), azathioprine (Azasan, Imuran), and methotrexate (Rheumatrex, Trexall) - anti-TNF therapies such as infliximab (Remicade) and adalimumab (Humira)
Corticosteroids are medications that decrease inflammation and reduce the activity of the immune system. These medications can have many side effects. Scientists have shown that budesonide is safer, with fewer side effects, than prednisone. Most health care providers consider budesonide the best medication for treating microscopic colitis.
Patients with microscopic colitis generally achieve relief through treatment with medications, although relapses can occur. Some patients may need long-term treatment if they continue to have relapses. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| What to do for Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | To help reduce symptoms, a health care provider may recommend the following dietary changes:
- avoid foods and drinks that contain caffeine or artificial sugars - drink plenty of liquids to prevent dehydration during episodes of diarrhea - eat a milk-free diet if the person is also lactose intolerant - eat a gluten-free diet
People should talk with their health care provider or dietitian about what type of diet is right for them.
Surgery
When the symptoms of microscopic colitis are severe and medications arent effective, a gastroenterologist may recommend surgery to remove the colon. Surgery is a rare treatment for microscopic colitis. The gastroenterologist will exclude other causes of symptoms before considering surgery. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| How to prevent Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | Researchers do not know how to prevent microscopic colitis. However, researchers do believe that people who follow the recommendations of their health care provider may be able to prevent relapses of microscopic colitis. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| Who is at risk for Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis? ? | No. Unlike the other inflammatory bowel diseases, such as Crohns disease and ulcerative colitis, microscopic colitis does not increase a persons risk of getting colon cancer. |
Microscopic colitis is a chronic inflammatory bowel disease (IBD) in which abnormal reactions of the immune system cause inflammation of the inner lining of your colon. Anyone can develop microscopic colitis, but the disease is more common in older adults and in women. The most common symptom of microscopic colitis is chronic diarrhea. Experts aren’t sure what causes microscopic colitis but think genes and abnormal immune reactions play a role. Certain medicines and smoking increase the risk for the disease. To help diagnose microscopic colitis, your doctor may order medical tests to check for signs of conditions that cause symptoms similar to those of microscopic colitis. Doctors order a colonoscopy with biopsies to diagnose microscopic colitis. To treat microscopic colitis, your doctor may recommend changing the medicines you take, changing your diet, quitting smoking, and taking medicines to help manage symptoms. Medicines may improve symptoms and help bring on and maintain remission. In some cases, doctors may recommend changing your diet to help reduce diarrhea symptoms in microscopic colitis. Talk with your doctor about what type of diet is right for you. 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. The digestive system is made up of the gastrointestinal (GI) tract—also called the digestive tract—and the liver, pancreas, and the gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. See more about digestive diseases research at NIDDK.
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:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
The NIDDK would like to thank:
Adam S. Cheifetz, M.D., Beth Israel Deaconess Medical Center, and Kristin E. Burke, M.D., M.P.H., Massachusetts General Hospital
| What to do for Microscopic Colitis: Collagenous Colitis and Lymphocytic Colitis ? | - Microscopic colitis is an inflammation of the colon that a health care provider can see only with a microscope. - The two types of microscopic colitis are collagenous colitis and lymphocytic colitis. - The exact cause of microscopic colitis is unknown. - Microscopic colitis is most common in females age 50 years or older. - The most common symptom of microscopic colitis is chronic, watery, nonbloody diarrhea. - A pathologista doctor who specializes in diagnosing diseasesdiagnoses microscopic colitis based on the findings of multiple biopsies taken throughout the colon. - Treatment depends on the severity of symptoms. - The gastroenterologist may prescribe medications to help control symptoms. - Medications are almost always effective in treating microscopic colitis. - The gastroenterologist may recommend eating, diet, and nutrition changes. |
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| What is (are) What I need to know about Bladder Control for Women ? | Not all bladder control problems are alike. Some problems are caused by weak muscles, while others are caused by damaged nerves. Sometimes the cause may be a medicine that dulls the nerves.
To help solve your problem, your doctor or nurse will try to identify the type of incontinence you have. It may be one or more of the following six types. |
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| What causes What I need to know about Bladder Control for Women ? | Urine leakage has many possible causes. |
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| What is (are) What I need to know about Bladder Control for Women ? | Talking about bladder control problems is not easy for some people. You may feel embarrassed to tell your doctor. But talking about the problem is the first step in finding an answer. Also, you can be sure your doctor has heard it all before. You will not shock or embarrass your doctor or nurse.
Medical History
You can prepare for your visit to the doctor's office by gathering the information your doctor will need to understand your problem. Make a list of the medicines you are taking. Include prescription medicines and those you buy over the counter, like aspirin or antacid. List the fluids you drink regularly, including sodas, coffee, tea, and alcohol. Tell the doctor how much of each drink you have in an average day.
Finding a Doctor
You will need to find a doctor who is skilled in helping women with urine leakage. If your primary doctor shrugs off your problem as normal aging, for example, ask for a referral to a specialist-a urogynecologist or a urologist who specializes in treating female urinary problems. You may need to be persistent, or you may need to look to organizations to help locate a doctor in your area. See For More Information for a list of organizations.
Make a note of any recent surgeries or illnesses you have had. Let the doctor know how many children you have had. These events may or may not be related to your bladder control problem.
Finally, keep track of the times when you have urine leakage. Note what you were doing at the time. Were you coughing, laughing, sneezing, or exercising? Did you have an uncontrollable urge to urinate when you heard running water?
You can use What Your Doctor Needs to Know (Item A) and Your Daily Bladder Diary (Item B) to prepare for your appointment.
Physical Exam
The doctor will give you a physical exam to look for any health issues that may be causing your bladder control problem. Checking your reflexes can show possible nerve damage. You will give a urine sample so the doctor can check for a urinary tract infection. For women, the exam may include a pelvic exam. Tests may also include taking an ultrasound picture of your bladder. Or the doctor may examine the inside of your bladder using a cystoscope, a long, thin tube that slides up into the bladder through the urethra.
Bladder Function Tests
Any medical test can be uncomfortable. Bladder testing may sound embarrassing, but the health professionals who perform the tests will try to make you feel comfortable and give you as much privacy as possible. |
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| What are the treatments for What I need to know about Bladder Control for Women ? | Your doctor will likely offer several treatment choices. Some treatments are as simple as changing some daily habits. Other treatments require taking medicine or using a device. If nothing else seems to work, surgery may help a woman with stress incontinence regain her bladder control.
Talk with your doctor about which treatments might work best for you.
Pelvic Muscle Strengthening
Many women prefer to try the simplest treatment choices first. Kegel exercises strengthen the pelvic muscles and don't require any equipment. Once you learn how to "Kegel," you can Kegel anywhere. The trick is finding the right muscles to squeeze. Your doctor or nurse can help make sure you are squeezing the right muscles. Your doctor may refer you to a specially trained physical therapist who will teach you to find and strengthen the sphincter muscles. Learning when to squeeze these muscles can also help stop the bladder spasms that cause urge incontinence. After about 6 to 8 weeks, you should notice that you have fewer leaks and more bladder control. Use the pelvic muscle exercise log included with the Kegel Exercise Tips sheet (Item C) to keep track of your progress.
Changing Habits
Timed voiding. By keeping track of the times you leak urine, you may notice certain times of day when you are most likely to have an accident. You can use that information to make planned trips to the bathroom ahead of time to avoid the accident. Once you have established a safe pattern, you can build your bladder control by stretching out the time between trips to the bathroom. By forcing your pelvic muscles to hold on longer, you make those muscles stronger.
Diet changes. You may notice that certain foods and drinks cause you to urinate more often. You may find that avoiding caffeinated drinks like coffee, tea, or cola helps your bladder control. You can choose the decaf version of your favorite drink. Make sure you are not drinking too much fluid because that will cause you to make a large amount of urine. If you are bothered by nighttime urination, drink most of your fluids during the day and limit your drinking after dinner. You should not, however, avoid drinking fluids for fear of having an accident. Some foods may irritate your bladder and cause urgency. Talk with your doctor about diet changes that might affect your bladder.
Weight loss. Extra body weight puts extra pressure on your bladder. By losing weight, you may be able to relieve some of that pressure and regain your bladder control.
Medicines
No medications are approved to treat stress urinary incontinence. But if you have an overactive bladder, your doctor may prescribe a medicine that can calm muscles and nerves. Medicines for overactive bladder come as pills, liquid, or a patch.
Medicines to treat overactive bladder can cause your eyes to become dry. These medicines can also cause dry mouth and constipation. If you take medicine to treat an overactive bladder, you may need to take steps to deal with the side effects.
- Use eye drops to keep your eyes moist. - Chew gum or suck on hard candy if dry mouth bothers you. Make it sugarless gum or candy to avoid tooth decay. - Take small sips of water throughout the day.
Medicines for other conditions also can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling-edema-or high blood pressure may increase urine output and contribute to bladder control problems.
Talk with your doctor; you may find that taking a different medicine solves the problem without adding another prescription. The list of Medicines for Bladder Control (Item D) will give you more information about specific medicines.
Pessaries
A pessary is a plastic ring, similar to a contraceptive diaphragm, that is worn in the vagina. It will help support the walls of the vagina, lifting the bladder and nearby urethra, leading to less stress leakage. A doctor or nurse can fit you with the best shape and size pessary for you and teach you how to care for it. Many women use a pessary only during exercise while others wear their pessary all day to reduce stress leakage. If you use a pessary, you should see your doctor regularly to check for small scrapes in the vagina that can result from using the device.
Nerve Stimulation
Electrical stimulation of the nerves that control the bladder can improve symptoms of urgency, frequency, and urge incontinence, as well as bladder emptying problems, in some people. This treatment is usually offered to patients who cannot tolerate or do not benefit from medications. At first, your doctor will use a device outside your body to deliver stimulation through a wire implanted under your skin to see if the treatment relieves your symptoms. If the temporary treatment works well for you, you may be able to have a permanent device implanted that delivers stimulation to the nerves in your back, much like a pacemaker. The electrodes in the permanent device are placed in your lower back through a minor surgical procedure. You may need to return to the doctor for adjustments to find the right setting that controls your bladder symptoms.
Surgery
Doctors may suggest surgery to improve bladder control if other treatments have failed. Surgery helps only stress incontinence. It won't work for urge incontinence. Many surgical options have high rates of success.
Most stress incontinence problems are caused by the bladder neck dropping toward the vagina. To correct this problem, the surgeon raises the bladder neck or urethra and supports it with a ribbon-like sling or web of strings attached to a muscle or bone. The sling holds up the bottom of the bladder and the top of the urethra to stop leakage.
Catheterization
If your bladder does not empty well as a result of nerve damage, you might leak urine. This condition is called overflow incontinence. You might use a catheter to empty your bladder. A catheter is a thin tube you can learn to insert through the urethra into the bladder to drain urine. You may use a catheter once in a while, a few times a day, or all of the time. If you use the catheter all the time, it will drain urine from your bladder into a bag you can hang from your leg. If you use a catheter all the time, you should watch for possible infections. |
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| What is (are) Amyloidosis and Kidney Disease ? | Amyloidosis is a rare disease that occurs when amyloid proteins are deposited in tissues and organs. Amyloid proteins are abnormal proteins that the body cannot break down and recycle, as it does with normal proteins. When amyloid proteins clump together, they form amyloid deposits. The buildup of these deposits damages a persons organs and tissues. Amyloidosis can affect different organs and tissues in different people and can affect more than one organ at the same time. Amyloidosis most frequently affects the kidneys, heart, nervous system, liver, and digestive tract. The symptoms and severity of amyloidosis depend on the organs and tissues affected. |
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| What is (are) Amyloidosis and Kidney Disease ? | The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine. When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men, the urethra is long, while in women it is short. |
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| What is (are) Amyloidosis and Kidney Disease ? | Primary amyloidosis and dialysis-related amyloidosis are the types of amyloidosis that can affect the kidneys.
Primary Amyloidosis of the Kidneys
The kidneys are the organs most commonly affected by primary amyloidosis. Amyloid deposits damage the kidneys and make it harder for them to filter wastes and break down proteins. When the kidneys become too damaged, they may no longer be able to function well enough to maintain health, resulting in kidney failure. Kidney failure can lead to problems such as high blood pressure, bone disease, and anemiaa condition in which the body has fewer red blood cells than normal.
Dialysis-related Amyloidosis
People who suffer from kidney failure and have been on long-term dialysis may develop dialysis-related amyloidosis. This type of amyloidosis occurs when a certain protein, called beta-2 microglobulin, builds up in the blood because dialysis does not remove it completely. The two types of dialysis are
- hemodialysis. Hemodialysis uses a special filter called a dialyzer to remove wastes and extra fluid from the blood. - peritoneal dialysis. Peritoneal dialysis uses the lining of the abdominal cavitythe space in the body that holds organs such as the stomach, intestines, and liverto filter the blood.
Dialysis-related amyloidosis is a complication of kidney failure because neither hemodialysis nor peritoneal dialysis effectively filters beta-2 microglobulin from the blood. As a result, elevated amounts of beta-2 microglobulin remain in the blood. Dialysis-related amyloidosis is relatively common in people with kidney failure, especially adults older than 60 years of age, who have been on dialysis for more than 5 years.1
More information is provided in the NIDDK health topics:
- Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis |
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| What are the symptoms of Amyloidosis and Kidney Disease ? | The most common sign of primary amyloidosis of the kidneys is nephrotic syndromea collection of signs that indicate kidney damage. The signs of nephrotic syndrome include
- albuminuriaan increased amount of albumin, a protein, in the urine. A person with nephrotic syndrome excretes more than half a teaspoon of albumin per day. - hyperlipidemiaa condition in which a persons blood has more-than-normal amounts of fats and cholesterol. - edemaswelling, typically in a persons legs, feet, or ankles and less often in the hands or face. - hypoalbuminemiaa condition in which a persons blood has less-than-normal amounts of albumin.
More information is provided in the NIDDK health topic, Nephrotic Syndrome in Adults.
Other signs and symptoms of primary amyloidosis may include
- fatigue, or feeling tired - shortness of breath - low blood pressure - numbness, tingling, or a burning sensation in the hands or feet - weight loss |
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| What are the symptoms of Amyloidosis and Kidney Disease ? | The symptoms of dialysis-related amyloidosis may include
- pain, stiffness, and fluid in the joints. - abnormal, fluid-containing sacs, called cysts, in some bones. - carpal tunnel syndrome, caused by unusual buildup of amyloid proteins in the wrists. The symptoms of carpal tunnel syndrome include numbness or tingling, sometimes associated with muscle weakness, in the fingers and hands.
Dialysis-related amyloidosis most often affects bones, joints, and the tissues that connect muscle to bone, called tendons. The disease may also affect the digestive tract and organs such as the heart and lungs. Bone cysts caused by dialysis-related amyloidosis can lead to bone fractures. Dialysis-related amyloidosis can also cause tears in tendons and ligaments. Ligaments are tissues that connect bones to other bones. |
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| How to diagnose Amyloidosis and Kidney Disease ? | A health care provider diagnoses primary amyloidosis of the kidneys with
- a medical and family history - a physical exam - urinalysis - blood tests - a kidney biopsy
Medical and Family History
Taking a medical and family history may help a health care provider diagnose amyloidosis of the kidneys. He or she will ask the patient to provide a medical and family history.
Physical Exam
A physical exam may help diagnose primary amyloidosis of the kidneys. During a physical exam, a health care provider usually
- examines a patients body to check for swelling - uses a stethoscope to listen to the lungs - taps on specific areas of the patients body
Urinalysis
A health care provider may use urinalysisthe testing of a urine sampleto check for albumin and amyloid proteins in urine. The patient provides a urine sample in a special container at a health care providers office or a commercial facility. A nurse or technician can test the sample in the same location or send it to a lab for analysis. More-than-normal amounts of albumin in urine may indicate kidney damage due to primary amyloidosis. Amyloid proteins in urine may indicate amyloidosis.
Blood Tests
The health care provider may use blood tests to see how well the kidneys are working and to check for amyloid proteins and hyperlipidemia. A blood test involves drawing a patients blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. Blood tests for kidney function measure the waste products in the blood that healthy kidneys normally filter out. Hyperlipidemia may indicate nephrotic syndrome. Amyloid proteins in blood may indicate amyloidosis.
Kidney Biopsy
Only a biopsy can show the amyloid protein deposits in the kidneys. A health care provider may recommend a kidney biopsy if other tests show kidney damage. A kidney biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. A health care provider performs a kidney biopsy in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography (CT) scan to guide the biopsy needle into the kidney and take the tissue sample. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab for amyloid proteins and kidney damage.
The biopsy results can help the health care provider determine the best course of treatment. More information is provided in the NIDDK health topic, Kidney Biopsy. |
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| How to diagnose Amyloidosis and Kidney Disease ? | A health care provider diagnoses dialysis-related amyloidosis with
- urinalysis - blood tests - imaging tests
A health care provider can use urinalysis and blood tests to detect the amount of amyloid proteins in urine and blood. Imaging tests, such as x-rays and CT scans, can provide pictures of bone cysts and amyloid deposits in bones, joints, tendons, and ligaments. An x-ray technician performs imaging tests in a health care providers office, an outpatient center, or a hospital. A radiologista doctor who specializes in medical imaginginterprets the images. A patient does not require anesthesia. |
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| What are the treatments for Amyloidosis and Kidney Disease ? | A health care provider treats primary amyloidosis of the kidneys with the following:
- medication therapy, including chemotherapy - a stem cell transplant - treating other conditions
Medication therapy. The goal of medication therapy, including chemotherapy, is to reduce amyloid protein levels in the blood. Many health care providers recommend combination medication therapy such as
- melphalan (Alkeran), a type of chemotherapy - dexamethasone (Decadron), an anti-inflammatory steroid medication
These medications can stop the growth of the cells that make amyloid proteins. These medications may cause hair loss and serious side effects, such as nausea, vomiting, and fatigue.
Stem cell transplant. A stem cell transplant is a procedure that replaces a patients damaged stem cells with healthy ones. Stem cells are found in the bone marrow and develop into three types of blood cells the body needs. To prepare for a stem cell transplant, the patient receives high doses of chemotherapy. The actual transplant is like a blood transfusion. The transplanted stem cells travel to the bone marrow to make healthy new blood cells. The chemotherapy a patient receives to prepare for the transplant can have serious side effects, so it is important to talk with the health care provider about the risks of this procedure.
Read more in What Is a Blood and Marrow Stem Cell Transplant? at www.nhlbi.nih.gov/health/health-topics/topics/bmsct.
Treating other conditions. Primary amyloidosis has no cure, so treating some of the side effects and other conditions seen with the disease is essential. Other conditions may include
- anemiatreatment may include medications - depressiontreatment may include talking with a mental health counselor and taking medications - fatiguetreatment may include changes in diet and activity level - kidney diseasetreatment may include medications to help maintain kidney function or slow the progression of kidney disease
A patient and his or her family should talk with the health care provider about resources for support and treatment options.
More information about kidney disease is provided in the NIDDK health topic, niddk-kidney disease. |
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| What are the treatments for Amyloidosis and Kidney Disease ? | A health care provider treats dialysis-related amyloidosis with
- medication therapy - newer, more effective hemodialysis filters - surgery - a kidney transplant
The goal of medication therapy and the use of newer, more effective hemodialysis filters is to reduce amyloid protein levels in the blood. Medication therapy can help reduce symptoms such as pain and inflammation. A health care provider may treat a person with dialysis-related amyloidosis who has bone, joint, and tendon problems, such as bone cysts and carpal tunnel syndrome, using surgery.
Dialysis-related amyloidosis has no cure; however, a successful kidney transplant may stop the disease from progressing.
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Transplantation. |
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| What to do for Amyloidosis and Kidney Disease ? | Researchers have not found that eating, diet, and nutrition play a role in causing or preventing primary amyloidosis of the kidneys or dialysis-related amyloidosis. People with nephrotic syndrome may make dietary changes such as
- limiting dietary sodium, often from salt, to help reduce edema and lower blood pressure - decreasing liquid intake to help reduce edema and lower blood pressure - eating a diet low in saturated fat and cholesterol to help control more-than-normal amounts of fats and cholesterol in the blood
Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein. Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients.
People with kidney disease on a restricted protein diet should receive blood tests that can show low nutrient levels. People with primary amyloidosis of the kidneys or dialysis-related amyloidosis should talk with a health care provider about dietary restrictions to best manage their individual needs. |
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| What to do for Amyloidosis and Kidney Disease ? | - Amyloidosis is a rare disease that occurs when amyloid proteins are deposited in tissues and organs. - Primary amyloidosis and dialysis-related amyloidosis are the types of amyloidosis that can affect the kidneys. - The most common sign of primary amyloidosis of the kidneys is nephrotic syndrome. - The signs of nephrotic syndrome include - albuminuriaan elevated amount of albumin in the urine. A person with nephrotic syndrome excretes more than half a teaspoon of albumin per day. - hyperlipidemiaa condition in which a persons blood has more-than-normal amounts of fats and cholesterol. - edemaswelling, typically in a persons legs, feet, or ankles and less often in the hands or face. - hypoalbuminemiaa condition in which a persons blood has less-than-normal amounts of albumin. - Other signs and symptoms of primary amyloidosis may include - fatigue, or feeling tired - shortness of breath - low blood pressure - numbness, tingling, or a burning sensation in the hands or feet - weight loss - The symptoms of dialysis-related amyloidosis may include - pain, stiffness, and fluid in the joints. - abnormal, fluid-containing sacs, called cysts, in some bones. - carpal tunnel syndrome, caused by unusual buildup of amyloid proteins in the wrists. The symptoms of carpal tunnel syndrome include numbness or tingling, sometimes associated with muscle weakness, in the fingers and hands. - A health care provider diagnoses primary amyloidosis of the kidneys with - a medical and family history - a physical exam - urinalysis - blood tests - a kidney biopsy - A health care provider diagnoses dialysis-related amyloidosis with - urinalysis - blood tests - imaging tests - A health care provider treats primary amyloidosis of the kidneys with the following: - medication therapy, including chemotherapy - a stem cell transplant - treating other conditions - A health care provider treats dialysis-related amyloidosis with - medication therapy - newer, more effective hemodialysis filters - surgery - a kidney transplant |
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| What is (are) Amyloidosis and Kidney Disease ? | You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.
Booklets
- What I need to know about Kidney Failure and How its Treated - Treatment Methods for Kidney Failure: Hemodialysis - Treatment Methods for Kidney Failure: Peritoneal Dialysis - Treatment Methods for Kidney Failure: Kidney Transplantation - Kidney Failure: Eat Right to Feel Right on Hemodialysis
Fact Sheets
- Kidney Failure: What to Expect - Vascular Access for Hemodialysis - Hemodialysis Dose and Adequacy - Peritoneal Dialysis Dose and Adequacy - Amyloidosis and Kidney Disease - Anemia in Chronic Kidney Disease - Chronic Kidney Disease-Mineral and Bone Disorder - Financial Help for Treatment of Kidney Failure
Learning as much as you can about your treatment will help make you an important member of your health care team.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
The NIDDK would like to thank: Glenn Chertow, M.D., University of California at San Francisco; William J. Stone, M.D., Vanderbilt University; Morie A. Gertz, M.D., Mayo Clinic
This information is not copyrighted. The NIDDK encourages people to share this content freely.
September 2014 |
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| What to do for What I need to know about Physical Activity and Diabetes ? | - Starting a physical activity program can help you lose weight or keep a healthy weight and keep your blood glucose levels on target. - Always talk with your health care team before you start a new physical activity program. - Ask your health care team if you need to change the amount of medicine you take or the food you eat before any physical activity. - Talk with your health care team about what types of physical activity are safe for you, such as walking, weightlifting, or housework. - To make sure you stay active, find activities you like to do. Ask a friend or family member to be your exercise buddy. - Write down your blood glucose levels and when and how long you are physically active in a record book. - Doctors suggest that you aim for 30 to 60 minutes of moderate to vigorous physical activity most days of the week. - Children and adolescents with type 2 diabetes who are 10 to 17 years old should aim for 60 minutes of moderate to vigorous activity every day. - Not all physical activity has to take place at the same time. For example, you might take a walk for 20 minutes, lift hand weights for 10 minutes, and walk up and down the stairs for 5 minutes. - Doing moderate to vigorous aerobic exercise for 30 to 60 minutes a day most days of the week provides many benefits. You can even split up these minutes into several parts. - Start exercising slowly, with 5 to 10 minutes a day, and add a little more time each week. Try walking briskly, hiking, or climbing stairs. - Whether youre a man or a woman, you can do strength training with hand weights, elastic bands, or weight machines two to three times a week. - Stretching exercises are a light to moderate physical activity that both men and women can do. When you stretch, you increase your flexibility, lower your stress, and help prevent sore muscles. - Increase daily activity by spending less time watching TV or at the computer. - Try these simple ways to add light, moderate, or vigorous physical activities in your life every day: - Walk around while you talk on the phone. - Take a walk through your neighborhood. - Do chores, such as work in the garden or rake leaves, clean the house, or wash the car. - If you have type 1 diabetes, try not to do vigorous physical activity when you have ketones in your blood or urine. |
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| What is (are) Medullary Sponge Kidney ? | Medullary sponge kidney, also known as Cacchi-Ricci disease, is a birth defect where changes occur in the tubules, or tiny tubes, inside a fetus kidneys.
In a normal kidney, urine flows through these tubules as the kidney is being formed during a fetus growth. In medullary sponge kidney, tiny, fluid-filled sacs called cysts form in the tubules within the medullathe inner part of the kidneycreating a spongelike appearance. The cysts keep urine from flowing freely through the tubules.
Symptoms of medullary sponge kidney do not usually appear until the teenage years or the 20s. Medullary sponge kidney can affect one or both kidneys. |
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| What are the complications of Medullary Sponge Kidney ? | Complications of medullary sponge kidney include
- hematuria, or blood in the urine - kidney stones - urinary tract infections (UTIs)
Medullary sponge kidney rarely leads to more serious problems, such as chronic kidney disease or kidney failure. |
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| What causes Medullary Sponge Kidney ? | Scientists do not fully understand the cause of medullary sponge kidney or why cysts form in the tubules during fetal development. Even though medullary sponge kidney is present at birth, most cases do not appear to be inherited. |
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| How many people are affected by Medullary Sponge Kidney ? | Medullary sponge kidney affects about one person per 5,000 people in the United States. Researchers have reported that 12 to 20 percent of people who develop calcium-based kidney stones have medullary sponge kidney1. |
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| What are the symptoms of Medullary Sponge Kidney ? | Many people with medullary sponge kidney have no symptoms. The first sign that a person has medullary sponge kidney is usually a UTI or a kidney stone. UTIs and kidney stones share many of the same signs and symptoms:
- burning or painful urination - pain in the back, lower abdomen, or groin - cloudy, dark, or bloody urine - foul-smelling urine - fever and chills - vomiting
People who experience these symptoms should see or call a health care provider as soon as possible. |
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| How to diagnose Medullary Sponge Kidney ? | A health care provider diagnoses medullary sponge kidney based on
- a medical and family history - a physical exam - imaging studies
Medical and Family History
Taking a medical and family history can help diagnose medullary sponge kidney. A health care provider will suspect medullary sponge kidney when a person has repeated UTIs or kidney stones.
Physical Exam
No physical signs are usually present in a patient with medullary sponge kidney, except for blood in the urine. Health care providers usually confirm a diagnosis of medullary sponge kidney with imaging studies.
Imaging Studies
Imaging is the medical term for tests that use different methods to see bones, tissues, and organs inside the body. Health care providers commonly choose one or more of three imaging techniques to diagnose medullary sponge kidney:
- intravenous pyelogram - computerized tomography (CT) scan - ultrasound
A radiologista doctor who specializes in medical imaginginterprets the images from these studies, and patients do not need anesthesia.
Intravenous Pyelogram
In an intravenous pyelogram, a health care provider injects a special dye, called contrast medium, into a vein in the patients arm. The contrast medium travels through the body to the kidneys. The kidneys excrete the contrast medium into urine, which makes the urine visible on an x-ray. An x-ray technician performs this procedure at a health care providers office, an outpatient center, or a hospital. An intravenous pyelogram can show any blockage in the urinary tract, and the cysts show up as clusters of light.
Computerized Tomography Scans
Computerized tomography scans use a combination of x-rays and computer technology to create images. For a CT scan, a health care provider may give the patient a solution to drink and an injection of contrast medium. CT scans require the patient to lie on a table that slides into a tunnel-shaped device where the x-rays are taken. An x-ray technician performs the procedure in an outpatient center or a hospital. CT scans can show expanded or stretched tubules.
Ultrasound
Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital. Ultrasound can show kidney stones and calcium deposits within the kidney. |
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| What are the treatments for Medullary Sponge Kidney ? | Scientists have not discovered a way to reverse medullary sponge kidney. Once a health care provider is sure a person has medullary sponge kidney, treatment focuses on
- curing an existing UTI - removing any kidney stones
Curing an Existing Urinary Tract Infection
To treat a UTI, the health care provider may prescribe a medication called an antibiotic that kills bacteria. The choice of medication and length of treatment depend on the persons medical history and the type of bacteria causing the infection. More information is provided in the NIDDK health topic, Urinary Tract Infections in Adults.
Removing Kidney Stones
Treatment for kidney stones usually depends on their size and what they are made of, as well as whether they are causing pain or obstructing the urinary tract. Kidney stones may be treated by a general practitioner or by a urologista doctor who specializes in the urinary tract.
Small stones usually pass through the urinary tract without treatment. Still, the person may need pain medication and should drink lots of liquids to help move the stone along. Pain control may consist of oral or intravenous (IV) medication, depending on the duration and severity of the pain. People may need IV fluids if they become dehydrated from vomiting or an inability to drink.
A person with a larger stone, or one that blocks urine flow and causes great pain, may need more urgent treatment, such as
- shock wave lithotripsy. A machine called a lithotripter is used to break up the kidney stone into smaller pieces to pass more easily through the urinary tract. The patient may need local or general anesthesia. - ureteroscopy. A ureteroscopea long, tubelike instrument with an eyepieceis used to find and retrieve the stone with a small basket or to break the stone up with laser energy. Local or general anesthesia may be required. - percutaneous nephrolithotomy. In this procedure, a wire-thin viewing instrument, called a nephroscope, is used to locate and remove the stones. During the procedure, which requires general anesthesia, a tube is inserted directly into the kidney through a small incision in the patients back.
More information is provided in the NIDDK health topic, Kidney Stones in Adults. |
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| How to prevent Medullary Sponge Kidney ? | Scientists have not yet found a way to prevent medullary sponge kidney. However, health care providers can recommend medications and dietary changes to prevent future UTIs and kidney stones. |
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| How to prevent Medullary Sponge Kidney ? | Health care providers may prescribe certain medications to prevent UTIs and kidney stones:
- A person with medullary sponge kidney may need to continue taking a low-dose antibiotic to prevent recurrent infections. - Medications that reduce calcium in the urine may help prevent calcium kidney stones. These medications may include - potassium citrate - thiazide |
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| What to do for Medullary Sponge Kidney ? | The following changes in diet may help prevent UTIs and kidney stone formation:
- Drinking plenty of water and other liquids can help flush bacteria from the urinary tract and dilute urine so kidney stones cannot form. A person should drink enough liquid to produce about 2 to 2.5 quarts of urine every day.3 - Reducing sodium intake, mostly from salt, may help prevent kidney stones. Diets high in sodium can increase the excretion of calcium into the urine and thus increase the chance of calciumcontaining kidney stones forming. - Foods rich in animal proteins such as meat, eggs, and fish can increase the chance of uric acid stones and calcium stones forming. People who form stones should limit their meat consumption to 6 to 8 ounces a day.4 - People who are more likely to develop calcium oxalate stones should include 1,000 milligrams of calcium in their diet every day. Adults older than 50 years should consume 1,200 milligrams of calcium daily.3 Calcium in the digestive tract binds to oxalate from food and keeps it from entering the blood and the urinary tract, where it can form stones.
People with medullary sponge kidney should talk with their health care provider or a dietitian before making any dietary changes. A dietitian can help a person plan healthy meals. |
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| What to do for Medullary Sponge Kidney ? | - Medullary sponge kidney, also known as Cacchi-Ricci disease, is a birth defect where changes occur in the tubules, or tiny tubes, inside a fetus kidneys. - Symptoms of medullary sponge kidney do not usually appear until the teenage years or the 20s. Medullary sponge kidney can affect one or both kidneys. - Complications of medullary sponge kidney include - hematuria, or blood in the urine - kidney stones - urinary tract infections (UTIs) - Many people with medullary sponge kidney have no symptoms. The first sign that a person has medullary sponge kidney is usually a UTI or a kidney stone. UTIs and kidney stones share many of the same signs and symptoms: - burning or painful urination - pain in the back, lower abdomen, or groin - cloudy, dark, or bloody urine - foul-smelling urine - fever and chills - vomiting - Health care providers commonly choose one or more of three imaging techniques to diagnose medullary sponge kidney: - intravenous pyelogram - computerized tomography (CT) scan - ultrasound - Scientists have not discovered a way to reverse medullary sponge kidney. Once a health care provider is sure a person has medullary sponge kidney, treatment focuses on - curing an existing UTI - removing any kidney stones - Scientists have not yet found a way to prevent medullary sponge kidney. However, health care providers can recommend medications and dietary changes to prevent future UTIs and kidney stones. |
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| What is (are) Prolactinoma ? | A prolactinoma is a benign noncancerous tumor of the pituitary gland that produces a hormone called prolactin. Prolactinomas are the most common type of pituitary tumor. Symptoms of prolactinoma are caused by hyperprolactinemia --- too much prolactin in the blood --- or by pressure of the tumor on surrounding tissues.
Prolactin stimulates the breast to produce milk during pregnancy. After giving birth, a mothers prolactin levels fall unless she breastfeeds her infant. Each time the baby nurses, prolactin levels rise to maintain milk production. |
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| What is (are) Prolactinoma ? | The pituitary gland, sometimes called the master gland, plays a critical role in regulating growth and development, metabolism, and reproduction. It produces prolactin and other key hormones including
- growth hormone, which regulates growth - adrenocorticotropin (ACTH), which stimulates the adrenal glands to produce cortisol, a hormone important in metabolism and the body's response to stress - thyrotropin, which signals the thyroid gland to produce thyroid hormone, also involved in metabolism and growth - luteinizing hormone and follicle-stimulating hormone, which regulate ovulation and estrogen and progesterone production in women and sperm formation and testosterone production in men
The pituitary gland sits in the middle of the head in a bony box called the sella turcica. The optic nerves sit directly above the pituitary gland. Enlargement of the gland can cause symptoms such as headaches or visual disturbances. Pituitary tumors may also impair production of one or more pituitary hormones, causing reduced pituitary function, also called hypopituitarism. |
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| How many people are affected by Prolactinoma ? | Although small benign pituitary tumors are fairly common in the general population, symptomatic prolactinomas are uncommon. Prolactinomas occur more often in women than men and rarely occur in children. |
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| What are the symptoms of Prolactinoma ? | In women, high levels of prolactin in the blood often cause infertility and changes in menstruation. In some women, periods may stop. In others, periods may become irregular or menstrual flow may change. Women who are not pregnant or nursing may begin producing breast milk. Some women may experience a loss of libido-interest in sex. Intercourse may become painful because of vaginal dryness.
In men, the most common symptom of prolactinoma is erectile dysfunction. Because men have no reliable indicator such as changes in menstruation to signal a problem, many men delay going to the doctor until they have headaches or eye problems caused by the enlarged pituitary pressing against nearby optic nerves. They may not recognize a gradual loss of sexual function or libido. Only after treatment do some men realize they had a problem with sexual function. |
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| What causes Prolactinoma ? | The cause of pituitary tumors remains largely unknown. Most pituitary tumors are sporadic, meaning they are not genetically passed from parents to their children. |
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| What causes Prolactinoma ? | In some people, high blood levels of prolactin can be traced to causes other than prolactinoma.
Prescription drugs. Prolactin secretion in the pituitary is normally suppressed by the brain chemical dopamine. Drugs that block the effects of dopamine at the pituitary or deplete dopamine stores in the brain may cause the pituitary to secrete prolactin. These drugs include older antipsychotic medications such as trifluoperazine (Stelazine) and haloperidol (Haldol); the newer antipsychotic drugs risperidone (Risperdal) and molindone (Moban); metoclopramide (Reglan), used to treat gastroesophageal reflux and the nausea caused by certain cancer drugs; and less often, verapamil, alpha-methyldopa (Aldochlor, Aldoril), and reserpine (Serpalan, Serpasil), used to control high blood pressure. Some antidepressants may cause hyperprolactinemia, but further research is needed.
Other pituitary tumors. Other tumors arising in or near the pituitary may block the flow of dopamine from the brain to the prolactin-secreting cells. Such tumors include those that cause acromegaly, a condition caused by too much growth hormone, and Cushing's syndrome, caused by too much cortisol. Other pituitary tumors that do not result in excess hormone production may also block the flow of dopamine.
Hypothyroidism. Increased prolactin levels are often seen in people with hypothyroidism, a condition in which the thyroid does not produce enough thyroid hormone. Doctors routinely test people with hyperprolactinemia for hypothyroidism.
Chest involvement. Nipple stimulation also can cause a modest increase in the amount of prolactin in the blood. Similarly, chest wall injury or shingles involving the chest wall may also cause hyperprolactinemia. |
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| How to diagnose Prolactinoma ? | A doctor will test for prolactin blood levels in women with unexplained milk secretion, called galactorrhea, or with irregular menses or infertility and in men with impaired sexual function and, in rare cases, milk secretion. If prolactin levels are high, a doctor will test thyroid function and ask first about other conditions and medications known to raise prolactin secretion. The doctor may also request magnetic resonance imaging (MRI), which is the most sensitive test for detecting pituitary tumors and determining their size. MRI scans may be repeated periodically to assess tumor progression and the effects of therapy. Computerized tomography (CT) scan also gives an image of the pituitary but is less precise than the MRI.
The doctor will also look for damage to surrounding tissues and perform tests to assess whether production of other pituitary hormones is normal. Depending on the size of the tumor, the doctor may request an eye exam with measurement of visual fields. |
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| What are the treatments for Prolactinoma ? | The goals of treatment are to return prolactin secretion to normal, reduce tumor size, correct any visual abnormalities, and restore normal pituitary function. In the case of large tumors, only partial achievement of these goals may be possible.
Medical Treatment
Because dopamine is the chemical that normally inhibits prolactin secretion, doctors may treat prolactinoma with the dopamine agonists bromocriptine (Parlodel) or cabergoline (Dostinex). Agonists are drugs that act like a naturally occurring substance. These drugs shrink the tumor and return prolactin levels to normal in approximately 80 percent of patients. Both drugs have been approved by the U.S. Food and Drug Administration for the treatment of hyperprolactinemia. Bromocriptine is the only dopamine agonist approved for the treatment of infertility. This drug has been in use longer than cabergoline and has a well-established safety record.
Nausea and dizziness are possible side effects of bromocriptine. To avoid these side effects, bromocriptine treatment must be started slowly. A typical starting dose is one-quarter to one-half of a 2.5 milligram (mg) tablet taken at bedtime with a snack. The dose is gradually increased every 3 to 7 days as needed and taken in divided doses with meals or at bedtime with a snack. Most people are successfully treated with 7.5 mg a day or less, although some people need 15 mg or more each day. Because bromocriptine is short acting, it should be taken either twice or three times daily.
Bromocriptine treatment should not be stopped without consulting a qualified endocrinologist-a doctor specializing in disorders of the hormone-producing glands. Prolactin levels rise again in most people when the drug is discontinued. In some, however, prolactin levels remain normal, so the doctor may suggest reducing or discontinuing treatment every 2 years on a trial basis.
Cabergoline is a newer drug that may be more effective than bromocriptine in normalizing prolactin levels and shrinking tumor size. Cabergoline also has less frequent and less severe side effects. Cabergoline is more expensive than bromocriptine and, being newer on the market, its long-term safety record is less well defined. As with bromocriptine therapy, nausea and dizziness are possible side effects but may be avoided if treatment is started slowly. The usual starting dose is .25 mg twice a week. The dose may be increased every 4 weeks as needed, up to 1 mg two times a week. Cabergoline should not be stopped without consulting a qualified endocrinologist.
Recent studies suggest prolactin levels are more likely to remain normal after discontinuing long-term cabergoline therapy than after discontinuing bromocriptine. More research is needed to confirm these findings.
In people taking cabergoline or bromocriptine to treat Parkinson's disease at doses more than 10 times higher than those used for prolactinomas, heart valve damage has been reported. Rare cases of valve damage have been reported in people taking low doses of cabergoline to treat hyperprolactinemia. Before starting these medications, the doctor will order an echocardiogram. An echocardiogram is a sonogram of the heart that checks the heart valves and heart function.
Because limited information exists about the risks of long-term, low-dose cabergoline use, doctors generally prescribe the lowest effective dose and periodically reassess the need for continuing therapy. People taking cabergoline who develop symptoms of shortness of breath or swelling of the feet should promptly notify their physician because these may be signs of heart valve damage.
Surgery
Surgery to remove all or part of the tumor should only be considered if medical therapy cannot be tolerated or if it fails to reduce prolactin levels, restore normal reproduction and pituitary function, and reduce tumor size. If medical therapy is only partially successful, it should be continued, possibly combined with surgery or radiation.
Most often, the tumor is removed through the nasal cavity. Rarely, if the tumor is large or has spread to nearby brain tissue, the surgeon will access the tumor through an opening in the skull.
The results of surgery depend a great deal on tumor size and prolactin levels as well as the skill and experience of the neurosurgeon. The higher the prolactin level before surgery, the lower the chance of normalizing serum prolactin. Serum is the portion of the blood used in measuring prolactin levels. In the best medical centers, surgery corrects prolactin levels in about 80 percent of patients with small tumors and a serum prolactin less than 200 nanograms per milliliter (ng/ml). A surgical cure for large tumors is lower, at 30 to 40 percent. Even in patients with large tumors that cannot be completely removed, drug therapy may be able to return serum prolactin to the normal range-20 ng/ml or less-after surgery. Depending on the size of the tumor and how much of it is removed, studies show that 20 to 50 percent will recur, usually within 5 years.
Because the results of surgery are so dependent on the skill and knowledge of the neurosurgeon, a patient should ask the surgeon about the number of operations he or she has performed to remove pituitary tumors and for success and complication rates in comparison to major medical centers. The best results come from surgeons who have performed hundreds or even thousands of such operations. To find a surgeon, contact The Pituitary Society (see For More Information).
Radiation
Rarely, radiation therapy is used if medical therapy and surgery fail to reduce prolactin levels. Depending on the size and location of the tumor, radiation is delivered in low doses over the course of 5 to 6 weeks or in a single high dose. Radiation therapy is effective about 30 percent of the time. |
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| Who is at risk for Prolactinoma? ? | Women whose ovaries produce inadequate estrogen are at increased risk for osteoporosis. Hyperprolactinemia can reduce estrogen production. Although estrogen production may be restored after treatment for hyperprolactinemia, even a year or 2 without estrogen can compromise bone strength. Women should protect themselves from osteoporosis by increasing exercise and calcium intake through diet or supplements and by not smoking. Women treated for hyperprolactinemia may want to have periodic bone density measurements and discuss estrogen replacement therapy or other bone-strengthening medications with their doctor. |
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| What is (are) Zollinger-Ellison Syndrome ? | Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum. The tumors, called gastrinomas, release large amounts of gastrin that cause the stomach to produce large amounts of acid. Normally, the body releases small amounts of gastrin after eating, which triggers the stomach to make gastric acid that helps break down food and liquid in the stomach. The extra acid causes peptic ulcers to form in the duodenum and elsewhere in the upper intestine.
The tumors seen with Zollinger-Ellison syndrome are sometimes cancerous and may spread to other areas of the body. |
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| What is (are) Zollinger-Ellison Syndrome ? | The stomach, duodenum, and pancreas are digestive organs that break down food and liquid.
- The stomach stores swallowed food and liquid. The muscle action of the lower part of the stomach mixes the food and liquid with digestive juice. Partially digested food and liquid slowly move into the duodenum and are further broken down. - The duodenum is the first part of the small intestinethe tube-shaped organ between the stomach and the large intestinewhere digestion of the food and liquid continues. - The pancreas is an organ that makes the hormone insulin and enzymes for digestion. A hormone is a natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. Insulin helps cells throughout the body remove glucose, also called sugar, from blood and use it for energy. The pancreas is located behind the stomach and close to the duodenum. |
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| What causes Zollinger-Ellison Syndrome ? | Experts do not know the exact cause of Zollinger-Ellison syndrome. About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1).1 MEN1 causes hormone-releasing tumors in the endocrine glands and the duodenum. Symptoms of MEN1 include increased hormone levels in the blood, kidney stones, diabetes, muscle weakness, weakened bones, and fractures.
More information about MEN1 is provided in the NIDDK health topic, Multiple Endocrine Neoplasia Type 1. |
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| How many people are affected by Zollinger-Ellison Syndrome ? | Zollinger-Ellison syndrome is rare and only occurs in about one in every 1 million people.1 Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old. A child who has a parent with MEN1 is also at increased risk for Zollinger-Ellison syndrome.2 |
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| What are the symptoms of Zollinger-Ellison Syndrome ? | Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers. A dull or burning pain felt anywhere between the navel and midchest is the most common symptom of a peptic ulcer. This discomfort usually
- occurs when the stomach is emptybetween meals or during the nightand may be briefly relieved by eating food - lasts for minutes to hours - comes and goes for several days, weeks, or months
Other symptoms include
- diarrhea - bloating - burping - nausea - vomiting - weight loss - poor appetite
Some people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER), which occurs when stomach contents flow back up into the esophagusa muscular tube that carries food and liquids to the stomach. In addition to nausea and vomiting, reflux symptoms include a painful, burning feeling in the midchest. More information about GER is provided in the NIDDK health topic, Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) in Adults. |
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| What are the symptoms of Zollinger-Ellison Syndrome ? | A person who has any of the following emergency symptoms should call or see a health care provider right away:
- chest pain - sharp, sudden, persistent, and severe stomach pain - red blood in stool or black stools - red blood in vomit or vomit that looks like coffee grounds
These symptoms could be signs of a serious problem, such as
- internal bleedingwhen gastric acid or a peptic ulcer breaks a blood vessel - perforationwhen a peptic ulcer forms a hole in the duodenal wall - obstructionwhen a peptic ulcer blocks the path of food trying to leave the stomach |
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| How to diagnose Zollinger-Ellison Syndrome ? | A health care provider diagnoses Zollinger-Ellison syndrome based on the following:
- medical history - physical exam - signs and symptoms - blood tests - upper gastrointestinal (GI) endoscopy - imaging tests to look for gastrinomas - measurement of stomach acid
Medical History
Taking a medical and family history is one of the first things a health care provider may do to help diagnose Zollinger-Ellison syndrome. The health care provider may ask about family cases of MEN1 in particular.
Physical Exam
A physical exam may help diagnose Zollinger-Ellison syndrome. During a physical exam, a health care provider usually
- examines a persons body - uses a stethoscope to listen to bodily sounds - taps on specific areas of the persons body
Signs and Symptoms
A health care provider may suspect Zollinger-Ellison syndrome if
- diarrhea accompanies peptic ulcer symptoms or if peptic ulcer treatment fails. - a person has peptic ulcers without the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen or a bacterial Helicobacter pylori (H. pylori) infection. NSAID use and H. pylori infection may cause peptic ulcers. - a person has severe ulcers that bleed or cause holes in the duodenum or stomach. - a health care provider diagnoses a person or the persons family member with MEN1 or a person has symptoms of MEN1.
Blood Tests
The health care provider may use blood tests to check for an elevated gastrin level. A technician or nurse draws a blood sample during an office visit or at a commercial facility and sends the sample to a lab for analysis. A health care provider will ask the person to fast for several hours prior to the test and may ask the person to stop acid-reducing medications for a period of time before the test. A gastrin level that is 10 times higher than normal suggests Zollinger-Ellison syndrome.2
A health care provider may also check for an elevated gastrin level after an infusion of secretin. Secretin is a hormone that causes gastrinomas to release more gastrin. A technician or nurse places an intravenous (IV) needle in a vein in the arm to give an infusion of secretin. A health care provider may suspect Zollinger-Ellison syndrome if blood drawn after the infusion shows an elevated gastrin level.
Upper Gastrointestinal Endoscopy
The health care provider uses an upper GI endoscopy to check the esophagus, stomach, and duodenum for ulcers and esophagitisa general term used to describe irritation and swelling of the esophagus. This procedure involves using an endoscopea small, flexible tube with a lightto see the upper GI tract, which includes the esophagus, stomach, and duodenum. A gastroenterologista doctor who specializes in digestive diseasesperforms the test at a hospital or an outpatient center. The gastroenterologist carefully feeds the endoscope 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. A technician or nurse inserts an IV needle in a vein in the arm if anesthesia is given.
Imaging Tests
To help find gastrinomas, a health care provider may order one or more of the following imaging tests:
- Computerized tomography (CT) scan. A CT scan is an x ray that produces pictures of the body. A CT scan may include the injection of a special dye, called contrast medium. CT scans use a combination of x rays and computer technology to create images. CT scans require the person to lie on a table that slides into a tunnel-shaped device where an x-ray technician takes x rays. A computer puts the different views together to create a model of the pancreas, stomach, and duodenum. The x-ray technician performs the procedure in an outpatient center or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. The person does not need anesthesia. CT scans can show tumors and ulcers. - Magnetic resonance imaging (MRI). MRI is a test that takes pictures of the bodys internal organs and soft tissues without using x rays. A specially trained technician performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The person does not need anesthesia, though people with a fear of confined spaces may receive light sedation, taken by mouth. An MRI may include the injection of contrast medium. With most MRI machines, the person will lie on a table that slides into a tunnel-shaped device that may be open ended or closed at one end. Some machines allow the person to lie in a more open space. During an MRI, the person, although usually awake, remains perfectly still while the technician takes the images, which usually takes only a few minutes. The technician will take a sequence of images from different angles to create a detailed picture of the upper GI tract. During sequencing, the person will hear loud mechanical knocking and humming noises. - Endoscopic ultrasound. This procedure involves using a special endoscope called an endoechoscope to perform ultrasound of the pancreas. The endoechoscope has a built-in miniature ultrasound probe that bounces safe, painless sound waves off organs to create an image of their structure. A gastroenterologist performs the procedure in an outpatient center or a hospital, and a radiologist interprets the images. The gastroenterologist carefully feeds the endoechoscope down the esophagus, through the stomach and duodenum, until it is near the pancreas. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. A sedative helps the person stay relaxed and comfortable. The images can show gastrinomas in the pancreas. - Angiogram. An angiogram is a special kind of x ray in which an interventional radiologista specially trained radiologistthreads a thin, flexible tube called a catheter through the large arteries, often from the groin, to the artery of interest. The radiologist injects contrast medium through the catheter so the images show up more clearly on the x ray. The interventional radiologist performs the procedure and interprets the images in a hospital or an outpatient center. A person does not need anesthesia, though a light sedative may help reduce a persons anxiety during the procedure. This test can show gastrinomas in the pancreas. - Somatostatin receptor scintigraphy. An x-ray technician performs this test, also called OctreoScan, at a hospital or an outpatient center, and a radiologist interprets the images. A person does not need anesthesia. A radioactive compound called a radiotracer, when injected into the bloodstream, selectively labels tumor cells. The labeled cells light up when scanned with a device called a gamma camera. The test can show gastrinomas in the duodenum, pancreas, and other parts of the body.
Small gastrinomas may be hard to see; therefore, health care providers may order several types of imaging tests to find gastrinomas.
Stomach-acid Measurement
Using a sample of stomach juices for analysis, a health care provider may measure the amount of stomach acid a person produces. During the exam, a health care provider puts in a nasogastric tubea tiny tube inserted through the nose and throat that reaches into the stomach. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. Once the tube is placed, a health care provider takes samples of the stomach acid. High acid levels in the stomach indicate Zollinger-Ellison syndrome. |
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| What are the treatments for Zollinger-Ellison Syndrome ? | A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery.
Medications
A class of medications called proton pump inhibitors (PPIs) includes
- esomeprazole (Nexium) - lansoprazole (Prevacid) - pantoprazole (Protonix) - omeprazole (Prilosec or Zegerid) - dexlansoprazole (Dexilant)
PPIs stop the mechanism that pumps acid into the stomach, helping to relieve peptic ulcer pain and promote healing. A health care provider may prescribe people who have Zollinger-Ellison syndrome higher-than-normal doses of PPIs to control the acid production. Studies show that PPIs may increase the risk of hip, wrist, and spine fractures when a person takes them long term or in high doses, so its important for people to discuss risks versus benefits with their health care provider.
Surgery
Surgical removal of gastrinomas is the only cure for Zollinger-Ellison syndrome. Some gastrinomas spread to other parts of the body, especially the liver and bones. Finding and removing all gastrinomas before they spread is often challenging because many of the tumors are small.
Chemotherapy
Health care providers sometimes use chemotherapy drugs to treat gastrinomas that cannot be surgically removed, including
- streptozotocin (Zanosar) - 5-fluorouracil (Adrucil) - doxorubicin (Doxil) |
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| What to do for Zollinger-Ellison Syndrome ? | Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Zollinger-Ellison syndrome. |
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| What to do for Zollinger-Ellison Syndrome ? | - Zollinger-Ellison syndrome is a rare disorder that occurs when one or more tumors form in the pancreas and duodenum. - Experts do not know the exact cause of Zollinger-Ellison syndrome. - About 25 to 30 percent of gastrinomas are caused by an inherited genetic disorder called multiple endocrine neoplasia type 1 (MEN1). - Although anyone can get Zollinger-Ellison syndrome, the disease is more common among men 30 to 50 years old. - Zollinger-Ellison syndrome signs and symptoms are similar to those of peptic ulcers. - Some people with Zollinger-Ellison syndrome have only diarrhea, with no other symptoms. Others develop gastroesophageal reflux (GER). - A health care provider diagnoses Zollinger-Ellison syndrome based on the following: - medical history - physical exam - signs and symptoms - blood tests - upper gastrointestinal (GI) endoscopy - imaging tests to look for gastrinomas - measurement of stomach acid - A health care provider treats Zollinger-Ellison syndrome with medications to reduce gastric acid secretion and with surgery to remove gastrinomas. A health care provider sometimes uses chemotherapymedications to shrink tumorswhen tumors are too widespread to remove with surgery. |
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| What is (are) IgA Nephropathy ? | IgA nephropathy, also known as Bergers disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues. IgA is an antibodya protein made by the immune system to protect the body from foreign substances such as bacteria or viruses. Most people with IgA nephropathy receive care from a nephrologist, a doctor who specializes in treating people with kidney disease. |
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| What causes IgA Nephropathy ? | Scientists think that IgA nephropathy is an autoimmune kidney disease, meaning that the disease is due to the bodys immune system harming the kidneys.
People with IgA nephropathy have an increased blood level of IgA that contains less of a special sugar, galactose, than normal. This galactose-deficient IgA is considered foreign by other antibodies circulating in the blood. As a result, these other antibodies attach to the galactose-deficient IgA and form a clump. This clump is also called an immune complex. Some of the clumps become stuck in the glomerulus of the nephron and cause inflammation and damage.
For some people, IgA nephropathy runs in families. Scientists have recently found several genetic markers that may play a role in the development of the disease. IgA nephropathy may also be related to respiratory or intestinal infections and the immune systems response to these infections. |
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| How many people are affected by IgA Nephropathy ? | IgA nephropathy is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure.1
IgA nephropathy can occur at any age, although the first evidence of kidney disease most frequently appears when people are in their teens to late 30s.2 IgA nephropathy in the United States is twice as likely to appear in men than in women.3 While found in people all over the world, IgA nephropathy is more common among Asians and Caucasians.4
A person may be more likely to develop IgA nephropathy if
- he or she has a family history of IgA nephropathy or Henoch-Schnlein purpuraa disease that causes small blood vessels in the body to become inflamed and leak - he is a male in his teens to late 30s - he or she is Asian or Caucasian |
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| What are the symptoms of IgA Nephropathy ? | In its early stages, IgA nephropathy may have no symptoms; it can be silent for years or even decades. Once symptoms appear, the most common one is hematuria, or blood in the urine. Hematuria can be a sign of damaged glomeruli. Blood in the urine may appear during or soon after a cold, sore throat, or other respiratory infection. The amount of blood may be
- visible with the naked eye. The urine may turn pink or the color of tea or cola. Sometimes a person may have dark or bloody urine. - so small that it can only be detected using special medical tests.
Another symptom of IgA nephropathy is albuminuriawhen a persons urine contains an increased amount of albumin, a protein typically found in the blood, or large amounts of protein in the urine. Albumin is the main protein in the blood. Healthy kidneys keep most proteins in the blood from leaking into the urine. However, when the glomeruli are damaged, large amounts of protein leak out of the blood into the urine.
When albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Too much fluid in the body may cause edema, or swelling, usually in the legs, feet, or ankles and less often in the hands or face. Foamy urine is another sign of albuminuria. Some people with IgA nephropathy have both hematuria and albuminuria.
After 10 to 20 years with IgA nephropathy, about 20 to 40 percent of adults develop end-stage kidney disease.5 Signs and symptoms of end-stage kidney disease may include
- high blood pressure - little or no urination - edema - feeling tired - drowsiness - 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 IgA Nephropathy ? | Complications of IgA nephropathy include
- high blood pressure - acute kidney failuresudden and temporary loss of kidney function - chronic kidney failurereduced kidney function over a period of time - nephrotic syndromea collection of symptoms that indicate kidney damage; symptoms include albuminuria, lack of protein in the blood, and high blood cholesterol levels - heart or cardiovascular problems - Henoch-Schnlein purpura
More information is provided in the NIDDK health topics, Kidney Disease and Kidney Failure. |
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| How to diagnose IgA Nephropathy ? | A health care provider diagnoses kidney disease with
- a medical and family history - a physical exam - urine tests - a blood test
Medical and Family History
Taking a medical and family history may help a health care provider diagnose kidney disease.
Physical Exam
A physical exam may help diagnose kidney disease. During a physical exam, a health care provider usually
- measures the patients blood pressure - examines the patients body for swelling
Urine Tests
Dipstick test for albumin and blood. A dipstick test performed on a urine sample can detect the presence of albumin and blood. The patient provides a urine sample in a special container in a health care providers office or a commercial facility. A nurse or technician can test the sample in the same location, or he or she can send it to a lab for analysis. The test involves placing a strip of chemically treated paper, called a dipstick, into the patients urine sample. Patches on the dipstick change color when albumin or blood is present in urine.
Urine albumin-to-creatinine ratio. A health care provider uses this measurement, which compares the amount of albumin with the amount of creatinine in a urine sample, to estimate 24-hour albumin excretion. A patient may have chronic kidney disease if the urine albumin-to-creatinine ratio is greater than 30 milligrams (mg) of albumin for each gram (g) of creatinine (30 mg/g). This measurement is also called UACR.
Blood Test
A blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood a patients kidneys filter each minutea measurement called the estimated glomerular filtration rate (eGFR). Depending on the results, the test can indicate the following:
- eGFR of 60 or above is in the normal range - eGFR below 60 may indicate kidney disease - eGFR of 15 or below may indicate kidney failure |
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| How to diagnose IgA Nephropathy ? | Currently, health care providers do not use blood or urine tests as reliable ways to diagnose IgA nephropathy; therefore, the diagnosis of IgA nephropathy requires a kidney biopsy.
A kidney biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs a kidney biopsy in a hospital or an outpatient center with light sedation and a local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the kidney. A pathologista doctor who specializes in examining tissues to diagnose diseasesexamines the kidney tissue with a microscope. Only a biopsy can show the IgA deposits in the glomeruli. The biopsy can also show how much kidney damage has already occurred. The biopsy results can help the health care provider determine the best course of treatment. |
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| What are the treatments for IgA Nephropathy ? | Researchers have not yet found a specific cure for IgA nephropathy. Once the kidneys are scarred, they cannot be repaired. Therefore, the ultimate goal of IgA nephropathy treatment is to prevent or delay end-stage kidney disease. A health care provider may prescribe medications to
- control a persons blood pressure and slow the progression of kidney disease - remove extra fluid from a persons blood - control a persons immune system - lower a persons blood cholesterol levels
Control Blood Pressure and Slow Progression of Kidney Disease
People with IgA nephropathy that is causing high blood pressure may need to take medications that lower blood pressure and can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medicationsangiotensin-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. A person may also need beta-blockers, calcium channel blockers, and other blood pressure medications.
Remove Extra Fluid
A health care provider may prescribe a diuretic, a medication that helps the kidneys remove extra fluid from the blood. Removing the extra fluid can improve the control of blood pressure. Taking a diuretic along with an ACE inhibitor or an ARB often increases the effectiveness of these medications.
Control the Immune System
Health care providers sometimes use medications to control a persons immune system. Since inflammation is the immune systems normal response, controlling the immune system can decrease inflammation. Health care providers may prescribe the following medications:
- corticosteroids, such as prednisone - cyclophosphamide
Lower Blood Cholesterol Levels
People with IgA nephropathy may develop high blood cholesterol levels. Cholesterol is a type of fat found in the bodys cells, in blood, and in many foods. People who take medications for high blood cholesterol levels can lower their blood cholesterol levels. A health care provider may prescribe one of several cholesterol-lowering medications called statins. |
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| How to prevent IgA Nephropathy ? | Researchers have not found a way to prevent IgA nephropathy. People with a family history of IgA nephropathy should talk with their health care provider to find out what steps they can take to keep their kidneys healthy, such as controlling their blood pressure and keeping their blood cholesterol at healthy levels. |
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| What to do for IgA Nephropathy ? | Researchers have not found that eating, diet, and nutrition play a role in causing or preventing IgA nephropathy. Health care providers may recommend that people with kidney disease, such as IgA nephropathy, make dietary changes such as
- limiting dietary sodium, often from salt, to help reduce edema and lower blood pressure - decreasing liquid intake to help reduce edema and lower blood pressure - eating a diet low in saturated fat and cholesterol to help control high levels of lipids, or fats, in the blood
Health care providers may also recommend that people with kidney disease eat moderate or reduced amounts of protein, although the benefit of reducing protein in a persons diet is still being researched. Proteins break down into waste products the kidneys must filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. People with kidney disease on a restricted protein diet should receive blood tests that can show nutrient levels.
Some researchers have shown that fish oil supplements containing omega-3 fatty acids may slow kidney damage in some people with kidney disease by lowering blood pressure. Omega-3 fatty acids may help reduce inflammation and slow kidney damage due to IgA nephropathy. To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/supplements.
People with IgA nephropathy should talk with a health care provider about dietary changes to best manage their individual needs. |
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| What to do for IgA Nephropathy ? | - Immunoglobulin A (IgA) nephropathy, also known as Bergers disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues. - Scientists think that IgA nephropathy is an autoimmune kidney disease, meaning that the disease is due to the bodys immune system attacking tissues in the kidney. - IgA nephropathy is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure. - In its early stages, IgA nephropathy may have no symptoms; it can be silent for years or even decades. - Once symptoms appear, the most common one is hematuria, or blood in the urine. - Another symptom of IgA nephropathy is albuminuriawhen a persons urine contains an increased amount of albumin, a protein typically found in the blood, or large amounts of protein in the urine. - Currently, health care providers do not use blood or urine tests as reliable ways to diagnose IgA nephropathy; therefore, the diagnosis of IgA nephropathy requires a kidney biopsy. - Researchers have not yet found a specific cure for IgA nephropathy. |
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| What is (are) Peyronie's Disease ? | Peyronies disease is a disorder in which scar tissue, called a plaque, forms in the penisthe male organ used for urination and sex. The plaque builds up inside the tissues of a thick, elastic membrane called the tunica albuginea. The most common area for the plaque is on the top or bottom of the penis. As the plaque builds up, the penis will curve or bend, which can cause painful erections. Curves in the penis can make sexual intercourse painful, difficult, or impossible. Peyronies disease begins with inflammation, or swelling, which can become a hard scar.
The plaque that develops in Peyronies disease is not the same plaque that can develop in a persons arteries. The plaque seen in Peyronies disease is benign, or noncancerous, and is not a tumor. Peyronies disease is not contagious or caused by any known transmittable disease.
Early researchers thought Peyronies disease was a form of impotence, now called erectile dysfunction (ED). ED happens when a man is unable to achieve or keep an erection firm enough for sexual intercourse. Some men with Peyronies disease may have ED. Usually men with Peyronies disease are referred to a urologista doctor who specializes in sexual and urinary problems. |
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| What causes Peyronie's Disease ? | Medical experts do not know the exact cause of Peyronies disease. Many believe that Peyronies disease may be the result of
- acute injury to the penis - chronic, or repeated, injury to the penis - autoimmune diseasea disorder in which the bodys immune system attacks the bodys own cells and organs
Injury to the Penis
Medical experts believe that hitting or bending the penis may injure the tissues inside. A man may injure the penis during sex, athletic activity, or an accident. Injury ruptures blood vessels, which leads to bleeding and swelling inside the layers of the tunica albuginea. Swelling inside the penis will block blood flow through the layers of tissue inside the penis. When the blood cant flow normally, clots can form and trap immune system cells. As the injury heals, the immune system cells may release substances that lead to the formation of too much scar tissue. The scar tissue builds up and forms a plaque inside the penis. The plaque reduces the elasticity of tissues and flexibility of the penis during erection, leading to curvature. The plaque may further harden because of calcificationthe process in which calcium builds up in body tissue.
Autoimmune Disease
Some medical experts believe that Peyronies disease may be part of an autoimmune disease. Normally, the immune system is the bodys way of protecting itself from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Men who have autoimmune diseases may develop Peyronies disease when the immune system attacks cells in the penis. This can lead to inflammation in the penis and can cause scarring. Medical experts do not know what causes autoimmune diseases. Some of the autoimmune diseases associated with Peyronies disease affect connective tissues. Connective tissue is specialized tissue that supports, joins, or separates different types of tissues and organs of the body. |
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| How many people are affected by Peyronie's Disease ? | Researchers estimate that Peyronies disease may affect 1 to 23 percent of men between 40 and 70 years of age.1 However, the actual occurrence of Peyronies disease may be higher due to mens embarrassment and health care providers limited reporting.1 The disease is rare in young men, although it has been reported in men in their 30s.1 The chance of developing Peyronies disease increases with age. |
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| What are the symptoms of Peyronie's Disease ? | The signs and symptoms of Peyronies disease may include
- hard lumps on one or more sides of the penis - pain during sexual intercourse or during an erection - a curve in the penis either with or without an erection - narrowing or shortening of the penis - ED
Symptoms of Peyronies disease range from mild to severe. Symptoms may develop slowly or appear quickly. In many cases, the pain decreases over time, although the curve in the penis may remain. In milder cases, symptoms may go away without causing a permanent curve. |
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| What are the complications of Peyronie's Disease ? | Complications of Peyronies disease may include
- the inability to have sexual intercourse - ED - anxiety, or stress, about sexual abilities or the appearance of the penis - stress on a relationship with a sexual partner - problems fathering a child because intercourse is difficult |
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| How to diagnose Peyronie's Disease ? | A urologist diagnoses Peyronies disease based on
- a medical and family history - a physical exam - imaging tests
Medical and Family History
Taking a medical and family history is one of the first things a urologist may do to help diagnose Peyronies disease. He or she will ask the man to provide a medical and family history, which may include the following questions:
- What is the mans ability to have an erection? - What are the problems with sexual intercourse? - When did the symptoms begin? - What is the family medical history? - What medications is the man taking? - What other symptoms is the man experiencing? - What other medical conditions does the man have?
Physical Exam
A physical exam may help diagnose Peyronies disease. During a physical exam, a urologist usually examines the mans body, including the penis.
A urologist can usually feel the plaque in the penis with or without an erection. Sometimes the urologist will need to examine the penis during an erection. The urologist will give the man an injectable medication to cause an erection.
Imaging Tests
To help pinpoint the location of the plaque buildup inside the penis, a urologist may perform
- ultrasound of the penis - an x ray of the penis
For both tests, a specially trained technician performs the procedure in a health care providers office, an outpatient center, or a hospital, and a radiologista doctor who specializes in medical imaginginterprets the images. The patient does not need anesthesia.
Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure.
X ray. An x ray is a picture created by using radiation and recorded on film or on a computer. The amount of radiation used is small. The man will lie on a table or stand during the x ray, and the technician may ask the man to change positions for additional pictures. |
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| What are the treatments for Peyronie's Disease ? | A urologist may treat Peyronies disease with nonsurgical treatments or surgery.
The goal of treatment is to reduce pain and restore and maintain the ability to have intercourse. Men with small plaques, minimal penile curvature, no pain, and satisfactory sexual function may not need treatment until symptoms get worse. Peyronies disease often resolves on its own without treatment.
A urologist may recommend changes in a mans lifestyle to reduce the risk of ED associated with Peyronies disease.
Nonsurgical Treatments
Nonsurgical treatments include medications and medical therapies.
Medications. A urologist may prescribe medications aimed at decreasing a mans penile curvature, plaque size, and inflammation. A man may take prescribed medications to treat Peyronies disease orallyby mouthor a urologist may inject medications directly into the plaque. Verapamil is one type of topical medication that a man may apply to the skin over the plaque.
- Oral medications. Oral medications may include - vitamin E - potassium para-aminobenzoate (Potaba) - tamoxifen - colchicine - acetyl-L-carnitine - pentoxifylline - Injections. Medications injected directly into plaques may include - verapamil - interferon alpha 2b - steroids - collagenase (Xiaflex)
To date, collagenase is the first and only medication specifically approved for Peyronies disease.
Medical therapies. A urologist may use medical therapies to break up scar tissue and decrease plaque size and curvature. Therapies to break up scar tissue may include
- high-intensity, focused ultrasound directed at the plaque - radiation therapyhigh-energy rays, such as x rays, aimed at the plaque - shockwave therapyfocused, low-intensity electroshock waves directed at the plaque
A urologist may use iontophoresispainless, low-level electric current that delivers medications through the skin over the plaqueto decrease plaque size and curvature.
A urologist may use mechanical traction and vacuum devices aimed at stretching or bending the penis to reduce curvature.
Surgery
A urologist may recommend surgery to remove plaque or help straighten the penis during an erection. Medical experts recommend surgery for long-term cases when
- symptoms have not improved - erections, intercourse, or both are painful - the curve or bend in the penis does not allow the man to have sexual intercourse
Some men may develop complications after surgery, and sometimes surgery does not correct the effects of Peyronies diseasesuch as shortening of the penis. Some surgical methods can cause shortening of the penis. Medical experts suggest waiting 1 year or more from the onset of symptoms before having surgery because the course of Peyronies disease is different in each man.
A urologist may recommend the following surgeries:
- grafting. A urologist will cut or remove the plaque and attach a patch of skin, a vein, or material made from animal organs in its place. This procedure may straighten the penis and restore some lost length from Peyronies disease. However, some men may experience numbness of the penis and ED after the procedure. - plication. A urologist will remove or pinch a piece of the tunica albuginea from the side of the penis opposite the plaque, which helps to straighten the penis. This procedure is less likely to cause numbness or ED. Plication cannot restore length or girth of the penis and may cause shortening of the penis. - device implantation. A urologist implants a device into the penis that can cause an erection and help straighten it during an erection. Penile implants may be considered if a man has both Peyronies disease and ED. In some cases, an implant alone will straighten the penis adequately. If the implant alone does not straighten the penis, a urologist may combine implantation with one of the other two surgeries. Once a man has an implant, he must use the device to have an erection.
A urologist performs these surgeries in a hospital.
Lifestyle Changes
A man can make healthy lifestyle changes to reduce the chance of ED associated with Peyronies disease by
- quitting smoking - reducing alcohol consumption - exercising regularly - avoiding illegal drugs
More information is provided in the NIDDK health topic, Erectile Dysfunction. |
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| How to prevent Peyronie's Disease ? | Researchers do not know how to prevent Peyronies disease. |
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| What to do for Peyronie's Disease ? | Researchers have not found that eating, diet, and nutrition play a role in causing or preventing Peyronies disease. |
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| What to do for Peyronie's Disease ? | - Peyronies disease is a disorder in which scar tissue, called a plaque, forms in the penisthe male organ used for urination and sex. - Medical experts do not know the exact cause of Peyronies disease. Many believe that Peyronies disease may be the result of - acute injury to the penis - chronic, or repeated, injury to the penis - autoimmune diseasea disorder in which the bodys immune system attacks the bodys own cells and organs - The following factors may increase a mans chance of developing Peyronies disease: - vigorous sexual or nonsexual activities that cause microscopic injury to the penis - certain connective tissue and autoimmune disorders - a family history of Peyronies disease - aging - The signs and symptoms of Peyronies disease may include - hard lumps on one or more sides of the penis - pain during sexual intercourse or during an erection - a curve in the penis either with or without an erection - narrowing or shortening of the penis - erectile dysfunction (ED) - Complications of Peyronies disease may include - the inability to have sexual intercourse - ED - anxiety, or stress, about sexual abilities or the appearance of the penis - stress on a relationship with a sexual partner - problems fathering a child because intercourse is difficult - A urologist diagnoses Peyronies disease based on - a medical and family history - a physical exam - imaging tests - A urologist may treat Peyronies disease with nonsurgical treatments or surgery. - Researchers do not know how to prevent Peyronies disease. |
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| What are the treatments for Financial Help for Diabetes Care ? | Diabetes management and treatment is expensive. According to the American Diabetes Association (ADA), the average cost of health care for a person with diabetes is $13,741 a yearmore than twice the cost of health care for a person without diabetes.1
Many people who have diabetes need help paying for their care. For those who qualify, a variety of government and nongovernment programs can help cover health care expenses. This publication is meant to help people with diabetes and their family members find and access such resources. |
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| What is (are) Financial Help for Diabetes Care ? | Health insurance helps pay for medical care, including the cost of diabetes care. Health insurance options include the following:
- private health insurance, which includes group and individual health insurance - government health insurance, such as Medicare, Medicaid, the Childrens Health Insurance Program (CHIP), TRICARE, and veterans health care programs
Starting in 2014, the Affordable Care Act (ACA) prevents insurers from denying coverage or charging higher premiums to people with preexisting conditions, such as diabetes. The ACA also requires most people to have health insurance or pay a fee. Some people may be exempt from this fee. Read more about the ACA at HealthCare.gov or call 18003182596, TTY 18558894325. |
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| What is (are) Financial Help for Diabetes Care ? | Insurance companies sell private health insurance plans. Two types of private health insurance are
- Group health insurance. People may be eligible to purchase group health insurance through their employer or union or through a family members employer or union. Other organizations, such as professional or alumni organizations, may also offer group health insurance. - Individual health insurance. People may purchase individual health insurance for themselves and their families. The website HealthCare.gov provides information about individual insurance plans. The website also provides a search function, called the Health Insurance Marketplace, to find health insurance options by state. Depending on their income and family size, some people may qualify for lower-cost premiums through the Health Insurance Marketplace. People can select or change individual health insurance plans during the open enrollment period each year. HealthCare.gov lists open enrollment period dates. The website also provides information about life events that may allow people to enroll outside the open enrollment period.
Employers may have a waiting period before an employee and his or her family members can enroll in the company health plan. Under the ACA, the waiting period can be no longer than 90 days. Certain health plans called health maintenance organizations (HMOs) may have an affiliation perioda time that must pass before health insurance coverage becomes effective. An affiliation period can be no longer than 3 months.
The ACA expanded coverage of preventive services. For example, adults with sustained high blood pressure may have access to diabetes screening at no cost. Adults and children may have access to obesity screening and counseling at no cost.
Each states insurance regulatory office, sometimes called the state insurance department or commission, provides more information about health insurance laws. This office can also help identify an insurance company that offers individual coverage. The National Association of Insurance Commissioners website, www.naic.org/state_web_map.htm , provides a membership list with contact information and a link to the website for each states insurance regulatory office.
The ADA also provides information about health insurance options at www.diabetes.org/living-with-diabetes/health-insurance .
Keeping Group Health Insurance after Leaving a Job
When leaving a job, a person may be able to continue the group health insurance provided by his or her employer for up to 18 months under a federal law called the Consolidated Omnibus Budget Reconciliation Act, or COBRA. Although people pay more for group health insurance through COBRA than they did as employees, group coverage may be cheaper than individual coverage. People who have a disability before becoming eligible for COBRA or who are determined by the Social Security Administration to be disabled within the first 60 days of COBRA coverage may be able to extend COBRA coverage an additional 11 months, for up to 29 months of coverage. COBRA may also cover young adults who were insured under a parents policy after they have reached the age limit and are trying to obtain their own insurance.
Read more at www.dol.gov/dol/topic/health-plans/cobra.htm or call the U.S. Department of Labor at 18664USADOL (18664872365).
If a person doesnt qualify for coverage or if COBRA coverage has expired, other options may be available:
- Some states require employers to offer conversion policies, in which people stay with their insurance company and buy individual coverage. - Some professional and alumni organizations offer group coverage for members. - Some insurance companies offer short-term stopgap policies designed for people who are between jobs. However, these policies may not meet ACA requirements. For example, they may not cover preexisting conditions. - People can purchase individual health insurance policies.
Each states insurance regulatory office can provide more information about these and other options. Information about consumer health plans is also available at the U.S. Department of Labors website at www.dol.gov/dol/topic/health-plans/consumerinfhealth.htm. |
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| What is (are) Financial Help for Diabetes Care ? | Medicare is a federal health insurance program that pays health care costs for eligible people who are
- age 65 or older - under age 65 with certain disabilities - of any age with end-stage renal diseasetotal and permanent kidney failure that requires a kidney transplant or blood-filtering treatments called dialysis
What health plans does Medicare offer?
Medicare has four parts:
- Part A (hospital insurance) covers inpatient care, skilled nursing home residence, hospice care, and home health care. Part A has no premium for those who have paid enough Medicare taxes. A premium is an amount a person must pay periodicallymonthly or quarterlyfor Medicare, other health plan, or drug plan coverage. Part A does have a deductible, an amount a person must pay for health care or prescriptions before the health plan will pay. A person must pay a daily amount for hospital stays that last longer than 60 days. - Part B (medical insurance) covers services from health care providers, outpatient care, home health care, durable medical equipment, and some preventative services. Part B has a monthly premium based on a persons income. Rates change each year. After a person pays the deductible each year, Part B pays 80 percent for most covered services as a primary payer. The billing staff of the service providerhospital or cliniccan calculate how much a person will owe. - Part C (Medicare Advantage Plans) are part of Medicare and are sometimes called MA Plans. Medicare must approve Medicare Advantage Plans. Each Medicare Advantage Plan must cover Part A and Part B services and may cover other services, too. Medicare Advantage Plans may have Part D prescription coverage. If not, a person can buy a Part D plan separately. Medicare Advantage Plans are not all the same. A person who is thinking of choosing a Medicare Advantage Plan should ask about the rules of the plan. The rules may specify which health care providers or hospitals a person may use. The plan may require a referral from a primary care provider to see a specialist. The plan may not cover medical expenses incurred during travel. How much a person has to pay out-of-pocket each year will vary by plan. People who have a Medicare Advantage Plan cannot have a Medigap plan to help pay out of-pocket costs. See the section on Medigap. Four types of Medicare Advantage Plans are available: - HMOs - preferred provider organizations (PPOs) - private fee for service plans - special needs plans for certain groups - Part D (prescription drug coverage) has a premium and covers some medications. Private insurance companies offer different Part D plans approved by Medicare. Costs and coverage vary by plan. A person who has few assets and earns less than 150 percent of the federal poverty level may qualify for extra help to pay Part D premiums and medication costs. People can apply for this help by calling the Social Security Administration, visiting www.socialsecurity.gov to apply online, visiting their local Social Security office, or contacting their state medical assistance (Medicaid) office. People can find the current-year guidelines at www.aspe.hhs.gov/poverty or by calling Social Security at 18007721213, TTY 18003250778. People can find information and applications for Part D plans at www.medicare.gov. A person can also apply for Part D with an insurance company that sells one of these plans.
Other Medicare health plans are for certain groups, such as frail people living in the community and people with multiple chronic illnesses, and include hospital and medical coverage. Some pay for prescribed medications, too. State health insurance programscalled Medicaidpartially finance and administer these services. The plans include the following:
- Medicare Cost Plans are HMOs, like the ones offered as Medicare Advantage plans, only out-of-network providers are paid as if the policyholder had Original Medicare. Original Medicare is Medicare Part A and Part B. - Program of All-Inclusive Care for the Elderly (PACE) combines medical, social, and long-term care services for frail people who live and get health care in the community. - Medicare Innovation Projects are special projects that test improvements in Medicare coverage, payment, and quality of care.
Read more about Medicare Cost Plans and Demonstration or Pilot Programs on the state Medicaid website at www.medicaid.gov or call 1800MEDICARE (18006334227). State Medicaid offices can provide more information about PACE. See the section on Medicaid.
Does Medicare cover diabetes services and supplies?
Medicare helps pay for the diabetes services, supplies, and equipment listed below and for some preventive services for people who are at risk for diabetes. However, coinsurance or deductibles may apply. A person must have Medicare Part B or Medicare Part D to receive these covered services and supplies.
Medicare Part B helps pay for
- diabetes screening tests for people at risk of developing diabetes - diabetes self-management training - diabetes supplies such as glucose monitors, test strips, and lancets - insulin pumps and insulin if used with an insulin pump - counseling to help people who are obese lose weight - flu and pneumonia shots - foot exams and treatment for people with diabetes - eye exams to check for glaucoma and diabetic retinopathy - medical nutrition therapy services for people with diabetes or kidney disease, when referred by a health care provider - therapeutic shoes or inserts, in some cases
Medicare Part D helps pay for
- diabetes medications - insulin, excluding insulin used with an insulin pump - diabetes supplies such as needles and syringes for injecting insulin
People who are in a Medicare Advantage Plan or other Medicare health plan should check their plans membership materials and call for details about how the plan provides the diabetes services, supplies, and medications covered by Medicare.
Read more at www.medicare.gov/publications/pubs/pdf/11022.pdf (PDF, 1,023 KB) or call 1800MEDICARE (18006334227) to request the free booklet Medicares Coverage of Diabetes Supplies & Services.
Where can a person find more information about Medicare?
A person can find more information about Medicare by
- visiting the Medicare website - calling 1800MEDICARE
Medicare website. Read more about Medicare at www.medicare.gov, the official U.S. Government website for people with Medicare. The website has a full range of information about Medicare, including free publications such as Medicare & You, which is the official Government handbook about Medicare, and Medicare BasicsA Guide for Families and Friends of People with Medicare.
Through the Medicare website, people can also
- find out if they are eligible for Medicare and when they can enroll - learn about their Medicare health plan options - find out what Medicare covers - find a Medicare Prescription Drug Plan - compare Medicare health plan options in their area - find a health care provider who participates in Medicare - get information about the quality of care provided by hospitals, home health agencies, and dialysis facilities
Calling Medicare. Calling 1800MEDICARE (18006334227) is another way to get help with Medicare questions, order free publications, and more. Help is available 24 hours a day, every day, and is available in English, Spanish, and other languages. TTY users should call 18774862048.
Access Personal Medicare Information People who enroll in Medicare can register with www.MyMedicare.gov, a secure online service, and use the site to access their personal Medicare information at any time. People can view their claims and order history, and see a description of covered preventive services.
What is Medigap?
A Medigap plan, also known as a Medicare supplement plan, can help pay what Original Medicare does not pay for covered services. Insurance companies sell Medigap coverage. People who have a Medicare Advantage plan cannot also have a Medigap plan. A person can buy a Medigap policy from any insurance company licensed to sell the policy in the persons home state.
For people who are 65 and older, federal law says that in the first 6 months a person has Part B, companies cannot deny an application or limit payment for anything Original Medicare covers. Some states make insurance companies sell at least one Medigap coverage plan to those under 65 with Medicare. State insurance offices can explain the plans in their state. Find local offices on a map at www.naic.org/state_web_map.htm . |
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| What is (are) Financial Help for Diabetes Care ? | People who enroll in Medicare can register with www.MyMedicare.gov, a secure online service, and use the site to access their personal Medicare information at any time. People can view their claims and order history, and see a description of covered preventive services. |
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| What is (are) Financial Help for Diabetes Care ? | Medicaid is a state health insurance program for those with low incomes and few assets. Each state runs its own program. The Federal Government requires that Medicaid programs cover a specific set of services; however, states can choose to cover more services in addition to the ones required. A person may have Medicaid alone or Medicare and Medicaid. If a person has both types of coverage, Medicare pays first and Medicaid pays second. Medicaid may pay for things Medicare does not. A person can apply for Medicaid at a city or county department of social services office. The state medical assistance (Medicaid) office can help people find out whether they qualify for Medicaid and can provide more information about Medicaid programs. A social worker can also explain a states Medicaid program and help a person apply.
To contact a state Medicaid office, people can
- search for Medicaid information for a state at www.medicaid.gov or call 18772672323 - search online or check the government pages of the phone book for the local department of human services or department of social services
CHIP gives free or low-cost Medicaid to children whose parents earn too much for Medicaid, though not enough to pay for a health plan. CHIP may also provide assistance to parents. CHIP is a federal and state program. Read more at www.insurekidsnow.gov or call 18775437669. |
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| What is (are) Financial Help for Diabetes Care ? | Assistive technology is any device that assists, adapts, or helps to rehabilitate someone with a disability so he or she may function more safely, effectively, and independently at home, at work, and in the community. Assistive technology may include
- computers with features that make them accessible to people with disabilities - adaptive equipment, such as wheelchairs - bathroom modifications, such as grab bars or shower seats
The following organizations may be able to provide information, awareness, and training in the use of technology to assist people with disabilities:
Alliance for Technology Access 1119 Old Humboldt Road Jackson, TN 38305 Phone: 18009143017 or 7315545ATA (7315545282) TTY: 7315545284 Fax: 7315545283 Email: atainfo@ataccess.org Internet: www.ataccess.org
National Assistive Technology Technical Assistance Partnership 1700 North Moore Street, Suite 1540 Arlington, VA 222091903 Phone: 7035246686 Fax: 7035246630 TTY: 7035246639 Email: resnaTA@resna.org Internet: www.resnaprojects.org/nattap
United Cerebral Palsy 1825 K Street NW, Suite 600 Washington, D.C. 20006 Phone: 18008725827 or 2027760406 Internet: www.ucp.org/resources/assistive-technology |
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| What to do for Financial Help for Diabetes Care ? | - Diabetes management and treatment is expensive. Many people who have diabetes need help paying for their care. For those who qualify, a variety of government and nongovernment programs can help cover health care expenses. - Health insurance helps pay for medical care, including the cost of diabetes care. Health insurance options include private health insurance and government health insurance. - Insurance companies sell private health insurance plans. Two types of private health insurance are group health insurance and individual health insurance. - Medicare is a federal health insurance program that pays health care costs for eligible people who are age 65 or older, under age 65 with certain disabilities, or of any age with end-stage renal disease. - Medicaid is a state health insurance program for those with low incomes and few assets. Each state runs its own program. - The Childrens Health Insurance Program (CHIP) gives free or low-cost Medicaid to children whose parents earn too much for Medicaid, though not enough to pay for a health plan. - Many local governments have public health departments that can help people who need medical care. Local resources such as charitable groups may offer financial help for some expenses related to diabetes. - People should talk with their health care providers if they have problems paying for diabetes medications. Less expensive generic medications for diabetes, blood pressure, and cholesterol are available. If a health care provider prescribes medications that a person cannot afford, the person should ask the health care provider about cheaper alternatives. - Health care providers may also be able to assist people who need help paying for their medications and diabetes testing supplies, such as glucose test strips, by providing free samples or referring them to local programs. Drug companies that sell insulin or diabetes medications often have patient assistance programs. |
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