Among the miscellaneous are the medications that affect the kidney such as the group called anti inflammatory medication (over the counter such as Ibuprofen, Motrin, Aleve, Advil, etc are in this group), intravenous iodine contrast used for CTs, certain antibiotics, cancer medications, etc. Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Covid-19 and Kidney Disease
Glomerulonephritis
Glomerulonephritis is an inflammation of the units that filters the blood in the kidneys. If glomerulonephritis occurs on its own, it’s known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it’s called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys.
Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis.
Signs and symptoms may include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
Fatigue from anemia or kidney failure
Treatment depends on the type of glomerulonephritis you haveThis inflammation can be caused by multiples causes such as lupus, vasculitis, hepatitis virus, HIV infection, problems that affect the bone marrow or the immune system itself, etc.
They present usually by blood and protein in the urine and high blood pressure and most of the time a kidney biopsy is required to make a correct diagnosis.
Drugs and kidney disease
Among the miscellaneous are the medications that affect the kidney such as the group called anti inflammatory medication (over the counter such as Ibuprofen, Motrin, Aleve, Advil, etc are in this group), intravenous iodine contrast used for CTs, certain antibiotics, cancer medications, etc. Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Covid-19 and Kidney Disease
Kidney Stones
Kidney stones
One of the most painful of the urologic disorders, have beset humans for centuries. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to health care providers and more than half a million people go to emergency rooms for kidney stone problems.
Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.
Introduction to the Urinary Tract
The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back, one on each side of the spine. The kidneys remove extra water and wastes from the blood, producing urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and form red blood cells.
Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine. They flatten together when urine is emptied out of the body through the urethra.
What is a Kidney Stone?
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.
Kidney stones in the kidney, ureter, and bladder.
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone-or ureterolithiasis-is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.
Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones.
Who gets kidney stones?
For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.
What causes Kidney Stones?
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.
A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.
In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.
Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.
Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.
Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.
Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.
What are the Symptoms of Kidney Stones?
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.
How are Kidney Stones Diagnosed?
Sometimes “silent” stones-those that do not cause symptoms-are found on x rays taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.
The doctor may decide to scan the urinary system using a special test called a computerized tomography (CT) scan or an intravenous pyelogram (IVP). The results of all these tests help determine the proper treatment.
How are kidney stones treated?
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water-2 to 3 quarts a day-to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.
Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids-water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.
In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones.
Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.
To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night.
Medical Therapy
A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.
Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.
Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine.
If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as Thiola and Cuprimine, which help reduce the amount of cystine in the urine.
For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.
If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.
People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.
Surgical Treatment
Surgery may be needed to remove a kidney stone if it
does not pass after a reasonable period of time and causes constant pain
is too large to pass on its own or is caught in a difficult place
blocks the flow of urine
causes an ongoing urinary tract infection
damages kidney tissue or causes constant bleeding
has grown larger, as seen on follow-up x rays
Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.
Extracorporeal Shock Wave Lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Several types of ESWL devices exist. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.
In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities in a few days.
Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves can occur. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment.
Sometimes, the shattered stone particles cause minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.
As with any interventional, surgical procedure, potential risks and complications should be discussed with the doctor before making a treatment decision.
Percutaneous Nephrolithotomy Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.
In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe-ultrasonic or electrohydraulic-may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.
One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.
Ureteroscopic Stone Removal Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar “blind basket” extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.
Glomerulonephritis
Glomerulonephritis is an inflammation of the units that filters the blood in the kidneys. If glomerulonephritis occurs on its own, it’s known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it’s called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys.
Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis.
Signs and symptoms may include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
Fatigue from anemia or kidney failure
Treatment depends on the type of glomerulonephritis you haveThis inflammation can be caused by multiples causes such as lupus, vasculitis, hepatitis virus, HIV infection, problems that affect the bone marrow or the immune system itself, etc.
They present usually by blood and protein in the urine and high blood pressure and most of the time a kidney biopsy is required to make a correct diagnosis.
Drugs and kidney disease
Among the miscellaneous are the medications that affect the kidney such as the group called anti inflammatory medication (over the counter such as Ibuprofen, Motrin, Aleve, Advil, etc are in this group), intravenous iodine contrast used for CTs, certain antibiotics, cancer medications, etc. Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Covid-19 and Kidney Disease
Cystic kidney disease
Inherited and Congenital Kidney cystic Diseases
Some kidney diseases result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure. Some kidney problems may show up when a child is still developing in the womb. Examples include autosomal recessive PKD, a rare form of PKD, and other developmental problems that interfere with the normal formation of the nephrons.
Acquired cystic kidney disease (ACKD)
Many people with chronic kidney disease develop ACKD, a condition in which the kidneys develop fluid-filled sacs called renal (kidney) cysts. ACKD occurs in children and adults. The cysts are more likely to develop in people who are on hemodialysis or peritoneal dialysis. Kidney failure, not dialysis, causes the cysts. However, the risk of developing ACKD increases with the number of years a person is on dialysis.
About 20 percent of people starting dialysis treatments already have ACKD. About 60 to 80 percent of people on dialysis for 4 years develop ACKD. About 90 percent of people on dialysis for 8 years develop ACKD.
In ACKD, the kidneys develop fluid-filled sacs called cysts.
In most cases, the cysts are harmless and require no treatment. Sometimes problems occur-including infection in the cyst, which may be associated with fever and back pain. Sometimes the cysts bleed and blood will appear in the urine. Blood in the urine should always be reported to a doctor.
Although doctors debate the exact percentage, somewhere between 10 and 20 percent of people with ACKD develop kidney tumors, which in some cases are cancerous. The rate of kidney cancer in people with ACKD is low, but it is higher than the rate in the general population.
What are the symptoms of ACKD?
ACKD often has no symptoms. If a cyst becomes infected, a person may have back pain, fever, or even chills. If a cyst bleeds, a person will often notice blood in the urine.
How does ACKD differ from polycystic kidney disease (PKD)?
ACKD differs from PKD in several ways. People with PKD often have a family history of PKD. They are born with the disease-causing gene. No disease-causing gene is associated with ACKD. PKD is associated with enlarged kidneys and cyst formation in other parts of the body. In ACKD, the kidneys are normal sized or smaller and cysts do not occur in other parts of the body. In PKD, the presence of cysts marks the onset of disease. People with ACKD already have chronic kidney disease when they develop cysts.
How kidney cystic disease is diagnosed?
A doctor may suspect kidney cystic disease based on a patient’s history and symptoms. To confirm the diagnosis, the doctor may order one or more imaging procedures:
Ultrasound. In an ultrasound, or sonogram, a technician glides a device, called a transducer, over the abdomen. The transducer sends harmless sound waves into the body and catches them as they bounce off the internal organs to create a picture on a monitor. Abdominal ultrasounds are used to evaluate the size and shape of the kidneys.
Computerized tomography (CT) scans. CT scans use a combination of x-rays and computer technology to create three-dimensional images. Sometimes a contrast dye is injected into the patient to better see the structure of the kidneys. CT scans require the patient to lie on a table that slides through a donut-shaped scanning machine. CT scans can help identify cysts and tumors in the kidneys.
Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of internal organs and tissues. No exposure to radiation occurs. With most MRI machines, the patient lies on a table that slides into a tunnel that may be open-ended or closed at one end. Some newer machines are designed to allow the patient to lie in a more open space. Like CT scans, MRIs can help identify cysts and tumors.
Images of the Kidneys may help the health care provider distinguish ACKD from PKD.
How is kidney cystic disease treated?
If ACKD is not causing pain or discomfort, no treatment is required. Infections are treated with a course of antibiotics. If large cysts are causing pain, they may be drained using a long needle inserted through the skin.
Kidney doctors usually follow cysts regularly with imaging testing. If tumors are suspected, a person may need regular examinations to monitor the kidneys for cancer. Some doctors recommend all patients be screened for kidney cancer after 3 years of dialysis. In rare cases, surgery is used to stop cysts from bleeding and to remove tumors or suspected tumors.
For patients with PKD, newer medications that will decrease the cyst growth are being investigated. Measures that are thought to decrease cyst growth are to increase daily water intake, diet with low animal protein content and rich on fruits and vegetables.
Kidney Stones
Kidney stones
One of the most painful of the urologic disorders, have beset humans for centuries. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to health care providers and more than half a million people go to emergency rooms for kidney stone problems.
Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.
Introduction to the Urinary Tract
The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back, one on each side of the spine. The kidneys remove extra water and wastes from the blood, producing urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and form red blood cells.
Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine. They flatten together when urine is emptied out of the body through the urethra.
What is a Kidney Stone?
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.
Kidney stones in the kidney, ureter, and bladder.
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone-or ureterolithiasis-is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.
Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones.
Who gets kidney stones?
For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.
What causes Kidney Stones?
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.
A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.
In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.
Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.
Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.
Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.
Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.
What are the Symptoms of Kidney Stones?
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.
How are Kidney Stones Diagnosed?
Sometimes “silent” stones-those that do not cause symptoms-are found on x rays taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.
The doctor may decide to scan the urinary system using a special test called a computerized tomography (CT) scan or an intravenous pyelogram (IVP). The results of all these tests help determine the proper treatment.
How are kidney stones treated?
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water-2 to 3 quarts a day-to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.
Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids-water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.
In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones.
Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.
To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night.
Medical Therapy
A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.
Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.
Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine.
If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as Thiola and Cuprimine, which help reduce the amount of cystine in the urine.
For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.
If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.
People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.
Surgical Treatment
Surgery may be needed to remove a kidney stone if it
does not pass after a reasonable period of time and causes constant pain
is too large to pass on its own or is caught in a difficult place
blocks the flow of urine
causes an ongoing urinary tract infection
damages kidney tissue or causes constant bleeding
has grown larger, as seen on follow-up x rays
Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.
Extracorporeal Shock Wave Lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Several types of ESWL devices exist. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.
In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities in a few days.
Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves can occur. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment.
Sometimes, the shattered stone particles cause minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.
As with any interventional, surgical procedure, potential risks and complications should be discussed with the doctor before making a treatment decision.
Percutaneous Nephrolithotomy Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.
In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe-ultrasonic or electrohydraulic-may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.
One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.
Ureteroscopic Stone Removal Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar “blind basket” extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.
Glomerulonephritis
Glomerulonephritis is an inflammation of the units that filters the blood in the kidneys. If glomerulonephritis occurs on its own, it’s known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it’s called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys.
Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis.
Signs and symptoms may include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
Fatigue from anemia or kidney failure
Treatment depends on the type of glomerulonephritis you haveThis inflammation can be caused by multiples causes such as lupus, vasculitis, hepatitis virus, HIV infection, problems that affect the bone marrow or the immune system itself, etc.
They present usually by blood and protein in the urine and high blood pressure and most of the time a kidney biopsy is required to make a correct diagnosis.
Drugs and kidney disease
Among the miscellaneous are the medications that affect the kidney such as the group called anti inflammatory medication (over the counter such as Ibuprofen, Motrin, Aleve, Advil, etc are in this group), intravenous iodine contrast used for CTs, certain antibiotics, cancer medications, etc. Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Covid-19 and Kidney Disease
Hypertensive Kidney Disease
High blood pressure can damage the small blood vessels in the kidneys. The damaged vessels cannot filter wastes from the blood as they are supposed to.
A doctor may prescribe blood pressure medication. ACE inhibitors and ARBs have been found to protect the kidneys even more than other medicines that lower blood pressure to similar levels.
The National Heart, Lung and Blood Institute (NHLBI), one of the National Institutes of Health, recommends that people with diabetes or reduced kidney function keep their blood pressure below 130/80.
Older patients blood pressure are usually allowed to have higher readings like 120/70 to 150/90.
Cystic kidney disease
Inherited and Congenital Kidney cystic Diseases
Some kidney diseases result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure. Some kidney problems may show up when a child is still developing in the womb. Examples include autosomal recessive PKD, a rare form of PKD, and other developmental problems that interfere with the normal formation of the nephrons.
Acquired cystic kidney disease (ACKD)
Many people with chronic kidney disease develop ACKD, a condition in which the kidneys develop fluid-filled sacs called renal (kidney) cysts. ACKD occurs in children and adults. The cysts are more likely to develop in people who are on hemodialysis or peritoneal dialysis. Kidney failure, not dialysis, causes the cysts. However, the risk of developing ACKD increases with the number of years a person is on dialysis.
About 20 percent of people starting dialysis treatments already have ACKD. About 60 to 80 percent of people on dialysis for 4 years develop ACKD. About 90 percent of people on dialysis for 8 years develop ACKD.
In ACKD, the kidneys develop fluid-filled sacs called cysts.
In most cases, the cysts are harmless and require no treatment. Sometimes problems occur-including infection in the cyst, which may be associated with fever and back pain. Sometimes the cysts bleed and blood will appear in the urine. Blood in the urine should always be reported to a doctor.
Although doctors debate the exact percentage, somewhere between 10 and 20 percent of people with ACKD develop kidney tumors, which in some cases are cancerous. The rate of kidney cancer in people with ACKD is low, but it is higher than the rate in the general population.
What are the symptoms of ACKD?
ACKD often has no symptoms. If a cyst becomes infected, a person may have back pain, fever, or even chills. If a cyst bleeds, a person will often notice blood in the urine.
How does ACKD differ from polycystic kidney disease (PKD)?
ACKD differs from PKD in several ways. People with PKD often have a family history of PKD. They are born with the disease-causing gene. No disease-causing gene is associated with ACKD. PKD is associated with enlarged kidneys and cyst formation in other parts of the body. In ACKD, the kidneys are normal sized or smaller and cysts do not occur in other parts of the body. In PKD, the presence of cysts marks the onset of disease. People with ACKD already have chronic kidney disease when they develop cysts.
How kidney cystic disease is diagnosed?
A doctor may suspect kidney cystic disease based on a patient’s history and symptoms. To confirm the diagnosis, the doctor may order one or more imaging procedures:
Ultrasound. In an ultrasound, or sonogram, a technician glides a device, called a transducer, over the abdomen. The transducer sends harmless sound waves into the body and catches them as they bounce off the internal organs to create a picture on a monitor. Abdominal ultrasounds are used to evaluate the size and shape of the kidneys.
Computerized tomography (CT) scans. CT scans use a combination of x-rays and computer technology to create three-dimensional images. Sometimes a contrast dye is injected into the patient to better see the structure of the kidneys. CT scans require the patient to lie on a table that slides through a donut-shaped scanning machine. CT scans can help identify cysts and tumors in the kidneys.
Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of internal organs and tissues. No exposure to radiation occurs. With most MRI machines, the patient lies on a table that slides into a tunnel that may be open-ended or closed at one end. Some newer machines are designed to allow the patient to lie in a more open space. Like CT scans, MRIs can help identify cysts and tumors.
Images of the Kidneys may help the health care provider distinguish ACKD from PKD.
How is kidney cystic disease treated?
If ACKD is not causing pain or discomfort, no treatment is required. Infections are treated with a course of antibiotics. If large cysts are causing pain, they may be drained using a long needle inserted through the skin.
Kidney doctors usually follow cysts regularly with imaging testing. If tumors are suspected, a person may need regular examinations to monitor the kidneys for cancer. Some doctors recommend all patients be screened for kidney cancer after 3 years of dialysis. In rare cases, surgery is used to stop cysts from bleeding and to remove tumors or suspected tumors.
For patients with PKD, newer medications that will decrease the cyst growth are being investigated. Measures that are thought to decrease cyst growth are to increase daily water intake, diet with low animal protein content and rich on fruits and vegetables.
Kidney Stones
Kidney stones
One of the most painful of the urologic disorders, have beset humans for centuries. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to health care providers and more than half a million people go to emergency rooms for kidney stone problems.
Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.
Introduction to the Urinary Tract
The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back, one on each side of the spine. The kidneys remove extra water and wastes from the blood, producing urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and form red blood cells.
Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine. They flatten together when urine is emptied out of the body through the urethra.
What is a Kidney Stone?
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.
Kidney stones in the kidney, ureter, and bladder.
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone-or ureterolithiasis-is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.
Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones.
Who gets kidney stones?
For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.
What causes Kidney Stones?
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.
A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.
In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.
Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.
Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.
Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.
Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.
What are the Symptoms of Kidney Stones?
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.
How are Kidney Stones Diagnosed?
Sometimes “silent” stones-those that do not cause symptoms-are found on x rays taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.
The doctor may decide to scan the urinary system using a special test called a computerized tomography (CT) scan or an intravenous pyelogram (IVP). The results of all these tests help determine the proper treatment.
How are kidney stones treated?
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water-2 to 3 quarts a day-to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.
Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids-water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.
In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones.
Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.
To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night.
Medical Therapy
A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.
Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.
Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine.
If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as Thiola and Cuprimine, which help reduce the amount of cystine in the urine.
For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.
If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.
People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.
Surgical Treatment
Surgery may be needed to remove a kidney stone if it
does not pass after a reasonable period of time and causes constant pain
is too large to pass on its own or is caught in a difficult place
blocks the flow of urine
causes an ongoing urinary tract infection
damages kidney tissue or causes constant bleeding
has grown larger, as seen on follow-up x rays
Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.
Extracorporeal Shock Wave Lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Several types of ESWL devices exist. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.
In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities in a few days.
Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves can occur. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment.
Sometimes, the shattered stone particles cause minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.
As with any interventional, surgical procedure, potential risks and complications should be discussed with the doctor before making a treatment decision.
Percutaneous Nephrolithotomy Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.
In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe-ultrasonic or electrohydraulic-may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.
One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.
Ureteroscopic Stone Removal Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar “blind basket” extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.
Glomerulonephritis
Glomerulonephritis is an inflammation of the units that filters the blood in the kidneys. If glomerulonephritis occurs on its own, it’s known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it’s called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys.
Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis.
Signs and symptoms may include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
Fatigue from anemia or kidney failure
Treatment depends on the type of glomerulonephritis you haveThis inflammation can be caused by multiples causes such as lupus, vasculitis, hepatitis virus, HIV infection, problems that affect the bone marrow or the immune system itself, etc.
They present usually by blood and protein in the urine and high blood pressure and most of the time a kidney biopsy is required to make a correct diagnosis.
Drugs and kidney disease
Among the miscellaneous are the medications that affect the kidney such as the group called anti inflammatory medication (over the counter such as Ibuprofen, Motrin, Aleve, Advil, etc are in this group), intravenous iodine contrast used for CTs, certain antibiotics, cancer medications, etc. Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Covid-19 and Kidney Disease
I have diabetes. Will I develop kidney disease?
About one third of people with diabetes will get chronic kidney disease (about 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes. There are several factors that can increase your risk of developing diabetic kidney disease. These include:
Having chronically elevated blood sugar levels
Having high blood pressure
Being overweight or obese
Smoking
Having a diabetes-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy)
Having a family history of kidney disease or belonging to certain ethnic groups (eg, African American, Mexican, Pima Indian) can also increase your risk of diabetic nephropathy, but the factors listed above are the ones you can do something about. Many people with diabetes do not get kidney disease or kidney failure. Talk to your doctor about your chances of developing kidney disease.
How can I prevent diabetes from affecting my kidneys?
The best way to prevent kidney disease caused by diabetes is to:
Control your blood sugar level.
Keep blood pressure under control.
Check your blood pressure as often as your doctor recommends.
Ask your doctor to test you for kidney disease at least once each year.
Take medicines to help control your blood glucose, cholesterol, and blood pressure if your doctor orders them for you.
Follow your diet for diabetes.
Get regular exercise.
What are the early signs of kidney disease in patients with diabetes?
Diabetic nephropathy usually has no symptoms, and people who have the condition often produce normal amounts of urine. To detect diabetic nephropathy, healthcare providers rely on tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function. When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine is a sign that the kidneys are in trouble. The main protein that leaks out from the damaged kidneys is called albumin. In normal healthy kidneys only a tiny amount of albumin is found in the urine. A raised level of albumin in the urine is the typical first sign that the kidneys have been damaged. Often people who have diabetic nephropathy also have high blood pressure.
What are the late signs of kidney disease in patients with diabetes?
The key complication of diabetic nephropathy is more advanced kidney disease, called chronic kidney disease. Further progression of this disease will eventually lead to total kidney failure. As your kidneys fail, the waste product levels will rise in your blood (blood urea nitrogen, known as BUN (BUN) and creatinine). You may start having nausea, vomiting, loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in your legs) and anemia (a low blood count). You may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin.
How do I know if I have diabetic kidney damage?
Urine tests are recommended once per year in people with Type 1 diabetes, beginning about five years after diagnosis, and in people with Type 2 diabetes, starting at the time of diagnosis. The urine test is looking for the protein (albumin). If there is albumin in your urine, it means you have diabetic nephropathy. The same urine test that is used to diagnose diabetic nephropathy will also be used to monitor your condition over time.
What will happen if my kidneys have been damaged?
Finding out that you have early diabetic kidney disease can alert you that your kidneys are in danger. It is important to take steps to protect your kidneys before the problem advances.
People with diabetes often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That’s because high blood sugar and high blood pressure work together to damage the blood vessels and organ systems. For these reasons, the most important things you can do to stop kidney disease and protect against other diabetes complications are to:
Keep your blood sugar as close to normal as possible.
Keep your blood pressure well-controlled.
Make healthy lifestyle choices.
Manage blood sugar: Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL. A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 percent or less is usually recommended.
Manage high blood pressure: Many people with diabetes have high blood pressure. Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye.
The treatment of high blood pressure varies. If you have mild hypertension, your healthcare provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal. If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several medications.
A blood pressure reading below 130/80 is the recommended goal for most people with diabetic kidney disease.
Blood pressure medications: Most people with diabetic nephropathy need at least one medication to lower their blood pressure. Several medications can be used for this purpose, but an angiotensin-converting enzyme inhibitor (ACE inhibitor) or a related drug known as an angiotensin receptor blocker (ARB) is used most commonly. ACE inhibitors and ARBs are particularly useful for people with diabetic nephropathy because they decrease the amount of protein in the urine and can prevent or slow the progression of kidney disease.
Lifestyle changes: Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have kidney damage from diabetes:
Limit the amount of salt you eat.
If you smoke, quit.
Lose weight if you are overweight.
Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications).
Monitor for signs of change: After beginning treatment and lifestyle changes to stop kidney disease, you will need to have repeat urine and blood tests to determine if urine protein levels have improved. If they have not improved or your kidney function has worsened, your healthcare provider may need to adjust your medications or recommend other strategies to protect your kidneys.
How are the kidneys kept working as long as possible?
The kidney doctor, called a nephrologist, will plan your treatment with you, your family and your dietitian. Two things to keep in mind for keeping your kidneys healthy are controlling high blood pressure in conjunction with an ACE inhibitor or an ARB, and following your renal diabetic diet. Restricting protein in your diet also might be helpful. You and your dietitian can plan your diet together.
Are there any new medications for patients with diabetic kidney disease?
Research efforts are under way and are focused on to delaying diabetic kidney disease progression. These medications are being tested for patients with protein in the urine due to diabetes. Renal Medicine Associates is working with pharmaceutical companies that are testing some of these new medications. Ask your kidney doctor if you may qualify for any of the ongoing studies.
What is end stage kidney failure in patients with diabetes?
End stage renal failure, or kidney failure, occurs when your kidneys are no longer able to support you in a reasonably healthy state. This happens when your kidneys function at only 10 to 15 percent.
How is end stage kidney failure treated in diabetic patients?
Three types of treatment can be used once your kidneys have failed: kidney transplantation, hemodialysis and peritoneal dialysis. To learn more about treatment options talk to your kidney doctor.
What is the future outlook for patients with diabetes?
Today, more and more research dollars are spent on diabetes research. Hopefully, the prevention and cure of diabetes is in our future. In the meantime, you can manage your diabetes better with:
Home monitoring of your blood glucose levels
Maintaining an awareness of controlling your blood pressure and possibly monitoring your pressure at home
Following your special diet and changing your life style
Ask your primary doctor about testing for common target affected organs ( eyes, heart, kidney, feet, etc)
Hypertensive Kidney Disease
High blood pressure can damage the small blood vessels in the kidneys. The damaged vessels cannot filter wastes from the blood as they are supposed to.
A doctor may prescribe blood pressure medication. ACE inhibitors and ARBs have been found to protect the kidneys even more than other medicines that lower blood pressure to similar levels.
The National Heart, Lung and Blood Institute (NHLBI), one of the National Institutes of Health, recommends that people with diabetes or reduced kidney function keep their blood pressure below 130/80.
Older patients blood pressure are usually allowed to have higher readings like 120/70 to 150/90.
Cystic kidney disease
Inherited and Congenital Kidney cystic Diseases
Some kidney diseases result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure. Some kidney problems may show up when a child is still developing in the womb. Examples include autosomal recessive PKD, a rare form of PKD, and other developmental problems that interfere with the normal formation of the nephrons.
Acquired cystic kidney disease (ACKD)
Many people with chronic kidney disease develop ACKD, a condition in which the kidneys develop fluid-filled sacs called renal (kidney) cysts. ACKD occurs in children and adults. The cysts are more likely to develop in people who are on hemodialysis or peritoneal dialysis. Kidney failure, not dialysis, causes the cysts. However, the risk of developing ACKD increases with the number of years a person is on dialysis.
About 20 percent of people starting dialysis treatments already have ACKD. About 60 to 80 percent of people on dialysis for 4 years develop ACKD. About 90 percent of people on dialysis for 8 years develop ACKD.
In ACKD, the kidneys develop fluid-filled sacs called cysts.
In most cases, the cysts are harmless and require no treatment. Sometimes problems occur-including infection in the cyst, which may be associated with fever and back pain. Sometimes the cysts bleed and blood will appear in the urine. Blood in the urine should always be reported to a doctor.
Although doctors debate the exact percentage, somewhere between 10 and 20 percent of people with ACKD develop kidney tumors, which in some cases are cancerous. The rate of kidney cancer in people with ACKD is low, but it is higher than the rate in the general population.
What are the symptoms of ACKD?
ACKD often has no symptoms. If a cyst becomes infected, a person may have back pain, fever, or even chills. If a cyst bleeds, a person will often notice blood in the urine.
How does ACKD differ from polycystic kidney disease (PKD)?
ACKD differs from PKD in several ways. People with PKD often have a family history of PKD. They are born with the disease-causing gene. No disease-causing gene is associated with ACKD. PKD is associated with enlarged kidneys and cyst formation in other parts of the body. In ACKD, the kidneys are normal sized or smaller and cysts do not occur in other parts of the body. In PKD, the presence of cysts marks the onset of disease. People with ACKD already have chronic kidney disease when they develop cysts.
How kidney cystic disease is diagnosed?
A doctor may suspect kidney cystic disease based on a patient’s history and symptoms. To confirm the diagnosis, the doctor may order one or more imaging procedures:
Ultrasound. In an ultrasound, or sonogram, a technician glides a device, called a transducer, over the abdomen. The transducer sends harmless sound waves into the body and catches them as they bounce off the internal organs to create a picture on a monitor. Abdominal ultrasounds are used to evaluate the size and shape of the kidneys.
Computerized tomography (CT) scans. CT scans use a combination of x-rays and computer technology to create three-dimensional images. Sometimes a contrast dye is injected into the patient to better see the structure of the kidneys. CT scans require the patient to lie on a table that slides through a donut-shaped scanning machine. CT scans can help identify cysts and tumors in the kidneys.
Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of internal organs and tissues. No exposure to radiation occurs. With most MRI machines, the patient lies on a table that slides into a tunnel that may be open-ended or closed at one end. Some newer machines are designed to allow the patient to lie in a more open space. Like CT scans, MRIs can help identify cysts and tumors.
Images of the Kidneys may help the health care provider distinguish ACKD from PKD.
How is kidney cystic disease treated?
If ACKD is not causing pain or discomfort, no treatment is required. Infections are treated with a course of antibiotics. If large cysts are causing pain, they may be drained using a long needle inserted through the skin.
Kidney doctors usually follow cysts regularly with imaging testing. If tumors are suspected, a person may need regular examinations to monitor the kidneys for cancer. Some doctors recommend all patients be screened for kidney cancer after 3 years of dialysis. In rare cases, surgery is used to stop cysts from bleeding and to remove tumors or suspected tumors.
For patients with PKD, newer medications that will decrease the cyst growth are being investigated. Measures that are thought to decrease cyst growth are to increase daily water intake, diet with low animal protein content and rich on fruits and vegetables.
Kidney Stones
Kidney stones
One of the most painful of the urologic disorders, have beset humans for centuries. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to health care providers and more than half a million people go to emergency rooms for kidney stone problems.
Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.
Introduction to the Urinary Tract
The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back, one on each side of the spine. The kidneys remove extra water and wastes from the blood, producing urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and form red blood cells.
Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine. They flatten together when urine is emptied out of the body through the urethra.
What is a Kidney Stone?
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.
Kidney stones in the kidney, ureter, and bladder.
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone-or ureterolithiasis-is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.
Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones.
Who gets kidney stones?
For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.
What causes Kidney Stones?
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.
A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.
In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.
Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.
Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.
Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.
Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.
What are the Symptoms of Kidney Stones?
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.
How are Kidney Stones Diagnosed?
Sometimes “silent” stones-those that do not cause symptoms-are found on x rays taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.
The doctor may decide to scan the urinary system using a special test called a computerized tomography (CT) scan or an intravenous pyelogram (IVP). The results of all these tests help determine the proper treatment.
How are kidney stones treated?
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water-2 to 3 quarts a day-to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.
Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids-water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.
In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones.
Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.
To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night.
Medical Therapy
A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.
Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.
Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine.
If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as Thiola and Cuprimine, which help reduce the amount of cystine in the urine.
For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.
If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.
People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.
Surgical Treatment
Surgery may be needed to remove a kidney stone if it
does not pass after a reasonable period of time and causes constant pain
is too large to pass on its own or is caught in a difficult place
blocks the flow of urine
causes an ongoing urinary tract infection
damages kidney tissue or causes constant bleeding
has grown larger, as seen on follow-up x rays
Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.
Extracorporeal Shock Wave Lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Several types of ESWL devices exist. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.
In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities in a few days.
Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves can occur. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment.
Sometimes, the shattered stone particles cause minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.
As with any interventional, surgical procedure, potential risks and complications should be discussed with the doctor before making a treatment decision.
Percutaneous Nephrolithotomy Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.
In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe-ultrasonic or electrohydraulic-may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.
One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.
Ureteroscopic Stone Removal Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar “blind basket” extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.
Glomerulonephritis
Glomerulonephritis is an inflammation of the units that filters the blood in the kidneys. If glomerulonephritis occurs on its own, it’s known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it’s called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys.
Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis.
Signs and symptoms may include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
Fatigue from anemia or kidney failure
Treatment depends on the type of glomerulonephritis you haveThis inflammation can be caused by multiples causes such as lupus, vasculitis, hepatitis virus, HIV infection, problems that affect the bone marrow or the immune system itself, etc.
They present usually by blood and protein in the urine and high blood pressure and most of the time a kidney biopsy is required to make a correct diagnosis.
Drugs and kidney disease
Among the miscellaneous are the medications that affect the kidney such as the group called anti inflammatory medication (over the counter such as Ibuprofen, Motrin, Aleve, Advil, etc are in this group), intravenous iodine contrast used for CTs, certain antibiotics, cancer medications, etc. Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Covid-19 and Kidney Disease
Diabetes is a disease that keeps the body from using glucose, a form of sugar, as it should. If glucose stays in the blood instead of breaking down, it can act like a poison. Damage to the nephrons from unused glucose in the blood is called diabetic kidney disease. Keeping blood glucose levels down can delay or prevent diabetic kidney disease.
Use of medications called angiotensin- converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) to treat high blood pressure can also slow or delay the progression of diabetic kidney disease.
Diabetes and the kidneys
Diabetes mellitus is a disease and occurs when your body does not make enough insulin or cannot use normal amounts of it properly. Insulin is a hormone that regulates the amount of sugar in your blood. When diabetes is not well-controlled, the sugar level in your blood goes up. High blood sugar can cause damage to many parts of your body, especially the kidneys, heart, blood vessels, eyes, feet and nerves.
What is diabetic kidney disease?
Diabetes is a leading cause of kidney damage. The kidneys play an important role in the body: they filter the blood, removing waste products and excess salt and water. Diabetic kidney disease (diabetic nephropathy) is a complication that occurs in some people with diabetes. In this condition the filters of the kidneys become damaged. With diabetes, the small blood vessels in the body are injured. which hinders your kidneys from cleaning your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may “leak” protein in your urine. Also, waste materials will build up in your blood. In some cases, diabetic kidney disease can eventually cause the kidneys to stop working altogether. If that happens to you, you will need to have a kidney transplant or dialysis, a procedure that filters the blood artificially several times a week.
I have diabetes. Will I develop kidney disease?
About one third of people with diabetes will get chronic kidney disease (about 30 percent of patients with Type 1 (juvenile onset) diabetes and 10 to 40 percent of those with Type 2 (adult onset) diabetes. There are several factors that can increase your risk of developing diabetic kidney disease. These include:
Having chronically elevated blood sugar levels
Having high blood pressure
Being overweight or obese
Smoking
Having a diabetes-related vision problem (diabetic retinopathy) or nerve damage (diabetic neuropathy)
Having a family history of kidney disease or belonging to certain ethnic groups (eg, African American, Mexican, Pima Indian) can also increase your risk of diabetic nephropathy, but the factors listed above are the ones you can do something about. Many people with diabetes do not get kidney disease or kidney failure. Talk to your doctor about your chances of developing kidney disease.
How can I prevent diabetes from affecting my kidneys?
The best way to prevent kidney disease caused by diabetes is to:
Control your blood sugar level.
Keep blood pressure under control.
Check your blood pressure as often as your doctor recommends.
Ask your doctor to test you for kidney disease at least once each year.
Take medicines to help control your blood glucose, cholesterol, and blood pressure if your doctor orders them for you.
Follow your diet for diabetes.
Get regular exercise.
What are the early signs of kidney disease in patients with diabetes?
Diabetic nephropathy usually has no symptoms, and people who have the condition often produce normal amounts of urine. To detect diabetic nephropathy, healthcare providers rely on tests that measure protein levels in the urine and blood tests to evaluate the level of kidney function. When the kidneys are working normally, they prevent protein from leaking into the urine, so finding protein in the urine is a sign that the kidneys are in trouble. The main protein that leaks out from the damaged kidneys is called albumin. In normal healthy kidneys only a tiny amount of albumin is found in the urine. A raised level of albumin in the urine is the typical first sign that the kidneys have been damaged. Often people who have diabetic nephropathy also have high blood pressure.
What are the late signs of kidney disease in patients with diabetes?
The key complication of diabetic nephropathy is more advanced kidney disease, called chronic kidney disease. Further progression of this disease will eventually lead to total kidney failure. As your kidneys fail, the waste product levels will rise in your blood (blood urea nitrogen, known as BUN (BUN) and creatinine). You may start having nausea, vomiting, loss of appetite, weakness, increasing fatigue, itching, muscle cramps (especially in your legs) and anemia (a low blood count). You may find you need less insulin. This is because diseased kidneys cause less breakdown of insulin.
How do I know if I have diabetic kidney damage?
Urine tests are recommended once per year in people with Type 1 diabetes, beginning about five years after diagnosis, and in people with Type 2 diabetes, starting at the time of diagnosis. The urine test is looking for the protein (albumin). If there is albumin in your urine, it means you have diabetic nephropathy. The same urine test that is used to diagnose diabetic nephropathy will also be used to monitor your condition over time.
What will happen if my kidneys have been damaged?
Finding out that you have early diabetic kidney disease can alert you that your kidneys are in danger. It is important to take steps to protect your kidneys before the problem advances.
People with diabetes often focus on keeping their blood sugar levels in the right ranges. And while it is important to control blood sugar, it turns out that controlling blood pressure is at least as important. That’s because high blood sugar and high blood pressure work together to damage the blood vessels and organ systems. For these reasons, the most important things you can do to stop kidney disease and protect against other diabetes complications are to:
Keep your blood sugar as close to normal as possible.
Keep your blood pressure well-controlled.
Make healthy lifestyle choices.
Manage blood sugar: Keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. For most people, a target for fasting blood glucose and for blood glucose levels before each meal is 80 to 120 mg/dL. A blood test called A1C is also used to monitor blood sugar levels; the result provides an average of blood sugar levels over the last one to three months. An A1C of 7 percent or less is usually recommended.
Manage high blood pressure: Many people with diabetes have high blood pressure. Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye.
The treatment of high blood pressure varies. If you have mild hypertension, your healthcare provider may recommend weight loss, exercise, decreasing the amount of salt in the diet, quitting smoking, and decreasing alcohol intake. These measures can sometimes reduce blood pressure to normal. If these measures are not effective or your blood pressure needs to be lowered quickly, your provider will likely recommend one of several medications.
A blood pressure reading below 130/80 is the recommended goal for most people with diabetic kidney disease.
Blood pressure medications: Most people with diabetic nephropathy need at least one medication to lower their blood pressure. Several medications can be used for this purpose, but an angiotensin-converting enzyme inhibitor (ACE inhibitor) or a related drug known as an angiotensin receptor blocker (ARB) is used most commonly. ACE inhibitors and ARBs are particularly useful for people with diabetic nephropathy because they decrease the amount of protein in the urine and can prevent or slow the progression of kidney disease.
Lifestyle changes: Changing your lifestyle can have a big impact on the health of your kidneys. The following measures are recommended for everyone, but are especially important if you have kidney damage from diabetes:
Limit the amount of salt you eat.
If you smoke, quit.
Lose weight if you are overweight.
Avoid any medicines that may damage the kidneys (especially over-the-counter pain medications).
Monitor for signs of change: After beginning treatment and lifestyle changes to stop kidney disease, you will need to have repeat urine and blood tests to determine if urine protein levels have improved. If they have not improved or your kidney function has worsened, your healthcare provider may need to adjust your medications or recommend other strategies to protect your kidneys.
How are the kidneys kept working as long as possible?
The kidney doctor, called a nephrologist, will plan your treatment with you, your family and your dietitian. Two things to keep in mind for keeping your kidneys healthy are controlling high blood pressure in conjunction with an ACE inhibitor or an ARB, and following your renal diabetic diet. Restricting protein in your diet also might be helpful. You and your dietitian can plan your diet together.
Are there any new medications for patients with diabetic kidney disease?
Research efforts are under way and are focused on to delaying diabetic kidney disease progression. These medications are being tested for patients with protein in the urine due to diabetes. Renal Medicine Associates is working with pharmaceutical companies that are testing some of these new medications. Ask your kidney doctor if you may qualify for any of the ongoing studies.
What is end stage kidney failure in patients with diabetes?
End stage renal failure, or kidney failure, occurs when your kidneys are no longer able to support you in a reasonably healthy state. This happens when your kidneys function at only 10 to 15 percent.
How is end stage kidney failure treated in diabetic patients?
Three types of treatment can be used once your kidneys have failed: kidney transplantation, hemodialysis and peritoneal dialysis. To learn more about treatment options talk to your kidney doctor.
What is the future outlook for patients with diabetes?
Today, more and more research dollars are spent on diabetes research. Hopefully, the prevention and cure of diabetes is in our future. In the meantime, you can manage your diabetes better with:
Home monitoring of your blood glucose levels
Maintaining an awareness of controlling your blood pressure and possibly monitoring your pressure at home
Following your special diet and changing your life style
Ask your primary doctor about testing for common target affected organs ( eyes, heart, kidney, feet, etc)
Hypertensive Kidney Disease
High blood pressure can damage the small blood vessels in the kidneys. The damaged vessels cannot filter wastes from the blood as they are supposed to.
A doctor may prescribe blood pressure medication. ACE inhibitors and ARBs have been found to protect the kidneys even more than other medicines that lower blood pressure to similar levels.
The National Heart, Lung and Blood Institute (NHLBI), one of the National Institutes of Health, recommends that people with diabetes or reduced kidney function keep their blood pressure below 130/80.
Older patients blood pressure are usually allowed to have higher readings like 120/70 to 150/90.
Cystic kidney disease
Inherited and Congenital Kidney cystic Diseases
Some kidney diseases result from hereditary factors. Polycystic kidney disease (PKD), for example, is a genetic disorder in which many cysts grow in the kidneys. PKD cysts can slowly replace much of the mass of the kidneys, reducing kidney function and leading to kidney failure. Some kidney problems may show up when a child is still developing in the womb. Examples include autosomal recessive PKD, a rare form of PKD, and other developmental problems that interfere with the normal formation of the nephrons.
Acquired cystic kidney disease (ACKD)
Many people with chronic kidney disease develop ACKD, a condition in which the kidneys develop fluid-filled sacs called renal (kidney) cysts. ACKD occurs in children and adults. The cysts are more likely to develop in people who are on hemodialysis or peritoneal dialysis. Kidney failure, not dialysis, causes the cysts. However, the risk of developing ACKD increases with the number of years a person is on dialysis.
About 20 percent of people starting dialysis treatments already have ACKD. About 60 to 80 percent of people on dialysis for 4 years develop ACKD. About 90 percent of people on dialysis for 8 years develop ACKD.
In ACKD, the kidneys develop fluid-filled sacs called cysts.
In most cases, the cysts are harmless and require no treatment. Sometimes problems occur-including infection in the cyst, which may be associated with fever and back pain. Sometimes the cysts bleed and blood will appear in the urine. Blood in the urine should always be reported to a doctor.
Although doctors debate the exact percentage, somewhere between 10 and 20 percent of people with ACKD develop kidney tumors, which in some cases are cancerous. The rate of kidney cancer in people with ACKD is low, but it is higher than the rate in the general population.
What are the symptoms of ACKD?
ACKD often has no symptoms. If a cyst becomes infected, a person may have back pain, fever, or even chills. If a cyst bleeds, a person will often notice blood in the urine.
How does ACKD differ from polycystic kidney disease (PKD)?
ACKD differs from PKD in several ways. People with PKD often have a family history of PKD. They are born with the disease-causing gene. No disease-causing gene is associated with ACKD. PKD is associated with enlarged kidneys and cyst formation in other parts of the body. In ACKD, the kidneys are normal sized or smaller and cysts do not occur in other parts of the body. In PKD, the presence of cysts marks the onset of disease. People with ACKD already have chronic kidney disease when they develop cysts.
How kidney cystic disease is diagnosed?
A doctor may suspect kidney cystic disease based on a patient’s history and symptoms. To confirm the diagnosis, the doctor may order one or more imaging procedures:
Ultrasound. In an ultrasound, or sonogram, a technician glides a device, called a transducer, over the abdomen. The transducer sends harmless sound waves into the body and catches them as they bounce off the internal organs to create a picture on a monitor. Abdominal ultrasounds are used to evaluate the size and shape of the kidneys.
Computerized tomography (CT) scans. CT scans use a combination of x-rays and computer technology to create three-dimensional images. Sometimes a contrast dye is injected into the patient to better see the structure of the kidneys. CT scans require the patient to lie on a table that slides through a donut-shaped scanning machine. CT scans can help identify cysts and tumors in the kidneys.
Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of internal organs and tissues. No exposure to radiation occurs. With most MRI machines, the patient lies on a table that slides into a tunnel that may be open-ended or closed at one end. Some newer machines are designed to allow the patient to lie in a more open space. Like CT scans, MRIs can help identify cysts and tumors.
Images of the Kidneys may help the health care provider distinguish ACKD from PKD.
How is kidney cystic disease treated?
If ACKD is not causing pain or discomfort, no treatment is required. Infections are treated with a course of antibiotics. If large cysts are causing pain, they may be drained using a long needle inserted through the skin.
Kidney doctors usually follow cysts regularly with imaging testing. If tumors are suspected, a person may need regular examinations to monitor the kidneys for cancer. Some doctors recommend all patients be screened for kidney cancer after 3 years of dialysis. In rare cases, surgery is used to stop cysts from bleeding and to remove tumors or suspected tumors.
For patients with PKD, newer medications that will decrease the cyst growth are being investigated. Measures that are thought to decrease cyst growth are to increase daily water intake, diet with low animal protein content and rich on fruits and vegetables.
Kidney Stones
Kidney stones
One of the most painful of the urologic disorders, have beset humans for centuries. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to health care providers and more than half a million people go to emergency rooms for kidney stone problems.
Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.
Introduction to the Urinary Tract
The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back, one on each side of the spine. The kidneys remove extra water and wastes from the blood, producing urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and form red blood cells.
Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine. They flatten together when urine is emptied out of the body through the urethra.
What is a Kidney Stone?
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.
Kidney stones in the kidney, ureter, and bladder.
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone-or ureterolithiasis-is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.
Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones.
Who gets kidney stones?
For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.
What causes Kidney Stones?
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.
A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.
In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.
Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.
Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.
Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.
Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.
What are the Symptoms of Kidney Stones?
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.
How are Kidney Stones Diagnosed?
Sometimes “silent” stones-those that do not cause symptoms-are found on x rays taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.
The doctor may decide to scan the urinary system using a special test called a computerized tomography (CT) scan or an intravenous pyelogram (IVP). The results of all these tests help determine the proper treatment.
How are kidney stones treated?
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water-2 to 3 quarts a day-to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.
Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids-water is best. Someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.
In the past, people who form calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that foods high in calcium, including dairy products, may help prevent calcium stones. Taking calcium in pill form, however, may increase the risk of developing stones.
Patients may be told to avoid food with added vitamin D and certain types of antacids that have a calcium base. Someone who has highly acidic urine may need to eat less meat, fish, and poultry. These foods increase the amount of acid in the urine.
To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night.
Medical Therapy
A doctor may prescribe certain medications to help prevent calcium and uric acid stones. These medicines control the amount of acid or alkali in the urine, key factors in crystal formation. The medicine allopurinol may also be useful in some cases of hyperuricosuria.
Doctors usually try to control hypercalciuria, and thus prevent calcium stones, by prescribing certain diuretics, such as hydrochlorothiazide. These medicines decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. They work best when sodium intake is low.
Rarely, patients with hypercalciuria are given the medicine sodium cellulose phosphate, which binds calcium in the intestines and prevents it from leaking into the urine.
If cystine stones cannot be controlled by drinking more fluids, a doctor may prescribe medicines such as Thiola and Cuprimine, which help reduce the amount of cystine in the urine.
For struvite stones that have been totally removed, the first line of prevention is to keep the urine free of bacteria that can cause infection. A patient’s urine will be tested regularly to ensure no bacteria are present.
If struvite stones cannot be removed, a doctor may prescribe a medicine called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to prevent the infection that leads to stone growth.
People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands, which are located in the neck. In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and kidney stones.
Surgical Treatment
Surgery may be needed to remove a kidney stone if it
does not pass after a reasonable period of time and causes constant pain
is too large to pass on its own or is caught in a difficult place
blocks the flow of urine
causes an ongoing urinary tract infection
damages kidney tissue or causes constant bleeding
has grown larger, as seen on follow-up x rays
Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.
Extracorporeal Shock Wave Lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Several types of ESWL devices exist. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.
In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities in a few days.
Complications may occur with ESWL. Some patients have blood in their urine for a few days after treatment. Bruising and minor discomfort in the back or abdomen from the shock waves can occur. To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment.
Sometimes, the shattered stone particles cause minor blockage as they pass through the urinary tract and cause discomfort. In some cases, the doctor will insert a small tube called a stent through the bladder into the ureter to help the fragments pass. Sometimes the stone is not completely shattered with one treatment, and additional treatments may be needed.
As with any interventional, surgical procedure, potential risks and complications should be discussed with the doctor before making a treatment decision.
Percutaneous Nephrolithotomy Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL.
In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe-ultrasonic or electrohydraulic-may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.
One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.
Ureteroscopic Stone Removal Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar “blind basket” extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.
Glomerulonephritis
Glomerulonephritis is an inflammation of the units that filters the blood in the kidneys. If glomerulonephritis occurs on its own, it’s known as primary glomerulonephritis. If another disease, such as lupus or diabetes, is the cause, it’s called secondary glomerulonephritis. If severe or prolonged, the inflammation associated with glomerulonephritis can damage your kidneys.
Signs and symptoms of glomerulonephritis may depend on whether you have the acute or chronic form, and the cause. Your first indication that something is wrong may come from symptoms or from the results of a routine urinalysis.
Signs and symptoms may include:
Pink or cola-colored urine from red blood cells in your urine (hematuria)
Foamy urine due to excess protein (proteinuria)
High blood pressure (hypertension)
Fluid retention (edema) with swelling evident in your face, hands, feet and abdomen
Fatigue from anemia or kidney failure
Treatment depends on the type of glomerulonephritis you haveThis inflammation can be caused by multiples causes such as lupus, vasculitis, hepatitis virus, HIV infection, problems that affect the bone marrow or the immune system itself, etc.
They present usually by blood and protein in the urine and high blood pressure and most of the time a kidney biopsy is required to make a correct diagnosis.
Drugs and kidney disease
Among the miscellaneous are the medications that affect the kidney such as the group called anti inflammatory medication (over the counter such as Ibuprofen, Motrin, Aleve, Advil, etc are in this group), intravenous iodine contrast used for CTs, certain antibiotics, cancer medications, etc. Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Medications are increasingly recognized as cause of kidney disease, patients with kidney disease are always advised to ask their doctors whether new prescribed medications are not going to harm the kidneys further.
Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone-or ureterolithiasis-is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.
Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain. These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.
To reduce the risk of complications, doctors usually tell patients to avoid taking aspirin and other medicines that affect blood clotting for several weeks before treatment.
The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar “blind basket” extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.
