Young diseases

Nephrologists treat a wide spectrum of diseases which result in chronic kidney disease (CKD) and renal failure as well as diseases which are influenced by damaged kidneys. To keep up with all the relevant publications which contain useful or potentially influential articles is a labour-intensive task. The "Expert Update" is intended to help in this task by selecting and screening on a regular basis publications which cover important new data in nephrology, as well as those which are relevant to nephrologists, but are not aimed directly at the field.

Every month, a European expert will analyse and summarise a publication with new data and will discuss the potential impact for nephrologists on their current or future practice. The "Expert Update" will cover a range of topics from highly scientific subjects to new information relevant to the daily practice of nephrologists.

Readers can also ask the expert for further comment about the article or review.

BACKGROUND: Epoetin delta, unlike recombinant erythropoietins, is produced in a human cell line and therefore has a human-type glycosylation profile. OBJECTIVES: The pharmacokinetics of epoetin delta were examined in 2 studies in healthy volunteers and 2 studies in patients with chronic kidney disease. METHODS: In study 1, 21 healthy men were randomized to receive epoetin delta 15, 40, or 100 IU/kg IV tiw or placebo for 4 weeks. In study 2, an open-label, cross-over study, 32 healthy volunteers were randomized to receive single doses of epoetin delta 75 IU/kg IV or SC. In study 3, 40 patients receiving hemodialysis were withdrawn from epoetin alfa and randomized to receive epoetin delta or epoetin alfa 50 or 100 IU/kg tiw for 4 weeks. Study 4 was a single-dose study comparing epoetin delta 150 and 300 IU/kg IV or SC in 28 hemodialysis patients. RESULTS: In study 1, after repeated dosing (day 24) in healthy men, mean C(max) values ranged from 219.9 to 1793.0 enzyme-linked immunosorbent assay units (EU)/L; AUC from 827 to 9318 h x EU/L; C1 from 0.014 to 0.024 L/h per kg; Vd from 0.067 to 0.076 L/kg; and t(1/2) from 2.23 to 3.35 hours. There was evidence of a dose-dependent effect of epoetin delta on hemoglobin levels and hematocrit, with doses of 40 and 100 IU/kg associated with significant increases compared with 15 IU/kg (P < 0.001 for dose trend). The only adverse event occurring in > or = 10% of healthy individuals in study 1 was headache (1 [20.0%] in the epoetin delta 15 IU-kg group, 3 [60.0%] in the epoetin delta 100-IU/kg group, 2 [33.3%] in the placebo group). In study 2 in healthy volunteers, mean values for epoetin delta 75 IU/kg IV were 1771 EU/L for C(max), 10,632 h x EU/L for AUC, 0.010 L/h per kg for Cl, 0.074 L/kg for Vd, and 5.12 hours for t(1/2); the corresponding values for epoetin delta 75 IU/kg SC were 113 EU/L, 3231 h x EU/L, 0.035 L/h per kg, 0.760 L/kg, and 14.90 hours. The serum epoetin delta concentration peaked after 10.9 hours with subcutaneous administration. The most common adverse event in study 2 was back pain (10 [31.3%] individuals). In study 3 in patients receiving hemodialysis, mean values for C(max) and AUC with a single dose of epoetin delta 50 IU/kg were 1103 EU/L and 10,896 h x EU/L, respectively, and with the corresponding dose of epoetin alfa were 1354 EU/L and 9957 h x EU/L. Values for the 100-IU/kg doses were approximately double those for the 50-IU/kg doses. Values for Cl, Vd, and t(1/2) were numerically similar for epoetin delta and epoietin alfa across doses. Epoetin delta 100 IU/kg was associated with a numerically greater rate of increase in hemoglobin compared with the 50-IU/kg dose (mean, 0.025 vs -0.004, respectively); the results were similar for epoetin alfa (0.029 vs -0.001). The difference between epoetin alfa and epoetin delta was not statistically significant. The most common adverse events were related to edema (peripheral edema: 60%/50% for epoetin delta 50/100 IU/kg and 60%/60% for epoetin alfa 50/100 IU/kg; facial edema: 30%/30% and 50%/70%, respectively; generalized edema: 50%/30% and 40%/40%). In study 4 in patients receiving hemodialysis, mean C(max) values with epoetin delta 150 and 300 IU/kg IV were 3257 and 4770 EU/L, respectively; the corresponding mean values were 36,208 and 77,736 h x EU/L for AUC, 0.007 and 0.005 L/h per kg for Cl; 0.097 L/kg for Vd in both groups; and 9.9 and 13.2 hours for t(1/2). With epoetin delta 150 and 300 IU/kg SC, the respective values were 162.2 and 467.7 EU/L, 9547 and 27,888 h x EU/L, 0.026 and 0.020 L/h per kg, 1.28 and 0.78 L/kg, and 33.1 and 27.8 hours. The only adverse event occurring in > or = 10% of subjects was headache (2 [40.0%] in the epoetin delta 150-IU/kg IV group, 3 [50.0%] in the epoetin delta 300-IU/kg SC group). No neutralizing anti-erythropoietin antibodies were detected in any individual. The bioavailability of subcutaneous epoetin delta is approximately 30%, and concentrations peak later and decline more slowly than with intravenous injection. Pharmacokinetic parameters in hemodialysis patients were similar to those in healthy individuals, although AUC and t(1/2) were numerically higher (by 49% and 34%, respectively). CONCLUSIONS: These studies in healthy volunteers and patients with chronic kidney disease indicate that the pharmacokinetics of epoetin delta are dose dependent but nonlinear, leading to dose-dependent increases in hemoglobin levels. The pharmacodynamic response to epoetin delta appeared to be as expected for an epoetin

Better food habits can help you reduce your risk for heart attack. A healthful eating plan means choosing the right foods to eat and preparing foods in a healthy way.

t's Not Just a Man's Disease
Heart disease is far and away the leading cause of death of American women, but you can do a lot to help protect yourself and women from it. Read this section for some important advice.


Exercise & Fitness
Swimming, cycling, jogging, skiing, dancing, walking and dozens of other activities can help your heart. Whether it is included in a structured exercise program or just part of your daily routine, all physical activity adds up to a healthier heart

Managing Your Weight
We can help you manage your lifestyle to better manage your weight and reduce your risk for heart attack.

Cholesterol Low Down
To urge Americans to reduce their risk for heart disease, the American Heart Association introduces "Taking It Personally," as part of the Cholesterol Low Down national education campaign.

Nama Tempatan: Gandarusa
Nama Saintifik: Justicia Gendarussa linn
Nama Lain: Daun rusa(melayu), bo gu dan(cina),gendarussa(english)
Famili: Acanthaceae
Lokasi dijumpai:
Asal:
keterangan:
Tumbuhan ini boleh dijumpai tumbuh liar dikawasan semak pada ketinggian 1-500 meter dari aras laut. Ia tumbuh tegak dan boleh mencapai ketinggian hingga 2 meter. Panjang daunnya lebih kura 5-20 cm dan daunnya dari jenis daun tunggal.Dua jenis gandarusa biasa dijumpai dan dibezakan oleh warna batangnya. Ada yang berwarna hitam dan ada yang berwarna hijau.Pokok berbatang hitam lebih popular sebagai ubat dari yang berbatang hijau
kegunaan:
Ia biasa digunakan untuk mengubat lebam akibat terpukul, tulang patah, rheumatik dan bisul.cara penggunaannya ,untuk tulang patah daunnya yang segar atau kering dikisar hingga lumat dan diampur cuka untuk ditampal pada bahagian yang luka dengan syarat tulang telah berada pada kedudukannya yang betul.Untuk rheumatik 15-30 g daunnya yang segar direbus hingga mendidih dan airnya diminum.Untuk lebam pula daunnya dilayurkan pada api hingga layu dan ditampal pada bahagian yang lebam.Ia juga boleh digunakan untuk menurunkan panas badan, menyembuhkan lumpuh otot muka (selalunya disebabkan oleh minor stroke),sakit kepala, mata dan telinga.

***Amaran: Tidak boleh digunakan oleh wanita hamil.
_____________________________________________________________________________________
Ulasan pembaca
Gandarusa hitam mempunyai batang hitan dengan daun hijau gelap.ada juga gandarusa yang mempunyai daun hijau putih dengan batang hitam. Jenis ini banyak ditanam sebagai tumbuhan hiasan. Nama saintifik gandarusa hitam ialah gandarusa vularis
~Admin
Knp tak leh guna utk wanita yg hamil??
~sweetgirl,penang
gandarusa hitam mempunyai khasiat besar yang kurang diketahui,antaranya untuk mengubati sengatan berbisa, mandi lepas bersalin,pulih tenaga.kami banyak menanamnya
~putrahero@hotmail.com
mcm mane nak guna kan ganda rusa for minor stroke bahagia muka
~nieya
daun gandarusa memang daun terpilih oleh orang tua-tua dulu gunakan sebagai bahan rebusan mandian, terutama kepada ibu-ibu bersalin..
http://livingnaturally.myblog.com

~kdier
tolongin dong carikan gambarnya! gue pengen ngliyat.
thanks
~Karman
e e ada pla,.. sorry ye lambat surf
~Karman
masalah PEKANG(angin dlm kepala/lebih kurang migrain).7 helai daun ini +sireh pinang sehelai seadatnya(di doakan terlebih dahulu)disemburkan pada kepala sebelum matahari terbenam.Insya-ALLAH mujarab...
~aurasyami_71@yahoo.com

Nama Tempatan: Belimbing tanah
Nama Saintifik: tacca integrifolia
Nama Lain: Belimbing batu, white bat plant
Famili: taccaceae
Lokasi dijumpai:
Asal:
keterangan:
Tumbuhan berumpun ini agak sukar ditemui namun ia biasanya didapati tumbuh liar dikawasan yang agak redup terutamanya dikebun getah.Daunnya lebar dan panjang berukuran kira-kira 15 inci panjangnya. Ia membiak melalui rizom dan pokoknya jika dilihat sekali imbas menyerupai pokok kunyit.
kegunaan:
Digunakan untuk menurunkan tekanan darah tinggi. seluruh pokok ini termasuk akar dan buahnya direbus hingga mendidih dan airnya diminum dua kali sehari. selain dari itu tonik ini juga berupaya mengubati masalah buasir, kencing manis, lemah jantung dan buah pinggang
_____________________________________________________________________________________
Ulasan pembaca
Pokok ini kami cuba tanam secara komersil tapi gagal.Tahap kematian agak tinggi, tumbuhan ini tidak tahan kepada transplanting.
~
Betul tu, dah beberapa kali saya try to transplant pokok ni, baru kali ni macam nak berjaya sikit, tapi growth very slow, saya letakkan polybagnya bawah teduhan pohon lain dan potong semua daunnya hingga tinggal pucuk saja sebab dari pemerhatian saya sebelum ni, pokok ni mati akibat daun asalnya mengering.
~Melur
kalau ada sesiapa jumpa atau memiliki pokok ini sila beritau saya. Ujang 019-3562893. Kalau tak silap saya pokok ini perlukan daun getah reput utk tumbesaran(makanan) dan memerlukan cuma air hujan saja, bukan air paip.(ada klorin)
~ujang83s@yahoo.com
Kat kampung saya ada le jumpa sikit-sikit dalam dua tiga rumpun sekali.Mungkin betul jugak sebab tanah mak saya tu dulunya bekas kebun getah.Saya ada try tanah sepokok dalam pasu kat rumah saya sekarang ni tapi pokoknya tak besar sangat, berbunga minggu lepas, cantik, macam dalam gambar ni lah.
~Nor
Saya rasa ini
~
sesiapa yang berminat dgn pokok belimbing tanah sila hubungi 0139553694 putrahero@hotmail.com
~rusli
The genus Tacca consists of long-lived, short stemmed, rhizomatous or tuberous herbaceous plants that grow in the shade of Asian rain forests. Four species of Asian Tacca have attractive, entire leaves, vertical growth habit, and strange whisker-like (filiform) bracts below the flowers that can hang down for as much as 1 foot in length. It is these structures and their accompanying cluster of luridly colored flowers that has given rise to the sobriquet "batflower" for these marvelous tropical plants. Unlike its better known close relative, T. chantrieri, T. intergrifolia has white bracts hovering over the nodding flowers. The bracts are beautifully veined with purple. The rhizome of this species grows vertically and the crown of large, attractive leaves emerge from the top of the rhizome. The leaves superficially resemble those of some Peace lilies (Spathiphyllum), but the resemblance ends when the flowers begin to appear. The good news for foliage producers in Florida is that large plants of the white batflower can be finished in just over 1 year from seed. The white batflower fits into any foliage production scheme with ease. The plants thrive in 70-80% shade, high temperatures, and even moisture. White batflower is remarkably free of pest and disease problems. Caterpillars, snails and slugs may occasionally feed on the leaves, but the damage is minimal. Flowering seems to begin when the plants have produced 2-3 full-size leaves. The season lasts from May to November. Large, flowering-size plants of Tacca integrifolia were distributed to foliage nursery contributors to the University of Florida Foundation-SHARE program last year. Packets of seed will be available later this year. ref: http://flrec.ifas.ufl.edu/tropicline/Volume%209(1).html
~Nor
sesiapa yang ingin ubat buasir sila sms 0139553694,rusli
~rusli
Nor hang tulis apa, aku tak paham... kalau nak tulih biaq org kita jer yang tau jangan bocoqkan pada org putih....pikiq la sikit...
~Nazhrol
Rujukan dibawah adalah dari sebuah website mat saleh, saya copy paste je, sebab tu saya tulis rujukannya kat bawah sekali tu, ada url untuk websitenya. Ni kajian yang mat salleh lakukan pada pokok ni
~Nor
ubat buasir. ambil satu perdu pokok belimbing bukit@belimbing tanah(bukan belimbing buluh)rebuskannya sehingga mendidih. minumlah air tersebut 2 kali sehari, insya Allah dalam 2 hari akan segera sembuh.air tersebut juga boleh dibuat ubat penyakit darah tinggi atau kencing manis.
~fajarsiang@yahoo.com
kenapa pokok belimbing tanah ni lain daripada belimbing tanah yang biasa digunakan untuk ubati pokok belimbing tanah yang selalu digunakan untuk merawat penyakit darah tinggi tu?
~nana
Seluruh bahagian:Dikeringkan serta direbus lalu air rebusan ini diminum utk merawat kencing manis dan mengeluarkan batu karang
~niksuzanna@jma.gov.my
Sesuai ditanam sebagai tumbuhan hiasan. Bentuknya yg menarik dan agak luar biasa cukup diminati oleh pecinta flora
~niksuzanna@jma.gov.my
YA POKOPNYA AMAT SUSAH DI TEMUI KAWASAN TERDEDAH CAHAYA MATA HARI.DAN SUSAH HIDUP DI KAWASAN PANAS.KEBIASAAN TUMBUHAN INI BERADA DI TEMPAT SEJUK DAN REDUP.
~condee04@yahoo,com.sg
sesuai dijadika motif studio lanjutan kayu ....ceh....ceh
~pensyarah upsi
Tumbuh secara semulajadi dalam belukar kebun getah yang tanah jenis halus berpasir dan lembab. Kadar cahaya matahari mungkin 25 %, redup, sejuk. Tanahnya gembur dan tidak kering. Berjiran dengan pokok paku gajah.Saya temui pokok ini di Kg Sungai Ramal Dalam,Kjg tidak jauh dari Tol Sungai Ramal, kat rumah Pak Din. 10 kali cuba pindahkan,..gagal.
La ni semuanya dah habis, sebab kebun tu dah terang. Pak Din jual batang getah.
~Apak Nuar
issyyy, issyyy, issyyy tak sesuaiiii langsung nama dia belimbing tanah. tak menunjukkan ciri-ciri belimbing langsung.
apa kata kita tukar nama lain yang sepadan dengannya....
seumur idup tak penah jumpa....
~nz
saya pernah beli pokok ni di pasar tani shah alam stadium.dah cuba tanam tapi mati.Tapi menurut kawan saya setiap hari ahad ada dijual dipasar tani tu.cubalah cari
~shim04
Pokok Belimbing Tanah adalah sejenis pokok yang sifatnya suka kepada tanah-tanah yang agak berpasir,lembab,tanah dilering bukit,redup hidup secara kelompok-kelompok diantara satu pokok kesatu pokok,senang didapati dibukit-bukit yang kurang tingginya dari paras laut.

Kegunaan Pokok Belimbing Tanah secara Perubatan:

1.Ubat darah Tinggi
2.Kencing Manis
3.Tambah Tenaga
4.Lancar perjalanan darah
5.Lancar saluran Hempedu lawas kencing

Cara-Cara Nya:

1.Ambil satu atau dua batang Pokok Belimbing Tanah kemudian dibersihkan dengan air bersih
2.Dipotong daun dan batang
3.Kemudian masukkan kedalam bekas periuk tanah direbuskan hingga mendidih
4.Biar ianya sejuk sedikit kemudian ambil air dalam satu cawan campur sedikit gula untuk tujuaan sedap minum sahaja buka manis sangat supaya senang hendak minum
5.Sedia untuk minum pada setiap hari pagi dan malam dengan secukup rasa sekadar yang sesuai dengan badan seorang itu.

SELAMAT MENCUBA DENGAN IZIN ALLAH BOLIH PULIH PENYAKIT TUAN-TUAN DAN PUAN-PUAN.

~Mohd Hadzri Abdullah,Pusat Pengajian Sains Kajihay
Pokok Belimbing Tanah adalah sejenis pokok yang sifatnya suka kepada tanah-tanah yang agak berpasir,lembab,tanah dilering bukit,redup hidup secara kelompok-kelompok diantara satu pokok kesatu pokok,senang didapati dibukit-bukit yang kurang tingginya dari paras laut.

Kegunaan Pokok Belimbing Tanah secara Perubatan:

1.Ubat darah Tinggi
2.Kencing Manis
3.Tambah Tenaga
4.Lancar perjalanan darah
5.Lancar saluran Hempedu lawas kencing

Cara-Cara Nya:

1.Ambil satu atau dua batang Pokok Belimbing Tanah kemudian dibersihkan dengan air bersih
2.Dipotong daun dan batang
3.Kemudian masukkan kedalam bekas periuk tanah direbuskan hingga mendidih
4.Biar ianya sejuk sedikit kemudian ambil air dalam satu cawan campur sedikit gula untuk tujuaan sedap minum sahaja buka manis sangat supaya senang hendak minum
5.Sedia untuk minum pada setiap hari pagi dan malam dengan secukup rasa sekadar yang sesuai dengan badan seorang itu.

SELAMAT MENCUBA DENGAN IZIN ALLAH BOLIH PULIH PENYAKIT TUAN-TUAN DAN PUAN-PUAN.

~Mohd Hadzri Abdullah,Pusat Pengajin Sains Kajihaya
ye juga, ini rupa keladi murai, boleh ubat buasir. blimbing tanah pokoknya kcil2, ada buah sebesar pangkal lidi, masam. ambil secekak, rebus utk drh tg. utk drh tg, boleh juga rendam kincam, 10-15 helai, dlm air panas, lepas 15 minit, tapis dan minum, sehari 2 kali. esok stop, selangkan sehari. kalau tiap hari, tknn drh jadi rendah pula. selangkan se hari. Saya dah cuba, trnkn tknn dp 206 kp 126 dlm sehari. insya Allah
~arbi, at arbipage@hotmail.com
ye juga, ini rupa keladi murai, boleh ubat buasir. blimbing tanah pokoknya kcil2, ada buah sebesar pangkal lidi, masam. ambil secekak, rebus utk drh tg. utk drh tg, boleh juga rendam kincam, 10-15 helai, dlm air panas, lepas 15 minit, tapis dan minum, sehari 2 kali. esok stop, selangkan sehari. kalau tiap hari, tknn drh jadi rendah pula. selangkan se hari. Saya dah cuba, trnkn tknn dp 206 kp 126 dlm sehari. insya Allah
~arbi, at arbipage@hotmail.com
di kenali jugak dgn nama belimbing bukit..kat kawasan - kawasan perkelahan banyak pokok nie.mujarab untuk darah tinggi.insya.dah cuba.
~az_2378@yahoo.com
tumbuhan ini banyak terdapat kawasan berhampiran sungai terutama kawasan berjeram(bagus untuk buasir)saya biasa jumpa di hutan simpan gading selangor dan hutan simpan batang kali.di hutan lenggor johor banyak tumbuh di kawasan permatang, jenis ini kecil tapi mujarab untuk merawat penyakit buah pinggang.sesiapa yg berminat sila hubungi saya 0136023073
~rusli forestry

Nama Tempatan: Bunga Cina / Melur Cina
Nama Saintifik: Gardenia Augusta
Nama Lain: Kacapiring, gardenia
Famili: Rubiaceae
Lokasi dijumpai:
Asal:
keterangan:
Bunga cina atau nama saintifiknya Gardenia augusta, Merr dari famili Rubiaceae banyak ditanam sebagai tumbuhan hiasan atau sebagai pagar kerana daunnya yang rimbun dan mempunyai banyak cabang. Bunganya yang berwarna putih berbentuk seperti bunga mawar dan berbau harum. warna putih akan berubah menjadi kekuningan selepas bunga mekar sepenuhnya.Tumbuhan ini boleh tumbuh ditempat sejuk atau panas dan ia merupakan tumbuhan yang senang dijaga.Tempat yang paling sesuai untuk pertumbuhannya adalah ditempat yang beriklim agak sejuk seperti dikawasan pergunungan dengan ketinggian lebih kurang 400 meter dari paras laut.Pokok ini boleh mencapai ketinggian 1 - 2 meter.Ia membiak melalui keratan batang dan semaiannya boleh dilakukan dengan memilih ranting yang agak tua, buang semua daunnya dan tanamkan di dalam polybag berisi pasir. pastikan air mencukupi semasa pertumbuhan akarnya.Pokok ini mempunyai potensi untuk di komersialkan sebagai minyak wangi kerana bau bunganya yang harum
kegunaan:
ia boleh digunakan untuk mengubati penyakit seperti Kencing manis (diabetes mellitus), sariawan, demam dan sembelit. carnya untuk kencing manis 12 helai daun bunga cina direbus dengan 2 gelas air hingga tinggal satu gelas dan diminum sekali sehari. Untuk sariawan pula 7 helai daunnya diramas dengan secawan air,tapis dan campurkan air itu dengan 2 sudu makan madu dan seketul gula batu.minum 2 kali sehari. Manakala untuk demam pula, ramas 7 helai daunnya dengan secawan air, tapi , capur dengan gula batu dan minum 2 kali sehari.Untuk sembelit pula ambil 3 biji buahnya, rebus dengan 2 gelas air hingga mendidih dan tinggal satu gelas, minum airnya.

Ulasan Produk
macam mana nak dapatkan pokok ni..nak beli tak tahu caranya..puas mencuba tak jadi
~m_mizall@ukyahoo
Saya pernah beli pokok senduduk putih di Nurseri tapi ia tak tahan lama lebih kurang dalam 3 bulan saja mati... Cuba biakkan menerusi tut juga tak jadi... Ada petua ke menjaga pokok ini supaya ia tahan lama?
~aedin

~siti
pokok ni senang je jaganya.minggu lepas masa saya balik Kelantan, tkejut jgk saya tgok pokok ni dah besar, sihat malah bebunga lebat.ia dtanam dtempat kering dan tak bbaja.ayah saya tu bukan suka jaga tp sihat bunganya.nak tanya ayah saya ke macam mana dia jaga??nanti bgtau.apa salahnya bkongsi pandangan ye
~sitizalehah@gmail.com
sepertinya tanaman ini dikampung aku banyak
tapi pada dipotongin karena dibilang tanaman pengganggu. kata kakek dikampung cuma rumput biasa. emang itu manfaatnya apa? sapa tau kalau itu percis sama mungkin aku bisa jadi pensupplay tanaman herbal tersebut.
aku bisa minta keterangan yang lebih spesifik
~ari_indigo@yahoo.com
senduduk ada 2 warna:

Purple & putih. Kata mak2 bidan, senduduk bunga putih lebih bagus khasiatnya pada kewanitaan berbanding dengan senduduk bunga purple tapi kalu takde yang putih, purple pun boleh!!
~sarina

Anemia, one of the more common blood disorders, occurs when the level of healthy red blood cells (RBCs) in the body becomes too low. This can lead to health problems because RBCs contain hemoglobin, which carries oxygen to the body's tissues. anemia can cause a variety of complications, including fatigue and stress on bodily organs.

Anemia can be caused by many things, but the three main bodily mechanisms that produce it are:

* excessive destruction of RBCs
* blood loss
* inadequate production of RBCs

Among many other causes, anemia can result from inherited disorders, nutritional problems (such as an iron or vitamin deficiency), infections, some kinds of cancer, or exposure to a drug or toxin.
Anemia Caused by Destruction of RBCs

Hemolytic ("hemo" means blood, "lytic" means destroying) anemia occurs when red blood cells are being destroyed prematurely. (Normally, the lifespan of RBCs is 120 days. In hemolytic anemia, they have a much shorter lifespan.) And the bone marrow (the soft, spongy tissue inside bones that makes new blood cells) simply can't keep up with the body's demand for new cells. This can happen for a variety of reasons. Sometimes, infections or certain medications - such as antibiotics or antiseizure medicines - are to blame.

In a condition known as autoimmune hemolytic anemia, the immune system mistakes RBCs for foreign invaders and begins destroying them. Other children inherit defects in the red blood cells that lead to anemia. Common forms of inherited hemolytic anemia include sickle cell anemia, thalassemia, and glucose-6-phosphate dehydrogenase deficiency.

* Sickle cell anemia is a severe form of anemia found most commonly in people of African heritage, although it can affect those of Caucasian, Saudi Arabian, Indian, and Mediterranean descent. In this condition, the hemoglobin forms long rods when it gives up its oxygen, stretching red blood cells into abnormal sickle shapes. This leads to premature destruction of RBCs, chronically low levels of hemoglobin, and recurring episodes of pain, as well as problems that can affect virtually every other organ system in the body. About 1 out of every 625 African-American children is born with this form of anemia.
* Thalassemia, which usually affects people of Mediterranean, African, and Southeast Asian descent, is marked by abnormal and short-lived RBCs. Thalassemia major, also called Cooley's anemia, is a severe form of anemia in which RBCs are rapidly destroyed and iron is deposited in the skin and vital organs. Thalassemia minor involves only mild anemia and minimal red blood cell changes.
* Glucose-6-phosphate dehydrogenase (G6PD) deficiency most commonly affects men of African heritage, although it has been found in many other groups of people. With this condition the RBCs either do not make enough of the enzyme G6PD or the enzyme that is produced is abnormal and doesn't work well. When someone born with this deficiency has an infection, takes certain medicines, or is exposed to specific substances, the body's RBCs suffer extra stress. Without adequate G6PD to protect them, many red blood cells are destroyed prematurely.

Anemia Caused by Blood Loss

Blood loss can also cause anemia - whether it's because of excessive bleeding due to injury, surgery, or a problem with the blood's clotting ability. Slower, long-term blood loss, such as intestinal bleeding from inflammatory bowel disease (IBD), can also cause anemia. Anemia sometimes results from heavy menstrual periods in teen girls and women. Any of these factors will also increase the body's need for iron because iron is needed to make new RBCs.
Anemia Caused by Inadequate Production of RBCs

Aplastic anemia occurs when the bone marrow can't make enough RBCs. This can be due to a viral infection, or exposure to certain toxic chemicals, radiation, or medications (such as antibiotics, antiseizure drugs, or cancer treatments). Some childhood cancers can also cause aplastic anemia, as can certain chronic diseases that affect the ability of the bone marrow to make blood cells.

High levels of hemoglobin and RBCs help fetal blood carry enough oxygen to developing babies in the relatively oxygen-poor environment in utero. Thus, infants are born with some protection from iron deficiency. After the child is born, more oxygen is available and the baby's hemoglobin level normally drops to a low point at about 2 months of age, a condition known as physiologic anemia of infancy. This temporary and expected drop in the blood count is considered normal and no treatment is required because the infant's body soon starts making red blood cells on its own.

Anemia also occurs when the body isn't able to produce enough healthy RBCs because of an iron deficiency. Iron is essential to hemoglobin production. Poor dietary iron intake (or excessive loss of iron from the body) can lead to iron deficiency anemia, the most common cause of anemia in children. Iron deficiency anemia can affect children at any age, but is most commonly seen in those younger than 2 years old.

Girls going through puberty also have a particularly high risk for iron deficiency anemia because of the onset of menstruation; the monthly blood loss increases the amount of iron they need to consume in their diets.
Signs and Symptoms of Anemia

If your child has anemia, the first symptoms might be mild skin paleness, and decreased pinkness of the lips and nailbeds. These changes happen gradually, though, so they may be difficult to notice. Other common signs of anemia include:

* irritability
* fatigue
* dizziness, lightheadedness, and a rapid heartbeat

Depending on what's causing the anemia, symptoms may also include jaundice (yellow-tinged skin), a yellowing of the whites of the eyes, an enlarged spleen, and dark tea-colored urine. In infants and preschool children, iron deficiency anemia can result in developmental delays and behavioral disturbances, such as decreased motor activity and problems with social interaction and attention to tasks. Recent research indicates that developmental problems may persist into and beyond school age if the iron deficiency is not properly treated.
Diagnosing Anemia

In many cases, doctors don't diagnose anemia until they run blood tests as part of a routine physical examination. A complete blood count (CBC) may indicate that there are fewer red blood cells than normal. Other diagnostic tests may include:

* Blood smear examination: Blood is smeared on a glass slide for microscopic examination of RBCs, which can sometimes indicate the cause of the anemia.
* Iron tests: These include total serum iron and ferritin tests, which can help to determine whether anemia is due to iron deficiency.
* Hemoglobin electrophoresis: Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia.
* Bone marrow aspiration and biopsy: This test can help determine whether cell production is happening normally in the bone marrow. It's the only way to diagnose aplastic anemia definitively and is also used if a disease affecting the bone marrow (such as leukemia) is a suspected cause of the anemia.
* Reticulocyte count: A measure of young RBCs, this helps to determine if production of red blood cells is at normal levels.

In addition to running these tests, your child's doctor may ask about a family history of anemia and your child's symptoms and medications. This may lead the doctor to perform other tests to look for specific diseases that might be causing the anemia.
Treating Anemia

Treatment for anemia depends on its cause. It's important not to assume that any symptoms your child may be having are due to iron deficiency. Be sure to have your child checked by a doctor.

If your child does have iron deficiency anemia, the doctor may prescribe medication as drops (for infants) or as a liquid or tablet (for older children), and also may recommend adding certain iron-rich foods to your child's diet.

If your teenage daughter is anemic and has heavy or irregular menstrual periods, in some cases her doctor may prescribe a birth control pill to help regulate the bleeding.

Folic acid and vitamin B12 supplements may be prescribed if the anemia is traced to a deficiency of these nutrients, although this is rare in children.

If a certain medication appears to be the cause, your child's doctor may discontinue it or replace it with something else - unless the benefit of the drug outweighs this side effect.

Anemia caused by an infection will usually improve when the infection passes or is treated.

Depending on the cause, treatment for more severe or chronic forms of anemia may include:

* transfusions of normal red blood cells taken from a donor
* removal of the spleen or treatment with medications to prevent blood cells from being removed from circulation or destroyed too rapidly
* medications to fight infection or stimulate the bone marrow to make more blood cells

Bone marrow transplantation may be considered in some cases of sickle cell anemia, thalassemia, and aplastic anemia. This procedure involves taking bone marrow cells from a donor and injecting them into the child's vein; the donated cells then travel through the bloodstream to the child's bone marrow, where they begin producing new blood cells.
Caring for a Child With Anemia

The type, cause, and severity of your child's anemia will determine what kind of care is needed. Rest assured, though, that children often tolerate anemia much better than adults.

In general, a child with significant anemia may tire more easily than other children and therefore need to limit activity levels. Make sure that your child's teachers and other caregivers are aware of the condition. If iron deficiency is the cause, follow the doctor's directions about dietary changes and taking any iron supplements.

If the spleen is enlarged, your child may be prohibited from playing contact sports because of the risk that the spleen could rupture or hemorrhage if your child is hurt. Certain forms of anemia, such as sickle cell anemia, require other more specific kinds of care and treatment.
Preventing Anemia

Whether anemia can be prevented depends on its cause. Currently, there is no way to prevent anemia due to genetic defects affecting the production of RBCs or hemoglobin.

However, you can take steps to help prevent iron deficiency, the most common form of anemia. Before following any of these suggestions, be sure to talk them over with your child's doctor.

* Cow's milk consumption. During the first 6 months of life, babies are usually protected against developing iron deficiency by the stores of iron built up in their bodies pre-birth. But after month 6, as infants continue to grow, they often don't get enough iron through breast milk alone or regular cow's milk (which contains less iron than fortified infant formula). Regular cow's milk can also cause some infants to lose iron from their intestines, and drinking lots of it can make an infant less interested in eating other foods that are better sources of iron. For these reasons, regular cow's milk is not recommended for children until they reach 1 year of age and are eating an iron-rich diet. In addition, your child should not drink more than 24-32 ounces (709-946 ml) of milk each day. If you can't get your child to eat more iron-rich foods, speak with your child's doctor about giving your child an iron supplement.
* Iron-fortified cereal and formula. These products can help ensure that your baby is getting enough iron, especially during the transition from breast milk or formula to solid foods.
* Well-balanced diet. Make sure that your child or teen regularly eats foods that contain iron. Good choices include iron-fortified grains and cereals, red meat, egg yolks, leafy green vegetables, yellow vegetables and fruits, potato skins, tomatoes, molasses, and raisins. If your child is a vegetarian, you'll need to make an extra effort to ensure sufficient iron sources because iron found in meat, poultry, and fish is more easily absorbed than iron found in plant-based and iron-fortified foods. Also, be aware that certain food combinations can inhibit or promote absorption of iron. For example, drinking coffee or tea (including iced tea) with a meal can significantly lower the amount of iron absorbed. On the other hand, vitamin C helps the body absorb iron.

If you have any questions about anemia, or you think your child might have the condition, talk with your child's doctor.

Your Kidneys and How They Work

On this page:

* What do my kidneys do?
* What is renal function?
* Why do kidneys fail?
* How do kidneys fail?
* What are the signs of kidney disease?
* What medical tests will my doctor use to detect kidney disease?
* What are the stages of kidney disease?
* What can I do about kidney disease?
* What happens if my kidneys fail completely?
* Hope Through Research
* Points to Remember
* For More Information

Your two kidneys are vital organs that perform many functions to keep your blood clean and chemically balanced. Understanding how your kidneys work can help you to keep them healthy.
What do my kidneys do?
Image of the parts of the urinary tract, with labels pointing to the kidneys, ureters, and bladder.
The kidneys remove wastes and extra water from the blood to form urine. Urine flows from the kidneys to the bladder through the ureters.

Your kidneys are bean-shaped organs, each about the size of your fist. They are located near the middle of your back, just below the rib cage. The kidneys are sophisticated reprocessing machines. Every day, your kidneys process about 200 quarts of blood to sift out about 2 quarts of waste products and extra water. The waste and extra water become urine, which flows to your bladder through tubes called ureters. Your bladder stores urine until you go to the bathroom.

The wastes in your blood come from the normal breakdown of active tissues and from the food you eat. Your body uses the food for energy and self-repair. After your body has taken what it needs from the food, waste is sent to the blood. If your kidneys did not remove these wastes, the wastes would build up in the blood and damage your body.

The actual filtering occurs in tiny units inside your kidneys called nephrons. Every kidney has about a million nephrons. In the nephron, a glomerulus—which is a tiny blood vessel, or capillary—intertwines with a tiny urine-collecting tube called a tubule. A complicated chemical exchange takes place, as waste materials and water leave your blood and enter your urinary system.

At first, the tubules receive a combination of waste materials and chemicals that your body can still use. Your kidneys measure out chemicals like sodium, phosphorus, and potassium and release them back to the blood to return to the body. In this way, your kidneys regulate the body’s level of these substances. The right balance is necessary for life, but excess levels can be harmful.
Illustration of a kidney and an enlargement of the nephron.
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In the nephron (left), tiny blood vessels intertwine with urine-collecting tubes. Each kidney contains about 1 million nephrons.

In addition to removing wastes, your kidneys release three important hormones:

* erythropoietin (eh-RITH-ro-POY-eh-tin), or EPO, which stimulates the bone marrow to make red blood cells

* renin (REE-nin), which regulates blood pressure

* calcitriol (kal-suh-TRY-ul), the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body

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What is renal function?

Your health care team may talk about the work your kidneys do as renal function. If you have two healthy kidneys, you have 100 percent of your renal function. This is more renal function than you really need. Some people are born with only one kidney, and these people are able to lead normal, healthy lives. Many people donate a kidney for transplantation to a family member or friend. Small declines in renal function may not cause a problem.

But many people with reduced renal function have a kidney disease that will get worse. You will have serious health problems if you have less than 25 percent of your renal function. If your renal function drops below 10 to 15 percent, you cannot live long without some form of renal replacement therapy—either dialysis or transplantation.

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Why do kidneys fail?

Most kidney diseases attack the nephrons, causing them to lose their filtering capacity. Damage to the nephrons may happen quickly, often as the result of injury or poisoning. But most kidney diseases destroy the nephrons slowly and silently. Only after years or even decades will the damage become apparent. Most kidney diseases attack both kidneys simultaneously.

The two most common causes of kidney disease are diabetes and high blood pressure. If your family has a history of any kind of kidney problems, you may be at risk for kidney disease.
Diabetic Nephropathy

Diabetes is a disease that keeps the body from using glucose (sugar) as it should. If glucose stays in your blood instead of breaking down, it can act like a poison. Damage to the nephrons from unused glucose in the blood is called diabetic nephropathy. If you keep your blood glucose levels down, you can delay or prevent diabetic nephropathy.
High Blood Pressure

High blood pressure can damage the small blood vessels in your kidneys. The damaged vessels cannot filter wastes from your blood as they are supposed to.

Your doctor may prescribe blood pressure medication. Blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (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 should keep their blood pressure below 130/80 mm Hg.
Glomerular Diseases

Several different types of kidney disease are grouped together under this category, including autoimmune diseases, infection-related diseases, and sclerotic diseases. As the name indicates, glomerular diseases attack the tiny blood vessels (glomeruli) within the kidney. The most common primary glomerular diseases include membranous nephropathy, IgA nephropathy, and focal segmental glomerulosclerosis. Protein, blood, or both in the urine are often the first signs of these diseases. They can slowly destroy kidney function. Blood pressure control is important with any kidney disease. Treatments for glomerular diseases may include immunosuppressive drugs or steroids to reduce inflammation and proteinuria, depending on the specific disease.
Inherited and Congenital Kidney 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. The signs of kidney disease in children vary. A child may grow unusually slowly, may vomit often, or may have back or side pain. Some kidney diseases may be “silent” for months or even years.

If your child has a kidney disease, your child’s doctor should find it during a regular checkup. Be sure your child sees a doctor regularly. The first sign of a kidney problem may be high blood pressure, a low number of red blood cells (anemia), or blood or protein in the child’s urine. If the doctor finds any of these problems, further tests may be necessary, including additional blood and urine tests or radiology studies. In some cases, the doctor may need to perform a biopsy—removing a tiny piece of the kidney to examine under a microscope.

Some hereditary kidney diseases may not be detected until adulthood. The most common form of PKD was once called "adult PKD" because the symptoms of high blood pressure and renal failure usually do not occur until patients are in their twenties or thirties. But with advances in diagnostic imaging technology, doctors have found cysts in children and adolescents before any symptoms appear.
Other Causes of Kidney Disease

Poisons and trauma, for example a direct and forceful blow to your kidneys, can lead to kidney disease.

Some over-the-counter medicines can be poisonous to your kidneys if taken regularly over a long period of time. Products that combine aspirin, acetaminophen, and other medicines such as ibuprofen have been found to be the most dangerous to the kidneys. If you take painkillers regularly, check with your doctor to make sure you are not putting your kidneys at risk.
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How do kidneys fail?

Many factors that influence the speed of kidney failure are not completely understood. Researchers are still studying how protein in the diet and cholesterol levels in the blood affect kidney function.
Acute Renal Failure

Some kidney problems happen quickly, like an accident that injures the kidneys. Losing a lot of blood can cause sudden kidney failure. Some drugs or poisons can make your kidneys stop working. These sudden drops in kidney function are called acute renal failure (ARF).

ARF may lead to permanent loss of kidney function. But if your kidneys are not seriously damaged, acute renal failure may be reversed.
Chronic Kidney Disease

Most kidney problems, however, happen slowly. You may have “silent” kidney disease for years. Gradual loss of kidney function is called chronic kidney disease (CKD) or chronic renal insufficiency. People with CKD may go on to permanent kidney failure. They also have a high risk of dying from a stroke or heart attack.
End-Stage Renal Disease

Total or nearly total and permanent kidney failure is called end-stage renal disease (ESRD). People with ESRD must undergo dialysis or transplantation to stay alive.
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What are the signs of kidney disease?

People in the early stages of kidney disease usually do not feel sick at all.

If your kidney disease gets worse, you may need to urinate more often or less often. You may feel tired or itchy. You may lose your appetite or experience nausea and vomiting. Your hands or feet may swell or feel numb. You may get drowsy or have trouble concentrating. Your skin may darken. You may have muscle cramps.

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What medical tests will my doctor use to detect kidney disease?

Since you can have kidney disease without any symptoms, your doctor may first detect the condition through routine blood and urine tests. The National Kidney Foundation recommends three simple tests to screen for kidney disease: a blood pressure measurement, a spot check for protein or albumin in the urine (proteinuria), and a calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement. Measuring urea nitrogen in the blood provides additional information.
Blood Pressure Measurement

High blood pressure can lead to kidney disease. It can also be a sign that your kidneys are already impaired. The only way to know whether your blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure when your heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when your heart is resting between beats. Your blood pressure is considered normal if it stays below 120/80 (expressed as “120 over 80”). The NHLBI recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.
Microalbuminuria and Proteinuria

Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of deteriorating kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. Your doctor may test for protein using a dipstick in a small sample of your urine taken in the doctor’s office. The color of the dipstick indicates the presence or absence of proteinuria.

A more sensitive test for protein or albumin in the urine involves laboratory measurement and calculation of the protein-to-creatinine or albumin-to-creatinine ratio. This test should be used to detect kidney disease in people at high risk, especially those with diabetes. If your first laboratory test shows high levels of protein, another test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, you have persistent proteinuria and should have additional tests to evaluate your kidney function.
Glomerular Filtration Rate (GFR) Based on Creatinine Measurement

GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection. Recently, scientists found they could calculate GFR without an injection or urine collection. The new calculation requires only a measurement of the creatinine in a blood sample.

Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When kidneys are not working well, creatinine builds up in the blood.

In the lab, your blood will be tested to see how many milligrams of creatinine are in one deciliter of blood (mg/dL). Creatinine levels in the blood can vary, and each laboratory has its own normal range, usually 0.6 to 1.2 mg/dL. If your creatinine level is only slightly above this range, you probably will not feel sick, but the elevation is a sign that your kidneys are not working at full strength. One formula for estimating kidney function equates a creatinine level of 1.7 mg/dL for most men and 1.4 mg/dL for most women to 50 percent of normal kidney function. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.

The new GFR calculation uses the patient’s creatinine measurement along with weight, age, and values assigned for sex and race. Some medical laboratories may make the GFR calculation when a creatinine value is measured and include it on their lab report.
Blood Urea Nitrogen (BUN)

Blood carries protein to cells throughout the body. After the cells use the protein, the remaining waste product is returned to the blood as urea, a compound that contains nitrogen. Healthy kidneys take urea out of the blood and put it in the urine. If your kidneys are not working well, the urea will stay in the blood.

A deciliter of normal blood contains 7 to 20 milligrams of urea. If your BUN is more than 20 mg/dL, your kidneys may not be working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.
Additional Tests for Kidney Disease

If blood and urine tests indicate reduced kidney function, your doctor may recommend additional tests to help identify the cause of the problem.

Renal imaging. Methods of renal imaging (taking pictures of the kidneys) include ultrasound, computed tomography (CT scan), and magnetic resonance imaging (MRI). These tools are most helpful in finding unusual growths or blockages to the flow of urine.

Renal biopsy. Your doctor may want to see a tiny piece of your kidney tissue under a microscope. To obtain this tissue sample, the doctor will perform a renal biopsy—a hospital procedure in which the doctor inserts a needle through your skin into the back of the kidney. The needle retrieves a strand of tissue about 1/2 to 3/4 of an inch long. For the procedure, you will lie on your stomach on a table and receive local anesthetic to numb the skin. The sample tissue will help the doctor identify problems at the cellular level.

For more information, see the fact sheet on Kidney Biopsy from the National Kidney and Urologic Diseases Information Clearinghouse.

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What are the stages of kidney disease?

Your GFR is the best indicator of how well your kidneys are working. In 2002, the National Kidney Foundation published treatment guidelines that identified five stages of CKD based on declining GFR measurements. The guidelines recommend different actions based on the stage of kidney disease.

* Increased risk of CKD. A GFR of 90 or above is considered normal. Even with a normal GFR, you may be at increased risk for developing CKD if you have diabetes, high blood pressure, or a family history of kidney disease. The risk increases with age: People over 65 are more than twice as likely to develop CKD as people between the ages of 45 and 65. African Americans also have a higher risk of developing CKD.

* Stage 1: Kidney damage with normal GFR (90 or above). Kidney damage may be detected before the GFR begins to decline. In this first stage of kidney disease, the goals of treatment are to slow the progression of CKD and reduce the risk of heart and blood vessel disease.

* Stage 2: Kidney damage with mild decrease in GFR (60 to 89). When kidney function starts to decline, your health care provider will estimate the progression of your CKD and continue treatment to reduce the risk of other health problems.

* Stage 3: Moderate decrease in GFR (30 to 59). When CKD has advanced to this stage, anemia and bone problems become more common. Work with your health care provider to prevent or treat these complications.

* Stage 4: Severe reduction in GFR (15 to 29). Continue following the treatment for complications of CKD and learn as much as you can about the treatments for kidney failure. Each treatment requires preparation. If you choose hemodialysis, you will need to have a procedure to make a vein in your arm larger and stronger for repeated needle insertions. For peritoneal dialysis, you will need to have a catheter placed in your abdomen. Or you may want to ask family or friends to consider donating a kidney for transplantation.

* Stage 5: Kidney failure (GFR less than 15). When the kidneys do not work well enough to maintain life, you will need dialysis or a kidney transplant.

In addition to tracking your GFR, blood tests can show when substances in your blood are out of balance. If phosphorus or potassium levels start to climb, a blood test will prompt your health care provider to address these issues before they permanently affect your health.

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What can I do about kidney disease?

Unfortunately, chronic kidney disease often cannot be cured. But if you are in the early stages of a kidney disease, you may be able to make your kidneys last longer by taking certain steps. You will also want to be sure that risks for heart attack and stroke are minimized, since CKD patients are susceptible to these problems.

* If you have diabetes, watch your blood glucose closely to keep it under control. Consult your doctor for the latest in treatment.

* Avoid pain pills that may make your kidney disease worse. Check with your doctor before taking any medicine.

Blood Pressure

People with reduced kidney function (a high creatinine level in the blood or a low creatinine clearance) should have their blood pressure controlled, and an ACE inhibitor or an ARB should be one of their medications. Many people will require two or more types of medication to keep their blood pressure below 130/80 mm Hg. A diuretic is an important addition to the ACE inhibitor or ARB.
Diet

People with reduced kidney function need to be aware that some parts of a normal diet may speed their kidney failure.

Protein. Protein is important to your body. It helps your body repair muscles and fight disease. Protein comes mostly from meat. As discussed in an earlier section, healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate the protein from the wastes.

Some doctors tell their kidney patients to limit the amount of protein they eat so that the kidneys have less work to do. But you cannot avoid protein entirely. You may need to work with a dietitian to find the right food plan.

Cholesterol. Another problem that may be associated with kidney failure is too much cholesterol (koh-LES-tuh-rawl) in your blood. High levels of cholesterol may result from a high-fat diet.

Cholesterol can build up on the inside walls of your blood vessels. The buildup makes pumping blood through the vessels harder for your heart and can cause heart attacks and strokes.

Smoking. Smoking not only increases the risk of kidney disease, it contributes to deaths from strokes and heart attacks in people with CKD. You should try your best to stop smoking.

Sodium. Sodium is a chemical found in salt and other foods. Sodium in your diet may raise your blood pressure, so you should limit foods that contain high levels of sodium. High-sodium foods include canned or processed foods like frozen dinners and hot dogs.

Potassium. Potassium is a mineral found naturally in many fruits and vegetables, like oranges, potatoes, bananas, dried fruits, dried beans and peas, and nuts. Healthy kidneys measure potassium in your blood and remove excess amounts. Diseased kidneys may fail to remove excess potassium, and with very poor kidney function, high potassium levels can affect the heart rhythm.
Treating Anemia

Anemia is a condition in which the blood does not contain enough red blood cells. These cells are important because they carry oxygen throughout the body. If you are anemic, you will feel tired and look pale. Healthy kidneys make the hormone EPO, which stimulates the bones to make red blood cells. Diseased kidneys may not make enough EPO. You may need to take injections of a man-made form of EPO.
Preparing for End-Stage Renal Disease

As your kidney disease progresses, you will need to make several decisions. You will need to learn about your options for treating ESRD so that you can make an informed choice between hemodialysis, peritoneal dialysis, and transplantation.

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What happens if my kidneys fail completely?

Complete and irreversible kidney failure is sometimes called end-stage renal disease, or ESRD. If your kidneys stop working completely, your body fills with extra water and waste products. This condition is called uremia. Your hands or feet may swell. You will feel tired and weak because your body needs clean blood to function properly.

Untreated uremia may lead to seizures or coma and will ultimately result in death. If your kidneys stop working completely, you will need to undergo dialysis or kidney transplantation.
Dialysis

The two major forms of dialysis are hemodialysis and peritoneal dialysis. In hemodialysis, your blood is sent through a filter that removes waste products. The clean blood is returned to your body. Hemodialysis is usually performed at a dialysis center three times per week for 3 to 4 hours.
Illustration of a man being treated with hemodialysis.
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Hemodialysis

In peritoneal dialysis, a fluid is put into your abdomen. This fluid captures the waste products from your blood. After a few hours, the fluid containing your body’s wastes is drained away. Then, a fresh bag of fluid is dripped into the abdomen. Patients can perform peritoneal dialysis themselves. Patients using continuous ambulatory peritoneal dialysis (CAPD) change fluid four times a day. Another form of peritoneal dialysis, called continuous cycling peritoneal dialysis (CCPD), can be performed at night with a machine that drains and refills the abdomen automatically.
Illustration of a person being treated with peritoneal dialysis.
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Peritoneal dialysis
Transplantation
Illustration of a transplanted kidney.
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Kidney transplantation

A donated kidney may come from an anonymous donor who has recently died or from a living person, usually a relative. The kidney that you receive must be a good match for your body. The more the new kidney is like you, the less likely your immune system is to reject it. Your immune system protects you from disease by attacking anything that is not recognized as a normal part of your body. So your immune system will attack a kidney that appears too “foreign.” You will take special drugs to help trick your immune system so it does not reject the transplanted kidney.

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Hope Through Research

As our understanding of the causes of kidney failure increases, so will our ability to predict and prevent these diseases. Recent studies have shown that intensive control of diabetes and high blood pressure can prevent or delay the onset of kidney disease.

In the area of genetics, researchers supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) have located two genes that cause the most common form of PKD and learned that a person must have two defective copies of the PKD1 gene to develop PKD. Researchers have also found a gene in the roundworm that is identical to the PKD1 gene. This new knowledge will be used in the search for effective therapies to prevent or treat PKD.

In the area of transplantation, new drugs to help the body accept foreign tissue increase the likelihood that a transplanted kidney will survive and function properly. Scientists at NIDDK are also developing new techniques to induce tolerance for foreign tissue in patients before they receive transplanted organs. This technique will eliminate or reduce the need for immunosuppressive drugs and thereby reduce expense and complications. In the future, scientists may develop an artificial kidney for implantation.

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Points to Remember

* Your kidneys are vital organs that keep your blood clean and chemically balanced.

* The progression of kidney disease can be slowed, but it cannot always be reversed.

* End-stage renal disease (ESRD) is the total loss of kidney function.

* Dialysis and transplantation can extend the lives of people with ESRD.

* Diabetes and high blood pressure are the two leading causes of kidney failure.

* You should see a nephrologist regularly if you have renal disease.

* Chronic kidney disease (CKD) increases the risk of heart attacks and strokes.

* If you are in the early stages of renal disease, you may be able to save your remaining renal function for many years by

o controlling your blood glucose
o controlling your blood pressure
o following a low-protein diet
o maintaining healthy levels of cholesterol in your blood
o taking an ACE inhibitor or an ARB
o quitting smoking

How does Diabetes affect how I respond to a cold or flu?
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Being sick by itself can raise your blood glucose. Moreover, illness can prevent you from eating properly, which further affects blood glucose.

In addition, diabetes can make the immune system more vulnerable to severe cases of flu. People with diabetes who come down with flu may become very sick and may even have to go to a hospital. You can help keep yourself from getting flu by getting a flu shot every year. Everyone with diabetes, even pregnant women, should get a yearly flu shot.

What should I do when I am sick?
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Be sure to continue taking your anti-diabetic medications or insulin. Don’t stop taking the medications even if you can’t eat.

Your health care provider may even advise you to inject more insulin during sickness.

Test your blood glucose every four hours, and keep track of the results.

Drink extra (calorie-free) liquids, and try to eat as you normally would. If you can’t, try to have soft foods and liquids containing the equivalent amount of carbohydrates that you usually consume.

Weigh yourself every day. Losing weight without engaging on a weight loss programme is a sign of high blood glucose.

Check your temperature every morning and evening. A fever may be a sign of infection.

Call your health care provider or go to an emergency room if any of the following happens to you:

* You feel too sick to eat normally and are unable to consume any food for more than 6 hours.
* You're having severe diarrhea.
* Excess weight loss within a short period of time.
* Your temperature is over 38 degrees Celsius.
* Your blood glucose is lower than 4.0mmol/L or remains over 15mmol/L.
* You have moderate or large amounts of ketones in your urine.
* You're having trouble breathing.
* You feel sleepy or can't think clearly.

Why is it important for Diabetics to be physically active?
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Physical activity can help you control your blood glucose, weight, and blood pressure, as well as raise your “good” cholesterol and lower your “bad” cholesterol. It can also help prevent heart and blood flow problems, reducing your risk of heart disease and nerve damage, which are often problems for people with diabetes.

How much and how often should Diabetics exercise?
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Experts recommend moderate intensity physical activity for 30 minutes for at least 3 times a week. Some examples of moderate intensity physical activities are walking briskly, mowing the lawn, dancing, swimming, or bicycling.

If you are not accustomed to physical activity, you may want to start with a little exercise, and work your way up. As you become stronger, you can add a few extra minutes to your physical activity. Do some physical activities every day. It’s better to walk 10 or 20 minutes each day than one hour once a week.

Talk to your health care provider about a safe exercise plan. He or she may check your heart and your feet to be sure you have no special problems. If you have high blood pressure, eye, or foot problems, you may need to avoid some kinds of exercise.

What are some good types of physical activities for Diabetics?
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Walking vigorously, hiking, climbing stairs, swimming, aerobics, dancing, bicycling, tennis, basketball, volleyball, or other sports are just some examples of physical activities that will work your large muscles, increase your heart rate, and make you breathe harder – important goals for fitness.

In addition, strength training exercises with hand weights, elastic bands, or weight machines can help you build muscle. Stretching helps to make you flexible and prevent soreness after other types of exercise.

Do physical activities you really like. The more fun you have, the more likely you will do it each day. It can be helpful to exercise with a family member or friend.

Are there any safety considerations for Diabetics when they exercise?
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Exercise is very important for diabetics to stay healthy, but there are a few things to watch out for.

You should avoid some kinds of physical activities if you have certain diabetic complications. Exercise involving heavy weights may be bad for people with blood pressure, blood vessel, or eye problems. Diabetes-related nerve damage can make it hard to tell if you’ve injured your feet during exercise, which can lead to more serious problems. If you do have diabetic complications, your health care provider can tell you which kinds of physical activities would be best for you. Fortunately, there are many different ways to get exercise.

Physical activity can lower your blood glucose too much, causing hypoglycemia (low blood glucose), especially in people who take insulin or certain oral medications. Hypoglycemia can happen at the time you’re exercising, just afterward, or even up to a day later. You can get shaky, weak, confused, irritable, anxious, hungry, tired, or sweaty. You can get a headache, or even lose consciousness.

To help prevent hypoglycemia during physical activity, check your blood glucose before you exercise. If it's below 5.6mmol/L, have a small snack. In addition, bring food or glucose tablets with you when you exercise just in case. It is not good for people with diabetes to skip meals at all, but especially not prior to exercise.

After you exercise, check to see how it has affected your blood glucose level. If you take insulin, ask your health care provider if there is a preferable time of day for you to exercise, or whether you should change your dosage before physical activity, before beginning an exercise regimen.

When you exercise, wear cotton socks and athletic shoes that fit well and are comfortable. After you exercise, check your feet for sores, blisters, irritation, cuts, or other injuries.

Drink plenty of fluids during physical activity, since your blood glucose can be affected by dehydration.

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Having high blood glucose for many years can damage the blood vessels that bring oxygen to some nerves, as well as the nerve coverings. Damaged nerves may stop sending messages, or send messages too slowly or at the wrong times. Numbness, pain, and weakness in the hands, arms, feet, and legs may develop. Problems may also occur in various organs, including the digestive tract, heart, and sex organs.

Diabetic Neuropathy is the medical term for damage to the nervous system from diabetes. The most common type is peripheral neuropathy, which affects the arms and legs. An estimated 50% of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. People with diabetes can develop nerve problems at any time, but the longer a person has diabetes, the greater the risk. The highest rates of neuropathy are among people who have had the disease for at least 25 years. Diabetic Neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40.


How can I prevent nerve damage if I have Diabetes?
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You can help keep your nervous system healthy by keeping your blood glucose as close to normal as possible, getting regular physical activity, not smoking, taking good care of your feet each day (see below), having your health care provider examine your feet at least 4 times a year, and getting your feet tested for nerve damage at least once a year.

Why is it especially important to take care of my feet if I have Diabetes?
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Nerve damage, circulation problems, and infections can cause serious foot problems for people with diabetes. Sometimes nerve damage can deform or misshape your feet, causing pressure points that can turn into blisters, sores, or ulcers. Poor circulation can make these wounds slow to heal. Sometimes this can lead to amputation of a toe, foot, or leg.


What should I do on a regular basis to take care of my feet?
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* If you have corns and calluses, ask your doctor or podiatrist (specialist deals with disorder of lower limbs) about the best way to care for them.
* Wash your feet in warm (not hot) water and dry them well
* Cut your toenails once a week or when needed. Cut toenails when they are soft from washing. Cut them to the shape of the toe and not too short. File the edges with an emery board.
* Rub lotion on the tops and bottoms of feet (but not between the toes) to prevent cracking and drying.
* Wear shoes that fit well. Break in new shoes slowly, by wearing them 1 to 2 hours each day for the first 1 to 2 weeks.
* Wear stockings or socks to avoid blisters and sores.
* Wear clean, lightly padded socks that fit well; seamless socks are best.
* Always wear shoes or slippers, because when you are barefoot it is easy to step on something and hurt your feet.
* Protect your feet from extreme heat and cold.
* When sitting, keep the blood flowing to your lower limbs by propping your feet up and moving your toes and ankles for a few minutes at a time.
* Avoid smoking, which reduces blood flow to the feet.
* Keep your blood sugar, blood pressure, and cholesterol under control by eating healthy foods, staying active, and taking your anti-diabetic medicines.

How can Diabetes affect the digestion?
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Gastroparesis, otherwise known as delayed gastric emptying, is a disorder where, due to nerve damage, the stomach takes too long to empty itself. It frequently occurs in people with either Type 1 or Type 2 Diabetes.

Symptoms of gastroparesis include heartburn, nausea, vomiting of undigested food, an early feeling of fullness when eating, weight loss, abdominal bloating, erratic blood glucose levels, lack of appetite, gastroesophageal reflux, and spasms of the stomach wall.

How can Diabetes affect my sexual performance?
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Many people with diabetic nerve damage have trouble having sex. For example, men can have trouble maintaining an erection and ejaculating. Women can have trouble with sexual response and vaginal lubrication. Both men and women with diabetes can get urinary tract infections and bladder problems more often than average.


How can Diabetes affect my mood?
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Several studies suggest that diabetes doubles the risk of depression, although it’s still unclear why. The psychological stress of having diabetes may contribute to depression, but the metabolic effect of diabetes on brain function may also play a role. At the same time, people with depression may be more likely to develop diabetes.

The risk of depression increases as more diabetic complications develop. When you are depressed, you do not function as well, physically or mentally; this makes you less likely to eat properly, exercise, and take your medication regularly.

Psychotherapy, medication, or a combination of both can treat depression effectively. In addition, studies show that successful treatment for depression also helps improve blood glucose control.

There’s a lot you can do to prevent kidney problems. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. Keeping your blood pressure under control is also important. Diabetic kidney disease happens slowly and silently, so you might not feel that anything is wrong until severe problems have developed.

Therefore, it is important to get your blood and urine checked for kidney problems each year. Your doctor can learn how well your kidneys are working by testing every year for micro-albumin (a protein) in the urine. Micro-albumin in the urine is an early sign of diabetic kidney disease. Your doctor can also do a yearly blood test to measure your kidney function. Go to the doctor if you develop a bladder or kidney infection; symptoms include cloudy or bloody urine, pain or burning when you urinate, an urgent need to urinate often, back pain, chills, or fever.


What are the early signs of kidney disease in Diabetes?
The finding of excess amounts of protein in the urine is an early sign of diabetic kidney disease.

This usually occurs after 10 to 15 years of diabetes. If the protein loss should become heavy, the amount of protein in the blood decreases. This low blood protein level results in fluid retention causing swelling of the legs.

High blood pressure usually develops or worsens as the disease progresses. People with diabetes should have their blood, urine and blood pressure checked regularly by their doctor. This will lead to better control of the disease and early treatment of high blood pressure, if present.

What are the late signs of kidney disease in Diabetes?
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As the kidney's function declines (this is shown by the results of progressive blood tests), non-specific symptoms may develop such as nausea, vomiting, loss of appetite, weakness, tiredness, itchiness, muscle cramps and anaemia.

The need for insulin may decrease. If any of these symptoms occur you should consult your doctor.

What happens if the kidneys fail completely?
If the kidneys become so damaged that only about 10% of overall kidney function remains, it is called End-Stage Kidney Failure.

The average time between the onset of diabetic kidney damage and End-Stage Kidney Failure is about 5 to 7 years, but it can vary from person to person.

For diabetics in a reasonable state of health, End-Stage Kidney Failure can be treated by dialysis or transplantation.

Can a person with Diabetes have a kidney transplant?
Yes, a kidney transplant can come from a deceased person (cadaver transplant) or from a close blood relative (living related transplant). However, it is important for the recipient not to have other organ damage due to diabetes, for example, to the heart, brains and eyes. If these are already present, a transplant may not be suitable.

Important points about Diabetes and the kidney
* Severe kidney failure is much more common in Type 1 (juvenile-onset) than Type 2 (adult-onset) Diabetes;
* Diabetes may affect small blood vessels in the kidney and cause permanent kidney damage (Diabetic Nephropathy) and kidney failure;
* Early diabetic kidney damage (Diabetic Nephropathy) can be detected by a urine test. The most practical way to follow the condition of the kidneys is with blood tests;
* Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with Type 1 Diabetes)
* Maintaining normal blood pressure is the most effective method for slowing the rate at which kidney function is lost;
* End-Stage Kidney Failure can be treated by kidney transplantation, haemodialysis or peritoneal dialysis.

It is very important for kidney function to be monitored in diabetic patients. This is done both by monitoring blood pressure and a special test for protein in the urine. It should be done at least once a year.

How can Diabetes affect cardiovascular health?
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Cardiovascular disease is the leading cause of early death among people with diabetes. Adults with diabetes are two to four times more likely than people without diabetes to have heart disease or experience a stroke. At least 65% of people with diabetes die from heart disease or stroke. About 70% of people with diabetes also have high blood pressure.

How are cholesterol, triglyceride, weight, and blood pressure problems related to Diabetes?
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People with Type 2 Diabetes have high rates of cholesterol and triglyceride abnormalities, obesity, and high blood pressure, all of which are major contributors to higher rates of cardiovascular disease. Many people with diabetes have several of these conditions at the same time. This combination of problems is often called metabolic syndrome. The metabolic syndrome is often defined as the presence of any three of the following conditions:


* excess weight around the waist
* high levels of triglycerides
* low levels of HDL, or "good" cholesterol
* high blood pressure
* high fasting blood glucose levels

If you have one or more of these conditions, you are at an increased risk for having one or more of the others. The more conditions you have, the greater the risk to your health.

How can I be “heart healthy” and avoid cardiovascular disease if I have Diabetes?
To protect your heart and blood vessels, eat right, get physical activity, don’t smoke, and maintain healthy blood glucose, blood pressure, and cholesterol levels.


* Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals.
* If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise programme.
* Quit smoking if you currently do.
* Get a hemoglobin A1C test (HbA1c) at least twice a year to determine what your average blood glucose level was for the past 2 to 3 months.
* Get your blood pressure checked at every doctor’s visit, and get your cholesterol checked at least once a year. Take medications if prescribed by your doctor.

Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.

How can Diabetes affect the eyes?
In diabetic eye disease, high blood glucose and high blood pressure cause small blood vessels to swell and leak liquid into the retina of the eye, blurring the vision and sometimes leading to blindness. People with diabetes are also more likely to develop cataracts – a clouding of the eye’s lens, and glaucoma – optic nerve damage. Laser surgery can help these conditions.


How can I keep my eyes healthy if I have Diabetes?
There’s a lot you can do to prevent eye problems. A recent study shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Keeping your blood pressure under control is also important. Finding and treating eye problems early can help save sight. It is best to have an eye doctor give you a dilated eye examination at least once a year. The doctor will use eye drops to enlarge (dilate) your pupils to examination the back of your eyes. Your eyes will be checked for signs of cataracts or glaucoma, problems that people with diabetes are more likely to get.

Because diabetic eye disease may develop without symptoms, regular eye examinations are important for finding problems early. Some people may notice signs of vision changes. If you’re having trouble reading, if your vision is blurred, or if you’re seeing rings around lights, dark spots, or flashing lights, you may have eye problems. Be sure to tell your health care provider or eye doctor about any eye problems you may have

How can Diabetes affect the kidneys?

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Over many years diabetes affects the small blood vessels throughout the body. Damage may be caused to the kidneys as well as the eyes, skin, nerves, muscles, intestine and heart.

The kidneys contain tiny filters made up of small blood vessels and as these become damaged, protein leaks into the urine and the kidneys are less able to filter (purify) the blood properly.

The normal removal of excess salt and water from the body is reduced and toxic substances build up in the blood. Kidney failure caused by diabetes is called “diabetic nephropathy”.

If the nerves in the body are damaged by diabetes, it is called neuropathy, and this can affect bladder control, resulting in difficulty in emptying the bladder.

Urine can remain in the bladder and the pressure that builds up can back-up and damage the kidneys. In addition, if urine stays in the bladder for long periods of time, infection may develop because of the rapid growth of bacteria in urine that has high sugar content. In diabetic kidney disease (also called diabetic nephropathy); cells and blood vessels in the kidneys are damaged, affecting the organs’ ability to filter out wastes. Wastes build up in your blood instead of being excreted. In some cases this can lead to kidney failure. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week, or has to get a kidney transplant.

A number of studies have shown that regular physical activity and moderate weight loss can significantly reduce the risk of developing Type 2 Diabetes. Type 2 Diabetes also appears to be associated with obesity.

Researchers are making progress in identifying the exact genetics and "triggers" that predispose some individuals to develop Type 1 Diabetes, but prevention remains elusive.

When should I be tested for Diabetes?
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Anyone aged 45 years and above should consider getting tested for diabetes, especially if you are overweight. If you are younger than 45, but are overweight and have one or more additional risk factors (see below), you should consider testing.

What are the risk factors which increase the likelihood of developing Diabetes?
* Being overweight or obese (ref:Nutriweb)
* A parent, brother, or sister with diabetes
* Prior history of gestational diabetes or giving birth of at least one baby weighing more than 9 pounds
* High blood pressure measuring 140/90 or higher
* Physical inactivity, exercise less than three times a week

How does body weight affect the likelihood of developing Diabetes?
Being overweight or obese (ref:Nutriweb) is a leading risk factor for Type 2 Diabetes. Being overweight can keep your body from making and using insulin properly, and can also cause high blood pressure.

What is Pre-diabetes?
People with blood glucose levels that are higher than normal but not yet in the diabetic range have "pre-diabetes." Doctors sometimes call this condition impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it.

IFG is a condition in which the blood sugar level is high (6.1 to 7.0mmol/L) after an overnight fast but not high enough to be classified as diabetes. IGT is a condition in which the blood sugar level is high (7.8 to 11.1mmol/L) after a two-hour oral glucose tolerance test, but is not high enough to be classified as diabetes. Insulin resistance and pre-diabetes usually have no symptoms. You may have one or both conditions for several years without noticing anything.

If you have pre-diabetes, you have a higher risk of developing Type 2 Diabetes. Studies have shown that most people with pre-diabetes go on to develop Type 2 Diabetes within 10 years, unless they lose weight through modest changes in diet and physical activity. People with pre-diabetes also have a higher risk of heart disease.

Effects of Diabetes
Diabetes can affect any part of your body. The good news is that you can prevent most of these problems by keeping your blood glucose (blood sugar) under control, eating healthily, being more physically active, and working with your health care provider to keep your blood pressure and cholesterol under control and getting necessary screening tests.

Your body converts carbohydrates to glucose. Glucose is the simple sugar that is the main source of energy for the body's cells. To enter cells, glucose needs the help of insulin. Insulin is a hormone produced by the pancreas. When a person does not make enough insulin, the body can’t utilise glucose. The glucose builds up in the blood. High levels of glucose in the blood or urine lead to a finding of diabetes.

Diabetes mellitus is a disorder where the pancreas does not make enough insulin or the insulin is not effective. This insulin imbalance causes the body’s blood sugar level to rise, and eventually many unhealthy changes can occur in different body organs.

The normal and target blood glucose ranges are:
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Ref: American Diabetes Association Guidelines & The Malaysia Clinical Practice Guidelines 2005

There are more than 1 million people in Malaysia have diabetes. Many times the disease can lead to kidney damage and even kidney failure. Diabetes is the most common cause of kidney failure in Malaysia.

Latest statistics indicated that 57% of kidney failure was due to diabetes. Most people’s diabetes does not damage the kidneys enough to cause kidney failure. Proper control of diabetes and blood pressure, together with certain medications may prevent the onset of kidney complications or reduce further kidney damage if that has already occurred.

What are the symptoms of Diabetes?
People who think they might have diabetes must visit a physician for diagnosis. They might have SOME or NONE of the following symptoms:

* Frequent urination
* Excessive thirst
* Unexplained weight loss
* Extreme hunger
* Sudden vision changes
* Tingling or numbness in hands or feet
* Feeling very tired much of the time
* Very dry skin
* Sores that are slow to heal
* More infections than usual

Nausea, vomiting, or stomach pains may accompany some of these symptoms in the abrupt onset of insulin-dependent diabetes, namely Type1 Diabetes.

What are the types of Diabetes?
Type 1 Diabetes, also called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for 5% to 10% of all diagnosed cases of diabetes. Occurs mainly in young people below 30 years and is caused by an inability of the pancreas to produce enough insulin. These people need insulin injections.

Type 2 Diabetes, also called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes usually develops in people older than 40 years, accounts for about 90% to 95% of all diagnosed cases of diabetes. The abnormal blood sugar in these people is usually controlled with diet and / or medications.

Gestational diabetes is a type of diabetes that only pregnant women get. If not treated, it can cause problems for mothers and babies. Gestational diabetes develops in 2% to 5% of all pregnancies but usually disappears when a pregnancy is over.

What are the risk factors for Diabetes?
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Risk factors for Type 2 Diabetes include old age, obesity, a family history of diabetes, prior history of gestational diabetes, impaired glucose tolerance, physical inactivity, and race/ethnicity.

Risk factors are less well defined for Type 1 Diabetes than for Type 2 Diabetes, but autoimmune, genetic, and environmental factors are involved in developing this type of diabetes.

Gestational diabetes occurs more frequently in people with a family history of diabetes than in other groups. Obesity is also associated with higher risk. Women who have had gestational diabetes are at increased risk for developing Type 2 Diabetes in the later part of their life.

Studies have shown that nearly 40% of women with a history of gestational diabetes developed diabetes later. Other specific types of diabetes, which may account for 1% to 2% of all diagnosed cases, result from specific genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

What is the treatment for Diabetes?
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Healthy eating, physical activity, and insulin injections are the basic therapies for Type 1 Diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.

Healthy eating, physical activity, and blood glucose monitoring are the basic therapies for Type 2 Diabetes. Most people will require oral medications and eventually will require a combination of oral medications and insulin or a switch to insulin to control their blood glucose levels. People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high.

People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists (specialist deals with diseases that affect organs that make hormones), who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists (specialist deals with disorders of lower limbs) for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.

Is there a cure for Diabetes?
In response to the growing health burden of diabetes, the diabetes community has three choices: prevent diabetes; cure diabetes; and improve the quality of care of people with diabetes to prevent devastating complications. All three approaches are actively being pursued by the Ministry of Health Malaysia.

Several approaches to "cure" diabetes are being pursued overseas:

* Pancreas transplantation
* Islet cell transplantation (Islet cells produce insulin)
* Artificial pancreas development
* Genetic manipulation (fat or muscle cells that don’t normally make insulin have a human insulin gene inserted — then these "pseudo" islet cells are transplanted into people with Type 1 Diabetes)

Each of these approaches still has a lot of challenges, such as preventing immune rejection; finding an adequate number of insulin cells; keeping cells alive; and others. But progress is being made in all areas.

What causes Type 1 Diabetes?
The causes of Type 1 Diabetes appear to be much different than those for Type 2 Diabetes, though the exact mechanisms for developing both diseases are unknown. The appearance of Type 1 Diabetes is suspected to follow exposure to an "environmental trigger," such as an unidentified virus, stimulating an immune attack against the beta cells of the pancreas (that produce insulin) in some genetically predisposed people.