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Kidney Disease

Overview :

The kidneys are a pair bean-shaped, fist-sized organs that are located below the rib cage near the middle of the back. In adults they filter about 200 quarts (190 L) of blood every day to remove waste products that result from the normal activities of tissues in the body. These wastes circulate in the blood. and if not removed they would damage the body. The kidneys also play a crucial role in regulating the amount of water and chemicals (electrolytes) in the body such as sodium, potassium and phosphorous.

Inside the kidneys are about one million tiny units called nephrons. Inside each nephron is a very thin blood vessel called a capillary that twists around a very thin tube called a tubule. This combination of capillary and tubule inside the nephron is called a glomerulous and it is here that the blood is filtered. Water, electrolytes, and waste products (but not red blood cells) can pass across the capillary wall and into the tubule. The kidney then regulates how much water and which other substances can pass back into the blood in the capillary to keep the body in balance. Waste products, excess water, and excess electrolytes remain in the tubule and eventually leave the body as urine.

The kidneys also release three regulatory chemicals—erythropoietin, renin, and calcitriol—that affect other functions in the body. Erythropoietin stimulates the bone marrow to produce new red blood cells. Renin helps regulate blood pressure, and calcitriol is a form of vitamin D and is important in maintaining bones and the level of calcium in the body.

Because the kidney has many functions, there are many types of kidney disease. Congenital kidney diseases are disorders that are present at birth. Polycystic kidney disease (PKD) is a rare disorder in which children inherit defective genes from both parents that cause cysts full of fluid to develop in the kidneys and replace the blood filtering units. As a result, the kidneys cannot adequately remove wastes from the body. There are two other types of PDK. One is inherited, but does not appear until adulthood, and the other develops as a result of long-term kidney damage. In total, about half a million people in the United States have some form of PKD. Hereditary disease and birth defects are the most common causes of kidney disease in children up to age 14.

Acute kidney diseases are problems that develop suddenly. Many acute kidney diseases can be cured, but some may cause permanent damage. Common acute kidney diseases include kidney infection, hemolytic uremic syndrome, nephrotic syndrome in children, and damage caused by injury to the kidney or poisoning. Hemolytic uremic syndrome is a rare disease that usually affects children under age ten and is caused by eating food contaminated with bacteria. The bacteria release a poison that damages the kidney and causes acute kidney failure. Most children who develop this disease recover and their kidney function returns to normal.

Chronic kidney disease is disease that is slow to develop and usually does not show any symptoms until kidney damage is permanent. The National Kidney and Urologic Disease Information Clearinghouse, a federal agency, estimates that about 4.5% of people over age 20 have chronic kidney disease as indicated by tests that measure kidney function. The most common cause of chronic kidney disease in the United States is diabetes. It accounts for between 33% and 40% of all new cases of chronic kidney disease in the United States. In diabetes, the body cannot break down glucose (sugar). This extra glucose in the blood damages the nephrons so that they no longer filter blood effectively.

High or uncontrolled blood pressure (hypertension) is the second leading cause of chronic kidney disease. It accounts for between 27% and 30% of all new cases of chronic kidney disease. High blood pressure damages the capillaries in the nephron, so that they can no longer work with the tubules to filter the blood. Glomerulonephtitis is a term for several different chronic kidney diseases where damage to the nephrons causes protein or red blood cells pass into the urine. Kidney cancer is uncommon, accounting for only 2% of cancer cases.

Over-the-counter analgesics (pain medications) such as aspirin, acetaminophen (Tylenol), ibuprofen (Advil), naxopren sodium (Aleve), and similar medications that can be bought without a prescription may make kidney disease worse in individuals who already have kidney damage or cause kidney damage in healthy individuals who take these medications daily for several years. The chance of damage is increased when these pain medications are taken in combination with each other or with caffeine or codeine (Some painkilling tablets are a combination of pain medications and caffeine or codeine). Individuals who take these painkillers regularly or who have been told they have kidney damage should discuss the risk of these medications with their physician.

Chronic kidney disease can lead to end-stage renal disease (ESRD), in which there is almost total failure of the kidneys. If renal function is reduced to only 25% of normal, serious illness results. When this drops to 10-15% of normal, death occurs unless the individual receives dialysis or a kidney transplant. In 2002, there were over 100,300 new cases of ESRD, 44% of which were caused by diabetes. Treatment of ESRD in the United States cost about $25.2 billion in 2002.

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