Acute Renal Failure

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Acute Renal FailureWhen acute renal failure occurs, waste products and excess water build up in the body, which upsets the body's normal chemical balance. Substances that are normally needed for the body to function properly become poisonous to the body when the reach abnormally high levelsTreatmentTreatment for ARF depends in large part on the cause and therefore varies widely. It may be necessary to

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• Replace lost fluids, such as water, blood, and plasma, and restore blood flow to the kidneys. In cases of prerenal ARF caused by dehydration or blood loss, for example, kidney function often can be restored rapidly once fluid and blood losses have been corrected.• Stop any medications that may be causing the problem, such as antibiotics, nonsteroidal anti-inflammatory drugs angiotensin-converting enzyme inhibitors, and, if possible, avoid X-ray tests that require a contrast agent.• Treat kidney disease that is causing intrinsic ARF by using plasma exchange, glucocorticoids or other medications, depending on the specific disease.• Use immunosuppressive medications, such as cyclophosphamide, when an autoimmune disorder is causing ARF. Autoimmune disorders that cause ARF include lupus, Wegeners granulomatosis, Goodpastures syndrome, and other types of vasculitis.• Remove or bypass a blockage in the urinary tract. In cases of postrenal ARF, kidney function often returns to normal rapidly once urine is allowed to flow out of the kidneys. Some obstructions, such as kidney stones, can be removed. If the obstruction cannot be removed, urine flow may be rerouted around the obstruction using a catheter or another method. If the bladder is not emptying properly, placing a catheter in the bladder to empty it can rapidly relieve symptoms and allow kidney function to return to normal.Kidney StonesKidney stones are one of the most painful disorders to afflict humans. A kidney stone develops from crystals that separate from urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, and some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without even being noticed. Most kidney stones pass out of the body without any intervention by a physician. Cases that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery.TreatmentBecause 0% of kidney stones pass out of the body on their ownwithin three to six weeks, a doctor will most likely at first prescribeonly plenty of water adding up to at least three quarts a day, and a pain medication, such as ibuprofen or acetaminophen withoxycodone. A hot-water bottle can also help ease the discomfort. Patients are often asked to urinate through a strainer so the stone canbe recovered and analyzed. Once the stones composition is known, adoctor can prescribe drugs or suggest dietary changes to preventdeveloping another one. The vast majority of kidney stones consist of calcium oxalate, so doctors may prescribe a thiazide diuretic toprevent recurrences. If complications develop, such as an infection or total blockage of theureter, the stone must be surgically removed. Depending on its size, type, and location, the stone is taken out either by conventional surgery or, more commonly, with a thin telescopic instrument. The surgeon passes the scope through the urethra into the bladder or ureter and then either pulls the stone out or bombards it with sound waves or laser beams, breaking it up into tiny pieces. If the stone is lodged in the kidney, the instrument is inserted into the kidney through an incision in the patients side. Another method, known as extracorporeal shock wave lithotripsy, uses high-energy shock waves to break up kidney stones without surgery.Renal Cell Kidney CancerAs kidney cancer grows, it may invade organs near the kidney, such as the liver, colon, or pancreas. Kidney cancer cells may also break away from the original tumor and spread (metastasize) to other parts of the body. When kidney cancer spreads, cancer cells may appear in the lymph nodes. Kidney cancer may spread and form new tumors, most often in the bones or lungs. The new tumors have the same kind of abnormal cells and the same name as the original (primary) tumor in the kidney. For example, if kidney cancer spreads to the lungs, the cancer cells in the lungs are kidney cancer cells. The disease is metastatic kidney cancer; it is not lung cancer.TreatmentTreatment for kidney cancer depends on the stage of the disease, the patients general health and age, and other factors. The doctor develops a treatment plan to fit each patients needs. People with kidney cancer are often treated by a team of specialists, which may include a urologist, an oncologist, and a radiation oncologist. Kidney cancer is usually treated with surgery to remove cancerous tumors, radiation therapy, biological therapy, chemotherapy, or hormone therapy.

Radiation therapy uses intense beams of x-rays, which are targeted directly and precisely at the cancer. Some burning of the skin may occur and cause some discomfort. Patients tend to be tired during a schedule of radiation treatments. Radiation therapy will generally last for 5- 6 weeks and occur on several days of the week.Biological Therapy (sometimes called immunotherapy, biotherapy, or biological response modifier therapy) is a promising new addition to the family of cancer treatments that includes surgery, chemotherapy, and radiation therapy. Biological therapies use the bodys immune system, either directly or indirectly, to fight cancer or to lessen side effects that may be caused by some cancer treatments. The body has a natural ability to protect itself against diseases, including cancer. The immune system, a complex network of cells and organs that work together to defend the body again attacks by foreign or non-self invaders, is one of the bodys main defenses against disease. Researchers have found that the immune system may recognize the difference between healthy cells and cancer cells in the body and eliminate those that become cancerous. Cancer may develop when the immune system breaks down or is overwhelmed. Biological therapies are designed to repair, stimulate, or enhance the immune systems natural anticancer function. Immune system cells and proteins called antibodies, which are part of the immune system, work against cancer and other diseases by creating an immune response against foreign invaders (antigens). This immune response is unique because antibodies are specifically programmed to recognize and defend against certain antigens. Antibodies respond to antigens by latching on to, or binding with, antigens, fitting together much the way a key fits a lock.Chemotherapy is the use of drugs to treat cancer. The drugs often are called anticancer drugs. Anticancer drugs destroy cancer cells by stopping growth or multiplication at some point in their life cycle. Because some drugs work better together, chemotherapy often may consist of more than one drug. This is called combination chemotherapy.Sometimes a special treatment called arterial embolization is used. This is a method in which a narrow plastic tube to inject small pieces of gelatin sponge into the main blood vessel that flows into the kidney. This blocks the blood cells that feed the tumor so that cancer cells no longer receive oxygen or other substances they need to grow. The doctors may decide to use one treatment method or a combination of methods. Some people take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.Diabetic NephropathyDiabetes is a disease that keeps the body from using sugar as it should. If sugar stays in a person's blood instead of breaking down, it can act like a poison. Damage to the nephrons from unused sugar in the blood is called diabetic nephropathy. If a person keeps their blood sugar levels down, they can delay or prevent diabetic nephropathy.TreatmentThere is no known cure for diabetic neuropathy. Treatment focuses on preventing the development and slowing the progression of the disease by consistently keeping a persons blood sugar level within a safe range. The results of long-term studies show that keeping the blood sugar level as close to normal as possible (using tight blood sugar control) reduces the risk of the development and progression of neuropathy. Keeping blood sugar level within a safe range helps decrease chances of developing other complications from diabetes as well. No treatment other than strict control of blood sugar has been proven to have an effect on the progression of diabetic neuropathy. All other treatments aim at relieving symptoms.Many people with diabetic neuropathy have mild to severe pain in specific parts of their bodies. Treatment can help reduce pain and the impact it has on a persons life. It can improve physical functioning, mood, and mental well-being. Several forms of treatment may be used to relieve pain caused by diabetic neuropathy. These include• Medications.• Complementary therapies, such as acupuncture, massage, and biofeedback.• Physical therapy.• Transcutaneous electrical nerve stimulation (TENS), a type of therapy that attempts to reduce pain by applying brief pulses of electricity to nerve endings in the skin. Diabetic neuropathy can affect digestion, urination, sweating, sexual function, blood pressure, and other involuntary (autonomic) body functions. Some symptoms of autonomic neuropathy can be hard to manage, but others respond well to treatment.• Digestive problems• Eating smaller, more frequent meals that contain less fat and fiber may reduce mild, frequent constipation, belching, and nausea.• More severe symptoms may improve in response to treatment with medications that help the stomach empty more quickly (motility agents), such as metoclopramide (Reglan) or erythromycin. (Erythromycin is an antibiotic, but it can also help the stomach empty more quickly.) In very severe cases, a feeding tube placed in the small intestine may be needed.• Frequent diarrhea may be treated with antibiotics such as tetracycline, amoxicillin, or metronidazole or with medications that slow how quickly digested food and waste travel through the intestines.• Urinary problems • Urinary tract infections (UTIs) are a common result of autonomic neuropathy because nerve damage can disrupt the proper emptying of the bladder, which increases the risk of infection. UTIs may be treated with antibiotics. Drinking more fluids each day can help prevent UTIs.• Nerve damage may reduce the ability to know when the bladder is full. Urinating on a regular schedule (every 4 hours, for instance), regardless of whether the patient thinks his bladder is full, is the usual approach to treating this problem. If neuropathy is causing a patient to urinate involuntarily (urinary incontinence), medications such as oxybutynin (Ditropan) or tolterodine (Detrol) may be helpful.

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