Shekswess/llama3_medquad_instruct_dataset huggingface dataset:
Question: What is (are) I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians ?
Answer: Diabetes causes blood glucose levels to be above normal. People with diabetes have problems converting food to energy. After food is eaten, it is broken down into a sugar called glucose. Glucose is then carried by the blood to cells throughout the body. The hormone insulin, made in the pancreas, helps the body change blood glucose into energy. People with diabetes, however, either no longer make enough insulin, or their insulin doesn't work properly, or both.
                
Type 2 diabetes
                
Type 2 diabetes is the most common type in American Indians. This type of diabetes can occur at any age, even during childhood. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the body cannot make enough insulin. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, blindness, kidney failure, and amputation.
                
Other kinds of diabetes
                
Type 1 diabetes
                
Type 1 diabetes is rare in American Indians. People develop type 1 diabetes when their bodies no longer make any insulin. Type 1 is usually first diagnosed in children or young adults but can develop at any age.
                
Gestational diabetes
                
Gestational diabetes is first diagnosed during pregnancy. It occurs when the body doesn't use insulin properly. Having an American Indian family background raises the risk of developing gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.
Question: What are the symptoms of I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians ?
Answer: Many people have no visible signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. More than 5 million people in the United States have type 2 diabetes and do not know it.
                
- increased thirst  - increased hunger   - fatigue   - increased urination, especially at night   - unexplained weight loss   - blurred vision   - sores that do not heal
Question: What is (are) Renal Artery Stenosis ?
Answer: Renal artery stenosis is the narrowing of one or both renal arteries. Renal means kidney and stenosis means narrowing. The renal arteries are blood vessels that carry blood to the kidneys from the aortathe main blood vessel that carries blood from the heart to arteries throughout the body.
                
RVH is high blood pressure caused by RAS. Blood pressure is written with two numbers separated by a slash, 120/80, and is said as 120 over 80. The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats. A persons blood pressure is considered normal if it stays at or below 120/80. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.1
Question: What causes Renal Artery Stenosis ?
Answer: About 90 percent of RAS is caused by atherosclerosisclogging, narrowing, and hardening of the renal arteries.2 In these cases, RAS develops when plaquea sticky substance made up of fat, cholesterol, calcium, and other material found in the bloodbuilds up on the inner wall of one or both renal arteries. Plaque buildup is what makes the artery wall hard and narrow.
                
Most other cases of RAS are caused by fibromuscular dysplasia (FMD)the abnormal development or growth of cells on the renal artery wallswhich can cause blood vessels to narrow. Rarely, RAS is caused by other conditions.
Question: Who is at risk for Renal Artery Stenosis? ?
Answer: People at risk for artherosclerosis are also at risk for RAS. Risk factors for RAS caused by artherosclerosis include
                
- high blood cholesterol levels  - high blood pressure  - smoking  - insulin resistance  - diabetes  - being overweight or obese  - lack of physical activity  - a diet high in fat, cholesterol, sodium, and sugar  - being a man older than 45 or a woman older than 55  - a family history of early heart disease
                
The risk factors for RAS caused by FMD are unknown, but FMD is most common in women and people 25 to 50 years of age.3 FMD can affect more than one person in a family, indicating that it may be caused by an inherited gene.
Question: What are the symptoms of Renal Artery Stenosis ?
Answer: In many cases, RAS has no symptoms until it becomes severe.
                
The signs of RAS are usually either high blood pressure or decreased kidney function, or both, but RAS is often overlooked as a cause of high blood pressure. RAS should be considered as a cause of high blood pressure in people who
                
- are older than age 50 when they develop high blood pressure or have a marked increase in blood pressure  - have no family history of high blood pressure  - cannot be successfully treated with at least three or more different types of blood pressure medications
                
Symptoms of a significant decrease in kidney function include
                
- increase or decrease in urination  - edemaswelling, usually in the legs, feet, or ankles and less often in the hands or face  - drowsiness or tiredness  - generalized itching or numbness  - dry skin  - headaches  - weight loss  - appetite loss  - nausea  - vomiting  - sleep problems  - trouble concentrating  - darkened skin  - muscle cramps
Question: What are the complications of Renal Artery Stenosis ?
Answer: People with RAS are at increased risk for complications resulting from loss of kidney function or atherosclerosis occurring in other blood vessels, such as
                
- chronic kidney disease (CKD)reduced kidney function over a period of time  - coronary artery diseasenarrowing and hardening of arteries that supply blood to the heart  - strokebrain damage caused by lack of blood flow to the brain  - peripheral vascular diseaseblockage of blood vessels that restricts flow of blood from the heart to other parts of the body, particularly the legs
                
RAS can lead to kidney failure, described as end-stage renal disease when treated with blood-filtering treatments called dialysis or a kidney transplant, though this is uncommon in people who receive ongoing treatment for RAS.
Question: What is (are) Amyloidosis and Kidney Disease ?
Answer: Primary amyloidosis and dialysis-related amyloidosis are the types of amyloidosis that can affect the kidneys.
                
Primary Amyloidosis of the Kidneys
                
The kidneys are the organs most commonly affected by primary amyloidosis. Amyloid deposits damage the kidneys and make it harder for them to filter wastes and break down proteins. When the kidneys become too damaged, they may no longer be able to function well enough to maintain health, resulting in kidney failure. Kidney failure can lead to problems such as high blood pressure, bone disease, and anemiaa condition in which the body has fewer red blood cells than normal.
                
Dialysis-related Amyloidosis
                
People who suffer from kidney failure and have been on long-term dialysis may develop dialysis-related amyloidosis. This type of amyloidosis occurs when a certain protein, called beta-2 microglobulin, builds up in the blood because dialysis does not remove it completely. The two types of dialysis are
                
- hemodialysis. Hemodialysis uses a special filter called a dialyzer to remove wastes and extra fluid from the blood.  - peritoneal dialysis. Peritoneal dialysis uses the lining of the abdominal cavitythe space in the body that holds organs such as the stomach, intestines, and liverto filter the blood.
                
Dialysis-related amyloidosis is a complication of kidney failure because neither hemodialysis nor peritoneal dialysis effectively filters beta-2 microglobulin from the blood. As a result, elevated amounts of beta-2 microglobulin remain in the blood. Dialysis-related amyloidosis is relatively common in people with kidney failure, especially adults older than 60 years of age, who have been on dialysis for more than 5 years.1
                
More information is provided in the NIDDK health topics:
                
- Treatment Methods for Kidney Failure: Hemodialysis  - Treatment Methods for Kidney Failure: Peritoneal Dialysis
Question: What are the symptoms of Amyloidosis and Kidney Disease ?
Answer: The most common sign of primary amyloidosis of the kidneys is nephrotic syndromea collection of signs that indicate kidney damage. The signs of nephrotic syndrome include
                
- albuminuriaan increased amount of albumin, a protein, in the urine. A person with nephrotic syndrome excretes more than half a teaspoon of albumin per day.  - hyperlipidemiaa condition in which a persons blood has more-than-normal amounts of fats and cholesterol.  - edemaswelling, typically in a persons legs, feet, or ankles and less often in the hands or face.  - hypoalbuminemiaa condition in which a persons blood has less-than-normal amounts of albumin.
                
More information is provided in the NIDDK health topic, Nephrotic Syndrome in Adults.
                
Other signs and symptoms of primary amyloidosis may include
                
- fatigue, or feeling tired  - shortness of breath  - low blood pressure  - numbness, tingling, or a burning sensation in the hands or feet  - weight loss
Question: What are the symptoms of Amyloidosis and Kidney Disease ?
Answer: The symptoms of dialysis-related amyloidosis may include
                
- pain, stiffness, and fluid in the joints.  - abnormal, fluid-containing sacs, called cysts, in some bones.  - carpal tunnel syndrome, caused by unusual buildup of amyloid proteins in the wrists. The symptoms of carpal tunnel syndrome include numbness or tingling, sometimes associated with muscle weakness, in the fingers and hands.
                
Dialysis-related amyloidosis most often affects bones, joints, and the tissues that connect muscle to bone, called tendons. The disease may also affect the digestive tract and organs such as the heart and lungs. Bone cysts caused by dialysis-related amyloidosis can lead to bone fractures. Dialysis-related amyloidosis can also cause tears in tendons and ligaments. Ligaments are tissues that connect bones to other bones.
Question: How to diagnose Amyloidosis and Kidney Disease ?
Answer: A health care provider diagnoses primary amyloidosis of the kidneys with
                
- a medical and family history  - a physical exam  - urinalysis  - blood tests  - a kidney biopsy
                
Medical and Family History
                
Taking a medical and family history may help a health care provider diagnose amyloidosis of the kidneys. He or she will ask the patient to provide a medical and family history.
                
Physical Exam
                
A physical exam may help diagnose primary amyloidosis of the kidneys. During a physical exam, a health care provider usually
                
- examines a patients body to check for swelling  - uses a stethoscope to listen to the lungs  - taps on specific areas of the patients body
                
Urinalysis
                
A health care provider may use urinalysisthe testing of a urine sampleto check for albumin and amyloid proteins in urine. The patient provides a urine sample in a special container at a health care providers office or a commercial facility. A nurse or technician can test the sample in the same location or send it to a lab for analysis. More-than-normal amounts of albumin in urine may indicate kidney damage due to primary amyloidosis. Amyloid proteins in urine may indicate amyloidosis.
                
Blood Tests
                
The health care provider may use blood tests to see how well the kidneys are working and to check for amyloid proteins and hyperlipidemia. A blood test involves drawing a patients blood at a health care providers office or a commercial facility and sending the sample to a lab for analysis. Blood tests for kidney function measure the waste products in the blood that healthy kidneys normally filter out. Hyperlipidemia may indicate nephrotic syndrome. Amyloid proteins in blood may indicate amyloidosis.
                
Kidney Biopsy
                
Only a biopsy can show the amyloid protein deposits in the kidneys. A health care provider may recommend a kidney biopsy if other tests show kidney damage. A kidney biopsy is a procedure that involves taking a piece of kidney tissue for examination with a microscope. A health care provider performs a kidney biopsy in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography (CT) scan to guide the biopsy needle into the kidney and take the tissue sample. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab for amyloid proteins and kidney damage.
                
The biopsy results can help the health care provider determine the best course of treatment. More information is provided in the NIDDK health topic, Kidney Biopsy.
Question: How to diagnose Amyloidosis and Kidney Disease ?
Answer: A health care provider diagnoses dialysis-related amyloidosis with
                
- urinalysis  - blood tests  - imaging tests
                
A health care provider can use urinalysis and blood tests to detect the amount of amyloid proteins in urine and blood. Imaging tests, such as x-rays and CT scans, can provide pictures of bone cysts and amyloid deposits in bones, joints, tendons, and ligaments. An x-ray technician performs imaging tests in a health care providers office, an outpatient center, or a hospital. A radiologista doctor who specializes in medical imaginginterprets the images. A patient does not require anesthesia.
Question: What are the treatments for Amyloidosis and Kidney Disease ?
Answer: A health care provider treats primary amyloidosis of the kidneys with the following:
                
- medication therapy, including chemotherapy  - a stem cell transplant  - treating other conditions
                
Medication therapy. The goal of medication therapy, including chemotherapy, is to reduce amyloid protein levels in the blood. Many health care providers recommend combination medication therapy such as
                
- melphalan (Alkeran), a type of chemotherapy  - dexamethasone (Decadron), an anti-inflammatory steroid medication
                
These medications can stop the growth of the cells that make amyloid proteins. These medications may cause hair loss and serious side effects, such as nausea, vomiting, and fatigue.
                
Stem cell transplant. A stem cell transplant is a procedure that replaces a patients damaged stem cells with healthy ones. Stem cells are found in the bone marrow and develop into three types of blood cells the body needs. To prepare for a stem cell transplant, the patient receives high doses of chemotherapy. The actual transplant is like a blood transfusion. The transplanted stem cells travel to the bone marrow to make healthy new blood cells. The chemotherapy a patient receives to prepare for the transplant can have serious side effects, so it is important to talk with the health care provider about the risks of this procedure.
                
Read more in What Is a Blood and Marrow Stem Cell Transplant? at www.nhlbi.nih.gov/health/health-topics/topics/bmsct.
                
Treating other conditions. Primary amyloidosis has no cure, so treating some of the side effects and other conditions seen with the disease is essential. Other conditions may include
                
- anemiatreatment may include medications  - depressiontreatment may include talking with a mental health counselor and taking medications  - fatiguetreatment may include changes in diet and activity level  - kidney diseasetreatment may include medications to help maintain kidney function or slow the progression of kidney disease
                
A patient and his or her family should talk with the health care provider about resources for support and treatment options.
                
More information about kidney disease is provided in the NIDDK health topic, niddk-kidney disease.
Question: What are the treatments for Amyloidosis and Kidney Disease ?
Answer: A health care provider treats dialysis-related amyloidosis with
                
- medication therapy  - newer, more effective hemodialysis filters  - surgery  - a kidney transplant
                
The goal of medication therapy and the use of newer, more effective hemodialysis filters is to reduce amyloid protein levels in the blood. Medication therapy can help reduce symptoms such as pain and inflammation. A health care provider may treat a person with dialysis-related amyloidosis who has bone, joint, and tendon problems, such as bone cysts and carpal tunnel syndrome, using surgery.
                
Dialysis-related amyloidosis has no cure; however, a successful kidney transplant may stop the disease from progressing.
                
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure: Transplantation.
Question: What to do for Amyloidosis and Kidney Disease ?
Answer: Researchers have not found that eating, diet, and nutrition play a role in causing or preventing primary amyloidosis of the kidneys or dialysis-related amyloidosis. People with nephrotic syndrome may make dietary changes such as
                
- limiting dietary sodium, often from salt, to help reduce edema and lower blood pressure  - decreasing liquid intake to help reduce edema and lower blood pressure  - eating a diet low in saturated fat and cholesterol to help control more-than-normal amounts of fats and cholesterol in the blood
                
Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein. Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients.
                
People with kidney disease on a restricted protein diet should receive blood tests that can show low nutrient levels. People with primary amyloidosis of the kidneys or dialysis-related amyloidosis should talk with a health care provider about dietary restrictions to best manage their individual needs.
Question: What is (are) Amyloidosis and Kidney Disease ?
Answer: You and your doctor will work together to choose a treatment that's best for you. The publications of the NIDDK Kidney Failure Series can help you learn about the specific issues you will face.
                
Booklets
                
- What I need to know about Kidney Failure and How its Treated  - Treatment Methods for Kidney Failure: Hemodialysis  - Treatment Methods for Kidney Failure: Peritoneal Dialysis  - Treatment Methods for Kidney Failure: Kidney Transplantation  - Kidney Failure: Eat Right to Feel Right on Hemodialysis
                
Fact Sheets
                
- Kidney Failure: What to Expect  - Vascular Access for Hemodialysis  - Hemodialysis Dose and Adequacy  - Peritoneal Dialysis Dose and Adequacy  - Amyloidosis and Kidney Disease  - Anemia in Chronic Kidney Disease  - Chronic Kidney Disease-Mineral and Bone Disorder  - Financial Help for Treatment of Kidney Failure
                
Learning as much as you can about your treatment will help make you an important member of your health care team.
                

                

                
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.
                
The NIDDK would like to thank: Glenn Chertow, M.D., University of California at San Francisco; William J. Stone, M.D., Vanderbilt University; Morie A. Gertz, M.D., Mayo Clinic
                
This information is not copyrighted. The NIDDK encourages people to share this content freely.
                

                

                
September 2014
Question: What is (are) Primary Biliary Cirrhosis ?
Answer: Primary biliary cirrhosis is a chronic, or long lasting, disease that causes the small bile ducts in the liver to become inflamed and damaged and ultimately disappear.
                
The bile ducts carry a fluid called bile from the liver to the gallbladder, where it is stored. When food enters the stomach after a meal, the gallbladder contracts, and the bile ducts carry bile to the duodenum, the first part of the small intestine, for use in digestion. The liver makes bile, which is made up of bile acids, cholesterol, fats, and fluids. Bile helps the body absorb fats, cholesterol, and fat-soluble vitamins. Bile also carries cholesterol, toxins, and waste products to the intestines, where the body removes them. When chronic inflammation, or swelling, damages the bile ducts, bile and toxic wastes build up in the liver, damaging liver tissue.
                
This damage to the liver tissue can lead to cirrhosis, a condition in which the liver slowly deteriorates and is unable to function normally. In cirrhosis, scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver.
                
The liver is the bodys largest internal organ. The liver is called the bodys metabolic factory because of the important role it plays in metabolismthe way cells change food into energy after food is digested and absorbed into the blood. The liver has many functions, including
                
- taking up, storing, and processing nutrients from foodincluding fat, sugar, and proteinand delivering them to the rest of the body when needed  - making new proteins, such as clotting factors and immune factors  - producing bile  - removing waste products the kidneys cannot remove, such as fats, cholesterol, toxins, and medications
                
A healthy liver is necessary for survival. The liver can regenerate most of its own cells when they become damaged. However, if injury to the liver is too severe or long lasting, regeneration is incomplete, and the liver creates scar tissue. Scarring of the liver may lead to cirrhosis.
                
The buildup of scar tissue that causes cirrhosis is usually a slow and gradual process. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse and scar tissue replaces more healthy tissue, the liver will begin to fail. Chronic liver failure, which is also called end-stage liver disease, progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or effectively replace damaged cells.
                
Primary biliary cirrhosis usually occurs between the ages of 30 and 65 and affects women more often than men.1