Shekswess/llama3_medquad_instruct_dataset huggingface dataset:
Question: How to diagnose Vesicoureteral Reflux ?
Answer: The most common tests used to diagnose VUR include
                
- Voiding cystourethrogram (VCUG). VCUG is an x-ray image of the bladder and urethra taken during urination, also called voiding. The bladder and urethra are filled with a special dye, called contrast medium, to make the urethra clearly visible. The x-ray machine captures a video of the contrast medium when the child urinates. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician supervised by a radiologista doctor who specializes in medical imagingwho then interprets the images. Anesthesia is not needed, but sedation may be used for some children. This test can show abnormalities of the inside of the urethra and bladder.  - Radionuclide cystogram (RNC). RNC is a type of nuclear scan that involves placing radioactive material into the bladder. A scanner then detects the radioactive material as the child urinates or after the bladder is empty. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist. Anesthesia is not needed, but sedation may be used for some children. RNC is more sensitive than VCUG but does not provide as much detail of the bladder anatomy.  - Abdominal ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. An abdominal ultrasound can create images of the entire urinary tract, including the kidneys and bladder. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. Ultrasound may be used before VCUG or RNC if the childs family or health care provider wants to avoid exposure to x-ray radiation or radioactive material.
                
Testing is usually done on
                
- infants diagnosed during pregnancy with urine blockage affecting the kidneys  - children younger than 5 years of age with a UTI  - children with a UTI and fever, called febrile UTI, regardless of age  - males with a UTI who are not sexually active, regardless of age or fever  - children with a family history of VUR, including an affected sibling
                
More information about urine blockage in infants is provided in the NIDDK health topic, Urine Blockage in Newborns.
                
VUR is an unlikely cause of UTI in some children, so these tests are not done until other causes of UTI are ruled out for
                
- children 5 years of age and older with a UTI  - children with a UTI but no fever  - sexually active males with a UTI
Question: How to diagnose Vesicoureteral Reflux ?
Answer: Following diagnosis, children with VUR should have a general medical evaluation that includes blood pressure measurement, as high blood pressure is an indicator of kidney damage. If both kidneys are affected, a childs blood should be tested for creatininea waste product of normal muscle breakdown. Healthy kidneys remove creatinine from the blood; when the kidneys are damaged, creatinine builds up in the blood. The urine may be tested for the presence of protein and bacteria. Protein in the urine is another indication of damaged kidneys.
                
- having to urinate often or suddenly  - long periods of time between bathroom visits  - daytime wetting  - pain in the penis or perineumthe area between the anus and genitals  - posturing to prevent wetting  - constipationa condition in which a child has fewer than two bowel movements in a week; the bowel movements may be painful  - fecal incontinenceinability to hold stool in the colon and rectum, which are parts of the large intestine
Question: What are the treatments for Vesicoureteral Reflux ?
Answer: The standard treatment for primary VUR has included prompt treatment of UTIs and long-term use of antibiotics to prevent UTIs, also called antimicrobial prophylaxis, until VUR goes away on its own. Antibiotics are bacteria-fighting medications. Surgery has also been used in certain cases.
                
Several studies have raised questions about long-term use of antibiotics for prevention of UTIs. The studies found little or no effect on prevention of kidney damage. Long-term use may also make the child resistant to the antibiotic, meaning the medication does not work as well, and the child may be sicker longer and may need to take medications that are even stronger.
                
- children younger than 1 year of age continuous antibiotics should be used if a child has a history of febrile UTI or VUR grade III through V that was identified through screening  - children older than 1 year of age with BBDcontinuous antibiotics should be used while BBD is being treated  - children older than 1 year of age without BBDcontinuous antibiotics can be used at the discretion of the health care provider but is not automatically recommended; however, UTIs should be promptly treated
                
Deflux, a gellike liquid containing complex sugars, is an alternative to surgery for treatment of VUR. A small amount of Deflux is injected into the bladder wall near the opening of the ureter. This injection creates a bulge in the tissue that makes it harder for urine to flow back up the ureter. The health care provider uses a special tube to see inside the bladder during the procedure. Deflux injection is an outpatient procedure done under general anesthesia, so the child can go home the same day.
Question: What are the treatments for Vesicoureteral Reflux ?
Answer: Secondary VUR is treated by removing the blockage causing the reflux. Treatment may involve
                
- surgery  - antibiotics  - intermittent catheterizationdraining the bladder by inserting a thin tube, called a catheter, through the urethra to the bladder
Question: What is (are) Diabetic Kidney Disease ?
Answer: Diabetic kidney disease, also called diabetic nephropathy, is kidney disease caused by diabetes. Even when well controlled, diabetes can lead to chronic kidney disease (CKD) and kidney failure, described as end-stage kidney disease or ESRD when treated with a kidney transplant or blood-filtering treatments called dialysis.
                
Diabetes affects 25.8 million people of all ages in the United States.1 As many as 40 percent of people who have diabetes are expected to develop CKD.2 Diabetes, the most common cause of kidney failure in the United States, accounts for nearly 44 percent of new cases of kidney failure, as illustrated in Figure 1.3
Question: What is (are) Diabetic Kidney Disease ?
Answer: The kidneys are two bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. Every day, the two kidneys filter about 120 to 150 quarts of blood to produce about 1 to 2 quarts of urine, composed of wastes and extra fluid. The urine flows from the kidneys to the bladder through tubes called ureters. The bladder stores urine.
                
When the bladder empties, urine flows out of the body through a tube called the urethra, located at the bottom of the bladder. In men the urethra is long, while in women it is short.
                
Kidneys work at the microscopic level. The kidney is not one large filter. Each kidney is made up of about a million filtering units called nephrons. Each nephron filters a small amount of blood. The nephron includes a filter, called the glomerulus, and a tubule. The nephrons work through a two-step process. The glomerulus lets fluid and waste products pass through it; however, it prevents blood cells and large molecules, mostly proteins, from passing. The filtered fluid then passes through the tubule, which sends needed minerals back to the bloodstream and removes wastes. The final product becomes urine.
Question: What is (are) Diabetic Kidney Disease ?
Answer: Diabetes is a complex group of diseases with a variety of causes. People with diabetes have high blood glucose, also called high blood sugar or hyperglycemia.
                
Diabetes is a disorder of metabolism the way the body uses digested food for energy. The digestive tract breaks down carbohydratessugars and starches found in many foodsinto glucose, a form of sugar that enters the bloodstream. With the help of the hormone insulin, cells throughout the body absorb glucose and use it for energy.
                
Insulin is made in the pancreas, an organ located behind the stomach and below the liver. As blood glucose levels rise after a meal, the pancreas is triggered to release insulin. The pancreas contains clusters of cells called pancreatic islets. Beta cells within the pancreatic islets make insulin and release it into the blood.
                
Diabetes develops when the body doesnt make enough insulin, is not able to use insulin effectively, or both. As a result, glucose builds up in the blood instead of being absorbed by cells in the body. The bodys cells are then starved of energy despite high blood glucose levels.
Question: What are the symptoms of Diabetic Kidney Disease ?
Answer: People with diabetic kidney disease do not have symptoms in the early stages. As kidney disease progresses, a person can develop edema, or swelling. Edema happens when the kidneys cannot get rid of the extra fluid and salt in the body. Edema can occur in the legs, feet, or ankles and less often in the hands or face. Once kidney function decreases further, symptoms may include
                
- appetite loss  - nausea  - vomiting  - drowsiness, or feeling tired  - trouble concentrating  - sleep problems  - increased or decreased urination  - generalized itching or numbness  - dry skin  - headaches  - weight loss  - darkened skin  - muscle cramps  - shortness of breath  - chest pain
Question: How to diagnose Diabetic Kidney Disease ?
Answer: A health care provider diagnoses diabetic kidney disease based on
                
- a medical and family history  - a physical exam  - urine tests  - a blood test
                
Medical and Family History
                
Taking a medical and family history is one of the first things a health care provider may do to help diagnose diabetic kidney disease. He or she will ask about the symptoms and the patients diabetes history.
                
Physical Exam
                
After taking a medical and family history, a health care provider will perform a physical exam. During a physical exam, a health care provider usually
                
- examines the patients body to check for changes in skin color  - taps on specific areas of the patients body, checking for swelling of the feet, ankles, or lower legs
                
Urine Tests
                
Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine. A patient collects the urine sample in a special container in a health care providers office or a commercial facility. The office or facility tests the sample onsite or sends it to a lab for analysis. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the urine. Patches on the dipstick change color when blood or protein is present in urine.
                
Urine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The patient collects a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed into the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine. A urine albumin-to-creatinine ratio above 30 mg/g may be a sign of kidney disease.
                
Blood Test
                
A blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood the kidneys filter each minute, called the estimated glomerular filtration rate (eGFR). The results of the test indicate the following:
                
- eGFR of 60 or above is in the normal range  - eGFR below 60 may indicate kidney damage  - eGFR of 15 or below may indicate kidney failure
Question: How to diagnose Diabetic Kidney Disease ?
Answer: People with diabetes should get regular screenings for kidney disease. The National Kidney Disease Education Program recommends the following:
                
- urine albumin-to-creatinine ratio measured at least once a year in all people with type 2 diabetes and people who have had type 1 diabetes for 5 years or more  - eGFR calculated at least once a year in all people with type 1 or type 2 diabetes
Question: What are the treatments for Diabetic Kidney Disease ?
Answer: A health care provider may treat kidney failure due to diabetic kidney disease with dialysis or a kidney transplant. In some cases, people with diabetic kidney disease receive kidney and pancreas transplants.
                
In most cases, people with diabetic kidney disease start dialysis earlier than people with kidney failure who do not have diabetes. People with diabetic end-stage kidney disease who receive a kidney transplant have a much better survival rate than those people on dialysis, although survival rates for those on dialysis have increasingly improved over time. However, people who receive a kidney transplant and do not have diabetes have a higher survival rate than people with diabetic kidney disease who receive a transplant.5
                
More information about treatment options for kidney failure is provided in the NIDDK health topics:
                
- Treatment Methods for Kidney Failure: Hemodialysis  - Treatment Methods for Kidney Failure: Peritoneal Dialysis  - Treatment Methods for Kidney Failure: Transplantation
Question: What are the treatments for Diabetic Kidney Disease ?
Answer: People with diabetes should work with their health care team to prevent or manage CKD through the following steps:
                
- measure A1C levelsa blood test that provides information about a persons average blood glucose levels for the previous 3 months at least twice a year and keep A1C levels below 7 percent  - learn about insulin injections, diabetes medications, meal planning, physical activity, and blood glucose monitoring  - find out whether protein, salt, or liquid should be limited in the diet  - see a registered dietitian to help with meal planning  - check blood pressure every visit with a health care provider or at least two to four times a year  - learn about possible benefits from taking an ACE inhibitor or an ARB if a person has high blood pressure  - measure eGFR at least once a year to check kidney function  - get the amount of protein in the urine tested at least once a year to check for kidney damage
Question: What is (are) Hemolytic Uremic Syndrome in Children ?
Answer: Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system. Red blood cells contain hemoglobinan iron-rich protein that gives blood its red color and carries oxygen from the lungs to all parts of the body.
                
When the kidneys and glomerulithe tiny units within the kidneys where blood is filteredbecome clogged with the damaged red blood cells, they are unable to do their jobs. If the kidneys stop functioning, a child can develop acute kidney injurythe sudden and temporary loss of kidney function. Hemolytic uremic syndrome is the most common cause of acute kidney injury in children.
Question: What causes Hemolytic Uremic Syndrome in Children ?
Answer: The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system. The digestive system is made up of the gastrointestinal, or GI, tracta series of hollow organs joined in a long, twisting tube from the mouth to the anusand other organs that help the body break down and absorb food.
                
Normally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream. The toxins travel through the bloodstream and can destroy the red blood cells. E.coli O157:H7 can be found in
                
- undercooked meat, most often ground beef  - unpasteurized, or raw, milk  - unwashed, contaminated raw fruits and vegetables  - contaminated juice  - contaminated swimming pools or lakes
                
Less common causes, sometimes called atypical hemolytic uremic syndrome, can include
                
- taking certain medications, such as chemotherapy  - having other viral or bacterial infections  - inheriting a certain type of hemolytic uremicsyndrome that runs in families
                
More information about foodborne illnesses and the digestive system is provided in the NIDDK health topic, foodborne illnesses.
Question: What are the symptoms of Hemolytic Uremic Syndrome in Children ?
Answer: A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritisan inflammation of the lining of the stomach, small intestine, and large intestine such as
                
- vomiting  - bloody diarrhea  - abdominal pain  - fever and chills  - headache
                
As the infection progresses, the toxins released in the intestine begin to destroy red blood cells. When the red blood cells are destroyed, the child may experience the signs and symptoms of anemiaa condition in which red blood cells are fewer or smaller than normal, which prevents the body's cells from getting enough oxygen.
                
Signs and symptoms of anemia may include
                
- fatigue, or feeling tired  - weakness  - fainting  - paleness
                
As the damaged red blood cells clog the glomeruli, the kidneys may become damaged and make less urine. When damaged, the kidneys work harder to remove wastes and extra fluid from the blood, sometimes leading to acute kidney injury.
                
Other signs and symptoms of hemolytic uremic syndrome may include bruising and seizures.
                
When hemolytic uremic syndrome causes acute kidney injury, a child may have the following signs and symptoms:
                
- edemaswelling, most often in the legs, feet, or ankles and less often in the hands or face  - albuminuriawhen a child's urine has high levels of albumin, the main protein in the blood  - decreased urine output  - hypoalbuminemiawhen a child's blood has low levels of albumin  - blood in the urine
                

                
Seek Immediate Care   Parents or caretakers should seek immediate care for a child experiencing any urgent symptoms, such as   - unusual bleeding   - swelling   - extreme fatigue   - decreased urine output   - unexplained bruises
Question: What are the complications of Hemolytic Uremic Syndrome in Children ?
Answer: Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health.1
                
However, children with hemolytic uremic syndrome may have serious and sometimes life-threatening complications, including
                
- acute kidney injury  - high blood pressure  - blood-clotting problems that can lead to bleeding  - seizures  - heart problems  - chronic, or long lasting, kidney disease  - stroke  - coma
Question: What are the treatments for Hemolytic Uremic Syndrome in Children ?
Answer: A health care provider will treat a child with hemolytic uremic syndrome by addressing
                
- urgent symptoms and preventing complications  - acute kidney injury  - chronic kidney disease (CKD)
                
In most cases, health care providers do not treat children with hemolytic uremic syndrome with antibiotics unless they have infections in other areas of the body. With proper management, most children recover without long-term health problems.2
                
Treating Urgent Symptoms and Preventing Complications
                
A health care provider will treat a child's urgent symptoms and try to prevent complications by
                
- observing the child closely in the hospital  - replacing minerals, such as potassium and salt, and fluids through an intravenous (IV) tube  - giving the child red blood cells and platelets cells in the blood that help with clottingthrough an IV  - giving the child IV nutrition  - treating high blood pressure with medications
                
Treating Acute Kidney Injury
                
If necessary, a health care provider will treat acute kidney injury with dialysisthe process of filtering wastes and extra fluid from the body with an artificial kidney. The two forms of dialysis are hemodialysis and peritoneal dialysis. Most children with acute kidney injury need dialysis for a short time only.
                
Treating Chronic Kidney Disease
                
Some children may sustain significant kidney damage that slowly develops into CKD. Children who develop CKD must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation.
                
In most cases, health care providers treat CKD with a kidney transplant. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a person's body to take over the job of the failing kidney. Though some children receive a kidney transplant before their kidneys fail completely, many children begin with dialysis to stay healthy until they can have a transplant.
                
More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children.
Question: How to prevent Hemolytic Uremic Syndrome in Children ?
Answer: Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by
                
- avoiding unclean swimming areas  - avoiding unpasteurized milk, juice, and cider  - cleaning utensils and food surfaces often  - cooking meat to an internal temperature of at least 160 F  - defrosting meat in the microwave or refrigerator  - keeping children out of pools if they have had diarrhea  - keeping raw foods separate  - washing hands before eating  - washing hands well after using the restroom and after changing diapers
                
When a child is taking medications that may cause hemolytic uremic syndrome, it is important that the parent or caretaker watch for symptoms and report any changes in the child's condition to the health care provider as soon as possible.
Question: What to do for Hemolytic Uremic Syndrome in Children ?
Answer: At the beginning of the illness, children with hemolytic uremic syndrome may need IV nutrition or supplements to help maintain fluid balance in the body. Some children may need to follow a low-salt diet to help prevent swelling and high blood pressure.
                
Health care providers will encourage children with hemolytic uremic syndrome to eat when they are hungry. Most children who completely recover and do not have permanent kidney damage can return to their usual diet.