fenil210/Med-Lamma huggingface dataset:
What causes Anemia in Chronic Kidney Disease ?
When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it deprives the body of the oxygen it needs.
                
Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food:
                
- iron  - vitamin B12  - folic acid
                
These nutrients are necessary for red blood cells to make hemoglobin, the main oxygen-carrying protein in the red blood cells.
                
If treatments for kidney-related anemia do not help, the health care provider will look for other causes of anemia, including
                
- other problems with bone marrow  - inflammatory problemssuch as arthritis, lupus, or inflammatory bowel diseasein which the bodys immune system attacks the bodys own cells and organs  - chronic infections such as diabetic ulcers  - malnutrition + NIDDK + Anemia in Chronic Kidney Disease
What are the symptoms of Anemia in Chronic Kidney Disease ?
The signs and symptoms of anemia in someone with CKD may include
                
- weakness  - fatigue, or feeling tired  - headaches  - problems with concentration  - paleness  - dizziness  - difficulty breathing or shortness of breath  - chest pain
                
Anyone having difficulty breathing or with shortness of breath should seek immediate medical care. Anyone who has chest pain should call 911. + NIDDK + Anemia in Chronic Kidney Disease
What are the complications of Anemia in Chronic Kidney Disease ?
Heart problems are a complication of anemia and may include
                
- an irregular heartbeat or an unusually fast heartbeat, especially when exercising.  - the harmful enlargement of muscles in the heart.  - heart failure, which does not mean the heart suddenly stops working. Instead, heart failure is a long-lasting condition in which the heart cant pump enough blood to meet the bodys needs. + NIDDK + Anemia in Chronic Kidney Disease
How to diagnose Anemia in Chronic Kidney Disease ?
A health care provider diagnoses anemia based on
                
- a medical history  - a physical exam  - blood tests
                
Medical History
                
Taking a medical history is one of the first things a health care provider may do to diagnose anemia. He or she will usually ask about the patients symptoms.
                
Physical Exam
                
A physical exam may help diagnose anemia. During a physical exam, a health care provider usually examines a patients body, including checking for changes in skin color.
                
Blood Tests
                
To diagnose anemia, a health care provider may order a complete blood count, which measures the type and number of blood cells in the body. A blood test involves drawing a patients blood at a health care providers office or a commercial facility. A health care provider will carefully monitor the amount of hemoglobin in the patients blood, one of the measurements in a complete blood count.
                
The Kidney Disease: Improving Global Outcomes Anemia Work Group recommends that health care providers diagnose anemia in males older than age 15 when their hemoglobin falls below 13 grams per deciliter (g/dL) and in females older than 15 when it falls below 12 g/dL.2 If someone has lost at least half of normal kidney function and has low hemoglobin, the cause of anemia may be decreased EPO production.
                
Two other blood tests help measure iron levels:
                
- The ferritin level helps assess the amount of iron stored in the body. A ferritin score below 200 nanograms (ng) per liter may mean a person has iron deficiency that requires treatment.2  - The transferrin saturation score indicates how much iron is available to make red blood cells. A transferrin saturation score below 30 percent can also mean low iron levels that require treatment.2
                
In addition to blood tests, the health care provider may order other tests, such as tests for blood loss in stool, to look for other causes of anemia. + NIDDK + Anemia in Chronic Kidney Disease
What are the treatments for Anemia in Chronic Kidney Disease ?
Depending on the cause, a health care provider treats anemia with one or more of the following treatments:
                
Iron
                
The first step in treating anemia is raising low iron levels. Iron pills may help improve iron and hemoglobin levels. However, for patients on hemodialysis, many studies show pills do not work as well as iron given intravenously.2
                
Erythropoietin
                
If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO. A health care provider, often a nurse, injects the patient with EPO subcutaneously, or under the skin, as needed. Some patients learn how to inject the EPO themselves. Patients on hemodialysis may receive EPO intravenously during hemodialysis.
                
Studies have shown the use of EPO increases the chance of cardiovascular events, such as heart attack and stroke, in people with CKD. The health care provider will carefully review the medical history of the patient and determine if EPO is the best treatment for the patients anemia. Experts recommend using the lowest dose of EPO that will reduce the need for red blood cell transfusions. Additionally, health care providers should consider the use of EPO only when a patients hemoglobin level is below 10 g/dL. Health care providers should not use EPO to maintain a patients hemoglobin level above 11.5 g/dL.2 Patients who receive EPO should have regular blood tests to monitor their hemoglobin so the health care provider can adjust the EPO dose when the level is too high or too low.2 Health care providers should discuss the benefits and risks of EPO with their patients.
                
Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions. In some people, iron supplements and EPO will improve the symptoms of anemia.
                
Red Blood Cell Transfusions
                
If a patients hemoglobin falls too low, a health care provider may prescribe a red blood cell transfusion. Transfusing red blood cells into the patients vein raises the percentage of the patients blood that consists of red blood cells, increasing the amount of oxygen available to the body.
                
Vitamin B12 and Folic Acid Supplements
                
A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia. Using vitamin supplements can treat low levels of vitamin B12 or folic acid and help treat anemia. To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements, with their health care provider.
                
Read more about vitamin B12 and folic acid on the MedlinePlus website at www.nlm.nih.gov/medlineplus. Read more about complementary and alternative medicine at www.nccam.nih.gov. + NIDDK + Anemia in Chronic Kidney Disease
What to do for Anemia in Chronic Kidney Disease ?
A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. Some of these foods are high in sodium or phosphorus, which people with CKD should limit in their diet. Before making any dietary changes, people with CKD should talk with their health care provider or with a dietitian who specializes in helping people with kidney disease. A dietitian can help a person plan healthy meals.
                
Read more about nutrition for people with CKD on the National Kidney Disease Education Program website.
                
The following chart illustrates some good dietary sources of iron, vitamin B12, and folic acid.
                
Food    Serving Size    Iron    Vitamin B12    Folic Acid          Recommended Daily Value        18 mg    6 mcg    400 mcg        100 percent fortified breakfast cereal     cup (1 oz)    18 mg    6 mcg    394 mcg        beans, baked    1 cup (8 oz)    8 mg    0 mcg    37 mcg        beef, ground    3 oz    2 mg    2 mcg    8 mcg        beef liver    3 oz    5 mg    67 mcg    211 mcg        clams, fried    4 oz    3 mg    1 mcg    66 mcg        spinach, boiled    1 cup (3 oz)    2 mg    0 mcg    115 mcg        spinach, fresh    1 cup (1 oz)    1 mg    0 mcg    58 mcg        trout    3 oz    0 mg    5 mcg    16 mcg        tuna, canned    3 oz    1 mg    1 mcg    2 mcg + NIDDK + Anemia in Chronic Kidney Disease
What to do for Anemia in Chronic Kidney Disease ?
- Anemia is a condition in which the body has fewer red blood cells than normal. Red blood cells carry oxygen to tissues and organs throughout the body and enable them to use energy from food.  - Anemia commonly occurs in people with chronic kidney disease (CKD)the permanent, partial loss of kidney function. Most people who have total loss of kidney function, or kidney failure, have anemia.  - When kidneys are diseased or damaged, they do not make enough erythropoietin (EPO). As a result, the bone marrow makes fewer red blood cells, causing anemia.  - Other common causes of anemia in people with kidney disease include blood loss from hemodialysis and low levels of the following nutrients found in food:      - iron    - vitamin B12    - folic acid    - The first step in treating anemia is raising low iron levels.  - If blood tests indicate kidney disease as the most likely cause of anemia, treatment can include injections of a genetically engineered form of EPO.  - Many people with kidney disease need iron supplements and EPO to raise their red blood cell count to a level that will reduce the need for red blood cell transfusions.  - A health care provider may suggest vitamin B12 and folic acid supplements for some people with CKD and anemia.  - A health care provider may advise people with kidney disease who have anemia caused by iron, vitamin B12, or folic acid deficiencies to include sources of these nutrients in their diets. + NIDDK + Anemia in Chronic Kidney Disease
What is (are) Anemia in Chronic Kidney Disease ?
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
                
- 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  - Treatment Methods for Kidney Failure: 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: John C. Stivelman, M.D., Emory University School of Medicine; Kerri Cavanaugh, M.D., M.H.S., Vanderbilt University
                
This information is not copyrighted. The NIDDK encourages people to share this content freely.
                

                

                
July 2014 + NIDDK + Anemia in Chronic Kidney Disease
What is (are) Vesicoureteral Reflux ?
Vesicoureteral reflux is the abnormal flow of urine from the bladder to the upper urinary tract. The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. Blood flows through the kidneys, and the kidneys filter out wastes and extra water, making urine. The urine travels down two narrow tubes called the ureters. The urine is then stored in a balloonlike organ called the bladder. When the bladder empties, urine flows out of the body through a tube called the urethra at the bottom of the bladder.
                
In VUR, urine may flow backrefluxinto one or both ureters and, in some cases, to one or both kidneys. VUR that affects only one ureter and kidney is called unilateral reflux, and VUR that affects both ureters and kidneys is called bilateral reflux. + NIDDK + Vesicoureteral Reflux
Who is at risk for Vesicoureteral Reflux? ?
Vesicoureteral reflux is more common in infants and young children, but older children and even adults can be affected. About 10 percent of children have VUR.1 Studies estimate that VUR occurs in about 32 percent of siblings of an affected child. This rate may be as low as 7 percent in older siblings and as high as 100 percent in identical twins. These findings indicate that VUR is an inherited condition.2 + NIDDK + Vesicoureteral Reflux
What is (are) Vesicoureteral Reflux ?
The two types of VUR are primary and secondary. Most cases of VUR are primary and typically affect only one ureter and kidney. With primary VUR, a child is born with a ureter that did not grow long enough during the childs development in the womb. The valve formed by the ureter pressing against the bladder wall does not close properly, so urine refluxes from the bladder to the ureter and eventually to the kidney. This type of VUR can get better or disappear as a child gets older. As a child grows, the ureter gets longer and function of the valve improves.
                
Secondary VUR occurs when a blockage in the urinary tract causes an increase in pressure and pushes urine back up into the ureters. Children with secondary VUR often have bilateral reflux. VUR caused by a physical defect typically results from an abnormal fold of tissue in the urethra that keeps urine from flowing freely out of the bladder.
                
VUR is usually classified as grade I through V, with grade I being the least severe and grade V being the most severe. + NIDDK + Vesicoureteral Reflux
What are the symptoms of Vesicoureteral Reflux ?
In many cases, a child with VUR has no symptoms. When symptoms are present, the most common is a urinary tract infection (UTI). VUR can lead to infection because urine that remains in the childs urinary tract provides a place for bacteria to grow. Studies estimate that 30 percent of children and up to 70 percent of infants with a UTI have VUR.2 + NIDDK + Vesicoureteral Reflux
What are the complications of Vesicoureteral Reflux ?
When a child with VUR gets a UTI, bacteria can move into the kidney and lead to scarring. Scarring of the kidney can be associated with high blood pressure and kidney failure. However, most children with VUR who get a UTI recover without long-term complications. + NIDDK + Vesicoureteral Reflux
How to diagnose Vesicoureteral Reflux ?
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 + NIDDK + Vesicoureteral Reflux
How to diagnose Vesicoureteral Reflux ?
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 + NIDDK + Vesicoureteral Reflux
What are the treatments for Vesicoureteral Reflux ?
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. + NIDDK + Vesicoureteral Reflux
What are the treatments for Vesicoureteral Reflux ?
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 + NIDDK + Vesicoureteral Reflux
What to do for Vesicoureteral Reflux ?
Eating, diet, and nutrition have not been shown to play a role in causing or preventing VUR. + NIDDK + Vesicoureteral Reflux
What to do for Vesicoureteral Reflux ?
- Vesicoureteral reflux (VUR) is the abnormal flow of urine from the bladder to the upper urinary tract.  - VUR is more common in infants and young children, but older children and even adults can be affected. About 10 percent of children have VUR.  - In many cases, a child with VUR has no symptoms. When symptoms are present, the most common is a urinary tract infection (UTI).  - When a child with VUR gets a UTI, bacteria can move into the kidney and lead to scarring. Scarring of the kidney can be associated with high blood pressure and kidney failure.  - Voiding cystourethrogram (VCUG), radionuclide cystogram (RNC), and abdominal ultrasound are used to diagnose VUR.  - Children with VUR should also be assessed for bladder/bowel dysfunction (BBD). Children who have VUR along with any BBD symptoms are at greater risk of kidney damage due to infection.  - 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. Surgery has also been used in certain cases.  - Secondary VUR is treated by removing the blockage causing the reflux. + NIDDK + Vesicoureteral Reflux
What is (are) Diabetic Kidney Disease ?
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 + NIDDK + Diabetic Kidney Disease