shaneperry0101/health-chatbot huggingface dataset:
Question: What are the treatments for Kidney Stones in Adults ?
Answer: Treatment for kidney stones usually depends on their size and what they are made of, as well as whether they are causing pain or obstructing the urinary tract. Kidney stones may be treated by a general practitioner or by a urologista doctor who specializes in the urinary tract. Small stones usually pass through the urinary tract without treatment. Still, the person may need pain medication and should drink lots of fluids to help move the stone along. Pain control may consist of oral or intravenous (IV) medication, depending on the duration and severity of the pain. IV fluids may be needed if the person becomes dehydrated from vomiting or an inability to drink. A person with a larger stone, or one that blocks urine flow and causes great pain, may need more urgent treatment, such as
- Shock wave lithotripsy. A machine called a lithotripter is used to crush the kidney stone. The procedure is performed by a urologist on an outpatient basis and anesthesia is used. In shock wave lithotripsy, the person lies on a table or, less commonly, in a tub of water above the lithotripter. The lithotripter generates shock waves that pass through the persons body to break the kidney stone into smaller pieces to pass more readily through the urinary tract. - Ureteroscopy. A ureteroscopea long, tubelike instrument with an eyepieceis used to find and retrieve the stone with a small basket or to break the stone up with laser energy. The procedure is performed by a urologist in a hospital with anesthesia. The urologist inserts the ureteroscope into the persons urethra and slides the scope through the bladder and into the ureter. The urologist removes the stone or, if the stone is large, uses a flexible fiber attached to a laser generator to break the stone into smaller pieces that can pass out of the body in the urine. The person usually goes home the same day.
- Percutaneous nephrolithotomy. In this procedure, a wire-thin viewing instrument called a nephroscope is used to locate and remove the stone. The procedure is performed by a urologist in a hospital with anesthesia. During the procedure, a tube is inserted directly into the kidney through a small incision in the persons back. For large stones, an ultrasonic probe that acts as a lithotripter may be needed to deliver shock waves that break the stone into small pieces that can be removed more easily. The person may have to stay in the hospital for several days after the procedure and may have a small tube called a nephrostomy tube inserted through the skin into the kidney. The nephrostomy tube drains urine and any residual stone fragments from the kidney into a urine collection bag. The tube is usually left in the kidney for 2 or 3 days while the person remains in the hospital.
Question: How to prevent Kidney Stones in Adults ?
Answer: The first step in preventing kidney stones is to understand what is causing the stones to form. The health care provider may ask the person to try to catch the kidney stone as it passes, so it can be sent to a lab for analysis. Stones that are retrieved surgically can also be sent to a lab for analysis.
The health care provider may ask the person to collect urine for 24 hours after a stone has passed or been removed to measure daily urine volume and mineral levels. Producing too little urine or having a mineral abnormality can make a person more likely to form stones. Kidney stones may be prevented through changes in eating, diet, and nutrition and medications.
Eating, Diet, and Nutrition
People can help prevent kidney stones by making changes in their fluid intake. Depending on the type of kidney stone a person has, changes in the amounts of sodium, animal protein, calcium, and oxalate consumed can also help.
Drinking enough fluids each day is the best way to help prevent most types of kidney stones. Health care providers recommend that a person drink 2 to 3 liters of fluid a day. People with cystine stones may need to drink even more. Though water is best, other fluids may also help prevent kidney stones, such as orange juice or lemonade. Talk with your health care provider if you cant drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.
Recommendations based on the specific type of kidney stone include the following:
Calcium Oxalate Stones
- reducing sodium - reducing animal protein, such as meat, eggs, and fish - getting enough calcium from food or taking calcium supplements with food - avoiding foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran
Calcium Phosphate Stones
- reducing sodium - reducing animal protein - getting enough calcium from food or taking calcium supplements with food
Uric Acid Stones
- limiting animal protein
More information about how changes in diet affect kidney stone formation is provided in the NIDDK health topic, Diet for Kidney Stone Prevention.
Medications
The health care provider may prescribe certain medications to help prevent kidney stones based on the type of stone formed or conditions that make a person more prone to form stones:
- hyperuricosuriaallopurinol (Zyloprim), which decreases uric acid in the blood and urine - hypercalciuriadiuretics, such as hydrochlorothiazide - hyperoxaluriapotassium citrate to raise the citrate and pH of urine - uric acid stonesallopurinol and potassium citrate - cystine stonesmercaptopropionyl glycine, which decreases cystine in the urine, and potassium citrate - struvite stonesantibiotics, which are bacteria-fighting medications, when needed to treat infections, or acetohydroxamic acid with long-term antibiotic medications to prevent infection
People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands. In most cases, only one of the glands is enlarged. Removing the glands cures hyperparathyroidism and prevents kidney stones.
Question: What causes Anemia in Chronic Kidney Disease ?
Answer: 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
Question: What are the symptoms of Anemia in Chronic Kidney Disease ?
Answer: 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.
Question: What are the complications of Anemia in Chronic Kidney Disease ?
Answer: 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.
Question: How to diagnose Anemia in Chronic Kidney Disease ?
Answer: 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.
Question: What are the treatments for Anemia in Chronic Kidney Disease ?
Answer: 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.
Question: What to do for Anemia in Chronic Kidney Disease ?
Answer: 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
Question: What are the symptoms of Lupus Nephritis ?
Answer: The symptoms of lupus nephritis may include high blood pressure, foamy urine, and edemaswelling, usually in the legs, feet, or ankles and less often in the hands or face.
Kidney problems often develop at the same time or shortly after lupus symptoms appear and can include
- joint pain or swelling - muscle pain - fever with no known cause - red rashes, often on the face, which are also called butterfly rashes because of their shape
Question: How to diagnose Lupus Nephritis ?
Answer: Lupus nephritis is diagnosed through urine and blood tests and a kidney biopsy:
- Urinalysis. Urinalysis is testing of a urine sample. The urine sample is collected in a special container in a health care providers office or commercial facility and can be tested in the same location or sent 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. A high number of red blood cells or high levels of protein in the urine indicate kidney damage. - Blood test. A blood test involves drawing blood at a health care providers office or commercial facility and sending the sample to a lab for analysis. The blood test can show high levels of creatinine, a waste product of normal muscle breakdown excreted by the kidneys, which increases when the kidneys are not functioning well. - Biopsy. A biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. The biopsy is performed by a health care provider in a hospital with light sedation and local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the kidney. The kidney tissue is examined in a lab by a pathologista doctor who specializes in diagnosing diseases. The test can confirm a diagnosis of lupus nephritis, determine how far the disease has progressed, and guide treatment. The American College of Rheumatology recommends biopsies for all people with evidence of active lupus nephritis that has not been previously treated.
Question: What are the treatments for Lupus Nephritis ?
Answer: Lupus nephritis is treated with medications that suppress the immune system, so it stops attacking and damaging the kidneys. Standard treatment includes a corticosteroid, usually prednisone, to reduce inflammation in the kidneys. An immunosuppressive medication, such as cyclophosphamide or mycophenolate mofetil, is typically used with prednisone. These medicationswhen taken as prescribed by a health care providerfurther decrease the activity of the immune system and block the bodys immune cells from attacking the kidneys directly or making antibodies that attack the kidneys. Antibodies are proteins made by the immune system to protect the body from foreign substances such as bacteria or viruses. Hydroxychloroquine, a medication for treating SLE, should also be prescribed or continued for people with lupus nephritis.
People with lupus nephritis that is causing high blood pressure may need to take medications that lower their blood pressure and can also significantly slow the progression of kidney disease. Two types of blood pressure lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have proven effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a diuretica medication that helps the kidneys remove fluid from the bodymay be prescribed. Beta blockers, calcium channel blockers, and other blood pressure medications may also be needed.
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. High blood pressure is a systolic pressure of 140 or above or a diastolic pressure of 90 or above.2
Question: What are the complications of Lupus Nephritis ?
Answer: In many cases, treatment is effective in completely or partially controlling lupus nephritis, resulting in few, if any, further complications. However, even with treatment, 10 to 30 percent of people with lupus nephritis develop kidney failure, described as end-stage renal disease when treated with blood-filtering treatments called dialysis or a kidney transplant.3 Scientists cannot predict who will or will not respond to treatment. The most severe form of lupus nephritis is called diffuse proliferative nephritis. With this type of illness, the kidneys are inflamed, many white blood cells invade the kidneys, and kidney cells increase in number, which can cause such severe damage that scars form in the kidneys. Scars are difficult to treat, and kidney function often declines as more scars form. People with suspected lupus nephritis should get diagnosed and treated as early as possible to prevent such chronic, or long lasting, damage.
People with lupus nephritis are at a high risk for cancer, primarily B-cell lymphomaa type of cancer that begins in the cells of the immune system. They are also at a high risk for heart and blood vessel problems.
Question: What are the symptoms of Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ?
Answer: Dermatitis herpetiformis is characterized by small, clustered papules and vesicles that erupt symmetrically on the elbows, knees, buttocks, back, or scalp. The face and groin can also be involved. A burning sensation may precede lesion formation. Lesions are usually scratched off by the time a patient comes in for a physical exam, and the rash may appear as erosions and excoriations.
Patients with DH may also experience dental enamel defects to permanent teeth, which is another manifestation of celiac disease. Less than 20 percent of people with DH have symptoms of celiac disease.3
Question: What causes Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ?
Answer: Dermatitis herpetiformis is caused by the deposit of immunoglobulin A (IgA) in the skin, which triggers further immunologic reactions resulting in lesion formation. DH is an external manifestation of an abnormal immune response to gluten, in which IgA antibodies form against the skin antigen epidermal transglutaminase.
Family studies show that 5 percent of first-degree relatives of a person with DH will also have DH. An additional 5 percent of first-degree relatives of a person with DH will have celiac disease.4 Various other autoimmune diseases are associated with DH, the most common being hypothyroidism.
Question: How to diagnose Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ?
Answer: A skin biopsy is the first step in diagnosing DH. Direct immunofluorescence of clinically normal skin adjacent to a lesion shows granular IgA deposits in the upper dermis. Histology of lesional skin may show microabscesses containing neutrophils and eosinophils. However, histology may reveal only excoriation due to the intense itching that patients experience.
Blood tests for antiendomysial or anti-tissue transglutaminase antibodies may also suggest celiac disease. Blood tests for epidermal transglutaminase antibodies are positive in more than 90 percent of cases.5 All of these tests will become negative with prolonged adherence to a gluten-free diet.
A positive biopsy and serology confirm DH and should be taken as indirect evidence of small bowel damage. A biopsy of the small bowel is usually not needed for DH diagnosis. However, if clinical signs of gastrointestinal disease are evident on examination, further workup may be required.2 Whether or not intestinal damage is evident, a gluten-free diet should be implemented because the rash of DH is gluten sensitive.4
Question: What are the treatments for Dermatitis Herpetiformis: Skin Manifestation of Celiac Disease (For Health Care Professionals) ?
Answer: The sulfone dapsone can provide immediate relief of symptoms. For patients who cannot tolerate dapsone, sulfapyridine or sulfamethoxypyridazine may be used, although these medications are less effective than dapsone. A strict gluten-free diet is the only treatment for the underlying disease. Even with a gluten-free diet, medication therapy may need to be continued from a few months to 2 years.
DH can go into remission, which is defined as absence of skin lesions and symptoms of DH for more than 2 years while not taking sulfones or other treatments and not adhering to a gluten-free diet. Cohort studies showing DH remission provide support for reducing sulfone therapy and weaning from a gluten-free diet in patients with well-controlled DH.6