KB – Your Urinary Tract Health

We diet. We exercise. We concern ourselves with our heart, lungs, and body in general. But we much less often think about our urinary tract – bladder, kidneys, and the rest. It’s something we just don’t pay attention to until something goes wrong. But the kidneys and bladder and the components that connect them play a vital role not just in eliminating urine but in our general well being.

The kidneys filter blood by removing waste products from cellular activity and produce urine that is stored in the bladder. But they do much more. They also release a compound (renin) that helps regulate blood pressure. They perform a vital role in balancing electrolytes, such as sodium and potassium, that have wide ranging functions in the body. They determine overall fluid levels that affect blood pressure and more.

Unfortunately, we rarely pay attention to any of that until something goes wrong.

What goes wrong can range from upper and lower urinary tract infections – in the kidneys, ureters, bladder, or urethra – to kidney stones and more. Those infections can be caused by a wide variety of things, such as E. coli bacteria or genetic factors that influence the immune system. Kidney stones can also be produced by a genetic abnormality or simply by inadequate fluid intake or excess protein consumption.

Diagnosing these problems can be as simple as a urinalysis performed on a urine sample or require complex technology like a multi-million dollar MRI machine. Treatments can range from doing nothing but drink a little extra water to a regimen of the most advanced drugs available.

Specific treatments, of course, depend on the exact problem. For simple cystitis or nephritis common antibiotics like amoxicillin can often do the trick. Sometimes treating the underlying disease, such as diabetes, can clear up any associated kidney or bladder problems. For more serious conditions, dialysis may be needed.

In the most extreme cases, a kidney transplant is called for. Like any major surgery, there are risks and benefits associated with it. But, thanks to new alternatives, such as improved medications, they are lower than in times past. Newer inventions, such as kidney-like devices worn on the outside of the body show promise of eliminating the need for dialysis or transplant entirely.

When urinary incontinence strikes, it can be treated with everything from low-risk drugs to physical exercise to improve muscle control. There are several different types and the exact form will, naturally, influence which course of action is required.

Of course, the best treatment is prevention and there are many ways of doing that for the entire urinary tract. Kidney health can be promoted by the proper diet, one that balances salts and regulates protein intake, among other things. Optimizing bladder health – to reduce the risk of cancer, interstitial cystitis, and other potential problems – is equally important. Good lifestyle choices, like moderate consumption of alcohol and coffee (which do have beneficial effects) can make this simple.

But the key to any prevention or treatment method is to be aware of the vital role the kidneys and bladder play in overall maintenance of the body’s health. Good health starts with good education.

KB – What is Dialysis?

Dialysis is a procedure to filter the blood, made necessary when the kidneys can’t. But filter what? How does it replace what the kidneys do? What does it involve? First, why do we need kidneys (or an artificial substitute) at all?

Chemical reactions that take place during cellular activity produce waste products. Those products move through the blood into the kidneys where they are turned into urine. That then moves through the ureters down to the bladder and out the urethra. If they remained in the blood harmful effects would occur, a condition known as uremia. Symptoms include severe muscle cramps, nausea, and skin discoloration.

At the same time, the kidneys help balance electrolytes, drain excess fluid, and even regulate blood pressure. Those, too, are vital activities to keep the human body in equilibrium.

When the kidneys can not perform those functions, a substitute is necessary. Dialysis is one traditional and effective method.

There are actually two types of dialysis: hemodialysis and peritoneal dialysis. They are very different. Let’s cover them in order.

Hemodialysis is a procedure that uses a dialysis machine to remove waste products from the blood and return filtered blood back to the patient. That is done through a special insert called an access point that is surgically prepared in advance.

The access point may be a simple catheter in the case of emergency hemodialysis, usually inserted in a vein in the neck or groin. Or it may be a more long-term structure created surgically in which an artery and vein are artificially joined. The arteriovenous (AV) fistula, as it’s called, is then used to insert the pair of needles used for extraction and replacement of blood.

The dialysis machine is then connected and the patient’s blood filtered, usually about 3 times per week for 3-4 hours per session. The procedure has two stages. In one stage, waste products move through a semi-permeable membrane. In the second, filtered blood is returned through another tube.

The procedure is usually carried out in a central location staffed by professionals. Home dialysis has become somewhat more common over the years, though, as machines grew smaller and less expensive.

Peritoneal dialysis is a very different procedure and one that is much more often performed at home by the patient and/or an assistant. In this method, a sterile tube is inserted in the peritoneal cavity near the large intestine. A solution is then injected into the abdominal cavity. The tissues there perform a filtering role similar to the semi-permeable membrane described above.

Though more convenient in one way because it is performed at home, it must be carried out 4-5 times per day, or by an automated system at night. It carries a slightly higher risk of infection, primarily because most patients are less skilled than professionals in antisepsis.

In years past, dialysis (once it became necessary) was usually a lifetime commitment. Today, it is more often temporary (though ‘temporary’ can mean several months or years), thanks to kidney transplants and other permanent solutions.

KB – What is Cystitis?

Cystitis is an inflammation that affects the bladder and a type of lower urinary tract infection.

Symptoms can include a burning sensation during urination, more frequent or intense urgency, or even blood in the urine. Pain in the lower abdomen is possible, too. Because any of these can easily accompany other conditions, it’s important to get a professional diagnosis.

The root causes vary. Sometimes it results from excess growth of E. coli (a normal inhabitant of the gastrointestinal tract). One method of transmission is simply incorrect cleansing habits during normal urination, more often in women. They have a shorter distance between the anus and urethra. Wiping from back to front rather than front to back can move bacteria from the feces to the urinary tract opening.

It can also result from a sexually transmitted disease. Chlamydia is one of the more common villains, particularly in women who are more prone to cystitis in general. Since the genitalia are more exposed, they are at greater risk for bacteria that can move from the tissue surrounding the urinary tract opening.

Women who are more sexually active are at greater risk, but menopause (when activity usually decreases, at least for a time) can also up the odds. Menopause causes changes to the lining on the vagina and urethra, changes which make infection more likely. Oddly, using a spermicide on a diaphragm can actually increase the odds of cystitis. The explanation is controversial, but at minimum has to do with the altered intra-vaginal environment.

Treatments vary.

There are several over-the-counter products that can be helpful.

For pain control, ibuprofen works well for some. In cases in which the level of acidity is contributing to frequent bouts of infection, bicarbonate of soda can be effective against symptoms. Sodium citrate capsules can also be beneficial. Ample fluid intake can help flush the infection, as well.

Cranberry capsules are sometimes recommended, but studies show mixed results. One hypothesis is that it helps prevent bacteria from sticking to the urinary tract. More advanced cases call for antibiotics, some of which must be obtained via prescription. Amoxicillin, Cipro, and others are commonly used.

But not all cystitis is produced by bacteria and therefore responds to treatment with antibiotics. One type called interstitial cystitis is the result of chronic inflammation of the bladder wall. The only way to know for sure if this is the case is to have a professional exam. That usually involves a simple urinalysis test that looks for bacteria or blood in the urine. If neither is found, your physician will begin to look for other causes.

Treatments for IC range from simple dietary changes to TENS (transcutaneous electrical nerve stimulation). Surgery is rarely warranted. Sometimes ‘retraining’ the bladder is used (involving changing the way one urinates by muscle control) and has been effective. Only a physician can prescribe a proper course of treatment for this more serious form of cystitis.

KB – What Does the Bladder Do?

Everyone is familiar with the feeling of a full bladder. They usually know, too, that when you feel that urge to urinate, it’s because the ‘bladder is full’. But what exactly is the bladder and how does it get full? What happens then?

The bladder is filled by the kidneys, small organs that lie ‘upstream’ from it. They filter the blood, help regulate electrolyte levels in the body, and perform other vital functions. One of those functions is very basic: to control the amount of fluid in the body. It does it by excreting excess fluid through the ureters down into the bladder.

While the kidneys filter about 42 gallons (160 liters) of blood per day, they produce only about a liter or two per day of urine. About 5% of that fluid is dissolved material such as urea, small amounts of protein and other substances. The remaining 95% is ordinary water.

Where the kidneys are, well, kidney-shaped and filled with neprhons (small filtering sacs) the bladder itself is hollow and more balloon shaped. It sits inside the pelvic region directly behind the pubic symphysis or pubic bone and stores the urine the kidneys excrete. As it swells with fluid, the bladder becomes rounder. At its peak, the average adult’s bladder will hold about 2 cups (about 1/2 liter), but the urge to urinate normally begins at about 1 cup (250-300 ml).

What happens next?

As the physical volume of the bladder increases, it presses on nearby nerves. Before long, those nerves (called ‘stretch receptors’) send signals to the brain that tell us ‘urinate’. That doesn’t happen automatically in the case of most people (fortunately), of course. The bladder is one of the few organs over which we have a large degree of conscious control.

Counteracting the urge created by those nerve signals, we can (up to a point) use the urethral sphincter muscles to ‘hold back’, for some people up to as long as five hours.

Then, whether through loss of control or by an act of will, we squeeze the bladder muscles to push urine through a tube called the urethra. But we have to do more than push. We have to relax those ring-like sphincter muscles to allow the urine to flow. It is poor control of the latter that produces incontinence.

The urethra, as well as the ureters and the bladder itself, are lined with a type of mucous that prevents fluid movement through their material. The bladder muscles are able to operate as they do because of their three layers: the mucosa, submucosa, and detrusor. The middle layer contains blood vessels that feed the cells of the organ. The outer layer performs the ‘heavy lifting’ in urination. When you ‘press down’ to urinate, it is this muscle you are chiefly contracting.

That sense of relief you feel is the result of those same nerves now signalling the brain, ‘done’.

KB – What Do Kidneys Do?

The kidneys are organs about the size of your fist that sit not far from the spinal column above the lower back. Unlike the appendix, as one example, they perform a variety of vital functions. Dual kidney failure means death. Luckily, the body provides two and one can do the job by itself. But, what is that job?

The kidneys are often said to be the body’s filtering system, and that is true. They filter what would be toxic substances if they built up inside the body. There is more detail to the story, though.

Even ordinary and essential chemical elements, like calcium, potassium, and others would be harmful if they existed in too-high levels in the blood, organs, and bones. Even ordinary body fluid in the form of water can be lethal if we retain too much. The kidneys are part of a regulatory system that keeps all these to the appropriate amounts.

One way the kidneys perform that function is by balancing what are called electrolytes. These are essentially dissolved salts – sodium and chloride, magnesium and sulfates, and others. Salts are crucial to a wide variety of cellular and muscle processes.

The heart, for example, pumps needed blood that bathes the tissues in oxygen and nutrients. That muscle action would be impossible without something called the sodium-potassium pump. In part, they supply the ‘electrical’ stimulus that keeps that critical muscle working in the proper rhythm. The kidneys play an indispensable role in regulating the levels of sodium and potassium.

They also play a role in balancing the level of acidity in the blood. People read the word ‘acid’ and automatically assume it is harmful. Battery acid burns your fingers. Stomach acid produces an upset tummy. But acid, which at bottom is just hydrogen ions, is essential when it exists at the right concentration. Similarly, the body needs certain alkali (hydroxyl ions or oxygen-hydrogen molecules) to perform other functions. The kidneys keep both from getting too far from equilibrium.

Even pH-neutral water has to be kept at the right amount. It is necessary for all cellular reactions, body temperature control, and other life-sustaining activities. But too much can actually cause cells to expand to dangerous proportions and drive electrolyte concentrations too low. The kidneys work in conjunction with the bladder and other systems to keep fluid levels within healthy bounds.

As part of this activity, the kidneys perform another vital function: they help regulate blood pressure by releasing a hormone called renin. They are part of a coordinated effort among many systems. By adjusting how much sodium is excreted, the kidneys are central to that effort. Another aspect of that system is the level of extracellular fluid volume, influenced by the kidneys’ actions.

The net result of all the kidneys’ behavior is to move urine containing waste products to the bladder through two small tubes called ureters. From there, the bladder takes over to eliminate the fluid waste.

KB – Urinary Tract Infections Symptoms and Causes

Urinary tract infection is just what it sounds like – an infection anywhere in the urethra, bladder, ureters, or kidneys. Its severity can range from not noticeable to life-threatening.

The most common areas affected are the urethra and bladder, and more often in women than men. Some of the potentially noticeable signs include a burning sensation during urination or blood in the urine. Other obvious signs include a persistent urge to urinate, difficulty producing normal amounts, or even an odd odor to the output. Unfortunately, these are easy to confuse with many other medical problems. More definitive signs include bacteria in the urine, but detecting that requires medical tests.

Cystitis, a type of infection of the lower urinary tract, more often shows up as increased pelvic pressure and discomfort in the lower abdomen. Sometimes a low grade fever accompanies the condition. Painful urination is possible, too. The latter is more common with infections of the urethra.

Kidney infections, by contrast, (known as pyelonephritis) are typically more serious. They may produce upper back and side pain along with high fever. Shaking and chills are a common sign. Nausea and vomiting are usual symptoms.

The underlying cause of any of these is generally bacteria, in amounts the immune system can’t immediately combat. The bacteria may start within the body or result from invasion from outside. The organisms sometimes enter through the urethra and multiply in the bladder.

Cystitis is typically caused by E. coli, which are a common (and usually benign) bacteria found in the gastrointestinal tract.

One reason women are more susceptible is the combination of the closeness of the anus to their more accessible urethra, and the shorter distance between its tip and the bladder. In women, the urethra is about 1 1/2 inch long, in men it is closer to 5-7 inches. Bacteria commonly inhabit feces and organisms can migrate from one place to another, especially through incorrect cleansing habits.

Despite common belief, urine is not inherently a good medium for bacterial growth. Unmixed urine is sterile. But outside the body it can mix with air, bacteria-laden water or underwear, and (not often, but sometimes) bathroom surfaces.

Intercourse is another common transmission route, particularly in women. Sexual activity encourages germs to travel through the urethra. Certain forms of birth control may also increase the odds of infection, if they’re not employed properly. A diaphragm, for example, may become unsterile if left out and not cleaned correctly. Some feminine care products may increase the odds, since they can irritate the urethra. Age and illnesses (such as diabetes) affect the odds, as well. Both can weaken the immune system.

Pyelonephritis (kidney infections) are more likely when cystitis is left untreated for too long, since the bacteria can migrate up the urinary tract. Diagnosis and treatment of this more serious form requires the immediate attention of a medical professional.

KB – Urinary Tract Infections – Diagnosis and Treatments

Diagnosis

Self-diagnosis of urinary tract infections is a tricky business. Some of the common symptoms – ranging from painful urination to severe back pain – often accompany other conditions. An STD (sexually transmitted disease) may be the root cause, or the back pain may be the product of a pinched nerve. Misdiagnosis is all too common. The only way to be sure is to have a urinalysis performed.

Fortunately, that is simple and painless. Some home tests can give you a first clue. Similar to some home pregnancy tests, you urinate on a small stick layered with a chemical reagent. The reagent reacts to display a color, or other indicator. But follow up with a professional exam is important if you feel any pain.

Often, physicians recommend simply bringing in a urine sample collected at home. Select or produce a sterile jar (via boiling, alcohol soaking or pre-packaged) and collect a few ounces of ‘mid-stream’ urine. That is urine that is NOT produced in the first couple of seconds, but liquid expelled later. That reduces the odds of any contaminants throwing off the results.

The urinalysis performed on the sample will look for the presence of pus, red blood cells, and most particularly any bacteria, such as excess amounts of E. coli.

Treatments

Treatments for urinary tract infections run a wide gamut, reflecting the different types and severity of the condition.

In some cases, the best treatment is no treatment at all. Simply allow the immune system to do its job. If symptoms don’t disappear in 2-3 days, other actions are called for. Sometimes, drinking lots of fluids will clear the condition. But those fluids should NOT be alcohol, coffee, or sugary soft drinks. Water is usually best, though cranberry juice is a traditional home remedy. The latter is not recommended for those on blood thinning drugs, such as warfarin.

If symptoms persist, antibiotics are the next line of defense. Some courses of treatment use a low-dosage regimen of Cipro or Amoxicillin (a cousin of the more well-known penicillin). A sulfa drug such as Bactrim (Sulfamethoxazole trimethoprim) is sometimes prescribed.

The symptoms usually disappear as the infection is cleared within a few days. For more serious infections, or those that have been left untreated longer, it may take a week to 10 days.

Some upper UTIs (urinary tract infections) that reach the kidneys can be very serious. Apart from stronger drugs or higher dosages of Furadantin, Macrodantin, or Levaquin, pain medication is usually essential.

Kidney infections typically produce pronounced back pain because of their location near the spine, just above the small of the back. An analgesic – aspirin, or more specialized drugs – is usually prescribed. Some produce blue or orange urine, so discuss this with your physician to head off panic at the unusual color.

KB – Two Tips for Optimal Kidney Health

An old saying states that the best treatment is prevention – an ounce of prevention is worth a pound of cure. It may be a clich but it is definitely true. Both to ward off kidney disease and to optimize overall health, it is wise to keep your kidneys in top working order. But how do you do that?

One utterly simple, but utterly obvious way to keep kidneys in good shape is proper hydration. Obvious in retrospect, that is, after you understand what the kidneys do.

One of their main functions is to regulate the amount of fluid in the body. So, help them out by drinking more on hot days and less during cooler weather. Take humidity into account, though, since this alters how the body retains water.

The right amount of fluid helps flush the kidneys, but doesn’t overtax them. How much is the right amount differs with gender, body weight, and activity level. Look for specific guidelines at your favorite sports health website or, better still, ask your doctor.

Just as a rough rule of thumb… The average urine output for adults is about 1.5 liters. So, that much will need to be replaced daily. Also, check that your urine is clear or lightly colored, indicating that not too much material is accumulating in the waste fluid. That will also help lower the odds of kidney stones.

Another major function of the kidneys, their role in balancing electrolyte levels, gives another guideline for kidney health. Electrolytes, as the word suggests, are chemicals involved in the body’s electrical activity. The two major ones are sodium and potassium though there are others, such as calcium and phosphates.

Among other things, sodium and potassium play key roles in regulating blood pressure and make it possible for the heart to beat at all. Following dietary guidelines about their proper intake, therefore, will help overall cardiovascular health along with kidney function.

Decreasing salt intake tends to lower blood pressure. Keeping it less than 2,300 mg is the official amount stated by the USDA. For those with hypertension (high blood pressure) no more than 1,500 mg is recommended. Potassium consumed should be no more than 4,700 mg per day.

On the other hand, too little is equally bad because of sodium’s vital role in the body. The minimum turns out to be about the recommended maximum, in the neighborhood of 2,300 mg. For potassium, the number is a bit lower than the maximum, around 3,500 mg daily.

Keep in mind that these are only rough amounts and can vary considerably depending on your total calorie intake, weight, age, and other factors. Your physician is among the best sources for nutritional guidance when it comes to your kidneys. Take information from any other source with an, ahem, grain of salt.

KB – Risks of Kidney Transplants

Kidney transplants are a now familiar procedure. Individuals with kidney failure, often ESRD (end-stage renal disease), endure dialysis until a kidney becomes available. But what is involved in a transplant and what are some of the risks?

Kidney failure is defined roughly as a 10% reduction in renal function. That figure combines a number of dimensions, since the kidney itself performs a number of tasks. It regulates fluid level, electrolyte concentrations, influences blood pressure, and other vital activities. When their ability to do that fall outside an acceptable range, treatment is called for. When or if those fail or are not desirable, transplant is the next stage.

But there are several risks associated with kidney transplant, even apart from the normal ones that come with any serious surgical procedure. Bleeding during or after surgery is possible. Infection (though there are excellent drugs available) is still a common worry. Heart attack and stroke, though rare, are far from unknown.

Blood vessels in the kidney can clot or narrow, post surgery. That raises blood pressure and (in extreme cases) can lead to tissue death or even organ failure. Urine may leak into the body from a malfunctioning urinary tract. Or, clots may form in the ureters or bladder following a kidney transplant.

But, without doubt, the major ongoing risk is organ rejection.

The body’s immune system is ‘keyed’ to recognize foreign objects. That is how it can attack invading bacteria without harming surrounding native cells. When a kidney is transplanted, the body sees the organ’s cells as a foreign substance. In the absence of immuno-suppresive drugs, the immune system attacks the organ.

That risk can be lowered by using a donor organ from a close relative, because they are a relatively close genetic match, prompting a much less extreme immune system reaction. A living donor who is unrelated represents the next best choice. A viable option, but the least attractive from a rejection perspective, involves a donor organ from a recently deceased person.

Immuno-suppresant drugs are used to address the problem in each case.

There are actually two classes of drugs, corresponding to the two types of potential rejection: acute or chronic. Acute rejection would occur within the first few weeks after surgery and immuno-suppressants generally do a very good job of dealing with this. Chronic rejection occurs over a longer period, often despite the drugs and involves a slow, progressive level of kidney function.

Unfortunately, those immuno-suppressive drugs (required even in the best cases) themselves carry risks, both short term and long term. They can substantially increase the odds of diabetes, a disease which can be either cause or consequence of kidney disease. They can increase the odds of heart attack.

Some signs that the drugs are no longer working include fever, soreness in the kidney area (after the pain of surgery itself has subsided), or significant changes in urine production.

Only your physician (usually in conjunction with a specialist) can advise you properly on the full range of risks and benefits, and treatment options for kidney disease. But knowing some of the more common risks can help prepare you for that conversation.

KB – Renal Failure

The kidneys are vital organs. They remove waste material, determine body fluid level, influence electrolyte concentrations, and even help regulate blood pressure. We are lucky that we have two, for kidney failure (also called renal failure) is a very serious condition.

Kidney failure comes in multiple forms, from reduced function (called renal insufficiency) to complete collapse (known as acute or chronic renal failure). Reduced function may occur, for example, when the top lobe of one of the kidneys flattens, reducing the number and surface area of nephrons, the small units that filter the blood. Or, a kidney may stop working altogether.

The causes are as varied as the types of renal failure. Decreased blood flow from constricted blood vessels is one. Hypertension is another. Necrosis, the actual death of kidney cells, is yet one more. Some autoimmune diseases result in kidney malfunction.

Symptoms also cover a wide range. In 70% of cases oliguria (decrease in urine output) is present, or it may stop altogether (anuria). The feet or legs may swell from excess fluid retention. Lethargy and decreased appetite are possible. We may bruise more easily or experience prolonged bleeding from a cut. Even seizures or coma are possible.

But since any of these symptoms may result from many other diseases as well, the only way to know is to get a proper diagnosis.

The exam starts with a check for physical signs. Using a stethoscope, the doctor will listen for heart murmur or crackling in the lungs, a sign of excess fluid. That is followed up with a urinalysis and blood tests. The lab will look for blood in the urine, excess creatinine levels, and check serum potassium levels. A BUN (blood urea nitrogen) test is performed. Ultrasound may be used, and sometimes an MRI (Magnetic Resonance Imaging) is performed.

Kidney malfunction is a serious condition, but it can be treated.

Dietary changes are the minimum one can expect. It will become important to control fluids, both the amount and type. Diuretics may be used to help the kidneys lose fluid. It will also be important to control electrolytes such as sodium and potassium. It will be essential to monitor and regulate blood pressure.

In more severe cases, blood potassium levels may be controlled by IV calcium treatments. Diabetes is often either a cause or a consequence of kidney disease and that entails regulating glucose and insulin levels. In extreme cases, dialysis is necessary.

The most serious stage is known as chronic renal failure or end-stage renal disease. This can be fatal, but need not be. It is more common when a kidney malfunction results from physical injury or surgery, or a severe infection. Treatments range from intermittent to continuous dialysis to kidney transplants to artificial kidneys worn on the outside of the body.

When properly treated, kidney disease can be kept under control and sometimes cured entirely. Naturally, the prognosis will depend on the underlying causes, but it is not uncommon for the most severe symptoms to be sharply curtailed within a few weeks. In many cases, full or near-full function is restored within months.