Natural Kidney Damage Cure and Treatment

Kidney Function Restoration Program

The All Natural Kidney Health & Kidney Function Restoration Program is a compilation of the best and most effective natural treatments for kidney disease from around the world. The system is meant to complement your usual medication and not to replace it. This easy to understand kidney disease program can help you make better-informed decisions about what is the right thing to do to support your kidney and return it to its former healthy state. The techniques shared in this program will help cure and retain your kidney back to its natural wellness. You may even be able to postpone or entirely avoid dialysis or a kidney transplant forever. The All Natural Kidney Health and Kidney Function Restoration Program contain zero filler and is fully backed by modern-day scientific research. Everything contained in this program is safe, natural, and with good safety profiles, proven case studies and doctor recommended. Many of the products including the diet, herbs, and supplements have been used safely in other countries for many years and in several hospitals in the United States. Read more here...

Kidney Function Restoration Program Summary


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Diabetic retinopathy or nephropathy during pregnancy

However, nephropathy continues to be a serious problem. I treated diabetic pregnant women with nephropathy at the Diabetes Center of TWMU from 1964 to 1996. There were 13 deliveries out of 631 and only 2.1 had nephropathy. Their incidence is not significantly different. Six (2.9 ) were Type 1 and seven (1.6 ) were Type 2 diabetics. A comparison of incidences of diabetic pregnant women with nephropathy was made. During my 32 years at the Table 20.3 Incidence of diabetic pregnant women with nephropathy Table 20.3 Incidence of diabetic pregnant women with nephropathy Diabetes Center of TWMU only 2.1 of my patients had nephropathy. In contrast, a more recent study conducted by my colleagues for a period of 7 years from 1997 to 2003, showed that there was 6.6 of patients with nephropathy (Table 20.3).11 The following reasons may in one way or another have contributed to the increase of diabetic pregnant women with nephropathy (1) their diabetes may have not been treated until pregnancy or...

Pathophysiology and treatment of diabetic nephropathy

Diabetic nephropathy is a progressive disease that affects approximately 30 of patients with diabetes and it is the most common cause of end stage renal disease in USA. The first clinical sign is increased excretion of albumin in the urine, so called microalbuminuria in the range 30-300 mg 24 h, corresponding to a spot urine albumine to creatinine ratio of 30 mg g. Untreated microalbuminuria progresses to overt diabetic nephropathy characterised by persistent proteinuria, hypertension and a relentless decline in glomerular filtration rate.4 Histological changes in the glomeruli with increased basal membrane thickness and glomerulosclerosis are characteristics, but universal leakage of albumin over the endothelium in the whole body is also present. Progression to end stage renal disease occurs with a median duration of 7 years after onset of diabetic nephropathy, if let untreated. The introduction of inhibition of the renin-angiotensin system in combination with other antihypertensive...

Effects of pregnancy on diabetic nephropathy

Few studies have examined the long-term effect of pregnancy on renal function in women with diabetic nephropathy after strict antihypertensive treatment has been widely used and improved the survivial. The most recent is a case-control study including 26 pregnant women with diabetic nephropa-thy and normal serum creatinine followed for up to 13 years and the decline in kidney function was compared to women with diabetic nephropathy who did not became pregnant in the study period.8 The women were offered strict antihypertensive treatment as routine treatment.during the whole study period. They found that in women with serum creatinine within the normal range, pregnancy did not accelerate the decline in kidney function or impair the long-term survival of the mother.8 However, in women with a reduced creatinine clearance reports suggest that there is an increased risk of deterioration of kidney function during pregnancy.9,10 The long-term survival of a mother with diabetic nephropathy...

Treatment of women with diabetic nephropathy during pregnancy

Strict metabolic control during pregnancy is of utmost importance but may be difficult because women with Type 1 diabetes and diabetic nephropathy often have an increased risk of severe hypoglycaemia. Close surveillance of blood pressure and urinary albumin excretion is central while 24 h ambulatory blood pressure recording has not been shown to be of benefit in the care of these women.15 Early onset and strict antihypertensive treatment as in the nonpregnant state might improve the outcome. In patients with microalbuminuria introduction of early onset antihypertensive treatment with methyldopa in normotensive pregnant women with Type 1 diabetes and microalbuminuria resulted in a significant reduction in preterm delivery before gestational week 34.16 Furthermore, early onset and strict antihypertensive treatment in women with diabetic nephropathy most likely also reduce the severity of pre-eclampsia end preterm delivery. Our center recommends initiating antihypertensive treatment in...

Counseling women with diabetic nephropathy

ACE inhibition was discontinued immediately after the positive pregnancy test and only four out of 24 women delivered preterm. Severe handicap or late infant death was seen in two cases.3 However, treatment with ACE inhibitors in early pregnancy has recently been shown to be associated with increased risk of congenital malformations.18 Furthermore ACE inhibition during the last part of pregnancy is associated with abnormal fetal renal development and neonatal renal failure.19 Treatment with ACE inhibitors or angiotensin II blockers should therefore in general be stopped prior to conception.18,19 It is often wise to change to other types of antihypertensive treatment that is regarded safe in pregnancy i.e. methyldopa, beta blockers such as labetalol or calcium antagonists. Although the use of diuretics throughout pregnancy is controversial20 we have good clinical experience with continuation of an ongoing diuretic treatment in stable doses during pregnancy in these women.16 Statin...

Peritoneal Dialysis Pd

With PD, the peritoneal membrane serves as a semipermeable membrane and its blood supply provides blood flow. After the insertion of a soft plastic tube into the peritoneal cavity, dialysis fluid (usually 2 l), is infused. The fluid is left to dwell in the peritoneal cavity, dialysis occurs and the fluid is then drained out and discarded. Fresh fluid is instilled back into the peritoneal cavity and the cycle is repeated. Most commonly patients perform four exchanges per day, at breakfast, lunch, teatime, and bedtime, and the fluid remains in the abdomen for approximately four hours between exchanges. This is called continuous ambulatory peritoneal dialysis (CAPD). Another alternative is to use a machine that automatically cycles the fluid exchanges in and out of the peritoneal cavity continuously overnight whilst the patient sleeps. This is called automated peritoneal dialysis (APD). The composition of the dialysis fluid is similar to that used for haemodialysis. The major difference...

Replacement of Renal Function by Dialysis

In medicine, dialysis is a method of replacing renal function that has been lost due to either acute or chronic renal failure. Dialysis works on the principle of diffusion of low molecular weight solutes down a concentration gradient across a semipermeable membrane. Fluid can be removed by exerting a hydrostatic or osmotic gradient across the membrane. Blood is present on one side of the semi-permeable membrane and dialysis fluid on the other. The concentration of undesired solutes, such as potassium, in the dialysis fluid is low and a buffer is also present to facilitate the removal of metabolic acid. There are two types of dialysis.

Effect of diabetic nephropathy on pregnancy outcome

The presence of diabetic nephropathy significantly affects the outcome of pregnancy, primarily due to three reasons (1) the increased risk of maternal hypertensive complications (2) the increased risk of preterm delivery due to deteriorating maternal blood pressure and pre-eclampsia and (3) the increased risk of intrauterine fetal growth restriction and fetal distress caused by placental dysfunction. Severe malformations have been described with a slightly higher prevalence in women with diabetic nephropathy compared to diabetic women with normal kidney function. However, this is most likely due to the poorer metabolic control early in pregnancy often found in these women. The risk of perinatal mortality in pregnancies complicated by diabetic nephropathy is now close to that of women with Type 1 diabetes without diabetic nephropathy.1-3 The rate of pre-eclampsia in women with diabetic nephropathy is high 53-64 1,2,3,11 especially when reduced kidney function,12 hypertension at onset...

Peritoneal Dialysis

In peritoneal dialysis (PD) the patient has a soft tube inserted into the peritoneal cavity. This is used to drain up to 2.5 l of fluid in and out of the peritoneal cavity, typically four times a day, by patients in their own home. Each patient has an individual dialysis prescription and a target 'dry' weight to ensure that the correct amounts of waste products and fluid are removed by their dialysis. Women of childbearing age receiving dialysis either have reduced fertility or are infertile.

Haemodialysis Hd

During haemodialysis the patient's blood is pumped by machine through a filter (dialyser) containing a semipermeable membrane with a large surface area. A physiological dialysis fluid (dialysate), is pumped on the other side of the semi-permeable membrane in the opposite direction. Excess water and metabolic waste products are cleared from the blood by the processes of diffusion, convection and ultrafiltration. Normally a patient will receive haemodialysis three times per week, for approximately four hours at a time. Some dialysis patients pass no urine at all, and fluid intake is usually restricted to only 500 ml per day (equivalent to daily insensible losses through breathing, sweating, etc.), plus the amount of the previous days urinary output. Otherwise, in between dialyses this fluid will accumulate in the body causing 'overload', hypertension and pulmonary oedema.

Preconception Issues And Care

The complications of pre-eclampsia are numerous and include placental abruption, intrauterine growth restriction, HELLP syndrome (Haemolysis, Elevated Liver enzymes, Low Platelet count), disseminated intravascular coagulation (DIC), renal failure, pre-term delivery, multi-organ failure, eclampsia (grand mal seizures in the presence of pre-eclampsia) and even death.

Fetal Risk Summary

A woman with primary gout and gouty nephropathy was treated with 300 mg day of allopurinol throughout gestation (8). She was delivered of an appropriate-for-gestational-age 2510-g healthy female infant at 35 weeks' gestation. The infant's weight gain was normal at 10 weeks of age, but other developmental milestones were not provided.

Explanation Of Condition

Chronic kidney disease (CKD) implies longstanding kidney problems often, but not always, associated with loss of excretory function. CKD is classified according to estimated glomerular filtration rate (eGFR). Five stages are recognised 1. Normal GFR 90 ml min 1.73 m2 with other evidence of chronic kidney damage* 2. Mild impairment GFR 60-89 ml min 1.73 m2 with other evidence of chronic kidney damage* 5. Established renal failure GFR

64 Renal Transplantation

The patient will have developed end-stage renal failure as a consequence of either acute or chronic kidney disease. At this stage renal replacement therapy is required. The options are haemodialysis, peritoneal dialysis or renal transplantation. Most patients spend some time receiving dialysis before receiving a kidney transplant. Kidneys for transplantation may be obtained from a cadaver donor or be donated by a living relative. Although non-functional, the patient's own kidneys do not cause a significant problem and are not removed. The success of the transplant may vary. Most transplanted kidneys function well for many years, whereas others function less well or not at all. Commonly however, kidney transplants work well initially, but their function declines slowly over time.

2810 Magnesium sulfate

Magnesium, when used in higher doses, or when kidney function is limited, can cause marked muscle hypotonia in both mother and newborn. In extreme cases, especially when its effect is enhanced by a calcium antagonist such as nifedipine, a dangerous drop in maternal blood pressure can occur which may result in fetal hypoxia.

65 Nephrotic Syndrome

The development of nephrotic syndrome indicates that the patient has renal disease affecting the glomerulus, i.e. glomerulonephritis. Many different types of glomerular disease may cause nephrotic syndrome (e.g. membranous nephropathy, diabetic nephropathy) and a renal biopsy is usually required to make a precise histological diagnosis.

2910 Other fibrinolytics

Epsilon-aminocaproic acid is an inhibitor of fibrinolysis. The use of this agent is associated with an increased risk of thrombosis and embolism, with possible renal failure from thrombosis in glomerular capillary arteries. It was reported not to be teratogenic in rabbits. No information is available regarding its use during pregnancy.

Pregestational diabetes

A complete anamnesis is imperative before planning for pregnancy. This should include, but not be limited to, questioning for duration and type of diabetes (Type 1 or Type 2), acute complications, including history of infections, ketoaci-dosis, and hypoglycemia, chronic complications, including retinopathy, nephropathy, hypertension, atherosclerotic vascular disease, and autonomic and peripheral neuropathy, diabetes management, including insulin regimen, prior or current use of oral glucose-lowering agents, SMBG regimens and results, medical nutrition therapy, and physical activity, concomitant medical conditions and medications, thyroid disease in particular for patients with Type 1 diabetes, menstrual pregnancy history contraceptive use and support system, including family and work environment.70 To minimize the occurrence of malformations, standard care for all women with diabetes who have child-bearing potential should include (3) integration of the patient into the management of...

2124 Selective immunosuppressants

Discussed elsewhere (sec Chapter 2.17). Certain advantages and disadvantages of tacrolimus in pregnancy are discussed compared to cyclosporine rejection and hypertension are less common with tacrolimus, and the necessary dosage of prednisolone is lower. On the other hand, gestational diabetes occurs more often, as does transient hyperkalemia and transient reduction of kidney function in the newborn. Jain (1997) even reported on a newborn with anuria which lasted 36 hours. As with other immunosuppressant drugs, pre-eclampsia, prematurity, low birth weight, and cesarian births were seen at greater incidence.

21316 Enzymes and antibodies exerting antineoplastic effects

Trastuzumab is a monoclonal antibody which blocks the human epidermal growth factor 2 protein and has an estimated half-life of 12 days. Waterstone (2006) reported on an uneventful prcgnancy and the delivery of a healthy girl whose mother conceived 3 days after her second cyclc of trastuzumab. There is one case report of inadvertent exposure of a 28-year-old with breast cancer who was given the drug every 3 weeks until week 20 of her pregnancy. When, in week 23, the pregnancy was noticed, a lack of amniotic fluid prevailed with a healthy female fetus. Gradually, Lhe amount of amniotic fluid recovered. In week 37, a healthy girl was delivered whose kidney function was normal at the age of 6 months and who showed no sign of pulmonary hypoplasia (Watson 2005). There is another report regarding the development of an oligohydramnios after trastuzumab therapy. Fanale (2005) described a case where therapy with trastuzumab and vinorelbine was started after week 27 because of metastatic breast...

2147 Magnesium sulfate

Magnesium, when used in higher doses or when kidney function is limited, can cause marked muscle hypotonia in both mother and newborn. In extreme eases, especially when a calcium antagonist such as nifedipine enhances its effect, a dangerous drop in maternal blood pressure can occur, which may result in fetal hypoxia.

Doppler velocimetry of fetal arterial area

Different and controversial is the application of fetal velocimetry to gestational diabetes or to insulin depending diabetes without vascular alteration (mainly nephropathy and retinopathy). Salvesen et al.18,35 used Doppler to examine 48 diabetic pregnancies, well controlled by insulin therapy. Except three pregnancies complicated by pre-eclampsia and or fetal growth restriction, uteroplacental and fetal flow velocity were normal no significant differences in velocimetric pattern of uterine, umbilical, middle cerebral arteries and of descending thoracic aorta versus control group. It is interesting to observe that in the majority of diabetic pregnancies with nephropathy, acidemia and hypoxemia were found in cordocentesis although velocimetric patterns were normal. It has been suggested that hypoxemia and acidemia may be the consequence of metabolic alterations of diabetes, leading to hyperlactacidemia in presence of normal fetal growth and in absence of redistribution of circulation.

2153 Prolactin antagonists

Oxytocin may be used obstetrically for the induction or augmentation of labor. Clinically important vasopressin deficiency (diabetes insipidus) justifies the use of vasopressin or desmopressin during pregnancy. Careful control of circulatory and kidney function is essential. Von Willebrand's disease type I and platelet dysfunction can also be indications for the administration of desmopressin. The use of the other vasopressin analogs is not grounds for a termination of pregnancy or for Invasive diagnostic procedures.

Clinical consequences of insulin resistance

Insulin resistance impairs glucose tolerance while promoting dyslipidemia, obesity, hypertension, and atherosclerosis. Its effects on salt handling by the kidneys predisposes the individual to renal dysfunction. Obesity, glucose intolerance, hyperinsu-linemia, hypertension, and dyslipidemia represent cumulative risk factors that generate an escalating cycle of vascular compromise and collapse. Patients with three or more of these risk factors have an increased incidence of stroke, nephropathy, ischemic heart disease, and peripheral vascular disease.82 Long-term diabetic complications are the most common cause of blindness, renal failure, and limb amputation in the United States today. Meticulous glycemic control has been shown to decrease the incidence of eye disease among diabetic patients. Antihypertensive therapy, specifically with angiotensin converting enzyme inhibitors (ACE-I), is effective in reducing the rate of progression of diabetic kidney disease. To prevent the peripheral...

Pregestational diabetes and hypertensive complications

In most cases, pregestational diabetes refers to Type 1 DM. The incidence of Type 1 DM in pregnancy ranges from 0.2 to 0.5 .119,120 Affected women contribute a heterogenous group in terms of duration of diabetes, White's classification, presence of hypertension, and end-organ damage, especially to the eye (retinopathy) and kidney (nephropathy). Pregnancy in women with Type 1 DM is associated with increased risks of pre-eclampsia, IUGR, neonatal morbidity, and perinatal mortality.110-127 The diagnosis of pre-eclampsia is difficult in women with preexisting hypertension and proteinuria,120 and women with chronic hypertension are at increased risk of superimposed pre-eclampsia independent of the presence of diabetes.128 The rate of hypertensive disorders (PIH and pre-eclampsia) in the various studies ranged from 9 to 66 . The lowest rate occurred in women with milder forms of DM (class B), and the highest in women with diabetic nephropa-thy. Table 41.1 summarizes the reported rates of...

Disorders of bone and mineral metabolism during pregnancy and lactation

Treatment options for hyperparathyroidism in pregnancy are influenced by the symptoms and severity of disease and gestational age. Optimal management requires a multidisciplinary approach surgery should be performed only by an experienced parathyroid surgeon. Symptomatic and severe disease should be treated surgically, preferably in the second trimester, whereas mild asymptomatic disease diagnosed in the third trimester may continue to be observed until after delivery. A consensus for other cases is missing, however. Medical treatment includes adequate hydration and correction of electrolyte abnormalities 49 . Pharmacologic agents to treat hypercalcemia have not been studied adequately in pregnancy. Calcitonin, a pregnancy category B medication of the US Food and Drug Administration, does not cross the placenta and has been used safely in pregnancy 49 . Oral phosphate, a pregnancy category C medication, has been used in pregnancy its most common side effects are diarrhea and...

Acupuncture and induction

I find that acupuncture works very well for women who are being induced (Figs 10.2, 10.3). Its main benefit is in reducing the acute pain that is often associated with induced labours (see above). Ear points such as Uterus and Shenmen are particularly effective if the needles are attached to a V-TENS machine. I have induced many women using acupuncture but I will use it only in normal, healthy, pregnant women who have had no complications in their pregnancy. I would not use it where a mother had suffered from conditions such as severe pre-eclampsia, kidney disease, a heart condition, diabetes, any bleeding, or if they had previously delivered by caesarean section.

Prenatal Diagnosis By Dna Analysis

In instances in which an autosomal-dominant disorder is suspected because of an affected parent or ultrasonographic examination results of the fetus, diagnosis by DNA is feasible for conditions in which the mutation is known, such as adult-onset polycystic kidney disease (168,169), Marfan syndrome (170), osteogenesis imperfecta type I (171), or neurofibromatosis type I (172).

Growth disturbances in infants of diabetic mothers General comments

Pedersen, in his monograph,5 summarized the literature on birthweight, length, organ size and body composition as well as the state of maturity of newborn children. He described the well-known macrosomia (large for gestational age, LGA) in most infants. The fetus responds to maternal hyperglycemia by hyperinsulinemia that reduces his blood glucose levels but may lead to enhanced growth. He also pointed out that in PGD women with nephropathy, there is a high rate of intrauterine growth restriction (IUGR). Farquar9 described in detail, as early as 1959, the appearance of macrosomic infants born to diabetic mothers and their prognosis. They were described as 'plump, sleek, liberaly coated with vernix caseosa, full faced and phle-toric.' 'They commonly exceed the mean body weight and crown heel length, and resemble each other.' Farquar also described a variety of perinatal complications, increased

Growth of SGA infants

There are few studies describing the growth of low birth-weight infants of diabetic mothers. In a relatively recent study published by Biesenbach et al.,34 10 children of mothers with PGD and nephropathy were compared to 30 children of mothers with PGD without nephropathy. In the first group, birthweight was significantly reduced (2250 vs. 3554g). In addition, prematurity was increased to 60 in the mothers with nephropathy with no premature infants in the second group. Reduced growth persisted and at follow-up at 3 years of age, six of the 10 children from the first group had body weight below the 50th percentile and five had height below the 50th percentile, with none in the second group. Language development in the children of the first group was also delayed and they had more infectious diseases.34

Intensified therapy in pregnancy

It is well established that the level of metabolic control in nonpregnant patients with pregestational diabetes influences the incidence and development of retinopathy, nephropathy, and neuropathy. The levels of glycemia achieved in studies on nonpregnant subjects (DCCT, UKPDS) 17,32 were significantly higher, however, than the targeted levels of glycemia during pregnancy.

10 What painkillers are safe during pregnancy

Taking pain-killers like paracetamol is safe during pregnancy as it has no harmful effects on the fetus. Avoid ibuprofen or mefenamic acid which are NSAIDs (non-steroidal anti-inflammatory drugs). This class of drugs is not safe during pregnancy, especially during the last three months. They may affect the baby's circulation, kidney function, or delay the onset of labor. However, there is no evidence that these drugs cause congenital abnormalities.

Diagnostic Tests for Ontd Afafp and AChE

Conditions other than ONTD that are associated with an elevated AFAFP and or detectable AChE include normal variance in a healthy fetus (AFAFP only), fetal blood contamination, open ventral wall defects detectable by ultrasound (gastroschesis, and less commonly omphalocele), congenital nephrosis (AFAFP only), and fetal demise.

Breast Feeding Summary

A 24-year-old woman, 17 days postpartum, was given a single 500-mg dose of the antibacterial to treat a urinary tract infection (13). She was also suffering from acute renal failure and had undergone her final hemodialysis treatment 7 days prior to administration of ciprofloxacin. Her serum creatinine and blood urea nitrogen at the time of the dose were 740 mmol L and 26.8 mmol L, respectively. Milk samples, 40 mL each, were collected at 4, 8, 12, and 16 hours. Concentrations of ciprofloxacin at these times were 9.1, 9.1, 9.1, and 6.0 pmol L, respectively. (Note 9.1 and 6.0 pmol L are approximately 3.0 and 2.0 pg mL, respectively.) Based on the volume of milk and concentrations, the potential cumulative dose for the infant, who was not allowed to breast-feed, was 1.331 pmol.

3 Treatment Of Postpartum Mood Disorders

Regarding breast-fed babies, it is useful to keep in mind that older children will be better able to fully and efficiently metabolize drugs than newborns. Likewise, preterm infants or babies with impaired liver or kidney function will have more difficulty effectively metabolizing medications. Children who are exclusively breast-fed are likely to be exposed to higher amounts of drugs than those who are not breast-fed or who receive supplemental formula feedings.

Glycated serum proteins

Mostly albumin, and other serum proteins, undergo the process of glycation. The turnover of serum albumin depicts a half-life of 25 days it provides an index of a mean glycemic level of a shorter interval than HbAlc. The fructosamine assay is the most widely method being used for estimating glycated serum proteins. Nevertheless, although fructosamine levels correlate with HbAlc levels within a population, transference cannot apply for individual values.41 Also, changes in serum proteins affect the readings of fructosamine 42 the technique is unreliable in diabetic patients with renal failure,43 liver cirrhosis and nephrotic syndrome.44 43. Morgan LJ, Marenah CB, Morgan AG, et al. Glycated haemoglobin and fructosamine in non-diabetic subjects with chronic renal failure. Nephrol Dial Transplant 1990 5 868-73.

Congenital Disorders Associated With Elevated

The demonstration of elevated AFAFP levels greater than 3.0 standard deviations from the mean, or over 2.0 multiples of the median (MoM) for gestational age will detect 98 to 100 of fetuses with NTD. Errors in estimation of gestational age account for the majority of false-positive results and can be resolved by ultrasonographic reassessment of fetal measurements. Increased AFAFP levels are usually the result of exudation of fetal serum proteins through skin defects or across fetal membranes. This mechanism accounts for the elevated AFAFP in anencephaly, open spinal cord lesions, and ventral wall defects such as omphalocele and gastroschisis. Abnormal renal filtration of protein, as is found in the Finnish type of congenital nephrosis, also results in high AFAFP. Gastrointestinal obstruction or swallowing defects make it impossible for the fetus to reabsorb the AFP in the small intestine, thus resulting in polyhydramnios and elevated AFAFP. Twin gestations, missed abortion, impending...

Respiratory Disorders

Hou SH 1994 Pregnancy in women on haemodialysis and peritoneal dialysis. Bailliere's Clinical Obstetrics and Gynaecology, 3. Hussey MJ and Pombar X 1998 Obstetric care for renal allograft recipients or for women treated with haemodialysis or peritoneal dialysis during pregnancy. Advanced Renal Replacement Therapy, 5 3-13 4. Hou S 1999 Pregnancy in chronic renal insufficiency and end stage renal disease. American Journal of Kidney Disease, 33 235-252 4. Hussey MJ and Pombar X 1998 Obstetric care for renal allograft recipients or for women treated with haemodialysis or peritoneal dialysis during pregnancy. Advanced Renal Replacement Therapy, 5 3-13

2157 Hyperthyroidism and thyrostatics

The corticosteroids arc grouped according to their capacity for Na+ retention, their effects on carbohydrate metabolism, and their anti-inflammatory effects. Thus, glucocorticoids have pleoiotropic effects and arc used in clinical practice in (as well as replacement therapy in cases of adrenal insufficiency) treating diverse diseases such as inflammatory rheumatic disorders, asthma, autoimmune diseases (systemic lupus erythematosus and others), acute kidney transplant rejection, and allergic and skin diseases. In pregnant women at risk for preterm birth, corticosteroids are also used for the induction of lung maturity. High doses of daily glucocorticoids are usually required in patients with severe diseases involving major organs, whereas alternate-day regimens may be used in patients with less aggressive disease. Intravenous glucocorticoids (pulse therapy) are frequently used to initiate therapy in patients with rapidly progressive, inmunologically mediated diseases (Rournpas 1993).

European Diab Care quality network

Network Information Sheet

The pertinent analysis provides the performance of care in both aspects of process and outcomes (intermediate and final). Demographic data (age, sex, etc.) are required for a number of purposes. True patient outcomes include the burden of the medical end points of the St Vincent Declaration (such as amputation, blindness, etc.). Symptoms of diabetes-related problems (e.g. painful neuropathy, angina pectoris, etc.) are also recorded. Specific outcomes regarding pregnancies are also included. For the measurement of quality of life, the DiabCare data sets only include information related to duration of hospital admissions and the number of days without the ability to perform normal activities. Assessment of diabetic complications (retinopathy, nephropathy, neuropathy), cardiovascular risk factors, pharmacological treatment and metabolic outcomes glycated hemoglobin (HbAlc), lipid profile were considered essential.4 The computer database (Figure 53.2)...

21511 Oral antidiabetics

These drugs have in common the fact that there is no evidence so far of effective prevention of diabetic late complications. Insulin, metformin, and sulfonylureas are the only antidiabetic substances where evidence-based data have shown positive effects on the late diabetic complications, such as neuropathy, nephropathy, etc., or coronary sclerosis and others.

Intrauterine factors in metabolic syndrome The fetal origin of adult disease

An additional factor that may underlie the proposed contribution of the intrauterine environment to adult disease is the reduced nephron mass documented in infants in disad-vantaged populations with intrauterine growth restriction and exposure to maternal diabetes and vitamin A deficiency. A lower nephron mass may impair nephrogenesis, thereby increasing the susceptibility of the infant to later kidney damage from diseases such as hypertension and diabetes, which also commonly affect disadvantaged people.44

Microalbuminuria diabetes and hypertension in pregnancy

The role of microalbuminuria in DM has been established over the last 20 years. At the early stage of DM, when glucose metabolism is not controlled, the increase in glomerular plasma flow and intraglomerular pressure is probably responsible for the increased protein excretion.144 Some authors believe these hemodynamic alterations are major determinants of both the initiation and progression of diabetic nephropathy.145 Several studies have reported that patients with Type 1146 or Type 2 DM147 who have above-normal urinary albumin excretion rates are more likely to acquire diabetic nephropathy, eventually progressing to renal failure.148 Microalbuminuria is also associated with an excess of known and potential cardiovascular risk factors, and it is a marker of established cardiovascular disease in both hypertensive149 and nonhypertensive150 individuals. Its role in diabetic and hypertensive pregnancy is less clear,151 but becoming increasingly recognized. One study found that the...

61 Urinary Tract Infections

Generally, if adequately treated, there are no significant effects on the fetus. If the mother has reflux nephropathy as a predisposing cause for UTI there is an increased risk that the baby may also suffer from this condition. If mother has recurrent UTI due to reflux nephropathy, then there is a risk that the baby could also have this condition. Early detection and prompt treatment of urinary infections in the newborn can help prevent renal scarring and chronic kidney disease later in life. A renal ultrasound scan, for reflux nephropathy, should be arranged for the baby

Diab Card as an instrument for quality assurance

The results of the DCCT showed that in Type 1 DM strict glycemic control resulted in a significant reduction in the rate of onset and progression of retinopathy, nephropathy and neu-ropathy.17 In the United Kingdom Prospective Diabetes Study (UKPDS), the difference of 0.9 in HbAlc between the intensively treated group and the control group was associated with a 25 reduction in risk of microvascular end points 18 intensive blood glucose control did not reduce the risk of myocardial infarction or stroke, but the control of hypertension was very important in this respect.19

The later years

The differences in their viewpoints as reflecting his realism and her optimism. Patients with nephropathy clearly had the lowest expectation of success of any class, but she started her career when no one had much expectation of success. Having been an effector of triumph over adversity no doubt influenced her optimistic view.

Frequent urination

Around 12 weeks), your uterus expands enough to rise up into your abdominal cavity. Your enlarging uterus may compress your bladder, which both decreases its capacity and increases the feeling that you need to urinate. Also, your blood volume rises markedly during pregnancy, and that means the rate at which your kidneys produce urine also increases.

Medical Authors

As a clinical academic, in addition to clinical responsibilities, he supervises a laboratory team investigating cellular mechanisms of kidney disease. His particular clinical interests include proteinuria, progressive renal disease and management of renal disease in pregnancy. He has published widely in the field of kidney disease.


New Zealand is a developed nation with a land mass of 270,500 km2 over two major islands (North Island and South Island). The population of 3,737,277 in 2001 included 2,868,009 of European descent (predominantly from the British Isles), 526,281 Maori (indigenous Polynesians who arrived mainly between 800 and 1200 AD), 231,801 Pacific peoples (mainly from Samoa, Tonga, Cook Islands, Niue and Tokelau Islands from the 1960s) and 237,459 Asians (who have arrived since the nineteenth century, but particularly in the 1990s).1 The high prevalence of Type 2 diabetes among Maori was first reported in the early 1960s.2 Subsequently, an increasing prevalence of diabetes among Tokelauan immigrants to New Zealand was found compared with those who remained in the islands.3 The growth in numbers with diabetes across New Zealand Europeans, Maori and Pacific people became apparent from studies in South Auckland and data relating to complications (e.g. renal failure) in the 1990s.4 Subsequent data has...

286 ACE inhibitors

The following reports of fetal and neonatal toxicity after exposure in the second half of pregnancy are typical hypoxia, hypotension, renal tubular dysgenesis, oligohydramnios, and anuria requiring dialysis following the use of ACE inhibitors in late pregnancy (Murki 2005, Filler 2003, Gilstrap 1998, Lavoratti 1997). Hypoplasia of the skull bones (calvarial hypoplasia) has also been observed in six infants, which could be a consequence of limited perfusion and increased pressure on the skull caused by oligohydramnios (Barr 1994). If oligohydramnios is diagnosed in pregnancy while taking an ACE inhibitor, and medication is stopped, there is a chance that amniotic fluids will regenerate (Muller 2002). The mechanism of toxicity is as follows. Fetal urine production and kidney function start at the end of the first trimester. Angiotensin-converting enzymes appear at about 26 weeks' gestation. ACE inhibitors reduce the tonus of kidney vessels, and as a conscquence urine production is...

2827 Mannitol

Diuretics are no longer part of the standard therapy for hypertension and edema during pregnancy they should only be used for particular indications. In such cases, hydrochlorothiazide is the diuretic of choice. Furosemide can also be given when treatment of heart or renal failure requires a diuretic. When therapy is long term, the mother's electrolytes and hematocrit should be monitored and the development of oligohydramnios ruled out. If treatment is continued throughout the pregnancy, hypoglycemia in the newborn should be determined. Mannltol may be used during pregnancy when an osmotic diuretic is necessary. Other benzthiazide derivatives, ethacrynic acid, amiloride, triamterene, and aldosterone antagonists should be avoided during pregnancy. If therapy with aldosterone antagonists is absolutely necessary, spironolactone should be chosen. None of the diuretics is an indication for interrupting the pregnancy. Filler G. Wong 11. Condello A el al. Early dialysis in a...


Preeclampsia is a multi-organ disease that occurs after 20 weeks gestation and is characterized by the development of proteinuria and hypertension. It is specific to pregnancy and complicates 5-7 of pregnancies 1 . It falls into the larger category of hypertensive disorders of pregnancy, which is addressed briefly within this chapter. The exact etiology or pathophysiology of this disorder is poorly understood. Additionally, there are no well-established methods of primary prevention or of reliable and cost-effective screening. Yet, preeclampsia is associated with increased maternal mortality and morbidity including placental abruption, acute renal failure, cerebrovascular and cardiovascular complications, and disseminated intravascular coagulation 2 .

Type 1 diabetes

Inappropriate hyperinsulinemia, either absolute or relative, is the initiating cause of hypoglycemia in diabetes mellitus. Hyperinsulinemia is the rule in diabetes mellitus, both Type 1 and Type 2, because of the therapeutic delivery of insulin into the peripheral rather than portal circulation and because of the empirical algorithms used to administer insulin. Absolute hyperinsulinemia, due to excessive levels of circulating insulin because of an excess of dosage or irregularity of absorption, causes hypoglycemia more frequently during the hours preceding meals or in the first morning hours. Relative hyper-insulinemia is due to other conditions such as delayed or inadequate diet (especially as far as the range of carbohydrates is concerned), physical exercise, renal failure, excessive alcohol consumption, delayed gastric emptying. In these conditions usually hypoglycemia occurs after meals.20

Existing guidelines

Published guidelines reflect a lack of consensus regarding timing and route of delivery for infants of diabetic women. The American Diabetes Association's Clinical Practice Recommendation for gestational diabetes advises delivery during the 38th week of pregnancy in an effort to prevent further in utero growth having achieved maturity.1 In contrast, the American College of Obstetricians and Gynecologists (ACOG) states that there is no good evidence to support routine delivery prior to 40 weeks gestation in women who have gestational diabetes.2 The same organization suggests that in the absence of diabetic nephropathy, retinopathy, poor glycemic control or prior stillbirth, infants of pre-gestational diabetic women be delivered at term.3 Similarly, the Australasian Diabetes in Pregnancy Society (ADIPS) recommends delivery at term for pre-gestational diabetic women who are in good metabolic control and who do not have such complications as pre-eclampsia, intrauterine growth retardation,...


It is estimated that 20-30 of diabetic women in the reproductive age group has some evidence of retinopathy.1 Risk factors for diabetic retinopathy include longer duration of the disease, onset of disease before 30 years of age, poor glycemic control manifested by higher levels of glycosylated hemoglobin, hypertension, hypertriglyceridemia, anemia, and evidence of diabetic nephropathy.4,11,14-21

2225 Animal toxins

More than 90 cases of snake bites in pregnant women have been reported in the literature, although only in a few have clinical data been described in detail (Sebe 2005B, Langley 2004, Nasu 2004, Dao 1997, Pantanowitz 1996). In addition, there are a very few case reports on spider bites (sec below Pantanowitz 1996), Not much is known about the effects on the fetus of the various neurotoxins, cytotoxins, and hematotoxins. There is a report concerning four women in Sri Lanka, of whom two were bitten by cobras and two by vipers (James 1985). Three of the women had no symptoms, but noticed a significant decrease in fetal activity. The fetal heart rate also diminished. Following administration of antitoxins, the fetal movements and heart rate were normal within 24 hours. These three mothers delivered healthy full-term infants. The fourth woman also noticed a decrease in fetal activity in the first 24 hours, but was only treated with the antitoxin after a severe toxic state with hemolysis...


The cause of preeclampsia is not fully understood but it may be an immune response by the mother. It runs i n families, and is more common i n younger and older mothers. You are also more likely to develop preeclampsia if you are overweight, have kidney disease or diabetes, or you already suffer from high blood pressure. High blood pressure is one of the main symptoms, along with fluid retention ( edema) in the h ands, feet, and legs and the presence of

465 ACE inhibitors

Following the use of ACE inhibitors in late pregnancy, kidney function disturbances as extreme as anuria requiring dialysis were seen in the newborn (Schubiger 1988), but this was not seen during breastfeeding. Thus, the American Academy of Pediatrics considers the use of those ACE inhibitors that have been tested for a long time to be acceptable during breastfeeding. Recommendation. Those ACE inhibitors that have been in long use, such as captopril, enalapril, and benazepril, can be used during breastfeeding when the antihypertensives of first choice are not effective or not indicated. As a safety measure, attention should be paid to edema and a possible increase in the infant's weight as indicators for disturbed kidney function. Accidental prescribing of another ACE inhibitor does not require limiting breastfeeding, but the therapy should be changed.

Anesthetic Agents

Workers exposed to excessive amounts of anesthetic gases may demonstrate symptoms of drowsiness, irritability, depression, headache, and impaired judgment or coordination. Hepatic and renal toxicity has been reported with certain agents, and the use of laboratory assessment of liver and kidney function should be considered. Sufficient evidence has not been found to support a risk to the fetus of an affected pregnant woman.

Hepatitis Viral

Unsanitary conditions and among young children who may not be suspected of having the illness because of mild or absent symptoms. Hepatitis B spreads through infected body fluids including blood, saliva, semen, vaginal fluids, breast milk, and urine. Infected infants usually have acquired the virus during the birth process from their HBV-carrier mothers. Hepatitis C usually spreads to children through transfused blood products, particularly with repeated blood product exposure as with chronic hemodialysis in a child with kidney failure. The virus may be passed from mother to infant, especially if the mother is also infected with HIV.

A future scenario

She has already read on the PHR about some of the treatments that she will discuss with the oncologist and the visit goes very well. The oncologist and BA decide on a treatment plan that involves radiation, chemotherapy, and surgery. It is an aggressive strategy, but the oncologist explains that this is in part due to a risky genetic profile uncovered in the many blood tests that BA has had so far. He is able to pull up the genetic profile via the EHR in the office, display it and show BA how her risk changes based on the profile. Given the fact that BA has expressed a desire to be very aggressive about her treatment in the electronic forms, the oncologist is able to further support this approach. He even recommends that BA's three sisters have genetic screening and more frequent mammograms. Since two of them are already signed up for the PHR, the oncologist is able to transmit summary recommendations to their profiles based on this information. The oncologist...


The results of methylmercury poisoning can be irreversible after destruction of neuronal cells. Treatment is directed toward early removal of methylmercury from the body before this damage may occur. Both D-penicillamine and N -acetyl-D-penicillamine are chelating agents effective in reducing blood levels of mercury (161). Oral administration of these drugs affects the enterohepatic circulation of mercury. Dialysis with a diffusible thiol compound can be highly effective in reducing blood levels of mercury (161). Dimercaptosuccinic acid and dimercaptopropane sulfonate are dithiocomplexing agents, which may be superior to currently used chelating agents.

Toddler Genitalia

Female Genitalia Deformity

Marked abdominal distention in an infant with massive polycystic kidneys. This infant died soon after birth. Infants with polycystic kidneys typically have an autosomal dominant pattern of inheritance in contrast to the autosomal recessive pattern in adult polycystic kidney disease. If little urine is produced, the fetus may exhibit the Potter sequence with fetal compression and pulmonary hypoplasia.

Monogenic diabetes

Renal cysts Developmental renal disease Renal failure Uterine abnormalities Short HNF-1 P mutations usually result in diabetes in the early twenties but the age of diagnosis is very variable and hence can occur before, during or after pregnancy.32 There is one report of woman presenting with gestational diabetes who had two pregnancies complicated by severe fetal cystic renal disease one fetus had severe renal failure in utero but the second pregnancy resulted in a live child with only moderate renal impairment.33 Generally, HNF-1 P diabetes is not responsive to sulfonylureas and most of these patients will require insulin treatment both during and after pregnancy.34 Some patients may have uterine and other genital abnormalities which interfere with normal pregnancy.32

Kidney Disorders

Vitamin D and minerals necessary for the growth and maintenance of bone. A number of kidney and urinary tract disorders affect children and may need treatment. Some of these conditions can result in problems with kidney function or, in some cases, lead to kidney failure. Birth defects or congenital malformations of the kidneys are relatively common. Fortunately, most of these abnormalities do not interfere with kidney function or produce other symptoms or health problems. Children can be born with a single kidney or two kidneys connected at their base to form a single horseshoe-shaped kidney. One or both kidneys may be abnormally positioned in the abdomen or pelvic region. In some cases, birth defects of the kidneys or urinary tract may be part of a syndrome (a group of congenital defects that tend to occur in a characteristic pattern). As long as the child has one functioning kidney, health problems usually do not result however, in this situation it becomes more important to protect...

Preterm delivery

Preterm delivery is strongly related to adverse neonatal outcome.2,4,13 Over one-third of infants of pre-gestational diabetic mothers were born prematurely.2 The rate of preterm delivery (both spontaneous and induced) in Type 1 diabetic population is as high as 45 .13 Poor glycemic control (elevated HbAlc) levels and vascular complications (pre-eclampsia and nephropathy) are predictive factors for preterm labor.60-62 Diabetes complicated by nephropathy or vascular disease causes an overall higher preterm delivery even when compared to a group of women with chronic hypertension, which might suggest there are other pathophysiological factors contributing to the adverse outcome.60

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