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Kidney -Liver
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Nephrology is the medical subspecialty that deals with the kidneys, especially their functions and diseases. A nephrologist is a medical doctor who specializes in diseases of the kidney. The term "nephrology" is derived from the Greek word for kidney, "nephros." Another term commonly used in reference to the kidney is "renal," as in "renal failure." This term is derived from the Latin for kidney, "renes."
 
Healthy people have two kidneys. A normal kidney can fit in the palm of your hand. Fortunately, if one organ stops working, or if both are partially damaged, the remaining kidney is usually able to perform adequately on its own. Unfortunately, many people suffer from loss of function of both kidneys resulting in total kidney failure.
 
Your kidneys serve several vital functions, including:
Remove waste from the body in the form of urine
Filter toxins from the blood
Help to regulate blood pressure and the balance of certain important nutrients, including potassium and calcium.
Because the kidneys perform several essential functions, treatment of kidney failure is complex and should be performed by a qualified nephrology specialist.
 
Kidneys are essentially blood-cleansing organs. An artery from the heart brings blood into the kidneys to be cleaned by a network of millions of tiny units called nephrons. The nephrons filter out toxins, excess nutrients and body fluid and excrete them in the form of urine into the bladder. The remaining cleaned and filtered blood then passes through veins back into circulation.
 
If both kidneys stop functioning due to disease, patients experience end-stage renal disease (ESRD), or total kidney failure. Because the kidneys perform so many critical functions, people whose kidneys fail face an immediate life-threatening condition. Kidney failure means that the body can no longer rid itself of certain toxins and cannot properly regulate blood pressure and critical nutrients. Unless those experiencing kidney failure are treated, they can die within days due to the build-up of toxins and fluid in their blood. More than 300,000 Americans today have ESRD and are dependent on artificial dialysis to stay alive.
 
There are four types of kidney disease, which are as follows:
Diabetes: accounts for more than 40% of all new cases of ESRD;
High Blood Pressure: (Hypertension) accounts for 26% of all new cases of ESRD;
Glomerulonephrities and
Cysts.
 
Dialysis is a life-saving process that artificially replaces the functions of the kidney. There are two types of dialysis: hemodialysis and peritoneal dialysis. Hemodialysis involves removing blood from the body and filtering it in a machine. The patient is connected by a tube to the dialysis machine, which continuously draws blood out, cleanses it and removes excess fluid and then returns the blood back to the patient. Hemodialysis must be performed for 3 to 4 hours at least three times a week. It is usually performed at a dialysis center, though home dialysis is also possible. Peritoneal Dialysis is internal or in-body dialysis. Peritoneal dialysis entails use of a blood-cleansing solution called "dialysate" that is injected into the peritoneal cavity, the region of the abdomen that is lined by the peritoneum. While in the peritoneal cavity, the dialysate works to extract toxins and excess fluid from the blood. After a period of time, the solution is then drained from the body cavity. Peritoneal dialysis may be done during the day or at night. Continuous ambulatory peritoneal dialysis (CAPD) is the name given to this procedure when it is performed at five-hour intervals four times a day during waking hours.

Dialysis is life sustaining and allows most patients to work and perform many normal activities, dependance on dialysis is strenuous, costly and is accompanied by severe dietary and lifestyle restrictions. Dialysis patients must continuously monitor and regulate their body's levels of salt, protein, potassium and calcium. ESRD patients are also highly prone to fatigue, especially immediately prior to dialysis treatment.
 
Many ESRD patients benefit greatly from a kidney transplant. After successful transplantation, patients no longer require dialysis. Today there are approximately 53,042 Americans on waiting lists to receive a kidney transplant. The development of effective anti-rejection drugs means that the prognosis for five-year survival for most of these patients is high. To avoid rejection, the best possible source of kidney donation is a close relative whose blood and tissue type match the patient's. Donated organs from cadavers also have high success rates. A growing source of kidneys for transplantation comes from living donors who are not blood relatives, but with whom the patient has an emotional tie, such as a spouse, friend or co-worker. Due to improved anti-rejection drugs, this promising type of donation has demonstrated success rates close to that of blood relative donation. There were 14,152 transplant operations performed in 2001. Of those, 5,949 of the organs came from living donors.
 
Diabetes and high blood pressure are the two leading causes of ESRD, accounting for more than 60 percent of new cases. Kidney disease can also develop from infection, inflammation of blood vessels in the kidneys, kidney stones and cysts. Other possible causes include prolonged use of pain relievers and use of alcohol or other drugs (including prescription medications).
 
Anyone can develop kidney disease. However, people over the age of 50 and certain minority populations, including African Americans, Native Americans, Hispanics, Asians and Pacific Islanders are disproportionately affected by ESRD. Approximately 360,000 Americans suffer from ESRD, and this number increases by about 7 percent each year.
 
The warning signs of kidney disease include:
High blood pressure
Swelling of the face and ankles
Puffiness around the eyes
Frequent urination (especially at night)
Rusty or brown colored urine
Back pain just below the rib cage.
If any of these symptoms develop, see a physician right away and ask to be referred to a nephrologist.
 
If you experience any of these warning signs, you should see your health-care provider right away. In addition, you should consult a nephrology specialist as early as possible. Treatment of ESRD and kidney diseases is complex, so if you or someone close to you has kidney disease, be sure to consult a qualified nephrologist. Studies show that your chances of surviving kidney failure are best if you are under the care of anephrology specialist.
 
 Due to the large and growing number of patients faced with long-term dependance on dialysis, ESRD is among the most expensive diseases to treat on a per capita basis. Fortunately, since 1972 the cost of dialysis and kidney transplantation for most Americans is covered through Medicare. In 1997, the total combined direct medical payments for ESRD by public and private sources was estimated at more than $15 billion (latest year for which figures are available).
 
As the population ages and as other at-risk populations increase, ESRD incidence is sharply on the rise. In fact, the U.S. incidence rate is the highest in the world -- 210 per million. While dialysis and improved treatments keep most ESRD patients alive far longer than we were able to just two decades ago, these developments also mean that more people are living with this debilitating and costly disease.
 
The best hope for ESRD patients, and those who care about them, is research. Through research in basic science and genetics, nephrologists today are beginning to unlock the root causes of many kidney diseases. The National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) provides funding for most of the kidney disease research in the United States. Other organizations, including the American Society of Nephrology, also fund grants for kidney research. A commitment to research is our best hope to reduce the enormous costs and human suffering imposed by ESRD.
 
You can do a lot to help fight this life-threatening condition. First become familiar with the warning signs of kidney disease. To maintain kidney health, you should:
Drink plenty of fluids
Exercise regularly
Don't smoke
Maintain your proper weight
Get checked regularly for diabetes and high blood pressure.

You can also help by becoming an organ donor. Becoming a donor is as easy as taking the time to speak with your family and let them know of your wishes. You can also contact the United Network for Organ Sharing at 1-800-243-6667 to request a uniform organ donation card. Finally, voice your support of funding for the NIDDK and other organizations that provide money for kidney disease research. You can do this by completing a sample letter found in the Government Relations section of the ASN web site and sending your signed letters to your members of Congress.

Liver:
 
Your liver is one of the largest and most important organs in your body. Your liver is behind the lower right part of your ribs. Your ribs help keep your liver from being injured. Your liver is very important to your health.
 
Your liver: Stores vitamins, sugars, fats and other nutrients from the food that you eat. Builds chemicals that your body needs to stay healthy. Breaks down harmful substances, like alcohol and other toxic (poisonous) chemicals. Removes waste products from your blood.
 
Makes sure that your body has just the right amount of other chemicals that it needs. Many diseases can affect your liver. If you have one of these diseases, your liver may not work as well as it should.
 
Some of the most common diseases that can affect your liver include:
VIRAL HEPATITIS. Hepatitis is a medical term that means "inflammation (swelling) of the liver." Viruses that attack the liver cause some of the most common forms of hepatitis. In most cases, your doctor can use a simple blood test to see if you have been exposed to one of these viruses.
 
Three of the most common viruses that attack the liver are:
Hepatitis A Virus (HAV). The hepatitis A virus is usually spread through dirty food and water. If you get hepatitis A, you may feel like you have the flu, and notice a yellowish color (called jaundice) in your skin or in the whites of your eyes. Just about everyone recovers from hepatitis A without any problems.
Hepatitis B Virus (HBV). The hepatitis B virus is spread through blood, semen and vaginal fluid. You can get hepatitis B if you have sex with an infected person. You can also get hepatitis B if you share needles or works to inject drugs.

Like HAV, HBV can make you feel sick for a short time. After that, most people with hepatitis B get better.
 
A small number (2%-6%) of people who get HBV infection have problems for a much longer time. In some cases, these problems can cause permanent liver damage. Following your doctor's advice is the best way to make sure that you recover from HBV disease.
 
Hepatitis C Virus (HCV). HCV is mainly spread through the blood. If you share needles or works to inject drugs, you have a high chance of getting HCV infection. People who had a blood transfusion before 1992 might find out that they are infected with HCV, as well.
 
Unlike the other hepatitis viruses, the virus that causes HCV may not make you feel very sick. In fact, you can be infected with the HCV and not even know it. Hepatitis C is still a serious illness. Most people who get HCV never get rid of the virus completely. Over time, it can cause permanent liver problems, including cirrhosis and liver cancer (see descriptions below).
CIRRHOSIS. Cirrhosis is a medical term that means "scarring of the liver." When you have cirrhosis, large parts of your liver are damaged. Because it has been damaged, your liver may not work as well as it should.
 
Cirrhosis of the liver is often the result of drinking too much alcohol. Other common causes of cirrhosis include hepatitis, especially hepatitis C.
Cirrhosis can be very dangerous if it is not treated properly. It is important to follow your doctor's advice if you have cirrhosis.
 
LIVER CANCER. Like many other body organs, your liver can get cancer. Liver cancer is a disease in which some of the cells in your liver begin to reproduce faster than they should. These cells form growths called tumors. Having hepatitis B or hepatitis C can increase your chances of getting liver cancer. Liver cancer can be deadly. If you find out that you have liver cancer, you need to get treated as soon as possible.
 
Your doctor can see how well your liver is working by looking at certain substances in your blood. When your liver is working well, the levels of these substances are low. When your liver is not working as well as it should, they can become much higher. These substances include liver enzymes (chemicals that your liver uses to do its work) and bilirubin .
 
Albumin is a protein made by the liver. The albumin level is below normal when the liver is injured.
 
Your doctor will compare the results of tests on your blood with the results that are normal for most people. If your results are high, your doctor may suspect that you have a liver disease. Usually, your doctor will have to perform other tests to make sure.

Your liver is one of the most important organs in your body, so it's a good idea to keep it healthy. There are many things you can do to protect your liver, including:
Don't have unsafe sex.
Don't inject drugs like heroin or cocaine.
Don't share any personal items that might have blood on them.
Don't drink alcohol. Alcohol can also make liver diseases like hepatitis much worse.
Get vaccinations (shots) against HAV and HBV. A simple series of shots can protect most people from getting infected with the viruses that cause hepatitis A and B. There is currently no vaccine against the virus that causes hepatitis C.
Make sure that the water you drink and the food you eat are clean. Most cases of infection with HAV result from poor cleanliness, especially in restaurants and cafeterias.
 
If you take any medications, make sure your doctor knows about them. Also tell your doctor about any over the counter medicines, supplements, natural or herbal remedies that you use. Certain medicines taken at the same time can cause damage to your liver, even if you can buy them without a prescription.
Many chemicals that are inhaled or swallowed can damage the liver. Among these are drugs, industrial solvents and pollutants. Almost every known drug has at one time or another been implicated as a cause of liver damage.
 
Chemicals which damage the liver fall onto two groups:
(1) Predictable liver toxins - These damage the liver regularly following exposure to a certain amount of the substance.
(2) Unpredictable liver toxins - These cause damage in only a small percentage of people exposed to them.
 
The reason the liver is so susciptable to injury by chemicals and drugs seems to be linked to the liver's unique function of processing the chemicals and drugs which enter the blood stream. Many of these chemicals are difficult for the kidneys to excrete out of the body. The liver helps by removing these chemicals from the blood stream and changing them into products that can be readily removed through the bile or urine. In this process, unstable toxic products are sometimes produced. These can attack and injure the liver. Predictable toxic chemical injury usually involves this type of mechanism. Examples are the cleaning solvent, carbon tetrachloride, and the pain medication, acetaminophen. Acetaminophen is present in many over-the-counter and prescription pain killers (e.g. Tylenol, Nyquil, Percocet, Excedrin, Darvocet, Vicodin) and is usually safe when taken as prescribed. When acetaminophen is taken in excessive doses, either at once or over a period of time, severe damage to the liver may occur. Acetaminophen is toxic at lower doses in individuals who are regular, excessive (over two drinks each day) consumers of alcohol, which is also toxic to the liver. In fact, alcohol is by far the most common cause of toxic chemical damage to the liver in our society.
The unpredictable type injury can be produced by many drugs and appears to involve an allergic reaction that is directed at the liver. Many different medicinal drugs (e.g. antibiotics, seizure medications and anesthetics) can cause this type of reaction in susceptible individuals.
 
Symptoms of chemical injury to the liver can resemble any form of acute or chronic liver disease. Acute liver injury can resemble viral hepatitis or blockage of the bile ducts. In other cases, a patient with fever, abdominal pain and jaundice may have a form of chemical injury that can be confused with conditions such as stones blocking the bile ducts that may require other surgery. Chemicals can also cause chronic liver disease and cirrhosis. Usually, chronic liver disease develops only after long-term use of the drug. Excessive exposure to certain drugs and chemicals may cause tumors of the liver. An important example is the group of drugs known as anabolic steroids, best known for their use in body building.
 
Liver damage is common in people who are regular, illegal drug users. Most instances of liver damage in these individuals result from viral hepatitis caused by sharing contaminated needles and using alcohol. However, certain commonly abused drugs (e.g. cocaine) may be capable of producing liver damage.
 
The Diagnosis of Chemical Liver Injury:
Usually it must be based on circumstantial evidence, as there are no specific tests. In any patient with liver disease, close attention needs to be given to the drugs used and the environmental and occupational exposures. No chemical is too trivial to be considered. Timing may be helpful, since many forms of chemical liver injury will occur days to weeks after the first exposure. However, there are exceptions in which a drug is taken for many months before liver injury or exposure to the toxic substance. In most cases, there will be rapid improvement in days or weeks after removal of the chemical. When drug allergy is involved, giving the patient the drug again will lead to a rapid worsening of the liver disease. This is a conclusive test, but is rarely justified because of the risk to the patient.
 
Even if chronic liver disease has developed, removal of exposure to the offending chemical or drug can lead to rapid improvement. Usually, no other specific therapy is needed. If there is any concern regarding a particular drug or chemical, a physician or poison control center (located in major hospital centers) should be consulted.