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Nephritis

Nephritis is the result of an inflammatory diffuse process of the glomeruli having as base an immunological phenomenon. It is responsible for 50% of the diseases. The immunological phenomenon responsible for the nephritis occurs when a strange substance (antigen) gets into the blood circulation and is loaded to the auto-immune areas in our body. The organism, to protect itself from the aggressor antigen, produces an antibody. The meeting of the antigen with the antibody forms a soluble complex antigen-antibody, which circulates in the organism and can deposit itself on the tissues, creating inflammatory lesions. When the glomeruli are the tissue damaged, the inflammatory lesion is called glomerulonephritis. The kidney inflammatory lesions can be mild or of such intensity that can sclerosis the entire glomeruli. The bigger the lesions, the bigger are the clinical and laboratorial manifestations of the disease.

How does the nephritis develop?

The nephritis can be acute or chronic. The acute nephritis shows blood and albumin (proteinuria) in the urine, generalized body edema, and high blood pressure. The acute disease becomes chronic after six months, and albumin, blood in the urine and eventually hypertension will still be present. In children, the acute nephritis is cured in 90-95% of the cases; in adults, the acute nephritis is cured only in 50% of the cases; the remaining becomes chronic. The damage of the glomeruli can be slow or quickly progressive. The slow chronic process can take many years, even decades to entirely damage the kidney.

The most common causes of the glomerulonephritis are infection sources. The infections are caused by any microorganism (malaria, typhus, salmonella, toxoplasmosis, herpes and other virus and bacteria) that forms an antigen-antibody complex and deposit itself on the kidney. There are also non-infectious causes, which are caused by diseases of many organs or by medicine such as lithium, gold, and captopril. These medicines release antigens that start the auto-immune mechanism causing the nephritis. The transplanted patients who had chronic nephritis disease can re develop the disease in the donor’s kidney.

When a person complaints about decreased volume of urine, dark urine (with blood), swelling around the eyes and or legs, high blood pressure, the doctor begins to suspect that the patient has glomerulonephritis. He must determine if the causes are infectious or non-infectious. The laboratorial examination confirms the blood in the urine (hematuria) and the proteinuria. In the acute stage of the disease, the clinical and laboratorial data are evident and convincing. In the chronic stage, the clinical and laboratorial data can be subtle, however in some cases, clinical and laboratorial signs of the chronic renal failure can be seen. Sometimes only a renal biopsy can confirm the glomerulonephritis and its stage.

The acute nephritis that occurs after a bacterium infection can be treated by careful ingestion of salt and water and rest. If the infection is still present an antibiotic must be used. After the acute stage the inflammatory process must be treated and the generation of the complex antigen-antibody that attacks the kidney must be reduced. This is made by the anti-inflammatory steroids and non steroid and immunosuppressant drugs. When there are chronic lesions, the treatment is supportive and lesions progress must be avoided. The nephrologists doctors have adequate therapeutic orientation for the acute and chronic glomerulonephritis.

Learn more: These are diseases that cause renal inflammation, but without any bacterium. They are immunologic illnesses. In the most of the cases the cause is unknown, but during childhood, the acute nephritis is preceded of sore throat (Pharyngitis) or a skin infection (impetigo). The mainly symptoms are: dark urine (containing blood) (hematuria), bubbly urine by lost proteins (proteinuria), high blood pressure, swelling of face and legs (edema). The treatment depends of the nephritis type, but it is important to treat sore throat skin infections as soon as possible especially in children. The eradication of the bacteria that cause these infections and precedes the nephritis is made with antibiotics. The nephritis is immunological and does not cure with antibiotics. Hence, when the disease reaches the kidneys the antibiotics do not act. The practice of mouth and skin hygiene (brush the teeth and take regular showers) is very important to avoid the disease. When the nephritis is chronic the disease is slow, and the symptoms and signs are difficult to be noticed. Usually people only discover the chronic nephrites when it is in very advanced stage.

Pyelonephritis

What is Pyelonephritis?

Pyelonephritis is a urinary tract infection that has reached the kidney. The bacteria or microorganisms that ascended from the urethra passed through the bladder and settled down at the kidney. In women, in most cases, it occurs by contamination and colonization of the perineum area by fecal bacterium flora. The most important representative of the fecal bacterium flora is the Escherichia coli, responsible for 85-90% of the urinary infection. Pyelonephritis is an infection that reaches one or two kidneys by germs penetration. Normally, the patient complain of back ache (under the last back rip) high fever, shivering, tingle when urinate, feeling of hotter and darker urine.

When the bacteria reach the kidney, it causes an inflammatory and infectious process. As an immediate consequence, the kidney increase in volume, the lumbar regions becomes very sensible to touch and the backache or the flank becomes continuous. The pyelonephritis is always accompanied by fever (> 37, 5º C) and shivering. The urine leaves in little quantities, many times a day, always tingling a lot. Sometimes there are drips of blood at the end of the urination. The patient notices that urine smells bad; it is not clear and shows some grumes (clot of blood) inside it (filaments). It could be some digestive symptoms, as nausea, vomit and anorexia. Tiredness, fatigue and prostration can be important signs. At the physical examination the doctor diagnoses fever, backache at direct percussion and in many of the cases, abdomen pain.

The germ can reach the kidney by blood stream or ascending from the urethra to the bladder and through the urethra to the kidney.

When there is a malformation of the urinary system or urine that returns from the bladder to the kidney (vesicle urethral reflux) or kidney stones or any other kind of obstruction, the pyelonephritis has favorable conditions to take place. The most frequent germs are the gram-negatives.

The patient that shows the signs and symptoms described above has kidney urinary infection. To confirm the diagnostic, a urine test and a urine culture must be prescribed. The urine test always shows a lot of leukocytes, erythrocytes and bacteria at the urinary sediment. In the uroculture, the germs grow in quantities higher than 100.000 per milliliter of urine. In the hemogram (complete blood count (CBC), there can be an increase of leukocytes, (leukocytosis), and at hemosedimentation, the indices is very high, showing the intensity and the severity of the urinary infection. In some cases, the patient presents high fever and intense shivers. In this situation, we should eliminate the possibility of bacteria’s invasion in the blood circulation; a blood test is needed in order to have the hemoculture (blood culture) done. Through the hemoculture, the bacteria that invaded the blood are identified, and the sensibility of the antibiotics (antibiogram) can be tested, leading to an adequate treatment of the blood infection.

An ecography or a simple abdomen X-ray shows the increased volume of the affected kidney and the presence of possible lesions. In certain cases, a urography excretory and/or renal scintigraphy can be necessary to identify the presence and evolution of the renal lesions.

The treatment is made with a sensible antibiotic accordingly to the antibiogram made with the bacteria founded at the uroculture. In all cases of pyelonephritis, besides treating the infection, complicator factors that can perpetuate or prevent the renal infection healing must be searched and treated. The most important complicator factors are: calculi, obstructions, congenital or acquired stenosis, vesicle-urethral reflux, congenital malformations, pumps and catheters. In some cases the patient with acute pyelonephritis requires hospital treatment. This occurs when there is a severe infection (septicemia), when the patient is incapable of taking care of himself alone, when administration of intravenous antibiotics is crucial, or in case of handicapped patients.

In case of acute pyelonephritis, is difficult for the doctor to know if the patient is a carrier of some complicate infection or not. If is a man, it is imperative look for the causes that possibilities the infection, thus, there is always some fact that contribute to forthcoming the pyelonephritis. At him the pyelonephritis causes almost always are obstructive. In the woman, there must be keep off the gynecological causes and in the young woman, the sexually transmitted disease. Taking a healthful life, ingesting a lot of liquids, treating rightly the interoccurences as urinary stones or malformation of urinary system. In case of doubt, call your doctor.

Learn more: They are the kidneys infection. They are bacteria’s that can cause the disease forming pus. The mainly symptoms are lumbar ache at the side of the affected kidney, fever and shivers. Generally there must be necessary a partial urine examination to detect pus and a test to know which antibiotic is more adequate for each type of bacteria that can cause the infection. This test is being called antibiogram.

High Pressure

There is a hypertension or high pressure when the blood pressure measured a lot of times in a doctor’s office, is equal or superior to 14 to 9. It occurs because the vases in which the blood circulates constrict themselves and make the blood pressure pump up. To understand better, we can compare the heart and the vases to a faucet and its various flushes. When we close the tips of the flushes, the pressure must elevate. At the same way, when the heart pumps the blood and the vases are constricted, the pressure inside will elevate.

The high pressure attacks the vases. All of them are internally recover by a very fine and delicate layer, that it is painful when the blood is circulating with a very high pressure. With this, the vases became constricted and hardened and can with passing the years, to obstruct or to breach it. When this happens at the heart, the obstruction of a vase induces to angina and can bring on the heart attack. At the brain, the obstruction or the breach, induces to a stroke or CVA. On kidneys can occur the obstruction, inducing to the standstill of them. All of these situations are very serious and can be avoided with the control of high pressure.

The high pressure or the hypertension is a very common disease that attacks one in each five persons. Among the aged, it can attack one in each two persons. The children can also have high pressure. We used to say that high pressure is a “democratic” disease, because it attacks men, women, blacks and whites, riches and poor, aged and children, fats and thins and persons calms and nervous. Which care we must do with my children if I have high pressure? Who has high pressure must orient his children to measure the pressure at each six months or at maximum once an year, to can diagnostic the disease few time after the appearance.

At the most of the persons that have high pressure, it appears because is inherited by parents. That ones that have the father or the mother or both of them with high pressure have a bigger chance to acquire the disease. Inappropriate life habits are also important: the obesity, the excessive ingestion of salt or alcoholic beverages and the physical inactivity can contribute to high pressure appears.

The high pressure is a chronic disease and keeps all of the life. It can be controlled, but not cured. In the most of times, we do not know what causes the high pressure, but is possible to control it, avoiding that the person has the life shorten. The treatment for high pressure also avoids the heart attack, the stroke (CVA) and the standstill of the kidneys

The treatment of the high pressure keeps all of the life. It must be made with medicines that help to control the high pressure and with healthy life habits like to reduce the ingestion of salt and alcoholic beverages, supervise the weight, make physical exercises, avoid smoke and control the stress.

The most of the people that has high pressure does not complain of anything. That is why we call the high pressure “silent killer”. Sometimes headache, stagger and ungrateful can happen in which has high pressure, but is common that, when the person feels something different the high pressure already damaged his organism. The only way to know if the pressure is normal is measuring it. The ideal is to measure the pressure at least at each six months or with an interval maximum of one year. Like this, when the disease appears soon we can make the diagnostic.

Any person can measure the pressure, since he is trained to do it. The professionals of health area are most indicated for this activity. To measure the people’s pressure in campaigns serves to alert them about the problem of high pressure. In the case of your pressure is high when measured in a campaign, look for a doctor to confirm it. The people also can measure themselves: in a quite ambient, calm, after five minutes of repose, with the arm in which will make the measure supported in a table at the height of the heart, the back supported in a chair and the feet leaned on the floor. The bladder must be empty and the person can not have smoked, fed or coffee intake at least 30 minutes before the measure.

There are different equipments to measure the pressure. The most commons are the aneroids that are portables and seems like a clock with an indicator. At the hospitals, generally are used the equipments with quicksilver columns with rotations. Currently, are also used the automatic equipments, mainly to measure the pressure at home. These new equipments allow the person to measure herself her own pressure. All of these equipments are goods, since the calibration be verified at each six months or at least once a year. There must use the armlet accordingly the size of the person’s arm. Arms slimmer needs armlet more tights, and large arms, as of the obese persons, needs larger armlet. The equipments that measure the pressure by the finger or by the pulse are still not considered trustworthy.

They are persons that only have high pressure when measured at doctor’s office. Out of the doctor’s office, the pressure is normal. To know if there is hypertension of white apron, the doctor needs to know the patient’s pressure at doctor’s office and the pressure measured at patient’s home or to adopt the ambulatory management, that measures the pressure during 24 hours with an automatic equipment.

The obesity and the overweight increase substantially the risk of high pressure, beyond to appease fat in excess in the blood, diabetes, cardiac diseases, stroke, respiratory diseases, vesicle stone, prostate cancer, breast, uterus and colon cancer. Who has high pressure, when get weight, will have your pressure more elevate and when loose weight, the pressure will downfall. The lost of weight, as in the obeses as in that ones with overweight, reduce the risk of diabetes and cardiac diseases, because provide the sugar and fat reductions in the blood, like the triglycerides, the total cholesterol and the "bad cholesterol" (LDL-cholesterol), that take place in the arteries. More than this, the lost of weight already increase the "good cholesterol" (HDL-cholesterol), that take away the cholesterol from the blood, avoiding its accumulation in the arteries. The great secrets to reduce weight are diet and physical activity. To loose or avoid acquiring weight, follow the tips below:

The salt makes the body holds liquids, and the increase of the liquids volume makes the pressure ascends. However, it is not necessary to eat without salt. We should avoid the exaggeration, as to put salt at fast food, or to eat food that contains a lot of salt. Thereabout half of the persons are more affected by sodium chloride, the kitchen salt. These persons are denominated "salt sensible". For those particular persons, there is important to eat with very little salt, to avoid that the pressure ascends. At the non-sensible persons to this condiment, the increase of the pressure with its use is very little. The Brazilians consume in average four or five full coffee spoons a day, in other words, ten grams. Our body needs very little salt, less than one coffee spoon a day (2,5 g/ day). This amount exists in proper foods. To prevent the excess of this condiment in the feeding, it follows the following tips.

The physical exercise helps to lower the pressure. Many times, who has high pressure and starts to make exercises can diminish the dose of medicines, or same to have the controlled arterial pressure without the use of remedies. The adjusted physical exercise does not present collateral effect and brings some benefits for the health, such as to help to control the weight and the arterial pressure, to reduce the taxes of fat and sugar in the blood, to raise the "good cholesterol", to reduce the emotional tension and to increase auto-esteem. To carry through physical exercises adequately, it follows the following tips.

The alcoholic beverages raise the arterial pressure. Therefore, the reduction of the alcohol consumption is efficient to reduce the arterial pressure and can prevent the high pressure. It known that five to ten percent of the men with high pressure have as cause of the problem the high alcoholic beverage consumption. The alcoholic beverages possess ethanol, toxic substance that injures organs as the brain, the heart, the liver and the pancreas. Moreover, they can get worse the gastritis, make it difficult the loss of weight (therefore they possess many calories) and delay the reflexes, making it difficult to drive an automobile. And who exaggerates runs the risk to develop dependence and to ruin the proper life. To know how much we can consume of alcoholic beverages, follow the tips below:

The tobacco aggravates the cardiac diseases because it can increase the rhythm of the strokes of the heart and the pressure, or still get worse atherosclerosis, hardening the arteries. Moreover, the tobacco also can provoke cancer in some organs.

The stress can make difficult to control the high pressure. The ideal would be to eliminate it, but, as it is hard, the better is to learn to control it.

The remedies for treatment of the high pressure act in the organism controlling the pressure. The ideal is to keep the pressure below of 13 for 8. The use of the remedies must be continuous, daily, in the doses and the schedules recommended by the doctor. Does not leave to take the remedies, notwithstanding your pressure is controlled.

Currently, there are remedies that control the high pressure without intervening with the sexuality. However if some alteration in its sexual activity happen, contact your doctors. It is important to remember that is the not treated high pressure that can cause sexual impotence, because it hardens the vases of the penis, harming the sexual activity.

MORE INFORMATIONS AT THE SITES:
http://www.sbh.org.br
http://www.portalbrasil.net/medicina_pressao.htm
http://acampe.com.br/sipat/hipertesao

To know more: It is a disease that the cause is unknown in 90% of the cases. Therefore, we do not know why it appears. However is known that it attacks around 50% of the people above of 50 years. There is also known, if it is not controlled it can cause spill (hemorrhagic vascular accident), heart attack (myocardium infarct) or fails in the functioning of the kidneys (renal failure). If the person has diabetes, to smoke, be fat, and does not take care with his cholesterol and to take a life very agitated (stress) will have more possibility to present the complications above cited. It is important to repeat that half of the people who make hemodyalisis or are carrying of high pressure or has diabetes. It is interesting that the kidneys when became insufficient also cause high pressure. Then the high pressure can cause the renal problem and the kidneys with problems can cause high pressure. The habit of the diet with little salt, physical exercises, the whim in taking medicines every day, the control of the weight and stress are standards that help to keep the pressure in normal levels and prevent the complications.

Diabetes

Disease generated by the deficiency of production and/or action of the insulin that takes the acute symptoms and chronic complications features. The riot involves the metabolism of the glucose, the fats and proteins and has serious consequences in such a way when it appears quickly as when it is installed slowly. In the current days it constitutes in problem of public health by the number of people who present the disease in Brazil.

Diabetes Mellitus of Type I (diabetes mellitus insulin dependent): The lack of insulin or its insufficient production for the body compels the person to apply insulin. It occurs with more frequency in young.

Diabetes Mellitus of Type II (not insulin dependent): it is the case of people who produce insulin that does not function in adequate form. It reaches more the adults, people with familiar antecedents of diabetes or excess of weigh. Adjusted feeding, physical exercises, control of weight, in some cases, medicines, be tablets or insulin, help in the control of this type of diabetes. Other forms of Diabetes Mellitus: picture associated to genetic clutters, infections, pancreas diseases, use of medicines, drugs or other endocrine diseases. Gestational Diabetes: Circumstance in which the disease is diagnosed during the gestation, in patient without previous increase of the glucose.

As it can above be observed in the item (clinical forms) there are several causes of the DM. In the DM type I, the basic cause is an auto-immune disease that in irreversible way injures the producing pancreatic cells of insulin (cells beta). Being thus, in the first months after the beginning of the disease, there is detected in the patient's blood diverse antibodies anti-islet pancreatic, the antibody against the enzymes of the cells beta (antibodies antidescarboxilase of the acid glutamic - antiGAD, for example) and antibodies anti-insulin.

In the DM type II, diverse mechanisms of resistance occur against the action of the insulin, being main of them the obesity that is present in the majority of the patients. In the patients with other forms of DM, what occurs in general is an anatomical lesion of the pancreas, decurrent of diverse toxic aggressions being for alcohol, drugs, medicines or infections, among others. What it is felt?

The symptoms of the DM are decurrent of the increase of the glycemia and the chronic complications that are developed in a long time.

The symptoms of the increase of the glycemia are: extreme thirst, increase of the urine volume, increase of the number of urination, sprouting of the habit of to urine at night, fatigue, weakness, giddiness, blurred vision, increase of appetite, loss of weight.

These symptoms tend to aggravate gradually and can take the severe complications that are cetoacidose diabetic (in the DM type I) and hyperosmolar coma (in the DM type II). The symptoms of the complications involve visual, cardiac, circulatory, digestive, renal, urinary, neurological, dermatological and orthopedic complaints, among others. Visual symptoms: the patient with decompensate DM presents blurred vision and difficulty of refraction. The complications in the long time involve reduction of the visual acuity and blurred vision that can be associated to cataract or to the retinal alterations called diabetic retinopathies. The retinopathies diabetic can take to the important involvement of the retina also causing the unstuck of the retina, glass hemorrhage and blindness.

Cardiac symptoms: Diabetic patients present a bigger prevalence of arterial hypertension, obesity and fats alterations. For these reasons and, mainly associated tobaccoism will be had, can occur cardiac disease. The cardiac disease can involve the coronary ones, the cardiac muscle and the system of conduction of the electric stimulations of the heart. As the patient in general presents also some alteration degree of the nerves of the heart, the cardiac alterations can not provoke any symptom, being discovered only in the presence of symptoms more serious as myocardial infarction, a cardiac insufficiency and the arrhythmias. Circulatory symptoms: The same factors that are associated with other complications become more frequent the circulatory alterations that demonstrate by atherosclerosis of diverse blood vases. The complications that obstruct important vases as the carotids, aorta, the iliac arteries and diverse others of extremities are frequently. These alterations are particularly important in the inferior members (legs and feet), inducing to a set of alterations that compose the “diabetic foot”. The “diabetic foot” involves, beyond the circulatory alterations, the peripheral nerves (peripheral neuropathy) fungi and bacterial infections and ulcers of pressure. These alterations can take the amputation of inferior members, with serious committal of the quality of life. Digestive symptoms: diabetic patients can present committal of the interface of the digestive pipe, with reduction of its movement, mainly in level of stomach and thick intestine. These alterations can provoke symptoms of abdominal distension and vomits with alimentary residues and diarrhea. The diarrhea is characteristically nocturnal, and occurs without significant pain, frequently associate with incapacity to hold back excrements (fecal incontinence). Renal symptoms: The involvement of the kidneys in the diabetic patient evolves slowly and without provoking symptoms. The symptoms when they occur in general already mean a loss of significant renal function. These symptoms are: swelling of the feet (edema of inferior members), increase of the arterial pressure, anemia and loss of proteins by the urine (proteinuria).

Urinary symptoms: Diabetic patients can present difficulty for empty the bladder in result f the loss of its interface (neurogenic bladder). This alteration can provoke loss of renal function and behave as factor of maintenance of urinary infection. In the man, this alteration can be associated with difficulties of erection and sexual impotence, beyond getting worse the symptoms related with increase of volume of the prostate.

Neurological symptoms: The involvement of nerves in the diabetic patient can provoke acute neuritis (acute paralyses) in the nerves of the face, the eyes and the extremities. Chronic neuritis can also occur affecting the nerves of the superiors and inferior members, causing gradual loss of vibratory, painful sensitivity, to the heat and the touch. These alterations are the main factor for the sprouting of modifications in the position to articulate and in the skin that appear in the plant of the feet, can inducing the formation of ulcers (“armor-piercing badly plantar”). The signals most characteristic of the neuropathies presence are the loss of sensitivity in boot and glove, the sprouting of deformities as the loss of the arc plantar and “hands in prayer” and the complaints of prickles and alternation of cooling and calories in the feet and legs, mainly at nigh.

The diagnosis can be presumed in patients who present the symptoms and classic signals of the disease that are: extreme thirst, increase of the volume and the number of urinations (including the sprouting of the habit to wake up at night to urinate), extreme hunger and attenuation. In the measure where a great number of people do not arrive to present these symptoms, for a long period of time, they present the disease, we recommend a precocious diagnosis. The laboratorial diagnosis of the Diabetes Mellitus is established by the measure of the glycemia in the serum or plasma, after one fasting of 8 to 12 hours. In result of the fact that a great percentage of patients with DM type II discovers its diseases very delayed, already with serious chronic complications, is recommended to the precocious diagnosis and the tracking of the disease in some situations. The tracking of all the population is, however arguable.

There are situations in which are present factors of risk for Diabetes Mellitus, as presented follow: Bigger or equal age of 45 years, History of DM (parents, children and brothers), sedentary life, low HDL-c or raised triglycerides, arterial hypertension, coronary disease, gestational DM previous, Children with 4 kg or bigger, abortions of repetition or death of children in the first days of life, use of medicines that increases the glucose (tiazidics, cortisones, diuretics and beta-chokes).

The objectives of the treatment of the DM are directed in such a way to get a normal glycemia as in fasting as in the after-prandial period, and to control the metabolic alterations associates. The treatment of the patient with DM always involves for the little 4 important aspects: Alimentary plan; Physical activity; oral medicines, hypoglycemints; Tracking.

The prevention of the DM only can be carried through in type II and in the forms associated to other pancreatic alterations. In the DM type I, according it is developing from the auto-immune alterations, these can even though be identified before the state of increase of the sugar in the blood. This precocious diagnosis cannot be confused, however with prevention, what is not yet available. In the DM type II, according to a series of well known risk factors, the patient’s carriers of these alterations can be tracked and periodically be guided to adopt behaviors and standards that take them off of the risk group.

Thus is that patients with familiar history of DM must be guided: to keep normal weight, to practice regular physical activity; do not smoke; to control the arterial pressure; to prevent medicines that potentially can attack the pancreas (cortisone, diuretics tiazidics). These standards, being adopted precociously, can result in the non appearance of the DM in person genetically predispose, or conduce to an important retardation in its appearance and the severity of its complications.

MORE INFORMATION AT THE SITES:
http://www.diabetesnoscuidamos.com.br
http://www.abcdasaude.com.br/artigo.php?127
http://www.diabetes.org.br

To know more: It is not an origin disease of the kidney. It is caused by the lack of one hormone: the insulin that is produced in the pancreas. It can start in infancy or youth and therefore calls diabetes youthful or type I. Generally it needs insulin to controls it. Diabetes type II is usually of adult and most of the time it is controlled by medicines. In this type of diabetes the patient produces insulin, but, there is a resistance for its use on the tissues. The people who contract diabetes generally present much thirst, much hunger, urinate a lot, suddenly peak, and become tired. The more common laboratorial manifestation is the increase of the glucose taxes (sugars) in the blood.

When the patient has diabetes per many years it presents complications, among them, the renal lesions. The diabetic disease in the kidney is called diabetic nephropathy. Produces occlusion in the arteries and is called diabetic arteritis. In the eye, diabetic retinopathies, and in the nerves diabetic neuropathies. In the heart, diabetic cardiopathy. Therefore, the complications of diabetes can be in all of the organs and systems. The complications happen more precociously when the prevention is not carried through. Diet without sugar, medicines and the use of insulin correctly to prevent oscillations of the glucose tax in the blood are absolutely necessary.

Congenital and Inherited cysts

The nephron is the functional unit of the kidney. The nephron anatomically, is constituted of a filter, glomeruli and tubules that take the urine until the renal pelvis. From this, through the ureter, the urine arrives until the bladder. The renal cysts are dilatations of some portion of nephron. They developed themselves and grow by the increase of the pressure inside the kidney, the increase of the gradient of the saline solutions that bathe nephron and by the obstructions of varied degrees that occur in any place of the nephron. These conditions favor the passage of the liquids to the fragile places of the nephron, making possible the formation of cysts. During the formation of the cysts, there is always a growth of cells, lining all its walls. Also it has increase of the interchange of liquids, similar to the plasma, that finish filling the cyst. In this way, the cysts have fine cellular walls and are full of a similar liquid to the plasma that can contain some semisolid substances. The cysts can occur in one of in the two kidneys and are almost always, in small number and of lesser size that 3 cm. When the entire kidney is taken by countless cysts, changeable sizes, and calls polycystic kidney. The responsible causes for the formation of the cysts can be hereditary or acquired.

The responsible ones for 70% of the acquired cysts are simple cysts. They occur after the 50 years and increase in frequency with advancing age and they are present in more than 50% of the people, after the 60 years. They can be solitary, multiple, uni or bilateral and, eventually, they can present clinical symptoms of lumbar pain, blood in the urine (14%), urinary infection and arterial hypertension (35%0. Hardly the cysts become infect and form abscesses. Rupture can occur eventually and appear internal bleed or appear in the urine examination.

Few times, they are touchable at the physical examination, because hardly they grow a lot, therefore, almost always are found in occasional way during the routine examinations. In the laboratorial examinations, signs of urinary infection, hematuria and difficulties to concentrate the urine. The way most efficient to find the renal cysts is in the abdominal and renal ecography. In the ecography, they appear rounded off, neatly marked for a fine wall and contain, in their interior, a homogeneous liquid, more of less dense, without masses (or nodules) and with a regular surface. These characteristics differentiate them of the tumors or solid nodules of irregular surface that are suggestive of benign or malignant tumors.

Simple cysts acquired also are those that occur in the patients with chronic renal failure. The frequency of the appearance increases with the number of years of failure. At renal failure, when the creatinine is of 3 mg%, 20% of the patients have renal cysts; when 3mg% is superior, 30% of the patients are reached.

Specific treatment does not exist, depends of the signals and symptoms that the patient presents. The person’s carrier of the cyst must be followed annually to prevent eventual complications (hematuria, calculation, infection) and to prevent that some cysts with exaggerated growth can provoke obstruction and suffering of the renal parenchyma. The majority of them follow the person for all the life, without causing any medical problem.

Among many inherited disorders, there is a few that have as characteristic renal cysts of various types. Between the main hereditary renal cystic diseases we find: Autossomal dominant polycystic kidney, that occurs in 1 to 1.000 births livings creature; Autossomal Recessive polycystic kidney (PKD), that occurs in 1:50.000 birth livings creature; Kidney medullar sponge, that occurs in 1:2.000 birth livings creature; Medullar cystic disease, that occurs 1:50.000 birth livings creature; and Multicystic congenital kidney that occur in 1:100.000 birth livings creature.

The autossomal disease can be dominant, when it is enough one gene of the father or the mother to transmit it. The autossomal dominant polycystic kidney is more common, known as polycystic kidney. The cysts are diffusing, countless and reach the two kidneys. In 1985, it was discovered that the gene responsible for 90% of polycystic kidneys of the white population is located in the chromosome 16 and remains 10%, in chromosomes 4.

In the diagnosis of the polycystic kidney, there is always a familiar historic. The kidney can be diagnosed at the embryo, but 80-90% of the cases are detected from 40 years. Before the 40 years age, the cysts are still so small that they can not be seen by common image methods. The ecography examination allows seeing the size of the kidneys, the cysts and the obstruction complications. The polycystic kidney can grow a lot, there are some cases that arrive to 40 cm of length, weighting until 8 kg; the normal one is 12-14 cm and 200 g of weight. The evolution of the polycystic kidney until the chronic renal failure can be very slow, generally starting to present symptoms after 50 years old. The patients with polycystic kidney are excellent candidates to the renal transplantation, because they do not have immunological diseases that can reproduce the anterior disease at the transplanted kidney. The main complications of the cystic disease are the hypertension, poliglobulia (much blood), litiase, urinary infection, renal obstruction by exaggerated growth, kidney fracture and renal failure.

Some factors of risk have been found in the patient’s carriers of polycystic kidneys. Thus the younger is the patient with it, more quickly and grave are the evolution of the cystic disease. In the black race, the cystic disease evolutes more soon than in the white race. There is still not certain that is more severe in men.

The patients are followed periodically with ecography and laboratorial examinations to prevent complications. Trying to avoid the evolution for the chronic renal failure, it must treat the hypertension, vascular and obstructive complications. Is better to keep the patient without urinary infections and try to reduce the accumulation of liquids inside the cysts, with the use of sodium expoliators. When the cysts grows very, can be carried through renal puncture to deflation. Others cystic renal diseases

The tuberose sclerosis presents full great kidneys of multiple and bilateral renal cysts. The cysts are composites of a mass of vases, muscles and fat, the called angiomiolipomas. The symptoms and signals are similar to the ones of the polycystic kidney. Disease of Von Hippel Lindau is a rare disease, autossomal dominant, that occurs in 1:36.000 of the births living creature. It is presented with innumerable renal and pancreatic cysts that are discovered, generally, after the 30 years old. Almost always they are followed of multiple neoplasy, such as angiomas, renal carcinoma, feocromocitona and others. Others inheritance diseases present cysts in the renal medullar zone and not at cortical zone as of custom. Two examples are the nephroptiasis youthful familiar and the medullar cystic disease. Discovered in 1951 as rare disease, today represent 4% of the heritage renal disease, that appear at second or third life decade, presenting some physical defects as skeletal abnormalities, hepatica fibrosis and lesions at central nervous system. Clinically, 80% of the patients complain of abundant ingestion of water (polydipsia) abundant diurese (poliuria) anemia, weakness, retardation of corporal and mental growth, hypertension and chronic real failure of varied degree. It is diagnosed with ecography by small cysts, the majority with 2 to 3 mm in the medullar zone e with a renal cortical zone very fine and sclerosed. The kidney medullar sponge was described for the first time in 1948 and is characterized for dilatation of the renal collecting tubules that give the aspect of a sponge when the kidney is anatomically examined. It is considered a sporadically congenital disease that can occur as in men as in women and appears in 1:2000 births.

In the patients’ carriers of medullar sponge kidney, can occur renal litiase frequently, by the exaggerated loss of calcium, facilitating the formation of stone calcium. Hematuria and litiase are the two clinical manifestations of this nephropathy. The diagnosis is made by the excretory urography that shows the dilatation of the collecting tubule of the renal medulla, many times full of small kidney stones. The multicystic congenital kidney is a form of cystic alteration of the kidney almost always unilateral, in contrast f the polycystic that is always bilateral. It is presented clinically with great abdominal masses by the enormous growth of the renal cysts.

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To know more: The most frequent is the polycystic kidney. Although it is congenital (the person is born with it) and hereditary (it is transmitted by parents to children), it is a disease that manifest itself in the adult age. The kidneys create cysts full of urine and go losing its function. As it is an anomaly of the structure the organ is subject to infections and high pressure. Blood in urine (hematuria) renal colic and high pressure are the main symptoms. With passing the years, the kidney goes losing its function. The treatment is carried through for the symptoms, infection when it will appear and high pressure. Other anomalies also exist: stenosis of pyelourethral junction, that is, the nip of the junction between the kidney and ureter. There is also the reflux of the urine between the bladder and the ureter. When the bladder enters in contraction the urine comes back in direction to the kidney being able to cause infection of the kidney and loss of the function at the lesion’s side. Moreover this type of anomaly can be of the both sides.

Cystitis

The cystitis is infections in the bladder. They disclose themselves mainly in the women. Pain in the low womb, difficulty to urinate, with pain and burning sensation, necessity to urinate many times is the main symptoms. The contamination of the bladder with cystitis is carries through with bacteria of the proper body. It is more frequent in the woman because the urethra is very next to the genital organs and anus, places that normally lodge bacteria. The treatment is realized with antibiotics and medicines for the discomfort and pain.

Systemic Diseases

They are diseases that attack various organs of the organism. Among them the immunological diseases, as lupus erythematosus that attack various organs and systems, arteritis that inflame the arteries. But the main ones are the diabetes and the arterial hypertension that when present renal complications takes the patients to the chronic renal failure. Half of the patients who need hemodyalisis and renal transplantation are diabetics of hypertensive.

Renal Failure

It is the loss of the function of the kidneys. It can be acute or in short space of time and generally reversible, or chronic. In this case that, it will be slow and gradual, sometimes leading years so that the kidneys lose its total function and definitively. All the described renal diseases described in the last three items can take to the loss of the renal function. When the kidneys lose definitively its function, then it has necessity what we call renal replacement therapy.