nephrolithiasis

A kidney stone is a solid piece of material that forms in the kidney from substances in the urine. It may be as small as a grain of sand or as large as a pearl. Most kidney stones pass out of the body without help from a doctor. But sometimes a stone will not go away. It may get stuck in the urinary tract, block the flow of urine and cause great pain.

The following may be signs of kidney stones that need a doctor's help:

• Extreme pain in your back or side that will not go away
• Blood in your urine
• Fever and chills
• Vomiting
• Urine that smells bad or looks cloudy
• A burning feeling when you urinate

Your doctor will diagnose a kidney stone with urine, blood, and imaging tests.

If you have a stone that won't pass on its own, you may need treatment. It can be done with shock waves; with a scope inserted through the tube that carries urine out of the body, called the urethra; or with surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Gout is a common type of inflammatory arthritis. It causes pain, swelling, and redness in one or more joints. It usually happens as a flare, which can last for a week or two and then gets better. The flares often begin in your big toe or a lower limb.

Gout happens when too much uric acid (urate) builds up in your body over a long time. Uric acid is a waste product your body makes when it breaks down purines. Purines are substances that are in your body's tissues and in many foods.

When your body breaks down old cells or digests foods that contain purine, most of the uric acid that's made dissolves in your blood. Your kidneys filter the uric acid out of your blood, and it leaves your body in your urine (pee).

However, sometimes your body can make too much uric acid or does not remove enough of it. Then the uric acid levels build up in your body, including in your blood. Having too much uric acid in the blood is called hyperuricemia. It does not cause health problems for everyone. But in some people, uric acid forms needle-like crystals. They can form in your joints, which causes gout. The crystals can also cause kidney stones.

Calcium pyrophosphate arthritis, sometimes called pseudogout, is a related disease. It causes similar symptoms and is sometimes confused with gout. But it is caused by a buildup of calcium phosphate, not uric acid.

Many people develop gout. You are more likely to get it if you:

• Are male.
• Are older; it usually develops in middle age.
• Have obesity.
• Have certain health conditions, such as:
  • Heart failure
  • High blood pressure
  • Metabolic syndrome
  • Chronic kidney disease
  • Conditions that cause your cells to break down more quickly, such as psoriasis or some cancers
  • Rare genetic conditions that lead to increased uric acid
• Have a family history of gout.
• Have an unhealthy diet and eat foods that are rich in purines, such as red meat, organ meats, certain seafoods.
• Drink alcohol.
• Eat and drink lots of foods and beverages that contain fructose (a type of sugar).
• Take certain medicines, such as diuretics (water pills), low-dose aspirin, and some medicines that weaken your immune system.
• Take high amounts of niacin (vitamin B-3).

Gout usually happens in only one joint at a time. It is often found in the big toe, but can also affect other joints, including your other toes, ankle, and knee.

Gout flares often start suddenly at night, and the symptoms in the affected joint often include:

• Intense pain, which may be bad enough to wake you up
• Swelling
• Redness
• Warmth

The flares typically get better within a week or two. In between flares, you usually don't have symptoms. Some people may have flares often, while others may not have another flare for years. But over time, if left untreated, your flares may happen more often and last longer.

And if gout is untreated over long periods of time, you can develop tophi. Tophi are hard, uric acid deposits under the skin. They start out as painless, but over time, they can become painful. They can also cause bone and soft tissue damage and misshapen joints.

To find out if you have gout, your health care provider:

• Will take your medical history, which includes asking about your symptoms.
• Will do a physical exam, including examining the affected joint(s).
• May order various tests, such as:
  • A test of a sample of fluid from one of your painful joints. The fluid is examined under a microscope and is checked for uric acid crystals.
  • A uric acid blood or urine test.
  • An ultrasound or special CT scan to look for uric acid crystal buildup in the affected joint and check for other conditions that may be causing the symptoms.

There are effective treatments for gout. Which treatment you get will depend on your symptoms and the cause of your gout. The goals of your treatment will be to:

• Reduce the pain from gout flares, by using medicines such as:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
  • Acetaminophen and the anti-inflammatory drug colchicine.
  • Oral or injected corticosteroids.
• Prevent future flares, for example by:
  • Making lifestyle changes such as losing weight, limiting alcohol, and avoiding foods high in purines. If you are taking medicines that can cause high uric acid in the blood, your provider may suggest stopping or changing those medicines.
  • If needed, taking medicines to lower uric acid in the blood.
• Prevent tophi and kidney stones, for example with medicines that lower uric acid in the blood.

With early diagnosis, treatment, and lifestyle changes, gout is one of the most controllable forms of arthritis. Treatment and lifestyle changes may help people avoid gout flares, lessen their symptoms, and sometimes even become gout free.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Paget's disease of bone is a chronic bone disorder. Normally, there is a process in which your bones break down and then regrow. In Paget's disease, this process is abnormal. There is excessive breakdown and regrowth of bone. Because the bones regrow too quickly, they are bigger and softer than normal. They may be misshapen and easily fractured (broken). Paget's usually affects just one or a few bones.

Researchers do not know for sure what causes Paget's disease. Environmental factors may play a role. In some cases, the disease runs in families, and several genes have been linked to the disease.

The disease is more common in older people and those of northern European heritage. If you have a close relative who has Paget's, you are much more likely to have it.

Many people do not know that they have Paget's, because it often has no symptoms. When there are symptoms, they are similar to those of arthritis and other disorders. The symptoms include:

• Pain, which may be due to the disease or to arthritis, which can be a complication of Paget's
• Headaches and hearing loss, which can happen when Paget's disease affects the skull
• Pressure on the nerves, which can happen when Paget's disease affects the skull or spine
• Increased head size, bowing of a limb, or curvature of the spine. This can happen in advanced cases.
• Hip pain, if Paget's disease affects the pelvis or thighbone
• Damage to the cartilage of your joints, which may lead to arthritis

Usually, Paget's disease gets worse slowly over time. It does not spread to normal bones.

Paget's disease can lead to other complications, such as:

• Arthritis, because the misshapen bones can cause increased pressure and more wear and tear on the joints
• Heart failure. In severe Paget's disease, the heart has to work harder to pump blood to affected bones. Heart failure is more likely if you also have hardening of the arteries.
• Kidney stones, which can happen when the excessive breakdown of the bone leads to extra calcium in the body
• Nervous system problems, since the bones can cause pressure on the brain, spinal cord, or nerves. There may also be reduced blood flow to the brain and spinal cord.
• Osteosarcoma, cancer of the bone
• Loose teeth, if Paget's disease affects the facial bones
• Vision loss, if Paget's disease in the skull affects the nerves. This is rare.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam
• An x-ray of the affected bones. Paget's disease is almost always diagnosed using x-rays.
• An alkaline phosphatase blood test
• A bone scan

Sometimes the disease is found by accident when one of these tests is done for another reason.

To avoid complications, it is important to find and treat Paget's disease early. The treatments include:

• Medicines. There are several different medicines to treat Paget's disease. The most common type is bisphosphonates. They help reduce bone pain and stop or slow down the progress of the disease.
• Surgery is sometimes needed for certain complications of the disease. There are surgeries to
  • Allow fractures (broken bones) to heal in a better position
  • Replace joints such as the knee and hip when there is severe arthritis
  • Realign a deformed bone to reduce the pain in weight-bearing joints, especially the knees
  • Reduce pressure on a nerve, if enlargement of the skull or spine injuries effects the nervous system

Diet and exercise do not treat Paget's, but they can help to keep your skeleton healthy. If you do not have kidney stones, you should make sure to get enough calcium and vitamin D through your diet and supplements. Besides keeping your skeleton healthy, exercise can prevent weight gain and maintain the mobility of your joints. Talk with your health care provider before you start a new exercise program. You need to make sure that the exercise does not put too much stress on the affected bones.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Urinary incontinence (UI) is the loss of bladder control, or being unable to control urination. It is a common condition. It can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

There are several different types of UI. Each type has different symptoms and causes:

• Stress incontinence happens when stress or pressure on your bladder causes you to leak urine. This could be due to coughing, sneezing, laughing, lifting something heavy, or physical activity. Causes include weak pelvic floor muscles and the bladder being out of its normal position.
• Urge, or urgency, incontinence happens when you have a strong urge (need) to urinate, and some urine leaks out before you can make it to the toilet. It is often related to an overactive bladder. Urge incontinence is most common in older people. It can sometimes be a sign of a urinary tract infection (UTI). It can also happen in some neurological conditions, such as multiple sclerosis and spinal cord injuries.
• Overflow incontinence happens when your bladder doesn't empty all the way. This causes too much urine to stay in your bladder. Your bladder gets too full, and you leak urine. This form of UI is most common in men. Some of the causes include tumors, kidney stones, diabetes, and certain medicines.
• Functional incontinence happens when a physical or mental disability, trouble speaking, or some other problem keeps you from getting to the toilet in time. For example, someone with arthritis may have trouble unbuttoning his or her pants, or a person with Alzheimer's disease may not realize they need to plan to use the toilet.
• Mixed incontinence means that you have more than one type of incontinence. It's usually a combination of stress and urge incontinence.
• Transient incontinence is urine leakage that is caused by a temporary (transient) situation such as an infection or new medicine. Once the cause is removed, the incontinence goes away.
• Bedwetting refers to urine leakage during sleep. This is most common in children, but adults can also have it.
  • Bedwetting is normal for many children. It is more common in boys. Bedwetting is often not considered a health problem, especially when it runs in the family. But if it still happens often at age 5 and older, it may be because of a bladder control problem. This problem could be caused by slow physical development, an illness, making too much urine at night, or another problem. Sometimes there is more than one cause.
  • In adults, the causes include some medicines, caffeine, and alcohol. It can also be caused by certain health problems, such as diabetes insipidus, a urinary tract infection (UTI), kidney stones, enlarged prostate (BPH), and sleep apnea.

In adults, you are at higher risk of developing UI if you:

• Are female, especially after going through pregnancy, childbirth, and/or menopause
• Are older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
• Are a man with prostate problems
• Have certain health problems, such as diabetes, obesity, or long-lasting constipation
• Are a smoker
• Have a birth defect that affects the structure of your urinary tract

In children, bedwetting is more common in younger children, boys, and those whose parents wet the bed when they were children.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms. Your provider may ask you to keep a bladder diary for a few days before your appointment. The bladder diary includes how much and when you drink liquids, when and how much you urinate, and whether you leak urine.
• A physical exam, which can include a rectal exam. Women may also get a pelvic exam.
• Urine and/or blood tests
• Bladder function tests
• Imaging tests

Treatment depends on the type and cause of your UI. You may need a combination of treatments. Your provider may first suggest self-care treatments, including:

• Lifestyle changes to reduce leaks:
  • Drinking the right amount of liquid at the right time
  • Being physically active
  • Staying at a healthy weigh
  • Avoiding constipation
  • Not smoking
• Bladder training. This involves urinating according to a schedule. Your provider makes a schedule from you, based on information from your bladder diary. After you adjust to the schedule, you gradually wait a little longer between trips to the bathroom. This can help stretch your bladder so it can hold more urine.
• Doing exercises to strengthen your pelvic floor muscles. Strong pelvic floor muscles hold in urine better than weak muscles. The strengthening exercises are called Kegel exercises. They involve tightening and relaxing the muscles that control urine flow.

If these treatments do not work, your provider may suggest other options such as:

• Medicines, which can be used to
  • Relax the bladder muscles, to help prevent bladder spasms
  • Block nerve signals that cause urinary frequency and urgency
  • In men, shrink the prostate and improve urine flow
• Medical devices, including
  • A catheter, which is a tube to carry urine out of the body. You might use one a few times a day or all the time.
  • For women, a ring or a tampon-like device inserted into the vagina. The devices pushes up against your urethra to help decrease leaks.
• Bulking agents, which are injected into the bladder neck and urethra tissues to thicken them. This helps close your bladder opening so you have less leaking.
• Electrical nerve stimulation, which involves changing your bladder's reflexes using pulses of electricity
• Surgery to support the bladder in its normal position. This may be done with a sling that is attached to the pubic bone.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

You have two kidneys. They are fist-sized organs on either side of your backbone above your waist. Your kidneys filter and clean your blood, taking out waste products and making urine. Kidney tests check to see how well your kidneys are working. They include blood, urine, and imaging tests.

Early kidney disease usually does not have signs or symptoms. Testing is the only way to know how your kidneys are doing. It is important for you to get checked for kidney disease if you have the key risk factors - diabetes, high blood pressure, heart disease, or a family history of kidney failure.

Specific kidney tests include:

• Glomerular filtration rate (GFR) - one of the most common blood tests to check for chronic kidney disease. It tells how well your kidneys are filtering.
• Creatinine blood and urine tests - check the levels of creatinine, a waste product that your kidneys remove from your blood
• Albumin urine test - checks for albumin, a protein that can pass into the urine if the kidneys are damaged
• Imaging tests, such as an ultrasound - provide pictures of the kidneys. The pictures help the health care provider see the size and shape of the kidneys, and check for anything unusual.
• Kidney biopsy - a procedure that involves taking a small piece of kidney tissue for examination with a microscope. It checks for the cause of kidney disease and how damaged your kidneys are.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

You have two kidneys, each about the size of your fist. They are near the middle of your back, just below the rib cage. Inside each kidney there are about a million tiny structures called nephrons. They filter your blood. They remove wastes and extra water, which become urine. The urine flows through tubes called ureters. It goes to your bladder, which stores the urine until you go to the bathroom.

Most kidney diseases attack the nephrons. This damage may leave kidneys unable to remove wastes. Causes can include genetic problems, injuries, or medicines. You have a higher risk of kidney disease if you have diabetes, high blood pressure, or a close family member with kidney disease. Chronic kidney disease damages the nephrons slowly over several years. Other kidney problems include:

• Cancer
• Cysts
• Stones
• Infections

Your doctor can do blood and urine tests to check if you have kidney disease. If your kidneys fail, you will need dialysis or a kidney transplant.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases