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

Kidney Tests

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

Low Blood Pressure

You've probably heard that high blood pressure is a problem. Sometimes blood pressure that is too low can also cause problems.

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure. Your blood pressure reading uses these two numbers. Usually they're written one above or before the other, such as 120/80. If your blood pressure reading is 90/60 or lower, you have low blood pressure.

Some people have low blood pressure all the time. They have no symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of a medical condition or certain medicines. Some people may have symptoms of low blood pressure when standing up too quickly. Low blood pressure is a problem only if it causes dizziness, fainting or in extreme cases, shock.

NIH: National Heart, Lung, and Blood Institute

Lung Transplantation

A lung transplant removes a person's diseased lung and replaces it with a healthy one. The healthy lung comes from a donor who has died. Some people get one lung during a transplant. Other people get two.

Lung transplants are used for people who are likely to die from lung disease within 1 to 2 years. Their conditions are so severe that other treatments, such as medicines or breathing devices, no longer work. Lung transplants most often are used to treat people who have severe:

• COPD
• Cystic fibrosis
• Idiopathic pulmonary fibrosis
• Alpha-1 antitrypsin deficiency
• Pulmonary hypertension

Complications of lung transplantation include rejection of the transplanted lung and infection.

NIH: National Heart, Lung, and Blood Institute

Lupus

What is lupus?

Lupus is a chronic (long-lasting) type of autoimmune disease.Autoimmune diseases happen when your immune system attacks healthy cells and tissues by mistake. This attack causes inflammation. It can also damage many parts of the body, including the joints, skin, kidneys, heart, lungs, and brain.

There are several types of lupus:

• Systemic lupus erythematosus (SLE) is the most common type. It can be mild or severe and can affect many parts of the body.
• Cutaneous lupus affects the skin. It causes a rash or sores, usually after your skin is exposed to sunlight. The two major types of cutaneous lupus are discoid lupus and subacute cutaneous lupus.
• Drug-induced lupus is caused by a reaction to some medicines. The symptoms may start 3 to 6 months after starting the medicine. The symptoms usually go away when you stop taking the medicine.
• Neonatal lupus, which is rare, affects newborns. It is caused by certain antibodies that are passed from the pregnant parent to the baby.

The cause of lupus is unknown. Researchers are studying what might cause or trigger the disease, such as:

• Genetics
• Environmental factors, such as viral infections, sunlight, certain medicines, and smoking
• Problems with the immune system

Anyone can get lupus, but women get it much more often than men.

Lupus is more common in African Americans than in White people. It is also more common in people of American Indian and Asian descent. African American and Hispanic women are more likely to have severe forms of lupus.

Lupus can have many symptoms, and they differ from person to person. Some of the more common ones are:

• Arthritis, causing painful and swollen joints and morning stiffness
• Fever
• Fatigue or feeling tired often
• Red rashes, most often on the face (also called the "butterfly rash")
• Chest pain when taking a deep breath
• Hair loss
• Pale or purple fingers or toes, from cold and stress (Raynaud phenomenon)
• Sensitivity to the sun
• Swelling in legs or around eyes
• Mouth ulcers
• Swollen glands
• Headache and dizziness
• Confusion and memory problems

Symptoms may come and go. When you are having symptoms, it is called a flare. Flares can range from mild to severe. New symptoms may appear at any time.

Lupus causes inflammation throughout your body. This can cause problems in your organs, including:

• Kidney damage (lupus nephritis).
• Heart problems, including inflammation in the heart (myocarditis), heart valves, or lining of the heart muscle (pericarditis).
• Inflammation of blood vessels (vasculitis).
• Blood clots
• Inflammation of the tissue that surrounds the lungs (pleurisy). This can make it painful to breathe.

Some people with lupus may be more likely to develop other conditions, such as coronary artery disease (CAD) and atherosclerosis.

There is no specific test for lupus, and it's often mistaken for other diseases that cause similar symptoms. So it may take a while to get a diagnosis. To find out if you have lupus, your health care provider:

• Will ask about your symptoms, medical history, and family health history
• Will do a complete physical exam
• May order blood tests, such as ANA (antinuclear antibody), antibodies, complete blood count, and complement tests
• May order other tests, such as urine tests
• May do biopsies:
  • Skin biopsy (looking at skin samples under a microscope)
  • Kidney biopsy (looking at tissue from your kidney under a microscope)

There is no cure for lupus, but medicines and lifestyle changes can help control it.

People with lupus often need to see different providers. You will most likely have a primary care provider and a rheumatologist (a doctor who specializes in diseases of the joints and muscles). Which other specialists you will depend on how lupus affects your body. For example, if lupus is damaging your heart or blood vessels, you would see a cardiologist (a doctor who specializes in heart diseases).

Your primary care provider should coordinate care between all of your other providers and treat other problems as they come up. You and your primary care provider will develop a treatment plan to fit your needs. You will both review the plan often to make sure that it is working. You should report new symptoms to your provider right away so that your treatment plan can be changed, if needed.

The goals of a treatment plan are to:

• Prevent flares
• Treat flares when they occur
• Reduce organ damage and other problems
• Improve your quality of life

Treatments may include drugs to:

• Reduce fever, swelling, and pain
• Reduce inflammation in your body
• Prevent or reduce flares
• Reduce or prevent damage to joints
• Suppress (lower) the activity of your immune system

Besides taking medicines for lupus, you may need to take medicines for problems that are related to lupus such as high cholesterol, high blood pressure, or infection.

Alternative and complementary therapies are therapies that are not part of standard treatments. Some people try alternative and complementary therapies to improve their lupus symptoms. But research has not clearly shown whether these treatments may help or treat lupus. Talk to your provider before trying any new treatments.

It is important to take an active role in your treatment. It helps to learn more about lupus - being able to spot the warning signs of a flare can help you prevent the flare or make the symptoms less severe.

It is also important to find ways to cope with the stress of having lupus. Exercising and finding ways to relax may make it easier for you to cope. A good support system can also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases