Causes and symptoms of acute tubular necrosis

Damage or destruction to tube-like structures known as tubules in the kidneys can bring about the development of acute tubular necrosis (ATN) and subsequently, acute kidney failure.

What causes acute tubular necrosis (ATN)?

A lack of supply of oxygen to the cells in the kidney is the most common cause of this condition. The reason as to why oxygen may not reach the cells and tissues of this organ could be restriction or blockage of the pathways. When this happens, the kidneys get damaged. Dehydration is the most important cause of ATN which may be because of loose motions, vomitings, heat stroke etc.

Health conditions such as diabetes, heart attack, and stroke can bring about a decrease in blood flow to the organs resulting in ATN and death of cells. Similarly, the presence of toxic substances in the blood can also lead to tubules damage and change the way the cells function in the tubules.

Other causes that may lead you to develop ATN may be medications, radiology dyes, anesthetics and chemicals that cause your body to react adversely.

In addition to these causes, a number of factors can put you at risk of ATN and there are:

- An injury to the body, more specifically your kidneys can cause clotting of the blood vessels
- An adverse response to blood transfusion
- Instances of septic shock can slow down blood flow to the organs
- A major surgery that can interrupt blood supply to the organs

What are the symptoms of the condition?

The symptoms associated with the condition can vary depending on the severity of the problem.

You may experience:

- Troubles in waking up
- Drowsy feeling even during daytime
- Feelings of lethargy
- Feelings of excessive thirstiness
- Problems with urination
- Fluid retention problems
- Instances of confusion
- Feelings of nausea



Can Acute Tubular Necrosis Cause Kidney Failure?

Problems of the large intestine are very common and patients should usually consult gastroenterologists for the proper diagnosis and treatment

1. Bleeding per rectum: Bleeding through the anal canal or rectum is usually the most common problem of the patients. It can be due to following reasons: 

A. Piles also known as Hemorrhoids: Hemorrhoids are dilated venous channels of the anal canal. They occur due to long term constipation or chronic cough or due to less fibre intake in the diet. Sigmoidoscopy or proctoscopy is required for diagnosis. Treatment options include medicines and high fibre intake, Injection therapy(Sclerotherapy) for stopping bleeding from piles and Stapler hemorrhoidectomy if the piles are large.

B.  Polyps: Polyps are soft tissue growths seen in the large intestine. They are usually silent but can present with bleeding or anaemia. Polyps usually grow slowly in size and large polyps can turn into cancer of large intestine also known as colorectal carcinoma. Colonoscopy is required for the diagnosis. The gastroenterologists can diagnose the presence of polyps by colonoscopy. Smaller polyps can be removed by polypectomy by gastroenterologists without the need for open surgery. However large polyps or those polyps with suspicion of cancer require surgery.

C. Large intestine Ulcer: They can occur due to early cancer, SRUS, Infections or drugs. They require colonoscopy for the diagnosis. The gastroenterologists usually take Biopsy from the ulcer to know the cause of the ulcer. The mere taking of biopsy does not mean cancer and biopsy samples are seen in the microscope for better diagnosis.

D. Ulcerative Colitis and Crohn s disease: Ulcerative colitis is one form of Inflammatory bowel disease (IBD). The other IBD is known as Crohn s disease. Whereas ulcerative colitis involves only large intestine, Crohn s disease can involve any part of the gastrointestinal tract including small intestine. Ulcerative colitis and Crohn s disease present with Loose stools(diarrhea), bleeding , abdominal pain, weight loss, Anemia and Perianal fissures and  fistula. The diagnosis of IBD is challenging and involves blood tests, CT Scan abdomen, Colonoscopy with biopsy and clinical history. Management includes Medicines which control the inflammation such as Pentasa, Rowasa, Mesacol etc. Severe disease requires additional drugs such as Azathioprine and Anti TNF sich as Infliximab and Adalimumab. Occasional cases require surgery such as those with tight stricture of the intestine, severe dilatation of Large intestine (also known as Toxic megacolon), excessive bleeding, the disease not responding to medical management, or presence of cancer with IBD.

E. Anal fissures: Cut in the anal skin (fissure) causes severe pain in the anal area during passing motions. It is usually due to constipation or straining. It is usually treated by Gastroenterologists initially by medicines and ointments. If the pain continues Surgery is required named as Lateral internal sphincterotomy (LIS).

2. Loose motions or Diarrhea: Excessive passing of liquid motions is known as diarrhea or commonly lose motions. It is usually due to Infections caused by contaminated food and water. It is usually self-limiting. Severe cases with dehydration require admission for IV fluids and antibiotics for the infection. Loose motions for more than 6 to 8 weeks is known as chronic diarrhea. It is evaluated by blood tests and colonoscopy. Usual causes include tuberculosis, celiac disease, ulcerative colitis, microscopic colitis, Malabsorption such as chronic pancreatitis and small bowel bacterial overgrowth.

3. Irritable bowel syndrome (IBS): IBS is very common and at least 20 to 30 percent of Indian patients suffer from it. Symptoms include altered bowel habits such as diarrhoea or constipation, abdominal pain which is usually relieved or increased by defecation. Weight loss or bleeding is not the feature of IBS. Few simple blood tests are required and good medicines are now available for IBS. Few cases may require colonoscopy to rule out alternative causes of the symptoms.

Understanding colonoscopy: Colonoscope is a flexible tube with a camera at its tip to see the inside of the large and small intestine. Bowel preparation is required at least 8 hours before the procedure so that the inside of the large intestine can be seen clearly without the interference of stools.colonoscopy is an OPD based procedure where the patients are discharged the same day. A colonoscopy helps in evaluation symptoms of the large intestine such as loose stools, bleeding and abdominal pain.

In Detail About Colorectal Disorders!

Colon polyps are growths that are typically found in the large intestine. Although the causes behind the occurrence of colon polyps are not known, this condition is usually seen to affect adults.
These colon polyps might turn into colon cancer over a period of time; the development of cancer can happen over a number of years.
Colon polyps are usually symptomless; hence it becomes difficult to diagnose the condition. They are commonly found as additional results of screening tests for colon cancers. Screening tests are conducted when there is a suspicion of a disease but it displays no significant symptoms. The symptoms can only be visible if the polyps are enlarged. Typical symptoms include:
Rectal bleeding.
Changes in bowel conditions such as diarrhoea and constipation.
Changes in urination patterns.
Change in appearance of stool.
As the presence of most polyps becomes evident only during colon cancer tests, it is recommended that regular tests for colon cancer be conducted for adults over the age of 50. Some of these tests include:
Colonoscopy: This is highly recommended for detecting colon polyps. A small tube used for viewing is inserted into the colon by the doctor.
Flexible Sigmoidoscopy: It is similar to colonoscopy with the only difference being that the tube is smaller.
Computed Tomographic Colonography (CTC): Also known as virtual colonoscopy, various computer systems and X-rays are used to create a detailed picture of the colon so that the doctor can search for polyps.
The size of the colon polyps helps to identify if the polyp is cancerous or not. Chances of the polyp being cancerous are high if the size of the polyp is higher than 1 cm or 0.4 inches. Hyperplastic polyps (smaller polyps) do not become cancerous and hence, do not need to undergo a colonoscopy. Another form of polyp is the sessile polyp which is usually a flat growth without a stalk and grows on the inner wall of the colon. Similar to other polyps, these polyps can be found and removed using a colonoscopy or a sigmoidoscopy.

Causes and Symptoms of Colonic Polyps

The prostate gland is a very important gland in the male reproductive system. It is responsible for producing around 30% of the fluid which comprises semen. While the statement that homeopathy cannot treat problems in the prostate such as prostate cancer is true, it is untrue that prostate gland enlargement cannot be treated by homeopathy. Here are the most common homeopathic remedies for prostate gland enlargement and what are the medicines best suited for it:
1. Baryta carb
Baryta carb is one of the best homeopathic remedies for prostate gland enlargement in the elderly. Common conditions which may indicate that baryta carb is the best remedy for your prostate gland enlargement patient include degenerative diseases such as losing memory, cardiovascular problems and other problems besides losing memory in the cerebral system. 
2. Digitalis
Digitalis is mostly used when the patient suffering from prostate gland enlargement also suffers from heart problems. Digitalis does make the pulse weak, slow or even intermittent, however it is worth note that oedema may also occur. 
3. Staphysagria
Staphysagria is one of the best homeopathic medicines for various pains which occur in the urinary system in addition to prostate gland enlargement. Common pains which staphysagria cures include pain while urinating, burning sensation in the urethra, feeling like the bladder is not completely emptied as well as pain in the urethra when one is not urinating.
4. Conium
Frequent urination is yet another symptom of prostate gland enlargement. This problem is caused by an injury to the area where the prostate glands are located. This injury hardens the glands. The passage of urine will be extremely difficult with urine starting to pass and then stopping again. There is also dribbling of urine after completion of urinating.
5. Sabal serrulata
Sabal serrulata is one of the most popular homeopathic medicines for prostate gland enlargement with many patients having consumed it reported great results. It works for most causes of prostate gland enlargement as well.
Even though homeopathy is supposed to have no side effect, it is still imperative that you consult your doctor about which ones to take.

Homeopathy in Prostate Problem

What is diabetic kidney disease?
Diabetic nephropathy, also known as Diabetic Kidney Disease is a type of complication that occurs in people who are a victim to diabetes. That does not mean every individual with diabetes will have this disease, but if the necessary precautions are not taken, then it can lead to this disease. Diabetic Kidney Disease is characterised by excessive amounts of albumin as well as protein in the urine. In diabetics, certain chemicals in the kidneys shoot up and hamper the function of the glomeruli.

The glomeruli are the main units of kidneys that are responsible for the filtration. Diabetic kidney diseases result in the leakage of essential products like albumin and protein into the urine. When this happens, the protein levels in the blood reduce. If proper precautions are not taken and treatment is not done, then the disease may worsen and the condition will progress to  end-stage renal failure .

How to avoid diabetic kidney disease?
The best way to treat diabetic kidney disease is to prevent it in the first place. Foremost, you should prevent the risk factors in order to avoid coming down with Diabetic Nephropathy. The risk factors include high blood pressure, high levels of blood sugar, dyslipidemia and smoking. Avoid excess of following 5S Sugar, Salt, smoke, stress and sedentary life.

Intensive control over blood sugar
According to certain clinical trials, maintaining and keeping a good control over your blood sugar levels drastically reduces the risk of developing diabetic kidney disease. If you are diabetic, make it a point to get your regular checkups and maintain your diet to prevent the levels of sugar in your blood to shoot up. Other things that you must keep in your mind are to take proper medication that has been prescribed to you. You must adhere to your treatment plans and follow the guidelines that have been given to you.

Intensive control over blood pressure
Hypertension is common in patients who are diabetic. Hypertension alone can result in end-organ damage due to excess pressure build up in the blood vessels. Hypertension associated with hyperglycaemia (diabetes) is a ticking bomb for your kidneys. Hence it is advised to keep your blood pressure under control as well to prevent diabetic kidney disease.

Diabetic nephropathy is not something that happens to every individual with diabetes, so if you follow the above simple tips, the chances of the same reduce, and thus the quality of your life goes up. Many diabetics will get kidney failure due to causes other than diabetes and that may be treatable. Hence early consult with nephrologist is a must.

Diabetic Kidney Disease - How It Can Be Prevented?

Renal Tubular Acidosis is a medical condition. When the kidney is unable to acidify urine, it leads to the accumulation of acid in the body. Usually, when blood is filtered by the kidney, it passes through the tubules of the nephrons (the functional unit of the kidney).

Before it flows into the bladder from the kidney, the urine undergoes an exchange of salts, acids and other solutes. Renal tubular acidosis results in the formation of excessive amounts of acid because the kidneys cannot drain them. This may happen because the kidneys cannot reabsorb the alkaline bicarbonate ions from the urine in the early segment of the nephron or because of inadequate production of acidic hydrogen ions in the latter half of the nephron.

Renal Tubular Acidosis is simply associated with abnormal urinary acidification. Other functions of the kidneys remain unimpaired.
There are several different types of renal tubular acidosis-

  Distal Renal Tubular Acidosis (RTA)
This is the most fundamental form of RTA. It is characterized when the hydrogen ions are not secreted into the lumen of the nephron by the alpha-intercalated cells of the medullary collective duct of the distal nephron. When this happens the pH of urine cannot be brought down below 5.3. Renal excretion is inhibited and hydrogen ions are not eliminated which leads to academia. At the same time, Potassium ions cannot be absorbed by the cell which leads to hypokalemia. The end result is protein retention and potassium excretion. Distal RTA can lead to the urinary stone formation, calcium deposits in the kidney, rickets and osteomalacia and Sjogren s syndrome.

  Proximal RTA
When proximal tubular cells reabsorb 85% of filtered bicarbonates and 60% of filtered sodium from the urine, then this again leads to academia. The distal intercalated cells, however, function normally and so the academia is not as severe as in case of Distal RTA. The alpha-intercalated cells can acidify urine to a pH of 5.3 or less because they produce hydrogen ions. Proximal RTA is also associated with Fanconi Syndrome which is characterized by aminoaciduria, uricosuria, glucosuria, and tubular proteinuria.

  Combined distal and proximal RTA
Inherited carbonic anhydrase II deficit leads to combined distal and proximal RTA. This is accompanied by osteopetrosis, cerebral calcification, and renal tubular acidosis. Cases of combined distal and proximal RTA are very rare.

How is RTA understood?
The following steps are applied to analyze Renal Tubular Acidosis-
  Determining the anion gap in acidosis. The normal Anion Gap is 8-12 (4-6 mEq/L)
  Separating the renal from the extrarenal causes of normal anion gap acidosis
  Classifying the types of RTA
  If it is distal RTA, further tests will be necessary to support the diagnosis

How is RTA diagnosed?
Three types of tests can reveal if a person is affected by Renal Tubular Acidosis-
  Urine test
  Acid load test
  Physical examination

Treatment of RTA-
Doctors prescribe either or both of the following two types of therapies-

  Alkali therapy- The pH level of urine is restored and electrolytes are balanced
  Vitamin D supplements- If RTA leads to bone deformities or rickets, your doctor will prescribe vitamin supplements to strengthen your bones.

Timely diagnosis can prevent the effects of Renal tubular Acidosis from becoming compounded. With the right medication, a person can lead a healthy normal life.

What Should You Know About Renal Tubular Acidosis?

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