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?

A kidney stone may not be as big as the stones in your garden, but can be quite a pain. Kidney stones are actually mineral crystals that are usually a combination of calcium and phosphates. The size of a kidney stone ranges from the size of a sugar crystal to a ping pong ball. While some kidney stones pass out of the body along with urine, others can block the urethra and become painful. 

In addition to being painful, a kidney stone can cause permanent damage to your kidneys. Since large kidney stones are usually painful, they rarely go undiagnosed. However, if a kidney stone is left untreated, it could cause the kidney to atrophy and lower the functionality of the kidney. Kidney stones that are related to an infection can also lead to chronic urinary tract infections and damage the kidney through scarring and inflammation. This could eventually lead to kidney failure.
 
Not all kidney stones need to be treated with surgery. If the kidney stone is very small, your doctor may prescribe plenty of water and medication to treat the pain. With plenty of water, you should be able to pass the stone in your urine. Ideally, you should take plenty of rest until the stone is passed. 

Larger kidney stones may need you to be hospitalized for treatment. These are:
- extracorporeal shock wave lithotripsy (eswl)
To begin this of treatment, a painkiller is administered. Ultrasonic waves are used to determine the location of the kidney stone. Shock waves are then passed through the kidney stone to break it into smaller pieces, which can then pass out of the body through urine.
- ureteroscopy
This is also called retrograde intrarenal surgery and is performed when the kidney stone is stuck in the ureter. A ureteroscope is passed through the urethra and bladder into the ureter. Laser energy may then be used to break the stone into smaller pieces to unblock the ureter. 
- percutaneous nephrolithotomy (pcnl)
This surgery is performed under general anesthesia. It involves a small incision being made in the back and a nephroscope passed into the kidney through it. Laser or pneumatic energy is then used to break up the stone into smaller pieces and pull them out. 

- open surgery
Open surgery is performed only in the case of an abnormally large stone or abnormal anatomy of the person. An incision is made in the back that allows the doctor to access the kidney and manually remove the stone.

Kidney Stones- Should It Be Removed

A problem pertaining to the storage function of the bladder that results in bouts of sudden, often uncontrollable urge to urinate is referred to as an overactive bladder. This condition which is marked by unconditioned or involuntary loss of urine can sometimes be quite difficult to stop. People who experience such a condition often feel humiliated and as such tend to limit their social and work life. Despite such, only a few are conscious that a brief evaluation can help them manage and overcome an overactive bladder.

Mechanism of urination

During urination, the urine proceeds from the bladder and flows into the urethra which is located at the tip of the penis in men and above the vagina in women. As the bladder fills, the nerve signals in the brain prompts urination by coordinating the relaxation and contraction of the urinary sphincter muscles.

Causes and symptoms of an overactive bladder

Primarily caused due to involuntary contraction and relaxation of sphincter muscles, several conditions can lead to overactive bladder. 

Some of them are: 
1. Parkinson's disease, alzheimer's and other neurological disorders
2. Poor kidney function due to diabetes
3. Medications that lead to increased production of urine
4. Bladder abnormalities like tumors or stones
5. Constipation
6. Excessive consumption of caffeine or alcohol

Some of the common signs of an overactive bladder are:
1. Bouts of sudden, uncontrollable urge to urinate
2. Awakening at night frequently to urinate
3. Urinating more than eight times a day

Risks
The risk of an overactive bladder gradually increases with age. Conditions, such as diabetes and an enlarged prostate results in the increased likelihood of an overactive bladder. People who have previously faced strokes and heart attacks experience cognitive decline, which often times lead to the development of an overactive bladder.

Urinary incontinence as well as a host of associated factors can be detrimental to your life. Emotional distress, interrupted sleep cycles and depression are some of the observed complications of this condition.

Thus if you experience or entertain suspicion of an overactive bladder, you should consider visiting a general physician who might refer you to a specialist, if need be.

All about Overactive Bladder

Polycystic Ovary Syndrome (PCOS) is a condition, which is born due to an imbalance of hormones within the female body. When this happens, the female body faces anumber of problems as far as her periods or menstrual cycles goes, besides finding it difficult to conceive naturally and easily. Let us find out more about this condition.

PCOS and hormones
To begin with, let us understand what hormones are. These are chemical impulses that send messages to various parts of the brain and rest of the body to signal the release of other kinds of hormones that may be vital for various functions. In PCOS, it is normally seen that the sex hormones are thrown out of balance, due to which the ovaries start producing a small dose of some male hormones. This creates problems as far as ovulation is concerned and also, it gives rise to the growth of facial hair, acne and changes in the overall appearance of the patient. Insulin resistance is another cause that may also trigger PCOS. It is also an inherited issue in many cases.

Symptoms
From irregular periods to an increase in acne and facial hair, there are many symptoms that may point at the existence of this condition. Fertility problems and issues related to normal ovulation are also often seen in women who are suffering from this condition due to the irregular periods. Additionally, depression may be seen in many patients who are suffering from this condition on a chronic basis. Thinning of hair and excess weight gain with difficulty in losing extra pounds may also be indicative of PCOS.

Diagnosis
The diagnosis of PCOS is usually done with the help of a physical examination as well as a blood test that will primarily help in determining the sugar levels and insulin. The doctor will also conduct other hormone tests so as to understand which hormones are not in balance and which ones may be triggering changes in the body. Apart from all this, the doctor will also study the body mass index (BMI) of the patient to find out if there has been a sudden and drastic change on the weight of the patient. During the lab tests, where the blood and urine are examined, the doctor will also seek to rule out any anomalies in the thyroid gland. An ultrasound of the ovaries will also be conducted.

Treatment
Weight loss programs as well as diet tweaks that remove excess dairy and meat may be recommended by the doctor. Further, the doctor may also put the patient on birth control pills so as to bring better balance of hormones. Moreover, moderate exercise will be required for the patient so that the normal production of hormones may be resumed eventually. 

PCOS - How It Can Be Diagnosed?

When do kidneys need dialysis?

Kidneys are a pair of organs that are located on either side of the spine, each about a size of a fist. The kidneys help in purifying blood by removing toxins, waste materials and excess fluids from the human body. Disorders and dysfunctions of the kidney can lead to severe and often fatal consequences. When the kidneys stop functioning as they are supposed to, dialysis is performed to resume normal functioning in the body.

Dialysis is a type of treatment, which filters and purifies the blood with the aid of a machine. It is an artificial way of purifying blood. There are two types of dialysis, namely hemodialysis and peritoneal dialysis. Hemodialysis, the most common form of dialysis, which involves using a manmade kidney called a hemodialyzer, which removes toxins and waste materials from blood.

Peritoneal Dialysis, on the other hand, is a type of treatment which involves implanting a catheter in the stomach. During the procedure, a fluid called dialysate flows into the abdomen that absorbs all the waste material, which is consequently drained out of the body.

You may need a dialysis if:

- Your kidneys are dysfunctional
- When waste materials and toxins start to accumulate in the body
- In an event of an injury or accident to the kidney such as internal lacerations (wound caused by the tearing of a tissue)
- If the creatinine (a type of a chemical waste product) level falls to 10-12 cc/minute
- In an event where the kidneys aren't able to work properly leading to accumulation of toxins, irregular amounts of chemicals in the body and other dysfunctions

Weakening of the abdominal muscles and weight gain are some of the risks involved in dialysis. Dialysis is a temporary treatment and serves to function till the time the actual kidneys get repaired. In chronic cases of kidney disease, kidney transplant may perhaps be the last resort.



When Do Kidneys Need Dialysis?

Glomerulonephritis is a disease that is caused due to inflammation of the small filters that are present within the kidneys or glomeruli. Glomeruli eliminate the excess waste, electrolytes and fluids from the blood, discharged through urine. A glomerular disease can be either acute or chronic. If the condition arises without a combination of any other disease, it is termed as primary glomerulonephritis. Secondary glomerulonephritis is characterized by diabetes or lupus (an auto-immune disorder) being at the root of the disease. Prolonged or severe inflammation can take a toll on the kidneys.


Causes-


Nephrotic syndrome can be primary, being a disease specific to the kidneys, or it can be secondary, being a renal manifestation of a systemic general illness. In all cases, injury to glomeruli is an essential feature. Kidney diseases that affect tubules and interstitium, such as interstitial nephritis, will not cause nephrotic syndrome.


Primary causes of nephrotic syndrome include the following, in approximate order of frequency:
Minimal -change nephropathy
Focal glomerulosclerosis
Membranous nephropathy
Hereditary nephropathies


Secondary causes include the following, again in order of approximate frequency:
Diabetes mellitus
Lupus erythematosus
Viral infections (e.g., hepatitis B, hepatitis C, human immunodeficiency virus [HIV] )
Amyloidosis and paraproteinemias
Preeclampsia
Allo-antibodies from enzyme replacement therapy


Nephrotic- range proteinuria may occur in other kidney diseases, such as IgA nephropathy. In that common glomerular disease, one third of patients may have nephrotic- range proteinuria.


Nephrotic syndrome may occur in persons with sickle cell disease and evolve to renal failure. From a therapeutic perspective, nephrotic syndrome may be classified as steroid sensitive, steroid resistant, steroid dependent, or frequently relapsing.


Treatment-
Whether one is suffering from acute or chronic nephrotic glomerular , with symptoms moderate or severe, the treatment lies in treating high blood pressure and other underlying conditions of the disease.
Water pills help control sweating, thus increasing the fluid flushed from the kidneys.
Statins reduce cholesterol level.
Blood thinners such as anticoagulants lower the risk of blood clots.
Corticosteroids regulate the immune system and ease the inflammation that results from kidney disorders.
Incorporating certain lifestyle changes such as opting for lean proteins, cutting on the intake of fat in the diet and consuming lesser amounts of salt can treat inflammation and swelling.
For kidney failure, dialysis can come to the aid in eliminating excess fluids and regulating hypertension.


Nephrotic Syndrome: Causes and Treatment

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