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pátek 24. února 2017

Kidneys and kidney disease

Kidneys and kidney disease

Healthy man in the body has two kidneys, each of which is about the size of a clenched fist
Healthy man in the body has two kidneys, each of which is as large as a fist. Kidneys are placed along the spine at the height of the lower ribs. The actual kidneys are made up of small renal corpuscles - nephrons. There are in each kidney about 1 million and is used to filter blood. Every minute flow through the kidneys 1.2 liters of blood, that is 1/5 of the total blood volume in the body of an adult per day i.e. up to 1700 liters.

Kidneys from blood removes various waste products which are formed in the body in metabolizing food or during muscular work. Additional renal function include removing excess water, filtered by the kidneys into urine. The daily amount of urine is an average of about 1.5 liters. Kidneys also have other important functions - are involved in theregulation of blood pressure and maintain balance electrolytes, e.g. potassium and sodium. Furthermore, regulate the balance of acid and alkaline substances in the blood and secrete the hormone erythropoietin, which induces bone marrow red blood cell production. Kidneys also produce vitamin D in an active form; that influences the metabolism of calcium, which is important for healthy and strong bones.

A person can live a full life with one kidney. If kidney performance drops below 10-20% of the original capacity, it ceases to proper functioning of the body suffice. When the kidneys fail, they accumulate in the blood of waste substances. It can manifest deterioration of general health - nausea, vomiting, loss of appetite or sleep disturbances.Kidneys constitute less urine and fluid collected in the body causes swelling of tissues - eg. Lower limbs, especially in the ankle, or eyelids. The patient appears dyspnea and weight gain. The body is unable to produce red blood cells. This manifestation of the disease is called anemia and is usually accompanied by fatigue and general weakness.Accumulation of pollutants in the body can also cause itching.
Read also: enlargement of the spleen

The most common cause of renal failure is usually diabetes (diabetes mellitus), high blood pressure (hypertension) or some kidney diseases, especially repeated or chronic inflammation, polycystic kidney disease or a variety of birth defects. Kidney disease affects a relatively large number of people - are estimated to suffer from some form of kidney disease every tenth person. Not everyone knows about the hidden disease, so it is important to focus on potential kidney disease when preventative checks at their general practitioner. Kidneys are the most commonly affected by inflammation (glomerulonephritis and pyelonephritis), kidney or bladder stones (nephrolithiasis, Urolithiasis) or specific renal tumors.

Once destroyed, renal tissue has not healed. The less functional tissue is destroyed, the greater the chance that the kidney will be able to continue to function. Healthy kidneys have a large reserve capacity, neither complete loss of one entire kidney may not be a problem for the organism. However, there are some diseases or certain stages, which almost always leads to irreversible kidney failure. In any case, even when the cause can not remove it, or not known, it is necessary to protect residual renal function as long as possible. Nephrologist in such cases will prescribe a special diet and drugs that slow down the further worsening of kidney function. If this does not work, you need to begin dialysis (peritoneal or hemodialysis), or a kidney transplant patient.

kidney disease

Renal disease suffer from currently around 10% of the human population.
Kidney disease can be divided into several main sections. Sometimes the kidney disease combined or modified other diseases of the patient.

Protracted kidney inflammations, immunological mechanism - glomerulonephritis.

Glomerulonephritis have many clinical pictures may occurs over days to a few weeks, or slowly, when the degradation occurs in the order of years, and sometimes decades. Renal disease is symmetrical (identical in both kidneys). Part of a hereditary origin and is found in the family of the patient. General feature is positive urinary finding, often with large losses proteinuria (with some other symptoms is then known as nephrotic syndrome). Rapid loss of renal function is the domain of rapidly progressive glomerulonephritis.Condition requires hospitalization, performing renal biopsy, specific immunological blood tests, diagnosis and immunosuppressive therapy which can often unfavorable course of the disease reversed. Patients in stable condition are monitored on an outpatient basis. During the life can cause relapse and the need for additional biopsy and treatment.

hereditary diseases

In adulthood is a common disease, polycystic kidney disease. Typically has a family history, rarely arises mutations in each patient and the family does not occur. From a certain age appear cysts in the kidneys and the number and size increases, the dimensions of the kidney may be repeatedly increased. Often associated with polycystic liver. They may include aneurysms, cerebral vessels and changes in heart valves. The decline in renal function is slow and gradual, a significant minority of patients, however, comes to malfunction.
Alport syndron. - Typically affects young men, women are carriers and the disease they strongly reflected. The main symptoms are blood in the urine, hearing and various rapid loss of renal function.

Urinary stones - nephrolithiasis

Urinary stones (nephrolithiasis) are found in the kidney kalichopánvičkovém system (KPS), or in the urinary tract stones. It affects about 4% of the population, of which two to three times more men than women.
Kidney stones or sand, formed by crystallization of substances contained in the urine, assuming an excess of these substances in urine. This is supported by the following states:
  • hyperparathyroidism and hypercalcemia (high blood calcium), oxalate intake in the diet (spinach, rhubarb, beets, pepper, coffee, tea, cocoa, peanuts)
  • a rare metabolic disease in the processing of cystine
  • abnormal kidney structure: polycystic kidney etc.
  • dehydration due to reduced fluid intake (even for the deliberate restriction of fluids in nephrology diets)
  • use of certain medications
  • proteinuria (protein in the urine waste)
  • stasis of urine outflow obstruction in the urinary tract
  • inflammations and infections of the urinary tract
Loose stone urinary bladder wandering paths and may cause a wedge. This state - colic - is accompanied by severe pain. Stone size may be different - from kidney stones sand to the dimensions of several centimeters. Above the stone created with congestive urine, leads to expansion of the ureter and renal pelvis. Such a phenomenon is called hydronephrosis.Here, there is an ideal environment for the development of urinary tract infections.
When the Stone - a spontaneous departure or after the removal during surgery should always be analyzed stone to determine dietary measures to prevent or slow recurrence.
What is a "Kidney Disease"?
Kidney disease is the name for any kidney disease, whether manifested by reduced kidney function, protein or blood in the urine, changing the amount or composition of the urine, kidney inflammation, other symptoms or various combinations of some of these symptoms. For a better understanding of kidney diseases it is useful to know the least about the structure and function of the kidneys, as it says here in Chapter Healthy kidneys.
Today, kidney disease independently divided on the cause of the severity of the disability, ie according to renal function into five stages, which are called CKD (from the English "chronic kidney disease" - a protracted kidney disease):
  • CKD I: normal, not reduced glomerular filtration rate (GFR> 1.5 ml / s)
  • CKD II: light renal insufficiency (glomerular filtration rate from 1.0 to 1.49 ml / s)
  • CKD III: moderately severe renal insufficiency (glomerular filtration rate from 0.5 to 0.99 ml / s)
  • CKD IV: severe renal insufficiency (glomerular filtration rate from 0.25 to 0.49 ml / s)
  • CKD: renal failure (GFR <0.25 ml / s)
To try to calculate the laboratory data from blood tests or urine your glomerular filtration rate, you can try on the medical formula.
The protracted renal insufficiency, chronic renal insufficiency in Latin (hereinafter renal insufficiency) is decreased hepatic clearance, leading to accumulation of certain waste products in the body, e.g. urea (Latin BUN) or creatinine. The renal function but may decrease even before there is an increase in urea and creatinine, their normal level therefore preclude kidney disease! According to the levels of urea and kratininu and in other formulas and tests so we can assess the severity of renal impairment (your doctor maybe called "drop filter"). However, since the kidneys are the body many other tasks, may exhibit renal insufficiency by a variety of complications.
The cause of kidney failure can be
  • inflammation of the kidney clusters (Latin glomerulonephritis)
  • nonbacterial inflammation of the renal tubules (tubulointerstitial nephritis), sometimes as a result of overuse of pain medications (analgesic nephropathy)
  • bacterial inflammation renal tubules (chronic pyelonephritis), sometimes as a result of kidney stones
  • longstanding diabetes (diabetic nephropathy)
  • insufficiently treated high blood pressure (hypertensive nephropathy nephrosclerosis)
  • advanced hardening of the arteries - atherosclerosis (ischemic nephropathy)
  • hereditary diseases, e.g. polycystosis
  • other rare diseases or conditions after kidney surgery
Often one patient there are multiple causes at the same time, like diabetes, hardening of the arteries and high blood pressure.
Renal insufficiency often despite treatment tend to spontaneously get worse, which means that the kidneys quickly variously reduce their activity over time and may even cause their complete failure. Kidney failure is therefore more advanced disease than renal insufficiency. It is a condition where the kidneys have lost over 90% of its tissue, little or nothing to fulfill their purge function (either sick or not urinating at all, although the urine, but urine is composed mainly of water and waste products of metabolism into it almost do not receive). At that moment, we needed a kidney somehow replace the sick die.
How identifies the cause of renal insufficiency, kidney or other diseases?
The cause of kidney disease finds nephrologist examination of the patient, detailed vyptáním all his health problems in the past and present, blood tests and urine tests and ultrasound of the kidneys. Use your own judgment will then recommend further tests, most specialized blood and urine tests, kidney biopsy, kidneys using isotopes, X-ray of the kidneys and urinary tract, or urological examination including particularly the bladder and urethra in men and prostate.
How does the body manifests renal insufficiency and renal failure?
At reduced kidney accumulate in the body, some waste products, e.g., urea or creatinine, increases blood pressure rise to anemia and disturbances in blood chemistry with a calcium deficiency and excess phosphorus, potassium, sodium, and often also uric acid. Simultaneously lacking vitamin D and increased acidity of the blood. The problem is that sick for a long time may not notice anything and may feel completely normal even with advanced kidney disease. Other times may feel fatigue, weakness, loss of appetite, often has edema (excess water in the body) and a decreased amount of urine, which is very bright. When kidney failure may also appear vomiting, diarrhea, difficulty breathing, heart rhythm disorders, or disorders of consciousness - doctors call this Latin uremia, which means the Czech presence of urine in the blood. More specifically, the complications of kidney disease can be found in Chapter complications .
Can renal insufficiency treated?
Kidney diseases are treated differently depending on the cause of the disease, which will discuss with your doctor. It often can not cure the disease, but it can significantly reduce or slow down, so it will also slow the loss of kidney function.
Renal insufficiency and renal failure may lead to a variety of complications (e.g. high blood pressure, renal bone disease etc.), And these are usually treated regardless of the type of the original renal disease. Proper treatment can prevent many complications and others may have been postponed for many years. The goal of treatment is for you as long as you feel better, keep your kidney disease as little influenced your life to give you long lasting kidney and so you minimize plagued related complications. The earlier and more active treatment is started, the less hassle is later. But always very much depends on you, how to treat and to recommended changes in diet and lifestyle stand. Therefore it is very important that you clearly understand what is happening within you.
And when the kidneys fail completely?
If you already occurs renal failure, usually ceases to be the original cause of the disease and the most important is that we have to somehow replace kidney function, otherwise the patient died (it also happened before).
How can replace the kidney?
Basically, there are 3 options of renal replacement therapy:
  • kidney transplantation, which consists of implanted foreign healthy kidneys into the lower abdomen
  • abdominal or peritoneal (Latin peritoneal) dialysis in which the blood is purified by gradient metabolic waste products in solution in peritoneal cavity; solution is impregnated into the belly thin tube permanently inserted into the abdominal wall
  • Blood dialysis (hemodialysis Latin), in which the blood purification occurs in a special device - an artificial kidney; contaminated blood tubing continuously fed into the apparatus and another tube is cleaned blood back to the patient
Every patient should be before complete renal failure should consider the possibility of a kidney transplant, ideally from a living donor. Kidney transplantation is the most natural of renal replacement, but unfortunately it is not suitable for everyone or its implementation is not any reason at that moment possible. Transplantation is not an obstacle to advanced age of the patient, but may be severe intractable heart and vascular diseases, cancer or infectious diseases. If there is no obstacle to transplantation, the patient can be transplanted before starting dialysis. Ask your doctor whether it is a suitable solution for you. Read more about kidney transplantation, kidney transplantation can be read.
Unless a kidney transplant, you can most patients choose one of the methods of dialysis - or abdominal blood. The selection will definitely help a doctor and nurse.
Choosing between blood and abdominal dialysis depends on your way of life, a desire to travel or wish to avoid contact with health professionals, on your ability and willingness to perform the dialysis at home alone or with a family member, etc. We can not say that one of these methods was always all patients better than the other. If you did not suit the method chosen, it is always possible to later choose the second. Perhaps it is better to start treatment of abdominal dialysis, and if necessary, go on dialysis blood. Read more about the difference between the two methods you can read on page Hemodialysis and Peritoneal Dialysis.
Just the body dialysis or transplantation of kidney own place?
Dialysis quite manages to cleanse the body of waste products, excess water and minerals, but it is not perfect and can not replace other renal like. Control of blood pressure, formation of erythropoietin and vitamin D. These things therefore require the use of medication and diet. Imperfection renal replacement sooner or later leads to complications. 
Examination of kidney disease

nephrology examinations
Nephrology examination is actually of Internal examination focused on the kidneys.
  • How does the first nephrology examinations?
    A doctor at the first visit to ask about the patient's all been a history or current diseases, surgeries and injuries, medications, smoking and use of alcohol or other addictive substances, the presence of allergies, the incidence of serious diseases in parents, siblings or children on job classification, domestic conditions , whether the patient as sports and, eventually. sexual difficulties. For women also asks for gynecological problems, pregnancy and the feasible presence and regularity of menses. Regarding themselves kidney inquire for any problems with urination and with stools, frequency of urination, the incidence of urinary tract infections or urinary how and other possible problems on blood pressure and on the fact whether and on what occasion found normal or pathological (bad) findings in urine (protein, blood, bacteria) in the blood or ultrasound. For children interested in the pregnancy about bedwetting and disorders with keeping stolice.Poté fully investigate the patient from head to toe and will test blood pressure, listens to the lungs and heart etc. perusing fetched documents and lab results, and according detections then provides a possible diagnosis, other necessary examinations and treatment. A regular part nefrologického examination and blood and urine tests, and usually ultrasound (about it will be even more written).
  • And how is repeated examinations?
    Retesting is not as detailed and follows previous findings, monitored disease, its treatment, and newly occurring problems or laboratory findings.
  • So what should I take with me when going into nephrology clinic?
    Be sure to take the recommendations from the referring physician (if you go there for the first time), the list of medicines taken, records blood pressure (if pressure at home or elsewhere measure) reports of other experts that you've recently visited, and possibly findings from previously conducted examinations (laboratory, x-ray, ultrasound, etc.). If you have an ID card, health diary or something, take it as well. The more information your doctor has, the faster can make a diagnosis and begin to heal. This will avoid unnecessary repetition also some examinations.

Blood and urine tests
Blood and urine tests enables physicians to assess kidney function and get a lot of important information about your body.
  • What are investigating the blood?
    On examination of blood suspected renal disease usually investigates blood count and a number of biochemical data - values ​​minerals (sodium, potassium, chloride, calcium, phosphorus, magnesium), urea nitrogen (BUN) and creatinine (whose levels increase with renal insufficiency ), the value of blood sugar (glucose), fats in the blood levels of albumin and proteins event. to make the liver and other tests, which depends on the discretion of the physician.
    From the levels of creatinine and event. other data can be calculated by estimating the glomerular filtration rate (by Cockroft and Gault or by MDRD equation), ie the level of kidney function.
  • I must be the collection of fasting?
    Because the determination of the blood sugar should be performed taking fasting for determination of fat in the blood even after 12-hour fast. Before sampling it is possible to drink water or unsweetened tea or coffee (but not sweet mineral water, juices, sweetened coffee or milk). If there is rarely need only check the necessary levels of urea, creatinine and minerals, it is not necessary to carry out collection of fasting.
  • How are investigating urine?
    The urinary sediment from morning urine are investigating its density, acidity (pH), presence of protein, sugar, ketones, urobilinogen, red and white blood cells and bacteria. In the morning urine was further investigated microbiologically urinary bacteria - evaluate their quantity and sensitivity to antibiotics - this is called cultivation. Examination of red blood cells in phase contrast allows a resolution that red blood cells in the urine comes rather from the kidney or urinary tract.
    In urine collected for 24 hours to measure its quantity, amount and possibly the type of protein, the amount of precipitated urea, creatinine and minerals. Determination of the amount excreted urea and creatinine allows the calculation of glomerular filtration rate as creatinine clearance event. diameter clearance of creatinine and urea.
  • How do I remove urine?
    Proper urine collection is a prerequisite for a correct result.
    Urine for culture examination is taken shortest possible time prior to delivery to the laboratory. Sampling is best done after washing the penis or the external female genitals with soap and running water from the so-called. MSU - patient begins to urinate (or even in the toilet directly into the tub), then performs sampling and then urinating freely the rest of the urine. The aim of this type of sampling is to prevent flushing bacteria from the penis or vulva (female genitalia) in the urine, as it would then not be possible to evaluate the bacteria in urine.
    Urine testing for phase contrast is drawn mostly directly at the lab. The patient urinate into the container in the laboratory gets.
    For an accurate assessment tests 24-hour urine collection is absolutely necessary proper collection of urine. When collecting the patient in the morning at a certain time (eg. In 6 h) urinating into the toilet, then urine throughout the day and night into a sufficiently large collection vessel. The last time this vessel urinating after 24 hours, thus again eg. In 6 hours. It is essential not to miss even one serving of urine (it is necessary to prevent leakage of urine during stool and stay home rather that patients needed to urinate outdoors, where the urine can collect) . When collecting urine should be fluid intake the same as on other days, the diet should not contain excess protein, ie meat, eggs and cheese (protein had increased glomerular filtration rate), and patients should not be exposed to great physical exertion. Upon completion of collection of patient urine mix from the bottom and from the shuffled urine sample is taken into a test tube. Furthermore, it is still necessary to measure the amount of urine, at least with an accuracy of 100 ml, preferably 50 ml, and communicate data in the laboratory or clinic when submitting urine sample
    For ease of measuring the volume of the collected urine in the pharmacy sell special plastic collecting containers which are on the side of the scale to determine the volume of the contents. A similar vessel is also possible to produce at home, perhaps from a jar. On its side glass is insoluble marker before collecting urine do brands adequate amount of urine (such as that in a glass pour 1 liter of water mark on the side where the water goes, pour another liter, again mark, and event. Pour the third liter and again mark, space between two adjacent marks, then divide the nine commas to 10 parts corresponding to 100 ml, or even to half, we can measure urine volume with an accuracy of 50 ml).
    Attention should not be confused with the morning tube and sample tube with a sample of urine collected.
  • They do still some other laboratory tests?
    In suspected certain specific diseases are then performed many other tests, e.g. detailed biochemical examination, examination immunological, culture, serological, and further, from urine, blood or other body fluids or samples.
  • How long will I know the test result?
    The most common tests such as blood tests and basic examination is done every day, the result may therefore be known in the afternoon the same day or the following day at the latest (depending on workplace practices). Special biochemical tests in the laboratory performed less frequently, e.g. twice a week or some only once in 2-3 weeks. A similar delay is usually characterized by several serological examinations and laboratory immunology. Microbiological (culture) examination with sensitivity takes 2-3 days, in the case of molds and yeasts 7-10 days, testing for tuberculosis to 9 weeks.

renal ultrasound
Ultrasound - sonography of the basic and most accessible examination of the kidneys. It is able to display the size and shape of the kidneys, about the structure of the renal cortex and medulla, captures kidney stones larger than 4-5 mm, enlarged renal pelvis and ureter. It is also used when searching cysts, and renal tumors. According to him, can not estimate the level of kidney function. Simultaneously with renal ultrasound and performs ultrasound of the bladder, which allows to evaluate the gross changes in the bladder wall or urine remaining in the bladder after urination (urinary residue) and full orientation and size of the prostate.
It is better to perform an ultrasound on an empty stomach because food and flatulence impair the clarity of the abdominal cavity.
Special subspecies called Doppler ultrasound allows the treating clinician to evaluate renal artery and vein, but only fasting for a cooperating non-obese patient.

X-ray of the kidneys and urinary tract
To determine the stones is done so. Plain radiography of the kidneys, which indicates stones in the kidneys and urinary tract. A more accurate examination is intravenous urography (IVU), in which intravenously administered a small amount of a substance showing the retgnenu (contrast agent). How is this substance excreted by the kidneys into the urinary tract, shows very well the urinary tract and eventual stones and assess the disorder can also drain the urine.
Contrast agent can damage the kidneys, therefore it is necessary to recommend this test to evaluate kidney function and after mature reflection. To protect the kidney is suitable enough to drink half a day before the examination and 2-3 days afterwards.
In patients with urinary outlet (nephrostomy) to the display urinary spraying nephrostomy. To evaluate vesicoureteral reflux is also spraying the bladder and ureters via the urethra (retrograde urethrocystography retrograde cystoureterografie).

CT kidneys and urinary tract
CT kidney is a special kind of X-ray space that will allow the building to see exactly kidney and possible deviations. It is used to assess accurately finds nezhodnotitelných ultrasound, e.g. complex cysts, tumors, multiple stones, shape deviations, wall thickening of the urinary tract, and also to assess the neighborhood of the kidneys and urinary tract. Usually also performs with the administration of the contrast agent, so you need half a day before the examination and 2-3 days after Nemo enough to drink.

Scintigraphy (isotopic tests)
Isotope examination (scintigraphy) is carried out by intravenously injecting a very small amount of a slightly radioactive substance that is excreted from the body via the kidneys.Depending on the type of the administered dose and type of device then distinguish different types scintigraphy.
Scintigraphy shows the ratio of activity of both renal failure urine flow from the pelvis or ureter (the accumulation of urine above the obstacle) and the possible return of urine from the bladder into the ureter when called. Vesicoureteral reflux. For exact resolution disorders urine flow sometimes during the examination carried out by positioning the patient (lying, sitting, standing) and administration of the diuretic agent furosemide (Lasix renal test).
Scintigraphy is a kidney friendly than IVU, but unlike her, do not appear good appearance of the urinary tract.
In healthy kidneys rapidly urine flow through the urethra into the bladder, without returning urine into the ureter. Both healthy kidneys are working at about 50%, ie. 50% of kidney function ensures the right and 50% kidney function left. (When the results right 40% and left 60% it does not mean that the right kidney is working only 40% of what it should be, but that its activities represent 40% of the activity of both kidneys (40% + 60% = 100%). If you previous examinations worked the left kidney at 76% and is now at 60%, it does not mean that the function of the left kidney has deteriorated - very often it means improved function of the right kidney. to evaluate the examination is an important overall kidney function, which is found by collecting urine and blood donations.

Cystoscopy of the bladder performed by a urologist. Due to the length and curvature of the urethra extending male penis is cystoscopy in men performed under general anesthesia (sleep), in females only local anesthesia. Special thin device allows visible inner side of the bladder, ureters evaluation entry into the bladder and possibly sampling tissues or bacteria. Simultaneously also performs evaluation width urethra. Minor changes are possible when cystokopii directly eliminate.

kidney biopsy
Kidney biopsy involves taking a small sample of kidney tissue, which is then examined under a microscope, and in most cases allows definitely make an accurate diagnosis, a type of disease.
  • When one approaches it?
    A kidney biopsy is accessed when the other kidney examination determines with reasonable reliability the type of kidney disease, and at the same time when it is expected that the diagnosis will contribute to further treatment. It is especially in cases of suspected rapidly progressive glomerulonephritis, while unclear acute renal failure, when suspected chronic glomerulonephritis or other renal damage clusters. At the moment it turns renal biopsy is necessary, it is better to defer to the kidneys can properly heal as soon as possible. The exception may be (sometimes only for a certain period), patients who would have the power at any given moment is too risky - eg., Patients with bleeding disorders, with one kidney and the like.
  • What happens? It makes ultrasound or X-ray inspection?
    Today renal biopsy is usually performed under ultrasound guidance, it was once the most common execution after an X-ray. Ultrasound is more accurate but harm the patient or investigating. After saving the patient flat on his belly will be inspected with ultrasound appearance and position of the kidneys and lying next to the bodies. In most cases the biopsy is done from the lower pole of the left kidney of about 1-2 cm from the edge, if it does not prevent anything. The planned injection site is marked on the skin, which is then disinfect and surroundings are covered with sterile drapes to prevent the introduction of infection. First injects local anesthetic and wait a few minutes into his full effect.Then a special needle designed for renal biopsy performed puncture into the kidney of sampling. Checking the position of the needle just before the puncture is performed either ultrasound or finding the needle in breathing (here the patient can most help - when breathing deeply when the doctor says, or, conversely, if necessary, hold my breath).After pulling the needle, the resulting tissue eyes checked and the site should be glued. At some centers still attach roller, which after a few hours while lying compresses the puncture site and reduces the probability of bleeding.
  • How long it takes kidney biopsy?
    The actual sampling (usually take 2) takes 2-5 minutes if the patient cooperates well and everything goes well, 5 to 10 minutes can be expected to bring local anesthesia and await its effect. Focusing kidneys, disinfecting and sealing the puncture site will occupy a majority of 20 to 30 minutes.
  • It takes the sample is one or both kidneys?
    Always taking a sample from only one kidney, usually from the left. Almost all renal diseases for which it can perform a biopsy, are reflected equally in both kidneys.
  • How to prepare the patient for a biopsy?
    If the biopsy in the morning, the patient usually eat breakfast and breakfast comes soon after the performance. Morning pressure medications to be used but should. Preferred is when it comes just before biopsy urinate in order to comfortably lie on his stomach, and to have a two-piece pajamas for easier detection of the lower half of the back. A day before the performance is usually admitted to the hospital, where it is checked for blood clotting, blood count and biochemistry. Sometimes, on the evening before the biopsy, and most biopsies morning before they get medicine to calm, either in tablet or injection.
  • What followed after her?
    After biopsy, the patient remains in bed, according to custom work 24 hours or at least in the evening while in the first 2-3 hours on the back. Thus, the puncture site pushing roller. Patient checks at regular frequent intervals nurse and doctor. Checks, in particular, how the patient feels, what his blood pressure and urinated if the performance draws to control blood tests and urine. The patient's task is to drink a lot - one liter of fluid during the morning and at least another liter of fluid into the evening, when his doctor tells you otherwise. The following day, performs control ultrasound kidneys to eliminate complications. When everything is in order, there may be sick that day or the next day home.Even 7-10 days before the kidney heals a fixed scar should avoid carrying heavy things, great physical exertion and jumps.
  • What are the possible complications?
    The most common complication is a small non-fatal bleeding in either urine or into the housing kidneys. Bleeding in the urine appear pink or red urine and occurs in about 10% of cases. Minor bleeding into the casing kidney wearing patient does not recognize and find out during sonication. Depending on the quality of the ultrasound device is described variously often, but does not affect kidney function. Both are treated with prolonged bed rest. Major bleeding into the urine or the surrounding kidney injuries tiny arteries are uncommon. Bleeding in the vicinity of kidney effect of different heavy pressure or pain in the abdomen, groin or back. Sometimes they have to deal with people clogging the arteries on angiography line (using a thin tube introduced from the femoral artery to the kidney), rarely open surgery. Absolutely rare it can happen that renal damage is so severe that it must be removed because of bleeding (eg. In the FN Brno this but for 15 years the number of biopsy in about 50 biopsies annually occurred even once).
  • When is a biopsy?
    Preliminary biopsy may be available as early as the day of surgery or the following day. The final assessment includes special processing, and so it takes a few days to 2 weeks.
  • What are its benefits?
    Contribution biopsy is that indicates what kind of disease, the patient is, enabling targeted therapy of the disease and significantly improve the outlook for the cure or deceleration. According to some extra characters can assess any long-term structural damage to the kidneys, and thus express the expected development of renal function.
  • What is different from the biopsy of the transplanted kidney biopsy own kidneys?
    Transplanted kidneys are located in the lower abdomen povrchověji more than a kidney biopsy of her own and is therefore easier to make. Performed from the upper pole renal deterioration in graft function or at regular intervals, especially during the first year after transplantation in tracing the changes that the function of the kidneys reflected yet (ie. Biopsy protocol).
Renal biopsy is all kidneys among patients about the most feared, most of them but its course was uncomplicated and very little pain. Our patients often after the surgery say: "That's it? That I did not have / -a much afraid and did not / -a I put it off!"
You've had a kidney biopsy and want to share with others about their feelings, if only because you gave them the courage? Write about it in the chapter about your experience !

kidney disease

kidneys are part of the urinary system of the body. They are paired authority. Their main function is to purify the blood from harmful substances which are formed in our body.Kidney y also regulate blood pressure and affect the acid-base balance. Important hormones renin and erythropoietin is now forming in the kidney ah.

anatomy of the kidney

kidneys are part of the urinary system, in terms of the two organs. They are stored in the amount of the twelfth thoracic vertebra to the second lumbar vertebra, located on the sides of the spine. Their length is about 12 cm, width 5-6 cm, height 4 cm. Kidney bean y have a characteristic shape. Their surface is smooth, reddish-brown color. On their inner side a recess through which the kidneys y enters renal artery network and performs network renal vein and ureter. When cut kidney ou's crust which is formed predominantly nephron, and pulp, which contains the urinary tubules and Henle's loop called the nephron. Nephron is the basic structural and functional unit of the kidney and y. Each kidneycontains about one million nephrons. Nephron has two basic parts: the glomerulus and tubules system. Glomerulus comprises about 30 capillary loops, in which through a specially modified three-layer wall of the capillary (capillaries) occurs for filtration of blood plasma and formed the so-called primary urine.

renal function

Their basic function is to cleanse the blood of waste products of metabolism, harmful substances and drugs. Per day will produce about 170 to 200 liters primary urine, which then enters the system tubules, where the vast majority of absorbed back through specific channels. The volume that has not been absorbed, constitute definitive urine, which is fed through efferent channels into chalices, renal pelvis and from there flows into the ureters. Daily arise about two liters final urine. Its composition is adjusted according to the needs of the organism, it is a very complex process. If one kidney is not working, the other kidney is able to stand up for itself a function of both. If none, one kidney, one is in immediate danger of life.

kidney disease


Among the common kidney disease include glomerulonephritis, an inflammatory kidney disease affecting mainly the glomerulus. Glomerulus is blob blood capillaries through which flows the blood and under high pressure is filtered.
Symptoms of glomerulonephritis may be different. They may be nonspecific, such as high blood pressure, vomiting, fatigue, fever and swelling of the eyelids. For many people it is the first sign that something was happening to the result of the analysis of urine and blood. If the glomerulus is damaged, the doctor may be able to find a small amount of blood or protein that into it a healthy person not fall. For larger damage urine colored to reddish or normal color, but cloudy. Another sign of glomerulonephritis, urine is lower than usual.For example, a patient for several days, even illness. If these problems occur, the physician removes blood and urine for confirmation of inflammatory indicators. Will further test of kidney function, which will show whether the kidneys filter blood and less than the norm. For final confirmation of the diagnosis of glomerulonephritis, it is necessary to perform kidney biopsy y, which is injected ew kidney tissue and fine needle sampling for microscopic analysis.
Treatment of acute glomerulonephritis consists mainly of bed rest, consumption jídlase reduced salt content, as well as in a balanced fluid intake, which does not overstress kidneyy, and taking medication to lower blood pressure. In poor urination are diuretics. After a few weeks to months, kidney y usually fully heal, and signs of damage. Treatment of chronic glomerulonephritis takes a very long time, often several years. The patient has a free movement regime but avoids excessive physical exertion. Of the drugs they are taking corticosteroids, cyclosporine, and cyclophosphamide, which reduce the immune response of the body. Usually it is required to diets low in protein and fat. A diet low intake of salt is prescribed only for high blood pressure.


Pyelonephritis is defined as an infectious inflammation of the kidney, and more specifically renal pelvis ing tissue. Most often it is ascending infection, which leads to climb pathogenic bacteria from the lower parts of the urinary tract.
Symptoms of kidney disease include a wide range of ailments, especially the biting pain during urination, dysuria professionally, as well as back pain radiating to the side of the affected kidney y, high fever with chills, headache, vomiting and percussion pain at the site of the affected organ.
Treatment of kidney disease is divided by stage of disease. Uncomplicated kidney inflammations requiring hospitalization is usually treated outpatient administration of antibiotics, especially amoxicillin and ampicillin. Patients requiring hospitalization due to dehydration, vomiting and high temperatures it is recommended to be administered quinolone antibiotics. Patients with complicated nephritis which can be attacked by a plurality of pathogens or have numerous associated diseases, received intravenously strong cephalosporins III. generation and are also observed in the hospital if they develop any rozšiřovánínemoci. If it does not, you can go from intravenous therapy for oral medicines.
Obstructive inflammation of the kidneys caused by obstruction in the urinary tract requires prompt surgical intervention as an artificial kidney Joint terminal. In good condition of the patient can directly remove the obstacle without making outlets. During therapy every 5-7 days performs control samples of urine and 4-6 weeks after completion of treatment is collected urine again to see if urinary tract infection remains free. Treatment of kidney disease sometimes takes up to 6 weeks.

Ew kidney stones

Ew kidney stones can arise from many causes and occur with very severe pain in his side, known as colic.
Oic kidney stones leave the body in the urine when they are small, this may occur without symptoms. If the stones are larger than 2-3 mm can cause blockage of the ureter and cause an obstacle to drain urine. In an effort to overcome this obstacle with the muscle in the wall of the urethra begins to spasm and relax. This is the cause of bitter pain, known as renal colic network. Pain in kidney stones-voltage characteristic has a fluctuating character. The pain is felt in the lumbar area and shooting along the urethra into the abdomen, scrotum and labia. There are frequent accompanying symptoms such as nausea and vomiting, may even arrest a bowel movement. Another symptom of kidney stones-voltage is the presence of blood in urine. This is because minor injury inner wall pelvis, ureter or bladder wall during the movement of the stone.
Treatment of kidney stones-voltage is divided into conservative and surgical. Conservative methods are based on the support of spontaneous expulsion of stone in the urine. These are mainly adequate fluid intake and diuretics to encourage urine flow and prevent the creation of additional stones. While consistently treat urinary tract infections and administered pain relieving drugs. First administered NSAIDs are not effective unless they are used opioids. NSAIDs are drugs that have anti-inflammatory, antipyretic (lowering elevated body temperature) and analgesic (pain relieving) effect. Opioids have a particularly strong painkilling effect. If pain persists, threatening renal failure, infection and the like, are selected surgical solution. Rarely uses open surgery. Ew kidney stones are crushed into smaller parts, either noninvasive lithotripsy extracorporeal shock, or access through the urethra for use laser, ultrasound or mechanical force. Thus, crushed stones, then leave the body with urine.
As a precautionary measure formation of kidney stones-voltage is the most important sufficient fluid intake (but reduce your intake of fluids with caffeine). Furthermore, reducing dietary intake of foods with oxalates (chocolate, nuts, spinach) and a diet with low protein intake, sodium and nitrogen.

kidney pain

Kidney pain is among the pain that can torment their wearers properly. Kidney pain is most often caused by inflammation, and acute pyelonephritis, or renal colic ou, which arises from barriers to drain urine from the kidneys to the bladder.

Pain in the right kidney y

Back pain in the right kidney y are people a lot. Pain in the kidney are a common symptom of another disease. Pain in the right kidney y may be the cause of irritable bowel syndrome or liver problems. Pain in these areas is often nervous origin. This pain may under certain circumstances cause ringworm. Sometimes the cause of the so-called wandering kidney.

Kidney y and alcohol

All drugs and alcoholic beverages are for kidney s most harmful, although they may temporarily benefit from any other authority. Beer is probably the most harmful liquid that the body offer because destroying kidney y very quickly. Only thanks to the enormous number of cells in the kidney oh and their excellent performance, many people are able to tow twenty years of life, although they are pouring into the body of harmful fluids. Lemonade and cola-type beverages are nearly always sweetened with sugar and because it is made in the body alcohol, which must undergo kidney ami to be filtered. Damage caused by such drinks consume children, adolescents, adults and older people is incredible. This tricky the whole thing is that it does not take effect immediately. Consuming these drinks results in a transient increase in performance, but the next one, hours or days-long downturn are already generally does not ascribe to these drinks.
Author: © Svevi
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