Atherosclerosis – The Disease with Many Names

Yes, there are different names for different types of atherosclerosis. All are determined by the amount of plaque that builds up in the various arteries. The image below is very descriptive and shows what happens during plaque buildup.

Atherosclerosis can affect any artery in the body, including arteries in the heart, brain, arms, legs, pelvis, and kidneys. As a result, different diseases may develop based on which arteries are affected. Arteriosclerosis does not involve plaque, but the thickening and hardening of the arteries.

Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are the blood vessels that carry oxygen-rich blood to your heart, organs, and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body. Atherosclerosis can lead to serious problems, including heart attack, stroke, or even death.

Coronary heart disease (CHD), also called coronary artery disease, is the #1 killer of both men and women in the United States. CHD occurs if plaque builds up in the coronary arteries. These arteries supply oxygen-rich blood to your heart. Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. Plaque buildup also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.

When blood flow to your heart muscle is reduced or blocked, you may have angina (chest pain or discomfort) or a heart attack. Plaque also can form in the heart's smallest arteries. This disease is called coronary microvascular disease (MVD). In coronary MVD, plaque doesn't cause blockages in the arteries as it does in CHD.

Carotid artery disease occurs if plaque builds up in the arteries on each side of your neck (the carotid arteries). These arteries supply oxygen-rich blood to your brain. If blood flow to your brain is reduced or blocked, you may have a stroke.

Peripheral arterial disease (P.A.D.) occurs if plaque builds up in the major arteries that supply oxygen-rich blood to your legs, arms, and pelvis. If blood flow to these parts of your body is reduced or blocked, you may have numbness, pain, and, sometimes, dangerous infections.

Chronic kidney disease can occur if plaque builds up in the renal arteries. These arteries supply oxygen-rich blood to your kidneys. Over time, chronic kidney disease causes a slow loss of kidney function. The main function of the kidneys is to remove waste and extra water from the body.

The cause of atherosclerosis isn't known. However, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors. You can control some risk factors, such as lack of physical activity, smoking, and an unhealthy diet. Others you can't control, such as age and a family history of heart disease.

Some people who have atherosclerosis show no signs or symptoms. They may not be diagnosed until after they have a heart attack or stroke. The main treatment for atherosclerosis is lifestyle changes. You also may need medicines and medical procedures. These treatments, along with ongoing medical care, can help you live a healthier life.

Improved treatments have reduced the number of deaths from atherosclerosis-related diseases. These treatments also have improved the quality of life for people who have these diseases. However, atherosclerosis remains a common health problem. You may be able to prevent or delay atherosclerosis and the diseases it can cause. Making lifestyle changes and getting ongoing care can help you avoid the problems of atherosclerosis and live a long, healthy life.

Nephropathy – Part 6

The topic for this blog is diagnosing and treating end-stage renal problems. In addition to a physical examination and complete medical history, your doctor will use diagnostic procedures for renal failure including the following:

1. Blood tests. Blood tests will determine blood cell counts, electrolyte levels, and kidney function
2. Urine tests
3. Renal ultrasound (also called sonography). A noninvasive test in which a transducer is passed over the kidney producing sound waves which bounce off the kidney, transmitting a picture of the organ on a video screen. The test is use to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.
4. Kidney biopsy. This procedure involves the removal of tissue samples (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.
5. Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. Contrast CT usually cannot be done when there is kidney failure.

Specific treatment for renal failure will be determined by your doctor and you, based on:

• Your age, overall health, and medical history
• Extent of the disease
• Type of disease (acute or chronic)
• Underlying cause of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

The treatment may include:

• Hospitalization
• Administration of intravenous (IV) fluids in large volumes (to replace depleted blood volume)
• Diuretic therapy or medications (to increase urine output)
• Close monitoring of important electrolytes such as potassium, sodium, and calcium
• Medications (to control blood pressure)
• Specific diet requirements

In some cases, patients may develop severe electrolyte disturbances. Often toxic levels of certain waste products normally eliminated by the kidneys will be part of this. Patients may also develop fluid overload. Dialysis may be indicated in these cases.

Treatment of chronic renal failure depends on the degree of kidney function that remains. Treatment may include:

1. Medications (to help with growth, prevent bone density loss, and/or to treat anemia)
2. Diuretic therapy or medications (to increase urine output)
3. Specific diet restrictions or modifications
4. Dialysis
5. Kidney transplantation

I will let you read this five page discussion of the two types of dialysis. Each has pros and cons and you will need to decide on the best treatment based on your circumstances.

People with end-stage renal disease (ESRD) are living longer than ever. Dialysis treatments (both hemodialysis and peritoneal dialysis) are not cures for ESRD, but will help you feel better and live longer. Over the years, ESRD can cause other problems such as bone disease, high blood pressure, nerve damage, and anemia (having too few red blood cells). You should discuss prevention methods and treatment options for these potential problems with your doctor.

Nephropathy – Part 5

This is another important warning for people with diabetes. Renal failure refers to temporary or permanent damage to the kidneys that results in loss of normal kidney function. There are two different types of renal failure and the distinction is important. The first is acute and the second is chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic renal failure progresses slowly over at least three months and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.

I will cover acute renal failure first. This list includes causes:

1. Myocardial infarction. A heart attack may occasionally lead to temporary kidney failure.
2. Rhabdomyolysis. Kidney damage that can occur from muscle breakdown. This condition can occur from severe dehydration, infection, or other causes.
3. Decreased blood flow to the kidneys for a period of time. This may occur from blood loss or shock.
4. An obstruction or blockage along the urinary tract.
5. Hemolytic uremic syndrome. Usually caused by an E. coli infection, kidney failure develops as a result of obstruction to the small functional structures and vessels inside the kidney.
6. Ingestion of certain medications that may cause toxicity to the kidneys.
7. Glomerulonephritis. A type of kidney disease that involves glomeruli. During glomerulonephritis, the glomeruli become inflamed and impair the kidney's ability to filter urine. Glomerulonephritis may lead to chronic renal failure in some individuals.
8. Any condition that may impair the flow of oxygen and blood to the kidneys such as cardiac arrest.

Next, I will turn to Chronic renal failure. This covers this list:

1. Diabetic nephropathy. Diabetes can cause permanent changes, leading to kidney damage.
2. Hypertension. Chronic high blood pressure (hypertension) can lead to permanent kidney damage.
3. Lupus (SLE). A chronic inflammatory/autoimmune disease that can injure the skin, joints, kidneys, and nervous system.
4. A prolonged urinary tract obstruction or blockage.
5. Alport syndrome. An inherited disorder that causes deafness, progressive kidney damage, and eye defects.
6. Nephrotic syndrome. A condition that has several different causes. Nephrotic syndrome is characterized by protein in the urine, low protein in the blood, high cholesterol levels, and tissue swelling.
7. Polycystic kidney disease. A genetic disorder characterized by the growth of numerous cysts filled with fluid in the kidneys.
8. Cystinosis. An inherited disorder in which the amino acid cystine (a common protein-building compound) accumulates within specific cellular bodies of the kidney, known as lysosomes.
9. Interstitial nephritis or pyelonephritis. An inflammation to the small internal structures in the kidney.

End-stage renal disease happens when the kidneys permanently fail to work. The symptoms for acute and chronic renal failure may be different. The following are the most common symptoms of acute and chronic renal failure. However, each individual may experience symptoms differently. Symptoms may include:

Acute (Symptoms of acute renal failure depend largely on the underlying cause.) include: Hemorrhage, fever, weakness, fatigue, rash, diarrhea or bloody diarrhea, poor appetite, severe vomiting, abdominal pain, back pain, muscle cramps, no urine output or high urine output, history of recent infection (a risk factor for acute renal failure), pale skin, nosebleeds, history of taking certain medications (a risk factor for acute renal failure), history of trauma (a risk factor for acute renal failure), swelling of the tissues, inflammation of the eye, detectable abdominal mass, exposure to heavy metals or toxic solvents (a risk factor for acute renal failure).

Chronic: Poor appetite, vomiting, bone pain, headache, insomnia, itching, dry skin, malaise, fatigue with light activity, muscle cramps, high urine output or no urine output, recurrent urinary tract infections, urinary incontinence, pale skin, bad breath, hearing deficit, detectable abdominal mass, tissue swelling, irritability, poor muscle tone, change in mental alertness, metallic taste in mouth.

The symptoms of acute and chronic renal failure may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

Concluded in next blog.