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The Kidneys
The body has two kidneys, each about 4-5 inches in length and reddish in color. The kidneys are located just above the waist, behind the abdominal cavity. Each kidney contains the hilus, through which the ureters are connected. Blood vessels and lymphatic vessels also are connected at the hilus, with the blood entering through the renal artery.
Three layers of tissue surround each kidney. The renal fascia, made of a dense connective tissue, anchors the kidneys to surrounding structures.
The principle task of the kidney is to preserve the volume and composition of the extracellular fluid constant. This it must do despite a varying outside environment, and varying input. A part of this task–but only a part–is to remove from the body some of the waste by-products of metabolism which the cells cannot break down further. Thus the principal function of the kidney is not excretion, but regulation. We can move and live on dry land, even though we are three-quarters water, and survive; our cells tucked away in a carefully preserved ocean of extracellular fluid, whose composition is guarded with exquisite accuracy by the kidneys, a major part of our life-support system in this hostile environment. We can roam into deserts, and (usually) survive, or drink a six-pack of beer, or starve, or gorge, but essentially the extracellular soup remains of a constant composition, and because of this, the composition of the cells themselves is constant.
The kidney is less in control of the intracellular water, since if the kidneys do their job adequately, each cells is largely autonomous, and will extract and eject what it needs or does not need from the extracellular fluid. The kidney conserves what we need, but even more, it permits us the freedom of excess. That is, it allows us to take in more than we need of many necessities—water and salt for example—and excretes exactly what is not required. This is essential, since neither our ancestors nor we, animal or human know the composition of the foods we eat, and the only way to ensure a sufficiency of everything is to eat an excess of at least some. Finally, the kidneys preserve the volume of our body fluids as well as their composition. Given that we’re almost ¾ water, quite simply weighing oneself each day can assess the precision with which the kidney achieves this.
Despite variations in diet, exercise or fluid intake, the figures remain constant. The kidney performs its tasks, with a precision of as good as 1% and never worse than 5%, under extremely varying circumstances. If the kidneys fail suddenly, death occurs after a few days, partly because some of the accumulated metabolic waste products are toxic to the heart, which stops. More interesting, is the way in which the kidney can adapt to slow destruction by dysfunction, so that one can survive on as little as 5% of overall kidney function. The kidney has greater reserve capacity in the face of disorder than (for example) the heart or the lungs.
The kidneys and bladder are silent when they’re sick. Many other parts of the body will give you symptoms when there is loss of function, but with the kidneys, you may not feel anything until you have lost 80% of your kidney function. Until then, there won’t be any symptoms to alert you to this condition, but it will reduce your elimination of waste and toxins and create multiple systems to loose function because of toxemia. By the time you first notice a problem, you can be almost dead. Glomerulonephritis occurs when the minute filtering units of the kidney become swollen and inflamed. There are 2 forms of glomerulonephritis that affect children. Cystitis is infection of the bladder, and pyelonephritis is an infection of the kidney. Pyelonephritis can be chronic or acute. A kidney infection is often serious, often requiring hospitalization. Bright’s disease involves nephritis, a chronic inflammation of the kidneys, and it is characterized by blood/protein in the urine with associated hypertension and edema. The kidney can not properly excrete salt and other wastes, resulting in retention of salt and water (edema). When the bloodstream becomes toxic with wastes due to kidney malfunction, uremia develops.
The kidneys are a pair of organs, which are situated towards the back of the body, just at the level of the waist. Each lies in a small pad of fat, on the muscles at the back of the abdomen. The upper part of the kidney lies under the ribs, so that the kidneys are protected from damage to some extent. They receive their blood supply from the main artery of the body the aorta, and give blood back to the main vein the vena cava. Each kidney is about 4 - 5 inches long and weighs about 6 oz. From the kidney, urine is conducted in two tubes, the ureters, which join the bladder in the pelvis. This is a hollow sac which can expand to contain urine and store it before it is passed. The average capacity of an adult bladder is about a pint, or a pint and a half before discomfort is noticed.
Each kidney is made up of about one million units called nephrons (from the Greek word for kidney, nephros). The Latin word is renes, so that one meets a number of words containing the roots nephr- (nephron, nephrology, nephrologist) and ren- (renal). Each of these nephron units is to some extent autonomous, but it would be a mistake to regard kidney function as merely the sum of the action of two million nephrons. The architecture of the kidney allows the whole to do more than the sum of its parts could do. Each nephron consists of two parts: a glomerulus (the filter of the kidney) and a tubule. The glomerulus is a bunch or tuft of capillaries with especially thin walls to permit its function as a filter.
The glomeruli can just be seen as tiny red dots in the cut surface of a fresh kidney, more easily visible under a magnifying glass. Under the microscope the tuft resembles a raspberry, with the small blood vessels entering and leaving at the ‘stalk’. The tubules drain the glomerulus, but are not straight. They loop downwards and since the glomeruli lie in the outer part of the kidney (the rind, or cortex) this contains both glomeruli and tubules while there is an inner part which contains no glomeruli but only tubules. This is called the medulla. These medullary tubules do not drain directly but first loop inward into the medulla and then pass back into the cortex to enter the medulla again. Human kidneys are shaped very much like kidney beans.
The blood supply of the kidneys enters at the center and fans out into smaller and smaller vessels, most of the blood going to perfuse the cortex and its glomueruli. The veins return into bigger and bigger vessels, reversing the fan and the main renal vein comes out beside the renal artery going in. The urine emerging from the individual nephrons is collected into about five or six cup-shaped collection tracts (calyces) which join to form a bag which lies beside the artery and vein, and leads into the ureter, which conducts urine to the bladder for storage before it is passed into the outside world.
The nephrons function in a fashion which appears paradoxical. First, each glomerulus takes in blood and filters off about one-fifth of the water and its dissolved substances. This first step is important in the detection of disease, since no protein or cells–including red blood cells–pass the filter in health. In disease of the glomeruli, both commonly pass and can be tested for in the urine. The volume of filtrate formed is very large for the two kidneys; it is about 50 gallons every 24 hours. A moment’s thought reminds us that the body only contains, on average, about 12 gallons of water. Nearly all salt and water are normally reabsorbed in the tubule; and only 3-5 pints of urine are finally passed each day. Thus, in the next step the tubule transforms the filtrate into urine, while reducing it greatly in volume. The kidney must do some very fine-tuning of the body fluids, and one way of doing this very accurately is to do a small amount of work on a very large volume, monitoring all the time what is going on.
One of the most important jobs the tubules perform is to regulate the amount of salt (sodium and chloride), which is excreted. Just as with water, much more salt than the body contains is filtered each day through the glomeruli. The great bulk of salt reabsorbed–99 to 99.5%–must still be regulated to match exactly the output needed to maintain the body’s salt normal and constant. his will match output to input in health. Output varies from 0.5 to 15 grams of salt per day, a thirty-fold variation. Day in, day out, the kidney achieves this almost to perfection, but the exact mechanisms which regulate sodium absorption in the tubules still eludes us, despite decades of research. Much of this control is achieved within the kidney by internal regulation, the rest by response to chemical messengers, usually called hormones, after the Greek for messenger. The kidney tubules also reabsorb some dissolved substances completely, such as glucose and amino acids since these are valuable. Why do we first filter these, and then reabsorb them? The filter can‘t be set to keep these in, and also permit some substances such as uric acid, urea, and creatinine to be lost in the urine, because they’re all of similar size. These last are all end products of metabolism, and like ash from a fire, must be cleared away. The kidney, in fact, does not get this one quite right, because some urea, and most of the uric acid are reabsorbed and have to be re-excreted again, while all the creatinine is excreted. The urea is used to help in the mechanism which determines how concentrated the urine is (how much water is excreted), but reabsorbing uric acid is simply a nuisance, making us liable to gout.
The mechanism of determining how much water is excreted is complicated, and depends upon the arrangement of tubules as long loops, with loops of blood vessels following. This permits the medulla of the kidney to accumulate a higher concentration of dissolved substances than anywhere else in the body. This high concentration around the tubules can be used to allow the formation of urine of high concentration, with the extraction of most of the water as the final stage of urine formation. The kidney tubule also has an important function in ridding the body of excess acid. It does this both by secreting them direct from the blood into the filtrate, and also in the form of ammonium, which contains one hydrogen ion. Why can’t we switch off urine production all together in times of drought? This is impossible because of two constraints. The first is that there is an upper limit to the degree of concentration of urine that we can achieve. This is a function of the length of the loops in the kidney tubules. The other constraint, given that there is a limit to our concentrating capacity, is that there is a minimum amount of soluble waste, which we must excrete through our kidneys each day. This is mostly nitrogen-containing compounds, principally urea; and on a normal diet we produce an amount which will not dissolve in less than about one pint of the most concentrated urine we can produce. Therefore, even on a raft in the ocean, or in the dessert, we go on passing this volume of urine. If you are dehydrated, your urine is already four times as concentrated as your blood.
Although the kidney operates autonomously in response to changes in the composition of the body fluids, it needs information fed to it from elsewhere in the body to tell it what to do. Some of this information is sensed directly by the kidney, first by looking at the stretch of the arterioles going into each glomerulus, secondly, by monitoring the composition of the filtered fluid within the tubule. These two renal mechanisms give the kidney a good baseline for both the blood pressure within the circulation, and the sodium in the filtrate–and hence the blood. However, there are other mechanisms outside the kidney, which send hormones to the kidney. The first of these to be described was the mechanism in the brain which senses the overall concentration of solutes in the blood and sends a hormone (antidiuretic hormone, ADH) to modulate the final amount of water which is extracted in final formation of the urine. The higher the blood concentration, the more ADH is secreted and the more water is reabsorbed, so that less urine is passed. The effects of some familiar drugs act through this pathway: alcohol–even when taken without volume–switches off ADH and the resultant increase in urine volume depletes the body of water. Dehydration forms part of a hangover, and a couple of glasses of water before going to bed will usually buffer its severity. Conversely, nicotine stimulates ADH production and urine volume, all other things being equal, will fall. Many people abuse both drugs at once. The second mechanism is more complicated and determines how much salt the kidney excretes, which in turn determines the volume of the extracellular fluid. ‘volume receptors’ within the circulation (especially the great veins entering the heart) prompt the secretion of hormones from the heart. One such hormone (catriopeptin) acts directly on the kidney to promote loss of sodium, and another, from the central nervous system, stimulates the adrenal gland to produce a second hormone (aldosterone), which promotes retention of sodium, in the tubule.
Now, we will finish by considering a third function: the secretion of hormones. The first of these hormones, which the kidney produces, is called appropriately, renin. This is part of the regulatory mechanism just outlined, and is produced by cells just beside each glomerulus usually called the juxta-glomerular apparatus (JGA). Renin of itself has no action, but it acts on a protein in the bloodstream to producce a small molecule with very powerful effects, angiotensin. First, it constricts blood vessels and raises the blood pressure. Secondly, it causes the kidney to retain sodium; and thirdly, it stimulates the adrenal gland to produce aldosterone, which is triggered by volume receptors in the blood. The second hormone, which the kidney produces, is the active form of vitamin D. This vitamin is essential for the formation and maintenance of healthy bone, and promotes the absorption of calcium from the gut. It is a compound that we require in our diet because we cannot make it ourselves. Without it, children get the bone diseases rickets, adults the similar disease of bones, which have finished growing, called osteomalacia (soft bones). However, before vitamin D can act on bone or on calcium absorption, it must be transformed twice, first in the liver, and then in the kidney to its active form. Thirdly, the kidney produces a hormone, which promotes the formation of red blood cells by the bone marrow. Red blood cells are called erythrocytes in Greek, and the hormone is called erythropoietin. It is released from the kidney if the oxygen in the blood falls low, for example, on going to high altitudes. Finally, the kidney produces several of an important group of compounds, the prostaglandins. These are very important in regulating blood-flow, sodium excretion and blood pressure and are produced in the kidney.
Kidneys and bladders can be so toxic that they just rot out inside of us–and we don’t feel a thing. When the kidney becomes cystic, it can double its normal size and will be covered with bleeding pustules. It can look like bubble wrap on the surface of the kidney–there’s rotten, atrophied tissue. You’ll have deposits of minerals and protein that look like deer antlers, or coral–rock formations growing inside the kidneys. Often, the kidneys literally fall apart. They rot inside you, and when surgeons attempt to remove them, they’re just like Jello, or overcooked meat, they can’t even get them out, they’re dissolved inside the patient.
When people eat acid-forming foods–such as protein (especially animal protein), grains, coffee, sugar, phosphoric acid in sodas, etc.–they must donate alkaline minerals (especially calcium) to buffer the acids. If you’re not replacing these from your diet in the form of fruit and vegetables, the body will rob these from your teeth and bones. This creates a condition called hyper-calcium urea, which means too much calcium is in the urine. Not only do you eliminate calcium from your body’s physiology, but it will precipitate out in the kidneys and bladder in the form of crystals, corals, stones, gravel, etc. Your bones end up in your kidneys! Often, by the time this condition is detected, the kidneys have been infiltrated to such a degree that there’s barely anything left. They remove the kidneys and put the patient on renal dialysis.
Urine
Normally there are no outward signs of kidney function except the intermittent passage of urine. There is no way of reminding yourself that your kidneys are working, such as feeling a pulse, counting respirations, or a reflex. Also, some patients with quite severe kidney disease may have no specific complaints, or only mild feelings, which may be dismissed as just part of life.
Volume & Frequency of Urine
Most people have very little idea of how much urine they are passing, although they can usually make a guess at how many times they pass it. In health, the minimum volume of urine an adult can pass and remain healthy is about a pint a day and the maximum on a average fluid intake in temperate climates is about 4 - 5 pints. Most people pass less urine when they have been sweating a lot, especially in hot and above all, humid climates, and fluid intake needs to be adjusted accordingly if you take exercise. However, most normal individuals pass urine four to eight times a day, occasionally at night. The ability to hold urine for 12-24 hours may be useful but (except when dehydrated) is probably abnormal. In children, ability to hold urine for these very long periods is one of the signs of a large, slack bladder.
Passing urine regularly at night, unless it is merely a habit or the result of taking fluids just before going to bed, is a valuable sign that something is wrong. It indicates that the usual fall in urine volume during the night is not happening, and probably the volume of urine to be passed has increased. These are signs that the concentrating power of the kidney is impaired. Some causes of this are malfunction of the medulla, where the concentrating mechanism is found; overall renal failure; or much more rarely, an absence of the hormone ADH; or resistance of an otherwise normal kidney to ADH. It is often caused merely from a distended sigmoid colon pressing on the bladder, reducing its capacity. This will give a full feeling much sooner than if the bladder was not being impinged. Colon cleansing will eliminate symptoms if involved. Passing urine very frequently, especially if accompanied by pain in the urethra and bladder and a feeling that the bladder has not been emptied, is the classical symptom of what is called a ‘urinary tract infection’. This is often caused by a pH imbalance. When the urine pH is too alkaline, the condition exists for a urinary tract ‘inflammation’ to happen.
Sometimes, in older men, this may be the main result of obstruction of the urinary outflow from the bladder by an enlarged prostate, but will usually be accompanied by a poor stream, an inability to start or stop passing urine as promptly as before, and perhaps dribbling between times. Again, this is usually caused by an enlarged sigmoid colon that wraps around the prostate gland and the uterus. Not only is there mechanical pressure applied to these organs, but, in the presence of leaky gut syndrome, bowel toxins leak through the wall of the colon from bowel herniations or diverticuli, into the bladder, prostate gland and uterus, causing urinary tract infections, prostatitis (enlarged prostate), endometriosis, fibroid uterus, prostate cancer and uterus cancer. Incontinence of urine, in a adult individual previously continent, is obviously abnormal. In older people it may be the only sign of a urinary tract infection, and will disappear when corrected. Again though, incontinence is usually caused by a distended sigmoid colon, that presses on the bladder and in women also the uterus and causes it to prolapse onto the bladder, causing constant pressure.
Specific Gravity
Urine specific gravity measures the concentration of particles in the urine (grams/ml). The specific gravity measures the total solids content of a urine sample and reflects its degree of concentration or dilution. Specific gravity (which is directly proportional to urine osmolality, which measures solute concentration) measures urine density, or the ability of the kidney to concentrate or dilute the urine over that of plasma.
Because urine is a solution of minerals, salts, and compounds dissolved in water, the specific gravity is greater than 1.000. The more concentrated the urine, the higher the urine specific gravity. An adult’s kidneys have a remarkable ability to concentrate or dilute urine. In infants, the range for specific gravity is less because immature kidneys are not able to concentrate urine as effectively as mature kidneys. The density (or specific gravity) of urine is normally in the range of 1.003 and 1.030. The density of urine is expected to be greater than the density of water because compounds such as salts and urea are dissolved in urine. If the specific gravity of a person’s urine is too low or too high, it indicates some kind of problem and other tests are usually conducted to pin down the real cause.
Specific gravity between 1.002 and 1.035 on a random sample should be considered normal if kidney function is normal. Since the sp gr of the glomerular filtrate in Bowman’s space ranges from 1.007 to 1.010, any measurement below this range indicates hydration and any measurement above it indicates relative dehydration. If sp gr is not > 1.022 after a 12 hour period without food or water, renal concentrating ability is impaired and the patient either has generalized renal impairment or nephrogenic diabetes insipidus. In end-stage renal disease, sp gr tends to become 1.007 to 1.010. Any urine having a specific gravity over 1.035 is either contaminated, contains very high levels of glucose, or the patient may have recently received high density radiopaque dyes intravenously for radiographic studies or low molecular weight dextran solutions. Subtract 0.004 for every 1% glucose to determine non-glucose solute concentration.
Osmolality is a more exact measurement of urine concentration than specific gravity because specific gravity depends on the precise nature of the molecules present in the urine. Specific gravity also requires correction for the presence of glucose or protein. But the specific gravity measurement is easier and more convenient to test. It frequently makes the osmolality measurement unnecessary.
Glucose, protein, or dyes used in diagnostic tests excreted into the urine increase the specific gravity. If none of these abnormal substances are present in the urine, there are two primary reasons why the kidney is producing concentrated urine with a high specific gravity. The first and most common reason for an increase in urine specific gravity is dehydration. The second reason for a high specific gravity is an increased secretion of anti-diuretic hormone (ADH). ADH causes increased tubular water re-absorption and decreased urine volume. Trauma, stress reactions, surgery, and many drugs cause an increase in ADH secretion.
A low specific gravity occurs in three situations:
1) In diabetes insipidus, there is an absence or decrease of anti-diuretic hormone. Without anti-diuretic hormone, the kidneys produce an excessive amount of urine, often up to 15 to 20 liters per day with a low specific gravity.
2) Glomerulonephritis and pyelonephritis cause a decreased urine volume and low specific gravity. In these diseases, damage to the kidney’s tubules affects the ability of the kidney to re-absorb water. As a result, the urine remains dilute.
3)The third reason for low specific gravity is renal failure, which results in a fixed specific gravity between 1.007 and 1.010. In renal failure, the remaining functional nephrons undergo compensatory structural and hypertrophic changes. These compensatory changes result in urine that is almost isotonic with plasma. Therefore, a patient experiencing renal failure will present with specimens measuring the same, or fixed, specific gravity regardless of water intake. For example, the first a.m. specimen is the same as the last p.m. specimen.
In a healthy person, more than 80% of the water he consumes will be excreted. In patients with SIADH (syndrome of inappropriate antidiuretic hormone) less than 80% of the water is excreted. This makes the urine more concentrated (high density) than normal and often registers a specific gravity greater than 1.02. This condition often has the following signs and symptoms: weight gain, diminished urination, nausea and lethargy. If untreated, this can result in severe neurologic changes, permanent brain damage or death. On the other hand, patients with diabetes insipidus, have urine specific gravity of less than 1.00.
These persons excrete large volumes of dilute urine (low density), necessitating a large intake of dilute solutions to maintain normal fluid and electrolyte intake. The diagnosis of diabetes insipidus must be considered in any person who complains of constant thirst and nocturia (causing sleep disturbance), and whose urine output exceeds 30 mL/kg per day. The person is unable to conserve water when deprived of fluids. Their osmoregulatory system is abnormal, because of insufficient production of antidiuretic hormone or because of renal insensitivity to antidiuretic hormone.
Collect a “clean-catch” (midstream) urine sample. To obtain a clean-catch sample, men or boys should clean the head of the penis. Women or girls need to wash the area between the lips of the vagina with soapy water and rinse well. As you start to urinate, allow a small amount to fall into the toilet bowl to clear the urethra of contaminants. Then, put a clean container under your urine stream and catch 1 to 2 ounces of urine. Remove the container from the urine stream. Cap and mark the container and give it to the health care provider or assistant.
Dipsticks are available that also measure specific gravity in approximations. Most laboratories measure specific gravity with a refractometer. The refractometer is considered the “gold standard” measurement device for determining the specific gravity of a urine sample. Although researchers have recommended creatinine as a more reliable indicator of dilution, its measurement is not practical as specific gravity, which is easily obtained through the use of inexpensive, on-site testing. The refractometer is approx. 6 inches long and resembles a telescope. The specific gravity of urine can be measured by placing a drop of the sample on the lens of the refractometer, which is then covered by the lens plate and held up to a light source. Next, the collector reads the specific gravity of the sample, by peering into the eyepiece of the refractometer. A digital refractometer utilizes the refractive index method to measure the specific gravity of urine. The digital readout allows you to take fast readings without having to place the sample close to your eyes.
After a major surgical procedure that produces high physiologic and psychological stress, increased secretion of antidiuretic hormone causes fluid retention within the vascular space. As stress after surgery decreases, ADH and other hormones, such as glucocorticosteroids, begin to drop to normal values, and the fluid that was held in reserve is excreted. This increase in urine volume a few days after surgery is sometimes referred to as a surgical diuresis. It is important for nurses to consider this type of fluid retention and related increase in urine specific gravity in the immediate post-operative patient to avoid excessive fluid replacement.
Increased urine specific gravity may indicate:
Illegal Drug Use
Dehydration
Diarrhea
Excessive Sweating
Glucosuria
Heart Failure (related to decreased blood flow to the kidneys)
Proteinuria
Renal Arterial Stenosis
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Vomiting
Water restriction
Decreased urine specific gravity may indicate:
Excessive fluid intake
Diabetes insipidus - central
Diabetes insipidus - nephrogenic
Renal Failure (that is, loss of ability to re-absorb water)
Glomerulonephritis
Pyelonephritis
Decreased urine specific gravity may indicate:
Excessive fluid intake
Diabetes insipidus - central
Diabetes insipidus - nephrogenic
Renal failure (that is, loss of ability to reabsorb water)
Pyelonephritis
Appearance of Urine
Surprisingly little information can be gained from looking at the urine. The color depends very much upon the volume, concentrated urine being darker (stronger) than the dilute urine passed if a good deal of water is drunk. The appearance of fresh blood, or dark-brown altered blood, indicates a problem. There are many causes of blood in the urine (hematuria), many of them benign, but the appearance of fresh blood is always alarming to the individual concerned. Renal bleeding requires investigation. In jaundice, the urine will often be dark, or even yellow from the pigment retained because the liver is obstructed or unable to get rid of this substance. Normally, fresh urine has very little smell, but on standing, the urea breaks down to ammonia, which gives the characteristic odor, most associate with it. In infection, urine may smell foul even when first passed, and this is a valuable sign. Some foods or drugs give unusual odors to the urine.
Frothy Urine
Normal urine froths a little, but persistent frothing which will not flush away is abnormal. This may indicate that there is an excess of protein (albumin) in the urine, which when beaten up by the passage of the urine stream, forms a stable foam–just as egg white will when beaten. Frothy urine may also be seen in jaundice, because of the bile salts in the urine.
Swelling
This used to be called dropsy, but now is referred to as edema (which is simply Greek for swelling). Swelling is an important sign of some kidney disorders, especially those affecting the glomerular filter. The first and earliest sign of swelling from kidney dysfunction is puffiness around the eyes in the morning. Often this is worse in one eye, that which has been underneath while sleeping on one side. This swelling will slip down to reappear as puffy ankles by nightfall. If severe, then the whole face will be swollen, the abdomen distended by fluid, and the ankles and even the thighs swollen, whatever the time of day. The arms may show the ‘Popeye’ sign, especially if in bed for a period. This is made more obvious because if the swelling is the result of protein loss in the urine, the upper arms can lose muscle and become thinner. In bed, the ankles become less swollen, but the bottom and back will become waterlogged. There are many other causes for swelling besides kidney disease. A common cause of swollen ankles is varicose veins, or after a clot has formed in the veins of the calf (phlebitis). Heart failure, liver disease, gastrointestinal troubles and systemic toxicity may all cause generalized swelling, and one of the most powerful ways of distinguishing one from the other is to test the urine.
Pain
Pain, as usual, is a signal that all is not well. However, many serious conditions are quite painless, in renal dysfunction as in other systems. The most common pain related to kidney disorder is pain on passing urine. This may be confined to the urination, continue between attempts to pass urine, or be associated with pain just above the pubic bone, over the bladder. It may also be associated with pain higher up, at the waist or behind, over the kidneys. This usually indicates, if the problem is an inflammation, that it also involves the kidneys; the reverse is not true: the absence of pain in the kidney does not indicate that the inflammation is confined to the bladder. The next most common form of renal pain is renal colic. This is a misnomer, since this pain is pain from the ureter. It begins in the side, or upper abdomen, and appears to travel down into the lower abdomen, becoming nearer the midline. It may radiate into the pubic region, into the penis or testicle in men. The pain comes and goes, and is very severe.
Usually this pain is associated with something jammed in, or passing down the ureter: commonly a stone. True renal pain is much more difficult to localize, but pain from the kidney itself is usually felt in the back and side, about the level of the waistband. This may be difficult to distinguish from pain arising from the spine, or elsewhere in the back. Occasionally, patients complain of pain, which is worse on taking large volumes of fluid, especially alcohol. This may indicate that the outflow from the kidney is narrowed enough to act as an obstruction to the urine flow when the load is large, but not otherwise.
A number of symptoms of renal dysfunction and particularly renal failure are non-specific. That is to say, they are common complaints, which would not, of themselves, make one think of kidney dysfunction. As a patient’s kidneys fail, the owner becomes gradually anemic; before this is visible, they may notice a falling off in performance and ability to cope, about which they may or may not complain, especially if they are overworking and expect to be tired. Patients with kidney failure may notice that they are becoming browner than before and that they tan more deeply and remain tanned longer than previously.
Their skin may also become drier, and they may notice one of the most distressing symptoms of renal failure, itching. The bone problems of renal failure may result in general ‘aches and pains’ especially upon walking, sometimes more specifically located in the bone. Cramps, especially at night, may be a problem, and larger coarse jerking movements of the limbs (’restless legs’) a real problem.
Kidney stones are hard masses that can grow from crystals forming within the kidneys. The stones often cause severe pain, sometimes accompanied by gastrointestinal symptoms, chills, fever and blood in the urine. Most stones are made of calcium oxalate. People with the greatest risk for stone formation are those with overactive paraythyroid glands or chronic kidney infections. Kidney stone formation is increasing, with men over 30 affected more than women. Vegetarians have a decreased risk of developing stones. Consuming salt, sugar, animal protein, and oxalate-rich foods such as spinach, chocolate and nuts is linked to kidney stone formation. Cutting down on these substances and increasing potassium-rich foods through fruits and vegetables can help avoid stone formation. Magnesium and vitamin B6 is used by the body to convert oxalate into other substances, so these supplements reduce the risk of kidney stones. Cranberry juice has been shown to reduce the amount of ionized calcium in the urine by over 50 percent in patients with recurrent kidney stones. Glucosamine sulfate and chondroitin sulfate may also play a role in reducing the risk the kidney stone formation.
The factories of the kidneys and the urinary system require raw materials to support their manufacturing processes and maintain the system itself. In order for the complex organs of the system to function properly, the muscles, nerves, blood vessels, and other tissues must be properly nourished. Adequate amounts of water and the maintenance of proper sodium, calcium, and magnesium levels is also important. Other nutrients play an important role in kidney function and in the overall health of the body. Those nutrients are:
Vitamin D becomes active in the body, after its synthesis in the kidneys. Vitamin D is absorbed in the presence of bile salts, transferred to the kidneys from the liver and synthesized into the most active form of the vitamin, for distribution throughout the body. Vitamin D also plays a role in the absorption of calcium in the intestines and reabsorption by the kidneys.
B-Complex vitamins play roles in kidney and endocrine function. Vitamin B1 is stored and excreted by the kidneys.
Vitamin B2 is important as part of the electron transport chain in a series of oxidation-reduction enzyme systems, which include glutamates, amino acids, and beta oxidation of fatty acids.
Vitamin B6 is synthesized to its active form in the brain, liver, and kidney and stored in muscle as the major component of the body’s pyridoxine pool. The active form of B6 participates as a coenzyme in the synthesis and catabolism of amino acids and metabolites such as dopamine, serotonin and nicotinic acid. It also serves as a precursor to the enzyme phosphorylase, important in the breakdown of glycogen.
L-Glycine is important in the formation of proteins in the body. The kidney converts glycine to serine, which is found in many proteins throughout the body.
L-Glutamine is an amino acid which works to form ammonia in the urine.
In a blender, mix the following:
Juice of one lemon and one lime
16 to 32 oz. of distilled water
A pinch of cayenne pepper
Maple syrup to taste (optional)
Fifteen minutes after drinking the kidney/bladder flush, drink 16 oz. of kidney/bladder formula. Also drink 16 o. of this tea in the early afternoon and early evening. In each cup of the kidney/bladder tea, add 4 dropperfuls of the kidney/bladder tincture. In severe cases, alternate one week with the kidney/bladder flush and one week on the liver/gallbladder flush for 30 days.
This formula will dissolve stones in the kidneys and the entire urinary tract. It is soothing to inflamed tissues and assists in the smooth and painless release of the stones.
2 oz. Hydrangea root -- 2 oz. Gravel root -- 1 oz. Marshmallow root
Start with 2 quarts of fresh-squeezed apple juice, organic is preferable, but it must be squeezed. Add half of the herb mixture (2.5 oz.) into each quart of fresh apple juice. Let it sit overnight and in the morning bring each to a boil and simmer for 15 minutes. Let it cool, strain out the herbs from one of the quarts, and drink this entire quart during the first day. Drink about 2 oz. per hour. The first day, you should also drink an additional 32 oz. of distilled water.
Let the other quart sit in a cool dark place, shaking it a few times this day, and the next morning, strain and drink this quart at the rate of 1 oz. per hour that you’re awake for the next two days. You will be consuming about 16 oz. per day. On these two days, you must also consume 32 oz. of distilled water and 32 oz. of fresh juices. On the fourth day, consume 64 oz. of distilled water and 64 oz. of fresh juices.
Consume only distilled water and the freshly squeezed juices during this period, but only up to one additional quart the first day and up to two quarts the second and third days. Usually, only one time is necessary, but you may repeat this procedure at one week intervals until all stones are dissolved. One large stone will dissolve slower than twenty small ones.
There are two formulas you will need for cleansing your kidneys. One formula is prepared as an herbal kidney tea. The other is a tincture, which gets squirted into the tea before you drink it.
Kidney/Bladder Tea
2 parts Juniper berries 1 part Dandelion leaf
1 part Uva ursi leaves 1 part Kidney bean pods
Add to this, one part of any of the following you can find:
Cornsilk -- Carrot tops
Parsley root or leaf Watermelon seed and rind
Pour sixteen ounces of boiling distilled water over one rounded tablespoon of this herb tea, and let steep. Add four dropperfuls of the following tonic.
Kidney/Bladder Tonic
2 parts Juniper berries
1 part Corn silk
1 part Uva ursi leaves
1 part Horsetail herb
1 part Pipsissewa leaf (optional)
1 part Burdock herb
1 part Goldenrod flower tops (optional)
In severe cases, take 16 oz. of the tea three to six times a day, along with 4 dropperfuls of the tonic in each cup of tea.
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