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Inflammatory Bowel Disease May Increase Ckd Risk
Inflammatory bowel diseases , such as ulcerative colitis and Crohns disease, or their treatments may increase the risk for chronic kidney disease , according to new research published in Clinical Gastroenterology and Hepatology.
Ravy K.Vajravelu, MD, MSCE, of the University of Pennsylvania in Philadelphia, andcolleagues conducted a retrospective study comparing 17,807 IBD patients fromthe United Kingdom with 63,466 matched control patients. Stage 3 or higher CKD,assessed by repeat measurements of estimated glomerular filtration rate ordiagnosis code, developed in 5.1% of IBD vs 3.5% of control patients, with age-standardizedincidence rates of 130.3 vs 91.3 per 100,000 person-years. The risk of CKD inpatients with IBD diminished with age, from a 7.9-fold increased risk of CKD byage 16 years to a 1.13-fold increased risk at age 77 years. The risk was onlyslightly lower for ulcerative colitis compared with patients who had Crohns disease.Active flare did not appear to influence eGFR.
Previous studies havelinked common non-biologic IBD therapies with impaired renal function. In thisstudy, neither 5-aminosalicylate nor methotrexate was associated with reducedeGFR. Azathioprine was associated with a slightly higher eGFR . Biologic medications, such as infliximab, adalimumab, andvedolizumab, are not usually prescribed by general practitioners in the UK, butthese medications have not been associated with CKD among IBD patients in priorstudies, according to the authors.
Signs And Symptoms Of Crohns Disease
Crohns disease can affect each patient a little differently. We are here to help guide you through the most common signs and symptoms of Crohns disease. The symptoms you or your loved one may experience depends on which part of the GI tract is affected.
Crohns is a chronic disease, which means patients will likely experience periods when symptoms are active, known as flares, followed by periods of remission when you may not notice any symptoms at all.
While it is important to recognize the signs of Crohns disease, only a doctor can confirm a diagnosis. If you suspect you may have inflammatory bowel diseases , please schedule an appointment with your doctor to work toward a diagnosis and treatment plan.
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What Are The Symptoms Of Crohn’s Disease
The symptoms of Crohn’s disease can vary, depending where and how severe your inflammation is. The most common symptoms include:
- Nausea or loss of appetite
- Skin changes that involve red, tender bumps under the skin
Stress and eating certain foods such as carbonated drinks and high-fiber foods may make some people’s symptoms worse.
Why Do People With Crohns Disease Get Kidney Stones More Often
There are a number of reasons why people with Crohns Disease are more likely to get kidney stones.
Kidney stones are formed when there is a decrease in urine volume and an increase in stone-forming substances in the body.
One of the most common causes of kidney stones is malabsorption. This is a condition where the small intestine isnt able to absorb nutrients properly. For example, fat in the small intestine could bind to calcium, releasing oxalates. This stone-producing substance can then absorb into the kidneys.
In addition, dehydration is a significant risk factor for kidney stones.
Those with Crohns Disease are more likely to have these two symptoms. Also, they may have more concentrated urine, which is another risk factor for kidney stones.
Kidney stones are a serious health concern. They cause pain and discomfort and create the potential to block normal urine flow. Speak with your treating physician as soon as you notice the warning signs of a kidney stone developing.
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Crohns Disease Symptoms From Diarrhea To Beyond
Having diarrhea can make it feel like youre kind of handcuffed to your toilet. For many people, these bouts of excessively loose, watery stools are blessedly infrequent. But for people who have Crohns disease, diarrhea and other symptoms can happen often enough to interfere with regular life.
Crohns disease is an inflammatory bowel disease that causes inflammation in the lining of your your digestive tract, which can spread deeper into your digestive tissues, according to the Mayo Clinic. Though people with Crohns can have symptom-free periods, during flares they may have to contend with awfully unpleasant or even debilitating symptoms that can run the gamut.
Crohn’s disease may attack different portions of the gastrointestinal tract and thus cause different problems in different people, Jessica Philpott, M.D., Ph.D., a gastroenterologist who specializes in treating inflammatory bowel disease at the Cleveland Clinic, tells SELF. In general, though, people with Crohns disease will experience some of the following symptoms:
So, remember how that inflammation can make your intestines go way overboard with cramping? That can introduce a ton of pain into your life. Also, people with Crohns may eventually experience scarring and narrowing of their intestinal walls . This causes pain and bloating because the stool has a hard time getting through, Dr. Philpott says.
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Acute Fatty Liver Of Pregnancy
AFLP is an obstetric emergency that, if left untreated, progresses to fulminant liver failure. It affects women in the third trimester of pregnancy and is characterized by sudden onset of acute liver failure with coagulopathy. Incidence of AFLP is 1/70001/20,000 pregnancies. AFLP is an autosomal recessive genetic disorder which causes defective function of long-chain 3-hydroxyacyl-CoA dehydrogenase. This enzyme is involved in mitochondrial fatty acid beta-oxidation. Because of defective oxidation, there is an excessive accumulation of fetal fatty acid, which in turn is released into the maternal circulation. The increased load of long-chain fatty acid is deposited in the liver tissue which leads to impaired hepatic function in the mother. The presence of lipid microvesicles infiltration of the hepatocytes, without inflammation, or necrosis are the typical histological findings in patients with AFLP.
The urgent and immediate delivery of fetus is associated with favorable maternal and fetal prognosis. The earlier studies have reported very high rate of maternal and fetal mortality in women with AFLP. However, the recent case series reported maternal and perinatal mortality ranging between 10% and 20%.
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Renal Function Supportive Measures
The important general measures to minimize renal injury should be started as soon as possible. The second step is administration of intravenous fluids to restore or maintain renal perfusion. This procedure also prevents hypovolemia and ensures an adequate uteroplacental perfusion and fetal well-being. These general measures are followed by pharmacological therapy of AKI and its known complications such as hypertension, hyperkalemia, metabolic acidosis, and anemia. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are contraindicated in pregnancy and diuretics are not recommended because of the high risk of volume depletion. The use of hydralazine is associated with adverse maternal and fetal outcomes in a recent study. Therefore, the first-line treatment options in pregnant women with hypertension are methyldopa and labetalol. The dihydropyridine calcium-channel blockers can also be used successfully and safely in pregnancy. The administration of insulin, glucose, and ion exchange resin is recommended for the treatment of hyperkalemia. The erythropoiesis-stimulating agent is safe in pregnancy, but higher doses are usually required to obtain the desired therapeutic effect in pregnant women.
What Are The Complications Of Ibd
Scar tissue may result as the inflamed tissue heals. This scarring can narrow or even block the intestine. The narrowed area is called a stricture. If food cant move through your intestine, you may have nausea and vomiting. Long-term obstruction raises the pressure in the part of the intestine before the narrowed or blocked area. This pressure can cause the inflamed intestinal wall to burst . An untreated perforation lets intestinal contents out into the abdomen. This is quite painful and requires immediate surgery. More commonly, the perforation forms a small hole and a tunnel to another organ as a way to release the pressure that builds up from the blockage. This tunnel is called a fistula. A fistula most commonly connects to another part of the intestine, to the skin, to the bladder, or to the vagina. If a fistula does not connect to an exit site, it can form a cavity filled with infected intestinal contents and pus. This is called an abscess.
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What Are Surgical Treatments For Crohns Disease
As many as 7 in 10 people with Crohns disease eventually need surgery when medications no longer provide symptom relief. During a bowel resection, a surgeon:
- Removes the diseased bowel segment.
- Connects the two ends of the healthy bowel together .
After surgery, the remaining part of the bowel adapts and functions as it did before. Approximately 6 in 10 people who undergo surgery for Crohns disease will have a recurrence within 10 years. Another bowel resection may be a good option for you.
Articles On Crohn’s Disease
Lots of people have stomach cramps with diarrhea or constipation. Itâs uncomfortable, but you usually get over it and forget about it.
But when you have these symptoms often and theyâre severe, thereâs a chance you could have Crohnâs disease. Youâll need to see your doctor to find out for sure.
As many as 700,000 Americans have the disease. Although thereâs no cure, treatments can manage it.
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Colitis And Crohns Disease And Incontinence
Incontinence can be a problem for some suffering from Colitis and Crohns. Both conditions can cause diarrhoea and also an urgent need to go to the toilet. This can lead to accidents which can leave you feeling embarrassed and uncomfortable. To avoid accidents, or if they cannot be avoided, to help you deal with them, it is a good idea to always be prepared.
When you are at home, accidents should be relatively easy for you to manage. Make sure you have the necessary equipment in the bathroom to hand should you have an accident, such as disposable tissues which are a lot more hygienic to clean yourself with and less likely to irritate the skin. Air fresheners are also useful to disguise any smells.
If you are concerned about having an accident when you are out and about, keep some spare, clean underwear in your bag and a packet of baby wipes to help you stay fresh and comfortable. Keep a plastic bag handy so you can dispose of any soiled items too. It is also a good idea to know where the nearest toilets are located.
B& BC can provide a Just Cant Wait toilet card which could help you gain access to a toilet when out shopping or socialising. The card states that the card holder has a medical condition and may require the urgent use of a toilet. If you would like to apply for a toilet card online or order one by phone, please visit our toilet card page for more information.
Eating Too Many Foods High In Sugar
Sugar contributes to obesity which increases your risk of developing high blood pressure and diabetes, two of the leading causes of kidney disease. In addition to desserts, sugar is often added to foods and drinks that you may not consider sweet. Avoid condiments, breakfast cereals, and white bread which are all sneaky sources of processed sugar. Pay attention to the ingredients when buying packaged goods to avoid added sugar in your diet.
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Drinking Alcohol In Excess
Regular heavy drinking more than four drinks a day has been found to double the risk chronic kidney disease. Heavy drinkers who also smoke have an even higher risk of kidney problems. Smokers who are heavy drinkers have about five times the chance of developing chronic kidney disease than people who dont smoke or drink alcohol to excess.
Thrombotic Microangiopathies Of Pregnancy
P-TMA are rare disorders occurring in 1/25,000 pregnancies. TMAs in pregnancy are characterized by thrombi of fibrin and/or platelet in the microvasculature of various organs, endothelial swelling, accumulation of protein, and cell debris in the subendothelial layer and splitting of the glomerular basement membrane in some cases. P-TMA may occur anytime during pregnancy or at puerperium, in previously healthy women. Thrombotic thrombocytopenic purpura and hemolytic-uremic syndrome may occur de novo with pregnancy, may relapse during pregnancy, and/or may recur with subsequent pregnancies. Pregnancy-related TMA accounts for 8%18% of all cases of TMA, and it is a secondary form of TMA. P-TMA can be classified into three groups based on underlying pathogenic mechanism: ADAMTS-13 deficiency related, complement alternative pathway dysregulation related, and unknown mechanism. Depending on the dominant clinical mode of presentation, two clinical forms of syndrome have been described TTP and HUS.
Thrombotic thrombocytopenic purpura
Atypical hemolytic-uremic syndrome
The counseling of patients with complement gene abnormalities who wish to start a pregnancy remains a difficult issue. The risk of P-aHUS varies according to the underlying complement gene abnormality this risk was highest for patients with CFH and C3 mutations and lower for those patients with CFI and membrane cofactor protein mutation.
Differential diagnosis TMA and AKI in pregnancy
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Symptoms Of Kidney Dysfunction
The kidneys are a vital organ that act as a filter to eliminate waste and toxins, remove excess water, help balance blood pressure, and influence the production of red blood cells and bone health. When the kidneys aren’t functioning properly, symptoms can include:
- Weight loss
- Headaches
- Erectile dysfunction
A MyCrohnsAndColitisTeam member said, I have a lot of kidney pain at times, along with blood in my urine. My kidney doctor says there is no explanation for it. He thinks it’s just from the Crohns. It is very painful.
What Are Surgical Treatments For Ulcerative Colitis
After 30+ years of living with ulcerative colitis, about 1 in 3 people need surgery.
A surgeon:
- Removes the colon or the colon and rectum .
- Connects the small intestine and anus.
- Creates an ileal pouch that collects stool, which then exits through the anus.
Rarely, you may need an ileostomy instead of an ileal pouch. An ileostomy bag attaches outside of the belly to collect stool.
A proctocolectomy is curative. Symptoms wont return after surgery to remove the colon and rectum. However, you may have problems with the ileostomy or ileal pouch, such as pouchitis .
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Mental And Emotional Health
The body and mind are inseparable, and the symptoms of Crohns can result in emotional difficulties. While the primary cause of Crohns is not emotional, flare-ups may occur in times that are more emotionally challenging. Coping with a serious chronic illness is already difficult, so its important to monitor stress and emotional levels.
Causes Of Acute Kidney Injury In Pregnancy With Respect To Timing Of Pregnancy
The causes of P-AKI are shown in Figure 1 based on their occurrence with respect to the timing of pregnancy. Approximately 75% cases of P-AKI occur during the late third trimester and in the early postpartum. The hypertensive complications of pregnancy, particularly PE and/or HELLP, are the leading causes of P-AKI in most parts of the world, including developing countries. Approximately 1% of women with severe PE and 3%15% of women with HELLP syndrome developed AKI. Other causes include septic abortion or puerperal sepsis, antepartum hemorrhage or postpartum hemorrhage , intrauterine death, acute fatty liver of pregnancy , and thrombotic microangiopathy of pregnancy . The following pregnancy-specific disorders causing P-AKI are discussed in this review article: PE, HELLP syndrome, AFLP, and P-TMAs, and hyperemesis gravidarum.
Timing of acute kidney injury with respect to the gestational period of the pregnancy. Atypical hemolytic-uremic syndrome typically occurs in postpartum period
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Not All Ibd Medications Linked To Increased Kidney Disease Risk
Azathioprine is linked to a slightly higher eGFR for patients with inflammatory bowel disease.
Ravy K. Vajravelu, MD
While the association between inflammatory bowel disease and chronic kidney disease is well known, how IBD medications increases the risk of CKD is not known.
A team of investigators from the Perelman School of Medicine at University of Pennsylvania, led by Ravy K. Vajravelu, MD, Division of Gastroenterology and Department of Medicine, determined whether IBD medications are linked to changes in estimated glomerular filtration rate , a key indicator of kidney function.
The investigators performed a retrospective cohort study of the data from The Health Improvement Network. A total of 17,807 patients with inflammatory bowel disease were included and matched for age, sex, and practice with 63,466 individuals without IBD.
The team used a Cox proportional hazards model adjusted for common chronic kidney disease risk factors calculate the relative hazard of chronic kidney disease for stages 3 through 5D in patients with inflammatory bowel disease.
They also evaluated the association of 5-aminosalicylates , azathioprine, and methotrexate with change in eGFR using a longitudinal model.
After controlling for the risk factors associated with chronic kidney disease, the investigators discovered inflammatory bowel disease is associated with the development of chronic kidney disease in patients between 16-77 years old.
Diagnosis Of Acute Kidney Injury In Pregnancy
Diagnostic definition of renal diseases during pregnancy is not uniform and is highly variable in the literature, and therefore, validated definition of P-AKI is not yet established. The use of the risk, injury, failure, loss of kidney function, and end-stage kidney disease classification in pregnant women needs further study and is not consensual. The prognostic utility of RIFLE system has been demonstrated in nonpregnant women, but there are few studies reporting its application in pregnancy. Pregnancy is associated with a physiological increase in GFR by 50%80% accompanied by an increase in plasma volume. Together, these result in a normal gestational fall in serum creatinine, which can easily mask mild AKI. A creatinine level of 1 mg/dl or a rapid rise of 0.5 mg/dl above baseline should be investigated for evidence of AKI. The knowledge of these physiological adaptations in pregnancy is of clinical importance because serum creatinine and blood urea nitrogen of 1.0 mg/dl and 13 mg/dl, respectively, would be considered normal in a nonpregnant individual but reflect renal impairment in a pregnant women. Since a consensus definition of P-AKI has not been established, therefore, the diagnosis of P-AKI is based on increase in serum creatinine. We have used following criteria for diagnosis of AKI in pregnant women sudden increase in serum creatinine > 1 mg/dl, oliguria/anuria, and need for dialysis.
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