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22 Adar II 5763 - March 26, 2003 | Mordecai Plaut, director Published Weekly
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Home and Family


Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

Our next series concerns the kidneys and urinary tract. Of course, there are topics in urology that are not appropriate for public discussion so feel free to write me if you have any private questions.

What we eat and what gets absorbed through our skin is often toxic. Furthermore, our cells produce byproducts that also must be excreted. Materials that are soluble in water are dealt with by the kidney. Non-water- soluble ones are dealt with by the liver.

The blood goes through the kidneys continuously, and there filters deal with these poisons. The kidney also maintains electrolyte and fluid balance. If you drink too much, then your kidneys will excrete more salt, bringing water with it. Potassium, magnesium, calcium and other ions are also dealt with here. Acid-base balance is done here too. Furthermore, the kidneys are responsible for the secretion of the hormones for making blood. We see what an important organ this is.

Once the urine has been formed and appropriately concentrated, it goes through a bigger tube called the renal pelvis and then into the ureter -- a long tube that drains into the bladder. The bladder then stores the urine until such time as it can be excreted. Note that once the urine leaves the kidney, its components cannot be changed.

Before we focus on the kidney and diseases affecting it, let us speak about how we study the kidney. The easiest way is by urinalysis. With the dip of a small stick we can see infection, concentration of the urine, invisible blood, protein, sugar, and acids. Inappropriate concentrating of urine can be a sign of kidney failure, or SIADH/diabetes insipidus. The last two are diseases that make the sodium concentration too low or too high.

The presence of blood can be sign of muscle injury, kidney disease, kidney stones, cancer, or trauma. Protein can be a sign of kidney disease. Sugar can be a sign of diabetes, but can also be a result of eating a very sugary meal. Acids in the urine can be a sign of diabetes gone bad.

Urine under a microscope can show us infection, blood or signs of crystals that can be kidney failure as well. Urine electrolytes can tell us the status of the kidneys and help us know if a patient is dehydrated or truly with kidney disease. The best test is a 24 hour collection of urine which gives us the most information. Blood tests of urea and creatinine -- two substances excreted by the kidney -- allow us to know the level of kidney failure, although measuring pH and potassium must be done to make sure a dangerous situation does not exist.

Kidney function can also be measured by a nuclear scan. Structural problems once were investigated by an IVP, a dye study with x-ray, but this has largely been supplanted by CT. Ultrasound can give some detail as well, but it is inferior to CT. More next week. Write me in care of the Yated.

A message from Glaxo, sponsor of this column. The American Association of Pediatrics has released their guidelines on head lice, and Lyclear appears as a treatment. Our particular form of head lice in Israel is a tough one to deal with, but Lyclear can be effective. Works well for scabies as well. This problem may be especially worrying in the elderly.

 

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