ACUTE RENAL FAILURE AND CHRONIC RENAL FAILURE

Acute renal failure is abrupt deterioration in renal function which is usually but not invariably reversible over a period of days or weeks and is usually accompanied by a reduction in urine volume. In contrast; chronic renal failure is the clinical syndrome of the metabolic and systemic consequences of a gradual, substantial and irreversible reduction in the excretory and homeostatic functions of the kidneys.

Both of these conditions if untreated, ultimately results in end stage renal failure where the death is likely without renal replacement therapy  and this article points out the differences  between acute and chronic renal failure with respect to their definition, temporal relationship, causes, clinical features, investigation findings, management and prognosis.  

Acute renal failure(ARF)

It defines as a reduction in glomerular filtration rate (GFR) occurring over days or weeks. The diagnosis of ARF is made if there is increase in serum creatinine of >50 micro mol/L or increase in serum creatinine of >50% from the baseline or reduction in calculated creatinine clearance of >50% or need for dialysis.

Causes of ARF are broadly categorized as pre-renal, intrinsic renal, post renal causes.  Pre renal causes are severe hypovolemia, impaired cardiac pump efficiency and vascular disease limiting renal blood flow. Acute tubular necrosis, renal parenchymal disease, hepato-renal syndrome  are some of the causes of intrinsic renal failure and bladder outflow obstruction by pelvic malignancies, radiation fibrosis, bilateral stone disease are some of the causes of post renal failure.

In ARF usually the patient presents with few warning signs at the early stages but may notice a reduction in urinary volume and features of intra vascular volume depletion in the later stages.

The cause may be obvious like gastrointestinal bleeding, burns, skin disease and sepsis but can be hidden such as concealed blood losses which can occur in trauma to the abdomen. Features of metabolic acidosis and hyperkalaemia are often present.

Once the clinical diagnosis is made patient is investigated with urinary full report, electrolytes, serum creatinine, imaging.  Ultra sound scan shows swollen kidneys and reduced cortico-medullary demarcation. Renal biopsy should be performed in all patients with normal-sized, unobstructed kidneys in whom the diagnosis of acute tubular necrosis causing acute renal failure is not suspected.

Principles of management of ARF include recognition and treatment of life-threatening complications such as hyperkalaemia and pulmonary oedema, recognition and treatment of intra vascular volume depletion and diagnosis of the cause and treat where possible.

Prognosis of acute renal ARF is usually determined by the severity of the underlying disorder and other complications.

Chronic renal failure (CRF)

Chronic renal failure is defined as either kidney damage or a decreased glomerular filtration rate of <60ml/min/1.73m2for 3 or more months comparing to ARF which occurs suddenly or over a short period of time.

The most common cause could be chronic glomerulonephritis with ever increasing number of diabetic nephropathy leading to CRF becoming common. Other causes include chronic pyelonephritis, polycystic kidney disease, connective tissue disorders and amyloidosis.

Clinically the patients presents with malaise, anorexia, itching, vomiting, convulsions etc. They may have a short stature, pale, show hyperpigmentation, bruising, signs of fluid over load and proximal myopathy.

Patient is being investigated to make the diagnosis, to stage the disease and to assess the complications.

Ultra sound scan of the kidney shows small kidneys, reduced cortical thickness, together with increased echogenecity, though renal size may remain normal in chronic renal failure in diabetic nephropathy, myeloma, adult poly cystic kidney disease and amyloidosis.

Principles of management include recognition and treatment of life threatening  complications such as metabolic acidosis, hyperkalaemia, pulmonary edema, severe anaemia, identifying the cause and treat where possible and take general measures to reduce the progression of the disease.

The prognosis of patients with chronic renal failure shows that all cause mortality increases as kidney function decreases but renal replacement therapy has shown increases survival though the quality of life is severely affected.

What is the difference between acute and chronic renal failure?

·         In acute renal failure as its name denotes impairment of renal function occurs sudden or within a short period of time (days to weeks) in contrast to chronic renal failure which is diagnosed if more than 3 months.

·         ARF is usually reversible but, CRF is irreversible.

·         Most common cause of ARF is hypovolaemia  but in CRF common causes are chronic glomerulopathy and diabetic nephropathy

·         In ARF patient usually presents with reduced urine output but in CFR can presents with constitutional symptoms or with its long term complication

·         ARF is a medical emergency

·         ARF prognosis is better than CFR

Great Concentration Killers

1.Social Media

Whether you're living with ADHD or just have trouble focusing from time to time, today's world is full of concentration killers. It's easy to connect with friends and disconnect from work many times an hour. Every status update zaps your train of thought, forcing you to backtrack when you resume your work.

2.Email Overload

There's something about an email, it shoots into your inbox and itches to be answered immediately. Although many emails are work-related, they still count as distractions from your current project. You won't make much progress if you constantly stop what you're doing to reply to every message. I

3.Cell Phone

Perhaps even more disruptive than the ping of an email is the ringtone on your cell phone. It's a sound few of us can ignore. But taking a call not only costs you the time you spend talking – it can also cut off your momentum on the task at hand.

4.Multitasking

If you've mastered the art of multitasking, you probably feel you're getting more done in less time. Think again, experts say. Research suggests you lose time whenever you shift your attention from one task to another. The end result is that doing three projects simultaneously usually takes longer than doing them one after the other.

5.Nagging Thoughts

It's hard to focus on the work in front of you if you're worrying about errands you need to run or housework to be done. Or perhaps you're hung up on a conversation you had yesterday, and you keep replaying it in your mind. Nagging thoughts of any sort can be a powerful distraction.

6.Stress

When you feel like you have too much on your plate, it can be hard to focus on individual tasks. To make matters worse, stress takes a noticeable toll on the body. You may develop tight shoulders, headaches, or a racing heart, all of which can chip away at your ability to concentrate.

7.Fatigue

Fatigue can make it tough to concentrate, even when you have few distractions. Studies suggest too little sleep can sap your attention span and short-term memory.

8.Hunger

The brain can't focus without fuel, so skipping meals – especially breakfast –  is a top concentration killer. Research indicates short-term memory and attention suffer when you rise and shine but do not dine.

9.Depression

Most people tend to think of sadness as the hallmark of depression. But the National Institute of Mental Health says difficulty concentrating is one of the most common symptoms. If you're having trouble focusing, and you also feel empty, hopeless, or indifferent, you may be experiencing depression.

10.Medication

Unfortunately, some of the medications used to treat depression can interfere with concentration. The same is true of many other drugs. Talk to your doctor or pharmacist to check if a medication or supplement you are taking may be affecting your concentration.

11.ADHD

Attention deficit hyperactivity disorder (ADHD) is not just a problem for children. More than half of kids with ADHD continue to experience symptoms as adults. The classic signs are a short attention span and trouble focusing on tasks.


WebMD Home Heart Health Center

Lowering Cholesterol - 15 Tips for Avoiding Heart Disease ( I )

Simple Steps to Lower Cholesterol

Has your doctor said you have high cholesterol (called hypercholesterolemia)?
Then you know you need to change your diet and lifestyle to lower cholesterol and your risk of heart disease. Even if your doctor prescribed a cholesterol drug to bring levels down, you'll still need to change your diet and become more active for cardiovascular health. These simple tips can help you keep cholesterol levels in check.

1.Portion Control: Give Yourself a Hand

Most Americans eat super-sized meals, with portions that are twice the size recommended for good health. That can contribute to weight gain and high cholesterol. Here's an easy way to practice portion control for a meal: Use your hand. One serving of meat or fish is about what fits in the palm of your hand. One serving of fresh fruit is about the size of your fist. And a serving of cooked vegetables, rice, or pasta should fit in your cupped hand.

2.Serve Up the Heart-Healthy Food

Load your plate with fruits and vegetables -- five to nine servings a day -- to help lower LDL "bad" cholesterol. Antioxidants in these foods may provide the benefit. Or it may be that when we eat more fruits and veggies, we eat less fatty foods. Either way, you'll also help lower blood pressure and maintain a healthy weight. Foods enriched with plant sterols, such as some margarine spreads, yogurts, and other foods, can also help lower LDL cholesterol.

3.For Heart Health, Look to the Sea

A heart-healthy diet has fish on the menu twice a week. Why? Fish is low in saturated fat and high in healthy omega-3 fatty acids. Omega-3 fatty acids help lower levels of trigylcerides, a type of fat in the blood. They may also help lower cholesterol, slowing the growth of plaque in arteries. Go for fatty fish, such as salmon, tuna, trout, and sardines. Just don't drop the filets in the deep fryer – you'll negate the health benefits.

4.Start Your Day With Whole Grains

A bowl of oatmeal or whole-grain cereal has benefits that last all day. The fiber and complex carbohydrates in whole grains help you feel fuller for longer, so you'll be less tempted to overeat at lunch. They also help reduce LDL "bad" cholesterol and can be an important part of your weight loss strategy. Other examples of whole grains include wild rice, popcorn, brown rice, barley, and whole-wheat flour.

5.Go Nuts for Cardiovascular Health

Need a snack? A handful of nuts is a tasty treat that helps in lowering cholesterol. Nuts are high in monounsaturated fat, which lowers LDL "bad" cholesterol while leaving HDL "good" cholesterol intact. Several studies show that people who eat about an ounce of nuts a day have lower risk of heart disease. Nuts are high in fat and calories, so only eat a handful. And make sure they're not covered in sugar or chocolate.

6.Unsaturated Fats Protect the Heart

We all need a little fat in our diet – about 25% to 35% of our daily calories. But the type of fat matters. Unsaturated fats -- like those found in canola, olive, and safflower oils -- help lower LDL "bad" cholesterol levels and may help raise HDL "good" cholesterol. Saturated fats -- like those found in butter and palm oil -- and trans fats raise LDL cholesterol. Even good fats have calories, so eat in moderation.

7.More Beans, Fewer Potatoes

You need carbohydrates for energy, but some do your body more good than others. Whole grains, such as brown rice or quinoa, whole-wheat pasta, and beans have more fiber and raise sugar levels less. These help lower cholesterol and keep you feeling full longer. Other carbs, like those found in white bread, white potatoes, white rice, and pastries, boost blood sugar levels more quickly, leading you to feel hungry sooner, and may increase risk for overeating.

8.Move It!

Even 30 minutes of physical activity five days a week (20 minutes three times a week for vigorous exercise, such as jogging) can help lower LDL cholesterol and raise HDL cholesterol – although more exercise is even better. It also helps you maintain an ideal weight, reducing your chance of developing clogged arteries. You don't have to exercise for 30 minutes straight – you can break it up into 10-minute increments.

9.Walk It Off

If you're not used to exercising – or hate the thought of going to a gym – just go for a walk. It's easy, healthy, and all you need is a good pair of shoes. Aerobic or cardiovascular exercise such as walking lowers risk of stroke and heart disease, helps you lose weight, and keeps bones strong. If you're just starting out, try a 10-minute walk and gradually build up from there.

 

10.Work Out Without Going to the Gym

If exercise sounds like a dirty word to you, here's some good news: You can boost your heart health by incorporating physical activity into your day. Any kind of cardiovascular activity counts – gardening, dancing, or taking the stairs instead of the elevator. Even housework can qualify as exercise – as long as you're doing serious cleaning that gets your heart rate up and not just light dusting.

11.Take Charge of Your Health

If you have high cholesterol, you and your doctor may be using a number of strategies to lower cholesterol levels. You may be working on your diet, losing weight, exercising more, and maybe taking cholesterol drugs. There are other actions you can take, too, to make sure you stay on the right track.

12.What to Do When Eating Out

If you're eating healthy food at home to keep cholesterol in check, don't blow it when you eat out. Restaurant food can be loaded with saturated fat, calories, and sodium. Even healthy choices may come in super-size portions. Try these tips to stay on track:

• Choose broiled, baked, steamed, and grilled foods – not fried.
• Get sauces on the side.
• Practice portion control by asking for half your meal to be boxed up before it’s brought out.

13.Look for Hidden Traps

A close look at nutrition labels is essential for a low-cholesterol, heart-healthy diet. Try these tips:

• Check serving sizes. The nutrition info may look good, but does the package contain two servings instead of one?
• If it says "whole grain," read the ingredients. Whole wheat or whole grain should be the first one.
• A food with "0 grams cholesterol" could still raise your LDL cholesterol. Saturated fat is the other culprit to watch for. 

14.Don't Stress Out

Chronic stress can raise blood pressure, adding to your risk of atherosclerosis, which occurs when plaque from cholesterol builds up in arteries.Reduce your stress levels with relaxation exercises, meditation, or biofeedback. Focus on your breathing and take deep, refreshing breaths. It's a simple stress-buster you can do anywhere.

15.When Losing Means Winning

Losing weight is one of the best things you can do to fight cardiovascular disease. Being obese increases the risk of high cholesterol, high blood pressure, and type 2 diabetes. These all affect the lining of your arteries, making them more prone to collect plaque from cholesterol. Losing weight -- especially belly fat, which is linked to hardening of the arteries -- helps raise HDL "good" cholesterol and reduce LDL "bad" cholesterol.

Follow Your Doctor's Advice

Managing your cholesterol is a lifelong process. See your doctor regularly to keep tabs on your health. Follow your doctor's recommendations on diet, exercise, and medication. Working together, you and your doctor can lower your cholesterol levels and keep your heart going strong.



WebMD Home Heart Health Center Cholesterol Management Health Center

Can Your Pet Predict Your Personality???

The Truth About Cat People and Dog People

Are you a cat person or a dog person? The answer may say a lot about your personality. A survey developed at the University of Texas at Austin found that some stereotypes about cat and dog lovers may be true, and you may be a lot more like your furry friend than you ever realized. Browse our gallery to see where you stand - and how other Americans divide into cat people vs. dog people.

Personality Trait

Conscientious

The online questionnaire asked participants to identify themselves as "cat people" or "dog people" and included more than 40 questions designed to reveal an individual's true personality.  Scoring showed dog people to be 11% more conscientious than cat people. What it means:

• Self-disciplined
• Strong sense of duty
• Tend to be planners

Extroverted

Are you an extrovert? If you're a dog person, it's likely that you are. People who identified themselves as dog people were, as a group, 15% more extroverted than cat people. What it means:

• Outgoing
• Enthusiastic
• Positive
• Energetic

Open

Are you open to trying new things? Cat people were 11% more likely to be open, according to the survey. Open people tend to be:

• Curious
• Creative
• Artistic
• Nontraditional thinkers

Agreeable

According to the survey, if you're a dog person, you're 13% more likely to be agreeable than a cat person. Agreeable people tend to be:

• Trusting
• Altruistic
• Kind
• Affectionate
• Sociable

Neurotic

If you get stressed out easily, you may be a cat person. Cat people were, as a group, 12% more neurotic than dog people. Neurotic people are:

• Easily stressed
• Anxious
• Worriers

The Typical Dog Person

If dogs tend to be energetic, faithful, and easy to get along with, well, so do the people who love them. But survey author and psychologist Sam Gosling, PhD admits that the differences between cat and dog people aren't huge. "There are certainly many, many cat people who are extroverts and many, many dog people who aren't," Gosling says.

The Typical Cat Person

Do you prefer to spend time on your own? Always game to try new things? Then you're probably a cat person. The survey found that self-proclaimed cat people were more likely to be curious, unconventional in thinking and behavior, and more prone to worrying than dog people.

Dog People Outnumber Cat People

 Of the 4,500 people surveyed by Gosling and his colleague, Carson J. Sandy, 46% identified themselves as dog people. Just 12% said they were cat people. Of the rest, 28% said they were both, and 15% said they were neither dog nor cat people.

 

GOD sees you struggle and He hears your prayers...

Be patient...

He may not come on your time, but He is ALWAYS on time..

So how bad d problem is... how hard d pain is....tolerate and have faith...

He will do d BEST..!!!!