tag:theconversation.com,2011:/fr/topics/kidneys-15393/articlesKidneys – The Conversation2024-02-05T22:24:10Ztag:theconversation.com,2011:article/2209412024-02-05T22:24:10Z2024-02-05T22:24:10ZThe uncertain fate of patients needing life-saving dialysis treatment in Gaza<p>More than 100 days into the brutal assault on Gaza, over <a href="https://news.un.org/en/story/2024/02/1146157">27,000 Palestinians have been killed — of whom 60 per cent have been children and women</a> — and 66,000 injured, according to the World Health Organization (WHO).</p>
<p>The destruction of Gaza’s health-care system has been catastrophic. The <a href="https://news.un.org/en/story/2024/01/1145317#:%7E:text=Hundreds%20of%20facilities%20hit,seven%20deaths%20and%2052%20injuries.">WHO says</a> that, as of Jan. 5, there have been more than 600 attacks on health-care facilities, with 26 out of 36 hospitals in Gaza severely damaged and 79 ambulances targeted. Over <a href="https://doi.org/10.1136/bmj.q203">300 health-care workers have been killed and over 200 have been detained by Israeli forces</a>. </p>
<p><a href="https://www.msf.org/letter-gaza-un-security-council">In an open letter</a> to the United Nations Security Council, Médecins Sans Frontières (MSF) president Christos Christou wrote: </p>
<blockquote>
<p>“Israel has shown a blatant and total disregard for the protection of Gaza’s medical facilities. We are watching as hospitals are turned into morgues and ruins. These supposedly protected facilities are being bombed, are being shot at by tanks and guns, encircled and raided, killing patients and medical staff.”</p>
</blockquote>
<p>Most of the resources within the collapsing health-care system in Gaza are directed towards treating acute trauma victims, such as the injured <a href="https://www.reuters.com/world/middle-east/baby-saved-gaza-rubble-after-mother-killed-israeli-strike-2023-12-29/">babies pulled from rubble</a>, the toddlers requiring <a href="https://www.reuters.com/world/middle-east/gazas-child-amputees-face-further-risks-without-expert-care-2024-01-04/">limb amputations</a> and the civilians suffering from <a href="https://reliefweb.int/report/occupied-palestinian-territory/gaza-strip-msf-treating-patients-severe-burns-following-airstrike">severe burn injuries</a>. This leaves patients with chronic life-threatening diseases, such as cancer, heart failure and end-stage kidney disease, with severely limited access to the ongoing medical care they need to survive.</p>
<h2>Patients unable to access care for chronic conditions</h2>
<p>As nephrologists and internal medicine physicians, we are gravely concerned about patients in Gaza with chronic diseases who are unable to access care. There are more than <a href="https://www.aljazeera.com/features/2023/10/25/terrifying-hope-shrinks-for-gazas-dialysis-patients-at-packed-hospitals">1,100 dialysis patients, including 38 children, in Gaza</a>. </p>
<p><a href="https://kidney.ca/Kidney-Health/Living-With-Kidney-Failure/Dialysis">Hemodialysis</a> is a treatment for patients with kidney failure that involves removing blood from the patient’s circulation and circulating it through a dialysis machine that clears toxins and removes excess fluid. Without adequate dialysis, fluid and toxins accumulate and patients typically die within days to weeks from respiratory failure or cardiac arrest. </p>
<p>Dialysis is a resource-intensive therapy that requires a dialysis facility, dialysis machines, filters, water supply and fuel, along with a team of technicians, nurses and nephrologists. Each one of these components has been severely and directly compromised since Israel’s assault on Gaza. </p>
<p>Israel’s complete blockade of food, fuel and water has left over <a href="https://abcnews.go.com/International/500000-people-gaza-face-catastrophic-hunger-unrwa/story?id=106593939">500,000 Gazans facing catastrophic hunger</a> according to the United Nations Relief and Works Agency (UNRWA), and Gazan children face a <a href="https://www.unicef.org/press-releases/barely-drop-drink-children-gaza-strip-do-not-access-90-cent-their-normal-water-use">90 per cent reduction in access to water</a>.</p>
<p>Several hospitals, including Al-Aqsa, reported being completely out of fuel, putting all patients in grave danger, <a href="https://www.aljazeera.com/news/2024/1/13/blackout-in-gazas-al-aqsa-hospital-as-fuel-runs-out-babies-at-high-risk">particularly those on life support, babies in incubators and those requiring dialysis</a>. </p>
<p>Even before the current conflict, the 16-year blockade of Gaza put the lives of kidney failure patients at risk due to chronic shortages of fuel and medical supplies. Al Jazeera reports that since Oct. 7, <a href="https://www.aljazeera.com/features/2023/10/25/terrifying-hope-shrinks-for-gazas-dialysis-patients-at-packed-hospitals">the number of patients at Al-Aqsa Hospital requiring dialysis has more than doubled</a> from 143 to about 300, including 11 children, who have just 24 dialysis machines between them. </p>
<p>This has forced dialysis units to significantly cut treatments, with patients receiving two-hour sessions rather than the typically prescribed 3.5-hour treatments. Treatment frequency, typically prescribed three times weekly, are now only available one or two times per week. </p>
<p>This decrease in treatment time and frequency is grossly insufficient to sustain life. But in a health-care system under assault, patients are fortunate to receive any dialysis at all. </p>
<h2>Patients needing life-saving treatment</h2>
<p>Ismail Al Tawil was a 44-year-old patient in Gaza who died of kidney failure after he was unable to access dialysis. In an interview with Al-Jazeera’s AJ+ social media arm, <a href="https://www.instagram.com/ajplus/reel/C15bdLAOVVi/">his widow described desperately trying to get him to dialysis at Al-Shifa hospital</a>, but being shot at by Israeli snipers who surrounded the hospital. </p>
<p>She then attempted to access dialysis at Al-Awda and Kamal Adwan hospitals, but both facilities had insufficient capacity to treat him. </p>
<p>Since Oct. 7, <a href="https://www.hrw.org/news/2023/12/20/most-gazas-population-remains-displaced-and-harms-way">1.9 million people or 85 per cent of the population of Gaza have been internally displaced</a>, according to Human Rights Watch. This is a tremendous challenge for dialysis patients who are faced with the uncertainty of when, where or if they will access their life-saving therapy. </p>
<p>Anssam, age 12, was displaced from Jabaliya in northern Gaza to seek treatment in Deir El Balah in central Gaza. She had gone 15 days without dialysis and had to leave with her mother to receive life-saving medical treatment. <a href="https://www.thenationalnews.com/mena/palestine-israel/2023/12/18/gaza-dialysis-patients-hospital/">In an interview with <em>The National News</em></a>, Anssam said: </p>
<blockquote>
<p>“I hope for this war to end and for us to go back to the way we were, happy and playing, and to go back to doing dialysis three times a week… Now, without filters, I cannot have dialysis and so I will die. My life depends on dialysis.” </p>
</blockquote>
<h2>Loss of medical personnel</h2>
<p>Beyond the destruction of health-care facilities and a critical shortage of supplies, the loss of medical personnel may have the most devastating and longest-lasting impact on the health-care system in Gaza. </p>
<p>Dr. Hammam Alloh was one of the only nephrologists in Gaza, <a href="https://www.democracynow.org/2023/11/13/medical_workers_killed_colleagues_mourn_hammam">described as a committed physician and a beacon of light by his colleagues</a>. He was 36 years old and a father of two young children. He had hopes to expand dialysis care in Gaza and build a nephrology educational training program.</p>
<p><a href="https://www.cbc.ca/news/world/gaza-hamman-alloh-killed-1.7027623">He was killed on Nov. 12</a> by an <a href="https://www.frontlinedefenders.org/en/profile/hammam-alloh">Israeli airstrike to his family’s home</a>, where he was taking a short rest after a busy shift at Al Shifa Hospital. His loss resonated far beyond his family, patients and colleagues in Gaza. Dr. Alloh’s <a href="https://www.presstv.ir/Detail/2023/11/19/714879/humans-of-gaza-hammam-alloh-nephrologist-alshifa-hospital">courage and dedication has become a powerful source of inspiration</a> for physicians and health-care workers around the world. </p>
<p>Multiple sources have reported the number of civilians who have been killed by the bombs and bullets during the assault on Gaza. We may never know how many cancer patients will die from lack of chemotherapy; or diabetics from lack of insulin; or kidney failure patients from inadequate dialysis. The consequences of the collapsed health-care system in Gaza will be felt for years to come. </p>
<p>The <a href="https://www.cbc.ca/news/canada/chilling-effect-pro-palestinian-1.7064510">attempts to silence, intimidate and smear health-care workers</a> for calling out the atrocities in Gaza have been well documented. These efforts not only attempt to rob us of our freedom of speech, but of our professional and moral duty as physicians to promote global health and protect the vulnerable. </p>
<p>As physicians, we will not be silent as our colleagues in Gaza are being killed, as hospitals are being targeted and attacked, and as vulnerable patients are endangered. We <a href="https://news.un.org/en/story/2024/01/1145462">join the UN</a>, the <a href="https://doi.org/10.1016/S0140-6736(23)02627-2">WHO</a>, <a href="https://www.doctorswithoutborders.ca/msf-immediate-ceasefire-is-needed-in-gaza-to-stop-the-bloodshed/">MSF</a> and the <a href="https://www.bma.org.uk/what-we-do/working-internationally/our-international-work/bma-position-israel-gaza-conflict">British Medical Association</a>, along with millions around the world, who call for an immediate ceasefire and unimpeded humanitarian aid. </p>
<p>We stand in solidarity with the true health-care heroes of Gaza who continue to work in harrowing conditions, and we honour the legacies of those like Dr. Alloh who lost their lives while upholding the highest values of our profession.</p><img src="https://counter.theconversation.com/content/220941/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Patients with kidney failure need regular dialysis treatments to survive. However, the equipment, supplies and medical staff needed for dialysis have been largely destroyed by the assault on Gaza.Ali Iqbal, Transplant Nephrologist, Assistant Professor of Medicine, McMaster UniversityAliya Khan, Clinical professor, Faculty of Health Sciences, McMaster UniversityBen Thomson, Masters of Public Health student, Bloomberg School of Public Health, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1970122023-01-18T13:38:33Z2023-01-18T13:38:33ZKicking off the new year by cleansing your body with a detox diet? A dietitian unpacks the science behind these fads<figure><img src="https://images.theconversation.com/files/503325/original/file-20230105-12-sxz5c4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7988%2C5329&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A healthy diet – with plenty of fruits, vegetables and whole grains – is one key to a healthy body.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-making-healthy-smoothie-for-breakfast-royalty-free-image/1237890164?phrase=juicing&adppopup=true">Oscar Wong/Moment via Getty Images</a></span></figcaption></figure><p>Detox diets are often touted as a way to cleanse the body after the excess food and drinks that come with the holidays. These diets promise quick results and can particularly entice people around the new year, when there tends to be a renewed focus on health and lifestyle habits. </p>
<p>There are <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">a few different types of detox diets</a>: fasting, juice cleanses, eating only certain foods, using dietary commercial detox supplements or “cleansing” the colon with enemas or laxatives. </p>
<p>Most of these diets have a few things in common: They are short-term and aim to eliminate allegedly toxic substances from the body. Typically, these diets include a period of fasting followed by an extremely restrictive diet for a number of days. </p>
<p><a href="https://www.linkedin.com/in/taylor-grasso-rdn-ld-mpp-d-214747a2/">As a registered dietitian</a>, I have seen clients attempt detox diets and experience a slew of negative side effects, including developing a negative relationship with food. </p>
<p>Research shows that there is little evidence to <a href="https://doi.org/10.1111/jhn.12286">support the use of detox diets</a> and that they are not needed anyway. The body is well-equipped to eliminate unwanted substances on its own, without expensive and potentially harmful supplements sold by the nutrition and wellness industry. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/DESCcjSQSKY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Doing a cleanse doesn’t “clean your pipes” – and it may do harm.</span></figcaption>
</figure>
<h2>About toxins</h2>
<p>What are toxins – and how do they get into the body in the first place? </p>
<p>Internal toxins <a href="https://en.wikipedia.org/wiki/Toxin">include natural byproducts</a> created by the body during metabolism, such as lactic acid, urea and waste from the gut microbes. </p>
<p><a href="https://www.atsdr.cdc.gov/csem/exposure-history/Organ-Systems-Are-Affected.html">External toxic exposures</a> enter the body through eating, drinking, breathing or penetration of the skin. These can come in the form of air pollutants, food or water contaminated with chemicals or heavy metals, household products such as laundry detergent and even beauty products like facial cleansers, body wash and makeup.</p>
<p>The body’s built-in detoxification system includes the liver and kidneys, with assistance from the lungs, lymphatic system, digestive tract and skin. Briefly, the liver breaks down harmful substances, which are then filtered out through the kidneys. The digestive tract also expels them through bowel movements. </p>
<p>But our bodies aren’t always functioning optimally. That’s why a proper diet and improved lifestyle behaviors, such as increased exercise and sleep, may have a significant – and positive – impact on the body’s detoxification system.</p>
<p>Having a diverse microbiome and an <a href="https://www.healthline.com/nutrition/improve-gut-bacteria#TOC_TITLE_HDR_11">abundance of healthy gut bacteria</a> also helps to rid the body of harmful substances. Fermented foods such as kefir, sauerkraut and cultured dairy products can benefit gut health. These foods contain <a href="https://www.healthline.com/nutrition/11-super-healthy-probiotic-foods">probiotics</a>, which are the beneficial bacteria that live in your gut. </p>
<p>Another category, called <a href="https://www.eatingwell.com/article/2059033/best-and-worst-foods-to-eat-for-gut-health/">prebiotic foods</a>, are also beneficial for gut health. They provide nutrition and energy for the healthy probiotics in the gut and are high in fiber. Examples of prebiotic foods are whole grains and fruits and vegetables, particularly bananas, greens, onions and garlic. </p>
<h2>The potential harms of detox diets</h2>
<p>Through glossy and pervasive advertising, detox diets perpetuate <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">a quick-fix mindset about weight and body image</a> rather than promote lifestyle changes that are sustainable for a lifetime. </p>
<p>Although proponents claim that detox diets and juice cleanses lead to weight loss, improved liver function and overall better health, research shows <a href="https://doi.org/10.1111/jhn.12286">they have little to no effect</a>. What’s more, they can <a href="https://www.nutritionletter.tufts.edu/healthy-eating/weight-mgmt/detox-dilemma/">lead to side effects</a>, including headaches, fatigue, weakness, fainting and irritability. However, studies show there is some evidence that certain foods and spices, such as coriander, may <a href="https://doi.org/10.1111/jhn.12286">enhance the body’s natural detoxification pathways</a>.</p>
<p>According to the Academy of Nutrition and Dietetics, other foods that may give the body’s own detox system a boost include cruciferous vegetables like broccoli and Brussels sprouts, berries, artichokes, garlic, onions, leeks and green tea. Eating adequate amounts of lean protein may also benefit the body’s natural system by <a href="https://www.eatright.org/health/wellness/diet-trends/whats-the-deal-with-detox-diets#">maintaining adequate levels of glutathione</a>, the body’s master detoxification enzyme, or catalyst. Glutathione is an enzyme produced by the liver that is <a href="https://www.webmd.com/vitamins/ai/ingredientmono-717/glutathione">involved in numerous processes</a> within the body including building and repairing tissues, assisting in the natural detoxification process and improving immune system function.</p>
<p>A handful of clinical studies have shown increased liver detoxification with a commercial detox diet or supplements, but these studies have <a href="https://doi.org/10.1111/jhn.12286">flawed methodologies and small sample sizes and are often done on animals</a>. In addition, supplements are <a href="https://www.fda.gov/consumers/consumer-updates/it-really-fda-approved#">not regulated by the U.S. Food and Drug Administration</a> as food and drugs are. They can be put on the shelf without full evaluation of ingredients or proven efficacy, except in rare cases in which supplements are tested by a third party. </p>
<p>In fact, some commercial supplements have raised so many health and safety issues that the FDA and the Federal Trade Commission <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">have taken legal action against the companies that make them</a> to remove their products from the market. </p>
<p>Some detox diets and programs can have serious side effects, particularly those including laxatives or enemas, or those that restrict intake of solid foods. These approaches can lead to <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">dehydration, nutrient deficiencies and electrolyte imbalances</a>. </p>
<p>In addition, diets that severely restrict certain foods or food groups <a href="https://doi.org/10.1007/s11894-017-0603-8">usually don’t lead to lasting weight loss</a>.</p>
<p>Instead, these types of diets often put the body into “<a href="https://doi.org/10.1038/ijo.2010.184">starvation mode</a>.” That means that rather than burning calories, your body holds on to them to use as energy. </p>
<p>Doing that repeatedly over a long period can <a href="https://doi.org/10.1038/ijo.2010.184">lead to a chronic decrease in metabolism</a>, which means that the number of calories you burn at rest may slowly decrease over time. This can make it more difficult to lose weight and balance blood sugar. It can also leave people more susceptible to chronic metabolic conditions such as cardiovascular disease and diabetes. </p>
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<figcaption><span class="caption">There’s very little evidence that detox diets remove harmful substances from your body.</span></figcaption>
</figure>
<h2>A healthy lifestyle, without the detox diet</h2>
<p>Focusing on sustainable lifestyle shifts can make a huge difference – and unlike a detox diet, actually work. </p>
<p>Number one, <a href="https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/">eat a balanced diet</a>. Aim to eat mostly whole grains, lean protein choices, fruits and vegetables of many colors, low-fat dairy, nuts and seeds. This way, you’re getting a variety of nutrients, antioxidants and a good amount of fiber. </p>
<p>Number two, <a href="https://www.eatright.org/health/essential-nutrients/water/how-much-water-do-you-need">hydrate</a>. For women, the <a href="https://www.eatright.org/health/essential-nutrients/water/how-much-water-do-you-need">recommended daily water intake by the Academy of Nutrition and Dietetics</a> is 11½ cups; for males, it’s 15½ cups. However, you get about 20% of that total from food, which leaves nine cups for women and 13 cups for men as the daily recommended water intake. This is comparable to 4½ 16-ounce water bottles for women and 6½ 16-ounce water bottles for men. </p>
<p>Lastly, move your body in a way that you enjoy. The more you enjoy being active, the more likely it will become a routine. Aim for at least 150 minutes, or 2½ hours of <a href="https://www.cdc.gov/physicalactivity/basics/adults/index.htm#:%7E">moderate-intensity physical activity every week</a>. </p>
<p>Focusing on these types of long-term, sustainable healthy habits is the key to weight loss and overall health and wellness.</p><img src="https://counter.theconversation.com/content/197012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taylor Grasso consults for Simply Healthy, LLC and CU Anschutz Health and Wellness Center. </span></em></p>Detox diets and cleanses supposedly clear the body of allegedly toxic substances. But the evidence suggests otherwise.Taylor Grasso, Registered Dietitian, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1842362022-06-02T01:52:03Z2022-06-02T01:52:03ZWhy do I need to pee more in the cold?<figure><img src="https://images.theconversation.com/files/466532/original/file-20220601-49081-pmkbqo.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C1000%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-female-distress-having-go-restroom-1882909777">Shutterstock</a></span></figcaption></figure><p>You’re taking a stroll through the park on a cold winter’s morning, when it hits you – the need to find a bathroom, and quick! This didn’t used to happen in summer.</p>
<p>Is there something about winter that makes us need to pee more?</p>
<p>We study the bladder and lower urinary tract. Here are two main explanations for what’s going on.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-my-hands-and-feet-always-cold-and-when-should-i-be-worried-184154">Why are my hands and feet always cold? And when should I be worried?</a>
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<h2>1. Our lifestyle changes</h2>
<p>In summer, we tend to be outside and more active. We sweat more (to lose heat) and it’s easy to become dehydrated if we don’t drink enough water.</p>
<p>This impacts the amount of free fluid our body is willing to <a href="https://www.nature.com/articles/ejcn2015233">excrete</a>, and our urine volume is often reduced because of this.</p>
<p>In winter, we’re often indoors, around water sources, so we are more likely to be hydrated, less active, and to sweat less. As such, we tend to have more free fluid to excrete via our urine.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-if-our-bodies-are-happy-at-37-why-do-we-feel-so-unhappy-when-its-too-hot-outside-159134">Curious Kids: if our bodies are happy at 37℃, why do we feel so unhappy when it's too hot outside?</a>
</strong>
</em>
</p>
<hr>
<h2>2. Our body wants to avoid losing too much heat</h2>
<p>If we become cold very quickly, the body protects our internal organs in a number of ways.</p>
<p>One is “<a href="https://pubmed.ncbi.nlm.nih.gov/4655205/">cold-induced diuresis</a>”, or an increase in urine excretion in response to the <a href="https://journals.physiology.org/doi/abs/10.1152/ajpregu.1993.264.3.R524">cold</a>.</p>
<p>Initially, blood is diverted away from the skin to avoid losing its heat to the outside air. This means more blood ends up flushing through your internal organs.</p>
<p>In particular, blood rushes to your kidneys in a greater volume and at a higher pressure. This increases the amount the kidneys need to <a href="https://journals.physiology.org/doi/full/10.1152/ajprenal.00430.2005">filter</a>. As a result, your rate of <a href="https://www.frontiersin.org/articles/10.3389/fphys.2022.841181/full">urine excretion</a> increases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-is-it-so-cold-right-now-and-how-long-will-it-last-a-climate-scientist-explains-184155">Why is it so cold right now? And how long will it last? A climate scientist explains</a>
</strong>
</em>
</p>
<hr>
<h2>What should I do?</h2>
<p>Our diet, age, blood pressure, and personal situation can all impact how much we urinate.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/blVmyrBPves?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Could you have a small bladder? Or an overactive bladder?</span></figcaption>
</figure>
<p>Producing more urine can also be a sign of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-201X.1998.0314f.x">hypothermia</a>. This is your body responding to the cold as a stressor, so act quickly. Find somewhere away from the cold, and slowly warm up your body. </p>
<p>If the increased urine is also accompanied by <a href="https://www.healthdirect.gov.au/hypothermia">other symptoms</a>, such as extensive shivering, breathing difficulties, or confusion, seek medical attention immediately.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-some-people-feel-the-cold-more-than-others-37805">Health Check: why do some people feel the cold more than others?</a>
</strong>
</em>
</p>
<hr>
<h2>Keep up the fluids in winter too</h2>
<p>If you’re out in the cold, you may not feel thirsty. Nonetheless, be sure to drink plenty of fluids during the day. Although it may be tempting to avoid drinking so you don’t need to keep rushing to the bathroom, this can lead to dehydration.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Smiling woman wearing yellow puffer jacket holding water bottle" src="https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466716/original/file-20220602-18-4l0pci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Keep drinking fluids, even in winter.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-hispanic-girl-smiling-happy-drinking-2053295111">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you’re often out in the cold in light gear, and you find this increases your urinary output, there can be impacts over the long term.</p>
<p>Frequent urination can be <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/osmotic-diuresis">detrimental</a> to your body’s natural salt balance (particularly sodium and <a href="https://www.mayoclinic.org/symptoms/low-potassium/basics/causes/sym-20050632">potassium</a>). So be sure to maintain a healthy diet.</p>
<p>It does seem like a bit of a balancing game. The key, however, is to avoid stressing your body this way when it’s cold. To do this, be sure to dress appropriately and keep warm.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/forget-heatwaves-our-cold-houses-are-much-more-likely-to-kill-us-83030">Forget heatwaves, our cold houses are much more likely to kill us</a>
</strong>
</em>
</p>
<hr>
<h2>What if you don’t notice a difference?</h2>
<p>Although the body has mechanisms to make you <a href="https://pubmed.ncbi.nlm.nih.gov/7330607/">urinate more</a> in the cold, not everyone notices peeing more in winter.</p>
<p>If you keep warm, there’s no reason to think your body would often be “shocked” into responding to cold temperatures.</p>
<p>In fact, when tracked in research studies, it has been common for researchers to record no difference in <a href="https://pubmed.ncbi.nlm.nih.gov/7330607/">urinary</a> <a href="https://pubmed.ncbi.nlm.nih.gov/1172/">output</a> between the <a href="https://pubmed.ncbi.nlm.nih.gov/29757578/">seasons</a>.</p>
<h2>What about the urine?</h2>
<p>It’s not just the volume of urine that might be different in winter. The composition can change too.</p>
<p>The body excretes a higher amount of <a href="https://pubmed.ncbi.nlm.nih.gov/29757578/">calcium</a> in the urine during <a href="https://pubmed.ncbi.nlm.nih.gov/7106963/">winter</a>.</p>
<p>This is more likely due to lifestyle during cold seasons rather than anything internal. We tend to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2800047/">less active</a> in winter, gain <a href="https://pubmed.ncbi.nlm.nih.gov/31093925/">extra weight</a>, and eat more salty, preserved and processed foods.</p>
<p>This means there can be a higher risk of developing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6237522/">kidney stones</a> during winter for people who are susceptible.</p>
<p>So as the weather cools down, be sure to maintain a healthy lifestyle, stay warm, and don’t forget to stay hydrated, even when it’s cold.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-is-urine-yellow-117747">Curious Kids: why is urine yellow?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/184236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>No, you’re not imagining it. You can pee more in winter. Mostly, there’s nothing to worry about. But it could be a sign of hypothermia.Christian Moro, Associate Professor of Science & Medicine, Bond UniversityCharlotte Phelps, PhD Student, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1261282019-11-26T14:30:39Z2019-11-26T14:30:39ZHIV factor in kidney transplants: research sheds new light on risks<figure><img src="https://images.theconversation.com/files/299684/original/file-20191031-187934-19ke80t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The use of HIV-positive organs is now a well-established practice in South Africa.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>South Africa has one of the highest incidences of HIV in the world. More than <a href="https://www.unaids.org/en/regionscountries/countries/southafrica">7 million</a> people in the country are living with HIV. This high prevalence rate has led scientists in the country to explore solutions for a wide range of clinical problems that HIV-positive patients face, including end stage kidney failure.</p>
<p>Over the past <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1408896">10 years</a> 51 kidneys from deceased HIV positive donors have been transplanted into HIV-positive patients in Cape Town, South Africa. My colleagues and I <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1903013">recently published</a> the longer-term outcomes of these patients.</p>
<p>The <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1903013">study looked at</a> survival rates and the impact of the second HIV strain – which is transplanted with the kidney and belonged to the donor – on the recipients.</p>
<p>We found that the survival rates of patients were high and there was no resistance to drug regimens passed on through the donor kidney. Although recipients did get a new strain of the HIV virus from the donor, this strain didn’t have a major long-term clinical impact on the recipient.</p>
<p>Our findings are good news for South Africa – and for other countries wanting to do the same transplants. They clear away a number of uncertainties that scientists have had about the efficacy of using kidneys from HIV-positive donors.</p>
<h2>What we found</h2>
<p>We found that five years after their transplant, 83.6% of patients had survived and 79% had a functioning kidney. So far, the longest survival period we recorded has been 10 years post-transplant. These results are comparable with patients without HIV.</p>
<p>Good patient survival rates are positive news for any country wanting to transplant kidneys from HIV-positive people to those living with HIV.</p>
<p>But we wanted to go beyond survival rates to gain a deeper understanding about the way in which a transplant containing a different HIV strain will influence the recipient.</p>
<p>Our <a href="https://www.nejm.org/doi/full/10.1056/NEJMc1903013">study</a> specifically looked at the impact of the second viral strain. In general, it is not advisable for patients with HIV to get exposed to a second viral strain. This is because the new virus might outgrow the old virus, be more resistant to medication, or form a possible resistant <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2525594/">recombinant virus</a>.</p>
<p>This issue was a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2525594/">limiting factor</a> for many centres interested in using organs from donors living with HIV. The concern was that the risk of obtaining a second viral strain for a fairly healthy HIV-positive recipient was too high.</p>
<p>We sequenced the virus in 24 donors and their matching recipients. Traces of the donor virus were detected in early plasma samples in 32% of recipients. But the donor virus disappeared from the system 12 weeks post-transplant in all cases except one. In this one case, the donor virus was undetectable at 26 weeks post-transplant.</p>
<p>This is reassuring, as we didn’t have to change any of the recipient’s antiretroviral therapy to cover resistant HIV infection. We couldn’t detect a sustained superinfection in any of the 51 South African patients who received transplants from HIV-positive donors. A superinfection is an HIV infection that happens in addition to an existing one.</p>
<p>There was one patient who didn’t adhere to her HIV treatment regimen and her viral load went up from undetectable to a level of 21,752 copies/ml. But we didn’t find any trace of donor virus in the samples taken at this time. We only found the patient’s original virus.</p>
<p>The conclusion we reached, therefore, was that the introduction of a second viral strain is not a clinically significant issue for this population group. This makes the procedure a safe long-term option for patients with HIV.</p>
<h2>Remaining questions</h2>
<p>The impact of transplanting a kidney with an inherent disease like HIV into the recipient is an ongoing research question.</p>
<p>In some South African patients whose transplanted kidney failed after a few years, the reason was identified as recurrence of HIV Associated Nephropathy in the transplanted kidney. This means that despite very good control over the virus in blood samples, there might well be some viral reservoir present in the kidney which is not reached by the antiretroviral therapy. This was also <a href="https://www.ncbi.nlm.nih.gov/pubmed/24309185">reported in another study</a> that used only HIV-negative donors. </p>
<p>Another clinical issue for these patients is exceptionally high rejection rates, requiring strong induction immunosuppression. Rejection happens when the recipient’s body recognises the kidney as foreign and tries to remove or disable it. In general transplant patients need drugs to prevent this process and interestingly, in HIV-positive patients the requirement for anti-rejection drugs is higher than in HIV-negative patients. This is due to a dysregulated immune system.</p>
<p>In this study, only 56.1% of patients were rejection-free after five years. This was despite aggressive induction therapy and high levels of ongoing immunosuppression. Induction therapy makes recipients vulnerable to opportunistic infections as the patient’s CD4 count drops dramatically because of the treatment. CD4 counts are widely used as an indication of how well an HIV positive patient’s immune system is functioning. </p>
<p>In the transplant patient there is a fine balance to keep the patient’s immune system strong enough to fight any infections, but not reject the kidney. It took most of the recipients in this study months to recover their CD4 counts. This meant that they needed ongoing therapy to prevent opportunistic infections and tuberculosis.</p>
<p>The use of HIV-positive organs is now a well-established practice in South Africa and also part of the ongoing <a href="https://www.ncbi.nlm.nih.gov/pubmed/27043422">HOPE study</a> in the US. Positive results showing little impact of the second viral strain are a welcome addition to this work.</p><img src="https://counter.theconversation.com/content/126128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elmi Muller does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research supports kidney transplants from HIV-positive donors to recipients with HIV.Elmi Muller, Head: Division of General Surgery, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1235362019-09-24T16:33:51Z2019-09-24T16:33:51ZHow economics can help save lives: a conversation with Alvin Roth, 2012 Nobel Prize laureate<figure><img src="https://images.theconversation.com/files/293871/original/file-20190924-51410-ah35m2.jpg?ixlib=rb-1.1.0&rect=0%2C22%2C1500%2C974&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alvin Roth exposes his work on "disgusting markets" at the European Meeting of the ESA (Economic Science Association) on 7 September in Dijon, France.</span> <span class="attribution"><a class="source" href="https://www.facebook.com/LESSACDijon/?__tn__=%2Cd%2CP-R&eid=ARBngSpMZimJYuZtJRtmF-Wpb0kA7jAHmrNQ5XvT3cL7BZbQfJGp2-zoJ2KhfStcwFF8cE-s6MM7xBaf">Lessac/BSB</a>, <span class="license">Author provided</span></span></figcaption></figure><p><em>The work of American economist Alvin Roth is a direct response to those who believe that economics is more about mathematics than the real world. A professor at Stanford, he built his reputation by applying economic theory to concrete, everyday problems. A winner of the 2012 Nobel Prize with Lloyd Shapley, Roth has dedicated much of his research to what are known as “repugnant” markets – transactions that “some people would like to engage in while others, even if not directly affected, think they should not be allowed to do so”. One example is selling vital organs for transplant purposes, which is considered repugnant everywhere (or almost) in the world. However, Roth has studied issues related to the supply and demand for organs and has developed a model that allows matching between kidney donors and recipients. In a nutshell, his work has helped increase the number of kidney transplants and thus saved lives.</em></p>
<p><em>The Conversation France met this eminent specialist in experimental economics in Dijon, during his visit at the European Meeting of the Economic Science Association (ESA), organized on September 7, 2019, by the <a href="https://lessac.bsb-education.com/index.php">Laboratory for Experimentation in Social Sciences and Behavioural Analysis</a> (Lessac) of Burgundy School of Business (BSB).</em></p>
<hr>
<p><strong>The Conversation: How would you define a “repugnant” market?</strong></p>
<p>Alvin Roth: I can’t give a perfect definition, but when I speak about repugnant transactions, I think about transactions that some people would like to take part in and other people who are not directly affected by these transactions think they should not be allowed to. A repugnant market is a market of repugnant transactions.</p>
<p><strong>Could you give us a few examples?</strong></p>
<p>One example that I spoke about today was same-sex marriage. Two people would like to marry each other but other people think they maybe shouldn’t be allowed to. This has been a divisive political issue in Europe and in the United States, and different countries and states have reached different conclusions about it. (Currently, constitutional or statutory provisions prohibiting same-sex marriage exist in 13 US states, while it’s legal in the others).</p>
<p><strong>You conception of the matching system to multiply transplantations. The purpose is to build a kidney-exchange chain. How does it works? And how does it cope with the repugnance factor?</strong></p>
<p>Transplantation is not repugnant at all. Transplantation saves the life of someone who has kidney failure, for example, and I don’t think many people object to that. What’s repugnant is <em>purchasing</em> the kidney. Kidneys are special: people have two kidneys and can remain healthy with one, so you might be able to save the live of someone you love by giving them a kidney. But the law requires that these be gifts, not sales. Just about everywhere in the world that’s the law, with the exception of the Islamic Republic of Iran. As a result, there’s a shortage of organs for transplants. Many people die without getting a transplant because there aren’t enough organs for the people who need them, living donor organs included. Sometimes, you might love someone enough to give him a kidney but you can’t give a kidney to the person you love, because kidneys have to be very well-matched. Kidney exchange is a way of getting some transplants done, even when patients and their donors are not well matched.</p>
<p>Maybe you want to give a kidney to your sister and I want to give a kidney to my sister, but neither of us can do that because we’re not good matches for them. But maybe your sister could take my kidney and my sister could take your kidney and that way we get two more transplants and two lives saved. That’s the basic idea of kidney exchange.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=248&fit=crop&dpr=1 600w, https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=248&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=248&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=312&fit=crop&dpr=1 754w, https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=312&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/292394/original/file-20190913-8693-17ngrw7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=312&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kidney chain from Alvin Roth’s presentation ‘Improved markets for doctors, organ transplants and school choice’.</span>
<span class="attribution"><a class="source" href="http://stanford.edu/~alroth/Congressional%20Briefing.BetterLiving.March2010.pdf">Stanford.edu</a></span>
</figcaption>
</figure>
<p><strong>How can your work on transplantations be useful on understanding other repugnant markets?</strong></p>
<p>Partly the question with kidney exchange was to understand what was repugnant and how we could move forward to the larger goal without offending. In a kidney exchange, no one is paid. No one gets money, it’s a kidney for a kidney, and that turns out not to be repugnant. In the United States we were able to get the federal law changed to make clear that kidney exchange is not repugnant. The reasons that some people don’t like certain transactions can be different from the reasons other people want to engage in those transactions.</p>
<p><strong>What are the ways around this repugnance? Are they necessarily to be found in regulation and law?</strong></p>
<p>Just as markets need social support to work well, so do bans on markets. So making laws against markets doesn’t always make them go away, as we learn in the markets for illegal drugs or for prostitution, for example. Different countries and states in the US have different laws about those things. Another market I’ve talked about where there are different rules in different places are markets for things like parental surrogacy. In France, it’s illegal. In California, where I live, it’s legal. Making it illegal in France, however, has not stopped French couples who need a surrogate from getting them. Then you have to deal with how should the law treat the children who should have French citizenship and French parents and might possibly have no citizenship and no parents if the French law is applied too strictly (The French courts have softened the restrictions of the French law in such cases) ! Markets may be both hard to create, and hard to prevent.</p>
<p><strong>How can the study of repugnant markets help regular legal markets?</strong></p>
<p>Technology changes all markets and the opportunities of people in markets. For instance surrogacy was only possible after the invention of <em>in vitro</em> fertilization. This is true in other markets too. We now see financial markets where most of the trades are done by computers. That has changed the nature of the market and sometimes it changes the nature of rules that markets need to run well. I think that markets are a little bit like living organisms. We have to see how they evolve. When we think about how to make them work well, how markets should serve the participants and society, we sometimes have to change the rules by which they work.</p><img src="https://counter.theconversation.com/content/123536/count.gif" alt="The Conversation" width="1" height="1" />
Stanford professor’s research has led to an increase in the number of kidney transplants in the United States.Leighton Kille, Rédacteur en chef, coordination internationale et technique, The Conversation FranceThibault Lieurade, Chef de rubrique Economie + Entreprise, The Conversation FranceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1177472019-08-06T20:07:46Z2019-08-06T20:07:46ZCurious Kids: why is urine yellow?<figure><img src="https://images.theconversation.com/files/286166/original/file-20190730-43153-osy3ym.jpg?ixlib=rb-1.1.0&rect=11%2C7%2C2486%2C1699&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you have been drinking more water than your body needs, the body tells the kidney filters to get rid of the spare water. That's when your urine will look paler.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281719/original/file-20190628-76743-26slbc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><em>If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au.</em> </p>
<hr>
<blockquote>
<p><strong>Why is urine yellow? – Ronan, aged 9, Greenslopes, Brisbane.</strong> </p>
</blockquote>
<hr>
<p>Thank you for your question, Ronan. </p>
<p>Our bodies use nutrients from the food we eat. But the processes involved in digestion also create what we call “byproducts”. That’s where a new chemical is created along the way. </p>
<p>Some of these byproducts in the body are waste and our bodies have clever waste processing systems to get rid of them. </p>
<p>Some of the waste goes out in your poo. And waste that can be dissolved in water goes out in your wee. We call this “water-soluble” waste. Water-soluble means it can be dissolved in water. </p>
<p>And the parts of your body in charge of “making” the wee are called the kidneys. They’re shaped like kidney beans.</p>
<h2>A delicate balance</h2>
<p>The kidneys work around the clock to make sure the body has the right balance of water, salt and chemicals and not too much water-soluble waste in it. </p>
<p>Kidneys have special filters in them that help sort out the useful bits from the waste. They also are in charge of transporting the water-soluble waste from your kidneys, down two special pipes called “ureters” and into your bladder (which is down near the genitals). </p>
<p>When the bladder gets full, it sends a message along your nerves to your brain that makes you feel like you need to wee. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286168/original/file-20190730-43118-jirbhy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kidneys also are in charge of transporting the water-soluble waste from your kidneys, down two special pipes called ‘ureters’ and into your bladder.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-have-two-kidneys-when-we-can-live-with-only-one-113201">Curious Kids: why do we have two kidneys when we can live with only one?</a>
</strong>
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</p>
<hr>
<h2>So…. why is it yellow?</h2>
<p>One of the water-soluble waste products that your kidneys put into your urine is a chemical called urobilin, and it is yellow. </p>
<p>The colour of your urine depends on how much urobilin is in it and how much water is in it. </p>
<p>If your urine is light yellow, it means you have been drinking a lot of water and there’s a lot of water in your urine. We call this being “hydrated”.</p>
<p>If your urine is dark yellow, that means there’s less water, and a relatively high amount of urobilin. It probably means you haven’t been drinking enough water and could be dehydrated.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=457&fit=crop&dpr=1 600w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=457&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=457&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=574&fit=crop&dpr=1 754w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=574&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/286167/original/file-20190730-43126-18hz1l7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=574&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If your urine is light yellow, it means you have been drinking a lot of water.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Too much water versus not enough</h2>
<p>When you haven’t been drinking enough water, the kidneys get a message from your brain to try to keep more water in your body (and out of your bladder). You will also start to feel thirsty. </p>
<p>If people can’t drink water (because they have a vomiting illness, for example), they might need water put directly into their blood. This usually happens in a hospital using a drip (which is where a bag of salt water is put into your blood via a needle in your arm).</p>
<p>If you have been drinking more water than your body needs, the body tells the kidney filters to get rid of the spare water. That’s when your urine will look paler.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-is-a-headache-is-it-our-brain-hurting-112951">Curious Kids: what is a headache? Is it our brain hurting?</a>
</strong>
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</p>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/117747/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Jaqui Hughes is a Torres Strait Islander woman, a specialist physician (kidney doctor) at Royal Darwin Hospital, and a kidney health researcher at Menzies School of Health Research in Darwin. She is employed by the Top End Health Service as a specialist nephrologist, and funded by the National Health and Medical Research Council to lead innovating kidney health research which advances health for Australians.</span></em></p>One of the waste products that your kidneys put into your urine is a chemical called urobilin, and it is yellow.Jaquelyne Hughes, Research Fellow, Menzies School of Health ResearchLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1150382019-06-11T12:10:36Z2019-06-11T12:10:36ZMinorities face more obstacles to a lifesaving organ transplant<figure><img src="https://images.theconversation.com/files/277708/original/file-20190603-69087-ypxh6m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People of color face more obstacles on the path to an organ transplant. </span> <span class="attribution"><span class="source">pixfly/shutterstock.com</span></span></figcaption></figure><p>Patients who experience organ failure need a transplant to improve their odds of survival and to achieve a better quality of life. </p>
<p>However, getting an organ transplant is often accompanied by several challenges, many of which can be attributed to factors like <a href="https://www.who.int/social_determinants/en/">the state of an individual’s living circumstances, their economic status and where they were born</a>.</p>
<p>As a result, many racial and ethnic minorities, such as African Americans, Latinx individuals and Native Americans, must <a href="https://doi.org/10.1111/j.1600-6143.2009.02561.x">unjustly wait longer for a much-needed new organ</a> – or never receive one at all because of these barriers to care.</p>
<p>Research shows that these disparities are avoidable, especially with changes <a href="https://www.ncbi.nlm.nih.gov/pubmed/3068205">at the institutional level</a>. </p>
<h2>Which groups are less likely to get a transplant?</h2>
<p>Transplant trends from the United Network of Organ Sharing indicate that approximately <a href="https://unos.org/data/transplant-trends/">113,600 people are in need of a lifesaving solid organ as of June 2019</a>. The majority have been diagnosed with kidney disease and liver disease.</p>
<p><iframe id="beKLG" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/beKLG/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The most recent data shows that, in 2016, the rate of kidney failure was highest among minority groups. For example, compared to whites, <a href="https://www.usrds.org/2018/view/v2_01.aspx">kidney failure</a> was 9.5 times higher among Native Hawaiians and Pacific Islanders. Latinx individuals were over 50% more likely to be diagnosed with kidney failure than those who did not identify as Latinx.</p>
<p>Although minorities are more likely to be diagnosed with kidney failure, they are less likely to be transplanted. <a href="https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/">The majority of transplants in the U.S.</a> go to whites. </p>
<p><iframe id="NbOLL" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/NbOLL/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>These trends are also evident in groups suffering from liver disease. Asians and Latinx individuals are <a href="https://doi.org/10.1002/hep.28677">more likely to be diagnosed with liver failure</a>, but <a href="https://doi.org/10.1016/j.surg.2017.10.009">less likely to receive a transplant</a>.</p>
<h2>What’s causing these disparities?</h2>
<p>A patient has to undergo several steps <a href="https://doi.org/10.2215/CJN.11731111">before they can receive a transplant</a>. </p>
<p>These steps include a physician deciding that a transplant is medically suitable, the patient demonstrating interest in a transplant, a referral to a transplant center, completion of a pre-transplant evaluation and identification of a suitable living donor. </p>
<p>At each point of the transplant preparation process, there are opportunities for barriers to occur as a result of patient, provider, community and institutional factors. Together, these potentially create disparities in access. </p>
<p><a href="https://doi.org/10.1136/bmjopen-2015-008677">Income level</a> may play a role. Patients with organ failure who experience poverty, for instance, may face challenges <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127035/">covering the cost of their insurance co-payments</a>, especially when they do not have comprehensive insurance or private insurance. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4946478/">Literacy issues</a>, such as gaps in formal education or English as a second language, may also impact a patient’s ability to understand the medical terminology involved in their treatment. This would affect their ability to communicate effectively with their providers. </p>
<p><a href="https://doi.org/10.1111/j.1399-0012.2006.00568.x">Limited knowledge of the benefits of transplantation</a> can also affect patients’ ability to access transplants. Patients who are unaware that transplantation is the preferred treatment may not complete the steps to transplant and instead remain on dialysis.</p>
<p>Providers can also play a role in limiting access. For example, doctors may not
<a href="https://doi.org/10.1097/01.TP.0000443223.89831.85">provide patients with the referral they need or wait longer to provide it</a>. </p>
<p><iframe id="9PpjB" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/9PpjB/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Given negative historical experiences, such as the <a href="https://www.cdc.gov/tuskegee/timeline.htm">Tuskegee Syphilis Study</a>, some patients, especially those who have been historically disadvantaged or are currently marginalized, <a href="https://dx.doi.org/10.1016%2Fj.transproceed.2015.01.016">mistrust medical providers</a>. As a result, they are less likely to seek medical assistance or trust that their providers are giving them accurate information. </p>
<p>Also, patients who report experiences of <a href="https://doi.org/10.2105/AJPH.92.5.811">discrimination by their medical providers</a> are less likely to seek transplantation. They may be discouraged from seeking further medical care because they expect poor treatment by providers. </p>
<p>Low rates of organ donation also influence transplant rates. Although about 95% of Americans are in favor of organ donation, <a href="https://www.organdonor.gov/statistics-stories/statistics.html">only 58% of them are registered as organ donors</a>. These low donation rates are pronounced among racial/ethnic minorities. This could be attributed to factors such as <a href="https://doi.org/10.1080/08838151.2017.1309413">not knowing other registered donors in one’s community and mistrust of providers</a>. </p>
<h2>How can medical providers close the gap?</h2>
<p>I am a counseling psychologist whose research examines health inequities and treatment. Given the enormity of these factors, I conducted a study with my colleague, <a href="https://cph.temple.edu/socialbehavioral/faculty/heather-traino">Heather Gardiner</a>, director of the Health Disparities Research Lab at Temple University.</p>
<p>We sought to identify barriers to the pre-transplant evaluation for African American kidney patients. Patients who complete this evaluation successfully become active on the waitlist.</p>
<p>We looked at barriers at several levels: individual barriers, such as limited income; health barriers, such as having multiple health conditions in addition to kidney disease; educational barriers, such as limited knowledge about the kidney transplant process; and systemic barriers, such as long wait times for medical appointments. We also asked people what motivated them to pursue a transplant.</p>
<p>Our research leads us to believe that changing systemic problems will help address problems at the other levels.</p>
<p>For example, medical providers could consider condensing the medical appointments and testing period for the pre-transplant evaluation. Patients who are motivated to get off dialysis will be more motivated to complete the pre-transplant evaluation if they are able to complete the majority of their medical testing at one place over a short period, rather than having to attend several medical appointments over a long period of time. </p>
<h2>Policy changes also matter</h2>
<p>In order to decide who gets an organ, medical providers give liver patients a MELD score that indicates the severity of their disease.</p>
<p>The introduction of <a href="https://unos.org/wp-content/uploads/unos/MELD_PELD.pdf">the current liver allocation system</a> in 2002 <a href="https://doi.org/10.1001/jama.2008.732">reduced the number of people from minority groups who died waiting for an organ</a>. </p>
<p>Under the previous system, African Americans were more likely to die waiting for a liver transplant, because they generally had higher MELD scores, indicating that their disease was becoming worse. However, the current system prioritizes patients with high MELD scores, which has improved liver transplant rates for this group. </p>
<p>The <a href="https://optn.transplant.hrsa.gov/news/two-year-analysis-shows-effects-of-kidney-allocation-system/">2014 policy change in kidney allocation</a> allowed patients to count time spent on dialysis toward their total time spent on the waitlist, thereby reducing racial and ethnic disparities.</p>
<p>The success of these systemic changes illustrates the effectiveness of policy change. In my view, policies such as comprehensive Medicare coverage – with transportation assistance for all patients with kidney disease, for example – could potentially reduce many of the disparities along the steps to a successful transplant. </p>
<p>Countries such as Austria and Norway have seen significant improvements in their organ donation rates by using an <a href="https://www.who.int/bulletin/volumes/93/3/14-139535/en/">opt-out system, which is based on the assumption that everyone consents unless an individual notes otherwise</a>. Although this topic may be somewhat controversial in the U.S., I feel that the potential benefits of an opt-out policy are worth exploring.</p><img src="https://counter.theconversation.com/content/115038/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Camilla Nonterah received funding from the American Psychological Association to conduct the study described in this article. </span></em></p>Although certain racial minorities are more likely to be diagnosed with organ failure, they are less likely to be transplanted. What’s behind the gap?Camilla Nonterah, Assistant Professor of Health Psychology, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1132012019-03-18T22:08:03Z2019-03-18T22:08:03ZCurious Kids: why do we have two kidneys when we can live with only one?<figure><img src="https://images.theconversation.com/files/264074/original/file-20190315-28475-1vh4qe0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3834%2C2160&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Right now, your kidneys are getting rid of all things your body does not need. They do this by 'cleaning' your blood. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em><a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a> is a series for children. If you have a question you’d like an expert to answer, send it to curiouskids@theconversation.edu.au You might also like the podcast <a href="http://www.abc.net.au/kidslisten/imagine-this/">Imagine This</a>, a co-production between ABC KIDS listen and The Conversation, based on Curious Kids.</em> </p>
<blockquote>
<p><strong>Why do we have two kidneys when we can live with only one? – Question from the students of Ms Morris’ Grade 5 class, Ringwood North Primary School, Victoria.</strong> </p>
</blockquote>
<p>This is a really great question. The answer is scientists are not completely sure but we do have some theories. That is often the case with science.</p>
<p>Most of the animals you see above ground on Earth today, including humans, are the same on both sides. We have two eyes, two ears, and even two nostrils. Scientists gave this a fancy name called “<a href="https://nph.onlinelibrary.wiley.com/doi/full/10.1111/nph.13526">bilateral symmetry</a>.”</p>
<p>If you look in the mirror and draw an imaginary line down the middle of your reflection you will see that you have an arm and a leg on each side. If you had goggles that let you see your insides, you would see that you also have a kidney and a lung on each side too. </p>
<p>But it wasn’t always like this. And some <a href="http://molluscs.at/gastropoda/index.html?/gastropoda/morphology/organ_systems.html">animals</a> still only have one kidney.</p>
<p>Around 500 million years ago, our long-lost relatives that were living in the ocean (some of whom probably only had one kidney) decided to leave the water to walk and live on land. </p>
<p>This was a very important moment in our history because on land, animals could change to grow a very complicated body with all of the important organs that are inside you, including two kidneys. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-does-my-tummy-turn-food-into-poo-110353">Curious Kids: how does my tummy turn food into poo?</a>
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<h2>Two kidneys better than one?</h2>
<p>Right now, your kidneys are getting rid of all things your body does not need. They do this by “cleaning” your blood. </p>
<p>All of this waste will exit your body when you go to the toilet to pee. But your kidneys do a lot more than just clean your blood. They help your bones stay healthy, tell your body when to make new blood cells, and even help you stay upright when you’re walking around all day by taking care of your blood pressure.</p>
<p>With all those important functions, scientist think having two kidneys must be important for our survival. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264077/original/file-20190315-28471-gblrhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Kidneys ‘clean’ your blood and send waste to your bladder, so you can pee it out.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Growing up with one kidney</h2>
<p>It is true, you <em>can</em> live with only one kidney. Some people are <a href="https://www.ncbi.nlm.nih.gov/pubmed/18612657">born with only one</a> because the other one did not grow properly. Other times, the two kidneys touch each other when they are first growing and join together, making one kidney shaped like a <a href="https://www.ncbi.nlm.nih.gov/pubmed/27324557">horseshoe</a>. People with these types of kidneys have to be very careful because they might get sick more easily than someone who has two kidneys. </p>
<h2>Needing an extra kidney</h2>
<p>Sometimes our kidneys stop working. When this happens our blood cannot be cleaned and we can get very sick. The only way to stay alive is to be attached to a big machine that cleans your blood for you, or have a <a href="https://kidney.org.au/your-kidneys/support/kidney-transplant">kidney transplant</a>. </p>
<p>This happened to me when my kidneys stopped working properly. My dad gave me one of his kidneys. Thanks, Dad.</p>
<p>There are two people involved in a kidney transplant: a donor who is going to give their kidney, and a recipient who will receive the kidney. </p>
<p>After the new kidney is put into the recipient, both the donor and recipient only have one kidney that works properly. Both the donor and the recipient can live long happy lives with only one kidney. They just have to take extra care that they eat healthily and exercise to stay fit. <a href="https://www.heraldsun.com.au/leader/south-east/springvales-twanny-farrugia-marks-45-years-since-receiving-kidney-transplant/news-story/e9ece94308f61042f5f2d9d328823d4c">One person</a> living in Australia has been using a transplanted kidney for 45 years!</p>
<p>So, while your body works best when all of your organs are inside you and working properly, scientists still don’t exactly know why we have two kidneys. However, it is good to know that we have a few spare parts that we can live without.</p>
<p>And if you’re an adult reading this, it’s good to make sure you are <a href="https://donatelife.gov.au/register-donor-today">registered as an organ donor</a> and also chat to your family so they know you want to donate. You may one day save a life.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-are-burps-so-loud-108988">Curious Kids: why are burps so loud?</a>
</strong>
</em>
</p>
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<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p>
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age and which city you live in. We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/113201/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brooke Huuskes volunteers for Transplant Australia and Kidney Health Australia.</span></em></p>When my kidneys stopped working properly, my dad gave me one of his kidneys. Thanks, Dad.Brooke Huuskes, Lecturer in Human Anatomy, Physiology Anatomy & Microbiology, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1074372019-01-09T19:11:26Z2019-01-09T19:11:26ZHealth Check: how do I tell if I’m dehydrated?<figure><img src="https://images.theconversation.com/files/251381/original/file-20181218-27755-1srl4gf.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our bodies are pretty good at telling us when we need to drink water.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/318707438?src=CgB_03VldITQhc4gtSJ0Mg-1-0&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>It’s a message that’s been drummed into us since childhood. Drink water, especially when it’s hot, otherwise you’ll get dehydrated.</p>
<p>But how do you know if you’re dehydrated? Who’s more at risk? And what can you do about it?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-i-have-to-drink-eight-glasses-of-water-per-day-we-asked-five-experts-93025">Do I have to drink eight glasses of water per day? We asked five experts</a>
</strong>
</em>
</p>
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<h2>What’s dehydration and why does it matter?</h2>
<p>When people use the term dehydration, they usually refer to what doctors call “volume depletion” or hypovolaemia.</p>
<p>Volume depletion is a reduction in the volume of water in the blood vessels. But dehydration is <a href="https://www.sciencedirect.com/science/article/pii/S0272638611008134">quite different</a> and is less common. It’s the loss of water from both blood vessels and the body’s cells.</p>
<p>Doctors are concerned about volume depletion and dehydration because adequate hydration is required for the body to function normally. Water maintains our body temperature and lubricates our joints. Our body’s cells rely on water as does our circulatory, respiratory, gastrointestinal and neurological systems. </p>
<p>Severe cases of volume depletion can lead to shock and collapse. Without resuscitation with fluid, the consequences may be devastating. </p>
<h2>Water, water everywhere</h2>
<p>A 70kg person is made up of 40L (40kg) is water. Two-thirds of that water is in the cells (intracellular), one-third outside the cells (extracellular). </p>
<p>Outside the cells, 20% of body water is in plasma (around 3L), which together with red bloods cells (2L) gives a total 5L of blood. It’s the movement of water between compartments that maintains each one’s biochemical composition, allowing your cells and body to work normally.</p>
<p>The total body water volume (water in both the blood vessels and the body’s cells) is remarkably constant given the large variation in how much an individual might take in and lose each day.</p>
<p>Water intake is accounted for mostly by how much and what you drink and eat, and the daily variation is regulated by the kidney, which alters your urine output.</p>
<p>The main function of the kidney is to regulate the volume and composition of body fluids within narrow limits by altering output.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidneys-are-amazing-for-all-they-do-be-sure-to-look-after-yours-30966">Kidneys are amazing for all they do, be sure to look after yours</a>
</strong>
</em>
</p>
<hr>
<p>When you drink large volumes of fluid, your body can afford to get rid of increased amounts of dilute urine. But when you drink a minimal amount of fluid, your urine is concentrated and you pass only a small volume.</p>
<p>If you’re urinating less often than normal, or urinating small volumes of darker coloured urine, it may be time to drink more water.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-can-your-doctor-tell-from-your-urine-74990">Health Check: what can your doctor tell from your urine?</a>
</strong>
</em>
</p>
<hr>
<p>Other small losses of water include through stool, sweat and lungs.</p>
<p>So if you have diarrhoea or are exercising in the heat, for instance, you will need to drink more fluids. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drink-plenty-of-fluids-to-cope-with-the-heat-but-there-is-no-need-to-avoid-caffeine-22077">Drink plenty of fluids to cope with the heat, but there is no need to avoid caffeine</a>
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</em>
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<p>As fluid is lost from the extracellular compartment such as in cases of diarrhoea and vomiting or bleeding, you can develop symptoms of volume depletion including:</p>
<ul>
<li>thirst, including a dry mouth</li>
<li>dizziness, particularly when standing due to the low blood pressure (a consequence of volume loss) </li>
<li>and when very severe, confusion (a consequence of inadequate oxygenation of the brain).</li>
</ul>
<p>Doctors might also note:</p>
<ul>
<li>that it takes longer for your skin to bounce back when pinched (known as reduced <a href="https://medlineplus.gov/ency/article/003281.htm">skin turgor</a>)</li>
<li>low blood pressure as a reduction in volume directly affects blood pressure</li>
<li>an increased heart rate, in an attempt by the body to maintain blood pressure</li>
<li>reduced weight as fluid makes up two-thirds of body weight. A loss of 1L of fluid will read as a drop in 1kg on the scales.</li>
</ul>
<p>Blood testing will often reveal a degree of kidney impairment. That’s because the kidneys require a large blood flow to work normally. </p>
<p>In cases of volume depletion and reduction in blood pressure, blood flow to the kidneys is compromised and they go into a state of “shock”. Mostly this is reversible when volume and blood pressure is restored. </p>
<p>As there’s no single test for volume depletion, doctors <a href="https://journals.lww.com/co-clinicalnutrition/Abstract/2016/11000/Diagnosing_dehydration__Blend_evidence_with.6.aspx">will make a diagnosis</a> after taking a note of your history, examining you and a combination of blood and urine tests.</p>
<h2>Here’s what happened to Tom</h2>
<p>I was on call at the hospital recently when, at 9.45pm on a Sunday, I received a call from the emergency department.</p>
<p>Tom, a 78 year old man, had come in by ambulance after neighbours had found him on his bedroom floor. Tom’s cognition was not great at the best of times, and that night he couldn’t tell us how long he had been on the floor.</p>
<p>There were no obvious injuries, his blood pressure was low (100/60mmHg), pulse rate high (98 beats per minute) and his temperature was normal. Blood tests showed he had low sodium salt levels and kidney impairment. </p>
<p>Tom had been in the emergency department for six hours by the time the call came to me; in that time he had not passed urine. It all pointed to volume depletion.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/251384/original/file-20181218-27761-1noco5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Elderly people are at increased risk, so keep an eye on relatives and neighbours this summer.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/3356108?src=epNbeK9CfuMh7N5r-SHO-w-1-32&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>We treated Tom with intravenous fluid. He needed 5L over 48 hours, after which he was passing urine again. His blood pressure was back to normal 140/70mmHg, his kidney function had normalised and his weight was up from 46kg on admission to 50kg. </p>
<p>Tom told us he had fallen while getting up at night. He had been on the floor for most of the next day and had not eaten or drunk anything for hours.</p>
<h2>Who’s most at risk and why?</h2>
<p>Some groups are more susceptible to volume depletion, including:</p>
<ul>
<li>elderly people like Tom, as our total body water reduces with age and the elderly often have a reduced sensation of thirst. Many older people also have other health problems including <a href="https://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942">chronic kidney disease</a>, which may impact the ability to concentrate urine when the volume is depleted</li>
<li>babies, because they aren’t able to articulate when they’re thirsty. They have a higher metabolic rate than adults meaning they require more fluid</li>
<li>people with impaired thirst mechanisms such as the elderly or people with certain brain injuries </li>
<li>people losing large volumes of fluid via the bowel (from diarrhoea or through a colostomy)</li>
<li>people taking medications that promote water loss, in particular diuretics, often referred to as water tablets.</li>
</ul>
<p>These vulnerable groups need to be aware of the increased risk of volume depletion, minimise their risk by maintaining fluid levels, recognise the symptoms of volume depletion early, and seek prompt treatment, including going to hospital if necessary.</p>
<p>If you experience the symptoms of volume depletion it’s important to take heed. At home, start with water if you’re thirsty. Once dizziness is present, significant volume loss has ensued and a trip to the doctor is in order. Confusion mandates emergency treatment.</p>
<h2>How about physiological dehydration?</h2>
<p>Physiological dehydration, which occurs when water is lost from both the blood vessels and from the body’s cells compartment, <a href="https://www.sciencedirect.com/science/article/pii/S0272638611008134">is distinct</a> from volume depletion. But there are many overlapping symptoms, such as thirst, a drop in blood pressure and when severe, confusion. </p>
<p>Dehydration can happen with prolonged and sustained high blood sugar levels as can occur in someone with diabetes. This is because the high sugar levels in the blood pull water out of the cells in an attempt to lower the levels. High sugar levels also make you pass more urine. So in this instance there is loss of fluid from both the intracellular and extracellular compartments.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-diabetes-11842">Explainer: what is diabetes?</a>
</strong>
</em>
</p>
<hr>
<p>So for those with diabetes, monitoring blood sugar levels is important. If the blood sugar is persistently high it’s important to seek medical advice to reduce the level safely and prevent dehydration. </p>
<h2>In a nutshell</h2>
<p>Water is vitally important to the normal function of the body. Volume depletion can occur during anytime of the year, but people are particularly prone over the summer months. The key is prevention and knowing what the signs and symptoms are. So in summer keep your fluids up; talk to your doctor about any medications that may need adjusting (such as diuretics) and keep an eye out for friends, family and neighbours.</p><img src="https://counter.theconversation.com/content/107437/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Dwyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most of us get thirsty when we need to drink more water. But there are other tell-tale signs that not all is well.Karen Dwyer, Deputy Head, School of Medicine, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/947102018-05-30T10:38:17Z2018-05-30T10:38:17ZOrgans-on-chips: Tiny technology helping bring safe new drugs to patients faster<figure><img src="https://images.theconversation.com/files/220515/original/file-20180525-90281-17z2fmg.jpg?ixlib=rb-1.1.0&rect=46%2C84%2C4087%2C3038&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It doesn't look like a kidney, but this 'kidney-on-a-chip' is a breakthrough for new drug testing.</span> <span class="attribution"><span class="source">Alex Levine</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Getting a new pharmaceutical from an <a href="https://www.fda.gov/ForPatients/Approvals/Drugs/default.htm">idea in the chemistry lab to market</a> takes many years and billions of dollars. Each year just <a href="https://www.fda.gov/Drugs/DevelopmentApprovalProcess/DrugInnovation/ucm537040.htm">several dozen new drugs are approved</a> for use in the United States. </p>
<p>Human “organs-on-chips” are leading a revolution in drug safety testing. These devices use human cells to model the structure and function of human organs and tissues. By testing the potential effects of drugs on different organs faster than traditional methods, organs-on-chips can reduce the need for animal studies and better predict which new drugs will effectively treat human disease.</p>
<p><a href="https://scholar.google.com/citations?user=dHBPovIAAAAJ&hl=en&oi=ao">As part</a> of an interdisciplinary research <a href="http://depts.washington.edu/kellylab/">team</a> with funding support from the National Center for Advancing Translational Sciences, we’re working on a kidney-on-a-chip to improve our understanding of how kidney diseases begin and which drugs can safely treat them. </p>
<h2>Quicker and better testing</h2>
<p>Historically, laboratory testing for new drugs is performed in cells grown in dishes or flasks. If a drug passes initial screening tests in vitro, researchers next test it in vivo in live animals to determine the effects of a new drug on a whole system instead of just one cell type at a time. Finally, after many years of laboratory investigation, researchers will test a promising new drug in people to see if it is safe and effective. </p>
<p>The problem is <a href="https://www.pharmaceutical-technology.com/features/featurecounting-the-cost-of-failure-in-drug-development-5813046/">9 out of 10 of these drugs</a> never make it from small-scale human tests to the patient because they turn out to be ineffective or toxic, even if they showed promising results in early testing.</p>
<p>Organs-on-chips have the potential to completely transform that system. Ranging from the size of a fingernail to that of a credit card, they’re composed of fluid channels and tiny chambers that contain human cell samples. Organs-on-chips <a href="https://ncats.nih.gov/tissuechip/about">in development in labs around the country</a> include kidney, lung, liver, intestine, skin, brain, heart, bone and reproductive systems.</p>
<p>In an organ-on-a-chip, flowing liquid supplies the cells with oxygen and nutrients, similar to the way blood sustains cells in the human body. It’s this constant flow that makes these devices special. Cells grown in organs-on-chips devices act more like cells in a human organ than do cells grown in flat dishes without flow.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/220361/original/file-20180524-51141-1z0jvvy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Fluid circulates through a kidney-on-a-chip.</span>
<span class="attribution"><span class="source">Alex Levine</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Case of the kidney-on-a-chip</h2>
<p><a href="https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work">Kidneys are incredibly important</a> to overall human health. The two fist-sized kidneys remove drugs and unwanted compounds from the body and play a critical role in maintaining proper salt and water balance, blood pressure and vitamin D and bone health. Genetic conditions and even commonly administered medications can, in some circumstances, damage the kidneys.</p>
<p>In the U.S., <a href="https://www.cdc.gov/kidneydisease/pdf/kidney_factsheet.pdf">15 percent of adults have kidney diseases</a>. But most don’t even know it, because kidney diseases often display no symptoms until the condition is very advanced. There’s a pressing need to understand how kidney disease begins, and to develop new safe and effective treatments.</p>
<p>Here at the University of Washington, our kidney-on-a-chip research team is composed of scientists from many different disciplines, including pharmacy, pharmaceutical sciences, nephrology (kidney medicine), toxicology, biochemistry and bioengineering.</p>
<p>In partnership with <a href="https://www.nortisbio.com">Nortis, Inc.</a>, a local biotechnology company, our team has created a small device — the size of a business card — with up to three tiny tubes, each one-thousandth the size of a drop of water, containing 5,000 human kidney cells. When tiny amounts of fluid are pumped through the tubes, the <a href="https://doi.org/10.1016/j.kint.2016.06.011">kidney cells are exposed to important signals</a> that help the cells in the chip behave as if they were in a live kidney.</p>
<p>We’ve found that the kidney cells release signals – called biomarkers – of injury when exposed to known kidney toxins. Our research showed that cells on the chip released markers of injury commonly seen in the urine of people with kidney damage. Testing with the older method, using cells on plates, did not show any damage with the same treatment. This suggests that the <a href="https://doi.org/10.1681/ASN.2015010060">kidney-on-a-chip may be better</a> than existing methods at predicting if a new drug will cause kidney damage in humans.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&rect=60%2C68%2C892%2C589&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&rect=60%2C68%2C892%2C589&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/215467/original/file-20180418-163975-nzy7ci.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">These devices do a better job of testing how molecules affect living human cells.</span>
<span class="attribution"><span class="source">Alex Levine</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Connecting organs-on-chips to mimic systems</h2>
<p>Now that we’ve had these promising results, scientific teams across the country are starting to connect different organs together to replicate a more complex, multi-organ system, to give greater insights into how drugs affect people. For example, we were able to connect a <a href="https://doi.org/10.1172/jci.insight.95978">liver-on-a-chip to a kidney-on-a-chip</a> to learn how a plant extract used in some herbal medicines, called aristolochic acid, damages kidney cells. This chip-to-chip investigation reinforces the need for interconnected organs-on-a-chip to replicate the complex mechanics in the human body.</p>
<p>In the coming year, our kidney-on-a-chip project will be one of several <a href="https://ncats.nih.gov/tissuechip/projects/space">sent to the International Space Station</a> where low gravity speeds up changes in cells, sometimes causing health problems for astronauts. The Space Station could be the perfect place to find out more about kidney diseases in weeks, rather than years or decades.</p>
<p>Organs-on-chips can also be used to discover new drug targets. Our team is evaluating the kidney-on-a-chip as a tool to personalize drug selection and dosing in people with kidney cancer, polycystic kidney disease and chronic kidney disease. Other organs-on-chips labs around the country are studying diseases of the immune system, brain, lungs, heart and blood vessels. By working together, dozens of research teams are developing this new technology to revolutionize drug discovery, leading to the development of better and safer medications for all.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/CYBrpCUkdVQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A pocket-size revolution in kidney research.</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/94710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Yeung receives funding from The National Institutes of Health (NCATS, NIGMS)</span></em></p><p class="fine-print"><em><span>Edward Kelly receives funding from National Institutes of Health, Environmental Protection Agency and Center for Advancing Science in Space.</span></em></p><p class="fine-print"><em><span>Jonathan Himmelfarb has received relevant grant funding from the U.S. National Institutes of Health and the Center for Advancement of Science in Space.</span></em></p>Researchers who’ve created a kidney-on-a-chip explain why these kinds of devices are an improvement over traditional ways to test new drugs.Catherine Yeung, Research Assistant Professor of Pharmacy, University of WashingtonEdward Kelly, Associate Professor of Pharmaceutics, University of WashingtonJonathan Himmelfarb, Director of the Kidney Research Institute and Professor of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/739772017-11-05T08:57:40Z2017-11-05T08:57:40ZChronic kidney disease is still a major health challenge in Africa<figure><img src="https://images.theconversation.com/files/167721/original/file-20170503-21630-oieauo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Africa, many patients with kidney failure either incur catastrophic out of pocket medical bills or die. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Close to <a href="http://ac.els-cdn.com/S0140673614616019/1-s2.0-S0140673614616019-main.pdf?_tid=f8b4e8d6-03fb-11e7-9f66-00000aab0f01&acdnat=1488976820_5379aaf2200a299d73269e2b7a23e5d9">three million people</a> suffering from chronic kidney failure across the world receive renal replacement therapy every year. But between <a href="http://mema.aub.edu.lb/wp-content/uploads/2017/06/VARIANCE-AND-SCOPE-OF-DESTRUCTION-IN-DELIVERY-OF-RENAL-CARE-DURING-CONFLICTS-Mohamad-Sukkarie.pdf">4.9 million and 9.7 million</a> more still need treatment. And at least two million die because they cannot access it. </p>
<p>Kidneys filter wastes and excess fluids from the blood which are then excreted in the urine. When someone has chronic kidney disease, their kidneys are unable to perform these tasks and they require renal replacement therapy in the form of dialysis or kidney replacement. </p>
<p>Chronic kidney disease is a global problem with about <a href="https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease">10% of the world’s population</a> suffering from the disease. </p>
<p>But in <a href="http://www.kisupplements.org/article/S2157-1716(15)31135-7/pdf">sub-Saharan Africa</a>, about 14% of the adult population suffers from chronic kidney disease . Between 1999 and 2006 South Africa saw a <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742015000300034">67% rise in deaths</a> as a result of chronic kidney disease.</p>
<p>There are three main challenges with managing chronic kidney disease on the continent. Firstly lifestyle changes have resulted in increasing obesity rates which in turn increases the risk of kidney disease. Secondly, there is the link between HIV and kidney failure and thirdly, there are treatment failures.</p>
<p>Many patients with kidney failure either incur catastrophic out of pocket medical bills, or they die. If the underlying challenges aren’t addressed the problems that come with expected increases in chronic kidney disease on the continent will only get worse.</p>
<h2>Obesity’s role</h2>
<p>Obesity is one of the most potent risk factors for people developing kidney disease. This is because it increases the risk of people developing diabetes and hypertension – two of the major risks for chronic kidney disease. </p>
<p>The rise in <a href="https://academic.oup.com/heapro/article/28/1/4/579695/Obesity-in-sub-Saharan-Africa-development-of-an">obesity rates</a> has been rapid, substantial and widespread. As a result, obesity has become a major public health epidemic in both the developed and developing world.</p>
<p>The estimations are that by 2025, obesity will affect 18% of men and more than 21% of women worldwide while severe obesity will affect 6% of men and 9% of women.</p>
<p>On the continent South Africa has the highest number of overweight and obese people. Close to <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30054-X.pdf">70%</a> of South Africa’s women are overweight or obese, according to a study by The Lancet. More 25% of girls are also overweight or obese. </p>
<p>The Lancet study found that 70% of South African women are overweight and 42% are obese. The problem is also acute in children. There is combined overweight and obesity prevalence of 13.5% for South African children aged six to 14 years. This is higher than the global prevalence of 10% in schoolchildren, but lower than current levels in the US.</p>
<p>If action is not taken to halt this epidemic, the expected increase in overweight and obese South African children will become a major concern.</p>
<p>There are very specific dietary and lifestyle changes that are linked to obesity. This includes patterns of increased eating, drinking and smoking along with reduced physical activity, and a shift to a diet high in sugar, salt and saturated fat.</p>
<p>Evidence shows that people with a higher weight-to-height ratio – more commonly known as a body mass index – have a higher risk of developing cardiovascular disease, cancer, diabetes, osteoarthritis and chronic kidney disease. </p>
<h2>Expensive treatment</h2>
<p>Treatment of chronic kidney disease on the African continent is dire. Of the world’s population that needed renal replacement therapy, only 1% of those who received treatment lived in Africa.</p>
<p>There are two main problems: </p>
<ul>
<li><p>dialysis is costly, and </p></li>
<li><p>there are too few facilities to perform transplants.</p></li>
</ul>
<p>In South Africa, more than half of potentially eligible patients are turned down for dialysis as a result of cost. But dialysis not a cure, it is a lifeline while patients wait for a transplant. </p>
<p>In South Africa there only three public hospitals that offer kidney transplants. And on the rest of the continent, there are very few countries offering routine transplants. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5325483/">Nigeria</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/8991246">Kenya</a> have started up programmes. </p>
<h2>The link between kidney failure and HIV</h2>
<p>Africa carries the world’s highest burden of HIV: In 2013, more than <a href="https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/overview">24.7 million</a> people were living with the disease, accounting for 71% of the total caseload on the globe. </p>
<p>Studies have also shown that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362304/">severe immunosuppression</a> – or CD4 counts less than 200 – are a predominant risk factor for acute kidney infection.</p>
<p>The extent of the HIV epidemic and its associated burden of chronic kidney disease on the continent make it a challenging problem. </p>
<p>The main challenge is that there are no measures to prevent renal disease in people living with HIV or to detect it early enough to treat it. As a result, most clinicians deal with advanced stages of chronic kidney failure in people living with HIV.</p>
<h2>Making changes</h2>
<p>The underlying causes that lead to chronic kidney disease need to be tackled as a matter of urgency.</p>
<p>Firstly, the challenge of a rise in diet-related non-communicable diseases – such as obesity and hypertension – which accounts for 28% of the burden of disease in South Africa, must be addressed.</p>
<p>One critical intervention would be to get people to eat healthier. For obese individuals sustained moderate weight loss by itself is definitely beneficial in obesity, especially “morbid” obesity, but also in diabetes, hypertension, hyperlipidaemia, cardiorespiratory diseases and other chronic degenerative diseases associated with any degree of excess body fat.</p>
<p>Reducing salt intake would also make a dramatic difference. Excessive salt leads to increased risk of stomach cancer, kidney failure, dehydration, high blood pressure and hypertension, which in turn can contribute to heart disease and strokes. </p>
<p>Another critical intervention is education: people need to understand the causes and risks. Action and clear strategies are needed. South Africa’s Department of Health realises the significance of the obesity crisis, and has included this in the national non-communicable diseases strategic goals to assist with the obesity problem in the country: </p>
<ul>
<li><p>Increase physical activity by 10% by 2020;</p></li>
<li><p>Reduce the consumption of alcohol by 20% by 2020; and</p></li>
<li><p>Reduce the percentage of people who are obese and overweight by 10% by 2020.</p></li>
</ul>
<p>But there’s only so much that governments can do. It’s up to the individuals to improve their health and quality of life.</p><img src="https://counter.theconversation.com/content/73977/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Chronic kidney disease is a global problem with about 10% of the world’s population suffering from the disease.Irene Labuschagne, Principle dietitian at the Nutrition Information Centre, Stellenbosch UniversityJohan Nel, Senior specialist in the Division of Nephrology, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/849842017-10-06T12:07:14Z2017-10-06T12:07:14ZSeven body organs you can live without<figure><img src="https://images.theconversation.com/files/188981/original/file-20171005-9767-cuvhjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/524547064?src=7BzLJVYQ1VRz-PBIWK19zA-1-7&size=medium_jpg">Komsan Loonprom/Shutterstock</a></span></figcaption></figure><p>The human body is incredibly resilient. When you donate a pint of blood, you lose about 3.5 trillion red blood cells, but your body quickly replaces them. You can even lose large chunks of vital organs and live. For example, people can live relatively normal lives with just <a href="https://www.scientificamerican.com/article/strange-but-true-when-half-brain-better-than-whole/">half a brain</a>). Other organs can be removed in their entirety without having too much impact on your life. Here are some of the “non-vital organs”.</p>
<h2>Spleen</h2>
<p>This organ sits on the left side of the abdomen, towards the back under the ribs. It is most commonly removed as a result of <a href="http://www.mayoclinic.org/tests-procedures/splenectomy/basics/definition/prc-20014837">injury</a>. Because it sits close the ribs, it is vulnerable to abdominal trauma. It is enclosed by a tissue paper-like capsule, which easily tears, allowing blood to leak from the damaged spleen. If not diagnosed and treated, it will result in death. </p>
<p>When you look inside the spleen, it has two notable colours. A dark red colour and small pockets of white. These link to the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25827019">functions</a>. The red is involved in storing and recycling red blood cells, while the white is linked to storage of white cells and platelets. </p>
<p>You can comfortably live without a spleen. This is because the <a href="https://www.nature.com/nm/journal/v22/n8/abs/nm.4146.html">liver</a> plays a role in recycling red blood cells and their components. Similarly, other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912742/">lymphoid</a> tissues in the body help with the immune function of the spleen.</p>
<h2>Stomach</h2>
<p>The stomach performs four main functions: mechanical digestion by contracting to smash up food, chemical digestion by releasing acid to help chemically break up food, and then absorption and secretion. The stomach is sometimes surgically removed as a result of cancer or <a href="https://www.ncbi.nlm.nih.gov/pubmed/23299691">trauma</a>. In 2012, a British woman had to have her stomach removed after ingesting a cocktail that contained <a href="https://www.theguardian.com/uk-news/2015/sep/17/oscars-wine-bar-lancaster-gaby-scanlon-stomach-liquid-nitrogen">liquid nitrogen</a>. </p>
<p>When the stomach is removed, surgeons attach the oesophagus (gullet) directly to the small intestines. With a good recovery, people can eat a normal diet alongside vitamin supplements.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/188997/original/file-20171005-9802-1xtnxvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/188997/original/file-20171005-9802-1xtnxvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/188997/original/file-20171005-9802-1xtnxvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/188997/original/file-20171005-9802-1xtnxvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/188997/original/file-20171005-9802-1xtnxvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/188997/original/file-20171005-9802-1xtnxvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/188997/original/file-20171005-9802-1xtnxvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Just say no.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/481346812?src=129ytwDJbwcoCKIBWkm-Hg-1-0&size=medium_jpg">Nazar Skladanyi/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Reproductive organs</h2>
<p>The primary reproductive organs in the male and female are the testes and ovaries, respectively. These structures are paired and people can still have children with only one functioning. </p>
<p>The removal of one or both are usually the result of cancer, or in males, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28181114">trauma</a>, often as a result of <a href="http://www.thesaurus.com/">violence, sports or road traffic accidents</a>. In females, the uterus (womb) may also be removed. This procedure (hysterectomy) stops women from having children and also halts the menstrual cycle in pre-menopausal women. Research suggests that women who have their ovaries removed do not have a reduced life <a href="http://www.sciencedirect.com/science/article/pii/S0015028211026707?via%3Dihub">expectancy</a>. Interestingly, in some male populations, removal of both testicles may lead to an increase in life <a href="http://www.cell.com/current-biology/abstract/S0960-9822(12)00712-9">expectancy</a>.</p>
<h2>Colon</h2>
<p>The colon (or large intestine) is a tube that is about six-feet in length and has four named parts: ascending, transverse, descending and sigmoid. The primary functions are to resorb <a href="http://gut.bmj.com/content/43/2/294">water</a> and prepare faeces by compacting it together. The presence of cancer or other diseases can result in the need to remove some or all of the colon. Most people <a href="http://www.macmillan.org.uk/information-and-support/bowel-cancer/colon/treating/surgery/surgery-explained/bowel-function-after-surgery.html#10376">recover</a> well after this surgery, although they notice a change in bowel habits. A diet of soft foods is initially recommended to aid the healing process.</p>
<h2>Gallbladder</h2>
<p>The gallbladder sits under the liver on the upper-right side of the abdomen, just under the ribs. It stores something called bile. Bile is constantly produced by the liver to help break down fats, but when not needed in digestion, it is stored in the gallbladder. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/189172/original/file-20171006-25779-1xhjb78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/189172/original/file-20171006-25779-1xhjb78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=858&fit=crop&dpr=1 600w, https://images.theconversation.com/files/189172/original/file-20171006-25779-1xhjb78.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=858&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/189172/original/file-20171006-25779-1xhjb78.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=858&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/189172/original/file-20171006-25779-1xhjb78.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1079&fit=crop&dpr=1 754w, https://images.theconversation.com/files/189172/original/file-20171006-25779-1xhjb78.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1079&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/189172/original/file-20171006-25779-1xhjb78.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1079&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Gallstones.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/402377269?src=nMNoBd-xTXOiy6me9B-njg-1-28&size=medium_jpg">Martin Charles Hatch/Shutterstock</a></span>
</figcaption>
</figure>
<p>When the intestines detect fats, a hormone is released causing the gallbladder to contract, forcing bile into the intestines to help digest fat. However, excess cholesterol in bile can form gallstones, which can block the tiny pipes that move bile around. When this happens, people may need their gallbladder removed. The surgery is known as (<a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0025032/">cholecystectomy</a>. Every year, about <a href="https://www.ncbi.nlm.nih.gov/books/NBK262451/pdf/Bookshelf_NBK262451.pdf">70,000</a> people have this procedure in the UK. </p>
<p>Many people have gallstones that don’t cause any symptoms, others are not so fortunate. In 2015, an Indian woman had <a href="http://www.huffingtonpost.co.uk/2015/11/30/gall-stones-removed-woman_n_8680178.html">12,000</a> gallstones removed – a world record. </p>
<h2>Appendix</h2>
<p>The appendix is a small blind-ended worm-like structure at the junction of the large and the small bowel. Initially thought to be vestigial, it is now believed to be involved in being a “<a href="https://www.ncbi.nlm.nih.gov/pubmed/17936308">safe-house</a>” for the good bacteria of the bowel, enabling them to repopulate when needed. </p>
<p>Due to the blind-ended nature of the appendix, when intestinal contents enter it, it can be difficult for them to escape and so it becomes inflamed. This is called appendicitis. In severe cases, the appendix needs to be surgically removed.</p>
<p>A word of warning though: just because you’ve had your appendix out, doesn’t mean it can’t come back and cause you pain again. There are some cases where the stump of the appendix might not be fully removed, and this can become inflamed again, causing “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183543/">stumpitis</a>”. People who have had their appendix removed notice no difference to their life.</p>
<h2>Kidneys</h2>
<p>Most people have two kidneys, but you can survive with just one – or even none (with the aid of dialysis). The role of the kidneys is to filter the blood to maintain water and electrolyte balance, as well as the acid-base balance. It does this by acting like a sieve, using a variety of processes to hold onto the useful things, such as proteins, cells and nutrients that the body needs. More importantly, it gets rid of many things we don’t need, letting them pass through the sieve to leave the kidneys as urine. </p>
<p>There are many reasons people have to have a kidney – or both kidneys – removed: <a href="https://patient.info/doctor/inherited-kidney-diseases">inherited</a> conditions, damage from drugs and alcohol, or even infection. If a person has both kidneys fail, they are placed onto <a href="http://www.nhs.uk/Conditions/Dialysis/Pages/Introduction.aspx">dialysis</a>. This comes in <a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022165/">two forms</a>: haemodialysis and peritoneal dialysis. The first uses a machine containing dextrose solution to clean the blood, the other uses a special catheter inserted into the abdomen to allow dextrose solution to be passed in and out manually. Both methods draw waste out of the body. </p>
<p>If a person is placed on dialysis, their life expectancy depends on many things, including the type of dialysis, sex, other diseases the person may have and their age. Recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5203814/">research</a> has shown someone placed on dialysis at age 20 can expect to live for 16-18 years, whereas someone in their 60s may only live for five years.</p><img src="https://counter.theconversation.com/content/84984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor is affiliated with the Anatomical Society. </span></em></p>Not all body organs are vital.Adam Taylor, Director of the Clinical Anatomy Learning Centre and Senior Lecturer, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/563902016-04-01T04:23:01Z2016-04-01T04:23:01ZFour things parents can do to keep their kids’ kidneys healthy<figure><img src="https://images.theconversation.com/files/116244/original/image-20160323-28178-1v0hze3.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ensuring that children eat healthily can prevent them from developing kidney disease. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>There has been an increase in kidney disease in children globally. In the developed world up to 5% of patients with chronic kidney disease are <a href="http://link.springer.com/article/10.1007/s004670050750">children</a>. But statistics are harder to come by in the developing world. </p>
<p>The overall increase in the incidence of kidney failure in children mimics that of adults. This is largely due to an increase in the incidence of obesity in children. Obese children develop hypertension and diabetes at a much younger age, which in turn affects their kidneys.</p>
<p>Kidneys perform vital functions. They rid the body of waste products and excess salts that would otherwise make people ill. They also:</p>
<ul>
<li><p>help the body maintain a good chemical balance; </p></li>
<li><p>control blood pressure; </p></li>
<li><p>keep bones healthy; and </p></li>
<li><p>help make red blood cells.</p></li>
</ul>
<p>Preventing kidney disease in children requires vigilance and awareness on the part of parents. Parents can do several things to help their children stay healthy and prevent chronic kidney disease. Four are listed below.</p>
<p><strong>1. A healthy diet:</strong> Parents should keep their children fit, active and eating well to ensure that they do not become overweight. As a start, children should be encouraged to take part in school sports, and families should become more active.</p>
<p>But parents should also ensure that their children eat healthy, well-balanced meals. Eating well helps children maintain a balanced weight. This will decrease their risk of obesity, which in turn decreases the risk of kidney failure. A healthy diet also helps to regulate blood pressure. </p>
<p>A balanced diet contains a mix of protein, fat and carbohydrates. It includes fresh fruit and vegetables instead of canned or refined foods. The refined carbohydrates found in processed foods, fizzy drinks, crisps and sweets result in children having both a sugar and salt overload. These should be kept to a minimum.</p>
<p>Salt is often “hidden” in foods and is not only found in crisps or other obvious snacks. Lower salt intake will decrease children’s risk of developing hypertension earlier in life and, in turn, kidney disease. If children complain of chronic headaches and fatigue, their blood pressure should be checked as they may be at risk of hypertension. Every time parents take their children to the doctor or nurse, they should ask for the child’s blood pressure to be checked. This can also be checked when immunisations are done.</p>
<p>In addition to checking the blood pressure, parents should also have their children’s blood glucose levels checked on at least an annual basis. Diabetes, like hypertension, is a silent disease. Only when a child’s blood sugar is extremely high, will he or she become symptomatic. An early sign of suspected diabetes in children is excessive thirst – not just drinking a lot of water when it is hot, but drinking large quantities of water with an extreme thirst. </p>
<p><strong>2. Sufficient fluid intake:</strong> Children need to drink enough healthy fluids, especially water. This allows the kidneys to stay healthy. Sugary drinks, including fruit juice, should be kept to a minimum.</p>
<p>Children’s kidneys can be affected after an infection or as part of a systemic illness, even as a result of something as simple as a throat infection (pharyngitis). When this happens there may be a change in their urine. They may pass less urine or their urine may change colour – the most common signs of trouble are urine that turns rose or red in colour, or the colour of black tea. </p>
<p>If a child is dehydrated and drinks large quantities of water, he or she should not pass a lot of urine. This is because the body has absorbed the water. Children who drink excessive amounts of water and pass urine frequently may be showing signs of diabetes.</p>
<p>Parents should ask for a urine dipstix test to be done when they take their child for a checkup. This is important because persistent protein in the urine is one of the earliest indications that a child’s kidneys might be taking strain. If a child is healthy, an annual checkup should be sufficient.</p>
<p><strong>3. No smoking:</strong> Smoking is another big no-no. Children should be dissuaded from smoking, especially during their teenage years, when they are more likely to experiment with cigarettes. Cigarettes contain toxins that can damage blood vessels and cause heart diseases that in turn damage kidneys.</p>
<p><strong>4. Beware of over-the-counter drugs:</strong> Parents tend to buy over-the-counter medicines for their children, but many drugs, especially anti-inflammatory medication and drugs used for fevers, can be harmful to their kidneys. </p>
<p>Aspirin, which is common in colds and flu medication, is not recommended for children under 12 due to the effect it has on their livers. Similarly, some anti-inflammatory drugs should be dispensed by a medical professional as they can cause acute kidney failure when children are dehydrated, ill and not taking in sufficient fluids. Paracetamol is a safe drug to use for fever in children, but it’s important that parents read the package insert to determine the dose and frequency for their children.</p><img src="https://counter.theconversation.com/content/56390/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christel du Buisson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An increase in child obesity is spurring on hypertension and diabetes among children, which may lead to chronic kidney disease.Christel du Buisson, Paediatric Nephrologist and Senior Specialist in the Department of Paediatrics and Child Health at the Faculty of Medicine and Health Sciences, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/509382015-11-19T15:41:24Z2015-11-19T15:41:24ZExplainer: what is the kidney disorder that Jonah Lomu had?<figure><img src="https://images.theconversation.com/files/102517/original/image-20151119-18418-1ms6r53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Rugby legend Jonah Lomu had a rare kidney disorder</span> </figcaption></figure><p>All Blacks rugby player Jonah Lomu <a href="https://theconversation.com/legend-hero-gentleman-jonah-lomu-changed-the-face-of-rugby-50940">has died</a>, aged 40. Lomu died of a heart attack, thought to have been a complication of the rare kidney disorder he’d been suffering from for most of his adult life. </p>
<p>The disorder, nephrotic syndrome, is a fairly rare disease with just two or three new cases <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2394708/">per 100,000 of the population</a> each year. But what exactly is it?</p>
<p>A nephron is a functioning unit within the kidney. Each nephron has a filter (called a glomerulus) and a drainpipe (a tubule), and there are about a million nephrons in a kidney, each acting in concert to clean the blood and regulate the body’s salt and water content. </p>
<p>The kidney cleans the blood over and over, at an incredible rate <a href="http://www.worldkidneyday.co.uk/kidney-facts/">of 180 litres a day</a>. Most of us have two kidneys which normally allows a lifetime’s worth of blood filtering to be performed.</p>
<h2>Nephrotic syndrome</h2>
<p>There are several diseases of the kidney where the filters of the nephron become damaged. This leads to a loss of large amounts of protein in the urine (when there should normally be very little), which leads to low blood protein levels and body swelling, known as oedema. It is this combination of symptoms and signs that is called nephrotic syndrome. It was first described in 1821, yet we are still learning new features of this condition.</p>
<p>There may be many different underlying causes, which include rare inherited forms, specific diseases of the glomerulus and secondary causes due to other medical conditions, such as diabetes, and drugs, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2218757/">such as Gold</a>, which is used to treat rheumatoid arthritis. </p>
<p>The consequences of nephrotic syndrome are severe. Complications that commonly occur include blood clotting problems (due to urinary loss of key proteins that prevent blood clotting), risk of serious infections (due to low blood protein levels) and kidney failure. </p>
<p>There are treatments for nephrotic syndrome, but no cure. Treatment often includes high dose steroid therapy and anticoagulants to prevent blood clots as well as diuretic tablets to control body swelling.</p>
<h2>Dialysis</h2>
<p>Certain underlying causes of nephrotic syndrome will eventually lead to complete kidney failure. This has devastating consequences and often means the patient has to rely on renal dialysis - where a machine does the job of the kidneys - until a kidney transplant can be performed. People can survive for many years on dialysis, but survival is often a long way from full health. </p>
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<img alt="" src="https://images.theconversation.com/files/102482/original/image-20151119-18413-1fkge46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/102482/original/image-20151119-18413-1fkge46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/102482/original/image-20151119-18413-1fkge46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/102482/original/image-20151119-18413-1fkge46.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/102482/original/image-20151119-18413-1fkge46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/102482/original/image-20151119-18413-1fkge46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/102482/original/image-20151119-18413-1fkge46.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People can survive for many years on dialysis.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=L-tprIwabOA-H-CENhNYUw&searchterm=kidney%20dialysis&show_color_wheel=1&orient=&commercial_ok=&media_type=photos&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=172564250">www.shutterstock.com</a></span>
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<p>Dialysis may be performed by cleaning the blood three times a week using an artificial kidney (haemodialysis) or by using the abdominal cavity on a daily basis (peritoneal dialysis). Both treatments can be performed at home with the support of a healthcare professional.</p>
<p>However, life expectancy of a dialysis patient is severely limited, with the average being <a href="https://www.kidney.org/atoz/content/dialysisinfo">just five to ten years</a>. It is possible to live for 20 or more years on dialysis but this is the exception rather than the rule.</p>
<p>A <a href="http://www.nhs.uk/Conditions/Kidney-transplant/Pages/Introduction.aspx">kidney transplant</a> is the best treatment for kidney failure. A transplant returns life expectancy to <a href="https://www.kidneyresearchuk.org/health-information/kidney-transplantation">near normal values</a>. But transplanted kidneys tend to wear out faster than the kidneys you were born with and sometimes the original cause of nephrotic syndrome can recur after the kidney transplant. Often a second kidney transplant is needed when this happens. </p>
<p>It seems that, over several years, Lomu’s own kidneys failed and he received a transplant at the age of 29, which went on to function for the next seven years before failing. </p>
<h2>Understanding the genetic causes</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310431/pdf/sfu129.pdf">Research at Newcastle University</a> aims to understand the genetic causes of nephrotic syndrome. This is where an inherited change in a gene predisposes patients to kidney disease resulting in a protein leak. Although we are born with our set of genes, often it isn’t until adult life that these conditions appear. Knowing the underlying genetic condition can allow early detection of the disease in other family members and allow treatments to be developed. It also gives information about whether the condition will recur in a kidney transplant. </p>
<p>The Genomics England <a href="http://www.genomicsengland.co.uk/">100,000 genomes project</a>, which has been piloted at our university over the past few years, is a platform to study inherited kidney conditions such as nephrotic syndrome. Here, the genome is sequenced and analysed to identify disease causing variants. It was through this project that whole genome sequencing successfully identified the underlying genetic cause <a href="http://www.genomicsengland.co.uk/first-patients-diagnosed-through-the-100000-genomes-project/">in a Newcastle family</a> with an inherited form of nephrotic syndrome and kidney failure. </p>
<p>Knowing the underlying genetic predisposition for rare kidney disorders such as nephrotic syndrome is the starting point for developing a better understanding of the disease and developing treatments that can prevent the ongoing kidney damage that leads to kidney failure and all its devastating consequences.</p><img src="https://counter.theconversation.com/content/50938/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:john.sayer@ncl.ac.uk">john.sayer@ncl.ac.uk</a> receives funding from MRC, Kidney Research UK, Kids Kidney Research, Northern Counties Kidney Research Fund and Newcastle Hospitals Healthcare Charity. </span></em></p>All Blacks legend, Jonah Lomu, suffered from nephrotic syndrome for most of his adult life. Here is what we know about the rare condition.John Sayer, Senior clinical lecturer in nephrology, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/309662015-03-12T03:00:41Z2015-03-12T03:00:41ZKidneys are amazing for all they do, be sure to look after yours<figure><img src="https://images.theconversation.com/files/74555/original/image-20150311-24203-zjs59l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kidneys are a feature-packed, highly efficient filtration and waste elimination system.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/64958688@N00/3349943474">Helen Taylor/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Tucked away just below your ribcage near your spine are two bean-shaped organs known as the kidneys. And when they’re quietly getting on with their job, it’s easy to forget they’re there and how important they are. But their absence, or even less-than-optimal performance can have dire consequences. </p>
<p>Kidneys are a feature-packed, highly efficient filtration and waste elimination system as well as the source of some essential hormones and vitamins. When all is said and done, the “factory-fitted” system for all they do beats alternatives for efficiency and convenience. They’re compact, built-in, self-contained, portable and low maintenance. </p>
<p>About 1,500 litres of blood pass through the kidneys each day, through a series of highly-regulated pumps and channels. Essential nutrients and water are reabsorbed and the waste products created by our cells are removed in volumes ranging from as little as 500 millilitres to as much as ten litres, in the form of urine. </p>
<p>Together with the bladder, which acts as a mechanism to batch this output, kidneys are the ultimate personal waste disposal system, requiring little maintenance. In fact, you could say the greatest inconvenience they pose is the need to occasionally quickly locate “conveniences”.</p>
<h2>When things go wrong</h2>
<p>Although the list of <a href="http://www.anzdata.org.au/anzdata/AnzdataReport/36thReport/2013c02_newpatients_v1.7.pdf">conditions causing kidney disease</a> is long, dietary and other lifestyle issues are beginning to dominate. <a href="http://www.kidney.org.au/KidneyDisease/FastFactsonCKD/tabid/589/Default.aspx">More than a third of all new patients</a> are now reaching end-stage kidney disease due to diabetes and about one in eight as a result of high blood pressure. </p>
<p>In contrast, the most common genetic cause of kidney disease (polycystic kidney disease) only accounts for one in 20 patients. Less common causes include autoimmune diseases and the toxic side effects of some medicines. Not only are <a href="http://www.kidney.org.au/HealthProfessionals/QKidneyRiskAssessment/tabid/861/Default.aspx">many of the risk factors</a> for kidney disease the same as those for heart disease, kidney disease itself is considered a risk factor for developing heart disease. </p>
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<img alt="" src="https://images.theconversation.com/files/74556/original/image-20150311-24178-1e69j9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/74556/original/image-20150311-24178-1e69j9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74556/original/image-20150311-24178-1e69j9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74556/original/image-20150311-24178-1e69j9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74556/original/image-20150311-24178-1e69j9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74556/original/image-20150311-24178-1e69j9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74556/original/image-20150311-24178-1e69j9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dietary and other lifestyle issues now dominate as causes of kidney disease.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/bijoubaby/6178847805">Heather Wizell/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>The development of kidney disease is often insidious, as symptoms are non-specific and occur late. Indeed, more than 90% of kidney function may be lost before any symptoms occur. </p>
<p>Common symptoms include nausea, a change in taste or loss of appetite, fatigue and itching, which reflect the build-up of toxins normally eliminated by the kidney. Less often patients may present due to swelling, or because they have noticed the presence of blood or protein in the urine (protein may cause urine to become frothy). </p>
<p>Thanks to advances in technology, kidneys are the only major organs that can completely fail but leave patients alive and reasonably healthy, even out of hospital. If your kidneys do fail, the first step is to get an alternative filtration system up and working. This is known as dialysis. </p>
<h2>Dialysis and transplants</h2>
<p>The <a href="https://www.renalreg.org/documents/patient-information/">two main types of dialysis</a> are peritoneal dialysis and haemodialysis. Both involve having some sort of permanent access point to enable regular dialysis. While these interventions keep people alive, they only provide at best about 10% to 15% of health kidney function. </p>
<p>Peritoneal dialysis, which can be done at home by patients themselves, involves having a tube surgically inserted into the abdominal cavity to enable fluid to enter.</p>
<p>Haemodialysis, which takes four to five hours and has to be performed three times a week, requires direct access into the bloodstream. This usually involves a surgical connection between an artery and a vein. Once these access points have been established, dialysis can begin. </p>
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<img alt="" src="https://images.theconversation.com/files/74557/original/image-20150311-24209-afqse3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/74557/original/image-20150311-24209-afqse3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/74557/original/image-20150311-24209-afqse3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/74557/original/image-20150311-24209-afqse3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/74557/original/image-20150311-24209-afqse3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/74557/original/image-20150311-24209-afqse3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/74557/original/image-20150311-24209-afqse3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Both kinds of dialysis involve having some sort of permanent access point into the body.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/newslighter/523392">Dan/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>For eligible patients, a <a href="https://www.renalreg.org/documents/patient-information/">kidney transplant</a> may avert the need for dialysis but it comes with its own problems. In addition to the risks of having an operation and general anaesthetic, unless the patient has an identical twin, the transplanted kidney will be seen by their immune system as foreign. </p>
<p>Left unchecked, transplanted kidneys are soon rejected, and fail. Immune-suppressing drugs can prevent this, but they have serious side effects and have to be taken for the rest of your life. The problem is that currently available immunosuppressants are relatively non-specific in their actions, and suppress the patient’s whole immune system. This makes them much more vulnerable to all sorts of infections, and also cancers. </p>
<p>Clearly, current treatments for kidney failure come with their own significant downsides. Life expectancy on dialysis, for instance, is considerably shorter than that of the general population.</p>
<h2>Love kidneys, yourself and others</h2>
<p>Chances are, if you are looking after your kidneys, you are also looking after the rest of your body. You’ve probably heard it all before but if you eat a balanced diet that’s low in salt, fat, and sugar, maintain a healthy weight, exercise regularly, drink sufficient water, restrict your alcohol intake and don’t smoke, you are caring for your kidneys. </p>
<p>There will be other benefits too. You’ll also be reducing your risk of diabetes, heart disease, high blood pressure and even cancer.</p>
<p>Despite the limitations of kidney transplants, they can transform and extend the lives of those with kidney failure. Only people with healthy kidneys can donate kidneys for transplantation. So looking after your kidneys may turn out to be an investment in someone else’s future and allow you to give the gift of life.</p><img src="https://counter.theconversation.com/content/30966/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Carson has in the past received funding from The Rural Industries Research & Development Corporation and companies in the natural products and complementary and alternative medicines industry.</span></em></p><p class="fine-print"><em><span>Aron Chakera receives funding from The University of Western Australia, Royal Australasian College of Physicians, Raine Foundation, Western Australian Department of Health.</span></em></p>Rather innocuous-looking and tucked away below the ribcage, kidneys are crucial for keeping us alive and well.Christine Carson, Research Associate at the University of Western Australia &, Harry Perkins Institute of Medical ResearchAron Chakera, Clinical senior lecturer, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.