Proteinuria = Kidney Disease?

Proteinuria—also called albuminuria is a condition in which the urine contains an abnormal amount of protein in it. Albumin is the major component of protein in the blood where proteins are the building blocks for all body parts, including muscles, bones, hair, and nails. Proteins in the blood also perform a number of important functions where they protect the body from infection, help blood clotting process, and keep the right amount of fluid circulating throughout the body.

Protein in your Urine?

As blood passes through healthy kidneys, they filter out the waste products and leave in the things the body needs, like albumin and other proteins. Most protein molecules are too big to pass through the kidneys' filters into the urine. However, proteins from the blood can leak into the urine when the filters of the kidney, called glomeruli, are damaged.

How Proteinuria happens

Proteinuria is a sign of chronic kidney disease (CKD), which can be resulting from diabetes, high blood pressure, and diseases that cause inflammation in the kidneys. For this reason, testing for albumin in the urine is part of a routine medical assessment for everyone. If CKD progresses, it can lead to end-stage renal disease where the kidneys fail completely. A person with end-stage renal disease must receive a kidney transplant or regular blood-cleansing treatments called dialysis.

What are the signs and symptoms of Proteinuria?

Proteinuria has no signs or symptoms in the early stages. Large amounts of protein in the urine may cause it to look foamy or fizzing in the toilet. Laboratory testing is the only way to find out whether a person is having proteinuria before extensive kidney damage occurs.

Check for Urine Protein

A 1996 study sponsored by the National Institutes of Health determined that proteinuria is the best predictor of progressive kidney failure in people with type 2 diabetes. The American Diabetes Association recommends regular urine testing for proteinuria for people with type 1 or type 2 diabetes. The National Kidney Foundation recommends that routine checkups include testing for excess protein in the urine, especially for people in high-risk groups.

What are the tests for Proteinuria?

An accurate protein measurement of urine required a 24-hour urine collection. In a 24-hour collection, the patient urinates into a container, which is kept refrigerated between trips to the bathroom. The patient is instructed to begin collecting urine after the first trip to the bathroom in the morning. Every drop of urine for the rest of the day is to be collected in the container. The next morning, the patient adds the first urination after waking and the collection is complete.

24 hours Urine Protein Test

In recent years, researchers have found that a single urine sample can provide the needed information - Urine Microalbumin. In this newer technique, the amount of albumin in the urine sample is compared with the amount of creatinine, a waste product of normal muscle breakdown. The measurement is called a urine albumin-to-creatinine ratio (UACR). A urine sample containing more than 30 milligrams of albumin for each gram of creatinine (30 mg/g) is a warning that there may be a problem. If the laboratory test exceeds 30 mg/g, another UACR test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria, a sign of declining kidney function, and should have additional tests to evaluate kidney function.

Microalbumin testing

What additional tests for kidney disease may be needed?

Tests that measure the amount of creatinine in the blood will show whether a person’s kidneys are removing wastes efficiently. Having too much creatinine in the blood is a sign that a person has kidney damage. The doctor can use the creatinine measurement to estimate how efficiently the kidneys are filtering the blood. This calculation is called the estimated glomerular filtration rate, or eGFR. CKD is present when the eGFR is less than 60 milliliters per minute (mL/min).

Estimated Glomerular Filtration Rate (eGFR)

Who is at risk for proteinuria?

People with diabetes, hypertension, or certain family backgrounds are at risk for proteinuria. according to studies, diabetes is the leading cause of ESRD. In both type 1 and type 2 diabetes, albumin in the urine is one of the first signs of deteriorating kidney function. As kidney function declines, the amount of albumin in the urine increases.

Another risk factor for developing proteinuria is hypertension, or high blood pressure. Proteinuria in a person with high blood pressure is an indicator of declining kidney function. If the hypertension is not controlled, the person can progress to full kidney failure.

Hypertension damages glomeruli

What should a person with proteinuria do?

If a person has diabetes, hypertension, or both, the first goal of treatment will be to control blood glucose, also called blood sugar, and blood pressure. People with diabetes should test their blood glucose often, follow a healthy eating plan, take prescribed medicines, and get the amount of exercise recommended by their doctor. A person with diabetes and high blood pressure may need a medicine from a class of drugs called angiotensin-converting enzyme (ACE) inhibitors or a similar class called angiotensin receptor blockers (ARBs). These drugs have been found to protect kidney function even more than other drugs that provide the same level of blood pressure control. Many patients with proteinuria but without hypertension may also benefit from ACE inhibitors or ARBs.

Doctor Prescription

People who have high blood pressure and proteinuria, but not diabetes, also benefit from taking an ACE inhibitor or ARB. Health care providers recommend that people with kidney disease keep their blood pressure below 140/90. To maintain this target, a person may need to take a combination of two or more blood pressure medicines. A doctor may also prescribe a diuretic in addition to an ACE inhibitor or ARB. Diuretics are also called "water pills" because they help a person urinate and get rid of excess fluid in the body.

In addition to blood glucose and blood pressure control, the National Kidney Foundation recommends restricting dietary salt and protein. A doctor may refer a patient to a dietitian to help develop and follow a healthy eating plan.

Eat Healthy

Other Conditions that can cause a temporary rise in the levels of protein in urine, but don't necessarily indicate kidney damage, include: 

• Cold exposure 
• Emotional stress 
• Fever 
• Heat exposure 
• Strenuous exercise 

You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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Headache, The Cause

Baffled by what's causing your pain? You may be surprised by what could be to blame. Take a look at your personality traits, weight, daily schedule, and what you're eating and drinking to find out if one of these is contributing to the problem.

Blame who?

Want to know what could be the reason that causing your headache? Could it be something you ate? Not enough sleep? Or something you do? The info below might help you out.

Your weight

In a recent study, researchers found that women with mild obesity (a body mass index of 30) had a 35% greater risk of headaches than those with a lower body mass index (BMI). Severe obesity (BMI of 40) upped the chances to 80%.

Put down your Weight

Your personality

Certain traits, including rigidity, reserve, and obsessiveness may make you headache-prone. If that sounds like you, it could be time to sign up for relaxation training.

What is your Personality?

The big O?

In one survey, 46% of headache sufferers said sex had triggered a headache. Usually, this is an overexertion headache (like joggers and weight-­lifters sometimes get); you may feel a dull pain that builds during foreplay or get a sudden headache around orgasm (more likely in men). In rare cases, such an intense headache could be caused by a tumor or aneurysm. For most folks, though, sex headaches are harmless.

Sex headaches?

That three-day vacay

Weekend or "let-down" headaches can happen when you take a break from your routine, says Alexander Mauskop, MD, founder and director of the New York Headache Center and co-author of What Your Doctor May Not Tell You About Migraines. Ease into the change by keeping your sleep time as normal as possible—you’ll end up feeling more rested than if you stay in bed until noon.

Holiday Headache

Dehydration

Well, you don’t have to drink gallons of water to stay hydrated, says John La Puma, MD, author of ChefMD’s Big Book of Culinary Medicine. "I’d love it if people got more water from eating fruits and vegetables because then they’d get all the other good things that come with them," he says.

Drink plenty of water or juice

Skipping meals

We know you’re very busy, but hunger is a common headache trigger. not only that, you can trigger something else.

Headache or not headache?

Too much caffeine

A little can help headaches but too much can trigger them, New York City neurologist Audrey Halpern, MD, says. If caffeine is causing your pain, gradually cut back until you have caffeine no more than two days a week.

Cut down caffeine

Inactivity

A recent Swedish study showed that those who were inactive were more likely to get headaches than those who worked out. Aim for 20 to 30 minutes of exercise a day, five days a week, to relieve stress, send blood to the brain, and get feel-good endorphin flowing. Exercise may be a trigger for some people, so consult your doc first.

You need exercises

Sleep deprivation

One large study says those who slept an average of six hours a night tended to have significantly more severe and more frequent headaches than those who got more sleep..

Sleeping time

What ever you do, Don’t feed your headache!

Everyone reacts differently, but some foods are known to trigger headaches for many people—and others (especially those rich in magnesium) seem to help prevent them.

Eat: Spinach, tofu, oat bran, barley, fish oil, olive oil, white beans, sunflower and pumpkin seeds

Avoid: Red wine, beer, MSG, chocolate, aged cheese, saurkraut, processed meats like pepperoni, ham, and salami

Sometimes you know exactly what's causing that pounding in your skull. Other times, you're blindsided. Outwit these unexpected pain triggers, from bright lights to bad weather. Talk to your doctor about your headache. Together, you can decide the best approach for your headache problems.

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Migraine Attacks

About 1 out of 8 people has migraines. They usually begin during the teenage years. After puberty, migraines are more likely to attacks girls and women. Experts still aren't sure what causes these headaches. But they seem to involve a wave of unusual activity in brain nerve cells, along with changes in blood flow in the brain.

Though migraines can trigger severe pain in the head, they aren't simply headaches. They often also cause other uncomfortable symptoms, such as: 

• Nausea 
• Vomiting 
• Unusual sensitivity to light, noises, and smells 

Nausea and Vomitting

A migraine episode can be a complicated event, with symptoms that change over hours or even days. Migraines tend to progress through several stages: 

1. Prodromal phase before the migraine 
2. Aura phase 
3. Attack phase 
4. Postdromal phase after the migraine 

Prodromal Phase: Early Warning Signs

Several hours before the migraine begins -- and sometimes even the day before -- many people with migraines notice unusual sensations. They may feel: 

• Either unusually energetic and excitable or depressed 
• Irritable 
• Thirsty 
• Cravings for certain foods 
• Sleepy, with frequent yawning 
• Need to urinate more 

Frequent Yawning

In some cases, these symptoms before the headache can help health care providers diagnose the problem as migraines.

Aura Phase: Strange Sensations Arise

About 1 in 5 people with migraine develop an "aura" that begins before the headache or starts along with it. An aura may not occur with every headache. An aura can include:

Changes in vision. 

Often visual symptoms begin first during the aura phase. During a migraine you may experience these vision changes

A flickering, jagged arc of light. 

This may take a complicated shape. It usually appears on the left or right side of your vision. Over a few minutes, it may spread in size. 

An area of vision loss. 

This problem -- combined with the flickering lights -- can make driving or focusing your eyes on small objects difficult. 

"See" images from the past or hallucinations. 

Changes in vision of Migraine Patient

These symptoms may continue to grow more severe over the next several minutes.

Skin sensations. 

This part of the aura may cause tingling or "pins and needles" sensations in the body. It may also cause numbness. These feelings often affect the face and hands but can spread out across the body. The sensations may continue to expand over the next several minutes.

Language problems. 

During the aura phase of a migraine, you may have trouble communicating with others. Symptoms may include:

• Difficulty expressing thoughts while speaking or writing 
• Trouble understanding spoken or written words 
• Confusion 
• Trouble concentrating.

Attack Phase: The Headache Begins

The attack portion of a migraine episode can last for a few hours to several days. During this phase of the migraine, the person usually wants to rest quietly and finds normal activities difficult.

The Attack of Migraine

A defining quality of migraines is their pain. The pain of a migraine: 

• Usually begins at the area above the eyes 
• Typically affects only one side of the head, but it may strike the entire head or move from one side to the other. It may also affect the lower face and the neck. 
• Tends to have a throbbing intensity 
• May throb worse during physical activity or when you lean forward 
• May get worse if you become physically active 

Other symptoms that may arise during this phase include:

• Unusual sensitivity to light, sounds, and smells 
• Light-headed and fainting
• Nausea and vomiting 

Postdromal Phase: After the Storm

Following the most severe phase of the migraine, you may not feel well for up to a day. Symptoms of this post-migraine phase may include: 

• Extreme tiredness 
• Sluggishness 
• Confusion 
• Head pain that flares up when you lean over, move quickly, or experience a rush of blood to the head 

Your overall experience with migraines may change over time. They can change in frequency or severity, and attacks may not always include all of these stages. Also, you may eventually develop the migraine aura without actually having a headache.

Feeling tired and sluggish

Making the Decision

You may want to consider medicine to prevent migraines if you: 

• Having severe pain that interferes with your life despite treatment. 
• Get at least three moderate-to-severe headaches per month. 
• Take a lot of painkillers. 
• Can't get enough relief from drugs you now taking. 
• Have side effects from your headache drugs. 
• Have uncommon migraine conditions like continuing aura (blurred vision or seeing spots or wavy lines). 

If you have severe migraines, though, your doctor may suggest first trying a non-drug treatment such as biofeedback, relaxation therapy, or stress-management training. He may also recommend a preventive drug that has the lowest risk possible.

Preventive medicine might not be right for you if: 

• Your headaches are controlled by anti-inflammatory like naproxen and ibuprofen. 
• Other health conditions keep you from taking preventive drugs. 
• There could be bad interactions with other medicines you take. 
• You prefer treatments that don't involve drugs 

Talk to your doctor about your thoughts on taking preventive medications for migraines. Together, you can decide the best approach for your headache problems.

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Can an AB father and an A mother have an O baby?

Yes they can. An AB parent can indeed sometimes have an O child. But it is by no means common. In fact it would be fair to say that it is exceedingly rare. The one exception is in certain Asian groups. Some of these folks have a rare version of the ABO blood type gene called cis-AB. People with this gene version have an AB blood type but can easily have an O child.

Now I don't want you to come away thinking this is an everyday thing for most Asians. It isn't. For example, one estimate I saw stated that about 0.03% or 3 out of every 10,000 Koreans have this blood type. And that is the group where it is most common!

The next most common group is the Japanese. There it looks like about 0.001% of folks have the cis-AB allele. Or 1 out of every 100,000.

So even though it is more common for an AB parent to have an O child among the Koreans and Japanese, it still isn't that common. And it is much, much less common in other ethnic groups. Still it can and does happen. Even though your high school biology teacher said it was impossible...

ABO Calculation

Why AB Parents Rarely Have O Children
The reason why an AB parent usually does not have an O child has to do with how blood type normally works genetically. Remember, we have two copies of each of our genes – one from mom and one from dad. This is true of the blood type (or ABO) gene as well.

The ABO gene comes in three varieties: A, B, and O. Since we have two copies of this gene, that means there are six different possible combinations of these three versions. These six combinations lead to the four possible blood groups as follows:

As you can see, O is sort of like a zero. If you have an O and something else, your blood type will be that something else.

The table also shows why AB parents so rarely have an O child. Because they don't have an O to pass on!

To be O, you usually need to get an O from both mom and dad. But an AB parent usually has an A and a B version, not an O. So they usually can't have an O child. Except, of course, when they can.


Ways to Break the Blood Type Rules
There are a few ways that an AB parent can have an O child. One of the less rare ways is when the parent has the cis-AB version I was talking about earlier. These people have the following possible gene combinations:

They are all AB blood type but the middle gene combination can have an O child. Let's see how.

Imagine a dad with the middle combination of genes. He has an AB version and an O version of the ABO gene. He is AB blood type but carries the O version of the blood type gene.

How AB and A produce O Child

Now let's imagine that he has a child with a woman who has an A and an O gene. She is A blood type but like the father, also carries an O version of the ABO gene.

As you can see in the image to the right, these two parents can have an O child. In fact, every one of their children would have a 1 in 4 chance for being O.

And this is just the most common way an AB parent can have an O child. There are many other, rarer possibilities too.

ABO testing

Although I won't go into them here, we have covered a lot of them before. What I have done is listed some other possible ways an AB parent can have an O child and linked each possibility to one of our previous answers that dealt with the subject. Enjoy!

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Simple Teachings: Depression, The Silent Stalker

Depression is believed to be the number one cause of disability in the world. In the United States alone, more than 17% of the population will experience varying degrees of depression at some point in their lives.

Some of the symptoms for depression are:

• Persistent sad, anxious or empty mood 
• Feelings of hopelessness, helplessness, pessimism 
• Guilt, feelings of worthlessness 
• Loss of interest in previously pleasurable activities, including sports, recreation and sex 
• Constant fatigue, decreased stamina 
• Difficulty in concentrating, downward trend in memory 
• Insomnia, early-morning awakening, oversleeping 
• Loss of appetite, weight loss or overeating and weight gain 
• Suicidal thoughts, suicide attempts 
• Constant restlessness 
• Irritability, anxiety 
• persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain 

There are various kinds of depression as well:

Major Depression: it is manifested by a combination of the above symptoms. It interferes with your ability to enjoy everyday activities. Chronic major depression might require treatment to continue indefinitely.

Dysthymia: This involves long-lasting symptoms that do not disable in any way, but prevent one from functioning at an optimal level or feeling good about oneself. Many people with dysthymia also experience major depressive episodes during their lives.

Bipolar Disorder: This condition is characterized by cycling mood changes. The victim experiences highs and lows, with periods of normal mood in between.

Treatment for depression can vary. Antidepressants are most commonly used. The major types of antidepressants are SSRIs (that alter the amount of serotonin in the brain), SNRIs (that alter both serotonin and norepinephrine), TCAs (that perform the same function as SNRIs, but are stronger) and MAOIs (these are the strongest antidepressants that are legally used).

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The Big V – is Vasectomy for You?

Men who sit down with consultant urological surgeon always have a lot of questions about vasectomy. Chief among them is: ‘It’s reversible, right?’ Here, he addresses some of the myths and uncomfortable truths:

What vasectomy does and doesn’t do

Vasectomy, also known as male sterilization, is a reliable and permanent form of contraception for men who are sure that they don’t want to father any more children.

It doesn’t affect your sex drive or ability to enjoy sex. You’ll still have erections and produce the same amount of fluid when you ejaculate. The only difference is that the fluid will not contain sperm. The testes will still produce sperm, but they can't travel to the penis and are naturally reabsorbed.

Vasectomy doesn’t protect you from contracting or passing on sexually transmitted infections (STIs) or diseases (STDs), therefore you should continue to take appropriate precautions.

The golden rule: speak to your partner

If you’re in a relationship, you need to make this decision together. It goes both ways. You’d be surprised how many men speak with a consultant about vasectomy before they speak with their partner. On the other hand, there are some men who might feel pressured to have a vasectomy by their partner. You should take some time to talk it through long before stepping into a consultant’s office.

Consider it irreversible 

You cannot go into vasectomy with reversal as a fall back option. A vasectomy reversal is a complex procedure, and the success rates of the operation decrease the longer the period after the initial vasectomy.

In some cases it's possible to retrieve sperm surgically from the testicles if your circumstances change. Some men choose to freeze sperm before undergoing a vasectomy. If your future fertility is a central concern, then vasectomy is probably not for you.

I’m starting to have doubts - what are the alternatives?

There are many different types of effective contraception, but things like condoms and the contraceptive pill require constant thought and attention. Couples also have the option of female sterilisation, although this surgical procedure is not as simple to perform, has more risks than vasectomy and requires a general anaesthetic. It’s worth discussing all the options before deciding what to do next.

The awkward bits of the procedure

It’s not unnatural to feel a little vulnerable at the idea of having your testicles felt by a surgeon as they plan to make small cuts in your scrotum. This is a fear you will have to face.

For the surgeon to have unobstructed access, you may have to shave an area of your scrotum. If you prefer, you can do it yourself at home before the operation.

While you shouldn’t feel any pain under the local anaesthetic, you may feel a little exposed as the surgeon feels the testicles to find the vas deferens, tubes that carry sperm to the penis, and makes tiny cuts in both sides of the scrotum. Sometimes it’s just one central incision, or a small hole. The tubes are pulled out through the holes, cut, and sealed off. The tubes are then gently placed back into the scrotum and the cuts closed using dissolvable stitches or adhesive strips. Often there’s no need for a dressing.

After the deal is done

Recovery from the operation is often swift, with many men returning to work the next day. It’s best to avoid heavy lifting or vigorous exercise as this can place strain on the healing wounds.

There can be side-effects. If the surgeon has had trouble finding the tubes, there may be severe bruising around the scrotum. Most men will have some mild soreness after the local anaesthetic wears off.

As with any surgery, there can be complications. Complications arising from vasectomy are rare, but can include anything from bleeding inside the scrotum to infection. Very rarely, even when performed correctly, there is a minuscule risk the tubes can rejoin naturally making you fertile again (1 in 2000 men).

Getting back to sex – hold your horses!

Sex can be resumed as soon as it feels comfortable to do so, but another form of contraception must be used until the live sperm that remain in the tubes are gone. This can take a few months. Two semen tests will need to be performed to ensure that the tubes are clear of sperm. One semen sample should be taken to the hospital 12 -14 weeks after surgery and a second sample two weeks later.

When your semen has been shown to have no sperm at all, you’ll be given the all clear to stop using other methods of contraception.

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Should I worry about testicular cancer?

Testicular cancer is relatively uncommon and little understood. Mr David Hendry, Consultant Urologist at Nuffield Health Glasgow hospital, busts the myths and gives you the facts.

Testicular cancer doesn’t get a lot of press. That leaves many men uninformed, vulnerable to late diagnosis and unduly concerned about the condition. Here’s what you should know: 

It’s not that common

Testicular cancer is the 16th most common cancer in men in the UK with only around 2,200 cases diagnosed a year. That’s not a lot compared to other cancers. For example, the most common cancer in UK men, prostate cancer, was diagnosed in 42,000 cases in 2011.

But it’s the most common cancer in younger men

Unlike other cancers, testicular cancer comes earlier in life - usually affecting younger men, aged 25 – 49. So it’s a key cancer to be aware of throughout this life stage. Most cases of testicular cancer are found by accident by the men themselves.

Who’s most at risk?

If you have an immediate family member who’s been diagnosed with testicular cancer then your risk is 10 times higher than average. Men who have low fertility or have had one or both testicles fail to descend naturally into the scrotum also have heightened risk.

Don’t panic – the overwhelming majority survive

Today, more than 95% of men with testicular cancer are cured, compared to less than 70% in the early 1970s. This is mainly because of the introduction of combination chemotherapy which stops the cancer from spreading.

You’ll probably lose a testicle

For obvious reasons, many men are alarmed at this prospect, but it’s a small price to pay. If you have testicular cancer the first step is usually to remove the affected testicle (orchidectomy). This is the most effective way to ensure the cancer doesn’t spread, which could save your life. 

Removing one testicle won’t impact your sex life – you’ll still produce plenty of sperm and testosterone with the remaining testicle. A prosthetic testicle can even be inserted into the scrotum to maintain its appearance. When the cancer is more advanced, chemotherapy andradiotherapy can then be used to prevent the cancer from returning.

How to self-check

Self-checking is especially important if you’re affected by one or more risk factors. But all men can benefit from understanding what feels normal for them. 

Gently roll each testicle between your index finger and thumb to help identify any irregularities. When you are checking your testicles, you may feel a rounded tube towards the back of each testicle that may be tender. This is normal and is called the epididymis. It is part of the male reproductive system. It’s easiest to check your testicles when they’re warm and relaxed – after a shower or bath is ideal.

What to look out for 

• A hard lump on the front or side of the testicle 
• Swelling or enlargement of the testicle 
• Pain or discomfort in the testicle or scrotum 
• An unusual difference between one testicle and the other 
• A heavy or dragging feeling in the scrotum 
• Don’t hesitate to see a specialist

If you are concerned that you have a lump or pain in your testicles, don’t let embarrassment stand in the way of your health. Get it checked out as soon as possible. Many lumps are non-cancerous. If there is no problem (which is most commonly the case) then you will be reassured, and if there are cancer cells found, early detection greatly improves the success of treatment.

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