Input: How to diagnose Hemolytic Uremic Syndrome in Children ?

Output:
A health care provider diagnoses hemolytic uremic syndrome with

- a medical and family history  - a physical exam  - urine tests  - a blood test  - a stool test  - kidney biopsy

Medical and Family History

Taking a medical and family history is one of the first things a health care provider may do to help diagnose hemolytic uremic syndrome.

Physical Exam

A physical exam may help diagnose hemolytic uremic syndrome. During a physical exam, a health care provider most often

- examines a child's body  - taps on specific areas of the child's body

Urine Tests

A health care provider may order the following urine tests to help determine if a child has kidney damage from hemolytic uremic syndrome.

Dipstick test for albumin. A dipstick test performed on a urine sample can detect the presence of albumin in the urine, which could mean kidney damage. The child or caretaker collects a urine sample in a special container in a health care provider's office or a commercial facility. For the test, a nurse or technician places a strip of chemically treated paper, called a dipstick, into the child's urine sample. Patches on the dipstick change color when albumin is present in the urine.

Urine albumin-to-creatinine ratio. A health care provider uses this measurement to estimate the amount of albumin passed into the urine over a 24-hour period. The child provides a urine sample during an appointment with the health care provider. Creatinine is a waste product that is filtered in the kidneys and passed in the urine. A high urine albumin-to-creatinine ratio indicates that the kidneys are leaking large amounts of albumin into the urine.

Blood Test

A blood test involves drawing blood at a health care provider's office or a commercial facility and sending the sample to a lab for analysis. A health care provider will test the blood sample to

- estimate how much blood the kidneys filter eachminute, called the estimated glomerular filtrationrate, or eGFR. The test results help the healthcare provider determine the amount of kidneydamage from hemolytic uremic syndrome.  - check red blood cell and platelet levels.  - check for liver and kidney function.  - assess protein levels in the blood.

Stool Test

A stool test is the analysis of a sample of stool. The health care provider will give the child's parent or caretaker a container for catching and storing the stool. The parent or caretaker returns the sample to the health care provider or a commercial facility that will send the sample to a lab for analysis. Stool tests can show the presence of E. coli O157:H7.

Kidney Biopsy

Biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs the biopsy in an outpatient center or a hospital. The health care provider will give the child light sedation and local anesthetic; however, in some cases, the child will require general anesthesia. A pathologista doctor who specializes in diagnosing diseasesexamines the tissue in a lab. The pathologist looks for signs of kidney disease and infection. The test can help diagnose hemolytic uremic syndrome. </s>


Input: What are the complications of Hemolytic Uremic Syndrome in Children ?

Output:
Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health.1

However, children with hemolytic uremic syndrome may have serious and sometimes life-threatening complications, including

- acute kidney injury  - high blood pressure  - blood-clotting problems that can lead to bleeding  - seizures  - heart problems  - chronic, or long lasting, kidney disease  - stroke  - coma </s>


Input: What are the treatments for Hemolytic Uremic Syndrome in Children ?

Output:
A health care provider will treat a child with hemolytic uremic syndrome by addressing

- urgent symptoms and preventing complications  - acute kidney injury  - chronic kidney disease (CKD)

In most cases, health care providers do not treat children with hemolytic uremic syndrome with antibiotics unless they have infections in other areas of the body. With proper management, most children recover without long-term health problems.2

Treating Urgent Symptoms and Preventing Complications

A health care provider will treat a child's urgent symptoms and try to prevent complications by

- observing the child closely in the hospital  - replacing minerals, such as potassium and salt, and fluids through an intravenous (IV) tube  - giving the child red blood cells and platelets cells in the blood that help with clottingthrough an IV  - giving the child IV nutrition  - treating high blood pressure with medications

Treating Acute Kidney Injury

If necessary, a health care provider will treat acute kidney injury with dialysisthe process of filtering wastes and extra fluid from the body with an artificial kidney. The two forms of dialysis are hemodialysis and peritoneal dialysis. Most children with acute kidney injury need dialysis for a short time only.

Treating Chronic Kidney Disease

Some children may sustain significant kidney damage that slowly develops into CKD. Children who develop CKD must receive treatment to replace the work the kidneys do. The two types of treatment are dialysis and transplantation.

In most cases, health care providers treat CKD with a kidney transplant. A kidney transplant is surgery to place a healthy kidney from someone who has just died or a living donor, most often a family member, into a person's body to take over the job of the failing kidney. Though some children receive a kidney transplant before their kidneys fail completely, many children begin with dialysis to stay healthy until they can have a transplant.

More information is provided in the NIDDK health topic, Treatment Methods for Kidney Failure in Children. </s>


Input: How to prevent Hemolytic Uremic Syndrome in Children ?

Output:
Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by

- avoiding unclean swimming areas  - avoiding unpasteurized milk, juice, and cider  - cleaning utensils and food surfaces often  - cooking meat to an internal temperature of at least 160 F  - defrosting meat in the microwave or refrigerator  - keeping children out of pools if they have had diarrhea  - keeping raw foods separate  - washing hands before eating  - washing hands well after using the restroom and after changing diapers

When a child is taking medications that may cause hemolytic uremic syndrome, it is important that the parent or caretaker watch for symptoms and report any changes in the child's condition to the health care provider as soon as possible. </s>


Input: What to do for Hemolytic Uremic Syndrome in Children ?

Output:
At the beginning of the illness, children with hemolytic uremic syndrome may need IV nutrition or supplements to help maintain fluid balance in the body. Some children may need to follow a low-salt diet to help prevent swelling and high blood pressure.

Health care providers will encourage children with hemolytic uremic syndrome to eat when they are hungry. Most children who completely recover and do not have permanent kidney damage can return to their usual diet. </s>


Input: What to do for Hemolytic Uremic Syndrome in Children ?

Output: - Hemolytic uremic syndrome, or HUS, is a kidney condition that happens when red blood cells are destroyed and block the kidneys' filtering system.  - The most common cause of hemolytic uremic syndrome in children is an Escherichia coli (E. coli) infection of the digestive system.  - Normally, harmless strains, or types, of E. coli are found in the intestines and are an important part of digestion. However, if a child becomes infected with the O157:H7 strain of E. coli, the bacteria will lodge in the digestive tract and produce toxins that can enter the bloodstream.  - A child with hemolytic uremic syndrome may develop signs and symptoms similar to those seen with gastroenteritis, an inflammation of the lining of the stomach, small intestine, and large intestine.  - Most children who develop hemolytic uremic syndrome and its complications recover without permanent damage to their health.  - Some children may sustain significant kidney damage that slowly develops into chronic kidney disease (CKD).  - Parents and caregivers can help prevent childhood hemolytic uremic syndrome due to E. coli O157:H7 by      - avoiding unclean swimming areas    - avoiding unpasteurized milk, juice, and cider    - cleaning utensils and food surfaces often    - cooking meat to an internal temperature of at least 160 F    - defrosting meat in the microwave or refrigerator    - keeping children out of pools if they have had diarrhea    - keeping raw foods separate    - washing hands before eating    - washing hands well after using the restroom and after changing diapers </s>


Input: What is (are) Treatment Methods for Kidney Failure: Peritoneal Dialysis ?

Output:
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Doctors call this lining the peritoneum. A doctor will place a soft tube, called a catheter, in your belly a few weeks before you start treatment.

When you start peritoneal dialysis, dialysis solutionwater with salt and other additivesflows from a bag through the catheter into your belly. When the bag is empty, you can disconnect your catheter from the bag and cap it so you can move around and do your normal activities. While the dialysis solution is inside your belly, it soaks up wastes and extra fluid from your body. After a few hours, you drain the used dialysis solution into a drain bag. You can then dispose of the used dialysis solution, which is now full of wastes and extra fluid, in a toilet or down the drain of a sink or bathtub. Then you start over with a fresh bag of dialysis solution.

The process of first draining the used dialysis solution and then replacing it with fresh solution is called an exchange. Most people do four to six exchanges every day, or during the night using a machine that moves the fluid in and out. The process goes on continuously, so you always have dialysis solution in your belly soaking up wastes and extra fluid from your body. For the best results from peritoneal dialysis, it is important that you perform all of your exchanges as your doctor instructs. </s>


Input: What is (are) Treatment Methods for Kidney Failure: Peritoneal Dialysis ?

Output:
The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysisalso called CAPDand automated peritoneal dialysiswhich doctors sometimes call APD or continuous cycler-assisted peritoneal dialysis. After learning about the types of peritoneal dialysis, you can choose the type that best fits your schedule and lifestyle. If one schedule or type of peritoneal dialysis does not suit you, you can talk with your doctor about trying another type.

- Continuous ambulatory peritoneal dialysis does not require a machine. You can do it in any clean, well-lit place. The time period that the dialysis solution is in your belly is called the dwell time. With continuous ambulatory peritoneal dialysis, the dialysis solution stays in your belly for a dwell time of 4 to 6 hours, or more. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch television, or sleep. Usually, you change the dialysis solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up and perform exchanges during the night.  - Automated peritoneal dialysis uses a machine called a cycler to fill and empty your belly three to five times during the night while you sleep. In the morning, you begin one exchange with a daylong dwell time. You may do an additional exchange around the middle of the afternoon without the cycler to increase the amount of waste removed and reduce the amount of fluid left behind in your body.

If you weigh more than 175 pounds or if your peritoneum filters wastes slowly, you may need a combination of continuous ambulatory peritoneal dialysis and automated peritoneal dialysis. For example, some people use a cycler at night and perform one exchange during the day. Your health care team will help you determine the best schedule for you. </s>


Input: What are the treatments for Treatment Methods for Kidney Failure: Peritoneal Dialysis ?

Output:
Your health care team will perform several tests to tell if your dialysis exchanges are removing enough wastes. These tests are especially important during the first weeks of treatment to determine whether your schedule is adequate.

Peritoneal Equilibration Test

For a peritoneal equilibration test, a dialysis nurse takes samples of your blood and dialysis solution during a 4-hour exchange. The peritoneal equilibration test measures how much dextrose your body absorbs from a bag of dialysis solution. The peritoneal equilibration test also measures how much urea and creatininewaste products of normal muscle and protein breakdownmove from your blood into the dialysis solution.

Clearance Test

For a clearance test, you will collect the used dialysis solution from a 24-hour period. A dialysis nurse takes a blood sample during the same 24-hour period. Your doctor or nurse compares the amount of urea in the used solution with the amount in your blood to see how much urea was removed. For the first months or even years of peritoneal dialysis treatment, you may still produce small amounts of urine. If you produce more than 100 milliliters (3 ounces) of urine per day, you will also collect your urine to measure its urea content.

From the measurements of used solution, blood, and, if available, urine, your health care team can determine your urea clearancea measurement doctors call your Kt/Vand your creatinine clearance rate. These measurements will show whether you are using the right peritoneal dialysis schedule and doses. If your dialysis schedule is not removing enough wastes, your doctor will make adjustments. More information is provided in the NIDDK health topic, Peritoneal Dialysis Dose and Adequacy. </s>


Input: What to do for Treatment Methods for Kidney Failure: Peritoneal Dialysis ?

Output:
Eating the right foods can help you feel better while on peritoneal dialysis. Talk with your dialysis centers dietitian to find a meal plan that works for you. Your dietary needs will depend on your treatment and other factors such as your weight and activity level. Staying healthy with CKD requires watching what is in your diet:

- Protein is in foods from animals and plants. Protein provides the building blocks that maintain and repair muscles, organs, and other parts of your body. Peritoneal dialysis can remove proteins from your body, so eat high-quality, protein-rich foods such as meat, fish, and eggs. However, many high-protein foods also contain phosphorous, which can weaken your bones. Talk with your dietitian about ways to get the protein you need without getting too much phosphorous.  - Phosphorus is a mineral that helps your bones stay healthy and your blood vessels and muscles work. Phosphorus is a natural part of foods rich in protein, and food producers often add it to many processed foods. Phosphorus can weaken your bones and make your skin itch if you consume too much. Peritoneal dialysis may not remove enough phosphorus from your body, so you will probably need to limit or avoid high-phosphorus foods such as milk and cheese, dried beans, peas, colas, nuts, and peanut butter. You may also need to take a pill called a phosphate binder that keeps phosphorus in your food from entering your bloodstream.  - Fluid includes water and drinks such as fruit juice and milk and water in foods such as fruits, vegetables, ice cream, gelatin, soup, and ice pops. You need water for your body to function properly; however, too much can cause swelling and make your heart work harder. Over time, having too much fluid in your body can cause high blood pressure and congestive heart failure. Peritoneal dialysis might cause you to have either too much or too little fluid, depending on the strength of the solution you use. Your diet can also influence whether you have too much or too little fluid. Your dietitian will help you determine how much liquid you need to consume each day.  - Sodium is a part of salt. Many canned, packaged, frozen, and fast foods contain sodium. Sodium is also a part of many condiments, seasonings, and meats. Too much sodium makes you thirsty, which makes you drink more liquid. Try to eat fresh foods that are naturally low in sodium, and look for products that say low sodium on the label, especially in canned and frozen foods.  - Potassium is a mineral that helps your nerves and muscles work the right way. Peritoneal dialysis can pull too much potassium from your blood, so you may need to eat more high-potassium foods such as bananas, oranges, potatoes, and tomatoes. However, be careful not to eat too much potassium. Your dietitian will help you choose the right amount.  - Calories are units for measuring the energy provided by foods and drinks. Eating foods with too many calories, such as oily and sugary foods, can make you gain weight. Your body can absorb the dextrose from your dialysis solution, which can increase your calorie intake. You may find you need to take in fewer calories to prevent weight gain. Your dietitian can help you create and follow a diet to stay at a healthy weight.  - Supplements help provide some of the vitamins and minerals that may be missing from your diet. Peritoneal dialysis also removes some vitamins from your body. Your doctor may prescribe a vitamin and mineral supplement that scientists have designed specifically for people with CKD and kidney failure. Never take vitamin and mineral supplements that you can buy over the counter. They may be harmful to you. Talk with your doctor before taking any medicine, including vitamin and mineral supplements, that he or she has not prescribed for you.

You may have a difficult time changing your diet at first. Eating the right foods will help you feel better. You will have more strength and energy. More information is provided in the NIDDK health topic, Make the Kidney Connection: Food Tips and Healthy Eating Ideas. </s>


Input: What to do for Treatment Methods for Kidney Failure: Peritoneal Dialysis ?

Output: - Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body.  - The two types of peritoneal dialysis are continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.  - The most common problem with peritoneal dialysis is peritonitis, a serious abdominal infection.  - When dialysis solution stays in the body too long, it becomes so full of wastes and extra fluid that it cannot absorb any more from the body. The process may even reverse, letting some wastes and extra fluid back into the body.  - Eating the right foods can help you feel better while on peritoneal dialysis. Talk with your dialysis centers dietitian to find a meal plan that works for you. </s>


Input: What to do for Facing the Challenges of Chronic Kidney Disease in Children ?

Output:
For children with CKD, learning about nutrition is vital because their diet can affect how well their kidneys work. Parents or guardians should always consult with their childs health care team before making any dietary changes. Staying healthy with CKD requires paying close attention to the following elements of a diet:

- Protein. Children with CKD should eat enough protein for growth while limiting high protein intake. Too much protein can put an extra burden on the kidneys and cause kidney function to decline faster. Protein needs increase when a child is on dialysis because the dialysis process removes protein from the childs blood. The health care team recommends the amount of protein needed for the child. Foods with protein include      - eggs    - milk    - cheese    - chicken    - fish    - red meats    - beans    - yogurt    - cottage cheese    - Sodium. The amount of sodium children need depends on the stage of their kidney disease, their age, and sometimes other factors. The health care team may recommend limiting or adding sodium and salt to the diet. Foods high in sodium include      - canned foods    - some frozen foods    - most processed foods    - some snack foods, such as chips and crackers    - Potassium. Potassium levels need to stay in the normal range for children with CKD, because too little or too much potassium can cause heart and muscle problems. Children may need to stay away from some fruits and vegetables or reduce the number of servings and portion sizes to make sure they do not take in too much potassium. The health care team recommends the amount of potassium a child needs. Low-potassium fruits and vegetables include      - apples    - cranberries    - strawberries    - blueberries    - raspberries    - pineapple    - cabbage    - boiled cauliflower    - mustard greens    - uncooked broccoli   High-potassium fruits and vegetables include      - oranges    - melons    - apricots    - bananas    - potatoes    - tomatoes    - sweet potatoes    - cooked spinach    - cooked broccoli    - Phosphorus. Children with CKD need to control the level of phosphorus in their blood because too much phosphorus pulls calcium from the bones, making them weaker and more likely to break. Too much phosphorus also can cause itchy skin and red eyes. As CKD progresses, a child may need to take a phosphate binder with meals to lower the concentration of phosphorus in the blood. Phosphorus is found in high-protein foods. Foods with low levels of phosphorus include      - liquid nondairy creamer    - green beans    - popcorn    - unprocessed meats from a butcher    - lemon-lime soda    - root beer    - powdered iced tea and lemonade mixes    - rice and corn cereals    - egg whites    - sorbet    - Fluids. Early in CKD, a childs damaged kidneys may produce either too much or too little urine, which can lead to swelling or dehydration. As CKD progresses, children may need to limit fluid intake. The health care provider will tell the child and parents or guardians the goal for fluid intake.

More information is provided in the NIDDK health topics, Nutrition for Chronic Kidney Disease in Children and Kidney Failure: Eat Right to Feel Right on Hemodialysis. </s>


Input: What to do for Facing the Challenges of Chronic Kidney Disease in Children ?

Output: - Children with chronic kidney disease (CKD) may have a negative self-image and may have relationship problems with family members due to the stress of living with a chronic disease. The condition can lead to behavior problems and make participating in school and extracurricular activities more difficult.  - CKD can cause learning problems because the buildup of wastes in the body can slow down nerve and brain function. Children with CKD may have trouble concentrating and may develop language and motor skills more slowly than their peers.  - Parents and other adults can help children with CKD fit in at school, deal with low self-esteem, make friends, be physically active, and follow their treatment regimen. As children with CKD approach adulthood, they may need help with preparing to enter the workforce.  - School attendance is vital in helping children with CKD lead the best life possible.  - One way to help children feel empowered is to give them as much control and responsibility over their own care as possible:      - Children can learn more about their medications, including doses.    - Children on dialysis should be encouraged to take an active part in their treatments.    - Parents or guardians should allow children to participate in treatment decision making.    - Participating in regular classroom and extracurricular activities may help children improve their social skills. Summer camps and recreational programs for children with special needs can be a good place to make new friends.  - Parents or guardians may feel protective of children with CKD; however, they should not try to limit activities unless instructed to by a health care provider.   - Children with CKD may need to take multiple medications, eat a specific diet, and follow their health care providers orders to help control their disease. Many children have a hard time following the treatment regimen. Health care providers use the term nonadherence to describe the failure or refusal to take prescribed medications or follow a health care providers directions.  - Adherence can be improved with a combination of health education, motivational techniques, and behavioral skill methods.  - Many skilled professionals are available to ensure that children with CKD get the best possible care. The family may want to talk with a social worker, mental health professional, financial counselor, and dietitian. If a child reaches kidney failure, the medical staff at the dialysis center or transplantation clinic can provide help.  - For children with CKD, learning about nutrition is vital because their diet can affect how well their kidneys work. Parents or guardians should always consult with their childs health care team before making any dietary changes. </s>


Input: What is (are) Cushing's Syndrome ?

Output: Cushing's syndrome is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. Sometimes called hypercortisolism, Cushing's syndrome is relatively rare and most commonly affects adults aged 20 to 50. People who are obese and have type 2 diabetes, along with poorly controlled blood glucose-also called blood sugar-and high blood pressure, have an increased risk of developing the disorder. </s>


Input: What are the symptoms of Cushing's Syndrome ?

Output:
Signs and symptoms of Cushing's syndrome vary, but most people with the disorder have upper body obesity, a rounded face, increased fat around the neck, and relatively slender arms and legs. Children tend to be obese with slowed growth rates.

Other signs appear in the skin, which becomes fragile and thin, bruises easily, and heals poorly. Purple or pink stretch marks may appear on the abdomen, thighs, buttocks, arms, and breasts. The bones are weakened, and routine activities such as bending, lifting, or rising from a chair may lead to backaches and rib or spinal column fractures.

Women with Cushing's syndrome usually have excess hair growth on their face, neck, chest, abdomen, and thighs. Their menstrual periods may become irregular or stop. Men may have decreased fertility with diminished or absent desire for sex and, sometimes, erectile dysfunction.

Other common signs and symptoms include

- severe fatigue  - weak muscles  - high blood pressure  - high blood glucose  - increased thirst and urination  - irritability, anxiety, or depression  - a fatty hump between the shoulders

Sometimes other conditions have many of the same signs as Cushing's syndrome, even though people with these disorders do not have abnormally elevated cortisol levels. For example, polycystic ovary syndrome can cause menstrual disturbances, weight gain beginning in adolescence, excess hair growth, and impaired insulin action and diabetes. Metabolic syndrome-a combination of problems that includes excess weight around the waist, high blood pressure, abnormal levels of cholesterol and triglycerides in the blood, and insulin resistance-also mimics the symptoms of Cushing's syndrome. </s>


Input: What causes Cushing's Syndrome ?

Output:
Cushing's syndrome occurs when the body's tissues are exposed to high levels of cortisol for too long. Many people develop Cushing's syndrome because they take glucocorticoids-steroid hormones that are chemically similar to naturally produced cortisolsuch as prednisone for asthma, rheumatoid arthritis, lupus, and other inflammatory diseases. Glucocorticoids are also used to suppress the immune system after transplantation to keep the body from rejecting the new organ or tissue.

Other people develop Cushing's syndrome because their bodies produce too much cortisol. Normally, the production of cortisol follows a precise chain of events. First, the hypothalamus, a part of the brain about the size of a small sugar cube, sends corticotropin-releasing hormone (CRH) to the pituitary gland. CRH causes the pituitary to secrete adrenocorticotropin hormone (ACTH), which stimulates the adrenal glands. When the adrenals, which are located just above the kidneys, receive the ACTH, they respond by releasing cortisol into the bloodstream.

Cortisol performs vital tasks in the body including

- helping maintain blood pressure and cardiovascular function  - reducing the immune system's inflammatory response  - balancing the effects of insulin, which breaks down glucose for energy  - regulating the metabolism of proteins, carbohydrates, and fats

One of cortisol's most important jobs is to help the body respond to stress. For this reason, women in their last 3 months of pregnancy and highly trained athletes normally have high levels of the hormone. People suffering from depression, alcoholism, malnutrition, or panic disorders also have increased cortisol levels.

When the amount of cortisol in the blood is adequate, the hypothalamus and pituitary release less CRH and ACTH. This process ensures the amount of cortisol released by the adrenal glands is precisely balanced to meet the bodys daily needs. However, if something goes wrong with the adrenals or the regulating switches in the pituitary gland or hypothalamus, cortisol production can go awry.

Pituitary Adenomas

Pituitary adenomas cause 70 percent of Cushing's syndrome cases,1 excluding those caused by glucocorticoid use. These benign, or noncancerous, tumors of the pituitary gland secrete extra ACTH. Most people with the disorder have a single adenoma. This form of the syndrome, known as Cushing's disease, affects women five times more often than men.

Ectopic ACTH Syndrome

Some benign or, more often, cancerous tumors that arise outside the pituitary can produce ACTH. This condition is known as ectopic ACTH syndrome. Lung tumors cause more than half of these cases, and men are affected three times more often than women. The most common forms of ACTH-producing tumors are small cell lung cancer, which accounts for about 13 percent of all lung cancer cases,2 and carcinoid tumors-small, slow-growing tumors that arise from hormone-producing cells in various parts of the body. Other less common types of tumors that can produce ACTH are thymomas, pancreatic islet cell tumors, and medullary carcinomas of the thyroid.

Adrenal Tumors

In rare cases, an abnormality of the adrenal glands, most often an adrenal tumor, causes Cushing's syndrome. Adrenal tumors are four to five times more common in women than men, and the average age of onset is about 40. Most of these cases involve noncancerous tumors of adrenal tissue called adrenal adenomas, which release excess cortisol into the blood.

Adrenocortical carcinomas-adrenal cancers-are the least common cause of Cushing's syndrome. With adrenocortical carcinomas, cancer cells secrete excess levels of several adrenocortical hormones, including cortisol and adrenal androgens, a type of male hormone. Adrenocortical carcinomas usually cause very high hormone levels and rapid development of symptoms.

Familial Cushing's Syndrome

Most cases of Cushing's syndrome are not inherited. Rarely, however, Cushing's syndrome results from an inherited tendency to develop tumors of one or more endocrine glands. Endocrine glands release hormones into the bloodstream. With primary pigmented micronodular adrenal disease, children or young adults develop small cortisol-producing tumors of the adrenal glands. With multiple endocrine neoplasia type 1 (MEN1), hormone-secreting tumors of the parathyroid glands, pancreas, and pituitary develop; Cushing's syndrome in MEN1 may be due to pituitary, ectopic, or adrenal tumors. </s>


Input: How to diagnose Cushing's Syndrome ?

Output:
Diagnosis is based on a review of a person's medical history, a physical examination, and laboratory tests. X rays of the adrenal or pituitary glands can be useful in locating tumors.

Tests to Diagnose Cushing's Syndrome

No single lab test is perfect and usually several are needed. The three most common tests used to diagnose Cushing's syndrome are the 24-hour urinary free cortisol test, measurement of midnight plasma cortisol or late-night salivary cortisol, and the low-dose dexamethasone suppression test. Another test, the dexamethasone-corticotropin-releasing hormone test, may be needed to distinguish Cushing's syndrome from other causes of excess cortisol.

- 24-hour urinary free cortisol level. In this test, a person's urine is collected several times over a 24-hour period and tested for cortisol. Levels higher than 50 to 100 micrograms a day for an adult suggest Cushing's syndrome. The normal upper limit varies in different laboratories, depending on which measurement technique is used.  - Midnight plasma cortisol and late-night salivary cortisol measurements. The midnight plasma cortisol test measures cortisol concentrations in the blood. Cortisol production is normally suppressed at night, but in Cushing's syndrome, this suppression doesn't occur. If the cortisol level is more than 50 nanomoles per liter (nmol/L), Cushing's syndrome is suspected. The test generally requires a 48-hour hospital stay to avoid falsely elevated cortisol levels due to stress.   However, a late-night or bedtime saliva sample can be obtained at home, then tested to determine the cortisol level. Diagnostic ranges vary, depending on the measurement technique used.  - Low-dose dexamethasone suppression test (LDDST). In the LDDST, a person is given a low dose of dexamethasone, a synthetic glucocorticoid, by mouth every 6 hours for 2 days. Urine is collected before dexamethasone is administered and several times on each day of the test. A modified LDDST uses a onetime overnight dose.  Cortisol and other glucocorticoids signal the pituitary to release less ACTH, so the normal response after taking dexamethasone is a drop in blood and urine cortisol levels. If cortisol levels do not drop, Cushing's syndrome is suspected. The LDDST may not show a drop in cortisol levels in people with depression, alcoholism, high estrogen levels, acute illness, or stress, falsely indicating Cushing's syndrome. On the other hand, drugs such as phenytoin and phenobarbital may cause cortisol levels to drop, falsely indicating that Cushings is not present in people who actually have the syndrome. For this reason, physicians usually advise their patients to stop taking these drugs at least 1 week before the test.  - Dexamethasone-corticotropin-releasing hormone (CRH) test. Some people have high cortisol levels but do not develop the progressive effects of Cushing's syndrome, such as muscle weakness, fractures, and thinning of the skin. These people may have pseudo-Cushing's syndrome, a condition sometimes found in people who have depression or anxiety disorders, drink excess alcohol, have poorly controlled diabetes, or are severely obese. Pseudo-Cushings does not have the same long-term effects on health as Cushing's syndrome and does not require treatment directed at the endocrine glands.  The dexamethasone-CRH test rapidly distinguishes pseudo-Cushing's from mild cases of Cushing's. This test combines the LDDST and a CRH stimulation test. In the CRH stimulation test, an injection of CRH causes the pituitary to secrete ACTH. Pretreatment with dexamethasone prevents CRH from causing an increase in cortisol in people with pseudo-Cushing's. Elevations of cortisol during this test suggest Cushing's syndrome.

Tests to Find the Cause of Cushing's Syndrome

Once Cushing's syndrome has been diagnosed, other tests are used to find the exact location of the abnormality that leads to excess cortisol production. The choice of test depends, in part, on the preference of the endocrinologist or the center where the test is performed.

- CRH stimulation test. The CRH test, without pretreatment with dexamethasone, helps separate people with pituitary adenomas from those with ectopic ACTH syndrome or adrenal tumors. As a result of the CRH injection, people with pituitary adenomas usually experience a rise in blood levels of ACTH and cortisol because CRH acts directly on the pituitary. This response is rarely seen in people with ectopic ACTH syndrome and practically never in those with adrenal tumors.  - high-dose dexamethasone suppression test (HDDST). The HDDST is the same as the LDDST, except it uses higher doses of dexamethasone. This test helps separate people with excess production of ACTH due to pituitary adenomas from those with ectopic ACTH-producing tumors. High doses of dexamethasone usually suppress cortisol levels in people with pituitary adenomas but not in those with ectopic ACTH-producing tumors.  - Radiologic imaging: direct visualization of the endocrine glands. Imaging tests reveal the size and shape of the pituitary and adrenal glands and help determine if a tumor is present. The most common imaging tests are the computerized tomography (CT) scan and magnetic resonance imaging (MRI). A CT scan produces a series of x-ray pictures giving a cross-sectional image of a body part. MRI also produces images of internal organs but without exposing patients to ionizing radiation.  Imaging procedures are used to find a tumor after a diagnosis has been made. Imaging is not used to make the diagnosis of Cushing's syndrome because benign tumors are commonly found in the pituitary and adrenal glands. These tumors, sometimes called incidentalomas, do not produce hormones in quantities that are harmful. They are not removed unless blood tests show they are a cause of symptoms or they are unusually large. Conversely, pituitary tumors may not be detectable by imaging in almost half of people who ultimately need pituitary surgery for Cushing's syndrome.  - Petrosal sinus sampling. This test is not always required, but in many cases, it is the best way to distinguish pituitary from ectopic causes of Cushing's syndrome. Samples of blood are drawn from the petrosal sinuses-veins that drain the pituitary-by inserting tiny tubes through a vein in the upper thigh or groin region. A local anesthetic and mild sedation are given, and x rays are taken to confirm the correct position of the tubes. Often CRH, the hormone that causes the pituitary to release ACTH, is given during this test to improve diagnostic accuracy.  Levels of ACTH in the petrosal sinuses are measured and compared with ACTH levels in a forearm vein. Higher levels of ACTH in the sinuses than in the forearm vein indicate a pituitary adenoma. Similar levels of ACTH in the petrosal sinuses and the forearm suggest ectopic ACTH syndrome. </s>


Input: What are the treatments for Cushing's Syndrome ?

Output:
Treatment depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs. If the cause is long-term use of glucocorticoid hormones to treat another disorder, the doctor will gradually reduce the dosage to the lowest dose adequate for control of that disorder. Once control is established, the daily dose of glucocorticoid hormones may be doubled and given on alternate days to lessen side effects. In some cases, noncorticosteroid drugs can be prescribed.

Pituitary Adenomas

Several therapies are available to treat the ACTH-secreting pituitary adenomas of Cushing's disease. The most widely used treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and fine instruments, the surgeon approaches the pituitary gland through a nostril or an opening made below the upper lip. Because this procedure is extremely delicate, patients are often referred to centers specializing in this type of surgery. The success, or cure, rate of this procedure is more than 80 percent when performed by a surgeon with extensive experience. If surgery fails or only produces a temporary cure, surgery can be repeated, often with good results.

After curative pituitary surgery, the production of ACTH drops two levels below normal. This drop is natural and temporary, and patients are given a synthetic form of cortisol such as hydrocortisone or prednisone to compensate. Most people can stop this replacement therapy in less than 1 or 2 years, but some must be on it for life.

If transsphenoidal surgery fails or a patient is not a suitable candidate for surgery, radiation therapy is another possible treatment. Radiation to the pituitary gland is given over a 6-week period, with improvement occurring in 40 to 50 percent of adults and up to 85 percent of children. Another technique, called stereotactic radiosurgery or gamma knife radiation, can be given in a single high-dose treatment. It may take several months or years before people feel better from radiation treatment alone. Combining radiation with cortisol-inhibiting drugs can help speed recovery.

Drugs used alone or in combination to control the production of excess cortisol are ketoconazole, mitotane, aminoglutethimide, and metyrapone. Each drug has its own side effects that doctors consider when prescribing medical therapy for individual patients.

Ectopic ACTH Syndrome

To cure the overproduction of cortisol caused by ectopic ACTH syndrome, all of the cancerous tissue that is secreting ACTH must be eliminated. The choice of cancer treatment-surgery, radiation, chemotherapy, immunotherapy, or a combination of these treatmentsdepends on the type of cancer and how far it has spread. Because ACTH-secreting tumors may be small or widespread at the time of diagnosis, making them difficult to locate and treat directly, cortisol-inhibiting drugs are an important part of treatment. In some cases, if other treatments fail, surgical removal of the adrenal glands, called bilateral adrenalectomy, may replace drug therapy.

Adrenal Tumors

Surgery is the mainstay of treatment for benign and cancerous tumors of the adrenal glands. Primary pigmented micronodular adrenal disease and the inherited Carney complex-primary tumors of the heart that can lead to endocrine overactivity and Cushing's syndrome-require surgical removal of the adrenal glands. </s>


Input: What to do for Cushing's Syndrome ?

Output: - Cushing's syndrome is a disorder caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol.  - Typical signs and symptoms of Cushing's syndrome include upper body obesity, a rounded face, skin that bruises easily and heals poorly, weakened bones, excess body hair growth and menstrual irregularities in women, and decreased fertility in men.  - Cushing's syndrome is caused by exposure to glucocorticoids, which are used to treat inflammatory diseases, or by the body's overproduction of cortisol, most often due to tumors of the pituitary gland or lung.  - Several tests are usually needed to diagnosis Cushing's syndrome, including urine, blood, and saliva tests. Other tests help find the cause of the syndrome.  - Treatment depends on the specific reason for excess cortisol and may include surgery, radiation, chemotherapy, or the use of cortisol-inhibiting drugs. </s>


Input: What is (are) Indigestion ?

Output:
Indigestion, also known as dyspepsia, is a term used to describe one or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen.

Indigestion is common in adults and can occur once in a while or as often as every day. </s>


Input: What causes Indigestion ?

Output:
Indigestion can be caused by a condition in the digestive tract such as gastroesophageal reflux disease (GERD), peptic ulcer disease, cancer, or abnormality of the pancreas or bile ducts. If the condition improves or resolves, the symptoms of indigestion usually improve.

Sometimes a person has indigestion for which a cause cannot be found. This type of indigestion, called functional dyspepsia, is thought to occur in the area where the stomach meets the small intestine. The indigestion may be related to abnormal motilitythe squeezing or relaxing actionof the stomach muscle as it receives, digests, and moves food into the small intestine. </s>


Input: What are the symptoms of Indigestion ?

Output:
Most people with indigestion experience more than one of the following symptoms:

- Fullness during a meal. The person feels overly full soon after the meal starts and cannot finish the meal.  - Bothersome fullness after a meal. The person feels overly full after a mealit may feel like the food is staying in the stomach too long.  - Epigastric pain. The epigastric area is between the lower end of the chest bone and the navel. The person may experience epigastric pain ranging from mild to severe.  - Epigastric burning. The person feels an unpleasant sensation of heat in the epigastric area.

Other, less frequent symptoms that may occur with indigestion are nausea and bloatingan unpleasant tightness in the stomach. Nausea and bloating could be due to causes other than indigestion.

Sometimes the term indigestion is used to describe the symptom of heartburn, but these are two different conditions. Heartburn is a painful, burning feeling in the chest that radiates toward the neck or back. Heartburn is caused by stomach acid rising into the esophagus and may be a symptom of GERD. A person can have symptoms of both indigestion and heartburn. </s>


Input: How to diagnose Indigestion ?

Output:
To diagnose indigestion, the doctor asks about the person's current symptoms and medical history and performs a physical examination. The doctor may order x rays of the stomach and small intestine.

The doctor may perform blood, breath, or stool tests if the type of bacteria that causes peptic ulcer disease is suspected as the cause of indigestion.

The doctor may perform an upper endoscopy. After giving a sedative to help the person become drowsy, the doctor passes an endoscopea long, thin tube that has a light and small camera on the endthrough the mouth and gently guides it down the esophagus into the stomach. The doctor can look at the esophagus and stomach with the endoscope to check for any abnormalities. The doctor may perform biopsiesremoving small pieces of tissue for examination with a microscopeto look for possible damage from GERD or an infection.

Because indigestion can be a sign of a more serious condition, people should see a doctor right away if they experience

- frequent vomiting  - blood in vomit  - weight loss or loss of appetite  - black tarry stools  - difficult or painful swallowing  - abdominal pain in a nonepigastric area  - indigestion accompanied by shortness of breath, sweating, or pain that radiates to the jaw, neck, or arm  - symptoms that persist for more than 2 weeks </s>


Input: What are the treatments for Indigestion ?

Output:
Some people may experience relief from symptoms of indigestion by

- eating several small, low-fat meals throughout the day at a slow pace  - refraining from smoking  - abstaining from consuming coffee, carbonated beverages, and alcohol  - stopping use of medications that may irritate the stomach liningsuch as aspirin or anti-inflammatory drugs  - getting enough rest  - finding ways to decrease emotional and physical stress, such as relaxation therapy or yoga

The doctor may recommend over-the-counter antacids or medications that reduce acid production or help the stomach move food more quickly into the small intestine. Many of these medications can be purchased without a prescription. Nonprescription medications should only be used at the dose and for the length of time recommended on the label unless advised differently by a doctor. Informing the doctor when starting a new medication is important.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve symptoms of indigestion. Many brands on the market use different combinations of three basic saltsmagnesium, calcium, and aluminumwith hydroxide or bicarbonate ions to neutralize the acid in the stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium, though they may cause constipation.

H2 receptor antagonists (H2RAs) include ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid) and are available both by prescription and over-the-counter. H2RAs treat symptoms of indigestion by reducing stomach acid. They work longer than but not as quickly as antacids. Side effects of H2RAs may include headache, nausea, vomiting, constipation, diarrhea, and unusual bleeding or bruising.

Proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium) and are available by prescription. Prilosec is also available in over-the-counter strength. PPIs, which are stronger than H2RAs, also treat indigestion symptoms by reducing stomach acid. PPIs are most effective in treating symptoms of indigestion in people who also have GERD. Side effects of PPIs may include back pain, aching, cough, headache, dizziness, abdominal pain, gas, nausea, vomiting, constipation, and diarrhea.

Prokinetics such as metoclopramide (Reglan) may be helpful for people who have a problem with the stomach emptying too slowly. Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness, including fatigue, sleepiness, depression, anxiety, and involuntary muscle spasms or movements.

If testing shows the type of bacteria that causes peptic ulcer disease, the doctor may prescribe antibiotics to treat the condition. </s>


Input: What to do for Indigestion ?

Output: - Indigestion, also known as dyspepsia, is a term used to describe one or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen.  - Indigestion can be caused by a condition in the digestive tract such as gastroesophageal reflux disease (GERD), peptic ulcer disease, cancer, or abnormality of the pancreas or bile ducts.  - Sometimes a person has indigestion for which a cause cannot be found. This type of indigestion is called functional dyspepsia.  - Indigestion and heartburn are different conditions, but a person can have symptoms of both.  - The doctor may order x rays; blood, breath, and stool tests; and an upper endoscopy with biopsies to diagnose indigestion.  - Some people may experience relief from indigestion by making some lifestyle changes and decreasing stress.  - The doctor may prescribe antacids, H2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), prokinetics, or antibiotics to treat the symptoms of indigestion. </s>


Input: What is (are) IgA Nephropathy ?

Output: IgA nephropathy, also known as Bergers disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues. IgA is an antibodya protein made by the immune system to protect the body from foreign substances such as bacteria or viruses. Most people with IgA nephropathy receive care from a nephrologist, a doctor who specializes in treating people with kidney disease. </s>


Input: What causes IgA Nephropathy ?

Output:
Scientists think that IgA nephropathy is an autoimmune kidney disease, meaning that the disease is due to the bodys immune system harming the kidneys.

People with IgA nephropathy have an increased blood level of IgA that contains less of a special sugar, galactose, than normal. This galactose-deficient IgA is considered foreign by other antibodies circulating in the blood. As a result, these other antibodies attach to the galactose-deficient IgA and form a clump. This clump is also called an immune complex. Some of the clumps become stuck in the glomerulus of the nephron and cause inflammation and damage.

For some people, IgA nephropathy runs in families. Scientists have recently found several genetic markers that may play a role in the development of the disease. IgA nephropathy may also be related to respiratory or intestinal infections and the immune systems response to these infections. </s>


Input: How many people are affected by IgA Nephropathy ?

Output:
IgA nephropathy is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure.1

IgA nephropathy can occur at any age, although the first evidence of kidney disease most frequently appears when people are in their teens to late 30s.2 IgA nephropathy in the United States is twice as likely to appear in men than in women.3 While found in people all over the world, IgA nephropathy is more common among Asians and Caucasians.4

A person may be more likely to develop IgA nephropathy if

- he or she has a family history of IgA nephropathy or Henoch-Schnlein purpuraa disease that causes small blood vessels in the body to become inflamed and leak  - he is a male in his teens to late 30s  - he or she is Asian or Caucasian </s>


Input: What are the symptoms of IgA Nephropathy ?

Output:
In its early stages, IgA nephropathy may have no symptoms; it can be silent for years or even decades. Once symptoms appear, the most common one is hematuria, or blood in the urine. Hematuria can be a sign of damaged glomeruli. Blood in the urine may appear during or soon after a cold, sore throat, or other respiratory infection. The amount of blood may be

- visible with the naked eye. The urine may turn pink or the color of tea or cola. Sometimes a person may have dark or bloody urine.  - so small that it can only be detected using special medical tests.

Another symptom of IgA nephropathy is albuminuriawhen a persons urine contains an increased amount of albumin, a protein typically found in the blood, or large amounts of protein in the urine. Albumin is the main protein in the blood. Healthy kidneys keep most proteins in the blood from leaking into the urine. However, when the glomeruli are damaged, large amounts of protein leak out of the blood into the urine.

When albumin leaks into the urine, the blood loses its capacity to absorb extra fluid from the body. Too much fluid in the body may cause edema, or swelling, usually in the legs, feet, or ankles and less often in the hands or face. Foamy urine is another sign of albuminuria. Some people with IgA nephropathy have both hematuria and albuminuria.

After 10 to 20 years with IgA nephropathy, about 20 to 40 percent of adults develop end-stage kidney disease.5 Signs and symptoms of end-stage kidney disease may include

- high blood pressure  - little or no urination  - edema  - feeling tired  - drowsiness  - generalized itching or numbness  - dry skin  - headaches  - weight loss  - appetite loss  - nausea  - vomiting  - sleep problems  - trouble concentrating  - darkened skin  - muscle cramps </s>


Input: What are the complications of IgA Nephropathy ?

Output:
Complications of IgA nephropathy include

- high blood pressure  - acute kidney failuresudden and temporary loss of kidney function  - chronic kidney failurereduced kidney function over a period of time  - nephrotic syndromea collection of symptoms that indicate kidney damage; symptoms include albuminuria, lack of protein in the blood, and high blood cholesterol levels  - heart or cardiovascular problems  - Henoch-Schnlein purpura

More information is provided in the NIDDK health topics, Kidney Disease and Kidney Failure. </s>


Input: How to diagnose IgA Nephropathy ?

Output:
A health care provider diagnoses kidney disease with

- a medical and family history  - a physical exam  - urine tests   - a blood test

Medical and Family History

Taking a medical and family history may help a health care provider diagnose kidney disease.

Physical Exam

A physical exam may help diagnose kidney disease. During a physical exam, a health care provider usually

- measures the patients blood pressure  - examines the patients body for swelling

Urine Tests

Dipstick test for albumin and blood. A dipstick test performed on a urine sample can detect the presence of albumin and blood. The patient provides a urine sample in a special container in a health care providers office or a commercial facility. A nurse or technician can test the sample in the same location, or he or she can send it to a lab for analysis. The test involves placing a strip of chemically treated paper, called a dipstick, into the patients urine sample. Patches on the dipstick change color when albumin or blood is present in urine.

Urine albumin-to-creatinine ratio. A health care provider uses this measurement, which compares the amount of albumin with the amount of creatinine in a urine sample, to estimate 24-hour albumin excretion. A patient may have chronic kidney disease if the urine albumin-to-creatinine ratio is greater than 30 milligrams (mg) of albumin for each gram (g) of creatinine (30 mg/g). This measurement is also called UACR.

Blood Test

A blood test involves having blood drawn at a health care providers office or a commercial facility and sending the sample to a lab for analysis. A health care provider may order a blood test to estimate how much blood a patients kidneys filter each minutea measurement called the estimated glomerular filtration rate (eGFR). Depending on the results, the test can indicate the following:

- eGFR of 60 or above is in the normal range  - eGFR below 60 may indicate kidney disease  - eGFR of 15 or below may indicate kidney failure </s>


Input: How to diagnose IgA Nephropathy ?

Output:
Currently, health care providers do not use blood or urine tests as reliable ways to diagnose IgA nephropathy; therefore, the diagnosis of IgA nephropathy requires a kidney biopsy.

A kidney biopsy is a procedure that involves taking a small piece of kidney tissue for examination with a microscope. A health care provider performs a kidney biopsy in a hospital or an outpatient center with light sedation and a local anesthetic. The health care provider uses imaging techniques such as ultrasound or a computerized tomography scan to guide the biopsy needle into the kidney. A pathologista doctor who specializes in examining tissues to diagnose diseasesexamines the kidney tissue with a microscope. Only a biopsy can show the IgA deposits in the glomeruli. The biopsy can also show how much kidney damage has already occurred. The biopsy results can help the health care provider determine the best course of treatment. </s>


Input: What are the treatments for IgA Nephropathy ?

Output:
Researchers have not yet found a specific cure for IgA nephropathy. Once the kidneys are scarred, they cannot be repaired. Therefore, the ultimate goal of IgA nephropathy treatment is to prevent or delay end-stage kidney disease. A health care provider may prescribe medications to

- control a persons blood pressure and slow the progression of kidney disease  - remove extra fluid from a persons blood  - control a persons immune system  - lower a persons blood cholesterol levels

Control Blood Pressure and Slow Progression of Kidney Disease

People with IgA nephropathy that is causing high blood pressure may need to take medications that lower blood pressure and can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medicationsangiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)have proven effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. A person may also need beta-blockers, calcium channel blockers, and other blood pressure medications.

Remove Extra Fluid

A health care provider may prescribe a diuretic, a medication that helps the kidneys remove extra fluid from the blood. Removing the extra fluid can improve the control of blood pressure. Taking a diuretic along with an ACE inhibitor or an ARB often increases the effectiveness of these medications.

Control the Immune System

Health care providers sometimes use medications to control a persons immune system. Since inflammation is the immune systems normal response, controlling the immune system can decrease inflammation. Health care providers may prescribe the following medications:

- corticosteroids, such as prednisone  - cyclophosphamide

Lower Blood Cholesterol Levels

People with IgA nephropathy may develop high blood cholesterol levels. Cholesterol is a type of fat found in the bodys cells, in blood, and in many foods. People who take medications for high blood cholesterol levels can lower their blood cholesterol levels. A health care provider may prescribe one of several cholesterol-lowering medications called statins. </s>


Input: How to prevent IgA Nephropathy ?

Output: Researchers have not found a way to prevent IgA nephropathy. People with a family history of IgA nephropathy should talk with their health care provider to find out what steps they can take to keep their kidneys healthy, such as controlling their blood pressure and keeping their blood cholesterol at healthy levels. </s>


Input: What to do for IgA Nephropathy ?

Output:
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing IgA nephropathy. Health care providers may recommend that people with kidney disease, such as IgA nephropathy, make dietary changes such as

- limiting dietary sodium, often from salt, to help reduce edema and lower blood pressure  - decreasing liquid intake to help reduce edema and lower blood pressure  - eating a diet low in saturated fat and cholesterol to help control high levels of lipids, or fats, in the blood

Health care providers may also recommend that people with kidney disease eat moderate or reduced amounts of protein, although the benefit of reducing protein in a persons diet is still being researched. Proteins break down into waste products the kidneys must filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. People with kidney disease on a restricted protein diet should receive blood tests that can show nutrient levels.

Some researchers have shown that fish oil supplements containing omega-3 fatty acids may slow kidney damage in some people with kidney disease by lowering blood pressure. Omega-3 fatty acids may help reduce inflammation and slow kidney damage due to IgA nephropathy. To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/supplements.

People with IgA nephropathy should talk with a health care provider about dietary changes to best manage their individual needs. </s>


Input: What to do for IgA Nephropathy ?

Output: - Immunoglobulin A (IgA) nephropathy, also known as Bergers disease, is a kidney disease that occurs when IgA deposits build up in the kidneys, causing inflammation that damages kidney tissues.  - Scientists think that IgA nephropathy is an autoimmune kidney disease, meaning that the disease is due to the bodys immune system attacking tissues in the kidney.  - IgA nephropathy is one of the most common kidney diseases, other than those caused by diabetes or high blood pressure.  - In its early stages, IgA nephropathy may have no symptoms; it can be silent for years or even decades.  - Once symptoms appear, the most common one is hematuria, or blood in the urine.  - Another symptom of IgA nephropathy is albuminuriawhen a persons urine contains an increased amount of albumin, a protein typically found in the blood, or large amounts of protein in the urine.  - Currently, health care providers do not use blood or urine tests as reliable ways to diagnose IgA nephropathy; therefore, the diagnosis of IgA nephropathy requires a kidney biopsy.  - Researchers have not yet found a specific cure for IgA nephropathy. </s>


Input: What is (are) Urinary Tract Infections in Children ?

Output: A UTI is an infection in the urinary tract. Infections are caused by microbesorganisms too small to be seen without a microscopeincluding fungi, viruses, and bacteria. Bacteria are the most common cause of UTIs. Normally, bacteria that enter the urinary tract are rapidly removed by the body before they cause symptoms. However, sometimes bacteria overcome the bodys natural defenses and cause infection. An infection in the urethra is called urethritis. A bladder infection is called cystitis. Bacteria may travel up the ureters to multiply and infect the kidneys. A kidney infection is called pyelonephritis. </s>


Input: What is (are) Urinary Tract Infections in Children ?

Output:
The urinary tract is the bodys drainage system for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are a pair of bean-shaped organs, each about the size of a fist and located below the ribs, one on each side of the spine, toward the middle of the back. Every minute, a persons kidneys filter about 3 ounces of blood, removing wastes and extra water. The wastes and extra water make up the 1 to 2 quarts of urine an adult produces each day. Children produce less urine each day; the amount produced depends on their age. The urine travels from the kidneys down two narrow tubes called the ureters. The urine is then stored in a balloonlike organ called the bladder. Routinely, urine drains in only one directionfrom the kidneys to the bladder. The bladder fills with urine until it is full enough to signal the need to urinate. In children, the bladder can hold about 2 ounces of urine plus 1 ounce for each year of age. For example, an 8-year-olds bladder can hold about 10 ounces of urine.

When the bladder empties, a muscle called the sphincter relaxes and urine flows out of the body through a tube called the urethra at the bottom of the bladder. The opening of the urethra is at the end of the penis in boys and in front of the vagina in girls. </s>


Input: What causes Urinary Tract Infections in Children ?

Output:
Most UTIs are caused by bacteria that live in the bowel. The bacterium Escherichia coli (E. coli) causes the vast majority of UTIs. The urinary tract has several systems to prevent infection. The points where the ureters attach to the bladder act like one-way valves to prevent urine from backing up, or refluxing, toward the kidneys, and urination washes microbes out of the body. Immune defenses also prevent infection. But despite these safeguards, infections still occur. Certain bacteria have a strong ability to attach themselves to the lining of the urinary tract.

Children who often delay urination are more likely to develop UTIs. Regular urination helps keep the urinary tract sterile by flushing away bacteria. Holding in urine allows bacteria to grow. Producing too little urine because of inadequate fluid intake can also increase the risk of developing a UTI. Chronic constipationa condition in which a child has fewer than two bowel movements a weekcan add to the risk of developing a UTI. When the bowel is full of hard stool, it presses against the bladder and bladder neck, blocking the flow of urine and allowing bacteria to grow.

Some children develop UTIs because they are prone to such infections, just as other children are prone to getting coughs, colds, or ear infections. </s>


Input: How many people are affected by Urinary Tract Infections in Children ?

Output: Urinary tract infections affect about 3 percent of children in the United States every year. UTIs account for more than 1 million visits to pediatricians offices every year.1 </s>


Input: Who is at risk for Urinary Tract Infections in Children? ?

Output: Throughout childhood, the risk of having a UTI is 2 percent for boys and 8 percent for girls. Having an anomaly of the urinary tract, such as urine reflux from the bladder back into the ureters, increases the risk of a UTI. Boys who are younger than 6 months old who are not circumcised are at greater risk for a UTI than circumcised boys the same age.1 </s>


Input: What are the symptoms of Urinary Tract Infections in Children ?

Output:
Symptoms of a UTI range from slight burning with urination or unusual-smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms. A UTI causes irritation of the lining of the bladder, urethra, ureters, and kidneys, just as the inside of the nose or the throat becomes irritated with a cold. In infants or children who are only a few years old, the signs of a UTI may not be clear because children that young cannot express exactly how they feel. Children may have a high fever, be irritable, or not eat.

On the other hand, children may have only a low-grade fever; experience nausea, vomiting, and diarrhea; or just not seem healthy. Children who have a high fever and appear sick for more than a day without signs of a runny nose or other obvious cause for discomfort should be checked for a UTI.

Older children with UTIs may complain of pain in the middle and lower abdomen. They may urinate often. Crying or complaining that it hurts to urinate and producing only a few drops of urine at a time are other signs of a UTI. Children may leak urine into clothing or bedsheets. The urine may look cloudy or bloody. If a kidney is infected, children may complain of pain in the back or side below the ribs.

Parents should talk with their health care provider if they suspect their child has a UTI. </s>


Input: How to diagnose Urinary Tract Infections in Children ?

Output:
Only a health care provider can determine whether a child has a UTI.

A urine sample will be collected and examined. The way urine is collected depends on the childs age:

- If the child is not yet toilet trained, the health care provider may place a plastic collection bag over the childs genital area. The bag will be sealed to the skin with an adhesive strip. If this method is used, the bag should be removed right after the child has urinated, and the urine sample should be processed immediately. Because bacteria from the skin can contaminate this sample, the methods listed below are more accurate.  - A health care provider may need to pass a small tube called a catheter into the urethra of an infant. Urine will drain directly from the bladder into a clean container.  - Sometimes the best way to collect a urine sample from an infant is by placing a needle directly into the bladder through the skin of the lower abdomen. Getting urine through a catheter or needle will ensure that the urine collected does not contain bacteria from the skin.  - An older child may be asked to urinate into a container. The sample needs to come as directly into the container as possible to avoid picking up bacteria from the skin or rectal area.

Some of the urine will be examined with a microscope. If an infection is present, bacteria and sometimes pus will be found in the urine. A urine culture should also be performed on some of the urine. The culture is performed by placing part of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified.

The reliability of the culture depends on how the urine is collected and how long the urine stands before the culture is started. If the urine sample is collected at home, it should be refrigerated as soon as it is collected. The container should be carried to the health care provider or lab in a plastic bag filled with ice.

The health care provider may also order a sensitivity test, which tests the bacteria for sensitivity to different antibiotics to see which medication is best for treating the infection. </s>


Input: What are the treatments for Urinary Tract Infections in Children ?

Output:
Most UTIs are caused by bacteria, which are treated with bacteria-fighting medications called antibiotics or antimicrobials. While a urine sample is sent to a laboratory, the health care provider may begin treatment with an antibiotic that treats the bacteria most likely to be causing the infection. Once culture results are known, the health care provider may decide to switch the childs antibiotic.

The choice of medication and length of treatment depend on the childs history and the type of bacteria causing the infection. When a child is sick or unable to drink fluids, the antibiotic may need to be put directly into the bloodstream through a vein in the arm or hand or be given as an injection. Otherwise, the medicationliquid or pillsmay be given by mouth. The medication is given for at least 3 to 5 days and possibly for as long as several weeks. The daily treatment schedule recommended depends on the specific medication prescribed: The schedule may call for a single dose each day or up to four doses each day. In some cases, a child will need to take the medication until further tests are finished.

After a few doses of the antibiotic, a child may appear much better, but often several days may pass before all symptoms are gone. In any case, the medication should be taken for as long as the health care provider recommends. Medications should not be stopped because the symptoms have gone away. Infections may return, and bacteria can resist future treatment if the medication is stopped too soon.

If needed, the health care provider may recommend an appropriate over-the-counter medication to relieve the pain of a UTI. A heating pad on the back or abdomen may also help. </s>


Input: How to diagnose Urinary Tract Infections in Children ?

Output:
Once the infection has cleared, more tests may be recommended to check for abnormalities in the urinary tract. Repeated infections in an abnormal urinary tract may cause kidney damage. The kinds of tests ordered will depend on the child and the type of urinary infection. Because no single test can tell everything about the urinary tract that might be important, more than one of the tests listed below may be needed.

- Kidney and bladder ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologista doctor who specializes in medical imaging; anesthesia is not needed. The images can show certain abnormalities in the kidneys and bladder. However, this test cannot reveal all important urinary abnormalities or measure how well the kidneys work.  - Voiding cystourethrogram. This test is an x-ray image of the bladder and urethra taken while the bladder is full and during urination, also called voiding. The childs bladder and urethra are filled with a special dye, called contrast medium, to make the structures clearly visible on the x-ray images. The x-ray machine captures images of the contrast medium while the bladder is full and when the child urinates. The procedure is performed in a health care providers office, outpatient center, or hospital by an x-ray technician supervised by a radiologist, who then interprets the images. Anesthesia is not needed, but sedation may be used for some children. This test can show abnormalities of the inside of the urethra and bladder. The test can also determine whether the flow of urine is normal when the bladder empties.  - Computerized tomography (CT) scan. CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. A CT scan may include the injection of contrast medium. CT scans require the child to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist; anesthesia is not needed. CT scans can provide clearer, more detailed images to help the health care provider understand the problem.  - Magnetic resonance imaging (MRI). MRI machines use radio waves and magnets to produce detailed pictures of the bodys internal organs and soft tissues without using x rays. An MRI may include the injection of contrast medium. With most MRI machines, the child lies on a table that slides into a tunnel-shaped device that may be open ended or closed at one end; some newer machines are designed to allow the child to lie in a more open space. The procedure is performed in an outpatient center or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed, though light sedation may be used for children with a fear of confined spaces. Like CT scans, MRIs can provide clearer, more detailed images.  - Radionuclide scan. A radionuclide scan is an imaging technique that relies on the detection of small amounts of radiation after injection of radioactive chemicals. Because the dose of the radioactive chemicals is small, the risk of causing damage to cells is low. Special cameras and computers are used to create images of the radioactive chemicals as they pass through the kidneys. Radionuclide scans are performed in a health care providers office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. Radioactive chemicals injected into the blood can provide information about kidney function. Radioactive chemicals can also be put into the fluids used to fill the bladder and urethra for x ray, MRI, and CT imaging. Radionuclide scans expose a child to about the same amount or less of radiation as a conventional x ray.  - Urodynamics. Urodynamic testing is any procedure that looks at how well the bladder, sphincters, and urethra are storing and releasing urine. Most of these tests are performed in the office of a urologista doctor who specializes in urinary problemsby a urologist, physician assistant, or nurse practitioner. Some procedures may require light sedation to keep the child calm. Most urodynamic tests focus on the bladders ability to hold urine and empty steadily and completely. Urodynamic tests can also show whether the bladder is having abnormal contractions that cause leakage. A health care provider may order these tests if there is evidence that the child has some kind of nerve damage or dysfunctional voidingunhealthy urination habits such as holding in urine when the bladder is full. </s>


Input: What are the treatments for Urinary Tract Infections in Children ?

Output:
Some abnormalities in the urinary tract correct themselves as the child grows, but some may require surgical correction. While milder forms of VUR may resolve on their own, one common procedure to correct VUR is the reimplantation of the ureters. During this procedure, the surgeon repositions the connection between the ureters and the bladder so that urine will not reflux into the ureters and kidneys. This procedure may be performed through an incision that gives the surgeon a direct view of the bladder and ureters or laparoscopically. Laparoscopy is a procedure that uses a scope inserted through a small incision.

In recent years, health care providers have treated some cases of VUR by injecting substances into the bladder wall, just below the opening where the ureter joins the bladder. This injection creates a kind of narrowing or valve that keeps urine from refluxing into the ureters. The injection is delivered to the inside of the bladder through a catheter passed through the urethra, so there is no surgical incision. Evidence of clinically significant obstruction may indicate the need for surgery. </s>


Input: How to prevent Urinary Tract Infections in Children ?

Output: If a child has a normal urinary tract, parents can help the child avoid UTIs by encouraging regular trips to the bathroom. The parents should make sure the child gets enough to drink if infrequent urination is a problem. The child should be taught proper cleaning techniques after using the bathroom to keep bacteria from entering the urinary tract. Loose-fitting clothes and cotton underwear allow air to dry the area. Parents should consult a health care provider about the best ways to treat constipation. </s>


Input: What to do for Urinary Tract Infections in Children ?

Output: Children with a UTI should drink as much as they wish and not be forced to drink large amounts of fluid. The health care provider needs to know if a child is not interested in drinking or is unable to drink. </s>


Input: What to do for Urinary Tract Infections in Children ?

Output: - Urinary tract infections (UTIs) usually occur when the body fails to remove bacteria rapidly from the urinary tract.  - UTIs affect about 3 percent of children in the United States every year.  - Most UTIs are not serious, but chronic kidney infections can cause permanent damage.  - A UTI in a young child may be a sign of an abnormality in the urinary tract that could lead to repeated problems.  - Symptoms of a UTI range from slight burning with urination or unusual-smelling urine to severe pain and high fever. A child with a UTI may also have no symptoms.  - Parents should talk with their health care provider if they suspect their child has a UTI. </s>


Input: What is (are) What I need to know about Hepatitis C ?

Output:
Hepatitis* C is a virus, or infection, that causes liver disease and inflammation of the liver. Viruses can cause sickness. For example, the flu is caused by a virus. People can pass viruses to each other.

Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can cause organs to not work properly. </s>


Input: What is (are) What I need to know about Hepatitis C ?

Output:
The liver is an organ that does many important things. You cannot live without a liver.

*See the Pronunciation Guide for tips on how to say the words in bold type.

The liver

- removes harmful chemicals from your blood  - fights infection  - helps digest food  - stores nutrients and vitamins  - stores energy </s>


Input: Who is at risk for What I need to know about Hepatitis C? ?

Output:
Anyone can get hepatitis C, but those more likely to are people who

- were born to a mother with hepatitis C  - are in contact with blood or infected needles at work  - have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease  - are on kidney dialysisthe process of filtering wastes and extra water from the body by means other than the kidneys  - are infected with HIV  - have injected illegal drugs  - have had tattoos or body piercings  - work or live in a prison  - had a blood transfusion or organ transplant before July 1992  - have hemophilia and received clotting factor before 1987

Also, men who have sex with men are more likely to get hepatitis C. </s>


Input: What are the symptoms of What I need to know about Hepatitis C ?

Output:
Most people do not have any symptoms until the hepatitis C virus causes liver damage, which can take 10 or more years to happen. Others may have one or more of the following symptoms:

- feeling tired  - muscle soreness  - upset stomach  - stomach pain  - fever  - loss of appetite  - diarrhea  - dark-yellow urine  - light-colored stools  - yellowish eyes and skin, called jaundice

When symptoms of hepatitis C occur, they can begin 1 to 3 months after coming into contact with the virus. See a doctor right away if you or a child in your care has symptoms of hepatitis C. </s>


Input: What is (are) What I need to know about Hepatitis C ?

Output: Acute hepatitis C is a short-term infection with the hepatitis C virus. Symptoms can last up to 6 months. The infection sometimes clears up because your body is able to fight off the infection and get rid of the virus. </s>


Input: What is (are) What I need to know about Hepatitis C ?

Output:
Chronic hepatitis C is a long-lasting infection with the hepatitis C virus. Chronic hepatitis C occurs when the body cant get rid of the hepatitis C virus. Most hepatitis C infections become chronic.

Without treatment, chronic hepatitis C can cause liver cancer or severe liver damage that leads to liver failure. Liver failure occurs when the liver stops working properly. </s>


Input: How to diagnose What I need to know about Hepatitis C ?

Output:
A blood test will show if you have hepatitis C. Blood tests are done at a doctors office or outpatient facility. A blood sample is taken using a needle inserted into a vein in your arm or hand. The blood sample is sent to a lab to test for hepatitis C.

If you are at higher risk of getting hepatitis C, get tested. Many people with hepatitis C do not know they are infected.

Your doctor may suggest getting a liver biopsy if chronic hepatitis C is suspected. A liver biopsy is a test to take a small piece of your liver to look for liver damage. The doctor may ask you to stop taking certain medicines before the test. You may be asked to fast for 8 hours before the test.

During the test, you lie on a table with your right hand resting above your head. Medicine is applied to numb the area where the biopsy needle will be inserted. If needed, sedatives and pain medicine are also given. The doctor uses a needle to take a small piece of liver tissue. After the test, you must lie on your right side for up to 2 hours. You will stay 2 to 4 hours after the test before being sent home.

A liver biopsy is performed at a hospital or outpatient center by a doctor. The liver sample is sent to a special lab where a doctor looks at the tissue with a microscope and sends a report to your doctor. </s>


Input: What are the treatments for What I need to know about Hepatitis C ?

Output:
Hepatitis C is usually not treated unless it becomes chronic. Chronic hepatitis C is treated with medicines that slow or stop the virus from damaging the liver. Your doctor will closely watch your symptoms and schedule regular blood tests to make sure the treatment is working.

Medicines for Chronic Hepatitis C

Chronic hepatitis C is most often treated with a medicine combination that attacks the hepatitis C virus. Treatment may last from 24 to 48 weeks.

Today, newer treatments with medicine for chronic hepatitis C are appearing quickly. Talk with your doctor if you have questions about treatment.

Talk with your doctor before taking other prescription medicines and over-the-counter medicines.

Liver Transplant

A liver transplant may be necessary if chronic hepatitis C causes severe liver damage that leads to liver failure. Symptoms of severe liver damage include the symptoms of hepatitis C and

- generalized itching  - a longer than usual amount of time for bleeding to stop  - easy bruising  - swollen stomach or ankles  - spiderlike blood vessels, called spider angiomas, that develop on the skin

Liver transplant is surgery to remove a diseased or injured liver and replace it with a healthy one from another person, called a donor. If your doctors tell you that you need a transplant, you should talk with them about the long-term demands of living with a liver transplant.

A team of surgeonsdoctors who specialize in surgeryperforms a liver transplant in a hospital. You will learn how to take care of yourself after you go home and about the medicines youll need to take to protect your new liver. You will continue to take medicines because hepatitis C may come back after surgery.

Testing for Liver Cancer

Having hepatitis C increases your risk for liver cancer, so your doctor may suggest an ultrasound test of the liver every 6 to 12 months. Finding cancer early makes it more treatable. Ultrasound is a machine that uses sound waves to create a picture of your liver. Ultrasound is performed at a hospital or radiology center by a specially trained technician. The image, called a sonogram, can show the livers size and the presence of cancerous tumors. </s>


Input: What to do for What I need to know about Hepatitis C ?

Output: If you have chronic hepatitis C, you should do things to take care of yourself, including eating a healthy diet. Avoid drinking alcohol, which can harm the liver. Talk with your doctor before taking vitamins and other supplements. </s>


Input: What to do for What I need to know about Hepatitis C ?

Output: - Hepatitis C is a virus, or infection, that causes inflammation of the liver.  - Anyone can get hepatitis C, but some people are more likely to than others.  - You could get hepatitis C through contact with an infected persons blood.  - Most people do not have any symptoms until the hepatitis C virus causes liver damage, which can take 10 or more years to happen.  - See a doctor right away if you or a child in your care has symptoms of hepatitis C.  - Acute hepatitis C is a short-term infection with the hepatitis C virus.  - Chronic hepatitis C is a long-lasting infection with the hepatitis C virus. Chronic hepatitis C occurs when the body cant get rid of the hepatitis C virus.  - A blood test will show if you have hepatitis C.  - If you are at higher risk of getting hepatitis C, get tested. Many people with hepatitis C do not know they are infected.  - Hepatitis C usually is not treated unless it becomes chronic. Chronic hepatitis C is treated with medicines that slow or stop the virus from damaging the liver.  - Tell your doctor and your dentist if you have hepatitis C.  - See your doctor right away if you think you have been in contact with the hepatitis C virus. Early diagnosis and treatment of chronic hepatitis C can help prevent liver damage. </s>


Input: What is (are) Cirrhosis ?

Output:
Cirrhosis is a condition in which the liver slowly deteriorates and is unable to function normally due to chronic, or long lasting, injury. Scar tissue replaces healthy liver tissue and partially blocks the flow of blood through the liver.

The liver is the bodys largest internal organ. The liver is called the bodys metabolic factory because of the important role it plays in metabolismthe way cells change food into energy after food is digested and absorbed into the blood. The liver has many functions, including

- taking up, storing, and processing nutrients from foodincluding fat, sugar, and proteinand delivering them to the rest of the body when needed  - making new proteins, such as clotting factors and immune factors  - producing bile, which helps the body absorb fats, cholesterol, and fat-soluble vitamins  - removing waste products the kidneys cannot remove, such as fats, cholesterol, toxins, and medications

A healthy liver is necessary for survival. The liver can regenerate most of its own cells when they become damaged. However, if injury to the liver is too severe or long lasting, regeneration is incomplete, and the liver creates scar tissue. Scarring of the liver, also called fibrosis, may lead to cirrhosis.

The buildup of scar tissue that causes cirrhosis is usually a slow and gradual process. In the early stages of cirrhosis, the liver continues to function. However, as cirrhosis gets worse and scar tissue replaces more healthy tissue, the liver will begin to fail. Chronic liver failure, which is also called end-stage liver disease, progresses over months, years, or even decades. With end-stage liver disease, the liver can no longer perform important functions or effectively replace damaged cells.

Cirrhosis is the 12th leading cause of death in the United States, accounting for nearly 32,000 deaths each year. More men die of cirrhosis than women.1 </s>