The urinary system works with other organs to eliminate waste from the body. The kidneys filter waste from the bloodstream and produce urine, which is stored in the bladder and released through the urethra. As people age, the urinary system's muscles and filtering ability can weaken, increasing risks of infections and incontinence. Common urinary disorders include kidney diseases, bladder conditions, urinary tract infections, kidney stones, and incontinence. Symptoms vary depending on the specific condition but may include blood in the urine, pain during urination, and frequent urges to urinate.

1. Overview
Your urinarysystemworkswithotherorgansto getrid of wastesand keepchemicalsandwaterin
the bodybalanced.Asan adultwoman,youeliminate aboutaquartand a half of urine eachday,but
the amountcan varydependingonthe amountof fluidandfoodyou’ve consumedandhow much
youlose throughsweatingandbreathing.Some medicationscanaffectthe quantityof urine your
bodyeliminates.
Whenyour bodyusesproteinsderivedfromthe foodsyoueat,itcreatesa waste productcalledurea
that iscarriedin the bloodstreamtothe kidneys,twobean-shapedorgansapproximatelythe size of
fists.Theyare locatedjustbelowthe ribcage near the middle of the back.Each kidneyhasabouta
milliontinyfilteringunitscallednephrons,whichremoveureafromthe blood.
A ball of small bloodcapillaries(aglomerulus)anda small tube calledarenal tubule comprise a
nephron.The kidneysremove orreturnchemicalssuchasphosphorus,potassiumandsodiumin
quantitiesneededtomaintainoptimal bloodlevelsof these substances.Urea,waterandother
waste productscreate urine as the substancesmove throughthe nephronsanddownthe kidney’s
renal tubules.
The kidneyalsoreleasesthreevital hormones:erythropoietinwhichstimulatesproduction of red
bloodcellsinbones;renin,ablood-pressure regulator;andthe active formof vitaminD,which
maintainscalciumlevelsinbone.
Urine exitsthe kidneysthroughtwothintubesabouteightto10 incheslongcalledureters,which
carry the fluidto the bladder,ahollowmuscularorganthatstoresurine.Uretermusclestightenand
relax topump urine downwardandawayfromthe kidneys.The processismore or lesscontinuous,
withminute quantitiesof urine emptyingintothe bladderaboutevery10to 15 seconds.If the urine
getsstuck inthe uretersor backs up,a kidneyinfectioncanresult.
Shapedlike aballoon,the bladdersitsinthe pelvisandstoresurine until youare readytourinate.As
it becomesfuller,itswellsintoaroundshape andthenshrinkswhenitisemptied.A healthyurinary
systemcan holdupto 16 ouncesof urine fortwoto five hours.Bladdernervessendsignalstoletyou
knowwhentourinate;the signalsgrowsteadilymore urgentasthe bladderfills.

2. To keepurine fromleaking,circularmusclescalledsphinctersclose tightlyaroundthe openingof the
bladder.Whenyoudecide tourinate,bladdermusclestightenandsphinctermusclesrelax,andthe
urine ispusheddownthe urethra.
As youage,the structure of your kidneys canchange,reducingtheirabilitytoremove wastes.Illness
and injurycanalso affectthe filteringabilityof the kidneysorblockurine’spassage.Urinarysystem
musclesalsotendtoweakenasyou grow older,leadingtoincreasedincidence of urinary tract
infectionsandincontinence.
Urinary systemdisordersare widespread.Accordingtothe National KidneyFoundation,
approximately26 millionAmericanshave chronickidneydisease,andmostdonotknow it. Millions
more are at risk.Incontinence andoveractivebladderare twoof the mostcommonhealthproblems
amongwomen.And85,790 Americansdiedof end-stagerenal diseasein2005.
Major Urinary SystemDisorders
Healthcare professionalsoftenuse the term“renal function”whentalkingaboutthe kidneys;if both
kidneysare healthy,youhave 100 percentrenal function.If one becomesnonfunctionaloris
donatedfora transplantoperation,youwill still be healthy,evenwithonly50percentof renal
function.However,if functionslipsbelow 20percent,serioushealthproblemsarise because the
kidneyscannolongerperformtheirfunctionof regulatingwaterandchemicalsandremovingwaste.
Levelsbelow 10to 15 percentnecessitate dialysisortransplantation.
Renal functionlevelsbelow 10to 15 percentnecessitate dialysisortransplantation.Unfortunately,
symptomsof chronicrenal failure (agradual lossof function) maygoundetectedforseveral years
and oftendonot become noticeable before kidneyfunctionfallsto25 percentor less.
Acute renal failure denotesasuddenonsetof renal failure,suchasthat causedby an accident,
certaindrugsor poison.The kidneysmayrecoverorthe damage maybe permanent.If the kidneys
stopworkingentirely,the resultisaconditioncalleduremia,inwhichthe bodyfillswithextrawater
and waste products,leadingtoswellinginthe handsor feet,fatigue andweakness.End-stage renal
disease (ESRD) referstowhenthe kidneyshave lostall ornearlyall function.
Specifickidneyconditionsinclude:

3. AnalgesicNephropathy
Improperuse of over-the-counterpainkillers,oranalgesics,canleadtokidneyfailure.These
productsinclude aspirin,acetaminophen,ibuprofenandnaproxensodium, all of whichare safe for
mostpeople whentakenatthe recommendeddosages.However,combiningthese drugsortaking
themwhenyouhave certainconditionsboostsyourriskof kidneydisease.Youshouldavoidthese
medicationsif youhave anautoimmune diseasesuchaslupus,advancedage,chronickidney
conditionsorhave recentlybingedonalcohol.
If you have any of these conditions,make sure yourhealthcare professional andpharmacistare
consultedbefore yourisktakingananalgesic,since short-termuse cancause acute (temporary)
kidneyfailure.
Takingone or more of these productsdailyforseveral yearscancause analgesicnephropathy,
chronickidneydisease leadinggraduallytoend-stage renal disease(ESRD).Combinationpainkillers
(suchas aspirinandacetaminophen) are especiallydangerous.If youfindyouneedpainkillersoften,
talkto a healthcare professionalaboutthe bestoptionsforprotectingyourkidneys.
Cystocele
A cystocele,occurswhenthe pelvicfloormuscles,whichformthe wall betweenthe bladderand
vagina,weaken,allowingthe bladderto dropinto the vagina.The consequencesare discomfortand
voidingdifficulties,suchasurine leakage orincomplete bladderemptying.
There are three gradesof cystocele:
Grade 1: the bladderdropsa shortway intothe vagina
Grade 2: the bladdersinks tothe openingof the vagina
Grade 3: the bladderbulgesthroughthe vaginal opening
Interstitial Cystitis(IC)
Interstitial cystitis(IC) mayalsobe calledpainful bladdersyndrome,urethralsyndromeand
frequency-urgencysyndrome.Itisan inflammatory conditionof the liningof the bladder.

4. The inflammationassociatedwiththischronicbladderdisordercancause diminishedbladder
capacityor size,glomerulations(pinpointbleeding) and(rarely) ulcersinthe bladderlining.Rarely,in
severe cases,scarringandstiffeningof the bladdercanoccur. Althoughthe cause of thisdisorderis
unknown,researchshowsthatitmaybe associatedwithotherdiseasessuchasvulvodynia(vulvaror
vaginal pain),fibromyalgia,irritablebowelsyndrome(IBS) andendometriosis.Interstitial cystitis
affectsan estimated1.3millionAmericans,more than1 millionof whomare women.
Typical IC-associatedsensationsinclude discomfort,pressure,tendernessorintense paininthe
bladderandsurroundingpelvicarea.The intensityof painmayshiftasthe bladderfillsorempties.
Othersymptomsinclude painassociatedwithintercourse andfrequentand/orurgentneedto
urinate (womenwithsevere ICmayurinate asmanyas 60 timesa day).Symptomsoftengetworse
before orduringmenstruationandaftersexual activity.
No one knowsforsure what causesIC;theoriespointtoan autoimmune disease,abnormalityinthe
urine,hereditarycondition,infectionorallergiccondition.
Glomerulardiseases
Diseasesthatdamage the glomeruli—the kidney’sfilteringunits—canleadtokidneyfailure.Two
majorcategoriesof glomerulardiseasesare:
glomerulonephritis,inflammationof the membrane tissueinthe kidneythatfilterswastesandextra
fluidfromthe blood
glomerulosclerosis,scarringorhardeningof tinybloodvesselsinthe kidney
Whenthe glomeruli are damaged,proteinandbloodcanseepintothe urine,andwaste products
can accumulate inthe blood.If too much of the proteinalbuminislost,the bloodislessable to
absorbextrafluid.
Glomerulardiseasesare indicatedby:
proteinuria
hematuria

5. reducedglomerularfiltrationrate (inefficientwaste filtering)
hypoproteinemia(low levelsof proteininthe blood)
swelling,oredema
The diseaseshave manycauses,including:
Autoimmune diseases,suchaslupus.Autoimmunediseasesare conditionsthatdevelopasaresult
of the immune systemattackinghealthytissueinsteadof combatinginvadingbacteriaorviruses.
Hereditarynephritis,alsocalledAlportsyndrome.A family historyof chronicglomerulardisease or
impairedvisionmaystemfromthissyndrome,andmenare more likelytoprogresstochronicrenal
failure and/orvisionloss.
Infection-relatedglomerulardisease,suchasstrepthroat,heartinfection(bacterial endocarditis),
HIV or skininfection(impetigo).The kidneysusuallyrecoverfrominfection-relateddamage,but
sometimesdamage ispermanentandESRDresults.
Hematuria
Hematuriaisa term usedforthe presence of redbloodcellsinthe urine.Sometimeshematuriais
visible,butinmanycasesthe urine appearsnormal.Hematuriaisnota disease initself,butasignof
some othercondition.
The cause maybe a seriousone,suchas bladderorkidneycancer,butmore oftenthe cause is
relativelybenign.Exercise cancause episodichematuria,forexample.Obviousbloodinthe urine is
oftenassociatedwithbladderinfectionsorkidneystones.Still,youshouldcheckwithahealthcare
professionalanytime yousee bloodinyoururine orfollow upif a urinalysisshowsredbloodcellsin
your urine.
To identifythe cause of hematuria,yourdoctormayordervarioustests,suchas urinalysis,blood
tests,ultrasound,intravenouspyelogramorCT urogram, or may examine yourbladderwitha
cystoscope.If white bloodcellsare presentinthe urine,aurinarytract infectionorkidneydisease
may be the cause.
Treatmentistailoredtothe cause of the hematuria.If itisnot causedby a seriouscondition,no
treatmentisnecessary.

6. End-Stage Renal Disease (ESDR) and KidneyFailure
The earlystagesof kidneydisease maynotcause noticeable symptoms.However,symptomsmay
include frequentheadaches,fatigue oranall-overitch.Worseningdiseasecancause urination
patternsto change (becomingmore orlessfrequent), appetiteloss,nauseaandvomiting,swellingor
numbnessinthe handsor feet,drowsiness,difficultyconcentrating,skindarkeningandmuscle
cramps. Treatmentgenerallyrequiresdialysisortransplant,describedinthe treatmentsection.
Diabetesisthe leadingcause of ESRD.
Whendiabetesisundiagnosedorpoorlycontrolled,excesssugarcirculatesinthe blood,leadingto
higherbloodflowintothe kidneyandglomerularscarring.Diabeticnephropathyisthe termusedfor
such damage,whichcanbe delayedorpreventedbymaintaininghealthybloodsugarlevels.If you
have diabetes,highbloodpressure orageneticconditioncalledpolycystickidneydisease,your
healthcare team will monitoryourconditiontopreventorlimitthe damage tothe kidneys. Such
damage may leadtorenal failure andESRD.
BladderCancerand KidneyCancer
Signsand symptomsof bladdercancerinclude bloodinthe urine (whichmaybe brightredor rusty
inappearance or onlyseenunderthe microscope),painfulorfrequenturinationorfeelingthe urge
to urinate eventhoughthe bladderisempty.
Renal cell canceris the mostcommonform of kidneycancer.Asthe cancer grows,it may spreadto
nearbyorgans,such as the liver,colonorpancreas,or may disperse (metastasize) to otherpartsof
the body.Cancer cellsoftenspreadtolymphnodes,bean-shapedorgansthatproduce infection-
fightingcells.Signsandsymptomsof renal cell cancerinclude bloodinthe urine,backorabdominal
pain,or a mass on the kidney.Manykidneycancersare diagnosedbyultrasoundorCTexamination
performedforothermedical reasons.
KidneyorUreterStones
Stones,orcalculi,are usuallyformedinthe kidneysbutmaybe foundanywhere inthe urinary
system.Stonesare amongthe mostpainful and mostcommonurinarytract disorders—anestimated

7. five to10 percentof Americanswill have akidneystone atsome pointintheirlives.Menare
afflictedwithkidneystonesmore oftenthanwomen,andCaucasiansare more susceptiblethan
AfricanAmericans. Stonesare mostlikelytooccurbetweenthe agesof 20 and50 inwomen(laterin
men) andare more likelytooccur inpeople whohave previouslyhadstones.
Kidneystonesvarywidelyinsize andinthe amountof paintheycause.Most are passedfromthe
bodywithoutassistance,butthere are avarietyof strategiestotreat stonesthatlinger.
A kidneystone formsfromcrystalsthatseparate fromurine andaccumulate onthe kidney’sinner
surfaces.Urine containschemicalsthatpreventcrystal formation, butinsome people the process
doesn’tworkwell andtheydevelopstones.If the stonesare small enough,theytravelthroughthe
urinarytract andleave the bodywithoutcausingsymptoms.
Most stonescontaincalciumandeitheroxalate orphosphate—all threeare partof a healthydiet.
Lesscommonare struvite orinfectionstones,causedbyurinarytractinfections.Termsusedto
describe stonesinclude nephrolithiasis(kidneystones),urolithiasis(urinarytractstones) and
ureterolithiasis(ureterstones).
Riskfor kidneystonesishigherinthose withfamilyhistoriesof stones;those whohave urinarytract
infections,kidneydisordersandmetabolicdisorderssuchashyperparathyroidism, cystinuria(too
much of an aminoacid calledcystine) orhyperoxaluria(excessproductionof oxalatesalt);andthose
witha disease calledrenal tubularacidosis.Highlevelsof urinarycalciumleadtocrystalsof calcium
oxalate orcalciumphosphate,whichcangrow intopainful stones.
Otherriskfactors include:
hyperuricosuria—adisorderof uricacidmetabolism
gout
excessintake of vitaminD
blockage of the urinarytract
use of diureticsorcalcium-basedantacids
chronicbowel inflammation,intestinal bypasssurgeryorostomysurgery

8. The initial symptomisusually sudden,intense pain,provokedbythe movementof astone inthe
urinarytract. The feelingisusuallyasharp,verysevere,crampingpaininthe backandside inthe
kidneyorlowerabdominal region.Nauseaandvomitingmayoccur,and the painmay spread to the
groin.A stone toolarge to pass easilycausescontinuingpaininthe musclesinthe ureterastheytry
to squeeze the stone intothe bladder.Asthe stone approachesthe bladder,youmayfeel compelled
to urinate more frequentlyorfeel aburningpainwhenyouurinate.
Note:Feverandchillssuggestaninfectionthatwarrantsahealthcare professional’simmediate
attention.
Kidneystonesare usuallydiagnosedviax-rayorsonogram.Urinalysisoftenshowsbloodcells.A
healthcare professional mayorderbloodandurine teststodetectabnormal substancesthatmaybe
stimulatingstone production.A type of x-raycalledanintravenouspyelogram(IVP) orspiral CTscan
may be usedto scan the urinarysystemaswell.Inaddition,tohelpdeterminewhat’scausingyour
kidneystonesand,therefore,toplanappropriate preventionmeasures,yourhealthcare
professionalmayaskyouto urinate througha strainerdesignedtocatchany stonesyoupassso the
stonescan be analyzedfortheirmakeup.
NeurogenicBladder
The smoothfunctioningof the urinarysystemdependsonmusclesandnervesworkingproperlyto
store urine inthe bladderandrelease itat the appropriate time.Nervesrunningbetweenthe
bladderandthe brain tell the brainwhenthe bladderis full andtell the bladderwhenit’sOKtorelax
and release the urine.Whenthe nervesthatcarrythese messagesmalfunction,aconditioncalled
neurogenicbladderresults.
Some possible causesof neurogenicbladderinclude:
diabetes
accidentsthatcause trauma tothe brainor spinal cord
nerve problemssuchasmultiple sclerosis,strokes,orParkinsonism
congenital nerve problemssuchasspinabifida
Primaryeffectsof neurogenicbladderare:

9. urine leakage,whenmusclesholdingthe urine donotgetthe message tostay tightto retainthe
urine
urine retention,whenthe musclesholdinginthe urine donotgetthe message thattheyshouldlet
go
damage to the tinybloodvesselsinthe kidneysthatresultswhenthe bladdergetstoofull.This
preventsgood drainage,causingbackpressure.
bladderinfectionorinfectionof the kidneys
PolycysticKidneyDisease(PKD)
Thisgeneticdisordercausesmultiplecyststogrow in the kidneysandgraduallydisplace functioning
parts of the kidney.PKDsymptoms sometimesshow upinchildhood,includingfrequentheadaches
and back or side pain.Othersymptomsincludehighbloodpressure,urinarytractinfectionsand
kidneystones,aswell asbloodorproteininurine.The disease,however,mayexhibitnosymptoms
for years.There are two formsof PKD :
Autosomal DominantPolycysticKidneyDisease (ADPKD)isthe mostcommon,affectingone in400 to
one in1,000 adults.Symptomsinclude highbloodpressure,andthe conditioncanleadtorenal
failure.
Autosomal Recessive PolycysticKidneyDisease (ARPKD),alsoknownasinfantile PKD,isfar less
common,affectingonlyone in10,000 to one in20,000 at a far youngerage,includingnewborns,
infantsandchildren.Itcan be detectedduringpregnancythroughamniocentesisorchorionicvillus
sampling.
Proteinuria
Proteinuriadenoteshighlevelsof proteininthe urine.Whenkidneysare healthy,filteringunits
calledglomeruliremovewaste productsbutleave behindnutrientsthe bodyneeds,suchas
proteins,whichare usuallytoolarge topassthroughkidneyfiltersunlessthe kidneysare damaged.
Whenalbumin,asmall protein,seepsintothe urine,bloodvesselslosetheircapacitytoreabsorb
fluidfromthe tissues.The fluidthenbuildsupinhands,feetorankles,causingswelling.
Symptomsof proteinuriainclude foamy-appearingurine andswellinginthe hands,feet,abdomenor
face.But the conditioncanalsobe invisible,producingnosymptoms.Laboratorytestingisthe only
wayto measure proteinuria.

10. One basictest usesa chemicallytreatedstripof papertodetectproteinlevels.The paperchanges
colorif dippedinurine withhighlevelsof protein.A more sensitive test,whichcandetect
microalbuminuria,requiresurinecollectionover24 hours.You mayalso have toprovide a blood
sample forcreatinine andureanitrogentesting(see kidneydisease andrenal failure).If bloodlevels
of these twosubstancesare high,kidneyfunctionisimpaired.
Proteinuriaisasignof glomerulonephritis,alsocallednephritis(inflammationof the kidney).
Diabetes,hypertensionandvariouskidneydiseasescancause the inflammation,whichcanleadto
renal failure and,ultimately,end-stage renal disease (ESRD).
The severityof damage correlateswiththe level of proteinuria andwhetherthe proteincontentis
entirelyalbuminorincludesotherproteins(themore kindsof proteins,the greaterthe damage).
If you have diabetes,youshouldbe regularlycheckedforproteinuria.The NationalKidney
Foundationalsorecommendsthatall routine checkupsinclude proteinuriatesting,especiallyfor
those at highrisk.
Small amountsof albumininthe urine—microalbuminuria—isthe firstsignof decliningkidney
functioninpeople withdiabetes(the leadingcause of ESRD).Asfunctioncontinuestoslide,the level
of albuminrisesandthe conditionbecomesproteinuria.
The secondmost commoncause of ESRD ishighbloodpressure.Proteinuriaandhighbloodpressure
togetherindicate deterioratingkidneyfunction.Medicationforhypertensionmustbe started,or
renal failure willresult.AfricanAmericansare athigherriskfor highbloodpressure andthe resulting
kidneyproblemsthanCaucasians.
Proteinuriaalsostrikesmore frequentlyinNative Americans,HispanicAmericans,PacificIslanders,
olderpeople andoverweightpeople.If youhave afamilyhistoryof kidneydisease,youshouldhave
your urine testedregularly.
Urinary Incontinence
Many factors can cause urinaryincontinence,oralossof bladdercontrol resultinginthe involuntary
release of urine.Incontinence isaproblemformillionsof Americanwomen,particularlythose aged

11. 65 and older.Itis especiallycommoninwomenwhoare pregnantorhave recentlydeliveredababy
and inelderlywomen.Incontinence canalsoaffect men.
Bladdercontrol,orcontinence,isthe resultof a systemof nervesandmusclesworkingtogether
correctly.If the musclesat the bladderneckor inthe pelvicfloorare weak,laughter,sneezingor
heavyliftingcancause leakage.
A condition calledurge incontinence ariseswhenthe bladdermuscle isoveractive andcontracts
involuntarily.Sincethe occurrence of urge incontinence isunpredictable,itismore devastatingto
one’squalityof life.Overactive bladder(OAB) occurswhenyouvoidmore thaneighttimesinthe
day andtwice at night,have a strong urge to void,and/orurge incontinence.Itaffectsmillionsof
Americans,bothmenandwomen.
Overflowincontinence occurswhenyourbladderisoverlyfull andleaksurine.Youmayfeel as
thoughyouneedto emptyyourbladderbutcannot.
Urinary Tract Infection(UTI)
Urinary tract infectionsare usuallycausedbybacteriafromthe bowel thatlive onthe skinnearthe
rectumor near the vagina.Because the openingsof the bowel,vaginaand urethraare close
together,it’seasyforthe bacteriato spreadfromthe bowel tothe urethra andtravel up the urinary
tract into the bladder,sometimesintothe kidneys.
Normal urine issterile,containingfluid,saltsandwaste products,butnotbacteria.Infectionscan
come from a varietyof bacteriathat normallylive inthe digestive system, butinfectionscanalsobe
causedby sexuallytransmittedmicroorganismssuchaschlamydiaandmycoplasma.
Infectioncanoccur whenthe bacteriaclingto the openingof the urethraandmultiply,producingan
infectionof the urethra,calledurethritis.Infectioncanalsooccur whenthe bacteriagetintothe
bladder,causingcystitis,orabladderinfection.If the problemisnottreated,the infectioncan
continue spreadingupthe urinarytract,causinginfectioninthe kidneys,calledpyelonephritis.A
kidneyinfectionthatisnottreatedcan resultinthe kidneysbeingunable todrainurine,permitting
the bacteriato enterthe bloodstream,whichcancause a life-threateninginfection.

12. The firstsignof a UTI isusuallya strongurge to urinate.Asyourelease urine,youfeelapainful
burningsensation,andlittle urine iseliminated.The urge tourinate returnsquickly,andurination
may be hard to control.You mayhave urine leakage duringsleep.Youmayalsohave sorenessin
your lowerabdomen,inyourback,orin the sidesof yourbody.Your urine maylookcloudyor have
a reddishtinge fromblood.Itmaysmell foul orstrong.You alsomay feel tired,shaky andwashed
out.If the infectionhasspreadtothe kidneys,youmayhave fever,chills,nausea,vomitingandback
pain,inadditiontothe frequenturge tourinate andpainful urination.
Vesicoureteral Reflux(VUR)
Whenurine flowsbackwardfromthe bladderintothe ureters,the conditioniscalledvesicoureteral
reflux (VUR).Itismostoftendiagnosedinchildhood.If yourchilddevelopsaurinarytract infection,
he or she shouldbe evaluatedforVURbecause the conditionisfoundinaboutone-thirdof children
witha UTI .
PrimaryVUR ariseswhenachildisborn withan impairedvalve where the ureterjoinsthe bladder.
The valve failstoclose fully,causingurine tobackupfrom the bladderintothe uretersandkidneys.
The conditionmayimprove overtime asthe uretergrowsand valve functionimproves.
SecondaryVUR arisesdue toa blockage inthe urinarytract, oftenthe resultof aninfectionthat
causesthe ureterto swell.Again,the resultisabackflow of urine intothe kidneys.
The leadingsymptomof VURis infection.Othersymptomsmayarise asa childgetsolder,including
highbloodpressure,proteinuriaandkidneyfailure.
DiagnosingVURmay involve avoidingcystourethrogram, atestthat providesanimage of the
urinarysystemtodetermine if adefectinthe urinarytract iscausingVUR and infection.Othertests
may include akidneyandbladderultrasound;anintravenouspyelogram(IVP),whichinvolves
injectingaliquidthatcanbe seenonx-raystohighlightanyobstructionsinthe kidneyorbladder;or
nuclearscans,teststhat use radioactive material injectedintoaveintoreveal how well the kidneys
and bladderare functioning.
The goal of VUR treatmentisto preventkidneydamage.Aninfectionshouldbe treatedimmediately
withantibioticstopreventitfrommovingintothe kidneys.Antibioticscanalsohelpcorrectreflux
causedby an infection.Sometimessurgeryisnecessarytorepairaphysical defectthatcausesVUR.

13. Urinary Retention
Sometimesthe bladderfailstoempty fully,leadingtoretainedurine.Acute urinaryretentionresults
ina suddeninabilitytourinate,accompaniedbypainanddiscomfort.The conditionmaybe caused
by a urinarytract obstructionfromthe prostate glandinmenor frompelvicmassesinwomen
(fibroidtumorsare the mostcommon);stressorneurological factors;infection;andcertain
medications.Relaxationof the pelvicfloorstructuresresultinginalarge bulgingcystocele mayalso
resultinkinkingof the urethraandurinaryretention.The cause determinesthe treatment.
Urinary retentionisarelativelycommonproblemaftersurgery.Itoccursas a resultof the
anesthetic,drugsusedforpaincontrol or the type of surgeryperformed.Chronicurinaryretention,
by contrast,referstoa persistentconditionof urine remaininginthe bladderandincomplete
emptying.Chronicurinaryretentioncanleadtourinarytract infections.
Evaluationforurinaryretentionincludesamedical historyandphysical examination(includinga
prostate examinationinmen) tofindthe source of the problem.If anacute nerve problemis
suspected,yourdoctormayorder a CT scan or MRI . A urogynecologistorurologistmayperform
advancedurodynamictestingtohelpdeterminethe cause of the voidingdysfunction.He orshe may
alsoperforma cystoscopicexamination.
Diagnosis
If you are havingurinarysystemsymptoms,youmaybe askedtoundergovarioustests.Some of the
mostcommon are:
Bloodtests.Testsforkidneydisease include:
Serumcreatinine.Measures bloodlevelsof asubstance calledcreatininethatisgeneratedwhenthe
bodybreaksdownproteinandusesit.
Creatinine clearance.Measureshoweffectivelyyourkidneysremove creatinine.
Bloodureanitrogen(BUN).A nitrogen-containingsubstance called ureaisanormal byproduct
resultingwhenthe bodybreaksdownproteinandusesit.Healthykidneysremoveureafromthe

14. bloodforexcretioninurine.Excessureainthe bloodisasignthe kidneysare notfunctioningwell.
BUN can also be transientlyelevatedwithdehydration.
Dipsticktestforproteinuria.Whenthe kidneysare notfunctioningwell,proteinmaybe presentin
urine.Foamyurine isa strongsignof protein,butusuallythere are novisible symptoms.The testfor
proteinuriausesadipstickthatchangescolorinthe presence of protein.
Renal biopsy.Inthisprocedure ahealthcare professional obtainsasample of kidneytissue to
examine underamicroscope.A needle isinsertedthroughthe skinintothe backof the kidneyto
retrieve atissue sample.
Renal imaging.If bloodandurine testingsuggestsimpairedkidneyfunction,yourhealthcare
professionalmayrecommendrenal imaging,aprocedure thatcapturesanimage of the kidneys
usingultrasound,computedtomography(CT) ormagneticresonance imaging(MRI).
Urinalysis.Forthistest,youurinate intoa special containerandleave the samplewithanurse orlab
technician.The urine isthenanalyzedforsignsof infection,bloodcellsandabnormal substances
such as proteins,glucose orwhite bloodcellsandbacteria.
Urine culture.A urine culture isa laboratorytestthat testsfor infectioninyoururine byallowingany
bacteriainthe urine sample togrowand multiply.The bacteriaare thenidentifiedandtestedtosee
whichantibioticwillworkbesttokill the bacteria.Yoururine issentfora culture if infectionis
suspectedonurinalysis.
Urine cytology.A urine cytologyinvolvesacheckof your urine forcancer cells.
Ultrasound.Lubricatingjellyisrubbedonyourabdomenand pelvis,andawandpassesoveryour
kidneysandbladdertocheckfor abnormalitiesinyoururinarytractor genitals,aswell asresidual or
leftoverurine inyourbladder.
Intravenouspyelogram(IVP).Thistestx-raysthe urinarytractto identifyamalformation,tumor,
kidneyorbladderstone orotherblockage preventingnormal urine flow.A dye containingiodineis
administeredviaaneedle intoavein;the dye isthenincorporatedintothe urine,makingthe urinary
tract easierto see onx-rays.

15. Cystoscopicexamination.Duringthistest,ahealthcare professionalinsertsaninstrumentcalleda
cystoscope throughthe urethraand intothe bladder.The cystoscope ispencil thinandhasa lightat
the tip to allowalookinside the tract.A cystoscope mayhave an additional instrumentattachedto
performa treatmentprocedure,suchasa biopsy.Cystoscopymaybe recommendedinavarietyof
circumstances,includingfrequenturinarytractinfections,bloodinthe urine,incontinence or
overactive bladder,presence of unusual cellsinthe bladder,needforacatheter,chronicpainor
interstitialcystitis,urinarytractblockage,kidneystone oranunusual growth.A ureteroscope,which
isan evensmallertube,canbe insertedintoaureter.
Urodynamictest. Thisis a seriesof testsof bladderfunction.Bladderpressureismeasuredasthe
bladderfills,storesandemptiesurine—inotherwords,ineachphase of bladderactivity.Forthis
test,a small tube calledacatheteris insertedthroughthe urethrainto yourbladder.The bladderis
thenfilledwitheitherwateroran x-raydye.Anothersmall tube isinsertedintothe vaginaorrectum
to measure abdominal pressure whenyoustrainorcough; if a dye is used,anx-rayis taken.Your
doctor maysuggestthis seriesof testsif yoursymptomssuggestmuscle ornerve problemsinthe
lowerurinarysystem(bladder,urethraandsphinctermuscles).
Treatment
A primarycare healthcare professionalcantreatmany urinarydisorders,butsome conditionsmay
require consultationwithaurologist,asurgeonwhospecializesinthe treatmentof urinarysystem
disordersandconditionsaffectingthe reproductivesystem.A urogynecologistisagynecologistwho
istrainedto treatbladderandpelvicfloordisordersinwomen.Forkidneydisorders,particularly
kidneyfailure,anephrologist(amedical specialistinkidneydiseases) maybe needed.
Treatmentforcystocele
A grade 1 or 2 cystocele mayrequire notreatment,exceptavoidance of heavyliftingorstraining.For
moderatelybothersomecystoceles,apessary(aplasticorrubberdevice thatfitsintoyourvaginato
helpsupportyouruterus,vagina,bladderorrectum) maybe fittedtothe vaginato holdthe bladder
inplace.A pessarymustbe removedandcleanedregularly topreventinfectionandulcers.
A large cystocele mayrequire surgerytorepositionthe bladder.The surgeryrequiresahospital stay
of one to several daysandfourto six weeksforafull recovery.
Treatmentforkidneystones

16. Surgeryisusuallynotnecessarytoremove kidneystones.Drinkingplentyof water—twotothree
quarts perday––and takingdrugswhichcan relax the uretermayallow forthe stone topass down
the tract. A healthcare professional mayrecommendthatyoustayhome,drinkplentyof fluidsand
take painmedicine asneeded.Youmaybe askedto save the passedstone fortests.
Shockwave lithotripsy.The mostcommonmethodforremovingstonesisshockwave lithotripsy
(SWL),inwhichshockwavesinitiatedoutsidethe bodytravel through skinandbodytissuesuntilthey
hitthe stones.The stonesdisintegrateintosand-like particlesandare passedthroughthe urinary
tract. The procedure maybe done ina hospital or onan outpatientbasis;youtypicallyresume your
normal activitieswithinafewdays,butitmay take monthsfor youto pass all the pieces.
Complicationsmayincludebloodinthe urine forafew days,bruisinganddiscomfortof the backor
abdomen.Tominimize riskof problemsafterthe treatment,youshouldavoidmedicationsthat
reduce bloodclotting(suchasaspirin) forone totwo weeksbefore treatment.
The stone particlesmaycause painas theypass throughthe urinarytract. Your healthcare
professionalmayinsertasmall tube calledastentthroughthe bladderinto the ureterto helpthe
fragmentspass.Some people mayneedtwoormore SWL treatments.
Surgeryisgenerallyanoptionwhenthe stone:
doesnotpass aftera reasonable time andcausesconstantpain
istoo large to pass onits ownor is caughtin a difficultplace
blocksurine flow
causescontinuingurinarytractinfection
harms kidneytissueorprovokesincessantbleeding
isgrowing(as shownonx-rays)
The two mostcommon surgical techniquesforremovingstonesare:
Urethroscopicstone removal.Thisprocedure isusedforstoneslodgedinthe ureterorforkidney
stones.A small fiber-opticinstrumentcalledaureteroscope ispassedthroughthe urethraand

17. bladderandintothe ureteror kidney.Whenthe stone isfound,the surgeoneitherremovesit or
shattersitwithan instrumentthatbreaksthe stone.
Percutaneousnephrolithotomy.Thissurgical procedure usuallyrequiresahospital stayandisused
for large stonesorstonesinlocationsnotconducive toSWL. The surgeonmakesa small incisionin
the back, createsa tunnel tothe kidneyandusesa nephroscope tofindandremove the stone.A
nephrostomytube maystayinthe kidneyduringthe healingprocess.Large stonesmayrequire use
of an ultrasound,electrohydraulicenergyprobe orlasertobreakup the stone.One advantage over
SWL is that percutaneousnephrolithotomyremovesthe stone particlesratherthanleavingthemto
pass throughthe kidneyandoutthe ureters.
Parathyroidglandsurgery.Insome cases,calciumstonesare causedbya small benigntumorinone
of the parathyroidglands,fourglandslocatedjustbelowyourAdam’sapple.If thisisthe case,you
may have surgeryto remove the tumoror one or more of the parathyroidglands.
Treatmentforbladdercancer
Treatmentforbladdercancerdependsonthe size andstagingof the tumor.For early-stage tumors,
the usual treatmentistransurethral resectionof the bladdertumor,aprocedure duringwhicha
lightedtube isinsertedthroughthe urethraandintothe bladdertoremove the cancer forbiopsy
and to cut or burn awayany remainingcancercells.Chemotherapyandimmunotherapymayalsobe
usedto preventcancerrecurrence.Inextreme cases,acystectomy,orremoval of the bladder,may
be performed.
Treatmentforinterstitial cystitis (IC)
Behavioral therapy.Make sure yougetenoughwater,ideallyabouttwoquartsa day.Althoughno
scientificevidence pointstodietaryfactorsasthe cause of IC, avoidingpotential bladderirritants,
includingcoffee,chocolate,carbonatedbeverages,acidicfoodsordrinks,mayhelpease symptoms.
Controllingstresscanalsohelp.
Medications.Medicationsare the primarytreatmentforIC.The onlydrugspecificallyapprovedfor
IC ispentosan(Elmiron).Pentosanhelpsrestorethe normal bladderliningbutmaytake up to six
monthsto work.Several othermedicationsnotspecificallyindicatedforICmayalso helpreduce
symptoms,includingnonsteroidal anti-inflammatorydrugs(NSAIDs),antihistaminesand
antidepressants,particularlyamitriptyline (Elavil) orimipramine (Tofranil).Youmayrequire more
than one medication.

18. Bladderinstillation.Alsocalledabladderwashorbath,the bladderisfilledwithadrugcocktail
containingone of several substancesincludingheparin,pentosan,ordimethyl sulfoxide (DMSO,
RIMSO-50),whichmust be heldfora specifiedperiodof time—usually10to 20 minutes––before
urinating.Thistreatmentisperformedeveryweekortwoforsix to eightweeksandrepeatedas
needed.
Because DMSO passesintothe bladderwall, itreachestissue more effectivelytoreduce
inflammationandpain.Italsoappearsto preventthe muscle spasmsthatcause painand
urgent/frequentneedtourinate.
Side effectsof DMSOinclude agarlictaste andodor that may lastup to three daysfollowing
treatment.Bladdersymptomsmaygettemporarilyworse foraday or so afterinitial treatments.
Bloodtests,includingacomplete bloodcountandkidneyandliverfunctiontests,shouldbe
conductedtwice ayear. Othermedicationsmaybe added,such asa local anesthetic,tomake a
DMSO “cocktail.”
In addition,anewerapproachtobladderinstillationinvolvesusingamixture of heparin,lidocaine
and sodiumbicarbonate.Wheninstilleddirectlyintothe bladder,thiscombinationof drugs
significantlyrelievedurinarypainandurgencyinthe majorityof people participatinginaclinical
trial.
Bladderdistention.Thistreatmentarose fromthe observationthatsome patientsfeltbetterafter
undergoingcystoscopy,duringwhichthe bladderisfilled tocapacitywithliquid.Symptomsoftenget
worse a day or twoafter distensionbutreturntopre-procedure levelsorimprove aftertwotofour
weeks.Noone knowsexactlywhythistreatmentiseffective,butone theoryisthatdistension
increasesbladdercapacitybyinterferingwiththe bladder’stransmissionof painsignals.Thisisnot
an ideal treatment,however.Itonlyhelpssmall numbersof patientsandrequiresanesthesia.
Surgery.All surgical treatmentsforIChave unpredictable resultsandmost healthcare professionals
turn to surgeryonlyasa lastresort.Surgical proceduresinclude:
Fulguration,aprocessinwhicha cystoscope isinsertedthroughthe urethra,andHunner’sulcers
(star-shapedlesionsfoundonthe bladderwallsof some people withIC) are coagulatedwith
electricityora laser.
Neuromodulationorsacral nerve rootstimulationisanewertreatmentoptionthatinvolves
stimulatingthe sacral nerve tohelpalleviatefrequency,urgencyandpain.A small electrode is

19. placedunderthe skinnexttothe thirdsacral nerve rootin the back. If a teststimulationiseffective,
a permanentbatteryisplacedunderthe skinforregularstimulations.Althoughthiscanbe very
helpful insome patients,the resultsare notalwayssustained.
Augmentationisasurgical procedure thatenlargesthe bladderbyremovingdamagedandinflamed
sectionsof the bladderandrebuildingitwithbowel (small orlarge intestine) tissue.The effecton
painvaries,andIC may recuron the bowel tissue usedtoenlarge the bladder.
The bladdercan alsobe removedentirelyinaprocedure calledcystectomy.The uretersare then
attachedto a segmentof bowel thatopensontothe skinof the abdomen.Urine emptiesthrough
the opening,calledastoma,intoa bag outside the body.
Bear inmindthat evenacystectomydoesnotguarantee the endof IC symptoms;some women
experience phantompain.Somake sure youexploreotheroptionsfirst.
Treatmentforurinarytract infections
Luckily,mostinfectionsare notseriousandcan be easilytreatedwithantibioticmedications.
However,aurinarytract infectioncanbe stubbornandsometimesrecursafew weeksafter
treatment.
Nearly20 percentof womenwhohave aurinarytract infectionwill have another,and30 percentof
those whohave had twowill have athird.About80 percentof those whohave had three will have a
fourth.If leftuntreated,urinarytractinfectionscanleadtoothermore complicatedhealthproblems
so theyshouldnotbe ignored.Preventionincludesdrinkingplentyof liquids,frequenturinationand
takingvitaminC.Cranberrypreventsbacteriafromadheringtothe bladderwall andmaybe an
effectivedeterrenttobladderinfections.Womenwhoexperience recurrentbladderinfectionsoften
have the bacteriaintroducedduringsexual activity.Treatmentprophylacticallywithasingle
antibiotictablettakenjustaftersex canpreventadditional bladderinfections.
Treatmentforurinaryretention
Treatmentforurinaryretentionmayinclude the insertionof a Foleycatheterthroughthe urethra
intothe bladderto relieveurinaryretention.Variousurethral dilatorsmaybe usedtoopenthe
channel wide enoughtopassa catheterthrough.If a cathetercannot reachyour bladderbecause of
an obstructioninthe urethra,a suprapubictube maybe placedthroughthe skin,overthe pubic
bone and throughthe lowerabdominal wall directlyintothe bladder.The tube providestemporary
drainage until the situationcanbe managedviaa cytoscopicprocedure.

20. Treatmentforproteinuria
Treatmentforproteinuriastartswithcontrollinghypertensionand/ordiabetes.Those withdiabetes
shouldmeasure bloodsugarlevelsfrequently,eatabalanceddiettoappropriatelymanage diabetes,
exercise andtake prescribedmedicines.Those withhighbloodpressureare usuallyprescribedACE
(angiotensin-convertingenzyme) inhibitorsora similarclassof drugs calledangiotensinreceptor
blockers(ARBs) tocontrol the condition.These drugsprotectthe kidneysmore thanotherblood
pressure medicines.People withreducedkidneyfunctionandhighbloodpressureshouldtrytokeep
theirbloodpressure below130/80 mm Hg.
The National KidneyFoundationalsorecommendslimitingsaltandproteinintake.A consultation
witha dietitianmayhelp youdevelopakidney-healthydietaryplan.
Treatmentsforincontinence
A varietyof treatmentsare available totreatincontinence,including:
Exercises:PelvicfloorexercisesknownasKegel exercisescanstrengthenthe musclesyouuse tostop
urinatingsoyoucan holdurine inyourbladderlonger.TodoKegels,squeeze the musclesyouuse to
stopurinatingfora fewsecondsandthenrelax.Yourhealthcare professional cantell youspecifically
howoftenandfor howlongyou shoulddoKegels.
Medications:A varietyof drugscan be usedtohelpcontrol incontinence.Some of themrelax
bladdermuscles,helpingyourbladdertoemptymore completely,some helppreventbladder
contractionsandotherstightenthe musclesinthe bladderandurethrato reduce leakage.
Biofeedbacktechniques:These techniquescanhelpyoubecome more aware of signalsfromyour
bodyso youcan gainmore control overthe musclesinyourbladderandurethra.
Pessary:A vaginal insertthatholdsupthe bladderneck.It mayalsopinchthe urethraclosedtohelp
retainurine inthe bladder.Itisusuallynotnecessarytoremove the pessarytourinate.Normal
bladdercontractionscanusuallyforce urine outthroughthe pinched-off urethra.
Surgery:Surgerycan improve incontinenceif the conditioniscausedbya physical problemsuchasa
change in the bladderposition.Commonsurgeryforincontinence involvesplacingaslingbeneath
the urethrato helpclose itduringepisodesof increasedpressureorreducingabulgingbladderor
urethraand securingit.Surgeryisusuallynotrecommendeduntil youare finishedhavingchildren
because bothpregnancyandchildbirthcancause damage.

21. OtherTreatmentsforKidneyConditions
Hemodialysisisthe mostcommontreatmentforadvancedorpermanentkidneyfailure.Inthis
procedure yourbloodiscirculatedoutof your body,the wastesfilteredoutina machine andthe
cleanbloodreturnedtothe body.Removingharmful wastesandextrasaltandfluidshelpscontrol
your bloodpressure andmaintainproperchemical balance inthe body.Treatmentsare givenina
clinic,oftencalledadialysiscenter,usuallythree timesaweekforthree tofive hourspervisit.The
annual survival rate forpeople ondialysisisabout80 percent.
Peritoneal dialysisallowsyoutogive yourselftreatmentsathome foradvancedandpermanent
kidneyfailure,butitisimportantthatyou workcloselywithyourhealthteam.Aswithhemodialysis,
the treatmentfiltersyourbloodandreturnsittocirculate inyour body. For thisprocedure,asoft
tube (catheter) issurgicallyplacedinyourabdomenandthenisusedto fill yourabdomenwitha
cleansingliquid.Yourbody’swaste productsandextrafluidtransferfromyourbloodintothe dialysis
solutionandthenare drainedoutof the body.The processof actuallyputtingthe solutioninandout
of yourabdomentakesabout30 to 40 minutes,butthe solutionstaysinyourabdomenforfourto
six hours.Thisprocessistypicallydone fourtimesaday.There are twoformsof peritoneal dialysis:
Continuousambulatoryperitoneal dialysis(CAPD) doesn’trequire amachine andyoucan walk
aroundwiththe solutioninyourabdomen.Continuouscycler-assistedperitonealdialysis(CCPD),
alsocalledautomatedperitoneal dialysis,usesamachine tofill anddrainyour abdomen,usually
while yousleep.
Infectionisthe mostcommonproblemwithperitonealdialysis.Youmustunderstandandfollow all
instructionsfromyourhealthteam.Keepaclose watchforany signsof infectionandreportthem
immediately.These include:
Fever
Nauseaor vomiting
Rednessorpainnear the catheter
Unusual coloror cloudinessinyouruseddialysissolution
A cathetercuff that isout of place
Transplants.Forsome withkidneyfailure,transplantationis anoption.If the donatedkidneyisnota
close match foryour body,yourimmune systemwill reactagainstitas if it were avirusor bacteria.
Drugs that suppressthe immune systemare usedtohelpthe bodyacceptthe transplant.Transplant
ismore effective thandialysis,withaone-yearsurvivalrate of 95 percentand80 percentat five

22. yearsfor people receivingliving-donorkidneys.(Survival ratesare slightlylowerforpeople receiving
deceased-donorkidneys.
Prevention
Drinkingadequate amounts of wateriskeytoa healthyurinarysystem.The urinarysystemregulates
concentrationsof substancessuchaspotassiumandsodium.Whenyoudon’tdrinkenoughwater,
your bodyrespondsbyretainingwatertomaintainthe properconcentration.
A goodrule of thumbisto drinkenoughwaterandotherfluids(atleasteightglassesaday) to keep
the urine clearor straw colored.The fluidsalsohelpclearbacteriafromthe urinarytract.Cranberry
juice mayhelppreventrepeaturinarytractinfections,butyoumaywantto avoidthe beverage
duringan infectionsince itcontainsacidthatcan exacerbate the painfulurinationassociatedwith
the condition.
Limityourintake of soda because carbonateddrinkscanmake some kidneyconditionsworse.High
levelsof calciumandoxalate (asubstance foundinchocolate,blacktea,peanuts,sweetpotatoes
and leafygreenvegetables) cancontribute tokidneystonesinsusceptible people.
Carbonateddrinks,coffee andspicyoracidicfoodsor drinkscancause bladderirritationforsome
people.Avoidingsuchfoodsanddrinkscanimprove bladdersymptoms.
Medications,poisonsandtrauma-relatedbloodlosscanalsoharmthe kidneys.Inparticular,
combiningover-the-counterpainkillerssuchasaspirin,acetaminophenandibuprofencanbe toxic.
Long-termuse of nonsteroidal anti-inflammatorydrugs(NSAIDs),suchasibuprofenandnaproxen,
can alsodamage the kidneys.Askyourhealthcare professionalorpharmacistaboutadverse effects
of anymedicationsyouare taking,includingover-the-counterdrugs.
Highbloodpressure canleadto kidneydysfunction.Smokingalsoelevatesbladdercancerrisk,and
chroniccoughingassociatedwiththe habitcanworsenincontinence.
Preventingkidneystones

23. If you have had more than one kidneystone,yourriskof developinganotherishigh.Fortunately,
there are strategiesforpreventingthe recurrence of stones.A goodplace tostart is a medical
assessmenttodetermine if youhave aknownstone-formingcondition.Bloodandurine testsmay
be required,andyoumay be askedto provide urine samplesafterthe initiationof treatmentto
assesswhetherthe treatmentisworking.
Medicationsmayalsobe usedto preventstones,including:
Allopurinol (Lupurin,Zyloprim) forsome casesof uric acid stones.
Diureticssuchas hydrochlorothiazide(Esidrix,HydroDIURIL) tocontrol hypercalciuriabyreducing
levelsof urinarycalcium.
Sodiumcellulose phosphate (Calcibind) forseverehypercalciuriaassociatedwithrecurrentcalcium
stones.Itworksby bindingtocalciuminthe intestinesandkeepingitoutof the urine .
Tiopronin(Thiola),whichreducesthe amountof cystine inthe urine.
Potassiumcitrate (Urocit-K),whichhelpsmake the urine lessacidic,reducingformationof uricacid
kidneystones.
Acetohydroxamicacid(Lithostat) forinfectionstones(struvite stones)thatcannotbe removed.
Acetohydroxamicacidisusedwithlong-termantibioticdrugstopreventthe infectionthatprovokes
stone growth.
You can alsomake lifestylechangestoreduce yourrisk:
Drinkmore liquids,especiallywater.Yourtotal dailyurine outputshouldbe twotothree quarts.
Eat foodshighin calcium.Inthe past, susceptible peoplewere toldtoavoidsuchfoods,butnew
studiesshowthathigh-calciumfoodsactuallyhelppreventstones.Calciumsupplements,however,
may increase the riskof stones,sotry to getyour dailyintake fromfoodsources.
Basedon the resultsof labtests,youmay be advisedtoavoidfoodswithaddedvitaminDas well as
antacidswitha calciumbase.If your urine ishighlyacidic,youmaybe advisedtoloweryourintake
of meat,fishandpoultry(all of whichboosturinaryacidconcentration).
If you tendto formcalciumoxalate stones,youmaybe askedtocut back onthe followingfoods:
beets,chocolate,coffee,cola,nuts,rhubarb,spinach,strawberries,teaandwheatbran.
Facts to Know

24. Approximately26millionAmericanshave kidneydiseaseandmillionsmore are atrisk,accordingto
the National KidneyFoundation.
Incontinence and overactivebladderare amongthe mostcommonhealthproblemsinwomen.
Drinkingplentyof wateriskeytourinarysystemhealth.A goodrule of thumbis to drinkenough
waterand otherfluids(atleasteightglassesaday) tokeepthe urine clearor straw colored.
Combiningover-the-counterpainkillerssuchasaspirin,acetaminophen,naproxensodiumand
ibuprofencanbe toxicto yourkidneys.Long-termuse of nonsteroidal anti-inflammatorydrugs
(NSAIDs) suchasibuprofenandnaproxencanalsodamage the kidneys.
Kidneystonesare amongthe mostpainful andmostcommonurinarytract disorders—about5to10
percentof Americanswill have akidneystone atsome pointintheirlives.Stonesare mostlikelyto
occur betweenthe agesof 20 and50 inwomenandare more likelytooccurin people whohave
previouslyhadstones.
Diabetesaccountsformostcases of end-stage renal disease (ESRD).Diabetes-relatedESRDcanbe
delayedorpreventedbykeepingbloodsugarlevelsdown.
AfricanAmericansare at greaterrisk than Caucasiansforhighbloodpressure andthe resulting
kidneyproblems.AfricanAmericansage 25 to 44 are more likelythanCaucasianstodevelopkidney
failure relatedtohypertension.
“Renal function”referstohowwell yourkidneysare functioning.If bothkidneysare healthy,you
have 100 percentrenal function.If one becomesnon-functional orisdonatedfora transplant,you
will still be healthy,evenwithonly50percentof renal function.However,if functionslipsbelow 20
percent,serioushealthproblemsarise,andbelow 10to 15 percentdialysisoratransplantmay be
required.
End-stage renal disease (ESRD) referstopermanenttotal ornearlytotal kidneyfailure,requiring
dialysisortransplantation.If untreated,ESRDcancause seizures,comaanddeath.In the United
States, 85,790 diedof ESRD in 2005.
The annual survival rate for people onkidneydialysisisabout80 percent.Transplantismore
effectivethandialysis,withaone-yearsurvival rate of 95 percentand80 percentatfive yearsfor
people receivingliving-donorkidneys.
KeyQ&A
What couldcause bloodinmy urine?The cause maybe a seriousone,suchas bladderorkidney
cancer, butmore oftenthe cause is relativelybenign.Forexample,urinarytractinfectionsor
exercise cancause episodesof hematuria—themedicaltermforbloodinthe urine.Still,youshould
checkwitha healthcare professionalanytime yousee bloodinyoururine.
Why am I havingrepeatedincidencesof kidneystones?A varietyof factorscan make a person
susceptibletostonesinthe urinarytract. Riskforstonesishigherinthose withfamilyhistoriesof

25. stones;those whohave urinarytract infections,kidneydisordersandmetabolicdisorderssuchas
hyperparathyroidism,cystinuria(toomuchof an amino acidcalledcystine) andhyperoxaluria
(excessproductionanoxalate salt);andthose withadisease calledrenal tubularacidosis.Another
riskfactor isabsorptive hypercalciuria,inwhichthe bodyabsorbstoomuchcalciumfromfoodand
dumpsthe excess intothe urine.Highlevelsof urinarycalciumleadtocrystalsof calciumoxalate or
calciumphosphate,whichcangrowintopainful stones.Variouslaboratorytestsandafamilyhistory
shouldallowyourhealthcare professional todetermine alikelycause.Youcanthenmake dietary
changesto preventfuture stones.
My healthcare professional isconcernedbecauseIhave proteininmyurine,butIfeel fine.ShouldI
worry?Yes.Proteinuriaisasignof glomerulonephritis(inflammationof the glomeruli;see below),
alsocallednephritis(inflammationof the kidney).Diabetes,hypertensionandvariouskidney
diseasescancause the inflammation,whichcanleadtorenal failure and,ultimately,end-stage renal
disease (ESRD).
What isthe connectionbetweendiabetesandkidneydisease?Diabetesisthe numberone cause of
end-stage renal disease.If diabetesisundiagnosedorpoorlycontrolled,excesssugarwillcirculate in
the blood,leadingtohigherbloodflow intothe kidneyandglomerularscarring.Diabetic
nephropathyisthe termusedforsuch damage,whichcanbe delayedorpreventedbykeepingblood
sugar levelsdown.
What isthe connectionbetweenhighbloodpressureandkidneydisease?Thenumbertwocause of
ESRD is highbloodpressure.Long-termcontrol of bloodpressure iscritical topreservingkidney
function.ACE(angiotensin-convertingenzyme) inhibitorsandasimilarclassof drugs called
angiotensinreceptorblockers(ARBs) are the bestmedicationsforcontrollingthe conditionand
preventingkidneydamage.These drugsprotectthe kidneysmore thanotherbloodpressure
medicines.People withreducedkidneyfunctionandhighbloodpressure shouldtrytokeeptheir
bloodpressure below 130/80 mmHg.
How can I protectmy kidneysif Ihave diabetes?
Have your glycohemoglobin(hbA1c) checkedregularly;the testmeasuresyouraverage bloodsugar
for the previoustwotothree months.
Adhere toyourdiabetescontrol regimen,includinginsulininjectionsandothermedications,diet,
exercise andbloodsugarmonitoring.
Have your bloodpressure checkedseveral timesayear(at everyvisittoyourhealthcare
professional) andfollowanyrecommendationsforreducingit.Askyourhealthcare professional
aboutACE inhibitorsandARBs.
Have your urine checkedyearlyforproteinandmicroalbumin(aproteincomponent).
Askyour healthcare professionalwhetheryouneedtoloweryourproteinintake.
How can I preventrecurrence of acystocele?Avoidance of strainingfromchronicconstipation,
avoidance of heavylifting andlearningtocontractthe pelvicfloormusclesto“splint”the pelvicfloor
duringcoughing,sneezingandliftingwillhelptopreventrecurrentcystocele.Inaddition,weightloss

26. inobese womenmaybe helpful.Seekingmedical attentiontopreventchroniccoughisalso
beneficial.
Is surgerythe bestoptionfora painful case of interstitial cystitis(IC)?No,the resultsof the various
typesof IC surgeriesare unpredictable—new ulcersmayformafteroldonesare removed,andIC
may afflictbowel tissue usedtoaugmentorrebuildthe bladder.Evenacystectomy—removal of the
bladder—doesnotguarantee the endof ICsymptoms;some patientsexperience phantompain.Be
sure to explore otheroptionsfirst.Healthcare professionalsshouldonlyturntosurgeryas a last
resort.
What othertreatmentoptionsare available forIC?Sometimeseliminatingirritatingfoodand
beveragesfromthe diet—suchastomatoes,coffee,spicesandacidicfoods—reducessymptomsof
IC. Nonmedicinal approachestoreliefinclude gentle stretchingexercisesandbladdertraining.
Bladdertraininginvolvesworkingwithahealthcare professional toplanspecifictimesatwhichto
urinate andthenusingrelaxationtechniquesanddistractionstosticktothe schedule.Patientskeep
a diary andovertime try to extendthe time betweenscheduledurinations.Transcutaneouselectrical
nerve stimulation(TENS) isarelativelyinexpensive treatmentthatusesmildelectrical pulsesto
relieve painandreduce frequencyof urination.The pulsesare administeredthroughwiresonthe
lowerbackor above the pubicarea, althoughsome devicesare insertedintothe vaginaorrectum
(inmen).Scientistsbelieve TENSworkstorelieveICbyincreasingbloodflowtothe bladderand
triggeringpain-relievingsubstances.
What testscan I expectif I am havingurinarysystemsymptoms?Urinalysisandbloodtestingare
standard.Dependingonyourparticularsymptomsandhistory,yourhealthcare professional may
performa cystoscopy,inwhicha tinytelescopeis insertedthroughthe urethraintothe bladder;a
biopsy,inwhichtissue isremovedforevaluation;anintravenouspyelogramora CT urogram, in
whichan x-rayistakenof the urinarytract enhancedwitha radioactive dye;aurodynamictest,in
whichthe bladderisfilledwithliquidandthenemptiedtomeasure function;orimagingusing
magneticresonance imagingorcomputedtomographytechniques.