The Kidney Diseases Dictionary


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The Kidney Diseases Dictionary

  1. 1. National Kidney and Urologic Diseases Information Clearinghouse The Kidney Diseases Dictionary U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse
  2. 2. The Kidney Diseases Dictionary Kidney Diseases Dictionary This dictionary defines words that are often used when people talk or write about kidney diseases. It is designed for people who have kidney diseases and their families and friends. The words are listed in alphabetical order. Some words have many meanings; only those meanings that relate to kidney diseases are included. Words that appear in bold italic are defined elsewhere in the dictionary. A term will refer the reader to another definition only when the second definition gives additional information about a topic that is directly related to the first term. This information is not a substitute for a visit to your doctor. Talk to a health professional if you have a kidney problem. U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse
  3. 3. A acute (uh-KYOOT): Acute often as well as hearing and vision means urgent. An acute disease problems. The common symptoms happens suddenly. It lasts a short of this condition are chronic blood time. Acute is the opposite of and protein in the urine. chronic, or long lasting. amyloidosis (AM-ih-loy-DOH-sis): acute renal (REE-nul) failure: A condition in which a protein-like Sudden and temporary loss of material builds up in one or more kidney function. (See also chronic organs. This material cannot be kidney disease.) broken down and interferes with the normal function of that organ. acute tubular (TOO-byoo-lur) In kidneys, amyloidosis can lead necrosis (neh-KRO-sis) (ATN): to proteinuria, nephrotic syndrome, A severe form of acute renal failure and kidney failure. that develops in people with severe illnesses like infections or analgesic (AN-ul-JEE-zik)­ with low blood pressure. Patients associated kidney disease: Loss may need dialysis. Kidney function of kidney function that results often improves if the underlying from long-term use of analgesic disease is successfully treated. (pain-relieving) medications. Analgesics that combine aspirin albuminuria (AL-byoo-mih-NOO­ and acetaminophen are most ree-uh): More than normal dangerous to the kidneys. amounts of a protein called albumin in the urine. Albuminuria anemia (uh-NEE-mee-uh): The may be a sign of kidney disease. condition of having too few red blood cells. Healthy red blood allograft (AL-oh-graft): An organ or cells carry oxygen throughout the tissue transplant from one human body. If the blood is low on red to another. blood cells, the body does not Alport syndrome (AL-port SIN­ get enough oxygen. People with drome): An inherited condition anemia may be tired and pale and that results in kidney disease. It may feel their heartbeat change. generally develops during early Anemia is common in people with childhood and is more serious in chronic kidney disease or those on boys than in girls. The condition dialysis. (See also erythropoietin.) can lead to end-stage renal disease, 1
  4. 4. A–C antidiuretic (AN-tee-DY-uh-RET-ik) (see dialysis). The AV fistula hormone (ADH): A natural body causes the vein to grow chemical that slows down the urine thicker, allowing the repeated flow. Some children who wet their needle insertions required for beds regularly may lack normal hemodialysis. amounts of antidiuretic hormone. autoimmune (AW-toh-ih-MYOON) anuria (uh-NYOOR-ee-uh): A disease: Any disorder in which condition in which the person the body is attacked by its own stops making urine. immune system. Examples are Goodpasture syndrome and arteriovenous (ar-TEER-ee-oh-VEE­ lupus erythematosus (see lupus nus) (AV) fistula (FIST-yoo-luh): nephritis). Surgical connection of an artery directly to a vein, usually in the biopsy (BY-op-see): A procedure in forearm, created in patients which a tiny piece of a body part, who will need hemodialysis such as the kidney or bladder, is removed for examination under a microscope. From dialysis bladder (BLAD-ur): The balloon- machine shaped organ inside the pelvis that holds urine. blood urea (yoo-REE-uh) nitrogen (NY-truh-jen) (BUN): A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney To function decreases, the BUN level dialysis machine increases. calcium (KAL-see-um): A mineral that the body needs for strong bones and teeth. Calcium may form stones in the kidney. Arteriovenous Fistula 2
  5. 5. C chronic (KRAH-nik): Lasting a long creatinine clearance: A test that time. Chronic diseases develop measures how efficiently the slowly. Chronic kidney disease may kidneys remove creatinine and develop over many years and lead other wastes from the blood. Low to end-stage renal disease. creatinine clearance indicates impaired kidney function. chronic kidney disease (CKD): Any condition that causes reduced cyst (SIST): An abnormal sac kidney function over a period containing gas, fluid, or a of time. CKD is present when a semisolid material. Cysts may patient’s glomerular filtration rate form in kidneys or in other parts of remains below 60 mL/min/1.73 m2 the body. (See also renal cysts.) for more than 3 months. cystine (SIS-teen): An amino acid congenital (kun-JEN-ih-tul) nephrotic found in blood and urine. Amino (nef-RAH-tik) syndrome: A acids are building blocks of genetic kidney disease that protein. (See also cystine stone develops before birth or in the first and cystinuria.) few months of life. Congenital cystine stone: A rare form of kidney nephrotic syndrome usually leads stone consisting of the amino acid to end-stage renal disease and cystine. the need for dialysis or a kidney transplant by the second or third cystinuria (SIS-tih-NOO-ree-uh): year of life. A condition in which urine contains high levels of the amino creatinine (kree-AT-ih-nin): A waste acid cystine. If cystine does not product from meat protein in the dissolve in the urine, it can build diet and from the muscles of the up to form kidney stones. body. Creatinine is removed from blood by the kidneys; as kidney cystitis (sis-TY-tis): Inflammation disease progresses, the level of of the bladder, causing pain and creatinine in the blood increases. a burning feeling in the pelvis or urethra. cystoscope (SIS-tuh-skope): A tool for examining the bladder. The procedure is called cystoscopy (sis­ TAH-skuh-pee). 3
  6. 6. D diabetes (dy-uh-BEE-teez) insipidus in type 2 diabetes, the body is (in-SIP-ih-dus): A condition resistant to the effects of available characterized by frequent and insulin. heavy urination, excessive thirst, dialysis (dy-AL-ih-sis): The process and an overall feeling of weakness. of cleaning wastes from the blood This condition may be caused by a artificially. This job is normally defect in the pituitary gland or in done by the kidneys. If the the kidney. In diabetes insipidus, kidneys fail, the blood must be blood glucose levels are normal. cleaned artificially with special (See also nephrogenic diabetes equipment. The two major forms insipidus.) of dialysis are hemodialysis and diabetes (dy-uh-BEE-teez) mellitus peritoneal dialysis. (MELL-ih-tus): A condition ● hemodialysis (HEE-moh-dy-AL­ characterized by high blood glucose (sugar) resulting from ih-sis): The use of a machine the body’s inability to use glucose to clean wastes from the blood efficiently. In type 1 diabetes, the after the kidneys have failed. pancreas makes little or no insulin; The blood travels through Dialyzer inflow pressure monitor Venous pressure monitor Heparin pump (to prevent clotting) Dialyzer Air trap and air detector Air detector clamp Arterial pressure monitor Clean blood returned to body Blood pump Blood removed for cleansing Hemodialysis 4
  7. 7. D tubes to a dialyzer, which abdomen with the catheter removes wastes and extra fluid. sealed. After several hours, The cleaned blood then flows the person using CAPD through another set of tubes drains the solution back into back into the body. a disposable bag. Then the person refills the abdomen ● peritoneal (PEH-rih-tuh­ with fresh solution through NEE-ul) dialysis: Cleaning the same catheter, to begin the blood by using the lining the cleaning process again. of the belly (abdomen) as a filter. A cleansing solution, • continuous cycling peritoneal called dialysis solution, is dialysis (CCPD): A form of peritoneal dialysis that uses drained from a bag into the a machine. This machine belly. Fluids and wastes flow automatically fills and drains through the lining of the belly the dialysis solution from the and remain “trapped” in the abdomen. A typical CCPD dialysis solution. The solution schedule involves three to is then drained from the belly, five exchanges during the removing the extra fluids and night while the person sleeps. wastes from the body. There During the day, the person are three types of peritoneal using CCPD performs one dialysis: exchange with a dwell time that • continuous ambulatory lasts the entire day. (AM-byoo-luh-TOH-ree) • nocturnal (nok-TURN-ul) peritoneal dialysis (CAPD): intermittent (IN-ter-MIT­ The most common type unt) peritoneal dialysis of peritoneal dialysis. It (NIPD): A machine-aided needs no machine. With form of peritoneal dialysis. CAPD, the blood is always NIPD differs from CCPD being cleaned. The dialysis in that six or more exchanges solution passes from a plastic take place during the night, bag through the catheter and the NIPD patient does and into the abdomen. The not perform an exchange dialysis solution stays in the during the day. 5
  8. 8. D–E dialysis solution: A cleansing liquid edema (eh-DEE-muh): Swelling used in the two major forms caused by too much fluid in the of dialysis—hemodialysis and body. peritoneal dialysis. Dialysis electrolytes (ee-LEK-troh-lites): solution contains dextrose (a Chemicals in the body fluids that sugar) and other chemicals similar result from the breakdown of to those in the body. Dextrose salts, including sodium, potassium, draws wastes and extra fluid from magnesium, and chloride. The the body into the dialysis solution. kidneys control the amount of dialyzer (DY-uh-LY-zur): A part of electrolytes in the body. When the hemodialysis machine. (See the kidneys fail, electrolytes get hemodialysis under dialysis.) out of balance, causing potentially The dialyzer has two sections serious health problems. Dialysis separated by a membrane. One can correct this problem. section holds dialysis solution. The end-stage renal (REE-nul) disease other holds the patient’s blood. (ESRD): Total chronic kidney Blood failure. When the kidneys fail, from patient the body retains fluid and harmful To drain wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. Dialysate compartment Semipermeable Blood compartment membrane erythropoietin (eh-RITH-roh-POY- uh-tin): A hormone made by the kidneys to help form red blood Dialysate Blood returning from cells. Lack of this hormone may machine to patient lead to anemia. ESRD: See end-stage renal disease. Dialyzer ESWL: See extracorporeal shockwave lithotripsy. dwell time: In peritoneal dialysis, the amount of time a bag of dialysis solution remains in the patient’s abdominal cavity during an exchange. 6
  9. 9. E–G exchange: A cycle in peritoneal glomeruli (gloh-MEHR-yoo-lie): dialysis in which the patient fills Plural of glomerulus. the abdominal cavity with dialysis glomerulonephritis (gloh-MEHR-yoo­ solution, carries it for a specified loh-nef-RY-tis): Inflammation dwell time, and then empties it of the glomeruli. Most often, it is from the abdomen in preparation caused by an autoimmune disease, for a fresh bag of dialysis solution. but it can also result from infection. extracorporeal (EKS-truh-kor-POR­ glomerulosclerosis (gloh-MEHR­ ee-ul) shockwave lithotripsy yoo-loh-skleh-ROH-sis): (LITH-oh-TRIP-see) (ESWL): A Scarring of the glomeruli. It nonsurgical procedure using shock may result from diabetes mellitus waves to break up kidney stones. (diabetic glomerulosclerosis) fistula (FIST-yoo-lah): See or from deposits in parts of arteriovenous fistula. the glomeruli (focal segmental glomerulosclerosis). The glomerular (gloh-MEHR-yoo-ler) most common signs of filtration rate (GFR): A calculation glomerulosclerosis are proteinuria of how efficiently the kidneys are and chronic kidney disease. filtering wastes from the blood. A traditional GFR calculation glomerulus (gloh-MEHR-yoo-lus): A requires an injection into the tiny set of looping blood vessels in bloodstream of a fluid that is the nephron where blood is filtered later measured in a 24-hour urine in the kidney. collection. A modified GFR Goodpasture syndrome: An calculation requires only that uncommon disease that usually the creatinine in a blood sample includes bleeding from the be measured. Each laboratory lungs, coughing up of blood, and has its own normal range for inflammation of the kidneys that measurements. Generally, the can lead to kidney failure. This normal range for men is 97 to condition is an autoimmune disease. 137 mL/min/1.73 m2 of body surface area. The normal range for women is 88 to 128 mL/min/1.73 m2. 7
  10. 10. G–H graft: In hemodialysis (see dialysis), a the Escherichia coli bacterium in vascular access surgically created contaminated food. People with using a synthetic tube to connect an HUS may develop acute renal artery to a vein. In transplantation failure. (see transplant), a graft is the hormone (HOR-mone): A natural transplanted organ or tissue. chemical produced in one part of the body and released into Looped the blood to trigger or regulate graft Artery particular functions of the body. The kidney releases three hormones: erythropoietin, renin, and an active form of vitamin D that helps regulate calcium for bones. Vein Graft hydronephrosis (HY-droh-nef-ROH­ sis): Swelling of the top of the hematocrit (hee-MAT-uh-krit): A ureter, usually because something measure that tells what portion of a is blocking the urine from flowing blood sample consists of red blood into or out of the bladder. cells. Low hematocrit suggests anemia or massive blood loss. Healthy Kidney hematuria (HEE-muh-TOOR­ ee-uh): Blood in the urine, which can be a sign of a kidney stone, glomerulonephritis, or other kidney problem. hemodialysis: See dialysis. Unhealthy Kidney hemolytic (HEE-moh-LIT-ik) Kidney smaller than normal uremic (yoo-REE-mik) syndrome (SIN-drome) (HUS): A disease Urine dammed back that affects the blood and blood into renal pelvis vessels. It destroys red blood cells, cells that cause the blood Renal stone stuck in ureter to clot, and the lining of blood vessels. HUS is often caused by Hydronephrosis 8
  11. 11. H–I hypercalciuria (HY-per-kal-see­ kidney. The IgA protein damages YOO-ree-uh): Abnormally large the glomeruli, leading to blood amounts of calcium in the urine. and protein in the urine, to swelling in the hands and feet, and hyperoxaluria (HY-per-ox-uh-LOO­ sometimes to kidney failure. ree-uh): Unusually large amounts of oxalate in the urine, leading to immune (im-YOON) system: The kidney stones. body’s system for protecting itself from viruses and bacteria or any hypertension (HY-per-TEN-shun): “foreign” substances. High blood pressure, which can be caused either by too much fluid in immunosuppressant (im-YOON-oh­ the blood vessels or by narrowing suh-PRESS-unt): A drug given of the blood vessels. to suppress the natural responses of the body’s immune system. Amount of Diameter of Blood Immunosuppressants are given blood blood vessel pressure to transplant patients to prevent in vessel organ rejection and to patients Normal Normal High with autoimmune diseases like Normal lupus. Too much fluid interstitial (IN-ter-STISH-ul) Normal High Normal nephritis (nef-RY-tis): Inflammation of the kidney cells that are not part of the fluid­ Normal Narrow High collecting units, a condition that Normal can lead to acute renal failure or chronic kidney disease. Hypertension intravenous (IN-truh-VEE-nus) IgA nephropathy (nef-RAHP-uh­ pyelogram (PY-loh-gram): An thee): A kidney disorder caused x ray of the urinary tract. A dye by deposits of the protein is injected to make the kidneys, immunoglobulin A (IgA) inside ureters, and bladder visible on the the glomeruli (filters) within the x ray and show any blockage in the urinary tract. 9
  12. 12. K–M kidney (KID-nee): One of the two erythematosus (eh-rih-theh-mah­ bean-shaped organs that filter TOH-sis). The condition can wastes from the blood. The cause hematuria and proteinuria, kidneys are located near the and it may progress to end-stage middle of the back. They create renal disease. urine, which is delivered to the membrane (MEM-brane): A thin bladder through tubes called sheet or layer of tissue that lines ureters. a cavity or separates two parts of kidney failure: Loss of kidney the body. A membrane can act function. (See also end-stage renal as a filter, allowing some particles disease, acute renal failure, and to pass from one part of the body chronic kidney disease.) to another while keeping others where they are. The membrane kidney stone: A stone that develops in a dialyzer filters waste products from crystals that form in urine from the blood. and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. Blood compartment Kt/V (kay-tee over vee): A Blood cells Waste measurement of dialysis dose. Waste products The measurement takes into products account the efficiency of the dialyzer, the treatment time, and the total volume of urea in the body. See also URR. Semipermeable lithotripsy (LITH-oh-TRIP-see): A membrane method of breaking up kidney Dialysis solution stones using shock waves or other compartment means. lupus (LOO-pus) nephritis (nef­ Dialyzer Membrane RY-tis): Inflammation of the kidneys caused by an autoimmune disease called systemic lupus 10
  13. 13. M–O membranoproliferative (MEM­ nephrolithiasis (NEF-roh-lih-THY­ bray-no-pro-LIF-er-uh-tiv) uh-sis): See kidney stones. glomerulonephritis (gloh-MEHR­ nephrologist (nef-RAHL-oh-jist): A yoo-loh-nef-RY-tis): A disease doctor who treats patients with that occurs primarily in children kidney problems or hypertension. and young adults. Over time, inflammation leads to scarring in nephron (NEF-rahn): A tiny part of the glomeruli, causing proteinuria, the kidneys. Each kidney is made hematuria, and sometimes chronic up of about 1 million nephrons, kidney disease or end-stage renal which are the working units of disease. the kidneys, removing wastes and extra fluids from the blood. membranous nephropathy (neh­ FROP-uh-thee): A disorder nephropathy (neh-FROP-uh-thee): that hinders the kidneys’ ability Any disease of the kidney. to filter wastes from the blood because of harmful deposits nephrotic (nef-RAH-tik) syndrome: on the glomerular membrane. A collection of symptoms Some cases of membranous that indicate kidney damage. nephropathy develop after an Symptoms include high levels autoimmune disease or malignancy, of protein in the urine, lack of but most develop without a known protein in the blood, and high cause. blood cholesterol. nephrectomy (nef-REK-tuh-mee): nuclear (NEW-klee-ur) scan: A Surgical removal of a kidney. test of the structure, blood flow, and function of the kidneys. The nephrogenic (NEF-roh-JEN-ik) doctor injects a mildly radioactive diabetes (DY-uh-BEE-teez) solution into an arm vein and insipidus (in-SIP-ih-dus): uses x rays to monitor its progress Constant thirst and frequent through the kidneys. urination because the kidney tubules cannot respond to oxalate (AHK-suh-late): A chemical antidiuretic hormone. The result is that combines with calcium in an increase in urine formation and urine to form the most common excessive urine flow. type of kidney stone (calcium oxalate stone). 11
  14. 14. P–R pelvis (PELL-vis): The bowl-shaped proteinuria (PRO-tee-NOOR-ee-uh): bone that supports the spine and A condition in which the urine holds up the digestive, urinary, contains large amounts of protein, and reproductive organs. The legs a sign that the kidneys are not connect to the body at the pelvis. functioning properly. percutaneous (PER-kyoo-TAY­ pyelonephritis (PY-loh-nef-RY-tis): nee-us) nephrolithotomy An infection of the kidneys, usually (NEF-roh-lih-THAH-tuh-mee): caused by a germ that has traveled A method for removing kidney up through the urethra, bladder, stones via keyhole surgery through and ureters from outside the body. the back. renal (REE-nul): Of the kidneys. A peritoneal dialysis: See dialysis. renal disease is a disease of the kidneys. Renal failure means the polycystic (PAHL-ee-SIS-tik) kidney kidneys have stopped working disease (PKD): An inherited properly. disorder characterized by many grape-like clusters of fluid-filled renal agenesis (ay-JEN-eh-sis): The cysts that make both kidneys larger absence or severe malformation over time. These cysts take over of one or both kidneys. and destroy working kidney tissue. renal cell carcinoma (KAR-sih-NOH­ PKD may cause chronic kidney mah): A type of kidney cancer. disease and end-stage renal disease. renal cysts (SISTS): Abnormal fluid­ filled sacs in the kidney that range in size from microscopic to much Cysts larger. Many simple cysts are Ureter harmless, while other types can seriously damage the kidneys. Polycystic Kidney Healthy Kidney 12
  15. 15. R–U renal osteodystrophy (AH-stee­ transplant (TRANZ-plant): oh-DIS-truh-fee): Weak bones Replacement of a diseased organ caused by poorly working kidneys. with a healthy one. A kidney Renal osteodystrophy is a transplant may come from a living common problem for people on donor, usually a relative, or from dialysis who have high phosphate someone who has just died. levels or insufficient vitamin D ultrasound: A technique that supplementation. bounces safe, painless sound renal pelvis (PELL-vis): The basin waves off organs to create an into which the urine formed by image of their structure. the kidneys is excreted before it urea (yoo-REE-uh): A waste travels to the ureters and bladder. product found in the blood and renal tubular (TOOB-yoo-lur) caused by the normal breakdown acidosis (ASS-ih-DOH-sis): A of protein in the liver. Urea is defect in the kidneys that hinders normally removed from the blood their normal excretion of acids. by the kidneys and then excreted Failure to excrete acids can lead in the urine. Urea accumulates to weak bones, kidney stones, and in the body of people with kidney poor growth in children. failure. renal vein thrombosis (throm-BOH­ uremia (yoo-REE-mee-uh): The sis): Blood clots in the vessel illness associated with the buildup that carries blood away from the of urea in the blood because kidney. This can occur in people the kidneys are not working with the nephrotic syndrome. effectively. Symptoms include nausea, vomiting, loss of appetite, renin (REE-nin): A hormone made weakness, and mental confusion. by the kidneys that helps regulate the volume of fluid in the body ureteroscope (yoo-REE-tur-uh­ and blood pressure. scope): A tool for examining the bladder and ureters and for struvite (STROO-vite) stone: A removing kidney stones through type of kidney stone caused by the urethra. The procedure is infection. called ureteroscopy (yoo-ree-tur­ AH-skoh-pee). 13
  16. 16. U–W ureters (YOOR-uh-turs): Tubes that urine (YOOR-in): Liquid waste carry urine from the kidneys to the product filtered from the blood by bladder. the kidneys, stored in the bladder, and expelled from the body urethra (yoo-REE-thrah): The tube through the urethra by the act of that carries urine from the bladder voiding or urinating. to the outside of the body. urolithiasis (YOOR-oh-lih-THY-uh­ uric (YOOR-ik) acid stone: A kidney sis): Stones in the urinary tract. stone that may result from a diet high in animal protein. When the URR (urea reduction ratio): A blood body breaks down this protein, uric test that compares the amount acid levels rise and can form stones. of blood urea nitrogen before and after dialysis to measure the urinalysis (yoor-in-AL-ih-sis): A test effectiveness of the dialysis dose. of a urine sample that can reveal many problems of the urinary vasculitis (VAS-kyoo-LY-tis): tract and other body systems. The Inflammation of the blood vessel sample may be observed for color, walls. This can cause rash and cloudiness, concentration; signs of disease in multiple organs of the drug use; chemical composition, body, including the kidneys. including glucose; the presence of vesicoureteral (VESS-ih-koh-yoo­ protein, blood cells, or germs; or REE-ter-ul) reflux: An abnormal other signs of disease. condition in which urine backs up urinary (YOOR-ih-NEHR-ee) tract: into the ureters, and occasionally The system that takes wastes from into the kidneys, raising the risk of the blood and carries them out of infection. the body in the form of urine. The void: To urinate, empty the bladder. urinary tract includes the kidneys, renal pelvises, ureters, bladder, and Wegener’s granulomatosis (GRAN­ urethra. yoo-LOH-muh-TOH-sis): An autoimmune disease that damages urinary tract infection (UTI): An illness the blood vessels and causes caused by harmful bacteria growing disease in the lungs, upper in the urinary tract. respiratory tract, and kidneys. urinate (YOOR-ih-nate): To release urine from the bladder to the outside. 14
  17. 17. National Kidney and Urologic Diseases Information Clearinghouse 3 Information Way Bethesda, MD 20892–3580 Phone: 1–800–891–5390 TTY: 1–866–569–1162 Fax: 703–738–4929 Email: Internet: The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases. Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication is not copyrighted. The Clearinghouse encourages users of this booklet to duplicate and distribute as many copies as desired. This booklet is also available at This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit Consult your doctor for more information.
  18. 18. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health NIH Publication No. 03–4359 May 2003