Pleurisy

Pleurisy is a condition that is caused when the pleura (moist membrane surrounding the lungs and rib cage) is inflamed. Pleurisy or Pleuritis, as it is otherwise referred to, is characterized by fluid accumulation at the site of the inflammation. This fluid makes it difficult to breathe and leads to shortness of breath and cough. It also lays pressure on the lunds and reduced their ability to move freely. Most often, pleurisy is caused by viral infection. It can be the result of lung or heart disease. Diseases such as tuberculosis, pneumonia and rheumatic disease. Pulmonary embolism or rheumatoid arthritis can also bring on an attack of pleurisy. Primary pleurisy occurs when there is inflammation of the pleural tissues from a direct infection or injury on them. On the other hand, secondary pleurisy occurs when it is the result of any other chest disease. Severe pain in the chest is one of the main symptoms of pleurisy. The pain is felt over the chest at the site of the pleural inflammation. Chest pain becomes acute during deep breathing, coughing and sneezing. Other symptoms of pleuritis are dry cough and fever. Pain may also be felt in the neck, shoulder or abdomen.

Diagnostic tests such as chest x-ray and chest ultrasound are used to detect the degree and extent of pleuritis. Thoracentesis involves collection of fluid from the pleural cavity. Removal of this fluid aids easier breathing. A pulse oximeter allows a physician to check the amount of oxygen in the blood. ECG may show any heart-related conditions that could be the cause for pleuritis. Sometimes a sputum sample is taken for analysis.

A patient suffering from pleurisy may be administered oxygen by a mask or nasal prong to facilitate breathing. If a bacterial infection is the cause, it has to be treated with suitable antibiotics. Inflammation of the pleura is reduced with the help of anti-inflammatory drugs or cortisone drugs. Often the patient is advised to rest and limit the strain on the lungs. Painkillers can help in alleviating pain and discomfort.

Uremia

Uremia is regarded as the end stage of Kidney Failure. Uremia is also called the 'second cancer'. Uremia is related to the second point filtering blood. The kidney is impaired and does not filter the waste products that result from the body's metabolism. When this function fails, the waste products and blood urea nitrogen accumulate in the bloodstream. This build-up is Azotaemia. Mild levels of azotaemia may not show symptoms. But continued kidney failure to filter the waste result in symptoms and this condition is called uremia.

Uremic patients show varied signs and symptoms collectively called as uremic syndrome.

Gastrointestinal tract: Loss of appetite, discomfort in the abdomen, nausea, vomiting, diarrhea, severe dehydration, oral ulcer, Glossitis (inflammation of the tongue) and urine taste in breath.

Nerves related: Headache, dizziness, lethargy, drowsiness, weakness, fatigue. In advanced stage symptoms such as irritability, muscle trembling, seizures and convulsions may be experienced.

Cardiovascular system: Hypertension and arrhythmia and in the advanced stage heart failure can happen.

Blood forming or hematopoietic system: Serious anemia and in the advanced stage bleeding can happen.

Respiratory system: Shortness of breath, difficulty breathing, chronic cough, respiratory disorders such as pleural effusion (fluid accumulation in the lungs), pneumonia, uremic bronchitis, pleurisy.

To decide on the course of treatment the cause of Uremia is of great significance. As Uremia can be life-threatening, quick and proper treatment may reverse the illness condition. The chief cause is of course, kidney failure or damage to kidneys.

Diseases that affect kidney function:

• Bright disease - Glomerulonephritis
  
  
• Chronic hypertension
  
  
• Diabetes mellitus
  
  
• Kidney diseases (Kidney failure, Kidney anomalies)
  
  
• Bladder cancer
  

Body conditions:

• Urinary stones that block flow of urine
  
  
• Enlarged prostate glands (in males)
  
  
• Injury to kidney
  
  
• Renal artery occlusion or embolism
  
  
• Cardio vascular problems (excessive bleeding, congestive heart failure)
  
  
• Gastro-metabolic disorder (diarrhea, vomiting, severe dehydration)
  
  
• Burns
  
  
• Lupus
  

How is Uremia diagnosed?

Most renal disease including Uremia do not cause symptoms in the early stages. Uremia is likely to be noticed incidentally from blood or urine tests done for other health issues. Urinalysis is done to detect protein and blood in urine. Blood clotting test, kidney biopsy and stool culture to ascertain presence of a certain type of E.coli bacteria or other bacteria.

• A normal hemoglobin level is below 80g/L. In persons with symptoms of Uremia, the level may decline to 40-60g/L. Also, the platelets or leukocyte levels may be high.
  
  
• In persons with symptoms of Uremia, BUN increases from its normal value of less than 20 mg/dL to approximately 80-100.
  
  
• A 24-hour urine sample for creatinine clearance is taken. If the test result shows below the normal of less than 1.0 mg/dL to approximately 10, there is a high possibility of renal failure.
  
  
• Estimated Glomerular Filtration Rate or eGFR is a measure that filtering and waste removal function of the kidneys. eGFR falls to less than 10-15 ml/1.73 m2.
  
  
• Calcium, phosphate, parathyroid hormone, albumin, potassium and Bicarbone- abnormalities prevalent in these are also observed as part of blood tests.

How is Uremia treated?

If the diagnosis is confirmed, the patient would be hospitalized for observation and treatment. The cause determines the treatment.

• Patients with diarrhea require intravenous fluids or re hydration and rebalancing of electrolytes like sodium and potassium which is lost with diarrhea. This is the immediate supportive care.
  
  
• Severely anemic patients are given blood transfusion when the hemoglobin falls below 6 or 7 gdL.
  
  
• Plasma exchange or plasmapherisis is usually for adults patients who are likely to have an abnormal chemical in the plasma stimulating abnormal clot formation. To rectify and balance, the plasma is removed and replaced with donor plasma.
  
  
• is done to filter the waste out of the blood while the kidneys recover.
  
  
• Kidney transplant is another choice.
  
  
• Eculizumab (Soliris) is an intravenous infusion approved by the FDA for the treatment of pediatric and adult patients with atypical hemolytic uremic syndrome (aHUS). Atypical Hemolytic-uremic syndrome is a syndrome characterized by three major problem areas, progressive renal failure, problems associated with red blood cell and platelet counts and problems that occur in the vascular system.