BUN blood test

Healthy kidneys filter urea nitrogen through the urine. The BUN blood test measures the urea nitrogen levels in your blood as an indicator of the efficiency of the kidneys. BUN - Blood Urea Nitrogen blood test indicates the functioning of the kidneys. The BUN concentration is measured by analysis of serum or plasma. It is also done to check for efficiency of dialysis. BUN blood test measures the levels of urea nitrogen in the blood. BUN blood test results can be compared with creatinine test to check for dehydration. BUN - creatinine ratio can throw light on kidney functioning.

BUN blood test levels

Normal BUN blood levels are 7 - 20 mg/dl. Abnormal levels of BUN are usually indicative of renal failure or bleeding into the stomach or intestines. High levels of BUN in the blood can mean congestive heart failure, gastrointestinal bleeding, urinary tract obstruction or myocardial infarction. BUN blood levels are noticed to be higher in diabetics. This is due to accumulated stress on the kidneys over years. This leads to kidney failure and dysfunction. Acute dehydration raised BUN blood levels due to inadequate level of fluids in the body. Lower levels of BUN in the blood may suggest malnutrition or liver failure. Some women notice decrease in BUN level in the third trimester of pregnancy.

Hydronephrosis

Hydronephrosis refers to the swelling of one or both of the kidneys that occurs due to accumulation of urine in it. The urine goes through the ureter and is excreted by the urethra. If the outward flow of urine is blocked for some reason, it passes back to the kidneys, causing pressure and swelling. This condition is called as Hydronephrosis. It is not a disease in itself but occurs due to other underlying conditions. Reasons such as obstruction in urinary flow, kidney stones, reflux of urine from bladder to kidney lead to Hydronephrosis.

Symptoms of Hydronephrosis

• Sudden or intense pain in the back or sides
  
  
• Dull pain in the groin area
  
  
• Nausea and Vomiting
  
  
• Reduced urine output
  
  
• Frequent or painful urination
  
  
• Blood in the urine
  
  
• Weakness or malaise
  
  
• Fever due to urinary tract infection
  

Causes of Hydronephrosis

• Urinary stone
  
  
• Blood clots in the kidney or ureter
  
  
• Kidney tumor or Tumors in the bladder, prostate gland
  
  
• Urinary scarring
  
  
• Renal enlargement
  
  
• Renal failure
  
  
• Uterine prolapse
  

Congenital Hydronephrosis

• Hydronephrosis can also occur in infants. Such congenital cases are noticed either at prenatal or antenatal stage.
  
  
• Hydronephrotic in infants is normally due to Vesico-ureteral reflux in which urine, instead of flowing from the kidneys to the bladder, abnormally flows back in the ureter.
  
  
• Another common cause is congenital Hydronephrosis obstruction either at uretero-pelvic junction or at ureter-bladder junction.
  
  
• The condition is also caused due to Ureterocele wherein the ureter does not develop properly and causes a small pouch into the bladder.
  
  
• Pregnant women also experience gestational Hydronephrosis due to mechanical compression of the ureter blocking the urine flow.
  

Diagnosis of Hydronephrosis

• Early diagnosis is very important; the longer hydronephrosis remains untreated, the more kidney function is lost.
  
  
• Diagnosis may begin by a thorough physical examination of the patient where the enlarged kidneys would be palpable due to swelling.
  
  
• After noting down the symptoms and the medical history of the patient, doctor may order few blood and urine tests to check the level of infection.
  
  
• Ultrasound scan is normally taken to confirm the diagnosis.
  
  
• Imaging tests like CT scan and MRI of abdomen and kidneys may be required to understand the underlying condition and the exact location of the blockage which helps in deciding the course of the treatment.
  

Hydronephrosis Treatment

• The first step in treating the condition would be to drain the accumulated urine through catheterization.
  
  
• Once the fluid is drained off, the underlying condition that resulted in Hydronephrosis needs to be addressed.
  
  
• If there is a blockage in the ureters, a stent can be placed to bypass the block for smooth flow of urine.
  
  
• Kidney stones are normally treated with lithotripsy, a shock wave treatment that fragments the stones into tiny pieces, to excrete easily.
  
  
• Enlarged prostate is treated with medication or surgery to remove part or whole of the prostate.
  
  
• If Hydronephrosis is caused due to kidney tumors, the same is treated with surgery, chemotherapy and radiation.
  
  
• Hydronephrosis in infants often resolves on its own and does not require any aggressive treatment except for some mild antibiotics to prevent infection.
  

Tuberous Sclerosis

This is a rare multi system genetic disease where benign tumors grow in the brain and other vital organs of the body such as kidneys, heart, eyes, lungs and skin. Tuberous Sclerosis is derived from the Latin word, tuber means swelling and the Greek Skleros means hard - a pathological finding of thick, firm and pale tubers in the patients. As these tubers were first described by Bourneville in 1880, it is sometimes known by the name Bourneville's disease.

Symptoms

A combination of symptoms including non-cancerous tumors or lesions in many parts of the body; in the brain, kidneys, heart, lungs and skin and also seizures, intellectual disability, developmental delay, skin abnormalities, lung and kidney disease.

Symptoms include

Skin abnormalities: Patches of light colored skin or small harmless areas of thickened skin or growth under or around the nails. Facial lesions resembling acne are common.

Seizures: due to lesions in the brain which can be the first symptoms of tuberous sclerosis. Infantile spasms in small children may occur.

Developmental delays: Intellectual disability and learning and developmental delays.

Behavior problems: Hyperactivity, raging outbursts, aggression, repetitive behaviors, social and emotional withdrawal.

Communication and social interaction problems: Children especially exhibit trouble with communication and social interaction and some may have autism spectrum disorder.

Kidney problems: develop lesions in kidneys which may damage kidney function.

Heart problems: Lesions may develop in the lungs and may cause coughing or shortness of breath, especially with physical activity or exercise.

Eye abnormalities: White patches develop on the light sensitive tissue at the back of the eye (retina). But these do not interfere with vision most of the times.

Causes

Tuberous sclerosis is caused by a mutation of either of two genes - TSC1 and TSC2 which code for proteins hamartin and tuberin respectively. These proteins act as tumor growth suppressors, agents that regulate cell proliferation and differentiation. The effect of these on the brain leads to neurological symptoms.

It is a rare genetic disease and is often detected during infancy or childhood. About one-third of the people with tuberous sclerosis inherit an altered TSC1 and TSC2 gene from a parent who has the disease. There is a 50% chance of passing the condition to the biological children although severity of the condition may vary. A parent with tuberous sclerosis may have a child with milder or severe form of the disorder.

Complications

Severe life-threatening complications can be caused depending upon where the tumors are developed and their size. Some complications that could develop are:

Lesions in the brain can block the flow of cerebral spinal fluid within the brain. This blockage can cause the buildup of fluid in the cavities, ventricles and within the brain leading to symptoms such as nausea, headaches and behavioral changes.

Lesions in the heart, especially in infants can block blood flow and cause problems in heart rhythm.

Lesions in the kidney can be large and life threatening - can cause bleeding or lead to kidney failure and sometimes become cancerous too.

Lesions in the lung can lead to lung failure. Lesions in the eye can interfere with vision.

Diagnosis

Patients are evaluated by different specialists including a geneticist, and those trained to treat problems of brain, heart, eyes, skin and kidneys. The doctors typically look for tumors who conduct tests to diagnose tuberous sclerosis. A child with seizures will undergo EEG as this can test the brain activity and help pinpoint what causes the child's seizures. Diagnostic testing to detect abnormal growths in kidneys and brain include MRI and CT and ECG to test electrical activity of the heart. In tuberous sclerosis, follow up monitoring is important and essential.

Treatment

Although there is no cure for tuberous sclerosis, treatment can help manage specific signs and symptoms. Education therapy can help children adapt to developmental delays and meet the classroom requirements. Medication may help manage behavioral problems. Everolimus is used to treat certain types of brain growths and kidney tumors that cannot be surgically removed. The topical ointment form of the drug called sirolimus can help treat acne-like skin lesions that can occur with tuberous sclerosis. Psychological therapy can help the child accept and adjust to living with this disorder. Physical therapy can improve his/her ability to handle daily tasks.

If the lesion affects the ability of a specific organ function, then surgery may be resorted to. Sometimes, surgery can control seizures caused by brain lesion in case medication fails. Dermabrasion or laser treatment may improve the appearance of skin lesions.

Family and support

Parents may consider genetic testing to confirm the diagnosis of tuberous sclerosis in their child, if the family history is not known. In case of a child diagnosed with tuberous sclerosis, there will be a number of challenges. It is essential to track the child closely with his/her peers in terms of academic, social and physical abilities. It is important to work closely with the child's doctor to establish an ongoing screening and monitoring schedule for health and developmental problems. Discovering and treating problems early will maximize the child's chances of a good outcome.

In case of early behavioral problems, it is essential to talk to the child's doctor and work with the child's school. Providing love and support is vital to help the child reach his/her full potential. It would also be helpful to connect with other families who are coping with tuberous sclerosis.