Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The kidneys are responsible for filtering waste products
from the blood. Dialysis is a
procedure that is a substitute for many of the normal duties of the kidneys. The
kidneys are two organs located on either side of the back of the abdominal
cavity. Dialysis can allow
individuals to live productive and useful lives, even though their
kidneys no longer work adequately. In the United States, there are
over 200,000 people who use dialysis techniques on an ongoing
basis.
Dialysis helps the body by performing the functions of failed
kidneys. The kidney has many roles.
An essential job of the kidney is to regulate the body's fluid balance. It does this by adjusting
the amount of urine that is excreted
on a daily basis. On hot days, the body sweats more. Thus, less water needs to
be excreted through the kidneys. On cold days, the body sweats less. Thus, urine output
needs to be greater in order to maintain the proper balance within
the body. It is the kidney's job to regulate fluid balance by
adjusting urine output.
Another major duty of the kidney is to remove the waste
products that the body produces throughout the day. As the body functions, the
cells use energy. The operation of the cells produces waste products
that must be removed from the body. When these waste products are
not removed adequately, they build up in the body. An elevation of
waste products, as measured in the blood, is called "azotemia." When
waste products accumulate they, cause a sick feeling throughout the
body called "uremia."
Patients usually require dialysis
when the waste products in their body become so high that they start to become
sick from them. The level of the waste products usually builds up slowly.
Doctors measure several blood chemical levels to help decide when dialysis is
necessary. The two major blood chemical levels that are measured are the
"creatinine level" and the "blood urea nitrogen" (BUN) level. As
these two levels rise, they are indicators of the decreasing ability
of the kidneys to cleanse the body of waste products.
Doctors use a urine test, the "creatinine clearance," to
measure the level of kidney function. The patient saves urine in a special
container for one full day. The waste products in the urine and in the blood are
estimated by measuring the creatinine. By comparing the blood and urine level of
this substance, the doctor has an
accurate idea of how well the kidneys are working. This result is
called the creatinine clearance. Usually, when the creatinine
clearance falls to 10-12 cc/minute, the patient needs dialysis.
The doctor uses other indicators of the patient's status to decide
about the need for dialysis. If the patient is experiencing a major
inability to rid the body of excess water, or is complaining of
problems with the heart, lungs, or stomach, or
difficulties with taste or sensation in their legs, dialysis may be indicated even
though the creatinine clearance has not fallen to the 10-12 cc/minute
level.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Sepsis (blood poisoning) is a potentially deadly infection with signs and symptoms that include elevated heart rate, low or high temperature, rapid breathing and/or a white blood cell count that is too high or too low and has more than 10% band cells. Most cases of sepsis are caused by bacterial infections, and some cases are caused by fungal infections. Treatment requires hospitalization, IV antibiotics, and therapy to treat any organ dysfunction.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Thrombocytopenia refers to a decreased number of platelets in the blood. There are many causes of thrombocytopenia such as decreased platelet production (viral infections for example rubella, mumps, chickenpox, hepatitis C, and HIV); increased platelet destruction or consumption (for example sulfonamide antibiotics, heparin, blood transfusions, and lupus); or increased splenic sequestration (enlarged spleen due to conditions for example liver disease, blood cancers, and more). Treatment of thrombocytopenia depends on the cause.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Polycystic kidney disease (PKD) is characterized by numerous cysts in the kidneys. Polycystic kidney disease is a genetic disorder. There are two major inherited forms of PKD, autosomal dominant PKD, and autosomal recessive PKD. Symptoms include headaches, urinary tract infections, blood in the urine, liver and pancreatic cysts, abnormal heart valves, high blood pressure, kidney stones, aneurysms, and diverticulosis. Diagnosis of PKD is generally with ultrasound, CT or MRI scan. There is no cure for PKD, so treatment of symptoms is usually the general protocol.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Arsenic comes in two forms, inorganic and organic. Organic arsenic poisoning is usually not poisonous to humans; however, inorganic arsenic in large enough amounts can lead to shock and death. Symptoms of arsenic poisoning include nausea, abdominal pain, diarrhea, dehydration, dark urine, vertigo, delirium, shock, and death. Treatment for arsenic poisoning includes Hemodialysis and a variety of drugs.
Fabry disease (Fabry's disease, alpha-galactosidase-A) is a genetic disorder with symptoms such as burning sensations in the hands, small-raised reddish-purplish blemishes on the skin, fever, decreases sweating, and GI difficulties. Fabry disease patients are at increased risk of heart attack, heart disease, kidney failure, and stroke. Symptoms of Fabry disease can be treated with medication.
In the United States diabetes is the most common cause of kidney failure. High blood pressure and high levels of blood glucose increase the risk that a person with diabetes will eventually progress to kidney failure. Kidney disease in people with diabetes develops over the course of many years. albumin and eGFR are two key markers for kidney disease in people with diabetes. Controlling high blood pressure, blood pressure medications, a moderate protein diet, and compliant management of blood glucose can slow the progression of kidney disease. For those patients who's kidneys eventually fail, dialysis or kidney transplantation is the only option.
Hemolytic uremic syndrome (HUS) is a diseases in which blood clots within the capillaries. Causes associated with HUS include E. Coli, birth control pills, pneumonia, medications such as chemotherapy, Ticlid, and quinine. Symptoms of HUS include gastroenteritis, abdominal cramping, vomiting, and bloody diarrhea. Diagnosis of HUS includes medical history, physical examination, and medical tests. Treatment includes rest, fluids, possible hospitalization for blood transfusion or complications due to kidney failure.
Renal osteodystrophy is a bone disease. The kidneys fail to maintain required levels of phosphorous and calcium in the blood. Renal osteodystrophy is common in patients with kidney disease and affects dialysis patients. Diagnosis is performed with a blood sample, and in some cases a bone biopsy. Medication is the general treatment for renal osteodystrophy.
Chemically, electrolytes are substances that become ions in solution and acquire the capacity to conduct electricity. Electrolytes are present in the human body, and the balance of the electrolytes in our bodies is essential for normal function of our cells and our organs.
Common electrolytes that are measured by doctors with blood testing include
sodium, potassium, chloride, and bicarbonate. The functions and normal range
values for these electrolytes are described below.
Sodium
Sodium is the major positive ion (cation) in fluid
outside of cells. The chemical notation for sodium is Na+. When combined with
chloride, the resulting substance is table salt. Excess sodium (such as that
obtained from dietary sources) is excreted in the urine. Sodium regulates the total amount
of water in the body and the transmission of sodium into and out of individual
cells also plays a role in critical body funct...
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