Acute Kidney Failure

Acute kidney failure is a life-threatening emergency that requires the fastest possible therapy. Read about the vital functions our kidneys perform and the symptoms that indicate kidney failure. You will also learn everything you need to know about diagnosis, therapy, and prevention of acute kidney failure.

When the kidneys do their job no longer or only very incompletely, doctors speak of kidney failure. A distinction is made between two forms of progression: acute kidney failure (ANV) and chronic kidney failure (CRF). Acute kidney failure develops within hours to days and usually heals without consequences once the cause has been eliminated. In chronic kidney failure, the disease progresses slowly over months to years and, if left untreated, leads to death.

Function Of The Kidneys

Healthy people have two kidneys, one on the left and one on the right. Both kidneys perform important tasks in the body:

    • Excretion of metabolic end products (so-called urinary substances) and drugs
    • Keeping the water balance constant
    • Regulation of the electrolyte balance
    • Maintaining the acid-base balance
    • Production of hormones (such as erythropoietin and renin)
    • Conversion of inactive to active vitamin D.
    • Blood pressure regulation.

The kidneys as an excretory organ

Around 1500 liters of blood flow through the kidneys every day. Every day they excrete about one and a half liters of urine, which is filtered out of the blood. The blood flows through special filter systems (nephrons). A healthy kidney contains about 1 million such nephrons. In these filters, substances that the body no longer needs are, so to speak, sifted out of the blood (so-called urinary substances). If the urinary substances remain in the blood, they will poison the body. On the other hand, the nephrons also hold back important substances in the body. Above all, this includes proteins and electrolytes.

Symptoms

The symptoms of acute kidney failure are different. In any case, the main symptom is the significantly reduced amount of urine that is excreted. Sometimes no water can be left at all. In the course of decreasing urine production, the overhydration of the body increases. The consequences are, for example, water retention in the legs (edema) and in the lungs (pulmonary edema). Furthermore, life-threatening electrolyte disturbances (e.g. increased blood potassium concentrations) and life-threatening acidosis (acidosis) can occur. These make z. B. in the form of cardiac arrhythmias, nausea, and vomiting as well as rapid fatigue noticeable. If fluid builds up in the brain, the patient’s behavior can change. Psychological abnormalities such as excessive tiredness, indifference to impaired consciousness are indicative.

Causes

Doctors classify the causes of acute kidney failure as follows:

    • Prerenal ANV: In a maximum of 60 percent of cases, the cause of the kidney failure lies before the kidney (i.e. prernally). Often this is a suddenly greatly reduced blood flow to the kidneys, for example, due to circulatory shock in accidents or operations, due to blood clots in the kidney arteries, or due to drug side effects.
    • Intrarenal or renal ANV: Here the cause lies in the kidney itself (i.e. intra-renal). Triggers are damaged kidney tubules due to long-term lack of oxygen, damage from drugs or contrast media, and, rarely, severe inflammation of the kidney function bodies (so-called glomerulonephritis).
    • Postrenal ANV: The cause is an obstruction of the flow of urine behind the kidney (i.e. post-renal). The main obstacles to the outflow of urine are enlarged prostates, kidney, bladder, or urinary tract stones, inflammations, or tumors.

Examination

To diagnose acute kidney failure, the doctor must first clarify whether it is acute kidney failure or chronic kidney failure. The ANV is easier to recognize: The lack of urine production quickly gives the decisive clue.

Further diagnostic methods are anamnesis (i.e. questioning the patient), physical examination with listening to the heart and lungs, and laboratory tests. In particular, urinary substances such as creatinine and urea are determined in the blood. Test strips help with the urine examination. They record proteins, red and white blood cells, nitrite as an indication of a urinary tract infection, the urine pH value, glucose, ketone bodies, and bile pigments. This is followed by an examination of the urine in the laboratory.

The imaging methods used are ultrasound (sonography) and color Doppler sonography of the kidneys as well as X-rays of the chest with the heart and lungs. If the cause is inflammatory, a kidney biopsy may be performed. In this examination, a tissue sample is taken from the kidney during an endoscopic procedure.

Acute-Kidney-Failure

Treatment

The therapy of acute kidney failure depends primarily on the cause. This includes the following steps in particular:

    • Compensate for lack of fluids (if necessary with infusions)
    • raise low blood pressure (with medication if necessary)
    • Stop or switch drugs (such as antibiotics, pain relievers, and X-ray contrast agents) that have caused acute kidney failure
    • Surgically remove obstructions to the flow of urine (e.g. bladder or urethral stones, enlarged prostate, tumors).

Medical therapy

In acute kidney failure, your doctor can try to stimulate the excretory function with medication. For this purpose, so-called loop diuretics such as furosemide, piretanide, and torasemide are primarily administered. Alternatively, dehydrating agents of the thiazide-type such as hydrochlorothiazide and xipamide or potassium-sparing agents such as spironolactone can also be used.

Dialysis

If it is not possible to stimulate the kidney function again with medication, the phase until the kidneys produce urine independently must be bridged with a kidney replacement procedure (dialysis).

Transplantation

Sometimes drug therapy and dialysis are not enough to restore or replace kidney function to a sufficient extent. In these rare cases, a kidney transplant may be necessary.

Forecast

The chances of recovery are very good if the cause of the acute kidney failure does not lie in the kidney itself. This is the case with prerenal and postrenal kidney failure.

Acute intrarenal kidney insufficiency is much less treatable, as more or less kidney tissue has been lost to varying degrees and irretrievably in this form. Acute intrarenal forms often lead to chronic renal failure. In addition, the complication rate (dialysis requirement) is significantly higher.

In many cases, serious illnesses, accidents or poisoning (also due to medication) are the cause of acute kidney failure. In these cases, up to 50 percent of those affected do not survive. The main cause of this is not kidney failure, but the circumstance that caused this failure.

Prevention

Many over-the-counter drugs can damage the kidneys and cause acute kidney failure. Examples of this are popular over-the-counter drugs such as the pain relievers diclofenac, ibuprofen, and paracetamol or gastric acid inhibitors from the group of proton pump inhibitors. Therefore, you should not take pain relievers in particular for longer than recommended. In principle, it is advisable to discuss any prolonged use of medication with a doctor.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report of the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In addition, the active ingredients omeprazole, pantoprazole, or esomeprazole are also available over the counter. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

The connection between proton pump inhibitors and allergies is possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.

Intermittent Claudication

The medical term for intermittent claudication is intermittent claudication – translated: intermittent limping. Just like the colloquial term intermittent claudication, this term indicates the typical symptoms of this condition. Those affected can only run or walk short distances painlessly. After a few meters, the pain forces patients with intermittent claudication to stand. So that this is not so noticeable, those affected like to stand in front of shop windows and look apparently interested in the displays. Actually, they are just waiting for the pain to pass and for them to continue on their way.

Intermittent claudication as stage II of PAVK

Intermittent claudication is stage II of PAVK. Information on stages I, III, and IV can be found in the paVK clinical picture.

Stage II is divided again into II a and II b. The subdivision is based on the walking distance that those affected can walk without pain. In stage II a it is more than 200 meters, in stage II b the legs already hurt at a distance of less than 200 meters.

Symptoms

In addition to the typical calf pain when walking, some patients with intermittent claudication also experience pain in the thighs and buttocks. Often there is also a feeling of weakness in the legs (tired legs). As a result of the lack of blood circulation, the skin on the lower leg sometimes appears pale and cool. Dark spots, wounds, and inflammation on the lower leg are also possible symptoms of intermittent claudication.

Intermittent Claudication

Causes

As with paVK, atherosclerosis and the resulting insufficient blood flow are the main causes of the disease in intermittent claudication. Risk factors such as smoking, diabetes, elevated blood lipid levels, and high blood pressure or metabolic syndrome increase the risk of intermittent claudication.

Treatment

Therapy for intermittent claudication consists in the treatment of peripheral arterial circulatory disorder. You can find out more about the different therapy options in the paVK guide.

Arteriosclerosis

Atherosclerosis is a pathological narrowing of the arteries that can lead to circulatory disorders and heart disease. Find out more about the causes, symptoms, and treatment of atherosclerosis here.

Medical professionals describe pathological (degenerative) narrowing of the arteries as arteriosclerosis. A similar term is or atherosclerosis. He basically means the same thing. But there is a small difference: medical professionals refer to the deposits of plaques in the blood vessels as or atherosclerosis. In colloquial language, arteriosclerosis and/or atherosclerosis are often referred to as hardening of the arteries or hardening of the arteries.

Atherosclerosis: plaques in the inner wall of the blood vessels

Healthy arteries are elastic and muscular and can adapt to different blood pressure situations. The arteries (excluding the pulmonary arteries) carry fresh, oxygen-rich blood from the heart throughout the body. In arteriosclerosis, substances dissolved in the blood (initially cholesterol, for example) are deposited in the inner wall of the blood vessels. In the further course, other substances such as calcium also accumulate at these points – so-called plaques are formed. These deposits change the inner wall of the vessel. It becomes rigid and swells. This narrows the vascular opening. The result is circulatory disorders in the areas that are supplied by the affected artery. A particular danger of atherosclerosis is that narrowed vessels can more easily be closed by a blood clot. The consequences of this are, for example, heart attacks or strokes. Men suffer from circulatory disorders more often than women.

Frequency

Atherosclerosis is a so-called widespread disease because it is particularly common. With increasing age, almost everyone is affected by a pathological narrowing of the arteries. The number of deaths caused by atherosclerosis in Germany is around 360,000 per year. At the same time, the hardening of the arteries is the most common cause of serious secondary diseases such as heart attacks or strokes.

Symptoms

The symptoms of atherosclerosis, once they become noticeable, are usually severe. The symptoms depend on where the arteries are narrowed.

Circulatory disorders in the legs

Circulatory disorders in the legs lead to so-called peripheral arterial occlusive disease (PAOD), the 2nd stage of which is known as intermittent claudication. The legs hurt at first when walking, later also when resting. The disease got its name because patients repeatedly take breaks while walking and look in shop windows, for example.

Another circulatory disorder in the legs is the so-called smoker’s leg. In the smoker’s leg, the tissue on the toes, ankles, and legs slowly dies off because the narrowed arteries do not provide enough oxygen. Amputation may be necessary under certain circumstances.

Angina and heart attack

A narrowing of the coronary arteries leads to angina pectoris, and if one of the arteries is completely blocked, it leads to a heart attack. These heart problems are among the most feared complications of arteriosclerosis. This also applies to strokes, which are often caused by a vascular blockage in the brain.

Arteriosclerosis

Stroke due to atherosclerosis

Circulatory disorders in the brain lead to declining brain functions such as memory disorders, dizziness, or confusion. Depending on which brain region is affected, other failure symptoms can also occur in other parts of the body. Examples of this are numbness in the arms or legs or impaired vision. If the vascular narrowing is very severe or if a brain vessel bursts, a stroke occurs.

Causes

Unfortunately, it cannot be glossed over: the majority of the causes of arteriosclerosis are our own responsibility. Because the risk is primarily shaped by individual behavior. The following risk factors promote the development of arterial constrictions:

    • Blood fat levels (cholesterol and other fats) are too high because fats are deposited in the blood vessels, and high LDL concentrations in particular increase plaque formation
    • High blood pressure, because the blood vessels are exposed to greater pressure and wear out faster
    • Obesity because is often linked to high blood pressure or high cholesterol
    • Smoking, as nicotine narrows blood vessels and reduces blood flow
    • Stress (which in turn can cause high blood pressure)
    • Diabetes, as blood lipids are increasingly “saccharified” and are more heavily deposited in the blood vessel walls
    • Age, because the risk of arteriosclerosis increases significantly with age
    • Lack of exercise because it promotes obesity and does not train the vascular system
    • Genetic predisposition: Genes seem to play a role as a disease risk in arteriosclerosis.

Examination

For a more precise diagnosis of a narrowing of the arteries, your doctor will first use special examination methods to determine the location and extent of the narrowing of the arteries. This diagnosis of arteriosclerosis can turn out to be quite complex if, for example, the condition of arteries has to be assessed by a catheter examination.

Treatment

For the drug therapy of arteriosclerosis, your doctor can use a whole range of active substances that relieve the blood circulation and the arteries in different ways. These are, for example, drugs that stimulate blood circulation, lower blood pressure, or thin the blood. Medicines are also available to treat high cholesterol or high levels of blood lipids. In addition, doctors usually recommend changing your diet and getting more exercise.

Surgical Therapy Of Atherosclerosis

Surgical treatment of atherosclerosis comes into play when medication and behavior change no longer help.

Stent Stabilizes Arteries

In the not-too-advanced stages of arteriosclerosis, the doctor has the option of making the affected vessels more accessible again. For this purpose, the affected artery is stabilized with a stiffener, the so-called stent, in an operation. In order to be able to place a stent, however, the artery still has to be narrowed enough so that the surgeon can reach the narrowing with an endoscope. If this is not possible, bypass surgery usually occurs.

Bypass Surgery

In particularly severe cases of atherosclerosis, there is no choice but to have surgery to detour around the narrowed or blocked artery or to replace the narrowed artery. This is called a bypass operation.

Self Help

Self-help for atherosclerosis is particularly effective if it reduces the risk factors. Eating a low-fat diet, losing excess weight, getting more exercise, and not smoking will support treatment and reduce the severity of the course of atherosclerosis.

Over-The-Counter Drugs For Atherosclerosis

    • Taking ginkgo preparations has a positive effect on blood circulation.
    • Taking garlic supplements in sufficient doses improves the flow properties of the blood and is also said to lower the cholesterol level.
    • Preparations with omega-3 fatty acids e.g. obtained from cold-water fish, reduce the risk of deposits in the arteries. They are also said to improve the flow properties of the blood and lower cholesterol levels and blood pressure.
    • Regular intake of acetylsalicylic acid (ASA) in low doses improves blood flow. Discuss this with your doctor.

Prevention

There are a number of ways you can help prevent atherosclerosis. In any case, you should do everything possible to minimize the risk factors mentioned under arteriosclerosis. In a nutshell, the best way to help yourself is to eat a low-fat, varied, and fresh diet, exercise regularly in the fresh air (as early as 20 minutes a day), consume luxury foods such as alcohol and coffee in moderation, and refrain from smoking (For tips, see quitting smoking). The following tips will also help prevent atherosclerosis:

    • Regular monitoring of blood pressure, cholesterol, and blood lipid levels.
    • If the cholesterol level is high, pay attention to a low-cholesterol diet, i.e. reduce butter, eggs and the amount of meat, especially avoid saturated fats (e.g. high-fat sausage) and trans fats (especially in fried products such as french fries or potato chips), for the diet guide with high cholesterol levels
    • Diabetics should always make sure that their sugar levels are set correctly.
    • Obese people should definitely lose weight.
    • Avoid stress and learn relaxation techniques such as autogenic training, yoga, or Jacobsen’s progressive muscle relaxation.

Cardiomyopathy

Doctors refer to a whole group of diseases as cardiomyopathies in which the heart muscle, the myocardium, is affected. The colloquial term is a heart muscle disease.

The word cardiomyopathy is derived from Greek. “Cardio” stands for heart, “myo” for muscle, and “pathie” for sick. Cardiomyopathy is a collective term for various heart diseases. A common feature of these diseases are changes in the heart muscle (myocardium), which are associated with a decline in cardiac output.

Cardiomyopathies are almost always very serious diseases which, without appropriate therapy, lead to heart failure.

Forms Of Cardiomyopathy

There are a number of cardiomyopathies. First of all, medical professionals differentiate between primary and secondary cardiomyopathies. Primary cardiomyopathies are caused by a disease or congenital malformation of the heart muscle. If other diseases affect the myocardium, doctors speak of secondary cardiomyopathies. In addition to the pure forms, there are also mixed forms.

Furthermore, medical professionals divide cardiomyopathies into four main types.

    • dilated cardiomyopathy
    • hypertrophic cardiomyopathy
    • restrictive cardiomyopathy
    • arrhythmogenic right ventricular cardiomyopathy (ARVC).

There are also other sub-forms such as

    • Non-compaction cardiomyopathy
    • Broken Heart Syndrome (Tako Tsubo Cardiomyopathy, Broken Heart Syndrome)
    • hypertensive cardiomyopathy (damage to the heart muscle caused by high blood pressure)

Frequency

By far the most common form is hypertrophic cardiomyopathy. There are around 200 cases for every 100,000 inhabitants (prevalence). The number of new cases per 100,000 inhabitants per year (annual incidence) is 19.

The second most common form is dilated cardiomyopathy, with a prevalence of 40 cases per 100,000 population and an annual incidence of 6 new cases.

Cardiomyopathies affect people of all ages. However, there are frequency peaks between 20 and 50 years on average for all forms. In men, the incidence is about twice as high as in women.

Symptoms

The common symptom of all cardiomyopathies is a more or less restricted beating and pumping power of the heart. Heart failure often occurs as the disease progresses. In the case of some heart muscle diseases, the symptoms resemble the symptoms of cardiac insufficiency at the onset of cardiomyopathy.

Complications

Cardiomyopathies are often very slow to develop and therefore often go unnoticed for many years. Without timely diagnosis and suitable therapy, the cardiac output – and with it the oxygen supply to the body – continues to decline.

The human heart is a very finely tuned system. When a component like the heart muscle itself changes, it has a variety of possible effects. An example: In the case of an emerging cardiac insufficiency, the heart compensates for the decreasing impact force by increasing the frequency and strength of the impact. This increases the mass of the heart muscle. If the heart muscle becomes too thick (heart muscle hypertrophy), mobility is restricted on the one hand. In addition, the blood flow in the heart changes. This can promote blood clots, which in turn can trigger a pulmonary embolism.

The extremely sensitive heart valves are also endangered by myocardial growth. Any heart valve defects increase the risk of heart failure.

Sometimes the heart expands as a result of the additional stress caused by cardiomyopathies, doctors speak of dilation. Then the heart chambers literally wear out. As a result, the heart’s pumping power and ejection performance drop drastically.

But cardiomyopathies also disrupt the heart’s excitation lines. This is a possible cause of cardiac arrhythmias, which can lead to ventricular fibrillation and sudden cardiac death.

Cardiomyopathy

Causes

Many primary cardiomyopathies are congenital. This does not necessarily mean that the heart muscle changes exist from birth. They can also only develop over the years. Most common, however, are primary cardiomyopathies with no apparent cause. In this case, medical professionals speak of idiopathic cardiomyopathies.

There are also acquired primary heart muscle diseases and secondary cardiomyopathies.

Acquired primary cardiomyopathies result from other diseases or are sometimes the result of pregnancy. Examples of such causes are:

    • Viral infections, such as a badly healed cold or flu, can lead to viral myocarditis. Infections with the mump pathogen during childbirth sometimes cause restrictive cardiomyopathy in children for years afterward.
    • Bacterial infections such as repeated inflammation of the inner lining of the heart also cause cardiomyopathies. Typical bacterial pathogens that cause myocardial disease are meningococci, streptococci, and diphtheria bacteria.
    • Fungi and parasites such as candida infections or toxoplasmosis
    • Tumor diseases
    • autoimmune connective tissue diseases such as scleroderma or sarcoid
    • Damage to the heart muscle due to deposits of foreign substances or metabolic products such as amyloidosis or hemochromatosis (iron storage disease)
    • Alcohol and drug abuse (toxic cardiomyopathy)
    • increased stress from pregnancy or competitive sport
    • Postmenopause or increased emotional stress (stress cardiomyopathy or, colloquially, broken heart syndrome).

Many other causes are conceivable, depending on the type of cardiomyopathy.

Secondary cardiomyopathies are mostly caused by other conditions. These can be congenital or acquired. Cause here are, for example, toxic substances, storage diseases, endocrine functional disorders, neurological and neuromuscular changes, autoimmune processes, drugs (especially chemotherapeutic agents), or malnutrition.

Examination

General practitioners, cardiologists, or internists usually suspect cardiomyopathy on the basis of declining physical performance. In pronounced cases, shortness of breath, blue discoloration of the skin (cyanosis), or water retention in the legs (edema) speak for themselves.

The diagnosis of cardiomyopathy is initially confirmed by an electrocardiogram (EKG, recording of heart activity), an X-ray of the chest, and an ultrasound examination of the heart (echocardiography). If the initial suspicion is confirmed, a cardiac catheter examination usually follows. During this procedure, a small piece of myocardial tissue is secured (biopsy) in order to better determine the exact type of cardiomyopathy.

Imaging methods such as computer and magnetic resonance tomography, stress tests, and rhythm diagnostics provide additional insights.

Treatment

Once the cause of the cardiomyopathy can be identified, the first step in therapy is to eliminate the causes. Often, however, therapy for heart muscle disease is limited to relieving symptoms and stopping the progression of cardiomyopathy.

Medical therapy

One of the most important goals of drug therapy for cardiomyopathies is to prevent the development or progression of cardiac insufficiency. For this purpose, drugs are used that relieve and strengthen the heart. It is not uncommon for several active ingredients to be combined.

Beta Blockers

The most commonly used active ingredients for the symptomatic therapy of heart failure come from the group of beta-blockers. Beta-blockers block activating hormones like adrenaline and northern adrenaline. Among other things, this causes the heart’s resting frequency to normalize and the blood vessels to expand. This lowers blood pressure, improves blood circulation and oxygen supply, and relieves the heart. They also reduce the excitability of the heart muscle.

Many used beta-blockers are bisoprolol and metoprolol.

Beta Blockers

ACE inhibitors block the action of the angiotensin-converting enzyme (ACE). This enzyme plays a key role in regulating blood pressure and water balance. ACE inhibitors such as benazepril, captopril, ramipril or zofenopril relieve the heart by widening blood vessels and thus lowering high blood pressure. At the same time, they help promote water excretion. This reduces the blood volume and the heart is relieved.

The excretion-promoting effect of ACE inhibitors is in many cases insufficient to relieve the heart of blood volume and to flush out edema caused by cardiac insufficiency. This task is carried out by the so-called water tablets (diuretics) such as hydrochlorothiazide, spironolactone and furosemide.

Antiarrhythmics

Antiarrhythmics are agents that normalize the heartbeat. As a rule, the aim is to slow down an accelerated heartbeat (tachycardia). Active ingredients such as ajmaline, flecainide, or phenytoin achieve this effect, among other things, by blocking the flow of sodium ions into the cells.

Other antiarrhythmics include potassium channel blockers such as amiodarone and sotalol and calcium channel blockers such as diltiazem and verapramil.

Anticoagulants

Anticoagulants such as Phenprocoumon or Eliquis, Pradaxa, and Xarelto are used in cardiomyopathies to prevent blood clots from forming in the heart. This is because these clots pose a significant risk. They can trigger pulmonary embolisms, for example.

Operative Therapy

If drug therapy for cardiomyopathies does not relieve the symptoms, surgery is another option. For example, damaged heart valves are replaced, parts of the heart muscle are removed or pacemakers are implanted.

The heart transplant remains the last possibility and the only causal therapy option.

Forecast

The prognosis for the course and life expectancy of cardiomyopathies depends on the type and extent of the heart muscle damage and the general state of health. In mild forms of blood pressure-related (hypertrophic) cardiomyopathy, for example, those affected have a normal life expectancy if the high blood pressure is consistently treated.

Dilated and restrictive cardiomyopathies, on the other hand, are often recognized very late and can then often hardly be treated effectively. Up to 80 percent of those affected die within 5 years of diagnosis.

Prevention

Cardiomyopathies are very often the result of cardiovascular disease. To reduce the risk of these diseases, you should lead a heart-healthy lifestyle. Above all, exercise keeps the circulation and the heart fit.

A fresh and varied diet provides the body with all the necessary nutrients and also helps to avoid obesity.

Lung and heart health are closely related. Quitting smoking is, therefore, a cornerstone in the prevention and accompanying treatment of heart muscle disorders. Regular consumption of alcohol is also harmful to the heart.

Finally, the prevention of cardiomyopathies also includes having favorable diseases (see causes) treated consistently.

Immune Deficiency

Definition

The immune system of our body protects us – mostly reliably and usually unnoticed – from pathogens. Doctors speak of immune deficiency or immune deficiency when the body’s own defenses are pathological or not fully functional.

Symptoms

Symptoms of the immune deficiency are above all an increased susceptibility to infection and – in the case of an infection – a protracted or complicated course of the disease. On average, every German has a respiratory infection such as cough, bronchitis, or runny nose around twice a year. If such diseases occur much more often and without an identifiable cause, there is a suspicion of a weak immune system.

Causes

Deficiency in the immune system can be congenital or acquired. In the congenital form, the development of the stem cells is usually disturbed or there is a lack of antibodies. More common, however, is the acquired immune deficiency. This leads to the fact that you get sick more often and more severely than other people. Typical causes of immune deficiency are:

    • Infections, injuries, operations, transplants
    • Cortisone therapy, radiation therapy, chemotherapy
    • Diseases such as HIV infection, leukemia, or diabetes
    • Removal of the spleen, tonsils, or appendix
    • Unhealthy diet with a lack of vitamins or minerals, such as iron deficiency
    • Heavy physical strain (physical work, competitive sports)
    • Stress, emotional stress, depression
    • Eating disorders such as anorexia or vomiting addiction
    • Drug and alcohol abuse
    • smoking
    • Lack of sleep or trouble sleeping

Examination

If necessary, your doctor will take some blood to help make a diagnosis of immune deficiency. The concentration of white blood cells is particularly meaningful for determining the functionality of the unspecific immune system. One microliter of blood in healthy people usually contains between 4,000 and 8,000 leukocytes.

A blood test can also demonstrate a weak immune system as a result of a disruption of the specific immune system. For this immune status, for example, a complete blood count is made, in which, among other things, antibodies (immunoglobulins), certain proteins or immune cells are determined more precisely.

Treatment

As a rule, a weak immune system is a weakened, unspecific immune system. In these cases, it is usually sufficient to follow the recommendations given under “Self-help in the case of immune deficiency”. It is different from a defensive weakness of the specific immune system. This is mostly caused by illness or medication. Here the doctor will usually treat the causative illness and/or change medication.

Vaccination against influenza and other infectious diseases such as hepatitis A and hepatitis B, diphtheria, pneumococci, or tetanus is recommended, especially in the case of specific immune deficiencies. These vaccines belong to the group of dead vaccines and can usually be given to people with weak immune systems without the risk of undesirable side effects. There is a certain risk with vaccinations with so-called live vaccines such as measles, mumps, rubella, or chickenpox. It is best to ask your family doctor about this.

Self-Help Against A Weak Immune System

Strengthening the immune system of largely healthy people benefits above all from exercise and a fresh, varied diet with many vitamins and minerals. In the following, you will find many suggestions for effectively strengthening the immune system.

Immune Deficiency

Healthy, Fresh Foods Strengthen The Immune System

Unless a disease is the cause or consequence of the immune deficiency, nutrition comes first. To effectively strengthen the immune system, you hardly need to know anything about food. And expensive fashion foods such as chia, quinoa, Kamut, or goji berries are also not a must. Just eat as fresh and varied as possible. Rely on local fruit and vegetables as well as fish and whole-grain products. They provide a wide variety of vitamins, fiber, minerals, and trace elements that strengthen the immune system.

Cook yourself as often as possible. And avoid industrially pretreated food. All experts agree: the fresher, more natural, and varied the diet, the better it is for the immune system. This form of nutrition very often has another advantage: You maintain your weight or even lose it – and also reduce the risk of diet-related diseases such as diabetes and high cholesterol levels.

Vitamins A, C, D, and E as well as the trace elements iron and zinc are particularly important for the immune system. They are contained in fresh fruit and vegetables, for example, in a composition that is very useful for the organism.

Exercise Strengthens The Immune System

Numerous studies have shown that exercise strengthens the immune system. Just 20 minutes a day – preferably in the fresh air – gets the immune system going much better. Exercise is a turbo for healing and prevention – and can even strengthen the immune system so much that the risk of developing cancer is almost halved.

Relaxation and sleep also play an important role. Relaxation exercises such as simple breathing techniques, meditation or autogenic training not only reduce stress (and thus relieve the body’s own defenses), but also strengthen the immune system directly. The immune system is particularly active at night while we are sleeping. In the topic special “Healthy Sleep” you will find many suggestions with which you can get rid of sleep problems and prevent sleep disorders.

Strengthen The Immune System With Home Remedies

Traditional medicine knows many home remedies that you can use to strengthen the immune system. These are for example:

    • A cold shower in the morning. First, take a warm shower for 5 minutes, then briefly shower with cold water from the outside towards the middle of the body (heart).
    • Kneipp applications, e.g. treading water
    • Sauna and plunge pool (if you have blood pressure problems or cardiovascular diseases, consult your doctor as a precaution.)
    • Drink herbal tea, for example with orchid, taiga root, coneflower, ginseng, lime blossom, or elderflower
    • Nicotine, caffeine, and alcohol put a strain on the immune system – and also disrupt the deep sleep that is so important for the regeneration of the body’s defenses.
    • Breastfeeding protects the baby from infections because it receives certain antibodies from the mother with the milk.

Anti-Immune Medication

As a rule, healthy people do not need medication for immune system weaknesses or nutritional supplements that are supposed to strengthen the immune system. Nevertheless, herbal remedies and nutritional supplements containing minerals are particularly popular. The benefits for largely healthy people have not been adequately proven from a medical point of view. This applies, for example, to the intake of herbal preparations, drops, or tablets that stimulate the body’s unspecific defenses. The preparations often contain extracts from Echinacea (coneflower), Eupatorium (water feast), Thuja (tree of life), Baptisia (indigo), or Eleutherococcus. The ingredients are also offered as homeopathic medicines.

In consultation with the doctor, vitamin preparations or minerals can be useful. However, this only applies in the event of a vitamin deficiency or deficiency in minerals. Preferably, you should take in vitamins and minerals fresh with your food. Taking a zinc supplement can help prevent colds. But not according to the principle: “A lot helps a lot”. More than 100 mg of zinc a day can lead to vomiting and diarrhea.

Prevention

The best way to prevent weak immune systems is to heed the recommendations given under “Self-help against weak immune systems”. If you have colds or infectious diseases more than average (more than 2 to 3 times a year), you should have the cause examined by a doctor. This is especially true for sick and debilitated people, senior citizens, and children of all ages.

Function Of The Immune System

The body has a complicated defense system that intercepts and destroys invading microorganisms (bacteria, viruses, fungi) and substances produced by pathogens. A distinction is made between two systems that work closely together.

Nonspecific And Specific Immune System

The unspecific immune system is generally directed against invading pathogens and tries to kill them. This happens regardless of the type of pathogen and the triggering disease.

The specific immune system acts much more specifically against germs. Depending on the structure of the respective pathogen, it forms special antidotes (so-called antibodies), with the help of which the disease is overcome. In some cases, a kind of memory of the disease that has been overcome remains in the cells of the specific immune system, so that the effective antibodies can be produced immediately upon renewed contact. With such diseases, immunity is built up upon initial contact. You usually only get these diseases once in a lifetime. Typical examples are measles, mumps, and rubella. The principle of vaccination is also based on the functioning of the specific defense system. Here, too, special antibodies are formed that prevent disease.

Immune System And Flu

In the case of certain virus infections such as flu, the virus changes its shape over the course of a year so that the body no longer recognizes it the next time it comes into contact and becomes ill again because it first has to produce new antibodies. Because of this variability of the flu virus, there is still no long-lasting flu vaccination. Rather, the flu vaccine has to be redesigned every season on suspicion.

Primary Immunodeficiency

Primary immunodeficiencies are congenital disorders of the immune system. Medicine now knows more than 300 different clinical pictures, many of them are among the rare diseases. More about the symptoms, causes, and therapy of primary immunodeficiency.

Definition

Primary immunodeficiencies are congenital disorders of the immune system, which can also be hereditary. The children are born with an immune system that cannot work properly or is incorrectly designed. As a result, those affected are exposed to an increased risk of infection. Medicine now knows more than 300 different clinical pictures that are caused by primary immunodeficiency. Some of the immune defects are so pronounced that the affected children cannot survive the first year of life without stem cell therapy. The symptoms can also only develop in the course of childhood or adulthood. Or they are recognized as an immunodeficiency after years of a doctor odyssey. Because most primary immune defects are very rare – and therefore not even known to many medical professionals. Some immunodeficiencies are treatable, others cannot. The most promising treatment options for primary immune deficits are drug therapy with immunoglobulins and stem cell transplants.

The Function Of The Immune System

Most people know the immune system as a protection against infection. The defense against pathogens such as bacteria, viruses, fungi, or parasites is only one task of the body’s own defense. A healthy immune system also fights cancer cells, for example, or protects the body cells from harmful influences. A defective immune system, on the other hand, triggers allergies, rheumatic diseases, or other autoimmune diseases.

The immune system is an extremely complex system. The most important actors in this system include antibodies, B lymphocytes, T lymphocytes, and their subgroups, as well as natural killer cells.

Antibody

Antibody is a slang term for the so-called immunoglobulins. This is a large group of special proteins that the immune system produces after contact with pathogens or their components. Immunoglobulins are produced by the B lymphocytes.

B lymphocytes

B lymphocytes (B cells for short) are a specific group of white blood cells called leukocytes. They play a central role in the immune system, as they are involved in the recognition of foreign germs and substances on the one hand and in the formation of antibodies on the other. B lymphocytes – like all other cells – arise from stem cells in the bone marrow. In the development process from the stem cell to the antibody-producing B-lymphocyte, a wide variety of genetic defects can cause various diseases. Two examples are B-cell non-Hodgkin lymphomas and B-cell lymphoblastic leukemia.

T lymphocytes

T lymphocytes (also called T cells) are another type of white blood cell called leukocytes. These defense cells are also formed in the bone marrow and, like the B cells, belong to the acquired immune system. They experience their actual “training” in the thymus gland, for example, to fight fungal or viral infections. To do this, T lymphocytes control the cell membranes of cells. However, T lymphocytes are not able to recognize pathogens on their own. To do this, they rely on antigen-presenting cells such as B lymphocytes. As soon as these cells present pathogens, T lymphocytes become active.

T Helper Cells

The T-helper cells are a subgroup of the T-lymphocytes. They recognize presented antigens and decide whether the body’s own defense system needs to be active. If so, the T helper cells pass on information to the killer cells via so-called receptors. These then destroy the infected or damaged cells.

T Suppressor Cells

Another important subgroup of T lymphocytes is T suppressor cells. After successfully fighting the pathogens, they suppress the active immune system. This prevents excessive immune reactions against healthy body tissue (so-called autoimmune reactions).

T Memory Cells

Memory T cells also belong to the T lymphocytes. These have a preventive effect by storing information about the pathogens being controlled. As soon as the same pathogen penetrates the body again, the “knowledge” of the T memory cells enables rapid defense measures. This often happens so quickly that an infection is not even noticed.

Primary Immunodeficiency

Phagocytes

Phagocytes are specialized cells of the immune system, which are also known as phagocytes or macrophages. They belong to the innate defense system. Scavenger cells envelop identified foreign bodies such as pathogens or cell debris and break them down. Like B and T lymphocytes, phagocytes belong to the white blood cells, the leukocytes. Subtypes of leukocytes are precursor immune cells such as monocytes (which transform into macrophages) and granulocytes (which in turn can be divided into three subgroups).

Natural Killer Cells

Natural killer cells are another subgroup of white blood cells that do not belong to either the B or T lymphocyte group. Like phagocytes, they are part of the innate immune system. Natural killer cells got their name because they can trigger the programmed cell death of these cells, especially in virus-infected or degenerate cells (cancer). Doctors refer to programmed cell death as apoptosis.

Frequency

Fortunately, primary immunodeficiencies are very rare. There is about 1 case of congenital immunodeficiency for every 10,000 births. In Germany, there are currently an estimated 100,000 people with PGD. About 70 percent of the cases are immune deficiencies with a lack of antibodies.

Since the total number of sufferers is spread over more than 300 diagnoses, many of the primary immunodeficiencies are rare diseases, orphan diseases.

Symptoms

The symptoms of primary immunodeficiency can vary widely. This mainly depends on the type and severity of the immune deficiency. In the case of severe immune deficiencies, the first symptoms often appear in the first weeks and months after birth. In the case of milder innate immune diseases, the symptoms can initially be masked by the mother’s so-called nest protection and breastfeeding. The nest protection is created by immunoglobulins that are transferred through the placenta to the embryo during pregnancy and birth. Maternal antibodies are also passed on to the infant during breastfeeding. The nest protection is thus positively supported with breast milk. In addition, there are immunodeficiencies that only show up during puberty or in young adults up to the age of 25.

Warning Signs Of Primary Immunodeficiency

Beyond the varied – and thus sometimes very difficult to recognize – symptoms of primary immune deficits, there are at least a number of warning signs that suggest the suspicion of a congenital immune deficiency:

    • Primary immunodeficiencies in first-degree relatives (parents or siblings)
    • Increased susceptibility to serious infections: 2 or more cases of meningitis, bone inflammation, pneumonia, joint inflammation, blood poisoning (sepsis), or sinusitis each year.
    • More than 8 purulent otitis media per year
    • Antibiotic therapy ineffectiveness for more than 2 months
    • Complications after vaccination with life vaccines such as rotaviruses
    • Failure to thrive with no other apparent cause
    • Noticeable skin and mucous membrane diseases such as persistent skin fungal infections or skin inflammation (erythema) in newborns and infants
    • Chronic diarrhea.

Causes

Primary immune deficiencies are innate, so the cause is a defective genetic material. How these DNA defects arise is largely unclear. The World Health Organization divides primary immunodeficiencies into 8 groups according to their causes:

    • Combined immunodeficiency, which affects several parts of the immune system
    • Immunodeficiencies, which are mainly characterized by a lack of antibodies
    • Immunodeficiencies associated with defective T lymphocytes
    • Other well-defined immunodeficiency syndromes
    • Immune defects with lymphoproliferative disease
    • Immunodeficiency associated with or as a result of another disease
    • Complement defects
    • Defects of the granulocytes and macrophages

Diagnosis

Most primary immune deficiencies are difficult to diagnose and often take many months or years to diagnose. First of all, this is due to the fact that the symptoms are usually very unspecific. In the case of recurring severe infections (see also warning signs), the suspicion could be obvious. However, many immune defects are so rare that doctors are barely aware of these rare diseases. For recurring severe infections and other warning signs, the diagnosis should therefore be made at an Immune Diseases Center.

Treatment

Primary immunodeficiency therapy is primarily medicated and depends on the type and severity of the immunodeficiency.

Acute drug therapy and prophylaxis

In the case of minor immune deficits, it can be sufficient to treat acute infections with antibiotics, antiviral agents, or antifungal agents, as in a healthy person. As a rule, children with weak immune deficiencies also receive these drugs permanently in order to better prevent possible infections.

Antibody replacement treatment

Many immune deficiencies cause a lack of antibodies. These immunoglobulins can be replaced by drug therapy. Depending on the type of antibody, they are injected under the skin at regular intervals or given as an infusion. Antibody replacement treatment is usually necessary for life.

Stem cell transplant

A stem cell transplant may be the method of choice for certain, particularly severe immunodeficiencies. During this procedure, stem cells are transferred from the bone marrow of healthy donors. This therapy option is by no means available to all those affected. There are several reasons for this. First of all, not all forms of primary immune deficiency can be treated with a stem cell transplant. Then children or adolescents must be in a state of health that allows the stressful transplant procedure at all. In addition, a donor has to be found whose stem cells match the patient. The decision about the possibility, benefits, and risks of a stem cell transplant can therefore only be made on an individual basis.

Gene therapy

Gene therapeutic approaches for the treatment of primary immune deficiencies are currently still at an experimental stage. The aim of the experiments is to replace the faulty section of the genetic material with healthy genes for immune cells.

Forecast

A general prognosis of primary immunodeficiencies is not possible in view of the diversity of the diseases. Basically, however, the earlier the diagnosis and treatment, the better the chances of survival. Many forms of antibody deficiency can be treated by immunoglobulins in such a way that life expectancy equals that of healthy people.

Prevention

Since primary immune deficiencies are innate, these diseases cannot be reliably prevented.

Risk Groups: Who Is Most At Risk From Covid-19?

Risk Groups: Old People, Men, Smokers And People With Chronic Diseases

The new lung disease COVID-19 is mild for most people, and the SARS-CoV-2 infection sometimes even goes unnoticed. However, very severe courses with a fatal outcome are also possible. It is not currently possible to say exactly who is most likely to be affected by these severe courses in individual cases. However, some risk groups can be clearly identified.

High-risk group of people with chronic diseases

The risk of a complicated course of COVID-19 is particularly high in people with chronic diseases. In the case of lung diseases such as asthma or COPD, the explanation for this is obvious: In people with diseases of the respiratory tract, healthy lung function is already impaired and the lungs are therefore particularly vulnerable.

The high-risk groups also include people with diseases that at first glance have little to do with the lungs or breathing. These are mainly people with heart failure, high blood pressure, diabetes, cancer, liver disease, or chronic kidney disease.

Why do the chronically ill belong to the high-risk group?

The chronically ill belong to the high-risk groups primarily because they are usually already burdened by the underlying disease. In the event of an infection with SARS-CoV-2 or a COVID-19 illness, the physical resources are not fully available to them as with a healthy person. In addition, some common chronic diseases indirectly affect healthy lung function. Heart failure, for example, increases the risk of pulmonary hypertension. Atherosclerosis promotes circulatory disorders, which in turn can put a strain on the cardiovascular system.

According to the Robert Koch Institute, according to the current state of research, young people with chronic diseases also belong to the high-risk group of people with an increased risk of severe disease progression.

Risk Increases With Combinations Of Risk Factors

A particularly susceptible high-risk group is made up of people who have a combination of risk factors. According to the RKI, this applies, for example, to older people with an underlying disease compared to one of the risk factors (age or underlying disease). Old and young people with several underlying diseases are particularly hard hit.

Risk From Covid-19

High-risk group of people with sick or suppressed immune systems

People whose immune systems are not functioning or not functioning adequately are particularly at risk from COVID-19. This does not mean people with general immune deficiencies, but people with serious diseases of the immune system such as HIV, primary immunodeficiencies, or secondary immunodeficiencies.

Primary and secondary immunodeficiencies

Primary immunodeficiencies are congenital disorders of the immune system. Medicine now knows more than 300 different clinical pictures, many of which are among the rare diseases.

  • Secondary immunodeficiencies are permanent disorders of the immune system that are only acquired in the course of life. Common causes of such immune deficiencies are, for example, cancer, side effects of drugs, or metabolic disorders such as diabetes.

High-Risk Group Of People Taking Immunosuppressive Drugs

Another high-risk group is people in whom the immune system is suppressed or weakened by drugs. So-called immunosuppressants such as glucocorticoids (in colloquial language cortisone) are used, among other things, after transplants or for autoimmune diseases. Chronic asthma, inflammatory bowel disease, or rheumatic diseases are other areas of application for drugs that suppress the immune system.

The Risk Increases For Everyone Aged 50 And Over And For Smokers

SARS-CoV-2 does not only infect high-risk groups. According to the Robert Koch Institute, the risk of a severe course of COVID-19 increases from the age of 50 and increases steadily thereafter. This is mainly due to the fact that the immune system becomes weaker over the years and is less able to fight pathogens such as viruses. There is also the possibility that the disease is recognized late in people with a weakened immune system. Why is that?

Fever is the classic symptom of infection. However, fever is not caused by pathogens such as SARS-CoV-2 but is a result of the reaction of the immune system. If the immune system is weak, a fever may be low or it may not occur. This increases the likelihood that infections such as COVID-19 will be discovered late and may have advanced.

Male mortality is nearly twice that of women

According to the RKI, the risk of infection with SARS-CoV-2 is about the same for women and men at 49 to 51 percent at the current state of knowledge (beginning of April). On the other hand, mortality seems to be significantly higher in men than in women. Of the 732 deaths with corona infection (as of April 1), 65 percent were men. An evaluation of the COVID-19 cases in China had previously also come to the conclusion that the mortality rate for men is almost twice as high as that for women.

The reasons for the higher mortality are not yet known. The virologist Alexander Kekulé names the overall poorer health of older men (compared to women of the same age) as a possible cause.

Even Young And Healthy People Shouldn’t Think They Are Safe

So far, it is not known how the individual risk of COVID-19 disease can be reliably assessed. After numbers at the beginning of the pandemic had suggested that young and healthy adults might have a rather small risk of severe disease, the number of those affected is now increasing in this group as well. According to the US Centers for Disease Control (CDC) as of mid-March, a fifth of COVID-19 patients admitted to the hospital were between 20 and 44 years old. According to the study, almost half required intensive care treatment. Young, healthy people must therefore under no circumstances feel safe.

Silent Heart Attack Diabetes

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Silent heart attack diabetes

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Heart Attack Emergency Treatment at Home

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heart attack emergency treatment at home

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What is The First Aid Treatment For Heart Attack?

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What is The First Aid Treatment For Heart Attack

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