Что за болезнь хмл: Хронический миелолейкоз — причины, симптомы, диагностика и лечение, прогноз

Хронический миелоидный лейкоз — Википедия. Что такое Хронический миелоидный лейкоз

Хронический миелоидный лейкоз (ХМЛ, хронический миелолейкоз) — форма лейкоза, которая характеризуется ускоренной и нерегулируемой пролиферацией преимущественно миелоидных клеток в костном мозге с их накоплением в крови. ХМЛ — гемопоэтическое клональное заболевание, основным проявлением которого является пролиферация зрелых гранулоцитов (нейтрофилов, эозинофилов и базофилов) и их предшественников. Это миелопролиферативное заболевание ассоциировано с характерной хромосомной транслокацией (филадельфийской хромосомой). В настоящее время основным способом лечения хронического миелолейкоза является таргетная (целевая) терапия ингибиторами тирозинкиназ, такими как иматиниб, нилотиниб, дазатиниб и другие, значительно улучшившая показатели выживаемости.

Патогенез

На примере ХМЛ впервые была показана связь злокачественного заболевания с конкретной генетической аномалией. В случае ХМЛ такой характерной аномалией является хромосомная транслокация, которая проявляется присутствием в кариотипе так называемой филадельфийской хромосомы. Эта мутантная хромосома получила своё название по месту работы её первооткрывателей, Питера Ноуелла (Пенсильванский университет) и Дэвида Хангерфорда (Онкологический центр Фокса Чейза), которые впервые описали её в 1960 году в Филадельфии (штат Пенсильвания, США)^[1].

При этой транслокации, участки 9-й и 22-й хромосом меняются местами. В результате, фрагмент гена BCR из хромосомы 22 и ген ABL из хромосомы 9 образуют единую рамку считывания. Продуктами этого аномального слитого гена могут быть белки с молекулярной массой 210 (p210) или, реже, 185 кДа (p185). Так как в норме белок ABL содержит тирозинкиназный домен, продукт мутантного гена также является тирозинкиназой^[2][3].

Белок BCR-ABL взаимодействует с одной из субъединиц клеточного рецептора к интерлейкину 3. Транскрипция гена BCR-ABL происходит непрерывно и не нуждается в активации другими белками. BCR-ABL активирует сигнальный каскад, контролирующий клеточный цикл, ускоряя деление клеток. Более того, белок BCR-ABL подавляет репарацию ДНК, вызывая неустойчивость генома и делая клетку более восприимчивой к дальнейшим генетическим аномалиям. Активность BCR-ABL — патофизиологическая причина хронического миелолейкоза. По мере изучения природы белка BCR-ABL и его тирозинкиназной активности, была разработана таргетная (целевая) терапия, позволяющая специфически ингибировать эту активность. Ингибиторы тирозинкиназ могут способствовать полной ремиссии ХМЛ, что ещё раз подтверждает ведущую роль BCR-ABL в развитии заболевания^[3].

Клиническая картина

Заболевание часто протекает бессимптомно, выявляясь при рутинном клиническом анализе крови. В этом случае ХМЛ следует дифференцировать от лейкемоидной реакции, при которой мазок крови может иметь схожую картину. ХМЛ может проявляться недомоганием, субфебрильной лихорадкой, подагрой, повышенной восприимчивостью к инфекциям, анемией, тромбоцитопенией с кровоточивостью (хотя также может наблюдаться повышенное содержание тромбоцитов). Также отмечается спленомегалия.^[2][4]

Стадии ХМЛ

В течении ХМЛ выделяют три фазы на основании клинических характеристик и лабораторных данных. В отсутствие лечения ХМЛ обычно начинается с хронической фазы, в течение нескольких лет прогрессирует в фазу акселерации и, в конечном счёте, завершается бластным кризом. Бластный криз — терминальная фаза ХМЛ, клинически подобная острому лейкозу. Вовремя начатое медикаментозное лечение, как правило, может остановить прогрессирование болезни по этому пути. Одним из факторов прогрессии от хронической фазы к бластному кризу является приобретение новых хромосомных аномалий (в дополнение к филадельфийской хромосоме)^[2]. Некоторые пациенты к моменту постановки диагноза могут находиться уже в фазе акселерации или бластного криза^[4].

Хроническая фаза

Около 85 % пациентов с ХМЛ к моменту постановки диагноза находятся в хронической фазе. В течение этой фазы клинические проявления обычно отсутствуют или имеются «лёгкие» симптомы, такие как недомогание или чувство переполнения живота. Продолжительность хронической фазы различна и зависит от того, насколько рано было диагностировано заболевание, а также от проведённого лечения. В конечном счёте, при отсутствии эффективного лечения, заболевание переходит в фазу акселерации^[4].

Фаза акселерации

Диагностические критерии перехода в фазу акселерации могут различаться: наиболее широко используются критерии, установленные исследователями онкологического центра Андерсона при Техасском университете^[5], Сокалом с соавторами^[6], а также Всемирной организацией здравоохранения^[7][8]. Критерии ВОЗ, вероятно, наиболее широко распространены, и отличают фазу акселлерации по следующим признакам:

• 10—19 % миелобластов в крови или костном мозге;
• > 20 % базофилов в крови или костном мозге;
• < 100 000 тромбоцитов в микролитре крови, вне связи с терапией;
• > 1 000 000 тромбоцитов в микролитре крови, вне зависимости от терапии;
• цитогенетическая эволюция с развитием новых аномалий в дополнение к филадельфийской хромосоме;
• прогрессирование спленомегалии или увеличение числа лейкоцитов, вне зависимости от терапии.

Фаза акселерации предполагается при наличии любого из указанных критериев. Фаза акселерации указывает на прогрессию заболевания и приближение бластного криза^[7]

Бластный криз

Бластный криз — финальная стадия развития ХМЛ, протекающая, подобно острому лейкозу, с быстрой прогрессией и непродолжительной выживаемостью^[4]. Бластный криз диагностируется на основе одного из следующих признаков у пациента с ХМЛ^[9]:

• >20 % миелобластов или лимфобластов в крови или костном мозге;
• крупные группы бластов в костном мозге при биопсии;
• развитие хлоромы (солидного фокуса лейкемии вне костного мозга).

Диагностика

Периферическая кровь (окраска Май-Грюнвальд — Гимза): лейкоцитоз со сдвигом влево

Предположение о ХМЛ часто делается на основании общего анализа крови, демонстрирующего повышение количества гранулоцитов всех типов, включая зрелые миелоидные клетки. Количество базофилов и эозинофилов повышено практически всегда, что позволяет дифференцировать ХМЛ и лейкемоидную реакцию. При диагностике ХМЛ часто проводится биопсия костного мозга, однако одной лишь морфологической оценки костного мозга недостаточно для постановки диагноза ХМЛ^[3][4].

В конечном счёте, ХМЛ диагностируется посредством выявления филадельфийской хромосомы в образцах костного мозга. Эта характерная хромосомная аномалия может быть выявлена в результате цитогенетического анализа, при помощи флюоресцентной гибридизации in situ или детекции гена BCR-ABL методом ПЦР^[4].

Существуют разногласия в отношении так называемого Ph-негативного ХМЛ, или случаев предполагаемого ХМЛ, при котором филадельфийская хромосома не обнаруживается. У многих таких пациентов в действительности имеют место комплексные хромосомные аномалии, маскирующие транслокацию t(9;22), либо эта транслокация обнаруживается только при флюоресцентной гибридизации или ПЦР с обратной транскрипцией, но не при рутинном кариотипировании^[10]. Для небольшой подгруппы пациентов с отсутствием молекулярных свидетельств присутствия гена BCR-ABL может быть поставлен диагноз недифференцированное миелодиспластическое/миелопролиферативное расстройство, так как оно, как правило, отличается от ХМЛ по клиническому течению^[7].

Примечания

1. ↑ Nowell PC (2007). «Discovery of the Philadelphia chromosome: a personal perspective». Journal of Clinical Investigation. 117 (8): 2033–2035. doi:10.1172/JCI31771. PMC 1934591. PMID 17671636.
2. ↑ ^{1 2 3} Faderl S, Talpaz M, Estrov Z, Kantarjian HM (1999). «Chronic myelogenous leukemia: biology and therapy». Annals of Internal Medicine. 131 (3): 207–219. PMID 10428738.
3. ↑ ^{1 2 3} Hehlmann R, Hochhaus A, Baccarani M; European LeukemiaNet (2007). «Chronic myeloid leukaemia». Lancet. 370 (9584): 342–50. doi:10.1016/S0140-6736(07)61165-9. PMID 17662883.
4. ↑ ^{1 2 3 4 5 6} Tefferi A (2006). «Classification, diagnosis and management of myeloproliferative disorders in the JAK2V617F era». Hematology Am Soc Hematol Educ Program. 2006: 240–245. doi:10.1182/asheducation-2006.1.240. PMID 17124067.
5. ↑ Kantarjian H., Dixon D., Keating M., Talpaz M., Walters R., McCredie K., Freireich E. (1988). «Characteristics of accelerated disease in chronic myelogenous leukemia». Cancer. 61 (7): 1441–6. doi:10.1002/1097-0142(19880401)61:7<1441::AID-CNCR2820610727>3.0.CO;2-C. PMID 3162181.
6. ↑ Sokal J., Baccarani M., Russo D., Tura S. (1988). «Staging and prognosis in chronic myelogenous leukemia». Semin Hematol. 25 (1): 49–61. PMID 3279515.
7. ↑ ^{1 2 3} Tefferi A, Thiele J, Orazi A, Kvasnicka HM, Barbui T, Hanson CA, Barosi G, Verstovsek S, Birgegard G, Mesa R, Reilly JT, Gisslinger H, Vannucchi AM, Cervantes F, Finazzi G, Hoffman R, Gilliland DG, Bloomfield CD, Vardiman JW (2007). «Proposals and rationale for revision of the World Health Organization diagnostic criteria for polycythemia vera, essential thrombocythemia, and primary myelofibrosis: recommendations from an ad hoc international expert pane». Blood. 110 (4): 1092–1097. doi:10.1182/blood-2007-04-083501. PMID 17488875.
8. ↑ Vardiman J., Harris N., Brunning R. (2002). «The World Health Organization (WHO) classification of the myeloid neoplasms». Blood. 100 (7): 2292–302. doi:10.1182/blood-2002-04-1199. PMID 12239137. Проверено 2007-09-22.
9. ↑ Karbasian Esfahani M, Morris EL, Dutcher JP, Wiernik PH (2006). «Blastic phase of chronic myelogenous leukemia». Current Treatment Options in Oncology. 7 (3): 189–199. doi:10.1007/s11864-006-0012-y. PMID 16615875.
10. ↑ Savage DG; Szydlo RM; Goldman JM (1997). «Clinical features at diagnosis in 430 patients with chronic myeloid leukaemia seen at a referral centre over a 16-year period». Br J Haematol. 96 (1): 111–116. doi:10.1046/j.1365-2141.1997.d01-1982.x. PMID 9012696.

См. также

90000 human disease | Definition & Facts 90001 90002 Health versus disease 90003 90004 Before human disease can be discussed, the meanings of the terms health, physical fitness, illness, and disease must be considered. Health could be defined theoretically in terms of certain measured values; for example, a person having normal body temperature, pulse and breathing rates, blood pressure, height, weight, acuity of vision, sensitivity of hearing, and other normal measurable characteristics might be termed healthy.But what does normal mean, and how is it established? It is well known that if the temperatures are taken of a large number of active, presumably healthy, individuals the temperatures will all come close to 98.6 ° F (37 ° C). The great preponderance of these values ​​will fall between 98.4 ° F (36.9 ° C) and 98.8 ° F (37.1 ° C). Thus, health could in part be defined as having a temperature within this narrow range. Similarly, a normal range can be established for pulse, blood pressure, and height. In some healthy individuals, however, the body temperature may range below 98.4 ° F or above 98.8 ° F. These low and high temperatures fall outside the limits defined above as normal and are instances of biological variability. 90005 90004 Biological criteria of normality are based on statistical concepts. Body height may be used as an example. If the heights of every individual in a large sample were plotted on a graph, the many points would fall on a bell-shaped curve. At one end of the curve would be the very short people, and at the other extreme the few very tall people.The majority of the points of the sample population would fall on the dome of the bell-shaped curve. At the peak of the dome would be those individuals whose height approaches the average of all the heights. Scientists use curves in determining what they call normal criteria. By accepted statistical criteria, 95 percent of the population measured would be included in the normal range-that is, 47.5 percent above and 47.5 percent below the mean at the very centre of the bell. Looked at in another way, in any given normal biological distribution 5 percent will be considered outside the normal range.Thus the 7-foot (213-cm) basketball player would be considered abnormally tall, but that which is abnormal must be distinguished from that which represents disease. The basketball player might be abnormally tall but still have excellent health. Thus, in any statistical analysis of health, the possibility of biological variation must be recognized. 90005 90004 A better example than height of how problems can arise with biological variability is heart size. If the heart is subjected to a greater than normal burden over a long period, it can respond by growing larger (the process is known as hypertrophy).This occurs in certain forms of heart disease, especially in those involving long-standing high blood pressure or structural defects of the heart valves. A large heart, therefore, may be a sign of disease. On the other hand, it is not uncommon for athletes to have large hearts. Continuous strenuous exercise requires a greater output of blood to the tissues, and the heart adapts to this demand by becoming larger. In some cases the decision as to whether an abnormally large heart represents evidence of disease or is simply a biological variant may tax the diagnostic abilities of the physician.90005 Get exclusive access to content from our тисяча сімсот шістьдесят вісім First Edition with your subscription. Subscribe today 90004 The effects of age introduce yet another difficulty in the attempt to define health in theoretical measured norms. It is well known that muscular strength diminishes in the advanced years of life, the bones become more delicate and more easily fractured, vision and hearing become less sharp, and a variety of other retrogressive changes occur. There is some basis for considering this general deterioration as a disease, but, in view of the fact that it affects virtually everyone, it can be accepted as normal.Theoretical criteria for health, then, would have to be set for virtually every year of life. Thus, one would have to say that it is normal for a man of 80 to be breathless after climbing two flights of stairs, while such breathlessness would be distinctly abnormal in an agile child of 10 years of age. Moreover, an individual’s general level of physical activity significantly alters his ability to respond to the ordinary demands of daily life. The amount of muscular strength possessed by an 80-year-old man who has remained physically active would be considerably more than that of his fragile friend who has led a confined life because of his dislike of activity.There are, therefore, many difficulties in establishing criteria for health in terms of absolute values. 90005 90004 Health might be defined better as the ability to function effectively in complete harmony with one’s environment. Implied in such a definition is the capability of meeting-physically, emotionally, and mentally-the ordinary stresses of life. In this definition health is interpreted in terms of the individual’s environment. Health to the construction worker would have a dimension different from health to the bookkeeper.The healthy construction worker expects to be able to do manual labour all day, while the bookkeeper, although perfectly capable of performing sedentary work, would be totally incapable of such heavy labour and indeed might collapse from the physical strain; yet both individuals might be termed completely healthy in terms of their own way of life. 90005 90004 The term physical fitness, although frequently used, is also exceedingly difficult to define. In general it refers to the state of optimal maintenance of muscular strength, proper function of the internal organs, and youthful vigour.The champion athlete prepared to cope not only with the commonplace stresses of life but also with the unusual illustrates the concept of physical fitness. To be in good physical condition is to have the ability to swim a mile to save one’s life or to slog home through snowdrifts when a car breaks down in a storm. Some experts in fitness insist that the state of health requires that the individual be in prime physical condition. They prefer to divide the spectrum of health and disease into (1) health, (2) absence of disease, and (3) disease.In their view, those who are not in prime condition and are not physically fit can not be considered as healthy merely because they have no disease. 90005 90004 Health involves more than physical fitness, since it also implies mental and emotional well-being. Should the angry, frustrated, emotionally unstable person in excellent physical condition be called healthy? Certainly this individual could not be characterized as effectively functioning in complete harmony with the environment. Indeed, such an individual is incapable of good judgment and rational response.Health, then, is not merely the absence of illness or disease but involves the ability to function in harmony with one’s environment and to meet the usual and sometimes unusual demands of daily life. 90005 90004 The definitions of illness and disease are equally difficult problems. Despite the fact that these terms are often used interchangeably, illness is not to be equated with disease. A person may have a disease for many years without even being aware of its presence. Although diseased, this person is not ill.Similarly, a person with diabetes who has received adequate insulin treatment is not ill. An individual who has cancer is often totally unaware of having the disorder and is not ill until after many years of growth of the tumour, during which time it has caused no symptoms. The term illness implies discomfort or inability to function optimally. Hence it is a subjective state of lack of well-being produced by disease. Regrettably, many diseases escape detection and possible cure because they remain symptomless for long years before they produce discomfort or impair function.90005 90004 Disease, which can be defined at the simplest level as any deviation from normal form and function, may either be associated with illness or be latent. In the latter circumstance, the disease will either become apparent at some later time or will render the individual more susceptible to illness. The person who fractures an ankle has an injury-a disease-producing immediate illness. Both form and function have been impaired. The illness occurred at the instant of the development of the injury or disease.The child who is infected with measles, on the other hand, does not become ill until approximately 10 days after exposure (the incubation period). During this incubation period the child is not ill but has a viral infectious disease that is incubating and will soon produce discomfort and illness. Some diseases render a person more susceptible to illness only when the person is under stress. Some diseases may consist of only extremely subtle defects in cells that render the cells more susceptible to injury in certain situations.The blood disease known as sickle cell anemia, for example, results from a hereditary abnormality in the production of the red oxygen-carrying pigment (hemoglobin) of the red cells of the blood. The child of a mother and father who both have sickle cell anemia will probably inherit an overt form of sickle cell anemia and will have the same disease as the parents. If only one parent has sickle cell anemia, however, the child may inherit only a tendency to sickle cell anemia. This tendency is referred to by physicians as the sickle cell trait.Individuals having such a trait are not anemic but have a greater likelihood of developing such a disease. When they climb a mountain and are exposed to lower levels of oxygen in the air, red blood cells are destroyed and anemia develops. This can serve as an example of a disease or a disease trait that renders the affected person more susceptible to illness. 90005 90004 Disease, defined as any deviation from normal form and function, may be trivial if the deviation is minimal. A minor skin infection might be considered trivial, for example.On the eyelid, however, such an infection could produce considerable discomfort or illness. Any departure from the state of health, then, is a disease, whether health be measured in the theoretical terms of normal measured values ​​or in the more pragmatic terms of ability to function effectively in harmony with one’s environment. 90005.90000 What kind of disease is PAD? 90001 90002 About peripheral arterial disease (PAD) 90003 90004 90005 Peripheral arterial disease is the narrowing or obstruction of arteries in the legs and feet due to arteriosclerosis, causing reduced blood flow. 90006 90005 Symptoms include numbness, pain, and coldness in the feet and legs while walking. As the disease progresses, walking may become impossible and the feet and legs feel painful (intermittent claudication) even when at rest.90006 90005 Arteriosclerosis progresses throughout the body, and so arteriosclerosis in the lower limbs and legs is connected to arteriosclerosis in the heart and brain, which may trigger angina, a heart attack, a stroke, or other conditions. 90006 90002 How PAD develops 90003 90005 90014 90015 90006 90005 As people reach an advanced age, their blood vessels become harder and increasingly fragile. This is exacerbated by lifestyle-related diseases such as diabetes, high blood pressure, and high cholesterol; cholesterol builds up inside the arteries (in the lumen), resulting in blood vessels becoming even harder and more fragile.As the condition progresses, the inside of the blood vessels becomes narrower, causing poor blood circulation; this condition is called arteriosclerosis (Figure 1). 90006 90005 When blood flow deteriorates due to arteriosclerosis, the organs, muscles, and other tissues can become damaged by an insufficient supply of oxygen and nutritional impairment. Arteriosclerosis can occur in any artery in the body, including the feet and legs. 90006 90021 Figure 1: Intravascular obstruction 90022 90023 90005 The arteries that primarily deliver blood to the limbs are called peripheral arteries.When arteriosclerosis develops in the peripheral arteries it causes poor circulation in the limbs; this is referred to as PAD. PAD causes numbness and pain, and if it worsens it may cause ulcers, and in severe cases necrosis. It is the most common disease of the peripheral arteries. 90025 Since PAD is a disease of the blood vessels, it is treated by doctors who specialize in vascular surgery and cardiovascular disease. 90006 90002 PAD has a high rate of association with heart attacks and strokes.90003 90029 90005 PAD is caused by arteriosclerosis in the legs and feet, meaning that PAD is associated with life-threatening health conditions that are also caused by arteriosclerosis such as angina, heart attacks, and strokes. Early detection and treatment are important to prevent PAD from worsening to a severe degree, and to guard against dangerous complications. 90006 90002 Arteriosclerotic diseases including PAD are on the rise. 90003 90034 90005 Health conditions caused by arteriosclerosis, such as angina, heart attacks and strokes, are increasing in Japan with the aging of society and the Westernization of eating habits and lifestyle.PAD, which is arteriosclerosis of the feet and legs, is no exception, and the number of PAD patients is increasing year by year. PAD is not a rare disease. 90006 90002 The relationship between metabolic syndrome and PAD 90003 90005 Metabolic syndrome is a combination of lifestyle-related conditions including high blood sugar, high blood pressure, high cholesterol, and obesity. Whilst in themselves they are not immediately life-threatening, if not properly dealt with, in combination they may cause arteriosclerosis, which increases the risk of suffering from angina, heart attacks, strokes and diabetes.90006 90005 The same conditions that lead to metabolic syndrome can lead to arteriosclerosis in the blood vessels of the limbs, which in turn can cause PAD. In addition to the disease being relatively unknown, subjective symptoms are not easy to spot, and so few sufferers will visit their doctor on suspicion of having PAD during its early stages. By the time the disease is diagnosed, symptoms may have progressed significantly, and in many cases it will have developed into a serious condition requiring surgery.90025 Those who have lifestyle-related diseases need to pay particular attention to avoid PAD; if you do develop PAD, an early diagnosis and appropriate treatment are required to avoid complications. 90006 90002 Think of PAD as a whole-body disease 90003 90005 Even though PAD symptoms are only felt in the limbs, arteriosclerosis itself is not limited to the limbs and could affect blood vessels throughout the body. It is important to consider PAD a disease of the whole body and to manage it appropriately.If neglected, PAD could cause other conditions such as heart attacks, angina, or strokes. 90006 90005 There are a number of treatment approaches available, selected according to how far the disease has progressed and the treatment goal. These include drug treatment, physical therapy, and surgery. Many people continue to lead active lives just as they used to thanks to catching the disease early and getting appropriate treatment. 90006 90005 Through learning about PAD you can also find out more about a variety of other diseases such as arteriosclerosis and metabolic syndrome, which are contributing factors to PAD, as well as cardiovascular disorders such as heart attacks, angina, and strokes.The more aware you are of how the disease progresses, the better you can control it at an earlier stage. This, in turn, may make it easier to keep other diseases in check that could otherwise follow. 90006 .90000 Preventing Chronic Kidney Disease | NIDDK 90001 90002 You are more likely to develop kidney disease if you have 90003 90004 90005 diabetes 90006 90005 high blood pressure 90006 90005 heart disease 90006 90005 a family history of kidney failure 90006 90013 90014 What can I do to keep my kidneys healthy? 90015 90002 You can protect your kidneys by preventing or managing health conditions that cause kidney damage, such as diabetes and high blood pressure.The steps described below may help keep your whole body healthy, including your kidneys. 90003 90002 During your next medical visit, you may want to ask your health care provider about your kidney health. Early kidney disease may not have any symptoms, so getting tested may be the only way to know your kidneys are healthy. Your health care provider will help decide how often you should be tested. 90003 90002 See a provider right away if you develop a urinary tract infection (UTI), which can cause kidney damage if left untreated.90003 90022 Make healthy food choices 90023 90002 Choose foods that are healthy for your heart and your entire body: fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Eat healthy meals, and cut back on salt and added sugars. Aim for less than 2,300 milligrams of sodium each day. Try to have less than 10 percent of your daily calories come from added sugars. 90003 Choose foods that are healthy for your body. 90002 90027 Tips for making healthy food choices 90028 90003 90004 90005 Cook with a mix of spices instead of salt.90006 90005 Choose veggie toppings such as spinach, broccoli, and peppers for your pizza. 90006 90005 Try baking or broiling meat, chicken, and fish instead of frying. 90006 90005 Serve foods without gravy or added fats. 90006 90005 Try to choose foods with little or no added sugar. 90006 90005 Gradually work your way down from whole milk to 2 percent milk until you’re drinking and cooking with fat-free (skim) or low-fat milk and milk products. 90006 90005 Eat foods made from whole grains-such as whole wheat, brown rice, oats, and whole-grain corn-every day.Use whole-grain bread for toast and sandwiches; substitute brown rice for white rice for home-cooked meals and when dining out. 90006 90005 Read food labels. Choose foods low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. 90006 90005 Slow down at snack time. Eating a bag of low-fat popcorn takes longer than eating a slice of cake. Peel and eat an orange instead of drinking orange juice. 90006 90005 Try keeping a written record of what you eat for a week.It can help you see when you tend to overeat or eat foods high in fat or calories. 90006 90013 90002 Research has shown that the DASH eating plan may help you lower your blood pressure. If you have diabetes, high blood pressure, or heart disease, you may want to locate and work with a dietitian to create a meal plan that meets your needs. 90003 90022 Make physical activity part of your routine 90023 90002 Be active for 30 minutes or more on most days. If you are not active now, ask your health care provider about the types and amounts of physical activity that are right for you.Add more activity to your life with these tips to help you get active. 90003 90022 Aim for a healthy weight 90023 90002 The NIH Body Weight Planner is an online tool to help you tailor your calorie and physical activity plans to achieve and stay at a healthy weight. 90003 90002 If you are overweight or have obesity, work with your health care provider or dietitian to create a realistic weight-loss plan. View more weight control and physical activity resources to help you get and stay motivated.90003 90022 Get enough sleep 90023 90002 Aim for 7 to 8 hours of sleep each night. If you have trouble sleeping, take steps to improve your sleep habits. 90003 90022 Stop smoking 90023 90002 If you smoke or use other tobacco products, stop. Ask for help so you do not have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov. 90003 90022 Limit alcohol intake 90023 90002 Drinking too much alcohol can increase your blood pressure and add extra calories, which can lead to weight gain.If you drink alcohol, limit yourself to one drink per day if you are a woman and two drinks per day if you are a man. One drink is: 90003 90004 90005 12 ounces of beer 90006 90005 5 ounces of wine 90006 90005 1.5 ounces of liquor 90006 90013 90022 Explore stress-reducing activities 90023 90002 Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Physical activity can help reduce stress, as can mind and body practices such as meditation, yoga, or tai chi.90003 90022 Manage diabetes, high blood pressure, and heart disease 90023 90002 If you have diabetes, high blood pressure, or heart disease, the best way to protect your kidneys from damage is to 90003 90002 90027 Keep blood glucose numbers close to your goal. 90028 Checking your blood glucose, or blood sugar, level is an important way to manage your diabetes. Your health care team may want you to test your blood glucose one or more times a day. 90003 90002 90027 Keep your blood pressure numbers close to your goal.90028 The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Read more about high blood pressure. 90003 90002 90027 Take all your medicines as prescribed. 90028 Talk with your health care provider about certain blood pressure medicines, called ACE inhibitors and ARBs, which may protect your kidneys. The names of these medicines end in -pril or -sartan. 90003 90002 Be careful about the daily use of over-the-counter pain medications. Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can damage your kidneys.Learn more about over-the-counter medicines and your kidneys. 90003 90002 90027 To help prevent heart attacks and stroke, keep your cholesterol levels in the target range. 90028 There are two kinds of cholesterol in your blood: LDL and HDL. LDL or «bad» cholesterol can build up and clog your blood vessels, which can cause a heart attack or stroke. HDL or «good» cholesterol helps remove the «bad» cholesterol from your blood vessels. A cholesterol test also may measure another type of blood fat called triglycerides.90003 90022 Ask your health care provider questions 90023 90002 Ask your health care provider the following key questions about your kidney health during your next medical visit. The sooner you know you have kidney disease, the sooner you can get treatment to help protect your kidneys. 90003 90002 90027 Key questions for your health care provider: 90028 90003 90004 90005 What is my glomerular filtration rate (GFR)? 90006 90005 What is my urine albumin result? 90006 90005 What is my blood pressure? 90006 90005 What is my blood glucose (for people with diabetes)? 90006 90005 How often should I get my kidneys checked? 90006 90013 90002 90027 Other important questions: 90028 90003 90004 90005 What should I do to keep my kidneys healthy? 90006 90005 Do I need to be taking different medicines? 90006 90005 Should I be more physically active? 90006 90005 What kind of physical activity can I do? 90006 90005 What can I eat? 90006 90005 Am I at a healthy weight? 90006 90005 Do I need to talk with a dietitian to get help with meal planning? 90006 90005 Should I be taking ACE inhibitors or ARBs for my kidneys? 90006 90005 What happens if I have kidney disease? 90006 90013 .90000 Discovered a disease? WHO has new rules for avoiding offensive names | Science 90001 90002 The World Health Organization (WHO) mostly works to reduce the physical toll of disease. But last week it turned to another kind of harm: the insult and stigma inflicted by diseases named for people, places, and animals. Among the existing monikers that its new guidelines «for the Naming of New Human Infectious Diseases» would discourage: Ebola, swine flu, Rift Valley Fever, Creutzfeldt-Jakob disease, and monkey pox.Instead, WHO says researchers, health officials, and journalists should use more neutral, generic terms, such as severe respiratory disease or novel neurologic syndrome. 90003 90002 Many scientists agree that disease names can be problematic, but they are not sure the new rulebook is necessarily an improvement. «It will certainly lead to boring names and a lot of confusion,» predicts Linfa Wang, an expert on emerging infectious diseases at the Australian Animal Health Laboratory in Geelong. «You should not take political correctness so far that in the end no one is able to distinguish these diseases,» says Christian Drosten, a virologist at the University of Bonn, Germany.90003 90002 Naming diseases has long been a fraught process. Badly chosen names can stigmatize people, as did gay-related immune deficiency, an early name for AIDS. They can also lead to confusion and hurt tourism and trade. The so-called swine flu, for instance, is not transmitted by pigs, but some countries still banned pork imports or slaughtered pigs after a 2009 outbreak. More recently, some Arab countries were unhappy that a new disease caused by a coronavirus was dubbed Middle East respiratory syndrome.90003 90002 Although «it’s usually scientists who come up with these names … the WHO gets the diplomatic pressure» if someone takes offense, Drosten says. The new guidelines, released 8 May, aim to smooth the process. «The WHO had to do something to take itself out of the firing line,» Drosten says. 90003 90002 Given that news of a new pathogen often spreads quickly, «it is important that an appropriate disease name is assigned by those who first report» the disease, WHO’s guidance notes. Following the guidelines, it adds, could «minimize unnecessary negative impact of disease names on trade, travel, tourism or animal welfare, and avoid causing offence to any cultural, social, national, regional, professional or ethnic groups.»90003 90002 To that end, new disease names should not include geographic locations; the names of people, occupations, animals, or food; or «terms that incite undue fear» (such as unknown, fatal, and epidemic). Instead, the names should use generic descriptions of symptoms (respiratory disease or watery diarrhea) and specific terms describing patients, epidemiology or the environment (juvenile, maternal, seasonal, summer, coastal), as well as pathogen names and arbitrary identifiers (alpha, beta, 1, 2, 3).90003 90002 The group that came up with these recommendations met «more than a few times» over the course of a year, says Kazuaki Miyagishima, director for food safety, zoonoses, and foodborne diseases at WHO, and a member of the panel. Among the ideas they discussed: naming diseases after Greek gods, using a system similar to the one used to name comets or alternating male and female names as is done with hurricanes. «But while naming a hurricane Katrina may not offend people, if we do it for a disease, it’s not just a hurricane for 1 week.It will make its way into the history of human suffering, «Miyagishima says. 90003 90002 The guide is well intentioned, but goes too far, says Ian Lipkin, a virologist at Columbia University. «I do not see how it will be helpful to eliminate names like monkey pox that provide insights into natural hosts and potential sources of infection,» he says. 90003 90002 It could also become harder to easily distinguish diseases. For instance, under the new rules, Marburg disease (named after a city in Germany) might have been called filovirus-associated haemorrhagic fever 1, while Ebola (named after a river) might have been filovirus-associated haemorrhagic fever 2.Such bland names «lose something that is more than just quaint,» says Howard Markel, a medical historian at the University of Michigan in Ann Arbor. Drosten adds that geographic names are sometimes justified. It was clear that MERS, for example, was associated with the Middle East. «Would it have been better if we had named it novel betacoronavirus clade C, type 1?» he asks. 90003 90002 The new rules make for more difficult names, Miyagishima admits. «But we think we have left a fairly large area for freedom.We do not want to kill the creativity of researchers completely. » 90003 90002 Linfa Wang knows all about the difficulty of naming diseases. Two decades ago, he named a virus and the disease it causes after Hendra, a suburb of Brisbane, Australia; he still gets angry calls from residents complaining that the name has hurt property values. These days his strategy is to «go small.» Recently, he named a new henipavirus isolated in a neighborhood called Cedar Grove simply Cedar virus. 90003 90002 Virologists encountered other sensitivities with Norwalk virus, named for a city in Ohio.The pathogen is the only species in the genus 90025 Norovirus 90026 and usually that name is used. In 2011, however, a Japanese individual asked for a change because many people in Japan carry the surname Noro. The International Committee on Taxonomy of Viruses recommended using «Norwalk virus» instead. 90003 90002 Acronyms are another good solution, says Ab Osterhaus, a virologist at Erasmus MC in Rotterdam, because they keep names short (another WHO recommendation) and people often forget what the letters stand for.But even acronyms can cause controversy. In 2003 WHO officials coined SARS (severe acute respiratory syndrome) to describe a novel pneumonia spreading in Asia, partly to avoid a name like «Chinese flu.» SARS did not go down well in Hong Kong, however, which is officially known as Hong Kong SAR, for special administrative region. 90003 90002 Giving new diseases a number may be the only way to avoid such issues, researchers say. There is precedent. Growing up in China in the late 1960s, Wang remembers that diseases had digits.»I was really scared of number 5 disease,» he recalls. «I do not know why, you just really did not want to get disease number 5.» 90003 .