Senate fails to pass ‘skinny repeal’ of Obamacare; what’s next?

Opponents of the Republican drive to repeal “Obamacare” have dealt President Donald Trump and GOP lawmakers a huge blow, rejecting a measure to roll back parts of the Affordable Care Act.

The bill failed in a 49-51 vote thanks to the GOP votes of McCain, Susan Collins of ME and Lisa Murkowski of Alaska, a shocking defeat for Senate Majority Leader Mitch McConnell (R-Ky.).

And he is reported to have been near to tears, as he echoed the sentiments of Republican majority leader, Mitch McConnell, that the Senate now must “move on”.

Trump’s failure sent the dollar down against a basket of other currencies on Friday. He had been expected to make rapid changes to healthcare, taxes and infrastructure spending. “Don’t let the American people down!”

“I and many of my colleagues did as we promised and voted to repeal this failed law”, the majority leader said on the Senate floor. “Watch!” He tweeted shortly after the failed vote.

ObamaCare is one of such as he has gone all out to fight for its repeal but only met a brick wall when the repeal was repealed.

The president has demanded at various times that Obamacare should be allowed to collapse on its own, that it should be repealed without replacement, and that it should be repealed and replaced.

Anthony “The Mooch” Scaramucci Heading To Divorce Court
Kelly, he continued, is “a remarkable Marine who has served his country his entire life”. Scaramucci said: “Reince and I have been personal friends for six years”.

Repeal-and-replace has been a guiding star for Republicans ever since President Barack Obama enacted the law in 2010. Additionally, it would have raised the contribution limit for tax-free health savings accounts, extended some more latitude through waivers in how states could run their marketplaces and blocked Medicaid funds from Planned Parenthood clinics for one year. Some insurers, including Anthem Inc, Humana and Aetna have pulled out of Obamacare markets, citing the uncertainty over the payments.

McConnell is a conservative, consummate Washington dealmaker who has worked across the aisle for years to painstakingly prevent government shutdowns, raise politically-tricky debt ceilings, and take other steps to keep Washington functioning, even when some in his conference wanted to tear the government down.

While there was an overwhelming sense of disappointment, some House Republicans appeared to relish the spectacular defeat in the Senate – just a little. Joined by McCain, Johnson and Bill Cassidy, Graham said he has grown increasingly concerned that contrary to GOP leaders’ assurances, the bill that the Senate passes would be immediately taken up by the House – rather than going to a House-Senate conference for further negotiations – and end up on Trump’s desk.

Senate Minority Leader Chuck Schumer of New York, speaks to reporters on Capitol Hill in Washington, Friday, July 28, 2017, after the Republican-controlled Senate was unable to fulfill their political promise to repeal and replace “Obamacare”. Seven Republicans opposed the measure.

The measure defeated Friday would have repealed an Obama mandate that most people get health insurance and would have suspended a requirement that larger companies offer coverage to their employees. But the law, which helped 20 million people obtain health insurance, has steadily grown more popular.

“What there is a consensus on, I don’t think anyone knows”, Republican Senator John Kennedy said.

Sen. Susan Collins of ME, another of the three Republicans to vote against the GOP plan (Alaska’s Lisa Murkowski was the other), said she is pleased that Sen.

Homeland security secretary replaces Priebus at White House
Traditionally, White House staffers including the communications director report directly to the chief of staff. I think it’s time to hit the reset button, ‘ Priebus said in a televised interview from the White House.

Republican Senators Susan Collins and Lisa Murkowski voted against the “skinny repeal” bill. Trump had criticized Murkowski, tweeting that she had let down the Republican Party and the country. They laughed as McCain said that the reporters in the balcony could probably read his lips. About a dozen Democrats gathered around him.

When McCain walked to the front of the Senate chamber to cast his deciding “no” vote, giving a thumbs down, Democrats cheered, knowing the bill would fail.

Schumer told reporters that he and McCain had been talking four or five times a day this week about the pared-down bill and that McCain had made up his mind on Thursday afternoon. Charles E. Schumer (D-N.Y.) said he looked forward to taking a bipartisan approach to healthcare reform.

Trump, who had long cajoled and strong-armed Republicans in a bid to get them into line, swiftly spoke out about the failure, apparently unmoved by Democratic pleas for the parties to work together and improve the existing law.

McConnell said it was time for Democrats “to tell us what they have in mind”.

The Senate Minority Leader, Democratic Sen.

“This was a heavy lift”. But like a lot of the weird things Republicans have said and done on healthcare in the past few months, it makes sense if you understand their underlying political goals.

Governor rejects plan to charge locals for crime lab fees
Greg Abbott said he would never allow the 13 crime labs that DPS operates throughout the state to go underfunded. But in a letter to McCraw on Friday , Gov.

American Eagle lingerie line soars above expectations

American Eagle Outfitters (NYSE:AEO) stock was up on Wednesday following the release of its earnings report for the second quarter of 2017. (AEO) failed to surprise the stock market in its last reported earnings when it earned $0.16 a piece versus the consensus-estimated $0.17.

Net in the quarter swung to a loss of $11.8 million or 15 cents per diluted share from profit of $10.1 million or 13 cents in the same quarter previous year. For the quarter ending Jan-17, 21 analysts have a mean sales target of 1,110.62 million whilst for the year ending Jan-17, 22 analysts have a mean target of 3,623.16 million.

KLX Inc (KLXI) is seen to release earnings in the last three months at $0.73 a share on $427.94 million sales. The firm has “Add” rating given on Tuesday, August 25 by Numis Securities. The firm now has a “buy” rating on the apparel retailer’s stock. The stock has a market capitalization of $2.14 billion, a P/E ratio of 11.17 and a beta of 1.09. Robert W. Baird downgraded the stock to “Neutral” rating in Thursday, August 27 report. American Eagle Outfitters Ne now has $2.16 billion valuation. American Eagle Outfitters (NYSE:AEO) has declined 31.50% since August 24, 2016 and is downtrending. About 181,568 shares traded. Therefore 46% are positive.

US Diplomats Suffered Brain Injuries From Sonic Attacks in Cuba
Spokesman Heather Nauert said two weeks ago the State Department learned of incidents at its embassy in Havana in late 2016. The Cuban Foreign Ministry said it has also opened an investigation into the US accusations from the US Embassy in Havana.

American Eagle Outfitters posted another unexpected rise in comparable sales for a second consecutive quarter thanks to a strong demand for its Aerie line of lingerie. Share performance for the month is now at -34.00%. The firm has “Outperform” rating given on Thursday, November 19 by RBC Capital Markets. D-C-Capital Advisors Ltd acquired 250,000 shares as American Eagle Outfitters Inc (AEO)’s stock declined 29.04%. If the share price is now hovering near the 52 week low and the value is achieved in the current past then it can suggest that the price of the shares is likely to go up. About 2.72 million shares traded.

Among 13 analysts covering Prothena Corp (NASDAQ:PRTA), 13 have Buy rating, 0 Sell and 0 Hold. As per Monday, July 24, the company rating was maintained by RBC Capital Markets.

Among 27 analysts covering American Eagle Outfitters (NYSE:AEO), 13 have Buy rating, 1 Sell and 13 Hold. Jefferies Group LLC set a $19.00 price target on American Eagle Outfitters and gave the company a “buy” rating in a research report on Wednesday, May 10th. The stock of Close Brothers Group plc (LON:CBG) has “Overweight” rating given on Monday, January 23 by JP Morgan. It has underperformed by 48.20% the S&P500.; The stock of American Eagle Outfitters (NYSE:AEO) earned “Sell” rating by Goldman Sachs on Thursday, August 18. The firm has “Neutral” rating given on Tuesday, September 15 by B. Riley & Co. LLC boosted its stake in shares of American Eagle Outfitters by 3.1% in the second quarter. The Company offers a range of apparel and accessories for men and women under the American Eagle Outfitters Brand (AEO Brand), and intimates, apparel and personal care products for women under the Aerie brand.

SpaceX Will Launch and Land a Rocket Today
The satellite also carries a secondary Advanced Ionospheric Probe instrument built by Taiwan’s National Central University. The FORMOSAT-5 satellite is created to operate in a sun-synchronous orbit about 447 miles (720 kilometers) above Earth.

The company said it incurred $21 million related to restructuring charges on conversion of company-owned and operated stores in the United Kingdom, Hong Kong and China to licensed partnerships.

The stock increased 0.29% or GBX 4.43 on August 24, reaching GBX 1534.93.

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Four transfers Manchester United could complete this summer
Despite the array of attacking tools at Mourinho’s disposal, the Armenian may just prove to be the sharpest of them all. When we were playing well and I was on the shoulder of the last defender, we were dangerous’.

Tonga qualify for 2019 World Cup and will compete in England’s group

A try by replacement lock Api Ratuniyarawa sealed the victory in the 75th minute.

Fiji has won the Pacific Nations Cup after defeating Samoa 38-16 in an entertaining and absorbing clash at Apia Park.

Fiji qualified last weekend after beating Tonga 14-10, and slotted into Pool D at the World Cup with Australia, Wales, Georgia, and an Americas qualifier, either Canada or Uruguay.

Two of the three unanswered tries in the second half were scored when the Fijians used quick passing out wide to outplay the Samoa defence.

EPS for General Motors Company (GM) Expected At $1.75
Floating stock is calculated by subtracting closely-held shares and restricted stock from a firm’s total outstanding shares. General Motors Company (GM ) have shown a high EPS growth of 5.60% in the last 5 years and has earnings rose of 1.70% yoy.

Fiji’s win Saturday continued an outstanding run of form in June and July internationals in which they have beaten Scotland and Italy and stayed unbeaten in the Pacific Nations Cup.

Samoa had five points, meaning a bonus point, a draw or a win would have taken them to the World Cup.

“It was a great win and I think our bench was great and it showed in the second half”. “We are proud to have defended our PNC title”.

The Fijians also won both of their games a year ago, beating Tonga 23-18 and Samoa 26-16 in Suva before they qualified for Japan last week with their third win.

Independence Realty Trust Inc
Following the sale, the executive vice president now owns 360,709 shares in the company, valued at approximately $3,653,982.17. Over the last week of the month, it was 3.43%, -6.68% over the last quarter, and -8.17% for the past six months.

“We had a good first half but we knew we had to get a lead as we had the wind in the first half”.

“We really wanted to win for the country and the boys tried really hard”. It’s why we play rugby. “We will regroup and I am sure the squad will do the country proud in the future”.

“Now we’ve secured ourselves a 2019 Rugby World Cup spot, we want to keep improving”.

The third-placed team then faces a playoff against a European side, with the losing team entering the repechage tournament.

CSK and RR to make IPL comeback next year
India superstar MS Dhoni was the face of the CSK franchise, which won the IPL title in back-to-back years in 2010 and 2011. Thala which is a shorter version of Thalaiva means leader and Dhoni is the IPL 2018 captain for Chennai Super Kings .

► Klinefelter syndrome

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Klinefelter syndrome

A chromosome abnormality that affects only men and causes hypogonadism.
Alternative Names:
47 X-X-Y syndrome
Causes, incidence, and risk factors:
Klinefelter syndrome is caused by an extra X chromosome and affects only males. An infant appears normal at birth, but the defect usually becomes apparent in puberty when secondary sexual characteristics fail or are late to develop, and testicular changes occur that eventually result in infertility in the majority of those affected. Some mild cases may go undetected with no abnormalities present except infertility. Increased maternal age is a risk factor. It is usually a sporadic event, not inherited, that leads to the extra X chromosome.
Review Date: 8/31/2001
Reviewed By: David G. Brooks, M.D., Ph.D., Division of Medical Genetics, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the
diagnosis or treatment of any
medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions.
Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute
endorsements of those other sites. Copyright 2002 A.D.A.M., Inc.
Any duplication or distribution of the information contained herein is strictly prohibited.

  The information contained in this web site is for educational
purposes only and is not intended or implied to be a substitute for
medical advice. Inclusion here does not imply any endorsement or
recommendation by any hospital in the University of Maryland Medical
System. Always seek the advice of your physician or other qualified
medical provider for all medical problems prior to starting any new

Burnley sign Bermudian Wells from Huddersfield

“Everyone here at Huddersfield Town would like to thank Nahki for what he has done for the club and wishes him all the best for the future”.

The former Bantams striker, who is now recovering from minor ankle surgery, put pen to paper on a three-year deal at Turf Moor.

Manager SeanDyche said that Wells adds “anotherstrikingoption” and is a “different player to those we have“.

The Bermuda worldwide had less than 11 months remaining on his contract and Huddersfield have made a decision to cash in now rather than lose him on a free transfer next summer.

Beaumont loses water supply in wake of historic flooding from Hurricane Harvey
Penisson described the situation as unprecedented saying that no one could remember the pump station ever failing in this manner. Until the pumps are fixed, residents will have to rely on local stores and the city’s distribution of bottled water.

The Bermuda forward joined the Terriers from BradfordCity in 2014 and scored 10 goals to help them secure promotion through the play-offs last season.

Earlier this summer Huddersfield boss DavidWagner admitted that he was open to offers for Wells, after the Terriers had already signed SteveMounie to be their first choice striker in the Premier League.

And he believes good times lie ahead at Turf Moor. I have always wanted to play there.

‘Now the opportunity is here and I’m very thankful to the football club to give it to me.

Gas prices surge in NY area in wake of Harvey
Storms such as Harvey typically cause an increase in fuel purchases in the market and a slowdown in retail demand. San Diego gas prices started rising slightly on August 25, the day Harvey was supposed to hit shore.

Wells, who started out in the United Kingdom at Carlisle, joined Huddersfield from Bradford for a then-club record fee of £1.5m in January 2014.


‘It’s a group I’m sure I can come in and blend with really quickly and it’s about trying to get out on that pitch and hit the ground running.

“I’m here to grow”.

Mayor of Hell impeached for banning heterosexuals
Elijah Daniel is a writer and a comedian, but it may be his very brief stint as Mayor that will bring him the most notoriety.

Dyche has been impressed with Wells, saying the forward “holds a different skill set” and can “only enhance the attacking options in due course“.

Netanyahu airs grievances to United Nations chief during visit

Israeli Prime Minister Benjamin Netanyahu greeted visiting U.N. Secretary-General Antonio Guterres on Monday with blistering criticism of the global body’s treatment of Israel and accusing it of failing to prevent arms from being smuggled to Lebanon’s Shiite Hezbollah militants. Al-Ghanim and the United Nations official dissected major issues including the Palestinian cause, the conflict in Syria and terrorism, according to Kuwait News Agency (KUNA).

Guterres asked Netanyahu that Israel help improve the Palestinian economy as a way to show the Palestinians that making peace with Israel will pay.

The meeting brought together a number of United Nations and Kuwaiti officials, KUNA reported.

Guterres is due in Ramallah on Tuesday for talks with Palestinian Prime Minister Rami Hamdallah.

Kevin Hart Calls on Fellow Stars to Help with Harvey Relief
Dozens of other celebrities have tweeted their thoughts and prayers to Houston and other parts of Texas. Katy Perry also urged viewers to donate while hosting the MTV’s Video Music Awards on Sunday night.

Israeli Prime Minister Benjamin Netanyahu declared on Monday that Iran is building sites in Syria and Lebanon to build missiles.

Guterres earlier visitedYad Vashem, Jerusalem’s Holocaust memorial site, and spoke with Israeli President Reuven Rivlin, who reiterated Israel’s claim that certain circles within the United Nations focused disproportionately on Israel’s human rights record.

Israel’s leaders, from President Reuven Rivlin and Netanyahu down through Defense Minister Avigdor Liberman and new Zionist Union head Avi Gabbay, bombarded Guterres with a litany of complaints about the organization he heads.

Guterres also told the Israeli president that he would be handling relations in the Middle East impartially and that he was devoted to implementing the principles in the UN Charter.

Taylor Swift slammed by Beyonce’s fans
Swift wiped her social media pages clean and caused a frenzy online with video snippets of slithery snake parts. She wrote and produced it with frequent collaborator Jack Antonoff, who performs in the bands Bleachers and fun.

In May, UNESCO, the body’s cultural agency, passed a resolution that criticized Israel’s actions in occupied Jerusalem and the Gaza Strip.

But, he said during a meeting with Rivlin, “you also understand that I sometimes disagree with positions of the government of Israel or any other government, and that is absolutely normal in a society where many of your citizens have exactly the same expressions of opinion”.

Monday evening Guterres, accompanied by Netanyahu and Danon, will view an exhibition of Israeli innovations at Jerusalem’s Israel Museum.

Speaking at their meeting at the President’s Residence in Jerusalem, Rivlin said: “This targeting of Israel, this singling out of the world’s only Jewish state, and even actions and statements that threaten to destroy Israel are unacceptable and should come at a price”.

Low mortgage rates not impressing potential new home buyers
One of the problems is that once rates reach rock bottom (which is pretty well where they are right now) the only way is up. This could be a good time for more young Americans to take out a Roth Individual Retirement Account or IRA for short.

The UN last week announced $2.5 million would be released to meet the electricity and medicine shortages in Gaza which came about after Palestinian President Mahmoud Abbas chose to cut supplies to the strip.

US police use gas to disperse protest over US President Donald Trump

(TIF) Q2 Comps Fall, But Earnings Beat The Street
New York-based Tiffany said it also benefited from higher sales of wholesale diamonds and increased spending in Japan. Tiffany’s past results drew the attention of activist investor Jana Partners, which said the shares were undervalued.

Western Digital launches a insane capacious 20TB desktop storage system
If you have a USB Type-C port on your PC, the WD My Book Duo will connect to it with an included USB-C cable and port. Western Digital has introduced the highest capacity external hard drive in its lineup.

Hegemonic policies are a threat to peace in South Asia
The US campaign in Afghanistan has always been criticized, having continued under three American leaders, including Trump. His point was that Pakistan’s war was also against the very elements America wanted punished.

White House: Trump ‘Committed’ to Building Wall
On Wednesday, both the White House and McConnell’s office issued statements that seemed to refute reports of a division between them.

Feds Say Demand for Inauguration Day Protest Info Is Narrow Enough
The legal battle between DreamHost and the DoJ raises questions about law enforcement overreach and access to user data. The government should not begin reviewing it, he said , until DreamHost decides whether to appeal.

Ministry of Commerce expresses ‘strong dissatisfaction’ with USA trade probe
Sanctions may contravene the United States’ membership to the World Trade Organization. But Ikenson doesn’t think it will come to that.

Stocks slightly higher at the open, led by big gains in retailers
The latest remarks by the president came as the concern is growing whether the government can push through pro-business policies. Herbalife (NYSE: HLF – news) surged 9.8 percent after announcing it would buy back as much as $600 million in common shares.

Stoilov won’t regret losing Twumasi after Champions League heroics
Just when you thought Celtic would cruise into the Champions League group stages without a care in the world, they emerged from their tedious trip to Astana mopping sweat from their brow.

President Trump to Sign Veterans Bill in Reno, Nev
Together, we can not fail. “We will make America great again – greater than ever before, I promise”. During his speech, the president also called on Americans to “heal the wounds that divide us”.

Apple invests in Iowa
Apple did not immediately respond to a request for comment as to why it picked Waukee, which is just outside of Des Moines. The City of Waukee will manage the fund for, “parks, libraries and recreational spaces, as well as infrastructure needs”.

Signet Jewelers Ltd. (SIG) Is Rising On Q2 Earnings & Acquisition
Primecap Com Ca holds 136,700 shares or 0.01% of its portfolio. (NYSE:IBM). 327,550 are owned by Canada Pension Plan Invest Board. The Company offers an assortment of brand name dress, casual and athletic footwear and accessories for women, men and kids.

Sebastian Vettel labels Mercedes ‘favourites’ for Belgian GP
I have no problem with Kimi, so if that influenced the decision you will have to ask Maurizio. “That’s it. He added: “We know what is going on with our auto and where it can be better”. “I’m here to win.

Four transfers Manchester United could complete this summer
Despite the array of attacking tools at Mourinho’s disposal, the Armenian may just prove to be the sharpest of them all. When we were playing well and I was on the shoulder of the last defender, we were dangerous’.

25 pounds of meth found in auto driven by 13-year-old
According to investigators, 22-year-old German Michel-Arreola and 19-year-old Irene Michel-Arreola were also inside the vehicle. The suspected 13-year-old driver is facing similar felony drug charges and additional charges of driving without a license.

Trump to open parts of Utah National Monument to miners, oil firms
So far, Zinke has announced no changes to six national monuments, including the Sand to Snow National Monument near Los Angeles. Interior Secretary Ryan Zinke to complete his review of national monuments created under the Antiquities Act, U.S.

Kidney stones

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  • Overview
  • Symptoms
  • Treatment
  • Prevention
  • Definition:

    A kidney stone is a solid mass that consists of a collection of tiny crystals. There can be one or more stones present at the same time in the kidney or in the ureter. (See also

    Alternative Names:

    Renal calculi; Nephrolithiasis; Stones – kidney

    Causes, incidence, and risk factors:

    Kidney stones may form when your urine becomes too concentrated with certain substances. These substances may create small crystals that become stones. The kidney stones may not produce symptoms until they begin to move down the ureter, causing pain. The pain is usually severe and often starts in the flank region, then moves down to the groin.

    Kidney stones are common. About 5% of women and 10% of men will have at least one episode by age 70. A person who has had kidney stones often gets them again in the future. Kidney stones are common in premature infants.

    Other risk factors include
    renal tubular acidosis
    and resultant

    Some types of stones tend to run in families. Some types may be associated with bowel disease, ileal bypass for
    , or
    tubule defects.

    Types of stones include:

    • Calcium stones are most common. They are two to three times more common in men, usually appearing at age 20 to 30. Recurrence is likely. The calcium may combine with other substances such as oxalate (the most common substance), phosphate, or carbonate to form the stone. Oxalate is present in certain foods. Diseases of the small intestine increase the tendency to form calcium oxalate stones.
    • Uric acid
      stones are also more common in men. They are associated with
      . Uric acid stones make up about 10% of all stones.
    • Cystine stones
      may form in persons with
      . It is a hereditary disorder affecting both men and women.
    • Struvite stones are mainly found in women as a result of
      urinary tract infection
      . They can grow very large and may obstruct the kidney, ureter, or bladder.

    Other substances may crystallize, precipitate, and form stones.

    Kidney anatomy

    Kidney anatomy

    Reflux nephropathy

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  • Overview
  • Symptoms
  • Treatment
  • Prevention
  • Definition:

    Reflux nephropathy is a condition in which the kidneys are damaged by backward flow of urine into the kidney.

    Alternative Names:

    Chronic atrophic pyelonephritis; Vesico-ureteric reflux; Nephropathy – reflux; Ureteral reflux

    Causes, incidence, and risk factors:

    Urine flows from the kidneys, through the ureters, and into the bladder. Each ureter has a one-way valve where it enters the bladder, preventing urine from flowing back up the ureter.

    Reflux nephropathy occurs when these valves fail, allowing urine to flow back up to the kidney. If the bladder is infected or the urine contains bacteria, the kidney is exposed to the possibility of infection (

    Because the pressure in the bladder is generally higher than in the kidney, the reflux of urine exposes the kidney to unusually high pressure. Over time, this increased pressure will damage the kidney and cause scarring.

    Reflux may occur in people whose ureters do not extend very far into the bladder. The ureters enter the bladder through “tunnels” in the bladder wall, and the pressure in the bladder normally keeps these tunnels pressed closed. If the bladder-wall tunnels are short or absent, pressure within the bladder can force urine back up the ureter.

    Reflux may be associated with other conditions including the following:

    • Bladder infections (
    • Bladder stones
    • Bladder outlet obstruction
    • Neurogenic bladder
    • Abnormal ureters

    In some cases, reflux nephropathy produces no symptoms. It is often discovered when a child is evaulated for repeat or suspicious bladder infections. If reflux is discovered, the child’s siblings may also be evaluated, because reflux can run in families.

    The degree of reflux — separated into five different grades — helps determine how the condition is treated. Simple, uncomplicated reflux often falls into grade I or II.

    Reflux nephropathy may also occur from temporary swelling that occurs after reimplantation of the ureters during a
    kidney transplant
    or because of trauma to the ureter.

    About 4 out of 1,000 people with no symptoms have reflux nephropathy, while up to 50% of infants and children with urinary tract infections have it. Reflux nephropathy may lead to
    chronic kidney failure
    end-stage renal (kidney) disease

    There may be no symptoms if only one kidney is affected or symptoms may be those of a
    urinary tract infection,
    nephrotic syndrome
    , or chronic kindey failure.

    The risk factors include a personal or family history of reflux, congenital abnormalities of the urinary tract, and recurrent urinary tract infections.

    Female urinary tract

    Female urinary tract

    ► Renal tubular acidosis – distal

    An ion is a substance that can carry an electrical charge. The acid-base balance is defined by the concentration of hydrogen ions (the pH). The normal pH of the body is very slightly alkaline. Acidic substances in the body include carbon dioxide and molecules containing hydrogen ions. These are buffered (counteracted) by alkaline substances, primarily bicarbonate, with some buffering by phosphate, proteins, hemoglobin, and other substances. Increased carbon dioxide or decreased bicarbonate levels can create an acidic state in the body, called acidosis. Decreased carbon dioxide or increased bicarbonate levels can create an excess alkaline state, called alkalosis. If the defect is caused by changes in carbon dioxide levels, it is a respiratory acidosis or respiratory alkalosis. If the defect is caused by changes in bicarbonate levels, it is a metabolic acidosis or metabolic alkalosis.

    The respiratory system regulates the levels of carbon dioxide through changes in the breathing rate. Carbon dioxide is lost with faster breathing and increased when breathing slows. This provides fast, but temporary regulation of body pH.

    The major, long-term regulation of body pH occurs in the kidneys, which excrete acids, and excrete or create bicarbonate for use in the body.

    Renal tubular acidosis is one common cause of metabolic acidosis. Distal renal tubular acidosis (Type I RTA) is a disorder caused by a defect in the secretion of hydrogen ions in the distalrenal tubule (the late portion of the kidney tubule). This causes a reduction in the reabsorption of bicarbonate into the bloodstream.

    Type I RTA is caused by a variety of conditions including hereditary disorders, autoimmune diseases and certain drugs including amphotericin B, lithium, and analgesics.

    Renal tubular acidosis causes disorders of the body related to the loss of bicarbonate and inability to excrete hydrogen. The body attempts to maintain an electro-chemical balance between positively charged and negatively charged molecules. If the excretion of a molecule is abnormal, the excretion of other molecules may become abnormal in an attempt to maintain a balance.

    Type I RTA causes retention of acid and is also associated with mild loss of potassium in the urine.

    The acidic condition of the body causes calcium to dissolve from the bones. The calcium accumulates in the bloodstream, and excess serum calcium is excreted by the kidneys, causing a loss of total body calcium and resulting in osteomalacia or rickets, impaired growth of children, skeletal deformities, and muscle weakness. There is an increased incidence of kidney stones and nephrocalcinosis associated with the excessive excretion of calcium and phosphate through the kidneys.