Dear Peter, in your body, which is built like a well-functioning factory, I am the most essential sanitary device. As the heart pumps blood to take food and oxygen to all your organs, you obtain the energy you need. But do you ever think about the disposal after so splendid activities are carried out in your body? If you burn a stove, you need to dispose of the smoke and the ashes if you want to keep it working. Likewise, as you burn your calorie intake, you dispose of the smoke (carbon dioxide) with your lungs and the waste with nitrate-poisonous after a certain level of intensity-thanks to my quietly and perfectly working filters. That is, I am an organ which saves your life by removing the poisonous substances in your blood. I do not only filter your blood, but also play a role at controlling the balances of the sensitive levels of water, sugar, amino acids and different minerals in your body. In short, I am a tiny but strategic laboratory.

The acid-base balance in your body and the amount of water and different salts are significant values which concern all of your bodily activities. When their balance is upset, different troubles arise in different units of your bodily mechanism. I am such a blessing, which works so sensitively to adjust the levels of water and mineral salts in your body while you don’t even realize it.

A watery environment is needed for the thousands of biochemical activities taking place in your body. In addition, activities like the contracting of the muscles and transmission of electrical stimuli between your neurons are realized with the presence of a pinch of mineral salt you don’t even give a thought about. Sometimes you sweat due to running or hot weather. The white stains on your shirt are the salts you lose after the water evaporates. When you suffer from diarrhea, you lose salt again, for the salt in the nutrients are thrown out without being absorbed. Especially when little children are concerned, this loss is of vital importance. The transfer between the blood and the liquid in the tissues is mainly realized through the concentration differences which are kept in a certain balance. If your body holds too much water, your tissues swell. You particularly feel it when you press your finger over the flesh near your shins.

Dear Peter, I will not list all of my duties in detail in order not to confuse you. However, let me tell you one more. Since not everyone knows this duty of mine, they just see me as an organ of liquid disposal. But I also take part in controlling the blood production! Surprised? Well, I also have the duty of secreting the hormone which stimulates blood production in the bones. I must always stay alert and maintain this balance in the best way; if you start losing blood, for instance, I must increase the hormone and accelerate blood production.

Yes Peter, I’ve told you about a few of my basic duties, but haven’t told you about how wonderfully designed I am. I am a bean-shaped organ and a single kidney like me weighs 130-160 grams on average. We are approximately 10 grams lighter in female bodies. I am surrounded by a soft but protective membrane. I need 35 grams of daily oxygen supply to survive and I use 13 % of your total body energy.

As an army is made up of individual soldiers, I am like a complex army, and a single soldier of mine is called a “nephron,” which does the real job. Thus, you can see me as a body of nephrons. Millions of these nephrons are brought together to make up one kidney.

A single nephron is a thin tubular structure with closed ends, and its length is about 3-4 cm. So the total length of my nephrons is about 50 km. The cup-like sac at the beginning of a nephron is named the “Bowman’s capsule.” The main artery bringing blood to the kidneys branch into smaller units, and one road leads to every nephron. The knot of capillaries (glomerulus) inside this double-walled capsule is more complicated than any road map you might have seen. The total length of the capillaries is nearly 25 km. The unwelcome substances in the blood are passed to the capsule thanks to blood pressure, and they proceed through the tubule. The total surface area of my tubules is about 20 m2. Within five minutes the whole of your blood passes through us. That is to say, an average of 1.2 liters of blood per minute, and 1800 liters a day are filtered by my nephrons, leaving the toxic substances in me. As this amount of blood (nearly 400 times the normal amount in your body) pass through my tubules and return to the veins they leave behind an average of 180 liters of liquid in me. In this case, you could be supposed to throw out 180 liters of urine a day. However, if you really did that, you would neither be able to find a sufficient supply of water nor salt. Fortunately, Providence granted you the mechanism to absorb back nearly 178.5 liters of this filtered substance. This way, the thickened urine throws out the toxic nitrogen-containing byproducts together with a little amount of water. Therefore, I give you back the substances you need with an amount of 1.5 liters of liquid disposal a day. This reabsorbing is realized in what you call the Henle loop. The cells in the walls of my tubules have neither intellect, nor consciousness, nor any knowledge of physiology; in spite of this, they work as if they were perfectly aware of their duty to adjust the amounts and types the substances to be kept or released. To give you an idea, you can think about the huge dialysis machines your engineers design to fulfill the job my tiny tubules do. You decide which one of us is the perfect work of engineering.

A rich network of veins surround the Heinle loop and the reabsorbed substances are released into the bloodstream. The drops to be disposed of are collected and then passed to your bladder. When the liquid in your bladder amounts to a certain value it tightens the bladder walls. The muscles blocking the way out give way and the urine is disposed of. However, know that the bladder has the capacity to expand as large as 1.5 liters when you cannot find the proper time and place.

Peter, most people take for granted the blessings they enjoy. If you visit the nephrology service in a hospital and talk to the patients waiting to be dialyzed, you understand what I mean better. Do not forget that many people who suffer from kidney failure need that huge machine to filter the whole of their blood and they pray for a kidney suitable for transplantation to be found at once.

Incidentally, thinking of chronic kidney failure recalled various reasons which ruin me: long lasting infections, long-term use of certain medicine, different chemicals like ethylene and mercury, heavy loss of blood, high blood pressure, serious burns, and wrong blood transfers etc. In such cases I can receive irreparable damage.

Another issue which troubles me is the formation of kidney stones. The stones which form owing to failures in different metabolic processes really hurt. When excessive decrease of liquids or increases of salts in the body upset my sensitive balance, some dissolved substances remain, begin to collect, and form stones. These stones hinder urine flow and might cause infections. You may drink water abundantly to prevent these stones. Most importantly do not wait too much before going to the toilet. If you excuse me, I also strongly recommend you to urinate in sitting position; this helps emptying your bladder completely and reduces the risk of kidney stones.

I do my job properly until I lose 90 % of my working capacity. When a considerable part of me loses its capacity, the remaining good part boosts its activity to make up for the loss. When one of our twins are taken out with an operation, the other one does not complain at all; it grows a bit bigger and keeps working.

As the nature of honey depends on the nectars bees collect, the ingredients of the urine I produce depend on what’s in your body. Therefore, a urine analysis tells much in the case of illness. For example, I normally do not release valuable substances like glucose and protein in your blood into the urine, but return them to the bloodstream. As my friends cannot fulfill this function in diabetic patients, their urine analyses reveal glucose. As for medicines, I throw them out right away since they are alien substances to me.

Peter! You are young and healthy but be careful and do not get cold around the waist, otherwise I might trouble you. There’s a lot to tell you Peter, but I do not want to confuse you. Like any other organ, I do not like being taken for granted and I just wish for you to appreciate what a blessing I am. Let me note that my perfect cooperation with the rest of your body is another wonder in itself. Anyway, the urea in your blood is increasing, so I must go help my twin now. Goodbye Peter!

Irfan Yilmaz is a professor of biology at Dokuz Eylul University, Izmir.

The family is the smallest unit of society and it should be a source of happiness for the individual. This is why a sound dialogue between parents and their children is so important. When we bring up our children, we should regard them as being entrusted to us by the Almighty. Treating them affectionately and inspiring confidence in them plays an important role in terms of preparing them for their future life as physically and psychologically healthy individuals.

In spite of the cozy atmosphere of the home, we might come across some problems that are difficult to solve. Some problems are apparent to our friends and neighbors, while others are known only by family members and are kept secret. In such cases, we may not know how to deal with a problem, and therefore need to seek help from an expert. Wetting the bed is a typical example of such problems. When such a problem persistently occurs it is only compounded if we hurt the child and cause them to feel bad or inferior because of this problem; what many people do not realize is that this is a problem that is easily solved.

Families with children who wet the bed while between the ages of 5 and 15, sometimes even up to the age of 20 have a serious problem. Every morning, these families wake up to find another problem. The nasty smell, changing the sheets and cleaning the pajamas are not things that people enjoy first thing in the morning.

Along with the burden of dealing with dirty clothes and sheets, the family members become worried, as they do not know when the problem will end. But it is the child who worries most. The problem is only compounded as the child realizes that they cannot have friends to stay, nor stay at someone else’s house, as this may lead to others finding about the problem; such worries only cause further problems such as losing self-confidence, inferiority complexes, shyness and poor performance at school.

Some families do not try to search for solutions, saying illogical things like, “His uncle used to wet the bed too. That didn’t go on for too long. The same will happen with our child as well,” or “It’s nothing unusual. Most children do it. It will be alright,” or “It will just stop without treatment. They say that there is no treatment anyway.”

Bedwetting is actually a common problem. What then, are the underlying reasons? How common is it in reality? Is there an effective treatment for it? Does it just stop on its own? If so, when and how does it stop? Or is it possible for someone to remain a bed-wetter all of their lives? Does the treatment have any side effects? What is the success rate of the treatment? We will try to answer all these questions.

Occasional cases of bedwetting until the age of five are considered as nothing unusual. If bedwetting continues after the age of five, then this indicates an illness known as “enuresis.” Research carried out on primary school aged children found that between 20-30% of children wet the bed in general. It is usually more common among boys. The percentage increases with children from families of a lower socio-economic background, mostly due to malnutrition.

The main causes for bedwetting

Genetic factors are accepted as playing a role, based on the fact that 70% of the children who wet the bed have close relatives with the same problem, and that there is a high incidence rate among identical twins. It is thought to be caused mostly by a lack of an anti-diuretic hormone that reduces urine production at night. There are other reasons as well.

If a person with diabetes has too great an intake of fluids before bedtime they may wet the bed. Moreover, urinary tract infections, kidney stones, parasites, anemia, a lack of calcium, magnesium, zinc, or vitamins (A, B, D, E), problems with adenoids, and enlarged tonsils may all cause bedwetting.

Anemia and adenoids cause hypoxia (a deficiency of the amount of oxygen available in the blood) and hypercapnia (the presence of an abnormally high level of carbon dioxide in the blood). If these conditions are present, then the patient sleeps too soundly and the control of the central nervous system over the other systems is weakened. As a result, the patient wets the bed as they have lost some control over their muscles.

At least half of people who suffer from bedwetting are considered to do so because of psychological reasons. If a child begins to wet the bed in spite of having had no such problem before, this indicates that the child subconsciously wants to return to their infancy when they were the center of attention. By wetting the bed, the child might be wishing to receive more care from the parents.

Wetting the bed might be a reaction to family problems or the birth of a sibling. Various types of anxiety may cause the child to suffer from depression, which is another reason that causes very sound sleep.

Bedwetting is thought to result from psychological problems if it is accompanied by problems like suffering from a tic, stuttering, nail-biting, over-jealousy, or failure at school. A child with a urinary tract or bladder infection or kidney stones may not be able to control their need to urinate during the day either. If no physical illness can be detected, then there may be a serious psychological disorder.

Diagnosis and treatment

Starting from the principle “every disease has a cause,” we should first of all search for any possible causes. We can begin with simple ways, such as urine and blood tests. If these do not provide a satisfactory answer, then the other possible causes that were mentioned above should be investigated. The kidneys and the bladder should be checked with an ultrasound, while the adenoids and chronic bronchitis, as well as the tonsils, should be examined. If no viral or organic cause can be found, then psychological problems should be investigated. When the reason has been found, then it is time to start the treatment.

After a diagnosis has been made, the parents should be informed about the cause of the problem. It should also be noted that enuresis may result from incorrect forms of toilet training.

In the treatment of psychologically-caused cases of bedwetting, taking the child to a doctor, carrying out blood and urinary tests, and the family’s efforts to treat the child (i.e. paying for the treatment, waiting at the doctor’s, etc) are all considered to be part of the treatment. The child sees that importance has been given to them, that efforts are being made and that money is being spent on them alone. Having seen that the parents and the doctor have played their part, it is the child’s turn to do what is expected of them. Prescribing the correct medicine, or if there is no physical problem, merely saying, “nothing is wrong” is the start of the treatment.

If the bladder turns out to be smaller than normal, the child is advised to hold their urine longer than normal in order to expand the bladder. The period of waiting is lengthened gradually. The child is asked to keep a record of “wet” and “dry” days and they are rewarded for the “dry” days. Drinking less in the evening may facilitate treatment.

Medication and treatment

The medication changes according to the diagnosis. For instance, if there is a urinary tract or bladder infection, then antibiotics are used. If there are psychological reasons, special pediatric anti-depressants will be prescribed. Anti-depressants cause the patient to sleep lighter. When the child does not sleep so soundly, they are able to control their urination, and wake up and go to the toilet.

There are drugs that help to expand the bladder capacity of people whose bladders are smaller than normal; these drugs can be very useful indeed. Some problems with the urinary tract or bladder can also be eliminated by surgery.

If the patient has trouble breathing due to adenoids or enlarged tonsils, these should be removed by surgery as well. For anemia, the patient is given substances such as vitamins, iron and zinc along with a prescribed diet. In cases of calcium deficiency, a calcium-rich diet and calcium tablets are recommended.

If a child shows more than one of the symptoms, then a combined treatment is followed. Laser acupuncture treatment can also be useful. Bedwetting can be prevented by using anti-diuretic hormone tablets or sprays as well. With the correct diagnosis and treatment, the success rate of such treatments is between 95-98%.

The most common occurrence is that children will stop wetting the bed after puberty without any need for treatment. However, it is not a good idea to wait for this to happen, because treatment that will help bedwetting stop occurring is available. Only 2-5% of patients continue to wet the bed after the age of twenty. Most often, such patients wet the bed due to some organic problem.

The medicines prescribed against bedwetting have been in use for about 30-35 years; they have been proven to be safe and to have no side effects.

A related study

In a study carried out in Bursa, Turkey, the records of 164 patients who suffered from bedwetting were examined. According to this study, the following data was obtained: 52 patients (32%) were girls and 112 patients (68%) were boys. 36 of the boys were aged 6-8, 48 of them were aged 9-12 and the remaining 28 were 13 years of age or older. 20 girls were aged 6-8, 16 girls were aged 9-12 and 16 girls were 13 or older.

When the causes were investigated, it turned out that 18 of the 112 boys (16%) had urinary tract or bladder infections and kidney stones, while 18 boys were suffering from cystitis, which can be diagnosed with an ultrasound, 12 boys (11%) had problems with their adenoids, chronic bronchitis, and tonsils, which made breathing difficult for them. No organic causes were found in 64 patients (57%); in these cases it was found that the cause was purely psychological. 24 out of 52 girls (46%) had urinary tract or bladder infections, while the other 54% had psychological reasons for wetting the bed.

Half of the patients stopped wetting the bed at the end of the first month, and almost all the patients were treated successfully by the end of the second month. The success rate was 98%.

After having examined this data, it is clear that the problem of bedwetting is not difficult to solve without blaming and hurting our children. When we confront such problems in life, we should not despair or panic. We should keep in mind that God Almighty has created a cure for every problem, and that finding the cure requires patience and determination.

Nephrology is the study of the kidneys, the essential organ of excretion, and elements related to it. If due observation and research are thoroughly carried out on every part of the human metropolis, when the integrated hierarchical mechanisms are analyzed, it can be seen that numerous events are constantly taking place; these can open new doors to various sciences and offer us new horizons of reflection on the Divine Wisdom. In this way, these events are an interpretation of the saying “If all the seas were to be made up of ink, and all the trees were pens, they would still not be able to write down the knowledge of God,” which points to the existence of an Omnipotent Being with infinite knowledge.

One of these constant activities in our body is the excretion system which works like a well-regulated clock. In the body of a healthy adult, the bladder, after an accumulation of urine that has been filtered through the kidneys, resembles a balloon that has been inflated. The bladder enlarges according with the amount of urine that has been filtered by the kidneys. The autonomous nervous system has a significant role in the wonderful functioning of this urine storage mechanism. If we assume that an average adult urinates 5-6 times a day, we can say that the average time adults spend for urination is about 5 minutes daily. The autonomous system of a baby however, is not properly developed and has a very limited capacity of urine storage. Therefore, the bladder of a baby is frequently emptied. As for newborn babies, the number of times that they empty their bladder can be as much as 20-25 times a day. In this way, both the urine that comes from the kidneys flows to the bladder freely, and the urination channels are automatically cleaned.

In order to allow the urine flowing from the kidneys to the bladder to pass freely through the small tubes that measure between 3-7 mm (the urethra) the inner pressure in the bladder needs to be kept at low levels. This is realized in the body of a baby by the frequent emptying of the bladder, until the autonomous nervous system has properly developed. After the sixth month, the autonomous nervous system develops, the urine storing capacity of the bladder increases, and the number of urination times decreases. As the child grows, the ability to store urine and to excrete it at the proper time and place is completed in a gradual process. Being only one of the hundreds of wonders in the human metropolis, this balance is maintained as a clear reflection of Divine Mercy.

Cooperation in the urinary tract

There is a fascinating cooperation between the departments of this metropolis. The urine that is excreted by the kidneys does an excellent job of cleaning all along the urinary tract, like a river cleaning the stones over which it passes. This cleaning includes not only any microorganisms, but also any gravel which might form in the urination channels. Research has proved that when bacteria are injected into the bladders of healthy people no infection is developed in the urinary tract, since the pressure of their urine excretion drives the bacteria away. The protection of the kidneys by both the expansion of the flexible bladder wall and the decrease in the pressure inside the bladder is a good example of the cooperation between the kidneys and the bladder. If the pressure was not able to be decreased by such flexibility, the kidneys could not function under the resulting high pressure. The smooth functioning of the kidneys is maintained through urine excretion in suitable amounts and at a suitable pressure. Taking all this for granted, one usually comes to realize what a blessing the excretion system is only when there is a problem.

The urination of a baby in the womb

The placenta has the duty of being the main regulator of the feeding and excretion systems of a fetus. The kidneys of a fetus also play significant roles. For instance, they balance acidity through liquid electrolytes, carry out the functions of hormone production, and growth. From the fourth month on, the fetus begins to produce urine and the bladder is filled and emptied every 30-60 minutes. The urine inside the bladder is emptied into the amniotic fluid which surrounds the fetus like a protective pad. The duty of the amniotic fluid includes protecting the fetus against the changes in the mother’s body temperature, providing space for normal development, providing suitable conditions for food and oxygen supply, and protecting the baby against any possible blows that the mother’s belly might be exposed to. The amniotic fluid in which a baby is placed is a liquid similar to urine, and it is produced for the comfort of this new guest to our world.

The formation of urine

The blood, which is charged with transmitting nutrients and oxygen even to the remotest parts of the body, brings the toxic disposal our body has produced due to various causes on its way back to the kidneys. The blood, which bears the responsibility of maintaining the health of metropolis of the body, is continuously filtered when it reaches the kidneys. In the kidneys, the waste material is so delicately separated that it as if the kidneys know “which substance is needed in what amounts,” without meticulous calculation and infinite knowledge. Artificial kidneys supported by latest technology (like modern devices of dialysis) are never a substitute for a real kidney. A healthy kidney, which is made to serve under the veil of causes created by the Owner of infinite knowledge and power, does its duty with divine guidance. It sends what is to be disposed of to the bladder in the form of urine.

The substances urine contains are used when diagnosing illnesses, for they possess different qualities. The color, smell, and density of the urine and the substances it contains give us various clues about the health of that person. Deviations in the sensitive balance established in the excretion system are considered to be a sign of something gone wrong in the human metropolis. In other words, a urine analysis is an important indication of health, for many factors, such as our lifestyle, our eating habits, disease, and the medicines we use can effect changes on the consistency and composition of the urine (figure 1-3). The urine of a healthy person is yellow and clear. This color is derived from the urochrome pigment along with urobilin and uroerythrin. Colorless urine can be seen if there has been recent fluid consumption, or the use of diuretics, or disorders such as different types of diabetes (diabetes mellitus, diabetes insipitus, etc). The color of urine can fluctuate between yellow and clear within the day (for example, 1-2 hours after a meal it can be clear, whereas it can turn to dark orange due when one has been making heavy effort). Beetroot, artificial colorings and some drugs can turn the urine red. When the complaints of a patient are taken together with a medical examination and lab analyses, urine samples which are colored red-brown, blue-grey, milky-white or which are cloudy may all be symptoms of disease.

As we learn new things about urine we will hopefully attain a deeper comprehension of the infinite divine blessings that have been bestowed upon us, offering thanks to our Creator from new perspectives.