Cytokine Storms Can Destroy Kidney Tissue
The bodys reaction to the infection may be responsible as well. The immune response to the new coronavirus can be extreme in some people, leading to what is called a cytokine storm.
When that happens, the immune system sends a rush of cytokines into the body. Cytokines are small proteins that help the cells communicate as the immune system fights an infection. But this sudden, large influx of cytokines can cause severe inflammation. In trying to kill the invading virus, this inflammatory reaction can destroy healthy tissue, including that of the kidneys.
What Can The Patient Expect After Treatment
The recovery time is usually fairly brief. After treatment, the patient can get up to walk almost at once, Many people can fully resume daily activities within one to two days. Special diets are not required, but drinking plenty of water helps the stone fragments pass. For several weeks, you may pass stone fragments.
Purpose Of Proposed Comparative Effectiveness Review
There is significant variation in current medical practice regarding management to prevent recurrent nephrolithiasis. Clinical uncertainty exists regarding the effectiveness, comparative effectiveness, and adverse effects of different dietary and pharmacological preventive treatments; the value of urine and blood biochemical measures for initiating and/or modifying treatment; and the potential impact of patient and stone characteristics on important treatment outcomes. Where data allow, the proposed systematic review and meta-analysis will comprehensively address all these questions. Our findings should inform providers and patients making treatment decisions, organizations developing clinical guidelines, and policymakers making coverage decisions. Results also should effectively define the limitations of existing evidence and the parameters of any future RCTs or other research studies needed to address remaining evidence gaps.
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Reducing Kidney Stone Risk
Drinking enough fluid will help keep your urine less concentrated with waste products. Darker urine is more concentrated, so your urine should appear very light yellow to clear if you are well hydrated. Most of the fluid you drink should be water. Most people should drink more than 12 glasses of water a day. Speak with a healthcare professional about the right amount of water that’s best for you. Water is better than soda, sports drinks or coffee/tea. lf you exercise or if it is hot outside, you should drink more. Sugar and high-fructose corn syrup should be limited to small quantities.
Eat more fruits and vegetables, which make the urine less acid. When the urine is less acid, then stones may be less able to form. Animal protein produces urine that has more acid, which can then increase your risk for kidney stones.
You can reduce excess salt in your diet. What foods are high in salt? Everyone thinks of salty potato chips and French fries. Those should be rarely eaten. There are other products that are salty: sandwich meats, canned soups, packaged meals, and even sports drinks.
Some herbal substances are promoted as helping prevent stones. You should know that there is insufficient published medical evidence to support the use of any herb or supplement in preventing stones.
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Coronavirus Might Target Kidney Cells
The virus itself infects the cells of the kidney. Kidney cells have receptors that enable the new coronavirus to attach to them, invade, and make copies of itself, potentially damaging those tissues. Similar receptors are found on cells of the lungs and heart, where the new coronavirus has been shown to cause injury.
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Age Distribution For Nephrolithiasis
Most urinary calculi develop in persons aged 20-49 years. Peak incidence occurs in people aged 35-45 years, but the disease can affect anyone at any age. Patients in whom multiple recurrent stones form usually develop their first stones while in their second or third decade of life. An initial stone attack after age 50 years is relatively uncommon.
Nephrolithiasis in children has historically been rare, with approximately 5-10 children aged 10 months to 16 years being seen annually for the condition at a typical US pediatric referral center. Over the last 25 years, however, the incidence of nephrolithiasis in children has;increased by approximately 6-10% annually. In adolescents, the incidence has reached 50 per 100,000.
What Can Be Done To Rule Out Or Confirm An Underlying Cause
Kidney stones are common and they are not caused by any known underlying disease for most people. However, some tests may be recommended to rule out an underlying problem. In particular, tests are more likely to be advised if:
- You have repeated kidney stones.
- You have symptoms of an underlying condition.
- You have a family history of a particular condition.
- A stone forms in a child or young person.
You may be asked to catch a stone so that it can be analysed. This will help to find out if there may be an underlying cause for the kidney stone. To catch a stone, you will need to pass urine through gauze, a tea strainer or a filter such as a coffee filter.
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How Successful Is Shock Wave Lithotripsy
ln those patients who are thought to be good candidates for this treatment, some 50-75% are found to be free of stones within three months of SWL treatment. The highest success rates seem to be in those patients with smaller stones .
After treatment, some patients may still have stone fragments that are too large to be passed. These can be treated again if necessary with shock waves or with another treatment.
Risk For Ckd By Stone Type
There is evidence that the risk for CKD varies by stone type, but more studies are needed. Population-based studies often lack the granular detailed data to characterize stone type because many stone formers never have their stones analyzed or urine chemistries evaluated, and, even if so, this information often is not available in the databases available for study. Saucier et al. studied community stone formers in Olmsted County, MN, and identified 53 who developed CKD and were matched with 106 who did not develop CKD. Hypertension, diabetes, six or more urinary tract infections, allopurinol therapy, and struvite stone type were identified as risk factors for CKD. The association with allopurinol could either reflect treatment of hyperuricosuria for stone prevention or treatment of hyperuricemia secondary to CKD. Only half of the participants had stone type determined, and even fewer had urine chemistry data. Number of stone episodes, surgical procedures, and stone passage symptoms were not associated with CKD, although there was limited statistical power in this study .
Pretreatment urinary creatinine clearance in normal control subjects and different types of stone formers: Brushite , calcium oxalate , apatite , struvite , uric acid , and cystine . Reprinted from reference , with permission.
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What Is A Kidney Stone
A kidney stone is a hard object that is made from chemicals in the urine. There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. A kidney stone may be treated with shockwave lithotripsy, uteroscopy, percutaneous nephrolithomy or nephrolithotripsy. Common symptoms include severe pain in lower back, blood in your urine, nausea, vomiting, fever and chills, or urine that smells bad or looks cloudy.
Urine has various wastes dissolved in it. When there is too much waste in too little liquid, crystals begin to form. The crystals attract other elements and join together to form a solid that will get larger unless it is passed out of the body with the urine. Usually, these chemicals are eliminated in the urine by the body’s master chemist: the kidney. In most people, having enough liquid washes them out or other chemicals in urine stop a stone from forming. The stone-forming chemicals are calcium, oxalate, urate, cystine, xanthine, and phosphate.
After it is formed, the stone may stay in the kidney or travel down the urinary tract into the ureter. Sometimes, tiny stones move out of the body in the urine without causing too much pain. But stones that don’t move may cause a back-up of urine in the kidney, ureter, the bladder, or the urethra. This is what causes the pain.
Treatment For Kidney Stones
Most kidney stones can be treated without surgery. Ninety per cent of stones pass by themselves within three to six weeks. In this situation, the only treatment required is pain relief. However, pain can be so severe that hospital admission and very strong pain-relieving medication may be needed. Always seek immediate medical attention if you are suffering strong pain.
Small stones in the kidney do not usually cause problems, so there is often no need to remove them. A doctor specialising in the treatment of kidney stones is the best person to advise you on treatment.
If a stone doesnt pass and blocks urine flow or causes bleeding or an infection, then it may need to be removed. New surgical techniques have reduced hospital stay time to as little as 48 hours. Treatments include:
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Is It Urgent That The Patient Be Treated With A Procedure Like This
lf the stone does not pass on its own, it will require treatment. lf you have an infection, severe pain, or if your kidney function is threatened, your doctors will act quickly. lf you only have one kidney or have had a kidney transplant, your stone will be treated more quickly. lf you have large stones or stones in both kidneys, your doctors will not wait to treat you.
What Are The Symptoms Of Hyperoxaluria
Kidney stones are usually the first symptom. Signs and symptoms of kidney stones include:
- Pain in the lower back or side of body. Pain can start as a dull ache that may come and go. Pain can become severe and result in a trip to the emergency room.
- Nausea and/or vomiting with the pain.
- Blood in the urine.
- Urine that smells bad or looks cloudy.
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Falling Under The General Heading Of Plumbing Your Bodys Waste Filtration And Elimination System Toils Silentlyuntil Something Goes Amiss If Your Kidney Stones Are Chronic You And Your Physician Need To Formulate A Plan Of Attack
It felt like a meteorite, our blogger writes, but his experience with a kidney stone pain began and ended with one episode.
It started as a pain in the mid-back, disassociated from any kind of spinal or muscle soreness that sometimes accompanies strenuous activity. It was a dull ache, off to one side, and it persisted into a dark and rainy night. Id heard about kidney stones and thought I might be experiencing one. A friend described kidney stone pain as no less than breathtaking, driving him to his knees. And when I wound up in a fetal position on the floor, my faint suspicions grew firm.
A trip to the ER and an x-ray confirmed ita kidney stone was just exiting my right kidney at the ureter, the tube that moves urine from the kidney to the bladder. A nurse said my urine sample looked a little rich with blood, and a physician said the best course would involve pain pillsand patience.
This too would pass, he said.
The pain pills helped, but a trip the next day to my exceptional urologist, Dr. Gerard Curtis in Sarasota, Fla., didnt offer much comfort. His staff equipped me with a little screen to pee into in the hopes of catching the stone.
When I successfully captured the little devil the next day, the word stone failed to do justice. It looked like a meteoritejagged, misshapen, ghastly. A real troublemaker.
Mechanisms Of Renal Injury
Recurrent obstruction
A reasonable mechanism for renal injury in patients with stone disease is recurrent obstruction. While most often this represents an acute kidney injury , it is now clear that recurrent AKI episodes are a risk factor for development of CKD. Being unilateral in most cases, stone passage may not produce obvious signs of kidney injury in patients with two kidneys. For example, GFR is not likely to fall and sodium retention may not occur unless the contralateral kidney has CKD and is unable to compensate. Notably, with only one kidney, passage of a stone produces an obvious fall in renal function, sometimes anuria with marked renal failure.
Associated diseases
In the Mayo study, risk factors identified among stone formers who developed CKD were hypertension and diabetes, diseases associated with both CKD and stone formation. Recurrent UTIs, struvite stones, and allopurinol therapy were other risk factors noted.
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Symptoms Of Kidney Stones
Many people with kidney stones have no symptoms. However, some people do get symptoms, which may include:
- a gripping pain in the back usually just below the ribs on one side, radiating around to the front and sometimes towards the groin. The pain may be severe enough to cause nausea and vomiting
- blood in the urine
- cloudy or bad smelling urine
- shivers, sweating and fever if the urine becomes infected
- small stones, like gravel, passing out in the urine, often caused by uric acid stones
- an urgent feeling of needing to urinate, due to a stone at the bladder outlet.
Should I Keep Taking My High Blood Pressure Medication
Hypertension is a common cause of kidney problems. Hypertension damages the blood vessels of the kidneys and affects their ability to filter the blood. Kidneys also help to regulate blood pressure, so kidney damage can make hypertension worse. Over time, hypertension can cause kidney failure.
If you are living with hypertension, you might take medication for the problem. You may be reading news reports questioning the safety of taking certain prescription medicines to manage their condition: ACE inhibitors and angiotensin receptor blockers .
Sperati says that patients should stay on their medications and discuss concerns with their doctors.
Right now there are two sides debating this issue. One side is saying, based on animal studies, that these medications might be harmful, increasing risk of infection. The other says these same drugs might protect against lung damage and other problems associated with COVID-19.
But all of the professional societies have published articles recommending that you not change your medications, he says. Staying the course with your prescriptions, he adds, can lower the risk of heart and kidney damage from unchecked high blood pressure.
Sperati does recommend that patients with kidney issues stay away from non-steroidal anti-inflammatory drugs , such as ibuprofen and naproxen. These can raise blood pressure and increase fluid volume in the body, which puts strain on the kidneys.
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What Causes Kidney Stones
Kidney stones are deposits of crystal-forming minerals such as calcium, salt, uric acid, and oxalate. If you dont have enough water in your urinary system to flush out these minerals, they can become concentrated in your urine.;
When these minerals are highly concentrated in your system, they crystalize and come together in your kidney to form kidney stones. Rather than being uniform, kidney stones come in different sizes, from as small as a tiny seed to the size of a golf ball.;;
Symptoms of kidney stones include:
- Back and side pain below your ribs
- Pain that goes to your lower abdomen or groin
- Pain that comes in waves
- Nausea or vomiting
- Burning or pain when urinating
Kidney stones can also cause you to only urinate in small amounts.;
Can Children Get Kidney Stones
Kidney stones are found in children as young as 5 years. In fact, this problem is so common in children that some hospitals conduct ‘stone’ clinics for pediatric patients. The increase in the United States has been attributed to several factors, mostly related to food choices. The two most important reasons are not drinking enough fluids and eating foods that are high in salt. Kids should eat less salty potato chips and French fries. There are other salty foods: sandwich meats, canned soups, packaged meals, and even some sports drinks. Sodas and other sweetened beverages can also increase the risk of stones if they contain high fructose corn syrup.
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D Assessment Of Methodological Quality Of Individual Studies
The primary and secondary abstractors/evaluators will independently review each study included in the review. Study quality for the individual RCTs included in the systematic review will be evaluated by using criteria based on the domains recommended by the Cochrane Collaboration. These criteria include an assessment of the risk of bias within each study by specifically evaluating: 1) adequacy of allocation concealment, based on the approach developed by Schulz and Grimes;30 2) blinding methods ; 3) data completeness ; and 4) whether reasons for dropouts/attrition were reported .31 Studies will be assigned individual ratings of good, fair, or poor. A rating of good generally indicates that the trial reported adequate allocation concealment, blinding, analysis by intention-to-treat, and that reasons for dropouts/attrition were reported. Studies will be rated as poor if the method of allocation concealment was inadequate or not defined, blinding was not defined, analysis by intention-to-treat was not utilized, and reasons for dropouts/attrition were not reported and/or there was a high rate of attrition. The quality of RCTs and observational cohort studies reporting adverse events will be evaluated by using a subset of questions from the McHarm Scale.32
Blocked Ureter And Kidney Infection
A kidney stone that blocks the ureter can lead to a kidney infection. This is because waste products are unable to pass the blockage, which may cause a build-up of bacteria.
The;symptoms of a kidney infection;are similar to symptoms of;kidney stones, but may also include:
- a high temperature of 38C or over
- chills and shivering
Kidney stones are usually formed following a build-up of certain chemicals in the body.
This build-up;may be any of the following:
- calcium
- ammonia
- uric acid; a waste product produced when the body breaks down food to use as energy
- cysteine; an amino acid that helps to build protein
Certain medical conditions can lead to an unusually high level of these substances in your urine.
You’re also;more likely to develop kidney stones if you don’t drink enough fluids.
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