Whats The Urinary Tract How Does It Work
Your urinary tract is vital to your body because it gets rid of waste and extra fluid. Its made up of both your kidneys, two ureters, your bladder and your urethra. Each organ has an important job :
- Kidneys: Your fist-sized, bean-shaped kidneys are located on either side of your spine, below your rib cage. Each day they filter 120 to 150 quarts of your blood to remove waste and balance fluids. Your kidneys make one to two quarts of urine every day.
- Ureters: After your kidney creates urine, the liquid travels through the tube-shaped ureter to the bladder. There is one ureter per kidney. Kidney stones can pass through the ureters or, if theyre too big, get stuck in them. You may require surgery if the stone is too large.
- Bladder: Between your hip bones is your bladder, an organ that stores urine. It stretches to hold about one and a half to two cups.
- Urethra: Like a ureter, your urethra is a tube through which urine passes. Its the final stop of the urinary tract where your urine leaves your body. This is called urination.
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.
Types Of Kidney Stones
There are four main types of stones:
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What Causes Kidney Stones
Kidney stones are formed from substances in your urine. The substances that combine into stones normally pass through your urinary system. When they dont, its because there isnt enough urine volume, causing the substances to become highly concentrated and to crystalize. This is typically a result of not drinking enough water. The stone-forming substances are:
These and other chemicals are some of the waste products that exit your body.
If The Kidney Stone Is Not Causing Any Symptoms Should I Still Be Treated
There are some instances when it is OK to leave a kidney stone untreated. If the stone is small and not causing any pain, there is a good chance that it will pass on its own after it falls into the ureter. Such stones may be followed with “watchful waiting.” This means that the stone is not actively treated, but instead your doctor keeps a check on the stone to be sure that it is not growing or changing. This can be done with periodic X-rays.
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Signs And Symptoms Of Kidney Stones
People with diabetes or obesity are also more likely to develop kidney stones. A hereditary disorder called cystinuria can also result in kidney stones.
If the stone is tiny enough, it will pass through the urethra and bladder via urination. The likelihood that a stone will pass naturally and without assistance depends upon the stone’s size.
The symptoms of smaller kidney stones that stay in the kidney are frequently nonexistent. You may not feel any discomfort before the stone enters your ureter. However, the degree of pain may vary depending upon the size of the stone once it enters the ureter. The majority of naturally occurring stones pass within 31 to 45 days.
How Can I Prevent Kidney Stones
There are several ways to decrease your risk of kidney stones, including:
- Drink water. Drink at least six to eight 8-ounce glasses every day . Staying hydrated helps you urinate more often, which helps flush away the buildup of the substances that cause kidney stones. If you sweat a lot, be sure to drink even more.
- Limit salt. Eat less sodium. You may want to connect with a dietician for help with planning what foods you eat.
- Lose weight. If youre overweight, try to lose some pounds. Talk to your healthcare provider about an ideal weight.
- Take prescriptions. Your healthcare provider may prescribe some medications that help prevent kidney stones. The type of medication may depend on the type of stones you get.
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.
Medication For Kidney Stones
For most people with recurrent calcium stones, a combination of drinking enough fluids, avoiding urinary infections, and specific treatment with medications will significantly reduce or stop new stone formation.
Certain medications such as thiazide diuretics or indapamide reduce calcium excretion and decrease the chance of another calcium stone. Potassium citrate or citric juices are used to supplement thiazide treatment and are used by themselves for some conditions where the urine is too acidic.
For people who have a high level of uric acid in their urine, or who make uric acid stones, the medication allopurinol will usually stop the formation of new stones.
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How Common Are Kidney Stones
Each year, more than half a million people go to emergency rooms for kidney stone problems. It is estimated that one in ten people will have a kidney stone at some time in their lives.
The prevalence of kidney stones in the United States increased from 3.8% in the late 1970s to 8.8% in the late 2000s. The prevalence of kidney stones was 10% during 20132014. The risk of kidney stones is about 11% in men and 9% in women. Other diseases such as high blood pressure, diabetes, and obesity may increase the risk for kidney stones.
Diagnosis Of Kidney Stones
Many kidney stones are discovered by chance during examinations for other conditions. Urine and blood tests can help with finding out the cause of the stone. Further tests may include:
- x-rays, including an intravenous pyelogram , where dye is injected into the bloodstream before the x-rays are taken.
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Potatoes And Sweet Potatoes
Potatoes and sweet potatoes are potassium-rich vegetables.
Just one medium-sized baked potato contains 610 mg of potassium, whereas one average-sized baked sweet potato contains 541 mg of potassium .
Fortunately, some high potassium foods, including potatoes and sweet potatoes, can be soaked or leached to reduce their potassium contents.
Cutting potatoes into small, thin pieces and boiling them for at least 10 minutes can reduce the potassium content by about 50% .
Potatoes that are soaked in water for at least 4 hours before cooking are proven to have an even lower potassium content than those not soaked before cooking .
This method is known as potassium leaching or the double-cook method.
Although double cooking potatoes lowers the potassium content, its important to remember that their potassium content isnt eliminated by this method.
Considerable amounts of potassium can still be present in double-cooked potatoes, so its best to practice portion control to keep potassium levels in check.
Potatoes and sweet potatoes are high potassium vegetables. Boiling or double cooking potatoes can decrease their potassium content by about 50%.
Tomatoes are another high potassium fruit that may not fit the guidelines of a renal diet.
They can be served raw or stewed and are often used to make sauces.
Just 1 cup of tomato sauce can contain upwards of 900 mg of potassium .
Unfortunately for those on a renal diet, tomatoes are commonly used in many dishes.
New Clinical Patient Registry For Hereditary Kidney Stone Disease
Table 2. Inclusion criteria for mutation analysis in clinical patient registry.
In summary, kidney stone disease is an increasingly prevalent condition which is clinically heterogeneous and poorly understood, notably its genetic drivers. As a series of recent studies indicated, monogenic conditions are most likely underestimated in prevalence. By implementation of a centralized patient registry on hereditary kidney stone disease, we will contribute to overcome, at least in part, the vast knowledge gap on genetics of kidney stone disease. In this context, clinical registries are valuable sources for several reasons: first, delineating better phenotypegenotype associations will be crucial for more precise patient stratification in future clinical research studies. Second, identifying new disease genes with new disease mechanisms will diminish the gap of unknown NL/NC etiology and third, deciphering new molecular targets helps to pave the way for developing drugs of recurrence prevention in severely affected families.
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Avoiding Recurrence Of Kidney Stones
If you have had one kidney stone, some tips that may help to prevent a second stone forming include:
- Talk to your doctor about the cause of the previous stone.
- Ask your doctor to check whether the medications you are on could be causing your stones. Do not stop your medications without talking to your doctor.
- Get quick and proper treatment of urinary infections.
- Avoid dehydration. Drink enough fluids to keep your urine volume at or above two litres a day. This can halve your risk of getting a second stone by lowering the concentration of stone-forming chemicals in your urine.
- Avoid drinking too much tea or coffee. Juices may reduce the risk of some stones, particularly orange, grapefruit and cranberry. Ask your doctor for advice.
- Reduce your salt intake to lower the risk of calcium-containing stones. Dont add salt while cooking and leave the saltshaker off the table. Choose low- or no-salt processed foods.
- Avoid drinking more than one litre per week of drinks that contain phosphoric acid, which is used to flavour carbonated drinks such as cola and beer.
- Always talk to your doctor before making changes to your diet.
Drinking mineral water is fine it cannot cause kidney stones because it contains only trace elements of minerals.
Epidemiology Of Kidney Stones
Globally, kidney stone disease prevalence and recurrence rates are increasing , with limited options of effective drugs. Urolithiasis affects about 12% of the world population at some stage in their lifetime . It affects all ages, sexes, and races but occurs more frequently in men than in women within the age of 2049 years . If patients do not apply metaphylaxis, the relapsing rate of secondary stone formations is estimated to be 1023% per year, 50% in 510 years, and 75% in 20 years of the patient . However, lifetime recurrence rate is higher in males, although the incidence of nephrolithiasis is growing among females . Therefore, prophylactic management is of great importance to manage urolithiasis.
Recent studies have reported that the prevalence of urolithiasis has been increasing in the past decades in both developed and developing countries. This growing trend is believed to be associated with changes in lifestyle modifications such as lack of physical activity and dietary habits and global warming . In the United States, kidney stone affects 1 in 11 people , and it is estimated that 600,000 Americans suffer from urinary stones every year. In Indian population, about 12% of them are expected to have urinary stones and out of which 50% may end up with loss of kidney functions .
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Editorial: Immunity And Inflammatory Response In Kidney Stone Disease
- 1Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- 2Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- 3Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
Editorial on the Research TopicImmunity and Inflammatory Response in Kidney Stone Disease
Kidney stone disease is a common urological disorder causing significant morbidity and financial burden in both genders at all ages around the globe . Its prevalence is increasing universally at an alarming rate . Moreover, the stone formation can trigger other renal and vascular disorders such as hypertension, chronic kidney disease and end stage renal disease . Kidney stones are mineral deposits mostly in the pelvis, free or attached to the renal papillae . Calcium oxalate is the main component of approximately 80% of all kidney stones, majority of them being idiopathic . Most of the idiopathic CaOx stones develop by attachment to sub-epithelial deposits of calcium phosphate on renal papillary surface, called Randalls plaques . Some of the stones form as an overgrowth on crystalline deposits within the terminal collecting ducts of the kidney . Both pathogenic mechanisms require periodic urinary supersaturation with respect to CaOx in association with low levels of its inhibitors .
How Are Kidney Stones Treated
Once diagnosed, your healthcare provider will first determine if you even need treatment. Some smaller kidney stones may leave your system when you urinate. This can be very painful. If your provider decides that you do need treatment, your options include medications and surgery.
Medications. Medications may be prescribed to:
- Your healthcare provider may recommend that you take an over-the-counter medication like ibuprofen or, if youre in the emergency room, an IV narcotic.
- Manage nausea/vomiting.
- Relax your ureter so that the stones pass. Commonly prescribed medicines include tamsulosin and nifedipine .
You should ask your healthcare provider before you take ibuprofen. This drug can increase the risk of kidney failure if taken while youre having an acute attack of kidney stones especially in those who have a history of kidney disease and associated illnesses such as diabetes, hypertension and obesity.
Surgery. There are four types of surgeries used to treat kidney stones. The first three are minimally invasive, meaning that the surgeon enters your body through a natural opening , or makes a small incision.
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Diagnosis Of A Kidney Stone
A doctor may suggest the following methods of diagnosis, if you suffer from symptoms of Kidney Stones.
Blood analysis: Blood tests may suggest that you have an excess of uric acid or calcium. The results of a blood test allow your doctor to look for additional medical issues while also monitoring the condition of your kidneys.
Urine analysis: A urine test may reveal the amount of stone-forming minerals or insufficient amounts of stone-preventing chemicals. Your doctor might ask you to perform two urine collections over two consecutive days in preparation for this test.
Ultrasound imaging: Diagnosing kidney stones using an ultrasound is a rapid and simple noninvasive examination. Kidney stones in your urinary tract may be visible on an ultrasound. Even microscopic stones may be found using high-speed or dual-energy computed tomography .
Stone analysis: To collect stones you pass, you might be requested to urinate through a strainer. The stone composition will be determined via laboratory analysis. This information is used by your doctor to identify the cause of your kidney stones and to develop a plan to stop further stone formation.
Genetic Basis Of Kidney Stone Formation
Environmental factors interacting with underlying genetic factors cause rare stone disease . The production of promoters and inhibitors of crystallization depends on proper functioning of the renal epithelial cells. Cellular dysfunction affects the supersaturation of urinary excretion by influencing ions such as calcium, oxalate, and citrate . Some genetic defects which lead to stone formation are shown in Table 3.
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How Long Does It Take A Kidney Stone To Form
You can have kidney stones for years without knowing theyre there. As long as these stones stay in place within your kidney, you wont feel anything. Pain from a kidney stone typically starts when it moves out of your kidney. Sometimes, a stone can form more quickly within a few months.
Talk with your healthcare provider about your risk factors. They might do a 24-hour urine test to check how quickly you develop stones.
Cell Injury And Apoptosis
Exposure to high levels of oxalate or CaOx crystals induces epithelial cellular injury, which is a predisposing factor to subsequent stone formation . CaOx crystal depositions in the kidneys upregulate the expression and synthesis of macromolecules that can promote inflammation . Crystals may be endocytosed by cells or transported to the interstitium. It has been suggested that injured cells develop a nidus which promotes the retention of particles on the renal papillary surface . In individuals with severe primary hyperoxaluria, renal tubular cells are injured and crystals become attached to them . The addition of CaOx crystals onto MadinDarby canine kidney cell lines showed an increase in the release of lysosomal enzymes, prostaglandin E2, and cytosolic enzymes . A study on animal models also revealed that the administration of high concentrations of CaOx crystals or oxalate ions appears to be toxic causing renal tubular cell damage . It has been suggested that oxalate increases the availability of free radicals by inhibiting enzymes responsible for their degradation. For instance, reactive oxygen species can damage the mitochondrial membrane and reduce its transmembrane potential. These events are known features of early process in apoptotic pathways .
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