Chronic Kidney Disease Of Unknown Aetiology
The cause of chronic kidney disease is in some cases not known; it is referred to as chronic kidney disease of unknown aetiology . As of 2020 a rapidly progressive chronic kidney disease, unexplained by diabetes and hypertension, had increased dramatically in prevalence over a few decades in several regions in Central America and Mexico, a CKDu referred to as the Mesoamerican nephropathy . It was estimated in 2013 that at least 20,000 men had died prematurely, some in their 20s and 30s; a figure of 40,000 per year was estimated in 2020. In some affected areas CKD mortality was five times the national rate. MeN primarily affects men working as sugarcane labourers. The cause is unknown, but in 2020 the science found a clearer connection between heavy labour in high temperatures and incidence of CKDu; improvements such as regular access to water, rest and shade, can significantly decrease the potential CKDu incidence. CKDu also affects people in Sri Lanka where it is the 8th largest cause of in-hospital mortality.
Although CKDu was first documented among sugar cane workers in Costa Rica in the 1970s, it may well have affected plantation labourers since the introduction of sugar cane farming to the Caribbean in the 1600s. In colonial times the death records of slaves on sugar plantations was much higher than for slaves forced into other labour.
Is Lithotripsy A Safe Procedure For Breaking Large
Lithotripsy is a fairly safe and quick procedure that uses shock waves to break up the stones in your kidney, bladder, or ureter. Extracorporeal shock wave lithotripsy is the most common type of all forms of lithotripsy.
Your doctor will give you medicine for pain relief or to help you relax before the procedure begins. When you are ready for the procedure, you may be given general anesthesia so you fall asleep and pain-free. High-energy shock waves, also called sound waves will pass through your and hit the stones to break them into pieces. If you are awake, you may feel a slight tapping feeling when this occurs.
The lithotripsy procedure finishes in about 1 hour. A tube may be placed to drain urine from the kidneys until all the small pieces of stone pass out of your body.
The recovery time is generally brief. After the treatment, the patient can get up to walk almost immediately. Many people fully resume daily activities within two to three days.
Are There Any Foods Or Drinks That Help Treat Kidney Stones Are There Any Home Remedies
There are three liquids rumored to help with kidney stones:
- Cranberry juice. Although cranberry juice can help prevent urinary tract infections , it doesnt help with kidney stones.
- Apple cider vinegar. Vinegar is acidic and it can sometimes create changes to your urine, which helps with kidney stones. But, this doesnt always help. Talk to your healthcare provider about the use of vinegar.
- Lemon juice. Lemon juice is rich in citrate, which can help prevent kidney stones from forming. Citrates are found in several citrus fruits including lemons, limes, oranges and melons.
- Coffee. Studies show that coffee may decrease your risk of developing kidney stones.
Avoid soda and other drinks with added sugar or fructose corn syrup. They increase your risk.
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What Are Kidney Stones
Kidney stones are solid crystals formed from the salts in urine. They are sometimes called renal calculi. Kidney stones can block the flow of urine and cause infection, kidney damage or even kidney failure. They can vary in size and location.
The risk of kidney stones is about one in 10 for men and one in 35 for women. Between four and eight per cent of the Australian population suffer from kidney stones at any time.;
After having one kidney stone, the chance of getting a second stone is between five and 10 per cent each year. Thirty to fifty per cent of people with a first kidney stone will get a second stone within five years. After five years, the risk declines. However, some people keep getting stones their whole lives.
Microstructure Of Kidney Stones
Kidney stones are solid masses, ranging in size from a grain of sand to a pearl a stone does not have to cause symptoms. Depending on their composition, stones are either yellow or brown in colour and smooth or jagged in appearance. They are composed of crystals and a ubiquitous organic matrix , which not only coats the crystals but is also present inside the crystals and the inter-crystalline spaces. The matrix of calcific stones contains many macromolecules, including osteopontin , inter–inhibitor and urinary prothrombin fragment 1 all of which are normally present in the urine, albeit in small quantities. The matrix also contains various forms of lipids, which have been shown to induce crystal nucleation. The association between the crystals and the matrix seems to start early upon crystal nucleation and continues throughout the formative and growth phases of the developing stone. Although some urinary molecules, such as UPTF1, are considered crystallization inhibitors, others such as osteopontin can act as both inhibitors and promoters of crystallization. These molecules seem to be produced as a protective response against mineralization. However, both CaOx and CaP crystals have been shown to induce the production of macromolecules that inhibit and/or modulate crystallization,.
Calcium oxalate kidney stones examined using scanning electron microscopyScanning electron microscopy and transmission electron microscopy of kidney stones
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How Kidney Stones Are Treated
Treatment is tailored according to the type of stone. Urine can be strained and stones collected for evaluation.
Drinking six to eight glasses of water a day increases urine flow. People who are dehydrated or have severe nausea and vomiting may need intravenous fluids.
Other treatment options include:
Size Of Kidney Stones
Kidney stones are of variable sizes. They range from small sized crystals to large sized stones such as the size of a golf ball. Variations in sizes of kidney stones affect the following things:
The size of kidney stones affect the treatment method required for their removal. Small-sized stones can easily pass through the kidney without any medical assistance but large-sized stones require medical intervention. Certain tests are conducted which help in determining the size of kidney stones, such as KUB, an Ultrasound or an IVP. They help in analyzing which treatment should be effective for the removal of your kidney stones.
It is estimated that one in ten people will have a kidney stone sometime in their lives. The prevalence of kidney stones has increased significantly in the United States from 3.8% in the late 1970s to about 9% in the 2000s. The lifetime risk of developing kidney stones is about 19% in men and 10% in women.
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Recombination And Genetic Linkage
The diploid nature of chromosomes allows for genes on different chromosomes to or be separated from their homologous pair during sexual reproduction wherein haploid gametes are formed. In this way new combinations of genes can occur in the offspring of a mating pair. Genes on the same chromosome would theoretically never recombine. However, they do, via the cellular process of . During crossover, chromosomes exchange stretches of DNA, effectively shuffling the gene alleles between the chromosomes. This process of chromosomal crossover generally occurs during , a series of cell divisions that creates haploid cells. , particularly in microbial , appears to serve the adaptive function of repair of DNA damages.
The first cytological demonstration of crossing over was performed by Harriet Creighton and in 1931. Their research and experiments on corn provided cytological evidence for the genetic theory that linked genes on paired chromosomes do in fact exchange places from one homolog to the other.
Genes generally their functional effect through the production of , which are complex molecules responsible for most functions in the cell. Proteins are made up of one or more polypeptide chains, each of which is composed of a sequence of , and the DNA sequence of a gene is used to produce a specific . This process begins with the production of an molecule with a sequence matching the gene’s DNA sequence, a process called .
What Happens To Patients With Kidney Stones
After the passage of a first kidney stone, recurrences are common with rates of approximately 40 % at 5 years, 50 % at 10 years, and 75 % at 20 years. Stone formation is associated with increased rates of chronic kidney disease, hypertension, osteoporosis, and obesity. Although systemic diseases increase risk of kidney stones, the majority are idiopathic.
More than 90% of recurrent stones are preventable with adequate management of metabolic risk factors.
Most idiopathic stone formers have at least one metabolic abnormality that can be addressed as a preventive measure for stone recurrence.
Preventive measures include:
Lifestyle modifications .
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Ultrasonic Determination Of Kidney Stone Size
According to a systemic review published in Research and Reports in Urology in 2018, the sensitivity and specificity for renal calculi are 45% and 88%, respectively, and for ureteric calculi, they are 45% and 94%, respectively. The sensitivity of ultrasound decreased when the size of the stone is <3 mm, and the sensitivity increased as the size of the stone increased.
The only limitation with a USG is its reduced sensitivity and specificity when compared with CT for diagnosing smaller stones of the kidneys. However, ultrasounds are usually preferred by doctors as first line diagnostic methods for determining kidney stones as USGs are easy to perform and involve less costs. They are much safer as well on particularly pregnant women. Therefore, supporting an ultrasound-first approach to determining renal colic in the emergency departments remains important for improving patient care and decreasing healthcare costs even though CT scans are more sensitive in determining small-sized stones. ;
What You Need To Know About Ckd And Kidney Stones
By Dallas Nephrology Associates
More than half a million people go to emergency rooms for;kidney stone problems;each year. It is estimated that one in ten people will have a kidney stone at some time in their lives. Kidney stones can vary in size and be as small as a grain of sand or as large as a pebble.
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Should I Cut Calcium Out Of My Diet If I Develop Calcium Oxalate Kidney Stones
If you develop kidney stones composed of calcium, you may be tempted to stop eating foods that include calcium. However, this is the opposite of what you should do. If you have calcium oxalate stones, the most common type, its recommended that you have a diet higher in calcium and lower in oxalate.
Foods that are high in calcium include:
- Cows milk.
Its also important to drink plenty of fluids to dilute the substances in your urine.
Who Is At Risk For Kidney Stones
Anyone can get a kidney stone. Men experience kidney stones more often than women do. Kidney stones are also more common in certain ethnic groups such as non-Hispanic Caucasians. You may also be more likely to have kidney stones if:
- You have had kidney stones before.
- Someone in your family has had kidney stones.
- You do not drink enough water.
- You follow a diet high in protein, sodium and/or sugar.
- You are overweight or obese.
- You have had gastric bypass surgery or another intestinal surgery.
- You have polycystic kidney disease or another cystic kidney disease.
- You have a certain condition that causes your urine to contain high levels of cystine, oxalate, uric acid or calcium.
- You have a condition that causes swelling or irritation in your bowel or your joints.
- You take certain medicines, such as water pills, antacids or calcium supplements.
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Oranges And Orange Juice
While oranges and orange juice are arguably most well known for their vitamin C content, theyre also rich sources of potassium.
One large orange provides 333 mg of potassium. Moreover, there are 473 mg of potassium in 1 cup of orange juice .
Given their potassium content, oranges and orange juice likely need to be avoided or limited on a renal diet.
Grapes, apples, and cranberries, as well as their respective juices, are all good substitutes for oranges and orange juice, as they have lower potassium contents.
Oranges and orange juice are high in potassium and should be limited on a renal diet. Try grapes, apples, cranberries, or their juices instead.
Processed meats are meats that have been salted, dried, cured, or canned.
Some examples include hot dogs, bacon, pepperoni, jerky, and sausage.
Processed meats typically contain large amounts of salt, mostly to improve their taste and preserve flavor.
Therefore, it may be difficult to keep your daily sodium intake to less than 2,300 mg if processed meats are abundant in your diet.
Additionally, processed meats are high in protein.
If you have been told to monitor your protein intake, its important to limit processed meats for this reason as well.
Processed meats are high in salt and protein and should be consumed in moderation on a renal diet.
Pickles, processed olives, and relish are all examples of cured or pickled foods.
Usually, large amounts of salt are added during the curing or pickling process.
Categories Of Stone Formers
Patients with kidney stones are generally classified in different categories according to the composition of stones and the history of previous stone episodes. This classification influences the diagnostic work up and preventive treatment. However, both of these aspects have limitations. For example, classification according to stone composition has the caveat that chemical methods are imprecise and do not distinguish the crystalline forms; infrared spectroscopy or X-ray diffraction are the preferred methods.
We suggest that stone disease should not be evaluated only in reference to stone composition and clinical activity, but the risk of complications should also be appraised in the diagnostic process and patient categorization .
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Mendelian And Classical Genetics
Modern genetics started with Mendel’s studies of the nature of inheritance in plants. In his paper “Versuche Ã¼ber Pflanzenhybriden” , presented in 1865 to the Naturforschender Verein in , Mendel traced the inheritance patterns of certain traits in pea plants and described them mathematically. Although this pattern of inheritance could only be observed for a few traits, Mendel’s work suggested that heredity was particulate, not acquired, and that the inheritance patterns of many traits could be explained through simple rules and ratios.
The importance of Mendel’s work did not gain wide understanding until 1900, after his death, when and other scientists rediscovered his research. , a proponent of Mendel’s work, coined the word genetics in 1905 . Bateson both acted as a mentor and was aided significantly by the work of other scientists from Newnham College at Cambridge, specifically the work of , , and . Bateson popularized the usage of the word genetics to describe the study of inheritance in his inaugural address to the Third International Conference on Plant Hybridization in in 1906.
How Should A Patient’s Kidney Stone Be Managed
Single kidney stone
Conservative treatment to prevent or delay recurrence is appropriate in the absence of special risk factors .
Increased fluid intake to achieve urine volume of 2-2.5 liters daily. Fluids containing large amounts of sugar or sodium may increase urine calcium excretion, and should be avoided. A clinical trial found that first-time idiopathic calcium oxalate stone formers that increased water intake and urine volume from 1 liter to 2.6 liters daily had significantly lower risk of recurrent stones over 5 years of follow up compared to a matched group who did not increase water intake .
Diet.Epidemiologic data suggests that diets high in sodium, sugar, and animal protein are associated with increased risk for kidney stones. In contrast, intake of potassium and dietary calcium are associated with lower risk, although use of calcium supplements may increase risk of stone formation. Therefore, low calcium diet is not advisable, as it may increase risk of bone disease, while failing to prevent stone recurrence.
Idiopathic stone formers
The following dietary recommendations are appropriate:
Lower intake of sodium and oxalate
Higher intake of potassium and fluid
Normal intakes of calcium and protein with an emphasis on vegetable sources
Recurrent kidney stones
Untreated idiopathic calcium kidney stones have a recurrence rate of approximately 40% at 5 years, 50% at 10 years, and 75% at 20 years.
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Dna Sequencing And Genomics
, one of the most fundamental technologies developed to study genetics, allows researchers to determine the sequence of nucleotides in DNA fragments. The technique of , developed in 1977 by a team led by , is still routinely used to sequence DNA fragments. Using this technology, researchers have been able to study the molecular sequences associated with many human diseases.
As sequencing has become less expensive, researchers have of many organisms using a process called , which utilizes computational tools to stitch together sequences from many different fragments. These technologies were used to sequence the in the completed in 2003. New technologies are dramatically lowering the cost of DNA sequencing, with many researchers hoping to bring the cost of resequencing a human genome down to a thousand dollars.
came about due to the ever-increasing demand for low-cost sequencing. These sequencing technologies allow the production of potentially millions of sequences concurrently. The large amount of sequence data available has created the subfield of , research that uses computational tools to search for and analyze patterns in the full genomes of organisms. Genomics can also be considered a subfield of , which uses computational approaches to analyze large sets of . A common problem to these fields of research is how to manage and share data that deals with human subject and .
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.
Whats The Outlook For Kidney Stones
The outlook for kidney stones is very positive, although there is a risk of recurrence . Many kidney stones pass on their own over time without needing treatment. Medications and surgical treatments to remove larger kidney stones are generally very successful and involve little recovery time.
Its possible to get kidney stones multiple times throughout your life. If you keep developing kidney stones, your healthcare provider may work with you to discover why the stones happen. Once the cause is found, you may be able to make dietary changes to prevent future stones.
Putative Mechanisms For Ckd In Stone Formers
Kidney stones could potentially lead to CKD via multiple pathways. Obstructive uropathy from a stone can cause acute injury but could also produce irreversible chronic injury. The mechanism by which any obstructive uropathy causes CKD is not completely understood. Renal vasoconstriction and inflammation can occur in response to increased intratubular pressure . The resulting fall in renal perfusion normalizes intratubular pressure but can also cause ischemia. If this ischemia persists long enough, glomerulosclerosis, tubular atrophy, and interstitial fibrosis occur . Complete unilateral obstruction for 24 hours in a rat model leads to irreversible loss of function in 15% of the nephrons of the affected kidney . Therefore, if kidney stones caused recurrent episodes of obstructive uropathy, then there could be substantial loss of functional nephrons. Initially, the remaining functional nephrons may hypertrophy and hyperfilter to compensate and cause no change in the overall GFR. However, long-term, these overworked nephrons may fail, leading to detectable CKD .
A stone obstructing the duct of Bellini in a brushite stone former during a percutaneous nephrolithotomy. Tubular atrophy and fibrosis score on cortical biopsy by stone type. Reprinted from reference , with permission.
Diagnosis Screening And Prevention
Patients with urinary stones generally present with the typical reno-ureteral colic and less frequently with loin pain; associated manifestations could be gross haematuria, vomiting and sometimes fever. However, patients can also be asymptomatic. A diagnosis of nephrolithiasis is only confirmed when a stone has been passed, has been extracted or destroyed, or has been identified in the urinary tract by imaging studies or surgery. Otherwise, other possible causes of the above manifestations should be investigated.
Symptoms of nephrolithiasis in children are often unclear. The only manifestations are microhaematuria or recurrent episodes of macrohaematuria; pollachiuriadysuria; acute or subacute episodes of recurrent abdominal pain, located in the flank in older patients or diffuse in the abdomen in younger patients; urinary tract infections; or, finally, nonspecific manifestations such as irritability, vomiting, unmotivated crying and motor agitation in those <2 years of age. In the absence of a clear demonstration of a stone, the only clue that these manifestations are due to urinary stones could be the observation of concurrent hypercalciuria or hyperuricosuria.
Preventing Future Kidney Stones
If you had a calcium stone, your doctor may suggest cutting back on salt, which cause the body to dispense more calcium into the urine, as well as animal protein. You may also be advised to avoid high-oxalate foods, including chocolate, instant coffee, tea, beans, berries, dark leafy greens, oranges, tofu, and sweet potatoes. The best way to ward off new kidney stones is to drink enough water to keep urine clear.
F Grading The Evidence For Each Key Question
The overall strength of evidence for the RCTs will be evaluated by using methods developed by the AHRQs Evidence-based Practice Center Program as outlined in the Methods Guide for Effectiveness and Comparative Effectiveness Reviews.35 For each of several important clinical outcomes within each comparison evaluated, the strength of the evidence will be evaluated based on four required domains: 1) risk of bias ; 2) consistency ; 3) directness ; and 4) precision . The risk of biasbased on study design and conductwill be rated low, medium, or high. Consistency will be rated as consistent, inconsistent, or unknown/not applicable . Directness will be rated as either direct or indirect, and precision will be rated as either precise or imprecise. A precise estimate is one that would yield a clinically meaningful conclusion. Other factors that may be considered in assessing strength of evidence include the dose-response relationship, the presence of confounders, the strength of association, and publication bias.
Based on these factors, the overall evidence will be rated as:
How Do Kidney Stones Form
- Crystals can be found within the urine of almost all humans. These crystals are thought to be a normal body response to get rid of excess dietary mineral and to conserve water. Instead of being harmlessly excreted, stone formers urinary crystals nucleate and aggregate within the kidney, resulting in a cascade of events that lead to stone formation. The exact biological mechanisms remain unclear, but one way to prevent urinary crystals is to decrease the amount of acid, calcium, and oxalate in the urine OR to increase the amount of citrate and magnesium.