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What Is The Pathophysiology Of Kidney Stones

Medication For Kidney Stones

What causes kidney stones? – Arash Shadman

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.

Where Do Kidney Stones Come From

Kidney stones form develop when certain substances, such as calcium, oxalate, and uric acid, become concentrated enough to form crystals in your kidneys. The crystals grow larger into “stones.” About 80% to 85% of kidney stones are made of calcium. The rest are uric acid stones, which form in people with low urine pH levels.

After stones form in the kidneys, they can dislodge and pass down the ureter, blocking the flow of urine. The result is periods of severe pain, including flank pain , sometimes with blood in the urine, nausea, and vomiting. As the stones pass down the ureter toward the bladder, they may cause frequent urination, bladder pressure, or pain in the groin.

“If you experience any of these symptoms, see your primary care physician,” says Dr. Eisner. “He or she will likely perform a urinalysis and a renal ultrasound, abdominal x-ray, or CT scan to confirm kidney stones are the source of your pain and determine their size and number.”

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.

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Should I Cut Out All Foods That Have Oxalate Or Calcium

No, this is a common mistake. Some people think that cutting out all foods that have oxalate or all foods with calcium will keep stones from forming. However, this approach is not healthy. It can lead to poor nutrition and can cause other health problems. A better plan? Eat and drink calcium and oxalate-rich foods together during a meal. Doing this helps oxalate and calcium bind to one another in the stomach and intestines before reaching the kidneys, making it less likely for kidney stones to form in the urine.

Plan Your Plate For Kidney Stones

Mechanisms Of Renal Stone Formation

9W2GDB: Renal Calculi (Kidney Stone)

The pathogenesis of kidney stone or biomineralization is a complex biochemical process which remains incompletely understood . Renal stone formation is a biological process that involves physicochemical changes and supersaturation of urine. Supersaturated solution refers to a solution that contains more of dissolved material than could be dissolved by the solvent under normal circumstances . As a result of supersaturation, solutes precipitate in urine leads to nucleation and then crystal concretions are formed. That is, crystallization occurs when the concentration of two ions exceeds their saturation point in the solution . The transformation of a liquid to a solid phase is influenced by pH and specific concentrations of excess substances. The level of urinary saturation with respect to the stone-forming constituents like calcium, phosphorus, uric acid, oxalate, cystine, and low urine volume are risk factors for crystallization . Thus, crystallization process depends on the thermodynamics and kinetics of a supersaturated solution . Therefore, lithiasis can be prevented by avoiding supersaturation.

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Prevention Of Urinary Calculi

In a patient who has passed a first calcium calculus, the likelihood of forming a 2nd calculus is about 15% at 1 year, 40% at 5 years, and 80% at 10 years. Drinking large amounts of fluids8 to 10 ten-ounce glasses a dayis recommended for prevention of all stones. Patients who form stones should drink enough fluid to produce at least 2.5 liters of urine daily. Recovery and analysis of the calculus, measurement of calculus-forming substances in the urine, and the clinical history are needed to plan other prophylactic measures.

In < 3% of patients, no metabolic abnormality is found. These patients seemingly cannot tolerate normal amounts of calculus-forming salts in their urine without crystallization. Thiazide diuretics, potassium citrate, and increased fluid intake may reduce their calculus production rate.

For hypercalciuria, patients may receive thiazide diuretics to lower urine calcium excretion and thus prevent urinary supersaturation with calcium oxalate. Patients are encouraged to increase their fluid intake to 3 L/day. A diet that is low in sodium and high in potassium is recommended. Even with a high potassium intake, supplementation with potassium citrate is recommended to prevent hypokalemia Hypokalemia Hypokalemia is serum potassium concentration 3.5 mEq/L caused by a deficit in total body potassium stores or abnormal movement of potassium into cells. The most common cause is… read more . Restriction of dietary animal protein is also recommended.

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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Struvite Or Magnesium Ammonium Phosphate Stones

Struvite stones occur to the extent of 1015% and have also been referred to as infection stones and triple phosphate stones. It occurs among patients with chronic urinary tract infections that produce urease, the most common being Proteus mirabilis and less common pathogens include Klebsiella pneumonia, Pseudomonas aeruginosa, and Enterobacter . Urease is necessary to split/cleave urea to ammonia and CO2, making urine more alkaline which elevates pH . Phosphate is less soluble at alkaline versus acidic pH, so phosphate precipitates on to the insoluble ammonium products, yielding to a large staghorn stone formation . Women’s are likely to develop this type of stone than the male. Escherichia coli is not capable of splitting urea and is not associated with struvite stones .

What Causes Kidney Stones

Kidney Stones(Nephrolithiasis) Causes, Pathophysiology, Signs & Symptoms, Diagnosis , Treatment

Stone disease has plagued humanity since ancient times. Kidney stones have been identified in Egyptian mummies. The Hippocratic oath describes their treatment: I will not use the knife, not even verily, on sufferers from stone, but I will give place to such as are craftsmen therein.

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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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How Can Kidney Stones Be Prevented

The best way to avoid kidney stones is to prevent the most common cause â dehydration. You are adequately hydrated when your urine is light yellow. Most people require between 8 to 10 glasses of water per day. Scientists are studying grapefruit juice and other drinks high in citric acid, which may help prevent the most common type of kidney stone.

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Can Diet Alone Treat Kidney Stones

For some people, dietary changes may be enough to prevent kidney stones from occurring.

In other cases, additional treatment may be necessary, including medication to break the stones up or surgery to remove the stones.

If stones become extremely painful, it is best to seek consultation with a doctor or nephrologist so they can recommend the best course of action.

How Common Are Kidney Stones

Precision Urology Melbourne

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.

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Patient Evaluation And Management

Patients who present for the first time with renal colic are often evaluated with an unenhanced helical CT scan. This is generally the most sensitive method for establishing the presence of a renal stone. The CT provides valuable information regarding the size and location of the stone, and any anatomical abnormalities can be defined. Ureteral stones smaller than 5 mm will generally pass spontaneously with adequate hydration. In the absence of fever, infection, or renal failure, these stones are generally followed conservatively. Pain may be managed with opioid analgesics and nonsteroidal anti-inflammatory drugs . Intravenous hydration is usually administered until the patient is able to consume adequate amounts of fluid by mouth. Most of these patients can be stabilized in the emergency room and then followed as an outpatient. Alpha1-adrenergic receptor blockers or calcium channel blockers are sometimes prescribed to assist with stone passage. Stones greater than 10 mm will generally not pass spontaneously and will require urologic intervention. Stones ranging from 5 mm to 10 mm will have variable outcomes. More distal stones will generally pass more readily than stones in the proximal ureter. Again, if the patient is afebrile, pain is controlled, and there is no evidence of infection or renal failure, the patient can be followed initially conservatively. Stones in this size range that do not pass will require intervention.3;

Kidney Stone Inhibitors And Promoters

Inhibitors are substances which decrease the initiation of supersaturation, nucleation, crystal growth, rate of aggregation, or any other processes required to stone formation . Normally, urine contains chemicals that prevent crystal formation. Inhibitors in urine includes small organic anions such as citrate, small inorganic anions such as pyrophosphates, multivalent metallic cations such as magnesium, or macromolecules such as osteopontin, glycosaminoglycans, glycoproteins, urinary prothrombin fragment-1, and TammHorsfall proteins . These inhibitors do not seem to work equally for everyone; therefore, some people form stones. But, if crystals formed remain tiny, usually it travels through the urinary tract and passes out from the body with urine splash without being noticed. Inhibitors may act either directly by interacting with crystal or indirectly by influencing the urinary environment . When inhibitory compounds adsorb onto the surface of the crystal, it inhibits nucleation, crystal growth, aggregation, or crystal-cell adherence.

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Dairy And Our Kidneys

When it comes to dairy products in our everyday food intake, most people would say that they have milk or other dairy products daily, if not more! Milk, cheese, cottage cheese, yogurts, pudding and ice cream are some of the favorite dairy products of young and old alike. Dairy products are naturally abundant in protein, B vitamins, calcium, phosphorus and potassium. All of these nutrients are important for our bodys many functions.

Healthy kidneys help remove waste products and extra fluid from the blood and help balance the levels of salt and minerals in the body. As kidney function declines, protein waste products, fluid, salt and minerals can rise to unsafe levels in the body and this may mean that dairy products must be limited.

A closer look at these key nutrients in dairy foods will help those with decreased kidney function understand the importance of limiting dairy foods.

Soda Causes Kidney Stones

Kidney Stones – Types, Formation, Treatment, Prevention

MYTH BUSTED: While we are tempted to let you believe this one as Soda is a nutrient empty, sugar-laden drink, we must inform you this is NOT the case. The fact is phosphoric acid is the culprit that is an ingredient in SOME sodas, typically colas, and pepper sodas such as Coke or Dr. Pepper and Pepsi. The other issue with Soda is that it is a diuretic because of the caffeine. This makes the salt content in your urine rise, which promotes kidney stones. So have a soda, but also follow it with an equal amount of water and you will decrease that concentrate. Alternatively, you could avoid soda altogether and replace it with healthier alternatives.

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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:

Who Gets Kidney Stones And Why

The lifetime risk of kidney stones among adults in the US is approximately 9%, and it appears that global warming may be increasing that risk. There are four major types of kidney stones: calcium oxalate/calcium phosphate, uric acid, struvite , and cystine.

A risk factor for all stones, regardless of type, is dehydration. Anyone who is prone to kidney stones should pay attention to good hydration. A randomized trial has shown that drinking 2 liters of fluid a day reduces the likelihood of stone recurrence by about half. The American Urological Association guideline for medical management of kidney stones recommends that patients who form kidney stones should aim to drink more than 2.5 liters of fluid per day.

Anyone with symptoms of kidney stones should be referred to a urologist. The initial evaluation will often include blood, urine, and imaging studies. Decisions about testing, and ultimately treatment, should be made jointly by the physician and the patient. Lets look at specific risk factors and treatment for each of the major stone types.

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Who Is More Likely To Develop Kidney Stones

Men are more likely to develop kidney stones than women. If you have a family history of kidney stones, you are more likely to develop them. You are also more likely to develop kidney stones again if youve had them once.

You may also be more likely to develop a kidney stone if you dont drink enough liquids.

Infection And Rare Stones

Kidney Stones Treatment in Vijayawada

The most important factors for the formation of infectious stones are highly alkaline urine pH in the presence of urease-producing organisms and supersaturated urinary environment with respect to magnesium, ammonium, and phosphate ions . Rare forms of kidney stones such as dihydroxyadanine, ammonium urate, and stones resulting from protease inhibitor drugs may also occur.

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Painful Pebbles: The Anatomy And Pathology Of Kidney Stones

Posted on 9/14/17 by Marian Siljeholm

Those who havent suffered a kidney malady are officially banned from casting the first stones regarding this blog post .

Ive never had kidney stones, however, I did have a kidney infection. While Im aware that the two are certainly not the same, when I arrived at the ER doubled over in agony, the degree and geography of my pain caused my very patient nurse to first test for kidney stones, which gave me an idea of the severity of the pain apparently felt by the poor souls who do suffer the dreaded stones. Having shattered my tibia four years previous to this ER visit, I can honestly say that this was worse.

;But what even are these exceptionally painful internal pebbles? Where do they come from? How can we get rid of them? All very good questions!

Lets take a look.

Image captured from Physiology Animations.

The kidneys, your bodys filtration system, are constantly busy removing extra fluids and waste products from your blood, which are then excreted as urine. Urine contains things like calcium, phosphate, oxalate, and uric acid. On good days, these substances are diluted so they flow through the urine easily, but if urine becomes concentrated or something changes the level of a substance in the urine, crystals can form and become lodged in kidney tissue and grow to become kidney stones.

  • Pain in the side or back, which then spreads to the lower belly and groin
  • Blood in the urine

Image captured from Physiology Animations.


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