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DIFFERENT KINDS OF CALCULLY. |
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By drtajammul
The most obvious reason to learn about kidney stones and modify a person's behavior accordingly is to avoid the intense pain which they cause.But the most important reasonis because kidney stones can quickly lead to failure of the kidneys which is life threatening. A kidney stone that does not pass on out can block the urinary tract. This blockage will probably cause pain initially. But if medical attention is not received to identify the cause of the pain and remove the blockage, the pain is likely to gradually go away over a few days time.This lack of pain may cause the sufferer to think the crisis has passed when,in fact, the kidney which has been blocked by the stone has shut down.If left untreated in just a few days this shut down can lead to permanent loss of function in that kidney. A kidney stone can even rupture the collection system of the kidney.
Definition
The medical terminology for kidney stones is Nephrolithiasis or Renal Calculi.A kidney stone is a solid lump (from as small as a grain of sand to as large as the size a golf ball) made up of crystals that separate from urine and build up on the inner surfaces of the kidney. A remarkable over an inch long shown still inside a bisected kidney is available from a medical center in England.There appears to be an increase in the number of cases of kidney stones in recent years. About 7 to 21 people out of every 10,000 (or less than two tenths of one percent) of the population will have a kidney stone attack each year. In 1985 there were 1 million cases of kidney stones in the United States. These account for about 7 to 10 of every 1000 hospital admissions (or nearly one percent). Four out of five kidney stone cases (80 percent) are among men; only 20 percent are women. And more causaisans have kidney stones than Afro-Americans.
Location
Kidney stones usually are formed inside the kidney,but they are sometimes found in the bladder or ureter. Click to see a UCLA colorized drawing of the Urinary Tract <http://www.radsci.ucla.edu:8000/gu/stones/anatomy.html>. The intense pain associated with kidney stones usually occurs during the period of time that the stone is being slowly moved along the small ureter between the kidney and the bladder.
Causes of Kidney Stones
There are many potential causes of kidney stone formation. In general they are the result of a super concentration of chemicals in the urine that results in crystals being formed. This may be brought on by one or more of the following:
- a family genetic predisposition to form stones;
- an excess of calcium or certain other minerals in the diet (sometimes due to local geographic water or soil conditions);
- intake of excess uric acid, certain medications, Vitamin C, or Vitamin D;
- a diet of fruits and vegetables high in oxalate (a by product of metabolism);
- long term dehydration (possibly due to inadequate intake of fluids) and its resulting concentration of urine;
- urinary infection;
- living in an area where high temperatures cause sweating and loss of fluids; or
- possibly, just leading a sedentary (low physical activity) lifestyle.
The function of the kidneys is to eliminate byproducts of metabolism.(The kidney's parts and workings are explained in detail and wonderfully illustrated at How the Kidney Works <http://www.clark.net/pub/nhp/med/kidney/basics.html>.) This means they are constantly collecting the major ingredients for kidney stones - including calcium, oxalate, and uric acid. Ideally these minerals are kept in suspension until they are passed out of the body. Too much metabolic byproducts in insufficient fluid (urine) makes a person prone to kidney stone formation.The over concentration of metabolic byproducts in the urine can cause these minerals to move out of suspension and crystallize. These small crystals that precipitate out of the super saturated urine will usually pass on out through the urinary tract, but they may begin to clump together. Any existing crystal makes it easier for other crystals to form.If they stay in the kidney very long,the crystals gradually grow larger and larger until they become a kidney stone so large that it cannot pass through the urinary tract such as the one in this PHOTO of a kidney stone <http://www.radsci.ucla.edu:8000/gu/WWW%20Kidney%20Stones/jpeg.color.stone.html> by the UCLA medical school.Several underlying metabolic disorders may be the root cause of excessive calcium and oxalate forming stones in the kidney. Often doctors overlook the basic cause because of the attention of the sufferer being on the immediate cause of the pain leading the physician to be primarily concerned with the extraction or dissolution of the kidney stone causing the problem. The potential root causes include, but are not limited to the following:
1. A re-absorption of the calcium from the bones back into the blood system which the kidneys then filter out (resorptive hypercalciuria or hyperparathyroidism).
2. The intestines absorb too much calcium from the diet (absorptive hypercalciuria).
3. The kidneys filter out calcium from the blood but do not allow the reaborption of the calcium back into the blood as it should while it is still in the tubule of the kidney (renal hypercalciuria).
4. Several forms of bowel disease (ulcurative colitis, regional enteritis, etc.) which can contribute to high levels of urinary oxalate excretion.
5. Excess dietary intake of oxalate from foods such as green leafy vegatables. (See list of high oxalate foods later in this article.)
6. High levels of uric acid in the urine can act as a breeding ground for calcium oxalate stones.
7. Or, in a reverse manner, the lack of certain stone formation inhibitors normally found in the urine may not be present in sufficient quantities and thereby allow the formation of stones. One such indigredient is citrate (which this author is deficient in); another is magnesium.
8. Infection stones are indicators of the underlying infection in the urinary tract.
Symptoms of Kidney Stones
Kidney stones may be formed, grow in size, and stay immobile inside the kidney for years without any warning pain or other indicators. Most people don't know they are at risk for forming kidney stones until one or more have been formed. A few people have and pass small kidney stones without experiencing pain, but that is not the usual case. More often the kidney stone makes itself dramatically known when it begins to move through the urinary tract.
A kidney stone attack has classic symptoms: the most agonizing pain in the lower back just below the ribs spreading around to the front of the abdomen and often extending into the groin area. The pain may come in waves as the stone tries to move through the tube between the kidney and the bladder (the ureter). Sometimes there will be blood in the urine. Often there is nausea, fever and chills, and vomiting. The abdomen or lower back may be painful to touch.The severity of the pain is no indicator of the size of the passing kidney stone. This pain is often described as the worst pain a person has ever suffered even by women who have given birth. It is reported to be more painful than gun shots, surgery, broken bones, or even burns. The pain is not a result of the stone moving or tearing the ureter as a sufferer might suspect. Rather, the pain is caused by the dilating or stretching of the urinary tract being blocked by the stone when it gets stuck in the ureter.More than one million people in the United States are hospitalized each year because of kidney stone attacks. A suffer should call their doctor or go to the hospital emergency room if they experience severe or persistent bleeding, if the pain continues to be severe, unrelenting and persistent, or if fever and chills or nausea and vomiting develop.During a kidney stone attack the sufferer should drink large amounts of water (two to three quarts per day). Stay active. Do not go to bed (except for normal sleep periods). Physical activity may actually assist passage of the kidney stones.
Eliminating the Kidney Stone
Unless the kidney stone is larger than 1/4 inch (or 5mm) in diameter it will most likely pass without medical intervention ... except for the administration of pain killers to allow the sufferer to endure through the episode which may last for several days. Those between 1/4 inch and 1/2 inch in diameter are less likely to pass on their own as they get larger.If the kidney stone is larger than 1/2 inch (or 10mm) in diameter it will likely need to be either removed by surgery or by lithrotripsy. Stones have been known to become as large as the size of golf balls. It is not necessary to remove a stone unless it causes other problems. Large stones usually remain in the kidney without symptoms, although they may damage the kidney.A complete diagnosis of kidney stones should include blood screens, 24 hour urine samples, provocative calcium loading tests, and stone analysis to determine the type of stone, its underlying cause, and proper treatment, and future stoone prevention.
Lithotripsy
The kidney stone machine fragments kidney stones by use of extracorporeal shock wave lithrotripsy (ESWL). This roughly one to three hour long process is known as lithrotripsy - which means stone crushing. It uses high energy shock waves which are focused at the exact location of the stone (located by use of x-rays) while the semi-anesthetized sufferer is suspended in a tank of warm water. (PHOTO of Lithotriptor at Midwest Stone Institutes) <http://www.mwstone.com/equipm1.gif> Newer lithrotriptors have eliminated the tank of water in favor of an enclosed bag of water that is placed in direct contact with the sufferer's body to transfer the shockwaves without the need to actually be immersed into the water.During a treatment up to 3000 lithrotripsy shock waves vibrate the stone so that it shatters into smaller sand-like fragments usually without injury to surrounding tissue. Pressure is felt, but not pain. This process is repeated until the doctors can see on the x-rays that the stone has been crushed by the shock waves. (DIAGRAM of a Lithotriptor ) <http://www.las.ele.cst.nihon-u.ac.jp/History/kidn-c.gif> The resulting stone fragments (some not so small and most in jagged shapes) then pass out of the body over a period of time that may be as long as three months or more. Passing these fragments are similar to passing small stones; and more than one sufferer has stated that next time they will opt for some type of physical stone removal to avoid the prolonged painful period of these fragments being passed.The most common type of stones, calcuim oxalate, is the most difficult type to break up with shockwave lithrotripsy due to its extreme hardness. While some larger or complicated cases may require more than one treatment, lithotripsy usually allows the sufferer to return to their normal life (with the aid of medications to reduce the pain and nausea caused by passing the fragments) in just a few days.
Kidney Stone Surgery
Kidney stone removal surgery is serious. It is resorted to in less than 5 percent of the kidney stone cases. During surgery the doctor actually opens up the kidney and physically takes out the offending stones. The surgery scar can be 5 to 10 inches long. Recovery from the surgery takes four to six weeks.The most serious factor against such surgery is that a kidney can withstand being opened up by surgery only once or twice and still remain adequately functional. It is estimated that each time a surgeon cuts through the meat of a kidney it will lose 20 percent of its functionality.
Alternative Methods of Treatment
For that reason there have been developed several less invasive techniques for physical removal of stones that will not pass on their own. These include ureteroscopy: sending instruments up through the urethra, the bladder, and into the ureter to grab the stone and pull it out.Another alternative method is the use of a laser threaded along that same path which is then used to vaporize the stone still inside the ureter.A third alternative (called PNL for short) is to enter the kidney through a small hole made in the back and into the kidney through which the stone can be removed.A new technique is call lithoclast. It uses air pressure to vibrate and break up the kidney stone. The the fragments are removed with forceps or flushed with water and then suctioned out.
Recurrence of Kidney Stones
The chance of having recurring stones are about 70-80 percent once a person suffers their first stone attack. After the first kidney stone attack occurs in a person they have a cumulative 10 percent chance per year of forming another stone (if no other stones are present at the time of the first stone attack). This translates into a 50% chance over a 5 year period of time. Family genetic tendencies can increase this risk.The younger a person is when they have their first kidney stone attack the greater their personal risk of having additional attacks. Those between the ages of 35 and 50 are in their peak stone formation period.Historically about 60 percent of individuals who have experienced one kidney stone will develop another within 7 years. But whereas just a few years ago recurrence of kidney stones was unavoidable, modern medical science has made recurrent kidney stones a preventable disease. With individualized medical therapy recurrence can be prevented in more than 95 percent of suffers.
Chemical Composition of Kidney Stones
Knowing which one of the several types of chemical composition has caused a suffer's kidney stone to form will allow medical treatment to prevent that particular type of stone and thereby prevent recurrent kidney stone attacks. Therefore it is very important to catch the stone - when and if it is passed - so that it can be chemically analyzed.Most stones are made up of calcium or a combination of calcium and oxalate. These stones show up quite well on x-rays. Calcium mineral combination stones cannot be dissolved with any known medicine. However kidney stones made up of uric acid are invisible to x-rays, but can sometimes be dissolved with the proper medications.
- Common Chemical Make Up:
- calcium phosphate (8%)
- calcium oxalate (most common: 73%, most opaque)
- magnesium ammonium phosphate (also called "struvite" - often caused by an infection)
Uncommon Chemical Make Up:
diammonium calcium phosphate
magnesium phosphate
Rare Chemical Make Up:
cystine (faintly opaque; 1%)
urate (lucent - meaning translucent to x-rays; 7%)
xanthine
A series of nine magnified PHOTOGRAPHS of these various types of stones <http://www.herringlab.com/photos> is available online from Herring Lab, the company who analyzes more kidney stones than any other - over 125,000 per year.The southeastern area of the United States is known as the Kidney Stone Belt because of the relative high ratio of people suffering from kidney stones in those states. North Carolina (where this author, a fellow kidney store sufferer happens to live) has more kidney stone cases per capita than any other state. Several factors probably come into play to create this situation. One is the typical southern diet which is high in green vegetables and brewed tea - both of which are high in oxalates. The second is the hot climate which causes increased amounts of perspiration and loss of body fluid. And finally, modern life styles often reduce physical activity.Together these factors put people at high risk for kidney stones. Oxalate from foods is usually present in urine. The oxalate forms a salt with calcium that has a low soluability factor (it does not dissolve easily; it does precipitate into crystals easily). Even mild chronic dehydration can increase the likelihood of kidney stone formation. Inactivity has been associated with increased kidney stone formation: Russian astronauts in space for long periods have developed kidney stones. Thus a southerner with high levels of oxalate combined with chronic dehydration and a sedentary life style is more likely to suffer from their increased risk of forming kidney stones.Vitamin C and Vitamin D increase the formation of oxalates during the food digestion processes. (Not only do certain foods contain oxalate, additional oxalates can be formed as a byproduct of the natural process.)
Preventing Kidney Stone Formation
The easiest step to take is to increase hydration. This applies to sufferers of all types of kidney stones. Drinking very large amounts of water - two or more quarts per day - is probably the most important step in reducing stone formation. It is recommended that sufferers increase their urine output to at least 2 quarts per 24 hour period. Drinking 2 to 3 quarts per day may reduce recurrence of stones by up to 90 percent.Initially many kidney stone sufferers may find it difficult to raise their fluid intake to this level. However, with a consistent conscious effort a person will develop a taste for water. After about a month their body will readjust its normal level of hydration. Once this new norm has become established a person will start to feel thirsty whenever their fluid intake falls below this level. Some tips on increasing fluid intake <http://www.mwstone.com/Water.htm> may prove helpful. One kidney stone sufferer says: I like water now. You acquire a taste for it.High calcium in urine can be caused by too much salt in a person's diet. Salt causes excretion of larger amounts of calcium and thus increases calcium in the urine. Increasing a person's intake of water will reduce the relative concentration of calcium in the urine and thus reduce the risk of crystal formation and kidney stone formation.Additionally, persons prone to the most common type of kidney stones (calcium oxalate) may find it advisable to cut back on foods with high oxalate levels such as those listed below to help prevent future stone formation:apples asparagus beer beets berries, various black pepper broccolicheese chocolate cocoa coffee cola drinks collards figs grapes ice cream milk oranges parsley peanut butter pineapplesspinach Swiss chard rhubarb tea turnips vitamin C yogurtStone suffers should consult with their doctor, of course, but in most cases, these foods can be eaten in limited amounts.A diet with high levels of sodium, sucrose, or animal protein increase the likelihood of kidney stone formation. Conversely, high levels of potassium, magnesium, and fluids lower the likelihood of kidney stone formation.The Division of Urology at the Toa Payon Hospital in Singapore offers dietary advice for kidney stone patients <http://www.sfcs.org.sg/urology/stone2.html> including both what to eat as well as what not to eat. There are, also, medications available to reduce the tendency towards formation of certain types of stones.One type of medication to reduce risk of formation of calcium oxalate stones introduces high levels of citrate into the kidneys. This citrate in the urine reduces the tendency for calcium oxalate stone formation. A similar increase in urinary citrate is generated by drinking lemonade (lemons are one of the good foods) containing at least 4 ounces of lemon juice per day.It has been discovered that avoiding calcium may do more harm than good when it comes to kidney stone sufferers who have, in the past, been warned to avoid foods rich in calcium. According to a study of over 45,000 men conducted by the Harvard School of Public Health, men who get lots of calcium in their diets have a one-third lower risk of having kidney stones than do those who consume calcium sparingly. It seems that high dietary calcium actually blocks a chemical action which causes the formation of kidney stones by binding with oxalates (from foods) in the intestine which then prevents both from being absorbed into the blood stream and later transferred to the kidneys. Urinary oxalate may be more important to formation of calcium-oxalate kidney stone crystals than is the urinary calcium.However it must be quickly noted here that calcium supplements increase kidney stone risks <http://www.aceology.com/med/mpost/calcium.htm> according to the Annuals of Internal Medicine, March 1997. High normal dietary calcium reduces kidney stones by 35 percent, but high calcium from non-foods - like calcium supplements - actually increase the risk of kidney stones by 20 percent.That same Harvard study found that:Those with the highest consumption of potassium, from eating fruits and vegetables, had only half the risk of stones; A high fluid intake was associated with a 29 percent lower risk; and Those who ate the most animal protein had a 33 percent higher risk of developing kidney stones. Winning the battle with kidney stones is a two stage war. The first hurdle - which is sometimes elected to be skipped by doctors and patients - is to become stone free to reduce later stone formation due to the presence of those existing stone crystals. Then the second hurdle is to eliminate (or at least reduce) the risk factors that might lead to formation of new kidney stones.
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