Natural Remedies for Kidney Stones
Because of its effects on acid-base balance, an increased dietary potassium intake might have favorable effects on kidney stone formation. In one large observational study of women (Figure 1), there was a progressive inverse relationship between greater intake of potassium and incident kidney stones. At a median potassium intake of 4.7g day (119mmol day), the risk of developing a kidney stone was 35 less compared to that for women with an intake of
A number of compounds, such as vitamin C, increase uric acid clearance and thus can precipitate urolithiasis. Perhaps not so well recognized is the uricosuric effect of a high-protein diet and the fact that purine-rich foods also predispose to renal calcium stones. This may be because many purine-rich foods, such as spinach, are equally rich in calcium oxalate. Approximately 25 of vitamin C intake is also excreted as oxalate, which can compound the problem. Exacerbation of kidney stone formation by dietary nucleic acids in inherited purine disorders Excess uric acid from dietary purines can also precipitate symptoms that may draw attention to milder forms in adults of HPRT deficiency or PRPS superactivity. A third genetic defect raises levels of adenine, which is converted by XDH to the even more insoluble uric acid analog, 2,8-dihydroxyadenine (2,8-DHA). Undiagnosed, such subjects have progressed to renal failure and even death. One child presenting in coma had a diet of pulses and...
Multivitamins or single-nutrient supplements to get your water-soluble vitamins, moderation is advised (see Supplement Sense, page 38), because high doses of several of the B vitamins can have harmful effects, and high doses of vitamin C may contribute to the formation of kidney stones.
The important physiological roles played by the nucleic acid precursor rNTP and dNTP molecules in humans has become apparent since the 1970s by the recognition of 28 different inborn errors of purine and pyrimidine metabolism. The spectrum of clinical manifestations ranges from fatal immunodeficiency syndromes to muscle weakness, severe neurological deficits, anemia, renal failure, gout, and urolithiasis (uric acid kidney stones).
Calcium-containing kidney stones are adverse clinical consequences of excess diet-derived acids. Diets rich in potassium with its bicarbonate precursors might prevent kidney stones and bone loss. In processed foods to which potassium is added and in potassium supplements, the conjugate anion is typically chloride, which cannot act as a buffer.
Severe potassium deficiency, which most commonly results from diuretic-induced potassium losses, is characterized by a serum potassium concentration of less than 3.5 mmol l. The adverse consequences of hypo-kalemia are cardiac arrhythmias, muscle weakness, and glucose intolerance. Moderate potassium deficiency, which commonly results from an inadequate dietary intake of potassium, occurs without hypokale-mia and is characterized by increased blood pressure, increased salt sensitivity, an increased risk of kidney stones, and increased bone turnover. An inadequate intake of dietary potassium may also increase the risk of stroke and perhaps other cardiovascular diseases.
The AI for potassium in pregnancy (4.7g day) is set at a level that will lower blood pressure, reduce the extent of salt sensitivity, and minimize the risk of kidney stones. There is no evidence that adverse effects of potassium are seen with high intakes from food and no UL was set, but potassium supplements can cause high blood potassium in some chronic diseases, such as renal disease and type 1 diabetes.
Chronic thiazide diuretics in the treatment of hypercalciuric patients with kidney stones may render them prone to the development of hypocitraturia (due to hypokalemia), hypomagnesemia, and hypomagnesiuria. Urinary citrate and magnesium are both important urinary inhibitors of crystallization of calcium oxalate and calcium phosphate salts.
Calcium stone formation, and may attenuate the beneficial effects of the decline in urinary calcium excretion. Recently it was shown that potassium supplementation in patients taking thiazide with potassium citrate not only prevents the development of hypokalemia, but also increases urinary citrate levels. Clinically, the addition of potassium citrate to ongoing thiazide therapy caused a remission of stone disease in 77 and reduced stone formation in 100 of the patients. The favorable response to combined thiazide and potassium citrate therapy, compared with that of thiazide alone or thiazide with potassium chloride, suggests that potassium citrate was largely responsible for the clinical improvement. In patients who continued to form kidney stones during long-term thiazide treatment with sufficient potassium chloride supplementation to prevent hypokalemia, only a slight rise in urinary citrate excretion was seen. Even so, the citrate value remained low relative to normal levels. The...
Pyelonephritis may also cause flank pain however the prodrome is less acute and the discomfort usually not as severe as renal colic. Fever is not a finding with kidney stones, and the urinalysis of renal colic does not demonstrate bacteriuria or pyuria in the absence of a concurrent infection. If renal obstruction is suspected concurrently with pyelonephritis, obstruction must be excluded by IVP, CT, or ultrasound. Antibiotics have poor penetration into an obstructed kidney. If infection in the presence of obstruction is confirmed, emergency urologic consultation for prompt obstruction relief should be obtained.
In older patients, infections and nephrolithiasis remain common causes of hematuria, but after age 40 any hematuria, even with a clear diagnosis of urinary tract infection or stone, warrants close follow-up and retesting of urine because renal, bladder, and prostate cancer increase in frequency and may coexist with urinary tract infection or kidney stone. Risk factors for uroepithelial cancer in addition to age over 40 include excessive analgesic use, tobacco use, occupational exposures (e.g., to dyes, benzenes, or aromatic amines), pelvic irradiation, and cyclophosphamide use. Similarly, hematuria in a patient on oral anticoagulants should not be attributed to the anticoagulant alone, since the incidence of underlying disease may be as high as 80 percent. 8 Expanding abdominal aortic aneurisms (AAAs) may erode into the urogenital tract or cause inflammation or obstruction from direct pressure. Signs and symptoms include back or flank pain, with or without hematuria.
Corynebacterium jeikeium is most frequently characterized by resistance to most common antibiotics. Although found on normal human skin it causes low-grade bacteremias, generally in the immunosuppressed and particularly in males with leukemia. The mechanism of pathogenesis is unknown. C. urealyticum is similarly a skin resident and resistant to many antibiotics, it is a rare cause of kidney stones.
Prevents scurvy helps to heal ulcers causes constipation unpasteurized milk has more nutrients than pasteurized a glass of milk before bed causes drowsiness mothers who drink a lot of milk have colicky babies milk and other dairy products are fattening and should be avoided on a low-fat diet the calcium in milk and other foods causes kidney stones Prevents vaginal yeast infections cures vaginitis, constipation, and diarrhea yoghurt applied topically heals a sunburn
Parathyroidectomy is indicated for all patients with symptomatic HPT. Nephrolithiasis, bone disease, and neuromuscular symptoms are improved more often than are renal failure, HTN, and psychiatric symptoms. Parathy-roidectomy for asymptomatic HPT is somewhat controversial (Table 15-1). Accepted indications include markedly elevated serum calcium, hypercal-cemic crisis, reduced creatinine clearance, asymptomatic kidney stones, markedly elevated urinary calcium excretion, and significant osteoporosis. Close observation is required for patients not treated surgically.
Uncontrolled production of parathyroid hormone may result from a pituitary adenoma or primary hyperparathyroidism or from a chronically low serum calcium level secondary to the renal failure of secondary hyperparathyroidism. Primary hyperparathyrodism occurs most commonly over the age of 60 years and is four times more prevalent in females. The classic findings of hyperparathyroidism include stones, bones, and abdominal groans. Stones refer to an increased incidence of kidney stones. Abdominal groans refer to the tendency to develop duodenal ulcers. Bones refer to a variety of osseous lesions such as the radiographic subperiosteal resorption of the phalanges of the index and middle fingers. Generalized loss of the lamina dura surrounding the roots of teeth is an early finding. With disease progression, loss of trabeculation results in a ground glass radiographic appearance of the mandible and maxilla. Persistent disease results in the development of other osseous lesions such as the...
Calcium is the major component of bone, providing structural skeletal support to the human body (see 00033). The approximately 2-3 kg of bone calcium in each person also provides a storage reservoir for the small percentage of ionized calcium that allows muscle to contract, nerves to communicate, enzymes to function, and cells to react. The body has developed several hormonal mechanisms, including vitamin D, parathyroid hormone, and calcitonin, to protect the small amount of ionized calcium in the blood from changing drastically. Tight control of blood calcium levels is needed because unduly low blood calcium might result in uncontrolled tetanic muscle contractions and seizures, while high blood calcium levels may cause kidney stones and muscle calcifications. To increase blood calcium levels, vitamin D and its metabolites increase calcium absorption from the intestinal tract, parathyroid hormone increases calcium reabsorption from the kidney, and both increase resorption of calcium...
The most common cause of calcium levels within 1 mg dl above the upper limit of normal is primary hyperparathyroidism. If the normal range of serum Ca concentration is 8.5-10.5 mg dl, most patients with primary hyperparathyroidism will show Ca levels between 10.6 and 11.5 mg dl. Even with mild hypercalcemia, if such a patient suffers from any of the adverse consequences of hyperparathyroidism such as kidney stones, recurrent ulcers, or fractures, or if underlying physiologic derangements are present such as hypercalciuria or markedly reduced bone mineral density, the appropriate recommendation would be parathyroid surgery. However, approximately 50 of patients with primary hyperparathyroidism will not demonstrate any of these complications and, thus, will not be clear surgical candidates.
On the basis of available data, an Institute of Medicine committee set an Adequate Intake for potassium at 4.7g day (120 mmol day) for adults. This level of dietary intake should maintain lower blood pressure levels, reduce the adverse effects of salt on blood pressure, reduce the risk of kidney stones, and possibly decrease bone loss. Current dietary intake of potassium is considerably lower than this level.
A variety of stimuli can produce an acute episode of autonomic dysreflexia. The commonest causes usually involve the urinary system bladder distention, urinary tract infection, and kidney stones. The second commonest reasons involve the colon fecal impaction or bowel distention. However, any noxious stimulus below the level of injury can lead to autonomic dysreflexia, including other abdominal problems, such as ulcers, appendicitis, and gallstones. Other causes may be fractures, deep venous thrombosis (DVT), pressure ulcers, ingrown toenails, tight-fitting clothing, sunburns, blisters, heterotopic ossification, sexual intercourse, pregnancy, and labor and delivery.
Primary hyperparathyroidism may present in a variety of ways. Patients may be asymptomatic and the disease may be recognized through routine screening laboratory tests. Other patients may present with severe renal or bone disease. Because calcium affects nearly every organ system, calcium dysregulation may present clinically with a multitude of signs and symptoms. The most common symptoms include fatigue, weakness, depression, arthralgia and constipation. Conditions associated with hyperparathyroidism include kidney stones, chondrocalcinosis, osteitis fibrosa cystica, osteoporosis, hypertension, gout, peptic ulcer disease and pancreatitis. Patients with excess PTH production may experience progressive loss of bone mineralization. This is manifested as subperiosteal resorption, osteoporosis and pathologic fractures. Skeletal involvement is most readily demonstrated by radiographic films.
Natives of desert regions have, over the years, habituated to being chronically dehydrated. A study of the desert inhabitants found that they had a curtailed thirst drive that was associated with excretion of low volumes of concentrated urine and a high incidence of kidney disease (kidney stones). When additional water intake (approximately twice normal) was ingested in a subsample of this population, they were able to exercise 10 longer in the desert environment, presumably due to improved thermoregulation. The results of this and other studies illustrate that humans probably do not adapt to dehydration but can become used to a mild chronic dehydration due to inadequate fluid intake. This is not a true physiological adaptation since there are negative health and performance effects associated with chronic dehydration.
Urine that collects in the hollow structure of the renal pelvis is propelled through the ureter toward the bladder by peristaltic contractions of the renal pelvis and ureter, both of which are invested with smooth muscle in their walls. As in the case of other visceral smooth muscle, this action is enhanced by parasympa-thetic and inhibited by sympathetic innervation. The walls of the pelvis and ureters are also invested with pressure receptors that convey pain sensations to the central nervous system if pressure rises in these structures. This is the origin of the extreme pain associated with obstruction of the urinary tract by kidney stones. These receptors are also the sensory input to a reflex arc, the ureterorenal reflex, which produces a sympathetic efferent discharge to the kidney that reduces the rate of glomerular filtration.
Stone formation occurs as a result of an imbalance between the solubility of salts and their crystallization. In the Western world, 70-80 of stones are composed of calcium oxalate. Ureteric stones form initially in a renal papilla from a small submucosal concretion. As the crystallization increases, it separates from the papilla and passes into the collecting system with the urine. Before they pass into the calyces, such stones are seldom symptomatic although they can be associated with recurrent urinary infections. Conversely, a staghorn renal calculus that fills the renal pelvis and calyces is formed within the collecting system. Such stones are often seen with urine chronically infected with Proteus mirabilis. This bacterium splits urea to ammonia, alkalinizes the urine and precipitates magnesium ammonia phosphate. This becomes calcified and the stone may form a complete cast of the collecting system. Small kidney stones can be fragmented by extracorporeal shock wave lithotripsy...
Indapamide is a relatively recent antihypertensive drug, the chemical structure of which differs from the classical benzothiadiazines, including chlorothiazide, hydrochlorothiazides, and bendroflumethiazide 1 . It has been shown that indapamide has a potent hypocalciuric effect in normal subjects and also in patients with hypercalciuria and calcium nephrolithiasis. Thus, indapamide could represent an alternative drug to thiazide diuretics in the treatment of calcium stones.
By virtue of its mineral-binding abilities, PA may also aid in the prevention of renal calculi Figure 14.3(C) . PA has been shown in vitro to best prevent brushite, a form of calcium phosphate and component of renal calculi, crystallization and precipitation 123 . In rats, it has been observed that PA treatment can reduce the number of ethylene-glycol-induced calcifications and total calcium amount in the kidney 124 . Grases et al. 125 have also shown that the propensity of the AIN-76A rat diet to cause renal calculi is due to a lack of dietary PA. In humans, it has been shown that individuals prone to stone formation had significantly lower urinary PA levels than those not prone to stone formation 126 . Also in humans, Ohkawa et al. 127 have shown that consumption of rice bran, rich in PA, for periods ranging from one to three years can reduce kidney stone formation. Thus, it appears that PA can effectively inhibit renal crystallization of calcium salts. Because urinary PA levels are...
Triamterene also has several unique side-effects. The drug can precipitate within the distal renal tubules and has been associated with acute renal insufficiency, especially when it is used together with nonsteroidal anti-inflammatory drugs. Clinically significant kidney stones, composed principally of triamterene, have also been reported.
It is also important to look at the vital signs and the overall state of the patient. Before beginning the directed physical examination, look at the patient. Are they lying still because any movement causes extreme abdominal pain, implying peritoneal irritation Or are they writhing around and rocking from side to side because they cannot seem to get comfortable, implying a more colicky pain caused by colonic distention or a kidney stone Are they lying with their knees bent or in a slightly folded over position because it hurts to straighten out Is the patient febrile, tachycardic, or hypotensive Patients who present with the complaint of abdominal pain usually have been experiencing the pain for a substantial amount of time before they present to a physician. Patients will often believe that they have the flu, menstrual cramps, or some other more common etiology before they realize that the pain has not gone away and is actually worse. As a result, they often present late in the...
These girls may present to the ED with a variety of symptoms, including fainting due to apnea or hyperventilation or with severe abdominal distension due to air swallowing. Apnea has been known to last 30 to 40 s and may involve cyanosis. Screaming attacks may occur in puberty. Children need to be assessed for possible pain due to an acute abdomen, dental pain, kidney stones, or other medical causes. If no source of medical concern is identified, the child may be suffering from a screaming attack.
Shock waves generated by external piezoelectric devices. The waves are guided toward the stones by ultrasound imaging. This procedure was first used for kidney stones. Its efficacy in gall bladder stone treatment has been much less impressive. Its complications are the consequence of migration of stone fragments and include postprocedure biliary colic and pancreatitis. The availability of laparoscopic cholecystectomy has limited the need for lithotripsy.
If the patient presents febrile, with a potential for infection or sepsis, it is appropriate to perform a thorough fever workup prior to identifying an exact diagnosis, drawing labs, blood cultures, sending off a urinalysis and urine culture and sensitivity, and checking a chest x-ray. Pneumonia, urinary tract infection, and kidney stones can all present as abdomen pain. If the chest x-ray and urinalysis rule out these sources of infection, then one should consider giving the patient an empiric dose of antibiotics with coverage of enteric bacteria, which can be later tailored to a specific organism or cause.
51 Tips for Dealing with Kidney Stones
Do you have kidney stones? Do you think you do, but aren’t sure? Do you get them often, and need some preventative advice? 51 Tips for Dealing with Kidney Stones can help.