Kidneys Stones Desease6 Nov 2017
For patients with struvite stones, it is important not only to remove the stone, but also to prevent recurrence of the urinary tract infection. However, some stones grow too large to be passed out of the body easily and get stuck on their way through the urinary tract.
You’re more likely to get kidney stones if you’ve had one before, if they run in your family, or if you have certain health conditions like obesity , high blood pressure or gout. 32. Taylor EN and Curhan GC. Dietary calcium from dairy and nondairy sources, and risk of symptomatic kidney stones. 29. Curhan GC, Willett WC, Knight EL et al: Dietary factors and the risk of incident kidney stones in younger women (Nurses’ Health Study II).
25. Curhan GC, Willett WC, Rimm EB et al: Body size and risk of kidney stones. 24. Curhan G, Willett W, Speizer F et al: Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. 23. Curhan GC, Willett WC, Rimm EB et al: A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones.
Due to the infected nature of struvite stones, patients may continue to be at risk for persistent or recurrent urinary tract infections even after stone removal. Patients treated for struvite stones may still be at risk for recurrent urinary tract infections after stone removal, and in some patients surgical stone removal is not feasible. Clinicians should offer thiazide diuretics and/or potassium citrate to patients with recurrent calcium stones in whom other metabolic abnormalities are absent or have been appropriately addressed and stone formation persists.
Clinicians should offer allopurinol to patients with recurrent calcium oxalate stones who have hyperuricosuria and normal urinary calcium. Prospective, randomized controlled trials have demonstrated that potassium citrate therapy is associated with reduced risk of recurrent calcium stones.37, 39, 109, 110 Patients in these trials had 24-hour urinary citrate excretion that was either low or at the lower end of the normal range. Along with high fluid intake, alkali citrate37, 39 and allopurinol40, 41 have each been shown to be effective in reducing the risk of calcium stones, although the effect of allopurinol is limited to hyperuricosuric and/or hyperuricemic patients.
In all three cohorts, subjects completed food frequency questionnaires and biennial surveys inquiring about different aspects of their health, including whether they had ever been diagnosed with a kidney stone.23-32 These epidemiologic studies have implicated low calcium intake23, 24, 28, 29 (women and younger men), low fluid intake,23, 24, 28, 29 sugar-sweetened beverages33 and animal protein23, 24, 28, 29 (men with a BMI >25 mg/kg2) as risk factors for the development of a first-time stone. Most of these surrogates likely underestimate stone prevalence because of failure to detect asymptomatic stones, because of spontaneously passed stones that never involve health care resources, or because a stone was not substantiated by imaging studies or by the documentation of a passed stone despite a history of classic stone symptoms. 17. Clinicians should offer thiazide diuretics and/or potassium citrate to patients with recurrent calcium stones in whom other metabolic abnormalities are absent or have been appropriately addressed and stone formation persists.
16. Clinicians should offer allopurinol to patients with recurrent calcium oxalate stones who have hyperuricosuria and normal urinary calcium. Drinking more fluids and changing the diet can help to prevent future kidney stones ( table 1 ). (See ‘Kidney stone prevention’ above.) ●Further testing is recommended for patients with recurrent kidney stones or in first-time stone formers who may be at risk for additional stone formation.
●The most common symptom of passing a kidney stone is pain; other symptoms include hematuria (blood in the urine), passing gravel, nausea, vomiting, pain with urination, and an urgent need to urinate. These include a past history or family history of kidney stones, certain dietary habits, underlying medical problems, certain medications, and dehydration ( table 1 ). (See ‘Kidney stone risk factors’ above.) The goal is to increase the amount of urine that flows through your kidneys and also to lower the concentrations of substances that promote stone formation.
In addition, your clinician may request that you perform a 24-hour urine collection (all the urine you make over a 24-hour period) to determine underlying risk factors for your kidney stone disease. Certain diseases, dietary habits, or medications can increase your risk of developing kidney stones ( table 1 ). The kidneys are part of the urinary tract, which also consists of two ureters, the bladder, and the urethra.
A growth on the parathyroid gland may cause an excessive production of calcium, leading to the formation of kidney stones. By drinking up to 12 glasses of water a day you can help flush away the substances that form kidney stones. Cystine stones can form in people who have cystinuria, a condition passed down through families in which stones are made from an amino acid called cystine.
A. Ureteroscopy is one of two preferred methods for the treatment of small- to medium-sized kidney stones. Once the stones are located, they are targeted with a laser that breaks the stone into smaller pieces, which are then extracted, or into tiny pieces of dust that wash out of the kidney with normal urine flow. Big meals, yo-yo dieting, and binging put big demands on the kidneys and can promote stone formation.
We know that yo-yo diets are a great way to form gallstones, but risk for kidney stones also goes up. Higher levels of calcium in the urine can increase the chances of kidney stones for certain individuals (calcium is the most abundant mineral in kidney stones). In theory, even if your diet was extremely concentrated in rich foods, if your urine was always dilute, you probably wouldn’t form stones (but you may suffer from hyponatremia ).
Doctors think that people who form stones lack specific chemicals in the urine to prevent them. High blood pressure in particular doubles the risk of stones, since it changes how calcium is absorbed in the kidneys. Oxalates prevent calcium from being absorbed by your body, and can accumulate in your kidney to form a stone.
If your kidney stone is caused by an excess of calcium, you may be advised to reduce the amount of oxalates in your diet.