Beware of kidney stones in summer
July 25 2019 11:22 PM
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Dr Joy P George

The weather in the region is relatively dry and hot winds are reported often. With temperatures reaching unbelievable highs, the heat and humidity wreaks havoc with the kidneys. Summer is often called the kidney stone season as our bodies get dehydrated faster due to sweating and chances of dehydration are high. Dehydration is one of the common causes of kidney stones.
Kidney stones are clumpy deposits that form in the kidneys because your body is not able to excrete the crystal like substances easily. They can occur in anyone, even youngsters, though genetics, age and sex may play a part.
A stone may cause no problems but often it causes pain. Most kidney stones are small and pass out with the urine. Some stones become stuck in a ureter or kidney and cause persistent symptoms or problems. There are various treatment options to remove a stuck stone. About half of people who have a kidney stone develop another one at a later time in their life. Drinking plenty of water each day may prevent a recurrence.

What are kidney stones?
Kidney stones can form within the kidney, within the ureter (the tube draining urine from the kidney) or in the bladder. They can be many different sizes and shapes. The size of kidney stones ranges from tiny microscopic crystals to stones as large as potatoes.

How common are kidney stones?
About 3 in 20 men and 1 in 20 women develop a kidney stone at some stage in their life. They can occur at any age but most commonly occur between the ages of 20 and 40. About half of people who develop a kidney stone will have at least one recurrence at some stage in the future.

How do kidney stones form?
The kidneys filter the blood and remove excess water and waste chemicals to produce urine. Urine travels from each kidney down a tube called the ureter into the bladder, then out of the body via the urethra when the bladder is full. Many waste chemicals are dissolved in the urine. The chemicals sometimes form tiny crystals in the urine which clump together to form a small stone.
If you have ever passed a kidney stone, you are not likely to forget the experience – it can be excruciatingly painful. Kidney stones are a fairly common disorder.
It often occurs when urine becomes too concentrated – causes mineral and other substances in your urine to form crystals. About 80% of stones consist of Calcium and Oxalate. Most other stone are composed of uric acid – end product of protein metabolism. Struvite stones result from urinary tract infection. Not all stone cause symptoms.

Usual symptoms
Intensive colicky pain
Bloody or cloudy urine
Fever and chills
Some of the substances filtered by the kidney – especially calcium, oxalate, uric acid and cystine – have tendency to form crystals. Other substances such as citrate and magnesium help to prevent crystal formation. Normally those substances are in balance. Crystal formation can occur when too many of these elements or too little of the protective substances.
Crystal forms when the urine is too concentrated or is too acidic or alkaline.

Factors Favouring Kidney Stones
• Heredity
• Diet
• Drugs
• Climate
• Life style factors

Variety of Stones
Calcium Stones
Form 75 – 85% – usually combination of calcium and oxalate, causes increased calcium excretion in urine
Large amount of vitamin D increases calcium absorption
Thyroid hormone drugs
Drugs used to control increased urination

Uric Acid Stones
Uric acid stone is bye product of protein metabolism. Seen in increase intake of meat or in gout

Struvite Stones
Are seen in urinary tract infection

Risk Factor
Family History
Age, gender and race
Certain diseases like – renal tubule acidosis, cystinuria
Certain medications – calcium based antacids
Diuretics
Diet – high protein diet (meat)/Fruits
Limited activity – bedridden patients

Diagnosis
Silent stones are detected by routine X-rays or ultrasound study for some other symptoms.
CT is useful in some case.
Treatment
Treatment varies with the type of stones, you may be able to move a stone through your urinary tract simply by drinking plenty of water. Stones that cannot be detected with conservative method may have to be treated surgically, either by:
ESWL (Extracorporial Shockwave Lithotripsy) – uses shockwave to break the stones into small crystals that are passed in your urine.
PCNL (Percutaneous Nephro Lithotripsy) – when ESWL is not effective or the stone is very large.
Ureteroscopic removals of the stones – for stones are which lodged in the tube.

Prevention
Life style changes – Research has shown that kidney stones can be prevented by making changes in the diet.
Drinking more fluid – At least 10-15 ounce glass fluid especially water / day is recommended. Cola beverages, coffee and tea should be limited to two ounces / day because these fluids contain oxalates – contributes in the growth of calcium and oxalate stones.
More fluid maybe needed to stay hydrated in hot days or when you are active. Drinking lemonade made from fresh lemon or lemon juice may help reduce the risk of kidney stone formation. Lemon juice increases the level of citrate in the urine which in turn prevents the formation of kidney stones.
Moderating salt consumption. Sodium increases the concentration of calcium and crystallation in urine (2,000 – 3,000 mgs/day). A table spoon of salt contains 2,325mg of sodium.
Eating a healthful amount of calcium. Ideally people should eat 1,200mg calcium each day preferably derived from food such as dairy products.
Moderating conception of animal proteins. Eating too much animal proteins can lead to calcium and uric acid in the urine as well as low level of citrate in the urine which in turn favour calcium, oxalate, phosphate and uric acid stones.
Moderating conception of oxalate rich food. Oxalate is found naturally in many fruits and vegetables. The highest amounts of oxalate are found in dark green leafy vegetables.
Using vitamin carefully. Do not consume more than the 100% of the recommended daily dose for vitamin C, Vitamin D & calcium. Dietary supplements especially calcium should be taken with a meal to minimise the risk of forming a kidney stone.
It can be especially helpful to drink more water, since low fluid intake and dehydration are major risk factors for urinary stone formation.
— Dr Joy P George MBBS, MS, MCh (Urology) is a Specialist Urologist at Aster Medical Centre, Al Hilal



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