I recently read about a report titled "Dietary and Pharmacologic Management to Prevent Recurrent Nephrolithiasis in Adults: A Clinical Practice Guideline From the American College of Physicians."
Stay with me here. We're talking kidney stones.
The loftily titled paper was developed by members of the American College of Physicians, who are internists, or specialists, in the care of adults. A summary was printed in the Nov. 4 issue of Annals of Internal Medicine, and it is available online at bit.ly/1yS5a1l.
The panel reviewed research on the benefits and detriments of drug and dietary treatments to prevent recurrent episodes of kidney stones. Should we drink more water? Should we drink fewer soft drinks? Should we try drug therapy? What approach would work the best? The authors conclude that -- while there's not strong evidence showing which behaviors or treatments prevent the formation of particular types of stones -- available evidence justifies two recommendations:
• People who keep getting stones should drink enough fluids throughout the day that they produce at least 2 liters of urine daily.
• If they still develop stones despite drinking all that fluid, medications are in order.
In other words, first try drinking a lot more fluid.
I've never had a kidney stone, thank God, but I know those who have, and I have heard the stones can be extremely painful.
According to the National Kidney Foundation website (kidney.org), more than half a million people go to the emergency room for kidney stone problems yearly. And the numbers are on the upswing.
The peak age is between 20 and 50, and men are more prone to them than women. Diseases like high blood pressure, osteoporosis, obesity, diabetes and kidney cysts increase the risk of stones.
I reached out to the experts at the University of Arkansas for Medical Science and was put in touch with Dr. Rajalakshmi Cheerla, who is an assistant professor and associate director for the Medical Student Education Department of Family and Preventive Medicine.
Cheerla says that kidney stones form when our urine contains more crystal-forming substances than it can dilute. These include calcium, oxalate and uric acid.
The Kidney Foundation says that the crystals attract other elements and join together to form a solid mass that will only get larger. In most people, having enough liquid on board washes these minerals out, or other chemicals in our urine stop the stone from forming in the first place.
But once a stone forms, it may stay in the kidney or travel down the urinary tract into the narrow tubelike ureter that leads to the bladder. Tiny stones can be flushed out in our urine without causing much pain. But stones that don't move can cause a backup of urine from the urethra, bladder or ureter up into a kidney, and that causes excruciating pain.
Cheerla explains that there are several kinds of kidney stones. Most common are calcium stones, usually in the form of calcium oxalate from foods that upset the balance of acid in the urine, but another culprit is a buildup of calcium in our urine.
Oxalate is a naturally occurring substance in food. It is found in things like peanuts, spinach, beets, sweet potatoes and chocolate. Avoiding these foods might help. And if you have high calcium in your urine, focus on limiting sodium in your diet. And look out for hidden sodium in processed foods.
Struvite stones form in the kidney or bladder in response to certain bacterial infections. These stones can become quite large, sometimes with little warning.
Uric acid stones can form in people who don't drink enough fluids or who lose too much fluid, those who eat a high protein diet and people who have gout.
To help prevent these, cut down on high-purine foods. Purines are naturally occurring, and are found in meat, seafood and many high-protein foods. Eat more vegetables, fruits, whole grains and low-fat dairy products. Cut back on things like chicken, fish, organ meats, lobster, shrimp, bacon, beef, ham, veal, cauliflower and venison.
Cystine stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids.
So what are the symptoms of a kidney stone? The Kidney Foundation lists:
• Severe pain on either side of your lower back.
• A vague pain or stomach ache that doesn't go away.
• Blood in the urine.
• Nausea.
• Fever and chills.
• Urine that smells bad or looks cloudy.
When in doubt, see a doctor. A professional can evaluate the health of your kidneys through testing and decide how to deal with it, factoring in your overall health.
As for treatment, Cheerla says, that will vary depending on the size of the stone and the underlying cause. Most do not require invasive treatment. Larger stones that cannot be passed naturally might need it, though.
Treatments can include:
• Using sound waves to break up stones with extracorporeal shock wave lithotripsy (SWL).
• Using a ureteroscope to remove the stones.
• In rare cases, very large stones may require a surgical procedure called percutaneous nephrolithotomy.
Say that three times fast.
One of the main things we can do is drink enough water throughout the day. The Kidney Foundation recommends 12 cups of fluid, and more if you live in a hot, dry climate. This will help keep urine less concentrated, which reduces the risk of stones forming.
And sweating can affect our system too. Be sure to keep well hydrated.
The Kidney Foundation says that people who get calcium-oxalate stones can try eating a combination of oxalate-rich foods and calcium-rich foods together during a meal. Combined, the calcium and oxalate are more likely to bind to one another in the stomach and intestines before the kidneys begin processing things. That makes it less likely that stones will form.
Cheerla says that we should use caution with calcium supplements. They have been linked to increased risk of kidney stones. If you do take supplements, reduce the risk by taking them with meals. Or skip the pills and instead eat more calcium-rich foods.
Email me at:
rboggs@arkansasonline.com
ActiveStyle on 12/01/2014