Kidney Stones

Brenda ZeladaKathy LiangPerla FalconXochitl Pedraza

Each year, more than half a million people go to emergency rooms for kidney stone problems.

The number of people in the United States with

kidney stones has been increasing over the past 30 years

The peak age for stones is between 20 years and 50 years.

White Americans are more prone to develop kidney stones than African Americans

Men are much more likely to develop stones than women.

What are Kidney stones?

A kidney stone is a hard object that is made from chemicals in the urine.

When there is too much waste in too little liquid, crystals begin to form.

The crystals attract other elements and join together to form a solid that will get larger

Sometimes, tiny stones that move may move of the body in the urine without causing too much pain

But stones that don't move may cause a back-up of urine in the kidney, ureter, the bladder, or the urethra. This is what causes the pain.

• In China in 2008, a toxin added to milk named melamine caused many children to develop kidney stones.

• Scientists found evidence of kidney stones in a 7,000-year-old Egyptian mummy.

FYI

Risk Factors / Possible causes Drinking too little water exercise (too much or

too little) obesity, weight loss

surgery eating food with too

much salt or sugar Infections and family

history Eating too much

fructose

Diseases like high blood pressure

Obesity Osteoporosis chronic diarrhea kidney cysts Diabetes increases the

risk of developing kidney stones, especially in younger women

Types of Kidney StonesName of Stone Approximate

incidenceConstituents

Calcium oxalate 70 percent of all stones Calcium, oxalate

Calcium phosphate 10 percent of all stones Calcium, phosphate

Uric acid 5-10 percent of all stones Uric acid

Struvite 10 percent of all stones Calcium, ammonia, phosphate

Cystine Less than 1 percent of all stones Cystine

Medication-induced stones

Less than 1 percent of all stones Composition depends on medication or herbal product (examples include indinavir, ephedrine, guaifenesin, silica)

• Kidney stones are comprised of various combinations of compounds

• The stone-forming chemicals are calcium, oxalate, urate, cystine, xanthine, and phosphate

Calcium Oxalate• Oxalate is a compound

that is naturally present in many foods.

Fructose can be found in table sugar and high fructose corn syrup. In some individuals, fructose can be metabolized into oxalate

The following six factors increase the risk of forming calcium oxalate stones.

1.The amount of oxalate in certain foodsbeets, spinach, rhubarb, strawberries, nuts, chocolate, tea, wheat bran, and all dry beans 2. The amount of calcium in your dietLow amounts of calcium in your diet will increase your chances of forming calcium oxalate kidney stones3. The vitamin C content of your dietLarge doses of Vitamin C may increase the amount of oxalate in your urine. Do not take more than 500 mg of Vitamin C

daily.

4. The amount of fluids in your dietGoal should be 10-12 glasses a day. At least 5-6 glasses should be water. Lemonade may be helpful in reducing the risk calcium oxalate stone formation5. The amount of protein in your dietLarge amounts of protein may increase the risk of kidney stoneFormation. daily protein needs: 2-3 servings a day, or 4 to6 oz.6. The amount of sodium in your dietReduce the amount of sodium in your diet to 2-3 grams per

day.Limit eating processed foods

Rarely, calcium phosphate stones can result from a condition called renal tubular acidosis, where the kidney is unable to appropriately acidify the urine.

• Uric acid is produced when the body breaks down protein

• People who consume high animal protein (meat) diets are more likely to form uric acid stones.

• Gout, chemotherapy, and disorders where there are high turnover of cells are also risk factors

• Struvite stones are composed of mixtures of magnesium, ammonium, phosphate and calcium carbonate phosphate crystals.

• These stones develop as a consequence of recurrent or chronic urinary tract infections.

• Cystine stones account for only 1% of all kidney stones.

• They are due to a rare inherited genetic condition that results in high levels of cystine in the urine.

• These stones can occur in childhood.

Diets that may contribute to kidney stone formation Eating a diet that's high in protein, sodium

and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium in your diet increases the amount of calcium your kidneys must filter and increases your risk of kidney stones.

Drinking plenty of water will help pass kidney stones and prevent them from forming

Foods to Avoid - sweet potatoes - rhubarb - black tea - spinach - chocolate - beets - okra - Swiss chard - peanuts -soybean crackers -wheat germ

- liver - grits -marmalade - grapes - strawberries - celery - fruit cake -red raspberries - green peppers

Drinks to avoid:- dairy products (milk, cheese etc)- white flour- tea- coffee- spices- sugar loaded foods- meats- condiments (ketchup, mayo, relish etc.)

Tests to diagnose kidney stones Blood tests. Blood tests may reveal too

much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may indicate your doctor to check for other medical conditions.

Urine tests. Tests of your urine, such as the 24-hour urine collection, may show that you're excreting too many stone-forming minerals or too few stone-preventing substances.

Imaging tests. Imaging tests may show kidney stones in your urinary tract. Options range from simple abdominal X-rays, which can miss small kidney stones, to computerized tomography (CT) that may reveal even tiny stones. Other imaging options include an ultrasound, a noninvasive test, and intravenous pyelography, which involves injecting dye into your arm vein and taking X-rays as the dye travels through your kidneys and bladder.

Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what's causing your kidney stones and to form a plan to prevent more kidney stones.

Signs & Symptoms A kidney stone may not cause symptoms until it moves

around within your kidney or passes into your ureter

•Severe pain in the side and back, below the ribs•Pain that spreads to the lower abdomen and groin•Pain that comes in waves and fluctuates in intensity•Pain on urination•Pink, red or brown urine•Cloudy or foul-smelling urine•Nausea and vomiting•Persistent urge to urinate•Urinating more often than usual•Fever and chills if there is an infection

Treatment your doctor thinks the

stone can pass on its own

Extracorporeal shock wave lithotripsy (ESWL). ESWL uses shock waves that pass easily through the body but are strong enough to break up a kidney stone. This is the most commonly used medical procedure for treating kidney stones.

• Surgery is rarely needed to treat kidney stones. Surgery is only needed when the kidney stone is very large, caused by an infection (staghorn calculi), blocking the flow of urine out of the kidney, or causing other problems like severe bleeding

• Ureteroscopy. The surgeon passes a very thin viewing tool (ureteroscope) up the urinary tract to the stone's location, and then he or she uses tools to remove the stone or break it up for easier removal.

Lasertripsy the calculus is visualized and destroyed with laser

Medications to prevent kidney stones Medications that assist in passing

stones are:• NSAIDS Non-steroidal Anti- inflammatory

Drugs• Alpha blockers, which relax the wall of the

ureter

PreventCalcium stone:

OrthophosphatePotassium citrateThiazides

  Uric Acid Stone:

AllopurinolPotassium citrateSodium bicarbonate

 

Cystine Stone:PenicillaminePotassium citrateTiopronin

 Struvite Stones

Staghorn calculi due to frequent infection.

Use antibiotic to cure the infection

Use Urease inhibitors

http://youtu.be/vKXofFLTce8

THANK YOU