Kidney Stones

 Kidney Stones

                       Kidney Stones are hard deposits of minerals and salts that form inside one or both sides of the kidney.

Symptoms

• Back and Belly Pain
• Pain and Burning Sensation during Urination
• Blood in Urine
• Smelly Urine
• Nausea and Vomiting
• Fever and Chills

Types

        Four types of kidney stones are mostly found in our kidneys.

1. Calcium Stones
2. Uric Acid Stones
3. Infection Stone
4. Cystine Stone

1- Calcium Stones

•  About half of calcium stones are pure Calcium oxalate and the rest are the mixtures of Calcium Oxalate and Calcium phosphate.

Causes

1. Idiopathic (80%)
2. Primary Hyperparathyroidism
3. Medullary Sponge Kidney
4. Renal Tubular Acidosis
5. Primary Hyperoxaluria

Idiopathic Kidney Stones

                                           Idiopathic Kidney Stones affect men greater than women.

Causes

• Heavy Labour in Hot Conditions
• Dehydration
• Lack of Fluid Intake
• Consuming Animal Protein Rich Diet
• Consuming Oxalate Rich Diet
• Excessive Intake of Calcium And Vitamin D

Dietary Management

• Calcium:  (Limited to 300-500 mg/day)
• Oxalate: (If calcium is present in limited amounts in the body, more free oxalate will be absorbed in the body leading to hyperoxaluria and formation of kidney stones, so calcium and oxalate should be kept in balance)
• Fiber: (Fiber should be increased in the diet as phytic acid present in cereal fiber binds calcium in the  gut and helps to inhibit calcium absorption)
• Fluid: ( Fluid Intake should be encouraged)
• Protein: (Consumption of Animal Protein is limited)

Management of Primary Hyperparathyroidism

• The parathyroid gland is removed
• A low calcium diet is preferred

Management of Medullary Sponge Kidney

• Calcium intake should be restricted

Renal Tubular Acidosis

                                          Patients with Renal tubular acidosis cannot produce acid urine because renal tubules are unable to reabsorb bicarbonate.

Management

• Administration of Alkalies
• Animal protein should  be restricted

Primary Hyperoxaluria

                                      Inborn error of glyoxylic acid metabolism

Management

• Pyridoxine doses of up to 1 g/day with a low oxalate diet

Secondary Hyperoxaluria

                                             Calcium binds with fatty acids in the gut leaving more oxalate available for absorption.

Management

• Low Fat Diet
• Low Oxalate Diet

2- Uric Acid Stones

• Commonly found in Industrialized countries
• Only a small portion of sufferers have raised urinary uric acid levels due to;

1. Higher Intake of Purines from a diet rich in Animal Protein
2. Acidic urine leading to uric acid deposits

Management

• Administration of Alkalis (such as sodium or potassium bicarbonate and citrate)
• Fluid intake should be encouraged
• Limit consumption of Purine-Rich Diet 

3- Infection Stones

• Limit Excessive Intake of calcium
• Fluid Intake should be enhanced
• Infections are eliminated with antibiotics
• Ammonium Chloride, Vitamin C, and Methionine should be given to acidify their urine

4- Cystine Stones

Causes

• A genetic disorder affecting a patient's renal tubular reabsorption of cystine, lysine, arginine, and ornithine.

Management

• Sodium bicarbonate is given to make the urine more alkaline
• Fluid Intake should be encouraged to increase urine output