Patient Education: What causes kidney stones?

Patients may be at risk for kidney stones if:-

• High concentrations of calcium, oxalate or uric acid in the urine.


• Low pH (urine too acidic)


• Concentrated urine (poor fluid intake)


• Not eating enough calcium (you absorb too much oxalate if calcium is low)


• Eating too much calcium


• High sugar intake


• High protein intake.


• High sodium intake.

MEDICAL CONDITIONS MAY ALSO PREDISPOSE TO KIDNEY STONE FORMATION

Gout

Diabetes Mellitus

Obesity

Gastric bypass

Primary hyperparathyroidism.

Crohn's disease.

SOME QUICK FACTS.

If you have previously had a stone you are at increased risk for a new one.

Drinking high volumes of grapefruit juice has been linked to kidney stones.

Green tea and coffee lowers the risk

Beer and wine are ok.

A normal calcium intake may protect you from kidney stone formation

A high calcium intake causes stones as well as a low calcium intake too.

Dietary fibres such as wheat and cereal reduces risk.

Excessive vitamin C intake increases the risk

Kidney stone symptoms.

Related articles

• Too Little Calcium, Water Linked to Kidney Stones (nlm.nih.gov)
• Impact of Nutritional Factors on Incident Kidney Stone Formation: A Report From the WHI OS (dynamomelano.wordpress.com)

Herbal corner: Can green tea prevent kidney stones

Red, black and green tea (Photo credit: mat.teo)

tea is more than a wonderful soothing beverage.....

Nephrolithiasis otherwise known as kidney stones are responsible for a very significant number of health issues. The lifetime risk of kidney stone formation is approximately 13% in men and 7% in women. The yearly economic cost of kidney stones has been estimated at 5.3 billion in the United States alone.

Anyone who has had a kidney stone knows it is not a pleasant occurence and would do almost anything to prevent them from recurring. Unfortunately most people are unable to comply with the large volume of water intake required to prevent stone formation. And drug therapy has provided mixed results, with some of the drugs intended to prevent stone formation causing different types of stones themselves.

Green tea has multiple health benefits but does it increase or decrease the risk of kidney stone formation?

A study published in the journal of urology has found that green tea reduces the formation of calcium oxalate stones which are the most common form of stone. It is though that this is brought about by the antioxidant effects of green tea. These finding are very similar to findings of other investigators.

How many cups of green tea should you drink, how hot should the water be, is there a difference in green teas obtained from China or Japan. There are no satisfactory answers to these questions yet. However in populations studies from the east it is proposed that the benefit of green tea particularly in prevention of cancer is approximately 5 to 6 cups per day. If the mechanism of this effect is the same then antioxidant effect may be maximal or near maximal at this dose. This should therefore be a reasonable starting point.

Patient Education: How do you lower your risk of Chronic Kidney Disease.

LAS VEGAS, NV - JANUARY 07: Dan Radin displays the USB Blood Pressure Monitor from Ion Health at the 2011 International Consumer Electronics Show at the Las Vegas Convention Center January 7, 2011 in Las Vegas, Nevada. The USD 70 device measures systolic and diastolic pressure and pulse rates and has an internal memory capable of holding up to 352 readings. The data can be uploaded via USB 2.0 to a computer where it can be used with Ion Health Suite software. CES, the world's largest annual consumer technology tradeshow, runs through January 9 and is expected to feature 2,700 exhibitors showing off their latest products and services to about 126,000 attendees. (Image credit: Getty Images via @daylife)

If you have diabetes and hypertension then you are at higher than average risk for chronic kidney disease. You should be aware of this and be very involved with your treatment, you must help your doctor to care for you!!.

Ask pertinent questions such as.

Q: Have you checked my kidneys? if so how are they doing.

Q: Is my Blood sugar within the normal range or at a range that reduces my risk of kidney disease developing?

Q:Is my Blood Pressure in the normal range. If not what can we do to make it so as that will reduce my chances of developing chronic kidney disease.

Q:My relative had kidney disease I am worried about developing it is there anything i can do to find out if i am at risk?

It is important to lead a healthy lifestyle exercise at least three times per week and eat a healthy balanced diet.

It is important to understand certain concepts.

SEELOW, BRANDENBURG - AUGUST 08: Country doctor Dieter Baermann measures the blood sugar level of an elderly patient in the patient's home on August 8, 2011 in Sachsendorf near Seelow, Germany. Baermann works in the state of Brandenburg in eastern Germany, a region that is struggling with a shortage of doctors in rural areas. Critics charge that current laws actually discourage doctors from taking up posts in rural areas, and the German government is debating a new law intended to reverse the trend. Many doctors across Germany complain about a legal system that they claim burdens them with too many costs and hampers their ability to provide the best care. (Image credit: Getty Images via @daylife)

Normal blood pressure is an arbitrary definition set at less than 120/80 mmHg. However large studies have shown that if blood pressure is lowered even further to just before the point of having symptoms of low blood pressure such as dizzyness and fainting then health benefits continue to accrue and your risk of stroke heart attack and chronic kidney disease improves.

When checking your blood sugar one of the most informative tests is a test of average blood sugar over the last 3 to 4 months. This is called the HbA1c or glycosylated Hb. For every point below 7 that this test registers you accrue benefits such as decreased heart attack and stroke and also decreased chronic kidney disease.

Having increased protein in your urine is not ok particularly if this is a recurrent problem. This could be a sign of early kidney disease. The earlier your disease the lower the protein is usually. Tests of microscopic amounts of protein in the urine can now be performed that detects very early kidney disease. Ask about the urine microalbuminuria test.

If you are male and above 45 having your regular prostate exam may reveal early enlargement which may obstruct outflow of the kidney. If early enough it is reversible and can prevent chronic kidney disease.

Infections of the bladder occur more frequently in women that men. Recurrent infections should never be treated as business as usual. A cause should be sought and if found may reduce your risk of chronic kidney disease from infection.

Males regardless of age should never have urinary tract infection this is never to be treated as business as usual or simply treated with a course of antibiotics. Referral to a specialist in urology and a detailed work up needs to be done to identify the cause so that it can be corrected before kidney damage occurs.

Patient Education: What causes Chronic Kidney Disease (CKD).

Studies done on the population of patients with CKD suggests that the two main causes are diabetes and hypertension. Together accounting for 30% of cases. When we look at patients who are already on dialysis the number jumps to almost 50%.

Diabetes is a condition where there is excess sugar in the blood stream, as a result of this the high concentrations of sugar damage the cells of the kidney leading to scarring of the delicate structures responsible for filtering the blood.

In hypertension the increased pressures that occur stress the the walls of the blood vessels within the body causing them to lose there elasticity or ability to stretch in response to increased pressures. This results in hardening of the blood vessels and decreased blood flow within the kidney which ultimately damages it.

Other causes of chronic kidney disease exist such as:

• Inflammation of the kidneys such as due to glomerulonephritis a long name for...you guessed it "inflammation of the kidney".
• Chronic infections of the kidney.
• Inherited problems with kidney development such as polycystic kidney disease.
• Obstruction of the flow of urine from the kidney such as in enlargement of the prostate.
• Cancer.

....and this is by no means an exhaustive list.

Patient Education: What is chronic kidney disease (CKD)

Chronic kidney disease refers to any process that damages your kidneys over a period of more than three months and as a consequence of that damage reduces the ability of your kidney to carry out its primary functions. This results in health related problems due to increased blood pressure and increased stress on the circulatory system, which puts you at risk for stroke and heart attack.

Decreased blood count (a situation known as anemia), poor bone health, damage to the nerves of the body and weightloss due to poor nutrition may also occur.

Chronic kidney disease can be detected early and appropriate treatment commenced which may stop this problem from getting worse. Unfortunately kidney disease can be a progressive thing and as such therapy will be directed to slowing th eprogression of your kidney disease. If it is progressive however preparations need to be made for eventual transplantation or dialysis in some cases.

Patient Education: The Facts about Chronic Kidney disease

The Facts About Chronic Kidney Disease (CKD)

• Recent data suggests that up to 26 million American adults have CKD and this is just the tip of the iceberg.

• Early detection by simple screening tests can help slow progression of chronic kidney disease and renal failure.

• Disease of the circulatory system such as Stroke and Heart attack are the most common killers in people with CKD. Therefore if you have CKD you must have a thorough consultation for heart disease as well for the best outcome.

• A simple blood test is sometimes inaccurate ask your doctor what percentage of kidney function you have. This will require a measure of what is called G. F.R. which can either be calculated at no additional cost or can be measured by a simple procedure an thus detect previously undetectable kidney disease.

• If you are hypertensive you should be aware that you are at increased risk of CKD even if your blood pressure is 140/90 and "controlled".

• The reason that you are hypertensive maybe due to undiagnosed kidney disease.

• Although protein levels in the urine may fluctuate, persistent levels of protein in the urine should prompt an immediate evaluation for possible kidney disease, acute or chronic.

• Patient groups at the highest risk of CKD include those with diabetes, hypertension and family history of kidney disease.

News: A Daily dose of baking soda preserves kidney function.

An upcoming study in the journal of the american society of nephrology (JASN) has shown that a daily dose of baking soda typically used for such mundane tasks as baking and cleaning slows the progression of some forms of kidney disease.

The study which is yet to be published consisted of 134 patients with advanced CKD and high levels of acid in the blood a condition known as a metabolic acidosis. Metabolic acidosis is one of the complications of chronic kidney disease that directly leads to organ dysfunction and may cause death via suppression of cardiac activity if severe.

It had been postulated previously but never quite proven that the presence of acidosis by itself may cause further damage to the kidney in addition to whatever disease process was also present.

This study is important because rapid progression of kidney disease occured in only 9 percent of patients in the group taking sodium bicarbonate as compared to 45 percent of patients in the placebo group.

Of all the drugs that we currently have available for slowing the progression baking soda is definately the cheapest.

Herbal corner: Is green tea beneficial in kidney disease?

http://www.flickr.com/photos/tim7423/ / CC BY-NC 2.0

Many herbal preparations have been marketed to patients with all manner of diseases ranging from the common cold to incurable cancer. Green tea however has been the focus of much main stream research recently with several studies of its efficacy being published. It has been shown to be effective in weight loss particularly in men, it has been shown at high concentrations to inhibit the growth of cancer cells in the lab and population studies have demonstrated some positive results where high intake of the tea reduces the incidence of gastric and esophageal cancer. There is an old saying that goes where there is smoke there is also fire. Applied to this case it would seem that there is something in green tea with very useful effects something that maybe if extracted purified and amplified may lead to a new drug. The problems with herbs however is that there are frequently impure and have many thousands of chemicals that have to be sifted through to obtain the one with the most useful medicinal effect. There is also the possibility that some useful combination of active ingredients may interact in a manner based on relative concentrations that we do not yet understand to produce the desired effect. All of this is relatively complex business and will take quite a bit of time to sort out.

What we can report currently, is that one of the most useful compounds to be derived from green tea or Camellia sinensis is EGCG. This compound is one of the most potent antioxidants ever encountered. It is likely to play a significant role in the health benefits to be derived from green tea. Administration of this compound has been shown to reduce the growth of renal cell carcinoma by a new mechanism, which incidentally is the first report of its kind for green tea.

The extracts of green tea had previously been shown to protect the kidney from drug induced damage which is common with the administration of certain antibiotics such as gentamicin.

Green tea extract has also been shown to have a potential therapeutic benefit in diabetic induced kidney disease as published here.

All of the data so far is pointing towards benefit but is there any chance of harm, how does green tea interact with medication that patients with kidney disease may be taking?

People who take warfarin, a blood thinning medication should not drink green tea. Green tea contains vitamin K and as such should be avoided for this patient group. Green has an effect on platelets, it makes them less sticky. This effect also occurs with aspirin which means combining the two may cause bleeding. In patients with chronic kidney disease which is quite severe or in patient with an acute deterioration in kidney function this may be harmful as the platelets within the body which are responsible for preventing bleeding may already be dysfunctional, green tea may cause bleeding in such patients. As with any herbal treatment or new medication speak with your health care provider before initiating treatment even if the substance is considered a food supplement such as green tea is.

Herbal corner: Herbal medicine can be dangerous

While herbal medicine has been on the rise and some herbal remedies do have medicinal effect, we must be cautious about the use of herbs for which we have very limited data or of products that claim to be mixtures of multiple herbs with no method to actually confirm the constituents.

In 1993 investigators published in the lancet a review of a rapidly progressing kidney disease associated with scarring of the kidney, it was believed at that time that the only thing these two young women had in common was the consumption of slimming regimen including chinese herbs.

Upon further investigations seven other women were found to have progressed rapidly to require dialysis and again they had been taking the same chines herbs. Tissue samples of the kidney showed significant scarring of the flesh of the kidney while sparing the vascular components.

With the detailed investigation of this incident that followed two chinese herbs Stephania tetranda and Magnolia officinalis were identified as the culprits.

http://www.flickr.com/photos/raeallen/ / CC BY-NC-SA 2.0

http://www.flickr.com/photos/randihausken/ / CC BY-NC 2.0

Three years later a study investigating the mechanism of kidney damage in the prior incident revealed that aristocholic acid derived from the herbs in question was capable of damaging the DNA of kidney cells preventing them functioning, leading to kidney disease, they also concluded based on the mechanism of damage that cancers could occur based on prolonged exposure to the offending agents.

In 2000 another article published in the new england journal of medicine concluded cancer is high among patients with chinese herb induced kidney disease. Several animal studies were done and the primary component of the herbs aristocholic acid was found to induce tumours in rodent. Now all patients who had kidney disease because of these herbs must have routine checkups to screen for the devlopment of cancers even years later.

Due to the rapid evolution of the disease from taking the herbs to requiring dialysis in three months, chinese herb nephropathy is difficult to effectively treat. High doses of steroid have been tried with some success however.

In this case carefully reading the ingredients could help a whole lot, however just discussing the supplements with your physician may actually save your life.

Herbal corner: Herbal medicine can be dangerous

While herbal medicine has been on the rise and some herbal remedies do have medicinal effect, we must be cautious about the use of herbs for which we have very limited data or of products that claim to be mixtures of multiple herbs with no method to actually confirm the constituents.

In 1993 investigators published in the lancet a review of a rapidly progressing kidney disease associated with scarring of the kidney, it was believed at that time that the only thing these two young women had in common was the consumption of slimming regimen including chinese herbs.

Upon further investigations seven other women were found to have progressed rapidly to require dialysis and again they had been taking the same chines herbs. Tissue samples of the kidney showed significant scarring of the flesh of the kidney while sparing the vascular components.

With the detailed investigation of this incident that followed two chinese herbs Stephania tetranda and Magnolia officinalis were identified as the culprits.

http://www.flickr.com/photos/raeallen/ / CC BY-NC-SA 2.0

http://www.flickr.com/photos/randihausken/ / CC BY-NC 2.0

Three years later a study investigating the mechanism of kidney damage in the prior incident revealed that aristocholic acid derived from the herbs in question was capable of damaging the DNA of kidney cells preventing them functioning, leading to kidney disease, they also concluded based on the mechanism of damage that cancers could occur based on prolonged exposure to the offending agents.

In 2000 another article published in the new england journal of medicine concluded cancer is high among patients with chinese herb induced kidney disease. Several animal studies were done and the primary component of the herbs aristocholic acid was found to induce tumours in rodent. Now all patients who had kidney disease because of these herbs must have routine checkups to screen for the devlopment of cancers even years later.

Due to the rapid evolution of the disease from taking the herbs to requiring dialysis in three months, chinese herb nephropathy is difficult to effectively treat. High doses of steroid have been tried with some success however.

In this case carefully reading the ingredients could help a whole lot, however just discussing the supplements with your physician may actually save your life.