KIDNEY stones are formed in the kidneys and some travel down the ureters causing severe excruciating pain some female patients describe as worse than childbirth. The ureters are sensitive muscular tubes, about 8 to 10 inches long, with an inner diameter of about 2-4 mm, roughly the size of the lead in pencils, that transport urine from each kidney to the bladder.
Prevalence
About one in ten individuals will have kidney stones in their lifetime. A prevalence of about 9.9 percent translates to roughly 32.9 million people in the United States, 10.8 percent in men and 9.1 in women.
Types of stones
The two most common types are calcium oxalate and calcium phosphate stones. About 70-75 percent of kidney stones are calcium oxalate crystals. They form when calcium in the blood combines with oxalates, a chemical found in food items listed below. The less common calcium phosphate stones are seen among persons with hyperparathyroidism and renal tubular acidosis. Other stones are struvite, uric acid, cystine stones.
The causes
Inadequate fluid, oxalates and calcium intake significantly contribute to kidney stone formation. While calcium itself, in a large dose as supplements, can cause stones, it can also prevent stone formation when you happen to eat foods high in oxalates and then eat calcium-rich items at the same time in order for the calcium to combine with oxalates while still in the stomach and intestines, before they go to blood stream and the kidneys. Our body needs oxalate also, so while we eat some foods with oxalate in moderation, we should also eat some calcium at the same time. Those who had kidney stones in the past are 50 percent more prone to form them again, unless they take precautions and pre-emptive measures. Lifestyle (hydration, diet, medications, activities) significantly affects kidney stone formation.
Prevention
Drinking between 2-3 liters of fluids (filtered water is best, between four to six 500 cc-bottled water), minimizing foods rich in oxalates, cautious calcium supplement intake under your physician’s advice, staying away from alcoholic beverages, minimizing coffee and tea, and being physically active, are effective strategies to minimize the chances of kidney stone formation. For those not on water restriction, that much water is also good for all organs in the body, including our eyes, skin, and nails
The best fluid for hydration is water. Soft drinks (toxic to the body), coffee, tea, alcoholic beverages are “aggravators” for people prone to kidney stone formation. Drinking lemon juice, cranberry juice, and apple cider vinegar is also beneficial.
Mechanics
The simple act of drinking a lot of water is the major strategy in helping prevent kidney stone formation or in aiding in flushing out kidney stones. All the other measures will fail if proper hydration is not foremost in the regimen.
The mechanics is simple: water dilutes minerals or substances in the urine, prevents them from clumping into crystals, and a large volume of water effectively flushes them down to the bladder and out through the urethra as urine. This is just like power-washing a large tube or flushing the toilet.
Oxalate-rich foods
Some of the oxalate-rich foods are spinach (6 times the safe level of oxalates), kale, beets, potatoes, legumes, grapes, currants, canned fruits, peanuts, almonds/almond-milk (high in oxalates and in unhealthy omega-6), wheat bran, seeds, miso soup, corn grits, salt and salty foods, processed meats and internal organs (high in purine, which increases uric acid, also bad for gout). There have been occasional ER reports of patients developing “oxalate poisoning” from too many greens in their smoothies.
Treatment
Good hydration is a salient part of the management. There are prescription medications to help pass kidney stones and some over-the-counter herbals too but be cautious and talk to your physicians before taking them because some of them have serious side-effects.
More than 90 percent of kidney stones smaller than 5 mm come out with the urine with no problem, within a month from the first pain. Larger than 7 mm usually needs surgery under general anesthesia, called ureteroscopy, a minimally invasive procedure using a catheter inserted “through” the penis. A basket in the catheter is used to snare and pull out the stone stuck in the ureter. Sometimes laser is used to break the stone into smaller fragments. A stent is left in the ureter, to keep open the area of the ureter where the stone was, and to allow easier urine flow. Percutaneous lithotripsy using ultrasound or laser to break the stones is also an option.
Erratum
In the news capsule about vaping in our column last week, the first line should read: “Smoking e-cigarettes, vaping, is not more dangerous than smoking.” But not totally safe either. While e-cigarettes do not contain the 7000 toxic (some carcinogenic) chemicals found in regular cigarettes, constant vaping has been found to be associated with heart attacks and other cardiovascular ailments. Besides medications and behavioral modification, e-cigarettes could be a useful transitional tool for those who are trying to quit smoking.
The air in our environment is polluted enough. Let us try not to contaminate it more, even with the so-called “odor-eliminator” air fresheners for cars or homes which are irritants to our lungs. Air-fresheners contain volatile organic compounds (VOC), formaldehyde, benzene, toluene, and others. VOCs are associated with cancer in high doses. These air fresheners are harmful to everyone, even to our pets. Mother nature’s ambient air is healthier without those contaminants. And it’s free!
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The opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of the Asian Journal, its management, editorial board and staff.
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The main objective of this column is to educate and inspire people to live a healthier lifestyle to prevent illnesses and disabilities and achieve a happier and more productive life. Any diagnosis, recommendation, or treatment in our article are general medical information and not intended to be applicable to or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.
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Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, Health Advocate, newspaper columnist, and chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. He was a recipient of the Indiana Sagamore of the Wabash Award in 1995, presented by then Indiana Governor, US senator, and later a presidential candidate, Evan Bayh. Other Sagamore past awardees include President Harry Truman, President George HW Bush, Muhammad Ali and Astronaut Gus Grissom (Wikipedia). Websites: FUN8888.com, Today.SPSAtoday.com, and philipSchua.com; Email: [email protected].
