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Wednesday, March 12, 2008

Kidney Stones

  • Diet and Kidney Stones

Diet and Kidney Stones

If you have kidney stones, you may need to follow a special diet. First, your doctor will run tests to find out what type of stones you form. From these, the doctor can determine which diet changes may be right for you. A registered dietitian can help you make the necessary changes in your diet.

What is a kidney stone?

A kidney stone is a hard mass that forms from crystals in the urine. In most people, natural chemicals in the urine stop stones from forming.

Are all kidney stones the same?

No. The most common types of kidney stones are made from calcium and oxalate. Individual treatment for kidney stones depends on the types of kidney stones that are formed.

Is there a diet I can follow to prevent me from having more kidney stones?

Sometimes following a special diet may be enough to prevent you from forming more kidney stones. Other times, diet and medications may be needed.

What kind of diet will I have to follow?

You may be asked to make changes to the amount of salt, calcium, oxalate, protein, potassium and fluid in your diet. A registered dietitian can help you with making these changes.

I had a calcium stone. What type of diet should I follow? Will I have to avoid high calcium foods?

If you have had a calcium stone, your doctor may ask you to cut back on the salt and sodium in your diet. Extra sodium causes you to lose more calcium in your urine, putting you at risk for developing another stone. Your doctor will probably advise you to limit your sodium to 2,000 to 3,000 milligrams a day. Your dietitian can help you make sodium changes in your diet.

You may not need to avoid excessive (too much) calcium in your diet. It is important that you learn from your doctor and dietitian the right balance of calcium you should eat. Following a diet low in calcium for a long period of time can lead to a loss of bone mass, or osteoporosis.

A registered dietitian or doctor can help determine if you need more or less calcium and help with the sodium changes in your diet.

I had an oxalate stone. What type of diet should I follow? Do I need to avoid foods high in oxalate?

If you have had a kidney stone that contains oxalate, some evidence (research) suggests that limiting high oxalate foods may help reduce your chance of forming another oxalate stone. Foods that are high in oxalate include: peanuts, tea, instant coffee (more than 8 ounces a day), rhubarb, beets, beans, beets, berries (blackberries, raspberries, strawberries, gooseberries, etc. ), chocolate, Concord grapes, dark leafy greens, oranges, tofu, sweet potatoes and draft beer. Because the stone contains calcium and oxalate, you may also need to follow the calcium recommendations from the last question.

My doctor told me to drink a lot of fluids. How much is “a lot” Does it matter what kind of fluid I drink?

To lessen your risk of forming a new stone, it is important that you drink at least three to four quarts of fluid throughout the day. In hotter weather, you may need to drink more to make up for fluid loss from sweating. This will help keep your urine less concentrated Less concentrated urine reduces the risk of stone formation. Most of the fluid you drink should be water.

Is there anything else I can do with my diet to help prevent the formation of kidney stones?

Reducing the amount of animal protein may help. Sources of animal protein include beef, chicken, pork, fish and eggs. Most people need only four to six ounces of high protein foods and three servings of milk or cheese a day. Check with your doctor or dietitian to be sure your protein intake is enough, but not too much.

Will it help/hurt me to take a vitamin or mineral supplement?

The B vitamins (which include thiamine, riboflavin, niacin, B6 and B12) have not been shown to be harmful to people with kidney stones. However, check with your doctor or dietitian for advice on the use of vitamin C, vitamin D, fish liver oils or mineral supplements containing calcium since some supplements can increase the chances of stone formation in some people.

  • Kidney Stones

What is a kidney stone?

A kidney stone is a hard mass that occurs when calcium oxalate or other chemicals in the urine form crystals that stick together. These crystals may grow into stones ranging in size from a grain of sand to a golf ball.

Are kidney stones common?

Some one million Americans--the majority between the ages of 20 and 40--are treated each year for kidney stones. Kidney stones are more common in men, who account for about four out of five cases.

Why do kidney stones form in some people and not others?

Normally, urine contains substances that prevent crystals from forming. However, these do not work for everyone. Factors that can contribute to stone formation in susceptible people include:

  • Too little fluid intake
  • Chronic urinary tract infections
  • Misuse of certain medications
  • Urinary tract blockage
  • Limited activity for several weeks
  • Certain genetic and metabolic diseases.

What are the symptoms of kidney stones?

Some people may not have any symptoms, but most have at least some, such as:

  • Severe pain in the kidneys or lower abdomen, which may move to the groin; pain may last for minutes or hours, followed by periods of relief
  • Nausea and vomiting
  • Fever, chills and weakness
  • Cloudy or foul-smelling urine
  • Blood in the urine
  • Blocked flow of urine.

How are kidney stones diagnosed?

X-rays can usually identify the presence of stones. Specialized x-ray techniques (sometimes using dye injections) or sound waves may be used to identify more accurately the size and location of the stones and to test kidney function. Blood and urine tests may help a doctor to find out what is causing the stone and plan the best treatment.

How are kidney stones treated?

Most stones can be treated with increased fluid intake, changes in diet and medication. About 90 percent of stones will pass by themselves within three to six weeks. Certain types of stones may sometimes be dissolved using medications; however, calcium-containing stones (the most common type in the U.S.) cannot be dissolved.

Stones should always be removed when infection, obstruction or kidney damage are present. When removal becomes necessary, several different methods are available. The best method for you depends on the size, location and type of stone. Some stones are removed by passing a telescopic instrument into the bladder or into the ureters--tubes that connect the bladder and kidneys--to pull the stones out or to break them into small fragments with shock waves or laser beams. Or a telescopic instrument may be inserted directly into the kidney through a small slit made in the patient's side to pull the stone out whole or break it down into small fragments.

The newest method of stone removal is called extracorporeal shock wave lithotripsy (ESWL). In this technique, stones are broken down into small fragments by high energy shock waves from a device outside the body.

Can kidney stones be prevented?

Yes, treatments that can prevent kidney stones from forming are possible in many cases. Strong evidence suggests that a high fluid intake may decrease the risk of stones. In addition, once the cause of the stone is found, medications or changes in diet may be used to help prevent new stones. The type of medication used is based on blood and urine tests.

  • Lithotripsy

What is extracorporeal shock wave lithotripsy?

Extracorporeal shock wave lithotripsy is a technique for treating stones in the kidney and ureter that does not require surgery. Instead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand. Because of their small size, these pieces can pass from the body along with the urine.

What does the treatment involve?

There are two ways to remove stones using shock wave treatment. In one method, the patient is placed in a tub of lukewarm water. Using x-rays or ultrasound to pinpoint the location of the stones, the body is positioned so that the stones are targeted precisely. In the second, more common method, the patient lies on top of a soft cushion or membrane through which the waves pass. About 1-2 thousand shock waves are needed to crush the stones. The complete treatment takes about 45 to 60 minutes.

What are the advantages and disadvantages of this treatment?

The main advantage of this treatment is that many patients may be treated for kidney stones without surgery. As a result, complications, hospital stays, costs and recovery time are reduced. Unfortunately, not all types of kidney stones can be treated this way. In addition, stone fragments are occasionally left in the body and additional treatments are needed.

Does the patient need anesthesia?

In general, some type of anesthesia--either local, regional or general--is used to help the patient remain still and to reduce any discomfort.

Does the patient need to be hospitalized?

Usually, patients are hospitalized for a day or two. In some cases, lithotripsy may be done on an outpatient basis.

What can the patient expect after treatment?

After treatment is complete, the patient can move about almost at once. Many people can fully resume daily activities within one to two days. Special diets are not required, but drinking plenty of water helps the stone fragments pass. Some pain may occur when the fragments pass, which begins soon after treatment and may last for up to four to eight weeks. Oral pain medication and drinking lots of water will help relieve symptoms.

What are some complications or side effects?

Most patients have some blood in the urine for a few days. The shattered stone fragments may cause discomfort as they pass through the urinary tract. Sometimes, the stone is not completely shattered, and additional treatments may be needed.

Can all kidney stone patients have this kind of treatment?

No. The size, number, location and composition of the stones are factors that must be taken into account when exploring treatment options. Patient size may limit use of the water bath method, but patients of many sizes can be treated with the water cushion method.

Also the stones must be clearly viewed by the x-ray monitor so the shock waves can be targeted accurately. If anatomical abnormalities prevent this, other methods of stone removal may have to be considered. Through examination, x-ray and other tests, the doctor can decide whether this is the best treatment for the patient. In some cases, extracorporeal shock wave lithotripsy may be combined with other forms of treatment.

How successful is extracorporeal shock wave lithotripsy?

In those patients who are thought to be good candidates for this treatment, about 70 to 90 percent are found to be free of stones within three months of treatment. The highest success rates seem to be in those patients with mobile stones that are located in the upper portions of the urinary tract (kidney and upper ureter). After treatment, some patients may still have stone fragments that are too large to be passed. These can be treated again if symptoms persist.

What other treatment choices are available?

About 90 percent of stones pass through the urinary system without treatment. In cases where this does not occur, treatment to remove stones may be needed. Some stones may be dissolved by medicines. In other cases, one of the following methods of stone removal may be needed:

    Percutaneous Stone Removal
    When stones are quite large (more than 2 cm) or in a location that does not allow effective lithotripsy, a technique called percutaneous stone removal may be used. In this method, the surgeon makes a small incision in the back and creates a tunnel directly into the kidney. A tube is inserted and the stone is removed through this tube.

    Ureteroscopic Stone Removal
    For stones found in the lower part of the urinary tract, the doctor may pass a ureteroscope (a hollow tube-like device) up into the bladder and ureter. A basket-like device may be passed through the tube to grasp and withdraw the stone.

How much does lithotripsy cost?

The cost of lithotripsy varies. Check with your urologist or your local medical center for information about current costs. If you are considering this procedure, contact your insurance company to make sure that costs are covered.

Where can patients receive this type of treatment?

Treatment is available at many hospitals, outpatient centers and sometimes even in mobile units. For information about where to have lithotripsy done in your area, contact your doctor, local hospital or health care facility.

Can kidney stones be prevented?

Yes. Kidney stones affect more than one million Americans each year. People who have had more than one kidney stone are likely to form another. To determine the possible cause of stones, the patient may be asked to collect a 24-hour urine sample. Once the cause is found, the doctor may recommend drinking more liquids, dietary changes and medication.

Via: http://www.kidney.org

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