Natural Remedies for Kidney Stones
In 1962, Bartter described two patients who had very low plasma K+ levels and metabolic acidosis, yet elevated plasma renin and aldosterone levels. Subsequently, it has become clear that the syndrome he described is both phenotypically and genetically heterogeneous, and at least three subtypes have been distinguished. The first of these is the classical Bartter's syndrome for which the underlying genetic defect remains unknown. The second, known as the Gitelman variant, is characterised by late age of onset and very low urinary Ca2+ and Mg2+ concentrations, and results from mutations in the gene encoding the NaCl cotransporter (NCCT). The third variant is known as antenatal Bartter's syndrome or hyper-prostaglandin E syndrome. It is a life-threatening disorder that presents in utero with a marked fetal polyuria and it can precipitate premature birth. Newborns show severe salt-wasting, moderate hypokalaemia and metabolic acidosis, and elevated urinary excretion of prostaglandins. In...
Chloride channels are important for the control of membrane excitability, transepithelial transport, and the regulation of cell volume and intracellular pH. They are also important in intracellular organelles where they provide an electrical shunt pathway which facilitates acidification of the organelle interior. Many different kinds of chloride channel exist (Franciolini and Petris, 1990), and not all of those that have been characterised electrophysiologically have yet been identified at the molecular level. Three major Cl channel families, with very different structures, have been cloned to date (Jentsch and Gunther, 1997). These are the voltage-gated chloride channels, the cystic fibrosis transmembrane conductance regulator (CFTR) and related channels, and the ligand-gated Cl channels opened by GABA and glycine. Mutations in the genes encoding members of these Cl channel families result in cystic fibrosis (CFTR), certain forms of myotonia and inherited kidney stone disease...
A medical history should focus on the patient's urologic history along with surgical risks and concomitant medical problems. Urologic history should include a history of sexually transmitted diseases, kidney stones, trauma, previous catheterizations, genitourinary cancer, renal insufficiency, neurologic disease, and neurogenic bladder. Medical conditions that may influence bladder functioning include diabetes and neurologic diseases. Surgical risks predominantly are the result of renal failure, coronary artery disease, and cerebrovascular disease. Medicines containing a-sympathomimetics, including over-the-counter cold remedies, enhance bladder outlet obstruction. A family history should focus on a history of urologic cancer, and a social history should focus on risks for cancer such as smoking and occupational exposure.
Bone minerals are a combination of calcium and phosphate. Thus, when PTH stimulates the release of calcium from bone, it also causes the release of phosphate. Increases in blood levels of both calcium and phosphate can be dangerous. The normal levels of calcium and phosphate in the blood approach the concentration at which they would precipitate out of solution as calcium phosphate salts, leading to maladies such as kidney stones and calcium deposits in the arteries (hardening of the arteries). To reduce this problem, PTH acts on the kidneys to increase the elimination of phosphate via the urine.
Kidney stones (renal calculi) are composed of crystals and proteins that grow until they break loose and pass into the urine collection system. Small stones that are anchored in place are not usually noticed, but large stones in the calyces or pelvis may obstruct the flow of urine. When a stone breaks loose and passes into a ureter, it produces a steadily increasing sensation of pain. The pain often becomes so intense that the patient requires narcotic drugs. Most kidney stones contain crystals of calcium oxalate, but stones may also be composed of crystals of calcium phosphate, uric acid, or cystine. These substances are normally present in urine in a supersaturated state, from which they can crystalize for a variety of reasons. The stones may be removed surgically or broken up by a noninvasive procedure called shock-wave lithotripsy. Remember that Emily had pain in her lower back, between the twelfth rib and the lumbar vertebrae. From which organ might the pain originate Is it...
The approximate tissue distribution and average daily flux of calcium among tissues in a healthy adult are shown in Figure 36.1. Dietary intakes may vary widely, but an average diet contains approximately 1,000 mg day of calcium. Intakes up to twice that amount are usually well tolerated, but excessive calcium intake can result in soft tissue calcification or kidney stones. Only about one third of ingested calcium is actually absorbed from the GI tract, the remainder is excreted in the feces. The efficiency of calcium uptake from the GI tract varies with the individual's physiological status. The percentage uptake of calcium may be increased in young growing children and pregnant or nursing women,- often it is reduced in older adults.
Sodium bicarbonate (650 mg x 3 day) is an alternative but this can increase the risk of forming calcium stones 29 . If hyperuricosuria persists despite fluid intake and correction of urinary pH, the patient can start allopurinol (300 mg day). However, it should be kept in mind that this drug may interact with azathioprine 6MP 30 .
In a cystoscopic procedure, the patient lies on a specialized table (Figure 4-158) with feet placed in stirrups. The patient is usually lightly sedated with conscious sedation, perhaps Valium via an IV in the arm. An endoscope with fiber-optic light (and optional tiny camera) is inserted into the urethra to diagnose the problem. If the scope has a camera connected to a video monitor, the procedure can be viewed in real time and, with a printer, images can be captured for future reference. Men who have prostate cancer or enlarged prostates, common as men age, routinely have this examination to monitor their conditions. Bladder tumors and kidney stones can also be discovered with this type of procedure. Sometimes the capacity of the bladder
Reabsorption continues along the distal convoluted tubule. Reabsorption here is increased by thiazide diuretics, which may be prescribed in cases of excessive Ca2+ in the urine, hypercalciuria, and kidney stone disease (see Clinical Focus Box 24.2). Thiazides inhibit the luminal membrane Na-Cl cotransporter in distal convoluted tubule cells, which leads to a fall in intracellular Na+ . This, in turn, promotes Na+-Ca2+ exchange and increased basolateral extrusion of Ca2+ and increased Ca2+ reabsorption.
Overactivity of the parathyroid glands, usually from a tumor, causes a high level of calcium in the blood. Because this calcium is obtained from the bones, there is also degeneration of the skeleton and bone pain. A common side effect is the development of kidney stones from the high levels of circulating calcium.
51 Tips for Dealing with Kidney Stones
Do you have kidney stones? Do you think you do, but aren’t sure? Do you get them often, and need some preventative advice? 51 Tips for Dealing with Kidney Stones can help.