Archive » September 27, 2007
By Dr. David Laub
Stone Season Is Upon Us
Kidney stone season is in full swing in Santa Barbara. September and October are traditionally the busier months for kidney stones to create problems locally. There is no direct evidence that global warming is responsible for an increase in kidney stones, but can it be simply a coincidence that over the last thirty years, there has been an increase in kidney stones across the nation?
For example: A review of our local emergency room and hospital admission statistics for Cottage Hospital show an increase in stone patients in just the last six years. In the years 2002 to 2003 there was an average of 269 patients per year diagnosed with kidney stone related problems. The numbers have increased for 2003 to 2006 to an average of 308 patients per year. Are rising temperatures causing a relative state of human dehydration, or is it perhaps increased gluttony? There are many variables that influence the development of kidney stones, but the most important factor is adequate hydration.
A universal recommendation to kidney stone sufferers: if you drink enough water you will reduce the chance of another kidney stone developing.
The Stone Belt
The “Stone Belt” is located in the southeast part of the U.S. People living there are at a higher risk for kidney stones. Contributing factors to stone formation are the increased heat and humidity of the South that can lead to dehydration. Add a diet high in salt, fat and protein, mixed with alcohol and physical inactivity and you have a recipe for painful kidney stones.
Sounds like a barbeque I attended Labor Day weekend in Montecito.
As with many complications, both environment and genetics play a role in who will get kidney stones. Compared to women, men have a 3 to 1 increased risk of getting stones. The national prevalence of stone disease is 12% for men. If any man wants to know what it is like to undergo childbirth they should try passing a kidney stone. A study, published in the Journal of Urology reviewed responses from women who have done both, suggested the pain from an obstructing stone is worse than labor.
A kidney stone is a hard mass of crystals that develop in the kidney. Stones cause blockage of the urine flow; the ureters, small tubes connecting the kidneys to the bladder, swell, and this causes the pain. Ureteral obstruction causes excruciating back or abdominal pain, with most first timers thinking they must be dying or just wishing they would. The peak incidence for stone formation is age 35 and statistically there is a 50% chance of forming another stone within five years of the first stone attack.
Getting Stone Treatment
Ninety percent of stones are small enough to pass through the body without surgical intervention. Treatment may include pain control and medications to help pass or dissolve the stone. There are circumstances that require hospitalization. Pain that is not manageable with oral medication may result in a trip to the Emergency Room. Infection associated with an obstructed kidney can be life threatening if not relieved immediately. Specific issues require treatment. For instance, the FAA requires all pilots before flying a plane to be free of kidney stones. People traveling to remote areas, like a sailor who sails to the Hawaiian Islands would be advised to have even an asymptomatic stone treated.
In Santa Barbara, symptomatic stones that are too large to pass on their own can be treated with Shock Wave Lithotripsy. This is an outpatient procedure that allows energy to be passed into the body, focused on the stone to cause the stone to fragment into dust. In some cases stones require laser surgery that is accomplished by passing very small scopes into the ureter from below or through the skin directly into the kidney. The camera in the ureteroscope allows us to see the stone inside the body without making a large incision. Looking at a TV monitor in the operating room the urologic surgeon points and fires the laser at the stone which then breaks up much like a meteor being vaporized in a video game.
Most people who have had a kidney stone will readily accept suggestions to prevent future agonizing attacks, however, the dietary or behavioral changes suggested may require some self sacrifice. General recommendations to prevent stones are: drink three liters of water a day, or more specifically, urinate more than two liters a day. Obesity and a sedentary lifestyle are risk factors for kidney stone formation. Regular physical activity reduces stone formation. Analysis of a passed stone and examination of the urine can help provide specific dietary suggestions. Many stones are made of calcium, and sometimes this is due to a disorder that is hereditary resulting in excess calcium being excreted into the urine. Often the calcium binds with oxalate, forming a hard stone. Increased calcium in the diet may not cause all calcium stones and not everyone with calcium stones need to decrease calcium in their diet. Calcium oxalate stone formers should reduce their consumption of oxalate, which is present in high concentrations in leafy vegetables like spinach and broccoli, coffee, chocolate, cola, nuts, green, tea, and strawberries. Ten percent of stones are made of uric acid. Uric acid crystals are byproducts of dietary purines. Food high in purines are beef, pork, chicken, peanuts and fish.
Alcohol is a diuretic, which promotes urine production and a few studies suggest drinking can reduces stone production. Most studies however, find there is an increase in stone formation because of the resulting dehydration that alcohol produces, especially in binge drinkers. Good advise if you are going to drink alcohol is to drink at least one glass of water for every glass of booze.
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