Tuesday, November 4, 2014

An Integrative Approach to Kidney Stones

Kidney stones are a common occurrence in the USA; statistics indicate that 1 in 9 adults will have a kidney stone in their life time. The tiny stones may pass unnoticed but a larger stone can induce excruciating pain – possibly the worst pain a person can experience. And once someone has had a kidney stone, there is a 50% chance of a reoccurrence. Men have more kidney stones than women and Caucasians are more prone than African Americans.
It’s interesting to note that North Carolina has the highest incidence of kidney stones in the nation! White collar workers have the highest incidence among North Carolinians. It has been speculated that high consumption of ice tea and tea's calcium oxalate levels is the cause. Another theory is the high mineral content in well water throughout the state.
What Are Kidney Stones?
Kidney stones (renal calculi) are solid, rock like material formed from mineral salts that crystallize anywhere in the kidney and may break loose and lodge anywhere along the urinary tract. A kidney stone with a diameter less than 5 mm (about 3/16 of an inch) will usually pass without the need for surgery. Even so, these stones can be painful. The larger stones may lodge in the ureter, bladder, or urethra. Lodged stones block urine flow completely and may cause extreme pain. In addition to the pain, long-term blockage of urinary structures can cause hydronephrosis, a condition that occurs when a kidney becomes swollen due to the failure of normal drainage of urine from the bladder. Lab values may reflect decreased kidney function via an increase in creatinine levels.
Signs and Symptoms
Symptoms include sudden extreme cramping pain that comes in waves in the lower back and the side. The pain can move down into the abdomen and into the groin area. Nausea and vomiting may also come in waves. Blood in the urine may turn it pink, red or brown. Because the stones block or decrease urine flow, urinary tract infections (aka UTIs) are common. Symptoms of a UTI include urine that becomes cloudy in appearance and has a bad odor. Burning and a frequent “need to go” sensation are common, and fever and chills also commonly present. Any of these symptoms require evaluation by a physician.
Types of Kidney Stones
Calcium Oxalate
Calcium oxalate is the most common type of stone; 60% to 65% of kidney stones are comprised of calcium and oxalic acid, which form calcium oxalate crystals inside the kidneys. Some people are genetically predisposed to excreting high levels of oxalate in the urine (thus increasing the incidence of kidney stones), but this is not commonly the case. Instead, the lack of a beneficial bacteria found in the colon, called Oxalobacter formigenes, and/or uncombined intestinal oxalic acid are the culprits for calcium oxalate kidney stones. During normal digestion, calcium crystaizes with oxalate, never gets absorbed, and is eliminated in the stool. Oxalobacter formigenes uses oxalate as a source of energy, reducing the amount of oxalate in urine. A loss of Oxalobacter formigenes may result in elevated concentrations of urinary oxalate, increasing the risk of forming a calcium oxalate kidney stone.
Taking antibiotics is one contributor to the loss of Oxalobacter formigenes from the colon's natural bacterial flora; however, studies show that when Formigenes is taken as a probiotic, it can re-establish itself in the gut and reduce the urinary oxalate concentration, thereby possibly reducing the incidence of calcium oxalate kidney stone formation.
Oxalic acid passes through the intestinal wall, into the blood and enters the kidneys where it combines with calcium to make a calcium oxalate crystal. Therefore, if it is combined with dietary or supplemental calcium (i.e. calcium citrate) inside the intestinal tract, oxalic acid will never reach the kidneys (and calcium oxalate kidney stones cannot be formed). Oxalate is mostly found in fruits and vegetables. Vegetables high in oxalate include spinach, greens (including beet greens), beet roots, okra, leeks, parsley, cocoa, nuts, green and black tea, wheat bran and soybeans. Fruits with high oxalate include berries, plums, currants, kiwifruit, concord grapes, figs, and tangerines.
Calcium Phosphate
Calcium phosphate stones are not as common as calcium oxalate stones. It is more common to find combinations of calcium oxalate and calcium phosphate crystals together. Usually more than 50%  of the stone is calcium oxalate. 
If a stone has a large content of calcium phosphate, then medical causes should be investigated. These include hyperparathyroidism and renal tubular acidosis (RTA). Patients with calcium phosphate stones are treated with citrate and they tend to have multiple recurrent stones and loss of bone density.
Struvite Stones
Struvite stones are the least common type of kidney stones. Struvite stones can be one of the most troublesome. These are fast-growing stones that grow and fill up the cavities in the kidney and take on a "stag horn" appearance. Struvite stone formation occurs only when ammonia production is increased and the urine pH is elevated (becomes alkalinized), decreasing the solubility of phosphate. Staghorns most commonly occur with urinary tract infections which lead to the precipitate of magnesium ammonium phosphate crystals. These stones can cause significant damage to the involved kidney. 
Cystine stones
Cystine stones are from a genetic disorder that causes cystine to leak through the kidneys and into the urine. When this happens, crystals form into stones. These stones are also very rare.
Uric acid stones
Uric acid stones are made from purines, which break down into uric acid. When the uric acid becomes concentrated in the urine, it can form a uric acid stone by itself or combined with calcium. When uric acid forms a crystal with calcium, the stone will have uric acid in the middle and calcium oxalate on the outside. The stones will be brown and not white like other types of kidney stones. Foods high in purines include organ meats, meats, shellfish, sardines, herring, anchovies, yeast, and other animal proteins. Other foods include dried legumes, spinach and mushrooms. People who form uric acid stones should limit their meat consumption to no more than 6 ounces each day.
Because uric acid also requires acidic urine to crystallize, eating healthy foods such as organic fruits and vegetables will metabolically alkalinize the body, including the urine.
Treatments
Identifying the type of kidney stone, size of kidney stone and signs and symptoms will determine the appropriate treatment. This can be accomplished by straining urine at home with a fine colander. Retrieve the stone for the doctor.
The most important thing to do to prevent kidney stones is to stay well hydrated, which keeps the urine from becoming concentrated. Also urinate when needed; this prevents the accumulation of stone-forming components in the kidneys. An inability to keep fluids down warrants a hospital visit.
For proper hydration, using the following formula: body weight in lbs/2 = number of fluid ounces of water that should be consumed per day. For example, an individual who weighs 120 lbs should consume 60 oz of water per day (120/2 = 60). Add a fresh-squeezed lemon to increase the citric acid levels and stop crystal formation. Drinking even more is recommended for patients with kidney stones, provided they are able to keep the fluid down. Consuming up to 2-3 quarts of water a day is needed to flush a kidney stone out.
Taking an over-the-counter pain medication or herbal remedy for pain is also advised. Aleve for pain may be used: a first dose of 440 mg, then 220 mg orally 2 or 3 x day (up to a maximum of 660 mg/day). Another choice could be Advil: 300 mg - 800mg orally 3 or 4 x day with a max of 3200 mg/day. These over-the-counter pain medications should be taken with food and avoided with stomach ulcers and bleeding problems.
A safer, natural pain reliever is curcumin: up to 3000 mg/day. Decreasing the pain will also help relax the ureter, allowing the stone to pass more easily.
Herbs can also be used for the successful treatment of kidney stones. Bergenia Liqulata can prevent and even dissolve kidney stones. Varuna reduces the body’s production of oxalate and has been used for more than 3000 years in Ayurvedic medicine. Chanca Piedra keeps calcium crystals, especially calcium oxalate, from entering the kidneys. Birch leaf stimulates urination while preventing inflammation and spasms, while Khella also prevents inflammation and spasms, it also helps heal trauma to the tissues caused by a stone passing. Marshmallow also has properties that sooth inflamed and irritated tissue and is mostly known for this effect on the bladder and kidney.
When consuming foods containing oxalate, take calcium citrate (150 mg to 300 mg); the calcium citrate will combine with the oxalate and be eliminated in your stool. Magnesium citrate can be taken as a preventive measure and it can actually melt calcium oxylate kidney stones. The process of melting the stones with magnesium citrate can take a few months. This process includes taking as much magnesium citrate as needed to induce diarrhea, then reducing from that dosage just enough to not cause diarrhea.
Individuals with Struvite stones can be treated with acetohydroxamic acid, while those with uric acid stone can be treated with allopurinol to decrease uric acid levels. Those with cystine stones can take tiopronin or penicillamine and increase their B12, B6, and folic acid levels. By increasing these levels, homocysteine levels decrease which in turn decrease cystines. Adequate vitamin K2 inhibits formation of calcium kidney stones.
The American Classic Diet, which includes processed foods, contributes to increased occurrence of kidney stones. People who are overweight, pre Diabetics and Type Two Diabetics excrete an increased amount of urinary calcium, which increases stone formation. Eating a meal high in simple sugars also increases urinary calcium oxalate especially in those who have had recurrent stones. Avoid soft drinks with phosphoric acid because they reduce citrate levels in the urine. This includes many dark sodas.
If conservative measures do not work then invasive procedures are indicated. There are two procedures by which kidney stones can be removed. For larger stones Percutaneous Nephrolithotomy ( PCNL) is used and for smaller stones Extracorporeal Shock Wave Lithotripsy (ESWL) is used. A combination may be used for some large Struvite stones.
Shock Wave Lithotripsy
ESWL (extracorporeal shock wave lithotripsy) is a procedure that uses sound waves. The sound waves pass through the person’s body to break the kidney stone into smaller pieces so they can pass more readily through the urinary tract. A long stent is placed using a cystoscope, by going through the urethra (the final tube where urine exits), the bladder, the ureter and up into the kidney. Using ultrasonography or fluoroscopy to visualize, a shock wave is then transmitted through a water cushion or tube resulting in breaking up the stone or stones in fragments. This is done on an outpatient basis and anesthesia is used.
Percutaneous Nephrolithotomy
In this procedure, an instrument called a nephroscope is used to locate and remove the stone through a nephrostomy tube. The nephrostomy tube is inserted directly into the affected kidney/kidneys through a small incision in the person’s back. For large stones, an ultrasonic probe that acts as a lithotripter may be needed to deliver shock waves that break the stone into small pieces to be removed. The nephrostomy tube drains urine and any residual stone fragments from the kidney into a urine collection bag. The tube/tubes are usually left in the kidney for 2 or 3 days while the person remains in the hospital.

Tina Arey, BSN, RN, is Board Certified as a Holistic Nurse by the American Holistic Nursing Association. She is a Certified Reflexologist and a Healing Touch Level 3 Student. As a team member at Vaughan Integrative Medicine, she works directly with Elizabeth Vaughan, M.D. providing patient education and coaching individuals who are willing to make substantive lifestyle changes.

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