Absorptive Hypercalciuria
Abnormally high urinary calcium caused by one of several mechanisms that increase calcium absorption from the digestive tract. Type I is the most severe and doesn't respond well to dietary calcium moderation which works well in Type II. The most common cause of high urinary calcium.
Acid
Any chemical that forms chemical reactions by releasing hydrogen. In practical terms, this often destroys or digests the receiving compound depending on the strength of the acid. The most common biological acids are stomach acid and uric acid. Vinegar and lemon juice are other examples. Acids general produce a sour taste.
Acidic
Pertaining to or containing acid.
Acidosis
Condition where the body has a higher acid load than normal. Urinary citrate excretion may probably be reduced in this situation. Treatment is usually with supplemental citrate or bicarbonate.
Alkaline or Alkili
Another name for base or antacid, the opposite of acidic.
Amino Acid
One of the building blocks of protein. Formed by the ombination of a carbohydrate (sugar) and a nitrogen compound.
Anaplylaxis
A severe allergic reaction in which the breathing tube or irway can swell and shut off the air supply ultimately cause death if not treated rapidly. Epinephrine (adrenalin) is the treatment of choice.
Anesthesia
Condition produced in order to permit a painless surgical peration. Loss of sensation occurs.
Anesthesiologist
A physician who specializes in the administration of nesthesia.
Balloon Dilator
An inflatable device designed to gently stretch or dilate mall tubular tracts. When the injected liquid is contrast or ye, the process can be viewed by X-ray. Most often used to pen the lower ureter for instrument passage, treat scarred areas of the ureter or prepare a passageway for percutaneous rocedures directly on the kidney.
Base
An acid neutralizing substance such as an antacid (See Bicarbonate, Citrate).
Benign
When used in a medical context, benign means non-cancerous.
Bicarbonate
A natural form of antacid or base that is normally excreted y the pancreas to neutralize the stomach acid as your food laves the stomach and enters the intestines. Bicarbonate is issolved in the blood and converted to citrate by the kidneys. common baking soda is chemically sodium bicarbonate.
Board Certified
Formal acknowledgement by a medical or surgical specialty board that the practitioner has met all requirements for specialization set by that board and has passed one or more rigorous examinations in that field. While not a guarantee of competence, it suggests a high level of knowledge in one particular specialty.
Calcitonin
A hormone made in the thyroid gland that increases calcium deposition in bone and increases urinary calcium. The opposite function to parathyroid hormone.
Calcitriol
Another name for activated Vitamin D, also called Vitamin D3.
Calcium
An important element that helps make bone and teeth hard. It's necessary for proper functioning of muscles and nerves. Normally regulated in the body primarily by the parathyroid glands. In the diet, it can be found mainly in dairy products like milk and cheese.
Calcium Oxalate
A compound made from calcium and oxalate. It can be in the monohydrate form, which is extremely hard, or dihydrate which is quite brittle. Calcium oxalate is the most frequently found ingredient in kidney stones in the United States.
Calcium Phosphate
Another compound that forms kidney stones. Calcium phosphate is more likely to occur due to a medical problem or illness. It is formed most often in alkaline solutions. There is a danger in treating some patients with uric acid stones where too much citrate or bicarbonate can alkalinize the urine too severely and allow calcium phosphate, which will not dissolve, to coat or cover the uric acid.
Calculi
The plural of calculus. Refers to many stones.
Calculus
Another name for a kidney stone. Actually, Latin for pebble or stone.
Catheter
A long, slender tube that enters the body. Most often it's used to drain the bladder but a smaller version is used for special X-rays called Retrograde Pyelograms. Catheters are flexible and usually made of latex or silicone.
Citrate
An important urinary acid neutralizer and inhibitor of kidney stone formation. It is excreted by the kidneys and will be reduced if there is too great an acid load in the body. Potassium citrate is an oral supplement available as either a liquid, tablet or dissolvable crystal packet that's used to increase the urinary citrate level.
Colic or Renal Colic
The extremely severe pain associated with a kidney stone attack.
Collecting System
The hollow, branched, interior portion of the kidney system that normally is full of urine. This is the target area for percutaneous procedures and the space in which most stones form. The exit of the collecting system (see Ureteropelvic junction) is shaped like a funnel and leads into the ureter, the tube that connects the kidney with the urinary bladder.
Creatinine
A blood and urinary chemical that is used to estimate overall kidney function. It is produced by the muscles at a regular, predictable rate and excreted by the kidneys through simple filtration. If the blood creatinine level becomes too high, it often means that not enough blood is being filtered by the kidneys. A serum creatinine up to 1.5 to 2.0 is generally considered normal, but lower numbers are usually better.
Creatinine Clearance
A calculated value that is a good indicator of kidney function. Since serum creatinine is filtered by the kidneys based on kidney function, it is possible to measure the total urinary creatinine passed in 24 hours and calculate how much blood was filtered by the kidneys in that time to produce the creatinine found in the sample. It comes out to about 100 cc's per minute. Anything below 30 cc's is considered to be kidney failure.
Crystal
A solid form of a substance where the molecules are arranged in a repeating pattern or asymmetrical arrangement. In kidney stone disease, microscopic crystals of various stone materials can be seen in the urine when conditions are right.
CT Scan
Short for Computerized Tomography, this refers to a computer manufactured image made from a special X-ray machine. The images are very good for soft tissues but often require contrast to look into the kidneys and the intestines. Also called a "CAT" scan. Most kidney stones will show up well on CT scans.
Cystine
An amino acid or ingredient in protein. Significant because in an inherited disorder called cystinuria, very large amounts of cystine can be excreted in the urine where it can form stones. These stones tend to be difficult to treat and require life-long therapy.
Cystinuria
The presence of cystine in urine. While this does not necessarily mean an excess, when used in common language, it generally refers to abnormally high urinary levels of cystine.
Cystitis
An inflammation of the bladder which is prevalent in women. Usually caused by a urinary bladder infection.
Cystoscopy
A procedure where a special telescope, either rigid or flexible, is passed into the penis or female urethra and enters the bladder. It is used for inspection of these organs and to place tubes, ureteral catheters and Double-J stents in the ureters or kidneys.
Dehydration
The loss of excessive water from the body. Such water loss can take place through the kidneys, the lungs, or from perspiration.
Dialysis
The process in which a machine filters and cleans the blood. An artificial kidney machine.
Dipstick
A thin plastic strip with various chemically treated pads attached at one end. The strip with its attached pads is dipped in the urine to be tested. The various pads turns colors depending on various chemical or cellular characteristics of the urine being tested. Acid content and concentration are two of the more common tests commonly performed with urinary dipsticks. Disease specific dipsticks for kidney stone patients with identified chemical problems are under development.
Diuretic
Proper name for a "water pill." A medication that causes the kidney to make more urine. Often used to reduce swelling and bloating. Some diuretics have unique effects on calcium (see thiazides).
DNA
Stands for Deoxyribonucleic Acid. This is the genetic code material found in virtually every living cell. When this DNA is digested, it produces urine which ultimately forms uric acid.
Electrohydraulic Lithotripsy (EHL)
A form of kidney stone fragmentation utilizing a small electric probe. A small spark is created at the tip of the probe which is placed just next to the stone to be treated. The spark generates a small shock wave which can fragment most stones. Usually used through some type of telescope.
Enteric Hyperoxaluria
Condition usually associated with some form of chronic diarrhea and fat malabsorption. Very high levels of urinary oxalate are produced by a lack of intestinal calcium, together with chronic diarrhea and very low urinary calcium.
Extracorporeal Shock Wave Lithotripsy (ESWL)
This refers to lithotripsy, and is sometimes called ESWL. This is a large machine that generates a powerful shock wave using one of several different technologies. The generator is outside the body but the shock waves are focused at a point where the stones are located. Probably the most commonly used tool to fragment kidney stones today.
Fat Malabsorption
Condition in which fat is not digested normally leading to chronic diarrhea and excessive oxalate absorption.
Fluoroscopy
An X-ray technique where live pictures appear on a screen instead of taking a permanent picture. Used while a procedure is being done to check on progress such as trying to basket a stone. With fluoroscopy it's possible to watch the interaction between the stone and the basket. ESWL uses fluoroscopy to aim the shock waves.
French Size
Many medical tubes and catheters are measured by French Size. This represents the circumference in mm of the tube. The higher the number, the larger the tube.
Gout
A disease caused by excessively high uric acid in the blood. This high uric acid blood level will sometimes allow formation of uric acid crystals in the joints, especially at the base of the large toe. This causes intense joint pain. Can contribute to calcium and uric acid stone disease (See Gouty Diathesis). Usually treated with allopurinol when associated with kidney stones.
Gouty Diathesis
Condition in which gout is associated with uric acid or calcium oxalate kidney stone production, usually from extremely acid urine or elevated urinary uric acid excretion.
Gurney
A mobile bed with wheels designed for transport of patients in hospitals and ambulances.
Hypercalcemia
Above normal blood calcium levels. In kidney stone disease, this frequently is due to hyperparathyroidism (see below).
Hypercalciuria
Excessive urinary calcium.
Hyperoxaluria
Abnormally high urine oxalate levels.
Hyperparathyroidism
Uncontrolled, excessive secretion of the parathyroid ;lands, producing a disease characterized by loss of calcium from the bones. Often resulting in high serum calcium levels and kidney stones.
Hyperuricosuria
Abnormally high urinary uric acid.
Hypervitaminosis D
An uncommon condition associated with kidney stones. caused by excessive or inappropriate Vitamin D intake.
idiopathic
From an unknown cause.
Ileostomy
The result of intestinal surgery where the far end of the ,mall intestine is brought out to the skin surface. The small bowel contents are then collected in a bag attached to the skin. This is normally done only for severe large bowel disease because the fluid, bicarbonate and electrolyte losses can be lifficult to treat or correct, especially on a long term basis.
intramuscular
An injection into the muscle. Usually abbreviated IM.
Intravenous Pyelogram (IVP)
This is a series of X-rays designed to show the inside of the kidneys and urinary system. Traditionally, this was the standard diagnostic tool for evaluation of possible kidney stones and tumors. A small amount of contrast or dye is injected into a vein. This contrast is excreted by the kidneys within five to fifteen minutes. When the contrast appears in the urine, it clearly outlines the shape, size and location of the internal urinary organs. If there is blockage or dilation, it will show up clearly. Virtually all significant stones will be visible either directly on the X-ray or indirectly through the blockage they produce.
Iravenous (IV)
Into a vein. (For example, an intravenous medication would be injected into a vein).
KUB
Stands for kidneys, ureters and bladder. This is just medical jargon for a flat X-ray of the abdomen. Calcium stones often show up well on this type of X-ray.
Laser
Most people now know what a laser is: a powerful, amplified beam of light that can cut through steel or tissue with ease. The laser discussed in this book is specially tuned to affect only materials that form stones. Normal tissue is not harmed. The laser is a powerful tool to fragment stones, but it requires direct contact with the stone through some sort of telescope in either the kidney, ureter or bladder.
"Lithoclast"
The proper name of a particular kidney stone fragmenting probe that uses a small version of a pneumatic hammer to fragment stones. Works very well and quite safe but relatively new and only now becoming widely available. More popular in Europe.
Lithotripsy
The name for any procedure, surgery or technique that fragments or breaks up a stone. Often refers to ESWL.
Lithotriptor
Literally meaning "stone breaker," it refers to any machine than can fragment a stone; usually refers to some type of ESWL machine.
Medullary Sponge Kidney
A benign condition of the kidneys caused by dilation of the microscopic renal collecting tubules. It's diagnosed by kidney X-rays (Intravenous Pyelogram or IVP) and is described as a faint, white blush on the inside of the kidney visible only on Xray. It's associated with an increased risk of stone disease but isn't otherwise dangerous.
Metabolic Testing
A comprehensive package of kidney stone prevention blood and urine chemistry tests. Good commercial packages or programs are available from Laboratory Corporation of America, Mission Pharmacal, Quest Diagnostics,Urocor, Litholink and Dianon.
Metabolism
The sum total of all of the chemical reactions involved in living organisms.
Micturate
Another word for urinate or void.
"Milk Alkali" Syndrome
A condition caused by excessive oral intake of calcium containing foods and antacids.
Nephrectomy
Surgical removal of a kidney
Nephrocalcinosis
A condition where one or both kidneys is full of stones located within the renal tissue. Usually associated with an underlying medical problem like Renal Tubular Acidosis.
Nephrolithiasis
Condition in which one or more stones is located in a kidney.
Nephrolithotomy
Standard surgical procedure in which the kidney is opened and a stone is removed.
Nephrologist
A medical specialist primarily in kidney problems. Nephrologists are usually involved in cases of renal failure and dialysis, but many are very interested and knowledgeable about kidney stone disease and prevention. They are not surgeons.
Nephrology
The medical specialty that deals with kidney diseases.
Nephron
The microscopic functional unit of the kidney. Each kidney is made up of thousands of nephrons.
Nephrostomy
A surgically created passage from the skin directly into the central collecting space of the kidney. Usually a tube is left in this passage to drain the urine into a bag carried outside the body. This same passage can be enlarged and used for percutaneous procedures on the kidney.
Non-opaque
Any structure that does not show up clearly on X-ray. Most calcium containing stones would be opaque and block the Xray beam. They would appear as white spots on standard Xray films. A non-opaque stone would allow an X- ray beam to pass through and would be very hard to see on an X-ray film. To make it visible, some type of contrast would need to surround the non-opaque structure. The area that remained dark or clear could then be seen.
Opioid
A class of strong pain medicines derived from Opium. Morphine and Codeine would be examples.
Osteoporosis
Condition in which the bones are weak because of loss of calcium. This often occurs in people with forced immobilization, astronauts, women after menopause and in patients with hyperparathyroidism. Usually treated with supplemental calcium and either estrogen, Fosamax, calcitonin, exercise or some combination of the above.
Oxalate
A chemical compound that is found in most calcium kidney stones. It binds strongly with calcium. Dietary sources of oxalate include tea, chocolate, green leafy vegetables, nuts, tomatoes and some cola soft drinks.
Oxalobacter
The name of a normal bacteria of the intestinal tract that has the unique ability to digest oxalate. Currently used only experimentally, but has great potential as a future therapy for oxalate problems.
Parathyroid Hormone
The name of the hormone that comes from the parathyroid glands. This hormone increases blood calcium. To do this, it will increase calcium absorption from the digestive tract and take calcium away from the bones and teeth. Abnormally high levels of this hormone produce a disease called Hyperparathyroidism.
Parenteral
Means "Into the Body" Usually refers to any type of injectable medication.
PCA
Literally "Patient Controlled Analgesia." This is a program where a machine dispenses a preset amount of pain medicine directly into a vein when the patient pushes a button.
Percutaneous
Literally means through the skin. Several different types of kidney stone procedures can be done by surgically creating a passage directly into the central, open part of the kidney and passing a variety of probes, graspers, stents, catheters and other devices through the passage and into the kidney. Very useful for large or complicated stones.
pH
A measurement of the acid content of a liquid such as urine. A pH of 7 would be "neutral" like water. Acids have a low pH while alkaline liquids and bases have high pH numbers. The usual range for living organisms is between 5.0 and 9.0.
Phosphate
A normal chemical in blood and urine. Usually associated with stone disease as an inhibitor although in some stones such as calcium phosphate or struvite it can increase stone risk. One of the important chemicals to measure in any metabolic workup. Low levels of phosphate in the blood will cause an increase in Vitamin D activation and subsequent increase in intestinal absorption of phosphate and calcium.
Predisposition
The state of being particularly susceptible to a certain condition or disease.
Protease Inhibitors
A new group of medications used in the treatment of AIDS. Unfortunately, some tend to form stones.
Purine
A component of the genetic code material (DNA) inside every cell. All proteins have some purine, but the highest levels are found in red meat, poultry and fish. Digestion of excessive amounts of high purine content proteins can create high levels of uric acid.
Pyelonephritis
An infection of the kidney. Can progress to sepsis or bacterial blood poisoning.
Renal
Anything to do with the kidney.
Renal Failure
The loss of the kidneys ability to adequately filter the blood, usually due to diabetes or other diseases. When severe, requires mechanical filtration (dialysis) or kidney transplant.
Renal Leak Hypercalciuria
A type of increased urinary calcium due to a defect in the kidney that causes excessive calcium loss. Parathyroid hormone levels will tend to be elevated. This type of high urinary calcium doesn't respond to dietary modifications and requires medical therapy. Thiazides are particularly useful here. It is important never to use Cellulose therapy with renal leak hypercalciuria because it will cause a severe calcium loss.
Renal Phosphate Leak Hypercalciuria
Condition where the kidney is unable to keep excessive amounts of phosphate from being lost in the urine. This causes a low serum phosphate, high Vitamin D levels and ultimately high urinary calcium (hypercalciuria).
Renal Tubular Acidosis
Condition in which the kidneys are unable to excrete acid. It's characterized by an inability to acidify the urine even after an oral acid load. Associated with extremely low urinary citrate and severe stone disease.
Resorptive Hypercalciuria
A condition of high urinary calcium where the source of the calcium is reabsorption from existing bodily stores such as bone. Most commonly caused by hyperparathyroidism.
Retrograde Pyelogram
A special type of X-ray in which a small slender tube is placed through the bladder into the lower end of the ureter and contrast injected directly while an X-ray picture is taken. Alough this procedure requires anesthesia or sedation, the technique gives a very clear picture of the ureters and kidney interior. Can be used safely even when patients are severely allergic to contrast because there is no contact with the bloodstream.
Sepsis
A serious disease condition in which live bacteria are in the bloodstream. Can lead to an overwhelming infection and death if not treated properly and rapidly. Also called urosepsis when caused by a urinary infection.
Sodium
One of the main ingredients of table salt. Excessive salt or sodium in the diet can increase urinary calcium excretion and block the effects of some corrective medication.
Spasm
An abrupt and forceful contraction of a muscle, usually maintained for several minutes or hours and frequently associated with marked pain.
Staghorn
Refers to the branched shape of certain large stones. Usually associated with struvite or infection stones, the actual stone material can be almost any chemical stone ingredient.
Steinstrasse of
Literally "street of stones." This refers to the collection stone fragments that have lined up in the ureter and have not passed. May require additional surgery to remove. Usually happens after ESWL with large stones when a stent is not used.
Stent
A thin, slender tube designed to bypass any obstruction of the ureter such as from a stone or scar tissue. One end of the stent is placed in the kidney, and the other is in the bladder. Each end of the stent usually forms a small circle to help keep it in place. Used to help drain the kidney, bypass a stone and relieve pain. Also used as a landmark to help locate smaller or hard to see stones. Helps protect against clogging when large stones, over 1 cm in size are fragmented.
Stone Basket
One of several types of wire instruments used to capture and remove stones in the ureter. Normally used either with fluoroscopy or with special telescopes called ureteroscopes.
Stone Belt
The area of the United States where there seems to be an increased risk of kidney stones. Generally refers to the Southeast, but extends across the lower half of the country. The reason for the increased risk is only partially explained by the relatively warmer climate.
Stricture
The medical term for a narrowed or scarred area. Often occurs in the urinary system after instrumentation or stone passage. If there is a stricture of the ureter, any stones trying to pass will probably get stuck there. Stents work well to gently stretch open strictures of the ureters, but cannot help strictures of other bodily organs.
Struvite
Another name for stones caused by infection. Also called "Triple Phosphate" stones.
the dipstick.
Urolithiasis The disease process in which a stone is formed anywhere in the urinary system. While this usually refers to kidney stones, the term includes bladder stones as well.
Tomograms
A type of X-ray where both the X-ray projector and film are revolving around the patient. This technique is able to focus better on the kidney and permit better visualization even in difficult cases. Plain tomograms without contrast will help demonstrate even relatively small stones not visible with other methods.
Triple Phosphate
Stands for magnesium, ammonium phosphate and calcium phosphate. Another name for struvite stones. The "triple" stands for the three ingredients of calcium, magnesium and ammonium that are found in these stones.
Ultrasound
High frequency sound waves. Usually used like sonar for diagnosis. Has the advantage of safety. When used as a therapeutic probe, ultrasound can drill through most stones and pulverize them.
Ureter
The name of the muscular tube that empties the kidney and carries urine down to the urinary bladder. Normally it gently squeezes the urine downwards much like the intestines slowly pass food along from the stomach to the rectum.
Ureteropelvic Junction (UPJ)
The anatomical location where the inside of the kidney connects to the ureter. It's a common place for strictures and blockages. One of the three most likely locations for a stone to get stuck.
Ureteroscope
A specially made telescope designed to be passed through the urinary bladder into the ureter. The longer, flexible versions can reach all the way up to the kidney.
Ureteroscopy
Use of the ureteroscope to examine the ureter.
Ureterovesical Junction (UVJ)
The anatomical location where the ureter joins with the urinary bladder. The entry is at an angle so that urine will not return up to the kidney during voiding when the bladder pressure is high. This is the narrowest part of the ureter and where many stones will get stuck.
Urethra
The tube that allows passage of urine from the bladder to the outside.
Uric Acid
The final chemical endpoint in humans of purine (protein) metabolism. Most of it is excreted in the urine. Uric acid can form stones, make the urine more acidic and increase calcium stone formation.
Urinalysis
An examination of the urine. Usually best done with a chemical dipstick and a microscope, but often done just with
Urine
The liquid excreted by the kidneys. Normally it has a clear amber color. Urine does not normally contain sugar, albumin, pus, blood, bacteria, acetone, casts or crystals.
Urogenital Tract
The urinary and genital organs (kidney, ureter, bladder, prostate, penis, urethra, etc.).
Urologist
A specialist in the field of urology.
Urology
The medical specialty field that primarily deals with surgical problems affecting the kidneys, urinary bladder and male genitalia. Urology is a surgical specialty.
Urosepsis
A serious infection where the source of the bacteria was originally from the urinary tract.
UTI
Urinary Tract Infection. Usually refers to a bladder infection
Vitamin D
Vitamin D is essential for absorption of calcium and phosphate particularly during childhood. It prevents rickets and helps maintain healthy teeth and bones. In excess, it can cause kidney stones. This condition is called Hypervitaminosis D.
Workup
The organized sequence of medical tests used to establish a diagnosis. A workup for diagnosis of kidney stones would include a urine examination and X-rays. A metabolic workup for stone prevention would refer to the blood and urine chemistry tests used to analyze chemical risk factors ultimately resulting in a diagnosis.