A newsletter for the prevention of kidney stones? You bet! There's an urgent need among the more than 1 million patients per year who will pass their first kidney stone. And the millions more who go on to form kidney stones. Empower yourself with knowledge of the latest information on treatment and prevention.
Need a foundation of knowledge? Consider The Kidney Stones Handbook an essential resource
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VISA & MC accepted. Order now or call 1-800-2-KIDNEYS. Subscription price (quarterly) $25/yr. in U.S., $30 Canada; $35 foreign subscription. Checks and money orders accepted at Four Geez Press, 1911 Douglas Blvd., Suite 85-131, Roseville, CA 95661. Fax (916) 781-3814
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Do kidney stones run in your family? Would like to know "why?" You and your family are needed to participate in research by Wake Forest University School of Medicine. The School of Medicine is initially focusing on the most common stone type: calcium oxalate. With these stones, genetic factors alone may cause 50 percent of patients to form stones. Other factors, including one's diet and the amount of fluids consumed also contribute to stone formation risk. To be eligible for this study, the most important criteria is that your stones consist predominantly of calcium oxalate. The second most important consideration is that there are three generations of first degree relatives in the family (beginning at about 14 years of age) that would be willing to participate. None of these individuals need to have formed stones nor do they need to be calcium oxalate stone formers. It does help if more individuals than you in your family have had stones as this means susceptibility genes for stone disease are prevalent in your family. Ideally, at least 15 family members should be willing to participate and all reside in the United States. Study participants must collect all their urine daily for three days, and provide a blood sample. For more information send an e-mail to: rholmes@ wfubmc.edu. Gail Savitz and Four Geez Press endorse this study! Please do participate if you meet all the requirements!! |
This is a straight forward, non-fiction book on the medical procedures involved for the donor, and all families involved. Ken's sense of humor under the most trying situations helps lighten this personal story.
After reading Ken's personal story, I felt I knew his family. I could not put this book down. Patients with kidney stones must read this book!
Too often kidney foundations do not provide enough information on kidney stones. We seem to be the stepchild of those on dialysis. This book helps understand and appreciate the medical procedures our brothers and sisters on dialysis encounter in their search for matching donor kidneys. Every kidney support group/foundation in America needs to make this book available to all!
A Small Part of Me, the true story of being a kidney donor written by Ken Anderson, is available by mail. The cost, including tax and return postage is $8.88. His mailing address is PO Box 141, Rehoboth, MA 02769.
The Oxalosis and Hyperoxaluria Foundation An excellent support group for patients with oxalosis and hyperoxaluria, including a newsletter and dietary information. Contact: PO Box 1632,Kent, WA 98035 (508) 461-0614
The I.R.S. Tax Plan increases fluid wealth. By following this plan, you will increase both fluid intake and urinary output. The I.R.S. Tax Plan consists of several tax schedules. These include Kitchen Tax, Meal Tax, Nighttime Bathroom Use Tax, Penalty Tax, Restaurant Tax, Snack Tax, Summertime Tax, Work Tax and Water Fountain Tax. You may add as many taxes as you would like to "pad" your I.R.S. Tax Return.
At least half of any increased oral fluid intake should be water. This is what the body was designed for. As a general rule, the urine should appear no darker than a very pale yellow. To keep track of the urinary output, collect all the urine for 24 hours in a half gallon milk container. If you can fill the container in just one day, then the urinary output is probably adequate.
The "tax" in the plan consists of a glass of water or other suitable liquid. The size of this additional glass will need to be adjusted between 4 and 12 ounces to maintain the urinary output at the desire level. We suggest that you start at just 4 ounces and let your body adapt to the increased fluid. Depending on your individual tolerance and metabolism, your system will gradually adjust to the increased fluid and you will become thirsty if you fail to keep your fluid intake up. This usually takes about a month of regular increased fluid intake. Until your internal fluid "barometer" is reset, it may be difficult to maintain the increased fluid intake, but your system will start to adjust in just a few weeks.
"Kitchen Tax" - One glass whenever you've entered your kitchen and wish to leave (this is more of a "toll" than a tax).
"Meal Tax" - One extra glass with each meal except if you eat out at a restaurant where you will need two extra glasses.
"Nighttime Bathroom Use Tax" - One glass whenever you get out of bed to go to the bathroom at night. (We do not usually drink very much at night when we're asleep. With this tax, if you're already up anyway, you might as well add that extra drink of water).
"Penalty Tax" - If you eat or drink a food item you've been instructed to avoid or limit, you must drink at least two extra glasses.
"Restaurant Tax" - When you eat out at a restaurant you need to double the meal tax to two glasses. This is because restaurant food is high in salt which causes you to retain water.
"Snack Tax" - At least one extra glass if you have a snack between meals or at bedtime.
"Summertime Tax" - During the summer months or whenever the outside temperature is over 75 degrees, you must double all the other taxes!
"Time Tax" - One glass if you've managed to avoid all the other taxes for at least two hours.
"Water Fountain Tax" - Whenever you pass a water fountain, you are required to take a drink consisting of at least 10 swallows.
"Work Tax" - One glass whenever you leave your designated work area or desk.
(Reprinted with permission from The Lorain Medical Group, Ohio).
(Written exclusively for The Kidney Stones Network Newsletter)
Prehistoric man (and woman) lived in fear of two things: being eaten by a raptor, or other carnivorous creature and the painful, slow death of an obstructed, infected kidney. Just look at man's diet during this time: leafy green vegetation, wild game, bones and bugs. Just imagine how dehydrated one became after chasing down a saber tooth tiger for dinner!
The reality today is that diet, more than ever, is responsible for many of the illnesses seen in our societies. Which leads to a very key concept: we can control our own health if we have knowledge. But today that takes dedication and understanding of the technical advances available to the consumer.
It wasn't too long ago that women were told they were fated to have chronic cystitis, an infection of the bladder, because they were "built wrong" or "having too much sex." Conversely, men were informed the cause for their prostatitis was "too little sex." Pity the poor couple who shared this common affliction.
Cystitis is not the result of faulty anatomy nor of a healthy sex life. Rather it is the result of a mechanical failure to empty the contents of the bladder efficiently during voiding. In order to understand this, you must realize that the mechanical function of voiding is dependent upon four factors:
A good example is to listen to the woman next to you in the stalls (men: if you are caught doing this at the urinals, well, you know the result!). One person can sound like a waterfall, and the other may go "tinkle, tinkle, tinkle." The Niagra lady has excellent mechanical voiding, but the lady who "tinkles" is unable to efficiently cleanse her urethra, labia and perineum (the bridge of skin between the vagina and urethra) of bacteria. I think you can guess which woman may be prone to bouts of cystitis.
If we followed her back to her desk, we would probably find a hidden stash of cranberry juice containers in her drawer. After all, what woman isn't aware of cystitis sufferer's mantra: "Cranberry juice will get me through the day." This self-help commandment is fraught with misinformation because cranberry juice will not acidify your urine sufficiently to prevent either an infection or a stone. In fact, using cranberry juice to treat an already existing infection makes as much sense as putting out a fire with gasoline.
The bacteria use a component of acidic urine, called urea, to help them multiply and thrive. When bacteria are present, they tend to make your urine more alkaline as they split molecules of urea in the process of multiplying. In other words, your alkaline urine is the result, not the cause, of a bacterial infection. When you acidify your urine in the course of a bacterial infection, you are helping the bacteria by giving them more fuel! To be fair, cranberries (and blueberries as well) contain a chemical called hippuronic acid which helps to prevent bacteria from adhering to the bladder surface. However, this same antiseptic is available without all the calories and sugar in a table form my prescription. It's called Hiprex.
As you know, kidney stones can be the result of a faulty mechanism in the filtering system of the kidneys, or they can be caused by obstruction to the drainage line (the ureter) by enlarged blood vessels (no wonder urology is viewed as a plumbing specialty, only we just don't have the hours like our trade associates!), glandular disorders or by medication. Most stones, therefore, are not infected unless there is stagnation of urine, like the backup of dirty water in the sink. Urine itself is sterile, but if it pools for prolonged periods of time, the breakdown products can serve as a fertile breeding ground for bacteria, commonly E. Coli, Enteroccoccus or S. Fecalis. Chronic and even acute infections of the bladder can cause sufficient irritation to the opening of the ureters in that they allow some of the urine to flow backwards up into the kidneys during urination. It is this "back-wash" that can infect a seemingly innocent stone in a calyx, turning it into a leaky faucet of continual infection.
Stones, by their very nature, are composed of a matrix, or honeycomb, of crystals, which serve as individual "rooms" for bacteria once they gain access to the structure. The suspicious hallmark of an infected kidney stone is two renegade bacteria: Klebsiella and Pseudomonas. Every stone patient should be aware that only a urine culture can prove if you have an infection, as many times bacteria will be seen during a urinalysis merely because they have been washing off the body during urination, not because they are growing in the urine.
Infected stones pose the most threat, as chronic infection without drainage can result in a kidney abscess. Because the kidney is essentially a vascular sponge, bacteria have immediate access to the bloodstream and septicemia, or blood poisoning as it was commonly called, may ensue. Without appropriate antibiotic therapy combined with drainage, heart valves can be damaged and death may be the result (remember the caveman!). So it is imperative that stone patients monitor their urine not only for crystals but for bacteria. Easy to use dip sticks are now available in drug stores to test for nitrites, a byproduct of bacterial multiplication (one such product is Biotel, and there are others). If your test turns "blue," the positive color, contact your physician so he or she can order a urine culture. It will be the best money you ever spent!
Larrian Gillespie is a sought-after international lecturer on women's health. Her book "You Don't Have to Live With Cystitis" (Avon) has been a best-seller for a decade. The new, revised edition is available at bookstores everywhere. Orders are also accepted by calling 1.800.554.3335.
(Stephen W. Leslie, M.D. is a certified American Board of Urology specialist who practices stone prevention. He has received many honors, including an award in 1988 for developing an outstanding stone prevention program. Dr. Leslie is the Medical Research Director for the Lorain Stone Research Center in Lorain, Ohio.)
New technological breakthroughs have revolutionized our treatment of kidney stones. We are no longer in the Stone Age! Innovations like lithotripsy and lasers have forever changed the way we treat the majority of existing renal stones. These successful new treatment methods have caused some people to suggest that stone prevention testing and medical prophylactic treatment are no longer necessary.
That would be a terrible mistake! In no other branch of medicine would surgical therapy take precedence over reasonable preventive measures. The surgical approach does not eliminate pain or affect the rate of stone recurrence. Additionally, it is relatively expensive compared to the medical approach and there is always the risk of a complication.
Kidney stone disease is a condition which almost guarantees progression and recurrence unless the underlying cause is identified and eliminated. This can now be accomplished in virtually every case with comprehensive testing and appropriate medical therapy.
Stone prevention testing programs, with computerized interpretation of the usually complex laboratory results, is now readily available to all physicians. New advances in the field of blood and urinary chemical analysis and computerized evaluation of laboratory date make it possible for any physician to offer his patients a complete stone prevention program in over 95 percent of patients. While on therapy, most patients will not develop any new calculi. Any existing stones will take longer to grow and are thus more likely to pass on their own.
Preventive therapy avoids the terrible pain of kidney stones. Unless you have experienced it yourself, it is almost impossible to describe the intensity of this particular type of pain.
Along with the pain, not all stones are easily removed or treated. An example might be cystine stones which are notoriously difficult to fragment or remove. Other patients at high risk are those with many previous stones, a solitary kidney or a kidney transplant.
This is one of the many reasons why identification of all underlying abnormalities will avoid inappropriate treatment and prevent medical complications outside the kidney. The correct diagnosis is obviously necessary for optimal treatment.
Patients have a lot of power through education. By becoming fully informed about kidney stone prevention techniques, you can become a partner with your physician and regaining control of your body. You have the right to ask for specific testing and metabolic stone risk testing is one of the first steps in preventing future stones.
Today, non-specific stone prevention advice, such as limiting dietary calcium in calcium stone disease is no longer adequate. In the case of dietary calcium in particular, recent studies have shown that drinking milk and eating other foods high in calcium may have a protective effect by binding to other ingested minerals such as oxalate which then prevents oxalate absorption. In other words, limiting dietary calcium may actually increase the patient's risk for a calcium stone recurrence. Other medical problems would go undiagnosed and untreated unless the patient receives comprehensive chemical testing performed at specific laboratories.
Kidney stone prevention testing and treatment is extremely cost effective. An initial comprehensive laboratory evaluation costs less than $400 while a typical hospital admission for stones is at least $3,000 and obviously more if surgery is required. The cost of hospital treatment and surgery multiplies by the number of recurrences, while the expense of metabolic evaluation and treatment remains quite low in comparison.
Having a test performed, however, is not without its problems in kidney treatment programs. There is the potential for side effects from the use of medications and some patients may fail to comply with instructions, particularly over long periods of time. The patient must continue the therapy for years, even when she doesn't feel any immediate pain, discomfort or sickness if treatment is stopped. Regular follow-up evaluations are required. The initial treatment plan may fail if the patient refuses to closely follow recommendations.
Despite these few difficulties, kidney stone prevention testing programs and specific preventive treatment plans are in the best interests of stone patients. They promote good health, avoid the costs and possible complications of surgery, prevent possible adverse medical problems and eliminate the pain associated with kidney stones. Excellent stone prevention plans, such as the "Comprehensive Kidney Stone Prevention Program" from Laboratory Corporation of America are readily available nationwide as a reasonable cost to through your physician.
If you've been through the pain of one kidney stone, then you're most likely motivated enough to prevent a second, third or more occurrence. Kidney stone prevention programs (not just analysis of the stone) will help you map your destination towards a stone-free world!
This company is to be commended for their willingness to educate kidney stone patients not only by providing a web site with beautiful photographs (if a kidney stone can be beautiful!) with each one labeled as to type of stone. Gross out your friends and family at this collection of jewels-and not those found in a jewelry store, either! Louis C. Herring and Company, 1111 South Orange Avenue, PO Box 2191, Orlando, Florida 32802 provides analysis of kidney stones. It's important for you, the stone patient, to know what type of kidney stone you have passed so that stone prevention treatment can begin! A three-star applause to the folks at Louis C. Herring and Company.
Most kidney stone patients have small stones which pass spontaneously through the
ureter--the tubes which urine flows from the kidney to the bladder. A smaller group
of patients, however, harbor stones which require invasive removal, or procedures
which use some kind of instrument. The good news is that approximately 90 percent of these
individuals can be successfully treated with minimally invasive techniques such as
shock wave lithotripsy or ureteroscopic removal.
In uniques cases, however, percutaneous nephrostolithotomy (PNL) can result in successful
stone removal. Today, patients with large renal stones (generally 2 cm or larger)
sometimes associated with abnormal renal collecting system problems (the portion
of the kidney which transports urine) can be considered candidates for this procedure.
Some of these abnormalities include severe hydronephrosis (excessive dilation of
this area) and congenital or acquired obstruction of the collecting system (blockage
usually due to scar tissue).
Patients generally require regional or general anesthesia for PNL. Some patients
can undergo this procedure just receiving local anesthesia with supplemental intravenous
sedation. The first step in PNL involves placing a hollow needle into an appropriate area of the collecting system. X-ray or ultrasonography is used for guidance. A small
flexible wire is placed in the hollow port of the needle and manipulated through
the collecting system and down the ureter. The tissues between the skin surface and
the renal collecting system are stretched by passing a balloon dilating device over the
wire and inflating it when properly positioned or by manipulating sequentially larger
catheters which dilate the area over the wire. The tissue is stretched to a 1 cm
width, allowing the passage of a Teflon tube of similar diameter into the edge of the collecting
system. This tube is called the "working sheath" as instruments for stone removal
are passed through it.
Rigid and flexible nephroscopes (instruments allowing visual inspection of the collecting
system) are passed through this sheath. Grasping devices are passed through the nephroscope
to remove stones less than 1 cm in width. Larger stones are broken up into smaller pieces with lithotripsy (stone fragmenting) devices. A number of instruments
are available for this purpose, which use various types of energy for stone fragmentation,
including shock waves generated by electrohydraulic probes or laser fibers (most commonly pulsed dye or holmium lasers), and directly applied mechanical energy
from ultrasound probes or pneumatically driven devices.
Great effort is taken to remove all of the stone(s) as remnants left behind can become
a nidus for new stone growth. This sometimes requires that other working sheaths
be placed in the kidney.
A nephrostomy tube (a drainage tube composed of rubber or latex) is inserted into
the collecting system to assure proper drainage of urine from the kidney. This tube
is generally removed 48 to 72 hours later. Patients can resume normal activities
10 to 14 days after discharge from the hospital. Patients are left with only a 1 cm scar,
which is certainly cosmetically acceptable.
Patients have an excellent chance of being rendered stone free with PNL. Today, this
is the preferred treatment for most patients with large kidney stones. PNL may prove
to be the preferred approach for patients with stones in the lower pole of the kidney. I am participating in a randomized prospective multi-centered trial comparing PNL
and shock wave lithotripsy as treatment for patients with large stones. Preliminary
results indicate that stone free rates are significantly higher with PNL. There is
a small risk (2 percent to 5 percent) of high volume bleeding where patients may need to
receive blood transfusions. There is an even lower chance for injury to organs and
structures adjacent to the kidney with PNL. Overall results with PNL are excellent,
providing the patient meets the guidelines and the operating surgeon is skillful with these
techniques.
Dean G. Assimos, M.D., is an Associate Professor of Urology at The Bowman Gray School
of Medicine of Wake Forest University. Dr. Assimos has gained international recognition
for his expertise in the treatment of urinary stone disease. He serves on the American Urological Association Nephrolithiasis Guidelines Panel and has participated in
numerous postgraduate courses on stone disease. His investigative interests include
oxalate metabolism and genetic aspects of nephrolithiasis.
New Techniques Help Urologists Remove Stubborn Stones
by Dean G. Assimos, M.D.
Associate Professor of Urology,
Bowman Gray School of Medicine of Wake Forest University
How to Order
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