KIDNEY STONES: Risks, prevention, and intervention 6/11/2014 1

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1 KIDNEY STONES: Risks, prevention, and intervention 6/11/2014 1

2 Paula J. Bunde, MD Undergraduate education: Saint Louis University Medical school: IU School of Medicine (Evansville, Indianapolis) Residency: IU School of Medicine, Indianapolis 6/11/2014 2

3 What are kidney stones? Too many minerals in too little fluid! 6/11/2014 3

4 Stone types: Calcium oxalate Calcium phosphate Uric acid 10% 80 85% Struvite (magnesium ammonium phosphate) Cystine Drug stones (indinavir, triamterene, ephedrine) 6/11/2014 4

5 Who gets kidney stones? Increasing number of women, now 40% of stone formers are women Caucasians more than other race/ethnicity groups Ages s 10-15% of Americans! You cannot change these factors 6/11/2014 5

6 More risk factors for kidney stones: Obesity Diabetes Dehydration/poor fluid intake Purine (meat) rich diet and other dietary excess YOU CAN MODIFY THESE FACTORS! 6/11/2014 6

7 Other risk factors: Family history (yep, it is your parents fault!) Inflammatory bowel disease or other malabsorptive conditions (bariatric surgery) Recurrent urinary infections Abnormalities of kidney structure Certain medications Some medical conditions (hyperparathyroidism, sarcoidosis, etc.) 6/11/2014 7

8 Medications associated with stones: Form a stone: Indinavir (Crixivan) Triamterene Ephedrine Silica antacids (Gaviscon) Alter risk for stones: Topamax (topirimate) Acetazolimide Excess laxatives Excess Vitamin C (> 2000 mg/day) 6/11/2014 8

9 TYPICAL Symptoms of Kidney Stones: - Pain in one side of the back, often radiating to the groin - Nausea and vomiting - Chills without fever - Blood in the urine - Intermittent flares of pain over hours - WORSE THAN HAVING A BABY! 6/11/2014 9

10 If you have a stone A picture is worth a thousand words CT scan, x-ray, ultrasound Is it an emergency? Infection, kidney function, solitary kidney PAIN control many times can be managed at home Will you pass the stone? 6/11/

11 Where and how big?? 6/11/

12 OUCH! 6/11/

13 Helping the stone to pass: Lots of liquids! Medical Expulsive Therapy (NSAID + α blocker) TIME What doesn t help: Jumping? Herbal remedies Cranberry juice 6/11/

14 What if you need surgery? ESWL (extracorporeal shock wave lithotripsy) Ureteroscopy (laser, basket) PCNL Open surgery 6/11/

15 ESWL Shockwaves focused on stone using x-ray Anesthetic procedure Sometimes will have a stent Least invasive Not for all stones 6/11/

16 Ureteroscopy Visualization and treatment of stone Anesthetic procedure Usually will have a stent Outpatient procedure For ureteral and renal stones 6/11/

17 What is a stent? 6/11/

18 PCNL Large diameter tube through back into kidney Larger instruments to visualize and treat stone Not outpatient Highest risk of complications Used for large stones in kidney 6/11/

19 Why did I have a stone?? Analysis of stone fragments Blood tests 24 hour urine collection for mineral concentrations Review of medications Based on this evaluation, your urologist can make the most specific recommendations to prevent future stones! 6/11/

20 Prevention Basic Strategies 6/11/

21 NUMBER ONE, TOP PRIORITY, NUMERO UNO Drink plenty of liquids! Goal is to urinate >2.5 liters (75 ounces) of fluid daily! Dilution is the solution! Water is the best liquid to drink but you can have soda, coffee, juice in MODERATION Depending on fluid loss from sweating and other excretion, you may need to drink 3 or more liters of liquids daily! 6/11/

22 #2, a close runner up You need a moderate amount of dietary calcium Adults: mg/day (3-4 dairy servings) Take any calcium supplements with meals Choose calcium citrate supplements Try to have calcium in the setting of a meal, not alone 6/11/

23 #3 AND #4 Limit your animal protein (all animals) to 2 servings daily, a serving is 4 ounces! Soy protein is okay Limit your sodium to 2300 mg/day or less 6/11/

24 Some myths of stone disease I can dissolve my stones There is nothing to do to prevent stones NO! Only stones that can be dissolved are uric acid NO! Take to heart the recommendations they work! 6/11/

25 What about Hard or soft water? Drinking soda? No difference but those using well water have slight statistical increase in incidence of kidney stones Soda in moderation doesn t cause stones Soda as mainstay of fluid intake CAN lead to stones 6/11/

26 So what about Citrate Oxalate Found in citrus fruits and juices, mainly lemon Inhibits stones from forming in the kidney Prescription supplements for those with stones and low citrate Component of some stones Found in many healthy foods Recommend moderation if oxalate is a known problem 6/11/

27 The bottom line After a first stone, you have a 50% chance of a second stone if you do nothing You can reduce your chance of more stones! There are many options for stone treatment if passing the stone is not the right option There are risk factors beyond your control but MANY than you can modify! 6/11/

28 Questions?? (don t be shy!) 6/11/

29 6/11/

30 Drs. Lenz, Walker, Bunde, Hoff /11/

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