Kidney Stones:Urinary Calculus

Number of Americans affected by kidney stones yearly — 1,000,000

Portion of U.S. population affected annually — 0.5%

Portion of population who will have at least one kidney stone –3%

Of these, how many will have at least one recurrence — 75%

Relative risk of forming a second stone — 60% to 80% over next 10 years (50% over next 5 years)

Rate of Stone production for recurrent stone formers — one stone every 2 to 3 years

Portion of stone patients with very aggressive disease — 10% to 15% (10 or more stones)

Incidence of kidney stones in areas of “soft” water — Higher

Peak seasonal occurrence –June to August

Likelihood of a patient eventually forming a stone if his brother already had one — 50%

Men:Women 4:1

Hospitalization in approx. 20%. Rarely death or renal failure.

Calcium containing stones are most common. 85% in men, 65% in women.

Stones pass spontaneously in 80%. If stone > 8 mm, only 10 % will pass.

Complications: Renal failure if unrelieved obstruction for > 7 days.

3% of all Americans will suffer from a kidney stone at some time in their life, and half of these people will suffer recurrences over the following ten or more years. It is thus a disease which touches a significant portion of the population.

Normal urine contains predictable amounts of calcium, magnesium, uric acid, and other by-products of metabolism. Normally these substances are in solution and pass into the bladder. Under certain conditions of high saturation, and in a complex chemical environment that is not yet completely understood, the chemicals may crystallize and form a stone-like particle in the kidney. Once formed it stimulates continued crystallization. If the stone remains in the kidney, no symptoms may occur, although there may be microscopic signs of blood in the urine. Once a piece of the stone breaks off and enters the ureter leading to the bladder, prompt spasms occur.

Urine of most normal people is supersaturated with respect to calcium oxalate, so all people can potentially form such stones. Normal urine is not supersaturated with respect to uric acid, cystine or struvite. Conditions that raise calcium oxalate supersaturation raise the risk of calcium oxalate stones. Hypercalciuria and hyperoxaluria are two main clinical examples, and both can result from many diseases. Hyperparathyroidism, renal tubular acidosis, sarcoidosis, vitamin D intoxication, and “idiopathic” hypercalciuria all are causes of hypercalciuria. Hyperoxaluria may be due to overproduction, from hereditary disorders of metabolism, or be acquired from intestinal disease or diet.

Apart from overexcretion, supersaturation can be increased by abnormal interactions between urine ions. Urine citrate forms a soluble salt with calcium that normally reduces free calcium ion levels appreciably; low urine citrate from bowel disease, renal tubular acidosis, and, perhaps, dietary and hereditary causes can raise calcium oxalate supersaturation and promote stones. Normal women excrete more citrate and less calcium than normal men, perhaps a reason why men form stones more often. Low urine pH from hereditary causes or bowel disease promotes uric acid stones; high pH, from alkali, drugs, or renal tubular acidosis increases calcium phosphate supersaturation.

An infection of the urinary tract can cause cellular debris to act as a focus or “seed”on which crystals can form. Bacterial action makes the urine more alkaline, resulting in the deposit of phosphates, which form calcium phosphate stones. Excessive uric acid, increased excretion of calcium by the kidney, combined with an increased insolubility of calcium in the urine, can also cause stones to form. Long-term confinement to bed or even a chronic lack of exercise may encourage mobilization of calcium from bones into the blood, increasing calcium levels in the urine. Similarly, steroids can increase blood and urine calcium levels. An inherited disposition and excess weight can also predispose you to kidney stones.

The pain of a kidney stone comes on suddenly. Classically, there is severe, excruciating pain in the flank on the side of the stone, coming in waves, radiating around to the lower abdomen and into the groin, scrotum or vagina, and occasionally into the upper thigh area. The intensity is as severe as most people ever experience. There may or may not be blood in the urine. There may be nausea, vomiting, and profuse sweating. After anywhere from minutes to days or even longer, most stones pass into the bladder, and the pain is gone. The small, usually brown or black stone may be identified in the urine, and should be kept for analysis. If fever is present it may be from infection which has formed behind the stone in the stagnant urine.

A Traditional Phytotherapeutic approach to Kidney Stones

Actions indicated for the processes behind this disease

Anti-lithics remedies are, of course, the core of any treatment of renal calculus.

Anti-inflammatories are indicated to lessen the inflammation that will be caused by the passage of hard materiel along the delicate tissue of the whole system. Using such remedies will lesson the pain and discomfort to some degree.

Anti-spasmodics are essential to help the body reduce muscular spasming along the urinary tract as peristalsis moves the stone. Unfortunately the legal plant anti-spasmodics are not strong enough to deal with the problem in acute cases.

Demulcents will help here as they are usually also anti-inflammatories in this system.

System support

Help must be given to the Urinary system because it is the focus of trauma, but also consider help for stress (because of pain) and anything else that is indicated in the patients symptom picture or medical history.

Specific remedies

There are a number of plants that have a long tradition of use as specifics in Europe. Examples are:

Hydrangea (Hydrangea arborescens); Parsley Piert (Aphanes sp.); Pellitory of the Wall (Parietaria officinalis); Couch Grass (Agropyron repens); Nettles (Urtica dioica)

To these can be added the following North American plants:

Gravel Root (Eupatorium purpureum); Corn Silk (Zea mays); Golden Rod (Solidago virgaurea)

One possible prescription:

Agropyron repens
Eupatorium purpureum
Zea mays
Dioscorea villosa
Viburnum prunifolium

1 cup of an infusion of Urtica dioica to be drunk 3 times a day.

This combination supplies the following actions:

diuretic (Collinsonia canadensis, Eupatorium purpureum, Zea mays)

demulcent (Zea mays)

anti-lithic (Collinsonia canadensis, Eupatorium purpureum)

antispasmodic (Dioscorea villosa, Viburnum prunifolium, Zea mays)

Broader context of treatment

Profuse sweating or a low fluid intake can make the urine more concentrated, causing urinary salts to solidify and stones to form. Avoid dehydration especially after exercise, but even during routine days, by the ingestion of copious amounts of fluid. Drink 4 to 6 pts of fluid a day and 1 pt of fluid before going to bed. Drink enough to ensure that twenty-four hour urine output is never less than 3 pts. Ideally, the patient should be drinking enough to cause routine awakening at night to urinate.
“Although there is no controlled clinical study that examines the effectiveness of an increase in fluid intake, data strongly suggest that hydration is effective in preventing stone formation. While strict guidelines are not available, a doubling of the urinary output or a 24-hour urinary output of greater than 2 liters is generally recommended to reduce new stone formation. In actual practice, however, the beneficial effects of hydration may be seen with much less increase in urinary volume.”1

Uric acid stones: Here the urine will be acid. To ‘dissolve’ these stones, eat an alkaline diet, including potatoes, vegetables and fruit (not citrus). Reduce protein intake, since eating protein tends to increase uric-acid levels. Also, drink alkalinizing mineral water. Reduction of dietary purine intake is also widely recommended. In particular, avoid liver, kidneys, fishroe and sardines.

Calcium oxalate stones: avoid foods containing oxalates, such as spinach, rhubarb, beet, parsley, sorrel, and chocolate. Those who have a tendency to form oxalate stones often secrete too much calcium in their urine, which reacts with oxalic acids to form the stones. Patients are advised against a calcium intake of more than 1 g per day, and a high sodium intake. For this reason it is also advisable to restrict dairy products which are rich in calcium. Drink mineral waters that are rich in magnesium to increase the solubility of calcium. Both Vitamin B6 and folic acid are thought to restrict the amount of calcium formed in the body.

Calcium phosphate stones: are usually formed when there is a urinary infection. The urine is alkaline, so eat foods to acidify the urine such as meat, fish, and eggs. However, avoid dairy products.

Indicators for Surgical Treatment

Some type of surgery may be needed to remove a kidney stone if the stone:

does not pass after a reasonable period of time and causes constant pain,
is too large to pass on its own,
blocks the urine flow,
causes ongoing urinary tract infection,
damages the kidney tissue or causes constant bleeding, or
has grown larger (as seen on follow up x-ray studies).

A number of surgical options exist that do not require major surgery.

Extracorporeal Shockwave Lithotripsy.

The most frequently used surgical procedure, ESWL uses shockwaves that are created outside of the body to travel through the skin and body tissues until the waves hit the dense stones. The stones become sand-like and are passed through the urinary tract in the urine.

Percutaneous nephrolithotomy

Involves an incision in the back to creates a tunnel directly into the kidney. Using a nephroscope, the stone is located and removed. For large stones, some type of energy probe may be needed to break the stone into small pieces.

Ureteroscopic Stone Removal.

No incision is made in this procedure. A ureteroscope is passed through the urethra and bladder into the ureter. The stone is removed or shattered it with a shockwave.

1 Prevention and Treatment of Kidney Stones. NIH Consens Statement Online 1988 Mar 28-30;7(1):1-23.

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