Tackling kidney stones: understanding causes, prevention, and management

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 Did you know that there is a considerable chance of developing kidney stones—the dreaded stones in the kidney? About 19% of men and 9% of women will experience at least one kidney stone crisis in their lifetime. The problem goes beyond the "functional" impairment, as the excruciating pain related to the stone can impact the pathway between the kidney and the bladder, causing severe urinary infections and even irreversible kidney loss, leading to hemodialysis. It is also known that those who have had a kidney stone episode are highly likely to have recurring stones, reaching 50% within ten years after the first episode. Therefore, understanding the pathophysiology of stone formation and knowing how to prevent it is necessary—a matter of life and health!

Stones are formed by the aggregation of substances in excess present in the urine. Some people who develop stones have a genetic predisposition to accumulate these substances in the urine, and many accumulate them due to dietary errors. However, even with the accumulation of these substances, if there is enough water to dissolve them, stone formation will become much more difficult. Thus, the first way to prevent stones is to drink plenty of water—at least two liters a day, spaced out so that the urine is never too concentrated at any time. The color should always be clear, almost transparent. The secret is to carry a reusable water bottle to overcome the laziness of fetching water glasses several times during the day.

The main substances forming kidney stones are oxalate and calcium phosphate. They tend to accumulate in the urine with increased renal excretion of calcium. Among the factors that increase renal excretion of calcium is a high intake of table salt, as excess sodium in the blood is partially eliminated in the urine, taking calcium from the blood with it. But beware! If you have had stones before or even want to prevent them, decreasing dietary calcium intake on your own is contraindicated since the formation of this type of stone is rarely associated with calcium intake itself, and calcium deficiency can cause serious problems such as osteoporosis.

Moreover, certain medical conditions and medications can also contribute to kidney stone formation. Conditions like hyperparathyroidism, renal tubular acidosis, and certain types of urinary tract infections can increase the risk of developing stones. Additionally, medications such as diuretics, antacids containing calcium, and certain antibiotics can alter the composition of urine, making it more conducive to stone formation. Therefore, individuals with these conditions or those taking such medications should consult their healthcare provider for proper management and preventive measures to reduce the risk of kidney stones.

Self-supplementation with high doses of vitamin D, on the other hand, can increase the risk of urinary calcium excretion. Vitamin supplements should only be used under medical or nutritional supervision, as they are not without risks and have few indications. Another vitamin commonly used as an unnecessary supplement is vitamin C, which, in high doses, can increase urinary oxalate excretion, also increasing the risk of stone formation.

 

Decreasing citrate excretion in the urine similarly increases the chance of kidney stones since citrate prevents stone precipitation. A diet high in animal protein can decrease the amount of citrate excreted in urine. Similarly, a diet low in fruits and vegetables decreases urinary citrate since the potassium excreted in urine is strongly influenced by the amount of vegetables consumed, and urinary citrate excretion depends in part on urinary potassium excretion.

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