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Quelle: ABC homeopathy
I
am copying below an interesting article on Kidney Stones appeared in The News
International.
Kidney
stones are as old as the human civilisation. Scientists have found evidence of
their existence in a 7000-year-old Egyptian mummy. Despite the passage of
several millennia they still constitute one of the most painful urologic
disorders.
Three
million people visit health care providers and more than half a million go to
emergency rooms every year for treatment of kidney stone problems.
A
kidney stone is a hard mass developed from crystals that separate from the
urine within the urinary tract.
Normally
urine contains chemicals that prevent or inhibit the crystals from being
formed. These inhibitors, however, do not work for everyone. If the crystals
remain tiny, they travel through the urinary tract and pass out of the body in
the urine without being noticed.
Kidney
stones may be as small as a grain of sand or as large as a pearl. Some stones
are as big as golf balls! Stones may be smooth or jagged. They are usually
yellow or brown. About 90% of stones that are 4 mm or less in size usually pass
spontaneously, however 9% of stones are larger than 6 mm. (gallstones and
kidney stones are not related with each other. They form in different parts of
the body. Someone with a gallstone is not necessarily more likely to develop
kidney stones.)
Different
studies on kidney stones showed there 4 types of stones. The most common type
contains calcium that is a normal part of a healthy diet. Calcium that is not
used by the bones and muscles goes to the kidneys.
1. Calcu-ox. In most people, the kidneys
flush out the extra calcium with the rest of the urine. People who have calcium
stones keep the calcium in their kidneys.
2. Uric-acid stones: Infection in the urinary
system may also cause the formation of stones in kidney. These stones contain
the mineral magnesium and the waste product ammonia. may form when the urine
contains too much acid.
3.
Struvite or infection stone. A less
common type of stone is caused by infection in the urinary tract. Another type
of stone, uric acid stones, are a bit less common, and cystine stones are rare.
Genes
also play a role in inheriting the tendency to develop kidney stones in many
patients. More than 70% of people with a rare hereditary disease called renal
tubular acidosis develop kidney stones.
Usually,
the first symptom of a kidney stone is extreme pain in back, bloody urine,
fever, chills, vomiting, the urine that smells bad or looks cloudy or a burning
feeling when you urinate.
Sometimes
nausea and vomiting may also occur. Later, pain may spread to the groin.
Most
people think that getting rid of an existing stone is the end of the problem
but stone formation can happen again and again. Kidney stones, acute as well as
chronic, can be effectively treated with homeopathic medicines.
Kidney
Stones in Adults
Most
kidney stones pass out of the body without any intervention by a physician.
Stones that cause lasting symptoms or other complications may be treated by
various techniques, most of which
do
not involve major surgery. Also, research advances have led to a better
understanding of the many factors that promote stone formation and thus better
treatments for preventing stones.
Introduction
to the Urinary Tract
The
urinary tract, or system, consists of the kidneys, ureters, bladder, and
urethra. The kidneys are two bean-shaped organs located below the ribs toward
the middle of the back, one on each side of the spine. The kidneys remove extra
water and wastes from the blood, producing urine. They also keep a stable
balance of salts and other substances in the blood. The kidneys produce hormones
that help build strong bones and form red blood cells.
The
urinary tract.
Narrow
tubes called ureters carry urine from the kidneys to the bladder, an
oval-shaped chamber in the lower abdomen. Like a balloon, the bladder’s elastic
walls stretch and expand to store urine. They flatten together when urine is
emptied through the urethra to outside the body.
What
is a kidney stone?
A
kidney stone is a hard mass developed from crystals that separate from the
urine within the urinary tract. Normally, urine contains chemicals that prevent
or inhibit the crystals from forming. These inhibitors do not seem to work for
everyone, however, so some people form stones. If the crystals remain tiny
enough, they will travel through the urinary tract and pass out of the body in
the urine without being noticed.
Kidney
stones may contain various combinations of chemicals. The most common type of
stone contains calcium in combination with either oxalate or phosphate. These chemicals
are part of a person’s normal diet and make up important parts of the body,
such as bones and muscles.
Kidney stones in the kidney,
ureter, and bladder.
Urolithiasis
is the medical term used to describe stones occurring in the urinary tract.
Other frequently used terms are urinary tract stone disease and
nephrolithiasis.
Who
gets kidney stones?
For
unknown reasons, the number of people in the United States with kidney stones
has been increasing over the past 30 years. In the late 1970s, less than 4
percent of the population had stone-forming disease. By the early 1990s, the
portion of the population with the disease had increased to more than 5
percent. Caucasians are more prone to develop kidney stones than African
Americans. Stones occur more frequently in men. The prevalence of kidney stones
rises dramatically as men enter their 40s and continues to rise into their 70s.
For women, the prevalence of kidney stones peaks in their 50s. Once a person
gets more than one stone, other stones are likely to develop.
What
causes kidney stones?
Certain
foods may promote stone formation in people who are susceptible, scientists do
not believe that eating any specific food causes stones to form in people who
are not susceptible.
A
person with a family history of kidney stones may be more likely to develop
stones. Urinary tract infections, kidney disorders such as cystic kidney
diseases, and certain metabolic disorders such as hyperparathyroidism are also
linked to stone formation.
Cystinuria
and hyperoxaluria are two other rare, inherited metabolic disorders that often
cause kidney stones. In cystinuria, too much of the amino acid cystine, which
does not dissolve in urine, is voided, leading to the formation of stones made
of cystine. In patients with hyperoxaluria, the body produces too much oxalate,
a salt. When the urine contains more oxalate than can be dissolved, the
crystals settle out and form stones.
Hypercalciuria
is inherited, and it may be the cause of stones in more than half of patients.
Calcium is absorbed from food in excess and is lost into the urine. This high
level of calcium in the urine causes crystals of calcium oxalate or calcium
phosphate to form in the kidneys or elsewhere in the urinary tract.
Other
causes of kidney stones are hyperuricosuria, which is a disorder of uric acid
metabolism; gout; excess intake of vitamin D; urinary tract infections; and
blockage of the urinary tract. Certain diuretics, commonly called water pills,
and calcium-based antacids may increase the risk of forming kidney stones by
increasing the amount of calcium in the urine.
Calcium
oxalate stones may also form in people who have chronic inflammation of the
bowel or who have had an intestinal bypass operation, or ostomy surgery. As
mentioned earlier, struvite stones can form in people who have had a urinary
tract infection. People who take the protease inhibitor indinavir, a medicine
used to treat HIV infection, may also be at increased risk of developing kidney
stones.
Foods and Drinks Containing Oxalate
People
prone to forming calcium oxalate stones may be asked by their doctor to limit
or avoid certain foods if their urine contains an excess of oxalate.
High-oxalate
foods - higher to lower
rhubarb
spinach
beets
swiss
chard
wheat
germ
soybean
crackers
peanuts
okra
chocolate
black
Indian tea
sweet
potatoes
Foods
that have medium amounts of oxalate may be eaten in limited amounts.
Medium-oxalate
foods - higher to lower
grits
grapes
celery
green
pepper
red
raspberries
fruit
cake
strawberries
marmalade
liver
What
are the symptoms of kidney stones?
Kidney
stones often do not cause any symptoms. Usually, the first symptom of a kidney
stone is extreme pain, which begins suddenly when a stone moves in the urinary
tract and blocks the flow of urine. Typically, a person feels a sharp, cramping
pain in the back and side in the area of the kidney or in the lower abdomen.
Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If
the stone is too large to pass easily, pain continues as the muscles in the
wall of the narrow ureter try to squeeze the stone into the bladder. As the
stone moves and the body tries to push it out, blood may appear in the urine,
making the urine pink. As the stone moves down the ureter, closer to the bladder,
a person may feel the need to urinate more often or feel a burning sensation
during urination.
If
fever and chills accompany any of these symptoms, an infection may be present.
In this case, a person should contact a doctor immediately.
How
are kidney stones diagnosed?
Sometimes
“silent” stones (do not cause symptoms) are found on x rays taken during a
general health exam. If the stones are small, they will often pass out of the
body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken
of someone who complains of blood in the urine or sudden pain. These diagnostic
images give the doctor valuable information about the stone’s size and
location. Blood and urine tests help detect any abnormal substance that might
promote stone formation.
The
doctor may decide to scan the urinary system using a special test called a
computerized tomography (CT) scan or an intravenous pyelogram (IVP). The
results of all these tests help determine the proper treatment.
Preventing
Kidney Stones
A
person who has had more than one kidney stone may be likely to form another;
so, if possible, prevention is important. To help determine their cause, the
doctor will order laboratory tests, including urine and blood tests. The doctor
will also ask about the patient’s medical history, occupation, and eating
habits. If a stone has been removed, or if the patient has passed a stone and
saved it, a stone analysis by the laboratory may help the doctor in planning
treatment.
How
are kidney stones treated?
Fortunately,
surgery is not usually necessary. Most kidney stones can pass through the
urinary system with plenty of water—2 to 3 quarts a day—to help move the stone
along. Often, the patient can stay home during this process, drinking fluids
and taking pain medication as needed. The doctor usually asks the patient to
save the passed stone(s) for testing. It can be caught in a cup or tea strainer
used only for this purpose.
Lifestyle Changes
A
simple and most important lifestyle change to prevent stones is to drink more
liquids (water). Someone who tends to form stones should try to drink enough
liquids throughout the day to produce at least 2 quarts of urine in every
24-hour period.
In
the past, people who formed calcium stones were told to avoid dairy products
and other foods with high calcium content. Recent studies have shown that foods
high in calcium, including dairy products, may help prevent calcium stones.
Taking calcium in pill form, however, may increase the risk of developing
stones.
Patients
may be told to avoid food with added vitamin D and certain types of antacids
that have a calcium base. Someone who has highly acidic urine may need to eat
less meat, fish, and poultry. These foods increase the amount of acid in the
urine.
To
prevent cystine stones, a person should drink enough water each day to dilute
the concentration of cystine that escapes into the urine, which may be
difficult. More than a gallon of water may be needed every 24 hours, and a
third of that must be drunk during the night.
Medical
Therapy
A
doctor may prescribe certain medications to help prevent calcium and uric acid
stones. These medicines control the amount of acid or alkali in the urine, key
factors in crystal formation. The medicine allopurinol may also be useful in
some cases of hyperuricosuria.
Doctors
usually try to control hypercalciuria, and thus prevent calcium stones, by
prescribing certain diuretics, such as hydrochlorothiazide. These medicines
decrease the amount of calcium released by the kidneys into the urine by
favoring calcium retention in bone. They work best when sodium = salt intake is
low.
Rarely,
patients with hypercalciuria are given the medicine sodium cellulose phosphate,
which binds calcium in the intestines and prevents it from leaking into the
urine.
If
cystine stones cannot be controlled by drinking more fluids, a doctor may
prescribe medicines such as Thiola and Cuprimine, which help reduce the amount
of cystine in the urine.
For
struvite stones that have been totally removed, the first line of prevention is
to keep the urine free of bacteria that can cause infection. A patient’s urine
will be tested regularly to ensure no bacteria are present.
If
struvite stones cannot be removed, a doctor may prescribe a medicine called
acetohydroxamic acid (AHA). AHA is used with long-term antibiotic medicines to
prevent the infection that leads to stone growth.
People
with hyperparathyroidism sometimes develop calcium stones. Treatment in these
cases is usually surgery to remove the parathyroid glands, which are located in
the neck. In most cases, only one of the glands is enlarged. Removing the
glands cures the patient’s problem with hyperparathyroidism and kidney stones.
Surgical
Treatment
Surgery
may be needed to remove a kidney stone if it does not pass after a reasonable
period of time and causes constant pain is too large to pass on its own or is
caught in a difficult place
blocks
the flow of urine causes an ongoing urinary tract infection
damages
kidney tissue or causes constant bleeding
has
grown larger, as seen on follow-up x rays
Until
20 years ago, open surgery was necessary to remove a stone. The surgery
required a recovery time of 4 to 6 weeks. Today, treatment for these stones is
greatly improved, and many options do not require major open surgery and can be
performed in an outpatient setting.
Extracorporeal
Shock Wave Lithotripsy
Extracorporeal
shock wave lithotripsy (ESWL) is the most frequently used procedure for the
treatment of kidney stones. In ESWL, shock waves that are created outside the
body travel through the skin and body tissues until they hit the denser stones.
The stones break down into small particles and are easily passed through the
urinary tract in the urine.
Several
types of ESWL devices exist. Most devices use either x rays or ultrasound to
help the surgeon pinpoint the stone during treatment. For most types of ESWL
procedures, anesthesia is needed.
In
many cases, ESWL may be done on an outpatient basis. Recovery time is
relatively short, and most people can resume normal activities in a few days.
Complications
may occur with ESWL. Some patients have blood in their urine for a few days
after treatment. Bruising and minor discomfort in the back or abdomen from the
shock waves can occur.
To
reduce the risk of complications, doctors usually tell patients to avoid taking
aspirin and other medicines that affect blood clotting for several weeks before
treatment.
Sometimes,
the shattered stone particles cause minor blockage as they pass through the
urinary tract and cause discomfort. In some cases, the doctor will insert a
small tube called a stent through the bladder into the ureter to help the
fragments pass. Sometimes the stone is not completely shattered with one treatment,
and additional treatments may be needed.
As
with any interventional, surgical procedure, potential risks and complications
should be discussed with the doctor before making a treatment decision.
Percutaneous
Nephrolithotomy
Sometimes
a procedure called percutaneous nephrolithotomy is recommended to remove a
stone. This treatment is often used when the stone is quite large or in a
location that does not allow effective use of ESWL.
In
this procedure, the surgeon makes a tiny incision in the back and creates a
tunnel directly into the kidney. Using an instrument called a nephroscope, the
surgeon locates and removes the stone.
For
large stones, some type of energy probe—ultrasonic or electrohydraulic—may be
needed to break the stone into small pieces. Often, patients stay in the
hospital for several days and may have a small tube called a nephrostomy tube
left in the kidney during the healing process.
One
advantage of percutaneous nephrolithotomy is that the surgeon can remove some
of the stone fragments directly instead of relying solely on their natural
passage from the kidney.
Percutaneous
nephrolithotomy.
Ureteroscopic
Stone Removal
Although
some stones in the ureters can be treated with ESWL, ureteroscopy may be needed
for mid- and lower-ureter stones. No incision is made in this procedure.
Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope
through the urethra and bladder into the ureter. The surgeon then locates the
stone and either removes it with a cage-like device or shatters it with a
special instrument that produces a form of shock wave. A small tube or stent
may be left in the ureter for a few days to help urine flow. Before fiber
optics made ureteroscopy possible, physicians used a similar “blind basket”
extraction method. But this technique is rarely used now because of the higher
risks of damage to the ureters.
Hope
through Research
The
Division of Kidney, Urologic, and Hematologic Diseases of the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) funds research
on the causes, treatments, and prevention of kidney stones. The NIDDK is part
of the National Institutes of Health in Bethesda, MD.
NIDDK
researchers and grantees seek to answer questions such as
Why
do some people continue to have painful stones?
How
can doctors predict, or screen, those at risk for getting stones?
What
are the long-term effects of lithotripsy?
Do
genes play a role in stone formation?
What
is the natural substance(s) found in urine that blocks stone formation?
Researchers
are also developing new medicines with fewer side effects.
Points
to Remember
A
person with a family history of stones or a personal history of more than one
stone may be more likely to develop more stones.
A
good first step to prevent the formation of any type of stone is to drink
plenty of liquids—water is best.
Someone
who is at risk for developing stones may need certain blood and urine tests to
determine which factors can best be altered to reduce that risk.
Some
people will need medicines to prevent stones from forming.
People
with chronic urinary tract infections and stones will often need a stone
removed if the doctor determines that the stone is causing the infection.
Patients must receive careful follow-up to be sure that the infection has
cleared.
Vorwort/Suchen Zeichen/Abkürzungen Impressum