Categories: Urology

Demystifying and Defeating Kidney Stones

This article suitably and aptly clears all the myths related to kidney stones.

Understanding the causes, predisposing factors and prevention of kidney stones is of utmost importance especially in these testing times of the pandemic when people are glued to their laptops in a bid to work from home. This sort of behavior, sedentary lifestyle and fear to go to hospitals to seek medical care increase chances to suffer from the same.

An easy way to study the predisposing factors causing stones is to conveniently divide them into modifiable and non-modifiable risk factors.

While some of the non-modifiable ones include sex (males being almost 2 to 3 times more prone for stone development), age (peak incidence of renal stones is in 3rd to 5th decade of life with females showing increasing incidence after menopause), geographical factors (high incidence in North and Western India viz a viz Southern and Eastern parts), Seasonal variation (typically highest incidence between July and September that correlates with high temperature and humidity, come October and we are typically past the stone season!!), some preexistent conditions (like inflammatory bowel conditions, gout, leukemia and lymphomas, weight loss surgeries, diseases of parathyroid gland, prostatic enlargement and neurogenic urinary bladder) and some anatomical factors that include horseshoe kidneys, ureteropelvic junction obstruction. The only thing that can be done to override these irreversible factors and keep kidney stones at bay is keeping adequate hydration levels the recommendations for which will be discussed in detail later.

Of more interest (for the very reason that these can be prevented and taken care of) are modifiable risk factors that include hypertension, diabetes mellitus, altered lipid profile, metabolic syndrome, afflictions of heart, poor lifestyle and recurrent kidney and urinary tract infections. So if you wish to remain free of stones, keep your blood pressure and sugar under control, exercise regularly (30 minutes of moderate exercise 5 times a week should suffice), adopt an active and healthy routine with a strict no to sedentary life (finds great relevance in these COVID times), keep your heart healthy, don’t allow kidney infections to linger on and seek timely and appropriate urological care.

Avoiding excessive and unjustified use of certain medicines like steroids (one of the most commonly abused drugs), cough syrups, laxatives, anti-HIV drugs, diuretics can be a prudent strategy.

Probably the most important of all the preventive strategies is to increase fluid intake. The word fluids is a broad term and encompass water, milk, tea, lassi, buttermilk, fresh citrus fruits juices and carbonated water. Soft drinks are a big no and their intake should be discouraged if not completely stopped as they promote stone formation. The same is true for caffeinated beverages like tea and coffee and should be avoided. How much daily fluids are important is the most common question that most of my stone patients have in mind. The daily urine output (should be around 2.5 liters) is more important than the absolute amount of fluids to have any preventive effects. To achieve this goal your 24 hours fluid intake needs to be at least 3 liters. Another simple gauge of this parameter is if you pass clear urine (not dark-colored or yellow) 7 to 8 times in a day (assuming that an average individual passes around 300 to 400 ml urine in each pass) this means that your hydration levels are adequate. Another way to put this is you should consume around 500 ml more fluids than your total urine output. So you need to increase your water intake accordingly in summers or if you are in a profession that demands heavy physical work or has a tendency to sweat more. Increased hardness of water does not promote stone formation contrary to what is believed commonly. Another intriguing fact is that professionals staying in air conditioners have the same chances of stone formation as constant evaporation and loss of body fluids continues even in the refined environment although the same is not realized.

Decreasing animal proteins in your diet, consuming not more than 5 grams of common salt daily (translates to 1 teaspoon, easily achieved by avoiding papads and not sprinkling extra salt on salads), increasing consumption of citrus fruits definitely help. The common man’s belief of avoiding ice creams, nuts and foods and vegetables with beej is correct but not practical at all in normal day to day life. The only thing which appears feasible and easy to follow is to carry at least 2 bottles of water to the workplace and consuming at least one more bottle after returning from work.

Does stopping calcium-containing products like milk really help? It is correct that the majority of kidney stones are composed of calcium so most of my patients are lured into not taking dairy products. Surprisingly this practice is counterproductive and leads to increased formation of oxalate stones. So what is the take-home message? Continue taking milk and related products in amounts we normally are used to taking daily and don’t try to decrease its intake in your diet.

As they say Once a Stone former is always a stone former. So if you are already having kidney stones an appropriate long-term preventive strategy would be getting repeated ultrasound scans of kidneys (preferably 6 monthly), plenty of fluids as already highlighted. Urinary alkalizer syrups may help.

Don’t be afraid to seek treatment for kidney stones in these testing times if at all you need it. Most of the hospitals nowadays are COVID safe. Avail of the teleconsultation facilities that these hospitals are offering (including ours).

Dr. Abhinav Jain, Consultant – Urology & Renal Transplantation, Dharamshila Narayana Superspeciality Hospital, Delhi

Narayana Health

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