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Kidney Stones

Kidney Stones

Description

Stone formation in the urinary tract has been recognized for thousands of years, but during the last few decades the pattern and incidence of the disease have changed markedly. In the past, stone formation was almost exclusively in the bladder, while today most stones form in the kidney or upper urinary tract. Over 10% of all males and 5% of all females experience a kidney stone during their lifetime. Each year nearly 6% of the entire U.S. population develops a kidney stone. In the U.S., 1 out of every 1,000 hospital admissions is for kidney stones. The incidence has been steadily increasing, paralleling the rise in other diseases associated with the so called "Western diet," i.e., atherosclerotic heart disease, gallstones, high blood pressure, and diabetes mellitus.

In the western hemisphere, kidney stones are usually composed of calcium salts (75-85%), uric acid (5-8%) or struvite (10-15%). The incidence varies geographically, reflecting differences in environmental factors, diet, and components of drinking water. Males are affected more than females, and most patients are over 30 years of age. Primary treatment for kidney stones is prevention. In individuals with recurring kidney stones thiazide diuretics are often prescribed, however, proper dietary changes usually offers better results.

Causes

Human urine is supersaturated with respect to calcium oxalate, uric acid and phosphates. These compounds normally remain in solution, due to pH control and the secretion of inhibitors of crystal growth. If these protective factors are overwhelmed, crystallization will occur. In general, the majority of cases of kidney stones are entirely preventable. Occasionally a number of primary and secondary metabolic diseases cause kidney stones. These include such conditions as: hyperparathyroidism, cystinuria, vitamin D excess, milk-alkali syndrome, destructive bone disease, primary oxaluria, Cushing's syndrome and sarcoidosis.

In general, conditions favoring stone formation can be divided into two groups: (1) factors increasing the concentration of stone crystalloids, and (2) factors favoring stone formation at normal urinary concentrations of stone crystalloids. The first group includes reduction in urine volume (dehydration) and an increased rate of excretion of stone constituents. This can be the result of a variety of disorders including: excessive calcium absorption and excretion; hyperparathyroidism; hyperthyroidism; high vitamin D intake; high aluminum salt intake; vitamin B6 deficiency; and many others. The second group of factors is related to urinary stasis, pH changes, foreign bodies and reduction of normal substances which solubilize stone constituents.

Accurate determination of the type of stone and the cause of its development leads to a better designed prevention program. If a stone is not available for chemical analysis, careful evaluation of a number of criteria (diet; underlying metabolic or disease factors; serum and urinary calcium, uric acid, creatinine, and electrolyte levels; urinalysis; and urine culture) will usually determine the composition of the stone. Your physician is invaluable in this process.

Signs & Symptoms

Stone formation is not associated with any symptoms until urinary obstruction occurs. At that time severe excruciating intermittent radiating pain from the kidney or flank occurs with nausea, vomiting and abdominal distension.

Nutritional Supplements

Structure & Function:
        Single Nutrients &
        Multi Vitamin/Multi Mineral Formulas


---------------------------------
General Supplements
---------------------------------

Adult
Chondroitin sulfate*
Glucosamine sulfate*
Glutamic acid300 mg/day
Green barley*
Magnesium (citrate)450 mg/day
Milk thistle (Silymarin)*
Potassium (citrate)150 mg/day
Vitamin A10,000 I.U./day
Vitamin B-625 mg/day
Vitamin K0.2 mg/day



* Please refer to the respective topic for specific nutrient amounts.

Notes:-

Citrate

Decreased urinary citrate is found in 20% to 60% of patients with kidney stones. This is extremely important since citrate reduces urinary saturation of stone-forming calcium salts by forming complexes with calcium. It also retards the nucleation and crystalline growth of the calcium salts. If citrate levels are low, this inhibitory activity is not present and stone formation is likely to occur. Low citrate levels can result from a variety of metabolic disturbances (acidosis, chronic diarrhea, urinary tract infection, etc.), but in general the reason for low levels in many individuals who develop kidney stones remains unknown.

Citrate supplementation has been shown to be quite successful in preventing recurrent kidney stones. Potassium citrate or sodium citrate have been used in clinical studies. A more advantageous salt of citric acid in the prevention of kidney stones would appear to be magnesium citrate.

Concern has arisen that increased calcium supplementation may result in increased calcium containing kidney stones similar to the milk-alkali syndrome. Calcium citrate appears to bypass this justifiable concern. In addition, calcium citrate has been shown to be much better absorbed than calcium carbonate. It has been demonstrated that mean calcium absorption in patients with deficient stomach acid output was 45% for calcium citrate compared to 4.2% for calcium carbonate. In individuals with normal secretion of stomach acid output, calcium citrate was also demonstrated to be the more optimum calcium form. While urinary calcium will rise in patients consuming calcium citrate, some of citrate's effects inhibits the formation of calcium oxalate stones. Generally, over 95% of the citrate ingested is used as an energy substrate with the remainder being excreted in the urine where it demonstrates its inhibitory action against stone formation.


Glutamic Acid

Depressed levels of glutamic acid (due to vitamin B-6 deficiency or other reasons) is significant, since an increased concentration of glutamic acid in the urine reduces calcium oxalate precipitation. Glutamic acid supplementation in rats significantly reduces the incidence of calculi, and it may do so in humans as well.


Magnesium

A magnesium-deficient diet in rats is one of the quickest ways to produce kidney stones. Magnesium is also critically important in the prevention of kidney stones in humans. Magnesium has been shown to increase solubility of calcium oxalate and inhibit precipitation of both calcium phosphate and calcium oxalate. A low urinary magnesium:calcium ratio is an independent risk factor in stone formation. Supplemental magnesium alone has been shown to be effective in preventing recurrences of kidney stones. When used in conjunction with vitamin B-6 an even greater effect is noted.


Vitamin B-6

Pyridoxine is known to reduce the production and urinary excretion of oxalates. Patients with recurrent oxalate stones show abnormal vitamin B-6 dependent enzyme levels, indicating clinical insufficiency of vitamin B-6 and impaired glutamic acid synthesis. These levels return to normal but usually only after at least three months of treatment. Restoration of normal vitamin B-6 and magnesium levels are of great importance in preventing further kidney stones.


Vitamin K and Vitamin A

The urinary glycoprotein that is a powerful inhibitor of calcium oxalate crystalline growth requires vitamin K for its synthesis. Impairment of glutamic acid formation or a vitamin K deficiency will reduce formation of glycoprotein. Vitamin A is also necessary in the formation of protective glycoprotein substances in the urine. The presence of vitamin K and vitamin A in green leafy vegetables may be one reason vegetarians have a lower incidence of kidney stones. A deficiency of vitamin K or vitamin A may be another reason why people with fat malabsorption are at higher risk for kidney stones as well.



Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Dietary Considerations

For all types of stones increasing urine flow to dilute the urine is vital. Enough fluids should be consumed to produce a daily urinary volume of at least 2 quarts.

As calcium containing stones are the type of kidney stones most common in the United States, the following suggestions are primarily for calcium oxalate stones although they are also appropriate for the majority of other types of kidney stones. Calcium-containing stones are composed of calcium oxalate, calcium oxalate mixed with calcium phosphate or, very rarely, calcium phosphate alone. The high incidence of calcium containing stones in affluent societies is directly associated with the following dietary patterns:

Low fiberHighly refined carbohydrates
High ethanol consumptionLarge amounts of animal protein
High fatHigh sodium intake
High calcium containing foodHigh vitamin D enriched food



As a group, vegetarians have a decreased risk of developing stones. Studies have shown even among meat eaters those who ate higher amounts of fresh fruits and vegetables had a lower incidence of stones. Overconsumption of protein, i.e. greater than .8 gram of protein per kilogram (2.2 pounds), should be avoided due to its ability the increase calcium excretion in the urine (See osteoporosis).

Bran supplementation, as well as the simple change from white to whole wheat bread, has resulted in lowering urinary calcium excretion. Simple dietary factors of eating more fruits and vegetables, and switching from processed foods to more whole foods would probably prevent kidney stone development in many individuals.

Weight and Carbohydrate Metabolism
Weight control and correction of carbohydrate metabolism are important, since excess weight and insulin insensitivity lead to hypercalciuria and are high risk factors for stone formation. This is relevant, because following sugar ingestion there is a rise in urinary calcium along with a decreased phosphate reabsorption. This leads to a low plasma phosphate which stimulates 1,25 dihydroxycholecalciferol (active vitamin D) production which results in increased intestinal absorption of calcium, and concurrently, increased urinary concentrations of calcium.

Milk-alkali syndrome
The long-term overconsumption of milk or antacids often results in the development of kidney stones. This condition has been termed the milk-alkali syndrome. Recently, due to the increase in the incidence of osteoporosis, there has been a tremendous push from physicians and manufacturers of antacids to use calcium carbonate antacids (Tums) as calcium supplements. This does not appear to be sound medical advice due to the risk of developing kidney stones with the overconsumption of antacids. Milk may not be suitable for people at risk for developing kidney stones due to fortification of most milk products with vitamin D. This results in increased absorption of calcium, but also increases the urinary calcium concentration. Increasing the amount of urinary calcium greatly increases the risk of stone formation. Compounding this negative effect is the fact that milk fortified with vitamin D results in lowered magnesium levels which increases the risk of stone formation.

Summary of dietary considerations
Increase intake of dietary fiber, complex carbohydrates, and green leafy vegetables, and decrease simple carbohydrates and high purines (meat, fish, poultry, yeast). Increase intake of foods with a high magnesium:calcium ratio (barley, bran, corn, buckwheat, rye, soy, oats, brown rice, avocado, banana, lima beans, potato). Reduce intake of high oxalate containing foods (black tea, cocoa, spinach, beet leaves, rhubarb, parsley, cranberry, nuts). Limit dairy products, particularly those fortified with vitamin D. Avoid antacid use.

Homeopathic Remedy

Calculi - Renal - kidney stones, colic

1. Berberis aquifolium - tincture to 30X
2. Sarsaparilla tinct. - 15-30C
3. Pareira brava - 15C

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

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Herbs
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Aloe vera
Cassia
Hydrangea
Madder (Rubia)
Marshmallow root
Stone root (Collinsonia)

Kidney Stones & Gravel (German Commission E)

Asparagus root
Birch leaf
Couch grass leaf
European Goldenrod
Horsetail
Lovage root
Parsley herb and root
Stinging nettle herb and leaf

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Madder and aloe vera

Compounds (anthraquinones) isolated from the Rubia, Cassia and Aloe species bind calcium and significantly reduce the growth rate of urinary crystals when used in oral doses lower than the laxative dose. Madder (Rubia tinctoria) and aloe vera are especially good sources of these anthraquinones and may be used to prevent stone formation and, during acute attacks, to reduce the size of the stone.

Marshmallow root (liquid extract) is recommended for acute situations. Its demulcent actions soothe irritation and quell inflammation. (Scalzo, 1996)

Hydrangea is a diuretic and removes calculus and gravel. (Duke, 1985)

Stone root is noted for its diuretic properties.

A simple "Home Remedy" is to drink lemon juice, which interferes with the formation of calcium oxalate-associated stones.

References:

Berry, MK: Lemonade for Kidney Stones. Clinician Reviews 8(1):89, 1998.

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Duke, JA: Handbook of Medicinal herbs. CRC, 1985.

Hoffmann, D: The New Holistic Herbal. Element, 1983. Third edition 1990.

Scalzo, R: Therapeutic botanical protocol for kidney stones. The Protocol J. of Botanical Medicines, Winter, 1996:179 - 188.

Aromatherapy - Essential Oils

Fennel Essence,Garlic Essence,
Geranium Essence,Hyssop Essence,
Juniper Essence,Lemon Essence.

Related Health Conditions

Fever
Headache
Pain
Vomiting

Abstracts

References

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