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Kidney stone can be prevented

Dr Waheed Zaman
Kidney stone is one of the most painful disorders that lead a person to expensive and unpleasant emergency visits, hospitalisations and undergo surgical procedures.
Half of all untreated people will form additional stones and some will form stones chronically. Preventing kidney stones is the primary goal and we have peer-reviewed clinical data for last 20 years proving that the treatment guideline can help reducing kidney stone formation rates up to 80 percent.
Kidney stones form when urine has too many crystalforming chemicals and/or not enough substances that protect against crystal formation. If the crystals do not rapidly pass through the urinary tract, they can accumulate and form stones. When the volume of urine is too low, stone-forming materials become concentrated helping to promote stones.
Kidney stones can be prevented if measures taken properly. During the last 30 years, treatment plans incorporating diet, fluids and medications have been developed to prevent or stall the formation of newstones.
The primary treatment have been proven in controlled clinical trials. Your
preventive treatment may consist of fluid, diet, and/or medications. Diet changes are just as essentia! as any medications your urologist may prescribe.
General kidney stone prevention guidelines
Increase fluid intake: very common question is how much water should I drink each day? You should be producing at least 2.5 liters of urine a day. How much you need to produce that much urine will vary depending on many things.
1. Activity level (The more active you are the more you perspire and need to replenish your body with fluids)
2. 1.iving/working in a hot/dry environment
3. Frequent flying (Pilots, flight attendants, business travelers etc.) and flying all day can cause dehydration
4. Salt intake (High salt intakes increases water retention)
Increasing your fluid intake keeps urine diluted and helps keep crystals from forming.
Low oxalate diet: Unfortunately. oxalate is found in healthy plant foods. High oxalate containing foods are tea, beans, nuts, peanuts, peanut butter, soybean curd (tofu), sunflower seeds, chocolate milk, pepper, ginger, soy sauce, blackberries, grapes, lemon peel, bread, whole wheat etc.
If you have other medical conditions like heart related problems, diabetes, high blood pressure, etc. you may have been advised by another physician to eat a diet low in fat and sugar but rich in vegetables that may contain high oxalate.
Then your key to diet should be everything in moderation. Cut on the portion size of the high oxalate containing foods and the number of times a day or week you are eating these foods.
Here and there you will indulge and when you do, make sure you flush out the extra oxalate with an added 8 ounce glass of water - before and after your treat.
Low salt diet: Your sodium intake should be between 2300-3300 mg per day.
Sodium is added to many of our foods that we buy in restaurants or at the store. A single restaurant meal can contain anywhere from 1000 to 4000 milligrams of sodium! It is important to read the nutrition labels on all packaged foods and to look at the ingredients listed. As a rule, if salt and several sodium compounds are listed as ingredients, the product contains more salt than is advisable on a low-sodiumdiet.
Low purine diet: Purine is a compound that is mainly found in animal protein and when metabolised, breaks
down into uric acid. When you eat a diet that is high in protein (beef, poultry, pork and chicken), you have higher uric acid levels.
The normal diet contains from 600 to 1000 milligrams of purines daily. A low-purine diet is restricted to approximately 100 to 150 milligrams daily.
Current treatments
The current treatments available for kidney and ureteric stones include conservative management (waiting for spontaneous passage), extracorporeal shockwave lithotripsy (ESWL), endoscopic techniques (rigid and flexible ureteroscopic lithotripsy), and percutaneous treat-
ments.
The American Urologic Association Stone Guidelines Panel has identified ESWLas a potential first-line treatment for both proximal and distal ureteric stones and for Kidney stones smaller than 2 cm.
ESWL is a noninvasive procedure that uses shock waves to break up the kidney stone into small pieces that can more easily travel through the urinary tract and excreted from body. However, complex presentations frequently are treated best endoscopically.
Following its introduction in 1980. ESWL dramatically changed the management of Kidney stone disease. ESWL is a procedure in which kidney and ureteric stones are pulverised into smaller fragments by shock waves. These small fragments then can pass spontaneously in urine.
ESWL can not be performed in patients with acute urinary' tract infection, uncorrected bleeding disorders, pregnancy, sepsis, and uncorrected obstruction distal to the stone. Otherwise, this noninvasive approach allows patients to be rendered stone-lree without surgical intervention or endoscopic procedures.
The writer is a Consultant. Urotogy. Apollo Hospitals Dhaka..