Kidney Stones

Kidney Stones

Kidney stones are a significant cause of illness and mostly affect men, first occurring between the ages of 30 and 40.

Urolithiasis is the condition where kidney stones are formed or located anywhere along the urinary system. Calculi are an accumulation of mineral salts that form crystal clumps, these can occur anywhere along the urinary tract in the kidney, ureter or bladder.

Kidney stones typically leave the body via the urine, and many stones are formed and passed without symptoms. If stones grow to a sufficient size (at least 3mm) they can cause obstruction of the ureter resulting in excruciating pain, nausea, vomiting, chills and fever.

Causes of Kidney Stones

The type of stone indicates the cause:

• Calcium (oxalate or phosphate): the most common types of kidney stone (80%) due to excess calcium being filtered through the kidney.

Dietary factors:

• Inadequate calcium intake: calcium in the GIT blocks absorption of oxalates. People with high calcium intakes have low rates of kidney stones
• Excessive dietary sodium: increases calcium release from bone
• Excessive oxalate intake: especially where there is increased oxalate absorption due to intestinal disease and SIBO
• Excessive animal protein intake: increases excretion of uric acid and calcium; excessive animal protein is also acid forming and can cause leaching calcium from bones to buffer acid, particularly with commercially produced animals
• Excessive vitamin D intake: usually from supplementation
• Excessive inorganic calcium intake: e.g. antacid or high-dose calcium supplementation
• Excessive phosphorus intake: soft drinks, red meat
• Excessive alcohol or caffeine: increases calcium excretion through the kidneys

• Sedentary lifestyle or prolonged immobility
• Certain medications: e.g. corticosteroids increase resorption of calcium
• Primary intestinal disorders e.g. IBD, SIBO, steatorrhoea, ileal disease, resection or bypass
• Some metabolic disorders e.g. hyperparathyroidism
• Destructive bone disease
• Sarcoidosis
• Uric acid: accounts for around 7% and often associated with gout. Risk factors include high dietary purine intake, inadequate fluid intake, aspirin use, bowel disease and chemotherapy.
• Struvite: form in response to a UTI, most commonly Proteus or Klebsiella infections. Form large stones which can lodge in the kidney and cause recurrent pyelonephritis and progressive kidney failure.
• Cystine stones: rare type of stone which forms as a result of a genetic disorder that causes kidneys to excrete too much of certain amino acids. Causes relentless, progressive renal failure.

Risk factors

• Adults > 40 years
• Male gender
• Dehydration: causes concentration of urine salts
• Diets high in protein, sodium and sugar
• Obesity
• Digestive diseases and surgery
• Certain medical conditions e.g. renal tubular acidosis, cystinuria, hyperparathyroidism, some UTI’s
• Certain medications

Signs & Symptoms of Kidney Stones

• Usually asymptomatic until a stone becomes lodged in the urinary tract leading to:
• Severe pain in flank (kidney) or pelvic area (ureter)
• Low urine volume, dribbling, blood in urine
• Nausea and vomiting
• Chills and fever

Differential diagnosis

• UTI
• Pyelonephritis
• Diverticulitis
• PID
• Ovarian pathology
• Appendicitis
• Small bowel obstruction
• Ectopic pregnancy

TREATMENT STRATEGY FOR KIDNEY STONES

Symptomatic kidney stones require acute conventional medical attention.

Chronic kidney stone issues can be assisted by preventing recurrent episodes

• Identify type of stone present: It is important that a stone analysis is performed as well as a metabolic evaluation – identifying and treating the underlying metabolic abnormality is important
• Assess digestive and gut function, bacterial overgrowth, SIBO etc
• Support kidney function and diuresis
• Decrease stone precipitation
• Encourage stone breakdown
• Remove precipitating factors
• Address precipitating medical conditions
• Prevent calcium loss from bones

Diet plan guidelines for Kidney Stones

• Increase fluid intake to 2L/day: pure, filtered water
• Increase calcium-rich foods; dietary calcium is protective against kidney stones; increase intake of green leafy vegetables, whole grains, nuts and seeds, tahini, bony fish, yoghurt
• Increase magnesium-containing foods: green leafy vegetables, whole grains (esp brown rice, barley, bran, corn, buckwheat, rye, oats if tolerated), avocado, banana, lima beans, potato
• Include fresh citrus juice daily: contains citrate which reduces the risk of stone formation
• Avoid excessive animal protein intake
• Reduce sodium intake
• Avoid excessive dietary phytates: binds calcium
• Moderate oxalate intake:
• If the individual shows high urinary oxalate levels, dietary oxalates may need to be restricted (raw green leafy vegetables (e.g. silverbeet, kale, spinach, beet greens, collards, parsley, cruciferous vegetables) rhubarb, nuts, chocolate, black tea, wheat bran, wheat germ, berries, stone fruits, green beans, celery)
• Ensuring adequate calcium intake instead is important to bind the oxalate.  Investigating cause of high oxalates, SIBO is a major contributing factor

• Avoid foods fortified with Vitamin D
• For pain relief: drink the juice of half a fresh lemon in a full glass of water every half-hour until the pain subsides – can alternate between lemon juice and fresh apple juice
• Include unsweetened cranberry juice to prevent UTIs
• Avoid alcohol: dehydrating

Supplements that support Kidney Stones

• Magnesium citrate: decreases stone precipitation
• Vitamin C with bioflavonoids: decreases stone precipitation
• L-methionine on an empty stomach: decreases stone precipitation
• B6: assists with the processing of oxalates
• Calcium: may be required in calcium deficiency (avoid excessive calcium supplementation > 1500 mg/day)

Herbal medicine treatment for Kidney Stones

• Antilithics (reduce stones): gravel root, hydrangea, stone root, aloe vera 
• Diuretics: dandelion leaf, parsley, celery, corn silk
• Urinary tonics: horsetail, crataeva
• Urinary antiseptics: cranberry, uva ursi, olive leaf
• Antispasmodic (to urinary sphincter): wild yam, vervain, cramp bark
• Analgesic: Jamaican dogwood
• Demulcent: corn silk, marshmallow
• Circulatory stimulant: ginkgo

FUNCTIONAL MEDICINE TREATMENT OF KIDNEY STONES

Kidney stones are formed in people that have long standing complications with their diet, digestion and/or their gastrointestinal tract.  Treatment requires addressing long-term diet and lifestyle factors as well as bacterial overgrowths and infections such as SIBO, these complications lead to high oxalates being produced.

At our Perth clinic of Advanced Functional Medicine we have experience with recurrent kidney stones and other urinary system problems.

If you or a family member are suffering from kidney stones of another urinary system complication we would love to hear from you.  Have you assessed your oxalate intake?  What treatment methods have worked best for your Kidney stones?  Please write a comment below.

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