Patient's question:
The kidney area always has a dull ache, which is very uncomfortable. A magnetic resonance imaging (MRI) was done last year, and now there are small stones inside the kidney that cannot be passed. Currently, I am taking "Shenshi Tong Granules" powder, but it has no effect. I would like to consult about which medications are better to use and what dietary precautions should be taken?Duration and frequency of symptoms: Intermittent, no definite time.
Medical history: Kidney stones have been present for over ten years. Four magnetic resonance imaging (MRI) procedures have been performed.
Previous diagnoses, treatments, and outcomes: Currently, the stones are present but cannot be passed.
Other: Could this lead to other complications??
Doctor's answer:
HelloThere are many factors that can cause kidney stones, such as metabolic disorders, hyperparathyroidism, urinary tract infections, obstructions, or chemical factors, as well as many unknown factors or causes. Based on the main crystal components, stones are classified into oxalate stones, phosphate stones, uric acid stones, calcium stones, and cystine stones. According to incomplete statistics in China, the composition of stones varies by region, with oxalate and phosphate stones being the most common. Therefore, dietary control should be given according to the nature of the stones.
Oxalate Stones: They are mostly formed from food, but some can also be generated by endogenous mechanisms. The diet should avoid vegetables high in oxalates, such as spinach, amaranth, Chinese lettuce, green garlic, onions, lotus root, and various types of bamboo shoots. Taking 5 mg of folic acid and 10 mg of pyridoxine orally can prevent glycine from transforming into oxalate. Patients with this type of stone should drink more water.
Phosphate Stones: Since they form in alkaline urine, acidic foods should be consumed more, while foods high in calcium should be limited. Acidic foods include meat, poultry, fish, eggs, grains, and peanuts.
Uric Acid Stones: They are caused by hyperuricemia, so foods high in purines should be avoided, such as animal organs, concentrated meat soup, mushrooms, peas, asparagus, sardines, anchovies, and fish eggs. More vegetables and fruits should be consumed, and more water should be drunk to lower uric acid levels.
Calcium Stones: Foods high in calcium, such as milk, cheese, and shrimp, should be limited. Acidic foods, such as meat, poultry, and eggs, should be consumed more to make the urine acidic and drink a lot of water.
Cystine Stones: Methionine and acidic foods (animal foods) should be limited, while alkaline foods (plant-based foods) should be consumed more to make the urine alkaline and drink a lot of water.
This article is quite detailed, take a look.
Kidney Stones
Urinary tract stones are one of the common diseases in urology. They can be divided into kidney stones, ureteral stones, and bladder stones, depending on their location.
Kidney stones are more common in middle-aged and young adults, with more men than women affected. Kidney stones may exist for a long time without symptoms, especially larger stones. Smaller stones have a larger range of movement. When small stones enter the renal pelvis and ureter connection or ureter, they cause severe peristalsis of the ureter to promote stone excretion, resulting in colic and hematuria. The pain caused by kidney stones can be dull or colicky. 40% to 50% of patients have a history of intermittent recurrent pain. The pain is often located in the waist and abdomen, mostly paroxysmal, but can also be persistent. Some pain may only manifest as a dull ache or discomfort in the waist, and activity or labor can trigger or worsen the pain. Colicky pain from kidney stones is severe and sharp, often recurring suddenly, and the pain often radiates to the lower abdomen, groin, or inner thigh. In women, it may radiate to the labia. When colic recurs, patients appear acutely ill, curling up in bed, pressing their hands tightly on the abdomen or waist, or even rolling in bed, groaning incessantly. The recurrence may last for several hours, or it may subside in minutes. During severe colic, the face may turn pale, cold sweat may break out, the pulse may become weak and rapid, and blood pressure may drop, leading to a state of shock. Nausea, vomiting, abdominal distension, and constipation may also occur. During colic recurrence, urine output decreases, and after the colic subsides, polyuria may occur.
Hematuria is another main symptom of kidney stones. During pain, it is often accompanied by gross or microscopic hematuria, with the latter being more common. Gross hematuria is not very common, and it may worsen after physical activity. Kidney stone patients can pass sand or stones in their urine, especially when pain and hematuria recur, when sand grains or small stones are mixed in the urine. When stones pass through the urethra, they may cause obstruction or irritation. The common complications of kidney stones are obstruction and infection, and many cases seek medical attention due to urinary tract infection symptoms. Obstruction can lead to hydronephrosis, causing a mass in the upper abdomen or waist.
The diagnosis of kidney stones is generally not difficult. Through medical history, physical examination, necessary X-ray photos, and laboratory tests, most cases can be diagnosed. However, it is not enough to diagnose kidney stones; it is also necessary to understand the size, number, shape, location, presence of obstruction or infection, renal function, stone composition, and potential causes. If stone analysis or stone cause examination is not performed, it may lead to recurrence, which could have more adverse consequences.
B and X-ray urography are the most commonly used examination methods for diagnosing kidney stones. Over 90% of kidney stones can be seen on X-ray plain films, and the degree of visibility is related to the chemical composition, size, and thickness of the stones. Stones of different compositions are ranked in order of visibility satisfaction as follows: calcium oxalate, calcium phosphate, magnesium phosphate, cystine, calcium-containing uric acid, and pure uric acid stones do not show up. The visibility of stones on plain films is affected by many factors, such as stone size, intestinal gas, and obesity, often resulting in unsatisfactory visibility. B examination is helpful in diagnosing lesions such as hydronephrosis and stones, especially for asymptomatic stones and non-visible uric acid stones. B should be used in conjunction with other examination methods.
Kidney stones can be divided into calcium-containing kidney stones, uric acid stones, and infectious stones. Calcium-containing kidney stones are mainly composed of calcium oxalate and calcium phosphate, accounting for 80% to 84% of all urinary stones. Other rare stones, such as those caused by long-term medication, are more likely to form crystals, with sulfonamide drugs being the most prone to form crystals, such as sulfamethoxazole. If alkaline urine drugs or more water is taken, sulfonamide crystals can be prevented from forming.
The goal of treating kidney stones is not only to relieve pain and protect kidney function but also to identify and eliminate the cause as much as possible to prevent recurrence. Treatment should include general treatment, etiological treatment, extracorporeal shock wave lithotripsy, endoscopic stone removal, dissolution therapy, surgical treatment, traditional Chinese medicine treatment, and dietary therapy. General treatment includes drinking a lot of water and acupuncture therapy. It is best to maintain a daily urine output of 2000 to 3000 milliliters. Drinking a lot of water with diuretic and spasmolytic drugs can help small urinary stones pass out. To maintain nighttime urine output, in addition to drinking water before bed, it is advisable to drink water after getting up to urinate at night. Diluted urine can slow down the growth rate of stones and the recurrence of stones after surgery. In the case of infection, a larger amount of urine can promote drainage, which is beneficial for controlling infection. During kidney colic, drinking more water may worsen the pain, but if combined with acupuncture and spasmolytic drugs, it can help stones pass out. If the stone is small and the patient is in good health, physical activity can be adopted, and Chinese and Western medicine can be used to help stones pass out naturally. In the past decade, there have been breakthroughs in the treatment of kidney stones, and the most commonly used treatment methods are extracorporeal shock wave lithotripsy (ESWL) and endourology, with only a few cases requiring surgical treatment.
Dietary Treatment for Kidney Stones
1. Drink a lot of fluids, preferably about 1.14 liters of urine per day.
2. Control calcium intake to avoid excessive calcium, but it is not prohibited.
3. Antacids often contain high levels of calcium. If you have calcium stones, choose brands with less calcium when taking antacids.
4. Avoid eating too many oxalate-rich foods, including beans, beets, celery, chocolate, grapes, green peppers, coriander, spinach, and strawberries.
5. Taking magnesium and vitamin B6 can reduce the recurrence rate by 90%.
6. Eat foods rich in vitamin A, which can maintain the health of the urethral lining and help prevent recurrence. These foods include carrots, green broccoli, cantaloupe, pumpkin, and liver. However, high doses of vitamin A are toxic, so it is best to consult a doctor before taking it.
7. Stay active to prevent calcium from depositing in the blood.
8. Reduce protein intake, including meat, cheese, fish, and chicken.
9. Reduce salt intake and eat less high-salt foods.
10. Limit vitamin C intake, especially for patients with calcium oxalate stones.
11. Do not take too much vitamin D.
12. If you have had kidney stones and experience any severe pain or blood in your urine, seek medical attention immediately.
13. Patients should understand the type of stones they have.
Dietary Health for Kidney Stones
1. Patients with urinary tract stones should not eat too much sugar. Eating too much sugar not only hinders treatment but also promotes the formation of urinary stones. Practice has shown that after consuming sugar, the concentration of calcium ions, oxalates, and the acidity of urine all increase. Both calcium and oxalates can promote stone formation, and their simultaneous increase makes it easier to form stones. Because the acidity increases, calcium oxalate and calcium oxalate are more likely to precipitate, promoting stone formation. Therefore, patients with kidney, ureteral, and bladder stones should not eat too much sugar.
2. Patients with urinary tract stones should avoid eating spinach. Analysis shows that the main component of urinary tract stones is calcium oxalate. In China, about 87.5% of urinary tract stone patients have calcium oxalate stones. A normal adult excretes 12 to 40 milligrams of oxalates per day. Some of these oxalates come from food. If the intake of oxalates from food is too high, the urine will be in a supersaturated state of calcium oxalate, and excess calcium oxalate crystals may precipitate from the urine to form stones. Among foods, spinach has the highest oxalate content, and it is also one of the most commonly eaten vegetables. Then, how does eating spinach affect the excretion of oxalates in the urine? Researchers conducted experiments on 10 healthy people, letting them eat boiled and stir-fried spinach, and then measuring their urine. The results showed that after eating 200 grams of spinach, the excretion of oxalates in the urine increased significantly, especially reaching a peak 2 to 4 hours after eating, and still higher than the pre-experiment level 8 hours later, increasing oxalates by 20 to 25 milligrams, close to the average daily excretion of oxalates in healthy people. The experiment also found that the excretion of oxalates in the urine after eating stir-fried spinach was higher than after eating boiled spinach. It can be seen that patients with urinary tract stones should not eat spinach again, because their urine is already in a supersaturated state of calcium oxalate, and eating more may worsen the condition. If patients with urinary tract stones have had stones removed through surgery, avoiding spinach can prevent recurrence. When healthy people eat spinach, they should drink more water to dilute the urine and reduce the concentration of oxalates; they should also use boiling methods more often, which is beneficial for preventing stones.
3. Patients with kidney stones should not drink milk before going to bed. In recent years, many people have advocated drinking milk at night, mainly because milk contains tryptophan, which helps sleep. This is undoubtedly suitable for general healthy people, but it is different for patients with kidney stones or those who have been cured. The reason is that after sleeping, urine output decreases, and the concentration of various substances in the urine increases, making the urine more concentrated. Since milk contains a lot of calcium, most kidney stones contain calcium salts. The most dangerous factor for stone formation is the sudden increase in calcium concentration in the urine. Two to three hours after drinking milk, it is the peak time for calcium excretion through the kidneys, and if you are in a state of sleep at this time, the urine is concentrated, and more calcium is excreted through the kidneys, making it easier to form stones. Therefore, patients with kidney stones should not drink milk before going to bed. To avoid this, they can drink milk four hours before going to bed.
4. In recent years, many reports have discussed calcium supplementation, and increased calcium intake leads to increased calcium excretion in the urine, while high calcium urine increases the risk of kidney stones. High intake of oxalates and other substances can easily combine with calcium to form stones. However, some reports also suggest that calcium intake from the diet can combine with oxalates consumed at the same time to form calcium oxalate and be excreted through the feces, which actually reduces the amount of oxalates that can be absorbed, so it does not increase the risk of kidney stones. However, calcium supplements taken outside of the diet do not have this effect. For people with a history of kidney stones, calcium supplementation should be taken with caution.
5. Patients with urinary tract stones should pay attention to drinking more water and exercising. Drinking water and exercising while tapping the urinary tract can be beneficial for the excretion of stones.
Dietary Precautions for Kidney Stones
What foods should kidney stone patients avoid? What foods can they eat? Is there a possibility of recurrence after treatment?
Kidney stones come in several types, and most common kidney stones are mainly composed of calcium salts. This condition has a high recurrence rate, so it is common for patients to relapse after treatment. Therefore, dietary control is particularly important. The following points should be noted in dietary care:
1. Increase calcium intake: Many people may wonder why there is calcium in the stones, but why should they eat more calcium? According to research, sufficient calcium combines with oxalates and is excreted through the feces, thus reducing the absorption of calcium by the intestines, and naturally reducing the chance of stone formation. Therefore, drinking more milk will not increase the risk of stones but may actually help reduce the risk.
2. Reduce oxalate intake: Foods rich in oxalates, such as spinach and tea, should be eaten less.
3. Reduce sodium intake: The diet should be light, and canned and processed foods should be eaten as little as possible. Eat more potassium-rich foods, such as bananas.
4. Reduce meat intake: Reduce the intake of animal protein to reduce the chance of stone formation.
5. Drink more water and exercise: Drinking more water can accelerate the metabolism of salts in the urine, so drink at least 3000 ml of water every day. Exercising more can reduce calcium loss from bones, thereby reducing the chance of stone formation.
Urinary tract stones are one of the common diseases in urology. Analysis shows that the main component of urinary tract stones is calcium oxalate. Patients with urinary tract stones should pay attention to drinking more water and exercising. Drinking water and exercising while tapping the urinary tract can be beneficial for the excretion of stones.