A Simple Guide to Kidney Stones and Kidney Diseases (A Simple Guide to Medical Conditions)
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All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. Patient Education. Here are some things you can do to help your condition. Diet changes Always discuss your diet with your healthcare provider before making any changes. Salt sodium in your diet Based on your condition, you may be told to eat 1, mg or less of sodium daily Limit processed foods such as: Frozen dinners and packaged meals Canned fish and meats Pickled foods Salted snacks Lunch meats Sauces Most cheeses Fast foods Don't add salt to your food while cooking or before eating at the table.
Eat unprocessed foods to lower the sodium, such as: Fresh turkey and chicken Lean beef Unsalted tuna Fresh fish Fresh vegetables and fruits Season foods with fresh herbs, garlic, onions, citrus, flavored vinegar, and sodium-free spice blends instead of salt when cooking. Always drain canned foods such as vegetables, fruits, and meats before serving.
Don't eat whole-grain breads, wheat bran, and granolas. Don't eat nuts, seeds, peanut butter, dried beans, and peas. Don't eat fig cookies, chocolate, and molasses. Cut back on protein. Eat less meat, milk products, yogurt, eggs, and cheese. Don't eat cheese, milk, ice cream, pudding, and yogurt. Don't eat liver beef, chicken , organ meats, oysters, crayfish, and sardines. Expert Opinion.
Treatment and Prevention of Kidney Stones: An Update - American Family Physician
Clinicians should not routinely perform "fast and calcium load" testing to distinguish among types of hypercalciuria. Recommendation; Evidence Strength: Grade C. Clinicians should recommend to all stone formers a fluid intake that will achieve a urine volume of at least 2. Clinicians should counsel patients with calcium stones and relatively high urinary calcium to limit sodium intake and consume 1,, mg per day of dietary calcium.
Standard; Evidence Strength Grade: B. Clinicians should counsel patients with calcium oxalate stones and relatively high urinary oxalate to limit intake of oxalate-rich foods and maintain normal calcium consumption. Clinicians should encourage patients with calcium stones and relatively low urinary citrate to increase their intake of fruits and vegetables and limit non-dairy animal protein. Clinicians should counsel patients with uric acid stones or calcium stones and relatively high urinary uric acid to limit intake of non-dairy animal protein.
Clinicians should counsel patients with cystine stones to limit sodium and protein intake. Clinicians should offer thiazide diuretics to patients with high or relatively high urine calcium and recurrent calcium stones.
Standard; Evidence Strength Grade B. Clinicians should offer potassium citrate therapy to patients with recurrent calcium stones and low or relatively low urinary citrate. Clinicians should offer allopurinol to patients with recurrent calcium oxalate stones who have hyperuricosuria and normal urinary calcium. Clinicians should offer potassium citrate to patients with uric acid and cystine stones to raise urinary pH to an optimal level. Clinicians should not routinely offer allopurinol as first-line therapy to patients with uric acid stones. Clinicians should offer cystine-binding thiol drugs, such as alpha-mercaptopropionylglycine tiopronin , to patients with cystine stones who are unresponsive to dietary modifications and urinary alkalinization, or have large recurrent stone burdens.
Clinicians may offer acetohydroxamic acid AHA to patients with residual or recurrent struvite stones only after surgical options have been exhausted. Option; Evidence Strength Grade B. After the initial follow-up, clinicians should obtain a single hour urine specimen annually or with greater frequency, depending on stone activity, to assess patient adherence and metabolic response.
Clinicians should obtain periodic blood testing to assess for adverse effects in patients on pharmacological therapy. Standard; Evidence Strength Grade: A.
Clinicians should obtain a repeat stone analysis, when available, especially in patients not responding to treatment. Clinicians should monitor patients with struvite stones for reinfection with urease-producing organisms and utilize strategies to prevent such occurrences. Clinicians should periodically obtain follow-up imaging studies to assess for stone growth or new stone formation based on stone activity plain abdominal imaging, renal ultrasonography or low dose computed tomography [CT].
Kidney stone disease is a common malady, affecting nearly 1 in 11 individuals in the United States at some point in their lives, and there is evidence that the number of those who have had a stone is rising. Consequently, these patients often seek advice from a variety of practitioners on how to prevent recurrent stones.
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However, misinformation abounds in the lay community and on the internet, and even medical providers often promulgate recommendations that are contrary to evidence-based medicine. Patient preferences and goals must be taken into account by the practitioner when considering these guidelines, as the cost, inconvenience and side effects of drugs and dietary measures to prevent stone disease must be weighed against the benefit of preventing a recurrent stone.
Eligible studies included RCTs and large prospective observational trials of patient populations limited to adults aged 18 years or older with a history of one or more past kidney stone episodes. Studies addressing acute pain management and treatment to promote expulsion of stones were excluded. Study populations were limited to adults 18 years or older with one or more past kidney stone episodes.
No limitations on study design were set, however the search protocol prioritized RCTs, CCTs and prospective studies with a comparison group. A total of 3, abstracts were obtained, from which 24 articles were selected for full-text review. All dietary and pharmacologic therapies were acceptable, with the exception of interventions addressing acute pain management for urolithiasis, treatment to promote expulsion of ureteral stones, pharmacological agents not approved by the FDA for use in the United States, and finally imaging for suspected acute renal colic.
Discharge Instructions for Chronic Kidney Disease (CKD)
Data on study design, treatment parameters e. Quality of Studies and Determination of Evidence Strength. Quality of individual studies was rated as high, moderate, or low based on instruments tailored to specific study designs. Cohort studies with a comparison of interest were evaluated with the Newcastle-Ottawa scale. The categorization of evidence strength is conceptually distinct from the quality of individual studies. Evidence strength refers to the body of evidence available for a particular question and includes consideration of study design, individual study quality, consistency of findings across studies, adequacy of sample sizes, and generalizability of samples, settings and treatments for the purposes of the guideline.
The AUA categorizes body of evidence strength as Grade A well-conducted RCTs or exceptionally strong observational studies , Grade B RCTs with some weaknesses of procedure or generalizability or generally strong observational studies or Grade C observational studies that are inconsistent, have small sample sizes or have other problems that potentially confound interpretation of data. Options may be supported by Grade A, B or C evidence. In some instances, the review revealed insufficient publications to address certain questions from an evidence basis; therefore, some statements are provided as Clinical Principles or as Expert Opinions with consensus achieved using a modified Delphi technique if differences of opinion emerged.
Expert Opinion refers to a statement, achieved by consensus of the Panel, that is based on members' clinical training, experience, knowledge and judgment for which there is no evidence.
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Limitations of the Literature. The Panel proceeded with full awareness of the limitations of the kidney stone literature. These limitations include heterogeneous patient groups, small sample sizes, lack of studies with diagnostic accuracy data, lack of RCTs or controlled studies with patient outcome data, and use of a variety of outcome measures. Overall, these difficulties precluded use of meta-analytic procedures or other quantitative analyses.
Instead, narrative syntheses were used to summarize the evidence for the questions of interest. Panel Selection and Peer Review Process. Once nominated, panel members are asked to record their conflict of interest COI statements, providing specific details on the AUA interactive web site. The GOC determines whether the individual has potential conflicts related to the guideline.
http://kamishiro-hajime.info/voice/espionner-un/localisation-microphone-iphone-6-plus.php A majority of panel members may not have relationships relevant to the guideline topic. The AUA conducted an extensive peer review process. The initial draft of this Guideline was distributed to peer reviewers of varying backgrounds; 40 responded with comments. The panel reviewed and discussed all submitted comments and revised the draft as needed.
Once finalized, the Guideline was submitted for approval to the PGC. Funding of the panel was provided by the AUA. Panel members received no remuneration for their work. Although calculi can form de novo anywhere within the urinary tract, including the kidneys, bladder and prostate, the pathophysiology related to stone formation differs according to the site of origin. The focus of this Guideline is on renal calculi as these stones are the main source of morbidity, cost and resource utilization associated with urinary tract calculi. Kidney stone disease is a common condition. However, prevalence data pose some problems.
Unlike other conditions, like appendicitis, for which the diagnosis is readily apparent and can be confirmed by a pathology report, stone disease can be asymptomatic and occurs intermittently and repeatedly. Some individuals harbor undiagnosed stones and require no medical attention, while others necessitate repeated medical encounters for a single stone.
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Consequently, stone prevalence depends on the metric used as a surrogate for stone disease e. Most of these surrogates likely underestimate stone prevalence because of failure to detect asymptomatic stones, because of spontaneously passed stones that never involve health care resources, or because a stone was not substantiated by imaging studies or by the documentation of a passed stone despite a history of classic stone symptoms.
As such, true stone prevalence is difficult to determine, and the best we can do is to define the parameter measured to determine prevalence. Historically, kidney stones have occurred more commonly in men than in women. However, by any number of metrics, the gender gap in stone disease is closing. Stone disease has been linked to systemic conditions, although it is not clear if stone disease is a cause of these disorders or if it is a consequence of the same conditions that lead to these disorders.
With the increase in the prevalence of stone disease, the cost associated with diagnosis, treatment and follow-up of individuals with stones has risen accordingly. Diet and lifestyle likely impact the risk of developing stones. The beneficial effect of dietary moderation in reducing the risk of recurrent stones was demonstrated by Hoskings and co-workers, who found a reduction in stone recurrence rate among idiopathic calcium oxalate stone formers who were encouraged to maintain a high fluid intake and avoid "dietary excess".