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Lecture 8b 24 February 2014 Renal Disease Kidney stones Affect about 50,000 Canadians each year Mostly males over the age of 20 years.

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Presentation on theme: "Lecture 8b 24 February 2014 Renal Disease Kidney stones Affect about 50,000 Canadians each year Mostly males over the age of 20 years."— Presentation transcript:

1 Lecture 8b 24 February 2014 Renal Disease Kidney stones Affect about 50,000 Canadians each year Mostly males over the age of 20 years

2 Kidney stones occur because of urinary concentration of components making up the stones is right to form the stones. The components are: -calcium, oxalate and phosphate -oxalate is the salt of oxalic acid (eg calcium oxalate) -oxalic acid comes from vitamin C metabolism

3 -most common stones are calcium oxalate and calcium oxalate combined with phosphate -less common stones are comprised of : -uric acid (from purine metabolism (purine is part of the nucleotide bases)), -the amino acid cystine -or magnesium ammonium phosphate

4 Get excess calcium, uric acid and cystine in the urine due to: -excess urinary calcium caused by overly efficient calcium absorption in the intestine or overly efficient calcium excretion in the urine -uric acid stones caused by gout –gout causes build up of uric acid in the blood and urine -cystine buildup in the urine caused by an inherited disorder called cystinuria in which renal tubules are unable to reabsorb amino acid cystine-get abnormally high concentrations of cystine in the urine-then get crystallisation followed by stone formation

5 Magnesium ammonium phosphate stones -magnesium ammonium phosphate stones (struvite) caused by repeated urinary tract infections -bacterial enzymes cause struvite formation -cranberry juice may limit struvite formation in females ( limited number of studies done)

6 Nutritional prevention of kidney stones - to prevent in the first place drink lots of fluid - to prevent a recurrence-consume 3-4 litres of fluid (mostly water) each day (possibly more in warm climates) to produce 2-2.5 litres of urine daily-why ? -people with fevers, diarrhea or vomiting need more fluid why?

7 Nutritional prevention of calcium oxalate kidney stones -for people who have never had a stone, an intake of calcium(800 mg male, 1200 mg female/day) may lower risk but not if high oxalate foods are taken with calcium

8 Nutritional prevention of kidney stones (table 28-9) -high oxalate foods include: -beans- green and wax -beets* -celery -leeks -legumes -blackberries -blueberries -raspberries -spinach*

9 Nutritional prevention of kidney stones -rhubarb* -strawberries* -chocolate and chocolate beverages* -nuts, nut butters* -tea* -wheat bran* -cocoa -coffee -nuts * documented to raise urinary oxalate- avoid if at risk of oxalate stones

10 Nutritional prevention of kidney stones - people with hypercalcuria should avoid excessive calcium intakes -but not below recommended intakes or get calcium removed from bone - avoid excessive vitamin C intakes ( in excess of recommended intakes)- why?

11 Nutritional prevention of kidney stones - to prevent uric acid stones -diets restricted in purines eg red meats in particular- organ meats, anchovies,sardines and meat products)- this is unproven but suggested - prevent cystinuria by limiting methionine intake –why?

12 Nutritional treatment once a stone has formed - once a stone has formed drinking plenty of fluid may help it pass - people with calcium oxalate stones should avoid high oxalate foods

13 Nephrotic syndrome -not a disease but a distinct cluster of symptoms caused by damage to the glomerular capillaries -damage due to diabetes, hypertension, infections (kidneys and elsewhere), immunological and hereditary disorders, chemicals (medications, illicit drugs or contaminants) and some cancers –there are others; this is only a partial list

14 Nephrotic syndrome -consequences -loss of blood proteins to urine -edema-retention of sodium -altered blood lipids-elevated cholesterol, triglycerides, LDL, VLDL, Lp(a) -platelets clot more easily

15 Nephrotic syndrome Treatment via diet: -ensure adequate energy intake- (35 kcal/kg body weight/d) as this sustains weight and spares proteins -if have accompanying weight loss or infections then one needs more energy to fight the weight loss and the infections -if obese, lose weight to control lipids and blood glucose as elevated blood lipids and blood glucose will exacerbate nephrotic syndrome

16 Nephrotic syndrome Treatments via diet -watch protein intake ( about 0.8 g/kg body weight/day –no more than 1.00 g/kg body weight/day)- protein must be from high quality protein sources -dietary fat- TLC diet first then antilipemic drugs

17 Nephrotic syndrome Treatment via diet -sodium-restricted due to sodium retention as the kidney is not clearing sodium as well compared to the healthy person (sodium restriction depends on response to diuretics but generally 1-2 g of sodium per day) Table 28-1


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