NO MORE KIDNEY STONES

Transcription

1 NO MORE KIDNEY STONES The Experts Tell You All You Need to Know about Prevention and Treatment REVISED AND EXPANDED EDITION John S. Rodman, M.D., R. Ernest Sosa, M.D., and Cynthia Seidman, M.S., R.D., with Rory Jones John Wiley & Sons, Inc.

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3 NO MORE KIDNEY STONES

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5 NO MORE KIDNEY STONES The Experts Tell You All You Need to Know about Prevention and Treatment REVISED AND EXPANDED EDITION John S. Rodman, M.D., R. Ernest Sosa, M.D., and Cynthia Seidman, M.S., R.D., with Rory Jones John Wiley & Sons, Inc.

6 Copyright 2007 by John Rodman, M.D., R. Ernest Sosa, M.D., Cynthia Seidman, M.S., R.D., and Rory Jones. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada Wiley Bicentennial Logo: Richard J. Pacifico No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) , fax (978) , or on the web at Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) , fax (201) , or online at Medical disclaimer: The information contained in this book is not intended to serve as a replacement for professional medical advice. Any use of the information in this book is at the reader s discretion. The author and the publisher specifically disclaim any and all liability arising directly or indirectly from the use or application of any information contained in this book. A health care professional should be consulted regarding your specific situation. For general information about our other products and services, please contact our Customer Care Department within the United States at (800) , outside the United States at (317) or fax (317) Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our web site at Library of Congress Cataloging-in-Publication Data: No more kidney stones / John S. Rodman...[et al.]. Rev. ed. p. cm. Includes bibliographical references (p. ). ISBN (pbk.) 1. Kidneys Calculi Prevention. I. Rodman, John S., 1946 RC916.R '2205 dc Printed in the United States of America

7 CONTENTS Preface Acknowledgments About This Book xi xv xvii PART ONE WHAT YOU NEED TO KNOW ABOUT KIDNEY STONES 1 THE KIDNEY STONE BOOM 3 What Are Kidney Stones? 5 Why Do Some People Get Kidney Stones? 5 The Stone Boom 5 Prevention Is the Cure 6 The Dietary Prescription 6 Preventing Kidney Stones 6 Commitment to Change 7 2 THE URINARY SYSTEM 9 The Urinary System and How It Works 9 The Balance Concept 12 How Trouble Starts 13 3 HOW YOUR KIDNEYS BALANCE YOUR BODY 14 Why Balance Is Important 15 Elements of Balance 15 How the Kidneys Keep the Body in Balance 15 What Happens When the Body Gets Out of Balance 18 How to Keep Your Sewer System Unclogged 19 4 NOT ALL KIDNEY STONES ARE CREATED EQUAL 20 Four Types of Kidney Stones 20 Calcium-Containing Stones 21 v

8 vi Contents Uric Acid Stones 22 Cystine Stones 25 Struvite Stones 25 Bladder Stones 26 Importance of Stone Analysis 27 5 HOW AND WHY KIDNEY STONES FORM 28 Genetics 28 Diet and Lifestyle 28 What Is a Kidney Stone? 29 Discouraging Crystal Formation 30 What Kidney Stones Are Made Of 30 The Conditions That Favor Crystal Formation 31 The Best Inhibitor of Kidney Stones 31 Making a Uric Acid Stone 32 6 WHY KIDNEY STONES ARE SO PAINFUL 34 Kinds of Pain 34 Three Areas Where Stones Hang Up 38 Secondary Symptoms 39 Never Make Your Own Diagnosis of a Stone 40 Treating Pain 40 When Hospitalization Is Needed 41 7 HOW MUCH WATER DO I REALLY HAVE TO DRINK? 43 Causes of Low Urinary Output 43 How Much Is Enough? 44 Hard Water, Soft Water 44 Mineral Water 45 How to Consume More Water 45 The Role of Fluids 46 8 DIETARY TROUBLEMAKERS 47 How Much You Eat Is Just as Important as What You Eat 47 Animal Protein Is Animal Protein 48 Protein and Kidney Stones 48 The Calcium Controversy 49 Salt 53

9 Contents vii Oxalate 54 Vitamins and Kidney Stones 55 Alcohol 58 The Dietary Troublemakers 59 9 MEDICAL CONDITIONS THAT CAN CAUSE KIDNEY STONES 60 Bowel Disease 61 Medullary Sponge Kidney (MSK) 63 Hyperparathyroidism 65 Milk-Alkali Syndrome and Ulcers 65 Anatomic Abnormalities 66 Paralysis and Immobilization 68 Renal Tubular Acidosis (RTA) 69 Acquired RTA in Glaucoma Patients 69 Cystinuria 70 Oxalosis DIETING YOUR WAY TO A KIDNEY STONE 72 The Problem with Rapid Weight Loss 72 Fad Dieting 73 Fad Health Regimens 75 Eating Disorders 76 Laxative Abuse 77 How Stone Formers Should Diet MEN AND STONES 79 Why Men Make More Kidney Stones 79 Pain Patterns WOMEN AND STONES 84 Why Women Make Kidney Stones THE WORKUP 89 Risk Assessment 89 The Workup 90 Translating Your Workup into a Risk Assessment 99 Where Are You on the Risk Ladder? 101

10 viii Contents PART TWO THE PLAN 14 NO MORE KIDNEY STONES 105 Diet Is Not a Four-Letter Word 105 The Master Plan 106 Tips for Staying on the Plan FINDING THE DIET THAT IS RIGHT FOR YOU 110 Rating Yourself 110 How Much Do You Have to Change? 111 Do You Consume Too Many Troublemakers? 111 How to Know if You Are Eating Too Much Protein 115 How to Know if You Are Drinking Enough Fluids 117 Do You Weigh Too Much? 119 Food Diary 119 Classic Stone-Forming Profiles LIFESTYLES OF THE KIDNEY STONE FORMER 130 Bathroom Access 130 Fluid Loss 132 Ultraviolet (UV) Light Exposure 132 Eating Patterns 133 Change in Lifestyle OPERATION OXALATE 136 Why Dietary Oxalate Is Important 136 The Problem with Oxalate Recommendations 137 Key Issues in Oxalate Control 138 Oxalates and Seasonal Foods MODIFYING RECIPES AND CONTROLLING PORTIONS 142 Recipe Modifications 142 Portion Control HEALTH-FOOD STORE HAZARDS 147 Supplements 147 Muscle-Building Protein Supplements 149 Herbal Teas 149

11 Contents ix Natural Weight-Loss Regimes 150 Hair Regrowth 150 Beverages 150 Vegetarian Burgers 151 Laxatives 151 Energy Bars 152 The Juice Craze 152 Pastas 153 Candies and Cookies 153 Read Labels in the Health-Food Store SPECIAL OCCASIONS Parties and Other Excuses to Cheat 154 Thanksgiving 154 Barbecue 158 Wedding Banquet 159 Breakfast Buffet 162 Four Pitfalls of Special Occasions ETHNIC CUISINES 164 Chinese 164 Mexican 167 Greek 168 French 169 Japanese 170 Italian 171 American 173 Indian STAYING MOTIVATED 178 How Far Can You Deviate? 179 Diluting the Mistake 179 PART THREE MEDICINES, SPECIALISTS, AND PROCEDURES 23 CHOOSING A SPECIALIST 183 Who Does What 183 How Do You Find Out Whom to See? 185

12 x Contents 24 MEDICATIONS 186 Who Needs to Take Medications? 187 What Are the Medications? DECIDING WHO SHOULD BE TREATED 193 Assessing whether You Need Immediate Intervention PROCEDURES AND TECHNOLOGY 201 Picking a Procedure 201 Comparison of ESWL and Ureteroscopy with Laser Lithotripsy 208 Treating Stones in the Kidney 210 Open Surgery WHAT TO EXPECT BEFORE, DURING, AND AFTER TREATMENT 214 What to Expect before and after Treatment 214 When to Call the Doctor 219 What if Treatment Fails? 219 Asking the Right Questions 220 Do Not Forget 221 Appendix A: Useful Tables 223 Appendix B: Food Diaries 235 Glossary 241 Bibliography 249 Index 251 About the Authors 269

13 PREFACE When I started practicing nephrology almost thirty years ago, kidney stones that did not pass, often required open surgery. Dietary advice usually consisted of drink more water and eliminate all of the dairy products from your diet. Most of the people I treated for multiple stone episodes were given drugs to reduce their urinary calcium. Today, most surgery has been replaced by shock wave or laser fragmentation of stones, and we know that reducing calcium is unnecessary for many people and may actually aggravate the problem for a few stone formers. When a prescription is written, it is more likely to be for a naturally occurring substance than for a drug. As I treated more patients with recurring stone disease, I realized that at least 75 percent of my patients stopped making stones with dietary advice alone. It became apparent that the key to helping people to avoid kidney stones was not going to be the prescription I wrote on a medical pad but the finding of an acceptable way for them to change the way they ate and in some cases the way they lived. I emphasize the word acceptable because many ideal diets represent such a departure from most people s food habits that they are totally impracticable. No other disease has a more critical relation to diet. The frequency of stone disease has increased in parallel with the richer Western diet. It is a rare emergency room in an industrialized nation that does not see several patients with colicky pain from kidney stones every week. As I mapped out diet and fluid recommendations for my patients, many of them wanted something they could refer to when they had questions. They wanted more explanation for oxalate tables, protein control, and fluid guidelines. They asked what they could order in Italian, French, and Chinese restaurants. Family members requested cooking information. The short summary I gave xi

14 xii Preface to patients Dietary Guidelines for the Stone Former became the first notes for this book. I started to look for patients who might characterize the eating habits of various stone formers, such as the forty-year-old man who began making stones when his weight increased, or the middle-aged woman who drank 2 quarts of iced tea a day. I also saw certain lifestyle patterns that led to the formation of kidney stones. Most sufferers fit one of these patterns. If you can find yourself in this book and make the appropriate changes, you will probably markedly decrease your chance of making stones. The second reason for writing this book was to find ways for people to stay on the wagon. One of the more difficult aspects of preventing stone disease is keeping people motivated. Frequently, people will follow guidelines religiously for the first three or four months after a stone episode and, when the memory of that awful pain begins to fade, return to the same habits that got them into trouble. However, I have found that the people who are most successful in eliminating stone episodes from their lives are the ones who understand how and why stones form in the first place. I have therefore tried to explain the science in a simple manner that can be used for reference. I hope this book will enable you to understand why your urine makes crystals and how these crystals grow big enough to become kidney stones. In the eleven years since the first edition of this book was published, many patients have asked me for more information on a number of important topics. In response, this version now includes expanded sections on surgical techniques and procedures as well as the latest scientific information on the role of calcium, vitamins, and various diets on kidney stone formation and treatment. I am grateful to my patients who have taught me to make my explanations simple enough for the nonscientist to grasp easily. They have also pointed out where my recommendations for diet and lifestyle changes were too ideal or impractical. In turn, I have often had to convince some of them that certain impractical changes were necessary if they were to prevent more procedures and more trips to the emergency room. It is from this give-and-take with thousands of patients that the suggestions in this book have evolved. Nevertheless, there is no substitute for advice from a physician who knows your individual case. You may also need to coordinate a

15 Preface xiii stone prevention program with other aspects of your health. For example, if you have diabetes, your diet will have to be appropriate to that problem as well. Therefore, if you have any questions, you should discuss the information in this book with your own physician. Your doctor can help determine which dietary emphasis is most appropriate for your own care. John S. Rodman, M.D.