The Tribune

By Dr Greggory Pinto

Kidney stones are relatively common across all age groups, occurring in approximately 12 per cent of men and six per cent of women. The higher rate of occurrence in men is influenced by diet.

Higher incidences are also seen in tropical climates, as in the Bahamas and in individuals with certain occupations, such as taxi drivers, secretaries and chefs, who often go long periods between hydration.

What causes them?

The main cause of kidney stones is not drinking enough water. Two to three litres of water daily, combined with a diet rich in fibre and low in salt, can be protective against stone formation. High red meat consumption contributes to the risk factors. Sufferers of certain hereditary conditions, such as distal renal tubular acidosis, Crohn's disease and ulcerative colitis are predisposed to stones. Other predisposing conditions include Dent disease, obesity, cystinuria, primary hyperoxaluria and hypocitraturia. The body naturally produces inhibitors of stone formation, magnesium and citrate and low levels can thus predispose one to stone formation.

Kidney stones are usually small crystallised mineral materials that potentially can cause the most excruciating pain known to man. Conclusive evidence reveals that kidney stones in an individual lead to a higher risk of developing diabetes and hypertension.

Can kidney stones be harmful?

Most kidney stones, although possibly excruciatingly painful while being passed, are usually not harmful in the long term. However, a kidney stone can cause obstruction of the kidney and can lead to acute or irreversible kidney dysfunction. An acute infected and obstructed kidney could lead to serious health problems. Prompt hospital care must be sought.

What are the treatment options?

Management commences with adequate hydration and pain relief plus imaging to determine the size and location of the stone and the possible degree of kidney obstruction.

A kidney stone causing kidney obstruction may require minimally invasive intervention with placement of a plastic stent or small tube into the kidney through the flank.

Laser endoscopic fragmentation or dusting of the kidney or ureteric stone is available. Shock wave therapy to pulverise the stone is a possibility.

Very large stones in the kidney require a minor surgery called PCNL (percutaneous nephrolithotomy). In this procedure, a tube is placed into the kidney and the stone is directly broken down and sucked out.

Prevention is always better than cure. Stay hydrated and consume red meat, salt and foods with high oxalate levels, such as peanuts, rhubarb, spinach, beets, chocolate and sweet potatoes in moderation.

Bahamas, seek the help of a urologist for the treatment of kidney stones!

• Dr Greggory Pinto is a Bahamian urologist who has trained in South Africa, Germany and France. He is a member of the European Association of Urologists. Dr Pinto can be reached at Urology Care Bahamas at the Surgical Suite, Centreville Medical Centre, Collins Avenue and Sixth Terrace. Call 326-1929, e-mail welcome@urologycarebahamas.com, or visit urologycarebahamas.com.